Medicine*Music*Chocolate*Life

Life-changing Medicine

Hey Y'all, I'm still working, although I'm at home.

Running a workshop for a partner institution, and it addresses some H1N1 issues.

It's the 2nd of two sessions, and it seems to be doing some good on the ground.

I have some great people with me doing this work.

By the way, did I say that I've stopped seeing patients for good?

Deja-Vu; please let it not be.

I remember how it felt. I can't even explain it. The 6,000-odd of us who battled it together.....are the only ones who can feel my terror. I locked eyes with some last night, and the same weary fear is there.

I'm actually crying. I remember my last thumbs-up to that bright and shining boy who never left the hospital. I remember the look on his sister's face. We can do better than that. We must.

So exciting. It's goin' down in a week, Bebehhhh!

The hospital is going to activate a new and rather radical change come mid-March. It's ridiculously exciting because I'm in the thick of it, but more than that, it's also because it will have teething problems unlike anything that we have seen for years.

Given, no birth without blood, but oh man.....it involves everyone. Some personalities are both prickly AND extremely resistant to change. It's akin to being dragged screaming backwards through a bush, I suppose.

In any case, we're having a fun dinner out tomorrow night: Ella, John, Baldwin, Nicar, Jane, Hubby, myself, and possibly a few others.

Three months in

I've been in a new job for the past 3 months. It's been quite a ride, but I'm really liking it. It's good to be doing something consuming which is enjoyable. There's tedium, of course. Nothing is a laugh a minute in life. But it's nice to have tedium amongst all the new stuff.

The last two weeks have been especially taxing. I have been answering to four heads. All with completely different personalities. Each asking for something totally different. Come next week though, I think I'll be whittling the scope down to something more specific. Goodness knows, I hope I've made the right choice.

I've certainly been a bad enough judge of character in the past.

Meanwhile, just a few random shower thoughts:

If you could rubbish a specialist by something within their own field, what would it be? Urologists would be pricks, colorectal surgeons would be a**holes, cardiologists would be heartless, and O&G's would be b*stards. Oh, and orthopods would be knuckleheads. Endocrinologists would be PMS-ing all the time. Pulmonologists would be full of hot air. Neurologists would be nervous wrecks.

Won't tell you what I am.....

Medical wardrounds....

And starting them young...

Carbon monoxide

A simple little molecule, but a deadly killer.

Tasteless, colourless, odourless, and non-irritant, it is generated by hydrocarbon combustion - the burning of fossil fuels, badly-ventilated chimneys, exhaust pipes etc.

Once breathed in, this little killer attaches itself almost irreversibly to the oxygen-carrying clamp of our red blood cells. Once attached, it acts like a disabling lock which prevents the red blood cell from transferring oxygen around the human body from lungs to tissue.

That's not the end. After hitching a ride in the bloodstream, carbon monoxide begins to disrupt other bodily functions by binding to important chemicals/enzymes/processes in cells and also locking them up.

There is a tragic tale that illustrates just how deadly this innocuous molecule is.

A 30-week pregnant woman awoke one day to find her husband dead in bed beside her. She called the ambulance immediately, but by the time the paramedics rushed over, she herself keeled over and had a seizure.

In the emergency department, her husband was pronounced dead on arrival, and a foetal scan done immediately showed that her unborn child was also dead.

She had survived the high level of carbon monoxide in their new apartment because her baby's foetal red blood cells had preferentially bound to the carbon monoxide. In other words, her child had absorbed the toxin from her blood and saved her life.

I don't know how that would feel, but I can imagine.

Check your motorised/fossil fuel appliances and ventilation, people. Watch out for persistent headaches, nausea, giddiness and fainting spells in relation to exposure to just such an environment.

NB: Smokers already inhale it on a daily basis - their blood levels show 4 times as much ambient carbon monoxide than a non-smoking urban dweller. Which is why smoking in pregnancy isn't exactly the smartest thing to do.

How marriage affects physical and emotional health

This is another intrigueing topic that bears further discussion.

Outside of the usual urging by aging parents to palm off their grown kids, there's some serious scientific work (lots actually) that have been done to investigation exactly what is so great about this oldest of social institutions (and whether it is still relevant, unchanged, in our progressive civilisation).

Of course, the very 1st question to address is if marriage itself is a selection bias? This asks if all studies will be expected to show that marriage is beneficial simply because only a certain mindset/group of people would marry, and hence be happier married, than another group which may be happier unmarried, and hence escape the statistics.

Conversely, what would happen if two unhealthy individuals got married? Perhaps one spouse may die early, but does that mean that widowhood is responsible for ill health? (in the remaining live partner)

One thing that is known is that marriage ups the per-head earnings of the couple, meaning that two can live together more cheaply than one individual. This means more moolah to spare. Always a good thought :)

Secondly, marriage automatically provides an emotional and physical foundation of support for both spouses, and these two things may translate to the gains that marriage seem to offer. Indirectly, less financial burden and the ability to vent or share with someone else may mean less incidence of psychiatric issues such as depression and anxiety. Married couples also have a higher chance of quitting risky behaviour such as alcoholism and smoking because they can moniter and encourage each other. These changes translate into well-documented health gains.

There is also a gain from beliefs prior to marriage. One study looked at churchgoers and non-churchgoers and found that those who reaped the most benefits were those who attended church, AND got married.

One quirk of marriage that researchers have found is that the benefits of marriage are resounding for males, but much less for females. They postulate that the unmarried female already has a better-established social network which offers her the same protective benefits as being married, while the male lifestyle/network changes dramatically after marriage.

To address the criticism that the "happiness" of marriage may be a transient effect (i.e. in newlyweds etc.) studies have been done longitudinally, following couples over a long period of time. Of particular mention is that marriage seems to drop the rates of alcohol consumption and depression very steeply compared to other groups. Conversely, divorce has also been shown to produce a surge in depression. With each successive divorce/remarriage, the benefits become less and less, and this is seen worse in females.

Some studies also examined the differences between married and cohabiting couples. Do the benefits come from actually living with someone, even without wedding vows? The data showed that the highest rate of alcoholism was in cohabitant men, and that there was no gain from cohabitation compared to marriage, hence the conclusion was that it wasn't simply an effect of having someone else around the house.

What about actual physical health? Curiously, men reap a very large and significant benefit from being married while women do not seem to gain very much at all in terms of lifespan. One funny side fact that appeared in this study was that time spent in front of the television correlated with earlier death, so the longer the TV was on, the shorter the life of the watcher. There is also a simple study looking into the rates of the common cold amongst married and unmarried people, and married people were found to contract the cold much less frequently.

They found some divergence in the data for longevity in men and women. In men, the married lived longest, followed by the previously married and then the never-married. In women however, the married lived longest, followed by the single, and THEN the previously-married. They also discovered that the QUALITY of the marriage affects the health of a woman, but not the health of a man. They also found that having children benefited the health of the woman, but had no effect upon the man.

Another amusing finding was that the health of a woman improved with marriage and stayed better longer if she DID NOT WORK. If she was part-time or full-time, her health benefits did not last.

So, dear ladies, the key to a healthy happy life is to have a good set of beliefs, get stuck into a great marriage, have kids, and stop work. Woo. That's something to think about alright, seeing that it is all evidence-based. This flies in the face of 200 years of sufrage.

Telling someone's family that their loved one is dead is not the only bad news we break

Check this out:

http://news.bbc.co.uk/2/hi/in_depth/photo_gallery/3246977.stm

There's a girl on the ward. I call her a girl even though she's the mother of a 3-year-old sprite who giggles and fusses at her hospital bed. I call her this because she has big almond eyes and an innocence about her, which is probably what got her into this mess.

She's one of the HIV-positive patients we treat.

This is the first time that she's been in a hospital other than when she had her child. Here in Singapore, expectant mothers are tested - which tells us that someone gave it to her after she had antenatal screening more than 3 years ago. We also knew that she had never required a blood transfusion, and so could not have contracted it as a contaminant.

She tells us that she lives with her current boyfriend, who is not the father of her child. He himself also has a child. A 5-year-old daughter he made with his estranged wife, from whom he separated 3 years ago when he found out that she had been cheating on him with another man - with whom she still cohabits. The father of my patient's 3-year-old was her former boyfriend, now married to someone else.

None of the adults other than my patient had ever been tested for HIV.

She presented to the hospital with a severe infection. A weird infection that doesn't normally attack healthy young people. We treated her; she got better.

In the course of her investigations, we found the HIV lurking in her body. She was not yet sick enough to die from it, but her white cell count - the particular kind that HIV loves to attack - was very low.

The day that we broke the news to her, she became very quiet. She refused to eat or drink for 3 days - anorexia is a common grief reaction - then told the nurse that she wanted to talk to us. It was fear that kept her silent. She was fearful for her child, and also for her current boyfriend, whom she loves dearly.

She was fearful because her safe innocent world had fallen apart. Everything had changed. Someone had given this disease to her, and she could not be sure who it was. Even worse, it was someone that she trusted and had loved or loves now. Her perception of her lifespan and her way of living had changed irreversibly.

Yet elsewhere in the bowels of the same hospital, there was another HIV patient. An old man, well into his 70's.

A cheeky cheerful man, he freely admits that he was irresponsible and had probably contracted his disease from visiting unlicensed prostitutes in Thailand, Malaysia and Indonesia. He felt no anger at it; only an acceptance that God's got him now, with a smack of retribution that was as bad as he thought he deserved. He only thanked God that he had not passed it to his faithful wife.

And yet, despite his age, his other medical issues, and the fact that we had diagnosed him with HIV infection more than 10 years ago, he's still alive. Still walking about, still talking at the tops of his lungs, still eating/drinking/laughing/living. And he's aware of what he has, and what it can do if he gave it to his family, and because of that, he's very careful with his grandchildren.

Every now and then, he'd be admitted for an opportunistic infection, but so far he's been lucky. On the antiviral treatment regime that we gave him, the disease halted - and has been held at a standstill for years.

It's treatable. One of the few deadly viruses in the world that we have the power to stop. Not completely, but our arsenal of antivirals is growing stronger by the year. Furthermore, the prices are coming down. There's hope that treatment can be sustained financially for years and years.

Even better yet, don't put yourself or anyone around you into the shoes of my patients.

You will never understand just how much you have lost, and just how precious was the gift of a healthy life, until it's too late.

http://www.worldaidscampaign.info/

http://www.stopaidscampaign.org.uk/

Glad to be alive and me

Dear Blog,

Everyone's been thrown to the sharks. CM sounds so stressed out that I feel like giving her back her birthday present to me (spa vouchers). Whew.

I DO have some good news though.

Baby and I have been househunting like CRAZY. We've been playing masquerades with the agents. So fun! We've been Type-A Boss/Bitch Couple, dominant working-husband and domestic subversive-wife, Two Mad Kids In Love, and many more guises.

Last week though, we finally saw a place that we would like to live and entertain in. It's on a high floor, in an old estate (I LOVE old estates because everything feels so...homely, and sturdy), and Baby has friends living in the same place who have become mutual :)

The other thing that's really made my day is that we reversed a stroke today.

An old lady came in today completely paralysed on one side. Her left arm hung limply at her side, and her left leg was lifeless and heavy on the stretcher. We treated her, and two hours later, the flicker of life came back into those limbs. She lifted her arm, and moved her leg, and smiled at me.

Sometimes, humanity seems too tender to be real. Sometimes it's just lovely to know that harshness isn't all the ways of the world are about.

I love my job :)

More nails, and humour to and from work

Dear Blog,

Oh dear, think I'm hooked on nail extensions. The reason? My own poor bitten-to-the-quick digits are improving so well under them! Very encouraging. My new set:

And this ad is SO WRONG. A paramedic should be the 1st to know that a stonking headache (in fact, "the worst headache ever") may be the 1st sign of an intra-cranial bleeding stroke in a young person. The guy who dreamt it up is a dumbass.

And here's the department dicking with us. Made everyone laugh. It's great to come across a caterer with a sense of humour. The lecture was more relaxed than usual.