doctors are humans

l feel that the medical profession has been under attack lately.

People think its bad that we sleep during our tour of duty (which can last for 24-a years, mind you - some specialties require perpetual duty such that the resident doctor will literally live at the hospital). we are not robots. It's physiologically impossible to work 27 hours and still be on your best game. Medical errors happen, you know. 

People seem to think that we call all the shots regarding the hospital policies and the like. 

We really don't. You may beg us to do a procedure before paying for the procedure, but in majority of cases its really not up to us unless we pay for it ourselves from our own paychecks. If we really think its necessary, yes, we push through hospital policies to give you what you need. However, if we give in to everyone, hospitals will shut down. There is not enough government support for this to be possible. trust us, we want free health care (government subsidized) for all. We want to heal everyone. In a perfect world, that could happen. please think about this before blaming us.

People seem to think resident doctors get a percentage of what they pay for (read: resident doctors are licensed doctors in training. they get monthly salaries. Fellows may or may not get salaries, depending on whether the hospital has plantilla for them). We don't. At Least not directly. We get salaries, but that is it. We don't have private practice to support us financially, so we depend on our salaries to eat and have å roof above our heads.

People seem to think that while we are not attending to their needs, we are somewhere else doing anything less important that attending to their needs. Chances are we are attending to someone more severe. Just thank God we don't have to attend to you first. That means we think you'll live a little while longer than another patient.

People seem to think that because we chose this profession, that we do not deserve weekends or even Holidays. Yes we do. We suffer burn out. We suffer depression. How dare the public remove the right to self indulgence from us? 

People seem to think, and sadly people who are also doctors, depressingly people who have the power to make changes in the health system of the country (doh secretary, for example) seem to think that because we chose to be doctors, we owe it to our countrymen to serve the indigent population barring our own needs to support our family and safety. 

Believe me, there are many who want to. I wanted to, before i entered residency. However, slots are limited and female doctors are discouraged because of instances of rape in some assigned posts.

Our government should build more public medical schools to train government doctors and they should build proper hospitals or clinics and address the issue of safety before belittling our sense of charity. 

most consultant doctors I look up to have served in public hospitals because even hospitals in the Metro remain poorly manned, poorly supervised. As a fellow doctor in Manila, I see 40-80 patients per day. That means that on a busy day, I see 4 patients 3-4 patients per hour on a 24 duty. But because Im human and i gotta pee, gotta eat, gotta nap. lets subtract 2 hours from the day for me to take care of my self too.. that leaves 22 hours for 80 patients. And any tour of duty will have code (aka resuscitation after cardiac arrests, or intubations) which will require 15-60 minutes each, leaving us with about 18 Hours for those..hmm.. 76 patients. 

New patients require most time because we have to talk to them, elicit their histories, do physical examination, doing labs, going back to the patient to explain the findings etc. requiring about 15-1hr minutes each. Each night there are 20-30 new patients out of the total 80. So lets take the average 25 patients x 30 minutes each = 12.5 hours. Leaving 5.5 hours to the remaining 51 patients needing our medical attention = 9-10 patients per minute. This includes doing their paper works : chart completion, medical abstract, prescriptions, all patients rush us into doing.

Sometimes, when I do rounds at night to a patient who complains that he couldn't sleep, my inside thoughts are "buti nga ikaw nakahiga ngayon e".

How to save up for beginners

If you've read my previous post, I've recently married the love of my life. :) So began our budget plans, and whatnots.

Oh, who am I kidding?! Our budget plans started WAY BEFORE and we are still in the process of learning how to save!

Here's the scenario:
I was a resident physician (READ: Doctors recently passed the Physician's Licensure examination has the option to continue training as residents to go to their desired specialization for 2-7 years such as Surgery, Internal Medine, Pediatrics and the like) and he is a Database administrator.

Resident physicians go on 24 hours duty aside from the usual 7AM to 5PM required hours during weekdays, and usually weekends are more lenient 8AM to 12noon, unless you're on duty and have to stay until the next day. In our contracts and simple due to the fact that we are mere humans, it is needless to say, we CANNOT by any means, have 2nd jobs. We simply do not have time and mental capacity to hold another income generating anything -- be it online jobs, holding private clinics, etc.

Resident physicians receive "allowance" or salaries on a bimonthly or monthly basis somewhere between Php 10,000 (minus 15% tax IAMNOTEFFIN KIDDING) to 40,000. This usually depends where you train. I got to be paid along the lesser spectrum.

Luckily, my fiance is not a doctor in training, he has more potential to earn as a DBA. Since I started receiving my paychecks, albeit low, my parental support stopped. Sure, grocery shopping here and there, they shouldered my rent for the 1st year, but everything I need, my fiance provided.

Since we were planning a wedding, we had to think of ways on how to save. Here's how we did it, not flawlessly mind you, and not completely -- but here's how:

1. Change your mindset.
Childhood to college, we were raised into consumerism thinking that we have to get jobs to buy this and but that. Before, we planned to buy Wii, the latest phones, live in a bigger space. We just have to wake up to reality that we really do not need so much material things! I think, for us, it took 2 years for us to change our mindset. It's hard, especially if those who surround you have so many, and you don't. But just keep your priorities straight and you'll shift the hell of your present paradigm in no time!

2. Savings first.
See, I like to write things on paper, list and computations. Even after reading Rich Dad, Poor Dad, our mindset still hasn't change dramatically so we always save the money left after all the spendings.
We realized after 1.5 years that this should not be the case.  We were still in the rat race back then, thinking how we still lack money even when my fiance's income is getting bigger, thinking the only way to save is for him to get another job for a bigger salary. WRONG!
The problem with that is we are easily swayed to get money from our savings when we need extra cash (usually for something you don't really need).

So what we did was subtract 5% from our combined salaries. Placed it in a mutual fund account and then calculate spendings later. You can make the percentage as high as you want, but you have to subtract your savings first and think of it as if it did not exist. Never look at that money again as a liquid asset.

3. Open up a "Savings account"
Open an account on the same bank as your payroll. That way you can automatically transfer your monthly savings per salary period. This way, you really cannot see your money, less risk of spending it instead of saving it.
This is difficult for us because we have different payroll accounts, but we just opened one at BDO for convenience.

4. Avoid late fees
We are late to realize that we were paying about Php 1000 plus per month due to late fees simply because we were too lazy to pay! Of course there are times when we overspent, like the months near our wedding date, but it was really crazy that we are paying late when numerically, we are financially able to pay all bills with our combined salaries.

5. Face your fears
This is related to number 4. See, my husband, and I think, most males suffer from the double standard that they have to be the breadwinner. Egos are crushed when there's a perceived inability to make ends meet.
Every time I bring up accounting our present expenses with my husband, he becomes annoyed by my efforts, postponing each time. When I finally convinced him to compute with me, we finally understood what we need to do -- just avoid late fees and save up on food.

In our case, our combined salary was enough. But when its not, maybe you can cut back on your bills by cutting your phone expenses? Do you really need all that data when you have unlimited internet at home? Do you really need to go online during your daily commute? Are you fully utilizing your gym access? Other memberships you can get rid off? Maybe you can move to a smaller space, or one nearer your workplace to lessen your transportation cost?

Confronting your budget once and for all will help you gain perspective to achieve #1.

6. No more Eat Outs
This consist bulk of our budget. Since I am a doctor and have bad hours, we usually eat out for dinner almost daily. For years, we had resolutions to save by just cooking at home. It was only 2 months into our marriage that I stumbled upon a tip that changed our lives (atleast for the past month).
Before, we went to the lengths of meal planning and grocery shopping, but food just ended up spoiled, ingredients unused. The secret pala is PREP TIME. Crazy as it may sound, but this simple process helped us prefer eating in than out almost instantaneously!

We plan that every Sunday, we go to SIDCOR for buy food. I want to eat organic meat, hence my preference of market. At first, we had proper meal planning: rotisserie chicken, use the left overs for chicken sandwich, buy veggies for salad. Then as soon as we arrived home, the first stop was the kitchen. We cook the chicken, eat our lunch, then proceed to cutting up the remaining chicken and storing it to reusable containers. For salads - we skin and slice all vegetables: carrots, beans, zuccini, etc. By doing so, as the week progressed, it was so simple to put together a salad since we need not pull out a knife to do that. 4 straight weeks, we ate out once a week. That, for us, is success!

Now we have less leftovers and our spending for food decreased dramatically.

----

Those are, I think, some essentials into saving up for beginners. These are lifestyle changes that you must do before you proceed to advanced stuff such as going into stocks, etc. An important point I wanted to drive at is that beginning to save is a process. I have seen so many lists of how to's before, but applying it to your self is really not so easy as it may seem. Results are not always fast. Sometimes, the path is slow, but hopefully, steady.

I wish our struggle/journey into savings may help and suit you!

How to take care of your puppy

1. Provide a Dog Bed.

We never had one before, our dogs would just sleep on rugs. But when we bought one for Meeko, she felt right at home!

We bought one so we can help her establish her place in our home. Once she claimed her space, we can more easily toilet train her.

We bought one from Pillows and More, at Php 900.00, were are able to buy a beauty. We got ours from UP Town Center.

2. Water dispenser.
As I am currently training at the National Kidney & Transplant Institute, I know that Leptospirosis is now on the rise. Tales of dogs dying within 1-2 days who had fever and jaundice sounds like Leptospirosis to me. Having a water bottle like this ensures fresh water for your pet versus having a water bowl which can be exposed to rats/cockroach and whatnots.
Brought this also at UP Town Center in the hardware store there at the 2nd floor at around Php500-600. Better safe that sorry, I say.
The thing is, Meeko can't operate it when we bought it for her. So every time we wanted to make her drink, we would operate it ourselves until enough water collects in the bottom portion, supposedly for food. Now, I just saw her drink from it! SUCCESS!

3. Shots!
5-in-1 and Rabies to protect our pets from dangerous diseases which will cost you more if your pet will have it.
I am not an expert at this, and I rely HEAVILY on my Veterinarian Aunt to remind us of her shots.
But first of all, you should get the shots record of your puppy from the owner. Then have an appointment with a friendly Vet for updates.

Flea shots can be given, too.

4. Dental hygiene
Daily Dentastix or daily brushing of teeth using a baby's toothbrush and a dog toothpaste for your canine's canines!

5. Chew Toy
Sources tell us to not give chew toys with any semblance to anything you wear s.a socks, t-shirt, etc.
Puppies need at least 20 minutes per day of play time/stimulation to dissipate their energies, otherwise they get anxious, destructive, and everything Cesar Milan so desperately tries to rehabilitate.

6.

Poodles of fun!

Last month, we received our first baby, Meeko, a 2 month-old red miniature poodle pup from my Tita.

Before, that, she lended us a male pup, Gatas since Meeko was just a few weeks old then. We rarely cook. When we do, its usually pasta, or my husband developed a destressing hobby of baking bread (good for me!). So for gatas, puppy dog food was the best! We did not have any problems with his food. Nor did he had fleas. We just made a make shift bed for him made of a top of a box filled with retaso and rugs.

Then came Meeko. We fed her same puppy food as Gatas, which she ate with gusto..for 2 days. My husband was on night duty that week, so he was home the whole day. He noticed that one morning, Meeko never barked when he went downstairs and left her. When he brought he down with him to the living area, she just stayed in place, barely touching her food and drinking water. He got alarmed and notified me.

When I went home, I examined her as I would a pedia patient - I googled signs of a sick poodle (Hehe I am an ADULT nephrologist in training, so to be thorough, yes, we do google, too BUT WE KNOW HOW TO CHECK THE SOURCES REALIABILITY).

I pinched the skin at back of her neck. Its said that it should retract fully once the skin is released. As in a child, failure to do so within 3 seconds means that the child is dehydrated. When forced to stand, her hind legs would shiver. She was so lethargic!

For more information on how to check for dog dehydration:

I tried to force Meeko to drink, but nothing did the trick. We went to My Tita, a veterinarian, conveniently and brought IV fluids. After a few drops, and seeing his brother there, brought her back to life. Apparently, because she's used to table food (rice and some shredded protein and broth), she probably had stomach upset which may the reason she refused to drink and eat. She advised us to prepare table food for now, until she's 6 months old.

I wanted to share our experience because, I took care of a puppy once, who grew into an adult dog and led a happy existence, and we were able to take care of Gatas for about a month. That experience taught us that each puppy is different. Sometimes, what's convenient for the owner is not good for the puppy.

So my husband would usually buy lutong ulam before going home especially for our Meeko.

Now, she turned 3 months! and I noticed she got significantly bigger! :D

I stumbled upon an old blog post back when I was in Medical School. Refreshing to read now that I'm in my first year of fellowship.

Hello World!

11/30/09

Let's retain that. :)

Here you will read the account of my remaining days on Earth as a free man. Beware, audience, as you might be held responsible to keep my sanity intact as I slave through endless hours monitoring patients q15 on the 1st hour, q30 on the next, and q1 thereafter. You must promise to keep me uncarved.

What? You haven't read The Tao of Pooh yet? Oh. Okay.

The Tao of Pooh by Benjamin Hoff is a take on Taoism (google this if you must) using Winnie-the-Pooh or Just Pooh as the embodiment of the philosophy. Pooh is also called the uncarved block, one that is devoid of unnecessary complexities that make life stresssful. The uncarved block sees the world as the child sees it, simple, exciting, and fun.

Others think of me as the uncarved block owing to instances I've stopped just to appreciate the shade of green the leaves exude, or the times I've helped stray, wounded animals get across the street, or the eccentric ideas I put into action my friends talk me out of just because its not customary.

Despite that accusation, I don't think I'm completely uncarved. What do you expect in a world dominated by television and competition? I am jaded. But I still like the idea that the childlike, uncarved me shows herself from time to time.

And since you read my intro, you are, therefore, obligated to stop me from carving my self as much as I might want to during my clerical internship, my senior internship, my board exam review period, my actual medicine board examination, and as I progress the food chain towards being a <insert preferred specialization here> consultant in my still very, very far future.

So there. May this journal keep me in touch with the little Pooh inside me with the hope that it will push me to take more pictures, start drawing again, listen to more music, and keep appreciating every little thing with each new day. :)

And promise me you'll read the Tao of Pooh. :)

A very happy wife

My boyfriend of 9 years and I got married on my birthday this year.
Now that we sleep on the same bed, almost every night (He and I have night duties), I can't imagine life without him.
Now I'm sick, in my bunting, awake doing my report, and you're cuddled up beside me such that I have to be careful typing because my laptop might hit you and awaken you.
I am sick and he made me my request of onion soup, and not due to my request, he made homemade whole wheat dinner rolls from scratch to match my soup.
Makes you really wonder how I landed such a catch.
Mind you, these are just ramblings of a virus infested doctor who had a 24 hours ER duty yesterday at the seemingly only hospital in Quezon City, or even Metro Manila who offers dialysis, but still has to finish her report (after procrastinating for a month or two) due tomorrow.

I kept saying earlier today, "by this time tomorrow, I'll be happy again" - see, a departmental case report where there is always a risk of public humiliation is really enough to make a Nephrology fellow quit fellowship and I had that feeling for days now.

But really, at this time of night, that I still have some cramming to do but know as an Internist, that as a patient, rest is the best, I feel really happy.

The RING!

What are your thoughts on your engagement ring?

You either want to invest on your engagement ring or you want to skimp on it, or forget it altogether.

WHY INVEST?

A precious gemstone can be passed on to the next generation. Your future son might may fancy giving your ring to her future betrothed. 

It is a symbol of how much he values you, kind of like buying you to be his wife.

Types of GEMs

1. You can go the "traditional" most expensive route, which is the DIAMOND RING.

2. Alternatives for the clear gem are: moissante, zirconia, white sapphire

3. Birthstone

4. Sapphire

sapphire is said to be a symbol for marital bliss

5. Synthetic

6. No gem ring. Pure and simple