Editing our paper for the conference. Am at that point where I want to scrap everything and re-write the whole thing. Of course, that's just me being crazy. I have been writing and re-writing one lousy paragraph the whole day. Oh look, I still have to look at three more sections of the paper.

My more artsy friends describe their struggles in finding the right syllable, word or note in order to produce the best work. I just can't find the right mix of words to explain what I have in mind. I need to sleep and do something totally unrelated to it for a while.

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Bakit andaming views ng latest post ko? Weird.

Two weeks into my elective. I constantly end up facing a wall of unintelligible equations and would have to take a step back and read on the basics. I really should have taken more math courses during my undergrad years. Then again, the BSPH program is not so heavy on the math part although I wish it would have been. It would be so nice to really understand Biostatistics and Epidemiology inside and out.

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Met an MD working as a research associate in our department. He advised me to take up a graduate degree in the Philippines first before applying to a grad school abroad. But but but... I don't want to take my master's degree here. The most I would do is take some math and statistics (maybe even economics) courses that I know is lacking in my education.

And I should also find my "patron" who will support me in my career and my grad school applications. I guess that's sound advice. I often hear that doors just open once you graduate and get your license. I do hope that is the case.

In any case, I need to join an organization that has good linkages, good pay and lots of opportunities for personal growth. I need to be impressive when I face those scholarship committees.

data cleaning. not the most fun job in the world. another task that I will have to inflict on the research assistants I will hire someday.

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I think I need some new button-up shirts and pants in warmer fabrics.Can't wait for Japan this December.

Last LRDR duty tomorrow and we have ICCs. I'm so happy that OB-GYN is ending that I almost forgot that I still need to look for my missing BP app that is less than a month old. I'm still puzzled as to how it disappeared since it has my name written all over it.

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The OB-GYN department gives good services. Too bad it's also very wasteful of resources.

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Saw Looper. Sci-fi short stories make good movies. 

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Chance encounters (clean encounters, you dirty person you). The habit of staring at people isn't too bad I guess.

I hate that I'm so close to the SC and I can't even find time to join the Cybercrime law.

I effin hate how it sounds like this law was made by people who do not use the internet.

It boggles the mind how this law was passed and how that person managed to sneak in such a nasty provision.

Knowing the speed of the legislature here in the country, we cannot settle for amendment. What will we do during the time that is in effect? Keep silent? Repealing it is the only way to protect our freedom.

OB-GYN starts tomorrow and then elective after.

This is bad. I'd rather read up on regression analysis than OB-GYN CPGs.

Witness to death as it approaches slowly but surely.

She's one of the fortunate ones. She is comfortable and the family members can say their goodbyes.

Failed to gain 5 pounds. Then again, there is still a week of Fammed left.

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How unfair is it to expect you to know a patient you have never seen in your entire life and answer questions regarding her status based on a piece of paper?

I'm anticipating the hell we'll go through next Monday. Apparently, we need to know about unresolved patients admitted at the OBAS by 7 AM even though we are not part of the duty team and we've never seen the patient. What do they want? Do they want us to go to the OBAS at midnight or around 5 AM and check out the unresolved cases?

Then again, at the very least, I should read on the theoretical stuff. It's time to consume CPGs like there's no tomorrow.

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I can't bring myself to work on that damn research manuscript. I need a pressing deadline and the editors of the journal aren't giving any.

I don't think I'd ever want to be a hospice and palliative care specialist. I can't handle that many problems. Biomedical problems seem like a piece of cake compared to psychosocial problems. I guess I just find it so difficult to force people into changing their behavior.I'm also uncomfortable interfering in family issues.

I do appreciate the lessons on disclosure and the opportunity to focus on the psychosocial assessments of patients.

My endorseable pedia patient died today.

I'm not rotating in pedia anymore. The new student-in-charge just sent a message to me this morning. Some part of me wishes that I had been there when my patient went into code. Maybe the resuscitation would be successful if at least one of the original team who handles him is there.

I actually feared that my patient would die after I shift out of the ward. He just received a new resident-in-charge and a new student-in-charge. They would not be familiar with his own brand of toxicity. Of course, it could very well be that he is beyond saving at that point in time.

At the very least, I want to comfort the mother of my patient who had worked so hard to keep my patient alive.

There's nothing like a patient to make you realize the inadequacies in your training. I wish they would have taught us how to run codes and advance life support during ICC year so we won't be so lost and be such a burden during the early parts of clerkship. Sure, they teach us about compressions and protecting the airway but they don't really teach us the specific steps and roles we as medical students can play during codes and resuscitation efforts. I hate the feeling of being a burden to my service team. And if I must act as a runner, I should at least be taught what materials we need rather than learning on the spot and being scolded for it.


OTOH, I do not like the inadequacy of materials in this hospital. Why should the medical students provide the basic needs like tape, scissors, syringes and gastric tubes? Why should we be forced to do a scavenger hunt in the hospital for necessary medicine for our patients? Shouldn't there be a stock supply of these things? I do not like the role we are put in to: walking supply cabinets. Sure we can opt not to provide these materials but you'd still have to produce them somehow. Frankly, it's much easier (and it looks better to your seniors) if you just have these materials on hand rather than run back-and-forth between wards and supply rooms. It teaches students to be resourceful and sneaky but is it really good to be proud of being resourceful if you work in a broken system?

Objective for the week: mastery over the fountain technique.

I dread the Pedia ER duty tomorrow. Monitoring at 4AM after a night of no sleep is probably one of the worst experiences a person can ever have in his lifetime.

I don't know which is worse: getting assigned a patient where it would be difficult to perform procedures on (e.g. psych patient needing restraints, leukemic patient with very weak veins) or getting the vital signs of patients in the ER every hour.

I'm just relieved that the pedia ER week is almost over and I have just only one duty left. I don't think my wallet can take any more abuse. I had to go to Bambang in order to replenish my stash after one lengthy ER duty.

Cinemalaya 2012 notes:

-The Filipino family. Diablo, Mga Dayo, Aparisyon, Requieme and Ang Nawawala; all films tackled family. Weird or maybe not. The concept of a Filipino family seem to be in a state of flux and each generation seem to value the family differently.

-Aparisyon is one of the best shot films I've seen in Cinemalaya. The film makers really hit the jackpot with their cinematographer.

-Requieme paints a really good portrait of Philippine society. Some scenes are almost too painful to watch, sapul eh.

-Ang Nawawala is a coming-of-age film done well. Can't help but notice the Norah-ness of Edin. Can't say it's a Filipino coming-of-age film though. If this is how upper and upper middle class kids are, substance abuse psychiatry sounds like an attractive specialization.

-Pwedeng wag tumawa sa mga eksenang hindi naman dapat tinatawanan? Mature mehn.

-Avoid watching any movie with med students or doctors. They can't help but cringe at the mistakes films make with regards to medicine and health.

"We tested the efficacy of those mosquito traps in areas with the highest reported incidence of dengue. In 2011, traps were distributed in Bukidnon—which had recorded 1,216 cases of dengue in 2010. After distribution, the number of cases decreased to 37—that is a 97 percent reduction rate. In the towns of Ballesteros and Claveria in Cagayan, there were 228 cases of dengue in 2010; in 2011, a mere eight cases were recorded. In Catarman, Northern Samar: 434 cases of dengue were reported in 2010. There were a mere four cases in 2011."

Right... The figures seem to good to be true and I remain skeptical. I have failed to find papers evaluating the effect of lethal ovitrap on dengue incidence. The ones I found are on mosquito populations which showed no effect or reduction to around 50% of mosquito populations.

I also have a problem with their indicator. Using DOH reports of dengue cases is not the best way to measure efficacy of this intervention. Dengue fever is probably defined differently from one doctor to another and may change every year. I think the WHO case definition (using the algorithm) is too sensitive and not very specific that it should not be used for research purposes. Seroconversion among a cohort should have been done as this is the best way to determine incidence.

At the very least, I hoped they used a valid control community where they implemented the same dengue program except that  the traps do not contain larvicide.

It's Cinemalaya time again and clerkship will not prevent me from enjoying this years selection of movies.


True to Cinemalaya spirit, lines still take a long time to clear up and tickets get sold out for many shows. Looking at the bright side, I get to see two films that was not part of my original choices. I think the two, Diablo and Mga Dayo, were in the bottom. Although I was not happy with Diablo, I do appreciate the wonderfully shot nighttime scenes. If the director had pushed for a more suspense-type movie, he would have been more successful. Mga Dayo was a pleasant surprise.

Mga Dayo has a really nice ending theme hence the link. I also see why it was chosen for this years festival despite having a much explored theme: immigration, OFWs, Filipinos abroad. The way I can best describe it is that it has a lightness rare in Filipino movies. It has a delicate touch I guess. It doesn't bash you and scream, "Look at me! I'm a Filipina abroad and my life kind of sucks too!"


Granted, I still want to see my top choices so I bought tickets for the next two movies I'm going to watch this week. No more lines! Yey!

Met a fammed case in ortho opd. I hate that these "surgeon" residencies often ignore the other problems of the patients. We are often told that we should always look at the patient as a whole and address the most pressing problem in the patient. This may or may not be within the area of specialization. This may or may not be related to the chief complaint. We are all trained to become general practitioners first and we should always act like one if the patient has problems outside of the specialty. Often times it means referring to another physician and at the very least, educating the patient and giving preliminary management.

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Today, I met a breast cancer patient who is deferring chemotherapy. It sucks that she got sent to Ortho. Surgical OPD clinics are not known for their use of the biopsychosocial approach. They don't even use the complete clinical approach. It was clear to me that her problem is not the shoulder pain but lies in her family. Something is terribly disturbing if a patient who just underwent MRM continues to view her cancer as death sentence. Maybe I should have sneaked in a referral to Fammed or Hospice on her chart.

Participated in another code.Again the patient was not revived. I wonder why our block is so unlucky.

On the other hand, I realize what skills I need to develop so that I could provide better care.

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Is it normal that I view my patients as puzzles that need to be solved?

Codes. Not as tension-filled as I had expected but really tiring. Or maybe this is just the de-humanization process kicking in.