Tuesday, 3 April 2018

Primum Non Nocere

A lot of people hate hospitals.

And I understand them for doing so. For it is where you go when you're sick. It's where you run to when you've broken a bone, when you feel unbearable pain, when you want to monitor recurrence. You run to it when you're bleeding, when you're dying. When something's wrong. 

I want to let you in a secret. Sometimes, I hate the hospital, too. 

Understand me for doing so. For it is where people run to us when they're sick. We painstakingly interview patients or relatives as we extract all the details we could get, thinking of the right pill to relieve them, and we do it while they are agitated, shouting, or worse, unconscious. There are times we give them bad news, there are times they blame us for it. There are nights we pronounce deaths, there are days our hands do the pumping for other people's hearts, and sometimes we bag their lungs with oxygen for hours, we vigilanty monitor and measure their urine - sometimes we do all of them in one hour.  

And that's what just the patient sees.

The doctor who saw you a while ago might be on his 36th hour in the hospital, devoid of sleep, glucose, and a smile. The resident who just prognosed your relative with only 3 months to live might have also gone from an audit wherein she was skinned alive by her consultant, yet putting on a brave face in front of you. The intern who pushed your wheelchair who seem like he was ignoring your small talk was probably in his mind, prioritizing the list of errands he has to do after he bring you to your room. He might probably forgot that you needed to bring your oxygen tank with you - add that to the list of errands, too. The Clerk who cannot extract blood from your crying child for the Nth try probably wants to cry with your child, too. 

We have a lot of reasons to hate this setting. I mean, most people get hospitalized maybe once a decade, visits a few relatives in the hospital once a quarter and feel sad. But us? We're here every day, sometimes spend the night here on duty. Even on Sundays. Even on Rainy Days. Even on family reunions. Even on the UAAP Championship Holiday. Maybe even on the Apocalypse (nah?)

And here's the thing: Everytime we go to work, we must always be on top of our game (or at least pretend to be), because there are times we need to compete with each other. Because what we write on charts triggers a cascade of events and errands and extractions and monitoring and reassesment, and revision or continue our orders until we write "MGH". Hopefully MGH. We always need to be on game face because our seniors expect a lot from us, and as we go up the ladder of heirarchy, we realize that it's a two-way street of expectations, the juniors expect a lot from you, too. 

We need to be on top of our game, most of all, because it's life that we are handling. Not the latest promos to promote a new gadget or to up the sales of a certain product, but the clogged coronary arteries of the CEO of that company, because if he dies, the company will not just lose a CEO, but a father to his kids, a husband to his wife, and a provider for his other wife. We're not like prostitutes who just open our legs and get paid, and sometimes leave our skin out, open, bare and cold and get paid some more - we slice up skins, and open rib cages and peritoneums and skulls - and we don't get paid sometimes. We don't just handle complaining customers on 8 hour shifts while sitting in an airconditioned room. We do 24+ hour shifts, on a damp, moist ward, standing for hours of rounds or errands or taking the vital signs on a sea of patients. We handle shouting kids, vomiting grandfathers, uncooperative adolescents, demanding relatives, sometimes flirty bantays (both opposite and the same sex), patients who needed attention every hour, or 15 minutes, or bedside - and did i mention? they're sick, they're contagious. And we, despite what you think, are mere mortals, still susceptible, still vulnerable. 

Don't get me wrong, I'm not belittling other jobs. We actually sometimes want to do your job, live your life, spend your weekends, sleep your sleep, we want your sick leaves (ironically we don't have any), your social life, your wives. It's just that the process of learning how to save and preserve life, the process of being the "almighty-savior" you imagined us to be, has has become too delicate and complicated that it had branched out to so many specialties, sub specialties, and not to mention the years that passed us by. While our highschool friends are referring their kids to us, We haven't even planned your proposal yet. That is, if someone stuck up.

A lot of people hate hospitals. Sometimes, we hate it too.But we have no other choice, but to love it. Because we promised to do good, and to do no harm.

Because if we don't, who else would people run to? Where else would they get their hope, strength, and understanding? who else would explain their disease? wikipedia? As my resident said to me last year when I was a clerk, "Always stand tall, even if you're tired, don't lean, keep your head up, smile. Don't be rowdy and dirty. Look neat and tidy" - because patients need that from you. While they are not strong, you are."

How will they get better if you smell bad? Pwede parin naman, pero, mas ok pag mabango diba? Help them get better by looking good, by cheering them up, but being their pillar of strength. Make them release endorphines by your mere presence. Appreciate every progress that's happening and give hope while you fix emerging problems. 

This is the reason why doctors' coats are white, and matched with a neat looking necktie. It emanates hope, purity, and cleanliness. It improves doctor-patient relationships. It promotes better mood and faster wound healing... Nah, I just made up the last 3 sentences. Haha.

We have a lot of reasons to hate this setting. But at any day, it's trumped by the fact that one way or another, you've been a part of someone's healing, of someone's journey. You've helped save a life, and whoever saves one life saves the world entire.


Right now, I still don't get paid. But sometimes, the simple thank you warms me up better than tequila, and it hangs over until from-duty. It never fails to fascinate me seeing the heart beat in the ultrasound. I love how God uses our hands to slice up the skin and fix what's wrong inside. How I teach girls natural methods of family planning. How the first cry of a baby is music to me. How death makes me understand life more. How you send a brother home for his birthday, how you make a grandmother live to see her first grand grandchild, how I hear the voice of a young child after being extubated. 

All these, and more are the reasons why I love this job way way more than I hate it sometimes. 

I know the world doesn't owe me anything for sacrificing too much for the sake of humanity.
The years I've lost and I will lose, the stress lines on my face, and the sleep im supposed to be getting. The world doesn't owe me for that.
And I'm fine with that.

As long as I put in my heart the reasons why I'm doing this, I will put them as my headlights as I travel this uncertain, challenging, yet fullfilling profession. These lights may not be enough to beam all the way to certainty, but it's bright enough for a few meters ahead, and the rest will just unfold along the way.

Coldplay couldnt have put it any better, in terms of fixing people and being guided: 


"Lights will guide you home.
And ignite your bones.
And I will try, to fix you."

Maybe

Maybe because I didn't forward the chain emails that said I must forward them or else I will have bad luck for years, and amazingly all those bloody bad luck concentrated in one section: the heart. Maybe I have karmic debt. Probably in the past life I've adulterized a whole town and this is the Universe's way of coming back at me. Maybe, someone in my bloodline had done screaming infidelities and I was the one who was selected by karma to pay for it. To balance up the scales of to-harm VS to-get-hurt. As much I want to suck it all up, it all regurgitates back and leave a sour taste, a foul mouth and a throbbing chest.

Maybe cupid had been drunk all these years. He sends the dumbest arrows, put fire on its head, unfortunately setting more than just sparks that it intended, and ends up burning the whole place down. Drunk arrows that wiggled and wobbled to random women but did not hit them where it needed to be. Instead it hit just their arms, her feet, her mouth, her freedom, her reason, her past - and mash it with my head, my eyes, my misinterpreted tone of voice, my jealousy, my unstable circadian rhythm, my distorted logic, and my enstrangling future - these will definitley set fire.  No, cupid, I won't accept your apology. You better sober up, sharpen your arrows, master your aim, and make up for all the mistakes you did to me.

Maybe God has a plan, a decking system on who will be next and it just so happened the ones who were decked to me left more blood than bandages. Maybe God is weaving a twist that will probably explain everything and make sense to all these. Maybe he did this intentionally. Or maybe neglected this aspect when he was planning me.

Maybe that's why there's a word called 'maybe.' A word made to always keep you wondering, will always keep you asking, will always keep you thirsty. And in finding those answers, you get to find meaning, you find ones purpose, and find a new set of maybes that come along with it. 

Maybe, just maybe.

Monday, 29 July 2013

Hope

A hope. That was invoked so many times, that it has been doubted more that it was hoped.
It has been prayed for over and over again that it has become the baseline of one's heartbeat.

A hope. That was born out of watching too much One Tree Hill, Disney Stories and stupid serendipitous telenovelas but grounded on the realities that they don't really happen in real life. But just looks magical if they do. And the drive to make it to.

A hope. Of the simple wish that it becomes mutual. And procreating. And lasting. That you could be sure that it's there tomorrow. And the next day after tomorrow. And you're sure never runs out. Like taxes. Like errands. Like a promise. Like the sun. Like oxygen. Like life.

A hope. That I will never find the words to quantify these feelings. So that I will constantly try to dance a poem to get around you. Even if I dont dance.
That I will always try to weave the lines to figure you out, and the song will never end just like how we will never end.

A hope. That it will be an answer to why everything else did not happen. That will answer the what ifs and could have beens. That will blur every single one before us. And will illumine every single step ahead of us. That will give meaning and reason to the whys and the why nots. To the road blocks and detours and the bumps that have led all the way to this story. Our story. 

Finally, a Hope. That you exist. More than just as my prayers at night. More than just someone trapped inside the songs. More than just a story in making. More than just wishing, but of granting. More than just believing, but of being. Of existing. Of happening. 

But for now, I could only hope.
Only hope.

Snowflake

It's hard for me to fight compulsion. I really think I should be medicated for that. I'd stare at the screen thinking of serendipities, and the next thing I know, I find myself typing your name. Again. Even goddamn facebook autocompletes your name after the first letter... And then, a horde of butteflies ram in my stomach. Some of them still sting fear. Scared that the last thumbmarks that left your steel heart might not be mine anymore. That that smile that draws from your pics doesnt come from me anymore. That maybe new flowers might bouquet their way into your facebook posts. That someone had slithered their way into your wall again.

I'm sure you know I have a trouble with compulsion. I'm sure you know I have a trouble with compulsion. I tend to be repetitive when my limbic system spells too much of you. But the beauty of the circuit of Papez is that it is an ever-evolving highway of learned lessons and strengthened emotions. But as for now, I hope I don't need drugs to silence my hands into shouting your name as it continually ride along this unsteady circuit despite how many times I put "detour" signs. Because you know, I have trouble with compulsion. I need to constantly remind myself why not. Why not. Why fucking not.

But like what I've always told you. Or tried to tell you. Or maybe I told you but I really didnt... That emotion will one day catch up with reason. That facts have established their way into my system, it's just that I've always been a slow learner (cause you know I have trouble with compulsion), but I know, too, I will get there. And I know it will get better. I mean, it should be, right, God? The sun have to set to rest awhile for the beautiful morning it will radiate a few moments later.

We were once like snowflakes. Perfect and symmetric. We fell hard and cold and fast. We were swift and beautiful and graceful and meaningful. We were flawlessly designed by what we thought the higher being had meant to be. But maybe that higher being had higher plans, and I am yet to understand why. But I think I already have a clue - because as seasons change, and tides move, and as trees shed leaves, so, too, does snowflakes melt. Not because it has grown ill, nor sick, nor hurtful, but simply because it has to. It was what nature intended it to be. Do we have to be mad with nature? Maybe. I think God will undestand why. But do we need to dwell on the melted snowflake and neglect to see the beauty of spring? 

I need no medication to know the answer. 

A Love Letter from the Scalpel to the Skin

Dear Skin,

Someone told me something's terribly wrong beneath you.
That you're covering up something so bad, your secretions are panicking.
I know you're trying to hide it by producing layers from your epithelial factory
but that doesnt change the fact that deep inside, something hurts. And it cannot be healed by band-aids and gentle touch or rubs. It's something way beyond your regenerative capabilities.

Something is wrong. But don't worry
I'm attracted to flawed people. 
I have a compulsion to fix things.

I like you.

But you know what, Skin? I will hurt you.

I will run my blades along your lines and layers and I will easily slice through them.
Deep. Straightfrorward. and Simple.
Because this is how I Love.
Harmful. Hurtful. and Painful

I will hurt you.
You may not understand why but there is a deeper purpose to all of this,
even deeper than all the layers I have to penetrate to slice you off.
I will hurt you because there is something inside you that we have to remove.
To let you live longer.
I know better, believe me. I know.

I will hurt you, but I will be careful. I will have everything cleansed on your surface before we'd come into contact. I will ask the gods to dose you with antibiotics to minimize risks. I will have to close you up the cleanest way I can to prevent any further insult. And I will use a blade only for that encounter of ours, and never will it be used again. I will Love you enough that I will never share that blade with anyone else. It will be used just for the purpose of you and me.


Now you can hate me for everything that I'm about to do. 
I will understand. And I could live with that.

I'm used to disposable relationships.
Because ever since I've been doing this
No one's even bothered to say Thank You

Well, why would they?

They say I'm a masochist.
And so, I'd do it anyway.

Throw a Prayer to the Sky

I know I shouldn't let this pass without writing about You. 
Because what happened to us deserves at least a piece of literature 
so that even just through a prose, we get to be immortalized. 
Because the beauty of what we had 
deserves even a bit of poetry.
Of rhyming beauty, 
Of measured words that sounds like sweet scented serenade 
And alliterating alliterations that allures and alleviates aches

But like all poems and literature
like all stories and sweet songs
like all books and novels
It all has to come to an end

And as I move 
from I Love You 
to I Loved You,
There will always be
that part of my timeline 
where I'd look back one day and I should feel nothing
...nothing but pure gratitude
That we may have left at a time where I couldn't decipher why. 
But I have great faith that someday I will.

If one day you will be reading this, 
I'll ask you to throw a prayer into the sky 
And hope it reaches the stars. 
So that every time I'd be looking at the constellations that used to blanket our conversations,
I'd hope that one of those sparkling lights is a prayer for me. 
A Prayer for the us that was meant not to be. 
For the Lesson it was supposed to teach. 
For the clarity it will soon bring to me. 
And a prayer hoping that one day 
I'll be thanking God why we weren't meant to be. 

There will come one night 
That I will come into peace with everything
That these feelings will all soon come into peaceful fading... 
Like the destiny of all stars, feelings too, will all fade
Fade after it has become part of a spectacular light show. 

And all the more I should say Thank You, for how it became part of you, and part of me, and part of we.

Things leave sometimes not because they wanted to, 
but because they have to. 

So I guess that's our story. Solitude shall soon come, and may it also bring Wisdom. And Peace. 
I know I shouldn't let this pass without writing about You. And now that just I did, I'll set myself adrift.


"Love arrives exactly when Love is supposed to. 
And Love leaves exactly when Love must.
And when it leaves, 
ask her to leave the door open behind her, 
turn off the music, 
listen to the quiet whisper. 
Thank You, for stopping by."

Nothing worthwhile comes easy

It was the first week of Medschool. My jaw dropped because of expensive books that we had to buy and have to read. Because of the requirements that we had to do. Of the sudden shift of study habits, routines, schedule, and change in circadian rhythm. I know right then that what I am in for is far from being called a joke.

It was the first Biochem Long Exam. I shotgunned 20 items out of the 60 item quiz. 20-goddamn-items-of-absolute-cluelessness. I was so puzzled with those questions as if they've been written in hieroglyphics or mandarin. Each answer I clasped a prayer to make the most of the 25% probability that I might be right. And repeated the prayer 20 times. Of course, I failed that exam. It was when I started to have doubts.

It was the last day of school. I have been taking exams every single day for the past month. My body was running on caffeine and clinging on the hope of even just reaching remedial exams. I was so tired, and I know I was getting desperate. It has all become a game of numbers. I wanted to give up.

It was a Friday. I took an exam that will determine if I will pass to the next year level or repeat and entire year. Unfortunately it's the latter. I have failed a major subject and it will cost me two semesters of enduring through that subject again. I wanted to quit medschool. I thought Med was not for me and I was incapable of being a doctor. I was miserable for 2 months. I wanted to quit. So bad.

It was a September and I knew I was so prepared for the Pharma Long Exam. 2 hours later, I felt like an incompetent student because no matter how I studied for it, it was still not enough for me to pass that horrific exam. Why does it have to be this hard?

It was my Nth Remedial Exams. Am I really dumb or everybody else is really smart?

There was another family reunion. I said Pass. My cousin were having a boys' night out. I said Pass. My friends were inviting me out to celebrate MY birthday. I said Pass. My bed was inviting me to sleep. I said Pass.

It was a tiring duty. I was facilitating all referrals for my patient and all papers that needed to be accomplished. We attached a line directly to her heart that took hours for us to do so. I did not sleep the whole night. I saw the towering expenses her family had to pay just for one night at the ICU. We megadosed her with IV Antibiotics, but alas, my patient died. 

A uremic patient entered the ER with rapid and shallow breathing and panicking for dear life. She needed a dialysis really bad. They have no money for the dialysis. As much as I wanted to help her, all I could do was watch her go out of the ER and find a hospital that could do it for her. I hope she's still alive. I could only hope.

It was after my Revalida. There was a crack in our relationship that was just mercifully shrugged so that it won't derail my game face for the big day. The crack grew and grew as the doubt she planted inside her only waited for the right time for it to break her image of me. After that, I never thought her thoughts went that far that I cannot catch up to it anymore. I asked why didn't she tell me about those doubts, she said she don't want to destroy me before I take my Revalida. She said it's better to break a heart that ruin a life. Credits to her for doing that. Was it the price of passing? Do I have to lose something to gain something else?
 
...

But despite everything... Despite all the years and extended years I've spent in medschool. Despite all the sacrifices, the numerous times I wanted to quit. Despite the heart aches that came along the way. Despite the clouds of doubt that hovered in my head for a long time. The weekends that I didn't go home, despite the failures in some subjects, despite some professors that shunned me and called me incapable, and despite myself who believed those thoughts... 

It all doesn't matter now, because next week, I will finally Graduate. 

Sabi nga ng Rivermaya, bukas sisikat din ang araw, ngunit para lang sa may tiyagang maghintay.Punyetang araw yan, ang tagal kong hinintay. No matter how long those nights were, and the times the grounds were shaky, God was always there to send something or someone to save me and keep myself intact. Sometimes, they were in the form of strangers, or brods, or classmates, or teachers. Sometimes, God speaks through the silence of the night when it is only you who are awake in your house, through a gentle breeze that pacifies you as you walk home from an all-night duty, through a cold beer soothing through your throat. God was there through all the dark times, and he was there, too, to share the great times. Through the times I knew I passed Pharma, the Thank Yous of my patients who had nothing else to give but that was more than enough, to the moment I passed Revalida. It was all worth it.  

Why did it have to be this hard? Maybe it was meant to be that way so that there will be more things to discover about thyself. More things to learn, and more avenues to explore, more people to meet - so you come back home richer and fuller and with a more profound meaning to every little thing in this funny thing called life.  I may not have understood it while I was inside the storm, but once I got out of it, the picture painted was so damn beautiful. It was here that I lost almost everything, but in the process, I also gained everything. 


So if a younger version of me would ask, "kung bibigyan ka ba ng pagkakataong mag Med ulit, uulitin mo ba?"

My answer would be obvious, plain and simple.

"Ulul ka ba? Syempre hindi...

...Sapat nang pinagdaanan ko yan ng ganon katagal, at nagpuyat ng ganon kadami. Ayoko ngang magPharma at mag Epid ulit. Ayokong magRemedials ulit at mag hintay lagi ng listahan ng mga pangalang di mo alam kung gusto mong nandun ka o wala..."

Every Med student who will graduate with me has a story to tell. Why they wanted to become a doctor, the trials they faced to cross that path, and the people they have met who went through the same journey as one did. As we did. We went through duties together, admissions, conferences, and codes together. They all had their stories why and how they've touched this shore of graduation and all of them are worth telling and worth hearing.

But I'm sure, one way or another, we will mention that we want to become a doctor because the bottom line of it all, is that we want to help humanity. We want to become part of this profession which they call the noblest one of all. For me, Medicine is Love at first sight.

And let this Love be our gift to the world.



“Ars longa,
vita brevis,
occasio praeceps,
experimentum periculosum,
iudicium difficile.

Life is short,
[the] art long,
opportunity fleeting,
experiment dangerous,
judgment difficult.”