There are days when I articulate myself more coherently, or with more flowery and eloquent words, at the spur of the moment, but I don’t get the chance to pen or type it down because, well, I’m not online all the time.
If only my thoughts (filtered) would directly be posted here! hahaha
Today marked the end of my fourth duty at the department of Obstetrics and Gynecology. Block six is halfway there.
The rotation has been rather fruitful, not much in the academic sense, but in skills, interpersonal relations and reflections with regards to the system.
Much of what I’ve learned over the past two weeks didn’t have a lot to do with didactic learning, or book knowledge. It delves more on on skills, on extracting blood, inserting IV lines, catching urine, extracting placentas.
More often than not, we are learning about the system: on how to make referrals, fill up lab requests, conduct patients, cover for our fellow clerks.
The past two weeks have also opened my eyes to the culture of the UPCM and UP - PGH.
During the past three years, some of our lecturers would mention that PGH doctors have poor bedside manners. Perhaps this is debatable, and it only becomes an aphorism on the eventual journey in the following months, rather than a fixed truth as we set foot in the walls of the hospital. Simply put, a medical student is not inherently disrespectful, showing little regard for the patient; rather, I hypothesize that it is a learned behavior.
For one, most of the patients are poor. I’m not entirely sure if the there is any psychology behind it, but I think dealing with people who are obviously in a lower position in the social hierarchy may serve as an impetus to greet them with nonchalance.
Another factor, and perhaps this is a more dangerous trap than any of the others, is that it is simply the culture. We see interns and residents reprimanding patients for their lack of preparation or money or planning, and I wonder if we subconsciously inculcate the behavior ourselves. Instead of making eye contact, or listening to their qualms, we avert our eyes and hurry to extract as much as possible from them. Which isn’t a bad thing in a sense, but I think not being aware of the manners we develop is the most dangerous pitfall of all. Because this is where we actually interact with our patients, and if we don’t catch ourselves in time, this will be a habit that would be hard to correct.
But this is not to say that not being too sociable with patients is a bad thing. Some would opt not to interact with patients at all in their laid out plans for their future, and it’s fine. What I mean is that if we do value patient encounters in our practice, it’s imperative that we become masters of our own body language.
Other times it’s just plain tiring to argue with patients. And maybe the reason we easily get irritated with them is that we hold standards and values that are disjoint from how they approach their life. For example, we castigate them for consulting for a problem that is obviously not normal, e.g. a gradually enlarging abdomen. In our minds, something as conspicuous as that should have been checked up and not disregarded before blowing out of proportion.
It’s also so surreal that we, the healthcare professionals and the PGH patients, are at extreme ends of the spectrum. We study in our condominiums, spend our free time at Robinson’s, study in a prestigious university while they are tethered to life by oxygen support, how much their relatives can borrow from their neighbors, the facilities of the hospital, and our own competency. It’s surreal because we interact with them everyday, but outside our little spheres of contact, we lead completely different lives.
Stripped of everything, all our possessions and abilities, we are all the same. But society and the value it places on how much you can contribute determines how you would fare out late in life. And you get the worst end of the bargain if you were born into a poor family.
It’s as if being poor strips you of the right to live in this world.
My duty last night was perhaps more eventful than others. From September 12 - September 19, the doors of the OB Admitting Section (OBAS)have been declared closed for annual cleaning. This may seem like a good thing for us, as students, because it would lessen the load that would have been assigned to us if the section were open. It was more benign, at times, compared to my first two duties, but it didn’t make a lot of difference; most of the time, whether you were assigned to OB (where you would take the history and PE of a patient, but you wouldn’t get decked patients) or LRDR (Labor Room, Delivery Room - you would get decked patients, but it’s less toxic than OBAS) during Code Black (the clean up schedule), you’d still be spending most of your time walking around.
When a taxi or ambulance would approach, they would be met with:
“Ma’am, kung nakikita niyo po sarado po kami. Pwede po namin kayong icheck up, ipa ultrasound, pero sa huli po papalipatin rin po namin kayo dahil wala na po kaming libreng kama. Pati po ung sarili po naming pasyente ay hindi po namin mailagay dito. Hindi naman po namin kayo tinataboy, pero sinasabi ko lang po na ganun po ang mangyayari. “
or some variant of this. But during my duty schedule last night, they delivered 4 (?) babies, because the women were already fully dilated (their cervices, rather) and the babies were already there! I think one delivered inside a taxi while another was delivered inside a van, with the residents rushing, asking for gloves, primi sets, and pedia catchers.
It was weird to see our own residents shooing away patients. Perhaps it was the rational and logical thing to do, seeing as they would not really be catered to if they chose to stay, but it doesn’t take away the pity that you should feel for them, by placing yourself in their shoes, and wondering how the husband, or mother, or sister, of the pregnant woman must feel, to be denied services, and scamper to find any open hospitals before the baby comes.
I guess that more than learning about our patients, and the hospital, we also learn more about ourselves, and the things we do and don’t want as we journey through this undertaking of becoming a physician.
I guess clerkship would put us all to the test; physically, mentally, emotionally, socially. I hope and pray that in the end, as we walk out of this crucible, we would become what we have always personally envisioned ourselves to be.
We don’t only owe it to ourselves; our patients deserve it too.