Surgery

Surgery takes de basic imperative of the medical profession to its outermost border,  where the human makes contact with the divine. When a person is clubbed violently on the head, he collapses and stops breathing. Some day, he will stop breathing anyway. Murder simply hastens a bit what God will eventually see to on His own. God, it may be assumed, took murder into account; He did not take surgery into account. He never suspected that someone would dare to stick his hand into the mechanism He had invented, wrapped carefully in the skin, and sealed away from human eyes. Thomas first positioned his scalpel on the skin of a man asleep under anaesthetic, then breached the skin with a decisive incision, and finally cut it open with a precise and even stroke (as if it were a piece of fabric - a coat, a skirt, a curtain) he experienced a brief but intense feeling of blasphemy. Then again, that was what attracted him to it! That was the "Es muss sein!" rooted deep inside him, and it was planted there not by chance, not by the chief's sciatica, or by anything external.

A doctor is someone who consents to spend his life involved with human bodies in all that they entail. That basic consent (and not talent or skill) enables him to enter the dissecting room during he first year of medical school and persevere for the requisite number of years.

In The Unbearable Lightness of Being, Milan Kundera

The machine

 Sometimes we lose our track. We have the feeling of not knowing anymore where our path leads us. We find ourselves deeply concerned about the current problems, about each and single one of the badly told news in our favourite tv channel. We tend to consolidate ideals, opinions which we believe are the ultimate truth in the world. That everything would work better if it would be as we imagine in the back of our minds. We are wrong most of the times. We would not do a better job. Even though we spend so much time upon these considerations, that we normally forget what is important in life.

We are lost in the middle of a fight we didn't wish for. We don't educate our children anymore, we let them to be a part of the huge 'democratic' machine that someday, just like fossil fuels, will stop to work. Education is not anymore the responsibility of the parents and they even feel angry with the teacher when the child does't have good marks. This transfer of duties will have a great impact later on the child's life.

 We don't take any extra second anymore to appreciate what surrounds us. We lost the ability of looking into a river and think about how beautiful it must be totally at the beginning, when it is only a small stream of transparent water. We have no idea which kind of fishes live in it, which birds depend on it. Nowdays a river is just an obstacle to build bridges connecting cities or a highway, so ships can enter the mainland.

 Moreover, we forget the basic values of our Human race. Relationships are not based anymore on the respect, on the game of flirting for weeks till finally pleasure is reached, as a way of consolidation, solidification, not in a way of a test, an exam or simply a way of achievement to be shown to the others. The marriage has no longer the weight, the responsibility associated with it that once had. Sometimes it is more easy to divorce than to get married.

 The possibilities of screwing up what is valuable in Human beings are so much! We spend so much time questioning, looking of evasions from our current lives, that we forget to appreciate every single moment we could. Few people keep going for a walk by a river or for a trip in the countryside. Those, for me, are moments of purity, moments in which you can really appreciate yourself, not being constantly mocked by so called 'news' that do not have nothing to do with you or your way of living. On those moments you find what is 'this' truly about.

 Of course we should have an idea of what is happening in the world, in our country, in our city. I am not saying to be a complete ignorant, a hippie that still believes everything is beautiful and pink. I am saying that we lose so much time at our jobs, then in front of the contagious channels of information (or entertainment) and finally then performing hard mind work leading to ultimate truths for your eyes and completely non-sense for the other people, that we forget all those values that were already taught by our grand-grand-grand parents.

Curtas

E se vivessemos todos num mundo GTA?

Ou será que já vivemos e somos apenas as prostitutas que se passeiam descontraidamente perto do lancil?!

The 6am case!

My nightshifts are always a big adventure. It is the time where I learn the most, where I feel more independent, but also the more dangerous for the patients, by letting a recent graduated alone, responsible for more or less 80 people.

On my 4th shift the nurses paged me at 6am. Someone had fallen at the toilet. After a quick physical examination, my heart rate went down. There were no reasons for alarming (I thought). Relevant was only a small bruise on her head, the fact that she felt dizzy when she got up from the sink and a mild melena. Because within 1 hour, the Consultants would be at the ward, I left further care for their decision.

This patient, a 85 years old grandma came to the hospital because of a biliary colic. She was jaundiced at admission, and an ERCP for the extraction of the stone was performed without complications, but with the need of a papilotomy.

I went home that morning (free day after nightshift) and on the next day I went to the geriatrics ICU, where I have been working for the past weeks. The patient that fell at the toilet was there, she had been admitted at the same morning I examined her.

What went wrong? What did I do wrong? Those were the first questions in mind. I went through her documentation and, for my surprise, there was a fallen in the Hemoglobin concentration from about 140 to 68 g/l, which i missed when I examined her. The near-syncope episode was already a sign of ortostatic hypotension after bleeding.

6am it is a bad time to think and to make decisions, but it was my mistake I didn't check the blood picture of this patient. I could have ordered an acute gastroscopy and save some time and suffering for this woman. Because I didn't take action, the patient had breakfast and the gastroscopy had to be delayed a couple of hours.

Of course the patient improved after two blood units and after cauterization of the bleeding source (the sphincter of Oddi), but the feeling of failing, and the thought that it could have been much worse (a patient that could not wait) almost didn't let me work the next day. One thing is certain, I will not repeat this mistake.

The expirence at the Geriatric's ward

One month after starting working at the Geriatric's ward, there are several things I would like to share. It is not new that the population demographics are changing very fast and the different fields of the economy are struggling to ensure fair systems to senior people.

This ward accept senior people over 80-85 years of age. As a part of the department of Internal Medicine and Metabolic disorders of a public hospital it is fully supported by the Czech government. However, as I understood later, the purpose of this ward is not to be used as a social dump for dependent senior people, but as a diagnostic centre. In a few words and in practice, this is what happens: senior people come to the Emergency department with their particular complains, through the General Practitioner or through the Paramedic services. Then, after a quick stabilization they are sent to the Geriatrics ward. Here we have the function of assessing the social situation of the patient and the prognosis, keeping in mind that old people are more fragile, and amenable to subtle changes with much greater consequences when compared to the 70kg, 35 years old male model.

We have a goal of a hospital staying of no longer than 1-2 weeks because the lying in bed and all the inactivity results in muscle atrophy without the possibility to walk again (you can really see the muscles getting atrophied). According to the particular comorbities of each patient, we have the chance to discharge them to their homes without additional care (ideal); with some Home Care service that will bring them food and do minor hygienic procedures; to discharge to long-term care hospitals (LDNs - léčebna dlouhodobě nemocných) in case of a high-degree of dependency (dementia, complicated diabetes mellitus, long-term catheterized people, chronic infectious diseases); to senior houses (DD - domov důchodců) in cases of loneness despite good health; and to hospices in case of terminal stage diseases. So, Geriatrics is thrilling because of the fast changes occurring in the bodies that lived already 80, 90, 100 years and, at the same time, demands knowledge about the best social service to provide to the individual patient.

"Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul." Samuel Ullman