This story took place some 5 months ago, and yet, I am unable to get it off my mind. I guess this is just like one of those experiences some doctors talk about that they are unable to part with.
I was a surgical intern in one of the hospitals, in country A (I'd like to leave out the country as it may offend some of the readers). In this hospital, and it this country, living by a hierarchy is above all else. With this understanding, let me begin my dreadful story...
It was a Sunday morning, about 8.30am, I was in the ER arguing with a junior resident that his method of treatment for active tetanus infection was lacking one drug which was recommended by WHO for "this" country. It wasn't a fruitful discussion, but at least the junior resident now knows what he lacks and hopefully, someday, will take it up with his seniors to follow the improvised WHO treatment plan. A sudden rush in the ER caught our attention as I saw 4 nurses wheeling in a patient of his early 50s, with obvious breathing difficulties. Naturally I jumped to measure his blood pressure which was low, and immediately started him on fluids to sustain his pressure within normal limits. The patient had subcutaneous emphysema on his neck and arms with crepitation (a term more familiar with fellow doctors, which means he had ruptured an organ that contains air in his body and the air is now in his skin). I looked up at the junior resident and suggested it could be a possible rupture of the esophagus as the patient also had some broken ribs. The junior resident agreed with me and as we prepared for an emergent mediastinostomy (a puncture into his chest to relieve the air from causing a block for the heart to pump efficiently), a procedure the junior resident was pretty competent with, the senior resident walks in and stops him! He tells us in his SLOW lazy voice that we are wrong and that an x-ray needs to be done first because this man had ruptured his rib cage and so he might have a bleeding chest (hemothorax).
As angry as we were, the junior resident asked me to help him get this patient into x-ray and stay with the patient to ensure adequate blood pressure is maintained. I got a fellow intern (my friend) to help me get more fluids and help this man with his chest x-ray (which should not have been done at all as it wasted time and was dangerous as we could have caused his broken rib cage to puncture his lungs). The senior resident walks into the x-ray room and as we're about to leave, he says we had to repeat the x-ray pictures of his broken leg bone in his lower leg! I insisted we get this man out and drain his chest of the air to save his life, but I was shut off (because according to hierarchy, seniors don't take advice from interns or juniors).
This patient lay there breathing shallow and looked at me, "please just call my family, I'm not going to be here long", and I replied, "hang in there sir, I know what is wrong with you and we're all going to help you. I am here for you." I wish I had brought his family into the ER instead.....
The x-ray took an hour (which should have only been 10-15 minutes)! It is now 9.30am and the patient gets hesitant and starts struggling with his breathing. He is extremely anxious. Now I looked at the senior resident who was busy teaching my friends (other interns) what a pneumomediastinum (air inside chest cavity) looks like (an x-ray was not needed to see this as it was pretty clear from the physical findings as I had pointed out earlier, and of course, there was no HEMOTHORAX), and I said to him loudly, "now can we save this man?". The senior resident laughed at me and said I needed to learn to relax. He got his team (along with the junior resident I was working with) to do a mediastinostomy. But it was too late .... 9.35am, I was holding this patient's hand and saw him take his last breath. It was too late. The patient's rib cage did indeed puncture his lungs. The last minute resuscitation that took another 15 minutes thereafter did not bring this man back to life. I stepped back, looking at it all....
The junior resident stands next to me, eyes filled with tears and says to me, "you must think we are slow in handling our patients in this hospital", and I replied, "No, your hierarchy system killed this man today. You are part of it, as am I"......
Sunday, September 11, 2011
Saturday, April 9, 2011
Perception of happiness.
Of the many major structures in the brain, many are and have been extensively studied while others are shy a few years of research from discovery. And yet of the structures studied and explained in great details, I have many questions for the integrity of the researches done or the discoveries presumed achieved.
It is thought that when we see an object (because of ample light), it is transformed into our thought processes. If this is the first time we see it, it gets stored in our memory, and if it is something we have seen before, we are able to retrieve the information and remember it. While this is all true (as written by great scientists), there is still the possibility of someone interpreting that object as something other than what others perceive it to be. When what is perceived is beyond the moral values (which humans at some point deemed right according to society?) of the norm, then it is said to be a psychiatric problem and these issues are later justified with the abnormal firing of neurotransmitters (substances in our brain that is said to control what we remember, feel, see, touch and can even turn around to cause great damage, even death).
Minus the boring medical story, let's get down to what brought me to these thoughts. Perception of happiness. If the title (and the dull paragraph above) doesn't suggest that I'm rather critical of it, then allow me to reinstate it: perception of happiness?
Say there are two people, A and B. At any point both A and B can be happy, and yet at other times, A and B can feel different. Say A and B grew up together, saw the same things, had the same parents, had the same friends, wouldn't they perceive what is happiness to be the same? I'm sure you're thinking NO, OF COURSE NOT. At some point in their lives they would've seen and learned different matters that later on shaped their personalities, thus giving them each, their own perception of happiness. A and B will no doubt have lots of fights and quarrels and perhaps someday down the lane, drift apart. Wouldn't it be better if scientists could discover NOT WHAT THE BRAIN DOES, but what we can do so we perceive happiness as the same despite personality differences?
Why is it that we say some people just don't understand while others do? Why is it that we think this sentence I'm writing now makes perfect sense in English? Just as the latter question may be alien to someone whose first language isn't English, the former question only justifies my point in writing, that a definite perception of happiness does not exist. What in our sense, and how we have agreed on believing since we were young, hence shaped us today, should not be the judge of someone else' personality.
We are all different in our own ways. When someone you know is having a hard time, or doesn't seem to understand you, perhaps it is best to approach the problem or matter at hand directly. Giving it space to cool off may work in movies, but from my observation (yet a vague or rather subjective perception of my believe), confrontation and talking things out helps. Help your friends, family and loved ones. Talk to them, even if it means boxing your ego into a take out container and hiding it in the freezer for a while. Who knows, after talking things through, perhaps you will learn to perceive some happiness together. Some happiness (if not indefinite) can take you a long way.
It is thought that when we see an object (because of ample light), it is transformed into our thought processes. If this is the first time we see it, it gets stored in our memory, and if it is something we have seen before, we are able to retrieve the information and remember it. While this is all true (as written by great scientists), there is still the possibility of someone interpreting that object as something other than what others perceive it to be. When what is perceived is beyond the moral values (which humans at some point deemed right according to society?) of the norm, then it is said to be a psychiatric problem and these issues are later justified with the abnormal firing of neurotransmitters (substances in our brain that is said to control what we remember, feel, see, touch and can even turn around to cause great damage, even death).
Minus the boring medical story, let's get down to what brought me to these thoughts. Perception of happiness. If the title (and the dull paragraph above) doesn't suggest that I'm rather critical of it, then allow me to reinstate it: perception of happiness?
Say there are two people, A and B. At any point both A and B can be happy, and yet at other times, A and B can feel different. Say A and B grew up together, saw the same things, had the same parents, had the same friends, wouldn't they perceive what is happiness to be the same? I'm sure you're thinking NO, OF COURSE NOT. At some point in their lives they would've seen and learned different matters that later on shaped their personalities, thus giving them each, their own perception of happiness. A and B will no doubt have lots of fights and quarrels and perhaps someday down the lane, drift apart. Wouldn't it be better if scientists could discover NOT WHAT THE BRAIN DOES, but what we can do so we perceive happiness as the same despite personality differences?
Why is it that we say some people just don't understand while others do? Why is it that we think this sentence I'm writing now makes perfect sense in English? Just as the latter question may be alien to someone whose first language isn't English, the former question only justifies my point in writing, that a definite perception of happiness does not exist. What in our sense, and how we have agreed on believing since we were young, hence shaped us today, should not be the judge of someone else' personality.
We are all different in our own ways. When someone you know is having a hard time, or doesn't seem to understand you, perhaps it is best to approach the problem or matter at hand directly. Giving it space to cool off may work in movies, but from my observation (yet a vague or rather subjective perception of my believe), confrontation and talking things out helps. Help your friends, family and loved ones. Talk to them, even if it means boxing your ego into a take out container and hiding it in the freezer for a while. Who knows, after talking things through, perhaps you will learn to perceive some happiness together. Some happiness (if not indefinite) can take you a long way.
Saturday, February 19, 2011
Anger in exchange for forgiveness
As I rush out of bed I wonder if Barry will forgive me for not returning his calls. I’m pretty sure he’s mad at me for leaving without telling him. However, I wasn’t about to refuse a great job offer. It did seem very selfish of me at the time, but now that it’s been almost a year since we broke up, I’ve made enough money to buy that dream car of ours. Barry will have to forgive me after I tell him the good news.
I brush my teeth and remember how Barry hated mint flavored toothpaste, I start to reminisce over small details that Barry disliked. He always hated the fact that I squeezed the toothpaste tube from the middle and that sometimes I don’t put it back into the mirror cupboard. So I open the mirror cupboard and put the toothpaste back and my eyes get fixed on a bottle of valium I purchased about a year ago trying to get over the horrible break up I had with my high school sweetheart. I pick up the bottle and take a tablet, and slip the bottle into my handbag as I think I may need it for when I’m back home.
I put on a stunning topless black dress and a cardigan to go with it, hoping Barry will remember how nice I looked in it when he took me out on our first official date since he got that job at the law firm. It was then when Barry had made many lovely future plans of what our life together would be like. There was a house, with a blue porch and a green swing, three Dalmatians running about and of course, our yellow dream car. But of course, with the money Barry was earning and with my low paid job for the local paper, we could not possibly have any of that unless we waited out at least 10 years. And I didn’t have 10 years, or so I thought. I wanted to have it all set up for us in 2 years so Barry and I could start thinking about children. Silly me though, Barry hadn’t asked me to marry him.
As I think about how Barry never asked me to marry him, I’m now raged and I wonder if I should board that plane back home. Despite my anger, I am unable to stop my feet. Luckily for the valium I took earlier, I wasn’t angry too long.
I checked in to a hotel back home as I didn’t feel like going back to my mom’s. I just didn’t have it in me to deal with all the questions about my whereabouts. Just as I sat on the corner of the hotel bed, thinking of the things that I have to say to Barry so he’d forgive me, I receive a call, from a withheld number, and I answered it anyway. It was Barry’s sister Meg. She said Barry had left me something and she wanted me to look at it before they took it down. I didn’t know what she meant but she sounded solemn and so I obeyed her request to meet her at the old boat house by the lake.
Walking on the wooden slabs towards the old boathouse, I think of the times that Barry would carry me down there because I hated walking on those rough wooden slabs in my heels. Meg doesn’t smile at me but directed me into the boathouse with her body language. As I look around the inside of the boathouse, unable to search for words, even of questions, Meg puts her hand on my shoulder and says to me that Barry had intended to ask me to marry him the day I left without telling him and had decorated the boathouse in red and purple ribbons, my favorite colors. Still unable to shed a tear as I stand there feeling remorseful and guilty, Meg tugs on my arm and I swing around to face her. With tears rolling down her face, she hands me a box open with a beautiful engagement ring that Barry had made for me. She says that Barry would want me to have it, as he waited patiently all this time for me to return his calls and emails. As Meg turns around to walk away, I start to think if the reason I am unable to shed a tear for my ex boyfriend’s tremendous love for me was the high dose of valium. 5 steps away and Meg turns around, forces a smile, and says to me, “come on, we’re going to be late for Barry’s funeral”.
Forgetting of all the things I was going to say to Barry at his funeral and hoping he’d forgive me for not telling him when I took off a year ago, I now hoped Barry would forgive me for not forgiving him and holding on to my anger for such a long time. Perhaps, if I stayed back, things would’ve been different.
Monday, January 17, 2011
patience is a virtue
patience is a virtue is an easier said than done phrase. I personally tried on a little experiment where I promised to remind myself to be patient every time my heart races and I feel like an outburst of rage coming. They were a lot of successes but there were a couple of downfalls to which I have somewhat established my threshold or rather the one thing that ticks me off without leaving a space for me to put thoughts of remaining patient into.
What I have noticed is that, most people I know are easily carried away by labile emotions or anger and rage when they are TIRED. It is as simple as being tired, that gets you to succumb to emotions that you are able to keep well under control when you have had enough rest or at least sleep. For some being rested would also mean having a good meal and enough fluids to keep the body healthy. In medicine we were taught in our first year, that a spiritual body with a healthy mind, is a body that has good physical health overall. However, when good physical health isn't accompanied by good mental or spiritual health, the body (or rather person) is said to be NON-healthy. And yet it makes me wonder, despite having had this knowledge from my first year in med school, it did not in any way influence the hours of rest I have devoted for myself. I have deprived myself of a healthy diet, healthy exercise, adequate amount of water per day to keep me hydrated, and most of all, I have always deprived myself of sleep! Most med students are used to staying up late putting in that extra hours of study when really a healthy time table can be conjured up so we could avoid strenuous practice of medicine, while preaching medical treatment or plans in the name of hypocrisy.
Having said that, let me add also that the medical facilities (hospitals, clinics, etc) albeit having tried various methods on reducing the number of accidents (medical accidents) that take place, have failed to reduce the number of hours required for a physician to work. Physicians worldwide have been trained from the time in med school that working life isn't going to be easy but rather one should get used to the number of sleepless nights as that is one of the requirements of being a physician.
Some of you who work in developed countries' medical facilities might rebut my views on this because perhaps your facility has reduced the number of hours you are required to work in order to produce healthier, less tired, more patient physicians who are able to make wise medical decision. However, this sadly isn't the same in developing countries, where the believe stands that, a physician that can train itself to sleep a mere 4 hours a day, is a physician who has the most experience (I call it experience based on the number of mistakes they may have done!).
Going back to the topic of patience is a virtue, no matter what your job title is, no matter what your stand in life might be, if you could truly control your mind and avoid falling into the traps of anger and hasty decisions, then my friend, you have allowed your mind and body, a healthy diet of peace and rest. Shalom!!
What I have noticed is that, most people I know are easily carried away by labile emotions or anger and rage when they are TIRED. It is as simple as being tired, that gets you to succumb to emotions that you are able to keep well under control when you have had enough rest or at least sleep. For some being rested would also mean having a good meal and enough fluids to keep the body healthy. In medicine we were taught in our first year, that a spiritual body with a healthy mind, is a body that has good physical health overall. However, when good physical health isn't accompanied by good mental or spiritual health, the body (or rather person) is said to be NON-healthy. And yet it makes me wonder, despite having had this knowledge from my first year in med school, it did not in any way influence the hours of rest I have devoted for myself. I have deprived myself of a healthy diet, healthy exercise, adequate amount of water per day to keep me hydrated, and most of all, I have always deprived myself of sleep! Most med students are used to staying up late putting in that extra hours of study when really a healthy time table can be conjured up so we could avoid strenuous practice of medicine, while preaching medical treatment or plans in the name of hypocrisy.
Having said that, let me add also that the medical facilities (hospitals, clinics, etc) albeit having tried various methods on reducing the number of accidents (medical accidents) that take place, have failed to reduce the number of hours required for a physician to work. Physicians worldwide have been trained from the time in med school that working life isn't going to be easy but rather one should get used to the number of sleepless nights as that is one of the requirements of being a physician.
Some of you who work in developed countries' medical facilities might rebut my views on this because perhaps your facility has reduced the number of hours you are required to work in order to produce healthier, less tired, more patient physicians who are able to make wise medical decision. However, this sadly isn't the same in developing countries, where the believe stands that, a physician that can train itself to sleep a mere 4 hours a day, is a physician who has the most experience (I call it experience based on the number of mistakes they may have done!).
Going back to the topic of patience is a virtue, no matter what your job title is, no matter what your stand in life might be, if you could truly control your mind and avoid falling into the traps of anger and hasty decisions, then my friend, you have allowed your mind and body, a healthy diet of peace and rest. Shalom!!
Sunday, January 2, 2011
The birthing process
For the first 4 years of med school, I thought a doctor's job was all about being able to crack what disease a person had and prescribing the right medicine. It still is actually.. :).. only it's not as hard as I may have thought it was. There's a whole thought process that we can follow to get us to our diagnosis. Of course, years of reading, hours of sleepless nights, and endless reading has to take place before we can feel comfortable enough to be in the RIGHT thought process.
Nevertheless, the best part of being a med student for me was when I became an intern. Being an intern allows us to put our knowledge to practice and it helps us recognize diseases or syndromes clinically rather than from a theory stand point. In theory, the birthing process seems very ritual, but in reality, seeing one can seem scary at first. And when I finally got the chance of handling a delivery myself, it was then, when I thanked my lucky stars this was the profession I chose. Albeit seeing the baby cry for the first time is truly a breathtaking moment, I only wish there was an easier way to enable child birth without having the mother go through a process so painful and risky, that her live has to be at stake.
If this short experience has taught me anything, it is to think twice before I actually decide to want to marry anyone... :)..
Nonetheless, I am hoping for more wonderful experiences that might change my mind into believing that this brief torture (the birthing process) is just part and parcel of life (although I doubt I'd change my mind that fast)
Nevertheless, the best part of being a med student for me was when I became an intern. Being an intern allows us to put our knowledge to practice and it helps us recognize diseases or syndromes clinically rather than from a theory stand point. In theory, the birthing process seems very ritual, but in reality, seeing one can seem scary at first. And when I finally got the chance of handling a delivery myself, it was then, when I thanked my lucky stars this was the profession I chose. Albeit seeing the baby cry for the first time is truly a breathtaking moment, I only wish there was an easier way to enable child birth without having the mother go through a process so painful and risky, that her live has to be at stake.
If this short experience has taught me anything, it is to think twice before I actually decide to want to marry anyone... :)..
Nonetheless, I am hoping for more wonderful experiences that might change my mind into believing that this brief torture (the birthing process) is just part and parcel of life (although I doubt I'd change my mind that fast)
What the new year means to me..
A new year can mean a lot to many people, which is why Hallmark pays their employees a handsome amount of money to come up with the simplest words to describe how one would feel about the new year or rather to help those in need of a line or two to wish their friends and family well (because coming up with the words "Happy New Year, May God Bless you", takes a genius with a good paying salary). I've always been under the impression that New Years Eve (NYE) was a day one should never celebrate alone. This year however was different for me. I tried to remember the NYE celebrations I've had in the past and tried to remember how I felt on all those occasions (I've got a pretty good memory!). And at all the times (at various places/countries), I remember always feeling the same way... LOST!
Why was I lost? I always wondered if what I was doing in life was the right thing. Sometimes I'd wonder why we had to do any of those things we were doing, be it studying, working, hanging out with family, friends. Why is it that we do these things? Then I start to question my very being and I get so confused and feel so alone. I mean, aren't we all alone on this planet anyway? We find what little comfort in the arms of family and friends, but really, aren't we alone most of the time anyways? If you can't agree with this, then savor this.. when you are reading a book or thinking of something to do, aren't you alone up in your head? We're up in our head or lost in our own thoughts most of the day, so in essence, we're all alone on this planet. So why is it that we 'think' we need others in our lives to conjure up relationships we feel are needed?
Anyhow.. this year I spent NYE completely in undeniably of what laid in front of me. Without the distractions from surroundings, I reminisced on all my goals and what was needed of me to achieve them. After much thought, I came to realize that I too have become a victim of society or the rules made by society. I found myself judging the way I had chosen to live my life alone when I forgot that the very essence of this choice was to enable myself to concentrate on achieving my world's greatest. Soon after I didn't feel bad for myself for spending NYE alone, watching a movie and reading a book. Thereafter I actually felt glad that I had taken some time off to spend with myself in the name of appreciation for all that I've been through.
I do not oppose of the idea of spending NYE or for that matter any holiday with family and friends, rather I feel what we miss most is taking the time off to appreciate ourselves. Who could appreciate ourselves more than us truly?
Why was I lost? I always wondered if what I was doing in life was the right thing. Sometimes I'd wonder why we had to do any of those things we were doing, be it studying, working, hanging out with family, friends. Why is it that we do these things? Then I start to question my very being and I get so confused and feel so alone. I mean, aren't we all alone on this planet anyway? We find what little comfort in the arms of family and friends, but really, aren't we alone most of the time anyways? If you can't agree with this, then savor this.. when you are reading a book or thinking of something to do, aren't you alone up in your head? We're up in our head or lost in our own thoughts most of the day, so in essence, we're all alone on this planet. So why is it that we 'think' we need others in our lives to conjure up relationships we feel are needed?
Anyhow.. this year I spent NYE completely in undeniably of what laid in front of me. Without the distractions from surroundings, I reminisced on all my goals and what was needed of me to achieve them. After much thought, I came to realize that I too have become a victim of society or the rules made by society. I found myself judging the way I had chosen to live my life alone when I forgot that the very essence of this choice was to enable myself to concentrate on achieving my world's greatest. Soon after I didn't feel bad for myself for spending NYE alone, watching a movie and reading a book. Thereafter I actually felt glad that I had taken some time off to spend with myself in the name of appreciation for all that I've been through.
I do not oppose of the idea of spending NYE or for that matter any holiday with family and friends, rather I feel what we miss most is taking the time off to appreciate ourselves. Who could appreciate ourselves more than us truly?
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