Friday, September 16, 2011

The Blur of Residency

Three years.


As long as that as has been, I can still remember how I was during that day -- nervous but quietly confident they'll pick this newly minted physician from Dumaguete City, who knew nothing but hard work, who was naive enough to think he was going to make a difference in the world, and bullish enough to think he could do it.

It's during these times where things are kind of winding down that, it's always nice to take that proverbial time to smell the roses.

My first day: November 1, 2008. Floors assigned were 1A, 2A and 2B. I remember the mad rush for labs, the fear that my patients die at my hand, and the relief that washed over me when I turned my floors back over to the on-duty residents the next day. It was a skeletal duty day, and for those who aren't medically inclined, only those that were necessary to make the hospital function were on duty as it was, after all, All Soul's Day.

Wanting to be the upstart resident that impressed on the first day, I religiously went through all the rooms in my wards (as it should always be, wink) and did every S-O-A-P method I could think of. I had an ICU Set-up patient at floor 2B that I really really did not want to be the one to kill, so I did a more than meticulous PE. I was in there for a good couple of minutes, inhaled all the cold, musty hospital air, and then read the label on the chart.

All the precautions in place. Meningitis. Oh, crap. I was so sure I felt my neck stiffen once or twice during the whole 24 hour duty.

When that patient had episodes of dyspnea while on his ventilator, I did my best to do the troubleshooting of the settings. When I decided I needed help, I called my immediate senior, and I got the first revalida and grilling of my young residency. No worries, I learned. First, never call without actually having some idea of what I needed to refer. Nevertheless, I didn't kill my patient, and I grew to respect my senior as he would become a source of infinite learning to my batchmates and I as we went through the muck of residency together.

My first mistake: One can never get through training without falling down once, or twice along the way. I had my share. I made the mistake of sending a text message to one of my attendings about a patient who had gone into acute atrial fibrillation, became hypotensive, among other things. It turned out he was on his way to the patient, but his reply throught text reached me first -- ALL CAPS, telling me that I should call if I needed to update critical patients. That I was not being trained by his INBOX -- I laugh now, but the first time I saw that message, I thought my spirit left my body and I was looking at my pale, drained face from the next floor. Imagine my surprise when he, just as suddenly, appeared at the patient's door. I tossed him the chart and ran -- kidding, I actually survived and he was a bit more forgiving in person.

The next time he reprimanded me was for waking him up so early for an update.

He became one of my ninongs at my wedding.

I had other mess-ups, some my fault, some not entirely mine. But, like any good resident and any good friend, you take it all on the chin, put your head down then barrel your way through.

My first code: I was first year. I informed my immediate senior but after a really busy night, she was out like a light. She answered my call, said she would be down, but never got around to doing it -- where cases like the mind is willing but the body is too weak proves to be exceedingly true.

She was a Breast Cancer Stage IV with metastases to the liver and lungs. After several attempts at appraising the family on the patient's condition, they decided they still wanted the CPR even with the odds against them. The patient arrested and I quickly did a flawless intubation and manned my first code. I was the captain of the ship. Code Captain.

The only problem was that it was just me and three nurses. One nurse did the bagging, one to give the medications, and one to get everything we needed. I was left to do the chest compressions by myself and man the code at the same time. I was rattling out orders while doing CPR all by my lonesome for a good 1 1/2 hours. I didn't even notice that one of the patient's relatives was actually taking pictures and videos of the whole thing. After we saw her, I was quick to send her out. It wasn't that we were doing anything wrong, it was just plain weird.

Time of death: 4:30 am.

My small victories: There are so many among which are making admitting orders for a patient in congestive heart failure with an array of arrhythmias where all the cardiology fellow on duty could order on the chart was "attach copy of ECG tracing at chart," being able to actually win a bet against a consultant/fellow that the patient was having digitalis toxicity rather than just plain hypokalemia, and going through a whole month in the ICU with just 3 mortalities out of 61 admissions (granted, some of those transferred out per request and passed away peacefully in the ward with DNR directives.

One cannot truly count the small victories, all that matters is that you make them count.

My band of brothers/sisters: I will forever hold dear the times spent in the trenches with my batchmates. Things happen for certain reasons, people come, people go, and I could not have asked for things to turn out any better than they have, because despite our differences, we work like the best of machines do.

To these people, I will always be indebted.

For all his patented "bowl of lies" and "snail-faced" ways, Mush was there with me from the beginning. Albeit, with two attempts at quitting under his belt, and a two-month extension coming up, I salute the guy for braving two straight years without vacation leaves, and a whole slew of controversies. He has always been a steady friend, sometimes wavering, has really-hard-to-understand principles, but I couldn't ask for maximum effort.

Christie came in December. She is, as I fondly refer to, but she vehemently rejects, is the glue. She compliments all our personalities. She holds us together with her incessant tact/naivete, and laughs at nearly everything, but is quick to shed tears for the most corniest of movies. She is one of the more honest people I have met, and sometimes to a fault, but one thing is for certain, she will always give her best. And you really could not expect anything less.

Mercurial is just one of the many adjectives for Gladys. She can become moody and snappy one minute and rolling over, crying with laughter in the next. Dependable, she zones in and simply gets the job done, her way. She will keep you in line with a sharp retort but is quick to help you when you need a hand.

Jeffrey has always been quick to lend a hand, and reliably strong against the criticisms and trash thrown at us. Aside from being an infinite supply of food, Toblerone and Lay's, he provides a level head at viewing certain subjects/problems. You don't need to tell him what to do, he just goes out and does it. His dancing and singing skills are, no doubt, valuable in presentations, though it takes quite push to get him to show his talents, he will stand there, with skinny jeans and a tight fitting shirt, grin bear it, and finishes what he starts.

Ian is the elder statesman. Haha, no doubt about it, he provides that certain maturity -- a dose of reality + dry wit + sarcasm and humor = actually good advice. Thought he has a certain code of rules that he lives by, his laid-back (literally) personality, is a welcome change to our group. But when it comes to getting stuff done, he never fails to find a way to actually make things happen.

Ours will probably go down in PSH-IM history as one of the chilled-out, hatred-free senior years of residency, and I would have it no other way.

My quiet prayers and deepest thanks go out to the people along the way. The friends I've made, the enemies who hated my guts (thank for building me up to feel that someday, with just the right amount of work, I will be better than you), for the mentors and tormentors, and for all that made a jolly rockin' great time of a residency.

I'll see you all again -- who knows, more sooner than you think, or a bit later than what you expect.

Official time-out will be October 31, 2011. 7 am.