He cares for the sickest patients

Dr Jonathan Tan, a senior consultant at Tan Tock Seng Hospital, relishes being a "multi-organ, multi-system" specialist.

Q I specialise in critical care medicine because...

A I enjoy the challenge of managing patients and situations where survival is dependent on quick decision-making skills and medical interventions.

Those early decisions do not merely dictate if the patient lives or dies, but how he lives or dies.

Q The human body is fascinating because...

A Despite medical advancements, there are aspects of the body that we still cannot fully explain.

It is why two brain trauma patients of similar age may have different outcomes: One wakes up after three days and, after two weeks, walks and talks again, while the other remains in a vegetative state.

Q One little-known fact about patients in the intensive care unit (ICU) is...

A Some can return to a quality of life that is meaningful and productive. We now have rehabilitation doctors and therapists who get certain patients to exercise even while they are on life-support machines, which helps them recover faster.

Q What I do is like being...

A The leader of a crack rapid response commando unit.

My team is called upon whenever there is a crisis and even if I don't know who or where the enemy is, I know someone will die if we don't succeed.

When the patient is stable but remains critically ill in the ICU, I switch gears and become a conductor of an orchestra where the musical piece is the patient. The sicker the patient, the more difficult the symphony.

Q A typical day for me starts...

A Before 8.30am with a handover from the on-call registrar working the night shift.

I lead the ward rounds in the ICU, speaking with the doctors who have sent their patients there and managing the allocation of beds for patients who are referred from other parts of the hospital.

During afternoon ward rounds at about 3.30pm, we review the treatments and investigations that were ordered earlier and make other treatment plans.

A significant part of my time is spent at family conferences, talking to patients' relatives and helping them understand and cope with what is often a sudden change in their loved ones' condition.

Q I come across all types of cases...

A Such as patients who are sent to the ICU with an illness or medical condition that may cause death or severe disability if treatment is not delivered promptly.

Even for stable patients, their conditions may change rapidly if a deterioration is not acted on immediately.

I recall a man in his 30s who suffered head injuries from an accident. It was so bad that everyone thought he would suffer from severe mental disabilities. Yet, a year later, he walked back into the ICU and was able to talk to people. In another case, we were heartbroken when a boy who drowned was resuscitated successfully in the emergency department, but was certified brain dead. He died a week later in the ICU.

Q I love patients who are...

A Motivated to resume life as soon as possible and those who have shared with their loved ones what their end-of-life expectations are.

Q Patients who get my goat are...

A Those who take no responsibility for their own health and well-being despite repeated serious and critical illnesses.

Q Things that put a smile on my face are...

A Seeing patients sitting on their beds or, even better, walking around the ICU in spite of being attached to their breathing machines.

Q It breaks my heart when...

A A patient suffers from a slow, lingering death, while hooked up to life-extending machines in the ICU.

Q My best tip...

A Live your life well and look after your health, so that you may never require the services of intensive care doctors, ever.

At the same time, think ahead about the quality of life that would be acceptable to you, should you suffer from a critical illness - and let your loved ones know about it.

Bio Box


Age: 42

Occupation: Senior consultant at the department of anaesthesiology, intensive care and pain medicine at Tan Tock Seng Hospital As a medical student, Dr Tan shadowed an anaesthesiologist in the hospital and saw how indispensable she was whenever patients became very sick.

This group of doctors - who were often intensive care specialists - were called on during life-threatening situations, such as when patients suffer from heart failure, respiratory arrest or a major stroke.

Now, he relishes being a ''multi-organ, multi system'' specialist. But more than just saving lives, he also works to ensure that those in their final stages of life are given a dignified and comfortable stay.

His 41- year-old wife works in marketing and branding for an IT firm. They have no children.

This article was first published on Aug 11, 2015.
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