When her mother was due to undergo surgery, one woman was counting on Singapore’s world-class healthcare system to handle everything properly. However, the frustrating medical journey ended up tragically as her mother died just a few days after a surgery that purportedly went well.
Within less than 10 days after being admitted for a medical review, Ms Esther Lim had to grapple with her mother’s death following a pneumonia infection—though without the usual symptoms of fever or cough—just 24 hours prior to that fateful moment.
Ms Lim’s mother, aged 81, was due for a medical review at Singapore General Hospital (SGH) on 24 October 2019 for a thoracic spine cord compression diagnosed in August. Since then, a doctor in the general had noted that her mother’s weak legs was due to ageing, said Ms Lim.
At the time, she was told that there was no urgency for any operation. Instead, her mother could go for rehabilitation or physical therapy instead, and only consider an operation in three to six months.
This review was actually brought forward to September instead after the elder Mdm Hay’s condition deteriorated following a fall at home, according to Ms Lim. Though the SGH said in its letter in response to Ms Lim’s later complaint that the review was brought forward on request of the family due to Mdm Hay’s weakening condition.
The letter also outline Mdm Hay’s underlying medical conditions such as high blood pressure, high blood cholesterol, diabetes, chronic kidney disease, subdural haematoma and meningioma.
So on 10 September, Mdm Hay was admitted into SGH for her second MRI scan—the first done in August 2019—in preparation for a procedure which was scheduled for 12 September. A young doctor, Dr Ang, had informed the family that urgent operations were needed.
As required, Mdm Hay fasted before the procedure. Unfortunately, a nurse had mistakenly administered the wrong medication, meaning that the operation had to be pushed back for the next 48 hours, “as advised”, claims Ms Lim.
According to Ms Lim’s account, the operation was then rescheduled for 8am in the morning of 13 September – decidedly well within the 48 hour period since the last time Mdm Hay took her medication. But there were clearly problems even then as the operation kept being postponed to make way for more “urgent” cases, said Ms Lim, adding that her mother had to fast the entire time.
Finally, she was given some food at 1pm on 13 September, and the nurse informed the family that the time of the operation remained unconfirmed.
Ms Lim noted that the family was left hanging right up until 8pm that day and Mdm Hay was eventually wheeled into an operating theatre at 10.30pm.
But rather than getting the operation immediately as she expected, Mdm Hay had to wait another two hours before the operation began. She was in the operating room alone the whole time and told her family that she was “terrified and nervous” about the operation.
SGH confirmed in its letter that the operation eventually happened at 12.40am on 14 September, adding that it was completed “uneventfully” at 5am when she was then placed in the High Dependency Unit (HDU).
When she went to visit her mother the next day, Ms Lim said was told by the doctor in charge of the case that the operation was very successful with 8 screws having been inserted. This was different to the initial 4 screws they were told it would be, she recounted.
Now, post-surgery, Ms Lim recalled that the doctor said Mdm Hay could be transferred to a normal ward the next day. However, Mdm Hay insisted on remaining in the High Dependency ward until she was fully recovered as she was still in so much pain from the surgery.
At this point, Ms Lim noted several concerning observations about how the hospital and nurses cared for her recovering mother.
First was that her mother was given brown rice for a meal even though she was supposed to be on a soft food diet. After voicing this out, the nurse then brought in porridge instead.
The other concern was how rough the nurses were when changing Mdm Hay’s clothes. Ms Lim recalled her mother telling her that they kept rubbing against her operation wounds, and that the pain was so terrible that she refused to change clothes. The nurses ignored her, however, and kept changing her clothes despite protests.
To this, SGH simply said that “Mdm Hay did not report pain when the nursing team changed her clothes and carried out bed sponging.”
Ms Lim had also observed a nurse coming to take blood but was unsuccessful, which caused her mother a lot of pain.
The next day, Ms Lim visited her mother again and tried to feed her some soup. But at this point, Mdm Hay said she had no appetite. She did manage some spoonful of porridge for lunch. The nurse had also checked Mdm Hay’s temperature and said that there was no fever, which was a good sign, said Ms Lim.
At this point, the doctor had once again tried to convince Mdm Hay to move to a regular ward. She still refused, said Ms Lim.
Here, SGH recounts in its letter a series of bowel related issues that Mdm Hay was apparently experiencing, including constipation for which she was prescribed laxatives.
Just two days after her operation—which was successful and she seemed to be recovering well—the family was informed by SGH that Mdm Hay’s oxygen levels had fallen drastically by half, said Ms Lim.
Ms Lim rushed over to the hospital that morning around 8am to see her mother. However, she found that her mother wasn’t in the ward. The neighbouring patient in the ward told her that many people attended to Mdm Hay around midnight.
After asking the nurses, Ms Lim was informed that her mother was taken to an urgent CT scan. She was also transferred to a different ward. Ms Lim made her way there.
SGH noted in its letter that Mdm Hay’s oxygen level had dropped “suddenly” around 12.27am on 16 September. She was given oxygen supplements. The hospital said there were also crackling sounds in Mdm Hay’s lungs and that her abdomen was distended.
She was referred to the Surgical ICU team and the General Surgery team for these conditions. The letter notes, “By then, Mdm Hay did not have signs and symptoms such as fever to suggest severe systemic infection but was possibly aspiration in the lungs.”
Ultimately, the hospital performed several more tests and procedures to deal with these issues including a plan to order an abdominal x-ray, carry out chest physiotherapy, chest, abdomen and pelvic CT scans, and more.
Ms Lim then recalled seeing her mother when she woke up, noting that Mdm Hay was thirsty and requested water but the nurse refused, only allowing dips of water onto the lips. She had to settle for offering her mother a soaked piece of cotton, she said.
On the morning of 16 September, SGH said that Mdm Hay had developed a fever and was subsequently referred to the infectious diseases specialist who, after some tests, diagnosed her with pneumonia and prescribed a broad spectrum of antibiotics.
Ms Lim says that the family was informed around 3.30pm by the doctor that Mdm Hay had contracted pneumonia and would need antibiotics, as well as further observation over the next 24 to 48 hours.
Ms Lim recalled that there were also several “procedures” conducted from then till about 5pm, thought she wasn’t allowed in the room while those were carried out.
A colon specialist was also assigned to brief the family – her job was to confirm if the Mdm Hay had an infection in her colon, as an operation would be required if it was. An endoscopy later confirmed that there was no infection.
Mdm Hay was then sent to the ICU for 24 hours of monitoring.
Things took a fatal turn the next day on 17 September when the family was informed that Mdm Hay’s condition had deteriorated. They then put her on new antibiotics.
According to SGH, Mdm Hay “remained very ill with septic shock” and that her condition continued to deteriorate, as she also started suffering from hypoxaemia “despite ventilation and maximum treatment”.
On this day, Ms Lim had visited her mother again in the morning and was shocked to find her mother lying face down on the bed, her face completely buried and unsupported. The hospital, in its letter, described this as a “prone position” in order to improve oxygenation.
When asked about this, the nurse on duty told Ms Lim that Mdm Hay was on 100 percent oxygen and not breathing on her own. Unsatisfied by that answer, Ms Lim requested for her mother’s head to be supported and tilted to a more comfortable position.
SGH explained this positioning as “part of the usual treatment for patients with severe hypoxaemia” and that their nurses were “extremely familiar” with the technique. Noting the family’s concern over the sight, SGH added that a headrest pillow was initially used to support Mdm Hay’s head but that was later swapped out for rolled towel “for better positioning”.
The hospital also noted that the nurses repositioned Mdm Hay’s head and limbs every two hours to relief pressure and that Mdm Hay’s head was not in direct contact with the bed, reassuring the family that “appropriate measures were taken to minimise harm to Mdm Hay when she was nursed in a prone position.”
At this point of questioning Mdm Hay’s positioning, Ms Lim said that the nurse asked her to leave and told her that ICU visiting hours would be at 12 noon. This, of course, was inaccurate. Ms Lim later learned that there was no time restriction on visiting hours at the ICU, only that it was limited to two persons at a time. Ms Lim was there alone at the time, so she later wondered why she was chased out of the room.
At the time, Ms Lim decided to stick around. About an hour later around 8.30am, Ms Lim snuck back into the ICU but was told that she had to wait outside because some procedures were being done.
At 10.30AM when she was finally able to go back into the room, she saw that a sponge cushion had been placed to prop up her mother’s face from the bed.
Ms Lim recalled that the nurse then said that the doctor wanted to meet the family for a briefing around 4pm. The family insisted on an earlier meeting given Mdm Hay’s critical condition, so they met at 2PM, instead.
To this, SGH said the primary team doctor had requested for a meeting anytime before 4pm. It added, “Mdm Hay’s clinical deterioration was rapid and may have overtaken any anticipated arrangements by the team who were arranging the family meeting”.
“We apologise if this have led to any misunderstanding,” it added.
At the meeting, Ms Lim said the doctor told the family that the Mdm Hay would not make it and had little time to live due to a “too fast” virus infection.
Mdm Hay died that day around 3pm.
Complaint to SGH
Following this harrowing chain of events and highly stressful few days, Ms Lim wrote in an official complaint to SGH on 30 September 2019. SGH replied with a letter on 29 November 2019 explaining its version of evens – which we’ve recounted above in tandem with Ms Lim’s recollection.
Not satisfied, Ms Lim followed up with more questions and clarifications, requesting further clarifications on the procedures that were done and the rapid deteriorating of Mdm Hay’s condition even after the doctor said she was recovering well. She also disputed the hospital’s claim that the nurses has acted professionally. Ms Lim had threatened legal action against the hospital.
This follow up prompted a meeting between the hospital and the family scheduled for 30 January 2020. However, Ms Lim recounted that the meeting was later cancelled but she was not informed until she called the hospital to find out the venue and time.
A meeting was eventually held on 29 November 2020, though without any conclusion, says Ms Lim, adding that it was “mainly for SGH to close their file.”
TOC reached out to SGH for their comments on the matter.
The hospital said: “We had arranged a family meeting with the medical team in Nov 2020 as the family has further concerns despite our detailed written explanation dated 29 Nov 2019.
“Out of respect to the family, we are unable to share details of the meeting.”
Ms Lim told TOC that she recalled SGH saying during the meeting that Mdm Hay’s cause of death was certified by a coroner to be “pneumonia” and that they were puzzled as well as to why her condition deteriorated so fast after being transferred to the ICU.
As to the question of how the nurses cared for Ms Lim—such as laying her face down on the bed with nothing to prop her head up, and a nurse saying that ICU visiting hours only started at 12 noon—SGH apparently said that their nurses were very professional and followed SGH guidelines.
They explained, as they did in their letter, that the patients were turned every hour and that the nurses ensured that patients were places in the most comfortable position.
About the ICU visiting hours, SGH just said that it could have been a “miscommunication”.
Overcome with anger, Ms Lim said she walked out of the meeting halfway through, unable to listen anymore to SGH’s rationalisation of the events.
On the issue of expediting the request a medical report, Ms Lim said that this took a long time as well since the hospital requested not only for all Mdm Hay’s children to submit their birth certificates and NRIC, but also for the dead certificate of Ms Lim’s father who had passed away 37 years ago.
Eventually, the medical report was received on 9 December 2020, more than two month after it was requested.
As described by Ms Lim, the two paged report was drafted by the young doctor who operated on her mother and advised the family that she was “well” enough to be discharged.
TOC reached out to SGH for further comments on Ms Lim’s detailing of the family meeting but have yet to receive a response.