tag:blogger.com,1999:blog-37286253.post1720321919960961133..comments2024-03-09T11:08:34.910+02:00Comments on other things amanzi: the last goodbyeBongihttp://www.blogger.com/profile/12918640034313468627noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-37286253.post-15525158052248405792009-10-29T21:23:34.437+02:002009-10-29T21:23:34.437+02:00the phosphate comment saved the life of one of my ...the phosphate comment saved the life of one of my patients. there you go, bongi, saving lives halfway across the world with your blog.DHShttps://www.blogger.com/profile/00251680600047999918noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-90960781534156145822009-08-02T07:28:42.948+02:002009-08-02T07:28:42.948+02:00dhs, essentially, especially to medical like peopl...dhs, essentially, especially to medical like people there is indeed pretty much no difference between this guy's inotropic driven pulse and no pulse. yet for the average person, a pulse means alive and alive means you can say goodbye before they are dead. this is not at all scientific of course, but hopefully on the perception of the family it was important.<br /><br />both lactate and phosphate are unfortunately late markers. by the time they are raised the patient is already in deep trouble. we used to measure acidosis and phosphate. a high index of suspicion is the real marker in the end.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-14782249343916728692009-08-02T01:18:14.038+02:002009-08-02T01:18:14.038+02:00I think you did a wonderful thing there, but I'...I think you did a wonderful thing there, but I'm not sure that saying goodbye to someone with a pulse driven by maximum inotropes is much different to saying goodbye to someone without a pulse.<br /><br />Just for my own education: I've always measured lactate in suspected ischaemic bowel; is phosphate a better marker?DHShttps://www.blogger.com/profile/00251680600047999918noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-50901916917842403262008-09-17T23:21:00.000+02:002008-09-17T23:21:00.000+02:00please excuse this unsolicited comment. My name is...please excuse this unsolicited comment. <BR/><BR/>My name is Luca, along with my doctor friends I've put together a website dedicated to creating a social community, just for doctors, based on blogs.<BR/><BR/>Our origins are humble as we have only just launched the site but our goals are noble as we're not out to make money, just give the medical community something we feel it's lacking, i.e. a tool that brings together doctors everywhere allowing them to benefit from the experience and ideas of colleagues from all over the world.<BR/><BR/>Your blog is great and we noticed that it has similar objectives to our’s and so we decided to contact you to see if you'd consider joining our community. If you’re interested visit us at www.medbrains.net and you can contact me with any questions(luca.hurst@medbrains.net). We'd be honored if you came on board.<BR/>Regards,<BR/>luca.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-37286253.post-30703458588383775312008-09-16T21:05:00.000+02:002008-09-16T21:05:00.000+02:00mitch, thanks for the comment.yes i agree. i once ...mitch, thanks for the comment.<BR/><BR/>yes i agree. i once told a student that i enjoyed breaking bad news. not that i like to be the carrier of bad news, but more because i do it well and it is better for them, to hear it from me than someone else. but you also hit the nail on the head by saying that it also has to do with living the calling.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-23773832146380055182008-09-16T18:58:00.000+02:002008-09-16T18:58:00.000+02:00Hi Bongi. Being present at these terrible moments,...Hi Bongi. Being present at these terrible moments, I think in a strange way is a great privilege; over 30 years in anesthesia and critical care I vividly remember the moments of tragedy and triumph with the same sense of having "lived" the calling. When these situations arise, by the way, I encourage the surgeon to "scrub out" and talk to the family while I drip in the epi...<BR/><BR/>best regards to you<BR/><BR/>MitchMitch Keamyhttps://www.blogger.com/profile/02552695021608383465noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-5797770580150321722008-09-13T08:13:00.000+02:002008-09-13T08:13:00.000+02:00dragonfly, i think my consultant did exactly the r...dragonfly, i think my consultant did exactly the right thing. he probably would have calmly waited there until the patient died if i hadn't made the decision. he used the situation to teach me something. that is exactly the fine point i thought there would be dissent about. in fact it is that point that almost made me not tell this story. and in a sense it is that point which brings across the detachment that sometimes exists between surgeons and 'real' people.<BR/><BR/>amanzimtoti, i am not impressed by surgeons who get aggressive in theater. it is simply not acceptable. maybe under these stressful situations (death in the family and a tense operation) all the inhibitions are removed and in fact the real nature is demonstrated. it is maybe an ideal moment to actually see what the person is really like.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-81115167632555266492008-09-13T05:01:00.000+02:002008-09-13T05:01:00.000+02:00The abuse from patients and their families is diff...The abuse from patients and their families is difficult to accept, but you have to bear in mind that sick and dying people and their families aren't exactly behaving under normal circumstances. They sort of lose their humanity in a way. It's like surgeons who get aggressive in theatre. It shouldn't be that way, but it's not really personal, it's a coping mechanism.amanzimtotihttps://www.blogger.com/profile/00547897825508141342noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-80971890365974097212008-09-13T02:06:00.000+02:002008-09-13T02:06:00.000+02:00What you did in allowing the family to say goodbye...What you did in allowing the family to say goodbye was right...but can be a hard or unpopular decision when resources are scarce. Your consultant did the right thing but he maybe could have stepped in a little earlier to clarify the plan if it was obvious you were waiting on him. <BR/>I have a nurse friend who was once punched in the face by a patients son so hard that she got a subarachnoid haemorrhage after he was told of his fathers prognosis. (Her nursing supervisor told her it must have been her attitude, prompting her immigration to greener pastures a few months later). People can act in irrational and uncivilised ways when grieving.Dragonflyhttps://www.blogger.com/profile/12759938692575603663noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-57048502746844233442008-09-12T22:09:00.000+02:002008-09-12T22:09:00.000+02:00i actually thought there would be more discussion ...i actually thought there would be more discussion on the action my consultant took. i mean he didn't act as if there was a human being just about to die. don't get me wrong, i thought what he did was exactly right, but i thought there would be voices of dissent.<BR/><BR/>the other point that i only hinted at was the abuse we often take from joe public out there. it is a very disheartening part of the job. whether the son appreciated what i did or not (i think later on he would have) his verbal abuse was not easy to deal with. it never is. maybe that is a topic for another post altogether.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-42550716396356184222008-09-12T10:58:00.000+02:002008-09-12T10:58:00.000+02:00I think you absolutely did the right thing. I don'...I think you absolutely did the right thing. I don't think it was a pointless admission to ICU at all, afterall, why do we practice medicine? It's not to for our own benefit or to to make life easier for ourselves or the hospital staff, but for the patients and their families. So they can go about the business of life. In the end, I'm sure that son was glad he got to say goodbye.amanzimtotihttps://www.blogger.com/profile/00547897825508141342noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-12982162252442447772008-09-11T21:38:00.000+02:002008-09-11T21:38:00.000+02:00Was this consultant the one with the very cool num...Was this consultant the one with the very cool number plate (y'know, referring to his rank and an organ he often operates on...) In english he had the same name as a Cluedo character. I always really liked him.<BR/><BR/>I saw a case like this one last year - it was awful. It's so sudden and hopeless.Karen Littlehttps://www.blogger.com/profile/10446187228064686202noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-23098301925403900202008-09-11T19:40:00.000+02:002008-09-11T19:40:00.000+02:00thanks ramona.quietusleo, yes that is another opti...thanks ramona.<BR/><BR/>quietusleo, yes that is another option. this guy was not going to make any trip anywhere without inotropes. i think he would have died before we mannaged to rush the family in. in icu we could at least maintain the facade of life for an hour or two.<BR/><BR/>walt, dankie. dood op die tafel is ook glad nie 'n goeie ding hier nie, alhoewel ek dit al so 4 keer gesien het. mense vermy dit, amper ten alle kostes, hoofsaaklik as gevolg van al die papierwerk wat daarmee saamgaan. <BR/>prognose is reg gespel.<BR/>die besluit het om inotrope gewentel. as ons hulle gestop het, sou die pasient binne enkele oomblikke dood gewees het.<BR/>ek dink my konsentrasievermoe is te kort om 'n hele boek to skryf, maar dankie dat jy dink dit die moeite werd sou wees.<BR/><BR/>kerry, thanks for your kind words.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-49630074325523629082008-09-11T12:10:00.000+02:002008-09-11T12:10:00.000+02:00I would reckon that the son would have been emotio...I would reckon that the son would have been emotional and aggressive regardless of what you'd done. That was maybe just his way of dealing with his father's death. <BR/>Thanks for a great blog, btw, I've been reading you for about a year now, and am glad I can follow you on Twitter to have quick access to new posts!Kerryhttps://www.blogger.com/profile/04135223178855970387noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-48787302113595680162008-09-11T07:09:00.000+02:002008-09-11T07:09:00.000+02:00Weereens pragtig geskryf Bongi. Dit was nog altyd ...Weereens pragtig geskryf Bongi. Dit was nog altyd vir my snaaks dat dit hier in Amerika taboo is vir 'n pasient om in die teater dood te gaan, maak nie saak hoe siek hulle is of hoe hopeloos hulle toestand is nie. Hier gaan almal icu toe, ten minste tot die familie "on board" is met die prognose (?sp). Ek dink dit het waarksynlik te doen met die vrees van 'n hofsaak. As jy teen die ICU besluit het, wat sou julle in die teater gedoen het? Ek bedoel hoe ver sou julle gegaan het met die onttrekking van sorg? Pressors af? Ekstubasie? <BR/>In vier jaar van mediese skool en vier jaar van residency kan ek net aan een pasient dink wat op die tafel in die teater dood is, en dit was 'n hopelose skietwond. ek sal weer se, jy moet definitief dit sterk oorweeg om 'n boek te skryf.walt dandyhttps://www.blogger.com/profile/01724405932742819658noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-40649110125589769522008-09-11T05:56:00.000+02:002008-09-11T05:56:00.000+02:00I shall gently suggest that there was a third opti...I shall gently suggest that there was a third option: close and have the family say goodbye in the recovery room. <BR/>This option would have saved the ICU staff a completely pointless admission, while still allowing the family to see the patient before he died.Anonymoushttps://www.blogger.com/profile/04217783969690894498noreply@blogger.comtag:blogger.com,1999:blog-37286253.post-77660254130559228932008-09-11T04:18:00.000+02:002008-09-11T04:18:00.000+02:00These are tough for all involved. You write so we...These are tough for all involved. You write so well about them. Sure hope someone helped the family and that young student.rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.com