The ICU Doctor Fighting for Critically Ill Patients
– Dr. Niwan Klinngam –
The First Steps
“It was difficult to adjust to life in the city. I was a top student from the provinces, achieving good grades, but when I came to study medicine and met the city kids, I felt insignificant.”
Phetchaburi Province is Dr. Niwan’s hometown. She was a highly active student, often standing at the flagpole, representing her school in various competitions, and ultimately becoming the student president. She grew up in an educational environment where her father was the President of Phetchaburi Rajabhat University and her mother was a lecturer at the same institution. However, the crucial lesson her parents instilled in her from a young age was ‘humility and modesty’.
“My parents taught me to speak to labourers and housekeepers with respect, to greet them with a ‘wai’ and address them as ‘Uncle’ or ‘Auntie’. This made me feel no different, not like I was special for being a professor’s child. They didn’t allow me to buy new things, encouraging me to use hand-me-downs. If something was broken, they taught me to fix it, always pushing me to be thrifty.”
“Can an expensive car fly? That was a frequent question from my parents. So, I grew up feeling that the price of things wasn’t important. To this day, I don’t use branded items; I don’t feel they make a difference.”
Becoming a Doctor
Whilst the path for a top student from the provinces in that era often led to becoming a doctor or an engineer, a trial internship at Siriraj Hospital made Miss Niwan realise that helping people brought her ‘happiness’. She was then selected for one of the first batches of the Rural Doctor Project at Chulalongkorn University’s Faculty of Medicine, embarking on a major adjustment in a new society far from home.
“Previously, I always got grade A. In my first year of university, I once got a C, and I was heartbroken, crying, wondering if I could handle being a doctor. After that, I re-evaluated and slowly adjusted. In the end, I graduated with a First-Class Honours degree, just as I had intended.”
Upon graduation, Dr. Niwan returned to serve in her hometown, as per the terms of the Rural Doctor Project. Phetchaburi is a province adjacent to Hua Hin beach and boasts the famous Cha-Am beach resort. However, further inland, minority groups live in remote mountains. Mobile medical units were the only hope for these villagers to access treatment. Dr. Niwan joined these volunteer units every year she was stationed in Phetchaburi.
“We saw their faces and their eyes, and we felt that the villagers were truly waiting for us to arrive. When we went, we could help them. It brought me happiness.“
“I was still a doctor when Her Royal Highness Princess Galyani Vadhana Krom Luang Naradhiwas Rajanagarindra arrived by helicopter to observe. I even had the opportunity to take a photo with Her Royal Highness. It was a great joy for a small doctor like me.”
In truth, Dr. Niwan wanted to return to work in her hometown to repay her debt to the land, in line with the Rural Doctor Project that had provided her with the opportunity to study. She wished to be a small part of increasing access to medical care for people in remote areas. However, due to family limitations and the fact that the specialised medical positions she was interested in pursuing further studies for were not offered with scholarships from hospitals in her hometown, she ultimately had to decide to resign from government service to pursue her desired specialisation with her own funds. Nevertheless, she continues to provide academic assistance to hospitals in Phetchaburi Province, fulfilling her original intention as a ‘rural doctor’.
Alongside Critically Ill Patients
“At that time, I attended a lecture by Associate Professor Dr. Chanchai Sittipunt and felt that he made difficult subjects seem so easy. Listening to that lecture felt like a ‘unlocking’ of doubts in my mind, making me confident that I could pursue a specialisation in Internal Medicine. I saw him as a role model and wanted to learn from him and be able to teach as skillfully as he did.”
Dr. Niwan enjoyed overseeing the overall care of patients, so she pursued a specialisation in Internal Medicine after completing her rural service. However, during that time, her grandfather suddenly fell ill with heart failure and required a ventilator. As a doctor, she felt helpless, unable to assist him. This became a significant reason for her decision to specialise in pulmonary and respiratory diseases and critical care.
“At that time, it felt like I still didn’t have enough knowledge. I felt like I should have been able to do better.”
Ultimately, her grandfather passed away, leaving her with many unresolved questions and mixed emotions, both as a doctor and as someone who had lost a family member. After that day, it became a turning point and a strong motivation for her to study more deeply, and she discovered that beyond treating diseases, understanding the patient and their family is the true heart of treatment.
“If you want to make everything better, you have to learn it and do it yourself.”
Even though almost every hospital has an ICU, there are very few critical care specialists across the country. Only about 20 doctors graduate from this field each year. Their work involves overseeing everything, like residents in the ICU. They are the ones who must see the overall picture of the patient, constantly assess, monitor, and gather problems from every system to present to the specialists. In many hospitals, specialists from each system care for critically ill patients themselves, without a dedicated ICU doctor.
For BNH Hospital’s ICU, Dr. Niwan became the pioneer, establishing and setting up the ICU’s workflow to accommodate critically ill patients to the standards of a medical school.
“When I first arrived about eight years ago, the ICU here had almost nothing. It could only handle less severe cases. Creating change here was a huge challenge. Firstly, the equipment had to be up-to-date, supporting complex treatments. Secondly, the personnel had to be skilled, alert, and willing to learn with us. We had to teach the nurses to have the knowledge to care for increasingly difficult and complex critical patients. They had to constantly monitor and care for patients to a high standard.”
“Now we have more equipment. We can perform heart and lung surgeries. We can use artificial lung and heart support machines. We have comprehensive systems. If there’s new equipment we’re interested in, we can propose it to the hospital for readiness without waiting for a case first, and establish it as a system.”
Beyond modern equipment, personnel development in the ICU is a top priority for the hospital because it is an area requiring high skills and constant alertness for the best patient care.
With BNH Hospital’s open policy on treatment, the development and adoption of new technologies for the maximum benefit of patients can be conveniently carried out due to its status as a private organisation. At the same time, it also grants doctors the freedom to treat patients comfortably, without being bound by business conditions. Even if patients sometimes face financial difficulties, the hospital provides full treatment first, and other problems are then jointly resolved with the patient.
Half of the critical patients Dr. Niwan encounters are foreigners who experience unexpected events in Thailand and are unaware of healthcare facilities, thus choosing to be treated at BNH Hospital, which is well-known among foreigners.
“Some people don’t have travel insurance. We try to contact their embassy, relatives, or the company they work for in Thailand, depending on their entry conditions. The important thing that makes working here enjoyable is that BNH Hospital provides full standard treatment first, regardless of who the patient is. Other matters are dealt with later. This policy allows doctors like us to work to our fullest without anyone forcing us to manage things in a certain way. This isn’t a new issue; it happens occasionally, and the hospital has well-established procedures for handling it.”
Caring for Patients in Their Final Stages
Critical care medicine partly involves fighting every possible way to alleviate a patient’s critical condition. But another part is caring for patients in their final stages to ensure they pass away peacefully and with the utmost dignity, or Palliative Care. This care extends not only to the patient but also to their loved ones who are grieving their departure.
“One thing I always consider, apart from the patient, is not letting relatives feel guilty about palliative care, because that will stay with them for life. We have to explain it to them, for example, withdrawing unnecessary treatment when treatment is no longer progressing. It allows the patient to pass away peacefully and naturally with dignity. If a patient wishes to return home for their final stage, they must be in a state of no suffering, like simply falling asleep, and the family must be able to accept that condition. Because for some, dying at home might be a deeply imprinted image. So, we have to look at the overall picture, for both those who remain and those who depart.”
“But sometimes, I feel sad, I want to cry, but I have to try to regain my composure because I am leading the treatment. If I cry, I can’t make everything proceed to the desired stage. There are cases where we fight and don’t succeed. I try to tell myself that I did my best. For terminal cases, I usually feel emotionally involved at that moment, but in the end, I know we did everything to allow the patient to pass beautifully according to their wishes.”
COVID and a Pregnant Doctor
“At that time, I was pregnant, and COVID was spreading.”
The COVID-19 pandemic in 2021 was a major challenge for the medical community worldwide, both in terms of treatment and self-protection from an emerging disease that no one fully understood. Many patients came to BNH Hospital. The hospital had to quickly build negative pressure rooms within two weeks to accommodate COVID patients, including outpatients, inpatients, and ICU patients, to prevent them from spreading the infection to regular patients, and to create separate areas in the hospital to accommodate patients with other diseases. Dr. Niwan, as a respiratory and critical care physician directly involved, played a crucial role in managing the epidemic alongside several other doctors, including infectious disease specialists and nephrologists.
“During that time, we tried to work as a team to plan medicine allocation. BNH Hospital provided full medication without limiting whether patients had to pay or not. During COVID, some patients were in the ICU for 3-4 months, but during that period, no one in our hospital died.“
And for Dr. Niwan, the beginning of the pandemic crisis coincided with her being heavily pregnant, close to her due date. When she returned after giving birth, it was during the peak of the Delta variant outbreak. Dr. Niwan had to wear a mask constantly, no matter where she was, to ensure no one in her family contracted the virus from her work.
“Every time I got swabbed, I was constantly anxious. At the hospital, I would wear a mask all the time. I wouldn’t eat with anyone. When I got home, I’d rush to shower and change. I wasn’t afraid of getting COVID myself, but what I feared was passing it on to my child. But to this day, my child hasn’t caught it, and I hope they have strong immunity.”
That X-ray Film
Dr. Niwan is a respiratory doctor who is deeply involved in examining patients’ chest X-ray films. On a normal film, you see ribs, lungs, and heart. But one particular film had something different.
“Will you marry me?”
That was the message imprinted on her husband’s chest X-ray film on their wedding proposal day. From high school classmates to university sweethearts, they had gone their separate ways to grow in their own careers before their paths converged again when both were ready to build a life together.
But for a doctor who must care for critically ill patients, where anything can happen suddenly, Dr. Niwan cannot always prioritise her family. She must be constantly prepared for changes in her patients. Almost every day, she has to go to the hospital. Sometimes she has to disappear from home late at night to intubate patients and adjust ventilators. Sometimes she has to disappear on weekends to see patients, and sometimes she cannot shake off the sadness of losing a patient she has cared for for a long time.
“When we remove a breathing tube and I come home, my child asks, ‘How is Mummy’s patient? Are they better after taking out the breathing tube?’ When we go on vacation, my child asks, ‘Who’s looking after Mummy’s patient?’ I tell them I’ve entrusted another doctor to help look after them, and they’re okay with that and can enjoy the trip.”
“My husband understands. He’s seen me for a long time, ever since we were dating. If I’m worried about certain cases, he’ll encourage me that I’ve done my best. He invites me to go to the temple, make merit, do something relaxing.”
Because of her family’s understanding, which extends to her patients, Dr. Niwan has the energy to dedicate herself to her work. The remaining time is given to her family to build bonds and instill empathy in her two young children, allowing them to understand the important role of a doctor.
“No matter how tired I am from work, when I go home, I have to play and sleep with them. I have to care for them during the time they need me. I try to spend as much time as possible during their childhood. My children are starting to understand what I have to do. I try to tell them and recount to them how patients got better because they allowed their mother to go to work, to perform her duties as a doctor. So, they feel they have a part in caring. They are caring and attentive and don’t feel that their time is being taken away. I’m happy that my children understand.”
A young girl who grew up in the provinces, lived a simple life, chose a path that inevitably confronts loss every day, and continues to teach the next generation empathy and compassion that enriches the world. Dr. Niwan may not be able to stop the course of nature in every case, but in every second she cares for a patient, she will do everything to provide them with the very best.
“We view the patient who comes to us as a person, with a mind and feelings, simply experiencing the physical suffering of illness that leads to mental distress. We don’t just look at the disease. We see them as our relatives. We feel attentive in caring for them, trying to devote everything we can to help them recover. We don’t want anyone to remember us, but rather to see what we do, understand what we do. They will then know that we are dedicated to caring for our patients, dedicated to caring for their families, and we want them to recover and return home happily, as much as one doctor can do.”
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NIWAN KLINNGAM, M.D.
พญ. นิวัน กลิ่นงาม
Speciality
Internal Medicine
Pulmonary Medicine and Pulmonary Critical Care
Critical Care Medicine
Education
Medical Degree, Doctor of Medicine, Chulalongkorn University, Thailand
Board and Sub board Certification
Thai Medical Council, Pulmonary Medicine and Pulmonary Critical Care, Chulalongkorn University
Thai Medical Council, Internal Medicine, Chulalongkorn University
Certificate
BDMS Bylaws, BDMS, Thailand
Code of behavior (TH), BDMS, Thailand
Language
English
Thai
Gender
Female
Schedule
Internal Medicine Department
| Day | Time |
|---|---|
| Monday | 14:30 - 15:00 |
| Tuesday | - |
| Wednesday | 12:00 - 16:00 |
| Thursday | 10:00 - 16:00 |
| Friday | 10:00 - 12:00 |
| Saturday | - |
| Sunday | - |
This is the doctor's regular weekly schedule. Actual availability may vary — please confirm the available date and time when you make an appointment.