SURE!!! Exactly what I aim to do right now…
:)
KILLING ME SOFTLY
TODAY… Today, today today…. 87 year - old granny was put off the mechanical ventilator per her folks’ request.
Three days ago I intubated “Granny Goose” (Of course not her real name! :-p) after she was noted to have decreasing sensorium and eventually impending Acute Respiratory Failure.
Lola was initially admitted by Orthopedics for possible dis-articulation of her contracted left hand. She had been bed bound (Having suffered CVA THREE times) but otherwise had good nursing care at home.
During the course of this admission, however, laboratory tests and the patient’s clinical status proved she could be at risk for complications brought about by the surgical procedure. She developed pneumonia, AND suffered yet ANOTHER cerebral infarct. Her course was … Downhill.
To cut the long story short, Lola was attached to the mechanical ventilator for 3 days. Sensorium had not improved: No spontaneous motor activity, no eye opening, and no signs of comprehension. On my next 24-Hour duty her folks gathered, and finally decided she should be put off life support. They were appraised as how to go about this hurtful procedure. The family acccepted the consequences, and after the “DNR” (Do not resuscitate) waiver was signed, turned off the machine and pulled out the E-tube.
In the Philippine setting, I have learned 2 instances where withdrawal of life support CAN be “acceptable” :
1. A terminal illness. Human as we are, being inflicted with an end-stage disease (Terminal-stage Cancer and other chronic illnesses ) should make one realize that sometimes, no amount of medical intervention can save or prolong life further. Even the best medical technology, and medical practitioners do not have the capacity to contradict what only GOD wills.
2. Exhausted financial resources. Sad but true. The cost of health still takes a major cut in an average Filipino family’s expenses. Majority would seek admission at a Government, rather than a Private hospital. A private hospital room can actually equal the cost of a good hotel suite. For long-staying patients, medical care can be financially draining. I recall an end-stage renal disease (ESRD) patient, on hemodialysis 2 times a week, who would occasionally rush to our E.R., severely dyspneic. Instead of her twice weekly sessions, she could only afford to have it once every 2 weeks. During one conversation I had with her husband, he was contemplating on selling his welding machine…. the only source of a meager income for his family. Upon hearing what he had said, I and my senior had to walk away… we couldn’t face him, couldn’t bear to hear more. Well, that patient will never have to worry about where to get money for dialysis again.. She’s perfectly happy where she is right now. :)
TODAY, Lola has been off life support for the past… 16Hrs or so…. I surely cannot tell how long she’ll stay, but she has fought a good fight…. :)
5:00AM
Just in time for my early morning jog… I should make this routine.
Couple of years ago I hit the gym 3 times a week, went swimming, and brisk walking at the PPC Baywalk area. My gym instructor was quite good. Made me work my muscles close to it’s limit, but not to the point of strainig. I loved my Abs then - so toned, I had confidence wearing whatever I wanted haha! I indulged in whatever I wanted to eat - NO “Low Fat, Low salt Diet” that we usually prescribe patients, hehe! More important was a feeling of wellness… I could feel my Heart contracting with a GOOD left ventricular systolic function and a high enough “Ejection Fraction” (haha!) I could feel my blood circulating though my vessels, feeding the tiniest arerioles. I felt so HEALTHY.
EWWWWW!!!!! Ok….. Sudden downpour outside…What Luck! :-(
MEDICAL MISSION
… NOT exactly what I planned on doing this weekend off. I wanted to spend time with someone special, though not physically…
So I literally dragged myself to the hospital, arriving LATE.
We saw 179 patients altogether: Pediatrics, Adults and a few Ob-Gyn. The “ENTIRE” barangay had “headaches”, “dizziness”, and “cough”. Most (Actually close to 90%) of my physical examination findings were within normal, diagnoses benign except one hypertensive urgency patient. What lured them all? FREE Medicine. I find it amusing that many “patients” have the SAME Chief Complaints at many of the Medical Missions I have attended. MOST, I guess, aren’t really ill, but just come up with their complaint so as to get free medication (And of course the MD has to arrive at a diagnostic impression. :-p)
The result? Patients receiving medicines they don’t really need. I had to advise my patients that increasing oral fluid intake would be a good help….AND I prescribed VITAMINS for all… hehehe. After all, it was FREE… Another advantage of these Med Missions. :)
All in all, my day was “OK” I guess. Time dedicated to “SERVICE TO HUMANITY” again (Yeah right, hehe…) At least we escaped from the city for a few hours, and stretched our sight over a sea of GREEN. Residents were hospitable (Well, Filipinos usually are) and were very thankful for the service renderd… and it gives me a sense of fulfillment in what I do. Another “Weekend OFF” well spent actually :)
AND.. as for what I had initially planned for, I know you’ll be proud of me, even if we din’t get to spend time together, I’ll always be here.. But the time I went to that far-flung barangay was probably something I might not experience again :)
