Treatment Refusal

While riding the jeep to school, I overheard this conversation.
“You’re now a diabetic?” a woman said to a man, who was obviously her friend. She wore what seemed to be a uniform of some generic office. He, on the other hand, was wearing home clothing.
“That’s what the doctor said,” the man said.
“You should go natural,” the woman said. “Don’t drink. Don’t eat too much. Go natural. Exercise.”
“No,” he said in obvious denial of his condition, “I feel fine.”
“Your condition might worsen,” she said. “You’ll end up injecting yourself with expensive medicine everyday.”
“I don’t care what the doctor says,” he said. “As long as I feel fine, I’ll do the same things I do normally.”
Now I must admit that I have a strange sense of humor. I don’t know how other medical students would react to this situation, but I just smiled. Call it weird, but I can’t help but imagine what this man in the future might look like. He’ll be weak, thin, and wasted. He’ll also be mouthing his regret over not changing his ways. Yet by that time, there would no longer be any major benefit from his reformation. He’d either end up dead or be sick for a long time.
To anyone think that I have a sadistic streak, “stop it”. I was just amused by the man’s stubbornness. It would allow him to enjoy a happy lifetime, but it would be a shorter lifetime. Also, I greatly respect autonomy. As long as an adult individual has sufficient mental capacity, he has the right to undergo or refuse treatment. The smile was also brought about by a small streak of what my future would bring. I’d be handling stubborn patients like him, who wouldn’t follow my instructions. Call it grim humor, because that’s what it is.
My smile was noticed by the woman. I believe she also noted my distinct* white uniform and the giant Pediatrics book I was holding because she turned the man’s attention to me.
“Am I speaking right?” she asked, and then turned to the man. “He’s a medical student, a future doctor.”
Trying to hide the grimace building up from her last statement, I nodded and smiled at them. No matter what I’d say, the man would still stick to his ways. If he didn’t believe what his doctor told him, he wouldn’t believe what a “future doctor”** would tell him. I left them shortly afterward.
I just knew the woman would still be trying to convince the man. The man, however, would not follow her. I consoled myself that the decision was his to make. Then I had an insight:
Doctors, ultimately, have a vital goal in order to fulfill their calling. They may know how to diagnose, cure, or manage a disease or condition. Yet their vital goal is to first convince their patients to agree to get well.

*Our uniforms are different from the Nursing students’ uniforms.
** Somehow, this just makes me cringe. There’s still about 5 years to go before I can claim the coveted MD degree.

PBL Part 2

I think all medical students since the time medicine has been formally organized have asked this question, “Must I become a doctor?”
Others ask this when they are bombarded with patients and the paperwork that come with them. Others ask this when they realize that their life would involve being perpetually exposed to sickness. Others ask this when they discover that their time is no longer their own, that they must stick their noses to books instead of having the fun they used to have. Usually, they ask this when they are already far ahead in their studies such that it would be too late for them to quit. Others, however, specifically students following the Problem Based Learning (PBL) model, ask this during even before their first month of taking Medicine ends.
We, I mean, I feel I have to read everything. We don’t have text books. We, instead, have recommended books, books that we have to read and understand. Those recommended books, btw, are not the only books that PBL students must read. They are told to read everything! I think even the most die hard bookworm would leave his mouth open in shock when he sees dozens of titles, of which some of them are more than a thousand pages thick.
Yet the reading part is barely half the taste of the main course of the PBL style. The discussions part is what gives it its distinct flavor. The following text features an exaggerated example of what happens in a PBL session gone wrong in the “right” direction. Imagine a room filled with seven medical students armed with the knowledge of several books covering the same topic. One of them says, “The corpus luteum undergoes degeneration 16 days after the unfertilized oocyte is released from its Graafian follicle.”
“By Guyton! That is wrong.”
“Harrison be with me, but what you are saying isn’t right.”
“Langman take you! Go read his book.”
“By the power of Williams, stop saying gibberish.”
And to think those books contradict each other with regard to the dates of embryological formation. Yet I’ve heard that loud debates have stemmed from these contradictory minute details. Students of the traditional learning style have textbooks, of which the “holy” Gray is chief. They don’t have to bother with bickering sessions. Nevertheless, loud discussions are preferable compared to silence. At least, there is a flow of communication and information. Yet woe to groups who have shy and silent members. If they don’t have good tutors goading them to speak, nothing gets discussed.
At least, medical students under the PBL style get to ask the question, “Must I become a doctor,” early when they haven’t yet encountered the rigors of higher medical training. They could opt to leave if they choose. Nevertheless, if they do choose to stay, then that means they would strive for excellence in the path towards becoming a physician.

First PBL

Image taken from Despair, Inc.
Last Friday, we had our first Problem Based Learning (PBL) experience.
It was different from the traditional learning style that I was used to. Gone were the teachers speaking to a class full of inattentive students. Instead, we were 7 students in a small room doing most of the talking while the doctors who acted as our tutors merely goaded us to discuss more.
First we students roleplayed as doctors and a doctor roleplayed as the foster father of a 15-year-old girl who hasn’t menstruated yet, but who was apparently impregnated by her 14-year-old boyfriend. The foster father cited the girl’s vomiting every morning as proof of her pregnancy. He wanted to have the supposed pregnancy aborted. We, the doctors, asked questions to gain as much information as we could for our analysis.
Personally, I think our case involves a patient with Androgen Insensitivity Syndrome. The “girl” hasn’t menstruated, yet she suddenly is supposed to become “pregnant” by virtue of her morning sickness. “She” might also look like the perfect girl, but it could be that chromosomally “she” is male. “Her” male genitalia just didn’t develop because “she” does not respond to androgens, or male hormones. So “she” gets to have female externally genitalia, but internally, she has balls that just didn’t develop and descend.
Nevertheless, that is only my opinion. It may not be the correct one, or even be the correct one. The PBL style, however, emphasizes the learning process instead of the solution.
From that roleplay session, we formed Learning Issues (LI) that we had to research about. Among our LI were Embryology, Gametogenesis, Male and Female Sexual Anatomy and Physiology, as well as ethical and legal issues regarding Abortion. We have to study these topics individually, and then discuss them in another PBL session. This learning style supposedly has a better edge than the traditional learning style where the teacher does most of the talking.
I am thankful that I was assigned to belong to my group. Our discussion moved smoothly, and we didn’t have extreme personalities as members. Other groups had very domineering members who eclipsed their more silent members, or so I heard. Other groups had very silent members, and the tutor had to coax them to talk.
Yet that was only our first day of PBL. I am sure that everyone would improve in the coming days as we get the hang of this new learning experience.

PS Despite the apparent advantages of the PBL, it also has its downsides. The picture above is a reminder on what could possibly go wrong with this style..

Theme Hospital (A Review)

You think you have what it takes to become a hospital administrator?
Then try your skills with Theme Hospital, Bullfrog’s best game ever. Deal with cocky doctors, docile nurses, and the not-so-handy-handymen. They could get tired, and this obviously would hassle you and your patients. Build diagnostic rooms, treatment rooms, and rooms for more personal use. Finally, don’t forget to manage your finances. Bankruptcy is the sure way to losing!
Patients with all kinds of complaints are your main source of income so take good care of them. They could die from lousy treatment, or leave your hospital in disgust at your method of running. So make sure you get a Slicer to hack away the extra tongue growth from speaking too much about soap operas. Employ at least two surgeons to repair Broken Hearts, and remove Kidney Beans and Spare Ribs. Hire a nurse and she’ll give them medicines to cure the Uncommon Cold, Gastric Ejections, and other ailments.
Do you think you’re still up to it? Then strap yourself to the computer chair and play. You won’t notice time pass by, but it will help if you have a dose of non-pharmaceutic grade caffeine from coffee to get you through your all nighters. Just make sure you don’t do this very often or you’ll get admitted to a real hospital.

NMAT Part 4

Congratulations to all who received their NMAT scores already. I really envy you, guys. I haven’t received mine yet, and if the reputation for the post office around here still holds then I’d have to wait at least a week before I get mine. It feels so sucky to be forced to wait for something this grand.
Yet, wait I must. I cannot do anything about it. I don’t know anyone working in the CEM. I don’t know if one of them could be “persuaded” to reveal my score. I don’t know if I even have enough “persuasive powers”.* And even if such a thing were possible, I cannot in all honesty pursue such a path. I want everything from my application of the NMAT to my receiving of the score to be honest and be free from guile.
So I am left with no choice but to leave everything to God, and in the meantime do everything required of me. I know my score would arrive at the right time. I just hope that I’d have the patience to wait for it…

*Take this with a grain of salt, please. I am not inclined to bribe anyone when I’m given the choice of waiting for the results. . Btw, I also hold the CEM in the highest regard. I don’t think anyone of them would stoop so low as to resort to bribery.

NMAT Part 3

NMAT’s over.
And no, I won’t be writing any more emo posts. I would also not post any questions from the exam per contract between the Center for Education Management and the examinee (Ahem). They, however, have nothing against saying what the test was like.
IMO, Part I should have been scheduled to be finished under a longer time limit. Every examinee I talked with fully agreed with me on this one. It was the first time in my entire life that I did not finish a section of a time limited exam. I had to randomly guess the answers of several numbers since there was no longer any time to read them all.
Part II was a breeze. Biology was easy. Social Science was easy. Physics and Chemistry were easy. If it was permitted to return to Part I, I would have had time to more confidently answer them. Plus I would still have a few minutes to catch up on my sleep debt from last night.
I do hope I can still get the coveted 99+ percentile*, but those sections that I missed would certainly affect the result. But whatever my result will be, I will still surrender it to God. I did my best. I leave the rest to Him.

*No harm in hoping. Besides, having high standards is a good motivator for excellence.

NMAT Part 2

So it’s judgment day tomorrow.
I’ll be taking the NMAT in Cagayan de Oro City, which is about an hour and thirty minutes from my home. It’ll start in about 8am, and I’ll have to be there a few hours before the exam. Thus I must cease blogging and go to sleep.

NMAT

I’m having exam jitters.
The National Medical Admission Test (NMAT) will be held this Sunday. I can’t say I’m not prepared. I have high hopes that I’ll be above average, but I’m not sure if I get to belong to the coveted highest percentile.
It’s not that I want to prove myself. I don’t need to do that. People should take me and other people as what we are, not basing their opinions on our reputations. I just feel as if every event of my entire existence was building up towards my climactic taking of this exam.
Ordinarily, I don’t feel the jitters until 5 minutes before a major event starts. Heck. I used to not feel the jitters every time I take exams. This time it’s different. It’s fully 3 days before the DAY, and I’m starting to feel anxious.
Thank God He will not leave me in this situation. As I post this blog I remember Philippians 4:6-7.

“Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding will guard your hearts and your minds in Christ Jesus.”

God of the Past, the Future, and the Present. I commit my life into Your hands. Do with it according to Your will in the name of the Alpha and Omega, the Beginning and the End, the Lord Jesus Christ. Amen.

Sick but not Sick

I decided to be sick today.
I wanted the fever to run its course. I wanted it to stimulate and augment my defenses. If all went well, the fever would stimulate my leukocytes (white blood cells) to destroy the invaders. It would also reduce the level of free iron in my blood* so as to reduce the spread of bacterial infection. And in another leg of the process, it would induce interleukin-1 (IL-1) production,which in turn aids in the production and maintenance of lymphocytes, another division in the army of body defenses.[1]
Unfortunately, I had things to do earlier so I couldn’t afford the weakness that comes from fever brought about by my runny nose**. I took one tablet of 250mg Mefenamic acid to get me through walking the breadth of the city. It worked. My perceived temperature dropped to normal. It allowed my feet to me into diverse places. I made the reservation for the family holiday. I scanned through shops offering “economically equalized goods”. I even walked with traffic enforcers*** as they tried to maximize the road width by removing vendor paraphernalia.
Then I went home for a day well spent. By then, my head was just about spinning and I was getting drowsy. I thought it was because the fever was coming back, but further research later revealed that those symptoms were minor side effects of Mefenamic Acid. I hit the sack almost as soon as I came home, planning to let the fever run its course after waking.
It didn’t go as I expected. The fever did not return. My body missed an opportunity to maximize its defenses. This might mean that I’d have this cold longer, or it could probably mean that my body boosted up its defenses despite my intervention. So even though I don’t act sick, I’m still technically sick. My body is still working overtime to get these nasty invaders out of my system.

*Some bacteria love iron; they use it to make toxins. The body recognizes this fact, and hides the iron from them.
**In actuality, only my left nostril is affected. For some strange reason, I have had colds that affected only one nostril at a time.
***These guys were nicer compared to their Manila counterparts. Manila raids can turn bloody as objects are torn, strewn, and defended by equally aggressive enforcers and offenders. Raids here are done by telling people off, and that usually gets the job done.

[1] Burton, Gwendolyn, R.W. MICROBIOLOGY FOR THE HEALTH SCIENCES, 4e. Philadelphia: J.B. Lippincott Company. 1992.

Darkening Cream

In an unbelievable event that would shock ordinary Filipinos, scientists have discovered a way to turn light skinned people dark.
Scientists recognize that fair skinned people have a damaged metabolic pathway that prevents them from producing melanin, the pigment that protects us from the sun. A study led by Dr. David E. Fisher, director of the Melanoma Program at the Dana-Farber Cancer Institute in Boston, tested a small molecule on red-eyed and fair skinned mice. It turned out that it restored the damaged pathway. Nevertheless, it would be a while before this would be used on humans. Good news for those Caucasians who want a tan. Bad news to those Filipinos who want to be fair.
Rumor has it that Filipino scientists are doing a parallel research. Instead of trying to repair the pathway that makes people dark, they are looking for ways to destroy that pathway. It wouldn’t be long before whitening would be as easy as lathering real whitening lotion on the skin. Now who wouldn’t feel happy throwing away those lying whitening soaps, lotions, and creams?