Physicians- Masochists and Sadists

It has been quite a while since I updated this blog site. I haven’t been writing anything just because I really got busy. 

Good news,  I am now a senior intern. Senior internship in medicine is known to be the most benign year in the medical profession. It is the year when you get a lot of alone time to study to prepare for the much awaited licensure examination.  They say that internship is the “rest year”; however, in our case, it is not.

I am currently rotating at the Surgery department—the department that I loved most when I was still a junior. I thought I’d be a part of this team someday; however, things changed. Now, I just don’t feel being part of the team anymore. Yes, I am still interested in the skill and knowledge but after reflecting and stepping back, I have discovered that surgery isn't for me. I cannot see myself in 10 or 20 years in the operating room cutting people. Also, surgery is not that “fun” anymore—it just mutated into an evil beast excited to devour me. 

I want things to go on fast forward mode. I want to end this madness. I am seriously getting tired of the routinary activities that we do. I hate the pre-duty-from sched. I'm sick of it. But, then again, I entered this harsh profession and I promised to finish this with finesse. 

Six months, and i'll be over this. Six months of torture, I must say. I am surviving this crap because in one way or another, I enjoy being guillotined to death. 

I conclude that physicians are all masochists and partly, sadists. I wonder why the culture in Medicine has been so awful that it became the norm. I wonder why hierarchy has been part and parcel of this profession. Once, I believed that Physicians are a conglomeration of people who just want to help others through health. I am surprised that physicians are mostly a group of intelligent, ego-centric individuals who try to get satisfaction by 1) helping their patients 2) humiliating their juniors and 3) making things complicated even if they're not.

Medicine has its own world that "ordinary" people will never fully understand. I guess, they'd have a glimpse of such only up until they submerge their heads into the life of being a doctor.   

Greed

When i was in college, during one of my public speaking classes, the professor asked an impromtu question to one of my friends. The question was simple and basic: "for you, what is the most dreaded disease?" Internalizing and feeling that i'm the one being questioned, thoughts of physical illnesses came rushing in my head-- heart disease, cancer, etc.

I was taken aback when my friend answered in a very soft, convincing voice. She said: "greed."

True enough and I have to agree that greed is the most prevalent disease in the world. We witness this everyday. We feel this. It is existing within and among us. It saddens me that most of time when I encounter people, they worry about money and how to get more of it. People are so overwhelmed and compelled to get more than what they need. Most people nowadays think that money is the answer to everything and that it is the main source of happiness; which I think is just wrong.  I wont be a hypocrite here. I myself had been greedy, well not only once but many times. However, i cant totally blame these people or myself for being greedy at times.

There is just so much in the world that we want to have or at least try. There are so many external factors that push us to be greedy. Also, we may have our inner id that  have gone overdrive. We as individuals innately want to have more. Theories in human behavior can attest to this. However, what I guess is more important is on how we deal with this compulsion. Just like in government, we should have a check and balance scheme. We need to constantly reflect and be wary of things that we do. We have to achieve a level of equilibrium where we learn that this inner desire of us wanting more should be tapered down.

What is wrong with greed? I seriously do not know. However, if we believe in the principle of justice where everything must be shared by everyone and that there is right distribution of resources, then i guess, there is something wrong with it. Then again, this is not absolute in all conditions. Bottom line is, we must continuously reevaluate our perspective of what is moral and immoral for us. We must define what we believe in and apply it in our daily life.

As for me, i rest the case that greed is immortal and that it will loiter our minds forever.

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.