Saturday, August 27, 2011
Death and Lessons from Google
Wednesday, December 1, 2010
Clichés and the End of R1 Year
I am happy to report that I learned a lot this year, not only about Internal Medicine but also about the more important thing in my profession: interpersonal relationships. I learned that people handle stress in many different ways and sometimes, one needs to let things slide to attain some form of peace. I also learned the value of being quick to apologize and admit error. I quickly averted several potential disasters just by immediately admitting my mistake and promising to do better next time. It's a work in progress but I'm slowly getting a handle on my temper and my impatience with incompetence, as I realize that I am incompetent more times than I care to admit, and in worse ways. Something Dr. Bengzon once said struck me and I think about it every time a patient (or family member) poses a "challenge": our patients remind us of our humanity. We are all impatient, difficult, cranky, and demanding at one point or another. We are all apprehensive about death and disease, albeit in variable degrees. These thoughts help me to maintain my composure, take a quick breath, and move on with my work.
This year, I also learned some good Medicine, mostly from the people who took the time to teach. We all had virtually no time to read Harrinson's so we were mostly learning by leeching: "leeching rounds," as one pre-resident put it. At one point, I was reading ECG tracings from a treadmill stress test and I remembered the time when I was a clerk and I was so impressed by the cardiology fellows who seemed to have read these same tracings as if it were a book, almost efortlessly. My clerkship self would be proud of my resident self, I think.
The learning was there. But the learning came with a huge price tag. Late nights, sleepless nights, missed time with family and friends ... the list is substantial. The way I coped, however, was to always have my long term goals in mind. As another cliché goes, I "kept my eye on the prize." I knew that sooner or later, R1 year would be over and I'd be moving on to more challenging stuff. But I'd be MOVING on and that means, pretty soon, the entire ordeal of residency would soon be over.
The Lord has shown me grace upon grace this year and my friend Angel, just tonight, reminded me of how undeserving I am of the favor I received from Him. He has been my source of strength, my source of peace, and the One who stretched my limits even more when I thought I had nothing else to give. He has given me an excellent set of duty mates (and now great friends) the past few months. He has sustained me through the most toxic of duty nights and has given me wisdom enough that I don't have screw-ups that endangered any of my patients' lives. As an added bonus, I get to do something I love more than medicine: teach. It might well be my only drive to read and study up on my cases.
I may be looking back and seeing things through rose-colored lenses because I am at a high right now: it is my last day as an R1 (and all its accompanying baggage, like DS!) and I had a pretty good dinner (more like excellent, really). But as I remember the year that has passed, it strikes me as being an over-all very positive year. And this makes me extremely happy. If you will notice the description I post about myself in my blog: "An occasional writer whose current preoccupation is getting through medical training unscathed and unjaded." I may have been scathed and stung the past year but I am as unjaded and enthusiastic about my work as the day I first started last year, considering everything that has happened. The ER and hemodialysis (and many more R2 issues) may quite possibly kill the buzz. But I say, bring it on.
Tuesday, December 1, 2009
First Day Blues
Tomorrow's going to be a brand new day. I just hope I wiped the slate clean this afternoon.
Wednesday, October 21, 2009
Reflections on the Pre-Residency Experience
Pre-Residency allowed me to refocus my mind and my heart on clinical work. I’ve been away from clinical practice for a few months, almost a year, really. It takes a while to get back into the groove. The three-week foretaste allowed me to remind myself of the need to balance the clinical and the academic side of medicine. It brought to fore all the dusty boxes of (what I thought were useless and trivial) medical information I learned from medical school, those phrases I highlighted in books using colorful markers and remembered only for the sake of tests and which I never thought I’d use.
I have never experienced being a resident before. I had an idea of the kind of work the residents did but it wasn’t a complete picture. I was a kid on the outside looking in. The past three weeks gave me an insider viewpoint and what I saw fascinated me. Residents, especially those in the first year, are in a very unique position to CARE for their patients. Their constant presence on the floor gives them the opportunity to develop something more than rapport with the people they admit into their wards; they the golden opportunity to establish genuine relationships with patients. This is something I have set forth as one of my goals when I made the decision to go into Internal Medicine.
For this realization and reminder, I have one first year resident to thank. He was my resident-buddy for about a week. This was enough time for me to witness the way he interacted with his patients and his genuine care for their welfare, something that went beyond facilitating labs and making sure they were discharged alive at the end of a set period of time. This isn’t to say the other residents I worked with were horrible. They were excellent in their own way but this guy went the extra mile. He held his patients’ hands, spent time explaining the case to them and their families, and, short of praying for them, he said “God bless” as he exited the room each and every morning after the routine morning visit. By the time these patients are discharged, this resident not only knew his patients completely, but he also knew the family members and the watchers.
By way of completing my requirements for the US Match, I drafted a “Personal Statement” wherein I outlined the reasons why I wanted to go into Internal Medicine. This essay was a chance for me to organize my thoughts and formally state on paper my reasons for the life-changing decisions I have made the past few years. In it, I wrote this: “At about this time, I had given much thought to what I would do after medical school. I was now sure that I wanted two things: I wanted to build significant connections with my patients and I also knew that I wanted to get the best training available. These premises led me to two things: first, I decided to go into Internal Medicine, and second, I started to look into doing residency in the United States...” And further on: “Internal Medicine is a specialty that deals with problems that usually require long-term care – diabetes and hypertension are not addressed overnight. As such, I saw it as a great opportunity to build long-lasting relationships with my patients.” I may not have gotten a training position in the US, and I believe this is something the Lord ordained, but my reasons for going into IM remain the same.
I post this here as a future reminder to myself. I went into Internal Medicine for all the right reasons. I am sure of it. It is my prayer that the challenges that come with residency training won’t leave me jaded and calloused. This resident allowed me to see that it IS possible to remain caring and compassionate while handling all the stress of residency life. Indeed, I pray that the three years I am about to invest in IM, while training me to be critical and objective, will leave my heart raw and bleeding for the concerns and the suffering of the sick patients that the Lord will bring to my floor, unit, or office door.
Friday, October 9, 2009
Code #1
After grabbing a bit of lunch at 2pm, while we were waiting for endorsements at the office, a Code* was sounded. It was our patient. We rushed up to his room and found full resuscitative efforts under way. CPR was administered, along with injections of medications and infusion of fluids. I stood there, helpless, and for the first time that I can ever remember, I was affected by the resuscitation scene unfolding before me. I had never met the patient before this morning and had only briefly spoken with him and his wife. But for some reason, this code was different from all the others. Maybe it was because of the wife crying quietly beside me outside the room. Maybe it was the fact that as soon as I noticed the patient's fast breathing, I knew something was wrong. Whatever it was, I was affected by that picture before me, a middle-aged man, at the prime of his life, previously healthy, just lying there literally breathless, pulseless, lifeless.
As doctors, we are trained to distance ourselves emotionally from scenes like these. It is the only way we are able to think clearly, to do the right thing and give the proper treatment at the exact time it is needed. We need to be objective and critical, and emotions will always affect our judgment. We can feel sad and sorry for our patients, but not when our clear judgments are needed the most. I've seen many codes before, and in fact lost my first laptop when I rushed to one in med school. There will be many more codes in the future. But for some reason, I feel this code will always stick out in my memory, a reminder that doctors need to be human and emotional too, albeit at the proper time.
As my resident was writing post-mortem orders in the patient's chart, a nurse passing behind me at the station said, "just another day at work." For the medical team, perhaps it is. For the family of this patient, not by a million miles.
*For my non-medical friends, a "Code" is sounded in the hospital's paging system whenever a patient "crashes," i.e., loses a pulse, stops breathing, or generally becomes unresponsive. You might be familiar with CPR scenes like these in shows like Grey's Anatomy or E.R, but it is rarely as dramatic.
Thursday, October 1, 2009
First Day and On Call
I'm sure future entries on this blog won't always be this, umm, happy. But allow me just this once to bask in the newness of my situation and the positive anticipation for the adventures about to come my way.
Sent from a BB.
Tuesday, September 29, 2009
Beginnings
But the cycle of life continues and I am about to embark on a journey that is the whole point of this new blog.
First, the back story. I have written about this extensively on my main blog, Chronicles of Boredom, and I will preface it here briefly.
The idea of going to the United States for residency training congealed in my head in sophomore year of medical school. I started reading about how the system works and by the time I graduated, I knew what I was supposed to do. After taking and passing my country’s Physician Licensure Examination in 2007, I started preparing for the USMLE. For the next year and a half, I was studying and laying down the foundation for what I hoped was a brief training stint in the US. I had intended to go for the 2009 Match cycle and the whole application effort culminated in a 6-month trip to the US beginning October 2008. I did a month-long observership with a cardiologist in Florida and attended an interview at a hospital in New York. I then waited it out in San Francisco. The Match results came out in March 2009, and I didn’t match into a program. A last-ditch attempt at Scrambling also proved fruitless. While there was much disappointment in my heart, I knew then that I was coming home to a definite path set by the Lord. He meant for me to stay in my homeland and train here. I returned to the Philippines in the last few days of March 2009 and have been waiting for this present moment since.
Upon my arrival, I was sure of three things, although I was initially in denial. First was that I was meant to return home and train here. Second was that I was going to apply to only one hospital’s internal medicine residency program. Third was that I have no idea what will happen after my three years of IM training. I submitted my application to the hospital in early September 2009. I sat for my interview with the training officer and chief residents a week later. A week ago, I was informed that I was accepted as a pre-resident. I’m attending the pre-residency orientation on Wednesday, 30 September 2009, and I am to begin working the following day.
A side note: Pre-residency is something unheard of in the US. It is part of the evaluation/application process in residency programs in the Philippines. The pre-resident works with a current first-year (incoming second-year) resident and learns the ropes. In the process, the pre-resident is evaluated based on his work ethic, ability to interact with patients and co-workers, and his medical knowledge. At the end of a set time, typically a month, the training committee of the program will evaluate who among the pre-residents will be accepted as first year residents. Most programs will allow them to begin working as official first year residents in either December or January.
While I have some idea about the life of a first-year resident (the US system calls this ‘internship year’ but in the Philippines, ‘internship’ is a different process), I don’t really know busy I’ll actually be and how often I can update this blog. But I intend to use this space as a cathartic medium. I’ve always found writing relaxing and it allows me to clear up my thinking. I also didn’t want to mix these entries up with my main blog. In my own little way, I can have a bit of organization too. Finally, I’m writing about my experiences in the hope that someday, somewhere, some first year resident or med student is going to read my entries and pick up a little piece of encouragement, or entertainment, or maybe even wisdom.
Welcome to Chronicles of Medical Residency. I hope that you will join me for this ride.