Auld Lang Syne: A Look Back

I am reposting an experience I had several years back. Original piece published December 2013.

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I was on-call that New Year’s Eve. As I remember it, even though it was the holiday season and no patient wants to be in the hospital, it was still very busy for us.

It was a time of a bad flu season and our ICU was full. In fact there was even a pandemic that year of a bad strain of influenza A, the H1N1, or otherwise known as “swine flu,” and we had confirmed cases in our hospital. The hog farmers here in Iowa detest the name “swine flu,” as it was detrimental to their trade.

Despite of my toxic duty, I was able to finish my rounds and saw all our hospital patients for the day (took me 12 hours or so), and made it just in time to a gathering of some Filipino friends for the New Year’s party.

I was only warming up with our friends when I was called for a “stat” consult that I have to see right away. Before I left, my friends told me that if I finish the consult and it was still before midnight, then I should come back to the party. It was around 10 o’clock when I drove back to the hospital.

The patient that I came back for was a woman in her 40’s. She had breast cancer and sad to say, despite all the surgery, radiation, and chemotherapy that she underwent, the cancer had spread to the lungs and pleura (covering of the lungs).

The patient was obviously struggling to breathe when I examined her. The chest x-ray that was done that night, which was requested by the oncologist showed hydropneumothorax. That means there was collection of fluid and air in the space surrounding the lungs. And that was the reason I was consulted, to surgically place an additional chest tube (as she already had one in place) to drain the fluid and air.

After reviewing the chest film and comparing it to the previous chest x-rays, I determined that the finding of hydropneumothorax was old. In fact the chest x-ray was unchanged compared to films from few weeks ago.

That meant that the worsening of the patient’s respiratory status was not from the collection of air and fluid primarily. Placing another chest tube would not matter as the lung was trapped and would not expand further. I surmised that her further deterioration was from the advancing cancer itself.

Maybe the patient and her family was hoping against hope that there was still something that can be done. Maybe they were grasping for straws for a possibility that she could see another New Year.

I explained my findings and I then solemnly, but respectfully told them that in my viewpoint, placing another chest tube would not matter, and that would not relieve her breathing difficulty.

Right after hearing my opinion, that was when the patient and her husband made the somber decision that it was time. Time to end it all. Time to let go. Time to transition to comfort measures only. It was time for her to rest.

The patient’s husband went out briefly, maybe to talk with other family members who were outside the room. When he came back, I bid them goodbye and left.

As I went out of the room I saw two girls, both were probably not older than 12 years of age. They were crying, while an older woman was comforting them. I assumed those young girls were the patient’s daughters. I think it would be safe to say that they were not having a “happy” new year’s eve.

I looked at my watch. It was less than an hour to midnight.

By that time the rest of the world was partying while waiting for some fancy ball to drop. At that time most people were celebrating while waiting to welcome the New Year, while another family was also waiting – waiting for suffering to end. Waiting not to welcome, but to say their final goodbyes.

I did not go back to the party. I went straight home to reflect, while the song Auld Lang Syne (translated as Times Gone By) echoed in my head.

Should old acquaintance be forgot,
And never thought upon;
The flames of love extinguished,
And fully past and gone:
Is thy sweet heart now grown so cold,
That loving breast of thine;
That thou canst never once reflect
On auld lang syne.

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Post Note:

For us who will be welcoming another new year, may we face it with hope and optimism, and embrace with reverence this precious life we are given.

(*Auld Lang Syne is traditionally sang to celebrate New Year at the stroke of midnight, but it is also sang in graduations and funerals; photo taken at Musée d’ Orsay.)

Electric Outlet Plugs and Precious Memories

I am taking a break from studying. I took two re-certification exams from American Board of Internal Medicine for different subspecialties this year. One in May and another this November. Next up is for another subspecialty, but it’s not until September next year. So I’ll chill out for now.

Because of the preparation I did for the boards, I have spent a lot of time reading and studying. I chose to review in my daughter’s room. Since my daughter is in college now and her room was empty, I took residence there and used her study table which is near the window. It was nice and quiet there plus it has a great view of the outside.

I also downloaded my favorite music for studying in Spotify and had it playing while I was reviewing. My go-to music when I’m studying is Jim Chappell’s. I discovered him back in the early 1990’s when I was preparing for my Philippine Medical Boards. His music is calming and perfect for quiet reflection. It puts me in a right mood too, I guess.

As I was studying in my daughter’s room, I was surrounded by her articles and effects – the stuff toys she had in one corner, the favorite books she read in the book case, the medals and trophies in the shelf, and other sort of things. Lots of memories tied to all of these items.

Then I noticed that some of the electric outlets in her room still has the plastic plug covers. We child-proofed our home and placed these outlet plugs when we moved into this house years ago. She was still a little girl at that time. Obviously we place those covers to protect her from being electrocuted in case she stuck her little fingers on those electric outlets.

But time has passed so quickly it seems that she has grown up and we have not noticed that she don’t need those outlet plug covers anymore. She probably left some outlets covered as she did not need them anyway. The wallpaper in her room may also require some updating as it was from the original owner of the house. But my daughter said she liked them, so we let it be.

I took out the plastic outlet plugs now for there were no use for them anymore. Besides I have to plug my laptop, my phone, and my portable speaker near her study table.

My daughter will be finishing college this year with a degree in Music. In fact, a few nights ago we attended her cello solo recital at the university. In a few months she’ll be performing in her final senior piano recital which will be a bigger event, since piano is her major.

It seems not too long ago that she was sticking her fingers in the peanut butter jar, playing dirt and picking dandelions in our yard. Today, those beloved beautiful fingers are electrifying musical instruments. We are glad we protected them from harm, including injury from electric outlets.

Below is a photo of my daughter during her recent cello recital. She was accompanied by her piano professor.

It is kind of funny that even the simplest of things like an outlet plug cover will evoke such precious memories. Or maybe it was the music that I was listening to that made me.

Alright, I’ll blame it all on the music.

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Here’s Jim Chappell’s song, “Precious Memories.” (video from Youtube)

He Checked Out

It is a lonely world out there.

Yes, we have this modern technology of all the world being connected and wired through broadband networks, internet, Wi-Fi, and all platforms of social media, and yet the proportion of the population suffering from loneliness and depression is on the rise at a rate that we have never seen before.

A couple of weeks ago, a man suffering from Parkinson’s disease presented to the hospital for progressive weakness and failure to thrive. He needed to be placed on a non-invasive ventilator (BiPAP) for respiratory failure. He was admitted to the ICU by my partner the night before.

I went to see the patient the next morning. Before going in to the patient’s room the nurse at the station made a comment to me, “I think he just has no more will to live.”

I examined the patient and I spoke to him. Despite him on the BiPAP mask, he was still able to communicate. After learning more about him, he expressed to me that he wanted to be DNR (Do Not Resuscitate), meaning, to let him go peacefully if his heart stops.

I learned from the patient too that his wife passed away recently. He also had a son that lives in the area but he did not want him contacted. His next of kin that he put on record was his church pastor.

I tried to get him off the non-invasive ventilator but his oxygen saturation dropped so we had to place him back on it. But I told him that we could take him off the BiPAP mask briefly to let him eat, however he said that he had no appetite.

After our initial work-up, his condition was still a conundrum. He was not in congestive heart failure. He had no apparent pneumonia. He had no viral or bacterial infection. He was just unwell.

I think the nurse’s assessment was spot on. The patient simply gave up on living.

That night, a little past midnight, my phone rang. It was one of the ICU nurse telling me that our patient went bradycardic (low heart rate) and then went into PEA (pulseless electrical activity). The nurse commented, “He checked out.” He gave up the ghost and died.

The saddest part as I learned later, was that there were no friends nor family that visited him. There was nobody around, except for our hospital staff, when he died.

I don’t really know what was the story behind this patient. What I know is that he was lonely and that he did not care to live anymore. What if somebody was there for him? Could it have made a difference?

Please take time to show people, specially our loved ones that we care.

(*photo taken from here)

A Warm Lunch

I have been back to work this week after a brief break when I went to California to visit my aunt.

(photo taken when we drove to the airport to fly back home)

I have been seeing patients all day in the hospital for the past few days and it has been hectic. We have already seen the first case of the flu admitted in our hospital this season and we are bracing for a more brutal time ahead as the wintry air have started to blow.

I don’t like to bash hospital food, but if I have a chance to eat somewhere else besides the hospital cafeteria, I would do so. I wish there is something like the Manila Sunset Grille (see previous post) in the hospital grounds for that would be bliss.

But I have a busy schedule, and going out of the hospital to get lunch is much of a hassle plus I don’t have much time to spare. So regularly I just go to the hospital cafeteria to grab something to eat just to avoid hypoglycemia. I don’t care if it tastes like cardboard as long as the food is edible. Usually I would inhale my food and then continue my hospital rounds.

Yesterday I was in the hospital cafeteria to get lunch. It was still not that bad as I still had time for lunch for there were rare times that I don’t. The lines were long when I went there. As I head down to the cashier, I was getting impatient as the line was not moving as fast as I wanted. In front of me was an old frail lady who moves gingerly slow. She was taking a longer time as she dug deeply into her purse. It was like watching the character of the sloth who moves in slow-motion in the Disney movie Zootopia.

After the old lady handed her money to the cashier which felt like an eternity to me, she took a look at me. I was wearing my white doctor’s lab coat with my to-go box on one hand and a bottle of water on the other. Then the old lady softly told the cashier that she wanted to pay for my food, as she appreciates people who works in the hospital.

I felt like ice-cold water was poured on the fiery coals on my head. I was having unpleasant mood and yet this lady showed me goodness. Shame on me!

Since I knew the cashier as I am a regular in the cafeteria, I told her not to let the lady pay for my meal. I thanked the lady though but politely declined her offer. I told her that I should be the one paying for her meal, and that I really appreciate her gesture.

Yes, there is still goodness in this world. This old lady made me believe again in human kindness.

I still quickly gulped down my food. But I leisurely savor the warm affection I was served.

Rx: Sleep

This year is quite hectic for me. Besides the load at work and other responsibilities, I also have to renew 2 of my 3 board certifications. That means I have to study and pass my board exams to keep my certifications.

The governing bodies of Medicine wants all the practicing physicians to be updated and competent in their field of expertise. After all the discipline of science and medicine is ever evolving and what may be true some years ago, may not be applicable today. That’s why doctors have to take regular scheduled exams to maintain their qualifications.

Most of the medical specialties need re-certifications every 7 to 10 years. But now, they are introducing an option of taking the test every 2 or 3 years. More frequent test, oh fun!

The first exam I had to re-certify for this year is for my Pulmonary boards. I am relieved to say that it is past and done. I took my re-certification exam last May, and for 4 months before the boards, I devoted at least 30 minutes a day for review. It must have been worth the efforts for I’m proud to say that I passed it. I’m good for another few years on this sub-specialty.

The next exam to tackle is this coming November. It is for my Sleep Medicine boards.

I took a break in studying the month of June. But this July I’m back to the books again. I’m allotting half an hour (or more) every day for study.

Come to think of it, this might eat up some of my time for training for the annual half-marathon that I do in October. Should I just skip the half-marathon this year? Though I think I should still do my regular 2 to 3-mile run to keep me from getting too flabby.

Should I take a break from blogging too? Nah! Blogging is actually my relaxation.

I was on 24-hour duty the other day, and it was a busy call. It was not until 2 o’clock in the morning that I went to bed in our hospital call room, only to be called several more times during the remainder of the night, or should I say early morning. One particular ICU patient that I admitted around midnight was so sick, that he died 6 hours later despite our best efforts to keep him alive.

By the way, my other sub-specialty is Critical Care (ICU Medicine) and my Critical Care boards re-certification is due next year. That means I will be studying again for next year. Who said you’re done taking test after you graduate from school?

Anyway, I was off the next day after my 24-hour call. I decided to do some “light” reading to prepare for my Sleep Boards. My brain may be half-awake, but I was resolute to stick to my schedule. But do you know that according to research, dolphins can have half of their brain asleep while the other half awake? Maybe I was trying to be a dolphin.

It so happened that when I opened my reviewer, the chapter I was about to read was about sleep deprivation and its ill effects on our health. Wasn’t it so ironic? I was studying about the bad effects of sleep deprivation, and I myself was sleep deprived!

I stopped reading. I put down the book and did the best thing. I went to sleep.

(*photo from the web)

An ICU Love Story: A Reload

I have posted more than 850 articles and stories over the years since this blog’s inception, which in a few months, will be 10 years. It’s quite a popular practice in the media to have reruns or replays. Even social media have their “throwbacks.”

I would like to repost a throwback story/article once in a while, not that I am running out of ideas or stories, for as a matter of fact, I have more than 30 unfinished articles in my draft bin. But sometimes, I just want to relive a bygone moment, or perhaps give a new breath to a favorite story from the past.

Here’s a reload of a love story that I witnessed a few years ago:

Making Things Right

“I just want to make things right.”

That was what my patient told me. Wanting to make things right. Don’t we all? Here is his story.

He was in his 50’s, and he presented to the hospital with leg swelling and worsening shortness of breath. After initial work-up in the Emergency Room, he was diagnosed with blood clots in the legs and lungs (veno-thromboembolism). A serious condition.

His chest CT scan also showed a lung mass. After further work-up, which includes a biopsy, it was found to be cancer. Cancer in itself is a risk for developing blood clots. A bad prognosis.

After more work-up, it was determined that the lung cancer was far advanced. It has spread to the bones, liver, and lymph nodes. A grim outlook.

During his hospital stay, his condition deteriorated and was transferred to the ICU.

I approached him as he lay in his ICU bed. Knowing the severity of his condition, I asked him about his “code status.” That is, what he wants us to do if in case he cannot breathe on his own, does he wants us to place a tube down his throat and have a machine breathe for him? Or if his heart stops, does he wants us to shock his heart or pound on his chest to try to resuscitate him? Or does he wants us to just let him go peacefully?

There was a long pause before he replied, as he breathed heavily under the oxygen mask. “I want everything done,” he finally answered. “I want everything done, until I have done one thing. I want to get married.”

Get married? Did I hear him right? Was he of a sound mind or was he confused and hallucinating?

As he continued talking, I ascertained that he was very alert and not confused at all. I did not ask why he wanted to get married, but he explained to me the reason why. Perhaps he saw the quizzical look on my face.

“I just want to make things right,” was his reason. Apparently, he was living-in with his girlfriend for twelve long years. He wanted to make their union legal. This would make her girlfriend the legal decision-maker for him if he becomes incompetent. And she would also inherit his estate without questions, when he dies. But more so, he just wanted to show her how he loved her over the years, but did not quite made it to the altar. Now, he was “making things right.”

Two days later, there was a wedding ceremony in our ICU room. A bride, a groom, a chaplain, and a couple of witnesses. That was all you need for a wedding. Of course there was a gown too. But it was the groom who wore it, for I’m not pertaining to a wedding gown, but rather a patient’s hospital gown.

There was many well-wishers too, courtesy of the ICU staff.

The patient’s son was also present. I believe he was his son from a previous relationship, and he came from out-of-state to visit his very ill father. He was probably expecting to attend a funeral, but was surprised that he was attending a wedding instead.

A few days after the wedding, our patient’s condition improved that he was able to be transferred out of the ICU to the Oncology floor. Perhaps, getting married gave him hope and a different outlook in life, and willed himself to get better.

He was started on combined regimen of radiation therapy and chemotherapy. Hope springs eternal.

Two weeks later, his condition started to decline once more. He grew weaker and weaker. His respirations became more and more labored. This time, he told us, he does not want to be resuscitated if his heart stops or if he cannot breathe on his own. I guess, he already accomplished his one wish, and now he was ready.

Then one day, he quietly faded away at the break of dawn. And he left a newly wed bride, a widow.

Cancer stumps hope. A so familiar refrain, sadly to say.

Yet love conquers all.

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(*This story was originally published in July of 2011; featured photo was taken a few weeks ago.)

Unburdened

It has been rough going for us in the past few weeks. Our work group is limping with regards to our coverage of clinic duties and hospital calls.

One partner is on maternal leave. There were sickness in our ranks as well for two of my partners went down with flu at the same time and they were incapacitated for a day or so, and we scrambled to cover for them. Then another partner underwent surgery and have limitations on doing procedures that we have to switch around our rotations. And with recent spring break season, there’s always one of us that is out of town for a vacation that has long been scheduled.

But life goes on and we managed.

I am in-charge of the ICU for almost two weeks now. It is awfully busy and I am in a lot of stress to say the least. My wife have noted that I’m in a foul mood in the past few days. Perhaps I’m becoming a grumpy old man. Or perhaps it’s male menopause, if that’s even a thing. I still blog though, partly to de-stress.

Then a couple of days ago I received an e-mail from our group’s Risk Manager forwarding a letter from the hospital’s Guest Relations Office.

When the hospital’s Guest Relations Office is involved, it is mostly to pacify disgruntled patients and families and to hear their grievances. And when Risk Management contacts a doctor, that’s not a good sign, as most of the time it means a patient is complaining or worse yet, filing a lawsuit.

This is at the heels of a recent local news of a patient that sued a doctor and the jury awarded the complainant several million of dollars for damages. The compensation was so steep that most medical doctors could not earn that amount of money even in their whole lifetime. As a physician it bring shivers down my spine. I am not saying that the doctor in that case is not at fault, but this is just the reality of the world we lived in.

The e-mail I received said that the call came from the family of a patient that I took care in the ICU. It was an elderly woman who became severely ill and died under my care. She was one among the recent strings of our hospital fatalities.

I am already under a lot of pressure from the ICU’s workload and I don’t need any more bad news or added stress.

But as I continue to read the letter, my yoke was suddenly lightened. In fact my burden was lifted and turned into joy.

The letter said that the patient’s daughter reached out to the hospital’s Guest Relations Office and recommended that her experience be forwarded to the appropriate leadership body. And it named me specifically.

What the patient’s daughter wanted was that me and two of my residents “be recognized for our hospitality, warmth, and kindness.” She shared, “they were wonderful in explaining my mother’s circumstances. I cannot even find the right words to express what they did for me. It was so heart-warming.”

God knew I badly needed some encouragement. And I am so grateful He provided me one.

(*photo from the web)

More than Tylenol

It was the height of flu season. I was working that weekend, and I was in the hospital for 36 hours straight. We had several patients in the hospital that had complications from the flu. There were five on ventilators due to respiratory failure from Influenza A in our ICU. Two of them were on ECMO.

ECMO is short for extracorporeal membrane oxygen or also known as ECLS, extracorporeal life support. It is an intervention to provide adequate amount of gas exchange or perfusion in patients whose heart and lungs have failed to sustain life. It is done by placing a large bore catheter in the patient’s central vein or artery, where the blood was sucked out from the body, then ran through a machine to bathe it with oxygen, then flow it back to the body.

Saturday morning, I got a call from another hospital for a woman in her 40’s who had Influenza A and who was rapidly deteriorating. She went into respiratory failure and was placed on ventilator. They want to transfer her to our hospital for possible ECMO.

We rarely have two ECMO patients at the same time in our ICU. Even one patient on ECMO makes us busy, so two was really demanding. But a third one at the same time? That never happened before.

I made some phone calls to verify if we have a machine for a third patient and if we have enough resources and staff to handle a third ECMO. After confirming, I was given the green light to accept the patient.

Additional ICU and ECMO staff were called to come in. I called the interventional cardiologist-on-duty who would assist us to put the Avalon catheter, a dual-lumen catheter half as big as a garden hose that goes from the jugular vein and through the heart. The cardiologist in turn called the cath lab to prepare for the arrival of this patient.

Avalon catheter in correct position (image from web)

The patient was flown in via helicopter to our hospital and went straight to the cath lab where me, my ICU and ECMO team, as well as the cardiologist and his cath lab team were waiting.

We were ready for the challenge and eager to make it happen.

While we were doing all this, our patient’s oxygen saturation was only in the 70-80% (below 90% is perilous) despite maximum ventilator support, so we knew we needed to work fast.

However problem struck. Working for more than an hour, we had difficulty placing the Avalon catheter in good position. We tried different approaches with different instruments, but cannot get the ECMO flow going.

I called my other partners over the phone and I probably disturbed their quiet Saturday afternoon off, but I needed some opinion of what else we could do.

After deliberation, we decided that we cannot sustain this patient on ECMO. Perhaps it was her vascular anatomy, or perhaps there was a big clot in her vein. Whatever the reason, we could not proceed.

I went out to the cath lab’s waiting room, and gave the sad news to the patient’s family that we couldn’t do the ECMO. All I could say was that we tried and gave our best, but it was unsuccessful.

I felt that we betrayed this patient and her family. After I thought I moved heaven and earth to get this patient to our hospital, only to end up like this was really deflating.

The worse part was, I knew that without ECMO, this patient had little to no chance of surviving and possibly could be dead in a few hours.

We transferred the patient to the ICU, but we left the big neck catheter in place even though it was not hooked to the machine. We have to wait for the heparin (anticoagualant) we gave when we attempted to start the ECMO, to wear off before we can pull the catheter out.

After about half an hour in the ICU, I was informed that the blood test showed that the heparin had worn off and I can remove the catheter with less risk of bleeding.

When I pulled the Avalon catheter out, I applied direct pressure in the patient’s neck to control the bleeding. I did this for 30 minutes. I was alone in the room with the patient most of that time, with the nurse intermittently coming in and out of the room to adjust the IV pumps or to check on the patient.

All along while I was holding pressure, I was watching the monitor which showed that the patient’s oxygen saturation was staying in the low 80%. I thought death was imminent.

During the time when I was alone with the patient, I felt helpless and defeated. I failed her. We failed her.

Then a thought came to me: I don’t save lives. It was not up to me. Only a higher power determines who will live or die. That’s when I fervently prayed.

With my hands on the patient’s jugular holding pressure, I turned my thoughts to heaven: “God I am nothing, but an instrument of Your healing hand. I failed. But You never fail. I don’t know this patient personally, but I am personally praying for her. Please heal her in my behalf, and let me witness Your awesome power. Amen.”

How many times have we prayed for a sick loved one? But do we really believe God would heal them? Do we add the phrase, “if it is Thy will,” so we wouldn’t get disappointed?

As a doctor, sometimes, I put more faith to the medical intervention than God’s healing. Like when I was bedridden earlier this year due to a bad viral infection, it seemed I had more faith in the Tylenol that I took than in God to take away my fever.

After 30 minutes of holding pressure the bleeding stopped. I left the room and went to see other patients, especially the new ICU admission, a young man in his 20’s who had a bad asthma attack, so bad we had to place him on a ventilator.

As I was busy attending to other patients, I was just waiting to be called back to that particular patient if she goes to cardiac arrest or expires.

More than an hour later, I went back to the room of our failed ECMO patient. I looked at the monitor and her oxygen saturation was 100%. I was amazed! The respiratory therapist told me that she even titrated down the oxygen level on the ventilator to almost half as the patient was really doing good.

I had no other explanation but one: God heard my prayer.

I went down to my call room to be alone. With tears welling in my eyes, I uttered a prayer of thanks. Never would I doubt the power of God again.

He healed my unbelief.

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Mark 9: 23 -24: Jesus said to him, “If you can believe, all things are possible to him who believes.” Immediately the father of the child cried out and said with tears, “Lord, I believe; help my unbelief!”

*Post Note: Our failed ECMO patient survived. She even did better than the two patients we had on ECMO.

Calendar Boys

I was rounding in the hospital with my team when we came to a room of one of our patients. The patient was a frail woman in her 70’s, who had significant lung disease and was oxygen dependent. She had improved on this hospitalization and we were discharging her home.

When we were heading out of the door, I overheard the patient told one of my team members, “I want a copy of that calendar.”

I have no idea what they were talking about, and not trying to be nosy or maybe little bit, I asked my resident, “What calendar was the patient talking about?” Since it is a new year, perhaps the hospital is giving away new 2019 calendars, I thought.

Then my medical resident sheepishly smiled and told me the whole scoop.

I learned that this patient thought that our team was “hot” and she was calling us the “Dream Team.” I have been in this teaching hospital for 15 years and have rounded with hundreds of medical students and residents that came and went, but I have never heard my team referred as such before. Or maybe it was, but I was just not aware of it.

So this particular patient, the elderly woman, suggested as a jest to my resident, that “we,” or my team should put out a calendar featuring our team members as models. Whether it’s a white lab gown edition or dress suit edition or a swimwear edition of this calendar they were thinking about, I dared not ask!

I then looked at my current team, and agreed that the old lady had a point. My team appears “hot.”

One of my new resident is a blue-eyed gentleman of English decent, clean-cut and handsome. Now that I think about it, he really looked like a much younger version of the actor Mark Harmon.

The other new resident is a young good-looking French guy with well-trimmed mustache and beard, with hair slickly combed back. He always dress very neatly too.

And then there’s the attractive and muscular Asian hunk of a guy. But before you think I was referring to myself as the Asian hunk, I was not. I was talking about the 4th year medical student I have on my team.

Of course I don’t consider myself as chopped liver. I can definitely hold my own. I deserve to be in that calendar too!

We have women medical residents and students as well in this hospital but it just so happened that this month’s rotation, I have all male house staffs.

But seriously, I never consider much the appearance of my residents. When I evaluate them during their rotation in our service, it is mostly based on their performance, their knowledge, their willingness to learn, and their emphathy to our patients. But of course we don’t want them to appear like hoboes or dress like gangsters. They need to look professional too.

I understand that our patients get well mostly due to our comprehensive care stemming from our intelligent decisions, skillful procedures and emphatetic support. But if our good looks help them heal faster, then I am fine with that too.

Would I put out a calendar featuring my team? Don’t count on it.

(photo is from the show Grey’s Anatomy)

A Battle Within

There is a raging war inside of me. The resulting blaze and smoke of this battle is evident while I am shaking and crouching under my blanket.

It all started a few days ago when the enemy gained unwelcome entrance to my domain. Perhaps these intruders escaped from another territory by a sneeze in which they could travel up to 20 feet at 100 miles per hour, and they usually travel as a mob with 40,000 others of their gang.

They got a foothold on my borders through my nasal and airway passageways. It’s really difficult to close all the entryways unless I quit breathing all together. The invaders then broke through my barriers and overwhelmed my sentinels. I should build a border wall and have Mexico pay for it. Hah!

As soon as there was a breach in my initial defenses, my border guards alerted the headquarters and radioed for back-up. They have identified these infiltrators and relayed their profile to the central intelligence.

The headquarters searched the database if I have a pre-fabricated artillery specific for this certain enemy. But lo and behold this “common” enemy is not so common after all, as it probably continues to change its appearance and structure to outwit my defenses. So my system staged an all out war to fight this common cold.

The first to arrive into the battle field are the big boys, called the macrophages. They are the biggest soldiers among my army of white blood cells. These big boys are like Pacmans as they hunt and engulf these viral invaders.

a macrophage in action (image from the web)

But the enemy has hijacked some of my manufacturing plants. They infused their DNA into my own cells and they are replicating themselves using my own factories and resources. The Pacmans cannot eat them all as they are too many now and they continue to multiply. Good thing my defenses have more tricks under their sleeves.

As soon as the macrophages got an exact profile from the captured intruders they send signals to the headquarters, my bone marrow, to have the rest of the cavalry released.

One of the most effective fighters are the B-cell lymphocytes. They are part of a line of my white blood cell army. These cells uses the information of the enemy’s profile and they start building specific missiles, a protein called antibody, to fight these particular intruders. Once these virus-seeking missiles are constructed they are launched into the system to seek and destroy every infiltrators.

antibodies attacking a virus (image from the web)

Some of these specific antibodies are stored into memory cells. So the next time this specific virus intrudes again, my body already has the pre-fabricated missiles ready to launch to fight them back.

Another important battalion of my soldiers are called the T-cell lymphocytes. These are elite fighting machines, like the SWAT or the Navy Seals. They don’t just track and kill the enemy but also destroy cells that harbor them. With some named as “natural killer T-cells” you know that these are badass soldiers.

Go, go, go my army and defend the motherland! And die you infidels!

There are also some foot soldiers that are deployed to the area of the breached wall. They have fortified the defenses there, and as a result the lymph nodes around my throat are swelled up, a sign of an ongoing battle in that area.

Besides the chills and runny nose, so runny I can’t keep up, I also started having this paroxysmal cough. I got out of my bed and went to the bathroom. I hacked up a phlegm into the sink – a nasty purulent and rusty mess. Then I realized that part of that purulent mess are dead bodies of my white blood cell soldiers. They have laid down their lives for the cause.

So before I flush down the purulent mess deep into the sink, I thanked them for their sacrifice, and as a grateful nation I fired up the canons and gave them my 21-cough salute.

After hearing my cough, my wife suggested that I should take some medicine to relieve my symptoms so I can have a better night sleep. Being hard-headed as I am, I said no to the medicine and just trusted that my body will take care of itself as I crawled back under the covers.

The next morning, I don’t feel as awful as the day before. Perhaps my army is winning the war, and they are rounding up the remaining stragglers, and cleaning up the residual wreck and ruins of the hard-fought battle. I guess I will live.

This is another victory for my immune system. But I’m not ready for a victory march and parade as of yet. I think I’ll take it easy and still stay in bed today.

Grateful to see another morning (photo taken with an iPhone)

(*Credits to my immune system and also to the Immunology class in my medical school)