24.

How do we become truly selfless?

I think about what commitments we have to people and the exploitations that happen almost everyday. People make decisions on misinformation, disinformation; pretty much anything further from the truth. Doctors are people in society that are respected at a level that is unique. There is no scale I can put it on. I just know there are forces that allow its magnitude. This occurred to me during Geriatrics.

One of the most common problems Geriatricians deal with is Delirium. This is a loss of orientation and attention, commonly occurs in the elderly suggesting an underlying disease. It could be anything from a simple urinary tract infection to a stroke. It is very difficult to explore as patients are confused, have no idea where they are and are at times concerned for their own safety. I wouldn't say I couldn't justify that.

Being part of the Geriatrics team meant plenty of emergency consults, which is not specific to that particular team, but none the less is a significant part of the workload for the senior registrars. A patient had been admitted for delirium and it was up to the Geriatrics team to assess his state and decide whether he required hospital admission. This is a significant decision as it often dictates whether the patient can go home again. It would be so sad having not the slightest idea that you're sick and it may just be the last time you're seeing the front door of your house as the ambulance takes you away.

The registrar introduced himself and asked the patient questions, to which the answers were incoherent, disorganised and nonsensical. The patient obviously was confused and had no idea where he was. His wife and son were there, but he couldn't recognise them in his state. He looked like he was insecure. Not sure whether we were there to hurt him or to help him; so he kept speaking about things that probably made sense to him (so to speak), but meant nothing to us.

The moment of clarity was at the point where the registrar looked at the patient and said "Okay. Stop talking now. I'm going to examine you." The patient just stopped what he was doing and his facial expression changed from confused to collected in a split second. He understood what was happening - Physical examination.

So I ponder the psyche and ask whether there is actually a state of delirium at all... this patient, who was so disoriented in time and location, all of a sudden stopped concerning himself with his value system and completely stuck his neck out (metaphorically speaking) and allowed the registrar to examine his hands, pulse, head, neck, chest and abdomen. How could this be? How did he stop?

Perhaps this was a one-off, I thought... but I was mistaken.

The next day we met a gentlemen in the emergency department brought in from a nursing home who was suddenly aggressive to staff and other tenants. So the provisional diagnosis of delirium was bestowed upon him. He was MRSA positive and so we had to gown up to speak to him. When I arrived, the junior registrar was already in there with the other medical student and were speaking to him. When I finally had my gown and gloves on, the registrar asked me to take a brief history.

Hi sir. My name is ******** and I'm a 3rd year medical student here. How are you?


Go fuck yourself! Is the response I received and I wasn't expecting it because I didn't know his presentation history beforehand. So the others had a good laugh at my reaction, but this patient was clearly aggressive and I soon found out from the registrar that he tried to punch him a few times across the jaw. Luckily my reflexes were faster he said.

What we really needed to do at that point was to give him some sedatives to calm him down. This decision had to be considered very carefully because we must weigh up the use of actually sedating him with the significant effects of sedative medication on a patient we know nothing about. The odds were not in our favour.

But before we could sedate him, someone had to cannulate him.

This man, so aggressive and confonting, saw the needle coming and stopped swearing. We didn't have to hold him down. He complained of pain, but he realised what we were trying to do. Despite his state of aggressiveness and disorientation, he understood the consequences of why we were accessing his veins with a needle.

Perhaps people will respond to me by saying that he didn't know what we were doing. My response would be with a rhetorical question: Why did he change his behaviour just when we were accessing his veins?

The same question holds true for the previous chap.

This number, twenty four, didn't mean much to me before tonight. However, after watching a particular movie, it meant so much to me. It's not my favourite number; it just holds significance to me.

Interestingly, when I was looking for symbolism of the number, I came across many images and pictures, drawings that explained other people's interpretation of it and the value assigned to it.

The variation is very interesting and limitless.

Maybe at some point in your life, you will watch the movie I did, feel the same as I did and wonder God, is that what he was thinking about?


It's unlikely... but as my parents always say:

What if?