Jitters

For the past few months, I've constantly re-vamped my work - I've been going on/off in different clinics, various schedules almost everyone is confused regarding my work schedule. They've always asked me "My bago ka na namang clinic?" I know they're confused. Me too.

Like before, I'm going through another series of changes starting next week. Today (as of this writing) is my last day here at Tokyo Healthlink in Makati. After less than 4 months of being their part-time Family Physician (from a reliever promoted to a regular physician just in the middle of June), I resigned one week ago due to personal, professional, and financial reasons.

My mother company, Health Delivery Systems Inc. recently has tied up with Philippine Long Distance Telephone Co. (PLDT) to be the third party outsource to man their different clinics in select branches. HDSI has recruited lots of specialist physicians, nurses to be assigned in different branches. I was offered this job & accepted the offer. In exchange, I had to leave Tokyo Healthlink.

Yesterday, we had our orientation regarding their electronic record system. Their system is very different, more complex in comparison to what we have in Health First. During the entire orientation, one thing was in my mind "Nosebleed ito!". There were more tabs to click, but with few available characters, more complicated steps. I got more & more confused because they have a system uniquely their own. Immediately I became worried, nervous about my performance on the first few weeks. Adapting to their system will take some time (but not too long, hopefully). Being the first doctor to "start the ball rolling" every tuesdays, punctuality is the top priority. I have to brace myself for a more toxic workload than in Health First.

After the orientation, I had many reasons to go back to HDSI Office. I signed my contract with PLDT, tried which size of long coat fits me for use at PLDT and anywhere else that is a client of HDSI (like in my case, at DMPI and Health First clinic itself), posed for a 1x1 picture & specimen signatures for our IDs at PLDT, filled an application form for an HDSI privilege card. I thought "Finally! They're starting to treat me like one of them" since I'm starting to get privileges.

However, this journey was not smooth-sailing. I went into argument with one of their HR personnel several times before; I almost thought of refusing this job completely. Since this is the beginning, taking an absence, looking for relievers is not being considered for now. I made some sacrifices, I postponed some personal matters. It was hard for me to accept at first & after crying through it, I thought that this job is the priority & it will be for my best.

But really, as early as now, I'm having jitters when I think of tuesday next week. Waah! Goodluck to me (& to all of us as well).

Advanced Cardiac Life Support (ACLS) Training

After successfully passing the BLS training, I can now proceed with the Advanced Cardiac Life Support (ACLS) training. During those 1 1/2 days, we were handled by 3 different ER physicians, and 1 anesthesiologist. Comparing to BLS, this is more difficult, more nerve-wracking, more stressful - more different algorithms to learn, more ECG tracings to identify, more drugs to give.

Prior to class, we were instructed to visit the website of AHA to read their supplementary discussions regarding ECG interpretation and pharmacology. They will not be discussed in class. Furthermore, we were also instructed to answer a pre-course evaluation, print the results, and submit it to class.

The class was already divided into two groups, alphabetically.

Day 1, July 7, 2011

2 to5:30 pm 

More videos were shown and we still had practice sessions regarding Rescue Breathing, BLS Surveys. No surprise, there were practical exams regarding them, but they were all a "piece of cake" (since we just had our BLS hours ago). Unfortunately since we started late, we also finished later than planned. Plus, we weren't able to discuss Acute Coronary Syndromes (ACS) as scheduled because we ran out of time. Prior to dismissal, we were all instructed to read our books, study the checklists (found at the appendix section) in preparation for the Megacode the following day.

I did try to read but I was distracted by something else, and it's not related to ACLS.

Day 2, July 8, 2011

8am to 7pm

I arrived at the place 30 minutes earlier. Everyone was talking about the Megacode, saying that they're unprepared because they just slept the entire night, they can't wait for the day to finish, blah blah blah. When we entered our classroom at quarter to 8, we saw that the mannequins, cardiac monitor, other equipment were ready. Gulp! It was going to be a loooonnggg day.

We met 2 different physicians - another ER physician and an anesthesiologist. One of them began to worry about our schedule since we failed to discuss ACS the previous day. Like a domino effect, the succeeding topics were adjusted as well. All of us bore the consequences - the discussions regarding the algorithms were fast, next thing we knew we were being tested individually as team leaders (but it wasn't graded). We were being criticised, corrected, reminded constantly.

My preparation for the course paid off - since most of our decisions, orders are based on correct ECG interpretations, I was able to go through the practice session well (when I was the team leader twice - cardiac arrest algorithm & arrhythmia algorithm). My groupmates had a hard time reading the ECG tracings that they kept on looking at me for answers or clues on what the tracing is. Ironically, some of them were physicians.

Thankfully, we had time "to put it all together" as a review before we went into the dreaded Megacode. We were given time for CR break, last few minutes to read our manuals. Then, it started.

My case was ok, but I had some flaws - my case was again Stable Tachycardia. I should've been lucky to get the same case twice but I screwed up. My instinct told me to do vagal maneuvers [when the QRS complex of the tracing went from regular-wide (I already gave adenosine 6mg) to regular-narrow] but I listened to my groupmate's whisper, telling me to give adenosine 12mg & I ended up doing that. Wrong! One cardinal rule - always follow your instinct. The other one was a SVT that was pulseless. I told the facilitator it was Pulseless VT and following the algorithm, I ordered for a shock. I was wrong again! It was PEA. I learned about my mistakes afterwards. I was able to see my paper and the remarks were high. Well, not bad but I'm not happy either because I felt I had an easier case, compared to the others. I had no excuse for messing up.

After the megacode, we weren't done yet. We still had the written exam to take. The rule was to obtain a score of at least 42 (or 84%) out of 50. Otherwise, you'll have to undergo remediation with 1 of the facilitators. I was the first to finish and I got exactly 42. Whew! It was more difficult than the BLS exam, because it asked questions all the way from the previous day's topics & it involved cases. Among 12, only 3 students (myself included) didn't had to go through remediation. We graduated from the course ahead of the others, claimed our IDs and certificates, and left the place; while the others have to wait more, go through remediation before they can get their IDs and certificates (if the facilitator is satisfied). I observed that if most of my classmates were prepared for this, we would've gone home earlier.

Once again, we were told to answer a course evaluation for the ACLS. Just like yesterday, I gave the course high remarks.

With regards to the current AHA guidelines, they are more simpler, easier to understand. There are major, major changes and it will take awhile for those changes to sink in & be actually applied. I just hope that everyone, physicians and non-physicians alike, will be able to apply it & be able to save lives.      

Basic Life Support (BLS) training

I underwent a basic life support (BLS) training last thursday at Global CE of America in Sta. Ana, Manila. This is my 3rd BLS training course, but my 1st training that is AHA (American Heart Association)-accredited. It's more expensive than my previous trainings but it's worth every penny.

Actually, I enrolled into 2 courses - BLS, and Advanced Cardiac Life Support (ACLS). Of course, you need to pass the BLS before progressing to the ACLS. During my enrollment, I paid half of the course fees and received the books for advanced reading. I started to prepare a week earlier, and read the BLS manual in just 1 day. Preparing for the ACLS was longer because I also had to review certain ECG tracings and pharmacologic drugs. We were instructed to arrive at class on-time since there are so many topics to discuss in such a limited time. Still, some students arrived late. Oh well... Old habits die hard.


Day 1, July 7, 2011
8am to 1pm


Our BLS instructor, a dermatologist by profession, started on time. After a brief "getting to know you" & laying down of the house rules, we proceeded to watching the videos followed by practice sessions with the mannequins. No lectures were done. The videos simply reiterated what was written on our textbooks, and it also serves as a review. Since AHA regards as all as professionals, they treat us as adult learners. No spoon-feeding. Personally, it's better that way because you're after the skill, the correct manner of doing it. Each part of the BLS algorithm was discussed & shown clearly - starting from 1-rescuer, we started with chest compressions then mouth-to-mask breathing, then 2-rescuer now with the incorporation of an automated external defibrillator (AED) & the correct way of switching roles. It was followed by the child BLS (which was faster) and finally the infant BLS. Like in the adult BLS, the steps are almost the same except for the manner of doing chest compressions, and the ratio of compression-ventilation when there are 2 rescuers. The video also showed how to relieve patients from choking - both in the adult and infant.

Of course, we are evaluated by 2 ways - a practical exam and a written exam. If you've read the book & watched the videos closely, the written exam will just be a "piece of cake". The practical exam is easy too. If you watched the videos closely and took the practice sessions seriously, then it will not be a big problem. You can be criticised by your instructors but they will be just few or minor pointers for further improvement.

In return, we also evaluated the course, the instructors, the place. I had no complains and I gave them high remarks in all aspects. I didn't put on any comments, and I couldn't think of other suggestions for improvement. I was completely satisfied & happy for what I came for.

In the end, I got my ID and certificate. Their valid for 2 years.

I was asked by the Operations Manager if I want to be a BLS instructor with them. I said sure (since being a BLS instructor is a "plus" factor not only for my resume but for practice as well. Oh yeah, source of additional income. Haha!). This seems promising for me. :)  

Busted Tail Lights

My green Honda car (1997 model) has gone through many repairs and replacements in the past years. Just like people who age, gradually its parts have succumbed to wear and tear. Well, I don't know which is more cost-efficient - summing up the expenses of the repairs or buying a new car instead. Hey, where's the promise of giving me a new car when I pass my medical boards?

I've recently noticed that the tail lights were still left open after I've turned off the engine. It's noticeable during the night, but not in the day. Before leaving the car, I've always checked if the tail lights are still open. I don't want the battery to be drained empty. Besides, it was just replaced 1 month ago.

My fear came true when around lunch time, after my clinic work in Pasig, the engine didn't fire. Every time I turn on the ignition, all I heard was "click!". Thankfully, I was parked in a secure place thus I felt confident leaving the car, to look for a mechanic and/or nearest motor shop. I was directed by a tricycle driver to a motorshop along Pioneer St. The mechanic went to my car, brought a spare battery, and some cables to do a "series". We got to the parking lot thru his motorcycle (yeah, I rode at the back of his motorcycle - my first time). The mechanic connected my battery with another one, and after one click, the engine roared to life. Then, I drove the car back to the shop and have it checked. Turns out the battery current is still adequate (not emptied as I initially thought). I mentioned to him regarding the tail lights and he hypothesized that the electricity could be grounded. No other repair was done. On my way to my other clinic in Paranaque & when I went home, I didn't encounter any problems.

I already told this to my dad. He'll have it fixed next week.

I thought "Bumili na kasi ng bago. Palitan na iyan".