In a couple of minutes I'll be a year older. Yup...I'm spending a quiet evening at home coz my significant other is on-call. Decided to just lay back, look back and have a quiet dinner by the candle, with a chocolate cheese cake desert and perhaps a glass of Chivas ;)
I wish I was a party animal but I'm not. I wish I was as suave as Sean Connery or as stylo as Chow Yuen Fatt in "God of Gamblers" but I'm not. However I'm pretty happy with who I am. And I wish there was someone to share the moment with. It gets lonely at times.
Sometimes patients (and relatives ) do not like me very much as I'm frequently the harbinger of doom. Well, I have the unenviable task of breaking bad news to the patient (and frequently the relatives too). And of course as ridiculously as it sounds I do ask if they want to know the diagnosis.
I feel to give inappropriate hope or unreasonably high hopes to a patient is not right. Preparing a patient for death is just as important as giving hope to life. It's a tough balance. But when there is an 95% chance of a patient dying...would you prepare him for death or lift his hopes up for the 5% chance? Colleagues may disagree with me, but I'm being pragmatic and sometimes patient's relatives do not like to talk to me because of this.
I think preparing a person for death is extremely important. A person may have personal stuffs to settle, dark closets to open, people to forgive, ask for forgiveness etc etc. Giving inappropriate hope may deter the patient from doing things dear to him before he leaves this world. Patient or their relatives may start to look for futile treatments to improve the 5% chance. They may spend lots of money for dubious treatments (futile treatments are never a justification for desperation), numerous 2nd, 3rd and 4th opinions, makes excessive demands to their loved ones, ultimately leaving everything in a mess when they pass away. Not to mention the relatives later blaming the nurses and doctors and trying their best to find any minor fault which they think may have contributed to his (hastened) death.
The common reaction given by the patient (and more frequently their relatives ), especially Christians I must admit, is that perhaps a miracle will happen. Yes, a miracle can happen I agree. But we cannot make decisions based on the hope that a miracle will happen. Yes, you might survive a 10 storey fall by miracle, but would you bet on surviving the fall?
Preparing someone for death is difficult. It's unpopular, nobody likes to hear it, nobody likes to do it. And nobody will thank you for telling them chances are they are dying. Not in our Asian culture anyway. We avoid it, we give inappropriate hope, we pass the buck, we refuse to address it. But I think it's absolutely necessary at the risk of looking as if we are "taking the easy way out", for not trying hard enough.
I had a 90 year old rather frail patient with end stage kidney disease who needs dialysis. Everybody knows dialysis slots are extremely limited (we are not in USA or Europe) and nobody wants to "give a death sentence" to this patient. She may get a couple of "urgent" dialysis but long term slots are not available. So the decision was left hanging. And unfairly I feel, doctors pushed the decision to the patient's children! Hey dialysis is not risk free, the patient may well collapse during dialysis. What the patient's children said? They said " Doc, you do what you think is best. DO NOT ask us again for our decision (to dialyse or not). Several doctors have asked us the same thing many many times ". My colleague and I made the final decision - rightly or wrongly. I would have done the same for myself.
On the other extreme there are relatives of dying patients who wants "Everything to be done to ensure the patient lives for as long as possible", whatever living means to them, perhaps to avoid their own conscience of "killing" the patient. Prolonging death is unethical. Not to mention the extremely limited resources which perhaps could be used to save someone else.
Thought of printing this T-shirt for my regular squash buddies from the hospital. Especially for tournaments.
I really don't know what to make up of the recent news that RM1.175 million is required to maintain 16 Proton Perdana cars over 4 years. And the Pahang MB said his Mercedes Benz needed RM42,000 to maintain a year while a Proton Perdana needed RM57,500. Check out here (I think I need to check my last year's income statement if my salary FOR A YEAR exceeded this amount or not)
Either way it sounds bad. Either we are making a lousy car which needs servicing every 2 weeks (to come out with that exorbitant amount) or someone is pocketing a lot of money.
A car mechanic and a doctor are similar in many ways. One is repairing cars, the other repairing the body. Both charges consultation fees. Both do house calls. Both can prescribe medicines (or spare parts). Both advocate regular health screening (or regular maintenance). The difference is that nobody sues a mechanic if he botched a job or charges exorbitantly. No one regulates the mechanic's charges.
Lebih baik baiki kereta daripada baiki orang
I found this list of "Quality activities" in the ward. Wow...this list exceeded my expectations. Never knew some of it existed. There are 25 "quality" activities in the hospital to ensure "quality service"!! But who are doing these activities? The same handful of doctors and nurses, in addition to their overloaded work and responsibilities with an overcrowded ward. Seriously which clinician is interested to do all these crap activities? All I can say is, please leave me out of it. Cannot "tahan" doing crap paperwork. Unfortunately I was "trapped" into doing one of them though :(
Please feel free to scrutinize the list!
Notable crap activities are : Corporate cuture, Development of administrative circulars, Total Quality Management, Innovation, MS ISO 9001:2000, Accreditation, 5S, Communication & Information Technology, Bench marking, Quality Control Circle and lastly Therapeutic garden!
I think we are trying to squeeze water out of stones.
I love waterfalls and rivers (clean one that is, not the Klang river- gosh!). Today, I drove to a river nearby the city and was met with a magnificent sight. Yes, clean and clear waters. A signboard nearby warns visitors not to dirty the river or catch any fishes in it. Any catch will be confiscated and the person fined severely. I think this river has a traditional fishing season to protect the local species.
I think Malaysians should be grateful we have such great sources of clean water. It is unthinkable that some rivers are used as large garbage dumps by irresponsible people. If we are not careful, the petrol price crisis will pale in comparison with a clean water crisis! We must protect our precious water resources.
Had this cake for desert in a get together dinner with juniors :) Made by a friend.
I just wonder how are students being taught in the interior schools.
I interviewed a 17 year old girl, a patient from a district, in the clinic. She is supposed to take her SPM examinations this year.
Me : Bila ambil SPM?
Her : Tak ambil dah. Henti sekolah dah.
Me: Kenapa?
Her : Tak pandai.
Me: PMR dapat apa?
Her : Dapat "telor" (giggling)
Me: Cikgu ada ajar? Kamu ada tanya?
Her : Cikgu kata siapa tak faham angkat tangan.
Me: Kamu ada angkat tangan?
Her : Tak
Me : Kamu tau baca dan tulis?
Her : Tak
Me: Jadi apa kamu buat hari-hari di sekolah?
Her : (Giggling)
Me : Bapa, mak kerja apa?
Her : Petani. Tanam padi.
Me : Di rumah kamu buat apa? Kamu ada tolong potong padi?
Her : Belum musim. Bulan dua-belas nanti...
Me : Tadi macam mana datang? Macam mana kamu balik?
Her : Ikut "Ngii...ngo...ngii...ngo" (giggling)
Me : Ikut ambulans kah?
Her : (Nodded)
After 17 years of schooling she cannot read and write. I tested her myself. She was very cheerful though. I could not detect even a hint of jealousy nor dissatisfaction.
However I felt sad. How did this happen in our country? Poverty? Ignorance? Lack of opportunity? Neglected? Education system? Some population just don't realize that they have not been given a fair share of the socio-economic pie. Easy going people. Easy to be taken advantage of. The state's wealth plundered away while they are still in the dark. Obviously the "Dasar Ekonomi Baru" didn't reach here. She is a "Bumiputra" though.
Whatever happened to the fair distribution of wealth and opportunity? Looks like it is a skewed distribution.
Does common courtesy and manners still matter today? Or have they given way in this "dog eat dog" world. Yeah, using vulgar language and signs are entertaining. It captures the attention and perhaps achieve the objective more clearly and faster. Some people seemed to idolize vulgarity, rudeness and brash language as though it is something great, something most people won't dare to do. So the person who does it must be brave, great and deserve to be idolized. Very "keng" as they say.
From our Member of Parliment, to even doctors, perhaps specialist and consultants too, we have seen such behaviour and language. An example of this is here. More often than not, it is spoken within an inner circle of pals. On and off we do blurt out some expletives, but is it great to make it as a habit? We have heard swearing, expletives, vulgarity uttered on a daily basis, most of the time behind close doors. The irony is that some people seemed to idolize people who uttered them, whether explicitly or secretly. What is so great about it? It is certainly easier to blurt out an expletive than to construct a courteous sentence.
I've had House Officers who came to the department, not bothering to introduce themselves to the Head of Department or their specialist and started working in the wards as though they place belong to them. Some do not even bother introducing themselves to the Sister of the wards either. For crying out loud, if you visit a friend's house, common courtesy dictates you inform the owner of the house that you are coming to visit, isn't it not?
How often do people remember to use the term "Thank you. I appreciate it"? Whatever happened to common courtesy and manners? Isn't there any other way to converse other than using expletives? Politeness may not be as entertaining as swearing but to me it indicates humbleness, softness in character and perhaps finesse. Although there are great pretenders out there, it isn't a reason not to be polite. I remember how I would receive a big slap on my face from my parents whenever I utter any languange which is remotely vulgar during my childhood. Alas we can't do that to the adults who uttered vulgarity at their whim and fancy.
However I can avoid people with only vulgarity in their vocabulary. If not I may forget how to converse in a civilized manner.
Recently another batch of medical students came for their clinical teaching in the hospital. I had the privilege of giving my 2 cents worth of bedside clinical teaching. There was a mixed composition of the students with regards to ethnicity and sex. Pretty well balanced. This was their first clinical bedside teaching so it wouldn't be fair to assess their knowledge or competence.
However I was appalled at the standard of their English. The Chinese students were no better than their Malay counterpart. The Chinese student could not even put together a decent short sentence of English. Fair enough clinical knowledge is not about language but we are learning clinical medicine in English and English is the medium of instruction and knowledge (at least to me). If the students were to learn clinical medicine in China, this probably wouldn't matter but the fact is the student is supposed to be learning in English.
And how he can learn medicine in English when he cannot even put together a couple of English words decently? I cannot imagine how would he be able to clerk a patient in English. The same goes for students learning medicine in Indonesia and perhaps Russia. I was told in Indonesia, they used "Bahasa Indonesia" in their studies.
The standards of House Officers are also dropping fast. There used to be a time where senior doctors would say any Chinese student who graduated from the local premier University should be ok in terms of knowledge. If he is not, he is just plain lazy and would deserve some scolding. The reason behind this is obvious (no need to mention lah). However lately this is no longer true. I just wonder if the local universities are still getting the cream of the crop or have the cream left Malaysia and we are left with "beneath the cream"?
Anyway back to the topic, I'm sceptical whether the students understood even 30% of what I've explained due to their poor command of English. But at the end of the session they asked me if I could take them for another session! I'm only paid to teach them for 60 minutes and I've voluntarily extended the session to 90 minutes as an hour was grossly inadequate. Should I do charity work for another 90 minutes? Hmm....
