Junior Internship, in Retrospect

Originally posted in Primum non Nocere on April 21, 2014.

In the first three years of medical school, you don't feel like you're training to be a doctor. It feels more like an extension of high school, not college -- high school.

You belong in one big class, divided into sections. You go to school at eight in the morning, leave by five -- at least that was how it is in my medical school. People get to shallow fights over notes and who sits where in class. We are scared of recitations and pop quizzes really pop everywhere. And yes, there are those little classroom romances and "issues", just like high school. But then once you get promoted to fourth year, things change drastically. 

For starters, no summer vacation. Immediately after promotion, you start the crash courses on doing procedures, basic life support, advanced cardiac life support. And then just like that, you are brought to the hospital. No ceremonies, no anything. 

I was "lucky" enough to have OB-Gyne as my first rotation. Yes. I was sarcastic. 

OB-Gyne is known as the most "toxic" of all rotations. During the first couple of weeks, I actually considered skipping duty more than once. Primarily because it was tiring. But mostly because I was scared. I was scared to poke patients, I was scared of the residents, I was scared of blood. And well, OB is like bloodbath everyday. 

My OBGyne groupmates and first year residents, Doc Mich and Doc Rhaizza.

 But then eventually, I got the hang of it. The don't mind the smell of lochia on my hair anymore or the fact that sometimes I fall asleep in the cab after a long night in the labor room or operating room. Until one day, I realized that I was already shifting rotations. After that, I can't say that it was a walk in the park, but it was pretty much downhill.

In Junior Internship, I got to meet many kinds of people. I got to know my fellow Junior Interns better. They say that people actually change during JIship. I beg to disagree. I think its more of we finally get to know people better. In med school, we go home at five. In JIship, we go home the next day. And overnight, a lot of things can happen that would bring out the best and the worst in each other. 

Subgroup C4: Shakes, me, Oliver and Ian.

Growing up, I experienced attending a private school and a public school. I was exposed to people from different economic backgrounds. I have classmates who arrive in big, chauffeured cars and I have classmates who walk n kilometers to school in battered rubbershoes two sizes too big. I thought I already saw the stratification in social classes, then I rotated in a government hospital, it took my consciousness to a whole new level. 

My family is lucky enough to be able to afford to go the big hospitals when we have to. Personally, I have a pulmonologist for my asthma, a cardiologist for my arrythmia, a dermatologist for my skin. But the patients I met in my rotations, they come in, their illnesses fullblown, uncontrolled. They come in because they finally have the money for transportation. Since that's the only money they have, laboratories and other ancillary tests will have to wait for an indefinite time. Diagnoses are hit and miss sometimes. Interventions are delayed. Sometimes -- most of the times -- we have to shell out our own money just so the simple procedures like drawing blood or putting an IV line can be done. 

My partner since day 1, Oliver. 

There were times during the 11 months of JIship that I was too tired, too jittery, too giddy, too sleepy to function well. There was a time when I was crying while driving home because the consultants kick my butt in conference. There was a time when I left my car in the middle of the parking lot just so I can sign in on time. There was a time when I was the patient in the ER because duty + makeup duty hours started to take its toll.

Block C San Beda College of Medicine Class of 2014.

The night before graduation, as I forced myself to sleep -- I couldn't, out of sheer excitement -- instead of counting sheep, I counted my patients. 

The first one, who I monitored in the Surgucal ICU because of asthma in acute exacerbation, at 22 weeks AOG, not in labor. 

The next one, postpartum bleeding. Stayed in the SICU for weeks, succumbed to sepsis.

Then there's the girl we admitted in the Pedia ER, transferred straight to Pedia ICU due to Dengue Fever Grade III. I didn't know what happened to her afterwards.

Then there's my patient in Psych, who got so drunk he ran around his town many times.

Then there's the MDR-TB patient in Silang, Cavite, who we have to transfer to DSLU for continuity of care. 

The list went on and on. Some of them, I can only remember faces, some last names, some only the diagnosis, most were just a blur. 

Then just as soon as it started, it came to an end. The last two weeks of JIship was an emotional rollercoaster for me. The prospect of breaking up with the subgroup I have known and love so dearly was enough to drive me into tears everytime (that was a secret).  And the thought of venturing into the unknown -- PGIship -- was great enough to scare me enough to want to crawl back to med school.  This time, a JI would ask me how to do things, why things are, and I don't know if I would know the answer to that. 

I am now less than two weeks away from PGIship (Post-Graduate Intern), still with no concrete plans of what hospital to go to. 

Am I scared? 

Yes. 

Am I excited? 

Definitely. 

Am I ready for it? 

In our profession, there's no such thing as "ready". Just do, the rest will follow.