The Arcade Fires

This entry was composed in the afternoon of 28th November, 2007.

Returned to the soft silky comfort of the bed from a night shift at ten this morning. I was late for bedtime. As soon as I popped myself into slumberland, my cell rang.

'Yeah?'
'You asleep?'
'No. Not really. Yeah?'
'The police called and they want to know what happen when you guys found her. I tried to call *, but uncontactable.'
'It's just like what we have reported. Asystole when we found her. Cold and clammy. No breathing. No pulse. CPR was initiated.'
'The police needs to know that. They were asking and I don't know enough to tell them. Can I get you to call them?'
'Huh? What? Now? Can it wait? I'm going back tonight.'
'They want to know now.'
'I... Okay. Alright. What's their number? I'm going to need the patient's name and NRIC too. What exactly do they want to know that we didn't already reported?'
'They want to know what was it like when you guys found her.'
'Nah. I was in the resus the whole time, but I didn't found her. It was *. I was at X-ray dept, escorting patients. When I came back to ward, I saw * pushing the E-trolley, calling my help. I wouldn't know what had happened before.'
'In that case. Alrighty then. I will call the police and tell them that and see if they still want to speak to you. Keep your handphone open eh?'
'Sure.'

I had begun my shift yesterday, determined to go home on time. The earlier shift was marred with stupidity and ignorance that held me back from home and I was eagerly determined not to repeat the errs again.

I zoomed around the ward as an In-Charge. I had worked for almost a year and they had decided to hook me up with a newbie *. I was ahead of my time, clearing medications, IVs and monitoring. I was determined to go home on time.

At the stoke of the midnight. I received a case of headache from a fall. The girl was nineteen. She was allocated to the corridor bed.
'Why corridor? How about bed 49?' I asked.
'They are saving someone special for us.'
Always a bad news when the Bed Management starts to crack jokes. God knew that it wasn't the doctors that nurses fought the hardest. The bitterest struggles were often dramatized between the Bed Management and the nurses. They like to round up the fifty patients from emergency dept, handpicked the worst case scenarios, the ones that shouldn't be nursed in general ward with inadequate resources, the ones lingering with a breath connecting to a support machine, the ones yellow and black. Often they came into the ward and collapsed almost immediately and had to be send to the Intensive Units. And what's the holly point in that?

The nineteen year old girl was fine though. Talking away jovially despite having to be cramped in the corner of the corridor.

Twenty minutes past midnight, a woman shrieked. I dropped the task of my midnight Nasogastic tube feeding and went to see if anyone need help.

There were blood all over the floor. Did someone fall? That was my instant question. A fall in the ward is the damnedest shit that could happen to a nurse. That was probably an overstatement, cos there are a million and one damnedest things that could always and will happen to a nurse. Bed 35, and old cherry teacher with white hair was doused with her own blood, more was jetting out from her IV site at the wrist. An afternoon shift nurse was holding onto her. The nurse was preparing to go home and attended to the screaming first. She was punched in the socket by Bed 35.

Bed 35 was rational and communicating when I admitted her the day before. Apparently after the surgery, she had lost her marbles. She communicating all right when the four of us tried to restrain her to the bed.

'What! What! Why you hold me like this? (Spit!) Jesus will see you! Jesus will come and kill you!'

And then she kicked me in the nuts.

'Jesus will come and kill you all! Because I am Christian! Jesus will see you and see this and will punish you for these!'

Entered the doctor, she prescribed sedatives and we fought to jab her tossing arm with injection.

She slept like a baby thereafter.

By then the back of my scrubs were stained with botches of her blood.

The rest of the night were pretty okay. Bed 45 kept pressing the call bell, crying loudly in the ward of pain and misery. Bed 56 walked around the ward like a zombie afflicted by a week's old insomnia.

At three, we were alerted to Bed 61. Apparently he had defiled a promise to another nurse on behaving without restrainer. With a free arm and plenty of time, he had worked on tearing off the IV drip from the drip stand and let the saline showered him all over. We worked on cleaning him and changing the bedsheets. He grew angry at the thought of restraining and tried to threw himself off the bed with the good arm.
'Wow.' I was amazed. 'Your limb power is improving.'
When he was transferred to the ward with brain hemorrhage, he was drowsy and couldn't lift a side of his body at all. Now he was progressing to throw himself of the bed with speedy manipulation of his good side. It was always the case when a person is given too much time on their hands, despite being restrained, they'd work their way around in true human spirit. I had seen patient trained their toes to free the reins of their arm restrainers and pried Nasogastric tubes from their noses.

As we tied him, he turned bestial and fought us nails and teeth. I didn't expected any kinder response.

At four thirty, with another staff, we escorted two patients, one bed after another to the X-Ray dept. I had sneaked Philip K Dick's Paycheck beneath the basket under the bed so I could have something to read while waiting. The wait was long at this ungodly hour, I tossed and turned at the plastic chair to a piece of a wall, trying to get some sleep.

At five thirty, I pushed the last of the patient back into the ward and saw people running around. * was pushing the E-Trolley and looked at me with a horrified look on her face.
'What happen? Which bed?' I threw.
'Bed... Bed 63.'
'What? Who, whatever! Just keep moving!' I rushed along with her.

Bed 63? Bed 63? I barely know her. Came in yesterday from a hip contusion. A very elderly lady. But to collapse from a hip contusion? What are the chances?

I traced the line of her neck and felt nothing. She was cold and clammy.

'You called the doctor?' I threw.
* nodded as she worked to connect the ECG strips on Bed 63.

It was a flat line.

'What management? DIL, Do Not Resus?' I tried another shot at finding a pulse.

'Nothing. It's a freaking hip contusion!'

'Okay. Call the family to come down now and get the rest of the staff in here now!' I said. The house officer arrived in the same stupefied shock as we began manual CPR on the frail lady.

We clanked down the bed, tore open the plastic wrappings of the tubes, hooked her up on absolute oxygenation as I hiked myself with one knee on the bed and began the chest compressions.

'Adrenaline!' The house officer yelled.

I tore open the drug kit, yanked open the confinements of the E-trolley and ransacked the glass ampules of the resuscitating medications. 'Adrenaline.' I showed her as I pushed in the saline. I hit her with Adrenaline through her IV line. No response. CPR was restarted.

The neurological medical officer arrived with the rest of my staff. We pushed in more medications to start the heart. I had stopped my compressions as her heartbeats trembled in the cavity of her chest. The heart rate was one ninety.

I was at a moment amazed by the returning of the heartbeat. She was dead when we found her, and yet her heart was pounding now.

'Blood pressure?' The medical officer asked. I snapped back to reality and tried to take the blood pressure. Unreadable. I looked at the chest again, fearing the heartbeats were gone. The chest were rippling. Heart rate - One seventy.

We heard rustling of feet's and weeping sounds. The family had arrived. * was preparing the trachy set as the Registrar arrived. She reviewed the case, had us repeating the resuscitation and spoke to the family.

'Now what?' I whispered to my colleague. Heart rate - One fifty. No detectable blood pressure.

'We wait.' She said as she continued to squeeze oxygen in.

Heart rate floated and sank to ninety seven. The medical officer came in and ordered to stop the resuscitation. We stopped charging the patient with absolute oxygenation and switched to a more comfortable apparatus. The earlier hope upon witnessing her heartbeats swept aside as I realised that it was purely chemically induced. In time, as the chemicals died, so will her heart.

We packed the setting, wore her back her clothes and placed her in a more comfortable position. The E-trolley beeped on her chemical heartbeat. The family was allowed in. The entire mob was crying away at the suddenness of the event.

Thirty minutes, at the break of the morning sun shinning into the hospital windows, her line was flat.

Finally when all documentations were done, I checked the clock on the wall. I was two hours late for home. So much for determination. Will and determination though will slow diseases, but will never stop death. The frailty of the living. I sighed heavily as I scrubbed my hands.

I went home.

'In that case. Alrighty then. I will call the police and tell them that and see if they still want to speak to you. Keep your handphone open eh?'
'Sure.'

I waited in my covers for my cell to ring. It never did and I sank into the sleep of the sandman. I woke up five hours later and saw that the time was three forty-five. Exactly the same time I had woke up the day before. The sense of Dejavu was strong. I couldn't sleep anymore. I sat at the computer and started writing this. At five, HL returned with lunch. We ate to a comedy, laughing away with pieces of meat between our teeth. Seeing that I had half an hour more to start before my shift, we laid in the bed with me holding her from behind. I smelt the shampoo in her hair.

I had closed my eyes and said with much effort.

'Do you know which was the worst part? When we detached the ECG from her body and removed the E-trolley. The grandson had asked anxiously on how could we monitoring the patient if the machine was removed? I told him that her heart had stopped. I almost couldn't bring the words out from my lips.'

Half an hour later. HL was sleeping. I showered, packed my stuff and left for my night shift.

The Singaporean Death Guide #3 - Arranging A Funeral

You can engage a funeral director to help you with the funeral. Depending on your religion, the funeral ceremonial rites and costs may vary widely. A funeral can be as simple or as elaborate in accordance with the wishes of the deceased or family. The following are some points to consider:

• Funeral Wake

Decide the location and the duration of the funeral wake e.g. at the funeral parlour, void deck or house.

If you are holding the wake at the viod deck, you will need to get a permit from your Town Council. If you are holding the wake in your landed property and need to use part of the road outside your house, you will need to get a permit from the Land Transport Authority. Your Funeral Director will assist you on this.

Please not that if the funeral wake extends more than 7 days after death, prior written permission will have to be sought from the National Environment Agency.

Please write to:
National Environment Agency
Environment Health Department
40 Scotts Road, Environment Building,
#21-00 Singapore 228231

• Burial/Cremation
  

Your funeral director can help you with the booking of the date and time for cremation or burial. Otherwise, you can do the bookings through the phone or at the relevant booking office:

Burial:

Cremation:

The NRIC of the applicant and next-of-kin, as well as the original
Death Certificate, which contains the Permit to Bury/Cremate is needed
when booking for burial or cremation.

Please not that of the
deceased is to be cremated, any valuables placed in the coffin will not
be recoverable after the high heat of cremation.

• Placing An Obituary

If you wish to place an obituary, please contact the local newspapers

• Storage of Ashes/ Scattering The Ashes At Sea

The ashes of the deceased can be stored at home or in a columbarium. Niches are available at the three government-managed columbaria and other private columbaria:

You will need to bring your NRIC and the Death Certificate to book for a niche.

Ashes may also be scattered at sea. The scattering of small amounts of ashes can be carried out at the designated site located about 1.5 nautical miles (2.8 km) south of Pulau Semakau. The scattering of ashes can be conducted daily, from 7:00am to 7:00pm. For further information on scattering of ashes, please call the Marine Safety Control Centre at telephone number: 6325-2488.

end.

The Singaporean Death Guide #2 - Death At Home

What to do if you are with someone who dies at home and during office hours?

Contact your family doctor who has been attending to the deceased. If the family doctor is able to certify the death, he will issue the CCOD on the spot. If he is unable to certify the death, call the Police for the body to be sent to the Centre for Forensic Medicine (CFM) Mortuary (located at Block 9 Singapore General Hospital) in a Police Hearse. The family will be told by the Police when to go down to the CFM Mortuary (usually the next day).

If you do not have a family doctor, contact the Police who will come to your house. The Police will contact the Forsensic Death Investigator (FDI). The FDI will come to your house to certify the cause of death. If cause of death can be certified, the FDI will issue the CCOD on the spot. If death cannot be certified, the Police will arrange for the body to be sent to the CFM Mortuary in a Police Hearse. The family will be told by the Police when to go down to the CFM Mortuary (usually the next day).

* Office Hours refer to : Mondays to Fridays (0800 to 1630)
Sat, Sun and Public Holidays (0800 to 1230)

What to bring to CFM?

- All medical documents relating to the deceased
- All medicine consumed by the deceased
- Identification papers of the deceased and informant e.g. NRIC/ Passport/ Certificate of Registration of Birth/ Fin Card

On engaging a funeral director, kindly refer to step 2 and 3 of the previous entry.

Then what if someone dies at home after office hours?

If death occurs at home after office hours:

Die die still have to obtain Certificate of Cause of Death (CCOD)

If your family doctor who has been attending to the deceased is unavailable, contact any of the neighbourhood doctor who is willing to make a house call (For what I know, house calls are usually quite expensive.)

If you are unable to contact a doctor, call Police. Then so on and so fro to the CFM.

At CFM, if autopsy reveals that the death is unnatural, the Police will need to conduct further investigations into the cause of death and the family will need to assist. Once the investigation is completed, the family will be told by the Police to attend a Coroner Inquiry at the Subordinate Courts.

The Singaporean Death Guide #1 - Death In A Hospital

What to do when a death occurs?

Step 1:
Obtain a Certificate of Cause of Death (CCOD) from the ward nurse when the doctor at the hospital can certify the cause of death if the cause of death is known AND the cause is natural. This can be done by producing the identity card of the deceased.

If the doctor is unable to determine the cause of death, or a death has been the result of or has been contributed by an unnatural event (e.g. surgical complication, a fall prior to admission), the doctor is under the requirement of the law (Criminal Proceedings Code) to refer the case to the Police/Coroner. In such cases, the body will be sent to the Centre for Forensic Medicine (CFM) Mortuary (located at Block 9 Singapore General Hospital) in a Police Hearse. The hospital will arrange for this to be done. The family will be told by the Police when to go down to the CFM Mortuary (usually the next day).

At the CFM Mortuary:

- Identify and view the body in the presence of the Coroner.

- The Coroner will review the case and determine if an autopsy is required.

- The family will be informed of the Coroner's decision and the time to claim the body for the funeral.

Step 2:
Engage a Funeral Director who will:

- collect body from the hospital mortuary
- send the body for embalming (if required), and
- send the body to the location of the wake

Step 3:
Register Death

Prior to registration, the family should decide whether the body will be cremated or buried.

If the body is in a government restructured hospital, the registration can be done at the hospital (consult the ward nurse where to do the registration). The Certificate of Cause of Death will have to be produced to register the death.

If the body is in a private hospital, then the family will have to register the death at:

- any Police Divisional Headquarters. Neighbourhood Police Centre/ Post

- the Registry of Births & Deaths, 3rd floor, ICA Building, 10 Kallang Road. Tel: 63916100.

If the body is referred to the CFM Mortuary, the death will be registered at the CFM Mortuary.