clerkship

Clinical clerkship begins in two days. The tension is starting to get to me already. This is not like the usual anxiety of going back to school after a semester break. This is that turned up a notch and coupled with feeling of inadequacy and incompetence -- definitely not a healthy mix.

An uncle is arriving from Bahrain this evening. His eldest son, now all of 12 years old, will be graduating from grade school (with honors, I believe) and he is arriving in time for the graduation rites. Grade school graduation. I do not doubt the importance or the impact this will have on my cousin. I can still remember that when he was only in 2nd grade he was already complaining about being tired of studying. In that context, getting past grade school certainly deserves congratulations. What's bothering me is that in the back of my head I can't stop thinking that he has a long, long way to go. As a college professor used to say while putting a twist on the old saying: Marami pa siyang asin na kakainin.

For my part, grade school graduation was 13 years ago. The 13 years that followed I spent studying for the most part, working for some while living in a dormitory, boarding house or by myself in an apartment -- a lot of years striving to get an education and to learn to be independent and self-sufficient. Thirteen years already and yet I'm not even half-way there.

I suppose I can say the same about my brother. He is turning 19 in October and about to graduate from high school in June. Indeed, his graduation is a monumental event and my grandmother is going to fly off to America to witness it. Why wouldn't it be when he spent three years finishing his "last year" of high school. So: Congratulations. Pat on the back. Whooppee. Then, what? What's next? No one really knows. His college education hasn't even be discussed yet, an unprecedented occurrence in the family where college naturally comes after high school graduation. I suppose everybody got tired of discussing his future for the past three years and now every one is just letting him be. Even though getting a great job and earning lots of money was never the point of getting a good education, someone does have to get food on the table. And while I miss having paychecks, 13th/14th/15th month pay, productivity bonus, health insurance (and even taxes) I'm as far away as my brother and my 12-year old cousin from getting a REAL job and putting food on the table.

Last words on clinical clerkship: I guess we're all just a little insane. I mean who in his right mind would pay more than a hundred thousand pesos so they can be "tortured" to work for free, driven mad and deprived of sleep and a social life. Definitely not for the faint of heart. And it's not even going to get any easier as the years pass.

my vacation, so far

Saturday morning, after waiting a week for the examination results to be posted, I found myself on a bus on the way to Batangas. I was fortunate enough not to partake of combo meals, side dishes or desserts. The fact that I was a week away from the first day of clerkship duty had not sunk in yet. I suppose the realization would be pretty overwhelming after I pay a whopping P144,000+ for enrolment in a few days.

Sunday morning I woke up early to hear mass with my grandmother and proceeded to visit the new addition to the clan, my week-old cousin Francesca. She was a lot smaller than his older brother at birth weighing only 5 lbs and some. As expected, she slept most of the time. I did an internal inventory about what I had learned about doing a neonatal physical exam and came up only with reflexes. So I stood over my week-old cousin, checked for Babinski, plantar, palmar, snout reflexes, etc. and concluded that I really, really needed to read more about neonatal P.E.

Monday, being broke I stayed home all day, started reading The Great Gatsby and waited for relatives to visit me.

Hmm. Exciting life, indeed.

remembered conversations 2

I finished reading on sleep apnea one night (it seems that our professor did lecture on it and I didn’t just dream of it) and the next day decided to share what I had learned to a classmate.

I started out with: May sleep apnea ata ako.
Classmate: Ha?
Me: I read last night that the common clinical manifestations are a result of the fragmented sleep and loss of slow-wave sleep during the night. So a patient may have cognitive and behavioral disturbances, excessive daytime sleepiness, intellectual impairment, memory loss and personality disturbances.
Classmate: (does not reply, continues studying)
Me: Swak di ba? Excessive daytime sleepiness, intellectual impairment, personality disturbances . . . di ba?
Classmate: (finally turns to me) Remember the discussion in Psychiatry on somatoform disorders? There’s this disorder called hypochondriasis . . .

Needless to say, we laughed our heads off like crazy after that.

today

I woke up at seven, had a cup of coffee and a slice of cold pizza. Not exactly breakfast for champions but it was no time to get picky. I checked my email and contemplated writing to my sister. I didn’t.

I re-organized all the reading materials for the past semester and filed them away in bulky folders and envelops. After two hours of this pointless task I gave up.

Lunch was like de javu: a cup of coffee and a slice of cold pizza.

I read a former co-worker’s draft for an M.S. thesis, made a few notes on the margin and left it as it was.

I stared blankly at the materials for the revision of a final paper for school, resented the fact that I had to toil over a paper that will not be graded nor read anyway. I only have to pass it for completion. It’s due next Monday. I did not get anything done.

I deliberated about going out to watch a movie. I checked the movie scheds and found nothing I’m even remotely interested in. I already saw V for Vendetta last Saturday. And yes, God is in the rain.

I started reading a few chapters of Ursula Le Guin's Changing Planes: Armchair Travel for the Mind. This is my first ever Le Guin book and I'm not exactly sure how I like it so far.

For dinner I ate more leftovers (but no more pizza this time). I prolonged the meal by using a pair of chopsticks given by a friend who recently arrived from Japan. I had a cup of mint tea after that, with an unusually big dollop of honey.

I then proceeded to watch Noah Baumbach’s The Squid and the Whale.

This is me on the 4th day of vacation and absolutely fucking bored already. Whoever it was who said that humans were not built for leisure was right (I believe it was Douglas Coupland in Generation X). At least this human isn’t. Maybe I should go out for a drink.


P.S. Watching V for Vendetta, I hated the fact that all I could think about was Anthony Burgess’ A Clockwork Orange. I'm just glad that, as expected, Hugo Weaving and Natalie Portman gave stellar perfomances (I can forgive Portman for the occasional vanishing British accent).

remembered conversations

#1 (On a bus on the way to Cubao)

Pasahero: Magkano po hanggang Farmer’s?
Konduktor: Para sa iyo bente na lang. Ngumiti ka kasi ng maganda.

Passenger hands over a twenty-peso bill and the conductor gives her a ticket.

Konduktor: May lahi ka bang Ruso?
Pasahero: Ano po? (hindi naintindihan ang tinanong ng konduktor)
Konduktor: May lahi ka bang Ruso?
Pasahero: (natawa) Ay, wala po.
Konduktor: Eh ano?
Pasahero: Wala po. (proud na proud!) Pilipino po ako.


#2 (In a school playground while waiting for class to be dismissed)

Older Girl: (standing beside a swing) Don’t you think it’s weird that this children work so hard to learn English.
Younger Girl: (sits on a swing)
Older Girl: I mean, they take extra classes and all.
Younger Girl: (still sitting on the swing)
Older Girl: But the moment you speak to them in Filipino they don’t understand a single word you’re saying.
Younger Girl: (kicks feet off the ground and starts swinging)
Older Girl: (annoyed at being ignored by Younger Girl) Stop swinging!!!
Younger Girl: This is a swing. You’re supposed to swing.
Older Girl: (embarrassed to silence)


#3 (On a street corner with an Ilongga customer buying corn from a Tagalog vendor)

Ilongga: (points to steaming corn)
Tagalog: Ilan?
Ilongga: Isa
Tagalog: (wordlessly wraps the corn in a plastic bag then adding a packet of salt)
Ilongga: Tagpila?
Tagalog: (stares blankly)
Ilongga: (points to coins in the palm of her hand)
Tagalog: Sais
Ilongga: (pays the vendor and wordlessly walks away)

the end

And the hell week has just come to an end.

I just finished my last exam for the finals week. After my denial phase the whole week ("Hindi ako magre-removals") reality just set in. There's this funny feeling in the pit of my stomach that tells me I will probably be having a second helping of the COMBO MEAL, this time the removals version. Oh well, just as long as it's just the COMBO MEAL (or part of it). I don't want to have any SIDE DISHES or DESSERTS to go with it (read: exams in subjects other than Pedia and Internal Medicine).

WAIT! I don't want to be thinking about exams right now. Who does? I have the whole week next week to agonize about it. I'm gonna get out of my white uniform, get dressed and step out to have a night of fun.

See you around :)

combo meal: "hindi ako mag-reremovals"

The second helping of what we like to call the exam COMBO MEAL will be served tomorrow. For the third year students, Pedia and Internal Medicine (the components of the COMBO MEAL) are the subjects that have a high mortality rate, that is, they have the greatest number of students who take the removals and fail the subject.

“Hindi ako mag-reremovals” has been my mantra for the whole week and tomorrow’s exam in Internal Medicine will test the power of my silly compulsion.

We often joke that this week is actually just the pre-finals week and next week’s removal exams are really the finals. In a way, we’re not really studying for the finals, we’re studying for the removals. Of course, I would like to believe this is untrue.

I am currently agonizing over failing grades in Cardiology (and here I am wanting to be a cardiologist). I initially wanted to be a pathologist, but my less than desirable grades/class standing immediately made me reconsider.

What to be? What to be?
A while back I answered a Medical Specialty Aptitude Test by the University of Virginia Health System to determine what specialization I was best suited for. The results were surprising:

Ranked 1st on the list of specialties was Allergy and Immunology, which I actually abhor not necessarily because I have a lot of allergies myself, but I hate having to remember immunoglobulins, hypersensitivity reactions, and also the blood components and cytokines involved in the immune response.

Number 2 on the list was Emergency Medicine. Go figure. I suppose it has something to do with my ability to remain calm and appear unperturbed at all times.

Although general internal medicine is ranked 4th on the list, cardiology is way below at no. 13. Another initial interest, Infectious Disease, is at number 10.

There are however a few things I’m sure are not amiss: Surgery is at number 30 and oncology is 34. Although I never thought that family practice would not be suitable for me it appears so as it is at the very bottom of the list at number 36. Again, go figure.

just do it

Just because I was reminded of it.
Just because it makes me feel good.

When you run, fear can't catch you
When you jump, doubt falls behind
When you play, the voice you hear is your own
And the more you listen, the more you feel free

No, I didn't write that. I have no idea who did. I think it was from a Nike ad, but I can't be too sure. I'm not even sure about the wording.

this is it

Huling hirit na.

FINALS EXAM SCHED:

Monday
7:30 - 10:30 Pathologic Obstetrics
11:00 - 2:00 Psychiatry
2:30 - 5:30 Dermatology

Tuesday
7:30 - 10:30 Clinical Therapuetics
11:00 - 2:00 Surgery
2:30 - 5:30 Neurology

Wednesday

7:30 - 10:30 Pediatrics
2:30 - 5:30 Community and Family Medicine

Thursday
7:30 - 10:30 Gynecology
2:30 - 5:30 Legal Medicine

Friday
7:30 - 10:30 Internal Medicine

Saturday
7:30 - 10:30 Otorhinolaryngology-Head and Neck Surgery (exempted!)
11:00 - 2:00 Applied Nutrition (had the exam last week)
2:30 - 5:30 Rehab Medicine

pox

I am currently reading The Demon in the Freezer by Richard Preston (author of Ebola outbreak taleThe Hot Zone and bioterrorism novelThe Cobra Event). In his recent book he leaves his tales of Ebola behind and tackles the trials and triumphs in the eradication of the devastating smallpox virus.

The writing in this book is what I would like to call terse and simple to the point of being barok. Preston shies away from any complicated descriptions and medical/microbiological jargon even explaining what a swab kit is and how to pronounce certain words and names (USAMRIID, United States Army Medical Research Institute of Infectious Disease is pronounced “you-sam-rid”, and epidemiologist Dr. Werhle’s name sounds like whirly). Although it has been a while since I’ve read The Hot Zone I would say that the storytelling is entirely different. Preston opts to be more factual and descriptive in his writing rather than creating a sensational narration. I have yet to finish reading a third of the book so my opinion is still subject to change.

I was initially struck by Preston’s description of smallpox or the variola virus.

“Experts in pox find the pox virion mathematical in its structure and breathtakingly beautiful.”

The pox is a large and complex virus with about 200 proteins. In contrast, the HIV has only 10 proteins and has a simpler natural design.

“HIV is a bicycle, while smallpox is a Cadillac loaded with tail fins and every option in the book.”

While it is difficult to picture out at first how small the pox virus is, electron micrographs and Woodstock music festival analogies more than suffice to enlighten the reader.

Having been published in 2002, Preston chose to start with the 2001 anthrax scare in which anthrax spores were mailed to offices of Senator Tom Daschle, NBC, CBS, ABC, American Media and New York Post. It is remarkable to note that until now that anthrax case is yet to be resolved.


[I’m reading a non-school related book on a weekday before the finals just because it keeps me sane. Then again, maybe I’m just procrastinating and using this reading activity as a delaying tactic before moving on to more serious reading. Yep, that must be it.]

no worries

STOP WORRYING, START STUDYING

That was exactly what I blurted out in irritation when a friend of mine started to have a perpetual scowl plastered on her face, growing fidgety and anxious by the minute. It seems to be the solution to everyone's most pressing problem right now. Our finals is in a week. It's "make or break" time. I have never been one to be overly worked out about exams. Which is probably not such a good thing since not being anxious about it makes me way too relaxed that I don't get much studying done. Add to it the fact that end that I don't care much what happens.

So you see, I've got the first part of the solution down pat. If only I could work harder on the second part everything would be just fine.

pedia

It is past 3 already. I am finally printing my Pediatric Clinical History to be discussed and submitted first thing in the morning. I understand that it is my fault that I finished this late (or more appropriately this early) since I started working on it very late last night. But tell me, who takes almost 5 hours to write a four-page Pediatric history? For that matter, who takes 2 hours to take a history from a very cooperative and reliable mother and almost another hour to do a complete physical exam of a very cooperative 7-year old child? Let’s face it, child health is definitely not for me.

On with the show.

can you take a hint?

Happy MARCH!!!

We just had the final presentation in defense of our project for Community and Family Medicine. With all the time spent and effort expended the three panelists who reviewed our project still saw many areas for improvement. If I chose to dwell on the undesirable comments I would be immensely disappointed. So I have now decided to focus on the fact that we were complimented by two of the panelists regarding the Situational Analysis/Research and Methodology done for the project. We were even encouraged to write a formal research based on the situational analysis we did. I take that as a pat on our collective backs.

Once again, this leads me to question my chosen profession. It has become increasingly evident that I have an aptitude for research. I am not implying that my research skills or capabilities are better then the next medical student. I am, however, concluding that the skills inherent to me make it easier for me to do research. This is in comparison to the application of my skills to do other things such as managing a program/project, clinical practice or even teaching. I will never be the most effective speaker, most efficient manager or a highly skilled clinician. I, however, am confident that I can be a fairly competent researcher.

All this reminds me of my Dad’s most recent email. From the start he had no misgivings about my desire to enter medical school. He has never even implied or hinted at a different profession that he preferred. On my part I have never mentioned that I was also considering doing medical/health-related research. As I overcome another hurdle in med school and approach clerkship I am inclined to think that in his email he was actually starting to hint at his preference.

"The hospital duty will be interesting. It is the time to find out in reality whether being a doctor and doing good and healing people (with both the nasty and the good things that comes along with dealing with sick people) is your calling, or whether medical research is your preference. "

To his credit, my Dad has always been very diplomatic about everything. In this particular email he has made the effort to append the following remark:

"Enjoy whichever direction you want to pursue."

This cannot always be said about parents and other family members.


These are just my thoughts for the day.