Rehab?

Rehab is not the most popular department in PGH, and I am being kind.  Most students hate it.  At some point, I did.  But quite honestly, I am attracted to the field.  I've been vocal about it, and most, if not all of the people who learned that I am highly considering to train under the department distort their faces in disbelief.  

But I like it.  I like it because in the spectrum of patient care, rehab is in the last phase, where our primary goal is not to make the patient live per se, but to make life a little better.  We make people walk better, talk better, function better.  I find that fulfilling.  And there are just a few rehab doctors in the country.  So why not?

Last week, during one of my OR assists, the consultant and the senior resident asked me what my plans are after internship.  I said I don't have a definite answer yet but I am highly considering Rehab Med, then I stated my reasons.  Well they were surprised (I was not able to see face distortion since we were all wearing masks, hehe)  But Dr. De Vera said it's a smart choice, and it's a good field.  Dr. De Dios then remembered that she has a Rehab book from way back and she promised to give it to me.

Early this week, some of my co-interns informed me that a certain Dr. Lee was looking for me.  I wasn't sure how she looks like, so I said I'm going to approach her if I get the chance during the conference.  And I found her, and she found me.  I've been looking for you since forever!  And guess what, it's because of the Rehab book.

Dr. De Dios instructed Dr. Lee to give me the book.  And that Rehab book is Braddom.  Bunch said the new edition costs 11,000 in Amazon.  Braddom is Rehab Med's Bible.  

Am I lucky or what?  

I will be forever grateful to Dr. De Dios and Dr. Lee.  If ever you read this, I'd like you to know that I will never ever forget this day ever.  I am slowly gazing at the Rehab Med road again.  Oh, the hated, dusty, deserted road.  

Is this a sign?

CABG

Nakahawak ka na ba ng tumitibok na puso?

No sir.

Sige hawakan mo na.

So I touched it, because I know that unless I decide to go into this field (which is unlikely), I would never have the same opportunity.  

Last night, I had the privilege to assist in an open heart surgery.  I saw and touched a beating heart.  It isn't very pretty, but it's an amazing piece of muscle.  It's rhythmic, and fatty and surprisingly bigger than I imagined.  It's not even very red.  I was asked to gently lift it up so the surgeons can anastomose the coronary artery with the bypass graft (they call it the lima).  

I saw the heart stop and beat again.  Isn't that amazing?

Ortho OR

According to Dr. D., sulit na sulit ang first day niyo dito ah.  

It was.  I always thought Ortho ORs were long and few, but I was wrong.  Like yesterday, I was able to assist/observe 4 cases, and my 3 other co-interns also had almost the same number of ORs.  But you know, it wasn't at all very stressful.  The ortho environment is generally happy and carefree so it was ok.

I was directed to the LCB ER for my first case.  It turned out that I did not need to scrub in as the resident needed a student only to make sure that the specimen is properly collected and sent.  So there, I waited for around 30 minutes.  Finally, Dr. F told me that he's done and that I can do my thing so the nurse gave me a pair of gloves.  I went over the patient and looked for the tissue (You see in OB, the specimen is collected and is usually placed on the instrument table).  The resident gave me a pair of scissors.  

Scissors?  Bakit hindi clamp?  I wondered.

Sige A***, pwede mo na icollect yung specimen, andun sa box.

Sa box?

So I went over the box, half denying what was obvious.  Hello, if it were something small, why would it be placed in a box that could contain more than a dozen of IV fluids?  And in a procedure called 'below-the-knee-amputation', what else could be big but...

"Oh, no, paa..."

No, make that:  "Oh no, an infected paa."  

Inside the box was a portion of the right leg and the right foot.  Apparently, the patient was sent to the OR  for an emergency amputation to prevent sepsis as her diabetic foot was getting worse.  The nurse chuckled when she saw the expression on my face.  Good thing I had my mask on, and I was able to gasp 'silently'.  But as any professional intern, I tried to appear nonchalant about it, got the box, unwrapped the leg and foot and got the samples.  Well, I was just thankful that we did not have to send the whole leg and foot to the surg path room.  Imagine me carrying the whole foul-smelling leg to the laboratory?  'kaawa-awang intern'.  

But looking back, it was an amusing, albeit smelly, experience.  I'm sure the resident wouldn't have had me do it if it were not necessary.  

Later during the day, the wheel turned.  Dr. O.  allowed me to put on a screw and staple the patient's wound.  The lead gown was worth it.  Yahoo.

It has just been the first day.  A happy first day.  What else could 13 days bring?  

Goodbye OB-Gyne.

One duty and one post-duty to go and I'm officially OB-free!  7 weeks and 5 days ago, this would have been a happy-party moment.  But 7 weeks and 5 days into OB, (kapit kayo, ngayon ko lang sasabihin 'to),  I don't want to go just yet.

I'm very happy with the people I've been with.  From PR's block to Lopao's block and the coolest, kindest, smartest residents in our service, I could not ask for anything more.  Of course, if I can undo the boo-boos, I would, but generally, I was in the best possible place.  

Dr. G recently allowed me to do the subcuticular suturing of my CS patient's abdomen.  She also had me do 'some' of the curettage in one of the abortion patients.

Dr. M allowed me to do amniotomy, delivery, episiotomy and repair.  Fortunately, Dr. M didn't have to do re-suturing hehe.  Oh, and I was the first assist in her BTL procedure.

Dr. J had given me a lot of procedures, and promised to treat us 'soon'.  He makes any duty lighter, promise.

Dr. A, though how scared I am of her sometimes, is worthy of her position.  She knows what she wants and makes sure to get them.  Luckily, teaching is one of her goals.  Lucky us.

Dr. V, even if she looks a little mataray, is the sweetest when she calls me by my first name in her melodic voice.  I feel the trust.

Dr. D., nung sinabi mong paanakin ko na ang isang fully na patient, I knew a part of you believed that I can do it.  I was just smart enough to know that you were not that desperate yet, and I was too kind not to risk your license. 

Dr. H, ang stoic na makikay.  My favorite OPD resident.  Besides Dr. J of course.

Dr. A2, Dr. J and Dr. A2, perfect! 

Nurse F.  Hay.  Sana lahat ng nurses ay katulad mo.

And my servicemates!  I cannot ask for anyone else.  Fun, fair, unselfish people with good work ethics.  And of course, P, who's super dependable. 

Oh, and how can I forget my clerks?  Ch., A., Sh., Tn., M., T., R. Mm., Rc.  Thank you.  As Dr. A. said, you've been very good.  I hope to meet you somewhere, sometime.  And the ICCs.  Thank you guys!  'Twas fun hanging around (haha do you actually hang around LR/DR?) with all of you.  Makes my existence as the senior intern justified.

Sa lahat ng pasyenteng makukulit, madradrama, maiingay, matotoxic, thank you!  You were all better than Williams, sana nga lang minus the hysteria.  

Summary Rounds, goodbye.

Speculum, goodbye.  It's funny.  I had this senti moment earlier when I realized it's going to be my last Pap smear as an intern, as I was pulling a speculum out of a patient's you-know-what.  Kadiri no?  But oh well, that's part of the things I'd miss.  The gooey discharge, the stench, the adrenaline rush, the blood.  They all contributed to what this rotation has been and what it has done to me as a person.  

J. and M., two of my new subservicemates, have been teasing and pushing me to go into OB, which, at this point, I don't totally dislike.  Even Dr. R and Dr. H.A. said 'pang-OB ka talaga'.  I don't know.  All I know is, I want to attend my children's recitals, cook my family's meals and take care of them before I even take care of other people.  That, I'm quite sure I can't do when I want to be a damn good OB-Gyne.  But let's see.

I might consider.  I might say hello OB again.

Today....

I am going to be a senior intern.

Pray for me.

Firsts in OB

October 7, 2008:  First amniotomy, first episiotomy, first delivery as primary attendant, first repair from the angle to the skin.  Thanks to the coolest OB resident in the whole PGH.   Yey!

Patients and Trust

I try my best to understand people.  I am even more patient with patients, considering their background, the stress of having a sick family member and not having the money to buy everything that they need, the guards, the hard-to-understand-PGH-system.  That's why, I say, it's understandable when they become makulit, masungit, etc.

But when patients lie and steal, it's a different story.

To me, trust is a very sacred thing.   There will never be an excuse for being not trustworthy - it's either you are or you are not.  I hope people understand that in the hospital where I am from, where compensation come in thank you's and occasional gifts, my relationship with my patients is the only thing I get to have - and that, I value a lot.  

Two nights ago, during my IMU duty, one of the patients attempted to steal a nurse's cellphone.  She hid it in her panty.  I was not there when it happened, but one patient actually narrated the whole story to me.  Reportedly, the patient denied that she has the phone, even when the ringing came from her shorts and a light was seen flashing.  

Earlier this week, I lost money.  Somebody took it from my wallet but was kind enough to leave the wallet and my IDs and just enough money to buy some food after the clinic.

When things like these happen, I feel really bad.  More than losing things and money, I feel like I'm losing a lot more.  You know how bad it feels when you believe that most people are good and be negated by what they do sooner or later. 

Yeah, things like this, I take personally.  

Poverty is and will never be an excuse.

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Today, I learned not to generalize.  

I had one patient who came at the OBAS because of vaginal bleeding.  She's 20, not married, on her first pregnancy.  We requested for a pregnancy test which revealed a weakly positive result. She's young, single, unemployed.  There's a big chance that she doesn't want this baby, I thought.  So I asked her the question that would spell out the difference between emotional trauma and professional treatment by almost everyone on duty at the OBAS.

May ininom po ba kayong gamot o ipinasok sa puwerta?

She said no.  I asked the question 2 more times and got the same answer.  Honestly, I was not convinced.   She went through the usual PE, she was made to lie on the examination table.  We did the internal examination.  As expected, the resident asked her again if she took any medications (she meant Cytotec).  She said no.

As soon as the resident finished and left, the patient quietly asked me, mawawala po ba ang baby ko, to which I immediately replied, may nakuha na po kasing mga laman bukod sa dugo at bukas na ang matres ninyo.  Malamang po ay ganun na nga.  Then I excused myself.  I was about to go back to get her papers which I left on the table when I saw the answer to convince myself that she did not intentionally abort the pregnancy.  From behind the curtain, I saw my patient cry.

She wanted the baby.  She was telling the truth.  But I was too skeptical to believe her.  It was a horrible horrible feeling.  Now I know some patients can be trusted.  Not all patients lie.

Tuberculosis

Tuberculosis - ang sakit ng mahihirap sa mahihirap na bansa.

I noticed that patients in PGH have a common thing for tuberculosis, they deny it.  They call it something else, like, mahina ang baga - tama sa baga - ubo.  I'm used to probing just so I can extract that important detail. Fortunately (or unfortunately) most patients don't know everything about it so I tend to catch them - how I do it, I wouldn't tell :).  There is at least one attempt to conceal their condition, whether or not it's recent or has been treated 20 years ago.  I've never encountered a patient who point-blankly admitted that he/she has TB, as opposed to admitting having Hypertension or Diabetes.

I know, we have the TB stigma, which I find ridiculous because a lot of Filipinos actually have it, in different areas.  I've seen lots!  Scrotal TB, TB Meningitis, TB Lymphadenitis, TB in the colon causing gut obstruction, and of course pulmonary TB.  

TB is treatable, friends.  Usually, we treat it for 6 months with different kinds of drugs. We can extend it to 9, depending on your response, exposure etc.   Around 3 weeks to a month of therapy, the patient is most likely not contagious anymore.  Let us not discriminate against these patients.  And if you have TB, it's ok to admit it.  There's nothing to be ashamed of.  It's still better than having cancer, or STD.  

Tell your friends.