My thoughts on something

Packing for a long overdue backpacking trip :)

Again, what to pack? Just cut down half the clothes and double the cash hahaha...

London, Paris here I come. No blogs for the next 2 weeks.

Managed to get up close and personal with the Olympic Torch thanks to an ex-Malaysian Olympian. A bona fide torch which he ran with, during the Malaysian torch run. Each runner can keep their torch.

The torch is made of metal in the upper half and plastic in the bottom half. And there is a keyhole at the back which requires a key to 'activate' the torch before it can be lighted!

And my new lens is fantastic :)

The top

Inside the torch2

Inside the torch

Keyhole in the torch

The torch

The torch box

Torch box

Who's the Olympian?

Was on-call with a Medical Officer recently and she updated her facebook with this ;

" will throw her phone if it rings again about some bloody bastard who wants to leave the hospital to sign some stupid document with his *ucking lawyer "

Here's her blog. For those readers with a low tolerance with word that rhymes with LUCK, a word of advice - brace yourselves hahahahaha.

Which brings to mind a rather outdated procedure in the hospital. Any patient who abscond from hospital will be reported to the police (Yeah, and what will the police do about it?). Any patient who wants to leave or be discharged from the hospital will need to sign the "Against Medical Advice" or "At Own Risk" form and countersigned by a doctor of the ward. Perhaps reporting the absconding patient with public health interest (infectious disease, psychiatric patients, medico-legal cases etc) to the police is understandable but for other reasons it's rather pointless. For example those patients with heart failure or poorly controlled diabetes who abscond because they feel they are fine.

Reminds me of ONE tuberculosis patient in the US not too long ago who absconded across the Atlantic and was pursued relentlessly by the police till he was caught. We have a Multi Drug Resistant tuberculosis patient (as far as I personally know) running around the state without any problems, not to mention the NUMEROUS active tuberculosis patients who are assimilated with the public without problems too.

Back to the topic, I truly believe patients are responsible for their own health. Many times, relatives force the patient to be admitted against his will and then not surprisingly the patient will ask for a AOR discharge ASAP which irritates everyone to their limit. I mean if you don't want to be admitted just say so!!! Don't get yourself admitted to avoid argument but the moment your "relatives" leave, you ask for a discharge. Does anybody realize the amount of work that is involved (plus paperwork) if you are admitted and then discharged after an hour ? Not to mention wasting bed space (and preventing other people from being admitted), wasting tons of papers, wasting water and detergents to wash your bedsheet (which was used for an hour) plus lots of other nursing work? This is blatant abuse of a public facility and people like that should be penalized severely.

Another version of the same thing is patients who want to leave the hospital to settle some personal stuffs - seeing his lawyer, going to the bank, visit their "relatives", sign some documents, even to do BUSINESS!!! - some mega businessman he is ! These patients like to walk in and out of the hospital at their whim and fancy.

I say whoever walks out of the hospital consider it an AOR discharge immediately without hesitation. No need signatures or anything. And patients who walk out cannot be readmitted again to the same hospital for say 72 hours. Since they are well enough to walk out they must be fine. Don't bloody waste our time which can be used more productively with patients who actually wants treatment. And whoever who wants to leave, just open the doors to them on the condition they cannot be readmitted to the same hospital again for 72 hours.

Problem solved.

Our foreign minister is proposing that ALL FEMALES travelling alone out of the country needs a letter from parents or employers....Haah can you repeat that? Check out in NST

Why penalize a few million women in M'sia (don't know how many women there is in the country) because 107 women ( 90% of 119 ) got caught for drug trafficking? It's always the easy way out - penalize the law abiding citizens while the criminals get away scot free. And how sure are you that these women are duped or forced to be mules?

Using the same logic, may I propose that everyone be allowed to carry firearms to protect oneself from being murdered?
Or that all men get castrated in case they turn into rapist?
Or that all motorcycles be banned because of some mat rempits? Or even all cars be banned because some of the drivers cause accidents?
Hmm...or even chop off everybody's hands so that nobody can steal...

What a stupid proposal. Not to mention it's an infringement of human rights. Why should I need anybody's consent if I want to travel out of the country?

Recently was on call, saw the numerous patients who are/were being artificially ventilated for various reasons. Among the reasons were inoperable metastatic lung cancer, liver failure with cirrhosis, progressive/untreatable lung disease and hypoxic brain damage.Their prognosis is worst than dismal at best. I really don't know if the patients really want to go like this. Is this really how they want to be "treated" or to leave this world? In any case they have no choice - not over here. Are we "treating" their family members rather than the patients? The world is a stage...

What would the patients say if they can or are allowed to make their own decisions? In any case, it would be over-ruled by the family members on the premise that the patient is not mentally alert or in right frame of mind to make that decision. Who wants to have a heated argument with the family members of a DYING patient? And with the sequelae that follows...

The best way is to have a living will - a legally binding document which cannot be over-ruled by the family members. To state how they want to be treated if they have a terminal/life threatening condition. Alas this is a very alien concept here. In any case, any living will has to be voluntarily produced by the family member or a legal officer - which may be with-held or destroyed too.

It is very disconcerting to see terminal dying patients having tubes shoved into their lungs, their stomach and urinary tract. And members of the public/relatives ( who can tell who is who? ) going in and out of the ward, peaking here and there - like watching a bloody blockbuster movie. And they love seeing CPR being done - like it's an entertainment show. The healthcare personnel will appear "uncompassionate" if they ask the "relatives/visitors" to leave to attend to/ resuscitate the patient. Some of the healthcare personnel are harassed and scolded by these relatives too. And like Murphy's law, these patients WILL deteriorate during visiting hours when the ward is like a fish market. Some visitors will just REFUSE to leave because they say IT'S THEIR RIGHT TO BE THERE DURING VISITING HOURS. And they will just stand around looking at the "drama" involving other patients. Bloody B***tards !!

So are you going to stand there arguing with the visitors or resuscitate the patient? Your choice.

Ventilated patients gasping for their breath, sedated or even already unconscious are being poked daily for bloods, their every bodily functions being "taken care of" artificially. Swollen limbs, bed sores, bruises, haematomas everywhere. Faecal smell permeates the whole ward every time a pampers is changed. Until the patient's heart finally stop, inevitably.

Is this how you want to die?

If I have no realistic chance of a meaningful life,
Please spare me the indignity of a prolonged painful death,
Kindly do not shove tubes down my every orifice,
Please do not inflict more pain by poking me daily for bloods,
And above all, do not hook me up to a machine while I die.

With the fantastic weather today, I attempted to capture some shots of the green parrots at the beach again. Alas, they flew pretty high and beyond the range of my zoom (beyond 400mm on a 35mm format!). Anyway managed to get some shots with my new Canon 55-250mm IS lens :) There's something about sunset at the beach which is so calming and rejuvenating... ;)

Sunset at the beach

Parrots up high

What does this nest houses?

Kingfisher

Eating some leaves

After their goldfish died time and again in the puny round fish bowl without aeration, my nurses asked me to get some fishes for the ward. So one fine day I went to the day market and bought some fishes for the ward.

From my childhood experience of rearing numerous fishes, from the "longkang" fish to the fighting fish (bettas) to the  discus, by trial and error I discovered that some fishes are just too delicate. The usual goldfishes are particularly quite fussy (not the black variety though). They need the right temperature, the right pH etc and particularly aeration from the bubbles.

So I thought - forget it. Goldfishes won't survive the ward. I thought hard....and finally got a pair of "ikan sepat" (snakeskin gourami, Trichogaster  pectoralis - I googled it, not  from memory hehe) and a pair of "ikan haruan" (snakehead fish, channa striata ) - I think it's haruan. Hah ! These fishes are hardy and won't die. They have special organs to breathe oxygen from atmospheric air and therefore do not require aeration. As long as the tank has water, they will survive hehe. So far they have settled in their bigger plastic tank which I bought too.

Here's the new addition to the ward. Let's see how long they will survive hahaha.

New patients

In my practising experience, this term is a rather foreign term here.

Example 1:

An extremely ill elderly lady has end-stage kidney disease. She will succumb in days, weeks or maybe months if renal replacement treatment is not instituted. She is old and frail. Dialysis carries a significant mortality risk for her. She declined any dialysis despite proper explanation ( to reasons only known to her ). She was ready to leave this world. BUT...her relatives (including children) somehow insisted she must get dialysis and managed to "persuade" her to have the dialysis against her wishes. So she underwent a risky procedure and was dialysed. She developed multiple complications and was artificially ventilated. She is now on tracheostomy (a tube into the windpipe) for breathing. She developed severe pneumonia and will probably succumb to it soon. Now she is just lying there, apathetic to her surroundings and would allow anybody to poke her, prick her, dialyse her, feed her etc. She just lies there gasping...doesn't speak nor move, staring at the ceiling, oblivious to her surrondings. Only god knows what is running through her mind.

But probably her relatives will be satisfied with the "heroic effort". After all we've done "everything possible" to "save" her. Patient's rights? What's that? After all, as I've said before a dead patient cannot speak for you but a living relative can certainly create hell for you.

Questions like "Why the doctors didn't do anything to "save" her?" or "I will lodge a complain/sue you if you don't dialyse her and she dies" can be expected from relatives.

Example 2 :

Again an elderly bed bound frail lady with multiple co-morbidities including previous stroke has chronic lung disease with failing lungs due to disease progression which is basically untreatable. She is unable to breathe properly to keep herself well oxygenated. She was previously artificially ventilated before and was not fully conscious any longer. Her VIP politician son THROUGH THE PHONE insisted everything must be done to "prolong her life" despite explanation of her condition. Politics came into the picture also. Veiled threats were made. So finally she was put on an artificial ventilator again. She developed cardiac arrest, was resuscitated and is still unconscious. (probably due to stroke/brain damage). So there she is, lying unconscious, the ventilator breathing for her while she is waiting to die from an inevitable hospital acquired infection/cardiac arrest again. BUT son is probably satisfied. "Everything" has been done to "prolong her life" - more like prolonging her death. And the hospital is probably saved from a potential lawsuit or a complicated sequelae with politics in tow.

WHAT ABOUT A PATIENT'S RIGHT TO DIE IN A DIGNIFIED MANNER?

I pity the many junior doctors who are bullied by the relatives in this manner. Even myself have succumbed to these pressures at times. After all you have 30 other ill patients to take care of with 40 others waiting in the clinic downstairs. You can fight, you can try to protect the patients' rights. But when relatives keep barging in your clinic every 5 minutes "to discuss with you" and takes your precious time away from other ill patients, you ask yourself "Is this a battle worth fighting at the expense of other patients?" Are you prepared to get physical (trust me, this is a real possibility) if necessary? Are you prepared to go to court? Are you prepared to go through months of attending a complaints committee meeting? Are you prepared to write tons of rubbish reports? After all with or without intervention the patient WILL eventually die. After all who cares about the lack of beds for other more deserving patients?- not my problem. Who cares about wasting resources in a public hospital? - not my money. Just do whatever the relatives want and save yourself from A LOT of problems. Trust me, these thoughts run through EVERY DOCTOR in public service. The poor junior doctors most often are the ones getting bullied - they have their career to think of too. Sad scenario.

WHAT ABOUT PATIENT'S RIGHTS, I ASK?

Welcome to the real world!

To go in peace