Past the midpoint

Wow, it's July already! We've already done six months of this crazy shitshow we call 2020. To think that everything seemingly started (from a local standpoint at least) with an unprecedented volcanic eruption..

Then the virus showed up. A country did what it did best (conceal information) and the resulting payout was an actual pandemic. Way to go. #sarcasm

To tell you frankly, I'm really sick of this virus and everything it has changed.. If you think about it though, everything DID change, and not necessarily for the better. I now often find myself longing for the so-called "good old days". I'm not just talking about immediately pre-Covid here, but of decades before when life was simpler and people seemed a bit more decent (I think?)

I think it's great that the government has finally thought of bringing back "Good Manners and Right Conduct" to the curricula. Too many shitty kids growing up into shitty adults already. The question remains.. Why did you only think of it now?

My optimism was dampened somewhat with the recent reports of a new peak in Covid cases reaching more than a thousand. It is no surprise that it coincided with the relaxing of restrictions. I understand that people have to get out in order to restart the economy, but why do people have to be so irresponsible though?

I read a news article the other day that a pair of individuals from the same household had passeddue to Covid, and that the infection could be traced to a get-together the family had to (probably) celebrate the return of a family member (repatriated OFW?). Frankly, I'm, not surprised. It would suck if I were the index case and I survived though. I would have to like out the rest of my life knowing that their deaths fall squarely on me and probably my irresponsibility.

With the relaxation of rules, more people are now going out, and my parents are no exception. Even though they hardly go out (thank goodness). Like any good son, I would like to keep them safely tucked at home, but would not deny them a bit of travel when needed (haircuts, etc), but the logistics of trying to keep them safe can be really exhausting.. 😟 My only consolation is at least they complied to my specifications this time around, so my heart is not so heavy with worry anymore.

Still, I find myself maintaining a heightened level of paranoia around my parents. Every little cough or yawn makes my hair stand on edge as I nervously wait of there are any other signs or symptoms.. There is still that ever-present fear that I might bring the virus home, and the results would be catastrophic. 😟

I grow tired of the disinfection routine I have performed since the lockdown of shedding clothes and soaking in bleach before entering the house to take a quick shower, plus the other little precautions I take. Be that as it may, I constantly remind myself that "Any lapse, or any breach may result in disaster for the family", so I carry on.

Sleep Med has been getting more and more interesting as of late. I'm finally getting the hang of reading the somnograms, and am now a bit more confident in dealing with patients on my own before referring them to the consultants. Looking back, I still can't believe that I'm an actual fellow-in-training again, 😅, but as I go along, I also realize that it was the best possible move I could make at the time, and has paid off until now. and in a few months' time, I will be better than ever! 😉 I just hope I can finish all these requirements and pass the board examinations though. 😅😅😅

USA, anyare?

I will let the graph speak for itself..

Grabe lang ha..

Hitting a snag

Here we go again.

I have a research proposal due tomorrow and I can't motivate myself to do it just yet.

I'm guessing it may have something to do with the fact that I was not able to blog for so long because reasons.

We only have a finite number of hours in a day, and the sad part is that despite my awareness of the situation, I still persist in doing other things, simply because there is only a finite number of hours each day.

I should get back to what I was doing. I've exhausted my creative output for the day. 😅

News from the frontlines

* Before I begin, I would like to state that the following piece I write here is based on my opinions and observations alone, and am not part of some cockamamie government plot to spread disinformation or other shit. Don't associate me with that garbage. A lot of crazy people of the internet throwing crap at innocent observations lately. Sheesh.

**EDIT: I have to clarify that my observations are from the standpoint of a Metro Manila hospital only, since I know the situation is  different elsewhere like in Cebu where cases are unfortunately spiking as of the moment.

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Ok, now that I got that disclaimer nonsense out of the way, its story time.

Things seem to have been winding down with regards to Covid at the hospital. One of the designated Covid wards has been converted back to regular (non-covid) use, and hopefully we'll be able to get the Sleep Lab back within the week. Though it is true that the number of cases is still increasing, the death rate remains quite low, and the Covid admissions has slowed considerably when compared to the shitstorm that was March 2020. Even though the general rate of admission has not slowed down, a greater proportion of the cases we are seeing are the usual admissions to the hospital which do not necessarily have Covid.

I think the reasons for this are threefold:

1) More testing and faster turn-around, so of course you would have more positive results, but we are now catching more asymptomatic and healthy individuals which do not need to be admitted at the hospital and are able to safely recover on their own.

2) We are getting better at managing Covid cases. Let's face the facts, this was a new disease and treating it was such a struggle for everyone across the globe since nobody had any idea what to use or what would specifically work since there was no preexisting data. Doing research on new treatments isn't easy, and if you're such a smartass to say that doctors slacked off, why don't you get off your lazy ass and do the clinical studies yourself to see just how complicated things are?

Sorry, I got a bit sidetracked for a moment.. :P I'm just so sick of all these armchair scientists who aren't worth a damn in real life chastising healthcare workers as if their opinions mattered.. Anyway, there are now more interventions in our armamentarium like the use of tocilizumab and hemoperfusion, as well as the modification of protocols like the shift from early intubation to a preference for non-invasive oxygenation like high-flow nasal cannulas. As more information is gathered and shared across the board, we will get better in managing the disease collectively. Gotta give props to all the researchers that shared their information freely as soon as it came out which helped all of us treat the patients better. (No, not you China. You sit in the back.) Thanks  to the deluge of vetted information, people are more confident in their management approaches. Compare that to the early panic we experienced during the first two months where patients were expiring left and right and we felt powerless to do anything about it.

3) The lockdown worked (somewhat). Let's face it, the Philippines has never been a perfect example of good governance or a compliant population, but somehow I think we got this one right.. for a few weeks at least. Yes, the lockdown could have been a little earlier, and yes the ban on Chinese travellers should have come much, much earlier, but when I compare the present Philippine situation to whatever the hell is happening in the United States and Brazil, I can't help but say to everyone that "you did a relatively better job, somewhat.." Consider that if we did not have as strict a lockdown as we did during the crucial first couple of weeks, our numbers could easily surpass the crazy infection and death rates they have in the States. People eventually got cabin fever and began violating in little ways, but for the most part people have been compliant, and I noticed that during my daily drive to and from the hospital. I follow the news in the US to see how they were coping as we went through our own pandemic experience, and I have to say that I'm shocked at the way these Americans seem to value freedom above safety and common sense, to the point that their obsession with absolute freedom borders on lunacy. I can only shake my head and scroll down.. No wonder their healthcare system is so overwhelmed. I honestly expected so much better from the country where we get our medical books from, but then again, its' not the fault of the doctors there, but the uncompliant populace.. Oh, but it's also unfair to blame it on an uncompliant people, because their leaders initially didn't believe in all these social distancing measures either. I never thought I would see the day that I would encounter Filipinos (who admire the US a lot ) who would say that "I'm glad I don't live/didn't move to the States". Grabe, how times have changed.. and now you have these racial tensions boiling over at the worst possible time.

Going back on-topic, we have to bear in mind that the lockdown was not meant to make us hide in a bunker until this Covid plague blew over like a passing storm, like the Israelites hiding in their homes during Passover while death befell the firstborns of Egypt. It was meant to push transmission rates down so that the hospitals could catch up and prepare better for the surge which unfortunately came earlier than we would have liked. Eventually we caught up though, and the hospital underwent a major restructuring to convert a majority of the hospital infrastructure into isolation wards which are better equipped to handle these Covid patients. Proper donning and doffing areas were put up, and designated "hot zones" were strategically created for safe movement of patients and personnel. This also helped a lot in keeping the hospital personnel infection rate to a bare minimum.  It was such a massive undertaking, and we have to thank the many donors who lent us support to help make that happen. Many thanks also  to the PEE and food donors who sustained us especially during those early trying times when despair against a lethal invisible enemy was the general feeling all around. We could not have done it without you.

4) People are still generally careful, and it helps. With the exception of those stubborn idiots with uncontrollable cabin fever (and probably underlying psychiatric illnesses),  I'm happy to observe that people are following distancing and protection guidelines as they are issued. Just to be clear,  I'm not beating down on those people who were forced to leave their homes to try and make a buck, because people were already getting hungry because of the shortcomings of the government, especially at the LGU level where I heard that even barangay officials were at fault due to greed, politics, or both... Really? In a pandemic?.. How low can you get?..

Wow, this has been quite long already, but expected since I had such a long time yo ruminate on what I wanted to get across. As we slowly open up to this new normal before us, I hope that people will still be responsible and keep each other safe, To those who suffered through the lockdown, thank you for your sacrifice and compliance. It's because of your contribution that things didn't spiral out of control as much as is happening abroad. Like I said before, I am cautiously optimistic that we can all get through this safely and not be overwhelmed by the pandemic, since the mass production of a viable vaccine is still a few months away.

Please, let us help each other get through this.  Comply with distancing guidelines. Keep the vulnerable at home for a little while longer. Wear a mask in public. Support local businesses. Don't be an irrational asshole who just wants to do whatever he/she wants without regard for others. I hope this experience would change a lot of people for the better, and help them realize that there is more to life than always just looking out for yourself.

With bated breath..

So tomorrow the Metro will finally be placed under General Community Quarantine (GCQ). While this relaxation of quarantine rules means that further economic activity can proceed, it also comes with a sudden increase in people on the road. Granted that more activity would be welcome in light of all the sacrifices people had to make while adhering to the rules of quarantine, but I can't help but be a little bothered by the fact that Filipinos are notorious for not following the rules, or at least trying to pakiusap their way out of everything. Its just sad that the Filipino mindset like is that of a privileged beggar:

"Kawawa ako kasi tinatamad akong maglakad pa ng onti kaya kailangan pagbigyan mo ako kahit tumawid ako ng wala sa tamang tawiran", or

"Dapat pagbigyan mo ako sa di ko pagsunod sa traffic light kasi nagmomotor ako, kaya nga nakamotor kasi walang pera bumili ng kotse", or even

"Kotse ka at motorsiklo ako, so dapat pagbigyan mo ako dumaan kahit na parang gago ako magmaneho, at kasalana mo kung magkabungguan tayo kahit na maayos ka naman magmaneho, dahil ikaw ang mas malaki ang sasakyan".

These are typical scenarios I encounter every day, even during this quarantine period. Nakakainis lang. Mahirap maawa kung alam mong kinukupal ka lang. Don't get me wrong, people in big cars are sometimes jackasses too. There's just so much jackassery to go around, but those jerks on two wheels are just too much!

Ok, traffic rant over.. A lot of people are making gloomy predictions about the outcome of this GCQ because lets face it, wala ka namang maasahan sa mga tao. Marami ang pasaway na di susunod diyan. These individuals would then probably spread the disease, and would render other people's efforts to properly distance, wash up, stay indoors, moot and immaterial. If we're lucky, these troublemakers would end up as casualties of the disease and we would be better off without them..

We at the frontlines continue to toil away, and we are faced with the potential of a larger wave that would come crashing down on everything we have worked hard for up to this point. Nakakapagod na, but we have no choice except to go on, because if we don't, then who will? So for those people, do what you like, flaunt your gross inability to follow the rules. I'll be waiting to see you on the opposite side of a body bag zipper.

The reintroduction of productivity

There's (hopefully) about a week left of the Modified ECQ  (Enhanced Community Quarantine) that was imposed here at the Metro. I would think that things have "stabilized" a bit. Relaxing the measures has helped a bit, as more people are now able to return to work, and the streets look a lot less lonelier.

Make no mistake, I still, and will always advocate for proper social distancing measures, frequent hand-washing, wearing of masks out in public, and other interventions that have stemmed the tide of this pandemic thus far. I'm not a fan of people going out and being stupid just because, and I feel that those people (who do something stupid without cause) deserve whatever infection they manage to get if they are irresponsible about it.

I'm just so tired of everything. Yes, as a front-liner, I do get to go out daily instead of being cooped up at home, but as what I have said in a previous post elsewhere, being on the front lines does not exempt you from being afraid for your life, or the lives of the people around you who are dear to you.. I have taken measures to make sure I minimize the risk I bring home to my family, even once doing laundry in the middle of the rain just so that my dirty clothes will be properly disinfected before anyone else gets to be exposed to them (I prepare a bleach soak when I get home, and we have an open laundry area). Despite all the disinfection routines I do, I'm still fearful because at the back of my mind, any lapse, any breach, any careless moment, could still hurt my family in ways I do not want to imagine.

Taking stock of the recent numbers that I find here, the numbers have appeared to have stabilized somewhat, and that is in spite of increased testing capabilities, so hopefully the numbers will be more reflective of the actual situation on the ground.

180 new cases in the face of an average daily increase of 200+ is not exactly a total win, but I'll take what I can.. Number of new COVID deaths is in the single digits.. Still not good since people are still dying, but I would say its' a little better than the peak of 50 mortalities last April 13..

Everyone is getting tired of this, especially the people at the hospitals.. I could see it in the faces of the nursing staff, the training fellows, and even the consultants. Despite their smiles, there is a palpable sense of weariness, and a desire to see the end of all this.. Our colleagues at other institutions have already taken strides to reopen their other services in order to serve the greater part of the population who are suffering from ailments other than COVID. These efforts are commendable and are very well thought-out and inspiring. We actually hope to be able to resume other services soon also, to introduce some hint of normality into our institution that has underwent massive changes in order to accommodate the patients with the disease. I just hope there isn't another surge, because even though we are still functional and healthy, a second wave could very easily break the spirits of everyone ...

I mentioned that I was cautiously optimistic, and still I remain so. I guess it helped a lot that I was able to enter a mall again to get stuff other than groceries. It was also refreshing to see other stores and stalls open again, and am hoping for everybody's sake that things will only get better from here on in.

Training has been going great, and we have streamlined certain new procedures as we adjust our way of doing things. These measures are not exactly the most efficient, but I guess getting something done is better than nothing. I just hope I will be able to complete the required census of patients before the training year ends..

Our center has the dubious reputation of being a COVID referral center, and it would be understandable if patients have apprehensions of coming in for consult. as things get better though, we can show everyone that everything is under control, and things could get back to the way they are (for the most part anyway).

Normalization?

By my estimate, its already about 7 weeks into the lockdown, with measures projected to ease up by the 16th.. As always, I should really be doing something more important, yet here I am, blogging away.. Hehe

Being a frontliner, I have the privilege of having a bit more freedom of movement, and I have been at the hospital on a daily basis since my official "start" of fellowship. I consider it to have been a stroke of luck that I chose to toss my hat back into the ring and train yet one more time. At least this move was able to secure me a small but constant source of income as the world eventually recovers from the pandemic.

It has been pretty interesting to say the least. I'm actually enjoying being able to hang around the faculty room with my esteemed mentors, giving mr the opportunity to casually interact with them and pick their brains. The best thing about it is that they consider me as somewhat of an equal now, except where the subspecialty training is concerned of course. I'm a sucker for a good storyline, and I'm loving the way all theses different batches come together, working towards a common goal. Its a lot of fun hanging out at the callroom, telling the newbies stories of how it was before the covid days, and what they would be facing once things eventually settle back to normal, whatever normal will mean in the next few months.

Its really fascinating seeing the composition of the consultant staff, myself included. It seems that our generation has finally bridged the gap in leadership, with the most junior of the senior consultants being around 10-12 batches our senior. I'm honored to be a part of this crew, and hopefully when I complete my training, I get to be a part of it again. Few people are presented with this unique opportunity to be a part of something great, even though I know I will always just be a bit player.

I find myself cautiously optimistic about Covid in the country. I really believe that the lockdown has indeed done its job, and that the numbers (at least in the metro) will soon be going down to manageable levels. I wish I could say the same about the provinces though. Places outside Luzon were a bit late in their lockdown measures, and presently we are seeing numbers peak in the Visayas... A lot of us yearn for a resumption of normalcy at the hospital, so that the training programs can finally start in earnest, and hospital operations can resume to serve patients who have nothing to do with covid. The necessary game-changer would be a rapid CoViD PCR test (*not antibody) that would allow triaging to the appropriate area (covid or noncovid) at the ER level. This would certainly save a lot of headaches and free up rooms filled with patients who are usually awaiting swab results which would then finally enable proper cohorting. It certatinly does not help that there is such a backlog of results at the laboratory, as the testing capacity has been overwhelmed by a deluge of tests (some of them unnecessary and are from certain agencies) that patient management is already compromised at times. Yes, I am bitter, but I'm sure you would too if you find out that the facility's scarce resources are being channeled to other endeavors outside of its' primary mandate..

Readers may have noticed the vitriol I have against the origins of the virus... Those statements were written in the heat of the moment and will not be revisited anymore, although they will not be retracted. I'm still pretty pissed that all this was allowed to happen due to stupid policies and whatnot. I just with they would outgrow their foolish (and selfish) ideology and just function as normal global citizens. I could go on and on about the country in question, but I decided I won't waste any more of my precious time.

Fellowship has been getting interesting. Thanks to the magic of video conferencing, we have been able to hold three lectures already, and has enabled participation of my batchmate who is still locked down in his province since the travel ban is still in place. Luckily, bulk of the initial necessary learning of the subspecialty deals with reading results from a screen. Hopefully s measures ease and the patients return, we would be able to wade deeper into the thick of things with patient interactions and interesting cases.

I'm actually a little confused with my status right now. I am recognized both as a member of the staff, as well as a subspecialty trainee.. I just hope I'm not overstepping any boundaries by hanging out at the "faculty room", but then again, our section head is part of the faculty as well. I guess I will just stay put until we are able to move into our temporary home, since the ward where our section is housed is still being utilized as a CoViD ward.

I really hope that the trend we are currently observing holds true until the end of the pandemic, so that we would be able to resume our state of normality, with adjustments ..