Exploring Horizons

I spent a good amount of the day thinking, so much so that I had absolutely no progress with my writing, reading, or studying. I have absolutely 0% progress with that latter, since I’m still having an internal debate with myself. With certain opportunities opening its doors to me, I just had to take some time to explore my horizons.

How do you know if a certain thing is for you? I hate these moments of indecision so much. I’m so afraid of making mistakes, so afraid of choosing wrong, of getting my spirit broken and wounded yet again when it still hasn’t healed completely. As much as I don’t want to compare myself to my peers, I can’t help but do that, and be envious of the determination they possess, of the paths they’re exploring, of seeing the path they know is theirs. I’m envious of their pursuit of their dreams.

I used to have dreams. I think I still have them, but they’re currently all so blurry in my mind. I miss the days when I have such a clear vision in my head, something that’ll provide me with a drive to succeed and better myself. Right now, because of the gift of time, I’m inclined to think long and hard about what I want to achieve, and so far, I unfortunately still can’t give a 100%.

Some part of me is thinking about going back to school, but circumstances would require me to pursue a public health degree and I don’t know if I’m up for that, not because I’m not interested in it, but because I’ve never imagined myself in that kind of work. Thinking about it terrifies me.

One thing I’m really sure about, though, is that I want to spend time writing. God knows how desperately I want to complete my long overdue novels. Maybe I should take a complete year off and just write? Mom and Dad say I have to at least do something medical so as not to lose hold of my knowledge and skills. I’m amenable to doing hospital duties, but I think what I just want for myself is an OPD post, something to do in the day, so that after work, I can go home and comfortably write.

In fact, if I’m really going to be honest with myself, I’m having an extremely difficult time deciding because what I really want is a medical field that will allow me time to write. Yes, it’s such a big part of my life that I really don’t want to sacrifice writing for a hardcore specialty. I love the OR, and it’s my happy place, but a lot of things are making me hesitant about pursuing Surgery or OB-GYN primarily because of the toxicity that will never allow me time to write (let alone time to think about writing), as well as the physical and mental demands of both. The relatively lighter field of Ophtha was what attracted me the most to the field, and it still seems like what can give me the best balance of my two wants. But the field is dangerously competitive nowadays and because I’m so afraid of getting my heart broken again, I want to be 100% certain that I want it before putting myself out there again.

Sigh~ This is so hard. I just want to commit to something. I wonder when I’ll ever reach, or even go near, 100% certainty.

Lord God, help me.

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The Year, My Year

“Our eyes are placed in front because it is more important to look ahead than to look back.”  – Anonymous

Hey! It’s been a while, I know, and a lot of things have happened since I last visited my little nook here in cyberspace. Not to worry though! I will try to get entries written more often, now that it seems like I’ve suddenly got a lot of time in my hands.

First things first – seeing as my last entry was waaaaay back during our OB-GYN rotation, I’m pleased to write that I’ve successfully finished my internship, graduated from medical school, and passed the Physician Licensure Examinations last September, making this my first Flight entry as an official doctor. Yay~! I did lots of studying during the interval, as well as a lot of self-doubting, crying, praying, and contemplating life decisions. But after all that, it’s been decided that I do not plunge into residency just yet and instead, come up with this battleplan: The Year, My Year.

You see, I realize that it seems that I’ve been rushing through things all my life. I didn’t get to graduate grade school since my parents thought I’d be fine without taking Grade 7, so I transfered schools to get into high school straight from Grade 6. High school was great, probably some of the best years of my life), and then came college/med school wherein I was given the opportunity to rush ahead again, this time in the form of the prestigious Integrated Liberal Arts and Medicine (INTARMED) program of the UP College of Medicine. I was to spend only two years of pre-Med before diving into the trenches of medical school. Those two years were fun, thanks to great company, but they were also some of my most trying of moments – everything had to be learned at a faster pace, and what made it even more difficult is that I had to act like I wasn’t having a hard time with all of it, especially since I was surrounded by geniuses, knowing that I was nothing like them. Hindi pala ako matalino, nagsisipag lang.

Even while pursuing residency programs, it still seemed like I was rushing, what with, at 23-years-old, I appeared one of the youngest among those in the running. While I think it’s ultimately not the case, a part of me can’t help but think that my age somehow turned against me with consultants commenting  “bata ka pa naman”, or “you have youth on your side, it’s okay”, or even “okay lang ‘yan, magpa-mature [ka] muna”. But, my youth is besides the point – the bottom line is I didn’t qualify now; it’s not for me yet, it’s not yet my time.

Maybe this is God’s way of telling me to stop rushing and just take some time to rest, explore, and grow. He knows just how exhausting it’s all been for me, in more ways than one. There’s never been a race, anyway; we get to our own finish lines at our times. 

For now, I’m eager to claim this year as The Year, My Year. In fact, I have such high hopes for this year that I’m officially making a tag just for it, so as to compile this and all future entries

I’m happy to look forward. 

I’ve been watching old and new Asian dramas just because I have the time now (especially when I get writer’s block). Here’s something from Atashinchi no Danshi, a J-Drama way back from 2009. :)

Why I Do It (and Why I Continue Doing It)

You never forget your first love. Even if you’ve already come into terms with the fact that you’re definitely not going to end up together, your first love still occupies a special part of your heart. I initially had qualms about facing my first love again and to make things even more difficult, we were to spend two whole months together. Dear Lord, how am I going to survive this? 

But here we are. It’s over. My OB-GYN internship rotation is officially over, and I’m exhausted. I feel so drained both physically and mentally, but every day of that seemingly endless pre-duty-post cycle was worth it. I learned a lot. I had fun. And most of all, I got to be a witness (as well as directly assisting) in the everyday miracle of bringing new life into this world.

Pre-Duty days were spent charting countless of new and follow-up patients at the OB-GYN General Service out-patient department. Normally, I liked seeing patients in this kinds of environment, since it’s relatively more benign and there was no pressure of urgency, but there were days when the OPD still went a bit out of hand. Intense. One particular day had us charting way past 5pm in the afternoon. I didn’t get the chance to eat a proper lunch! Still, our days at the OPD gave me the chance to learn from the rich pool of patient cases in UP-PGH. I know the basics of pre-natal check-up like the back of my hand, and can confidently do internal examination and the Pap smear test. What a far cry from my old self, who basically panicked at the thought of having to do IE. (Read about my memorable LU IV OB-GYN experience here: Crepes, Cramps, and Contractions)

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Service B-est! :) Endless charting at the OPD is nothing when you’re with awesome co-interns and residents! || Photo from Biel Faundo

Duty days were, of course, where the action was. It was real roller coaster ride going through 4-5 straight OBAS (OB Admitting Section a.k.a. OB emergency room) and LRDR (Labor Room – Delivery Room) duties. All those unbelievably toxic duties! In the OBAS, we practically defined fast charting. And every time our resident would yell out “Admission!” caused a rapid call to action to ‘admit’, which entailed inserting an IV line, drawing blood, making the patient’s identity “flag”, and of course, the insistent reminder to fill up that patient info slip (the perpetual Kaalaman form). I was unfortunate to have two Labs Master duties, both on High Risk Fridays. This meant that I had no other task during the duty day, except to run up and down to and from the Department of Laboratories to submit specimens and retrieve and take note of results. And when there is a suspected pre-eclampsia patient, stat Alb meant stat Alb, and make sure the labs know it!

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The benign color spectrum at the LRDR :) Thank you, thank you to our stellar clerks and our awesome residents for everything! And of course, thank you to all the mommies who allowed us to be a part of an important milestone in their lives. || Photo from Gienah Evangelista

 

On the other hand, LRDR duties were spent on labor watch. Whew. All that toco-monitoring! All that TIC (Temporary-In-Charge) work, what with all the LR backlogs I had the weird tendency to get decked Young Primigravids (ie. 18-year-olds and below who were pregnant for the very first time), so you can only imagine how my patience was repeatedly tested by these obviously-too-young-for-this types. They generally had a low pain threshold, so they didn’t take labor too well. I had to repeatedly counsel them about the responsibility they were to face as new mothers, and that they had to stop thinking only about themselves from that point on. Another life was going to be at the mercy of their hands, come the birth of their child.

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I love Pay duties. I love witnessing the “ideal” side of things. But most of all, I love Complete Bed Rest duties. Yaaay~ || Photo from Gienah Evangelista

 

I definitely wouldn’t miss the 24-hour monitoring duties at the OB ward, not to mention the grabe-naman-tama-na-po list of To-Do’s that required me to line, line, extract, and line some more. The end of OB-GYN also marks the potential end of my OR career, should I choose not to go into a cutting specialty in the future, so there’s that to think about. And yay, no more 7AM Summary Rounds! No more I-don’t-know-anything Gyne Onco and Tropho Rounds!

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“Nasaan na ang pasiyente? Higa na sa kama! Tanggal ng pambaba!” 

All-in-all, I’d say that I had a pretty fruitful OB-GYN Internship rotation. I had a blast helping all the new mommies. There were definitely days when I would repeatedly question why I continue to do this doctor thing. God knows how extremely difficult duties can get. And though you are granted a day of rest what with the true post-duty status, it can never be enough, ’cause before you know it, you have to go on duty yet again. It never ends! It was definitely a bloody business, but I learned that as long as you push hard enough and don’t give up, good outcomes can definitely be expected. It was all definitely worth it, considering everything you’ve gained at the end. #BabyOut

Hinga ng malalim, pigil, and push! Only 70-something more days left of Internship! Let’s do this!

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Community Medicine Week 5: Familiar Paths

“Home isn’t a place. It’s a person.”
– Stephanie Perkins

Tita Nini, the midwife of Barangay Luksuhin Ibaba, and I were walking towards the tricycle terminal, together with one of our Barangay Health Workers, Nanay Aida, after another long Wednesday clinic day. Wednesday was our busiest clinic day, the day when most of the patients came to consult, especially the pregnant women who were to be seen by the midwife for their prenatal check-up. That said, it was quite understandable why the three of us were eager to go home and rest a bit.

We were halfway towards the Luksuhin Public Market when Tita Nini remembered she had to check something out at one of the local parlors. Parlor-parlor din ‘pag may time! Nanay Aida offered to come with her. I smiled and said that I’ll go ahead of them.
“Sigurado ka ba, dok?” asked Tita Nini, looking a bit reluctant to let me go off alone. “Kaya mo ba mag-isa?”
“Ay, oo naman po, Tita Nini! Kayang-kaya!” I laughed, reassuringly. My two companions heartily laughed along while waving good-bye and walking towards the direction of the local parlor.

As I proceeded towards the tricycle terminal on my own, I thought about the ease at which I reiterated that I was fine on my own. I also realized that it was true, that I could easily head back to Barangay Sulsugin by myself, that I no longer feared getting lost, that I knew my way back to my foster home, that a lot about Luksuhin Ibaba has become familiar.

Five weeks can never be enough to fully understand a place and a way of living, but in this very short time, I’ve grown to be fond of these paths. It is a far out cry from my first week, during which I felt like a lost wanderer most of the time. I remember being so wary of having to commute everyday just to reach my assigned barangay. I remember being so afraid of getting lost, of ending up who knows where with no idea how to get back home. But now, the paths have become familiar. The place has really grown on me.

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The barangay health workers of Luksuhin Ibaba, Dr. PJ Francisco (Family and Community Medicine resident), and I after our vital signs OSCE || It’s been a great five weeks. Thank you for making me feel right at home! :)

But more than the place, what I’ve really grown fond of are the people. Also among my fears upon starting out was feeling a bit lonely amidst all the new people. Though I’ve never been much of a shy person, there is still always that worry that there’ll be difficulty getting along with people. But everyone here has been more than welcoming. The new-found friends in my health team as well as within the other people of the community will surely never be forgotten. I’ve learned a lot from them about the simplicity of life, the dedication to work, and the importance of family. Because of them, despite being a mere visitor, I felt that I found something of a home here in Luksuhin Ibaba and in Sulsugin.

As my community medicine rotation is slowly coming to an end, I hope I was able to contribute something, no matter how little, for the betterment of the people of Luksuhin Ibaba.

Community Medicine Week 4: Recognized

” There is undoubtedly a lot of pressure that comes with recognition, which can be a good thing and a bad thing all at the same time.”

– Prabal Gurung

I had just finished another clinic duty and was walking towards the tricycle terminal found just behind the public market. I was in the middle of one of my usual daydreams when I was suddenly pulled back into reality by an eager “Hello po, doktora!”. Looking up, I saw that it was one of the tricycle drivers. He was already pulling away from the terminal, a passenger on board his vehicle, but when he saw me, he took time to greet me and even call out at his fellow drivers, informing them that I needed a ride. The man I assumed to be a foreman of sorts directed me to an empty tricycle and immediately informed the driver where I was going home to. I didn’t have to say anything. They already knew.

It felt strange to be recognized. I honestly couldn’t remember how I got acquainted with the tricycle driver, if he consulted at the barangay health station (BHS), at the rural health unit (RHU), or maybe even visited our foster home in Sulsugin as an acquaintance or relative of our foster mom. There was nothing about my appearance that may have tipped him of my identity. I wasn’t in scrubs, wasn’t wearing an ID, nor carrying any of my medical tools. The tricycle driver simply knew that I was their doctor.

Going into this rotation, I knew that it was going to be a challenge being the sole doctor at the barangay health station. With Luksuhin Ibaba being the largest and most populated barangay in Alfonso, I had the additional challenge of having slightly more patients than my co-interns. That said, maybe it was inevitable that people would start actively seeking out this sole doctor. For some of them, you’re the only doctor they’ll ever get to see.

It really is such a different world here in the community, compared to what I know in UP-PGH. Back in the hospital, my patience would repeatedly get tested after being called “Nurse! Nurse!”, “Ate! Ate”, or worse “Ineng! Ineng!” by patients and their watchers. All these, even after all these years and after finally earning the right to wear my Intern’s coat. I’d all but grown tired of correcting them about my confusing position as ‘almost a doctor’. But here in the community, even without the coat, people recognize me as their doctor. And though this initially brought me delight, thinking that, at last, I’ve sort of arrived! I actually talk knowledgeably and act skillfully enough to be seen as a physician!, the recognition now brings a little bit of panic in me. For I once again realize that to be called and recognized as a doctor is more than just a title, it is really such a big responsibility. Being a doctor makes people put their utmost trust in you. There will be moments when you’ll literally have lives on your hands.

“…to be called and recognized as a doctor is more than just a title, it is really such a big responsibility.”

Two more weeks remain of my stay as the intern-in-charge of Barangay Luksuhin Ibaba, and I’m planning to make the most of every moment. I’ll do my best to prove worthy of my patients’ trust and their everyday greetings of “Hello, doktora!”.

Community Medicine Week 3: In Good Company

“People are always good company when they are doing what they really enjoy.” 

– Samuel Butler

A big part of Barangay Luksuhin Ibaba is found along the major highway of Alfonso, the long road that stretches from its welcome arc and passes through several barangays before arriving at the town proper. However, a part of Luksuhin Ibaba’s Purok 3, the largest and most populated of the three, is a bit more secluded. Nasa looban, as the locals would say. It is a part that can only be reached after passing through several small passageways, zigzagging this way and that. That said, the residents of this part of the barangay find it a bit difficult to reach the barangay health station (BHS), which is located along the highway. It is quite the walk towards the Sulsugin-Luksuhin road, where they will be able to ride a tricycleon the way to the BHS.

And so, the barangay health team [that is, the barangay health workers (BHWs) and I] decided to hold a satellite clinic day last Thursday, February 2, 2017, at this part of Purok 3, so as to reach out to those unable to go to the BHS. Nanay Linda, one of our BHWs, generously offered the use of her house as the host of this satellite clinic. We converted the dining area into a clinic of some sorts, bringing along even the height chart from the BHS.


The most memorable patient encounter I had at our Purok 3 satellite clinic would have to be Lola L.M., who I wouldn’t have thought was already 94-years-old. Still strong for her age, she had a smile on her face as she entered Nanay Linda’s dining room, albeit with some difficulty due to her aching legs. Lola  L.M. was a known hypertensive, but she admitted having difficulty complying with her medications. Through the efforts of our BHW, she would have her BP monitored, sharing that the highest reading reached up to 200/100 mmHg. Lola L.M. had a bit of difficulty hearing as well, so she had one of her neighbors, Nanay A.C. (also the one who accompanied her there at the satellite clinic), help her understand my questions as I continued history-taking. I tried to probe as to reasons why she was poorly compliant to her medications. It was then that Lola L.M. began to tear up as she related how she was already living alone, how all her children already had their own families and had moved out of Alfonso, how she couldn’t commute, much less walk to the main road, all the way to the BHS.

 I couldn’t imagine how a 94-year-old lady, even if she was as strong as Lola L.M. was,  could live alone. It was truly saddening. I thought perhaps that beyond her uncontrolled hypertension, beyond her muscle pains, what Lola L.M. was really suffering from was loneliness. Thank God for neighbors and friends like Nanay A.C., who take time to help her with whatever she may need. At the end of the day, I was really happy to have been able to come see Lola L.M. and the other patients who found it difficult to reach the BHS. 
In the true spirit of Filipino hospitality, Nanay Linda, assisted by the other BHWs, prepared a feast of sorts, food that wasn’t just limited for us, the health team, but offered to every patient who came to consult at the clinic. My tummy had a hard time keeping up with all the food they prepared, but of course, I gamely tried all the dishes.


The sudden downpour of rain that came in the afternoon, a few minutes after I saw the last patient, paved the way for lively chatter among our barangay health team. This, of course, could not be complete without more food – we had coffee/hot choco + pan de sal during the long conversation. It was stimulating to be among such people, whose friendship and bond were apparent for all to see. They talked about their work. They talked about recent events happening within the barangay and beyond. They talked about their families. They talked about their past interns. They shared all sorts of stories that I happily listened to. I could tell that despite it being a volunteer job,  despite there being some problems along the way, these women, when it comes right down to it, enjoyed what they were doing. After the sky cleared up a bit, I went home that day with my stomach full and my heart happy to have spent a day in good company.

Community Medicine Week 2: Breathless

“Life is measured not by the number of breaths we take, but by the moments that take our breath away.”  

                                                                                                                                             – Author Unknown (Uncertain Origins)

When a patient comes to you, complaining of difficulty of breathing, a long list of differentials come to mind, ranging from the apparent pulmonary etiology to the more complicated renal pathology. But in the case of A.D., 23/F, it is highly probable that her shortness of breath is caused by an exacerbation of her bronchial asthma, most likely exercise-induced. It is probably her own fault, knowing that her lungs can’t handle prolonged walks, much less keep up with her healthy, non-asthmatic friends when it comes to physical activity, yet still attempting to assert herself. Ayan tuloy, hingal na hingal…  To think I’d have an uncontrolled asthma week here in the community. Sigh…

It is ironic that an aspiring doctor such as myself would have several co-morbidities, yet it is proof that physicians, no matter how much they are sometimes revered as mortals attempting to combat death, one disease entity as a time, are still quite human when it comes right down to it. A beloved Family Medicine consultant once told me that I should look at my illnesses as a sort of blessing in that they help me empathize more with my patients. I know first hand what pain is, and not just physical pain, and I know first hand how difficult and extremely debilitating it can all get. I know what it’s like to feel so hopeless, when you feel so, so weak that it’s hard to even feed yourself. I know what it’s like to gasp for air, to literally be breathless. 

when the doctor becomes the patient…. || 23-year-old female presents with shortness of breath and slight chest tightness; Tx: Salbutamol 2mg/tab q6 for now || Never take breathing for granted. Some of us find it so difficult to do.

So, even more so now that I’m in a way running my own clinic at the Luksuhin Ibaba Barangay Health Station (BHS), I make it a point to listen to my patients’ stories, to believe in pain scores, to take note of all complaints. If it is something they deemed important enough to warrant a consult, then by all means, let me do my best to address all concerns. I’ve heard all sorts of complaints during my clinic duties at the BHS. There was a young mother who brought her 2-month-old baby for ‘loss of appetite’ when in fact, the baby was well and healthy, just a little bloated and  needed a little burping. I simply taught the mother about feeding cues and to not force feed her baby. I also had a variety of ‘headache’ complaints, the history-taking of which was almost enough to induce a headache of my own. Di ko po alam, doc. Basta po masakit! goes on, while another insists, Ay, 10 out of 10 po talaga, doc! Ganun kasakit! Still, pain is subjective. 

My determination to hold clinic today despite my breathlessness seems to bear little as I only saw three patients today. But maybe, for the three of them, my efforts were a big deal. They were able to see a doctor (well, almost a doctor) today. They were able to get free medicines today. They were able to be advised today. And as always, I am comforted by their grateful smiles. 

I remain constantly appreciative of the little moments, those quiet patient times when you can just converse freely with patients. A welcome change from hospital life (UP-PGH life, in particular) where everything seems to be in fast forward and just the mere thought of taking your time is seemingly punishable by demerit. It is these quiet moments that frequently go unnoticed, frequently taken for granted. We are sometimes so overcome with excitement, with adventure, with twists and turns, that we fail to appreciate the quiet times. 

But they are, in fact, what we live for. They are the very moments that make every breath we make worth making.