Embracing Medicine

Last July 24, 2011 (Sunday) was my last day as a medical clerk in the Internal Medicine department. To orient you, my rotation started with 3 weeks of being with an IM resident assigned to the floors (or wards as some would call it). Then, I had 2 weeks of ICU/ACSU rotation with the 2 best consultants I have ever met. Then, 1 week in the Pasig City General Hospital in their out-patient department. Lastly, 2 weeks in the Emergency Room.

My first week as a medical clerk was bumpy since I am totally clueless of what I should do and how the definition of "initiative" comes in so many forms. The endless continuum of such noun is hard to grasp. Initiative may be defined as doing almost everything. It can be termed as continuously asking questions and participating in the discussion with your consultants. Or volunteering to be on duty despite completion of requirements. Yes, I know it is complicated. People who show initiative get merits. Merits where the criteria are taken from space.

First lesson I've learned as a medical clerk, INDEPENDENCE is the key to survival. No one will guide you or watch out for you. If you would show an inch of such need for guidance, they would mistaken you as being pampered or spoon-fed. You can never lean on someone to help you out (except for your co-clerks) especially in times of influx of patients. With independence comes self-directed learning. You seek for your own answers to feed your hunger pangs for knowledge. Read, read and ask.

Second lesson is the need to be FEARLESS and SHAMELESS. Note that the adjective I have used is not courage, bravery nor boldness. Fearless in terms of conquering whatever fear of inadequacy you might feel in your bones -- try to get rid of it. I have had my own dose and it did not help. The fear of not knowing on how to handle a case of difficulty of breathing and seeing the patient gasping for air made me crumble before my residents. Now, I have learned my lesson. I need to be shameless to learn. Emotions are not entertained in this kind of field and training. Physical endurance is the key in the floors and the ER. I almost cried due to the physical struggle I had to deal with during my first few days in the emergent and urgent section. Despite giving your all, your ALL isn't still good enough. But, learn to shrug it off and keep on going.

Third lesson is, of course, EXCELLENCE. Excellence comes hand in hand with initiative (which I believe still needs clarification). The competitive nature of medicine stems from this value. In any patient that you encounter, one is expected to provided optimal care and to know everything about the patient from their history down to their physical examination and laboratory results, the pathophysiology of their disease, your different differential diagnoses -- would I still ramble on? I think you get the point. There is no excuse of being ignorant once you enter the realms of the hospital or any clinical setting for that matter.

Despite these, I was able to get a good realization from my 2 months of rotating in IM. I have learned to appreciate happiness in its ultimate simplicity. Ever since my duty started, my mother would always try to make time in making me sleep comfortably and prepare my things. She would pack my things since I have decided to stay in the hospital for 4 days straight. The simple lending hand a co-clerk would offer would be much better. The little jokes that we make during the dead hours of the night just to keep us awake make me feel better. A simple sign of gratitude from your patient keeps the heart warm despite the freezing temperature inside the hospital. A good night's sleep makes me excited every now and then. A simple chat with a friend in a coffee shop assures me that everything will be okay. The wonders of simple Facebook messages reminds me that people still care for me.

It is not all that bad. I am slowly entering reality and its diversity. Bumps in the road come along the way but I must keep a steady hand on the wheel and my sight along the horizon. I am still trying to find my place here and unleash that firework kept hidden for a long time.

A Slap on the Face Will Do

First day jitters is a common experience for everyone. I've had my share recently before my clerkship started. Now, before I start my Emergency rotation, I'm having it again! It is normal to notice a certain level of inadequacy in our part as clerks but not an excuse to be at that certain level for quite some time. In admitting my inadequacy as a medical clerk, I have to learn to slap myself once in a while and get over the endless fears that I have constructed many times in my mind.

There were moments where I was just standing in an empty hallways or walking along the corridors of the hospital early in the morning, then I catch myself trembling deep down, not knowing what my next step would be. Every medical student will experience a sense of being thrown into the unknown with no one available to hold your hand as you both jump together into the abyss. Life is not that easy inside the hospital. Each has their own task to do -- which seems endless. Seeing one little lost creature ask a multitude of questions would be a grave mistake.

Here students should not ask questions but learn it in some other way. For some reason, people of experience hate being asked questions. They would rather bounce it back to you and let you do the searching yourself. Thus, making students refrain from asking questions -- having an unproductive learning environment for the both of them. I guess there is no room for critical thinkers in the hospital. However, there are a few who appreciate questions and I feel blessed whenever I meet such doctors. Usually, these doctors are the best in their field. I was taught to ask questions endlessly since it is from questions that we begin to search for answers. Questions are sparks for curiosity, for interest. From interest, we can derive meaning from everything.

I guess my jitters come from the fear of not knowing enough and of not knowing who to ask when I have problems or committed mistakes. Good luck to me tomorrow and my last 2 weeks in Medicine!

16th French Film Festival

This event reminds me of my passion for foreign languages and culture. Still, I haven't tried studying French. So far, my checks go for Mandarin Chinese and Japanese. According to my Philosophy professor, the mind can accommodate 5 languages, wherein you can be fluent in each. I envy him so much since he can speak in French, Greek, Latin, Spanish (I think)... I believe he tried to master the various European languages. My dream is to master the following: Mandarin Chinese, French, Greek and Italian. Each language brings about a unique taste of the country's culture without even traveling to their cities. It is in their languages you can get a glimpse of their short history and greatness as a society.

Below are the movies I'm interested in, to be shown at Shang-Ri La Plaza Mall.

7 Ans (7 Years)
June 10, Friday 6:30 p.m.
June 13, Monday 6:30 p.m.
June 17, Friday 9:00 p.m.

Adele: Rise of the Mummy
June 11, Saturday 1:30 p.m.
June 17, Friday 4:00 p.m.

Dans les cordes (Inside the Ring)
June 14, Tuesday 9:00 p.m.
June 15, Wednesday 6:30 p.m.
June 19, Sunday 6:30 p.m.

La Tete de Maman (Mama's Smile)
June 16, Thursday 4:00 p.m.
June 19, Sunday 4:00 p.m.

Un Poison Violent (Love Like Poison)
June 9, Thursday 9:00 p.m.
June 13, Monday 4:00 p.m.
June 18, Saturday

Madamoiselle
June 9, Thursday 1:30 p.m.
June 14, Tuesday 6:30 p.m.
June 18, Saturday 4:00 p.m.

A Question on Professionalism

This is my third week as a medical clerk. So far, I believe that I have an idea on how to go about things when I am stationed at the Medicine floors. Yet, the self-directed way of learning is still ever present. Clerks, interns, and residents run around the floors when they see consultants -- run around to hide or to go after them. Being equipped by our school with a new perspective on how Medicine should be, we never fail to receive a rude comment, a constructive criticism or just plain gossip going around from consultant to resident to intern to clerk. Imagine, it's as if my idea of high school life in medical school suddenly had a sequel! It is hard to hold on your reigns since you don't have anything to hold on to. Yes, you will feel that you are the lowest of all creatures or even frustrated since 3 years of medical school seem to have just slipped away in a dark corner.

Despite the many personalities and moments of ignorance, a few have tried to shed some light on a new way of teaching medicine. One of the values that keeps medicine firm is compassion (I would like to believe so). Compassion since this profession is service-oriented. Service does not matter when done out of necessity. It's just empty. In relating to their patients, it is a must to show such value. What amazes me is how such compassion and sincerity sometimes disappears when faced with their colleagues. Superiority does not equate with respect. Respect is earned. It is not an obligation. It is just funny to observe those who got their MDs to be still acting like little adults. In that tiny world, all medical professionals are really shut off from reality. Now, I have a dilemma on how should I be.

The rigidity of the system puts pressure that it reminded me of my previous dilemma of continuing medical school. Imagine a consultant reprimanding you in the corridor because you are holding a cup of coffee. It looks unprofessional. How should professionalism be defined in the healthcare system? Is the participation in a circulating gossip becoming of a professional? Does superiority issues reflect true professionalism?

If we bring this structure into a business perspective, this will soon become bankrupt and close down. Rigidity in its systems will not help a company survive. Flexibility is the key since globalization is fast approaching. Healthcare is one of the big industries that should keep up. In that rigidity, many have become narrow-minded. In that setting, frustrations easily arise, insecurities pile up on top of the other, suffocation and death due to social pressure can be a possibility.

It is fun to observe a new clique of individuals. In each day that I wake up and enter the office at 7 am, many of assumptions are affirmed and some are negated. On our part, we should learn the value of patience and humility. Both are hard to master but should be mastered. Hopefully, the time would come where you would feel your importance as part of the medical team. Appraisals rarely come in this field, which is sad. The pressure that such profession builds is in its unstable form that it may just explode. It is easier to say "You did well." rather than comment on the wrongs they have done.

I would like to stay, it would take more than a decade for the school's VMO to take place. Now, I would say we are still far from it.

Fear, after all, is our real enemy.

This is a memorable quote about fear from the movie, "A Single Man" starring Colin Firth. :)

"The Nazis were obviously wrong to hate the Jews. But their hating the Jews was not without a cause… But the cause wasnʼt real. The cause was imagined. The cause was FEAR.

Letʼs leave the Jews out of this for a moment and think of another minority. One that can go unnoticed if it needs to.

There are all sorts of minorities, blondes for example, but a minority is only thought of as one when it constitutes some kind of threat to the majority. A real threat or an imagined one. And therein lies the FEAR. And, if the minority is somehow invisible……the fear is even greater. And this FEAR is the reason the minority is persecuted. So, there always is a cause. And the cause is FEAR. Minorities are just people. People……like us.

Fear, after all, is our real enemy. Fear is taking over our world. Fear is being used as a tool of manipulation in our society. Itʼs how politicians peddle policy and how Madison Avenue sells us things that we donʼt need. Think about it. The fear of being attacked. The fear that there are communists lurking around every corner, fear that some little Caribbean country that doesnʼt believe in our way of life poses a threat to us. Fear that black culture may take over the world. Fear of Elvis Presleyʼs hips. Well, actually, maybe that one is a real fear. Fear that our bad breath might ruin our friendships… fear of growing old and being alone. The fear that we're useless that no one cares what we have to say."

Toastmasters

Do you bring bread there? Do you drink wine there? What do you do?

Yesterday, I've attended a meeting of the Toastmasters Club (Molave). I am not sure which division or chapter or whatever. I appreciated the thrust of the group where they aim to train their members in terms of their communication and leadership skills. Based from experience, one of the essentials of a leader is good communication skills. It is in the unique trait of a human being, to speak, that we can move people beyond the horizon.

In one of the prepared speeches, she has clearly demonstrated how the organization wishes their product speakers should be. Big. Bold. Brave. Big in a sense that its members are forced to think bigger. To see things beyond their reach. It pushes a person to think on their toes and to create something out of nothing. It is amazing to witness how ideas pop out instantly within a minute's grasp. In thinking big, one must be bold with their thoughts and beliefs as they communicate their deepest desires, cherished experiences and life's lessons to their peers. In conquering the stage before them, one must be brave in owning their stage. Be in command and cherish the spotlight.

One of the comments raised was not to let yourself be distracted by your audience. In a greater perspective, you must not let yourself be distracted by those who live around and with you. Be your own self, be firm on your stand and beliefs, stick to your own principles in life. Just wonderful.

They do not eat bread nor drink wine. They are just a group of people who would want to make a difference by simply talking with their peers. It is amazing how an explosion of ideas can just happen in a room with people of great intellect and passion.

Philippine Brand vs Chinese Brand of Justice

Last Wednesday, 3 Filipinos died due to being drug mules. My condolences to the families who have lost a precious member of their family. Drug possession in China automatically condemns you to death penalty. However, with the case of 3 Filipinos, our country would like to an exception. Does this sound wrong? As the Malacanang repeatedly stated, we must respect the law of China.

However, media, being their usual selves, feasted on this issue making the grieving process for the families difficult. While I was listening to the radio, one of the families announced of their wish to be left alone as they wait for their beloved daughter's execution. Still, media became persistent and asked the grandmother's condition. As I recall, the questions were: Kamusta na po kayo? Ano ang mga plano ninyo? Ano ginagawa ninyo ngayon? Well, of course, the family feels sad. Why would you ask them of their plans? Isn't this invasion of privacy already?

Even if the radio seems irritating at that moment, I had no choice but to listen. What deeply bothered me the most was the concept of milagro or miracles for Filipinos. The association of miracles with fairness or justice is a bit skewed. Instead of determining the culprit, we plead for a miracle in something that is innately wrong and beyond our control. It's as if Filipinos have easily given up hope on brining justice to the crimes committed. Instead of the media feasting on their emotions, they should have helped identify the drug recruiters (since they're good at finding people too).

What is sad about the Philippines is we don't recognize the value of what each Filipino brings to the country. In that loss of recognition, we, in the end, lose sight of a greater country. Working as individuals, competing against each other will not bring the country to a competitive level at par with the other Asian countries. When someone does, all industries try to shoot it down with all kinds of disrespect one can ever imagine.

Based on the surveys conducted by a certain station, many agreed that the government did what it can. I appreciated that. We all have our limits. We all live in a global world. The best we can do is to educate each other to prevent from having another humiliating event from happening in our country.

We are all responsible for their fate. Each one of us brings the Philippines with us wherever we go. To be considerate to your countrymen, stop, listen and think before doing anything else.

As I end, I would like to quote from an article I've read about the China execution, "moreover, we confuse justice with mercy, or to be more precise, the Philippine brand with the Chinese brand of justice."