Short of a well-composed entry

Here's a little (rather hurried) rundown of last week...

Enjoy na ang aking elective...kasi Service B na ako. Hehehe. =) I now report to the Chief Resident and his Junior Resident, and they have accommodated me well. Last wednesday and thursday I joined their morning rounds. Pinatikim pa nga sa akin ng Chief Res (Dr. Cruz) kung paano magsulat ng orders sa chart.. I felt privileged kahit na sinusulat ko lang ang dinidictate ni Sir (hehe). At dahil ako ang nagsulat, kasama ang name ko sa undersigned, along with their names (e.g. CRUZ/SANTOS/ROCHA)...cool. =) I went on duty last Wednesday, hoping for a new referral from the ER, kaso walang dumating. Hay. :) I really must see a patient firsthand before this rotation ends para meron naman akong sense of 'ownership' ng history and PE findings, at makapag-present ako sa consultant... kasi yung mga patients nina Sir sa wards, syempre nakuhanan na ng history before..

Dr. Cruz also suggested na mag co-manage ako ng isang patient--meaning I'd check on the patient everyday, then I make my own notes and orders (pero syempre hindi ko ilalagay sa actual chart)... hesitant ako nung una. Then naisip ko I'll start pag may dumating na ER referral, kaso wala nga nung duty. The next day a patient was transferred from pay to charity; siya na lang ang kinuha ko. Turns out she's an interesting case na kelangan pag-aralan at mag-research pa on the topic. Hindi pa kasi clear kung ano exactly nag-cause ng bleed (subarachnoid hemorrhage) sa brain niya. An angiogram will give us an idea kaso this Friday pa ang schedule niya sa PGH. Hopefully makakuha sila ng earlier sked sa Makati Med. We're thinking her systemic vasculitis, rather than an aneurysm, could be the cause. Which leads us to another question--bakit siya may vasculitis? May SLE kaya siya?? Mga ganyang challenge lang naman ang meron sa case na ito. I hope this co-managing thing goes well..ϋ

Masaya--marami akong natututunan. Still the fact remains na inherently tough ang Neuro. Pero ok lang, buti nga napupuwersa ako mag-aral. May times lang minsan na pakiramdam ko hindi pa rin the best ang ginagawa ko. I've been praying that the Lord will help me be excellent for Him but sometimes I still fall short of my own expectations of myself. Nevertheless, I get to be reminded of what I should do next time. I just need to be more patient with myself, and count on His grace and not my own strength. Gusto ko lang ingatan ang Pangalan na dala-dala ko.ϋ Lord, all and only by Your grace...

One Stormy Friday Morning

Classes have again been suspended today, but I'm still here in Manila. I wasn't sure if I should still report for work today, so I lingered in the dorm... and then I decided to check on my patients anyway, since I didn't go to PGH yesterday. (At niyaya rin ako ni Ninay manood ng sine. ^__^)

As I was poring over one chart at the ward, my resident came and saw me and said, "O, bakit ka pumasok? Di ba wala kayong pasok?" Hay, life... At least I don't have to go on duty tonight, and I can go home later. Although, by the sound of the rain outside it looks like I'm going to be stranded for a while...

Do I watch the movie with Ninay or my sister?

I hope I can still get home in one piece. ^__^;

Talk About Ups and Downs...

My Neuro elective, so far, has kind of lived up to that label on my previous entry. After the shock of being asked to go on duty for the weekend, I decided to ask permission to be excused and start the following Monday instead because I had no confidence that I could be mentally and emotionally prepared. And I was really desperate to go home just to keep my sanity. (I couldn’t bear the thought of treating my elective like a regular rotation when OB-Gyn is up next; I need a break!) Thankfully, they weren’t that strict and permission was granted, giving me two days to relax at home. :)

Monday was a little crazy. First thing in the morning I reported to the residents’ call room and since it was still early, I was told to hang out at the clerks’ call room for the meantime. While waiting for specific orders I decided to join my batchmates taking the regular rotation for a Neurosurgery lecture; and then I was informed that I was to meet my consultant preceptor at the OPD at 10:30 am. But this rendezvous didn’t exactly push through because she arrived late and had to attend to the third year students, while I had to hurry off to my Pedia exam (which was kinda difficult, by the way). Sometime afterward, I bumped into my resident buddy, who was on her way to see her patients in the Neuro ICU (NICU) and in the Post Anesthesia Care Unit (PACU). I decided to join her and observe her do her rounds. I felt a little awkward just standing nearby though, because other than getting oriented about the patients, I had little else to do but watch her and do errands like take the patient’s BP or fetch the relative from outside. Anyway, it was just my first day so I let it go. Late in the afternoon, I was able to catch my consultant at the Neuro office and finally got to discuss my objectives with her. I realized that going on duty was inevitable after all; but at least I was able to bargain to have my weekends free. Hurray! :)

Tuesday gave me the blues. It was my second day and rounds still meant “watch-your-resident-do-her-thing” in my vocabulary. Every now and then she would explain the cases to me and assign me topics to read up on. She also let me examine one of the patients and allowed me to record my PE on the chart. Even then, I still felt like a sore thumb sticking out—confused and unsure of what I was to do specifically. When we’re not doing rounds I wouldn’t know what else to do but stay in the call room and study. Was I supposed to be left to fend for myself or go scurrying after my resident the whole time? I needed clarity about my job description—being assigned a resident buddy was not enough.

That night was the least toxic duty I’ve had in my still young life in PGH. Ma’am said she would text me if she'd be summoned to the ward, but there was no referral during the night. The only time I left the call room was just to check on our patients, study one of the cases, and follow up lab results. I slept the rest of the night, taking turns with the duty team to lie down on the only bed there was in the call room.

Wednesday—things began to look up again. After a little debate with myself what to do next, I decided to go down to the ward and check on our patients. I got to examine just one (out of three), because ma’am soon caught up with me. But it was fine; at least she saw my initiative, and I felt less of a ‘space-occupying lesion’ because she involved me more. She let me sit beside her and explained how to write orders on the charts. We still discussed theoreticals as we went from patient to patient; those questions I couldn’t answer off the top of my head became reading assignments as usual. After the rounds I was free to go… but before I could finally rest, my classmates invited me to join their service rounds with their consultant. I went willingly, expecting to play the role of a mere observer. However, when we reached the second patient I was able to join in the discussion too. I was thrilled because it was about brain herniation, a topic I studied just the day before. To think I was previously wishing that I was with a different resident… if that happened indeed, I might not have been assigned to study that topic, and I wouldn’t have been able to contribute answers during the rounds. Indeed, there is reward when one studies. :) I just hope I can keep it up…

Thursday—rest day. Thanks, super typhoon Egay. ^__^


♪ Everyday it’s true, You make all Your mercies new… ♪

This past week has been quite a ride. But after Wednesday, I felt God’s reassuring hand upon me. He has shown me that He’s in control right from the beginning. The thrill from the consultant rounds, the warm reception from the only two Service B residents (I’m currently part of Service A), the comfort I began to have, the lifted spirits—it was all Him. He answered me not so long after I pleaded with Him to take away my discouragement just the day before. And just as He has been sovereign and gracious this week, I pray that He will continue to prove Himself so for the remaining weeks of my elective. If I get another round of ups and downs, I pray that His peace and presence will be my anchor.

Help me enjoy this elective, Lord. All for Your glory.

Elective ≠ Benign

Asa pa ako.

So much for thinking up my own learning objectives and activities... sana hindi na lang ako pinagawa kung sasabihan lang din pala ako na magkakaroon ako ng resident buddy at sasama ako sa duty nya every three days. At bukas daw ako magsisimsula... I am so not prepared. I was only informed within the last hour! Akala ko makakauwi na ko sa bahay for the weekend... ='( Did I really choose the right elective? Feeling ko tuloy ang martyr ko. =(

Panibagong rotation :)

Ang bilis ng oras… tapos na ang Pedia. Yahoo! Pardon the lack of entries about it… minsan kahit gusto ko mag-update drained na either ang physical strength ko or ang storytelling faculties ko. Hehehe. Suffice it to say that after that first week at Ward 11, Pedia wasn’t so bad. I enjoyed going on duty at the nursery where I learned how to resuscitate newborns and determine their pediatric age. Nakakatuwa talaga ang mga babies… bangag man ako pagdating ng madaling araw napapangiti pa rin nila ako. :) Ang cute cute nila…bale wala sakin ang iyak nila (sa newborns lang ‘to ha hehe). Nakakaawa lang pag hindi sila nabibigay agad sa mommy nila (dulot ng iba’t ibang dahilan), di sila napapakain agad. Kapag pre-duty day, sa Neonatal ICU (NICU) kami… pero di masyado remarkable sakin yun compared sa 24-hr nursery duty. Anyway, after nursery, Pedia ER naman. Ang saya kasi pagdating namin dun, it wasn’t its usual congested self. Dati sobrang init at crowded sa PER. Pagdating namin, m a l u w a g, as in… tsaka mas maaliwalas. Na-practice din ang skills ko dun somehow sa pag-blood extract at insert ng IV line. (Pero mahirap pa rin talaga mag-line ng bata. Eto tapos na ang pedia clerkship at sinasabi ko kailangan ko pa rin ng practice.) Enjoy din kasama yung mga nakasabay naming interns dun. :) Then for the last week, Ward 9… it wasn’t as scary as I thought it would be, because I previously had the notion that Ward 9 was more toxic than Ward 11. I had a few little boo-boos, pero at least I learned from them atsaka mabait naman ang residents ko… Mas nagustuhan ko rin ang naging decking ng trabaho kapag overnight duty, parang hindi kasing exhausting kumpara sa experience ko sa Ward 11. At na-realize kong factor lang talaga kung sino mga katrabaho mo…

Ok, so how about my past few days? Marami man ang nakawawa dahil sa bagyo at baha, hindi maikakaila na para sa isang estudyante, masaya pa rin ang mawalan ng pasok. Pasensya kung may ma-offend ^__^, pero kaya ganito rin ako magsalita ngayon kasi nung time na nagsimulang bumagyo (Tuesday night), last duty ko sa ward. Then the next day, imimeet ko dapat ang preceptor ko for my Neuro elective pero dahil sa panahon, hindi rin yun nangyari at umuwi na lang ako (by a P20 pedicab ride dahil buhay na naman ang Taft River that time). Classes were again suspended yesterday, so I got to sleep in after a long time of not being able to do so. Plus our end-of-rotation Pedia exam was re-scheduled to Monday next week. What a very nice way to end my Pedia rotation. =)

Ayun nga lang, hanggang ngayon hindi pa rin ako makausad sa elective ko. I still haven’t met my faculty preceptor, who’s supposed to check if the learning objectives I came up with are ok. And I need her input in terms of fixing my schedule. Four weeks ang elective…di yata biro ang gumawa ng sked. Well ngayon, I have 3 ½ weeks remaining. I spent practically the whole day today inside the Neuro clerks’ callroom, studying and waiting for any update from my resident monitor-slash-mediator. Ganun ba talaga kahirap hagilapin si Ma’am? I just hope they don’t reprimand me and say I should have coordinated with them earlier. Nagparamdam naman ako sa department two weeks before, then tinext ko yung resident one week before. He said I should be prepared to discuss my personal objectives with Ma’am before my elective rotation. But when I asked for a time to meet with her, Wednesday rin pala ang bagsak (yes, that stormy day). Kung policy man na dapat way earlier ko pa ‘to ginawa, they should have emphasized it. Nagawa ko na ang part ko. I hope this doesn’t spoil my learning experience and my effort to appreciate Neurology more (despite it being a rather unpopular subject among most of my classmates). Let’s see what happens…