Wednesday, May 13, 2015

Mother and son

He cried like a baby, and maybe that was what he was, in his mother's eyes.

With her eyes closed, she looked like she was sleeping. On her arms and limbs were multiple bruises; they started appearing just six months ago, like random pencil blots on a skin canvas. Then came the pallor, unexplained weakness, and a feeling that something wrong was going on. She couldn't put a name into it until months after her descent into being bedridden, just around the time when her doctor, after seeing her lab tests, told her she had leukemia.

The boy was 14, but he had the eyes of an old man who has been through a lot. Her cared for her mother, brought her to the hospital for intermittent sessions of blood transfusions, put up with the long queues at the Blood Bank, and even pleaded with the Social Services staff to give her free antibiotics.

On Mother's Day, he was still a boy—soft wisps of hair just starting to grow on his arm pits, his voice barely beginning to crack—but already mother-less. Her mother's blood infection was so profound that even the strongest antibiotics were almost powerless against the battle. Her platelet count was too low as to graciously permit spontaneous bleeding to happen anywhere in her body: her eyes, her lungs, her brain. That was what killed her: a ruptured vessel, perhaps, that decided to snap in her cerebrum. She was gone in minutes.

As he grieved and sobbed and wished that this was all but a dream, IV lines were still attached to her mother's veins, made fragile by chemotherapy. Medications meant to raise her blood pressure to the bare acceptable minimum were still flowing in futility.

It was just another day at the hospital. He had to bring her body home. He had been through a lot, surely he could handle her mother's funeral, too.

Sunday, May 3, 2015

By the lake

BATANGAS is the farthest we've all been to, my batchmates and I, since residency had begun. This weekend we had our first outing at a lakeside resort, allegedly made famous by the fact that it was the venue of a celebrity's wedding—the celebrity's name escapes me. All in all, it was a welcome respite from the endless charting and patient interaction and code-ing and social work-ing—not that we minded doing those things. It's just that, at some point, we've all gotten beaten down.

batch 2017 internal medicine residents, pgh.

Friday, April 24, 2015

Twenty-eight

Manila

TWENTY-EIGHT is what I now tell my patients when they ask me--usually with fascination, occasionally with suspicion--how old I am. It never fails: I barge into a private hospital room, auscultate a patient’s chest, and a relative, usually an elderly lady, tells me how smart I must be, still so young and already a doctor. This explains why I always carry a stethoscope around my neck even if I don’t do rounds, or why I wear long-sleeved shirts even on temperatures that leave most people dehydrated after sweating (plus the fact that I'm in Internal Medicine, where tucked in, rolled-on shirts are the norm).

Monday, April 20, 2015

Changed

In what I would consider as the closest thing I've had to a two-day weekend, I witnessed friends from church share their conversion testimonies during baptism. The venue was a private pool just blocks away from the church building. A colorful tarpaulin shielded the rest of us from the intense morning sun. We must've looked like a family on a reunion, or an outing—the look of anticipation and excitement on our faces must've been unmistakable. The baptism ceremony is something I personally look forward to year after year, if only to remind myself of my own coming-to-Christ narrative.

Tuesday, March 31, 2015

March madness

March was a whirlwind of sorts. I was in Service Three, the same service I had been in when I was a clerk, intern, and pre-resident. Going back to it as a full-fledged resident reminds me that things have already gone full circle.

Every day was an admitting day—at least that was what we told ourselves. Our patient census was filled to the brim. The two wards were a wellspring of our service's readmissions, walk ins, and ER consults, despite the fact that the Emergency Department was supposed to be closed to make way for the periodic generalized cleaning protocols. Even on Sundays we were swamped.

The fact that we admitted at least 60 patients to our service for the past doesn't surprise me at all. By God's grace, we were able to send most of our patients home, improved.

I had worked with Racquel Bruno in January. Since then I've known her to be a very focused, determined, yet hilarious colleague. We've had our shares of laughter that came in many bouts, especially when new patients were decked to us before we even made sense of the other patients we were presently examining. She made it lighter for me—the heavy patient load—and I learned a lot from her.

Our clerks and interns were very good, too—in a sense, way better than when we were at their stage of training. They knew how to prioritize their tasks. They were very receptive to criticism, and never once did they complain that they were overworked. We must have taxed them to their limits at some point, but they carried on.

I consider it a great privilege to have been mentored by Sir Nemo Trinidad (who used to be my first year resident when I was an intern—talk of going full circle again!). He let me and Racquel independently manage our patients, but we always came to him for guidance. His plans were practical, and his management goals were clear-cut. He was so gracious with his time and effort and money in making sure our clerks and interns were taught well. He was passionate in making sure they learned something. I had never seen him panic, and even when he reprimanded a patient—and rightly so—he was calm and compassionate.

Nemo Trinidad, service senior

Our service consultants were Dr. Aldrin Loyola and Dr. Angela SalvaƱa. They were very hands on, doing weekly rounds without fail despite their packed schedules. Their inputs were helpful and set direction for our medical management. Their practical clinical gems were things one cannot read in books. 



Last night the entire service went out for dinner. It was a great way to end the month and to celebrate the end of The Season of Incessant Charting. Here are some photos.

Our clerks and interns were so happy to see the outside world.

Service Three — whee

Racquel, my partner-in-crime, who topped our batch's Cardiology Exam. She will kill me when she reads this.

Racq, my partner in crime

Christian Lingan, our favorite Junior Admitting Physician on Duty (JAPOD)—was lost, and still is.

Christian Lingan, our favorite JAPOD

Gian, Joy, and Raf—wonderful interns who'll make great doctors in a few months.

Interns Gian, Joy, and Raf

Stephen King-look alike—thick glasses, white complexion—don't you think so?

Raf Gavino

Delicious dinner with wonderful company. I'm so glad to have worked with all of them.

Service farewell dinner with clerks and interns

Our senior interns gave us this. So very touching—thank you. The clerks gave us something to eat for dessert, too. 

image

To emphasize how small I am compared to the rest of the team, here's a photo. 

image

Saturday, March 21, 2015

The other end

IT IS already 9 PM. I admit a patient for an elective coronary angiogram procedure, a short diagnostic test that maps the vessels supplying the heart and identifies where the clogs are. I phone the Cath Lab to inform the anesthesiologist that the patient is now ready for preoperative evaluation.

"Good evening, this is Dr. Catedral."

"Good evening po," says a shy sounding woman at the other end.

Friday, March 20, 2015

Catching up

I'm more than halfway through my second stint at the Charity Ward. Time goes by very fast, especially when one has a lot of things in mind. It is, I suppose, better the second time around, though the transition from the Medical ICU to the Ward (which is really an extension if the ICU, if you think about it) wasn't as smooth as I'd expected.

But enough about residency.

Friday, February 27, 2015

Moving in (and out)

I'M MOVING to a new place again, somewhere much nearer, literally a stone's throw away from the hospital entrance. Moving out (and in) is stressful for me. My upper body strength is so weak, such that carrying two volumes of Harrison's inevitably brings about pain the next day. My friend Jef, who penned my college yearbook write up, referred to my arms as “wispy.”

Sunday, February 22, 2015

Best lunch I've had in a while

WHENEVER I overhear someone say he “enjoys” residency—as if it were as easy as window shopping or reading Danielle Steele—a part of me doubts him. Either he's exaggerating the ease of his transition into residency life, or he's not doing what he's supposed to do. Medical training is hard work—more so during the first year.

Thursday, February 19, 2015

Late entry for Valentine's

ON MY WAY out of the Medical ICU to catch a quick breakfast before I did my rounds, I was greeted by unusually giddy nurses, “Happy Valentine's Day, Doc.” I would've told them that Valentine's Day is a non-entity for me—and not in a romantically bitter way, for those emotions escape me—but I replied, in the interest of time, something like, “Happy Valentine's Day, too.”

No man is an island

ONE OF the greatest joys of my week, assuming I'm not on a 24-hour shift, is the Bible study (or cell) group I've been attending for months now. It's called Pilgrims, composed mostly of married, basketball-loving, middle-aged men. In terms of age, I'm in the minority—at 27, I'm among the youngest. We meet Thursday nights in church.

Saturday, February 7, 2015

Libro

HANDFUL of quotes from materials, mostly books, I'm currently reading.

On the art of seeing and managing too many patients all at once.

To a medical student who requires 2 hours to collect a patient's history and perform a physical examination and several additional hours to organize that information into a coherent presentation, an experienced clinician's ability to decide on a diagnosis and management plan in a fraction of the time seems extraordinary.—DB Mark and JB Wong, In: Decision-Making in Clinical Medicine, Harrison's Principles of Internal Medicine, 18th Ed., Vol. 1

Tuesday, February 3, 2015

Part of the narrative

MY FIRST foray at the Wards as first year resident was made up of a whirlwind of experiences—a combination of frustration and fulfillment (mostly the former). I suppose my month-long stay there was an initiation to the tough, challenging world of residency training in Internal Medicine at the Philippine General Hospital.

Thursday, January 29, 2015

Recap: first month

Service 6
Service Six. From right: myself, Racquel Bruno, Josh Abejero (back), Julie Gabat, Raymond Lozada (back), Amy Lopez, Jing Lagrada, Bea Eusebio (back), and Mia Licyayo.

TWO DAYS left, and I'm done with my first stint at the Charity Ward as resident. It's where much of the action happens. The first year's roller-coaster life—victories and failures, recoveries and morbidities—essentially revolves around Wards 1 and 3.

Monday, January 26, 2015

Baffled

I HAD the immense privilege of helping Rich King, our batch head, compose the speech for the welcome ceremony for incoming first years in the Department of Medicine last week. His delivery gave this short message a more serious, determined tone; and he spoke like a seasoned orator. Here it is, in full.

Internal Medicine - Philippine General Hospital
Credit: Dr. Nemo Trinidad

It still baffles us: the fact we made it to residency in Internal Medicine at the Philippine General Hospital. When we look back at the rigorous pre-residency process just a few months ago, we had no way of knowing whether we were going to get in at all. There were so many applicants, many at the top of our own classes, all oozing with brilliance and compassion, so much so that in the end, we felt it was anybody's game. We wouldn't feel cheated if we didn't get in and they did. And yet, by God's grace, by a beautifully orchestrated miracle, we received the call one fateful afternoon. Some of us were still curled up in bed, or watching a movie over our laptop, and when we heard the resounding, “Congratulations! You made it!”, many of us couldn't believe our ears. Our lives finally took a new direction for the next three years.

Sunday, January 11, 2015

How do you measure a year?

LAST THURSDAY night, during my time with the Pilgrim Men—the Bible study (or cell) group I've had the privilege of attending in church—we shared what made our year memorable. The question was, in effect, like this: what criteria do we employ to say that our year has been a success?

Saturday, January 10, 2015

Basement boys at the Ward

MORNING always has us scrambling for charts—not an easy task at all, but one that requires the visual acuity of an eagle, the extraordinary flexibility of a snake, and the father's forbearance in the Parable of the Prodigal Son.

Friday, January 2, 2015

New Year's Eve, PGH, and 2015

I WELCOMED the new year in the hospital. I was on 24-hour shift at the Pay Ward, intermittently called up by nurses for referrals that ranged from possibly fatal complaints (difficulty breathing or chest pain) to electrolyte abnormalities easily corrected by telling the patient to eat a piece of banana. I had brief moments of rest, perhaps the longest ones I've had since I had begun residency two weeks ago. From the call room window I could see fireworks decorating the expanse above Manila Bay. I imagined that, if I were home on New Year's Eve, my street at St. Gabriel would be noisy too. I could see our dog, Benjamin, cowering in fear whenever our neighbors lighted fireworks. The Dizons, who live just right across us, would call us up and invite us to their home; I wonder if their family computer, which we always fantasized about, is still working. My parents would probably be asleep, especially my mother, who cannot tolerate staying up late lest she incur a migraine the next day. But Tatay would wake me and my brothers up sometimes—that much I can remember when I was in elementary school. He would give us firework sticks and light all three of them at the tips with a single matchstick, assuring us that our hands wouldn't need to be amputated because that hardly ever happens if one is careful. I was particularly paranoid; I liked my hands very much.

Monday, December 29, 2014

My Reading Year 2014

HERE'S a list (probably incomplete, and not in any particular order) of books I've read this year. I'm not sure which ones I like best; the top ten should include the works of Marilynne Robinson, William Faulkner, and, well, of pretty much everyone else in this roster. Jhumpa Lahiri was a surprising discovery for me; her simple prose evokes so many complex emotions. I read The Interpreter of Maladies once in a while, and I get a different insight from it every time. Roddy Doyle, the Irish writer, famous for The Barrytown Trilogy of which The Commitments is the first, is a happy addition to the Funniest Writers list I'm compiling—a list that already includes David Sedaris and PG Wodehouse. Also included in my 2014 reading diet are essay and short story collections, like Chabon's Manhood for Amateurs and Faulkner's Go Down, Moses. The New Yorker anthology, Secret Ingredients, features the best magazine articles about food; I enjoyed that immensely, too. Spiritually, I've benefited from Jon Bloom's Not by Sight—great retelling of Biblical stories Christians have come to love. Overall, a great year for reading.

Saturday, December 27, 2014

Fellowship

ONE of the greatest blessings—and joys—of the Christian life is having a church family. Having been literally rooted out of our home in Mindanao to pursue further studies in Manila, my brother and I didn't have any immediate family members to go to, homes to spend the weekends in, aunts or uncles to visit. Yet the Lord, in His sovereignty, brought us to a small, faithful church where everybody knew each other. Over the course of many years we have developed meaningful relationships with many of the members who have always prayed for us and wished us well. Our local church is the closest thing we have to a family in Metro Manila.