To This Day

I gazed up sleepily into her eyes and she let out a small laugh as I cleared the cobwebs from my head.

Aaaaghh, I dozed off again, and she wasn't giving me a hard time about it. I was on duty last night and despite the malaise slowly overpowering my body, I urged myself to go out to a nearby coffee shop to get some reading done. Getting up, she said we'd better get a move on if we wanted to get home alive and not have me dozing off at the wheel.

I knew better than to argue.

While driving, flashes of the past few years go by.

I remember seeing her coming up to class with books clutched close to her chest, the early morning sunlight streaking down her shoulder-length hair, and that ever familiar twinkle of her eyes. She gives me a smile and moves into their room.

I remember hearing her humming softly and singing quietly in perfect tune.

I know of her quick wit as we shared a laugh over a joke no one else seemed to get.

I've always admired her for being smarter than I am as she often appeared to effortlessly answer questions on exams that she would never openly admit on knowing the answers.

I remember her quiet understanding about the upsides and the downsides of my life.

The flashes go by like the lamp lights outside the car window. She was quiet as we went home with sleep slowly setting in.

To this day, she is still the same smile that lifts my spirits.

To this day, she is still the laughter that picks me up when I am down.

To this day, she is the hand that reaches for me when I reach out for help.

In this instance, she is the angel that wakes me up at this nearby coffee shop and kept me from being sprawled across the floor, passed out in exhaustion.

To this day, she saves me every waking moment.

Happy birthday.

525,600 minutes

A year ago, I was a scared, excited newly sworn-in doctor who was curious about his decision to train in internal medicine and fresh from a year of a great PGI-ship in Silliman (hence the title of this entry, piano music in the background).

I can't believe it has been one year. When they said time would fly by once you got into residency, they weren't kidding.

I'm done with first year.

Not that I'd miss having a ward with my name on it (as well as my phone number plastered all over the walls), the incessant nurses who page me every time anything went wrong from simple spelling errors on orders and deciphering unintelligible handwriting to actual codes, as well as the daily grind, DTR's (direct-to-rooms) among a whole lot of first-year stuff.

I'm moving on to subspecialties this year -- my first one is a personal favorite, neurology/endocrinology. I'll be going through a host of medical fields, cardio, gastro, nephro, you name it. Not to mention the added responsibilities of a second year medical resident.

And don't forget extended time at the ER and ICU - the dreaded rotations.

Sure, I'll miss my surgery dreams but I'll still practice shadow stitching and knot tying when nobody is looking, and I'll miss out on earning more and living the life moonlighting.

I guess I'm on my own adventure.

When I started out, I didn't get how people get into internal medicine. Yes, some part of it appealed to me then -- diagnosis, patient interaction, being in charge -- but I didn't get the dynamics of the field, the medication interactions, the fluid management and a whole lot of other stuff I could fill in but I won't. Now I have an idea of how much understanding it takes.

Not that I fully understand it yet, but trying to.

I'm one year in. Two more.

Two more and then the rest of my life.

My vote

Elections are fast approaching, and each candidate who is hoping for a shot at the glory of the presidency are out there, reaching out to people through media -- written, radio, and largely TV.

I hate traditional politics but I cannot deny its entertainment value. When election time comes, you can't help but get the latest fix of who is stacking up the most dirt against who -- from affairs and corruption to digging up old unpassed bills.

Every election time, we renew the hope of reviving our country from traditional politics and the entrenched corruption, yet who do we have as candidates? The same breed of people who were running the country in the first place.

That is why I've always been drawn to candidates who offer a reasonably radical change from the usual suspects, the usual program of change and the usual traditional politics.

The last time I voted, it was for the late Raul Roco -- which was a good couple of years ago.

I don't know if I'll get to vote this year, with residency and all. But if I do get the chance, Noynoy will most likely be at the top of my list.

I think someone who is running that actually doesn't want to run qualifies as a good sign. Having someone who does not have a premeditated plan to grab the presidency is somewhat refreshing in this power-starved government.

Whether I change my current opinion and whether I actually get to vote remains to be seen. I challenge you to convince me.

I think Conrado de Quiros said it best that Noynoy would probably be the only candidate among the rest where people will not mind being cheated on.

I think that's funny.

It's probably true.

Deadlines

Definition: Days I dread because I have to have something on that day to show for an effort spread out over a given period of time.

In the span of the next two weeks, I've had deadlines shoved in my face from a thick wad of census papers and evaluation forms, case reports, my first medical grand rounds, journal appraisals, and presentations for each one. I've driven myself crazy, sleepless over the past few days just to keep up.

I've caught a few breaks along the way -- a cancellation, being assigned to the Outpatient Department (though ER assist isn't really an easy rotation) and of course Tonette.

But all through the muck, I realized that it has almost been one full year of internal medicine residency under my belt.

And hopefully, hopefully, I'll move up a year level come November 1.

That's one deadline I welcome.

Deaths That Matter

There were a couple of deaths that mattered this past two weeks -- well, it probably did not matter to the rest of the world who did not know them but, they were intertwined and I was right in the middle of it.

In my ward, I had this patient, Mrs N who was suffering from gallstone pancreatitis. She had a poor Ranson's Score on admission and on re-evaluation 48 hours after. Her abdomen was distended with fluid and she was starting to get a yellow tinge to her sclerae and skin. But she was a fighter and gave it all she had -- smiled through the air hunger because her diaphragm was being pushed upwards by the fluid in her abdomen, followed all the restrictions, and was an over-all good patient. A doctor could not have asked for more. Her husband was always there beside her, encouraging, making her laugh, and buying the expensive medications without question.

Over in the ward next to mine was another patient, Mrs R who just found out she had lung cancer and was suffering from malignant pleural effusion (fluid in the lungs) for which she had to undergo an insertion of a tube into her chest to drain out the fluid. Pneumonia was quickly setting in and the infection was overwhelming her defenses.

Last week, on one fateful day, their paths crossed.

Mrs. N's condition worsened. She underwent an ERCP to remove the stone which was done without a hitch but a few days after that, she began to bleed. She vomited and put out blood, her blood counts were still high indicating an infection and her blood gas measurements showed severe acidosis (yup, that's bad). In the hopes of monitoring her better, her attending physician wanted her transferred into the ICU but she was number 8 on the priority list, which was not too soon enough for the attending. She told me to ask a favor from the one on top of the priority list -- Mrs. R.

At the time, Mrs R was morbid but stable. Her blood pressure had not dropped in two days. I spoke to her attending and to her and she gave me a smile, "It's okay doc, you can give my spot to her, she needs it more than I do."

"Are you sure?" I asked again.

"Yes doc, it's ok. I feel fine at the moment. Maybe if, God forbid, I have problems, I'd like to ask the same favor from the other patients." she calmly said.

So I said my thank you's, and Mrs N was transferred into the ICU.

The next day, I learned that Mrs N gradually deteriorated and was intubated, and a combination of disseminated bleeding, severe infection, and shutting down of her kidneys were among the few problems she was facing and had to undergo dialysis.

What made matters worse, was that Mrs R's BP fell. Her vital signs were unstable and infection was also taking over her system.

I was tried in vain to find a spot for Mrs. R to take so she could be moved into intensive care and I managed to move her up from number 8 up to number 4 and all the way to number 2, but, alas, they had no more money. Their lands had all been sold to keep up with the growing hospital costs.

I didn't have the heart to face her again knowing I failed. I talked to my co-resident in charge of her ward and even found out, she had expressed the desire to be transferred into the ICU, but the family had decided on a DNR status knowing full well the prognosis of her condition and the financial situation they were in.

She passed away the next day.

Meanwhile, Mrs. N was also losing her battle with her pancreatitis. The infection, the bleeding, the acidosis all took its toll on her body and she gave in and passed away the next day was well.

Before she passed away, as what I heard from the ICU staff, she pulled her husband to her side and said, "Thank you for loving me. Even up to my death, you're still here by my side. Thank you and I love you."

Hearing that, I was awash with emotions -- sorrow, guilt, failure and then later admiration.

For Mrs R, thank you for showing me the meaning of what selflessness truly is.

For Mrs N, thank you for showing me the meaning of what loving and what never giving up and finally letting go should be.

I've long posted that there will be many deaths on the roads we've taken, some harder to accept than others, some easier to let go, but what matters most is how we let it affect us.

As I close, I want to say, you mattered to me. You have affected my life in more ways than you know and I will carry the memories of these past few days with you as I go on treating patients and helping them through disease and in living my own life as well.

Thank you. Rest in peace.