Learning my ABCs

An excellent rendition of the Sesame Street theme song on piano by Joshua Radin.

Sunny Day
Sweepin' the clouds away
On my way to where the air is sweet

Can you tell me how to get
How to get to Sesame Street

Come and play
Everything's A-OK
Friendly neighbours there
That's where we meet

Can you tell me how to get
How to get to Sesame Street

It's a magic carpet ride
Every door will open wide
To happy people like you
Happy people like
What a beautiful

Can you tell me how to get
How to get to Sesame Street

As a child, I was a huge fan of Sesame Street. I would be stuck in front of the tv every weekday afternoon, learning how to pronounce,

"break....................fast"
"break...............fast"
"break..........fast"
"break.....fast"
"breakfast"

and countless other words.

I remember the characters I enjoy, the really grouchy Oscar, Cookie Monster gobbling down cookies, with the cookie crumbles spraying everywhere, and the big bright yellow Big Bird. Not forgetting Kermit the frog, Bert and Ernie.

The show is still running, since 1969!. In a way, I believe that the show has been able to survive for so long is mainly down to its ability to adapt. It uses a combination of puppets and live actors to stimulate children's minds and to improve their literacy and numeracy skills. Besides that, it also teaches basic life skills, such as proper hygiene (teaching Cookie Monster to clean his teeth at night), healthy eating habits, and social skills (how not to be as grouchy as Oscar).

What more can you ask from an educational tv program for children?

This blog has been brought to you by the letter M and the number 27.

Ps. I have heard of Joshua Radin prior to these due to some of his songs being aired on Grey's Anatomy. After a random google, I found out that he will be performing in London this March. So, without hesitation, I bought tickets for his performance. =)

Angels Flying Too Close

If you had not have fallen
Then I would not have found you
Angel flying too close to the ground
And I patched up your broken wing
And hung around a while
Tried to keep your spirits up
And your fever down
I knew someday that you would fly away
For love's the greatest healer to be found
So leave me if you need to
I will still remember
Angel flying too close to the ground
Fly on, fly on past the speed of sound
I'd rather see you up
Than see you down
Leave me if you need to
I will still remember
Angel flying too close to the ground

Heard the above song, 'Angels Flying Too Close' by Beth Rowley in Private Practice, another medical drama series, which is a spin-off from Grey's Anatomy. Like Grey's Anatomy, it deals with complex emotional medical problems, which I can relate more to, being a medic at heart.

One thing I enjoy about watching these tv series is that they find an interesting collection of under-heard or under-appreciated tunes. There are lots of undiscovered talents out there and they managed to find good wall-to-wall music that goes well with the show. I have discovered more artists and their music through these series than our local UK radio station, that's for sure.

Ps. The above song was originally sung by Willie Nelson, but I like this version better.

A surgeon or an executioner?

Following on from the post on organ donation, Grey's Anatomy recently aired a 3-episode series focusing on organ donation.

A young 16-year old boy requires a liver and small bowel transplantation, desperately.

A heavily guarded death row patient comes into the hospital following a home-made knife (a sharpened toothbrush) inserted into his spine. He denies any life-saving operation as he is due to be executed next week for slitting 5 women's throat 'for fun'. Dr Shepherd, the neurosurgeon refuses to comply with his wishes, as he does not want to allow the patient to 'cheat the system'. He waits for the patient to become unconscious and takes him to theatre to be operated on.

Post-surgery, the death row patient finds out that the young boy requires a transplant and offers his own.

'Let me save a life before I go'

However, protocol does not permit it, despite him being a perfect match for the young boy.

Meanwhile, time is running out for the young boy.

The death row patient suffers a self-inflicted post-operative complication and is rushed back to theatre. In desperation, Dr Bailey, the surgeon looking after the young boy, rushes into theatre to request that Dr Shepherd stops the operation.

'This man is trying to kill himself. God forgive me, I need you to let him.'

Dr Shepherd puts down his scalpel and asks Dr Bailey.

'It's your call. Am I an executioner or a surgeon?'

If one believes in utilitarianism, where the moral worth of an action is determined by its outcome, simply put, the end justify the means, it seems the right decision to do. The man wants to die. If he does, his organs can be put to good use to save a young boy's life. The man is going to be executed in 5 days regardless, and his organs will be wasted, so to speak.

Watching the series, I can understand the emotional turmoil going on in Dr Bailey's mind. It's a difficult situation to be in, complicated by her being emotionally-involved with her young patient. As doctors, we are often told not to become too emotionally-involved with our patients as it can cloud your clinical judgement, as in this case. Dr Bailey crossed a line by asking another surgeon to intentionally withhold treatment for his patient, in order to save her own patient.

I will not reveal how the series ended. Watch it yourself to find out.

The above scenario explains why I enjoy watching Grey's Anatomy. It's very melodramatic due to the complex ethical surgical problems that occurs on the series. Granted I am not a surgeon, but with each problem, I can visualise how it can happen in my own medical world and sort-of gives me a simulated training on how I would handle such scenarios in the future.

Who says you can't learn from the tv? :P

Itinerary headache

Spent the whole afternoon planning my itinerary for my trip to Delhi, India next month. Will be there to present my abstract at a medical conference and will use the extra days there to travel around. Using my Lonely Planet guidebook and this absolutely fantastic forum, India Travel Forum, I have finally managed to sort out my accommodation in Delhi, Agra and Jaipur (the Golden Triangle cities).

Also managed to buy all my train tickets (Delhi-Agra, Agra-Jaipur, Jaipur-Delhi) online, which are e-tickets. Thanks again to the helpful India Travel Forum, where every question you could possible ask has been asked before and answered by people who have been there and know their 2 Rupees worth.

I could have saved myself all the trouble by using a tour package which covers Agra and Jaipur from Delhi, but the tour packages were pretty expensive (about 250 pounds), and it's much more fun to plan the trip oneself.

Am excited about my trip but also slightly scared at the same time. It will be my first trip to India, and I am going alone. It will definitely be an enriching experience for me. I just hope it all goes well.

Seven pounds - spoiler

If you intend to watch the movie, 'Seven Pounds', please do not read any further unless you want to know the plot.
You have been warned....

It's a story about a man who causes a car crash by reading his mobile phone's display while driving, and causes the death of 7 people, including his fiance.

As a result, he sets out to change the lives of 7 people by donating his organs to them. While alive, he donated a lung lobe to his brother, a part of his liver to a stranger called Holly, a bone marrow to a young kid and a kidney to another stranger.

He also donated his house and a large amount of money to a domestic-abused mom and her 2 children.

So, that's 5 people he had helped.

He needed 2 more people to help. And decides to donate his heart to a woman with congenital heart failure and his eyes to a blind man. And he does it by committing suicide in a way that preserves the heart - by allowing to be killed by a poisonous jelly-fish in a bathtub fulled with ice. He leaves a note to warn people about the poisonous jelly-fish and rings 911 to inform them about his impending suicide.

What bothered me about the story plot was the issue that the protagonist in the story made sure that the people he was about to donate his organs to were worthy of his organs. When alive, yes, you can make a decision that I want to donate my kidney/lung/liver to Mr X or Miss Y. And if you find out that Mr X is a paedophile, you can choose not to proceed with the donation. That is your choice. You have the autonomy to do so. However, for living donation, there is a lot of strict regulations to meet and a thorough process of assessment and discussion before it can go ahead.

However, once dead, I do not think that it is right that one has a choice to dictate who he wants his organs to go to. It should be a matter of need and priority. Not discriminated by how naughty or nice you have been this year.

As it is, we are in desperate need for organ donors and this movie does not help the cause if people were to come away from the movie thinking that they can choose who receives their organs.

In the UK, organs and tissue cannot be accepted unless they are freely donated. No conditions can be attached in terms of potential recipients. The only restriction allowed is which organs or tissue are to be donated.

I hope this has helped to clear up any misunderstanding that people might have on organ donation. If you have any further queries, please visit the NHS Organ Donor website or the Malaysian Society of Transplantation website.

Consider being an organ donor today....

Decision-making time

Am back from the US. Am extremely jet-lagged and tired now due to the non-stop traveling.

It's time for me to make some decisions now. However, the ball is not just in my court. It's a two-way system. The US programs have to want me and vice versa. I just need to decide which programs do I want and hopefully, they feel the same about me.

All will be revealed in mid-March.

Meanwhile, I need to get started on my list of things to do which has been accumulating and accumulating. Not to forget another exam and more assignments to complete.

I think I bite off more than I can chew.

US trip

Am off to the US today for a week. It will be an important week for me as it will determine if I decide to move to the US to further my postgraduate medical training.

Lots of people have asked me why I am considering moving to a new country for training when I am already established in the UK training system. To be honest, I don’t know but somehow, I feel as if I am not getting the training I need here in the UK. It could just be due to the hospital I am working in, which might improve if I move to a different hospital. Don’t get me wrong, I have really enjoyed my time working in my current hospital. I have met really friendly and helpful consultants and registrars who have taught me well. But somehow, the daily grind is wearing me down. I can feel my enthusiasm for going to work each day decreasing day by day.

Maybe all I need is a good break, a good holiday.

Or maybe I am getting restless and would like to explore new pastures.

We shall see…..

I survived!

Oh what joy! I survived my first week of nights on the unit.

Phew!

And repeating the same process in early February and late March. Hopefully by then, I would have had more experience and no longer be so stressed out.

Stressful sleeping

Am having extreme difficulty sleeping for the past few days. The reason for this is because I am currently working the night shift on the unit. The stress of working the night shift is giving me sleepless days, as I keep on worrying about my shift.

Why am I so stressed? Let me explain.

During the night shift, I am the sole doctor in the unit. I look after 14 patients in the unit. Patients with multi-organ failure and are the sickest of the sickest. Me! A doctor who is only 18 months out of medical school. Of course, I have been told that the on-call consultant (who is at home) is just a phone call away and I can call them for any queries/problems/issues that I have. Furthermore, the on-call consultant lives very close to the hospital and if needed, they can arrive within 5 minutes at the hospital.

Besides that, I attend cardiac arrests and take referrals for admission from other specialties. Luckily for me, I don't make the decision whether to admit or not. I review the patient, gather the information and present the information in a coherent and succinct manner to my consultant (over the phone). And what worries me is that there is a potential that I might not present the information correctly, thus resulting in a wrong decision made, which could either be

1) Admitting a patient who actually doesn't need intensive monitoring
or
2) Turning away a patient who actually does need intensive monitoring

(I prefer scenario 1 rather than 2, obviously)

In some patients, it's very easy to tell that they need admission to the unit. It is the grey cases where they seem to be manageable on the ward but have the potential to deteriorate which makes it difficult to decide whether to admit them or not. Of course, if we had unlimited resources, we could admit everyone but this is not the case. A bed in the unit is a precious commodity which should only be used if necessary.

Now, you understand why I am so stressed out?

The value of life

A fit and healthy 65-year old man was hit by a motorcycle while out jogging in the evening and was admitted to a district general hospital. On examination, he was found to have suffered a complicated fracture of his hip, which required specialist input. He was due to be transferred to a tertiary medical centre for further management. Unfortunately, due to the shortage of beds, he waited 6 days before being transferred.

On the day of his operation, as he was lying on the operating table, he suffered a cardiac arrest secondary to a massive pulmonary embolism (clot in the lungs). They performed CPR for a total of 45 minutes before a return of spontaneous circulation was obtained. Unfortunately, during that time, the brain lacked oxygen and he suffered hypoxic brain injury.

The operation was postponed and he was transferred to the unit for post-cardiac arrest management. Following stabilisation of his condition, he had his operation 2 days later. Unfortunately, his neurological status never improved due to the prolonged hypoxic brain injury.

What is the next management plan for him? What will his quality of life be? Considering that he will very likely be mentally-disabled for life, is prolonging his life in his best interest?

Difficult issues to consider, difficult decisions to make. What would you do?

Rest in peace

Case 1 : Elderly man with past medical history of Crohn's disease, and has had multiple abdominal surgery in the past, was admitted for acute confusion and high temperature. Blood results showed severe sepsis with a coagulopathy, while the CT abdomen showed multiple collections in the abdomen. Was transferred to the unit for stabilisation prior to surgery which involves correcting the coagulopathy with multiple blood products. Had a laparotomy by the surgeons which involved removing 3/4 of his large colon and then transferred back to the unit for further management. On Christmas eve, he suffered a massive myocardial infarction (heart attack) of which the risk of treating outweighed the benefits due to his coagulopathy. Family and unit consultants agreed for conservative management and the patient was transferred to the ward for palliative management. He died on Christmas Day.

Case 2 : Elderly woman, known alcoholic abuse, admitted on the eve of New Year's Eve for shortness of breath of 2 days duration. Daughter reports patient normally drinks a lot (unable to quantify) but has been drinking more than her usual amount since Christmas Day. Initial diagnosis was community-acquired pneumonia and was started on antibiotics. However, due to the lack of respiratory symptoms of cough or sputum, a pulmonary embolism was suspected. A CT pulmonary angiogram was performed which was unable to rule out a pulmonary embolism. Patient started on treatment for PE. While on the ward, she suffered a respiratory arrest and was found to be in pulseless electrical activity. Appropriate cardiopulmonary resuscitation (CPR) was performed. Patient intubated, ventilated and transferred to the unit on New Year's Eve. Despite adequate ventilation, she developed renal failure (requiring dialysis) and heart failure (requiring inotropes). Due to her progressive deterioration, the family and the unit consultant agreed to withdraw treatment to prevent prolonging death. Terminal weaning plan was started and the patient died on New Year's Day.

Looking at the 2 cases, they are both individuals who, despite all our intervention, did not survive. However, there is more.....

What would you say if I told you that case 1 and case 2 are husband and wife? May they both rest in peace.

Auld Lang Syne

Went to work as normal on New Year's Eve, and managed to finish work at 6-ish pm. Then, it was a dash home to shower and change for a small gathering at a friend's house for dinner. As my friend had no television or radio, we resorted to using the internet for BBC radio 1 to listen to the countdown. I had an enjoyable time despite my emotions running wild as a month back, this was not how I had thought I would be celebrating the New Year. But then again, who could have predicted that it would have ended up this way?

New year's resolution. Hmm... Looking back at 2008, I realised that I had not been looking after myself. Due to my now-ex-relationship, I had become too complacent and had slack off in many areas, particularly exercise and beauty care. For 2009, I resolve to look after myself first and to make an effort to pick up where I had slack off.

And I hope that I get over this current predicament that I am facing, and that I will also be able to find it in my heart to forgive him.

The passing of the new year will not be complete without the song Auld Lang Syne. A song that I know very well but never knew the true meaning of. Auld Lang Syne is a Scottish poem written by Robert Burns in 1788 and is set to the tune of a traditional folk song.

The English translation of the song is as below.

And for old long past, my joy (sweetheart),
For old long past,
We will take a cup of kindness yet,
For old long past,

Should old acquaintance be forgot,
And never brought to mind?
Should old acquaintance be forgot,
And days of old long past.

And surely you will pay for your pint-vessel!
And surely I will pay for mine!
And we will take a cup of kindness yet,
For old long past.

We two have run about the hillsides
And pulled the wild daisies fine;
But we have wandered many a weary foot
Since old long past.

We two have paddled in the stream,
From morning sun till noon;
But seas between us broad have roared
Since old long past.

And there is a hand, my trusty friend!
And give me a hand of yours!
And we will take a right good-will drink,

For old long past.

Auld Lang Syne by Mairi Campbell (from Sex and the City: The Movie)

Happy 2009!

Happy new year! Happy 2009! May it be a prosperous and blessed one.