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. :)

2016: a farewell

7 years ago, 16-year-old me unknowingly made a decision that would change her – our – life forever. As she embarked on the journey that would shape a great deal of the person she would become, she felt like the end goal was lightyears away. 7 years was definitely a long time. 

But look where we are now, 16-year-old Angeli. 2017 is but hours away. This is our year. 

~

I spent the first hours of the last day of the year, December 31, 2016, as the duty intern at the UP-PGH Cancer Institute. As the dawn set in, and I started my scheduled monitoring of the patients undergoing chemotherapy, the patients as well as their watchers began greeting each other a happy new year. When I entered one of the rooms to check on the patients’ vital signs, one of them, Mr. S, a middle-aged man undergoing chemotherapy, smiled me and enthusiastically greeted me, “Happy New Year na, doktora!” 

It was a mood uplifter in the middle of yet another duty night at the hospital. I smiled back at him and greeted him back. I proceeded to take his vital signs and ask him again how he was doing, how he was feeling. Mr. S just smiled and gave me a thumbs-up. He then told me how excited he was about being able to go home to spend the celebration of a new year. His chemotherapy session ended that morning and he was being discharged right after. I gamely shared my own gratitude for being able to go home to celebrate. Internship has been really tough in that you sometimes have to accept that you’ll be absent for a lot of things going on in the world outside the hospital, but when you get those rare times off, you have to make the most out of every second and spend those moments with the ones that mean most to you.

The sun was beginning to rise and for a short quiet moment, before returning to the Intern’s Corner, I found myself gazing at the mini-playground found in the middle of the Cancer Institute. Little by little, the expanding sunlight brought into view the humble garden that serves as a sanctuary of some sorts to the warriors fighting the battle known as cancer. The light signals the end of yet another duty night and I am overcome once again with gratitude. It was time to head home. 

~

That’s how I’d like to summarize my 2016. Tons of gratitude for being able to come home.

 Home has never been a singular concrete place. It is that feeling of belonging, of acceptance, of love, of simply being yourself. And after the rollercoaster that 2015 had been, 2016 was spent slowly finding my way back home. 

So, thank you, 2016. It hasn’t been easy, but I’m definitely glad to be here.

I’m definitely glad to be here to face the coming year and make it what it is meant to be: my year. 

2017, here I come. 

Live While We’re Young

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.

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Weeks 1-2 of Pedia Internship consisted on unlimited charting at the OPD Sick Child Clinic and the numerous Subspecialty Clinics, and at night, ER back-up duties. Our three-woman duty team did great! Jobs tend to get a lot easier when you’re working with awesome people. But, since it’s the PGH PER we’re talking about, it is inevitable that things get a little rough every once in a while…
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And we end up pretty tired from it all. But of course, being the benign team that we are, we do get short nap times. :)) PER Triage hits! #kinderjoypamore #presentingKatyFairy || Photo credit (c) JB Besa — stolen shot! 
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Always a treat to go on post duty binge eating with these two! :)) Much to the regret of my stomach and wallet though… Haha! The post duty sleep that soon follows this is quite something as well, and the eventual realization that things have once again come full circle and you have to repeat the whole Pre-Duty-Post cycle once again. Haaaay Buhay Medisina! || Photo credit (c) Myza Espallardo

~

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.

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A beacon of light within such a sad reality… It was a common sight at our HO Ward, having do-gooders come to share food, gifts, and time with our patients. :) These characters from Star Wars came not only once to cheer up patients and to wish them a speedy recovery! || Photo credit (c) Teedee Estrada

~

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!

Twinning! :) My first catch of  Pedia Internship is this live baby boy! Cutie! Photo taken and posted with mommy's permission
Twinning! :) My first catch of Pedia Internship is this live baby boy! Cutie! Photo taken and posted with mommy’s permission || Photo credit (c) Myza Espallardo

Tales from the SOD

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.  

 

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Bringing a little dose of sunshine into the gloomy ACU! Team Sachi-TeeDee-Angeli-Biel, reporting for SOD! :D Photo grabbed from Biel Faundo (C)

 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! 

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No task is too great for this awesome duty team! :)

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…

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The feeling when you finish charting a patient only to find 10 more new charts freshly piled on the nurse’s desk… Sigh. Chart pa moooore! || The aftermath of 53 OPD consults

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.

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Hooray for the clingiest SOD duty team ever! Hanggang sa Radio, nagpunta para sabay-sabay pa ring uuwi. Thank you to our SODs, Dr. Joan Flor, Dr. Denor Sotalbo, and Dr. Kat Guillermo, for everything. On to the wards~!  Photo grabbed from Biel Faundo (C)

 

Scarred

This goes out to all the survivors, who proudly wear their battle scars both externally and internally. Fight on, warriors of life! 

 

You won’t immediately see it, but it’s there.

If you look a little closer, you’ll find that it’s unmistakable.

That mark. That permanent mark.

Once you see it, it becomes pretty hard to look away.

To some, it might look like an imperfection.

It’s a scar. Those are scars. She’s scarred. 

 

Because even if time does its magic,

And heals the wounds you’ve sustained,

There are some wounds that never do fully go away.

They leave behind scars.

Those marks. Those permanent marks.

That serve as a reminder of all the hurt and pain.

But more than that, it serves as a symbol of survival.

Those little blemishes are all that are left of that time.

You’ve done it. You’ve gotten through it.

So, never mind the stares of the ignorant.

Let them stare.

They have no idea what you’ve been through.

Wear those marks with pride.

They are proof of your strength.

It’s a scar. They are scars. We are scarred. 

Rehabilitating the Heart – 2 Stories

Part I. A Little Bit of Space

The world of Medicine can be a bit overwhelming at times. Throughout the past six years, I’ve spent quite a number of hours in deep thought, repeatedly questioning the decisions I’ve made and fearing over the decisions I have yet to make.

My first duty as a Rehabilitation Medicine intern last Saturday bore witness to yet another one of my deep thinking episodes. If you’re not in the ER, weekend duties are generally a bit more ‘benign’ in UP-PGH. Even more so, if you’re in Rehab! With no pending jobs left for me at the ward, I decided to take time to walk around the place that has become my second home.

It was a bit overwhelming thinking about how far I’ve come. I’m already a medical intern, for crying out loud. My coat bears my name with two additional letters attached to it, and I am a year and a licensure exam away from making it all official and legal. It’s been quite the journey and honest to goodness, I can’t believe a month’s already come and gone as far as internship is concerned. It all feels so fast.

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My three companions for the duty – putting a little bit of PLE 2017 (yes, trying to! this early on in the game :) ) studying with Biochemistry, leisure reading and celebrating #BuwanNgMgaAkdangPinoy with Dean Francis Alfar’s The Kite of Stars and Other Stories (brilliant fantasy short story collection!), and of course, getting some writing done (LAST.THREE.CHAPTERS.)

I still have days when I think about just abandoning the world of Medicine, in favor of a less stressful life. It’s true, after all, that Medicine is not for everyone. It takes a lot of sacrifice and patience, dealing with people at a very difficult point in their life, dealing with that gray line in between life and death. It takes a lot of heart. You’ll find that the simple act of going home becomes more of a privilege during non-duty days, and golden weekends become such a rarity that you have to properly manage your time to make the most of every moment.

But no matter how much doubt builds up within me, I always find myself going back to the start, to the reason behind all these sacrifices. Because in the end, it’s all going to be worth it. And these little bits of space in between, these little bits of quiet and deep thinking, gives me time to take it in, to take the entire journey in, with all its highs and lows, twists and turns. Every single moment, worth it.

 

Part 2: Love Hurts, Love Heals

Quite an interesting patient I had at the Rehab Med OPD the other day. R*, an elderly man in his late 60s, comes in with the chief complaint of low back pain, more so near the hip area, with pins-and-needles sensation and occasional numbness radiating down his right leg. History and physical examinations, including a positive straight-leg-raise test, points to lumbar radiculopathy, and by the looks of the MRI results he’s got, it looks like it’s due to spinal stenosis. He’s gone through several pain medications and initial physical therapy sessions, all to mere partial relief of his symptoms.

Kahit anong gawin ko, masakit pa rin talaga, doktora…” With his persistent pain, R is doubtful of another round of physical therapy. After undergoing 2 sessions, he doesn’t think it’s doing much for the pain. I reassure him and try to explain that therapy doesn’t work instantaneously. It requires patience and diligence, and results will only manifest if you are continuously compliant with your program. It will take time.

Kung magpa-opera na lang po kaya ako?” R asks, wondering if surgery will be a better option. I explain to the patient that with his work-up findings, surgery is an option, but he’ll have to follow-up with the Ortho Spine clinic to better understand his treatment choices. I then remind him that surgery, of course, has its risks.

R, however, doesn’t seem that bothered. “Ayos lang po sa akin ‘yun. Eh, kung mawawala ba ang sakit eh! Ang hirap-hirap na po kasi, doktora. Matindi na po ang sitwasyon ko sa bahay dahil sa sakit kong ‘to. Nag-aaway na po kami ng asawa ko.”

“Kaya hindi po ako naniniwala sa pagmamahal eh. Hindi talaga nagtatagal.” 

Talk about #walangforever! I was really taken aback by my patient’s statement. Then again, I, of all people, understand what he means. I know just how much pain changes people and the people around that person in pain. It is during those hard moments, the moments when your real self gets buried underneath your sickness, that the support of your loved ones matter the most. Because their support is a treatment all on their own. Their support paves the way towards true recovery, towards returning to your self and, perhaps, even discovering a whole new you and a whole new them.

The heart takes some sort of a beating as you deal with all the stresses of sickness, especially if that sickness involves a certain degree of pain. The heart would benefit from a rehabilitation program of its own, probably focusing on lots of exercises on understanding and forgiveness, and just like any therapy, you’d need a lot of patience and diligence. Results will only manifest if you are continuously compliant with your program. And of course, it will take time.

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On Mondays, We Wear Pink. :) Who run the world? #Jirls || One month of internship done with these awesome ladies, eleven more to go. Thank you, UP-PGH Department of Rehabilitation Medicine! || Having fun with your friends does wonders towards the rehabilitation of the heart. 

In the meantime, we must appreciate and take comfort in our sources of support. They serve as our walkers, our wheelchairs, our handlebars, as we regain the ability to stand on our own again, completely recovered from the pains of disease.