It’s 2 AM. I am home. I wish I don’t have to go back to Manila come daylight. I’ve only been here three days since the 14-hour drive back from Ilocos Norte and I have no idea when I’ll have the chance to come home next. When I packed my first travel bag to the brim with clothes and shoes for UP 10 years ago, I did not realize that it would be for good – that it was going to be the first of the countless packings and unpackings that will soon erase all traces of me living in this place. The life I live in Manila will always be foreign to that small-town girl who only learned to cross a busy intersection at 16, that same girl who was so hell bent on fulfilling her promise to take the Hippocratic Oath before turning 26. Now here we are, a full-pledged physician feeling like a stranger to the very place where she built those dreams.
This is the first real break I had since getting that MD. I managed to cram 4 years of medical school in 2 months, took the boards for 2 weekends, spent the next 5 hell days battling panic attacks and finally getting the results, decided over the course of the next 3 days that followed before applications deadline whether I can survive 4 more years of training without taking a gap year. Two days after sending in my application, I took the pre-res exam. Pre-residency started the next day and 2 weeks after, they’d announced the 2 applicants who made it to the program. It was October 2017, exactly 20 days after I passed the boards, I was transitioning to 1st year residency. I never got to stop after that.
When I was 8 years old, my family and I happened to pass by PICC on a particularly happy day. The newly beautified lawns were filled with people, mostly families dressed fancily, on an endless spree of smiles for cameras big and small.
“It’s Physician Oathtaking today”, I remember Tatay quipping. My mother replied with a long “wow” while peering through the car window and as I watch my parents marvel at this warm and blissful scene, in that moment, I knew I would one day take them here for when I take the Oath myself. What I didn’t envision though is that 17 years later, I would go back to PICC as a from-duty 1st year resident who’d only spend the entire ceremony sleeping. Ugly and unglamorous, but real.
It’s 3 AM. My toes, which had been mostly purple throughout the night, are starting to hurt. A few hours shy of making another trip to Manila, back to the arms of residency, back to life in the fast lane.
Intramuros, January 2018
The clock just struck 8:00 in the evening. I decided to wear a black sleeveless turtleneck blouse to match my ankle length black electropleated skirt. I had just come from a nearby Starbucks to purchase tokens for two of our senior residents who will be graduating tonight. In a large hall with one too many doctors and their families and consultants gathered around beautifully set round tables, I’m seated across my deparment’s chairman and our academic training officer, both dapper in a jusi barong and black coat, respectively. One of the many things one learns as a first year resident, apart from basic surgical skills and a great deal of scut, is taking good care of the consultants. Dinner had depleted my arsenal of small talks and anecdotes to keep everyone entertained.
“After 4 years, I will dress up for your graduation too, ha. No quitting...”, my training officer nudged as I set the leche flan and chocolate mousse plate in front of him.
Tonight was the perfect time to hear that. Almost 4 months in and I had already lost count of the times I thought about walking away from all these - the program, the new dream. I’ve never quit on anything my whole life. Never did I imagine that I would one day find myself wanting to quit on anything, but residency just does that to you. It strips you of the rose-colored lenses through which you used to see the world when you were a clerk or intern. You now see the hidden setbacks, the ugly, the strings attached. The body can recover from the physical tiredness, but being so emotionally spent is what gets you.
Although I hate to admit it, I am officially tired. Some days, I feel so inept, so clueless about what the hell am I doing. On the flipside, I should remind myself how lucky I am to be here – to get one of the two slots allotted for accepted applicants every year, to train under one of the founding institutions of ORL in the country (OMMC was the 3rd hospital in the country to open an accredited ENT residency program), to actually have the big guns in this field as my mentors. I keep telling people that the universe will always, always conspire to bring you home, where you deserve to be, where something waits for you. I dredge up memories of how I almost never showed up for my pre-residency examination back in September because I was badly intimidated by the other applicants and how Ma’am Karen, who graduates tonight, convinced me to try my luck. As they say, the rest is history. I will always thank her for that. I am so so tired, but I am too far in and too grateful to turn my back now.
Centuria Medical Makati, March 2018
I’m spending the day at The Surgery Center. I type this on my smartphone as I finish munching on my apple pie. We’ve just finished ironing out the glitches with the tech team. It’s MIFAS Day 2, spanking new red scrub suits on. We had spent the past months preparing for a series of postgraduate courses. I covered for everyone at the OPD, ER and wards 4 days ago while they were at The Medical City’s CASSTI for fresh frozen cadaver demos. I spent the day that followed at East Avenue Medical Center for Rhinoplasty Masterclass Manila. Back at CASSTI the day before yesterday, we each partnered up with MIFAS lecturers and preceptors for fresh frozen cadaver pre-dissection. Inheriting the department’s property custodian line, I was the instruments girl. I used the first hour after we’d arrive making sure all dissecting tables each had surgical instruments, all clean and complete. We had the nice techs’ assistance from the bioskills company at our disposal. It was my first time seeing fresh frozen cadavers and I was excited. By sheer luck I was partnered with Dr. Arzadon, a very soft-spoken man, who as I’d learn later on, was past president of the Philippine Academy of Facial Plastics and Reconstructive Surgery.
“Scalpel please…”, he requested as he extended an open hand in my direction.
The next few hours were spent mostly on one-on-one mentoring as we explored fascial planes, released retaining ligaments, isolated arteries, veins and nerves on half the face of the cephalus assigned to us. These heads were all latex injected and the way the structures were all very clear and marvelous and well preserved had me speechless. Excuse the language, but it was as if what we were dissecting had just died. It even bleeds sometimes. Nothing like the cadavers we used in freshman anatomy.
“I’ll see you tomorrow”, the humble doctor bid me farewell. I was left to work on the cadaver alone and as I was suturing the cadaver face in key points, I could not believe my luck. Who was I anyway to deserve those few hours dissecting this cadaver head with one of the top guns in Plastics? I cannot believe I got a free solo walkthrough of everything there is to know about facial anatomy, on a pristine specimen, in a well-equipped skills laboratory. Fellows train abroad and pay tens of thousands of dollars for a short course of this caliber. And as I finish my last few square knots, I realized this is one of the reasons why they say our program’s strength is in Facial Plastics apart from Head and Neck. I cannot believe this is what I was bound to miss on had I really quit the program a few months back. So thank you, universe, for helping me stay.
Sandbar Puerto Galera, May 2018
It’s 4AM. I had woken up to find my co-residents still purring in their sleep. It was apparent my body clock is still running on Manila mode. This is my usual bath time on OR days in Manila so I’d have enough hours left to clear the ER, do wound care on all the ward patients, do morning rounds before bringing all surgical paraphernalia to the OR and setting up the suites at 6AM.
I cannot go back to sleep. My muscles are sore from the snorkeling and island hopping yesterday. I decided to walk down to the beach alone. The wind was crisp, the water was chilly and my feet are sinking under the damp sand with every step. I never had this much calm in the months that had past. I needed this. People do not know it, but I’m always scared. I always tell myself, I eat anxiety for breakfast. As they say, it’s what keeps us running day in and day out - a little anxiety to power through and be productive. But sometimes, my anxiety is a little way too much. Sometimes, I don’t think it’s fair to subject myself to this much overthinking, to too much reading between the lines.
Puerto Princesa, Palawan, May 2018
“What time’s our return flight again?”
“7:05 PM, sir.”
Four people, four times the time of departure on the boarding pass got overlooked. I write this to kill time at the airport. Apparently, our plane takes off at 7:50PM, not 7:05. At the pre-departure area, I sit next to my immediate senior who had just been mistaken by a World Vision representative as my boyfriend. For the past days, I’ve been feeling uneasy, thinking about how I might get stopped by airport officials for carrying a considerable amount of surgical equipment in my check-in luggage. I went instruments shopping for my and Kiel’s tonsil sets at the Midyear Convention held here and I was hoping I don’t have to explain why I have sharps, so many tonsil clamps and 2 Dingman retractors in my luggage.
The past week had definitely been a breath of fresh air. The time I spent here in Palawan has been nothing but amazing. Nature here is breathtaking, the food always gives a party in your mouth, the people are extremely hospitable, there’s so much to do and go to in the city which, thankfully, has kept its provincial charm. This place is one of the very few that easily etched its place in my heart. Suddenly, private practice here in the future seemed like an interesting and feasible idea. I may be leaving tonight, but I’ve already made plans to come back.
I have mixed feelings about going home. When the plane lands in Manila tonight, I will be assuming post as the duty resident. Goofy and carefree mode off, agitated mode on. I was at Cowrie Island in Honda Bay taking a break from kayaking this morning when I received the news that 2 days from now, we will be admitting my and Kiel’s first elective tonsillectomy patients. I got extremely excited that it was all that I could think about on the boat ride back to Puerto Princesa. And as I type this tonight, in this city that I do not want to leave, I realized how scared I actually am. True, we’ve been accumulating OR techniques as early as October, but this is going to be my first elective case under general anesthesia. One of the consultants volunteered to supervise and assist us in our teaching case, which is comforting as much as it is daunting.
The past few years have taught me that anything can happen in the OR and being the surgeon, it’s all on you. A human life is literally in your hands. It had been one of my observations as a medical student that it was our professors who are surgeons who are the most demanding. From requirements, to reports, to even the sound system in the lecture hall, everything had to be perfect when they come in. They always need an assistant. I’ve always wondered why. I’ve always thought it was the ego that came with the cutting fields. But now that I am slowly becoming a surgeon myself, I realized I’ve become one of them too. And that is because in the OR, everything is prepared for you when you’re the one holding the scalpel. Being juniors, it is our job to make sure the OR runs as smoothly as possible so the surgeon can focus on nothing else but the patient and the surgery. Where I come from, the non-scrub junior residents, especially in my department, function as the circulating nurses (OR nurses here are a different story). We autoclave the instruments on premeds night, establish the sterile field on the crescent table and mayo table, arrange the instruments, alcoholize micromotors and cameras, prepare the cautery and suction, serve sutures, hold the surgeons’ phones to their ears during a call, run here, run there. Every malfunctioning paraphernalia is all on us. But it’s perfectly justifiable. As the captain of the ship, you cannot be bothered to worry about a malfunctioning suction or cautery, when someone’s life is on the line, when you have someone bleeding out on the table. Every step is crucial. I cannot believe I’m actually about to be that surgeon. I am very scared. In three days, I will be in an OR suite, heart racing, praying to God and the universe for guidance. It’s all on me. When I did an appendectomy as an intern, I had nothing to lose. Now, that I have a license that was 22 years in the making, I have everything to lose.
Ortigas, September 2018
I woke up to see Kiel lying prone beside me on the bed, holding her phone and updating her consultant. My eyes had hurt from the bright light emitted from her phone’s LED screen and I ended up flailing aimlessly with my eyes closed until I found my own phone in the dark. It’s 4: 20 AM. We had spent the night at Kiel’s loft-type condo in Ortigas after a last full show of Crazy Rich Asians and a night of shopping in AyalaMalls The 30th. I was from duty yesterday, my legs edematous and my head throbbing from a restless premeds duty. Our elective surgeries finished rather late yesterday, and we were able to only leave the hospital at 6PM, but I insisted that we both go out and relive what it feels like to act like normal human beings. It has been an emotional week for all of us, even traumatic for my only batchmate, most especially. It was the first time I’d seen Sir Migs cry and the first time I also cried over a patient since residency started. The past few days had us running countlessly to the operating room and pediatric intensive care unit, on a daily basis. We’d run codes every 5 minutes, until he stabilized, only to repeat the same thing the next day.
“42 codes total”, she sighed.
I was not able to speak. I do not know what to say. I sat on the bed and saw the gloomy weather outside. Rainwater was trickling down the floor-to-ceiling windows as smog covered the city below. Hauntingly beautiful, I thought, as if the heavens have decided to grieve with us. Painful, yes, but there was no one to blame. Everyone did everything by the book, by the guidelines. And yet we lost a life. But being captain of the ship, it was Kiel who had to face the family.
“I don’t know what to do had I been in her position”, I remember Sir Migs telling me 2 days ago. I don’t know what to do as well. I hope I would never have to.
I must have dozed off again. The next thing I know, the rain had ceased temporarily, the windows gave a better glimpse of the Ortigas skyline but I could not remember what day it was.
“Do you want to grab breakfast? Or should I book a Grab now?”
Remembering Kiel was supposed to be at the hospital by 8 AM for duty and that I have to do rounds on my post-op and update my consultant, jolted me up. In fifteen minutes, we were out the front door and into the chilly Sunday morning air. I still don’t know what to say to my batchmate. I was never good at comforting people. But I only know I have to be here, to just be present. Sometimes, it’s all you need. Sometimes, it’s all you can be.
Mactan International Airport, Cebu, November 2018
It’s 12: 15 PM. My family’s plane had just taken off for Manila. I’m typing this while stuck at the Starbucks in Mactan airport. I had booked a 6PM flight 2 months ago as I initially intended to explore Cebu alone after my parents and sister had left the city, but Tatay, being always worried about his girls, wouldn’t allow it. Recently, I have this constant itch getting lost in another city alone.
I just submitted my ward, ER and OPD census. You’re really doing a great job, self, for bringing work hundreds of miles from Manila on your supposed leave.
I just submitted my ward, ER and OPD census. You’re really doing a great job, self, for bringing work hundreds of miles from Manila on your supposed leave.
After a little more than a year, I finally got to take a leave of absence. Technically, I am allowed to have one since June, but there was too much work to be done. I used to ask a lot why we are required to take a leave, but now I get it. One of the saddest things you can hear as a resident from your ward nurses is “Doktora, nagtransform ka na.” Although it pains me to admit it, perhaps, I really have changed. A year’s worth of agitation from hospital problems, loops in the system, research stress, millennial medical students, crazy duties, and toxic life-and-death surgeries, I have transformed. When you have to be present in the ER, ward and OPD simultaneously every three days on duty for one whole year, it changes you. When you have to make ends meet in the a highly stressful situation on a daily basis, you can’t help but snap easily. It happens to all residents at one point, and it is happening to me. Cebu had been a really great distraction. A week away from everything had taught me to live normally again – to wake up without having to worry that you have rounds to do, procedures or surgeries to perform, books to read, consultants to update. Everything is a breath of fresh air and I needed that.
I’ve also realized something paradoxical recently. Sometime October, I noticed that somehow, I started to get my own rhythm as a first year resident. Maybe it’s the wisdom that comes after being bombarded with so many experiences and being made to feel a lot of different emotions and being subjected to the rigors of training. I’m more comfortable managing my ER and dealing with the flow of OPD patients recently. I’m less agitated during ORs and more confident with how I want things done in the wards, without being worried that I may not have enough time to do all tasks before endorsements. But just as 1st year started to become comfortable, easy and really fun, just as I felt I started to find myself in this place, it’s already the start of transition to 2nd year. More tasks, more responsibility, more expectations had started to tip the scales once again. Transitions and beginnings are for me, the hardest. And when my plane lands in Manila tonight, I go back to that life.