Category Archives: Clinical Internship

Prescriptions & Prejudice

rxpad

kindly include prayers as needed..

Part of what I do as an In-House physician in the hemodialysis center where I work is to review the patient’s list of medications and if needed, refill prescriptions for the said medicines, as we often limit them to a month’s worth as they may have to be changed later based on their response to the said medications. One time, the husband of a patient came to me asking if I could make three identical copies of his wife’s prescription. When I asked why, he reasoned that he was going to ask three different entities, namely, the City Health Service of the City of Angeles, the Philippine Charity Sweepstakes Office and the Office of the Governor, for the said medicines. Further reasoning that if all three gave him, he would have at least been assured of 3 months worth of meds, if not, he will just buy them instead. I pause and give a short sigh, but remember having read this letter from a woman who experienced prejudice firsthand, I would think twice before passing judgment.

Going back to the said letter, I was drawn to another website where it was also featured not to the article itself but the commentaries of the people who have read it. Some of them pointed out that true, there may be people who are actually in need of this kind of aid from the government, there are still those who abuse these kinds of things as well. Government aid, they argued, can be a bane or a boon depending on how we look at it and from whose perspective. Given the ongoing talks about misused funds and taxpayers money, I heave yet another sigh.

I remember when I was still a Junior Intern (or Clinical Clerk as they are known in some other institutions) during my rotation at the Out Patient Services, Charity Division of the hospital my then OPD resident told me to assist a patient to the Social Services office prior to their admission. The patient was a male in his early 20’s and with him was his father. Based on the planned surgery, he would be needing titanium plates and these would cost money of course. The question would be: will the hospital shoulder some or all of the medical expenses, given that this was a charity case. At the Social Service office he was asked routine questions about their family and the patient: Where they lived, source of income, etc. I was there so I know for a fact that the father claimed that he had no stable source of income, when lucky he would ply the streets as a tricycle driver. That they were living with relatives in Manila just for the time until the surgery can be done. He presented some documents for scrutiny, and after several minutes had his admission stamped with “class D” – meaning he was from the lower income bracket and was indeed qualified to avail of the hospital’s charity services.

So what has the above story connect with the first? It was only later when I went to see how the patient was doing when I accidentally overheard the father of the patient talking to another relative in the ward. He said, or rather boasting, that he wasn’t really poor at all, that they had just been from Hong Kong the month before, and that he just wanted to save the money he would have otherwise spent on the titanium plates had they known his real status in life. We have to be wise about these things he said with a laugh. I cringed. We all have been fooled, the people who just wanted to help, by some people who deliberately choose to deceive and get the upper hand.

What is disheartening most about this is not the fact that part of what was used to pay this particular patient’s hospital expenses came from our tuition fee as medical students, but that the same treatment could have been given to someone who actually did deserve and needed it. This happened several years ago, but with today’s current issues at hand foremost the circus that is the pork barrel scam still to find a resolution, I choose to abide by the oath that I have taken as a physician, and rather than be a critic, to just do what it is we hope to do best: to be a healer to the sick and afflicted no matter their race, creed or stature in life and hopefully in our own little way, be a catalyst for the change that we yearn for.

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Old Methods, New Learnings

[NB: The following appeared on the opinions pages of the Philippine Daily Inquirer  the online version can be found here. The article was written by Dr. Leonardo L. Leonidas who retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career Teaching Award in 2009. He is a 1986 graduate of the UP College of Medicine. All copyrights remain with their respective authors and the Philippine Daily Inquirer]

med_school_591

medicine.. lifelong learning

About 17 years ago, Bethany, a former patient of mine, asked if she could shadow me for three months at my office. She had just finished her premed course at the University of Maine. She wanted to apply to a medical school.

In the first couple of weeks, she just observed what I was doing. Then I let her listen to the chest and heart of my patients and, in time, to use the otoscope to look at the eardrum. Soon she was palpating the abdomen of babies and checking the hips for dislocation.

After about a month of Bethany’s observing and listening to how I took the clinical history of children with ear and throat infections, I would leave her to interview the parents and write the history herself. When I would return to the examination room, I would find the history and details of the physical exam already done in the computer.

Near the end of her three-month “training,” Bethany was writing prescriptions for the most common antibiotics for ear and throat infections as well as pneumonia.

A couple of years later, my son, Len, completed his course in biology at the same university that Bethany went to. He wanted to take a year off before applying to medical schools, and he volunteered to help at my office. Like Bethany, he shadowed me and learned how to take a patient’s clinical history and conduct a physical examination.

Neither Bethany nor Len attended formal lectures in basic medical subjects like anatomy and physiology. Because my office was busy, I just told them the main features of a disease to make a diagnosis. I advised them to read about pneumonia, asthma, ear infections, strep throat, appendicitis, migraine, etc. after office hours.

Len shadowed me for about 11 months, and I treated him like a third year med student. And during that time, aside from diagnosing the most common illnesses in children, he was able to suspect appendicitis in two cases—and the surgical reports confirmed it. Just after about three months, I left Len alone with my patients and their parents, and he independently wrote the histories and physical examinations, made diagnoses, and wrote prescriptions. I reviewed what he had done and signed the Rx. In the vast majority of patients, his diagnoses were on target.

Now why am I telling you about Bethany and Len? With the advent of the iPad, tablets, smartphones, and laptops, I think we can drastically change how we educate our medical students, in a better and faster way, with less of the stress that may lead them to depression or suicide.

The only lecture-based topics that medical students need are: how to take a history, to do a physical examination, to make a differential diagnosis, and to request the most common lab and imaging procedures. These can be done in the first six months of med school. Then they should be exposed to patients as early as the second half of the first year. The “basic sciences” standard lectures should be reduced by 80 percent; they should be allowed to study independently outside the lecture room using video lectures by the best teachers, which are available 24/7.

During the bedside interview with the patient, using an iPad or tablet, students can easily look for the common signs and symptoms, pertinent physical exam, and patho-physiology procedure needed to figure out the diagnosis. With a resident guiding or demonstrating to them the steps in making a diagnosis, students will learn clinical medicine faster than in the traditional lecture-based education which, from my experience, was stressful because of tons of memorization.

Armed with an iPad, tablet, or laptop, students can make an electronic patient portfolio file (EPPF) that they have to keep from first to fourth year. Their graduation will be based on this EPPF. However, they will have to see a minimum number of patients afflicted with asthma, migraine, diabetes, pneumonia, heart failure, meningitis, depression, head injury, fracture, appendicitis, etc. The EPPF will carry complete histories, physical exams, differential diagnoses, work-ups, discussions, and evidence-based medicine references (if available).

The EPPF will be designed to include a self-assessment test after each case; a student should be expected to answer and pass this test by at least 90 percent. The questions will be almost the same as what are being asked in the national board exams.

Students’ EPPFs can be easily reviewed by senior residents, mentors, or consultants without them leaving the comfort of their office or living room. A patient may also access an EPPF if he/she desires to do so, and correct or add new information. If the patient has an e-mail or Facebook account, a student can do follow-up work and an outcome study. Those who are interested in teaching, even if not part of the faculty, may volunteer to be e-mentors. With this pool of talent and experience, learning can be more personal and global.

About 10 years ago, I hosted an e-learning case-based problem-solving session with third year students of the University of the Philippines College of Medicine. It was fun, and one of my e-students commented that he learned from my e-mails much more than in the six-week rotation at the Department of Pediatrics. This student has just completed his gastrointestinal fellowship at Mayo Clinic.

Bethany is now a cardiovascular surgeon, and Len an internist-pediatrician.

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We would like to acknowledge the author for giving us permission to repost his article in this blog and saying that he might contribute here as well.


Wonders

Always be in awe of the wondrous mechanism of the human body. Let this be your inspiration in your studies, not the quest for grades

– Patch Adams


A Day With Kids

[This was previously published  as a contributed article in the Aesculapian Vol. 40, No. 1, slightly modified and updated for this blog post]

It was supposed to have been the last day of school before the much awaited (and very much needed) Christmas break, but some friends of mine asked me if I wanted to join them visit an orphanage. I thought to myself, “why not?” Little did I know that this visit would change not only the way that I look at life in general, but also how our actions affect other people’s lives  in particular.

The place wasn’t far, just a jeepney ride from school. I really didn’t know what to expect when we came in, not that I didn’t visit orphanages before. It’s just that sometimes, we get a little more than what we bargain for, and this was one of those times. It was their play time when we reached the place so the kids were, well, playing. In the beginning, I wasn’t really sure what I was supposed to do. In the orphanages that we used to visit, the kids were usually already around grade school age. The kids here were barely in pre-school. The resident volunteers told us that we could play with them. Most of my friends quickly approached them and started playing with them. Me? I waited. I waited and looked at the kids and wondered, “How long have they been here? Do they realize that they are orphans? What will become of them when they grow up? Does he really think he can climb that fence?” The last question at least I can answer. Finally, I decided to approach the kid who thought he was Spider-Man and smiled at him. He didn’t give me much attention though, as he was really intent on climbing the perimeter wire fence. Being the kind guy that I was, I helped him achieve his goal. It was then that I realized that he was trying to get a toy that fell on the other side of the fence. I retrieved the toy for him and probably gained his trust by doing so (but apparently not enough for him to willingly lend me his toy). The volunteers said that this was quite unusual because he doesn’t usually warm up to volunteers and visitors like us. Perhaps he was looking for a father figure or maybe because most of the volunteer workers there were females. So I realized what I was going to be for the kids. I was going to be a big brother to them, even just for a few hours that day. But it turned out to be a difficult task. It was as if these kids were like the energizer bunny. They just kept on going and going and going…

It was after my fill of kids clambering around me like I was a tree, chasing one of them only to be chased by half a dozen later, waiting patiently as another tries to impress me with his imitation of soiled laundry in the hamper, and my own imitation of a helicopter that I decided to take a break and sit at a corner. And that’s when I noticed him. Maybe because of the innocence on his face, the way he wasn’t always moving about like the rest of the kids, the way he held his arms up gesturing to be picked up, or maybe because he was the one nearest me that made me go and pick him up. Big mistake I later realized, because he never wanted to let go after that. It was then that I realized that he was, unlike the other kids, “special.” He longed for more attention than the rest of the other kids, and actually did deserve more care and attention because of his condition. It was only when John (the only other guy in the group) got him from me that I got to rest.

Luckily, soon it was already lunchtime for them. We were left to put away the toys that they were playing with – a truck with a missing wheel, a faded action hero, and some other toys that have seen better days. Some of us used the time to try our hands at feeding some of the kids. Others attempted to lull the younger resident babies to sleep, which I also tried with limited success.

After eating, it was bath time for the kids and when they smelled fresh again, it was time for their afternoon nap. And it was also our time to go. We left the administrator with some treats for the kids when they woke up. On our way back, I was thankful that my friends invited me. That day with the kids taught me something that I probably wouldn’t have learned within the confines of the lecture rooms. They made me realize to value the things that really mattered in life – a sound home, friends, and a complete family to which I belong. It wasn’t a fair trade. The kids gave us more than what we gave them. So with child-like innocence and faith, I’m praying that the future be kind to them.


The Sandwich, The Bananas and The Blind

image courtesy of 7bigspoons.com

A patient came in for follow up consult today after being confined in the hospital for elevated blood pressure. She was grateful that I took her case even though at the onset she stated that she did not have any money on her. I told her that if I didn’t take care of her when I did, she might have ended up with a stroke or worse a heart attack. Although she’s still not out of the woods yet she is thankful that she now knows what she has and with the right medications and motivation, she can still enjoy a rewarding life ahead of her. I told her that her consultation today was on me. She can pay me the next time she visits for consult. It was then that she said no, and gave me two bunches of bananas. She insists that she will pay me for my services as soon as she is able, that the bananas were a thank you gift. I could not say no and graciously accepted them.

It made me think of the time when I was still a clinical clerk (4th year medical student) doing rotations in the department of ophthalmology, I had come to see a patient who came in for consult at the outpatient clinics for a much needed eye surgery. When I saw her all she had was light perception, but if operated on there was a chance that she could see again. Being in the charity service, there was a lot of work to be done and papers to be filled out. I did all that I can to help her out. It took us almost half the day to finish, but it was all in a day’s work for me. She asked me what my name was and I told her. I won’t forget you she told me. And they went home to get some of the other requirements. I saw them a few more times in the OPD but then we were to rotate in general surgery already, so I never did know what happened to her after.

Until after a rather busy tour of duty, in the flurry of activity in the surgery quarters, someone called out my name and was handing me a package of what seemed like food. “Your breakfast” he said. “From who?” I asked. He mentions the name and in my half asleep, half awake state I realized that it was the name of the patient I had helped before. Apparently she was already admitted and was scheduled for surgery that day.

Eventually, I did find to time to visit her and see how she was doing. She was already in the ward, but still with bandages over her eyes. “Oh, it’s you” she said when I greeted her “did you get the food that I sent you?” I responded in the affirmative and advised her not to strain herself as she just underwent surgery. Again I thanked her for the kind gesture but she was quick to say that she was just giving what is due to her “doctor”.

At another time, as part of our rotation in the department of obstetrics and gynecology, we needed to complete a month of outside rotation from our private teaching hospital to a government institution, either at East Avenue Medical Center or at Quirino Memorial Memorial Medical Center. Half of the team went to the Quirino Questors while I was with the East Avenue Avengers.

At one time during my duty at the delivery room there was a patient who looked famished and asked, no she begged me actually, if I could call her husband for her. Since I couldn’t leave my post, I said no. But a feeling of guilt and sympathy took the better of me and I asked if there was anything else I could do instead. She said if it was possible for me to text her husband to bring her food. I obliged and a few hours later I found her eating a sandwich, presumably the one her husband brought for her. She had even offered me a bite which I respectfully declined, even if my body probably did need some form of nourishment as well. I was off to my other duties and between assisting in the residents, doing post op orders and generally just trying to survive, I never saw her again. She would just be another nameless patient I had encountered in my tour of duty, nothing of major significance. Or so I thought.

A few days before we were to leave the hospital I heard someone calling by an unfamiliar title “Doctor, doctor!” they said. It was a while before I realized who they were. It was the sandwich lady. I did not recognize her because she was in a much better state than when I saw her at the delivery room. For one thing she was cleaner and looked refreshed. And she did not look famished anymore. But the dead giveaway was that she could now afford to smile. “I’m on my way home. We’ve been discharged already. I just wanted to thank you” she said. “You were the only one who was kind enough to help me.” I was at a loss for words so just I bid them good luck and to take care of their most precious possession, but by the smile upon their face, I knew that whatever the day was still to bring, it was all going to be worth it.

They teach us all kinds of stuff in med school from how to diagnose diseases to what medications to give them, but here in the hallways of an understaffed overworked government hospital a patient has taught me that an act of kindness no matter how small or insignificant it may seem, goes a long way.

So whether it be a bunch of bananas, a packed meal, or simply just a smile and ‘thank you’ I will always be thankful to the patients who remind me why I chose to be in this profession in the first place and why I continue to do so.


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.


Crabs and Kindness

This now brings new meaning to the term crab mentality

Pediatrics was my first tour of duty as a post graduate intern at JBLMRH, a tertiary level government hospital that also served as a referral center and training institution. I was already about to end my pediatrics rotation then, I pause for a while and think, is it all worth it? Was I ready for more sleepless nights, the endless harassments, the unkind words and the harsh treatments? Should I have taken the chance to transfer to another hospital where the conditions may not be that much better, but at least I will be among friends who will act as my support group? Looking back, I honestly did not know how  I managed to keep up with the kind of treatment, then I remember at least one saving grace to all the madness.

It was during my tour of duty at the out patient department. As always we were packed to the rafters as an endless sea of sick kids brought in by their parents came in droves for a chance that a remedy to their ailments was at hand.

I was all alone that day as my senior resident told me that I could handle the remaining cases for the day. Either she had complete faith in my abilities or she was also taking some time off for herself, I wouldn’t know for sure. It was taxing doing everything yourself. I was just about to give up. Realizing that I would also be on duty at the emergency room later did not help. I just wanted the day to end. Then, miraculously I was down to the last patient for the day, a follow up consult. It was a child swathed in the all too familiar white cloth. He came in accompanied by both parents. Nothing unusual so to speak. But what caught me off guard was when they were suddenly thanking me profusely for taking good care of their sick child while he was still admitted in the wards. I can barely remember what I did for them that seemed so important, but apparently to them I was definitely not forgotten. It was then that they handed me a plastic bag containing a singular crab. It was a large one by any standard and I stupidly asked them what it was for. It was a gift they said. It was their way to show their thanks. Initially I didn’t want to accept it, telling them that they needed it more than I did, knowing quite well that the population we serve here at the hospital are the lower income bracket, or simply put those who could not afford better equipped hospitals who charge by the visit. But they insisted that I take it, it was just a catch from the fishpond they said. Then I remembered something I was often told about the rich and poor. The rich give to others what they have in excess, but the poor give all that they have. I did not want to insult their generosity so I accepted their gift and fervently hoped for their good health.

This story could have happened to anybody else in my profession, you probably already heard a similar story from someone else, but at the end of the day, this is my story.

Many times I’m asked if being a doctor is worth all the hard work and the sacrifices that we do. Looking back at this story I can tell you, it is.


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