The Issue of Brain Dead

I think perhaps one of the most horrible things that could happen to someone would be to be ‘brain dead’. Now I’m sorry to anyone if my use of the term ‘brain dead’ is offensive, but I simply don’t know any other way to convey a more concise meaning, without being too wordy. The alternative is something like “loss of higher cerebral functioning secondary to brain hypoperfusion”, which is a handful. I do feel it is less offensive than the term ‘vegetable’ however. So I’m going to use the term ‘brain dead’ throughout. I’ve seen the term used in my medical lectures too, so I’m assuming it’s not necessarily as offensive as it sounds.

The state of being brain dead; it’s a mysterious state – the state of existing, but having no existence mentally.

The person essentially, just exists, sort of like how a desk just exists. The person still has relevant physiological processes occurring, like the body can maintain itself plus a little bit of support from external sources like ventilators, but there is no deeper cerebral function to actually define a brain dead person. The person loses all personality, loses all abilities to make judgements, loses all their emotions, for none of that they can possibly do.

And that is just the tragedy of facing such a situation. A person who once had a uniqueness about them, who had a character and personality that defined them, are no longer there anymore. And it happens so suddenly.

Speaking back from one of the first such patients I had encountered, it was very sad. The patient was in her mid 30’s. Three weeks prior to presentation to hospital, the patient had some cosmetic procedure of varicose vein removal. Two weeks after her surgery, she started getting some leg swelling, and some shortness of breath, but ignored such signs. It wasn’t only until another week afterwards, that when she saw the GP, she collapsed in front of the GP, having cardiorespiratory arrest, with the GP having to provide full CPR. The estimated downtime of lack of perfusion to brain was around an hour. The patient had had a massive PE secondary to DVT developing in her legs.

Investigations I believe, showed her to have a massive saddle embolus, which caused her sudden collapse.

The prognosis from the outset of hearing her presentation wasn’t good. A full hour of no brain perfusion, would certainly lead to irreversible brain damage. Seeing the family was heart breaking, as the husband held his wife’s hand, and ran his fingers lovingly through her hair.

There were hopes of the patient surviving, as there were talks that the patient was spontaneously breathing. But I’m not sure if it was a reliable finding or not.

CT brain scans however, confirmed the worst possible news; there were irreversible brain changes, with loss of white matter differentiation, and changes consistent with someone who was ‘brain dead’.

The thing that makes it so sad is the young age of the patient, and the fact that something so devastating happened from a procedure that had cosmetic value only.

A few days afterwards, I heard that the surgeons were busy retrieving her organs for organ donation. To me, it is very noble of the family to allow organ donation to proceed ahead, and I’m sure no doubt that the doctors bringing up such a topic would have had a hard time in doing so. The fact that someone beloved does not mentally exist anymore, and then to have them get asked whether they would like for doctors to extract all healthy organs would be even more traumatizing.

Seeing the patient during my ward rounds was something that still kept me thinking. She exists in terms of being alive, but she doesn’t exist, because she is no longer who she used to be.

I remember my registrar saying that she hoped this patient dies. Taken out of context, it sounds like something really horrible to say. She added on later “because if she didn’t she’d be continually suffering, and putting her family through suffering.” In that regards, I too had the same wishes as my registrar. The suffering would be too great for her and her family.

Hitting the Books Again

A lot has happened in the last few weeks. I’ve been too busy trying to sort through work related issues to have had any meaningful time to myself to blog and to relax. It’s only this past week that I have had a taste of working in a more relaxed and less chaotic environment.

And with this more relaxed and less chaotic environment, I’m actually wanting to do more study, and wanting to hit the books. I actually feel like I can start to sit down, and learn a few things from what I encounter at the hospital. My previous rotations were way too draining for me to get into a good mood for reading.

I’m spending more time with my Oxford Handbook of Clinical Medicine, and the small Harrison’s book. They give me great information about general medicine. Reading in itself to learn about the information feels much more different than as a student however. As a student, I was reading because I had to for exams. Now, I’m reading because I want to. It’s a way for myself to expand my mind about things related to medical.

I get up early in the morning, and I start to read. I think I might incorporate some meditation before starting the books. Meditating early in the morning is just tranquil… It will help me to get in the zone. So, I usually wake up around 5-5:30 am, do some reading, breakfast and preparing for tonight’s dinner, and then 7:40 am, head off to work. It means I can get at least an hour or so of reading every day.

With my new tablet, perhaps I can create some flash cards to reinforce the stuff that I have read up on? And perhaps I could read the PDF files I have on my new tablet as well. I’ve never felt more motivated to read about medicine than before, and I attribute this to work stress. When you feel stressed at work, you come home and don’t want to study, because you don’t want to be confronted by more work related stuff. I guess it’s kind of like chefs who come home, and don’t cook dinner, because they’ve been cooking all day.

Well, reading up on medicine will hopefully give me some much needed knowledge about things, since I feel that my previous rotation taught me nothing much, except how to handle chaos, and how to survive against ruthless consultants. More about that on another day…..

Drinks with Registrars

It’s funny when I went for drinks with my registrars. When alcohol is involved, they say all sorts of funny things. Things that were not quite appropriate, given our professional relationship.

The talk involved things more than just about medicine. It started off about the bizarre and funny cases that they saw during their time at work, and then it went on to gossip about other colleagues, things like how much one colleague in particular always waffled on, giving very little clinical details in their presentations. And then another gossip about another colleague who got a needle stick injury.

This later evolved into talks about the dating scene, relationship statuses, and how they had done one night stands and all!

Then they talked to me, about how I was still young, and should enjoy life as much as I can, how I should also go find someone else for a one night stand!

I enjoyed seeing how my registrars were so open and inappropriate in what they were talking about. That’s what alcohol does I guess. Me – I hadn’t had a drop of alcohol that night (I don’t drink). But it’s interesting to see what alcohol does to people – namely, they lose inhibitions, they talk about inappropriate things. And my registrar was so professional at work, a bit serious at times too.

I’ll never forget about that time my registrars talked to me about one night stands….