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!”.

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

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

Stepping Stones

"The river rushes ever so fast,
ever so constantly.
It is a struggle to make the crossing. 
Take one stepping stone at a time,
one foot after the other,
slowly, but surely...
Make the great leap to the other side."

- Stepping Stones, 07/18/16

Celebrating 5 years of this amazing flight through life, I present the new look of theangeltakesflight! Cool, yeah? :) Credits to Shari Altamera for the shot taking waaaay back in 2012 during our trip to Guimaras Island, and to my lil’ bro, Chino Dumatol for the great editing work!

We’ve been medical interns for three weeks now! And so far, so good, I think. It felt bittersweet to be back in the hospital after a month’s break (the happenings of which I have yet to fully chronicle), and though part of me will always yearn for the chill life, another part is actually glad to be back.

Opening the year with a week at the MICU and a week at the Gen Med ER was tiring! Thank God for awesome residents, great duty mates, and amazing block mates to make things bearable and, at most times, fun. It does make a big difference. I’ve still got a lot to learn, but I’m very eager to continue growing to become the very best doctor that I can be.

It’s definitely not easy. Once again adjusting to daily grind of the pre-duty-post cycle, as well as the countless number of orders to carry out, chart and conduct, proved to be a challenge for the brain and body that still weren’t satisfied with a month of restless vacationing (blame it on the novel that has STILL yet to be finished!). To make things worse, at the back of my mind, I’m still really worrying about STILL not having a clear picture of what I want to do after internship and boards. What path to take? What path to take?

Still, as with every journey that requires a giant leap of faith, you can only take one stepping stone at a time, one rotation at a time. With hard work, prayer, and some miracles here and there, anything is possible. The right path has yet to open for me, and I only have to believe in it!

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Presenting the Ladies of UP-PGH Interns 2016-2017 Block J!  Here’s to a great year with you, girls!

We’re currently on our Orthopedics rotation, and while I’ve never pictured myself in the field, it’s been okay so far! Then again, I haven’t had an ER duty yet, so yeah… I maybe speaking too soon. Haha! Here’s to a benign duty tomorrow! Hoping for the best! :) Now if you’ll excuse me, I’ll be spending the rest of my pre-duty day, getting some writing AND studying in.

Soar high!

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Donning the Intern’s coat really does make a difference! It makes me feel more responsible in the way that I have to be extra mindful of my actions as well as decision-making! Patients and watchers designate me with the title “Doktora” without any hesitation now. With the extra kulit bantay even jokingly calling me Doktora Kim Chiu (after the Chinita actress) and promising to help me find my Xian Lim (said actress’s love team partner). Haha!

 

 

First Cut: Angeli in SLMC Week 4

And with that last OR assist, my ‘summer’ Surgery clinical elective in St. Luke’s Medical Center has finally ended. I was able to learn quite a lot during my short stay. :) It feels like it’s over too soon!

DAY ELEVEN: MONDAY, JULY 20, 2015

OR day for me! Modified Radical Mastectomy, Lumpectomy, Open Parathyroidectomy — and learning at the Breast Conference and PIPC

What a day~! 3 OR exposures today – Modified Radical Mastectomy with Dra. Macel, Lumpectomy/Breast Conservation with Dra. Gene Padilla-Evangelista, and Open Parathyroidectomy with Dr. Domino. Thank you, awesome consultants, for orienting me anatomy-wise! Also, the surgical residents assisting in the three cases all helped me make sense of stuff, willingly answering my questions (well, the ones I was brave enough to ask. haha! Being makulit and mapagtanong, I had a lot more questions in mind, but I was ultimately too shy to ask.) Thank you, Chief Resident Dr. Maranon, Dr. de Asis, and Dr. Reyes-Lao! Let’s see if I remember some of the important tidbits…

The Anatomical Boundaries of Modified Radical Mastectomy
Superior: clavicle
Medial: lateral border of the sternum
Lateral: anterior margin of the latissimus dorsi 
Inferior: caudal extension of the breast 2-3 cm 
below the inframammary fold

- MRM preserves the pectoralis major (unless there is clear
tumor invasion to the muscle) with removal of the 
axillary lymph nodes


Breast Conversation - resection of the primary breast cancer
with a margin of normal tissue; superior to mastectomy with
regards to aesthetic appearance
On FS of the bordering tissues, should there be an area of 
(+) spread, further dissection and resection may be warranted.

At the Breast Conference, a case of metaplastic breast cancer, a rare type of breast CA involving less than 1% of invasive breast cancers, was discussed. It involved a lot of discussions on the histopathology (metaplastic involves a mix of malignant mesenchymal and epithelial components – squamous cells and spindle cells) and hormone receptor status (frequently triple negative – i.e. negative for ER, PR, Her2/neu) as well as the other biomarkers (all of which completely got lost on me. huhu). It’s a pretty hard to make diagnosis. Haha. Again, hooray for higher learning! :)

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Thank you very much for the amazing last 4 weeks, Tita Macel! :) I learned a lot and at the same time, enjoyed every experience. Yay~!

DAY TWELVE: WEDNESDAY, JULY 22, 2015

OPD Post! Just when you thought you left the Breast Center, guess what? It’s Benign Breast Day!

I got decked at the General Surgery OPD today and with the St. Luke’s clerks at their preceptorial, it was initially just me and Dr. Liquete. Oh boy. I’ve been spending much of my time at the Breast Center, since my preceptor’s a breast surgeon and the Head at that, so practically all history and PE has been concentrated on the breast, so this OPD exposure was supposed to let me see other cases. But, no! :)) It was still all about them breasts! Goes to show how common breast complaints really are. Chief complaints were mostly confined to either breast pain or a palpable mass. Thanks to my ICC stint at the OPD and the many learnings at the Breast Center, I was able to conduct Hx and PE on my breast patients with ease. Yay~! Puro r/o fibrocystic changes naman!

LAST DAY: FRIDAY, JULY 24, 2015

Open Total Thyroidectomy and Parathyroidectomy – grabe. ang laking parathyroid! Thank you, SLMC Surgery! Had a blast! :)

Ending this rotation with a bang! Chief Resident Dr. Maranon had me assist in an open total thyroidectomy and parathyroidectomy with Dr. Domino, and despite my painful wrist – still undiagnosed – I did my best to retract and hold those instruments as firmly as I should. Such a big parathyroid! O.O I think it was even bigger than the thyroid itself. Intense. Dr. Domino says in all his years of practice, this one’s the biggest he’s ever had to remove. I don’t think I’ll ever forget how that looked like. :)) Pity I didn’t get to take a picture on account of I was scrubbed in.

I very much enjoyed my stay with the St. Luke’s Institute of Surgery! :) My endless gratitude to Tita Macel, best preceptor ever, Chief Resident Dr. Maranon, who took care of my schedule, Dr. Siozon and all the consultants, the fellows, the residents, the nurses, and the hospital staff. I learned a lot. Mamimiss ko po kayong lahat! Maraming salamat po! 

This marks the end of my first clerkship rotation – inuna na talaga ang elective! It’s back to UP-PGH this August! Mixed feelings about it, but looking forward to LU6 just the same. Let’s do this! #ReignSupreme

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11805713_10205067125023823_84937025_n Pansit and cake to celebrate the end of my rotation as well as a token of gratitude for taking such good care of me over the past 4 weeks. Thank you, SLMC Surgery! :)