Saturday, November 11, 2006
Death - our nation's number one killer.
How can I describe the contentment of having 2 whole days to oneself on a weekend, to sit around doing nothing as it pours violently outside and having gusts of cold rain-misted wind splutter through the window. Beautiful day, wonderful weekend. It feels great not having anything to worry about. No horrid patho write-up to type, no playhouse to stress over, nothing at all on the schedule. I'm starting to really treasure my weekends, though I'm not sure when they started being so precious. I can totally imagine wishing desperately that I had two days to rest every weekend by the time I start housemanship.
Anaesthesia posting is not bad; the SGH anaesthetists are such wonderful and witty/sharp people and most of them are always so willing to teach that it makes me almost weep with gratitude (No, really, it does). I don't need any reminder that SGH is my favourite hospital, but it reaffirms my love for the place, haha. Things have been enjoyable and all, but I guess anaesthesia isn't really for me. Procedures are much excitement and sparkly stars, and of course when you do one successfully it's great, pop the champagne and all, but I don't like having to do them all the time (though what am I saying, I'll have to set a gazillion plugs and place half that number of catheters as a HO anyway). I don't like staying in the OT the whole day and having my fingers turn purple from the cold, I don't like wearing scrubs and changing into and out of them, and I don't like wearing the irritating surgical mask and cap. All very trivial reasons, but I guess if you're going to be annoyed by your work environment then why choose to work there? For me, wards are preferred. Or A&E.
I've been feeling rather zonked out the whole week which probably explains why I'm not really enjoying the posting very much so far. One of the anaesthetists say inhaling the anaesthetic gases makes you feel extremely exhausted at the end of the day, but I shouldn't blame the gases when I don't get enough sleep because I'm staying up playing computer games or watching anime. Sleeping past 11 makes me really cranky, so I don't know how I'm going to survive with less sleep than that, ever.
Being addicted to computer games is a really, really bad thing. Ghastly. I just got my hands on Heroes of Might and Magic V some weeks ago and Sid Meier's Railroads last week, and both games are highly (rather annoyingly) addictive so much so that I give up studying to play them. Very bad. Add that to the fact that I've been watching Bleach off Youtube, at least 3 episodes a day, because the story's so darn suspenseful and exciting, and I end up spending extremely little time studying. Abstinence is difficult to practise, unfortunately.
I woke up this morning with great resolve to study, but Robbins is sitting on my table with barely 5 pages read, and my anaesthesia book is totally untouched, and why am I not surprised? This happens every weekend. I'm getting highly worried for Patho because there's only 3 weeks to study before the exams, not to mention I have to go through the pain of having O&G posting before that. Patho is like my worst subject ever, I do worse for it than even Pharmaco, and reading Robbins everything seems so remote and alien, how? *panics*
Patho write-ups are seriously the most annoying contraptions of mass torture ever, did I ever mention that. Especially the group write-up you have to do for the Forensic Path posting, which rather curiously has almost nothing to do with Forensic Path, with topics to choose from including organ transplant and brain death, something about in-vitro fertilisation, and other crap stuff. We chose to do Living Will and the Doctor, which focussed on the Advance Medical Directives (AMD), something which has been reported in great detail in the news lately. It was a good choice, I suppose, because in doing the write-up I ended up thinking (more deeply than usual, because I hate thinking about ethical stuff) about the issues involved and about what the AMD entails. The writing was a whole other matter, and I think we almost died trying to make our write-up sound logical.
I have to admit I knew very little about the AMD before starting this write-up, and always thought it was something like euthanasia. That is possibly the most incorrect perception ever, I think, haha. There are several criteria to fulfill before the AMD can come into effect: firstly you have to have a "terminal" illness where death is "imminent", and then you also need to be unable to participate in any decision-making regarding your medical management, for example, when you are comatose. The value of the AMD comes from being able to direct future decisions regarding your management when you are still healthy and in a right state of mind to make such decisions. The problem with the AMD, in my opinion, is that the definitions are rather vague (possibly because none, or very few people have who have actually signed their AMD have had it come into effect, hence the lack of practical application) and if you think about it, the criteria are extremely narrow. How many people get a terminal illness where any life-sustaining measures are seen as extraordinary and futile, and end up being unconscious, anyway? An example given is patients with end-stage cancer. Granted, I haven't spent any time at all in an oncology ward, so perhaps this situation is actually quite common there.
Still, it seems the recent spate of news reports on the issue of AMD have been providing views of the issue that are pretty far from what it essentially is, and even with the health minister himself commenting on AMD, or maybe I should say because of this, things are just getting muddier and muddier. You know something is wrong when you see an article titled "Don't leave it to your family - you can decide how you go: Khaw" (Today, Fri Nov 10). The article goes on to clarify that its title wishes to convey the message that the decision is a painful one that shouldn't be left as a burden to the family, but on first glance I had the distinct impression that the title implies that one's family would probably make unwise decisions regarding the issue so you're better off making your own decisions beforehand. Whatever the point may be, I feel that the way people talk about it in the press is rather misleading. How can you get people to sign the AMD (if it is indeed for the benefit of the society and the individual, as the health minister likes to emphasise) if you don't provide accurate information? Even I am confused now.
The problem, I think, lies in the fact that the way the AMD act is worded is in itself misleading and open to misinterpretation, which is the reason why no one is really able to provide some kind of logical and consistent explanation of how the system works. And without application of the act, we're not going to be able to refine it such that it becomes more practical. Thus we are caught in a sort of Catch-22 situation. My take is, if you want to make the system better, you've got to have the chance to apply it, so why not get oncologists to raise the issue of an AMD to their patients, get them to think about it, and maybe sign it, in case they one day end up in a terminal state? I would think that when it comes to having to face mortality and decide which path they'd rather go down when the day comes, they're the most suitable candidates around. It's like a prospective study, and you'll have more results to guide your policy revisions when you choose a study population that's going to have a high incidence of the end-point you're studying anyway, right? I don't see any problem with that, if you're just opening the option to your patients for them to consider, and not forcing them to sign the AMD or offering them any worse treatment if they don't. Why not?
[I'm a teeny bit worried that what I just said is somehow unethical and is going to get me lynched, but it just doesn't sound wrong to me, so I'll post it anyway. If I'm found hanging from a tree in Sembawang you know what happened.]
Avaris / 11/11/2006 03:22:00 PM
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