Just Once

I won't sugar coat it kids, let's admit it. Masakit bumagsak. And for those you haven't experienced failure, let me try to show you a picture what goes down in the process of and accepting failure.

*while taking exam* 
'Oh sh*t. Nag-aral naman ako eh. Bakit ganito? Ano ba itong tinatanong nila? Isa diyan sa mga choices ang sagot? Bakit hindi ko sila alam?'

*terminate exam*
'Bahala na ang Justice League. Feeling ko hindi kaya ni Batman ito mag-isa.'

*sees score*
'Oh no. Sana magcurve. Two points lang please. Sana... pero asa pa. Pero sana...'

*night after the exam*
'Eto yung sagot eh, nabasa ko yun eh. Bakit kasi lumabas pa ako last week, sana nag-aral nalang ako... Sana magcurve, sana pumayag ang promoboards.'

*upon seeing official list of passing students*
'Wala ako.' (tulala for a while)
'Official na, bagsak ako. Uulit ako.'

*titingin sa mga ka-klaseng nag-eenjoy*
'F*ck you all, I hate you.'
'Anung gagawin ko next year, isa lang subject ko.'

CLASSMATE 1: Kumusta?
CLASSMATE 2: Tara kain!
CLASS TOP 1: Wow exempted ako.

'Ikaw na. Ikaw na talaga, p*nyeta ka.'

YOU: Hindi sige, uwi muna ako. Mainit eh, kelangan ko matulog.

*habang nasa LRT pauwi*
't*ng*na, uulit ako'
'nagpabili pa naman ako ng bagong phone'
'ibibili daw ako ng kotse pag napromote ako'
'sh*t paano ko ito sasabihin kay Mama'

*bubuntung-hininga. sunod-sunod. pipigilin ang luha. hindi pa pwede. titingnan nila ako pag umiyak ako*
'paano ko ito sasabihin kay Mama?'

*pagdating sa bahay, mabilis na papasok sa kwarto at magkukulong. babaha na nang luha. itatapon lahat ng trans sa kama. iiyak nang malakas. minsan, mas sigaw pa. tapos, after a few minutes, kakalma.*
'ganun talaga, nagkulang siguro ako.'
'gagalingan ko nalang next year.'
'paano ko ito sasabihin kay Mama?'

*mahihiga. makakatulog sa ibabaw ng trans.*

*tutunog ang phone*
'si Mama.'

MAMA: Kumusta? Ano, clerk ka na ba?
YOU: Ma... sorry. Hindi ako pumasa sa isang subject.

*silence sa kabilang linya.*
'sigawan mo na ako, Ma.'
'bawiin mo na yung iPhone ko.'
'okay lang hindi ko naman kelangan ng kotse.'

*tapos maririnig mo ang pinakamasakit na mga salita sa araw na yun*

MAMA: Okay lang yan. Ganun talaga. Babawi ka sa isang taon. Ayusin mo na gamit mo, susunduin ka na namin ngayong gabi. Magtitingin pa kayo ng kotse ni Papa bukas, diba?

***

Ang hirap aminin, but the truth is, I experienced that anecdote one too many times, even before medical school. I am no stranger to failure. Which is why I know that feeling all too well.

But looking back, sure, sana hindi ako bumagsak kasi siguro, instead of trying so hard to get into a good internship and residency program, I would be having interviews left and right. I won't need some consultant to back me up, my grades would do that for me. But things happen, and sometimes, we fail. And when that happens, there really is no other choice but to accept and move forward.

Sometimes, I ask the Universe why I had to fail during college and med school. Then I reviewed the significant events that happened and discovered that those failures led me to doors I would not dare knock if I had any other choice. They led me to lifelong friendships. They led me closer to God and even gave me the chance to serve his youth before I concentrated on studying medicine. They actually led me to medicine eventually. They led me to discover what kind of person I want to be. They led me to my convictions and own set of values. If not for those failures, I probably got married earlier and to someone who I would eventually grow apart from. Those failures brought me here. And quite honestly, I like who I evolved into compared to who I was before.

But all those things I said that happened after the failures, I will leave them for you to have your own post-failure discoveries. Let's keep our focus on the now. The days will drag themselves until the day you get to redeem yourself. In the meantime, endure the social media posts of classmates celebrating. Unfollow if you must. Shut the world out. Go to a place where you make sense. Reconnect with friends that you rarely see because of our tight schedules. Spend time with your family.

Then hit the books again. Don't look too far. Focus on the now.

***
*and then that song starts playing*

I did my best
But I guess my best wasn't good enough
Cause here we are
Back where we were before
Seems nothin' ever changes
We're back to being strangers
Wondering if we ought to stay
Or head on out the door

JAMES INGRAM
Just Once

*looks at the new car keys on the study table. opens book*
'Chapter 1...'

***

When I finally shook the failures away and got my medical degree, a mentor warned me with these words, "Take extra careful, in my experience, most of the students who had a hard time in medical school do not pass the licensure exam on the first take." Those words were embedded on my mind. Come licensure exam, I shut everything off and focused on the mother of all exams. Nailed it on the first take, while I know some former classmates who did fairly well in med school, even received recognitions, had to take the exam again. 

And to make my story a bit more concrete, I will site a "for instance". During medical school, I had to take surgery twice. Come board exam, it was my highest subject. True story.

In one of my interviews during my applications for residency, a consultant asked me:

"You have a low ranking in medical school, how can we be sure that you can turn this around and pass the specialty board exam?"

I thought, how can I possibly answer that question right?

"With all due respect, Ma'am, if you will review my transcript of records from both undergrad and medical school, I was never on top of the class. I even had to take some courses twice. But if you'll review my record in the Professional Regulatory Commission, I never failed my board exams."

So go ahead. Fail. Fail when it's not yet that relevant. Fail when it's easier to redeem yourself. Fail, then make it a part of your learning process. Fail but don't make that same mistake again. Let failure teach you compassion and empathy. Fail to be sure that when it really matters, all that is left is success. 

Aside from surgery, I also had to take pharmacology twice. But guess what, I will be starting my residency training soon. I was recently appointed as a first year anaesthesiology resident in a hospital in Quezon City.

Kind of cool karma, don't you think?

--------

Missing-In-Action

It's been a while, huh?

I only recently revisited my blog and realised that my last post was still pre-Boards 2015. And well, a lot of things happened since then, many of which I really want to write about but I don't have enough time to actually sit down and pin all the ideas down.

So updates...

1. Yes, I passed the Physician Licensure Examination during the August 2015 season.

2. I am now a part-time junior faculty in my Alma Mater.

3. I underwent two pre-residency cycles. Currently waiting for the call-back anytime now. Posting more about it once it's been signed and sealed.

4. I moved to a new apartment. Sort-of. Same building. Different floor.

5. My mom underwent a major surgery, which is why I have been a bit busy last year.

6. Had a few adventures in the "moonlight".

7. Got engaged.

8. Then I got married.

All of that (a few bits more) in one year and a half.

I recently gave my blog a facelift in hopes that maybe I can find the time and inspiration to post more often. And though I don't have many readers, recently, I found it entertaining to read my blog entries from years ago, so here I am writing so I have more to read later.

In Search For A Miracle

A few nights ago, I had dinner with my boyfriend's roommates in the University. The conversation was light and I enjoyed those few hours with them. This was a table of student engineers and most of them are Christians. They know that I am an MD and one of them, Rob, asked if in my many duty hours, I witnessed a miracle. At that time, I boxed a miracle as a patient coming in DOA and us helping him back to life. Because that, I have never seen. Which is why my answer was a quick, "No."

The next night, it was my turn to go out with my college friends, whom I haven't seen in a while. One of them asked me the different surgeries I've assisted in and I recalled one that I don't think I will forget in a long time.

I was in the General Surgery Service of the hospital I am rotating in. Instead of calling the pre-duty interns, they asked me to scrub in because the surgery might extend after 5 pm as it a staged surgery. Honestly, I cannot remember the name of the patient nor her exact age, all I know is that the patient is a mid-50s/female who came in due to increasing abdominal girth and jaundice. Work-ups were done and they found out that she had liver and kidney cysts. She was put on dialysis and the surgery will unroof the liver cysts and remove one of her cystic kidneys. It is called a staged surgery because one service -- the General Surgery team, where I belong, will open her and unroof the liver cysts and the Urology team with their own intern will do the nephrectomy, after that, we (the GS team) will go back in and close the patient.

I cannot go into the detailed events of what transpired in that OR because of confidentiality reasons. But I will write the details that I can. Our official time out was 2pm. What was supposed to be a 4-5hour surgery stretched to 9. Our patient's BP started falling by the 6th hour. We had to transfuse 13 bags of blood. I can't remember if they were packed RBCs or whole blood. We also transfused platelet concentrate and voluven but the patient's BP was still falling. Our surgeons seriously considered doing damage control. Once or twice I heard that there was the possibility of a table death, which we are all avoiding because a table death is never a good thing. One of the surgeons said that it'll be a miracle if we can get her into the recovery room, more so in the ICU.

By the 8th hour, her BP started stabilizing. We quickly closed her, using staples instead of sutures should there be a need to open her up again.

By the 9th hour we unscrubed and I literally fell down on a chair from exhaustion and hunger. My phone started beeping because I forgot to tell my boyfriend that I will scrub in a 9-hour long surgery. Because in the first place, it wasn't supposed to be a 9-hour long surgery.

I climbed up to the wards for my prerounds for the census after a quick nap as it was already well past midnight. I woke up at around 3 or 4 in the morning for my prerounds with the resident. I told her I will just check on the patient in recovery.

"Huh? Sino? Wala na tayong patient sa RR." She said.

"Doc yung OR ni [General Surgeon] kanina." I answered. "Oh no, she went into the light?"

"Yung unroofing? Hindi, naikayat na sa ICU kanina lang." She said as-a-matter-of-factly.

"No! Seriously?"

"Oo nga. Balita ko nga ang daming nangyari sa OR na yun."

Then for the next three wards that we pre-rounded, I told her the details of the surgery. Yes. Three wards. Because it took that long to relay all the events of the surgery.

"Ang swerte niya ano?" She said.

"And lakas ng mga nagdadasal para sa kanya." I said sleepily.

My rotation in that service ended the next day and I didn't know if the patient made it to full recovery but for us, adding just a few more days to another's life to be with the people they love is miracle enough.

So there. Recalling my many duty days I realise that my answer to Rob's question shouldn't have been a flat "no" but a resounding "yes". As I look back, there are more patients that I have seen at the worst condition one night and walking up and about on the next. But they deserve their own entry, their own story. This is just one of the many.

Talitha Koum!

Many times have I encountered the gospel for today, and I can still remember the first time I read it, it was one of our bible study homework in the protestant grade school I studied in. Of course at that time, it was just some story about Jesus and the girl who rose from the dead.

It was during the homily today that this gospel hit home. I recently finished my post-graduate internship and is on my way to becoming a licensed physician. To most of the people I know and are always with, and even my boyfriend of three years, this is who I am. But they do not know who I was before. 

In a different life, a little over seven years ago, I was a nomad, a vagabond, an aimless wanderer. I did not know what I want to be. I lived in the present. I wasted my parents' time and money sending me to college and culinary school without so much as to what I really want to be. I haven't graduated from college and I almost conceded to being a college undergrad my whole life. I didn't want to go back to the University. I just want everyone to leave me be. 

Until an argument with my Mom drove me to pack my bags and leave home for a while. I sought refuge in my grandmother two expressways away. She took me in, and after a weekend with them, my cousins talked me into going back home. So I did. Little did I know that I was in for a surprise. 

My Mom, while I was away, relayed my problems to a congregation of nuns who serve our community. Upon coming home, their Mother Superior talked to me and gave me a few responsibilities in the community, aiming for me to find my way. It was in their community that I realised that I want to try medical school. But my undergrad degree is in the way. 

I went back to the University to finish the units that I still have pending. Until one day I approached my Mom with an application form for medical school. I need her signature to make sure that I will be able to pay for my way in. My Mom was more than thrilled to sign, her hand was still holding the pen when she hurriedly called my Dad to tell him the news. 

I was in the brink of throwing my life away when circumstances led me to where I am now, and I would be a fool to not recognise God's hands steering my way, I could almost hear him saying "Little girl, get up!"

After the DOH Post Graduate Interns' Commencement Exercises 2015
Philippine Heart Center, Quezon City

I can't say that med school was a breeze but here I am now. I knew that everything I went through before med school prepared me for it and beyond. And I would not have it any other way. 

Your Heart Today (Holy Week 2015 Epiphanies)

"Where there is fear, I can allay

Where there is pain, I can heal

Where there are wounds, I can bind

And hunger, I can fill

Lord, grant me courage

Lord, grant me strength

Grant me compassion

That I may be your heart today..."

Pink Sisters, Tagaytay
PYM Visita Iglesia 2011

To those who don't know, I've been heading the PYM for quite some time, and believe me when I say, they have been with me through many of my ups and downs. During the times that I needed validation of my existence, it was these kids that gave me back my self-esteem and self-confidence. It was also these kids who inspired me to continue and pursue my dream of becoming a physician.

It was during my years with them, when I thought that I have to give up that dream, it was actually the years that God prepared me for a bigger challenge. With them, I learned patience, resilience, resourcefulness and the ability to tolerate a lot of things. While I was in the classroom studying to be a physician, they, together with family and friends, were with me to keep me going and serves as a reminder that no matter how bad things may seem, I would be able to get through it all. 

PGI Pagdanganan, DOH-PCSHC 2015

Roughly one year ago, I received a text message from DOH-Philippine Centers for Specialized Health Care about getting accepted in their Integrated Internship Program. I did not know if this is what I really want or not. I know the demands of this internship program. I know about the hours I have to burn inside the hospital for me to be worthy of putting their name in my Curriculum Vitae. And most importantly, I know what I have to give up to be able to fulfil all of its demands. I have to let go of one of the things that define who I am, the Parish Youth Ministry. 

But being the best Internship Program in Quezon City (I wouldn't dare say that it's the best in the whole country in fear of my UP-PGH internship friends -- although can we tie for being the best?), I know that this is one opportunity I could not let go of. So with excitement and a heavy heart, I went. And sadly, I missed a lot of events and traditions. I missed birthdays and celebrations. 

Serving the marginalized sector in Old Balara, QC

"When comes the day I dread

To see a broken world

Compel me from my cell grown cold

That your people I may behold..."

In the year that I spent with the Program, I met many kinds of people from all walks of life. But mostly, I met patients from the lowest economic sector of the country. I met patients who come in with nothing but the clothes they have and the slippers on their feet, illnesses full blown and there's nothing much we can do. There are times when all I their loved ones can do was hold their hand as life slipped out of their mortal bodies. There were times when we receive patients so broken that I have no idea how we can put them back together. Not once did I have to reassure relatives that everything will be okay, no matter what. 

There was one particular anecdote in the Emergency Room when a young man in his late 30s who came in due to a cerebrovascular bleed, we tried to revive him but to no avail. As he flatlined, my resident asked me a question I don't really want to answer. "Nakapagpronounce ka na ba?"

I shook my head and she said, "Pronounce it, doktora."

And with a sigh and a heavy heart, it was a "first" that I never want to really have. "Time of death, 8:45pm." His name was Michael, he was a family driver. 

There will be more instances that I will have to call it, but this is one that I won't forget in a long time. 

"And when I've done all that I could

Yet there are hearts I cannot move

Lord give me hope

That I may be your heart today..."

 Maybe that is why I was put here. Maybe that is why He had to prepare me. I may not be the best in theory and I'm sure, skills-wise, I am not be that good. Young physicians like me flock the DOH program for the training, He put me there for more than that. 

He taught me courage. To see death face to face yet not be faltered by it. To use what I have learned in school and through experience to be able to help save and improve the quality of life of our patients.

He taught me strength. To know when to let go and let Him take over when all our human efforts to save and heal are exhausted. 

He taught me compassion. To be able to help my patients get through their crosses. Improve, recover. And if it is His will, go home to Him. 

My year with the Program is about to end. In a few months, I will have to declare my specialization and more years of training to follow. But this Holy Week, I go home to my family and my extended family that is the Parish Youth Ministry. Now I understand why I have to give up my position and time with them. Maybe because now, He has put me in a position where I can reach out to more, beyond the youth of the parish, beyond the perimeters of our little parish courtyard, maybe even beyond the walls of the Mother Church, since they are also His people. 

Reunited with the Parish Youth after almost a year of absence. 

Welcome to the Emerald City

Originally posted in Primum non Nocere on May 3, 2014.

Sometimes, when we run after the things we want, the more elusive they can be. But when we stop and stay still for moment, a tornado may sweep us off our feet and bring us to the yellow brick road to our dreams.

I tried to get matched to the DOH-Philippine Centers for Specialized Health Care twice. During the first matching, I went all Legally Blonde and did not have a second choice. But the during the second matching, I listed down my two other hospitals of choice -- our base hospital, Quirino Memorial Medical Center and the other hospital in close proximity, AFP General Hospital. I got matched to QMMC. And from the minute I found out that I was matched, I accepted it and tried to forget my dreams of being a DOH intern.

QMMC, after all, is not a bad choice. It is actually a very close second choice, yung tipong hindi ko lang magustuhan ang isang bagay sa DOH, tatakbo na ako pabalik ng QMMC. QMMC has been my home since 3rd year medical school. I know every twist and turn in its halls. I know almost all the hacks a Junior Intern must know to make life easier. Most of all, a lot of my dear friends chose QMMC, too.

So the wires in my head went all berserk when one of my friends, whose dad can work wonders in East Avenue Medical Center, told me that he is backing up my application in the internship program. Then my cousin, who is a former DOH intern, told me to go ahead and try my chances during the third matching. But I am backing out of DOH, I thought to myself. I have given up. I am going to QMMC and that's that.

But who was I kidding, this was the internship I have been pining for. So, cancelling all my plans for Maundy Thursday, I braved the scorching heat of the summer sun to try and pass the third matching exam and interview, hoping to maybe get in without having to call my friend's dad or my cousin.

Wore my red shoes to the interview to pay homage to Dorothy and her visit to the Emerald City. My red bag is Toto. 

They told us to wait for the results of the 3rd matching after the weekend. And wait I did. It was excruciating to wait. Until I got the message I have been waiting for. I got in. With all the people who supported me and my panel said that my interview went very well, I was thankful that I finally have an official slot.

The girls of Group G. Or at least half of us. 

Fast forward to a week later, after all the uniform-fitting and teambuilding, I found myself in a new group of 15 individuals who braved the challenge of DOH, and fitted into my new subgroup of four -- subgroup G4.

When I saw those two letters, I knew my name will never be the same again. To top it off, it sits above that much coveted DOH - PCSHC logo. 

Labor day 2014 marked the beginning of my year in my Emerald City. I have high hopes for this year, much like my year in QMMC previously. And who knows, after my 365 days here, I might choose to stay or click my ruby red slippers together to find my way back home.

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.