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Wednesday, 4 April 2012

Work Experience - The Children's Trust, Part 2

Following on from the good morning game, my next objective was to wheel one of the students around the building, delivering Christmas cards to the various classrooms. There were 4 or 5 classes, including FE - Further Education. The tragic nature of their conditions was even further amplified by seeing students my age, even older sometimes. To think these people were born in the same year as me really saddens me to see them in their current condition. But fortunately, the FE students also happened to be the students who had made the most recovery, which was simultaneously very heartening.

At lunch on that monday, I was invited to observe the feeding of non-residential students. The vast majority of the students reside in homes adjacent to the school, but 4 or 5 live nearby and so their parents pick them up everyday. The students who live on the Trust's premises return to their rooms for lunch and for a midday nap, but those who live elsewhere are fed in a separate room. I was uplifted to discover that all of these non-residential students were orally fed, as opposed to having the food delivered straight into the stomach via a tube. Feeding certainly appeared like a challenge, all but one of the students disliked being fed their food. Fortunately the one that did like it was able to feed herself - marvellous. With the other students, there was definitely an element of force-feeding involved, I suppose there has to be. One particular student had a condition where he constantly inflicted pain upon himself through thrashing his own head, or aggressively scratching his wrists. It was uncomfortable to watch, and he certainly seemed to be resisting the food. But the staff were all very lovely and patient, and when I say force-feeding I don't mean it with the aggressive connotation that the phrase brings with it, but instead with a patient and unsettled demeanour.

The day concluded with a visit from Santa Claus (smiles all around) and yes, it was a delightful experience to be able to help the children to open their presents. Even more so considering I received no such present from the white bearded one! Alas, on to day 2.

Day 2 started with the good morning game, as I once again imagined myself as one of those students off Glee. Fun times, I know. The focus of the morning, however, was the coffee shop that FE had set up for their Duke of Edinburgh award. Now, I've done Duke of Edinburgh Silver, and the expedition was the most gruelling 3 days of my life, thoroughly unenjoyable! To imagine FE would one day do an expedition of some sort was certainly very heartwarming. Students here have been known to walk stretches for other charity events, such as the Sports Relief Mile, so I presumed they would do a similar expedition soon. However the aim of this morning was to complete the other aspects of DofE that are required, as we piled into a classroom to be greeted by some FE students, who we could interact with either via spoken word or via their push-button switches. It was a touching morning seeing these students serve us tea, coffee and biscuits (albeit assisted by their carers) and reminded me once again of the thorough recovery that is possible.

Day 3 was among us, begun once again by the good morning game. Maybe I could start getting some choreography together...this morning we played sensory bingo, which I helped to make the day before. Instead of having a card of numbers, the students had a card of various material such as shells, corrugated paper, straws, glitter, pipe-cleaners and other objects which the students could feel to engage their sense of touch. Afterwards, we ate some peppermint creams which we, along with the students, had made the day before. The peppermint creams were a double whammy, for the students benefitted from the movement and senses involved in making them, as well as the enticing smell that peppermint creams have. My lunch that day involved observing the physiotherapy carried out on some students. This involved trying to help students move about on their own accord, either in a standing-wheelchair concoction, or with a walking frame. I wasn't able to observe it that week, but one of the Trust's proudest aspects of its curriculum is their hydrotherapy, where students are placed in a pool where they can move around facilitated by the presence of water. This type of physiotherapy is very widespread in treatment of sports injuries, for example, and it obviously had an important place in the Trust's curriculum. Plus they reportedly have all sorts of lights which they can turn on and off for a full sensory experience.

Day 4, surprisingly, did not commence with the good morning game. Instead, all the classes were invited into the main hall for a spot of wheelchair dancing. Yes. Wheelchair dancing. I had been informed of something similar earlier in the week, but was very much looking forward to seeing this for myself. We played musical wheelchairs, before dancing to Over the Rainbow and Lord of the Dance in choreographed unison. The dancing simply involved the carer (and me on one occasion) pushing the wheelchairs in lines or circles or whatever the choreography required. I have to be a bit sceptical of this, as the only benefit of this exercise I could think of was the rush of wind on the students' face, similar to the fan in the good morning game. But altogether it was a fun activity to watch and participate in, and I'm sure the change of immediate environment would have been advantageous to the students in some way or another.

Day 5 began with snow, and the gloomy white of outside certainly proved an ominous setting for the day. As it had transpired, a student had, unfortunately, passed away some time during the night, and was discovered only about 20 minutes before I arrived by an unexpecting nurse. All the staff were extremely upset - it is such a tight-knit community at the Trust and the bond between staff and students is very strong, particularly between individual carers and their students. Many of the staff were in buckets of tears, and what made it all worse was that the death had been very unexpected, and the exact cause was unknown. I had known this boy, he was in the feeding I observed on monday and was only a year younger than me - I was certainly very moved by his passing, and the whole event really emphasised the fragility and sanctity of life in everyone, especially those with an acquired brain injury here at the Trust.

Class 2, and the rest of the school, was short on staff today. Many were tied up with dealing with the unfortunate death, and many others were affected in such a way that they needed to visit the on-site counsellor, or return home for the day. So with a rather sombre start to the day, our teacher encouraged us to try and not dwell on it, as we burst into song for the good morning game, before playing some more sensory bingo and wrapping some Christmas presents. Today was the last day of term, and all week we had been helping the students to prepare a gift-goodie-bag with all kinds of objects the students could present to their loving and caring families. A nice sentiment.

As I entered the final couple of hours of my tenure at the Trust, we all proceeded into the main hall for an end-of-term Christmas service. The service was a mournful affair due to the unfortunate events of that day, but I was still incredibly moved by the turnout of parents and relatives. I myself am a Christian, and it was extremely heartening to view all of these relatives who, despite what has happened with their child, had a strong faith in God. Whether you are religious or atheist, I believe one has to respect the utmost loyalty and devotion they show, not only to their religion, but to their sons and daughters. There are cultures around the world where disabled children are discarded, and fortunately this was definitely not one of them.

And so my week was up. It was enjoyable - I got to do a lot of singing (I'm still awful), I was touched by the realities of the lives I saw, and I also learnt a lot on the medical side of things. And there was no better way to end things than by seeing swarms of families connect with their children with their loving care and deep hearts. A beautiful sight.

Thanks for reading,

Tuesday, 3 April 2012

Work Experience - The Children's Trust, Part 1

I would like to use this blog post today to write about a week of work experience I did last December at The Children's Trust's School For Profound Education. The Children's Trust is a large-scaled charity very close to my home, that provides care, education, therapy and rehabilitation to children with an acquired brain injury (through a car accident or a viral infection, for example). I spent a week in the Trust's school which the children attend daily. The charity's website can be located here.

I have always had a strong family connection to the charity, as my mother is a perennial fundraiser and I myself have gotten involved organising a few quiz nights to raise money over the years. It seems to be the local charity of choice, and nearly everyone in the village is aware of it and all generously support it. However, despite all of this, I had never actually been to the Children's Trust's grounds, let alone see what happens inside. Shocking, I know.

To be honest, I had never really considered the sorts of children who resided there. Even eating breakfast on the morning I started, I assumed these children only suffered severe 'learning difficulties' of sorts. To put it less bluntly, my expectation of what these children would be like was a very underdressed image indeed. Even more shocking, I know - as I was soon to discover.

So on a freezing December monday morning, I lumbered up to the main reception (absolutely lavish building) where, soon enough, I am taken over to the school, a good 300 metres away. The grounds are enormous. If I didn't already know, I'd assume I had entered a palace! The school was a cosy little block in the middle of it all, and it wasn't long before I was introduced to Class 2 - the classroom I would be helping in during the week. My immediate impressions - overdressed! Unsure of the dress code, I had gone for the timeless smart-casual look of a shirt, a v-neck and some jeans. But it appeared my colleagues-to-be had not received such a memo, instead deciding to deck out in sweatpants and baggy hoodies. Were these pyjamas? Either way, I felt like a pretentious snob...

They seemed nice enough however, offering me tea and biscuits, seconds after the customary "hello I am.." The students themselves were not in the classroom at this point, they were being transported from the residential buildings next door. But when they did the place was packed. Each student has a personal carer, and there were a multitude of physiotherapists, occupational therapists, linguistic therapists,  classroom assistants, nurses, volunteers and teachers. Altogether? About 4 staff a pupil (luckily not all worked in the classroom at the same time!) Wow. I was expecting my class to be similar to my own one at school - a decent number of children. But I was stunned to see my class had no less than 4 pupils. 4!

Admittedly beforehand when I was told my role would include "helping out around the classroom", I had dandy visions of helping the children to colour in pretty pictures of flowers, or play hopscotch, even sing Ring a Ring o'Roses with them. But my hopes of such an experience were dashed immediately by their physical condition. I was truly shocked to see all of the students were wheelchair-bound, unable to communicate any language other than a few involuntary noises, and with all sorts of physical twitch - their arms would swing around in the air, they would jerk their heads and drool. It was a very unpleasant feeling that came over me next, as I realised the suffering these children must be going through, and the suffering that the parents go through on a daily basis. Note, all of the children suffer from an acquired brain injury. At one stage in their lives, these children were perfectly healthy, but unfortunately had suffered a catastrophic tragedy that had left them in their current state. I wondered if these children were aware of their current condition, or if they were mentally and emotionally trapped in their body.

I tried to make contact with one of the two girls. Encouraged that they would respond to stimuli, I stroked the her hand, calling her name and greeting her. She seemed responsive enough, turning to face me and (I think) offering me a heartening smile. It made me realise that not all hope was lost, and I remembered the success stories the Trust had conjured. Men and women struck down in traffic accidents, severely brain damaged, but recovering to full functionality and becoming part of the working community. These are certainly encouraging stories.

The first task of the day, as it was everyday, was the good morning game. Before I proceed, I should say that the curriculum of this school is not one that you would find at my school, for instance. The students do not sit learning the nuances of biology and chemistry and maths all day. Instead their curriculum focuses on their rehabilitation: of speaking, of listening, of walking. The good morning game consists of the staff in the room (about 8 of us at this point) singing lyrics of "good morning" and other phrases, to the tune of a nursery rhyme. The aim is to greet each student personally, in order that they (hopefully) respond by attempting to say good morning back. I was struck when one student did indeed repeat blurred words to that effect. The second part of this game focuses on object-interaction - the main teacher holds up a sari, a fan and a mirror before singing a collective song about these as well (yes, I thought it was madness too). Each student had, on their wheelchair tables, a large button which they could press that, on contact, would relay to a speaker along with the words "[X] wants to play!" and, although it took a few fair moments, one student did actually push the button. The songs about the objects would then be repeated and the student would have to choose one by saying the name of the object. This next part positively surprised me because the student, and everyday that week, promptly made a noise that effectively resembled one of those objects. It was amazing to see these children aren't completely isolated in their thoughts! So anyway, yes, a sari - to be placed over the student, who would realise this to be an 'uncomfortable' situation, and try to wiggle out of it; a mirror - to be placed in front of the student so they can see their reflection; and a fan - to be blown at the student, who would wiggle their face in amazement. And yes, each object had their own individual song. I was beginning to wonder whether I really was in a neurorehabilitation centre, or had unknowingly floated into a West-End production of Mamma Mia. All jokes aside though, it was clear the songs had a proven function, so I was happy to singalong.

So that was my initial experience, come back soon for the second instalment of my week at the Children's Trust!
Thanks as ever,

Thursday, 29 March 2012


Yesterday I boarded a plane to Hong Kong along with my lovely family. A long journey to say the least - 11 hours (not helped by an hour delay at Heathrow!) Scouring through the BA inflight entertainment, I have to say, only one movie really appealed to me - Contagion.

Without spoiling the plot (although to be honest, the film was so bad I strongly advise you don't see it), Contagion concerns a deadly pandemic of the fictional disease Meningoencephalitis Virus One (MEV-1). MEV-1 is a retrovirus that infects both the lungs and the brain,  causing severe cough, fever and headache, before culminating in seizure, brain haemorrhage and death. By the end of the film, 26 million people in the world die and it seems everywhere there is chaos and suffering. For those of you keen to see what I'm talking about, the trailer can be found here. Now, as I said, the film was beyond dreadful - horrific, I could have probably have done a better acting job (that's saying something!) However, the film first captured my attention because it concerns the outbreak of a deadly, global pandemic. This is an issue that really fascinates me.

The world has experienced its fair share of epidemics and pandemics. We've had the Black Death, Spanish Flu, Smallpox, Malaria and more recently SARS, MRSA, Bird Flu, Swine Flu and of course, HIV and AIDS. The topic of end-of-the-world situations has always fascinated me for some reason, and simulating such an event through a sudden outbreak of disease is something I take an even greater interest in. The aim of this particular blog entry is to assess (albeit with very limited knowledge) what we can expect to see pandemic-wise in the future.

Bird Flu, or H5N1, sent the world into shock in 2004, killing around 60% of the people it infected, which was only 565 people with 331 known deaths. There was great danger especially in China and Asia. However, despite the initial large shock, H5N1 died down because not that many actually caught the disease. A 60% mortality rate is high, but what stopped H5N1 from becoming a Contagion-esque pandemic was the virus' inability to effectively spread between humans. This all changed, however, when in September last year, scientists in America introduced 5 gene mutations to the H5N1 virus genome. These mutations enabled the virus to spread a lot more effectively between ferrets in a lab, yet the virus was still just as deadly. If H5N1 were to mutate in this way, the world would definitely have a serious problem on its hand. There is even a big dispute Stateside at the moment regarding as to whether it would be safe to publish a scientific report on these findings - bioterrorists could easily access the information and use it to their advantage. David Nabarro, UN coordinator for avian and human influenza, predicted Bird Flu could kill up to 150 million people around the globe. That, folks, would be a big problem indeed.

MRSA stands for Methicillin-Resistant Staphylococcus Aureus; it is a selection of strains from the bacterium species Staphylococcus Aureus. A decent proportion of us find S.Aureus on our skin and in our nasal passages - it is generally harmless. However, once it gets under our skin (through open wounds for example), S.Aureus can be a real pain. It can cause conditions from pimples, impetigo (skin condition) and boils to life-threatening conditions such as pneumonia, meningitis, septicaemia and toxic shock syndrome. My late grandmother suffered from MRSA - it was particularly unpleasant. MRSA and more 'normal' strands of S.Aureus do not tend to differ in how aggressive they each are, they differ in how they can be treated. Simply put, MRSA are strands of S.Aureus that have survived antibiotic treatment (somebody forgot to finish their course..) and through a few natural genetic mutations. They have evolved (natural selection etc.) to become resistant to that particular antibiotic. Over time, hospitals have resorted to using a range of antibiotics to treat MRSA, and over time MRSA had indeed become resistant to this variety of antibiotics too. Thus MRSA appears, theoretically, to be unstoppable over time - it will always win. Maybe so, maybe not. Maybe other bacteria will become antibiotic-resistant too? Multidrug-Resistant Tuberculosis and then Extensively Drug-Resistant Tuberculosis have already been identified. What's next? We'll have to wait and see.

My final scenario revolves around a disease like Smallpox. Smallpox was the first ever disease to be eradicated from the world in 1977 through a lengthy, but effective, vaccination campaign. Smallpox was both extremely deadly (mortality rate of 62%) and could easily spread - in the 20th century alone, it was estimated there were between 300 and 500 million deaths worldwide. Two phials of Smallpox were kept safely stored in US and Russian laboratories, however there are (and always will be) conspiracy theories that the phials were removed for whatever reason (robbery, experiments etc.) and thus there is a definite chance that Smallpox could once again invade the planet. The incubation period (time elapsed between primary infection and appearance of symptoms) is 12 to 24 days. This long period of time would allow infected individuals to spread the virus all over the world (particularly through the recent boom in aviation travel) before any symptoms were detected. Besides, we eradicated Smallpox years ago - how many people are actively looking for symptoms and incidences? Since the virus was completely eliminated back in 1977, no one was vaccinated for it afterwards, as there was no need - people born within the last 35 years would be very vulnerable to it. Governments do stockpile vaccines but they would have to act extraordinarily quickly to prevent significant fatalities. This could very well become a Contagion-esque situation, although fortunately we do know how to treat Smallpox. There's no doubt in my mind, however, that Smallpox would absolutely storm the planet if let loose.

Am I scaremongering? Any other pandemics you reckon could erupt? Let me know!

Monday, 19 March 2012

Fabrice Muamba

I'm sure that if you didn't see this game in progress, that you will at least definitely have heard about this story on the news. During a football match between Bolton and Spurs on saturday, Bolton's Muamba suddenly collapsed after about 40 minutes of play. He had not been contacted in any way, nor was he moving particularly vigorously - he simply fell to the ground. Obviously, play was stopped and both players and officials were very quick and keen to whistle on the hospital staff. Six medical staff rushed over to try and stabilise the 23-year old, before he was rushed to the London Chest Hospital. A video of the incident can be viewed here.

It is always very concerning when a very fit and healthy 23-year old suffers from such a catastrophic and sudden heart attack. In 2003, Cameroonian footballer Marc-Vivien Foé suffered a very sudden heart attack, similar to Muamba. He was not contacted, he was not even near other players, however he died right there on the pitch. Similarly in 2004, Hungarian footballer Miklós Fehér suffered a sudden heart attack on the pitch, from which he died within a few hours. Fehér was issued a yellow card, to which he bent forward to sigh upon the penalty, before falling backwards and collapsing. Both incidences can be viewed here.

What these two footballers have in common (and I suspect Muamba too) is that both died from cardiac arrest, caused by hypertrophic cardiomyopathy. 

The U.S. National Library Of Medicine defines hypertrophic cardiomyopathy as:

"Hypertrophic cardiomyopathy (HCM) is a condition in which the heart muscle becomes thick. The thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood...Hypertrophic cardiomyopathy is often asymmetrical, meaning one part of the heart is thicker than the other parts. The condition is usually passed down through families (inherited). It is believed to be a result of several problems (defects) with the genes that control heart muscle growth. Younger people are likely to have a more severe form of hypertrophic cardiomyopathy. However, the condition is seen in people of all ages."

The most severe symptom of hypertrophic cardiomyopathy is sudden heart failure, seen in young athletes. This condition is so dangerous as it often has no obvious symptoms and would be undetectable unless it is found through a (very thorough) medical examination.

Obviously this is a terrifying condition. We are all, especially at a young age, encouraged to eat well and exercise frequently to keep our health up. Well these three individuals all did that - their careers depended upon their fitness. It is scary to think that despite their best efforts, they can be ambushed by hypertrophic cardiomyopathy in such a way that two of the three died soon after cardiac arrest (luckily Muamba appears to have been stabilised now). Especially through watching the videos, it is like the hand of God has come down and attacked them with one fell and fatal swoop. It is a truly tragic condition and it is a very distressing situation seeing a player collapse as such, and seeing the horrified and distraught reactions of his teammates and the crowd. Traumatic to say the least. All we can hope for is, I guess, better and more frequent screening for hypertrophic cardiomyopathy.

Let's hope Muamba holds up and makes a swift return!

Thursday, 15 March 2012

Professor Anthony Warrens

Today, at school, we were all fortunate to receive a visit and a talk from none other than Professor Anthony Warrens. For those of you who do not know who this illustrated man is, he is the Dean of Medicine at Barts Medical School. Professor Warrens holds many a degree, and is a member of the Royal College of Physicians. This is only a brief outline of his career, for a more detailed (yet also undoubtedly brief) summary of his career, please click here.

The main focus of Professor Warrens' talk today was on the concept of transplantation, in particular renal transplantation. He showed us much evidence and urged us to support his view that we should, if we agreed with organ donation, sign up to become an organ donor as soon as we could. Professor Warrens showed us that living with renal failure is very tough, and living with kidney dialysis isn't particular pleasant or easy either - it's hard to maintain a 'normal' life whilst on dialysis. Warrens continued by stating that whilst patients needing a kidney transplant could technically survive on dialysis, this sort of treatment isn't available for other organ failures: a brain transplant, for example. In short, we were urged to consider how important transplants are. An issue that is frequently in the news, and one that was illustrated to us today on a graph, is the number of transplant operations undertaken against the demand for transplants. It was staggering - sometimes the demand for transplants were up to five times the supply. This is a shame, for 70% of the UK agree with organ donation, yet only 25% or so of citizens are a registered organ donor.

An underlying question to the talk that we all thought was, "how can we increase the number of organ donors?" This, it appears, is a significant challenge. Professor Warrens explained to us that when he has been supervising patients who were, unfortunately, very close to inevitable death. It was very difficult to convince the patient or his/her family to let the patient's organs be used after death, even if they might be pro-donation. This is understandable - death is a very grave and stressful period in the patient's and family's lives - they do not want to conceive the idea of death in their mind, nor do they want to focus on what to do after death.

Speaking to his patients who did receive transplants, it is worth knowing that the patients were eternally grateful. They realised that the transplant had effectively given them a second chance at life, improving not only their potential lifespan, but also significantly improving their quality of life. This cannot be understated - I am completely for transplants, it is a wonderful thing. However, unfortunately, the UK stance is that in order to become an organ donor, one must sign up to be so. I whole heartedly disagree with this. Coming back to the fact that 70% of people are pro-donation, but only 25% sign up, I believe the UK should shift from an opt-in procedure, to an opt-out method. It would benefit the lives of patients, their family, the government. And no less, it would make Professor Antony Warrens (and myself) very happy and satisfied indeed.

Let me know what you think!

Sunday, 11 March 2012

Work Experience - RASS

I would like to write today on the subject of work experience, and more specifically my experience of it. One of the placements I have is working as a volunteer at a nursing home called The Royal Alfred Seafarers Society, for 2 hours every sunday. The home is almost exclusively for those who served in the Royal Navy, or in the Merchant Navy; and specialises in treating dementia - an extremely prevalent and saddening condition in the elderly.

Unfortunately, there is very little an unpaid, untrained volunteer can do, as most of the jobs are delegated to the experienced nurses. However, I do have a few roles. I like to think of myself as the home's welcome party - whenever there is a new resident I am asked to greet them, welcome them in and have a chat with them about their life, their career, their family and just about anything really. I also chat, in a similar fashion, with other incumbent residents every week. In addition to this, the RASS has spectacular gardens and scenery and whenever the weather's nice, I ask around if any of the residents would like a walk around the garden. I say walk - unfortunately the majority of residents are too weak to use their legs and so my job is to push them in their wheelchairs. It is an enjoyable bonding experience nonetheless, and it really is encouraging to see their positive reactions to the great outdoors.

As I mentioned earlier, the home specialises in treating dementia. What is dementia? In a nutshell, it is a condition caused by diseases such as Alzheimer's, characterised primarily and most notably by memory loss, but also other symptoms such as personality changes and impaired reasoning. It is a particularly saddening condition because sometimes the memory loss is so severe. Once, I was tasked with asking a resident to sign some Christmas cards for his family. He seemed fine at first, able to write the first couple of letters of 'love from'. Then dementia set in: he suddenly dropped his pen. I picked it up and handed it back to him, but after a few rough strokes it wasn't long before he admitted he had forgotten how to write, and that he had no idea what he writing about. Completely new to dementia at the time, I couldn't quite believe it. I bewilderedly filled out the last few letters of 'love from' and handed the pen back to him, to see if he could sign his name. And then it was the next bit that was most tragic - this particular resident had forgotten his own name. I was shocked. I won't conceal it, I had never given much thought to dementia. I held the rather naïve and insensitive view that dementia was only a minor condition - HIV is imploding Sub-Saharan Africa everyday, that was a big deal. But dementia? Dementia never directly killed anyone. How wrong I was. 

Dementia steals identities. A once proud, successful, vibrant life now effectively ended, replaced by pure nothingness. An empty body, you could say - the lights are on, but nobody's home, and nobody will ever come home. This leads me onto my experiences today. I was asked to welcome a new resident, who we shall call Mr. X. I was informed Mr. X was a former Head of Intelligence in the Royal Navy, in which he served for around 60 years. He seemed like a very friendly, engaging person, and spoke with that air of intelligence that makes the conversation flow just that little bit better. The trouble came when I asked him what his job as HoI entailed. He had to think long and hard about it, and his answer of "the odd job here and there" seemed like a rather empty, unsatisfying response to me. Unfortunately Mr. X had dementia. Fortunately, it wasn't severe. But again I saw the horrifying effects of dementia. One of the country's greatest heroes: fighting during WW2, progressing to HoI, serving for 60 years. A life to be celebrated by all, and with many lavish stories to tell. Now all that was left was a few scraps of memory here and there. A general outline - he remembered that he was HoI, but no detail - he couldn't remember what his job was like. Dementia is one of life's greatest tragedies. Such a prominent man reduced to almost nothing. A grave shame indeed.

In my experience, the vast majority of new residents tend to like the RASS. It is an outstanding, clean and well designed home, with exceptional facilities and a loving, dedicated staff. However there is the odd anomaly every now and again. The biggest reason for this is that they simply don't want to be there, for whatever reason. This story was no different. Today I was told to avoid another resident. She was new too. I do not know why Mrs. Y was admitted here, but it was clear she disagreed with whoever or whatever placed her here. Over the past week she had been barking to the nurses from her wheelchair, "Nurse nurse! Get the police, police! I've been kidnapped! Urgent!". Obviously, no nurses felt obliged to call the police, but this is another prime example of the tragedy caused by mental illness and dementia. Mrs. Y was also known to ask to have her wheelchair placed next to her husband's in the lounge area. Her husband? Try the resident who forgot his own name. Were they married? No, he had been at the home for several years, she had been here for one week - they did not know each other, and the extent of the dementia would, unfortunately, mean they would be unlikely to start their 'marriage.' From a certain, disturbing perspective, one might find this story somewhat comical. However, in reality, it is far from it. It is a harrowing story of how dementia can ravage a person so greatly that such events could ever happen.

We do not know great deals about dementia and Alzheimer's. But I know these patients can't be saved now. A panacea may cure them of their memory loss but ultimately their memories have been lost forever in the warps of time and space, never to be discovered again. Such a shame.

Signing off on that rather sombre note,

Tuesday, 6 March 2012

Medical Ethics - Euthanasia

"Dr. X is a medical SHO (Senior House Officer) working in the stroke team. An 89 year old lady is admitted following a large stroke which has left her bedbound, incontinent, paralysed down one side and unable to speak. After a few days on Dr. X's ward she develops a chest infection which requires antibiotics. Her daughter tells Dr. X that her mother was always fit and active and it would have been her "worst nightmare" to live like this. She suggests that if her mother could speak, she would refuse the antibiotics."

Does Dr. X administer the antibiotics?

Firstly, it would be worth to clarify the situation. If Dr. X withholds the antibiotics on the daughter's request, allowing the mother to die, then this would be voluntary passive euthanasia. By this I mean that Dr. X would not be actively killing the mother (by injecting a large quantity of morphine, for example), but would simply be permitting her death by removing life-saving treatment. There is a very fine line between active and passive euthanasia, the former of which is illegal, the latter legal. The difference between active and passive euthanasia essentially relies on two key questions that must be asked:

1. Is Dr. X acting or omitting?
2. Is Dr. X intending death or foreseeing it?

Thus we can conclude that in this situation, Dr. X would commit passive euthanasia as he is omitting treatment, and foreseeing death. Death is somewhat intended, although in the realms of law and ethics, death here is passively intended and is thus considered to be foreseen instead. Please note that this is also voluntary passive euthanasia. This is because the mother's daughter has a clear duty of care for her mother - she is close family - as we assume her mother is incapable of making medical decisions due to her condition, therefore this is respecting the patient's autonomy and the daughter's decisions regarding her mother should be carried out as long as they are permissible and legal (i.e. not active euthanasia), regardless of whether Dr. X agrees with withdrawing the antibiotics. The daughter believes it is in her mother's best interests to die, and Dr. X should act accordingly. For Dr. X to go against her daughter's decision would be to commit, in legal terms, battery.

Some may argue against Dr. X allowing this passive euthanasia. The most common opposition comes from the absolute moral principle that killing is wrong in any situation. These opponents may accept there are some very difficult situations and sometimes killing may seem like the right thing to do, but they will always stick to that single, absolute principle that killing is wrong. However, I firmly believe we need to be more relative and flexible with situations like this. A reason these opponents might view killing as a harmful wrong is because of the harm of dying. For most people, dying now would be a great harm compared to living onwards. Thus if there is no harm caused in dying, then killing shouldn't be considered wrong. In the case of voluntary euthanasia, dying would be a benefit in the patient's eyes, not a harm, therefore I hold the position that the voluntary euthanasia would not be morally wrong. To quote Professor Hope:

"Those who argue that mercy killing is wrong in principle forget the conceptual link between the wrong of killing and the harm of dying…It is perverse to seek a sense of moral purity when this is gained at the expensive of the suffering of others."

I do indeed agree that having a first priority of seeking "moral purity" is essentially foolish. In my opinion, Dr. X must allow the withholding of antibiotics.

This is a tricky medical situation, but certainly a more common one.

This is just what I made of the situation,
Let me know what you think!