Stallions MD: Congratulations!!!!!!

Taken from a post at the Xavier School website (www.xs.edu.ph)

Two Xaverians Top Medical Board Exam

August 2006 Boards Produces Ten New Doctors

Cesareo U. Tongco II (XS ’97)

The Physician Licensure Examination in August 2006 was topped by two Xaverians. Patrick Leonard G. Co (XS ’96) bested 2,696 examinees from all over the country to emerge as the board topnotcher, #1 overall. Nathaniel L. Yu Chua (XS ’97) also made it to the top ten, he tied for #8 overall. This is probably the first time that a Xaverian has become the #1 board topnotcher, and certainly the first time that two of our own have made it into the top ten.

Eight other Xaverians were among the 1,491 new doctors. These are Ishmael Christian D. Ching (XS ’97), Vicente Francisco Q. Firmalo (XS ’97), Patrick H. How (XS ’96), Rey Emmanuel S. Lu (XS ’97), Fernando A. Melendres Jr. (XS ’97), John Eric N. Tan (XS ’97), Kimberson C. Tanco (XS ’98), and Cesareo Amadeo U. Tongco II (XS ’97). The Oathtaking of the New Physicians was held on Sunday, September 17, 2006 at the PICC Plenary Hall.

Both topnotchers, Patrick Co and Nathaniel Yu Chua, were from UST, as was Kimberson Tanco. Ishmael Ching, Vicente Firmalo, Patrick How, Rey Lu, and Cesareo Tongco II, took Medicine in UERM-MMC. John Eric Tan was from De La Salle - Dasmariñas, while Fernando Melendres studied at UP-PGH.

Luceat Lux!!!

Legal Med, Ophtha, ENT, and now Derma...

Well, that was quite a month that passed by...

I've been through 3 rotations since the last entry. And I've yet to continue work on my much-heralded San Lazaro Chronicles, which is merely gathering dust here at the DRAFTS section of my blog..

But come to think of it, it dosen't seem as important as my Fabella stories 'coz of the simple reason that we were not the first of our batch to rotate there (at San Lazaro). So I guess I might have to put it off indefinitely.. The hoispital stay there was unremarkable anyway. Hehehe

So off we went to Legal Med, or what they called The Medico-Legal Department in the hospital. I won't go through the day-by-day occurences because much of it was pretty dull anyway. Duties were still every 3 days, but the pre- and from-duty posts really rocked. =)

PRE-DUTY:
You're supposed to report to the PNP Crime Laboratory there at Camp Crame. There you would encounter rape cases, where you're supposed to examine the victim for documentation. Eh siyempre since I'm a guy, my job was purely clerical.. which suits me just fine... =D There were also some cases of physical examination of prisoners prior to transfer, which seemed like a formality more than anything.

DUTY:
The most toxic of the posts. You stay in UST for a good 24 hours (yes, its true, only 24 freakin hours!!) to answer all calls from the ERCD or TR-Pay for medico-legal cases, which you have to document via history and PE, let the relative and attending physician sign, and go back to the legal med office to type the rest of the papers! Its that freakin' simple!! =P Well, it should be simple as long as there aren't TOO MANY cases/calls that come through... Let's just say that during my duty night (with Johnny O. as my ever trusty sidekick), we were called down for 12 cases, 5 of which were people involved in the same vehicular accident!..And that was at around 9pm up to about 2am!!! Enough said... But in fairness to the "most nontoxic rotation" label, it was only here where I was able to actually finish volume 1 of the Handbook of Must-Knows! I just wish we had a laptop during those boring duty nights. Nakakasawa nasi yung sounds sa PPC ko eh..

FROM-DUTY:
This one takes the cake... UST expects us to be at Crame.... Whilre Crame expects us to be at UST... Go figure.. ;D

After 8 wonderful days at Legal Med, it was time to move on to Ophthalmology

Ok, here goes...

Ophtha was a bit different as compared to the other services I've rotated to, since it was the first time we got to experience "duty" status that dosen't require you to stay for the full 24++ freakin' hours! :D Non-duty clerks had to man the OPD and face the seemingly never-ending masses of ophtha patients that come to consult every day. Duty days were great, since you go home by 7pm. Other than that, I found my stay in Ophtha less than appealing... In fairness to the department though, I was really able to learn a lot, especially with regards to the proper ophthalmological physical examination. I even had the chance to observe a phaecoemulsification with IOL placement done by Dr. Say himself!! Ang bilis! At ang galing!!! :D

But there's a flipside to every story... Lets just say that in my opinion, the supposed "niceness" of the ophtha staff is seriously overrated.. and I'll just leave it at that... In other words, I left the service with a bad taste in the mouth..

After another 8 days, it was time to go to the department of Otorhinolaryngology (aka ENT)...

With ENT, the group prepared for the worst.. Feedback from other groups had made ourselves brace for the worst posible scenarios.. Impressions at the time were the following...

1. ENT has EXTEMELY LONG ORs (20 hours long pa daw, or even 8 hours just for a simple thyroidectomy)
2. ENT residents are really strict and mean
3. ENT duties are the most "wasakan" duties this side of Medicine
4. ENT leks to mass-admit on weekends

I won't argue with #3 and #4, since the duty days were REALLY TOXIC, and they really are fond of mass-admitting patients on Saturdays and Sundays, but I feel that they've been given a bum rap with regards to #'s 1 and 2. I myself assisted an ENT total thyroidectomy, which took about 4 hours. Not really ala-GenSurg speed, but reasonable enough, since they (ENT) take great pains not to hit the recurrent laryngeal nerve and preserve vocal function. And the ENT residents really rocked! I mean, they may be strict at first, but if you get to know then, they;'re actually a pretty cool crew. :D

Yes, contrary to popular belief, the ENT people do have ORs. That's why the department is called ENT-HNS (HNS stands for Head and Neck Surgery)

Here's a rundown of the duty posts:

Pre- and From-duty:
Similar to Ophtha, non-duty clerks have to go down to man the OPD at the ground floor. There you perform the complete ENT physical examination, using such tools as the ever-popular otoscope to the lesser-known items like the nasal speculum and the laryngeal mirror (which is more familiar in the hands of dentists). We encountered the more common cases that you see if you do OPD work at ENT like impacted cerumen, acute and chronic otitis media, pharyngolaryngeal reflux, postnasal drip, and even some cases of goiter presenting with an enlarging neck mass (duh!) with/without hoarseness.

I really enjoyed the OPD time at ENT. There's just so much you can do! The residents realized my enthusiasm and gave me the go-signal to perform some simple procedures done at the OPD (which the patients have to pay a little bit extra to have done :D) like ear irrigation to remove impacted cerumen. It's just too bad they didn't let me use the vaccum yet.. hehehe

I'm really giving ENT a serious thought when the time comes to choose Elective rotations. :D

Duty:
Duties, on the other hand, were just plain terrible! In the words of our interns, it was ":THE WORST". I mean, you're just a team of 2, running the entire 2 wards (which were filled with patients over the weekend) with various "weird" tasks like CT scans, neck ultrasounds, Thyroid function tests, Radio-onco referrerals, applications to St. Cosmas, clinical abstracts for DOTS treatment, and many many more...

Sobrang nakakapagod talaga... but in fairness to them, the staff aren't that strict when it comes to monitorings.. heeheehee.. plus the fact that you get another chance to "make money" from walk-in patients from the ER by way of the ever-famous "donation box" =D.

In short, ENT was very tiring, but it was a lot of fun. ORs I attended were a Total Thyroidectomy and a Tracheostomy (where thery even let me suture!)

That's enough for this entry. I'll follow-up later on with stories from Derma and (hopefully) the San Lazaro Chronicles..

Surgery Backtrack and a sneak peek at the San Lazaro Chronicles

On the prowl again here at the LRU.. Some things were never meant to change.. ;)

Just got back after duty at San Lazaro... you know, THE official infectious diseases hospital of the Philippines.. Good Lord, I just had duty at the dreaded Pav 10, the TB WARD... Tsk tsk... I can only shake my head at the state of things that I saw.. But I won't get ahead of myself and stick to the chronology =P

Surgery... What can I say? I'm really grateful that the teams agreed to slide for Neuro/Plastic and I'd like to congratulate our group for a job well done!

Shoutouts go to the Neurosugery team (Drs. Ranoa/Navarro/Pacia) and the Plasticman himself, Dr. Butch Mapayo! Astig kayo doc!

By the way, I forgot to mention the ORs I attended/observed at this service, so here's a brief list..

NEURO
Cranitomy (open up the skull to remove something from the brain)
Emergency Ventriculostomy (drill a hole through the skull to reach the ventricles and put a drain)

PLASTIC
Burn wound care (as in a VERY LARGE burn wound, encompassing the entire back, butt and some of the extremities)
Cheiloplasty (repair of cleft lip)

With Neuro-"toxic" behind us, we prepared to settle down to an easier time with Pedia/Uro, which was not really the case.. Urology is infamous for it's ultra-rapid turnover of patients, while Pedia referrals for Pedia Surg cases are at times toxic, to say the least...

Be that as it may, I really enjoyed this particular rotation, especially Uro (since my only patient at Pedia surgery was a case of a leg abscess which needed to be drained). The Uro ORs that I went to really rocked, although they looked pretty painful (well, from a guy's point of view anyway. I won't elaborate 'coz it might be too graphic...). I was able to observe a TURP and assist in an Anatrophic Nephrolithotomy and a Cystolitholapaxy.

Here are some short definitions to my dear uninitiated readers

TURP - short for Trans-Urethral Resection of the Prostate. Basically, you literally scape the enlarged protaste like wax from a candle though an acess port passing through the male urethra.. I won't explain how this is done.. You hafta research and imagine it nalang 'coz descibing it could make make some people flinch and my blog could lose what little readership it has. =P

Anatrophic Nephrolithotomy - you cut through the back to reach the kidney, cut open the kidney, and remove the stone trapped there. But believe me, its a lot harder than how I made it sound..

Cystolitholapaxy - another transurethral technique. You basically put a "nutcracker" into the urinary bladder by passing through the urethra, and use it to crush the stones trapped within. Then you aspirate the stone fragments via the same route.. Ouch...

It was times like these that made me grateful to the guy who invented anesthetic...

Thanks to the Urology team (Drs. Hipol III/Bisnar/Domingo/Ocampo) for making our stay as pleasant and interesting as possible, even though we screwed up big time with a particular patient. Thanks for not chewing us out even though you were really pissed off at what happened.

Also thanks to the Pedia surg people from GS (Drs. Dizon/Olalia/Alay-Ay/Nitisasmito/Manzo) during that time. You guys keep on rotating that it's hard to keep track with regards to who is assigned to what..

Moving on, we found ourselves at our last rotation at Surgery.. TCVS/Ortho, branded my some as the most benign rotation in all of Surgery. =D And it didn't disappoint one bit.. It was during this rotation that I was finally able to use the slippers I brought for exclusive use at the clerks room, and this was the time I got the most amount of sleep from any duty night I've been through so far... Not bad, not bad at all... =D

TCVS didn't have any ORs for me though. New TCVS patients are a rarity at the clinical division. But thanks to Dr. Jay Junio, the sole TCVS man of the hospital, we were able to observe at an Open-Heart Surgery there at the Pay division. He also let me assist during a bedside CTT insertion, and ako pa talaga yung nagpasok ng tube!!

*CTT - Chest Tube Thoracostomy. You cut a hole in between the ribs to drain whatever is in the cavity of the lungs which requires removal, be it extrapulmonary air, blood, or tissue fluid)

I also won't forget the times we went with him on rounds, and he gave me the power to write at the Physician's Order Sheets! Wow pare, parang intern! Astig!! =D It made me feel so powerful! Bwahaha! Wala lang...

For Orthopaedics naman.. I'm all praises for the Ortho team (Drs. Yumul/Tarigan/Angeles/Braganza). They made stuff seem light and interesting, especially Doc Braggy (who I happened to have already met a few years back when I was an MT intern and he was still in 3rd year med). Cool ka bro! Thanks for everything! I also had quite a bit of OR time at Ortho, assisting in an ORIF and arthotomy/synovectomy..

ORIF - short for Open Reduction Internal Fixation. Done for some types of fractures, it means opening up the patient, re-aligning the fractured bony parts, and applying internal fixation devices (like screws and plates) which are left inside the patient's body.

Arthrotomy/synovectomy - Literally means opening up the joint cavity/removing the lining of the joint cavity

Before we knew it, Surgery was over! And to think that at times it just seemed to drag on forever...

We held a sportsfest at the end of the rotation. Ang gagaling nung mga residents sa basketball! Tambak kami 30+ points!! =(

We also had a grand duty which I was unfortunately unable to attend.. Not that sobrang naghihinayang ako or anything, coz I heard that it was too loud for my taste anyway. =D

Alas, all good things must come to an end.. Id like to thank my surgery teammates for all the laughter we've shared and all that we've been through together, and I'd also like to say sorry for anything I've done (or not done for that matter)...

My Surgery groupmates...

Osang a.k.a. "partner"
Em
Rhyan
Leigh
Tricia
Marlon
Au

Thank you guys for everything!! I won't forget yung mga pinagsamahan natin!!

I'd also like to give a shout-out to my dutymates (the people from the other services na palagi naming ka-duty ni Osang, well, except for the time na nag-sliding kami.. (and nung nauso na rin ang sliding sa inyo) hehehe

Joanne/Mary/Maan
Braix/Dinah
Michelle/Ira/Jacky
Kathy/Aina/Grace
Lawrence/Christine

It was loads of fun despite the toxicity! I'm glad to have known some of you better during the bonding seesions. Thanks for the memories friends!!

For the next issue.. the SAN LAZARO CHRONICLES

"Don't you find it ironic that they call the place San Lazaro, but this happens to be where a lot of people end up dying or dead?..." - BraniaxMD

Sliders

Yup, that's what we are... sliders..

In med talk, "sliding" is defined as going direct from one duty to the other (Duty-From-Duty-From)

And believe me, it hasn't been easy...

Our group decided to slide because of the apparent lack of manpower required when a group rotates to the Neurosurgery/Plastic surgery rotation...

And despite all the sliding, we can't help but feel that it still isn't enough..

But we get by, somehow... We're currently wrapping up the Nuero/Plastic rotation. Two more freakin' days to go. Then we "unslide" and return to the old pattern which recognizes a "pre-duty" status.

Last night has got to be one of the worst days to ever hit a neurosurgery duty team. Grabe, last night, we were undermanned, overworked, and underslept (if there was ever such a word.) as in WALANG TULUGAN!! The day started out neatly enough. Not many ORs since it was a Saturday, however, we had one in the PM when the non-duty people had already left. Not bad, I could handle the ward all by myself for the next couple of hours.. When my groupmates emerged from the OR, I felt such a great surge of relief.. WE only had one more OR to go later that evening which was merely a simple change of dressing for a severely burned electrical burn patient, hence the need to perform it in the OR. This poor guy had his skin burned off his entire back, parts of the back of his head, and even his ass!! Tsk! Tsk! And he already lost a leg during an earlier operation to save his life.

AFter that was over, we preppede ourselves for a relaxing night.. However, our peace and solitude was shattered by a call which told us to proceed immediately to the Emergency room of the Pay hospital (we were in the "clinical" division, a nicer word for "cheaper") to pick up a patient who was to undergo emergency crainiotomy ASAP! And there was another patient who needed to be admitted, but thankfully was in no need of an emergency operation.

Things got pretty wild back at the CD. Rhyan scrubbed in for the OR while Em acted as his runner, getting blood from the blood bank, etc. While little old me had to admit the additional patient and I was again master of the entire ward... plus the ICU, which got kinda spooky during the early morning because of the stories I've heard coupled with my wild imagination.. Lets just leave it at that for the meantime..

The fun never ends if you're in Neurosurgery... i hate it... bah! :P

By the way, belated Happy Birthday to my Mom who celebrated her 53rd birthday yesterday while I was at the hospital taking care of sick people... I love you mom.. :D

Nakakasawa...

Pre, Duty, From...

That pretty much sums up my life for the past 1-2 months...

And to tell you frankly, I'm getting sick of it..

Especially here in Surgery...

I mean, the residents are ok, the consultants are great, but I just can't take the srtess that come with everything, plus the fact that "from" status is not honored here.. which means that even though you've already finished a full 24-hours worth of duty (7am-7am), you're still obligated to stay 'til 5 pm!

If that dosen't suck, I don't know what does...

I'm presently pre-duty, but I still haven't shaken off the effects of the previous duty..

Oh yeah, and there's still an admitting conference later... bah....

Kung 'di lang sana talaga malaki yung ginastos namin pangmed.... hay....

Pagod, puyat, sakit...

I'm so damn tired...

I'm in the midst of our Surgery rotation, and it sure takes a lot out of you...

I thought the other groups/batches said that it would be benign?...

Anyway, that being said, the Surgery rotation covers a span of 2 months and is divided into 6 parts/services which you'll be rotating to: ER/OPD, GS 135, GS 24, Neuro/Plastic, Pedia/Uro, and TCVS/Ortho.

I won't be elaborating on the individual services for the meantime, since I'm just blogging on borrowed time here at the LRU.

Basta, nakakapagod talaga...

And to think that my cureent service isn't really one of the toxic ones...

Sigh... and the battle continues...

Back to the wards, my friend!

* I just discharged my patient today, a 68 y/o female with an admitting impression of acute ruptured appendicitis. We opened her up and found a gangrenous appendix. She was discharged improved and stable. yun lang po. =D

Gynecology, Obstetrics, and now Surgery...

Damn, time sure flies... (but it seems to drag on forever when you're toxic)

It's been more than a month an a half since my last blog entry...

I'm not sure what to write down, given that I'm always toxic and I don't have the luxury of time to write down everything that comes to mind..

Let me just say that I'm all praises for the Department of Obstetrics and Gynecology. They're very nice people, from the consultants to the residents, and even the current group of OB interns (who became close friends with our group).

Gynecology, our first rotation when we got back to UST, was kinda shaky for me. I really had a hard time adjusting to the more OC system in UST because it was SOOOO different from the workman's simplicity that we experienced in Fabella. On the plus side, it was there where I was able to handle my first patient, and I even got a free lunch for being a good boy. Hehehe.

But seriously, I was REALLY grateful that her family gave me the food when they did, 'coz it was pushing 1pm already and I haven't even had BREAKFAST yet.. I was damn near the state of total collapse when I recieved that gift (of food) which I will remember for the rest of my days.. Thank you Ma'am Agnes, you taught me a very valuable lesson in patient care and love for one's work...

Moving on to our 1-month stint with OB, it was the first time we were gonna be working with 8A, the other half of our clerkship group. It turned out to be a pleasant stay, as we worked pretty well as a unit (considering all the different hitches we encountered along the way). Too much happened in OB foe me to mention at this time, seeing as I have to prepare a report before I go on duty again tomorow. =( But let me just say that I'm also grateful to the OB-GYN consultant and resident staff foer making our 1 1/2 months stay there a very valuable learning experience. Despite all the toxicity and the poor accomodations (the OB Batcave), I really learned A LOT, expecially from OB.

Surgery was up next, we moved up last June 16, and we made the transition kinda smoothly I guess.. my present post is OPD/ER, which means that we man the ER on Duty days and take care of things at the OPD when we aren't (yes, even if you're FROM DUTY, kasi walang From status ang Surgery...).

I'll leave things at that for now. I have to get at least part of this stupid report done before I go to bed... sigh...
I guess that's enough