Sickening tales of a medical intern

(As told to the author)

Being a doctor is wonderful in theory.

After almost ten years studying the human body and putting this knowledge into practice through internship, a medical student finally graduates and gets to pin a name tag on his white jacket that says "M.D." If he gets so lucky as to pass the board, he will apply for residency in some hospital to specialize in some field of medicine for three to five years, depending on what he chooses. Then comes the sub-specialization phase of his training, which will again take a number of years. It is at this point that the fledgling doctor gets into a specialist’s wings and becomes a "fellow."

I am one of these young doctors – a medical intern.

As you read this story, I should be in a hospital doing my rounds to help patients get better. As you sleep soundly tonight, I would likely be still on my feet, still doing my rounds. You see, we interns are on duty for 36 to 48 hours straight.

So if you happen to be at the hospital as a patient or as a visitor and you happen to meet me, bear with me if I look pale or haggard or sound lethargic or even crabby. It may be that sleep deprivation has gotten the better of me.

When I tell friends and relatives about my tight schedule, they get shocked. Tedious, gruelling, cruel, inhuman – they might say. But not for me. Helping the sick is what I have always wanted to do. So I accept the consequence of my choice. I am not heroic, just honest. But come to think of it, that is what I am in the eyes of others. Simply being a doctor has made me some sort of family hero or star. My mom, for example, would never miss an opportunity to introduce this "doctor in the family" to her friends, expecting the usual reaction of admiration and praise

Honestly, being a doctor is overrated.

Maybe you would agree after I finish telling you these sick or sickening stories of what I have so far experienced as a medical intern.

My Story

The hospital I am working at now will have to be unnamed. All you need to know is that it is a public hospital and that a public hospital is very different from the private hospital you might be familiar with.

I am assigned to the OB-Gyne department where I help deliver any number of babies every day. Don’t ask me exactly how many, because I’ve lost count, but numerous enough for me to stop wondering why overpopulation is hard to lick in this country.

Typically, mothers would be on their feet, with only blankets to cover their bodies. They line up for their turn for a doctor to check their babies’ heartbeats. Now, these women should normally be lying down, but because there are few doctors supervising them, some are left to wander along the halls, waiting for the labor contractions. When they begin labor, they share a labor room with five to ten other expectant mothers.

Not too exceptionally, women would arrive with their babies’ heads already half out of their vagina, ready to slip down any second! Once, I had to actually place a hand into a patient’s puerta to stop the baby from coming out in the congested and unhygienic emergency room where deliveries are strictly prohibited. You can’t blame these mothers for not knowing when to run to the hospital. They could ill afford pre-natal consultation with a specialist who would be in a position to tell them exactly what signs to watch out for when the baby is due.

Emergency rooms tell a more gory tale.

The ER in this government hospital is always packed with people -- not only the sick but more often the injured, whether accidentally or willfully. Stab victims are a dime a dozen. The place is redolent with the scent of blood – blood flowing from patients with deep cuts or cracked skulls. We interns would clean and sew these wounds on the spot. Otherwise, we lose the patients.

Inside surgery rooms, the condition is not much better. Air-conditioning is seldom turned on. The rooms are comparable to wet markets and butcher shops. Let’s leave it at that.

I have experienced operating on six patients within a three-hour stretch. Because there are so many of them, we perform surgery on patients as fast as we can. A procedure that would take two hours in a private facility should be over in 30 minutes in the hospital where I work. Doctors don’t have the luxury of taking it slowly and carefully because more patients, also in critical condition, would be waiting for their turn on the operating table.

Public hospitals are horribly underfunded. There is always a shortage of medicine and other supplies. We interns and doctors have to make do with what is available. Or improvise. We use generic medicine in place of better, branded ones, or reduce the amount of vaccine we use to save it for more serious cases.

‘We’re only human’

I’ve heard far too many complaints on the behavior of doctors and nurses in public hospitals. We have been bashed for being insensitive, callous, and mean. We have been charged for being crabby and unapproachable. Hindi daw kami makausap nang matino.

Bear with us if you please.

If you work 36- to 48-hour duties, are sleep-deprived, and are constantly faced with patients who come in endless numbers, in a place not at all conducive to work, it is next to impossible to put up your best bedside manner and keep it up.

Doctors, you see, are not tireless robots but creatures of flesh and blood – just as prone to fatigue and losing our temper as everybody else.

Before you judge me rashly, I’m not one of those doctors who habitually yell at their patients. Even when a patient gets pushy and tells me what to do, I try to keep my cool. But at times I am very near the edge, due to sheer exhaustion and lack of sleep, and may not be able to resist retorting: "Sir (or Madam) if you’re not going to believe me anyway, then why did you even bother coming here to the hospital?"

Communicating with patients is often frustratiing. We are duty-bound to explain to the patients about their condition and what they need to do when they check out from the hospital. We try to speak clearly, plainly, in layman’s language, often drawing diagrams to illustrate what we want to say. For all these efforts, some patients still misunderstand or end up confused. The discussions can be long, drawn out, and repetitive, leading to nowhere.

A bit of hope

According to the Department of Health (DOH), there are 1,921 hospitals in the Philippines, of which 719 are public and 1,202 are private. This means there are fewer facilities servicing the health care needs of the majority of the population. Most of these are under-funded, under-equipped, and lacking in material supplies. Aggravating the situation is a decreasing number of doctors who stay in public facilities due to poor conditions and low pay rate.

There have been bills proposed in Congress to improve health care and the plight of health care workers in the country, but none has been implemented yet. Last May, in a speech before the Alliance of Health Workers, Senator Loren Legarda spelled out a plan for reforming the health care system, including a five-grade salary increase for all health workers, higher investments in facility upgrades, and more organized structure of personnel placements in hospitals.

I have often been asked if I plan to train or practice abroad. I often reply that I don’t know. Honestly, I don’t see the point of helping foreigners from other countries when many of my countrymen need medical services direly. Still, I cannot be certain where the future will lead me.

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