Sunday, May 18, 2008

FW: [jublintan65] Not So Pearl & Gem:Random Thots on Deat

Friends ,

Yesterday , while busy going through my morning clinic list ,I received a call from a clinic staff of Dr Shuiab ,a classmate ,Family Physician practising in Kampong Bharu : He died early morning ,in University Hospital ,presumably from heart failure following a massive heart attack .

My work involve me to think about 'man's fragility and mortality' all the time from from morning till evening even in the seemingly 'fit and healthy individuals passing my door just for a simple annual examination' ,call in a paranoia or whatever ,but after 30 over years in 'the business' , just like any hard nosed top gun entrepreneur ,you have to develop a 'bottom line' approach to your patients ,your clients :ie what is the chance of this individual being seen around end of this year , next 5 years ,will he make it to his 60th birthday etc etc on the basis of limited statistical clinical data I have just from the 'cardiological and endovascular viewpoint I have .Taking away the other variables of a fatal motor vehicle accidents ,latent cancer ,suicides etc etc of course .

A hardnose clinical assessment all the time ,never discussed or divulge unless to the very few ,who really ask .In my experience ,in the ones who really need to know amongst my patients ,very few really want to know and ask .

Still a classmate's demise even at 56 hit me like a speeding car crashing on a brick wall .Time's up .Think of you own mortality .Average lifespan of Malaysian males ,74 ,75 ? .Mashaallah 'we' are heading there already !What if I am diagnosed with a terminal lung cancer tomorrow ?Like another colleague the other day walking in the clinic with just vague weight loss and abdominal discomfort and found on CT scan to have terminal 'pancreatic ca' . Or TS Nazamuddin ,a former occasional patient years back who went to LA for his wife's medical check up but instead brought back in a cold coffin 2 months later ,of 'metastatic lung ca' .And another friend ,Nik Aziz formerly of Petronas ,fighting for his life ,in Selayang Hospital also of lung cancer . And that 35 year dog trainer in Cardiac ward with a heart as big as a' football' with idiopathic dilated congestive cardiomyopathy with only a left ventricular function of 15 % .He asked me gingerly yesterday whether he can get back to his favourite badminton game next month .I was not sure whether he can survive walking to the 'loo' on his own safely even while in the hospital ,preoccupied in my own thought about possible litigation if the unwanted cardiac arrest actually do happen in such compromising circumstances .Knowing that this chap on good statistical basis will improve to go back to his dogs and more than 99 .9 % sure he does not want me to tell him what is in store for him in the next 6 months , 1 year of 5 years .

That is the burden and realm of the cardiologists !
And yet still Dr Shuiab's sudden death hit me like a brick .But is death really sudden ?Is death really sudden ? Sudden to us but as soon as you are born ,your 'date' has already well been cast in iron ! You cannot change that even a second !The scenarios of your death can somewhat be a variable :Death by drowning , plane crash , MVA's , sudden death of a brain haemorrhage , fatal heart attack ,chronic brain or heart failure , kidney failures ,cancers and so on and so forth .Some may appear sudden some insidious , but all to the family members and individual involved seemingly 'untimely ' .

In some it may appear as a 'relief' ie in people with chronic debilitating diseases , in situation of prolong dementia , death is a relief to both patients and care givers especially the long suffering spouses .I know this because my elder brother died last year after 10 years of dementia .After the initial period of grief when we look back that was a relief for everyone around him .

What about those young chaps in Palestine who have decided that there will be more meaning in the deaths than to carry on living meaningless lives under a perceived ' repressive Israeli regime supported by and equally belligerent West ' .All avenues in the last 60 years leading to nowhere except more denials and more repression .Death to them is just like walking 'from a room feeling like a hot furnace thru a door into an air-coditioned heaven ' .

Some random thots on Death ,I must get on with the clinic ,Shan my Clinic assistant frowned at me to indicate some of patients are already making 'animal'noise outside there for the long delay ! More structured thots on death later, if you guys can bear this 'depressive mood ' of mine ! Still Dr Shuiab's death hits me like a brick wall !

Dr Nik Howk

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