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.

No More Breaks

Caution: THIS BLOG ENTRY IS NOT SPOILER FREE.

Prison Break was my favorite TV show. No matter how preposterous the plot had gotten, the non stop action and sudden twists and turns kept me glued to the screen. It was my favorite show--- until it returned last month after a very long mid season hiatus. I don't know why, but somehow, it did not feel the same. Somehow, I no longer found the episodes exciting. I no longer cared for the characters. In truth, during some episodes, i was already rooting for the villains. Maybe it's bad writing. I hated some of the decisions made by the protagonists. I hated the way they acted. Maybe the extended hiatus made me realize how extremely silly the whole season 4 plot was in hindsight. Maybe it made me realize how the show has deteriorated. Yes, season 4 was exciting and action packed, but looking back, the whole storyline seemed forced. All that excitement only served to distract the viewer from that fact. Obviously, the writers have been milking the series for all its worth, up until the point where they can hardly squeeze anything at all. They should have ended the series sooner, back when the whole story arc still made sense. In truth, I was only watching these last few episodes to see how it will all end. These characters have grown on me through the years, and it will be shameful to cop out as we're nearing the end.

As for the two part finale? There were so many twists and turns that it made the two hour finale very convoluted. It wasn't just convoluted, it was downright silly at times. Each scene jumped to another in a very brisk pace, it left very little time for the viewer to absorb just what happened. And whereas before the viewer is often astounded by the ways Scofield and co. maneuvered their ways around every problem they've encountered, the things they did in the finale was just--- blah. boring. routine. mechanical. And bringing back Kellerman at the very end just to provide an easy way out? Man, I've been impressed by the writers of this show since the excellent first season, and this is the first time they've really let me down. They couldn't think of anything else that would make sense? Kellerman was obviously dead, the same way that Sarah was obviously dead--- until they made up that not so believable story on how her death was faked when the contract disputes were already resolved. And as for the ending? I though it was both believable and fitting that Michael died in the end. No violent reactions from me. Sure, a lot of fans are clamoring for the predictable storybook ending, some have been ranting on how Michael deserved a happy ending after all he's been through, but c'mon. The series has never been about fairy tale endings. That's not even how things go in real life. Kudos to the writers for not going through the predictable path. The ending even gave the series a lasting emotional impact, as compared to an ending wherein everyone is riding happily towards the sunset. So yeah, season four a was great ride during the first half, but everything else pretty much sucked. But as a whole, Prison Break still remains as one of my favorite TV shows, thanks to the strengths of the incredible previous seasons.

As for the direct to DVD movie called The Final Break that's intended to tie up all loose ends? I ask--- what loose ends? Man, this is another attempt to cash in on a series that's on its dying breath! Fox is really milking the series for all it's worth. If they could really expound the storyline, then by all means go for it. But if it would only serve to make the ending even more convoluted, then they better leave it as it is.

Unbelievable...

Whoa. 

With J.J. Abrams' magic touch,  just like that:  Star Trek has actually become COOL.

For decades, Star Trek has been associated with nerds and geeks, while Star Wars has been associated with cool people. Never mind the fact that fanatics of both Star Wars and Star Trek all look like freaks during conventions. Star Trek has been perceived as the more cerebral of the two, while Star Wars lore is more accessible to the masses. Plus, nothing can be cooler than those light sabers. Hence, Star Trek has attracted more of the geeky audience. Trekkies should take no offense. That's just the way it is.

With the recent installments in the Star Wars series (episodes 1-3), George Lucas and co. decided to retain the visual style of the first three films. Sure, these prequels had more advanced special effects, but the general campy feel of the series was retained. The visual style used made these new installments seem dated. Add the fact that the basic plot in these sequels seemed forced and hollow as compared to plot in the original trilogy... it's no wonder that a lot of Star Wars fans weren't impressed.

And now we have the reboot of Star Trek. I've occasionally seen reruns of the original show when I was a kid. Sometimes I'd try to watch for a few minutes, and then switch channels. Man, was that show boring. When a new TV series was launched I had no interest. When new movies were shown, i didn't care. Trailers showed more of the same. Boring. Something only nerds would appreciate.

And then I saw trailers for the new film. Leave it to J.J. Abrams to ignite a series that was already struggling for relevance. A fresh new cast. Huge explosions. Mind numbing special effect. Clearly, this wouldn't be the Star Trek I once knew, and as i was watching the film at the movie theater earlier this evening, I was overwhelmed by what i was seeing. The opening sequence was intense--- and the film was only a few minutes in! I couldn't believe that i was actually liking a Star Trek film. Sure, it's "dumbed down" for the masses, but that's a necessary step to make the series accessible to a broader audience. Even with the mostly young cast, the acting ranged from good to exceptionally well (although I always expected Sylar to steal someone else's powers in every scene he's in. i guess Zachary Quinto doesn't have that much acting range... yet.) It has everything that people want with their summer movies--- it has drama, action, comedy, tragedy, victory... and of course it has the requisite explosions. Now, Star Trek is reaching out to the Star Wars audience--- a statement that would sound so preposterous if mentioned years ago. 

It's not a perfect film, but J.J. Abrams and co. are on the right track! This is the right way to reboot a franchise! Other film makers should take notice. I can't wait for the next installment! :)

er... I hope that doesn't make me a trekkie. :O