Health for all?

I was pretty annoyed recently when I read of a statement by the Minister of Health that alcoholics should be denied treatment by the public health sector. That sanctimonious ... um... person...!!! Who is he to decide who gets treated and who gets denied? And then my second thoughts kicked in. I have been guilty of thinking the very same thing, not once but a hundred times, not just about alcoholics, but also of smokers and several others too.

It's hard to think charitable thoughts when an alcoholic is wheeled in as a "stat" admission, usually semi-conscious, vomiting blood, delirious and uncooperative. I confess I usually suppress a groan of despair at the sight of them... and with good reason. Almost invariably it results in a lot of running around, organising blood, plasma etc. etc. Especially at night where there is only one doctor and two nurses in a ward, this usually means that other patients might get neglected. Drugs and injections are not given on time, and other admissions are not seen to, because everyone is hovering around the alcoholic dude.

You see, the chronic alcoholics are LOUD. They are dramatic - swollen bellies, hallucinations, screams, blood and guts. They are critical - they may go into cardiac arrest at any time. And when (not if) they do, they are so obese, that it is near impossible for me to clamber on to their beds to deliver effective CPR. An additional thing I've noticed is that somehow, the relatives are the most demanding I've come across, the ones who are quick to make a fuss if things aren't done NOW.

And in the melee it is easy to miss the young dengue patient whose blood pressure has dropped, or the guy with the heart attack who has developed a rhythm disturbance of the heart, or the guy with leptospirosis whose urine output has dropped. When we do find out, it's because they too have progressed to a critical stage, when it could have been nipped in the bud. And that's not fair.

Then there is the expense. It's ironic that the patients with chronic lung disease due to smoking and chronic liver disease due to boozing cost the state more that the innocent johnny on the next bed who has done nothing to deserve his illness. Spiral CT scans, high resolution CT scans, ultra-sound scans, endoscopy, radiographically guided biopsies, inhalers, drugs, blood and blood products. Factor in the cost of hospital stay, meals, linen etc., which are also borne by the state. And then the health care sector runs through its allocated budget, and it is the other poor patients that bear the brunt of it. That's not fair.

You have to admit that the diseases are distressing, painful and associated with the hopelessness of knowing there is no cure. Yet because of the whole psychology behind short term rewards vs. long time penalties, very few cut down on their consumption, despite begging and pleading by the mothers, wives and children, and despite dark predictions by their doctors. I strongly believe that addicts must take responsibility for their actions, but there's always that niggling knowledge that for a person who is physically/psychologically addicted to something, the choice to stop is that much harder.

And this is where I blame the people in charge - officials who issue liquor licenses, politicians who extol the revenue brought in by taxing alcohol and tobacco but who are too short sighted to see the costs of a diseased society. I blame policemen who consort with brewers of moonshine in exchange for bribes, and officials who exploit legal loopholes. It has been scientifically proven that increase in taxation and ban of advertising and ban of public consumption are effective measures in controlling tobacco and alcohol. And yet we have this. No perfumes or jewelery; no watches, electronic gadgets or chocolates. Just tobacco and alcohol, sold duty free... thithata matha.

I am no saint. Even though I have never spoken it out for a patient or relative to hear, I have often thought viciously to myself "yes, go ahead, drink all you want, just die at home instead of landing in the small hours of the morning and ruining my sleep" (remember in SL, we don't get the following day off after a rough night on-call). To deny those thoughts is to be dishonest and blind to my own failings.

In spite of all that, we should never lose sight of the fact that we are dealing with human beings. That denying healthcare to anyone - whatever their failings may be - is unethical, unacceptable and a betrayal of the compassion we all need to cultivate within ourselves.

First death

Somehow, I think that is something that really affects all doctors... the first time someone dies on your watch.

Mine was a few years ago and I still get flashbacks... still remember locking my self up in the teaching room of our ward and retching over and over again until there was nothing left to throw up. Still remember sliding against the cool wall until I was seated on the floor, alone in the darkness, hot tears burning my cheeks and whispering "I'm sorry" over and over again. Still remember it taking the best part of an hour to stop shaking... and then walking out, completing the night round, calmly writing out the death certificate. Still remember going home in a daze, walking into the shower, clothes and all. I threw away those clothes - they were so soaked in blood I don't think anything short of a blade would have gotten the stains out.

Since then, I have watched scores of people breathe their last, closed their sightless eyes, talked to hysterical relatives and filled out the forms over and over again. Death no longer has the power to shock... but the awe still remains. And so do the memories. I remember every. single. one.

That fateful night was a Saturday, and the patient was Rupasinghe* a transfer from Dambulla, who had a couple of episodes of blood stained vomiting. We had scoped him the day before and found an ugly ulcer in his stomach, probably cancer. I had explained about the surgery to him, told him about eating well and getting his strength up and informed the anesthetist to do the pre-op prep.

Sometime during the ward round I heard a hoarse shout from the toilets... and I remember running into the patients' toilets and finding Rupasinghe lying on the ground... he mumbled about passing blood with his stools, and started to moan. I'm not sure how, but I had him out of there and almost onto a trolley by the time the attendants heard what I'm sure were my semi-hysterical shrieks and came running.

One look at his eyes and tongue was enough to confirm what I feared - he was as pale as a sheet of paper and that meant the ulcer had eaten into a blood vessel and he was bleeding into his stomach, so fast that fresh blood was coming from the other end. Rupasinghe clutched my hand, and asked me if he was going to die... and I said something soothing, and told him we'll be taking care of everything.

My senior was there in minutes, and we started pushing in pint after pint of blood, saline, and starch - me on one side, a nurse on the other, squeezing the blood packs to push the fluid in faster. Suddenly R started gasping and before any of us realised what was happening, a gush of blood fountained out of his mouth, drenching my white blouse. The cold hard realisation that this man was going to drown in his own blood terrified me. We pushed a tube into his mouth, and fixed it to the suction machine, removing the blood as it welled up. More doctors were called in, more blood and more fluid, all of us working with silent, grim determination.

And then he improved... blood pressure started climbing up, and he opened his eyes, staring semi comprehendingly at the drenched sheets. I told him not to worry... that everything was under control... and we kept on with fluids. I remember smiling at my senior, and wondering why the relief wasn't showing in his face. Then Rupasinghe clutched my hand again and said, "I'm going to die doctor". I shook my head and managed a smile and said no, that's not going to happen, things will be ok.

He looked straight into my eyes and gasped out "you doctors are such liars".

Those were the last words he spoke. Less than a minute later, he started vomiting blood again, and this time, we couldn't stem the flow. Deprived of its lifeblood, his heart stopped, and CPR was just a futile exercise.

And looking into his sightless eyes, all I could hear were those final words, clanging over and over again inside my head, each syllable a skewer through my consciousness.

Little Johnny Batta

Image taken from here

Whenever I pass through the accident service, I get flashbacks to the times when screaming ambulances brought in casualties airlifted to Colombo, human beings mangled and torn apart by gunfire, batta mines, claymores, RPGs etc. Our hospital would sometimes get as many as 100 casualties in a single night... and this was after the "less" injured had been sent to Homagama, Jayawardenepura etc. Often the accident service theaters and staff will be overwhelmed and the general surgical units (such as the one I worked in) would be called in, and every theater would have teams working into the small hours of the morning.

One of the Consultant Surgeons I worked with once gave us the history of batta injuries. Once upon a time the blast only removed a part of the calcaneous, the heel bone. Surgery removed the damaged tissue, and the chipped bone was smoothed out so that post injury, walking wasn't too much of a problem.

Gradually the doctors began to see crushed ankle joints and lacerated calf muscles. Then one day my boss (who was at the time working at the Anuradhapura hospital) was called in to see a soldier whose foot was completely blown off, knee joint shattered and muscles ripped apart up to the upper thigh. An above knee amputation was the only option. Later, my boss had to face an inquiry as to why a "simple batta injury" needed such drastic surgery - a question he was more than prepared to answer as he had detailed records including photographs of the incident. Since the end of the 1990's, the batta injuries have gotten progressively more horrific as the terrorists packed in more and stronger explosives into the little device. I have seen and read of injuries where the pelvic ring was blown apart to smithereens, where the bowels have been ripped and torn by the blast and one instance on ruptured diaphragm and damage to the lungs.

Every time I remember the mangled flesh and horrific wounds, I curse the people who invented landmines and those who used them, and continue to use them. They rank high among those guilty of crimes against humanity, IMHO at least.

I believe there is a special part of hell reserved for them.

To the true heroes...

Life was so crazy that V-day in May passed by without so much as a meh from yours truly. Therefore is came as a bit of a surprise to find out that the whole victory day parade and she-bang had been postponed to June 18th as the rain gods had expressed their displeasure regarding the timing. It was the very welcome public holiday and long weekend that triggered it alll! :)

On a very personal note, I can't even begin to find words to describe my relief when the conflict was finally over. Like so many many more, the bloody civil war was a part of my life... I grew up with it, went to school with it, felt the tremors of explosions, watched black columns of smoke climb heavenwards and felt the fear of those who wondered, day in, day out "will my loved ones come home in one piece".

Whatever his situation is now, we should never forget the role played by Gen. Sarath Fonseka in the brilliant tactics and sheer persistence that helped stomp the collective tiger asses. Whatever their failings now, we should acknowledge the political backing that supported the military. But, as so succinctly put by David Blacker, these are the true heroes. To he military strategy, to the political bulwark but most of all to those who fought long and hard, to the everyday men and women, burnt under the grilling sun and drenched by relentless rain, hungry, tired, lonely -who gave up their health, their limbs and their lives for us - to them I bow my head.

The following is adapted from the famous poem In Flanders Fields by John McCrae. It is dedicated to all who sacrificed their today for our tomorrow.

In quiet fields, wildflowers grow
Amongst row upon haphazard row
Of monuments, that mark where heroes lie;
And birds spread carefree wings and fly
For the guns are silent down below.

They are the Dead. Short days ago
They lived, felt dawn, saw sunset glow,
Loved, and were loved, and now they lie
In eternal sleep.

Oh ye who live, hold up high
The torch of mem'ries of those who died;
Let not conflict cause untold woe,
Let the guns be silent forever more;
Let them in peace at long last lie.

EPIC fail!!!!

So.. um... yeah. I'm referring to this. And, no, it's not because I was busy having an affair... (wry face).

Needless to say, I'm feeling sheepish, and generally as blah as I felt on the 8th of April, which was when I typed my last post. And of the 61 comments I had queued up, 57 were from chinese spam bots. As Gehan put it and as underlined by the lovely Knatolee, I seem to have flunked the worst at #12. I haven't done too well in the others either... am trying hard not to burst into wails of frustration and despair.

Careful analysis of the last 9 weeks shows that I actually ended up gaining weight. This in spite of the fact that I was working literally round-the-clock for the last 6 weeks, elbow deep in the organisation of 2 international conferences. In spite of taking thyroxine in a bid to lose weight (I gave up after 3 weeks - and yes, I understand that this is abuse). In spite of sticking fingers down throat trying to throw up (it doesn't work for me, maybe my larynx is selectively paralysed). During the conference, I was asked if I was pregnant - by 7 different people. I guess you can underline the "epic" part again. The moral of this story, boys and girls, is don't go looking for eating disorders until they come looking for you.

On the slightly bright side, I am topping my PG class. The cloud to the silver lining is that I have so many asignments pending, and penalty assignments that it is unlikely I will stay there long. At least the view was nice.

I haven't made time for the girls. We are all busy, work full time and are generally more on the broke side than otherwise. Where I work, the company is intellectual from a medical point of view... but not in any other way. I have a very short attention span, and even a few free hours means I have crammed my head with thoughts and ideas and have no one to discuss it with. I recently re-read Dante's Inferno. I come across various interesting and hilarious tid-bits and comics during random net trawls. And I can't think of a single person I can discuss them with... no one I come into contact with on a day-to-day basis anyway. Sigh...

I did manage to buy some nice sarees, and new jackets that fit means there is less incentive to lose weight... hmmm... but the colours are pretty! Mostly pinks and greens... because once I get a colour stuck in my system, I can't seem to see beyond it.

So anyway... here I am, not given up, yet, hoping against all odds that I have a second chance.

The great OMGWTFIDK self help plan

So yeah... two important things came out of my previous posts.

• Boredom isn't reason enough for having an affair


• People who want to have an affair go ahead and do it, they don't blabber about it on their blogs

So, although there is more to it than sheer joblessness, I turned my creative energies towards making a self help plan... implementable in 12 easy steps.

1. Concentrate on PG programme throughout the week, instead of procrastinating and doing everything at - literally - the last minute, every. single. week.


2. Upgrade baseline mood from irritability to detachment. Be more understanding, tolerant and loving. You are prone to double standards - recognise and deal with it.


3. Cut down on the calories, work out more and match Dee in her goal for washboard abs! Current weight 60kg (eeeek!) Target weight 48 kg (facepalm!)
   
   
   
4. Wear bright colours to work instead of signature funeral/neutral black, gray and taupe. Use money saved on calorie cut down to buy new sarees. Jewel colours are the new black!


5. Try to spend at least one evening a week helping the less fortunate... e.g. teach at the local orphanage


6. Nip in the bud any "what if" thoughts about old flames. Refrain from googling any flames. Realise that path to hell is paved with dodgy chatlogs. Attention whoring does not pay on the long run.


7. Commence personal truth and reconciliation commission and leach out regrets, horror-movie type moments and disappointments that poison self.


8. Get into domestic goddessing more often.


9. Find diva time for self - blow dry hair, do up nails, defuzz. Use the selfcare products at home without wasting them. Do best not to be unattractive, unlovable, unlustworthy and fugly.


10. Stop obsessing about hormone status and embrace motherhood as and when it comes - start taking folic acid. Daily.


11. Make time for the girls. Text, phone, mail when meet-ups are not possible.


12. Blog more often - this is my pressure vent, my sanctuary. Stop worrying about trolls... people are fundamentally nice.

The many options....

So, Darling is rather miffed about one of my previous posts. Can't blame him really... actually I can, a bit, because I showed it to him before publishing. Proponent of free speech that he is, he said to go ahead. Now he says that with free speech comes the responsibility to deal with the consequences. Gah!

He is right, of course.

So anywez, I got quite a few comments on that post - on my blog, by mail, over the phone and to my face. Yeah, I'm popular. They have been summarised below.

1. You're attention whoring, WTF is wrong with you? Snap out of it!
2. The perfect couple isn't really perfect? (shock, horror, dismay)
3. Thou shalt not cheat!
4. Your situation is understandable - and I'm available!
5. Everyone goes through tough times, may I offer a shoulder to weep on?
6. Have a kid, things will work out.

But only one or two answered my fundemental question --> what is cheating? If I may qualify further --> where do you draw the line? I think PR and Knatolee gave the best responses... but I'd like an answer in the concrete rather than the upfront. So, please take the very long but seriously fun poll given below.

Oh, and one final question... is it "cheating" if you tell your partner about it first?