caring
i have three patients. the first one is this man in his early thirties with a huge rectal mass. the mass obstructs 95% of the rectum. his abdomen grows exponentially in size thanks to the "ascites" which is a complication of the cancer. he can't eat because his gut is obstructed. his stomach bleeds whenever he drinks the smallest amounts of water. he needs several blood transfusions, but he doesn't have enough money for all the processing fees. his brothers have no jobs. surgery refuses to touch him as long as he hasn't been "optimized" for surgery.
the next patient is a 69-year-old woman who has been in the hospital for 47 days. she has been hooked to a ventilator for more than a month. her severely malnourished frame seems inappropriate for her spunky attitude. she waves at me whenever i pass buy. we have conversations consisting of my questions and her wild gestures. they've been trying to wean her several times, but her muscles have become so weak that she can't breathe on her own. imagine, having to rely on a machine to do something as simple, but vital as breathing. it looks like she will be on ventilator support for a very long time - maybe for the rest of her life.
my last patient is 56-year-old woman who has breast cancer. she has been abandoned by her family. as her intern-in-charge, i go to the social service to beg for free labs, go from one administrative officer to the next to have papers signed, wheel her to radiology to have her x-ray taken, nebulize her when coughing becomes too difficult,beg her to eat her lunch, wipe the sweat off her face.
i've never cared for strangers. it exhausts me. but at the end of the day, after failing to answer my residents' questions, after forgetting to update my labflow sheet, after realizing that i suck at co-managing... i go to sleep knowing that i did something right.
for the first time in my entire life, i feel like i'm finally what i've always wanted to be - a doctor.
premature musing
a little more than 5 years ago, i looked in awe at the interns and residents scrambling about in the hospital. here i was, a student who knew nothing, among a sea of doctors saving lives. five years seemed so far off. but now, my five years are almost up. what have i learned?
1. that you should *always* put the name of the phlebotomist, time, and date of blood extraction on the label of your bloodtyping/crossmatching sample. always.
2. that when you push the standard metal stretcher, the "rotating" wheels should always be in the back. (you eventually figure this out in ob or trauma, whichever come first)
3. that you can write "to follow" on the abg request form if your patient's cbc result isn't in yet (or if you're too lazy to check).
4. that a chest x-ray, 12L ecg, cbc, crea/na/k/cl, urinalysis are free, but bun is 40 bucks, calcium is 20, abg is 85 and pt&ptt is 180 if you're class d.
5. that you should never touch, or heaven forbid, get, a patient's chart at 6 am, 2 pm and 10 pm... unless you want to face the wrath of a postduty nurse.
6. that you can get the pulse and respiratory rate while getting the blood pressure all in less than 10 seconds. (hay, trauma...)
7. that you should put sterile os on the site after inserting a line in a CI patient.
8. that renal, ids, cl psych and caap referrals require special forms which you can find at the renal office (6th floor), ids ofice (2nd floor of er complex), psych callroom (ward 7, submit before 3pm!) and central block pharmacy, respectively.
9. that all the tiny things that i thought were meaningless saved my patient's lives. that despite the silliness of #s 1-8, they allowed my patients to go home.
10. that i will miss class 2010 (plus plus) when we finally go our separate ways. :(
we have six months left. i feel like my life is on fastforward. i'm excited about graduation. i just... don't want this to end yet.
given the chance, i'd go through all of it again.
how i survived (and enjoyed) ob-gyne
yes, i enjoyed it - as hard it is to believe.
we came from community medicine, the most benign, duty-less, beach-filled rotation in the med school universe. to plunge head-first into ob-gyne - it's exact opposite - is... well, less than thrilling. but what was i to do, right?
it turns out ob *can* be fun. how?
first, get an awesome duty team. for us, it's not a choice. you're assigned groupmates. i was placed in team 3 with geno (someone i've never had a duty with) and joy (the most toxic person on earth second only to glai). needless to say, i was nervous. i'd gotten used to working with other people, namely mel, joseph, kathy, roan, reci, mamer, glai, etc. all of whom were no longer in my block. i never had a single duty with geno despite being his blockmate for 2 years. and joy was... toxic. and we all know that ob + toxic magnet = disaster. plus, we had a senior intern in our team, rj, someone i did not know at all, and a spanking-new batch of clerks: cheska, sara, bin, gen and mac. yikes, shifting dullness for all. but i was wrong. our combination was actually good. my three co-interns and five clerks were so much fun to be with that i actually *GASP* looked forward to duties. despite the toxicity of intubated patients, giant pregnant mommies with obesity 5 (harhar), simultaneously admitting 4 patients, fasting for 24 hours, running codes, i had a lot of fun because we were fun. ob became fun. and i owe it to them. :)
second, make lots of bloopers/jokes, and spend most of your time laughing at them. call a patient's name only to realize that you're screaming her address (i.e. "sino si bocaue, bulacan?"). realize that you're not getting any arterial blood because your palpation of the radial artery is actually compressing it. tell mommy to take off all her "accessories" (meaning jewelry, false teeth, hair clips/ties) before entering the labor room. congratulating your blockmate because "her" pregnancy test turned out positive. asking your patient 20 questions to figure which male intern interviewed her. maitim? maputi? mataba? payat? matangkad? may salamin? wala? gwapo (my fave)? sigh, and somehow, we always get it wrong in the end.
third, play around. dance to "nobody" each time your OOD's phone rings. sing cheesy karaoke songs while on labor watch. ride a wheelchair up and down the obas corridor just for the heck of it. substitute maroon 5 songs for the annoying bell when you get areas of reduced variability. stamp your co-intern's trodat on everything you can get your hands on. talk. always find time to talk about anything and everything, right joy?
fourth, eat. be it during a toxic obas duty, during a ward duty (where we ALWAYS eat lunch, dinner and midnight snacks together), or lrdr duty, we find time to stuff ourselves. never again will we go on a 24-hour fast. ugh.
fifth, make new (and old) friends. i made eight. and even if we've gone our separate ways, we still find time to talk/text/visit.
the jolly clerks: mac, bin, sara, gen, cheska
kulit interns: rj, joy, geno, tara (me!)
thanks guys. you made ob a hell of an experience. shift-out party, anyone? ;)
24-hour fasting blood glucose
a year ago, i had the worst duty of my young life (in the OB LRDR) where we had 40+ admissions. we had all stopped counting how many patients were decked to each of us. my co-clerks and interns were already screaming in insanity inside the delivery room. the residents didn’t even bother scolding us because they were screaming too, or singing out loud while dancing. i thought nothing could be worse than that duty.
clearly, that was nothing.
come august 14, 2009. the obas duty team consisted of residents dr. lopez and dr. tan, clerks gen and cheska, interns rj, geno, joy, and me. the morning started with non-stop charting because, as we all know, the philippines never runs out of pregnant patients. and incidentally, all of them want to deliver at pgh. *eyeroll* anyway, it was way past lunchtime, the interns stomach’s were growling, and the patients kept coming. “no prob,” i thought. i’ve survived duties without lunch. so I kept charting, my patience i carefully nurtured since commed slowly dissipating in the steaming, thick atmosphere of the OBAS. i kept running back and forth from the labs (circulating!) when i wasn’t charting. by 7 pm, I was already starving, but guess what? more pregnant patients! “guys, kaya natin ‘to!” encouraged geno. then with a sarcastic tone, he reminded, “nangangalahati na tayo.” kalahati pa lang?! eh parang isang taon na akong nandito! sheeeeeeeeeet…
it was a few hours past midnight when i was asked to push a stretcher bearing two huge, pregnant mommies to the imu for tracing. rj gently scolded me for not calling their bantay to help me. oo nga no? sorry boss, mabagal na utak ko nun. hehe. then, more mommies to push and trace for the conduction intern/clerk (ako yun from 1:00 to 6:59 AM). the clerks still haven’t eaten dinner. the interns were running on energy from God knows where because we were still lunch/dinner/snack-less. an intubated patient coded. i did cpr with what little energy i had left. geno looked like he was about to code next. joy squirted blood and ETA on the nurse due to vigorous chest compressing. wahehehe. panalo ka ate. a myasthenia gravis patient in crisis, 18 weeks pregnant was intubated in the OBAS. i still can’t figure out why she was with us and not neuro. my ACR apparently agrees.
5 AM: i still had a handful of mommies to trace. i haven’t had a wink of sleep. my stomach contents were a bottle of c2 and hydrochloric acid. the other interns were still charting. i was silently repeating my mantra: ilang oras na lang…
it was 7 AM and the duty team was still missing. people from inside were calling for the circulating clerk/intern. “sorry kids, post-duty na kami!” we called back, very much drained thanks to 24 hours of torture. i still had to do my IMU admission’s papers and referrals. i arrived at the unit at 9 AM, still hungry (my last meal was 6 AM the previous day), sleepy and oh so stinky. sleepy won out. i collapsed on my bed, dead to the world.
highlights:
1. dr. lopez: nasan na yung mga interns? clerks? bakit wala na akong mautusan?!
intern tara: si cheska po, nasa OR. si gen, nagdala sa perinat. si rj, nag-run ng abg. si joy, nag-conduct. si geno, may pasyente. sir, papunta po ako sa labs ngayon so wala na pong matitira sa OBAS. na-stress si sir. inubos ng buntis ang duty team!
2. tara's ranting
tara (pissed): ang ayaw sa reproductive health bill, ipag-duty natin ng 24 hours sa OBAS. tingnan natin kung hindi magbago isip nila!
dale: *lol*
3. on distinguishing between the two boys
patient 1: lalaki po yung tumingin sa akin.
tara: sino dun? yung maitim o maputi?
patient 1: yung maitim po.
tara + joy: genoooooooo…
patient 2: “hinahanap ko po yung duktor. yung lalaki.”
joy: “alin dun?” (dalawa kasi sila, si geno at si rj.)
patient: “yung ano… gwapo.”
joy: iniisip na si geno siguro yun. “siya ba?” sabay turo kay geno.
patient: “hindi. yung naka-salamin.”
sorry dude, ikaw pala yung hindi gwapo sa duty team natin. bwahahaha!
wasak ang duty team!
[l-r: int. tara (yung masungit), int. joy (yung maliit), int. geno (yung maitim/yung walang bigote/yung hindi gwapo), missing-in-action, senior int. rj (yung maputi/yung may bigote/yung gwapo)] wahahaha! wards na ulit tayo!
how to save a life
step one: make friends with that adorable little girl with portal hypertension. play fishing, make play-doh food, watch over her while trying to overlook the fact that in a few years, months, her liver will fail her. that her promising life will be cut short, and all you can do is give her happy memories of ward 9.
step two: waive ABGs everyday for a 4-month-old permanently on ventilator support because he can never breathe on his own. listen to his irritating mother unload (i mean it, she gets on everyone's nerves) while monitoring all the q1 and q2 patients because you admire her genuine concern for her baby. because once you get past her constant questioning of how you're managing your patient, you realize that she's losing hope. she has done everything in her power (and ours) to pay for the ventilator, procure all the anibiotics and seizure meds, make sure the labs are done. she says she will never give up on her child, but on mother's day, she was crying softly, saying over and over how hard everything was.
step three: steel yourself as you are left alone in the nursery obas late in the evening with a pre-term twin gestation (with an fdu second twin) on the way. try hard not to panic as you tell your resident over the phone that you have to go because the mother suddenly delivered in the labor room, and that the baby is being brought to the nursery as you speak. try hard not to cry as the baby is placed in front of you - bradycardic, not crying, not moving. try hard not to panic despite the fact that no amount of thermoregulation, tactile stimulation and suctioning will get this baby to cry. remember your resident telling you that bagging the patient is the best you can do if you cannot intubate. heave a huge sigh in relief as the baby starts wailing after bagging.
i'm barely a month into internship, and i feel like so much has happened. thank You, Lord, for never leaving my side.
sa lahat ng mahilig sa labsong at drama
“hindi ko gets bakit si ely ang pinagkakaguluhan ng mga babae. personally, mas type ko si buddy.” the words spontaneously slipped past my mouth without much thought as the camera panned showing screaming eheads fans holding up signs proclaiming their love for the band’s frontman. i was watching the eraserheads reunion concert on dvd thanks to my generous cousins one night.
watching the concert was like a time machine bringing me more than a decade back to the time of black doc martens, social awkwardness, sweet valley books and superior rock OPM music (sorry kids, it’s true). the eheads were always famous for their controversial but equally relatable lyrics, and melodies that tend to get stuck in your head, with good reason, of course. for me, i always loved how each song is able to tell a story - from the cutesy but sad “tindahan ni aling nena,” to the nostalgic “minsan,” to me personal favorite, the tragic “ang huling el bimbo.” i’ve yet to see a current pinoy band that can come close to what the eheads has done to OPM.
missing both reunion concerts was horrible. who knows when the next reunion will be? never, most probably. my last chance to listen to my favorite band sacrificed for wards 9, 11, 3 and 1. *grumble* oo, duty ako sa pedia at IM noon. on the plus side, watching the video satisfied me to some extent. when i concentrated hard enough, i fooled myself into believing i was among the sweaty crowd, singing along to every song they’d dish out, jumping like a crazed person to ely’s command. insanity FTW. -_-;
apparently, i’m not the only one who thinks that buddy should get more love from the fans. my cousin prefers him too. maybe it’s the clean look? the fact that he plays bass? another cousin justified that “gumugwapo ang lalaki pag kumakanta.” does that mean team ely siya? touché. pero mas type ko pa rin si buddy!
big yellow taxi
three years ago, at exactly 5 pm, classes would end, and i’d be free to go home. i could spend the rest of the night studying (like a good girl), eating (studying makes me hungry), watching TV (my favorite form of rebellion), socializing (just to prove that i have a life), or sleeping. all my weekends were free. i *always* went home to QC because no matter how toxic med freshies were, weekends were always ours.
second year came, and things started to get a little more complicated. exams took place weekly. readings quadrupled in volume (and mass?). gimiks with classmates became less frequent. i stopped going to diliman to see my UPIS friends. i started to stay up late every single night just to barely pass all those exams. by then, i was seriously doubting continuing. if things only got harder from then on, why should i even bother?
as the years passed, i found myself sacrificing more. i only had half of weekend days free; but in the strictest sense, we’d still be in the hospital on a Sunday afternoon because we *never* finish our work before 12. there were times when i’d be miserable in the hospital thinking how i'd give anything to be back at home with my family, eating my mom’s cooking, playing with my dogs and catching up with mik. i'd miss family parties (i was the only one who was always absent). every third day was spent in the hospital – weekends included. post-duty days were dedicated to sleep (because seriously, you’d be too exhausted to think about doing anything else). meals became optional, especially during the toxic rotations. precious free time was spent studying to avoid being humiliated to the consultant/fellow/resident/nurse/patient/patient’s family. not that it does much because it still happens. in medicine, you learn that no matter how much you read, you will always know less than everyone else. i’d miss church services to finish clinical abstracts and discharge summaries. i’d skip org meetings to research for SGDs or to finish my “clerk responsibilities.” my friendships with some people started to deteriorate with me realizing only months too late. i am becoming a doctor, yes, but i feel like i’m also turning into a horrible person.
where is the tara i used to be? the girl who would drop everything to answer to a friend in need? the girl who would always have time for music? the girl who loved to write whether it be on a blog, on paper or in the mind? the girl who would never end a day without praying? the girl who always had time for family? i feel like i’m losing more of myself day after day. i have one more year of med school – internship. how much more do i have to sacrifice to become *that* something i’ve always dreamed of? how much of myself do i have to give up to earn the right to heal? is it still worth it? is this what i really want?
don’t it always seem to go that you don’t know what you got ‘til it’s gone?
i paved paradise, and put up a parking lot. i don’t blame medicine. i chose to do this. this is my fault. i can only blame myself.
