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...

2008 had its ups and down for me. I had to give up, give in, bear it, take it as it is, do more, be better. I've been involved, missed out, loved a lot, been excluded, lived my dreams and drifted back with nostalgia. Now, the new year is here, and i'm this close to turning the big 3-0!

What's in store for me then?

Stay tuned!

A few days ago, I became both the daughter and the sister of board exam topnotchers. My brother found out that he got 4th place in the recent ECE board exams. He somehow bettered the 9th palce finish of our own father in the Chemical Engineering booard exams several decades ago.

Just as the results were about to be released, our phone lines and internet access died. We had to rely on text messages from an aunt for news.

My youngest sister (forever at odds with the brother, the place I held before I "matured" and stopped quarreling him myself ) couldn't care less. She couldn't understand our concern about not being able to get to the news first. We were all going to find out about the news the following day anyway.

A little past midnight, my mother woke me up with the news that my brother had passed the exams and was in the top ten placers. He learned about it from the text messages of classmates. One of his classmates also gave him a call which woke him up. The rest of the family was already awake and celebrating: Mama, Papa, my brother and my other younger sister.

We decided to let the youngest in the family sleep it out in the couch.

The next day, when I asked if she had congratulated her brother, she said nothing.

I still owe my brother a tub of ice cream though.

Congratz, Joven!