Last Holiday

the end of break
so mumbler's last proper break in med school has ended. wasn't as jam packed as the previous one, but at least she got to cycle, bowl, watch movies, pub and shop shop shop. the paeds test kinda took away some of the fun, but i can't complain, can i, though i'd like to ask how does a picture of a kid with b/l peri-orbital bruising + pallor = neuroblastoma?! like, huh?! methinks this is a question that will haunt me till i retire. haha.

ethics
since mumbler has to retake her ethics test this thursday, here is a case in point that she heard about recently:

young bangladesh construction worker.
presents with 1) atypical chest pain and 2) loss of weight over 5 months.
on examination, noted to be cachexic and to have massive, non tender splenomegaly extending into the right iliac fossa.
bloods: hb 10.9 tw 445 (myelocyte line, blast cells 4%) plt 460
impression: chronic myeloid leukemia

in most cases, plan is to to a bone marrow aspirate(bma) with trephine, and to start on glivec. but in his case, given his financial and social condition (glivec costs three grand a month, not including the cost of procedures and other medications) all the team can do is to deal with his leukocytosis...and send him home.

would someone like to discus the ethics of it? i don't blame the doctors - which doctor wants his patients to die? but the truth of the matter is that we can't pay for everyone's treatment, and while we mug (yes mug, not discuss or debate, but mug) for ethics, we have to come to terms with such situations as practitioners of medicine.

random

• mumbler can't believe that she sent someone home yesterday without thinking of jone's fracture as a differential. argh! lesson learnt.
• and mumbler misses her care group seniors!!
• totally random, but here's a clip of hugh laurie as shakespeare and rowan atkinson as his editor, in a skit about how the line "to be, or not to be" came about in hamlet. hilarious.

"all i'm saying shakey" really takes the cake, doesn't it. heh.