sleeplistening, sleepreading

I am a thinking zombie. I am sleeplistening through lectures. I have perfected the slight angling of the neck in contemplation and the perceptive nodding of the head implying understanding. It has become a reflex. It does not matter if none of the words spoken ever really reached my ear or my head. It really does not take much to pretend that everything is all right in class. With me always sitting near the aisle right next to the professor I can’t help but exude a vibe of interest and involvement.

Sleep deprivation has taken its toll on my body. It is the week before the finals and my sleep-wake pattern has been drastically altered. This can only grow worse when the exam week starts. Already, I have been visibly slow to react and becoming irritable. There is a dull aching in my head that never seems to go away. Less sleep has me drinking more coffee to keep me awake during the day. At night, the coffee in my system does not allow me to sleep a restful sleep. It is a vicious cycle. Less sleep >>> more coffee >>> less sleep >>> even more coffee. The cycle just goes on and on.

Last night while studying for Clinical Therapuetics I could barely keep my eyes open. My mind was willing to work and so was the rest of my body. It was only my eyes that were unwilling to cooperate. My eyes wanted to stay shut. If only I could read with my eyes closed.

In all the sleepreading I did yesterday this was the only thing that piqued my interest: Patients with rheumatoid arthritis (RA) have gone in remission when infected with HIV.

But who would want to get infected with HIV just to control RA anyway?

Dr. Emer has this to say about the importance of sleeping.

lesson for the day

"Medicine is not like Mathematics. Sometimes 1 + 1 is not equal to 2."

- Dr. Montellano from the Department of Child Health,
on how a whole gamut of clinical manifestations do not always
point to the correct diagnosis.

sundays are for fiction: [salamat po, doktor]

[Salamat Po, Doktor]

“Ringggg . . . ringgg !!!!!”

“Ringgg . . ringg!!!”

Tingin muna ako sa orasan. Alas singko y media.

“Putang ina. Sino ba naman ang tatawag ng ganitong kaaga?”

Kinuha ang telepono, inangat ang awditibo.

“Hello?”

“Hello, anak!”

Napatigil ng sandali.

“Ang nanay ‘to,” sabi ng boses sa kabilang linya.

At natauhan din ako. Biglang napalundag sa kama.

“Inay!!!” ang sigaw ko naman.

“O, kumusta na diyan?

Kumusta ka na? Ang kapatid mo? Binabantayan mo ba ng mabuti? May pera pa ba kayo? Baka nangangayayat ka na diyan? Ano na namang ‘yang mga rally-rally na nababasa ko sa diyaryo? Anong impeach-impeach? Aba, baka sumasali ka sa rally, ha? Delikado yan ineng. ”

Napa-opo na lamang ako sa mga tanong niya.

Mag-aanim na buwan na rin mula pag-alis ni inay patungong States upang magtrabaho bilang nurse. Nawala kasi si itay ng maaga. At ngayong gagradweyt na ako mula sa kolehiyo na may digri sa Biolohiya nangagailangan kami ng malaking pera. Inaasahan kasi nila akong tumuloy sa medisina. Ewan ko nga ba.

“’Neng, ano ‘tong nasulat mo sa akin tungkol sa di mo pag-aplay sa medisina? Anong ibig sabihin mong di ka nag-aplay?”

Di ako umimik, kaya nagpatuloy sa pagtatanong si inay.

“Sa PGH ba kamo? O sa UST? Aba, dapat mag-aplay ka na. Kelan ba ang deadline ng aplikasyon?”

“Kahapon po, inay.”

“Kahapon?”

“Kahapon po. Yung PGH.”

“Susmaryosep! Anong kahapon? Tapos hindi ka nag-aplay? Gaga ka ba? Anong gusto mong gawin sa buhay mo? Ay anak, hindi nakakatawang biro ‘to, ha.”

Tahimik lang ako.

“Eh, yung sa UST?” patuloy pa rin ang pagtatanong ni inay.

“Bukas po yung deadline.”

“Hindi ka rin nag-aplay?”

“Hindi po.”

“Eh, susmaryosep na bata ‘to. Ano bang pumasok sa isip mo at di ka nag-aplay? Mag-aaplay ka lang naman. Tatanggapin ka naman doon.”

“Unhh . . .” napaungol ako.

“Oo naman. Tatanggapin ka doon, dahil magaling ka. ‘Ne, magaling ka. Kailangan mo lamang mag-aplay.”

Ang kulit nga naman ng matanda.

“Tapos na nga po kasi ang deadline.”

“Eh, bakit nga . . . Ano bang gusto mong gawin sa buhay mo, ha? Magbabad na lamang diyan sa bahay? Akala ko ba’y gusto mong mag-doktor. Ano bang gusto mo gawin, ha?

“Ewan po.”

“Ewan-ewan. Susmaryosep.” Nakakatawa na ang kunsumisyon ng matanda. Nagpipigil lamang ako. At kung hindi lang kinabukasan ko ang pinag-uusapan namin ay talagang tatawa na ako.

“Hindi ko po kasi alam ang gusto kong gawin.”

“Naku naman itong anak ko,” biro ni inay. Akala ko tuloy ay makikinig siya, sa halip siya ay nagpatuloy. “Ay, siya, siya mag-aplay ka na ha. Gawin mo na kung anong gusto mo.”

Tumigil siya sandali. At nag-umpisa akong magpaliwanag.

“Kasi inay, hindi ko naman po . . .”

“Ano iyan?” daglian putol nito sa sasabihin.

“Inay, gusto ko po sanang . . .”

“Ay, anak. Naku! Sige na, matagal na rin tayo sa telepono. Malaki na rin ang babayaran ko. Siya, mag-ingat kayo ha. Sabihin mo sa kapatid mo magpakabait siya. Basta anak, gawin mo lang ang gusto mo. Mag-aplay ka na. Mahal ka ng inay.”

“Opo.” At binaba na rin niya ang telepono.

Tatlumpong minuto na ang nakalipas hindi pa rin ako gumagalaw mula sa pagkaupo ko sa kama. Kung ano daw ang gusto ko. Basta lang mag-aplay ako. Hindi ko yata naunawaan yon. Hindi malinaw. Magulo.

Kung ano daw ang gusto ko.

Napatungo na lamang ako at natahimik. Mayamaya’y napabuntunghininga. Tumayo ako at pumuntang banyo.

Naghilamos, nagsipilyo. Nag-ayos ng buhok.

Pagkatapos tumayo ako sa harap ng salamin, nagpakatikas ng tindig, nag-akmang may tangan na stethoscope sa kaliwang kamay, samantalang ang kanan naman ay nakaangat at nakikipagkamay sa imahinaryong kausap.

Nginitian ko ang sarili ko sa salamin. Isang magandang ngiti. Masayang ngiti. Ngiti na ibibigay ko sa mga pasyente ko kasabay ang pagsabi ng “walang anuman.”

“Walang anuman,” ang siyang ibibigay ko na kasagutan sa kanilang mga “Salamat po, doktor.”

[December 1, 2000. Friday]

perseverance

My uncle’s family arrived from New Zealand a week ago. Today they will be having a little gathering with siblings and my grandmother on another uncle’s farm. I find myself unable to take part in the occasion on account of forthcoming final exams, the first of which will be given on Monday.

My maternal grandmother has controlled hypertension. However, it is in times of family gatherings that we expect her blood pressure to rise. In preparation for holidays and long weekends in which she expects her children to arrive she works up a storm cleaning, going to the market and cooking. It is a big production. Even her garden has to be perfect.

Her children and their kids usually stay overnight. Long meals are taken which roll into the next meal. There are numerous discussions with her children and one-on-one sessions with each of her grandchildren. When the last of her sons or daughter leaves from home at the end of the weekend and the silence once again prevails she will meekly take her medications, go to her room and lie down feeling dizzy.

One time late in the evening, she asked me to check on her every now and then because in all the excitement her systolic blood pressure had risen to 180. I was only a freshman in medicine then and was at a loss for what to do. I checked on her maybe once or twice until she fell asleep but did really nothing more than to see if she was awake and if she was still breathing (!). It is in times like this that I question my competence as a [would-be] doctor. If I am unable to take care of my own grandmother, how am I supposed to care for a patient with a previous medical history I am unfamiliar with? How am I to go about establishing rapport that will lead to a good doctor-patient relationship when I am unable to ask my own grandmother how she is doing?

This was two years ago. I have attended lectures and taken part in small group discussions that have enlightened me on the management of hypertension. I have seen a few patients in the ward with similar conditions and discussed treatment plans with the attending internist. Even with all these I understand I have a long, long way to go. I have this great desire to be a very good doctor. I will not allow whatever weariness or disillusionment I may sometimes come across to be a hindrance to the attainment of my goal. I may have a tendency to be complacent but I am still willing to work hard. I will not leave my education to chance and allow it to take me wherever it wills.

It is a little past noon on a weekend. I have been studying since early morning.

ward

I agree with my classmate. We are lucky.

Our IM Clinical Ward group has been very fortunate with regards to patient assignments for clinical history and physical examination. Last semester my group was stuck interviewing patients who suffered from myocardial infarctions (heart attack) or cerebrovascular accidents (stroke). This semester we have been introduced to less common diseases.

It all started with a discussion in Immunology about autoimmune diseases. One of the topics we covered was Myasthenia Gravis. The week after, we were assigned a patient whose clinical manifestations were almost textbook.

GO is 32-year old female presenting with a chief complaint of dyspnea. For Myasthenia Gravis women are more commonly affected with a 3:2 female to male ratio, the peak incidence occurring in women in their 20s and 30s. The disease is often unmasked by coincidental infections leading to disease exacerbation. Exacerbations can also occur before menstrual periods. Our patient had the first day of her period when she was admitted and was having a lower respiratory tract infection. The history of the present illness revealed a slow progression of symptoms commonly seen in the disease – ptosis, dysarthria, dysphagia and generalized weakness worsening in the late afternoon. To stretch our luck a little more we later found out that the patient in the next bed also had Myasthenia Gravis.

I will not go into the details of the other patients. Let me just say that our next patient, MC, was diagnosed as having Antiphospholipid Syndrome secondary to Systemic Lupus Erythematosus, a topic we discussed the week before. Patient MCG who we saw last Tuesday is being treated for arthritis possibly of autoimmune etiology. Today in Immunology we talked about Rheumatoid Arthritis.

I dare you to tell me I’m not lucky.

on malaria

Interesting facts I learned this week:

In the Philippines the following places are Malaria-free: Cebu, Bohol and Catanduanes.

In addition, there have been no reported cases of Malaria from the provinces of Batanes, Iloilo, Leyte del Norte and Leyte del Sur since 1992!

the disappearance of time

I broke the strap of my watch months ago. I have been procrastinating about having it repaired but had not done anything about it until recently. While it sat looking broken and forlorned on my night table I resorted to various tactics to solve the problem I liked to call The Disappearance of Time.

On one occasion I deftly pronated a patient's arm exposing his wrist watch and proceeded to check his pulse and count his respiratory rate. In another occasion, I have subtly glanced at a professor's watch (I have an aisle seat right next to him) as I started losing interest in the lecture. I have twisted the arm of many classmates more times than I would like to acknowledge.

In any case, I have finally made the trip to the repair shop. Unfortunately, it was not my lucky day. The repair man had left for home earlier than usual and I had just missed him. The attending personnel who was trying to be helpful took my watch and started tinkering with it. This was her solution to my problem of lost time.

"i-scotch tape na lang"

just like a bicycle ride

Last Saturday I went to see my friend in the laboratory where she works as a research associate. She was working overtime (with no pay!) just to meet a deadline. She was already running behind schedule and I ended up helping her to speed things up. I was familiar with the procedure having been able to work in the same project before albeit very briefly. Late in the afternoon her supervisor arrived requesting additional slide mounts for examination on top of the samples she had to process. I helped her with that also.

I was surprised at how easily I got back in the groove of things. It was just like clockwork. Everything just fell into place. To make a terrible analogy, it was like riding a bicycle. When I learned how to do it, it didn't matter if I stopped riding a bike for a long period of time. After a few wobbly turns, I was bound to get back to riding like before. The ease of my transition from studying to laboratory work made me wonder if I was actually more suited for research and laboratory work than clinical practice. It is no secret that my abilities to get a COMPLETE medical history leave much to be desired. On the other hand, my normally shaky hands never feel more comfortable than when I am holding a micropipettor and performing procedures requiring skill and precision.

bicycle joyride

I have a little over a year before graduation. After that I still have postgraduate internship and the medical board exams to worry about. With regards to the decision to do research or clinical practice, all I have to say is I’ll cross the bridge when I get there.

bata, bata

[inosente]

literally

It has been raining the whole week. The air is cool. The streets are clean. It feels like December. I fall into a deep slumber every night and in the morning sleep through the incessant ringing of my alarm clock. Eight hours of sleep has never felt this good.

School hasn’t been very stimulating lately. I often drift in and out of lectures. I have lapses of inattention and innumerable moments spent daydreaming. My mind is in constant motion. It is as if my mind is trying to compensate for the transient immobility I must endure sitting through hours and hours of lecture. I know I complain too much. I am lucky enough to get through classes without studying much. However, it is not something I am particularly proud of.

I have found that as I grow older I approach the one thing that I abhor. As I grow older, I become the embodiment of the very thing I swore not to become. I have allowed myself to sink to an unacceptable level of MEDIOCRITY. I have every reason to excel yet I chose to be MEDIOCRE. This is all such a terrible, terrible waste of potential.

the highlights of medicine, literally

the week after

blue skies

The Monday after it all I find that everything is the same. Everything is as it is. Nothing seems to have changed. I am wondering if I was wrong to think that I am a better person than I was last week. After accomplishing something, which from my vantage point is a mean feat, I am reluctant to come back down to reality. Is it so bad to have my head in the clouds sometimes? Is it so bad to allow a dream to take hold of me for a little while?

“Everyone is trying to accomplish something big, not realizing that life is made up of little things.”

diagnosis

[alteration of mental status]

The morning of the grand clinico-pathologic conference: still in pajamas, still cramming, still unsure of the diagnosis.