The Dorsalis Pedis Mishap

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Second to the last day ko na of paying my dues in what I call the “surgical retribution”. I was assisting Dr. Jon (a medical intern who is at the same time a licensed dentist). And it was already our last patient, our fourth one after several circumcisions. Graduation ng mga UPCM interns kaya ang naiwan ay ang PGI, si Dr. Jon. Natapos na din ng pag-assist yung mga kasama kong ICC’s.

Patient was Ms. R who has a small mass over the dorsum of the left foot. Excision was initially uneventful, especially with Dr. Jon, who I think is good enough, as it is already the second day I am assisting him. We were careful not to destroy the mass which the surgical resident, Dra. Che, diagnosed as benign tumor. Naisip na namin ng intern sa simula pa lang na hindi iyon basta lipoma o sebaceous cyst. Kaunting blunt dissection, and we’re done.

Nang biglang… may squirt of blood. Kala ko, minor lang, so we just need to clamp it with mosquito then tie with the cotton tie. Then the intern asked me to call the resident who had just finish in her operation. Ibig sabihin, it’s something that he can’t handle alone.

“Maam, may naputol pong artery,” sabi ko. She just smiled, and the nurse went to provide cotton ties. Wala akong sinabi kung sinong nakaputol, pero alam ko, sa smile ni Maam, ako yung salarin na iniisip niya.

“Maam, sorry,” sabi ni Dr. Jon. Okay pa kaming tatlo, relaxed din ang walang alam sa nangyayari na pasyente namin, kahit bumubuhos ang dugo na parang fountain.

The resident then meticulously tried to reduce the nick by tying up the vessel, twice or thrice I think. That time, I was already praying. And telling myself, I don’t want to become a surgeon. I think I can’t handle situations like this.

Dra. Che released the mosquito clamps… and boom, blood spattered, at napaiwas pa kami. That time I can already sense the change in mood of the resident, but she contained her anger/anxiety by looking away for several seconds. Napatingin na lang din ako sa intern who is clueless of what to do next.

“Bulldog vascular clamp, please,” sabi ni Dra. Che. I was already anxious deep inside, especially when the cotton tie was not successful against the nick on the artery. Nagiging clumsy na rin yung kamay ng resident, ilang beses niyang naputol yung suture.

Nang biglang… pinutol ni Dra. Che yung vessel intentionally. I was flabbergasted for a moment. Iniisip ko, was that the solution to that mishap? Kaso wala na akong maisip, unless okay lang magka-hematoma at maging anemic ang patient. Hindi na rin ako nagtanong, for the whole moment was a period of silence, and probably prayers.

The resident cut the dorsalis pedis, tie it with the cotton tie at each end, then told Dr. Jon to close the wound with simple interrupted. As the resident walked away from the room, I was thinking of what will happen to the patient’s left foot. I was convincing myself that it was the only thing we could do, because reducing the nick is close to impossibility. The gush of blood precludes the procedure the resident is trying to do.

I just hope and pray that it would not be that bad. I left before they all left. Sana pag-alis ko, na-explain din sa pasyente kung ano yung nangyari. This happened from 12 noon to around 3 pm. Hence a very late lunch.

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Tulian

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Nagpunta kaming Brgy. 143 sa Pasay, para magtuli. Before going there, I was in a dilemma of whether I’ll be going to Pasay or just attend the kite flying with my other two friends at the Quirino field. Conflicting thoughts came to my mind. I am not worthy to play with leukemic kids because first, I flunk the Surgery OSCE. I’d rather be in a surgical mission than be with kids and try my best to feel undisturbed. Besides, I am a bit envious of my friends. They are safe, and of course, I am not. 

Nung tulian na, I assisted first (thanks Aidz) since I know I am not yet competent. I once participated in a circumcision session in our barangay but I hardly remember the procedures. But eventually I remembered everything once I saw the procedures being done.

Iyakan ang mga bata. My patient Jayson did not. One thing awkward during this operation is that I cut the foreskin so long. I think it was good enough since his prepuce is actually long. The end result is a flowery suture. Andaming knots more than 6. Kawawa si Jayson, but I just kept talking to comfort him. Something came to my mind: I am doing something with the creation of our God. 

Summer na nga pala. At andito pa rin ako.

13th

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Di ako naniniwala sa Friday the 13th. Pero maraming nangyari sa araw na to, since this is post-exams day. Breaking of bad news,… and good news as well, each from the corresponding LO’s of the department. Also, I learned that I am indeed envious of those who passed the exam, especially my close friends. Waaaah. Why am I like this? Also, today I almost jeopardized a classmate for forgetting to tell him his deficiency and makeup. I realized how delinquent I am as a liaison officer, especially on the last days of the academic year. I did not succeed as a lightwriter. Nevertheless, I am still grateful to our God, for reminding me that I am not alone and that mundane circumstances are part of His medical training to me. 

I accept your apology. And I’m also sorry.

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– this is the note Jhing wrote to me, after an awkward incident, I retained the title as well

I was thinking about this during my ride home.

 

“A true gentleman should not display special treatment towards a girl unless he has definite plans of courting her, and he should not make concrete plans unless he receives a clear go signal from the Lord.”

 

This was shared to me by the last person I liked (in a romantic kind of way). I’m really thankful he mentioned this to me though he apologized too for not being able to apply this in our relationship (but not in a romantic kind of way).

 

What you and I we’re doing–teasing each other–is really funny. I actually enjoy laughing out with you guys because of this but just today, I realized that soon it will bring harm. It’s like compromising each other’s feelings. As Sharmie told me before, “If you really love a person, you will protect his/her feelings.” For example, you wouldn’t want people to be teasing Tintin as this will compromise her feelings and may hurt her. In the same way, you should not do this to other people unless you don’t truly care about them. And since you apologized already, I accept your sorry and forgive you.

 

This brought me to another realization—this rule applies to me as well. You are a very good friend. I truly value and admire you as a person and appreciate the way you treat me as your little sister, and I want to protect that. I don’t want to compromise you and your feelings either. My sincerest apologies to you, Kuya. I hope you can forgive me.

The Gastrocolic Effect

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Para sa marami sa medical field, the gastrocolic reflex is just another concept to understand especially in physiology. According to Ganong (2003), distension of the stomach by food initiates contractions of the rectum and, frequently, a desire to defecate. Yan ang gastrocolic. Actually, may duodenocolic reflex din. And they all have the same purpose – mass movements.

Utang na loob naman, mawala ka na! Yan ang gusto kong isigaw during bouts of my gastrointestinal affliction. I have been suffering from this since high school. And I am now a medical student. The thing literally controls my day. In fact, sinisira niya ang umaga ko kapag hindi maayos ang preparation ko. Pero kahit naman ata mag-prepare ako, aatake pa rin to in the most unexpected scenarios. Muntik na ngang hindi ko tapusin ang UPCAT dahil lang dito. Ilang beses na din naapektuhan nito ang pagpasok ko sa class. People think this is psychogenic, but I am firm that it is autonomic, that is, physiologic. Alam mo yung feeling ng may goosebumps na associated with the call of nature? Yan. Hahaha. I agree with it being psychogenic, but up to some extent only. Iba naman kasi yung pakiramdam kapag out of stress or anxiety at iba rin kapag ito.

Aggravating factors include: umaga, malamig na hangin (aircon, electric fan), pag-inom ng liquid sa umaga (kape, gatas, tubig/malamig na tubig, juice), pag-inom ng madaming tubig, matamis na pagkain (cake, candies), pagkain ng madami, pagkain ng may sabaw (noodles, sopas). Relieving factors: no need to mention, pero since they say it’s psychogenic, e di kausapin ang sarili by biofeedback hahaha. My rituals to lessen this thing: gumising ng maaga, eat any solid meal, drink half cup/glass of water/milk/coffee and wait for the call of nature.

Now what is the weirdest thing in my case? Previous lectures told me that around 15 mins after the meal, nature will call. That is true. BUT, when you think you are done, think again. Because at some instances pag nasa school ka na, there will be another call which will start with a generalized/migratory abdominal discomfort/pain. Ang triggers nun include umaga nga kasi, uminom ng kahit anong liquid sa school, kumain ng may sabaw o matamis sa school at siyempre, unknown causes, or minsan, kapag kinakabahan.

Some questions bothering me are as follows: How am I going to explain this to consultants and residents during early morning rounds? Will I still experience this come our medical board exams?

I can only think of 3 things to counter this GI affliction: self-medicate (na hindi ko pa mahanap sa mga nasubukan ko na), prepare, pray.

Temptations

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The battery of exams has begun. And it will be on a Holy Week, and the week after. Temptations are within me, incapacitating me to work efficiently. Temptations come in different forms and ways. But they come for one purpose, to lead you astray.

Our dear God, help us, especially those people who have the same dilemmas as mine. Please reply.