medicine (2) : 死 - 2 resuscitate the dead

Prologue 

Can you measure my blood pressue?

*Reading ~170/120*

Are you currently on any medication? Yes *shows Amlodipine 5mg, 1 daily, dispensed 6 months ago*

Is that your current box? Yes. 

...

Can you give me another box? please? said softly 

Are you really a professional

早幾日serve 咗一個中國客，佢拎咗兩樽唔同牌子嘅supplements 畀我睇叫我找不同。

一樽就 Lysine 1000mg, Zinc 50mg, Vitaminc 250mg, 而另一樽就得Lysine 1000mg. Treasure hunt 呢類野唔駛讀大學都做到，但難到我嘅佢問我

邊隻防到cold sore？

Supplement 呢類野唔理有冇效食你唔死就reg. 到ARTG. 最火滾嘅係我同佢講supplement好少evidence 佢話自己有睇電視有教，are you really a profession?

係Hippocratic writings本書有講過，就連當時生活嘅人醫自己都係根據自己個experience, 今次treat完係recover度，到下次翻發(symptomatic)嘅時候都可以用返同一招；甚至身邊見到嘅人都monkey see monkey do. 既生電視可生我？

Consumerism 就係層出不窮，vitamin C包裝下成唔同牌子，加埋濕鳩channels 教學，最後變成一個抗疫神藥，得出黎嘅效果就係架上嘅products成日都係空曬 (e.g. 掃嘅數量夠食十幾年…). 

食黎為乜？個個都想活過2020，個個都想延長自己條命。

講到死又有幾多個人接受到？

Stage of grief

 雖然話stage of grief 係theory, 講到好經典嘅5個experience, 

Dr. Elizabeth Kübler-Ross's five stages of grief: denial, anger, bargaining, depression, and finally acceptance ("which should not be mistaken for a happy stage").

未必個個都會go through 曬所有stages, 甚至有人會滯留係某個stage郁唔到, or even 倒退, 迷失係呢個感情遊戲。舉個例子，幾年前係醫院睇醫生notes見到

 …（中譯）個屋企人喊曬，情緒非常繳動。個大仔同我講唔理咩辦法都要救返佢… 

"死"未必一定係肉體嘅消逝，但其中一面就係dead-end, 係好多人都好難接受嘅事。連登媽咪麵突然間入廠搞到成班信眾為佢擔憂；高登文員仔叫雞無意中愛滋；高登炸雞村姑女神連屎眼都玩埋嘅事實。事實就係事實，呢個就係dead-end，你accept 唔到係因為時序上嘅discrepancy。

就係我上幾篇有個熟客同我講完一返說話，雖然講唔出咩大道理，但係嗰刻我就知道佢已經係個dead-end等緊。

//...我已經咁老，仔女又大曬，佢地生活又過得好，係時候要退落黎...// - 熟客, 圖片北斗之拳from google

有時我諗緊，接受唔到現實嘅係我：當你將生死睇到咁淡，你叫我係呢度，咁嘅身份可以講啲乜？我你幫唔到，in fact你唔係搵緊幫助。同時亦到synchronize 你同我對死之間嘅感受。吊弔地要死嘅係你，但係接受唔到嘅係我。到底係因為朋友將要嘅離開而接受唔到；定係對接受死嘅態度太淡？

我都唔知。Out of sight, out of mind.

Agonising mental loop

...我諗你都知死唔去，個後果係會慘過而家... - 我之前個psychologist

好多國家都有euthanasia/ physician-assisted suicide, 對象多數都係腦幹死, 末期病患，點都好，有一樣野common嘅, 就係mentally capacitated. 肉體嘅死，or 就死，都有好多parameters/ evidence 參考。咁長期以來話要focus又畀人冷落嘅mental health呢？

Depression 可以食藥可以CBT，但係都會有人對藥resistant. 面對著呢個dead-end, 咁又可唔可當做mentally capacitated? 當然你可以話undiagnosed bipolar, depersonalized disorder, 但係要suffer到幾耐先meet到個norm? 先violate 唔到個moral/ethics? 

Mental death 同體質 mismatch, 剩底嘅時間夠你繼續wander 定係夠你成為一個nihilist?

一個人死唔去，唔剩止會殘障，同時解決唔到本身個問題；而又吊弔地個問題係解決唔到。

Medicine

每年放榜一定有公屋狀元同傳媒講想做醫生幫人乜乜乜。唔排除係真心，不過做醫生係醫人定醫病？呢個問題我成日都問自己，特別有班狂燥病人執血壓藥。可能佢地唔明點解執藥要等，但係有時火滾可能唔係本身性格問題，可能係hormone imbalance. 試想像一個打緊Reandron (i.e. testosterone) 係你面前發脾氣：唔係性格，就係monoamine/ cortisone:testo imbalance. 

確實拎完隻藥係醫到(or manage到)隻病，但observably 就唔見棺材唔流眼淚/人之將死其言也善。當藥物延長咗你嘅壽命，亦都延長咗你閪嗰面嘅壽命。

去救人？你估QALY係univariate? 舉個例，連登好多你問我登post, regardless, 我見到一定會問

可摸耳借廿蚊買盒飯食

我

我晨早死咗。你問我打呢篇野打到一半中風；聽日出街畀車車死有冇乜野遺憾，我可以答你係冇。冇曬感覺，晚晚發惡夢都會有desensitised 嘅一日。

由duloxetine 60-120 到 fluoxetine 20-40 準備轉sertraline + mirta ，多少我都覺得好攰。每個人都會死，as mentioned 接唔接受到係一個問題。因為：

1. 死唔一定係準備到。e.g. sudden infant death syndrome, 剩係focus個B，我想問佢可以有乜遺憾？
2. 唔係個個人都有happy/ meaningful ending. 

你問我人生有乜野意思？讀書做placement嗰陣有個送貨佬就係咁講

you don't know. you don't need to know. life is too long to live

一個人要幾歲先死，一個人出世要做夠耐野先可以死，我諗到你死嗰日都未知。壽則多辱，或者我地從頭到尾行緊一條錯嘅路。emergency and accident 可以另計，食chronic藥最後increase 其他chronic disease 從而引伸出一條casacade 出黎(e.g. statin > NIDDM; ACEi/ARB > hyperuricemia)。條命係長咗，但就好似一個笑話：

你健身多出黎嘅時間已經用咗係健身度。

Fiona

阿叔真係好攰，但係亦都係一個死唔去，徘徊緊 anger, bargaining, depression嘅人。所以呢排我有好多夢，好多返去以前嘅夢，返去以前可以鳩hea嘅時光。

Fiona 係我嘅好朋友，好遺憾我都唔知點解可以失聯。當我嘗試聯絡佢亦都冇回音嘅時候，我都唔知可以點。或者接受唔到一個dead-end, 一個friendship死嘅人係我。

或者以前個Fiona一早死咗，而家嘅佢已經係拋開以前重過新生嘅人。亦都因為有可能係咁，我都唔敢再搵佢，二來真係驚畀差佬拉。不過都豁咗出去，又何必 resuscitate the dead呢？