Posts Tagged ‘doctor’

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.

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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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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.

When I was a kid, my parents enrolled me and my brothers into a lot of classes.  For learning and improvement, they said.  My mom tells me now it was their way of making sure that their kids would be able to achieve all of their potentials in life.  Thus, from my childhood to my teenage years, I had taken classes in piano, ballet, karate, taekwondo, landscape sketching, portraiture, acrylic painting, guitar, typewriting, computer technology, swimming and First Aid, declamation, theater, and journalism.  My older brother got enrolled into a summer course on automechanics once.  He was ten.

As a result, there are a lot of things that I know how to do.  The problem is that I’m not sure if I’m that good in all of them.  As such, each one of them is a hobby that I don’t share with a lot of other people, simply because I don’t think they’re at that level of share-ability.  This desire to know or maybe to learn was probably the one thing that my parents had painfully but successfully instilled in me because of the constant barrage of diverse information during my formative years.

Speaking of the constant barrage of diverse information, which sounds suspiciously like medical school, perhaps the downside to being enrolled in an MD-MBA program is that it can be a bit confusing sometimes.  Sure, we know we are here to become clinical doctors but how can you focus on becoming that doctor when you also have to put aside what little time you have to become a public health practitioner, a quick-witted businessman and a social catalyst all at the same time?  Excuse the whining but I’m simply wondering, in earnest, how can you compete, clinically speaking, with other medical students from other medical schools whose only concern is to become the best clinical doctors ever?

It makes me think sometimes that, to have an MD-MBA attached to your name, you have to become sort of like a jack-of-all-trades –you have to know how to do a lot of things but you can’t be so sure if you’re that good in all of them.  Not unless you get the balls to try them all out, all at the same time – now that’s some serious balls.  However, these days, whenever I feel the urge to complain about the work load, I think about Daddy and Mummy and how they used to (irrationally) bombard me with diverse information that are so unrelated, I sometimes thought they were torturing me.  Yeah, my parents were very loving people.

The point though was that I learned how to do many different things and, in a way, I was able to achieve the potential to achieve.  I don’t care that I cannot readily define Ashermann’s syndrome or that I do not know what to call lub-dub-click-whoosh when I auscultate a cardiac patient or that I still cannot pinpoint the parts of the basal ganglia.  I mean, I am doing a lot of things here, okay, I am trying to be a lot of things here so chill, okay?

That is the reason why I am still slaving away right now, not for the MD-MBA titles (although, of course, they are still a major reason why I’m doing the shiz nits I’m doing right now, haha), but because I want to learn something new everyday and, these learnings may not be totally related to each other but they will help me achieve all of my potential – as a doctor, as a social catalyst, as a businessman, as a person.

Boom, we just had a pseudo-mature monologue right there.

Grey's Anatomy (season 7)

House MD is great. It’s hard-core medicine. It’s irreverent. It’s sarcastic and I love sarcastic humor.  However, this series? It’s kind of dark.  Sometimes I feel the doctor lacks respect for life.  So, screw the hard-core medicine because hell would freeze over before I would allow myself to turn into the kind of doctor – maybe even the kind of person – that House is in that series. He’s a great a doctor but I’m just gonna go hit my books and hit them hard to be a good doctor.

On the other hand, Grey’s Anatomy is full of drama. It’s exhausting – the drama and the complications and the personal lives spiraling out of control and people dying and getting cancer.  So messy (which is why I have no personal life whatsoever).  However, the one thing that makes me like Grey’s Anatomy a lot is how it presents the human condition.

Okay, I just made Grey’s Anatomy sound philosophical when it’s basically all about sex.  I’m kidding, haha.  For me, Grey’s Anatomy shows what life is like as a person practicing medicine but is also completely immersed in an uncontrollable world. Ergo, it shows me that doctors still have a life and it’s as messy as anyone else’s.

You see, what I’m trying to understand and look forward to is the life with the medicine. I’m already expecting the life of a workaholic. The hospital is a really small place and, as a clerk or an intern or a resident, that is going to be our world.  What a small, constricting, suffocating world.  It excites me.

The thought of waking up at 3 in the morning to go to the hospital while everybody else is asleep and be good at what I do excites me. The thought of myself in an O.R. with a scalpel in my hand just standing for eight straight hours fixing a stranger up excites me because that’s just so hardcore. The thought of travelling to other countries and treating people by the millions excites me.  Yes, it’s exciting to think about the medicine but I want to understand not just the medicine but the life that we are to live while practicing medicine.

I want an exciting life but I don’t want a messy one.  Constantly thinking about people you care about who are dying on you – well, it’s exhausting and that’s inevitable. People gravitate towards drama because we feel. We get hurt. We want to hurt others. We get angry. I just want to do my job well. People make it so hard to do just that because, honestly, it’s not the work, no matter how heavy or how seemingly unending the load is, that makes everything exhausting. It’s the people.

Which means that I do like watching Grey’s Anatomy and the series and the messiness it depicts never fails to entertain me.  In essence though, I don’t want to be House but I want to learn way he handles his life as a doctor practicing medicine because he finds ways to make life less messy.  How ironic is that?  Does that even make sense right now?

Maybe I’m better off in Pathology. Dead people can’t be that exhausting to be around.  Or maybe this is exactly the reason why I want Surgery. People can’t talk in my O.R.  The person on the table sure as hell couldn’t when he’s heavily sedated and I’ve my hands full squeezing his heart, his kidneys and his bowels. Now, that’s exciting.

Bullshit Ahead warning in style of warning roa...

It is not (that) difficult figuring people out. I am of the belief that we, as human beings, inherently wish to be understood by those around us that, even though we would like to seem mysterious and unreadable, that innate desire to be understood is reflected on our faces, on our body language and even on the simple physiological processes (i.e. sweating, increased blinking rate, body position and even the occasional smirks and eye-rolling etc.) that reveal the emotions that are boiling within us. Yes, I am a big believer of body language reading. However, although observation plays an integral part in showing the realness within us, intuition plays an even greater role in how one is able to gauge the character of another human being. This is what we call getting vibes or testing aura and, in my case, this is how I gauge the level of another person’s genuineness.

Genuineness is (personally) an important concept because having surreptitious agendas or putting on a mask of overt plasticity for no productive reason is, admit it, somewhat a waste of time. A mentor once said that the only way you will be able to spot bullshit is by being completely honest with yourself. Her point was this: how can you tell if another person is being honest with you if you are always lying to your own self? An argument could be that constantly bullshitting with yourself will make it easier for you to recognize other people’s bullshit but that would probably lead to a slap at the back of my head so I just keep my mouth shut.

It is a difficult endeavor, this being honest to self thing, which is why I truly appreciate people who have the most transparent faces. It makes spotting either bullshit or genuineness easier in the sense that there is no need to be paralyzed by analysis. There is no need to try to sift through their childhood and what could have gone wrong and the motivations that make them the way they are and how you can possibly help them and, damn, would prayer be enough to yield change in these people? Don’t hate on the effort at Psychiatry – I’m trying to make myself believe I didn’t flunk that exam. In short, it makes life easier… and why does life need to be easier at this point?

Because we do not have time for bullshit. Just kidding. Life needs to be easier because we are here to work, boo, not to produce, um, stool.

But what do I know anyway? There is a land called Denial-asia and I am their top monarch… and I bet I’m ruling this kingdom with several other monarchs.