musings of an assist

my whole month of october is dedicated to two things: emergency room (ER) duty and operating room (OR) assists. while at the OR as second assist (or rarely as first assist), i have tons of time thinking about other things: e.g., mulling the prospects of my career after one and a half years, wondering what movie or TV show is on HBO, AXN, or CinemaOne tonight, and looking forward to eating a vanilla sundae with cookies & cream and chocolate fudge after scrubbing out.

as student, i have the luxury of sleeping on my own bed when i'm not on duty, which happens every 3 days. in comparison, the amount of time required from surgery residents is quite ridiculous. there was a time when we did a whipple's procedure for an ampullary mass, and the surgery residents that i assisted at the OR were supposed to be post-duty status, but the procedure went well into 3am the next day. one of them called her husband to say, see you nalang in 3 days, and told her spouse to look after their 5-year old son. i feel sorry for her not being able to cuddle her son as often as she's supposed to, but i guess surgeons are tough like that.

aside from eavesdropping, er, accidentally overhearing results of pre-residency and being able to staple the skin, i also thought about doing a survey on medical students who are or who have been assists at the OR, such as:

which of the following best approximates your feeling about being an assist at the OR?

• gusto kong umaakyat para sa OR at gusto ko pang mag-assist sa next case
• ayaw ko sana umakyat sa OR kanina, pero since nakascrub-in na, ako na sa next
• ayoko talagang magscrub-in kung may choice ako [obviously wala]
• none of the above 

please rank these locations of hospital duty in order of preference:

• emergency room
• operating room
• wards

do you think about surgery-related stuff during assists?

• yes
• no 

do you think about NON-surgery-related stuff during assists?

• yes
• no

do you intend to train in surgical fields, such as Surg, ORL, ObGyn, Ophtha?

• yes
• no

Then, after getting enough responses, I can actually do some multivariate logistic regression, and answer basic questions as to whether our atittude towards OR assists translate to career choices. To take it further, someone can probably do a longitudinal survey and see if such choices are actually realized.

But, of course, instead of doing such tedious stuff, I might be better off sleeping and conserving energy for the next assist.

davao regional

after having worked for 3 months already at the philippine general hospital in manila, i decided to compare a major tertiary referral center in davao, in my hometown, and see if the place is at par in terms of health care.

davao regional hospital, or regional as we the locals call it, is an impressive hospital, it turns out. i actually grew up at a stone's throw from the hospital, roughly around 200 steps away, but without really seeing its insides. yes, because there is still that public versus private hospital mentality.

except for one instance where i went to their chapel to attend mass when i was still a child, funnily this was my first time to actually see, hear, smell and feel the place as an authentic medical center.

the demographic in regional is almost the same as with my dear pgh: poor helpless citizens of the philippines with no money to pay for private health care, although i feel a little more attached to my fellow dabawenos because they speak my language.

from what i gather based on the clusters of happy smiling faces of doctors on the hospital walls, regional has several accredited residency training programs. they have a pretty solid reputation in residencies in internal medicine, pediatrics, surgery, obstetrics & gynecology, anesthesiology, and family medicine. i also heard that they have graduated their first neurology specialist in tandem with davao doctors hospital.

ha! what's amazing with regional is that they seem to have way better infrastructure than what pgh currently has. true, emergency room pa lang, taob na, ang ganda at ang linis kahit madaming patients, parang private hospital.

the hospital has a spanking new, shiny lift! pgh's elevators are put to shame. regional also has several ramps where wheelchairs and stretchers can be pushed and pulled to and from the 2nd and 3rd floor. i don't think we will ever have that in pgh.

the charity wards have the same feel as that in pgh on any normal day, where all beds are filled to capacity. i went to the pedia wards at the back of the main complex to take a look, where patients and watchers have a small playground outside the department.

the hospital is actually very proud of having been cited by the country's president in his annual state of the nation address as the first public end-referral cancer center in mindanao, with a functional linac machine and several specialists on board, e.g., surg-onco, med-onco, and rad-onco.

i was able to write to dr faiqha bagis, one of the few rad-oncologists in davao, although nanghihinayang talaga ako that i wasn't able to meet up with her.

i am really happy to see that regional has evolved into a hospital i can be proud of, comparing it to pgh standards of course. here's hoping that more medical centers like this are put up in other parts of mindanao and the philippines as well.

ted city 2.0

TEDCity2.0 was a day-long event held at the Times Center in New York, in celebration of urban innovation around the globe and in anticipation of emerging issues in population, health, education, architecture, engineering, transportation, environment, and sustainability.

Tweets about "#TEDCity2"


thankfully the goodies are uploaded on livestream for people like me on the other side of the planet. you can watch all the talks in the TEDCity2.0 archive.

session 1 featured redefining what it means to be citizen. i especially liked atlanta mayor kasim reed's speech who was trying to charm the audience into why mayors should rule the world.

session 2 was about reinventing the urban experience.

session 3 was all about reimagining the concept of city.

session 4 discussed how we can redraw geographies and learning from other countries.

career analysis

having enough time to think about the future is probably not a good thing, largely because it makes me worry too much, when in fact, i should be glad that the thought of earning a degree in medicine will open up several opportunities that might not have been possible if i weren't in my state right now.

below is a mckinsey analysis of my possible career options. a mckinsey or GE matrix is a common marketing strategy tool that plots the strength of a product versus the attractiveness of the market. if two or more products are placed in one matrix, then you have a business portfolio analysis. in an oversimplistic sense, it helps identify products with a competitive edge, although we know the real world is full of variables that we cannot control.

let's just say that biostat, pedia and radio are three options out of the many. now i won't deny nor confirm that these three are my top considerations, but i thought that it'd be easier to contrast the difference between pediatrics and radiology doctors, and as well as someone involved in research. also, i know for a fact that these things tend to change, so i'll just cross the bridge when i get there.

the size of the circle dictates the perceived market size, and the size of the pie is the perceived market share. the arrows indicate the perceived direction of each entity in the future.

doing pedia in my province is a no-brainer; there are a lot of pedia patients, and the current inverted demographic pyramid of our population just tells me that more adults in the future will bear more kids.

doing biostat is a different matter, since there are fewer slots in the academe or government, but being good at a specific skill that only 5% of all current medical students are even considering as their future career will expand the market size considerably.

radio is a rather contentious area; technology will likely push the supply-demand curve forward, but will your personal market size increase? probably not, even in the provinces, where even a small number of radiologists are capable of providing their services to multiple hospitals; they're an efficient lot.

i realized that the mckinsey matrix is useful in plotting the complexity and in elaborating the variables involved, but it does not provide a ready answer. this is also true with regards to other market strategy tools. it is always up to the market strategist to decide whether to divest the concept entirely, to focus on a niche market, to further differentiate the product, or to think out of the box and innovate new ideas.

return service ala germany

Barbara is a story about, well, Barbara Wolff, a doctor in communist East Germany in 1980. To be able to understand the film, you must first know a little back story. She previously worked at the prestigious Charite at the capital, but after signifying her intent for an exit visa from the German Democratic Republic to work overseas, she was laid off from work and was instead reassigned to a provincial hospital.



One scene includes Barbara on a train with the local security official saying something like "since the people has funded your studies, it is time that you return their favor". It's a familiar phrase that begs a lot of explanation, but I guess, back then, as it is still now, we don't have the courage to question it.

manila book fair

registration is only 20 pesos. the place is already teeming with people at the opening hour. 

look at those crazy sale tags. books can go as cheap as 5 pesos.

the book fair runs sept 11 to 15 at the smx convention center, and is open from 10am to 8pm.

doing vaginal repair

during our end of rotation with the obgyn department, we had a skills assessment session aka osce, an objective structural clinical exam. my favorite exam station was doing the episiorrhaphy, primarily because i practiced this at home using sponges, anatomy dissection tools, and of course youtube.

i had to practice a lot because during my first laceration repair on a real postpartum woman, i was being coached by the ever-supportive ob residents and i really did not know what i was doing until i finished my sutures. after that, i knew that i had to practice.

this was my home practice set.

here's one of my favorite practice vids showing an episiotomy repair.

i'm looking forward to the next osce skills stations, especially during my Surgery rotation.

eats in baguio

baguio is known for their 'gulay' (vegetables) and anything fresh. at the hangar, a walking distance from the maharlika market, one can find heaps of fresh produce at a cheap price, compared to manila at least.

i was only able to take photos of strawberries and several wine bottles, but let me tell you that their tomatoes and radishes are ridiculously ginormous.

if you are in baguio but you want someone else to cook for you, the next best thing to a home-cooked meal is finding the right resto. since baguio is a tourist town, expect a lot of foodie places to choose from.

i can vouch for the restaurants below because i've had eaten their food and i was not disappointed.

Good Taste

when in rome, do as the romans do. this restaurant offers the best bang for the buck. a single plate serves 3-4, and costs 100-150 pesos. it's a family foodcourt for both locals and tourists, not a dating place, so please keep your expectations reasonable. it's a stone's throw from the west side of burnham park.

  
Ketchup

this place right across the wright park is a small community of 5 theme restaurants: Canto, Green Pepper, Rancho Norte, Happy Tummy, and Rumah Sate. filipino food was our first choice so we decided to eat at Rancho. a single plate serves 2-3, and costs 150-250 pesos. their beef bulalo was generously meaty, and the baboy ramo liempo has that distinct savory, smoky taste. as usual, the vegetables are wonderfully crisp and fresh. not bad overall.

and oh, an alfresco branch of Pizza Volante is just beside Ketchup, but you might want to check out the new Volante Technohub branch and the original Volante Session Road branch instead.


Glenn 50's Diner

the servings are plated with hungry truck drivers in mind. you can choose from a variety of carbo-loaded meals, or you might want to dine light and eat skyflakes instead. yes, i think they have skyflakes in their menu. a plate can serve 2-3, and costs 100-150 pesos. plus the ambiance is unmistakably 50's; go figure. i'd go there again one of these days.

 

Solibao

the branch nearest to us was at the heritage mansion - contrary to the name, the place is not really intimidating so don't hesitate. this restaurant embraces the antique Spanish-meets-Cordillera woods concept; nothing fancy, maybe a bit pretentious but i guess all restaurants do that.

i liked the food. each dish serves 2-3, and costs 200-250 pesos. their special bagoong was a revelation, with a nice contrast to kare-kare. if you can, please ask the waiter where to find the bagoong and do leave a comment here. for now, supermarket bagoong will do. the crispy bagnet dinuguan was also divine, but my friends say the crisy dinuguan at Kanin Club at the Ayala Triangle was a better version.

but before you leave, you must try the puto bumbong, because it's only 50 pesos and it's a decent puto bumbong at that.

Author's note:

it seems that baguio has this love affair with bagnet: bagnet pinakbet, bagnet chopsuey, bagnet dinuguan, bagnet, bagnet, bagnet... bagnet equals clogged arteries, hypertension and kidney failure. i'm not complaining.

on my next food trip at baguio, i intend to eat at the Cafe by the Ruins for breakfast, Forest House for lunch, and Hill Station for dinner. we passed by Cafe by the Ruins but decided to postpone to another date because we were running out of time for pasalubong duties. in toto, Baguio equals foodie haven.