Spontaneous lachrymation

Don't know why

lately, I have had recurrent episodes of spontaneous and involuntary lachrymation.

# I have voluntarily not been in a relationship for a year.

# My financial status is stable and secured from the inflation and globalized economic depression.

# My work is pretty boring but there's no conflicts nor any pressures from work, my work is easy.

# My mom and dad are doing just fine.

# No family/social conflicts.

Is it loneliness?

Or is it involuntary celibacy?

Yesterday, while I was watching "The sum of us" the part when "Dad" had a sudden hemiplegic, motor aphasia stroke, I just burst out crying into a fresh flood of tears for almost half an hour without any obvious certain emotional or physical stimuli.

No certain situations nor any physical/emotional stress at all.

Well it might be one of my subconscious conflicts or stress I didn't recognize that gave me this "emotional tears".

I don't try to find the medical or scientific explanation for this.

I don't use Freudian psychoanalysis to find this underlying conflicts or their resolutions. 

But I just happened to know it.

Tears have been categorized into 3 groups

1. Basal tears

2. Reflex tears

3. Emotional tears

1. Basal tears for lubricating the cornea and keep it clear of dust

2. Reflex tears are secondary to an irritation from the foreign body or chemical, e.g., onion, dust, eyelashes, mascara etc.

3. Emotional tears or crying are a result of emotional stress or physical pain, are a complex process of frontal/temporal cerebral cortex and a limbic brain and contain many hormones, e.g., ACTH, prolactin, enkephalin. 

Us humans seem to be the only mammal that are capable of crying. I do believe that crying plays a major role in the subtle physiologic/neurobiologic and psychologic processes of compromising and optimizing the emotional/psychological conflicts and pain so that we can live in this so-called "complex evolutionary primate social system".

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The last time I had an emotional cry was back in the October2007 when I broke up with "B".

It's been 12 months

This must be a serious sign of emotional/mood disturbance.

     

     [Id]

     [Ego]

     [Superego]

Id  = childish/basic instincts/ur needs

Ego = you try to optimize them[id&superego]

Superego = ur moral/ethics/ur values

Id  = child

Ego = teenage

Superego = grownup

Id  = amygdala/limbic primitive brain

Ego = mix of id&superego conflicts

Superego = frontal cortex of cerebrum

Id  = I "want"

Ego = Well "Let's see what I can do"

Superego = I "need"

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This might be the cross road that you have to choose which way to go.

[A single = Loneliness] 

or

[A couple = Heartache]

No way we can deny both of these.

Only one of these two ways

[A] Single : loneliness

    focus to the work

    residency training means "NO LOVE"

    neurosurgery training is possible

    be able to work on a research "acute nervous tissue injury"

    "deep brain stimulation"

    "neurobiology"

    "nervous tissue"

    "brain tumor"

    no love, no relationship

    dried up

    

    

[B] Couple : heartache

    relationship ends with either leaving or dying

    being in a relationship is tiring

    less than 7% of the relationship lasts more than 7 years

    more than 90% of avians(birds) are monogamous

    less than 7% of mammals are monogamous

    less than 1% of male animals are monogamous

    love and life is totally an investment

    being "in love" is like an investment in 

        a stock/futures markets : high risk/high payoff

    being single is like an investment in the government bonds

        low risk/low payoff

    simply love equates sex, intimacy and neurotransmissions

        [oxytocin/dopamine/vasopressin]

    I still cannot buy an insurance for love accident 

        in the year 2008

    

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I am too lonely, distorted and scared to let myself falling in love.

It's like I had a motorcycle accident and it makes me too scared to drive a motorcycle again.

It's also as horrible as a "PTSD" (Post-traumatic stress disorder) that every veteran has to face.

I have an insight.

I need help.

Containment of conflicts between "id" and "superego"

I need to use only good defense mechanisms

[suppression]

[altruism]

[sublimation]

[humor]

[realistic plan for future discomfort]

or

Simply I just need to get laid. That's all.

The Dark side of me

The fact is that we cannot see 

the other side of the moon with our naked eyes and a telescope.

A "Man" is like the moon, you'll only see his bright side 

and never see the dark side of him.

The moon becomes so bright and amazingly beautiful only when it's the darkest night.

So "love from me" is like the moonlight in the cold and darkest night, 

it is so beautiful that you cannot resist.

I will come and go once in a while.

You will only get "love from me" only if u're not scared of the darkness and 

not too weary to be in the cold night.

You might get tumbled, 

you might get lonely, 

you might get hurt, 

you might cry or 

you might even lose all your faith in love.

But the truth is

You are like a moth to a flame.

Only you are to blame.

You go straight to me.

To have and not to hold

To love but not to keep

To look but not to see

To kiss but never be

To be with me

The iceberg of Malpractice

 

คดีที่พิพากษาแล้วว่าเป็น 

"malpractice"

ลองพิจารณาดู 

iceberg modelง่ายๆกัน 

[Clinical vignette]

case "epistaxis BP 230/120 ยังรู้เรื่องอยู่"  จนต่อมาอีก 15 นาที >>> arrest ในER : asystole no pulse ...พยาบาลตามมาดูcase 4  ครั้ง แล้วมาช้า  และ   พอมาถึงER ให้ atropine ไปทั้งหมด 5 amp + CPR ตามเรื่องตามราวไป สุดท้ายตาย ญาติไม่พอใจ จึงวีนกันในER 
 
>>>  malpractice ชัวร์ๆ เพราะ มีหลักฐานทั้ง ประจักษ์พยาบาล(ประจักษ์พยาน) และ nurse note ...ผิด 100 % 
>>> ดู iceberg model ของ contributing factors of malpractice ง่ายๆตามนี้  
 
10% >>> อยู่เหนือน้ำและเราเห็นว่าเค้าผิด 
90% >>> อยู่ใต้น้ำ เรามองไม่เห็น 
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10% = หมอมาช้า,  หมอให้atropine ทั้งที่ไม่มี pulse และให้ตั้ง 5 amp [ให้ 5 amp นั้นผิด, ถ้าผู้ป่วยรอดก็คงตายจาก atropine 5 amp เนี้ยแหละ], พยาบาลตาม 4 รอบแล้ว, ด่าพยาบาลด้วย 
 
90% = case malpracticeที่ศาลตัดสินแล้วทั้งในและต่างประเทศ มักอาจจะมี underlying factor ที่ส่งผลทำให้เกิด malpractice เช่น 
 
     A. อยู่เวรมา 48 ชม แล้ว 
 
     B. การเป็นinternเมื่อ 8 ปีก่อน ทำให้หมอเค้ากลายเป็นคนใจร้อน  ขี้หงุดหงิด  วีนแตกได้ง่าย ไรงี้จากเมื่อก่อนติ๋มๆ ใจเย็น ทำบุญ ปล่อยวาง ไม่ใจร้อน 
 
     C. 6 วันก่อน แฟนบอกเลิก  เพราะ ทะเลาะกันบ่อย  อยู่ไกลกัน 600 km 
 
     D. เป็น sinusitis มา 1 อาทิตย์แล้ว 
 
     E. โดนญาติคนไข้เด็กด่า / ต่อว่ามาก่อนเมื่อกี้ : "หมอห่าอะไรแมร่ง ไม่ดูคนไข้เลย ลูกฉันโดนงูกัดมา  ไม่เห็นทำห่าไรให้เลย เซรุ่มแแก้พิษงูอ่ะ  หมอไม่รู้จักใช่มั๊ย  ส่งสัยท่าทางจะจบหมอมาจากเขมรแน่ๆ  กลับไปเป็นหมอเขมรดีกว่านะ แค่เซรุ่มแก้พิษงูยังไม่รู้จัก" 
 
     G. หมออึอยู่ ท้องเสีย ตั้งแต่เมื่อคืน + moderate dehydration  pulse 110/min แต่ต้องอยู่รับเวรเพราะต้อง ผ่อนรถและคอนโด 
     

     H. ไม่มีเวลาส่วนตัวเหลือในการทบทวนความรู้ เช่น เรื่องmanagementใน hypertensive crisis / ACLS 
 
     I. เมื่อเช้าขับรถมาอยู่เวร(วันอาทิตย์)>>>  โดนปาดหน้า + roadrage = claimประกัน >>> หงุดหงิดตั้งแต่round caseแรกเลย 
 

     
underlying factor 90%>>>

physical stress

psychological stress

social/financial stress

spiritual deprivation 
 
สรุป คือ underlying factors ในแต่ละ "malpractice case" ก็มีมากน้อยต่างกัน   และอาจจะฟังดูเป็นข้ออ้างซะมากกว่ารึเปล่า?

 
ผิดหน่ะผิดจริงๆ>>>  แล้วพวกเราเองเห็นใจกันบ้างมั๊ย? ถ้าหากว่าเราเป็นเพื่อนสนิทเค้า อยู่โรงบาลเดียวกัน รู้นิสัยกัน  รู้ความเป็นไปของเพื่อนเรา  ผมว่าน่าเห็นใจมากกว่านะครับ 
 
[ญาติคนไข้ถามว่า  "แล้วไงจะไม่ชดเชยอะไรเลยใช่มั๊ย"]

malpractice ควรไปจบที่ 

"เงินชดเชยให้ผู้ที่เสียหายจากการรับบริการทางการแพทย์" 

  

ไม่ใช่ไปจบที่การฟ้องร้อง 

 ไม่ใช่ไปจบที่ ศาลอาญา 

 ไม่ใช่จบด้วยการฟ้องแพ่งแบบไม่มีขีดจำกัด 

เพื่อให้ระบบบริการสุขภาพไม่แย่และแบกรับ pressure ไปมากกว่านี้

  

การกล่าวขอโทษผู้ป่วย และ ญาติ + ยอมรับว่าผิดพลาด + ให้เงินชดเชย = น่าจะดีกว่า 

 

เพื่อหลีกเลี่ยงการเติบโตของmedical hub และ defensive medicine (ซึ่งทำให้ระบบบริการสุขภาพแย่ลงเร็วขึ้นโดยภาพรวม) 

 

 

ผมคิดว่า> 98%(คิดเอาเอง) ของ malpractice case>>> มันต่างจากคดีอาญา ที่มีผู้ได้รับความเสียหาย +เจตนาของจำเลย 

 

หมอในmalpractice case ไม่มีเจตนาโดยตรงจะทำให้เกิด malpractice 

(หมอไม่ใช่มือปืน หรือ พวกเมาแล้วขับชนคนตาย) 

 

แต่ถ้าแบบทำเป็นธุรกิจ เช่น ดูดไขมัน ทำแท้ง ฉีดglutathione  หรือ คลินิกเสริมความงามแปลกๆแถวดอนเมือง  ไร้งี้ก็ฟ้องไปเลย ไม่ต้องไปคำนึงถึงunderlying factorsอื่นๆ

The avant-garde pinheads

This will be the last political article in this blog. I am not interested in the politics but I have seen these avant-garde pinheads for yrs and the western avant-garde activists also.

Thai PAD(People's alliance for Demon"crazy") street protesters and civil disobedience are just a hype / propaganda... and not truly based on the essence of Individualism / Non-Violent Gandhi and Democracy. (Government sucks, I know, and the Prime minister should resign or at least he should dissolve the House.)

The Govt has been nothing but just a failure simply resembles the authoritarian-3rd world-Ferdinand-Marcos-former-Philippine-Government.

Thai people should become more individualistic and independent. 

Thai people should read more books and look for the fact themselves... the mass media and the Thai press are stupid... both the pro- and anti-govt, i.e., NBT and ASTV.

Thai people have an issue in gaining self-esteem, judgement, proper way of making a political devotion.

If the Thai police were the white blood cells and 

the judiciary power of Thailand were the reticuloendothelial system and thymus...

then, by now, Thailand would have had a full-blown AIDS

and it just doesn't know how to deal with this condition.

Because of poor infrastructure, weak economic / patronage system / "mai pen rai"way 

of living and the failure of the executive & legislative power, which resemble the rest of the body system.

This is like "The Domino effect" & "The Vicious cycle" of all the system of the Body.

e.g. 

renal failure >>> hyperkalemia >>> Vfib >>> poor cardiac output >>> anoxic brain injury / renal failure ... and so on til death from cardiac arrest

renal failure >>> salt & water retention >>> pulmonary congestion >>> left-sided heart failure >>> poor tissue oxygenation / cardiac arrest >>> death

HIV infection >>> AIDS >>> systemic infection >>> systemic failure / MOF(multi-organ failure like Dominos)

Thailand has been under a paroxysmal political turmoil for the past 5 decades.

It's the results of the MULTI-system failure, i.e., 

1. educational system failure

2. health system failure

3. weird social values

4. relative judiciary failure

5. lack of art appreciation

6. no harmony in life/family

7. FAMILY FAILURE

8. copying all the modern western world architecture and sociology/philosophy without appropriate adaptation and proper application to the country in the past 150 years.

9. weird patronage system

10. economic failure >>> it's not the matter of "24/7 way of the Americans" but it's all because of the lack of team work, innovations, researches and "mai pen rai" way of life.

11. DEPENDENCE

12. Thai people are always dependent on the complex and stupid social hierarchy / family support / govt / "Pu Yai" / anti-avant-garde bourgeoisie.

13. Stupid Press

14. GOVERNMENT FAILURE

This country ever has RULES & REGULATIONS ???

The street protesters and civil disobedience are a result of GOVERNMENT failure.

But the way the PAD / protesters act is also uncivilized and weird/inappropriate.

The way of the PAD/street protesters are absolutely not the way of Mohandas Gandhi / anti-apartheid Nelson Mandela.

Most of this PAD are the result of the so-called "FAMILY FAILURE".

Some of them have low self-esteem and need something to cling to... that's why most of them want to become a part of this "HYPE" / "PROPAGANDA" (I realize that the GOVT sucks)

Though they are like the "wild teenagers" or "avant-garde pinheads" but still... their core essence is interesting and good for the turning point of Thai politics.

Their goal is crucial and civilized, but the way they act is so uncivilized and desperate.

Quote from Martin Luther King

"Christ gave us the goals and Mahatma Gandhi the tactics"

The PAD protesters just DO NEED the Gandhi tactics even though it will be a long and tiring way to go but it is just simply better.

A sample scenario : what if your son had been kidnapped and murdered... you and the press know who did it

but the judge and jury found him "NOT GUILTY"

What would you do next?

A. Vigilante

B. Do it in the forensic pathology way >>> look for more of the forensic evidences and prosecute him again.

----------------------------------------------------------

A. Vigilante is fast & easy, not complicated, suitable for the third world countries and usually happened in the uncivilized society. An eye for an eye... satisfactory outcome is guaranteed.

B. Forensic pathology is time-consuming and can not guarantee the "layman GUILTY verdict", suitable for the developed / civilized countries but satisfactory outcome is not guaranteed.

By the way The GOP protesters at the RNC this morning are far off aggressive than the Thai's.

Keywords

Thailand political turmoil.

Thai political turmoil.

Thai politics.

Liberal west

Thailand committed suicide this morning Aug 26, 2008 declaring the state of emergency

and the world is watching through CNN / Fox / BBC... we should not stand for what we believe in, especially if we're in Thailand.

We should be quiet, shut-the-....-up,

dependent, dull & ordinary if we're still in Thailand.

Thai people don't speak out ... 

they just don't stand for what they believe in.

After watching Saturday Night Live from New York making fun of liar Hillary 

and a receding hair-line and hair transplant of Delaware Senator Biden... 

and BBC / Fox /CNN, though it's all about the personality/physical flaws of the politicians and should not have become an issue in the news, 

but at least it showed that the western-world press has freedom of speech 

and the Americans can do anything they want or show / speak or stand for what they believe in under the same non-double-standard rules&regulations / law and constitutions,

I realized that Thailand is nothing but ...

The Thai press was always requested not to publish blah blah blah. 

"This is a delicate issue and we don't want the public to know much about it." 

Thai press is useless in helping in developing this country.

We, the liberals, should just focus to our family/finacial/work plans and go west.

We will go our way, we will leave someday.

Your hand in my hands, we will make our plans

We will fly so high... tell all our friends goodbye

We will start life new... this is what we'll do

Life is peaceful there... in the open air...where the skies are blue

This is what we're gonna do

To whatever it is attributed, I go for "this song is all about the peaceful west".

Can't wait to live in a beautiful lake house in Minnesota.