It’s kind of a late announcement, but I guess most of you guys know that my internship is finally OVER! Can you believe that one whole year has passed, and here I am still, blogging away, with full body intact. I can’t even believe that I gained a few pounds, which was the total opposite effect that I was going for in this internship. Even my make-up hours for OB and Pedia are done. So now I am supposed to be doing my reviews but I still haven’t formally started yet. Can’t a person have her long awaited vacation? I already went to my province for some quiet time, but I decided not to fully give up my dorm because I still want to go to the gym near it, and the internet here is ultimately better than the one we have at home. I’ll go back to my house when my review session in PGH is over and that’s gonna happen a month from now.

Isn’t it ironic that the annoying sounds of the basketball game combined with the drilling/construction work which happened for about 2 weeks or more stopped on the last day of my internship?

On the last day of internship, we held the annual “sunog”, which means “burn”… A few days before all interns submitted their votes on their most hated, most burnable people in all of PGH… I guess this is the only way we will ever get back on those professors, doctors, nurses, and staff, and even clerks, who made our lives more difficult than it should be. I was going to post the pictures of the people who were burned in this blog but I changed my mind because they might get more humiliated and there are limits to the embarassment people could incur. Their pictures would be posted on a big poster in the hospital itself anyway. I think they got all the people right, except for a resident who should not have been burned (I believe that she was only pressured by her seniors… oh well… )

The only thing I miss about internship is the interaction with people. Right now, the best interaction I get is with the Internet. I kinda wish that the new tenants of the dorm would come already just so I could talk to some other people. This is kind of a good environment for really reviewing and I plan to use it to the fullest. The earlier the boards are done the earlier my new life will begin.

Just this morning, my cousin called me to consult about his daughter’s cough, and all I could think of is, it has finally begun. I feel honored to be acknowledged by my clan as the new clan doctor, even if I don’t have my license yet. Just the fact that he called me means so much for a new doctor like me.

As I review my anatomy, I realized how relatively easier it is for me to take in the data compared to when I was in 1st year medical school. The experience I got from clerkship and internship are the reason I guess. I realize now how important each fact is to my practice… This realization is what will keep me determined to acquire that coveted surgery residency in the United States. I may not be the star scholar, I may not be the brightest of the bunch… But I know I have the determination. I guess that’s why I can relate to those cartoon heroes who are average but compensates by there zealousness.

For those of you who continue to support me, thank you very much. I will try my best, and not only aim to pass but aim for the highest spot. If you happen to pass by Taft Avenue, let’s have some coffee… ^_^

Working in a government hospital sure has its ups and downs.  The people of the Philippines are lucky to have a hospital like PGH that makes the skyrocketing hospital bills a little more reachable.  People all of the country flock to this hospital because they don’t have to pay for the rooms daily, and they don’t have to pay the doctors professional fees at all.  All they need to pay for are the meds and the OR equipment (which, for some people are still pretty expensive, but goes there anyway).  Unfortunately, this hospital is not like the other government hospitals in other countries which are completely free.  People have no choice but to settle for this place because it’s the cheapest bill they will ever get.   And because the funds of this hospital rely on government money, you can’t expect top notch care, as much as they say it is.  We get donations from different associations and people, but once those equipment gives out, then we are in big trouble.  This hospital hardly has money for maintenance.

And that’s where the problem pertaining to that written on the picture above comes in.  I saw this message written on manila paper on one of the bulletin boards in the hospital.  In English, it is translated as, “The heat because of the broken air conditioning in the operating room, makes the heads of the staff and doctors hot as well!”

I experienced assisting in OR’s in these non-air conditioned rooms.  Most of the time the electric fan in the OR would be facing the head surgeon, which means I am stuck with the dead air.  We can’t turn the fan on full power because it will mess with the surgical field.  And so we end up with sweat beads on our forehead with the mission impossible hope that the sweat doesn’t contaminate the field.  Oh man!!!  I got lucky because the OR i am in lasted for less than 5 hours, but think of the 12 hour operations!  It must be hell!

I really hope that they fix this problem because it’s not just for the the staff but for the patient to be operated on too.. There are just some parts of medicine that cannot be compromised.

ok… so time flew by so fast that i didn’t even post an article when I was in Orthopedics!  Gosh… well, basically it was great because unlike the whole OB experience where you feel like you are working working working, in Ortho, your resident is your big brother and friend.  I had to present twice in front of them, and it was like a casual conversation… piece of cake!  I DID have some trouble with the ER, just because I didn’t have a resident with me the whole time, and so I was kind of the one managing the whole ORtho area with some help from the clerk on duty come the afternoon.

And so Day 2 of Rehab has arrived.  I never thought the day would come, when I would rather screen a hundred patients in the blood bank rather than see 2 rehab patients… SERIOUSLY.  The 2 days have been excruciating!  First of all I feel like I am a crow at gunpoint.  I’ve been hearing people say you have to sign in on time, no problem with that.  Then sign in at the OPD, then sign in at lunch time at the rehab office, sign in at 1 pm at opd, sign out at 4:30 pm… Basically they are tracking our every move.  What am I, 3?  Then even if we are done with OPD, we can’t leave earlier because we have to sign out at 4:30 not a minute earlier.  The point being…?  Even so, it was never an issue for me, because I don’t leave early coz I have to make these utterly long histories with too much detail… *sigh*  Then I got this message from my friend that they now want the histories to be computerized… OK… fine… On duty, you have to sign in on 7:30 am, spend the whole time at the ward even if there are no toxic patients there, then at 4:30 pm till morning, at the call room, answering calls… answering calls?  for what?  Good thing I am ok with quiet time, so I guess it won’t be that much of a crazy time for me… come post duty, you can’t go home yet… you have to stay in the ward… make your progress notes… then? just make sure you stay there or ELSE… they will demerit you… OUT OF POST!  This is supposed to be a minor rotation, but that doesn’t mean it is a piece of cake.  It makes me all the more paranoid because of all the rules.  Not that I am out to make any trouble.  I am just getting too anxious because I might break a rule even though I don’t mean any harm.  So, basically I think I will get by, I just want to say, that for the record, that the rules are absurd.

27 days to go and it’s goodbye PGH!

Shifting dullness… It’s actually a physical finding that pertains to ascites, or to put it more plainly it’s like having abnormally large amounts of fluid in your tummy.  But when you are talking intern-lingo, when we actually say “I am experiencing shifting dullness right now.”, we mean we are in the state of adjusting to a new rotation or environment.  Right now that’s exactly what I am feeling… SHIFTING DULLNESS.  As I probably described in my earlier write-ups, medical clerks, interns and even residents have a schedule of departments to rotate in.  Like right now, I am in my second day in the OB-GYN rotation.  I am going to staying in this rotation for 2 whole months, and then later I am going to shift to Orthopedics.  That’s where we got the term shifting, I guess.  And when I personally come into a new rotation, I become this robot that kinda acts slow, still trying to get into the natural speed of things, trying to remember what I learned last year in clerkship, etcetera etcetera.  If you’re lucky, like me right now, you’ll enter a new department on a post duty status, meaning you don’t go on 24 hour duty on your first day, and you don’t have much work to be done, so you kind of get the chance to ease your way in.  But if you’re UNlucky, you enter the rotation as a duty intern, where you spend your first 24 hours running around still trying to recall, “What labs do I have to request for again?”.  It’s like riding a bike again after years of not getting on one.  You know what to do, and you’ve done it before, it’s just taking the time to seep it’s way into your system again.  Usually it takes a week for shifting dullness to subside, but letting it get to you makes you look lost.  And so now you know exactly how I feel at this particular moment.  Tomorrow is my 3rd day in OB-GYN, and it will be my first duty in the OB Admitting Section, where I get to see people frantically wanting to get in coz their water bags broke.  Please pray that my shifting dullness is cured by tomorrow.  And as extra precaution, I am going to be reviewing from this point forward.

Doctor Beans, signing out.

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! ^_^

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.

This weekend happened to be one of the longest “breaks” I had ever since I started internship.  My friday OPD time only lasted until 1 pm, and then I won’t have any work until tomorrow.  Even if tomorrow is another Pedia duty, I don’t mind since I had a long rest.  I wish I had more weekends like this.  It was just too bad that I didn’t see my parents and my siblings since my parents and sister are in the US and my brother is busy with his work.  I did go out to see Phi’s premiere showing of “Stardust” a new fantasy-adventure flick starring Claire Danes, Michelle Pfeiffer, and my favorite Robert De Niro.  I invited my cousins Cielo and Tikoy to watch with me.  It was such a great movie, and I totally loved that fact that almost all of the people who watched were laughing together.  It was truly a night of relaxation for the med students of UP and its alumni.  I definitely recommend this movie to everyone who is out for a good laugh and is looking for a love story that is not so cheesy.  I definitely loved the performance of Robert De Niro and Michelle Pfeiffer, in Tagalog they are truly “Walang kupas”.  Seeng it in the big screen is definitely worth it, don’t watch it in a pirated copy, or you’ll miss the special effects and the great soundtrack.  Besides that, I spent the rest of the weekend finally reviewing (promise!) and downloading some old tunes that I loved as a kid.  I then remembered the good old days when I used to play with DLSU Pops Orchestra.  Those were definitely a part of my golden days.  Tomorrow is the start of another week, the 2nd week of my Pedia rotation.  I love the fact that the days are going by so quickly, that only means that I am finally getting the hang of things and that I am really enjoying my stay in UP.