Pneumonia

As mentioned before, I was hospitalized at the end of March for pneumonia. A recent online article reminded me of my experience and the general state of healthcare in Singapore.

One Saturday afternoon, I was feeling dizzy and happened to test the oximetry before applying it to a patient. The oximeter indicated my SpO2 as 87% despite my deep breathing. SN LT tested it after I raised the issue to her, and her SpO2 was 98%. Although I felt dizzy, I wanted to complete my shift as the ward was very busy that day.

I must admit that for a brief period when my SpO2 was 87%, I wasn't effective at work. E.g. I was in the 4 bedded room attending to 1 patient. When I was done, another patient's NOK asked me for some items. Then the 1st patient's NOK also asked for something. Normally, I would either remember the items or write them down. I heard and understood their requests, but when I tried to write the items down on my notebook, I just couldn't think of what to write. Guess, that was the effect of short-term O2 deprivation. I turned around to ask the NOKs to repeat what they wanted. They both said something like "forget it" kindly. I don't know why. Perhaps they could see that I was struggling and I wasn't well. I was glad that they seem rather forgiving, compared to the ward staff who were working me and SN LT like slaves.

I knocked off from work late at the end of a busy shift. When I arrived home, I felt slightly feverish, drank some water, coughed with thick yellowish phlegm and rested in my room. Awhile later, the fever didn't seem to subside, thus I decided that seek treatment at a 24-hour GP clinic. Unfortunately, the 24-hour GP near my home no longer operated round-the-clock, thus I went to SGH A&E on the wee hours of a Sunday at 12+ midnight. I was having fever, cough and body ache all over. I informed the nurse at the A&E triage that I was having fever and was concerned because my oxygen levels dropped below normal earlier at work on Saturday afternoon. I also informed the A&E triage nurse that my appetite had dropped severely over the past week. From 2 bowls of porridge a day a week ago when I first felt slightly unwell, to 1/2 a piece of cake the whole of Saturday.

I was given high priority, less than 15 min wait. The SGH A&E assessment nurse took my blood pressure and oxygenation levels and they were back to normal at 12+ midnight. I was not coughing while I was at the A&E. Based on the symptoms of fever and body ache, and my information that my home was undergoing upgrading, the A&E doctor suggested a full-blood count test (FBC) as he suspected dengue. I asked for a dengue test and the doctor told me that no public hospital in Singapore offers that. The FBC results came out, the platelet count was within the normal range. I was sent home with antibiotics, lozenges, cough syrup and mouth gargle for the cough, paracetamol for the fever and MC for 3 days. The doctor focused only on the potential dengue fever, and told me to look out for bleeding under my skin (petechie). Neither the doctor nor the nurse bothered to check further on my cough. No CXR, no listening to the lungs with stethescope (auscultation). No further questions or check on my loss of appetite.

That Sunday was my day-off. I slept much of the morning, waking only for medication. That afternoon, I called my ward to inform them that I could not report for work the next day. While I was on the phone with Snr SN R, I started coughing non-stop and couldn’t get out of my bed. By evening, I managed to walk unsteadily to my kitchen. I found out that a potentially fatal complication of dengue was hypoglycemia, so I tried to drink some honeyed water. I vomited. Then I thought that perhaps honey was too strong, so I tried some plain water. I vomited the fluids on the kitchen floor and was so weak that I fell to my knees. Then I thought that perhaps I need the dextrose-saline equivalent of fluid replacement, thus I added some salt into honeyed water. It took me more than 20min to slowly sip down half a cup and I could barely retain the fluid. I sat in my room, resting, and waiting to feel better. I was still hoping that I would be well enough to continue with the SGH A&E medication.

After about an hour or 2 (at around 9+pm), I felt strong enough to walk. I debated whether to return to SGH A&E to review my condition. I decided against it since the SGH A&E doctor told me to return if I get petechie, which IMHO is a really late sign of dengue haemorrhage fever. I decided that if I could last through the night, I could visit a GP 1st thing on Monday morning for review instead. Given that I felt better after my improvised oral-rehydration drink, I went to the pharmacy to buy more oral-rehydration solutions to last me through the night. When I reached home, I opened a packet of Pedialyte ready-to-drink rehydration fluid. It took me another 20min to sip down the 62.5ml. I decided to pack my bags to be ready for hospitalization, in case my condition worsens. Once again, I sat in my room, resting, and waiting to feel better. However, this time, I found myself drifting in-and-out of consciousness and began to sense "others" around me. After an indefinite period , I drifted back to consciousness and decided to go to a hospital for my own safety. My housemates were out-of-Singapore that weekend, so no one would know if I drifted off again. While I like the peace of drifting off, I had some unfinished work to be completed, so I wasn't ready to leave my body as yet.

[30-Mar-2009 Extract of my CXR indicating LLL Pneumonia]

[15-May-2009 Extract of my CXR, for comparison]

Around midnight of the Monday morning, I arrived by taxi to my private hospital's A&E because I knew that they offered dengue tests there. I was put into the A&E isolated observation room due to my fever. The A&E triage nurse noted down my medical issues. Later, the private hospital A&E doctor auscutated my lungs and ordered for an immediate CXR, blood tests, besides my requested dengue test. Upon reviewing the CXR, the doctor told me that I need to be warded immediately. It was obvious from the CXR that I had left lower lobe pneumonia. The private hospital A&E doctor referred me to a specialist consultant. Within the hour, I was warded, given nebulizer and attended to by the referred specialist. The blood tests results followed. My week-long lost of appetite has resulted in below normal levels of potassium (2.6 mmol/L moderate hypokalemia) and sodium (133 mmol/L mild hyponatremia) in my blood and I had to be on intravenous therapy. In addition, I was also on intravenous antibiotic Avelox (moxifloxacin hydrochloride). Later in the wee hours of that morning, the dengue test report was out -- negative. All the treatment started before dawn; and by 7+ am that morning when the specialist came again for review, I was already feeling better. [Other abnormal lab results on admssion: FBC Hemoglobin 11.1g/dL, PCV 34%; Blood Differential Count Neutrophil 85%, Lymphocyte 10%; Urine Microscopy WBC 8/uL, RBC 5/uL.] The specialist gave me a capsule of nutritional supplement and reviewed my food in-take. Treatment continued. The next morning, the specialist reviewed my case and (upon my request) discharged me for a week-long recuperation at home.

The specialist consultant told me that my pneumonia did not come about suddenly, it took a period of time. Thus, I am still puzzled why the SGH A&E doctor missed it totally. I went to the public hospital to save cost. In the end, I am glad I switched to the private hospital. It may have cost my life otherwise.

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Click here for the aftermath of pneumonia.