Notes From Hanoi

Illustration by Dili Chen

Illustration by Dili Chen

“Maybe in 10 years time, I will become one of them too.”
I’ve only been shadowing after Dr. Ly (pseudonym) for two days and already I think I know perhaps half of what he feels when he has to return the call to the mother of an 18-month-old with anhidrosis knowing that there is nothing he can do to save the child’s life. It’s so much easier not to care. It’s so much easier to blindly follow the rules. It’s so much easier to just take the money and shut up. But in spite of finding himself caught up in the medical system that he’s in, Dr. Ly continues to come back to work every day and see his patients with an amount of patience and reassurance that I can only admire.
Maybe in 10 years time he will become one of “them” too, just another one of the doctors who take this job to make a living. I wish I had the power to do something—offer words of advice, consolation, or some miraculous cure to this devastating disease— but instead I felt as useless and empty as he did when he stared at his phone that afternoon, wondering what to say to the mother of his very young patient.

~

Perhaps it was from hearing that morning about what had happened to the patient who came in last week that had put me in a mood (and perhaps I also got a little too sentimental with my music playing in the background). The first operation that day started at half past eight. Another craniectomy, where a bone flap of the skull is temporarily removed via surgery. For the whole time that I was there, I sat with my back against the wall, viewing everything happening in the OR with my earphones on.
The nurse anaesthetist was monitoring the anaesthesia, the surgeons were getting gowned, and the scrub tech was laying out all the instruments. Nothing was out of the ordinary. Yet, there seemed to be something fundamentally wrong with the whole picture that morning. The scalpel gleamed like tiny eyes under the light, the patient was rendered unrecognizable under the sheets, and the scar on his shaved head made it look like a blown-up baseball. Everything slept beneath a sinister veil of melancholy.
And then one of the doctors called me out of the room. Another emergency case that I might like to see, he said.
Good timing.

~

It’s time for those rose-tinted spectacles to come off.
Dr. Ly is not that perfect.
He is an amazing doctor, highly disciplined learner, responsible teacher, and generally full of positive energy; but he is also a horrible person to be around sometimes. Watching him make his way around the hospital through most days is like watching a three-year-old trying to find his way around the bustle. Charged with a strong sense of justice, but with the energy of a delinquent picking a fight – hear all! Lest he get his way, temper tantrums are sure to come (no innocent children and unicorns were harmed in the process, although some hospital property may have been inconvenienced).
Yet, it is remarkable what his patients can do to him. Have you ever tried to talk some sense into an angry three-year-old? His patients somehow bring out the best in him. One time, out of genuine curiosity, I asked him why he cares so much about each of his cases. He was very taken aback by my question, as if I were somehow implying that he should not “waste” his energy caring so much for his patients.
I often watch him pour his head and heart into every single one of his patients; he fights for them like their families would and cares for them like their closest friends would. But, as is for any naïve three-year-old, his approaches lack both insight and foresight. He almost always has a tendency to oversimplify the situation and when it concerns the self, I admit, we both share the same unsettling black-and-white thinking.
Have you ever tried telling a three-year-old to not eat that cookie in the jar? And then watch your patience and confidence in parenting crumble as they ate that cookie in the jar in slow motion? Well, he too could give a crap about rules. I just want to know how bad it would have been for the eight-year-old craniotomy patient had he made the new incision like he had been instructed to make. He talks about the crucial role of standardization, strict protocols, and unity in a strong surgical department; yet, when it comes to the OR table, he himself is incapable of following the rules.

~

Today is most accurately summarized by the following dialogue:

DOCTOR: I want to quit this fucking job!
ME: Where will you go?
DOCTOR: (Silence and pout).

~

During an evening, over the phone, a friend asked me about my day. I told her about an urgent case that closed off the (very long) day. Long story short, an elderly patient had been recovering well from a cervical spine surgery from some days ago. That late afternoon, without any warning, he suddenly became paralyzed from the neck down. I remember how the windows were open and it was 40 degrees Celsius outside, but inside the office the atmosphere was frigid. A revision surgery was scheduled immediately, and the two surgeons did not get back home that night until 11 pm. Fortunately, the patient could sense and move arms and legs by the next morning.
At that point, I remember the only words my friend said in response, “That’s a miracle! Those doctors must be really good!”
I will always be guessing how the two surgeons would have reacted to her words. One of them had once said to me on my first day, “Patients’ families want miracles, not doctors.”
Personally, if that is the average person’s definition of a “good doctor” – well – then that’s pretty sad, isn’t it?

~

It has been a week since I first came to this department, and I saw for myself how a single doctor has to be a neurologist, a neurosurgeon, a politician, a lawyer, and a businessman to “make it to the top.” In Hanoi, overcrowded and underfunded urban hospitals have become the norm, and the ability and willingness to deal with nerve-racking dilemmas on a daily basis are merely part of the job requirement.
Most of the patients who turn up at the department are middle-class people living and working in Hanoi; but there are just as many of those who come from Vietnam’s rural areas – near and far – to the big hospitals in Hanoi just to seek the medical treatment that they need. As Vietnam saw the Doi Moi reforms and gradually does away with the old socialist model of healthcare, a paradoxical situation arises where even in the best-staffed and most-qualified hospitals of Hanoi, the quality of care received by each patient is dramatically compromised by the over-crowding.
While patients need not wait for weeks to obtain their angiograms or elective CT scans, as they might do in other countries with socialist healthcare systems, the only available MRI scanner in the hospital is (and I quote the MRI technician) “probably the last remaining 0.3T in the world that is still in active service.” There are also few, if any, options for patients considering minimally invasive procedures. The trade-off for this pitiful lack of financial attention by the government is usually a remarkably detailed and thorough clinical examination of the patient; but in the conditions of Vietnam’s overcrowded urban hospitals and underpaid doctors, such attention and detail are almost a luxury.

~

Experience can only bring you so far down the road. Your experience would tell you which option would appear to be the best, how long this surgery is going to last, every numbered step that you will make intra-operatively, each and every complication that you may encounter post-operatively, the body’s anatomy somewhere in that bloody mess, and the risks and probabilities of complete recovery all calculated in clean and ready percentages. But your experience won’t tell you whether your next case would be the exception. In the OR, there are no old and wise men.
They are human after all, and when you thrust so many lives into their two palms, some either choose to turn away, stunned, in cold retraction whilst others go all in. I have seen what the former does to people, and what it turns them into, and I have seen others pay the price for it. I will never forget about the first case that I witnessed and how a mother lost her baby. In a world where natural disasters and terrorist attacks seem to happen every other day, a sacrifice of one mother and her child doesn’t always seem like a big deal; but when you put a face onto those words, everything changes. It’s so unfair. No, that is not what I want.
For the latter, insecurity and child-like panic abound beneath their sterile masks and steady rubber fingers. They light up the hospital’s corridors – white to the point of an electric blue – at two in the morning and there is something burning inside them.



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