Eternal Lament

All alone, I walk on this road to nowhere
Weighed down by all the guilt and regret.
I look on beyond all that’s left behind
As I try to move on, as I try to forget.

I feel her warmth as the sun burns my face.
When she was still here, I always found my place.
As the wind blows I hear her whisper.
The last words that she spoke, I will always remember.

I feel her caress as the wind blows through my cheeks
She gave me all her strength whenever I felt weak.
I sat on the ground, finally beaten and weary.
too late to say goodbye, too late to say I was sorry.

If I choose to turn back, all that I would find is nothing.
That’s all that is left of what was once my everything.
If I choose to remain still, maybe things would turn out well
Until the storm has passed, I’ll remain inside my shell.

If only there was a way to turn back time
I could be free from this personal damnation.
I could try to erase all past mistakes.
I could have listened to the voice of reason.

I convince myself that I’m perfectly fine
But it’s just so damn hard to pretend.
I may move on, but I can never forget
For so many words were left unsaid in the end.

09/15/10

Why Should I Be Sad

Yesterday, I did some voluntary work. A friend invited me to one of the charitable activities his organization had planned for the Christmas season. We went to a government hospital and gave out several goods and supplies to the indigent patients. It was heart warming to see their smiles, to hear their thanks, to feel their embrace. Nothing can match the feeling one gets when he realizes that he was able to give a helping hand. That was a great experience. It put me right back on track.

Somewhere along the way, I’ve lost sight of my target. I have been disillusioned. Several distractions have made me mistake my goal for something else. The whole experience reminded me of why I chose the path that I’ve previously taken in the first place. Why did I choose to work in this country, in the land of my birth, when my peers have been leaving in truckloads? Because I preferred to serve my own countrymen--- that was what I said then. It may be true that there are places around the world that are also in dire need of medical help, but why should I go elsewhere when there are already people who can use my help here? And why did I choose to work in a government hospital as opposed to working in a private hospital, where the working conditions are more humane and comfortable? Because I wanted to reach out to those who were mostly in need of help. I wanted to reach out to those who have nothing, to those who have little to turn to. To the oppressed. To the members of society that are largely ignored or looked down upon.

That was my train of thought a year ago.

Somewhere along the way, I’ve looked for other motivations. I began to think of monetary benefits. I equated my work with salary, and was disappointed by the fact that we were grossly underpaid. I’ve let extraneous factors, such as conflicts with other residents and dismay at the rotten system dampen my drive. I never got into this line of work because of money. Although it's great to be able to buy the things I want with what I earn, it wasn't all about the money. Even if I did not really want to be in this profession in the first place, I continued walking along this path because I wanted to help. I knew from the very start that I wouldn’t be getting much in return, but I went through that path because money wasn’t my primary concern… but when I reached the boiling point, what did I do? I took the easy way out. I resigned. Because I said I was no longer happy with what I was doing. I’ve let those other factors distort my definition of happiness. A lot of good that did. I can’t change a rotten system by leaving it. I won’t be able to help anyone by abandoning them. I was a coward. Instead of facing those trials head on, I opted to cop out.

I felt a tinge of regret as I realized that. Even more when i saw familiar faces, my previous co workers who still looked beat from all the work being dumped on them. But they looked happy, probably because the year is about to end, or partly because what they said was somehow true--- that they've missed me terribly and they were happy to see me after such a long time. One thing is evident--- They never lost their drive, while I have lost mine. I made my decisions haphazardly. I’ve let certain emotions cloud my way of thinking. When I visited the department again yesterday, that put the nail in the coffin. Although I resigned months ago and I knew it was inevitable--- they finally updated the roster of residents by the entrance to the wards. It included the list of incoming residents, and though my name was still there last week, now it was no longer there. It wasn’t unexpected, and it was foolish to think that they’ll never remove it--- they should have removed my name months ago… but somehow I was overcome with great sadness.

Why should I be sad? Is it because of “what could’ve been”? If I didn’t quit I would already be an incoming second year resident. Maybe if I accepted that last minute offer from our training officer, if I answered “no” when he asked me if I was sure that I really wanted to leave… if I told him the truth, that I really wasn’t sure about leaving… if I just swallowed my pride and admitted that… then maybe I wouldn’t feel so lost. Why am I so sad? Is it because it’s finally official and tangible, that I am no longer part of the “family”? The past few months since my resignation may not have been a burst of sunshine--- although I was in crisis and spent most of my waking hours wrestling with my thoughts and trying to drown it all out with alcohol, it wasn’t all doom and gloom. I did have fun. I went to parties and did things that would feel awkward for me to do after residency when I’m already in my 30’s. Call it the last hurrah of my youth. I don’t want to be that pathetic guy in his 30’s trying to be an eternal 20 something. I’ve met new people. I tried new things. I’ve rekindled past friendships. And most importantly, I had time to think. I wouldn’t exactly call the past few months a waste.

Why should I feel sad? This was what I wanted then. It was a decision I’ve made, and I stuck with it. It may not have been the best choice, but I thought it was best at that time. i wanted out. I wanted to leave. I wanted to work elsewhere. And every time I wondered if I made the right decision, all I had to do was read the entries on this blog from January to August of this year… then I would remember how unhappy and miserable I was back then. I thought I was in hell. I quit because I was no longer happy, and I believed no one should keep working in a place where he does not find happiness and fulfillment. Call me an Idealist, surrealist, unrealistic. I though that quitting would make me happy… yet here I am, still far from what people would call happy.

In just a few more days, we’re about to say goodbye to the year 2007--- from one point it’s a year I’ve wasted… from another point of view, it’s a year of testing the waters, a year of awakening, a year of sorting out my priorities. It’s all a matter of perspective. Focusing on the negative can only bring me down. Why should I be sad when there are a lot of things to be happy about? The new year ushers in new opportunities, a chance to start over. A clean slate, wherein the mistakes of the previous year has no bearing. Once again I return to the starting point, re-energized. Hopefully this time, no stumbling blocks can hinder me from reaching the finish line.

I shouldn’t be sad just because an episode in my life has ended. I should be happy because I’m about to start a new beginning. But at times like this when my mind is still riddled with doubt and confusion, I can’t help but see the glass as half empty instead of half full. And I still can’t figure out exactly why I am so sad.

This Bum's Life

When I resigned from work, I thought I'd finally have some fun. Going out every night, watching movies, drinking with friends, or simply just hanging out. A few hours ago, I wanted to go somewhere... anywhere. I'd rather go to any place as opposed to staying at home and be bored to death. I tried to think of someone who'll be willing to keep me company. I realized my choices were limited. Most of my close friends either have work or already out of this country. Friends from years back? forget it. Either they already have families of their own or they think they're too old to be going out at night. Come to think of it, I may be getting too old for this sort of thing. I just have this illusion that I'm still part of the Youth because I'm still dependent on my parents for almost everything. Being a "bum" isn't much fun when there are no fellow bums to keep you company.

Wrong Move?

Last night, I went to my friend's farewell party--- yup, another one's leaving for the United States. I expected it to be a night of drinking, where everyone will be in a festive mood, then slowly turning sentimental as the night progressed, because we'd soon say farewell to a dear friend... I never thought it would leave me in deep thought about the things I've been trying hard not to confront these past few days.

EMPLOYMENT: yup, it has been on my mind before I went to the party, because I had a ton of questions to ask several of the people attending. Those people taking up residency somewhere usually don't have time to attend parties, so that leaves the people who are unemployed, those who haven't taken the boards yet, and those who are "moonlighting".

MOONLIGHTING--- that's the term we call those young physicians who have work other than residency. And for young physicians, moonlighting is where the money is, not residency. They get jobs here and there--- there are actually a lot of options. They can go on duty several days a week at a certain hospital, usually those municipal or provincial hospitals where there are no residents, and they're free to choose a schedule that's convenient to them. Every procedure, even for just inserting an IV line, you get paid. So it's okay when it gets hectic, because the more hectic it is, the more money you'll earn. Some work as general practitioners at company clinics,, pre-employment clinics, etc. You can even work as a research assistant. One friend even said you can actually get into a lot of non med related professions because as soon as they see that medical degree, they'd think you were someone whose really brainy. Lol. Most juggle duty work at more than one hospital, thus translating to more money. As one friend told me--- moonlighting is great. You control the schedule, it can be as benign as you want it to be--- plus, there's lots and lots of money.

Coming from a job where most of my earnings go to my patients and my seniors and not to my personal war chest, can anyone blame me for wanting to earn money? A lot of my questions were answered, and I got really excited. I wanted to apply for work ASAP. Then as the evening progressed, the talks turned to plans for residency. Turns out it's the time of year when hospitals are accepting applicants for residency, and all of them are in the process of applying. Suddenly I felt out of place. The topic was something I could relate to--- a year ago. It seems that a year of moonlighting is enough for them. I can't help but feel that I'm a little bit late in the moonlighting game. I should have done it a year ago, then I probably would've have felt so burned out as I was during residency. Most take a year off after taking the board exams, so why didn't I? Hearing that their hospital of choice was PGH sent even more chills down my spine. Is this another one of the many wrong moves I've made in this life?

One of my friends said: "moonlighting is great--- it really is. It's benign, you can do a lot of other things, plus there's money. When moonlighting, you feel like you can't lose. You can live the life you want. You're in control. But there comes a point when you'll feel the need to grow. When moonlighting, you do have time, you do have money, but you're in a standstill. Sooner or later, you'll feel the need to learn more, and you can only have that when you take up residency."

Great. Just great. My life is full of uncertainties as it is, and I still keep making one wrong decision after another... Maybe I haven't made a wrong move after all, I just feel that way because I feel left out... Have I been hasty in my decision to pack up and leave the residency program that I've worked so hard to get into a year ago? i remember how happy I was when I received the letter that I've been selected for the program. Was it wrong to give it all up after just seven months of torture? An even bigger question remains, as if to punctuate the uncertainty that I'm feeling. Where will I take up residency instead? No other hospital seems attractive. I just can't see myself anywhere else. I feel like someone who has lost his identity.

Why do I waste brain matter trying to find answers to such questions... I can't do anything about it anyway. I've been gone for way too long, I can't go back even if I wanted to.

Tomorrow, I'm making it official. I'm finally submitting the resignation papers that I've already filled out last week.

The Year That Was

Today, my medical internship (which lasted from May 1, 2005- April 30, 2006) was formally over. We had a rather lengthy (4 freakin' hours!!!) closing ceremony this afternoon. It was bearable for the most part, but judging from the many sleeping guests in the audience, I guess the program was rather boring to a non medical person. hehe.

Looking back, I would say it was not a very good internship program. For one thing, it was medical clerkship repeated for post graduate interns like myself. There was nothing new to learn theoretically. I guess the way the program was structured was necessary for UP interns--- after all, their medical clerkship is something like a "taste test" (I can't find the proper words to describe it) of clerkship. How else can you describe a clerkship program wherein they have summer vacation, christmas breaks, and holiday breaks? And in the hospital, they are often pulled out of the workforce, because of lectures, usually in the afternoon? And their rotations are mostly in the wards instead of going through the different sections of each department (i.e. in the case of pediatrics: nursery, emergency room, intensive care unit, out patient department). I guess they really can't rotate in each section because of their long vacations (how can you fit everything in less than 10 months?! they only rotate in OB-gyne for 2 weeks, which is supposed to be a major 2 MONTH rotation), thus the need to rotate in those sections in internship. So we can say that internship in PGH is like an extension or continuation (there, I found the proper terms!) of clerkship. It is the ideal program for UP interns because their clerkship would be severely lacking without it, but a highly inefficient program for post graduate interns like me. And here lies a huge gap in their training program.

In other hospitals, interns are like pre-residents already. Writing orders in charts, joining consultants during rounds of every single patient, adding insights to the management of each patient--- in addition to manual labor such as IV line insertions, pushing IV meds, creating a daily census etc. In PGH, clerks and interns are basically equal (except in IM wards wherein you act as a "real" intern during the last 2 weeks) because their duties are basically the same. Doing charts, carrying out orders, doing blood extractions (which is a job for med techs--- but since we have to cut costs in PGH, the job is given to clerks and interns... hey at least I'm now an expert in blood extractions. hehe), and gaaah!----- MONITORING! Checking the blood pressure, heart rate, respiratory rate, and temperature of each patient! In other hospitals, monitoring is a nurse's job, and in a teaching hospital, it is a clerk's job! Add that up to the list of PGH exclusives--- INTERNS WHO MONITOR. Thus seniority is seldom felt; rarely can an intern order--- or should I say, ASK a clerk to do something. So when can we experience true internship? Wouldn't it take huge adjustments when residency comes without such training?

The fact is, INTERNS are basically treated as STUDENTS in PGH. So blatantly, in fact, that the term used is "student-in-charge". I guess that's proper since most of the interns (150 out of 250 are from UP) haven't graduated yet. It's just that in other hospitals interns are treated as real doctors already. Heck, in PGH even the nurses see you as students only. They call you "SIR", "MA'AM", or sometimes "DOC" out of politeness only... you hear them talking behind your back and you'll realize they view you as mere students. Some patients even see you as students only. The "Dr." before our names on all our name plates are probably just there to appease post graduate interns since we already have medical degrees. In reality, we're not really treated as doctors yet.

Also, initially, I was under the impression that PGH is the ideal place for internship for the sole reason that it has the most varied cases, and cases are also numerous. Thus, there would be more learning on my part. That's not really the case though. Think of it as some sort of learning curve, wherein the optimal level is breached, thus learning starts to go down--- a lot of times, there are so many patients, you just want to get the job done, there's no more time for learning. Add the fact that residents are also so busy because of the sheer number of patients, they rarely have time to teach you what they know. I'm not generalizing though, there are some (mostly senior IM residents) who really find the time to teach you.

"Toxicity" (i.e. too much work, to the point of being er--- deadly, or poisonous. hehe) in PGH is also so over rated. Yeah, being the premiere government hospital in the country, you'd think it really is the most toxic, but that's not really the case. Ask around, the only people who would say this are those who haven't experienced training in other hospitals. For one thing, PGH receives the greatest subsidy from the government, while other state hospitals fight over the crumbs. If you say PGH is the most "low-tech", that PGH is the most toxic--- you haven't been to other government hospitals, wherein conditions are much much worse. Ever been to San Lazaro? Fabella? Jose Reyes? Sure, compared to interns in other hospitals, the work load is heavier because you're still basically a clerk, but there is such a huge gap with the workload of residents and interns. The residents absorb most of the work! Where else can you find medicine interns just sitting around the emergency room, while the residents rarely have time to rest? In other hospitals, since interns are like pseudo-residents, they take a huge burden away from the residents. The fact that the residents are also so nice takes a lot of toxicity away--- they're like your peers, unlike in some hospitals where you can really see the hierarchy between interns and residents. Also, in several rotations (in minors like ophtha, ENT), there are weekends off!--- completely unheard of where I took up clerkship! SO what's with all the complaining? Especially among clerks? They have a lot of vacations, they get pulled out from hospital duties (for lectures--- that's still REST nevertheless), and they do less of the dirty work! Where I took up clerkship, we take the urine output, we suction secretions, while in PGH the nurses do that. And where I took up clerkship, clerks are the ones who ambu-bag their patients, which can last for a full 24 hours without rest! In PGH, (here's another exclusive) it is the patient's guardian who ambu-bags. And in some instances, the patients ambu bag themselves. hehe. There may be more patients in PGH, but taking all factors into account, the work load for clerks is much much less.

Here's one glaring example. I remember how every UP intern was talking about how "toxic" the Ob-gyne rotation is, like it was some deadly fatal obstacle or something--- the ultimate in toxicity! And I almost believed them. For. Crying. out. loud. what exaggeration! Residents do most of the work! Interns only assist them most of the time! In Fabella, we do everything--- unless if the baby has an abnormal presentation, or when a CS is needed.. From labor up to the baby's birth, resuscitation of the baby, up to suturing lacerations, no matter the degree, we do all the work. Only if we really REALLY REALLY can't manage the patient will we refer to the resident. And it's like a baby factory in there--- LITERALLY, a baby is born every minute. The work is NON STOP. And what toxic paperworks? we have templates in PGH for crying out loud. During my clerkship, we had to do paperworks from scratch, and they had to undergo several revisions until the resident thinks it's PERFECT already, because it is an OFFICIAL hospital document and shouldn't be made haphazardly. And the dreaded morning endorsements? It's not like they'll shout at you or insult you or shame you if you can't answer their questions...unlike where I took up clerkship. Pushing stretchers on your own? been there, done that--- A lot of times, and with an oxygen tank to boot. Anyone who has a first hand experience of working in other government hospitals knows that he or she has no right to complain about the workload in PGH.

Do I regret taking up internship at PGH? It may seem like that, but I'm not. It's not all bad after all :) There are a lot of rare cases, cases you won't find anywhere else. It is up to each intern whether he or she finds the time to take each opportunity for learning. With the multitude of cases also, you'd be surprised that patients with myocardial infarction are so common that thay are monitored every 4 hours post MI instead of every hour. hehe. And in surgery, they let interns do minor operations--- and this includes not so minor ones such as removal of breast masses. hehe (though in other government hospitals wherein there are fewer residents, it's not uncommon for interns to do major operations such as appendectomy, but those are only in few institutions). And as I've said, the residents are so nice, demerits and sanctions are very rare, there are weekends off, that it's like a dream vacation! Okay, it's not really a dream vacation, but I felt like some caged animal who recently got free. hehe. You get used to the fact that there are no airconditioners in the wards and in some operating rooms, the heat's not so bad once you get used to it. The food is actually OK, including those freebies served in the mess hall. PGH may not be the best place for internship--- I may not take up internship there if given a second chance--- but it's still a good place for internship, at least when compared to most hospitals out there.


It's getting late and I have to wake up early... maybe tomorrow i'll post some pictures of those rare cases I've mentioned. :)

sex, lies, and...

Last night was a total wreck, one of those nights i'd rather forget...

I was on my way home from an incredibly boring party. The place was fine, and so was the music... I just didn't feel like I belonged with the crowd. I was still in the mood for some fun, but most of my friends wanted to go home instead of going someplace else. Heard Embassy was the place to be on wednesdays, but no one was in the mood. Figured I'd do some joy riding since I didn't want to go home yet. Driving with no particular destination can be so relaxing. Found my way in makati, thought I'd do something I've never done before--- go inside a bar, alone.

So there I was at the bar, sitting alone, ordered a few beers, listening to music, when suddenly, this hot chick appeared out of nowhere, asking if I was alone too. Yeah she looked hot, dressed in a skanky attire, just the way I want it when I'm in a "playful" mood. Since I was a bit lonely that night---- driving alone put me in a pensive mood, been thinking about the mess that was my life for the past few months--- I fugured I could use some company. Small talk at first, what do you do for a living, where are you from... all that shit. But when the question became why are you alone--- I guess i poured my heart out. Opening up to a stranger can make you feel better at times, and the fact that he or she doesn't know much about you can make it easier to open up. I talked about my previous miserable relationship, how I absolutely despised my ex, family problems, how my life seemed to be going nowhere, that I'm stucked in a profession that I don't really seem to want... And she poured her heart out as well. A child out of wedlock, the father was an asshole who beat her up, and now nowhere to be found. Her sick mother with a heart ailment, and how expensive the medications were that she keeps missing doses. Add the fact that she's the sole breadwinner of the family because she's the eldest--- my life seemed to be a vacation compared to hers. A few more beers put me in the mood for something more, and I guess it put her in the same mood as well. Went to a relatively cheap motel. talked for a while, hugging, embracing, kissing... did the deed, which was almost perfect, then took a bath. After two hours, I was about to call room service to inform them we're checking out of the room. then out of the blue---

She asked to be paid. What the f*ck--?! This chick is a damn prostitute! She's not just some skank in a skank attire, she's a skank for hire! Not that I detest these people. In my curious teen years, I've had some experiences with them along with my friends. It's just that she caught me off guard! why didn't she tell me in the first place?! With a few more beers I would probably have gone with her--- PROBABLY. probably not... And she was asking for a lot. A whopping 5000 bucks! that's a lot for someone like me who has no more allowance since he's already graduated, but currently still unemployed. I refused to pay her. TOld her she came with me willingly. and besides, she came under false pretenses. If she wanted to be paid, she should have told me in the first place. The way things went, she came with me voluntarily. Then she was screaming like an insane person, that I tricked her, that she would destroy furniture, break thr TV, make a scene downstairs, bring me to the police station to see who suffered injustice, that she doesn't mind the shame since she's used to it, that she didn't mind getting jailed, yadda yadda yadda. I wanted to beat herup for tricking me, but I didn't wantto get jailed for that. I felt trapped! I didn't want to make a scene, I didn't want to cause a commotion and I hate being talked about! Being part of rumors seem to be an inherent part of my life! I don't want more rumors! And I'd hate it if my parents found out that I picked up a random prostitute and brought her to a seedy motel--- at least that's the impression they'll get. So I gave in. I pleaded. Showed her my wallet. Just 4000 bucks. minus 500 for the room. I can only give her 3500, and that's all I have. She told me she'll go with me to my house so i can get more money. If I don't have money, she'll tell my parents what happened. She's making my blood boil. Told her NO WAY! Then the bitch said if i didn't want my parents to find out, she'll get my watch instead. Told her no F*cking way! If she'll insist, my fear of making a scene would have dissipated, I was getting angry! REALLY ANGRY! I was about to beat her up! And I guess she got that. After a few more minutes of bargaining, she agreed. Dropped her off at a nearby bus station. God, I wanted to shoot her! or push her out of my car! But I thought, what If her story was true, her sick mother, her child, her poor family---- I guess the thought that those things might be true kept me sane. So what If 3500 bucks was practically stolen from me? That's almost nothing compared to the needs of that poor family. Of course, she was probably lying about it, some script she's been using for months, maybe years, to get pity. Yeah, I'm aware of that. But believing that the things she said were true gave me some degree of comfort. After all, poverty is the main reason people like her are driven to their profession, right? Bah, Now I'm thinking I was charitable. And i have to admit, It felt good. Might as well think it was money well spent.

God, what a miserable night.