On the last day of my internship at a local community hospital, with the permission of the nurse manager, I headed to a nearby Kopitiam to buy back a packet of char kway teow. Freshly stir-fried from the wok, the packet of noodles was bought not for myself but for a friend I made at the ward whom I shall call Madam Y. I learnt that Madam Y, while not very fond of the food served during hospital mealtimes, loved to eat hawker food. This unique experience we shared over our common love for food was one of the many relationships I had the opportunity to build and engage in during my four-week stint as a nursing intern during my summer break. In this article, I reflect on the importance of humanising healthcare for long-term care patients, as well as on the pearls of wisdom I learnt from the patients themselves: on how to become a better physician 0 one who is humble, humane and present – and, by extension, a better human being.
Listening, not just hearing
On slow-moving weekday afternoons, the call bell would not ring as frequently as it usually does and most patients would either take naps or be out undergoing physiotherapy. I would then take the time to speak with some patients. On such days, I would sit beside Madam S on a patient chair upholstered in maroon. To her right was her personal entertainment device, an electronic tablet.
Madam S had been admitted after a fall that caused a left intercondylar humeral fracture. Communicating with Madam S took some effort as she was a person with some intellectual disability. I attempted to bond with Madam S by spending time with her. We would watch a series of black-and-white short video films by P Ramlee, one of her favourite filmmakers on YouTube. At the parts where the actors made laughingstocks of themselves – even though Madam S had probably seen the same film many times over before – she would give an infectious chuckle. On other days, she would play a children's educational video on Arabic letters, where we would learn the A to Zs of the language, or we would re-watch an Indonesian singing contest which she was particularly fond of. Madam S would say to me, in her child-like demeanor, "This girl is blind, she cannot see," referring to the female singer dressed in a white gown performing on stage with her melodious voice.
Among the many roles I served as a nursing intern at the ward – including serving meals, feeding the less mobile patients, showering patients, and pushing patients on the commode chair to the toilet – watching YouTube was a task I least expected, but it was one of the few shared activities which I bonded with patients over. Beneath the occasional smile Madam S made while watching her favourite shows was a girl missing her home and missing her mother. Madam S would speak to me, in a fragmented mix of English, Malay and Mandarin dialect, about how she could not sleep at night because she would cry, longing to return home to her mother who was unable to visit for various reasons. While it seemed that there was nothing I could do to give her what she needed, I thought that perhaps being present right there and then at her bedside would give Madam S a chance to share her feelings with someone.
Beyond hearing what patients have to say about their situation at the hospital, I learnt, more importantly, to listen to their predicament to paint a clearer picture of their overall well-being. The difference between hearing and listening is to therefore gain a more thoughtful understanding of the other person's vulnerabilities and emotions, giving these feelings due consideration, and sometimes to simply be present.
Learning from patients
Staying at the corner of the ward were Nenek ("Grandma" in Malay) and Madam P, two very kind, sweet and loving ladies with whom I got the chance to interact with. Nenek spoke only Malay and, for my first few encounters with her, I could not understand a single word she spoke. I could not respond save for generously nodding my head, and I walked away feeling embarrassed and very aware of my conversational incompetency. A few times, whenever I lingered around that corner of the ward, Madam P would ask for my help to remove her socks from her gangrenous feet. "Thank you, young man", she would say. Very keenly aware of her surroundings, her voice clear and sharp, I came to realise that Madam P was a retired schoolteacher.
On one of the days when I was again generously nodding my head, Madam P turned in my direction and translated a few words for me. It was then that our daily ten-minute conversational Malay lessons started. Armed with a piece of paper and a wooden pencil, I sat on a plastic chair at the foot of Madam P's bed as she entertained every "How do you say... in Malay?" from me. While a patient-doctor relationship traditionally circles the professional need to attend to a patient's concerns, in this scenario the patient's sharing of their knowledge enriches that of the healthcare professional. (Arguably, as a medical student, I would learn more from being in a clinical setting than any form of professional help I can offer to others. I thus appreciate the role reversal here.) Indeed, I learnt more from Madam P than what help I could offer her, and I humbly received this knowledge. I would greet Nenek in Malay ("Apa khabar?" "Khabar baik"), ask her if she had slept well last night ("Tidur bagus?" " Ye bagus") and ask if she had eaten ("Sudah makan?" "Sudah" "Makan apa?" "Makan roti").
Language plays such a crucial role in one's ability to relate to people. Towards the end of my internship, finally able to understand some of her words, I came to know that Nenek wanted to offer me bread to eat. To me, it was an incredible experience learning, understanding and being able to converse with another individual in their native language. The beauty of this exchange is beyond any content a medical textbook can teach.
Art, music and healthcare
At the other corner of the ward, I would find Madam Y seated slouching on her bed. On morning shifts, the air-conditioning would turn on at around 9 am for about two hours. Madam Y would beckon me towards her by waving her hands. Then, as I approached her corner of the ward, she would make a gesture indicating for me to help her close all the windows.
Madam Y had been admitted due to a fall at home, and she had previously been diagnosed with schizophrenia. She was vehemently opposed to any proposition to get her out of bed (she insisted that the bed railings were not to be lowered at all times, and that her table had to be adjusted to be "just below the height of the bed railings", arranged parallel to the bed), and would not feed herself with utensils during mealtimes ("My hands very shaky", she said, "the food will drop on me!"). As such, I had the privilege of serving food (and char kway teow) to Madam Y during my shifts. On slower mornings, typically after breakfast, I would bring a set of The Straits Times and we would share the newspaper. As she flipped through the "Lifestyle" section, looking at the pictures since she could not read English, I would put on some old Mandarin songs at her request:
- 奔向彩虹”（邓丽君）
- 白光”（秋夜)
- 白天不懂的夜黑”（那英)
- 满庭芳”（包娜娜)
- 慈祥的爸爸”（包娜娜)
- 朋友”（周华健）
- 爱拼才会赢”（葉啟田）
-
细水长流 ”（ 梁文福）
"At home I got CDs but now don't have already", she says to me in a mix of Mandarin and Chinese dialect, "these songs are very meaningful to me". As we both shared the space listening to those songs, I was brought back to my childhood during overseas family trips when my parents would play CD playlists of Mandarin classics in the car. I imagine it could have been a similar experience for Madam Y. Art and music have the capacity to bring an individual back in time to relive memories of their past beyond hospital gowns and commode chairs. For a short period of time, the reality of the world just pauses for us to appreciate our individual unique history.
Building relationships through listening, learning and art
Beyond prescribing medicine, changing diapers and serving meals, there is often an overlooked part of the patient's well-being that can be difficult to address. This aspect of well-being often encompasses the patient's own values, their emotional and mental state, and their perspective of being at the hospital, coupled with the promise of any therapeutic goals for their stay.
Sometimes, addressing this aspect of patient well-being involves spending time interacting with them and simply being present, however transient or short. Whether listening to what they have to say beyond simply hearing their voices, or looking directly at the patients when speaking to them and observing their body language and facial expressions, it all adds up to build a broader picture of what patients are going through as they transition from being community-independent individuals to being a patient. They, as patients, become someone who requires and receives medical care, and is less independent and less familiar with their immediate surroundings. Caring for patients might also include relating to them while doing shared activities, such as watching YouTube, learning from their experiences or listening to music. As a medical student helping with nursing duties, I had a special opportunity to not only provide nursing care, but to also interact with patients in various ways that allowed me to build a unique relationship with them, thus understanding the patients beyond their medical condition.
You've got a friend
Towards the end of my internship, I returned to the ward to find Madam S' bed empty with its sheets removed, exposing the creases of the waterproof mattress beneath. The microUSB charging cable, used to charge Madam S' depleted electronic tablet after hours of watching P Ramlee, was no longer there on the top left corner of the bed. That was the first time at the ward (or rather, the first time with whatever clinical exposure I had till then) that I felt a sense of parting with someone whom I called my friend. A friend who shared with you her feelings about being in a hospital, sharing from a place of loneliness her fear of being away from her immediate surroundings and a sense of uncertainty surrounding her future. I think about how we would spend hours just watching YouTube, the same few short films over and over again. In that moment, we were not alone.