Toying With Lives

I have always said that I prefer working at government hospitals because that's where I can reach out to a greater percentage of people who need our help the most. But at the place where I'm working now, even when I know the right thing to do, the utter lack of facilities makes my profession futile, and downright pathetic.

First, there are stupid hospital policies, that the administration cooked up from God knows where. Blood glucose meters are not allowed in the emergency room because the department of health allegedly came out with a directive saying that CBG monitoring should be handled by the lab department, along with other blood works. Since when did the Department of Health come out with such a stupid directive? I know for a fact that this is not the case in other hospitals. It just boils down to common sense. There are many instances wherein a patient's blood sugar level should be taken immediately--- when an unconscious patient comes in for example, hypoglycemia should be one of the conditions that should be ruled out at once. But since there are only a few lab personnel on duty at a given time, they can't respond to such cases immediately. Things would be much simpler if we had a blood glucose meter in the emergency room. We had one last year, until the department of health allegedly banned such devices from the emergency room. Honestly, I can't think of a logical motive behind this policy. They even went as far as saying that they are only implementing orders from the Department of Health, when in truth, they are not.

Want to hear another stupid policy? Intubated patients cannot be admitted to the wards, or even in a private room unless they are connected to a mechanical ventilator. This means that if a patient cannot rent a mechanical ventilator, they are stuck in the emergency room until they are extubated, or worse, until they have expired. Staying at the emergency room is more expensive since patients are charged by the hour. We even have the tendency to neglect stable patients when a critical patient comes in. It would be understandable to impose such rules when the patient is to be admitted in the intensive care unit... relatives are not allowed to stay inside, so continuous ambu bagging by the relative is not an option, but to require mechanical ventilators in the wards even when the relatives can provide positive pressure ventilation via ambu bagging? They even have the tenacity--- or should i say enormity to defend themselves, saying such a directive is a standard protocol in all hospital. Christ, give me a fucking break! I wasn't born yesterday. I have worked at other hospitals, and I know for a fact that's not the case in other hospitals! I can't help but feel that it's just another ploy to milk these patients for more cash, just like that directive about the glucose meters. One such case was a patient with a "do not resuscitate order"--- basically we were just waiting for the patient to die. His life could no longer be saved. The family managed to get a private room, and yet the administration wouldn't allow them to be admitted at that room unless they would rent a mechanical ventilator. What the hell for?! The patient only had a few hours left to live, and the relatives only wanted to share their last moments with him in a private room, away from the chaotic atmosphere at the emergency room--- and they were to be deprived of that right because they had to rent a ventilator, of which the payment was non refundable?! Such practices may be acceptable (but arguably unethical and stupid) in private hospitals, but most of the patients we encounter cannot even afford to buy their own medicines, and most of them definitely can't afford to rent a mechanical ventilator. The fact that the administration proclaims that the hospital is a government hospital (even going as far as promoting the hospital as such in local papers), yet imposes such directives that would compel each patient to cough out more cash even when they are obviously unable to--- that's not just hypocrisy to the highest level, it's downright unethical.

And then during my last tour of duty, the only laboratory exams that were available were electrolytes, urinalysis, and fecalysis. That's right, even a complete blood count was unavailable. All other blood works had to be sent out. Good thing we still had paper for ECG tracings, and we still had x-ray films... there were many times that we ran out of both. Yes it's understandable that government hospitals do run out of these things due to budgetary constraints, but such degree of ineptitude is laughable. I would be laughing out loud if it weren't for the fact that the hospital charges exorbitant fees for such procedures, even comparable to the rates charged by some private hospitals. With the rates that they are charging, one would expect a little more quality in terms of services. If they could not deliver, then they should just slash their rates to prices that would be proportional to the pathetic services that they can offer.

And what about the laryngoscope with the busted lamp? We've been complaining for all eternity, practically begging for a replacement, and yet we still see no action. How many times do we have to insert an endotracheal tube blindly, hoping that we have inserted the tube on the airway, and not on the esophagus? And the worst part of my last tour of duty? A patient with a stab would on the abdomen came in dyspneic and very hypotensive. 2 Liters of IV fluid couldn't even raise his blood pressure to normal levels. The abdomen was rigid and slowly expanding. Breath sounds were clear upon auscultation, his dyspnea was probably due to an internal bleeding in his abdomen pushing his diaphragm upward. An emergency exploratory laparotomy was indicated. And as expected, no surgeon was available. Jesus Christ, in that fucking hospital, if it's not the surgeons who are not available, it would be the anesthesiologists. And if by some miracle both were available, the operating room doesn't have all the required materials for emergency operations. It's a NO WIN situation! As I've said before, with regards to these physicians--- if they can't make themselves available for emergency operations, why would they even allow themselves to be decked in the first place?! The surgeon on deck wouldn't answer his phone, and the others had something else to do. I can't really blame them since they were not the ones on call that night, but would it hurt to show even a little bit of concern during our conversations? They all sounded indifferent, some even sounded a bit peeved. We had a life or death situation, wherein every second counts, and I couldn't do anything. If I could operate on the patient in the emergency room, I would have. This has happened many times before, we should just put a huge sign at the emergency room entrance saying "Trauma patients cannot be accommodated in this hospital" to save all of us from trouble. Maybe something as explicit as "Trauma patients die in this hospital. If you want to live, just go straight to another hospital"--- yeah, that would effectively drive the message across.

So what did i do? I called up friends from where I used to work. I told them about my dilemma, and we all agreed that the patient was non transferable (obviously) because he could die any minute, but what else could I do? My hands were tied. i was working at a place that had the gall to call itself a hospital. In truth, it's only a hospital on paper, it's just a hospital by name. It's just a building that's pretending to be a hospital. So yeah, we agreed to transfer the patient as soon as possible... because I had no other choice. We were talking about a patient's life that could be saved. I had to transfer the patient personally because he could die any minute. When we arrived at the place where I used to work, they immediately recognized how critical the situation was, everyone worked quickly and efficiently... a far cry from where we came from, wherein only two of us seemed to recognize that the case before us required immediate action, wherein very few people genuinely seemed to care. Man, I couldn't help but reminisce on how things were more than two years ago, when I was the trauma resident on duty at the emergency room. We also lacked a lot of facilities back then, often we didn't do what is ideal and we often improvise, but we always managed to get things done, somehow. I miss working in a place where i can really help people. These days, on each tour of duty I'm still overwhelmed by feelings of altruism... but I can't seem to put such feelings into action. I genuinely want to help, but because I'm working in such a fucked up place... I just can't. It wouldn't matter if there were no doctors on duty at the hospital, because it wouldn't make a big difference at all. Tears are shed, lives are lost, and no one seems to care. No one seems to do anything about it, and it would seem that not one of those people who are in the position to take action would want to do any action. Patients are just sources of income. For them, lives are dispensable. For them, life just goes on.

Now I'm counting the days until my last tour of duty. I only have until next month, and this is one phase of my life that I couldn't wait to get over with. A person can only go so far before the sense of futility breaks him down. Even though I'm not doing it deliberately, I've had enough of toying with people's lives.

Addicted

I've been down with the flu for about 8 days now. Initially, I thought it would be nothing, but towards the middle of the week it has actually become worse than I had expected... i found it difficult to breathe when I moved around a lot. I even had to nebulize with salbutamol while I was on duty at the hospital because this stupid flu seemed to have exacerbated my asthma. I had to give up work for one day, and felt too weak to go to the gym. Basically, my whole daily routine was put on hold. My schedule was messed up. I was in bed for the most part. Looking at the bright side, I figured I would get some serious studying done. I was breaking personal records in studying for one day, but then I discovered this evil entity:

To the uninitiated: that's a Facebook application/ game called Rock Legends. it's a very simple game, and the graphics wouldn't make your heads turn, just the usual look of a java based game... but for some reason, it's incredibly addicting. How addicting, you ask? The first time I played the game, i was playing for 10 straight hours. No meal breaks, no bathroom breaks. That's 10 whole hours that I've wasted, i could have used the time doing something productive. I couldn't help it, i found it hard to turn the computer off. Good thing my laptop ran out of battery and I was too lazy to put the plug in the nearest socket. Unlike the other Facebook games wherein one's energy takes up hours to recharge, in Rock Legends, one's battle points go up by two point every ten minutes--- that's enough for two battles between competing bands. One battle usually lasts for two minutes, so after two battles, i'd realize that if I waited for about 5 more minutes, I could battle more bands... and this cycle goes on and on and on! And when you're offline, stronger bands can continue demolishing your band, therefore depleting your "fame"... so every time i went offline, I had this urge to go online again! There's this consistent need to keep building up your level so that you won't be trampled upon by the other bands, so i kept doing odd jobs just to level up and make some virtual cash so that i could buy more powerful instruments. There's an option to speed things up if you coughed up some real cash (via your credit card)--- and you guessed right... I gave in. I wasted $20 just to build up my band in this stupid game. I had this secret dream of putting together a rock band back in my teen years, so maybe that's one reason why I've grown too fond of this game. But looking at my some of my friends who have been playing this game too, I have to say that's not really the case here.

How am I supposed to get any work done now? It's hard to lock up my laptop somewhere because I'm also using it for studying. The study materials that i'm using are online. And after I log off from Blogger, I'm sure I'm going to log on to Rock Legends again.

Man, this game is probably as addicting as cocaine, it shouldn't even be legal.

Misunderstood

During one casual conversation, a friend exclaimed that as a group, we only watch the movies that I want to see. When they ask me to watch movies that they want to see , i say no if i don't feel like watching it. It was said as a joke, but obviously, it was half meant.

Why is this even an issue?!

Does it create the impression that I'm selfish? That I only want things to go my way? It's either we do it my way, or we don't do anything at all?! First of all, I ask people to watch movies or go on trips, to hang out, or do whatever, based on how I enjoy their company. The first people I ask are those whose company I enjoy the most. For such simple matters, that's how I prioritize. If they say no, that's perfectly fine with me. It's not like I'm FORCING anyone to come with me, and it's not like I'll hold a grudge for something so trivial. I understand that people have different tastes, we can't possibly all like the same things. If one group of friends say no, it's no problem at all. I can ask A LOT of other people. Of course, the next group of people i ask are those whose company I also like, but not as much as the first group. I won't simply just ask anyone I know, even if those people would probably say yes. But yeah that has happened several times... it beats watching movies alone. hehe.

When I say no, why is it such a big deal? Heck, money isn't exactly overflowing these days. Is it a sin to only watch the movies that I really want to see? Yeah, I say no when I'm being ask to do something i don't really want to do, or to go where I don't want to go--- I wouldn't think anyone would harbor ill feelings because such trivial matters, but I understand how some people can get overly sensitive when they have been declined, even for the simplest things. i would say no, yeah... but did they ever try asking me again, in a different manner? Did they ever try to point out that it's not such a trivial matter to them? If one friend asks me to watch a movie I do not like, if a friend asked me to watch a movie i've seen several times, I would say yes if he or she told me that no one else could go with him or her, if he or she would say that he or she just wants my company, or if watching that movie is a big deal to him or her. I've done that many times. I've done a whole lot more for friends, it would be stupid to think I wouldn't do such simple things--- like watching a movie, going to the mall or bar, or just simply hanging out, for my friends... Unless of course, a great deal of cash would be involved. hehe. But if they would offer to shoulder some expenses, just enough for me not to burn a hole through my wallet, then I'd go with them, even to the ends of the world, without even a bit of hesitation. :)

******************

Oh yeah, as an afterthought... that same friend exclaimed that if only I cleaned up my act years ago, I wouldn't be so bitter about that failed relationship three years ago. One thing I am certain of, is the fact that I AM NO LONGER BITTER. I didn't even feel anything when she sent me a private message via Facebook a few days ago. Now what was that about cleaning up my act? WTF?!

Okay... honestly, i can no longer recall every single detail. Those events have transpired three years ago, and because of all the conscious suppression of memories that I have done, i may have missed a few things. Looking back at the past at this point in time may give me a better perspective. So yeah, I tried looking back. But after reading this single entry dated July 14, 2006:

She- Devil

I really have to say... what the f*ck?!

Public Disservice

Roadwork has started on the northern end of our street last April, and it was nowhere close to being finished. That's why I had to pass through the side streets and take the longer route home for the past few months. They said the old pipes need to be replaced, and since the pipes on our street are located right smack in the middle of the road, they can't do repairs one lane at a time. The entire width of the road has to be smashed up, hence making that section of the street inaccessible to vehicles. I wonder what's taking them so long. Limited supplies? Budgetary constraints? Not enough manpower? Or too much time off for the workers? and I wonder why they have to start doing their repairs at the start of the rainy season. Everything was fine before their work started, we weren't experiencing any problems with water drainage. I wonder if repairs were really needed to be done, or if this was just another opportunity for incumbent politicians to show that the taxpayers' money are working for them since elections are going to be held next year. Heck, ever the cynic, I suspect that this also gives those politicians a chance to siphon more of the tax payers money with their under the table deals with construction companies.

When I got home from work this afternoon, there were a lot of people outside, but i didn't really mind them. I was so tired, and all i wanted to do was lie on my bed and sleep. When i woke up several hours later, I heard the sound of trucks outside. And--- I swore i could have been wrong at first, but i was hearing the sound of jackhammers. I went outside to take a look.

F*ck. Just like that, someone had the bright idea to do roadwork on our part of the street, even when the northern end was far from being finished! Now the entire length of our street was closed! My dad and grandparents were pissed, because apparently we weren't informed beforehand! Even our neighbors weren't informed beforehand, and everyone was angry! My dad and my brother had to park their cars on some side street a mile away, while my car was trapped in our garage. Who wouldn't be pissed? For the next few weeks--- or god forbid, MONTHS, knowing how road work crawls at a snail's pace in this country... I'm back to using public transport. Our other cars would be exposed to possible theft. And then there's my grandmother, who has already been rushed to the hospital several times this year, most often in the middle of the night. How the heck are we supposed to carry her all the way to our car that's parked a mile away and reach the hospital in time when the road outside our house resembles a demolition site?! At its present state, it looks as if an atomic exploded!

My dad has talked to the mayor (who's my grandfather's friend), and he said roadwork would be done in a few days. It's possible--- on another city, roadwork was done in only two days... but then again, the house of the mayor's mother was on that street. The same thing cannot be said with regard to the other streets in this country though. That's too bad, because having VIPs within the vicinity seems to be the only way to make people work both quickly and efficiently. A little over a week, let's see. That's what the mayor said. We're just hoping nothing bad happens within the next few days... nothing emergent, nothing critical. No life or death situation. because if something does happen, you can bet on it... our family will SURELY raise HELL.