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.


BOTD said...

*tear tear* congratulations maam jean! grabe patapos ka na. thanks for always teaching us. I'll read this post when I feel haggardo or stressed drilon ahahahaha. good luck sa outside world! i'm sure you'll make it. :)

RPJA said...

I can't believe that you're done na! You will always be remembered as Ma'am Jean :-)

And so the journey continues...

edhel said...

Aww mam Jean. Im just a month into private practice here in the province and I always catch myself missing the familiar walls of PGH. Missing the people, the weird way we have of doing things back there and even the toxicity of loads of patients... Your post just reminded me how I'll always be a little sad that my PGH journey is done =) Congratulations!

drrayms said...

madz, its going to be a different world out there. i wish you luck mother! it's either you get suck into the system or be at the sidelines throwing up.

i'll miss bumping into you in the corridors of pgh. MWAH!!!

Isa said...

Beautifully written, and I can relate to most of it. But I'll be back in PGH, so I'm entitled to whine some more about it. Hehe. Congratulations, Jean!

franz marie said...

wonderfully written! it made me miss PGH too! i've always said that we had excellent training in PGH.

Bonedoc said...

exactly what I felt too leaving the halls of PGH. And until now, I get to meet people whom I met and connected with PGH in one or another and we call each other "Sir/Mam!". Don't worry doc, when you do get into the medical "ocean" as you say, your PGH experience will always be a strong "moral, ethical and medical compass" for which to guide you in your everyday medical life. And there's always a "PGH" moment in your every day physician life...


wendy said...

so nice jean <3. lalong nakakasenti when you've been away for a while and have had many nice baths :D

Lance Catedral said...

This is a moving piece, Ma'am—and thanks so much for sharing! We have so much to learn those who are already far ahead like you.

Anonymous said...

maam jean, i am so excited to leave, but reading your piece made me take a look back. thanks for the teaching and for all the help. it was a pleasure serving with you.

but on to other things! i am excited about that as well!

smoketh. :)

ronibats said...

But somehow, if I’m in a far flung hospital and somebody screams, “Mam Jean!”, it will be PGH all over again.

This has to be my favorite line. Hehe. We'll miss you Ma'am Jean. :)

Kris said...

A well-written piece. I've been practicing in the province for almost 3 years now, and miss the "PGH culture" that I never knew existed until I stepped out of its walls. One of the things I miss is the constructive criticisms during conferences that everyone takes with better health care, and not swaggering egos, in mind. I am proud to be a "Ma'am"!!!

aggie said...

this is very nice, jean! ;)
glad to know you're not leaving PGH all jaded and stuff, despite the great temptation to be so. ;)
Congratulations! :)

Anonymous said...

so moving... brought tears to my real...I am not a full-blooded PGH grad like you but I spent my residency and fellowship in PGH... you just verbalized my thoughts...really a very good and inspiring piece for all of us who will be establishing a practice.

manangbok said...

Hi Jean! Part of the reasons I didn't continue in PGH for my fellowship training are all the ones you posted. I loved that hospital for the rigorous training, the diversity of cases/patients, the discipline it instills which can literally break your back (and heart). I'm glad I went through that, but I have second thoughts if I'll be willing to go through the same brouhaha all over again.

I somehow lost my empathy along the way and that's what I regret. But maybe it's my failure and not the hospital's.

It's a different world out there. Good luck.

Anonymous said...

very nice blog ma'am jean! so true, it left me teary-eyed... i really do miss pgh, iba pa rin... it's a totally different world outside, but we will never forget where we came from...

agnes dominique said...

Beautifully written, got me almost misty-eyed there. I ended 13 yrs of UP-PGH in 2004, been in private practice for 8 years now, and I still consider myself most fulfilled as an MD when I was an Endo fellow at the OPD. The patients have been so generous in BLESSING ME, i.e., at the end of their follow-up consult, they impart to me an unspeakable joy, a different kind of fulfillment.

Amen to the Maam/Sir thing! I'm the only one i know in this corner of the world [and i practice in Metro Manila] who calls everyone in the hospital Maam and Sir, too, and now including waiters, street sweepers etc.

A resident once told me, as I was writing the discharge prescriptions and lab requests for follow-up [again, a habit acquired in PGH, where it's the MD, not the NOD, who has to write all these]:
Resident: Dra., taga PGH ka ba?
Me: Yes, how do you know?


P.S. yes, private practice is very different. But if there's anything I learned, it is that PGH doesn't have the monopoly of knowledge, nor of what is the best. There is also much to be learned from our colleagues from other institutions, especially when it comes to surviving in the real world.

All the best to you, Dr. Alcover!

Anonymous said...

Some things never change. Twenty-five years ago, into internship, then residency, it was shark and jaws at the mess hall. :).
We were there at a time that the elevator took forever to reach the second floor in the old OR complex. The central block was still to be opened. You are right, the most memorable gifts were those that came from those that did not have so much to spare. I still remember the crabs (as in alimango)that ended in our shoes at the Neurosurgery office in the morning. Or the patient treated in first year surgery residency would come every Christmas and give a half sack of rice or precious pinipig.

One thing I've learned, though after 20 years of private practice, you carry the education and training that PGH offered and you willingly took in.
I wish you good luck. And yes, there is life after PGH.

Walking on Water said...

Thank you for your comments and for sharing your own experiences, mams and sirs.:-) It's a big exciting world out there. But as our speaker during yesterday's graduation said, somehow you never really leave. Cheers!:-)

blogngbulag said...

congrats ma'am jean, finally its time to move on and make another place better...thanks for making it a bit better while you're there:) your blog post speaks for us who have this bittersweet feelings with PGH and the demands of training..its a very different in the real world,God bless I know you'll find the right niche for your practice...but definitely, it's true, you're one of those who will be missed bumping into in the corridors of pgh. :)

rochie cuevas said...

Very well written.

These are what my friends are going through as they help others at the PGH. But I have never heard them complain about anything once they're in the residency program.

These are what I have not experienced because I decided not to study medicine when I was in my fourth year of college (after dreaming of being an MD since I was in nursery!). I took the research track instead... not as exciting everyday, but also fulfilling.

Plus, in the school I went to, supervisors are on first name basis. They corrected me when I called them Ma'am and Sir. Those titles are reserved for royalty, they said.

lulayct said...

Reading this has brought back so many memories of my 12 years in UP-PGH. Couldn't have said it better myself....Thank you for putting all our collective memories and reflections into words.

Daghang salamat, kapwa-Dabawenya!

Dr Elizabeth Paz Pacheco said...

Your blog has me ended up in tears, the same feelings from my own experience about 25 years ago. PGH is God's place, where everyone gets the opportunity to help another. It must be the reason why we all come back and stay to be part of PGH, in our small way. God bless!