99-day struggle in the ICU

Housewife endures long hospital stay due to complications from a fall. Joan Chew reports

ST 20150528 ICU 

Madam Premavathi John (right), 70, with her son Jeyantheran Amurthalingam, 44.
Mr Jeyantheran called all seven of his mother’s siblings when her condition took
a turn for the worse in October last year.


The Straits Times (28 May 2015) - In early October last year, Madam Premavathi John’s festive shopping in Little India was cut short when she tripped and fell. For the next two days, the 70-year-old housewife complained of breathlessness and difficulty in swallowing.

Little did she know that this was the start of a gruelling 99-day battle in an intensive care unit (ICU) at Tan Tock Seng Hospital (TTSH) – putting her among the top five long-stayers at the hospital’s surgical ICU, said its director, Dr Jonathan Tan.


When Madam Premavathi did not get better, her granddaughter took her to TTSH, where an X-ray scan showed that the pharyngeal tissues in her throat and neck had swelled up.

Associate Professor Siow Jin Keat, a senior consultant at TTSH’s department of otorhinolaryngology, suspected the elderly woman might have a haematoma – a swelling of clotted blood from an injury.

Prof Siow thought pus might have gathered in her neck because of it. She was put on antibiotics, and underwent a procedure on Oct 14 last year to drain the pus and bacteria from the right side of her neck.

When she continued to languish, she had another operation, this time to drain the left side of her neck. Pus had also tracked down into her chest.

Prof Siow could not cut through Madam Premavathi’s chest to drain it because of scar tissue from a previous surgery, so he inserted a tube into her chest through her neck.

At that time, Madam Premavathi faced more than a 50 per cent chance of dying from septic shock if pus and bacteria entered her bloodstream.

Mr Jeyantheran Amurthalingam, the youngest of her three children, said he was “scared stiff” when her condition took a turn for the worse a day after Deepavali, on Oct 23.

He called all seven of his mother’s siblings, who expected the worst when they went to hospital to see her. By then, she had been in the ICU for close to three weeks.

She had to be fed through a tube, breathe through a ventilator, receive drugs to support her blood pressure and was on continuous renal replacement therapy, a type of dialysis for very sick patients.

Dr Tan, who is also a senior consultant at the department of anaesthesiology, intensive care and pain medicine, said she would have died within minutes to hours without one of those supports.

He recalled: “At her sickest, she was on the strongest antibiotics we have in the world today.”


There were other problems, too. From lying down and being so sick, Madam Premavathi developed pneumonia, which also had to be treated with antibiotics. She also had a build-up of fluid between the layers of tissue that line the lungs and chest cavity, which had to be drained through a chest tube.

Dr Tan said her recovery was slow, and the bulk of her ICU stay was to wean her off the ventilator.

“Some days, she could be off the ventilator for hours while on other days, she would be too tired to breathe on her own.”

She was started on simple exercises as soon as possible, from just sitting up on the bed to standing beside it. Soon, she was marching on the spot, recalled Dr Tan, and was able to walk around while still attached to the ventilator.

Dr Tan said he was there for every “big walk” she took outside the ICU, where she would bargain with him about the number of steps she had to take. “I had to personally escort her and practically ordered her to walk with me,” he said with a laugh.

Late last month, Madam Premavathi had an operation to place a flexible feeding tube into her stomach as she still cannot eat and drink through her mouth. She was finally discharged on April 29.

Last month, she told Mind Your Body about the things she wanted to do when she is back home: cook fish curry and bake pineapple tarts for her family and hug her three-year-old grandson.

She has forgotten the worst of the dark days when she was close to death.

But she has not forgotten her promise to Dr Tan to treat him to “the world’s best chicken briyani”.

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Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.