Dr. Fe Del Mundo, Mother of Modern Philippine Pediatrics
Today is her first death anniversary. I find it notable that today on my first day rotating with Pediatrics I am reminded of how one woman’s life of commitment and service to the Filipino children serves as the ultimate role model of a clinician worth emulating.
Random conversations with best friends over French fries and with an on-duty blockmate at the callroom made my day today.
That’s on top of the happiest feeling after waking up to your own bed because you came home the previous day to your house to be welcomed by a feast shared with the family you haven’t seen in a long time.
And the happiness secondary to the fact that of all the days you’ve spent in your current rotation today was when you learned the most after seeing the most interesting of cases.
Plus you got to watch your first basketball game in like, ages; and that it was really exciting.
Thank You for today. It was refreshing and most welcome.
Personally, I prefer the ER. I like action, the adrenaline rush, the rapid history-taking and PEs, the walking to-and-fro to attend to referrals and to shadow the residents while they do their thing, to walk miles and miles to get lab results or conduct patients and whatnot (exercise while you work - it’s amazing!). And the best part is, I get to learn a lot given the variety of cases we go through in a day.
Ward duty isn’t exactly dull though. Still, I get to do procedures (I’m kinda getting the hang of it, just a handful of mistakes here and there) and monitor and check on admitted patients. The major difference though is that instead of the usual worried, harried looks on ER patients’ and their bantays’ faces (it is in fact, the ER) you are dealing with happier, more relaxed patients at the wards in general. Here you get to spend more quality time talking to them while you ensure that all is well - that they’re comfortable and their needs are met - and usually they’re more grateful every time you check on them. And every time, this gratitude is most rewarding, especially after a long, tiring day.
Three days in rotating at the PGH Department of Otorhinolaryngology, Head and Neck Surgery (that’s their complete name, it’s more descriptive of the work they do than just plain ORL) has made me realize that this was exactly the career I imagine myself would be in.
Enjoyed the last two weeks rotating in Orthopedics.
Learned a lot, mostly about assessing fractures. And how to properly evaluate suspected fractures (mobilizing is a NO-NO!). Got dirty with the cement and helped out in the actual casting of patients. And practiced sleeping in bouts only to be awakened by tasks to do (then back to sleep afterwards.)
Benign as always. The hospital duty part that is.
That’s because all the paperwork submissions are piling up on me now. It had always been a sickness of mine, me not doing my requirements ahead of time, when the schedule isn’t so jam-packed yet, and cramming stuff last minute, when the deadline’s already round the corner. Fine, I may be having some other major stuff going on to think about (i.e. my personal life, plus the fact that I’m moving from my place) but still, these paperwork would have been done with a long time ago were I not such a procrastinating slob.
Valuable Med School Lesson # 1
Never skip your morning coffee.
Get your lazy ass off your comfortable bed early, even if it’s drizzling outside and the cold’s telling you to stay in bed just for a few more, if only to have some spare time to have your AM dose of bitter happiness.
Valuable Med School Lesson # 2
Weird residents are weird.
Especially when they’re presenting in front of consultants. About things like wheelchairs.
Hope no one from my hospital reads this.Valuable Med School Lesson # 3
Come to an SGD prepared. And with good luck.
Good thing Dr. MD’s toxicity as a preceptor was endorsed by previous med students. I wasn’t exactly optimally prepared for it really compared to my blockmates, but good luck (fine, divine intervention) saved my lazy ass from her anger and mockery. My other comrade wasn’t so lucky.
Still, she’s one of the best consultants I’ve been lucky to have been handled by. Learned SO MUCH about cerebral palsy, aside from the emphasis on the importance of a focused but thorough physical exam.
Valuable Med School Lesson # 4
Watch your friends and orgmates perform for the freshmen night (and regret not volunteering to dance with them again), have a hearty dinner with a friend, or hang-out at the callroom of your friend on duty (and talk about other people while she’s in-between monitoring patients.) Or do all of the above.
Or, watch a movie. Basta, detox. It will keep you sane.
I’m so thankful that because our rotation is benign, we get to ease our way into the terrifying life that is clerkship.
Anyway, today was very uneventful.
One of Sir Vlad’s favorite quotes.
Sir Vlad: my high school Economics teacher and one of the best teachers I’ve had to date. I never forgot this quote because of him.
4. (Severely) High Risk Pregnancy, OB-GYN
HG 38/F: I blogged about this patient a few months ago. I saw her at the PGH OB-OPD, an elderly primigravid (a first pregnancy beyond 35 is a significant risk factor) referred to the PGH for multiple problems, namely;
She was just on her 31st pregnancy week but her abdomen was already enlarged to the size of a term, multiple pregnancy. She had severe leg edema and difficulty ambulation as a result of the excessive weight of her gravid belly. Her labs suggested impaired glucose tolerance. The resident and I suspected gestational diabetes, which led to the whole lot of complications such as the fetal abnormalities, macrosomia and polyhydramnios.
5. Systemic Lupus Erythematosus, Pediatrics
JI 13/F: A patient in her early teens diagnosed with lupus came in with her adoptive mother for follow-up. Clinically the case was not so remarkable, except for the fact that she came in with the classic presentation of SLE (fulfilling 8 of the 11 criteria.) What was more of note though was the fact that they came in with their complete records organized in an envelope - doctors notes, copies of ward charts, even the prescriptions and receipts for every laboratory request and medication throughout the course of the child’s illness. They also came in conversant about the disease - they knew its basic pathology and principles of management (like things to do to avoid complications.) Most importantly, they were curious and inquiring, asking questions to clarify points, etc.
In short, she was the poster girl for the ideal patient. Every clinician appreciates patients who make work easier for them and are in-charge of their own health. The strongest allies of a doctor in optimal patient care are in fact the patient and his/her family themselves. In a setting full of ‘difficult patients’ such as that in the PGH, this patient was a refreshing reminder to everyone that they should be in-charge of their own health.
When we started our third year (Integrated Clinical Clerkship) last year our professor from Family Medicine gave us an assignment. She told us to make a log of every patient we were to encounter that year, including the patients’ diagnoses and management plans.
Yesterday I was poring over my notes trying to collate my records of patient encounters. Being the OCD case that I am, I wanted my patient log to be complete and organized. The process took me back to all those patients I’ve encountered - all the histories I took, the cathartic interviews on OPD patients, the physical examinations performed in the cramped clinics of the PGH OPD.
I finished compiling my patient log this morning, and doing so made me relive five of my most unforgettable patient enocunters of ICC year. And in so doing, it made me recall the valuable lessons (academic and otherwise) I’ve picked up from each of them.
More on the individual cases on later posts.
Yesterday was a very busy day, spent bonding with my sister as I tagged along her clinical practice.
She and I spent the morning as first and second assist (respectively) to her close friend and residency classmate Dr. T, on the case of an elderly male with rectosigmoid cancer (colon adenocarcinoma.) Called a Hartmann Procedure, the operation involved surgical resection of the rectosigmoid containing the tumor, with closure of the distal bowel (creating a rectal stump) and the creation of an end-colostomy on the proximal bowel. The colostomy creates a stoma, an opening in the abdominal wall through which the remaining colon is sutured into place, creating an alternative passage for evacuation of fecal matter. (More on this from eMedicine.)