only a bit bloody (but still unbowed)

I’ve collected a lot of feelings over the last eight weeks. Alternative titles for this introspection include “exhausted but inspired” and “tired but still hot as fire”. 

I’m sipping a grande mocha frappuccino as I write this. Admittedly, this might mean I’m a hipster millennial stuck in the 2010s. More importantly, it’s an indulgence I can’t afford. One, there’s no time for blogging. Two, I’ve had a stress-related cough for the last several weeks. Who needs more sugar? Three, I’ve got no time. Fourth, I’m broke. And last— you guessed it. There’s no time. 

But this moment is a luxury I’ll take as a reward or a motivation. I woke up today to a deceptively easy schedule: a small group discussion on the pathophysiology of a pediatric shock and immunodeficiency-related case at 7:30AM, a lecture on HIV/AIDS before lunch, and an exam on health informatics management in the afternoon.

It looks straightforward. But all of this came at the heels of eight weeks of progressively harder modules and schoolwork and exams, and I think I need to update this blog to show that yes, I am still alive. Also I’m tired. 

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A career in medicine is difficult…

There’s nothing easy about medical school. I laugh at people who say that doctors go into the career for the money. Honey, there are thousands of other careers that have better return-on-investments than medicine. If I stop and think about the financial costs I’m hoisting onto my mom, I literally curl up in shame. 

The mental, physical, and emotional costs are innumerable. One of my latest blog posts was me moping about missing family events (I also missed my lola’s 87th birthday last weekend because I couldn’t go home to Laguna). Judging by the high cases of suicide among healthcare practitioners, both medical school and the unhealthy work hours can take a toll on people. 

You might say, it’s only your second year of medical school! It can’t be that hard? 

You’re right. It’s not that hard. At least, according to one of our lecturers [1]. Today is harder than yesterday, third year medical school is harder than second year, internship is harder than clerkship, fellowship is harder than residency. The difficulty only rises. The demand escalates.

Truthfully, my first year medical school was a walk-in-the-park in hindsight. I can’t believe I had the temerity to complain about it. I can’t believe I have the gall to do this now, when everyone says the coming months will only be bloodier.

I feel like I can make an exhibit of how ridiculously taxing medical school can be. For example:

  • I don’t remember what six hours of sleep on a weekday feels like. Good sleep? A myth. 
  • My healthy delivery plan is for show. I have to stress-eat at midnight every other day. 
  • Sitting for up to eight hours in a day with virtually no legroom means my scoliosis gets 1 degree worse every other module (not to mention I’ve got classmates whose chairs are literally broken, what is happening). We get little breaks to stretch, but over 50% of the class (me included) take those precious moments to nap. 
  • Exams can define your life every Monday, because what better way to start the week than with a bang? As in a gunshot. To your face and to your weekend plans. 
  • Cracking open an 80-page chapter that your lecturer covers in 2 hours is a nightmare. It takes you exactly five nights to finish the same coverage reading. By then, the backlog is so high you don’t even know what to do with your book… probably throw it at yourself as an example of self-inflicted mechanical head trauma. 

I also want to add that as a (willing) student of ASMPH, we also have requirements in research (with the goal to publish with drafts written in the shortest time inhumanely possible, what’s new), public health, and management. And as a (willing) part-time worker, I have to set aside a few hours every week to earn my lifestyle. 

Is this a roast blog post? Am I here to say that I’m dropping out of medical and masters school, adieu to the dream and goodbye to the calling? 

Mom, breathe. I’m still here. With everything that’s happening I’m tempted to say there’s no time to even think about it. But that’s not true. With every lecturer, nerve-wracking patient encounter, and fair exam, there’s a reminder. 

…but it’s worth it. 

Before the stress piled up, I got a chance to meet with some of my constants, M and C [2]. As usual, we spent a lot of time planning our trip out of town (the day we fly out is the day I can finally have closure from my high school days and accept that I’m an adult).

During one of the lull moments –and there were many while we were waiting for the uber-cars-that-never-came), M asked me a question: Knowing what you know now, would you have still chosen to become a doctor? 

For a moment, I had to pause and really think about it. I thought realistically. I thought of the struggle and the exams and the stress. I thought, I can’t stop now. I’ve spent all of my undergrad years and a good year of my post-graduate life on becoming a doctor.

If I stop now just to pursue something else that I love— like art, or writing— then I’ll be a burden to my mom and to own conscience. How am I supposed to work to give back to my family? That was my first thought. 

M changed her question. She asked: If you had all the money in the world and no worries for your family, will you still go on with medical school?

I tried imagining it. I tried to imagine living a life of leisure, where I could spend what I want and work on what I wanted with no thought of healthcare, or pharmacologic treatments, or anything medicine-related. I could live a life providing for my family, wearing anything I want except a white coat. And I couldn’t imagine it. I can’t imagine living any life but the one I’m choosing now. 

Nothing is more “worth it” than having the honor of saving lives.

We had an integration project the other week for our Family and Community Health module. We had to submit photoessays related to public health. Walking around Ortigas for that perfect shot, I felt keenly aware of our privilege.

For one of our photos, a homeless man in an overpass became part of our narrative. I thought, if this is the kind of privilege we have, we should be able to do more than just take pictures and make photoessays. We should be able to help him beyond a simple offering of food.

Maybe we don’t have the capacities to make full use of our privilege right now, but everything we do has to work towards something. Maybe that something has to do with uplifting the quality of human life universally. Right now, that something is becoming a doctor. 

It’s a constant process to understand what makes me stay. I don’t know how others feel about medicine as a career, but for me, that definitive “why” remains a revelation every day. Sometimes, knowing that I have this conviction, wherever it comes from, is enough for me to keep going. 

Other times, like these times when there’s an overload of stress and expectations, nothing feels like enough. 

Until inspiration strikes, again and again and again. There’s no end to the number of times medical school will drive you away, only to bring you back. A lot of this is thanks to the kind of environment we have here in ASMPH. I’ll get to that later. 

One hundred and one heartbeats

hush-naidoo-382152

YL6 (second-year medical school) is also a bit special in the sense that we aren’t handled with “kid gloves” anymore. We don’t get advance notice of a lot of things. It’s assumed that we were able to get the basics of physical examination and patient encounters in our first-year medical school. Either we ate Bates in our free time so we could perform physical examinations well, or we didn’t and we’d end up failing our patient. 

During our first (and so far only) patient encounter this year, the task was simple: conduct a full-body physical examination (minus optional parts like the mental status exam and ophtha).

At that point, a couple of weeks ago, I still couldn’t confidently take a blood pressure reading (I’ve practiced plenty now, don’t worry). I was worried. We were all a bit high-strung. And we were scared we were going to embarrass ourselves and fail. 

But the beauty of medical school is that we are allowed to fail —at least, for the first couple of years without actual clinical encounters. Our responsibilities and liabilities only go as far as our capabilities. If we fail, it’s okay. That’s why there’s a preceptor to tell you where you went wrong. The important part is that you try. Actually, the more important part is that you learn, and that you practice, and that you keep going. 

YL6 is teaching me that for a lot of things, theory is not enough. You can’t memorize the description of the different abnormal heart sounds and expect to recognize them when you hear them first. You can’t expect to recite what rales or wheezes sound like, and think that handling your stethoscope well will do all the work for you. 

Our preceptor during our first patient encounter impressed this on me [3]. She said something I’ll carry with me as I practice tests on my siblings, my friends, and the patient volunteers.

She said: if you’ve practiced enough, if you’ve listened to a hundred normal heartbeats –on the hundred-and-first heartbeat, you’ll know what we mean when we say pathological. You’ll know there’s a difference, because you’ve heard enough to say it’s not the same.  

Clinical and field experience is the reason why good physicians can look at a person and know their probably diagnosis. It’s not a matter of Sherlockian investigation (though it might be a little bit of that). It’s a matter of familiarity, of knowing what to look out for because you’ve spent a lifetime learning the difference. 

These are the kinds of moments that inspire me to keep trying. Maybe I don’t hear bowel sounds on the first try. Or the second, or the third. But maybe at the 20th time I will, and after a hundred times I can get it right consistently, and by the time I get to clerkship I can do right by my patients. 

Learning curve

You look at a patient and you see the signs, you record the symptoms. Why is there mottling? Hypotension? Tachycardia?

“Our lives as doctors revolve around our knowledge.” That’s the key insight I got from our small group discussion earlier [4]. Our preceptor was a pathologist who challenged us to think –not for the sake of the exercise, but for the sake of our future patients. One day, when we become residents, we would be the first line of response in an emergency room full of uncertain and anxious patients. We needed to be both certain and calm. We needed to know.

The case we were presented with was long, though I can’t and won’t go into the details. We had to recall molecular and cellular events, the pathophysiology of shock, the types of immunodeficiency. We had to know why you can’t give fluids for patients with septic shock because otherwise you’ll do more harm in your ignorance.

Theory is the other side of practice, and both dimensions demand familiarity and experience. If we didn’t know something, we couldn’t just google it in front of the patient. Common sense says that would mean a loss of trust and a huge failure on our part.

Sometimes, SGDs, demonstrations and team-based learning can become so immersive and high-yield when done right (as they have been so far in YL6). Yes, it’s difficult preparing for SGDs with everything else that’s on your plate. But finding resolutions can be rewarding in its own way.

This dummy mannequin might be the actual person in need of CPR [5]. The patient in this fictional case might be the patient we’ll be treating 5, 10, 15 years from now. When that day comes, I’ll look back at this moment and say, Thank you Lord. Because of this moment, I saved a life.

One big family

Tonight is the Blue Toast. It’s a celebration of the 134 newly-licensed physicians from ASMPH. Congratulations to all the new doctors! Serve the people!

It’s the culmination of the Pugad Agila culture, a manifestation of the school’s “no one left behind” philosophy. (As an aside, I still haven’t volunteered for this effort, is it my lack of commitment? Who knows.)

We have lecturers and graduates who are leaders in their respective fields, from public health to health technologies. We have a transcription system that means we get notes from previous batches, and we share our own to the next. During major exams, we are still welcomed with good-luck candies and notes from older years and our fellow batchmates.

In a way, this sense of community is just as inspirational as all the other experiences I just mentioned. With all these talented and intelligent people believing in the doctor you can be, how can you not work hard to deliver?

Writing so long about the great and inspirational things in this med school life, I’m beginning to forget what my exhaustion feels like. To any and every medical student out there, stay strong. Hold on to your “why”. Keep going.

——-

The title of this post is derived from W. E. Henley’s Invictus, which remains one of my favorite structured poems. I remain idealistic.

Footnotes
[1] Dr. Tolentino
[2] Should I attach a photo? As always, we met in Makati. We’re such adults now. And M, I don’t think you know how much I thought about our sleepy conversation afterwards. In the off chance that you’r reading this, hello.

[3] Dr. Bueno
[4] The other Dr. Tolentino (Tolentino-Molina)
[5] The Superman is Dr. Cinco

Featured Photos
Hush Naidoo

Sebastian Mantel

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