9 posts tagged “medicine”
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.
Back in high school I wanted to become a pathologist. I was a lab rat: more comfortable viewing slides under the microscope than dealing with people in the real world. And then Scully was a forensic pathologist (Yup! I was an X-phile). I never really thought much about doing autopsies but all the other things related to pathology interested me. Then came 2nd year med school and actual Pathology classes. It was shameful to admit that I wanted to be a pathologist and then be accosted by near failing marks. After 2 semesters I said goodbye to my future as a pathologist.
For this week I will be spending most of my time in the blood bank for my Pathology rotation. I won't be working with actual blood and other bodily secretions. I will be screening the blood donors instead. The American Red Cross has this blood donation eligibility guidelines. Similar guidelines are followed in the country (of course with more emphasis on common infectious diseases such as TB, hepatitis and malaria). I have to admit that I needed to read up on these guidelines before being confident that I was screening the donors properly. For my first day I was feeling a bit bothered that I had deferred half of the donors. I was thinking I was doing something wrong. Now I know better than to count accepted donors. I have been thinking more of the donors and recipients safety instead.
I have three more days left before I start another rotation. But I think I will prematurely conclude that if there was a way to entice me back to going into Pathology this certainly isn't it.
Can you work at the ER and still be nice?
This is the question a veteran ER nurse posed. My answer to her question is YES, you can.
I came from an institution (and have rotated in other hospitals) where nurses in general have no respect for interns. As nurses who have worked longer in the hospital they are free to pass on work to the interns who have no option but to accomplish them. The work consist of inserting IV lines, foley catheters and NGTs, blood extraction, ABGs, monitoring vital signs, and pushing IV fluids and IV medications. Even errands such as bringing charts to residents and having them sign prescriptions or lab requests are often times done by interns. While I understand that I do need to do most of these things also, sometimes I just can't understand why they have to wait for me (for more than two hours) to push IV medications (now long overdue) when they can easily do it themselves. Giving meds to patients is certainly more important than charting, right?
Anyway . . . that was my background, which is why when I finally rotated at the ER as a post-graduate intern I was relieved to find out that even with the toxic environment the ER nurses managed to still be nice. I still do all of the things I used to do before plus do all the prepping for other procedures (suturing, chest tube insertion, etc.) but the ER nurses are always of assistance whenever they have a free hand. And even if they don't the fact they make the working environment less stressful by being nice makes all the work easier. I still find it weird when they call me doctor, greet me good day and ask how my duty was. I am still quite hesitant to ask them to do something for me so I always say please and thank you, and always use Sir and Ma'am whenever I have orders that need to be carried out. Even the other staff at the ER are nice. The clerks, nursing aides/attendants and utility are very helpful so even if I can't get a wink of sleep for more than 24 hours I still get by.
I suppose it helps that I actually enjoy working at the ER. I would probably go into Emergency Medicine for my residency if more hospitals offered it here. At present there are probably only a handful of Emergency Medicine doctors in a handful of hospital ERs in the country. Most of the ERs are managed by different specialties so that from the triage patients are sent to Pediatrics, Internal Medicine, Surgery, OB, ENT, Orthopedics, Urology or Ophthalmology to be treated. Interdepartmental referrals are made if a multi-disciplinary approach is needed to manage a patient. Which reminds me of a previous post from the same blog discussing how all ER doctors should be board certified in ER medicine. That would be wonderful but there just aren't enough ER med professionals to go around.
It would be really great if I could get into a good Emergency Medicine residency program here.
As a junior intern in the ICU/CCU a large chunk of our duty was to monitor patients’ vital signs. The patient’s were all hooked to a cardiac monitor and a pulse oxymeter but medical clerks were asked to monitor the blood pressure of each patient manually and to refer to residents if anything didn’t seem right. It was terrible to be on duty when the ICU was full. By the time I finished one round of monitoring 15 minutes had passed and I had to start monitoring again for the next round. The ICU/CCU was equipped with automated blood pressure monitors so the whole thing seemed like an exercise in futility.
Now in my Anesthesiology rotation as a post-graduate intern I realize we were much better off before. In the OR I monitor the blood pressure manually every 2 or 3 minutes while a procedure is ongoing. Not all OR’s are equipped with pulse oxymeter’s or cardiac monitors. And in the wee hours of the morning not all emergency surgical procedures can be done due to manpower limitations (nurses, surgeons and anesthesiologists).
Initially, I was apprehensive about being cooped up in the OR for this rotation but halfway through my first duty I have become to appreciate what these anesthesiologists do. (I’m still not going into Anesthesiology, though). And the highlight of my duty? My first subarachnoid block!
I did my first subarachnoid block (spinal anesthesia) atraumatically and successfully on the first try. I was feeling a little nervous when I was still preparing the patient but when I was holding the spinal needle it all suddenly seemed so simple (simple does not mean easy, okay). So I got it during the first try and I was beginning to wonder why I wasn’t feeling elated like I did during all my other firsts (first IV insertion, first blood extraction, First assist on my first thyroidectomy, etc.). But a first is a first and I was still happy about it. It was already 3 in the morning when that particular OR ended and I slept soundly after that.
The morning after, the sun was out. It had been raining all day the day before but now sunlight streamed in through all the grayness. I went home with a good feeling in my gut and U2’s Beautiful Day playing in my head.
My mother once mentioned to a co-worker that her daughter was now a medical intern. She tries to humor the co-worker by saying that as an intern I was lucky to get an allowance of $20 a month. Smiling, the co-worker tries to correct her by saying "Oh, you must mean $20 an hour" which by California standards was still way below minimum wage. My mother smiles back and replies "Oh no, it's $20 a month, and she's a doctor at that." Needless to say, instead of being humored, the co-worker was flabbergasted.
Now at my fourth month of internship I am yet to see a single centavo of that ~ $20-allowance. Not that it would do much to ease my financial burdens. It is more icing (or the candle) on the cake that is my monthly allowance from my parents. But I'm not complaining. We do get free meals from the dietary when we go on duty anyway. But I sometimes wonder how the residents make ends meet with their meager salaries. My salary six years ago as a new college graduate working as a research assistant is only slightly lower than the present salary of a resident in a private hospital. While residency in a government hospital would ensure a larger salary, the increase in salary is not really commensurate to the increase in amount of workload. And of course there's that elusive item everybody is running after. Without it, residents slave at their work without pay.
Patients often wonder why doctors in government hospitals are not generous enough to give free meds. It's not that they don't want to. There just isn't any free medications to give. The polite reply of the medical staff to patients asking for freebies? "Government nga po ito, pero hindi po ibig sabihin libre." Without the benefit of a salary, you can't really expect much in the way of generosity from doctors except bending over backwards to provide good patient care.
(Oh, to be a doctor in the Philippines!)
I took a bath as soon as I got home from my last duty at "a particular hospital with psychiatric patients". I needed to wash off the offensive mix of sweat, broken dreams and fabric softener which however strong does nothing to hide the unmistakable smell of grown-up fantasies with sad endings. I will never forget that smell. It is the smell characteristic of that particular hospital. It sticks to your skin. It gets into your clothes. It weighs you down.
I didn't think I would ever come back to the that particular hospital. I had a two-week rotation there as a junior intern and I remember that experience as being more pleasant. If it weren't for the hilarious insanity offered by a co-intern I wouldn't have appreciated my recent experience there but instead cursed it to high heavens.
Back in college and med school I did consider taking Psychiatry. While it was not exactly a strong contender for my choices for residency it was still a consideration. However, as soon as I stepped inside the hospital grounds I made up my mind that it wasn't for me.
My work during my recent post-graduate internship there was definitely lighter than my junior internship but still highly unpleasant. I kept thinking that those people I worked with are Psychiatrists (or Psychiatrists in training) and should know better about treating people. It was such a letdown to see that a lot of them treat their subordinates like trash. They treat their patients just a tad better. I suppose all the psychoses gets to them at some point.
After it all, reading Maria was definitely a breath of fresh air.
There was one patient in the Acute Crisis Intervention ward who was brought in for detox. All through the night he was exhibiting grandiose behavior, pacing the ward like he was the owner of the whole complex. He kept on bribing the nurse to give him a cigarette and cursing her every time she refused. With each demand he upped the bribe by a few million pesos until he reached the final price of "200 million pesos". Later in the evening he tried to seduce a medical clerk to have sex with him for the sum of "2,000 million pesos".
Yes, I suppose all the psychoses gets to them at some point.
Try as I might I can't get myself particularly interested in Radiology. The new technology involved in CT angiography and Cardiac Magnetic Resonance Imaging (cardiac MRI) did spark an interest but only for a short time. With the necessary equipment available only in a couple of hospitals in the country, and the procedures costing P30k and higher per scan (according to one consultant), I doubt we will be seeing the full utilization of these diagnostic modalities in the very near future.
I have been stuck in the Radiology Department's viewing room for more than 2 weeks now. The viewing room is a windowless room with the walls lined with negatoscopes (X-ray film viewer), and even though I'm not staring into another radiograph everything I see is starting to turn into black and white. Granted there is a spectrum of grays in between, at times I find myself wanting to just see a live, breathing human being in full color. I guess I'll be crossing out Radiology from the long list of residency programs I can't seem to choose from.
I did appreciate my 4-day rotation in the Philippine Heart Center. But I suppose it's more because I was interested in Cardiology. I have gotten used to reading chest radiographs for infections, masses, atherosclerotic aortas and bony deformities. Little did I know that more can be said about the heart than it being enlarged. I was fascinated that one could tell if a probable shunt anomaly was present and determine what other structural defects there were. But then again, it was not enough to sway me to go into Radiology.
From the bloody and harried environment of a surgical ER my co-interns and I were transported into the viewing room. Whatever dullness and mental ineptitude (not excluding forgetfulness) we have demonstrated so far we attribute to the radiologic effect.
I so love this one from PHD Comics. I've been putting off studying for the boards for two months now. *chuckles* And really, nobody cares. But I do know I need to study.
Anyway, it's the first time in 10 weeks that I'm finally getting a weekend off. I've been on a sliding schedule that has me going on every other day 24-hour duties at times (meaning I always have weekend duties). Although things haven't been so bad in my internship at the moment, there's just something about weekends off that I shouldn't take for granted. Plus it's really nice to get out of bed late once in a awhile.
Happy weekend everyone!
Grand Rounds is up at Aetiology. Be sure to check out A Hitchhiker's Guide to the O.R. Universe.
In matters involving the ear I turn to the newly-concluded Wimbledon for a high-decibel shriekfest that comes pretty close to damaging the hearing.
Plus, I'm glad I stumbled onto Eye on DNA. Considering my background and interest in molecular biology I think I'm going to feel at home going through the archives.
