lefthand's blog

the mission

            I’m back to watching House, MD.

I suppose this is another one of my ploys to get my interest (in medicine) back.  It has to work.  It should work.  I’m still trying to get hold of a DVD player so I can watch ER.

But Community (and Family) Medicine is actually something I like.  Maybe it’ll help that it’s my last rotation, same as last year as a Junior Intern.

Last Saturday, for my first day in Community Medicine, we had a medical mission deep into one of the barangay’s we would have to serve.  The smell of tobacco was unmistakable as we were set up in a covered gym near a tobacco factory.  No wonder we get all kinds of respiratory consults.

A long time ago I always thought medical missions were the way to go.  But as I went through med school (actually, as I got older) I understood that in the bigger picture of health care they almost mean nothing.  The people who actually seek consult during med missions are not always that concerned about their health.  They’re just there for the freebies.  I generally ask patients to follow-up in their local health centers but I suppose only a small fraction do.

I do understand that however one looks at it medical missions are still a lot of help.  But I wish I could instill in those patients that health care is not a one way street.  Wellness and Health Care is a big highway where the input of the patients and their relatives mean as much as the input of the health care staff.  I want to tell them, I’m giving you this consult not just to give you free meds.  I’m here not to treat your cough/ colds/ headache/ dizziness/ muscle ache/ stomachache or whatever you have.  I am here to educate you to take better care of your health.  I am here to tell you there is much you can do to make things better.

But how exactly can I say so much in a span of a 5-minute consult when all they want is for me to give them a prescription so they can get multivitamins and cough syrup from the pharmacy for free?

 

There just has to be a better way.

firefly

"Death is not the opposite of life, but a part of it."  - Firefly, Haruki Murakami

After responding to codes every single night of my Internal Medicine duty it is hard not to view death as a common occurrence.  I am able to act nonchalant and joke about during a code - something I try not to do for the sake of the patient's relatives.  When the code doesn't go well, as some inevitably do, I am left with crying or shocked relatives looking on as the nurses start postmortem care.  And while I can now handle seeing my patient's die, what I need to learn is how to talk to those relatives left behind.  I didn't take the death of my grandfather very well year's ago.  I'm not expecting these people to take their loved one's death any better.  But beyond the pat on the back and quiet words of condolences to relatives there really isn't much I can do right now.

I suppose a priest would be better equipped to handle these situations.  But what if the relatives are people who don't believe in a god or a heaven?  Saying that the recently departed is in a better place will certainly be of no help at all.  Nor will talking about death as being part of the circle of life.

How to?  How to?

"Dying is easy, living is hard."

pisay

Finally got to see it.  Now I'm feeling a little bit nostalgic.  Egis, er'p!

Pisay

IM blues

 

mismatched limb leads of the ecg

    
       I suppose it's true what a co-intern says.  It's almost like I've been demoted.  My exhilarating ER days were over 2 weeks ago.  Last week I was stuck rounding at the ward, where when I go on duty I seem to be doing both the writing of orders in the chart and the actual carrying out of the orders.  [Where are the good and efficient nurses when you need them?  They've all gone away abroad to seek greener pastures leaving behind arrogant half-wits who think that charting is the priority above giving of meds and actual taking care of patients].  These days I'm stuck at the ICU staring through glass doors at patients who don't seem to be getting any better.  On weekends and when I go on duty I become the ICU Medical Intern/ ECG Technician-on-duty for the WHOLE hospital.  If I would get paid even a fraction of the cost for each ECG I take per duty I'd have enough money to celebrate on weekends and feed me on the weekdays.  Alas, I'm still not getting anything from all the hard work.  Even the learning I'm supposed to be getting is not commensurate with the number of hours I spend in the hospital.

       These days I'm trying to get that bounce back in my steps -- a literal bounce I seemed to have lost after I left the ER.  Truth be told, I'm tired and feeling bummed out about my low productivity.  I have a week's worth of one-disease-per-day reading to catch up on. At the same time I need a weekend off to just chill. 

       I go on duty again this Sunday.  I still think I should go into Internal Medicine for my residency training but lately I've been really worried.  If the total lack of interest I am showing is any indication of what my outlook in residency will be I doubt that IM would be the best fit for me.

in search of a new game shirt

         I have a game shirt (game blouse, actually).  It's my favorite pink button-down blouse I always wear on the first day of my rotations or my first ER duty.  I wear it when I'm expecting a toxic hospital stay or 24-hour duty.  Because when I can't stop every few hours to freshen up and look pretty, when I'm wearing my game shirt I know I at least look presentable every time.  At the same time I'm more than comfortable wearing it.

       With my internship program taking me to different hospitals and subspecialty rotations every few weeks you can just imagine how many times I've worn my game shirt.  It isn't tattered and torn yet, but I suppose its close.  A dozen more firsts and ER duties and it will probably stop looking presentable.

      I need a new game shirt.

*            *            *

       Day 3. First ER duty.  My game shirt is buried under a mountain of laundry.  To make up for its loss I slept early the night before my duty.  I woke up early on my duty day, ate a full breakfast and had a good cup of coffee.  I took an antihistamine just in case my allergic rhinitis rears it's angry head and took two puffs of my Salbutamol inhaler.  Certainly no one can fault me for being prepared. 

        The only thing missing was my game shirt.

        I need a new game shirt.
    

addendum

3 am on a school day

For February, my goal is to read on one disease per day.  I repeat, one disease per day.

That should amount to a lot in one year.  Yey!

wax

        Much can be said about last month's Internal Medicine subspecialty rotation.  The only reason there hasn't been any posts is because after getting over internet connection problems my hard drive decided to take a long vacation - the permanent kind.  Of course, I had it repaired immediately -- I can't be away from my laptop too long. Hehe: )  The sucky thing about it is I wasn't able to back up recent downloaded articles, case presentations and all the pictures I took during my internship.  They're all gone now.  I can only wax nostalgic about them.

       More to come (including back logs) . . . for I miss blogging.

thoughts from previous rotations

        General Medicine rotation.  Day 1.  I was sitting attentively as endorsements started and the junior resident from duty ran down the admissions. 

       I always enjoyed morning endorsements even when I was a junior intern.  For me so much learning occurs in that hour of grilling and review of patient's management.  And every time a senior says something however cliche they may sound I swallow them whole like pearls of wisdom, because most of the time that's exactly what they are.  Plus the fact that when you're so lost and you feel like you have no idea what you're doing those words are exactly what gets you through the day.

       *               *               *

       I have absolutely great respect for residents/interns' monitors who make it a point to teach.  A lot can be learned from observing the residents as they work, but so much more is ingrained into one's system if the rationale behind each patient's management is explained.  Which is why I make it a point to tail residents who do teach.  Most interns I know don't like to do this because when you do rounds with residents there are a gazillion calls over the paging system and there is no way you can answer them while you're doing rounds.  And even after 30 minutes of not answering calls I usually get buried under a ton of paperwork and errands to do.  And of course, rounds with residents generally mean sleeping late into the morning or not sleeping at all.  Because their work never stops.  But I figured, one night's worth of lost sleep is the lesser evil compared to a week's worth of reading textbooks and never really understanding anything.

*                *                *

Always remember:  Treat the patient  . . . not the chart.

(Even with standing orders to be carried out automatically for specific patient complaints, symptoms, etc., go see the patient each and every time something new comes up.  Never just add another order from the already long list of orders to be carried out without first checking up on them.)

nugget

COPD* is like a diamond . . . it lasts forever.

   
      Just a tiny nugget from the recently concluded Post Graduate Course on common pulmonary diseases held at the Lung Center of the Philippines.


*Chronic Obstructive Pulmonary Disease

tidbits

9:32 am. 

Someone comes down from a red car and knocks on the glass door of the ER.  "Stretcher," he shouts, "and fast!"  The nurse opens the door and a nursing attendant pushes a stretcher out.  A young man is carrying a cachectic old woman onto the stretcher.  We notice her pale skin immediately.  My co-intern touches her forearm, then shot a meaningful glance at me across the stretcher.  She immediately pulls out her stethoscope and listens for her heartbeat as the stretcher is being rolled in.  A few seconds later she looks at me again and shakes her head.

I say one word which mobilizes both my co-interns and I:  CODE.

Intern C starts doing CPR.  Intern V grabs the ambubag, hooks it to oxygen and starts bagging.  I check the patient's forearm and see an existing heplock.  I say to the nurse next to me "Ma'am, one epi," and head to the supplies saying "IV line please."  All three interns automatically go into action to resuscitate the patient. 

For a split second all three of us stop and we suddenly notice that none of the nurses are responding to our call.  The sad reality suddenly slips in.  Anywhere else we could run a code.  But in that particular hospital, we were just interns.  And none of the nurses would carry out something we ordered.

The fellow on duty was paged and arrived shortly.  He stood there at the foot of the stretcher and simply said "Epi.  IV line."  Then, everything was a flurry of motion as the nurses rolled into action to get the crash cart, start a line and prep for an intubation.

A sad day at the ER.  A no win situation.