Friday, August 29, 2014

Kinda Carpe Diem

It is getting harder and harder to find time to write in fellowship. In between reading thick textbooks and making reports and presentations, I barely have time for a good night's sleep or watching all the movies I've downloaded over the past year. And once my daughter comes into our room and runs into my arms, all the time for NBA 2K14 and TV, happily goes out the window.

It is a tough, tough schedule to keep.

In memory of Robin Williams, I watched Dead Poets Society for umpteenth time again and wondered if I, having taken this road that I am on, am indeed seizing the day and the Carpe diem-ness of this life. Or maybe I have been handed a vertebrae while others have been given femurs to suck the marrow out of.

I look at facebook and my timeline is filled with friends' amazing lives. Well, and a few not so amazing ones but I guess, significant in their own right. I see pictures of trips to wherever, beautiful sunsets at the beach, breathtaking selfies in the Parises of the world, newfangled gadgets and wheels and sometimes, I find myself asking if spending time to write a little entry to a just-remembered blog in the cardiology specialty office of this hospital I exist in every three days, why am I not out there taking these pictures? Why am I not basking in the sun somewhere with not a care in the world?

It's not envy, I assure you. I love looking at all my these moments in my friends' lives. It's more of questioning myself from time to time. I have never been much of a traveler nor have I show much wanderlust but I'd love to go to new places eventually. I have no taste for activities that could be a scene in a Final Destination movie like going skydiving and your parachute suddenly doesn't open, or as simple as riding a zipline that breaks. I'd love to spend my spare time hitting the links if I were any good at it or ride my brand new pickup truck, if I had one.


Maybe I'm not too left out, after all.

During the course of writing this short entry, I've realized that maybe I'm where I want to be. I'm where I'm meant to be. Sure, this may not be the stuff of Facebook legend and may not be picturesque enough to put up on a post, but this is just a good life as any.

I'm in a death-defying job. Every. Single. Day.

There is excitement in what I do, a lot of puzzles and mysteries to solve. I get to places where only a few could only imagine and set my eyes on sights not seen anywhere else -- the beauty of the valve leaflets, the beating heart, the reopened coronary arteries saving a patient's life -- and for others who have chosen this same path, the birth of human being, the gyri and sulci of the human brain, and so much more.

Though blame can be a part of the job, there are a lot of thank yous to be had at the end of the day too.

I've done a couple of stuff in my spare time that's worth a post or two, but there's little time left before I have to leave to do rounds on my patients again.

There will come a time when I'll be through with fellowship and go on to have my own practice and my own patients. I doubt if time will allow me a better schedule but I'm sure I'll be fine with catching a few quality moments with friends and family on a beach somewhere and getting back to the grind of this so-called life I call medicine just because I know it's where I'm meant to be.

Saturday, May 31, 2014

Residency Survival Guide 101: New Advice for the New Resident

Being in fellowship training has allowed me to see how residency training has evolved over the last few years. It has conformed to society's latest fads and the newer graduates of medical school. This is an ever evolving guide to surviving residency training, in this day and age.

1. Be responsible using social media.

It has become a selfie-dominated residency generation. And mind you, this has exploded over just the past 2 years or so. In the age of the selfie, these past few years' crop of residents have been so eager to pose and post their latest outfits (nevermind that their white medical coats cover them anyway), their latest duck-faces (nevermind that a good number of them actually make themselves look worse than their regular faces), and their quote/s for the day, that they do not notice the little things in their statuses. The time stamp and the pictures can place them out of post should they be anywhere else in the hospital where they are not supposed to be. The selfie with the patient in the background can be a breach in the patient's privacy (I'm not a lawyer, but that should qualify right?). The blatant photo op at the ER can arguably be used against them, being that they should be attending to admissions first, and poses the least of their priorities.

Yet, social media has permeated every aspect of our society and its use cannot be prevented. Heck, this post is going to be on it. But careful judgment on what to post, when to post it and who to post it for goes a long way in making sure that you don't get sued.

So if you are a resident or planning to go into training, please think before you post.

2. Do not quote information without basis.

More and more residents are quick to pick up tidbits of information during rounds, most especially so when they like the consultants (criteria includes any combination of physical looks, elite status in the community, treats to free food at the canteen, and the like) and are just as quick to use this in medical conferences with corresponding quotes and name-dropped sources. Please, if you are one who does this, stop. Do not ever answer another consultant's question with, "But doc, Doctor so and so said that the, yada, yada..." (you get the drift). That will surely earn you an eyebrow raise and you'll get laid the smacketh down.

It is just different when you say, "Based on the current practice guidelines..." or "According to Harrison's..." or more if "The latest online issue of the New England Journal of Medicine has an article that tells us..."

3. Do not act like you are infallible.

There is always going to be someone better than you at something. A nurse can outshine you on knowing the patient. Acknowledge them. A fellow tells you to follow up on a urinalysis that you have not gotten to yet. Listen. You are not the perfect specimen of medical practice you think you are walking down the hallways with a stethoscope draped around your neck, white coat billowing behind you. You are in training, and learning from everybody, anybody should be your foremost goal.

4. Know your place

There is this hierarchy in medical training that has blurred somewhat in the past few years because of braver students with gifts of gab and older consultants who are content on quietly getting by treating their patients. The students can appear deceptively good, and the older guard, deceptively incapable of handling their juniors.

This past few years has seen an admitted change of philosophy in terms of medical training. It is geared more towards lifting residents and guiding, nay, nurturing them towards their goal as compared to the old Spartan way of throwing you into to the sea just to see if you can swim and survive. Admittedly, I am a mix of these two philosophies and I see advantages to both nurture and nature (hierarchial, pyramidal, etc) but the key is getting a balance of the two. Nurturing has led to "intellectual arrogance," a blinding of the clinical eye and an often uncompromising allegiance to guidelines. Nature has often seen bullies exploit their place in the organizational system, and those that cannot hack it are scarred for life.

The key is finding the balance. Know your role. You are here to train and learn. Respect those that have come before you even if a few months separate you. They have seen more than you have and are still there standing. And all the more for those who you do rounds with and report to because they do not have those additional letters at the end of their names for nothing.

Do not cross the line between pushy and timid. Once you establish that, do not rock the boat and tip yourself over.

5. Read, study and learn.

Yes, this still does the trick.

Friday, April 4, 2014

Where It Counts

These past few days to weeks to months, I've felt a little bit more stressed than what I've been used to. And for someone well into the his second year of Adult Cardiology fellowship, that is going to be a little bit understated.

But yes, I have felt a little bit more strain on my resolve lately from worries about friends and family and work has not been doing me any favors. My country's tax arm is slowly taking aim at my profession and at the same time poking one of the world's biggest countries. Talk about a messed-up government.

But that's beside the point...

This blog was initially just meant to be an outlet of sorts -- a chronicle of life experiences and work situations where I felt I turned the corner, not just as a physician but as a person as well, and maybe have the chance to have these little life stories touch whoever reads them.

I have in my care, a female charity patient, 28 years old who came in for difficulty in breathing. She is reed thin and any lay person could see the cachexia was eating away a few minutes of her life each day. She developed pulmonary edema (fancy words for fluid in the lungs) so she couldn't breathe well and we had to intubate (that thing on TV where we put a tube in someone's mouth). She had severe mitral stenosis (the valve that guards the left atrium and ventricle of heart is half-closed, or half-open, depending on how you look at it) with severe pulmonary hypertension (the pressure in her lungs were really high). Her right side heart chambers were extremely dilated, there was severe leakage of her tricuspid valve, and because of the right sided pressure and volume overload, the left ventricle was reduced to less than half its normal dimensions.

She was in severe heart failure. To what, I couldn't really say for certain unless I did some more tests. I couldn't subject her to valve replacement surgery because sending her to the procedure would be sending her to death on the table due to the severely elevated lung pressures. We had to figure out why everything was what it was before doing anything else.

But how? They were in the charity service for a reason. They had no money. How do you tell a mother or an expectant sister that you could not do anything more? We could not do hemodynamic studies, they had no money for medications and we barely scraped by with our three free days in the ICU.

Now she is thankfully out of frank heart failure. I see her everyday with her mother, sisters, brother and aunts, and everyday I tell them of how her heart is failing her and that she could go anytime. Yet they smile, seemingly in denial and acceptance at the same time, and say that "Prayers are all we have, doc" and "It is in God's hands now." I nod every single time, knowing how true it was.

Today, I went up to them and told them that as of this time, this is the best we were going to get -- out of failure, able to walk a few meters, smile and entertain guests, her talking about getting a whole serving of her favorite halo-halo and the possibility of home oxygen therapy -- until such time we were able to come up with funds to do the next steps in her treatment. They nodded and I ended the morning signing my name on their discharge orders and take home medications

Sometimes, I feel helpless amidst all the poverty, all the economic ruin my country is supposedly in, all the stress of training and the emotional strain with every family member getting sick or a friend in trouble. With all this, it would be so easy to dismiss the troubles of patients who can not pay their way to even a decent diagnosis, but I don't. I would never want that for anyone.

I have never thought of going abroad and plying my trade there nor has there ever been the desire to do so. I will work and serve patients here, and continue doing my best for patients with whatever I have just like how every physician gives a part of themselves to each patient that walks through their clinic doors. Despite this messed-up country, I feel that I am where my life counts and giving back to where it counts the most.