To be the best for my patients

THIS IS an excerpt from my pre-residency admission essay for Internal Medicine - Philippine General Hospital. A set of guide questions where given. The essay reads like one of my blog entries, so here it is.

1

I'M LANCE, and unlike many people who go by other names, I'm simply “Lance” to most people I know—except perhaps my father who still calls me “Bon,” after the best sound I could blurt out when I was barely beginning to speak. My mother, then a voracious reader before her migraine attacks, named me after Lance Morrow, the Time magazine essayist who wrote about Imelda Marcos's shoes in the late 1980s. I emailed him ten years ago (I was 14), and Mr. Morrow jokingly said he and my mother were just “friends.” These days people call me “Doc,” so I guess I had better get used to that, too.

I was born and raised in Koronadal, South Cotabato, where my parents still live. Both sides of my family were descended from Iloilo and Antique before my grandparents migrated to Mindanao during the early 1950s. This explains why we speak Ilonggo—Hiligaynon, to be more linguistically appropriate—at home. Ours is a family of farmers. My grandparents were farmers. My father is a farmer. And, as a kid growing up, I also dreamt of becoming a botanist—short of being a farmer—someday. Sadly the plants I grew in our small backyeard—corn, monggo, and onion—didn't seem to love me back. My mother is a dentist, the closest thing to a medical practitioner in the family. I have two other brothers—the eldest, two years ahead of me, is now a lawyer; the youngest, three years younger, is a dentist. We didn't grow up with all the toys we could dream of, we barely had enough pocket money to buy sandwich in the school cafeteria (our father prepared snacks when we got back from school), but we felt we had everything because we had each other.

I'm a Christian, a work in progress, with too many character flaws not immediately visible to the eye, but I'm thankful for the grace God has given me despite them—a new life lived for Him. The idea of Someone sacrificially giving His life for people who do not deserve it never ceases to amaze me. I like literature, blogging, molecular biology, films, photography, good meals, and not necessarily in that order. To work as fiction editor of The New Yorker, to apprentice in Dr. Shinya Yamanaka's laboratory specializing in induced pluripotent stem cells, and to play the piano in solo concerts are my dream jobs. But I'm a doctor now, and that's a dream-come-true for me.

2

I STUDIED at the UP College of Medicine and did my internship at PGH. My experience was one for the books, as those who've gone to PGH will claim. A stressful encounter that comes to mind is my two-week old patient at the Pediatrics Ward, diagnosed with hypoxic encephalopathy and concomitant pneumonia. The family was supportive but was constrained financially. The mother, in desperation and tears, at one point begged me to adopt the patient instead. I, too, was heartbroken and, in a way, discouraged, because it reaffirmed the reality that for the poor, health care is a privilege, not a right. Still I kept on. For most times of the day I became the patient's social worker. I personally endorsed her case to Social Services daily, hoping that my smile, however charming, would free my patient from having to pay for a CBC, even for a day. My team and I found an unused stock of antibiotics, just a few weeks expired. It was the best we could find, and after the family agreed, we gave her the antibiotics which resolved the infection. The patient was eventually extubated, and was then discharged, improved. That anything is possible is pretty much the summary of the life of every PGH doctor.

On my MICU rotation during clerkship, I took care of a 70-year old patient with severe leptospirosis. He was beginning to show signs of pulmonary hemorrhage, and I treated him the best way I could. I actively updated his chart, checked his labs religiously, and updated his family constantly. I also studied my case with a rabid intensity I had not experienced before; I wanted to make a difference for this patient. I think he genuinely liked me. Days before he died he wrote me a note, “Paano na lang, Doc, kung wala ka?” I felt I did something right with my life—that medicine is the path for me.

I was also actively involved in the management of a 60-year old man admitted for septic shock during internship. I worked closely with the family who claimed that my daily visits were the only moments when the patient actually did smile. Through the experience, I learned the value of strong family support. I was introduced to the family members, many of whom I haven't seen before, who were profuse with gratitude.

I also recall—both with fondness and dread—my tour of duty as the JWAPOD/JAPOD (Junior Ward Admitting Physician-on-Duty/Junior Admitting Physician-on-Duty). The weight of the task was overwhelming to me, for I did not think of myself as particularly exceptional. But I worked with an efficient team that strictly monitored the patients and referred them for abnormal vital signs and other complaints. I learned a lot from the inputs of my seniors, who were patient with me, and who took time to share their clinical know-hows. To treat patients well requires that a doctor work with a team. I'm thankful that our group was a team that esteemed and respected each other, one that complemented strengths and weaknesses, one that celebrated victories with delicious breakfasts.