57/M

Dad's gonna expire in 6 months time. Thats what his doctors told him earlier.

This is the case of M.F./57 year old male who came in due to difficulty of breathing.

2 days PTC, patient suddenly experienced severe dyspnea associated and exacerbated by movement. No other signs and symptoms noted except for easy fatigability.

Signs and symptoms persisted; hence, consult.

Patient is a known diabetic and hypertensive. He was also diagnosed with kidney and gall stones three years prior to current consult. Patient underwent angioplasty 10 years prior. He was also diagnised CAD 10 years prior. No other surgical histories noted.

Patient's dad died of pancreatic cancer while his mom died of colonic cancer. Hypertension, dyslipidemia, diabetes are all present in his family.

He was a previous smoker and an alcoholic. Patient stopped smoking and drinking alcohol when he was diagnosed with CAD 10 years prior.

Solitude

The past few months were complicated. My journey has been tainted with blood-- battle wounds and scars. For the past few months, I've been unconsciously containing my feelings and emotions. I have been unintentionally blocking my frontal lobe to feel pain, happiness, and shame. 

Lola died a few months ago. Just yesterday, one of my uncles died and before that, my dad was diagnosed with pancreatic cancer with liver metastasis. All these passed without me feeling the deep emotional thing that usual people feel when they are faced with these circumstances. 

I am confused. I'm confused with the fact that I draw positive things from these "painful" situations. I'm afraid that I have converted myself into an apathetic person. I am afraid that I might care less in more sad yet relevant life situations. I am afraid of being the person that I don't like. 

I am afraid. I am confused. I am human. I am in solitude.

  

 

Free Fall

I completely and wholeheartedly believe in my capabilities, talents, and individuality... that's why i continuously dream, hope, and wish BIG TIME. However, whenever I don't get what I dream of, I succumb in pity blaming everything to myself.

I have been raised as an individual who thinks positively of life. I was given all needed support in order to get what i want. I was nurtured by my parents to become the best that i could be or at least think the best that i can be. These things are some reasons why i set limitless borders in terms of my journey towards my Disneyland.

I set skyrocketing targets in life. I wish to be the best in all aspects; i aim to be perfect; i aim to be on top. That's who I am. But how I wish, i could best all these.

When I was in High School, I did nothing to be on top of my whole batch. I go home, i do my homework. No extra effort. Just like any classroom kid. I got the top spot without dirt on my hands. That was when I started to boast silently  that hey, I'm the best out of these 300++ students. That's part of my bragging rights before, I claimed. I was labeled as intelligent, talented, and "distinctly one of the best". Such a nice feeling.

College came. Still with my usual get-up... not studying, not listening during lectures, not making extra efforts.  Beautiful thing was, despite my "katamaran", i always end up *scratching my head* in the deans list; mind you that was 1st to 4th year. At the end of 4th year, I wished to finish with merits i.e. cumlaude but wasn't able to reach the needed grade. I lacked 1 point. I got disappointed in myself but was able to move on after a while.

Now, med school came. When I met my classmates for the first time (that was when I was in first year, of course), I got intimidated, honestly. From a simple student from the province (well actually not a province but away from MM) now entering the big university of Ateneo (sorry, THE Ateneo), what would you expect? CULTURE SHOCK.  I was so intimidated that I labeled myself as stupid and incompetent. However, there's still that slight pride in me that says, hey, you can do it! YOU CAN BEAT THEM (yes, i'm a competitive person)! But yeah, i tagged along eventually. Time passed and then i realized, Im not doing good in Med School. Least that I asked myself was to be with the creme de la creme-- the top 10. But I always fail. However, being that person that I am, i still continue to believe in myself. The irony of rationalizing. (Honestly, i get hurt, irritated, and frustrated)  

Well  I guess, there's nothing wrong with setting skyrocketing standards... its just that... you have to prepare yourself for the big drop when something weird happens along the path. And another thing, i guess, one must take it with a free fall feel. 

The Last Battle and Flight of the Condor

At the end of it all, we will all die.

Yesterday, my grandmother died. I received a call from my sister. She was crying. At first, I was not able to understand what she was saying because all i hear were sobs. Then it came to me, what she was saying was, lola was pronounced dead just 15 mins prior to her call.

Honestly, I was not surprised. As what I said, the one certain thing that i know in life is that death is just around each one's corner. The fact that lola had been suffering for about a week with her sickness, her old age, I had already a foresight that she will expire anytime soon. I was at the ER department that time. It was 4:00 PM. Patients were clamoring along the corridors of the hospital-- it was a toxic afternoon... then i got the call.

Few seconds after i ended the call, i slowed down. I didn't know what to feel. I equipped myself with strength and prepared myself for her death that my feelings were obscured. I continued my work. I got three more patients to admit, three more patients to hear their own illness stories. I pretended to be strong when in fact, i was deeply confused of what to feel.

Endorsements came, SGD followed. I still tried to remain focused. I have not told anyone of what happened to my loving lola. I kept myself busy so as not to think about what just had happened. My ER duty rotation for that day ended and I needed to go home.

I was at the foyer of the hospital, waiting for a cab. Now, thinking of what really happened. Now, the thought of my lola just passing away slowly overwhelmed me. I got a cab, we stopped at a stop light. I saw the lights. Red, Yellow... green. Tears fell from my eyes.

I couldn't help but cry. I cried for the loss of my one and only lola. My lola who has been forever-ly supportive of my life. She was the gospel of my books. She's one of my inspirations. Now, she's gone.

I'm not sad because she passed away or that I'll never see her again. I'm sad because i wasn't there and i wasn't able to say my goodbyes... or ever said to her that i love her.

You will always be in my heart lola and that everything that you said to me, i will not forget. I will do my best in everything that i'll do. I promise. I love you so much po.

Rest in peace my dear lola. Good bye.

The Code Blue

"Everything was fine until few hours after,
 patient bled inside her head."

I ended up my rotation in the ICU with a Code Blue--a patient arrested.

The night prior, patient A succumbed into a cerebral infarct. As what doctors usually do, they provide antithrombolytics and all. Patient stabilized for a while. Vitals were normal. There were no signs of respiratory distress. Everything was fine until few hours after, patient bled inside her head. From this point forward, everything went in a down slope pattern.

Patient was ordered a stat craniotomy to drain the hemorrhage. In total, patient was under the knife for about 5 hours.

There was a call from the OR that patient A is desaturating and that she'd be transferred to the ICU for stabilization. Patient was brought to the ICU by the surgical team. At first, i thought everything was okay until one of them shouted: "We're on code blue"

"Patient went asystole for 6 minutes"

That was the first time that i'd really felt a patient's soul trying to leap out of its body. Asystole. Everything was being done to her but to no eventful results. Arterial and venous lines were added, blood transfusions were given stat. A central line was placed. Boluses of epinephrine, bicarb, and atropine were given. Cardiac resuscitation was being done simultaneously until a pulse of showed up. Patient went under arrest for over 6 minutes. That, i must say is long. That, according to studies is tantamount to brain damage.

The patient survived; however, stepping back, I would say the life of the patient may have only been prolonged for just days. I hope she lives longer. I hope she can fight-off her illness. I hope that one day, she'd be able to function again. And I hope, that after all these things, I'd never see her again in my entire practice.

Death is just around the corners of the ICU or should I say around us. We can never know when a patient or when we will expire; what we only know is that living is a slow process of meeting our end, inevitable  goal-- death.

The Intensive Care Unit

I'm currently rotating as a junior intern at the ICU. Being a junior intern is no joke. As they say, this year would be the worst year of my medical-student-life and this is just the second week of my rotations. It is difficult, i tell you. Not only does lack of sleep  pushes you to your limits; the agonizing emotional and psychological aspects does, too, contribute to the difficulty of being a junior intern.

Let me tell you what the routine is in the ICU. Everyday (morning and afternoon), we do rounds on all our patients. We have at least 15-20 patients a day. The team of doctors includes two consultants, three fellows, 5-6 residents (neuro, cardio, infectious, et. al.), 1 senior and 4 junior interns. The team discusses the cases one by one- from one room to another. It is like doing window shopping; however, a lot more intimate and requires more of intelligence. We discuss the cases in front of the patient; however, they can'thear us because the person of interest  is separated by the glass panel from us (and yes, i think they are sound protected). Here, we try to predict the future of the patient- will he live or die. Questions are always raised by the consultant. Usually, all these questions are addressed to the junior interns. Which makes the lives of junior interns toxic.

The junior interns are what they call the lowest breed of doctors and as of now, i am part of this. We are the ones who usually get challenged and ridiculed. We are the ones who, literally, do not have anything to offer. We are the "slaves" of the team. This may sound devastating and saddening; however, this has been how the system has been going since time immemorial. I myself, have already been humiliated in front of the team. But oh well. Our curriculum tries to defy this; however, it can only do as much, as of now.

I call their ICU team as the Team of Extraordinary Brain Cells. For heaven's sake, the team consists of intelligent, highly reasonable, objective, and very competent doctors. They can throw multitudes of differential diagnoses and can defend such in just few seconds. I am amazed how these doctors were trained. I was owe-struck on my first day of rotation on how they are able to memorize all lab values of their patients down to the last decimal. Believe me, they are really that good. Here i saw the pseudogods they are telling. Downside, what I personally think is, they purposely detached themselves from the souls of their patients.

Tomorrow would be the last day of my rotation there. I'm not sure if i'm gonna miss the team, the pride, the angst, or not. I'm not sure if i'd like to go back there. I really don't. I'm happy about the rotation; however, i think, i was caught in between intimidation and self-preservation.

     

Medesina

Going into medical school isn't just a "one-night-stand" decision. It must involve a thorough investigation of one's own strengths, weaknesses, passions, and desires. It is a lifelong process of rediscovering one'self and being open minded to all things in life. Once you enter med school, you willingly embraced a lot of heartaches, disappointments, and sacrifices. Once you finish med school, you opened gates for a lifelong journey with science, religion, and human epitome.

Insensitive

It's plainly BS that you still talk to my relatives and closest friends while you continuously hurt me.

Happy 6th Anniversary

Today, I lost everything that I had. It could have been easier that I’ve lost all my material possessions in life than me losing this—the person who gives me life.

Today is our anniversary, our 6^th anniversary. I was studying in my unit. I told her that I won’t make things possible for this day because I need to cram for tomorrow’s exam. Well, she surprised me.

I heard a knock on my door. First, I ignored it. The second time I heard the knocking, I stood up. I looked into the pin hole and saw no one. I opened the door and there, I found her.  She brought dinner for me.

Yes, I was surprised that she was there but I’m the bastard who doesn’t appreciate surprises. She brought dinner for the both of us. She had a liter of coke on her left hand and a yellow cab pizza with a brown bag on the other hand. She entered the room. I did nothing.

I kissed her. She kissed back. She was still the same—same sweet perfume, those beautiful eyes.  She walked inside. I took the seat of my table. She sat on my bed. I did nothing.

I opened the last three pages of one of my readings. I studied without acknowledging her being there. She stood up, said something like: “it’s hot”. I smiled at her then returned my glance to what I was reading.

She walked near the balcony of my windows. I glanced at her. She pulled her black straight hair up. She was searching for a breeze of air. There was none. I ignored her.

As I finished what I was reading, I called her. “Baby!” I screamed. There was no response. She was still looking outside my opened window. I called her twice, no answer. I stood up, came closer to her and asked: What’s the matter? “Nothing”--a soft wimping sound broke. I took a look at her. She was crying.

I’m no good when I see people cry. She knows this. So I sat down, back to my table. I tried to do something. I panicked.  I got my stash of cigarettes, went to the bathroom, turned on the ventilator, turned on the faucets and the shower. I stayed there for about 15 minutes. I lit a cigarette as I calmly hear the rustling of the flowing water.

I went out. I asked her, now sitting on my bed, “What’s the matter?” She replied in a soft tone: “I wasn’t expecting that kind of reaction from you” I frowned and felt a lot more uneasy.

I took a sit. I tried to mutter a word but nothing came out. “I just want to surprise you” she said. Still, no words came out from me. She stood up. She grabbed her bag, pulled a book and left the book right in front of my nose—The 48 Laws of Power, my favorite book. She left.

Now, I’m fucking angry at myself. I hate the whole of me. I hate myself. I don’t want to be this kind of person anymore. L

Sembreak's Over

I wanted to stay with my family... but then again, goodbyes must be made. This has been my pattern and this will always be the cycle of my life. This is fucking terrible.

I think I have an anxiety problem-- separation anxiety. I feel down right now. I feel sick. Post a differential-- somatization.

Oh well, life must go on. I have to be strong. I have to live strong. Mantra repetition: I will make this, I will live this, I love this.