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 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.

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)

 

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.

 

Heal Them with Kindness

I had my last Ortho duty last Monday and it was, like all the previous duties before it, extremely tiring! ER duties at UP-PGH have always felt like stepping into some kind of battlefield, and heading into the chaos solo is a whole new experience of its own. Huhu for clerk-less rotations! Still, I am very grateful for our kind residents who, despite facing a whole different level of stress and pressure, take time to teach and guide us as we deal with our patients.

That said, it was not at all surprising that I felt so exhausted come post-duty Tuesday. We are given a grace period in the morning to freshen up before heading to the OPD to see patients at a less toxic environment. After taking a shower, it was a bad idea on my part to decide to lie down and take a short nap. It took all I had to force myself to get up and head back to the hospital. Thank God I remembered to set alarms! My exhausted body and sleep-deprived brain were both begging me to just keep on sleeping, but of course, I must fulfill my duties as a medical intern.

At the OPD, I did my best to see patients, partially struggling with the Ortho Special Tests, what with my lack of upper body strength (I blame biology!) and the fact that my hands still bother me every now and then. All the while, I tried not to let my exhaustion and sleepiness show, knowing very well that my patients deserve my full attention and the best care I can possibly give them.

One particular patient made my day. She’s a middle-aged lady who came to the OPD on follow-up after getting closed reduction for her laterally displaced right patella. Our encounter began with me repeatedly calling out her name so as to show her into the examination room. After getting no response after about 5 times of calling, I was about to set her chart aside to be seen later on when I finally caught sight of one of her watchers desperately waving her arms up to get my attention. Her voice had been drowned out by the sounds of the OPD hustle and bustle. I instructed her to guide the patient into to the examination room, only to be met by a hesitant expression on her face. When I finally approached where she and the patient were, I immediately understood the reason behind her hesitation.

The patient was stretcher-bound! She couldn’t walk or even sit comfortably on a wheelchair, what with her right leg immobilized with a brace. As with all OPD rooms in our hospital, the Ortho OPD was a cramped space and there was no way the stretcher could be brought inside. And so, I decided to interview and examine the patient outside, right there at the waiting area.

I didn’t think I did anything unusual with the way I talked with her, asking after any new complaints, if she still felt pain, how she was reacting to her medications, as well as with the way I did my examination. But after a while of waiting and after eventually getting my chart entries and findings confirmed by the resident, I diligently explained what we saw on her post-reduction x-rays (her patella was back in place!) and what she should do about the persistent pain and swelling as well as when she should come back for her next follow-up.

It was then that she smiled and repeatedly thanked me for seeing her. She happily praised me on how from the very moment I approached her, she immediately knew how kind I was and she wasn’t at all disappointed when we began talking.

“Ang sarap-sarap mong kausap, doktora! Napakabait. Sana ikaw ‘uli ang tumingin sa akin pagbalik ko rito…” she regaled, her words instantly perking up my mood. Bibihira na ang mga mababait dito, alam niyo naman!”

 I eagerly returned her smile and expressed my regret over almost shifting out of Ortho, making it very unlikely for me to be the one to see her come her next follow-up. “Sayang naman! Good luck sa ‘yo ha. Hahanapin ko ang pangalan mo ‘pag lumabas na ang resulta ng board exam niyo!” 

Suffice to say, it was like my exhaustion practically vanished.

 

It’s funny how spending a mere 30 minutes with that patient, wherein I did nothing but talk with her and quickly examine her aching leg, had such a great impact on her. Hearing how happy she was just because I greeted her with a smile and made an effort to make the interview a lively conversation affirms my belief on how kindness can truly contribute towards the process of healing. Though there will truly be times when exhaustion and stress would get the best of us, and our tempers would be repeatedly tested, making the effort to be kind will always be worth it, not just because it is what our patients deserve, but also because it is a treatment in itself.

After all, what really makes a doctor great is not the size of her brain, but the size of her heart. 

It’s been a terrific two weeks of Ortho. I had fun and certainly learned a lot, thanks to our consultants and residents, and of course, our patients. Here’s to the continuing battle of saving lives, limbs, and functionality! :) Let’s continue healing, not just with our medical knowledge, but also and more importantly, with our kindness.

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Block J during last week’s Casting session || Had multiple chances of applying my casting skills at the ER! :) || Thank you, UP-PGH Department of Orthopedics! || Photo credit – Regina Estrada