Postcards On the Roll....

I grew up in the time when we had to travel to post offices to drop mails to different places (either to local places or to cousins based overseas). It was also during that time that I was fascinated with postage stamps & tried to collect them. When electronic mails (or e-mails) were introduced and words such as Yahoo!, Hotmail, Gmail became household names, post offices & snail mails turned ancient.

Until recently when my youngest sister asked me a favor - go to the post office to send post cards. I dug deep in my brain on the location of our post office. She narrated that she joined a postcards-exchange website called Postcrossing. You start by sending a postcard from your country to a random registered person anywhere in the world. The admin will give you a postcard-id which you must write on the postcard. The recipient will use the postcard-id to register the postcard you've sent. You can send a maximum of five postcards any time. When your first postcard is successfully received & registered, your name will show up as a recipient for another person who wants to send a postcard. So on and so forth.....

I paid almost P50 for the 3 postcards my youngest sister sent to european recipients. I don't have an idea how long it will take until the postcards reach their destinations. I already have 2 recipients - both in Europe. I haven't purchased my postcards yet & I am clueless what to write down. I've seen their profiles, & I've read the postcards they like to receive - common theme: nature.

I'm excited to start sending & receiving postcards. I feel like a kid all over again. Promise, I'll take a picture of the first postcard I'll receive. :)

www.postcrossing.com

What Late?

Not to boast but I'm not the type of person who arrives late at class/work. Since I was a kid, I was trained by my parents on avoiding tardiness. Even until my residency, I haven't gotten tired of that habit. Of course, you cannot avoid unexpected incidents (like car radiator going up which eats up a lot of time or very very heavy traffic) but those were just rare occasions. My colleagues will start to wonder that something did happen to me along the way. To quote a colleague, "Bihira lang ako ma-late." I'm a professional, and it starts at arriving on time.

With my present work, there's a rule imposed that tardiness will be sanctioned through salary deduction to encourage us to arrive on time. There was no "grace period".  Since I started there, I didn't receive any salary deductions due to tardiness. There were occasional days that I logged-in between 8:01 to 8:10 am (the latest) but I guess they were okay with it. There's just this 1 incident when I was late because of car radiator problem. I informed a colleague and a nurse by phone that I will be arriving late. I logged-in at 8:18 am. I thought "One time lang naman, hindi naman habitual. Baka pwede pa nila akong pagbigyan since may dahilan naman ako." And with my overtime hours, I guess makakabawi ako.

When I saw my payslip for the second half of December via email, I was shocked to see that I had 251 minutes (equivalent to more than 4 hours) tardiness. Almost P1000 was deducted from my salary. What?! Where did that come from? My colleagues and even the staff were surprised when I told them about it. I called our Payroll division to clarify/verify that. It turns out that the accountant was wrong about my actual clinic schedule. For 2 days (wednesday and friday mornings), she assumed that my log-in time was at 7 am but my actual time-in is at 8 am. So when I logged in at 7:59 am, she thought I was 59 minutes late. She repeated that pattern for the other days. Thus tallying to 251 minutes late. Right then & there, I corrected her by giving her my actual clinic schedule. Surprisingly, that's the first time I encountered it. If she's unaware of my actual clinic schedule, why didn't it happen before or during the first few months? Why only now? She told me that she'll give back the amount (that was deducted) on the next pay. Dapat lang! Sayang din yun.

Starbucks 2012 Planner

Every time that Starbucks Coffee offers their Christmas drinks, I become one of their patrons. I'm after the peppermint mocha. Completing the sticker booklet for a planner is just secondary, but I care less about it.

It just so happen that I was able to complete the 20+ stickers needed for the new planner. I asked myself what will I do with it since I already use Navi? On the other hand, sayang naman if I don't claim it. Probably I could sell it.

The planner (cover bamboo) is neatly stored in my book shelf, unopened. Anyone interested in buying it? :)

Change of Plan-ner

I used a Belle De Jour planner for 2011, a gift from my youngest sister last Christmas. In contrast to my previous planners (Starbucks), I used all pages from January to December. Aside from reminding myself of important activities like birthdays, anniversaries, I was able to keep track of must-do's, errands to follow, and other important details. The weekly design was very useful because I was able to write down thoughts, reflections on anything and everything that happened on one day. The downside was the discount coupons which I occasionally used. I confess I'm not very "kikay" and it will just encourage me to spend more rather than save. Also, it's bulky since it's hard-bound. So far, it's the only planner I was able to successfully use.

But for 2012, I wanted to look for other planners. Perhaps there's another planner that's useful as BDJ but less kikay. 

Last month, I bought a Paolo Coelho Daily Moments 2012 planner at Powerbooks in Greenbelt 4. It's supposed to be for my youngest sister as her christmas wish list. But she changed her mind. Instead, I gave it as my exchange gift during our department christmas party. I didn't like the design - it has no monthly calendar, has a few lines to jot down important events, thoughts during the week. 

I went back to Powerbooks to search for my next planner. I saw Navi. It was done by the same people behind BDJ but less kikay, lesser coupons, cheaper. Without hesitation, I bought it. Navi is short for navigator and as the name implies, it is a travel journal. Very, very appropriate for me - I like to travel & I want to travel. I also adore the uniqueness of the design - the right page of each book is blank. I have the freedom to write down anything & everything under the sun, I can paste pictures, and even draw. 

I can't wait to start writing down on it. :) 

Offer - Rejected!

While at work this afternoon, I made up my mind regarding the offer of employment at Tan Tock Seng Hospital in Singapore as one of their medical officers. With the help of a forums site, I learned a lot about the job description of medical officers (or clinical associates), and their condition/s outside of the hospital. Plus, the contract said I was going to work under the Department of Geriatric Medicine. I know for a fact that they have an aging population, and it was mentioned to me during the interview. I remember I told my interviewer that I just had 1 month rotation at Geriatric Medicine during my last year in senior residency but it was less intensive - mostly giving prescriptions to the patients left & right so that they can buy their medications at the pharmacy. Little did I know that it was going to be offered to me seriously.

It wasn't an easy decision but deep down, I felt that that job is not for me. On the other hand, it can be a good stepping stone for possible employment at New Zealand, Australia, or other Commonwealth country. I asked myself several questions -- what are my intentions there, knowing that I have less chances of being recognised a family physician there since I didn't earn my medical degree there. Am I after the practice itself? Am I going to receive potential recognition from the Singapore Medical Council in the future as a family physician? Or am I just there for the money? When my contract ends, what then? Is the monthly pay justifiable or sufficient enough to shoulder all of my expenses? Most importantly, am I going to be happy there? Well of course, we'll never know until it happens.

I know other physicians will gladly grab the opportunity if they were in my shoes. Sa kanila na lang. But for me, thanks but no thanks.

Prayer Answered

I just received the best christmas gift ever... Never mind that it arrived early.

I passed the Diplomate Exams! Woot!

My batchmate and I were going nuts since yesterday about the results. I was hesitant in calling the PAFP office to learn the result. I was so scared, anxious. While I was having my usual clinic hours in the morning at a big industry, little did I know that there was a text message going around about the results of the exams. My batchmate called me over my mobile phone, she was frantic and I could barely understand what she was telling me. I was also distracted because I had a patient/employee in front of me at the same time. Keeping my professionalism, I told her I'm quite busy and I hanged up. After 30 minutes, another female colleague (junior co-resident) called me & greeted me "Congratulations!" Coincidentally at that moment, I didn't had a patient so I talked with her for a while. She told me about the text message. I was puzzled because I haven't received any other text message that morning. She said that according to the text, my batchmate and I passed! I swear I wanted to shout for joy right then and there. But I still had doubts, maybe it was a hoax. After our conversation, my inbox was flooded with messages saying "Congrats!" It was around 10am that I received a forwarded text message stating that we indeed passed the exams. The original message was sent by 1 of the national directors of the Academy and a former specialty board member. My doubts were cast aside and I felt relieved. I told the good news to my family and my boyfriend. Everyone's happy for me.

Aside from my batchmate, I also greeted 1 of my co-workers (had residency at Veterans Memorial Medical Center) for passing the exams. I'm extremely happy to share the same joy with them, relief that we won't go through the same hardships all over again.

Can't wait to wear those togas during the Annual Convention next year. And I'm psyched to add 5 initials to my name - DPAFP.

I just wish my professional fee also goes up. Haha! :p

The Damage Has Been Done

Projection Exams
December 2, 2011
1600H
UST Faculty of Medicine & Surgery Medical Informatics Lab (Formerly known as LRU)

The first part of our 2-day Oral Diplomate Exams. The exam consisted of pictures (skin rashes, microscopic anatomy, ECG, x-rays, etc.) in timed powerpoint slides. In less than 2 hours, we were done. But before I could say "Thank goodness", we still had two more tests that involved purely Family Medicine physician's skills. After 30 minutes, I could finally give a sigh of relief - well, for that day. The projection exams were satisfactory.

On a side note, I was impressed with the new facilities of LRU. Flat, bigger screens, updated operating system, keyboards and mouse. So that's where part of the tuition fee is going.


OSCE
December 3, 2011
0800H
UST Faculty of Medicine & Surgery

"This is it!"

7 stations (5 manned, 2 unmanned), nerves, butterflies-in-my-stomach feeling, members of the Specialty Board going around, colleagues reading/holding books while you're not holding any. While you're in the holding area, you hear the bell countless times. And then, you hear your colleagues review many things like leopold's maneuvers, classification of body mass index, etc. Oh boy! I hated the agony of waiting.

When it was my turn, holy cow! My nerves got the best of me. I did very, very poorly. When I was finished, I cried my heart out. I wanted to think positive, be optimistic but in the back of my mind, I was already anticipating that I'm going through this again next year. I tried to smile but deep inside I was sad. I thought "Let it be done, according to Your will."

Results are going to be released 1 week after. I'm going to pray my hardest.

Preparing for the Oral Diplomate Exams

2 days to go before our Oral Diplomate Exams.

In contrast to preparing for the written exams, I'm at a loss on how to review for our Orals. Perhaps browsing through our Proceedings could be valuable but what will I read next? Bates? De Gowin? Dra. Maglonzo's book? Heck, I really don't know.

I feel like going to a war, unarmed.

So help me God.

Hello SG?

2 days after that interview for a hospital in Singapore, I opened my e-mail and received an unexpected reply. I was successful at the interviews, the official letter of offer will be available within two weeks. Alright then.

But I didn't tell this good news to my parents. Only to my other younger sister and my boyfriend. At the back of my mind, something might flop along the way. I decided to tell them if the letter of offer actually arrived at my doorstep & if I really want to be a medical officer in Singapore. That will mean being away from my family, boyfriend for quite some time. For how long am I going to be away? I have no idea at this time. Everything's stated in the letter of offer. If it comes or not, well at least I tried.

Application for TTSH, Singapore

During the looong holiday break last week, I got an e-mail from a former co-resident/colleague regarding a job opening in a hospital in Singapore as a medical officer. Without doing any research on what a medical officer does in Singapore, I gave my resume to the HR head of the hospital by e-mail and kept my fingers crossed.

After 2 days, I received a reply from the HR head inviting me for an interview in a 5-star hotel in Metro Manila on a sunday afternoon. Coincidentally, it was the same day as the fun run my sister & I will be joining. The email also mentioned the requirements that I should bring during the interview. The requirements were a challenge for me - since Singapore follows the British system, I hardly understood the papers/documents they would be looking into. I asked a colleague who's working in another hospital in Singapore, but she also has no idea about the requirements. I thought "Bahala na."

We met at the lobby of the hotel, proceeded into a cafe and were given sheets of paper. It was a written exam! It composed of less than 10 cases and asked regarding diagnoses, management, etc. We were informed that failure to pass the written exam means oral interview will not be conducted. I had to dig deep into my brain & remember everything that I've encountered/read/seen/observed during residency. I'm not an internist but while answering, I acted that I was.

Thankfully, I passed the written exam. I was accompanied into another room, met a top official of the hospital (who is also a physician). After less than 5 minutes of "tell me about yourself", I was shown ECG tracings & x-ray films from his laptop. WTF? I swear I was blabbing crazily. I felt like I was going through the Oral Exams already.

Finally, he asked me if I had enough experience/exposure with Geriatric Medicine. I told him that I don't have enough exposure since we only have 1 month rotation in Geriatric, and most patients I dealt with consulted for refill of their maintenance medications. Yet, I'm always willing to learn.

As usual, his parting words were "Thank you for your time. We will inform you via e-mail regarding the interview." The sentences entered my left ear, and left my right ear.

SGV Fun Run

My youngest sister invited me to join a fun run organised by her employer, SGV. For this year, this is the 2nd "fun run" we joined together. The run happened in the grounds of SM MOA but it was a rainy start. I thought the run was going to be suspended but the organisers decided to push through. Thankfully, the rains stopped before the race started.

The roads were damp, the air was cold, and it was cloudy. Thank goodness, or else I'd be looking hard for a sunscreen. With new, comfy running shoes (ahem!), it was a good day for running. Not to mention, it was a long weekend. So I didn't mind the muscle sores that will happen after.

My sister ran ahead of me, but I didn't care. I alternated my jogging with walking and occasional brisk walking. Nevertheless, I crossed the finish line and she was waiting for me. I asked her if our gap was long. She said it was less than 5 minutes. After a few drinks, we headed back to our car and went home.

I'm not a fitness buff but I'm glad to run again. I just wish I had the luxury of time to run more often.

Preparing for the Written Diplomate Exams

For the past several months, one of my batchmates and I have frequently discussed if we're going to take the Diplomate exams of the Philippine Academy of Family Physicians this year, or postpone it for next year. We've debated countless times the pros and cons of taking it this year. We usually end our discussions uncertain, anxious, no definite answer.

Last month, I received a letter from the Academy telling me that I am eligible to take the examinations. I was torn - take it this year or next year. I know my preparation is not going to be enough, and I will be relying on my stocked knowledge (if there was, or was it "stucked"). A deadline was set and my batchmate seemed eager to do it. I had no choice, I went with the flow. I was like a robot when I went to the office of the academy somewhere near Buendia, Makati City, to pay for the fees (written & oral). I told myself "Bahala na si Lord if I'm making the right decision."

Before I knew it, it was the end of September and I haven't opened any single reference book in Family Medicine. I didn't know where to start! I had two weeks to study/review but I was not determined, had no drive. My almost-daily trips to Starbucks Coffee to review (similar to what I did when I reviewed for the local licensure exams) became my sort-of security blanket. Most of the times I was drained. I watched movies, window shopped, strolled around the malls, even got my hair rebonded, and slept more hours than my usual. 

Then the dreaded day came - the day of our written exams. I surrendered everything to the Lord. With the few stuff I reviewed, I hoped & prayed that I could remember them all.  

RIP, Grandma Regina P. Lopez

July 27, 2011
Around 1pm

While having lunch with my youngest sister somewhere in Pasig, I got a call from my younger sister informing me of an unusual situation back at home. She was called firsthand via mobile phone by our helpers that our grandmother was found unresponsive in her bed. I told her to bring her to the nearest hospital immediately and we will follow them. At that time, my parents were also somewhere else but they were also informed about the situation. 1 hour later, I arrived at the hospital. Our grandma was being attended to by the emergency physicians on-duty. Being a physician myself, I told them about her past medical history - diabetic for more than 15 years, controlled, not on any insulin therapy nor oral hypoglycemic agents, had stroke around 2003 with left-sided residual weakness, had upper gastro-intestinal bleeding due to aspirin intake, transfused with 2 (I think) bags of packed red blood cells, admitted at another private hospital last year due to complicated urinary tract infection. The ER physician also told me his working impressions - another episode of stroke, possibility of heart attack (NSTEMI/non-ST Elevation Myocardial Infarction), Pneumonia in the elderly. I saw my grandma intubated, but with stable vital signs, yet still unresponsive and a high capillary blood glucose level. I was also told that she must be admitted at the intensive care unit/ICU but I didn't give my consent. Instead, I told them I had to wait for my mom & will ask her. I doubt she'll agree with it. Moments later, my parents arrived and they went to the Admitting section to get a room. Not surprised, my mom didn't consent for my grandma to stay at the ICU. She opted to hire a private bedside nurse instead. 3 hours later after arriving, we finally settled in 1 of the private rooms in the hospital. And we hoped, prayed for her recovery.


July 28, 2011 to August 3, 2011

I always visited her at the hospital on my way home from work. There were moments that she was "going down" and I had a feeling that we will not be able to bring her back home alive. My mom decided to bring her home to her original home town, even if it meant travelling by ambulance for many hours. My mom's relatives arranged for my grandma's transportation and transfer of hospital. On her last night at the hospital in Manila, I realised that probably it was the last time I'll see her alive. She was transferred after midnight. She was accompanied by my parents and another relative on the maternal side.


August 4, 2011
AM

When I woke up for work, my dad left me messages on my mobile phone, giving me updates about their travel and grandma's condition. It seemed that she was "stable" during the entire travel. They finally arrived at another hospital by 9am. They were attended to, immediately brought inside a room. I thought everything was going to be okay.

12noon

I got a text message again from dad. The content was what I dreaded for - grandma joined our Creator. I was stunned, distracted from work. I informed our friends, other relatives about it. Details regarding the wake and interment followed suit.

She was 86 years old.


I went home (with my youngest sister) to Ilocos night before her interment. When we arrived early morning, everyone was in frenzy and we were extremely busy. No time to catch up for some sleep. Mass was at 8am, followed by the procession to the cemetery, the burial rites, and finally lunch at her place. We headed to the beach for awhile at high noon for a ceremonial "cleansing" and letting go. Of course, we had to put lots of sunscreens on ourselves. Then back again at the house for bathing.

(My younger sister stayed behind in Manila because she was reviewing for the Physicians' Licensure Examinations. Thankfully, the results turned out to be great.)

The activities didn't stop there. Since we had guests from Manila, we toured them in Vigan, ate empanadas, bought lots of souvenirs. By night, I was so tired. Since I was also headed back home, I decided to sleep in the bus. I was in Ilocos for less than 24hours.

Tomorrow is her supposed to be 87th birthday. We will still celebrate it, like she's still alive.

We will celebrate her "40 days death anniversary" on 13 September 2011. I'm not sure if I was going to Ilocos because of work. But I'll try to file for a 2-day leave.

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".

Blame It On Miscommunication

String of bad lucks happened to me recently. One thing lead to another. In the end, I had no work today. Blame it all on miscommunication.

Yesterday, 20 June, monday was a public holiday. On a regular day, I was supposed to be at Del Monte Philippines Inc. as their company physician (by third-party outsourcing). But last monday, June 13, the HR manager and I have agreed that I will hold my clinic with them on a wednesday. It's like having a make-up duty. I informed my company (Health Delivery Systems Inc. or HDSI for short) immediately of my plans. The response of HR to me was "Ok po." I thought everything was settled. I wasn't aware that the HR manager from both companies discussed amongst themselves to hold a clinic on a tuesday and will look for my "reliever" instead. I felt that they "by-passed" me.

At home, our two helpers resigned. With my grandmother handicapped and a parish fiesta looming, everyone was uber busy. Last thursday, my parents talked to me about filing for an "undertime" at work today supposedly. There are many parish fiesta activities that they had to go to, no one will look after our grandma from 6pm onwards. I said I'll try.

Last saturday afternoon, I asked permission from the clinic manager of Tokyo HealthLink Makati (where I work T-Th, 8am to 8pm) if I could go on "undertime" just for today. She said it was against company rules to go home earlier, since we're being paid on an hourly basis. Instead, they'll find a reliever for me. Since family comes first for me, I decided not to hold clinic, have another colleague take my place instead.

Afterwards, my mom called to tell me that there's no need anymore for me to go on undertime at work today. They've asked one of our relatives to go to Manila and look after grandma & be one of our helpers temporarily while looking for replacements.

Since I was available, I called up the HR manager of HDSI to tell her that I'll have my clinic 1 day earlier than planned. Then, she dropped the bomb on me. I was surprised! I became mad because they've made their decision without informing me, or consulting me first since I'm the company doctor; and if I haven't called her, I would've also gone to DMPI as I've planned, thus making it two doctors visiting the company in one week alone. The reliever has already committed to it, and there's nothing I can do about it.

I went back to Tokyo Health Link. Unfortunately, they've already called up a colleague and she has already agreed in relieving my post today.  

I tried to look for other work as reliever. Too bad, there was none.

Ako ang nawalan.

Net Book Or Smart Phone?

Just a few weeks ago, I've posted something about my laptop being fixed and how I almost bought a new laptop. Even if it's fixed now, my perennial problem is still there - it takes approximately 30 minutes to start up the system, and running some programs take time. Like for example when I open Adobe Lightroom, other programs hang, it will take 10 minutes before the window of Adobe Lightroom pops up and I can resume my activities. It's "turtle-like" actions has been my complain for several years, and people have been telling me to buy a new one. It crashed for three times already and I'm getting dissatisfied more and more. I thought maybe because of the operating system (Windows Vista Home). But if I'm going to buy another license to change into Windows 7, heck! I'll just buy a new one instead. Perhaps a net book.

On the other hand, I just got a new mobile phone unit (white Nokia X3-02 Touch & Type) at the start of the year because of plan rebate and upgrade of postpaid plan. For basic necessities like SMS, calls, FM/AM radio and camera functions, it's ok. The downside is when you surf the internet. The screen is very small and I'm confused with its buttons/controls even if I've read the user manual many times. The OS of the phone is Symbian, not Android. Probably perhaps it's not quiped for frequent 'net users like me. For months, I've been studying/looking into Android phones. Not primarily because it's the trend but the necessity of installing applications into mobile phones for quick reference, specifically medical ones. I have an iTouch but having too much gadgets is confusing & heavy on my pockets. I barely use it nowadays, strange as it may sound. 

Both gadgets (the model units I'm targetting at least) are priced almost Php25K. I want 'em both but I have to choose only one and prioritise which I need more - the new netbook or an Android phone? I'm starting to weigh the pros and cons of each one.

Beauty Blog 1: Daily Facial Routine

During residency, I cared less about my looks. Because of pressure, workload, doing basic tasks like washing your face, toothbrushing and even taking a bath were a luxury instead of necessity. Especially if you're a first year resident, in which you're always "first on call". As one of my colleagues said before "Sayang ang damit."

By graduation, I've begun to be more conscious of myself. Actually, I should thank my sisters and my boyfriend for this motivation. Aside from the daily facial wash, I gradually added stuff to my daily facial routine - first was a toner then I bought night cream, eye cream, a serum & the latest addition is a day cream. Yeah I used to place a moisturizer before but I was not religiously using it. But due to the growing number, my dilemma was rising. Back when things were simpler/fewer, it was cleanser-toner-moisturizer. Period! With the creams and serum at hand, now where do they come in? Is the arrangement of my application right? Is there something redundant?

My regimen became this: cleanser-toner-moisturizer-serum-eye cream-day/night cream. In denial that I was unsure of what I was doing, I did that for 2 months (I think). It was only last night I got the courage to ask a friend if what I have been doing was right. Well, almost. And my instincts were right - some areas in my regimen were redundant. Call it overkill. Haha!

In summary, here's her advice. As a bonus, she also gave me tips for the morning regimen.
AM: facial cleanser-toner-eye cream-moisturizer-sunblock
PM: facial cleanser-toner-serum-eye cream-night cream (no need for the moisturizer)

In order to make the most of what I have (para hindi sayang), I can alternate the moisturizers and the day/night creams. For example, day/night creams today, no moisturizer. Then tomorrow, moisturizer in the morning and evening, omit the day/night creams. And so on. At least, I still get to use all of them.

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Here are the brands I patronize:
Celeteque Facial Wash
Celeteque Oil-Control Toner
Pure Beauty Eye Cream (once consumed, I will be shifting to Pond's Age Miracle Dual Eye Therapy)
Celeteque Moisturizer
Cetaphil UVA/UVB Sunblock
Pond's Age Miracle Concentrated Resurfacing Serum
Pond's Age Miracle Day Cream
Pond's Age Miracle Overnight Repair Cream