Stories from Internship Part 06: Pagkain, Ligo, at Facebook

Tatlong bagay lang ang naging bisyo ko nung intern ako: pagkain, ligo, at Facebook.

Alam na alam ng mga kasama ko ang tungkol dun sa una; ako yung intern na laging may baon na crackers o biskwit kahit saan. Ako rin yung kapag nakasalubong mo, laging may kinakain na tinapay, taho, o tsokolate. Pagkain lang naman ang panangga ko sa puyat at pambawi ko sa haba ng oras na ginugugol sa gawain naming mga intern. Mabilis ko rin maubos ang alinmang kinakain ko. Marami rami na ring consultant, fellow, at residente ang nakakita sa aking umubos ng kanin at ulam nang di hihigit sa limang minuto. Naging bisyo ko ang pagkain matapos ang isang buwan (ang unang buwan) ko ng paninilbihan sa IM wards na tila naka-NPO ako, at pumayat ako agad ng mga 10 pounds. Sa dami ng kailangan gawin, at sa kaunti naming mga gagawa ng scut work, wala nang oras para kumain. Lalo na kung yung iisang beses na nga ako kakain sa mess hall, di na rin natuloy kasi bago makasubo ng kanin, tumatawag na ang seniors ko. Effective naman na weight loss program, kasabay ng pagtakbo takbo sa loob ng ospital para sa labs, x-ray, at iba pa. 

 Ang Facebook, panlibang sa sarili, basta may load at kasama yung netbook. Kaya naman yung senior ko nung Pedia, ang bansag sa akin, "Nakatali sa laptop." Oo, wala akong iPod, iPad, Galaxy tab, o kung ano mang mas high end na portable device, kaya nabugbog si netbook at tuluyan nang nama-alam habang nag-review ako para sa boards. Facebook ang pang-alis sa stress matapos, habang, o bago mag-duty. Kapag online, pwedeng kumustahin ang pamilya at kaibigan, para man lang maramdaman ko na may pseudo-social life ako kahit papaano sa labas ng ospital. Nakaka-addict rin naman kasing basahin ang mga mas makukulay na nangyayari sa buhay ng mga kakilala sa loob at labas ng ospital. Mas maigi na yun kasya maglagay ako ng status message na "Q1? Q1 lahat ng pasyente sa Ward 3?!" At siyempre, pang-stalk na rin ang Facebook sa crush ko. Yihee. 

 Ligo ang pinaka-"the best" sa lahat ng ito. Bukod sa pagtanggal ng germs, dugo, pawis, dumi, at kung anu ano pang nasasagap sa ospital, iniisip ko sana nalulunod na sa tubig yung katoxican ko. Pantanggal ng sumpa o kung ano man yun. (Oo na, toxic na kung toxic. Acceptance is the key daw, sabi ng mga blockmates ko.) Parang yung pamahiin ng pagpag pagkatapos dumalawa sa patay, ganun ang ginawa ko sa pagligo. Iniisip ko na lang sa pagligo, sana kapag nakapag-shampoo ako milagrong gumanda ang buhok ko na parang pang-commercial ng Pantene kahit alam ko na nagkakanda lagas lagas na ito. Sa bawat hilamos ko, kunwari na lang na nabubura ang eye bags ko at kunwari nagiging rosy cheeks ako kahit magkasing kulay na kami ng mga bangkay na kaka-code lang namin. Sa bawat kuskos ko sa kamay ko, iniisip ko na lang, balang araw magiging malambot ulit ito. Kung may luha man na sumasabay sa tubig, eh di tubig na lang din siya. Pagkatapos maligo, pakiramdam ko tao na ulit ako. Tila wala na ang pagod, lungkot, ka-toxican. Refill na ulit ang glamour at ganda. Chos.

Stepmother of Dragons is Very Happy

The most beautiful wake up call I ever received

Truly beautiful

With the sweetest message of all

Stepmother of dragons is very happy :)

Stories From Internship Part 05: "Doc, Kaya Niyo Ba Siya Buhayin?"

Two fifteen in the morning and I'm settling in for some moments of peace in the triage area.  The initial evening surge of patients starting 7 PM has let up and the breeze is slowly making itself felt, finally.  I can finally disinfect my stethoscope, BP app, and pen.  In fifteen minutes' time, my triage duties are ending and the Rehab intern is hopefully coming to relieve the post.  Before I finish the first swig of the now lukewarm soda I bought hours prior, a taxi drives up followed by a tricycle, both crammed with anxious looking relatives.

Here we go again.

"Doc, doc, tulungan niyo po kami, tulungan niyo po kami!"

I ask them to lay down the patient in the benches immediately beside me and ask the relatives to find a stretcher ASAP.  They refuse to remove themselves from the patient whom I have yet to see, and commence the "TV Patrol" scene in front of me.  No one seems to be listening as my voice rises, "Humanap na po kayo ng stretcher, ako po ang bahala sa pasyente ninyo."

"Kuya, kuya, gumising ka na!"  The relatives keep wailing into their Good Morning towels, crowding around the patient that I still can't get to him.

"ATE, PLEASE, KUMUHA KAYO NG STRETCHER!"

One of them proceeds to disentagle himself from the clump of relatives clinging like barnacles on the patient.  A crowd gathers to watch as I frantically wrench away relatives to get the initial vital signs of the patient.  The relatives wail louder, stomp their feet, push each other, and try to rip each other's clothes in their frenzy.  TV Patrol levels, in the words of Eugene Domingo.  The crowd of bantays and kibitzers grows and moves closer, anticipating their entertainment for the night.  I yell at the guard for crowd control.

After almost five minutes of wrestling with the relatives, I get the first glimpse of the patient.

HOLY BILLY BOB BATMAN, WHAT THE HELL.  WHAT THE FREAKING HELL IS THIS?

The patient is obviously dead, very very dead, at least more than 24 hours dead.

Do I even call a code for this one?  He obviously is starting to decompose.

I try to feel for a heartbeat and obviously there is none.

"Kailan pa po nangyari ito?"

"Doc, kahapon kasi, di namin siya magising para mag-hapunan, ginigising namin di naman sumasagot."

"Wala po siyang ibang sakit? Di po siya nahulog o na-aksidente? Wala pong mga gamot o bote na nakakalat sa paligid niya? Wala pong sinabing nararamdaman sa inyo bago nangyari ito?  Ano pong ginawa ninyo kahapon?  Dinala niyo po sa ospital?"

"Wala naman nangyari bago ito, malusog naman siya!"

"Masakit lang minsan ang ulo!"

"Dati, nakulam na yan!"

"Di naman nadulas, di sementado ang bahay namin!"

"Walang iniinom yan, liban sa gin gabi-gabi!!"

"Doc, dinala namin sa clinic, sabi po patay na kaya inuwi namin, kasi parang natutulog lang naman!"

"Bakit niyo po siya naisipan dalhin dito?"

"Eh doc, nung inuwi namin siya, matigas at malamig na siya.  Naghahanap na kami ng funeraria.  Tapos kaninang umaga lumambot po yung katawan niya tapos medyo uminit nang kaunti.  Akala po namin, nabuhay ulit.  Doc, kaya niyo ba siya buhayin?"  

One relative starts massaging the dead man's muscles, probably in an attempt to get his circulation going.  I try not to wince at the sight of the dead boy being manhandled, and stop the relative.

Lord, I don't have the heart to tell them that You're the only one who raised the dead.

"Ma'am, patay na po talaga si Sir. Di na namin siya kayang buhayin, mahigit 24 hours na rin po kasi siyang namatay.  Sa katotohanan po, nagsisimula na nga pong ma-agnas yung katawan niya.  Sandali lang po at tatawagin ko po yung kasamahan ko para maipaliwanag sa inyo."

I call the resident and look at my watch, it's almost two thirty.  My reliever is coming in soon.  It's a crazy end to my triage duties.

Stories From Internship Part 04: One Hour in ACU

07:00 PM

"Kelly, maraming patients, so ganito hatian...si patient A, di pa na-send yung labs kasi wala talagang pera, si patient B, paki-follow-up daw yung trop I stat, si patient C baka i-akyat sa dialysis so standby, si patient D mukhang titignan muna ng MICU senior, tapos si patient E, paki-dress daw yung paa...tapos ito yung decking based dun sa time kung kailan tayo dumating dito...so ikaw first monitoring, last on deck"

"Uy, ang toxic mo talaga! Sige, bye!"

07:01 PM - 07:10 PM

100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum

Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

07:10 PM

"Kelly, i-follow up mo raw labs ng patient mo kung na-send na"

Hay na-ipit na naman ang monitoring ko. Asan na ba yung pasyenteng yun?

*lalapit sa bantay*

Ate, may pampadala na po kayo sa dugo niya?

"Eh wala eh."

(She turns back to playing whatever game on the PSP dangling from her neck and resumes kicking her right foot to and fro.)

(Wow, may pang-PSP siya pero walang pambayad ng 250?)

07:10 PM - 07:15 PM

100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum

Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

*looking for patient X. NAWC since 4 PM*

07:15 PM

*may kumakalabit na bantay*

(Bantay who seems slightly drunk [at 07:15 PM!] in a most condescending tone) "Nurse, kunin mo BP ko."

Kuya, mga pasyente po muna uunahin ko, may 25 pa ako kailangan ikutin...

 "Bakit hindi pwede kami ngayon? Ha, diba nurse ka? Ano bang pangalan mo?"

*Trying to evade the spittle from said bantay's mouth*

Kuya, kung gusto niyo po, pumunta muna po kayo sa AMBU, di ko talaga kaya kayo asikasuhin sa dami ng pasyente. At doktor po ako, di po ako nurse. Pasensya na po.

 07:20 PM - 07:23 PM

*Psych resident* "Ma'am, paki-BP naman to."

Sir, 70/40 po.

"Ay, dalhin to agad sa resus!"

*wheels patient to resus area and proceeds to have a paramedical give me a stink-eye because I wheeled a patient in*

"Bakit yan dinala dito?!!"

Sir, 70/40 siya. Psych patient.

"Bakit dito sa resus? Eh bakit ngayon lang dinala dito?"

(Hay naku kuya, rhetorical questions ba raw ang peg? Dadalhin ko ba yan dito kung gising to at maayos ang BP?)

07:23 PM

"Miss, di pa ba kami dadaanan ng doktor?"

Ano po apelyido ng pasyente?

 *checks list, patient's name not there, and belatedly realizes patient is decked to another service, makeshift sling and all*

Nay, paki-tanong po sa loob sa may Ortho, di po kasi namin siya pasyente

 "Eh, bakit nga wala pa yung doktor?"

Di po namin kilala yung doktor ninyo, sorry po. 

07:24 PM

*may kumakalabit na isa pang bantay*

"Nurse, wala nang dikstros"

(Ah, the all-powerful panacea, IV fluid.)

Sige po, pakisabi na lang po sa nurse ninyo na naka-violet sa loob.

"Sa loob?"

(Hay, ate.) Opo sa loob.

07:24 PM - 07:33 PM

100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum

Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

07:34 PM

*sees a patient eating a Chickenjoy meal happily amidst the horrid smell of his DM foot*

07:34 PM-07:37 PM

"Kelly, si patient D daw, paki-extract ng bagong labs. May bagong orders galing sa MICU"

*prepares supply list for patient D*

Tatay, punta po kayo sa pharmacy, pakibili po ng gamit, kailangan po natin kunan ng dugo si Kuya.

 "Saan ang pharmacy? Kailangan na ba ngayon? Masakit na kasi yung paa ko."

Sige tatay, yung isang bantay na lang muna. Kayo muna mag-bomba kay Kuya.

"Hindi ako marunong."

Tatay, susundan lang po natin yung paghinga ni Kuya. Sige po, pisil tapos 1-2-3, pisil tapos 1-2-3. Sabihin niyo na lang po sa kasama ninyo dalian na lang.

*bantay proceeds to pump the bag with all his might, completely out of sync with patient's breathing pattern*

Tatay, dahan dahan lang po, pisil, 1, 2, 3...

07:37 - 07:44 PM

100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum

Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

07:44 PM

*checks ACU logbook and realizes patient X was already brought to the ward at 4 PM, hence "NAWC" and erases name from monitoring list*

07:45 PM

*uupo saglit*

Siomai na hilaw naman, patapos pa lang ako ng monitoring, magsisimula na ako ulit. Teka may trop I pa si patient B (sana may kumuha na ng labs), tapos si patient C baka kailangan ko makipag-switch para ma-i-akyat sa dialysis.

07:45 - 07:56 PM

(At the labs counter)

Ma'am, sa ACU po

Pangalan?

Intern de Guzman po

*handed a stack of labs that unfortunately does not have patient B's result and checks with lab inside*

Ma'am may trop I na ba sa ACU patients?

"Tignan mo diyan sa listahan"

Andito po, kanina pa pong 5:30 PM ma'am

"Tignan mo yung number diyan"

62 po.

"Tignan mo dito sa screen. Mamaya pa yung print-out niyan ha."

*writes down result*

Thank you po.

Ma'am, yung trop I ni patient B, 0.1 po.

"Ah, okay. Sige, mamayang 11, extract ka ulit. Tapos bigyan mo nitong bagong reseta yung bantay"

Yes ma'am.

07:57 PM - 07:59 PM

"Kelly, pakitignan mo raw yung dressing ng DM foot, dumudugo raw. Baka kailangan ng re-dressing. Tapos may FBS siya dapat kanina, pero di nagawa. Habulin na lang daw kung di pa kumakain yung patient."

(Shucks, lumalamon na ng Jollibee yun kanina nung dumaan ako.)

"Pakidagdag daw sa monitoring yung intubated dun sa Bed 9 sabi ng Neuro. With NVS and pupils daw."

"Yung patient mo na isa, iaakyat na raw sa dialysis maya maya. Sabihin daw sa relatives, i-handa na lahat ng gamit at meds. Sabi ng fellow, wag na wag kang aakyat kung walang diazepam, nag-seizure kasi yan."

"Si patient A daw pakikulit yung labs na bayaran na. Hinihintay na kasi kanina pang morning.  Malamang hemolyzed na yung iba so extract na lang din ng bago."

08:00 PM

Here we go again...

Stories from Internship Part 03: On Pockets of Kindness in This Dismal Place (Or Why I Loved My PGH Experience)

It's no secret that a hospital isn't the best place to be at anytime, maybe except when you have this life-threatening condition that needs immediate remedy.  It's teeming with all sorts of drug-resistant germs (be prepared to get at least one MRSA infection during your tour of duty or rotation despite the best efforts on hygiene and sanitation), it smells awful (hello ACU when there are three diabetic foot patients crowding around the table, the smell of blood mixed with alcohol, the macromolecules of sweat hanging in the air, and the smell of unwashed bodies crammed together inside a room designed for 20 patients), it's dark (guess how much the power bill is), it's maddening (ever been to the ICU where machines beep and whoosh and hum 24/7 to the point that even you, a doctor has this perpetual sort of tinnitus or auditory hallucination of the soundtrack of the ICU invading your not so sweet dreams?), it's depressing (not enough to go around and patients sometimes die in the most desperate of circumstances), and people eventually get on each other's nerves because of the exhaustion and stress.  There are so many more negative things or experiences that a hospital brings to the point that it seems like this huge dump of negativity.  No wonder health workers seem to be fixated on getting out of the place at any given time.

On the very first day of internship, I was ready to throw in the towel.  Why would I make the rest of my 366 days of internship miserable in what seemed to be a special circle of hell?  Among the things that made me stick it out in what turned to be the greatest place to intern were those little pockets of kindess that were found in and around the hospital.

Being blessed with great co-interns, and residents was one thing.  For starters, I loved that my blockmates would look out for each other, help each other out in the hospital and outside, keep our spirits up, and just work together as a good team.  Sama sama sa hirap at ginhawa, sa pag-gastos at pagtitipid, sa kalungkutan at saya.  Joy, Gina, Nikki, Richelle, Alex, Jeleen, Mickey, and Patty are the best blockmates ever. No contest yan.  Other co-interns also made the work lighter because we would also share in the workload, swap funny stories about our rotations and experiences, and generally likewise cheered each other on.  Residents are another special bunch of people worth mentioning - I could safely say that 99.9% of the residents I encountered were the good kind.  I'm thankful that there was no additional drama or emotional abuse that I encountered during my internship year.  Pagod lang kung pagod pero di ka iiyak or paiiyakin for no good reason.  I felt that they understood how it was to be among the people who had to do the scut work for such a large number of patients.  They treated us as part of the team, not lackeys or people they could bully because they were bullied/scolded by fellows or consultants.  What I admire more is that the residents had tremendous workloads but managed to teach us practical stuff, look out for our welfare, treat us to food when they felt like it, or join us in celebrating on post-duty or pre-duty days.  

I'm also thankful for the nurses, NAs, manongs, social workers and guards whom I encountered on a regular basis in the hospital.  Sure, some of the hospitals' paramedicals were really cranky or sometimes outright rude, I encountered the ones who were kinder and professional.  There were nurses who would offer me coffee and pancit ("Sige na doktora intern, di ka naman matotoxic kapag lahat tayo kumain nito") during the long lonely hours in the cancer institute, those who would help me scrounge around for the much needed IV-cannulas or syringes during codes or true emergency situations, those who would treat me to an occasional stick of ice cream or halo-halo in the sweltering ER, the ones who would hold down the fort while I ran for food or a quick hygiene break, those who would keep me awake while assisting in long ORs either by asking a million questions about the love lives of my colleagues or relating what happened to what soap opera the night before, those who would offer to serve gloves in the OR or volunteer to cover the strands of my unruly hair that managed to escape my gap before the attending noticed, those who would give me the 411 on certain patients whom I just inherited for a night or for a service when I had no clue what to do or where to start, those who would offer an extra hanger in the OR changing rooms so that my coat wouldn't get creased, those who allowed me to shop for extra supplies for the truly indigent patients, and those who would still smile and joke around with me even if patients were toxic that night.  There were the NAs who would gladly give out balls of cotton, packets of gauze, or whatever I needed for a procedure in the ward or the ER.  There were lab techs I could ask for results that weren't printed yet because my seniors needed the values stat. There were the manongs who would offer to help me conduct the patients to wherever, especially when they noted a discrepancy between my build and that of the patient(s) I was to push through the corridors or load into the creaky elevators.  There were the elevator operators who would joke, "Ma'am saan kayo? Cashier, lab, NICU, ABG?" while I was on 'manong' duty.  There were the social workers I could always count on for extra food rations for the bantay, waiving of fees, procuring medications, or helping locate relatives of certain patients.  There were guards who would always greet me kindly, no matter how haggard or polished I appeared, or those who would protect me from the combative and rude patients or relatives at the ER.

Another was getting to experience taking care of kind patients and encountering even kinder bantays.  Sure, I was probably among the most toxic interns to walk the halls in the past year, but I got patients whose niceness made up for the workload and for the rudeness of 90% of my other patients.  There was this family whose patient expired due to cancer, but never kept on forgetting to text me to take care of myself because they knew I had asthma.  There was this woman who kept thanking me and promising to pray for my exams because I called a priest to bless her dying husband's body.  There was this young man who kept on updating me about the progress of his dad's treatments and how his dad finally overcame the fear of needles after I struggled with multiple blood extractions when he was under my care.  There was this woman from the MICU who would seek me out in whatever rotation I had to update me about how her heart was getting better.  There was the bantay in the medicine ward who had given birth a mere few weeks prior and had leaking breasts and asked me if she could donate her milk to the babies in the pediatric ward, to the gratitude of three mothers whose breasts produced very little.  There was the bantay who would tell me that this certain patient's parents fell asleep again and that the kid looked very ill.  There was the lola who kept needling another bantay to go to PCSO and get the necessary funds for a scan that the somewhat negligent bantay's patient needed.  There was the woman who kept insisting that she wanted to pay for the "consult" at the triage area.  There was the young man who kept thanking the triage officer for suggesting an OPD consult, even if it meant huddling in the cold air for another 8 hours.  There was the newly married woman who left a pack of cookies because I attended to her abnormal bleeding and got her up to the ultrasound area.  There was this cervical cancer patient who never failed to tell me that she wanted me to marry a good man.  There was a lady who accompanied a complete stranger to the Ambu because she noticed that the stranger was thisclose to a massive attack of asthma.  There were the random bantays who would help us load (onto stretchers) or unload (from whatever vehicle) the heavy, unconscious, bloody, smelly, drunk, MVA patients who found their way to the ER at 3:45 AM.  There was the old man who surprisingly was able to put a combative patient on a choke hold when he noticed the patient trying to attack other patients.  There was the patient who was offering a towel to wrap around my skirt when I bled out (long story) in the Fam Med OPD. There was the ortho patient who left a banana to "keep my energy up" during a ward duty.  There was the patient who kept on hugging me every chance she got, psychotic episode and otherwise.  There was the post-op patient who told me I needed to sleep more because my eyebags invaded half of my cheeks that fateful day in PACU.

Moving away from the kindness I received, I observed still that people around the hospital benefitted from the kindness of strangers and colleagues all the time.  Despite the overwhelming feeling of helplessness most often than not, we would find ways to give the care that was needed by the patients.  I think there is this certain beauty in the despair and poverty (but I'm not one for romanticizing it) of PGH in general.  While one may be rubbed raw (hopefully not to the point of just deciding not to care) by the challenging work environment, it is in the toughest of times that one learns to appreciate the people/things/events that are so easy to overlook yet so beautiful in their simplicity.  While there is a shortage of funds, equipment, supplies, manpower, food, and sleep, the inherent kindness of people keeps the hospital going.

Done With Internship, Y'All!

May 20, 2012

After one year and one day, I'm done with my internship!

Stories from Internship Part 02: Tormentor vs. Terrorist

As a clerk or an intern in any hospital, you are placed under (the care?) of future colleagues who are several years ahead in training: resident, fellow, consultant.  Simple-minded person that I am, I categorized my seniors into two groups, the tormentors and the terrorists.  The tormentors are those who seemingly exist to make your life a living hell because of the tremendous amount of scut work they pile on you, and the criticism you take from them.  The terrorists likewise seemingly exist to make your life a living hell for the same reasons an the criticism you also take from them.  At first, I couldn't distinguish between the two groups, realizing their differences in retrospect, but two years into the clinical part of training and I could easier pick out who was who.

The terrorists, well, I can't explain why they do what they do.  At this point in training, I don't think I can make excuses for them-I mean, we're all human, we get tired/hungry/angry/cranky/sleepy, but as a colleague, I think there is a certain standard I hold them to.  Initially, I would get so hurt and depressed whenever a terrorist would unload so much negativity in the air, but I guess an additional 11 months of training toughened me up a bit.  (Just a wee bit.)  I guess I learned to not let such things get to me and to just focus on getting things done.  This, all the while promising myself never to bring my family or friends to them for consults or referring patients to them in the future.

The terrorist will pile scut work on you because you are a bottom feeder who conveniently is somewhat dependent of their power to issue a grade.  The terrorist will tell you to get a stack of delinquent charts returned from records for completion and place ICD codes in all the diagnoses before he/she signs the attendance.  The terrorist will tell you to print eleven copies of a journal at 0545 AM on a post duty day and run across two long buildings in 5 minutes to a conference room where said terrorist needs to do a presentation that you are not even invited to.  The terrorist will leave signed forms and tell you to deal with patients on your own when you have absobloodylutely no idea what to do. The terrorist will alternately verbally abuse you for not knowing the answer to the most esoteric and specialized question on the old name of this certain structure present in 0.0001% of all people with a certain disorder that skips generations and for not asking questions anymore because you're too afraid to add to the terrorist's horrible mood because said terrorist hasn't had the requisite two cups of non-fat vanilla soy latte with sprinkles or a smoke.

The terrorist tells you off because you're in the way of the cautery when your fingers are in a pretzel holding 20 clamps up for the greater part of two hours already.  The terrorist fixes you with an annoyed look when the sponge handed to you was not dampened enough by the scrub nurse.  The terrorist elbows you on your boob inside the OR because the retractor you're frantically trying to keep in place is slipping and your other hand is trying to keep up with the massive amount of fluids leaking out of a friable vessel that was accidentally nicked.  The terrorist lashes out when you refer that 1 year old who pulls out every single IV line you inserted successfully and there's no other vein to use, swear.  The terrorist throws a tantrum because you can't finish fixing a specimen because all formalin jugs are bone dry in all OR complexes at 2 AM and you have to unscrub and plead with the grumpy lab techs to give you just another 20 cc of formalin.  The terrorist berates you in front of other people for not getting blood typed ASAP when you were the one who paid for the typing (without the white card!) and needled the poor tech on duty to get the blood typed in 15 minutes tops.

The tormentor may pile on scut work on you, but such work is in the end, for your benefit.  The tormentor may ask you to chart so many patient properly, which means spending a so much of your precious time on a crochety old man who smells of pee or that toddler with grimy hands and a never-ending supply of drool to decorate your previously pristine white uniform or that demanding and slightly histrionic hypochondriac who visits the clinic every single day or that grand multigravid who finally decides to consult a hospital on her 39th week of her 11th pregnancy.  In the course of learning to chart patients properly, the tormentor teaches you to pick out pertinent points in the patient's history and physical exam.  How else would your clinical eye be made better than this exercise?  

Perhaps the tormentor may ask you to extract 20 cc of blood from a patient who happens to be an 8 day old septic neonate whose parents tsk every time they see a needle go near the fragile skin of their baby who happens to be missing the normally accessible veins of 99% of humanity.  The best revenge for the stress of having to exchange a 4 cc purple top for the more expensive microtainer or the never ending tsking and rude comments of the bantays is successfully extracting enough amount of non-clotted blood to send to the lab tech who loves using that green pencil to mark tubes inadequate for testing because of the microscopic clot spotted on the rim of the tube; it becomes somewhat of personal achievement and something to tide you over the grueling 24 or 36 hour duty.  

The tormentor may criticize your technique of clipping that slippery suture with the dullest scissors on earth, your chart entry at 4:45 AM while the patient had just finished coding (and oh, your pen is running out of precious ink and your arms are shaking from pumping the patient's chest), or your rectal examination of a patient with multiple bleeding necrotic masses.  You seethe with rage and hurt, but then realize that it was all constructive criticism and held no note of malice at all, unlike the terrorist who just projects their stress all around and mouths off without making any point.  The tormentor makes you work hard for things or skills that will carry you further and make you a better practitioner, and in essence, becomes a mentor.  A mentor with a little bit of torment to make you remember forever.

Stories from Internship Part One

First day. Duty day. Admitting team day. Not six hours into today, I get my first patient, a case of encephalopathy of multiple etiologies transferred from another hospital. The resident from that hospital leaves with a smile and a sigh of relief because she's got the patient off her hands and conveniently delivered it into mine.  The patient is placed in SD Bed 3, the infamous bed that holds patients who mostly die in the hospital.  (An SD bed is reserved for cases that should have been in the intensive care unit but cannot be accommodated there due to lack of space or the patient's inability to afford the expense.)  It's an ominous start to my internship.  The beautiful thing is the patient does not feel the repeated needle pricks for the numerous laboratory examinations my resident has ordered; those are repeated needle pricks from my inexperienced hands, as I've never done venipunctures prior as a clinical clerk in a private hospital.  This day has me on a steep learning curve of where the laboratory is, how to extract the right amount of blood per examination depending on the tube that the patient bought, how to get a result even if it isn't printed out officially, how to schedule an x-ray and push the stretcher there (all the while ambubagging the patient and hoping he doesn't go into cardiorespiratory arrest right in front of me), how to refer to the myriad of other services in the hospital who would become part of the massive team who will manage the patient, and how to endorse to the ward team who will be my duty mates but off the admitting team.  Eighteen hours into this day and I'm ready to throw in the towel and run back to a private hospital, so I try to bargain with my mom so I can transfer to another hospital for training, I whine to my fellow PGI that I'm ready to quit, and I text a UP CM co-intern that I don't think I'm ready to become an intern in the national university hospital.  All three tell me to stick it out for just another day to try it out and assure me that I'm having a brief reactive psychotic episode from the massive adjustment I have to make, but I'm not even sure that I could stand another minute.  After finishing my monitoring schedule and completing the last of the errands, I lie on the thin mattress covered by a musty decades-old sheet in the call room and try to force myself to take a short nap.  Worrying that my patient would go anytime has me staring wide eyed at the upper bunk of the bed, its thin wood stamped with the names of interns and clerks past.  I swat at the mosquitoes buzzing in my ear for another three hours before I plead for a hygiene break at 4 AM and cross the street to the dark dorm that has become my home.  I'm greeted by ice cold water from the faucet and start thinking of how miserable my life has become in less than 24 hours.  For a full minute I'm just letting the water go over my head and seriously thinking about not returning to the hospital across the street.  It's my hospital coat that has me trudging back across to the hospital, this time minding the huge buses and trucks speeding past the red light.  On the white coat it is my name, appended by M.D. crowning the embroidered patch representing the hospital that I willingly chose several months prior to train in.

Lessons

"There is a lesson in almost everything that you do, and getting the lesson is how you move forward. It is how you enrich your spirit."

Being an intern in the pediatric ward means that the bulk of the work is euphemistically termed 'clinical assessement.'  Clinical assessment being a nicer term for the term 'monitoring,' the dirty job that clerks and interns perform as (hopefully) part of the learning experience and perform due to necessity because of the sheer bulk of patients outnumber the nursing staff.  We actually get it easier nowadays, that monitoring of the more stable patients is delegated to the nursing staff and we only monitor the more critical cases.  Compared to internal medicine, where patients can be more cooperative and more stable, pediatrics entails meticulous monitoring of vital signs of patients who are actively resisting all efforts to be held or are so unstable that even close monitoring doesn't do the trick.  I guess the clinical assessment part is one of the reasons that I collapse and stay in a coma after a duty in the ward, missing out on family gatherings and other events.

Okay, this picture was taken prior to Peds, but I'm wearing my 'frogs' suit more often and I look like this 99% of the time

Looking back, there is some gain on my part due to the clinical assessment part of duties in the ward.  Never mind the disparity between the effort and the reward.  There is now some semblance of confidence with my pediatric clinical eye, knowing when a patient is or is not getting better.  I get to call and participate in code blues.  I get to interact with parents (nice calm pro-active ones or rude histrionic indifferent ones) and still reassure them that no, 37.6 does not mean that their kiddo is going to go into seizures anytime soon.  I learn how to stretch my patience further when it's thinner than a fragile sheet of dumpling wrapper.  I get to teach parents how to take better care of their little ones.  I guess those are the lessons for this trying two weeks of my life.  The lessons aren't as fun as the ones I had before, but I hope those lessons are helping me become a better physician.

Girl Crush

Christina Hendricks is my girl crush

Christina Hendricks is among the most amazing actors I've encountered so far. She has the loveliest and most luscious curves and she isn't afraid to flaunt them. She's smart, sensible, sexy, and talented.  Wish more actors were like her. :)