GARGANTUAN steps
Thursday, November 22, 2018
being mortal
'At least two kinds of courage are required in ageing and sickness. The first is the courage to confront the reality of mortality - the courage to seek out the truth of what is to be feared and what is to be hoped...But even more daunting is the second kind of courage - the courage to act on the truth we find.'
And so the end of year readings spree gets in to full speed and the latest sombre book is Atul Gawande's thought-provoking 'Being Mortal'. Questions arise on how one practices medicine - do we truly know what is best for our patients? Do we know what they truly want, at the end of their lives? Do we still, in this age, practice a rather paternalistic form of medicine, that is to extend a patient's life as much as we can, at the cost of what they truly are? Thoughts arise too, on our own mortality, and our parents' mortality. That we may never truly be prepared for it, but prepare we must, to see what we truly want in our final days. What truly matters. What it finally means to rest in peace.
'The battle of being mortal is the battle to maintain the integrity of one's life - to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be.'
- Atul Gawande
Tuesday, March 01, 2016
when breath becomes air
You that seek what life is in death
Now find it air that once was breath
New names unknown, old names gone
Till time ends bodies, but souls none.
Reader! Then make time, while you be
But steps to your eternity
- Baron Brooke Fulke Greville, 'Caelica 83'
' In taking up another's cross, one must sometimes get crushed by the weight.'
And so I've just finished reading this inspiring book, written by Paul Kalanithi, an astounding neuroscientist and neurosurgeon, who was diagnosed with terminal metastatic lung cancer at the age of 36. The meaning of life changes dramatically for him, as he struggles to hold on to what was once precious to him - neurosurgery - and what is now precious to him - time. And he faces death valiantly, when one can only feel the dread knowing how the book ends. In it all, he portrays the humanity of being a doctor, and a patient, so eloquently. The mortality of youth, and of being a doctor, suddenly being crushed by the weight of cancer, hits very close to the heart in every doctor. Seeing how your patients handle their diseases, and their end of life, brings about a certain sobriety in our day to day lives as doctors, as we contemplate on our own eventual demise. And so this book is something to cherish - to pursue our goals, dreams, and hopes, without wasting a single moment, and to pursue it with excellence, and without regret.
' The secret is to know that the deck is stacked, that you will lose, that your hands or judgement will slip, and yet still struggle to win for your patients. You can't ever reach perfection, but can believe in an asymptote toward which you are ceaselessly striving.'
- Paul Kalanithi
Saturday, June 15, 2013
the medical detective
'The Medical Detective' details the exploits of John Snow, a modest physician of the late 19th century considered by many to be the father of modern epidemiology, and his conquest of the cholera epidemic in London and England. The word cholera means 'bile' in Greek, though how it came about, I'm not entirely sure. Just for some enlightenment - England (and the rest of Europe) was afflicted with multiple cholera epidemics in the 19th century and back then, the medical opinion of its spread was that of a miasma, or 'bad air'. All concoctions of remedies were administered by quacks and doctors alike, rendering the victims' deaths even more inevitable. Meanwhile, John Snow vigilantly studied the disease and came to the conclusion that cholera was spread via contaminated water. This was proven beyond doubt in his investigations in the cholera epidemic surrounding the Broad Street pump. In 1854, Soho, London, was hit by a massive cholera outbreak, where nearly 600 people perished. John Snow mapped the disease origin to a pump on Broad Street and had its handle removed - the deaths from cholera in the vicinity subsequently came to a halt. In his lifetime though, John Snow was never fully recognised for his impact on the disease and his handiwork was only fully appreciated after his passing. Meanwhile, his achievements are commemorated by a pub, unceremoniously named the 'John Snow Pub', and a pump with no handle along the newly named Broadwick Street. Wish I had paid a visit when I was still in London! Guess I will when I'm there next.
John Snow's mapping of those deceased from the disease and linking it to the Broad Street pump
You and I may not live to see the day, and my name may be forgotten when it comes,
but the time will arrive when great outbreaks of cholera will be things of the
past; and it is the knowledge of the way in which the disease is propagated
which will cause them to disappear.
- John Snow
Friday, May 16, 2008
sicko
I've just watched finished the latest film by Michael Moore on the American healthcare system and I am truly shocked at the poor standards of healthcare there. Though definitely biased towards all that is wrong with the system, I find it unforgivable that people have lost their lives because they have been refused treatment because they do not have money to pay. It really is ridiculous that your insurance company has to be called first before treatment for a serious, life-threatening condition can begin, and even then, there is a high possibility that you might not receive the treatment.
This is definitely a show that everyone in the health profession should watch - how medicine and the healthcare system should NEVER, EVER be. In America, people pay for their healthcare via insurance. Apparently, after submitting a claim for your medical bill, the health insurance companies might sought out for nitty-gritty details on your form so as to find a reason to deny paying for your medical bills. People have become bankrupt as a result of escalating insurance premiums; someone had to choose between which finger to be reattached after having two of them severed; worst of all, lives have been lost. Doctors have to choose between whose life to save - what happen to the principle of justice? I wouldn't be able to live with myself if I ever had to come to such a situation. One of the most shocking moments on the documentary was when one of the personnel in the higher echelons of the healthcare system came clean about her duty to "use her medical expertise to the financial benefit for the organisation that (she) worked for" and that she was "not denying care but denying (those who could not afford) payment". This really left a sour taste in my mouth and made me despise the supposed democracy that is suppose to exist in America.
The healthcare system was compared to those around the world - Britain and the NHS, the French and the Cubans. Here I am thinking that the NHS was a flawed system because it is in a permanent debt, but the main principle of healthcare, that of maintaining health and life, has never been compromised and I am glad that I am not studying in the states. France has the best healthcare system in the world and the amount of services that the government gives to its people is just astounding - they provide free college education, six months of paid leave after delivery and even a personal nanny during that period of time.
The final bit of the movie was the most shocking bit - Michael Moore brought a group of 9/11 fire-fighters who could not afford healthcare in the very country they were risking their lives for to Cuba and there, they received free healthcare and treatment and the care was really full of love and warmth. I found this really unbelievable and I felt touched that they have such an uncorrupted heath system there, even though they are at odds with America. Even in America, the prisoners in Guantanamo Bay get free healthcare and better treatment than the average American.
Many other fascinating facts appear on this movie and I urge all to watch this film, you will be sufficiently shocked. One final anecdote was that someone who was anti-Michael Moore could not afford to keep up his anti-Michael Moore website lest he could not afford the treatment for his wife's health condition. Michael Moore commented that he had lost his right to free speech as a result, and donated a substantial amount of money to him anonymously. Following that, rather ironically, his anti-Michael Moore website continued to be running.
I really respect Michael Moore for this film - all he wants is for the best for his fellow country-men, and at least he is doing it in the most poignant way ever - non-violence - unlike how the government deals with those against their 'ideas of democracy'.
This is definitely a show that everyone in the health profession should watch - how medicine and the healthcare system should NEVER, EVER be. In America, people pay for their healthcare via insurance. Apparently, after submitting a claim for your medical bill, the health insurance companies might sought out for nitty-gritty details on your form so as to find a reason to deny paying for your medical bills. People have become bankrupt as a result of escalating insurance premiums; someone had to choose between which finger to be reattached after having two of them severed; worst of all, lives have been lost. Doctors have to choose between whose life to save - what happen to the principle of justice? I wouldn't be able to live with myself if I ever had to come to such a situation. One of the most shocking moments on the documentary was when one of the personnel in the higher echelons of the healthcare system came clean about her duty to "use her medical expertise to the financial benefit for the organisation that (she) worked for" and that she was "not denying care but denying (those who could not afford) payment". This really left a sour taste in my mouth and made me despise the supposed democracy that is suppose to exist in America.
The healthcare system was compared to those around the world - Britain and the NHS, the French and the Cubans. Here I am thinking that the NHS was a flawed system because it is in a permanent debt, but the main principle of healthcare, that of maintaining health and life, has never been compromised and I am glad that I am not studying in the states. France has the best healthcare system in the world and the amount of services that the government gives to its people is just astounding - they provide free college education, six months of paid leave after delivery and even a personal nanny during that period of time.
The final bit of the movie was the most shocking bit - Michael Moore brought a group of 9/11 fire-fighters who could not afford healthcare in the very country they were risking their lives for to Cuba and there, they received free healthcare and treatment and the care was really full of love and warmth. I found this really unbelievable and I felt touched that they have such an uncorrupted heath system there, even though they are at odds with America. Even in America, the prisoners in Guantanamo Bay get free healthcare and better treatment than the average American.
Many other fascinating facts appear on this movie and I urge all to watch this film, you will be sufficiently shocked. One final anecdote was that someone who was anti-Michael Moore could not afford to keep up his anti-Michael Moore website lest he could not afford the treatment for his wife's health condition. Michael Moore commented that he had lost his right to free speech as a result, and donated a substantial amount of money to him anonymously. Following that, rather ironically, his anti-Michael Moore website continued to be running.
I really respect Michael Moore for this film - all he wants is for the best for his fellow country-men, and at least he is doing it in the most poignant way ever - non-violence - unlike how the government deals with those against their 'ideas of democracy'.
Labels: Film, Healthcare, Medicine
Sunday, October 08, 2006
majority report
Lectures have begun rather proper, which suits me fine since I can't really wait to get going. Mental sinews have hardly been tested since the A Levels, but already I can feel the stress and pressure here. Perhaps a good 80% is contributed by myself, but there's quite a bit of reading to do. Its all about self motivation and if I don't start the engine now, I might just lapse into procrastination.
Meanwhile, a few events happened the past few days. Unbeknownst to many, I have actually not been as anti-social as I am well capable of. Thought of spending my Saturday reading up for the week's lectures ahead (it's Molecules, Cells and Disease), but the day was just too nice and bright and shiney that I went to Hyde Park for a Singaporean society 0f Imperial College gathering. I played soccer from 11am to 2pm, and currently am suffering the effects. It is aches personified and there's no resting position that I don't feel an aches in my muscle (unless I'm sleeping on my head upsidedown, perhaps, but then my neck muscles will then be aching in the morning). But it was well worth the fun. However, I'm hitting the books tomorrow. It feels good to be back in the company of the land of lahs and lors, it's an amazingly coherent speech.
Two things happened yesterday. One was an anatomical lesson in a hospital and the other was the celebration of the Mid-Autumn Festival (or happy moonie/mooncake day, as someone happily went about telling everyone). The former first.
Parental Guardiance is adviced for the following paragraph
Stepping into the dissection laboratory has significantly changed my views on waxed duck and lap chiong (chinese sausage). We had our first encounters with dead bodies yesterday and it wasn't so much of an unpleasant sight as compared to an unpleasant smell. Imagine a room filled entirely with waxed ducks and lap chiongs. And we stayed in there for a good 2 hours, by which the smell is good enough to make one want to commit suicide. I brought ham and sausage sandwiches for lunch, and it took guts to eat that after the session. Of course we got a hands-on, but no worries, they were done with gloves. Most could stand the sight, but many couldn't stomach the smell and had to leave abruptly. I have indeed a dreaded year ahead until anatomy sessions are concluded.
Dinner last night was specially prepared by Fon's mom, in celebration of the day when two things happened in ancient China. One - Chang Er flew up to the moon after wresting the pill of immortality from some lunatic and promptly consuming it, in which she flew up to the moon, thus making her the first woman on the moon Two - messages were stuffed in mooncakes and given to the oppressed people of China to tell them of the day they were to retaliate against the government ala V for Vendetta. (hope I got most of my facts right, if not, you are allowed to correct me) It's amazing how some Chinese festivals have two stories about them. (Chinese New Year is one of them. I'll elaborate about them when the time comes nearer) But anyhow, dinner was really good. And the company was even better. Quite enjoyed myself last night. It's a pity Fon's mom left today.
The highlight of the week was definitely going to watch Les Misérables (pronounced Lei Mi-ze-ra, for those of you witty enough to call it less miserable), the musical, with Fon and her mom on Thursday. For my ignorance and future reference, the musical (which is adapted from a book written by Victor Hugo) principally focuses on the struggles of the protaganist—ex-convict Jean Valjean—and his struggles to redeem himself through good works. An excellent musical I must say with various themes and touching moments. For those able to catch it, please do, it's well worth the money! My next musical in mind (not anytime soon at least), is going to be Spamalot. If you don't know what kind of musical it is, it's actually about King Arthur on his quest to find the Holy Grail. And spamalot being the only word that rhymes with Camelot.
Meanwhile, a few events happened the past few days. Unbeknownst to many, I have actually not been as anti-social as I am well capable of. Thought of spending my Saturday reading up for the week's lectures ahead (it's Molecules, Cells and Disease), but the day was just too nice and bright and shiney that I went to Hyde Park for a Singaporean society 0f Imperial College gathering. I played soccer from 11am to 2pm, and currently am suffering the effects. It is aches personified and there's no resting position that I don't feel an aches in my muscle (unless I'm sleeping on my head upsidedown, perhaps, but then my neck muscles will then be aching in the morning). But it was well worth the fun. However, I'm hitting the books tomorrow. It feels good to be back in the company of the land of lahs and lors, it's an amazingly coherent speech.
Two things happened yesterday. One was an anatomical lesson in a hospital and the other was the celebration of the Mid-Autumn Festival (or happy moonie/mooncake day, as someone happily went about telling everyone). The former first.
Parental Guardiance is adviced for the following paragraph
Stepping into the dissection laboratory has significantly changed my views on waxed duck and lap chiong (chinese sausage). We had our first encounters with dead bodies yesterday and it wasn't so much of an unpleasant sight as compared to an unpleasant smell. Imagine a room filled entirely with waxed ducks and lap chiongs. And we stayed in there for a good 2 hours, by which the smell is good enough to make one want to commit suicide. I brought ham and sausage sandwiches for lunch, and it took guts to eat that after the session. Of course we got a hands-on, but no worries, they were done with gloves. Most could stand the sight, but many couldn't stomach the smell and had to leave abruptly. I have indeed a dreaded year ahead until anatomy sessions are concluded.
Dinner last night was specially prepared by Fon's mom, in celebration of the day when two things happened in ancient China. One - Chang Er flew up to the moon after wresting the pill of immortality from some lunatic and promptly consuming it, in which she flew up to the moon, thus making her the first woman on the moon Two - messages were stuffed in mooncakes and given to the oppressed people of China to tell them of the day they were to retaliate against the government ala V for Vendetta. (hope I got most of my facts right, if not, you are allowed to correct me) It's amazing how some Chinese festivals have two stories about them. (Chinese New Year is one of them. I'll elaborate about them when the time comes nearer) But anyhow, dinner was really good. And the company was even better. Quite enjoyed myself last night. It's a pity Fon's mom left today.
The highlight of the week was definitely going to watch Les Misérables (pronounced Lei Mi-ze-ra, for those of you witty enough to call it less miserable), the musical, with Fon and her mom on Thursday. For my ignorance and future reference, the musical (which is adapted from a book written by Victor Hugo) principally focuses on the struggles of the protaganist—ex-convict Jean Valjean—and his struggles to redeem himself through good works. An excellent musical I must say with various themes and touching moments. For those able to catch it, please do, it's well worth the money! My next musical in mind (not anytime soon at least), is going to be Spamalot. If you don't know what kind of musical it is, it's actually about King Arthur on his quest to find the Holy Grail. And spamalot being the only word that rhymes with Camelot.
Labels: Imperial College, London, Medicine, Musical, Theatre
