Thoughts on life and death

See here and here for starters. It has been a strange week all round really. With the main features seeming to revolve around life and its two extremes.

One one hand my sister's brother-in-law and his wife had a baby (well he didn't but you get the picture) on Monday - their first, and only 2 weeks late! I got the text about it on a day iw as talking to a patient on placement who was in for a knee replacement, and yet, had been swimming until 6 weeks before, helped into the pool by friends, because in the pool she could move freely and with less pain. She had been a runner from being you and ha been very active until her knees developed osteoarthritis about 4 years ago. They were the positives.

Then today I was writing up two cases. One is a woman whose son was horrifically injured 7 years ago, and who died last year. She herself has had Oesophageal and soft palate cancer for 7 years, and had a recent acute admission with gallstones. She spoke of the future with so little hope and expectation, and seemed to have a very low quality of life, due to her illness and the side effects of the vaious therapies. The patient is depressed, has problems sleeping and can only consume liquids, but still smokes 60 cpd to help with 'the stress'

The second is a lady with alcohol problems. She drinks a litre of whisky a day (28 units) at home, and sometimes goes out with friends. She was admitted with acute pancreatitis, and is the same age as my Mum, yet was very slow in spoeeach, tired easily, looked about 70, cannot walk waell due to bruises and breaks sustained whilst drunk. Her mouthw as a mass of ulcers, and her blood results indicate severe hepatic disease of one type or another, as well as acute pancreatitis and gastric erosion. Again, she had no hope for the future, and was convinced that only by drinking could she escapoe the situation she was in.

In both cases, I have struggeld in my write up to avoid being judgemental, and yet to try and understand their thinking, their viewpoint and how best to help them (albeit in a hypothetical Management plan). And yet, we get 2 or 3 such cases into the wards every week on this small unit.

So I find myself, having written both cases up, needing a small reminder of the positives of human nature, and why we as creatures care for each otehr, and as asociety why we demand that the NHS care for everyone equally regardless of status or outlook. I guess I'm tired and just a touch drained after 4.5 weeks in DEPCAT hospital.

Blowing the budget on booze

Good

• I don't have a gas guzzler (or indeed any car)
• I don't smoke
• I don't fly (well not for past 3 years)
• My income is below taxable levels
• Increase in winter fuel credit for over 60's (must visit parents more....)

Bad

• Tax on alcohol....but dose dependent......
• No reinstatement of 10% tax banding
• Will have to pay the extra 1.8p a litre duty on petrol from August - could make peripheral hospital attachments that bit more expensive.

The BBC reckon I will be £16.32 worse off next year, all of it alcohol related........ so since the slcohol duty changes don't kick in til sunday...........Cheers!

Irony

On the day that my student body elected someone with an alcohol problem to represent us to the University, we 3rd years had a session on alcohol, addiction, treatment and also a personal story from a GP who has alcohol dependency. Of these, the GP was the most listened to, with less talking and noise from the back rows. The GP referred to their realisation that they had a problem; their attempts to abstain; their family background; the effect on their patients and colleagues and the support from other addicts within the profession.

This was actually a really good end to the session as it brought together the 'academic'' talks about epidemiology, aetiology, genetics dependence syndrome, co-morbidities, treatment and management. This PBL has also been interesting as it also looked at the responsibilities of us to our colleagues if they have issues which affect their ability to do their job. The scenario was in a GPO setting, which is harder as the line manager is not so clearly defined.

As ever the advice seems to be, call the BMA advice line, call your Defence Union, talk to the person concerned, then call your Clinical director, and/or the GMC if needed.

Anyway, I'm, sure Charles, the GUU and the LibDemSoc will be celebrating with a few glasses tonight.