Saturday, February 18, 2012

Some Things I’ll Miss About PGH

Now that I am about to conclude seven years of my stay in the country’s biggest charity hospital (15, including my college, medical school and internship years), I couldn’t help but count the things I have come to love most about it - things I will definitely miss once I depart its hallowed walls. Perhaps it is only normal among humans to occasionally feel excessively sentimental about things they’re about to leave. Of course I am excited. In fact, ecstatic is more like it. My years of financially underpaid hardwork are about to come to a close. I qualify that as “financially”, take note. Some of life’s greatest satisfactions have nothing to do with money. However, the prospect of going out into the real world where I will finally be exposed to the challenges I have prepared for for so long is truly sensational. My real mettle will finally be tested. There’s this intense trepidation that comes from questions such as: “Will I be able to make it?”, “Will I measure up to the standards with which I was molded?”, “Will I bring honor and glory to the institution that spawned me and the people who taught me well?” , “Will I be just another PGH graduate who will eventually be forgotten and/or will eventually forget where I came from?” , “Will I be just another shark in the ocean?”. Whatever the answers to those questions are, only time will tell. I know one thing though. I need all the help I can get.

So before I even get swallowed by the outside world, I will write down some things, so I will not forget. Here are some things I will miss the most about the PGH that I have learned to love-hate-love in the last fifteen years. These are in no particular order, still subject to changes/ additions/ deletions as I continue to ponder about them in the next few days (ahaha, my last remaining days as a PGH fellow):

1. PGH food. I blamed Carmina’s siopao for my weight gain during my med school days, then mess hall brown sauce during internship. During residency, there was Breakfastival at the foodcourt, where I was a frequent customer. Recently, I realized the breakfast buffet no longer exists. I had other favorites too. Arrozcaldo at the foodcourt is my comfort food. Sopas from the 2nd floor coop store is worth all the long lines especially on rainy days. I also loved the sisig (crispy chicharon with all the onions), spareribs caldereta, munggo with galunggong from the coop. For snacks, my favorites have always been camote cue and turon.

2. PGH elevators and their unlimited capacity. Lining up at the main lobby’s elevators is one of my most hated PGH moments. Especially during weekends when there is only one elevator for visitors and employees. And most especially during days when all the other elevators are undergoing maintenance and there is only one elevator for everybody, including patients! Sometimes I get tempted to ride on the patient’s bed to even fit in the cramped space! However, there is something strangely profound about it. The old PGH elevators kind of remind me of PGH itself – you can fill it beyond capacity and it will continue to function. You pound it with your fists or with your coins and it will continue to go up and down. You think it’s impossible to take more people, and the elevator lady just tells you “Usog usog lang po, kasya pa yan."

3. The Ma’am-Sir culture. You know a PGH graduate if he calls everybody Ma’am or Sir. Not a Doctor or Doctora. Not a Kuya or Ate or a Manong or Manang. A janitor is called sir, so as the most hotshot professor emeritus. You meet a nurse on the hallways and greet her with “Good morning Ma’am.” Ma’am or Sir because you forgot their names. Ma’am or Sir because you don’t remember which ward she or he works in. Ma’am or Sir because you respect them anyway. I know I’ll be going out to that world where I’ll be “Doctora Alcover”. But somehow, if I’m in a far flung hospital and somebody screams, “Mam Jean!”, it will be PGH all over again.

4. Recycling as a way of life. My fellowship batch mate Dave once said that. Somehow, conserving our resources is our way of life here. Always, we try to make use of materials most people discard. Order sheets in charts are back pages of old documents. Papers used to wrap cotton balls and sponges are from old documents whose back pages can’t be used for chart order sheets. I remember some of my co-fellows actually asking Cardiology fellows in other hospitals if they have patients with pacemakers who recently died so they can harvest these pacemakers, sterilize them and use them on patients who need them. Alumni from the United States send us medicines, cath lab materials, other equipment from their hospitals there that we could still use. One of my consultants made it his life’s advocacy to ask for pacemakers (both new and harvested) from everywhere and this noble action has already saved hundreds of people.

5. Creativity to make up for the things we lack. Cardboards as facemasks, cardboards as cervical collars, plastic jugs as containers for sharps, cut-up IV bottles as urinals, cut up IV tubings as nasal prongs, wooden planks as cardiac boards. The list can go on and on.

6. Teaching rounds with my consultants. Yeah, they grill you. They check your chart entries meticulously, criticize your grammar, make sure you have adequate documentation. They know when you’re bluffing about your history, they can tell if you’re inventing your lab result values. They pound history and physical exam into your weary head until you learn how to literally smell your patient's diagnosis. Because of them, you know Dr. House is wrong. It's history and PE, kid. History and PE, not labs. History and PE, not MRI or PET scans. History and PE... They get disappointed because you didn’t see your patient die when in fact you’ve been at that patient’s bedside until midnight and you only went home to bathe and get a little shut-eye because you’ve been awake since the previous day. They know stuff you never get from textbooks. They are the country’s biggest names in the field. Most of them are not even paid at all. But they see your charity patients. They trust you with their own private patients. And they teach you. And somehow, you just know that to them you are not their future competition, you are their trophy.

7. Everyday conversations with my consultants. Ahhh, these are even better than the teaching rounds. Haha. This is when they reminisce about their PGH experiences, they tell you about their patients and their families, when they tell you about how they started their medical practice. These are times when they asked if you have a copy of this song or that movie, when they ask you to edit their slides or their speeches. These are times when you dance with them to Lady Gaga’s latest song, when you share shots of tequila or bottles of beer, when you vomit on their tables. These are times when they show you their human side, when you to them are not just a minion or a student but a colleague and a friend.

8. Teaching my students. Undoubtedly, this is among the most fulfilling moments of my PGH career. You “grill” them during endorsement rounds and then few years later they become that really smart and competent IM resident. You check and criticize their clinical histories and few years later you ask their help for a surgical case you’re comanaging. They look at you wide-eyed, nodding their heads to the bits of information you picked up from Medicine Blue Book. They think you’re some smart, hotshot Cardiology fellow, when in fact, you haven’t even taken your morning bath from your duty the night before. Then they give you these nice little thank you notes, or happily text you that they passed or topped the board exams, or post some flattering comments on your Facebook wall. You get so depressed about your life but then you teach them for an hour and you feel like you’ve done something really important for the world. And you did.

9. Professional fees in the form of anything. When you take care of patients who barely have enough to eat, you expect nothing in return, only that they’d get well and go home back to their families. But then they give you all sorts of stuff from their homes – buko pie, pastillas, salted eggs, bags, wallets, rosaries, bracelets, bagnet, chicharon, chichacorn, shirts that are too small or too big for you, lipstick, make-up, etc. etc. When they follow up at your OPD, you know they barely scraped enough funds for the fare, but there they were, greeting you with a huge smile on their faces with Goldilocks mamon or a Jollibee Yumburger for you. Some doctors get thousands as professional fee from patients who can afford it, but you get siopao and a bottle of coke from a patient who skipped his lunch so you can have yours. The feeling is just priceless.

10. The best possible care for people who have nothing. I’ve seen several Mr. X or Ms. Y come to the ER with nothing in their pockets and somehow, PGH people find ways to give them antibiotics or complete their required surgeries. Penniless patients with myocardial infarction who get thrombolysed, and residents will find ways to give their required drugs, and even scrape enough drug samples for a 2 week supply of home medications. I’ve seen street sweepers, jeepney drivers, and ordinary farmers given implantable cardioverter-defibrillators (ICDs) and pacemakers worth hundreds of thousands of pesos. I’ve seen patients with heart tumors removed, valves repaired, coronaries bypassed, etc. even if they could not afford them. I’ve seen one of my consultants go to PCSO to ask for donations for somebody he didn't even know. A number of my own consultants ask their own private patients for donations for PGH patients. I have seen residents and co-fellows give their own money for their patients, seen them ask for funds from their own relatives just to give one more dose of antibiotics, or just to get a surgery done. I’m not saying that this is absolutely right, something is wrong with this set-up of course, something that is more deep-seated in the Philippine social order. However, I am still amazed at how here, “Walang mamamatay sa masipag na bantay.” I believe this is a place where sincerity and real generosity can still happen. Hope still exists.

I know I’ve probably spent half of my years in PGH complaining and whining about everything we lack. Now that my days here are numbered, I begin to see the beauty of this institution that I’m about to leave. I know I will always look back and remember it with fondness. And wherever my path leads me, I hope I will never forget where I came from. I’ve been given much. Soon, it’s payback time.

Monday, February 13, 2012

Winter, Spring, Summer, Fall

In terms of finances, I am about to reach the winter of my life. After 2 years of living on politician's dole-outs and one year of being a market-driven company investment, I am down to my last pay check. Long rainy days are yet to come, however, when I know I will be scraping the barrel, looking for my last crumbs of bread, living on Lucky Me pancit canton and canned tuna while studying for the last board exams of my life. How I would survive without asking for money from my folks, I really don't know. It would take a miracle, maybe manna will fall from heaven, or I will win in a lottery I don't even bet on.

Nevertheless, moving on to another phase of my life is something to look forward to. Going through another set of birthing pains is another adventure to get excited about. Maybe things will get better soon. Perhaps I need to go through these dark months of my life so I would appreciate the times when I actually have a few bills in my pocket. Perhaps I need to endure a week long diet of pancit canton and develop a talent in extending a single can of Century Hot and Spicy tuna for 3 full meals so I would learn to appreciate a warm Jollibee meal. Winter is here. Time to look for snowflakes. I heard they're beautiful.


While Shakespeare spoke of the winter of discontent, I speak of the spring of my discontent and the autumn of my idealism. The recent events in my life were like a slap on my face, a loud wake up call that shook me out of my slumber. I've been living in this little utopian universe of my own making. A world where everyone is good, sincere, incapable of doing anyone else harm, free of any trace of wickedness and greed. Well, maybe I'm exaggerating. But my point is, I used to think that the world revolves on one basic tenet - the Golden Rule. Be nice, and everyone will be nice to you. Do good and everything will come back to you. Serve without expecting for anything in return. Love without limit. Recently however, I realize I failed to think about one thing - money. Yes, money. Love does not make the world go round. Money does.

I write this as I sit on my treadmill. I'm a 32 year old physician, an almost-cardiologist who actually sleeps on a mattress laid on a treadmill machine. People my age have cars, investments, several properties such as real estate, huge savings in the bank. While I sleep on a treadmill machine because I can't afford a decent apartment. Is this worth it? The girl who will change the world actually sleeps on a treadmill machine?!? Isn't that ridiculous.

Now I can't wait for all this to be over. So this is what happens when you finally realize you were being naive and stupid for a very long time. I deserve something better.


Will I be just another shark in the ocean? I wonder. Now that I have reached the autumn of my idealism, I could not help but worry about how I have transformed into a different person throughout my seven years of postgraduate medical training. Have I become so heartless? Has my patience and tolerance been reduced to minimum and my temper to extremely explosive? I know I am still functional. I still project that image of authority and professionalism. But inside me, I know I'm going nuts. If this isn't compassion fatigue, I don't know what is.


And then there's summer. Sometimes, no matter how tired you are or how screwed up you think you have been, you just can't help but count your blessings. There are unexpected circumstances, people who just come from out of nowhere who bless you with their presence. Sometimes the sun even shines from half the world away and you still feel its warmth. These are the rays of light that make you hope for something again. I wait for that ray of sunshine everyday. I hope it never stops coming.