Man on fire!

Filed in Current Affairs, Health, Hong KongTags: , , ,

True story.

It was supposed to be a straight forward operation, a small one, a simple one. Cut a small hole above the bronchial airway, pull the large oxygen breathing tube out from the mouth and push the new smaller tube in through the hole.

My brother-in-law Joe had a stroke almost two weeks ago. A blood vessel in his brain had developed an aneurism and while walking the streets of Macau, it burst, streaming blood into his brain. He knew immediately that something was wrong and asked a nearby policeman for help. He was transported to a hospital and treated. He had lost consciousness well before getting to the hospital and his situation was serious.

Fast-forward a week. Joe has been transferred to the Prince of Wales hospital in Sha Tin and is resting and recuperating in the crowded and understaffed Neural ward on the third floor. He can open his eyes but cannot move any of his muscles. He has a long way to go before he'll be normal again. His mouth is perpetually open because his jaw muscles don't respond to commands. Consequently, he breaths through his mouth but cannot moisten it or control where the saliva and nasal fluids go allowing some of it to run down the trachea and build up in the lungs. According to the attending doctor, this may have been one of the causes of the secondary pneumonia infection noted a few days later.

The pneumonia produced massive amounts of phlegm in his lungs and without motor movement or coughing capabilities, the phlegm would remain in his lungs, significantly impeding his ability to breath. Without help, he would die, possibly of suffocation. An air tube was inserted down his throat to assist with his breathing but leaving the tube there long term would probably damage his throat. The doctors therefore decided to cut a small hole through his chest into his trachea and insert a small tube. For the immediate future, this would be a safer and more convenient solution to his breathing problems.

The procedure is relatively simple. Cut a small hole through to the trachea. Pull the large tube out through the mouth. Push the small tube in through the hole. To make sure that the patient doesn't suffer from a lack of oxygen during the procedure, almost-pure oxygen is fed to the patient through the large tube just moments prior to the operation. The extra supply of oxygen is supposed to keep the patient going while the tubes are being exchanged.

The procedure took place yesterday in an operation room. During the operation, instead of using a traditional scalpel, the doctor used an 'electric scalpel'. For reasons not yet explained to us, the 'electric scalpel' released sparks during the operation which ignited oxygen coming out of the hole. Joe was literally on fire; for approximately ten seconds. The fire was reportedly quickly put out with water (water??). Once the damage had been surveyed and evaluated, the tube procedure was completed and Joe was once again able to breath.

The fire was real. According to the doctor, it was an accident and it was the first such known incident in Hong Kong although according to the doctor, web searches revealed twenty or more similar cases overseas. The fire produced heat and smoke, and some of it may have entered Joe's bronchi, scorching the bronchial epithelial layers. Best case scenario; the bronchi will recover without further complications. Worse case scenario; the epithelial layers swell and result in thickened bronchial walls and narrower wind ways possibly leading to further serious long term complications.

The fire was an accident. We believe that. The question though is one of negligence. In my (admittedly inexperienced) mind, I can only see two possible reasons for the fire. First, the electric scalpel used was faulty, leading to the sparks that ignited the oxygen. Second, the procedure was flawed. With oxygen pumping through it, the larger tube was pulled up above where the hole was to be cut before the cut was made and oxygen was still pumping through the tube while the hole was being cut. This lead to direct contact between the almost pure oxygen and the electric knife hence the fire.

In either case, negligence is the cause of the accident; lack of maintenance and equipment inspection in the first case, and incorrect procedure in the second case.

If we were in the U.S.A., we'd be suing the hospital. Here in Hong Kong, suing is much more complicated. That said, it's far more important at the moment to keep an eye on Joe and make sure that his road to recovery is not hampered again. Hopefully, the nurses and doctors will pay more attention to his case.

In the end though, the real criminals here are the Hong Kong Government and the Hospital Authority. While happily advancing funds to large corporate contracts for extravagant projects, and while the Hospital Authority management staff joyfully award themselves high salaries and large unsubstantiated bonuses, they continue to cut financing to the hospitals. Public hospitals in Hong Kong are now overcrowded. Even the Intensive Care Unit looked like a refugee zone with beds camped hither and thither in the hallways and in the walking areas between beds. The staff are overworked, understaffed and underpaid. This can benefit no-one.

Similar situations are building in the public school system, situations which have recently led to multiple suicides in the teacher population.

Funding and expenditure need to be controlled but there's a limit to how much you can save on staffing costs and the lives of the people have to be considered. If the government doesn't work soon to remedy the situation in a sensible realistic way, the consequences will be dire; for everyone (except the rich which not surprisingly includes those same government officials and hospital authority management staff. Maybe the middle-class citizens should be the ones making the life-and-death decisions instead of the rich.)


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20 Responses to “Man on fire!”
  1. ricky says:

    hi greg

    i hope that joe will be ok, i hope he recovers soon. my grandad has had so many strokes in these few years and he once lost all movement in his left side, the doctor who came for home visits after he was released from hospital said oh forget it he'll never move again,he spoke of him as if he were not even a person and this is in the uk. after a while my grandad recovered and began to walk and talk something we were told will never happen again. my grandad has been sick for a long time now and every year he seems to get worse and is taken to hospital every so often now he is in a wheelchair and has no use of his left hand but we are thankful he is still with us and not in pain. anyway sorry for talking of my family but i'll pray for joe.

  2. Phoenix says:

    thats so scary!!!:S is he ok now??bless him~
    i believe most of the doctor's passion has gone. as u said they are all overworked, understaffed and underpaid. they get tired on caring their patients and forget their intension is to save the others. therefore they start to treat their job as "a job", go to work on time and waiting to come off work.
    "u get ill!? thats YOUR fault! and u are increasing MY work load. i am sorry if i do things wrong, but cant help, u can c how busy i am. and i just work here, pls ask for no-more."i bet some of doctors have this in their mind.
    btw dont forget doctors come out of an education system which full of problems. with the pressure from family, they pass all the exams and become a doctor, so not everyone are totally willing n study to become a doctor. thats y i think they are all doing quite well. at least they still do their "job".
    this may sounds a bit extreme, but thats part of the truth~

  3. Frankie from Boston says:

    That’s insane... I sure do hope you sue the hospital. That kind of treatment and the long term damage is unacceptable… Someone need to be held accountable. There is no accident in medicine... You either do it right way or the wrong way.

  4. yan says:

    i am a little audience. i feel sorry to hear your brother-in-law's story. hope he will recover soon. take care. pray for him and your family.

  5. sapphire says:

    Your brother-in-law’s true story of “man on fire” was a heart-broken one. I’d prefer to the version played by Denzel Washington.
    Accident or medical/clinical negligence? It’s all depends on how serious the health care workers are about their own jobs. Hope he’ll recover soon.

    Btw sorry for something out of topic, I liked the movie “Man on fire” and Denzel Washington very much.

  6. sue says:

    Sorry to hear about what happened to your brother-in-law. Hope he's onto a speedy recovery. It's disheartening knowing that 2 key systems that underpin our society - education and medical - are plagued by a multitude of structural problems. I know friends in both professions who are frustrated about the situation and at the same time feel very helpless as they can't/don't know what to do about it.

  7. angela says:

    this is my first time posting here:)

    i'm so sorry about what happened. unfortunately, i do feel the same way as Phoenix that most doctors' passion are gone. remember last time when my grandma stayed in hospital due to some kind of respiratory illness, she couldn't walk on her own, not to say she couldn't take care of herself like taking a shower and stuff. the medical staff simply 'throwing' her from one department to another, without treating her properly. afterwards, we've found out the true reason for her deterioration was that the pills prescripted were incorrect and it was some kind of drug overdose.

    every cloud has a silver lining. for my grandma, though she've suffered alot, she's now recovering with the love and care of family and friends. i sincerely hope that your brother-in-law will do the same. supportive family and friends do him most good at this moment. take care.

  8. Stephen says:

    My sympathies to you Greg. I completely agree with both Phoenix and Angela. Here in Toronto, Canada we experience the same and especially in the Emerge (aka ER) of the hospital in my neighbourhood. Anyways, Greg, my prayers are with Joe and your family.

    If you don't mind, lemme share my experience with. Last yr, my wife and I've experienced a pregnancy that I wish to happen to NO ONE. During the second trimester, our child was diagnosed as a fetus with severe congenital heart complications. We went thru genetics counselling where we were offered 2 choices: Continue or Terminate pregnancy. Being dependant on the basis of our faith, we decided to continue the pregnancy. Despite the fact she still has those complications, my daughter is 3 and half months old. She's in the process of learning how to turn over. Other than those sleepless nights up to a few weeks ago and monthly appts with the cardiologist, we're now blessed with this cute baby girl who constantly learns on a daily basis and most of all, still no medications prescribed. What more could a parent ask for? Therefore, despite being disappointed at the doctors and health systems, miracles do happen. Just be hopeful and our Creator will do the rest. Btw, after seeing the TVB series of "The Last Breakthrough" I'm in search of "Dragon City Health Clinic." Don't think we'll ever find Dr Wong-Po anywhere in the world.

  9. Aggie Yip says:

    Hi Greg,How's your brother-in-law now? I sincerely hope that he will recover soon. Seeing doctor in Hong Kong is really a gambling -to see if the patient can meet with good doctor or not. I understand the doctors working situation are tough, but I still believe that they should work in their best because beyound the GOD, they are one who control "live and death" in the earth.

    Anyway, sincerely hope Joe will recover soon and would appreciate if you can keep us informed about his latest situation.

    Don't worry too much, the world still go on.

  10. Richard says:

    Hi Ho Kwok-Wing. My wife left your blog running on the computer so I thought I might add some comments on this topic :)

    Good news, HK Hospital Authority is getting my former boss, Shane Solomon, as its CE. He is a good man and knows what he is doing. He is very ethical and honest and extremely competent at running health systems.

    He is particularly an expert at demand diversion, meaning getting people out of hospital who don't need to be there: the old, who often have complex health problems but for whom regular admission to expensive hospitals is not the best option, people with problems that are more psycho-social than medical, and so on. This will leave time and space for those like your brother-in-law with acute medical conditions.

    Doctors will also find it better as most would rather work on genuine medical issues than act as counsellors or social workers.

    He will also be very good at getting money from your Financial Secretary, as he was very successful at getting the Victorian Treasury to cough up $HK billions more.

    HK also has a problem with drug prescribing - overuse, conflicts of interest, expensive brand names and so on, but I don't think this is for the HA to fix.

    Most of my colleagues at DHS are quite excited for you to get Shane Solomon, it means we must be doing something right if he is attracting attention like this.

    Best wishes for the recuperation of your brother-in-law

  11. 河國榮 says:

    hi Richard.

    > HK also has a problem with drug prescribing
    > overuse, conflicts of interest, expensive brand names and so on

    many doctors here prescribe too many varieties of drugs for common-day problems like the flu. unfortunately, most people here have come to expect more tablets in their doctor bags as they leave the clinic, and unfortunately again, many of the drugs prescribed by the average doctor here seem to be sub-standard; i.e., it can take many more than 7 days to recover.

    my doctor is very reliable. he's not cheap, but he's not too expensive either. he only prescribes the drugs necessary for the patient's problems and the drugs tend to work very quickly. when I came down with pneumonia last month, my symptoms were under control in less than 2 days, and the pneumonia was under control within a week. good medicine!

    in recent conversations with people from the HA, we heard that the hospitals are having problems recruiting nurses. people simply can't justify working as a nurse in the public hospitals because the hours and pay are not agreeable.

  12. Joan says:


    Hope Joe will be getting better very soon.

    All the best.

  13. Aggie Yip says:

    Hi, how's Joe situation recently???

  14. Aggie Yip says:

    Well, HK is facing very tough situation - staff have to work long hours, but receiving different salary package (some new doctors just received half salary when compared to those whose graduate 2 or 3 years earlier),heavy workload etc causing high turnover especially for those experienced professional, finally causing the HA have to spend more resources to recruit "new blood" and this circle keeps on happening.

    And I agree some doctor had prescribe too many un-necessary medicine, but I believe it was the custom(bad habit) of HK patient. Because pstient have to pay for consultation from their own pocket, so they believe that quantity of medicine (number of pills) is direct linked with the consultation fee especially when the fee is expensive. They just focus for the quantity rather than the effect of the medicine. If the doctor refuse to provide ton of medicine, probably he will lose the patient. Interesting huh ???

  15. Karl says:

    A Honkie in Melbourne
    Hi Gregory.
    It's my first post and I somehow feel obliged to do so. I have been reading your blog a while now. And I really give it to you when I last read an interview with you. You have got quite an Aussie spirit, don't you... Wonder whether you ever catch up with that other famouse Aussie Kim Robinson.
    Anyway, I am going for my specialist exam in ten days (wish me luck please...) so I will be brief.
    This is pure negligence and you should entertain the legal route. I feel for the doctors and nurses but I am simply aghast at the pure incompetence. We all make errors, but that's why we have consultants. I have NEVER heard of the use of an electric scalpel in doing a tracheostomy (the above procedure). It's pure incompetence - oxygen and sparks. I mean... doctors with full marks etc etc... with an IQ of ? We laugh of people who we knew are still smoking and we sometimes supply home oxygen for "palliative grounds" - in more ways than one - for their end stage lung disease... but this...

    I sincerely wish you well, and your brother in law. Such incompetence is laughable and makes me think twice whether I'd come back to work in HK. I'd hate to have to train upcoming imbeciles of that proportion. Regards.

  16. waisikgwai says:

    hi gregory,
    i hope that joe recovers without any permanent injury. but don't assume that the u.s. legal system provides much better redress. here in california, members of many health maintenance organizations (hmos) like kaiser permanente have no access to the courts. instead they are stuck with binding arbitration before arbitrators who are under pressure to favor the hmo to get repeat business. it's a rotten system that may not be any better than hk's.

  17. rou says:

    wow I didn't know u had a blog! you certainly aren't too old for that! well I know u, being a HKer myself, but didn't know u had bothered to put up a blog. It's er er quite nice really. And this piece I've just read was truely amazing. Bravo! Oh, I didn't know u were Aussie either - u looked English.

  18. rou says:

    Sorry about all that silly excitement about finding your blog, now that I've finished reading the whole piece (and others' comments too) I realize I've forgotten the most important thing, I'M VERY VERY SORRY. I really feel sorry for your brother, and wish he's well again. As for utter stupidity in our systems, I completely agree with you. If you could, PLEASE DELETE MY LAST COMMENT - I imagine I could be flamed to death because of that.

  19. 河國榮 says:

    Rou, don't worry about your previous comment. it's fine ;-)

    For The Record (ftr), Joe's doing fine. His mind is active, his body is catching up and he's trying to get back to work asap. more later...

  20. Dylan Sung says:

    Hi Gregory,

    I'm sorry to hear that your brother-in-law has been through a stroke, as my mother is still enduring the effects of one. She was hospitalised from October till February, and she has made a lot of progress since the first days with the gloomy prognosis. She's home with me now, able to speak a little, eat fairly well, albeit on a soft mashed food diet, but she has lost the strength in her back to physically get up, and her legs are weak. Time, that's the healer. The doctors here say that even after the blood clots dissipate, residual effects of the stroke will take a long time to heal. I wish him well, and our hearts go to his family.