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. :)

Satchel Love

Satchel and surgeon ;)

This is a special shout out to Manila Fashion Observer and Schu! 

Congratulations on the blog anniversary and thank you so much! 

Useless Anxiety

“I keep the telephone of my mind open to peace, harmony, health, love and abundance. Then whenever doubt, anxiety, or fear try to call me, they keep getting a busy signal and soon they'll forget my number.” - Edith Armstrong


I'm having one of those days that I'm feeling bummed and spent.  Blame it on my monthly or what, but I guess the biggest thing that's sapping me of energy is all this anxiety.  I typically tend to get it around the time when I'm shifting in to a new service (like now I'm finishing surgery and moving to otorhinolaryngology) and I don't have an inkling of what's going to happen next or what to expect or what to do. Typical of me to try and seek some semblance of control over events that I totally have no control over. So I spend my seconds, minutes, and hours thinking up a storm about all the worst case scenarios that MIGHT happen, and end up tired and depressed.  It's a habit I have to break soon if I'm ever going to keep my sanity as a physician-in-training.  I'm still on the way to telling myself firmly to stop worrying and let things be.  I have to have a little more faith that the universe won't be throwing disasters my way, and meekly surrender to Divine Providence.


Negativity out, positivity in. Om. Amen.

Four Months Down

Fun! Done with 123 days on internship so far! :)

For those 123 days, I've learned to become a monitoring machine, a med-tech, a counselor, a nurse, a secretary, a social worker, a child psychiatrist, a rectal examiner, a retractor b*tch, a blood runner, a vein stripper, a pseudo-anesthesiologist, an EMT, a rad tech, a bullet extractor, a research assistant, and a nose job model.  A colorful road to becoming a full-fledged doctor don't you think? :)

(Forgive the random rambling. I have a headache and too much fastfood in my blood.)

Little Blessings

For every whine of every day, I get little blessings in return. Gotta love the Big Person Upstairs for throwing the little surprises to keep my spirits up.


Like I got a Sunday with my family, which is quite rare because the universe somehow conspires to make my duty days fall on Sundays most of the time.  We ate a lovely lunch at The Old Spaghetti House in Robinson's Otis; thin crust cheese and pepperoni pizza, hearty spaghetti, pesto pasta, calamares, nachos, and chocolate chip cookie a la mode.  Our family then headed over to our ancestral home in Sampaloc to celebrate my sister's birthday with pancit palabok and mocha-chocolate cake.  I had a chance to play with our family's lovable askal Cloud, who loved horseplay and belly rubs (and took extra care to keep his paws off my hospital whites.)

Monday found me finishing chart rounds early (as most patients were out-on-pass, given the long weekend), being a research assistant for a greater part of the morning, then off at noon.  My aunt sent me a message inviting me to go around the mall with her, which I accepted.  Spent a good part of my afternoon eating (a delicious grilled burger, chunky fries, enchiladas, and chips), browsing shops, and snagging two new tops.  I also got a haircut (my first in about eight weeks); the stylist happily lopped off about 8 inches of frizzy hair off, leaving me looking about 5 years younger. Teehee.  Since it was late, I opted to go home to the ancestral house in Sampaloc to sleep, but not before watching a bit of TV, eating some cashew roca, and browsing through gossip rags.

Today, again finished chart rounds early, interviewed two more patients for the study, had the funniest encounter in the plastic surgery office (where a patient pointed to my nose and asked for similar nostrils), and observed in the pre-op conference. Lunch was followed by a short nap, then a visit to my friend in Tahilan.  Back at my dorm, I took a nice shower then dinner. Now I'm just checking my email and producing this post.

So far, I've had this great stretch of little blessings and I am more than thankful for everything that came my way.  They are such great pick-me-ups because the previous weeks weren't quite as restful.

Heartless

About 100 days into my internship in the national hospital (also known as 100 days of being a glorified aliping sagigilid or scut monkey), I was ready for a break.  I noticed that I was becoming less compassionate towards patients and their bantays, and such greatly bothered me because I'm usually the person who would find any and every way to make sure that a patient got a radiologic procedure, labs, or medications.  Helping the really needy is a noble job, however, the health care situation here is far from ideal, so things become draining and feel futile after a while.  I guess that truth finally sunk in and has me all but scrambling to get back into the slightly more civilized world of private practice.

I guess it was encountering a certain subset of patients on a daily basis that had me figuratively throwing my hands up in defeat and saying "fuck all this."  Ever heard of the phrase "mahirap tumulong sa mahirap?"  I particularly am bothered by patients (and bantays) who come in and demand top notch care (and whatnot), yet refuse to move a muscle when the time comes to do their part.  We need them to register, go to social services, submit labs, get radiologic requests approved, buy the medications or needs, while we doctors tend to the patient's most immediate needs; some of these bantays are content to watch or want us to do those things mentioned, which is unfair and impossible because we're tending to a good number of other patients who need urgent care as well.  I particularly loathe those people who are exceptionally rude and feel so entitled.  There are times I want to scream at them, "you're not even paying your taxes!"  I guess being constantly exposed to the harsh urban life bestows a certain mean (cue in Taylor Swift now) attitude on them, that they can't help being that way, much to their detriment and our dismay.  In the beginning, I tried to reason with this people in the sweetest possible way, but repeated "fail" moments have me abandoning the attempt.  I'm not ashamed to say that there were times I had to raise my voice and put on a mega-frowny face to get things moving.

Gah, being a doctor is such a thankless job.  I don't want the negativity from this people to influence my life but I think I'm beginning to turn into a heartless automaton bee-yotch.