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

Let the banks to fall!

We achieve a point where the consumer (the client) no more knows which taxes/fees he is paying. Economists have their own language and people are unable to learn it because they are busy earning some money to eat and a big slice for bank fees. We no longer have access to our own money (bank account) without paying to see it! Paying money to see our money! Curious...

This letter was addressed to a Portuguese bank and reflects well this absurdity:

Dear Sirs,

I would like to know if you would accept to pay a small monthly fee for the existence of this bakery, located near your bank; or for the existence of the petrol station or the pharmacy or the kiosk, all indispensable for our daily routine.

It would work in this way: all clients would pay a small fee to maintain these services (bakery, pharmacy, kiosk, mechanic, grocery store). A fee that would not guarantee any extra right to the client. It would be used only in the maintenance of a high quality service and to amortize investments. What do you think?

Well, yesterday I got out of your bank sure that you Sirs would agree with such fees. For a reason of equity and honesty. My certainty derives from a simple chain of thoughts.

Let us imagine the following situation: I go to this bakery to buy some bread. The baker complies with kindness, sells me the bread and charges me a fee to pack the bread. Besides he imposes fees for "accessing the bread", "storing the bread", and even a fee for "having the bakery opened". Everything fulfilled with cordiality and professionalism, of course.(...)

Do you want some enlightenment?

- fee to open credit = fee to access the bread
- fee to open bank account = fee to open the bakery store
- fee to see your bank account = fee to the existence of the bakery store
- fee to maintain a special limit of funding (every trimester, no advantages) = fee to keep the bread warm
- fee in any account money transfer = should I pay to breath the air of your facilities?!

(...)After I payed all the taxes maybe you would answer, always with such cordiality and professionalism, that a bank service is quite different from a bakery store. That your responsibility is much bigger, that there are many legal requirements, that the business risk is huge, etc, etc. That besides being profoundly sorry about this situation, you cannot do anything, because you are not inflicting the law. I know that. I also know that you are covered by some special legal advantages that protect your business from any disturbance. I presume a bakery store does not have as much risk and also that does not count with the influence power that you Sirs have.

I know that everything you do is within the law, but I also know that it is immoral.

Imagine now that you do not just laugh with this adapted letter, but that we really do it. That we start fighting for special benefits (introduction of stupid fees) in every single private branch. Companies from which people depend on their daily activities... On the other hand, should we all go to jail for trying to rise up some morality and mutual help between people of this crazy world? Examples of success, of what is accepted as right in this society are corrupting the basic human principles and if we do not do something, these legal fees might become a reality.

As a wise man said once, save your money under the mattress!

Fuck The System

The Human being is a social being, more precisely, its nature and interactions are based on the biopsychosocial model, first theorized by the psychiatrist George L. Engel in 1977. An individual cannot develop without social interaction. In fact we would not fit in this world without the surrounding social environment, so important for the development of language, values, religious views, and, ultimately, of crucial importance for the perpetuance of our species once we still do not know how to reproduce asexually. This social interaction begins at the time we have not seen a light beam, when our development is influenced by our mothers’ mood, stresses, personal problems, cuddling over the tiny piece of skin that separates us from the outside world. Then, we are fully dependent on the touch we receive from the caregivers (mother, father, others). If we are not held on the arms of our caregivers we simply die, we do not acquire the notion of self-esteem, self-confidence; we do not develop our ‘self’.

Being so dependent on the environment for our correct development, one might ask, what is the best environment to raise a human being? The answer is so obvious that does not even deserve discussion. What is of extreme importance is that the role of the closest persons in our lives is being lost to the big scramble of information, politics, propaganda, wars, crimes, lists of death people, educational programmes, etc, etc. Every single person knows the power of the media in the transmission of information, nowadays so easy with the development of our technology, the creation of social networks, online newspapers, and wide range of TV channels. It is so widespread and it does its work (transmission of information and entertainment) so well that its control is desired by the most evil people living on Earth.

This ‘social’ interaction is killing our species.

Nowadays we simply accept the options that were first given to us. We live in a capitalist system and if you do not share this common sense notion, you are called anti-capitalist; if you believe that the government can have some power over private companies you are called fascist; if you defend a more patriotic and nationalist approach, you are called nazist; if you think everyone should have some social support from the government, you are called communist! All these words are so negatively-charged that people are suppressed by them when trying to make a point that has no similarities with any of the true definition of these terms. More, when arguments fail, people with new ideas are simply ignored or, even worse, called anarchists simply because they do not feel as a part of the system the world has to offer.