1Q84 by Haruki Murakami

I never thought there is such a thing as book trailer. Well, this is it. One of my favorite author's latest. I saw the book at Powerbooks earlier today. It's hardbound and kinda pricey so I thought I could wait for the paperback. :) But friends, it's not yet too late for my birthday gift! *wink*

Taft Avenue

I grew up in a healthy environment where people opt to walk from their homes to their offices or schools. It would only take us 5-10 minutes to reach our destinations. We don't have heavy traffic to blame for our tardiness because we live inside the Mindanao State University Main Campus. I have developed the love for walking out of necessity. Even after we purchased our family car, my father didn't send us to school on wheels unless there's a typhoon that inhibits us to trudge our way to school. Back then, my siblings and I would hope for a heavy rain either in the morning or in the afternoon so that our father would be left without a choice but to drive us to or from school. :) 

I used to walk with my friends. It was during those times that we discuss about our day, our sheer hopes and building our dreams. We were a bunch of teenagers who can leave a household flustered with our boisterous laughter and giggles as we pass our way from 4th street all the way to our homes. Since I live at the farthest street (8th), I was the last person to reach home. I was the only one among my girls who's left walking alone. I loved those solitary moments as I muse about the forces that create my world. As I pace towards home, I recapitulate the day and plan for the following day. 

Here in the metro, walking from my home to the hospital is like a punishment. Our building faces Taft Avenue so this should have my normal route towards PGH. I do not expect my fresh fragrance to be preserved when I pass by these:

This scene is not just a pain in the eyes but also an irritation to the nose!!! Mixed stench of dried urine, dirty canal and all possible human waste you can think of!!!

Ooopss! Ate caught me taking a shot at her! 

All kinds of pollution are present here. 

So there, ladies and gentlemen. Welcome to the Philippines. 

Since I cannot do anything about the perennial problem our country have, first I must accept that I LIVE IN THE PHILIPPINES and second I need to find a way to avoid the situation. Thanks to the existence of UP Manila (Pedro Gil street) beside PGH. UP Campus has become my regular route towards the hospital. Calm, cool, less pollution. 

I regained my love for walking. I didn't really mind about my toned gastrocnemius. :) 

Conversations at the interns' call room can go like this:

Scene 1

Intern1: O kamusta na patient mo?

Intern 2: E4V1M1 (referring to Glasgow Coma Scale of 6, which means that the patient has spontaneous eye opening but no more verbal output or body movements)

Intern 3: Uy, siguraduhin mo yan ah! Dahil ang patay, E4V1M1 din! Diba? Yung mga namamatay na dilat ang mata?

Everybody laughs. 

Scene 2

Intern 1: Oh my God, nagto-toxic na mga patients namin! Nagmo-morb na sila! (morb stands for morbidity, either intubated or cardioverted)

Intern 2: Naku, i-mort niyo na yan lahat. Wag niyo nang paabutin sa duty namin bukas! (mort or mortality, means dead). 


Do not judge. There's nothing really as "ideal". 

Love Actually----Hospital Setting

If you remember the movie “Love Actually”, the opening scene was at an airport where, as the narrator says, the most sincere kind of love can be perceived. There’s more to that----the hospital. I have been rotating for three weeks in Internal Medicine and never did I see such form of sincere love as that of the love I have seen among my patients and their family members—fathers, mothers, sisters, brothers, husbands and children. 

Patient A.M. is a 48 year old female, married with one child, and was diagnosed to have colon cancer earlier this year. She underwent colon resection and had been on six cycles of chemotherapy until three months ago when a palpable mass was noted in her abdomen. The mass have been growing gradually and was seen by her medical oncologist but they cannot rule out whether the mass was a primary growth or a metastasis from her previous colon malignancy. On my first week of rotation, November 4 to be exact, she was admitted at the ER due to “agitation”. She was restless and agitated, shouting at her husband and her brother who accompanied them to PGH. The physician on duty considered the increased levels of toxins in her body as a cause of her behavioral changes (uremic encephalopathy), that’s why she was admitted under our service. Apparently, her abdominopelvic mass impinges on both of her ureters which causes her minimal urine output, hence, accumulation of toxins in her body. She underwent series of hemodialysis and marked improvement of her sensorium was noted. She was herself again. We referred her to different services such as OB-GYN, Med Onco, Urology and General Surgery for possible intervention to relieve her of her symptoms. Laboratory work ups were done, her abdominal CT scan showed an ovarian new growth which obstructed the pathway of her urine that led to chronic kidney failure resulting to all her symptoms. Since we have treated the encephalopathy, we were contemplating on transferring her to other services particularly the GYN-Oncology. While waiting for the response of other services, I visit her everyday at her bedside to ask on the progress or relief of her symptoms. Her husband and her brother were always there too while I pass by for a quick chitchat, they never failed to meet my patient’s needs. What I appreciated most was that they were very aggressive; they comply with ALL the laboratories we request no matter how costly it would seem for them. I never had any difficulty facilitating her labs because the husband and the brother were always on the go. She was my patient for more than two weeks and despite the asymmetry of her face caused by congenital neck muscular problem (torticollis), she’s always ready for a warm smile as she slowly raises her hand to wave at me. I always feel important whenever I visit her because she stops whatever she does saying “Uy, ayan na si doktora”. She always tells me how she feels about her illness, her high hopes and her fears. While I can only offer my listening ears and an occasional light encouraging rub on her back, she would usually hold my hand tight while she complains how awful she feels about her edematous feet and her abdominal mass which frequently cause her pain. 

After more than two weeks, her encephalopathy had resolved, all labs were done, the decision now lies in the hands of OB-GYN. They did a transvaginal and abdominal ultrasound and saw the strongly adherent mass on the abdominal wall, it would be a difficult operation and the result may be unfavorable, the OB-GYN senior resident said. They can only do mass debulking and staging, which, obviously is already stage 4. They presented the option to the patient, they can do mass debulking followed by chemotherapy but the prognosis is still bad, OR we refer them to the Hospice for counseling and terminal illness care. After a lengthy discussion among the family, they decided to just do home care. My patient was crying while she was telling me “Doktora, hindi na raw ako gagaling. Wala rin namang mangyayari, gagastos pa kami. Uuwi na lang po kami”. I do not know what sympathizing words to say. I only stood beside her and held her hand tightly, trying to utter comforting words (of which, I am very bad at) and reminded her how lucky she is that her husband and her brother never left her side. I reminded her of the love her husband had shown and given her. That, I said, makes her the luckiest person on earth because despite her illness, she was loved sincerely by her family. 

They already went home yesterday, and because I got so very busy at the other ward tending to another dying patient, I lacked time visiting her. Besides, I suck at goodbyes and I hate being attached to patients because it’s not just right for people like us who see dying and hopeless people every single day. But with this patient, it’s different. I noticed her empty bed on my way to the interns’ callroom and felt a pinch in my heart. I had many unsaid goodbyes in the past and this patient is an addition to my semi-regrets. Suddenly, I heard her brother calling me asking where he can possibly find the Nephro Fellow who attended to them. I asked the whereabouts of my patient and told me she was at the ambulance outside. I hurriedly ran outside, saw the parked ambulance and peeped behind the green curtain. Her husband swung open the back door and saw my patient lying on the stretcher while weeping and saying “Doktora, hindi ko po kayo makakalimutan. Maraming salamat po.” I jokingly told her not to cry because she got me teary-eyed as well. I pacified her by telling her to have her picture taken with me using my mobile phone. Her torticollis made her unable to smile normally but she still attempted to give me a good one. 

I will never forget this patient and her family who stood by her from the beginning all the way until all the possible means were exhausted. Through her husband, I saw the picture of what true love is. I can only pray that he will never get tired of taking care of her until the very end. There may not be a cure for her disease but when the time comes that she has to leave this world, I know that her heart is full of love and contentment by what her family has given her. That, for me, is true love.

Photo with my patient inside the ambulance right before they went home against medical advise.  

11.11.11

What to do on a postduty Friday night that corresponds to a date deemed astrologically important? 

DINNER with Friends! 

At Martabak (Malay-Indo resto) with (l-r) Rox, Jay-jay, Sam (na mukhang tanga in this photo!), Isaw, moi, and Jehan

 Post-birthday dessert treat at Chocolat [sho-ko-lah], named derived from Johny Depp's movie under the same title. We had loads of chocolate maple cake, chocolate hazelnut, New York cheesecake, chocolate carrot cake and tiramisu. 

Tell me a girl who doesn’t love chocolates and I will tell her what she’s been missing!

**********

While strolling around, I passed by at Regalong Pambahay and found these super nice stuff! They can be make-up or jewelry boxes that came in Eiffel prints! So cute! Kinda costly so I didn't buy. I so want it! :'(

Skin Food and The Face Shop

Pat, my co-intern whose mother just came back from Seoul with lots of freebies from Skin Food and The Face Shop generously gave all these to me! Apparently, the price cuts half when you buy it there compared here in the Philippines. Because I am yet to become a globe-trotter (ahem!), I have no means of buying Korean beauty products there. I might as well endure the price or just resort to NOT buying at all. Haha! And because I'm a free loader, I accept blessings from other people. 

 I have only tried Skin Food’s Egg White Pore Foam and The Face Shop’s The Smim Toner and Emulsion yet and I loved them for my skin! Thank you Pat!

Service Dinner

Service 5 residents, interns and clerks. We are a team! 

For Internal Medicine (IM), our block was divided into different services to be with interns from other block. It's kind of mingling with other interns as well. Last week, we had dinner at Patricia's house at Forbes Park (!). She's rich but she's not mayabang. Good times, good times. :) 

Beware Of What You Wish For

Status: Day 11 at Internal Medicine ward and because I got lame cases such as penile cancer, acute pancreatitis and uremic encephalopathy secondary to obstructive uropathy by a possible ovarian newgrowth, I asked our junior admitting physician on duty (JAPOD) to give me a cardiac or renal case. The one that will drive me to study. God granted my wish and gave me this 25 year old male patient with the following admitting diagnoses: 

• Acute intracerebral bleed, left parieto-occipital lobe with intraventricular extension, probably secondary to hypertensive bleed
• t/c health-care acquired pneumonia with possible aspiration component 
• Pulmonary tuberculosis III, Category I, intensive phase 
• Chronic kidney disease stage V, on chronic hemodialysis, s/p permanent catheter insertion 
• with secondary anemia, hypertensive urgency 
• upper gastrointestinal bleeding, considerations 1. Stress induced mucosal injury                                                                         2. r/o bleeding peptic ulcer disease

SIYA NA!

Birthday Post

(an overdue post. written November 6)

My age has climbed a notch higher. The only thing that puts pressure to people about getting a year older is the direct proportion of accomplishments associated with ageing. At certain age, society expects you to be like this or like that. Otherwise, you’re a failure to everybody’s eyes. I don’t agree with society dictating us how we should do about things but I absolutely agree that we must not hold ourselves stagnant only because we repel society’s standards. For every birthday comes the annual self-assessment: the meaningful things we have done and how we have contributed in our own tiny ways to the evolution of humanity. We ask ourselves how much we have learned from the dynamics of our daily lives and how much we adapted to the unsuitable conditions we try to crouch into. 

What now at 26? 

A decade ago, I see myself 10 years from my 16th birthday as someone that is so NOT me right now. I still can’t believe I’m already 26. I can be categorized as a WOMAN, there’s no confusion on that. I’m way past that confusion phase. Honestly, it took me six long years to finally sink in that I’m no longer a teenager, especially now that I’m PAST MID-TWENTIES! The truth is, as we age, we do not really let go of that child in us. We merge maturity with that tiny voice of childhood in us. I believe that if we strike a balance between the two, playing the role of an adult will come naturally and smoothly. 

Nothing really life-changing happened to me this past year, but I must say that I have increased understanding about life, love and people. I learned plenty about myself which quite surprised me a bit. I learned to fight for what I believe is right as much I learned the vital role of communication in knowing and opening the minds of people. I learned to carefully choose the people I will trust and most importantly, I know now the specific people who will run to my aid when I fall on my knees. Unfortunately on the other hand, I have specifically identified the people who will turn their backs on me in the middle of a battle. Sigh. But hey, life is beautiful! Let’s us not dwell on the negative ones, such thoughts contribute to premature ageing and we don’t like that. Allow me to welcome myself into the world of adulthood with radiant and glowing positive vibes! 

At 26, I still have so many things to improve about myself and so many things to accomplish and I’m taking things step by step. Life is just so beautiful it deserves to be celebrated every single day! Cheers to the adult, 26 year old me! 

P.S. 

I feel so lucky for having the Eid’l Adha fall on my birthday. I celebrated the day with my cousins as we also celebrated the Aqiqa of Fia, the additional angel of our family. Thanks to everyone who sent their sweetest greetings in every way that they knew. You made me feel so special! Allah bless you all! 

Bah! I'm now 26, happy and still single!