from point then to point now

it's 3:05 AM.  i can't sleep.  i've been trying to read this thick textbook on my desk, preparing and studying for my next in-service exam.  who knew that in residency we still had to take exams?  as a sort of diversion, i started opening folders here in my files.  i have files from med school, about time i deleted them right?  i started looking at pictures too.  scrolling through, i saw pictures from all the way back (scanned) as well as the most recent ones.  what particularly drew my attention were the pictures from med school.  yes, med school.  that time of my life really is one of the most significant chapter in my life.  it got me thinking of how i managed to survive it all, of how i managed to be where i am now.

it all started in 1996.  i was still in second year highschool then.  before that all i ever wanted was to be an engineer.  dad was an engineer, so i wanted to emulate him.  but i was never really good at math.  up until that point i never really appreciated how good i was at my science subjects.  it was because of my biology teacher that i started thinking about a career in medicine.  she had started med school but had to stop because of financial reasons.  she took up a teaching post in out school in order to earn and save for her med school tuition.  she told us stories of her med school days, of how fun it was and how fulfilling.  that got me thinking, hey maybe i can do that instead.  after that i was gearing up for a career in medicine.  i told my parents and they were very supportive.  (oh, and my teacher was able to go back to med school after that.)

i took up bs public health in college.  in my application form for UP, i chose bs fine arts and bs biology for up diliman and bs public health and bs biology for up manila.  3 pre-med courses and one course that totally has nothing to do with medicine.  also checked the box for intarmed (7-year straight medicine program of UP), who knows right?  i decided taking up a 4 year course for my pre-med even if another great opportunity was presented to me.  had one of the best 4 years of my life.  and it very well prepared me for med school.  we took up subjects that would also be taken up in med school (anatomy, histology, physiology, biochemistry, pathology, etc) as well as having a strong background in microbiology and parasitology.  got decent NMAT grades, good enough i guess to flaunt to the medical schools i applied to.  at that point in my life, i was excitedly shouting, "med school here i come!"

i was at a fork in the road to becoming a doctor.  which med school to go to?  it was a choice of going to UST, where majority of my friends were going, or to UERM where i got accepted first, had an innovative teaching style (problem-based learning), and not to mention where all my doctors are.  i decided to apply to UERM since i was assured of a spot, only having confirmation of my acceptance to UST after about a few days after enrolling.  even after then i was presented with another option: UP med has just recalled me.  an opening came up about a week after classes started.  after weighing my options, i decided to stay.  looking back, i think i made the right decision.  i benefited from the teaching style of problem-based learning.  making good friends and having a great time while i was there were bonuses.  i was able to pass med school, clawed my way through the hell year that was medical clerkship and survived the grueling internship year.  all that was left was to pass the board exam.

it was a rough three months.  studying, or rather cramming for the boards was all i did from morning until early morning, only sleeping a couple of hours before repeating the cycle.  i did get to have a vacation of some sort, having spent a week in boracay a month prior to the board exams.  i said to myself that had i failed the exam, this trip was to blame.  a lame excuse, i know.  but lucky for me, i passed the boards on my first take.  finally, all the hard work paid off.

looking through the pictures again, i began to scroll through my pictures during residency.  time has really flown.  from pictures during pre-residency, to first year and now to my fourth and final year, a lot has happened.  a lot has changed.  back then i was so unsure of the future.  back then all i was hoping for was for this hospital to accept me into their training program.  and after that, all i ever thought of was to survive first year residency.  i have had my fair share of mistakes since then.  from forgetting to check the patient's bleeding parameters resulting to a postponed procedure, to missing out findings in imaging studies, i've experienced them all.  those experiences have taught me well.  better to make mistakes now during training than to make mistakes in my private practice.

a little less than 6 months from now, i will have finished my residency training.  this toxic year would be over.  i will be relinquishing my duties as chief resident.  next step: diplomate board exams.  but that's looking at the future.

emergency

i was driving along fort bonfacio (the camp, not bonifacio global city), it was already around 2:30 AM.  i had just come from the interns' acquaintance party, and i must admit i've had enough of my fair share of liquor.  although a bit buzzed, i still had complete control of my faculties.  

the road i was driving on had some sections blocked off for repairs, so cars had to swerve to avoid the problem spots.  as i was near the end of the road and almost at nichol's bridge, i saw a spot where cars were trying to avoid something in the middle of the road.  thinking that it was just another repair spot, i slowed down so that i'd have enough time to maneuver my car away from the repairs.  as i was passing by the spot i found out what the others were trying to avoid.  right there in the middle of the street were two motorcycles that crashed head-on.  and right there were the drivers of the said motorcycles, lying bloodied in the middle of the road.

i quickly parked my car on the side of the road and immediately went to assess both drivers.  i came up to the one closest to me.  he had several lacerations on his face and arms, but was conscious and seemed stable enough.  after doing a quick initial survey, i told him to just stay still and assured him that additional help was on the way.

i immediately went to the next driver, and oh boy was i in trouble.  first look at the guy and i knew we had to transport him out of here and bring him to the nearest hospital asap.  he had a big contusion hematoma on his right maxilla and zygoma, he had deep lacerations all over his face, he was spluttering blood.  initial survey also showed a fractured right leg.  he was unstable and he kept on moving.  i asked a bystander to hold his head in neutral as i assessed him further.  i was asking for some first aide materials as the crash happened just a few meters from a police station.  the disappointing thing is, the police station did not have any.  i asked if they could get me some planks of wood that i can use as a splint for the fractured leg.  while all this was happening, i kept on shouting to all to call an ambulance.  my frustrations were mounting as i saw that the people were all just standing there while i tried to help out these two accident victims.  i had to hold the patient down as he kept on moving his fractured right leg.  after making a makeshift splint i personally called for an ambulance.  in less than 10 minutes one came.  imagine my disappointment when the paramedics told me that they did not have any cervical collars because apparently they already used up their supplies on the last call.

after performing some first aide, i asked the paramedics to transport both patients to the nearest hospital.  at first they told me they were going to bring them to this one hospital.  to my assessment it was too far.  i told them to bring both patients to the hospital where i do my residency as it was just a few minutes away.  i told them i'd drive behind them.  to my surprise they brought the patients to another hospital.

at the said hospital, the paramedics didn't even endorse the patients properly.  i was the one who did.  after making sure that both patients were taken cared of, i left them in the capable hands of the physicians at the ER.

blood-soaked and tired, i drove my way home.  it was around 4:30 AM when i got home.  needless to say, the adrenaline rush washed away all the effects of all the alcohol i drank hours prior.

it just pissed me off that the witnesses to the accident did not show any initiative to help.  all i heard them say was,"buti na lang may dumaan na doktor" or "buti na lang nandyan si doc!"  had the people there showed some initiative and some sympathy, we would have transported both patients to the hospital a lot faster.

(events happened June 12, 2011 at around 2:30AM at fort bonifacio)

silk 2.0

(written on January 2007, lifted from my other blog.)

summer ng May 2003 nung nangyari ito.  summer ng 2nd year college.  nasa bahay ako.  wala si manang, yung aming kasambahay, day off niya.  so ako na lang ang nagluto para sa aming magkapatid.  di naman pang-professional ang level ko sa pagluluto pero nakakain naman yung mga niluluto ko, so pwede na din.  medyo may mantika na sa kamay ko nung tinangka kong kunin ang bote ng asin.  nadulas mula sa kamay ko yung bote, nabasag sa kitchen counter at nagkalat ang mga bubog.  teka, ba't may kasamang pula?  dugo pala yun, nahiwa pala ang hypothenar aspect ng kanang kamay ko.  medyo mahaba yung sugat.  dali-dali akong tumawag sa mommy ko para sabihin ang nangyari.  pumunta daw ako sa clinic.  ilang sandali pa ay may bumusina sa labas.  nandyan na ang driver ng tita, dadalhin daw ako sa clinic.

sa clinic tiningnan ng naka-duty na doktor ang sugat ko.  nilinis ang sugat, nilagyan ng betadine para ma-disinfect.  tapos bigla niyang sinabi na kelangan daw tahiin ang sugat ko.  syet.  so eto na, tinurukan ng anesthesia tapos tinahi.  masakit din pala.  all-in-all mga 7 stitches din ang inabot.  maganda naman yung pagkakatahi.  kahit parang zigzag ang korte ng sugat ko eh nagawa naman niyang mahabol ng tahi.  after 10 days, tinanggal na yung sutures ko.

bakit ko ba ito nakuwento?  ngayong nasa med school na ako eh madami na akong natahing sugat sa kamay.  at sa paa.  at sa ulo.  at sa mukha.  pero nung unang beses ko ito gagawin, syet sobrang takot ako.  junior intern (medical clerk kung sa ibang hospital) ako nun.  paano kung pangit ang pagkakagawa?  pano kung tabingi yung tahi?  naaalala ko yung unang beses na yun.  takot na takot on the inside pero calm and collected on the outside.  form before function daw.  pero halata mo pa din na may takot.  eh ang lakas ba naman manginig ng kamay ko habang nagtuturok ng anesthesia at habang nagtatahi.  pero naging maayos naman ang pagkakatahi, down to the very last suture.  naging confident na ako mgtahi pagkatapos nun, madami na akong natahi pagkatapos.  suture sa OR, suture sa clinic, pati nga pagtahi ng bagong panganak eh nagawa ko na.

ang galing din ng nakaimbento ng surgery, pati na din ang mga gamit sa pagtahi ng sugat.  kahit nasugatan ka, gaano man kalalim ang sugat eh natatahi pa din.  gumagaling ang sugat.  pero yung nga lang, nag-iiwan ng marka, ng peklat (malas kung keloid former).  alam mong may nangyari, may pinagdaanan.  parang heartache.  pag nasaktan ka, masusugatan ka, minsan madudurog pa ang puso.  pero in time, naghihilom din ang sugat.  parang tinahi ang nagpira-pirasong puso.  pero may maiiwang marka, may maiiwang peklat.  tanda na may pinagdaanan.

nasa ER ako ngayon (may internet dito hehe!).  may dumating na pasyente, nahiwa yung kamay.

"(tawag sa nurse aid) suture set nga po.  pahingi ng silk 2.0!"

connection

can you imagine how it is a few years back, when we didn't have all these technology at our disposal?  you want to research something so you open an encyclopedia.  you type your report using a typewriter.  you don't have that fancy cellphone so you make a call using the payphone.  so much advancement has been achieved in such a short time.

with all these hi-tech stuff that we have, it is so easy to get connected.  gone are the days when you'd have to call an operator so you can send a message to your friend's beeper/pager.  now all you have to do is text him or her.  you want to know what he's doing, just open facebook and see his status message.  the world has become a smaller place indeed.

however, in spite of all these why do we sometimes feel that we can't get through?  yes, we receive text messages from friends, but why does it feel like we're not really communicating with them?  we read their latest blog entries everyday, but sometimes it feels like we don't know what's happening to them.

in this modern age of technology, i feel like we've lost that something that we once had.  we've lost that personal touch.  i sometimes feel that i've lost my connection to friends and family.  i am a people-oriented person, i enjoy other people's company.  i like to talk to them, to listen to what they're saying.  but in the midst of this busy, hi-tech world that we are in right now, the personal touch has taken a back seat.i feel like i'm talking to my friend's phone instead of her.

i am going to make some changes.  instead of just texting or talking to a friend over the phone, i'd make the effort to go to his or her place.  or set up a meeting at a coffee shop.  or just hang out with them.  that way i'd really get to talk to them.  in that way, i can connect with them.

***

not really connected to my current topic, the new fellows of ct-mri have already started their training.  they were co-residents of mine who decided to undergo further training.  it feels nice to have them back.  although i feel a bit sad that the previous fellows are not with us everyday anymore.  they're busy studying for the subspecialty exams.  i wish them all the best.

insomnia

def. repeated difficulty with the initiation, duration, maintenance, or quality of sleep that occurs despite adequate time and opportunity for sleep that results in some form of daytime impairment. (from eMedicine)

last night was one of the most toxic duties in my residency training period.

it all started out as a regular day.  i started the day at my rotation (MRI), just about our regular patient census.  as i was on duty, i assumed my duty post (CT scan) by 4pm.  when i got in, i saw their patient census and noticed that they've already had quite a number of patients already, and my co-residents were already having backlogs.  i looked at the worklist for the duty period and saw that there were a lot of patients scheduled for CT scans, even during late night.  i braced myself for a toxic duty.  guess i didn't prepare myself well enough.

call after call for patients to have their CT scans came pouring in: outpatients willing to wait, inpatients waiting for their turn, ER patients that need to be accommodated.  for every one patient that i was able to manage to type in an initial reading, 2 patients would get scanned.  benign cases, toxic cases.  in the end i had so much backlog.

eventually the toxicity died down a bit.  we were able to eat a decent dinner.  due to the sheer number of patients who had their scans, i didn't get an ounce of sleep at all.  my junior resident asked if she can lie down for a few hours and sleep off the eye fatigue and headache.  of course i said yes.  she woke up a couple of hours later and she was very apologetic when she saw the worklist.  i managed to do initial read for almost all the pending cases while she was sleeping.  i said that it was okay.  i don't feel at ease on duty nights if there are pending cases.  plus for some strange reason, sleep eluded me last night.  even if i stopped and tried to go to sleep, i never did get to.  so i just worked on.

on an unrelated note, my co-residents who recently finished their residency have all passed the diplomate exam for the Philippine Board of Radiology.  the streak continues, 100%.  i always knew they'd make it.  i've been with them for a few years now and i know their capabilities.  there was never any doubt that they'd all pass.  and now i'm officially hitting the panic button.  it'll be my batch's turn to take the exam next year.  hoping that we'll keep the streak alive.

another unrelated note, the graduation for the residents will be this thursday.  included in the program is the presentation of the incoming chief residents.  gotta have my long coat rushed, i'll be needing it for the occasion.  it'll be the first time that i'll be wearing my long coat.  after that it's official, chief resident for 2011.

and now after the adrenaline rush has died down, sleep has come to me at last.  be hibernating

looking forward

time flies when you're having fun.

or when you're not paying attention.

or both.




the year was 2007. fresh from passing the board exams (barely, if i may say so), i was pondering my career options. which specialization was i to take? there are a few number of choices.

one was surgery. i always loved surgery. back in medical clerkship and internship i always loved it when i get to scrub in. sure, back in clerkship all we ever had to do was to retract and expose the operating field (a painstaking task, especially if you had to keep the operating field exposed for 5 hours straight). but back in internship i was able to perform minor operations in the outpatient department and even had the opportunity to perform a few uncomplicated surgeries from cutting to closing. i enjoyed it. it is a very exciting field. the drawback is that it is a very stressful specialty. long hours in the operating room, on-call status, long work hours. for someone with a medical history such as myself, i don't think i would survive 5 years of surgery residency. too bad.

January 2007 during the Surgical Mission

another option was pediatrics. i loved being around children. i like playing with them, goofing around with my little patients even if it means making a fool out of myself. and kids seem to gravitate towards me, i don't know why. i guess they think i'm a kid too, although much bigger than they are. my little patients seem at ease with me. i can even make a baby stop crying when his/her mother fails to do so. it's a great joy, being around kids. i feel younger when i'm with my little patients. but sadly, when your patients are little kids and you tend to be sickly, you really can't hang with them too much. i'd make their conditions worse rather than make them better. again, too bad.

early morning at the nursery

one other option was radiology. it has always interested me, radiology. to diagnose a patient's condition using imaging techniques, that's just fascinating! a simple x-ray study can give you so much information on what you're dealing with. plus, the workload is not so much like in the other specialties. with the advancements in technology, radiology has become a very appealing field especially now that everything can be converted into a digital format and you can view the images anywhere, be it at the hospital, in the coffee shop or even at home. very, very appealing. plus, it's very challenging. so i ended up in radiology.

i applied to different hospitals after researching which has good training programs. i was fortunate enough to have been accepted into one of the best. but once i started residency, i realized how not so benign radiology can be. sure, you interpret imaging studies. but to do that for the entire day even until the unholy hours during duty nights is very tiring. i often get migraines from staring at the bright lights of the negatoscope (view box) or from looking at images on the computer monitors. and the imaging studies just keep on coming and coming. that's the drawback of getting into one of the busiest hospitals in the metro. and when you do get some time off to catch a few z's, you'll hear a knock on the door and waiting on the other side is an intern or a fellow resident who's requesting you to do an initial read of an x-ray film (if you're lucky) or a ct scan or mri study. to miss a crucial finding is a big no-no. you wouldn't want the emergency department to send home a patient because you said the study was normal only to realize hours after that the patient has a fracture only very subtly seen in the x-ray and you missed it because you were half asleep when you were looking at his/her film hours before. and i never knew there were so many books to read. each organ system has their own reference, and each modality has their own book as well. i spent more on books now compared to med school.

although it was unexpectedly tough, it was also fun. i am very fortunate to have co-residents that are good-natured, fun to be with, and who do not care about the hierarchy of residents. and the consultants are all very nice. they even take the time to teach.

time flies fast. one minute i was just starting residency, and now i'm almost done with my 3rd year. and wouldn't you know it, i was appointed as chief resident for next year. there are two of us actually. but still, chief resident. i never wanted nor dreamed of it. if there was a way to, i wouldn't be chief next year. but i guess things happen for a reason. of course being made chief is a huge honor, but it comes with a very big responsibility. i do hope i can live up to the expectations.

so here's to 2011. it's going to be one heck of a year, that i'm sure.

amnesia

i totally forgot about this.

back in college and in the early part of med school, i often found the time to write down my thoughts using pen end paper and this medium we call blogging. i've had a few blogs here and there, some of which are still active even if i don't visit these sites anymore. such was the case in this one. i totally forgot that i had this. if not for my google account i wouldn't have stumbled upon this little space in the internet i call my other blog (yes, like i said, i have a few blog sites).

when i first created this blog, i was planning to make it into an informational blog. being in the field of medicine, i planned to make this as some sort of a resource blog for cases, different illnesses, and other medicine-related stuff. i guess i never did accomplish that. but hopefully now i'll be able to inject some cases here, interesting stuff i've encountered during my training.

so here's to re-opening this blog. i do hope i find the time to fill this up with interesting stuff.