Tuesday, March 24, 2009


Passed


Well, I guess I passed.

=)

I have to thank my AH tutors, Prof Sum, Dr Terence Tang, Dr Goh, Dr Li, for so patiently teaching us, and not treating us as "failures". For taking time out of their busy schedules to not just to give us tutorials, but going around the wards preparing cases for us. Thanks alot alot.

Especially want to thank Dr Noel Tay from TTSH, who was my M3 Medicine posting tutor. It was he who called me after knowing that I've failed, not to scold me, but to tell me that its ok. It was he who agreed to give me extra tutorials during my reposting after I sent him a facebook msg. It was also he who told me, "Just remember, what doesn't kill you will make you stronger." Thanks alot alot alot.

Thanks to my group mates during the reposting!! Mogilan, Siying and Mirriam. Thanks for all the smiles and laughter along the way. Thanks for tolerating my crankiness and occasional angsty-ness.. =)

Thanks to my frens who provided encouragement along the way. For bothering to ask me "how is it going?" For believing in me, even though I'm not sure it was well deserved. And especially Ivy and Raphael, who kindly agreed to act as patients and let me clerk them over the phone. Thanks for actually preparing the histories!!! Yup, this resulted in me "clerking" almost 10 long cases in the final week, ranging from the simplest of cases to the most irritating, complicated types of cases. Thanks aloooooooooooot.

And of cos, all the other ppl that I've met in the wards, my fellow classmates, who were always generous in sharing the cases. (Wenphei, thanks for the PCK!! my 致命伤..) And thanks to all the patients who allowed me to talk to them and/or examine them.

Thanks =)

posted by nwxiang at 12:04 AM | 0 comments


Wednesday, March 18, 2009


Clarification on the last post


Hi, perhaps it's the way I wrote the last post that my emphasis was misread. I was actually emphasizing on the part that we shouldn't base our clinical decisions on subjective opinion, rather than the part on who to choose to operate on first. The example I gave was just a lead into the later part that I was trying to make a point about.

(Fortunately) In real life, we seldom face "artificial" dilemmas like this. Patients seldom arrive at the same second and seldom have "identical" vital signs. Even if they arrive at the same time, they would usually present with differing problems, and one would probably require more urgent attention from the other. Besides, there would definitely be more than one operating theater available (unless we are talking about major disasters).

My point is that we should not judge our patients (at least not as a reflex). We should not label them as being "deserving" or "undeserving" to live or to receive treatment. True, the guy may have committed suicide. On the surface, he might seem to value his own life less than the other guy, thus leading to the conclusion that he is less "deserving" of another chance at life. But is it really that simple?

Have we asked why?

Why did he commit suicide? The answer is almost inevitably "multifactorial". Ignorance? Financial? Social? Family? Medical? There is no single answer. You may say that he chose to end his life, by his own freewill, but is it that "free"? I would say that it is rather a choice shaped by circumstances, circumstances that might be out of his control, that might not be of his own doing. It might help to take a step back and be reminded that not everyone has the fortune of being highly educated like us. Not everyone has a complete family. Not everyone has a stable financial status.

There are a myriad of things, infinite permutations and possibilities. And almost definitely, these factors are influenced both by this individual's own actions and external contributors, some not directly "correctable" by him himself. And the interplay of these factors have cumulated in his act of self-destruction. True, he is accountable for his actions, but given all the above, is he deserving of his current circumstances? How do you define "deserving"? Who defines whether someone is "deserving"? I am pretty sure it is not us.

On the other hand, how much is the other guy free from "accountability"? Why was he involved in the accident? (eg. did not wear seat belts; did not wear safety harness/helmet; working/driving under influence of drugs/alcohol etc etc) Again, both intrinsic and extrinsic factors play a role, both directly influenced by the individual's actions and totally uncontrolled by him. How much role did his individual actions play? We do not know. Again, we do not know.

Before I leave this part of the discussion, I want to remind everyone of a medical condition called "depression". This patient likely has depression. In fact, it is likely that the majority of suicidal patients have depression. Depression is a medical condition, not so different from a flu, a pneumonia or a cancer. It merely affects a different part of the human body. I do not think anyone chooses to be depressed, same thing as nobody chooses to have a pneumonia or a cancer. That said, how "accountable" is this patient for his act of self-destruction committed under the influence of his illness? I will not elaborate, for this opens up another can of worms (in fact patients with COPD can be said to be "undeserving" of treatment because they chose to smoke; patients have cancer because they chose to lead an unhealthy lifestyle.. where do you draw the line??)

Hence I shall summarise my points as follows
  1. We do not have sufficient information to judge the actions of our patients
  2. There is no clear definition of who is "deserving", based on the actions of our patients
  3. It is not our job to judge the actions of our patients
  4. We do not give/withhold treatment based on what perceived right and wrongs of the actions of our patients.
When faced with the artificial situation above, true, we may have no choice but to choose one (oxymoron) to save. But I would base it on objective measures: who's vitals are more unstable, thus requiring more urgent attention etc. I hope I made my point. My point was not about who to choose, but rather a discussion against making a judgment based on the actions of patients. Thanks for reading.. =)

posted by nwxiang at 11:13 PM | 0 comments


Saturday, March 14, 2009


Life or Death


Below is a scenario based on true events, modified slightly to give the reader a dilemma.

2 patients are admitted to the emergency department. One fell from height while working. One fell from a (failed) attempt at suicide. Both are grievously injured*. Their vital signs have been temporary stabilised, but they will probably die in hours without surgery. There is only one operating theater available currently. Who will you choose to operate on first?

(*when I say "grievously injured" I mean grievously. Forget your hollywood gore flicks, they dun even imagine half of what we see.)

I was really aghast, and disgusted even, when someone commented that he would choose the one that was injured at work to save first, because the other guy deserves it. To top it up, he even said that he would go as far as to fake the working guy's vital signs so that he looked that he was in a poorer condition, so that he might be saved first.

We have no right to judge.

Patients are admitted to the hospital to be treated, not to be judged. True, doctors are humans too. We have our own feelings, our own subjective views of things, BUT we must try as hard as possible to not allow them to cloud our clinical decisions. We are doctors, not judges. We do not get to decide who lives and who dies. That is not within our duties. The society has not accorded us that power.

No matter what the patient has done, no matter what background he/she came from, we must still discharge our responsibilities dutifully, to the best of our abilities. True, this may only be an ideal, but it should be an ideal that we all try to strive for.

Perhaps a simple guideline would be "do unto others as you would have others do unto you". Who knows, someday you might be at the other end of the stethoscope/scalpel.

posted by nwxiang at 2:15 AM | 0 comments


Saturday, March 07, 2009


Over?


It still hangs in balance. I have lots of people to thank, but I will reserve it until I know my results..

posted by nwxiang at 9:24 PM | 0 comments


Friday, March 06, 2009


This time.


Stronger, faster, better.

But is it enough?

posted by nwxiang at 10:34 PM | 0 comments


Sunday, March 01, 2009


10km


Somehow I managed to finish it. Not a very good timing, but I guess it's ok for a first time? Plus it's like 1 week b4 my end-of-posting test.. ok enough self-consolation..

posted by nwxiang at 10:28 PM | 0 comments