Day 268

Posted by kidsaregifts20

Successfully completing medical school was an exhilarating experience but confusing at the same time. I figured that becoming a doctor was just the beginning. I had no idea where I wanted to go from there. What did I want to specialize in?

After a year and a half of trying this and that I found my vocation. It sounds cheesy to say that I did not choose Anaesthesia, it chose me. But that is true. It was just right for me. I learnt to comfort and reassure patients and their families just before their operations when they were vulnerable and worried. I developed delicate practical skills in the form of medical procedures and sensitive difficult conversations. I learnt a lot about patient safety as, when under anaesthesia, it is completely up to us to ensure that every patient is safe in every way possible. Maintaining good blood circulation and keeping the blood well oxygenated, hence keeping the patient alive is the very basic requirement.

In addition, we worry about the smallest things – a slight drop in temperature, a little scratch on the cornea of the eye or a tiny chip on a tooth, causing pressure sores or nerve injuries as a result of lying in one position for a long time or a bit of nausea or sore-throat after the operation. Many other seemingly tiny considerations are borne in mind to avoid the smallest possible complication.

Death directly related to anaesthesia is a highly unlikely event. A cause for much concern if it happens! Especially to a fit and healthy 20 year old lad.

Clearly, not all specialties think like we do. Every disease process is different and what is applicable in one field is not in another.

When it comes to safety there are many parallels drawn between medicine and the aviation industry. Martin Bromley is a pilot who lost his young wife Elaine, when under anaesthesia. He has used that experience to educate a lot of people about the importance of Human Factors in medicine.

This video tells us his story and the lessons learnt. It is humbling to hear him speak. I have watched it many times and also used it for teaching junior medics. It is called “Just a Routine Operation”. A lot of learning in 14 minutes.

Day 264

Posted by kidsaregifts20

“Youth who feel suicidal are not likely to seek help directly.”

This is clearly stated on the Suicide Prevention page of an American organisation called National Association of School Psychologists (NASP)

It also says: “Parent notification is a vital part of suicide prevention. Parents need to be informed and actively involved in decisions regarding their child’s welfare. Even if a child is judged to be at low risk for suicidal behavior, schools will ask parents to sign a Notification of Emergency Conference form to indicate that relevant information has been provided. Additionally, parents are crucial members of a suicide risk assessment as they often have information critical to making an appropriate assessment of risk, including mental health history, family dynamics, recent traumatic events, and previous suicidal behaviors.”

This document is written for students up to the age of 19. But it is equally applicable to older ‘children’.

One set of parents bereaved by suicide discovered after the death of their young son that he had spoken with most of his friends about his suicidal ideation. It is well known that the parents are the last to find out. They have now set up a foundation with this sole message to young people: “if your friends share suicidal thoughts with you, please tell someone older who is in a position to help. Anyone.”

This afternoon I spent a few hours with one of my son’s close friends from university. I was amazed at his level of empathy and maturity. He shared this website with me on which he is a Listener. It is called 7 Cups of Tea, an on-demand emotional health and well-being service. Their bridging technology anonymously & securely connects real people to real listeners in one-on-one chat. I was impressed by the range of topics, languages and countries it covers.

It sounds perfect for those of us who may not wish to speak to anyone in person.
It must be an impossible subject to talk about, but it is amazing how many people are willing to listen.

Day 228

Posted by kidsaregifts20

All day today 55 years old Charles Kennedy has been on the news – a prominent political figure found dead at his residence yesterday. He struggled with alcohol, his father passed away earlier this year and he lost his parliamentary seat of 32 years in the recent elections. Police are treating his death as ‘not suspicious’.
Interesting description. Isn’t it? I, on the other hand, am very suspicious.
My thoughts and prayers are with his family. For them the nightmare begins.

From the documents that have been sent to me for the inquest, it is revealed that my son’s depression score on PHQ-9 was the highest possible, ie. 27/27, sixteen days prior to Day 0. It indicates severe depression. It doesn’t get any worse. Yet, no alarm bells rang for anyone and he was sent home on the same medication and no escalation of care, despite it being requested. On the follow-up visit 2 weeks late, the test was not repeated. Wonder why?

PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression and it is a validated tool for monitoring depression.

Eli Robins and colleagues at Washington university studied 134 suicides and came to this conclusion: “If we had found that suicide was an impulsive, unpremeditated act without rather well defined clinical limits, then the problems of its prevention would present insurmountable difficulties using presently available clinical criteria. The high rate of communication of suicidal ideas indicates that in the majority of cases it is a premeditated act of which the person gives ample warning.”

Identification through proper assessment of suicide risk must precede any attempt to treat psychiatric illness. Asking the patient directly about suicidal thoughts or plans is an essential part of history taking. Other major risk factors that need to be evaluated are: the presence of severe anxiety or agitation; the type and severity of psychiatric illness, the extent of hopelessness; presence of severe sleep disturbance, current alcohol or drug abuse, ease of access to lethal means, lack of access to good medical and psychological treatments (!), a recent setback, family history, close proximity to a first episode of depression, mania or schizophrenia and recent release from a psychiatric hospital.

Once identified, acutely suicidal patients need hospitalisation as a protective measure and for further evaluation. It does not prevent all suicides but definitely saves lives.

Hospital beds are like gold dust. Patients verbally and clearly proclaiming suicidal intent are sent home due to lack of beds. ‘Length of stay’ is another criterion for assessing how well a hospital is doing. So, even if they do manage to find a bed, patients are discharged earlier than they should be. There is tremendous pressure on the system and the carers at home.

There is almost nothing doctors can do about major stresses in patient’s lives as they are difficult to predict and govern but there are things that can be done to influence the underlying biological vulnerabilities to suicide. The proper management of mental illnesses, especially those closely linked to suicidal behavior, is vital.