GUT FEEL: Keith Tan, a senior medical social worker who is now at the 
  Singapore General Hospital. TNP PICTURE: GAVIN FOO

This is the first in a series of heart- warming and sometimes painful stories from our medical social workers. They work quietly among other health professionals in S’pore’s public sector hospitals, helping patients deal with difficult issues including financial hardship and impending death.

By Ng Wan Ching

DRESSED in hospital pyjamas and hooked up to a drip, the old man stood next to a ledge near his hospital ward.

Staring out into the open, he dragged on his cigarette, deep in thought. But something was amiss.

The patient did not act as if he was afraid of being caught.

“His face showed no fear that nurses would reprimand him if they found him smoking in the ward lobby,” said Mr Keith Tan.

The senior medical social worker was visiting his sick grandmother a couple of years ago. His professional instincts told him that something was wrong and that he should alert the nurses to check on the patient.

But before he could do so, he was interrupted by a relative updating him on his grandmother’s condition. Minutes later, there was a commotion. A man had jumped to his death.

Mr Tan went to the window and tried to see who it was.

A sinking feeling hit the pit of his stomach – it was the same man who was standing by the ledge.

“I thought I should have trusted my intuition which hinted to me that this man may be contemplating suicide. If I had informed the nurses of my concern, the suicide may have been averted,” said Mr Tan.

The 31-year-old, who is now working at the Singapore General Hospital, said intuition is one attribute that he picked up from his job. His special interest is in working with the elderly who are depressed.

That example was one of two situations where he did not act on his instincts in time.

Coping with loneliness, depression

In another case a few years ago, he was counselling a single 80-year-old man admitted to hospital after a few giddy spells. The man was highly anxious and the psychiatrist diagnosed him with depression.

“He was worried about who would take care of him as he lived alone,” said Mr Tan.

Prior to his discharge, Mr Tan contacted the Senior Activity Centre at his block. The staff readily agreed to help out the elderly man.

Mr Tan also made a referral to the Singapore Action Group of Elders (Sage) counselling centre which scheduled a home visit the day after the patient went home.

“However, throughout the journey home, he was engrossed in his thoughts. I asked if he felt all right, he said he was fine,” said Mr Tan.

He went to the man’s home to help him settle in and after ensuring that everything was in order, Mr Tan left.

“But something bugged me. When the unease persisted, I asked a colleague about it. He said that the patient was already linked up to community agencies. What I could do was to call and check on him the next day,” said Mr Tan.

The next morning, Mr Tan received news that the patient had been found by police at the foot of his block. He had jumped at 5.15pm.

Said Mr Tan: “I left him at 4.45pm. It affected me personally as I was probably the last person he saw. What did I miss?

“What did the look on his face mean? His flat was clean. It was obvious that he was a proud home owner. Other than his giddy spells, he was healthy.”

He was reminded again that there will be times when a person, especially an elderly one, feels that there is no one to care for him and can become determined to end his life.

He said: “Once again, I learnt about the need to listen to my gut feelings even if it means having to escort the patient back to the hospital.”

For a social worker like Mr Tan, who is trained to handle such cases, such recollection and conclusion can add to the anguish and guilt for not having done more to avert or prevent the suicide. However, where suicide is concerned, it can be difficult for even a trained eye to see.

Sometimes, unfortunately, the lesson is obvious only in retrospect.

TAPESTRY OF CARE
 
You can read more such stories in the book 'Tapestry of Care – Voices of Medical Social Workers.' The 47 stories in the book open a window into the lives of medical social workers and the multi-faceted journeys they take with patients.

In addition to the stories, told from a first-person perspective, practice pointers have been included to make it a reference guide for other medical social workers.

The stories are about abandonment; abuse; awaiting death; grief; hope; suicide and also about it being all in a day’s work.

You can buy the book ($14.90 including GST) at selected retail pharmacies of public healthcare institutions, the National University of Singapore Co-operative bookshops and Kinokuniya.