Chapter 1: ONLY IN PGH CHART BATTLES
One weekend on my tour of duty, a potentially toxic patient who was admitted in ward seven was endorsed to me as a probable case of dengue. She's a known patient with a mental illness who developed a fever and she was admitted in the ward with considerations of possible adverse drug reactions. But she developed the typical rash, her blood tests showed a downward platelet trend, her NS1 dengue strain came out positive and "'twas the season" so to speak. She was referred to the proper department for co-management and was worked up. Of course, being the resident on duty for the day, I did my rounds and checked her lab results. It's probably a bad habit of mine, I don't know. I like to scribble. I do it everywhere: on books, pictures, magazines. It's just like extensions of my thoughts. I'm sure I'm not the only one. No harm there... or so I thought, because while I was reading the other doctor's entry on this patient's chart, I stopped short, underlined his diagnosis and put a question mark. It wasn't an affront or a challenge (because I didn't agree with what he wrote), I was just asking myself why he didn't think the patient had the dengue fever. I decided to wait it out, after all, the patient was clinically stable, and I forgot about it after some time. It was only later that my co-resident informed me that my name was especially mentioned in the next chart entry:
"TO DRA ROBLES, PLEASE DO NOT WRITE ANY MARKINGS ON MY CHART ENTRIES.
As if, it had anything to do whatsoever with the management of the patient's case. Hindi ba gagaling ang pasyente kung susulatan ko ang entry niya? I was so tempted to underline and question mark it again (panggarit-garit,hehehe!), because these, including my own "markings", I admit, are things that shouldn't be on official legal documents and have nothing to do whatsoever with patient care. But, Jesus... My self esteem does not rely on the defenses of others.
I'm not even going to start with my most recent chart-battle encounter in the ER. A lot of those entries are way too emotionally charged to even be allowed in legal prints. Talk about defensive medicine, indeed. It's a good thing there are mentors who know how to pull us away and prevent us from being sucked into that useless whirlpool.
It's just so frustrating, that's all. In PGH, cases like this is nothing uncommon. People from all over the country admire a doctor who has trained in PGH. I wonder what they will think if they were given the time to study what these doctors actually write in the official charts. tsk...tsk... They'll think it's not a hospital but a courtroom.
But enough of that. I'm not saying I'm the expert in medical conditions. I wouldn't refer to other departments if I didn't value their input. I'm just saying that if we're all really confident in our clinical choices then we don't have to be so insecure and defensive about what we deem clinically important enough to write in these charts... But, I'm simply finding myself in a war that has long been started prior to my even stepping foot in this hospital. I just don't want to get pulled into the band wagon. It's embarrassing and quite unprofessionoal, you see, when a lawyer or a judge sees these charts and finds grudges, arguments and other what-nots.
I'm just saying...
Chapter 2: AND THE BUDOL-BUDOL GANG RISES AGAIN!
I don't know how that one went. I remember a previous blog where I wrote about my best friend's dad who suddenly disappeared and everybody thought he was victimized by the Budol-budol. It turned out he was just driving around for no reason and came home safe. But anyway, Manag B, our housekeeper had a visitor the other week who claimed to be her "tito". He was let into the house while Tope and I were at work and Nanay Ring was in Cubao with my baby. She's pretty vulnerable sometimes, Manang B. But this "Tito" allegedly knew so many things about her family. He was practically telling her the story of her relatives that she didn't once think it could have been a heist. He was plain looking and friendly that she put her guard down and actually let him into our house. He walked away with 1,000 pesos (because Manang B had no money and there's practically nothing in the house worth stealing) but he was asking her for ten thousand. If Manag B probably had the cash at hand, he would have gotten away with it, because she basically handed over whatever she had and even walked him to his jeepney ride. It was only when she arrived back at the apartment that she realized she didn't know anything about this man: not his name, not his address, not his contact number. Not even his purported relationship with her family ties.
Needless to say, Manang B found herself sleepless that night until we came home. Tope and I were worried, of course. I've had one nightmare of Manag B mindlessly handing over a happy, drooling little Promise in an attache case with a dollar sign.
I remember laughing about the Budol-Budol. The name, itself is hilarious to me. But, my God! one of them got into my house! Tope keeps saying it's a good thing we're poor.
Chapter 3: FREUDIAN TEXTS AND GOYOSONWE
How do I explain goyosonwe?
I can't.
The very essence of it won't let me. It's against its very nature.
Let's just say goyosonwe is invoked when things simply happen without our conscious control, like when you're dreaming and your ego sets are weak and the only thing that your mind can do to temper the unbridled id is to transform your unfulfilled wishes into something non threatening like a unicorn or a pink cloud... or make you believe you're answering a text message when you're actually still asleep...(yiii!)
You realize your mistake only when it's hilariously too late. So you resort to humor to hide the fact that you're unbearably embarrassed with yourself.
Like sending a text message to your consultant at 11 pm which was meant for your sweetheart.
My ultimate goyosonwe.
Haist! It's all my fault!
It was a toxic from-duty day. The last text message was to Dr. Vista, who was my consultant on deck for my tour of duty. I was referring a patient for possible admission. She's the same patient whose ER chart is filled with emotionally charged entries with underlying currents of vindictiveness and boiling frustrations, and most other things I'd rather not describe. It took me until close to midnight before we could finally settle what to do with her.
And then they decided to go home against medical advice.
And LU 5 was about to start again.
And I haven't seen Promise for 2 days.
And I was so tired.
And I texted a "patweetums" message to Tope and then sent it to the last person I sent a message to.
And Dr. Vista brings it up in the ER conference the next day with a big, naughty grin that I couldn't bear to look at.
And I wanted to crawl under the table and never come out again...
I wish I could say lesson learned, but the more I tell myself never to invoke the goyosonwe again, the more it comes back with a vengeance.
I suppose it's kin to the cosmic joke...
I don't want to invoke that either.
So there. :)
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