I just found out that a secluded corner behind some old buildings in the hospital is a herb garden. I don't really know who maintains it. But it has some interesting plants and flowers. Here are some of them. Managed to capture a shot of a green dragonfly too ;)
When to throw in the towel? When to call it a day?
When patients are extremely ill with an extremely poor chance of survival. Some criticize to say nobody should play god. But isn't putting patients on artificial support is playing god as well?
When does the line cross from prolonging life to prolonging death? When does the line cross from meaningful battle to futility?
I really don't know.
I guess nobody is comfortable in breaking bad news and withdrawing treatment. It's much easier to just do whatever is possible so that one can say "I've done my best". Is it to pacify ourselves or in the best interest of the patient?
Today was a rather horrible day. Boss away, colleague went for course and basically me left behind. And yeah, some people can say "Why you didn't do this and that?" "You must do this, you should have done that etc etc". Hey, I can't help it if other people don't do their job! I don't hire and fire.
Helloooo, I'm not the only person responsible for the whole hospital's well being you know.
Anyway when I was about to go back, I was asked to see a patient whom I've known since she was diagnosed. She was a young patient with cancer. She was struggling with her disease for some time, unfortunately her disease has progressed. She was ill but there was still hope albeit a small one. In all likelihood she is probably not going to make it. The nurses were telling me that she refused iv lines, refused medications etc etc.
I went to have a talk with her since I've known her for some time. She told me her thoughts. She said "I understand my predicament and I've accepted my fate. I just don't want to suffer any longer. How long can I last with supportive treatment only? Can you give me some medication so that I'll go painlessly and peacefully without any suffering?"
When I directly avoided the issue at first and asked about her family and where her mother was, she said "My mother is a rubber tapper and needs to work to support my many siblings" What about your father? "My father has passed away" she answered.
She further said "I have many siblings and I do not want to burden my family any longer". She has a younger sister who always accompanied her in hospital every time she is admitted.
She repeated her request. When I said it's against the law for me to practise euthanasia ( a good way out when your back is against the wall ) she said " If you just give me some medicine for sedation without intravenous drip and nutrition, how long would it take for me to go?" I said perhaps a couple of days to a week. I really don't know. She said " Wow, so long..." I'll skip the other details for confidentiality sake.
I can see she was afraid to die with suffering. Who wouldn't? She was way too young to die. I was really touched by her honesty, sincerity and bravery. Not often I'm faced with this conversation. She was one of the most compliant and pleasant person I've come across as a patient. An intelligent person too. And a really brave person.
That conversation changed my day. And I'll pray for her tonight, if she has to go, may she go in peace without pain and suffering. A prayer which I've never done for a patient before.
Some handheld shots by the sea. Forgot to bring my tripod :( The clouds and the setting sun beyond it gave some exciting contrast.
I'm kinda fed up with patients who just wanna do as they like. They love treating themselves according to their whims and fancies. Oh well, it's their right. Just don't expect me to be overly concerned if you don't get better. If you wanna do as you like, pleeeease do let your next of kin know, it's your choice. Just in case you die and your next of kin accused doctors of not doing anything. Public nowadays loves to blame doctors for any adverse outcome.
Patients who says "I don't want antibiotics", " I don't want any intravenous lines", " I don't want any medication today ", " I want to go home today and I'll may come back tomorrow ", "I don't want any blood transfusion today ", " I don't want my blood to be taken", "I don't want this medication because I don't like it, but I'll take that ".
If there is not an urgent need for treatment I can understand, but most of the time it is a life threatening illness. Cases like severe life threatening blood stream infection where an antibiotic may mean you will live or die the next day. Or rapidly growing cancers. But no, some fellas don't believe what we tell them. As long as they are not gasping for their breath, they think they are fine. Some patients even throw away their medication or hide them to trick us into thinking they have taken it. Luckily some alert nurses found the medications stashed away in the cupboard. And we doctors keep scratching our head on why they don't respond to treatment. Bottom line is that they just don't believe they are ill and nothing we say can change their strongly held belief. And of course without saying, some of them are taking "traditional medications" and did not want to take certain "western" medicine because their traditional practitioners tell them not to. They think taking medicines is like taking candies - today I'll have the red candy, tomorrow I'll take the blue one. Oh wait, I also don't like the green candy, so I'll just omit it.
Nowadays I just write it clearly down in their notes after enough persuasion and explanation. In any case it's the patient's right. But in treatment of cancers especially, the combination regimen and timing of treatment is crucial to success. If you wanna choose your candies, well then you are just not ready for treatment. And I'll stop treatment if you've started already. It's like a drowning person asking for assistance but doesn't want to use the life jacket because it's uncomfortable.
And often, these patients will abscond or default. And couple of weeks down the line, inevitably they come gasping at the ward at 2 am in the morning with scores of relatives breathing down your neck. It's usually too late. I will always clear the air with their relatives, it's not that I do not want to "save" him, I can't - it's too late. I'm not god.
Do what you like, it's your life ! And I'm gonna sleep soundly.
The weather was great today. Wild grass were "flowering" everywhere recently and I had wanted to take their photos for a long time. I think they looked so beautiful, swaying along with the wind and can be found decorated all along the roadsides.
Nurses are the backbone of any health service. Good nurses are crucial in more ways than one. And they are leaving. According to NST, many are leaving to Saudi Arabia where the salary is RM12,000-RM15,000 per month.
I've personally known 2 nurses in my ward who has moved on to Saudi. I mean I totally understand. One is a young nurse perhaps in her early 20s and another maybe in her late 40s. Why stay in a place with a meagre salary, unappreciated and over worked. Many who didn't go to Saudi cited family commitments. Not even one mention the hospital is great.
Over the years I can personally vouch the transition of more experienced nurses to the "just graduated" nurses in my ward. One can see the low morale and the inadequate training of the current nurses. Even the Sisters (nurses' direct superiors) are aware of the trend and morale but there is no solution. I mean how do you expect 2 nurses to take care of 30 ill patients, from serving their medication to preparing the beds, to feeding and toilet needs, to paperwork, to assist in resuscitation etc etc. And you know how demanding patients are these days. Some patients just treat nurses like amah or their slaves. Headache, backache,whatever ache - call nurse, want to pee- call nurse, want to shit- call nurse, want food- call nurse, want water- call nurse, food not palatable- call nurse, no pillow- call nurse, bed creaky- call nurse, bed uncomfortable- call nurse, too hot- call nurse, too cold, want blanket- call nurse, patient next bed too noisy -call nurse, ward too smelly- call nurse, toilet clogged- call nurse, oxygen finished- call nurse, even cannot sleep also call nurse!!!!. And some of them call the nurses almost once every 10 minutes! I can see many nurses are just shrugging in despair. Indifferent is the word. Who can blame them?It sucks to be a nurse nowadays man. Only some Matrons (Sisters' head) are still living in their own fantasy world based on their experience 30 years ago.
I've asked some of them why they wanna be nurses? Some of them were frank- job security and no other choice. Period. Of course the quality suffers. What do you expect?
And patients are paying RM3 per day for a 3rd class ward stay, RM20 per day for 2nd class and RM30-80 per day for 1st class ward. And the treatment charges are free for 3rd class ward, RM5 per day for 2nd class and RM10 per day for 1st class. Check the charges here and here.
Meaning in a 3rd class ward, a patient only has to pay RM3 per day !!! For consultation (including consultant/specialist), treatment, hospital stay, hospital food and water, hospital gowns and a nurse to standby for your needs. How cheap can it go some more?!!!! And some patients still demanding A-Z , the best and latest and can complain some more. Can vomit blood man...
And if you happen to have ANY infectious disease eg dengue, TB, malaria, typhoid etc...ward charges are waived !!! Check here .
All I can say is free healthcare will not be sustainable. At least quality healthcare will not be sustainable.
Every year without fail we hear of students clamouring for medical seats. Tops students are disappointed when places are inadequate for all who "dreams" of becoming a doctor despite scoring multiple As.
Many top students claims to be altruistic when interviewed on why they wanna become a doctor. Many said they do not mind the hard work and low pay. Many want "to do good to mankind", wanna help the needy, help the sick, help the poor etc etc. In short, everybody justified their dream of becoming doctors with well rehearsed lines.
However my years with House Officers has showed me a different face of the scenario. Not soon after starting work, many will start fighting among themselves on who is doing less "on-calls", who did less weekend calls, why they were posted to a busy ward for so long, even to the extent why some House Officers get less patients and they get more. Some even asked why must they do weekend rounds, why must they start work early, why must they cover other colleagues when they go on leave. The most fought after must be who gets to go on leave. In short they are fighting with each other in order to do less work.
What happened to the "do not mind hard work and low pay?" Or the altruistic reasons they wanna be a doctor before they entered medical school?
Is it the health system which turns them into this? Or is it the medical schools taking in the wrong students? Or Is it just human nature? After all even some our parents and elders can often be heard saying " Aiya, why you so stupid one? Other people also never work so hard why are you working so hard? Your pay also not extra. Stupid boy..." or "You so dum dum one, people can take leave for New Year/Hari Raya/Deepavali, why you can't take? You also got celebrate wat. Why so stupid wan..."
I can bet everyone has heard these lines before.
Some shots taken today of the famous mosque in the city. Waited from dusk till nightfall to take the shots. Which looks better? :)
Finally my wife's handphone got cranky and we had to get a new one. Guess which one is hers and which is mine? I'm pretty happy with mine. It only has a torchlight function which comes in handy and has been dropped countless of times without hurting my heart hehehe. Hers has a VGA camera, bluetooth function, plays MP3, accepts microSD card, has MMS/internet function. Mine can be used to throw at robbers if necessary - priceless, hahaha.
We checked out the numerous handphone shops and found out two different "variety" for the same model. They offer the "original" sets, from the authorized distributor eg Zitron, FMG, or the AP sets ( "approved permit") which are cheaper and only carries the shop warranty. There are also handphones which are dubbed "China sets" presumably made for the Chinese market. Some of the "China sets" had sophisticated functions ala PDA with TV tuner and is relatively cheap compared to "branded" ones. But the built quality...ayoyo. The buttons looked like they can drop out anytime after repeated use.
Man.., some people are willing to foot out more than RM2k for a handphone. Most of the handphones with the usual gizmos costs between RM1000 - RM 2000. The prices of some handphones costs more than a laptop! especially the PDA ones.
