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. :) 

Snapped!!!

BLOCK U!! Thank U for such wonderful year! This photo simply describes Us. I will miss seeing Ur faces everyday! 

"We revive, U survive"

Internship shouldn't end just like that. WE HAVE TO CELEBRATE THIS ALMOST FREEDOM!!!! Wohoo!! I guess I was the happiest intern on earth when the clock struck 5:00PM of April 30, which signals me to go and not be back the following day! I was literally dancing on tiptoes and singing a happy tune on my way home. Haha! Love it! 

To wrap up the year, you may click on the items labeled "internship" or "medical internship" on the rightmost of this page and join me in reminiscing what went through the year. :)

In hindsight, do I have remorse upon choosing PGH? Nada. Sure, there were heartbreaks and feelings of incompetencies, there were moments of being on the brink of disintegration, but accepting the fact that what doesn't kill you makes you stronger made me thrive all year long. Alhamdulillah. 

My friends, this is my last entry under the label medical internship. 

Yours truly,

Ronsing, MD. 

Why This Jungle

 Written on April 21, 2011; 2:55 pm, thousands feet above the ground on PAL flight PR 186.

I am writing in a plane bound for Manila, where after spending my whole life in Mindanao, I will be settling for a year (and more) to pursue my internship. I left my loved ones with a heavy heart due to the distance and the fact that I will not be seeing them for the coming months. I melted when my aunts and uncles threw a surprise send-off party two days before I leave, everyone was there! I was ecstatic! Then, my mom invited them for dinner a night before my flight. Happiness! I couldn’t help my tears though when it was time to bid farewell.

Several months ago, I was confronted by a major confusion on where to pursue my one year post-grad internship (PGI). There were several aspects to consider and after a long mind boggling battle, here are the reasons why I chose a hospital in Metro Manila over Cebu and Davao:

1.       It is Manila, the Capital of the Philippines which monopolizes almost everything that is supposed to be shared to other parts of the country. Hence, Manila has almost everything. Here is where is you can see and observe everyone from the opposite ends of the economic scale. Exploring this urban jungle will help me become strong and vigilant. I will meet plethora of people with different personalities, way far from where I came and for that I believe I can adapt proficiently. *cross fingers*

2.       It is UP-PGH. The National University Hospital. Need I say more? Yes, toxic na kung toxic, OA sa katoxican but how can one become better if one doesn’t push himself a little harder? One has to try to the end of his limits to test what he is capable of.

3.       I have my cousins here. Like I always say, nothing beats being with the family. Knowing I have my cousins here, my parents are quite comfortable sending me here. They need not worry about me coz I have people to run to whenever something untoward is up.

4.     I have my friends here. More than half of my highschool berks are Manila-based. Some are raising a happy family here (yes, they have children, I’m so old!), some are pursuing post grad studies while others are earning bundles of bucks here. My Quasar friends are here also, in fact, Rox is a co-intern ad hopefully Jehan will join us here at UP-PGH, soon! Happiness!

With this, I can only pray to God to give me the courage and strength (physical, spiritual, intellectual and emotional strength) in facing and beating all the ODDS.

Born 29 weeks age of gestation (AOG).

Preterm infant under blue light phototherapy.

He clasped the tip of my finger as my heart broke over the huge probability of his non-survival. :'(

Photo taken using my iPod without any filter at all. 

Looking Through The Eyes.....

Literally. That's how we roll at Ophtha. Another loved rotation because, again, it made me learn things I didn't know before. I was inept at ophthalmologic exam so this was another challenge for me in gathering skills at looking at the back of the eyes called the retina and identifying the optic disc, the macula, the fovea and determining abnormal structures as a manifestation of a systemic disease.  

Googled photo. 

Ophtha residents' duty schedule has been envied by any other PGH residents. They're relatively the most benign training. Their patients are not benign but they got the most relaxed schedule. They don't run bloods for the surgery of their patients and they don't need much assists. So cool!!!   

Kaya pag tinamad ako, mago-ophtha ako!! Hehehe. 

Cataract extraction and insertion of lens. 

It was included as a bonus question in our end-of-rotation exam the best and worst part of our Ophtha stay. 

Best: 

a. The residents are so chillax. They're not always in a state of hurry, thus, not creating hypertoxicity among interns. They're intern-friendly as well. :)

b. The building. They're the only department with a separate building called the Sentro Oftalmologico Jose Rizal donated by the government of Spain in honor of our very own National Hero, Gat Jose Rizal, who is the First Filipino Ophthalmologist. 

Worst:

That the rotation lasts only for two weeks. :( It's so sad that it ends when we already get the hang of it (and the time I discovered how gorgeous this certain resident is. haha!)

**************

Internship update:

We are so back into the fragile arms of Pedia, the time when the clerks are off for their vacation in preparation for internship. Waaaahhh!!! I'm ready to be killed. 

Wrapped Up ORL

This is a two-week late entry for we were already done with otorhinolaryngology (ORL) a.k.a ENT for ears, nose and throat. I was a bit of having a cold feet for this rotation since we didn't have it back in clerkship. The last time I studied ORL was during the upper respiratory module in medschool freshman year!!! That was eons ago, my friends! This is a confession, but yes, I just learned about the thorough ENT exam here in PGH!! I compelled myself to master it in anyway that I can---identifying the normal tympanic membrane from the perforated ones and visualizing the vocal cords and the posterior nasopharynx no matter how the patient gags! And I'm more than glad that after two weeks of our rotation, I brought with me a lot of things I didn't know before. Naks!! Hail, ORL! Hail, ORL!

What we do at the OPD. I'm so sorry Suzie for capturing your awkward moment! Hahaha!

This is Fiona, 5/F, who came in due to a foul discharge dripping out of her right nostril. She's so makulit but very cooperative little girl. Children her age are expected to revolt and throw tantrums upon examination, but her? No, she gaily sat on the examination seat and followed every single step of instruction! I wish all kids are like her! Haha! After suctioning her nostril for a better view of the turbinates, we found a greenish rubber material that was inserted deep inside her nose!! Apparently, her classmate put it there and was accidentally pushed deeper when she inhaled that they could no longer pull it back. She didn't report the incident to her mom until that day we found the foreign body inside her nose. Hahaha! Kalokang bata ito!

This is Dr. Caparas. Being the FIRST alumnus of the Philippine General Hospital Otorhinolaryngology Department, he is an institution in this field. He graduated in the 1960s, the time when ophthalmology was still incorporated in ORL. He's also the author of the book I used to read back in medschool. It's kinda awesome hearing straight from the authors. I remember my OB-GYN days when the people who wrote the Clinical Practice Guidelines used all over the country are those consultants teaching us during the Malignancy or Trophoblastic rounds. Great. Great. :) 

For a speck of time, I considered ORL as a specialty field because it's both surgical and medical plus the cases are really interesting. However, upon realization that the field deals with all the most filthy and most despicable odor you will ever smell in your entire life coming from all the cavities of the head, my friends, I changed my mind. Hahahaha!!! I really enjoyed ORL, I must say, one of the best rotations ever!! :) 

BURN For Me Baby.

This is where we literally skin people alive. Does that made you cringe? I do, too, upon seeing and hearing them scream as we peel of necrotic tissues from their burnt skin while begging us to do it slowly and gently. Indeed, we do it as slowly and as gently as we can but it is really painful. Ideally, burn patients should be sedated during debridement, but what can we do? It is literally painful to be poor. :'( 

PedSx

My surgical subspecialty of choice. Too bad I only have one week to bask in the subjects of Intussusception, Hirschprung's disease, Imperforate Anus and other pediatric surgical cases. It's frustrating though that subspecialty rotating interns do not assist in their ORs. :'( I wanna see how PSARP (posterior sagittal anorectal plasty) procedure  and pediatric intestinal anastomosis are being done. :'(

I don't have plans of pursuing surgery but this sparks some curiosity in me. 

The only pediatric surgical OR I assisted was herniotomy at the Major OPD OR which was done in like 30 minutes, my gloves weren't even stained!! 

By the way, we have a rotating German intern  from a certain university in Germany. I don't talk to him much like I would do to someone I can easy-breezily have a conversation with mostly because I have difficulty understanding his accent!! Lol! German-English accent!! Nakaka-nosebleed!! So I would usually allow him to do his thing while I do mine and ask him once in a while how he's doing. Awkward? Hahaha!

We had a laparoscopy workshop along with PedSx residents and consultants. It was fun manipulating beads and rubber bands by using the graspers just like in an actual laparoscopy although it takes huge amount of patience and good hand-eye coordination!!! If I would become a surgeon, I would most probably opt for an open laparotomy than laparoscopy!! Haha!! 

On another news,  I found the perfect place for studying!!! Taaadaa!!!

It's a walking distance coffeeshop near our place where everybody goes not to chat but to read! Awesome! So you get to read books with pure serenity, plus the high-ceiling structure of the place allows enough light for ventilation. :) This place is a huge help for me to avoid many temptations at home: TV, internet, bed, and fridge. :) 

Also, our photo with a cardiac pacemaker recipient patient was published in Heart and Health Magazine. This was taken during my MICU (medical ICU) rotation, and together with the resident-in-charge, Ma'am Gelay, we posed for this photo which was sent to Heartbeat International Foundation and Pusong Pinoy Foundation for the purpose of seeking funds for this lucky patient. 

Credit goes to my blockmate Alaric Salonga for taking this one. If you look closely, he manually wrote his name underneath the photo while bantering why his name wasn't on it. Lol! 

*All photos were taken using my iPod. Such poor qualities, my point-and-shoot Canon should have been used for that DSLR-like shots I'm so proud of. Haha. 

Cefazolin 2g loading dose now then 1g Q8.

PGH Intern does:

IV insertion

blood extraction

drug administration

vital signs monitoring

paperworks: clinical abstracts, discharge summaries

first in line at the ER

triaging

pushing stretchers and wheelchairs

chest compressions and ambubagging if patient has no bantay

Anything amiss?

Remorseful? NOT.

I say, grateful. :)

TRAUMAtized.

"Oi Aisha, sobrang sorry kanina ah. Zero sleep kase ako kagabi tas nag-assist ako til umaga kaya pagdating ko jan knocked out ako. Tapos andami dami tumatawag na nanonoxic na wala ko kaalam-alam sa mga sinasabi nila kaya natoxic kita dun sa charts. Sorry talaga ah."

That apologetic text message came from my resident after an incident at the ER when he sort of raised his voice at me when I delayed gathering the patients' charts for him. After the morning rounds with the Trauma* team captain, she instructed me to give all the charts to the nurses so they can immediately carry out some of the orders and I did what I was just told. By and by, this resident arrived at the ER slumped on the table to steal some naps after, I guess, weeks of being on straight duty!! Once in a while, he would raise his head to ask if we have referrals but it was obvious that he was half-asleep half-awake. He spoke as if he's sleep-talking. Hehe. I heard his phone ringing several times but he was still in deep sleep. I hesitated disturbing him as I fully understood how it feels to be sleepless. Later on, I guess when he was fully awake, he sprung his head from the table and was reading his text messages. He then asked me to gather the charts. I bet the senior residents were asking him stuff about the current status of our patients and since he wasn't present during the morning rounds, he's not updated about anything. That's probably why he wants to see the charts. Problem was, the nurses were in the middle of carrying out the orders and they wouldn't give the charts to me. If I steal those charts, the carrying out of doctor's orders will be put off and if that happens, I will answer to the team captain. I thought the resident can wait, I even showed him our logbook where we wrote  patients' updates but he insisted on me collecting all our charts. I told him the nurses won't give the charts and that's when he got mad and raised his voice, but not to the point of shouting. I didn't answer back as it is not my habit to answer back to people older or senior than I am. I kind of giving in to their whims with all due respect to the position they hold over me. So without any words, I returned to the nurses' station and started begging for the charts. I saw him stormed out of the room, he was probably called at the ward. I was disgusted by him that morning I didn't wanna see him again.

At around afternoon, my co-intern Sherwin and I were conducting patients to Radiology when that resident called him up asking for my number. I told Sherwin not to provide my number as I assumed he would just give me series of orders nanaman. Do this and do that. Plus, I'm loathing him pa, I told Sherwin. A few while later, I kept wondering ano nanaman iuutos niya so I decided to just phone him. He said he'd just text me. Gah, mahaba-habang utos nanaman siguro 'to, I thought to myself. That's when I was surprised by that text message. I am humbled by the humility he has shown. Very few residents would have done that. They'd just assume we understand what they're going through and would never bother to apologize. That's one of the things I like here in PGH, residents do not terrorize interns as much as in other hospitals do. At least, we are not being treated as slaves to them like the stories on asking interns to buy them food, or groceries or withdraw money for them. You know, stuff which are no longer hospital-related. Those don't happen here in PGH. You will get terrorized if you cannot explain what happened to your patient. Nothing of those monkey businesses. 

All Trauma first year residents (3 of them) had been on what seems like a perpetual duty. They don't have the leisure time to go home to even change their clothes. They were either at the ER, at the ward or at the OR assisting at operations. They are the first people to be called regarding patients' status. These three residents help and cover for each other, so nobody among them goes home. That would explain their mood. Seeing them in that state discourages me to go into residency in a government-owned hospital. I'm not sure if I can devote that much time, or rather, if I can devote my whole self in the spirit of training when I can have the same learning if I go into a private tertiary hospital. I do not know yet. I haven't made up my mind yet where to go for residency for I am yet to take the boards!! Hahaha!! 

If you wonder what I replied to that message, I said. "No probs, Sir" and a smiley. He again said sorry. My crazy co-intern Issa suggested I should have replied just a plain and simple "K"!!!!!!! I wonder how the resident would react to that!! Seriously, apology accepted. I admired the humility. It's either humble lang talaga siya or ayaw lang niya masunog at the end of the year!! Either way, apology accepted pa rin. :)

*After everything I said about Trauma, yes, I ate my words and now I am a Trauma intern! Grrr! I had to shift over to Trauma because they lack one person in the group so I volunteered after realizing it might be of help in my future practice as doctor to the barrio. The way I feel for Trauma is just the same. 

Mark Onglao, August 2011 Physician Licensure Exam Board Topnotcher, and currently a 1st year Surgery resident, sat right next to me last Wednesday during the department mortality and morbidity (M&M) conference. I wished I possess some sort of mental imbibing powers so I could have grabbed the opportunity! Hahaha! 

At the OPD Major OR, this patient was supposedly for hemorrhoidectomy. But because he weighed 122.6 kilograms, the anesthesiologist had difficulty doing the spinal anesthesia so he resorted to general anesthesia. However, when the surgeon assessed the surgical field, he knew he would have difficulty doing the operation with that weight so he deferred. After the intubation and all, the patient was brought home. Haha! Morale: LOSE WEIGHT!! 

Surgery resident waiting for the anesthesiologist. Postduty Ma'am? :)

Now, here's something smurfed to scare those tiny mosquitoes away! 

...buzzz.....

Update: we're shifting out from GS2.

Have a blessed Friday! :)

Hand Me Tha' Scalpel

Back to some hospital lovin' stuff, I'm already on my third week in Surgery. This would be our second to the last major rotation, we still have one month remaining at Pedia after ORL and Ophtha. This is my second most loved rotation next to Pediatrics, perhaps because I've had too much amazement of the subject back when I was a clinical clerk. I also see surgeons as the COOLEST people in the medical field, they're neither the nerds nor the laid back guys. They're just awesome! As it turns out, I have a thing for Surgeons rather than Surgery itself. LOL! Kidding! Seriously, I am enjoying every single moment in this rotation just like when I was a clerk. 

On our first two weeks, we manned the Surgery-ER where we did wound suturing and inserting IV lines, the usual stuff. There were less suturing here as compared to when I was a clerk, that's because of the existence of hierarchy (residents > interns) and there are separate Trauma interns to share the job with us. Reminds me of my good ol' clerkship days where I had seen practically ALL kinds of TRAUMA cases and had to suture ALL kinds of avulsed or lacerated wounds. Kanya kanyang style ng pagtatahi! The good thing about our first two weeks was how we are entrusted to do our own operations at the Minor OR. I never had that experience---breast fibroadenoma and polyp excision! Awesome! I thought I couldn't do it, but hey, I DID! High five for that! :) I was really nervous on the first day. My resident just made me palpate the mass and verbally instructed me how to do it. I figured it in my mind and continued with the surgery squeezing out all that confidence in me. I succeed with the first patient and the others except on our last day when a a certain patient's mass was so deep and quite large (~3 x 4 cm) and I kept hitting on arteries which bled quite profusely! I was so scared I had to seek my resident's help! She controlled the first bleeder by ligating the bleeding artery using cotton tie and came my lightbulb moment. Aha! Oo nga 'noh, bakit nga ba hindi ko naisipan yun. I am such a panic. So there, I used the same technique for the rest of those lecheng bleeders I encountered. 

Five days later, one of those patients followed-up at the OPD and I was thankful she had no complications. Haha! Otherwise, I don't think I can forgive myself.

Surgery is one helluva coolest and tough field! That's why I don't blame Surgery residents who feel so astig  even if they don't look like one! Haha! Peace yo! :) 

We are currently at the Wards under the GS2/3 services. That's the Colorectal and Hepatobiliary services. Good thing about Surgery here at PGH is that we are given the option which field we might wanna take. So I took GS2/3 rather than GS1/Trauma. GS1 comprises of head, neck and gastric cases. I avoided Trauma simply because with all conviction, I would explicitly say I loathe Trauma. I don't like the subject and I don't like the patients. Most often than not, they are those who are brought to the hospital because of their own fault. Usually vehicular crashes and/or stab wounds are the cases. These are the social liabilities that I feel like they don't deserve my time and energy. I am so mean at that, but I just feel exactly that way towards Trauma.

On our last week, we would be exposed to subspecialty fields however we are only to choose one among the four subspecs (Plastic Surgery, Thoracocardiovascular Surgery, Pediatric Surgery and Urology). I chose Pediatric Surgery. :)

I don't see myself as a Surgeon one day but I am happy that I'm enjoying this rotation. 

Plus, I always wear an extra smile on my face pa everyday. :)

Remaining Days

Kick-off party for the remaining 100 days of internship!!

ONE-HUNDRED FREAKING DAYS INDEED!

Last Saturday was the 4th session of our monthly board review series at the Buenafe Auditorium of UP-College of Medicine. The subject was Microbiology and was productive as I unexpected it to be. Previous ones, the first two because I was absent on the third session, were really boring lectures I had to bring coffee inside the hall to keep me alive.

All interns are excused every second Saturday of the month since November 2011 to attend the 4-hour lecture on basic medical subjects. It's an opportunity to leave the humid environment of the ER when the review falls on a duty day. Hahaha! :)

As always, I took notes. 

P.S.

LAST FOUR GRILLING MONTHS OF INTERNSHIP!! WAAAAH!

Ideals

How many of you, medical students and physicians alike, have Oxford Handbook of Clinical Medicine?  Have you read the section "Ideals"? If you haven't because the moment you get your hand on the book, you directly flipped on the index to search for a particular disease, well, here goes:

Decision and intervention are the essence of action; reflection and conjecture are the essence of thought: the essence of medicine is combining these realms of action and thought in the service of others. We offer these ideals to stimulate both thought and action and action: like the stars, these ideals are hard to reach--but they serve for navigation during the night. 

• Do not blame the sick for being sick.
• If the patient's wishes are known, comply with them.
• Work for your patients, not your consultant.
• Use ward rounds to boost the patient's morale, not your own.
• Treat the whole patient, not the disease. 
• Admit people--not 'strokes', 'infarcts' or 'crumble'.
• Spend time with the bereaved, you can help them shed their tears.
• Question your conscience--however strongly it tells you to act. 
• Be kind to yourself--you are not an inexhaustible resource.
• Give the patient(and yourself) time: time to ask questions, time to reflect, time to allow healing to take place, and time to gain autonomy.
• Give the patient the benefit of the doubt. If you can, be optimistic: optimistic patients who feel in charge live longer and feel better.  

I have always categorized my books into two: school books and non-school books. School books are the text book ones, the boring ones, the one you read with the pressure of understanding it to get a fairly good grade during the exams. Non-school books are the fiction ones, literary ones, non-boring ones, the one I read with utmost desire while I let my imagination take me to some far away land and meet strangers and bizarre characters, books that teach me how to live life, books that present me with a new perspective. So it kinda surprised me to read something about how to practice the medical field in a humane kind of way. I should place this book under the uncategorized label because it is more than just a school book, it is a book on life--both literally and figuratively. :)

With all due respect, I've observed doctors who treat patients as patients and not as human being that they actually are. I, myself, is guilty of referring to patients according to their specific diseases and not by their names. (E.g., "Pauwi na si Lupus!" Instead of "Pauwi na si Ms. De Leon".)

I believe that medical practice shouldn't be based on how genius you are in treating your patient's disease but by treating the patient as a respected human being. :) 

Will post more about the few chapters in this book preceding the discussions on the diseases per se. :)

Acute Care Unit-Emergency Room

(late entry)

After the strangling schedule at IM wards for one whole grilling month, we welcomed ourselves to a relatively benign duty at the ER! I say benign because PGH ACU-ER will be subjected to fumigation, hence only "real emergencies" such as cardiac cases, intubated and trauma patients will be admitted! Woot! Alhamdulillah, God has given me some time to breathe! 

However, the scene below shows the LEAST number of patients this institution can accommodate. 

We normally write on a white board the name of our patients under the student-in-charge's (SIC) name to easily keep track on the patients' progress. Last November 30, 4 of us had only 1 patient and no new patient came in! Cheers! This is one of the things I love about PGH--- it is never impossible to close the ER. Back when I was clerk, I always wished for our ER to close!

During this time, we have the power to choose the patients we want to admit while the rest will be transferred to hospital of choice (THOC). 

Yet and again, I'm in the company of boys! Rona and Pat though will return from Medical ICU (MICU) on the second week at the ER in exchange for Borg and AD. This photo was intentionally taken blurred.

Dane's post-birthday dinner treat at Recipes. Duty Team with Jeboy. They talked about boys' stuff, if you know what I mean and I just had to pretend I didn't hear them or just play innocent. Most of the time, I ride on with their jokes and I guess they completely forget that I am a woman. Fine, I am a medical student hence, no fuss. 

Below shows the lecture on cutaneous leishmaniasis with Dr. Henry Murray of Cornell University. Listening to the world's expert on the disease is another opportunity of a lifetime. 

I can't wait for this Internal Medicine rotation to end. I badly need some time off. :)

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.  

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!

At the Psychiatry interns' callroom, this was glued on the wall like an important note beside the list of decked patients, interns' guidelines, etcetera. Oh well, I must say it is equally important. 

If you have at least 4 of the above symptoms. CONSULT YOUR PHYSICIAN. NOW!