Back Again (Internship)

previously rant post, now deleted, haha adulting na tayo pre. (So millenial)


Instead internship post! Yey. Di ko matandann if may previous pst na but idc, yey!

So internship, hindi na ikaw ang aliping sagigilid ng hospital, may mas mababang uri na ng hayop sayo! Wooo! (Term po yan ng ibang kaklase ko, actually isa lang naiisip ko, let's not name names) Pero ako kasi gusto ko ng clerkie para may mainspire din ako tulad ng pag inspire sakin ng iba kong interns, yehes naman. Though seriously, madaming mabait kasi eh, so gusto ko ding katulad nila, yey!

The power of the blazer meant mas kagalang galang ka na. Hindi na napagkakamalang nurse or koya or hexcuse moi, who you (potang experience ko talaga sa pasosyal na yon, i sont know kung nakwento ko na sa clerkship files pero clerk ako nun eh, elective sa Radio, may questions ako para sa asawang Pinay ng foreigner kaso sabihan ba naman ako ng "What are you saying? I can't understand tapos sabay punta sa residente ko, what's he saying? I can't understand" so residente ko na nagtapos ng interview, in the middle nagtatagalog na yung Pinay, i have nothing against DH ofws pero pota to, swanget ng english mo, ilang taon ka lang nag-Amerika di ka na marunong magtagalog??? Don't me bitch. Si Sandara Park nga hindi Pilipino pero ang galing niya magtagalog! Gusto pa niyang kausapin siya in tagalog para mapractice sya! Kagalit eh, hahaha)

Anyways, because of the blazer, they are making respeto you more. Mukha ka na kasing doktor, hihi.

But with great power comes even greater responsibilities! Hahahuhu. Mas magrerely na sayo residents kasi mas may alam ka na and stuffs. So yeah! Like sa ER ikaw ang first line kung may kailangang puntahan at sayo tiwala residente etc. Or kung mas mahirap yung case sayo yung nasa Crit area and not the clerkie. Mga ganong stuffs. Iba na din hawak mong wards. Mas madami na, haha tsaka criticals sayo na. Like ICU and NeuroICU sayo na? Ikaw na magrarounds there and stuff. More learnings naman pero, hehehe.

Seniority

May clerk so syempre may feeling of mas senior ka so mas may alam ka dapt. Ehpano kung clerk mo yung top1 ng batch nila, keri lang? Haha. Keri naman siguro, atmost yung top 2 at 3 lang ata naging clerk ko, matalino nga. Pero sa trabaho, wapakels sa talino kung di mo naman magawa agad trabaho mo at kelangan saluhin ng senior mo.

Issues sa clerk, infairness ilan lang naman siguro. Una attitude talaga. Yung mas plastic pa sa orocan pero biodegradable naman? Yung tipong hate na hate daw niya yung Pedia (yes pedia pa siniraan niya sa akin) tapos sa residents kapal na kapal na close af ang asta? Yung nagvolunteer pang gumawa ng ppt tapos kayo ng clerk mo gagawa ng trabaho tapos bibigyan siya ng incentive after? Ay tumaas talaga BP ko nun! Tipong pinapalabas pa niya sa DR clerk ko para magtrabaho outside, ay pota, NO!) haha, ekis ka besh.
Isa kong issue ay yung tipong plastic pala siya sa amin yung akala mong super bait pagkaharap iba pala sinasabi pagkatalikod mo. Though late ko nalaman kasi nga super bait niya at the time, after ko na nalaman na nagsasabi siyang mas gusto daw niya yung ibang intern kesa sa amin, hahaha, ay wow. Gusto daw niya mag work kami, eh teh iba endorsement ata sayo, iba work namin sa community sa work ninyo, isang buwan kayo dun kami 2 weeks lang. hay. Ekis ka, ekis.

And sa walang katapusang mabagal si koya. Kawawa naman eh, hindi naman ako nagagalit na mabagal siya eh, yung residente ko kaya gawin ko na lang lahat ng kaya ko. I mean hindi naman ako gaging hindi ko gagawin work ko dahil feeling ko unfair na naka 5 patient nako ikaw 1 pa lang, urti pa yan, pero you know, it hurts. Kasi ako dinadamdam ko kung sabihan akong mabagal (which happened when i was a clerkie so from there hypermode/beastmode dapat, kape kung kape para di lang sabihing wala kang kwenta, ekis ka)

Boards Review

Doktor napo ako, huhu, sa wakas bes pumasa ako!
Share ko lang ang review experience ko, iba eh. Ibang-iba! Sabi nila hindi na mauulit itong level ng review sessions, kasi kung mag residency ka, atleast specific na yung aaralin mo and mejo hiyang ka na sa topic. Eh sa boards? "Favorite na favorite" mo ba Biochem dati? Eh Anatomy? Pathology? Microbiol?
Syempre kanya kanya tayo ng gusto at hilig, strengths and weaknesses, premed course so unless Diyos ka na nagbalat kayong mortal, (bakit nandito ka pa teh? Bumalik ka na sa langit), may hate na hate kang subject, for sure (neuro kang ina mu!)

Batch namin madaming time para magreview, 3months eh, wow beh, daming time!
Sa akin hindi advantage yun, naging complacent ako, tamad ako mag-basa sa first month, huhu dapat hindi. Dapat basa-basa din kahit daming time. Aral lang ng aral or gawa ng cram materials. Like flashcards, summary notes or poster sa wall.

What is nagtape ako ng iba-ibang kulay na cartolina sa pader tapos random info sa post-it susulat ako. Tapos kapag praning na ng konti, tayo na lang ako sa harap ng kartolina and review yung mga nakasulat doon. Examples na nilagay ko sa kartolina, formula sa prev med. Npv ppv? Ay sos, efficacy  etc andun yun. MI location depende sa lead ng ecg? Yun din yun. Gamots sa worm infections, andun din. Basta mga random info divided by subject matter.

Nag review center pala ako sa superduper awesomeness masters na TopNotch Boards Review. Super awesomeness dito kasi ganda reading materials and super warm nila. Alaga ang mga studyante.

Nag aral ako ng matindiban start ng 2nd month or so. As in gising, kain, ligo, aral, tv break aral kain, tulog. Dapat siguro nag start ako nung 1st month na ganyan, may aral pa din kahit longer tv break and  game break.

Hindi ako nagFB hiatus, haha, kasi looking for FB announcements ako eh. Which i think is the wrong choice. Hahaha. Dapat nag FB hiatus ako. Dapat tinapon ko phone ko and pinaubaya ko ang FB announcements sa kaptid ko and gumamit ako ng non-smartphone phone. Haha, ohwell. Just a suggestion I guess.

Nag-stay ako sa bahay, hindi ako nag coffeeshop or library. Nagpaka-loner ako, thinking back, siguro dapat nakisama ako sa friends at nag-aral with them. Wala eh, loner ang peg ko sa bahay.

From the start may tendency for anxiety na ako. I guess napaghandaan ko ito kaya pinapunta ko nanay ko sa apartment. Ayun, siya nanghandle ng stress ko. Favorite kong ikwento is yung monster transformation ko during review. Super bipolar ang peg beshy, one minute super galit na galit tipong sisigaw ako ng "Mommy tubig! Asan na lunch ko!? Gutom nako!!!" Then iiyak kasi sasabihin ko na lang na hindi ko na kaya, tapos mag bebreak ako magna-9gag tapos tatawa sa stupid video or pic or sumthng tapos magagalit sa sarili kasi yung 10min break naging 30mins (minsan 1 hour) tapos iiyak kasi feeling babagsak ka na (those were very manly tears, haha yeah right) tapos game face back on ka nanaman and repeat the cycle. Daily.
Super grateful ako sa nanay ko for doing that for me, and my older sister na naging semi-punching bag ko din that time. And of course my family for supporting me. Yes, parang nanalo ng Best Actor. Hahaha.

Hindi ko natapos lahat yung review material. That was a mistake. Dapat nabasa ko yun atleast once.  Hindi ko nabasa fully yung OB tsaka IM. Samantalang twice ko binasa anatomy, pedia, surgery tsaka biochem. Sheesh. Talk about poor time management. Hindi ako nagpamentor sa topnotch. Huhu. Dapat nagpamentor ako. To be honest. Kasi kakausapin mo mentor mo then iga-guide ka nila and stuffs like schedule making or kung may problema ka sa pamilya or boypren and stuff. Or kung pinagnanasaan mo yung tracher sa pathology or biochem, kakatawa na kwento nung mentor, madaming mga ateng may time pang lumandi. Haha. Baka naman effective sa kanila at nag-aral sila ng patho better.

In the end may mga pinagsisihan akong practices, pero grateful and happy pa din ako na pumasa ako. Hindi na issue sa kin yung chismis about sa other schools and their top ten, sila na yung manghusga sa sarili nila kung totoo man yun. Basta ako alam kong pumasa ako n boards dahil sa sarili kong nilaga, huhuhu. Andaming dugo (literal, nagka hemorrhoids ako at toothache) pawis at luha (again, those were very manly tears) na binigay ko for that highly coveted MD and the right to prescribe, hahaha. It was fun and difficult and I wouldn't dream it happen on my worst enemy (che di niya kakayanin, joke wala akong mortal na kaaway) and hell, i wouldn't wanna go through it again.

Gahhh!


Signing-off on my medschool journeys,
John Ellison D. Jamorabon, MD

Clerkship: Mga bagay bagay

before going into medschool, hindi ako aware sa concrete details ng clerkship at internship. before going into medschool, alam ko lang, pag 4th year tawag don clerkship at 5th year ay internship. na ang last 2 years of medicine ay igugugol mo sa hospital training. actually before, ang akala ko 4 years lang talaga ang medicine, na ang stupid ng mga iba for choosing schools with 5 years of medicine. pero buti na lang at nalaman kong ang internship ay REQUIRED sa lahat ng Med Students (so tiklop bigla ako, kasi heto ako sa isa sa mga "stupid" na eskwelahang pinupuna ko dati-rati na may 5 years of Medicine) sa loob loob ko kasi noon, ang strict na nga ng requirements ng St. Luke's na yan tapos 5 years pa yung training! wag na uy! naiintindihan ko yung sa PGH, UP yun eh, gusto nila matagal training para man power! (nakakatawa pala pag-iisip ko noon)" Man, was i ever wrong. Pero still, One of the reasons I chose SLCM then is because they had the 5-year thing going for them. I was thinking then (nung nalaman ko yung internship thing ay required before taking the boards) "Ayaw ko ng ma-hassle pa at maghanap pa ng papasukan sa internship, dun nalang para diretso, atleast mafafamiliar ako sa environment, besides, St Luke's is still St. Luke's anyway) so andito nako! Lols

Information I WISHED I KNEW and UNDERSTOOD FULLY BEFORE GOING into MEDSCHOOL


1.  5 years. You will study Med for 5 years before you can take the BOARDS and be able to practice      Medicine (bago ka makareseta dude),

• 3 years for academic/classroom learning wherein you'll learn fundamentals of medicine (THE BASICS: ANA-HISTO, PHYSIO, BIOCHEM, MICRO/PARA, COMM MED (?) PHARMA (?) PATHO (?) and LEGAL MED) *the (?) ones kasi considered basic pero mejo clinical na din, parang asa gitna sila
• 2 years in the hospital to practice and apply your Hx and PE skills and your Diagnosing and Managing skills and learn first hand patient care  

2. PRE-DUTY-FROM STATUS - ito yung pinaka-importante para sa akin. Kasi hindi ko talaga siya maintindihan before, narinig ko na sya pero hindi ko pala sya naintindihan fully until i was being oriented before clerkship and noong naeexperience ko na sya. I won't lie, nabigla ako and i felt so tanga for not knowing such a critical information. atleast hindi ako mag-isa, hindi lang ako yung nashock at ngumanga nung sinabi nila what PRE-DUTY-FROM is, so here goes

• PRE STATUS also PRE-DUTY - ito yung time/day bago ka mag-"Duty" day, ang sabi nila, ito yung araw para mapractice/maghanda ka bago ka magduduty, like knowing who you're patients are going to be and what to expect or do on your duty day. Sa St. Luke's iba iba ang time-in nyan, it can either be 630AM, 7AM, 730AM 8AM or 9AM. Dismissal time is universal at 5 but can be earlier or later depending on the department/if your work is done. 
• DUTY STATUS - ito na, magduDUTY ka sa hospital, you will stay in the hospital for 24 hours! walang mintis yan 24 hours ang "DUTY period" mo sa hospital so kung 630AM call time, 630AM  to 630AM (the next day) ang "DUTY" mo, pero here's the catch, the FROM status.
• FROM STATUS / FROM DUTY STATUS - so nag "Duty ka na, 24 hours ka ng asa hospital, pagpatak ng call time/time-in mo the next day (kung 630AM, 630AM next day, etc) considered "FROM" status ka na. Ito ang masaklap. ang "FROM" status ay kapareho ng time period ng PRE, uuwi ka ng 5PM that day. Gets mo ba? in short, kung 7AM halimbawa call time mo, papasok ka ng January 1 7AM, uuwi ka the next day ng January 2 5 PM. Kung di mo nabilang, yun ay a total of 34 hours na nasa hospital kang nagduduty.
• Sa St. Luke's may special rule na kapag pumatak yung PRE mo ng SUNDAY or HOLIDAY considered OFF ka. that is, may DAY-OFF ka! so kung ang isang buwan ay may 4 SUNDAYs, siguradong may atleast 1 day kang DAY-OFF for the MONTH! grabe ang swerte noh? (no, I'm not actually happy, I'm being sarcastic) AND kapag FROM ka ng Sunday or Holiday, AS RELIEVED ang status mo, ibig sabihin, pwede ka ng umuwi the next day kapg dumating na yung DUTY for that day. (saya ulit no?) so again, atleast may 1 kang AS RELIEVED status.
• SPECIAL NOTE: OTHER Hospitals do not have a "FROM" status. yung iba, kapag DUTY ka, after ng 24 hours mo, uuwi ka na. but not in St. Luke's and PGH if i am correct. basta ang alam ko walang FROM status sa UE at UST, sa UST mas maganda actually, ang alam ko ang pasok ng DUTY sa kanila ay 1pm (though not sure 100% about that)
• AUTHOR's NOTES: Oo hanggang ngayon may issue ako sa scheduling na yan, kasi kung sinuswerte ka, may chance na for 1 week you will spend 108 hours sa hospital. Tanggap ko ng ganyan talaga ang scheduling pero I can't help but ask, bakit hindi maadapt yung ginagawa ng iba? bakit hindi pwedeng walang FROM status? bakit hindi pwedeng gayahin sa training institution na may 60, 70 at 80-hour week tulad ng sa ibang bansa? just a thought, pero I'm too coward to bring it up further aside from me ranting here. lols. and to be honest, kahit natutunan ko yung PRE-DUTY-FROM (PDF sked) i think i would've still gotten into Medicine.

CLERKSHIP TASKS

• This is way too varied to discuss and syempre, St. Luke's perspective to dahil malay ko ba sa ibang school, puro haka-haka at kwento lang naman ang alam ko about them. Sa St. Luke's depende sa department or rotation mo at sa day or status mo, iba iba talaga ang task, 
• First off - ER tasks (take history, pe, update labs, get results of imaging, log the patients in log book, do census, discharge patient, give instructions to patients on their medication, and things to watch out for/ when to come back, explain why a certain laboratory/blood exam is requested, or what is wrong/disease they have or how they might have gotten it) for me, ER is the most rewarding rotation. and i am actually considering ER medicine if only I'm not slightly (ah wow, underestimating) overweight, haha (hidden trophy lols, ps3, or that is, silent requirement) na dapat may kaaya-aya kang BMI para matanggap sa ER Med (huhu), 
• Next WARDS - kakamustahin ang mga admitted na patients, check if the patients have complaints and do PE, update the consultant or resident. In St. Luke's almost always lahat ng galaw mo may residente ka, emergency status mejo rare yan kasi dito, hinding hindi ka mag-iisa, lalo na kung expected na critical or unstable status ng pasyente. Kasi defensive practice tayo, syempre, ayaw natin magkamali at may masamang mangyari sa patient. Para sa akin, this is the most nakakapagod part of any rotation, nasa iba-ibang rooms ang patients mo at nasa iba-ibang floors. Tapos kapag may consultant na dumating, masisira lahat ng plans nyo for rounds at sasamahan said consultant. KAPAGOD!  
• OPD (out-patient department, charity cases) do complete Hx and PE, diagnose and give medications/ do work-ups. Dito, ikaw yung attending physician/consultant. pero syempre, kailangang ipacheck sa residente. Actually minsan simpleng Hx and PE ka lang kasi residents na ang magdadaignose at magbibigay ng gamot. But still, ikaw una nakakita sa patient eh, so ikaw dapat, meron ka ding diagnosis or differentials in your mind and the possible management/treatment for the patient. Mix emotions ako dito kasi sobrang nakakairita yung OPD with all the politics and the not so friendly nurses/staff (Actually 2-3 lang naman sila, pero nakakairita sila) Rewarding sometimes, exhausting sometimes especially when you're patients are difficult to communicate/talk to. 
• OR Duties - ito depende na ito. For people who are inclined to surgery, then this is heaven for them. For me who hates standing for hours at the time holding/pulling/pushing instruments for residents/consultants to operate, it felt.... hellish (yes, theme song sa utak ko yung "Jealous" ni Nick Jonas right now). Kasi hindi ko kayang pigilin ang ihi ko ng matagal at ayaw na ayaw kong tumayo at tumanga for a long time, hindi ko appreciate ang OR duties. Here, ikaw mauuna sa OR, babantayan kung dumating na pasyente at i-update mo ang residente mo. Kung may kelangang materials na ipa-prepare, ikaw magsasabi. Kung out-patient procedure yung OR, ikaw gagawa ng paper. Kung may imaging like CT scan plates, MRI plates or Xray films, ikaw din magdadala minsan. Ikaw din gagawa ng Operative Techniquqe (kung anong ginawa nyo sa OR). And most of all, ASSISTING. This.I.Hate. Kasi role ng clerk ay mainly, to retract. You will retract that annoying bowel/innards that keeps getting in the way. Or the skin/fascia/muscle that obstructs the surgeon's blade or instrument. For Mastectomy (one the worst ORs ever) skin retraction means pulling your patient's skin upwards to dissect off them breasts. Not only are you watching your surgeons remove a perfectly well looking, albeit malignant breast, but they're also making you ache all over. well, yung elbows mo lang naman kasi hinihila yung balat pataas for an hour nakaangat lang kamay po, that was hell. lalo na kung yung breast mass na tinatanggal nyo ay Cup C or D. Pota.....Makes me hate boobs. Or yung matatagal na ORs (hello Whipples! Laryngectomy! Total Maxillectomy! or any other 8-15 hour (yes, 15 freaking hours) ORs) Hindi ko ata kayang tumagal ng 6 hours ng hindi umiihi! (lols, unless tulog ako) kaya no, no, no, i love my kidneys please. Although masaya sya and most of the time, kapag nakikita ko at naaappreciate mo yung anatomy ng OR, nakaka-invigorate, pero when you are way too big and will obstruct the surgical field and is asked to lean away, but keep retracting from a distance. nakakapagod and nakakadegrade. Also, kung mabait or SS yung patient, suturing, patatahiin kayo! oh diba! yehey! haha OR tasks din from OB is delivering a baby (syempre hindi high risk cases) delivering placenta and suturing the vajayjay. 
• OTHER MEDICAL STUFFS - Discharge Summary ng pasyenteng inadmit nyo at pinauwe, so ikukwento mo history and pe ng pasyente at kung ano ngyari sakanya sa hospital. Sa surgery favorite ko tong ginagawa kasi nakaupo kalang, nagbabasa at nagtatayp, medyo may matututunan ka din naman ng kaunti like kung anong ginagawa sa patient when they develop something or watever. PLUS nakaupo ka lang! yey! (dapat talaga hindi nalang ako nagmed at nagpaka-office worker/call center agent na lang ako, lols) Admission! Do History PE and Problem List Database. which is very annoying kasi sinulat na nga sa order sheet ipapasulat pa sa lintek na database.. i swear.. what is the point! #conservetrees #recycle #mothernature kainis! at kung nasa ENT ka (my pinaka-favorite [insert vomiting smiley] rotation ever!) isusulat ninyo sa ER sheet, gagawa kayo ng Green Referral notes (kahit kayo yung admitting service at hindi naman kayo ang nareferan, talagang feeling ko ang tanga tanga ng ginagawa ko at sobrang sayang sa papel, kaya ata mahal magpagamot sa st lukes eh!) isusulat sa Order sheet/Doctor's notes at gagawa ng freaking Database na 21 pages! 21 pages! as in! 21 pages! Other medical tasks, IV insertion, Blood extraction, NGT insertion, Foley cath insertion. 
• OTHER NON-MEDICAL STUFF. Most important payo sa akin ng naging Intern ko, (Non-verbatim) "Mas madali ang buhay mo kung matatanggap mo agad na Clerk ka, like it or not, sa hierarchy ng Doctors, ikaw pinakamababa, alam kong masakit tanggapin/marinig pero yun talaga most effective way of saying it na madaling maintindihan. Hindi naman porket lowest of the low ka hindi ka na respetado or what eh, ikaw lang kasi yung wala pang experience or yung may pinakakaunting experience. Isipin mo na lang na kung may pasyente diyan at may kung anong mangyari sa kanya baka hindi mo pa alam gagawin eh. Mejo life-changing/traumatic experience din kasi yun para sayo. Ako iniisip ko na lang na kaunting tulong ko nalang sa residente yung non-medical tasks, kasi sila napapagod din sila, tapos tinuturuan pa nila tayo. kaunting tulong lang naman din yun for them." So ano ba yung tinutukoy nyang "non-medical" tasks. to be honest, kahit ano. may nagpapabili ng pagkain, nagpapabili na kung anu-ano, nagpapahanap ng kung anu-ano. nagpapabitbit. sacrificial lamb sa consultant para magtanong ng kung anu-ano. call center agent kasi magpapatawag sa kung saan saan para magtanong ng kung anu-ano. as in anything and everything under the sun. 
• Famous story ever, is may isang consultant, itago nalang natin sa specialty na Psychiatry (as in, sa Psych pa talaga ha! considered benign rotation) na nagpahanap lang naman sa hamak na clerk ng Helicopter. as in. kasagsagan ng bagyong Ondoy (yes, clerkship year nila si Ondoy) ng kinailangan daw ng helicopter ng isang VIP patient ng helicopter para masundo sya (somewhere) at magpakonsulta kay bigtime psychiatrist. and need i say more, sumabog nalang yung clerk. #watdafack #sanakohahanapnghelicopter #meronbasayellowpagesngrentahelicopterservice. in fairness, tumawag daw siya sa redcross who redirected her to the army where she eventually was able to inform them of the need for a rescue.... potang inatalaga! buti nalang nung kami ang nagpsychiatry, ang pinapahiram lang naman nya ay piano, sabi namin kung yung organ ba na piano, hindi daw... yung grand piano... but portable.... (promise, nag-migraine ako after)

HOSPITAL ENVIRONMENT
 SPECIAL ENDORSEMENTS

• Time-in: sa Surgery at Medicine 630 AM dapat asa hospital ka na. (lalo na if you have an early OR sa surg or you have patients to do rounds to sa Med) in Neurology, ENT and OB 7AM, 730 sa pedia. 8 sa Ophtha, Radio, Patho, Derma, Psych. 9AM sa community med. Time-out is usually 5PM or earlier depending on the department and the work for the day or later depending on (again) the department and work that still needs to be done. Some departments are notoriously known na for early and late dismissals. Neuro, ENT and Surg (in descending order of frequency and intensity) are heavily endorsed (Med lingo, endorsed/endorse/endorsement term used for everything and anything you "teach/say/advice/habilin/chismis" to other people) as Departments where you may be asked to extend beyond the dismissal time. Neurology is a very tough rotation, as expected and as kwento by most doctors, kasi IT IS NEUROLOGY, utak kasi pinaguusapan natin teh