Monthly Archives: September 2009

What is the point?

A patient voluntarily checks himself into a hospital because he is afraid of harming himself. He has severe depression. He voices his suicidal idealations, a clear cry for help. He is admitted.

The next morning, he was found unconscious with a suicide note beside him. The staff did not have a policy of monitoring his access to drugs. He was sent to a major hospital for resuscitation. He is now in ICU.

If you need access to drugs, which is the best place to go? The hospital, or a pharmacy. Hence it is not surprising to discover healthcare professionals who are substance addicts. The easy access to drugs, coupled with the high pressured workload is an easy trigger for someone to walk down the addiction pathway.

If you are a suicidal patient, and you are not closely monitored, and let’s say, you discovered a way to get hold of drugs, then what happens? I find it very strange that healthcare staff are not more vigilant in monitoring this patient, especially when it is obvious this patient wants help to stop his depressive behaviour. If you do not have the resources, then surely you should be refering this patient onto another hospital who is better equipped to manage such patients? If all these boils down to financial transactions, then it is a very sad affair.

As fellow healthcare professionals, when we encounter such situations, we usually frown, give a grunt of disapproval, shrug and move on. We do not usually whistle blow because the process is complex, ugly and seriously not worth the time. We have a shortage of doctors with patients to care for. No one is interested in the legal wrangling business. But i can tell you one thing, it gives you a very bad look. You lose our respect, and your reputation is marred in our professional circles. Plus you are not getting any referrals from us.

This is about peoples’ lives. Think about it.

Superficiality or reality?

It has always bothered me how bootlicking political correct people always rise to the top faster than others. I do not think the art of shelling compliments nor the act of pretense is difficult; rather they run along the lines of being immoral, the former being shameless and the latter tedious. So it comes as a shock, albeit a rather enlightening one, when recently, someone of quite high standing, decided to take it upon herself to teach us how to survive in this society.

Her pearls of wisdom?

“In Life, there are plenty of occasions where you are forced to apologize for mistakes you did not do.”

“You must be as bootlicky as possible.”

“You must call the other person’s bluff, certainly i have done that plenty of times.”

This coming from a nearly seventy year old retired doctor.

She gave us this lecture not out of goodwill, but rather out of exasperation for our lack of foresight? Intelligence? Pride?

I felt relieved that this was acknowledged by someone high up the totem pole, at the same time, i could not help but shove the tiny feeling of disgust at the back of my mind.

So this is what society is like?

Seriously, when someone lavishes you with praises, surely, you should get at least a tad suspicious? Taking such words without a pinch of salt can blindsight you and cause your demise. That’s how i operate anyway.

Very sad world.

Another strange product of society

I hate being a University student, specifically a medical student. I am so poor, i am always in despair. Ok, not always, that’s an exaggeration, but i have sporadic worries about my financial situation. University is infamous for ripping great big gaping holes in students’ pockets. Medical school is a double-whammy, because our timetable is so hectic and all over the place that we can’t even hold down a proper part-time job. Who wants to hire people who have irregular schedules, or who can only work a few hours on the weekend? It is difficult to bond with the team, and the boss has to pay us a higher wage since we obviously have to be casual workers, and not the usual part-time or full-time staff.

More importantly, with whatever time left on our hands as medical students, we would probably like to spend it more productively with patients, clocking clinical experience, so we are less likely to kill someone when we graduate, or we would really appreciate a break where we can catch up on our sleep, then we will also be less likely to kill someone accidentally.

Yet our starting wage is such a pittance, i wonder whether it even justifies the hefty course fees we have to pay as an initial investment. True, we earn more as we gain seniority. But honestly, what is the point of earning so much, later on in our lives, where it will come in less helpful, then now, when we are struggling and trying to make ends meet?

Society just befuddles me sometimes. We make it so difficult for us to function, and then we wonder about the rise of mental illnesses. Jeez.

Pathological admiration

You know how some people are filled with so much respect for you, their admiration so open, it is almost embarrassing? I get that quite often by virtue of my profession. I usually just shrug it off, especially if it comes from someone my age or younger. I know i have accomplished quite a lot compared to my peers, so i can understand their sentiments. (And no, i am not being conceited, i am just saying, that is all. Compared with the other medical students my age, that will be a different issue althogether. I am considered mediocre. So anyway…)

I had this open admiration from one of my language teachers. She is way older than me, probably make better pals with my mother than me i reckon. Don’t get me wrong, she is a great teacher and i really enjoy my language lessons with her. But when her admiration became very obvious because i am in the medical profession, i was quite uncomfortable. She was quite open about it, saying that i am in a very respectable profession. I wanted to remind her that she is in a noble profession herself. Teaching requires so much patience it ain’t funny. At least in medicine, when i get bored, i sedate the garrulous patient. Ok i am kidding about that. But yet, i am very uncomfortable with the load of respect she is giving me. Call me old school, but i think admiring someone younger is just wrong.

We were practicing my conversation skills, using family as a topic. (Why do language teachers like to talk about family anyway?? It always perplexes me. Isn’t it rude to inquire about one’s family even if it is for educational purposes?) Being the daft one, i am not accustomed to lying, so i was very honest about my answers. Ok, i can lie, but i can’t blatantly lie to someone who has done no harm to me. And it seems the more answers i gave, the more excited she became. I had the impression she was very curious about my upbringing, and she wanted to know what was the key that landed me in med school. Being the private one, i got increasingly uncomfortable, to that point that i am still brooding about this a few days later. I am a little distressed by this.

I am going to start lying the next lesson. I have a wall that i would like to keep erect around me. Strangers are not welcome. You gotta earn your pass.

Generic medication

Generic medication is cheaper, though not original. We like generic medications when they are available, because it means more patients can afford them. There is better compliance, and perhaps better outcomes. Last week, i went to the pharmacy to get some anti-diarrheal medication. I am a poor student therefore cheaper is better. I knew exactly what i needed. There were two brands, and you guessed it. A generic one, and an original one. The price difference was stark. Except i found myself hesitating. My other friend shot me a knowing look. I bought the original medication instead of the generic one. It has made me wonder whether i am advocating double standards. Obviously generic medication is in no way less inferior than its original counterpart, yet marketing and irrational reasoning have prompted me to choose the non-generic medication. I cannot explain this phenomenon.

Ponyo!

Imagine my shock when i played the first YouTube video and it started singing in English. My heart actually skipped a beat. The English dubbed version was wrecking the entire song. Appalling.

I watched some of the English dubbed trailers, and i must admit that i was cringing when i heard the characters utter heavily American accented English. Guys, you need to watch the original Japanese version. The dubbed ones were off the mark, ruined the atmosphere, and had too much Americaness in it, rendering the whole film ridiculous.

Anyway, the theme song, in Japanese! (There’s English subtitles.)

Code

The last few days i have observed behaviour in the Emergency Department that i hope are misunderstandings on my part. Today security guards were called to deal with a psych patient. A patient who was depressed and who wanted to just go home. A patient that the psychiatrist deemed not safe to be discharged. They called in the bouncers of the hospital. Predictably, the patient panicked, grew more agitated and went beserk. She started shrieking. They dragged her off into an isolation room where they would restrain and chemically calm her down. I saw the nurse prepare the injections and medications.

I was upset. When i spoke to that patient, she was calm and very much in control. Now she isn’t. She does not speak English, could not convey herself properly. The members of the guard team were all English speakers. They did not understand what she was saying, and i do not think they tried very hard. They spoke to her like she was a drunk or a drug addict, using condescending soothing tones as though she was a child. I wondered why they did not call me. I could have interpreted. I can understand if the doctors did not call me. They just came on the shift so they were probably not aware that i had been doing the translating. But the nurse in charge of the patient knew. But he did not bother. In fact, in the middle of the Code, i stopped him as he was wheeling his bloody arsenal of chemical weapons into the isolation room.

I asked if they would like me to talk to the patient. Perhaps she would be able to calm down. I saw her gave me a stricken look as the guards dragged her away. She was weeping. I merely stood to a side, not sure what i was supposed to do. On one hand, i had a medical obligation and i understood certain regulations need to be followed. On the other, we hail from the same culture, and i too understood why the patient was acting the way she was. Yet somehow, i am not able to connect the both, and make people from both sides comprehend. Everything just swept past me, like a massive undertow. I was helpless.

The nurse said the patient was probably too agitated to be spoken to. He was more concerned about my safety. After all, i am only a medical student. But a part of me wondered, isn’t that the whole purpose of me talking to the patient? So that she could calm down, and we do not have to resort to restraining and sedating her?

I left at the end of the shift, her screams emanating from the isolation roon, following me. I was and am upset. Did medical school not teach us that communication was first and foremost, and that different cultures have different practices? How is it that the majority of healthcare professionals seem not to put that into practice?

I am still appalled. And just a little angry. I wish i could do more, but i am not sure what i would do could help.