Monthly Archives: February 2013

Hearts’ Day

hold my hand..

While I really have no idea on where or how other people spent valentine’s day, I spent mine  doing my rounds and working as the resident on duty in the ward section of the hospital.

And while some people, and probably the rest of the world were having candlelit dinners, watching a musical, a movie or even just having a romantic walk in the park, I did my rounds alone.

I’m pretty sure that at some point in time, while someone else might have been holding a special loved one’s hand, putting on a ring and promising forever, I held on to my 90 year old patient’s frail and shriveled hand just long enough to reassure her that she is not alone; that it won’t be long now, that things will get better soon.

And for a moments I pause and wonder if I’m saying all these for the benefit of my patient or for myself..

[NB: this piece was originally written and posted at my other blog, this event happened during my first 2 months of being a resident in training in Internal Medicine, modified and reformatted for this blog post]

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Lifeblood

[NB: This blog post first appeared in my other blog as life and living July of last year. It has been slightly modified for this particular blog post]

I was on hospitalist duty the night before. It was a good duty, meaning there were no untoward incidents during the time that the patients were under my care. There were 2 new admissions, both cardiac cases, but otherwise the ICU was already quiet after 3 AM when the post craniectomy and ventriculostomy patient came in. Morning came and I endorsed the care of the patients back to the ICU resident of the day. I had other things to do.

I asked if the patient due for follow up came in, apparently she forgot, so I cut my clinic time short as I needed ample time as I would be taking the public transport. On the bus ride to Manila, it felt a bit nostalgic and poignant at the same time. I seem to have this thing with bus rides. Having nothing to do but sit, given the horrendous traffic of the city, it gives me time to think and mull over things that I would otherwise not have the time for, like having to ride the bus alone. Thankfully, I reach my destination less than 2 hours later. I enter the hospital and go up the elevator to the pediatric wing. I finally find the correct room after getting lost somehow and knock gently on the door. I was greeted by a welcoming smile on a face that’s obviously wanting of some more rest.

 There on the hospital bed was the reason I came here in the first place, my best friend’s cousin who by some unfortunate circumstances beyond his control is being treated for a disease that even with my medical training could barely explain how, more so, why it happened. Currently he is being infused with ATG (anti-thymocyte globulin) for immunosupression. He smiles at me, barely, as he asks that the channel on the TV be changed. After some small talk I am assisted to the ground floor where I sign a waiver and answer some routine questions. I know the drill. Having done all of this before. When it was my time to be tested, my ante-cubital area was unceremoniously being patted by the med tech intern, but was later relieved by the med tech on duty. “Good afternoon doctor” she greeted me, which probably took the intern off guard as he distanced himself from me. “I didn’t tell you, that’s why it was my alumni ID that I gave” I said to the med tech. “We have ways of knowing” she said. Then it dawned upon me, I placed physician after the question “occupation”. That’s how they knew. To be fair, they were professional about it, but I did appreciate the courtesy they extended, whether because I was a doctor or they do it to all blood donors is beyond me. I was willing to go for the apheresis, but apparently my veins were not large enough. I ended up giving one unit of whole blood instead.

 A friend asked me about the incident and why I did it. Truth be told, because I felt it was the right thing to do. For all the good things that have happened to me, this is my way of paying it forward. It is by no small incidence that today also happens to be my late sister’s birthday. I guess in some way at least I want to honor her this way and I will remember today as one of those moments in my life where I made a choice and that choice made a difference. Perhaps this is also why I ended up in this profession. No matter that there are questions that remain unanswered, that things don’t always end up the way we want them to be, and others needs sometimes come first before our own personal happiness, I still choose to be a doctor, a healer, a friend. And I still would like to believe that sharing your precious time, God given talents and expecting nothing in return and making this world a better place is what makes life worth living.

 


Pooreigners

I remember some years back, while working as an Emergency Room physician, a patient came in. He was a Caucasian male in his late forties maybe, and sought consult because of chest discomfort. Now any time comes in with such a complaint we’re on our toes and expecting the worst and prepare for the worst possible scenario. But after a while, we realized that this was probably a case of Coronary Artery Disease with episodes of angina. On physical examination one could see the midline scar on his chest, indicating that he underwent a previous thoracic surgery. On history taking he would disclose that he had a coronary artery bypass graft done on him years before. He would also disclose, that he was only able to do the procedure because his father loaned him the amount needed for the surgery. I can remember him saying that he was still actually paying off that loan, with interest. The patient was treated with emergency meds, felt some relief and thanked us profusely. But when we told him that he still needed to be admitted for observation and work up, he regretfully declined.

He said he couldn’t pay for the hospital bills. The hospital, being a privately owned institution, would have our heads if we admit a patient knowing very well that he could not pay. But knowing his current state of health, we advised to make arrangement to transfer him to a government hospital instead, but that too he declined. “I’ll just sign the papers” he said, referring to the hospital waiver that he was being discharged against the advice of his doctor. Reluctant as we were, we let him sign and gave him instructions to return should he feel anything out of the ordinary again. He was what we have termed a “pooreigner” a foreign national staying here in the Philippines because of circumstances beyond his control without the benefit of a stable source of funding, or in this particular patient’s case, “this is the only place where I can be happy” he said. When asked why, his reply was “Back there I’d probably die a long and lonely death”

He lives off the pension he receives, but since he has to pay off his debt to his father, what’s left is barely enough for his daily needs.

I have worked for and in a government hospital before, so it comes to no surprise when patients come in with only the worn down sandals on their feet and the clothes on the bodies and the hope that they can be treated for whatever it is that ails them the most when they come in for medical consult. It pains me to know that sometimes they could not even afford the antipyretic for their fever, much less the diagnostic exams needed to confirm what he has. Here you rely on your clinical eye, hand out a prescription you never know if and when it will be filled and offer a prayer that he gets well just the same.

But I’d like to believe that despite all of this, we remember that are all citizens of the world. Regardless of the colors of our skin, the lands of our birth, it all boils down to basic human dignity and one of the most basic of human needs as well.


Doctor as Patient

[NB: The following is the editorial reproduced in full from the Philippine Journal of Internal Medicine Vol. 50 No. 1 January – March 2012 issue, it was written byDr. Margarita Cayco. All copyrights remain with their respective authors and the Philippine College of Physicians]

I am the primary example of a doctor cast in the role of a patient.

This editorial is not a scientific or theoretical one but is my way of educating internists on another facet of medical care. To my medical students, may this article highlight to them that knowledge of the principles of medicine is not enough to practice medicine. It is also important to practice medicine in a humane way.

This article is the first time that I have put down in words my experience and my feelings about what happened to me. I hope the readers of this journal will allow me leeway in my choice of topic for this editorial.

I was hospitalized in late 2007 because of encephalitis, etiology unknown. I do not recall my symptoms prior to my admission. I was told I was highly febrile and complained of urinary retention. I ended up on a
mechanical ventilator because I was in a coma for several weeks and eventually got a tracheostomy, percutaneous endoscopic gastrostomy, a urinary cystostomy and had the requisite central lines. I had to undergo multiple lumbar punctures, phlebotomies and even blood transfusions. My case was a real meeting of minds which knew no boundaries or rivalries among graduates of different Filipino medical schools, just like my marriage to a UERM graduate (my being a graduate of UST medicine). My doctors were from UP-PGH, UST and UERM.

I was comatose for at least two months and thankfully I dot not remember anything that occurred in the intensive care unit. When I woke up I had to undergo rehabilitation (physical therapy and visual rehabilitation) for several months.

I owe my life to all my doctors, the residents, nurses and therapists and of course to my family, classmates, colleagues, friends and medical societies.

Being a patient made me realize what my own patients go through and gave me a firsthand glimpse into their sufferings. It made me sympathize and empathize more with them and made me more patient and understanding in my dealings with them. It makes it easier for me to discuss with them whenever the need for a procedure arises, especially a tracheostomy. I just show them my scars and almost always they agree to have the procedure done. I actually have not had a patient refuse a procedure after I talk to them. I tell
them that if I did not have those procedures done I would not be talking and walking now.

My experience as a patient was a humbling experience and hopefully made me a better doctor and teacher.


Chasing Dreams.. Again

[NB: This article was previously published in my other blog as chasing dreams sometime in 2008. This has been slightly modified and updated from the original article for this blog post]

nurturing the dream

While on board a bus in heavy traffic, this thought came into my mind: when we were still kids and the issues of global warming and the environmental concerns were already present, although not yet a tangible reality, we were told to plant seeds in the hope that it will one day become a majestic tree.

Needless to say, that was a long time ago.

Now all grown up, I realized that it was not entirely a lie but it was more of a half-truth if you please. I do not know if it was an oversight of my teachers then, but in hindsight and retrospect, they should have also taught us that it was not enough that you plant a seed and hope that it will grow. It should be nourished, taken cared of and even protected from the harsh elements. Or perhaps they were actually wise in letting us learn that fact of life for ourselves as we grew older. I will never know. What I do know is that seeds are pretty much like our dreams. It’s not enough that we have a dream, it should be protected, nourished, and nurtured until it becomes a reality.

And that’s part of the reason I am writing all of this again now. A good friend of mine once told me that his dreams of becoming a doctor are becoming blurry and his work in the hospital only make matters worse.

It pains me to know about his situation and not be able to do anything about it. He has the intelligence, the skills and most especially the heart and passion needed to be a doctor. Wait, no, a great doctor. All that bars him from being so is a piece of plastic that serve as proof that he has the license to practice.

How 1,200 questions divided among twelve subjects taken in a span of 4 days determines who is “qualified” or not to treat people of their medical ailments is not for me to judge. Why must his his dream of being able to help others through healing of the body and of the spirit so elusive in the first place?

During our freshman medical orientation talk, one of our professors told the story of a young and promising medicine student who wanted to quit his studies because as much as he wanted to become a doctor, he wanted to be a pilot as well. When he told his professor his dilemma, all he was told was “I don’t see anything wrong with that.” Whoever said you could not pursue both dreams? To make the long story short, the young doctor to be did not drop out of school, finished his degree and went on to pursue his other dream. The last time he saw him, our professor said that he maintains his private practice as a doctor while flying for a commercial airline twice weekly.

Likewise, I had the chance once to meet a fellow doctor that not only treats people with pills and prescriptions, but he also heals with the arguably best medicine there is: laughter. And no, he’s not Dr. Patch Adams, although I did have the pleasure of meeting him once when he visited the country. He is Dr. Carlo Jose San Juan creator of the medical comic strip callous comics.

But going back to my friend, he once wrote on his online post, that he was at a crossroad and had asked for a sign. In irony, I had hoped that he failed in getting the promotion so that he can be once again free to chase that dream of his. And I’m still hopeful that his dream will be realized one day.

Our dreams may be grand or otherwise, but what is important is that they are our dreams, not dictated upon us or simply borrowed from others. We may have others who share and support our dreams, but ultimately it is ours to fulfill.


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