A Death in Hong Kong: an evolving essay and insight into medicine and the law in contemporary Hong Kong (part four).

I had found Dr Wong exposing a dying patient for his own vicarious gratification. I had specifically forbidden him to do so three times. I had even found him sneaking in behind my back whilst a nurse was helping the patient into a gown. The patient had a massive tumour and was desperate. His doctor knew of our reputation at the Prince of Wales Hospital in Shatin. Shehkar, KC, myself, we did some incredible surgery. Very advanced malignant disease that was located at a hip or shoulder. I had had this wonderful patient in the UK called Susan. I used the skin from her useless arm to cover the hole on her chest where I had removed a foul smelling, painful, radio-resistant recurrent breast tumour. Meeting Shekhar was a meeting of minds. Surgically. I am soft tissue, he is bone and bio-engineer. We did some incredible things and word got around. Presentations, publications. We were proposing aggressive palliative surgery for advanced malignancy. Highly selected cases where the process of selection involved full and frank discussion with patients and their relatives.

And so I had included all of this background about why we were doing what we were doing. The patient found himself disgusted by his appearance. The patient’s doctor was one of my old students and had reassured him that there would just be a few specialists to talk with him. No students, juniors or gawkers. Shehkar, KC from orthopaedics, Calvin Ng and Innes Wan from cardio-thoracic and Tor and myself from plastics. We were meeting in the burns unit and there was a dressing room with privacy curtains and a bed where we could see a patient. KC, who is a wonderfully empathetic surgeon would usually begin in Cantonese with the patient and Tor might join in and Shekhar and I would stand back and look on. This was to take in the big picture. We were processing the clinical and anatomically feasibility of providing a significant improvement of quality of life and a reasonable risk of being able to enjoy it. Yes, it was dramatic medicine if observed with a cinematic mind set.

Before we meet the patient, we have a short presentation of his history and looked at the objective evidence, the films. Basically, the first part of the equation is whether the tumour can be removed without killing the patient. My role comes in the second part, the reconstruction of form and function (as best one can). So, I popped in to the dressing room next door to make sure the patient is okay. I had asked a nurse to get him into a gown and get him on the bed and give him an over sheet. The nurses were busy and so they made sure the patient was comfortable and then gave him a bell to ring if he needed anything.

I found the patient sleeping and I remember gazing at his face and feeling an immense sadness for him. For those who have to face the nightmare of a lingering physical death as a cancer eats them up and stinks out their families and destroys their hopes, their joys, destroys them. To do what we were doing required such an absolute trust and respect between the surgeons, the relatives and the patient. We would cut out the heart of the cancer and give the patients some dignity in death.

I re-joined the discussion outside. I was there just but for a moment but thought I heard something. I was thinking of the bell on the patient’s tummy, perhaps it had rolled off?!

I popped back and was shocked to see Dr Wong, with his back to me, attempting to expose the sleeping patient. Not wanting to disturb the patient I gently tugged on Dr Wong’s coat lapel to attract his attention. He looked around at me and his face flooded with both anger and guilt. I indicated for him to follow me and walked to the door. I opened it and stood back and he barged through saying, “This isn’t right. This isn’t right. I am a consultant.” He was blowing up again as he had done a year previously. His face was red and he was spluttering. His eyes were narrowed and he was searching for a threat. Something nasty to say, but all he could hiss out at me was “I am going to report this to Professor Lai.” “Please do,” I quietly replied. And off he sloped down the corridor, a sad and angry old man, shoulders bent and lop-sided, close to the wall.

I returned to the group and the patient and spent a couple of hours on administrative clinical work before returning to my office. And there I considered carefully what to do? I wrote an email to give a contemporaneous record of what had occurred and sent a copy to both Dr Wong and the Chairman of the Department. I wrote a further but more detailed contemporaneous account in another email which I sent to myself, (my insurance). And that I thought was that.

I was wrong. Dr Wong must have gone home that night in such a fury. Angry. Frustrated. He most probably did not sleep and perhaps drank rather too much strong liquor. How else can you explain the absolutely bizarre and fevered imaginations that appeared in his chaotic letter of complaint? Being grabbed from behind and being dragged, powerless, in fear of his life, unable to cry out. Thirty terrifying seconds, and then being thrown out of the door.

5 June 2012, the Queen’s birthday. I went to the birthday party reception hosted by the British Consul and then dashed to the Hong Kong Medical Association to present to the Council my preliminary thoughts on addressing patient safety in the private aesthetics industry. And then I dashed to hear Dr Wong give a presentation at the New Medico-Legal Society. I had invited him and felt the responsibility of being his senior colleague to be there to give support. He had recently given me a copy of his new book signed “To my respected friend and colleague.” What I cannot understand is why within two weeks he was writing a grossly defamatory letter in a pseudo-legal manner and within three was accusing me of physical assault? What had happened to him? Who, had happened, to him?

CONTRIBUTOR
Andrew Burd (Prof)

Editor - Freelance Medico/Legal Consultant.

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