Opt-In or Opt-Out?

Went to an excellent debate today on organ donation, specifically the current debate on whether citizens of the UK should have to choose NOT TO donate their organs following death (Opt-Out) rather than the current system where we choose TO donate our organs (Opt-In).  Representing those against any change was Earl Howe, conservative spokesperson on health and an Intensive Care doctor from Addenbrooke's Hospital in Oxford.  The other side was represented by Dr Evan Davies, Liberal Democrat MP and Veronica English, vice-chairwoman of the BMA Ethics Committee.

There are about 8000 people waiting for a transplant, with about 2300 transplants carried out each year and something like 1000 patients die each year waiting for a new organ.  The UK is waaaaaaaay down the list in terms of donor numbers with ~13 per million population, compared with Italy (21 pmp), France (22 pmp) and Spain (35 pmp).  When a patient dies 40% of patient's families will refuse, but survey's have shown that if the choice is actually put in front of a person an enormous majority (90% I think) would to sign up to the Organ Donor Register.

So, with Opt-Out, you presume consent.  You assume that if the patient were alive and able to give his or her consent, they would choose to allow their organs to be used for transplant.  Is that something you can presume?  Do we, does anyone, have an assumed 'right' to someone's organs?  Would you like to have an organ from a person when you couldn't be sure that the donor wanted their organs to be used?  With there being so many people dying before an organ can be found do we have the luxury of being apathetic to the need to donate organ?

There are so many more questions and I have a lot of opinions, but do you? Have you thought about organ donation?

The View from the Other Side

Well, here they are:

my irritating little buggers of wisdom teeth.  In my first year I spent two weeks with an oral surgery department and saw several patients have their wisdom teeth out under general anaesthetic.  This week it was my turn.  What a weird experience to be on the other side, to be the one led into theatre and asked to lie down on the table.  "Sharp scratch" is what I've heard them say a thousand times when they put the cannula in...not so bad really, "This might feel painful as it goes in" is what they say when they inject the propofol (the white coloured anaesthetic)...and it really does hurt.

Anyway, I'm left doped up on painkillers and getting bored with episodes of ER.  I'd kill to be able to eat Big Mac.

Funny Career

So, I was thinking, as I inserted my finger into the rectum of a 60yr old gentleman, that this is a strange career choice.

Then, today I walked onto a surgical ward. I had to go past three police officers, then as I went onto the ward there were two more, each with biiiiiig machine guns...exactly like this:

Why? Because there are two guys on the ward who were stabbed and there's a concern that the guys who didn't kill them the first time are going to come back and try again.  This is all while I'm stood about half a metre from one of the guys.  Some guy comes on the ward shooting I'm worried he's not that good a shot...

1/3 of healthcare staff are abused at work, 1/10 are physically assaulted and there's a good chance at some point I'm going to seriously harm a patient in the future...

Funny career.

Was watching some endoscopy today, basically cameras inserted into a patient's mouth or bottom.  During which they sometimes use a local anaesthetic spray.  The drug company states that it should taste like bananas.  The Consultant says "Try it" and puts some on the back of my hand to taste a little.

Couldn't feel the end of my tongue or lips for half an hour.

Fact Me 'till I Fart 1

So, three little facts about your life, you have at one time:

- Been called a blastocyst

- Drank a LOT of your own urine

- Had both male and female genitalia

Patients are COOL

I LOVE patients.  There are moody ones, boring ones, sometimes really nasty and mean ones but mostly they are lovely, kind and...well...patient.  

I met a lovely young lady this week.  I had to take a full history and then present my findings back to the Consultant.  As a result I had to take some blood for cultures (testing for bacteria) and the way I had to take it meant it was painful and I messed up a little and there was blood dripping down her arm on to the chair!  In fact, I had to get someone else to do it in the end...But, after recovering, funnily enough, she was very thankful and when I saw her the next day as she was going home she had a big smile and said thanks!

What's more, the older they get, the better.  The amount of times I've heard an older patient say "You've just got to make do haven't you?" or "It's not so bad is it really?"  or something like it in the face of illness, always with a cheeky grin, you'd have thought that getting ill wasn't so terrible!  They've got such a great attitude to life, is it just their generation or will we be like that when we're older?

Anywho, many Doctor has said that the only reason they enjoy working in the NHS is the patients and I can see why.

An Old Man

Just met an old man who is 80.  Has had tongue cancer, throat cancer and now it’s spread to his bones which means it terminal, he won’t live that much longer.   I was taking a history from him, about his illness and treatment.  I got that but I also got an entire life history, ask any medical student, you can’t talk to an 80 year without getting an entire account of that person’s life.

I asked him at one stage “So, how do you feel?”  To my surprise he started crying, he said he was sad, that he was scared and that he didn’t want to leave his family.  First of all, why was I surprised?  Of course it’s sad, of course you’d be scared!

It made me think about all those speeches we've heard, at funerals or something like that, about how we should live life to the full and how we should treat each day as if it’s our last.  We’ve all heard it so many times, I’m sure, that it's become cliché, to the point where we almost ignore it.

Do any of us really live like that, or even try to?  Do we care that much about doing so?  It seemed to me that this guy was upset because he rather enjoyed living and thought he’d had a good life, so much so that he was sad to leave it.  We should all be so lucky.