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.