When it is worth staying

I had come home full of doubts. The four-year specialty program on anatomic and clinical pathology at the Philippine General Hospital was difficult to get into, but no one told us getting in was the easy part and staying was quite another thing.

I chose that specialty because I found an aptitude for it during medical school. It was also where my highest board rating came from. But real-life pathology—capturing lesions, diagnosing and grading tumors, resolving clinical chemistry or blood bank discrepancies—leaves no room for error. A patient’s life is at stake and the clinicians heed your opinion because the patient’s chemotherapy or treatment will depend on your diagnosis.

Ideal pathologists are objective, sharp, and obsessive up to the littlest details. I was a writer before I became a doctor. Whenever I came up with a diagnosis of cancer, instead of immediately checking for lymph node metastasis for staging or perineural invasion, I would think: How is this going to affect the patient and his/her family? Even with reports, my writer skills are of little or no value because describing specimens must be done very concisely and clinically, with no fancy turns of phrase.

I cannot recall an instance when my heart didn’t pound like it was going to burst out of my chest while doing live microscopy or presenting an autopsy case in front of the whole department or interdepartmentally. Six months into surgical pathology, I still sometimes struggle to read slides, feeling dizzy or having a headache after reading two or three trays. I read reference books while looking at slides, making it twice or thrice longer than when my seniors do it. During our exams every 15th of the month, I feel like I haven’t studied enough. I feel inadequate, which never happened before (I finished among the top group in med school).  Missing minute details or inadequately staging or grading lesions pointed out by consultants made it difficult to save face. It was time for me to reassess.

As the plane descended and taxied on the runway of Tacloban airport, I was starting to feel like myself again. Gone were the hustle and bustle of Taft Avenue in front of PGH; what I could see were the green canopies and the blue-green waters of Cancabato Bay. I was home to talk to my mentors and fellow residents, formerly my classmates in med school.

I spoke with residents of anesthesiology, surgery, obstetrics, and pediatrics. As we talked more about residency training, I realized that at the baseline it was difficult in any specialty. Seeing our seniors now in their second year and beaming with newfound confidence made me want to try harder and stick with the program.

Seeing also how much we needed to do to fill the need of Eastern Visayas patients who sometimes have to go to Cebu or Manila for diagnosis of various malignancies, I felt a new resolve to complete the program in PGH. I was lucky to have had access to rare cases of a large volume and variety, with subspecialists in pathology to teach us. I hope we can bring such expertise to Leyte and Samar one day.

There was a lot to be done, and it started with my flight back to Manila. I was met with horrible traffic from the airport to Taft, but I needed to sign out cases with a consultant. Suddenly, no hardship or challenge was enough to make me leave the program. Now I wake up thankful for every day that I get to learn something new about pathology—knowledge that I can take home one day to Tacloban.

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Thaddeus C. Hinunangan is a resident physician in pathology at the Philippine General Hospital.