Weight on My Shoulder

Ever since I have chosen this career, I have this feeling of weight on my shoulder every time I am at work. There’s always something around my neck.

It’s not that I feel like Atlas, the Titan in Greek mythology who was condemned to hold up the sky for eternity. No, nothing like carrying the world on my shoulder.

I know this profession can be stressful. And in fact it is always in the top 10 of most stressful jobs in the world. Though it may not be as much stress as police officers, fire fighters, and enlisted military personnel.

On the other hand, at least our profession is handsomely compensated. I agree though that the salary for police officers, fire fighters and the military should be increased, for the services they provide and the risks they take just to perform their duties.

But this weight on my shoulder and this feeling of something hanging around my neck could be a badge of pride as well. A symbol of our profession if you will.

Come to think of it, there may be other ways to bear this, but this is the easiest way to carry this load. That is around our neck. Thus I would always carry this weight on my shoulder, perhaps until I change career or until I retire.

Like what the Beatles’ song say:

Boy, you gotta carry that weight,
Carry that weight a long time,
Boy, you gonna carry that weight,
Carry that weight a long time.

If you’re wondering what is this weight on my shoulder?

I am just pertaining to the stethoscope that I always carry around my neck when I am working.

Were you thinking of the load of responsibility that we are burdened with? Well, that too. Especially when we’re in charge of the ICU.

By the way a stethoscope only weighs 6 ounces, which is not even half a pound. Unlike the taho vendor in the Philippines who has to carry that enormous weight on their shoulders as they go through streets after streets, just to make a living.

I really have nothing to complain about.

 

I’m Free

I was on-call last weekend, and it was busy. The ICU was full. Our patients list was quite long. I only got about 8 hours of sleep from Friday to Sunday, that by the end of my 58 hours shift, I was really exhausted. I felt deflated and defeated.

Days like those, I even wonder, “Why am I doing this?”

After having Monday off, I came to the office the next morning and found this on my table:

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flowers and a memorial service program

The flowers came from a patient, or should I say from his relatives. My patient passed away. I should be the one sending flowers. But in this occasion, it was the dead and the grieving who gave the flowers.

I guess the family was just grateful and appreciative of the care I gave their loved one. Even if the end result was death.

Day like this, reaffirms why I am doing this.

I have taken care of this patient for almost 10 years. And over the years I saw his constant struggle to breathe, and his progressive decline. By the past year or so I have been seeing him so often in the clinic or in the hospital, that I have come to know him very well. Yet, despite our efforts he continued to get worse.

At the end I knew I have nothing left to offer him, and so we have agreed to place him under hospice care.

He had Chronic Obstructive Pulmonary Disease or COPD.

Damn cigarettes! If there’s any young people here reading this article and are smoking and feels that you’re indestructible, I am pleading to you, please stop smoking. I am a constant witness of the destructive effects of cigarettes and the utter suffering they cause. Whatever pleasure smoking gives, it is not worth it.

Though I would admit, some of the nicest people I came to know were smokers. And that includes my patient. They are just slaves of a bad habit that may not be their own doing.

In the funeral program of my patient that they also sent to me, was a poem by Ann Davidson, printed on it. A poem so apt for my patient. It was entitled “I’m Free.”

Free from the pain. Free from suffering. Free from the disease that tormented him. He was indeed free.

I’m Free

Don’t grieve for me, for now I’m free

I’m following the path God laid for me.

I took His hand when I heard Him call

I turned my back and left it all.

I could not stay another day

To laugh, to love, to work or play.

Tasks left undone must stay that way.

I’ve found that peace at the close of the day.

If my parting has left a void

Then fill it with remembered joy.

A friendship shared, a laugh, a kiss,

Ah, yes, these things I too will miss.

Be not burdened with times of sorrow

I wish you the sunshine of tomorrow,

My life’s been full, I’ve savored much

Good friends, good times, my loved one’s touch.

Perhaps my time seemed all too brief

Don’t lengthen it now with undue grief.

Lift up your heart and share with me.

God wanted me now; He set me free!

Are Resident Doctors Really Doctors?

No, they are not.

According to a recent article (read here) that appeared in Mindanao Times, here are the new essential qualifications for a real doctor.

1. Wears a uniform. Preferably white, and in impeccable condition. One that does not get hot nor dirty even when you’re rushing and answering to all calls, especially in the Emergency Room.

2. Speaks English. It does not matter whether you’re in Manila, or Ilocos, or Cebu, or anywhere in the Philippines (or world) for that matter. It does not matter if the patient you’re attending to speaks Tagalog, or Ilocano, or Ilonggo. You must talk to them in English. That’s how you discern one from an impostor.

3. Knows the “problem” of the patient, even if the patient does not tell them anything about what ills them. They must master the art of foretelling the disease, even without taking history and doing physical exam. In other words, can read crystal balls. Nurses should possess this power too.

4. Must be courteous at all times. Never rude. Even when faced with arrogant yet idiotic patients. If you’re not courteous, that means you are a fake doctor.

5. Must see a demanding patient, right away. Now na! It does not matter if you’re attending to a sicker patient. It does not matter if you’re running a code or doing the CPR itself, or assisting in surgery, or doing a procedure. Your doctor’s license expires within an hour of not seeing the patient.

The following standard eligibility on becoming a real doctor are not needed anymore:

1. Four years of undergraduate degree. Forget it!

2. Another four years of medical (graduate) school. Forget it!

3. One year of post-graduate internship. Forget it!

4. Pass the Philippine (or other country’s) Medical Board Exam. Forget it!

5.  Lastly, no need to do three to seven years (depending on specialty) of Residency after passing the board exam. Remember when you’re a “Resident” doctor, you are a fake doctor.

*******

(This post is in response to an article with the same title, that was published 7/20/15, in the Opinion section of Mindanao Times, written by Fely V. Sicam)

Blast from the Past

Change. That is the only constant thing in this ever-changing world.

Not too long ago, we cannot get by our daily lives without the typewriter, mimeograph machine, telephone booth (not just Superman), cassette tape recorder, floppy disc, and film negatives. Do you even know what they are?

When was the last time you placed a 35 mm roll of film in the film cartridge of your camera? Or when was the last time you held a real printed photograph instead of viewing it on a computer monitor or from a smart phone?

In the world of medical radiographic images, the same is true. In our practice, rarely do we see a real printed x-ray film nowadays. Instead, everything is now digital or electronic.

Gone are the days when we have to wait for several minutes for an x-ray technician to develop the film in a dark room. Then wait for it to dry. Then hand you the film. And then you have to find an x-ray view box to hang it so you can read it.

Today, we view radiographic images digitally through PACS (Picture Archiving and Communication System), which is a network of computers used by radiology department, that we can access through our desktop, laptop, tablet, or even our smart phone. And if a referred patient comes with an x-ray taken by a radiology department not in our network, he brings in his x-ray images in a CD that we can load and view.

However the other day, a new patient referred to us came in with a real copy of her chest x-ray film. A real film!

I have not held one of these for a while. I missed the feel of its smooth texture on my fingers. The crisp sound of the film as you pull it out of the envelope and wave it softly in the air. Its peculiar slight acidic scent (from the x-ray developer and fixer chemical solution). The unmistakable exotic taste of its…..ah, er……. no, I have not done that.

Who knew that a plain x-ray film will bring me such nostalgia?

As I hold the x-ray film in my hand, I looked around for a viewbox (negatoscope is the technical term), but can’t find one. I guess they don’t install them anymore. I was in one of our newly constructed multi-specialty satellite clinic, and they don’t have a negatoscope in the whole building. None. Zilch. Nada.

So how did I view the x-ray?

I held the film against the bright window and squint my eyes a little, just like the “old” days.

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Right after graduating from medical school, almost twenty-five years ago, I worked in a small (and I mean really small) rural hospital in Plaridel Bulacan, in the Philippines. There whenever I ordered an x-ray, I even helped with shooting and developing it. That’s why I cannot forget the aroma of the freshly developed x-ray film. And while the film was still wet, I would hold it against the light, squint my eyes, and read it.

That was just like yesterday. Yet so much have changed.

As I looked at the film of my current patient, I also peered through the window and looked outside at the present world I’m in, while I relived and reminisced the past through the window of my mind.

(*photo taken with an i-Phone; and in case you’re asking, the chest x-ray was normal)

Life’s Worries

A couple of weeks ago, I took care of a patient who was admitted in the hospital for shortness of breath. She has COPD (CDOP if you’re obsessive-compulsive), a disease due to smoking, and went into acute respiratory failure.

The patient was really struggling to breathe thus the Emergency Room doctor placed her on a non-invasive positive pressure ventilator (NIPPV), a device similar to CPAP used by people with sleep apnea, to provide assistance in her respiration. She was then transferred to our ICU.

On the first day that I rounded on her she was still on the NIPPV and unable to talk much, as it was almost impossible to talk with that mask on, for it’s like having a blower in your face. I would not be able to hear her clearly anyway even if she wants to speak. Though I examined her thoroughly, I limited my history-taking to questions she can answer by yes or no.

The next day she was much better and we have weaned her off the NIPPV. She was sitting in a chair, breathing much easier and looking comfortable.

I pulled up a chair and sat beside her and talked. She admits she has been diagnosed with COPD for years, and has even been on oxygen at home. But sadly to say she continues to smoke. Damn cigarettes! I guess old habit never die.

I told her that it was vital that she quit smoking. Yet in the back of my mind, she has done quite good despite of her bad habits, for she was 84 years old after all, and she still lives independently, all by herself.

Then when I asked her how can I help her quit smoking, she relayed to me that she smoke because she was stressed out.

What? She was eighty-four years old and still stressed out? She should be relaxing and enjoying life, or whatever is left of it, at this age.

That was when she told me that she has not gotten over the death of her husband, whom she was married for sixty-one years. He died three years ago. I suppose the heartbreak never heals when you lose somebody you love and lived with, for that long.

If we only peel off our prejudgment and peer behind the puff of cigarette smoke, we will learn that these people are hurting inside.

Then she said that she was also worried about somebody she knew longer than her husband. She was worried about her mother.

Her mother? What?!!!

Wait a minute, was my patient confused? Too much medications maybe? Was she having ICU delirium? Or does she have the beginning of dementia perhaps?

But as I talked to her more, I ascertained that she was very lucid and of clear mind. She was indeed worried and stressed out about her mother, who has been in and out of the hospital for the past several months.

Her mother was 103 years old!

I came out of the ICU room with a smile. I was ever so determined to help my patient get well. And maybe if I can get her to relax and convince her to quit smoking, she will live more than 103.

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view from the hospital’s corridor

(photo taken with an iPhone)

Doctor’s Report

We were sitting in a waiting area of a posh Cancer Center building. This time I was on the receiving end of this business. I was not a provider (doctor) but rather a consumer (patient). I was accompanying my wife for her follow-up appointment with the Hematologist-Oncologist doctor.

It was a day of reckoning. We were going to get the dreaded results of her bone marrow biopsy.

Have you ever waited on a report before? A semester’s grade perhaps? Or a qualifying examination? Or a job application? Or a tax return? Nothing can compare to the anxiety level of waiting for a biopsy report.

As I looked at the people in the waiting room, I can easily identify the patients. To lighten up her mood, I told my wife that I look more as the patient than her, for I am the one with the thinning hair. Though I am not poking fun of the chemotherapy patients at all, for I only have admiration for their courage and resolve as they undergo this difficult treatment.

When we were called inside, we met with the cancer specialist. He reviewed the results of the bone marrow biopsy with us, including some fancy genetic tests that he obtained.

The doctor went into detailed medical description, for he knew I am a doctor too and speaks his language. He then concluded that the test did not show any evidence of Myelodysplastic or Myeloproliferative disorder. In simple terms, no evidence of badness to worry about. It was a good report overall.

It was such a relief!

For the past several days, we experienced silent and unspoken fear about our future. For my wife, for me, and for our family. But now, we will grow old together after all.

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my wife and I (photo taken last summer in Vail Colorado)

If there’s something good that came out of this, is that it made our bond stronger and our faith more steadfast.

As we were leaving the doctor’s office, I glanced once again at the people in that waiting room. One elderly woman who was in a wheelchair, was wearing a colorful bandana but looking glum. Another not so old lady who was wearing a fancy hat accompanied by few friends or family. One middle-aged man who looked frail and sitting alone. And some other ones I failed to describe.

What would the doctor’s report on them be? Would it be very good like ours was? Or not so good perhaps? Or would it be downright heartbreaking? I can only hope and pray for each of them.

Life. So unpredictable. Live it to the fullest. And celebrate it while you can.

Today we will.

 

Usog, Gayuma at Anting-anting

“Hijo, nausog ka. Hubarin mo ang iyong damit, upang ating banlian ng mainit na tubig.”

Iyan ang aking naaalala na sabi ng aking lola. Akala ko ay mga sanggol lang ang nauusog. Ako noon ay nasa elementarya na, at kami ay dumadalaw sa aking lola na nasa Bulacan. Masaya akong naglalaro sa harap ng bahay nang biglang tumikwas ang aking sikmura, at ako’y nagsuka. Hindi humupa kaagad-agad ang aking pagsusuka, kaya ako ay tinuringang nausog.

Pagkatapos akong asikasuhin ng aking lola ay huminahon naman agad ang aking pakiramdam. Impatso lang kaya iyon?

Kung ikaw ay Pinoy, siguro ay alam mo ang usog, gayuma, anting-anting, kulam, at iba pang mga paniniwalang Pilipino. Siguro ay nausog ka rin noon? Naka-usog? Nagayuma? Nang-gayuma? Nagkaroon ng anting-anting? Nawalan ng anting-anting? Nakulam? O nang-kulam? Kung ikaw ay mangkukulam, paki-usap naman po, huwag naman sana ninyo akong kagalitan.

Bilang isang tunay na Pilipino ay namulat ako sa mga superstisyong ito. At minsan sa aking musmos na isipan ay naniwala rin sa mga ito. Sabihin na lang natin na kasabay ng paglisan ng aking tiwala kay Santa Claus ay ang pagkawala rin ng aking paniniwala sa mga ito. Ipagpaumanhin ninyo po sana ang aking pagiging pasaway.

Maliban sa usog, ay pinagsabihan din ako noon na mag-ingat sa mga gayuma, lalo na noong ako’y magbinata na. Hindi naman sa pagmamayabang, ay naging habulin din ako ng mga chicks. Hindi pala chicks, kung hindi mga inahing manok at tandang ang mga humabol sa akin noon, dahil nagalit sila sa aking pagbubalabog sa mga manok at sisiw na nasa silong ng bahay ng aking lola doon sa probinsiya.

Tungkol sa gayuma, maraming paraan ang paggawa nito. Maari daw itong katas ng halaman, pawis ng hayop, o sarili mong laway. Maniwala ka o hindi, hindi ako gumamit ng mga ito. Peks man!

Kung pag-uusapan naman ay mga anting-anting o agimat, ay wala akong karanasan dito. Pero may nagsabi sa akin na may malayo raw kaming kamag-anak na may anting-anting. Tinangka niyang sumalo ng bala ng armalite, kaso nga lang hindi umubra ang kanyang anting-anting. Sa kasawiang palad, siya ay natepok.

Hindi ba naging palasak din ang mga pelikula noon (at hanggang ngayon!) tungkol sa mga taong pinaniniwalaang may mga anting-anting. Tulad ni Nardong Putik, Pepeng Agimat, Tiagong Akyat, at siyempre pa, ang Panday. Siguro, isali na rin natin dito si Enteng Kabisote. Pinanood mo rin ba ang mga ito?

Kung ikaw ay mapapagawi sa may Quiapo, sa may labas ng simbahan, ay tatambad sa iyo ang mga tinitindang mga anting-anting. Samahan lang daw ito ng bulong at orasyon, at magkakaroon ka na ng agimat. Totoo nga kaya?

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mga anting-anting sa Quiapo (photo credit: docgelo)

Sa kulam naman, ay marami akong kwento tungkol dito. Hindi dahil sa may lahi kami ng mga mangkukulam. Marunong lang daw kaming lumaban sa mga kulam.

Balikan natin ang aking lola doon sa Bulacan. Siya ay pinupuntahan noon ng mga taong inaakala nilang kinulam, at siya ay pinapakiusapang kontrahin ang mga kulam. Naging tanungan din siya ng mga taong may nawawalang bagay. Isa sa mga kwentong aking narinig ay isang magsasakang nawala ang alagang kalabaw. Matapos ang munting dasal at pagsisindi ng kandila, ay sinabi niya ang lugar kung saan makikita ang kalabaw. At natagpuan naman ito!

Minsan daw ay kinulam ang aking tita, ngunit nahadlangan ito ng aking lola. Tunay naman na may angking galing ang aking lola. Nasa lahi pala talaga namin ang pagiging mang-gagamot. Huwag na ninyong itanong kung naisalin o naipamana sa akin ang abilidad na ito. Walang tsansa, sapagkat ako’y isang erehe at hindi naniniwala.

Noong ako’y nasa kolehiyo na, minsan kami ay nagbakasyon sa Ilocos Norte, kung saan lumaki ang aking nanay. Habang nagpapahinga ang aking tatay sa ilalim ng punong mangga ay biglang sumama ang timpla ng kanyang pakiramdam. Siya ay nahilo, sumakit ang ulo, at nagsimulang sumuka.

Sabi ng mga matatanda doon sa Ilocos, ay baka raw kinulam ang aking tatay ng mga naiinggit sa kanya. Sabi naman ng iba ay baka raw napagkatuwaan siya ng nuno sa punso sa ilalim ng punong mangga.

Matapos kaming makabalik sa Maynila, hindi pa rin umigi ang lagay ng aking ama. Nagpatingin na siya sa duktor. Pagkaraan ng maraming mga eksaminasyon, kasama na ang CT scan ng ulo, ay napagtanto na hindi kulam o nuno sa punso ang problema. Isang malaking tumor sa utak ang dahilan. Ito na rin ang naging sanhi ng kanyang maagang pagyaon.

Mula noon ay lalo nang nawala ang aking paniniwala sa mga superstisyong ating kinagawian. Habang patuloy ko namang tinahak pa ang landas ng siyensiya at medisina.

Lumipas pa ang panahon, ay naging tanungan na rin ako ng aking mga kamag-anak. Hindi ng mga nausog, nagayuma, o nakulam, kung hindi ng mga may karamdaman at sakit. Dahil ako ay naging isa nang ganap na duktor.

At sa aking mga paglalapagan ng kamay: “pwera usog!

On Being a Patient

I opened my eyes as I slowly regained consciousness. I looked around and I was alone in some kind of cubicle where the curtains were drawn close. I was lying in a stretcher with nothing on but a flimsy hospital gown. I felt cold and naked. Wrapped around my left arm was a blood pressure cuff, and attached to my chest were leads of a heart monitor. In the back of my right hand was a small catheter inserted through my skin, while intravenous fluids infusing slowly through my veins.

My mind was still foggy like I was dreaming. I felt like floating and detached, and yet I was so calm. Is this out-of-body experience? It must be the sedatives I received.

Moments later the nurse entered through the curtains and smilingly told me that everything went smoothly. Not too long after, the doctor came in and said everything turned out to be alright.

Before you think that there was something bad or serious that happened to me, it was not that. I just had my screening colonoscopy done. Nothing more.

Colonoscopy is a recommended procedure for all people above 50 years of age, to screen for colon and rectal cancer. It is through this test that small polyps in the colon, which can be pre-cancerous or early cancerous lesions, can be detected and removed. And though I am still a few years from fifty, yet with my strong family history, as my mother was diagnosed with colorectal cancer, my good friend who is a gastroenterologist, recommended that I have the procedure done early according to the American Cancer Society’s Guideline. That was more than two years ago that I was told that, but I dragged my feet to have it done. Doctors can be the worst patient you know.

When I had my annual physical exam few months ago, my personal physician also recommended that I undergo colonoscopy. Now I cannot escape the doctor’s orders. So I finally gave in. Doctors like to give orders, but not necessarily like to follow their own advice or follow the orders they were given.

So there I was lying in the recovery room, still dazed from the sedatives I received during the procedure. As the doctor approached the stretcher where I was, it dawned on me that there was a big reversal of role. I was not the doctor in control. This time I was the patient.

The doctor came in, who was nicely dressed with his white coat on, while I was butt-naked with nothing on but a hospital gown. He towered over my bed confidently like the man in-charge, while I laid there feeling groggy and helpless. Not knowing what just happened as I was just coming out of sedation, I felt so vulnerable and invaded. If having a scope shoved down in you-know-where would not give you a feeling of invasion, I don’t know what will. And lastly, when my doctor came in to give me the news whether it be good or bad, he knew something that I don’t, and yet it concerns me, my health, my life.

So this is how a patient feels. Exposed and powerless. No option but to submit, for resistance is futile. Entrusting your life to the hands of somebody. Somebody you barely know, except for his name. Somebody that you can just hope, will take good care of you.

I am glad that I experienced being a patient, for it gave me a different kind of perspective. A point of view that I have never seen before. Though I don’t look forward of having my colonoscopy done again in about 5-10 years as what was recommended. But I admit the floating, detached, and calm feeling from the medication was some kind of “high.”

The next time I stand over patients’ bed while they lay there defenseless, with my white coat on while they are almost naked, and with facts that I know while they don’t know and yet it concerns their life – I will certainly hold it with such high esteem and with utmost reverence, that trust that was given to me.

Being patient is a virtue. In my case, being “a patient” made me virtuous.

Doctor’s Prayer