The 3rd Amelia Lapeña Bonifacio Writers Workshop was held last July 11-15, 2018 at the University Hotel at the University of the Philippines – Diliman. This year’s workshop focused on the novel / nobela, and I was blessed to have been chosen to be part of the 12 participating fellows.
Writing is like baring a part of your soul and putting it into paper in the form of words. You can never get the writer out of the words she puts down on the page, so it goes without saying that my anxiety levels shot up high at the thought of having my words read by no less than some of the finest authors of the Philippine literary scene. As if that wasn’t pressure enough, we were also going to spend an hour and a half of the workshop discussing nothing but my words.
But the nerves eventually all went away as I immersed myself in the experience of learning and basically just having fun with people who were just as, if not even more so, passionate about literature and creative writing as I am. We had lectures on craft and publishing, all providing much insight as to the ways and means of writing the novel. The panel workshop sessions wherein we discussed each other’s manuscripts brought forth allowed the sharing of opinions and ideas that gave a new take to the works-in-progress.
We talked about character development, the many ways of driving a narrative, setting a scene, and pushing forth a message. We talked about tone and voice and metaphors. We talked about world building and the power of imagination. We talked about the importance of research and how to translate it into a fictional story. I found myself very much blown away at the knowledge and talent around me.
It was truly an experience! Though, ironically enough, I didn’t get a single word of writing done during the 5-day event, I thoroughly enjoyed the stimulating discussions and was able to take home advice to help me improve my craft. (The free food certainly helped in completing the whole experience. As in. My stomach could not keep up with the immense amount of food.)
At the end of the day, what I’m most thankful for is gaining a place within a community of artists, all intent in using their God-given gift of words to express, to educate, and to inspire. Writing may be a solitary activity, but behind that single byline are so many people who shaped and influenced the writer to bring out the very best in her words. Being amongst fellow word weavers who were going through the same joys and pains of the life of a novelist is truly a gift. I think sepanx (separation anxiety) hit us not long after parting! Haha!
I end this entry as the Amelia Lapeña Bonifacio did her speeches during our welcoming ceremony as well as graduation: Write.
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.
“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
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)
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!
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.
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!
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!
“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.
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.
I’m a little behind on my writing, aren’t I? Okaay. Maybe not just a little. Ugh. As much as I’d like to blame the whole ‘I-can’t-access-Wordpress-what-on-earth-is-wrong-with-my-Internet?!’ situation, that’s not really the real problem here. Once again, I found myself caught in between my two worlds. I spent any free time I had, resting while I could, spending time with my loved ones, and indulging in good books, movies, and dramas. I am such a lazy writer, gah.
Thus, here is my effort to get back on the road of the written word. I have at least two blog entries I have to write to catch-up (will work on those soon!), but before I backtrack, I’d better get these thoughts written down before I get too lazy again… #internshipissoooooootiringyetfun #howtomaketimeforwritingpo
As we were ending our Ophthalmology rotation (much to my absolute regret, see more in a future blog post), I was suddenly struck with an unexplicable sense of impending doom. It was weird. At the back of my head, I wondered if something bad was going to happen, or if it was a symptom of some sorts (Med Tidbit: feeling a sense of impending doom could actually point to a variety of diseases, including anxiety attacks, depression, myocardial infarction, and even aortic dissection). Thinking back, it was probably just because we were starting our Pedia rotation the next day after. Something about dealing with such a toxic rotation, and the fact that I’ve never been really good with kids, must have had me in jitters. And the only bad thing that happened that day was that I forgot my umbrella and got wet from the starting drizzles.
And now, all of a sudden, I find myself halfway through Pedia. It wasn’t bad at all. In fact, there are several moments when it was actually fun.
Weeks 3-4 sent me back to the Pedia Wards and this time around, I got to spend time with the Hema Onco patients. One of the challenges of being a Hema Onco (HO) Intern was that you went on duty alone and you were semi-in-charge of all 15 HO patients admitted for the tour of your duty. Mini-JWAPOD-ship every duty!
Still, the greatest challenge for the HO intern was probably training your heart to deal with the hardships of caring for children with cancer. It honestly broke my heart, seeing all these children, some as young as 11 months old to adolescents at the bringe of adulthood, dealing with such a complicated thing such as cancer.
One time, when I was in the middle of monitoring duties, 18-year-old L.O. (not her real name) caught me off-guard with such a difficult question. As she held her arm out so I could take her blood pressure and pulse rate, wearing such a sad expression on her face, she asked me, “Dok, kailan po ba gagaling ‘tong leukemia?“. I honestly struggled with an appropriate answer, completely unsure of how I should go about it. I went with a general reply, saying that patients, being different from one another, also responded to treatment regimens differently. She only had to do what she ought, be compliant with her medications and to take care of her self, so we could hope for her best shot at recovery.
It was a sad reality, what these children have to deal with. Instead of spending time playing, having fun, learning, making friends, discovering the world and what it had to offer, they were stuck in a hospital, getting their blood examined daily, dealing with medications and diagnostics here and there. They were forced to struggle with the war of life versus death, when they haven’t really gotten their fair shot at life yet. Meanwhile, their families, especially the parents, were facing their own battles. It is unimaginable how a father or a mother could bear seeing their child suffer. Dealing with mortalities at the Pedia ward was difficult, to say the least, both for the loved ones left behind and for healthcare workers like us.
And just like that, we’re in Week 5-6 of Pedia internship! Time to spend time with the newborns at the catchers’ area/NICU. First duty down, and it went pretty well! Here’s looking forward to more fun and learning! Can’t believe I actually worried about this rotation in the first place… Hehe!
Late post! This blog entry chronicles some of my favorite experiences from our Surgeon-on-Duty (SOD) rotation last August 12 – 25 2016 . It was a challenging yet fun two weeks that consisted of rough ER duties, seemingly endless OPD charting, and solo Minor OR stints.
The Emergency Room can be a pretty tough place to handle, what with the need for quick and systematic action in facing what may be the difference between life and death. This is especially true for the UP-Philippine General Hospital, where patients come in overwhelming numbers on a daily basis.
And when you happen to be among the Surgery interns on duty at the SOD, you have to be prepared for the rush. Wounds of all sorts of shapes and sizes. Abdominal pain of varied character, severity, location, and radiation. The different shades of jaundice. Vomit there, vomit everywhere. Bleeding love. And there never seems to be a shortage of mauling cases. All these and more, and before you know it, it’s already 7AM or 7PM – shift over!
Tale 1. What Really Matters
Two patients arrive at the SOD, both sustaining multiple injuries after a vehicular crash. Our four-man intern team quickly divides into two and takes action – fast-chart, insert IV access, extract blood, prepare imaging requests, do skin tests for tetanus shots and antibiotics, and clean wounds. History reveals that our patients, who I shall pertain to as Girl and Boy from this point on, are sweethearts who were on an afternoon drive, and a mistake on Boy’s part caused their unfortunate accident.
Girl’s most obvious injury is her forehead laceration and Sachi goes to work on suturing. With the injury not so deep and not so long, the repair is easily finished, the wound cleaned and dressed. Meanwhile, I grab a 1L bottle of plain LR, a macroset, and an IV cannula and proceeded to insert an access on Boy.
“Naku, Doktora. Tatahiin niyo na po ba ako?” Boy asks, clearly a bit nervous about getting stitched up, as I tie a tourniquet (actually a tourni-glove) around his left hand. I reassure him and say that I’d only be inserting an IV line for now.
Holding up his hand as I try to look for the ideal vein to puncture, Boy takes a deep breath. “Masakit po ba ‘yun?”
“May anesthesia naman po, sir. Pero siyempre, may kaunting sakit pa rin sa umpisa,“I reply. I get the IV cannula inserted with no problems and set up the line.
“Eh, yung kasama ko po? Kumusta siya?” Boy asks, peering outside the suturing area where his girlfriend was stationed.
“Ah, OK na siya. Natahi na ‘yung sugat niya.”
He sighs in relief. “Mabuti naman. Ang mahalaga kasi, siya…”
Amazing how love can make a person think so much of that special someone to the point of forgetting himself. Boy’s thoughts are so concentrated on how Girl is that he failed to recognize that he’s the one in a much problematic state. While Girl only sustained an easily repairable forehead laceration, Boy suffered what appeared to be an intense hit to the inguinal area, causing gross swelling and erythema of his scrotal area. One can imagine just how much that hurts, but what really matters most to him at that moment was how Girl was.
#TrueLoveAtTheER How sweet! Pa-CBG naman po ‘dyan!
Tale 2. While I Can
One of things I like the most about OPD clinic days is the fact that you get to sit down, talk and examine patients at a relaxed environment. In contrast to the super fast-paced and confusing ER environment, the OPD actually allows you to take time to build rapport, the first step in any history-taking and physical examination lecture I’ve ever attended since I started medical school.
My team is relatively toxic when it comes to OPD days. Our new patient numbers always approaches or even exceeds 50, meaning charting galore! On one particular day, everyone seemed to have urinary problems, requiring me to do the digital rectal examination more than a couple of times. Oh boy…
My patient encounter with a 80-year-old grandmother, who we shall call Lola in this story, was particularly memorable. She comes in unassisted, shuffling towards the seat in front of my desk, looking a bit winded from walking, but with a smile pasted on her face nonetheless. I greet her with an equally enthusiastic smile and proceeded with “Ano pong pinunta niyo rito sa PGH?”.
I still find it a little striking how patients can put so much trust in their doctors, especially ones they have just met, as to immediately reveal parts, if not their entire, life story. This is especially true when you actually succeed in building rapport in that short period of introduction. Lola immediately begins telling me about this mass she noticed on her left shoulder, a mass that started out small and that she ignored until it became big enough to catch her daughter’s attention. The conversation then strays away from her medical problem – the mass – and towards what I suspect is her more pressing problem, her family situation.
With times being as hard as they are right now, Lola is the one taking care of her grandchildren, even the one who brings them to school and cooks their baon. They were the real reason why it took her so long to consult about her shoulder mass. In fact, she wouldn’t be consulting at that moment, had it not been for her daughter’s insistence.
“Sabi niya sa akin, baka kung ano na ‘yan, ‘nay. Ipatingin mo na…” Lola narrated, her eyes a bit watery. “Lumalaki na. Hanggang kaya natin, ipatingin mo na at ipa-opera…” She dabs at her eyes before continuing. “Ang sa akin naman, OK lang kahit anong manyari sa akin. Matanda na ako eh. Pero para sa kanila, hanggang kaya ko, sige. Magpapatingin na lang ako…”
I did my best to reassure Lola, that we would do our best to help her. Physical examination points to a simple cyst and excision seems to be an easy option for her. She looked relieved to hear that it didn’t appear to be anything serious and thanked me for taking time to see her.
Our patients truly are our greatest teachers, more so than any textbook, trans, reviewer, or lecture. Life can be a very confusing journey, with its endless ups and downs, twists and turns. But as Lola said, for the people we love the most, we must do what we can while we can. No one knows what lies ahead, so we have to cherish the present.