Lecturer

In the midst of starting work on yet another lecture as part of the requirements for clinical fellowship, I was struck with a sudden burst of inspiration and felt compelled to type my way into the contents of this entry. I kept it short because I really do have work to do, but I want to put this up here to save it for posterity. Who knows, this might actually end up helping someone out as well. :P

-----------------------------------------------------------------------------

HOW TO MAKE A MEDICAL LECTURE by BrainiaxMD:

If you wish to lecture about something, you have to have this mindset that you would like your audience to actually understand and learn from what you are saying. This attitude will help you structure your lecture as you create it. Since we are talking about medical lectures here, this would follow a specific format:

1) Takeoff case

2) Define the disease and any associated terms, including a bit of epidemiologic data if available

3) Explain the mechanism causing the said disease

4) Now that you know what it is, how do you diagnose it? 

    a. Clinical features (history and PE if applicable)

    b. Diagnostics 

5) Next you have to answer the question of “How are you gonna treat it?”

    a. Treatment options, starting from the more simple interventions

6) Summarize!

7) Thank you slide :P

 

That's all folks!

Why can't we all just get along? (an amateur commentary on religious dialogue)

 I read a legitimate news article recently about Israel having ties with two Arab nations. My first thought was "Well, that's nice. Why can't everyone do that?". Then I began ruminating on that last thought.. "Yeah why CAN'T everyone do just that?", thus triggering this post.

In this day and age of global connectivity and open communication, I find it hard to fathom sometimes why people of different religions find it extremely difficult to coexist peacefully. It is definitely a hell of a lot easier to get a conversation going, but people just don;t seem to want to do that..

All this talk about "infidels" and "slaying the unbelievers" makes me throw up my hands and say: "Really? You really can't move past that?? Damn, you guys are such infants!"

I am not against good organized religion in any way. I like my faith. It keeps me grounded, and I feel that it holds me accountable for my actions. A belief in a higher power is supposed to keep human behavior in check for the most part. Following a set of rules for morality is meant to keep people from being assholes all the time towards their fellow human beings. The concept of doing good to others for a future gain for all of eternity may still seem a little selfish in itself, but is necessary given the way human nature works.

The problem arises when people rely too much on their sacred texts and are childishly unable to see the evolving context as the world modernizes and moves on from certain outdated points that are no longer relevant. I will not go into specifics in the interest of peace, since I have no desire to engage any religious keyboard zealots out there over a useless debate wherein they will just show how backward they think. I will say this though, all those statements in various religions about making war on unbelievers are there for a reason that was valid AT THE TIME. For the writers of those texts who lied centuries to millennia ago, war was an inevitable necessity for survival, since the ancient world was a far less friendlier and less evolved place. To attempt to forcibly shoehorn all these violent notions into the current situation we live today simply just won't cut it, nor does it really make good sense for that matter. Societies have evolved (for the most part), and blind violent religious fervor no longer has a place at the table.

I wish these various religions would concentrate on the good tenets of their faith, preaching about love for others, cooperation, and taking care of your neighbor, concepts that are very badly needed in the world we live in today.  They could also do away with those irrelevant passages about killing others in the name of the particular deity because dude, that kinda goes against your other teachings anyway, so what the hell?

Sadly, human nature does not allow for such evolved thinking on a massive scale. Selfishness and greed will always be part of the norm, and people will always take advantage of the gullibility of others by waving the banner of organized religion to facilitate more sinister purposes..

Why is it so hard for ALL religious leaders to come together, shake hands, and make a united show of force, telling their flocks to "Just get along with each other for the good of everyone"? Isn't it much easier to say "put down your weapons and pick up your tools, we are gonna make the would better for everyone!", than to always say "death to the unbelievers/infidels/what have you?"

Some may say it is a matter of pride for these religions. That reaching out would show weakness or some other nonsense like that. It is just so frustrating that people are still on that line of thinking. Get off your high horse and stop being such children! Do your part in making the world more united! There are much bigger problems we presently face as a race that we no longer have time for relatively petty squabbles over whose prophet was right a thousand years ago.

Yes, I may be oversimplifying things, but I do have a right to dream for a better day.

What can we do?

 I have been thinking a lot about how ordinary citizens can help each other out during this pandemic..

Being a healthcare worker, I fully advocate for continued distancing and the wearing of face coverings to help stem the tide of the disease, and though I still feel a need for lockdown measures, I am not naive to the fact that people are hungry and hurting, and that the economy really does need to be up and running if we are to avoid further catastrophe or devolution into anarchy.

Almost everyone has been tightening their belts throughout this crisis, and rightfully so, because it only makes sense to avoid unnecessary expenses during these times. The lockdown measures have forced a vast majority of establishments to close for months. As a result though, many business are shuttered for good, due to lack of income but continued costs (rent, utilities, consumables, etc). It saddens me to see many people being laid off, and beloved stores closing down..

Going back to the title of this post? What CAN we do? It is only logical that to get the economy going again, people don't just have to be selling stuff again, but people need to be buying stuff as well..

Those people who are fortunate enough to have a salary during this crisis may need to keep on spending (but not beyond your means obviously) in order to help the others stay afloat.

For example: Buy food from restos, who in turn would be able to pay their employees, as well as purchase from suppliers. These suppliers would then get income and be able to pay their employees as well. We need to pump life back into the economy so that everyone would be able to have spending power again.. I know that this is really easier said than done, but hey, you gotta start someplace, right?

People who apply for (undeserved) discounts should really stop doing that. I get those senior citizens who need the discount since they have retired and do not earn money anymore, or those ACTUAL PWDs whose impairments are impediments to getting a normal livelihood. But how about those FAKE PWDs who are perfectly healthy and functional who just paid off some guy at the city hall so that they can get their mocha frappes at a discount while hanging out at Starbucks? Or those millionaires with senior IDs (some of which are still not of age anyway) who VEHEMENTLY demand they get their discounts even though they really don't need it, and just want to get away with anything they could (typical greedy behavior wanting to take advantage of anything and everything)?

I am not telling the real seniors or PWDs to just give up their discounts, but for those who can afford it (myself included, as I have a physical impairment from childhood has resulted in some degree of permanent limitation to my locomotion), why don't we just scale back a little, until such time that everything is up and running again. A lot of people don't realize that the discount given to you is shouldered by the establishment you are purchasing from. I seriously doubt if the government fully compensates all of the 20% discounts that all these stores encounter. The cost needs to be shouldered by someone, and more often than not, it falls on the seller. 

In summary, I know that money is a little tight right now, but for those who are blessed to be still earning a living at present, help others out. I'm talking about propping up businesses by your purchases. There is a longer-lasting and more practical effect in keeping someone employed as opposed to just giving a one-time handout. Oh and if you can, avoid scrimping on essential services like haircuts. Tip a little more generously if you can afford it, especially since they have been out of work for a while. These people could use the money too. An example that comes to mind is going for the shampoo service after the haircut even though it seems a little pricey and not really necessary, as this gives the shop additional much-needed income.

I guess that's it. Be a little more generous, and don't be an asshole to others. We will all get through this together.

Spark

Feeling a bit inspired today, hence the workstarter post.

I can't really put my finger on it.. Maybe it is because of the unexpected one-day work break? Or the satisfaction I got after accomplishing some "atypical errands" that I would not be able to pull off on a regular day without taking time off from work? I dunno..

Or maybe it's that rare shot of caffeine I got a while ago from the milk tea we ordered for merienda. :P Oh damn, I'm gonna have reflux later, aren't I?.. 0_0

To be honest, things have been pretty dull as of late. Everyone seems to have settled into the daily grind with a grudging acceptance that Covid conditions at the hospital are not going to change anytime soon, and people are just trying to make the most of things and attempting to get on with their lives and daily duties.. It is just saddening when I think of all the training programs that were forced to adapt or outright be put on hold because of the pandemic. All of a sudden we are not training specialists enymore, but teaching a new generation how to manage a disease that the entire world is just learning to deal with.. Academic growth (apart from Covid knowledge) seems to have slowed to a crawl. In the Sleep Medicine program I presently find myself in, I find that I am sorely lagging behind  in terms of census requirements.. An extension is all but inevitable, but I hope that the additional months will still have a salary to go with it..

So much uncertainty about the future.. It can get really depressing at times...

I have been thinking about the future lately, and how my plans have taken a different shape with all that has been happening.. It is disheartening to think that we are now really living in the End-times, with all these disasters happening all across the globe, with no signs of letting up.. Seeing this forced us to reevaluate what we will be doing in the next few years.. Seeing how the guys are struggling with putting their kids to school under the current conditions makes us think twice about bringing another life into the world.. Its a sad reality, but I guess we just have to accept it... Oh, this post seems to have taken a more somber tone compared to when I started..

Despite that, I still named this post "Spark" since this is the most positive I have felt in the past couple of weeks.. Could it be a sign that things may finally get a bit better? Only time will tell, but for now, I gotta study and do some paperwork. Got a report in exactly a week, and I haven't really done jack squat. :P

Oh, I guess my current musical obsessions may have something to do with it, but that's a story for another post. ;)

Pessimist

 I should be doing something far more important, nut a number of things weigh heavily on my mind.

2020 has been such a bad year... I don't even know where to begin.. So much tragedy abounds, and it shows no signs of relenting..

Can it be the end times already? Maybe.. I don't know anymore..

Such a shame that humanity will not be able to move on and be better.

I have kinda given up hope on humanity to be honest.. To say it in the vernacular, "hanggang diyan na lang talaga ang mga tao, hindi mo na maaasahang bumuti pa". To expect something greater from people is folly. I feel that people collectively will not be able to rise above all the selishness and stupidity that is so prevalent in the world today.

The ideals that they portray in Star Trek, about humanity coming together and working for the common good which allowed them to reach for the stars is simply not possible in this present situation. I feel that humanity has devolved so much that a critical mass of people being altruistic enough to put aside their differences to make the world a better place is simply not possible anymore.

The bad thing about social media is that it is universal, and gives a voice to those who do not deserve it. It provides a readily-accessible platform to those who seek to do harm. It allows ignorant people to pass on their stupid ideas to the world, and make themselves noticed not by their intelligence, but simply by being the loudest voice in the room. And the worst part of that? Other people would actually support these ideas. So yeah, I don't think humanity will be able to rise up from the muck, mainly because people are content to wallow in the mud.

I figured if you want people to be nicer to each other, you have to have solid values training, which comes with education (both in schools and at home). If you can't raise your brat to be a decent human being who is capable of caring about others, then you have no business making children, as you are just contributing to the cumulative jackassery of the human race.

 Sorry to be so pessimistic, but I now think we are fated to wipe everyone off the face of the planet instead of coexisting peacefully. For as long as you have ignorant people (universal education is not a government priority in most banana republics, as poverty and ignorance can be used by despots to stay in power, just look at us) and selfish people who are unable to move beyond thinking about themselves, the countdown will continue for humanity's finite time on this Earth.

 

FORWARDED - A Filipino Medical Frontliner's thoughts

Day in and day out, it has been exasperating to hear that many of the countrymen we are supposed to be serving are unfairly griping about how it is the healthcare sector's fault as to why the certain areas are placed under MECQ again. Personally, I think I have grown calloused already, and I just hope that after this entire pandemic is over (if this DOES ever end and I am still alive by then), that I will still be able to minister to the sick with the same amount of compassion that I have, because to tell you frankly, nakakasawa nang mag-alaga ng mga walang utang na loob.. Sobra na kaming dehado eh.. but I digress..

This circulating post seems to summarize what I want to say quite nicely (although it seems that the original poster is more empathetic).

---------------------------------------------------------------------------------------------------

PLEASE SHARE, KINDA LONG BUT HE SHOULD BE HEARD:

Magandang araw po sa lahat,

Ako po si Brian S. Callanga, isang nurse sa isang COVID Hospital sa Manila. Ayaw kong gawin to pero sa tingin ko ay kailangan. Pinili ko ang social media dahil ito na ang best way para makaconnect ka sa maraming volume ng tao sa panahon ngayon. Wala naman na kasing nagbabasa ng dyaryo, sobrang busy na ng media sa dami ng kailangan nilang icover, pero ito na sana huling naisip kong paraan para maglabas ng hinaing ko.

Kanina bumili ako ng pagkain ko then I overheard other customers na naguusap about MECQ.
"Frontliners daw nagrequest niyan kasi magpapahinga sila"
"Frontliners din naman tayo, bakit di naman tayo napapagod"
"Pahirap naman yang mga yan"
"Pag naman pumunta ka sa ospital parang wala naman ding umaasikaso sayo"
"Susungit pa nang mga tao dun"
"Buti pa sila may sinasahod"

So ilan lang yan sa mga naalala kong words na mga sinabi nila. Bagong gising ako, galing ako sa nakakapagod na night shift, tapos gutom. Pinilit kong pakalmahin yung sarili ko at kinuha nalang yung order ko at umalis.

So ganito nalang, let me give you people a glimpse of what we are doing sa loob ng hospital.

OR nurse ako, pero dahil kulang na sa tao, naassign nadin ako sa COVID Wards and ICUs. So ganito ang mga common na sinasabi o tinatanong ng patients namin,

"Sir, sana pala hindi nalang ako lumabas"
"Sir, sana pala naging mas maingat kami"
"Sir, sana pala hindi muna ako pumasok"
"Sir, yung asawa ko admitted din sa kabilang hospital"
"Sir, ang hirap pala ng ganito"
"Sir, nasaan na si Mama, bakit wala po akong kasama dito"
"Sir, pag ba namatay ako, paglalamayan paba ako?"

Take note, yan yung mga patients na nakakapagsalita. Most of them matatanda na halos naghahabol ng hininga nila. Yung iba nakatubo na.

Di ba kayo kinikilabutan? Kasi kami halos araw araw kinikilabutan at halos di na namin alam ang isasagot namin sa kanila.

Hindi po namin gusto na kayo ay hindi makalabas at hindi makapaghanapbuhay, hindi po namin kasalanan itong mga nangyayari. Kami po ang talo sa parehas na sitwasyon, kasi kapag hindi kayo nakakain ng tama, sa ospital din ang diretso niyo. Kapag naman nahawa kayo sa labas, sa ospital din diretso niyo. Gets niyo po?

So ECQ vs GCQ, nung ECQ, sobrang bihira ng trauma cases namin dahil walang gaanong tao sa labas. Then here comes the GCQ, may mga naging cases kami ng nasaksak, gunshot wounds, and recently bata na nabaril ng tatlong lasing. And we have to treat them as PUIs kasi wala na kaming chance na intayin ang resulta ng swab nila dahil kailngan na sila iOR. Tsaka try to look at the number of cases per day between ECQ and GCQ. Sobrang laki ng gap diba? Check it yourself, punta ka sa ncov tracker ng DOH, check niyo yung bar graph after June 1 (start of GCQ). At uunahan ko na kayo, after 2 weeks ng mECQ, may posibilidad na hindi baba ang cases kasi some people pwede magkasymptoms after 14 days dba? So lahat ng mga naexpose kahapon, pwedeng magbibilang ka pa ng 14 days. Baka kasi sabihin niyo na wala naman palang silbi ang mECQ kasi hindi naman bumaba ang kaso sa 2 weeks.

Nakakatakot diba? Wala pa yan kasi hindi na magkasya dito yung ibang kwento namin. So sana kilabutan na kayo. Sinasabi ko lang sa inyo kung ano ang realidad. Kung paano makita ang sitwasyon first hand.

Kaya sa mga nagcocomment about sa mga frontiliners and sa sitwasyon ng Pilipinas, punta muna kayo kahit sa ER lang. Para malaman niyo kung gaano na kapuno ang ospital. O iPM niyo ako kung may tanong kayo, rereplyan ko kayo hanggat may energy pa ako. At suggestion lang sa mga nagcomment sa social media posts about sa situation, kung hindi niyo naman naexperience first hand, wag nalang kayo magcomment please. Manuod nalang kayo ng mga videos ng cute na mga aso o pusa, o kaya ng tumatakbong ostrich sa gitna ng siyudad, makimine nlang kayo sa mga live japan surplus na nagaalok ng mga porselana galing japan, tingnan niyo yung mga ulam na post ng mga kaibigan nyo, ang daming pwedeng gawin sa social media kung ito lang talaga ang ginagawa niyo mula umaga hanggang gabi, kesa magcomment pa kayo ng wala nman kayong idea kung ano nga ba talaga ang nangyayari, kasi words can hurt too. Wag nating gawing toxic ang social media, kaya nga siya social media kasi ginawa ito to socialize with other people hindi para idown ang kapwa.

Kung gusto niyo lumabas, bahala na kayo. Pero I encourage all na wag na kung hindi naman importante, kung lalabas man magsuot ng facemask at shield, magalcohol kapag humawak sa mga bagay bagay, maghugas ng kamay kapag may chance, umiwas sa mataong lugar, paguwi maligo at ibabad na ang damit sa sabon at zonrox. Sana hindi namin kayo makita sa ospital. Basta gagawin namin lahat ng makakaya namin kung sakaling kailangan niyong maospital, pangako yan. Kasi mas gusto namin na mabuhay kayo kesa mamatay, kasi pag namatay kayo at may covid kayo, itatry namin kayong irevive, tapos kapag wala na talaga, iinform ang families tapos ibabalot namin kayo sa dalawang body bag, tapos cremate. Wala ng lamay lamay, wala nadin chance ang families na makita ang bangkay niyo. Di ako nanakot, again, yan ang realidad, nangyayari siya sa totoong buhay, okay? Siyempre walang video nyan sa facebook baka maghanap pa kasi yung iba. Alam niyo ba kung gaano kabigat para sa aming mga healthworkers yon? Tao din kami may awa din kami sa kapwa naming tao.

Konting background lang, since March pa ako di nakakauwi sa amin, sa family ko kasi nandun yung takot ko na baka carrier ako dahil halos araw araw kaming nakaharap sa mga covid positive. Para akong nagabroad. Ni sarili kong pamilya hindi ko masamahan sa ganitong mga sitwasyon, dont worry naaccept ko na yun kasi part na siya ng pagiging nurse, sinasabi ko lang para lang makita niyo yung reality.

Sobrang haba na nito and I hate to say this dito sa social media pero there's no better way to reach people out without any physical contact. Di ako mapost na tao pero this time people need to know para mahinto na yung mga misunderstanding about sa timeout timeout na yan. KAHIT KAILAN HINDI NAGPAHINGA ANG HOSPITALS. SAN KAYO NAKAKITA NG HOSPITAL NA SARADO KASI HOLIDAY. HINDI LANG KAYO MATANGGAP NG IBA KASI WALA NG PAGLAGYAN. PARA SA ATING LAHAT ANG ECQ NA ITO LALONG LALO NA SA INYO. KUNG PATULOY NA DADAMI ANG CASES BAKA SA HALLWAY NA KAYO MAADMIT BAKA UMABOT PA SA POINT NA KAILANGAN NIYO MAGDALA NG FOLDING BED PARA MAY MAHIGAAN KAYO, MAHIRAP O MAYAMAN.

To my fellow healthworkers, share your stories para malaman ng tao kung ano ba talaga ang ginagawa natin. Alam ko na meron pang mas malalang sitwasyon kaysa sa nararanasan ko. Stay strong, healthy and pray for the wellbeing ng buong sambayanan. God knows how we are doing our best to be a blessing sa bawat tao na nakakasalamuha natin.

Pahinga lang saglit,
Brian

It's been about 4 months already..

I should be reading a book right now in preparation for a case presentation/lecture this coming week, but lemme get this article off my chest real quick..

Coronavirus cases are once again on the rise across the globe, although obviously with different rates of infections among the different nations. This is the dreaded second wave, and it shows no sign of slowing down anytime soon..

Here in the local setting, the sudden spike in cases occurring approximately 2 weeks after the easing of lockdown measures did not really come as a surprise, but quite frankly I was hoping that it would not come to this.. I still look back and think about what went wrong, and if there was anything the Philippines could have done better given how the country and its people are?.. It is quite easy to imagine an ideal scenario where variables are at a minimum, and situations can be idealized, but this perspective requires a real-world approach, given the sham that passes for governance in this banana republic, as well as the apparent disdain for authority and common sense that the people seems to posses on such a large scale..

People are nearing the breaking point, and that includes the healthcare workers as well.. It is actually quite demoralizing when you have been toiling and living with anxiety for more than a quarter of the year, and yet the tide seems insurmountable. I perfectly get those HCWs who have resigned or decided to back away from the profession, especially since support from government agencies seems to not be forthcoming.. And there is also the issue of rumblings from an ungrateful public who we want to keep safe and prevent them from flooding the hospital.

Its so frustrating. The government always harps about creating new beds and wards without giving much thought to adding people to man those extra areas and tend to those beds. Instead, they expect the preexisting staff (some of whom are falling ill already) to pick up the slack with no end in sight.

I do not claim to be a policy-making genius, so I shall refrain from making any bold suggestions or change in policy since that is clearly beyond my pay grade, but I wish we would get a bit more consideration from the Health ministry and less of these insulting statements from politicians who have absolutely no idea how it is to serve at the frontlines of a pandemic (and no Cayetano, hindi ka frontliner kahit ano pang sabihin mo, unless you go out there every day and face people with the disease, or even more terrifying, facing people who may have the disease but don't know it)

A special shoutout to our non-medical co-frontliners (AFP/Police, delivery peeps, grocery staff, food and beverage staff, pharmacy staff, bank staff, etc) who were there with us from the very beginning when the streets were still deserted and the people were cowering in fear. I never got to thank you for bravely standing with us during those dark and troubled times. Kaso, hindi pa po tapos ang laban natin, and unfortunately it has been getting worse..

I understand the need to open up businesses to keep the economy afloat. Its just common sense that people need to work to eat, and having a prolonged closure of businesses will cause them to fail and shutter down for good.

I have often blogged with a bit of a positive tone because I was cautiously optimistic, but now I guess I'm just too tired of everything to still be an optimist.

They say the that a vaccine is on the horizon. The bad side though, is that it will be coming from China. With that being the case, it's going to be like playing a game of russian roulette. You have a sizeable chance of falling ill, suffering from different side effects, or getting Covid after inoculation, for the simple reason that you never know what the real deal is when you are dealing with China.

Are they just giving you a vaccine that does not really work that well to generate a tidy profit? Did they rush vaccine development or had skipped certain phases of trials in order to corner the market? Honestly I wouldn't put it past them. Based on behaviors I have noticed, China has demonstrated that it is one of the most morally bankrupt countries in the world. They have no respect for intellectual property, they knowingly sell substandard goods, have no regard for the primacy of human life, and will draw a few goddamn dashes on an old map and claim territory that does not even conform to the shape of their actual coastline. Y u so selfish China? Didn't your mother teach  how to share and get along with other kids? Oh, I forgot. Communists. Without any belief in a higher power and a sense of reckoning for the last day, you get a system which exists only for itself without any empathy for others.

It is just unfortunate that while China continues it's ascent into the asshole bully of the world, the United States, once recognized as the peacekeeping superpower, has fallen so far, from the shining example of a working democracy, to the laughingstock of the world. This was all because the Americans elected someone who seemed to best embody what they were really like at their very core, a loud obnoxious bully who would do anything to get ahead, has no sense of propriety and no respect for others. Good luck shaking that pathetic image in the next 10 years or so.

Ok, so this entry went from local problems to geopolitics in a mater of a few paragraphs.

I'm actually tired of reading about the situation in the US, because man, these people cannot get their shit together! People are as selfish as you would expect, and they seem to love there freedom more than life itself. I have often said that the US is a perfect example of the perils of giving too much freedom to the people, such that they end up making bad/stupid/unsafe decisions just because they want o do what they want.,

I guess thats's enough for one night.