I have overheard some students saying that they were disappointed that there wasn’t enough death in hospital. Maybe I’m too soft and squishy right now, but I’m in no hurry whatsover to see more than what comes.

Random Violence
I observed a craniotomy .

The man’s brain was, in a word, buggered. There was a haematoma covering probably a 1/3 of his left hemisphere, obliterating his 3rd ventricle. It had lost its nice colour, the normal texture and architecture, and to top it off, there was an uncontrollable cerebral bleed. He never regained conciousness and passed away. We never found out what exactly led to these horrific injuries – other than some sort of altercation. I know it happens all the time, but its sad that someone can be beaten this badly and be left there – he was only brought in as a chance finding.

On suicide and not knowing
I had interviewed him recently. I was chastised for not delving into his deep melancholy having been distracted by his more florid pathologies though my risk assessment and management plan had been satisfactory.
I had been the last one interview him, in fact. We had gotten on well, talking about music and ultimate fighting. He was picking up, becoming happier, more reactive, interested in getting better.
But somewhere along the day, and I’ll never know why, something changed and he tried to take his own life by leaping off a building. He didn’t suceed totally, but will be severely paralysed at the very best.

I wonder what was going through his head, I feel awful for his family, for the team that has been looking after him and inevitably we all think back to when we last saw him, was there a clue there? could we have forseen this? could we have done something about it?
But mostly I just feel sad.

on dying
He’s dying. He knows this but not quite know how soon yet and the question has come whether we treat him aggressively, for little gain, or we go palliative and he can return to his country(land) and family. He thinks that aggressive treatment will get him 5-6 years. It won’t, 12 months or so at best. If the renal failure doesn’t get him, the cancer will.
So we talk, about life, his family and about dying. He’s not afraid of dying and is remarkably cheerful and graceful, and for that I’m grateful – it makes a difficult topic easier to discuss.
We’ll meet again soon after he talks with his family and he invited me cheekily to his country some 6 hours away.
I hope I can get there, I hope that I did the right thing, I hope that he chooses well, and I hope that he has a good death.