ER Forays of A Newbie

Our training program here has one quirk not found in other hospitals in Cebu (or so I think) -- first year residents get to go on duty at the Emergency Room.

Yup, First Year.

The reason given to us was that it would double our exposure to ER duties, and we get to see more cases, and get experience on how to handle these patients first-hand.

I get the logic, but that doesn't make the anxiety of being alone at the desk fronting the Emergency Room doors any less stressful. It takes triple the testicular fortitude to survive and conquer the fear of what comes in through those two swinging doors. So scared am I on nights prior to ER duty that I fear and depression drives me to my knees in prayer that everything would go smoothly (but it rarely does) and that He will be with me every step, order, and IV insertion of the way.

One thing for sure though, ER duties certainly have given me so many moments:

WORST: There was one time when, the outpatient consults were endless into the wee hours of the morning and right up to endorsement time, and after I got received (the next shift comes in) I literally had to run from room to room, ward to ward, get all my X-rays and scans, ECG's to get ready for endorsement (grilling time), and needless to say, I got fried to a crisp.

BEST: Just recently, at my last ER duty, we had someone come in, in severe respiratory distress. He was brought to the hospital by two of his neighbors after they found him knocking on their door for help, all blue and air hungry. We didn't know what he had because of a really poor medical background given to us, all the neighbors knew was that he smoked and drank a lot, was admitted the year before and a handful of medications in his bag. It was a cross between respiratory and cardiac, which is which we didn't know. He flatlined for about 5 mins. We treated him as best we could and revived him to full consciousness. To see him writing his name on a piece of paper, considering he was probably walking towards whatever light at the end of the tunnel he was in, is joy immeasurable to me. Now he has a second chance to be able to make peace with a family he has left behind, and that is just gravy.

FUNNY: An order on a referred patient's chart: "May eat juicy fruit - not the gum."

SCARY: There was a time where I had no activity at the ER whatsoever for the whole afternoon of a weekend duty, the calm before the storm if you will. Then it got crazy as first an arrested patient came in, probably a massive heart attack, followed in seconds by an electrocuted patient in ventricular fibrillation (a really scary heart rhythm). Needless to say again, everybody got plenty of action and exercise that night.

DRAINING: You get to take on really demanding patients from expats who think they deserve top billing because they earn dollars for a living to aristocrats and the psychologically-off patients who think they are the only ones in the ER.

COOL: I once said that if I could not become a surgeon, I'd be the one at the foot of the bed manning a code, shouting lines like "We need an ABG stat," "Start Dopamine 400/250 at 10 cc/Hr," or "This ECG shows an ST Elevation in Leads II, III and AVF, Morphine 2 mg now, O2 at 2 Lpm, ISDN drip at 10 cc/Hr, and Aspirin now."

And now I'm getting to do that.

Maybe not as confident, not as fluid nor as collected as I make it to be, but I'm definitely working on getting there.

It's been so long since I last posted that I'll be going on another ER duty in the next couple of days, so, gulp, here we go again.

The Lull of Lent

Cebu is surprisingly quiet for Lent -- that is compared to the regular hustle and bustle of the regular work week. I still remember celebrating the Holy Week in Dumaguete and recall the near empty streets, the processions, and the one of the few days of the year, or if not the only day, where we don't open up shop at the market to sell meat.

I came from duty on Maundy Thursday and we were on skeletal duty (to the nonmedical people, meaning only those on duty would be roaming the hospital). After endorsement, I was on my way home, and I the lesser-than-usual number of taxis and jeepneys driving around, the malls were closed and the quiet was a nice change from the honking and the revving of engines.

I spent most of the day sleeping, enjoying the peace and the sedative effects of the mid-afternoon breeze and went to say a few words of thanks at the church.

Good Friday was even more serene and beautiful and I took time to breathe in the freshest air I've ever inhaled since I've been in Cebu. I took the time to do some long overdue cleaning.

This was always the best thing about the Holy Week -- the peace, the quiet, the time for reflections, and in the same way I've always ended it, a prayer of thanks for Him who came and saved me.

And of course gave me a schedule where I could enjoy two skeletal duties in a row.

In connection, a couple of my posts that I remember having fun making or just simply made my day:

1. Who Wants To Be A Superhero?

2. Some Good Things

3. A Pedestal For Mellie

4. It's A Little Bit...

5. Piano By Starlight

6. The Years Gone By

7. Death Becomes You

8. In Sickness and In Health

9. Behind the Half-Rimmed Specs

Behind the Half-Rimmed Specs

Ahh, introspection. Where does one begin?

Lying down in my quaint rented bedroom, staring at the dirty-white paint on my ceiling, I paused to think how to write this next entry. As sleep slowly drifted and took away my conscious perception of the night, I took off my glasses and just stared into the blur.

There are two sides to my life at the moment, the one that exists and the one that exists in my head. The basics are out there -- Dumaguete City, Physical Therapy and on through medicine, though I never knew exactly why and how I came to be the doctor I am today and residency is the imposing and prevailing presence in my life at the moment.

I blink and pause to think about what I could do had I not chosen this path. I still love to lose myself in music and song as I float my fingers over a piano, or find solace and freedom in the lyrics I can make with a simple melody. Or had I worked hard enough, could I have played a sport for a living? Or anything remotely related to sports? How about movies? Me and showbiz...

I blink again and realize, I'm drifting off into slumber. Well, I guess while I'll do medicine, I'd do all those other stuff on the side.

Reflecting on the day that has passed, I still remember the mortalities that mattered, the mistakes and the right decisions, the days where I was too tired to think and the good days where going into a patient's room and giving good or bad news came easy. There those really depressing days where I'm tempted to stop and rest and those days where I feel really good that I did something right.

I twist in bed and accidentally roll over onto my glasses and I quickly remove it from under my shoulder and place it on my side-table.

These glasses don't hide a Superman, but I'd love to be a mild-mannered doctor and leap tall buildings in a single bound as well. I'd be the Philippines' alternative hero to Manny Pacquiao. I'd stop bad guys left and right, arrest corrupt officials, get rich, save lives, be someone, and the whole world will remember me....

And then I wake up...

Stare into the streaming sunlight...

Off to work again.

Maybe tonight I'll dream another dream.

I take a bath, stuff all my books and clothes in a bag, take my glasses from the table and got ready to go though another day. Oh the joy...