Locked Down

Damn.. A lot can happen in a  couple of weeks..

We are currently about 1 week into the lockdown of Metro Manila which was brought about by the onslaught of the new coronavirus which originated in a wet market somewhere in China *why am I not surprised?).

It hasn't been pretty. Thousands have died in China alone, and although it is seemingly fizzling out already there (new case rates have allegedly bottomed out to ZERO for the past several days in mainland china), it is just emerging in other parts of the world..

An actual PANDEMIC.. I never thought I would see this in my lifetime..

Tensions are running pretty high, but I guess people have kinda adjusted to this new norm. In my part of town people have been generally compliant, although I'm not too sure in the less fortunate areas where people are often belligerent about following rules and regulations due to a poor understandign of the current situation.

There were some really crazy scenes during the leadup to this lockdown. I witnessed firsthand a couple of panic buying situations at the local supermart. We had luckily stocked up on other esentials just the week before, so I wasn't reallly pushing around a cart with a mile-high pile of tissue paper. :P It was soo errie. The mall where I had clinic was basically closed except for the basement level containing the supermarket, a bakery, the clinic, and a cafe (presumably for those senior citizens awaiting their companions who went for groceries). The fastfood was obviously closed. Since I had some lead time before my clinic hours, I explored a bit. The air conditioning was turned off, and the mall was deserted.. I had never seen that place so quiet, save for the occasional footsteps of random store staff checking on their places of work.

As the days went by, stricter measures were put into place, hence the second wave of panic buying. The entirety of Luzon was now under community quarantine, with travel out of homes strictly being monitored and implemented by the local officials, law enforcement, and armed forces. It has been peaceful thus far, with most of the battles being waged in the hallways of hospitals across the country. Being a respiratory physician, I find myself thrust into the frontlines of this new conflict, and I have to admit that I am afraid not only for my life, but more for the people I love.. But these are trying times, and I have to put up a brave front to do what I have to do because this is what I signed up for.. Make no mistake, there is a great temptation to just run away and stay huddled indoors amidst the safety among family. There could always be excuses, to take the easy way out. But this is not compatible with the reality on the ground..

I want to go on, but it feels so heavy already. So much sad news in such a short span of time..

What's with the Title change?

In the grim darkness of the far future, there is only war..

Some of you may be wondering why I decided to finally drop the Organized Chaos title for a more stylized handle. To the 40k fans out there, I'm sure its quite obvious to you that I have found the lure of the Imperium quite appealing. :P

Seriously though, I think it has more to do with growth.. I began blogging sometime before medschool I think.. I had initially started out here, then decided to take my talents to Multiply before it sold out and became this grotesque marketplace which was unrecognizable from the creator's paradise I once enjoyed being a part of.

Ok, so I just visited Multiply.. Its no longer this online marketplace, but a kind of trendy website catering to  the yuppie crowd.

So after the old Multiply shuttered, I found myself crawling back here to Blogger, with all my previous Multiply posts in tow. At least Multiply was gracious enough to allow us to migrate our content as much as possible to other platforms.

All through these three stages, the blog title has remained the same. I felt that all my musings and ramblings would seem totally random to the outside observer, hence the equivocal label which lazily excuses the lack of coherence of the content.

I guess I felt it was time to grow up, and te blog had to grow up with me. I noted that I am no longer slinging out random nonsensical rants. Make no mistake, I still rant a lot, but now my rants have acquired a certain sophistry and coherence compared to my sophomoric tirades of yesteryear.

Why a Warhammer reference though? Simply because I have found it fascinating in recent days, and I have been dicing deep into the lore of the Imperium of Man, as well as the Xenos that inhabit the universe of the 41st century, looked in an epic struggle  across millions of worlds and costing trillions of lives.

Pilyoship part 2

That went better than I expected..

I had an exam and interview a few days ago for a position in (yet another) fellowship training program. When I was way younger, I used to look with awe at those people who took training a few extra steps further. I mean, medicine by itself is already challenging, and residency is definitely not for the weak of heart. Sub-specialty training in is often a must among Internal Medicine residency grads who intend to practice in urban centers, and is no walk in the park either.

After I was done with fellowship training several years ago, the concept of going for further "sub-subspecialty" training seemed like such an abstract idea for me. Maybe its because I felt that I didn't have what it takes? Or perhaps after having been in training so long, I wanted to do things on my own terms? Or maybe because I was just tired of going through the entire process?

To give you an overview of the life of a person in medical training, here is a breakdown of the average years spent in education of someone who would eventually be a sub-specialist:

College degree - 3-5 years*

Medical School - 4 years

Postgraduate internship - 1 year

Residency (Specialty) Training - 3-5 years**

Fellowship (Subspecialty) Training - 2-3 years***

For the sake of simplicity, I chose not to include the INTARMED program popularized by UP Manila.

* College courses in the Philippines are 3 to 5 years in length depending on the university of enrollment and the coursework involved.

** Residency training ranges from 3 years for Internal Medicine and Pediatrics, to 5 years for General Surgery. Not included among these are the so-called "Straight programs" offered by some institutions wherein trainees have a lengthened residency period but are already qualified to take the sub-specialty examinations upon completion (common among the surgical sub-specs like Neurosurgery and Orthopedics).

*** Fellowship training for most sub-specialties like Pulmonology and Gastroenterology last around 2 years. Cardiology and Oncology fellowships are usually longer by a year. I have little idea about the subspecialities for other feilds, but I know Thoracic Surgeons have to take an extra 3 years after their General Surgery residency.

People may opt to take things one step further and pursue either a new sub-specialty (like one of my bosses who is BOTH a Pulmonologist and Oncologist), or delve further into the specialty by choosing a focused area of study to concentrate on (e.g. Interventional Cardiology, Hepatology (Gastroenterology), Sleep Medicine (Pulmonology). The length of this further training is variable, depending on the extent of training required.

From what I have seen, specialization can range from all-out fellowship programs lasting a year or two, to short trainings abroad (2 weeks to 6 months) for the emerging and newly-established fields of study.

Medical practice has been continuously evolving by leaps and bounds the past few decades, and the growth of specialization was inevitable, since it is necessary to keep up with the tremendous amount of new research and advanced techniques.

Having said all that, I made the decision to go and try for further training. Since my practice is in the highly competitive environment of the metropolis, its easy to get lost in the background noise and be considered irrelevant unless you have something that can help you stand out. ;)

I just hope everything eventually works out in the end.. :)