One down :)

Last duty ko na sa Pedia ER bukas!

I've been through 6 weeks of internship already... nakayanan ang ka-toxican sa Pedia ward (we were just four interns taking care of 45 patients), nag-enjoy/nagdusa sa Nursery at NICU (enjoy dahil sa babies, dusa dahil sa physical exhaustion kaka-run ng errands sa NICU), at nasiyahan sa ER kahit na may times na gusto ko na lang layasan ang ka-toxican (hehe).

For all that has passed so far, I thank Him for His ever-sufficient grace. =)

11 months to go.. :D

Looking Forward

The previous week has been the most eventful part of my last summer vacation as a student. It was just great seeing friends that I haven't been with for so long and going places I have never been to. :) Maybe I'll share more on this part later; probably better when I get my photos from my brother (who insisted that I give our camera back to him in Bacolod before I fly back home).

Heartbeat for Christ in Dumaguete was basically the reason (among others) I found myself heading off to Negros island. It was an annual convergence of Christian medical students from all over the country, organized by the Campus Crusade for Christ. I joined with expectations of having a fresh encounter with the Lord and getting my bearings, so to speak, for my internship that lay ahead. Indeed, the Lord met these and gave me more. Here are some of what I learned and re-learned:

• I am to seek first His kingdom and righteousness, and all other things will be added unto me.
• I must not worry or be anxious. It's a waste of time and energy and unbecoming of a Christian!
• Live one day at a time; trust Him one day at a time.
• Pray CONSTANTLY.
• Thank God for everything. Gratitude keeps one from worrying.
• I must make time for God's Word. My soul needs it.
• Remain in Him and bear much fruit.
• In pressing on toward my goal to know Christ more, I must face my faults, forget what is behind, and focus on what lies ahead.

It was truly a refreshing time spent worshipping Him and hearing from His Word. The Lord gave me a resounding reminder that to be a physician is a high calling and an effective tool for ministry. It was also encouraging to find that there are actually many Christians in the country's different medical schools. If we take our calling seriously then this means making a bigger impact for His glory. Wow. :)

I really thank the Lord for this conference and I'm glad I went, even if it was so near the start of internship. I found that it was actually just what I needed before beginning that "last frontier". He recharged me, put me in the right perspective, assured me of His presence and gave me peace. I will survive internship as long as I put my trust in Him always. And so I came home saying, "By faith, I am ready."

Once more I felt His presence as we sang this hymn in church the next day:

Be strong in the Lord, and be of good courage;
Your mighty Defender is always the same.
Mount up with wings, as the eagle ascending;
Vict’ry is sure when you call on His name.

Be strong, be strong, be strong in the Lord;
And be of good courage, for He is your guide.
Be strong, be strong, be strong in the Lord;
And rejoice for the vict’ry is yours.

So put on the armour the Lord has provided;
And place your defense in His unfailing care.
Trust Him, for He will be with you in battle,
Lighting your path to avoid every snare.

Be strong, be strong, be strong in the Lord;
And be of good courage, for He is your guide.
Be strong, be strong, be strong in the Lord;
And rejoice for the vict’ry is yours.

Be strong in the Lord, and be of good courage;
Your mighty commander will vanquish the foe.
Fear not the battle, for the victory is always His;
He will protect you wherever you go.

Be strong, be strong, be strong in the Lord;
And be of good courage, for He is your guide.
Be strong, be strong, be strong in the Lord;
And rejoice for the vict’ry is yours.

In just a few moments, it'll be May 1st. Pedia wards + summertime - clerks = toxic.

Okay Lord, even if there are no clerks yet, we can do this. :) Let me not let stress and toxicity steal my joy.

I'm Back

Countdown to internship: 5 DAYS.

I choose to trust God and draw from His love and grace. May my light shine so brightly each day I spend in PGH for the next year...

Time Running Out

Wow. Two of my precious three weeks have actually elapsed already.

So far my vacation has been more or less a cycle of sleeping, eating, doing house work, reading (i've finally finished Dr. Paul Brand's "The Gift of Pain" after ages; sorry can't share the current one just yet haha), surfing the internet and occasionally watching TV. I also did my customary share of organizing my desk and other stuff that get neglected here at home when I'm away 'stuck' in Manila. I'm glad I still have the opportunity to travel a bit this coming week to visit friends (and my brother attending Kawayan Camp) and attend Heartbeat for Christ (a conference)... Iloilo and Negros, here I come! =)

I feel like this week is a dream, because when I come back, I'll have to start separating myself from home again and get used to my hot dorm room, polluted Manila air, and last but definitely not the least: the more stressful life of a PGH intern.

I hope I will have a blast this week and a meaningful encounter with Him, too. I need this just before I embark on another crazy, colorful ride waiting for me in just twelve days. :)

My Last Duty as a Clerk

I had a tiring but amazing morning yesterday. For the first time, I got to witness and assist in a spine surgery. =) The patient was a 14-year old girl who had scoliosis with a 50-degree curve on her spine. Now I know exactly how scoliosis is corrected with the use of screws and rods and most importantly, bone grafts. We stood for nearly 6 hours in the OR (they say scolio cases typically last about 10 hours or more)! And while I kept silent the whole time, in my head I couldn't stop marveling at the way God created the human body, and the knowledge He gave man to be able to come up with ways to "fix" whatever is wrong (like what we did yesterday). It was just so cool. =)

I didn't like the afternoon part of my duty though. I was up for my second procedure for the day--it was supposed to be just a simple closed reduction for a dislocated elbow of an 18-year old guy who encountered a motorcycle crash. The problem was, he also had a big bleed in his brain from the head trauma and putting him under anesthesia for the closed reduction would be tricky. After some delay the neurosurgeon evaluated him and decided to do a craniectomy. We had to wait for the patient to be anesthesized before we could reduce his dislocation, and that took us hours. Argh. Five hours of doing nothing until I got tired and hungry. I was there from 3 til 8pm! Then my resident let my go down to the call room and have dinner for a while, for which I took my time. I came back after about 40 mins (I think) and behold, the patient's elbow was fixed alreay. Oookay...so much for waiting that long. I spent the rest of the night tinkering with my new laptop [wee...=) too bad the Ortho Wifi was down though], trying to drown out the ghost stories the residents were sharing. Hahaha. And then I slept from 12-6:45 am. :)

It was still a fun duty, in spite of the hassles.

Clerkship is winding down! One more week left... :)

In A Nutshell

I spent half of my birthday in the hospital and nearly the other half asleep--was on duty at the ER from tuesday to 7am of wednesday, then stayed on for some activities at the Orthopedic ward... and then i slept through the afternoon and early evening.

Now i'm awake way past midnight and i still need to study for a case discussion tomorrow.. i feel like my day has just begun. The things going on duty can do to your body clock.. tsk. ^__^

Anyway, I thank God for 23 years of his faithfulness and grace, and as I come closer to the end of the first leg of my medical training (since Medicine is a lifetime of learning) i trust that He will lead me to the field where He would want to use me.

More importanlty, I pray that by His grace I will continue to seek His face everyday until He leads me to the center of His will.. :)

Nearer to the end [of this year at least]

Obviously, blogging has become the least of my priorities. Somewhere along the way (while rotating in IM), I seem to have lost my drive to post regularly. I might have to rethink maintaining this site... ^__^;

Well, things are not as toxic now. Just about three weeks left and clerkship will be over! Three days packed with exams though (including a graded compre, yikes) will cap it all off at the end, and I haven't studied yet. Oh no.

This year has been quite a ride... It is my constant prayer that He'll fill me to overflowing with His joy. Can't go on without Him.

Backlog Pa Rin

(Pagod na ‘ko mag-English. Hehe)

Sumunod sa Anes ang Emergency Medicine… dito ko nakita kung gaano ka-halaga ang triage. Maraming dumarating na pasyente na nag-aakalang emergency ang kaso nila, pero kung tutuusin hindi pa. Kelangan talaga piliin kung sino lang ang i-aadmit sa ospital, kasi kung hindi, mauubusan agad ng vacancy ang wards, at matatagalan lang ang mga pasyente sa ER. Well, in the first place puno naman lagi ang PGH. ^__^; Halos nakabisado ko na nga ang mga linyang sinasabi ng mga residente sa mga kumukonsultang pasyente:

“’Tay/’Nay, ang kondisyon niyo pang OPD naman, balik na lang kayo sa OPD bukas at pumila kayo alas-singko pa lang ng umaga ok?”

“Pasensya na kayo, wala ho kaming bakante sa charity ngayon. Pag tinanggap namin kayo, maiinip lang kayo sa ER at mahahawa pa kayo sa sakit ng iba dito. Subukan niyo sa Ospital ng Maynila o kaya sa Jose Reyes, baka sakaling may bakante sila…”

Ganyan sa ER ng PGH (sayang wla ‘kong pic)… ang Acute Care Unit halos laging puno, parang extra ward. Mainit pa’t ang simoy ng hangin, kakaiba. Haha. Sa dalawang linggong tinagal namin dun, katulong kami ng mga residente sa trabaho. ‘Pag pre-duty, tumatambay sa triage, at tulad ng sabi ko, sinasala ang mga pinapapasok upang magamot. Ang duty naman, oras para ma-practice ang skills tulad ng venous at arterial blood extraction, IV line insertion, foley catheter insertion (kasi ginagawa ang mga ‘to sa halos lahat ng pasyenteng inaadmit). Pag-post duty, matapos ng mga lecture (kung meron man), uwi na! Yey. :)

Dahil frontline ang DEMS (Department of Emergency Medical Services) sa pagtanggap ng pasyente, iba’t ibang kaso at personality ang na-encounter ko dito—may mga inatake sa puso, may masakit ang tiyan, may nahihirapan huminga, may na-stroke, maraming mga naaksidente, at pati nagbibigti at umiinom ng mga kung anu-anong kemikal meron din. Kadikit na ng pag-atupag sa kanila ang samu’t saring aksyon at drama. Madalas, ang mga tumatatak sa isipan ko ay yung mga dumarating na ‘coded’ (walang heart rate at blood pressure), o di kaya, malapit nang mag-code. Isang gabi, may dumating na maliit na grupo ng mga bading, dala ang kasama nila na blue na ang mukha. Sinubukan namin sila hingan ng impormasyon tungkol sa pasyente, pero bukod sa alias na “Joan”, wala na silang alam. Kahit edad man lang, o kung san siya nanggaling. Siguro, sandali pa lang ang pinagsamahan nila (magkakasama silang nagtatrabaho sa isang beauty parlor). Nung gabing ‘yon, galing daw sila sa gimik. Nakainom daw ng marami si “Joan”, at pag-uwi ay parang nag-collapse. Akala ng mga kasama, nakatulog lang. Pero later on napansin nilang unresponsive na pala. Ayun, dinala sa ER. Sinubukan i-resuscitate ng code team (dito ko unang nasubukan gumamit ng defibrillator), kaya lang hindi naging successful. Nakakalungkot isipin na hindi pa niya kasama ang pamilya niya o kung sino mang nakakakilala sa kanya talaga nung binawian siya ng buhay.

Ibang gabi naman, nag-admit kami ng mag-asawang biktima ng vehicular crash sa may Nakpil St. Nakasakay silasa motor at bumangga sa isang taxi. Hinatid sila ng driver sa PGH, at pinasok sa ER buhat ng stretcher—parehong bali ang buto ng kanilang kanang hita. Nahirapan sila i-intubate ng residents kasi pumapalag at gusto hilahin ang tubo. Grabe rin yung time nay un, basta emergency kailangan mabilis ang kilos. Hindi ko na alam kung ano ang sunod na nangyari sa kanila pagkatapos dalhin sa X-ray kasi Surgery na ang nag-handle sa kanila.

Hindi ko rin malilimutan ang pasyenteng sumubok sa pasensya ko dahil ayaw niya magpalagay ng NGT. Alam kong masakit ang malagyan ng NGT, pero grabe, walang kasing likot si Tatay to the point na kinailangan siya itali. Kailangan niya yun kasi nagdudugo na ang tiyan niya. Kaya na lang ganun din siya ka-resistant kasi wala na siya sa tamang pag-iisip dahil naapektuhan na ng Hepatitis niya ang utak niya. Sa sobrang frustration ko nataasan ko ng boses pati yung bantay na gusto nang mag-walk out. Hay, ang pasyente hindi dapat iniiwan ng bantay. Na-guilty rin ako pagkatapos nun… proof na kailangan ko pa rin ng extra helping of Grace. :)

Ilan lang ang mga ito sa mga naging karanasan ko sa ER. Ok ang EM rotation… may times na toxic—pero pag benign, benign talaga. :) Isa pang maganda dito, kailangan mo lang i-stabilize ang pasyente at pagkatapos, pwede na i-refer sa magiging primary service (kung for hospital admission), o kaya, pwede na pauwiin. Sobrang bait at fun pa ng mga residents na nakasama namin. At siyempre, masaya kasi I went through it with my all-time favorite blockmates. :)

Last day ng DEMS. Bojit’s ice cream treat. Kumpleto kami d2! Jill, Dezi, Ida, Bojit, Trine, Q, Suzi, Cesca

season's greetings + a rewind...

Merry Christmas everyone! I hope we are all having a wonderful time with family and friends this season, not forgetting the very Reason why we celebrate this time of year... :)

I've never been happier that finally I get to stay home after months of being practically stuck in Manila. Oh, I've had opportunities to go home but to be able to spend even a day here seemed impossible when I'm caught up in the middle of a rotation. Anyway, here I am, getting my much needed rest. :)

Here's a rehash of the past months in my world--part one, at least. I planned to write and publish just one article reaching up to my IM experiences, but realized I couldn't do it in one sitting. Sorry na rin kung di masyado coherent. ^__^ I'm conceding to my sister's suggestion of uploading one section at a time...

Major Backlog: Bits and Pieces

As you can see, the last time I shared anything about my med life I was having my Neuro elective. Maybe I’ll just skip the tiny details for this part. Suffice it to say that though I began the elective with apprehension, I left the department all smiles. The residents were even asking if they should prepare a spot for me in their call room after two years. To that I said, “We’ll see…” :)

<-- souvenir photo from inside the Neuro residents' call room

After Neuro came Ob-Gyne. I liked it less than I did last year, probably because the excitement of learning skills for the first time has already come and gone. We were not ‘beginners’ anymore; we have already become part of the workforce. We fell into a routine of staying in the wards during pre-duty, hustling and bustling at the admitting section or in the LR/DR during duty, then hitting the sack dead-tired on our post-duty day. Too bad I didn’t get the hang of delivering babies myself. The downside was that there were pre-residents with us—which meant added competition for deliveries and episiorraphies (a.k.a. repair of episiotomies). I should remember to make up for this loss next year. Anyway, I still got my share of OR assists for Caesarian deliveries and THBSO’s. I encountered some interesting patients as well, such as a deaf-mute victim of sexual abuse, and a patient also named Ingrid. :)

Oh well, thankfully the Lord has enabled me to endure the uniquely stressful environment of this department for a month. Witnessing the miracle of life in all those newborns also helped. :) Thank God for fun blockmates and kind interns and residents too. :)

<-- Ito ang pastime ko sa LR/DR--magbuhat ng baby ^__^

The next two weeks were spent with the Department of Anesthesia, and life took a benign turn once again. Benign, because we get to go home early (the residents would usually “shoo” us away once we’re done with procedures, haha), and if we’re not on duty on weekends, we’re free.:) I learned how to administer spinal anesthesia and intubate a patient— though the latter still needs practice. I got familiar with what was taking place on the so-called “other side of the drape” on the operating table—where we periodically check the anesthesia machine and the patient for any changes in his vital signs while the surgery is ongoing. I used to think that Anesthesiology was only about administering analgesic drugs prior to an operation, but I have come to realize that it starts with seeing the patient even before he is brought to the operating room and lasts until his post-operative pain is adequately relieved.

Cesca's Iceberg treat during Anes. L-R: Jill, Bojit,
Ida, Suzi, Cesca, Trine

***Okay, to be continued. haha. next part to follow--soon, I hope ^__^; ***

Trying to break the silence

This is just to say I'm still alive (haha). Been wanting to update this poor blog but now that I kind of owe two months' worth of stories, I would need more time--which I don't have much of now.

Clerkship is about halfway done (!) and I haven't been doing good in documenting my life lately... tsk tsk.

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…

Post duty status

Nakakatawa...just came from my first duty day at the Pedia ward, at ito ang nakita ko habang online. Naka-relate. Haha. Ang hirap ng first day, yung tipong naninibago at nangangapa ka pa sa kalakaran sa wards. But I hope I get the hang of it soon. Ayoko lang yung part na mag-momonitor ng vital signs tas andaming pasyente na every hour dapat i-monitor. Funny, pero halos breaking point yun sakin kagabi. Pano kasi, lahat na ng pagod at stress parang naipon...at kahit na sobrang gusto ko na maupo o humiga hindi ko naman magawa. Kanina, habang post duty ako (24 hrs ka nang duty tas mag-stay ka pa ng ~10 hours to attend to your particular patients..grabe no?) na-realize ko na mas gusto ko pala ang pre- at post- kesa duty mismo. Hehe. Magbago kaya yun? ^__^

Lord, help me survive and even enjoy Pedia kahit na ganun siya ka-toxic... (Hay naku, hindi pa nga ito IM...)

Nanay Evelyn

I was at PALCare yesterday, where I met Nanay Evelyn, 59 years old, diagnosed with Invasive Ductal Carcinoma of her left breast just last month. She just had her first chemo session about three weeks ago, and she went to PALcare to seek for financial assistance for her subsequent sessions. I was asked to interview her before they help her out, so talk with her I did. It was a good conversation in that I did not have a hard time getting to know her. Despite her rather sad countenance, she was still willing to share about herself, her family, and how—in the face of all the hardship, her family has been a source of strength and comfort. But even as she was affirming her resolve to stay strong, her glassy eyes would betray her. I felt a tug at my heart as we talked… Why did I have to forget to bring a tract that day? I wanted to reach out to her with more than just the short ‘generic’ reassurances like “Tatagan niyo lang ‘Nay…” I wanted to talk with her more, try to share the Gospel to her, but time was limited. Sometimes I wish an instance like this wasn’t the only time I would see patients like Nanay Evelyn. But soon, I realized that God will not run out of ways to reach her. I pray that He will lead her to people who will point her to Him and that she will truly surrender her life to Jesus…

I was just reminded yesterday that being a doctor is indeed such a strategic way to share God’s love to needy patients. I pray that He’ll enable me to witness to them better in the future… ●

Back to PGH

Tatlong linggo na akong clinical clerk... at sa benign kong rotation na Family and Community Medicine, pinaka-naramdaman ko ang katotohanan ng bago kong identity nung nag-duty ako sa Ambu nung first week. [Ambu--short for Ambulatory Care Unit, para sa mga emergency cases na hindi ganun ka-seryoso. Dito pinapadala ng mga tao sa ER ang mga pasyenteng pwede namang hindi i-confine, yung mga pinapauwi rin eventually]. Noong una, medyo kinakabahan at nangangapa pa, pero di nagtagal at medyo nasanay rin sa kalakaran ng pagtingin sa pasyente. Halos puro abdominal pain, hypertension, UTI ang mga cases na nakikita namin. Marami rin akong nagawang procedures tulad ng pag-inject ng pain reliever, pagkuha ng dugo at pagpasok ng foley catheter [kaya ko na mag-isa.. =)]. Syempre nakakapagod din, madalas nalilipasan din ako ng gutom. Buti na lang tig-8 hours lang ang duty dun, at limang beses lang in one week. Pabago-bago nga lang ang oras ng pag-tulog (iba-ibang shift din kasi ang na-experience namin). Hay, pano kaya pag Pedia na...

Pagdating ng second week, bagong environment naman. Tuwing umaga, sa Malibay Health Center sa Pasay ang duty namin. Nakakatuwa kasi computerized ang charts nila dun. Simple lang din ang cases ng mga pasyente kaya mabilis lang sila tingnan. Libre ang konsulta, pati ang mga gamot. Nagbibigay lang sila ng donations para patuloy na makatakbo nang maayos ang center (hindi kasi lagi on time ang dating ng funding galing sa gobyerno). Na-enjoy ko rin ang pagbakuna sa mga babies; there was a morning na naka-nine babies ako. =)

Isa pang highlight ng community rotation ay ang exposure namin sa activities ng Remedios AIDS Foundation, isang NGO na tumutulong sa pag-alaga ng kalusugan ng mga taong sangkot sa prostitution. Ibang klaseng experience din yun. Hmm.. I-upload ko na lang kaya dito ang ginawa kong paper? :)

For the last two weeks of Fam Med, sa Supportive and Palliative Hospice Care unit naman ako. Ang focus naman dito ay pag-alaga sa patients na hindi na responsive sa curative treatment (i.e. cancer patients). Meron ding patients na referred galing sa ibang wards, usually for psychosocial support. I hope this last week and a half will be meaningful..

Ayun.. so far ito ang mga nangyari sakin sa pagsimula ng clerkship.
I'll just end this abruptly for now and hope for a more coherent entry next time. Hehe. =)
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Sige... storytelling time... here's my paper about my Remedios experience. :)

Bitter Reality

It’s for real. This was what I thought when I got off from my first duty at the PGH Ambulatory Care Unit. I was taking in the fact that I really am now a clinical clerk—one step away from being an intern, two huge steps from being an M.D. It seemed that life as a medical student will be getting more serious every rotation from here on. But before plunging further into a myriad more duties and patient encounters, I got a break from the hospital environment the following week and had a different taste of reality. This time it was beyond the gates of PGH.

An objective of our Community Medicine rotation this year was to provide an opportunity to work with vulnerable sectors of society and integrate them into the health referral system. One particular vulnerable population group we focused on was the people involved in the business of prostitution. For two days, we rotated at the Remedios Aids Foundation, an NGO committed to serve the health needs of people at risk for contracting HIV/AIDS and other sexually transmitted infections (STIs). One of RAF’s main endeavors was their “Prevention Project,” where it seeks to inform, educate, and give people in prostitution (PIPs) a shot at more quality of life (albeit relatively) by reaching out to them where they can be found. So our experience consisted not only of interviewing patients in the Remedios clinic, but also of interacting with PIPs out on the streets and inside bars, a.k.a. ‘establishments’. It was an activity that was first met with a little uneasiness on my part, given my preference to avoid stepping into red light districts. But I went with an open mind still. I knew that learning experiences usually make more impact if one goes through them firsthand. Thus during the briefing at Remedios and while on the jeepney ride to Makati Avenue, I continued to psych myself up for the sights I would see, the responses I might get, and the stories I’d hear.

Three community health outreach workers (CHOWs) accompanied us to Makati—Kuya Con, Ate Roselynn, and Kuya John (who later pulled out for his own duty at Marikina). At about half past eight, with umbrellas over our heads, the six of us set off in search of Con’s current contacts, as well as other ‘freelance workers’ that could also be potential contacts. We hadn’t gone far when he spotted Jenny, a previous contact, sitting outside a bank on the corner of Makati Ave. and Durban St. Jill went with Con to talk with her; the rest of us left them alone for a while. As we walked on, I couldn’t help but wonder if every girl we passed standing by buildings was involved in prostitution too. I had guessed that they most likely were. We reached Burgos St., where the bars were mostly concentrated. We did not enter one though, because Ate Roselynn said the managers are a little stricter in Makati. And besides, they get their own supply of condoms from the City Health Office. Nevertheless, the CHOWs are still able to schedule lectures in these establishments every now and then.

After a while Con fetched us and walked back, and then we dropped off Suzi, Chrys and Ate Roselynn at another cruising point (a.k.a. pickup point). Before heading back to Jill, who was still with Jenny, Con introduced me to Sally and Krystal, who then consented to spend some time with me. Since Sally asked about the common symptoms of STIs, I started by explaining the topic to them. Apparently, Krystal was already familiar with these symptoms, but claimed not having experienced any yet. After my first round of educating them, I asked how they were doing that day. They said they weren’t doing very well. Again, I asked: “Bakit, kapag maganda ang araw, ano ang ibig sabihin sa inyo?” To this Krystal replied, “Huwag mo na lang alamin, tama na ang kami lang ang nagtatanong sa ‘yo.” I didn’t know how to proceed after that. I wanted to ask more questions, to scratch their surface, no matter how little, but I feared they would just build a stronger wall against me. After a few silent moments, Jill and Con arrived, somewhat to my relief. Jill helped re-emphasize why we were there that evening—that we wanted to help them to be aware of the risks of their business, and to stay protected by using condoms. The visual aids we brought came in handy during our interaction; it caught their attention and facilitated some discussion (two more girls came to listen to us at this point). I also found out that Sally used to work in one of the bars there, and used have an annual check up and “cleaning” at the Social Hygiene Clinic. I got curious about this “cleaning” procedure they referred to several times, realizing later that “cleaning” was actually having a pap smear done. I wonder if the people at the Social Hygiene Clinics ever really explain the purpose of doing a pap smear. After some more chit-chat, we gave them free condoms, thanked them for their time, and then headed back to Chrys and Suzi’s spot. While waiting for them to finish with their own audience several feet away, I got to witness more typical Makati street activity late in the evening, even if it was raining. Clusters of PIPs stayed on the sidewalk, waiting for ‘guests’ or customers. Every now and then a foreigner would walk by with a Makati girl in tow, all smiles. Later, Chrys and Suzi attracted a bigger audience, all males this time. And not long after, more condoms were given out. I heard a few more stories from Ate Roselynn as well, of how these girls in prostitution are also living with the risk of getting whisked off by guests in vehicles then getting gang-raped in a hotel.

Soon, it was past 10 pm. By this time on a normal Saturday night, I would be at home sitting in front of the TV set, watching a rerun of Lost. But for countless girls in entertainment districts all over Metro Manila, a normal Saturday night would mean getting dolled up and enticing guests to sleep with them just so they could pay for bills, or tuition, or medicines, or simply be assured of a full stomach next mealtime—and the more guests, the better. We did not stay until midnight, yet even for a few hours that night I got a closer glimpse of a world that I deliberately kept to the margins of my consciousness. Quite naturally, the girls did not easily open their lives up to me, an outsider. I could only surmise how desperate they are to be going out and offering sex for money so they could get by. Sally and Krystal appeared all perky when I talked with them. But when the gaiety and nonchalance wear out, how often are they haunted by the shame of what they do?

That night showed me how valuable the painstaking work of the CHOWs was. These PIPs would not readily come to PGH or to the local health center, and many apparently still have misconceptions about reproductive health and hygiene. Thus it is really better to go and reach them where they can be found. I hope that with persistent information and education campaigns, they would be stirred to act positively about taking care of their bodies. I hope more organizations will pay attention not just to their health needs, but to their emotional and spiritual needs as well. Frustrating as it is, I wish the government would do something substantial to alleviate their condition. While it seems that this Prevention Project is all we could do for them in the meantime, I hope we don’t resign ourselves to thinking that when it comes to radically changing the system, there is nothing much we can do. This bitter reality will go on if we do nothing else.

An Adventure of Faith

(Warning: Detailed kwento up ahead. ^__^ )

I just had a trip to Baguio that was unlike any I have had before. For the first time last week, I boarded a passenger bus bound for the Summer Capital—not for rest and recreation, but for a mission trek with some IVCF students. Just the fact that I was traveling without my family made me anticipate that it was going to be an exciting journey. But I had no idea how much of an adventure it would turn out to be until we arrived and actually began the tasks that we were to do: reaching out to our “M” cousins and sharing the Gospel to people downtown.

Trusting in the Lord’s guidance and leading was one lesson that stood out from day one. A few weeks before the trip, we were told that we would be assisting several churches and organizations in their outreach. So I assumed that it wouldn’t be too ‘labor-intensive’ on our part. But as Kuya Dave and Ate Jeanette oriented us, it wasn’t long before I realized that this trek would be no walk in the park. It turned out that the program with the “M” children would mostly be up to us, and the church youth would be the ones helping out. I wasn’t used to flexible and spontaneous schedules, and I felt a little overwhelmed about having to plan for something we haven’t really done before. But there was no choice but to trust Him and plunge ahead. I figured this was how God wanted it to be—that we wouldn’t be secure apart from Him.

The First Two Days

Our core team of 10 (including K. Dave) was divided into two groups for the two “M” communities we were going to visit. Faye, Ron, Alvin, Jaylord, Paul, Jana and K. Dave went to Central Ambiong, where they ministered to some 35 hyper-active kids. Jeremy, Cedrix and I were sent to the community at the Crystal Cave area. On our first morning, Kuya Carlo and Ate Beverly gave us a background about their ministry of helping several “M” children prepare for Grade 1, while at the same time building relationships with the parents. We also visited some families to see how they’re doing and inform them of the assessment that their children will undergo the next day. It was an encouragement to learn that most of Kuya and Ate’s students will be entering Grade 1 come June. The following morning, we finally met Aliyah, Jamaliah, Aiman, and Alida. After praying, brushing their teeth and singing some songs, Ate Beverly reviewed their counting lessons. And then, unexpectedly, more children came and wanted to join the class (they thought school at the center has started already). Ate Bevs just relented and let them in. The whole program was changed—since these kids weren’t exactly students yet—and given over to us. We taught them a little origami, and then I told a Bible story for the first time. I discovered that it was fun to teach little kids and they’re not really that hard to get along with. :) It was amazing, that morning—even if the academic assessment was cut short, Ate Bevs found new prospective students for the coming school year. God is good. :)

Monday and Tuesday afternoon, we went in pairs downtown to share the Gospel using tracts and Gospel bracelets. We tried SM on the first day (we didn’t really have much choice since it was raining hard). It was difficult—our first time to be deployed for ‘stranger evangelism’—and we all had to overcome our timidity. With much prayer and asking from the Holy Spirit, He led us and enabled us to share the Gospel to several people, but not without a few blunders, though (like not being able to follow up the bracelet with a tract). But we still learned a lot, especially about the importance of prayer and practice. The next day, God continued to reveal Himself, His goodness and grace. He held back the rain, to our amazement! Two teams, mine included, were able to go around and witness to people in Burnham Park. It was a better environment for talking with people; they were more relaxed, more accommodating (compared to the hustle and bustle and noise of SM). Even our sharing was somehow improved, no matter how little. I guess you could say that our “SM episode” prepared us for this next round of sharing. But I still pray that I’ll continue to learn how best to connect with people who need Him.

Rebukes, Eye-openers, and Lessons Learned

The third full day was another faith-stretching experience for me. We did an evangelistic gathering for the “M” teenagers who came over to Bibak Bible Church. With such short preparation (just the day before), and being “amateurs” in cross-cultural missions, we continued to hang on to the Spirit’s leading and enabling. Everybody enjoyed the games and the singing, but when it was time to give a short message from the Bible, I wondered and worried if we were getting through to them at all (knowing how short a kid’s attention span could get, and not to mention their religious background). I could sense that we would have to improve on several areas from that meeting. Nevertheless, broken vessels though we were, I know the Lord will carry out His task and work in the hearts of these students in His own ways.

Another blessing was how God brought to the same meeting one girl that we shared the Gospel to at SM. I almost assumed that she wouldn’t come, but she did—even if she had to travel from Marcos Highway. After lunch, Paul and I were able to follow her up and further explain the Gospel to her. Praise God that in the end, she prayed to receive Jesus Christ as her Lord and Savior. :) This was a somewhat unexpected but welcome turn of events; because when we first met her at SM, we thought that was going to be the last time we would see her. I felt a gentle rebuke from the Lord: Things aren’t always what they seem.

Apparently, that was not the last that I would get for the day. We were still scheduled to share the Gospel downtown for the last time. Unpredictably, after taking siesta, I grew tired of sharing and deep inside wished that we didn’t have to go anymore. As we went on our way to SM, I told God that I was struggling and just hung on to what a Kuya said way back—that the time when you don’t feel like sharing the Gospel (or praying or having your Quiet Time), is the time when you all the more should do so. And as it turned out, God actually proved this statement true. He gave me a fresh wave of encouragement through my KCmate Alf, who agreed to join me after work; even on short notice (this too I doubted would happen). With Alf’s help and God’s orchestrating hand, we had a good conversation with a nursing student who willingly gave her time and later decided to accept Christ’s gift of salvation. What’s even more wonderful was that she was from the University of the Cordilleras, where Alf was working as an IVCF Grad Team volunteer. She’s also acquainted with Alf’s student contact there, so there is opportunity to follow her up this June. Wow. God truly is sovereign. I struggled with feeling obliged to share, but in the end it is still He who has the last say and all the glory goes back to Him.

The five days we spent in Baguio kind of felt longer than they actually were, because of everything that happened. Kuya Dave was right; mission is romantic—it is full of unexpected surprises. I have actually come to associate this experience with the phrase “living on the edge.” Each day had a story of its own, filled with first times and many other adventures in various forms, but always with His signature written all over. He has taught me what it means to trust Him—and that is to pray hard, let go of my nervousness, hang on to Him and take that step of faith. I have also learned that it is God who opens hearts to respond to Him. I will never know who was sincere and who wasn’t among the people we shared with, or when they will decide to follow Jesus. All He asks of me is to just go and share the Gospel, and the rest is up to Him. I thank the Lord for the privilege to serve Him in a way I haven’t quite done before. Now, as I say goodbye to the summer, I pray that this experience will drive me to keep on laboring for more harvests for His Kingdom in my “home front”: the UP College of Medicine. ●

We Have A Long Way To Go

Hearing how the recent election was labeled ‘peaceful’ (relatively) gave me but little comfort about the condition of our nation. They say technology and more vigilance from the people have made it more difficult for fraudulent schemes to succeed. But then I watch the news, I read the news paper, and I hear of controversial ballots, flooding of counterfeit money in the provinces, bombs going off, a school getting burned, teachers, watchers, and even some officials getting killed, ballot-counting by candlelight, the never-ending count update of our utterly slow canvassing system (when, oh when will we be automated?), and how the partial senatorial tallies reflect what the people think of the administration.

There may be a few fresh winds blowing our way—a priest wins as Pampanga governor and vows a jueteng-and scam-free term, a positive alternative to the Senate presenting itself in the form of the Kapatiran party (yes, even if they’re trailing far behind), the Stars are fading, and most of the not-so-deserving did not really make it to the Top 12. At least we have that. (And maybe a few more that I am not aware of and so fail to mention here.) But I think these little sparks of hope are still in a big struggle to keep from getting snuffed out by the darkness. I strive to stay hopeful for my country, but sometimes the pessimism tries to strangle my dreams for this nation, and I cannot help but lament. We are still a corrupt people.

Let me share this vision for the nation that I am holding on to. Our church pastor was the one who wrote it, and he shared it with us a year ago (I can’t remember if it was during a worship service or a teaching session). The piece of paper got buried in the clutter on my desk, and I got reminded of it when I went on a mission to clear up that clutter. =) I hope this becomes your vision too.

What kind of PHILIPPINES do I long to see?

A land that is PEACEFUL. Where Muslims and Christians and animists and those with no religion at all can live together as friendly rivals but not as enemies. Where disputes are resolved by discussion and debate and not with the barrel of the gun. Where one may walk the streets at night unarmed and remain unharmed.

A people who are FREE. Free to think even the unthinkable, free to worship God according to one’s best light, free to elect rulers and to replace them, free to argue one’s case in the media, free to travel wherever one pleases, free to live and work anywhere in the islands.

A territory that is SOVEREIGN. Friendly with all her neighbors, and working in solidarity with them in promoting regional interests. Cordial with all nations in the East and the West, the North and the South, but sovereign in her foreign policy. Free to chart her own destiny for Filipinos have the special duty to promote the welfare of their nation.

A nation that is JUST. Every man and woman and child receives his/her due. The poor are not discriminated against because of ignorance or lack of access to legal services. Judges and justices cannot be bought but dispense and apply the law with impartiality. Equal pay is given for equal work. Everyone has equal opportunity for education, housing, employment, medical care, and other social services.

A community that is PARTICIPATORY. People taking responsibility for their lives, and increasingly empowered to do so. Making decisions that affect their families and neighborhoods, their towns and cities, and the entire country. Being responsible for one another for “each man is his brother’s keeper.” Political in the broadest and best sense. Our stewardship includes the care of the planet Earth, God’s appointed habitat for mankind.

A country that is PROSPEROUS. Not prosperity at the expense of freedom, but a progressive economy that grows from wise policies, efficient, government, and honest business practices. Prosperity that does not merely make the rich even richer, but one that benefits all the people, reaching to all parts of the countryside, finally breaking the back of centuries of feudalism.

A society that is RIGHTEOUS. Only through the Christian gospel are people “put right with God,” so we evangelize as vigorously as we can. However, there is a public righteousness that Christians can promote as salt of the earth and light of the world. As an “overwhelming minority,” we can influence the rest of society to minimize graft, tax evasion, violence, prostitution, and other expressions of a corrupt society. “Righteousness exalts a nation, but sin is a disgrace to any people” (Proverbs 14:34).

(Sgd.) Ida Ingrid Rocha
Date: June 25, 2006