Intern on Duty

        I miss taking photos. 

        I have a roll of film which I haven't developed yet.  It's been sitting on my desk for almost a year.  I can't afford to have it developed.

        I can't afford to buy batteries for one digital camera that captures great color but I can never quite use correctly for low light conditions.  The other digital camera that I borrowed so I could take night photos has this horrible blinding flash that I never use anyway.  Of course, I can't use film.  I can't afford to buy film and even if I could I can't have them developed anyway.

       And the saddest thing about wanting to take good photos is knowing that the first handful of photos I took that recently got published in the newspaper will never be attributed to me.  And that those photos could very well be the only ones I took that will ever be published.

       AND as much as I want to take credit for them (because for crying out loud they are MINE and they captured the moment perfectly) I can't.  Because the person who wrote the newspaper article actually did a big favor to a number of people (including me) and I can't ruin all that by demanding photo credits right now.

       I don't want to act juvenile or angst-ridden, but today it sure sucks to be me.

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        I have been quiet for so long.  Remiss with regards to blogging.  Well, what can I say.  Life happened.  Now that my postgraduate internship has come to a close (I graduated last week, yehey!) I've been trying to get a week's worth of a (rainy) summer vacation and then I'll be gearing up for more studying.  The Physician Licensure Exam is in August.  Three months is such a short time.  It'll be over before I can even start to think.

       Oh, well.  We all know what people say about life . . . it goes on.

One: E turned to me and said expectantly "Let's go to the interns' party on the 9th."

       "What are we going to do there?"  I asked absentmindedly.

       "Drink," she beamed, stating the obvious as she mimed downing a bottle of beer.

       I smiled noncommittally in reply.

Two: (17 minutes later)
        E turned to me and said "Let's go to Puerto Galera on the 25th."  Her voice laced with excitement.

       I turned to her and asked "What are we going to do there?"

       Her jaw drops in mock-exasperation.  "Swim, of course!"

       I smiled noncommittally for a second, laughed when I realized the stupidity of my question, then laughed out loud as I had her stating the obvious again. 

       The resounding slap on my arm afterwards was entirely called for.

Where was I then?  Once is enough, twice is just one too many.
      

            I’ve been feeling a bit stressed lately.  I’m not really sure why.  But I’ve been having a series of headache that at times has been incapacitating.

 
            Lately, I have become really disappointed by patients/parents’ conduct in my health center.

It’s a given that my co-interns and me exchange notes and share our experiences about seeing patients at health centers.  Recently we talked about requesting lab work-ups and patient follow-up.  I commented on how I have always had difficulty in having patients to come back for a follow-up.  I eventually do see these patients at a later date and know that they turned out okay but I’d really like to see them as their diseases resolve or, heaven forbid, progress.  In general patients never come back because of the long lines and long waiting time during the scheduled consultation period.  Somehow we can’t seem to get across the importance of patient follow-up (or they just don’t really care).

E was feeling really good about her health center.  For one, all the patients she asked to come back with laboratory results came back the next day with said results.  Two, the parents do bring their children for follow-up while on antibiotic therapy.  And three, there are those parents who just out of the blue decide to drop by just to say that their children were already all better.

So wanting to get better patient compliance and follow-up I tried a different tack.  Secretly, and against health center schedules, I asked a number of patients to just come back for follow-up on certain afternoons where there were no scheduled consultations (read: no need to wait in line for hours) and asked them to come and see me directly.  But still, none of them ever came back.  For this week, the passing of days seem to bury me deeper in my disappointment.

One can argue it could be due to poor doctor-patient relationship.  But to this I will have to strongly disagree.  In my group, I am the least likely to get annoyed.  I do not  get irritated easily and I can honestly only count two instances when I had to raise my voice just to get my point across to a non-compliant patient.  Di talaga ako nagtataray, as in!.  I play with the kids (if time permits) and have learned to make small talk just to build rapport.   I shower praises on mothers who breastfeed and commend those who bring their children immediately for consult not waiting for the patient’s symptoms to get worse.  In other words, I expend effort just to have a good relationship with my patients.  And for every rise in pitch of my easily irritated health center’s MD’s voice, there is a compensatory centimeter increase in the width of my smile and a tad more gentleness in my handling of patients.

So yes, being in my health center has been quite disappointing.

Until today, that is, when my first patient came back.  Hooray!  I was so glad that the mother took all the trouble to come early, stand in line and wait to be seen.  And of course, I was so glad that after only 3 days of antibiotic therapy the infant’s lungs had cleared up a bit.  Now with better appetite and activity, she was smiling as if apparently well.

It’s funny how a week’s disappointment is easily reversed by just one parent committed to giving her child the appropriate health care.

Suffice to say, that I went home today quite satisfied, not minding my headache.  On the jeepney ride home I wasn’t even bothered by the loud music booming from the cd player.  As if the heavens conspired to finally lift the veil of my disappointment, for a change, they were playing music I actually liked.

            After lunch I went over to 7-11 to have a cup of coffee.  The afternoon heat was making me sleepy.  I continued reading 1984 at the edge of my seat but seemingly disinterested with half-closed eyes.  Then for a moment there I thought I could do this.  This being I could work in a sleepy health center in some far-off barangay, see patients in the morning and read the whole afternoon.  In a sense it was not all that different from my previous work as a research assistant in a molecular microbiology lab a stone’s throw from the beach.
 

            Looking back, I remember working from 8 to 5, reading novels during the waiting time in between PCR’s, gel electrophoresis and culture preparations.  After work I would go straight to the cafeteria and have an early dinner while watching the local news.  By 6 pm I was back in my dorm room rekindling my love affair with books.  I usually dragged my chair out to the terrace and continued reading while smoking my Camels.

             Things have changed a lot since then.  I no longer work in research and have not done any molecular biology work in almost 5 years.  But like before I have rekindled my love for reading.  I have become a polybookist, not content in reading one book at a time but having a specific book to read to complement my different moods.  I have long quit smoking and replaced cigarettes with coffee.  And with my caffeine dependence I have become a chain reader.

             Going back to my present situation at the barangay health center: depending on the day of the week I help immunize 80 or so children, either see around 40 pregnant women for their prenatal check-up or around the same number of patients with various complaints.  In the afternoon I read.  This morning there were 91 children who came in for immunization.  After an early lunch I finished George Orwell’s 1984. 

           In the afternoon I was left wondering if I should finish Charles Bukowski’s Factotum which I started yesterday or plunge deep into Haruki Murakami’s Kafka on the Shore.

           I still believe what my sister said year’s ago is right.  If I had a year off to read I would learn more and be wiser than if I spent the year studying in school.  If I finish my whole TBR pile (130+ good books – including books on history, travel and philosophy) and barely passed the med boards it would still be worth it.

"In life, every ending is just the start of another story.  Except when you die - that's an ending that's really an ending. I suppose if novels were really true to life, they'd all end with all the characters dying; but if they did, we wouldn't want to read them, would we?"   - Love, etc, Julian Barnes

       This had me laughing . . . and at the same time remembering this.

       Dying is an art.

            I’m back to watching House, MD.

I suppose this is another one of my ploys to get my interest (in medicine) back.  It has to work.  It should work.  I’m still trying to get hold of a DVD player so I can watch ER.

But Community (and Family) Medicine is actually something I like.  Maybe it’ll help that it’s my last rotation, same as last year as a Junior Intern.

Last Saturday, for my first day in Community Medicine, we had a medical mission deep into one of the barangay’s we would have to serve.  The smell of tobacco was unmistakable as we were set up in a covered gym near a tobacco factory.  No wonder we get all kinds of respiratory consults.

A long time ago I always thought medical missions were the way to go.  But as I went through med school (actually, as I got older) I understood that in the bigger picture of health care they almost mean nothing.  The people who actually seek consult during med missions are not always that concerned about their health.  They’re just there for the freebies.  I generally ask patients to follow-up in their local health centers but I suppose only a small fraction do.

I do understand that however one looks at it medical missions are still a lot of help.  But I wish I could instill in those patients that health care is not a one way street.  Wellness and Health Care is a big highway where the input of the patients and their relatives mean as much as the input of the health care staff.  I want to tell them, I’m giving you this consult not just to give you free meds.  I’m here not to treat your cough/ colds/ headache/ dizziness/ muscle ache/ stomachache or whatever you have.  I am here to educate you to take better care of your health.  I am here to tell you there is much you can do to make things better.

But how exactly can I say so much in a span of a 5-minute consult when all they want is for me to give them a prescription so they can get multivitamins and cough syrup from the pharmacy for free?

There just has to be a better way.

"Death is not the opposite of life, but a part of it."  - Firefly, Haruki Murakami

After responding to codes every single night of my Internal Medicine duty it is hard not to view death as a common occurrence.  I am able to act nonchalant and joke about during a code - something I try not to do for the sake of the patient's relatives.  When the code doesn't go well, as some inevitably do, I am left with crying or shocked relatives looking on as the nurses start postmortem care.  And while I can now handle seeing my patient's die, what I need to learn is how to talk to those relatives left behind.  I didn't take the death of my grandfather very well year's ago.  I'm not expecting these people to take their loved one's death any better.  But beyond the pat on the back and quiet words of condolences to relatives there really isn't much I can do right now.

I suppose a priest would be better equipped to handle these situations.  But what if the relatives are people who don't believe in a god or a heaven?  Saying that the recently departed is in a better place will certainly be of no help at all.  Nor will talking about death as being part of the circle of life.

How to?  How to?

Finally got to see it.  Now I'm feeling a little bit nostalgic.  Egis, er'p!

Pisay