THE MAKING OF A NEWBIE HEALER

By Tin Guevarra

THE MAKING OF A NEWBIE HEALER By Tin Guevarra

A Collection of Blogs on Life as a Medical Student

Copyright December 8, 2011 Manila, Philippines Email author at antintin@yahoo.com

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For my parents, Abby & Cora Guevarra, I am forever grateful.

Sirach 38:1-15

Give due honor to the doctor, for you need him and God himself established him. Healing, in fact, comes from the Most High; the gift of healing comes from the Sovereign. The doctor's expertise gives him prestige and wins for him the administration of the powerful. The Lord created the medicinal herbs which grow on earth, and these a sensible person will not despise. Remember that he used a simple wooden rod to purify water and so make known his power to everyone. It is he who gives knowledge to humans so that his power be glorified; the doctor uses it to heal and comfort, the chemist to make his mixtures. In that way the Lord's work never ceases and well-being prevails on earth. My son, when you are sick do not be anxious; pray to the Lord to heal you. Give up bad habits, keep your hands unsoiled, and purify your heart from all sin. Offer incense and a memorial gift of fine flour and rich offerings according to your means. Then consult the doctor; remember that he was established by the Lord, so do not disregard him - you need him. There are cases when good health depends on doctors. They, too, will pray to the most High to grant them success in healing in order to save life. May he who sins before his Maker, fall into the hands of the doctor!

About the Author & this Book

Tin Guevarra is a Physician by profession but a writer at heart.
These are her blog entries during her years as a medical student. For those who might need it. And for those who are intrigued.
Mount Medicine (7) PGH Emergency Room cries, Emergency! (8) A Pediatric Tale (12) My first ever minor surgical operation (14) Walking on Water (15) When it rains, it pours (17) When sleep become mortal sin (19) Other than physical healing (22) When suddenly you realize you are stripped (24) Pauses for Breathing (28) Assessing Cardiac Rhythms (29) And he said, I dont like the smell of hospitals (31) The Miracle that is Gods Will (33) Happy Tired (36) Operations outside the Operating Room (37) Inspiringly Exhausting, Exhaustingly Inspiring (42) Stronger than Vodka (43) When Hes on duty like You (46) A Vision of Praise (48) Revalida Haunts me in my Sleep (50) More than just a Dream (51) For the girl who loves surprises (53) Emotional Periodic Pseudoparalysis (54) Foolish (Open) Heart (56) Knudson two-hit to Gods two-kulit Hypothesis (58) The Last 365 days o Twenty somethings (62) Progress Notes (63)

Mount Medicine
-July 4, 2007Medicine is such a tough mountain to climb. Unlike Mt. Apo or even Mt. Everest, this is one mountain that will take a lifetime to reach the top. But I can imagine the exhiliration one would feel as the journey ends and flaglet is fixed on the ground. The happiness, more so, the joy, I must say, would be endless. And here we are, at the foot of the mountain, staring at the peak high above us. With God's prodding, hard work, and a lot of heart, we, all of us, will get there.

PGH Emergency Room cries, Emergency!

-April 12 2007There is a sense of urgency at the emergency room. And it's not only the treatment of patients I am pertaining to. It's actually the room itself. I started my duty as a volunteer for Pahinungod - UP PGH: Emergency Room Volunteers' Program this morning. I'm a level 1 volunteer, meaning, a Patient Liaison Officer. All volunteers get to be deployed to different areas of the emergency room: Triage, Pediatrics Unit, and Observation Unit. My first task was in the Triage which is the admitting area of the ER. There, I got the opportunity to work with my partner, an incoming 4th year Biochemistry undergraduate at UP Manila, 2 medical interns, and a very inspiring ER resident working round the clock, Dr. Noel Refarial. At first, my partner and I really didn't know what to do or how to assist the doctors. Usually, interns & volunteers do the vital signs: blood pressure, respiratory rate, pulse rate, etc. There was no "real" emergency case this morning. Not like the ones we see on tv, the real bloody stuff, if that's what you have in mind!
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Not even cardiac cases! We got a lot of old patients coming in for check-ups, hoping to be considered as emergency cases so they could get admitted in the hospital. But you see, the dismal condition of government hospitals lie not on the doctors because they were very skilled, resourceful, and intelligent, but on the facilities. Because of lack of resources, one patient on a wheel chair with dextrose had to wait for a day just to find an unoccupied stretcher for him to be transferred to the ward. Imagine how many more will wait during rush hours at the ER! Watchers of the patients were requested to just stand so that the real patients could take their seats; there were just, I think ten seats in the receiving area. Volunteers like us don't even have seats. And like what Dr. Refarial said, it was really hard for them to send some patients home even if they have ailments, although not emergent, because the 1,000 bed capacity of PGH cannot accommodate everyone who enters its doors. But they have to or else the hospital will just overflow. Man power is lacking. I was really moved when I saw Dr. Refarial, in his busy schedule, being the only resident at the triage, the only ONE responsible for diagnosing all patients to be admitted and even those who will eventually be advised to go to the Out-Patient Department prepared a stretcher and a wheelchair for two different patients and personally pushed them to the Observation unit. We offered our help but he was too much of a gentleman not to give us tasks like that. I had a share of pushing a stretcher when he was busy with the patients at the desk. And boy, it was no joke!

Every once in a while he would explain to us why he had to send some patients home or why he had to be firm with the others who were insisting on being admitted. If I were in his place, gee, my heart would really melt just looking back at those pleading eyes of the patients. But I guess, I have to get used to that. Pahinungod sends volunteers because of this reason. People from farflung barrios came too. Even as far as Kalibo, Aklan. And I heard Dr. Refarial explaining to them that all government hospitals are competent enough to treat the case of the patient. They need not come to PGH for that. But I guess people just want to be reassured of having high quality health service knowing that doctors here are highly efficient. It was said that there had been times when doctors had to revive patients on the floor because all stretchers are already occupied. Or even use the insides of the syringe package, which is sterilized, to stop bleeding because they ran out of gauze. Doctors run to and fro to attend to patients, do janitorial work, carry, scoop, push wheel chairs, etc for 24 hours. Being an incoming 2nd year medical student, I can only smile at the patients to help them ease their pain. When they smile back, I feel a little bit relieved knowing that at least I have helped them a bit. And to the doctors, haha! Sabi ko kay Dr. Refarial, "Astig ka, doc!" He is truly inspiring. Pagod na siya e, pero, sige lang!

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But I was truly inspired to be a better medical student so I can render excellent service to my future patients just like them. Yung literal na agaw-buhay, nasa ER yun. Kaya sobra akong napahanga ng mga ER doctors. Hope I could be trained like them. FYI (specially those who are in medicine & incoming!) 3 years residency ang Emergency Medicine. Si Dr. Refarial 1st year resident ata ng ER. Astig no? Parang gusto ko rin! Sabi nga ng classmate ko, I have to study Medicine well (yung field/subject na Medicine) kung gusto ko ng ER. As we bid the doctors farewell, we wish them rest. But the real emergency this day is a glimpse of the ER of the whole country, represented by the best trauma center in the Philippines, screaming, "EMERGENCY!" Who is around to save the ER? Looking forward to reporting for duty next week!

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A Pediatric Tale
-April 18, 2007Akala ko uubra ang charms ko lagi sa mga bata. 'Pag may sakit pala sila..."hindi kita love." (quoted from a subdued epileptic patient) Yesterday was quite a full day; starting at 4:30 am to get to PGH for a 6am duty. I can only imagine now how my day would start and end once I begin with real hospital work when I become a clerk in two years' time. But working at the pediatrics unit ignited once again this passion to serve in the health profession, knowing that counseling won't be enough to help ease other people's pain. Lalo na pag bata...pag masakit, masakit talaga kaya, "wag kang epal!" (huhuhu) It was a good thing I met Maam Tess, a nurse at the ER Pediatrics Unit. She was very willing to teach us different procedures, explain ailments, and use the machines. The highlight of the day was a dramatic episode of a little girl diagnosed with biliary atresia. This means that there is either an obstruction or absent bile duct due to inflammation. Because of this, bile cannot pass through from the gall bladder (which is dorsal to the liver) to the intestine. Thus, the bile retained within the confines of the liver and prolonging such condition

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would lead to cirrhosis or destruction of the liver. The only other option is a transplant. The child was jaundiced (yellowish skin discoloration), her abdomen was so enlarged and distended and her face is twisted in so much anguish. In fact, she was screaming and squirming at first when monitors were attached to her. But I noticed, after some time, she became more subdued with faint sounds with every breath. At this point, the residents came to her and asked assistance from the others since a procedure was going to be done. Maam Tess failed to finish explaining the procedure to us because she was called by another patient but from what I heard, the resident already advised the parents for liver transplant and they were given a few minutes to decide. It was a tear jerker. To actually witness parents deciding for a life and death situation of their child, considering their financial capacities as well. At 12 noon, my partner and I had to leave already. As we walked out of the Pediatrics unit, I could still hear the child's breathing and the parents talking to the resident. Somehow, there was relief upon hearing them, "Sige, doc, anong oras ang operasyon?"

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My first ever minor surgical operation

-May 6, 2007I have just experienced my first anesthesia injection first cut first stitch with my first patient And how it ignites my passion for surgery! Grabe! Ang saya-saya! And I still feel the shaking of my hands the first time I inserted the needle into the patient's flesh. But as I went on with the procedure, under the guidance and well-meaning supervision of resident Dr. Roderick Arcinas. I became more confident and I began to stitch faster. You must be wondering what kind of surgery I did. Well it was just circumcision but it surely was something worth remembering. I did my first surgery on a human being, and not on a cat! And so, more operations to go! Excited to do so!
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Walking on Water
-June 23, 2007Despite my busy schedule I was able to go to the CFC Glory Music Summit last night at the Ateneo theater with my very dear friend Joyers. It was a songwriting contest and Joy and I couldn't help but reminisce the good old times we had together with our band in Youth For Christ, Human: Imperfect. We have a couple of compositions. I was the writer. She was the composer. And now that we're busy of our own affairs, we saw each other again after more than a year only yesterday. Aside from that, I went to Tanglaw Study Center yesterday morning and had a meeting with the ORI (Optional Religious Instruction/Catechism) facilitators for Pisay this year. Lala, our Tanglaw coordinator asked me, "Diba Med ka? Buti may time ka pa for this?" Even the people in Pisay wonder how I still have time to go there for SCA. This amuses me so much. Because I really don't know how to answer them. I just tell them, "May time pa naman ngayon kasi early dismissal kami 'pag Thursday." But I know deep in my heart, "somebody" is fixing my time. And I'm enjoying every bit of my "itinerary" here on earth.
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The Lord knows I love variety yet, I'm a bit of a sigurista so I stick to what I used to do or have. But little by little He frees me from being a sigurista. My qualms about medicine, about my personal affairs, yes, even my lovelife, He's changing them all. As I write all these things, I can't help holding back my tears. How grateful I am for His goodness despite my unworthiness. I know I have done a lot of disappointing things for my "General", as I consider myself part of His army. But still, He promotes me to higher ranks that at first I cowardly back out from. Blessings just pour in. And the next thing I know, I couldn't say NO to Him. I am enjoying my classes. I am happy getting tired Thursday nights coming home from Pisay. I get excited over making programs for kids. My life changes in every unexpected way. How do I do all this? I walk on water.

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When It Rains, It Pours

-August 6, 2007The much-awaited and prayed-for rain has come. And it poured hard. Soaking my shoes, smudging my uniform, almost wetting my Sabiston (surgery textbook), and most of all, ironically, "highlighting" my sad face day. The gloomy sky and heavy rain drops may be a blessing ...as everything that happens in my day. But sometimes it's hard to see the sun behind the dark clouds. Even the tiniest bit of rays that can make one smile. Rain comes to nourish and allow flowers to bloom. I eagerly wait for that day. Hoping I could also bloom in my new garden. Sometimes I feel like a sunflower planted among orchids. How sometimes I wanted to go back to my old garden because I know I live best there. 12 I know God is teaching me about something that I don't understand He has worked miracles for me in the past. And I know when He wills something, it will happen. This is His will for now. If through this I'll be a better person, a better servant, then so be it. "My sun truly doesn't shine without You. So come, and turn my night into day." Let me bloom as I should in Your own time. And so, as my window pane drips with cold rain tonight, I reflect on my nothingness and pray

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that in my nothiness God will use me still and He would emerge victorious. Hay....anyway, tomorrow...Im sure, is a smiley face day
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When Sleep becomes Mortal Sin

-October 15, 2007Yep! Mukhang mortal sin nga sa mga medical students ang matulog lalo na 'pag exam night. At nangyari sa kin yan. Quick lang ito kasi may exam pa ako bukas, the last two exams for the semester, woohoo!!! Anyway, it's like this. Ive been studying for pathology since Friday. Super haba kasi niya and I didn't have much time to study surgery...yung aral ko dun was last Sunday pa before our 2nd shifting exam. So, last night, after mass, I wanted to browse through everything just to be sure I studied everything and to have this kind of confidence during the exams. But as we all know, parang hindi mo alam kung talagang prepared ka na until you're there at the exam. So, sige aral. Pero at around 9pm, drowsy na ako. So sabi ko, sige nap ako til 12mn tapos aral uli. I set the alarm clock and I asked my dad to wake me up.

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BUT NOOOOOOOOO!!!!!!!!! Parang galing sa bangungot ako napagising kanina. Na-trigger ata ako dahil tungkol sa school ata ang panaginip ko. At ang unang tinignan ko ay ang relo... 5am NA!!!!!!!!!!!! At nagbilang ako kung ilang oras ang tulog ko....a horrific 8 HOURS OF SLEEP!!!!! Naiyak na ako... at nagtampo ako sa dad ko. Alam ko mali. At pinigilan ko nung una. Pero hindi ko nakayanan...Nagmadali akong magbrowse through sa notes at samplex ko. AT...hindi na rin ako nakaligo....hihihihi! Ganun kalupit. Dahil 8am ang test ko, paano ba naman, e bibyahe pa ako at magrereview!!!! Siyempre medyo tampo-tampo pa ako sa bahay pero before I left, nag-sorry ako. I just said, "Well, at least I had 8 hours of sleep!" Nagbati na rin kami ng dad ko at hinatid pa niya ako sa school. When I got to school, I couldn't study well kasi andun pa yung heaviness sa heart ko. Nagtext ako sa parents ko tapos punta akong banyo...kinausap ko si God...ipinaubaya ko na sa Kanya. Dun lang ako na-relieve. SIyempre, kelangan talaga ng unting conference sa Kanya. Sa banyo lang kasi medyo private at that time. Naiyak na rin ako dun. Anyway, to cut the long story short, the day turned out well. At in the end feeling ko He put a spell on me to sleep for exactly 8 hours, "pahinga muna, anak" hehehe.

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I got a good score in my patho exam. And surgery, I banked on my stock knowledge...ok na! Wala rin sa samplex at previous notes ang mga lumabas...so useless din kung nagpuyat ako sa wala. So, again, I felt God played a prank on me and tested my temper, I failed on that part. I was panicky and as usual, medyo napikon ako. Pero here I am, thanking Him for saving me and...for putting me sleep.

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Other than Physical Healing

-November 28, 2007I felt a little bit nervous as I entered the Outpatient Department of the UST Hospital. I havent completely read the survey since we were sent off immediately after a brief orientation and we needed to interview 3 patients that day. As I scanned the room full of patients and frantic medical students, I felt even more anxious, hoping I could get started right away just like them. So, I greeted the three people seated on the side bench and started my survey (Drug Utilization; physician vs self-prescription). Ive been moved the most by the second patient who even waited for me to finish with my first patient instead of going straight home since she was already finished with her consultation. We have talked about a lot of things other than the survey itself; shed a tear or two when she shared about the death of her mother; and we shared stifled giggles as I teased her to not drive her suitors away just because of her ear impairment. I even told her, Ayaw mo ba nun? Edi bubulungan ka nalang niya ng I love you
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I actually spent a lot of time talking about many other things with my three patients aside from the questions on the survey sheet. The other patient was a teacher, and the last, a former OFW presently going out to Christian missions with his fiance. Maybe I wasnt as hurried as the others since I was able to get interviewees all seated together and who readily agreed. But I realized, many of these patients in the OPD needed fast physical healing, thats why they are there but that does not mean that is all they really needed. There is healing in listening to their woes and acknowledging their achievements in life despite their disability and in talking with them about hope in the Lord that in their suffering, they are never alone.

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When suddenly you realize you are stripped

-December 15, 2007Stripped of sleep parties shopping money weekend dinners with friends time for helping in household chores eating time (lately, I eat lunch in 10 mins...lunok lang ng lunok!) bonding time with family ego because of pharma (my problematic subject) yeah, even love life And then early in the morning your high school best friend would text you: Tin, magparamdam ka naman.

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Lately, I am becoming more aware that I am being stripped of so many things. Some of them, I really hold close to my heart: people, relationships, time. And so many times since I started in med school I have thought of giving up. Because I enjoyed my previous work so much. I had freedom. I was good in my field. And it is so tempting to go back to that kind of life especially when you know you still can. My position as a Guidance Counselor in first job (SHAP) is still vacant and open for me. The same thing with my position at Pisay. It's as if it's my rightful place in this world. Waiting for me to go back. And last December 3, I thought I've had enough. I was so depressed during Pathology class that for the first time, I slept in class. Well, actually, half asleep. I just couldn't focus on the lesson because my heart is so heavy thinking of the sacrifices I have made for med. Not only me, also my parents who drove me to school that day even if they were tired the night before. And so, my makulit self asked the Lord again, "Give me a sign." Should I really stay in med? I really don't see the point of me staying in med. I could do so much better in counseling. Please, give me a sign. Lo and behold. I got a sign. Somebody texted my brother (that was my old number) this: "Hi ate tin, may kelangan po ba ako isubmit today and kelangan ko po ba magset uli ng guidance interview for this sem?"

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Up until now, I could not connect this to anybody I know. The sender did not reply when I texted him/her. People from SHAP and Pisay are the probable source of this message but all of them know I am no longer working as Guidance Counselor. Much more in SHAP because they know I already resigned 4 years ago. But you know what? I felt different when I read the message. I felt like I was being challenged by God if I could get carried away by a message, thinking that was a sign from Him. Probably a sign from Him but for a different purpose. I knew it the moment I read the message. I entered med school because I wanted to be dependent on God. Because I felt Counseling was such breeze for me. It was so easy. It felt so natural for me. I wanted to go to med because that was where He was leading me and it even took me a long time before I finally decided to go. And here I am still asking, "Why am I in med?" And then I realized that God was just being faithful to His promise to me. I wanted to learn true love in my lifetime. I wanted to sincerely love Him. And now I know, it is hard to do. Because I often fail to be faithful to my commitment to Him, which is to trust in Him that He brought me to med for something even if I don't see the point, really. That day, I told Him to help me be faithful to Him too. Even if I have to renew my commitment everyday. Yes, Lord, I am staying in med.

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It isn't easy to be a med student. Much more a doctor. So many sacrifices. And sometimes I couldn't help but count all the things I have lost just because of med. And for a time, I was angry and hurt and sad and lonely. Yesterday, I was supposed to go home early since we didn't have decury class (hospital ward) for Med 1. But I left school at 4pm because I had to fill in the parts of our mpprc paper which some of my group mates should have done. Well, I CHOSE to fill in the parts...And I felt...angry at first because I started my part early so I could do other things for the weekend (Well, window shopping sana nung Friday for Christmas) but I ended up being the last one to hassle on the missing parts of our paper and I just went home after that. Nasabi ko nga sa friend ko, simple lang naman ang gusto ko: Magpahinga, mamasyal, makipagkwentuhan...pati ba yun mawawala rin sa akin? Masakit minsan ang gawin ang tama. I know I am being stripped of so many things. And I know, some of them aren't really as important as the things that really matter in life or even with my service for the Lord. I just could not help but magtampo talaga sometimes. But in my heart and mind I KNOW it's all for the greater good. Ganito siguro talaga ang magmahal. Mawala na ang lahat, masunod lamang Siya. Ang hirap, hehehe. I guess, the more painful it gets, the more I am assured that I am on the right track because I become more, and more, and more dependent on my God.
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Pauses for Breathing

-June 20, 2008With much joy And an overwhelming sense of unworthiness I turn to You in this Wet window bliss to honor You and thank You For this bestowment of a life full of pauses for breathing In momentary urgencies of miniscule value Of dreams fulfilled and of desires constrained Those that are worth living And the ones that are worth leaving You are there In my busy days As it begins to get tighter I only long to remind You (As if You don't already know) That You are my reason I now ask only this That You make Yourself felt So that I won't forget When I pause for a while Just a pause for breathing Nothing is more exciting Than a life filled With just pauses for breathing.
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Assessing Cardiac Rhythms

-August 18, 2008It cannot be seen on 12 lead ECG Nor is it visible on Doppler Maybe on auscultation You may hear it when you listen closely On palpation, perhaps The thrills, yes How does your heart beat? Is it in sinus rhythm? Calm and composed Or in tachy Always in anticipation Sympathetic Compensatory Or the one buried in deep melancholy Bradycardic Deep, deep melancholy Too far from solace
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Just not arrythmia No, not arrhythmia For no one desires A frequent gasping For life In brief moments When impulse is null There is a certain kind of dying Death in a millisecond When there is no feeling When there is no response When there is chaos When body and spirit And emotions and consciousness Lay in knots Just because the heart failed To beat To be in rhythm Because of this When symptoms get worse When after arrhythmia there is fibrillation And after fibrillation there is Cardiac Arrest There is a need for CPR. Have the defibrillator ready.

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And he said, I dont like the smell of hospitals.

-February 28, 2009I have a friend who once said this. He is an injury magnet (hihihi, now, you know who you are!). Maybe that's why he doesn't like the smell of hospitals. I remembered him last Wednesday when I passed by the hospital pharmacy (I always pass by the hospital and its pharmacy but somehow, this day was different). The smell of the hospital that day was so...like hospital. Haha, you know what I mean. It's like the smell of purity, of cleanliness, of medicines straight out of the box. And yet there is this gloomy feeling that you get...the smell of illness combined with the aroma of hope. As I remember him, I suddenly thought of my life being in the hospital starting this April, hopefully. There is contrast between my life before and my life today and the coming more years. I miss the chatter of the kids in school, their sour smell in the afternoon, their knocks on the glass of the
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office, the warmth of the school setting. And this, I bring upon myself, to never let go of these as I enter a place lacking of such things. But it's a hard thing to do. Ever since I've been to med school, I've changed a bit. Not as cheerful as before, but always as anxious as ever, that's for sure! What more in the hospital. Will I be swept away in the glum? Or will I be able to bring joy to people I will meet, to the patients I will try to heal, and senior doctors who would harshly teach us the ways of the profession? I become afraid. I get tired. I get bored with routine stuff, really. But this is where I am. I thank my friend for being an inspiration to me as he, once again, with his funny antics, corny hirits, and very sensible advices, reminded me of the real reason why I am where I am. Thanks tonatzky! *( ^ ^, )* -from Espaa to Espaa =P (Our pun at the time he was off to Spain while I am about to start medicine at UST) Beyond grades, teacher recognition, and fortune. I am here being trained to become a healer. Period. And though clerkship is near, I've got a long way to run. And I ask for your prayers!!! Thank you, my friends!!!

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The Miracle that is Gods Will

-March 31, 2009I guess I must say that I have just received the best Easter gift ever. And I received it in advance! There can truly be miracles when you believe. ******************** Medical studies has never been a breeze for me. Contrary to how people see me or their perception of me, my time in med school can be described in one word: struggle. All the changes, emotional burden, even physical relocations had been part of this struggle and sometimes I could not help but ask God if I truly deserve all these pain when the reason I entered med school was Him. His constant prodding, my abandonment of my beloved job as a guidance counselor, thus, my colorful career as that ended when I entered med school and despite the many sacrifices and things I have given up for Him, still, med school wasn't a breeze for me. My pride lost, my heart lost, my name lost, I practically died when I entered medical school. There is dying when you want rebirth.

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I died these past 3 years. And I was almost double dead until today when I received the best news I have ever heard in 3 years. I passed everything. All third year subjects, I passed them all. No remedials. No retakes. I passed. I passed. And with tears, I write this as a testimony of God's love for me. Ever constantly there for me. Never doubted me. And what makes me cry really is the thought that He never stopped believing that I can be a doctor because all this time I have always doubted myself. And many times I have given up on myself. I guess, He is not after me topping the honor roll or perfecting all my exams. He wants me to have the right attitude, the character of a doctor. Why and how so? Yesterday, I was half-angry at Him because of the daunting fact that I might take a remedial in one subject. I was thinking of all the sacrifices and things I've done in place of studying. Things I deemed more important than studying, time I have lost because I believed they are more important than the books. I was questioning all of them, whether I have truly done the right thing or not. But when I saw my mom. I took everything back. I am proud of all the things I've done and I won't ever change them even Im given another chance to pass that road again. I love my family. I love my parents and I will support them in all their activities. I love teaching students. I love spending time in prayer. Hearing out a friend in distress. I love God. I really do. And all the anger just faded. And I just told Him that it is ok. I'll just study harder but if He could make a little miracle out of this, then it would be great. And I slept with a light heart. When I woke up this morning. I gathered all my reviewers in that subject just when I received Ten's message that I passed all subjects.
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Isn't that a miracle? He really wants me to become a doctor. And I should start believing that especially now that I'd be facing patients. I'M OFFICIALLY A CLERK!!! I am so happy. And I can never trade this kind of feeling for anything in this world. Miracles do not need to be big to be noticed. It all starts in our hearts. When we believe and pray and we allow God to guide our paths. Thank you, Lord. You're simply the best. My MD is for You and for Your people. Sana pwede ganitong shoes...ganda!

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Happy Tired
-April 19, 2009I guess Im just lucky. Maybe I'm simply blessed. Our first rotation in clerkship is Surgery, specifically Neurosurgery and Plastic surgery. Three days in clerkship and I have assisted in three operations: one plastic surgery and two for Neurosurgery. I'm so lucky! And tired, of course. Because the two neurosurgery operations were done in one day. I underestimated the length of surgical operations. I have participated in rotational flap, emergency ventriculostomy, and ventriculoperitoneal shunting. Grabe! Super exciting! Maybe it's kind of a reward for accepting seemingly tedious tasks and considering them not as burden but venue for learning and gaining experience. Although it surprised me to be called and told that I'm on deck again? Still, it's ok, the I am
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benefited and I get to stay awake for my 7pm-7am duty. The memorable operation is the VPS wherein we had to call two general surgeons to do exploratory laparotomy because of the abdominal adhesions of the patient. Grabe! we started at 12mn and we finished at around 6am! But I learned alot and I am grateful for our residents for teaching us and allowing us to assist in their operations. Grabe. I can't believe how our doctors could manage to have several operations until the wee hours in the morning and leave the OR dressed up as if nothing happened, looking very fresh and rejuvinated! While I look wasted =P Maybe they are also tired but happy. Astig. I hope my classmates, especially my close friends would get the same experience or even more. Im sure they will. And so, this is the beginning of everyday being happy tired. This is it for now!

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Operations outside the Operating Room

-May 1, 2009I want to share so many things with you about my thoughts, my deep feelings, my realizations, my small heartaches, my sighs of relief and periods of adrenaline rush but I just could not find the words to sum them all into a short blog. I am currently in my rotation in Orthopedics/TCVS and I got lucky again by having the opportunity to be the Clerk-in-charge of the first operation in our group, partial hip replacement wherein I realized I could not imagine myself getting into orthopedic surgery. It's a great specialty but I just don't have the muscles to do the work. Hahaha. "Traction!" said Dr. Angeles during the OR. Yikes, I think I only did a bit of tugging of the patient's lower limb. When he did it himself, whoah, I can't do half of what he did. What I can share with you tonight are my sentiments these past few days. I'll start by enumerating them here:

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1. There are lots of great looking guys (esp. in surgery) but after being overwhelmed with their good looks, what matters is admiring their good hearts. And sometimes, even the not-so-good looking becomes super gwapo when he is super nice. Hihi. I have a crush on a certain resident but he seems so serious and a little snobby. He's nice when he's teaching you, though. But I am more comfortable talking with the other resident who is more approachable and friendly. But I only consider him as a big brother I could greet warmly in the corridors. I don't have a crush on him. It's nice when there's something to amuse you while in the hospital but it ends as that, nothing more. =) Besides, crush is different from love. 2. Part of becoming a doctor is accepting responsibilities given to you at that time even if it is not your "official" duty in the rotation. I got two doses of this in a week. One is a patient from Surgery ICU. One of my groupmates thought I was on duty that night so the Intern asked me to run errands and have the xray be initially read by the radiology resident, etc. I actually told him I'll endorse it to the next person on duty but when I returned to the clerk's quarters I felt guilty so I returned to him and told him that I will do it. And I did. I got a little scolding from the radiology resident because I went to her for the initial reading without knowing the complete PE of the patient. All I knew was she was stat and tachycardic and pneumothorax was being ruled out. I was really just asked to run and do the errand. The resident understood that so I just got a little scolding and now I know what I should know when I go to her again. It felt good
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after Im done with my task. All for the patient. The other one was the Operative Technique report of another patient which I typed for another clerk. Good thing I was a CIC for Ventriculoperitoneal Shunting before so I have notes and I used it. Again, all for the patient. The Lord knows what good things we do in our anonymity to others. May we always remember that. 3. A big ego does not fit in a white coat. There are things we can learn from others. It kinda hurts sometimes when we look dummy and less knowledgeable in front of some patients but it's all part of the learning process. 4. Pray always so that you will not get boljacked by the residents. So far, hindi pa ako naboljak. Siguro kasi I don't have major referrals and natataon mababait ang residents na napupuntahan ko. Pati mga technicians sa X Ray CD at nurses sa station ngitian lang and be nice to them para you can all help each other. I remember when I referred an ortho patient to rehab medicine, I told Dra. Zamora and Intern Ostrea, "Dra, Dr. thank you so much. I know I am lacking in so many things..." And even before I finish they stood up and said, "Ay nako, sobra na ito, tama na." They were so understanding and nice that my apologies for my incapacity were humbly taken. So, so, so nice of them.

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Kahit ung referral ko kay Dra/Sr. Blanco sa Infectious diseases, pinaghandaan ko hanggang madaling-araw only to be accepted right away. Thank you, Lord, at hindi pa ako naboboljak. Ibig sabihin lang, binibigyan mo pa ako ng time para mag-aral para hindi ako maboljak diba? 5. It is much harder for a girl to choose the medical subspecialty she likes because she always thinks of her time for her family. I am currently contemplating on going into surgery. It is too early, yes, but I am liking it every single day. But I am also thinking of my future life, family, etc. It's in the Lord's hands. I know when the time comes, He will guide me in my decision as He always does. As for my lovelife, hayy...It's His doing. I know He is preparing me para mamahalin ko nang todong-todo ang para sa akin talaga. Todong-todo. 6. Busy times occupies the mind but longing and missing loved ones lingers in the heart. 7. Treat patients as family and the wards as home. 8. Never allow your friend to take a picture of you and the resident you have a crush on when there is a gap in between. It's too obvious. (HAHAHAHAHAHA) 9. Love always. 10. Pray always. Lord, it's all for You.
Dearest Lord, teach me to be generous. Teach me to serve You as I should. To give and not to count the cost. To fight and not to heed the wounds. To toil and not to seek for rest. To labor and ask not for reward save that of knowing that I do Your most holy will.
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Inspiringly Exhausting, Exhaustingly Inspiring

-June 1, 2009Faster than my skirt, still faster than my watch but a sighting for sighing Although I wanted to walk faster, if only I could fly from ERCD to Xray Pay, maybe I could have done that. I can't even remember how many times I went there today! And how many times my attention was shifted from one patient to another! Whew! From fracture to scorpion bite to hemorrhoids to countless chemotherapy patients waiting for their turn to get admitted. I can feel my legs walking with strain as I extend each lower extremity as far as I could, only my skirt is the limiting factor. And the clock ticking slowly before 7pm arrives, my off time. As I feel my skirt and my watch drag me to the endless line of patients in the ER, suddenly, a sight to behold came *(^^,)* ...at long last... (hahahahahahaha)...after a month of waiting...truly a sight to behold that keeps me smiling widely until now that I'm typing this (waahhhhhhh!!!!!!)...my ultimate crush in the hospital...the one above the rest (hahaha, sori ang dami nila e).
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But then, this day made me realize how toxic ER can be. And how admirable ER doctors are, to be able to handle stress every single day of their career. Much more those who are working in public hospitals. Benign na ito kung baga. Simple lang talaga to e. One can combine work and love (?), toxicity and inspiration, exhaustion and a sense of fulfillment. Maraming salamat sa lahat ng taong tumulong sa akin ngayon. Sa mga GS 1,3,5 people and 2, 4. Thanks guysh...At kay Lord, na nagbibigay-inspirasyon, at literal na nagpadaan ng inspirasyon sa nakakangarag na araw na ito *(^^,)* Of all days pa naman, ngayon siya dumaan. Maraming salamat, Lord! Salamat sa bonus! Ayan, nakangiti tuloy ako at napapasayaw pa sa tuwa!

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Stronger than Vodka

-June 28, 2009I had a blog entry about detoxifying by going to church and eating pizza. http://tinguevarra.multiply.com/journal/item/34/Prayers_and _Pizzas_for_cheering_up That was just last year. Now that I have more reasons to be toxic (and I am being endorsed as a toxic clerk *sigh*) and benign rotations become toxic when I am on duty (it's just a coincidence, really), thus, I need to level up in detoxification. That is, leveling up in social desirability. I still go to church, I still eat pizza, but now, I also drink vodka! Cherry and chocolate are my favorites. Sarap matulog after! Hehehehe. My status becomes: non-alcoholic beverage drinker --> occasional alcoholic beverage drinker But what proves to be the most effective one is still, going to Church. Sometimes its hard to be responsible and take on the duties exceeding the working hours just to finish everything most especially when, in the first place, it is not yours.
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But then, maybe that's why medicine is a vocation. It is not simply a profession. I honestly admit I was toxic this week because I took another person's responsibility because I felt it wrong to leave without attending to the patient's needs especially just after admission. I felt bad afterwards because I was already tired and I had to stay beyond our duty time while everyone else has gone home or somewhere else. I hid in the nurse's station, stared at the chart to prevent a tear from falling, and just mumbled, "Lord, Lord, bakit mo ginagawa sa akin ito." I stayed there for about 10 minutes, just flipping through the papers, thinking of my pending referral to Neurosurgery, and the whitenotes I have to give to ENT, and the database I have to finish but I have to do history and PE first and it's past 6pm. Should have been off by 5pm. And I am the only clerk left. and I am from-duty status already. And I was up and about the whole day, trying to be jolly but when one is tired...just can't force a smile. Simply put, reklamador to the max ako especially that time. I stared one last time at the POS with: "Database c/o CIC" and "Refer to Neurosurgery" and then I was off my feet again. I went to the patient to start with my interview just when I received a text message from Surgery SS intern that I could present the case. I did. Then I went back to the patient and after 10 minutes, Dr. Pacia and Dr. Dadufalza were walking right there in San Damian ward! After they're gone, I talked to the patient and his wife again. And then I started feeling good. I did something right even if it felt wrong at first. And the patient is
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benefited. Kwentuhan kami tapos pinauwi na nila ako. I left at 8pm with a smile on my face again. I love this work. It's just that when you're tired, you can't help but rant and feel bad. I would always have to remind myself that I have to find a reason to be happy in this field. With God's help, especially prudence and fortitude, in their roughest forms, I got through the day starting...and ending with a smile. =) Vodka is simply a beverage to me that I drink because it tastes good with Cherry and Chocolate. But it is not a remedy to toxicity. For me, only God is. So, between vodka and this (about feeling wrong), I choose both, drinking vodka may seem right to do (occasionally, hehe), but the 2nd one is so, so, so, right always and forever.

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When Hes on duty like You

-July 25, 2009It'll definitely be toxic. Even if you ask Him for a peaceful night It will still be toxic. And more toxic the day after When you're from duty And then you hear a heartbreaking news When best was not good enough...it truly wasn't. Rewards come in plain wrappers. When you notice, you care, you get tired, you fall in love When you work with friends and love interests (hmm...) While you're toxic and on duty. Because in half-open lids and almost (+) Romberg's stance He is there. When code is about to be called Or when another ambulance is heard at the ER He is there. Because He is my duty mate. He is also on duty Like me And that, I should not forget.

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A Vision of Praise
-November, 2009Noong isang beses na ako'y nalulungkot, naho-homesick, feeling sawi at kung anu-anong pakiramdam ang nadarama ko, naghanap ako ng pwesto sa dorm namin na kung saan pwede akong makahinga. Pumunta ako sa balcony ng dormitory floor namin (4th floor). Paborito ko kasi ang mag-stargazing at lumanghap ng malamig na sariwang hangin. Umiyak. Nagdasal. Umiyak. Sumulyap sa ospital. Umiyak. Tumingin sa paligid. Umiyak. Nagdasal uli. Hanggang sa napatitig ako sa kalangitan. At ang pumasok sa isip ko ay yung alaala ko ng daungan ng barko sa Cebu. Nung dumating kasi kami dun ng mga CFC Youth for Christ mga 9 years ago para sa International Leaders Conference, madaling araw. Madilim pa at makikita mo lang ung mga ilaw sa pier. Pero alam mo na nasa Cebu ka na kasi ang alam ko doon kami papunta (hehehe). At namiss ko ang pagiging YFC ko. Minsan kasi sa dami ng ginagawa sa ospital, mga bulong na lang ng dasal ang nagagawa ko. Simba tuwing linggo. Genuflect sa chapel. Pero miss na miss na miss na miss ko na ang mga Praisefests, worship, at kung anu-anong creative stuff na ginagawa namin sa YFC. Iba kasi pag binigay todo mo para kay Lord. Lahat lahat ng ginagawa mo para sa kanya. Minsan, nakakaligtaan ko yun. Minsan sa iba ko naibibigay ang atensyon ko.
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Kagabi, nag-Praisefest sa CFC at ang mga tinuruan kong Tito at Tita ng hand mime ay nagperform na. At ang ganda. At nagworship. Grabe, ang sarap...Sobrang sarap to the point na it numbs you. At meron din nahilo. At siyempre, tinawag ako. *shucks* Naisip ko tuloy maliban sa kailangan lagi akong may dalang stethoscope at bp app, na may dahilan talaga kung bakit ako nandito sa kinaroroonan ko. At marami pang dahilang madidiskubre along the way. Minsan lang nawawala ako sa focus. Pero kailangan lang bumalik sa Kanya. Sa mga ka-household ko dati, ang Dreaming Team, sa banda namin na Human:Imperfect, sa mga Tito at Tita ng YFC, sa mga doktor at nagdodoktor na busy sa ginagawa. Nakakamiss no? When worship is in the heart, there is always the mouth to express what's inside and the hands to extend that love within. But nothing beats the kind of worship when you give your whole time in songs of praise, body swaying, hands raised up, heart burning, and soul glorifying. Lord, I remind myself today, this is all for You. And i get up again. And Focus on You.

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Revalida Haunts me in my Sleep

-February 22, 2010I saw her in my dream. For the longest time since we last saw each other (when I was in 3rd year high school), this was the first time I dreamt with her in it. Her name is Dra. Milagros Fernandez. My school physician. My spiritual guide in my teens. One of the people who inspired me to pursue medicine. She's a UST graduate too. She was in my dream, as if reminding me to study harder. My dream was a revalida setting. Only, I have a different panel (Dr. Sanchez, TCVS), a classmate for a patient (Hanna Lu), and so many people like Fabella in the ward. Then I chanced upon her in her usual white uniform and all white hair. I almost greeted her in my dream, only I was surprised to see her (as I remember it vividly). A shadow of my stare lingered in the air. Then I talked to a nurse who looked like a young version of her and said "I almost greeted you only to realize the person I recognized has long been gone." And then I woke up. Dra. Fernandez passed away more than 10 years ago. And she came into my dream, a week before my revalida. "Tin, study harder. I will wake you up." Thank you, dra. You just scared me a little.

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More than just a Dream

-March 4, 2010It is true. Today, I am officially, definitely graduating from medical school. So close to being an MD. The pressure, the stress, the worries, fears, anxieties, doubts and nightmares all now converted to sheer joy. For my parents who work hard for my education For my brothers, how I miss your teasing For my aunt, Tita Dina, for being an example to me For all the friends and loved ones who supported me, boosted my morale, and believed in me... For my dearest friends from across the world who prayed hard for me... For the future patients I would be meeting... For all my teachers who inspired and taught me a lot... My seniors (interns, residents, fellows) whom I became friends with and got inspired by their example and awed by their youth and excellence For my classmates and group 6 mates whom I hold close to my heart For the special people who touched my heart in chinky ways and had me smiling day by day

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For Dra. Fernandez, from dream to reality, my prayers for your repose. Thank you for guiding me and being with me.
(Remember my past entry about her. I found out that yesterday was her death anniversary and did you know she died of breast cancer? I got a breast case for my revalida.)

And of course, the mightiest of the mightiest, the greatest, the closest, and the most faithful of all, the one who loves me dearly, and wants me to become a doctor...The God who Rocks!!!! Thank you so, so, so much. I will take care of the patients you will send me, Lord. So, duty na every night? Hahahaha =) Good luck and God bless sa lahat ng magrerevalida pa. More than grades, it's becoming a good doctor that matters.

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For the Girl who Loves Surprises

-April 9, 2010-

That's a really good one, huh? Didn't see that coming Had me spinning this time For the nth time You've proven Your faithfulness and love What do I give? I give my yes Maybe I was looking at another's paper But mine is in Your hands Still writing it? My story, my life Thought I could fast forward a little Maybe scribble a few lines of my own But I guess that's how it is To say you are my author I really love surprises This time it's for real For I don't know what's coming For yet another year.
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Emotional Periodic Pseudoparalysis

-InternshipMy mind was racing with questions, "Where are they leading me? Will I be safe? What kind of patient will I see? Can I handle the case? What next?" as I pulled up the ends of my pants before walking across the river; fighting against the water current, battling with the fear in my mind, fully aware that my heart beat is at least 110 beats per minute. I was led by the barangay captain (community leader) and several community members to the house of my first off-the health center consult in our community rotation in internship. Climbing on the muddy stairway like footholdings as we go up the hill gave me time to pray and focus on what's ahead, "Patient first. Patient first." The clearing exposed a small nipa hut where a 22 year old male lay motionless but conscious and his relatives all around him looking at me with somewhat a look on their faces that seem to say, "Is this the doctor? Why is she so young?" Armed with just a BP apparatus and a stethoscope, I began to check his vital signs but was not contented with that. I had to do a Neurologic examination with nothing but just these. A brief history and the M-C-M-C-R-S-M...I went about examining the patient with crude tools, 4 years of medical school, and 5 months internship experience with the hope of making a sound decision on what to do with a patient in the middle of nowhere. "This is not stroke. It looks like an electrolyte imbalance. We need to bring him to the Regional Hospital. I was thinking Hypokalemic Periodic Paralaysis.
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The patient was then wrapped in blankets, carried by 5 people, and, amazingly, did not slip as we went down the slope of the hill. A jeepney stood by waiting on the other side of the river in which we all boarded and went to our destination. My partner, co-intern at my side and speedy text messages sent to our consultant and resident, we all drove the zigzag of Quipot, San Juan, Batangas.
**For the past month, I have been missing a lot of people: my family, my friends, my colleagues. There was never a day that I did not think of them, to at least eat lunch with my mom when she visits me at the hospital, or to catch up with the going ons of my friends volunteering in the doctors to barrios, moonlighting, or those who already got accepted in their respective residency programs, or still in pre-residency like me, how much I would want to work in the company of old friends, theater plays missed, high school reunions in exchange for sleepless duty nights...all of which when resurface from my unconscious, a tear falling is inescapable. But, with this memory of a patient waiting for help to come, maybe, just maybe, tons of tears may equal lives saved. Doctors must really be crazy.

Emotional Periodicity but should never be Paralysis.

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Foolish (Open) Heart

-InternshipOne of the most painful things an optimistic and all-time positive and hopeful person could ever experience, I think, is to be led on. As a TCVS (Thoraco-Cardiovascular Surgery) Intern, you get to scrub in open heart surgeries and assist the most skilled, amazingly the fastest, and the most calm surgeons you could ever meet in the country. Aiming for moving targets and suturing in prosthetic valves in calculated and precise manner would make you stare and want to be like them. As a TCVS Intern, you have Thursday and Friday as scrub day. I was pining for an assist the whole week and my heart was swelling with joy as my resident, Dr. Rainier Lutanco, prodded me to go up the 6th floor of PGH early in the morning to do so. But sometimes, things don't go the way we always imagined them to be. That Thursday morning, the consultant chose my clerk-partner to assist them in the operation, understandably, she was the most junior of the team. When the hype is at its peak and it suddenly plunges to its nadir, certainly, earth will shake and rain would fall. You could imagine what happened. All of which occurred, of course, most luckily, behind rimmed glasses and the life-saving surgical mask. The
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operation that day was a correction of Tetralogy of Falot. Earth shook again. Friday came as a surprise when a senior TCVS resident called at 6:30am at the Intern's Call room looking for the TCVS Intern...hey, that's me! And he asked me to scrub in an operation, Mitral Valve replacement! The consultants were a tandem, and he was to be their first assist and they were all too nice and generous in teaching and they were FAST! And I was simply overjoyed. But this also marked the day when I felt I have seen enough. Contented and happy, given a dose of delayed gratification, I realized that I loved scrubbing in ORs but I am meant for something else. Taming of the heart, eh? Taming a foolish, foolish heart in the presence of an open surgical heart. Mushy but it happened in the most literal sense of the event. Fixing hearts in different ways. And so, I remember this certain episode in my life when, yet again, thinking I was led on only to find out that being led on or the feeling of which is a Limbo, from which I was rescued by the optimism and positivity that my heart emanates, the source of which is the pacemaker of my life, of course, God. Moving on from heartbeats and heartbreaks, I now fight for a chance to work on synapses (my first love, juvenile synapses, if you get what I mean) and cracked minds (again, young cracked minds) and pray that it is where I belong.

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Knudson Two-Hit to Gods Two-Kulit Hypotheis

-July 22, 2011; Board Review-

Nasanay na akong masyadong toxic ang buhay. Toxic sa duties. Toxic sa papeles. Minsan, nagtotoxic-toxican sa pag-aaral. Sabi tuloy ni Lord, "Ahem, nagtotoxic-toxican ka nanaman sa pag-aaral."
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Paggising sa umaga aral. Sa tanghali, imbis na siesta, aral. Sa gabi, sa pagitan ng telebabad, aral. Sa panaginip.... Hindi, hindi naman... Mga tao lang naman na naka-duty, nakatrabaho, nakasama sa SCHOOL at OSPITAL ang napapaginipan ko Toxic nga yata talaga ako. Kaya naman, lately, natutulala, napaparalisa, at PANIC MODE NA AKO!!!! Ginamitan tuloy ako ni Lord ng isang bagay na inaaral nating lahat Introducing: God's Two-Kulit Hypothesis Isang pagpapatotoo 1st Hit, este, 1st Kulit Friday, nag-announce ang President namin sa Section B (UST Med) na si Our Lady of Manaoag ay nasa Radio Veritas hanggang Linggo. At dahil sobrang bait at responsable ni Ten (as always!) nakalagay lahat: address, how-to-get-there, parking, landmarks, pati pagdala ng paypay! hehehe. "Uuyyy! Gusto niya pumunta! Sige na! Pinuntahan ka na nga e. From Pangasinan! Kita mo na." Hindi ako marunong pumunta doon at...ibibigay ko na lang yung time sa pag-aaral. Takot na ako eh. Diba you understand naman, Lord? "Bakit dati, may first friday mass ka pa (na hindi mo rin napuntahan ngayon). Dati kahit malayo, napupuntahan mo. Puro aral, puro aral. Bakit ka ba nag-aaral?"

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Ang sagot ko: isang alanganing, hmmm...hindi ko alam bakit ako ganito ngayon. *PANIC MODE* "Hayyy nako..." 2nd Kulit, naging epektib! Halos nakatulugan ko ang laptop sa pagbabasa ng reviewer ng pedia kagabi. Paggising ko kaninang umaga. Good morning, mommy! "Anak, nasa Radio Veritas daw si Our Lady of Manaoag sabi sa radio." *****OWKAY****** 11:30 am hawak ko ang burdadong damit ng isang napakagandang babae at pagdampi ng kamay ko, no kidding, nangatog ang kamay ko at nag Raynaud's (eto kidding na ito). At naiyak ako. Buti na lang nakasalamin ako at hindi masyadong halata. At isinulat ko na ang pinakahihiling ko at pinagdadasal: ang board exam. Bumalik sa akin ang tanong, "Bakit ka ba nag-aaral?" Namiss ko. Sobrang namimiss ko ang mga panahong ganito na dati, nagagawa ko. Daily mass, na First Friday mass na lang, na Sunday mass na lang, kung minsan, "Lord, sorry, duty po ako.' Dating catechista, tugtog sa misa, hanggang, "Naku, wala na akong oras para jan." Nabaon ako sa ka-toxican ng buhay clerk (oo, clerk palang ako toxic na ako) at intern, pero lalo nang intern ako. At hindi ko na magawa ang mga importanteng pinaglalaanan ko dati.
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Siya ang naglagay sa akin dito. Siya ang nagpanatili sa akin dito. Siya rin ang maaaring bumawi ng lahat ng ito. Pero kahit minsan, madalas, pumapangalawa Siya sa mga gawain ko dahil TOXIC nga ako, heto na naman Siya, nangungulit at nanunuyo. "Eto ako. Ako na ang lumalapit sa iyo. Hindi ba't sabi mo dati, nagaaral kang maging doktor para sa Akin?" Naramdaman ko kanina na sobrang miss ko na Siya. Sa pagtulo ng luha ko ngayon, alam Niya kung gaano ko Siya namimiss. Nakadalawang tawag Siya sa akin. TWO-KULIT HYPOTHESIS. Heto ako, "Cancer" free =D kabaligtaran ng inaaaral nating Knudson Two-Hit Hypothesis. Tunay nga Siyang Healer. Ang antidote ng aking ka-toxican. Siya lamang. Kaya, heto na naman ako. Happy again! At! "Lord, sandali lang ha, mag-aaral ako ulit! Hehe." *Dahil dito sa experience na ito, isa nga naming intercessor si Mama Mary dahil napaglapit na naman niya kami ni Lord!*

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The Last 365 days of Twenty-somethings

-September 12, 2011During my 20th birthday, I was cramming for reports as a college student. I happily wore my Sablay (Graduation sash used at the University of the Philippines) months later. At 21 years old, I was teaching Values Education at Sacred Heart Academy of Pasig. I loved being with kids. When I turned 22, I became a Guidance Counselor at Philippine Science High School. Stayed another year because I loved it there so much. And would not have left if not for a calling. At 23, my friends and I were singing Plumb's "Real." After that year, I got detached from their world because of medical school. I was a first year medical student at University of Santo Tomas (UST) Medicine when I turned 24. I cut my hair so short. At Quarter life, I was struggling with my first real heart ache. Pharmacology was a real pain in the **** head, silly.

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I had a Friday night surprise with my block mates when I turned 26. I still have the birthday candles with me. At 27, I spent my birthday at the UST Internal Medicine Outpatient Department. Ice cream and "double treats" present!

Last year, I was a post duty intern at Philippine General Hospital

Pediatrics Ward with a teddy bear in my hand given to me by my favorite patient named JC, a case of Guillain-Barre Syndrome, who got discharged that same day. I missed him terribly. The next time I saw him, he was at the Rehabilitation Medicine Ward. After saying goodbyes, I turned around to have one last look of him, he was still waving at me. Today, I am 29: one day old as a licensed Physician, one year short of being thirty, 20 years of being a student, 3 years of being a Guidance Counselor, but forever a friend, a sister, and a daughter. My heart remains at 20, when one is no longer a teenager but not quite an adult. Each life milestone leads us closer to the end. I thrive on relationships. So, this shall be my compass. My North is my God, my South is the land on my feet, my East is my family, and my West, well, it's you, my friend and the many others I am blessed to have in my life. And so, let us begin the last 365 days of my being a twenty-something. Thank you for being here with me. Fasten your seat belts. We are about to take off. Enjoy the flight!

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Progress Notes
-November 13, 2011Patient is a 29 year old, female, single (shucks), right handed, Neurology & Psychiatry pre-resident, Roman Catholic, from Manila, came in with a chief complaint of head over (edematous) heels. Patient apparently well (and sane) until September 9, 2011 when she finally decided to go for UST Neurology-Psychiatry pre-residency rather than anywhere else. She initially presented with changes in mind but finally, made the craziest decision ever. Started with sliding scale (duty, that is) where she first experienced post-duty RTDs, learning with enthusiastic & fun clerks and interns, and the most edematous, erythematous legs she has ever had. Positive for missing baths due to 6am ER referrals, and loss of consciousness (with good head control) during conferences. Endorsed by clerks and interns as the most toxic, she remains...well, toxic as ever. She is found to be teary-eyed, emphatic, and, yes, supportive, as commented by a manic patient. Edema resolved after 30 days; noted when every-three duty started. But her fate did not change. Whether she is in the Pay Hospital or in the Clinical Division, ER seems to be full and patients just keep on coming. She is now on her 58th day post-ictus, awaiting admission in the said institution. Along with 4 more, equally insane and pretty pre-residents. ROS: unremarkable PMHx: No hospitalizations, no heplocks (yet), s/p Sultamicillin x 7days, lovesick FMHx: unremarkable PSHx: Nonsmoker (never), occasional alcoholic beverage drinker, iced coffee addict, no illicit drug use OBHx: nullipara
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PE: normal systemic findings NE: conscious, coherent, follows some commands, oriented to 3 spheres No cranial nerve deficits (seeming facial asymmetry is because of chubby cheeks, that's all) MMT 5/5 on all extremities, no rigidity, flaccidity, spasticity; obviously, no atrophy; no, that's not hypertrophy, just fats Cerebellar: no ataxia (just sleepy), dysmetria, dysdiadochokinesia DTR ++ on all extremities No sensory deficits No nuchal rigidity (-) Babinski

A> Head over (slightly edematous) Heels over Neurology & Psychiatry Single, until head over heels in love with someone Homesick Stage II, uncontrolled Obesity, resolving Excitement, accelerating Insomnia, secondary to toxic duties probably due to various inter-service referrals Supportive

P> Admission!!!!

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And she was admitted. On the day this compilation was made.

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I will practice my profession with conscience and dignity. The Health of my patient will be my first consideration. - The Hippocratic Oath

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