Saturday, August 27, 2011

Death and Lessons from Google

I have a confession to make: I google-stalked someone today.

It all started out like this...

“Code! Code!,” someone screamed even before he was through the double swing doors of the critical care area of the ER I was manning about a week ago. The orderlies and triage nurse rushed through the doors pushing in a stretcher containing the limp body of a young man. As we’re programmed to do, we started resuscitation on the patient. While the code team was pounding away at his chest and continued to give life-saving medication through his vein, I had started the interview with the family to document what had led to the patient’s present condition. It was then that I realized that the patient was vaguely familiar to me. The patient was in his early twenties and he’d been in and out of the hospital for a hematologic malignancy. He’d undergone chemotherapy and radiation but remained sick. The latest development, and this I only found out that night, was that the cancer had already spread to his brain and the tumor wasn’t responding to radiation. I never knew the patient personally and had only seen him once or twice, but his name was familiar.

After about an hour of resuscitation, we had explained to the family that continued resuscitation efforts will be futile. The father was trying to compose himself but had agreed to stop the code. It was over, confirmed by the flat green line on the cardiac monitor. The nurses and orderlies started turning off drips and unplugging equipment. The lifeless body of the young man was perfunctorily cleaned and wrapped in a shroud, in preparation for the morgue. This scenario is not unusual at the ER and it happens almost everyday in the hospital. I was used to it. Just another day at work. It was a sad day to be sure, but just another day all the same.

This morning, some Facebook messages reminded me about that patient. Some of the floor nurses that had been friends with the young man had posted their goodbyes on their closed Facebook group. This piqued my interest and that’s when I started my google search.

The patient was an athlete and a student. I found pictures of him horsing around with friends, a genuine smile on his lips. One photo was of the patient with another friend, in sepia, both of them wearing barongs and looking up smiling at the camera. The pictures were accompanied by a blog entry by one of the patient’s close friends and through it, I caught a glimpse of a vibrant young man, about to begin his adventure in the world. In the article, the friend reminisced about their 9 years of friendship and lamented that he had lost a brother.

After one has done countless of codes and resuscitations, after many failed intubations and seemingly intractable arrhythmias, after handling the patient with stubborn low blood pressure that just wouldn’t go up after 5 vasopressors, it’s easy in Medicine to steel oneself from the realities entwined with one’s patient. It’s easy to detach oneself from all the drama and just focus on getting back a heartbeat or a breath, or even a continuous spike of electrical activity on the EKG. On some level, health care providers need to be removed from the emotion-laden realities of our patients so we can focus on the medical aspect, the main area we are called to address. We need to think and think quick. There is also the factor of seeing something too often that it becomes rote. Death and dying is such an integral part of the hospital, especially as a resident, and especially at the ER.

While each doctor and each health care provider will have a short list of memorable anecdotes about memorable patients, my google search reminded me that every single patient I see, whether at the ER, the floors, or outside the hospital, each one of them has a network of people who love them and will for certain be affected by any decision, wrong or right, I make in the patient’s behalf. In the hustle and bustle of the ER, such an obvious and instinctive thing can easily get lost, buried under piles of academic steel and medical jargon. My patient’s death reminded me that death is painful for those left behind and the grieving process for the family extends far beyond the confines of that little room I man in the ER. For us doctors, tomorrow means more patients to see and help get better. For my dead patient’s family, it means an empty bed and a quiet bedroom, a brother gone too soon, and one more grave to visit.

Sent from a BB.

Sunday, August 21, 2011

Twentysomething No More


One of my all-time favorite albums is that one by Jamie Cullum, entitled "Twentysomething." As I celebrated my birthday yesterday, the album came to my mind as I realized I officially am no longer a part of that twentysomething population. I still am surprised when children born in the 1990s, the little kids of my youth, are wheeled in to the ER as adult patients. When did they grow up to be adults? More importantly, when did I grow up?

As a little boy, I looked up to my kuyas and ates, twentysomethings and thirtysomethings, and I thought of them as Adults, spelled with a capital A, mature, self-sufficient, grown-up. It may be that I just wasn't privy to their personal struggles and issues but as I look at myself and my generation, I may have had, as a child, a too idealistic picture of being a grown-up. I don't feel like the grown-up I built up in my mind. I am immature, a hothead prone to temper tantrums, impatient, at times irrational. And as I look around me, every other adult I know is the same way, just in varying quantities of childishness.

I find it a little bit funny and a little bit depressing to ruminate on the fact that I am no longer a twentysomething. I haven't been able to fully wrap my head around living life as a thirty year old man. I don't know if I'm going through some form of delayed quarter life crisis but I've never had a birthday before when my age bothered me as much as this birthday. Thirty. Three zero. Such a round number. I don't feel like I'm thirty.

My preoccupation with my age-change should not be taken as a lack of zest or as fearfulness of the future. I face tomorrow headstrong, with my pack of dreams, filled to the brim, slung over my shoulder. I aim to leave my mark on this earth, and I mean to do it as excellently as I could and by the grace and blessing of the Lord.

It is a strange thing to be, thirty. But it's not so bad. Goodbye Twentysomething. It's been a great decade. But I'm positive the next one will be even better.

Sent from a BB.

Sunday, December 05, 2010

Clichés and the End of R1 Year

It has become a cliché to say that something you’ve been waiting for seemed to have arrived sooner than expected. “As if it was only yesterday that we were starting our residency training” is a statement I will not agree with. This year seemed to have passed too slowly and the end could not have come sooner. I am happy to report that I learned a lot this year, not only about Internal Medicine but also about the more important thing in my profession: interpersonal relationships. I learned that people handle stress in many different ways and sometimes, one needs to let things slide to attain some form of peace. I also learned the value of being quick to apologize and admit error. I quickly averted several potential disasters just by immediately admitting my mistake and promising to do better next time. It’s a work in progress but I’m slowly getting a handle on my temper and my impatience with incompetence, as I realize that I am incompetent more times than I care to admit, and in worse ways. Something Dr. Bengzon once said struck me and I think about it every time a patient (or family member) poses a “challenge”: our patients remind us of our humanity. We are all impatient, difficult, cranky, and demanding at one point or another. We are all apprehensive about death and disease, albeit in variable degrees. These thoughts help me to maintain my composure, take a quick breath, and move on with my work.

This year, I also learned some good Medicine, mostly from the people who took the time to teach. We all had virtually no time to read Harrinson’s so we were mostly learning by leeching: “leeching rounds,” as one pre-resident put it. At one point, I was reading ECG tracings from a treadmill stress test and I remembered the time when I was a clerk and I was so impressed by the cardiology fellows who seemed to have read these same tracings as if it were a book, almost efortlessly. My clerkship self would be proud of my resident self, I think.

The learning was there. But the learning came with a huge price tag. Late nights, sleepless nights, missed time with family and friends ... the list is substantial. The way I coped, however, was to always have my long term goals in mind. As another cliché goes, I “kept my eye on the prize.” I knew that sooner or later, R1 year would be over and I’d be moving on to more challenging stuff. But I’d be MOVING on and that means, pretty soon, the entire ordeal of residency would soon be over. The Lord has shown me grace upon grace this year and my friend Angel, just tonight, reminded me of how undeserving I am of the favor I received from Him. He has been my source of strength, my source of peace, and the One who stretched my limits even more when I thought I had nothing else to give. He has given me an excellent set of duty mates (and now great friends) the past few months. He has sustained me through the most toxic of duty nights and has given me wisdom enough that I don’t have screw-ups that endangered any of my patients’ lives. As an added bonus, I get to do something I love more than medicine: teach. It might well be my only drive to read and study up on my cases.

I may be looking back and seeing things through rose-colored lenses because I am at a high right now: it is my last day as an R1 (and all its accompanying baggage, like DS!) and I had a pretty good dinner (more like excellent, really). But as I remember the year that has passed, it strikes me as being an over-all very positive year. And this makes me extremely happy. If you will notice the description I post about myself in my blog: “An occasional writer whose current preoccupation is getting through medical training unscathed and unjaded.” I may have been scathed and stung the past year but I am as unjaded and enthusiastic about my work as the day I first started last year, considering everything that has happened. The ER and hemodialysis (and many more R2 issues) may quite possibly kill the buzz. But I say, bring it on.

Wednesday, June 30, 2010

An Encounter with an Old Mentor

I saw my old med school mentor the other day. He was with his family at the photo printers. I was about to have my picture taken when, out of the corner of my eye, I saw him looking expectantly at me, like he knew I would recognize him. And I did. He's gained some weight but he seemed more cheerful and relaxed than when he did his rounds at the hospital way back then. I approached him and cheerfully said hello and asked him how he was. He asked me why I was still in Manila (he knew about my plans to leave for the US). I told him the plans fell through. Pleasantries. It was a timely meeting for several reasons.

I remember that on my med school graduation, I sent him a thank you letter where I said I considered him one of my mentors. But to be honest, I don't know if he fits the description of mentor. We weren't exactly close and I don't think he necessarily thinks of me a protege but ever since I met him in sophomore year, I knew I wanted to develop in myself the same love for teaching that he so generously exudes. He was very tough and most of my classmates were terrified of him. But I saw through the tough mantle and knew that at the core, he just loved to see his students understand medicine. My encounter with him was timely because I am at a point where I have started becoming involved in some form of teaching. And seeing him again after so many years reminded me of how much time he spent with the students and that, in a smaller scale, the same is expected of me. I do not aim to emulate his technique. A lot of students find his ways too abrasive. His passion for teaching, his concern and love for learning, these are the things I find inspiring in him. And I guess these are also the reasons why, in some small way, I can look up to him as one of my mentors.

Sent from a BB.

Posted via email from karlmd's posterous

Tuesday, October 27, 2009

Daydreaming at Starbucks

I cracked open John Steinbeck's The Grapes of Wrath the other night. I bought it from a used-books store a few weeks ago, right when I was halfway done with East of Eden. For the first time, I noticed the writing on the book's inside front cover. In fat and neat American print, someone wrote "Tuan Grogman Mrs. K. C-24."

Someone, somewhere used to own this volume. As I sit here nursing my latte, my mind's eye starts spinning.

The image I have is of a classroom in a public middle school somewhere in the US, Kansas perhaps, or Arkansas. Mrs. K, a stout, bespectacled, little lady with curly grey-streaked white hair, hobbles into C-24, a class of eighth-graders. She is dressed in a white blouse with a lacy collar and a long skirt with small floral prints. Around her neck is a thin gold necklace. She squeaks more than speaks in her high-pitched grandmotherly voice, but most of her students pay attention.

Tuan Grogman sits on the third row from the front, right by the window. He is a thin boy with a shock of uncombed golden brown hair that cover his ears. Today, he wears the last pair of clean blue jeans he has, along with a striped blue and yellow shirt and tattered used-to-be-white sneakers. He squints at Mrs. K. He doesn't like wearing his glasses.

Judging by the condition of the book I'm holding, he hasn't read the assigned chapter. Instead, under his Trapper-Keeper, he has the Cliff Notes open. In the fat and neat American print I am familiar with, he writes a final few words on the paper summarizing Chapters 1-10. He takes the sheaf of papers the pretty girl behind is passing to him, places his paper at the very bottom of the pile, and hands everything to the kid in front of him.

Mrs. K collects the homework and keeps it in her folder. She sits down and in her tiny voice begins to talk about Tom Joad. Tuan Grogman looks to his left. He sees the open green fields, the grass swaying and the leaves of the trees shuffling along with the soft breeze. It is mid-afternoon and school is almost done for the day. He begins to daydream.

Sent from a BB.

Posted via email from karlmd's posterous