Tag Archives: truth

Medicine Maxims

THE MAXIMS OF MEDICINE

Before you examine the body of a patient,
Be patient to learn his story.
For once you learn his story,
You will also come to know
His body.
Before you diagnose any sickness,
Make sure there is no sickness in the mind or heart.
For the emotions in a man’s moon or sun,
Can point to the sickness in
Any one of his other parts.
Before you treat a man with a condition,
Know that not all cures can heal all people.
For the chemistry that works on one patient,
May not work for the next,
Because even medicine has its own
Conditions.
Before asserting a prognosis on any patient,
Always be objective and never subjective.
For telling a man that he will win the treasure of life,
But then later discovering that he will lose,
Will harm him more than by telling him
That he may lose,
But then he wins.
― Suzy Kassem, Rise Up and Salute the Sun: The Writings of Suzy Kassem

Advertisements

The Good Doctor

good-doctor-area_bc39d76106a930fc

be good, always

A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must love his fellow human beings in the concrete and desire their good before his own

– W.H. Auden 1907-1973


Weathering the Storm

1098335_10151805844234267_758211870_n

Image from the author’s original post

I woke up yesterday to the sound of rain outside my window and news that school and work had been cancelled. It had been raining since last weekend and parts of Manila were under water. I literally had to drag myself out of bed because we still had to go to the hospital. We still had patients to see and take care of at the Philippine General Hospital.

While a tropical storm above the northeastern waters of the country was enhancing the southwest monsoon and bringing heavy rainfall over Luzon, another storm was brewing.

My first patient for the day was Gibb, an 8-year old child who underwent brain surgery for a malignant tumor in his cerebellar region. He was scheduled for an MRI of his head and whole spine.

I saw his mother, Precy, hunched over in prayer, her fingers nimbly going through one rosary bead at a time. I began chatting with her about her son.

Gibb began exhibiting symptoms last year when his family noted that he was becoming cross-eyed. This eventually progressed until the little boy couldn’t stand or walk straight. They brought him to a private hospital in Cavite but decided to transfer him to PGH because of financial constraints. Something we usually hear from a lot of our patients.

Gibb soon underwent the operation he needed. Precy told me they had to use all of their savings and money given to them by her sibling for the surgical procedure. She used to work in manufacturing but had to stop. Her husband, Antonio, currently works as a regular contractual waiter in one of the restaurants in Manila. Both paid taxes. Both had very little. She said it cost them around 60 thousand pesos.

For the craniospinal MRI, Precy shared that she was able to get money from other relatives and from people in her baranggay. She said it wasn’t easy, but she was glad that they were able to come up with the money. I saw the sense of relief in their eyes when Gibb was wheeled into the MRI complex. It was another step towards getting better. Another hurdle passed. It cost them around 18 thousand pesos.

Like most cancer patients, Gibb and his parents were advised chemotherapy. For this, Precy had to approach people in government for help. And as people in healthcare know, it’s no easy task. The 34-year old mother had to secure requirements, papers, and had to take several trips to a number of government agencies and offices. It took her a number of weeks. Precy then began enumerating the Guarantee Letters she was able to secure: P10 thousand from Senator Pia Cayetano, P5 thousand each from Senators Recto, Marcos, and Trillanes, and P2 thousand from Senator Enrile. She also received financial help from her congressman, mayor, and vice governor. All of these, she said, will go to Gibb’s chemotherapy.

Aside from that, Gibb will also have to undergo radiation therapy. The young mother shared that for this, they had planned to sell some of their possessions like inherited jewelry. Papers for aid from PCSO and help from their governor were also being processed.

She sounded hopeful. She admitted that they didn’t expect to end up where they were right now. The whole process of giving their son the appropriate medical and surgical treatment he needed was long and arduous. She said they were tired. There were times she felt defeated. “Para ho kaming nanglilimos,’ she said.

Recently, Janet-Lim Napoles and the P10-billion pork barrel fund scam hit the headlines. I felt bothered, disturbed, and angry. As a tax payer, if things people have been saying are true, I am appalled with how my hard-earned money was ill-spent and allegedly stolen. As a Filipino, I am deeply bothered. I weep for my beloved nation.

If all of the allegations are true, I hope Napoles, her family, and all the other people involved can live a day in the life of our patients. Walk in their shoes. And see how difficult things are for most Filipinos, especially the marginalized ones. I hope they experience the panic and hopelessness our patients face when they are given huge hospital bills prior to a procedure. Or the discomfort of sleeping under the patient’s bed on cardboard mattresses. Or being confined in one of our wards instead of a luxurious suite, where privacy is almost non-existent and where every cough, cry, and sneeze is shared by at least 40 other people in the room.

There is now a movement calling for the abolition of the pork barrel fund. While I am for it, Precy’s and Gibb’s story reminds us of where part of our taxes go and the good that can be done if our financial resources are managed correctly.

Some people have been saying that P10 billion could have bought us new roads and bridges, built new school houses or railroad tracks, paid for badly-needed education or healthcare for thousands of Filipinos. I think that absurdly huge amount of money could have given us something equally important – hope. Hope that the government is investing in its people. That Big Brother has your back during your time of need. That politicians can put the interest of the majority before theirs. That things can get better – not just for some, but for all of us.

I usually just go about my business everyday, reading the headlines. Sure, I get bothered by the troubling things I see on the news. Predictably, I complain with my coworkers over lunch about how our country is going to the dogs, like a couple of rants on Facebook, and then eventually shrug things off. Like the pseudo-couch activist that I am. However, things resonate differently within me now. I’ve decided I’ve had enough and I feel I should do something, even if it’s a small thing. I asked Precy if I could share her story to which she agreed.

On August 26, Monday, people will gather in Luneta asking for an explanation from our government. I hope to be there. Things may not change and we may never uncover the truth. But I hope our voices will be heard. And hope, is hope.

Today, Tuesday, I woke up to the sound of rain outside my window. And while I prepare to go to work, I think about our countless patients like Precy, Antonio, and Gibb and the long journey they still have to take.

It’s still dark outside. A storm is brewing.

——————————————————————————————————-

About the author:

Toto Carandang, M.D. is a graduate of UERMMMC Medicine Class of 2003 and is currently pursuing post graduate training at UP PGH. Our heartfelt thanks to him for allowing us to post his article on this blog.


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.


Obligations

After a rather long day with one particularly difficult case, I remember this status update from a fellow doctor on her Facebook timeline:

The worst part of my job: Having to break bad news to a patient. How do I tell a jolly, friendly patient that his life is about to change and cancer is about to turn his world upside down? How do you objectively, professionally explain findings in an honest way without being brutal, when the truth, in itself, is brutal? How can you not break someone’s heart when his body is breaking him from the inside out? Worst part of the job…

to which the following reply was offered:

Our doctor said: your mother has glioblastoma multiforme. Then she explained the diagnosis in very simple terms. The best part of the talk was this: We will MANAGE this the way we manage regular diseases like diabetes. The word MANAGE and the use of WE meant the world for a family whose life changed in a second.She had to give us a timeline but her words were careful. She DID not say how much time my mom had. She just said that her best case lived for a certain number of years.

True, as doctors we may not always have the answers, and even if we do, the dilemma is in how do we go about it. And this is where the art of medicine comes into play, something that I hope to develop more as I realize that sometimes all that is left of a person is hope, and we as doctors, and more so as fellow human beings at that, should understand this fundamental matter.


Mythbusters (repost)

Image

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

What We Say.. What We Mean

I just told some friends who were interested in your case

Just in case you get the notion that medicine is all serious stuff and that’s all you will get to read from this blog, well, most of the time probably, at other times we’ll feature some stuff on the other end of the spectrum. The following was sent to me years back via email, so my apologies to the original sender whom I cannot acknowledge anymore. Anyway, it’s supposed to be about interpreting what we really mean when we say the following during your visit. Happy reading!

___________________________________________________________

"Well, what have we here...?"
He has no idea and is hoping you'll give him a clue.

"Well, we're not feeling so well today, are we...?"
I'm stalling for time.

"If it doesn't clear up in a week, give me a call."
I don't know what it is. Maybe it will go away by itself.

"Let me check your medical history."
I want to see if you've paid your last bill before spending anymore time with you.

"Well, now, we have some good news and some bad news."
The good news is, I'm going to buy that new BMW. The bad news is, you're going to pay for it.

"This should be taken care of right away."
I'd planned a trip to Hawaii next month but this is so easy and profitable that I want to fix it before it cures itself.

"Let me schedule you for some lab tests."
I have a forty percent interest in the lab.

"Let's see how it develops."
Maybe in a few days it will grow into something that really needs to be cured.

"I'd like to prescribe a new drug."
I'm writing a paper and would like to use you for a guinea pig.

"That's quite a nasty looking wound."
I think I'm going to throw up.

"This may smart a little."
Last week two patients almost bit off their tongues.

"This should fix you up."
The drug company slipped me some big bucks to prescribe this stuff. Hope it works...

"Everything seems to be normal."
Rats! I guess I can't buy that new beach condo after all.

"I'd like to run some more tests."
I can't figure out what's wrong. Maybe the kid in the lab can solve this one.


%d bloggers like this: