25 posts tagged “internship”

        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.

      

            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.

I head bopped and sang my way home :)

            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.

 

    
       I suppose it's true what a co-intern says.  It's almost like I've been demoted.  My exhilarating ER days were over 2 weeks ago.  Last week I was stuck rounding at the ward, where when I go on duty I seem to be doing both the writing of orders in the chart and the actual carrying out of the orders.  [Where are the good and efficient nurses when you need them?  They've all gone away abroad to seek greener pastures leaving behind arrogant half-wits who think that charting is the priority above giving of meds and actual taking care of patients].  These days I'm stuck at the ICU staring through glass doors at patients who don't seem to be getting any better.  On weekends and when I go on duty I become the ICU Medical Intern/ ECG Technician-on-duty for the WHOLE hospital.  If I would get paid even a fraction of the cost for each ECG I take per duty I'd have enough money to celebrate on weekends and feed me on the weekdays.  Alas, I'm still not getting anything from all the hard work.  Even the learning I'm supposed to be getting is not commensurate with the number of hours I spend in the hospital.

       These days I'm trying to get that bounce back in my steps -- a literal bounce I seemed to have lost after I left the ER.  Truth be told, I'm tired and feeling bummed out about my low productivity.  I have a week's worth of one-disease-per-day reading to catch up on. At the same time I need a weekend off to just chill. 

       I go on duty again this Sunday.  I still think I should go into Internal Medicine for my residency training but lately I've been really worried.  If the total lack of interest I am showing is any indication of what my outlook in residency will be I doubt that IM would be the best fit for me.

        General Medicine rotation.  Day 1.  I was sitting attentively as endorsements started and the junior resident from duty ran down the admissions. 

       I always enjoyed morning endorsements even when I was a junior intern.  For me so much learning occurs in that hour of grilling and review of patient's management.  And every time a senior says something however cliche they may sound I swallow them whole like pearls of wisdom, because most of the time that's exactly what they are.  Plus the fact that when you're so lost and you feel like you have no idea what you're doing those words are exactly what gets you through the day.

9:32 am. 

Someone comes down from a red car and knocks on the glass door of the ER.  "Stretcher," he shouts, "and fast!"  The nurse opens the door and a nursing attendant pushes a stretcher out.  A young man is carrying a cachectic old woman onto the stretcher.  We notice her pale skin immediately.  My co-intern touches her forearm, then shot a meaningful glance at me across the stretcher.  She immediately pulls out her stethoscope and listens for her heartbeat as the stretcher is being rolled in.  A few seconds later she looks at me again and shakes her head.

I say one word which mobilizes both my co-interns and I:  CODE.

Intern C starts doing CPR.  Intern V grabs the ambubag, hooks it to oxygen and starts bagging.  I check the patient's forearm and see an existing heplock.  I say to the nurse next to me "Ma'am, one epi," and head to the supplies saying "IV line please."  All three interns automatically go into action to resuscitate the patient. 

For a split second all three of us stop and we suddenly notice that none of the nurses are responding to our call.  The sad reality suddenly slips in.  Anywhere else we could run a code.  But in that particular hospital, we were just interns.  And none of the nurses would carry out something we ordered.

The fellow on duty was paged and arrived shortly.  He stood there at the foot of the stretcher and simply said "Epi.  IV line."  Then, everything was a flurry of motion as the nurses rolled into action to get the crash cart, start a line and prep for an intubation.

A sad day at the ER.  A no win situation.

  

1.        A fellow sends me an SMS at 10:03 pm:   Hello! Please insert an IV on patient at 20--.  Patient for blood transfusion with blood already coming.  I tried but the vein bulged.  Edematous.  Thanx.
          I paused a minute and scratched my head - if she can't do it how does she expect me to?
          I go anyway and tried.

2.       For some reason I'm always at the same wing when a code is called.  It goes two ways, as I see it.  Either I'm terribly unlucky and end up answering all the codes, or the patient is terribly lucky a "doctor" gets to attend to them immediately.  Quite honestly, I think the former is more true. 

3.      I ended up giving an impromptu case report about my patient.  I prepared slides but didn't get to use it.  I'd like to believe I didn't make a total ass of myself.  But I suppose I did.  I was from duty, and it was late into the post-call day already.  I couldn't even think.  Anyway . . .

All is well that ends well.

1.        It was my second day on duty.  A classmate back in college, now a medical resident, asked if I was going to take an Internal Medicine residency also.  The way she said it seemed to imply that it was just natural that I would, so I said yes.  She says "you should apply here".  And I couldn't stop myself saying "I actually thought about it already."  She smiles and says "Okay, see you around then."  For a while there I thought I had it all planned . . . and then the ward calls started coming over paging the system . . .

 2.      A groupmate once said "If ward calls were chocolates I'd have diabetes by now."  Yes, so true.

 3.      It was 3 in the morning.  In between ward work and admissions I was trying to get some sleep in the call room.  I had the call room to myself so I could arrange things the way I wanted.  There I was lying on the bottom bed of the first bunker, the phone with its loud incessant ringing was an arms' length away and my cellphone was in my hand which was next to my ear.  I was so ready to jump up any time one of the phones rang.  And rang they did.  Repetitively.

 4.      From duty.  I was inserting an NG tube on an intubated patient when a nurse comes calling.  "Doktora" she says.  "Doctor A needs your assistance.  She's intubating a patient."  Of course, I dropped what I was doing at once and went over to room 21--.  The patient was already hooked to a cardiac monitor and two nurses were there to offer assistance.  It was a difficult intubation.  The resident already paged an anesthesiologist in case she couldn't get the endotracheal tube in.  She did eventually.  And I was left there ambubagging the patient until the pulmonary technician arrived with the mechanical ventilator.  All the while I was thinking - I would still love the adrenaline rush of working at the ER.  And all of a sudden the Emergency Medicine residency was back on my list of residency programs to choose from.

5.       I was talking earlier with a toxic and obsessive-compulsive groupmate.  I had previously rotated with her.  Though she would get on everybody's nerves at times, when she was my partner she mellowed down with the obsessiveness a bit and we got along pretty well.  I have been with a different partner during the last two months in my OB rotation, and for this month I will be with another groupmate.  Imagine my surprise when out of the blue she blurts out "I wonder when we will be partners again."  There was no other way for me to take that comment except as a compliment.  I replied civilly with a smile and said "maybe next month."

    

     

        Yesterday the patients never stopped coming.  All in all there were 68 consults and 44 admissions.  I was on my feet the whole time.  Sitting down and meals were forgotten in the flurry of admissions of pregnant women in imminent delivery.  It was already 6 in the evening when I had my lunch and by then I had lost my appetite. 

         Today I've been trying to sleep the whole afternoon off but there's still too much adrenaline in my system that I barely got 2 hours of sleep.  The antihistamine I took earlier for my allergic rhinitis didn't even make me sleepy. 

        Maybe I should have gone out instead. 

       Over the phone my brother kept kidding me on Christmas day that I was a total loser with no life.  Which if one thinks about it is actually not far from reality.  I didn't even get drunk during the series of Christmas parties with friends, co-interns and families as I went home early each time to get some sleep before my OB duty the next day.

        I think I need to make good New Year's resolutions so I can get a life.

        Things have been going really well in my OB-Gyne rotation.  Yesterday I was on 24-hour duty at the ER (saw about 50 patients and admitted 33).  The resident with me during the day surprised me by saying that OB-Gyne seemed to suit me and that I would probably do well as an OB-Gyne practitioner.  One:  I never even considered taking up OB-Gyne for residency.  Two:  this is the first time that someone thought that OB would suit me.  And three: although I don't cringe anymore when someone shouts out that the patient we are examining has a cervix that is fully dilated, I am still basically taking baby steps to learning the appropriate management for common OB-Gyne conditions.

       Speaking of fully dilated cervices, I never got the chance to explain the four words that I dreaded the most.  Fully  - would mean that a pregnant woman has a cervix that is fully dilated to 10 cm and if all goes well would probably deliver her baby in the next few minutes or within the hour.  After the (once) cringe-inducing announcement of full cervical dilatation would come the awkward shout of table.  At this point the patient is transferred from the stretcher to an operating table and placed in lithotomy position in preparation for delivery. Calling out table is actually directed to nurses and nursing aides to assist in the transfer of the patient, but most of the time we wheel the patient to the delivery room ourselves and transfer them onto the table.  And then there's baby out which is pretty much self-explanatory.  Lately, these words haven't been so scary.  They've transformed from loud hairy, red-lettered words in my head to small, furry animals which scurry along the path they're pre-directed.  Cute, really.

       Having said all these I am really enjoying my rotation so far. 

       Cheers!