Temptations & Ambitions

Just got my certificate that would maybe last 2 years in the freezer. The Basic Life Support skills, which are slightly more advanced than the layman's ones, would be put into waste. When would we really be helping a victim? With the rampant HIV/ Hep B viral spread, no one's gonna take the risk unless you have the face mask kit. And are we going to carry it 24/7?

I'd rather freeze the skill for 2 years and wasted it down. Muahaha.. End of story.

I guess among all the patients, brain death is a rare case scenario in the hospital. I happened to be there, in the ICU, by chance. All these while, I've only heard of it in the movies, Hong Kong TVB drama series (making it looked very common), and any novel stories of the fiction side. Never would I thought that I'll be encountering one yesterday.

Brain death may sometimes, be the most traumatic death one could ever imagine. With a mechanical ventilator along with other life support, the patient seems to be lying peacefully on the bed. Close family members would of course, wish that the patient was just in deep sleep, waking anytime soon. But all lies is but just a human body in a vegetative state, incapable of human function. A living corpse, as one would name it (perhaps that was what that gave ideas to the creation of zombies anyway).

The patient was in her 30's. Late thirties. A young one for that reason. After somewhat of her state, her family members were told of the outcome. A bleak one. The father had accepted it, but the mother was in denial. Sometimes, it is hard to swallow the fact that your beloved ones are gone, what else when you can see them unstiffed as one would expect a dead could be, with what seem to be chest movement with every breath of the ventilator.

We were taught on the brain death certification prior to the test. The widespan ethics enclosing the brain death matter can be a flinching idea for any doctors. To certify was rather easy, but to break the bad news to the family members was the hardest of all. On the moment of truth (brain death certification), she was still. No response. Her chest was moving up and down as a sign of surviving act, but the tests of the brain stem (Cranial nerves tests) indicated otherwise. Absent pupillary reflex, absent gag reflex, and absence of natural breathing exasperation when the ventilator was removed temporarily (apnea test). The eye balls were held in a fixed gaze despite turning her head left and right, although there were some wobbly motions of the eyeballs in the transition.

We've watched a lot of movies and series to tell us that miracles do happen. Comatosed patients waking after 5-10 years, or even 20-30 years, with no signs of aging nor muscle wasting. Not even any malnutrition was noted despite the long comatosed duration (And we audience believed the TV back then, even till now). But the cold hard truth was, no one would wait that long. No one could ever last that long.

There are reasons why brain death certification is more important in government hospitals. The Intensive Care Unit (ICU) houses limited beds, and each one is a rare commodity with a price tag numbered with the number of human lives which can be saved. The life support machine could be needed elsewhere, for those who would be able to benefit more than the sole one which had an extremely dimmed chance of living. Besides, the organ donation team would also benefit from salvageable parts, and saved the lives of many other patients. Some may think that it is a form of "harvesting the living being", but rather than allowing it to rot in years. Even if that patient manages to wake in 10 years time, the body function would be worse than an 80 years old man. Physiotherapy would not be able to substitute the "exercise" of our normal body function and activities, at least for that long period of duration. There are many more ethics and issues involved, but I guess it'll never end if allowed to continue. But, not all hope is lost. If you're as rich as Lee Kuan Yew, you'll be able to sustain a continued support of ICU maintenance with the life support in private hospitals. Mind you, the cost is no laughing matter. A few days' stay in ICU in private hospital can cost up to 5 figures, what else a year's worth!

In the end, it's all up to weighing the pros and cons. "Sacrificing" a life to save more lives may seem justifiable. But then again, who would do so if it happens to themselves?

This is the dilemma where even Big Bro would need some head cracking.

2nd day of Anesthesiology. Ophthalmology has been the past tense, with much sweat wiped off. This time? It's been a whole long day of standing. Walking and standing in the labor room OT in hunt for log book procedures and gobbling down the Anesthesiology book as soon as possible. Each book ought to be finished in the 1st 3 days by right, so I'm sure taking my effort in finishing it.

The labor room OT sure brought back some nostalgic memories. And of course, some attitude. Imagine when you greet two doctors and there wasn't any acknowledgment. You thought they didn't hear you, so you practically raise your voice to greet them. But all you get was some stare with the intent "Nonsense medical students, shoo away!", and you knew that they weren't exactly ENT's candidates of sensorineural deafness. They wouldn't need cochlear implants either, but perhaps some EQ implants. And mind you, they weren't the merely housemen or registrars, but prominent figures in the department.

And then, some doctors just never change . The hormonal level in O&G has always been a lingering high even in the bloodstream of some doctors. Mood swings, and disregard for others when it comes to petty quarrels. Our Anesthesiology professor was being pursued from 1 OT to the other just for the extension of time and the long-winded argument ala housewife from the O&G doctor who was of the same rank. Well, the anesthesiologists were right on one thing, they were treated just like nurses by the surgeons. Whether the surgeons respect you or not, depends on their very own personalities.

And the nurses? As usual, barking up on every tree they could scramble on. The superiority complex just never ceased to amaze me, for no other nurses act like those in the O&G department. Saving lives is one thing, keeping your head sane is another. If only they could realize that, I'm sure they'll be great doctors and nurses if not fantastic. But I guess they are humans after all, fallible to mistakes. Perhaps, it'll take some time before the realization sank, which by the time, I hope it wouldn't be too late as to see the freefall of the department.

On the bright note, I'm sure there are equally as many good doctors in the department. The doctors who are always involved in the Personal and Professional Development has always been the doctors with a respectable integrity. I wonder if the PPD gave them a good perspective or the nice doctors and PPD has always been having good affinity with each other. It's just that sometimes, it's rather frustrating when there are so many "bad apples" in a department that they influence the registrars and housemen. And this can give a hard time for us medical students.

I"ll just dread my return to O&G next year should I able to proceed to 5th year. It could be a torture if I got some "hawks" (as described by Prof Oteh), or it could be some paradise if I had one of the "doves". Anyway, lets just see how it goes for Anesthesiology for this 2 weeks, and we'll worry about the future, in the future instead.

I have been having allergic rhinitis from young. Just pick me up and I'll be a decent ENT "specimen" for nasal speculum. Engorged inferior turbinates, deviated nasal septum, etc. Plus, you can just diagnose me from many of my symptoms, from coughing, stuffy nose, sleep apnea to heartburns. The spectrum of complications would never seize in fact, and might worsen any day possible.

All I can say is that perhaps none of the ENT doctors would have notice it. Or it was too minor that it escaped attention. So common to them that no one really bothers about it. It's either I'm being compliant or non-compliant to medications (which I am definitely not a good one).

And then, there was 3 weeks in Ophthalmology, my supervisor would have notice it from my constant rubbing of nose. A prominent sign of "itchiness" for allergic rhinitis. Never mind that she might have missed some of my symptoms. But at least, she could know what I'm having. Seems like it takes an ophthalmologist to diagnose a nose problem.

I'm not saying that the ENT doctors are no good, but most likely it was overlooked and ignored. Seeing the same cases everyday, everything in your field becomes a routine that the minor signs can be ignored completely. Doctors are humans too. Most of the time, we even overlooked our very own health when we as doctors should be the most concern of ourselves. Have you heard of the case of a Cardiologist dying of myocardial infarction, or the doctor in the public health advising the public on healthy lifestyle when they can be obese themselves. Luckily, the male obstetricians would not have the chance to suffer from postpartum complications!

I'm heading towards the last week of Ophthalmology posting as well. Be it a pass or fail in the mini-CEx, I think I've learn a lot, especially from the fundoscopy. At least UKM's new must-buy-ophthalmoscope policy ensure that we would be knowing how to use the fundoscope properly. :P And coupled with a strict supervisor? Well, at least we're learning something.

Note: Case-write up is almost finish with the PPD component remaining and some amendments. Anesthesiology posting would start the following week.

Ophthalmology posting sent me back the memory lane: MAB. It was a surprise for me to be there for the 3rd time, and I'm going to know the place inside out soon.

It wasn't really a pleasant visit as I could say. We could make use of some punctuality as MAB people have to wait for 1 and half hour for us. Mind us for not even having any gifts or souvenirs of appreciation, but we were the ones begging them to show us around in the first place. Plus, 57 of us was way too much for them to handle since tours are done in 20 persons max (forcefully). I really felt shameful for how we are doing things in UKM. Everywhere we go, we bring such "fame" along. Not to be reminded that Dr Sheik Muzaphar did carry the same burdens and acts too, where more and more blogs are reporting on his infamy acts in schools and much much more, which might qualify me into trouble if I spilled out anymore. Until when will we be able to apply our PPD skills thoughfully?


Nevertheless, here's a brief summary of events with photos: