This afternoon, I found a new haven in PGH. That is the Cancer Institute. I revisited one of our patients there, to see if she is still admitted there. We have an exam tomorrow, but who cares, I will only have this free time today. Maybe next time, I won’t have this luxury of time.
So, I went there with a friend. The pedia ward was already filled with a sea of new faces. I could not find that girl wearing a mask we visited before. She was diagnosed with WIlm’s Tumor (I was amazed at how those lecture terms have already come to life). I felt a slight sense of disappointment. Her mother was talking to me before, anxious on how to get money for blood. I felt so powerless. I asked myself: could she be gone? Could I have done something more as a student?
My friend and I left the place, a little bit on the gloomy side. On our way out, we got lost. The halls of CI were not yet too familiar since we haven’t had any rotations there. Lo and behold, we met another patient we visited before, on the same ward as the little girl we were looking for. He was on check-uup, waiting for his turn. Surprisingly, he saw that little girl.
We looked around the halls and found her. It was the best feeling to see that the girl is there, smiling. How she was able to get a blood donation for her cancer.
We thought we were lost. Where we thought we are lost, we found. We never really get lost. There are just U-turns leading us to the right direction.
At the OPD Clinic of Gynecology in PGH, I had this patient last week. She presented with abdominal pain on two quadrants of her body as well as progressive enlargement. An Ultrasound was taken indicating a pelvic mass, probably ovarian in origin.
As she narrated her history of illness, she broke into tears. She told me that it would be her birthday the following day. Due to her disease, she was sad most of the time and could not celebrate it the way she did a year ago. She used to be so excited with Christmas until she had a disease. She kept on saying na “sana hindi cancer.”
My empathy goes for the woman. Before she left, I told her that I want her to celebrate her birthday and be happy. Yes, she has a sickness but she is more than that.
Tonight, I pray for all the sick people, that the spirit of Christmas may penetrate their hardness and dried-up hearts. I also pray for inner healing.
The Philippine General Hospital (PGH) is one
of the oldest hospitals in the country. It is also
one of the largest in terms of patient referrals.
To this day, PGH remains to be one of the few
government hospitals where patients do not
pay for basic services.
The PGH Department of Pediatrics serves
62,000 patients annually. Of this number,
approximately 7,000 patients are admitted
in the PGH pediatric general wards, 15,000
seen at the OPD clinics, 10,000 newborns
are directly roomed in with their mothers
upon birth, and between 25,000 and 30,000
consult at the emergency room, and are
either sent home or transferred to other
hospitals. It is the only pediatrics department
in the country with a complete complement
of pediatric subspecialties, from adolescent
pediatrics and allergy and immunology to
cardiology, infectious and tropical diseases,
neonatology, pediatric intensive care, and
many other fields.
On the average, the cost of treatment for
common illnesses like diarrhea and pneumonia
is around P10,000-P15,000 per hospital stay.
For dengue and typhoid, it is P20,000. The
budget of PGH is only P1,500 per patient.
On the average, around P300 million is needed
each year to support the patients in the wards,
PICU, and NICU
This is one reason to study well in my Pediatrics module.
First pedia patient
i am going to have my first official patient in pediatrics today at the SCC (sick child clinic) of the philippine general hospital out-patient department. i can’t wait. pedia has been soooooo much more exciting and less intoxicating as compared to our previous OB rotation. thank God i am now able to breathe once again. :)
i will bring my gigantic textbook in pediatrics so that i will be guided during our preceptorials.
pedia is <3.
1st Pedia Patient.
We were given a one-month old baby girl, who looks otherwise well, except, she was positive for G6PD (glucose-6-phosphate dehydrogenase) deficiency. In a nutshell, this enzyme is responsible for neutralizing the poisons which may attack the red blood cells. She tested positive for this diseases via the newborn screening. For management, she was sent to the National Institute of Health to confirm the diagnosis.
Children with this disease may present with blood in the urine and anemia.
From now on, I will try to write the patients I see, in an effort to raise awareness on medical diseases and to help my fellow health professionals reading this blog. :)
The extra mile
In the afternoon, I had a patient who was able to teach me what it feels like to be a patient in PGH.
This boy had increased white blood cells and protein in the urine. [read: there might be something wrong with the kidneys]. The urinalysis indicates that there is increased protein wasting in the urine and the blood test indicates increased concentration of red blood cells. In a nutshell, we are considering a case of Nephrotic-Nephritic Syndrome.
My partner and I treated it as normal case, until we got the blood pressure. 130/90. Our preceptor then told us to accompany the patient to the emergency room. It was such an experience. We walked from the outpatient department to the emergency room, where the patient had to get another blue card [read: passport to the hospital] because he left it at the nurse. Then, we accompanied him at the ER. The ER was chaotic, with a smell of body fluids and a sauna-like atmosphere.
The pedia resident was friendly, and listened to the child. As my partner accompanied the child at the ER, I told the “mother” to pay the necessary materials at the pharmacy, such as the syringes, etc. which might be needed for the child.The waiting time was long, and I waited with the “mother.”
The young boy is an orphan. A social worker serves as his foster parents at the Center for Streetchildren in Baclaran, Paranaque. His mother died of a heart problem while his dad already has another family and does not visit him anymore. The boy wants to be a future doctor someday.
Maybe, this is what it means to walk the extra mile, in both senses. I went home exhausted, but hey, this might be one of the few instances I’ll be able to do this for a patient- an instance which reminds us that more things can be learned outside the pages of book.
Pedia ER duty
I just had my very first duty at the Pedia ER last Friday.
Pedia ER this time was not full-house. There were some beds which were empty or had “bantays” resting on them- this was a stark contrast to a jam-packed room I visited before when I came to bring water for some friends.
The place was not as hot as I thought it would be. Thank goodness, I am the sweaty type of guy and I always feared that place before because of the temperature inside- not because of the patients or what.
We had a lot of cases. We were tasked to monitor patients, q3 and q4.
We had almost 4 cases of children with luekemia. Yes, this was rather saddening again. One grandmother narrated of how her grandson has been punctured 4 times for bone marrow biopsy. They were there at the ER awaiting the results. As she narrated her story, tears fell behind her eyes. Again, I ran out of words. She was wondering what kind of leukemia her grandson has and what treatment they need to undergo.
Another patient we had was a three-year old, with leukemia again. This boy grew as one of my favourites during my duty since almost all children would cry their hearts out while we take their blood pressure. This boy, would rise from the bed, extend his arms meekly for blood pressure voluntarily. And, I never saw him cry. Does the three-year old boy know he has cancer? Does he understand what it is that he knew blood pressure or any kind of procedure is less painful than that disease he has?
Monitoring these patients made me awake the whole time. :)
2/3 of surgery done
Things are going pretty fast.
We are on our third week of surgery. I was able to have a couple of patients already- from ingrown toenails to hemorrhoids to cholelithiasis to breast cancer to hirschprung’s disease to trauma to mandibular mass to hepatocellular carcinoma.
The hardest patients I had were the ones who had cancer. Why? because I did not know who to tell that they had the most dreaded 6 letters of the alphabet. It was hard for me as a student. On one side, I wanted to keep their hopes alive but on the other hand I want them to be in control of their disease. I am sorry for running out of words.
Very soon, we will be having Internal Medicine. How time flies. Before I know it, I will be a clerk.
Time flies and I am always thankful that I made it this far. Slowly becoming a doctor, one step at a time. :)
the long walk
As we were heading towards a group meeting, my friend casually posted a question: matagal pa ba ang med? Serendipity. It was exactly the same question I have been asking for the past few days.
We are on the last stretch of third year med. We are over the half-way mark. Yet, I find myself asking why it is taking so long. Lately, we have been very busy finishing our grand rounds. Somehow, I realized that med lifestyle is not for me. Things happen swiftly, changes happen left and right. Sometimes, I find myself lost in the middle of a heated discussion among my blockmates. Hence, doubting myself I am really meant to be for mde.
Each morning we are at the OPD, I always put my best forward. I smile and make the patient feel that doctors really care for them. Yet, I still fall short. I am a student and I realized I still have to learn a lot of things. Sometimes, a patient asks me a question and it baffles me. I have not a single idea on the answer.
We just finished surgery last week. I had a patient who has a dentoalveolar carcinoma. I was really tired and sleepy that day but I tried my best as a student to do my history and physical examination to the best of my abilities. At the end of the interview, the resident-in-charge told her that she needs to undergo and operation. The old woman then told me, “Doc, sana nandoon ka sa operasyon ko.” One of the most heartfelt statements I have ever heard from a patient. As a student, sometimes I feel I can only do so much. However, this statment says this ain’t so.
Somehow, when I find myself asking why it is taking so long to finish med, I just have to look back at this experience and remind myself why I am here.
Last week was the week of closures, not of any relationship whatsoever, well, yeah if you consider med school a relationship. Haha.
We just had the Internal Medicine Grand Rounds. That almost month-long preparation we had. From interviewing the patient to formulating and finally to our presentation. “Based on the gamut of signs and symptoms..” Yeah, I practiced my lines endlessly until it came out naturally (did it? Haha.) in front of a multitude of consultants, residents and classmates. We delivered. :)
The case that we had was on Cushing Syndrome. I will try my best to explain it in layman’s lingo. So, cortisol is formed from our adrenal gland. When the production of the hormone cortisol goes haywire, the metabolism of our body becomes chaotic. This hormonal imbalance causes features such as abdominal stretch marks, acne, easy fatiguability, weakness, hypertension, etc. Why? I dare not explain. :D
Anyways, the patient underwent a total adrenalectomy. It was a 180-degree turn on the patients life. Her menstruation came back. Well, I’ll leave it to her why this is important. Haha. :) And, most of all, she will be able to go back to school and resume her degree in Education. This for me is the essence of the operation- for her to be able to resume her schooling and function. I mean, as a patient, the pathophysiology of this syndrome is not so much important. As a patient, she looks forward to getting back to a state of normalcy and function.
We were honored and humbled to report her case, even if we slept at 4 am one night. Twas all worth burning the midnight oil, especially if you know you’ve been a catalyst for change. :)
Off to Pasay for Community Medicine
The near finish
It was a rainy afternoon when we left Pasay going back to our dear school in Manila. The sky was gray and there were not so many people in the campus. We were all tired after our youth lecture on teenage pregnancy, addiction and STDs. I just hope we were able to impart, even just a thought or two to these teenagers living in Pasay.
I asked my friend to accompany me to the chapel to offer a prayer. As we lifted our tired feet off the ground, moving forth, I realized that the incoming week would be our last week as Integrated Clinical Clerks.
It made both of us smile. A sigh of relief and contentment. Yes, relief but at the same time nervous of the incoming exams that we will be having next week.
Kudos everyone! :)
It was another ordinary night. I found myself walking back to our unit. I was walking, tired as usual from our long-day shifts at the Outpatient Department. I just came from Taft, that busy avenue in front of our hospital.
I looked into the dark night, which is what I usually [on safe grounds]. The hospital stood dimly yet proudly against the black sky. Dimly, because its dim-lit ancient-looking windows combine effortlessly with the dark clouds above; proudly because it houses the lives of hundreds of patients, most of which cannot afford the fees from private hospitals, are under its tender loving care.
As I was staring at the night sky, I noticed flickering lights floating. Were they stars? I hesitated a bit for a moment. They were a bit larger than the regular stars I see. [I love stargazing and trust me, they are around 10 times larger than the stars I usually see.] Moreover, they were dancing, with waving borders, not just flickering.
After around thirty seconds of awe, I finally realized that they were floating Chinese lanterns. I finally chanced upon these lanterns, I first knew from the movie Tangled. I have always wanted to see one. It was a surreal experience, magical to say the least. They literally looked like dancing stars in the middle of the silent, dark night. Balls of radiance making their way up, up above until they are consumed by the silent night.
I have been consumed by so many dark nights- moments of doubt, exhaustion, and sometimes, apathy. But, it is in these dark areas that we find the most unexpected flickers of light. A patient who wages a battle with cancer, a priest who spreads God’s power of healing to patients, a doctor who stay up until the early morning for her duty and lastly, an aspiring doctor, are all tiny flickers of hope. Small floating lights which illuminate against the immensely dark skies.
The floating lights of hope.
First Ward Duty
Before I head on for my next ward duty tomorrow..
Duty begins at 7 am, with the endorsements of the previous on-duty: what-to-do’s. Okay, since this was my first time, everything sounded greek to me. The ORL ward is mainly filled with patients for pre-operation. Therefore, we have to clear them from the Medicine department to make sure that they are fit for surgery.
I spent about an hour writing and contemplating what I have to do. I fixed the labs of patients and went up and down the staircase. I checked the charts of the patients, taking note of new entries from the residents. I was able toe at lunch on-time, except, it is taking its toll on my allowance. Cafeteria is closed so I have to content myself with food from the COOP upstairs.
Afternoon was benign. Just waited and fixed the clearance of some patients. I was able to extract blood successfully and insert an IV line to a patient. :) Yeah! I prayed each time I hold a syringe and canula, asking God for me to hit the veins one-time so the patient won’t have to endure another trial.
Evening. Around 11 PM, IV fluids and canulas line up in at the nurses station, waiting for clerks and interns to gamble with the patients veins. I was able to line another patient and extract blood from another one, one of whom was my favorite patient in this rotation. I also missed extraction and insertion in two patients. A good start for me. This has been my frustration before.
3 AM was time for sleep, and I woke up, rushing to the Major OR for another operation, total removal of the thyroid gland. :)
I am so clueless the whole day. I kept on bugging my intern where and what I should do with this and that. We learn as we go along.
and I made it through another day in clerkship.
I still don’t know how to react. Still at a loss for words. Maybe, because this does not usually happen to a 25 year old like me. My pedia professors even congratulated me and I was surprised that they knew about it. :D Life.
Somehow, residents and fellows in OB get easily agitated. We had an undecked patient, and the resident had to pay for that. She was reprimanded in front of her co-residents. We tried our best to track the new admission, but somehow, things did not go our way. The patient was left undecked, without referrals, for almost three days. The patient is due on OR soon. It was something to learn from, albeit the harder way.
The OB LRDR and Admitting sections opens tomorrow. Hence, we admit all. The section was recently closed for sanitation purposes. Weather forecast: expect rainfall on this side of PGH. Rainfall of babies, that is.
Time to study suturing. Time to study perineal repair. Time to study how to stay awake. :D