Mabalos

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Mabalos to everyone who helped me become a full-fledged physician. Mabalos means ‘thanks’ in Bicol. More than a month ago, I wrote Brace yourselves, the Boards is coming and shared it to some of my closest friends and relatives. Sabi sakin dati ng isang kaibigang duktor, kung magte-take na ako ng board exam, wag ko gagayahin ang iba na ayaw sabihin kasi natatakot malaman kapag bumagsak. Dapat daw, ipaalam ko sa mga pinagkakatiwalaan ko, para my support pa rin ako kahit anong mangyari. I followed his advice. And so this entry is also for them.

Almighty GOD, for giving me this opportunity and birthday gift.

Mabalos. Wala na ko masabi, buhay pa rin ako, nakaka-amaze lang kung paano ako napunta sa medical field, from that time na muntik na ako maligaw sa Alabang sa unang beses ko sa Manila sa pag-aasikaso  pa lang ng NMAT (National Medical Admission Test) application ko, and kung paano nung first year med pa lang ay hinayaan ko na lang manakaw ang bago kong Toshiba laptop kaysa naman pagsasaksakin ng grupo ng Laglag-Barya gang. Miracles happen, buhay pa rin ako at naging duktor. Thank You. Mas mag-iingat na din ako sa pagtawid para may pakinabang ako ng maayos kay Lord.

Patients

Mabalos for allowing yourselves to become our teachers. Kahit awkward sainyo na ‘duktor-duktoran’ pa lang ang unang humaharap lalo na pag SGD (Small Group Discussions)/OSCE (Objective Structured Clinical Examinations), sa clinic at wards. Mabalos for trusting your SIC (Student-in-charge). Naalala ko pa yung names ng iba but they are already in peace. God bless your soul Kreng, John Robert, Arvey, Lola Pacita, Ate Bernadette, Tatay Zacharias.

Mama, Papa, Dhaden, Yatyat, Tin2

Mabalos sa pagpapa-aral, sakripisyo at suporta. Mabalos for being my number one fans and inspiration.

Nen2, Kuya Darrel

Mabalos for being my allies in surviving the urban Manila life.

My Beloved Families and Relatives (Gornal, Tagomata, Espares, Ferandez/Fernandez, Zagada, Salcedo, Huerno, Lavilla, Delgaco)

Mabalos sa ngamin na suporta, dire ko na kamo ping-usad usadon ta sana raw agko pa ko malingawan, basta kaiba kamo san.

Kuya Mike/Dr. San Juan

Mabalos for being a true friend, guide and inspiration. Idol!

Block Y

Mabalos for our team kahit may mga di pagkakaintindihan kapag pagod na sa duty or unfair lang talaga schedule. Ang swerte pa rin natin sa trackers at sa rotations, dabest!

UP College of Medicine

Mabalos for the grueling exams and SGDs, preceptorials, demo-return demo, OSCEs.

Previous senior interns from Class 2013, some previous clerks of Class 2015, some PGH nurses

Mabalos for the teamwork and friendship.

UP Philippine General Hospital

Mabalos for letting us ‘serve and learn’ from your patients. Nakakapagod ka, nakakagutom, nakakangiti, nakaka-ewan ang nagagawa mo samin. Mabalos sa pagiging isang hulmahan ng panahon at pagkakataon sa aming mga duktor at nagduduktor. Mabalos kahit minsan  kinakain na kami ng OR or sandamakmak ang mino-monitor na pasyente or ginigisa kami ng consultants or nagiging manong/manang kami sa pag-run ng labs.

UP Med Class 2014

Mabalos for the five years with you, lalo na sa first two years natin sa med school. I really appreciated those classmates who extended their helping hands in every possible way. Alam nyo naman kung sinu-sino kayo.

Pisay-Bicol ’05

Mabalos for the support kahit di ako nagpaparamdam, sana makasama na uli ako sa mga get-together.

Teachers from LOES, Pisay, UPLB

Mabalos for everything.

Phileos brods and sisses

Mabalos for the support lalo na yung mga nakakasalubong at nakakausap ko pa.

AC-CYA

Mabalos for the prayers and fellowship.

UP Med Regionalization Students’ Organization

Mabalos for the camaraderie and reminders to go back and serve our own regions.

Topnotch

Mabalos for guiding the path of reviewing

UP Med CLC, Fr. Jordy, Fr. Nono, Fr. Francis

Mabalos for helping me with my own struggles, mabalos for your support and prayers.

Dra. Rances-Tuy

Mabalos for guiding me on my Regionalization Program

Dr. and Dra. Ladia, Dra. Gomez, Dra. Cuayo-Juico; Kuya Renz

Mabalos for giving me scholarships; Mabalos for arranging my STFAP

BMC Doctors and Nurses

Mabalos for helping me in my third year IM elective

Mga Baboy na Inalagaan nila Mama and Papa

Mabalos for becoming a part of my tuition/allowance.

I hope mabigyan ko ng justice ang pagiging duktor ko. Dapat lang. I have my issues in life but I promise to help people. Isang rason kung bakit ako nagduktor is because di ako marunong magpakita ng concern/love sa mga tao, lalo na sa parents ko. So I intentionally masked it with being in the caring field. I believe it is a work in progress.

Med student pa lang, sinasanay na kami tawaging Dok. Kami naman, tuwang tuwa, parang legit na, pero duktor-duktoran pa lang naman. This time it’s real. Ewan ko, baka sakin lang to. Kapag pasyente na ang tumawag sayo ng Dok, alam mong iba siya sa pagtawag sayo ng Dok ng mga kaibigan o kakilala mo. Alam mong iba ang pakiramdam kapag pasyente o bantay na ang tumawag nun sayo.

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Brace yourselves, the Boards is coming

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Nung third year med ako, I chanced upon a blog of a newly-licensed MD of that year. Sabi nya, nakaka-overwhelm daw mag-review for the Physician Licensure Examinations. During those times na nasa examination phase na siya, all the more. Sabi niya sa sarili niya, papasa naman siguro siya for the following reasons:

1. Nag-aral naman siya.

– sabagay, kung nag-aral ka naman talaga, at least may maisasagot ka

2. Naging mabait at maayos naman siya sa mga naging pasyente niya as clerk or intern.

– base sa principle ng good deeds, susuklian naman daw siguro ng Diyos yung mga sakripisyo nya sa ospital

3. Sasabay na lang siya sa anod ng karamihan.

– may tinatawag kasing ‘curve’ sa exam, yung naa-adjust ang passing score base sa score ng mga nakakarami, or at least that’s how I understand it

Today, it’s exactly 30 days from my own medical board exam. Sinong mag-aakala na matatapos ng isang “taga-uma” (what we call ourselves, those whose houses are in the rural areas amidst the ricefields of our town) ang UP Medicine, and here I am now about to take the boards after five long years. I am overwhelmed. Naalala ko tuloy yung blog na nabasa ko before. And I think, his or her thoughts are also my thoughts right now.

Nag-aral naman ako, at nag-aaral pa rin. Ang dami nga lang sasauluhin, at mukang di naman talaga matatapos. Kung may matapos man, nakakalimutan din agad. One thing is very amazing pala pag nag-aaral for boards — mas naiintindihan mo yung mga di mo naiitindihan as med student, clerk or intern. How I wish, alam ko to every time humaharap ako sa residents/consultant at mga pasyente para di naman nakakatanga or nakakahiya minsan.

Naging maayos naman ako sa mga naging pasyente ko, and I treated them na parang si Lord nagbigay para matulungan ko, and at the same time, para matuto ako. Serve and learn, turo samin yan ng college. I remember the days when I write about some of my patients’ stories nung di pa ganun ka-busy. Right now, gusto ko sila maalala uli, lalo na yung may impact sa buhay ko as a med student. Because I want to be inspired kahit papano despite all these review materials that I have to eat.

Sasabay na lang ako sa anod, sana makasabay ako sa tinatawag nilang ‘curve.’ I am just an average student sa med, pasang-awa to the max lagi, minsan nagre-removals pa sa Pharmacology nung second year, Surgery nung third year at Family Med sa internship. But then again, sa simula palang nung first year, pinilit ko na yung sarili ko na maniwala na ang Diyos ang nagpapaaral sa akin, at instrument lang ang pagpilit sakin ng mga tita ko at ang pagpapaaral sa akin ng parents ko.

So, after all these, ano na ako? Sana by September this year, I am already a newly-licensed physician. Naumpisahan ko na, konti na lang. I just need your prayers, all those who happen to visit my site. Para sa mga naghihintay sakin sa Bicol, sa mga kapitbahay namin na umaasa ng medical checkup at di makapunta sa duktor, para sa mga kapatid ko na naghihintay ng libre dahil ang tagal ko na daw na nag-aaral at tumatanda na ako, para sa parents ko na nag-eexpect sakin at nagsakripisyo, para sa Nasa Itaas na nagpaaral sa akin. 

Ang hirap pala kumbinsihin ang sarili, kung may mga katabi kang reviewer na kailangan pang basahin. Come what may. Whatever happens, buhay pa rin naman ako. Puso. Tiwala lang. Laban.

Mrs. “Matapang”

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This entry is a tribute to a non-psychotic patient referred to Psychiatry by IM for a number of symptoms that cannot be explained by normal lab results, and of course, knowing IM, a thorough history and PE. 

She is a middle-aged woman, thin-looking who is conscious and has good insight why she is at the clinic. Her anamnesis struck me. She had a lot of struggles in life. She has been a waitress, a dancer, a vendor, a dishwasher, every possible work a mother can do just to bring up her seven children. I can say her children are very lucky for having her as their mother. She is very afraid to die because she does not want to leave her children at very dependent ages. She said she has prayed it to God several times, “wag Nyo po muna ako kukunin.” At different times, she would volunteer that she is “matapang” especially if it is for her family. She is one of those vendors that the MMDA is constantly pestering to leave the sidewalk. But at times, during the interview, we probably prodded her too much that tears would flow from her eyes, which she immediately wipes with her white face towel. 

I can feel her. That feeling of spending laboratories just to rule out disease condition and eventually ending up in a clinic just because she is being suspected to have a condition that she is probably having a psychiatric illness.

Haligi

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This entry is a tribute to a man who unintentionally showed to me how it is to become a gentleman, a real man. He must be half-Filipino half-Arabian. He was tall and dark with a pointed nose. At first I thought he was a foreigner who is somewhat involve in the scene. But why would he be accompanying the patient. Later I found out he is the boyfriend of her sister. He was speaking in Tagalog. He claims he has long known her father, who is a seaman coming home every 7 or 9 months only. It turned out he is the only man who can become the father/brother-figure who cannot be around during the hard times. The mother and sister cannot come, most probably from the emotional burden that has just strike them. And so this man became that haligi, caring for his girlfriend’s sister to accompany to the police station and to the hospital. This man showed to me the opposite of what the perpetrator has done. Imagine that event that the rape victim went through. Your life is at the mercy of the perpetrator’s decision or insanity to just rape you or even kill you. Thanks to the Lord, the suspect was caught.

Neo-Paleo-Neo-Neo-Neo

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After some decades of inactivity in blogging, here I come back. I have just decided, writing is one diversion to do away from doing nasty things in life.

Today, we started in Psychiatry. What more interesting if it was started by Dr. Vista, one of the consultants I remember from last year. He introduced something that his resident psychiatrists are bypassing in therapeutic management of a patient diagnosed to have just a Normal Psychological Reaction to Illness. And that is something beyond Supportive Psychiatry. He claims that it is not just something he conjured. He says it has neurologic basis.

The idea is to spark the patient’s neocortex with facts thereby inhibiting the paleocortex, the realm of feelings and emotions. By talking about anything factual to the patient, we do away from the emotional reflexes, decreasing the tachycardia and restlessness of the patient. Then after some time, ask the patient’s feelings, then go back to facts again. Hence, the title of this entry.

It does not take a psychiatrist to do this, according to Dr. Vista, and, this should be done in the premise of a non-psychiatric patient.

I hope I’ll be able to do this in the coming years.

Anew

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Living anew is one of my greatest dreams. But there are temptations of course. Living with real people is indeed better. Catching up with them is the best. The online world is just sometimes a distant one. Following Jesus should be the main goal.

An Incident Report

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This is to narrate the circumstances that happened to patient MGD, 22, G3P2 (2002), as far as I am concerned. I was not the SIC of the patient and was not the one who assessed the baseline VS and FHT. At around 7:40-7:50 PM, I was asked to look for a stretcher for a new admission which was supposedly for the said patient. I was able to obtain one but since she was not yet there when I brought the stretcher, the stretcher was given to another patient (either for conduction to Perinatology Center or for the scheduled tracing of IMU patients).

The patient eventually came and since there is difficulty getting a vacant stretcher (i.e. transferring stable patients from their stretcher going to the nearby beds), the patient was just sitting on a stool next to an occupied stretcher near the door. All of a sudden, a new patient with cord prolapse was admitted and rushed inside. That time I was looking for another stretcher, which I was able to provide to the patient, after which I hooked her to the tocodynamometer. I volunteered to do the tracing since I had still no patient then and there is no procedure yet, at the same time, the SIC (Intern WM) was assigned for the 8 PM monitoring. According to the flag of the patient, the FHT was 150’s at the right lower quadrant. However, I had difficulty looking for the fetal heart tones even if I was using the ultrasound probe. There was a reading of 138 bpm but this did not stay for long, although I noticed that there was a fetal kick and I remember saying to the patient, “Maam ang likot naman ng baby niyo.” Still, I was not able to locate a consistent FHT at the RLQ and so I opted to check it on the other possible quadrants. I eventually referred the patient to the RIC (Dr. F) who advised me to just listen to Dr. T near the door who was talking to the other students about the patient with cord prolapse.

During this time, the doctors were having difficulty looking for FHT so I was asked to change the ultrasound probe with the other probes. They then referred the patient to Dr. T. Patient was eventually sent to Perinatology Center and eventually came back with the unfortunate news.