The fall

April 18, 2006 was a normal working day. Normal as hotel was busy and today we have our regular management workout day. We believe a healthy body will have a healthy mind, so the management at Shangri-La's Tanjung Aru Resort has scheduled that every Tuesday at 5pm we will gather for some games and fun. So far, we have run on the beach, have aerobic session, played soccer as well as beach volley ball. Today's game is "Touch football". We are to play the Australian rule rugby only that instead of tackle, one only need to touch the opponent.

After a brief warm up and rules explained we started the game. Barely 5 minutes after the game started, the ball was passed to me. I ran across the field to avoid the opponent and head for the end zone. Suddenly I felt there was a muscle cramp on my right foot and begin to lost control. At the same instant, Mr Andersen, my opponent team gave me a push, my whole body catapulted and I landed on the side walk with scratched arm and severe pain on my right leg. I have no feeling on my right foot. Laying on the side to wait for the pain to subside, an ice pack was placed underneath my calf which was very painful. A masseuse was called to give a little massage. However, when the pain did not stop, masseuse left and hotel van was asked to send me to SMC, Sabah Medical Center. Wheel chair was used to send to Blue Note entrance to the waiting van.

Upon arrival at SMC at about 640pm. Resident Doctor, Davies Hong was taking shower and I waited for a few minutes and was attended to. He examined and said that there is muscle spasm and probably some torn ligament. He gave me some pain killer and advised to return the next day and appointment with Dr Surinder on 19/4/06 at 11am was made. No X-ray was taken.

My wife, Flora picked me up and we returned home. After taken shower, dinner and the medicine, I noticed that the right calf was swollen and right leg was uncomfortable and painful. I was not comfortable and called Dr Ong of Klinik Jaya and he advised that there is risk of compartment syndrome where the lower foot may be starve of blood supplies and I should go back to SMC for them to monitor. He also called Dr Hong. Dr Ong then called back and advised me to be admitted to SMC.

We went back to SMC at about 930pm and Dr Hong noticed the swell and arrangement was made to be admitted.

I was admitted to room 312. The nurse enquired when was the last time meal was taken and said that operation can only be conducted four hours after meal. Some time later, a nurse came and asked me to change to operation garment as I will be operated. I told her that no doctor has seen me yet. About half an hour later, Dr Heng came and introduced himself, He said as the right foot is cold and may turn blue soon, I need to have operation on the calf to release the pressure. Consent form was given and signed.

Operation was done around 1230am - 1am. Spinal epidural was used. After operation, as the lower limbs are numb, I was able to sleep. Woke up at about 6am, 19/4/06, Wednesday with severe pain on the right foot. Asked nurse for Doctor Heng and was told he was out station and will be back in the afternoon. I called Hotel to enquire telephone number of SMC. Called SMC and spoke to Dr Heng’s aides and was advised that doctor will be back at 3pm. From 6am to 3pm, no doctor attending and I was in excruciating pain. It was the most painful 9 hours I have to endured while waiting for the doctor.

Doctor Heng came at 3pm and was told of the continued pain and swell. He said it is not a traumatic fall and cannot be serious. He checked and did not suspect any fracture. He was happy that the foot is warm and colour is good. He is concern with the blood flow and said that another operation to cut the other compartments need to be done. No MRI or X-ray was ordered. At about 330pm, another operation to cut open the compartments was carried out. Epidural on the spine was done again. By 8pm, my legs were wrapped up nicely but the three open wounds would remained open.

By mid night, I felt severe pain on my right foot again and after endured for about 2 hours, I decide that I could not bear it anymore and call the nurse. Nurse said he will contact Dr Heng.
Dr. Heng came at about 230am and commented that the foot was warm and colour pigmentation on the toes were good. He ordered the nurse to give me a jab which put me to sleep and ended the misery.

On 20/4/06, the pain and swell continued. The right foot could not be lifted up although it was possible to wiggle the toes. Dr Heng ordered for a wound clean up at 5pm and said that it is to be done at the operating theatre. This time I was sedated. Later he said that he will do another clean up at 8am next day, 21/4/06. Apparently, Dr Heng will be away until Sunday. He did the clean up at about 8am at the same ward (level 3) in one of the operation rooms and not the operating theatre. He ordered an MRI said I may be discharged and spoke to Flora. He told Flora that we can go home and that on Sunday when he returned he will call us to come back to clean up the wound.

I decided to wait till Saturday as my situation has not improved. The leg was swollen and still in pain.

An MRI was conducted in the morning of 21/4/06. In the afternoon, Dr Peter Ong came and see me explained that Dr Heng has asked him follow up with me as Dr Heng is away. I was disappointed because he could have told me. (I did not realize at that time that Dr Heng had spoken to my wife before he left.) Dr Ong explained that the MRI confirmed there is fracture to the plateau of the tibia bone. He also said that I will have to take an X-ray. An X-ray was taken in the late evening. Going home is out of the question now.

At about 8pm. Flora spoke to Dr Ong and was told that Dr Surinder will see me on the next day since the MRI and X-ray confirmed fracture to the tibia.

On 22/4/06, at 8am Dr Ong came and said that he had referred the matter to Dr Param who will take over the case. He further explained that since Dr Heng had discharged me, the case with him is more or less closed and it is alright to hand over the case to another doctor.

At about 830am, Dr Param came and explained on the fracture through MRI results. He said he had to assume the risk to operate now as I still have open wound. Operation is to be conducted as soon as possible. Depending on the condition, bone marrow may be taken from the hip and plate may be inserted.

At about 11am, it was a go ahead with the operation. This is the third epidural anesthetic through the spinal cord in 4 days. Dr Param inserted two screws to the fractured tibia. There was a posterior torn ligament but it was left as it is. No bone marrow or metal plate was needed.

Dr Heng dropped by on 23/4/06, Sunday afternoon trying to justify the situation and that he ordered the MRI. However, he never mentioned that he discharged me with a broken tibia.

It was rest days from 23/4/06 to 25/4/06 as it was decided that the open wounds are to be closed on the operation on 26/4/06. On 26/4/06, Wednesday afternoon at 1pm, the fourth operation was carried out. Another epidural spinal anesthetic was done. No skin graft was needed as Dr Param was able to stitch up all 3 wounds.

27/4/06 was a rest day. However, the right foot continued to be numb and not able to be tilted up. Dr Param is not sure if this has anything to do with the nerve. He said a nerve conduction test is to be carried out with the neurologist at my next visit.

28/4/06 another X-ray was taken in the morning. The X-ray shows the 2 screws that are in place. Dr Param was happy with the result and I was discharged at about 12 noon.

During the 11 days at SMC, streams of visitors from my family, Grace Chapel as well as the hotel dropped by to visit me. The room was full of flowers, fruits and drinks. Staff also brought in helium balloons which brighten up the room. The Church mebers are particularly encouranging because they always end the visit with a prayer. Little Joshua said the Lord's prayer each time he visited me. He even brought a ballon for me. My brother and sometimes my sister-in-law, Adrian and Sylvia visited me almost every night. Gene Chong was at the hospital everyday as she is visting a few patients there with her ministry with Agapage Counselling. Jenny Chong was also a regular visitor. She was good in bringing some food from outside as the food in the hospital is getting too monotonous and blend. Flora was coping better than I expected. She has gained a lot of confidence to be able to look after the household alone without depending on me. She has to wait up early to send the kids to school and then spend the day with me. She was worried and frustrated at times especially when knowing that the doctor has been negligence in handling me.

Three patients came and go while I stayed in ward 312. Mr Wong of Ranau was discharged on 22/4/06. The bed was later occupied by Mr Ho. Mr Ho is the husband of Karen, the X-ray radiologist from SMC. Earlier, Karen has came by and prayed for me. She is with the Basel Hakka church. Mr Ho had cut in wrist while transporting a piece of glass during his office move. The broken glass cut his tendon, artery as well as nerve. Dr param spent 3 hours to joins all back again. Mr Ho is quite a joker as he will entertain everyone visited him with his loud and funny jokes. After Mr Ho stayed for a night, the bed was occupied by Megat. Megat came in for a small operation on his thigh and we both left on the same day from SMC.

Looking back at the whole situation, there are certainly many areas that Doctor Heng could have done better. Granted that first operation to open up the calf to release the pressure and ensure blood supply to the foot was necessary. On the next day, after returning from Sandakan, he hastily ordered another operation to open up the other compartments was unnecessary. Instead an MRI or X-ray should be ordered, If this has been done and the root of the problem would have been discovered earlier, the right treatment would have been administered. The operation to open up the calf also have consequences on my nerve as now the right foot cannot tilt upwards. I ended up staying longer in SMC and paying more for many of the unnecessary suffering.