Saturday, December 31, 2011
2011 was one hell of a year. It was the year I ran out of excuses to delay my residency training. I remember hoping that January 1 would never come. The first week of the year found me going (reluctantly) to different hospitals looking for what training slots were open. It was hard not knowing what field I wanted to specialize in. I was clueless.
I was also happy. I was in the best relationship I ever had. I had put my heart and soul into it, held nothing back. But like the song goes - "Flames to dust, lovers to friends. Why do all good things come to an end?" - it also came to an end a month before our 24th month. The song "Nag-iisa, Wala Ka na" suddenly felt oh so much more personal.
The next 2 relationships were short-lived - my fault. I was still a wreck. Maybe I still am now. In the past 2 months I've met and/or dated 22 persons! It's just like when I was looking for a specialization to train in - I don't know what I'm looking for.
And as for my training, it is everything I feared it would be.
Now that I feel totally shrouded in dark clouds, I'm thankful for every ray of light that shines through.
Happy New Year!
Wednesday, November 30, 2011
Just the fact that my co-residents are all women, married, with kids makes my own concerns seem small in comparison. How can I argue with a request for me to go on duty on a Sunday because it's a son or daughter's birthday, the only time to attend to wedding plans, etc. etc.?
Ask me what I know so far - not enough. I should know a lot more by now but I'm not focused. I've never been disciplined enough to study a few hours every day. Whatever amount of free time to myself gets wasted on mundane things like sleep and looking for dates.
What bothers me is that I don't have anything good to say about what I'm in right now. It's not that I'm in over my head. It's just that my perspective is somewhat skewed.
I need something to balance the stress. Maybe someone will do.
Sunday, November 6, 2011
Like I said, I was deep in thought and it was maybe after 10mins that I got a look at the driver. He was cute (just when I least expected it). Maybe it was the frustration or stress of work that made me foolhardy enough to try and flirt with him :) anyway, i started small talk...
The easiest topic I could think of was to ask about his work (one of my ambitions is to become a taxi driver. Don't ask). He said he drove for 24hrs every other day and since he had insomia, this job made good use of it.
I guess he assumed that I worked at an office because of my clothes. He asked me,
"how much do you earn in a month?"
I answered honestly to that.
He said, "i make that much in one week." and then added, "you could apply as a taxi driver at our office."
(and as for the flirting part - where was traffic when it was needed!)
Saturday, October 8, 2011
The second was while attending to a fellow personnel of the institution I am in. I may or may not have intentionally made them wait longer than was usual. And I might have been slightly callous in my interaction.
Maintaining a pleasing demeanor is hard when things are happening so fast and when I get surprised. It’s something I need to learn or one day it’ll get me into big trouble.
Friday, September 23, 2011
If only people would do the same when it comes to news about other people.
Wednesday, September 14, 2011
So this is what it feel’s like to have an incident report (IR). You feel defensive and paranoid all the time. More so when the focus of the report is my attitude and body language - very subjective. There are too many things that affect one’s interpretation. Because of this, I’m overly conscious that I might offend someone again. That may be a good thing. But it feels like having a backseat driver - you’ll still get to your destination, but you’ll have one hell of a headache!
Monday, September 12, 2011
|Sometimes Love Just Ain't Enough|
I'm wiser now and not illusioned by the thought that love conquers all. I now know that my beloved will not be thinking of me all the time, especially when he's busy. In fact, he may even forget all about me for a short time when under stress (either work- school- or family-related). I also know that when he tells me he is having a bad day, he just wants to tell me that's that. He's not asking me what to do, he's not blaming me. He's just sharing what he's going through and wants someone to listen.
Sunday, September 11, 2011
Sunday, September 4, 2011
He came in because of nasal stuffiness and was found to have sinusitis. He was given antibiotics but the doctor forgot to give meds for the itchiness and stuffiness. The patient was uncomfortable for 4 days more but eventually got well;
She had difficulty swallowing for 1 week and decided to go to the ER. Nothing wrong could be seen on PE and the doctor suggested using a small camera to visualize the deeper parts of the throat. The patient hesitated and downplayed her symptoms. The doctor didn’t insist. Five days later she came back unable to eat and drink without difficulty for the past 5 days.
I was the one who saw those patients. It was a busy day. The senior residents were in the operating room and I was the only one manning the OPD and ER of my department. It was also one of those “toxic” days when patients seemed to have decided to come in all at the same time - I was on my toes the whole time. Still that isn’t an allowable excuse in this field. Maybe they were minor mistakes, small things overlooked and friends would even give encouraging words. But, what if you were one of the above patients?
Saturday, August 27, 2011
In a way it somehow mirrors reality. While dating someone whom I share mutual attraction with,the feelings are intense. Even simple conversations take a life of their own. But the real test comes when commitment steps in. All of a sudden, there are things you cannot talk about, things you cannot share (for one reason or another) because it might cause misunderstandings.
Ironic how we sometimes can be completely honest with strangers and keep secrets from people close to us.
Wednesday, August 24, 2011
It didn't help that I was particularly irritable today. I happen to be the only guy :p in the department and I have to say that when males are the minority, expect the workplace to have a bit more tense atmosphere. It has a lot to do with the FACT that women expect a lot more but explain a lot less - when they tell you to do something, they leave out certain instructions that they EXPECT you to already anticipate. And when you fail to do what was "expected" they have a way of making you feel ashamed for not having thought of it.
Maybe it's not my nature to ask others to do tasks. And maybe women are natural leaders because it seems 2nd nature for them to "delegate" tasks to those around them. In fact, they don't run out of tasks to do, nor do they run out of tasks to do for people around them.
It just wasn't my day.
Saturday, August 20, 2011
when does infatuation end, and love start?
I still envy those who are not single. They're lucky to have someone to share with. It's becoming increasingly difficult to find someone after each relationship. Maybe because, the definition of love changes after each (failed) relationship. There are more expectations as to what love is. That might be the so-called wisdom concerning relationships of those who are older.
I don't agree. It just seems that as time passes by, we become less willing to take the risks involved in falling in love. Whether that is wisdom or not is subject to debate.
Finding a Quality Doctor
By Danielle Ofri, M.D.
“Quality.” It’s one of those words that used to mean something: actual quality you could trust. Nowadays in hospital hallways, quality is a charged word that is more corporate-speak than actual English, eliciting stomach churning and eye rolling in equal measures.
Quality. Who can argue with such a noble goal? Of course we all want quality medical care. Doctors want to provide quality care, patients want to receive quality care, and administrators want to demonstrate quality care in their institutions. All parties aligned in agreement.
The problem, of course, is that no one can agree on how to measure quality. This might be an intriguing question to untangle, if it weren’t for the fact that the quality measurement field has long since left the starting gate. Despite a lack of agreement on how best to measure quality, metrics are being applied broadly, with concrete consequences for doctors, nurses, hospitals and patients.
My own experience in being evaluated for “quality” left me with decidedly mixed feelings. Our hospital had undertaken a laudable and herculean effort to improve the care of patients with diabetes. There was no disagreement that diabetes is one of the most complicated diseases we face, and that these patients would benefit from the best medical care possible.
In that light, each doctor was given a report card citing the percentages of his or her patients whose glucose, blood pressure and cholesterol were “at goal.” These seemed like reasonable data points to evaluate how good a job we were doing.
My report card was dismal, way below the targets our institution had set. It made me feel awful, because I was already working hard. But I felt guilty about the bad numbers, so I worked harder, staying later in the office and calling patients from home. Still, my numbers didn’t seem to budge; it was downright dispiriting.
I wrote about this experience in an essay in The New England Journal of Medicine. In it, I tried to point out that these sorts of metrics don’t give a full measure of quality; they simply measure what is easy for administrators to measure. Like the blind men touching the elephant, they can describe only isolated parts of a medical encounter. Each metric might be important, but they do not add up to the totality of good medical care.
Most people, when they need a doctor, ask for personal recommendations about someone who is smart, caring, thorough, thoughtful and trustworthy. Rarely do they ask for a physician with the best stats.
The responses were swift and vehement. “Dr. Ofri, are you afraid to be measured by hard data?” was a common refrain. My suggestions that most doctors are genuinely doing their best to help their patients and that these report cards might not be accurate reflections of their care were considered evidence of arrogance.
Many of these opinions came from doctors — but mostly doctors who were not involved in direct patient care (medical administrators, pathologists, radiologists). None were in the trenches of primary care.
In contrast to these comments, I was flooded with personal letters from nurses and doctors who felt demoralized by the quality measurement system. These were clinicians who were trying their best in a dysfunctional system, but were constantly being told how they weren’t measuring up. Many said that they were ready to quit, but couldn’t countenance abandoning their patients.
I thought about these nurses and doctors when I came across a recent study that found that patient outcomes (in this case, preventing readmission to the hospital after being discharged) were correlated more strongly to the “fuzzy” measure of patient satisfaction than to the standard “objective” measures of quality.
Patient satisfaction can be an amorphous thing to quantify. But typically, when someone expresses satisfaction with a doctor’s care and would recommend him or her to someone else, it usually includes those “soft” attributes like attentiveness, curiosity, compassion, diligence, connection and communication.
There certainly are some bad doctors out there — incompetents, loafers — and they should be weeded out. But they are a minority.
This is not to say that there isn’t room for every doctor to improve. I don’t view my poor scores as a free pass to blame the system for everything. I have to take responsibility for the things that I have control over, and do my best to stay current and improve my skills.
We need to remind ourselves and the public, though, that these quality measures miss much of what makes a good doctor good. If you want every blood pressure below 130/80, hire a computer to dose the drinking water with antihypertensives. The quality measures will be perfect, and every hospital will be No. 1 in the U.S. News & World Report rankings.
But if you are facing illness — critical, chronic or terminal — you might seek other qualities.
Thursday, August 4, 2011
Sunday, July 31, 2011
They were couple in their 60s. The earned their living by selling clothes hangers at a market. It was around 4am on a Sunday and it had been raining throughout the night. It was cold and they were cold from the rain so they decided to skin the pedestrian overpass and just jay-walk across the main road. Anyway there were so few vehicles this early in the morning.
It was a rainy night and nothing was better than enjoying the night out with friends and some beer to counter the cool weather. It was almost 4am and most of his friends had already gone home. He was a bit tipsy but he decided he could manage driving his motorcycle home. It was still raining when he left the bar and he didn’t have a raincoat with him. He got into his motorcycle and drove as fast as he could, a bit irritated that the drops of rain flowed into his eyes.
They were almost at the other side of the road and watching their step on the slippery asphalt, anxious to put their heavy wares down. They almost made it safely.
He had just a little too much to drink and the cold rain wasn’t helping a bit. He had to focus all his concentration on avoiding the puddles along the road. He didn’t see the two people crossing the street.
The woman was suddenly flung from the side of the man. She hit her head on the pavement. The driver of the motorcycle that hit her thankfully stopped and brought her to the ER. She had a broken leg and although conscious, it was very likely at the very least that he had a concussion.
Who was at fault:
The motorcycle driver who should have waited until he was sober before driving home? [but it was raining, and he was cold, and he was within the speed limit]
The couple who should have used the pedestrian overpass? [but it was several steps high, and their wares were heavy, and it was raining]
Sunday, July 24, 2011
She kept pointing but her mom couldn't see who she was pointing at.
But the kid insisted that she could see someone...
So they decided to take a picture...
Thursday, July 14, 2011
Patient: I don't think the ear drops the other doctor gave me is working.
Doc Ry: why do you say that?
Patient: because when I place a few drops in one ear, they come out the other.
Tuesday, July 12, 2011
I saw him. He was a typical middle aged man maybe in his 40s. He didn't seem to have any difficulty breathing but he looked a bit anxious.
It turned out that his primary concern was throat pain which he had been experiencing on and off for about 2 months. He described it as extreme dryness of his throat and a sensation that not everything he swallowed would 'go down'. Then he added the other litany of complaints - difficulty breathing, tires easily, various muscle pains.
They say that an accurate diagnosis can be made 80% of the time just from the history. In this case I was fairly sure that he was under a lot of stress, maybe work-related which would explain all his complaints as well as cause hyperacidity which could cause reflux symptoms.
Usually an endoscopy would be needed to confirm my suspicions but due to technical difficulties that wasn't an option at the moment.
Instead I tried to explain what was going on in his body. Illustrations helped a lot. It turned out to be an interactive lecture about physiology in as simple terms as I could manage. If I had a laptop and projector on hand...
Usually this kind of thing makes the patient go, "I don't care about this stuff! Just give me something to feel better!" But apparently several of my educated "guesses" were spot on that he paid attention.
Eventually we came to the part of stress where he volunteered that he indeed had a demanding job and he was stressed out to the point that seeing the long queue for the train ride to work would almost cause him to panic.
It took me longer to talk to him than it took me to suture the wounds of several past patients. By the time we were done he was visibly relaxed (and I was tired)
No medications were given.
He still had his stressful job.
He still had throat dryness.
He still had the sensation of difficulty in swallowing food.
He still tires easily.
He claimed he felt better and the pain had subsided and he was breathing easier. But nothing had changed...
Except maybe the level of his self-awareness.
[PS: An accurate diagnosis can be made 80% of the time with a good history. So there's a 20% chance he'll be coming back mad as hell because I was way of course.]
Sunday, July 10, 2011
A referral was made to our department for evaluation. A camera was passed through her mouth to visualize her throat. Just above her voice box and covering half of the entrance to the food tube was a tumor. This was definitely the cause of the difficulty swallowing and voice changes. But the pain might be because of another problem.
A few nights before she left the hospital I came across her fully awake. She burst into tears. "I don't want to die," she said. She recounted the suffering she had been through for the past few months. "I'm loosing hope. My brother just died of cancer and I'm going next."
I talked with her. and left.
A few weeks later, I saw her again. She was back for a follow-up consultation.
Yes, she still was experiencing the pain.
Yes, it was still a chore to swallow food.
Yes, her voice was as raspy as ever.
Yes, the thing in her throat was cancer.
Yes, she had to undergo radiation therapy.
Yes, she was still frail to look at.
Yes, she still had difficulty sleeping.
In fact, everything that caused her recent confinement to the hospital was still there.
Now she even knew she had cancer.
But she was smiling. Her voice was energetic. She was making jokes.
She walked on her own. She was stronger.
The only thing different was that somehow, during the last few weeks...
She had found the will to live.
Thursday, July 7, 2011
I was on my way to the Emergency Room when I heard someone calling my name. It was a former classmate in medical school. She was sitting outside the ER, teary eyed. “It’s my father.” she said. “He has metastatic cancer. Now, he’s unresponsive. His pupils are dilated.”
I didn’t know what to say. Just in the hospital where I work, a consultant had already lost her mother to an illness. Another’s father
is loosing lost a fight against an infection. And yet another’s newborn son is fighting for his life.
Her father had prostrate cancer that had spread to his bones. “You know the course of this disease and how painful it is,” I told her hoping to imply that she should take comfort that the suffering would come to an end.
“I know,” she said, “but it’s still so hard.”
“I think I’ve forgotten that I’m a doctor.”
That froze my mind. How are doctors supposed to act and feel when it’s their loved ones who are slipping away? Are we expected to look on impassively, and intellectualize what is happening to loved ones who are suffering from disease?
Whether it’s our fault or not that many think we have power over death – Well, we don’t!
The process of loosing someone is more painful for us than for anyone else because we, of all people, know ahead of the others when nature has chosen it’s course. But we have to suffer with that knowledge, alone, while waiting for the others to accept that it is time to let go. And during that time we can only grieve while in private because showing grief even to family members may destroy what small hope they have left, despite the odds.
To my classmate, “No, you haven’t forgotten that you’re a doctor. You are part of the minority who now knows what it really means to be a doctor.”
Tuesday, July 5, 2011
Friday, July 1, 2011
Against the odds he survived the first 3 months and it was finally decided that he could go home with his parents as a complete family. He had been through a lot, and so did his parents. The good news was welcomed by everyone.
Three weeks later he was back in the intensive care unit. Something was wrong with his lungs. They wouldn't function properly. While life goes on, his and those of his parents are a standstill. Seeing his father telling him that he loves him and his mother smiling at him through tear-stained eyes would break anyone's heart.
But miracles still happen.
Maybe he will be one of them.
Sunday, June 26, 2011
Maybe when I start operating It'll change.
Wednesday, June 22, 2011
I don't know what to make of the fact that all my co-residents are female, married, and have 1 kid each. And each having her own unique personality it's a wonder that they've managed to get along well for more than a year :-P
Females sure seem to have the natural ability to multitask. Their brains seem to be quad- or even hexa- core while mine is just single core. And I have to admire how they can manage to give you instructions on an installment basis for several tasks and remember all of them, reminding you what you have forgotten - and you will always miss one or two
As for myself, I've managed to avoid major conflicts (so far) although I think I have to talk less and keep my opinions to myself - coz they're usually misunderstood.
Monday, June 20, 2011
I used to have an opinion on everyone and everything. But for the past few months no matter how busy I've become, I don't seem to have anything to say.
Tuesday, June 14, 2011
It was the first major case of my residency. A case of tongue cancer. The operation would need several surgeons and would take at least 12hrs.
Preparations required that the patient would be seen by several surgeons who would palpate and poke and prod the patients mouth... And discuss where the possible incisions would be made, what parts of the mouth and neck would be taken out... All in front of the patient.
It wasn't meant to be rude. It just seems to be the way doctors detach themselves. The importance of detachment during an operation has its merits.
Being able to emphasize with the patient may affect the judgment of the doctors, could make them play safe instead of doing what is right or ideal.
But... Patients are still people
Sunday, May 22, 2011
... That's what I feel looking at our patient. She's 53. Found to have cancer of the food tube. She was supposed to undergo radiation therapy when she experienced difficulty breathing. She had to be admitted to the ICU and hooked up to a machine that would do the breathing for her. Doctors found out that the cancer had spread to her lungs. There is nothing they can do. It's practically game over.
It would be easier if she wasn't fully awake and comprehending. I cannot imagine what is ging through her mind. But she either is in denial or is not aware of her actual status. She's in limbo. Midway between life and death... Or maybe nearer death. But what she's going through right now is no way to live nor is it a way to die.
Only a miracle can save her. And if there's no chance of one happening, she has to at least die with dignity... But there doesn't seem to be a chance of either.
Saturday, April 23, 2011
There are 3 other more experienced residents in the department and all 3 are women, all have kids, and husbands :) I have no idea how they manage to have energy to play with their kids considering that we work 96hours/week and yet they manage. While I fall in bed exhausted when I get home, they are always in a hurry to get home and spend time with their kids, go out with their partners, and take care of household stuff. Where do they ever find the energy for that?
Monday, February 21, 2011
But once in a while I've been feeling a certain heaviness the cause of which I can't place my finger on.
It's not the work load.
I hope it's not resignation.
Tuesday, January 18, 2011
She was brought back because the smell became stronger. All that could be seen in her nose was the mucous, and something black. And the smell... like something rotten.
She denied she put anything in her nose. But there was something black inside. It took almost 20 minutes to get it out - a now corroded battery which had been in her nose for about 3 months. With medications the smell will eventually disappear. But the battery had already leaked and could still cause the bones of her nose to collapse. Only time will tell. Hopefully this time she'll be brought in for follow up.
This is going to be something I will routinely see in the specialty I've chosen (finally). And the more I observe in the out patient department, the more I seem to be looking forward to start the training. Hopefully I'll also enjoy the major operations.
In 2 weeks I'll be starting my pre-residency. No salary for about 2 months. And there'll be 2 of us vying for the slot. I hope after 2 months it'll be me
Friday, January 14, 2011
2011 is going to be a year of change and it seems not only for me but for a lot of people I know. Even the dates of the zodiac signs have changed :) After living the life of a Libra, I may be a Virgo after all.
Change can be scary sometimes but I think I'll get through. Now have to think of a new blog banner design to reflect the new things coming my way.
[UPDATE: so I'm still a Libra after all. Only those born 2009 and up are affected by the changes :| ]
Wednesday, January 5, 2011
when mortals are faced with indecision they turn to a higher power and that was what I was doing while sitting at a bench near the entrance of a hospital. I think I was there for 15 minutes seemingly staring at nothing.
I don't know if my eyes were closed or I was so caught up with my thoughts that I couldn't see anything but suddenly I was nudged by someone and heard "bata pasok ka na (kid, go inside)". It was a doctor I knew who specialized in otorhinolaryngology (ENT - ears, nose, throat). I just stood up and followed him into the hospital making small talk. Just inside was another otorhinolaryngologist I knew. I parted ways with the 1st doctor and headed to the office where residency applications where accepted.
Why I was talking with the secretary about the open slots, a lady doctor (a resident) came into the office and sat next to me waiting her turn to talk to the secretary. As I was standing to leave, it just came to me to ask if there was an opening in the ENT department. And suddenly the lady doctor said, "yes". Turns out she was an ENT resident in the last 2 months of her training freeing up one slot when she did.
... so what do mortals do when we receive a sign?
... we doubt and ask for other signs.
and so I'm still looking, not knowing what I'm looking for.
Tuesday, January 4, 2011
I’m at a crossroads again and saying I’m terrified is an understatement. The past 10 years was a fork in the road and it led me to:
1. a degree in Medicine
2. a degree in Nursing (don’t ask)
3. my first job (with pay)
4. my first delivery (of a baby)
5. new friends
6. old friends
7. 4 relationships
8. lose a laptop and 2 cellphones
9. own 5 cellphones
10. my first digital camera (S5IS)
11. my first DSLR (D5000)
14. Baguio (5x)
15. Cagayan de Oro
16. Puerto Galera (3x)
18. Subic (2x)
19. Baler, Aurora
20. Boracay (4x)
21. Christmas Vacations with Family (5x)
22. But the best thing that happened to me was I gained weight.
If you’ve been following this blog you know what I mean. There’s a reason I had so few pictures during before 2006 – I hated myself. I can see myself in medschool (2000-2003), clerkship (2004), and internship (2005) looking like I was the patient instead of the doctor. My long-time friends can attest that I looked that way even before 2001. Actually I was that way since highschool.
After passing the Medical boards I didn’t go into specialty training. I was tired of that life. I instead look for a clinic where I could work as a general physician. It was while working there that a medrep visited and recommended a certain chinese herbal medicine that could increase appetite. I had tried everything else before and even in I was sceptical I took this meds. The result: pictures Sept 2005 – April 2006.
My life changed.
Why am I writing this? Because this year I have to start my specialty training. For the next 3 years (minimum) I’ll have to give up my time, my income, vacations, sleep, and I just pray that my relationship is strong enough to survive.
If I had my way, I wouldn’t go into training but my future would be at stake. I have to.
Why am I writing this? because if I went directly into specialty training immediately after the board exams I would already be a specialist now. But it’s very likely that I would still look and feel the way I did during the first half of the past decade. If I went straight into training I wouldn’t be confident and happy about myself. I wouldn’t love myself.
I am trying to convince myself that those years weren’t wasted. I want to believe it was worth it not going into training immediately.
Because the consequence of that delay now means that my life as I know it will end, and will again start at 40, literally. While others will be enjoying the results of their hard work at that time, I’ll be just starting my hard work.
I have made a lot of decisions I regret but the past 5 years can’t be part of them. They were worth it.
I’m still (quietly) hoping that no hospital will accept me or for some reason find me unqualified but deep inside I know I’ll be starting this year and I can’t put it off anymore.
I just pray that somehow I learn to love what I do because,
“Time flies when you’re having fun.”