I saw her

After my vacation, I was especting to see the pre-resident... Unfortunately, it seems that the higher ups have yet to make a decision... and it has been passed to the hospital medical director to decide on the two remaining candidates... I don't know if we'll find out by tomorrow, but whe is actually supposed to begin pre-resicency tomorrow, Monday... looks like she'll be around until the third week of December for one month of pre-residency..

We are still screening the applicants for the first year of residency training for the next year. Looks like our incoming chief resident (duh, you automatically become chief resident at our institution since there's only one radiology resident accepted every year...) R.J. got his wish... the next resident will be female since the three who are undergoing screening right now are all female... The other three residents (R.J. will be the lone male resident then) will be from hereon dubbed as "R.J.'s Angels".

I've always been a teacher at heart (I remember drawing a teacher way back in second grade when asked about what I wanted to be when I grow up), and both my parents have taught, too. (Mama-grade school English, Papa-college level business management/accountancy math subjects), so I enjoy showing the applicants the day-to-day lives of the radiology resident...Can be boring, not too stressful, but a lot of technology and equipment to master. We also are asked to lecture the third year medical students, which, though an extra job, and the need tio travel to the university, is secretly something I have grown fond of.

Initially, I agreed with R.J. on his choice for a future co-resident, but now that the second applicant is rotating, I'm again weighing things in mind...

Whoever it is, I hope she sticks through the thick and thin of four years so that there won't be anymore rotation problems....

For the past few weeks, we have been in the midst of the ongoing changes a the department's ct-scan with the pull-out of one machine,renovation of the scan room, reception area and control roon, and the upcoming installment of the brand new machine.

We're still open for business though...

Thus all the inconveniences: dust flying left and right, the worker going in and out, the scent of paint, thinner varnish, etc. all over the air, cables, wires, pipes, left and right, the noise of the drillers, hammers, drivers, etc, the construction crew moving in and out of the area the whole time...

What is one to do then?

One can choose to complain the whole day and drive oneself ill... On the other hand, I think the best response is to take in all these inconveniences with a smie and inwardly offer them up to our Lord.

Offering unexpected inconveniences to our Lord makes for a triple win situation: You are not going to be saddled down by the inconveniece, you can gain merits in front of our Lord, and you can also attached an intention to the inconvenience as well.

All it takes is inwardly saying: "Lord, I offer up this noxious chemical smells to You with the intention of my mother getting better from her current illness." You can replace the underlined words with your own inconveniences and your own intentions.

That's the beauty of seeing things in a supernatural manner.

What awaits

Beyond the dawn

Escapes my thoughts

I cannot seem to

Comprehend

The waves as they

Rush

Against the sand

Not much to glance

Yet I adore

These petals strewn

Amidst the grass

Under the shade

Of the forest grand

Stars seem to dance

On the sunbeam's last rays

Admitting that

The night has come

To take its chances

Against the setting sun

Still my heart then

To a silent tune

Beneath the glance

Of things to come

Magical mystery

Woven and wrought

By Time's sure hands

To grieve no more

And rejoice again

-jara-

(c.2009)

The year while doing my senior clerkship, I received a homemade Christmas Card/Joke depicting me as the "Sleeping Intern/Senior Clerk".... My friends knew exactly the reason why I deserved this distinction....

Reason 1: A code was called early in the morning. The medical resident attempted to insert a line. Failing to do so the first time, he handed me the IV cath while he searched for another site. I absentmindedly placed the the IV catheter on the bedside table. He put out his hand to receive the IV cath from me to re-use. Not a few eyes were on me as I was about to hand it back to him. In a split second he pause and asked, "Sterile pa na? (Is it still sterile?)". It took me about a minute to react, withdraw my hand from his reach with the IV cath in hand and say, "Ay, Doc, dili na diay... (Doctor, it's not sterile anymore...)." Later that day, I was the butt of jokes from my male groupmates for the near fiasco.

Reason 2: I was assigned to the 3rd and 4th floors a private hospital, mostly made up of private rooms. Not having many morbid patients, I decided to take a snooze. I was still disoriented upon waking up when the nurse-on-duty casually commented, "Doc, wala diay ka kadungog sa code sa ER? (Doctor, didn't you hear the code called for the ER?)." I quickly tested my on-duty groupmate. She confirmed what the nurse said, but added that I should not worry about being cited for a possible extension since the patient was declared dead on arrival anyway. That morning during endorsements, she shook her head at me and said, "You were the only one who wasn't able to wake up and respond to the code; Everyone else was there."

Reason 3: While on neurosurgery rotation, I was sleeping on the counter at the nurse's station sometime past dawn. The resident had to drum his knuckles on the counter for close to a minute steer me off of dreamland. I raised my head and inquired, "Yes, Doc?" "We have a patient in the ER,"he said. I was still bleary eyed as I followed him down the stairs to see the patient.

Reason 4: I had just stirred from sleeping on the ER reception table while on pediatrics rotation. The resident was attending to a patient at that time, but she turned to me and gave the shocked remark, "Hoy, panudlay intawon! (Hey, comb your hair!)" Talk about bad hair days....

Nowadays, while on duty, I usually get to sleep until the radiologic technologist, senior clerk, post graduate intern, resident or consultant wakes me up to give preliminary readings of plain radiographs, ct-scan or mri images. I guess somethings never change...

The radiology resident-on-duty at our institution have long been hiding away at the panoramic x-ray room for the night instead of at the call room.

Yesterday, while on duty, I was preparing to go to bed in this x-ray room as usual. I used a plastic chair to get my mattress and comforter stored in a high cabinet. While still on top of the chair, I incidentally spied something on top of the conventional panoramic x-ray machine. I moved the chair closer and climbed on top of it again to get a closer look.

At that point, one of the pediatric residents on duty who was looking for me had opened the door. "What in the world are you doing?," she asked in bewilderment.

"There's a loaf of bread on top of the x-ray machine, " I replied as I quickly jumped off with the bread wrapped in plastic in one hand. I then followed her to the PACS system computer to review images and give her the requested preliminary readings. The rad-tech on duty was on hand as well. We talked about the bread for a while.

After some thought, I remembered what had transpired earlier that day. It was the last day in the department of our two interns (senior clerks) and they decided to give a little treat of bam-i (a fried noodle dish), dinuguan (congealed pork blood), puto (rice cakes) and soft-drinks. I asked then not to leave any of the dinuguan for me though since its one of the few dishes I don't eat. They had promised there was still some bam-i, but by the time I had finished attending to pending patients, all that was left was about a glass of soft-drinks, a single puto and half a loaf of sliced bread (this usually goes with bam-i). I was a little peeved that there was no bam-i in sight. I decided to take the half loaf of bread home for dinner. That half loaf of leftover bread happened to be from the same bakery as the whole loaf that I now discovered hidden on top of the machine. Coincidence? Putting two and two together, I surmised that this hidden loaf was part of the little treat put together by the interns.

I ran into the MRI-tech on duty and I told him about the discovery. We both came to the conclusion that a certain clerical staff in the department must be responsible. She has a reputation of often putting away food given to the department for one reason or another and claiming none was left for this last person who has yet to partake of the celebration though she already neatly hid away her stash. Around mid-afternoon, I also remembered seeing her quickly exit the panoramic x-ray room, which was a little odd since I seldom see her go in there for any reason.

The MRI-tech told me to bring the loaf home. Right now, it is in the family refrigerator, ready for any of my siblings to put some spread on it. On hindsight, I can only shake my head in consternation. The incident reminded me of this point which St. Josemaria wrote in "Friends of God" under the heading of Detachment:

• Many years ago, twenty-five and more, I used to visit an eating place run by a charitable group for the benefit of beggars who were so poor that their only food each day was the meal they were given there. There was a large canteen looked after by a number of kind women. After the first meal was served, more beggars would come in to finish off the leftovers. Among this second group of beggars one man in particular attracted my attention. He was the proud owner of... a pewter spoon! He would take it carefully out of his pocket, look at it covetously and, after he had downed his meagre ration, he would look at the spoon again with eyes that seemed to exclaim: 'It's mine!' Next he would lick it a couple of times to clean it and then, with deep satisfaction, would hide it away again in the folds of his tattered garment. True enough, the spoon was his! Here was a wretchedly poor beggar who, among his companions in misfortune, thought himself to be rich.
  
  Around that same time I knew a titled lady who belonged to the Spanish aristocracy. In the eyes of God such a thing counts for nothing. We are all equal, all of us are children of Adam and Eve, weak creatures with virtues and defects, and capable all of us, if Our Lord abandons us, of committing the worst crimes imaginable. Ever since Christ redeemed us there are no distinctions of race, language, colour, birth, or wealth: we are all children of God. This lady of whom I have just been speaking lived in an ancestral mansion. But she spent next to nothing on herself. On the other hand she paid her servants very well and gave the rest of her money to the needy, while depriving herself of almost everything. This lady had many of the goods which so many people are anxious to obtain but she personally was poor, given to mortification and completely detached from everything. Am I making myself clear? In any event, all we need do is listen to the words of Our Lord: 'Blessed are the poor in spirit, for theirs is the Kingdom of Heaven.'
  
  If you want to achieve this spirit, I would advise you to be sparing with yourself while being very generous towards others. Avoid unnecessary expenditure on luxuries and comforts, whether out of caprice, or vanity, etc. Don't create needs for yourself. In other words, learn from St Paul 'to live in poverty and to live in abundance, to be filled and to be hungry, to live in plenty and to live in want: I can do all things in him who comforts me'. Like the Apostle, we too will come out winners in this spiritual combat if we keep our hearts unattached and free from ties.
  
  'All of us who enter the arena of the faith', says St Gregory the Great, 'are committed to fight against evil spirits. The devils possess nothing in this world and therefore, since they enter the lists naked, we too must fight naked. Because, if someone who is clothed fights against someone who goes naked, he will soon be dragged down, since his enemy has something to get a grip on. And what are the things of this world if not a kind of apparel?' (pt. 123)

Attachments and lack of generosity make us appear like caricatures of what we should be, and ridiculous actions are not far behind. It is a detached person's generosity which never ceases to attract and receive praise when it becomes known.

Arrangements were made for me to be driven to the airport for my trip back to Cebu. The driver was just about to turn into the gas station when the vehicle suddenly came to a jolting halt. He jumped out to check under the hood. By this time, I had decided to take a look as well (though this person-unwilling-to-learn-how-to-drive had no idea about car engines). The poor thing was overheated. The driver then hailed a few gas attendants to lend him a hand to park the vehicle to one side.

Then I heard the fateful words from his lips, "Ma'am, sumaklolo na ho kayo."

"Ha? Matatagalan pa ba?"

"Opo. Dapat humanap ka na ng ibang masasakyan."

I made a few inquiries and got directions to get on a bus to Metro Manila, get off at Magallanes and take a taxi to the airport.

I was hesitant to call a friend because my phone's battery was nearly empty, but I decided that it was necessary. One of the gas attendants suggested that I make the call inside a nearby building. I told my friend the plan. At that moment, I noticed that this building was a bus stop for a certain bus company and , coincidentally two buses were making a routine stop. The sign on one bus, "LRT, Buendia" seemed oddly familiar.

I asked the driver of my vehicle if this was the bus to Metro Manila. The response was affirmative.

I immediately gave him money for the toll fare going back to Laguna, got my luggage, then quickly jumped on the bus a few minutes before it was set to start traveling to Metro Manila. I texted someone to pray for me to get on my plane ride to Cebu on time.

When I got off the bus, I hailed the only taxi parked at the bus stop. Though it was clearly against my better judgement, I decided to accept his offer of a fixed rate instead of agreeing to pay the fare on the meter. I got to the airport in about 20 minutes.

I arrived at the airport an hour and a half early for my scheduled 5:30 pm flight, just in time for me to answer a friend's inquiry that I was already in the airport. Then my phone went dead.

Sometimes, so many things go wrong in a day, but it only takes a lot more reflection to realize that other things out there are turning our day right.

Moral of the Story? Someone up there loves me and wants to make sure I take a good night's rest before I get back to work the following day.

I'm already looking forward to...

- not being on call (i.e. having to sleep right next to my perpetual-silent-mode-phone so that I won't miss an emergency call)

- sleeping on time and waking up on time (for a change)

- having a schedule that I can live with

- reading a few more chapters of the Lord of the Ring Trilogy

- meeting a few old friends, and making new ones

- escaping the intrigues and all (no comment!)

- real rest while still being productive!

A lot for just five days, isn't it?

It's been a hectic week (finally about to end this Saturday!) since I went on double duty then had to forgo the usual every-three-day rotation to be assigned to the MRI during office hours while the MRI consultant is out-of-the-country for a conference.

It's hilariously exhausting to:

- Have the DCC (Disaster Coordinating Council) a.k.a. tandem of J.M. and K.L., the most junior MRI-techs giggle hilariously over one mis-scan (mistakes while scanning and or filming) after another.

-Almost freeze to death everytime R.B. arrives from travelling 2-3 hours from his hometown and turning up the central air conditioning again.

- Deal with patients demanding results when results cannot be promised at the usual 24-hours after sccanning release time (pending if Doctora is not exhausted enough to open the sent images and type them.

-Re-edit the results and signing for them (and also wasting a lot of yellow sheets --- try editing something techinical when you just had been woken up a couple of times at dawn!).

-Listen to the racket (some MRI-techs love their noisy music --or is it noise masquerading as music?).

-Snack without fear of being found out...

-Have the MRI-techs almost caught by the hospital medical director playing NBA via bluetooth sharing on PSP while on hospital duty.

-Make the call on sequences to be taken (and decide if contrast administration is necessary-- yikes!)

I enjoyed it, though... Unfortunately, I haven't found the time to complete my study goals for the next in-service exams because of this.

I thought about this post when the currently rotating senior clerk/intern in our department said to me: "Doc, I don't think you would ever grow old rotating here with such funny people to work with." And it's true... The radiologic technologists (radtechs for short) can be crazy... Majority of them (I'm beginning to think it's a requirement before you get hired at our institution) can make a gay impersonation close enough to fool any consultant radiologist (the sonologist actually got tricked into thinking this, when currently none of the radtechs are male homosexuals). The CT-scan techs did do Tuesday Vargas' ditty which went "Hindi ako bakla..." complete with costume for last year's Christmas party celebration. I also had this intern last month who would don two-three lead gowns the entire time he was assigned to the ct-scan.... No wonder his next 15 days of rotation was spent at the psychiatry department of the local government hospital. In the MRI, we usually hide the food in the drawers or in the dressind room, but i think the consultant knows that we eat in the control room when she's out. At lull periods, they are quick to hide their PSP's when she drops in at the control room, and everybody then pretends to be busy. We have also been hiding the water dispenser from the administrator in the IR dressing room for almost a year or so (water deliveries done only after office hours). Then, there's the free for all internet access from one of the network computers (the provider knows that we use it for the access because of some sort of team-sharing and the fact that the radtechs have shown not a few websites and message boards to the engineer while he was visiting). Crazy.... But this is where I work... ;)

One day, the potter came by an open field. There he discovered the finest pure clay he had ever seen. He brought a large bagful with joy in his heart back to his workshop. Sitting at his wheel, he began to work with his hands after adding a few cupfuls of water to the clay. A few more spins on the wheel soon revealed the form of a high-quality jar. Excited by the result of his hard work, he decided to add a rainbow-colored glaze to finish off his masterpiece. Now, tested in fire, his work was completed. He then placed it on his shelf.

A few minutes later, his careless children came to the room to play a game of tag. The little boy got off balanced as he was chased by the little girl. The little boy bumped into the shelf, and the glazed clay jar came crashing down the floor and shattered into a million pieces.

The potter came into the room when he heard the sound of broken ceramic hitting the floor. He was dismayed at first but he just shook his head and motioned for the little girl and little boy to help him clean up the pieces.

"Don't worry," he told them as they cleaned up the mess together. "I am not angry with you, since I can always make another one more beautiful than the one you broke. I can even show you how." Afterwards, he took the little boy and little girl to the field to get more clay and then make another glazed clay jar in his workshop.

~ o ~ o ~ o ~ o ~ o ~ o ~ o ~

When we make mistakes, things can come crashing down into a million pieces it seems. There are things that will never be the same again. But we can always build something new, something better in our lives. It only takes for us to realize that God leads us to help make amends and start anew again.

Rumor was not true at all...

The truth is, certain (in)famous person came to our institution to visit current (or is it ex?) paramour's sick father confined in the icu. This was confirmed to me by the radtech who happened to be about to take the portable chest radiograph of the said patient when the visit occured. I guess not a few staff took camera phone videos of him when he was spotted in the hallways. Since this is Cebu City, most likely people took their shots from a distance, nobody crowded around him, and after looking his way for a few minutes, everyone went back to his own business. Yes, culturally, we are that cool with celebreties...

So how did we all know that he was up for a visit?

Well, the sick patient happens to be one of the sponsors at the wedding of one of our consultants several decades ago. He also is the one who reads all the sick patient's imaging studies.

Sick patient also happens to be my "assignment" (the consultants assign us certain patients for preliminary reading, everytime he/she gets an x-ray the resident assigned has to submit a preliminary reading to be checked by the radiology consultant before the final official radiology report is encoded and printed).

Thus is summary: Certain (in)famous person came to visit the current (or is it ex?) paramour's sick father confined in the icu who happens to be the wedding sponsor of our consultant who has given me sick patient as my "assignment".

Now, how's that for a few degrees of separation!

Certain (in)famous person is set to have medical check-ups at our institution starting tomorrow.... My traning officer told me so herself, though I still have a hard time believing her... And I happen to be on duty tomorrow... Will I get to meet this personality? And more importantly, will the imaging results be unremarkable? Stay tuned...

I just downed the last of the 28 Erythromicin tabs prescribed for the atypical pneumonia I got last week (superimposed on influenza), but I still have coryza (runny nose) and a cough from post-nasal drip...

I was strong enough to still go on duty like nothing happened. When I open my mouth though to say something, it's plain obvious I have a respiratory tract infection.

The interns (senior clerks) rotating at our department have yet to hear me talk in my normal tone of voice (the rad techs have had their field day ever since I started sounding sick and funny...) I hope to be back to normal by Easter Monday. I still have to go on duty this Good Friday though.

Have A Blessed Holy Week and Advanced Happy Easter Greetings!

If ever this story would be picked up by the Cebuano tabloids, I think it would read:

Intern Nang-Head Butt ug PGI

That was precisely what happened.

In a fit of anger, one of our supposed-to-be-graduating senior clerks broke the nasal bone (it looked comminuted to me -> three fragments) of an intern at our hospital. This happened at nearby popular hang out when the said intern was with three other female interns and also in site of several other senior clerks.

From the information I got, it seems that he felt this particular intern had snitched on him (do you really need to snitch to the resident when you are around but the senior clerk isn't--> plain obvious that the senior clerk is out of post!) thus he got more extensions than he bargained for. Probably though, his ego was hurt when the PGI calmly explained to him why interns scrub in for appendectomies and PGI's don't (Hello--- haven't they seen their share of appendectomies when they were interns a year ago?)

Actually, he had all these extensions coming his way for his laziness (not wanting to assist in OR's as he had not been allowed to scrub out of one after wanting to eat) and absences (going back to the U.S. for holidays--whoever heard of an intern getting excused for going home for the holidays! That's 7 days for each day absent!). There's a rumor he was forgiven for falsification as well for timing in on a day that he was absent.

If I heard it right, the extensions all amounted to approximately 200 days (he got repeat rotations in the surgical rotations).

His only extension at our department though was half a day for playing at an alumni basketball game. But I keenly remember threatening to give him an extension for insubordination for making a subversive comment (I can't seem to exactly recall what it was as of the moment), the only intern thus far whom I addressed such a threat to.

Maybe it was the stress of his whole family coming to see him graduate on stage when he could not make the grade...

Instead, he threw four years out the door (the dean isn't about to give him a diploma after such a public display of anger) plus a criminal record as the intern (a simple guy who comes from a local political family and has relatives who are lawyers) shall be pressing charges.

I kind of feel sorry for him though because I was involved in similar circumstances when anger came to play many years ago.

Yet, I kind of wish that his intern (she actually just quit) girlfriend and senior clerk (his classmate) girlfirend (yes, they know of each other's existence and he's having them both at the same time) would both dump him.

Disclaimer: All information on this piece were taken from a reliable second-hand source a.k.a. a co-PGI of the agrieved party. I will attest though that I personally know both parties involved as they had rotated in our department while doing their senior clerkship.

Once upon a time, way back in senior year of high school, we were each asked to write an autobiography for our Filipino class. I put myself to the task and that soft-bound copy of typewritten pages with pictures containing the 1^st 16 years of my earthly existence is still in a place of honor at the third drawer of my old desk along with other stuff I had written in the past twenty-eight and a half years. Here, I shall present to you a summarized version of that plus the 12-odd years of the gap that needs to be filled.

I’m the eldest of four children of an eldest daughter and an eldest son. I attribute the success of us four to nature (my chemical engineer father graduated magna cum laude and landed 6^th place in the board exams) and nurture (my elementary school teacher mother became a full-time housewife to see to it that no one leaves the house without breakfast, everyone keeps a study schedule, assignments and requirements are complied, and books for references are aplenty). I’m a doctor (radiology resident), the sister next to me is working on an MBA (she graduated cum laude), my brother an electronics and communications engineer (he graduated magna cum laude and landed 3^rd in the board exams), and our youngest sister is about to start her 4^th year at the local science high school. None of us siblings are married, and we still all live under the same roof that was built by our parents in 1986.

I was born in Cebu City and shortly after moved to Batangas where my father worked. When I was around two or three, my father got a job at the Jeddah Oil Refinery, so we moved to Saudi Arabia, where we spent the next 4 years. When I started school, we moved back to Cebu City and would visit him during the summers until he quit and put up our fully-furnished apartment business. I went to an exclusive girls’ grade school and high school, an environment I thrived in academically, but not socially. It didn’t help that I have glasses, thick, unruly hair, a severe case of acne, as well as palmar, axillary and plantar hyperhidrosis. The few close friends I made though are still my close friends until now. In senior year, I was literary editor of the school paper and class chairperson. I graduated 3^rd in excellence with 1^st honors (equivalent to 1^st honorable mention) in a class of 206 girls.

I only discovered that I wanted to become a doctor in the last few months of high school, specifically a medical oncologist. I initially decided to take up Medical Technology, but then changed my mind and took up Biology at my parent’s college alma mater. A maternal aunt who used to serve as the department chairman’s secretary and knew several faculty members did a lot of convincing. It was one of the best decisions I had ever made in my entire life. I became a member of a class of Biology and Marine Biology students who are still emotionally close until now though we are now spread out all over the world. We even are familiar with the members of each other’s families. While in college, I discovered what I was meant to do for the rest of my life (as explained more thoroughly in this post). While studying at the university, I won several interschool quiz bowls, was a BPI Science Awardee (the same year blind mathematician Roselle Ambubuyog was also awarded), was nominated for most outstanding graduate, and graduated magna cum laude.

My one wish as I began medical school was to be just another one of the many ordinary students of my class, and stay out of the limelight. I got my wish since I did not even end up as among the top 20 students of our class. I managed to pass majority of my exams though.

Senior clerkship was one of the worst years of my life. The every other day duty at our teaching hospital was second to none, as well as the detailed discharges, histories and operative techniques you had to work on. In pediatrics rotation, I had to be absent after suffering from viral exanthems. In my batch, I had the distinction of having been the only one to present a CIM case to the legendary Dr. Josefina Poblete which was then subsequently rejected (my resident’s fault, though as the patient could have been worked up without being admitted to the hospital).

During senior clerkship, while doing my rotation in Internal Medicine at our teaching hospital, I discovered that I could not see myself doing the work of an IM resident. It was then a toss-up between radiology and pathology. I thought that my myopic eyes would hardly stand the strain pursuing a career involving microscopes. It was then that I decided that the field of radiology was the one for me to pursue.

My first mortality as a senior clerk (patient directly under my care when she died) was a very sick young woman in her early to mid-twenties admitted at the provincial hospital, who had multiple sexual partners and a toddler daughter born out of wedlock, probably suffering from sepsis. We couldn't actually figure out what was wrong with her (no money for further work-up) and she couldn't be treated either (no money, again, and a mother caring for her who was clueless on where to get help). I couldn't offer her any financial help either. She was my resident's case during the ward rounds. Shortly before he was about to present her case, she went into arrest, but was revived. Then my resident proceeded with the presentation of the case like nothing happened. We moved on to the patients of the other residents. She then went into arrest for a second time. My resident and I tried to revive her again, this time to no avail. She died before the IM ward rounds ended.

I decided to place as my hospitals of choice for internship those private hospitals in Cebu City which had training programs in radiology. I ended up being matched to the hospital where I am now doing my residency. I stopped for six months before doing my internship to attend to other things (to the consternation of my mother), but was allowed to observe for a few months at the radiology department where I now work. At that time, I got an overnight hospital stay for dengue fever. I then did my mid-year internship, no extensions but a few intrigues…

We were the 1^st batch of students studying under the Problem Based Learning (PBL) curriculum. We knew all eyes would be on us as even then, the previous batches would look at as with envy as we studied at our own sweet time. My batch rose up to the challenge and set the bar high – three topnotchers and a near perfect batting average at the board exams (thus far, in the entire history of PBL at the Cebu Institute of Medicine, only one pure-PBL medical student had to re-take the exams, she passed it on the second try, and is now the only psychiatry resident in our batch that I know of).

I am now doing my second year of residency in radiology at a local private hospital. Aside , we also give lectures on radiology topics to the medical students at the school affiliated with the hospital as well as giving them exams. I have the usual night shift duties, but we can also go on call (just coordinate with the radiologic technologist on duty) if necessary. Since I live a short 8 min. walk away from the hospital (or a 3 min. jeepney ride) I usually get to go home for dinner when I am on duty for the night.

Back in high school, I had already made a choice not to become a writer for practical reasons, even if ever since early childhood, it has been one of my treasured hobbies. I loved being transported to a make-believe scenario and putting it in words. Writing short stories, essays and poetry is still my hobby, and with this new technology--- blogging as well.

I would have been a poet, a short-story writer or an essayist if I weren’t a radiology resident.

My former high school English teacher, Gilmin Royo-Kakilala (now based somewhere in the U.S.) is someone who influenced me in writing. She was a member of the WILA (Women in Literature Association) and gave all her students a love for literature through innovative ways of teaching. Once she asked to see me about a particularly poignant piece that I wrote for English class… out of embarrassment, I refused to approach her on that piece. The following year she moved to another teaching job at a local university. She was the one who then trained the applicants to staff positions in our high school paper the following year. I had applied for the literary section editor position specifically (a lot of guts on my part since I had never been involved in the school paper before), and she was one of those who decided that the position suited me just fine.

My reading consists of my favorite children’s classic novels which are also books that adults can learn from time and again, presented here in no particular order:

1. The Wonderful Wizard of Oz by Frank L. Baum
2. Little Women by Louisa May Alcott
3. The Secret Garden by Frances Hodgson Burnett
4. The Jungle Book by Rudyard Kipling
5. The Lord of the Rings by J.R.R. Tolkien
6. The Swiss Family Robinson by Johann David Wyss
7. The Lion, The Witch and the Wardrobe by C.S. Lewis
8. Heidi by Johanna Spyri
9. Alice's Adventures in Wonderland by Lewis Caroll
10. A Christmas Carol by Charles Dickens

The only other blogs I frequently visit are those of my friends on Multiply which are the following:

Enjoy Sherryl's World – What this budding wildlife biologist, former college classmate and close friend has to say about life.

Fair-inner glimpse - Teacher, business guru, and friend who has always something to say about everything.

stars got tangled in her hair whenever she played in the sky - Musings of my friend, my brother's high school classmate, Fair's soon-to-be-sister-in-law, and now in the midst of medical school.

These are links to my own top 7 blogposts, mostly my poetry:

Return to Waterfalls

Ballad of the Hermit Crab

Disco Without Dancing

Lantaw

28 Verses (Under the Post Entitled "Bisperas (The Day Before)")

Prophecy

Encounters of the "Dean" Kind

Note: This blog was made by answering all of Gaya's questions for this edition of TBR.

I think I caught a strain of infuenza just this week, but since fever is controlled by paracetamol, and I'm now taking antibiotics because of signs of a superimposed bacterial infection, it hasn't stopped me from reporting for work. It's only obvious that I'm sick when I talk though... So I'm trying to keep my mouth shut! Hopefully I'll be better by next week and not have some people avoid me like the plague.

This has been something only those working in our hospital had knowledge of last year, but not anymore. I can't seem to find a link to this story in English, but it did appear in today's SunStar Cebu after being reported in yesterday's Suberbalita as well as on FM radio. Sunstar Cebu's print version has the name of the doctors as well as the hospital... Incidentally, I share the same high school alma mater as the patient and one of the doctors charged. You may access the link in hardcore Cebuano here.

What the media has is just the start of the story of this poor woman though. After having her sigmoid colon nicked in the video-lap procedure to drain fluid from a fallopian tube. ad some complications, was brought to the CT-scan and found to have her ureter cut or nicked as well. She had another operation, then more complications, another CT-scan done showed her iliac artery was cut or nicked, so they opened her up again, a third time. She was really this close to death when I saw her at that time...

The last operation done was several months later when her ileostomy was closed. A few days prior, I had her as a patient for part of the work-up and it was only then I noted how pretty she was, now that she was in the pink of health and about to be made whole again. Her husband was with her the whole time, quite supportive.

Since several months had passed, nobody thought they would sue, until now.

In the course of medical treatment, you can never tell what could happen. A simple thing could have different risks, which you have to clearly explain to the patient. Sometimes, we could never know the extent of what could go wrong. Almost everything could go horribly wrong as in this case.

Observing things from the sidelines, I can only shake my head and silently pray such things don't ever happen to me or to any of the fellow doctors I know well, my classmates, friends, consultants.... But it already has, and it can always happen again.

In hindsight though, I guess none of these would have happened if they had decided to adopt a needy infant instead...

As stated in the previous post, I had to travel by myself to the retreat venue all the way from Cebu by myself. Now, getting to Manila by plane is the easy part but taking the bus to a town in Luzon by myself and getting to the venue I have never been to before was the tricky part. I can't ever remember traveling on a bus alone before. The whole thing made me nervous.

Later, I discovered I was given out-moded directions by friends. The only saving grace I thought I had is the ability to speak fluent Tagalog (my Tagalog friends often ask me why since I have lived most of my life in Cebu City) thanks to having Batangueños for playmates during my early childhood in Saudi Arabia. Incidentally, I was also headed for the province of Batangas.

Getting off the plane, I decided to take the metered airport taxi for safety reasons. The driver was pretty pleasant and helpful. He even guided me on which bus to actually board and not to allow anyone to act as porter for my baggage so I won't have to spend more by tipping.

It was almost lunch time when I seated myself in the almost empty bus. A mestiza lady with dark sunglasses, who seemed to be around my age took a seat to rows behind me. Then, for some unknown reason, she got up and asked if the seat beside me was taken. I offered it to her.

I asked her how long the trip would take to Lipa City,and then found out we were going in the same direction but she would get off first. She was surprised to find out that I was traveling by myself there from Cebu to attend a retreat, and that no one was out there to meet me.

She then proceeded to hum in tune to the music from her I-pod while I took my packed lunch as the bus finally got filled up.

My seatmate pointed out a few landmarks along the way for me as well as pointed out that the reason we were apparently delayed was that the bus went through the different towns, stopping each time instead of taking the SLEX.

We said our goodbyes as she got off at Lipa City Hall. I still had several meters to go before getting off at SM City Lipa to take a tricycle to Latag Study Camp. It was then that I realized that I had forgotten to even ask for her name, due to my tiredness (I was on hospital duty the night before) and nervousness about traveling alone.

My tricycle trip to my retreat venue was then uneventful.

It's funny how God kind of sends us people to help us along the way in such a natural, unobtrusive manner. I may not know her name, but I'm so glad she decided to sit beside me.

Due to circumstances of work, I haven't been on a retreat for approximately a year and a half. Now that this second year radiology resident has some days allotted for paid leave, I can go on that much needed breather from the humdrum of daily work to renew myself spiritually. I'll be out of touch and out of reach from March 17 to 22. I really need to take a good look at how things have been---just thinking of all the mess I've been through in the past couple of months, I need to get a good look at the way my spiritual life is running to strengthen me in my vocation as an associate of Opus Dei.

I'm not looking forward to travelling to Latag, a conference center in far-away Lipa City, by myself though. I have a tendency to get lost...

Say a prayer for me that I won't, will you?

I have talked to a lot of young medical students, paramedical students, pgi's (interns) and interns (senior clerks) in the course of the few years of so that have passed since I got my medical degree on April afternoon in 2005. Here's some unsolicited advice I may have handed in these various conversations with people younger than me in one form or another.

1. Know yourself well enough to know where you want to go now. Graduation is not the beginning but the start of a life long career. I do know a few of my batchmates who have decided to do absolutely nothing (not practicing even as a general practitioner, not taking the board exam, not even reverting to practice what they took up as a pre-medicine bachelor's degree) just because they have forgotten to take a good look at their options, thus they ended up stagnating.

2. Stick to your principles. At least in this country (the Philippines), one is blessed to follow one's conscience with regards to ethical matters, and this is clearly spelled out in our medical jurisprudence text book. If you do not agree with doing a procedure as a matter of conscience, don't even think of compromising. Others may think you weird or backwards for doing so, you might even have to submit yourself to a sanction, but people will think more highly of you for doing so.

3. Patients are persons. Trust me, the many times I have forgotten so in the course of being tired, cranky, previously on duty, or pre-menstrual, I have gotten in trouble...

4. The other staff members in the hospital are human too. Likewise, as above, experience has taught me that one can get into so much trouble for forgetting this simple fact.

5. Nevermind what every one else is planning- do your own thing! To illustrate, one friend decided to forgo training, review for exams in a foreign country she has never even thought of going to and is now (hopefully!) a few weeks pregnant after deciding to resettle someplace else with her husband. And the bottomline is --- even if she just emailed me the news, I know that she is so happy with her decision.

6. You will be a student for the rest of your life. Medicine is an ever-changing field and somehow, new discoveries will always suplant the old. You have to keep yourself therefore updated.

7. Medicine isn't everything... Of course, it is your work, your vocation, what will bring food for the table, but there are several things that have to take priority-- your faith, family, friends...

8. Accept that you can make mistakes. We aren't gods. Mistakes may be costly at times at the expense of a life. Still, we have to learn from them and carry on.

9.Your colleagues are there to help you. The approach to treating a patient is multidisciplinary most of the time. Listen to your peers. They may have ideas that you will be surprised to know.

10. Gratitude has its rewards. Be grateful to those who have helped you in this path, be they family, mentors, friends, colleagues. This thankful attitude will make you happy.

Note: I apologize for missing some of the other opportunities to join the previous blog rounds editions. I guess the adjustments for the second year of my residency training just got to me (see previous rAdIoLoGy NoTeS ). I even missed my hosting chores (Yikes!) I will make up for it, somehow....

At times you end up doing what you don't like to do...

I have made it no secret since junior clerkship that I have absolutely no liking for doing anything remotely surgical... from suturing to performing a minor operation to looking into someone's insides... well, you name it... Mind you, I'm not the squeamish type, but while doing a surgical rotation way back in the internship (a.k.a. senior clerkship), one resident once remarked to my groupmate: "Dili lagi na siya ganahan ug O.R., noh? (She doesn't like the O.R., does she?)"

A few years later, I find myself doing my first month of interventional radiology rotation in my second year of residency. Like I said, it is no secret to the entire department that I don't like being first assist on the biopsies, the stenting, the cyst aspiratuions, the angiograms, and finally, today, assisting for the first time in coil embolization of an aneurysm. I have already made it clear to the hospital's lone intervetionist that I have no plans whatsoever of following in his footsteps.

I never intend this blog to go into the scientific nitty-gritty details of the procedure. So, i will just expound on the experience in laymens' terms.

Initially it would begin with an angiogram, but we had already done that for the same patient a few days earlier. The neurosurgeon had to abandon clipping the aneurysm on opening up thus patient was referred back for the procedure.

Patient was placed under general anesthesia. A small incision is made into the femoral artery where the catheters and guide wires are passed throught the larger arteries of the body into the blood supply of the brain. Everything is checked using real-time fluoroscopy and digital subtraction angiography with the introduction of radio-opaque contrast material. The guide wire with the platinum coil is then introduced and gently eased into the aneurysm.

Some of the guide wires had to be softened with a specialized steamer. Before introduction into the patient, the coil is first checked in a small basin of water. After precision placement, the coil is released from its guide using an electric charge and the guides are withdrawn.

Without complications or other confounding circumstances, everything is done in about two hours, as in the case I assisted today. Only two coils were put in place.

It's a pretty amazing and relatively safe procedure done to save a life.

Then again, I have no intention of ever doing it myself in the near future. I have never felt at ease in the OR.

(Note: Above image was taken from the internet and not of the patient refered to above.

I never thought my first month of second year residency would keep me so busy that I could hardly fine time to post in my blog and get my hair fixed up (boy, that's a whole other story!). Now there's a first year resident once in a while asking for my help (kind of a dejavu in reverse since she was one of the PGI's while i was an intern a.k.a. senior clerk in the pediatric rotation at the local government hospital), I'm trying to figure out the multiple sequence images in the MRI, fixing up the two lectures on pediatric radiology assigned to me at the medical school affiliated with the teaching hospital I work at, and a last minute can't-say-no-to request from the gastroenterology fellow to lecture on the imaging of the pancreas (hey, she was my group preceptor way back in my first year of medical school... can't say no to such a request!)

I also had to do some soul-searching after a few issues regarding my apparent lack of social skills and insensitivity to the needs/feeling/emotions of patients, their relatives, the staff, my fellow residents in the department and elsewhere, the consultants; and a seeming perception that I was not fulfilling my duties as a radiology resident. The last one was kind of a shock as it was the second time it was pointed out to me by the department chairman and training officer since I started out and here I was totally unaware (just like the first time my attention was called) and I was again guilty of the charges all over again. I am still kind of reeling from the experience (yup, up to the point of seriously questioning whether I am fit to pursue this line of work in the first place... Maybe I should switch to being a medico-legal officer-I mean the dead don't complain, do they?). Thoughts of resigning seriously crossed my mind and I again spent several days pretending nothing was wrong when I ended up crying my heart out for a few days.

Once in a while, it still crosses this melancholic mind of mine and I am now overly cautious about dealing with patients to the point that I sometimes refuse to be the one to face a patient if I find out that the situation may be a little difficult and let the receptionist or the radiologic technologist explain things to the patient. It may sound like paranoia, but I am no stranger to the intrigues and uncomfortable situations which seem to follow me as it did a few instances when I got in trouble for being insensitive and naive as an intern and a pgi.

I'm now beginning to figure out what's wrong with me and trying to fix it... I hope though that no more strikes would come my way... three strikes and you're out they say... Nevertheless, the words I will write in a possibel future forced resignation letter already come to my mind...

Pray for me... Please...