I wrote my last entry during my surgery rotation as a clinical clerk.

Today is 13 months and 1 doctor of medicine diploma after.

I've decided to do my post graduate internship in UERM to avoid the hassle of adjusting to a new environment. I guess I'm too lazy (and afraid) to go outside my comfort zone. For a brief period during the beginning of my 5th year, I regretted that decision--mostly because around that time I wished I had a clean slate and more "room" to make mistakes.

For years people have relentlessly asked me what specialty I want to take for my residency, and for years I had no idea what to answer. Recently I've made progress by narrowing it down to my top 3 (in no particular order):

1) Internal medicine
2) Neurology
3) Radiology

I've decided to steer away from anything surgical. But I do love surgery--general surgery--but since my brother has taken interest way ahead of me (he is now about to finish his 5th year residency in GS) and I don't want to have any conflict between the two of us, I've scratched off GS among my choices. In the remote chance that I will take anything surgical, it might be OBGYN (really?!).

No.

The Virgin Suicides
Charlie St. Cloud
I.Q.
The Diving Bell and the Butterfly

My livejournal account is dying because of Facebook and Twitter. Not that I even update my microblog that often. I want to write more to document my misadventures during clerkship, but here I am, half-way through my 4th year, with only 2 entries dedicated so far to my life as a clinical clerk.

Fresh from my one month every other day duty at Neuro, I'm officially here on my first duty at Surgery. Before I write anything about Surgery, I just have to say, Neuro has got to be one of my favorite rotations so far. It has "strengthened" my dislike for Pediatrics and OB-GYN. Not that I don't like kids, it's just that I'm not so good with them. On the other hand, after going through Neuro, I realized how boring and textbook OB-GYN cases are. To me, they are all the same--unless maybe I take up oncology as a subspecialty for OB-GYN, I'm not really into having the same cases everyday.

Neuro.

Neuro, neuro, neuro. I enjoyed this rotation, despite the fact that I have to be on-duty every other day (and on my from status we have OPD clinic until 5 pm). I appreciated the variety of cases, the challenge in diagnosing them, neurosurgery, WOW, I just love everything about it. Kung lalaki lang ako, siguro nag-neurosurge na ako. During my rotation, I encountered:

Guillain Barre Syndrome, Miller-Fisher Variant
Amyotrophic Lateral Sclerosis
Cauda Equina Syndrome (due to liposarcoma)
Aneurysm at the distal AICA
Acoustic neuroma

Amazing.

I'm seriously considering Neuro as my specialty in the future.

Flash forward to now. Updating my journal from the "Surgery Lungga" and waiting for 10 pm, when I will monitor patients again. Currently I'm in my orthopedics subspecialty (Surgery has 6 subspecialties we get to rotate in: ortho, genitourinary, general surgery ward and pay, ER/OPD, Amang Rodriguez Hospital for trauma). This rotation is 2 months long.

I have a feeling I will enjoy this rotation too :)

Hello LJ world, I'm still here.

I'm currently on my 2nd rotation (OB-GYN), which started on June 1st. My month-long rotation at the UERM OB-Gyn ward is almost over, and by July 1st, I'll be at East Ave Hospital for my 15-day outside rotation. The latter half of July will be my ER-OPD rotation--then that's the last part of my Ob-Gyn rotation.

Compared to Pediatrics, this rotation is less toxic. On some duty days, we get swamped with new admissions, but on some days, the most number of admissions we get are 1 to 2. Some cases are pretty interesting, like myomas weighing 4000 g (like the size of a small turkey!) and emergency laparotomies for ectopic pregnancies. The part I hate most would have to be labor watching--because it's the most boring monitoring required for this rotation. Something I definitely won't miss.

(had to postpone writing because a patient came in)

I'm not really looking forward to my East Ave rotation. I've had my share of duties at a government hospital. And based on what I've heard, it's TOXIC. Hay. 15 days lang naman. I'll live.

Ok nag-brown out for 30 secs.

Next rotation after OB is community medicine. One month of bliss.

Last April 3, my life as a clinical clerk started. Pediatrics is my first rotation, hence for 2 months (until the end of May), I will be bonding with kids of all shapes and sizes from 18 years old and below.

My first 15 days were spent on the nursery. My job as a clerk (along with 2 of my "mini group" groupmates) include the following:

1. Monitor the newborns inside the Nursery Charity, Rooming-in Unit (at the O.B. Ward) and the roomed-in babies on the pay floors
2. Update the residents and senior interns regarding "waiting mothers" (aka mothers in labor) and inform them if they're "fully dilated" or in the "cutting phase" (for CS deliveries)
3. (my personal favorite) Assist in "catching" the babies of the moms in labor
4. Accomplish all the paperwork if I'm the intern-in-charge for the patient (initial summary, database, progress notes, discharge summary)

As a clinical clerk, my day starts at 7 am if I'm on-duty, which means I have to sign-in at the pediatrics department on time to avoid getting my name crossed out (tardiness earns demerits--which are paid in additional hours on duty). After signing in, the clerks who were on-duty the day before become officially on "from-duty" status, and then they endorse all the current patients to "on-duty" clerks. Monitoring patients (newborns, for that matter) means we have to take their vital signs (temp, HR, RR, input and output) on a regular basis. Stable patients usually only require monitoring every 4 hours, while those fresh out of the womb are monitored q15 for the 1st hour, q30 for the 2nd hour, and then q1 until thermoregulated. I don't mind monitoring that often, but it can be such a pain to monitor babies who won't stop crying for almost an hour. We're not allowed to monitor crying and feeding babies since their HR's and RR's increase above normal. And for uncooperative patients (like crying newborns), making our lives as clerks a little easier is not in their natural instincts. Often, I get questioned for my "above normal" readings, and more than once I've explained that I've tried all means to calm the baby down--including carrying it and popping a pacifier into its mouth. I've never counted heart rates so much in my life before.

Sometimes, there are babies with special needs. There are those who are prone to infection, and hours from being brought into the world they have persistent tachypnea (which goes beyond the normal duration of TTN, aka "Transient Tachypnea of the Newborn"). These sick babies require monitoring every hour, sometimes they require pulse-oximetry and BP monitoring as well. BP monitoring is quite interesting. I once had a premature patient who needed BP monitoring, and I had to do it while she was inside the incubator. I thought I was going to break her stick-thin legs. Sometimes I can't help it but feel sorry for these babies, because I could see their desperate parents wringing their wallets dry just to pay for the rising hospital bills.

In the nursery, if the O.B. department as many admissions, we also expect to have our "toxic shifts." Meaning, as more preggy moms come in labor, the more babies we have to catch then monitor after. As a clerk, once I am informed of a mother in "waiting," I am tasked to get the maternal history (MOGSC = maternal, obstetric, gynecologic, sexual, contraceptive history) and text it to all my seniors on duty (2 senior interns and usually 2 residents on duty). Every time the OB clerks do an internal exam of the mom in labor, I would forward the updates to my seniors, then finally call them (in panic) when the mother is fully-dilated. Same goes for CS deliveries. I simply update my seniors when the patient has been brought to the delivery room, if the patient is undergoing induction, prepping, draping and cutting. Once the baby is out, my task is to check the time and inform the residents and interns once the 1st minute and 5th minute has past (for the APGAR scoring). I am also tasked to hold the oxygen funnel in front of the newborns mouth as they try to resuscitate it and assess the APGAR score. Unfortunately, I never got to do the suctioning myself. I did, however, get the chance to do cord care, where I sort of do the "second clamping" of the cord after the baby has been weighed, cleaned up and dried.

There are days which are pretty benign, and there are days when my mini group had to catch 6 babies during our 24-hour shift. 6 babies sound few, but to have to do q15, q30, and q1 monitoring one after the other on your own (because only one clerk is allowed inside the nursery, the rest of the clerks on duty do monitoring in the roomed-in babies) is very exhausting! I once had to monitor 9 babies for several hours!

All in all my 15 days at the nursery were good. I'm still in the "adjusting phase," but I'm pretty lucky my first rotation isn't as hard-core as the medicine and neuro rotations (aka "baptism of fire" rotations). I'm lucky to have very understanding senior interns who are very willing to help out (in case I have questions or when I get into trouble).

Currently I'm on my rotation at the pay floors. This time I get to monitor all pediatric patients admitted at the pay wards. On my 1st shift, I monitored only 4 patients: 1 with rheumatic fever, 1 with ALL, 1 with carbuncles, and 1 still undiagnosed, probably a viral exanthem. Pay ward rotations are the most benign of all pedia subrotations. However, compared to my nursery rotation, this has more paperwork ;(

Today I'm on-duty again at the pay wards. For some reason I like being in the nursery more, since the charity patients seem more appreciative for me. Parents of the pay floor patients don't really mind me at all. I get the feeling that they don't take my advice seriously (like please don't throw the diapers after changing because I still have to weigh them).

By May 1st I'll be on my next 15-day rotation at the National Children's Center. I hear clerks like us are "monitoring machines" there, hehe. And we could try blood extraction, IV insertion and even lumbar punctures on patients! (UE does not allow us to to those on pediatric patients)

My day as a clerk doesn't end at 7 am. After 24 hours at the hospital (7 am on duty day until 7 am of the following day), I sign in again at 7 am, this time I would be "from duty" status. As a clerk "from duty," I help out by monitoring with those on duty, but if they don't need much assistance, I could do paperwork OR I could (yay) SLEEP. I only get to go home at 5 pm. YES, THAT'S A TOTAL OF 34 HOURS AT THE HOSPITAL. The following day, I'm on "pre-duty" status, which means I spend the entire day (from 7 am to 5 pm) at the Out-patient department, interviewing patients and doing physical examinations. However, if pre-duties fall on a Saturday when the OPD is closed, we have reportings (and yes, we still go home at 5 pm). If pre-duty is on a Sunday, I still go to the hospital from 8 am-12 noon.

When do I get "days off"?

1. When pre-duty falls on a Sunday, which is (yay) half-day for me
2. When from-duty status falls on a Sunday, for which I also get to go home at 12 noon
3. When pre-duty falls on a holiday (announced), for which I don't have to report at all
4. When from-duty status falls on a holiday, for which I can go home after endorsements

MOST OF THE TIME, I'LL BE AT THE HOSPITAL 7 DAYS A WEEK. O_o

It's all pretty overwhelming to understand, I know. I'm still getting used to the fact that I have no weekends at all. For now I live on the fact that I look forward to Sundays when I'm half-day, or countdown to the next holiday when I'll be on "from duty" or pre-duty status.

I just woke to the sound of somebody watering the plants outside my window. My first thought was my mom's up early again. But then 2 seconds after that I realize they all left for Sorsogon yesterday morning. This sucks.

I had my orientation for my first hospital rotation at the pediatrics department yesterday. I will be spending my first two weeks at the nursery, bonding with those tiny babies...I wish that's all that is involved. We have to "catch" the babies during delivery, get the time from the point of "baby out" to 1st and 2nd APGAR scores, etc etc. I can't remember all the instructions and tips given by the outgoing clerks yesterday. But it's comforting to know that they, too were scared on their first week as junior interns. Though despite that, they stressed DON'T QUIT. They all had to question why they were there in the first place. And there were so many occasions when they went home from duty just crying out of exhaustion. Oh man, I don't know if I'm that tough. I hope I don't give in so easily.

I'm thinking of buying an actual journal again, since I won't be able to be online a lot. I want to document my clerkship year as detailed as I can. They say that 25 years from now on your "Grand Alumni Homecoming," these are the stories you will be telling to each other. They say that 4th year is the best year--the most fun you will ever have. Really now. I hope I can see it that way too.

I'd like to say that my short two-week break before clerkship is action-packed and interesting. Unfortunately, so far I've only managed to tan myself brown to the shade of caldereta; sleep every night before 12 midnight and wake up at 9; spend all 1700 pesos from my freshly "sacrificed" piggy bank on food, booze and gasoline; watch at least 2 movies per day; and catch up on episodes of Gossip Girl, Life Unexpected, Grey's Anatomy, Ugly Betty...

I haven't even gone back to the dorm to clean up my post-exam mess.



It's a Boy/Girl Thing
Saved!
Transamerica (an indie film featuring "transexual" Felicity Huffman and his bisexual son played by Kevin Zegers)
Alice in Wonderland 3D
The Bucket List

The movies I've seen so far. Kevin Zegers is currently my "flavor of the week." Personally I think he should've played the part of Edward Cullen.

I managed to sleep through the last 10 minutes of Alice in Wonderland. Too bad, it was even in 3D. It was just so boriiiiiing. True, it was really pretty and visually stimulating, but I didn't find it as engaging as the other works of Tim Burton. I wish I saw The Hurt Locker instead. I'm still looking for a willing companion to go with me, because apparently no matter how much I convince anyone that it's so good it even won an Oscar, no one wants to go with me.

The downside of having the final two weeks of third year spent on purely exams alone is the lack of time to prepare ahead for any class outings. Hence, when the last day came everyone was just too relieved that the marathon of 18 exams is finally over, that people simply resorted to night outs at the usual inuman place and pass out drunk. As much as I want to go to more out-of-town trips with friends, I couldn't because of lack of preparation (which includes lack of funds). It's just sad because it's our final "long" break before life ends as we know it on April 1st. I should've seen this coming. Now I'm stuck with an overworked router because of round-the-clock downloads and then watching them first thing in the morning in my pajamas, until my mom makes me change by noon. I'm such a slob.

I wasn't even able to buy tickets for Avenue Q ahead of time. UGH. No more loge tickets available!!! /wrists.

Aside from watching TV episodes and movies I still squeeze in a little time for reading. Comics, that is. Right now I'm reading Y the Last Man lent to me by eula_tequila. I'm enjoying it so far. I kinda wish I could start a collection of comics too, but I don't really have an idea where to start. Right now I'm content with borrowing, hehe.

So next week, I still have no plans. From Monday to Wednesday we'll be having our orientation for clerkship (crash course on IV insertion, catheterization, and other procedures). Not really looking forward to that. Reminds me of reality.

Ayoko pa mag-clerkship :((

Since I've done nothing academic this weekend and spent two days roasting myself in the football field for Palarong Med, I thought it should be appropriate that my "come-back" to LJ is about sports.

As many of you know, the 2010 Winter Olympics in Vancouver began a few weeks ago. Now being in a tropical country all my life and never experiencing snow has made me care less about the Winter Olympics. Until I saw Mo Twister's blog entry about Fil-Am short track speed skater, J.R. Celski.



At only 19 years old, J.R. Celski joins Team USA's short track speed skating team, where he has so far won a bronze medal for 1500 m race. Unfortunately, he got disqualified during the 1000 m race semi-finals (since he shook off the Canadian who grabbed his arm and the judges mistook it for a second motion). However, he will still compete in the men's 5000 m relay.

However, 5 months before the Winter Olympics, he sustained a 6 inches wide and 2 inches deep wound on his left thigh after crashing into a wall during the 500 m race for the U.S. Short Track Speed Skating Olympic Trials held last September 8-12, 2009. His right skate sliced his left leg. His injury cost him almost 3 months in rehab.


Look at the tip of his right skate--that dug into his thigh!

Celski's recovery was faster than expected. Six weeks post-injury he was ready to walk without crutches and start skating once again. Now that's what I call motivation! (something I should learn whenever I ditch football practice)

Another fact that's amazing about him is, he's proud to be part Pinoy:


3 stars and the sun tattoo on his chest!

I wish I was that patriotic.

Usually I don't mind all the hype about Valentine's get to me (ok, that was a lie), but yesterday, I couldn't help it but be a wee bit sad.

I hate Facebook, it's all your fault.

Micro-blogging is killing my journal. I haven't made a decent update in weeks! It's hard to admit, but I think I'm starting to outgrow this journal, or I'm just finding excuses to do other things online (like Facebook and YouTube). Or I could be just lazy and starting to lose my command of the language. Sooner or later when I get all too busy to be online, I'll start forgetting how to write essays, and my so-called "literary work" would sound boring as ever. Everyday I'm expanding my arsenal of scientific terms, but at the same time, I'm slowly finding it more and more difficult to do creative writing without sitting through a moment of writer's block. I'm pretty lucky to be able to even squeeze some of my time for drawing, but unfortunately, I haven't done anything new since July. My art materials are shunned in a corner (or several corners, as they might've been carelessly scattered all over my room) gathering dust.

By the end of this semester (which is on October 13), I will officially be half-way through medical school. Yes, I will be officially mid-way through my third year in medschool, half a semester away from being JI (Junior Intern), a year-and-a-half away from my graduation from UERM Medicine class 2011, and two-and-a-half years before I take the board exams. It sounds like a short time away from now, but in the shoes of a medical student, it's more like a lifetime away. Friends of my folks often remark, "Sandali na lang 'yan!" to which I would simply shrug, because, really (for lack of a better phrase) it's easier said than done.

Some of my friends back in high school and college who are already working would tell me how much they miss being in school and how lucky I am to be free from "adult responsibilities." I've grown tired of explaining how medschool isn't anything like college at all, except maybe the fact that you're living on allowance. But everything else--schedules, loads, exams, expectations, classmates, weekends--is an entirely new culture. Impromptu movie dates are a thing of the past, because really, if I could choose to ditch I would spend it on catching up on my sleep backlog.

One of my professors said in a lecture that medical school is like extended adolescence. I guess that's true, being an "adolescent" in my 20's means that I don't pay taxes, I live on allowance, I remain to be a "dependent," and strong rains translate to no classes. But on the downside, this late adolescent phase equates to delayed maturity, delayed independence and delayed freedom to explore other interests without jeopardizing my one responsibility: school. This isn't like college where in failing 3 units would simply mean retaking it at another sem. Being aware of just how your expenses for each school year reach up to six figures (and 4 times that) eats you up every time you think about it. I've (almost) come to terms with the fact that I would finally be able to spend for my 1st trip to Disneyland probably in my late 30's. Maybe I'm exaggerating, but you get what I mean. This profession doesn't happen to be the shortest route to being filthy rich.

So here I am, a few weeks before the half-way mark, counting down to the next week-long break (countdowns usually commence after the end of the previous break), still feeling half-cooked and under prepared, but ironically itching to finish at the same time. Yeah, let's just get this over and done with...what a dramatic path I've chosen to start a career (or technically, prepare for a career since I haven't even started yet). While my friends are already on their own, getting married, starting a family and building up their careers, I remain here, buried under piles of books, making homework as an excuse to miss a girls' night out, and looking forward to coming home on weekends from the dorm. I'm still a kid, I guess, and I will remain to be one for the next couple of years. Don't expect too much from me, world, while I'm on my way there. I'm still baking in the oven.