Constipated Teaching

Since I am practicing in a teaching hospital, besides treating patients, part of my duty is educating and training residents (doctors-in-training) and medical students. In fact the state university even gave me an academic title. My official title is: Adjunct Clinical Associate Professor. Adjunct, means extra or accessory. In other words, not that major. Maybe “A Junk” Professor is more appropriate. In my native language, saling-pusa.

Anyway, most of the time when I am seeing patients in the hospital, I am accompanied by medical residents or medical students. In the ICU though, my entourage could be quite large, composing of 2 to 3 residents, a medical student, a pharmacist, 1 to 2 pharmacy students, a respiratory therapist, and respiratory therapy students. Then when we round on a specific ICU patient, the nurse taking care of that patient will join our discussion too.

Having a group shadow me on my rounds has its perks, as many of the scut work the team could already accomplish in my behalf. Plus the bigger the entourage, the bigger the likelihood that people think you are important (not mere “a junk”), just don’t let that get into your head. But it has its disadvantages too. For one, I have to ask permission to break rounds, every time I needed to go to the restroom.

In our rounds, besides talking about the patients’ cases and our plan of treatment for each one of them, we also discuss about snippets of medical teachings, current trends of practice, new drugs and even latest research that support our plan of management. Thus I really needed to be updated on the most recent guidelines and studies.

Few weeks ago, as I was conducting my ICU rounds, we have been dealing with some very difficult cases as well as some unfortunate patients in our ICU whose chances of surviving were slim. As we went through consecutive depressing cases, I could sense the sadness and stress rubbing in into my team. I could feel the morale of the team was low, for taking care of these sad cases of patients.

As the captain of the team, besides making sure that the right management is given to each of our patient and assuring proper education and adequate training for my residents and students, I feel that it is my duty as well to keep a high spirit in my team.

One particular patient that we have was having a bad case of constipation that was made worse by his requirement for pain medications, on top of all his other life threatening conditions. We then discussed causes of constipation and its management in general. One complication of using opioid pain medication is constipation, as it can slow down the intestinal movement. So we decided to give our patient the relatively new injectable medicine for constipation that blocks the opioid receptors in the gastrointestinal tract without decreasing the pain relieving ability of the opioids.

Then I asked the team, “Have you heard of the long-awaited big study on constipation?”

They all looked at me shaking their heads as they have not heard of it, and anticipating more words of wisdom from me.

To this I said: “It has not come out yet.”

Realizing that I made a joke, and not to be outdone, our knowledgeable pharmacist chimed in, “But I heard of the recent study that said that diarrhea is hereditary.”

The team was smiling now, and seems to be in a better mood , waiting for the punchline.

The witty pharmacist concluded, “Because it runs in jeans (genes).” Eeeww!

With that we moved on into our next ICU patient.

*******

Pahabol na hugot: Constipation ka ba? Kasi I cannot get moving since you dumped me.

 

Puto Rounds

Sometime in the year 2000, in the heart of New York, New York. In the hallways of the intensive care unit (ICU) of Memorial Sloan Kettering Cancer Center, a world-renowned hospital, and one of the best cancer center of the world, if not the best. Five doctors – four were fellows-in-training and one young attending physician with a specialty in Critical Care – were in a huddle, making their rounds on the critically ill patients.

The doctors were scholarly in their discourse of each case, deliberating what the best management approach was for each individual patient. There was nothing really special in their rounds, especially given that it was a regular occurrence and practice in an academic center. Except that they were all speaking in Tagalog – deep in the bowels of New York City, a thousand miles away from Manila.

Of course English is the official language of the academe and of this country. And those Filipino doctors were discrete not to talk in their native tongue in the presence of other people. There were several other doctors-in-training as well as consultants of other races aside from Americans in that institution. But in this opportune time, with all of them Filipinos, they felt comfortable speaking in Tagalog. Who says Tagalog or Pilipino cannot be the language of the learned?

All of those young doctors finished their medical education in the Philippines. They came from different schools though: one from University of the Philippines, another from University of Santo Tomas, one from University of the East, one from Lyceum-Northwestern University  in Dagupan, and another from Saint Louis University in Baguio. That they  ended up in one place, at one time, is a happy twist of fate. And here they were all now, in an Ivy-league-affiliated hospital of Cornell University. Who said Philippine schools do not produce world-class graduates?

After a demanding few hours of rounding and working in the ICU, those Filipino doctors took a break. They did not go down to the hospital cafeteria for an american doughnut or for an English muffin. Instead they headed back to the fellow’s call room, and snacked on home-made puto (rice cake), brought by one of them. No one asked for dinuguan (blood stew) to complement the puto. I guess the gory sight of some of the ICU cases were deterrent enough to make dinuguan unappealing. So you’d think puto is only found in the streets and markets of the Philippines?

puto

Was the puto special? Does it have cheese on top? Or salted egg perhaps? Did only the Tagalog-speaking doctors eat the puto? Or did they share them to other people?Did the puto made the medical rounds noteworthy? Did the puto made the doctors more brilliant? Did the puto help cure the sick patients? Was puto prescribed to the patients to be taken at least once a day?

Is the puto even the focus of this story? I don’t know.

Twelve years have passed since those puto rounds. What has happened, you may ask, to those young Filipino doctors? The young attending physician then, is now the chief or Program Director of the said training program. One of the doctors after completing her training, went back to the Philippines, where she now practices her profession. She is also an elected congresswoman.

The other three physicians-in-training then, found their niche in different areas of the United States, where they are now specialists, involved in private practice as well as in some academic institutions.

How do I know this story as a fact? Because I was there. I was the one who brought the puto.

*****

(*image from here)

(**compliments to my wife for making the puto, and the story it inspired)

*****

Post script: This piece was later published in Manila Standard Today, on Oct. 2, 2012.