Today is one of the days to hate being a medical student

I was the receiving end of a OB-GYN resident’s wrath. Okay, I’m over-reacting. But this is just one of the days when you think nothing could go wrong, because you’re pre-duty, and it’s supposed to be a benign day… but you end up having to carry your groupmates’ burden of endorsing a patient and becoming the receiving end of, well, that.

I have been warned. You think you’re okay, you think you’ve done enough, but your good-enough will never be good enough. I get it. I just have to sleep it off. If there’s something I’m proud of about myself, it’s that I have learned to control my tears now. I can tell myself not to cry about things, and I will not cry about things. This just made me feel like crap. It’s like a bad menstrual cramp.

OB-GYN is really fun to study, but the environment is toxic, both work-related and emotionally, so it’s a huge turn-off. I don’t know if I should consider it as a specialization even though it is fun, because it would mean I’d have to go through four years of hell during residency. I just realized surgical fields could be fun, too. Except, I always think about my future family, my future husband and three kids. There are a lot of moments, now that I’m in my clinical rotations, that I thank God my mom isn’t a doctor. I thank God my mom was a housewife. She just really started working when my dad died, which is kinda late for her, because middle-aged women are now enjoying things mom could only dream of. It sucks even more, because she has Facebook, and her other friends have Facebook. But to be honest, I’m thankful for the time she spent with us when we were kids. I don’t mind being generally broke most of the time if it means quality time.

So yes, my train of thought just deviated. I think I’m just gonna eat up all this sadness. Tomorrow’s a Sunday, and duty in a surgical field like OB-GYN on Sundays is usually benign. I’m expecting a lot of downtime tomorrow.

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A mass found on x-ray

Can I just say, I am tired of cancer. My dad’s sister had breast cancer first, then my dad followed. My dad’s sister passed two years before my dad did, in 2014. I don’t want any of it anymore.

So I don’t know how to think or feel when a soft tissue mediastinal/ pulmonary mass was found on my mother’s x-ray. I saw the film. I was hoping it was a lymph node. But it was equal to or more than 3 cm across, located in the right suprahilar area. Chest CT was suggested. I told her to get a lateral x-ray film and consult a pulmonologist first. My mom is asymptomatic. The rest of her blood and urine results were normal. She does not feel anything. Her hypertension is controlled. She doesn’t get sick often. She does not have weight loss. She does not have chronic cough. She is a non-smoker, non-alcoholic-beverage drinker. She does not even have a first- or second-degree relative who has cancer. It couldn’t be cancer.

I’m being selfish when I say this, but I don’t want to have to go through this again. Not for the second time around. I don’t want my grandmother to go through something like this. She doesn’t deserve it. I don’t want to have to walk out the hospital doors with one less loved one. Not again.

I hope I’m overreacting. I haven’t been reacting lately, actually. I’m about to end one of the toughest rotations in the hospital – OB GYN – and it taught me to tell myself to stop crying, or even to stop reacting emotionally. If any, I’ve been rationalizing, just like what I just did. If I would react, and if I’d have to justify in non-medical terms, it would be unfair for my mom to have cancer. She’s been eating like a bird, she’s been avoiding red meat. She’s your typical paranoid mom whose husband died of cancer, avoiding all sorts of cancer-causing food and cancer-causing things like putting cell phones near your face. She does not have vices. I don’t know. It’s just one of the most unjust things that could happen in this world – someone like my mom having cancer.

I don’t really want to dwell on this anymore. I told her not to worry, of course, but I’ve been waking up for the past few days with this looming thought again – what the freaking hell is that solid thing doing in my mom’s mediastinum? What is it? And mom has been asking lately – where do we get the money for diagnosis, and even treatment, if need be? We barely have money to get her a chest CT. It’s been like a heavy weight on my back.

I haven’t been praying lately. I don’t know how to ask the Lord for things anymore, because I believe that whatever happens is not up to me. At most, if I’d ask for anything, it’d be guidance. I don’t know if I should ask for this to be nothing to worry about. I don’t know if it will be answered. I don’t know the purpose of this. All this worrying is bound to make me sick. I’ve only just recovered from what happened with my dad, though not fully. I’ve just learned to stand on my own two feet again. Please don’t kick me back down to the ground.

Down to the last duty

I remember, almost 5 months ago, crying during second day of clerkship. If you must know, clerkship is what we call going on duty for the first time as medical students. We basically enter the hospital as “the lowest forms of mammals.”

I didn’t expect I’d survive… or adapt. Tomorrow, it’s my last duty at the public hospital we’re rotating in for OB. I didn’t expect to actually adapt. By that, I mean not having emotional breakdowns every few days or so. I’d just sleep off the exhaustion until we have to go to work the next day again.

I always thought I was in touch with my emotions. It was one thing I hated about being INFJ. I hate that I always rationalized things depending on how I felt about it. But now, I just rationalized. Period. I try to leave feelings out because it would just mess up my work. Even so, I can’t do it 100% successfully the whole time. Most of my decisions still end up being so because of how I or people feel about it.

So yes, I am about to come out of a battlefield I thought I wouldn’t survive. It turns out all it had to take was time. I just had to let time take its course. I just had to make the decision to not give up.

Don’t trust your doctors

At least, not too much. Doctors are human, even if they think they’re otherwise. I don’t really know what makes them think they’re gods. It could be the fact that they managed to survive 36- to 48-hour work shifts straight without, you know, dying. I’m surprised people’s heads aren’t stuck to the ceiling, what with so much air in them. Seriously, doctors have got to have the biggest egos in the world.

And yet I want to be one of them.

I just find myself being disgusted at a lot of things I’m seeing in the hospital. Patient care is not really the priority most of the time. Most of the time, it’s money. Most of the time, doctors don’t have the time and energy to make the most out of their abilities so that patients won’t have to shell out more than necessary. Doctors act from what they know. Nothing’s new to them. Nothing should be new to them, if they’re gonna live up to their “expert” reputation. Otherwise, patients would be better of seeking consult from other “more experienced” doctors. In comes pride.

This is why when I encounter seniors – such as senior interns, residents, or consultants – who are down-to-earth, I treasure them and I keep their names in my heart. You find jewels like them rarely in a hospital. Hey, ever “hostile” and “hospital” don’t sound so different, do they? Some of my seniors don’t mind doing the work we, vermin, are supposed to do. I think it’s the best marker of humane. It’s the best marker of the beautiful soul – being in such a hostile environment and coming out unchanged. I guess this is where you should immerse your future life partner in, to expose his or her true colors underneath the rainbow.

Even I discovered there were things I would do, thoughts I would think. I never thought I could cross some lines. But I already forgave myself for doing so. Unfortunately, I am still making excuses for myself. However, if there’s something I’m proud of, it’s that I still won’t be trampling on people just so I could be first to the ladder. At the end of the day, respect is still paramount, no matter how much you think people don’t deserve it. They do. They always do.

“Hard” is subjective. Usually, it involves the beginning. It involves the unknown. But familiarity tends to dissolve “hard.” I guess this is why they call it “practice medicine.” Because it’s never gonna be perfect. We will always have to greet the unknown every time a new patient comes in. And when we rest on our laurels and settle with familiarity, that is when “hard” makes its comeback.

Don’t settle.

I always thought I loved medicine. I guess I do. But there are a lot of things around it which I don’t. If I had a kid and he wanted to become a doctor, it would break my heart to think about all the sacrifices he’d have to make. No one would want their kid to suffer like this. Getting no sleep for 24 hours straight is not meant for humans. Doctors are humans. One would be stupid to assume otherwise. Familiarity can build a shell, but shells are still fragile.

To break away from familiarity, one must always be on an adventure. The white-washed hospital walls seem too bleak to be called an adventure. But really, the adventure is in every patient’s story, every patient’s heart. They came to the hospital for one thing. They would only have one concern at a time. Doctors should really keep reminding patients that all their efforts are for that one concern. Otherwise, you’d call it “treating,” not “healing.”

It’s time to delight in my weaknesses

Because it means it’s also time to receive grace.

These weaknesses are not something I’d be truly proud of. It’d make me disappointed at myself. It’d make me look like I’m contradicting my faith. It’d make me look like a hypocrite, not practicing what I ought to preach. But I already committed these mistakes, and there’s nothing left but to ask for forgiveness, and for wisdom to deal with the situation better the next time it happens.

I’m currently rotating in OB, in a public hospital in the Philippines, and it hasn’t been easy. It would be a lot easier, though, if my duty-mates from the other school were not lazy. Unfortunately, they are. Even more unfortunately, the two of them were grouped together, always, because no one in their school wanted to be duty-mates with them. We’ve been working for 24-hour shifts straight, while these two girls have been disappearing off the face of the earth, napping or resting in who-knows-where, while residents berate us for not getting the job done. In my mind, I know we could’ve completed the tasks, if we just had a helping hand. All of us would be able to rest if all of us were working. Sadly, that’s not the case.

And then I and the rest of my duty-mates spent time being angry at them instead of confronting them. When we confronted them, they came up with excuses. One of the excuses was that one of them was pregnant, which I think is true, but then, there are residents who are pregnant who still go on duty. There is never a valid excuse for laziness.

So I’m not proud of how I reacted because there were moments when I was ready to go on full beast mode, especially that one time when I found one of them just sitting idly in the dressing room, staring at a blank wall, just moments after I was reprimanded for not heeding a patient’s concern because I was swamped with other tasks. I did not react like how Jesus would.

It took a long while to calm me down. It took days to make me realize I should not respond with anger. But I realized I didn’t have to feel guilty anymore. These are the moments when I shouldn’t shy away from God’s forgiveness and grace. I should always just approach Him, because He knows how to deal with the situation in the best way. I realized He should always be praised, and I should always praise Him, because He would always have the power, the power to forgive someone like me; the power to forgive even the worst of sins. I then asked for the strength and wisdom to deal with the situation better the next time it comes around… because October is not over yet. These times, it’s difficult to speak blessings about others, so I guess I should just shut up if nothing good will come out of my mouth. It would be better for me to shut up if all I will do is rant to a friend about them, rather than confront them about it (even though I already tried doing that, and it resulted to nothing good). Let me end with a verse my mom told me about as I was ranting to her through text messages:

“Do not plot evil against each other, and do not love to swear falsely. I hate all this,” declares the Lord. – Zechariah 8: 17

And another one:

“Therefore encourage one another and build each other up, just as in fact you are doing.” – 1 Thessalonians 5: 11

I greeted my birthday

at 12 midnight inserting a Foley catheter on a pregnant woman. The only reason I was excited about my birthday was because I wanted to find out what I would be doing the moment 12 midnight strikes. I thought I was gonna be in the OR, assisting in a Cesarean section or an abdominal surgery, but no. I was peeking through a woman’s external genitalia, trying to find a urethra. It was then that I was thankful I was born at 2:05 PM on October 6, 24 years ago, so it’s not exactly 12 midnight that I turn 24. Maybe that’s just me being defensive.

I forgot to include feelings as I processed the fact that it is my birthday, and I spent the first few hours of it in the hospital, without sleep for 24 hours. I even forgot to be stressed about some things, because there are a lot more things to worry about. In the public hospital, they never run out of pregnant patients. And they’re not just pregnant. They could be 14 years old with two previous pregnancies. Or 40 years old with six previous pregnancies. It could be a 19-year-old who has a dead baby in her uterus, which she lied about. It could be a patient who has Type 1 diabetes mellitus, whose baby probably has structural abnormalities.

Therefore, a day in the hospital is exactly how the night looks like. Except… at 4 in the morning, you’re practically dragging yourself towards 7 AM, the time you’d be off work. I realized I forgot that it was my birthday when I forgot for a few moments what date to put in the lab request forms. I forgot to be stressed out about the fact that I let my phone go swimming in a pail of water which was previously used to catch blood, vaginal fluids, and placenta. I had my mom pick my phone up so she could place it in a sack of rice grains. It worked – my phone had been resurrected and did not need replacement.

I guess if we’re gonna talk about birthday wishes, what I would really want deep in my heart is for my relationship with God to be resurrected, too. It’s been busy with work, but when I’m not at work, I’ve been distracted by a lot of things. I don’t know what quiet time feels like anymore, because any stimulus makes me feel like I have to run off to follow orders. Med school does that to you. Then again, I don’t want my relationship with God to be based on feelings, and I don’t want it to be present only when I need Him, especially in times of trouble. I appreciate His presence in my life, and even though life is still the same – technically hard and still full of struggles, every day – I know He is there. He’s been guiding me, and when I say that, I don’t mean He is whispering to me, literally, what to do. I am not perfect and I still do things I regret, but I know that when I follow Him even though I don’t want to, during those moments, I am awestruck by His presence in my life.

INFJ

I haven’t experienced anything like this. When we said 36-hour hospital duties back then, we were allowed around 1-2 hours of nap if we’re lucky. But in a public hospital in the Philippines, this is not possible. I just came home from a 24-hour duty, and when I say 24-hour duty, I mean 24 hours. For real.

As a slave, I’m called left and right to do IV insertions, foley catheter insertions, blood extractions, and skin test readings. I’m lucky to have cheated a 15-minute nap, only to be awoken by the ring of the phone of the nurse’s desk, calling the “OB intern,” me, to do all these things related to body fluids. Not to mention, I already have “baseline duties,” which is to take all vital signs of all patients in the ward I’m in. Some of them are due every 4 hours, some every 2 hours, some every hour, especially those mothers-to-be in labor. Patients also come in every so often to get their cardiotocography scans done. Oh, and you’re expected to assist in the OR when a patient gives birth.

Not to mention, when you say public hospitals in the Philippines, it means you have to maximize everything you have. They have three patients per bed, and that doesn’t include the babies yet. The beds are lined against one another along the hallway or in a giant room. That serves as the wards or the “hospital room.” It’s not uncommon for patients to have Hepatitis B, HIV, syphilis, cervical cancer, gonorrhea, chlamydia, or any other STD you can think of, but you start to get a bit more cautious when you realize you’ve been toying with their body fluids… and you’re a newbie. So you’re no expert either with needles, and blood, and catheters. You practically use only one set of gloves for blood extraction, and another set for inserting foley catheters.

F-U-N.

It actually is fun if you don’t think about the exhaustion associated with it. If you concentrate on the learning, and how much of a humbling experience it is, it is fun. You get to touch the lives of patients, because almost everyone in the hospital is nasty to them. You can prove to yourself that you don’t have to be as nasty to get things done. Although… I am tempted to lash out at patients who are practically my age and have had four pregnancies, with no means to support their family. Either way, it’s part of the system, which you have no power to radically change. The only way you can contribute right now is by educating these patients.

Moreover, you’re inspired to study more so that you can help manage patients more efficiently. Our seniors don’t expect us to just be the vitals bitch, or the extraction bitch. If we have good input based on our patients, these will be much appreciated and helpful. So I guess I have to study instead of fan-girling all the time, because I know it’ll help someone, and because it’ll also help me appreciate OB more and get the best out of my learning, even though most are dreading OB as a rotation, and I’m not really inclined to be in any surgical field in the future.

As an INFJ, I find it really hard to deal with being an introvert who is feeling-oriented. I consider it a hindrance in times like these, because my emotions can get the best of what I can expect from myself. I can’t help but react with emotions to things around me, which is why I am prone to getting a breakdown in the middle of things. But it’s funny, because I can also convince myself not to cry. I already told myself I would cry just once during clerkship, which I already did. I wish I can concentrate on work, and I wish I can tell myself that I have to get things done, and put these things first before my emotions.

I consider it a huge milestone to have survived the first duty. It’s just a matter of time