There have been several things that have brought a smile or two to my stress-laden face these past few days. I’m not talking about the crappy one-liners that crack you up, but rather it’s all about those times that come up and surprise you – that box of chocolates, those life-affirming purpose-filling experiences and those moments that bring joyful memories and images that you just can’t help but radiate happiness.
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I’ve made it no secret that I fell in love with this line of work during my post-graduate internship. The endless diagnostic puzzles and the countless thanks we get when we see a patient walk out the hospital doors floor me now as much as it did then. And for every intern that has come through our hospital (two batches) I’ve always tried to impart that sense of awe, respect, and interest in the diagnosis and treatment of patients. One way of doing that is having them man the triage and outpatient consults (as we did then). After they see the patients and take their histories, they come to us, residents, with a plan for diagnosis and treatment. I have always given them a little free hand to do and get what they want as long as it is in line with the diagnostic possibilities.
A week ago, we were saddled with a patient with abdominal pain, mainly in the epigastric area with radiation into the back, noted after eating a meal of squid. There was epigastric tenderness and vomiting. My intern mentioned all the differential diagnoses and was hedging on Gastroesophageal Reflux Disease and Pancreatitis, ruling out of course an acute coronary syndrome with a negative ECG. I was already happy with the way she handled the patient. In the background of a previous history of GERD, it was highly likely just GERD, but she wanted to rule out Acute Pancreatitis.
I said, “Convince me to allow you to take a serum amylase.” She went into the doctors call room and brought out our text books and began to read from the symptomatology of Acute Pancreatitis. I laughed and conceded. Who couldn’t say no to that?
Serum amylase was negative. Endoscopy eventually still showed GERD.
She came up to me after the results came out and said, “Doc, I’m kind of disappointed and happy at the same time. Happy that my patient doesn’t have pancreatitis, but disappointed that I didn’t get it right.”
For someone to try that hard, to figure out a patient, and bounce back after getting it wrong is a lesson learned in itself.
That became a life-affirming moment for me. I love teaching whatever I can to those who listen and when you see it come together like that, it’s a wonderful thing.
I told her, “You can’t get all your patients right, you can hope to try, but you just can’t. It’s the thinking process that counts. And you are well on your way.”
She stood up, flashed a smile and went on to the next patient.
Small victories.
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I don't have any fangled camera DSLR's and whatnot, but I have my hearing and I've rediscovered my love for music -- thus, thanks to my mother (ever-supportive, she was the one who had us take lessons way back in kindergarten), I've been reconnecting with my love for music through a new keyboard. (thank you ma.)
As Gaya says, it's chasing giants that make this life worth living. Hahaha, if I didn't know better, I would have sworn those were lyrics. But that's just me.
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Tuesday, August 17, 2010
Monday, July 12, 2010
Broken
It's been too long.
It feels like it's been too long.
I spent a whole 5 years on my pre-med course, a whole 4 years on studying medicine, a year of post-graduate internship and a nerve-wracking board exam. I got through it then moved onward to practice medicine.
I'm two years into residency -- seeing patients, greeting them, diagnosing and treating them, knowing some secrets, building relationships -- and it feels like it has been forever.
We get patients, walking, talking, breathing human beings in our ER and sometimes, it would just feel good to be able to say that "You're gonna get out of here in one piece," or "it's gonna be alright," but we don't. It's not that we don't want to say it.
It's because we can't.
We don't know what's lying around that corner. Some unforeseen complication, some undiscovered comorbidity that just lurks in there and takes you away from us.
Or sometimes, we do everything we can, yet it still falls short.
I spent the better half of the past 3 weeks pondering what I could have done more at that ER table while writing down the orders for my patients to change the outcomes of the certificates I had to sign. I asked people who knew more than I did, who had seen more than I did, yet they just smiled, comforted me with words like, "it wasn't your fault," and moved on.
You see, here in impoverished Philippines and I assume in the better part of Third World Asia, we get sick patients who most of the time, do not even have the opportunities for a cure. We get a patients who don't even get a chance to swing for that home run, or that open three-point shot to tie the game. Instead, we get patients and their crying families, and we have to look them in their eyes and give them the options, surgery, a thousand-peso antibiotic to be given for two weeks, an ICU stay, eight units of blood, and what have you, but all we get in return are more tears. Then they wipe them away and all that's left are faces with clenched jaws, and flushed skin, and the realization that this is the end for a loved one. The hand is dealt and they've lost.
It's hard to be the one on that other side.
I spent a week trying to convince a patient with a manageable cerebellar stroke to undergo a needed decompression -- wall, no money.
I started two large bore IV's and got blood without delay for a patient with an upper gastrointestinal bleed and stabilized her in the ER before sending her up, but she exsanguinated and bled out 3 days later on her rebleeding probably due to massive peptic ulcer -- she was awake the whole time until the last minute, where I stood from a distance knowing full well the Do Not Resuscitate form was signed.
I did my first child intubation two weeks ago, mainly because I was at my ER post when they came. He was blue, unresponsive, and severely dehydrated. Somewhere from the first hospital they went to until they reached us, that poor kid was lost to his mother and family, and the screaming, bawling was enough to remind us of how much pain we try to prevent each single day.
I lost another patient to a puzzling diagnosis that really can't matter now because his daughters have brought him back home for his funeral rites.
We've had so many losses.
And everything goes slow each time we do that I look around and I feel that it goes on too long.
The grief, the sadness, the pain...
Sure we are not your family, we are not your friends and we are strangers but that doesn't mean we don't care.
Walk one day in my shoes as you go through the wards and the hospital rooms and see how many people we try to bring back to health. See us as we break the news to more than one family. We feel the pain too, two, three times over.
And I do.
I hurt when I lose a patient.
Each time I walk out there to talk to someone about what treatment someone's wife, or someone's mother, someone's brother, or someone's boyfriend needs, it is from the deepest, most well-intentioned part of my heart, that they heed my advice. And if by some way fate deals us something that we can't overcome, well, I am not going to pretend that choosing or making a decision is easy, but I'll be there, and I'll listen, because I do feel pain. It might not be the same as their pain, but pain and hurt nonetheless.
Like the faults that people easily notice, losses seem to count more than gains.
Reflecting, I realize I admit as few as 10 to as much as 20 people in a span of a 12 hour duty and 1 out of those 20 might die, 2or 3 might need an ICU stay, and some fraction could refuse treatment, but nobody sees the 15 or so that I help cure.
I realize that.
People can say that at times doctors are heartless and cold because we move on so quickly from a death to the next patient that walks in our doorway, but the truth is, the losses do hurt, but more people are out there who need our help, and the only way to make it hurt less, is to make the losses matter.
If the time comes when losing patients doesn't hurt anymore, it would be the time to hang up the white coat and stethoscope and stop because to what end are we working for?
For Mrs C, Mr. P, it will matter. It will count.
I'm scared every time I take that ER floor. But it is easier to accept that I am there determined to have you smiling walking out the doors, handing in your discharge papers and knowing your free of pain and sickness.
And a faint fleeting flicker of memory flashes at the back of my mind, and I remember the losses and how I should make them matter, how I should count more the gains, and move on to the next patient because I am a doctor, and that's what doctors do.
It feels like it's been too long.
I spent a whole 5 years on my pre-med course, a whole 4 years on studying medicine, a year of post-graduate internship and a nerve-wracking board exam. I got through it then moved onward to practice medicine.
I'm two years into residency -- seeing patients, greeting them, diagnosing and treating them, knowing some secrets, building relationships -- and it feels like it has been forever.
We get patients, walking, talking, breathing human beings in our ER and sometimes, it would just feel good to be able to say that "You're gonna get out of here in one piece," or "it's gonna be alright," but we don't. It's not that we don't want to say it.
It's because we can't.
We don't know what's lying around that corner. Some unforeseen complication, some undiscovered comorbidity that just lurks in there and takes you away from us.
Or sometimes, we do everything we can, yet it still falls short.
I spent the better half of the past 3 weeks pondering what I could have done more at that ER table while writing down the orders for my patients to change the outcomes of the certificates I had to sign. I asked people who knew more than I did, who had seen more than I did, yet they just smiled, comforted me with words like, "it wasn't your fault," and moved on.
You see, here in impoverished Philippines and I assume in the better part of Third World Asia, we get sick patients who most of the time, do not even have the opportunities for a cure. We get a patients who don't even get a chance to swing for that home run, or that open three-point shot to tie the game. Instead, we get patients and their crying families, and we have to look them in their eyes and give them the options, surgery, a thousand-peso antibiotic to be given for two weeks, an ICU stay, eight units of blood, and what have you, but all we get in return are more tears. Then they wipe them away and all that's left are faces with clenched jaws, and flushed skin, and the realization that this is the end for a loved one. The hand is dealt and they've lost.
It's hard to be the one on that other side.
I spent a week trying to convince a patient with a manageable cerebellar stroke to undergo a needed decompression -- wall, no money.
I started two large bore IV's and got blood without delay for a patient with an upper gastrointestinal bleed and stabilized her in the ER before sending her up, but she exsanguinated and bled out 3 days later on her rebleeding probably due to massive peptic ulcer -- she was awake the whole time until the last minute, where I stood from a distance knowing full well the Do Not Resuscitate form was signed.
I did my first child intubation two weeks ago, mainly because I was at my ER post when they came. He was blue, unresponsive, and severely dehydrated. Somewhere from the first hospital they went to until they reached us, that poor kid was lost to his mother and family, and the screaming, bawling was enough to remind us of how much pain we try to prevent each single day.
I lost another patient to a puzzling diagnosis that really can't matter now because his daughters have brought him back home for his funeral rites.
We've had so many losses.
And everything goes slow each time we do that I look around and I feel that it goes on too long.
The grief, the sadness, the pain...
Sure we are not your family, we are not your friends and we are strangers but that doesn't mean we don't care.
Walk one day in my shoes as you go through the wards and the hospital rooms and see how many people we try to bring back to health. See us as we break the news to more than one family. We feel the pain too, two, three times over.
And I do.
I hurt when I lose a patient.
Each time I walk out there to talk to someone about what treatment someone's wife, or someone's mother, someone's brother, or someone's boyfriend needs, it is from the deepest, most well-intentioned part of my heart, that they heed my advice. And if by some way fate deals us something that we can't overcome, well, I am not going to pretend that choosing or making a decision is easy, but I'll be there, and I'll listen, because I do feel pain. It might not be the same as their pain, but pain and hurt nonetheless.
Like the faults that people easily notice, losses seem to count more than gains.
Reflecting, I realize I admit as few as 10 to as much as 20 people in a span of a 12 hour duty and 1 out of those 20 might die, 2or 3 might need an ICU stay, and some fraction could refuse treatment, but nobody sees the 15 or so that I help cure.
I realize that.
People can say that at times doctors are heartless and cold because we move on so quickly from a death to the next patient that walks in our doorway, but the truth is, the losses do hurt, but more people are out there who need our help, and the only way to make it hurt less, is to make the losses matter.
If the time comes when losing patients doesn't hurt anymore, it would be the time to hang up the white coat and stethoscope and stop because to what end are we working for?
For Mrs C, Mr. P, it will matter. It will count.
I'm scared every time I take that ER floor. But it is easier to accept that I am there determined to have you smiling walking out the doors, handing in your discharge papers and knowing your free of pain and sickness.
And a faint fleeting flicker of memory flashes at the back of my mind, and I remember the losses and how I should make them matter, how I should count more the gains, and move on to the next patient because I am a doctor, and that's what doctors do.
Wednesday, June 2, 2010
realizations
i realize that no matter how great one wants to be, and no matter how great you become, one would still be small in the grand scheme of things.↲
in residency, i have come to realize that my teachers are my patients, my books are my consultants, and how i learn is all entirely up to me and my desire to be a better doctor, nothing else.↲
i've come to realize you can serve two masters at the same time, but should these masters go on rounds at the same time, you might as well go into the emergency craniectomy and do cardiac monitoring.↲
i realize that we as a nation should have our heads straight, if all we could muster as an internet headline is that a local fastfood chain on Glee, then i should think we have either a) we do not have our priorities straight or b) we have nothing else going for us.↲
gasp, i just realized that in the above realization, it could be both.↲
i read, in a national newspaper that voters have become wiser because most senators elected in the last elections were pro-RH bill supporters. I hate to put us down, but seriously, whose leg are you trying to pull? Are you really that convinced that the first thing that came to the voters' minds was the candidates' stand on the RH Bill? Should that have been the case, in my opinion, we'd have a better cast of senators. But, i realize, that's just me.
in residency, i have come to realize that my teachers are my patients, my books are my consultants, and how i learn is all entirely up to me and my desire to be a better doctor, nothing else.↲
i've come to realize you can serve two masters at the same time, but should these masters go on rounds at the same time, you might as well go into the emergency craniectomy and do cardiac monitoring.↲
i realize that we as a nation should have our heads straight, if all we could muster as an internet headline is that a local fastfood chain on Glee, then i should think we have either a) we do not have our priorities straight or b) we have nothing else going for us.↲
gasp, i just realized that in the above realization, it could be both.↲
i read, in a national newspaper that voters have become wiser because most senators elected in the last elections were pro-RH bill supporters. I hate to put us down, but seriously, whose leg are you trying to pull? Are you really that convinced that the first thing that came to the voters' minds was the candidates' stand on the RH Bill? Should that have been the case, in my opinion, we'd have a better cast of senators. But, i realize, that's just me.
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