Should we get annoyed?

a.k.a. Why do good things happen to bad people.

Over the past few weeks, a common pattern seems to be emerging - often young, previously healthy patients with wives/husbands, young families, and who are working and contributing to society* are getting very sick, and or dying, whilst chronic alcoholic, IVDU's end up recovering from their alcoholic encephalopathy, seizures, and coronary events*.

*the above are composites of different patients.

It seems unfair that people who were doing good, and are only a little older than myself are dying, despoite all the treatment we can offer, and yet people who are on their second or third ICU visit are recovering, but not reforming and going back out to continue their downward spiral.

I am not suggesting that some lives are more important than others, but there does seem a fundermental unfairness about the fact that those who contribute to society are the ones to die, and those who sponge/take from socety are the ones who survive.

As one doctor put it today "those with a rough paper-round have just become so tough that it takes more than a bit of alcohol and an MI to kill them".

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.

How long have I got?

Leaving aside any politics or debates about the pro's and con's of our welfare state, and pension system (which in fact predates the welfare state - the random facts you get from watching BBC4 documentaries, or was it QI?) , this makes interesting reading. If we lay all the economics and social policy stuff about pension pot, and actuarial scales...something I don't even profess to comprehend let alone understand, one table hit me:

Lowest Life expectancy at age 65
432	Glasgow City	Scotland	13.8
431	Inverclyde	Scotland	14.9
430	North Lanarkshire	Scotland	14.9
429	West Dunbartonshire	Scotland	14.9
428	Renfrewshire	Scotland	15.0
427	Knowsley	North West	15.3
426	Manchester	North West	15.3
425	Liverpool	North West	15.3
424	Hartlepool	North East	15.4
423	Cannock Chase	West Midlands	15.4

Copy and paste directly from BBC Website on 30th September 2008

Note how the bottom 5 are all in the area covered by my beloved Medical school. One factor that those of you not familiar with the West of Scotland can be seen in this map
Sitting squarely between Glasgow City and North Lanarkshire, and adjoining West Dumbartonshire is East Dumbartonshire, and area which one might except to have a similarly poor life expectancy for its 65 year old residents. Except that it does not. If we look at other statistics in teh full report (here) we see that East Ayrshire adnd Clackmannanshire also have poor life expectancy figures. And yet, East Renfrewshire does not.

There seems to hjave been some nice games played when the old Strathclyde region was divvied up in the 1990's, to create the unitary authorities you see on the map above. The two areas I identified, East Dumbartonshire and East Renfrewshire also have very high (for West of Scotland):

• school exam results,
  
• owner occupier,
  
• car ownership,
  
• house prices,
  
• health indicators
• incomes.

It seems that there was a plan to create these areas of middle-upper class suburbia perhaps by civil servants who wanted to create areas for people like us? Note how there is a real U shape in the top of Glasgow to shoehorn East Dumbartonshire (Milngavie & Bearsden) between Maryhill and Drumchapel housing schemes which stay in Glasgow City. They also have lower council tax, and allegedly better services. And who lives in these areas? Well there are a fair few Consultants, Civil Servants, Teachers, University Lecturers, professional people and accountants/Lawyers. They get the benefits of city life, with the benefits of suburban council taxes. Now Greater Glasgow maybe too big for one council to run it, but there are other options to divide the area.....

The local health profiles designed by the ISD of NHS Scotland are interesting reading (unless you are a Glasgow First Year Medical Student doing Block3/4 Community Diagnosis coursework, or year 2 Family Project coursework). Similar are available in England. They also offer tobacco atlases! I can't stand doing statistics but I like graphs and maps... Maybe epidemiology is worth understand after all, but I still don't think I could deal with a career in public health.

Living life to the minimum?

Today set me thinking. Painful so soon after exams I know, but anyway.

Seeing the pics that Rach posted on her Facebook about sunny beaches and fireworks made me realise just how you can spend ages of your life only noticing what you are doing and failing to notice the world around you.

Sunday and today I achieved very little beyond the basic activities of life. I spent half of yesterday afternoon, despite the sunshine, and warmth in the flat tidying up and watching the F1. I spent yesterday evening packing for my week away, and then had a long lie this morning on another sunny warm day.

I'm not saying i could or should have climbed mountains, forded stream or followed rainbows, but I could probably have worked through some of my 'To-Do' list, or gone for a walk, or down to the seaside, or met up with some friends.

I guess what I am saying is that the weather puts me in a very positive mood at the moment, despite the exams uncertainty, and I should relish it, use it and take advantage of it to live life, and enjoy the world around me and do some life affirming things this summer - hopefully with a car.....if I can sort out the money