Treatment or No Treatment?

I have always found myself stuck in a difficult position in medicine. But I always believe that I could only do what I feel is right and best for my patient. Of course, I have to ensure that whatever I do, does not cause more harm to my patient. During the final months of medical school training, I began to accept that I am the person in charge of making decisions, that could either safe or kill a patient! Shite!

Last night, I found myself in such a position. A poor elderly lady with dementia and has been registered blind, was admitted to the hospital with a chest infection. Unfortunately, things turn for the worse, when she developed kidney failure and, looking through her ECGs (heart tracing), it was noted that she might have also suffered a silent heart attack. A further blood test confirmed that she definitely did have a heart attack whilst in the hospital. She was hardly passing any urine because of her poor kidney function. She had antibiotics and intravenous fluids running to treat her illness. Looking at her co-morbidities, I felt that she is such a frail old lady with hardly any quality of life. I made the decision that she should NOT BE RESUSCITATED (DNAR) in the even of a cardiopulmonary arrest, but we should, however, continue to treat whatever we can.

Later in the morning, she became even more unwell. She started to breathe really hard and her oxygen saturations deteriorated. I wondered whether she was overloaded with fluids or her chest infection has worsened. I made the decision to perform another chest x-ray and repeated a couple more blood test. At that time, I was assisted by a specialist nurse and a few other staff nurses.

The moment they heard that I was going to get another chest x-ray, they looked very puzzled. They questioned me about it. They said, "But she has a DNAR status. Why are we still doing chest x-rays and repeating blood tests?"

I felt abit frustrated with that question. From my humble opinion, although she is no longer for resuscitation, there is still an opportunity to reverse anything that could potentially be reversible. As far as I am aware, a DNAR means do not attempt to restart the heart when it stops beating, and NOT withdraw any treatment. If we were not going to do anything about her increasing respiratory distress, then why even asked me to review her?

I mean, let's face it, if she did have fluid overload, this is treatable with diuretis etc. And she only had 3 days worth of antibiotics, so if her chest infection is worsening, we could try to add a few more antibiotics to see if it will help. I mean, we should at least try a minimum of 7 days of antibiotics before we could say, "oh right, looks like she's not going to improve...we have tried what we could."

I don't know. I felt that my decision was not supported by my fellow team members. Deep inside of me, I still did not want to give up on that poor old lady. I know she is demented, she does not have a clue on what is happening, but I believe that if there is a chance to treat something, we should still try before giving up on a life....rather than let her die uncomfortably.

To treat or not to treat? DNAR or not, I personally feel that she should try our best, and only give up, if there is evidence that she has not responded at all.

Credit Crunch? yeah rite....

The much awaited Boxing Day sale has begun! In fact, because of the credit crunch, many shops have started their sale even before Boxing day.

I decided to pop into town yesterday to hunt around for good bargains too. And credit crunch or not, the people in Glasgow are spending money like there was no tomorrow! Some woke up as early as 5 am to start their shopping spree at Next (a famous brand here, and their sales start at 5 am!). The number of people shopping was crazy! I could hardly walk inside the River Island store.....and the queues to pay was up to the entrance! Talk about credit crunch, not!

I visited a few of my fav shops, ie Zara, Mango, Gap, Warehouse and Accessorize. =) I did manage to get myself a few pretty accessories, tights, and also a lovely purple dress from Zara. I was, however, disappointed that I couldn't find the thigh length cardigan at Zara....There wasn't much that caught my attention at Mango. But its alright, I am very happy with my purchases....

To be honest, the sale wasn't THAT great either. I mean, not all of the stuff are half price or less.... some of them only had 20% off or so. I am still looking to buy my body butters from Bodyshop....but I think I will do this online....because I get free delivery! muahaha.

okie...I am feeling very drained now...on-call last night was the quietest one I EVER had! But because I didnt rest before the on-call and also partly contributed by the 1 hour long resuscitation (in which the poor young lady died)....I am now absolutely shattered. The fact that I might have caught the cold from my kind patients doesn't help either.

=) well....me going to hide under duvet now!

Crackers n Cheese, Anyone?

I was really looking forward to watching Wallace and Gromit, "A Matter of Loaf and Death," last night....and I was not disappointed at all!

If you have no idea who Wallace and Gromit are, please cover your face in shame. =P

It is actually a clay animated comedy, starring Wallace, a chesse-loving man, and his ever faithful doggie, Gromit. They both work together very well to create all kinds of super high technology machines to make life easier for them....or for their own business. In this animation, they are both very funny and always supporting each other in their adventures. Although Gromit doesn't talk, his facial expressions say a million things!

Anyway, last night, BBC 1 premiered a brand new adventure, titled as above. Oh man, it was hilarious! There were witty lines, and an exciting storyline. This time, Wallace n Gromit started a new bakery business. However, Wallace fell in love with Piella Bakewell, a deadly murderer, who was killing all the bakers in town! It was up to Gromit to make Wallace realise that. So do catch their adventure on BBC iPlayer...

I was laughing my way through the animation....and *shhhh..... I watched it twice! muahaha. That's how crazy I am. Anyway, its breakfast time, and I might just have some cheese and crackers, with a nice cup of tea, would you like to join me?

Mince Pies n Mulled Wine

ahh...finally, here I am sitting in front of my notebook, on Xmas morning, hiding under my duvet, writing on my blog, which I have not done for AGES!

=)

so merry xmas everyone.

For once, I am not working today. I had a few old frens over for dinner last night. It was no traditional dinner though. There was no turkey, no christmas pudding...but we had tasty spanish paella, pakora, spicy curried fish, risotto, with buttered broccoli, runner beans and carrots. Pretty random menu, no? It was lovely though...not had such meals with frens for such a long time. Its amazing what work can do to you...you become so anti-social, and basically, you forget to enjoy life!

I was very sleepy and tired after dinner....and kinda fell asleep on the couch after a half a glass of mulled wine and mince pie. And I have woken up on the couch, greeted by the lovely glow from my xmas tree, which has been decorated with purply-black baubles! And oh, hehe....I still managed to open my pressies before I dozed off.

What did I get? I got a lovely embellished clutch from my best friend, Laura. Got a big box of Thornton's chocolate, a christmas cake, and a nice scented cande from Helen, my flatmate. Also, I received a lovely bracelet from another friend who's now in Birmingham. Ah Hoon gave me a lovely pair of earrings. There were a few other pressies which I have opened before xmas...and they were smellies from Lush (which were not the slightest bit smelly!), a lovely Xmas card holder (again, from Ah Hoon)....and the best of all, Kev gave me my favourite Take That CD, n cute little wee Nigel (that fat rat in Ratatouille). =D

hmm..let me see, this year's build up to Xmas day has been really excellent. Here are my reasons:
- From never popping a christmas cracker all my life, to cracking 4 of them this year.
- From never attending any work xmas nite outs, to attending 2.
- From never getting any pressies from ppl at work, to receiving 2 red wine bottles!

haha...so yes, I am quite chuffed about it.

No real plans today. Ah Hoon is flying to KL today. So I'll take her to the airport later. But, we will need to savour the huge almond pannettone first for brunch, accompanied by a lovely cuppa. =D

I am looking forward to watching Wallace n Grommit tonight. BBC is premiering a 30 min animation from Wallace n Grommit called "A Matter of Loaf n Death." Will be back to work tomorrow....NIGHT ON CALLS again! I always seem to be doing nites! ah well, shouldn't complain.

Have a lovely day everyone....I have alot more things to blog about...so will prob do them slowly over the course of this holiday period!

Spread the joy of christmas. Sing xmas carols. MERRY CHRISTMAS!


ps. my all time xmas favourite is Fairytale of New York.