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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Crepes, Cramps, and Contractions

Just woke up from an excellent nap. Thank God for mefenamic acid and methyl salicylate and the wonders of food cooked by Mom! My headache’s gone! But before I start studying (Williams is practically begging me to read and Robbins is making its fair share of demands), let me write about this very interesting day.

My day started pretty OK. The lectures were pretty interesting – abnormalities in Obstetrics: HPN, DM, hemorrhage and obstetrical complications. I was still pretty fine during the first lecture but as the day progressed, so did my unbelievably bad menstrual cramps. It’s one of those days when I just hate being a girl! And the pain doesn’t just end there, as usual, the intense throbbing headache came soon after and pretty much ruined the rest of the lectures for me. Sayang. I really wanted to listen pa naman! I was able to rest a bit during lunch break as well as take some meds already.

Comfort food to rid me of my “those days” pains :) Thank you, Jan! The ice cream melted, but it was still as delicious as ever.

But if I thought my pains were bad, I had to think again! The afternoon saw us, Block A of Class 2017, tour the PGH OB-Gyne wards, OPD, admitting section and LR/DR (Labor Room/Delivery Room). Let me just say that it’s a sight to behold! We’ve been in the wards last year already and we weren’t able to catch any patients in the OPD since they finished early today. The real highlight of the whole thing was the OBAS and LR/DR visit.

It was just our luck that it was a high risk Monday at the OBAS. The moment we entered, I caught sight of several women waiting, probably the ones from the OPD who were referred to because of certain high risk factors (i.e. hypertensive, diabetic, young primigravid, etc.). Not far from where they were seated, there are the initial examination tables, where I believe the patients were assessed immediately after admission. Here’s where the toxicity starts. I could feel it in the air as well as see it so clearly painted in the residents, interns, and clerks’ faces and even hear it from the cries of the women seeking care and help. Our resident guide started explaining things, things I couldn’t quite hear what with the entire room being noisy and me being a bit far away from the doctor. Imagine my surprise when I suddenly hear my classmates saying my name. Huh? 

RESIDENT: O, sinong may gustong mag-OB?
CLASSMATES: Si Angeli po! *makes way for me* 
Angeli! Go!
ANGELI: Uh, yeah.. *raises hand* Ako po. 
RESIDENT: Okay, halika. Mag-IE ka!

So I suddenly found myself in front of the patient, preparing to do an internal examination. My patient (name withheld :) ), according to the resident, had a submucosal myoma. The whole experience was a rush with the resident instructing and demonstrating at lightning speed. I only had time to say hello to the patient and introduce myself as “Angeli” before a glove was handed to me. If I was so overwhelmed, I wonder what the patient must have felt at that moment. The least I could do was try and act professional, though the Lord God knows that I have no idea what I’m doing. It took me several tries to locate the cervix, something that the resident described as a “doughnut”, and yes, a doughnut it really did feel like. Though the whole IE thing must seem a bit hard to digest for some, it didn’t really had that kind of effect on me. I was more affected by the obvious pain and discomfort the patient was in as well as the whirlwind dispositions of all the OB people.

And that made questions pop inside my head: Am I really going to be able to handle this? Will there come a time when I won’t be so bothered seeing the patient in pain and/or discomfort anymore? Will I become another whirlwind mess come the stress and toxicity of duty days? I certainly hope that things will turn out to be okay in the future. Let God show me the path I have to take. May I never lose sight of what is truly important despite all the difficulties that I have to bear. #ParasaBayan

In any case, I am thankful for the opportunity – having done my first ever IE during my second year of medical school. Dad says that it takes “finesse” to do an IE properly and I hope to be able to develop my own sense of finesse in the future.

The action in the OBAS continued on as another patient was admitted and identified to have placenta previa totalis. OB truly involves bloody business, but seeing the condition in person was something else. Our group moved on to the LR/DR where, unfortunately, we weren’t able to witness a live birth. But the conditions there were quite so surprising. Several mothers supposedly in the recovery phase share only four beds, making do with the small space. There were also mothers were in pain due to the intensity of contractions, but could only wait for their turn in the OR. I felt really bad for one of the patients, the one who knew that the baby she was bearing was already dead and that she was only there to wait for the right time to expel her child. She seemed to have accepted the sad truth already, but my heart couldn’t help but mourn. The usual noisy me turned silent for a short while as I prayed for the mothers at the PGH, the mothers all around the Philippines and the world, as well as their children.

I wonder how you did it, Lolo Prim. You were one OB-Gyne to look up to. Think I’ll be able to handle it?  Will I be able to be as good as you were?

Today has reminded me why OB-Gyne is among my top choices for specialization in the future. How is the process of childbearing and childbirth not a miracle? It is witnessing the start of life right here before your very eyes! How is the sight of a mother, totally forgetting the unbearable and incomparable pains of pregnancy and labor, cradling her precious baby not one of the world’s wonders?

I end this lengthy journal entry with a thank you message to my own mom.

Mommy, alam ko po na ikaw mismo nahirapan sa pagbubuntis. 
Thank you for bearing it all for me and Chino as well 
as our siblings up there in heaven. I don't know what I
did to deserve someone like you as my mom. I thank God 
every day for giving me life, for allowing me to survive
on that day of emergency nineteen years ago, and for 
blessing me with a family whose love is always more than
I can ever hope to have and receive. You're the best :)

Now, I’m all set to study to become the best doctor I can be. :)