A Year From Now

Nope, this won't be another post about the uncertainties of my future--- I've had a lot of those lately. hehe. I've just seen the spiderman 3 teaser trailer online, and all i can say is WOW! They've included the Venom story arc in the third movie! there's freakin' VENOM! I'm so psyched for next year's summer movie season, even if they're only halfway with this year's blockbusters! I haven't even seen Superman Returns yet. hehe. And there's still Miami Vice on my must-see list, if only for Michael Mann.

There's even a TRANSFORMERS movie next year! Hope they don't screw that up! The official site is already up. Their war, Our World... Woo-hoo! There's also a teaser trailer, but it seemed lackluster... I hate to say it, but it seemed bland. I didn't feel the same excitement I felt when I first saw the Spiderman 3 teaser. It's still too early though, hopefully when I see it next year, I'll be wrapped in pure nostalgic bliss! The inner child in me is already dying of anticipation. But the director is MICHAEL BAY... is that another bad sign? Michael Bay!!!! i hope he does not screw up the mythos of one of the cartoon series that was a huge part of my childhood! Let the movie be a special effects laden wet dream come true!!! hehe.



I'm also hoping I won't be too busy next year when these movies are already showing. What the heck, I'll surely find some time to watch both movies no matter how busy I am. LOL. I'm such a child. :D

Reality Sets in Again

A penny for my thoughts.

I've been having a lot of talks with my peers lately, and I've been having second thoughts about which path I should take in my medical career. I thought I've decided to take up general surgery--- that's a no brainer. After all, that's the only field where I've shown much interest. But many have been saying that such a career is not such a good choice. There are already so many general surgeons in this country, that it seems not worth the amount of time you spend on training (5 years as opposed to 3 years for other residency training programs). After finishing the program, it's hard to earn money because of all the competition. Plus, there are already a lot of established surgeons out there. It's a specialty wherein there's a huge discrepancy between the supply and the demand--- unless one chooses to practice in a far flung province.... but I can't live like that. FOr a short time, maybe, but not my whole life. That's why a lot of surgeons leave the country to search for places where there's a demand for them. They have to earn to live, after all. To add to their woes, some countries prefer those who have undergone residency training in their country. I don't want to spend 5 years of my life in training, then regret it afterwards because i'm not earning enough.

If I choose a field where there's few competition or where there's such a huge demand, I know I'll make money. But I'd be stuck I'm a profession marked by tedium. I don't want to spend my whole life doing something I'm not interested in, no matter how lucrative the profession is.

Maybe I should just take a year off after passing the board exams. I'll have time to clear my head, before I start my journey to the point of no return. And I can do non medical stuff, too. I'll spend the rest of my life being a part of the medical field, having a year off from it may actually do some good. Maybe I can live someplace else for a change, some remote province, so I can think straight. or travel to another country, not one of the usual haunts. Maybe in South America, some place not vandalized by tourism so I can fully immerse myself in another culture. Taking a year off may be my last chance to do the things I've always wanted.

Voyeur View

I've just spent the last 3 hours of my study time doing something else instead of studying. It has become a habit that I click the "next blog" button whenever I view my blog--- I just seemed to have this undying urge to keep on clicking and clicking on that button today. The blogs I've read earlier seemed to be extra interesting. I've become fascinated with the lives and thoughts of other people, it's like seeing things through the eyes of these strangers. It's amazing how different each person thinks and behaves. I'm like a voyeur--- in a decent sort of way. It's like watching other people's lives from a hidden vantage point. There's this odd fascination, not unlike watching a fish in a fishbowl all day, even though nothing happens... you just can't seem to take your eyes off it, wondering what it may do, wondering how life is from another creature's point of view. Reading other people's blogs has become a guilty pleasure for me. I'm sure I'm not alone, judging from the many comments on the different blogs that I've seen.

Many times before, I used to take this "jeepney ride to nowhere" when I have nothing to do, or when I'm stressed out or really pissed off. What I'm doing now seems a bit similar. The whole activity strangely soothes my nerves, it relaxes me. I often just sit and watch my surroundings--- what people are doing on the streets, how my fellow passengers behave, how they look, how they inteact with one another, what they must be thinking or feeling. I'm not a snoop--- I'm not waiting for interesting things to happen just so I can tell them to others. I just like watching people, I'm awed with their peculiarities, their uniqueness from each other. We truly are one of God's most complex and amazing creations.

Because of this fascination, I used to consider being a psychologist... "shrinkologist" to some people. But I've discovered I don't have much patience with most psychiatric patients, those who are not in their proper state of mind. hehe. I bet if there was a way to watch myself from a third person's perspective, I would probably find my behavior amusing, especially with my jumbled thoughts and erratic behavior lately...


gah!!! got to turn this computer off now and do some studying.

When Reality Sets In

I'm the type of person who prefers to have things planned. I'm not the obsessive compulsive type, I just don't feel comfortable with the uncertainty that comes with spur of the moment ideas. Nor do i feel comfortable with drastic changes.

I already have this rough blueprint of how I'd spend my life in the coming years. When I (hopefully) pass the board exams, I'd apply for residency at a certain local hospital (I have yet to decide which one). Pre-residency usually lasts a month. After that, I'd probably do part time work at a local clinic, or some municipal hospital wherein they pay you on a daily basis. Come January, I'd start the grueling journey of residency, which would last for 5 years. After that, fellowship which would last for another 3 years.

Then a few days ago, my father kept on bugging me to take the USMLE examination so I could take up residency in the USA instead. Whoa. That caught me off guard. For one thing, I'd never expect such a suggestion from him, because he kept on saying that he doesn't want any of his children to go abroad. And if I take the USMLE exams, that would drastically alter my plans for the next 5 years. If he brought that up 5 years ago, I would have wholeheartedly agreed. After all, one of the reasons why I thought going through med school was not such a bad idea was that I could go as far away from home as possible when I graduate. I was a selfish 21 year old back then, and a reluctant would be med student. Funny how 5 years can change a person's perspective.

You could say I'm eating my words right now. I imagined my life would be miserable because I'd be stuck in a profession that I don't really want. But I've learned to like what I'm doing. Even when it gets too hectic at times, to the point beyond saturation, all of those things begin to fade away when you see patients that you take care of actually become well. And nothing beats the joy you'd feel when patients say "thank you", or when they even give you stuff to show their appreciation, even when you know they barely have money to pay for hospital expenses. Nothing can give a person more happiness, than knowing that he has touched the lives of others. Another reason why I'd rather stay in this country is that I would prefer serving my countrymen. I don't think I'll feel content serving foreigners, knowing that a lot of people back home can use my help. Call me idealistic now, but I'd prefer service than monetary benefits.

One minor reason why i'd rather stay in this country is that my family and my close friends are here. I've come to a realization that I would probably feel homesick when I go to a foreign land. And to think I once thought I could live alone, that I don't need anyone. The high probability of discrimination also won't be helping. Who would want to work in a place where they'd treat you as a second class citizen, when you are appreciated back home? Again, I don't see money as a reason. No amount of money can pay for such ill treatment.

Yesterday though, I had a conversation with a friend who has been planning to work in the USA from day 1. I guess it was an eye opener. Sure, he said, I can be idealistic now because I can afford to be. Monetary benefits are only secondary because I can still rely on my parents for that. But what will happen a few years from now, when I have my own family? i guess that's when reality will set in. What's real will overcome the ideal. I used to think all these people who dream of going abroad are only blinded by colonial mentality and the promise of greener pastures. I used to think doctors going abroad were selfish. They'd rather make money than serve their countrymen. I even thought those doctors who study nursing just to be able to go abroad were pathetic. Now, reality sets in. In reality, money is a factor. Indeed, how can you serve others, when you have nothing to eat, no place to live, because you don't have money? One has to take care of one's self before he can take care of others.

Medicine is not a lucrative profession--- at least not initially. Whoever said it was needs to be hit hard in the head to bring him back to his senses. Return of investment takes such a long time. After spending a fortune to get through med school, you'd spent 3-5 years in residency, wherein they pay you such a small salary. The amount you get is definitely not proportional to the work load. In this country, nurses get paid more, even if in some hospitals they mostly just sit around and chat. Residents are one of the most underpaid professionals in the country. It's enough if you live alone, and if you live a very simple life. It's definitely not enough if you're planning to start a family. No wonder those who can afford to go abroad go abroad. After that, you'd spend another 3 or so years to subspecialize during fellowship. You'd need to if you want to be competitive. By the time you finish fellowship, you'd be in your late 30's. That's when the return of investment would come in--- provided you've subspecialized in a field that has a huge demand. It would be hard to have a lot of patients if you're in a very competitive field. And knowing myself, such return of investment won't come quickly--- I won't have the heart to charge excessive fees for my services after all.

So now I'm back to square one. I have no definite plans as of now. I haven't decided which path to take. Maybe I'd take a year off instead, to have some time to think. I guess there's no rush anyway, I have so many years ahead of me.


If only there was a way to combine the ideal with what is real...

No Doctor In the House

I have probably slept for less than an hour, when I woke up to a rude awakening. My dad was banging at the door of my bedroom as if it was the end of the world. Turns out my grandmother was not feeling well. I'm used to this situation, so I didn't feel like it was an emergency. Usually her blood pressure is elevated. Turns out I was right, it was 230/110 mmHg. Honestly, I'm at a loss when this happens. I just ask her to take her prescribed medications for hypertension. At the hospital, such a high blood pressure reading constitutes an emergency (or to be more precise, an urgency since there is no acute end organ damage present). We have to lower the blood pressure gradually. But her doctor who's a cardiologist/ cardiothoracic surgeon says it's normal for her blood pressure to be 170-180 systolic, it doesn't have to be lower than that. He's the consultant, I'm just a lowly... er--- medical bum (what else would you call a person who's finished med school and currently unemployed, just studying for the upcoming physician licensure exam?). Maybe her previous heart operation has something to do with it. I dunno. He's more experienced, and he's the expert, so I took his word for it even if it doesn't really make sense--- you know, it's a bit contradictory to what they've been teaching in med school. I should pay him a visit one of these days to know the rationale of the management. Or maybe I should finally open that highly technical cardiology book that I have that's been gathering dust ever since i bought it. hehe.

Anyway, this time, there's something a bit different, not the usual hypertension induced headache/dizziness. There are clusters of bullae on her upper back, with erythema, accompanied by pain. The whole affected area probably measured 10x10 cm. And there was a 4x3 cm erythematous patch on her right upper quadrant. (Am i getting too technical here?) Apparently, the lesion on her back started 3 days ago, spontaneously, with no predisposing factors, and it looked like the one in her abdomen initially. She self medicated with betamethasone + Gentamycin cream, which allegedly dried up some of the bullae and lessened the pain. Now was that right? A topical steroid for a patient with diabetes mellitus?! I couldn't think straight at such an ungodly hour! And I was confronted with a dermatological problem! Dermatology may seem simple to some people, but it's not. It's one of those subspecialties, wherein a certain common manifestation like bullae or erythema has so many differentials to be considered. And with such symptoms that are not pathognomonic (i.e. pointing to a certain disease), it's harder for someone like me to diagnose. Heck, I don't even have the license to act as a general practitioner yet. At least my head was clear enough to attribute her increased blood pressure to the pain on her back. After a few minutes, it lowered a bit. Gave pain medications too. Told her she doesn't have to be rushed to the hospital wherein only residents and interns would attend to her. It's better to wait for regular clinic hours. As for the skin lesion? officially, my diagnosis as of this time is--- TO BE ANNOUNCED. hehe. i have to scan my dermatology book first.

People in other professions seem to have it easier... I mean, if you're a lawyer, others would approach you if they have problems with the law--- that's not everyone. Same with being a policeman. If you're in the business profession, only people who want to do business with you, or those who seek business advice would approach you. It's different for physicians... virtually every person you'd encounter, even the healthy ones, can approach you for consultation regarding health matters. And most often, those people include your own family.

There's so much pressure when your own family or relatives consult you for their health problems. If I'm dealing with strangers, I can be a bit lax, there's less pressure. I'm not that afraid to make the wrong decisions, I could try again after all (as long as it's not an emergency!) It's also easier with friends, they seem to understand if you don't know the answer. And it seems okay with them if you say you don't know. hehe. But when it comes to family, there's this pressure that I have to perform well, to get it right the first time, even for trivial complaints. I guess they want to get their money's worth, that's why they keep on asking these health related questions. They spent a fortune to get me through med school after all. I'm literally bombarded with health related questions every day. Sure, these questions help. If I don't know the answer, I read up on the topic and therefore I gain more knowledge. I have this cousin who keeps asking me about the treatment for a lot of STDs like crabs, gonorrhea, syphilis (For crying out loud what has he been doing?!), that I seem to be an expert now on the topic. I can tell you the proper treatment at a drop of a hat. hehe. It's just depressing that many times I don't really know the answer. For crying out loud I don't know everything!!! It's impossible to know everything! Sometimes I'm wonder If I really should know these things, that I won't be a good doctor if I don't know the answers to every health related question thrown at me. Maybe I didn't study well enough. Maybe the answers are "must knows" after all, and not as esoteric as I think. For every question unanswered, I can't help but feel so down. And the look on their faces aren't helping. I could almost read their minds, they're thinking that I SHOULD know the answers. I SHOULD. This could be a sign of things to come after all. Maybe I won't be a good physician. In a few years, I could still perform the same way. What a bleak future. What a depressing career.

Geez, I think I'm going to be a lousy doctor.

knock, knock...

so what's with the paucity of blog entries lately? There seems to be a problem with my account (or maybe it's with the whole blogger), I can't upload pictures... for almost 2 weeks now! Maybe I should've created an account on one of those less populated blog sites, such as live journal. Call me obssessive, but I don't feel like creating a lot of entries without pictures--- it makes my blog too plain. haha. It's actually a good thing, now I have more time for studying--- that's one less distraction from what I should be doing. :)

Little Boy Lost

It's already June and I haven't even finished one subject yet... at this rate I'd be finished with my review of human anatomy on Sunday... that would be Seven days! and I thought I could finish each subject in 3-4 days. Argh. This is getting to be frustrating. The fact that I seem to be encountering some of the terms for the first time disturbs me. How can I forget those terms? Sure, I took up anatomy 5 years ago... but shouldn't I still know it by heart? Or maybe I wasn't a good student at all, with all the cramming I did, that probably resulted to little retention... or maybe I'm just expecting too much from myself... others are probably in the same situation I am in.

Ever got lost somewhere when yo were little? Like in the woods, in the park, or in the mall? I've never been in such a situation... except maybe in my adult life where I can't seem to find a certain place, but being all grown up, i wasn't envelope with fear and hopelessness. My sister got lost in the mall once--- i think she was 3 or 4 years old then. I remember her crying when we found her. I'm in a different situation now, but somehow, I think now I know how she felt back then--- because I seem to feel the same way now. There's this fear of the unknown. Passing the board exams on the first try is a MUST. My peers know that it isn't a gauge of how much you know, or if you're going to be a good doctor in the future. Many intelligent people have failed it, and many of those we consider stupid have miraculously passed it. But there's this public perception, especially with family and relatives who have such high expectations, that if you failed the boards, you're stupid or you didn't study even if you know you've studied hard enough. Others may think that you won't be a good doctor if you failed the board exams once, it's a stigma that you'll carry your whole life.

So passing the boards is a given... but what next? Until now, I still have misgivings if I really want to be a doctor all my life. I guess I have to be one, 9 years of my life would be wasted if I don't become one. besides, i can't think of anything else that I could do. So should I proceed immediately to residency or just "moonlight" (doctors who apply for part time job openings at hospitals or clinics) for awhile? they make more money after all. But on the downside, I'd be left out by my batchmates who'd proceed to residency. Others plan to take the USMLE and take their chances in the United States. I don't really want to go down that path--- first of all, it's so expensive. At my age, I want to give something back to my parents. They've already paid so much for med school, i don't want to "take" more money from them. Also, it is plagued with so much more uncertainties. And I have certain issues--- I don't want to serve a country who doesn't really want me. Funny how many of my peers don't mind if they get assigned to certain remote places in the US, as long as they'll be in the US. Don't they realize that the only reason they get assigned there is that American doctors don't want to work in those places? It's like scrambling for leftovers. It's not about pride, it's more of dignity.

So if I take up residency in this country--- there's a lot of residency programs to choose from. Frankly, I'm only interested in surgery. I find the other programs boring. Internal medicine? zzzz. But there are so many surgeons in the country already, that it has become a very competitive field. After the residency program, there's very little income for new surgeons. Yeah, I know that medicine is a service oriented profession, but let's face it--- you can't serve others properly if you can't put food in your table first. So I have to subspecialize... yet I'm not really interested in the several subspecialties! Plastic surgery? not for me. Urology? it seems boring. Cardiothoracic surgery? ugh. there's trauma, but what kind of patients would I have then? The issue of income comes up again.

Also, should I work in a government hospital where the pay is better but you have so much work you end up looking like zombies, and you have very little free time? Or in a private hospital where there's less work, but you don't learn as much in terms of skills? plus the salary is also very little compared to government hospitals. I guess I can't really blame those who search for greener pastures abroad---- residents in this country are severely underpaid. Nurses earn more, when they have less work, and they only stay for 8 hours a day.

Argh! Just thinking about all these nauseates me!

I've been typing all these gibberish, all these nonsense, when I could have used the time to continue studying instead. hehe. I still have to pass the boards first, i still have time before i think about those other things. Take each step one at a time, that's what they say. Whatever decisions and choices I make, i hope they're the right one--- for my sake, and for others, especially my future patients. I may be a reluctant doctor, but I still want to be a good, if not great one.