Playing with the Legatoscope

Wala lang, perpective pics kunwari, using a digicam, the legatoscope, and CT plates of a guy with hydroceph…

First Paycheck

Just received my first paycheck as a “Medical Officer III,” employed by the Republic of the Philippines-University of the Philippines-Philippine General Hospital. And now that the customary treat for the more senior residents and the required contribution for bills at home are already done/paid, it’s time to contemplate what to do with the rest of what the government has decided to compensate for my (rather amateur) services as a physician. Do I:

 [  ] buy a laptop I can use to make the 7 mortality presentations I need to finish by the end of the month? (correction, 7 and running, since Feb is not yet over)… I’m eyeing the white ultraportable eeePC:

[  ] buy a dual-SIM phone I can use to call my family and friends (Globe) and co-residents (Sun), without the hassle of having 2 bulky phones in my blazer pocket? The stylish myPhone Slyder is at the top of my list:

[  ] buy the latest edition of Adams’ Principles of Neurology? So that I won’t fail the next exam? (or else, Sunday duty ang katapat).

[  ] buy a new Littman branded stethoscope? I lost mine in the Pay wards last month, and I’m now using a cheap imitation (works great, by the way, so this item is at the bottom of my things-to-buy).

Or, I could be really childish and buy something totally unrelated to work… like my own Playstation!

It’s shopping time!!!

Neuroyloy#1: Earthquakes and Epilepsy

Starting today, I’ll be posting interesting stuff related to my chosen specialty (Neurosciences) that I find on the net in a series I’ll call neuroyloy in aloyloy. This serves two purposes: 1. to promote Neuro as an alternative to boring old residency programs (calling all medical interns out there still deciding where to go after the Boards… join us in Neuro na lang!); and 2. to prevent this blog from CODING (ie, flat-line) while I am in first year (ie, while I am the slave of all slaves in the department, at the bottom of the totem pole, jingle lang ang pahinga). So, even when I’m too busy with hospital work or too tired to post, you, dear loyal readers (yes, the 3 or 4 of you) will have something to aloyloy about.

The first of this series is a very interesting article from The Guardian about what I think is one of the most complex diseases known to man, epilepsy. I remember that there were many instances in the past when, while I was in Church, or at a dine-in, or even while I was lounging at the beach (yes! true story!), a PWE (Person-with-Epilepsy) near me suddenly seized. All these events I took to mean that I really belong to Neuro. Here’s the article, pasted without permission from The Guardian’s website (I cite Fair Use):

Admitting Orders

Aloysius Domingo, MD
A> Neuro first-year resident
Chronic fatigue syndrome

Admitting Orders
January 1, 2008

> Admit to Ward 5 under PGH Adult Neurology service
> Secure consent for admission and for 4 whole years (and possibly more) of toxicity
> Diet: diet as tolerated but mostly PGH canteen food or fastfood
> IVF: none for now, will insert once with dengue secondary to callroom mosquito bites
> Monitor NeuroVSq3days (ie, everytime mag-postduty), WOF decrease in sensorium
> Monitor I&O qshift and record, refer if already urinating coffee
> Diagnostics: [ ] CXR-PA upright — baseline, in case mag-pulmo eff 2dary to PTB
                      [ ] plain cranial CT Scan STAT – R/O first-duty stroke
> Therapeutics: start ChartRounds 25mg tab 1 tab PO bid x forever
                               ServiceRounds 100mg cap 1 cap PO q3days x forever
                               ConsultantRounds 1 amp IV qweekly, WOF hypersensitivity rxn
                               OPD neb 1 neb twice a week
> May give diazepam 1 amp IV PRN for frank seizures during rounds
> Self to ensure meds are given, else will be kicked out of program
> Limit social life
> Refer to Psych for evaluation and co-management
> WOF hypertension (when in Charity Svc), WOF pedal edema (when in Pay Svc)
> Close watch please, for standby intubation
> Inform family and friends once admitted, because they might think he disappeared
> Refer PRN

RIZAL, MD
Lic No 000001

Rizal, MD

Yesterday was Rizal Day; today is new year’s eve; and tomorrow is my first day as a resident physician at the Philippine General Hospital.

So many have inquired about this choice of mine, to stay in the Philippines, and to undergo residency training here.

On Topical Penicillin

This afternoon I was convinced by my mother to allow a manicurist to work on my ugly toenails. And since these toenails of mine have not been seen by a professional in a year or so, the ill-fated manicurist had to contend against what was probably the largest, deepest, and ugliest ingrown cuticle she had to remove in her entire career (judging from the old woman’s routine, she’s been at it for a long time). Her experience and agility was unfortunately not enough against this monster of an ingrown that I had been allowing to thrive in the corner my right big toe: I was injured as she was trying to extract it (the monster of course was resisting death). We both gasped at the sight of blood, but what happened next was very interesting.

First she comforted me and told me that everything was fine, that sometimes these things happen, and that everything was under control (hmmm… familiar lines of medical interns missing IV insertions). Then she wiped away the blood with a cotton ball, which she followed with antisepsis using alcohol (OK so far). From her kit she then took a packet of what I later found out to be ground penicillin tablets; this preparation was carefully topically applied onto the side of the nail (where presumably the wound was). Her home instructions were to not allow the toe to get wet, as it would wash away “the medicine.”

DeMyer: Treat Your Patients Like Robots

(This post also doubles as my announcement that I want a Robosapien for Christmas )

 

The medical school where I graduated from leans to the application of the humanistic approach to the practice of medicine. When I was a student, we were always encouraged to develop rapport with our patients; we were always instructed to get not just a detailed history of the course of illness and the reason for consult, but to also derive the thoughts, feelings, and emotions of the patients we were assigned to. Emphasis was given to finding out the context of the patient: his family situation, economic capacity, educational attainment, social standing, etc. All these were postulated to have significance and relevance to the nature of the patient’s illness, and were taught as important in the treatment of the disease and eventually in the patient’s healing. “Your patient is a living person, and not just a defective machine” were frequently spoken words of wisdom from our teachers.

DeMyer, however, in his textbook Technique of the Neurologic Examination (my favorite med school book of all time) teaches us something else. He makes a compelling case for the treatment of patients like robots:

5 Documentaries Today

Sometimes the problem with med school is that you get so busy with duties and with studying, that it becomes difficult to find time to attend to other interests, especially those that are not relatable to work inside the four walls of the hospital. So many episodes, movies, games, plays, books, events, news, issues etc etc were lost this way during my 5-year stay at the PGH. Survival sometimes meant having to block out all other competing interests in an effort to understand and commit to heart (yes, not just to memory) the fronto-ponto-cerebello-dentato-rubro-thalamo-cortico-spinal pathway; and for this, the feeling that one is detached from the real world is an all too common experience for the average med student.

Good thing there are reruns.

Today I watched five documentaries in a docufest sponsored by my sister’s org in UP Diliman. All were from the award-winning GMA show I-Witness, and all I missed when they were originally shown on TV. The first, Howie Severino’s Brod Is Thicker Than Water, discussed the death of UP stude and Sigma Rho neophyte Cris Mendez from hazing. When news broke out of Cris’s death, I was on duty at PGH for pre-residency qualification; I found out about it from my sister, Cris’s classmate at the NCPAG. We usually talk about updates on this issue (or the lack thereof) during dinner.

The QC Reproductive Health Scandal

It was around two Sundays ago when the parish priest in our church first invited mass attendees to read the circular issued by QC bishop Ongtioco opposing the proposed reproductive health bill for Quezon City sponsored by Councilor Joseph Juico. The ordinance “Establishing a Quezon City Population and Reproductive Health Management Policy” was attacked in that it supposedly ”kills unborn children, causes deadly cancers, (and) destroys the Catholic educational formation of our youth.” A leaflet with the letterhead of the Our Lady of the Miraculous Medal Parish (in QC) says the ordinance would bring “sexual promiscuity to intermediate and high school students in their class lessons.” In the next few days, the proponent has apparently been villified by pro-life advocates and has come under intense pressure and condemnation from the Church (see related news items: ABS-CBN, Inquirer).

The objection of the Catholic Church to the progressive concept of Reproductive Health is not new (“progressive,” to distinguish from the Church’s archaic view that the natural method is a safe, effective and acceptable method of reproductive control). In 2005, the Church and its pro-life minions successfully buried House Bill 3773 or the Integrated Reproductive Health and Population Reduction Bill. As a result, there are still no comprehensive government strategies to combat the continually exploding population size of the country and family planning efforts nationwide are still underfunded and lacking; the situation is expected to get worse as the USAID fund for contraceptives (the largest source of free contraceptives for the Filipino poor for the past 30 years) runs out by the end of 2008.

Numbers

One of the major trends in modern medicine is its respect for the intrinsic power of numbers and their study. In the movement known as Evidence Based Medicine (or EBM), the teachings of tired old doctors passed on from generation to generation are not taken as absolute truths, but as principles that are less convincing than those supported by hard evidence. The NHS classification of medical literature uses Level A to apply to theses supported by strong studies such as consistent Randomised Control Trials (or RCTs), and Level E to refer to expert opinion or theoretical results (find out what Level B, C, and D mean in Wikipedia). The whole idea is to determine best practices in the medical field by testing them against objective observations and to do away with extraneous variables such as bias in making important medical decisions.

Indeed numbers have a very strong power to convince. When used properly (ie, in presentations that can sustain the interest number-haters like myself), they can strongly influence opinion, affect stances, and forward certain advocacies  (who can forget that three-storey projection in The Inconvenient Truth? 3:15 on this YouTube video). I am sharing below my favorite number-play sites (ie, sites I go to when I suddenly get that nerdy urge to know more about the world):