Those old war stories..

This evening found me wandering aimlessly among my old blog posts when I was drawn to the stories from my Clerkship year, starting off with this one.

After reading all the way to the start of Internship, I was awestruck with the realization of what I had already been through in such a short span of time, and what I willingly put myself through to earn my MD..

Some of the stuff I wrote made me chuckle, especially those that said "I hope one day I'll just look back at this and laugh" when describing a particularly toxic rotation. :P

I remember the sleepless nights, staying up to monitor a critical patient closely; those days when you'd be so busy that you're only able to eat lunch at 11pm that evening; the nights when you're just going to bed when your groupmate bursts into the room shouting "Code! Code!" and you get up and rush out to try and resuscitate a patient whose heart had stopped beating...

Clerkship is really a mixed bag. You're supposed to learn and work at the same time, and it's not just simple on-the-job training for routine tasks.You monitor patients and scrub in for ORs one moment, you're attending a major lecture or conference the next.

It still boggles the mind how we were able to survive all that. Considering the workload thrust upon us with very little shut-eye during the duties (which were every other or every 3 days, depending om the rotation), it was a miracle that we were able to stay sharp and healthy enough to do the things that were expected of us..

To cope with the stress and fatigue, people come up with all sorts of creative ways to make oneself "happy" or maximize downtime. During clerkship, a lot of people were drawn to the casual games like Bejeweled and Diner Dash (casual gaming was just gaining a foothold back then).

We had to put up a brave front especially when we were seeing the patients. A lot of the things going on behind closed doors at the hospital is unknown to the public. Al the sacrifices, heartaches, and sob stories remain untold, often by choice.

But there were a lot of good things as well. Fascinating cases, incredible ORs, not to mention all the knowledge one would gain just by interacting with a patient as compared to just reading about cases in a book. 

In the end, it would still be all about the patients. People who came in hoping for relief from whatever malady they are afflicted with. I guess we took on that great responsibility as well, sometimes unknowingly, since we were just medical clerks at the time after all. I guess we could say that we gave it our best(in our own limited way) to make sure that our patients got the care that they deserved.

We were lucky to have our seniors (interns, residents) who have been there and done that, to help us in our goal of learning to treat the sick and give comfort to the afflicted.

We also learned a lot from each other, especially when different people would be lucky enough to handle different cases. Those little informal learning sessions with your groupmates/classmates served not only to increase our collective knowledge, but to tighten the bonds of camaraderie that only a common experience of hardship could forge.

After a year's worth of learning and hard work, it was time to move on. Groups split up as people went their separate ways after graduation. Most proceeded to their post-graduate internships at the different hospitals. Others, particularly those who came from the states, opted to forgo internship (and thus the local boards) and went straight home to take the US boards and eventually train there. 

Clerkship is a very memorable and life-changing experience, but certainly not one which I would ever want to go through again.. :P

My "Urban" reflection paper

As I was browsing through my old files, I came across this reflection paper I made during our Community Medicine rotation in Clerkship. I decided to post it for posterity because I liked the way this essay turned out, especially since it was made amidst the hustle and bustle of the "clerk year". I remember that we were required to write this during the "Urban" part of the Sapang rotation, when we were made to read a short story and had to answer certain points for reflection.

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Insights

    "The Story of Rosary" is a story that one too many Filipino families can relate to. For those who belong to the lower brackets of society, the trials and difficulties that the couple Jaime and Lucy face is the reality of everyday life – poor environmental sanitation, poverty, malnutrition, lack of education, inadequate wages, and lack of government funds.

    The beginning of the story narrates the living conditions of the family. Unlike a middle class family who get to live in a safe neighborhood, poor families hardly have a choice – either they sleep along the streets, or settle for a cramped and crowded relocation area. The implications of such a set-up are numerous, especially for the children and the elderly. Living in close proximity to one another means faster spread of illnesses and infections. Poor sanitation and inadequate facilities promote transmissible water-borne, food-borne, vector-borne diseases. In addition, environmental hazards pose an increased risk of preventable accidents and deaths. Living in such conditions further increases the burden of expenses that the family has to shoulder when untoward incidents such as illnesses, trauma, and death occur.

    The narration continues on to describe how Jaime and his wife Lucy ended up in barrio Tanyong. As like most of the Filipinos in rural areas, the search for a better life begins by moving to the city. The lure of more job opportunities appeals to those who have not been able to sustain profitable work in the provinces. Most families come to the city with hardly an idea of what to do, and most of them did not finish schooling. It becomes a risk, a gamble, to move out of their comfort zone, into an area where urbanization calls for more white-collar employees. Thus, those who can only do manual labor are left with menial jobs, under compensated, earning barely enough for the many children they have brought with them. And even so, because their education is sub-standard, the family continues to grow, with little consideration for family planning. The more children they have, the more they think that their children will eventually be able to rise their family out of poverty.

    It is not surprising then that Filipinos in the lower income bracket tend to look to persons of authority as persons who are infallible, including doctors, politicians, lawmakers. We, as physicians, thus have the responsibility to properly educate our patients, and not to mislead them for our personal gain. Comprehensive and proper health care begins with proper patient education. Proper maternal counseling on nutrition and breastfeeding, as well as vaccination and its possible side reactions, for instance, could help the family save on unnecessary medical expenses, and aid in prevention of future illnesses that could have been avoided.  

    Comprehensive health care entails not only treatment or management, but also prevention. If one of these components is lacking, then we have short-changed our patient. It has been said to us time and again, that we must first do no harm; the patient and his or her welfare should always be of paramount importance. We are always called to guide our patients to decide rationally, and if they are unable to do so, to educate and enlighten them so that they can make the right decisions. This includes understanding the current situation and condition of the patient – personal, social, economic, educational, and spiritual. Thus, for example, in prescribing medication, we should assess if the patient can fund the treatment, for if not, we must alter the regimen into one that is more affordable with comparable efficacy. We prescribe generic drugs so that the patient always has a choice.

    In the end, "The Story of Rosary" cries out the reality that is poverty. Its impact on our society is profound, and may spell the difference between life and death. We have seen how death can be prevented if proper action is taken. Although there is no simple solution to eradicate it, we can do our part in the fight against poverty. We can begin right when the patient-doctor relationship is formed. We are not called to be saviors, but are called to lead those who need to be guided.

BrainiaxMD '07