I know Christmas is coming but what I did not realize until a few hours ago is that it is just barely 6 days away. No, it is not my first Christmas away from home. In fact, I'm pretty much used to it now. But with this thing called residency training, I haven't really delved into the whole spirit of things.
How didn't I notice?!
People are nicer.
Exchange gifts.
Our seniors asking us less questions and offering more suggestions.
Lesser frowns on people I meet.
The cool breeze wafting through my curtains in the morning.
People talking about bundles of joy and bonuses.
How come I did see it until today?
I guess, I'm more preoccupied with adjusting to this whole residency thing. Following up laboratories, not killing people, getting ready for endorsements and actually learning as much as I can before I get another crack at the ER are what mostly occupies my mind during the waking hours.
It's just hospital-home-sleep and repeat-the-next-day for me right now.
Thankfully, an occasional movie and Tonett break that cycle but, as doctors, trainees, and residents, we all live life every three days.
As I'm nearing my second month of residency and being that time of the year, I'd like to offer some nuggets of wisdom for surviving two months in a residency program:
1) Make your seniors look good. Even if you end up looking ridiculously dumb. But if you are not ridiculously dumb, you'd find a way to make both of you look good.
2) Get a good history. There's just no substitute for a good clinical history and physical exam. Even if you don't know what the heck your patient is suffering from, I'm pretty sure you'd get killed in endorsements with a poor history and end up with something if you bring all your cards to the table.
3) Endorsements and morning reports are not easy things. Get ready for them and plan them in your mind.
4) Some allied medical professionals (nurses, PT's, OT's, etc) could be your best friends in the ward, helping you with patients and ward work. But a good portion of them can be the bane of your existence at times from reading too much into a simple order to not actually giving the medicines you needed to give or not referring nada to you at all.
5) Move fast. Sweat. Look toxic. Look busy.
6) Survive. Just take it an hour at a time. You'll be previous the next day, preduty after that, then repeat the cycle again.
7) Pray. Pray a lot. It helps if you have Him on your side.
As the day of Christmas draws near, I bid you all a Merry Christmas with trimmings of red, green and gold.
Somewhere in the middle of Cebu on the 25th of December, I will be on duty, at the ER, no less.
It's definitely that time of the year.
Merry Christmas.
Thursday, December 18, 2008
Wednesday, December 3, 2008
In Sickness and in Health
Now that I'm a month into my residency torture err, training, there is a dearth of topics to blog about. But somehow, you always find something that will make you write and share.
There are two people whom I have come to admire these past few days and they aren't consultants, seniors nor doctors for that matter. They are ordinary, everyday, SO's (significant others) of patient's admitted here at the hospital.
They have given me a perspective of how "in sickness and in health" is supposed to work.
First, Mr. Tomas (not his real name, of course). His wife was diagnosed with Gastric CA since 2003 and underwent resection and chemotherapy. She was admitted for anorexia (loss of appetite) and body malaise.
She was everything you'd notice of a cancer patient -- bald, weak, pale. She had bruises all over that I could not explain because everything was normal save for the fact that she had cancer.
Yesterday, she suddenly started screaming at the roof, praying and was restless despite the sedatives I gave her. I've noticed that patients who suddenly start seeing stuff and screaming out Bible phrases have a tendency to start heading towards that proverbial white light at the end of the tunnel.
I thought it was brain mets. CT scan negative.
I thought it was encephalopathy. Nada. Nil. Zilch.
As I was going off duty, I walked by Mr Tomas outside their room. I stopped and talked to him for a few minutes and I talked to him about where we stood with treating his wife, and anybody could see the toll of taking care of his wife on his face. His hair was a bit mussed up, eyes bloodshot and teary, unshaven and worry crinkles on his brow. He was standing outside as his two sons tried to calm their mom down inside their room. He thanked me for whatever explanation or insight I could give, mustered a smile and I bid him good night.
Later that night, his wife was transferred to the ICU because of a probable seizure disorder probably with the cancer spreading to parts of the brain not easily visible on scans.
I can only imagine what he is feeling right now. Because as corny as it sounds, one could see how much he cared by looking into those teary, bloodshot eyes.
The other person is Mrs Cecilia (again not her name). I admitted her husband for the complaint of unresponsiveness and probable severe pneumonia and a stroke. They barely scraped by with money for admission, intubation and a CT scan, and let alone the mounting expenses for antibiotics, heart medicines and the ventilator to the point that she had approached me for a DNR.
Insensitive as I was at that time, I was quietly comforted knowing she would be signing that sheet of paper that would relieve everyone of us on duty that day, of any responsibility. I almost even groaned when the attending discouraged her from doing so.
But I'm thankful I realized I was wrong.
While I monitored everything about the patient that whole day -- his vitals, his sats, his weaning, his IV's -- she was always there beside him. I could tell she loved him even from the time she came up to me and tears trickled down her cheeks asking for that piece of paper.
I gave her a smile every time I came. She smiles back.
I was assigned to another ward at the start of the month, but still I see her from time to time walking in the hallways, bringing a bottle or two of IV fluid. I asked from my co-residents how her husband was doing only to find out they have not been procuring the IV antibiotics and some meds. Sometimes they have money, sometimes they don't.
But love, in sickness and in health, they have an abundance.
And to love like they do is how love is supposed to be.
There are two people whom I have come to admire these past few days and they aren't consultants, seniors nor doctors for that matter. They are ordinary, everyday, SO's (significant others) of patient's admitted here at the hospital.
They have given me a perspective of how "in sickness and in health" is supposed to work.
First, Mr. Tomas (not his real name, of course). His wife was diagnosed with Gastric CA since 2003 and underwent resection and chemotherapy. She was admitted for anorexia (loss of appetite) and body malaise.
She was everything you'd notice of a cancer patient -- bald, weak, pale. She had bruises all over that I could not explain because everything was normal save for the fact that she had cancer.
Yesterday, she suddenly started screaming at the roof, praying and was restless despite the sedatives I gave her. I've noticed that patients who suddenly start seeing stuff and screaming out Bible phrases have a tendency to start heading towards that proverbial white light at the end of the tunnel.
I thought it was brain mets. CT scan negative.
I thought it was encephalopathy. Nada. Nil. Zilch.
As I was going off duty, I walked by Mr Tomas outside their room. I stopped and talked to him for a few minutes and I talked to him about where we stood with treating his wife, and anybody could see the toll of taking care of his wife on his face. His hair was a bit mussed up, eyes bloodshot and teary, unshaven and worry crinkles on his brow. He was standing outside as his two sons tried to calm their mom down inside their room. He thanked me for whatever explanation or insight I could give, mustered a smile and I bid him good night.
Later that night, his wife was transferred to the ICU because of a probable seizure disorder probably with the cancer spreading to parts of the brain not easily visible on scans.
I can only imagine what he is feeling right now. Because as corny as it sounds, one could see how much he cared by looking into those teary, bloodshot eyes.
The other person is Mrs Cecilia (again not her name). I admitted her husband for the complaint of unresponsiveness and probable severe pneumonia and a stroke. They barely scraped by with money for admission, intubation and a CT scan, and let alone the mounting expenses for antibiotics, heart medicines and the ventilator to the point that she had approached me for a DNR.
Insensitive as I was at that time, I was quietly comforted knowing she would be signing that sheet of paper that would relieve everyone of us on duty that day, of any responsibility. I almost even groaned when the attending discouraged her from doing so.
But I'm thankful I realized I was wrong.
While I monitored everything about the patient that whole day -- his vitals, his sats, his weaning, his IV's -- she was always there beside him. I could tell she loved him even from the time she came up to me and tears trickled down her cheeks asking for that piece of paper.
I gave her a smile every time I came. She smiles back.
I was assigned to another ward at the start of the month, but still I see her from time to time walking in the hallways, bringing a bottle or two of IV fluid. I asked from my co-residents how her husband was doing only to find out they have not been procuring the IV antibiotics and some meds. Sometimes they have money, sometimes they don't.
But love, in sickness and in health, they have an abundance.
And to love like they do is how love is supposed to be.
Monday, November 24, 2008
Pay, Check
I got my first taste of a monthly salary last 20th of November and though I've never been given that kind of money in one setting, it felt like it wasn't enough for all the stuff I've been through.
I realized, I can't hope to have a life and raise a family on this salary. Nor can I hope to help my parents, pay my rent, and other stuff we use money for.
I offered to buy my dad and sister dinner, but my dad said I'd better save it for me.
Haha, I laugh silently because my brother and my sister earn much more than I do and I've been in school the longest. The return of investment in medicine really is not much. I'd be lucky to even break even in giving back to my parents what they've spent on my education.
Such is the state of this young medical doctor today -- wishing I have a cushy (by my standards) job like Gaya's, earning more by moonlighting like Chofi and Benjo, or simply being able to bum around rich like the Mittals and Bill Gates of the world.
They say it's bad to keep and save your first salary.
I do not know if there is truth in that or it's something people make up to get a gullible co-worker to shell out for a round of beers and pizza, but I did get some stuff for it.
- Went out with Tonett for dinner
- Treated my Ward 2C station to pizzas because one of my DNR patients went home, albeit HAMA, alive.
- Bought a pair of sandals
- Bought some groceries (I, as much as possible, will not use my mom's extension credit card)
- Saving the rest for stuff like a house, a car, land and whatnot (Hahaha, well, I have to start somewhere)
I'll be going on duty again tomorrow. Gaaaaahhhhh.
Our chief, Dr. Roa, says we will be flying solo next month at the ER -- that would mean facing acute coronary syndromes, hypertensive emergencies, endocrinologic emergencies, COPD exacerbations, cardiac dysrrhythmias ALL ON OUR OWN.
Uggghh, I'm dreading next month's paycheck already.
I realized, I can't hope to have a life and raise a family on this salary. Nor can I hope to help my parents, pay my rent, and other stuff we use money for.
I offered to buy my dad and sister dinner, but my dad said I'd better save it for me.
Haha, I laugh silently because my brother and my sister earn much more than I do and I've been in school the longest. The return of investment in medicine really is not much. I'd be lucky to even break even in giving back to my parents what they've spent on my education.
Such is the state of this young medical doctor today -- wishing I have a cushy (by my standards) job like Gaya's, earning more by moonlighting like Chofi and Benjo, or simply being able to bum around rich like the Mittals and Bill Gates of the world.
They say it's bad to keep and save your first salary.
I do not know if there is truth in that or it's something people make up to get a gullible co-worker to shell out for a round of beers and pizza, but I did get some stuff for it.
- Went out with Tonett for dinner
- Treated my Ward 2C station to pizzas because one of my DNR patients went home, albeit HAMA, alive.
- Bought a pair of sandals
- Bought some groceries (I, as much as possible, will not use my mom's extension credit card)
- Saving the rest for stuff like a house, a car, land and whatnot (Hahaha, well, I have to start somewhere)
I'll be going on duty again tomorrow. Gaaaaahhhhh.
Our chief, Dr. Roa, says we will be flying solo next month at the ER -- that would mean facing acute coronary syndromes, hypertensive emergencies, endocrinologic emergencies, COPD exacerbations, cardiac dysrrhythmias ALL ON OUR OWN.
Uggghh, I'm dreading next month's paycheck already.
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