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The events of the week have left me doing some serious thinking on my own. Of right and wrong and the in betweens.

The first event was when a man in the ward went into cardiac arrest. He was resuscitated successfully. But after the event the decision to resuscitate came into question. Because he has metastatic lung cancer. To make matters more complicated, he hasn’t got a histological diagnosis just yet -so technically the diagnosis remained unconfirmed. (but then again what else can cause masses in the lung, the nodes and bones?)

Is it right to get a ‘do not resuscitate order’ now??what if the family said no, and the patient remains undecided? (like in this case).

From the medics’ point of view, DNAR is most appropriate. But when I asked the patient, this is what he said,”I’ve been well before i came into hospital, you know, playing golf and all. I want to see my granddaughter performing, she took this dancing class..and there is a family wedding next year, you know.”

He was recuperating well now. walking in the ward freely and entertaining his visitors. What if they did not resuscitate him before? Does this mean we deny him a few more months of quality life? of being with his loved ones?

But what if the resuscitation was unsuccessful? and he end up comatose, but breathing? Are we tempering with nature and preventing what should have been?

We had this lecture about ‘letting go’ a while ago. about knowing when to stop to interfere and let nature runs its course. But this is the first time i am faced with situation when we are ready to let go, but the patient is adamant to hold on.

The second event was when this highly regarded (by friend and foe alike) blogger cum political journalist in mudcity was detained without trial. Because he was alleged to be a national threat.

I could see teh point of the act. when it comes to people that pose clear and imminent threat to the security of the community or the wider nation. For example someone who is about to take off on a plane and hit the twin tower. Or some one who propagates racial hatred and people are getting ready to march in the street and kill everyone that come across them as having a darker or fairer skin shade. Then the use of this act is not only appropriate, but the one and only alternative to take.

But of course real cases are not this clear-cut. And when inconsistencies exist about the crime someone commited, would it then, be fair to impose detention without trial? If half of the nation belief that someone is innocent, then who have the right to jail him without hearing his side of the story?

And because of this act, we will never know about the people who are detained under it. Never knowing whether they did commit the crime as alleged. And whether we did make the nation a better place by jailing these individuals. The saddest thing is, we may have a hand in letting innocent men rot in jail by supporting this act. We never know.

Personally, I belief strongly that everyone is innocent until proven otherwise. As strongly as I belief that first, we must do no harm. And for these two principles alone, this act neither has my support nor acknowledgement. I am happy to know why other people think otherwise..

I do learn in the ward. From the patients mostly. Here’s what I learned this week alone..

1. On the art of listening..

Patient:”what do you want me to do doctor?”

Doc: “I want look at your neck to see if your vein is bulging, have a tap on your chest to hear what it sounds like, and listen to your chest with this stethoscope. I am looking for any signs of the fluids in your lung getting any less. If it hasn’t that I would hear a crackling sound..bla bla bla”

Patient:”What do you want ME to do, doctor?”

Doc:”Ohh..just lie still please”

2. On getting old

Patient:”It’s hard work this..”

Me: What is, Mr. B? (thinking to self: is it because he has to drag his catheter bag everywhere he goes? oh, wait a minute he needs to get to the wheelchair first coz he only has one leg, or is it because he is tied down to the oxygen..?)

Patient: Getting old.

3. On showing your appreciation to your loved ones

Doc: we need to get the tube in so that we can feed you. Your wife and son agrees that it is the best way to go from here. is that ok?

Patient: ghhhee..raaaa…mmeeeyy..hghhrrrrr (while pointing at the wife and son)

Doc: What is it sir?

Patient: theyyy..ghraaa..dentttjj..lifeeee..

Doc: hmm?(leaning closer)

Patient: (trying again)

Doc: Oh, they are the most important people in your life, your wife and son!

Patients: yesss..

*the patient had vocal cord plasy by the way.

4. On the unpredictability of death.

Me: thank you for letting me examine you. I hope your breathing continues to get better.

Patient: No, thank you love. You know what, next time I see you, you will be my doctor.

Me: gehehehe (grinning sheepishly)

*The next time i saw her was the day after. she was dead then.

An esteemed colleague once told me. In medicine you’ll always be frustrated by people. But you will never get bored. Because people is never boring. They will never cease to amuse you.

They are amusing, yes. But above all, they teach me loads. About the reality of life. About humility. About being nice to people -just because, and not having to have a reason to. I bet there is no better way to learn.
And that is why medical students are let loose in the ward, despite knowing for a fact that we are accidents awaiting to happen. Ha!

It is now 3.30 a.m. I vowed to myself 3 hours previously that I will read about peripheral vascular disease. This is the punishment for sleeping the whole day today. And thus far I’ve only covered 2 pages. 10 more to go. I give up.

Let me reminisce about happier times. A time when books and exams are distant memories. My Eurotrip!! Yeah I (and my friend) did it on our own 4 feet! Within the span of 19 days, I’ve set my foot on 9 different countries all over Europe: Budapest, Hungary-Bratislava, Slovakia-Vienna, Austria-Krakow, Poland-Pague, Czech republic-Munich&Fussen, Germany-Lucern, Interlaken, Laussane&Geneva, Switzerland-Paris, France-Brussels, Belgium.

We brave sleepless bumpy nights on the train, confusing maps and road signs, annoying beggars, unrelenting fatigue, rice-less and meat-less days and open shower. And in doing so we met some very lovely people, sample interesting cuisine, witness breath-taking views of natural beauty and man-made architecture and generally had so much fun. Oh yeah, I learnt a lot too. Seriously I did. Here’s some (+advices too)..

1. Don’t trust the exchange rate quoted in the guide book. We get less for our british pound wherever we go.

2. If u can’t find your hostel, go into another hostel/hotel and ask. Chances are, the receptionist speak English.

3. If people stare at you, they are either: 1. Never seen someone as pretty before. 2. Never seen someone as exotic before 2. Had a bilateral squint-so they are actually looking at something else. The main point is, don’t take it to heart.

4. If you book a couchette on an overnight train, don’t expect to be able to sit at all. Lie on your tummy, sides or back to get comfortable. Just don’t sit up, not unless you want a head concussion.

5. Taking a wudhu’ (ablution before prayer) on a moving train can be tricky. having a good vestibular function helps.

6. Dont pass bowel motion in the toilet of a non-moving train. Chances are, people at the platform can see your stools once the train get moving (not that they can tell it’s your n’way). Passing water is less of an offense but is still frown upon.

7. Expect to just go to museums and lazing in starbucks / mccafe on sundays. All teh shops are close. Every single one. I guess people in Europe don’t have any emergency on Sundays. They don’t run out of baby napkins/milk, women’s tampon or paracetamol on Sundays.

8. Mc Cafe is even greater than starbucks. Do try.

9. If you are offered a cigarrete by a drunk man carrying a radio (blasting German rock song at full volume) do decline it politely, regardless of how tempting it is. I girl accepted, and the man ended up sleeping on her lap- and she ended up having vascular insufficiency/nerve compression of the lower limb after some time (or more famously known as ant-ant in malay)

10. Don’t offer Germans, Swiss or French people the shower before you. Chances are, they are going to strip right in front of you. Also keep your gaze low the whole time you are in the shower. Also expect no curtain or door to go with your shower cubicle.

11. Dont bother going to Lido or whatever in Paris-unless you have loads to spend. Various performances can be seen in the metro stations, in the train itself, or in the streets. From classic Chinese songs to puppet shows. It’s even free!-if you pretend you dont understand them when they come for money.

12. Learn to drink coffee in bowl, using spoon in Paris.

13. There are so many elderly people working for a living. They stand from morning to night trying to make a sale. And as it near 10 p.m, one old man looked dejectedly at the dying flowers by his feet. It touches the heart. This is not supposed to happen.

14. Let yourself be 7 again in Disneyland Paris. Scream in excitement when you catch side of Minnie. Wave and jump like crazy at the processions. Run up the stairs of Sleeping Beauty’s Castle, imagining you are Beauty. Believe in true love, for one day. Ha.

15. Be prepared to be spellbound by the beauty of switzerland. Blue skies, Green Mountains, with splashes of whites from the distant Jungfrau and greenish blue lakes. You have to see it to be spellbounded.

16. King Ludwig WAS crazy. Certified by Dr B, my previous PBL tutor whose great3x grandfather was the psychiatrist treating the king. He was found dead alongside with the king-who drowned in a lake, but who was known to be a good swimmer. After all, genius borders insanity. There’s a thin line between them. It takes a genius and a madman to envision and build a magnificent castle with the backdrop of mountains, waterfalls, lakes and valleys.

17. There is never a shortage of sadist psychopaths who take pleasure in killing and torturing fellow humans. Austwich-Birkeneau concentration camp is a testament to this. Sadly, there is no ‘Austwich-Birkeneau’ in Sebrenica Bosnia, Darfur Sudan, or Shabra and Shatilla in Palestine. We must take heed of all these, because “if one does not understand history, one is bound to live through it again”. “Unlimited, however, are the moral and physical powers that man has within him” to face the oppressors.

18. If you think you have been to the biggest, greatest museum on science and technology, you have seen nothing yet till you’ve been to Deutsche museum in Munich. Proper hydration and lots of sugar-based food is advised. Be selective. Just visit displays that interest you. After you have decided, half the list. Even then, you will still feel like vomiting after 5-6 hours. For the brave hearted, you can push to 7 hours maximum. Once you experience the following symptoms, I advise you to get the hell out of there; dizziness, unsteadiness, leg cramps, blurry vision and difficulty differentiating a ship from an aeroplane. And i do mean get out quick. The same advise is applicable when visiting the Louvre in Paris as well.

19. Go to Brussels just for the waffle and the chocolate. Unless a monument of a-3 year old growth hormone deficient boy doing what a boy does (peeing in public) is your cup of tea.

That’s it. I cant think of anything no more. 19 lessons for 19 days. I think that is enough. There’s a lot more lessons that is too complicated and intricate that requires more than one lousy paragraph. It need a proper face-to-face story-telling with lots of high-pitched squels and hands flying in the air. Enough said.

Like the dell ad. Difference is, I was eager and excited when i received my dell. I am neither of those now.

Not all is bleak and gloomy like the current preston weather, though. For a start, the new accomodation is great (most of the greatness comes from the fact that everything is free). In hospital I feel more confident (and find more enjoyment in) when i disturb, interogate, prode and prick patients with needles. So all in all life is not bad at the moment. Not bad at all. If manchester suddenly realize that we can graduate without sitting for the finals then it will be much better. Great, even.

so what is the point of this entry. None actually. none at all.