I received a phone call a few days back from a dear friend telling me her father was coming in for admission. He had been having exertional dyspnea (difficulty breathing on exertion) and a bothersome cough that got worse once he was lying down. I said I'd take care of him while she was still finishing up a few things as she was completing her residency training in my hometown.
I had gotten the chance to meet her father before at her wedding, but never got the chance to know him and on his admission, I shook his hand and introduced myself. He was a cheerful guy with an easy smile, talked about his symptoms and I reviewed his case. His medications, I couldn't understand since he had gotten them from somewhere in South America (for the life of me, I never knew we had blood thinners that we could dissolve in water). From just that conversation, I could see how his daughter got her demeanor -- calm, calculating, and a seemingly exceptional control over his emotions.
I walked out of the room, glanced at his labs and electrocardiogram and nothing stood out. His chest X-ray had some signs of congestion but it was on looking at his echocardiogram that I felt my heart sink a little. His heart showed a significant drop of his ejection fraction (the amount of blood pumped out of the heart with each beat) to 27% (normally >55%). His chamber walls were enlarged and barely moving. Everything about it was definitely not good.
I called my friend and broke the news. I owed it to her to tell the truth both as a friend and as a doctor. She asked me what was next, and being a doctor herself had questions and suggestions of her own. I said a viability study could be next to check the extent of surviving heart tissue, then maybe a coronary angiogram and if there is anything we can do next, cardiac bypass surgery or angioplasty. She took the news in with all the strength I knew her for. I could hear her voice cracking a bit as we spoke over the phone but I said we'll take it one step at a time, get the extra fluid out of his system, decongest his lungs and take it from there. She was coming in two days after some exams and we would talk then.
The next two days would have me visiting my friend's father often, chatting a bit and he was significantly improving. No more coughing on lying down, and he was up and about, walking around his bed, in the hallways and all the way to the hospital chapel. When she arrived, we all chatted in the room, and caught up. Everything was as smooth as can be.
Then came the call.
The resident's call came in at around 3 pm, "Doc, our patient went stiff and is unresponsive!"
"What?" "Who?!" "What happened?!" I could hear my friend in the background, screaming.
It was the fastest I've ever responded to a code in my life. In less than a minute, I ran from the male doctors quarters to the fourth floor and found my friend's father unresponsive. "Bri, he's not responding! He just complained of sudden dizziness and then this!"
Numbly I processed everything, tried to remain calm and tried to establish an airway. I brushed off the nurse offering a pair of gloves and a mask so I could save a few more precious seconds as I inserted his ET tube, while my friend took out her father's dentures. Arrhythmia most definitely, as I ran down the list of differentials in my head. We started CPR and waited for the cardiac monitor to come. Ventricular tachycardia, torsades (really bad abrnormal heart rhythms), you name it, we had it. He was responsive, restless and was still able to respond to us by blinking his eyes. We did everything -- antiarrhythmics, defibrillation, CPR for a good two hours. I did not want to stop until I had him back, talking, smiling.
But I knew it was bleak. His heart was too weak.
It broke my heart to see my friend, her tears freely flowing, never leaving her father's side, saying everything was going to be okay, that they will take care of each other if he chose to go, that it was alright to let go if it hurt too much already. She looked at me and I gave her a hug as she sobbed. I knew she saw the defeated look in my eyes and she managed a nod. She understood how most of these situations turned out.
We stopped everything after nearing two hours of resuscitation.
I keep asking myself, what could I have done differently to make sure we had a different ending? Everything was so sudden, and in just one sweeping moment, I lost a patient. A patient who not only was someone who just happened to walk in through the ER doors, but someone who was dear to a close friend. And that made him, part of me. And now, his memory is part of mine.
How God chooses when to bring people from this life into the next is beyond any man's comprehension. One thing I've learned from this profession is that each death is meant to teach us something, no matter how close it hits to home. I have to brush away notions of what-ifs and what-would-have-beens to able to look my friend in the eye and say "I'm sorry for your loss," and carry on with treating more people.
Life and love truly go on after a loss, and as I see my friend and her family carry on, I am reminded of how fragile our existence is on this earth and how unpredictable our life scripts are being played out, and how, despite everything, we should make this existence count.
Thursday, November 28, 2013
Saturday, August 31, 2013
Whispers To Sadie
There is this moment every night when every well-meaning parent looks in on their child sleeping soundly and whisper a short prayer of thanks or a well-meaning thought or hum a favorite lullaby, gently stroke the hair on their heads and kiss them goodnight.
On most nights, I look in on my daughter sleeping in her crib, tossing and turning, letting out a little whimper or a small laugh as if enjoying a nice dream, and I marvel at how truly great God is to have given me such a gift.
These moments are the times where our imaginations as parents roam as we think of all the possibilities that lie ahead for our children. We smile at the prospect of seeing them walk and talk, growing up and going to school, fending for themselves and finding their own friends, falling in love, choosing careers and walking down the aisles and seeing grandchildren walking up with them as they visit for a weekend. Oh how they will grow up so fast.
Then come the fears of how the world we live in will be just a little bit too much for our little ones. The pollution, the growing moral ineptitude , disease and disability, accidents and we shut our eyes and hold back tears as we drive these thoughts out of our minds. We will be fine.
Then come the prayer to Him who granted us this chance to be parents in the first place. That He watch over this little angel sleeping peacefully, so innocent, so full of hope and promise and as vibrant as all the little children whom He let come to Him even when he was burdened and tired.
Just like all the other well-meaning parents in the world, all these emotions wash over me each night looking at my daughter in deep slumber -- all the happiness, the fears, the tears, the joy, the excitement and the hope that we will be okay.
The hope that someday our little girl will tell us the same exact thing.
So I whisper to her just before fixing her pillows and kissing her good night, "I love you little girl, with all my heart. I thank the Lord each day for giving you and your mother to me. May you always have a reason to smile. Always be good. I'll see you when you wake up in the morning."
On most nights, I look in on my daughter sleeping in her crib, tossing and turning, letting out a little whimper or a small laugh as if enjoying a nice dream, and I marvel at how truly great God is to have given me such a gift.
These moments are the times where our imaginations as parents roam as we think of all the possibilities that lie ahead for our children. We smile at the prospect of seeing them walk and talk, growing up and going to school, fending for themselves and finding their own friends, falling in love, choosing careers and walking down the aisles and seeing grandchildren walking up with them as they visit for a weekend. Oh how they will grow up so fast.
Then come the fears of how the world we live in will be just a little bit too much for our little ones. The pollution, the growing moral ineptitude , disease and disability, accidents and we shut our eyes and hold back tears as we drive these thoughts out of our minds. We will be fine.
Then come the prayer to Him who granted us this chance to be parents in the first place. That He watch over this little angel sleeping peacefully, so innocent, so full of hope and promise and as vibrant as all the little children whom He let come to Him even when he was burdened and tired.
Just like all the other well-meaning parents in the world, all these emotions wash over me each night looking at my daughter in deep slumber -- all the happiness, the fears, the tears, the joy, the excitement and the hope that we will be okay.
The hope that someday our little girl will tell us the same exact thing.
So I whisper to her just before fixing her pillows and kissing her good night, "I love you little girl, with all my heart. I thank the Lord each day for giving you and your mother to me. May you always have a reason to smile. Always be good. I'll see you when you wake up in the morning."
Wednesday, July 17, 2013
A Little Time
Ah, prose, how I've missed you.
It's been a while since I've written anything of note that wasn't an introduction to a research paper I'm supposed to continue, a meta-analysis that will have to be finished by the end of the month, the gazillions of reports on basic cardiology, arrhythmias, vascular lesions and echocardiograms.
It is now, 10:34 pm on the 13th of July and taking a break from running around in the wards, that I am taking time to write in a few things in this taken-for-granted blog.
First, I am in fellowship. For the run-of-the-mill reader of this blog, I am referring to my never-ending quest to better myself as a doctor, which involves finishing another 3 years of Cardiology training on top of the 3 years of Internal Medicine, the 1 year of post graduate internship and 4 years of medical school. Oh, and to top it all off, there might be a possibility that there could be another year of subspecialty training after this.
Yes, there are times I question my sanity. The pay is paltry, the hours are wickedly draining, and the stress is beyond belief. I questioned it all the more when I recently found out that our security guards, with all the hazard pay, earn more in a month than I do.
But seemingly, I think I belong. I'm where I'm supposed to be -- learning more, treating patients and until the Great Planner up there changes up the script for me, I'm here to stay.
Second, I have graduated from being a resident, to dealing with residents. And every single day, I ask myself, "Was I this hopeless when I started out?" I'd like to think that I turned out okay.
It is a very very busy world I exist in these days but I've finally found a moment in between exams, reports, research, patient rounds and echocardiograms to just sit down, reflect and as this day would have it, write down a few words.
It's been a while since I've written anything of note that wasn't an introduction to a research paper I'm supposed to continue, a meta-analysis that will have to be finished by the end of the month, the gazillions of reports on basic cardiology, arrhythmias, vascular lesions and echocardiograms.
It is now, 10:34 pm on the 13th of July and taking a break from running around in the wards, that I am taking time to write in a few things in this taken-for-granted blog.
First, I am in fellowship. For the run-of-the-mill reader of this blog, I am referring to my never-ending quest to better myself as a doctor, which involves finishing another 3 years of Cardiology training on top of the 3 years of Internal Medicine, the 1 year of post graduate internship and 4 years of medical school. Oh, and to top it all off, there might be a possibility that there could be another year of subspecialty training after this.
Yes, there are times I question my sanity. The pay is paltry, the hours are wickedly draining, and the stress is beyond belief. I questioned it all the more when I recently found out that our security guards, with all the hazard pay, earn more in a month than I do.
But seemingly, I think I belong. I'm where I'm supposed to be -- learning more, treating patients and until the Great Planner up there changes up the script for me, I'm here to stay.
Second, I have graduated from being a resident, to dealing with residents. And every single day, I ask myself, "Was I this hopeless when I started out?" I'd like to think that I turned out okay.
It is a very very busy world I exist in these days but I've finally found a moment in between exams, reports, research, patient rounds and echocardiograms to just sit down, reflect and as this day would have it, write down a few words.
Sunday, March 17, 2013
Here I Go Again
I've always loved donning the white coat and seeing patients, walking the hospital hallways and holding the charts. So returning for three more years of punishment, sleepless nights, stress and torment in an Adult Cardiology Fellowship was just about right for me.
For those not in the medical field, after four years of medical school, and a life-changing board exam, comes residency in specialty field of choice. After that comes another certifying exam then onto a fellowship into a subspecialty in the field you originally specialized in. Then comes another exam and sub-sub-specialization, you get the drift. It is a long and arduous process that does not come with the wealth and prestige most people think doctors have. But rather a long road of training, reading books, examinations, sleepless nights and tears that others don't seem to get.
But I do this because I love the work. I love being with patients.
In my interviews for my neurology and cardiology applications, a staple answer I gave when asked why I chose these particular fields, was that I love puzzles and I love to figure them out, and I love working with people and talking to them and building rapport and working relationships. Thus, I always pictured myself forging on in medicine -- through residency, fellowship and subsequent studies to be the best doctor I could possibly be.
It's not about the money -- never was and never will be. But being compensated enough to be able to have my family and I live comfortably is the goal.
Fellowship is an acquired taste and is not for everybody. Right now, I have to contend with residents lost in the nature of their job (I'd like to think I wasn't that hopeless when I first started out), more responsibility and specialized books to read, and not to mention all the intrahospital and intraspecialty politics that doctors have to deal with.
So here I go again, another 3 years of echocardiograms, angiograms, CABG's, ECG's and angioplasties.
All in the hopes that at the end of it all, I'd be more confident in seeing you come through the clinic doors as my patient and having you walk out the same way, feeling a wee bit better for having seen your friendly neighborhood cardiologist.
For those not in the medical field, after four years of medical school, and a life-changing board exam, comes residency in specialty field of choice. After that comes another certifying exam then onto a fellowship into a subspecialty in the field you originally specialized in. Then comes another exam and sub-sub-specialization, you get the drift. It is a long and arduous process that does not come with the wealth and prestige most people think doctors have. But rather a long road of training, reading books, examinations, sleepless nights and tears that others don't seem to get.
But I do this because I love the work. I love being with patients.
In my interviews for my neurology and cardiology applications, a staple answer I gave when asked why I chose these particular fields, was that I love puzzles and I love to figure them out, and I love working with people and talking to them and building rapport and working relationships. Thus, I always pictured myself forging on in medicine -- through residency, fellowship and subsequent studies to be the best doctor I could possibly be.
It's not about the money -- never was and never will be. But being compensated enough to be able to have my family and I live comfortably is the goal.
Fellowship is an acquired taste and is not for everybody. Right now, I have to contend with residents lost in the nature of their job (I'd like to think I wasn't that hopeless when I first started out), more responsibility and specialized books to read, and not to mention all the intrahospital and intraspecialty politics that doctors have to deal with.
So here I go again, another 3 years of echocardiograms, angiograms, CABG's, ECG's and angioplasties.
All in the hopes that at the end of it all, I'd be more confident in seeing you come through the clinic doors as my patient and having you walk out the same way, feeling a wee bit better for having seen your friendly neighborhood cardiologist.
Sunday, February 17, 2013
To Ashes
Somehow, Ash Wednesday took on a whole new meaning for me and my family last February 13, 2013.
At around 3 pm that day, I took out my phone to take a call from my sister, and she said ," Nong, do you know?"
I looked up from peering over a patient's chart and said, "No. Wala. Why? What?"
"Our house is on fire. It's burning down along with Tiya Fely's and Tiya Intay's!"
"WHAT?!" I exclaimed, immediately getting up from the chair and heading for the empty stairwell. "Are you guys ok? Is anybody hurt?"
"Everybody's ok nong, but our house is mostly gone. Most of the second floor is gone. Mama's room was the first to go, as well as all of our rooms. But what's important is we're ok. Jassen got out in time and right now, we're going to buy milk for Luke."
Still in a state of shock, I could only manage to ask "Ha?!"
"Yup, nong. It's okay, we'll call you later for more details. We're going out to buy Luke's milk because we don't have any here."
Our home was gone.
The place I grew up in -- the halls were I ran through to greet my parents when they came home, the porch where my grandparents used to sit on their rocking chairs to talk to us grandkids, the ancestral home by all of us who grew up in and around Dumaguete City, burned down last Wednesday.
Allegedly, the fire started from our former neighbor's empty house directly 2 houses in front of ours. It had recently been sold and had been mostly empty these past few years. But apparently this didn't stop a group of local teenagers from raiding the wires and melting these to retrieve the copper inside. Not only were they trespassing to get these, but having a jolly good time with beer and glue.
Long story short, their fire ended up burning down 5 houses, including ours.
No human lives were taken, which is great, but our two dogs perished. My nephew hasn't eaten since the fire and keeps on saying "Go home?" My almost complete Hardy Boys collection has gone up in smoke, I think, along with a host of what I referred to as my mini-library.
But all is not lost. I came home this weekend to find my family in good spirits despite everything we've been through. These past few days, we are reminded of the value of family and friends -- all those who have extended themselves to us through prayers and aid and consoling words -- and we, collectively, owe you and offer you our deepest gratitude. Thank you for standing with us in our hour of need.
The house is in shambles, mostly gone, but the family that shared that home and memories spent with them will stay with me and these will withstand the strongest of fires.
At around 3 pm that day, I took out my phone to take a call from my sister, and she said ," Nong, do you know?"
I looked up from peering over a patient's chart and said, "No. Wala. Why? What?"
"Our house is on fire. It's burning down along with Tiya Fely's and Tiya Intay's!"
"WHAT?!" I exclaimed, immediately getting up from the chair and heading for the empty stairwell. "Are you guys ok? Is anybody hurt?"
"Everybody's ok nong, but our house is mostly gone. Most of the second floor is gone. Mama's room was the first to go, as well as all of our rooms. But what's important is we're ok. Jassen got out in time and right now, we're going to buy milk for Luke."
Still in a state of shock, I could only manage to ask "Ha?!"
"Yup, nong. It's okay, we'll call you later for more details. We're going out to buy Luke's milk because we don't have any here."
Our home was gone.
The place I grew up in -- the halls were I ran through to greet my parents when they came home, the porch where my grandparents used to sit on their rocking chairs to talk to us grandkids, the ancestral home by all of us who grew up in and around Dumaguete City, burned down last Wednesday.
Allegedly, the fire started from our former neighbor's empty house directly 2 houses in front of ours. It had recently been sold and had been mostly empty these past few years. But apparently this didn't stop a group of local teenagers from raiding the wires and melting these to retrieve the copper inside. Not only were they trespassing to get these, but having a jolly good time with beer and glue.
Long story short, their fire ended up burning down 5 houses, including ours.
No human lives were taken, which is great, but our two dogs perished. My nephew hasn't eaten since the fire and keeps on saying "Go home?" My almost complete Hardy Boys collection has gone up in smoke, I think, along with a host of what I referred to as my mini-library.
But all is not lost. I came home this weekend to find my family in good spirits despite everything we've been through. These past few days, we are reminded of the value of family and friends -- all those who have extended themselves to us through prayers and aid and consoling words -- and we, collectively, owe you and offer you our deepest gratitude. Thank you for standing with us in our hour of need.
The house is in shambles, mostly gone, but the family that shared that home and memories spent with them will stay with me and these will withstand the strongest of fires.
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