You only die once

Chapter 4B Helping to save a life

Chapter 4B

Helping to save a life

Is there a lesson to learn here? Why do we put ourselves in danger to help others? Relatives, maybe. Our children, almost always. Our elders, most likely if the potential sacrifice is not too great.

There is a Chinese question, "When the boat is sinking, who do you save? Your mother or your wife?" In ancient Chinese cultural belief, it is your mother because without her, you cannot be born. It is an old Chinese way of addressing a filial son or daughter. In today's world, one could argue that the usefulness of the mother is over, and the usefulness of the wife has just begun. What if the situation is your mother vs your child? Who do you save?

Thus, we have a similar question. You risk your life to save another. Do you choose to risk your life thinking that his or her life is more precious than yours?

Today, in our Covid-19 ravaged world, healthcare workers have to decide between their health and life and their families' and patients' health and life. No different probably from a soldier needing to make a decision between saving his friends and killing the enemy. Whose life is more precious?

We keep hearing the repeated notion that all human lives are equal, and each and every one of us should be treated equally despite sex, religion, and race. We preach and hope. Is there true fairness and equality? Can it ever exist?

Communism in its purest state probably believes this can be achieved if everyone is the same and the state owns everything and you and the person next to you is exactly the same. But this failed. It may seem very odd that we fight the system that tries to make us all equal. (Point of fact: I do not support Communism or believe it. BTW, China is no longer communist since the last 30 years. They are very capitalistic. Ownership is very much allowed as personal wealth. They are nevertheless authoritarian.)

Unfortunately, or fortunately, we are never equal. We are so similar and yet so different. We like to say, "you look like her." And the reply is, "Yeah, we have one nose, two eyes, one mouth, two ears, and hair." 😂😂😂 Obviously we are similar but never exactly the same. Even twins have things that are not similar.

We are born with different personalities, are nurtured differently, and grow up being different. A different environment and we become different people. We say we have choices but our choices are already affected and have been nurtured. So do we, when we are already programmed?

So back to the question: when faced with choices of life and death, how do we choose? The old are discarded and the young is preferred. We like to say no. All equal. We cannot play God. Suddenly, the Western world had to decide. Doctors are quoted in the news saying they had to choose who to ventilate and who is left to die as there are too few machines available. Resources need to be justified.

But do we really need to look at a disaster to have a taste of that? Nope. In cancer care, medication has now become so expensive that few can really afford the full treatment. Patients and doctors have to make 'adjustments' to hopefully get the best for their patients. "We have done so much with so little, we can do everything with nothing."

The following was related to me by a paediatric haematologist in private practice in a developing country.

She was faced with a real dilemma two years ago. A 16-month-old girl was diagnosed with acute lymphoblastic leukaemia. This leukaemia has a cure rate beyond 80% today. The girl and her parents came from a neighbouring country. They hardly could raise the money needed for her treatment. It would cost RM200k thereabout for her treatment lasting two to three years. To raise that money, they would need time. The hospital wouldn't allow debts to accumulate without any credible guarantee for payment.

The paediatrician had a tearoom chat with some doctors. They offered options:

1. Treat her till well enough and send her home to her country to continue therapy.

2. Send her off immediately even when she is not ready.

3. Continue to treat her and get the wrath from the management.

No other options, it would seem. There was no fund they could tap into. She wasn't local and the government centre would not accept her. She felt she had to have a fourth option.

That night, she had a chat with her husband and they both agreed to guarantee the girl's treatment cost. With that guarantee, her little patient has so far received all her therapy and continues to do well.

As doctors, we are faced daily with problems. A life is always worth saving. Yet there are so, so many factors that come into the decision.

Finances, pharmaceutical-driven data, real data, guidelines, standard operating procedures, social, emotional, and religious considerations, and a thousand other things affect the decision. Is there ever a right decision?

The paediatric haematologist confided in me that when she went into private practice, she had struggled with many dilemmas. She needed to provide for her family, children, and parents, thus needing to work in the private sector. The public sector was short of specialised doctors like her and it was truly a difficult decision to justify family and children over the patients in need that she had to leave.

What made it easier was she had already started to groom another to replace her before she left. And a seasoned senior told her, "Your responsibility is to your family now. There will come a time when you can help those again in future."

Many years into her practice, she has already settled comfortably, though much less than other colleagues. Her children have made their own way already. She could afford the monetary loss if need be.

What struck me was her sincerity. And I think it also got through to her patients. With the credible guarantee, the girl had and is having her therapy on her road to a cure. And the trust is returned. They have been up to date with the monies. She of course did not charge any professional fees.

Because the girl was a foreigner, was she viewed differently? In life, is there really true equality? She could not be treated in the public hospital.

She shares many views similar to mine. I have guaranteed smaller amounts in emergencies. I lost a fair sum. But similarly, I have been rewarded with full payments from patients.

Do we stop doing what we think is right? Or do we continue regardless? I like to think we should continue.

Do we help others if we can? Or do we hold on to our precious possessions and value life less?

I also justify my private practice in my own way. By treating the patients who can afford it, the public sector will be less loaded with patients and valuable resources can be freed up for those who can't afford. Yet there are patients who can well afford with BIG cars who would rather crowd in the public hospital, utilising the resources there, than pay for their treatment. Treating the affordable patients allows me to adjust my fees to help others who can ill-afford it.

Then I struggle with another question. What about those whom I am unaware of that need our help? How do I justify this to my conscience? One at a time. Rome is not built in a day.

What matters is we try and never stop trying, even though we fail or others fail us many times.

💧💦 'Drops of water can crack a stone.' (Perseverance is rewarded.) This is translated from a Chinese proverb.

Stay tuned. The next chapter will be up by 4th March 2021.