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.