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.. :)

Hello Fellow

There is a lot of confusion generated by doctors with the title of FELLOW, especially among the non-physicians. It can get quite convoluted, since sub-specialty trainees are called fellows, but so are esteemed members of medical societies who are obviously not trainees anymore. So, to set the record straight, I did some light research and here are the best explanations I have read:

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1) The FELLOW as a TRAINEE:

A fellow is a physician who has completed their residency and elects to complete further training in a specialty. The fellow is a fully credentialed physician who chooses to pursue additional training, the fellowship is optional and is not required to practice medicine, but is necessary for training in a sub-specialty.

2) The FELLOW as a distinguished member of the medical society:

Fellows are a special group of physicians who are dedicated to continuing education in medical practice, teaching, or research. Fellowship is an honorary designation given to recognize ongoing individual service and contributions to the practice of medicine.
Fellowship is a mark of distinction. It says that your physician has made - and continues to make - special efforts to be a better physician. Ultimately, it says your physician cares about delivering good health care.

How does a physician become a fellow?
Physicians must show that they are always growing and learning in order for the honor of Fellowship to be conferred. They may show this through activities such as teaching, hospital appointments, public service, community health planning, continuing medical education, publishing articles, and advanced training.
They may also be recommended by other Fellows who must attest to their character, ethics, and excellence in professional medical activities (This is usually the case here in the Philippines)

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 * A quick additional note about the distinguished fellows. Being conferred the honorary title of fellow of the society grants you the privilege of adding an additional acronym after your name comprised of the title (Fellow), followed by the society that gave you the distinction, and this is usually placed after the MD.

Example: Juan Dela Cruz MD, FPCP (Fellow, Philippine College of Physicians)

There you have it! I hope this clarifies things for a lot of people out there, especially the younger doctors or doctors-to-be, who still get confused by the hospital hierarchy.

Gratis

I'm getting tired of working for free, especially with paid opportunities abound. You can just get by on so much good will and good intentions. If nothing improves, I might have to make drastic moves I never thought I would do.

Death in the family

A beloved relative passed away recently due to natural causes. Prostatic malignancy with spinal metastases to be specific..

There were plenty of coming-of-age moments I encountered because the last death in the family occurred when I was still quite young and not yet taking part in the responsibilities of family logistics.

I was able to watch an embalming process for the very first time. I have seen my fair share of cadavers and patients who passed away in front of my eyes, so I was no stranger to death. However, since this struck a little closer to home, it made me be a bit more introspective with my musings. My father commented while we were watching the process that when someone passes away, the body is reduced to a mere shell.

He was right, of course. The person, the very essence that defines who we are leaves the world with death. The body left behind is a mere representation of the person who once was.. It suddenly dawned on me that this was going far beyond the physiologic concept of cellular death..  

What makes a person alive? Is "living" just a summation of all the different specialized cellular processes that occur inside everyone every single day? It kinda baffles the mind to think that we have evolved from a single-celled organism, that eventually banded together with other cells forming aggregates. Eventually the mass of cells developed particular functions for different parts of the cellular mass, like digestion, circulation, sensory perception, higher intergration, etc.. So if this is the case, is the very essence of who I am (well, at least the cognitive part of me), defined by the mass of neurologic tissue situated within this bony skull? Am i just a living brain, subserved by masses of other organs that work with the single goal of sustaining the brain? If this last statement were true, then why do bodies still work in the case of comatose patients or those who have already suffered ireversible neurologic injury? Could we say that a person is still truly alive when the brain is gone? I'm not talking about cellular life or death here, but the essence of who the person is..

Does that body become just a living shell, able to sustain basic life functions but unable to truly live?

I still find myself going back to the evolution from a unicellular organism. In essence, the eukaryotic cell, with all its specialized organelles, is a microcosm of the multicellular creatures with different organ systems. No wonder the multicellular organisms evolved like this, they were just following a pattern inherent to nature itself.

Does my brain organically define who I am, since it is the source of all voluntary acts, and is the repository of information for all my experiences?

I'm still struggling to fathom how a densely packed bundle of gelatinous material capable of electrical conduction could be the cause of so much in this world, both good and bad..

Going one step further, why would the brain mass be so concerned with pursuing things that would only serve to pamper the shell which it it housed?.. But yeah, I re-read that sentence and it seems to make sense after all..

I think I'll stop here for the meantime.. All these cellular concepts are making my protected cellular mass hurt :P 

Getting back on track

No, this is not a kickstarter post to trigger a cascade of productivity, actually it's quite the opposite. Believe it or not, this post is actually a byproduct of enhanced productivity.

I recently attended a seminar on motivational interviewing as part of my duties as the SC clinic head. It wasn't really heavy content-wise, but I guess that was not the point of the speaker. She wanted us to experience various aspects of being interviewed in order to be able to develop insights into empathy  which would hopefully lead us to develop techniques that would work on the patients that we see.

Some of the exercises of the seminar involved making one vulnerable by opening up about a problem or roadblock that you have been encountering. I think it was about things you needed to change/give up for the better. The responses were varied, but most people went with food excess. I chose to discuss my excessive screen time, particularly with the tablet. I identified this as problematic because it cut into my productivity and even my sleep time. I guess I;m at this point where I wasn't to maximize my productivity but am still struggling with leaving the past behind (in this case, my 3-year old Galaxy of Heroes account hehe).

It's still a struggle, but I guess opening up to someone about it (my OPD boss nonetheless) has kind of set something in motion inside me. Owning up to the solvable problem to others enables them t hold you accountable for it, and may thus drive change more than just a simple note that you would keep to yourself.

I have also been contemplating taking up a masteral course, since my prospects for subspecialty training abroad have gotten slimmer when I took a step back to consider the massive logistics (and finances) that it would take..  A strong, solid program that can be accomplished locally and satisfy the bigwigs at the hospital would be more of my style. I'm not getting any younger either, so I find myself less than eager when faced by the prospect of spending my money frivolously.

One of the things my auntie doktora told me before she passed away was that a doctor is a perpetual student, that one should always strive to learn new things in order to move ahead in life. I guess that applies to beyond the business of "doctoring". I do have a thirst to learn something new, and hopefully be of service to others in the process.. So yeah, I'm taking a step and holding myself accountable.. I'm openly declaring that I will be pursuing further studies by next year (after certain commitments have already been resolved).

I hope I'm not biting off more than I can chew.. But then again, I already know the answer to that, right? ;)