I just realized that my last entry in this blog has been for quite some time already, but I am still blogging somewhere else by myself and with others... 
These two blogs and the one I am writing on right now stand for the reasons that I blog:

• To be an outlet for my thoughts on various issues of my life. 
• To share my creativity and construct an archive of sorts for my poetry past and present
• To give a show of support to a cause very close to my heart: the pro-life movement.

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...

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 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....

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.

The subtitle of this post happens to be one of my less irritating current pet-peeves. A certain radtech has started calling me "Dra." (Yes, you do pronouce it in the way you spell it... Not "doktora", but "dra") and everybody else in the department is joining the bandwagon... Of course, it means "doktora", but alternate meanings are as follows: "drama queen", "dramatics", "hydra"... Oh, the list could go on with a lot of smart-alecky staff around you (although, the last one actually came to me in a conversation with the radtechs... ). I guess that's precisely what you get if you're the only female resident in the department training for a male-dominated specialty...

I studied elementary and high school at an exclusive girls school. I took biology as a preparatory undergraduate course for medical school in a female dominated class. In medical school, approximately 70% of our class consisted of female students. My senior clerkship group (in my part of the country, we usually refer to it as internship), consisted of five females and only three males. When I did my internship (in my part of the country, we refer to it as post-graduate internship or pgi), my first group was all-female. In my second group (I did PGI mid-year) I had only two male groupmates (and one of them is an outed homosexual, the other one, people had been speculating on for a time, though he now has a girlfriend). I have more female friends than male friends. I also lend a hand to a foundation that specifically caters to female youth. I was definitely in for a culture shock of sorts...

I actually applied for residency at two hospitals, and at both hospitals, they asked me whether or not i was married, or had plans to get married, musing on the possibility that I might get pregnant while doing my training (the other residents will have to cover for a pregnant radiology resident doing and supervising radiographic procedures due to fetal risks). Then, at the other hospital I applied to (not the one I am currently working in), one of the interviewers specifically stated that in a span of two or so years, they had two residents resign, and both of them happend to be female. At the back of my mind, I was already thinking that they won't accept me (which was a blessing in disguise since I was more keen on doing residency where I currently am now). That was exactly what happened although I think my gender was not the main reason (I think they were more keen on accepting the other two applicants who had their PGI in the same hospital).

When I did begin residency, I had to adjust to a predominantly male work environment. There is only one female radtech in general radiology (the rest of them are in the women's imaging center), and only one female interventional radiology nurse. I answer to only one female radiology consultant. The receptionist and secretaries though are all female. At our monthly meetings with radiology residents training in our city, I found out that only two of us are female, and she is already about to end her training while I am just starting mine. Hopefully, more females will take up radiology in our place in the years to come. Otherwise, I will have to contend with the fact that I'll be the only female radiology resident in the years to come.

I still detest having to listen to my seniors and other staff comment on the way certain females look/dress/etc. Sometimes, they start talkig about their night out at some lewd place (Do they sometimes forget there is actually a female working nearby or is it just to irritate me?) I still put my foot down on any joke or conversation in any shade of green (Totally inappropriate in any working environment, or any environment for that matter even if to some, the mere fact we are in the medical field, anything goes in that direction...).

The equipment are actually more tailored to be handled by male staff. The fluoroscopy machine's image internsifier is bulky, heavy and a little difficult to manipulate, more so if it gets stuck in one place ever so often. The lead gowns are heavy. The cassettes are also heavy. Giving an intravenous push of contrast also requires some degree of force. Preventing a hematoma after taking out a femoral catheter also requires some force (Perhaps that's why the interventional radiologist has not yet asked me to remove a femoral catheter from any of his post-coil embolization patients?) In the first few months, our chief resident has occasionally joked that I consider working out to build some upper body strength.

Not having had a female radiology resident for the past three years has sort of confused the nursing staff. Just one of the many cases to point:

Department Receptionist: Doktora, telephone call.

Me: Hello, Ma'am?

Nurse: Who's this? I'm looking for the radiology resident.

Me: Ma'am, this is Dr. J.A., the radiology resident.

Nurse: Hello, Ma'am, we have a referral for Dr. --- at room --- for ultrasound-guided liver biopsy.

Me: Who's the primary atttending physician?

Nurse: Dr. ***

Me: Ok, I'll inform, Dr. ---.

Nurse: Who's this again, Ma'am? Are you going to tell the radiology resident?

Me(now a little bit irritated): Ma'am, this is Dr. J.A., the radiology resident.

Nurse: (Pause) Ah, ok, Doctor.

Some female patients undergoing more delicate special radiographic procedures (i.e. a hysterosalpingogram) do appreciate that the resident around is female. At one time, a patient did request for a female resident. It was a good thing that it was also my assigned day for special radiographic procedures. I have no qualms about doing a urethrogram on an adult male patient though. It is part of my job, and anyway, more likely that not, the staff around are also male. At one time though, while supervising a voiding cystourethrogram, I decided to leave the room while the radtech was doing overhead films as I thought that the young boy might have inhibitions on urinating while an unrelated female was around.

I still get a little irked when some patients still refer to me as "Miss" or "Ma'am" while I am wearing a doctor's coat. I guess the average Filipino mentality still thinks females in white at a hospital are nurses while males in white at a hospital are doctors.

I am relatively young in the world of the medical profession, having just received my license to practice a little over a year ago. And with that came automatic membership into the local medical society under the Philippine Medical Association. Until now, I actually have no idea what their activities for doctors is, although I recently heard about some symposium in our place, which I'm not sure any of the other young doctors were able to attend. For most of us residents, the next time you usually here talk about the PMA is when someone is about to take the specialty board exams (i.e. the chief resident in our department) and finds out he/she needs to pay the requisite membership fees for the past 3-5 years which he/she was not faithfully remitting to the society. After that , probably you won't hear much about the PMA... you'll hear more from the specialty societies...

I'm sorry that I still have to figure out for myself exactly what they are doing for us and what we are doing for the Philippine Medical Association in turn. Honestly I'm clueless... So, I really can't say anything more based on personal experiece.

I hate to say it but the fact that a lot of the doctors in their mid-30's to early 40's are taking up nursing to seek greener pastures seems to say volumes about the state of the profession. Maybe they don't feel their family will be secure with them staying and practicing their first profession in the country?

Fewer students are deciding to take the additional 4 years of medicine plus one year internship to get that M.D., and of these, probably 3/4 (I'm stating this as a reality in terms of my own class- CIM 2005) will be aiming for the USMLE and other foreign board examinations with the intention of settling elsewhere for good.

The few of us left doing our residency training are probably also thinking of doing further studies abroad (that's one option I'm personally inclined to) and probably settling somewhere else in the near future (Personally, I'm not inclined to the option of permanently renouncing my citezenship, but it's not something I'm totally ruling out either).

So, what's the value being put on us? Maybe it isn't that much. I know residents in the capital are paid a paltry. In our part of the country, most of us are paid a little higher (can't complain about my own salary as I get to save since I work pretty near where I live with my family and can save on some expenses) yet there is still a general dissatisfaction about the income that pervade (i.e. a co-resident of mine having plans to get married next year is taking up a side-line job just to afford to pay for the wedding expenses). When you go into sub-specialty training locally, you still get paid a paltry sum... Then, when you start your practice, it's another story... A friend and college classmate of mine, also planning to go into residency training in radiology stated it plainly when she told me: "You know, we will probably have to set-up a diagnostic center together..."

So... Maybe I am a bit worried with regards to the financial side of this profession. Still, I think it is a pretty noble endeavor, although reaping the rewards of the time, effort and finances you have sacrificed are a long time in coming or won't come at all. Afterall, we touch on something basic in a person - health. Sometimes, it is not just the physical side of the person that you touch but also one's mental, emotional and spiritual well-being. Still it is a way for one to earn a living so one has to be able to determine the pros and cons of determining the right professional fee for one's services, or maybe decide to charge nothing at all.

Somehow, I have always sort of counselled most of my younger friends not to enter medical school by presenting the hardships that are in the way. My advice though is seldom heeded as just this school year, I happen to have two good friends who are not about to heed my advice by beginning their freshmen year of medical studies.

I'm keeping my fingers crossed that my youngest sister (about to start 3rd year high school) won't follow the footsteps of this eldest sister... I still don't want anyone else in my immediate family to go through everything that I did to become a doctor and whatever difficulties I have yet to undergo to establish myself in my chosen profession.

It’s just about time for us to cut the chitchat short, say grace and dig in! This banquet is officially about to commence!

FAMILY TRADITIONS:

MerryCherry, MD gives us a glimpse of how Kapampangans do their cooking in “Mangan Tamu”

DINING OUT:

Joey MD gives us a glimpse of her food choices in “Around Robinson’s Place Manila in 5 Days”

Noel gives us a sampling of international cuisine in his entry “Recent Acquaintances: Pastitsio, Kulfi & Cherry Garcia”

APPETIZERS:

Dr. clairebear takes us down memory lane with this oh-so-familiar street food in “Fishball Memories”

MAIN COURSES:

Kittymama shares how Lasagna became her comfort food of choice in “Garfield’s (Kitty)Mama”

Dr. Tes glorifies the quintessential Pinoy fiesta favorite and mainstay in “Lechon of my Life”

SWEETS AND DESSERTS:

Got meloinks shows us his sweet side as he savors the sweetness of muscovado in “The Case of the Skin-Rejuvenating Chicharong Bulaklak and the Evil ‘Kamay’, which turned out to be Muscovado”

Ness teaches us the intricacies of cooking this native kakanin the old-fashioned way in “How to Cook Palitaw”

REFRESHMENTS:

Your host, J.A. presents you with her favorite drink, on the house in “Ice Tea Girl”

I don't drink coffee. For some strange reason, this medical doctor doesn't even like the smell of this brew which has aided generations of medical practitioners in their quest to be awake while serving 35 or so hours in one shift. In other words, I abhor the drink. What kept me partially awake the whole time (and still does today, although I am an unusually light sleeper when on duty...) is iced tea.

I'm not exactly an iced tea addict, more like a connoisseur of sorts. I don't take it everyday. I don't crave it all the time. I do fully enjoy a little sip or a long slurp every time.

When eating out with family, friends or colleagues, its my usual drink of choice.

At home, I'm the one you see mixing up a pitcherful of any instant iced tea flavored mix for household consumption. Occasionally, there's some lemonsito (Philippine lemon) in the mix as well. It could also be half an iced tea mix and half another fruit flavored mix. It depends on my creativity (or the supply in our refrigerator).

Sometimes, I take my tea hot as well, or brew it hot then place it in the freezer. Occasionally, I'd brew some tea, then add powdered milk or some powdered fruit juice into my hot beverage, take it as is or chill it as well.

Now that I seldom have the luxury of time to mix things up, one usually finds me with a bottle of C2, Lipton or Sola with my afternoon snack, bought from the hospital's pharmacy/convenience store.

[Taken from the Frindster site of CIM with the original captions: Recognize the white figure inside the library? ]

Our newly retired Dean, Dr. Josefina L Poblete has been a defining icon of sorts for all of us graduates of the Cebu Institute of Medicine ever since she has been at the helm of our medical education. She's one of those persons who leave an impression on you. I think it can be summed up by this one thing comment I remember in a conversation with her daughter, Dr. Poblete-Chan, who was then my Problem-Based Learning (PBL) group preceptor when she asked me, "Are you (referring to me and my groupmates) uncomfortable with me just because I'm the daughter of your dean?" I have never felt uncomfortable around Dr. Poblete-Chan, but her mother makes you uncomfortable when she's around just because you know that she is dead serious that she wants you to become THE "Physician With a Heart"

I remember a panel interview with her and the deans of the other local medical schools as part of the application for the regionalization program of the UP College of Medicine (I never pushed through with applying there due to non-compliance with a requirement though). She was the only panelist I remember who rarely ventured a smile throughout the interview.

Everyone was always careful when she was around. Maybe it's because she has the tendency of spotting something awry with one's uniform (i.e. too short skirts for females, wearing earrings for males). She would tell it exactly to your face when you did something wrong/inappropriate/not to her liking. She also makes you want to be somewhere else when she was around. Interns (senior clerks in local parlance), PGI's (post-graduate interns), and residents literally disappear from the OPD's hallway when they spot her coming through the door from a mile away.

One time, at our stay-in community rotation, she caught one of my co-interns walking around sans uniform in the primary care center. She saw him running into the male quarters to hide, so she went right up there to talk to him, ask him why he was running and to give him a piece about being properly dressed when assigned to the center and not to loiter there when not on duty.

Another time, at the same community rotation, she noticed that I buttoned my smock. She really came up to me and told me to unbutton the smock as it is more becoming to look at us in uniform that way. I was quite taken aback. I am until now still uncomfortable with buttoning my now long-sleeved resident's white coat.

For an entire two weeks, in my internal medicine rotation, our sub-group was on our toes when she was house consultant and would annouce house rounds almost daily, and even a surprise ward rounds on a Sunday morning which caught even the house resident by surprise.

Charity cases were presented to her on a one-on-one basis directly by the interns for her approval. You never know whether she would focus on the socio-economic background of the patient in question or the intricacies of the treatment modalities the patient would be subjected to. I had the misfortune to once present to her the only charity case which to my knowledge was unapproved (mostly through the lack of foresight of the admitting resident, and the lot just falling onto me to present the case). I felt like dying on the spot when she said the words, "..., and that's why I'm not going to approve this case!"

One thing that I do appreciate is her effort to help us learn to practice medicine in an ethical manner through lectures, though I guess it has sometimes fallen into deaf ears. I also appreciate her emphasis on modesty and dressing in a manner in which people would regard you with more respect, which a lot of my peers have tended to disregard.

There are people you won't forget your entire life. Dean Poblete is exactly on one of these people in my life.

I was probably in second grade when one of our projects was a needlecraft sampler with the Phlippine flag stitched on it and the words "I love God and my country". Somehow, this childhood memory resurfaced in my mind when the topic for this week's TBR came up.

I can't deny the reality that our homeland has its share of problems, yet I can't imagine living and working anywhere else. Sure, in the future, I may have the chance to train further in my field somewhere else, but ever since, I knew deep in my heart that I would still go back and practice here, nevermind that probably half my med school classmates are setting their sights elsewhere around the world with a mind on permanently living there for good.

There is no where in the world where you find people who find humor in the most serious of situations and who would venture a smile at a camera or a friendly wave even if they are waiting to be rescued on a rooftop from rushing floodwaters brought by a raging typhoon. There's a different kind of optimism and faith there.

We have so many places of interest, both typical and atypical from beaches to waterfalls to trekking sites to caves. The natural wonders these islands have to order are amazing. There's a wide variety of food choices as well wherever you go.

I have spent most of my life in this country, and I'm sure that if I go away again, I will long be back with all my heart.

Dorothy is right: "There's no place like home." Even if it is this grey, dreary one called the Philippines.

TBR 6, Here I come!

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It was my rotation at the local regional government hospital, and the first time I had a patient under my care die right before my eyes.

CC, single mom, early 20's, was one of the patients I inherited from the previous group of rotators at the department of medicine. Her mother, probably in her mid-forties, was quite frantic, not knowing where to get money for the labs and medications... To make a long story short, we called a code a few minutes before her case was presented by my resident for weekly ward rounds and then revived her. After the presentation, we called another code and the patient expired. A little girl lost her mother...a mother lost her daughter.

I felt awful afterwards as I talked to friends about it. But what could I do? And then I started to ask... Who's to Blame?

We can always say that it is the system, but behind the system, it all goes back persons. Graft and corruption is so rampant, one feels no need to raise eybrows when another anomaly comes to light. Values seem to get askewed along the way when millions of pesos are at stake.

Health is often times not a priority to people as well and since the cost of health care from trained professionals is astronomical to the everyday Filipino, people go to the oftentimes well-meaning local "mananambal" (translated-> healer) who can sometimes just complicate the matter before the case is finally brought before the doctor.

Then, there are the health care professionals who become so anesthesized to the human suffering around them... Overworked and underpayed, what incentives do they get to provide the best care to those entrusted to them? The call of greener pastures then comes and off they go to find more appreciation and fortune in foreign shores.

I could go on and on and on and on about all the other things that come into play.... In the end though, it starts with each one of us in the health care profession to find even small ways of bringing health care closer to everyone.