Posts Tagged ‘medicine’

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 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.

There was a time when I seriously thought about pursuing law. I wanted to be a human rights’ lawyer, one who had more pro bono cases than one could count, who wore slippers with a suit to courtrooms just to be disrespectful, and who traveled to remote places in Mindanao to get “accidentally” killed in an ambush attack by a rival politician’s private army.

The night I told my mother I wanted to take up Political Science or Journalism in a state university, she told me she wouldn’t support me financially if I did what I said I would. Now I know I could’ve survived in the big city alone without any financial support from family but, apparently, being fifteen and a minor render one quite helpless when it comes to making big decisions like this. So, I went on to study Biology in a non-state university.  It had not been an easy track, of course, but then nothing is supposed to be easy, yeck. What made it all worthwhile was the knowledge that medicine could get things done, which ultimately lessens my frustration over things that seem innately uncontrollable.

The Law in this country frustrates a lot of people, doesn’t it? Corruption has becomes so common that people make it into a joke just to make it less serious. In fact, meeting a man with conscience and integrity in this system strikes me speechless, mouth open and tongue-tied. If I had pursued law, I bet I would’ve been one very angry beaver, the kind who violently slaps everyone in the face with her freaking tail all day, every day. Medicine can be the same way too, having personally lived with and seen government doctors live in eternal frustration over this country’s health system. However, medicine allows things to be done right now, the results of which cannot only be seen acutely but also in the long-term. The most important part is to see that there has been a change that has occurred, no matter how minimal, as a result of an action. As opposed to law, where the result of your blood, sweat, tears, and sleepless nights is usually the inevitable freedom of a criminal because of the patronage of a powerful politician, which sounds so corny but which I also know for a fact is a reality.

The Law frustrates me too but I know it’s there for a reason. Plus I would have probably made an awful lawyer. Spoken words and I are not good friends. Moreover, explaining things with my tongue to people, especially to those who have their minds already set anyway, frustrates and angers me even worse. And I probably would have gotten myself killed before I turned twenty-five. I never want to hear my mother say to my grave, “I told you so.”

In the end, I guess I did not really agree to medicine. I chose it over and above my desire to be, well, everything else, as well as my desire to be with my family, to be home, to travel the world, and, most importantly, to earn my own living. It’s killing me to have to depend on other people for finances, haha.  Medicine allows me to understand even if I cannot do anything about it, to do something about it even if I know I’m going to fail, to fail as long as I tried anyway but still understanding where I went wrong so I don’t make the same mistake again. So, during the times I get frustrated with it, this is what I tell myself, repeatedly – I chose this over and above everything else so, honey, kindly don’t screw it up.

Yes, I talk to myself in my head sometimes.

Going home to celebrate the holidays with my family does not mean that I’d left medicine in the closet in my dorm room to rot for two and a half weeks.  In a family of (mostly) doctors, the topic of conversations usually is (you guessed it) medicine.  By now, you’d think I’d be bored to tears or, at the very least, frustrated with the commonality of it all but no.  As funny as it sounds, I feel more of a (would be) doctor in the company of other doctors who believe that I actually know what I’m talking about as opposed to being in the presence of doctor-teachers who look at me as if I know nothing despite three years of drowning myself in all these medical shiz-nits.  See what I just did there?  I just allowed Pride to run its mouth.

Going home to my hometown also means having to meet up with the few high school classmates I’d chosen to keep in touch with over the years and bumping accidentally into those I’d tried very hard to not come into contact with in the last several years.  With these people, the topic of conversations usually revolves around what everyone else is doing – to put it simply, who’s at the top and who’s at the bottom, who’s the winner and who’s (still) the loser.  I would be a hypocrite if I said I’d never listened intently or asked prodding questions myself but the bottom line is that high school never ends, does it?

As one of my medschool friends would tenderly say, we rise up in people’s estimation with a medical diploma.  The honorable part of me wants to believe that that medschool diploma does not make one better than the other, despite the other thinking it himself already, but the realistic part of me has got to accept that we, as a society, put so much emphasis on education, especially further studies, because acquiring one seems to be tantamount to inevitable future success.  What people seem to forget is that a diploma can only serve its purpose if partnered with the priceless experience necessary to achieve that level of success.

I am halfway through medschool but I froze – totally poleaxed – when I saw a woman fall to the floor in the grocery store a few days ago when a thick holiday crowd was milling about.

The one other thing that made me ashamed of myself as a medical student, besides the fact that I totally went cold and froze as I watched her spontaneously fall, hit the floor, and look disoriented, is the fact that, at that time, I was thankful I wasn’t wearing my white medschool uniform.  Only when people had rushed to her aid did my brain start working again – ticking off the signs and symptoms, trying to come up with differentials etc.  As penance for my inaction, I stood at one side for a good 20 minutes just in case while the grocery store staff brought her a chair and her companion started to fan her.

I don’t like giving excuses so I cannot say that I was not able to help like I’d wanted because I did not have a stet or a pen light or a sphyg because who would I be kidding then?  I thank the good Lord that it was most probably just hypoglycemia or acute mild hypoxia instead of stroke or a seizure.  So, no.  I was not proud to call myself a doctor-in-the-making at that time… and my medschool education did nothing during an emergency situation when this supposed doc was on vacay.

As such, I repeat.  A medical diploma needs the necessary medical experience to be able to achieve expected results.  So, really – I do respect my mentors for they’ve seen more patients and been in more emergent situations compared to me.

I am humbled.  Humbled me shall now go take an ocean swim.  Pass the suntan lotion, please!

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.