Wounded healer

AFTER BARELY three months of working as a clinical clerk at the University of the Philippines College of Medicine, I became acquainted with the different facets of a fourth-year medical student:

A clerk is a phlebotomist. Phlebotomists are trained to extract blood from and insert IV lines into patients, especially in private hospitals. At the Philippine General Hospital, clerks and interns are frustrated phlebotomists. Sometimes, it would take us one attempt to locate a vein. On not-so-good days, it would take us three or four punctures. Mind you, it is painful for both the patient and the clerk, especially if the activity involves a pediatric cancer patient whose veins have been punctured so many times for blood transfusions.

A clerk is a  manong, a messenger. A clerk transports laboratory specimens to the central bank, especially when the real messengers are not within sight (read: busy) or the residents are just too eager (read: agitated) to have the lab work finished stat. From one floor to another, from one place to another, we run to finish the lab work for our patients and to have them cleared prior to an operation.

A clerk is a father. I was on pre-duty once at the Neonatal ICU. There were babies left and right. Sobs every now and then. I experienced my inner father as I held a fragile neonate and tried to lull him as he wailed. There I was, dancing left-right, left-right, probably the way my dad carried me around two decades ago. It’s one of the simple joys of being a medical student.

A clerk is a shoulder to cry on. At the hospice, I was able to interview the children of patients with end-stage diseases. These children would weep in front of me as they talked about issues of loss, financial constraints, and the like. It was during these times that I discovered that someone’s presence is worth more than a thousand words, and that silence is worth more than a million words. I also realized that death does not always have to be sad, but it always has to be meaningful.

A clerk is a teacher. I had a patient who had a brain mass, craniopharyngioma, that may present with seizures, headaches and impaired consciousness. Yes, we discussed this disease in the classroom during our first two years in medical school, but I had already forgotten about it and could not remember anything beyond the brain mass. The mother wanted to know what was ailing her son. So, the student in me told me to study the matter and explain to the mother her son’s disease as simply as I could.

A clerk is a companion. I had a patient at the Otorhinolaryngology Ward who had tongue carcinoma. One of our tasks as clerks is to write incoming notes for our patients, including the history of the illness and the results of our physical examination. I was able to see the progress of this elderly woman, how she was not able to talk and her life-changing progress after surgery. A string in my heart was plucked when, after being unable to visit the patient one day, her relative told me that she had been asking about me.

A clerk is an aspiring doctor. At the ambulatory clinic, I had my first experience of writing my own assessment and plan. In most of our rotations, the residents would almost always dictate to us what to write. At that time, dengue and leptospirosis were the flavors of the month. And so, a patient presenting with fever was almost always a candidate for these diseases.

This was what I wrote:

Assessment: Dengue fever with warning signs. Plan: Repeat CBC with platelet count, increase oral fluid intake, paracetamol 500 mg every 4 hours, watch out for gum bleeding and vomiting.

A clerk is a prayer buddy. A neonate with gastroschisis (a congenital defect in the abdominal wall in which the bowel herniates into the defect) was assigned to me for Pedia. I carried out all the orders for this patient, making sure all the lab work and referrals were being done. At PGH, it takes forever and a day to have a surgical procedure done. The mother requested me to include her son in my prayers, so that the exposed intestines would be finally put to a definite close. The baby underwent surgery, and died the week after my Pedia rotation ended.

A clerk is a wounded healer. On some weekends, many of us do not get to go home. We report to the hospital and still do student-in-charge work. It’s part of the price we have to pay for aspiring to become doctors. It is something we choose to accept—that we would be with our family only once in a blue moon. Other sacrifices include being awake for 24 hours (sometimes 36) during our duty. I will never forget the time when I just heaved a sigh and told my patient in all honesty, “I am so tired.” At that moment, when I was able to say it, I did not feel less tired. I felt less alone.

A clerk is not Clark Kent. We cannot save each and every life the way Superman does. We make mistakes. I feel inadequate at times. In my three months of being a clerk, I learned that doctors can only do so much. But I can still do something.

I get tired. I get sick. I get wounded. Sometimes, I lose the drive and I get disheartened. Still, I manage to pick myself up and remind myself why I took up medicine in the first place.

Rogelio N. Velasco Jr., 25, is a medical clerk at UP-PGH.