tag:blogger.com,1999:blog-37286253.post8509081756925913281..comments2024-03-09T11:08:34.910+02:00Comments on other things amanzi: practiceBongihttp://www.blogger.com/profile/12918640034313468627noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-37286253.post-25760210644091863252007-12-18T17:46:00.000+02:002007-12-18T17:46:00.000+02:00in some places, stage fours are not even entitled ...in some places, stage fours are not even entitled to blood products or IV antibiotics. Where I work, we have a really good infectious diseases team who can bring these people back from the edge pretty miraculously, but intubation of a stage four patient is still very muh frowned upon.<BR/><BR/>We practice a lot on stab hearts, though - guys who come in pretty much dead, but we still go through the motions of a full front-room thoracotomy on. We hope that it will iron out the glitches in the process so that when somebody who an be saved comes in, we can do a good job.Karen Littlehttps://www.blogger.com/profile/10446187228064686202noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-70537379202806535602007-12-18T13:07:00.000+02:002007-12-18T13:07:00.000+02:00hello. i'm a doctor from the philippines, although...hello. i'm a doctor from the philippines, although I just finished my residency training in a charity tertiary hospital rather than a rural hospital.<BR/><BR/>i related very much to your story. limited resources are the bane of our existence in our health care setting, and just as you were called on to make a decision regarding what type of care to allocate to this patient, we also face these kinds of decisions every day. maybe some people may think we are playing God, but the truth is that we are just making the most of a bad situation. <BR/><BR/>It's just logical to give the most resources to one who will benefit from it the most. This doesn't mean that these same decisions don't come back to haunt us or hurt us. They just become an additional burden for doctors who practice in this kind of environment to carry. And that is what makes it so sad.dr_clairebearhttps://www.blogger.com/profile/14019592712453965433noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-65661611367900127792007-12-17T08:15:00.000+02:002007-12-17T08:15:00.000+02:00lynda, thanks for your comment. the feelings we so...lynda, thanks for your comment. the feelings we south africans have to violence is different to first worlders. i posted on a similar topic under the heading stories of guns. take a look.<BR/><BR/>but my treatment and line of thought was the result of being a doctor. the doctor commenters here had no problem with what i did, even the americans. one of the aims of this blog is to give a keyhole into our world. sort of like er, only truer. it seems that it is achieving it's goal.<BR/><BR/>pelican, my concern was about my decisions. what the ward sisters did i had no say over. i didn't like it. but i couldn't do anything about it.<BR/><BR/>at the time, one of my thoughts was that if we could bring him back, then maybe his lungs weren't as bad as i suspected. if he had the benefit of icu and tb meds, maybe he would have had a chance. the decision to deny this patient an icu bed, although justifiable, probably had a lot to do with his eventual demise.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-38410950456128856822007-12-17T04:56:00.000+02:002007-12-17T04:56:00.000+02:00Hmmm, I suspect your concern about comments wasn't...Hmmm, I suspect your concern about comments wasn't about your decision to run the code, but about the ward sisters' decision to let the patient cool before calling you when he expired. <BR/><BR/>This is an issue in the "developed West" as well, but our default is to "do everything" for a 98 year old patient with advanced Alzheimer's- someone who has no awareness of life, let alone quality thereof.<BR/><BR/>Check out Panda's <BR/>http://pandabearmd.com/blog/<BR/>most recent post, I'd be curious to hear your comments, coming from a system where cost vs benefit is acknowledged as a significant factor in medical care decisions.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-37286253.post-10683076995661897362007-12-17T04:33:00.000+02:002007-12-17T04:33:00.000+02:00I think the difference is in the fact that in othe...I think the difference is in the fact that in other parts of the western world, perhaps someone would not get that sick if they treated...as in...most people here with HIV will get treated before it got that bad...and when it got that bad they would be dying hopefully without so much pain in Hospice.<BR/><BR/>Gosh.... bit to have the TB double whammy...<BR/><BR/>My friend is a critical care nurse and she tells me about all the "slow" codes for people without DNRsLadyk73https://www.blogger.com/profile/08293016397853788993noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-60430636993204020202007-12-17T02:38:00.000+02:002007-12-17T02:38:00.000+02:00You live in a different world. Great story. Noth...You live in a different world. Great story. Nothing immoral about your actions. We "practice" all the time on humans, even in America. Gross anatomy labs. Inguinal hernias on patients at VA and Charity hospitals. The early days of organ transplantation. Triple zeroes (no BP, no HR, no respirations) that came in through the trauma bay always got the full workup, even ED thoracotomy occasionally, (the trauma attending knowing full well the patients chances were nill.) If it prepares the team for the next patient, some 15 year old clinging to life, then what's the harm? <BR/><BR/>I don't know if I could do what you did in the setting of florid HIV and no treatment options. Crash intubations and resus scenes can get a little messy......Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-61259917235187915782007-12-17T01:29:00.000+02:002007-12-17T01:29:00.000+02:00Interesting post. My reaction to it was that in a ...Interesting post. My reaction to it was that in a way your 'treatment' of the patient kind of shows that you are in a way a victim of the violence/death etc South Africans suffer/face all the time, in that your response was so densensitized - he is going to die anyway, so lets just forget his rights etc and make use of him for our own benefit. Difficult to explain what I mean, but as a South African now living abroad - I find that South Africans have this disregard for life caused by the SA situation - as though living with the threat of death just results in total devaluing of life. I don't mean it as a criticism my own parents still live there and I am often shocked at how casually they can tell me about some or other crime that would make headlines here but doesn't even get a mention there. I know you're a great doctor and there were benefits to be had etc etc but still doesn't sit well with me.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-37286253.post-87459988152211731682007-12-16T23:38:00.000+02:002007-12-16T23:38:00.000+02:00It seems clear the benefit outweighs any other con...It seems clear the benefit outweighs any other considerations. I doubt the patient consciously suffered any, and the next patient to come along ought to be grateful. It's not unlike the intubations after expiration we practiced as med students.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-75256504047450013342007-12-16T19:27:00.000+02:002007-12-16T19:27:00.000+02:00Vijay, I gave you top billing when I mentioned tha...Vijay, I gave you top billing when I mentioned that we both had given him the award. Same with several of our friends. :)rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-37772380923075269832007-12-16T19:20:00.000+02:002007-12-16T19:20:00.000+02:00vijay, yes. if you read my post about keyhole on o...vijay, yes. if you read my post about keyhole on our world (http://other-things-amanzi.blogspot.com/2007/10/keyhole-on-our-world.html)<BR/>you will see i have been worried about the take that people who are not exposed to our world have on what is written. but in the end if you want to get an honest take on our world, here it is. if it offends, it is not supposed to.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-29053521119972449682007-12-16T17:23:00.000+02:002007-12-16T17:23:00.000+02:00Great post Bongi. I guess you were worried if your...Great post Bongi. <BR/><BR/>I guess you were worried if your international readers would have problems with the ethical/moral issues that this raises. Believe me, I come from a place where this kind of thing is common. <BR/><BR/>I saw that Ramona had mentioned the BTB award in a comment in another post. I'd like to place on record that I gave it to you first, it just didn't occur to me to notify you.Vijayhttps://www.blogger.com/profile/06710965375559259238noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-876948712911362572007-12-16T16:41:00.000+02:002007-12-16T16:41:00.000+02:00Yes, often resources are limited, but wasn't it wo...Yes, often resources are limited, but wasn't it worth much to "practice" and learn in a semi-calm manner. You were calm and walked them through the entire thing. What a great way to learn! What a great benefit to the next patient on whom the resources would not be considered wasted.rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.com