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.
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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.
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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.
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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.
