Full Circle

It was my first duty as an Internal Medicine Intern, my first assignment was the Pay Wards. I just received the endorsement from the outgoing intern and was perusing the census when I arrived at the nurses' station. I dropped a post-it with my name and contact number for them to contact me when they need me. I received a message from my resident that I am to attend to one of the pay patients there who is currently hypotensive, so I went ahead to his room.

I wasn't able to ask permission to mention his name in my blog so let's just call him Mr. SG. He is around 50 years old and is suffering from uretelial cancer, and from the looks of it, at a very advanced stage.

True enough, he was hypotensive at 80/50. I carried out all the orders my resident told me to do. Fast drip. Start levophed. Start dobutamine. Monitor patient q15. Every once in a while messages would come from other wards so I would run to those stations then come back to monitor Mr. SG again.

I spent too much time in his room that Mrs. SG and I have already bonded. We found out that we have common family friends since they were from Laguna, too. We talked about many things. UP, mathematics (yes!), medicine, religion. And despite all our efforts, Mr. SG's condition remained as is, hypotensive. I received him hypotensive, I endorsed him back hypotensive.

On my second duty, I found out that they were planning on transferring Mr. SG to a big private hospital along E. Rodriguez. I checked on him, still hypotensive. I prepared his discharge summaries and abstracts then wished him good luck. Later that night, the ICU intern told me that Mr. SG will be coming back from the big private hospital, straight to ICU. I waited the whole night, but until I was relieved the next day, he wasn't transferred in.

The next day, I officially became the Service Ward intern, which made me so busy that I forgot to check the ICU if Mr. SG was transferred in. Many things happened during my week in the Service Ward (that will be another story) that Mr. SG slipped my mind completely, even if I was already the ICU intern (I was very preoccupied -- again, another story).

But then on my last day as an IM intern, I was walking from the ICU to the elevator lobby of the fifth floor when I saw that the patients' and visitors' elevator was open. I shouted "DOWN", and quickly stepped in.

Then I heard someone call me, "Doktora!"

I looked around and saw Mrs. SG smiling at me.

"Ma'am, kumusta na po? Kumusta na si Sir?" I asked smiling widely at her.

Mrs. SG's smiled wavered a little then said, "Wala na siya."

It was then that I noticed that she was wearing a black blouse. On our way down, she told me that he just stayed in the ICU of the other hospital for a day before he went. I told her that I have been waiting for him in the ICU when I heard that he was to be transferred back.

We both stepped out of the elevator, still talking about Mr. SG, and how he's in better place now, and that it's sad since Christmas is approaching. We said our hurried goodbyes and she left.

I walked back slowly to the parking lot thinking that it is this rotation that somehow affected me in more ways than I expected. Other rotations came and went, but none of them compared to this.

Meet Me Halfway

The main reason why I was looking forward to my Internal Medicine rotation is simply because this is my specialization of choice. Based on my JI year, Internal Medicine is what really caught my interest. Though most of my friends say that OBG is the ticket for me or maybe even Orthopedics. But I know from the start that the only blade that I want to be holding is that of the kitchen knife.

And so finally, here we are, halfway through the PGI year, now in the rotation I have been waiting for. I hoped that it would be much like my JI year, and at first, it looked like it is going pretty much like JI year, until my 3rd duty, the first in the Service Ward. Something, though not really unexpected, happened. And that pretty much told me what kind of doctor I am and going to be.

Welcome to the Medicine Service Ward.

It was the first of my two duties in the Medicine Ward. Though I have been on preduty the day before, I was still learning the ropes. Thank goodness my JIs (shout-out to FEU JIs Kaye, Nikki and Jow) were very helpful as I tried to balance rounds and referrals and errands. After endorsements, the ward calls did not stop. It was a very long and rough night. 

I had to fight for our rights as interns, because the Emergency Department wanted one of us (either me or Kaye) to go on an unofficial ambulance conduction to Rizal, just because the patient is a friend of the secretary of some high ranking official. 

Then not even an hour passed, we were running back to the wards because of a code. And that did not end there. It was a long night of DOBs and chest pains. 

I tried to catch a few minutes of sleep but my resident asked me to fetch the radiographs of the new admissions from radiology, which took a while because I had to check the ER for any new admissions. 

The first rays of the sun were shining happily into the corridors when I got a call from JI Nikki. There is another code from the east wing. 

Uh-oh. I thought. I had a feeling who it was.

This patient, a 55-year-old female, whose history I know by heart because of the many referrals I had to write for her. A case of periampullary mass, status post chemotherapy, with probable lung and bone metastasis. I visited her room several times during the tour of our duty because the doctors asked me to talk to them about intubation and resuscitation. I was tasked to have them sign a DNI and DNR. 

The first time I talked to her husband, he said he understood. He needs to talk to his children first. The second time I went to their room was the same story. And everytime I would pass by their door, I would peek inside. It's the same picture. A middle-aged man, well into his 50s, looking at his frail wife with sad eyes, all hope gone.

When I arrived in the room, two of the JIs are already there. The family already signed a DNR and in a few minutes, the patient was pronounced. We said our sorries to the family when the husband grabbed my hand and said, "Maraming salamat sa pag-aalaga ninyo sa asawa ko."

I walked out of the room with a heavy heart. The incoming duty and preduty teams are arriving one by one. I barely noticed. My eyeglasses were all foggy. I slowly slipped into the interns lounge and for the first time since I started my JI year, I cried because of a patient. 

I heard my JIs hurriedly change into their white uniforms for an exam in their school. As this was their last day in EAMC, we bid our goodbyes and goodlucks and I told them that the medical field is not that big, we'll be seeing each other soon. They left as we started our morning endorsements and admission conference.

The next day, I knew I was about to meet the new JIs in our team. But before that, I was stopped in the east wing, the nurse told me that I had to accomplish a death summary. I was about to tell her that I will send a JI in a while, but then I saw our patient's husband sitting there. I sighed and took the folder to do it myself. I opened the folder and once again reviewed the history that I knew so well and relived the circumstances that led to her demise. It was a relatively short death summary, and as I handed the folder over to her husband, once again thank me for all our efforts. 

I watched him walk away head bent, looking at the floor. I let go of another sigh, knowing that it'll take a few days or maybe weeks before I can shake the feeling off. I quickly walked to the Interns' Lounge, trying to get ready for another Pre-Duty-From spin, smiled at the new JIs and asked, "So, sinong preduty ngayon?"

Welcome to the Emerald City

Sometimes, when we run after the things we want, the more elusive they can be. But when we stop and stay still for moment, a tornado may sweep us off our feet and bring us to the yellow brick road to our dreams.

I tried to get matched to the DOH-Philippine Centers for Specialized Health Care twice. During the first matching, I went all Legally Blonde and did not have a second choice. But the during the second matching, I listed down my two other hospitals of choice -- our base hospital, Quirino Memorial Medical Center and the other hospital in close proximity, AFP General Hospital. I got matched to QMMC. And from the minute I found out that I was matched, I accepted it and tried to forget my dreams of being a DOH intern.

QMMC, after all, is not a bad choice. It is actually a very close second choice, yung tipong hindi ko lang magustuhan ang isang bagay sa DOH, tatakbo na ako pabalik ng QMMC. QMMC has been my home since 3rd year medical school. I know every twist and turn in its halls. I know almost all the hacks a Junior Intern must know to make life easier. Most of all, a lot of my dear friends chose QMMC, too.

So the wires in my head went all berserk when one of my friends, whose dad can work wonders in East Avenue Medical Center, told me that he is backing up my application in the internship program. Then my cousin, who is a former DOH intern, told me to go ahead and try my chances during the third matching. But I am backing out of DOH, I thought to myself. I have given up. I am going to QMMC and that's that.

But who was I kidding, this was the internship I have been pining for. So, cancelling all my plans for Maundy Thursday, I braved the scorching heat of the summer sun to try and pass the third matching exam and interview, hoping to maybe get in without having to call my friend's dad or my cousin.

Wore my red shoes to the interview to pay homage to Dorothy and her visit to the Emerald City. My red bag is Toto. 

They told us to wait for the results of the 3rd matching after the weekend. And wait I did. It was excruciating to wait. Until I got the message I have been waiting for. I got in. With all the people who supported me and my panel said that my interview went very well, I was thankful that I finally have an official slot.

The girls of Group G. Or at least half of us. 

Fast forward to a week later, after all the uniform-fitting and teambuilding, I found myself in a new group of 15 individuals who braved the challenge of DOH, and fitted into my new subgroup of four -- subgroup G4.

When I saw those two letters, I knew my name will never be the same again. To top it off, it sits above that much coveted DOH - PCSHC logo. 

Labor day 2014 marked the beginning of my year in my Emerald City. I have high hopes for this year, much like my year in QMMC previously. And who knows, after my 365 days here, I might choose to stay or click my ruby red slippers together to find my way back home.

Matched

Since I started med school, I only had eyes on one internship program: the DOH-PCSC program based in East Avenue. But when they said that they'll only be taking in top 20 students from medical schools across the country, I knew my chances were slim.

I did my research on how to get in despite not being in the top 20. "They" said I should walk in, "they" said I should try and get matched during the 3rd matching. But duties during clerkship wore me down that I was too tired to be competitive. I found myself matched to another hospital during the 2nd matching.

I gave up all hope until my cousin called me and asked if I really wanted a slot. I said yes. He gave me specific instructions on what to do next, and when.

After endless pep talks (kaya mo yan, Noah!!), a car that won't start, and exam made in the depths of hell somehow I nailed that final interview. Now here we are. It's official.

QMMC, I love you. Someday, I might find myself back in your embrace. But for now, I will have to go with my "other" hospital. 

Here's to new adventures, new friends, new environment. Here's to my Emerald City. Let's go, Toto. It's time to meet the wizard.

JIship in Retrospect

In the first three years of medical school, you don't feel like you're training to be a doctor. It feels more like an extension of high school, not college -- high school.

You belong in one big class, divided into sections. You go to school at eight in the morning, leave by five -- at least that was how it is in my medical school. People get to shallow fights over notes and who sits where in class. We are scared of recitations and pop quizzes really pop everywhere. And yes, there are those little classroom romances and "issues", just like high school. But then once you get promoted to fourth year, things change drastically. 

For starters, no summer vacation. Immediately after promotion, you start the crash courses on doing procedures, basic life support, advanced cardiac life support. And then just like that, you are brought to the hospital. No ceremonies, no anything. 

I was "lucky" enough to have OB-Gyne as my first rotation. Yes. I was sarcastic. 

OB-Gyne is known as the most "toxic" of all rotations. During the first couple of weeks, I actually considered skipping duty more than once. Primarily because it was tiring. But mostly because I was scared. I was scared to poke patients, I was scared of the residents, I was scared of blood. And well, OB is like bloodbath everyday. 

My OBGyne groupmates and first year residents, Doc Mich and Doc Rhaizza.

 But then eventually, I got the hang of it. The don't mind the smell of lochia on my hair anymore or the fact that sometimes I fall asleep in the cab after a long night in the labor room or operating room. Until one day, I realized that I was already shifting rotations. After that, I can't say that it was a walk in the park, but it was pretty much downhill.

In Junior Internship, I got to meet many kinds of people. I got to know my fellow Junior Interns better. They say that people actually change during JIship. I beg to disagree. I think its more of we finally get to know people better. In med school, we go home at five. In JIship, we go home the next day. And overnight, a lot of things can happen that would bring out the best and the worst in each other. 

Subgroup C4: Shakes, me, Oliver and Ian.

Growing up, I experienced attending a private school and a public school. I was exposed to people from different economic backgrounds. I have classmates who arrive in big, chauffeured cars and I have classmates who walk n kilometers to school in battered rubbershoes two sizes too big. I thought I already saw the stratification in social classes, then I rotated in a government hospital, it took my consciousness to a whole new level. 

My family is lucky enough to be able to afford to go the big hospitals when we have to. Personally, I have a pulmonologist for my asthma, a cardiologist for my arrythmia, a dermatologist for my skin. But the patients I met in my rotations, they come in, their illnesses fullblown, uncontrolled. They come in because they finally have the money for transportation. Since that's the only money they have, laboratories and other ancillary tests will have to wait for an indefinite time. Diagnoses are hit and miss sometimes. Interventions are delayed. Sometimes -- most of the times -- we have to shell out our own money just so the simple procedures like drawing blood or putting an IV line can be done. 

My partner since day 1, Oliver. 

There were times during the 11 months of JIship that I was too tired, too jittery, too giddy, too sleepy to function well. There was a time when I was crying while driving home because the consultants kick my butt in conference. There was a time when I left my car in the middle of the parking lot just so I can sign in on time. There was a time when I was the patient in the ER because duty + makeup duty hours started to take its toll.

Block C San Beda College of Medicine Class of 2014.

The night before graduation, as I forced myself to sleep -- I couldn't, out of sheer excitement -- instead of counting sheep, I counted my patients. 

The first one, who I monitored in the Surgucal ICU because of asthma in acute exacerbation, at 22 weeks AOG, not in labor. 

The next one, postpartum bleeding. Stayed in the SICU for weeks, succumbed to sepsis.

Then there's the girl we admitted in the Pedia ER, transferred straight to Pedia ICU due to Dengue Fever Grade III. I didn't know what happened to her afterwards.

Then there's my patient in Psych, who got so drunk he ran around his town many times.

Then there's the MDR-TB patient in Silang, Cavite, who we have to transfer to DSLU for continuity of care. 

Th list went on and on. Some of them, I can only remember faces, some last names, some only the diagnosis, most were just a blur. 

Then just as soon as it started, it came to an end. The last two weeks of JIship was an emotional rollercoaster for me. The prospect of breaking up with the subgroup I have known and love so dearly was enough to drive me into tears everytime (that was a secret).  And the thought of venturing into the unknown -- PGIship -- was great enough to scare me enough to want to crawl back to med school.  This time, a JI would ask me how to do things, why things are, and I don't know if I would know the answer to that. 

I am now less than two weeks away from PGIship (Post-Graduate Intern), still with no concrete plans of what hospital to go to. 

Am I scared? 

Yes. 

Am I excited? 

Definitely. 

Am I ready for it? 

In our profession, there's no such thing as "ready". Just do, the rest will follow. 

The PGI Bucket List

I've done and/or assisted numerous procedures during my Junior Internship year. This upcoming PGI year, I wish to do more, and possibly every item on this list.

[   ] Intubate an adult.

[   ] Intubate a newborn.

[   ] Lumbar tap an adult.

[   ] Hold the drill in an Orthopedic surgery.

[   ] Spinal tap during Anes rotation.

[   ] Episiorrhaphy -- 4th degree laceration.

[   ] Close the skin, C-section.

[   ] Close the skin, open cholecystectomy.

[   ] Assist in CABG.

[   ] Assist in kidney transplant.

[   ] Appendectomy, surgeon.

[   ] Deliver a frank breech via NSD.

My magic 12. Make it happen Universe! List me down for DOH-PCSC!

Here's to Us!

I wasn't given the chance at a privilege speech during my graduation. That honor is reserved for the brightest in class. I am not. I never was the "--est" in my class even before coming to medical school. But I feel that some form of gratitude speech/post is in order, especially for the people who helped me reach my second pitstop.

1. My parents -- Noel and Angie Pagdanganan.

Before attending college, people assumed that I would follow my mother's footsteps as a nurse. But surprisingly, my mom was against it. I am not that good in math so becoming an engineer like my dad was out of the question, too. So I decided to level-up my mom's profession, I went into the health sciences and eventually medicine. I am now the 8th doctor in the family. The 7th in my generation. The 10th, including the laterals.

So it is fitting that the first in my list are my parents, who never gave up on their daughter, despite lots of mischiefs she managed to get into. Seeing your proud smiles during the graduation erased all the exhaustion I felt especially during the last few weeks of junior internship.

2. Ninang Allyn and Tito Mon.

My mom's older sister and her husband who serves as my second parents. I didn't have to invite them to my graduation, it is given that the two extra seats are for them, no questions asked. Ninang has been my second mom ever since I can remember even until after she got married and had a kid of her own. Thank you for always praying for me, the guidance during the times when I was confused as to what I really want to be. Sorry for missing many important family gatherings, but I know that you understand the demands of the profession I want to belong to.

3. My Oca Cousins -- Erjohn, Anna and Feliz.

There's only four of us, and being your super ate, sorry if at times I cannot be with you. But this is for you, too. We have a relatively small family and all we have is each other. Always keep that in mind. Ate is always here for you, no matter how busy or crazy her schedule becomes.

4. My Pagdanganan Cousins -- Kuya Almer MD, Ate Lisette MD, Ate Ivy JD, Ate Chela MD, Arni MD, Jhec MD and Hester MD.

I finally feel that I belong. Thank you for the kind words and encouragement during the times that I want to just quit and go into research seclusion. Thank you for making me realize that even though a PhD is just as rewarding, an MD will suit me better. And you were right.

5. The DVMI Sisters -- Sr Bren, Sr Julien, Sr Cristina, Sr Eloisa and Sr Adelie.

Thank you for always including me in your Vespers and Lauds. For always telling me to not give up when med school was slowly dragging my hopes down. For giving me the spiritual integrity to fight every battle with a clean heart, that despite being soaked in science, I would never fail to marvel at the work of God and to know where my abilities as a healer would end and to let God do the rest.

6. Fr. Anthony.

You were my Parish Priest when I decided to go to medical school. You wanted to send me to World Youth Day 2008 in Sydney, Australia but unfortunately, I had to say no because of my classes. You supported me throughout my tenure as President and eventually Coordinator of the Parish Youth Ministry. A few months into medical school, I started losing grip of the Ministry but you never lost your faith in me. Thank you for the prayers, for the spiritual support and for being a good friend throughout my med school years.

7. Fr. Rico.

Since you came to our Parish more than a year ago, you never failed to show support to PYM. And even though I had my share of shortcomings especially in the last few months, you stood by me as the Coordinator. I am almost ready to turn over the position I have been holding since 2006 to someone equally capable of handling the youth soon.

8. The Parish Youth Ministry.

These kids were my lifesavers. They gave me back my self-confidence and self-worth when I was going through one of the most painful heartbreaks one can imagine. You gave me back my life when I thought things would not get better.

9. My first med school barkada -- Nikki, Jilly, Apple, Tres, Gary and Ron.

It's kinda sad that we didn't get to the finish line at the same time. But here we are, one more year and almost all of us are MDs. Thank you for a very colorful first 2 years in medical school. Maybe we can get together again sometime soon?

10. C3 and C4 -- EA (kahit iniwan mo kami), Czi, Lei, Makoi, Shakers, Ian and Oliver

I actually enjoyed the year with you. You guys helped me make my JI year bearable and happy. The thought of going back to the duties without you there breaks my heart. I miss you all already. And to my subgroup C4 -- for making me you "baby", for always reminding me to not to fight with intoxicated patients, for saving my ass when I can't get a procedure done. I miss you already.

11. Rochie Cuevas PhD -- the Bestfriend

Remember when we were in 1st grade, we said that we'll attend HS in UPRHS, college in UPLB then go to med school. So I didn't go to UPRHS, I didn't make the cut or UPLB because I took my chances in UPD instead. But you didn't go to med school so that makes us even.

Seriously, thank you for being my breath of fresh air year after year. Whether I got promoted or retained, you always show up in the Orange House, either to congratulate me or cheer me up. Twenty-four years of friendship can never go wrong!

12. The DLRC Kids

Hey you. Thank you for always being "happy". You always spread happiness when you're around. Sorry for the missed birthdays and gatherings when I'm on duty or have a big exam. We'll have SS again this year, yes? Yes!

Did I miss anyone? Yes, I did. I deliberately did. You know who you are. No thank you for you just yet, we still have a long way to go.

Beyond the Glory

Fifteen years ago, on an ordinary day, a young probinsyana from one of the Southern Provinces, with her little bags and a box of buko pie, decided to embark on a journey to try and reach her dreams.

The journey is long and weary. There are many obstacles on the road. She met a variety of people. Some with kind faces, very few with kind hearts. She experienced failure after failure. Frustration after frustration. Heartbreak after heartbreak. Many times she would go to sleep, thinking that in the morning she would stop and go back, back to her comfort zone, back to her little town in the middle of a rice field. But she didn't. She would wake up the next morning, telling herself that she would try again.

And so that went on. Until she suddenly saw herself on pitstop #1. She thought, maybe this is all there is to it. Maybe this is her destiny. She decided to stop. She decided to settle.

But she wasn't the settling kind. Her heart grew restless easily. She couldn't keep still. She couldn't stay in one place. She knew she had to make a leap of faith. She knew she had to continue her journey.

So on another ordinary day, she packed her bags and moved to a place she never thought she would live in. And there, even through more struggles, she found what she was looking for.

Now, she has reached pitstop #2. But this time, she knew that stopping is never going to be an option anymore. She knew that this journey is far from over, and that she is only at the very beginning. But it doesn't matter. Because she is where her heart is happiest.

"But to look beyond the glory is the hardest part, for a hero's strength is measured by his heart."

Go the Distance, Michael Bolton

With the people who stood by her to the second pitstop. Cheers to us! (Photo Credit: Red Magdayao, MD)