No Such Thing As Quality

Don't they build things that are meant to last these days?! A few months ago I was complaining about the power windows of my now demised Honda Civic, which were malfunctioning just a few months after it was purchased. And now, after just two months, there's something wrong with my Toyota Altis! The radio, which is very essential to me--- it keeps me awake when I'm sleepy, It helps me release tension when I'm pissed, it plays songs that I could sing along with when I'm bored... is malfunctioning! A month after using the car, I noticed that the radio changed radio stations when I turn the steering wheel too hard. I figured there was a glitch in the electrical system, but since such an occurrence could be avoided, I just ignored it. The real problems started about a month ago. All of a sudden, the CD player would eject all CDs even when I'm not doing anything. At first I thought I just accidentally pressed the controls on the steering wheel, but then it happened again when my hands were off the wheel. It didn't happen for about week, so I dismissed it as an isolated glitch. But then it started doing the same thing again--- this time more frequently! And to make matters worse, sometimes the radio would suddenly turn itself off! Then this afternoon, i couldn't even turn the damn radio on! Argh!

Good thing the customer service of Toyota is prompt. They would replace the radio with no additional fee as soon as I bring the car to their service center. It's just so annoying when glitches happen in something that you've just purchased. Either they don't manufacture things like the way they did in the old days, or I'm just extremely unlucky when it comes to cars.

D.N.I., D.N.R.

Do not intubate, Do not resuscitate. Usually, we give relatives of critically ill patients a choice, whether to resuscitate the critically ill patient or not. We explain the patient's case thoroughly, and when we believe that there is no more hope for the patient to get well, we inform the relatives of this option. People have different reasons for not wanting to resuscitate their relatives. Most people say that they do not want their loved ones to experience any more pain and suffering, especially if the illness has been chronic. Their loved one has already gone through enough. I believe others base their decision on their finances... though they do no admit it. I believe most of them really do care for their relatives and they want us to keep trying even when all hope is lost--- they just couldn't afford it. But I get the feeling that some are relieved when we bring up this option--- relieved that their bank accounts could finally take a breather. Whether or not they truly cared for their patient is beyond my perception. I understand how someone could choose not to resuscitate a person they loved deeply when resuscitation could offer nothing more than to prolong the inevitable, and simply result to broken ribs in the process. When all is lost, the best option at times is to let go.

But what if resuscitation can clearly save a patient's life? I understand patients who refuse to give consent--- after all, intubation seems to be a very uncomfortable, even painful procedure. If I was conscious, I doubt if I would give consent myself. But when the patient cannot decide on his own, whether conscious or unconscious, I can't understand how their guardians choose not to resuscitate even when we explain the benefits to them. Why bring these patients to the hospital when they refuse to allow us to perform the appropriate management? At times I'm tempted not to follow protocol and just pretend that the patient has no guardians or relatives so that I could do whatever I must do to try and save a person's life. I couldn't understand the relatives of this one patient who could still speak, who could still walk, who is still capable of emotions--- and yet his relatives ask us outright if they could already sign the form that says that we shouldn't resuscitate the patient in the event that he goes into arrest. I guess I'll never understand why some people behave the way they do.

Last week, another patient came in with difficulty of breathing. Breast Cancer Stage IV, with pleural effusion. Thoracentesis and closed tube thoracostomy done several times. The disease was no longer curable, patient was discharged from where I used to work a week prior, and was told to just let the patient spend the last few days of her life at home with her loved ones. Right off the bat, the patient said she did not want to be intubated. She did not want to have needles injected either, and inserting a chest tube was definitely out of the question. She was quite delirious, screaming and gasping for breath, yet asking for soup, which would definitely quickly ended her misery if her request was heeded. We turned to the relatives, and they said the same thing. They did not want to have any resuscitative measures done, because the patient did not want to. I wouldn't call it ignorance because we kept on explaining everything to them in simple, clear layman's terms. It would be harsh to chalk one up for stupidity, but I could think of any appropriate term. Maybe stubbornness. Maybe weariness. Maybe surrender. There she was, screaming and gasping for breath, and we couldn't do anything--- except watch her slowly die. A few hours later, she finally succumbed to pulmonary arrest---- just when her relatives decided to just bring her home. Maybe we should've just let her have her soup--- at least she would've died with some sense of satisfaction, her last request granted.

I've always thought that I was already numb to the idea of death, having witnessed a number of deaths each day that I am working at the hospital. One patient died, no big deal, just move on to the next. But on that moment, I couldn't help but feel sad. I knew that our hands were tied and it wasn't our fault, but I couldn't help but feel guilty. Maybe we should've tried convincing them more, maybe we should have tried harder. Maybe we should've thrown protocol aside and just pretended that we did not need their consent. Foregoing consent may be deemed unethical--- ignoring the patient's rights, physicians playing God, imposing on others what they believe is best... but for me, the sin of omission seems just as unethical... even more so.

But what do I know? I'm just a hospital employee carrying out orders, following protocol, in a line of work where having a conscience is a sign of weakness. With all the pain, death, and suffering we face each day in our working environment, letting emotions overwhelm you could only lead you to the brink of your own sanity.

Two Sides of The Trade

Last week, a good friend of mine asked me if I was on duty. It was my day off from work, and I was just surfing the net at home, so I told him I was just at home doing nothing important. He asked me if I wanted to go out, he was having problems with his work--- at a crossroad, so to speak. Plus, his love life, which seemed cloyingly warm and sunny a few weeks back, suddenly fell apart. He wanted to talk, maybe over a few rounds of beer. As we were driving around looking for a place to hang out, we ended up at the part of the city where there were so called health clubs and massage parlors left and right. He then asked me if I was in the mood for something that wasn't so wholesome. I immediately knew what he was talking about. Although I've never been inside one of those places, I'm aware that most of those establishments are just fronts for prostitution. Health club my ass. I know there are extra services rendered after a so-so massage. It's been a while since I last got laid, and since I've never been inside one of those places, I figured--- what the heck. I'd chalk one up for experience.

We went inside the first health club. The interiors were classy enough, you'd really think it was a legitimate spa. Along with a couple of other men, we were led towards a room with a viewing window--- not much different from those viewing rooms you see on cop shows on TV, where suspects line up and you'd be asked to identify the culprit. When the curtains were drawn, a number of women, all smiles and fully made up, wearing clothing that left very little to the imagination, each one with a number on the upper portions of their clothing, were seated side by side. Unlike the other men in the room, I didn't feel excitement. Yeah, I was quite horny as we were led to the viewing room, but when the curtains were drawn, I felt a sudden wave of sadness and guilt come over me. I'm not a newbie in the flesh trade--- heck, I'm not what you can call a beginner, since I've been engaging in the very risky practice of picking up random women (who are obviously in the flesh trade) in the streets occasionally, for several years now. But the experience in the "health club" was very different. For one thing, it wasn't a one on one transaction, wherein you immediately get down to business because terms were already understood. A lot of people were involved that time. There was the manager of the place, along with usherettes giving out recommendations. There were also other patrons in the room, choosing the right girl to render services to them. I've never seen women treated that way, where they were lined up as commodities, like meat or vegetables that you buy in the market. Life must be really difficult for those women to resort to such work. They were all wearing smiles, trying to look as enticing as possible to would be customers that they can't see through the one way mirror--- but those smiles were obviously not genuine. Those smiles can't hide the desperation and sadness you see in their eyes. they were obviously forced by circumstances into a job that they didn't want to be doing in the first place. I know exactly how they are feeling. My friend didn't find anyone he liked, so we left. I immediately felt a sense of relief when we got out of the building.

I was no longer in the mood, but obviously my friend wasn't. He had a lot of problems, and if that was the way to relieve some of the stress that he was feeling, then I should be there to support him. We stopped by three other health clubs before we found girls that we found attractive. We were led to separate rooms, and I waited for the girl I picked--- some half Asian- half Australian, who was referred to as Number 34. When she entered the room, the smile was gone, all that I saw in her face were her real emotions. Mostly apathy, with a hint of misery, as if saying "let's just get this done with immediately so that we can move on..." It was my first time, so I asked questions. She didn't seem surprised, saying I looked too young to be frequenting places like that--- most of her customers were dirty old men, although there's the occasional 21 year old like me (LOL!) who's looking for his first sexual experience. I almost laughed. I played innocent, and I asked her if all of them gave sexual services, and if so, doesn't that make them prostitutes? She admitted that pointblank--- what else would they be doing there? She's not really a masseuse---- but if I wanted a massage she could give me one. If I didn't want her other services it would have been fine with her, she'll just leave and I could stay in the room until my time was up. Obviously she was in no mood to talk about her life, which I assume to be riddled with anecdotes on poverty based on the sporadic answers she was giving me. I really wasn't in the mood for sex that time--- her indifference clearly wasn't helping either. i told her to just give me a massage, then we'll talk about where we'll go from there.

That was the most. pathetic. massage. ever. At least she was truthful from the very start--- she really wasn't a masseuse. I told her to give me a hard massage since I'm just tickled when being given a soft massage. She was basically just rubbing ointment all over me, with no pressure at all. Jeez, we weren't at a beach and I wasn't asking her to rub sunblock on me. When I told her to put some pressure, I felt as if she was deliberately tickling me. Apparently she found my stifled laughter weird since she gave me a certain look. Great, now the mood was definitely a hundred percent gone. Afterwards, she asked me if I wanted anything else. Seeing that I still had 30 minutes to spare, I asked her if she really wanted to do those extra services, because her face clearly shows that she doesn't want to... and I wouldn't force anyone to do anything they don't want. It would be okay for me to just take a nap. She said that although a part of her doesn't want to, another part of her wants to because she really needs the money. The amount I paid on the front desk doesn't go to her, but for the extra services, all the money I pay her goes directly to her, she doesn't have to give a part of it to the establishment. Although the mood was lost, my sense of charity wasn't. And although she didn't say it outright, I felt that she was hoping that I would say yes.

And so we did it. It wasn't great, and although her stinky pussy (which was one of the stinkiest my olfactory nerves have ever been exposed to) nearly ruined it, i would say it was satisfactory. And I finally saw a genuine smile as I gave her the money. I had to wait outside for a few minutes since my friend was taking his sweet time. I sat at the couch on the foyer area, and I saw more gentlemen coming in, taking their pick. Once again, I was overcome with pity.

Fast forward three days. My grandmother's health was becoming problematic again. It's bad enough that I'm in a line of work that I don't really want to be in--- but I could treat that as simply WORK. Things that I HAVE to do for MONEY, and thankfully I could isolate work from the other aspects of my life. But to do the same WORK at home where I should be free from the stress of work--- that can really get on my nerves at times, especially since the whole family relies on me, saying I'm the doctor in the family. It doesn't matter if i absolutely detest everything about internal medicine, it doesn't matter if I'm not really an expert in that field and that I might be making the wrong decisions, that I might not be treating her properly... to them, I'm a doctor. period. I should be able to manage her case well. I love my grandmother, but at times like that when her numerous health problems crop up, the pressure I'm feeling get so high, I feel as if I'm going to explode.

I had plans that night, which I obviously had to postpone or maybe cancel since I was the only one at home who can drive her to the hospital in case things turned from bad to worse. Thankfully my dad got home just before midnight and I was able to leave--- of course a bit of scolding came with it, saying I don't care about anyone else but myself yadda yadda yadda.... but I was able to leave! On the way home I decided to drive around since I wasn't sleepy yet. As I turned on one corner--- whoa, what was that? A scantily clad female was smiling at me... although she obviously can't see me through the tinted windows of my car. Ah, now that's the type of flesh trade that I'm accustomed to. I drove away, but then I thought of making another round, and she was still there. I thought I should drive away and just go home, she wasn't even that attractive in the first place. Just when I thought that my rational side had already won, i started thinking with my dick again instead of my head. I made another round and she was no longer there. I said thank God, but then she popped out of nowhere. I drove away again, then drove back. There she was, very plain looking yet somehow inexplicably attractive to my dick, now walking towards my car. I unlocked the door on the passenger's side, said hello, and immediately laid down the terms.

Fast forward 15 minutes. Seedy hotel with the smell of cigarettes and mothballs. Paid at the front desk. Went back to the room. Five minutes and we were done. That was fast. It was a long night and I was beat. I fell asleep. Woke up after an hour. She was no longer there. That dirty average looking slut was no longer there. Still a bit dazed as I went to the bathroom... what I saw as I went back to the bed completely woke me up. It shook me back to my senses. My bag was open. I checked my bag and I was relieved. I laughed out loud when I saw that my ipod, camera, and PSP where still beneath my gym clothes. The bitch wasn't smart enough to check. My wallet was still at the dresser--- only spare change were there, of course she wouldn't take it. Then I remembered another prized possession. I checked my bag again, on the side pocket this time, and as I expected--- it was gone. My cellphone was gone! That good for nothing bitch! I told myself I must be dreaming, but it was very, very real! Yeah, it was a crappy phone, but it would take a month's salary to replace that phone... and I'm not actually swimming in cash these days! There were also some private pictures and videos in there, some with sentimental value that I haven't made back up copies of! That's what I get for thinking with my dick! i swear if I see that good for nothing asshole on the streets I would run her over! If I bump into her anytime in the future I would completely beat her up! I know times are hard and some people would resort to stealing when the opportunity arises---- but I gave her my trust! I hate it when people betray my trust!If she just told me she needed the money and if she gave me a valid reason I would have given her more out of pity! But how could I give these poor people pity when they betray the trust that we give them! I hope to see her again in the near future so that I could STRANGLE her! Fuckin' bitch! Good for nothing filthy whore!!!!! >:O


*****

If there's one good thing that came out of this---- I would think thrice before picking up some random slut in the streets again. And hey, if I really have to nitpick and look for something positive that came out of this situation--- I've managed to get rid of the crappy phone I was complaining about a few weeks ago.

An Incredible Feat

I'm not part of the overwhelming majority who thought that the first Hulk movie sucked big time. In fact, I liked the whole Greek tragedy allusions and I didn't think it was overly dramatic. But of course, that was not the Hulk movie people wanted. Both fans and casual movie audiences expected an all out action movie with lots of destruction. No one wanted a Hulk movie that would be better suited for the art house film crowd. Four short years later, Universal pictures released this reboot. At first, I didn't want to see this movie. First of all, the trailer--- which was supposed to show the best scenes in order to attract audiences, did not interest me. The film looked pretty boring for an action film. Regarding special effects, The hulk still looked incredibly fake, even with all the advancements in digital technology. I thought they just wasted the acting talents of the cast. But after reading the reviews in the Internet which were mostly positive, and since I'm a sucker for films based on comic books, I decided to give this film a try. It's not perfect, but it's the Hulk movie people have clamored for in the first place. Action packed, fast paced, and with lots of destruction, you'd end up asking for more. At frist i thought Ed Norton didn't fit the part, but then I realized that Bruce Banner was meant to look geeky, unlike Eric Bana who looks like someone who can already beat you up pre-transformation. hehe. The effects weren't really that bad--- you would get used to the Hulk as he blends with reality. It's not as good as Ironman, and I doubt if it will even be half as good as The Dark Knight, but comic book fans would still be pleased, and action fans wouldn't come out of the movie theater disappointed this time. 3 1/2 stars out of 5. :)

No to Nokia

The brand Nokia used to be synonymous with quality. That was years ago, when cellular phones weren't that sophisticated. A few years ago, after I bought a Sony Ericsson phone, I swore I would never go back to Nokia. Not only were their phone models sturdier, there were also less bugs in the software. Plus all of their high end phones actually had all the features you need in one model. A music player, a camera, an FM tuner, a basic web browser... I used to wonder why Nokia used to separate those features when it was possibly to offer all those features in one cell phone model.

Last March, I realized that it was time to buy a new cellphone since my phone already looked very worn out--- i've been using it for more than three years after all. Since I was very pleased with my old phone, I checked out the Sony Ericsson website and browsed through their latest phone models. What I was really looking for was a model with an excellent camera since I like taking random pictures every now and then, but the phones that had good cameras didn't look aesthetically pleasing... in fact, some of them looked downright weird. About the same time, Nokia was advertising their N82 model. At first I ignored all those ads, but out of curiosity, I searched the net to check out its features. It also had a 5 megapixel camera which was great... but what surprised me was the fact that it was loaded with features! Aside from the usual web browser, fm tuner, music and video player, it came with wifi! it also came with GPS! WOW! And aesthetically speaking, the phone didn't look bad at all. I guess all those features blinded me, because after a few days I threw all caution to the wind and purchased a Nokia N82.

When I first held it, I immediately thought of one thing--- Fisher Price. I thought the phone felt too plasticky --- it would probably break if I held it too tight. It really felt like a toy. What the heck, i thought. I'd just take care of it since I'm very careful with my gadgets anyway. Besides, I was very satisfied with the camera. But after just a few days, there were scratches all over, even on the screen!--- Even though the phone was usually just on my pocket with nothing else, except maybe a handkerchief. I have to admit, A lot of those applications were really useful like the document viewer, but the software was painfully sloooooooow. It takes several seconds to open a single text message, and I won't even get started on my web browsing experience. even with a good connection, it takes ages to move back and forth through web pages I've visited. The default web browser wasn't any good, I had to download a third party web browser. There's also a lot of bugs--- some are negligible, but there were many times that I felt like throwing the damn thing out of frustration. The phone would suddenly hang, or spontaneously reset. I couldn't delete messages because text message memory is full?! What the fuck is that?! Clearly, Nokia still hasn't gotten the whole software development thing figured out.

I knew better, and yet I've made the mistake of giving Nokia phones another shot. I thought it was safe to assume that they've mastered the art of manufacturing next generation cellphones by now. So much for giving second chances. It's not really a bad phone... I have to say that it's above average, but there are a lot of better options out in the market today. I should have just waited for the 3G capable iphone which will be out later this year. Packed with a zillion features, with an SRP of $199 for the 8GB model, it's practically a steal.

Natural Bliss

If someone would ask me if I ever feel genuinely happy, I would say yes. I'm genuinely happy when I'm drunk. The alcohol blurs out all worries, erases all problems temporarily, that I am overcome with such joy. The happiness that I feel may be unnatural, the happiness I feel may be unreal, but during those moments, I could truthfully say that I am happy.

Do I ever feel happy without the aid of chemicals in my system? Yeah, I do. I'd usually say I am genuinely happy when I'm at the beach--- such a simple answer, some might even say shallow, but it's true. What can I say, I'm a beach person. :) Every time I see the untouched beauty of nature, I could simply sit down for hours, admiring the view, awed by the splendor right before my eyes, appreciating the peace and quite that seem to be a luxury these days, doing nothing else... and I can still truthfully say I am happy--- genuinely and naturally. :)

*pictures were taken during my camping trip with friends last week. Just like that old Mastercard ad... cell phone to call friends: $___. pda to beam friends: $___. internet set up to IM friends: $___... actually being with friends: priceless :)

Omission

It started out like any normal day in the emergency room. Nothing out of the ordinary. Managing patients left and right. Writing down orders. The occasional cardiopulmonary arrests break down the monotony. Then someone came up to me, his face vaguely familiar. Was he a patient on follow up? He spoke some words that at first i could not understand. He seemed really upset, even angry. It took me a few more seconds to realize that he was blaming me for something...

He said his brother, a patient that I managed in the emergency room, died two days after being discharged from our hospital. And he was blaming ME for his death. Saying that we did not attend to his brother, that we basically just ignored them, that's why they were forced to leave--- because apparently staying at our hospital would bring them nowhere. That's his version of the story. I took me a while longer to remember his brother's case. With the number of patients we see everyday, faces have this tendency to blur.

They sought consult because of a carbuncle on his right buttock. It gave him great discomfort because it was very painful every time he tried to sit down. At first we directed them to the outpatient department because clearly such cases aren't managed at the emergency room. But since he looked weak, we decided to give him some primary treatment. Upon closer inspection, the patient was febrile, and he had yellowish sclerae. He was probably septic. The carbuncle, his primary complaint, was probably the result of a system wide infection. But since there were very limited ancillary procedures available in the God forsaken hospital where i am employed, I couldn't really pinpoint where the source of infection was. Empirical treatment seemed to be the only option, as always. But since the antibiotics of choice were not available in the hospital, we had to ask the relative to purchase the antibiotics in one of the drugstores outside. That's the first stumbling block that we couldn't seem to hurdle. The money they brought with them weren't enough to purchase the medications. If only the medications were available, then they could just opt to pay for the meds prior to discharge from the hospital. Sadly, such a scenario remains to be a dream in most government hospitals.

The second stumbling block--- the patient can't be admitted because there's no room available. Because he was septic, it was not advisable fro him to stay and wait at the emergency room when there's no certainty as to when he would be admitted. In the emergency room, patients with various infectious diseases are placed side by side. Prolonging his stay in the emergency room would only worsen his condition. We had no choice but to advise them to transfer to another hospital where adequate treatment would be given. I was about to explain this to them, when the patient's brother told me that they decided to go home instead, because they would be leaving for the province the very next day. I told them that it was not advisable to go home. And he was definitely not in the condition to travel. I specifically told them that they should transfer to another hospital. I thoroughly explained his brother's case, but they were stubborn. They said they already purchased tickets for the trip, and they have to back to the province the next day. They would just seek consult at the provincial hospital. I told them that if they would insist on what they want, they should sign a waiver that they want to be discharged against medical advise. They agreed. It was against hospital policy to give a referral form when patients decide to go home against medical advise, but I gave them a referral form that they could show to another doctor when they decide to seek medical consult. The patients vital signs were stable, and though he was weak, he could still walk. I signed the discharge papers saying it was okay for them to go. That was two weeks ago.

And then the patients brother suddenly showed up, accusing me of negligence. Accusing us of being numb. Saying things like just because they are poor we didn't give them the necessary treatment, making the whole thing case of oppression, a clash between socio economic classes. What did they expect us to do? Shell out money to but the medications outside? If we did that to one patient, shouldn't we be doing the the same thing to each and everyone of them? If I had enough money, maybe I would have done that out of pity, but I certainly didn't have enough money to buy medications. Just because we are doctors doesn't make us martyrs. Sure, we could be martyrs if we wanted to, and I have been a martyr several times in the past. But in reality, doctors couldn't afford to always be martyrs. Majority of doctors can't afford to be martyrs at all. And it's not like I gave them faulty advise. I kept on reiterating that they must transfer to another hospital, they should not go home. I explained the possible consequences. I kept on explaining this to the patient's brother and he can't seem to understand. It even seemed as if he suddenly had selective amnesia, completely forgetting the preliminary treatment that we gave, forgetting the fact that i was persuading them to transfer to another institution, completely forgetting the fact that it was THEIR choice to leave. I kept on explaining and yet it couldn't get through his thick skull. He kept of blabbering the same things, keep on sputtering those accusing words, and my patience was slowly running out. I decided to look at the other patients before I said anything I would probably regret later on. I could still see him at the corner of my eye, just standing there, as if waiting for something. I had no idea how long he was waiting. I just realized that after some time, he finally left.

I know i did what was needed to be done. I managed his patient properly. I know I wasn't negligent. I am not guilty of the sin of omission... but why do I feel a tinge of guilt? A few hours after he left, when the work load became benign, my conscience started bothering me. Did I do something wrong? Was there something more I could have done? Maybe all I felt was empathy that I've mistaken for guilt. I could feel the deep sadness as I looked into his eyes. I could feel his pain. I could feel his loss. I could also feel his frustration... hopelessness... futility... anger. Anger brought about by loss. Misplaced anger brought about by a lack of understanding. And with the amount of anger that I also saw through his eyes--- even an innocent man would probably feel guilty with such a hateful gaze directed towards him.