Monthly Archives: October 2012

Junior Intern On Duty

[NB: the following is an original article written by a batch mate  in medical school. We would like to thank the author for giving us permission to post the article  in this blog. ]

Maundy Thursday. April 8, 2004. 10:30 pm. 

It was my first week as a junior intern in UERM. I was doing my rounds in the Medicine pay section monitoring my patients’ vital signs when I got a message from the nurse that there was a patient who was transferring from the charity wards. He was JM, a 45-year old male, who came in due to bipedal edema of several weeks duration. He was previously diagnosed with Congestive Heart Failure, a condition wherein the heart could not pump enough blood to supply the body, causing him respiratory distress.

I did not attend to him right away as I was busy recording the vital signs of the other patients I was monitoring.

Maundy Thursday. April 8, 2004. 11:00 pm.

 I was in my station, 3 North 1, when Dr. Uy, the cardiologist of JM, together with Dra. Escasa, the medicine resident on duty, arrived to do their rounds. Guilty of not having seen the patient before their rounds, I was hesitant in handing them over the patient’s chart. I had no choice but to present it anyway. As they were discussing the case of the patient, I ‘slipped out’ to monitor the other patients assigned to me. However, Dr. Uy noticed that I, the junior intern assigned to his patient, was ‘missing’ and called my name. I reported right away. He asked me, “Have you seen the ECG tracing of this patient?” I answered honestly, “No, sir.” He showed me the ECG recordings and asked me to interpret it. I could not say a thing. Reading an ECG, a must know, was my Achilles’ heel. He was very kind for not humiliating me in front of everybody.

He then asked me, “Have you heard the patient’s heart sound?” I said no. He asked me to listen to his heart and come back and tell him what I heard.

I entered room 308, where the patient was confined. I saw an obese, dark-complexioned man lying on his bed. He was gasping for breath. A nasal cannula of an oxygen tank was attached to his nostrils. He was in moderate respiratory distress. He was sweating profusely and his skin was cold and clammy. His nail beds were cyanotic.

I lifted his shirt and placed the bell of my stethoscope over his chest to listen to his heart. I could not hear any heartbeat because his breath sounds were louder than the latter, thus, giving me a ‘noisy environment’. I used the diaphragm of my stethoscope but his heart sounds were overshadowed by his breath sounds. I did this for more than five minutes but I could not hear any distinct heart sounds. Then I went out of the room and reported back to Dr. Uy. I told him I could not hear anything so I could not describe his heart sounds. He accompanied me back to the patient. He auscultated the patient then he let me listen through his stethoscope. He told me to listen to the gallop sound. A normal heart sound is “lub-dub… lub-dub…” His was very rapid “lub-dub-lub-dub-lub-dub…”

Maundy Thursday. April 8, 2004. 11:50 pm.

The patient was a time bomb waiting to explode. I was beside Dr. Uy when he was explaining the condition of the patient to his relatives. Sooner or later he was going to have an arrest – he was going to die. That was the reason I have to monitor his vital signs hourly.

The relatives were faced with two choices if ever he went into cardiac and pulmonary arrest. Choice A was simple: Do Not Resuscitate. Choice B was to intubate him now so to avert a respiratory arrest and place him in the Critical Care Unit. His relatives were not sure if they would be able to afford his 100-thousand weekly hospitalization cost if ever he was placed in the CCU.

They were undecided.

Good Friday. April 9, 2004. 12:30 am.     

The patient was observed to have yellowish penile discharge. Pauline, a fellow junior intern who would help monitor some of my patients whenever my load was overwhelming, and I were assigned to get the tip of the patient’s Foley catheter for gram staining and culture. We were also instructed to put on a new catheter to monitor his urine output accurately. I was kind of excited since I had not done this procedure in my first week of being a junior intern. It would be my first time.

When the materials were ready, we entered the patient’s room. She told me that I was the one who was going to do the entire procedure, as she would be there only to assist me. I put on my gloves and told the patient that the procedure would be not comfortable. We were able to get the specimen and re-insert a new Foley catheter without much difficulty.

I also pushed Furosemide 80 mg IV, a diuretic, to help the patient urinate and lose much of the fluid he had retained which was contributing to his respiratory distress and edema.

Good Friday. April 9, 2004. 1:15 am.

I checked the patient’s vital signs which had not changed much. His BP was still 120/80 mm Hg, heart rate was more than a hundred, and axillary temperature was 36.5˚C. However, he was tachypneic as his respiratory rate was already 56 cycles per minute. His urine drainage bag was empty. He was diaphoretic – his two pillows and bed sheet were wet with sweat. I told myself that Dr. Uy’s assessment was correct, this patient was about to die soon.    I urgently referred his condition to Dra. Escasa, who promptly ordered another Furosemide 40 mg IV push.

Good Friday. April 9, 2004. 1:30 am.

I went to his room to check if he had urine output. There was none. “Did I insert the Foley catheter correctly?” I asked myself. Even his relatives called my attention to check if it was connected. I told them it was in place. I was sure that it was in his bladder. Pauline confirmed it. But the zero output despite the administration of two doses of diuretic agent made me wonder why he had not any urine in his drainage bag. I referred this matter to my senior intern.

Good Friday. April 9, 2004. 1:45 am.

A relative went into my station and informed me that the patient wanted to be nebulized. I checked his breath sounds but I heard no wheeze. I just explained to him that the reason he was having difficulty of breathing was not due to constriction of airways, which could be relived by nebulization. He was gasping for his breath because of pulmonary congestion. I told him that his heart could not pump blood efficiently so there was backflow of blood into the pulmonary arteries. It was causing fluid build-up, impeding proper expansion of his lungs for oxygenation of blood.

Good Friday. April 9, 2004. 1:55 am.

As I was going to leave the station to monitor JM, I saw Dra. Escasa approaching. She was now opening the door of room 308 and I immediately followed. As soon as we entered the room, the patient collapsed!

I sensed panic but I kept my presence of mind. I pulled the patient’s bed so I could go to the patient’s left side as Dra. Escasa was checking his heart and shouting instructions to the nurses, “Bring in the intubation and suction machine now! Call ECG technician now! Page Dra. Mabilangan now!”

A bloody frothy discharge came out from the patient’s mouth. She told me to do chest pumps so I immediately climbed onto the bed and knelt on his left side and performed chest compressions.

I could hear the relatives crying outside the room as the paging system announced repeatedly: “Dra. Mabilangan 3 North 1 NOW!” Dra. Mabilangan was the Chief Resident of the Department of Medicine. Announcing her name to go to 3 North 1, my station was a code that someone was being resuscitated. Seconds later she was inside the room. Some residents and senior interns were already helping Dra. Escasa in intubating the patient. A group of male junior interns were also outside waiting for their turn to do CPR.

The ECG technician also arrived and instantly placed the three electrodes to the patient. An ECG tracing showed that the heart was still contracting but failing. Epinephrine was administered while the residents and senior interns were intubating the patient. Chest pumps were resumed and after 20 or more pumps, I felt exhausted and I shouted, “Change!” Gio, the junior intern next to me, occupied my space and continued pumping. There were five of us alternating in giving him chest compressions.

A repeat ECG tracing done showed flat line – his heart was not beating anymore! Finally he was intubated but auscultation of the chest and abdomen showed the tube was in the stomach and not in the lungs. First intubation try was unsuccessful. A nasogastric tube was simultaneously being inserted to decompress his abdomen. It was now Yay, another junior intern, who was giving CPR as I pushed the sixth dose of Epinephrine.

After thirty minutes, ten doses of Epinephrine, countless chest pumps, a dozen flat ECG tracings and several intubation attempts, JM was pronounced dead by Dra. Mabilangan. All residents, senior interns and junior interns, exited one by one.

I remained inside as he was still my patient and my responsibility. He was the first person I had given chest compression, hoping that my effort would give him a new lease on life. He was the first person I had seen dying. All throughout his last moments, I was beside him. I silently prayed for his soul as I left the room to give privacy to his grieving relatives.

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About the author:

Arbee Bascuna, M.D. is a graduate of the UERMMMC College of Medicine Class 2005 and is currently taking up residency training in urology at the St Luke’s Medical Center.


Mythbusters (repost)

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start them young ..

[NB: These are old posts which I will repost from my old blog which I started early back 2007 which got torn down by friendster. I am reposting them for public consumption. Salamat po ]

Here’s my take on Medical School Myths, Mythbuster style

Myth 1“I am better than my classmates” NOT.

Everybody in my class is better than me. They know more, they sleep less, and they are all better looking than me. Sabi nga ni Nel sa PBB “Lahat sila pang main dish, ako.. pang appetizer lang”. Buti na lang Mr. Personality ako Myth Busted

Myth 2 “Biology is the best pre-med”

I saw this one on a phamplet published by UST describing biology as the “preferred pre-med” for medicine. God, kung alam ko lang sana nagnursing na lang ako or nag medtech para sana mayfallback man lang ako. I guess kanya nila sinabi yun para wala ka talagang choice kung hindi magtapos ng med diba, ano ba pwede trabaho ng biologist? Myth Busted

Myth 3“All of the answers are in the books”

This is true up to a certain extent, until of course your professor blurbs out the proverbial phrase, “Class, base on my experience” In which case when examinations come, always choose the answer your proffesor told you even if all the books you read glaringly point out otherwise. Myth busted

Myth 4“If you retain about 15% of what you read in med school then you are already a good doctor”

I heard this when I was cramming up for an examination. It was supposedly quoted by Dr. Gisbert of Makati Med. What if 7% lang alam ko, does that make me an average doc? Myth Plausible

Myth 5“Teacher’s are gods and there powers trickle down to their Secretaries”

This 2 beings in med school are all omnipotent, in a whim they may make your life a living hell. They are the law, and what they say is final. There are always 2 sides to a coin, 1 good and 1 bad, usually the latter of the 2 beings would be mephisto incarnate. Myth plausible

Myth 6“Anak ng Diyos”

Meron din kami nito. This is the student who has the right blood lines, he/she is considered royalty in med school, in the corporate world he/she is the boss’s son/daughter. Even the feared secretaries kowtow to such a being. They get all the breaks. Word of advice, befriend such a being. Myth True

Myth 7 “Sandali lang ang medicine anak”

It takes too long, 4 years of premed, 4 years of med proper plus a compulsory 1 year of internship, another 3 months to wait for the august board exams, another 6 if you’re taking February. Two to three days to wait for the results, then 1-6 months being a pre-resident (depends I heard meron daw nagtiis ng 2 years), then another 3-5 years for residency training. Add 2-3 years for a subspecialty, and a life of reading volumes and volumes of books. Bottom line is by the time your earning your 1st paycheck your classmate in high school has already earned his 1st million. 26 na ako nay at nagaaral pa rin ako. Myth busted

originally posted @ jimbopogi.blogs.friendster.com on March 09, 2007

Borrowed Dreams

[Previously posted as Recycled Dreams in the Aesculapian Vol. 40, No. 2, modified and updated for this blog post]

Kung saan ka masaya, te suportahan taka…                                                                                                                                                             

image credits: yourjustine.tumblr.com/

The line above (loosely translated from Ilocano: whatever makes you happy I will support you) is from an old PLDT TV commercial advertisement circa 2001 where a father, a Doctor apparently, reassures his son, who was taking up Medicine at that time wanted to shift to Fine Arts, that regardless of what he wanted to become he’d still support him. Personally I liked the print ad version better. But this article isn’t just about the ad, but rather it’s about what we can learn from it.

Flashback to the time when I was just a kid and people asked me what I wanted to be when I grew up I always had a ready answer: I wanted to be a scientist. What kind they asked still and I’d say just a scientist. What was I to know, I was just a kid right? Now fast forward a few years later, it was the time just before graduating from college. Like so many others of our class I mulled at what lies ahead for me. If I wanted to I was offered the chance and position to go into research and become the scientist of my childhood, but I decided to take on another career path, where most of my classmates were also heading — I was to pursue a medical course. And mind you it’s not because I bumped my head on the wall that I got this idea. I guess it was part of me all along and I just didn’t realize it.

So when I was interviewed here at UERM and asked why I wanted to study Medicine for lack of a better answer I uttered the most over used and abused cliché “Because I want to help my fellowmen” and the interviewer seemed unimpressed. He then proceeded to ask me, again, why I wanted to become a Doctor of Medicine and I said that it’s my dream, and that I didn’t want it to remain just another dream.

And like any medical student will probably tell you, I worked, studied and persevered to fulfill the dream that I can honestly say is mine. I wasn’t forced, coerced, and most definitely not bribed to becoming a doctor. It’s my own choice.

Unfortunately I can’t say holds true for all of us. Like the father in the advertisement, and most other parents who are professionals, there is the tendency to want to pass on the dream, to follow in their footsteps, and ultimately continue their legacy. I know of a friend who is taking a medical course only because both his parents are doctors, his uncles and aunts are doctors and apparently, as logic would place it, so should he. In the long run, he will just continue the tradition of being another doctor in the family. It’s a good thing that he did not take his studies half heartedly, and embraced the dream as his own, otherwise he’d probably end up a mediocre, a doctor who never wanted to be one, in stark contrast to those who really want to become doctors but could only dream of it. Such is life.

Mulling over these thoughts of mine, I dream again. Perhaps if and when the time would come when I have a family of my own, I will allow my kids to live and choose their own dreams as my own parents allowed me to live and choose mine. Their dreams doesn’t necessarily should be a duplication of mine, but if ever he does tell me what he wants to pursue, I’ll probably look back at this article, smile and say kung saan ka masaya te suportahan taka.


At Any Price

[NB: the following is an original article written by a classmate in medical school. We would like to thank the author for giving us permission to post the article  in this blog. ]

dreams are the seeds from which our realities grow

dreams are the seeds from which our realities grow

I am writing this on board a plane. I have just visited my uncle and his family in Seattle, Washington, for a week, and I am on my way back to my father’s place in New York City.

My dad graduated from the University of the Philippines, Los Baños many years back. He immediately took a job in a big agricultural company selling fertilizers and at the same time educating farmers in the province of Pampanga. He was a good lecturer and educator, being pro-farmer. In Pampanga, he met my mother, the daughter of a small-time fertilizer dealer. They had me a year after they were married in 1978.

My mom worked for an airline company. Even if they were both working their bottoms off and thought they only had me at the time, they felt that they still didn’t have enough. We didn’t have our own house and the budget was always tight.

My dad decided to work in Saudi Arabia (yes, I am an overseas Filipino worker’s child). When he was working in the Middle East, we were able to build a house and buy some properties, and later we, the children, were sent to exclusive private schools.

My father was not around when my brother was born. I had such a skewed idea of family that when my brother was born in 1983, I blurted out: “Ma, lalaki ang anak natin!” [“Ma, our child is a boy!”]

My dad tried to find work again in our country, but because of his age, and maybe partly because of politics, he failed to land a job. Thus, after his stint in Saudi Arabia and multiple failures in business and employment, he decided to try his luck in the land of the free and the home of the brave.

He went to the United States on a tourist visa. He had no permit to work and he carried the burden of making our lives comfortable.

Raising us was no picnic for mom. She was single-handedly taking care of two boys, and taking all the physical, emotional and psychological blows they entailed.

My dad, for all his expertise, educational background and vast experience, landed a job as a housekeeping staff in a nursing home. Later, he worked as a nurse’s aide. After that, he worked as a carpool driver on the streets of New York. All the time he saved as much as he could so he could send money home to mom. And this was a man who had graduated from San Beda College and University of the Philippines and who had managed people in a large agricultural company.

At the age of 40, he decided that it was time to move up. He studied nursing. And when he completed his studies, he worked as a nurse — a job that he holds up to the present.

He could not go back to the Philippines because his immigration papers were not in order. So we visited him instead.

As the years passed, we started to drift apart, until we became almost like strangers. My mom loves my father, but she does not really know him well because during their 30 years of marriage, they were only together for a total of 10 years. All their married life was focused on providing a good life for us, even if it meant giving up the romance, the long walks, the “growing old together” that most couples enjoy.

I sometimes wonder why my parents gave up being together and how they were able to go through it day after day. I can imagine them just newly married and making plans to grow old together, to raise two boys together and then retire together—to start and to end together, as husband and wife.

This did not become a reality. It did not come true because of the great American dream.

The American dream is defined differently by different people. This I have learned from long conversations with my relatives. To some, it means living in the USA, building a family there, having a good career, and buying a house in a good neighborhood. To others, like my father, the American dream means working in the US, no matter what the price, to make their loved ones in the Philippines live comfortable lives.

My father is 54 now, but he looks much older than his age. Years of hard work as a nurse have taken its toll on his body. Diabetes has destroyed his joints and impaired his eyesight. He has spent several days in the intensive care unit alone. Despite all this, he continues to serve American patients and doctors.

Maybe a part of the American dream is the feeling of self-worth. When he was in his 40s, many companies in the Philippines turned his job application down because of his age. In America, his patients and co-workers love him and his age and his race hardly matter. Because he pays his taxes on time, he enjoys great benefits in terms of health care. His insurance paid for his ICU confinement as well as his laser surgeries for glaucoma. He has worked hard and Uncle Sam now takes care of him.

Ah, the American Dream: My father is weak but he is happy. His American dream came true in his accomplishments, in the properties he owns in the Philippines and in his sons, one a doctor, the other a lawyer. After more than 20 years of being apart, I think he’s trying to make up for lost time.

I am a new doctor in the Philippines. I am my father’s son, and I, too, am searching for my American dream.

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About the author:

Carlo N. Lazaro, M.D. is a graduate of the UERMMMC College of Medicine Class 2005 and is currently taking up post graduate fellowship training in gastroenterology.


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