The RN, MD Phenomenon

Before, doctors become nurses. This time, it's the other way around.

Medicine, as what everyone knows, deals with the treatment of disease. Nursing, on the other hand, deals with the biopsychosocial aspect of the disease, or dealing on how to care for the patient.

In short, Medicine deals with curing, while Nursing deals with caring.

In a career options interview that was recently conducted at a certain nursing school, student nurses were asked what career option they would like to pursue after nursing. During those interviews, majority of student nurses answered Medicine as a suitable career path, apart from several other choices such as nurse educator, specialty nurse, and a lot of others.

Several years back, particularly in the early to mid 2000's, the social trend was that medical doctors shifted to nursing in order to earn a better living and a better source of income. What leads doctors to do this?

According to an article by Dr. Jaime Galvez-Tan on "The Phenomenon of Nursing Medics (Doctors becoming nurses)," nursing has "highly competitive salary rates, attractive compensation and benefits, good living as well as working conditions," in which this "all in all translates to a better life and security." (1)

This prompted a lot of degree holders, including doctors, to study nursing in the hopes of a better job opportunity. This led to an inverse effect: a decline in the number of medical doctors and a steep increase in the number of nurses in the Philippines.

But, the increasing number of nurses led to an oversupply in the country. According to a Philippine Daily Inquirer article dated November 10, 2011, the founder of the Asia Pacific Action Alliance on Human Resources for Health (AAAH), Dr. Suwi Wibulpolprasert, described the country as a "diabetic" with its oversupply of human health resource. (2) This prompted the Department of Labor and Employment to advise "newly licensed and unemployed nurses to seek alternative employment rather than wait for job openings in medical facilities." (3)

What happened, in short? There was an increase of job unemployment in nursing. Doctors, other degree holders, and young upstarts kept on jumping ship until the ship overloaded and eventually sank, along with their supposed hopes and dreams for a better life.

Recently, a lot of articles about the shortage of medical doctors popped out of the internet. According to a recent article by the Philippine Star dated January 31, 2014, the President of the Philippine Medical Association (PMA) Leo Olarte said that there were "only 70,000 'active' PMA members to serve 100 million Filipinos." He stated that "the growth in our population should be complemented by the increase in the number of doctors." He also said that  “our population is expected to rise so the problem on the shortage of doctors will surely worsen.” (4)

This poses a striking question: is it worth it to enter Medical school after Nursing school?

Medicine, as what everybody knows, is an expensive course to pursue. Tuition fees skyrocket to as much as PHP70,000+ in state-run schools to PHP120+ in private medical schools such as UST, UERM, FEU-NRMF, ASMPH, and others. Financially-capable nurses, with the help of their parents or relatives, are given this opportunity to pursue this road less-traveled. For those who are well-deserving but financially incapable, they can opt for scholarships in order to pursue Medicine. But still, the financial burden is what keeps majority of nurses held up in pursuing another level of health education.

There are some nurses who also feel that they want to step up to a higher level and become a better health care provider. Medicine provides the benefit of allowing nurses who become doctors to diagnose and treat disease without the risk of losing their nursing licenses, mainly because of the perk of being supervised by a licensed physician, and also, eventually acquiring a medical license. Medicine teaches an more in-depth discussion of diseases which were also learned in Nursing. The diseases that were learned in Nursing are discussed in detail in Medicine, including the pathophysiology and management of these diseases, now in medical parlance. Skills-wise, there is an enhancement of the abilities nurses were able to learn back in nursing school, such as the skill of nasogastric tube (NGT) or Foley catheter (FC) insertion. Additional skills are also learned, skills which breach the legality of the Nursing profession, such as invasive procedures like intravenous (IV) line insertion (unless the nurse has an IV therapist license), thoracentesis, appendectomy, central line insertions, and many more. It is said that Nursing is the only undergraduate degree where "medical skills are performed." (5) Also, the respect is great when a nurse becomes a doctor. Gone are the days when patients and relatives scorn at innocent and kind nurses for things that are out of the nurses' hands. Patients and relatives respect doctors at a level that will make you feel proud of who and what you have achieved.

When a nurse becomes a doctor, the skills that were learned from Nursing school are also brought with him/her to Medicine. This applies well to clinical clerks or junior interns (J.I.) who took up nursing as a pre-med course. This is because what doctors do are also what nurses do: take the patient's history, perform physical exam, and do basic procedures like vital signs monitoring. This means that what doctors do is not new to nurses. This is a big advantage compared to other pre-medical courses. The basic knowledge of disease nurses learn also give them the advantage over others who enter medical school. Nurses, through lessons learned during Medical-Surgical Nursing, Maternal and Child Nursing, and others, are able to respond well to diseases that are laid on to them when they become starting doctors. This is concurred by a lot of health care providers, particularly Medical Consultants who explicitly admit that Nursing is THE best pre-medical course today.

If there are advantages, then there are also disadvantages. Nurses regularly work 8-12 hour shifts. Doctors, well, they don't. Registered Nurses who work in hospitals are well-aware that doctors work 34-hour shifts once every 3 days, sometimes every other day, or worse, everyday (it happens in some institutions and residency programs). Doctors also carry a heavy burden of being the so-called "Captain of the Ship" in legal matters, in which the doctor (usually surgeon) is responsible for ALL actions conducted in the course of the operation. (6) (7) Apart from that doctrine, doctors carry a lot of legal responsibilities, prompting them to practice this so-called "Defensive Medicine," or when doctors "order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability." (8)

Just remember what one article states: 

"Nurses can become full pledged doctors if a higher education is pursued in a medical school. Like other pre-medical courses, BS Nursing can be used as an undergraduate course to qualify an individual to study in a medical school. Unlike other pre-medical BS courses, having a degree in nursing will already make an individual a professional – a nurse, and can already start practicing their profession and earn by working in clinics and hospitals." (9)

There are a lot of advantages and disadvantages of taking that big leap from Nursing to Medicine. If you ask any doctor who was once a nurse if jumping ship from nurse to doctor is worth it, most would answer that it is one of the best decisions they have made. The road to becoming a doctor is definitely rough. But, with a loading dose of heart and a maintenance dose of patience, the road from being a nurse to a doctor will just be short, and once you know it, you'll be on your way to becoming the best doctor that you can be.

Want to join the RN, MD Phenomenon?

Think about it.

Sources:
(1) Galvez-Tan, J.Z. The Phenomenon of the "Nursing Medics"Doctors becoming nurses: The Philippine Experience. http://rcpsc.medical.org/publicpolicy/imwc/8sess4_abstract_tan.pdf

(2) Mongaya, C. Oversupply of nurses but no jobs. Cebu Daily News. November 10, 2011
http://newsinfo.inquirer.net/91509/oversupply-of-nurses-but-no-jobs

(3) Jaymalin, M. DOLE advises nurses to seek alternative jobs. The Philippine Star. February 26, 2013
http://www.philstar.com/headlines/2013/02/26/913217/dole-advises-nurses-seek-alternative-jobs

(4) Crisostomo, S. PMA warns of worsening shortage of doctors. The Philippine Star. January 31, 2014 http://www.philstar.com/headlines/2014/01/31/1285056/pma-warns-worsening-shortage-doctors

(5) -- Nursing as a Pre-Req for Med School Applicants. Premed 101 Forums. April 10, 2011 http://www.premed101.com/forums/showthread.php?t=50889

(6) Blumenreich, G. (1993) Captain of the Ship. Legal Briefs. Journal of the American Association of Nurse Anesthetists Vol. 61 No. 1 pp. 3-6
https://www.aana.com/newsandjournal/Documents/legal_briefs_0293_p003.pdf

(7) McConnell v. Williams, 361 Pa. 355, 65 A.2d 243, 246 (1949)

(8) Manner, P. (2007) Practicing defensive medicine - Not good for patients or physicians. American Academy of Orthopaedic Surgeons.

(9) -- Can A Nurse Become a Doctor. http://howtobecomea-doctor.com/wordpress/can-a-nurse-become-a-doctor/

The blogger's misadventures: MMC Internship Orientation (and personal inputs)

A lot of soon-to-be Medicine graduates (me included) from various medical schools attended the General Orientation for incoming Interns at MMC yesterday. Seeing MMC at its full glory, one will almost never imagine that to work in such a very nice and cozy environment will be the best feeling so far. Leaving the sweatshop-like confines of the base hospitals for a cool, ideal workplace was a big adjustment for most of us. Being a former student of MMC's Nursing school, I felt anxious about everything in my "new" hospital: the new, almost-commercialised environment, the stricter, more stringent rules and regulations, its up-to-date technology, and the level of toxicity it will give to the incoming interns. I had to adjust to the fact that I wasn't returning to MMC as a Nurse, but this time, as an Intern, a fresh graduate physician who'll be getting a different kind of beating this time around.

Our orientation lasted almost the whole day. The interns were oriented about the hospital, its staff, the various departments, and a lot of other things. We were also given our schedule for the whole year. We were also given free snacks and lunch, almost ala-medical conference style of catering: a thing which we barely get to experience back during JI-ship/clerkship. We got to see and hear each and every department chairman, chief resident, intern's monitor, nursing supervisor, social service head, and even the librarian and resident chaplain, explain and describe both ends of this "big book" called MMC life. The orientation was enlightening, and at the same time, humor-filled. The good words of each department chairman speaking in front of the incoming interns gave everybody optimism that life at MMC will be unforgettable, and at the same time memorable.

Some details which were shared to us during the orientation are as follows (as far as memory serves me right):

• Attendance is usually at 7am (6:30am for Surgery and OB-GYN, 7:30am for Pedia), and sign-out is at 4pm (for pre- and from-duty status, except for OB-GYN, which sends their interns home at 11am).
• Interns get to have one day-off every 7 days
• Interns have 5-8 hours (usually 5-6 hours) mandatory rest periods for each department, usually from 12mn-5am (OB-GYN places the mandatory rest period during the from-status, making interns on from-status go home earlier than 12nn)
• The intern's ID has a microchip in it which can be used to gain access to various places. It is also used to check attendance. (just like what is being done in prominent universities)
• Community Medicine only has 5 working days. Weekends are days-off.
• Smoking constitues to termination of the internship program, (bigat ah)
• Interns get to wear 3 kinds of uniforms: the gala uniform (any formal top with white pants/skirt, and black shoes), the working uniform (the blue scrubs), and the OR/DR scrub suit. (Our outgoing Intern's Council President suggested that we wear the gala uniform during pre-duty and formal gatherings, and the working uniform during duty status.)
• Parties are held on certain occasions, and everybody even on duty status are excused from their posts when there are officially-announced events, even nightly events.
• Interns are required to complete a certain number of procedures for clearance (i.e. 10 IV insertions, 1 minor surgery, 5 NSD's, etc.). A booklet is provided for that purpose.
• Each intern is assigned to a mentor, who is tasked to guide the intern regarding career and anything under the sun
• Not attending any orientation, this General Orientation included, constitutes to 2 Sunday make-up duties, whether excused or unexcused. 
• There are so-called "star merits," which can offset any demerits from any department that has demerited an intern.

We were also given the opportunity to meet our new group mates. We were oriented by our outgoing interns about our future departments. We also assigned our individual groups different pipette colours for our OR/DR scrub suits (ours was apple green/sea spring). Most importantly, we get to know each other for a short while. (Personally, it was fun meeting new people, especially my new group mates.)

Senior Internship life is about to start in 24 days. It's about high time that each intern starts to leave that shell of clerkship and start new ground. Like what one consultant from Med. Education said, everybody starts off with a clean slate, regardless of whatever past which may have been haunting each and every intern during clerkship. This is the time to make a new name for every intern: something that is worthy of having that M.D. after each surname.

The 3 statuses of Clinical Clerkship

Dear incoming Junior Intern/Clinical Clerk,

Since we entered medical school, most, if not all of us, wondered how going on duty as an intern/clerk feels like. We would become dreadful of that so-called 36-hour duty because of fears that we might not find enough time to sleep, or maybe lose that social life that we are trying our best to balance with internship.

Recently, our batch was involved in a scuffle with the admin and consultants, wherein a certain JI sent a letter to CHEd regarding our revised duty schedule. He/she apparently called our "from" status "garbage hours" because of the observation that JI's apparently do nothing at all once they are "from" status. That incident caused a stir within the higher-ups, and because of that, a new schedule was born.

Based on the current status, here are the three duty statuses that each JI/CC must know and understand:

1. Pre-duty (7:00am - 5:00pm; 8:00am - 12:00nn Sundays)

• From the word itself, this is the status that JI's observe before going on a 24-hour duty. Pre-duty JI's are the ones who usually monitor patients in the morning up until the time they are relieved from their posts. In some departments, they also admit and deck patients to themselves if they follow the so-called "grand" decking (to be explained in a different blog).

2. Duty (7:00am - 7:00am next day, 8:00am - 7:00am Sundays/Holidays)

• This is the 24-hour duty each and every JI has to follow. This is the one of the bread and butter essentials in JI-ship: the overnight duty. Based on the new schedule, JI's on duty status start working/monitoring from 5:00pm - 7:00am the next day. The hours prior to 5:00pm for those on duty are for "in-charge" work, or for those clerks who have patients-in-charge who need to be taken care of, like working on protocols, diagnostics, etc. They are also the ones who admit patients during the afternoon until the next morning, once they are relieved by the Pre-duty clerks. In some departments, they are the ones who admit patients throughout the day if they follow the so-called "duty" decking (to be explained in a different blog).

3. From-duty (7:00am - 12:00nn; 8:00am - 12:00nn Sundays)

• This was the so-called "garbage" hours that was reported to CHEd a month ago. During the months prior to December 2012, the original schedule of the from-duty status was from 7:00am next day - 5:00pm. This status was scrapped for 2 months starting December, and was then replaced to a "once relieved" status, or in short, a "day-off" for JI's. Because of certain issues stemming from that "once relieved" status, the "from" status was reinstated in February, and this caused a stir within the JI ranks. This prompted someone to report to CHEd, and the said body acted on this issue days to weeks after the letter was received. The effect: angry and frustrated consultants, and stressed-out interns/clerks. Because of that incident, the schedule was then changed from 7:00am next day - 12:00nn. 
• This status is also called the "untouchable" schedule because those on this status are free to do anything, unless they have patients-in-charge to be taken care of. They also accept and deck patients if they follow the "grand" decking. This is the time to recuperate from a 24-hour duty by taking a bath, eat breakfast at the canteen, or read a book during spare time. After 12:00nn, they can now go home and sleep the rest of the day off, or maybe do something else.

For holidays, there is the "Skeletal" duty, wherein only those on duty status will go to the hospital and literally work for 24 hours. Those on pre-duty status need not come to the hospital, while the ones on from-duty status are relieved at 8:00am. In short, malas mo lang pag duty ka on a holiday.

Recently, some incoming freshman from a med forums page shared his discontent on the usual JI schedule. Kinda premature for an incoming med student to say such thing. Hindi mo pa nga napapasa Biochemistry, gumaganyan ka na? Tsktsk. Pero, it was his opinion, so it's best to respect it anyway.

Well, this just explains what JI's go through everyday. I hope this helps. Good luck!

The 10 most important paperworks in Clinical Clerkship

Dear incoming Junior Intern/Clinical Clerk,

Now that you've seen your name posted on the registrar's office, I'd like to congratulate you for making it to JI-ship.

Junior Internship isn't just about roaming around the hospital, seeing patients, monitoring them, and seeing them either go home or die. The most important thing, the part and parcel of JI-ship, is the tons of paperwork that are in store for each and every JI out there. That is why JI's are officially called CLINICAL CLERKS. The second word explains everything.

Clerk, the master of paperworks.

So, in preparation for your JI-ship come April 1, here are 10 important documents that you should be familiar with starting day 1:

1. Initial Summary

• This is the first document that you should accomplish, because this should be clipped in the chart within 6 hours upon admission. You should write this on the "Intern's Notes" form, which you will definitely see on your first day. There you write your patient's history and PE, all in SOAP format. Because it's "initial," this is like a rough draft of your complete database, which is explained next.

2. Complete Database

• From the word itself, this contains the whole package of your history and PE. This consists of 2 parts: the history form and the physical exam form. You fill that up based on your initial summary, wherein you try to fill in or add answers to certain questions you might not have answered during your initial summary. This should be clipped in the chart within 24 hours upon admission. 

3. Case Discussion

• This is where "the patient is like a textbook" comes in. Clipped in the chart within 24-48 hours upon admission, this contains the case of your patient that you would like to report on. From definition to treatment and prognosis, this is where you try to unravel that human textbook of yours and make a paper about it. Originally computerised, some departments might require you to write your case discussion on your Intern's Notes form.

4. Drug Charting

• This goes hand-in-hand with your Case Discussion. Also clipped in the chart within 24-48 hours upon admission, this contains the drugs of your patient prescribed to him in the hospital. It's like how you did your formulary in pharmacology: you write down the generic name, class, mode of action, indications, adverse effects, and contraindications. You can add the half-life, peak plasma time, etc., if you so wish. Bahala ka magpakatoxic!

5. Lab Flow Sheet

• Some departments, especially when you're rotating in the charity wards, will require you to clip this on your chart the moment the first lab results come in. You update that form every time a new laboratory result arrives, or if a new imaging result comes. Some residents check that sheet, and if you don't even bother making one, well you can say hello to life's big bitch slap to the face, a.k.a. demerit.

6. Monitoring Sheet

• This is where you put in your patient's vital signs monitoring and intake/output monitoring. That is one of the most looked-at sheets, because you might not know about it, but even the consultant looks at what you write on the monitoring sheet to see how their patients are doing.

7. Referral Slip

• This is the slip that you will need whenever you will refer to a different department. Departments such as Medicine, Neurology, and Surgery are big users of this slip. Here, you write the SOAP format history and PE of your patient, and along with an attached Lab Flow Sheet, you have this slip signed by your Chief Resident, and have the receiving Chief Resident see it. Once they see it, be ready to present your case. And be sure to read before referring. You don't want to ruin your day because of poor referral, trust me on that.

8. Progress Notes

• A chart essential, especially when rotating in the charity wards, this contains what has happened to your patient or your group mate's patient throughout the 24-hour duty. This is written in SOAP format. Some departments are dead strict when it comes to this, so do not forget to update your Progress Notes everyday...unless you want to be bitch-slapped (if you know what I mean).

9. Endorsement/Take-Over Notes

• Aww, and it seems like you will be moving to a new department, or maybe a new sub-rotation. If so, then this is the form that you need to make before passing the baton to the incoming JI who'll be taking care of your patient. As the outgoing JI, you make Endorsement Notes in SOAP format, and if you're the incoming JI, the same goes with the Take-Over Notes. Residents check on this, too, so be on your toes with this one.

10. Discharge/Mortality Summary (DS/MS)

• And now your patient has to say good-bye to you, either dead or alive. If so, then this is the last form that you need to clip in the chart before the patient goes home or to the morgue. This contains the components of your Complete Database, plus all laboratory and imaging results, the course in the wards, and the take-home/discharge instructions. In the charity wards, you are required to give an extra copy of the DS (without the course in the wards) to your patient for follow-up purposes. You have to have this signed by your PGI and resident. Remember: you need to have at least 25 DS/MS in order for you to be cleared by the Records Section. But, because of the big number of your batch, I'm hoping that they will decrease the requirement to less than 25.

There are still other forms that are not discussed here, but for now, these are the essential ones that you must know once you step inside the halls of the hospital.

Good luck!

The 10 things a Clinical Clerk should know

Dear incoming Junior Intern/Clinical Clerk (JI/CC),

It's about 10 days to go before your "normal" life takes a twisted turn.

I'm sure that most, if not all, are anxious on how JI or CC life, as how some of us call it, is like. The life of a junior intern, also known as a clinical clerk, is not as daunting as you might expect, and it is not as wonderful as you might imagine.

To go straight to the point, let me share to you 10 things you need to carry on once you start wandering the hallways of the hospital and start becoming the future doctor that you are:

1. Love what you do

• You will be scattered throughout the corridors of your hospital for the next 365 days. Loving what you do will give you the motivation to work hard and do your best. Do not perform tasks with a heavy heart. There will be times that you will regret doing what you are doing every single day. Just remember: loving your work is like loving your patient, and also loving yourself. So show some heart and work that ass off!

2. Learn from each patient

• When you are decked with a patient, treat each patient with utmost care, like how you would like to take care of your loved ones. But, most importantly, learn from them, like you're reading a textbook. Each patient carries a unique case that you might have read from your previous years. Internship is the time to reinforce those tiring coffeehouse sessions with real-life scenarios.

3. Take criticisms in a constructive way

• Being a JI/CC isn't all glitz and glamour. There will always come a time when you will be subjected to criticism and embarrassment. When that inevitable moment comes, try not to frown. Though it is human nature to be sad, just do so for a while. Then, when you get back to your senses, take it as a means to improve yourself. Almost all of us went through that phase, so don't think that you're alone.

4. Be nice to everybody

• Like what I've said, you will be scattered throughout the corridors of your hospital for the next 365 days. And with that comes a good attitude. Remember to be nice to everybody: from your friendly janitor up until your terror consultant. Show some love to your co-JI's, residents, nurses med techs, and a whole lot more. Your attitude will speak of how you will be seen by everybody for one whole year, so don't risk being a jerk and acting like one.

5. Treat demerits as life's painful lessons

• When life gives you accolades, it also gives you heartbreaks. That is how it goes with demerits. A demerit is life's big bitch slap to your face, telling you to man up and do better next time. Don't sulk over a demerit, because you WILL have to serve them eventually. Take it with a grain of salt: don't take it literally. Instead, learn from it, and let it teach you to become a better doctor.

6. Do not be late

• Gone were the days when we can go to class 30 minutes before it ends, and get away with it smooth and clean. It NEVER works that way in JI-ship. When attendance is at 7:00AM, do come earlier than that. Trust me, you won't like being crossed out. Three (3) strikes is equals to a 24-hour demerit. Succeeding lates is tantamount to additional 24 hours. Ain't that a bitch.

7. Know your role, and stick to it

• When you are given a role, or a certain function, live with it, and don't go overboard. When they tell you to monitor a certain patient, don't go doing other stuff not related to your assigned task. Going overboard incurs certain consequences that, mind you, you do not want to face. Know your job description, do it, and if they give you another task to do, make sure it is justifiable, and do it. Don't work on something that will implicate you into something bad. 'nuf said.

8. Know what to prioritise

• Patients are always first priority, no doubt about that. But in between patients, there will always be a #1 priority. Know who and what to prioritise. Identify tasks that are needed to be done immediately, and know which patient needs closer monitoring. It helps you save time and effort despite the unbearable load of patients that you will be having.

9. Share what you know, and learn what you don't know

• There will always be rounds with either residents or consultants. Stay alert: if you know something, and the senior asks something about it, share it with everybody. It will not make you less of a person if you get it wrong. If you don't know what is being asked, don't let it slip through your head. Learn what is lacking, and take it as a golden opportunity to learn something new.

10. Treat every single day as a blessing

• JI-ship is a roller-coaster ride. There will be days that you will love what you're doing, and there will be days that you would wish you would've quit while you still can. Take each day in JI-ship carpe diem: seize each day and treat it as a blessing. Don't treat each day as a "this again?!" moment. Each day is a blessing, so never forget to thank God for each and every day that you will live as a JI, because as a day passes by with you feeling fine, there will always be someone who's life is on the thinnest line.

Our batch's run throughout this whole JI-ship thing has been unforgettable. It taught us how to become better than what we were before. We started out as zombies, knowing nothing and treating everything as hieroglyphics. Now, we can say that we are confident to be exposed to the world of the sick and suffering. We do hope that you will become better JI's than we are. It's just a mix of a good attitude and positive outlook that will take you to better places in the near future.

Good luck, incoming JI/CC. See you in a few days! :)

Medicine: 4 years later

Four years...

How fast time flies...

It was back in 2009 when college life ended for me. It was a time when the dreams of becoming a medical student was a fresh one. It was a time when I left the comfort of my hometown to venture into another city to reach a dream some people say only a few can achieve...

To become a Doctor of Medicine..

It was the first two weeks of medical school when I first tasted the reality of medical school, that it was more hard than college life. Later, there was that temptation of quitting. For the first time in my life, I felt sad because I entered medical school without looking at how hard it was to become a doctor. My parents were very supportive of me, even encouraging me to just have fun in medical school, and quit if I cannot take it anymore.

I guess I had to give it a try. So I began to walk the road less traveled back in..

First year.

First year medicine was memorable, for it was a time that I gained new friends and gained new knowledge beyond the bounds of Nursing. There were those usual ups and downs, such as failing examinations, being involved in misunderstandings with friends, arguing with group mates, and a lot more. But, it was in freshman year that I learned that medical school can fly so fast. So fast that in a few months time, I entered...

Second year.

Second year medicine was the most chill of the 3 year levels except 4th year. It was true when our preceptor said that it was the easier than the 1st and 3rd year. I met new friends, who would later become my buddies until now. It was that year when I learned the basic skills of the physician. It was similar to Nursing, but it was more in-depth. What made it memorable was that t was in second year where I met a simple, down-to-earth girl, wherein I became so much comfortable with her, my emotions couldn't control my rationality. Our friendship eventually led to a better friendship, but it later ended up in a sad turn. That of which happened during...

Third year.

Before I even talk about that, third year was the most stressful because it was the preparation for Junior Internship/Clinical Clerkship, or fourth year. It was then when I felt so stressed, that there were times that I would have bouts of mental and emotional breakdowns, up to the point of entertaining thoughts of quitting again. My solace that time was teaching kids Bible stories on Sundays, and most especially, spending time with the girl I met back in second year. About her, she was just the comfort from the stress, the happiness that made me smile despite the sea of sadness. It was that year, during that cold November evening, when my college past caught up with me, and our friendship got strained completely. It was a emotional downward spiral for me, in which the thoughts of her keep on catching up with me until internship.

But enough of that. Third year was a bumpy ride, wherein I thought I would fail some subjects, that I wouldn't be able to make it into internship. The months that ensued during third year had my anxiety levels increase to insurmountable levels because of the uncertainty of becoming an intern. But, during that chilly March evening, I learned the greatest news: I was promoted to...

Fourth year.

I have to admit, fourth year, or Junior Internship (JI)/Clinical Clerkship (CC), has been the BEST thing that has happened to me. It was this year that I felt like a doctor. Admit it or not, this is the year where we start from the bottom of the medical totem pole. It's true about what someone told me before, that internship unleashes the 'natural' in you. It was here that I learned about the true nature of people, the 'real' them in the face of reality. On the bright side, it was in internship that differences were settled, and friendships rekindled. It was here where the textbook learnings sprung to life. It was here where we learned to keep our emotions to ourselves whenever someone dies right in front of our eyes. It was here where we were given demerits, where were learned the pains of being scolded at and being embarrassed in front of a lot of people. It was here where we met new people in the form of friendly residents and staff members. It was here where I met new people. It was here where....

Okay, enough of that.

After so many years, it all boils down to the last few weeks of internship. Much as I want to tell my medical school story in detail, it will not be enough for 1 post to share it all.

I just wanna graduate.

I really want to become a doctor.

It'll almost be over. It's just these eyes on the prize.

Almost there

For the past 10 months now, my life has been living on a series of events which I can vividly enumerate:

1. Wake up before 6AM, even before the alarm hits.
2. Reset the alarm and sleep for another 5 minutes.
3. Wake up feeling so frustrated, begging for another round of sleep.
4. Prepare for half an hour (breakfast included), then head off to the hospital.
5. Drive for 20-25 minutes through the bustling traffic.
6. Make it to the hospital, work my bum off for 10-34 hours, depending on the schedule.
7. Go home, driving another 20-25 minutes feeling all groggy and sleepy.
8. Make it home, use whatever time is left for myself (surf the net, watch a movie, read notes, etc.)
9. Sleep for 5-6 hours, depending on what time I doze off.
10. Repeat.

Yes, repeat.

That is how my life as a Junior Intern/Clinical Clerk has been going. It has been like this for such a long time, I sometimes forget what day of the week it is.

It makes me reminisce how much I miss the life of the classroom: its ambiance, listening or sleeping through lectures, going home and study, and even going out.

Back then, I was in command of my time. I almost had every minute for fun.

When the calendar struck April 1, that life became a thing of the past.

Everyday has been a struggle. The sight of patients and staff, and the sound of endorsements greeted me every morning as I arrived at the hospital. My day would run monitoring patients, referring left and right to different departments, doing chart rounds, attending conferences, and sometimes get my bum kicked for some incursions. That would end as the sun begins to set, sometimes leaving the hospital at night because of unfinished tasks.

I then sometimes become envious of other people, who get to enjoy their lives, having control of their own time. I couldn't help but wonder how I can use up the remaining hours of the day to make my own day worth it.

It's a sad thought, to be honest. But it is a reality that I chose to live. For me, it's a blessing to be in the hospital, despite the hardship. It's a moment for me to realize and appreciate the importance of life and health.

What makes a day in the hospital worth the hard work is when a patient says "Thank you" with a smile on his/her face. Those 2 words and that nice expression never fails to erase a day's worth of stress.

It's almost 50 days to go before this present life of mine draws to a temporary close. I can't wait for vacation to come, to have time for myself, my family, and loved ones (friends included).

Most especially, I cannot wait to graduate.

"Almost there." That is what is on my mind right now.

Clinical Clerkship: Medicine Life

So, I'm back using this blog again. Hello world, we meet again!

It's almost 60 days since we entered another world in medical school called Junior Internship. It's more known as Clinical Clerkship nowadays, just to keep us in check with the modern trends. Clerkship is considered the last stage (4th year Med) in medical school before graduation. Students in this level now assume the position of a clerk, whose tasks include interviewing and diagnosing patients, formulating diagnostic and treatment plans, perform various procedures that not everybody can do, and especially, monitor. Oh yes! Sounds a lot? You haven't seen anything yet.

Our group started out clerkship with the Medicine rotation, which is considered by majority of people that I've asked as the most "toxic," or more commonly, the hardest of all rotations. This is where 3 years of Patient-Doctor come into play.

If you ask what a Medicine Clinical Clerk does everyday in the hospital, well...

You initiate rapport with patients, handle them, and deal with them, especially the relatives. You learn how to do the "diskarte" factor when it comes to patient care, wherein you try to maximise your time handling more than just 1 or 2 patients. You also learn how to refer to different departments, where medicine is most of the time the starting point for all referrals. You also attend teaching rounds and subspecialty conferences to enhance your knowledge in certain areas of medicine. You answer to codes and either do chest pumping (for males) or ambu-bagging (for females) of the patient who's life is as thin as  a strand of hair, in short, at the brink of death. Much more, you learn how to THINK. Yes, THINK. To use the brain, to think, to analyze, that's how we do it. 

There's more to what medicine can offer to clerks, it's just up to you to discover.

This rotation of ours, which is set to end in a few days' time, is for me the best rotation...yet. There's a lot of learning in the Department of Medicine. Interns rotating outside of Medicine say that rotating in this department is hard, taxing, and most of all, "toxic." Yes it is, but learning is abundant because of the fountain of cases that can be found in the pay and charity wards, and don't forget the out-patient department. Rotating in the department has been a memorable experience, especially because of the friendly residents and consultants who are more than willing to teach what interns need to know. There are no dull moments with the house staff because they make you feel at home, despite the toxicity. The coolness of this department makes me think of pursuing Internal Medicine as a specialty in 2 years' time.

As the 1st chapter of our 12-month journey to graduation draws to a close, I'm proud to say that I've survived one of the most "toxic" areas of the hospital. What makes me a proud intern, a soon-to-be-physician, is that what was complex has been made simple because of experience. At the end of the day, the fund of knowledge is filled with new information and knowledge that is waiting to be shared to everybody who needs assurance from a person who knows health better than the layman does.

As seen in a Twitter user that I've been following for quite some time:

"When the complex becomes simple, it's pretty amazing."

Two months down, 10 months to go.

Looking Back at Nursing: the social 'trend,' training hospital issue and salary problems

(This is an unfinished post from last year, which I just finished now.)

It has been 3 years since I graduated from my pre-med course. Since then, much has changed within the atmosphere of nursing: the decline in enrollment rates, the appeal of AYNLA on nurses' rights, the still-uncertain future for nurses who are just left working in non-nursing jobs, and recently, based on FB posts, the nurses who keep pushing for the imposition of the salary grade of nurses stipulated in RA 9173 or the Nursing Law. Despite being on the other side of the fence for 3 years, I keep on looking back, even for just a sneak peek on what has happened in nursing since I jumped ship. It must have been a tumultuous road for nursing in the country, and I must say, the problems that have burdened the profession I was once a part of, but until now I still cherish and love, is somewhat overwhelming.

Nursing has been the course of so many people who believe that this course is the easiest way to a better life. Most parents entice or prod their children to take up Nursing so that these children will be the ones who will put food on the table of their parents and siblings once they have fulfilled their obligation to achieve the profession. Because of this humongous trend, a lot of  so-called Nursing schools have sprouted left and right, front and back, and lure students to achieve a Bachelor of Science degree and become certified Board passers in the near future. It turns out, instead of promoting the improvement of Nursing in this country, the overemphasized trend of Nursing as a "way to escape poverty" has backfired in ways unimaginable. Think about it: because of the increasing number of Nursing graduates who couldn't land a sure ball job as a nurse, there has been a surplus of nurses of unthinkable proportions. According to the Board of Nursing, there are hundreds of thousands of licensed nurses who still don't have a decent job as a nurse in a hospital. To curb that problem, the Department of Health has launched their pro-nursing campaign of letting fresh board passers to work in the community and gain experience.

On the other side, hospitals would launch their own "pro-nursing" campaign of hiring nurses and letting them train in hospitals, but for a certain price. These nurses pay training fees, and train without the certainty of landing a job. Because of this, in January 2011, the Association of Young Nurses, Leaders and Advocates International, Inc., or AYNLA, has been called in Senate hearings about this commotion between nurses and training hospitals. With this commotion, training hospitals became more stringent with their training criteria, and now would barely accept nurses for training. Despite that patriotic move from AYNLA, what they did, instead of helping nurses land better jobs, taking their complaints to the Senate made it worse because hospitals became more strict and impeded the flow of nurses who are supposedly to train. The thing about the hospitals is that they shouldn't be exploiting the number of nursing graduates and let them train for a hefty price with a big void of landing a stable job. It's also inappropriate for hospitals to become more strict with letting nurses train. AYNLA just wanted for proper nurses' rights in terms of training. Either way, there was no winner or loser in this case. AYNLA was a winner because they took their grievances to the Senate, but lost in terms that nurses now found it kind of hard to train in hospitals and land good jobs. The hospitals, on the other hand, won because the move by AYNLA made them more stringent in letting nurses train, which would save them more money in the long run. They lost in this case because they just let the trust and confidence of nurses down in their potentials to become great nurses someday.

Another issue is the appeal of nurses to uphold the salary grade of 15, amounting to PHP20,000 a month. If you work at a government hospital, it is a possibility to gain such salary. But, despite such law implementing such a salary grade, it's just a dream that is left unfulfilled for most, if not all, hard-working nurses. What's with the promise of a better life if the hospital that you're working for is not even abiding to the law that stipulates the implementation of salary grades? Earning 10k a month in a private hospital won't suffice to put a month's worth of food on your family's table, that's for sure.

Nursing is a noble profession, but, the issues that nurses handle in this ever-worsening society makes it losen its nobility because of necessity: hefty paychecks and a taste of the good life. What happened to nursing as a caring profession, a profession that doesn't crave for money, but instead for the respect of society? It's up to the nurses in this country to set the mindset of everyone that nursing is not a money-making profession and a way out of poverty. Rather, it is a profession that leans on care and trust towards the client/patient.

Think about it.

Intern's Log

Watch out for a blog page about life as a Junior Intern a.k.a. the lowest life-form in the hierarchy that is MEDICINE.

Onward to Junior Internship!

Deep reflections: on leaving Med and pursuing the different road

Moments ago, a friend of mine decided that she will quit from studying Medicine. It was a tough semester for everybody, especially for her. I deeply wondered how a wunderkind who had such a strong work ethic eventually surrendered the long haul. That decision of hers made me think very deeply on how I felt about what she did. The pressure was just very great, so it seems, for her to decide to quit. But nonetheless, I thought at first that it was kinda unnecessary for her to do that, given that she has high grades and a passion for learning.

I was unconsciously getting a grip of myself as I learned of her decision. She said it was final, and it was just sad for me to know about it firsthand. I was starting to feel the sadness inside, that I was about to lose a close confidant, where I found comfort and happiness despite living inside the hellhole that was really keen on consuming my sanity.

Weeks have passed since we talked about this. I persuaded her to think about what she was planning to do. I convinced her to take the road less traveled even if it meant sacrificing mind and body just to achieve such purpose. I belted out almost all of the persuasion tactics I knew of just for her to reconsider. It was a big effort for me, to go and push her to continue on with studying. I always knew that she had it in her, that she can do things that would make even the most hardworking student green with envy. I couldn't accept the fact that she wanted to quit. She was really adamant about her decision to surrender. The good thing was, she eventually decided to move on and continue on with it. I thought it would be the end of painstaking convincing, but now I guess I was wrong.

For the first time, someone close to me has decided to leave the dream only a blessed few would even dare to take, a dream that she used to share to me even before she entered the halls of Med school. I understand how her pain felt, because I also went through that same ordeal years ago. Now that I'm sitting on my study table and making this blog, her decision has made me reflect deeply on my situation in Med school. Her eventual decision to quit made me rethink about how my life in Medicine has been. Sure, that my life inside Med was tough, that it had its ups and downs. But, the question is: am I really happy with this? Am I happy with some classmates hating me and some classmates liking me? Am I happy interviewing patients from time to time? Am I happy making paperworks and study every evening until my brain cells deplete to zero? Am I happy that I get to pass my subjects? Am I even happy being inside Medical school?

These are the questions that are now reentering my mind. I've been through these questions before, but why of all things would these questions visit me again, when I'm already a few months away from Junior Internship? It's hard for me to reflect on these, but as the minutes linger, these voids are slightly devouring me up to the point my emotions and thinking start to run empty. 

A while ago, I started looking at websites of flying schools. My dream of becoming a pilot was slowly creeping back into me. I began considering skipping JI-ship, enter flying school and maybe try it out for a change. My mind was even thinking about entering flying school after finishing JI-ship, without the possibility of taking Senior Internship or even the Physician Board Exam. My passion of flight and flying was slowly coming back. It was a dream I have already shared to my parents, but my Mom wouldn't let me because of its risks. Other than flying, my mind was slowly entering a void of uncertainty: a mindset that was making me feel empty and sad, just like how it felt when I was considering quitting Medicine back 2009.

I know Medicine is hard, and that enduring this course really entails the full potential of the mind, body and spirit. But, it is true that sometimes, we should just know when to give up. It is not forever that we can continue on not being ourselves. Most Med students would say they want to be doctors, but along the way, a few would quit. It is not because that they are weak, but because they do not see themselves as doctors anyway. If one seems to surrender despite all the painstaking efforts to continue, then there is nothing wrong in taking a different path. There will be people who will think that quitting Medicine is a stupid thing to do, but one thing I've realized is that if one is not happy in what he/she does, then why continue on? It will be sad for me to see her leave, but there will always a tinge of happiness deep inside because she will be able to follow what really interests her. In the end, doing things that we can't see ourselves to be in the future is like wearing a shirt that isn't your size. It is the pursuit of the inside passion that is important to follow. One should not force himself/herself into something he/she is not. Live life and be free, and wherever God will take you, for sure He will take care of the rest.

Strongest: weird, introverted, but still cool

Think of this: you're someone who is very introverted. You don't talk that much to other people, stutter a lot, become clumsy at times, and would either go alone or go with a bunch of people. You also try your luck in PC games, but to somewhat no avail or little improvement, if any. You're also this type of person who would come to class with a gadget and would have a knack for a sleep-wake cycle within lectures. Because of your unique personality, you gain haters and friends. Haters who hate you because you're "special," and friends who accept you for who you really are. Despite this kind of behavior, deep inside, you have a wonderful mind filled with creative ideas that you can only express online. Despite all of this, you are a very hardworking person who knows how to dedicate work to the highest level.

Think about it.

This is about a classmate of mine, a friend and a group mate who I've been with since day 1 of Med school. Name withheld, but for sure any reader who's a classmate of mine will have the biggest idea on who this person is based on my seemingly obvious description above. Personally, with no sugarcoating, he is a weird guy with a kinda weird demeanor. Some people, especially those who know him well, would diss him because of his personality. Despite this, only a few accept him for who he really is. He is considered within our circle as a person who should be loved and treated like any ordinary human being. Sometimes, I admit, I kinda bully the guy, but I personally like him because of his real deal, no shit dedication to any work that is being given to him.

I met him back during stress management session, when we were all strangers to each other. The moment I saw him, from the way he stood up, the way he looks, and up to the way he talks, I knew that this guy is not any ordinary person. I saw him as someone who is "special": not the mentally retarded-type ones, but as a person who looks endowed with a potential to bring color to a class of people with different origins. When I first talked to him, I could barely understand a word he was saying because he kept on stuttering. But as time passed by, I started to get used to his stuttering way of communicating. I understand he has this stuttering problem, but nonetheless, he can still communicate. I was with him when we were with our 1st clique. We hung on there until the day I left the old gang because my old friends started to become distant. He was left all alone there, trying to struggle and keep up with what he had back then. I felt bad for him because despite the barrage of bad words against his clumsiness and his weird ways, he never seemed to fight back. He took all of the blows in stride. Define STRONGEST, and I'm dead sure that all of the synonymous words of languages around the world all point to him. With a new set of friends, he seems so comfortable being with the new gang. He found solace in playing PC games (despite his slow progress for improvement), in hanging out with people who really know how to have fun based on his preferences, and in being accepted for who he really is. 

In terms of communicating, he seems not to be the extroverted type. He's active in the online realm: he posts announcements more like any active member in our class. His activeness online is the almost entire opposite of him in the real world. He seems kinda distant to others, but not to the present gang who took him and treated him like a man deserving of respect. His dedication to work is also unparalleled. Give him something to do, and he will not hesitate to work on it. Because of this, I knew that what our classmates see everyday is only a shell of the man he really is. Only a few can notice his importance and worth, and because of this, our friends agreed upon protecting him from any hater that would pose a threat to him.

I posted this blog about him not because I'm bored, but because I just wanted to show to you, the reader, how cool this person is. His being a weird dude doesn't mean people can treat him like shit. His not being able to defend himself doesn't mean people can just diss him and make fun of him. I may be one of those pricks who would sometimes diss him, but despite that, I still accept him for who he is. I would get reprimanded by one of our friends because of that. Haha. Nonetheless, this person who I'm pertaining to has a very beautiful heart and mind that only a few can see: only those with pure hearts who know kindness more than hatred.

To those who still mock him for his shortcomings, I just appeal that instead of making fun of the person and putting out a mischievous smile behind his back whenever he'd say something that would maybe be weird, let's just remind him of his mistakes in a straightforward way. Like what some of us would do (especially me), if he would commit a mistake, we would tell him that he did a mistake and that he should not do it again. But despite that, what is important is acceptance. People should just accept him as to who he is, not mock him and shit. If moralists taught us to love the mentally-challenged ones, why can't we love a person who is just plain introverted, definitely not schizoid, but nonetheless game for anything that is given to him? This goes all to those who have been bad to him, especially the ones who have know him very well. We can say jokes about him, but not mock him entirely, strip him of his humanity and make him feel so down and degraded. He's a human being, just like the rest of us.

What if we have children who are born just like him, what would you feel if your child's classmate would treat your child like a douchebag?

This is dedicated to you buddy, just in case you get to read this. I'm sorry if I was such a prick towards you. I was just like that because I just want you to improve and become a better man. I made this into a blog so that not only the people who know you would get to read this, but also the entire world who can maybe relate to what you have and what you are experiencing as of this present.

How I wish I can post a picture, but this blog goes out to the public eye as well. Kaya wag muna. Haha!

You deserve a blog that the whole world should read.

Words of wisdom for this: Let's love each other like how God taught us to love Him. Love God and your neighbor. It may not be a common fact, but it sure is a general rule.

Medicine: 2 1/2 years later

It has been a while since I last blogged about how life in Med school was. Because of the tight schedules we have been experiencing in 3rd year, the time that has been spent on using the computer for blogging has been overshadowed by the tons of paper work, reading, and other academic priorities.

It has been already one semester (actually, 3 days to go before the end of the sem) and it feels like time has flown so fast. It felt like it was just yesterday when we returned to the halls of our school (now on a revamped look) and hurdle another year in Med school. It felt like it was months since we endured 2nd year, and it felt like almost a year since we narrowly passed 1st year. 

Looking back and comparing 3rd year with the past 2 years, this year has been the most mentally toxic of all the year levels. It's true what our preceptor back in 2nd year said: that 2nd year was the easiest. I guess she's right: 2nd year was the easiest, but only the easiest in terms of the schedule and light workload. Back then, we had more time for ourselves, though in 1st year we had the most time because of the few subjects that we took during those times. It is in 3rd year where we soon found out that the demands of academics and clinical work were somewhat overwhelming. 

Entering 3rd year was like adding another weight to the already heavy load students have been carrying since the 1st day we entered Med. Third year, the year before Junior Internship, required us to become more adept into the clinical analysis and application of what we have learned from the 2 years in school. I personally admit that not all of what I learned from 1st to 2nd year came back immediately whenever we had preceptor sessions, but they slowly reappeared and were put into good use as time passed. Despite that lofty advantage, there has been a lot of difficulty in terms of meeting the demands of clinicians and professors. In 3rd year, we are required to think and act like doctors: we interview patients, examine them, and later on form a diagnosis from the findings. Not only that, we were made to submit paper works every week for each patient we checked up on. We have 3 to 4 preceptor sessions, and each session required us to submit a paper case per week. It's like working 3 to 4 papers weekly on top of the interviewing and examining of patients. It is a definitely heavy load for junior Med students. At first, the rigors of it were too overwhelming. The time spent on adjusting to the demands of clinical practice made us get used to these rigorous tasks. Truth be told, because of the loads of paper works, patient interactions, and lectures with exams, time really flew so fast. We thought that life would be so slow in 3rd year. Turns out, it kinda wasn't.

What's new in UERM is that the school has made quite a face lift of their classrooms. Five new classrooms were added to accommodate new and old students. The classrooms are quite nice: they have movie house seats, cozy atmosphere, and an environment that is really conducive to studying or sleeping (pick one). We have a new Skills Laboratory, which replaced the old rooms of the 2nd floor of the JMC building, which is really nice and clean-looking. In terms of student population, the 1st year batch was divided into 3 sections because of the enormous number of students who wish to try their luck in passing 1st year. Also new to the mix is the requirement of some classes to have an arranged seating for students, and a mandatory attendance sheet for strict monitoring of who's attending and who's not. It wasn't like that in the past. It just happened that most students tend not to attend lectures, that's why they made attendance mandatory. There's nothing wrong with it, as long as this is included in the grading system of the student. 

Much as I want to say more to this, I just feel sleepy right now. It has been a long week for me because of the exams, and my mind is still exhausted from all the studying and mentally preparing for this past week.

It'll be a few more months before we become Junior Interns. I just hope that the remaining months would be so gentle to us so that we can be one step nearer to become the future doctors we have been molding to become.

Acceptance is the key to freedom

Have you ever tried living in a fantasy that you wished to be real? Have you put yourself in a position that you would dedicate your time and effort for something or someone just to make yourself sane and happy?

Happiness knows no bounds: it is a testimony of human existence. There are a lot of things that makes a person happy: money, career, objects, friends, loved ones. We all think that we can have these things forever. We wish it was so. The truth is, if there is happiness, there will always be sadness behind it.

A while ago, I was slapped back to the reality of things. I thought that the future will turn out great. Turns out, it didn't. It was something that I had to inadvertently accept because it seemed like I had no other choice. 

It was wishful thinking, though. It was fun while it lasted. Thoughts rushed into my mind as to whether I should deny it or accept it. As of now, it is a tough decision to take. Denying the fact of having differences and just pretending it wasn't there was like unconsciously stabbing yourself multiple times without feeling it, and when the pain starts to seep in, it would be totally unbearable. Accepting the fact of having differences would open a lot of doors for opportunities, but it would be for a hefty price. 

I never realized that what I thought was getting better was snapped off just like that. I was like woken up from a dream that lasted for months. It was like how a happily ever after turned out to be just a literal dream: a moment where you would inevitably wake up from after a few hours of enjoyment. It was like rising up with a bad headache, a brain fog that was just too painful to bear. 

In short, it just had to suck.

I cannot deny the fact that I am disappointed about what had transpired. I am still hopeful for things to become much better. I do not wish to rush into things that I know might end up in despair. It was a matter of accepting something that has been laid on the table.

It's just knowing your limits and setting it, and learning how to control yourself and contain what needs to be contained.

It's just accepting something for what it is.

Acceptance is the key to freedom. It opens a lot of opportunities to take. It's like carpe diem everyday. It may be hard, but it takes adjustment to accept facts.

If there is no freedom, then there will never be happiness.

The attempt at quitting medicine: the letter of withdrawal

Ever felt that you wanted to surrender, despite only being on the road to success for less than a week? Did you ever feel envious of your batch mates who were earning cash, having long vacations, or doing job huntings? Did you even see yourself not being the person who you really want to be?

A while ago, I scoured through the documents file of our family PC. As I was looking for an authorization letter for family business matters, I stumbled upon a letter which I made way back 1st year.

And this is just not any ordinary letter.

It is not an LOA (Leave of Absence) letter.

It is a letter of Withdrawal.

June 19, 2009

ALFARETTA LUISA T. REYES, M.D.

Dean, College of Medicine

University of the East Ramon Magsaysay Memorial Medical Center

Quezon City

Dear Madam,

I am currently a 1^st year Medicine Student this school-year 2009-2010. Unfortunately, it brings me with a heavy heart that I am filing my Withdrawal from the College.

I graduated from BS Nursing last April of 2009, and recently, I took the Nurses Licensure Examination.. For 4 straight years, including the summer breaks and the 2 months of review prior to the Licensure Examination, I have been immersing myself on the study table, fervently and wholeheartedly studying my lessons in order for me to obtain a degree and, hopefully, a license. Though I had only a week’s rest, my mind was raring for me to enter the doors of medicine. Upon entry into the medical school, I found myself overwhelmed with the subjects and topics to be studied. My mind wants to continue on studying, but my heart and body was giving up on me. And as the days passed, my zest for studying has been slowly fading away. I did not want this to happen, but I believe that my capabilities have exceeded the limit, and that my mind, heart and body deserve a much needed rest from all the books and paperwork for now.

It was my childhood dream to become a very good doctor someday, and everyone, including me, believed in my capabilities to achieve and someday become successful in the medical field. But, now, I realized that I have found what my heart truly desires: to be a successful nurse, and hopefully, a nurse educator.

With this, I am officially filing my Withdrawal from the College effective today. I would like to thank you and the whole university for giving me this very honorable opportunity to enter the medical profession. If ever I return again to your college, I sincerely hope that the doors of the college of medicine will still be open for me.

Thank you for this wonderful experience.

Respectfully yours,

Jose Antonio L. Bautista

As I read the letter, this reminded me of the day that I wanted to surrender, the day which almost took away my dream in a near-instant. In just a matter of a few days after I started med, I started to have the deepest intention of quitting Medical School for the reason that I couldn't stand another day reading a book, much more something that was totally new to me. My mind back then wanted to continue going on, but my heart dictated that I should stop, that I should rest this one off for a long time. This was, for me, the biggest dilemma of mine in Medical School, much more, my studying career. Never in my life that I wanted to give up so easily in such a short time. My heart wanted to follow another track, the track which I originally started, which was Nursing. 

It was a classic case of burnout, academic burnout.

But as my parents' unwavering support for me grew, up to the point that they finally accepted that I can get a grade as low as 3.00, my heart started to become motivated again. My mind and heart cooperated with each other, determined to make a push towards the road less traveled. After the emotional talk with my parents, I discontinued my interest in quitting school. Despite not quitting, I made sure that I do not get to erase this letter, for this letter would serve me as a stern reminder of how I actually started and almost quit on Medicine.

Now, almost 2 years since I made this letter, I start to look back at what has happened in my life since the day I entered Med and almost quit because of burnout. A lot of things have happened and passed by but though there have been rough times, I have still kept the flame burning. The desire to become a doctor, a man with double professional degrees, a man with an RN, MD attached beside his surname, is almost near the corner. Next year, in 2012, our batch will become Junior Interns (JI), the last step into becoming a real-deal physician. The thought of quitting is now but a distant but significant memory in my life as a Med student: a memory that will remind me of the blunder that almost ruined my chances of achieving a childhood dream, a dream that everybody would want, but only very few can achieve.

Motorcycle and the city

Life can be seen like a Jack-in-the-box. One cranks the lever out of curiosity, until a clown pops out and surprises him/her. The thrill of surprises is a part of life, and it can either be enjoyable or forgetful, depending on the experience such surprise brings. In surprises, there are some that can be considered an adventure: a surprise that feeds on curiosity and returns back a once-in-a-blue-moon moment that is much more rewarding as it may seem.

Ever felt that all the necessities that you need are not at your disposal when it is most needed? Ever felt that you had to go to an urgent commitment and see that there is no transportation available for use? Ever felt that you don't want to spend cash just to commute? 

Well, here's one for the record books:

After I was online exchanging humorous blows with a great friend of mine and monitoring thesis updates, I prepared myself to go to the dentist. My dentist is quite far from where I live: it is situated in the heart of the Central Business District (CBD) of the country's premier business capital. After much preparation, I went out of the house, looking for a car which I can use to take myself to the dentist. Unfortunately for me, there was no available car in sight, except for a company van which I couldn't risk driving because of number-coding. The mere fact that there was no transportation available at my disposal irked me: I was about to be late for a dental appointment, one which I cannot afford to miss.

The thought of commuting ran into my mind. Though I am used to riding the jeepney and the taxi cab, I did not feel the need for commuting. Thrifty as I am (in a situation like this), I crossed out commuting as a solution to my transportation problem. I was running out of options, when all of a sudden, a radical idea barraged into my mind:

A decent motorcycle ride.

The thought of a motorcycle ride scared me at first. Riding a motorcycle has been a fear for people not used to taking such kind of transportation. In fact, this has been implicated in most traffic-related accidents, with more deaths than injuries on record. I know of people who had lost a part of their lives due to motorcycle accidents, most especially in areas where helmets are not a gold standard to wear (i.e. province). It was a risk for me to take, but risk-taking has been a part of my being spontaneous. I love surprises, and I love the thrill of adventure. Risking all the hazards that it may bring, I took on the challenge. Besides, it's only for just this once.

I went to my brother's office just a house away from home. I asked his secretary if I can borrow one of the company riders to take me to my dentist. Surprised as they were, I stood my ground, adamant on my decision to ride a motorcycle. I was informed of the risks, I took it in me, and replied that no one is to be blamed for any accident that may be incurred during the duration of the trip. Good thing a brave rider took my challenge: the guy was almost half my size, but he willingly accepted it and gave me a ride behind the motorcycle that he owns. 

Wearing a helmet on my head and the left earpiece of my iPod headset attached to my left ear, I hitched at the back of the motorcycle, taking a ride for the first time since my early childhood days. It was the first time for me, in such a very long time, to ride on the motorcycle, this time being a passenger taken around the busy streets of the CBD. It was a sunny Thursday, where all the people are about to return to their jobs from lunch, and where all the air pollution is rampant because of the thick congestion of cars and public utility vehicles jamming the streets and avenues of a bustling metropolis.

As the motorcycle started, my heart started to race. It was a thrill that I haven't felt since driving my Med friends to Laguna and back. When it started to move, the thrill intensified, and I was now moving along towards the busy streets on a 2-wheeled vehicle that posed a greater risk rather than a benefit, in terms of safety. When we made it past the simple roads, we then entered the jam-packed roads of the CBD. The breeze of polluted air and the heat of idle cars started to collide and were felt all over my body as the adventurous ride progressed. The rider zigzagged his motorcycle right past a bunch of cars, big and small. There was a time that during the overtaking moments, my shoulders would almost hit the corners of big cars. My heart would pound harder as the overtaking maneuvers were getting sharper, as the feeling of that was like I was about to fall off a motorcycle in almost fast speeds. We rolled over humps, a few ditches, and turned nearly-hard lefts and rights, but every dangerous action turned out safe in the end. It took me 10 minutes from home to make it into my dentist. After we alighted on the side of the road, I requested the rider to go back to the office and not wait for me, as I preferred commuting back home after my appointment with the dentist.

Riding a motorcycle is really scary when one rides on it for the first time. It takes a matter of getting used to it, usually after a couple of rides. The experience of riding on a motorcycle just to go to the dentist is a memory that I will never forget. To challenge my fears of riding such a vehicle along the country's busiest city is a once-in-a-lifetime event, for successive rides on it would bear no fear on me after this unique joyride. It may cause fear at first, but to ride it and experience the thrill of it is just so extraordinary, it'll make you become fearless afterwards. To feel the breeze all over your body is like immersing your body in front of a big fan, only thing is, there is a mixture of bad air from all the fumes that come out of other vehicles. In short, motorcycle rides is one of a number of highlights in urban living. It may be a drag, but in reality, it packs a smooth, yet, thrilling ride.

Try the motorcycle for one. It'll suck the fear right out of you, and replace it with bravery, and some bragging rights to slap on a hater's face from time to time.

You think going to the beach and hitting the blue waters is the only fun thing to do this summer? Well, think again.

The Tennis Camp experience, 6 years later

Playing a sport of your choice while at your prime is one of the most unforgettable moments that can be etched in one's personal memory. It is that unforgettable moment that signifies a personal achievement: one bragging right that can be flashed to others when one retires from a sport that is well-loved.

It has been 6 years since I last played tennis on a full-blast scale. The whole of my High School life revolved, not just around studies, but also around playing tennis, from the day back in 1st year where I started playing the game, until 4th year where I became a varsity player. Every summer, during HS days, I'd ask my parents to enroll me at summer camp, tennis summer camp that is. The whole of my summer is immersed into playing tennis: improving my personal game, playing junior age-group tourneys (and eventually lose), and meet new friends along the way. Those were the summer days back then which really molded me, not just a tennis enthusiast, but also as a person who uses tennis to build self-confidence and self-esteem as the game is improved, little by little.

Everything about tennis eventually stopped when I made it to college. The tight schedule, the irrevocable commitments in school, and the career path itself really took me away from playing the game that I love most. I was shunned away by college life from holding a tennis racket, hit tennis balls, and play my heart out. This went on for the whole duration of my college life. Only in Med school where my love for tennis was revived because of an annual sporting event in Med land: Palarong Med.

I came back to my HS Alma mater a while ago to join another summer tennis camp. It has been 6 years since I joined camp. Back then, I used to play with people who were just my age or just a few years older than me. By the time I returned to the courts that molded my love for the game, everything was so different. The environment was not ideal for my time and age. The people who I was playing with were kids and teenagers: the oldest teenager was just 6 years younger than me. Good thing, an old teammate of mine joined camp. But still, it was a big number of youngsters who dominated the group. Who would've thought that just because of an annual Med event, this would cause me to join summer camp which is specifically concocted for kids, and not just for young adults like me.

As I warmed-up before hitting tennis balls, I noticed that at first, my teenage-era, youthful energy came back at me. I sprinted and did laterals like I was just back in HS. As time went longer and as I started to play again, the youthful energy waned off, and I felt that I was losing my senses. I gasped for air like I have never gasped before. My vision started to narrow, and my body was starting to get heavy. Not only was I feeling the fatigue, my feet were starting to form blisters, just as I was wearing new tennis shoes bought for that occasion. Every time I was hitting tennis balls, the shots were flying in all directions. Though there were some shots that legitimately went in, most of the supposedly clean shots turned dirty. My forehand was rusty, my backhand was becoming less orthodox (I play with an orthodox single-handed backhand, unlike the modern two-fist backhand), my serves were going out of the service box or hitting the net, and my footing and leg bending was not proper. Though I had my share of these problems, only my net approaches and volley shots were still intact, all thanks to playing badminton during college and Med. All the trainers there said that I lacked practice, and I cannot deny it: I really lack practice. I have to admit, 6 years of not actively playing can cause severe rusting of a once-good playing style.

The worst thing that had happen to me during the 1st day of summer camp was that both my legs started to cramp. I couldn't sprint faster; I had to jog to prevent, as much as possible, my legs to go down on me. After 2 laps, my legs started to give away. Much worse, my left leg had the worst cramp. I had to call on a trainer to manage my severely cramping leg. I didn't go on sprinting after that. Instead, I just ended cool-down by doing a few stretches.

As we grow older, we only get to do, with ease, what is left of our youthful prime. Though I may still be young, long years of inactivity (except for occasional leisure games with Med teammates) can really take a toll on the playing style. I may feel that I am undergoing a state of readjustment. It will take some time to get back the old game. Nevertheless, the mere fact that joining summer camp again is just a good feeling. It's a good way to start summer to prepare for the upcoming Palarong Med a couple of months from now. 

The old High School Best Friend: the springboard for everything

Friendship is a thing that makes people feel important. This is what makes a rational human being feel alive. Having good friends to keep dictates how a person approaches life in so may different aspects. The experiences gained from such friendships tell a story on how he/she is molded into the person he/she is now.

This is the story of an unforgettable friendship with an old High School friend of mine. A great friend, a cool, funny person, and the big reason why everything in my life changed in just one stroke of an instance.

This is how a friendship rises and falls, just because of a regretful mistake.

Her name is Hazel (I do not wish to hide her name). She was my classmate back in Grade 4 and 2nd Year High School, and now currently in Medical School. Back in the day when we were in Grade School, we never get to notice each other that much. I barely even remember noticing her in class. Though there were some vivid memories of her in my mind of those days in particular, what I can absolutely recount is that she was just a grade school classmate. That was just the start of how I knew her.

Second year High School was the time I get to know her more. She was, in particular, a part of a small group of 3 who played tennis during PE hours. I, Joey, and Hazel were the 3 persons who joined the special PE group, apart from the usual PE classes conducted in school back then. Our common love for the sport of tennis was the key that bound our group closer. Back then, we would always play tennis either inside the covered shell courts, or the outdoor hard courts, either during PE days or after school hours. Playing tennis with each other was the source of each of our enjoyment. We simply had fun playing the game, and from the love of the game, a friendship blossomed. 

Summer of 2003 was, for me, the best summer back then. The two of us, excluding Joey, joined the CSA Summer Tennis Program, which consisted of varsity players and intermediate players wanting a taste of the tough side of the game. Everyday, we get to play tennis, have fun, share insights, and keep our heads up high with the big smile of happiness. Those were the times where the two of us started to get to know each other more, if not better. It was during those unforgettable times where we became best friends (for me, she was my best friend: my 1st girl best friend). Besides the fun of the sport, we started to hang out most of the time. There were those times when, after tennis sessions, while waiting for our drivers to pick us up, I'd usually wait for her to go home first than me, though there were times the opposite would happen. While we wait for someone to fetch us, we would tell stories, jokes and ideas which made our friendship one-of-a-kind. From those simple moments, we took those spare times to bask on a wonderful moment: a moment that was unforgettable for me, but maybe  forgettable for her. 

Away from the courts, we had our share of the good times. I remember those good old times such as watching a good movie at GB3, and going to Hard Rock Cafe watching Jimmy Bondoc perform live singing his own version of "Happy." There were times that we would hang out at G4, though that memory of mine is only etched in 2 small pictures, that of which includes her cousin, and that of our tennis group (where I was the only guy in the mix), which I have kept up until now. Every time I get to see it, it reminds me of the old times that were just epic. Our usual conversations never ended through verbal communication. The power of text messaging and the land line helped us be in constant communication with each other. Our conversations back then would never cease to end. Even during the early part of 3rd year, we would keep ourselves in constant contact, though becoming transient was already starting to loom in our friendship. That friendship even influenced my decisions in joining activities in school: I even joined the C.O.C.C. because of her; we wanted to become CAT/ACP officers back then. In essence, those were the best times that I had spent with her, as far as my memory is concerned.

Her company was the thing that made me feel happy, special, and unique. Her bubbly personality, liveliness, and positive outlook in life was the one that kept that spark of joy lighting up deep inside me. I was not romantically inclined to her, I wish to stress that. I just find her mere presence a powerful healing salve to those unhealed wounds of my past. 

I always thought back then that our wonderful friendship will last forever. That belief is a philosophy only seen in movies and soap operas. The succeeding story became the reason for everything that has happened up until this present time. This is the part where I share my part of the story, from my own experience, shown to the world for everyone to see. This is the part where the reader starts to balance from what they have heard from her, to what they will read in this blog.

It was during the varsity tryouts when this pivotal moment in our friendship started to happen. It was during such time that I was talking to a teammate of hers, who was also trying out for the team. That teammate of hers and I talked about a lot of stuff about tennis, even up to the point that I said something that was to be the most regretful, bullsh*t thing that I have ever done to destroy a friendship. I told that teammate of hers my opinion on her game. I counted various strengths and weak points, stated as a neutral opinion. I never intended to quash my best friend's style of play back then. I was trying to become neutral, as far as her upcoming game was concerned. What I forgot to keep in mind was that the person I was talking to was my best friend's upcoming opponent during the tryouts. That is what I can remember. I have nothing else more to say about it.

After that unfortunate incident, word reached her that I said something bad about her game. A violent reaction started to form. I was told by her that she was told of my indiscretion of her game. I never intended to quash her style of play. In fact, the argument that started to loom in did not actually involve my trampling of her personality whatsoever. It was an argument about a tennis game. It was a hot head steaming with anger against a repentant person defending himself from harm. I thought of the incident as a misunderstanding. It just had to turn much more sour in the days to come.

I soon realized then that her anger towards me was not just about the game: it was about the friendship in particular. The argument became a clash of principle against issue. There was a breach of trust: a very fundamental pillar in the stability of friendship. I ruined her trust; I ruined our friendship; It was as simple as that. I did so many ways just to earn our friendship back, but even after we shook hands, a Saturday after my last C.O.C.C. traning (I left training for good because of that debacle), her outlook towards me never became the same again. It was the most painful moment in my life back then. It was the first time that I lost a friend, much worse, in a very bad way.

I can never, ever forget the most famous line that has left a deep scar in my outlook of her: "Forgiven, not forgotten." This has been a line that I have used in a few blogs of mine in the past up until the present. She texted me this line as a reply after a botched reconciliation attempt through a quote sent through a text message. That was the very last word that was said to me by her. That was the very last time we have ever talked. It marked the end of a very great friendship. 

That point in time was the most devastating point of my teenage life, much more devastating than my break-up with my 1st GF. That moment in my life became the turning point in my current approach of friends. That incident has taught me a very valuable lesson in the pillars of friendship: never to break the trust of others through unwanted actions. That incident molded my personality into who I am at present: a person who others can see and describe as to who I am now, and not that of the past.

There are so many valuable lessons learned through this incident of mine, and I would like to count off these things:

1. Never, ever say anything bad about someone, most likely your best friend.

2. Keep neutral thoughts to yourself. Neutrality is a two-faced coin that can heal or hurt two sides of the spectrum.

3. Cherish each and every moment with friends as much as possible. Never leave any single moment to waste. Keep in mind that the best of times outside the home are best spent with the best of friends.

4. When arguing, always keep in mind to listen to both sides of the story. Never keep yourself into a story and live with it: it blocks the other side a chance to explain, and a chance to weigh the options precisely.

5. Do not let emotion corrupt rational thinking. These two should be balanced in order to arrive at a very wise decision when problems arise.

6. Always keep vigilant about the people around you. They may be saying something which is detrimental to your favor. If such thing occurs, either confront it or leave it alone, depending on how you view the opposite person involved.

Personally, I want to thank her for a very, one-of-a-kind time back in High School. It is so ironic that after so many years of not talking to each other, we'd still be classmates in Med school. Up until now, I still want to make amends with her, but it seems that her reluctance to talk about it has prevented me from making such things come into reality. I don't expect any reconciliation, much more never. A lot of people, not only in Med school, but also those back in HS, have said that we should reconcile for good. I guess it will never happen, and I have already accepted that fact.

I don't care if any of her friends in Med get to read this and show this to her. I don't mind if her remarks about this will likely quash any attempt at reconciliation. I don't give a bird's sh*t if she thinks that I'm getting all emo up in this joint and blog my feelings away (Sira na nga naman ako sa kaniya, ano pa ba pwedeng masira pa?). Blogs are the avenues of communication: it's like a journal of sorts that speaks of the ideas of the mind. This is my side of being truthful, honest, and transparent. I have to be honest, I have not moved on from that unfortunate incident. That part of my life has almost dictated how I currently approach my friends. I hope through this blog, all of that burden has been cast aside, and that I can now move on with my life the way it should be.

This is a blog, almost 8 years in the making. Almost 8 years since that friendship went into a disaster. I have nothing else to say about her. I just want to say I have nothing against her, ever. It's now a matter of acceptance that reconciliation is highly unlikely. This is a blog that is intended to let the world know of how I lost a very wonderful friendship, and how I learned from that biggest mistake of my teenage life.

I mean what I say and I say what I mean. There is no sugarcoating in this blog. This is what I want to tell: that side of my story that has been kept within myself for almost a decade, not until now.

Take that for truthfulness and transparency.