A Different World.....
I was chatting with a friend yesterday and our conversation steered towards the practice of medicine as it usually does with medicos. We just cant seem to seperate our work from our everyday lives can we? Being a doctor permeates everything you do, you sleep, you talk, you walk medicine, and for a dreamer like me ( i actually dream almost always when i sleep. if i put my head down for a couple of minutes i drift off into dream land) i actually dream about seeing patients and performing surgeries, yes o!
Well our jist came round to resuscitation of patients. Before i tell you her side of the story ill tell you mine. A patient who decides to gasp down here (ie take the last few breaths on planet earth) does so with no assurance of being brought back. First of all you are ill equipped to do anything, no suction machine to clean up secretions, an ambubag is sometimes available, Oxygen? you've got to be kidding, most times there is none in the hospital and as always the oxygen concentrators are out of order. A resuscitation tray is non existent, if you want to intubate a patient hmmm..........
Her side of the story is- she was on call and there was a code on a patient. In her words 'nobody dies' Hmm i was intrigued. It happened that the patient was retroviral positive and they went as far as intubating the patient. For me that is new. Usually patients with HIV present at our own facility very late, they usually discover they are positive when we carry out the test and many already have full blown AIDS. Some come with atypical presentations- sudden loss of consciousness, seizures etc and are too far gone for any meaningful intervention, that is not to say we don't do much, we try our very best.
So when such a patient who may or may not have commenced ARV's( anti-retroviral drugs) suddenly starts gasping, what do you do?. He is the breadwinner of the family but since the onset of the illness all the families savings and potential source of income has been wiped out. He can hardly afford to feed himself, then he still has to pay for the drugs used to treat his oppurtunistic infections, he can hardly afford the subsidised ARV's, if they are free the money for the trip to collect them may not be available. It is a vicious cycle.
If he suddenly starts gasping, do you go all out to resuscitate him?, keeping in mind the meagre resources of his family ( wait hear me out!) Do you do everything including deploying the very few half filled oxygen cylinders the hospital has to make sure the gasps of air he is taking are not his last, using up further money that is not just available. If you do, does he come back to an ideal world where ARV's are freely available where there are facilities for testing resistance to the different drugs so he can be switched to different combinations whenever a resistant strain comes up, like my friend in the states says happens over there.
Well if i go to all that length to resuscitate a patient with this condition my heartfelt wish and desire would be that he would wake up to take in fresh draughts of air in a world where the value of a human being is placed far above the love of money, position and titles, where the common man has a chance to life, where the very basic needs of life are not beyond his reach.
Yes i wish he would wake up in a different world!
Well our jist came round to resuscitation of patients. Before i tell you her side of the story ill tell you mine. A patient who decides to gasp down here (ie take the last few breaths on planet earth) does so with no assurance of being brought back. First of all you are ill equipped to do anything, no suction machine to clean up secretions, an ambubag is sometimes available, Oxygen? you've got to be kidding, most times there is none in the hospital and as always the oxygen concentrators are out of order. A resuscitation tray is non existent, if you want to intubate a patient hmmm..........
Her side of the story is- she was on call and there was a code on a patient. In her words 'nobody dies' Hmm i was intrigued. It happened that the patient was retroviral positive and they went as far as intubating the patient. For me that is new. Usually patients with HIV present at our own facility very late, they usually discover they are positive when we carry out the test and many already have full blown AIDS. Some come with atypical presentations- sudden loss of consciousness, seizures etc and are too far gone for any meaningful intervention, that is not to say we don't do much, we try our very best.
So when such a patient who may or may not have commenced ARV's( anti-retroviral drugs) suddenly starts gasping, what do you do?. He is the breadwinner of the family but since the onset of the illness all the families savings and potential source of income has been wiped out. He can hardly afford to feed himself, then he still has to pay for the drugs used to treat his oppurtunistic infections, he can hardly afford the subsidised ARV's, if they are free the money for the trip to collect them may not be available. It is a vicious cycle.
If he suddenly starts gasping, do you go all out to resuscitate him?, keeping in mind the meagre resources of his family ( wait hear me out!) Do you do everything including deploying the very few half filled oxygen cylinders the hospital has to make sure the gasps of air he is taking are not his last, using up further money that is not just available. If you do, does he come back to an ideal world where ARV's are freely available where there are facilities for testing resistance to the different drugs so he can be switched to different combinations whenever a resistant strain comes up, like my friend in the states says happens over there.
Well if i go to all that length to resuscitate a patient with this condition my heartfelt wish and desire would be that he would wake up to take in fresh draughts of air in a world where the value of a human being is placed far above the love of money, position and titles, where the common man has a chance to life, where the very basic needs of life are not beyond his reach.
Yes i wish he would wake up in a different world!
Word!
ReplyDeleteI quite understand your points here and they are really true. But one thing that bothers me is attitude to diseases like HIV in Nigeria. Most of us still don't believe it exists but many are killed daily. And it is proven that the greatest % of cases are through sexual means and not clippers or other sharp instruments. The statistics is alarming. About saving that kind of life ....uhmn .... it is hard to comment on that but really it is hard to explain to anyone the logic you just described.
And talking about BMC .... I have slept there before. My brother had his appendix removed at BMC and I stayed with him. I actually saw u there and introduced myself as Toyin's friend.
Enjoy the future challenges!!