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Showing posts with label emergency. Show all posts
Showing posts with label emergency. Show all posts
Desperate Antibiotic Mom
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A 40 year old female patient came in due to a cough that started few hours ago. At last I’m not dealing with diabetes this time, or else, I could already build a sugar factory. It was the usual clinic day, seeing patients one after another, giving words of encouragement, sighing in between, every time someone has a high blood sugar, or reminding again and again when DM complications starts to show. Sometimes it is a thought-provoking combat against the scourge of diabetes. Having this woman in front of me with a one day cough, I thought her case was easy.

 Shifting my brain back to General Medicine, we started our conversation and physical exam:
Patient: I started coughing this morning doc. It’s disturbing my sleep. Can you give me my antibiotic for this?
Me: Did you have fever? Difficulty of breathing? 
Patient: No I don’t have. But I usually run for an immediate consult and my doctors gave me antibiotic every time. 
Me: Well, based on my physical exam, your lungs are clear. You do however have fine tremors, a palpable thyroid gland, though only mildly enlarged, Your heart rate seemed a bit fast, your BP is slightly elevated and… Did you just say it started just today? 
Patient: Yes. I always have that seasonal cough and colds. But I have a transplant patient at home. 
Me: Oh I see. Then you should get flu shots yearly. We have a lot of vaccinations now for your age. I fear you might develop antibiotic resistance if you keep on taking it. 
Patient: Yes I know but I’m running out of budget after all the costs we've been thru. Next visit maybe. I just want the antibiotic. 
Me: Yes ma’am, unless there is a clinical indication, I can give you that.  What I’m saying is, you might have a thyroid disorder, and your cough might be cardiac in origin. 
Patient: But I already have a cardio doctor that deals with my heart. He gave me the medicine for blood pressure. I came to you for the antibiotic. 
Me: I mean your present problem may be hyperthyroidism with a thyrotoxic heart disease. It’s a problem in your thyroid gland hormones which gives a problem in your heart. Now if you want some antibiotic lets run these test and lets see if you have an infection.
 The patient returns after several hours bringing all the laboratory results..
Me: The tests confirmed my suspicion of a thyroid disorder. Here’s the medicine for your thyroid, and here’s for the heart. You take this every… 
Patient: I did all your tests doctor, now can I have my antibiotic and attend to a post transplant patient?  
Me: You’re a care-giver now? 
Patient: Yes, a care-giver, at home, to my only daughter..I don’t want her to get this cough. 
Me: May I ask what organ ? 
Patient: Kidney. It got injured in a car accident and she’s diabetic, type 1, on insulin since 10 years old.
Hearing those, I prescribed her the pill she desperately asked for,  allowing my medical principles to bend a little while giving advice on vaccinations and prophylaxis.

When you’re a mother, sometimes you are blinded by the welfare of your children that you wouldn't take any principles and arguments attached to these. She was never interested in her illness. It was her daughter she wanted to protect. Here’s  a mother who is brave enough to raise a Type 1 DM child and strong enough to fight for her child’s welfare over her own. Shame on me for not paying attention immediately.

And I thought I wasn't dealing with diabetes this time.

Happy mother’s day to all the mothers in the world.
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Post-Pregnancy Panic Attacks
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Breathing deeply, mind running, panic…

That’s after I knew I have to perform after giving birth. 
So how do you speed up recovery?

I usually hated my physical looks during pregnancy. But in this last gestation, I have embraced it silently with an underground agenda to strike back on my beauty regimen after delivery. Due to a temporary restraining order to the salon and spa issued for pregnant women (for medical reasons), I have waited nine long months of uncut, undone hair, dry, wavy and unevenly colored without any treatment till the ban is lifted, which also means I have to wait till my delivery. So it came as a shock to me to learn that my parents are having their 2nd wedding in a grand Renewal of Vows within the time table of my EDD (Expected Date of Delivery).

When they announced to move their 40th wedding anniversary a month later than their official anniversary, I still complained as I was expected to sing, dance, and entertain guests while being able to function as a breast-feeding mom. Perhaps because I have just delivered a baby, they have given me a little over a month to compose myself. After all, the obvious ravages pregnancy has done to the weight and skin of this panicked-stricken self- conscious mom required a stat overhaul. I actually told my parents to move the celebration 6 months later so I’ll be back to the usual me. They gave me 6 weeks.

So here goes the constant search to rid off pregnancy discolorations, running low on  dermatologist consults. I tried spa-hopping for an effective scrub offers, but all gave a shrugged shoulders with no assurance to magically vanish these displeasing masks in a month’s time. Unbelievably, everything now was on the go as I was able to convince my husband to sing with me the Twilight’s “Thousand Years” and dance to the medley of cha-cha and swing, which he had never ever done in years. Again, how would I be judged as a graceful partner of my dashing husband? I suddenly turned vain, my friend told me. Of course, my retaliation must come in full battle gear because my siblings and I am at the front line of a compulsory variety presentation for my parents. And front line meant all the scrutiny’s on us.

And literary so up front that I was tasked to give a welcome address. It was supposed to be just short, but I think my parents deserved more from me, not just for the panic attacks and the post-partum blues. They merit a good welcome speech from their only daughter as a sign of gratitude for rescheduling the wedding day (even if its just for a month), and for considering my condition, plus of course, gratitude for raising me with much love and concern. So I made one fairly nice short speech hoping to touch the listening crowd and not just a simple welcome greetings to the guests.
my family












And I think I did well. After the show, the audience commended, and some couples who wished to renew their vows wanted to ask for a copy. Unfortunately, I only have one. I gave my dad my speech after it was over. They might love to review what I said to the crowd. 

 As for the rest, I gave this blog site. Here’s the link: http://annasantosbonje.blogspot.com/2013/05/time-and-distance.html
Read on ..
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The Intersection
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I have been trying to decipher what I longed in my life. A lot has been given now by our Almighty but I still need to achieve more. Was it truly the saying that man (or woman) doesn't satisfy himself (or herself)?

After all the code blue and code red, code white and code black, intubate here, there, ASAP, Now, STAT, run go move, think accurately but think fast.....One great moment to save someone's life at the brink of death is one great leap to a euphoric disposition... . So now what?

Post-residency and post- ICU days, it seems that my life went to a halt. Yes, frozen like a toad mortified in the pond of ice cold water. I get flustered, and I don't like it.
For 3 months now, I've been dealing with OPD consultations, walk-in patients, and possible admissions. And what do I deal with?

  • * Students who sometimes came to me with their own self-made diagnosis;
  • * Ladies who came for documentation of a slap on their faces but without a slap mark (what would I write on the medical certificate?);
  • * Teens complaining of their breast getting bigger (it's just their growth hormone);
  • * People who want to avail their sick leave, so they complain to you:
  • * They have cough without fever;Or flu without symptoms; Or just anxious of 0-3 rbc on urine; Or walks towards you limping after accidentally hitting their ankle, but walked out straight after receiving the medical certificate.


Times like this, when I like to vomit all the nonsense complains of these ambulatory people, I think of wanting to go back to ICU, to say hello patients, I miss you. There, they really are sick that they are sick to death of their illness.
And so I miss the days when I'm the captain of the ship. When I shout they scram, when I say move, everything was laid to you in place. Back then, the patient can't tell straight what to do or what not to do, because they are either dyspneic (difficulty in breathing) or comatose or moribund, they will just be grateful for you later.




I miss the intensity of how I deal with life, of how I respected it, that seconds counts, and that life is not to be joked at, that I could lose him/her in my hands. ICU and Emergency Room were the best places I was assigned. It makes you forget problems, gets you to be focused.




I remember during my junior days of residency, I can't wait to be out of the hospital life, and live normally. I had a whole bunch of unsupportive seniors who knew nothing of helping and camaraderie but moves great on crab mentality. Friend colleagues who turned out the same way, soon I have nothing to trust on to but myself,for life in the residency training is all about competition.




Shortly I learned the art of therapeutics, by myself, in the midst of those who wanted to sabotage my existence. I conquered my fear and the lack of confidence; I acquired clear insights and judgment. Later speed on critical analysis of the disease ensued. Who would have thought ICU and ER will become my favorite place when I kept on evading this area during my first year. I have won over my seniors, they failed to fail me.


Now I'm here, working as a consultant, funny I'd like to go back. I don't know, the hype of the hospital rush is addicting, "I love the playing field" so to quote.


Subsequently, I am now at the focal point of an intersection, laying down options is hard but deciding ultimately is tougher. I want to pursue further, I want to prove myself worthy in my medical world. Scholarship grant has been offered. Subspecialty training is waiting. Should I proceed or should I not? Here I go again. I am torn from my being a career woman, to a mother, a wife and a daughter.



But one thing is sure, I will aim high.

So help me God.
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