Twists and Turns

He passed away. The man with the lung cancer I wrote about earlier. At 2.29 pm he exhaled for the last time. He finally found the rest he so desperately wanted. Met his son briefly at the stairway. He was squatting at the steps, busy talking with some one on the phone and smoking! Normally I would have told anyone I see puffing there to stop smoking but today I kept quiet. Let him smoke, after all, he just lost his father. I just hope and pray it doesn’t become a life long habit for him. He might just follow his father’s painful exit. People use that stairway to smoke so often in this hospital that we have taken to calling it ‘The Chimney’.

And the one who wrote in with displeasure regarding sponsored trips? Turns out she/he (now I am no longer sure of the gender…. it’s hard to tell on cyberspace) is working in a pharmaceutical company!! She said she was playing the devil’s advocate. Fair enough but it is rather disconcerting to realise that while these reps may be offering us, lowly MOs, a sponsorship, deep within they may actually disrespect us for accepting it! (read her response in the comment page). Ouch! Now that’s not very nice is it? Yes, people wear so many masks.

It’s been a long day today. Depressing to say the least. The haze is back. No need for alerts (read the front page of The Star). It is BACK! One look outside the window confirms it. Soon fingers will be pointed at our neighbouring country. Denials will abound and resolves will be taken that next year things will be better. Same old story, same old cycle. Nothing changes. Before long my ward will be full with wheezing coughing breathless patients. Sigh…..

Slow painful exit to the other side

I feel sad and helpless. Right now there is a elderly chinese man in my ward who is suffering. He was diagnosed with lung cancer about 6 months ago in a private hospital. He has smoked practically all his life. By the time he was diagnosed with the ailment, he was already in Stage 4. The histopath was ‘poorly differentiated adenocarcinoma’.

He was administered 2 doses of chemotherapy after which he felt a lot better and decided to forgo chemotherapy and sought traditional herbal remedy. He came back to us in January this year when he started to be forgetful. A scan revealed that the tumor has spread to his brain, adrenals and also the mediastinum (the area in the chest wall where the heart and other major vessels were located). He was offered chemotherapy but he declined. He was given some steroids to ‘shrink’ the tumor and he was better.

He was readmitted over the weekend after becoming increasingly breathless. Another xray showed the tumor has grown very large, almost covering 2/3 of his right lung! More steroids did not help. He requested for chemotherapy! By now his functional status is grade 4 (very bad).

Coming in on a weekend is bad news as we could not trace his notes. He didn’t have any card or letter on him. All I could do was give him steroids and put him on oxygen 24 hours a day.

I feel sad because here is a man literally suffocating and in his last stretch of life and I could not do anything. I am trying to get the oncologist to give him some palliative radiotherapy to ease his breathlessness but I don’t think it’s going to be of much help. He is too far gone.

I got to know that he is divorced. He has an only son, in his late teens who has been by his bedside since yesterday. His wife is in Australia and according to his son “she couldn’t care less”. He has a sister in USA who may not make it back in time to see him.

The man drifts in and out of drowsiness and confusion; sometimes scolding the son, sometimes pleading, breathless all the time. He could not lie flat at all. He can’t sleep. He is literally suffocating.

It sickens me to know that the traditional therapist that he has been to has strongly advised him against having any more chemotherapy. Instead he was fed concoctions after concoctions (which probably contain loads of steroids anyway) adn he got no better. I am thinking, perhaps things could have been a lot different had he continued with his chemotherapy earlier. Perhaps not. For stage 4 lung cancer, the end is probably guaranteed. Medical science has no cure as yet for this stage.

It was hard for me to take the son aside and tell him that his father is dying. It’s hard for me to look at the patient in the eye and tell him we are doing the best we can. Can he see the helplessness in my eyes? Does he know that there is no more hope?

I don’t feel good. Once again I am reminded that human life is finite. Life is short. It’s a terrible way to go. It reminds me again that in my short life, I want to try and make the most of it; to leave this place a little better, or make someone’s life a little easier. It reminds me also of God’s sovereignity. In the end He has the final say.

However, I am also reminded that, just as Gandalf whispered, with a little twinkle in his eye, to little Pippin (or was it some other hobbit?) just before the assault by the dark forces on the stronghold, in Lord of the Rings: The Two Towers (or was it the third part? I forgot), death is but the door way to something better. And that is strangely comforting.

Controversy on Sponsored Trips

Another (or the same) person has responded to my article on sponsored trips and voiced her displeasure over the matter. I have responded to her remark (please read the comment page on the article ‘Sponsored Trip’).

Perhaps I should not have written about this matter. Some people feel very strongly about it. I can understand their feelings. I feel strongly about some matters too.

The above author mentioned that how come pharmaceutical companies chose to sponsor me instead of some MOs (medical officers). She remarked that it’s because MOs have no purchasing power and cannot get a drug into the blue book.

Now for those who are ignorant, the blue book is the coverted place for all pharmaceutical companies, at least in Malaysia. If your drug is listed in the blue book, it means that the Health Ministry has approved it for dispensing to the public and the government will be purchasing that particular drug from that particular company. I think it’s safe to say that it’s every drug rep’s dream for their product to be listed in the blue book. Frankly, I don’t know if the actual book is really blue in colour.

I believe the above author was under the illusion that I am a specialist or consultant; and that I have clout to get any drug into the blue book, and so that’s why the pharmaceutical company wanted to sponsor me. The other matter she raised was that she “do not see other MOs being sponsored”.

Let me clarify that she is wrong on both counts. In truth, I am a MO. By the grace of God, I passed my final exam last year and now am in the midst of doing my dissertation. God willing, I should complete my course at the end of this year. My blog personal profile says “Physican in the making”. So, yes, technically I am still an MO. However, I perform the duties of a physician now in the hospital. It’s part of the final year training in my course, so to equip us to be good physicians by the time we leave.

And as am MO, I do not have any clout nor purchasing power at all. In fact, as far as I know, in this hospital the only people who seem to have enough power or clout to get a drug into the blue book are the pharmacists! And UMMC being a semi-private institution, even if the drug gets into the blue book, the patients still have to pay for them, albeit at a subsidized fee.

As for sponsorship for other MOs, I am going to this conference along with nearly a third of the MOs working in my department; all sponsored by various pharmaceutical companies. And none of us have any clout.

Lets not see evil or badness in every action. Lets not generalise everyone. Lets not think all pharmaceutical companies think of is profit, profit and more profit. Lets not think everyone has a motive. For some one to think like that often, perhaps he or she has not really tasted any action just based on pure goodness and the wanting of the betterment of the another person.

Sometimes things are done out of pure goodness. I may be accused of justifying my accepting the sponsorship. I can’t please everyone. There will always be people who disagree with how things are done.

For me, the buzz word is ‘find out the whole truth, then speak your mind; and if some one disagree with you, then lets agree to disagree’. Life is too short to be cynical and bitter.