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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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.

 

Young, Wild, and Sick: ICC in Pediatrics

"The child is not a miniature adult."
This post is dedicated to my favorite pediatrician, the one 
and only Dr. Susan Dumatol. :* You're the best, Ma! I got to 
live your life as a pediatrician for 4 weeks and it was
definitely no walk in the park! Don't know how you do it, 
alongside taking care of two even wilder "kids" at home. Haha!
Love you, Ma~!

It’s been four great learning-filled weeks in the UP-PGH Department of Pediatrics for the awesome Babablock 3. I’ve been so invested (and not to mention, exhausted) in my studies and work that I’ve once again neglected to blog. Hopefully, come the succeeding rotations (though I think it is very unlikely come our OB-GYN rotation), I won’t have to wait until the end to write about all my experiences.

My Integrated Clinical Clerkship (ICC) in Pediatrics started with a patient contact experience (PCE) and a week of lecturettes filled with high-yield information that would later prove to be useful come our stints in the OPD. Our PCE taught us just how difficult it was for patients to come all the way to the OPD, fall in line and wait, wait, wait, and wait in that extremely hot waiting area, all for a turn to get seen by a doctor and hopefully, get the cure and care they need and want.

Then, all the fun started come the second week!

This was it! Two years of endless studying in the classrooms has led to this – it was finally time for me to start seeing patients. How nerve-wracking. I was filled with a mix of excitement and anxiety. Dear Lord, am I ready for this? Well, ready or not, I had to face reality.

My amazing ICC team - "D" Team - on our first day of OPD duty.  || Dx: cervical lymphadenitis :)
My amazing ICC team – “D” Team – on our first day of OPD duty || Dx: cervical lymphadenitis :)

My three weeks at the general pediatrics clinic and the various sub-specialty clinic I had the opportunity to rotate in taught me so much. Really, it goes beyond the art of history-taking and physical examination. I met so many kids and their parents. I got to see a glimpse of the life they’ve lived, the problems they’ve faced and are currently experiencing. I didn’t just get to examine the children; I got to play a part, no matter how small, in his or her path to getting better. And at the end of the day, hearing your patients say “Thank you!” or even just getting a smile or a high-five from your kid patient fills you up with so much warmth, you forget all the fatigue.

"D" Team takes on the recognizable patterns of human malformation in our Genetics rotation with Dr. Eva Cutiongco-dela Paz! Hooray for learning~! || One of the most memorable preceptorials! Dra. dela Paz make things so simple and easy to understand!
“D” Team takes on the recognizable patterns of human malformation in our Genetics rotation with Dr. Eva Cutiongco-dela Paz! Hooray for learning~! || One of the most memorable preceptorials! Dra. dela Paz make things so simple and easy to understand!
Extra protection - N95s on! - because of Code Black! || The code was raised due to a varicella epidemic brought about by an untoward incident with the patients and the vulnerable hospital staff, and with the vaccine still unavailable and the proper measures not immediately undertaken, the ER was closed to new admissions as well as all the pediatric wards.
Extra protection – N95s on! – because of Code Black! || The code was raised due to a varicella epidemic brought about by an untoward incident with the patients and the vulnerable hospital staff, and with the vaccine still unavailable and the proper measures not immediately undertaken, the ER was closed to new admissions as well as all the pediatric wards.
Quite a different preceptorial as well! :) OPD Sick Child Clinic with Dr. Ramon Arcadio, former UPCM Dean and UPM Chancellor. Rather than just teach, he told us stories! We picked up pointers on giving sponge baths, dealing with fever, cough and "dracula eyes" (the debate is still ongoing: conjunctival injection or subconjunctival hemorrhage?)
Quite a different preceptorial as well! :) “D” Team at the OPD Sick Child Clinic with Dr. Ramon Arcadio, former UPCM Dean and UPM Chancellor. Rather than just teach, he told us stories! We picked up pointers on giving sponge baths, dealing with fever, cough and “dracula eyes” (the debate is still ongoing: conjunctival injection or subconjunctival hemorrhage?)

On our orientation to the rotation, we were given a list of the Top 10 Most Commonly Seen Cases at the UP-PGH OPD and guess what? At the end of it all, I only saw 1 “common case” (acute gastroenteritis)! Guess our group really got to see some of the rare ones; then again, it is UP-PGH. The rare can actually become quite common here. Some of the cases we encountered include Chiari Type II Malformation, Aarskog Syndrome, Global Developmental Delay, Benign Childhood Epilepsy, Polycystic Ovarian Syndrome (in an adolescent!) progressing to what might be Metabolic Syndrome, and Subdural Hematoma.

An absolute part of this Pedia ICC experience is the playing and kuwento part! Some of the kids were really hard to keep up with! I was running out of games and questions to ask! Haha! Wild! Two of my personal favorites include a certain patient at the Allergy clinic who noticed we were struggling with our preceptor’s questions and told me, “May libro naman pala kayo eh! Bakit ‘di niyo basahin?” and the cute girl at the FMAB clinic who danced, sang and did all sorts of imaginative role-playing…up until she saw our preceptor, her doctor, and then came the association of needles and pain, and thus, the terrified shriek of “NO! DON’T WANT DOCTOR! WANT TO GO OUT! NO OUCHIE!”

I am immensely thankful for a chance to learn from the best consultants, the awesome residents and of course, the patients who truly were patient as they allowed us students to be the ones to examine them. This was truly a great experience!

One rotation down! But before that, ER duty tomorrow! Yep, they finally lifted the Code Black! Then, it’s off to OB-GYN! Yey~! I know it’s going to be toxic but it’ll definitely be worth it for all the learnings we’ll get! Can’t wait!

Reach-Out-and-Read session with my little group of intense listeners! They were also quite game to answering my questions in the interactive part! (But it looks like that one kiddie finds my face more interesting than the book! Haha!) || Thank you, Pedia! Thank you, kids! :)
Reach-Out-and-Read session with my little group of intense listeners! They were also quite game to answering my questions in the interactive part! (But it looks like that one kiddie finds my face more interesting than the book! Haha!) || Thank you, Pedia! Thank you, kids! :) || Photo courtesy of Cecile

Looking, but not Seeing II

This day came as such a pleasant surprise to me that it warrants a second entry. :) You may recall my musings earlier this morning upon the transfer of our SGD and Practicum (supposedly tomorrow, after the lectures) wherein we had to report at SOJR at 7AM. Well, it all turned out for the best in the end! Such a high yield day~! :)

First up, SGD on Eye Deviation and Globe Displacement with Dr. Veloso. We discussed a case on left sensory exotropia with developmental cataract. Ma’am was awesome! :) Not only was she pretty, she handled our session very well. I learned a lot and was also able to connect a lot of stuff from the lectures and readings. Awesome-sauce!

Next up was our dreaded practicum. My groupmates and I were pretty nervous about this because we just had the teaching session yesterday and were supposed to practice on ourselves today to prepare for tomorrow. We had no idea what to expect and what was expected of us in return. Thankfully, our patient was nice and cooperative, and as a bonus, I guess, had perfect eyesight! 20/20 OU! Absolutely no problems!

ACHIEVEMENT UNLOCKED – I was finally able to appreciate the optic disc and cup! Wooooh~! Unfortunately, I have no idea how to estimate the cup/disc ratio. Haha. Using an ophthalmoscope can be so hard. :| But there was no way to improve on it , except to practice and practice and practice.

Lectures were pretty OK too, though I had a hard time listening what with the extreme extension of the prof which almost consumed our entire lunch period.

The very highlight of this day would have to be the SGD on Disturbances in Vision with our amazing preceptor, Dr. Dela Cruz! You rock, sir! Idol! Now that’s how discussions should be done! Fun, interactive, informative! It was a great way to learn about something boring like cataracts. We were even able to watch cataract surgery videos, both the old ICLE and phaecoemulsification versions. I have to say na sobrang nabenta ni Sir sa akin ang Ophtha, which is actually a second-choice specialty of mine. Because of Dr. Dela Cruz, I’m kind of really considering the field now :D But we’ll see. There’s still plenty of time to work towards all those choices.

achromatopsia
SGD1 groupmates with the amazing Dr. Dela Cruz :) || in achromatopsia (full color blindness) view || who would have thought learning about cataracts could be fun?

An awesome day overall~! :) If only all days were as great as this one…

I’m really gonna miss the Ophtha module when it ends :( For now, aral-aral din pag may time – exam na sa Thursday~! Let me end this entry with a few words from our SGD preceptor:

"Sa Ophtha, ang patients nakakakita, 
ang doctors kumikita."