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?"