Giant Turtles. swords and what to say and not say

March 27, 2008

Since last post I have been out and about. Roberto, the Italian that helped me find the hotel saw me on the street and showed me a nice restaurant for supper. He says I will owe him a meal if he helps me out again. I also have been able to get the Blackberry up and going and so that lets me do work emails so that I won't have thousands at home when I get back.

Eric and I went to K2 hospital together today. This time the taxi did take us all the way to the building. I got to round with the fellows to see a new patient with cervical cancer and we reviewed the case and x-rays. It is good to look at the x-rays together so that they can learn to look at the studies themselves. Lots of discussion about the treatment and cause and now what do we do with it coming back. Culturally the discussion of goals of care that I am so used to doing is not appropriate. I don’t know what to say about this. Kubler-Ross when she wrote about death and dying in the US in the 1960’s, was heretical because it was assumed that talking about cancer and prognosis openly was not culturally appropriate. Now we know that many people do want to know about their illness, and with the movement of patient autonomy we tell everyone what is wrong with them.Usually this is for the good, although some people still are overcome by the prognosis and diagnosis.

I think that here it is more of a cultural issue here than it was in the USA ; but it might be overstated here in Vietnam like it was in the USA. It would be interesting to interview patients for their preferences of information and amount of information to see if it is true that they do not want to know the prognosis. I always think people really know most of the time inside that things are not going well. It is hard to plan care though. when you cannot talk openly about how people want to spend the time they have left.

I bought a mobile phone for use here in Vietnam for 600,000 dong; about 30 dollars. Now if I get stuck somewhere I can call locally for help and plan meetings and outings with colleagues here.

After that I went to walk around the Lake of the Redeemed Sword? This sounds a lot like King Arthur and Excalibur but it involves Confusion philosopher and a giant turtle that carrys the sword around. I guess the turtle will keep it until it is needed again. Area is pretty lots of people watching to do and I will want to go back soon.

Now to work on next lectures for tomorrow.