I've listed down in random order the things I would do after passing the physicians licensure exam. 

Inshaa Allah, all of these shall begin after August this year! Waaah! I can feel the chills down my spine!!

Ending 2011 Right. :)

I never anticipated that I would end 2011 on a road trip. It was merely a wish I do not know how to put into reality considering the meager time I have for myself. After my IM (Internal Medicine) rotation which demands interns to stay 90% of their time inside the hospital, I longed for a vacation where I could just forget the hospital and just relax.Oooohh...relax. The word. I initially swayed my best friend Lily to come here in Manila so we can set off into an adventure but she lacked time as well. FYI: she's also a doctor which justifies her reasons for not coming. So when my cousin Ate Hannah buzzed about an impending three-day family trip to Subic and Baguio, I never thought twice and asked about the details. Luckily, I was already rotating at Rehabilitation Medicine which is benign so I planned for my great escape!! Hohoho! 

It was my first time at Subic and Baguio, hence the pure excitement!! The weather was perfect for a road trip! The sky was azure blue as the sun smiles on its mighty throne!

We stayed at The Lighthouse Marina Resort, Subic Bay. The place was impeccable! Just perfect for hanging loose! 

Star sighting: actress Dawn Zulueta and her husband's entire family were also there. She kinda irked us for being snob, but hey, she could just be in one of her mood swings! So, um, forgiven?  

Hosni and I ready to zooom!!

Subic is quite synonymous to Zoobic Safari and Ocean Adventure but unfortunately, I wasn't able to experience those as we arrived late in the afternoon already. Instead, we joined the boys on their jet skiing spree! I looked so ridiculous because I'm not even on a jet skiing gear! SO WHAT? I had fun!! I bet my cousin Hosni couldn't stand me screaming my lungs out as he sways the jet ski to full speed I had to really hold on tight! That was superb!!!! I will definitely return to Subic one of these days and experience everything! :)

Breakfast buffet at Sands Restaurant, Lighthouse Marina's premiere resto. The food was excellent I was able to try and discriminate different types of cheese! My favorite? CHEDDAR still! Hahaha! 

We had to leave Subic early the following day in preparation for the long road trip to Baguio City! We had an heads up that it's chilling 12 degrees celsius in the Summer Capital of the Philippines!!! To my ultimate surprise, beads of sweat were rolling down my forehead as we explore the Philippine Military Academy and The Mines View Park! And I thought to myself, all those people wearing winter clothes here in Baguio as if it's raining snow were all fooling themselves! Hahaha! And oh, Session Road was filled with heavy volume of people almost equal to those in the metro! 

Photo collaging on the web with a slow laptop and slow internet results to such disaster! I'm sorry baby Fia! 1/4 of her plumpy cute face is obliterated by an unwanted road photo! Sorry babe! 

The traveling team! The Khalil-Ayo, Ayo-Tomawis Families and I! LOL! 

Sabreen was highly ecstatic as she runs and giggles! Kulang na lang mag-somersault and bata! Haha!

 Emoterang Asma beside the beach where we jet skied. 

My nieces made the trip extra memorable! Although they'd sometimes throw tantrums, their adorableness overrides their tantrums you'd just want to carry them in your arms so they's stop crying! Cuteness overload! 

There. I'd end my entry with this hilarious photo of the year! Haha! We paid ten bucks each to wear the traditional Igorot costume! Kalurkey!

I'd be forever grateful to my cousins who made my year end with a huge bang!!!! 

Hoping for more travel sprees this 2012! Cheers yo! And, HAPPY NEW YEAR! 

This is the hallway that connects the two wings of the Outpatient Department building. I find it very dramatic as the rays of the sun penetrate the glass roof creating shadows behind those pillars. To put it in a movie, this is where a couple break their vows of love as the other walks away leaving the other soaked in tears. 

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. :)

Say No To Prejudice!

As I scroll down my Facebook homepage, I come across this post by Atty. Algamar Latiph to Atty. Toie Mitmug's  page. 

"Glad to hear that Anti-Ethnic, Racial or Religious Discrimination and Profiling Act of 2011 is in bicameral committee. glad to be one of the first lawyers who wrote the first working draft during the time of then AMIN Cong now RG Mujiv Hataman who first introduced and sponsored the bill at the House of Rep. I still remember when we sat with Amie Sangcopan and Raissa Jajurie i think on Nov 5 2008 at Greenhouse. Couple Atty Toie Alonto Biruar-Mitmug and Ras Mitmug also volunteered. Hopefully, this bill will be enacted into law so Muslims in this country can have a legal mechanism to redress wrong against discrimination on account of ethnicity and religion."

I am more than glad to know that there are people who exerted an effort for passing such bill. Majority of non-Muslim Filipinos, especially those in the northern area (Yes, I mean Luzon and the National Capital Region) may deny that there is an actual racial discrimination going on, as they claim that we are their "Muslim brothers" who enjoy the same rights as everyone else. However, they may be unconscious of their words or actions, but racial and/or religious stereotyping is an undying epidemic.  For instance, I was walking with a male co-intern to grab a lunch when my phone rang. It was my cousin who I normally greeted with "Assalamu'alaikom"  preceding our conversation. I absolutely heard this male co-intern let go of a loud sneering sound while I was talking over the phone. As I put down my phone, he asked me what "Assalamu'alaikom" means so I did a little lecture on how we, Muslims, politely greet one another. As the person that he is who keeps on teasing me a lot about every little thing, he said: "Hindi eh. Sinasabi nyo yun kasi by default, at war kayo sa lahat ng tao kaya kelangan niyong i-declare muna na at peace kayo with the person na kakausapin niyo". He was saying those words guiltlessly while a mocking smile was painted on his chubby face. And then our endless debate about my being a Muslim and his being a judgmental, narrow-minded person began (Of which, he wholeheartedly claim that he is a bad, bad, judgmental person). He would utter sentences that imply prejudice such as, for instance, when I unintentionally commit a mistake, he'd say "Ganyan ba talaga kayo?", or, "Muslim na 'to oh". He say those words in a joking manner, because he's really funny by nature, but I honestly take those words as a form of discrimination. And yes, I tell it to his face how pernicious he is. But you know, you can never straighten a crooked perception until you show them the truth through actions.

I think it's pathetic that we actually NEED to create a LAW so that majority of this nation's citizens will change the way they see us. But this is just the first of the baby steps towards achieving "total freedom" without declaring independence from the entire system. 

And yes, I am more than glad for the passing of this bill because when the time comes, I can literally file a lawsuit against this co-intern of mine who enjoys and loves bullying me. Hah! *evil grin* Now I can actually hear him say "Ganyan naman talaga kayo eh!". 

Facebook It!

While Facebook has become the perfect avenue for giving people a piece of your mind, there are stuff that you can't put on Facebook because you know it will light a fire and you don't want that to happen. In this tiny nook of mine, I know this is the perfect place for shouting:

DO NOT PROVOKE ME! I BITE TOO, BITCH!

I may be keeping my silence most of the time, laughing things off and pretend it didn't occur, but hey, I know exactly what you're talking behind my back. Now I'm telling you this, YOU'RE NOT PERFECT EITHER SO DON'T PRETEND LIKE ONE. Nuff said.

P.S.
I wish the font size could get any larger than that. My emotions are way too huge for those font size! Haha. 

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!