I saved P95 for buying Paulo Coelho's latest book and his 2012 Planner/Journal. Not bad. In a world where we need to tighten our belt to make both ends meet, a single centavo matters.

Bring it on, 2012! :)

Watching the sun rise as I rush off to the hospital. Hoping for a great weekend. :) 

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. :)

Note To Self

Repost from @BebanglovesRed. 

It starts with marrying the right person and ends with doing things that will make your mom proud. I shall find congruence in that. I promise you, Mom. :) 

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!

Coffee for me. Cigarettes for A.

Mexican cuisine. Three Musketeers. Chat about self-generated theories.

Sometimes we need to surround ourselves with people having totally different perspective about life. It nourishes the mind and is also a form of escapade. :)

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!

Elusive Peace

I’m in the middle of a routinely work when the urge of writing suddenly popped up like an old friend tugging at my back seeking for a little attention. And after months of neglecting my personal journal, here I am trying to jot down bottled-up feelings I attempted to ignore. 

I was reading a fiction called “Below The Crying Mountain” by a Filipino author Criselda Yabes about the entangled story of an American mestiza who eloped with a Muslim educated man towards the land of the “Dirty People”; and of Nahla, an ambitious Muslim woman who fell in love with a Christian soldier declared by her people as an enemy. The story revolved in the poverty-stricken and nest of rebellion Sulu. It broke my heart as the story unfolds piece by piece. My heart got even more broken when I opened the television after putting down the book and saw what happened in Basilan which is on the headlines as of speaking moment. It’s as if what I was seeing on TV is a continuation of the book I just finished reading. 

There were 19 soldiers who died in the encounter, 6 of them were held captives before they were mercilessly murdered, the news said. I heard the weeping family members airing their sentiments at how their loved ones’ lives were grimly taken. Stories of these national heroes were told and the images of them bidding farewell to their mothers, fathers, wives and kids promising to come back soon quickly flashed in my mind. Just like a scene in a movie accompanied by sobby music on the background. Little did they know, they will return as cold corpses. I can’t help but shed a tear for their loss. 

I sympathize with the mothers who lost their sons after decades of nurturing them, protecting them from the harsh rains, feeding and educating them to become better men. 

I sympathize with the fathers who worked hard to raise their sons to become perfect gentlemen and good citizens of the nation. 

I sympathize with the wives who, after days and weeks and months of patiently waiting at the doorstep, no soldier husband would arrive. 

I sympathize with the little sons and daughters who will grow up without a father at their homes. 

I sympathize with the nation for losing great men—men who died while serving their motherland. 

On the other hand, it hurts me even more that the culprit were Moro rebels. Muslim rebels, the news said. Not Christian rebels because the media knows not of any Christian rebels, only NPA who unknowingly kills and burns acres of lands in other parts of the country. But they’re not on the news. Only the Muslim rebels are the highlights. The bad guys. My people. 

There goes the media for their one-sided story, feeding the nation with false information. While we sympathize for the nineteen people who died, did it ever occur to any one of the millions of televiewers the other side of the story? How about those thousands of helpless residents who were displaced in their war-torn areas? They are the real victims in the situation. Do the media even investigate as to why the MILF attacked the AFP camp in the middle of the Peace Talk? For all we know, there must be a reason. 

Nineteen were mercilessly murdered as opposed to the thousands who were ripped off from what was left of their lands, from their dreams, from the good future that could be awaiting them. Thousands of mothers and fathers will endlessly hide and protect their children from the bullet rains fired by the national government ammunition. Thousands of children will be deprived of a happy childhood, a better education, and most importantly, deprived to live a meaningful life. Tell me, how does that differ from being killed? 

Then there’s the pushing for an all-out war against the MILF, against the Moros, against the Muslims. They want us to perish. Those people pushing such evil idea know better---there’s no victory in war, most especially, evil shall not triumph over the good. My rebel brothers in the South know that too, but why do they push for a Bangsamoro Republic when we can’t even handle ARMM? Let’s admit it, we Moros aren’t even united. We’d get at each other’s throat to gain power to fuel our pride. I believe we’re too ambitious for a Bangsamoro republic. Yes, it will happen, but not now. Let us not be governed by our impulsiveness and blinded by our pride. To quote a character from the book “Below the Crying Mountain”: 

“Of course Allah was not on his side. He was not on Allah’s side to begin with…did He ever say, take up arms and follow me? There should have been no turning back for Jolo but it kept on doing so because violence breeds violence. 

“..I’d say that of any revolution is to succeed here and now it would be the weapon of tolerance. Only tolerance will bring peace, but no one here, not the Muslims, not the Christians, not this government we’re stuck with, understands the meaning of that word. 

“…Omar failed because he was thinking only of himself. He was trying to prove something, seeking vindication because he was a Muslim. He may talk for all he wants about building an independent state for Sulu but I doubt if he knew what it meant to serve Allah.” 

In the midst of all these confusing chaos, all we can do as spectators of this reel-like reality is to pray for our leaders to make a decision that is unbiased and beneficial for all. Let us pray for a nation undivided by religion, race and language—a nation so united that people coexist peacefully. 

Amen. 

There, I just said my piece. 

NSS

I sat down for a good 3 hours listening to the Neurosurgery Pre-/Post-operative conference. I almost felt my CSF leaking out of my ears by just listening to them. This department consists of brilliant people without exception, almost all of them were board exam topnotchers! My hats off for them for understanding the complexities of the brain and actually opening the skull and working on the organ! Personally, manipulating the brain vessels, gyri and sulci is the toughest thing in the medical field! Astig! On the photo above is Sir Ronnie, first year Neurosurgery resident who's an excellent writer as well. 

Interns do not assist in Neurosurgery because of the very minimal operative field. In this photo above are two BISDAKs (Bisayang Dako), Sir Villamor (a Cebuano and Chief Resident) and Sir James (Iliganon and first year resident), doing a craniotomy and clipping of aneurysm. 

Cerebral angiogram of the patient being operated on the other photo above. Somewhere along the branches of his brain blood vessel ruptured creating a blood clot on his brain which subsequently causes him dysfunction. The clot need not be evacuated (depending on the volume of clot) as the brain has a natural mechanism for reabsorption but the ruptured vessel must be clipped to halt the blood from leaking. 

FUN-TASTIC FOUR! (I'm number four!) 

L-R: Alaric, Dane and Rex. 

Our block was divided into two and (un-) fortunately, I got into this group. They're the people I was with for the past three weeks until our Anesth rotation next week. Being around boys is a lot more easier than being around girls (haha! peace, girlies!). 

P.S.

Alaric, being my fan (!), wishes to be featured here in my blog. Will write about you so long as you cook a perfect meal for me and hand me a copy of your best photographic shots! Yes, I will write about it. Promise. :) BWAHAHAHA!

Parental Visit

Mama and Papa, October 2011.

It has been said that marriage is a match made in heaven. However, from a school of thought I read eons ago, when an individual is a wandering soul in heaven, he was asked who he wants to become his parents when he assumes a physical form on earth. He will have to choose his parents in heaven prior to his arrival on earth, whether a marriage between the would-be parents will occur or whether it will last or not. This  explains why there are illegitimate children and there are broken marriages. Hence, we have no right to tell our parents that we did not choose to be born! We actually did and we chose them to be our parents. 

I guess, I made the perfect choice. 

I pray for a longer life for my Mama and Papa. :)

Desiderata

When I feel like I'm on the deepest pit, my go-to book is the (behold!) The Holy Qur'an. Seriously, it is. I cannot put into simpler words the magical feeling I get after reading the Holy Book. Yesterday, while I was sitting at the nosebleed-inducing Neurosurgery case conference, I got a glimpse of Desiderata hanging on the wall. I loved this poem since forever because it is a spirit-lifting read when you have some suicidal ideations boiling inside your head. I haven't read it for quite sometimes and I was reminded when I saw it printed on a frame dangling beside the Chairman's certificate like it was saying "hello, do you remember me?". It made me smile, and so here, I share it with everyone else who have forgotten how to live a life. :)

DESIDERATA

Max Ehrmann

Go placidly amid the noise and the haste,

and remember what peace there may be in silence.

As far as possible, without surrender,

be on good terms with all persons.

Speak your truth quietly and clearly;

and listen to others,

even to the dull and the ignorant;

they too have their story.

Avoid loud and aggressive persons;

they are vexatious to the spirit.

If you compare yourself with others,

you may become vain or bitter,

for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans.

Keep interested in your own career, however humble;

it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs,

for the world is full of trickery.

But let this not blind you to what virtue there is;

many persons strive for high ideals,

and everywhere life is full of heroism.

Be yourself. Especially do not feign affection.

Neither be cynical about love,

for in the face of all aridity and disenchantment,

it is as perennial as the grass.

Take kindly the counsel of the years,

gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune.

But do not distress yourself with dark imaginings.

Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline,

be gentle with yourself.

You are a child of the universe

no less than the trees and the stars;

you have a right to be here.

And whether or not it is clear to you,

no doubt the universe is unfolding as it should.

Therefore be at peace with God,

whatever you conceive Him to be.

And whatever your labors and aspirations,

in the noisy confusion of life,

keep peace in your soul.

With all its sham, drudgery, and broken dreams,

it is still a beautiful world.

Be cheerful. Strive to be happy.