Public Disservice

Roadwork has started on the northern end of our street last April, and it was nowhere close to being finished. That's why I had to pass through the side streets and take the longer route home for the past few months. They said the old pipes need to be replaced, and since the pipes on our street are located right smack in the middle of the road, they can't do repairs one lane at a time. The entire width of the road has to be smashed up, hence making that section of the street inaccessible to vehicles. I wonder what's taking them so long. Limited supplies? Budgetary constraints? Not enough manpower? Or too much time off for the workers? and I wonder why they have to start doing their repairs at the start of the rainy season. Everything was fine before their work started, we weren't experiencing any problems with water drainage. I wonder if repairs were really needed to be done, or if this was just another opportunity for incumbent politicians to show that the taxpayers' money are working for them since elections are going to be held next year. Heck, ever the cynic, I suspect that this also gives those politicians a chance to siphon more of the tax payers money with their under the table deals with construction companies.

When I got home from work this afternoon, there were a lot of people outside, but i didn't really mind them. I was so tired, and all i wanted to do was lie on my bed and sleep. When i woke up several hours later, I heard the sound of trucks outside. And--- I swore i could have been wrong at first, but i was hearing the sound of jackhammers. I went outside to take a look.

F*ck. Just like that, someone had the bright idea to do roadwork on our part of the street, even when the northern end was far from being finished! Now the entire length of our street was closed! My dad and grandparents were pissed, because apparently we weren't informed beforehand! Even our neighbors weren't informed beforehand, and everyone was angry! My dad and my brother had to park their cars on some side street a mile away, while my car was trapped in our garage. Who wouldn't be pissed? For the next few weeks--- or god forbid, MONTHS, knowing how road work crawls at a snail's pace in this country... I'm back to using public transport. Our other cars would be exposed to possible theft. And then there's my grandmother, who has already been rushed to the hospital several times this year, most often in the middle of the night. How the heck are we supposed to carry her all the way to our car that's parked a mile away and reach the hospital in time when the road outside our house resembles a demolition site?! At its present state, it looks as if an atomic exploded!

My dad has talked to the mayor (who's my grandfather's friend), and he said roadwork would be done in a few days. It's possible--- on another city, roadwork was done in only two days... but then again, the house of the mayor's mother was on that street. The same thing cannot be said with regard to the other streets in this country though. That's too bad, because having VIPs within the vicinity seems to be the only way to make people work both quickly and efficiently. A little over a week, let's see. That's what the mayor said. We're just hoping nothing bad happens within the next few days... nothing emergent, nothing critical. No life or death situation. because if something does happen, you can bet on it... our family will SURELY raise HELL.

Revenge of the Fallen

One of the cartoon series that I was extremely fond of during my younger years was Dragon Ball Z. I was so obsessed back then, I even watched several episodes that didn't have subtitles nor dubbed in english, even though i couldn't understand a single word of japanese. Even now, I still find the battles amazing. And now that I'm older, I've realized that the battle sequences were the only things the series had going for it. Everything in between pretty much sucked. Preposterous to downright silly story lines, littered with corny jokes and tiresome dialogue. Overextended, boring expositions that only serve to lengthen the running time. Many times, I wished i could fast forward the show when I'm watching it on TV. If only they cut out everything else and just showed one battle sequence after another, then Dragon Ball Z would have been an excellent series.

I know you are wondering... Why the heck am I talking about Dragon Ball Z when this is supposed to be a Transformers review? Because I feel pretty much the same thing with this movie. In typical Michael Bay fashion, the movie is filled with explosions, special effects, hot women, and heavy artillery. A showcase of women, military, and weaponry. The shots during the action sequences are superb, all that eye candy can really overcome one's senses. To put it bluntly, the action sequences are downright orgasmic. As for the rest of the movie? The plot sucks. The characters were written poorly. Some jokes weren't funny, and some were even offensive. Heck, some scenes that weren't meant to be funny were the ones that I thought to be funny. All the cheesy dialogue nauseated me. The scenes in between all the mayhem were overly long and unnecessary, they only made the movie less satisfying. Just when you get pumped up with adrenaline because of all the action you're seeing on screen, it all ends abruptly. You get another boring scene. another failed attempt to portray characterization and to elicit sympathy. If only all the fluff were taken out, if the scenes in between all that noise were shortened... heck, if they only showed one action sequence after another, then we'd have a more cohesive, and ultimately more satisfying movie.

But I still liked the movie... a lot. I know... WTF?!, right? How the heck can I like this movie with all the complaints that I have? Because I grew up with the Transformers. I loved the series to death, and seeing those giant f*ckin' robots for the first time on the big screen two years ago was a wet dream come true. I was a skeptic at first, but as soon as I saw the first robot transform, I was filled with awe. And upon watching another Transformers movie, I was filled with the same level of awe. Yeah I'm incredibly biased with this one. If this wasn't Transformers, I would've trashed this movie to death. But alas, nostalgia can really dull one's senses, and dulled senses made those action sequences even more intense. Nostalgia + Michael Bay signature action sequences = one incredible movie experience. Just throw you common sense out the window and take this movie for what it really is--- a summer popcorn flick (and it's not pretending to be something more than what it is, so critics should give Michael Bay and Co. a break), and you'll walk out of the movie theater entertained. You may not really like the movie as a whole, but to some degree, I'm willing to bet that you'll be entertained.

Dreamscapes

Dreams can be really weird sometimes. At times, dreams are ordinary and believable, sometimes they are completely out of this world. There's this theory that dreams are manifestations of one's subconscious thought, and yeah, some of my dreams do seem to reveal my hidden desires, but some of the dreams I have come out of left field. They don't make any sense at all.

I have always been fascinated with dreams. Way back in college, I even did a research paper on the subject--- but I didn't really get any definite answers. The general consensus seems to be that dreams are manifestations of the unconscious. But that conclusion leads to even more questions, and to many, even doubt. Take this weird dream I had last night:

From what I can remember, it started with me flying through space, but I somehow ended up in an igloo on top of Mt. Everest. Some of my friends and relatives were there, along with a few strangers. It was a rest house of sorts. One of my cousins was skateboarding on the icy ground, he couldn't stop and subsequently fell off a ledge. Then somehow, the place was a became an icy movie theater, i was in a balcony, looking down at the audience below... and there was an event: it was a movie premier. Then the screening had to stop because the stars of the movie have arrived. They apologized for being late, because there was a storm outside. Then the movie started playing from the beginning again. Then my mother was coming up from the ladder along with my aunts, and they were all wet because of the storm. Then I told them I had to go down to get something important. She told me to be careful, the path is slippery. As soon as I got off the ladder, I was no longer in Mt. Everest, I was in some weird town. I sat on the wet ground, and suddenly a truck passed by, which almost ran over me if I hadn't moved quickly. Then suddenly I was in some living room. I was seated on the floor, then a huge dog was all over me. i thought it was going to bite me, but it only sniffed me all over. It then said something, then proceeded to suck my balls.

I'm not kidding.

Just to make things clear, there's no way I'm having thoughts like that, even subconsciously, and never in my wildest, most horribly nauseating fantasies do i even wish for some dog to suck on my balls. Symbolism perhaps? If things in our dreams are symbols, what could they mean? On a scientific perspective, the subconscious theory seems more plausible, along with conscious thoughts, things that we are preoccupied with, manifesting themselves even in our sleep. But I don't really think my conscious nor my subconscious thoughts could be related to that dream i just had. Are dreams merely random images? Do they make sense at all? Are we putting too much thought into nothing? Seeing that there are no definite answers, dreams remain to be in the realm of mysteries for now, and would therefore pique our curiosities indefinitely.

Of Least Concern

Another day in the emergency room. Usually exhausting, at times benign. Always unpredictable.

It was around 9 PM when those two stab wound patients came in. I've encountered a lot of trauma patients, and I have been trained regarding the proper management of such cases. Both Patients were hypotensive, but one of them already has parts of his intestines eviscerating from the stab wound on his abdomen. And he had a lot of other stab wounds on his back, which could account for the probable massive blood loss. On ausculation, his lungs didn't appear to be injured, but I ordered an immediate chest x-ray just to be sure. An emergency exploratory laparotomy was indicated. The other patient only had a single stab wound. Auscultation revealed a possible pneumothorax, but since he was more stable, i first administered fluid resuscitation and ordered an immediate chest x-ray.

While waiting for the results, i referred both patients to the surgery consultant on call. I was surprised by his response. First he asked me if there was a vacant room available. I told him there was none. He said how can the patient be admitted at the hospital when there's no available room. He reminded me of the "no room, no admission" policy. i told him in such emergency cases, a patient can be admitted even if there's no vacant room. Then he told me we lacked supplies at the operating room, and I said I already checked the supplies at the operating room. The hospital did not lack the necessary supplies. Then he said that he would need blood for the operation, and without waiting for my response he told me that's it's better to just stabilize the patient and transfer him to another hospital as soon as possible because we cannot operate on the patient. WTF?! Good thing one of the nurses had the foresight to check if we had available blood at the blood bank, so I told him that blood was available in case a blood transfusion was needed. Then this surgeon sounded irritated. Even more when I told him that I could do the operation for him if he would allowed me. He ran out of excuses, so he just told me he'll be at the hospital in thirty minutes.

Searching for an anesthesiologist was another problem. I already called all the anesthesiologists on deck at the hospital. Some said they had an ongoing case, others said they were out of town and that they wouldn't make it in time for such an emergency procedure... but i doubted if these anesthesiologists were telling the truth. It has always been such a chore finding an anesthesiologist in a government hospital. The others simply didn't answer their phones. I had no choice, so I just called their department chairman and told him the situation. I told him bluntly, if he can't find an available anesthesiologist, he had to administer anesthesia to the patient. I didn't care if he found me disrespectful. A patient's life was at stake, I've had about enough of these consultants and their stupid excuses.

The x-rays were done after that. The patient's chest x-ray was unremarkable, but the other patient had a massive pneumohemothorax on the left side. And whereas previously he didn't find it difficult to breath, after the xray he was almost gasping for breath. So I did an immediate closed tube thoracostomy without referring him to a consultant. It was an emergency and I've done the procedure dozens of times, so I didn't bother informing any consultant. Several supplies were not available, but miraculously, I managed to improvise. Afterwards, the patient became comfortable, although he complained of pain in the left lower quadrant of his abdomen. Palpation of the area elicited tenderness. Since the stab would was on the lower ribs, an abdominal injury was possible. I could have done an abdominal ultrasound to rule out an intraabdominal injury, but it wasn't available at the hospital. The chest xray didn't show any signs of pneumoperitoneum, so I decided to just observe the patient. An exploratory laparotomy could also be indicated if symptoms progressed.

And then Mr. Surgeon on duty came. He ordered the nurses to bring the first patient to the operating room ASAP. I mentioned the other patient to him, and that I already inserted a chest tube. He didn't seem to care, but when I told him about the abdominal findings, he told me to transfer the patient to another hospital while it was still early, because there's no way he could do another laparotomy. Christ. Is he aware of how difficult it is to transfer such a patient? Especially when the mentioned patient lacked sufficient funds? I can't just transfer a patient when I have already managed his immediate concerns. Most government hospitals already have their hands full, and they would not be inclined to accept a stable patient. What the heck. Screw him. I chose to continue with my present management. I knew what to do anyway.

The patient was stable when I endorsed him to my reliever. Ultrasound was still pending, but all abdominal symptoms have disappeared. Before I left, I referred the patient to another surgeon, who was more amenable. When he saw the post thoracostomy xray, his words were "perfect placement". He looked at the patient's chart and commended my management. He then asked me if I was already done with general surgery residency, and if I was just moonlighting while waiting for the results of the exam administered by the board of surgery. i told him no, and he seemed surprised. He told me that I more capable than a lot of doctors who have already finished surgery residency. I couldn't help but smile. I was extremely pissed a few hours earlier, and all those miserable hours seemed to have vanished suddenly. It's great to end one's tour of duty on a high note. It makes the whole day seem fulfilling, even when it's not.

I understand why a lot of consultants don't really want to accept patients at the hospital where I'm working. For one thing, they are not adequately compensated. Most of these patients don't have money, and I guess they often get promisory notes as payment for all their efforts. i understand where they are coming from. Of course I want to receive just compensation as well. But these consultants are aware of this fact when they signed up. They are aware that it's a local government hospital, therefore majority of the patients that they would receive won't really have sufficient funds. If such patients would always be the least of their priorities, or worse--- if such patients won't even be a priority at all, they shouldn't have signed up in the first place.

I. Saw. Red.

Went home intoxicated, with a glimpse of sunlight already on the horizon. Only slept for two hours. Had to force myself out of my bed. My day wasn't starting out right. And from the moment that motorcycle hit my car from behind as I was on my way to work that morning, i knew it would be a horrible day. It just wouldn't be my day.

I know how irrational patients and their relatives can get in times of emergencies... or more often, in times that they mistake for emergencies. Back in 2004, the year of my clinical clerkship, I experienced first hand how a patient's relatives showered utmost hatred towards the medical staff when we failed to revive their relative. Expletives were shouted, and they had the look in their eyes that screamed murder. In times of grief and despair, people tend to become incapable of rational thought. That's human nature, I guess.

There are a number of times that I behaved unprofessionally while at work. I can't help it, so sue me. I work at a government hospital, and although I like the fact that the patients we encounter are those who really need our help, one drawback is that most of these patients and their relatives are uneducated, some may say even uncivilized. They can't understand simple instructions, and they fail to grasp simple reasoning. I'm aware of this fact, and often I can show patience. But the workload can sometimes limit the extent of how this patience can be stretched... especially when these patients don't treat you with the respect that you deserve, I can't help but to retaliate at times. Respect begets respect, one does not need fancy education to grasp such a simple concept.

Often, patients demand to be admitted at the hospital even when they have no basis for admission. They just think they need to be confined at the hospital because of the subjective symptoms that they feel. To be admitted just because you want to be admitted is acceptable at a private hospital, but not in a government hospital wherein we save beds for those who really need to be confined. Most the time all beds are full because the bulk of patients in the general population seek consult at government hospitals. It would be both foolish and impractical to admit patients because they want to. Or how about those patients who go to the emergency room to seek consult for such simple and benign illnesses that could obviously wait until the next day? Do they not understand the meaning of the word "emergency"? It's fine when there are only a few patients. But when we are dealing with a lot of patients, most of whom are really in emergency situations, these patients can really be a waste of time and manpower. And it even gets more irritating when they demand immediate attention, saying they were there first, even when the patient who came after them is already gasping for breath. At times I can't help but shout at these patients. If they refuse to wait, then they better transfer to a private hospital. Their non- emergency complaints along with their money, would be fully appreciated there. It even gets more annoying when they start to namedrop, saying that they know the hospital director, or someone from the government. D-oh, as if those people can really do anything. So what if they are from the government? We can't just discharge patients randomly just so we can admit their patients. Often, all beds are full, all rooms are full. There are even makeshift beds and stretchers along hallways just to accommodate the huge patient load. If those people that they know can add rooms or beds just to accommodate them, then fine. But if they can't, then they better just shut the f*ck up.

There was a time last year when I actually challenged a patient's relatives to a fist fight. Highly unprofessional behavior, i know. There were a lot of patients coming in, and seeing that the patient only had a simple laceration, I asked him to wait. After about an hour, I fully explored the wound, and I saw that a tendon was transected. I couldn't find the proximal part, I had to extend the would longitudinally to find it. A local anesthetic wouldn't be enough. Such a procedure can't be done at the emergency room, and since the operating rooms were full, the patient had to be transferred to another hospital. I called another institution and they were willing to accept the patient. Our ambulance was available, so the patient was ready to be transferred. But then the patient's brother started rapping about making them wait. If I couldn't do something about his brother's condition, I shouldn't have let them wait that long. i explained the situation again, but he refused to listen. I was getting exasperated. I haven't eaten yet, and there were more patients coming in. i couldn't waste any more time explaining. Then I heard an expletive. My patience ran out. I shouted at him. I exclaimed an expletive as well. He answered back. he pointed a finger at my face, and I pushed his hand away. Then I challenged him to a fight outside to settle things. He then said something like what aprofessional I am, challenging him to a fight. I told him that was the way I am and he couldn't so anything about it. I was about to kick his sorry ass when the hospital's security guards grabbed him and brought him outside. Such unreasonable people can really bring out the worst in me, especially when I am stressed.

The last time I went on duty, things were going smoothly at first. I've managed to keep that stupid motorcycle driver who scratched my car out of my mind. From morning until the afternoon, the patient load was tolerable. Then that patient with two gunshot wounds to the head came it. He was brought in by the local rescue team. They said they found him by the road, so the exact time of injury was unknown. Both pupils were already dilated. On my assessment, his Glasgow Coma Scale was only 4... definitely not a good sign. But the patient was still alive, so we had to resuscitate him. I inserted an endotracheal tube, started fluid resuscitation, and after a few minutes, his vital signs began to stabilize. The patient was stripped as i searched for other injuries. His pockets were emptied, which had a small bag of marijuana among other things. I knew the outcome wouldn't be favorable, and an operation would be useless, but as per the hospital's protocol, I referred him to a neurosurgeon. Just as I suspected, the prognosis wasn't good. But an immediate CT scan had to be done just to see if an immediate operation would be of benefit. If there was a subdural or epidural hematoma causing a compression or herniation of structures, then immediate craniotomy would be of benefit. If there was none, then a craniotomy would be useless. The location of the bullets had to be known too. If the bullets were only superficially located, they could be excised. If the bullets were located deep in the brain though, excising them would mean dissecting the whole brain, which would only do more harm than good. That was when some relatives came. Since the hospital had no CT scan, the patient had to be transferred temporarily to another hospital. Good thing the relatives had sufficient funds. The CT scan was done immediately. One bullet did not penetrate the skull, but the other was at the center of the brain. There were no subdural nor epidural hematomas, only intraparenchymal hematomas around the bullet's trajectory. Based on my initial assessment, I figured that an operation was useless. The CT scan affirmed my presumption. When I relayed this to the relatives, that was when all hell broke loose. The patient's mother grew hysterical. She demanded that the patient be transferred to a private hospital because we weren't doing anything.(WTF?!) To appease her, I tried to call the hospital where they want to transfer the patient. The physician at that hospital told me that they could not accomodate the patient. The patient's mother grew even more hysterical. She screamed at me and told me that I was a liar. She said the hospital would accept them because money was no object... never mind the fact that that hospital had no available rooms. Obviously, she knew nothing about patient transfer protocols. I let that pass. I knew that she was grieving and she was still in denial. Then they wanted to transport the patient by themselves, which we cannot allow because the patient was intubated. Now the other relatives were also shouting. Why wouldn't we let them go, they ask. Jesus Christ. To appease them, I called another hospital--- one that I was sure had available rooms because of their exorbitant rates. And true enough, they can accomodate the patient. One of the patient's relatives, who was a doctor herself, asked me questions. She understood the fact that transferring the patient to another hospital was useless, that it would only incur additional expenses, and yet she wouldn't help me make her relatives understand. No amount of explaining could make things clear to people in denial. But she could somehow provide the voice of reasoning. When I asked her to explain everything to her relatives--- because maybe they would listen to her... she just remained silent.

Another half hour of crying and screaming. The mother shouting that her son was a good person, he had no enemies, he did not deserve what happened... i just wondered how good he really was, when illicit drugs were found in his pockets. He had two shots in the head, one on each side... a person must really be consumed with anger in order to do that to another human being... More crying. More shouting. It was a madhouse. I was glad when they finally settled their hospital bill. A few more minutes, and we were off. When we arrived at the other hospital, a few more relatives arrived. The patient's brother, who was crying and begging me earlier to let them transfer their patient to another hospital said something that really made my blood boil. He told his relatives that the doctors at our hospital weren't doing anything. He told them that we were stupid and we did not know what we were doing. And the he turned to me and said that all the years i spent in med school was a waste, because look at the way I turned out.

I wanted to punch him in the face.

I was trying so hard to control myself. I knew that they were in grief, and that's why I remained incredibly patient all that time. But to say something like that, to personally attack my and my profession?! That comment was way below the belt. It's bad enough when patients accuse you of not knowing what you are doing--- but when you are 100% sure that everything you've done is correct and they still question your management, it's even more offensive. I know I'm not perfect, and I know I'm not a great doctor. I've made a lot of mistakes in the past, but on that patient's case, I did everything right. I tried so hard to control my temper, simply because I wasn't at my home turf. I was at another hospital. If we were outside and I wasn't on duty, I would challenge him to a fight, punch him in the face, I don't care even if he's bigger than me. We weren't doing anything?! whether they brought the patient to a private or public hospital, it wouldn't have made a difference. We followed resuscitation protocols by the book. The treatment would be the same even if the patient was brought to a private hospital. And he calls us stupid?! They're the ones who can't grasp the reality that their patient was brain dead to begin with, that he wouldn't survive anyway--- and in the unlikely event that he does survive, it would only be in a comatose state. They kept on demanding that the patient undergo operation no matter how hard I explain to them that an operation is useless. If there's anyone stupid in the emergency room, it's their whole family, not us. I wanted to tell him that only a blind person would say that we were not doing anything. Only an imbecile would tell me that i don't know what I was doing. Only a moron would tell me that the things that I did were wrong. But what could i expect from a family that can't grasp the simple fact that their relative has no chance of survival? What could I expect from a family that keeps on insisting on an operation that isn't even needed? Mark my words, if the neurosurgeon at that hospital recommends an operation, he or she would only be milking money from them, knowing very well that an operation is not indicated. But what could I expect from a family that's drowning in denial? What could I expect from a bunch of know-it-alls? Stupidity must really be genetic. Their family is the living proof of that.

But i stayed silent. I tried to symphatize, i tried to understand their situation. But I was really offended, and that feeling rises above all others. It doesn't dissipate... it lingers. I kept all that anger inside, instead of finding a way to release it. And now... two days later, I'm still pissed. Really f*ckin' pissed.

I should've punched that asshole in the face. Who gives a f*ck about consequences. I could deal with all that later. At least punching him would have immediately made me feel better.

Standstill

It has become a monthly thing.

I got home a little late today. Traffic was bad, and with all the roadwork going on near our house, I had to take a longer route home. I was so tired, and all I wanted to do was sleep, but as soon as a lied on my bed, my aunt told me that my grandmother was finding it difficult to breath again.

*groan*

Not again.

July 2008. September 2008. December 2008. January 2009. April 2009. That's five hospital admissions in a span of less than a year.  It has only been 30 days since she was discharged from the hospital. That last attack was the worst one so far. Whereas before she would be fully recovered after about two weeks, she never fully recovered her strength after the last admission. After walking a short distance, she needed to sit down. She would already be gasping for breath. And when i say a short distance, that distance doesn't even reach a hundred meters. At home, she would occasionally find it difficult to breath, but a few minutes of pure oxygen inhalation would solve the problem. Maybe it was just another one of those episodes. Oxygen inhalation: done. Intravenous diuretics: given. Calcium channel blocker: given. After about thirty minutes, she fell asleep. She seemed to have stabilized. Breathing was normal. Heart rate and rhythm were normal. Everything seemed okay. After a few more minutes, i left her room and went to sleep.

I woke up almost midnight. Everyone in the house is usually asleep at that time so I didn't notice anything that was out of the ordinary. I ate dinner, watched a little TV, surfed the net, took a bath. Then I received a text message from my dad. Apparently, my grandmother was brought to the hospital while I was asleep, and she was again confined at the telemetry unit. She didn't want to wake me up because she noticed that I was tired, so my dad was called instead.

I knew it was inevitable. The fact that she has not yet fully recovered after a month was a bad sign. Hospital admissions have been increasing in frequency, I doubt if she still has long to live. Last month, we had to take her to the hospital right after we had dinner at a restaurant. All of a sudden, she couldn't breath, and she was quickly getting pale. Good thing the hospital was nearby, because that was a close call. That was a week before the exam i took. I couldn't properly do some last minute studying (or should I say cramming) because I had to take part in hospital shifts--- a relative must be present near her room at all times. And because I had the most flexible schedule, i had to take the bulk of those shifts. It was fine, except for the fact that I couldn't get much studying done at the hospital. I'm not saying that was the reason why I didn't get a high grade on the exam, but I guess it was a factor.

Somehow, I'm at a standstill. I can't really make definite plans for the future when she's like this. I have to put everything on hold when these things happen. I HAVE to be always available. Even when it was impossible, my dad pressured me to make it possible--- that was one of the factors that led to my eventual resignation as a surgery resident. That job required me to give all my time, and it wasn't compatible with a family situation that occasionally required me to give my full time also. Just two weeks ago, I found it extremely irritating when my dad specifically told me that when my grandmother has to be brought to the hospital, even when I'm at work, I should still be available to bring her.  He's going abroad and my brother is out of town, and I would be the only one in proximity. Uh... don't we have the family driver for that???? Did he really expect me to do something so irresponsible? To suddenly leave the hospital where i worked when it was virtually impossible to find another doctor to cover for me on such short notice? Yes, I was often pressured. At times I'm given such huge and impractical demands, but I never felt that I was being forced. I'm not obliged to. But as person who cares for someone he owes his life to, I feel that i have to. It's my duty. It's my responsibility. Because of that, I have realized that I can't really go on unless she completely recovers and  stay fit and healthy, or sadly... just the opposite. Yet I can't keep on postponing my plans waiting for such a thing to happen. I can't remain on a standstill for months, even years, or God forbid... even a decade. Who knows how long this will go on? I'm praying for more years ahead of her life, but I can't remain like this during all those years. Eventually, I have to go ahead and carry on, just wish for the best, ignoring all distractions,  and stick to my plans without looking behind...

No matter how uncaring and selfish it makes me look.

No matter how sad, contrite, and pitiful it makes me feel.

Even if I end up hating myself, I have to move on... sometime.

The First Obstacle

Down in the dumps. So f*ckin' depressed. That was how I felt when I received the results of my USMLE step 1. I know, I should be happy that I passed, but I just can't help but feel depressed. A long time friend pointed out that it must be because of my bruised ego. As someone who was viewed as a genius/ nerd a decade ago, getting a below average score is a major downer. Fine. My ego was bruised. It wasn't just bruised. It was crushed. But that's not the reason why I'm feeling depressed. I feel sad because for a fleeting moment I thought I really had the chance of getting into the program that I really wanted. Yeah, it was probably a long shot, but I still had that chance. And just like that, as quick as a blink... the chance was gone.

What exactly am I talking about, you ask? If you manage to read my blog from the very beginning, you'd come to the impression that I'm sort of a morbid creature. I get high with the sight of blood and guts. I get that adrenaline rush when I encounter emergency situations. The most obvious clues would be my entries from the year '07, when i was blatantly ranting about the residency program that I was in. I didn't want to be a doctor in the first place. But here i am now, it would be really impractical to make a sudden and drastic career shift. So if I had to choose a program to specialize in, it had to be something I enjoyed doing. Every incision I make gets me high. Successfully doing an operation, no matter how simple it is, gives me a great deal of satisfaction, a remarkable sense of accomplishment. In order to lessen the bitter taste that this profession leaves in my mouth, to make everything easier to bear... if I had to choose a residency program, it has to be surgery.

When one of my close friends told me I had a shot two months ago, as long as I get an above average score, I was extremely happy. I knew how hard it is for a foreign medical graduate to get into surgery in the US. One needs to have a lot of credentials. US clinical experience. Published research works. Recommendation letters from renowned American Physicians. Exemplary grades in Med school. Exceptionally high scores in the USMLEs. Most of which i don't have, but I still had a chance because my friend has relatives on "the inside", and they could help me out. I just had to get high scores on my MLEs. And when I got my score, that dream vanished instantly.

It's not a big deal really. Crap, I know this would sound selfish, but my main reason for wanting to train in the US is money. Yeah, I know the medical profession is service oriented, and financial matters should not be at the forefront... but I'm just so tired of getting such a paltry some for all my efforts. All those years spent in med school, with all those lavish expenses, those sleepless nights, the mental torture... all for what? For a job that offers salaries that can barely support a single person? Don't get me wrong, I like serving others, I like to help out. But how can I continue helping others when I can barely support myself? So yeah, financial gain is my primary purpose. If that's my primary purpose, then it shouldn't matter which residency program I get into, right? But is it so wrong to dream? To wish that i could get into that certain program that could make this whole profession I'm in a little easier to swallow?

Now reluctantly, I'm exploring other options. First is family medicine. They say it's the easiest program for foreign medical graduates to get into because it's the least competitive. Most American medical graduates choose other specialties, and I can't blame them. Because family practice, deals with primary care, they get the huge patient loads. Schedules can become hectic. On the upside, that means more cash. Plus, the option to take up Sports Medicine as fellowship makes the program attractive to me. And---! I heard that doing minor surgical procedures is part of the program, and sometimes family medicine residents even do major operations when no surgeons are available. i can do something I like, although it would be mixed with rotations that i hate, like obstetrics and gynecology. Yuk. The only problem is, the option to go back to my home country after residency is still an option for me... depending on how things go. In this country, other physicians look down on family physicians and emergency medicine physicians... the "jack of all trades, master of none" stigma... add the fact that family medicine is not a lucrative practice at all back here.

So... option number two would be internal medicine. Since med school i hated this subject matter. Even during clerkship and internship I hated rotating in this department, and now, every time i go on duty at the emergency room, I cringe whenever i have to handle medical cases. I'm also more hot headed when dealing with these patients. It just isn't my thing. At times, I even feel like a fish out of water when I encounter such patients. I know I can learn eventually, but when it comes to this subject matter, I have no urge to learn at all. Would the promise of hefty salaries be enough to make me last for years in a program that I absolutely detest? One upside would be a better private practice back home if ever I decide to go back. And there would be none of that family medicine stigma. And I could take up gastroenterology or pulmonology for fellowship, the two subspecialties that piqued my interest back in med school. But I just can't stomach the other subspecialties. Just thinking about those three years during residency where I have to go through those other subspecialties nauseates me.

The other residency programs are not for me. I just can't see myself as a pediatrician, an obstetrician, a gynecologist, a radiologist, an anesthesiologist... i just can't. So it's a toss up between family medicine and internal medicine... I don't really like both, so it's going to be difficult weighing the pros and cons, which program would be easier to stomach. Man, I hate choosing between two evils. But as they say, beggars can't be choosers. I'm in no position to be choosy.

But it's not over yet, is it? That's just one step, there are three more to go. Maybe if i get a better score on the next one, I might still have that chance again. It's a long shot, but maybe there's still a chance that I won't be spending everyday in residency drenched in utter misery.



Hey, the last time I checked, everyone is still free to dream.