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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.


There had been a drought just a few years ago but things were looking up. There had been rain, the stock was looking good and there was plenty of feed. In 10 short hours, 10,500ha were burnt, six homes lost, 580 cattle, 2451 sheep, 2990 tonnes of fodder and hundreds of kilometres of fencing.
By chance I had been with the vet that day and in late afternoon we were called up to assess the animals. It is something I will never forget and hope never to have to see again. The charred and still smoking landscape was disorientating, the smell of smoke, charred flesh and burnt hair thick in the air around the bodies of badly burnt animals. The worst off were calves, unable to get away fast enough. The most unfortunate were paralysed by their charred flesh, but still alive with airways destroyed and frothing from the nose. Others were laying down, but staggered up as we approached. The landscape was quiet with occasional plaintiff cries from injured animals punctuated by the brutal sound of gunfire. We shot those which couldn’t get up, though others would return to cull more as the extent of injury became more apparent.
Horses too were caught up in the inferno, a mare and her foal particularly caught our attention, suffering deep dermal and full thickness burns to their heads, legs and flanks. They would die in the coming days, despite our best care.

Angelique Flowers was dying of cancer just before her 31st birthday. She recorded this message for the Australian Prime Minister and asked Exit International to publicise it after her death. She died on Aug 19 2008.

I’m reviewing laws around end of life care, and was reminded of this case from a few months ago. I had a heated argument with a friend of mine over the matter.
It is a topic I am very interested in, and will continue to mull over.
In med school, you can see in people the optimism of science, the primacy of survival. Death is losing, and losing is anathema to these people.
But my thought was that, death is not always bad, there is a dignity in knowing when it is time to move on.

from Angelique’s video:
“I don’t believe in stoicism. I freely admit to not being a brave soul who grins and bears the pain and soldiers on

I deeply admire people who rise above the adversity and their suffering. But I haven’t grown from my illness or become a better person from its torments. All I want after 16 years of painful Crohn’s disease and now cancer is to die a pain-free peaceful death.

“Because euthanasia was banned in Australia I am denied this right …

“We finally have in Kevin Rudd a prime minister who is a person as well as a politician. A man who had the conscience to say sorry to our indigenous people, the integrity to ratify the Kyoto Protocol.

“I beg the Labor Government to continue beating with the heart it has shown and to ensure euthanasia is made legal once again.

“The law wouldn’t let a dog suffer the agony I’m going through before an inevitable death. It would be put down. Yet under the law, my life is worth less than a dog’s.”

I was talking to a friend of mine who recently got a job as a research assistant to a law professor looking at we could/should legislate a minimum ‘quality of life’ line to make decisions about who to save/let go clearer and simpler.
They are going to look at whether there is a minimum quality of life, which can define a viable life – where the patient is unable to make their wishes known.

My initial reaction was no – there are far too many factors involved in such a decision for a blanket legislation. Also for something this personal, I really feel the law should stay out – it should provide support for either action, but proscribe neither. But having also had a discussion about death on one of my forum rampages, it did get me thinking.
In Australia, and most western countries, we do shy away from death and the discussion of death.
Death is the ultimate limit, the final failure

“The USA is a nation which tends to find failure shameful, mortifying or even downright sinful…It is a nation of eager yea-sayers and zealous can -doers…American culture is deeply hostile to the idea of limit, and therefore to human biology. “Terry Eagleton, After Theory

Because of this fear and refusal to accept death as simply part of life, perhaps it means we never really engage with the idea of passing during our lives, and causing problems when it comes to treatment at the end of life.

I’ve never had to make the call, and people tell me that often once families see a code, they quickly decide not to call for it again, but I hope that I will gain the wisdom and strength to make the right choice when and if I ever have to.

I’ll probably return to this over time, its one of my favourite topics of mulling over. But here are some other perspectives

A beautiful post which expresses my thoughts far far better than my garbled musings can.

Religious perspectives on withdrawal of treatment from patients with multiple organ failure (Medical Journal of Australia)