Just a really quick thought as we are ending this clerkship year with a bang.

“Don’t go Grey’s Anatomy on me now” is what I often tell myself when I find myself in situations that could be worthy of a scene in that infamous medical TV drama that has dominated television for quite some time now.  Although I love that TV series and have been watching it for the past six years or so, no way in heck would I ever wish to be one of the cast members in real life because, really, if ever I go through what any of them has gone through in the past nine seasons or so, I’d probably have to check myself into a mental institution out of necessity.

Over the course of the past year, there had been many circumstances when emotions would become so uncontrollable that we are thrust into situations that we would later wish we could forget.  See, drama in medical school and in the hospitals cannot be avoided.  It seems as if we become so fed up with the medicine that we desire to feel just to affirm our own humanity.  Is that too philosophical?  Yeah, I’m profound.  Medical training forces people to interact on such an intimate and constant basis.  That is enough to drive anybody crazy.  It often drives me crazy.  However, for me, it takes constant self-reminder of what it is I came here for.  I came here for the medicine, something that genuinely makes me happy, for some weird reason.  The time I spend here could have been precious time with a family I will not have forever.  With what I gain with this training, I lose a whole lot more where people I love are concerned.

Often, I wish I were the Tin Man.  No heart, no emotion, drama like that.  Or, no drama like that, if you get my drift.  I really do believe that, in this profession, emotions do get in the way of good judgment calls.  This year is testament to that.  But, of course, we are human.  We had been created to feel a significant and diverse amount of emotions, which unfortunately puts many of us into unbelievable positions – positions I would never wish on anybody.  I like medicine because it is very objective – there is a definite practice guideline for a particular condition and such.  But with the human heart, there’s no such thing.  We feel and we work with people who feel and sometimes our feelings… they go haywire and that is when working with each other become so damn difficult, which is inevitable and inconvenient.

This is why I honestly believe that, in this profession, we have to endeavor to place our personal lives as far away from our professional lives as possible.  It is not a requirement but, hot damn, it tends to absolutely decrease the level of stress in one’s life.  Well, that is what they tell me.  Who am I to say stuff like this anyway?

Well, that wasn’t so quick a thought but a thought it truly had been.

The lure of what is out there has led many Filipino doctors to leave the country for greener pastures abroad.  The goal is always to seek a higher standard of living that this country is seemingly unable to provide.  Although some of these doctors have been successful in establishing their own medical practices abroad, some had to accept positions that are vastly incompatible with the skills level they had acquired with close to ten years’ of medical training in the Philippines.

After asking if they had ever considered going abroad, my folks replied that, of course, they actually had.  However, there’d been many reasons why they’d stayed, one of which had been to provide their kids with stable and secure roots.  Different factors had also affected the decision to serve government and country, one of which had been the lack of sufficient funds to set up a private practice.  Yes, it was a very blue collar background, despite the abstract boost in social status that an MD at the end of one’s name often conveniently bestows upon an individual.  So here we are, several years later, living with the frustrating fact that, in this country, financial compensation for government doctors, especially in the provincial areas, is adequate but not exactly highly motivating.

There is a world map on my bedroom wall right above my study table.  It is there to constantly remind me of what it is I might probably have to give up if I do what it was that my parents had done and more – settle down, have a family, put down some roots, and stabilize finances.  See, my version of the “greener pasture” does not involve a house in the most exclusive subdivision or a lucrative medical practice in the best private hospital in the country.  Of course, there is nothing wrong with the better things that life has to offer.  My family would love to see me settle down in a big house in one of those high-end villages with the guarded, gilded gates that only the rich could afford with a successful medical practice under belt.  I’m sure that is what a lot of medical students aspire for as well.

However, my itch to go abroad is not to settle down.  I don’t really need vast amounts of wealth and/or luxury to get through life.  I just want to see the world, not just to visit other places but to actually live in each country for some time.  Every night, I wonder why I’m studying to become a doctor when what I would like is to travel everywhere.  I should’ve been a pilot or a diplomat or maybe a writer… something that could’ve allowed me to wander wherever I wanted.  However, the desire to practice medicine “gets in the way” of all that.  Perhaps one argument is that a doctor is a doctor anywhere he goes.  However, besides the fact that settling down is the socially acceptable course of adulthood, the thing with being a doctor from a developing country is the irony of leaving the place that most needs your skills.  Is it martyrdom?  Heck, no.  If it were, then everything else would be so darn simple.  Still, one can never be faulted for the choices one makes because, after all, to each his own.

Maybe I will travel everywhere someday and even live in a different country for a few months, simply to scratch the itch to frolic in my own version of “the greener pasture” and to see what the world looks like beyond the visible horizon.  I do hope so.  I honestly hope so because, really, I only have so much nationalism in my blood.  I know that sounds awful but this is just so darn itchy.

I don’t know about other people my age but, between you and me (and the rest of the World Wide Web), I have this intense, almost irrational, fear of marriage.  The thought of waking up beside the same person for the rest of my life, knowing that this thing we have is a forever kind of thing, makes my fingers go cold, the hairs at the back of the neck to stand up, and my stomach to coil and recoil about itself violently.  I’ve never understood it.  It surely is not a result of some personal craving for as many lovers as possible.  Wouldn’t that just shock the Catholic nuns who had given me my elementary and high school education if that were true?  Some close friends have actually scoffed at this fear, saying that I’m just probably trying to appear strong and independent.  Oh how I wish that were the case because it would make everything else so simple.

I’ve always been told that this type of fear could be outgrown.  It simply has something to do with youth, that inherent desire of young age to not be tied down by anything irrevocably permanent.  Although I believe that divorce and/or annulment may be utilized sparingly in situations that necessitate them, I also believe that if one has to enter into something that institutionalized in the first place, one has better be damn sure one stays in it and keeps the vows that had been made before God, spouse, and family.

In the real world, normal people in their mid-twenties generally are already starting to get married, get pregnant, and have families.  However, for those who’d gone to medical school, that normal phase in life gets pushed further until after passing the medical boards or even beyond.   Only a select few would tempt Fate by getting their girlfriends pregnant and getting married prior to that just as my older brother had.  My mother used to nag me to hurry up because she believed that, when a female medical student is still not in a serious relationship by the time she turns twenty-five, chances are she will turn out to be an old maid with bilaterally dried-up eggs to match.

The life of a surgeon is not an easy one, much more if one is married to a fellow doctor with very little time at his disposal as well.  Even if one gets hitched with a non-medical/lay person, the arrangement would still be a difficult one because a) one will only be unfair to the partner because one will not be able to give him the time and affection he needs/deserves and b) one will only be unfair to one’s self because one will not be able to completely immerse one’s self in that relationship enough to maintain it.

There’s a saying that goes work is not a warm bed partner or something to that effect but I’d personally rather take the risk of a cold bed than to have a bed partner, warm or otherwise, who could, at any moment, abscond or die, leaving me with too many problems and too many uncontrollable emotions that I would have no time to deal with.

I’ve always deferred to my mother where a lot of things are concerned.  I’ve always respected her experiences and the choices she had made in life.  So, the ultimate question I was asking her was this: in case I do outgrow this irrational, immature fear of marriage, where is it supposed to fit in a medical career, especially in the kind of career I want for myself?

This was what my wise mother replied, for she is such a sage (and I’m being sarcastic here):  “Marriage is a choice.  It takes effort so you make it fit.”  A lot of help you are, Mom.  You are a freaking fountain of golden answers.

Image  —  Posted: October 26, 2012 in Medschool Bits
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I first met Edwin (not his real name) one Saturday in September 2011.  He was around 5 feet 4 inches tall but was all skin and bones that his slight mother could actually carry him with very little effort in her arms.  Bedridden, unable to talk, and with a nasogastric tube stuck into his nose, he did not present a very comfortable sight.  Edwin has SSPE, or subacute sclerosing pancephalitis, actually been living with it for the past two years.  He was then only 11 years old.  SSPE usually occurs at around the age of 9-11 in children who have had measles before the age of 2 or before they had been vaccinated against the disease.  It is a rare sequelae of untreated measles but it happened to Edwin.  His family lives in a single-room house in one of the most impoverished and least sanitary areas in urban Metro Manila – Payatas.

The medstudent organization of which I’ve been part of for the past three years is socially- and health-oriented.  As such, it is typical for the health coordinator to impart with us some of the community’s health-related troubles from time to time.  More often than not, the problem is usually public health in nature.  However, when the health coordinator quietly asked me to go with her that particular Saturday to meet a family with a special health problem, the first thought that popped into my mind was that I was going to meet a family with a bedridden elderly patient, most probably diabetic, hypertensive, or stroked out.

According to one doctor who wanted to volunteer his services by alleviating Edwin’s pain through acupuncture, Edwin was facing a <20% chance of survival.  Despite the helpful tone of his text message, the underlying question was, “Why are you wasting your time on that?” In all honesty, I do not know but, having met Edwin, having spoken to his mother who had been crying the whole time she was talking about the difficulties that came with Edwin’s condition, it is difficult not to “waste” some time on this.

Every time my orgmates and I would return to the community once or twice every month since then, visiting Edwin and his family became a routine.  He may not know any of us, not really.  I certainly was not a lot of help since I do not have money, connections, influence, or even the adequate knowledge to truly help.  But, for families struggling with a chronic disease, emotional support means a whole lot and can go a long way in lifting morale.

How did I get to know Edwin?  I never really did.  Maybe I never will.

Yes, I want you to cry at this point.  That is exactly my intention when I started writing this piece.

Most doctors tend to remember specific diseases by the signs and symptoms presented by their patients.  These patients eventually lose their faces and individualities in these doctors’ minds by the time these doctors’ have mastered those said diseases.  Of course, it is imperative for doctors to master diseases to be able to conquer them with effective treatment plans in the future.  However, perhaps we do a disservice to ourselves and to the faces that embodied those diseases by forgetting the patients who have taught us not just to be competent doctors but how to be human as well.  Those patients were not, are not, and will never be a waste of time.

 

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Many of us have probably already watched Katy Perry’s music video, “Part of Me.” In that one particular scene after confronting her cheating boyfriend, she went into a public restroom and started chopping off all her hair in a fit of tearful rage.  After that, she signed on for a tour with the marines in Iraq and began a grueling training to become one of the meanest fighting machines the world has ever produced.

Although most women do not necessarily join the marines after going through a major life-changing experience, it is generally a truth that the desire to control that which seems to be uncontrollable becomes so great that we try to control that which seems to be feasibly controllable – our hair.  Of course, other women have enough vanity in them to not actually try to raze their own hair so they solicit the help of a professional hairdresser.  However, something more drastic than just a trim is bound to happen like coloring it from black to blonde or getting a perm or having it chopped off from waist to ear level.  Others who are less adventurous would just stick to cutting their own bangs just to feel like, “At least that didn’t turn out to be such a disaster.” If the purpose is merely to show off and not to change something in her psyche, then a woman would generally not do something so immensely drastic to her hair.  It was after all Coco Chanel herself who said, “a woman who cuts her hair is about to change her life.” The bottom line:  women have a very special relationship with the hair on their heads.

I was asking my brothers if they felt the same way about their hair and, of course, they did not.  My younger brother does apply some blonde streaks to his black hair from time to time but it is more of a show-off thing rather than a control thing.  Perhaps it has something to do with the fact that the socially accepted concept of feminine beauty appears to be directly related to none other than a woman’s hair.  I heard a group of guys talk about how pretty one of my female classmates’ hair was and one of them said in a loud, obnoxious voice, “Well, that’s what she uses to flirt and play around.” Not cool, bro, not cool.

A male friend was once put on the spot by a group of girls who were asking him questions about which girls he found more attractive – the long-haired ones or the pixie-haired ones.  He told them that he found long-haired girls to be more feminine because the long hair showed him how different the girl was from him – a guy who preferred to keep his hair close to his scalp.  On the other hand, he also said that what he liked most about pixie-haired girls was that he could see their pretty faces without them hiding behind long hair.  That last one, I’m not sure if it’s complete bullshit but, at that time, it sounded so freaking good to female ears.  His point though?  To each his own; whatever floats his woman’s boat.  This is one guy who knows better than to come between a woman… and her hair.

A few days ago, my batch wrapped up our first three years in medical school with a week-long “celebration” marked with a series of written, oral, and skills exams. Now, we are officially done with classroom-based learning and are (supposedly) ready to embark on a journey of gaining knowledge from the hospitals full-time.

On the last day after our final exams, the batch partied in a way only medical students knew how – wildly. Prior to that however, the lower year level and the school administration threw us a send-off party, where a couple of people who’d gone before us gave us tips on how to survive clerkship. One of our favorite doctor-teachers, who specializes in obstetrics-gynecology, also wrote each one of us a few tips on how to survive not only clerkship but also internship and residency as well. I’m collating all of their tips here and philosophizing on each one because, despite being medical clerks, we are still extremely philosophical beings.

  1. Remain humble; in short, don’t be a primadonna since you are the “lowest animal in the food chain.” How can we not respect the hospital peking order? Learning from the experience of other people is a privilege. Why be a primadonna over that?
  2. Always show professionalism; don’t answer back. I used to think that being professional meant doing your job and, as much as possible, doing it well. It sucks that it actually also means doing it with a smile on your face, which transparent faces could sometimes be unable to do when faced with lack of sleep, food, and camaraderie. How do you hold your tongue when you can’t even hear yourself thinking?
  3. Always smile; kill them with kindness. We have to admit that, when faced with an extremely disagreeable person, killing him/her with kindness instead of with violence is quite hard, if not humanly impossible, to do.
  4. Take the initiative; always go the extra mile. I was telling a friend the other day that one of the advantages of living away from family during medical school is the absence of familial obligations. It’s a sad but somewhat valuable fact at this point in our training.
  5. Look forward to a “toxic” duty.  I cannot remember a lot of things from the lectures but I am hoping sincerely that I learn from doing.  So yes, bring all the toxics!  I just hope I don’t unwittingly kill a lot of people in the process.
  6. Be assertive without being aggressive. Middle children, which I am, are particularly flexible and good compromisers but, having been surrounded with testosterone growing up, being aggressive in the face of apparent attack is what I know how to do. How do you fix that part of yourself in a little over a month?
  7. Be confident without being cocky. In all honesty, I have no idea how one can be cocky when one is at the bottom of the food chain. It’s like trying to be the alpha male when one is apparently a puppy. Furthermore, if one has no idea what one is doing, I am not sure the line “confidence is key” applies.
  8. Pray. Human limitation is the most common reason why our actions, our knowledge, our ability to be kind and understanding, and our endurance can only go so far.

Perhaps the most important thing medstudents can learn from shadowing their seniors is this rare virtue called humility.  The medical field is rife with people with egos the size of Jupiter, which in some way could be understandable given the vast amount of knowledge they have had access to over the years and given that they literally hold other people’s lives in their hands.  Maybe they have a right to those egos?  Gee, I don’t know but, before they were doctors with big egos, they had been medstudents with even bigger egos… and the medical training system had found a way to ensure that those ego could be brought down a peg or two… or a thousand.

moi

Rarely do I particularly write about the people I deal with on a daily basis because I have found a long time ago that it tends to get one in a lot of trouble if one is found out.  However, I am going to make a rare exception simply because I find it so fascinating that she is the only person I know so far who has ever had the cojones to admit to wanting to pursue a career in, wait for it, Geriatrics.

Geriatrics… the very word itself sounds so unappetizing that one could just wonder why she had ever considered it as a specialty.  Pediatrics is unappetizing to me as well but, in itself, it already is hardcore simply because kids as patients are so damn difficult to deal with.  It takes a certain amount of talent and skill to engage kids and make them cooperate.  Internal medicine is hardcore as well because it takes a bad ass to have complete confidence in one’s self to be able to diagnose something without directly seeing it, which sounds frustrating to me.  Surgery is the most hardcore of them all because one gets to open up another human being and directly see what one is doing with one’s hands – lesser probability of screwing up that way.

Geriatrics, on the other hand, sounds so staid, boring and, I have to admit, a little bit depressing.  One classmate actually verbalized it in a way I probably could never have:  “Geriatrics is the safest specialty ever.  If your patient dies, nobody’d care anyway.” Witty, so witty.  People did laugh out loud but, after much philosophizing over the matter (because I have so much time in my hands, you know), I have realized that it had got to be one of the more insensitive things we could ever say about the people who’ve seen more than we’ve ever had, who’ve lived through pain more than we’ve ever had, and who’d survived through all of it and have the scars to prove it.

In one lecture on Geriatrics, it was mentioned that a person reaches the point of being completely comfortable with himself when he is already at his fifth or sixth decade of life.  That actually surprised me and brought me down a bit.  See, the day I hit my twenties, I had sent a silent prayer of thanksgiving to the Lord, rejoicing that my awkward pre-twenties phase was finally ending.  Now, although I believe myself to be quite happy and content with the person that I have become, I realize that I am so far from that point where the old and the wise now stand.  When you’re in your twenties, you haven’t exactly lived yet and, in a way, it’s another phase of life you just have to understand yet again.  While those who are already in their fifties and sixties?  Those are people who’ve already lived and seen it all.  Those are people who are comfortable in their own skin because they’ve been through so much already as themselves.  How could one not respect experience?

Now, this girl who wanted Geriatrics as a specialty?  She wanted it because she grew up with old people around the house.  She wanted to learn how to take care of them specifically.  Although I’m sure there are more and deeper reasons behind this desire of hers, this simply reinforced what I have long ago believed to be the truth.  A medical doctor’s specialization says a lot about that doctor – what matters to him, what drives him, and what he was brought up with.  One cannot simply go into something and live with it happily without a motivation driving the need and the desire, be it money or something else.

Geriatrics is a noble medical specialty.  To have the desire to take care of those who’d painstakingly paved the way for us to become who we are now is just plain amazing.  Why do old people matter?  Because we’re all going to become them someday.