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.
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.
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.
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.
(*Credits to my immune system and also to the Immunology class in my medical school)
Part of the duty of a medical resident in a teaching hospital is to formally pronounce a patient dead. When a patient dies, the nurse would call the resident-on-call to assess and examine the patient and confirm that he or she is indeed dead. Normally this is done in a timely fashion, within several minutes after the patient breathes his/her last breath, and the resident would chart the time the patient was pronounced dead. This would be the official time of death.
I understand that in a non-teaching hospital the attending doctor would be the one to call. If the doctor is not available, a nursing supervisor or a charge nurse can declare the patient dead.
You may argue that it does not really take a lot of training to determine if a person is dead. Any reasonable person can discern this. Though there are some people you probably know who look like dead, but I’m not talking about that. So why do we need a doctor or an experienced nurse to pronounce a person dead? I think it is more for a medico-legal purpose.
Of course sometimes your judgement that a person is dead can be challenged by somebody. The following is an actual exchange of questions and answers as recorded in a court documents:
A lawyer was cross-examining a witness, who was a pathologist.
Q: Doctor, before you performed the autopsy, did you check for a pulse?
Q: Did you check for blood pressure?
Q: Did you check for breathing?
Q: So, then it is possible that the patient was alive when you began the autopsy?
Q: How can you be so sure, Doctor?
A: Because his brain was sitting on my desk in a jar.
Q: But could the patient have still been alive, nevertheless?
A: Yes, it is possible that he could have been alive, practicing law somewhere.
Several nights ago, we had a very busy night in the ICU. I believe we had 7 admissions to the ICU in a short span of time. This is in addition to the 20 or more critically-ill patients that we already had in our unit. So “busy” may even be an understatement.
One patient that we had that night had been in the hospital for almost 2 months and had been in and out of the ICU a few times. This time around the family had decided that they would transition to comfort cares and the patient would be taken off life support. So death was imminent and expected.
For some reason, whether the medical resident was not called, or he was so busy at that time, or he was called but forgot to do it promptly, but the patient who was taken off life support was not officially pronounced dead right away. Of course everybody knew that the patient expired – the ICU nurses knew, the family members who were gathered in the room knew, and even the morgue and funeral personnel knew.
Perhaps it was assumed the he was already pronounced dead, so the body was taken down to the morgue within an hour or so after the patient died.
It was not after a few hours later that our medical resident learned that the body of our deceased patient was taken to the morgue without him officially examining the patient and pronouncing him dead.
So what would a diligent medical resident do?
Our conscientious resident went down to the morgue in the wee hours of the morning to search for the body. He pulled out the body from the freezer. He opened the body bag. He identified the deceased patient. Then he examined the body and pronounced it dead. I know, it sounds like a plot of a horror movie. At least he had an interesting story to tell his co-residents the next morning.
A couple of days ago, I received a notice from a funeral parlor to complete and sign a death certificate. Part of the certificate is to write down the official cause of death. Since I had 3 death certificates to complete that day I checked each of the patient’s hospital electronic medical record to be accurate on what I would write. That was when I read our resident’s note on the chart and I could not help but smile:
Patient examined in morgue. On exam patient did not respond to verbal or physical stimuli. No heart or lung sounds were heard and patient has no response to painful stimuli. Pupils were fixed and dilated. Patient pronounced dead at 0336.
Since the patient was only officially pronounced dead after a few hours in the morgue’s freezer, should I write “froze to death” as the cause of death?
Of course I did not.
(I meant no disrespect to the dead, nor do I make fun of a rather serious situation. I am just relating a light moment in the otherwise morbid world of ICU I lived in.)
Noong isang araw, ay nakikinig ang aking misis ng instructional video kung paano magsalita ng French. Malay ba namin, baka bukas makalawa ay mapadpad kami sa Quebec o kaya sa Paris para mag-order ng almusal na croissant at café au lait.
Hindi ko alam kung ako lang ba o lahat ng tao na hindi Pranses, pero para sa akin ay napakahirap yatang lenguahe ang French. Parang ngongo na hindi ko maintindihan. Ibang-iba ang pagbigkas kaysa sa pagkakasulat.
French: Où est la gare routière? (Pronounced as: Uh eh lah gah uhutiye?)
Putris na ‘yan, magpapakaligaw-ligaw na lang ako, kesa magtanong kung nasaan ang istasyon ng bus.
Pero masarap pakinggan ang French kahit na hindi ko maintindihan. Alam mo ba na ang French language ay mayroong 17 na patinig (vowels)? Anak ng tinapa!
Pero mas matindi ang Danish language. Sila ay mayroong 32 na vowels. Limang vowels nga lang sa Pilipino ay hirap na tayong magkaintindihan, 17 o 32 pa kaya?
Pasalamat tayo at mas madaling bigkasin ang ating wika, dahil lima lang ang ating patinig, at bawat isa sa ito ay iisa lang ang pagbasa at pagbigkas. Pero siguro kahit pa isa lang ang patinig ng ating wika ay kaya pa rin nating ipahayag ang ating saloobin at magkakaintindihan pa rin tayo. Totoo, kahit isang vowel lang.
Hindi kayo maniwala?
Sege, pepeteneyen ke se enye. Besehen me ete:
Eng beyen keng Pelepenes,
Lepeen neng gente’t beleklek,
Peg-ebeg ne se kenyeng peled,
Neg-eley neng gende’t deleg.
Kete me ne, neeentendehen me pe ren, kehet pereng tenge leng. Enek neng tenepe! Eng geleng geleng, ‘ne. Ene be yen?
Kehet hende ke mekepenewele, pere ngeyen beleb ke ne. Genyen kegeleng eng eteng esep, keyeng ementende kehet ne pereng gege ne eng pegseselete. Mge Pelepene leng keye eng pewedeng mekesekey neng genete? Weleng senebe eng Englesh et French se eteng Peney.
Henggeng dete ne leng et beke meteleyen neng mesere eng etek nenye. Selemet pe.
Today is Friday the 13th. For superstitious folks out there, please beware!
Many people consider this as the unluckiest day in the calendar. According to an article from National Geographic, the fear surrounding Friday the 13th may be rooted in religious beliefs. It has to do with the 13th guest at the Last Supper, who is Judas, the apostle who betrayed Jesus, who in turn was crucified on a Friday.
The fear for Friday the 13th is so widespread that psychologists even have a term for people who suffers from it: paraskavedekatriaphobia. That’s a mouthful. The irrational fear for the number 13 is called triskaidekaphobia.
Irrational or not, many buildings don’t have a 13th floor. So elevators will go from 12th floor and then skip to 14th floor. In 2002, based on an internal review of records, a report from Otis Elevator Company estimated that 85% of the buildings with Otis brand elevators did not have a floor named the 13th floor.
Most hotels have no room 13. Many hospitals have no room 13. Even our own ICU has no room 13. So you think medical institutions are not superstitious? Though I get it, I think patients or their family will freak out if they learn that they are being admitted to ICU room 13.
Speaking of ICU, I have been the ICU attending for the past couple of weeks now. It has been busy, plus you know that July is when the new residents or physicians-in-training start, so it is an added stressor to me. To destress, I blog.
It is known in the medical world that the rate of medical errors and surgical complications spikes in the month of July. The hospitals even have a name for it: the July effect. This is not due to a mystical phenomenon, but due to a very logical reason stemming from the inexperience of the newbie doctors.
Thus I am supervising and watching my residents like a hawk this time of year. And today, Friday July 13th, I will even be more vigilant.
To end, in connection to mystical events, I would like to share a story that was posted by a batchmate in the group chat:
Murder Mystery at the Makati Medical Center
There was this case in the hospital’s Intensive Care Unit where patients always die in the same bed on Sunday mornings at 11 A.M., regardless of their medical condition. This puzzled the doctors and some even thought that it had something to do with the supernatural or even murder. No one could solve the mystery as to why deaths happen on Sunday at 11 A.M.
Mr. Licauco, Fr. Bulatao and the Ateneo paranormal folks were called. They arrived armed with special photographic equipment, infra-red devices and motion sensitive radar to detect any presence.
So on the next Sunday morning, a few minutes before 11 AM, all the doctors and nurses nervously waited outside the ward to see for themselves what the mysterious phenomenon was all about. Some were holding wooden crosses, strings of garlic, amulets, prayer books and other holy objects to ward off evil spirits.
Just then, the clock struck 11. And then……..
Mang Joe, the part-time Sunday janitor, entered the ward, unplugged the life support system and plugged in the vacuum cleaner.
Sangayon sa mga balita, kasalukyang iniimbistigahan ng International Basketball Federation ang naganap na insidente sa laro ng Gilas Pilipinas at Australian Boomers. Hindi pa alam kung anong parusa ang ibababa sa mga sangkot sa labu-labong suntukang nangyari sa basketball court.
Inakusahan ni Luc Longley, dating NBA player ng Chicago Bulls at kasalukuyang associate coach ng Australian basketball team, ang head coach ng Pilipinas na si Chot Reyes na ginatungan nito diumano ang kanyang mga players, kaya nauwi sa rumble ang laro.
Dinepensahan naman ng dating coach ng Pilipinas na si Yeng Guiao si coach Chot Reyes. Sabi ni Guiao wala raw kasalanan ang kasalukuyang coach at hindi dapat itong idiin sa mga nakakabahalang pangyayari.
Ganoon pa man, hindi nagustuhan ng Samahang Basketbol ng Pilipinas ang naging papel ni coach Reyes sa mga kaganapan. Hindi rin nila nagustuhan ang “performance” ng ating mga manlalaro at ang estado na kulang sa “skills” at “training” ang ating mga basketbulero.
Dahil dito ay tinibag na si Chot Reyes.
Ito na ang kanyang kapalit:
(*Ang balitang ito ay hindi fake news. Totoo, peksman.)
Last week, my partners and I went to a fancy restaurant in town. We have a candidate who is applying to join our practice that we interviewed so we took him to a place, a little pricey, but reputable, especially when it comes to steak and chops. We don’t want to have an applicant think that we are cheap.
I am not really in to steak and chops, but after tasting their food, I would say that this restaurant have a valid reason to claim that their steak is the best in town.
Besides the entrée, some other small things are remarkable. The fresh sea food platter appetizer was nicely presented and decorated in a bucket full of ice. The drinks were cold and chilled. Those were expected, I suppose.
However, when I excuse myself from the group and went to the restroom, I found something else that was “cool.” This one I was not expecting.
Do you see it? I know their urinals are not really swanky nor high-tech, yet it is classy. Though, I’m pertaining to something else.
Yes, you got it. Those are ice cubes in the urinals! Why they put ice in there, I have no clue.
I guess they chill the appetizers, the drinks, and yes, even the pee. Cool!
After searching the web, I found out why restaurants and bars put ice on the urinals. No, it’s not to chill the pee. But ice is a cheaper alternative to the urinal cake. When the ice melts it flushes the urine, so no need of auto-flush. Plus, the restaurants have a lot of supply of ice anyway, and it is easier to toss the used ice, like those in their fresh sea food platter, in the urinal than tossing them outside. And lastly, it gives the men (sorry ladies, you may never understand this) something to aim for when they take a leak.
I really learned something from this post. I hope you did too.
Sa isang luxury car show, may mga tao mula sa iba’t ibang lahi ang nagkausap-usap. Habang tinitignan nila ang mga magagarang kotseng naka-display sa show, ay nagsimula silang magbidahan.
Taga-Europa: “Doon sa Europa, ang mga luxury cars, gaya ng Mercedes Benz at BMW ay hindi lang para sa mayayaman. Ordinaryo lang na pinanghaharabas at pinampapasada namin ang mga iyan bilang mga taxi.”
Amerikano: “Naku, walang-wala iyan sa Amerika. Doon sa amin, ang mga mamahaling kotse tulad ng Mercedes, BMW at Corvette, ay binabale-wala at linalaspag lang. Walang patumangga pa naming binabangga at pinapasabog ang mga ito sa mga pelikula.”
Pilipino: “Nakow, taghirap naman pala sa bansa ninyo. Walang panama iyan sa Pilipinas. Doon sa amin, ang mga bagong-bagong luxury cars gaya ng Jaguar, Mercedes, BMW at Corvette ay hindi ginagamit o sinasakyan! Pinayuyupi lang ng aming Presidente para ang bakal ay gawing tansan!”