Sunday, July 13, 2008

The Junior Internship (12 months of REAL medical drama...) - Part 2

Oct-Nov 2007 - Surgery
Surgery, probably the most diverse rotation of them all... when i say diverse, it's because of the different subrotations each has to go into. i dont exactly recall which rotations came first so i'll go with whatever comes to mind first. anyway, when i think of surgery, the first rotation i will remember would be that of Amang Rodriquez. again, on single duty, every other day duty. this was the first time i experienced, significant surgical emergencies. this hospital was busy during weekends and holidays... when i say busy, it's so damn toxic. this is also when i realize, that alot of the locals find alcohol binging as a common practice during weekends/holidays. and as advertised on television, don't drink and drive. you'll see patients who come in complaining of getting into different types of vehicular accidents, from a mere getting side-swiped all the way to collisions. Aside from having to deal with patients of vehicular accidents, you can never neglect those who were in a mauling incident. criminals were also usuall brought there by the police for clearance prior to bringing them to the precincts or wherever have you. you'd see ER bedside CTT insertions, "codes" where one nurse would do everything... yes, everything from pump to push medications to doing ECG tracings. other departments usually don't tag along if that's not their patient since alot more has to be attended too. i also saw there a separte pediatric ER table. that's where all pedia patients come in first before being referred to other services... one thing UE has to have. anyway, i learned alot in terms of wound suturing there. i was able to stich avulsed phalanges, torn auricles, to helping out a bedside emergency CTT due to hemothorax. i was even told that i should choose to have a career in plastic surgery due to my OC-OC even in stitching. given that thought, i take so much time doing a stitching procedure that when im left alone at the surgery ER table, patients pile up. well, i'd like to consider it as making sure i have completed everything i need to in each patient rather than just passing them by. when you see teenagers or other young individuals that come in due to trauma, they would usually say "napagtripan lang" (were just at a bad place at a bad time) but while figuring their speech, their alcohol breath, and even their own dress code and arrogance, you know its the result of a brawl. i was also able to attend to a skin grafting operation there by a pay-patient... one thing that really amazes me as how their operating was so bright, not crowded, clean and alot of new items all around... sadly, very much nice than where i am from. anyway, regarding the residents that i work with, most of the women, except 2 were sooo mataray and loves to order people around. the males are often at their "cools" and the one 1st yr. resident that i got to frequently work with, Dr. Tamondong, took alot of patience to teach me all how to suture and some other stuff. anyway, back to UE, pay rotation was very much hell. thankfully, the tandem of me, bridel and grace were enough to glide through the rotation. we didnt count each others tasks, we helped doing the discharge summaries, the monitoring, etc. as for ortho rotation, it was relatively as what they called benign, however, we helped out during times when some other were toxic... assuming these people also helped us when we needed and not those that screwed us off. GU rotation was also great, for me, at least, this might have been the most enjoyable, even if we had a "perpertual" resident. ER-opd, was one crazy rotation. in ER i remember, in a duty day, we had a minimum of 60-64 patients... and apparently, on our first day we had only about 40s. we had our fair share of Medical codes, as well as Neuro, Surgery, and even a OB. those were priceless memories/experiences. as for OPD, patient's weren't really that much as compared to other departments, yes, even derma OPD had more patients than surgery did at those times, probably because surgical patient come in with a complaint, you take care of that problem, patient follows up after the operation, and when all is well, patient doesnt need to come back, unlike for example, a patient with DM or asthma or TB. i do recall Dr. Agustin to be the OPD rotator and he has been one for i think almost or more than year, i really can't recall. i remember he said before that it was getting pretty boring and non-challenging anymore for him. anyway, our last rotations for this department was at male/female wards. for the male ward, the one patient that i can recall is that of the one we had to dress twice daily due to gangrene. his suprapubic and scrotal area where affected by such an infection. i always took time to do the dressing myself even after we shifted rotations, since the patient complained that after we rotated, those that followed us, usually dresses himself once or would not do it so well. i can't blame him, im an OC guy, if im doing something, whether i like it or not i try my best to do it. i believe its just part of my work ethic, but anyhow, the patient was eventually able to get home and that is what's more important. as for the female ward, we had relatively much more of a benign ward, but we had patients that complained alot... they felt like they were pay patients... but it was their desire to be admitted at the charity wards and demanded so much. anyway, nothing significant really happened there except as we were nearing the end of our rotation, i forgot to follow up the schedule of one patient's CTT removal for which Dr. Astudillo got really angry. i admittedly failed to follow up the scheduling of the patient since i was busy with all the needed paperworks (DS due to ending of departmental rotation). and luckily the OR nurses were able to squeeze in this patient in the OR but only with a limited time for which was not enough to do the task very well... another one of my last day funks...

Dec 2007 - Jan 2008 - OB-GYN
OB-GYN, probably the only rotation where i was able to spend alot of time reading, watching, and sleeping even when on duty. it's because the rotation only involved, Wards and non-wards. we started with an ER rotation and as usual like that of surgery, had relative a minimum of 60-64 patients in 1 duty day. i could not exactly recall whether it was during my surgery-ER or OB-ER rotation that we got the most number of patients... that each of us JIs at the ER had approximately 18 patients each. anyway, that was one freakishly toxic duty day. i do recall however, that dr.Maliwat told us, whenever he would be the ambu surgeon, a psyche patient would usually come in, and since that time he told us, that was never proven wrong. i rotated in Quirino Hospital for my outside rotation and i really liked my SIs and Dr. Masangkay. Dr. Masangkay, Emay as her friends and co-residents would call her, was always kind enough to teach me all that i can learn in the deliveries of the children. i even had my suturing lessons as well. i recall, one time that we were so toxic, i was left alone to fix the laceration in a patient for which i was able to do very much nicely upon inspection of a senior, although it took me over an hour to do it...sometimes it's these moments were you yourself can be proud of what you've learned or did after everything that has transpired. i was able to work with some Perpetual Medical Interns, and though i would say that im lucky enough to have met some that was quite hardworking than what i was been told off. during my last day there, i was assigned to watch over an ICU patient who developed psychosis after delivery. back in the wards, the charity wards was relatively benign because during our rotation the charity delivery room was still under renovation, and no patients are accepted unless they are willing to have their deliveries at the pay delivery room which would cost more than what they would expect. however, some patients were very much prepared that it was not much of a problem for them. but the one thing i myself hated to do was to do labor watching for more than 24 hrs or 36 even maybe that would eventually end up with a caesarean delivery. i even observed that most of these pay patients when they go into labor and don't deliver within a certain amount of hours, the consultants would usually do a caesarean already to minimize further complications to both mother and baby, however, my longest experience ever in labor room was staying in the labor room for ~36 hrs. that was hell even for just 1 patient because, the monitoring is PER contraction, and the contractions were not predictable, and yes, i fell asleep at times during the labor watch. it was not as easy as one can expect. as for the house staff party, OB won the 1st prize. this department had the most consultants that participated and our SIs at that time were pretty much game to every little detail of it. of course Claro and Dr. Casurao were significant proponents of it. my part? well, was to lift Dr. Casurao up together with 2 other guys, and one fast paced dance. i secured that video to criticize my own performance... which i would not expound on it here. let's just say that as the tension builds up, my performance is affected. im really not used to performing infront of alot of people... (my first ever was during 2005 in Dance nAPO). and again as part of my usual last day funks, we had our fairshare of demerits due to a SP quiz to serve among others and some "conflicts" as well...

Feb 2008 - Neuro
oh hell... hell... hellish... crazeeee... the most crazy-toxic rotation of probably my entire JI-ship, most especially neurosurgery. if not for the help of the pay & charity ward groupmates, we would have been dead. we meaning grace and I. yes, 2 people on 10 days of perpetual duty. when one is in the OR everything else is left to the other one. we didnt have and "in-charge" or backing system since logic dictates it's but an either/or scenario only. grace and i did the IS/DS depending on who knows the patient more or admitted the patient. but we made sure that the data on the chart was suffice to keep each other aware of the status and clinical data of the patient should one of us becomes inacessible. imagine this, all monitoring, referrals, laboratories, and procedures are left to the Neurosurg JI left at the wards while the other is inside the OR. that tops my single duty of NCHA. i experienced having spent my entire morning referring to different departments, while Pep and Keiko took over the ward monitoring. thank you pep and keiko... so much. neuro pay & neuro ward was less problematic than neuro surg. yes, we had Q1s like forever, but with sharing the patients that we monitored we basically could minimize the toxicity. we didn't do a by floor thing but rather by patient among grace, bridel, and me. that would have been much equal and less toxic. (e.g. 3 q1s in 4th floor and none at 3rd floor would be better managed when each of us had 1 than all 3 done by 1 JI only). the one thing we hated only in this rotation was that of the attendance and the "emergency quiz". the attendance was so hard to time since if the office was closed and you failed to sign at before 7am, you'd get crossed out. the residents watches were likewise not at part with that of the wall clock in the office. as for the emergency quiz, we can only blame those that made Dr. Pineda angry at our group. anyway, i'm glad it was only for a month...

March 2008 - Psych
our last rotation... as i write this part of my entry, i am once again feeling that sense of relief... like when we were just counting the days till we would say goodbye to our clerkship...this rotation was a challenge to our individual interviewing skills. psychiatric interview requires you to spend an ample time with the patient and relative to get a better idea of the problem. this is also the time i realized how much people go "crazy" because of either traumatic experiences or poor communication with others. the paper work was very long and took alot of effort to make. the reports to be submitted were likewise the same. one unique aspect of this rotation is that of the occupational therapy, daily exercise, and socialization. the daily exercises were left to duty/pre-duty groups to handle and each did it differently. for our group, i was the one who created the "dance steps". i tried my best to keep it as simple as possible, however, no matter how i made it so, the patients had so much difficulty following. the dance steps were so easy that even my niece and nephew could follow. our group usually started with stretching exercise while i prepare the music. i take alot of time at home trying to master the dance step at home and honing/modifying it as it is seen on TV or music videos to make it very simple to follow and atuned to the beat of the music, sadly, i completed the rotation with not much success on my part. guess i cant be a dance instructor... ahehe. anyway, for our occupational therapy, we did the usual simple activities like that of art classes. for our group, i noticed that games were so much the preference of these patients. the patients tend to interact more, share more and speak up more if it was in a game. somehow, the feeling of playing and to some, winning, creates a sense of confidence in them. socializaton was likewise similar to that of occupational therapy, only it included food to share with the relatives, patient, co-JI, our residents, and nurses/aides. we had our rounds with the chairman of the department as well, and it proved to be an eye opener regarding this subspecialty. the most "toxic" monitoring during this rotation would be the Q1 sleep wake cycle for most of the patients. we did our usual decking so that we would have time to sleep at least for more than 6 hours each at night.

March 31st - April 1, 2008 Last duty day in Psychiatry
the last duty day, i recall was people (co-JIs, residents, nurses, even consultants) signing JI's uniform with greetings and what have you as a celebration of the last day. the JIs were allowed to walk around the institution with these "valid vandalisms" on their uniforms. i had my own uniform signed as well. hehe. however, as everyone was enjoying the last day, doing friendship-rounds. i was sadly stuck to my laptop doing paperworks for a March 30th admitted patient. had to do both the paperworks and endorsements... all in less than 25 hrs. yes, since we are officially relieved after we have properly endorsed to the new batch... but again as i tried to mix my duty with mingling... i falled short of finishing early to leave early on the 1st of April. i do recall i went home at around 2pm that afternoon, finishing my endorsement.

in the end, it doesnt matter what time you leave... but the feeling of finally finishing a year of clerkship is the ultimate victory... for now... ^__^


Anonymous Dot said...

You write very well.

7:45 PM  

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