clerkship.

such a hard life. it makes you sacrifice a lot. your friends, your family and yourself. your life isn't yours anymore and you are a slave to the medical field. it doesn't care if you feel sad and lonely. it doesn't care if you have this one rare moment to see your longtime friend. it doesn't even care who you are, what you were and who you will be in the future.

this is the life i'm living and will live for the rest of my life.

i'm afraid that i might just quit. i'm just not happy right now.

duty at pay

yesterday was an experience. i had my first near-death experience... it was my patients'. not mine.

8:07 am
W.S., 43y/o G5P3(2012) admitted for the first time in our institution with a chief complaint of dyspnea.

when she came in, i was the one who took her history. she was a very nice lady who really had no idea what she had. she was already having irregular contractions, thus, beginning labor. but being in beginning labor was not her only problem. the fact that she had diffuse toxic goiter and starting to have congestive heart failure made her pregnancy more risky both for the mother and the fetus. she already had 2 pillow orthopnea.

12:44 pm
she was transfused with packed RBC because her hemoglobin was only 86 and hematocrit was 23. furosemide was also given because of signs of water retention. she was apparently fine until...

5:35 pm
CVP was requested. while undergoing CVP, patient suddenly had sudden shortness of breath and preferred sitting up. a few minutes later, patient was in severe respiratory distress. patient was then given endotracheal intubation and ambubag was started. fetal heart tone decreased from 140s to 100s.

7:08 pm
emergency CS was done. patient gave birth to a live baby girl, 35-36 weeks age of gestation with an apgar score of 3(due to anesthesia). patient was then admitted to medicine and brought to the ICU.

although some information are missing, this would be how the course in the ward would go. what wouldn't be included would be, while the patient was having respiratory distress, she was hugging me and calling out my name, asking for my help that i couldn't give because i was just a clerk. i stepped out of the way and let all the residents do what they had to do. i felt so afraid for her. before that, i was holding her hand everytime an invasive procedure had to be done but during that moment, i couldn't. after the trans out to the ICU, i slept. i didn't want to think about it anymore. i didn't want to let it bother me. unlike some of the residents, i was still an emotional doctor.

today, i'm still thinking if i want to ditch school tom. i desperately need a break. and i definitely want to hang out with other people. i rarely see anyone other than my group anymore. being a doctor is tough. it's like living in a separate world. we don't know what's happening outside anymore. i feel like a stranger from another planet whenever i come home to my family. nothing seems to be rewarding anymore and everyday, coming to work is like torture. i almost feel like crying everyday.

medicine is not for the weak at heart. i'm starting to realize that i might be weak. just a few more moments like these.

the pregnant patient

it's been a week since my OB rotation started and i'm like this everyday: "kaaarreeeeennn. ayoko pumasok!!" OB sucks big time. not only is it physically and mentally draining, it's also emotionally draining. the consultants hit on you hard. no wonder there are no happy OB residents. if it's not the residents or the consultants, it's the labor watch that will kill you. labor watch means monitoring the patient every 15 or q15 minutes for uterine contractions and fetal heart tones until delivery. it also means sitting on your ass the whole damn night holding the mother's tummy counting for contractions and not getting any sleep at all. it's torture. slow and painful torture. i can't wait for my next rotation... surgery...

anyway, lucky for me, i'm preduty at OPD. meaning, since it's araw ng manila, there's no OPD. and if there's no OPD, there's no school for me! whoopee! it's been one whole month since i woke up at 11 AM. can you believe that?! i woke up really really late! i feel like crying now... hehehe... i feel 85% rejuvenated already. what's even better is that i'll be duty at the pay hospital tomorrow. meaning, i will be getting at least 5 hours of sleep during duty hours and doing nothing but eat and hang out with my co clerks... if there aren't any patients.

life is good right now =)

294 days left.

thea's patient

our patient is, j.v., 2 week old male admitted for the first time at our institution with a chief complaint of jaundice.

on the third day of life, mother noticed that patient had discoloration of the head first, then progressed downward. mother took patient to UST-ERCD where Total bilirubin, B1 and B2 was requested and showed elevated TB, B1 and B2. patient was then admitted to our institution.

on the 1st hospital day, patient was started on phototherapy, blood typing and coombs test was requested. mother and patient has same blood type ruling out ABO blood group incompatibility. hematology referral was done.

diseases to consider for now: RBC morphology defect or RBC enzyme defect.

la lang...

i just found this case interesting. i rarely see any cases interesting anymore. it's always bronchial asthma, pneumonia or hemophilia... or a renal problem. it may sound dorky but i can't wait for the hema referral to come out. i just want to know what the diagnosis might be. this is how my life has come to be...

ang saya no?

my room

i'm home.

finally. after 6 long days. 6 days of no actual sense of time. the only day that matters to me anymore is sunday... the day that i hope and pray i'd be at home. in my room. confined in my own space, far far away from the hospital, from the residents and most unfortunately, my co-clerks. sometimes, your co-clerks won't be always on your side.

this afternoon, i helped marie accompany her patient to her ophthalmology referral. her patient, B.V., was a diagnosed case of Systemic Lupus Erythematosus. she was on hydroxychloroquine and one of the adverse reactions of the drug was vision problems. hence, the ophtha referral. while we were inside the ophtha examination room waiting for the resident to come. she suddenly began to complain about her groupmates. what was even more sad was that she was in tears. i felt sorry for her. i've always made it a point to myself that one should never take clerkship on a personal level. work is work and people seem to act differently during work. these are the real them that you see. pag nagkakagipitan, nakikita ang totoong pagkatao natin. it's up to you to accept who they are. i learned that today from marie even if i told her what i just wrote. honestly though, i don't think what i just said made things any easier. worse, it just made us feel more sad than we were when we started clerkship.

on my way home though, i saw some of the parents of our patients. when they saw me, they smiled(sincerely with no hint of plasticity) and said, "uwi na po kayo, doctora?". i couldn't help but give a warm smile and realize that sometimes, when you're down, a simple phrase from someone who cares will bring you back to your senses...

even if it came from a stranger...

"D.A." a.k.a disappearing act

i'm here, now, at the learning resources unit stealing time away from the pediatrics ward. this is what we call "disappearing act" or D.A. but if you get caught, it's called "out of post"(along with 7 days demerit).

right now, i don't have any patients so my chances of getting caught are slim to none. tomorrow will be another rotation... acute ward. and still, i won't be inheriting any patients. woohoo...

my life is just swell =)

first post

i'm almost finished with my pedia rotation. that's when i decided to make a new blog about my clerkship. i feel like i have no outlet... plus i have to practice my english for future admitting conferences. after my last ADCON(admitting conference), i feel like i have no dignity left. at least, i've done my worst.

on a brighter side, my only patient was discharged today... i'm happy despite the heavy paper work i had to do to evacuate them from the premises. what was touching though was that my 4 y/o patient, diana gaiel rivera, wanted to give me a kiss before she left. one of the priceless rewards of being a doctor.

311 days left.