Coming Out Clean

Enter the Dragon

noreply@blogger.com (Rygel) — Sun, 22 Jan 2012 13:26:00 +0000

I was on hospital duty when the humanity welcomed 2012 and now I'm on duty again as the Year of the Water Dragon will engulf the world. That's 2 New Years. I'm feeling hardpressed to come up with some new years' resolution that should make a better me. So far I've come up with nothing.

It's not as if there is nothing I have to change. It's more of, "where should I start?" I should start showing gratitude and for what I have and stop looking for something I think I want. I have to let those around me know that I appreciate them instead of pretending not to notice. I've got a lot to be thankful for and not a lot to be angry about but yet I act the opposite. My perspective has to change.

Enter the Dragon

[PS: Years of the Dragon should be lucky but the Chinese Zodiac isn't as simple as it sounds. Apparently there are several kinds of Dragons (2012 is the Water Dragon) and every Dragon Year is some body part of a dragon - 2012 is the tail of the dragon - which is the unluckiest of all the dragon years.]

Touch blogging

noreply@blogger.com (Rygel) — Sun, 22 Jan 2012 06:17:00 +0000

Typing a blog on a cellphone should be easy if you're using a qwerty keypad. However, using a touch screen is another story altogether.

I always reasoned that having a smartphone would make me a more active blogger but somehow it hasn't helped at all. Moments worth blogging just pass me by most of the time.

Or maybe it's just my phone.

1st Runner Up

noreply@blogger.com (Rygel) — Fri, 06 Jan 2012 10:19:00 +0000

I finally got the courage to approach him at the gym. Maybe because I was coming down with the flu that's why I actually did this stupid thing. Anyway, I asked if he'd like to grab something to eat when he was done. Meanwhile, I could continue working on my report while waiting.

He actually agreed.

About 15 minutes later, he came over to where I was working. He gave me this excuse that he had to finish some year-end reports and couldn't join me.

I know better. He met someone else in that short period of time. No harm done, except to my pride and ego.

So this is what it feels to be the 1st runner-up.

Another Year's Over

noreply@blogger.com (Rygel) — Sat, 31 Dec 2011 01:00:00 +0000

2011 was one hell of a year. It was the year I ran out of excuses to delay my residency training. I remember hoping that January 1 would never come. The first week of the year found me going (reluctantly) to different hospitals looking for what training slots were open. It was hard not knowing what field I wanted to specialize in. I was clueless.

I was also happy. I was in the best relationship I ever had. I had put my heart and soul into it, held nothing back. But like the song goes - "Flames to dust, lovers to friends. Why do all good things come to an end?" - it also came to an end a month before our 24th month. The song "Nag-iisa, Wala Ka na" suddenly felt oh so much more personal.

The next 2 relationships were short-lived - my fault. I was still a wreck. Maybe I still am now. In the past 2 months I've met and/or dated 22 persons! It's just like when I was looking for a specialization to train in - I don't know what I'm looking for.

And as for my training, it is everything I feared it would be.

Now that I feel totally shrouded in dark clouds, I'm thankful for every ray of light that shines through.

Happy New Year!

the first 6 months

noreply@blogger.com (Rygel) — Wed, 30 Nov 2011 11:23:00 +0000

It has been already a bit more than 6 months since I started my residency training. I wish I could say that it was not as bad as I expected.But it's exactly as I expected. The time constraints are getting to me and the additional activities not directly related to the training are getting on my nerves.

Just the fact that my co-residents are all women, married, with kids makes my own concerns seem small in comparison. How can I argue with a request for me to go on duty on a Sunday because it's a son or daughter's birthday, the only time to attend to wedding plans, etc. etc.?

Ask me what I know so far - not enough. I should know a lot more by now but I'm not focused. I've never been disciplined enough to study a few hours every day. Whatever amount of free time to myself gets wasted on mundane things like sleep and looking for dates.

What bothers me is that I don't have anything good to say about what I'm in right now. It's not that I'm in over my head. It's just that my perspective is somewhat skewed.

I need something to balance the stress. Maybe someone will do.

Taxi!

noreply@blogger.com (Rygel) — Sun, 06 Nov 2011 02:30:00 +0000

It was around 9pm and I was heading home after watching a movie. It was a bit of a movie date that wasn't bad but just felt... Lacking. I had been at work the whole day so was a bit tires and I decided to take a taxi home. I was lost in thought while waiting for the specific taxi line that wouldn't mind going to my place (taxi drivers here are choosy). After maybe 30min I finally got to flag one down.

Like I said, I was deep in thought and it was maybe after 10mins that I got a look at the driver. He was cute (just when I least expected it). Maybe it was the frustration or stress of work that made me foolhardy enough to try and flirt with him :) anyway, i started small talk...

The easiest topic I could think of was to ask about his work (one of my ambitions is to become a taxi driver. Don't ask). He said he drove for 24hrs every other day and since he had insomia, this job made good use of it.

I guess he assumed that I worked at an office because of my clothes. He asked me,
"how much do you earn in a month?"

I answered honestly to that.

He said, "i make that much in one week." and then added, "you could apply as a taxi driver at our office."

....

(and as for the flirting part - where was traffic when it was needed!)

Un(self)aware

noreply@blogger.com (Rygel) — Sat, 08 Oct 2011 09:20:00 +0000

I had not one but two instances this week where my temper slightly got the best of me. The first was a miscommunication with another department over what was being referred to the department I was in. I didn’t make a mistake but when I first heard about it, I suddenly went on the defensive. I should have remained calm.

The second was while attending to a fellow personnel of the institution I am in. I may or may not have intentionally made them wait longer than was usual. And I might have been slightly callous in my interaction.

Maintaining a pleasing demeanor is hard when things are happening so fast and when I get surprised. It’s something I need to learn or one day it’ll get me into big trouble.

Gossip

noreply@blogger.com (Rygel) — Fri, 23 Sep 2011 14:11:00 +0000

Almost everyone I know won’t give a second thought to spreading gossip as something they heard or saw firsthand. That’s why I find it ironic (and very irritating) why relatives of patients always want to hear the news straight from the doctor - they don’t seem to trust others to give them news about the medical status of their loved-ones. Irritating because you have to repeat the same stuff over and over and over everytime a new relative comes to visit.

If only people would do the same when it comes to news about other people.

Incident Report

noreply@blogger.com (Rygel) — Wed, 14 Sep 2011 13:41:00 +0000

Ganito pala feeling pag nagkaron ng incident report (IR). Parang defensive ka lagi at paranoid. Lalo mahirap kung yung attitude and body language ang point of conflict, very subjective. Masyadong madaming variables ang involved sa interpretation nun. Pero dahil sa nangyari pati sa galaw ko paranoid ako baka kasi meron maoffend ule, which may be a good thing. Pero parang parang may backseat driver pag ganito - makakaabot ka nga sa pupuntahan pero ang sakit sa ulo

(trans:)
So this is what it feel’s like to have an incident report (IR). You feel defensive and paranoid all the time. More so when the focus of the report is my attitude and body language - very subjective. There are too many things that affect one’s interpretation. Because of this, I’m overly conscious that I might offend someone again. That may be a good thing. But it feels like having a backseat driver - you’ll still get to your destination, but you’ll have one hell of a headache!

Sometimes Love Aint Enough

noreply@blogger.com (Rygel) — Mon, 12 Sep 2011 11:42:00 +0000

Sometimes Love Just Ain't Enough

There was a time when I believed that love conquers all, that it was all that was needed. I used to believe that as long as one was in love and was loved, nothing else would matter - every problem at work or in school would mean nothing. I was selfish to believe that I could do that for someone, and even more selfish to think that when the person I was in love with experienced a setback and became upset, I would see it as my failure or a sign that he forgot about me that's why he was affected by the setback.

I'm wiser now and not illusioned by the thought that love conquers all. I now know that my beloved will not be thinking of me all the time, especially when he's busy. In fact, he may even forget all about me for a short time when under stress (either work- school- or family-related). I also know that when he tells me he is having a bad day, he just wants to tell me that's that. He's not asking me what to do, he's not blaming me. He's just sharing what he's going through and wants someone to listen.

Gimme Time!

noreply@blogger.com (Rygel) — Sun, 11 Sep 2011 09:46:00 +0000

As if the work-related stuff wasn't enough. Our department is in charge of handling the Christmas party preparations of the hospital, the Christmas party of the organization of our specialty involving 4 other hospitals. On top of that we have quite an ambitious presentation number to be presented at the annual national convention. These all need time. It's not enough that work already demands most of my time. The extra-curricular activities will require whatever is left. Suddenly Christmas season isn't something I'm looking forward to anymore.

Only Human

noreply@blogger.com (Rygel) — Sun, 04 Sep 2011 12:53:00 +0000

The kid was brought in because of episodic right ear pain. PE showed hardened ear wax but the doctor mistakenly wrote down “left ear” and gave instructions for oil to be dropped in the left ear. After 5 days, patient came back without any improvement;

He came in because of nasal stuffiness and was found to have sinusitis. He was given antibiotics but the doctor forgot to give meds for the itchiness and stuffiness. The patient was uncomfortable for 4 days more but eventually got well;

She had difficulty swallowing for 1 week and decided to go to the ER. Nothing wrong could be seen on PE and the doctor suggested using a small camera to visualize the deeper parts of the throat. The patient hesitated and downplayed her symptoms. The doctor didn’t insist. Five days later she came back unable to eat and drink without difficulty for the past 5 days.

I was the one who saw those patients. It was a busy day. The senior residents were in the operating room and I was the only one manning the OPD and ER of my department. It was also one of those “toxic” days when patients seemed to have decided to come in all at the same time - I was on my toes the whole time. Still that isn’t an allowable excuse in this field. Maybe they were minor mistakes, small things overlooked and friends would even give encouraging words. But, what if you were one of the above patients?

Vampire Love

noreply@blogger.com (Rygel) — Sat, 27 Aug 2011 04:09:00 +0000

In the world of Anne Rice’s Vampire Chronicles, vampires are passionate creatures that are always in love (although in a twisted sort of way). Usually it is a human who draws their affection. As supernatural beings, vampires have the ability to read the thoughts and even feelings of humans and this intensifies the bond between the vampire and his human love. But when mortality catches up, either by sickness, injury, or old age, the vampire is faced with the hard choice of loosing the one he loves or to make his lover a vampire, an immortal. The irony here is that in “making” a vampire, the maker looses the ability to see the thoughts of his offspring and more ironic, the newly made vampire will almost always despise his maker for taking away his humanity.

In a way it somehow mirrors reality. While dating someone whom I share mutual attraction with,the feelings are intense. Even simple conversations take a life of their own. But the real test comes when commitment steps in. All of a sudden, there are things you cannot talk about, things you cannot share (for one reason or another) because it might cause misunderstandings.

Ironic how we sometimes can be completely honest with strangers and keep secrets from people close to us.

Late!

noreply@blogger.com (Rygel) — Wed, 24 Aug 2011 12:21:00 +0000

It really wasn't my day. Out of the 4 months I've been in training, this was the first time I was late for work. For some reason the traffic was unusually heavy and what was usually a 15-minute commute became 45 minutes.

It didn't help that I was particularly irritable today. I happen to be the only guy :p in the department and I have to say that when males are the minority, expect the workplace to have a bit more tense atmosphere. It has a lot to do with the FACT that women expect a lot more but explain a lot less - when they tell you to do something, they leave out certain instructions that they EXPECT you to already anticipate. And when you fail to do what was "expected" they have a way of making you feel ashamed for not having thought of it.

Maybe it's not my nature to ask others to do tasks. And maybe women are natural leaders because it seems 2nd nature for them to "delegate" tasks to those around them. In fact, they don't run out of tasks to do, nor do they run out of tasks to do for people around them.

It just wasn't my day.

Love Wiser

noreply@blogger.com (Rygel) — Sat, 20 Aug 2011 10:28:00 +0000

I've always believed that I have never learned to love someone. In my past relationships, my attraction to them was instant and I believe was love at first sight. Many would disagree but then no one can give a direct answer to the question:

when does infatuation end, and love start?

I still envy those who are not single. They're lucky to have someone to share with. It's becoming increasingly difficult to find someone after each relationship. Maybe because, the definition of love changes after each (failed) relationship. There are more expectations as to what love is. That might be the so-called wisdom concerning relationships of those who are older.

I don't agree. It just seems that as time passes by, we become less willing to take the risks involved in falling in love. Whether that is wisdom or not is subject to debate.

Finding a Quality Doctor (Repost)

noreply@blogger.com (Rygel) — Sat, 20 Aug 2011 05:43:00 +0000

Reposted From http://well.blogs.nytimes.com/2011/08/18/finding-a-quality-doctor/

Finding a Quality Doctor
By Danielle Ofri, M.D.

“Quality.” It’s one of those words that used to mean something: actual quality you could trust. Nowadays in hospital hallways, quality is a charged word that is more corporate-speak than actual English, eliciting stomach churning and eye rolling in equal measures.

Quality. Who can argue with such a noble goal? Of course we all want quality medical care. Doctors want to provide quality care, patients want to receive quality care, and administrators want to demonstrate quality care in their institutions. All parties aligned in agreement.

The problem, of course, is that no one can agree on how to measure quality. This might be an intriguing question to untangle, if it weren’t for the fact that the quality measurement field has long since left the starting gate. Despite a lack of agreement on how best to measure quality, metrics are being applied broadly, with concrete consequences for doctors, nurses, hospitals and patients.
My own experience in being evaluated for “quality” left me with decidedly mixed feelings. Our hospital had undertaken a laudable and herculean effort to improve the care of patients with diabetes. There was no disagreement that diabetes is one of the most complicated diseases we face, and that these patients would benefit from the best medical care possible.

In that light, each doctor was given a report card citing the percentages of his or her patients whose glucose, blood pressure and cholesterol were “at goal.” These seemed like reasonable data points to evaluate how good a job we were doing.

My report card was dismal, way below the targets our institution had set. It made me feel awful, because I was already working hard. But I felt guilty about the bad numbers, so I worked harder, staying later in the office and calling patients from home. Still, my numbers didn’t seem to budge; it was downright dispiriting.

I wrote about this experience in an essay in The New England Journal of Medicine. In it, I tried to point out that these sorts of metrics don’t give a full measure of quality; they simply measure what is easy for administrators to measure. Like the blind men touching the elephant, they can describe only isolated parts of a medical encounter. Each metric might be important, but they do not add up to the totality of good medical care.

Most people, when they need a doctor, ask for personal recommendations about someone who is smart, caring, thorough, thoughtful and trustworthy. Rarely do they ask for a physician with the best stats.

The responses were swift and vehement. “Dr. Ofri, are you afraid to be measured by hard data?” was a common refrain. My suggestions that most doctors are genuinely doing their best to help their patients and that these report cards might not be accurate reflections of their care were considered evidence of arrogance.

Many of these opinions came from doctors — but mostly doctors who were not involved in direct patient care (medical administrators, pathologists, radiologists). None were in the trenches of primary care.

In contrast to these comments, I was flooded with personal letters from nurses and doctors who felt demoralized by the quality measurement system. These were clinicians who were trying their best in a dysfunctional system, but were constantly being told how they weren’t measuring up. Many said that they were ready to quit, but couldn’t countenance abandoning their patients.
I thought about these nurses and doctors when I came across a recent study that found that patient outcomes (in this case, preventing readmission to the hospital after being discharged) were correlated more strongly to the “fuzzy” measure of patient satisfaction than to the standard “objective” measures of quality.

Patient satisfaction can be an amorphous thing to quantify. But typically, when someone expresses satisfaction with a doctor’s care and would recommend him or her to someone else, it usually includes those “soft” attributes like attentiveness, curiosity, compassion, diligence, connection and communication.

There certainly are some bad doctors out there — incompetents, loafers — and they should be weeded out. But they are a minority.

This is not to say that there isn’t room for every doctor to improve. I don’t view my poor scores as a free pass to blame the system for everything. I have to take responsibility for the things that I have control over, and do my best to stay current and improve my skills.

We need to remind ourselves and the public, though, that these quality measures miss much of what makes a good doctor good. If you want every blood pressure below 130/80, hire a computer to dose the drinking water with antihypertensives. The quality measures will be perfect, and every hospital will be No. 1 in the U.S. News & World Report rankings.

But if you are facing illness — critical, chronic or terminal — you might seek other qualities.

Macho

noreply@blogger.com (Rygel) — Thu, 04 Aug 2011 15:52:00 +0000

This may be a “macho” culture but in the hospital you can witness that the pain tolerance of the male species is so low it’s humiliating to watch. Whether it be physical or emotional pain even the largest man falls a lot earlier than women.

The Blame Game

noreply@blogger.com (Rygel) — Sun, 31 Jul 2011 04:54:00 +0000

They were couple in their 60s. The earned their living by selling clothes hangers at a market. It was around 4am on a Sunday and it had been raining throughout the night. It was cold and they were cold from the rain so they decided to skin the pedestrian overpass and just jay-walk across the main road. Anyway there were so few vehicles this early in the morning.

*****

It was a rainy night and nothing was better than enjoying the night out with friends and some beer to counter the cool weather. It was almost 4am and most of his friends had already gone home. He was a bit tipsy but he decided he could manage driving his motorcycle home. It was still raining when he left the bar and he didn’t have a raincoat with him. He got into his motorcycle and drove as fast as he could, a bit irritated that the drops of rain flowed into his eyes.

*****

They were almost at the other side of the road and watching their step on the slippery asphalt, anxious to put their heavy wares down. They almost made it safely.

*****

He had just a little too much to drink and the cold rain wasn’t helping a bit. He had to focus all his concentration on avoiding the puddles along the road. He didn’t see the two people crossing the street.

*****

The woman was suddenly flung from the side of the man. She hit her head on the pavement. The driver of the motorcycle that hit her thankfully stopped and brought her to the ER. She had a broken leg and although conscious, it was very likely at the very least that he had a concussion.

*****
*****

Who was at fault:

The motorcycle driver who should have waited until he was sober before driving home? [but it was raining, and he was cold, and he was within the speed limit]

The couple who should have used the pedestrian overpass? [but it was several steps high, and their wares were heavy, and it was raining]

The Celebrity Visitor

noreply@blogger.com (Rygel) — Sun, 24 Jul 2011 09:07:00 +0000

The kid saw her first and tried to get the attention of her mom.
She kept pointing but her mom couldn't see who she was pointing at.
But the kid insisted that she could see someone...

So they decided to take a picture...

In One Ear....

noreply@blogger.com (Rygel) — Thu, 14 Jul 2011 04:45:00 +0000

Patient: I don't think the ear drops the other doctor gave me is working.

Doc Ry: why do you say that?

Patient: because when I place a few drops in one ear, they come out the other.

Get Well or Feel Better Part II

noreply@blogger.com (Rygel) — Tue, 12 Jul 2011 04:00:00 +0000

It was barely 8am when I was informed we had a patient in the ER. Male, complaining of difficulty breathing and throat pain among other complaints.

I saw him. He was a typical middle aged man maybe in his 40s. He didn't seem to have any difficulty breathing but he looked a bit anxious.

It turned out that his primary concern was throat pain which he had been experiencing on and off for about 2 months. He described it as extreme dryness of his throat and a sensation that not everything he swallowed would 'go down'. Then he added the other litany of complaints - difficulty breathing, tires easily, various muscle pains.

They say that an accurate diagnosis can be made 80% of the time just from the history. In this case I was fairly sure that he was under a lot of stress, maybe work-related which would explain all his complaints as well as cause hyperacidity which could cause reflux symptoms.

Usually an endoscopy would be needed to confirm my suspicions but due to technical difficulties that wasn't an option at the moment.

Instead I tried to explain what was going on in his body. Illustrations helped a lot. It turned out to be an interactive lecture about physiology in as simple terms as I could manage. If I had a laptop and projector on hand...

Usually this kind of thing makes the patient go, "I don't care about this stuff! Just give me something to feel better!" But apparently several of my educated "guesses" were spot on that he paid attention.

Eventually we came to the part of stress where he volunteered that he indeed had a demanding job and he was stressed out to the point that seeing the long queue for the train ride to work would almost cause him to panic.

It took me longer to talk to him than it took me to suture the wounds of several past patients. By the time we were done he was visibly relaxed (and I was tired)

No medications were given.
He still had his stressful job.
He still had throat dryness.
He still had the sensation of difficulty in swallowing food.
He still tires easily.

He claimed he felt better and the pain had subsided and he was breathing easier. But nothing had changed...
Except maybe the level of his self-awareness.

[PS: An accurate diagnosis can be made 80% of the time with a good history. So there's a 20% chance he'll be coming back mad as hell because I was way of course.]

Get Well or Feel Better I

noreply@blogger.com (Rygel) — Sun, 10 Jul 2011 04:15:00 +0000

She was in her 60s. Apparently she was suffering from a disease that caused her nerves to go haywire. For several months she had been experiencing lightning like pains on her face and head. She also started to have difficulty swallowing. Her voice had become hoarse and breathy. Several tests had been done, medications given but the symptoms were becoming worse. She had lost a lot of weight, had poor appetite, and was very weak and had to be sedated to be able to sleep.

A referral was made to our department for evaluation. A camera was passed through her mouth to visualize her throat. Just above her voice box and covering half of the entrance to the food tube was a tumor. This was definitely the cause of the difficulty swallowing and voice changes. But the pain might be because of another problem.

A few nights before she left the hospital I came across her fully awake. She burst into tears. "I don't want to die," she said. She recounted the suffering she had been through for the past few months. "I'm loosing hope. My brother just died of cancer and I'm going next."

I talked with her. and left.

*******

A few weeks later, I saw her again. She was back for a follow-up consultation.

Yes, she still was experiencing the pain.

Yes, it was still a chore to swallow food.

Yes, her voice was as raspy as ever.

Yes, the thing in her throat was cancer.

Yes, she had to undergo radiation therapy.

Yes, she was still frail to look at.

Yes, she still had difficulty sleeping.

In fact, everything that caused her recent confinement to the hospital was still there.
Now she even knew she had cancer.

But she was smiling. Her voice was energetic. She was making jokes.
She walked on her own. She was stronger.

The only thing different was that somehow, during the last few weeks...
She had found the will to live.

When Doctors Cry

noreply@blogger.com (Rygel) — Thu, 07 Jul 2011 04:50:00 +0000

I was on my way to the Emergency Room when I heard someone calling my name. It was a former classmate in medical school. She was sitting outside the ER, teary eyed. “It’s my father.” she said. “He has metastatic cancer. Now, he’s unresponsive. His pupils are dilated.”

I didn’t know what to say. Just in the hospital where I work, a consultant had already lost her mother to an illness. Another’s father ~~is loosing~~ lost a fight against an infection. And yet another’s newborn son is fighting for his life.

Her father had prostrate cancer that had spread to his bones. “You know the course of this disease and how painful it is,” I told her hoping to imply that she should take comfort that the suffering would come to an end.

“I know,” she said, “but it’s still so hard.”

“I think I’ve forgotten that I’m a doctor.”

That froze my mind. How are doctors supposed to act and feel when it’s their loved ones who are slipping away? Are we expected to look on impassively, and intellectualize what is happening to loved ones who are suffering from disease?

Whether it’s our fault or not that many think we have power over death – Well, we don’t!

The process of loosing someone is more painful for us than for anyone else because we, of all people, know ahead of the others when nature has chosen it’s course. But we have to suffer with that knowledge, alone, while waiting for the others to accept that it is time to let go. And during that time we can only grieve while in private because showing grief even to family members may destroy what small hope they have left, despite the odds.

To my classmate, “No, you haven’t forgotten that you’re a doctor. You are part of the minority who now knows what it really means to be a doctor.”

Praying and Doctors

noreply@blogger.com (Rygel) — Tue, 05 Jul 2011 11:58:00 +0000

Would you feel better or worse if your doctor says

He’ll pray for the (your loved one) patient?

Boj

noreply@blogger.com (Rygel) — Fri, 01 Jul 2011 14:45:00 +0000

His arrival was sudden. He was not expected until a full 3 months later. Even his own body was not ready for the real world. He was not ready to breath our air. He had to stay in an incubator until he could survive on his own. He was fondly called Boj, short for 'bundle of joy'. His parents loved him unconditionally.

Against the odds he survived the first 3 months and it was finally decided that he could go home with his parents as a complete family. He had been through a lot, and so did his parents. The good news was welcomed by everyone.

Three weeks later he was back in the intensive care unit. Something was wrong with his lungs. They wouldn't function properly. While life goes on, his and those of his parents are a standstill. Seeing his father telling him that he loves him and his mother smiling at him through tear-stained eyes would break anyone's heart.

But miracles still happen.

Maybe he will be one of them.