Tuesday, February 24, 2009

Catching Up

It's been a while since I faced the blogger screen and typed my thoughts away, but now that I have my own connection, (woohoo!) I'm looking to do it more often, not as often as Doc Ness does, but once in a while, as opposed to never. Haha.

Residency is all I've had on my plate since starting almost 4 months ago, and it is pretty evident that it's about all that's happening in my life because all my latest blogs are about it. I have to admit, that there are times when it's really hard to get up in the morning and letting go of 5 precious minutes of sleepytime and get dressed for work. But it has not come to the point where I hate going to work, so forge on we shall.

Random thoughts:

1. We began residency 4 months ago with initially 4 doctors. Of the first 4, one quit. The next 4 came in last January, 2 quit (after 1 24 hr duty! arrghh). It's hard to lose a co-worker, sort of a brother/sister-in-arms if you will, who came in with the same purpose as you did, and cover for the same person's workload after he/she is gone. But now, we are at full strength again, and hopefully we make it through together.

2. Residency has become survival of the fleetest (fastest walkers get labs first, and do the appropriate intervention and finish their rounds first). When I slow down, literally, from my regular walking pace, my fellow residents whizz past me. Everybody walks fast. Well, it helps that I take big steps.

3. I did not know Dr Madamba personally, but I knew him as one of the institutions of pediatric practice in Dumaguete City, and even had 1 check-up with him when I was a kid when my pediatrician was out of town. For him to go in the manner that he did (he was shot, for those who did not know) is a tragedy and I hope the perpetrators get brought to justice. Not only does the city lose its only allergologist albeit in pediatric practice, it loses one good doctor.

4. I sit here with the Eraserheads reunion concert CD on the player (thanks hon), and they still sound good. Some good things never do last.

5. Slumdog Millionaire wins Best Picture! Truly, one of the best films of the year. If you haven't seen it, you should.

6. Congratulations to old friends and classmates who passed the boards -- Jeanette, Laurje, Jouie, Rainier, Ver, Chiong, Pura, Dinkoy, Siao, Nevi and all those who took the February 2009 boards. Welcome to the club. With your license comes great....you know the rest.

7. I'd like to apologize to Nevi, Cindy, Baby Boi, Carrie the other day. They passed by the ER and I was busy as heck with a full house and I wasn't able to chat. Uhm, my mood was less than pleasing during that time, but I think I managed a smile in between writing orders. Congrats guys.

I'm off to catch up on some sleep, err, work with today being a skeletal holiday.

Oh the simple joys...

Good night...

Sunday, February 8, 2009

Tales from the Residency Dark Side

I had my first complaint this week. Or at least I think it was for me. And I don't think it was deserved.

I saw a patient the other day, something like a 29 year old female complaining of chest discomfort, squeezing in character associated with shortness of breath. I saw her a bit later in the afternoon and came into the OPD with an ECG in hand.

Nada, sinus rhythm, non specific ST and T wave changes (for lay speak, perfectly ok).

During the interview, I found out she has had this complaint fairly recently, she recently took the bar and was awaiting the results, and the night prior, she got into an argument with his brother.

No history of heart disease, high blood pressure, diabetes, and the like.

I pretty much came up with an anxiety reaction or a hyperventilation syndrome.

Sure, sure, it still could have been something more severe like a heart attack and the like but practicing here in the Philippines have forced doctors to sharpen their clinical skills and all the years of internships (though not much yet) told me that this was nothing like that. I could never, in my right mind, order for stress testing, angiograms or even cardiac enzymes for a clinical setting like that.

So I proceeded into what was like a 15-minute discussion of her symptoms, explained that her ECG was ok, and advised her to come back should she have any further problems.

I asked her if she had any questions, and she told me she was fine.

The next morning, while at the ER, the nurse received a call from the insurance coordinator relaying a complaint that someone consulting for chest pain the day before was not properly diagnosed.

I was pretty certain it was her.

Everybody can't be pleased. Would she have rather welcomed the news that she had coronary blockage rather than an acute stress reaction? And after spending the time I did to explain to her and her boyfriend, the nature of her reaction, I get that?

But I'll take that, 1 undeserved complaint in 4 months from a well-attended patient, that's a pretty good rate, I'd say.

Or maybe some people just have a funny way of saying thanks.

Sunday, February 1, 2009

Small Blessings

I think we've all received this text message:

Little birdie in the sky
Dropped a poopoo in my eye

then something like
I thank the Lord, that cows don't fly.

You get the message, right?

I couldn't help but remember this message as residency life goes on for me (gasp, going 4 months of Internal Medicine, who would have thunk it?).

I went on rounds with one of my consultants the other day and came to a really well-off patient in the suite room on my floor. While doing the usual check-up -- BP, physical examination, pulse rate, a random scan of the labs and ECG -- the usual chit chat came to discuss his many medical problems and previous hospitalizations. He had Coronary Artery Disease (fancy medical term for heart blood vessel blockage), hypertension, Diabetes Mellitus and had underwent bypass grafting, percutaneous transluminal angioplasty, and a pacemaker insertion all in the last 8 years.

He casually chuckled and said that he had too many problems and it was all because of how old he was.

My consultant shared a laugh and said, "Well, you have lived a full life."

My patient said, "Well, you know, life is like money, you can never have enough of it."

There it was, the lesson for the day.

Well, this statement was coming from a guy who owned companies (plural) and had loads of money, but he longed for more days to his life as well. It helps that you have money to spend during those additional days too, but what caught me was how simple a thought it all boiled down to: You can never have enough of life.

Then I was brought back to how I measured my own life -- the sleepless nights, the endless reports and assignments, the proddings from our superiors, the way we drag ourselves out of bed EVERY morning -- and stopped.

I realized, I didn't have to look at it that way. I'll try my darndest to look at the small blessings -- the extra hour of sleep I get for finishing work early, sharing a cup of coffee, studying with the beautiful woman reading William's Obstetrics across from me, helping people get well, the mystery and allure of diagnosis that got me into IM in the first place -- the small blessings.

It's true, you can never get enough of life. One would want to suck it's marrow for how many days we are given. But the funny thing about it is that we don't have that expiration date stamped across our foreheads, so even though how much likening the need for life to money, it isn't measured with the latter, it's measured in blessings -- the blessings of how we lived it.

So thank God for the small blessings.

Thank you for yet another day.

Off to do rounds again.