silence

we can't speak but we know we share a sense of togetherness. we can't write but it's definitely stirring deep down in our hearts. how long can physical barriers hold. a dam can only hold that much water. when the pressure is too much there will be cracks and it'll finally burst. surely they know. is it their denial that continues to garner such actions. I can only pray.

Overcoming Addiction

i didn't mean for this blog to be filled with so much healthcare related stuff, but it seems like most of my inspirations / ideas to write come from there. pardon me. :)

i had an attachment at the Methadone Clinic this morning. it's a clinic where people with problems in drug addiction voluntarily come and seek treatment. They are assessed by a doctor and prescribed with Methadone, which is a drug that is chemically similar to Opioids (eg. Heroin, Morphine) but harmless. (relatively) it helps them combat the withdrawal symptoms of not taking say Heroin anymore and slowly wean off the addiction.

now when u think 'Drug Addicts' what comes to ur mind would be (well for most of us at least) shabby unkempt looking immoral hopeless criminals who in no way should be associated to us. in a less harsh way, it's pretty hard to be compassionate for this group of ppl.

do they deserve to be shunned by society?

can they control their addiction if they had immense will power?

who asked them to start taking drugs in the 1st place anw? it's their problem. is it?

Drug addicts caught by the police used to be thrown into cells and left 'cold turkey'. meaning, left to suffer the effects of drug withdrawal such as bodily pain, feeling as if a thousand needles were poking through ur body, u can roll around in agony take off all ur clothes and u would still feel that intense burning pricking pain that wont go away for all mercy. there would be secretions flowing out from ur nose and ur eyes tear non stop. u feel like u have no ounce of energy left in ur body to move. in more severe cases, they start vomiting and have diarrhea and start shaking.

I used to picture all these in fear, feeling slightly sorry for them but not really feeling much empathy.

There is another perspective to this.

Drug addiction is a disease. An illness, that requires treatment. Just as how ppl brought obesity to themselves by overeating and lacking exercise, or bringing lung cancer onto themselves by smoking cigarettes out of their fingers, drug addicts were thrown into this desperate abysmal, unable to climb out due to a wrong step in their past. perhaps due to immaturity / curiosity / lack of moral judgement / multifactorial stress etc.

In other words, leaving people with drug addiction problems to die with this problem / refusing to help them is inhumane.

To expect them to completely put a halt to this drug abuse would be like asking yourself not to sleep for 3 days. ok poor illustration. lol. but u get what i mean. the drugs affect a person's mental condition. and unfortunately ur mind is what controls ur body. so when ur mind goes haywire, so does ur body and its a whole vicious cycle.

The Methadone replacement therapy helps them to overcome the addiction. But not entirely so they still have to have self discipline and want to help themselves overcome it in order for it to work. The dose is slowly tapered off, however, it takes years for a person to completely overcome the addiction. They visit the clinic daily for a dose of methadone, a pink liquid that they gulp down in front of the pharmacist. those who're more stable are allowed to take home let's say 2 or 3 days of supply.

now this was a new aspect of humanity to me. i always thought of methadone clinics being a programme. not so afterall. it's a treatment. there's a difference if u get what i mean.

the downside though is that Methadone only helps Opioid addiction. for other drugs like Amphetamine, Benzodiazepine, Cocaine, Cannabis etc, there isnt yet a solution. in future perhaps hopefully. :)

it's a social phenomenon. we dont want it but it exists. and its rampant. prevention and cure needs to come hand in hand. and the best way to treat it is in a humane way.

nothing in particular

its... one of those wkends whr u get really idle and the internet line is really slow and u wonder how ppl in the past managed to get through days without the internet.

now try imagining life without this almighty entertainment information networking provider (to me).

1. Hackers would be out of jobs and probably working on sth that might actually benefit the world.

like making the world's largest strawberry cake.

2. Your stamp album collection continues to grow with snail mail.

3. Your weekends would be filled with outdoor activities instead of talking and laughing in front of a screen and checking your facebook news feed every 5 mins.

4. He/She would have a hard time finding out if she/he's single or attached.

5. Less chances to spread hate mail and defame someone.

6. The Nyan Cat, the annoying orange and Rebecca Black would never really be famous.

7. University students would have to spend their life in the library to get an assignment done.

8. I might just get a pet.

kidding.

9. Phone bills would either rocket sky high or phone calls become free because they become a mega huge life necessity.

10. I would be exercising for fun.

nah. boring.

:D

Now the above are just random thoughts, some merely exaggeration, obviously not done with proper prior research and just my way of spending 15 mins on a saturday evening for self entertainment. apologies for lack of substance and analysis.

the internet line in my campus is horriblyyyyyy slowwwwwww.................. (every page needs to be refreshed 3 times to get the whole thing to load)

i cant wait to go siew pao hunting in seremban :D audrey teo ju yeng tan ek guan norfaidhi akram shalisha jaelyn hehehehehe ok xuvin shaddap.

How far would you go.

this week's clinic touched me emotionally. i'll keep it short.

at the child and adolescent psychiatry clinic,

- thr was a case whr distraught parents came in with their 9 year old daughter who was really adorable, friendly, happy but unable to talk / read / recognize alphabets, communicating only by making certain audible sounds and hand gestures. they had flown in all the way from Brunei for a 2nd opinion, with some hope, for a diagnosis and some form of treatment. they left knowing that their child might just never ever be able to talk. bcz the success of speech therapy esp at such a late age is subjective.

- parents coming in with both children having autism and both parents suffering from depression due to financial problems and being unable to cope with taking care of their children. thr were many other cases with children suffering from depression and mental retardation, attention deficit disorder etc.

i tried imagining hw life would be like if i was the parent.

i was awed and touched by the love they displayed for their child.

in the adult psychiatry clinic, i watched elderly parents bringing in their sick adult child with schizophrenia / depression / bipolar, stories of aggression at home, the child screaming at the parents to get out of the house, suicidal tendencies, caused by noncompliance to treatment. the elderly parent kept reassuring his son it'll be alright, we're with you, we'll always be with you, dont worry.

it was really something. imagine one of your family members suffering from a mental illness. it takes a lot of love to commit yourself to care for them for a lifetime. bcz these sort of illnesses usually relapse and are chronic. they cant be 100% cured with medication. and lots of patients are not compliant to medication bcz of their side effects like drowsiness, abdominal upset, insomnia etc. some of them also cause addiction.

this kind of love is really amazing.

Cause of Death was?

today's class opened up another window for thought.

Medico-legalism. in the world of Forensics.

Ensuring you're protected.

Affording yourself protection.

(just a word of caution that the word dead and death will be mentioned numerously in this post. hope it doesnt cause uneasiness)

Doing an autopsy as a forensic specialist doesnt start with dissecting a patient - a body i mean. saying a patient sounds like he/she's alive.- and using all your years of expertise to analyse the cause of death and injuries on / in the body and then writing the autopsy report. This part, would be what most of us think as the most important part or the part that matters most. Determining / Confirming the cause of death.

Nope. Not really as I thought.

It starts with:

the Dr. in charge correctly identifying the person to be dead.

so i thought: ok that should be easy.

and then the Dr. asked: So, tell me, how do you know a person is realllllyyy dead?

*hmmmm.... awkward silence..

Answer:

There're 7 criterias that confirms a person to be dead:

1. No body movement

2. No respiration

3. No pulse / heart beat

4. Pupils fixed and dilated

5. Fragmentation of column of blood in retinal vessels

6. Primary flaccidity of limbs

7. ECG flat for more than 5 minutes continuously.

Misjudging the death of a person can bring a Dr. to face lawsuit. even pronouncing a person to be dead at the wrong time can bring you to court.

(most of us would think, sure, if a Dr. wrongly pronounced some1 who's still alive as being dead, that would be a really grave mistake that acceptably warrants a court case)

i do agree with that. but there're more technical things that we can worry about as well.

there was a case whr the Dr. clinically judged (without ECG) that a person was dead before arriving at the Hospital (as in he was dead already at the crime scene before being brought to the Hospital). the Dr. did, upon the arrival of the victim at the hospital, confirm his death with the ECG (showing the flat line).

later in court, the Dr. was bombarded by defense lawyers (of the suspected murderer) who tried to make the Dr. look incompetent for saying that he thought the person was dead before reaching the hospital.

with the reason that he couldnt be 100% sure of that (whether the victim was dead before reaching, or upon reaching the hospital) cz his clinical judgement cannot beat that of an ECG machine.

yups...

ok maybe that was quite confusing.

but conclusion is: be especially careful if u're facing a homicidal case. only officially confirm death when the ECG machine is there.

standard protocol when pronouncing death.

1. check that patient has fulfilled the 7 criterias. report as 'clinical death'.

2. reconfirm the death 1 hour later. then only register the death with time of death being the time 1 hour earlier.

before this bores u to the bones, thr's more. :P

Before performing the autopsy:

1. Ensure the police officer bringing in the body, the relative / next of kin of the body (is there for identification purpose and consent for autopsy) and yourself are there beside the body.

2. snap a photo where all can be seen clearly.

(to protect urself from false claims by the relative that he was not aware or explained to about the autopsy. relatives have tried suing Dr.s, accusing them of performing autopsy without their knowledge)

3. snap a photo of the next of kin looking with opened eyes at the body.

(eyes cannot even be closed in the photo cz in court they can say they were in too much stress to correctly identify the body and u as the Dr. who's not in apparent stress at that moment is at fault) - in cases of suing the Dr. for wrong identification of body.

now i think i just made the 'relative' sound like unethical ppl who would do anything to swindle ur $$ by suing you in court at any opportunity. no offense. not my intention at all.

but things like that have happened before. (innocent Dr.s performing autopsy, forgetting a protocol, ending up in court and swindled from their life savings) and can / is likely to happen in today's society where things do get screwed up, ill moral is everywhr and $$ matters a lot to most of us.

putting legal issues aside, i'd say that the forensic lectures did feel a little like watching the Professor analyse dead bodies CSI style.

wow. quite awed. but quite grossed out as well. lol >8P

wasnt mentally prepared to see images of mangled / strangled / suicidal remains esp right b4 dinner.

ok. that aside as well, it's been a pretty good week. 1st week in psychiatry has been relatively relaxing cz no assignments/presentations/case write ups due yet. missed home and taiwan so much last monday but the feeling has somewhat diminished. thank goodness. hav a great wkend ev1! :)

some photos: my housemates in our 4-person sharing unit in the taiwan hospital hostel (min jie, pei sun, wendy)

a group photo in front of the administrative office. the white coats for medical students are this length. residents@registrars wear slightly longer 1s, and specialists wear knee-length white coats like our med students ones back in Msia.

come to think of it, thats a pretty good way to differentiate ranks which can be really confusing for patients. hehe. sometimes patients wonder how come 10 different Dr.s visited them in 1 morning when in actual case 9 of them were medical students. heheh.

Rants

i'm in a mess. i'm not sure if i should emo about

1. missing taiwan- the friends, the serenity, the people, the shopping, my cousin and his wife penny, the hospital, the friendly dr.s and staff

2. starting the term tmr - tho i'm quite excited about starting psychiatry cz its an entirely different posting and quite interesting. just that missing taiwan kinda kill joyed the excitement of starting this new posting.

3. the absurdness of msian issues - the Obedient Wives Club promoting sex classes to enable women to 'serve' their husbands better. it's so absurd i just do not have the energy to comment on it. i don't know where to even start criticizing the way they execute measures to highlight the principle they stand on. like it wasnt bad enough, they had to bring in 1st class prostitutes as a comparison. any educated person would know that you didn't have to go to the extent to bring up prostitution to make your point. so why draw prostitution into the picture. as a mere gimmick to illustrate women as sex objects? ridiculous. all drama.

4. unpacking my luggage and cleaning up my room - dont we all resent this part. heh.

5. missing home. i wish i had another week of holidays to go back to kuching.

that's bout it. i still cant decide which one of these 5 things are most worthy to emo about lol. but by hook by crook i gotta finish unpacking real soon if i wana get some proper sleep tonight. yargh.

last few thoughts in Taiwan

i reached the official end of my 3 week elective posting in the Tzu Chi Hospital and left with a pang of sadness. heh. i'll miss that place. particularly bcz the surgeon i attached with in this last week was most kind, patient and really fatherly. he specializes in Breast and Endocrine Surgery and has taught me a lot about reading sonograms and mammograms in clinic and the OT. even allowed me to scrub in for a thyroid surgery. that's another story grins i was creating a mini chaos in the OT with the scrub nurse and anaes dr. trying to instruct me in mandarin to make sure i donned on the sterile apron and gloves correctly. extremely pai seh...

i previously mentioned i had knowledge ego problem lol hee and had loads of trouble reading chinese characters off the computer etc. i had wanted to give up and go back to msia to tell juniors who were so called bananas like me not to do an attachment in taiwan. but i've had a change of mind. :D

i seriously learnt a lot in this hospital. not just knowledge wise, dissecting ecg charts and x rays and ultrasounds (still horrible at it but less blur), but humanity wise.

the nurses and dr.s here treat the patients really really well. the rapport established is extremely strong and the patients love their dr.s. ev1 treats one another with utmost respect. ev1 greets each other in the hallway / wards / lunch place. regardless whether they know you or ur status. i never saw enough of this back in msia.

and technical barriers can be overcome. hehe. its also partly bcz i've got friends doing the attachment with me and helped me a lot in reading signs and all that. i'm not sure if my mandarin improved? grins. but i picked out (not up) some taiwanese accents that i find pretty amusing teehee. so... i think i would really recommend ppl who are even tho partial bananas like me to come attach here. :D

owh! and i found a cousin i've never met before in taipei. huge surprise lol. but extremely pleasant. heheh.

its my last day touring taipei today b4 i head home and start sch again. i'll miss this place. XP

starting 4th year with psychiatry. wish me luck. :P