tales from the fire exit

and so i've . . .

2007-07-16T16:37:00.000+08:00

Moved to a different fire exit. One with an entirely different view :)

good friday

2007-03-02T18:50:00.000+08:00

It has been a very good Friday.

I fell into a deep slumber last night, tired after the day’s activities. Post-call, but with no admissions, I woke up refreshed and hopeful for the day to come. Now, as the day comes to a close, I couldn’t be more satisfied with what has come to pass.

Today, I am grateful for compliant patients who come back for follow-up, who take their medications as directed and follow doctor’s advice.

I had a patient with Pulmonary Tuberculosis who has been religiously taking her multi-drug therapy. She came back for follow-up after having been diagnosed with pneumonia, now much improved yet still taking her medication and following her doctor’s advice.

Today, I feel very grateful for the people I work with. I am grateful for excellent professors. I am very grateful for doctors/residents who are blessed with a good clinical eye, who have had years of experience handling a varied mix of ailing patients and yet retain that air of wonder every time a new patient enters the clinic.

I am grateful for residents who respect their clerks/interns, who share their knowledge and experience, and impart the proper values and attitude by example. They have my utmost respect and deserve the same from their patients and colleagues.

Today, I was humbled by my patients.

Today, I was a good would-be-doctor.

Pahabol:

Today, I had a classic case of Benign Paroxysmal Positional Vertigo or BPPV. I knew the right questions to ask for my history and the right examination to do - which obviously led me to the diagnosis. I’m glad. I’ll get to the drugs soon enough.

"special"

2007-02-27T19:50:00.000+08:00

I have been feeling tired lately. It’s like I’m never well-rested after a night’s sleep. I have already cut my caffeine intake and have been eating well but I still feel the same. I feel old. Maybe it has something to do with finally graduating from Medicine in a month and half’s time. More pointedly, I suppose it has something to do with being another year older at the same time.

I am twenty-six years old and I already feel old. My co-clerk who sits beside me during lectures is at least 14 years older than I am and although he complains of always feeling tired he seems to be doing better than I am.

I am twenty-six years old and already my mortality is haunting me. I suppose it doesn’t help that when I used to be obsessed about death and dying I believed I would probably be dead by the age of thirty-five. Some days I like to believe that my inactivity is making me feel tired. On other days, reality hits me and I understand that laziness rather than inactivity is the problem. I have become complacent.

Every day I sit in class and observe that I’m the only one who even bothers to read my Family Medicine manual. I sit in class as we wait for professors and I use the time to read a little on the most recent outpatient case I have handled. I take this extra effort to do better and yet I feel more stupid than I have ever felt before. I will be graduating with a degree of Doctor of Medicine in a month and a half. Although this doesn’t give me the license to be smug about this small triumph I should at least feel good that I have attained something. Yet all I feel is insurmountable stupidity all because I have become complacent. I have not achieved what I should have. I should have been so much better all because I know I could have been.

Yes, I need something to pick me up before I actually fall down.

* * *

When I was driving home, I just thought of the word “special” . . . I was very grateful to have heard it again. Because we all forget sometimes. And I think everyone is special in their own way.

- The Perks of Being a Wallflower
Stephen Chbosky

february

2007-02-01T23:35:00.000+08:00

It is the first of February. I am feeling a little sullen, nostalgic as always for the rotation when vast amounts of time were not at hand and feeling bored is not an option with the amount of work to do. I have been irritable of late, feeling a little too unappreciated and taken advantage of. People I have learned to care for make me shake my head in regret for the helping hand I have extended. Some people need helping, others just need the attention. Whatever advice or aid that can be given is wasted.

It is the first of February. I am listening to a Lonely Planet podcast on road trips, the closest I can get to traveling at this time. In April I am planning to whisk myself off to Iloilo to attend my best friend’s graduation than hopefully hop on to Cebu or Bohol. As always, the things that are holding me back are money and going around to asking permission from family.

It is the first of February. As much as I gave a sigh of relief on the last day of my last toxic rotation yesterday I flounder at the thought of having nothing to do. I anxiously fidget as the end of clinical clerkship approaches and fear the great changes that will once again take place.

It is the first of February. Already I am missing the good times.

holiday cheer

2006-12-27T19:23:00.001+08:00

I was on duty on Christmas Eve. What should’ve been a much needed time with family turned out to be a slow night on OB duty. Noche Buena was cold Chicken McNuggets meal. Not that it would’ve been much different if I weren’t on duty. I stocked up for a lonely Christmas with whole wheat cereal and a liter of non-fat milk only.

As Christmas day approached I chose to isolate myself in the empty labor room and sleep. I would’ve slept until morning if I hadn’t been awakened by a resident who was looking for drinking buddies. I wasn’t really up to it, nor were my other co-interns. So wiping sleep from my eyes, I downed a couple of glasses of white wine (the bottle of Tequila had been emptied earlier) as the already drunk residents called every contact listed in their mobile phones and greeted each with a slurred “Merry, merry Christmas”.

I got home from the hospital around lunch on Christmas day and went straight to bed. I woke up minutes later too lazy to get up or go out. I ended up watching old ER episodes the whole afternoon.

The streets were almost empty the day after Christmas, the distance between cars measured in kilometers instead of the usual fraction of a meter. All I could say was, “it’s just another day on duty”.

my december

2006-12-23T19:06:00.000+08:00

December, thus far, has turned out to be a month of revelations and realizations.

No. 1: After delaying the inevitable I found myself face to face with a new mother’s genitalia applying gentle traction on an umbilical cord to deliver the placenta. A few days later I found myself delivering an actual baby, clamping and cutting the umbilical cord, taking out the placenta, then proceeding to sew up the incision made to widen the birth canal. Hurrah, hurrah! Baby out. No, I’m not going to take Obstetrics and Gynecology for my residency but surprises of surprises I enjoyed very much assisting in delivering of babies via Cesarean section and other surgeries (tubal ligation, hysterectomy, salphingo-oophorectomy, etc). In my sleep I still hear myself coaching would-be mothers in labor: “Mommy, kapag humilab, hinga ng malalim, kapit sa bakal, ire!”

No. 2: Two weeks ago I was awakened by a phone call from my grandmother relaying that my Dad was to arrive in a few days. The next thing I know I got an email from my Dad (after months of silence) confirming his flight details. Our meeting after 11 years would be under unexpected circumstances. His brother had suffered a nervous breakdown and he had the responsibility of accompanying him home to the Philippines to have him admitted to a hospital. It was going to be a very short visit, he was to arrive early morning one day and leave in the evening the next day. Imagine my anxiety over meeting him. Eleven years is a long time. But then surprise! His brother would not board the plane. As it turned out I got anxious over nothing. I think it’s going to be some time before I lose sleep about meeting him again.

No. 3: After years of not seeing close friends and officemates, they finally got a chance to take a break from their graduate studies abroad and come home. We were a motley crew when we met. When I took a step back to take it all in an almost painful reality of where I stood struck me. If I would write a caption for the picture we took of ourselves it would go like this:

Cor: From Switzerland

Mic: From Washington

Cat: From Thailand

Me: From DUTY!

In the pictures I was still in my white uniform, curly hair on end, with bags under my eyes. It’s a good thing, I’m still enjoying my clerkship or I would feel really bad about myself.

No. 4: A couple of weeks after my interview in a hospital for my post-graduate internship I found out that I didn’t get accepted to my hospital of choice. For a moment there I felt so second rate. Then I figured, what the hell! If it was really not for me I’m not going to waste my time and energy crying over it. So it’s hello DOH for me instead. I get to rotate in the following hospitals for my post-grad internship next year: East Avenue Medical Center, National Kidney and Transplant Institute, Lung Center, Heart Center and Philippine Children’s Medical Center.

No. 5: After talking with an old friend she spills the beans about an old classmate who has finally outed himself to his friends and family. Yup, he’s bisexual alright. This was the guy who treated me like a girlfriend substitute after he got turned down by another friend. This was the guy who used to call me every night back in college. We used to play table tennis after class and tennis on Saturdays. Then finally when he was miles away in New York he revealed that he actually liked me. We chatted online once in a while, then when he jokingly popped the question I turned him down in the same tone citing my dislike for long distance relationships. That was not me being mean, because true enough I had just gotten broken by a previous (semi) long distance relationship and swore I’d never enter one again. Hmm . . . it’s just that I never would have guessed. I guess you really never know.

Christmas day is just two days away. The cold air is making me brood over my loneliness again.

surgery nostalgia

2006-11-29T21:59:00.000+08:00

After rotating in five different hospitals for Surgery I have to say that I am going to miss the action at the Emergency Room, all the bleeding and gaping wounds to be sutured, fractures to be reduced, and burns to debride and dress. (No, I'm not going to miss retracting body parts in the OR). This is me saying goodbye to all the operating rooms that look like tiny closets to ones in big hospitals that look like spaceships.

Tomorrow is my last duty. It better be good.

(And then it’s hello to the delivery room for OB)

commute

2006-11-14T20:57:00.000+08:00

Sa kahabaan ng España

On my way to the hospital in Tondo for my surgical rotation I am barely bothered that I’m already late. Time in is at 7 am. It is almost 8 and I’m barely halfway there. I look up from the book I’m calmly reading and notice for the first time that the bus is packed, both men and women standing in the aisle, holding on to chairs and metal bars lest they be thrown off balance as the bus careens almost aimlessly despite the heavy traffic. I have always wondered how all these commuters handle their hour-long commute to and from work/school/wherever. I have always lived in a dormitory or apartment very near school or my place of work. The longest jeepney ride I’ve had to endure to go to school lasted 45 minutes only because at that time I was already running late and caught in rush hour traffic. On the good days, it only took 10 minutes to get to school. On the not so good days when I’m running late I would often choose to take the 20-minute walk to school if the weather permitted. It was always just a few minutes walk or a short jeepney ride to school/work. It is only when I’m on outside rotation in government hospitals that the daily plight of the commuter shock me into reality.

I cannot imagine wading through floods during the rainy season. I cannot imagine not having an end to the street’s madness. I at a least have something to look forward to. I am out of the hospital base for a month at most at any one time. There is always an end to the madness. There is always time to recuperate (far from the maddening crowd) before I am thrown off balance again.

But not these people. No these commuters whose hour-long commute is nothing but run-of-the mill.

I have much to learn in this life.

surgery

2006-11-04T21:48:00.000+08:00

Surgery was never one of my strengths. Imagine the dread I felt on the first day of rotation in a government hospital near a slum area known for high crime rates (read: lots of stab wounds, mauling, gunshot wounds).

The first day fell on a holiday, so the hospital was working on a skeletal staff and only the staff on 24-hour duty were required to report. The number of patients I saw in the ER and the ward was overwhelming. I had barely warmed a chair with my backside during morning endorsements when I was called to assist in an emergency appendectomy.

Of course, there’s that peculiar practice in some hospitals of having junior interns like me pushing fluids and IV medications aside from doing IV catheter insertions, blood extractions and dressing of wounds in the ward. You barely finish with one surgical wing, when you hear yourself being paged to hurry on to the next wing. And when you think you’ve just about had it working in the ward, you get called down to the ER to help de-bulk the increasing number of patients coming in. So you proceed to take the history and P.E. of incoming patients, insert IV catheters to bleeding patients with collapsed veins barely there, insert nasogastric tubes and urinary catheters to drunks who proceed to pulling said tubes/catheters as soon as you turn your back. In the wee hours of the morning you end up suturing the wounds of said drunk patients on whom anesthesia do not work so they squirm and holler in pain with every stitch you make.

It is not enough to be on 24-hour duty, you have to endure the burden of ward work again the the next day – so that all in all you are awake for at least 36 hours, with not even a wink of sleep, literally. After my first duty I had the audacity to invite a friend over to my place for dinner. Poor friend had to endure my inability to make conversation as I head-bobbed my way through the meal. I would eat one spoonful and halfway through chewing the mouthful I’d doze off. At the end of the meal I had to be awakened and told to go to bed. Poor friend had to do the cleaning up after the meal. As soon as my head hit the pillow I was off to dreamland.

I can’t wait until this week is over.

call me stupid m.d.

2006-10-01T14:29:00.000+08:00

Here I am again on the first of the month, starting a new rotation and hopelessly sad about leaving the last one. This is me moping over leaving my Pediatrics/Child Health rotation where I've learned so much and enjoyed myself the most. Yes, this is coming from the same person who cannot find enough patience to deal with children and who hates Pediatrics as a specialty. Well, what do you know? When the department is good,and when the people there are nice, some objectivity does get through all the personal biases.

And to think that this is one of the rotations I dreaded the most. Call me stupid, but right now I'm eating all my words.

not

2006-09-12T17:38:00.000+08:00

For my Pediatrics rotation, I have already spent 5 weeks looking up running noses, looking down sore throats, willing crying children to stop so I could hear their breath sounds or heart sounds better. I have watched over dengue patients as they received repeated blood transfusions, as their rashes spread, and as they approach near shock. Last week, I watched as mothers with complicated pregnancies gave birth to babies who needed to be treated as soon as they were born. I watched as one mother cried as she left her sick baby behind in the nursery. I watched as a first time mom sang to her premature baby as tears run down her face. Her baby lay spread-eagled inside an incubator as a breathing tube ran down her throat.

One moment I think I hate children and that I’ll probably never have children of my own, then I carry a crying 2-day old baby and watch as she falls asleep in my arms and anything becomes possible.

Today, in early morning rounds, the hospital director tells me that I am exactly what a clerk should not be. It is surprising that quite scathing remarks barely made a dent in my system. I suppose I was expecting to be called stupid, or worse, an idiot. The post-graduate interns with me were not much better off.

Exactly what a clerk should not be *Sigh*

communication

2006-08-30T21:31:00.000+08:00

So I’m sifting through dozens of mp3s of songs I’ve never heard before but I just might like. I feel so detached from the real world of today, sitting in the near-dark, gaining comfort from the knowledge that I am alone.

And so I have a new laptop, and so I have a new mobile phone, and so I have a new landline, and so I have these news things to make communication easier but I still have no one to write to, no one to send messages, no one to call.

Sometimes I think I make my life miserable on purpose.

self-worth

2006-08-23T18:43:00.000+08:00

You sit in the dark one day wondering where your life has gone. It is not the first time you think about this. The other day your eyes were swollen from crying the whole night after having another argument with the significant other. It makes you wonder about the life you really want to live.

Today, the slightly irritating and stand-offish parents of the patient who kept you awake while monitoring her vital signs at bedside the night before takes your picture and starts talking about this brother who is an AVP in some car company. They ask your age. They ask if you will still be in the hospital later in the evening when the brother is going to drop by to visit. Instead of being thrilled that there is still someone who thinks you are good dating material you are left wondering if this is the best that life can offer.

Two weeks ago, on your first duty on outside rotation the resident on duty blurts out that you should try getting rid of your eyeglasses and getting contact lenses instead. She adds, “because you have a very pretty face.” You just smile and think “this pretty face hasn’t gotten me anywhere so far”. A few days after, a sleep-deprived from duty intern (also a girl) asks if you have a boyfriend. You answer “no”. She is surprised. “How come,” she asks, “when you are so beautiful?” The world spins a little, and you think maybe life is worth living. Later, the guy who likes you who you just dumped drops by and stays until around lunch time. You talk about nothing, guiltily wishing he would go away but unable to shoo him away because maybe he’s really staying for his other close friend, the one who you go on duty with, and the one he hasn’t seen in a while. And you wish so much for him to leave you alone, but deep inside you know some time ago you appreciated his gestures because for once you learned that you’re worth running after, that you’re worth all the attention he gave you.

Life’s a bitch. I bleed.

life, so far 2

2006-07-13T10:27:00.000+08:00

Today I woke up at 5:30, made myself a cup of coffee and a bowl of oatmeal before proceeding to iron the white uniform I was supposed to wear for the day. A few minutes later I receive an SMS saying that due to the bad weather the hospital would be running on a “skeletal” staff and only the staff on 24-hours duty would be required to come. Well, so much for waking up early. I won’t be going on duty until Saturday. I hate being on duty on weekends. For my rotation this month I get weekends off so it’s really a bummer when my duty falls on a weekend.

Last month’s rotation was in Psychiatry. Imagine my surprise the first day I went to the National Center for Mental Health (aka Mental Hospital). I’m a fool to think that NCMH was just this one big building and that there couldn’t be so many patients at all. Well, NCMH is a big compound with an ER, Outpatient Service, and dozens more pavilions catering to specific patients/mental illnesses. The only good thing I had going for me before I went on rotation was that I believed that there was more to Psychiatry then depressed rich people paying lots of money for 50-minute hours reclining on those weird-looking chairs waiting to be told that they were making progress and given refills of Prozac or Zoloft.

Before starting on my Psychiatry rotation I had planned to brush up my knowledge with pop cultures take on the field. I had planned to watch Girl, Interrupted, read One Flew Over the Cuckoo’s Nest and similar shit. I’m on my next rotation already and I haven’t even read or seen anything yet. I think it’s safe to say that I’m not making as much progress as I hope to make during my junior internship. I’m still way, way behind.

I start my 8 weeks of pediatric rotation next month. It’s the peak season. Cold weather and rains are probably a pediatrician’s best friends. I’m afraid I can’t say the same for mothers and their sick children. To be honest, I’m beginning to be a little scared. Kids are great, but unlike my sister who is doing a great job teaching grade school and motivating the utterly hopeless, and my brother who is everyone’s kuya, I have absolutely no talent dealing with kids. I’m just way too serious to kid with kids. I would not put it past me to treat a seven year old like an adult.

But I’m getting ahead of myself. I have another 2 weeks and some to prepare myself. I just hope I start with inside rotation and not get thrown out for outside rotation in a public hospital to deal with screaming children before I know what I really need to know.

Well, that's my life, so far.

life, so far

2006-04-13T21:47:00.000+08:00

My two week-rotation in the male service ward of Internal Medicine is almost over. I am at a loss for descriptions to encapsulate the innumerable embarassments and foolishness that I have done in so short a time. And while some doctors, patients, patient's relatives, nurses, aides, etc. trample upon my dignity from time to time there are moments of pure ecstasy that makes being a junior medical intern (aka slave-on-duty) worth it. The 24-hour duty plus the next day's 8 hours can be hell on my feet and monitoring vital signs every fifteen minutes does get tiresome but one does get used to it. As they say, what doesn't kill me makes me stronger. So, each morning I wake up with a roar . . . then I try to get out of bed and feel every single muscle aching.

Such is life.

day 1

2006-04-01T13:00:00.000+08:00

First day as a junior intern: decking. male ward. female ward. pay patients. endorsements. grand rounds. staff rounds. case discussions. labs. history. P.E. SOAPing. monitoring RR, HR, BP, temp. q1, q2, q4. Ambubagging. CPR. extraction. IV insertion. catheterization. pre-duty. from duty. duty. forms. forms. forms. and more forms.

There's only one word to describe everything: OVERWHELMING.

Tomorrow, it gets worse: FIRST 24-HOUR DUTY

clerkship

2006-03-30T21:40:00.000+08:00

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

2006-03-27T19:49:00.000+08:00

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

2006-03-24T13:05:00.000+08:00

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

2006-03-22T20:59:00.000+08:00

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

2006-03-22T14:24:00.000+08:00

#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

2006-03-18T18:05:00.000+08:00

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"

2006-03-16T08:21:00.000+08:00

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

2006-03-13T18:44:00.000+08:00

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

2006-03-13T18:34:00.000+08:00

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

2006-03-07T19:59:00.000+08:00

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

2006-03-06T04:19:00.000+08:00

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

2006-03-03T03:07:00.000+08:00

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?

2006-03-01T18:09:00.000+08:00

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.

Links

2006-02-28T22:42:00.001+08:00

>> New Scientist has launched its very own blog. Short Sharp Science contains a "daily round-up of science news" served in bite-sized chunks that go down easy.

>> I can't believe I missed this before: Potential Ebola Vaccine passes first human tests

>> DNA can reveal a person's last name: Turi King and her team discovered that in 20% of cases they could predict a man’s surname by matching his DNA with that of another man with the same last name. "This discovery means that forensic scientists may eventually be able to use DNA to help determine the identity of a suspect, or at least narrow a search down to a few pages in a phone book."

what's going on in pisay?

2006-02-26T12:35:00.000+08:00

High school will always be high school, but the recent turn of events in my alma mater is not something I'm particulary proud of. It has gone too far already.

I do remember the innumerable stupid things I did back in high school. I remember being late for curfew. I remember that as a dormer I went out of campus several times without a gatepass. I remember strolling around the campus with friends whose idea of fun was throwing stones at street lamps and seeing who could bust the most bulbs. I remember friends who sought thrills by lying down in the middle of Agham road. I remember the incident where the F-word was spray painted on one of the classroom blackboards. I remember the time when the dormers from the Boys Residence Hall smeared feces all over the dorm manager's room. Yet, in all these I have to agree with what Ina has to say, at least then "the only person you can kill is yourself".

getting some zzz's

2006-02-21T21:53:00.000+08:00

1:30 p.m. right after lunch break, having taken an antihistamine for my allergic rhinitis I was close to falling asleep. I kept taking notes only to find out later on that my handwriting was not legible at all. It's not even funny. I was pinching myself, trying hard not to fall asleep as my professor discussed sleep disorders. I kid you not. I almost couldn't tell whether I was dreaming about sleep apnea or my professor was lecturing on it.

2006-02-20T20:46:00.000+08:00

The first letter I saw when I checked my email this afternoon came from my grandmother. I didn't even have to open it to know what it was all about. The subject gave it all away: My sister is dead.

She didn't even try to put it nicely. I suppose with death there really is no way of breaking the news gently.

Here's to remembering being read bible stories when I was a little girl and hearing my grandmother pray the rosary in Spanish. Here's to a long life of having loved and cared for family and being loved and cared for in return. I'm sure she is in an even better place today.

caffeine nap

2006-02-19T17:09:00.000+08:00

Achieve-IT! blogs:

Sleep researchers at the Loughborough University in Britain did several tests on fatigued drivers to compare the effects of different methods a driver can use to stay awake . . . What researchers found worked the best was a caffeine nap.

The Caffeine Nap is simple. You drink a cup of coffee and immediately take a 15 minute nap. Researchers found coffee helps clear your system of adenosine, a chemical which makes you sleepy. So in testing, the combination of a cup of coffee with an immediate nap chaser provided the most alertness for the longest period of time. The recommendation was to nap only 15 minutes, no more or less and you must sleep immediately after the coffee.

Hmmm, so that's what it's called. I've been taking caffeine naps without my actually knowing it. I do, however, have a tendency to prolong the duration of the nap. I suppose that's the reason why it doesn't work for me all the time :)

sa wakas

2006-02-16T20:22:00.000+08:00

Finally through with midterm exams.

The exam for Applied Nutrition went well enough but I was rather upset about the last 15 items of enumeration and identification. I'm glad I the the computations, because as with the prelim exam, the computations (done correctly) are the only ones I can count on.

The second exam, Legal Medicine, wasn't so good to me. While I did get questions 2 and 3 (legal definition of rape and quantities of prohibited drugs that warrant a penalty or lifetime imprisonment or death and a fine ranging from P50,000 to P10,000,000) I wasn't able to enumerate and define all the personality disorders for the first question. Not that I didn't know what the personality disorders are or how to differentiate them. It was just that our professor specified that our definitions should be based entirely on his book. So you see, the recent lecture in Psychiatry about personality disorders was of no help at all. After the exam, we finished the day by discussing firearm wounds (how very interesting?!). Next week's quiz/recitation will be on impotence and sterility and medicolegal investigation of wounds. I promise to read his hand-out at least twice this time. I definitely need a better grade for the subject.

midterms pa rin

2006-02-13T10:57:00.000+08:00

There is nothing much to write about especially after my post about 37-pound woman with osteogenesis imperfecta giving birth to a 3-lbs 7-oz baby got lost in cyberspace. Today is officially the last day of our midterms although I do have 2 other exams which were rescheduled for Thursday. As such, the studying and the toxicity continues. This is how it has been for the past few days:

Thursday
A break from the exams (no scheduled exams for today, but of course the studying continues)
>> Level of Toxicity: 4 cups of coffee + 2 colas

Friday
Internal Medicine 7:30 - 10:30
>> Level of Toxicity: 4 cups of coffee + 1 cola

Saturday
Otorhinolaryngology, Head and Neck Surgery 7:30 - 10:30
>> Level of Toxicity: 3 cups of coffee + 1 cup of tea

Sunday
>> Level of Toxicity: 3 cups of coffee + 1 cola

Monday
Gynecology 7:30 - 10:30
Rehab Med 2:30 - 5:30
>> Level of Toxicity: 4 cups of coffee . . . so far

[And yes, I'm blogging just a few hours before an exam. I really just want all this to end.]

rant

2006-02-09T18:15:00.000+08:00

It is the second time this week that I’ve been stood up for a study session. When you have absolutely no life, going out to meet friends to study is a big deal. It’s practically the highlight of the week.

I'm pissed. Life sucks. To compensate for my sorry state I ended up buying a roll of film and looking for postcards to send to people I don't know.

Back to studying.

phdcomics

2006-02-09T13:39:00.000+08:00

Piled Higher and Deeper

I’m not exactly taking a PhD (I would have if I wasn’t taking Medicine) but I still think this comic strip is cool and funny. My friends in grad school think so, too. As well they should if they have a sense of humor. It pokes fun on their daily trials and tribulations, and the frustration that research and the academe invariably bring about. In short, it practically depicts their life.

Does anyone out there know of a nice comic strip about medical students and doctors? Please, please do tell me about it. I really would love to check it out. Thanks.

[If you’re wondering how I find the time to surf the net and blog in the middle of midterms, there’s only one word to explain it all – PROCRASTINATION. Okay, okay. Enough of it. Back to studying.]

Oh, I almost forgot. Here’s another interesting and informative blog I’ve happened upon: Aetiology. Blogger Tara C. Smith is an Assistant Professor of Epidemiology at University of Iowa and is also the Deputy Director of the university's Center for Emerging Infectious Diseases.

midweek midterm madness

2006-02-08T20:25:00.000+08:00

My present state is such that if I close my eyes even for a few seconds I fall asleep. Imagine my paranoia when taking exams. I can't even close my eyes to try and search the recesses of my brain for the answer to a hemorrhage-inducing difficult question. Stretch the paranoia a bit more and understand that with too little sleep I am afraid that when I do get to sleep I won't wake up in time to take my exams. I have reached a point where I am setting two alarm clocks to wake me up in the morning and it is still not that effective since I always hit the snooze button. Yesterday I was awakened by the phone ringing and found out that I was holding one alarm clock as I slept. It seems that I had stood up to turn it off, and with it still in my hand, I had gone back to sleep.

My midterms sched:

MONDAY
Pathologic OB 7:30 - 10:30
Psychiatry 11:00 - 2:00
Dermatology 2:30 - 5:30
>> Level of toxicity: 4 cups of coffee + 2 glasses of cola

TUESDAY
Clinical Therapuetics 7:30 - 10:30
Surgery 11:00 - 2:00
Neurology 2:30 - 5:30
>> Level of toxicity: 3 cups of coffee + 2 glasses of cola

WEDNESDAY
Pediatrics 7:30 - 10:30
Community and Family Medicine 2:30 - 5:30
>> Level of toxicity: 3 cups of coffee + 1 cup of tea . . . so far.

The midterm exams go on until next week.

Kaya ko to!

midterms

2006-02-04T17:31:00.000+08:00

Last night until about 3 in the morning I was hanging out at McDonald’s along with a couple of friends determined to get some studying done. In one of our 10-minute breaks I couldn’t help but comment on how we deal with exams and our expectations for the results. As the years go by our standards seem to be going down. You can say that it takes less to make us happy (that is, lower scores) but really it’s just that exams are becoming immensely more difficult. Plus, there certainly is just too many things to remember.

To illustrate, here is a typical conversation after exam results are given:

As first year students:
Kumusta ang exam?
Ayos lang. Mataas naman ang nakuha ko.

As second year students:
Kumusta ang exam?
Pumasa naman. Ayos na rin kahit sabit lang. Babawi na lang ako sa susunod

As third year students:
Kumusta ang exam?
Syempre, bagsak. Buti na lang high failing. Sana makabawi pa sa susunod.

I suppose this is how it will be like next year:
Kumusta ang exam?
Anong exam?

may the force . . .

2006-01-31T22:39:00.001+08:00

It was almost midnight when I got ready to sleep. I had a report to finish but my head was already throbbing and I was too sleepy to care. I decided to have a few hours of sleep before continuing with work on my report. I was having difficulty in falling asleep at a relatively early hour and I found myself tossing and turning. It was while I was trying to still my thoughts when the scary “incident” happened.

There I was in bed, with all the lights switched off. My back was towards the wall next to my bed. I was looking at the wall on the far side trying to focus images without eyeglasses. It was when I thought I was seeing some strange shadows in one corner when I felt movement behind my back not too different from someone stepping on the mattress. I turned a little to see what was causing the mattress to move only to be met with an image of old “thing” looking over my shoulder. It was like I was looking Yoda in the face with its almost bald head and pointy ears. As with these kinds of occurrences I was paralyzed with fear and was unable to do anything but stare ahead. One, two, three seconds passed. I still couldn’t move. Eventually, I gathered enough strength to roll over in bed and see what was going on behind my back. Nothing.

If this occurred earlier in my life I would have attributed it to supernatural forces and other superstition. However, at this point I am hard-pressed to find a perfectly logical and scientific explanation. Right now the only thing I can think of are hypnagogic hallucinations.

There is a phenomenon in which a person may have visual or auditory hallucinations when going to sleep or upon waking up. A person may perceive someone speaking in a distance or have a perception of seeing objects that are not present. When these occur while a person is falling asleep the term used is hypnagogic hallucinations. If the same occurs upon waking it is called a hypnopompic hallucination.

These false visual or auditory perceptions are often associated with narcolepsy reflecting a disorder of REM sleep. However, many people without any disorders also experience these phenomena. Although often frightening, these may not be harmful at all.

Yes, at this point hypnagogic hallucinations is my best explanation. Although I wouldn’t mind thinking that it was actually Yoda come to dispense his words of wisdom, very much needed for a case discussion in Internal Medicine plus a report on dietary management of cardiovascular diseases.

May the force be with you.

work and play

2006-01-30T19:58:00.000+08:00

Next up for Family Medicine is another group's answer to stress and lack of extracurricular activities. The Work & Play activities opened today with a 2-hour session of ballroom dancing. It was well attended (enough) considering the late hours (4:30-6:30 pm) and hectic schedule of students, staff and faculty. I suppose it's too early to assess the success of the project. I believe the group will be having three more weeks with ballroom dancing on Mondays and Tae-Bo and aerobics on Thursdays. Exercise twice a week is still not enough but it's a start. So far, so good.

I leave you with a quote from Douglas Adams, author of the weirdly amusing The Hitchhiker's Guide to the Galaxy:

A common mistake that people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools.

de-buhos

2006-01-25T18:50:00.000+08:00

After rhinosinusitis last week and this week’s toothache disguised as a headache (too much chocolate is bad!) I find myself mentally and physicall drained and in much need of sleep. I have been using caffeine as a crutch, drinking 2 cups of coffee in my first waking hour and having a cola or another coffee around midmorning or lunch. I still manage to get some sleep at night since I refrain from drinking coffee late in the afternoon or the evening.

Onto school matters: Today’s exam in Pediatrics was canceled, which is a good thing. However, we will be having the exam tomorrow, a bad thing, considering I already have 2 other quizzes scheduled for tomorrow.

In the afternoon my classmates and I dropped by the Clinical Laboratory to have a few milliliters of blood extracted for Hepa B screening - another group’s project for Family Medicine. Everyday it’s Family Medicine day. It saddens me that although my group started early with our project’s implementation we are now two weeks behind based on the deadlines we ourselves set. I suppose it’s easier to downplay the importance of the subject and not pay much attention to it especially if we seem to be encountering a lot of problems. But I’d like to think it would’ve been better if we just worked on it immediately and finished it early. By postponing our implementation we are prolonging the duration of our problem, which is never a good thing.

It’s been raining intermittently all day. Every time I look out the window I am reminded of toilets, yung de-buhos (pour flush). That's exactly how the rain looks from inside a classroom.

frazzled

2006-01-24T21:29:00.000+08:00

"Frazzing. frantic, ineffective multitasking, typically with the delusion that you are getting a lot done."

Here I am - blogging, checking my email, arranging my lecture notes for an exam in Pediatrics AND reading an article in TIME magazine. Basically, I'm reading about the pitfalls of multitasking while multitasking.

I have previously read on New Scientist how emails and the internet at the office actually decrease productivity. These emails are a constant source of distraction, not allowing a person to focus on one task indefinitely. The problem with multitasking here is that the brain cannot easily move from one task to another. The brain requires a certain amount of time to be able to return to a previous task after a distraction. The more tasks a person is doing, the longer it takes for that person to be able to focus on a specific task.

The article from TIME just expounds on the matter by giving examples (Hollywood producer Jennifer Klein) and tips from "some of the most productive people on the planet" (Condoleezza Rice, Donald Trump, J. Craig Venter, etc). There are, however, still some successful people who still insist on doing one thing at a time.

Suze Orman is a businesswoman, author/columnist and TV personality. One would expect her to be a "master multitasker" yet she is the total opposite - unwilling to answer phones when she is working, unwilling to discuss anything else but the topic for her next speaking engagement. Her single-mindedness borders on obsessiveness. She explains:

"The people who multitask . . . do everything to mediocrity at best. While they are getting a lot done, they are getting it done in such an inefficient way that they usually have to do it again."

That last quote definitely hits home. For now, I don't think I need to read much more about this. However, I do believe it is about time I sign out, shut down my computer and focus on the most important task at hand: studying for my Pedia exams for tomorrow.

alay na buhay

2006-01-22T18:00:00.000+08:00

Last Friday, a group for Community and Family Medicine conducted a mass blood drive. All students from the Institute of Medicine were invited to donate blood and although I am unaware of the number of actual donors it is pretty obvious that the turn out was good. I, unfortunately, have yet to donate blood.

The first time I tried to donate blood two years ago I was deferred. No, not like a good half of my classmates who were deferred for being underweight or possibly anemic, I was deferred because I recently had an asthma attack. Not having my medications with me at the time of donation, the physician who examined me deemed it unwise to let me proceed with the blood extraction.

For yesterday’s blood donation let me just say that I deferred myself. I have just gotten over a week of rhinosinusitis and have been feeling light-headed and tired over having not enough sleep for the past couple of days. I do, however, look forward to the day I am finally allowed to give blood. I believe it’s a necessary learning experience for a would-be doctor like me besides being a much needed contribution to the hospital’s blood bank.

Yesterday, another group had a different activity. A symposium was held for medical and non-medical staff of the hospital. Speakers from National Kidney and Transplant Institute (NKTI) and Human Organ Preservation Effort (HOPE) talked about being organ donors.

There are two categories of organ donors, the non-living and the living. The living donors are further classified into living non-related and living related. The objective of the symposium was to increase awareness on organ donation programs, specifically the deceased or non-living organ donation. In the morning, the talk given to medical staff (clerks, post-grad interns and residents) touched on the need for referrals for organ donors and a lecture on maintenance of organ donors prior to retrieval of organs.

In the Philippines today, the top 3 organs transplanted are the liver, the kidneys and the cornea. The list of organs that can be donated include the eyes, heart, lungs, pancreas, bones and skin. The current program on organ donation still needs a lot of push. In the USA, the deceased organ donation program has already been maximized and they are now looking to improve organ donation from living donors. Spain also has a good program and they are even able to give incentives to donors, something we are unable to do.

As one doctor said, with the 5th leading cause of mortality being associated with trauma (vehicular accidents, etc.) and the 10th leading cause of mortality being renal failure, it is a wonder how the 5th leading cause cannot sustain the 10th leading cause.

I do believe that awareness about organ donation is important. Cultural and religious beliefs along with lack of knowledge about the need for organ donation are the main obstacles to the success of the program. With a 200-long waiting list for organ donors and only around 8 to 15 deceased organ donors a year it is evident that support from every medical institution is necessary.

Help someone to live. Be an organ donor. Check the back of your driver’s license and mark the box indicating that you would like to donate your organs after your death. Or better yet, get an organ donor card.

“Don’t take your organs to heaven . . .

Heaven knows we need them HERE.”

For more information call HOPE at 924-HOPE (924-4673)

Or contact
National Kidney and Transplant Institute
East Avenue, Quezon City, Philippines
Tel No: 924-3601 to 19 Local 2514
http://www.nkti.gov.ph

perspective

2006-01-15T13:13:00.000+08:00

This morning I found myself lying flat on my back on the cold, blank tiles of my living room trying to see things from a different perspective.

You know what, the view from below isn't always so bad.

mathematics

2006-01-12T16:24:00.000+08:00

She said:

"Medicine is dynamic. It changes every month, every week, every second. One plus one will not always be equal to two."

More of the pediatrician's mathematics

this and that

2006-01-11T17:44:00.000+08:00

On the Alumni Homecoming Celebrations:
Tomorrow, together with the celebration for the year’s alumni homecoming, special awards will be given for students earning the highest grades for each subject. It is with a feeling akin to regret that I acknowledge the fact that I am not one of the students receiving an award. Previously (as in a loooooong time ago), I have been included in the top 10 ranking students of my batch. Recent turn of events have seen me slip down the rankings unable to find a subject where I can inarguably be the best.

I remember once talking with a classmate reflecting on his class standing. He said that however good one is there is always seems to be someone way better. No matter what you do, there is someone who is always a step ahead of you. While this may sound discouraging, the reverse does make you feel a little better: that no matter how dumb one student is, there is always someone dumber.

My recent drop in class standing should drive me to work harder to excel. Unfortunately, I am the type of student who, for the most part of my schooling, is not very particular about grades. As long as I am satisfied with my progress, I am content to remain as just an above average student who studies enough and is unwilling to deprive herself of a life.

When I come to a realization that given my capabilities I cannot exceed what others have done I tend to be complacent and work only to get an acceptable grade. I understand, that the desirable reaction would be to strive to be better but I guess I just don’t see the point.

On last December’s preliminary exams:
I have done well (by my standards) for Obstetrics, Rehab Med, Clinical Therapeutics and Psychiatry. While still getting a good grade in Head and Neck Surgery, I am a bit disappointed it isn’t any higher. As for Gynecology, it is best to forget my grade and just study harder for the next exam :)

I have yet to receive results from other subjects but I do hope they are a little better. It would be really nice to get a good grade in Internal Medicine, especially in Cardiology.

eleanor rigby

2006-01-06T19:17:00.000+08:00

"Lonely lives are filled with ritual to ward off the void of evenings spent alone . . ."

Reading: Eleanor Rigby by Douglas Coupland
Lead characters Liz Dunn (36 years old, single, loner, just had two wisdom teeth extracted) and Jeremy (Liz’s long-lost son from a teen pregnancy, 20 years old, rehashing memories of foster families and reliving visions as his health spirals down from multiple sclerosis) seem as if they popped out from a Chuck Palahniuk novel (i.e. Invisible Monsters, Survivor, Fight Club). The story, however, is entirely Coupland’s.

I believe in what travelers say that the journey is more important then the destination. For most part in my reading the actual unraveling of the story is more important than the ending. A good ending is just a big fat bonus. But right now I can’t wait to find out how Coupland is going to tie everything together, or not.

sneeze

2006-01-05T19:45:00.000+08:00

When your brother who is particularly fond of you starts calling you a loser it’s a signal that it’s time to reassess your life. Whether he did so in jest or not is immaterial.

first pix

2006-01-01T18:05:00.000+08:00

[the sky on the first of january]

overseas call

2005-12-26T23:14:00.000+08:00

Una: This morning I was on the phone with my mother who was only starting to tell me about their recent trip to Hawaii. She says she eventually played the role of the group’s tourist guide identifying trees and fruits that the kids in the group never saw before. “Oh, that’s a papaya.” “That one’s a mango.”

While in Hawaii they had visited a botanical garden. Unfortunately, my brother was not even remotely impressed with the plant life saying, “They’re all just like the plants I see in Lola’s garden.” Well, so much for the learning experience.

Pangalawa: On the phone with my 19-year old brother the first thing he asks is what we had for Christmas. I told him we had a whole lechon. As soon as I mentioned the lechon he dropped the phone and complained to my mother “See, they had a whole lechon. We don’t even have any food here.” Returning to talk to me he relays that he only had a bacon and egg sandwich for Christmas. Adding insult to injury I gloated, “Oh, that’s not all we had. We also had ox tongue in tomato sauce, jamonado and macaroni salad. For dessert we had tiramisu and fruit salad.” Poor kid, always hoping to come home to the Philippines for Christmas. He did regain his composure a little as he later boasted about his new soccer ball and David Beckham soccer shoes.

Christmas. No matter how old we are, we’re all just kids on Christmas day.

scenes from the dinner table

2005-12-25T23:23:00.000+08:00

One: My uncle who is a priest is showing of his belly which, although still the size of a volleyball, is definitely smaller than when I saw it last. He has lost 30 pounds in a little over a month. The improved self-image and health is giving him an indescribable high. The other priests staying with him in the parish are also going on a diet and increasing their physical activity. One of the sisters was not so thrilled about it. “Ay naku, Father, hahabulin lang kayo lalo ng mga babae,” she complains. To which my witty uncle replies, “kaya nga po nagpapapayat, para maunahan sa pagtakbo ang mga humahabol.” He then relays an incidence when he was on a sick call recently. He was blessing the sick woman on her bed and the daughter was shaking her mother admonishing her to open her eyes. “Nanay, mulat!” the daughter says, “Mulat kayo at gwapo ang pari!” And of course this little tale of his has all of us laughing.

Two: As expected every time there is a family gathering talk eventually leads to my “non-existent” love life. As if being young and single is such a crime. If they only knew about the complicated mess I’m in. At my age, my grandmother points out, she already had four children. At my age, an aunt-in-law retorts, she has been with my uncle for eight years. Not to be left out, an aunt who is a doctor exclaims “Basta pag clerk ka na dapat may boyfriend ka na.” She pauses and looks knowingly at her husband seated beside her before adding, “para may magdadala ng pagkain sa iyo pag duty ka.” Peals of laughter.

Of course I was glad when the focus of attention shifted as another aunt-in-law shares a phone conversation she had with my sister. She had asked my sister if she had a boyfriend and my sister had no choice but to reply in the affirmative. Aunt-in-law was joking “Hindi siguro alam ng lola mo, ano?” To which I replied “Alam po niya, in denial lang.” More peals of laughter.

Three: Auntie doctor out of nowhere remembers her apo and her long letter to Santa. “Dear Santa, gusto ko po ng doll at saka damit at saka clip at saka . . . at saka . . . at saka . . . at saka . . .” And after what seems to be ten at saka’s the apo adds “at saka po pera pangbili ng mga gusto ko.” Kids, sheesh!

While on the topic of letters to Santa, aunt-in-law shares the root of his 9-year old son’s irritation. In his letter the son was asking Santa to give him a PSP. Aunt-in-law teasingly told his son that he should clarify what he meant by PSP. Son replies, “Santa knows what it is already”. “Okay,” aunt-in-law counters and to his son’s horror adds, “Santa will give you a Pack of Special Peanuts.”

Each day leading to Christmas Aunt-in-law keeps repeating to his son that he will be getting a Pack of Special Peanuts. To this the son can only shout out while almost in tears “No!!! I am not getting a Pack of Special Peanuts!” Come Christmas morning the son gives a sigh of relief after opening his presents and finding a shiny white PlayStation Portable.

this christmas feeling

2005-12-24T23:52:00.000+08:00

Christmas always surprises me. There are, of course, the wonderful surprises of gifts from generous friends and family that are entirely customary. What I find uplifting in a peculiar way are the greetings of holiday cheer from people I least expect to remember me.

While it is quite commonplace to receive greetings from vague acquaintances and long-forgotten friends during the holidays what is disconcerting is that during the holidays the greetings I do receive are usually from this group of people only and not from my close friends. No, it is not that I feel hurt or slighted by this. It’s pretty much understood that my close friends wish for my happiness and the health and prosperity of my family. A close friend does not need to thank me profusely for a favor. I know they appreciate the good deed done even if they don’t say anything. Yet sometimes I wonder, maybe by not voicing out our gratitude we are taking each other for granted.

There is always something in the air during Christmas that turns me into a reflecting, sentimental schmuck. It could be the cold air and the lights. Or it could be the fact that whatever time of day it is the atmosphere feels like a cold early dawn (or a quiet late evening), something which I have always associated with the right time for deep thought. You see, there is nothing better than an early morning walk to clear my mind and prime me for the day. Well, perhaps there is nothing better except for a long walk home in the late evening to reflect upon the day that has just gone.

Christmas always reminds me of those lucid nights of insomnia back in college when I would sit by the fire escape and watch as the world sleeps. On the good days I would remain in the fire escape waiting for the world to rise again. On the bad days I would lie down in bed and try unsuccessfully to sleep.

Those days are gone now. I do not have the luxury of time to while away my days in deep thought. Nor do I have the endurance to stay awake all night and still feel alive and well the next day. There are no more nights of lying in the “gutter” and looking at the stars. There are only curses of reluctance to awaken in the morning.

I am only 25 and yet I already feel old. My grandmother was asking me how many more years I had left for my studies. She has this notion that my schooling would end with my post-graduate internship in two years. Even as I become a licensed physician after the board exams my education cannot end there for I doubt I will be successful and content. I jokingly retorted that I would probably be 35 before I settle down.

I wonder how it really feels to have lived my life. How does it feel to be really old and to look back on one’s little triumphs? I always say that I can die if I’ve done something worth being proud of but I can never really explain what I mean by something worth being proud of.

Christmas always makes me feel sad and lonely. There is always something or someone that’s not there. It’s always a compromise. It’s never getting the best of both worlds, whatever both worlds really mean to me.

Adam lives in theory. Everything works in theory but that is not the way it is in reality. Christmas always makes me feel like I live in a fantasy, but every time I stop and think I am confronted by reality - that Christmas only lasts one day and there is still the rest of the year to try and be happy.

People say Christmas doesn’t have to last just one day. People say that we should strive to make every day Christmas day. But then, if that were so, there wouldn’t really be any Christmas at all. There would just be EVERYDAY.

Merry Christmas. May the peace and grace of the season bless you and yours.

(Adam lives in theory . . . Now can you tell me what, what we’re gonna do now, where we gonna go now, what we’re gonna say now . . .Lauryn Hill)

these are the events that transpired today

2005-12-22T18:03:00.000+08:00

Setting: Around four in the afternoon at the Institute of Medicine. It is the day after the last day of exams, the day after the last day of classes before the Christmas break. There are no more students in the whole building. The offices, although open, are empty. Only the guards by the doors remain at their posts.

Characters:
Resident – smug female who delivers each line with a sneer or more denigrating, a smile; bored and power-tripping
Harassed medical student – AKA me

Harassed medical student enters the department office in full view of the resident who ignores her completely. The harassed medical student ventures farther inside the office and tries to catch the attention of the resident who refuses to look up.

Harassed medical student: Doc . . .
Resident: (no reply)
Harassed medical student: Doc . . .
Resident: (grunts)
Harassed medical student: (looking meek and smiling) Doc, nandito po ba si Dr. X o si Dra. Y (Doc, is Dr. X or Dra. Y here)?
Resident: (smugly) May nakikita ka bang tao dito? Do you see anybody here?)
Harassed medical student: (still smiling) Nandito po ba sila ngayong araw (Are they here today)?
Resident: (sneering) Mukha ba akong secretary? (Do I look like a secretary?)
Harassed medical student: Nasaan po yung secretary Where is the secretary)?
Resident: Di ba Christmas party ngayon (Isn’t it that today is the Christmas party)?
Harassed medical student: Ah. (Enlightened pause) Thank you.

The Harassed medical student exits the department office.

Harassed medical student: P-tang ina! P-tang ina! P-tang ina! (sarcastic) Merry Christmas to you, too!

In the light of the Christmas season, I will refrain from narrating the events that happened in the next office I entered, the Dean’s office. Let’s just say an almost threat was conveyed to stop me from pestering the Dean, combined with an almost slamming of the door in my face.

Hay, buti na lang pasko (at mabait ako).

the morning after

2005-12-22T09:30:00.000+08:00

The morning after the exams, after the party, after drinking and barely sleeping. I am surprised I don’t have a hangover or any other noticeable effects of alcohol intake. The party was okay, so-so for the lack of stimulating or revealing conversation. It would’ve been better if a lot more came but I’m not really complaining. The morning drive with M to Baywalk did not materialize but I was quite happy with the idea of it. It was something to hear M toying with the idea. Coming from her (and from C) it seemed rebellious enough. God, we’re so square.

I think I need to sleep. I’ve killed too many neurons from not sleeping. I’m sure the alcohol has done added damage, too.

Good night.

ano raw?

2005-12-21T05:27:00.000+08:00

Last day of the exams. Last day of school for the year. Two more exams to go. I can't study anymore - which is pretty obvious because I'm blogging two hours before an exam. I have slept less than four hours yet I have covered only half the material for my first exam. I have all but neglected my second exam.

Honestly, at this point, I really don't care much about the results of today's exams. I just want to sleep and then party, in that order if possible. And then read. And perhaps take pictures afterwards (it's been a while).

[Sigh]

Samplex (sample exams) time!

books!

2005-12-19T14:28:00.000+08:00

Back to the ordinary daily musings.

Yesterday Cathy and I met up with a former co-worker at Glorietta. She was in Manila for a week for a job training. After eating at Mexicali we found ourselves looking for gift items at National Book Store. Yes, I am the type who gives books or other learning materials to her little cousins for Christmas. But the agenda for the day was not to look for gifts for cousins but to search for a book that was requested for our class Kris Kringle. Unfortunately, the book By the River Piedra I Sat Down and Wept by Paolo Coelho was nowhere to be found. I did find other books to give to friends, though.

One Hundred Years of Solitude by Gabriel Garcia Marquez goes to a Friend C who has expressed her desire of reading it when she saw my copy. I’ve read the book years ago and although I’m usually happy with reading magical realism this book unfortunately fell short of my expectations. I suppose high expectations prior to reading was the cause of the disappointment.

The second book is Eat My Frog: Get More of the Important Things Done – Today! by Brian Tracy. I’ve never read it before but I’m sure Friend M would get the joke, laugh about receiving it and possibly actually read it.

I bought You Know You’re Filipino If . . . A Pinoy Primer edited by Neni Sta. Romana-Cruz for my sister in the States. She has been asking for it for a long time but I haven’t been able to find a copy until now. I think she would like to share it with friends for them to know more about the Filipino mindset. I would like to look for more children’s books in Filipino with English translations to send to her. She’s teaching three levels in grade school and I know she would love to read a few tales from the Philippines to her students.

The last book I bought is for myself. (It will serve as my Christmas gift to myself because it was worth so much that now I am left with no more money to spend.) I splurged and bought The Lonely Planet’s Guide to Experimental Travel. And when I say I splurged, I mean I really did splurge. The book burned a P1k+ whole in my shallow pockets. In any case, I’m pretty happy with the buy. I do hope this will quench my wanderlust and my penchant for the quirky and bizarre until I feel I am entitled to splurge as much for myself again (which will probably be next Christmas).

So, what are YOU getting yourself and your friends and family this Christmas?

alta presyon

2005-12-19T12:47:00.000+08:00

A knock on my front door at midnight is what drove me to write this entry. It was Neighbor 8’s aunt inquiring if I had a BP apparatus while pointing to an unmistakable redness in her left eye.

She had just taken a calcium channel blocker to lower her blood pressure. Prior to the intake of her medication her systolic blood pressure was 160 mmHg.

Having been alerted to her increasing blood pressure she had taken her medication and asked her niece to take her BP immediately afterward. It had risen to 180 mmHg. Not entirely convinced about the accuracy in measurement of her niece’s new BP apparatus, Neighbor 8’s aunt was knocking at my door at midnight to have her BP checked.

Prior to having her BP taken she explained that her niece’s father (a doctor) had just been there and told her that the redness in her left eye was possibly a “hematoma” resulting from her increased blood pressure.

I took her BP. 190/90 mmHg. I reported it to her. Mistake Number One. She was asking me if her systolic BP was indeed 180 mmHg and in my honesty I informed her that it was actually 190 mmHg. The knowledge of such a high BP became a source of additional concern to Neighbor 8’s aunt who had already been anxious about her BP from the start. Her BP had never increased to this level before and she was visibly agitated.

Having been seen by a doctor previously who dismissed her eye problem and only advised her to take her medications I was left with no other option but to try to downplay the gravity of her condition in order to allay her fears. In so doing, I only suggested that she retire early and rest. She had already taken her medication and her BP would eventually go down anyway. In any case, she had admitted that she was worrying too much about her blood pressure and this might have caused it to increase even more.

Mistake Number Two. Advice from a student like me (solicited or otherwise) would never be enough to allay her fears about her condition. Especially since I had been the one to alert her about it and it was one that she had not encountered before. On my part, knowing that the hospital was only a short walk away, I should have offered to accompany her to the OPD for a check-up. Just as I was about to hit myself on the head for this oversight there began a slight flurry of activity next door. In a few minutes Neighbor 8’s aunt, accompanied by her niece, were on their way to the hospital.

“Magpapatingin na rin ako para sigurado,” she said, indicating that to be safe, it would probably be best if she would go to the hospital, saying so while pointing to her left eye, the one with the ocular hemorrhages, saying that it had been there since Friday.

The point of all this seemingly senseless narration is that amidst her gratitude and my level-headedness throughout the entire episode I have actually handled the situation unsatisfactorily. The score is 0-1, the incompetent medical student leads this time. I just hope that this does not happen again and that this incompetent medical student will hopefully turn into a competent doctor someday. To ensure that this does not happen again I am logging out right this very minute to read further on hypertension, its ocular manifestations, management and recommended medication.

Note: The onset of action of the particular calcium channel blocker used is 30 to 50 minutes. The peak action occurs between 6 to 12 hours. That being said, the effect of the drug is not seen immediately (as in only a few minutes) after intake. And yes, worrying too much about hypertension may contribute to an increase in BP.

[To the more knowledgeable readers (that is assuming I have readers) feedback in the form of advice, corrections, clarifications and criticisms are welcome.]

follow-up

2005-12-19T10:35:00.000+08:00

A follow-up on Neighbor 8's Aunt:

In the hospital Neighbor 8’s aunt sat beside two other elderly patients. One was having difficulty in breathing and was being nebulized. The other one had a heart condition.

At this point Neighbor 8’s Aunt was getting more anxious then ever, fearing that her condition would get as worse as the person she was sitting next to. She was eventually accommodated a little after two in the morning. By that time her blood pressure had risen to 220/100 mmHg. She was given a nitrate sublingually to effect vasodilation. Blood pressure monitoring showed that the sublingual drug was not enough and she was given another calcium channel blocker in. Her BP was continuously monitored until her systolic BP went down to 160 mmHg.

It was already past 4 in the morning when she was sent home. She was advised to continue her medication and avoid eating fatty and salty food.

I had an hour-long conversation with her earlier and on hindsight she kept insisting that she was really afraid of the sudden increase in blood pressure. She had been around too many sick relatives to take health matters lightly. As well she should, I thought, as she ticked off a litany of heredofamilial diseases in her family.

But all is well now. She is going off to the market to buy bananas. And I have a box of Danish cookies to show for my efforts.

[Tell me if I shouldn’t be writing about this. Seriously, please do.]

white out

2005-12-15T18:06:00.000+08:00

Another afternoon not well spent.

I have been saddled with envy every since the next-door neighbor came over with her new HP notebook (P135k) with it’s wide screen and shiny exterior. My Compaq Armada is what you might call top-of-of the line . . . 10 years ago. It certainly pales in comparison with her HP.

I am never one to be envious of the shiny things other people have. That is to say I cannot understand why every one I know has to have the newest mobile phone/ipod/PDA every time. I am the type of person who would still be using her 4 ½-year old Nokia 3310 if it didn’t just stop working properly one day.

The reason for my present envy stems from the fact that my laptop is useless when it comes to presentations in class. The screen has this horrible tendency to go all white (due to an unknown reason -- overheating, perhaps). When this happens I am left with no other option but to restart. Unfortunately, mine is not the one-click type that reboots in less than a minute. I need to suffer through disk checking and starting up processes that on bad days could last for 3 or 4 minutes. This “white-out phenomenon” occurs for no apparent reason and at the most unpredictable times. Sometimes I can totally forget that it happens as my laptop is white-out-free for weeks. Other times the screen is white longer than it is in color and virtually useless. The most frustrating times are when I have just rebooted the system and finally about to finish with the start-up then the screen just goes white. Take this white-out phenomenon away and I will embrace my laptop lovingly and never let it go.

NOTE: In the time I took to write this entry the white-out phenomenon has occurred thrice making what should have been a 5-minute blogging update to last more than 30 minutes.

face off

2005-12-14T21:38:00.002+08:00

Face/Off

Remember that movie starring John Travolta and Nicholas Cage? I'm sure you do. It was a good enough action movie based on an unbelievable and entirely out-of-this world premise that people could exchange faces.

Guess what? It can actually be done today.

Face Transplant Gives Hope to Disfigured

Well, almost.

hell week

2005-12-14T18:52:00.000+08:00

An ability to understand the true cause and meaning of a situation coupled with a disturbance in form of thought results in utter failure. To illustrate:

Intellectual Insight: understanding of the objective reality of a set of circumstances without the ability to apply the understanding in any useful way to master the situation.

plus

Irrelevant answer: answer that is not in harmony with the question asked

equals

BAGSAK na naman sa exam!

The hell week (exam week) has just begun. Three down, 11 more to go.

Definition of terms taken from Sadock, B.J. and V. A. Sadock, 2003. Kaplan and Sadock's Synopsis of Psychiatry, 9th ed. Lippincott Williams and Wilkins, Philadelphia, USA.

The illogical equation stems from my own sleep-deprived mind :)

events on pothole monday

2005-12-12T23:35:00.000+08:00

Monday. Oh, Pothole Monday. The proverbial pothole in my road of life.

Early in the morning we were fuming over the demands of the professor handling our class. She was nitpicking regarding our presentation of clinical cases. The reporters were repeatedly reminded to keep their transparencies straight, to mind their grammar, to maintain eye contact with the audience and to completely abolish the use of ah’s and um’s as fillers. The reporters were chosen randomly so each student had to prepare for the case. The break between cases became a time to exchange rants about her demands.

Looking back on it later in the afternoon I realize that her demands were reasonable. When you are reporting or lecturing on something it is but natural that you should be knowledgeable about the topic and not resort to reading only what is written on the transparencies. The transparencies are only visual aids, they do not make the report. Her plea about speaking in straight English, using correct grammar, avoiding fillers and keeping eye contact only speaks of her desire to make us good communicators. A little effort on our part to improve upon the areas she suggested would surely go a long way. In other words, there is certainly a lot of room for improvement for most of us.

* * *

It was already 9 pm when my “health team” adjourned the meeting after creating a problem tree and formulating objectives to address the problem at hand. In my opinion it would have been really stimulating and more worth our time if we were discussing health concerns such as immunizations or increase in non-communicable diseases. We were not discussing any of those. What we were discussing were the unsatisfactory photocopying services in the Institute of Medicine and its “detrimental” effects on the students. We were bringing our blood to a boil and exhausting innumerable neurons on that matter simply because of the topics we proposed (immunizations, additional skills training for medical clerks, CPR, addressing risk factors for diseases present among medical students) it was the only one that was approved. Problems regarding poor photocopy services seem simple and easy enough to address but we are nowhere near the completion of the first step in program/project management. The final project proposal, all two pages of it, is due in a week’s time. We have a long, long way to go yet.

* * *

Side note no. 1: Another round of massive cheating for the quizzes and pre-prelims exam occurred today, entirely tolerated by the residents. Given that the quizzes are just for bonus points or additional grades it is a great help to improve our class standing. The downside to it is that it does not do anything to improve our knowledge or aid in our learning. Bottom line: I’m too square to cheat without my conscience nagging me forever.

Side note no. 2: I just bought a mix of ground coffee which, according to the label, is a blend of Arabica, Brazilian Variety and Baraco. I want a strong cup of coffee but the extended roasting has resulted to a bitter blend which is not not to my liking. Too bad.

Side note no. 3: Something must be done to improve my writing. I am too wordy, entirely unorganized and discuss matters only tangentially. Something must be done to improve my narration. Learning to write in the active voice as opposed to habitually writing in the passive voice would help also.

breathe

2005-12-11T13:00:00.000+08:00

I am drinking Yogi tea, Breathe Deep Tea to be exact, and mulling over the adage found on the piece of paper attached to the teabag string.

"A plant can't live without roots. Your soul is your root."

Err . . . okay.

I am drinking tea, trying to cut down on coffee, and willing this blasted upper respiratory tract infection to go away. I hate being sick. I have not done a single thing related to school. Tomorrow, as always, my Monday will be hell. Four cases to submit, four quizzes, one chapter outline for Oncology to finish, one pre-preliminary exam in Head and Neck Surgery. I'm sure there must be something else I've forgotten to do.

I just want to lie down in bed and get better.

more SA

2005-12-08T21:07:00.000+08:00

I’d like to believe that we are finally getting somewhere with our situational analysis. There is a copy of IM student’s chief complaints from the Pay Treatment Room (PTR) on my desk. I have finished tabulating the data assigned to me and have found out that for 44 students, fever is the number one chief complaint. Of the 44 students, 35 are female and 12 are students of Medicine. Now what?

On my desk, too, are statistics obtained from the library regarding books borrowed by the students and the purpose for borrowing (reading, Xerox, overnight). The most common reason for borrowing books was for reading inside the library but the numbers borrowing for Xerox increase to a comparable number during exam period. So what? What do I do with this data now?

Certain points of the project and the action plan are already mapped out - Point A the problem, Point B the survey, Point C the action plan and alternatives. Our main concern right now is getting from one point to another – from SA to point A, from point A to point B, and so on. There is a gap between these big stepping stones and at this point I can’t figure out how to utilize the still non-existent small stepping stones.

Do you get the picture? Am I getting my point across? Things would be better if I could work with people who are actually trying to make this project work. It entails too much effort for me to put my point across, even more to push people into action. After 25 years of life I have not developed characteristics that make me a leader. I’d like to believe that as a good member I am still a valuable part of the group. As I always like to say there will be no good leaders without good followers. I have no problem with working hard. I just wish that each member of the group would work equally as hard as well.

Thursday. It’s Thank God it’s Thursday!

situational analysis

2005-12-07T19:32:00.000+08:00

Situational Analysis. SA. Words for the day.

I came out from my class without sense or direction. My group, or "health team" as our adviser would like to call it, is nowhere near completing a project proposal targetting issues in the Institute of Medicine. First and foremost we cannot seem to grasp the idea of a situational analysis. On paper it seems easy enough to comprehend. However, when we are seated in front, all in a row like in a firing squad, we can't seem to put across the fact that we have actually done a situational analysis. While our SA is neither comprehensive or sufficient for us to identify areas for improvement (problems) and formulate a course of action, it is not fair to assume that we have not done any background check at all. We have.

We have one more week to do a situational analysis, identify a problem, make an action plan AND defend our project proposal. Program and project management is definitely not my cup of tea. Lock me up inside a laboratory any time.

Situational Analysis is HELL.

Still reading: The Dante Club by Matthew Pearl (just because I had to put it down to catch up with schoolwork)

maximo

2005-12-06T22:29:00.000+08:00

Tuesday. Aha!

I am reminded that the movie-week is about to end. By that I mean that it is almost Wednesday, the day that cinemas change the previous feature film shown and start screening a new one. I am reminded of this because the movie I was so glad that was released commercially is now about to be replaced. I have regretted not being able to watch Ang Pagdadalaga ni Maximo Oliveros when it was shown at the UP Film Center and now I am about to miss it again.

In the event that the screening of the film has been successful and the cinemas opt to extend the screening I doubt I can still be able to watch it. It is the week before the preliminary exams. I am buried neck-deep in reading material already.

That being said I am itching to watch Truffaut’s Day for Night. A re-viewing of Coppola's Lost in Translation or Wong Kar Wai's 2046 will do also.

inferno

2005-11-28T14:33:00.001+08:00

I recently went to National Book Store to buy some school supplies and left with not even a single pen but instead hauled out a big plastic bag containing books. One of the four books I bought, and also the one I’m reading at the moment, is The Dante Club by Matthew Pearl. I’ve heard of the book a year ago but was unable to find a copy until the other day.

The Dante Club is set in Boston in the year 1865. A small group of elite literary men and Harvard professors are about to publish an English translation of Dante Alighieri’s The Divine Comedy but the members of the Harvard Corporation are bent on stopping this venture. This strengthens the resolve of the Dante Club to introduce Dante’s vision of hell to America. Their plans fall apart when a series of gruesome murders is reported and they realize that the killings embody the description of punishments from Dante’s Inferno. I have yet to get far in my reading but all these takes me back to the first time I read the works of Dante.

I was a senior in high school when we began reading excerpts from The Divine Comedy for an English class. As a project for our last quarter we were tasked to “rewrite” the Canto I of Dante’s Inferno and from there create a comic strip. One of my groupmates wrote quite an interesting script and we set to illustrate it in washes of watercolor. The finished product turned out quite well. Good enough at least to warrant praise from our teacher who insisted on keeping the comic strip and using it as an example for students the following year. Dante was forgotten afterwards amidst the flurry of exams and graduation.

I was already a sophomore in college when I decided it would be nice to actually read through the whole Divine Comedy. I bought a copy of Inferno and started reading it. I did pretty well reading the first few pages but as Dante descended into hell and introduced revolting punishments I found myself slowing down in my reading. I would read only about 5 pages a day trying hard to grasp the meaning of each verse. I’m not sure if I actually finished the book. What I’m sure of is that I never got to reading Purgatorio and Paradiso. Now, reading The Dante Club, I wish I had.

Another “episode” comes to mind when I think of Dante. There was this movie I saw as a junior in college. It was set in Death Valley in the desserts of North Mojave with Dante’s View serving as its glorious backdrop.

One afternoon as the two main characters sat watching the sun set over the valley the first one turned to the other and asked,

“Did you know that you lived this close to hell?”

The second just laughed and said, “I don’t know. But I kinda like it.”

Hell is everywhere.

cold turkey

2005-11-25T17:46:00.000+08:00

It is two hours past my dismissal and everything feels wrong inside my head. The continuous ache that started last Saturday has suddenly changed character from a sharp, stabbing supraorbital pain to a dull ache that is deceiving. It almost feels that my week-long headache has finally subsided but I know it is still there, like a fading memory of an obscure dream. I'm not sure if I should be worried about it or not.

Earlier in the day I was going up and down the school's fire exit - to buy a drink, to get to my locker, to go down to a department. The fire exit was always the quicker route because it was on the side of all my above destinations. Going up and down the stairs all I could think about was having my camera fixed simply because I was itching to take pictures of the fire exit. This blog is not "Tales from the Fire Exit" for nothing. It is where I disappear to have my cup of coffee or to get some peace and quiet when the noise inside the classroom seems overwhelming. It's a good enough place to shout off frustrations or study without being disturbed. Of course there are other things that happen in the fire exit. But those stories are better left for another time.

Friday, thank God. I wonder why I always have friends who don't go out on a Friday. We seem like a goody-two-shoes band of quiet revelers. I am stuck between classmates who go straight home after school and friends who are too tired to go out after working overtime every day of the week. I am stuck in my apartment again although I am definitely not the homebody type.

Oh! By the way Happy Thanksgiving, well at least to those who celebrate the turkey day. My grandmother just called to say that my mom and two siblings are in Hawaii for a conclave right now. I'm not sure how long they will be staying there but I'm mightily pissed they didn't tell me about it.

My blog posts always seem to come on a Friday. I suppose being stuck in my apartment with nothing to do is the reason behind it. I am a cold turkey with my head in my hands trying to stop it from throbbing. Picture that.

lemon-sweeting

2005-11-18T17:55:00.000+08:00

It is Friday once again. I am stuck inside my apartment, bored and hungry. The occupants of the first apartment downstairs are hanging out with friends. My ears are filled with their laughter and my nose wrinkle reflexively as the smell of cigarette smoke waft up to my second floor window. I refuse to call myself a loser for staying in on a Friday night. Besides, I already had my Friday night on a Thursday. I went out with friends last night, arrived late and went straight to bed too tired to do anything else but sleep. In any case Saturday has always been my lakwatsa day. I have a whole day to relax and gallivant around.

This is me sour-graping.

Sour-graping. Lemon-sweeting. Things people do on a daily basis. Behavior, I learned today, that patients often use as a defense mechanism to be able to cope with impairment or disability. Not that I never thought that patients utilize such behavior. It was just nice to hear a physiatrist confirm what seems to be a common enough reaction to a patient's current health status. And that, I'm afraid, is the only thing that comes to mind as I try to remember today's lessons.

My mind is blank. There seems to be nothing more to write.

For now.

sampung mga daliri

2005-11-12T22:47:00.000+08:00

Noong isang araw nagkaroon ng pagpupulong ang mga estudyante kasama ang dekano ng medisina. Sabi ng dekano:

"Iba-iba ang tao. Ang mga daliri nga, iisa lang ang kamay, iba-iba pa ang taas . . . ang tao pa kaya."

Para sa akin, ito lamang ang nagpapaliwanag sa dami at pagkakaiba-iba ng mga naging hinaing ng mga estudyante hinggil sa bagong patakaran ng removals at promotion boards, pagbago ng pagkakasunod-sunod ng mga pagsusulit at iba pang mga isyu.

Totoo nga. "You can't please everyone."

life is waiting

2005-11-08T21:52:00.000+08:00

Second day of classes. For today alone I spent more hours waiting for professors to arrive than actually listening to a lecture. It was such an awful feeling waiting for more than an hour for each class unable to go anywhere, unable to do anything else but wait. My schedule for today is from 7 am to 6 pm. Imagine how many hours of waiting I had to endure pretending it was not such a waste of time. And when I started to be quiet and my head started to throb the only excuse I could give to curious classmates was low batt na kasi ako e. I hate having a headache.

I am starting to read on topics for Obstetrics. Next door, the occupants and their friends squeal over the recent capers in Pinoy Big Brother. Such is life.

everything is illuminated

2005-11-07T21:05:00.000+08:00

It was 6:30 in the morning when it hit me. I was in the middle of preparations for my first class and I had to sit down for a moment until the wave of illumination passed.

After a trying semester I felt good about having a break. I went home to the province for the first time in 5 months and slept soundly in my bed. I slept late and woke up late, attended family reunions and had conversations with my grandmother. I watched TV, something I did not have the luxury of doing in my TV-less, mirror-less apartment. In the midst of Numbers and CSI marathons, Discovery Channel features, endless coffee breaks and reading books I actually enjoyed reading, I found myself saying this is not so bad. And for a vacation virtually free of travel, malling and movie marathons I still couldn’t help but feel satisfied. It was like having my Buddha-on-the-mountain-top moment -- enlightenment that life wasn’t bad at all.

Anxiety over going back to school didn’t hit me until yesterday. I was unsure of how easily I could get back in the groove of things after having the longest sem break I’ve ever had in med school. I was still pretty much holding it all together though, psyched about attending classes, refreshed after my month-long hiatus.

And then this morning the veil was swept aside.

Who am I deceiving? That entire sem break is not who I am. Nor is it how my life will be. I am not long vacations, eight hours of sleep, TV and books to read.

I am a perpetual student, destined to have a life in the academe. I am waking up early, going to school, studying, doing homework and sleeping late at night. Lectures, patients, hospitals. THIS is my life. Who am I to pretend otherwise?

I have not chosen a life involving arts, culture and history. There is no reason why I should expect to have one.

This is my life. This is as good as it gets.

deadwood

2005-10-24T21:27:00.000+08:00

It's 9 o' clock. I'm up in my room having just finished watching Gilmore Girls. It's an old episode I haven't seen before but have probably read the transcript of. There's nothing else to watch now.

I have borrowed Lola's cassette/CD player because I thought this is probably a good time to pay attention to my once growing record collection. For some reason the first song I play is Deadwood, the second track of Garbage's "I Think I'm Paranoid" single. Right below that disc is Catatonia's "International Velvet". I play Road Rage. I wonder what I'm going to play next.

Last night it was around this time that I was eating dinner - leftover spaghetti with a little too much ground meat and needing a lot more spice. I was glad that The Italian Job on HBO turned out better than I thought it would. I was still very much awake after the movie. I took a light beer from the fridge and went up to my room. And that was the highlight of my day.

Fantastic.

I am 25. This is how I choose to live my life. Nothing is different. Everything is the same. Where has my life gone?

I was going to be someone by the age of 25.

Reading: Microserfs by Douglas Coupland

My "Hit List" for the night:
1. Deadwood - Garbage (I Think I'm Paranoid)
2. Road Rage - Catatonia (International Velvet)
3. All Eyes are Different - Shudder to Think (50,000 B.C.)
4. All Over You - Live (Throwing Coppers)
5. Dyslexic Heart - Paul Westerberg (Singles - OST)
6. Walk Down the Road - Cynthia Alexander (Rippingyarns)
7. Moonchild - Cibo Matto (StereoTypeA)
8. Winners - K's Choice (Cocoon Crash)
9. Indian Ragas - Makiling Ensemble (Per Square Meter: A benefit for Habitat for Humanity Philippines)
10. Mad About You - Hooverphonic (The Magnificent Tree)
11. Glory Box - Portishead (Roseland NYC Live)
12. American Adagio - Anne Dudley (Seriously Chilled)
13. High Life - Mono (Formica Blues)
14. Awesome - Veruca Salt (Eight Arms to Hold You)
15. My Sex - Elastica (The Menace)
16. I Can Buy You - A Camp (A Camp)
17. Angel of Sadness - A Camp (A Camp)

"Angel of Sadness leave me alone. When the music is over. The silence is home."

sa overpass

2005-10-19T18:01:00.000+08:00

It has been alternating days of waking up late at ten in the morning or waking up early at six. Aside from the waking hour there really isn’t much difference between the two. I still make myself a cup of coffee as soon as I wake up, check my email and afterwards decide what book to read. I’m usually too lazy to go out so I don’t move from my seat until after twelve when I fix something for lunch and wolf it all down in five minutes. I have another cup of coffee after that and resume reading. I swear, if I were man I would be a terrible, terrible slob. As it is, I’m already on the way to getting there.

The other day I managed to get myself out of bed early, take a shower and get out of my apartment before noon. I found myself at Cubao after an uneventful ride on a bus that smelled faintly of mangga and bagoong. I’ve never crossed the overpass near Farmer’s market in the day before. Usually it would be at around 8 or 9 in the evening when I find myself crossing EDSA, waiting to have dinner with a friend. Why Cubao for a dinner date? Simply because it was the most convenient, just a single bus ride both ways.

Late in the afternoon, holed up in one corner of Mister Donut having a cup of coffee and pretending to read a book, I watched as the pedestrian traffic traversing the mall increased. Here were all the men and women going home from their day job, getting off the MRT, crossing the mall to get a ride somewhere else. I watched for hours as all these beautiful people go through the rituals of daily living. I think to myself, aside from the people minding their stores around the area, no one really stays at Cubao for long during the day. But between 5 and 8 pm Cubao seems to be teeming with life. It appears to be at the heart of everything until one realizes that it serves as nothing but an unremarkable stop on the way to one’s destination. Just like an airport. An airport is never really a destination in itself, it is just a means to get to one. I think to myself: if I was here earlier there would be an entirely different set of people passing through.

And I watch as the people shuffle tiredly along.

overpass

Listening to: Wine, Women and Song (Harvey Danger)
Reading: The Tesseract (Alex Garland)

how it ended

2005-10-18T03:33:00.000+08:00

I’m half way through Jay McInerney’s collection of short stories How it Ended.

The first four stories has me doing a double-take every time I remember that McInerney is the author and not some bright, young and hopeful writer just on the rise. He reads like David Sedaris but less funny, less cynical and more preoccupied with sex and drugs*. The short story Smoke reads McInerney only because I’ve read it before as part of his novel Brightness Falls. Getting in Touch with Lonnie is vaguely familiar but I don’t remember where I read it first. I have three more shorts to go through and for some reason I am reminded of T.C. Boyle’s After the Plague which I never finished reading. It sits atop my bookcase with another book by the same author I have yet to plow through.

I have another week until Promo Boards and enrolment but I really don’t want to go home to the province yet. Food, family and TV do not match the enticement of reading (or at least trying to read) one book a day. I tried making a list of the books I’ve read this year and the number does not even come up to half of the amount I usually read in a year. I am a painfully slow reader, what a friend reads in a day I read in a week. The number of books I do devour in a year is still not to be ashamed of.

I don’t know. I’m just feeling really, really lazy today. All I want to do (as usual) is have my nth cup of coffee, listen to music and read**.

* Right now I wish I hadn’t given away my copy of David Sedaris’ Barrel Fever. I really didn’t care much for his writing there but I would love to read it again just to compare.
** I remember something I wrote years ago about how my life can “distilled” into cups of coffee, sleepless nights, books read and rain. Well, fours years down the road nothing much has changed. Everything’s still the same.

bits and pieces on a monday

2005-10-17T06:53:00.000+08:00

So.

It's 6 am on a Monday morning. I haven't gotten out of bed this early in a week. I go out the door to stretch a bit while I wait for my coffee to cool down a little. There's no use in having it burn my tongue, you see. As I start twisting and contorting my ill figure my neighbor from across the hall comes out and chats up a storm with me. We end up talking about . . . nothing much. Her niece is doing her last minute studying for a removal exam in Physiology and at the same time worrying about the results in Biochemistry. For a minute I feel very fortunate that I didn't have to go through the same ordeal when I was a freshman. Or as a sophomore or junior for that matter. NO to removals!!! I think at this moment that's the one thing I'm most scared of. I feel that the "pass or fail" option is not much of an option at all.

My mom called again last night. She is never one to check up on me regularly and yet for the past six weeks she has called me every Sunday at 11 pm with no fail. I do not take this sudden interest in my life as a fault. However, I can't help but feel mildly curious about what brought on this sudden shower of attention.

My grandmother sent me an SMS yesterday asking when I was going home to the province (yes, aren't I a darling, everyone seems to want to get in touch with me). As always, completely evading the question, I replied that the results for Surgery haven't been posted yet. I am going home in a day or two, and it is truly because of the delay in the release of Surgery grades that my trip to province has been waylaid. But I'm also trying to delay going home as long as I legitimately can because I need a few days to sleep until late in the morning and spend the whole day just reading a book. (It seems I've already had enough sleep already, since I'm back to waking up at 6 in the morning as is my habit.)

More bits and pieces later.

Listening to: Joss Stone, in my head, she's singing the theme from Alfie :)
Reading: The Weekenders: Travels in the Heart of Africa

"You are a wise man, my friend, a wise man in a place of great foolishness, and one who may yet survive this theatre of lunacy."
- Contamination, Irvine Welsh

I'm off

2005-10-13T20:17:00.000+08:00

Tonight I want to stay up late to listen to music and read, the way I used to do when I was still working. I want to once again feel the relaxing calm of living (and working) near the beach even if at this point I am nowhere near one.

Tomorrow I want to wake up before the sun rises to go out and take pictures. No, not of the sun as it begins its journey across the sky. I want to take pictures of the city waking up. I want to take pictures of the night’s silence turning into a busy hum. I do not wish to document my life in pictures; writing is enough for me. What I want is to document other people’s life in pictures. What I want is to immerse myself in the harried vibe of the city but feel calm inside, not burdened by commitments, not held back by attachment, not lost in a daze of school work and exams.

I’d like to say I’m off to have a vacation but I’m not so sure about that. I doubt I’ll be able to go anywhere to actually unwind for the sem break. It’s still a nice thought though, me having a vacation (especially since I haven’t had a good one in a really long time).

Listening to: Lovesong (The Cure)
Reading: High Fidelity (Nick Hornby)

on bathing (and smart toilets)

2005-10-12T18:22:00.000+08:00

I am currently browsing through Lisl and Landt Dennis’ Soap for Body and Soul, a book that my aunt lent to me. She makes handmade soap for a living (in addition to being a pediatrician) and thought I would be interested in what history has to say about bathing and its relation to health.

The book starts out with a short history of soap across the ages. While it is interesting to note that evidence of soap-like material were found in clay cylinders from 2800 B.C. Babylon, the part I found compelling occurred much later with the downfall of the Roman Empire.

Initially, with the rise of the Roman Empire, there was a burgeoning obsession with cleanliness. Enormous and elaborately adorned public baths were built, the largest being Emperor Caracalla's thirty-acre water world. With 1,350 public fountains and cisterns, and thirteen aqueducts bringing water to Rome, per capita the citizens used about 300 gallons a day. Unfortunately, as with the power of the Roman Empire, this fixation with bathing did not last.

“With the decline of the Roman Empire and the rise of Christianity, appalling filth spread throughout Europe. The clergy, shuddering at the debauchery and promiscuity that took place in Roman baths, condemned parishioners who bathed.”

Historians have called the Dark Ages that ensued as “the one thousand years of filth”.

“ . . . plagues swept the Continent, killing hundreds of thousands. Devastating epidemics of infectious diseases, rampant infant mortality, and short lifespans were all common . . .”

I think that pretty much brings anyone reading to the conclusion that the plagues and epidemics of the Dark Ages where brought about by poor hygiene. Of course, there are others things to consider. The inadequacy of medicine in those days plays a huge role also.

Good hygiene and proper sanitation certainly do go a long way in disease prevention. In the hospital, frequent handwashing alone has been the most cost-effective way to prevent nosocomial infection.

More about plagues and epidemics are discussed with the history of plumbing(!) at theplumber.com. Also check out the smart toilets which measure sugar level in the urine, blood pressure, body fat and weight before dispensing advice on diet and exercise.

In unrelated “news” I just learned that I passed my Pediatrics class. Oh the joy of living! The recently modified system of Promotion Boards and Removal Exams has everyone shaking in fear. I still haven’t decided yet if the new system will be of more benefit to the students. Most of the people I’ve spoken to recently do not seem agree.

tripping: sunset

2005-10-12T14:39:00.000+08:00

On a rainy day like today while I wait in gloom for what seems to be a very short list of students who passed this semester's class in Pediatrics (and while 108 friends and classmates study for the dreaded removal exam in Internal Medicine tomorrow) I just thought that more people should see this.

yosi break

2005-10-07T03:17:00.000+08:00

“Hoy, mahiya ka. Umagang-umaga yosi kaagad,” ang walang pakundangang singhal ng Ate ng bumaba ako mula sa kwarto upang mag-agahan.

“Malamig kasi,” ang palusot ko.

“Eh di magkape!” ang sumbat ng Ate. “Sa kasisigarilyo mo bukas makalawa wala ka ng baga!”

“Si Ate naman, over,” biro ko. “May baga pa naman.”

“May baga nga, butas-butas naman. Anong silbi nun!”

* * *

While studying for Community and Family Medicine (CFM) a classmate and I were discussing how difficult it is to sustain interest in a health program. Initially, the programs seem to go well with enough support from hospitals, health practitioners and the community. Eventually the interest and support dies down. Sustainability seems to be a bigger problem than actually getting a program off the ground. (Yes, I don’t know what I’m talking about.)

In particular we talked about anti-smoking campaigns.

Republic Act No. 9211 or The Tobacco Regulations Act of 2003 prohibits smoking in public places and public transportation. It also regulates tobacco sales, advertisements and distribution. Around the time the bill came out the then junior medical students taking up CFM came up with a project to support it. There were stickers and flyers distributed to the students and the staff; posters were everywhere. I remember one banner quite clearly. It depicted a man on a horse riding towards the sunset ala Marlboro Country. He was alone presumably because his cigarette-smoking buddy had already succumbed to lung cancer.

Another campaign I remember fondly is Yosi Kadiri which was launched by the Department of Health in 1994. Considered one of the more successful campaigns its aim was to lower the prevalence of smoking among the youth in the age 7 to 19 bracket. I kind of miss seeing the Yosi Kadiri mascot now.

Antifaust has written several times about the hazards of smoking. Recently I came across an old entry from newleaf (another blogger who incidentally is also a medical student), sharing a cartoon about smoking. Although based on U.S. statistics it does put things in perspective.

My dad is a chain smoker so it is no wonder I tried smoking before. I never was a heavy smoker but the bad habit did last for a few years. I’m glad I quit. I still think I’m at risk for the detrimental effects of smoking though. Most of the occupants in my apartment building are smokers. I’m quite surprised they’re not smoking up a storm especially since it’s the finals week. Or maybe I have gotten used to the smell that I don’t notice it anymore. Oh well.

* * *

Naiintindihan ko: kanya-kanyang buhay, kanya-kanyang baga. Pero ngayon para sa akin:

out of time

2005-10-06T10:47:00.000+08:00

No pictures. No posts (that makes any sense).

I woke up yesterday morning at 6 am having slept for 7 hours. Seven f*cking hours! I was supposed to sleep for only 3 hours and wake up at 2 in the morning. When I woke up it was already light outside. The sun was streaming in through my window falling right on my bed. I didn’t even have time to panic. My first exam was at 7:30. The only thing I could say was:

Oh well, that’s life.

I had two exams yesterday and I didn’t get to study much for both.

LSS: Out of Time by Blur
(I just changed all the you’s to I, and your to my and it was perfect!)

And I’ve been so busy lately . . That I haven’t found the time. . . To open up my mind . . .And watch the world spinning gently out of time

ignore this post

2005-10-05T21:52:00.000+08:00

imagine the sunset

Alone. Feeling sad and lonely again. Surfing the net and not landing anywhere I can glean much insight from. All of the people I admire are getting old. Younger people are replacing them as they silently fade away. These people who stand in the place of my old greats are light years away from me. There is no connection anymore, no inspiration, no drive. All these are replaced by blank stares and an emptiness that never goes away.

Day 3 of the finals. Four down and four more to go. I am tired and saturated. The week might as well be over, 8 exams might as well have been finished. I’ve never felt like this before. All my energy drained. Only sadness remains.

I don’t want to be lonely.

Where are all the people in my life?

helicobacter pylori

2005-10-04T02:42:00.000+08:00

H.pylori image courtesy of www.hpylori.com.au

Some people do go out of their way to learn something.

Barry J. Marshall, working with J. Robin Warren, had to swallow a culture of Helicobacter pylori just to prove its role in the causation of peptic ulcer disease and gastritis.

I suppose in the end it was all worth it:
Nobel Prize in Physiology or Medicine 2005.

More about it here and here.

2005-10-03T03:02:00.000+08:00

3 am on a school day

sundays are for fiction: [alas onse y media sa mcdo]

2005-10-02T14:59:00.000+08:00

Alas Onse Y Media sa McDo

"Ate, barya lang po."

"Kuya, sige na. Pang-kain lang po."

* * *

Ang ihip ng hangin sa labas ay nakakapanindig-balahibo. Sa ibabaw ng hagibis ng mga sasakyan sa kalye ay maririnig pa rin ang patuloy na pag-ungol ng mga bata. Mayroong nakaupo lamang sa tabi ng kalsada at mayroon din naman kahit na yapak ay habol-habol pa rin ang bawat taong nagdaraan.

Humihingi ng limos. Nagbebenta ng sampaguita. Nangungulit. Malalim na ang gabi. Ang mga batang silang sa maykayang pamilya ay may ilang oras na ring nananaginip. Ngunit hindi sila. Ngayon, tulad ng karaniwang araw ay hanggang hatinggabi silang nakabalandra sa lansangan.

May mga mababait na lumalabas mula sa magkakahilerang kainan tangan ang mga tirang pagkain upang ibigay sa mga bata. Mayroon din namang kulang na lamang ay itulak at isubsob sa semento ang bawat makasalubong. May mga suki na araw-araw bumibili ng sampaguita mula sa mga bata. Mayroon ding ilang metro pa ang layo ay umiiwas na sa mga sumasalubong na bata.

Sa loob ng McDo ay nagbukas ako ng isang peketeng ketchup at pinahid ang isang french fry sa mapulang likidong tumutulo mula sa pinagbuksan. Masarap ang french fries, mainit. Sumagi ang kamay ko sa plastik na baso ng Coke at ito'y kinuha. Ilang lagok pa lamang ay naramdaman ko nang dumadaloy ang malamig na inumin sa aking bibig papuntang lalamunan hanggang sa tiyan na walang laman. Naaamoy ko na rin ang hamburger at napapatakam ako. Unang kagat na sana kung hindi kumatok ang mga bata sa bintana malapit sa aking kinauupuan.

Nakakaawa ang mga itsura nila. Lamlam na mga mata, mga pisnging walang laman. Gusgusin. Marumi't butas-butas ang mga damit.

"Ang lamig sa labas, hindi ba sila giniginaw?"

Pumikit na lamang ako at kumagat sa hamburger.

[November 27, 2000. Monday]

sleeplistening, sleepreading

2005-09-29T22:27:00.000+08:00

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

2005-09-28T17:10:00.000+08:00

"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]

2005-09-25T23:25:00.001+08:00

[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

2005-09-24T12:32:00.000+08:00

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

2005-09-22T16:37:00.000+08:00

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

2005-09-22T15:42:00.000+08:00

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

2005-09-21T17:45:00.000+08:00

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

2005-09-19T16:17:00.000+08:00

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

2005-09-17T00:35:00.000+08:00

[inosente]

literally

2005-09-16T11:21:00.000+08:00

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

2005-09-13T09:08:00.000+08:00

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

2005-09-08T09:05:00.000+08:00

[alteration of mental status]

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

tales from the fire exit

and so i've . . .

good friday

"special"

february

holiday cheer

my december

surgery nostalgia

commute

surgery

call me stupid m.d.

not

communication

self-worth

life, so far 2

more links

life, so far

day 1

clerkship

my vacation, so far

remembered conversations 2

today

remembered conversations

the end

combo meal: "hindi ako mag-reremovals"

just do it

this is it

pox

no worries

pedia

can you take a hint?

Links

what's going on in pisay?

getting some zzz's

caffeine nap

sa wakas

midterms pa rin

rant

phdcomics

midweek midterm madness

midterms

may the force . . .

work and play

de-buhos

frazzled

alay na buhay

perspective

mathematics

this and that

eleanor rigby

sneeze

first pix

overseas call

scenes from the dinner table

this christmas feeling

these are the events that transpired today

the morning after

ano raw?

books!

alta presyon

follow-up

white out

face off

hell week

events on pothole monday

breathe

more SA

situational analysis

maximo

inferno

cold turkey

lemon-sweeting

sampung mga daliri

life is waiting

everything is illuminated

deadwood

sa overpass

how it ended

bits and pieces on a monday

I'm off