PGI Dilemma

                                                      

Twitter exchange with my sister who's still deciding where to apply for her post-grad internship. I suggested she go with the DOH program so she can rotate to the country's topnotch hospitals such as NKTI, Lung Center of the Phil., and Phil. Heart Center. But I guess she'd follow her heart and put PGH as her first choice (she wants to follow my footsteps. Chos!). Basta, whatever your heart whispers, and kung sa'n ka man matanggap, I am always Facetime away to support you, cheer for you, and listen to your rants. Hehe. 

Not so long ago, I was in the middle of this dilemma. Someone said encouraging words to me that made me pursue PGH. I can still remember the euphoria when I learned I was accepted in one, if not the best, teaching hospital in the country. And now my one and only sister is tracing my footsteps. How time flies. :) 

At the back door of the interns' callroom at Ward 8 (Ortho ward), some crazy fella wrote:

And the Chief Resident said:

"Let there be a callroom" And behold! 

There was a callroom.

Then on the 6th day, he said:

" Let there be a bed!"

And they rejoiced as a 

stretcher bed appeared. 

Not all departments provide a callroom for interns, so THANK YOU Mr. Chief Resident. :D

OB Admitting Section duty. The scene: unemployed, unmarried, pregnant bitches come inside with various chief complaints such as ruptured bag of water, vaginal bleeding, or labor pains. We get the necessary papers, extract their histories and do physical examinations including pelvic exam, of course. We let them urinate in those tiny bottles and vacuum their blood in a syringe and pour them in a color-coded vials according to the test needed: purple (CBC), blue (PT, PTT) or red (serum electrolytes and others). 

It's uninspiring when you know well that these mothers who don't even know how to take care of themselves will give birth to a tiny angel whose future is uncertain. 

And that disgusting mixture of dried blood and peculiar cervical CA scent wafting in the air clearly sends me a sign: I have no space in the OB-GYN world. 

Another Season Has End

                                Our last week in the community was filled with mixture of excitement, triumph and heartbreak. Excitement as we finally go home for good, triumph for we have survived six-weeks of intense community immersion and heartbreak as we bid farewell to the homes that temporarily sheltered us. Turning back on the days we spent in the community, I mused on the significance of my stay and what I have learned thus far. During our block evaluation, this question was also raised and it seemed as though each and everyone has their own views and explanations about this immersion.

                While others may find the past six-weeks futile and a waste of time, I find it fruitful and an eye-opener. Witnessing people in dire need of health services is nothing new to us but exploring deep down into the roots---psychosocial and even political causes is what community immersion has taught me. If the entire internship is a movie, this rotation is the “behind the scenes”. It made me understand why an old man who is a TB suspect with atheromatous aorta had to wait a month after consultation to go to the laboratory and have his sputum examined and his chest x-rayed. Because he has to wait a month to adequately fatten his pig in order to sell it at a reasonable amount that will cover his medical expenses. It made me understand why an entire family came in with impetigo contagiosa which apparently started from the mother who had prior check up at the same health center and was given meds but still the skin infection persisted and even spread to her younger children. Because there is shortage of Cloxacillin at the health center and since she cannot afford to buy the said antibiotic to cover the entire regimen, she took the meds one capsule daily instead of taking it 4 times daily for a week. It made me understand why a three-year old boy who came in due to cough and colds can be mistaken for a 2-year old. Because he is the youngest in the brood of six to a 30-year old housewife mother and a fisherman father who earns at most P200 a day. Ultimately, it made me understand clearly the bitterness of social hierarchy. Those who gets better education can acquire power and wealth and most often than not, such assets are used as weapon against those who fail to acquire such. The latter are being displaced and ripped off from their own lands with a little compensation by the former that will be benefited for the rest of his life. Sounds more like the Hispanic era in the land of the Indios, eh? Indeed, history never fails to repeat itself.

                A colleague mentioned that we might as well leave these people alone and allow them to continue believing that a boy who seizes is “nasapian” or a girl who has cerebral palsy is a result of “karma” to his parents or a woman who had anaphylactic shock is “nabarang”. Accordingly, what we are doing in the community is just complicating matters to them and the aftermath is piles of debts from medical expenses. In simpler terms, we are ruining the peaceful life in the community. I beg to disagree. We are not heroes to change lives (we can’t even change ourselves, much more others). We are not here to turn the lives of community people into another direction we perceive as the better one. We are not here to change their beliefs and tell them not to seek the traditional healers. We are here to implement primary health care defined as equal distribution of health care for all people regardless of culture, race, religion, and social and political status. We are here to give them the options and show them that there is another path aside from traditional healing. What is education for if not being shared and applied in a manner beneficial for all? 

                We may never return to San Juan, Batangas for community medicine (we may go back for the beautiful beaches though) but the impact of the entire experience will forever be with us. For every patient we see in the ER or at the OPD or even those haggard-looking patient-watchers we ran into the hospital hallways, picture of where they came from will always flash in our minds so we can have a better understanding of them. We may have miniscule role in the empowerment of the community, but it is undeniable that the community itself has a major role not only in our medical career but as human beings per se. Therefore, our six-weeks were never put to waste. Others may not have realized it yet, but I know they will.

               

Oh that O! O_O

Old houses

I don't know if it's a municipal ordinance to preserve their century-old homes or perhaps renovation is prohibited but houses at Poblacion, San Juan, Batangas are really old and vintage!! Remember my entry about Cafeno? Last week, we were introduced to Orange Grill restaurant. I thought it was just an ordinary old house like its neighbors until I saw the tarp plastered at the fronthouse. I presumed this used to be a home to a prominent family and they decided to turn it into a restaurant which is a smart idea because people from the metro will definitely visit this place for that unfamiliarly cool ambiance. 

 Look at those enormous windows! It certainly felt like time traveling to the 19th century where you were gulped by a strong wind and ended up standing at Kapitan Tiyago's mansion where Maria Clara was sitting covering half of her face with a fan.

Gastronomic satisfaction guaranteed!!

 If you live in this house, you will definitely suffocate in too much ventilation! You will have excessive amount of sunshine, wind, rain, and unsolicited visitors!

Ultimately, they got great foods!! We ordered for Orange Chicken and Chicken Teriyaki which are both approved by our tastebuds. What we loved most was their Orange Lemon Iced Tea which comes at a super cheap price of P30!! Imagine?!? 

Chicken Teriyaki with fried camote on the side. 

Off-key

I know, I know. I am not supposed to post this because we are not supposed to meet at the community unless it's a Tuesday or a Saturday due to the NO-BARANGAY-HOPPING rule,  but hey, we are adults!! (alright, are we?) Anyways, last Friday night, our block decided to sleep over at Alaric's place (he's from San Juan, Batangas by the way) for practical reasons since theirs is near the staff house where we conduct our weekly Mortality and Morbidity report before going back to Manila. Now, guess what? They have a videoke machine at home!! Us, girls, sang our heart out, non-stop, from 5:00 pm to 9:00 pm!! We didn't notice the time as we continued to enter songs! 

Biritan na 'to!!

I have many discoveries among my blockmates that night such as:
a.) Crystal, our elitistang blockmate can turn into the most jologs person ever!! Well I guess, every person has that secret side.
b.) Suzie can actually rock Linkin Park's Papercut and rap In The End!! Memorize niya ang lyrics!!
c.) Tina is not just your average doctor-to-be, she has the capability to join in a singing contest!
d.) Alaric keeps on singing "Dahil Ikaw" by True Faith and up until now he cannot perfect the song...nice try by the way.
e.) Irving!! *Bakit Ngayon Ka Lang starts playing in my head now!* Woot, Julius Babao!
f.) Despite singing off-key almost the whole time, I picked Adele's Chasing Pavments to be included in my videoke song box!! LOL. Yun lang ata yung nakanta ko ng medyo tama!

Any of my blockmates will kill me if they get to read this!!

OMJ--as in Oh My Journal!!!


Suzie and I worked last night at Figaro to finish and "rehearse" our journal reporting that took place today.

Here, Dane is reporting on their cluster's journal. Reporting was done in front of 4 consultants, 2 residents and members of the 3 blocks currently rotating in the community: Block U (that's us!), Block T and the newcomers, Block S. Unintentionally, my crush is in the photo!! Yiiiheee! Kaya pumapalakpak puso ko while reporting. Hihihihi. 

Ombrella!!

Can I spell umbrella that way, just now, please? For the sake of this entry. Hehe. It's raining so hard. Another low pressure area, I guess. 

Ombrella display at the UP College of Medicine. 

***

We got only two more weeks of packing and unpacking!!

Unusually Better... Or Is It Just LUCK?

How often do we fail our expectations? How often do we heave a that's-life sigh while accepting our fate when things turn out worse? Or, what is the probability that things will turn out BETTER?

I was having some anxiety attack prior to our 6-weeks community immersion due to the possibility of having a not-so-nice experience from my would-be partner, would-be foster family and the community itself. I was faced with many issues and what-ifs like what if my partner (a choice between Crystal, Suzie and Tina) is someone who isn't tolerable enough (okay, that is vague), what if my foster family is reluctant to have a Muslim foster child, what if we need to hike kilometers of muddy and unpaved road to be able to get to the health center, how about my safety and security in the place? A lot of questions were running through my head I almost didn't wake up on Tuesday for our early morning trip.

Our block is divided into four clusters: Bataan, Bulsa, Imelda and Laiya,  meaning two sets of girls and another two sets of boys. We draw lots with our hands in tremors. Luck was on our side that fateful afternoon when Suzie and I picked LAIYA APLAYA!!! It's the farthest yet it's the best! For one, our foster home is a public resort which only means that our room is the one rented by guests during summer vacayes. It's not the million-dollar worth kind of resort but hey, it is absolutely NOT BAD as we expect it to be! Imagine the comfort!! Suz and I decided not to brag about our place to avoid depression among our blockmates who are, well..... unfortunate. Sorry guys. :'(  The distance of 22 kilometers from the poblacion of San Juan, Batangas is all worth it.

So guys, welcome to our home!!

Island Sky resort is owned by Ate Edith Abanilla, our foster ate who lives with a lola (non-blood related to Ate Edith, apparently, inampon daw niya si lola kasi pinalayas ng anak!! ) and her niece whose parents are OFWs. Our room is that brown door immediately from the terrace while Ate Edith lives at the back house, that silver-colored door at the rightmost. Technically, we don't live together as a "family" in it's real sense. Well, they're not a real family in the first place. I think that defeats the purpose, but we don't care so long as we have a tiled CR with a ceramic bowl, two large beds, fridge, electric heater and an aircon!! Ok, that part we do not want to brag to our blockmates coz they might cry sands and stones!

Another good thing is that the health center where we hold clinics every Wednesdays and Thursdays is just a five-minute tricycle drive from our home. Hailing a tricycle is one of the difficult things in our place but thankfully, Kuya Raffy's just one text away! We mingled with Ma'am Ellen, the barangay midwife and some of the barangay health workers who are more than willing to accommodate us. Most of our cases were just upper respiratory tract infections and systemic viral infections, rarely do we have hypertension and others. The most toxic one was a diffuse toxic goiter which we referred to the district hospital for the work-ups. Alhamdulillah. Things went really just fine on our first week.

We had a courtesy call to the Barangay Captain on our second day. This captain is not your ordinary captain because he owns Kabayan Resort  and most business establishments at Laiya Aplaya. He welcomed us into his mansion within his resort, and he offered us their trademark kape barako. His friend, Mr. S. from the Aplaya Corporation was also there that morning. Too bad we weren't able to linger around the resort kasi nahiya kami!!! 

Kap also owns this quiet and quite high-end coffee shop located just a few meters away from the HC. We arrive here after clinics at around 3:00 pm and that's the time they turn their aircons on, which could only mean that we are probably their only customer for that day! LOL. We stay there until nearing curfew time connecting with the rest of the world through the world wide web aka Facebook and Twitter. 

Meet the lucky duo, Suzie and I! 

Hello, Laiya Aplaya!!
If you woke up everyday to this magnificent view, don't you just wanna lie down and daydream all day loooong? 

FIVE WEEKS TO GO!! :)

FamMed With A B-A-N-G!!!!!

It was Suzie and I's last PM duty at the Ambulatory Care and instead of the hackneyed Last Duty Syndrome, this is what we got!!!!!

Lights off. Basically, our role last night was "bantay" ng Ambu. LOL. This scene was opposite from our last PM duty na 4:30 AM, may mga pending patients pa.

 Empty Ambu!!!! Weeee!! Record breaker kami! We had only one patient at around 11:30 pm who came in due to palpitations, shivering and a feeling of choking. We thought of a medical condition like arrythmia or some endocrinologic problems, but upon probing, we found out that she's been worrying about a lawsuit against her and the future of her 8 children, 7 of which married at an early age without finishing college, unemployed and with children of their own. It's a bitter world for that old lady. Hence, our verdict was: 

I- panic disorder, without agoraphobia 

II- defer

III- hypertension, diabetes mellitus, obese 2

IV- financial and family problems

V- 71-80

Another good news, our block received a 12-hour merit "for actively participating during EBM conference". Technically, it was only DS and Irving who should receive the merit because it was they who did most of the talking but we were just so lucky to have been showered by their blessings. The two got an additional 5 points though, perhaps will be added to their shifting exam score. Speaking of shifting exam, bukas na pala yun!!!! 

Alhamdulillah. Allah's the best! :)

FamMed Week 2

Ang sarap mag-duty sa Ambu kung ganito ang eksena. Walang tao. :)

Lalo na pag ang nasa katapat na Pedia Triage ay ang crush na benign din. Kung close lang kami, a wave would suffice to make my day. <3

At the FamMed-OPD, this sight greets us everyday. Kulang pa nga 'to eh. 50% lang 'to ng total OPD consults, our quota is at least 70 patients everyday. It doesn't seem toxic at all because there are at least 6 interns and around 5-7 residents catering to patients. So around at most 7 patients everyday for each. Plus, our cases are the super benign ones like dyspesia, UTIs, BPHs, acute gastritis, hypertension and etcetera.

 What I appreciated most about this rotation is we get to make our own assessment and plan for every patient we handle. The resident would check what's unnecessary or lacking in our management so we are being corrected. The most rewarding feeling is when the resident agrees with my management and is being carried out. I know I did the right thing. Love it! 

The one with the arrow below is the genogram I did for a patient, yan ang toxic! Mahaba-habang chikahan yan with the patient. 

We're about to end in few days time and we're off to the Community. I'm so not looking forward to it. But let's see. Baka mag-enjoy din ako. 

EBM Dilemma

I'm on my 2nd week at Family Medicine which is our last week in the department. I'm enjoying every single moment of my OPD duty especially when the resident agrees with my diagnosis and my management. There are always glitches but it feels good when the resident gently discusses the case with me and tells me what should have been done. I'm enjoying my learning experience EXCEPT for this Evidence-Based Medicine shit that I have no knowledge about. I wonder why our school didn't teach us such! Thanks to my blockmate who sent a copy of an EBM self-instruction manual to our yahoogroup. The introduction goes:

Medicine is a dynamic endeavor. Everyday challenging problems

arise, new modalities of treatment are promoted, disease 

management done under minimal or far from ideal conditions etc. 

Because of these challenges the quality of care also changes.  

Suppose a patient who consulted in your clinic with a diagnosis of

dyspepsia is asking for another prescription because the antacid

you previously prescribed was not effective. What will you give H2-

blocker or proton pump inhibitor? Or you may see another patient 

consulting for cough productive of yellowish phlegm who asked for 

a prescription of an antibiotic. Will you prescribe an antibiotic or 

not? These are common problems that may escape our attention 

and diminish the quality of care we give if we make inappropriate 

decisions. 

In the old practice faced with this question, a physician will just ask 

a colleague or an expert for the answer or rely on his/her prior 

knowledge of the disease. He may also prescribe a drug because 

of the promotional lecture he attended previously about the 

product.  

In evidence-based medicine a new paradigm is introduced. Before

he makes a decision, the physician will first try to retrieve his latest 

article about the topic that he kept from his file, appraise the article

then makes a decision. Later, he evaluates the effectiveness of his 

decision. This loop ensures improvement in the quality of care.  

The purpose of this self-instructional manual is to introduce to 

family physicians the concept of evidence based medicine and the 

use of these concepts to improve the quality of his/her own 

practice. 

EBM is real complicated for someone like me who will start from scratch. Formulating a clinical dilemma is non-tedious, clinical appraisal is. 

I'm contented with the pacing of our duty hours: 12 hours at Ambulatory Care, we receive patients from the triage who are not suited for admission. Not toxic in terms of the work load, toxic lang ang history taking and PE! Like you need to include a genogram and you're not supposed to abbreviations! Ayos lang, ganun naman talaga ideally but my hands hurt a lot! Tsaka, ubos na ink ng ballpens ko! 

When we're not on duty, we do OPD works at FamMed OPD, which means we're free on weekends like this. I want to watch a movie tomorrow but I don't know who's available to accompany me. 

We're off to the community in one-week time and I'm cringing at the idea. I just don't like going off. Hmp. 

My mind's clouded. I'm going senti. Need some shut eye. 

Hijab+Uniform+Pork

On some days I wear my old skirt, on most days I wear pants which is the "proper" uniform. I felt the urgency to shop for more pretty tops. This is the time I wish I am rich. :D 

P.S.
My blockmates inquire about why I wear my hijab. They ask too many a question while I try my best to enlighten them about it but most of the time, the conversation falls to why I don't eat pork! I might as well have a deeper Islamic research about that. #choz!

Poor Brain, Rich Eyes

First of all, I know that this blog was created to air my insights and all that weird things boiling down inside my thoughts. However, due to the swift constant revolution of my everyday life, there has been some scarcity of musings nowadays. Or probably I get used to the wretchedness of this world---the hospital, that is---that I lost connection to my inner humanity. While it's good to escape and find diversion, I'm afraid to get stuck into  the "other world" that I might get lost on my way back. Still, I escape because I need that diversion. Now, instead of sharing a piece of my brain, I'm gonna share pieces of what my eyes see in my everyday life. I don't have a great camera, I only have my mobile phone with me hence the poor quality of my photos. :( 

Last weekends, I was fortunate to be duty-free on Saturday and Sunday morning, so I went home to Merville at my cousins' home. I haven't been there since the start of internship. I was so glad to be back and play with my nieces. Here is Sabreen, my cousin Ate Pie's eldest. Such a cute darling!

In this photo, she's pretending to read. I love it when she mumbles un-understandable words while pointing to every single paragraph. Haha!

Sab. She's only two.

 Before I went back to my dorm. I accompanied Ate Hannah to SM Makati where I had a chance to feast my eyes on the pretty dresses and blouses of Forever 21! Aaaaah! How I drooled! But I was broke I went out empty-handed. :(

 I loiter nowadays at our condo lounge at 10th floor where there is swimming pool and free Wi-Fi. I never tried the pool kasi stagnant ang water! Haha. One fine afternoon, I had this view from where I was sitting and tweeting. :) Love the sunset sky! I imagined myself to be sipping coffee with a loved one sitting beside me...but nerrrhhh, it didn't happen. Most probably it won't happen. Aaaaahh!!! Nooooo!!

 My housemates: Emily and Sal. We're gonna have a new housemate since Pie moved out. Yay for that! :D

Meet the Block U. "We Revive, U Survive!". That is our temporary slogan until we come up with a smarter one. LOL. Taken at Pedia-ER on our last day. Photo courtesy of Renzo G., our Track B co-intern. 

First row L-R: Crystal, DS, Dane and Rex
Second row L-R: Tina, moi, Suzie
Back: Alaric

 Our Pedia-ER team. I'm gonna miss them, they're the best so far! They're so sweet and all. I admire Ma'am Glo, our senior resident, for being so composed and calm no matter how toxic we are! (except for that time her voice rose because of a cruel patient's watcher).

L-R: Suzie, moi, Ma'am X-Tina (thanks for allowing me to write my own order!), Ma'am Glo (the great!), Ma'am Inah (thanks for that recommendation for 24-hour merit!) and Tina. :)

 Block U's first lunchdate. So, these are the people I'm gonna be with for the rest of internship. :)

Done with my first month in Pedia. Next round of Pedia-OPD and Ward will be April next year.

Next stop: Family and Community Medicine. I am so ignorant about Evidence-Based Medicine. We just don't have that back in MSU. Aaaah, why oh why!!! It will take time for me learning that while my blockmates are so knowledgeable about it. 

Talk To Me, Kid.

I declare: I LOATHE STUBBORN KIDS! Only because I wasn't when I was little. I wasn't afraid of needles, of people wearing white, i.e., nurses and/or doctors, and most importantly, I was easily talked to! I still am, by the way. Why do kids nowadays are so maarte like they are trying to act like an adult and they wanted their whims and caprices to be followed? BRATS! You know what, parents and older sibs out there, these kids MUST know who takes the lead and who is the follower. Right? 

We had a patient last night, 9 year old male, brought in at around 9:00 pm and was complaining of right lower quadrant abdominal pain. He was s/p appendectomy last year so we were contemplating on bowel obstruction secondary to adhesions. In other words, he will be transported to the OR as soon as possible to prevent further compromise. The Pedia-Surg resident asked us (Suzie and I) to insert a foley catheter and nasogastric tube. I was the one who inserted his IV line so I knew he was so inquisitive like he asks too many questions and since you cannot lie to a child, I had to explain tiny details including why I need to place leukoplast all over the IV cannula. Then comes foley cath insertion, we had to explain ALL the details that need to be done. The parents were there to console and assure him. So we thought everything's okay. When Suzie was about to enter the tip of the tube, he shrieked and closed his thighs together which made it impossible for us to perform the procedure. We talked him down in our most soothing voice, said all the things that would probably make him comfortable. Epic fail. We left and decided to return when he's ready.

Two hours later, we came back with another set of foley cath. Still wearing our baby voice, we talked to him as if he's an adult hoping to alleviate his apprehension. Yet, no effect. We called a resident, who did a lot consoling. The kid was shouting: "Hindi niyo kasi alam ang pakiramdam!", and the resident answered: "Naku hijo, pinagdaanan ko na ang lahat. Lahat na ng klase ng tubo nagawa na sa'kin..Kaya sige na please, mabilis lang naman eh. Please?" in her most begging look.We even mixed lidocaine with the lubricant to make him a little numb. Still, no effect.

Five hours passed and he was still throwing tantrums. We called the Pedia-Surg resident to help us out who did a lot of bargaining with the boy until she almost lost her patience. He was so whimsical he wanted everything he says to be followed. We were initially giving in to him, until the Pedia-Surg resident noticed how stubborn he is. So much talking on our part and so much yelling and shouting on the boy's part. He's 9 years old and difficult to restrain. He doesn't listen to anyone, not even to hisparents. We gave him midazolam which sedated him for like a few minutes, but when he felt the NGT poking on his nose, he struggled again and regained his energy!! Aaaaack! This time, we had other watchers help us restrain him until we successfully inserted both the NGT and the foley cath at around 3:00 am! The worst part is, when I pushed 10cc of water on the catheter for inflation, he squeaked and struggled so the needle passed through my skin! That was my second prick last night. On the positive note, both needles were not used for blood extraction...otherwise, I need to panic!

It was a long 24-hour duty. We bagged almost whole day, two of which expired. :(
Conducting patients who doesn't respond to midazolam to the CT-Scan room.
Suzie and I had "The Phenobarbital Incident".
And, THAT BOY.
We left the ER this morning with the preduties bagging again. *Sigh*

Bagging Tina

Triage Area. 

Adult Triage. Sitting and looking from the Pedia Triage, parang ayoko mag-duty diyan!

Finally, na-sedate na rin ang patient na ayn!

L-R: Tina, Ai and Suzie! :)

What Now, Internship

I'm on my third week of the daily grind of internship, my first rotation is Pedia-NICU where we catch babies at the delivery room, doing rounds at the ward and on the last four days of our NICU rotation, we served as manongs (meaning, running all the errands) at the neonatal intensive care unit. Here, we are practicing the Essential Newborn Care (ENC) advocated by the World Health Organization wherein there is delayed cord clamping (to prevent anemia), skin to skin contact with the mother and early latching on. Apparently, this provides closer mother-child bonding. Sweet. :) Although, I don't get to read as much as I can (oh well, I don't actually read at all! crazy!), the residents here are not selfish of their knowledge. You ask anything and everything and they will totally exhaust whatever they know to teach you. All you need is to be inquisitive. At first I was hesitant to ask because I get used to the culture of getting your questions thrown back at you with that "hindi mo alam?" look. It's so different here, residents say a lot of thank yous which they're not actually obliged to because it is our job to do the work. They're that courteous. I am not saying that people from where I came from are not courteous enough, they're just different, probably in the manner of speaking (?). On my first catcher duty, I didn't know it was High Risk day, which means that all high-risk pregnancies are scheduled to deliver. We got two congenital hydrocephalus, one nasoethmoidal meningocoele, one 24 weeker (we considered abortion because the baby weighed only 450 g), another 28 weeker and babies of preeclamptic mothers. We got 16 catches that night. 

At the NICU, where I had hard time studying how mechanical ventilators work (yeah, shame on me, right? wala kaya kami dun, bow.), we still had cases of hydrocephalus, mostly preterm babies on sepsis, hyaline membrane diseases, cases of craniosynostosis like pfeiffer syndrome and we also had cases of abandoned babies!! No kidding! There's an 8-month old twin girls there! Nananawagan po kami sa nanay nila, balikan niyo po mga anak niyo!

*I want to share photos of them but to avoid legal issues, whatever it is, wag na lang. :)

We are now posted at the Pedia ER where the cases continue to amaze me. We got rare cases (rare from where I came from, but they seem to be uncommon here, LOL) such as:

a. posterior fossa tumor probably astrocytoma vs. medullastoma with hydrocephalus (5 year old, male)

b. sacrococcygeal teratoma (3 year old, female)

c. hereditary spherocytosis

d. aplastic anemia vs. acute leukemia (9 year old, male)

e. congenital heart disease, cyanotic; transposition of great arteries (7 month old)

f. nasoethmoidal meningocoele (3 year old, female)

g. chronic idiopathic thrombocytopenic purpura 

h. congenital heart disease, cyanotic with severe infundibular valvular pulmonary stenosis (3 year old, female)

i. congenital adrenal hyperplasia in crisis

j. acute lymphoid leukemia

There are also cases that seemed to have no place in the ER like:

a. kerosene ingestion, accidental

b. paracetamol overdosage, non-accidental

c. mr. muscle ingestion, non-accidental

d. acute appendicitis

People are asking me how toxic PGH can get, I say toxic is an understatement, yet it is only in the mind! *winks* :) 

P.S.
I got merit during the Pedia-Neuro teaching rounds last night for being able to trace the CSF pathway. What now, Dr. L? HAHA. :)