The Doctor's Consultation
by Dr. Iain Corness
DNR – is it the end?
A few years ago, a consultant in a hospital in the UK was
reported to have hung a sign over a patient’s bed that had only three
letters – DNR. Turned out that they stood for “Do Not Resuscitate”! Needless
to say there was a great furor over this, with much heated argument on all
There were those who looked at the resuscitation matter as a bean-counter
would. If the patient was not a member of the working community generating
Gross Domestic Product (GDP) then this patient was a drain upon community
resources. What was to be gained by resuscitating such people? This approach
always amazed me, to be quite frank. Do bean-counters not have mothers and
Then there were those who would claim that all human life is sacred and
everything possible must be done to keep the patient alive, no matter how
courageous those procedures would be. And no matter what the patient would
go through as a result of all this. Quality of Life was not under
consideration for this group.
Eventually some reason returned to the emotive debate and it was decided
that the only ethically correct way was for the treating physician to
discuss all the options with the patient, and let the patient decide whether
or not he or she actually wanted to be resuscitated.
However, there would still be the vexed question as to what happens when the
patient is incapable of making such informed decisions through conditions
such as Dementia, for example.
Further ethical argument and discussion ensued, and it is the consensus
these days that ‘resuscitation’ only refers to Cardio-Pulmonary
Resuscitation (CPR). In other words, the resuscitation that would be done
following a cardio-pulmonary arrest. The question of DNR did not refer to
other treatments such as antibiotics, transfusions, dialysis, ventilator
support or even care in an ICU.
This to me looks like a reasoned approach and the American Medical
Association Council on Ethical and Judicial Affairs issued an eight point
guideline to be used. The first is the most important, and the rest hinge
upon that. Point 1 stated that “Efforts should be made to resuscitate
patients who suffer cardiac or respiratory arrest, except when CPR would be
futile, or not in accordance with the desires or best interests of the
The efforts would be considered futile if they could not be expected to
restore cardiac or respiratory function. This is the situation where you
already have a seriously ill and dying patient, and even if you could get
the heart started again, the damage to the heart would be such that the
patient would become a coronary ‘cripple’, on top of all his or her other
problems. And that gets us back to the Quality of Life.
In my mind, unless we (as treating physicians) can offer the patient a
better quality of life, are we treating the patient ethically by embarking
on a course of treatment or therapy that leaves the patient with a poorer
quality of life?
I had a friend who developed stomach cancer. By the time he consulted a
doctor after months of symptoms, it was really too late. He had been
continuing to work in his small business, but he could continue to function.
Unfortunately, he consulted a surgeon who could only see the fact that the
man had stomach cancer and he operated. The operation was hazardous, the
cancer could not be totally excised, he never recovered and spent his last
three months in hospital with tubes out of every orifice, begging to die.
As medical practitioners we must never forget the Quality of Life, and as
patients you owe it to yourselves to always inquire as to what the Quality
of Life will be after any proposed course of action. It may be the most
important decision you will ever make.
Heart to Heart
A couple passed through our lives, and my wife noted with alarm the
total lack of even basic understanding between them. Recently joined,
they had come together through the usual (for here) contractual
arrangement - which they both understood and agreed to. But that was the
end of it. She had no understanding of who he was, what he did for a
living, etc., etc. She spoke no English at all, he no Thai. My wife was
perplexed. How could they possibly stay together?
First I recalled that one of the most thrilling moments of my life was
the first time I made love to a girl I couldn’t talk to. As a budding
intellectual, I had found it impossible to enter any relationship
without a great deal of soul searching discussion - which consistently
squelched the fires below and stopped any further progress.
And then by extension I hypothesized that perhaps, if you could somehow
magically endow all the ladies in Pattaya with a perfect command of the
English language, perhaps many of the Thai/farang encounters here would
never develop into relationships, and Pattaya’s (Thailand’s?) economy
would be significantly different.
Aren’t you the contentious one! Firstly let me deal with your “most
thrilling moments of my life was the first time I made love to a girl I
couldn’t talk to.” This made me wonder just what it was that you were
expecting from the deep and meaningless encounter? Germaine Greer
referred to events such as this as the “zipless four letter word meaning
intercourse and starting with F”. So what did you get? Personal
gratification that was slightly warmer than handing yourself the
solution, if you get my drift.
Your problems, where you felt you should have, and needed, a deep and
meaningful relationship which “consistently squelched the fires below
and stopped any further progress” to me smacks of repressed Calvinism,
with all the self-recriminations that went with attempting normal
relationships with the opposite sex. The parental tapes that said that
sex was somehow bad were coming forward, and to overcome this, you had
to put “meaning” into it. Forget simple lust. That was too much!
Now as to the hypothetical situation of all the ladies in Pattaya having
perfect English understanding and expression, and whether this would
stifle relationships - no, Petal, I think it would lead to even more
spurious relationships. The belles of the bounteous beer bars would be
even more skilful at extracting money for houses, gold chains and
motorcycles if they knew the right words to use, as well as the right
buttons to push! But I do agree that yes, the economy would be
significantly different. It would move even further upwards!
I have been trying to take your advice and look for female company away
from the bar scene, as I know how shallow and grasping those women can
be. So far all this has done is give me extreme frustration as I don’t
know how to approach your good girls. For example, there is one girl in
a display area in the Royal Garden who always smiles at me when I walk
past, but by the time I have got up enough courage to talk to her (and
I’ve heard her speak English, so that shouldn’t be a worry) there’s
customers there and I’m too embarrassed to just hang around. Then when I
decide to march right up to her the next day I find that her display has
moved, and I have to wait for a few days until she is back. Don’t tell
me to pretend to be a customer, because she sells shawls and stuff like
that that I’d never need. I get so depressed that I go back to the beer
bar, but the senseless chatter from the birds there is also depressing.
What do I do now, wise one. (Bubbly and chocs if it works!)
What is wrong with the young men of today? If you are embarrassed about
pretending to be a customer, don’t be! All you have to do is really
become a customer! Just because she sells shawls doesn’t mean that you
can’t be buying one for your aunt, or mother, my shrinking Petal. So
next time you see her in the shopping center, go right up like any other
customer would, and ask the price of her shawls. You don’t have to buy
that day, now do you. You can ask if she is in the center all that week.
You can ask does she get any time for a break, maybe she might like a
cup of coffee? She will soon tell you if she is willing to entertain the
idea of being entertained. Do that a few times and you will see if the
attraction you have for her is more than just physical, and whether she
is interested too. Relax! Even if she isn’t interested, it is not the
end of the world, and you just got some practice at talking to a woman
not from the bars. After all that good advice, please leave the champers
and chocolates with my secretary on the way out! Best of luck!
Camera Class by
where do you go to get a camera repaired in this country? Let me tell you right
off, that if it is an electronic and or digital that is out of warranty, it is
probably better to buy a new one! Sad, but true, I am afraid. We are in the age
of disposable technology.
Another sad but true is the fact that eventually all mechanical things must
fail, yet we expect our expensive cameras to last forever. This represents a
double standard worse than double pricing, because we are fooling ourselves in
OK, how do you look after your expensive investment? The first thing to remember
is that cameras are very delicate pieces of equipment. They have lots of moving
parts (shutters, apertures, film transport/wind on, LEDs, and a whole farmyard
full of pixels, etc.) plus expensive optical glass in the lenses, mirror system
and viewfinder, let alone all the fancy electronics, batteries and such. The
humble camera is not so humble these days.
Let’s start with the outside and clean it. Do not get the kitchen universal
“Spray ‘n Wipe” all purpose cleaner and spray liberally. The family that sprays
together doesn’t always stay together. With a clean soft brush (like a child’s
water colour paint brush, or a lady’s make-up brush) gently wipe the nooks and
crannies on the surface. Round the eye piece and all the little edges, and under
the knobs. Now dampen a cloth with plain water and gently rub it all over the
exterior of the camera body. By now, the camera should be looking like new again
– but we’ve hardly started!
The next item to deal with is the lens. Unscrew the lens and put the camera body
aside somewhere safe. With your soft brush gently dislodge any dirt and dust
from the lens barrel. What is really good here is one of the soft blower brushes
available in most camera shops for around 180 - 300 baht, depending on fancy
packaging and a little bottle of cleaner. Go for the brush only type - do not
use commercial camera cleaning fluid anywhere near your camera! Blow brush the
lens elements as well (front and rear).
Now with a very clean damp cloth gently clean both the front and rear surfaces
of the lens. Use a spiral motion to clean from the center to the edges. Use a
fresh piece of the cloth and give it one last swipe. Put the cleaned lens aside
Now let’s turn our attention to the camera body. This is where you have to put
in the majority of your time, and the ultimate care and attention. There are
certain things you must never do. Let’s look and note these first. You must
NEVER touch the mirror or the focussing screen with your fingers. Even to change
the focussing screen, you will be supplied with special tweezers by the
The other part of the camera that should never be touched with your fingers is
the shutter. This is a very delicate part of the workings and can be bent or
twisted very easily. The other DO NOT is oiling or spraying with CRC or other
similar lubricating fluids. Leave lubrication to the manufacturers agents or
camera repair shop only.
Now open up the back of the camera and clean the internals with the blower brush
again, taking particular care with the channels where the back fits in as it
closes. You are quite likely to find small particles of dust and dirt in the
cassette holder area, as this is the part you open up every time you change
film. The pressure plate inside the back has to be completely clean too, because
the film emulsion runs across it. Any dirt or grit there will leave a scratch on
The last area to check is the battery compartment. Again, a quick brush and blow
should be enough. Do not use the damp cloth in here. Finally, if you don’t know
how old the battery is – then change it for a new one.
Thanks to my photographic friend Ernie, I can also give you the name of what I
believe to be an honest repair shop in Bangkok. It is TK Camera Repair, 164/1
Sukhumvit Road 8, and is directly at the Nana BTS station on the left side of
Sukhumvit inbound. The manager’s name is Oddy.
Money Matters Graham
Macdonald MBMG International Ltd.
With the holiday season almost upon us, several clients
have asked what I think about travel insurance. To cut a long story short,
it is a must. For the sake of a few shekels (or whatever), it can save you
untold misery and expense.
GBP39 billion - that’s the value of Britain’s walking wealth. New research
from Zurich Insurance reveals that on a typical day, the average Briton has
an ‘on-the street’ value of £851 - the total worth of the clothes and
jewellery we wear, the gadgets that we carry and the other possessions we
take with us when we’re out and about. And, it is the women that are bathed
in the most riches, with a price tag of £904 compared to men, with just
£725. Professionals aged over 35, however, have the highest average ‘worth’
of £991, because of the designer watches, mobile phones, PDAs, laptops and
MP3 players they carry around with them, ramping up their worth.
However, the average man (and woman) on the street is also walking around
wearing and carrying expensive goods. More than one in 10 (12 percent) wear
a designer watch, and a similar number (8 percent) carry a laptop. One in
six (13 percent) have an iPod or MP3 player on them most days, and the
majority of us carry around a mobile phone - 84 percent. But being kitted
out with the latest gadgets could spell disaster. The Home Office’s British
Crime Survey 2006 concluded that the rise in people carrying mobile phones
and MP3 players was to blame for an eight percent increase in street
robberies and muggings last year. If it is happening in the UK then it will
New research from Halifax Travel Insurance shows that 7.2 million Brits have
had over £2.7 billion worth of items stolen while holidaying abroad in the
past five years. Worryingly, more than half, £1.5 billion worth of the
items, could not be claimed for, as the victim either had insufficient
travel insurance cover or did not have a policy at all. Apart from the
trauma involved - it takes an average of 2.25 days to resolve a crime from
start to finish - the financial implications are also significant with the
average loss totalling £375 per incident. Halifax’s research also reveals
that despite the sizeable average value of items stolen abroad, one in four
(25%) victims did not bother reporting the incident to foreign police. And
whilst 80% of holidaymakers say they are aware that a crime number or report
is required to validate any theft claim, 3.5 million holiday theft victims
(35%) still failed to obtain a crime number from the foreign authorities.
2.5 million Brits (20%) claim they are oblivious to this requirement. Of
those that did report the crime to the police, nearly half (44%) of Brits
found them to be unhelpful.
The majority (32%) of holiday theft incidents take place from inside the
victim’s accommodation; 13% of incidents occur on the street and a further
13% whilst the victim is relaxing by the pool or on the beach. Horrifically
1.4 million (11%) of travellers said their goods had been forcibly taken
from their person as they’d fallen victim to a mugging.
The majority (48%) of holiday thefts take place in Southern Europe; 18%
occur in Western Europe and 9% in Eastern Europe; Africa (7%) and Asia (6%)
complete the top five. Interestingly, Northern America only accounts for 5%
and Northern Europe 1%. Money is the most common item to be stolen abroad
followed by cameras and video equipment. Next comes clothes, jewellery and
credit/debit cards and mobile phones.
Travel insurance is a must and can be arranged on a single, multi-trip or
annual basis and should always include medical coverage unless it is already
a supplement to an existing healthcare plan such as that provided by William
Russell, JBI or BUPA, etc.
In general, Thailand is a safer place to be than most places in the West.
Crimes against tourists are relatively rare and minor, but like anywhere in
the world crime is present and sometimes tourists in Thailand are victims of
crime. There are certain areas that tourists should avoid when visiting
Separatist rebels who desire a Muslim state in the south are, allegedly,
behind a spate of bombings in the Narathiwat, Pattani, Songkhla and Yala
provinces. Also, Thailand’s borders with both Cambodia and Myanmar (Burma)
contain a volatile mixture of land mines, bandits, smugglers and rebels.
Several embassies and consulates have issued warnings stating that travel in
these areas should be approached with caution.
Bangkok, on the other hand, as long as the traveller observes the same
commonsense precautions he would in any of the world’s big cities, is
probably as safe as any big city gets. Tourists often remark that they feel
perfectly safe walking around Bangkok, even in the early hours of the
There are plenty of western conmen in Thailand who prey on tourists in order
stay on living here. Many have taken to the busy tourist areas with a myriad
of sob stories designed to lighten the weight of your wallet. Don’t be too
compassionate when approached by someone with a story similar to: “Excuse
me, mate... I was wondering if you could help me? I’ve just been robbed and
I need to borrow 100 baht to make a phone call back to the U.K.” Over the
years, crimes committed by westerners on westerners range from glorified
begging - like the example above - to muggings, rape and murder.
Bangkok is overrun with taxis, and whilst most Bangkok taxi drivers are
honest, there are others who are not. When attempting to catch a taxi at the
airport, travellers should avoid unlicensed taxis and only enter taxis from
the airport’s official taxi stand or go to the airport limousine counter and
hire a car and driver there. Unlicensed taxis and minibuses often overcharge
tourists for airport transfers and there have been several incidents over
the years of unlicensed taxi drivers robbing, assaulting, and murdering
Before signing on the dotted line always make sure you check:
- The small print
- Confirm you are covered in all areas of the world
- Sports injuries are included
Now, you can really enjoy your holiday!
The above data and research was compiled from sources believed to be
reliable. However, neither MBMG International Ltd nor its officers can accept
any liability for any errors or omissions in the above article nor bear any
responsibility for any losses achieved as a result of any actions taken or not
taken as a consequence of reading the above article. For more information please
contact Graham Macdonald on [email protected]