Sun, 06 Aug 2000

A day with an emergency room doctor

Dr. Ahsan Hatman, 37, is a senior resident at the anesthesiology department of Cipto Mangunkusomo General Hospital (RSCM) and an emergency room (ER) doctor at the Metropolitan Medical Center (MMC), South Jakarta. Born in Ujung Gading, West Sumatra, he moved to Jakarta to study medicine at the University of Indonesia in 1982 and lives here with his wife, Rifi, two sons and daughter in Ciputat, South Jakarta. He spoke to The Jakarta Post's William Furney.

JAKARTA (JP): When I wake up at 4:30 a.m., I'm thinking about my duties for the day. I have to be at RSCM by 7 a.m., so after I pray and have some breakfast, usually rice and some fish the maid has cooked, I'll say goodbye to Rifi and the children. It's a very busy household in the mornings, with the children getting ready to go to school.

The journey to RSCM takes about 45 minutes in my small Mazda. It's my first car; I bought it about five years ago but I'd like to have a nicer one. It's fine driving in the mornings as there are no traffic jams at that time.

When I get to the hospital, there's a meeting with the other doctors about the operations for the day. We discuss the patients' needs. And after that, I go to the operating room and administer the anesthetic to the patients. At RSCM, there are between 30 to 40 operations every day. I do just one or two. They are fairly general, from laparotomies to cesarean sections. RSCM is a big hospital, but not very modern. It's very old. The equipment is old too -- it's just enough for usual surgery, but nothing too complicated like thoracic or cranial surgery.

I've been an ER doctor at MMC for two years. In the ER, it's all about saving lives. It's reality. My work at RSCM is routine for me now, but in the ER, there's a lot of stress. Heart attacks, vehicle accidents and strokes are common. Pneumonia is a tricky one to deal with.

I've never had a patient die in the MMC ER. But before this, I worked in the ER at Pertamina Hospital and some patients died there. But usually, they were people who came to the ER too late, like victims of car accidents, heart attacks and strokes. But it's still awful when they die in the ER, there's some guilt. I ask myself if I did something wrong and if I did the best I could. It's hard to take and usually I can't sleep for one or two days afterward. That's the most difficult part of the job.

I've had a patient die on the operating table in RSCM. Usually when there is too much internal bleeding and the surgeon cannot stop it, even with transfusions. If the mistake is not from the surgeon, I don't feel bad about it, but once I asked a nurse to connect to the oxygen supply and she connected to the nitrous oxide supply instead and the patient died. It was a bad time for the team. I won't use someone like that for the next operation.

I break for lunch at 12 p.m., and usually go to the canteen where I'll have fried chicken or something like that.

There was no doctor in my village when I was growing up and there were many sick people. I decided I'd become a doctor because of that. My father was just a carpenter and couldn't really afford to pay for my studies. But I came to Jakarta and supported myself with extra medical work and savings from when I was sent to a puskesmas (local community health center) in a remote district of Aceh, under the government's health program. I was there for three years and made many friends whom I'm still in contact with. They tell me they are afraid of the situation there now but they don't want to separate from Indonesia.

A doctor's salary is not that good in Indonesia. You have to be a specialist, like a surgeon, to earn a lot of money. But there are doctors earning up to Rp 200 million per month, plastic surgeons and so on.

Medicine in Indonesia is lacking in a lot of areas. The Ministry of Health has ordered every hospital to have standard procedures, but many people go abroad to get treatment because we either don't have the equipment or it is out of date. For others, it's a kind of lifestyle thing -- they can tell their friends they are going overseas for treatment.

There are many doctors here who are invited to speak abroad, as they have the skills and expertise. But for the others, skills and the transfer of knowledge needs to be developed. We can't carry out a lot of procedures, such as lobectomies, as we just don't know how to. We have to go abroad to learn.

We get people coming to the ER with all sorts of ailments and diseases. But we quickly find out what they are and if someone is a drug addict or AIDS carrier, it's no problem. We follow universal procedures.

MMC is near to a well-known nightspot and we get a number of drunk people coming into the ER, particularly ones who have been fighting. It can be hard to treat them.

There's a policy at MMC that if someone cannot afford treatment in the ER, we'll give it for free. Afterward, if they need further care, we'll send them to other hospitals.

There are two shifts in the ER, from 7 a.m. to 4 p.m. and from then to 7 a.m. I get tired in the early hours when I'm on the late shift and there are a lot more cases, but I stay focused.

I get home at about 5 p.m. if I'm not working the late shift. I'll just rest for a while and maybe watch some television. I love playing with my children. I don't drink or smoke and never go out with Rifi; we just stay at home.

I go to bed at about 10 p.m., thinking about my duties for the coming day.