The Senior Citizen as Patient 9/21/2008 08:52:00 PM

In the course of 9 months doing residency, I have encountered several patients in the twilight of their lives... I think I already described my impressions of three such persons in a previous post, which can be my entry for this edition of "The Blog Rounds". If I ever live to that age, I wish I can be as gracious as the second patient and as grateful as the third. God-willing I won't be acting like the first one.
Read rAdIoLoGy NoTeS 06 to see why.

rAdIoLoGy NoTeS 13 9/12/2008 10:52:00 PM

It's a busy month: a mid-year convention, in-service exams, trying to get applicants to then start pre-residency mid-November.... And I just realized that I'm no longer going to to be the most junior resident of the department... I can now say goodbye to being responsible for supervising the work of the medical interns... I more or less already know what I am doing, although I still make an occasional inexcusable mistake (i.e. Do not fail to look at the skull base bone destruction and subtle mass lesions, especially with symptomatic patients with known primary malignancies! -> Major note to myself!!!).
Next month I shall assume office as the secretary of the local radiology resident's organization. I was elected in absentia (I had to get back to the hospital that night for a referral. I later ended up doing the preliminary reading of the brain CT-scan of that certain boxer all the other residents saw lose that night on national TV). The main reason I was elected was again, my gender. I guess I have already mentioned in a previous post that I am only one of two current residents in this part of the country who are female (she's already about to graduate!). I can't wait for the new resident to start though. Currently all the applicants are female so there's a good chance my junior will be a she.

Bisperas (The Day Before) 9/06/2008 10:31:00 AM

Tomorrow, I will be celebrating my 28th birthday. Since, I will be the radiology-resident-on-duty at the hospital tomorrow, I'm writing my birthday post on the eve of the day itself. I'll be cooking for the staff of the department (yes, those guys I have been occasionally ranting about who have appetites of epic proportions!) and my co-residents for breakfast tomorrow. They are planning a maƱanita (dawn serenade) which I am strongly opposed to! I don't know yet if they will really carry out their plan...

Anyway, I used to celebrate my birthday by writing a poem with the exact number of lines as my age when I was in college. I think it is about time to revive this custom...

~@ ~ @ ~ @ ~ @ ~ @ ~ @ ~ @ ~ @ ~ @ ~

Twenty-Eight Verses

With the night at end

Ane the day begun

The sunlight glides

To break the dawn

And allow the rain

To pause and think

Of puddles that muddy

The path one takes

Or rainbows to usher

The day's delight

And I pause to wonder

Of the things to come

Be they lights or shadows

Joys or adversities

And see that the difference

That lies beneath

Depends on one's perspective

Of what is at hand

Thus, I resolve to wear

Those rose-colored glasses

That I may see

The world anew

From the optimistic perspective

Despite the hurts

Or the ills that come

The darkness shall fade

And the light shall come

With the rising sun



Why I'm Pro-Life, Anti-Artificial Contraception and Think That Reproductive Health Bill is Totally Unecessary 9/01/2008 07:06:00 PM

I'm already bracing myself for a lot of violent reactions to this post... I know I'm not the only pro-life physician in this country (I know several others just like me, a few, but I would like our tribe to definitely increse), yet perhaps I will be the lone voice of dissent in this edition of the blog rounds. Do allow me to explain myself though.
Since I was in high school, the issue of contraception has been my pet peeve. I had to write an assigned article, elaborating on the artificial methods of contraception as well as the reason why it was immoral. Pretty hard to digest for a teenager then. But I did get the point of the Church's teaching on it: Separating the procreative and unitive aspect of sex from each other was what made it against the natural law and therefore immoral in itself (the same principle applies to the immorality of doing an in-vitro fertilization procedure, but that's a whole other story).
In college, I once mentioned to a friend (who happenened to be a physician as well) that I had to write a paper on a topic for my ethics class. She suggested that I take it up artificial contraception as using abortion as my topic would be too easy (the act is already banned by our constitution). Thus I found myself reading books that explained why this was so not in terms of the teachings of the Catholic Church but in terms of the nature of the sexual act. Unfortunately, I have lost my original soft copy of the paper I made, but I shall reiterate here the little that I remember in my own words.
The sexual act is a means of a very intimate form of communication between the man and the woman, essentially indicating that they are giving their whole selves to each other. Artificial contraception in whatever form it comes is tantamount to saying "I give you my whole being, except that I hold my fertility back." Thus in this most intimate form of communication, the man and woman are lying to each other (the same principle applies to the immorality of pre-marital sexual relations, but again, that's a whole other story).
When I finally went to medical school and did my senior clerkship, I found out that a lot of times, patients were not actually giving informed choices as they were not in the first place fully informed either. A lot of physicians seemed to not take the time to explain to patients the real pros and cons of one family planning method and the other. For instance, how often does a woman hear that an IUD and oral contraceptive pills can cause induced abortions as one of their mechanisms of actions as sited in even the latest OB-GYNE textbooks. Do people ever hear that the natural family planning methods are the only ones without any side-effects and are upto 99% effective if they are employed to the letter? I have also witness illeterate mothers berated into signing the consent form for Caesarean sections plus bilateral tubal ligation once it has been noted in their history that it is their third C/S? Is this even mandatory? I have heard of at least 1 woman who has had 5 C/S (In one ethics book, it states that there are cases of 9 or more C/S without maternal or fetal complication). I heard some of my then OB-Gyne residents say that the uterus gets too scarred the third time around. Well, if the uterus gets too scarred, they should remove it as a diseased organ and not tie the perfectly healthy fallopian tubes. This violates the ethical principle of totality and bodily integrity. I also find it apalling that it seems people think that people are incapable of periodic abstinence thus sterilization is the easy way out. It seems to close to saying that we are like, let's say those dogs who have to be spayed or neutered as they cannot control themselves either. I think there is also a tendency for many to selfishly see child as a burden, not as a real gift from above.
Unfortunately, there are so many Caholic physicians who have as little knowledge of some basic teachings of their faith as they are well-versed of their subspecialty. In one online article, I read about this Catholic doctor who didn't know that it was a mortal sin to consel a woman to use artificial contraceptive methods. I also remember the shock of one of my doctor-friends when I told her that even assisting in a bilateral tubal ligation is a mortal sin as it publicly signifies that you are approving of the act (I have at least once refused to assist my resident in a C/S + BTL while she was doing the BTL part). If the reader has had no previous knowledge of the above facts, at least I have now stated the obvious for your benefit.
Pope Paul VI was quite prophetic when he wrote these words in point 17 of the landmark encyclical HUMANAE VITAE in 1968, and I quote:
Consequences of Artificial Methods
Responsible men can become more deeply convinced of the truth of the doctrine laid down by the Church on this issue if they reflect on the consequences of methods and plans for artificial birth control. Let them first consider how easily this course of action could open wide the way for marital infidelity and a general lowering of moral standards. Not much experience is needed to be fully aware of human weakness and to understand that human beings—and especially the young, who are so exposed to temptation—need incentives to keep the moral law, and it is an evil thing to make it easy for them to break that law. Another effect that gives cause for alarm is that a man who grows accustomed to the use of contraceptive methods may forget the reverence due to a woman, and, disregarding her physical and emotional equilibrium, reduce her to being a mere instrument for the satisfaction of his own desires, no longer considering her as his partner whom he should surround with care and affection.
Finally, careful consideration should be given to the danger of this power passing into the hands of those public authorities who care little for the precepts of the moral law. Who will blame a government which in its attempt to resolve the problems affecting an entire country resorts to the same measures as are regarded as lawful by married people in the solution of a particular family difficulty? Who will prevent public authorities from favoring those contraceptive methods which they consider more effective? Should they regard this as necessary, they may even impose their use on everyone. It could well happen, therefore, that when people, either individually or in family or social life, experience the inherent difficulties of the divine law and are determined to avoid them, they may give into the hands of public authorities the power to intervene in the most personal and intimate responsibility of husband and wife.
I would like to end this post by stating his particular appeal to those of us in the health care sector in point 27 of the same encyclical:
To Doctors and Nurses
Likewise we hold in the highest esteem those doctors and members of the nursing profession who, in the exercise of their calling, endeavor to fulfill the demands of their Christian vocation before any merely human interest. Let them therefore continue constant in their resolution always to support those lines of action which accord with faith and with right reason. And let them strive to win agreement and support for these policies among their professional colleagues. Moreover, they should regard it as an essential part of their skill to make themselves fully proficient in this difficult field of medical knowledge. For then, when married couples ask for their advice, they may be in a position to give them right counsel and to point them in the proper direction. Married couples have a right to expect this much from them.