i miss bending

I have no idea how I am gonna start this blog so I am just going to blurt it out and say it:  My left knee got dislocated yesterday.

June 26, 2008 | 7:50 PM

I’ve been at Maan’s house for almost a week now.  I missed working out at the gym so I suggested that we work out.  We did a few stretching exercises first and then started dancing when I got into this really unexpected event.  I was shifting my weight from one leg to the other, which really isn’t a big deal… I’ve gone to a lot of dance classes before!  So here I am, shifting my weight to my left leg when I just felt it give way.  I couldn’t stop myself from falling and so I just screamed and fell to my left side.  My left knee was obviously deformed and I didn’t make an effort to try to reduce it myself.  Maan was quick to try to find a makeshift splint for my knee.  By this time her parents and the house help were already running around trying to figure out what to do.  I couldn’t help but say sorry over and over because it was so embarrassing to bother these people with my injury.  Maan’s sister Macyl had a look of fright on her face and told me honestly that she didn’t know what to do… Maan rushed to my side as she tried pieces of wood and even a chopping board to properly fix it to my knee.   It took a lot of people who I didn’t bother to look at in embarrassment to carry me down to the first floor and into the van.

Before we left, Maan asked me if I wanted to bring something to the hospital, and all I could say was, “Bring my Surgery Recall book!”

As they drove me to St. Luke’s Hospital, I called my dad to tell him the awful news.  At first I didn’t want to call him until I came to the hospital but I knew I had to tell him eventually, plus I needed a name of a doctor that he wanted.  He was very calm when I told him and asked me to call him to report any progress.

As we were riding to the hospital, with most of the pain already disappearing, all me and Maan could talk about was what they were gonna do to my knee.  Were they going to manually reduce it or would I have to undergo surgery?  Both definitely scared me, but I guess I was braver than a lay-person would have been if he or she was in my shoes.  Lots of random thoughts were running through my head, like,

“Oh my God, this is the first time I am going to be sent to the ER as an adult” (the first time was when I was a kid and I could hardly remember that)

“Are there going to be interns interviewing me?  That’ll be cool…”

“Am I going to have to use crutches going to the boards?”

June 26, 2008 8:40 PM

We arrived at St. Luke’s Medical Center ER.  They instantly called for an ER resident and requested for a stretcher for me.  They took a quick history and got me on to the stretcher.  As they pushed my stretcher into the ER, all I could think of was “I’ve never seen the ER in this perspective.”  I’ve always been the one pushing the stretcher and looking down at the patient, and now here I am with only the ceiling in my view.  I didn’t get to see much of the ER since they immediately placed me in one spot that was covered with curtains of some sort on all sides.  They took my initial vital signs, fixed my splint and then left.  By this time we were already in a better mood.  I can’t believe they have a cushioned stretcher and a blanket for me!  Oh my gosh I have been working in a charity hospital for so long, everything else looks like luxury now.

June 26, 2008 9:00 AM

The first thing they did was to place a heplock on my arm.   This is again, my first time to officially have a heplock on.  The last time someone tried to place a heplock on me was when Maan was still practicing before clerkship started.  I was kind of disappointed because I thought an intern was going to insert the line, but a nurse did it instead.  All I could say was thank you for placing it in in one shot, I totally appreciate it.  She gave me one shot of Ketorolac through the heplock which was oddly painful even if it was given very slowly.  After the shot, we were already calling a lot of people about what happened to me.  Thanks to all of the people who called and texted

9:46 PM

It has been 46 minutes since I got my Ketorolac shot and I was already wondering why I haven’t been sent to the X-ray yet.  I know I was not a big priority in terms of an emergency, but I wasn’t hearing any codes happening or something like that.  I think we were overhearing that the patient next to me had a stroke, but other than that, there was no other major trauma cases going on at that time.  There wasn’t even a single clerk or intern interviewing me.  My friend told me that clerks and interns weren’t allowed to mingle with private patients.  I had to ask but then how are they supposed to learn anything?  All of the patients in St. Luke’s were private patients.  Most of the staff that I have seen so far were residents and the nurses.  I know St. Luke’s is a teaching hospital but where, I say where are the lowly clerks and interns?  I even told Maan to request that the intern or clerk be allowed to see me since I didn’t mind being interrogated by a student or something like that.  But no clerk or intern came.   Then a resident peeked into the curtains and asked, “You haven’t been x-rayed yet?”  And so a few minutes later a man came and pushed my stretcher to the radiology department.  Maan and Macyl let out there ooh’s and aah’s at the fancy couches at the waiting area at the Radiology department, which I found highly entertaining myself, as I recalled sleeping in the hard benches outside La Salle’s own Radio dep.  As the radio techs adjust my leg for the picture, they kind of unintentionally reduced my leg to its normal place.  After the x-ray we went back to our place in the ER and waited.

10:30 PM

It took almost another hour for the ER resident to come in and show me the x-ray.  I don’t think she knew that she was talking to a fellow health worker because she kept her terms very simple, which I appreciated and also found funny   She said, “So there are actually 3 bones on your leg plus your kneecap…” And I just kept nodding my head hehehe, so cute.  In short, my patella or kneecap was dislocated and needed to be manually reduced.  She still had to refer me to an Ortho resident and so she asked me to wait some more till he or she arrived.  She also gave me the option of getting admitted.

10:50 PM

The same nurse who gave me pain medication earlier came in and gave me Midazolam (Dormicum) to partially sedate me for the closed reduction.  In my opinion, the Midazolam hardly worked at all, but my friend told me that in some occasions I was talking like I was drunk.  She said I was talking slurred and I was talking nonsense, but all I could remember was talking to the Ortho resident who also came in at this time.  Dr. Domacena, the ortho resident, brought me to the Radio room again for additional x-rays (Skyline view).  By the time he saw my knee, it was already reduced because of all the adjusting and moving around that people did to it.  He asked me if there was any pain, and I said no, maybe because of the meds.  He asked me if I had an ortho who I can do some follow up with and I just said that I’d figure it out once I got to the province.  He then fashioned a knee immobilizer which covered my thigh up to my leg. 

11:48 PM

By this time a pharmacist came and gave me the prescription for my home medication.  It was Etoricoxib (Arcoxia (R)), a fairly common but expensive pain medication which I have to take 120 mg once a day as needed.  I was advised to keep the knee immobilizer on for 2 whole weeks.

June 27, 2008 12:10 MN

After all that, we were on our way back to Maan’s house.  All this time I thought I was finally going to be admitted, but in a lucky way, I wasn’t.  I was able to walk up the stairs to Maan’s bedroom, and I have not felt pain since the accident.

Today, the main stuff that was bothering me was how am I going to be able to take a shower without taking of the immobilizer, what are my dorrmates going to think when I return tomorrow with a broken knee, and how am I gonna get my stuff done.  I miss dancing already.

And I know I won’t be doing any of that anytime soon.  It has been a frustrating and amusing day for me.  I definitely miss flexing my knee!  It is so darn difficult to keep it straight.  And I feel awful to have to ask Maan to get stuff for me once in a while.  I told myself that maybe this is like one right of passage to become a doctor.  At least I got to experience being a patient of trauma myself before being a trauma doctor.  I still feel bad for the interns and clerks that I didn’t get to encounter.  If this happened in PGH, I would be handled by the single intern and clerk on duty, seen by the ortho resident the next day, and sleep on the floor or the metal stretcher.  My final diagnosis was: Patellar Dislocation, left.

I was so damn lucky to have gotten good service at St. Luke’s (except that I felt that things would have been done if there were clerks and interns around helping out).  It was kind of boring to be inside the ER with curtains all around me.  I wanted to see what was happening all around me!  Why wasn’t there a resident or a nurse checking me out once in a while?  I guess you can’t have it all.  But I don’t want you guys to get the wrong idea, I appreciate what the St. Luke’s staff has done for me.

Thank you so much Maan, for managing me like a pro.

Thank you Macyl for staying with me even though I know you were scared most of the time.  Sorry for making you end up eating a lot of donuts

Thanks to Maan’s parents for being there for me, I promise the moment I get to an ATM I will pay for the bill.  I am sorry for making you guys worry.

Thank you to the people at Maan’s house for carrying me downstairs and for driving me to the hospital.  I know it wasn’t easy.  I was crying not out of pain but of embarrassment, really.

Thank you Papa for staying calm and not yell at me for getting into this mess.  I’m gonna be home soon.

Thank you James, Zi, Mel, Johb, and Nina for the calls and text mes

sages.  ^_^

Thank you Dave for that worried voice on the phone.  I’m ok now ^_^

I know it really helped being exposed to the hospital for a long time.  I didn’t have that fear of the unknown that most people had.   Of course I never wanted to be injured, but in some way this experience surely added to my desire to work on the trauma team more than anything else.

Still, I wanna bend my knee so badly… ^_^

post duty hang over

Good morning everybody… It’s been 26 minutes since I got home from duty. I already changed into my sleepy clothes for a well deserved morning sleep after a 24 hour duty. Compared to my last OBAS (Obstetrics Admitting Section) duty, this duty was particularly more toxic, because of the constant influx of patients. But now that it’s the second time around, I wasn’t as scared as I used to be, and because I knew tomorrow there you would be no endorsements of new patients, I gladly became the intern in charge of patients with no study pressures for the next day Despite the non-stop action from all the tasks we had to do, the most fun part of the duty was our ice cream time. One of the patients who gave birth treated all of us to a bucket of mango graham ice cream… Dee-lish!

start of something new

Today was my first day in Family Medicine.  A part in my medical career, that I vow to PERFECT.  Come on, if you can’t be a simple all-around family doctor, then how do you expect to manage the really tough cases?  I was really nervous (as usual) going into the ambulatory care clinic, but I was lucky enough to have a wonderful resident with me, Dr. Fadrilan (is the spelling correct?)  She gave us a good introduction and orientation, and then guided us through the entire shift.  Duty in Fam Med is different from the usual duty in other departments.   Either you are day or night shift, each lasting for 12 hours.  It went by more quickly than I thought it would.  I was lucky enough to get the day shift on the first day.  Night shift meant that I still have to attend the morning OPD from 7:30-5 pm and then go on night duty from 7 PM till 7 am, and then going on OPD again from 7:30 am till 12 NN.  Night shift is pretty tough, and I go on night shift on Thursday.  That’s 2 days from now.  But for tomorrow I go on normal non-duty status, meaning just attending the OPD from 7:30 AM till 5 PM, with a quota of 15 patients per day (not so bad).  This rotation will last for 2 weeks.  and then off we go to Community Medicine!  Get set for the cool province shots that we’re gonna be taking while being doctors at San Juan Batangas!  ^_^ I’m kind of scared about the oral reports though coming up next week.

I got lots of stories already about the patients I encountered today.  But I’m kinda tired, so let’s just leave that for another day.  Thanks for reading! ^_^

pedia mania

I just realized that I had so many stories to tell during the time I was in the pedia wards but I didn’t write a single thing on my blog for the simple reason that I was really busy.  Well, I am finally done with pedia wards and I have now moved on to the Nursery Catching Area to take care of newborns.  I’m excited and frightened at the same time… Why?  Because this is my favorite part of Pediatrics, dealing with neonates (newborn babies).  I always said that if only I could have be a neonatology resident only and not have to deal with the other parts of Pediatrics that would be great (Fat chance!).  Tomorrow is going to be my first duty, and now I have this heavy feeling on my chest that I always get when I am anticipating the arrival of a new baby.  This is the only real place when it is music to my ears to hear a baby’s cry and to see it flailing about and turning pink before my eyes as it catches it’s first breaths.  It is magical I tell ya.  But the tension could really kill me.  I don’t know if I am just exaggerating, but the tension that surrounds keeping that newborn alive has reached a whole new level since clerkship.  As a clerk, you feel scared but comfortable because you know that your experienced resident or intern will always be by your side as you resuscitate that baby.  But as a PGH intern, now that’s a whole different story.  They warned us that there will be times when a resident won’t be there, and that now, you have a clerk of your own to assist you.  Ahh!!! Responsibility!!!  And with all the babies that come in to PGH in a single day?  Scaaaary… Please wish me luck, tomorrow is my first duty.  Let it be a benign one please I beg you.  Save the weird cases for later.  (ok time to review!)

heart of stone: no vacancy

The Pedia-ER has reached the point that it is overflowing with patients.  Considering that PGH is the transferring capital of the Philippines, it is no surprise that patients from all over the country come there for the possibility of getting in for a cheaper price.  But contrary to popular belief, not all patients get in.

The usual story at the ER front desk of the Pedia Department:

A ____ yr old comes in for an admissible case (example:Dengue Fever II, Sepsis Neonatorum, AGE w/ signs of dehydration)

I, the triage intern, will ask for the name, age, the chief complaint, and work on the history and do a complete physical examination.  If the patient has lab results I will look at them as well.  I confirm with my resident that the patient is or is not admissible.

Parents: Doc, pwede na po ba sha maadmit?  Naaawa na po kase kami sa kalagayan ng anak namin. (in English: Doc, can our patient be admitted now?  We are very concerned with our baby’s condition.)

Intern/Resident:  Nanay/Tatay/Lolo/Lola/other relative, Mukhang kailangang maconfine or maadmit ng pashente ninyo.  Hindi niyo sha pwede iuwi dahil kelangan shang mabantayan sa hospital para mabigyan ng gamut na padadaanin sa swero at gawan ng karagdagang mga laboratory exam.  Ang problema po ay ang PGH po ay puno na sa ngayon.  Madami pong mga pashente na nandito pa rin sa ER dahil walang bakante sa ward.  Tabi tabi na po ang mga bata, 3 sa isang stretcher.  Nagkakahawahan na sila ng mga sakit dahil sa sikip sa loob.  May iba nga po na nakaupo na lang sa tabi dahil wala na kaming mapaglagyan.  Habang kaya pa ng pashente ninyo,dalhin niyo na lang sha sa ibang government hospital katulad ng National Children’s Hospital.

Parent:  Baka naman po pwedeng pagbigyan niyo na po ang anak namin, nanggaling pa kaming Cavite/Batangas/Cebu (state your place).

Intern/Resident:  Mam/Sir, hindi po kayo ang una naming tinanggihang pashente, madami na po kami napaalis dahil wala talaga kaming bakante.  Sana man lang itinawag kayo ng ospital na pinanggalingan ninyo para alam ninyo na wala kaming bakante or sana napag-reserve namin kayo ng pwesto.  Pero dahil bigla na lang kayong dumating dito, hindi ninyo nalaman na wala pala kaming lugar para sa kanya.  Ilipat ninyo na lang sha sa National Children’s, at least doon po ay puro bata ang pashente.  Dito kase halo ang bata at matanda.

The parents and relatives stare blankly and then consult with one another.  Some will stay for a few hours and check if we will break down and let them in anyway, and some will just nod and leave right away.  On rare occasions, some will get aggressive and fight us to let them in, saying that we are unfair.  And when that happens…

Intern/Resident:  Mam/Sir, kung pwede ko lang kayo i-admit ginawa ko na po sana kanina.  Kaso po WALA KAMING BAKANTE.  Hindi na rin po kaya ng mga doctor at nurse na pagsilbihan kayo ng maayos dahil sa dami ng inaalagaan nila.  Kawawa lamang po ang pashente ninyo kung ititigil nio lang sha dito.  Walang mangyayare sa kanya.

Grumble, grumble… 

And that’s how my heart turned into stone.  Welcome to the Philippines.