random thoughts

LAST DUTY SYNDROME… def: a)toxicity x 3 during last duty b)no sleep on shifting out day c)toxic Sunday duty

I have recently coined the term because of my experience in my Surgery rotation. Be it the ward, the ER, and the Operating Room. I usually have an uneventful duty, however with the recent events I have been forced to think that maybe, my last duty is bound to be a toxic one. parang binabawian ako sa benign-an ko. In non-med lingo, toxic roughly refers to something that is difficult, time consuming, or anything that is out of the ordinary hellish.

Take for example my duty in the Surgery ward on June 11. Being the intern on duty, we monitor 2 wards for Surgery, wards 2 and 4. The Surgery ward 2 and Medicine Ward 1 are recently being renovated so the old ward 12 (of Ophthalmology) has been converted into 2 half-wards to accomodate the patients.

Usually the patients in ward 12 were usually stable during our 2 week ward duty and we only monitored 13 patients for both wards that day. But on my last duty, (which coincidentally fell on a Sunday) as I entered ward 12 I saw the ECG guy leaving Bed 20, a middle-aged female who had breast cancer. So I thought, standard procedure before a scheduled operation. No biggie. As I finished monitoring the rest of the ward, I saw a group of people crowding around that bed.  Apparently, they had just called a code and the patient expired before I entered the ward. And this happened at around 2 pm, a time when most of the patients would be having their siesta. And in the interns’ callroom, the other surgery interns would just be sleeping too.

6 pm.. PACU (Post-Anesthesia Care Unit) The surgery intern on duty is tasked to monitor the post-op patients every 15 minutes for the 1st hour and every hour thereafter.  You are also tasked to get blood extractions and other procedures.  My co-intern endorsed several blood extractions that he couldn’t perform on an intubated combative neurosurgery patient. The patient was a 34 year old guy, intoxicated while driving his motorcycle and met a road accident, fell off his bike and hit his head on the pavement. the usual story for PGH ER patients.

As I was getting his ABG, he flailed wildly even when he was tied to the bed and his bantay held his hand. Horror of all horrors, the 1 cc syringe filled with the patient’s blood, flew mid-air and hit my index finger near the nail with no/minimal bleeding.  Paranoid ako sa needlestick injury, my very first! I searched for his chart, looking for a history of Hepatitis B. What if may HepatitisB/Hepatitis C/HIV+ sya? Oh no!!! I got the patient’s name and had to report it the Infectious Disease Section so we could run my blood and check for antibodies and test the patient’s blood. but the next day was June 12, so the office was going to be closed. malas nga naman! shet last duty syndrome na naman ako. For several days after that, I couldn’t think of anything else except my needlestick injury.

9 hours later, I was called to assist in the operating room for a triple A. What’s an AAA or an aortic abdominal aneurysm? Basically, an aneursym is when a blood vessel becomes abnormally large or balloons outward. The abdominal aorta is a large blood vessel that supplies blood to your abdomen, the pelvis, and legs so when your aneurysm is at risk for rupture, it is definitely an emergency. I thought, isa siyang madugong operation! Get ready for the sight of gushing blood.

I was sleepy pa because it was 3 in the morning, and as I entered the OR, I saw a thin man, with white hair on the operating table. He was 84 years old, making the procedure more risky. He came in tachycardic at 120s (a fast heart rate). Even before the anesthesiologist could induce the patient, suddenly his blood pressure monitor dropped and went blank, his heart rate dropping in the low 50s. They palpated the arm for his pulse and couldn’t feel any. I instinctively reached for the patient’s neck and couldn’t feel any pulse. Another code. Last Duty Syndrome. The anes resident handed me his stethoscope, "Doktora pakinggan mo." while the other one called the service senior. The junior anesthesiology resident said, "ito kasing intern natin last duty na daw niya ngayon!" He had to blame me, even in a joking manner. We ended up trying to revive the patient on the operating table for nearly an hour. The epinephrine was the only thing that’s keeping his heart rate up.  Of course, if the surgeons proceeded with the operation, the patient will die on the operating table. After 5 epinephrine vials, the thoracocardiovascular surgeons talked to the relatives and they decided, to keep him on supportive care in the ward, if only to make the patient’s condition a bit better until the eventuality of death.

I went down the OR at 5:30 am, feeling a bit defeated. tired.. 2 codes, 1 needlestick injury after.. In 1.5 hours, I’ll be starting my 2 week trauma rotation, a Monday… the start of my new week. I have to change my mindset.

"SURGERY INTERN!"

And I am transported to a room filled with beeping sounds, the smell of a gangrenous foot, mixed with dried blood and sweat, and harsh white lights.  Duty again with Tiger and Al… the three of us have been duty-mates for a week as surgery interns… Move over Meredith Gray.. Here comes Monica Jara.  Unlike my American counterpart however, I am a newbie at this, inexperienced.. and admittedly i have to read up.

7 am (5/20/06) The two are not yet here.. Shar and Annie have just endorsed their patients in the ER.. Asan na ba ang boys? But what the two girls failed to endorse was that they had a drunk patient with a 15 cm laceration from his right forehead to his temporoparietal area covered in bandage.. Dr. Berces tells me "ok you can suture na.. you have the entire morning." So what should have started as a benign morning in my ER duty became an encounter with 3 drunk men. Poor helpless me! But somebody has to do it. We don’t have clerk (4th year med students) rotators yet.. just the 3 of us.

"Nurse, nurse.. ikaw magtatahi sa akin?" oh no! i don’t like dealing with drunk people in the ER.. They’re noisy, loud and really don’t give a damn about what they say.. "Hindi po sya nurse, doktora po yan.", Tiger says.

I proceeded to shave his head (as hair would most likely become a focus of infection) and the shiny periosteum started peeking from his scalp.. shet ang laki. i had to suture half of his head! "Doktora, hihimatayin na ata ako!" This burly looking guy told me… hehehe.. "relax lang kayo diyan sir." Even if blood started to drip into his shirt.

I noticed it really takes me a long time to suture.. I want every bite to look  aesthetically pleasing. Im a bit OC about the spacing in between the sutures.  Dr Berces said, "wow pang-plastic surgery!" then started to laugh.. But what I like about my SOD(Surgeon on Duty) is that he always gives me constructive criticism and dishes out praise all the time.. "You’re doing good.." Positive reinforcement.. He helped me excise my first lipoma in the Minor OR. He helped me gain confidence in placing IV lines in the trauma patients.

10 pm Being an intern, nakakahiya kasi my former blockmates keep on teasing me that I’m like an ICC(a 3rd year medical student) because I’m slow at lining… Give me NGTs, foley catheters, blood extractions! But there’s something about IV catheterization that makes me feel queasy. So last night, I conquered my fear and attended to the gunshot wound and multiple stab wound patients. My SOD remarked, most improved intern. hehehe

i was cursing the other day because i will be assigned as a trauma intern in 3 weeks time.. malas ko nga naman! not everybody rotates there and it is common knowledge that it is the MOST TOXIC part of the surgery rotation.

But somehow, the sight of blood and lacerated skin didn’t scare me last night. I was feeling a surge of adrenaline during my duty. My body was tired. My feet was killing me. The soles bearing all the pressure and all the blood pooling in my gastrocnemius muscles.  I even developed leg cramps at some point after we attended to our patients.

But I was happy. I was even singing in between blood extractions. iba pag ok ka-duty mo! we’re doing ok kasi walang scum sa duty namin. it helps if the residents are ma-chika and patawa. Even if you have a toxic rotation you don’t feel toxic.

Tomorrow, I’ll be charting in the outpatient department. more patients.. at least 120 a day divided by the 4 of us. but im enjoying my surgery rotation so far.

Before thinking of going into a dermatology program, only my closest friends knew I dreamt before of going into plastic surgery.. before liposuction, and other procedures of self-enhancement became commonplace. we’ll see.. i have a long way to go. Dermatologic surgery is still my dream. pero malayo pa yun.. one rotation down, one day at a time. i am a bit ambitious, if not a tad bit idealistic.

"Sometimes reality has a way of sneaking up and biting us in the ass. And when the dam bursts, all you can do is swim. The world of pretend is a cage, not a cocoon. We can only lie to ourselves for so long. We are tired, we are scared, denying it doesn’t change the truth. Sooner or later we have to put aside our denial and face the world. Head on, guns blazing. De Nile. It’s not just a river in Egypt, it’s a freakin’ ocean. So how do you keep from drowning in it?" This is what Dr. Meredith Grey said in an episode of one of my favorite tv shows, Grey’s Anatomy.

What a difference 7 days make. In one week, our lives will change.. a red nameplate will now graze our left breastpocket.. We’ll be back in our whites. How many times have I asked myself if I am worthy of being called a Medical Intern? Sure, I may long for that immaculate white coat that our counterparts in other hospitals will wear on May 1. But I am in PGH, mind you. To tell you the truth, the thought of going back to the wards makes me squirm.

I was having dinner with a group of friends the other day after badminton. There were 2 doctors and 2 non-med people. My friend graduated from UST Med a couple of years back and me, as you know, official alalay ng PGH. He said "If you go to PGH, you’ll end up smelling like the patients, like the bantays" (Uhmm what smell? Ako ba yun?!?! hahaha) “Yung parang hindi na nakakaligo tapos since magkakatabi kayo, magkaka-amoy na kayo…" Oh My God. I do NOT smell bad.. oh yeah, maybe nasanay na kami sa amoy ng bawat isa sa ER and wards.

I said "Yeah. Bakit sa UST charity ward ba hindi ba pareho lang? By the way naiinggit ako sa white coat ninyo. Pero and init naman sa PGH noh." and then our non-med friends remarked, "Bakit hindi ba aircon sa PGH?" Lord, sana aircon nga.. Sana i-aircon na nila ang buong PGH! If only our government would give us enough money for the medicines, facilities.. maybe the aircon is next! But for me it is the least priority.. So i explained to them the budget deficit in health etc. and how i actually dreaded going back.

I WILL BE A MEDICAL INTERN IN A WEEK’S TIME. There has been an outpouring of messages from relatives, doctors and friends who all say "Congratulations!" They all thought our batch in PGH already graduated from medical school. "Ooops thanks you pero next year pa po. Sa other medical schools after clerkship ang graduation. Kami hindi pa.. The system was changed years ago."

And what a change! our ICCs this year will be the 1st batch of those undergoing the new curriculum of UP. My younger sister, Nikki, will be a 1st year medical student.. just like her "ate" 4 years ago when she used to walk towards BSLR-East and headed for the chairs in the 3rd row, right side.  Our experiences would be different because I am part of the last 2 batches of the "traditional" curriculum, the lecture type of teaching medicine.

So here I am, have the 4 years in UP-PGH made me wiser? Tinuruan ako mag-HB (hanapbuhay). HB means prescribing extra syringes and the like to relatively "well-off" patients so that other indigent patients who cannot afford to buy anything may have something to use. It is a trade secret that medical students learn from their residents, from their SODs in the ER. I leaned to manage my time. To go to class until 5 pm and run to the dorm to pick up my badminton stuff every Tuesday. To finish my papers and endorsements then go to a gimmick on a Thursday night. To drop your renal, endo, CI, CAAP, IDS, SAPOD referrals and proceed to the ECG/X-ray room and after which, buy food sa Coop.

Oh the food in Coop! I love it. Where else can you buy ulam and kanin for 35 bucks, prepacked in styrofoam? My highschool friends couldn’t believe it. "Hindi ka ba natatakot magkasakit niyan?" Not really. Matibay yung tiyan ko from eating in UP Diliman’s CASAA " Ang mura naman!" Yes my dear, 35 bucks is all you need. But i heard it’s 40 pesos na daw but it can still go a long way. "Ikaw?" Yes. Why are you surprised? I need to save up. Besides, it is edible and yummy.

We have learned to be warriors and do QT/Qtingin. Whatever term you may use for it, it all means the same. Not really make up the values, but using this example to illustrate, copying the blood pressure measurement of the previous clerk/intern who monitored this patient. It does happen, believe me, especially if this patient has been in the hospital for months already and has stable BP. It does happen when the baby you are monitoring in the ward has teeny tiny legs that you can’t even feel if there is a palpable BP but he looks active. It does happen when the mommies in the OB ward are not diagnosed with pre-eclampsia/gestational hypertension. I’ve always regarded myself responsible for the patients in the ward. I won’t say na i haven’t used Qtingin at least once in some rotation. But there are times when I do get this feeling, when I know a certain patient is going to be toxic during our duty.  Gut feeling ko lang. And how many times have we seen Q4 patients (those monitored every 4 hours) in Internal Medicine as part of the mortality endorsements the following day? These patients looked well and usually died during the hour in between when they were to be monitored. In medicine, there is no second guessing.

So future doctors, if any of you watch Grey’s Anatomy (Star World, Thurs 9 pm) or have seen the entire season on your trusty pirated DVDs, you might as well know the characters there are medical interns! The doctors juggle romance and foster friendships while trying not to stab each other in the back over who’s going to assist in the surgeries. Actually in PGH, we hate assisting because it’s so hot inside the OR! There you go again, no airconditioning. "Don’t you worry about it not being sanitized then if the door to the OR is open?" I’m sure there is some bacterial overgrowth somewhere causing all the nosocomial infections. And unlike in the TV series, our scrub suits don’t remain pristine, it usually has blood splattered on it or reeks of human secretions. Sorry, there’s no hunky attending physician like Dr. Derek Sheperd (Patrick Dempsey).. The consultants in PGH are all old, bald and married except for a few. (Ooops si Dr. Sheperd din pala married!) Think Dr. House, ganun ka-tanda. Reality bites.

I am a medical intern, struggling to become a doctor.. struggling to be more human on a day to day basis.. It’s no joke to be a more compassionate and caring doctor but i try. Sometimes to the point that I get so affected when a patient dies or I become entangled in the patient’s day to day problems. Why watch soap operas on tv when the perfect script can be lifted from your patient’s medical interview ? Ito ang teleserye ng tunay na buhay!

I am a medical intern, struggling to become a doctor. How many classmates of mine said "I want to be a doctor, but I dont want to be a medical student!"? It’s impossible if you haven’t at least noticed a slight increase in the intonation of your voice while arguing with a makulit bantay. Or looked with despair at the impossibly long line at the Family Medicine/General Surgery OPD and you thought how can we finish? (But it can be done!) It’s impossible if you haven’t missed a meal during your duty in the labor room.

Medical school can bring out the best and the worst in people. We’ve all seen it. Arguments. Bashing. Gossip (after all, PGH is not called Philippine Gossip Hospital for nothing). But I’ve seen how it brought us together during break-ups with our ex-boyfriends, pigging out on Banana Split from Gary’s. Bahala na  muna ang monitoring.  How we managed to stay sane in Neurology with a ward and the ER all to ourselves. Because you know when you go back to the callroom, all the madness outside is gone. And we would just have DVD marathons and eat McDonald’s breakfast inside after a morning of Internal Medicine endorsements. And your friends are there. Pagtatawanan niyo na lang. These were the best years of our lives.

As my blockmate Tina said, "Paano na ang kikay, kilig at kadiri moments naten?" when she found out this morning that we weren’t going to be blockmates in internship. Another reason why I am a bit bummed out because my friends will be in the next block. And i tell her "Di bale magkakasama naman tayo in Surg/OB/Community/IM wards" if only to hide my dissapointment.  Frankly, I hate being alone during duty. I really don’t mind the toxicity of it all, as long as my friends are there.

Surprise, there’s a new list out on the e-groups! The names of our new blockmates… The incoming postgraduate interns from the other medical schools. 4 new faces. New interactions this year. I think this is going to be interesting.

Sink or swim in De Nile. It’s all up to me.

We are the next medical Interns… soon to be doctors… I can pretend to be in la-la land, basking in the summer sun, eating halo-halo on a hammock in the beach all day.. but not for long. Time to face reality. Time to pack my duty bag.

Dear Kenneth,

I remember the day I met you..  It was November 21, 2005. That was my 1^st day in ward 9, the Pediatrics ward of PGH. You were in Bed 22 then.  I was supposed to do a medical interview but your mom was super makuwento and she was telling me how nice the previous SICs (student-in-charge) were. She was happy because I knew your pediatricians from Manila Doctors because they were family friends of ours.  Your mom said your dad was a retired employee of San Miguel and you were the 3rd of 5 kids. Your family was doing ok up until the doctors diagnosed you with Acute Myelogenous Leukemia.

Sorry I had to extract blood from you almost everyday. Pumutok na lahat ng ugat mo and hindi na kita malinyahan coz you’ve been in the ward since August. But still, you were nice to me, and didn’t act bratty unlike the other kids. Tinuturo mo pa sakin kung saan kita puedeng kunan ng dugo. You were having low grade fever almost every other day. Parang alam ko na kelan ka lalagnatin. Kaya nga nagsumbong yung mom mo sa akin nung hindi ka namonitor ng intern dahil akala niya natulog lang kayo.. Bilib din ako sa mommy  mo because she took your temperature at night and I never saw her na bugnotin or nagreklamo even if she was on perpetual duty, parating gising. I remember you were excited with the new bedsheets with the nice print that somebody gave as a gift for the patients. I remember when my blockmate had fever and a viral exanthem, we couldn’t go to the pharmacy at the time and I went to your bed and asked your mom if we could replace it. She gave me 4 Paracetamol tablets.. “Maliit na regalo para sa aking paboritong doktora”

Everyday I would be greeted in Ward 9 with “Good morning Dra. Monica!” I would always have P.F. (professional fee) consisting of cookies and Happy salted peanuts.  And I remember how your mom used to pair me up with my co-clerk and your former SIC, Zed kasi crush niya si Zed kasi daw gwapo. But a week later you were teasing me to this really tall intern who was rotating in Hema-Onco also and tinatanong mo pa ako kung nanliligaw siya. “Yes, Kenneth.”. and you were always teasing me about it.

I remember your 16^th birthday party in December. Your ate cooked pancit, prepared pineapple juice, and Goldilocks Mocha Chiffon Cake and I brought you a miniature Coffee Cake.  You said “ang sarap kc malamig yung cake.” I was there with my pedia resident, your basketball teammates, and of course your entire family and we ate till 7 pm.  Instead of receiving birthday presents, you asked me before if I could give you extra toy cars and trucks, not for yourself, but for your 2 younger brothers.

It was on December 16 when I got you on a wheelchair, wheeled you out of the ward, and took you to Only The PHInest, the annual Christmas variety show for the patients of PGH. You mom was ecstatic and super kilig when I introduced you to Onemig Bondoc and she proceeded to kiss John Prats on the cheeks. We had our picture taken pa with the Ginebra PBA players.  Small gift ko yun for you… I think your mom was more happy than you at that time because she was so starstruck and puro picture taking with artistas. She sent me our pictures afterwards, both of which are still on my desk. Binobola pa ko parati ng mom mo feeling ko.. kc gandang ganda siya saken. Hahaha!

On December 24, your mom texted me because you were going to be transferred to the Cancer Institute in January. I was already rotating in Surgery then and Gio and I went to visit you.. Sabi mo pa dalhan kita ng pagkain! in your text messages for me. Kaya we brought you GoNuts Donuts. This time you texted me “Kamusta na po kayo at yung matangkad niyong manliligaw po?” Ang funny mo talaga! Your mom even told Gio “Alagaan mo si Dra. Monica ha. Kasi ang bait bait niyan at maganda pa.” Actually nahihiya nga ko sa inyo eh,

In February, you texted me ”Doktora Moneka, si Kenneth Samson po ito. Andito po ako sa ER ngayon. Naaalala niyo po si Lawrence, yung katabi kong kama dati? Yung kasinglaki ko? Namatay po siya kahapon. Natatakot po ako Doktora.” I didn’t know what to tell you because I knew both of you had leukemia. And do you remember what I told you? “Lakasan mo ang loob mo Kenneth. Think positive. At parati kang magdadasal at magtiwala sa Diyos.” You thanked me and every so often updated me whenever you would be in ward 9.

I would run into Mommy every so often in PGH and I would be greeted with the usual “Hi Doktora!” and she would update me how your chemotherapy is going. Your other SIC, Nimrod, shaved his head and nagpapicture pa with you para kalbo kayo pareho.. Idol mo nga daw kami di ba? Hehehe.

Kenneth, I saw how you try to make your siblings happy and appreciate when they watch over you during the day. I knew your body was getting weak but your spirit is strong.  Im sorry I haven’t seen you in 2 months. I don’t know if you were ready to meet with God. Maybe. I fear a lot of things because I know I am still young and at the same time I know I am vulnerable.

Nimrod texted me a few hours ago and he said “Monica, nabalitaan mo n b nagyari kay keneth? Namatay n sya yesterday.”  This afternoon I saw our picture on my nearly empty desk. I was wearing my black scrubs with the pink ballerina prints and you were holding your toys. We were smiling and sitting on your bed. I will always remember that day. I will always remember you as my smiling patient. Thank you for affirming my responsibility as a future doctor, for making me feel more human, and for making me realize the importance of not taking things for granted.

From, Dra. Monica

     Have you ever wondered what is it like to live in a different country? For the average Filipino, maybe you have the American dream. The promise of a bigger salary.. For graduating medical students, you have the option to take the USMLE, in hopes of getting into a good residency program in the US. But what is it like to live in a different country other than the US? Have you ever thought of that? How about our Asian, African, South American and European counterparts?

I was watching Oprah this morning and the show was all about 30 year olds living in different parts of the world.. An eye-opener to a more global perspective..

First off. KUWAIT. A 30 year old woman, married to a commoner whom her family disapproved of. By commoner it meant somebody outside your family. Traditionally, you should marry a cousin, to keep the wealth inside the family. But even if her family kind of disowned her, she is still better off than most of the women living in different parts of the world. They live temporarily with the man’s parents quite comfortably, in a house that could rival the houses in Ayala Alabang and Forbes. The couple was showing off architectural plans to build their own house, complete with a tennis court and a swimming pool. Not bad! And 67% of students in Kuwait University are women. They have been educated and are a vital part of the workforce. Education and medical services are free. So what do women in Kuwait do in their spare time? Take two hour lunches, and my favorite pasttime, shopping! Because they could afford to. Take note they are quite label-conscious. Fendi. Prada. Gucci. Burberry. Chanel. Maybe toting around the latest Hermes bag before anyone else in Asia could. Of course, some women you would still see in their traditional attire of burqa covering their entire body and revealing only their eyes or a sheilah, but underneath wearing designer clothes from Dolce and Gabbana. Jewelry from Van Cleef and Arpels and Cartier. Do you know why they could afford luxury goods? THEY DON’T HAVE TAXES! Now you can imagine how rich this tiny country in the Middle East is. The same oil fields that Saddam Hussein wanted to get his hands on made them rich. When somebody gets married in Kuwait, the King sends them a gift. You can even get financial loans to build a house WITHOUT INTEREST. By now, the American audience is shocked. No interest and no taxes. Sounds good. But there is always a trade-off.. Women are NOT ALLOWED TO VOTE in this democratic nation. Despite being the intelligent, outspoken, strong women that they are.

      Let’s compare this to IRAQ. This 30 year old journalist lives in a house in Baghdad with electricity turned on for two hours then turned off for the next 4 hours during the day. It looks like any suburban house from the inside.. but with gunshots continuously fired and heard outside their house.. She keeps an armalite-looking gun inside the house for protection.. Imagine a constant fear of being killed, of someone breaking into and entering their home. Her father and brother were all killed in the war. Iraq has been liberated from Saddam however so-called freedom has its price. There is no order, no basic services. Women are being raped, killed. They are afraid of going out the house, lest they want be killed, shot. There is no running water, no electricity. The new problem that Iraqi women face is how to cope with the situation. The answer that most of them have turned to is popping a VALIUM which is available in Iraq without a prescription. To escape from reality.. to escape from living in a war-torn area. A bottle roughly costs $0.20 which is a small price to pay for getting a good night’s sleep. A small price to pay to numb your sadness from loved ones killed as casualties of war. Women in Iraq are getting addicted to Valium and it is something that is not discussed.

      One thing that remains universal though is the desire to remain beautiful. The standards of beauty differ from country to country. In BRAZIL, the land of Havaianas, bikinis, beaches and thongs, women pay attention to what else, their buttocks? The gym would be the place to go, never mind if you’re not married by the time you’re 30 as long as your buttocks are worthy of some booty shaking. Waxing, hence the term Brazilian wax, is a must! Brazil remains to be a haven for plastic surgery with more North American women flocking there to have something nipped and tucked because of its relatively cheaper price. While you’re at it, take a vacation in Rio de Janeiro while you’re recuperating from your liposuction.

      Women in Brazil place a high premium on their looks as is women in South Korea. In SOUTH KOREA, a whopping 80% of women by the age of 30 admit to having plastic surgery. Usually, Koreans want to have their eyelids done. Asians are born with a fold of skin over the eye and want to create the illusion of wider, bigger and deep set eyes. This medical procedure is called blepharoplasty and is also popular among the Chinese.. As is rhinoplasty or more popularly known as a nosejob. Add a little chin tuck and enhancement of the cheeks, to keep yourself looking young. The average monthly income for a professional woman is $1500 a month in South Korea and procedures could cost up to $2000 which for them is a small amount to make their Asian features look more Western. Blame it on Western influences? The Korean women who were interviewed admitted that they did it to make them more desirable to the other sex, or probably get a better, high paying job. Some of them appeared docile and were embarrassed to admit they had plastic surgery but if you ask them in general, it is something they wouldn’t deny. Take for example the latest trend there, surgery to shave off your calf/gastrocnemius muscles to make them look thinner!!

      The women from the other countries agreed that women in the US are overworked. In LONDON, a typical workweek would be 35 hours and you get a 5 week paid vacation yearly. Women in the US dress more comfortably (*a politically correct term for dowdy hehehe) in their oversized jeans and huge t-shirts with their backpacks slung over their shoulders whereas their Mexican counterparts like to flaunt with their tightfitting outfits. MEXICAN women don’t like going to the gym because for them, the standard of beauty is having all those curves and would not want to be stick thin.

      As one Mexican telenovela actress on the show recounted, even the way we drink tequila is wrong. It’s meant to be sipped slowly like Cognac and not as shots like there’s no tomorrow. One of the reasons why American women are obese (up to 70%) is not just because they don’t exercise and the huge servings that they serve. They also eat fast and gobble their food for a good 10 minutes. Compare this with the FRENCH who eat all these fattening cheese, bread and drink wine but they savor every bite. Compare this with the Mexicans who eat enchiladas, nachos and tacos but take it over a 2 hour lunchbreak. They also have siesta breaks afterwards. The French make it a point to WALK, WALK, WALK.. Live well, Eat well..

      As a woman, pampering yourself is not something you have to apologize about. MALAYSIANS have regular massages which cost them roughly $10 twice a month. It’s not a luxury, it’s just a way of life. And then you can buy yourself those strappy Jimmy Choo shoes (who happens to be Malaysian himself).

      Too bad there was nothing mentioned about the PHILIPPINES! Ano kaya ilalagay nila? 30 something woman, still living with her parents.. maybe goes to the gym, goes to the salon once in a while.. Overworked, Underpaid, Overtaxed! I doubt if you could afford plastic surgery by the time you’re 30 with a regular salary unless you’re one of those starlets who want to have breast augmentation and liposuction. I doubt if you could afford Fendi, Chanel and Vuittons.. Oh, but there’s always Greenhills!

"OLD COW, NEW COW"

i woke up this morning, thinking "where did I hear this before?" do you get that itching feeling that you want to know the answer to this question but you were too embarassed to ask anyone at 7:15 am because either a) everyone you know is on this pretty, overexploited, desert island named Boracay b) too blasted from last night’s partying c) attending Summary Rounds in OB-Gyne d) don’t really care.. Being the movie/TV junkie that I am, I searched the net to find my answer (unless I want to be tormented the entire day what movie that is)

If anybody remembers this movie called Someone like you circa 2001… ("oh-kay, the guys go pretty lame movie so what Monica?") But it’s not about the movie per se but the theory that movie revolved on that stuck with me.. So i got this from this website called www.realmoviecritic.com (*just to refresh your memory*)

Story Line: This romantic comedy stars Ashley Judd as Jane Goodale, a talent booker for TV talk show host Diane Roberts (Ellen Barkin). Jane’s a woman who is in and out of relationships and not very happy about it. She is not worrying about the ticking biological clock as much as she is about the possibility of innumerable, meaningless, short-term romantic relationships.

When hot shot executive producer Ray (Greg Kinnear), joins the talk show staff, the cartoon cloud of "attraction" pops on the screen, so we know they are meant to hit it off…at least for awhile.  Soon they are in the "establishing intimacy" phase. After good times in the sack comes the "vocalization of emotions"…the "L" word," love, and Jane and Ray are soon planning to share an apartment together. Jane now has to give notice on her place because her lease is about to end, and Ray has to break things off with his girlfriend of three years, Dee.

Needless to say Ray is either afraid to break up with Dee, or it’s the "C" word of commitment to Jane, or any other woman, that derails the plans that Jane has. Ray starts to avoid Jane and it’s at this stage that she becomes victim of the "new cow" theory. Supposedly a male cow only wants to mate with a female cow once, and 95% of males in the animal kingdom don’t believe in monogamy. Once the new cow has served its purpose, a syndrome is created called the "old cow theory." This rationale helps her deal with their break up.   

Since Jane does not have a place to live, and co-worker Eddie (Hugh Jackman) needs a roommate, she moves in with him. It’s a large loft apartment with two bedrooms and one bath. Eddie is a womanizer who tries to bed a different woman every night. Jane observes this, wondering if he is living proof of the new cow theory, or if there might be something deeper. She also decides to move on professionally.

A call to arms is made, and Jane becomes a columnist with her best friend Liz’ (Marisa Tomei ) magazine. To further theorize, Jane intones  "when, not if, the man comes running back, symbolizes the current cow sob story," as he tries to get "back into the bullpen." Of course, later on Ray does try to make a comeback.

As hard as relationships are to develop and maintain, certain aspects of Someone Like You reminds me of someone like me and others I know. If there is any merit to this goof ball theory, it may be that to sustain a relationship, old cows, both male and female, must constantly reinvent themselves as new cows. Moooooooooooo……

If any of these is to be believed then it means that an old cow, no matter how much you paint it, dress it up will always be OLD COW. no offense. A woman confused by men and searching for a logical explanation behind being dumped… Hence "THE NEW COW THEORY" (Zed, I know you will like this). This theory, based on research done on actual cows, states that bulls will dump their old cow for a new cow after having their way with them.. Once they lose interest, they start looking for other new cows.. MEN ARE LIKE COWS.. ("oh-kay, so ano ba talaga? cows, dogs, or pigs?")  Men, unable to be satisfied with the cow they have, constantly in search of a new fresh cow..

I was in McDonald’s Katipunan at 2:30 am after a girls’ night out at Embassy Cuisine and my good friend whom we shall refer to as JANE (*name changed to protect her true identity) was pouring her heart out to me and dare I say crying like hell (baka isipin ng ibang customers ako ang nagpaiyak ha!)

So over a double cheeseburger and fries (yes, my arteries are clogging at this very moment and although I have sworn off fastfood, this is a special exception to the rule..) I was telling her that a guy shouldn’t make you feel like a very high second priority… Like, I wouldn’t compete with the other girl na lang… well, in my case, let the guy decide… If he wouldn’t stand up for you, then HE IS NOT WORTH YOUR TIME… At the back of our minds, women always have this nagging thought.. "well yeah, my boyfriend can replace me anytime with this hot chick.. everybody is replaceable…"  if you go on thinking that way, you might never realize the true potential of your relationship.. if you think about it, there will always be someone who’s prettier, richer, smarter, better-dressed, sexier than you.. but deal with it! I admit I have a lot of insecurities of my own which is why it is crucial to always have reassurance and communication in a relationship… Because men are wired differently from women… We’re not on the same page, heck not even on the same book…

Old cow, new cow… it’s up to you if this is to be believed…

I dont wanna be an old cow anytime soon…

Everybody wants to be a celebrity… to acquire the latest gadget, the fastest car, best looking clothes… Earn more money.. Get a better paying job.. We all want to look a certain way, dress or talk differently… so we can feel better about ourselves.

Shame, embarassment or fear prevent us from realizing our self-worth.. "Am I enough?" The pressure of keeping up with the Joneses. It prevents us from pursuing things that will make us really happy. We don’t have the courage to step up to the moment and claiming our own truth. We don’t realize that maybe the life that we are living now, the cards that we have been dealt with, may be the best one for us. 

People have different ways to escape- shopping, affairs, food, compensation by any other means. Here’s a new cellphone, here’s a new pair of pointy heeled shoes.. Here’s your dream vacation..

Everything has consequences.. We’re moving through life without really thinking… Just living in the moment meanwhile accumulating credit card debts or maxing out our allowance.. Living beyond our means…

I admit my personal escape is shopping… But no matter how much you compensate, equate happiness with these material things.. It may not have the power to make you feel good.. Albeit temporarily..

They say that learning to love yourself is the first step that you take when you want to be real. And flying on planes and exotic locations won’t teach you how you really feel. Face up to the fact that you are who you are. And nothing can change that belief.  "Just Be"-DJ Tiesto

Note for the squeamish… the following blog contains really sensitive and PG material.. If you dont like reading this i suggest you stop now but what Im trying to do is to raise more awareness and make the general public more aware of this important issue…  Once can hurt a lifetime is the title of a video we were made to watch during this rotation. It recounts stories of adults who were abused as children and grew up with low self-esteem and problems with relating to people later on…  I think kids should be kids, and as such, they have a right to grow up in a caring and nurturing environment..   I started my elective rotation in CPU this March.  CPU stands for Child Protection Unit under the Pedia department which is supposedly the most benign rotation being only 2 weeks instead of 4 weeks …

However, I wasnt prepared for the things that I saw in this elective..  On our first day, we reviewed the Shaken Baby Syndrome.  Never shake a baby who is crying unconsolably.. It may affect his mental capacity and bring neurological problems later on such as mental deficits.  That same morning we saw a 3 month old baby boy in the ER..  He was drowsy and presented with vomiting.  Ano kaya yun?  You would think meningitis (infection in the meninges of the brain)?  Puede. But the baby had a depression in the lateral part of skull bigger than a 10 peso coin..  Now you would suspect sumthing here because babies that age may be active but dont spontaneously get all these injuries.. Apparently, his father was drunk that night and he kicked his own helpless baby in the head. 

Nakakagulat pero ang dami talagang abused children in our country, either physically or sexually abused.  And usually the perpetrator is someone they know… In the case of that kid, his own father was to blame.

During my rotation, I watched several interviews and medical examinations of children who were sexually abused: either molested or raped.  May incest, may pedophilia.  Minsan nade-depress ako and you cant help but feel affected.. We would stay in an adjacent room where the kid is interviewed by the pediatrician.  We watched ala Pinoy BIg Brother, through a one way mirror while the interview is recorded for future use in court.

There are several stories that really got to me: a 5 year old girl poked in the vagina using a barbecue stick by an 8 year old boy.  12 year old boy molested by a 70 year old man who is regarded in their community as a religious and prominent person,  17 year old girl gang raped by 3 friends  during a gimik. an 8 year old boy with ADHD from a well to do family who was sexually abused by his teacher.

The common denominator here is that the perpetrator is someone they know.. someone they could trust supposedly.. Someone who has more power over them.. Someone with authority perhaps, sometimes giving them candy or trying to bribe them with cellphones… And warning them never to tell anyone.. Clearly, it is an abuse of power.. What is disturbing is that the justice system in our country would take a long time before they can prosecute these people because of the backlog of a lot of cases…

Do you think you can put the 70 year old lolo in jail if the boy had normal physical examination findings.. And 90% of the time these sexually abused kids would present with normal findings.. "Why?" you ask? Because the perpetrators are smart, they wont leave evidence… lalo na yung pedophiles. What happened to the 8 year old ADHD kid? The school he was attending in Makati apparently tried to cover up the incident.. Ako naniniwala ako dun sa bata.. Bakit? We watched the interview at least 4 times and I transcribed his interview for court, 12 pages containing very graphic descriptions of what the teacher did.. consistent, never flinching.. Paulit-ulit yung sinasabi niya.. ADHD ba naman.. I dont think the boy would make up something like that.  The thing is, the other children attending that school are also at risk!  We wouldn’t know if other children in that school are sexually abused as well since they are "special children" na nga and wouldnt understand that situation..

We even attended a court hearing in the Manila Regional Trial Court last Tuesday… it’s not like what you imagined in the movies.. The room is cramped, and filled with papers and filing cabinets.  It has 3 benches, with the 3rd bench being occupied by the suspects. There were about 15 cases heard in the morning, ranging from petty theft to rape.  Our case was that of a 17 year old girl who was being raped since she was 7 by her maternal uncle who is a known shabu user…  Apparently, the uncle had raped 2 of her cousins who also lived in the same house and it was not until this year that the grandmother (who raised the victims herself) decided that her son should be put in jail.  And it was not until 3 years later (when the victim is already 20 years old) that the case has been filed and if proven guilty, the uncle may be either given a life sentence or the death penalty.

Most kids would never report incidents like abuse.. for fear of being ostracized.. for fear that otehr kids will laugh at them, for fear that older people might not believe them and think they’re just in a make-believe world..  And several years later, these abused children may grow up to be dysfunctional adults… all the hurt and anger would resurface.. the memory they have repressed for a long time will come back…

So if you know of incidents of children who are being abused, you may refer them to PGH.. They may be brought and examined at the Child Protection Unit… Because these kids deserve to be kids..

Serious ko noh? I feel really strongly about this kasi.. maybe even be an advocate for children’s rights in the future…

Last Friday, we had the privelege of being assigned to Dr. Annie Francisco’s private clinic.  It is common knowledge that when the new batch of clerks rotating in Family Med come to visit every month, she prepares a huge feast.. (and i mean huge!) and if you’re lucky she has giveaways from her travels, which is another reason why everybody looks forward to it.  Her only requirement is that she takes pictures of every group that comes to visit and you write something like a reflection paper (sa amin kahit insights na lang cz every year it’s the same).. Through hard work, she and her husband were able to build a three storey building with a lying-in clinic, x-ray machine, her own pharmacy and a laboratory.

Dr Francisco keeps photo albums of clerks dating to circa 2003.. so it’s quite amusing to see our 2nd year PGH residents dressed in their immaculate white med uniforms.. funny how graduating from med school makes you look more mature than your real age… incidentally, it was Annie’s (my blockmate) birthday that day and she doesnt look older than 16 but she’s actually already 23… let’s see 3 years from now whether Annie will look older than 26.

Anyway, I was inspired by Dr Annie Francisco, not only because she has a successful practice, but also because of her demeanor as well.. She is funny, makuwento, talks really fast and animatedly, down to earth and candid. She even gave us a few practical tips on how to start your private practice..

1. maging ma-PR - well, i always thought this would work for me.. you have to build rapport with your patients.. even if you see them in the malls or in other public places, dapat ikaw bumati sa kanila.. as Dr. Annie said "wala naman mawawala sa yo" Besides, patients are still people.. For me, biggest accomplishment ko na yung binabati ako ng patients sa PGH canteen, sa ER, sa CI etc. long after my rotation is over..  that means, i am not just a monitoring machine.. i actually made an impact in their short stay in PGH

2. be business minded - Ang pangarap daw niya sa buhay nung siya ay bata pa ay yumaman because their family was not that well-off.  She was able to buy her parents a rest house even. Hindi porket doctor ka eh hindi ka na puede mag-business.. but this doesnt automatically mean you take advantage of your patients… for example, pooling your financial resources with other doctors to purchase equipment so you can set up a laboratory diagnostic center.. unless you are uber-rich and you would like to shell out P10 million bucks of your own money for equipment.. eh kelan pa yung return of investment mo? after 20 years? cost-effectiveness lang yan she even gave us an idea of setting up a dialysis center.. (sana magka-pera ako to do that so i can help treat my Kuya Paolo) because there will be more chronic kidney disease patients who will need dialysis in the future

3. network - Again, recognize that as a doctor you have your limitations. you can’t treat everything. That is why you need to refer to other doctors.. Dr Francisco has this notebook filled with calling cards from different subspecs.. Sometimes she call them up herself so the patient will feel inaasikaso talaga siyang mabuti..

4. dont be masungit - don’t be masungit to your patients, your classmates, your co-residents.. they will be your future patients and colleagues.. nobody will refer to you if you act so snooty and masungit. oh well, easy to say, hard to do in PGH.. you will need loads of patience.

5. Be happy  with what you have - Obviously they have been blessed but the good thing about them is they don’t desire for more than what God has given them.. baka magalit pa si God at bawiin if you’re ungrateful..

6. Go the extra mile - Take time to listen to your patients. Treat them nicely.. and soon, they won’t be just patients but your friends as well. Work hard and you will reap your rewards.

I asked Dr. Francisco if we could come back and observe or talk to her again and the gracious person that she is, she willingly obliged. sobrang bait.. sobrang nakakatuwa.. Im hoping future doctors will be more like her and that she will continue to welcome and inspire the idealistic clerks who come to visit her clinic.

For those who were glued to their television sets yesterday, it was quite disturbing to see the dead people from the ULTRA stampede being piled up on the trucks… I was watching at 11 am and was puzzled how this could have happened.  At that time, I saw this elderly woman, her face paper-white, with her arms outstretched while being transferred from a stretcher… without even being covered by a blanket..The idea was incomprehensible to me even if Im used to seeing people dying everyday in the hospital.

A friend texted me to say she was angry to see some of the Wowowee audience members still waving at the camera despite knowing that a tragic event had just occurred.  Apparently, some of the audience members stayed on hoping that the program would continue while outside the crowd was composed of family members looking for the missing.  I was pissed off to see one of the Viva Hot Babes say on camera that sayang they had practiced 5 days just for the opening production number of Wowowee and she continued to complain of the bruises she had sustained from dance practice. Hel-lo?!?! kung hindi ka ba naman insensitive, 74 people had just died and hundreds more injured from the stampede outside of your comfortable dressing room and all you can say is that you have bruises on your arms? ano ba yun?!?

if you read the editorial of anthropologist/sociologist Michael Tan in the front page of the Inquirer today, he made an interesting comment "How long will we allow the entertainment industry to use celebrities, with their manufactured aura, to dictate to us what to buy, how to live- how to die? Doubtless, heads will roll as authorities ferret out people to blame."

In my personal opinion, it would be wrong to blame the Wowowee staff or the ABS-CBN management for everything that happened yesterday.. It was an unforeseen event that could have happened anywhere because of the present economic crisis our country is facing.  It is not the entertainment industry that is solely to blame for giving hopes to our countrymen.. They say that the program has been giving dole-outs… Maybe in a sense all they wanted was to help because they recognized that these people are really hard-up.   And if you saw Willie Revillame and the other hosts of Wowowee, they looked like they were in a state of disbelief, still dazed from the incident.

The crowd estimate was around 50,000 and only 17,000 will be accomodated inside.  Can you imagine that? Instead of saying, how much security officers did they need to secure ULTRA or if the promoters given the raffle tickets in advance, would this have been prevented?  Maybe we failed to ask how many of the 50,000 people who lined up and travelled all the way from the various provinces, are unemployed? Most of those who died were elderly women who wanted to try to bring home even a small amount of money, or even just catch a glimpse of their favorite artistas. Michael Tan said that the dead were human sacrifices on the altar of consumerism and latter-day idols.. Perhaps he is right to some degree.. But I think that it must be out of sheer desperation to camp out outside of ULTRA for several days, in hopes of being able to be part of the program’s Pera o Bayong segment or to try your luck in winning the P2.5 million house and lot or the car they’re giving off in the raffle. Im sure you wont stay there for several days, wondering what your next meal is (probably instant noodles), with your belongings in one bag if you did not really need the money that badly.. It is a reflection of how a big part of the Philippine society has continued to be uneducated, unemployed and impoverished. On a personal note, our patients in PGH have to pay for every laboratory exam and meds, walang gamit sa ER for Surgery trauma patients and we have to run to the Pedia-ER just to get NSS (layman’s terms: dextrose) kasi out of stock so that the trauma patient wont suffer more blood loss and the bantays are surprised to find out that their money had just run out and we can’t do anything else for the patient.

Imagine nanunood lang ako ng television and this event got me thinking.  Gio says i live in a perfect bubble.. at present, wala akong problema. I admit im even apathetic at times because in the hospital you have no contact with the outside world, kinda detached from reality.. kaya na-bother talaga ako to watch TV yesterday..  And for those who are wondering we are not stakeholders in ABS kaya i dont blame them.. personal opinion ko lang ito.. tell me what you think!