Monday, June 29, 2009

Good Burger

The best thing about outside rotations is that you could go on a food trip during lunch breaks.

Yesterday we went to Tinie's cousin's resto at Maginhawa St. near UP Diliman. Good Burger. They serve chicken or veggie burgers in different mouthwatering combinations. Super affordable pa. Good burger (1/4 lbs. patty$ costs around 55-90 bucks, Better burgers (1/2 lbs. patty) cost 70-100 bucks and Best burgers (1 lbs. patty) costs 90-120 bucks. Not bad!

Libre ni Tinie ang fries and drinks so, solb talaga :-)

I had the Silly burger (chilly burger). Maanghang siya but nothing special. I kinda liked Allain's Persian burger more, I swapped half of mine hehe. Justine's Margarita burger is ok too as well as Cai's Three cheese burger.

Just the thought of burger's making me hungry!

Branches:
Sikatuna: 162 Maginhawa St. 435 4663
Greenhills: One Kennedy Place, Annapolis cor. Ortigas Greenhills
Pasig: 10 East Capitol Drive, Brgy. Kapitolyo Pasig
Pasig: 106 E. Rodriguez Jr. Ave. Brgy. Ugong C5 Pasig

Sunday, June 28, 2009

Camp Crame

I'm making this entry while stuck in heavy traffic. We're on our way to Camp Crame, our homebase til June 30. Ok naman siya, malinis, peaceful, pero ang mga patients namin re not the usual sick patients. Most, if not all of them, ay victim ng crime.

First Patient

Alleged rape victim. Minor yung girl. Minor din yung offender. Nakipaginuman sa mga guys. Si Gran Ma(tador) ang tinira ng mga loko. 4x!!! Later on nakita na lang nung friend nung girl sa damuhan na nakapatong yung isa sa mga guys sa girl, both of them naked!!! Hay buhay. Ayun, nakulomg yung guy, yung babae pinaexam sa amin sa Crame.

Intact hymen but with congestions within the periphery of the vagina. Based on the new Rape Act, di naman na kailangan mapenetrate ang hymen para maconsider na rape ang incident. Basta may ipask ka doon, daliri man o pencil, basically kahit ano na against the girl's wishes e, pwede ka ng makasuhan ng rape.

Lesson learned: hindi mapagkakatiwalaan si Gran Ma!

Second "Patient"

"Patient" kasi patay na siya. Autopsy of a motor vehicular accident victim. Guy was driving a Honda Civic, on his way home, when out of nowhere, a drunk alleged DLSU prof, driving a Ford Escape rammed into the right side of the car.

"Patient" sustained a fractured arm and pelvis, subarachnoid hemorrhage, subdural hemorrhage, ruptured aorta, and hemothorax. "Patient" was 30, married and has a 7 yr. old child.

According to the victim's family, the family of the driver tried to negotiate with them, but they declined.

Hinding-hindi ko makaklimutan ang unang autopsy na ito. My first ever autopsy. It was gruesome. It's like going to the butcher. The utensils were unlike those we used in the operating room. Knife na sobrang matalim at hack saw talaga ang gamit namin. Kung ako ang relative ng victim tapos I'd be required to watch the procedure, I'd be mortified!

The good thing about the autopsy naman is that you get to apply the reasoning we learned in legal medicine. We also get to see fresh specimen, the organs are not dry and rotting like those of the cadavers we used in med school. All in all it was a great learning experience.

Lesson learned: Matibay ang Ford Escape! Mismong sa mom ng victim nangaling yan. Wasak daw ang Honda Civic while the Ford Escape was still intact after the incident. Alam nila na matibay talaga ang Ford, account manager bg Ford ang victim e.

Third Patient

Domestic violence. Husband is a cop who's assigned at the building beside ours. Wife is a midwife working at a hospital in Ortigas. Husband punched wife and tried to ran her over with his motorbike.

Wife's scared of reportig her husband. She's terrified of being seen inside the clinic for her husband might find out that she's filing a case against him. We were on a lookout yesterday while she's under our care. There was a time na nagpanic kami since the patient started complaining of headache. Buti it wasn't anything serious, thank God.

Lesson learned: Learn self-defense? Don't get married? I don't know.

Hopefuly all our patients get the justice that's rightfully theirs.

Tuesday, June 9, 2009

I am sick and some other stuff

May sipon, ubo at lagnat ako ngayon. Trankaso sa tagalog, Flu sa ingles. Unang beses kong umabsent ngayon. Kaninang umaga, pagising, nilalagnat na ako, barado ang ilong at mabigat ang ulo. Nagdecide ako na huwag ng pumasok. Tinext ko ang groupmates ko at nagendorse ng trabaho. Mahirap ding umabsent sa surgery, lalo na kung ang pasyente mo ay for operation that day. Buti na lang bukas pa yung sa akin. Kaso, sa condition ko ngayon, feeling ko hindi din ako papasok bukas. Mahirap na, baka makahawa pa ako ng iba, o kaya e mahawa pa ako ng mas opportunistic diseases habang immunocompromised ako sa flu na ito. May multidrug resistant staphylocauccus infection pa naman kami sa 3rd floor ngayon, malapit sa surgery lounge kung saan kami nagstastay. Yung patients pa namin ngayon e mga cancer patients, yung iba nagtatake ng chemodrugs, kaya immunocompromised sila, so naisip ko na mas lalong dapat umiwas muna ako sa pagpasok.

Natatakot lang akong matambakan ng make-ups. Hindi pa naman ako nagpacheck-up sa health service. I need a medical certificate para maging excused absence ito, pero naman, nanghihina na nga ako, eeffort pa akong pumunta ng UST?! Bahala na, gamitan ko na lang ng charms hahaha.

Ang boring pala ng life kung wala kang ginagawa bigla. I mean, araw-araw akong nasa hospital. Bawat hakbang na gawin ko may purpose: pumunta sa pasyente, mag-run ng labs, mag-code. Ngayong may sakit ako at nasa bahay, biglang wala. Bedridden. Natutulog lang ako. Kung hindi naman e nakahiga lang. Umaalis lang ako ng kama para mag-CR o kumain o ka'y magpabili ng pagkain. Nalulunod na ako sa tubig at pineapple juice. Gusto kong magkape, hindi naman pwede. Kanina, naglaro na lang ako ng Nintendo DS. Hindi kasi ako makatulog. Kung kailan naman makakatulog ako, tatawag ang mga kaklase ko sa ospital, magtatanong about my patient.

Heto, ngayon, nagresearch ako about H1N1. Wala lang. Sa dami ng mga taong nagpupunta sa ospital compainging of fever, etc. baka mamaya kasi meron na ako nito. According to my research, parang regular flu lang naman pala ang H1N1. Bedrest and proper hydration lang ang kailangan. Hopefully this thing I got is not H1N1. Baka masama ako sa statistics e hehehe.

-0-

Anyway, I've been talking with MH about Virgin Labfest. It looks like I will be able to watch the plays from June 23-27. Hindi na ako sa surgery that time. Legal Med na. Good thing about it is that wala silang night duty. Hopefully matuloy kami. May student discount pa kaya this year? Hehe. Since student pa dina ko, regardles of age, I'll buy the student tickets kung meron.

Saturday, May 23, 2009

To my brokenhearted friend

People have a way of disappearing from our lives, one way or another. No matter how you hold on to them, it seems they're determined to slip away from your fingers. Just like a pen or a card or a cellphone, no matter how carefully you hide them, put them in your pocket, if you're destined to lose them, you will. The people in your life will come and go, no matter what. No phone call or email or drama could make them want to stay once they've made up their minds.

This I will tell you my friend, because I once was in your position. Holding on to someone long gone like it's the end of the world is like holding on spilled milk.. Impossible. Carlo always come to mind. Remember him? When I went to Hong Kong a couple of years back, we were still a couple then, I would call him everyday. Just to say hi. Check on how he's doing; how he and his mentor's doing. I would stop by a mall in Causeway Bay, just to use an internet connection in one of those coffeeshops just to send an email, or just to chat with him. When I went home, after a couple of months, Carlo hooked up with Mentor, and I was left with nothing, I learned that they started 'dating' when I was away. So after that, I realized that no amount of text or calls or e-mials would have changed the way things turned out to be. Don't get me wrong, I'm not telling you not to try and fight for your partner, or chase after him. I'm just saying that once you've reached that point where everything's said and done, learn to stop. Learn to move on. Because you can hold on to them for the rest of your life, while they hold on to someone else.

Learn to look at it as an opportunity for you to meet other people. I said learn because I know it will be hard to will yourself up and look beyond the person you so dearly love or loved. Yes it's not always a fun process, but hey, you just might meet someone better. Way better than the one you're crying over now.

Poeple will come and go, my friend. Remember that. Enjoy the moments, cherish the happiness and forget the loneliness.

Hugs.

Wednesday, May 20, 2009

Fragmented Angelita

Dear Angelita,

It's been a week since the last time I saw you. You were lying in your bed at the MICU. The tubes have been removed. Only the JV catheter's in place. There's a kind of peace in your face. Your beautiful face.

-0-

You remind me of my mom when she was first brought to the ICU a year go. She looked terrible. Her face was swollen from all the beating she took. She's got dried blood in her hair and bruises all over her body just like yours. There were tubes connected to her all over. Just like yours. Yes, just like yours.

-0-

I feel for your daughter. I know how she must be feeling the night everything went wrong. Did you remember that night? It was my first day at neurosurgery. It was also my first duty in that rotation. Tinie had a new admission that day. The patient's kinda in a bad shape so she was assigned at bedside. Cay was busy doing rounds. I was basically helping both of them. I remember the hour before you became toxic. I was the one who took your vital signs. Your BP that time was 110/80 mmHg. It was within the normal range. You didn't speak to me when I said hi. Your daughter was at your side, offering you a drink. I chatted with her for some time then went on my way. I didn't have any inkling of what was in store for all of us that night.

-0-

I remember receiving a call from Cay an hour later. Your BP's going down after she took it at three intervals. She was panicking. I called the intern. we were at your bedside that time. You were complaining of stomach pain. We were considering MI, since it was noted at your chart. Possible MI. I referred you to the Med resident on duty. I remember vividly how it all happened. From a stable patient, you've become someone in need of 6 bags of blood. We were still clueless at what's happening to you.

-0-

Your ECG's were fine, we've placed all sorts of stabilizers so that you're BP will go up. The residents were thinking of having a CT scan done to determine where you're bleeding. I went back to the lab to get more blood. I remember seeing the sky turn light blue as I walk back and forth from one building to another.

-0-

I remember that morning at the CT scan. The first time I saw melena. My head's floating in the air that morning. I didn't get any sleep and you were toxic. Instead of bringing you to the ward, we brought you to the MICU. I endorsed you to our alternates and then I went home.

-0-

I remember the day we referred you to psychiatry. You told your attending physician that you wanted to die. He wrote an order asking that you be evaluated by a psychiatrist. I was the one who interviewed your children as well as your sister. I even interviewed your husband and friends. You were at the ICU that time. You were still bleeding internally.

I visited you at the ICU that same day. You were awake. There were tubes attached to you. You look helpless, but I know it's what's keeping you alive. You were smiling at me. I said hello. You held my hand and told me that you wanted to get well. Remember? You said, " Pagalingin mo ako, I'm very hopeful, galingan mo ha". I didn't kow what to say. I just held your hand tight and smiled back.

That day at the ICU, I felt we formed a bond. You shared your life story with me. You told me about your apo's and how much you missed them. You even promised me a taste of the Pancit Malabon which you cook so very well. You recounted your days as a teacher at Makati. You don't know it that time, but you were a teacher that day to me as well. You taught me about psychiatry and how important it is to know you well, to look beyond you as a patient but as a functional individual, with relationships and value beyond which we at the hospital can just imagine. Yes Angelita, I became a student of yours that day.

-0-

I will never forget the way you held my hand when you told me that you thought I was a snob. You were smiling. You were explaning to your clerk-in-charge how we first met. At the end of your story, you called me charming. Then you smiled. It was the same smile that greeted me when I enetered the MICU. It was the same smile that greeted me your entire stay at the ICU.

-0-

There were times when your name will come up during our conversations. Out of the blue we'd remember how well you were before you took a turn for the worse. There were days when we'd discuss the procedures as well as the labs that were ordered for you. We would discuss the things that should and should've not been done in your case.

-0-

We were the clerks who took your vital signs. The ones who ran your labs and got your blood. We were the ones who pushed your stretcher when the residents requested for a CT scan and endoscopy and RBC tagging. We were the ones who pumped your ambubag as well as suctioned your secretions. Somehow, we can't seem to shake you off of our head. I can't get you off my head.

-0-

I hope you're in a better place right now. I'm writing this to say thank you. Thank you for being a teacher to me. Thank you for sharing with me your life; for inspiring me to do better in the field I've chosen.


Love,

Eugene

Thursday, May 7, 2009

Everyday

I'm now under Neuro/Plastic Surgery rotation. I just had my first duty and boy was it toxic! 2 patients went into code last night. One died early today, the other one's been transferred to the MICU before I went off duty. If you're one of those people who read the tabloid, you might have come across one of our patients in the front page last May 6.

Anyway, it's been one hell of a duty. There's basically 3 of us in a group. We usually do 'deckings' which means that we divide the number of hours we're in duty between the three of us. So if we're on duty from 7 pm to 7 am, 12 hours, we divide the 12 hours equally. We go on 'duty' each night for 4 hours although we're at the hospital from 7pm to 7 am. The remaining hours, we either sleep or do paperworks, or if if there are admissions for the night, we do the admissions. Anyway, last night, Tinie had the most toxic patient ever. The patient is on 'q30' (vital signs every 30 minutes, togethr with urine output). It was a really complicated set-up. She was at bedside the entire time. I was there helping her out since I'm not that toxic. Cay and I decided to split the duty hours into 2 instead of 3. She takes the first half, I take the last 6 hours. In the early part of the night, one of the patient's bp started going down. Way below the normal. That brings the total number of toxic patients to two. Cay was elevated into a bedside clerk when the patient became q15 (vitals every 15 minutes). I then took Cay's remaining sked.

When Cay's pt.'s condition took a turn for the worse, 'q'-ing was suspended. I was then assigned to facilitate emergency labs and x-rays. I was basically running from one building to another, bringing blood samples, requesting packed RBC's and bringing them to the ICU. It was really, really tiring. After several drugs and transfusions, pt's bp was still going down. We're sure there must be bleeding somewhere. Ancillary procedures were ordered. CT scan didn't show any abdominal aneurysm. It was only during the time when we were transferring the pt. from the CT scan table to the stretcher that we noticed that there's blood in the sheets as well as a foul-smelling odor. Turns out pt. has melena (black, tarry stool, representative of upper gastrointestinal bleeding). As of this moment, when I asked for an update, pt's still at the ICU, condition is still not stable.

-0-

Lesson learned that night:

1. I now know what Melena is. I'll never forget how it smells and how it looks like. Iba talaga when you see it first hand compared to just reading what it is sa mga books.

2. Intern-based learning ang clerkship. Imbes na matuto kami from the residents, we basically get our knowledge from the interns. Take for example, last night I was curious on what to do just in case our patient went into code. In our lectures we were taught how to do CPR etc, but then it was just described to us. In the actual setting, like in Tinie's pt., he has tubes in his face and the bedrest was elevated. I don't know, if and when the patient goes into cardiac arrest, 1.) Should we remove the tubes and lower the bedrest before starting CPR? 2.) Should we leave the tubes in place, just lower the bedrest and start CPR? These are valid questions. So I told the medicine resident on duty that I have questions. His reply? "Not now, I'm toxic". Would you believe that? I then went to our intern. He told me to leave the tubes in place and just lower the bed rest and start CPR.

During the orientation, we were encouraged by the consultants to ask questions when we don't know what to do. Better safe than sorry lalo na now that we're handling real people. Nakakainis lang na napapansin namin, especially medicine residents, na tipong they are allergic to referrals or questions from us. Dahil ba added work ito? Siguro if they're getting paid for each referral they won't feel the same way, kasi yayaman sila sa kakarefer naming mga nasa surgery rotation. I've yet to meet a medicine resident who would welcome referrals from clerks without smirking, shouting or making rude comments. Thank God there are interns who help us out.

Basically, I get the point that we are really in the bottom of the food chain when it comes to the field of medicine. Even lower than the secretaries and the janitors. I don't mind at all, doing all the things we're required to do. It's just that nakakabother lang yung mga power trippers na secretaries as well as nurses. Anyway, tinitiis ko na lang lahat ng mga lait and all just for my patients. Really, kapag makipagtalo ako sa residente, intern, nurse or secretary, ang totoong talo e yung patient ko. It's either he won't get the treatment that he needs o kaya matatagalan ang procedure or mga requests. In medicine, time is gold talaga, mas mabilis mafacilitate ang mga requests and procedure, the better. Kung makipagtalo pa ako, lalo lang tatagal ang mga bagay-bagay, baka mamatay pa ang pasyente. Sabi nga ng friend ko, wala namang namamatay sa kahihiyan, so go na lang. Do everything for your patient. At the end of the day, we're basically at the hospital to treat patients. Yung paglunok ko araw-araw ng pride ko, tulong ko na sa mga patiente na naaassign sa akin.

3. Thank God for the storm. Pm duty was cancelled so basically nasa bahay lang ako the entire day. I was in bed the moment I got home from the hospital. I was so tired. Natulog na lang ako. When I woke up in the afternoon, my body was aching all over. Sobrang sedentary na kasi, nagmuscle strain ata ako sa kakatakbo kagabi from the different buildings just to get blood and have the ABG interpreted. Iba ang takbo lalo na when you know that every second counts. Constantly my mind was thinking that I should do every request fast since in distress ang patient ko or ng classmate ko. I'm actually hoping na bukas cancelled pa din ang pasok. Kapag ganoon kasi only those on duty that day are required to go to teh hospital. Sunday pa ako duty ulit so basically bukas, kung cancelled ang pasok, I'll just stay at home and rest.

-0-

I've been amiss these past few weeks on my duty as a son, friend and bf. lagi na lang akong unavailable because of my schedule at the hospital. Lagi din akong pagod. I couldn't even text or reply to text ng mga friends ko. Kahit nga magbasa ng libro hindi ko magawa. I still haven't found the set-up wherein I could accomplish all my obligations. It's kinda frustrating. Pero sa totoo lang right now, all I want to do is be a bum. I miss the times when I'm just surfing the net, watching tv shows I've downloaded on the net, or going out and having coffee. I miss my life wherein I could basically do what I want, when I want it. Yung tipong you don't feel torn between all your obligations. Now kasi I feel like kailangan ko atang hatiin ang katawan ko just to be a son, a friend and a bf. I hope I get to adjust to things in the coming weeks. God help me out.

-0-

Ok, so I'm really having a hard time with clerkship now. What's new? Everyday, I try to find a reason for me to stay in the program. Aside from thinking about the expenses my lolo incurred para maka-med ako, I'm looking for something to inspire me to continue doing what I'm basically doing right now. Kung hindi ko gagawin iyon, siguro nag LOA na ako by now, what with all the bad experiences I've been having since the start of the program.

Anyway, yesterday, my inspiration was my patient's caregiver. She's the wife of my patient. I call her lola (generic term we use to address the elderly). They were suppose to go home na kahapon, but they've encountered some problems with the billing, so they couldn't go home yet. I was on duty last night when I bumped into her while I was doing the rounds. It was around 10 pm na and she was still walking in the hallway. At that time I thought nakauwi na sila. Kinamusta ko si tatay. She informed me nga na they weren't allowed to go home yet since at the last minute may nadagdag sa bill nila. E kaso wala na siyang pera now at napauwi na niya lahat ng gamit nila, like food etc. kaya basically, silang dalawa na lang ni tatay ang nandoon. Gusto na nga niyang umuwi since hindi pa siya nagdidinner. Oh God, lola is like 77 years old na din ata like tatay. Hindi pa siya kumakain that time? I decided to buy her dinner. I gave it to her, and she was happy. Si tatay nakakain naman na since kasama pa siya sa food list ng hospital. I felt giddy inside when I saw the smile on lola's face. I thought ito din siguro yung 'giddy' feeling surgeons have after a succesful operation, or a doctor finding out that their patient is improving under their care. And so I lived to see another day as a clerk sa UST hospital. I might not have directly treated my patients illness, but then I was able to help them out in one way or another.

Thursday, April 30, 2009

Ranting Again

The UST Surgery Department were selling Wolverine tickets the past few weeks. It's for their special screening last night at Trinoma. Fundraising siya for their medical mission this summer. I was suppose to go there with my sister since our resident sold me 2 tickets. I thought it would be a good way to bond with her na din since we seldom get to see each other because of my schedule.

Earlier that day, I gave her the tickets. I told her to be at Trinoma earlier than the screening time so she could reserve good seats for us. 6 pm yung screening. She was there around 4 pm. I didn't imagine na toxic kami kahapon. Nagulat na lang ako when we were called to be at UST earlier than 7 am. Wala palang mga interns. So, we ended up scrubbing in their operations. Ok naman yung mga OR, until my patient's OR was deferred. Mataas kasi yung BP. 150/100 ang highest. He's just 7 years old. Instead of OR, I ended up doing his labs and paperworks. Yesterday, I realized that the hardest thing in clerkship is not the errands or the paper works. It's the referrals. Hindi mo alam kung ano ang itatanong sayo ng mga residente. Since bata pa ang patient, I had to refer him sa pedia. Then pedia referred the patient to pedia nephro. So bagong presentation. Nangarag ako sa mga questions. Bagong labs. Then referred na naman siya sa pedia..Pedia nutrition. Doon ako nadali. At 5 pm, kung kailan uwian na dapat, nagprepresent ako sa resident. The bad news pa, e dinemand niya ang mga paperworks and diet computations by 6 pm the same day. Patay kung patay. I called my sister to tell her na maghanap na lang siya ng papalit sa akin. Sa totoo lang, I was kinda bad trip. I was really looking forward to spending time with her. Ang thing pa e, wala siyang masyadong friends dito. Ang ending? Nanood siya mag-isa. Umuwi siya mag-isa din. I wasn't able to pick her up after the movie.

By 6 pm last night I approached the resident again and informed her that I wouldn't be able to finish the things she wants me to submit. She told me na dapat first thing in the morning meron na siya. By that time start na ang movie. Hay. Bad trip din ako last night dahil by 12, hindi pa ako tapos sa mga referrals, requests and paperworks.. Ang daming labs na kailangan i-carry out. Maghahating gabi na nagrerefer pa ako ng same patient sa radio. Siguro hindi ko pa masyado nahahanda yung sarili ko sa situation na last minute nacacancel ang mga plans mo kapag doctor ka na. Any minute pwede kang tawagan, in the middle of a date or a movie, pwedeng may patient na magcode or mangailan ng labs.

As of the moment my sister is still not talking to me. My patient is still hypertensive. We still don't kow why, but we're getting there. I like to believe that we're ne step closer to finding out why. Hay.

Basically, I'm just ranting. I'm just tired. La lang. Pauwi pa lang ako to get some sleep. Parang hindi holiday. Imbes na magliwaliw, matutulog ako. Duty pa ako bukas. =(