One Out Of Two

The long wait was over. Though I did not receive a call from PAFP, a friend informed me that the results of the exams were out. They informed only those who will be conferred Diplomate today, February 17. I was not among them… I passed only the written part. Better than my friend who did not pass any of the two. Out of the more than 450 who took the written part and 300 for the oral part, 121 made it. For my friend, it was over. For me, I will try again next time.

Cell phone: Not Just for Voice and Text Communications

I thought that cellular phone (cell phone) are just for voice and text communications until I met Andres (not his real name). Andres was brought to the hospital for abdominal pain. He is a special patient because he is deft-mute. I can only understand him through his relatives who interpret his sign language.

One time when I made my rounds, only his wife was with him. The first she did was hand me her cell phone. She is also deft-mute. Written in text message was how Andres feels. So, I wrote my questions and explanations in my phone. Now I look at cell phone in another way, not justfor voice and text messages, but also a writing pad that we carry everyday.

Back To Normal

My exams were finished 2 weeks ago. Everything is back to normal. I am seeing my admitted and clinic patients again, updated the websites and blogs I maintain, assisted my wife in home schooling our son and helped around the house.

There are still those who will take the oral exams on February 7. Results will be out probably on the second week of February before the Philippines Academy of Family Physicians (PAFP) annual convention on February 18-20, 2010. 

I hope that I will pass. By then I can say that everything is back to normal.

Filipino Physician OffLine

After typhoon “Ondoy”, it’s too hard to find time to blog. There are so many things to clean after the flood. I am also studying for my specialty board written exam in December and the oral exam in January. For the meantime I will be offline... so this is the Filipino Physician OffLine. But you can still email me at dfcs@dfcsantos.com.   By February, everything will be back to normal.

Rainbows

After the rain, there is a rainbow. Marikina was hardly hit by typhoon “Ondoy”. I was not spared. Chest-deep flood entered our home, including my clinic and car. All my medical records, prescription pads, stethoscope, BP apparatus and other equipment were submerged in muddy flood water. Most of it I have to discard but I cleaned my stethoscope and BP apparatus. These are the basic tools I needed to re-start my practice.

I felt like a newly licensed doctor. I have to start from scratch. I bought stuffs to furnish my clinic. Make new records for every patient I treat day by day. The only difference is that I already have my patient base.

I did my first rounds 2 days after the flood. I have to take a jeep and walked a kilometer because traffic was not moving. The road was slippery because of mud, and dirty because of files of thrown-away things destroyed by the flood. I was commuting and walking for 3 days more until my sister lent her car.

After every disaster, sickness follows. Cases of diarrhea increased because of contaminated water supply. Leptospirosis, a rat urine-borne bacteria, lingered in the flood and mud. Many consulted at my clinc. Hospital admissions rose, making all hospitals in Marikina full. Never in my practice that I had 11 admissions in a day. Some were simply diarrhea, some confirmed case of Leptospirosis, and requiring dialysis. Until now, I have more than 5 confined patients in a day.

After the rain, there is a rainbow. They say that at the end of the rainbow there is a pot of gold. I need patients to earn a living.

After the flood that flushed away most of the things that make my life comfortable, I learned one thing. “We must live simply so that others may simply live.”

Life Is A Gamble

G.T., a 24 year old male was referred to me because of fever, rashes and decreased platelet count. His initial platelet was 76. In the management of decreased platelet like in dengue, transfusion of platelet is warranted if the platelet count is 50 or less or if there is a sign of bleeding... epistaxis, gum bleeding, tarry stools... The reason for the delay is that a rising platelet count is the gauge if the patient is already recovering from the disease.

When the patient’s platelet was already 58, the attending physician requested 3 units of platelet concentrate as standby. However the blood was not immediately available. Platelet went down to 50 and I ordered the transfusion at once. But they haven’t secured even a unit.

When we were informed that 3 units are available in another hospital, the latest platelet was already 62. I was faced with a decision whether or not to go on with the transfusion. The next platelet was 63, so I proceeded. A unit of platelet concentrate will increase the count by 10. With 3 units, I expect his platelet to rise by 30 or to 93 starting with 63. But later platelet counts after the transfusion were 67, 74, 78 and 84. This means probably that his count further decreased even after transfusion.

I compare this decision like playing black jack. When your card total is around 18 to 20, you can hit for another card. But there is a chance that you can go over 21. If I had not proceeded with the transfusion, I could have compromised the life of my patient.

Going Home

I have given the order to discharge patient P.R. (see Stubborn Mother). He has less phlegm and breathing without oxygen. He was very happy to go home. I attended a meeting. After about 3 hours, the resident physician called because P.R. arrested. His heart rate is zero, blood pressure is zero and no breathing. CPR was futile. I considered that he aspirated.

He is now going home. Not to their earthly home but in the home of our Father. Home... where he will be always happy... no physical deformities... no mental deficiencies. He will be forever with our Fathers arms.