Summertime

"In the summertime, when the weather is fine...you can jump right up, and touch the sky..."

(CG's nanny, enjoying the afternoon swim at Lalimar Beach resort, La Libertad, Negros Oriental. April 10,.2010. We had the office outing there earlier. I saw her sitting by the pool's edge, and was reminded of bright bright carefree summer days...and just had to snap this one.)

A Piece of Me (For April)

I Like:
 > Spontaneous, surprise adventures, like the one my best friend Ivy called me up for yesterday afternoon...

IVY and the Sulfur pools. (She's a geologist, and she did a pretty good job of explaining how these sulfur pools came to be.)

That's my best friend and her sister, and her sister's friends (all new med school graduates), doing a jump shot at the Pulang Bato, Valencia sulfur site. :-p

Twin Falls, Valencia, Oriental Negros. Iron oxide leaches onto the rocks , coloring them red. It looks pretty fab. :-)

See what I mean, when I say red rocks? It's not slippery even, like algae. It's just a coating, a dusting of red on the rocks.

Dinner with Ivy's family. :-)

> My easter sunday outing in Lake Balanan (in Siaton, Oriental Negros)  today!

The  Balanan Girl. haha. :-p Anyway, Balanan is a mountain lake  about an hour (felt like more) away from Dumaguete City. It was a spur of the moment trip out there that my cousin Greggy suggested for Easter Sunday.

Kayaking. April 4,2010. Balanan has many water stuff to do...we went kayaking too, my cousins and I (including Tita Joy) at about 12noon (immediately after we got there.) I'm not much of a "rower" and my nephew CioCio complained that I'd only paddle in short bursts daw. :-p I feel sore now, admittedly.)

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Lake Balanan and tourists. :-p that's me and my cousin Smongkie (not her real name, but what I like to call her anyway, and Tita Joy (but I don't call her that, I call her Jocie Baby).

Ciocio and Smongkie at the Lead. The kayaks usually fit only two people, but since I was in a "Tri-Yak", i sat in the middle and didn't have to paddle, which was why I was able to take pictures while we were in the middle of the lake (it was a big risk, actually, one false move and it'd have been byebye to my beloved Canon forever...but luckily, that wasn't the case.:-)) My called me a dead weight, by the way, 'cause I didn't paddle. lol

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Lake Balanan, Siaton, Oriental Negros. April 2010. Its nice and serene, really. You should come visit. :-p

> also, I like studying/reading my medical books. 

> Rocky road ice cream.

> Parker pens.

> Wearing dresses.

> Delivering babies. 

> Having to say no.

> Thinking about someone.

> Hanging out with my cousins.

> That i was almost in a bad car accident yesterday, but was lucky enough that it didn't happen.

Wheel-less wonder. April 3,2010. This is a perfectly normal van, with no wheel seen. :-p Well, yesterday afternoon, instead of taking the bus, I decided to just rough it and ride on of those "V-hire" vans. (They're small, and get cramped because operators tend to stuff it with as many people it can accommodate.) So anyway, we were about 40 minutes into the trip, and I was starting to doze off, when suddenly, we all hear a sound, and the van starts getting into a weird angle. And then there is this burnt crude oil-ish smell...and then the driver stops us and shakes his head.

Renegade. Now, if that looks like the renegade wheel, then it probably is. :-p The wheel had popped out of the...thing. (I don't know what it's called, ok! :-p) and ended up like this...

Yes, it ended up that far away... (I actually had to cross to the other side of the road to take this.) Anyway, it was very lucky that the driver wasn't going fast (they usually drive really fast) 'cause if he were, i think I would have been telling you about my sixth unfortunate accident in a moving vehicle, if i had lived to tell the tale. But that's really exaggerating. (As my uncle keeps saying, "If it's your time, then it's YOUR time...") :-)

Well, for the driver, it's another thing to pay for. My heart goes out to the man. 

Thanks Mister, whoever you are. :-)

I DON'T LIKE:

> feeling as if I have to please everybody.

> Mothers who don't care to have prenatal check-ups.

> eating liver dishes. 

> fried eggs or oily food that I usually get served for breakfast when I'm on duty.

> not being as physically strong (or limber, haha) as I was when I was younger. 

> Being told by the hairdresser that I'll look "beautiful" if I get my hair rebonded (like everyone else? No thanks. I like curly hair fine.)

I WANT YOU TO KNOW:

> that the best way to forget is to stay away.

> that in infertility testing, both husband and wife have to be tested.

> that I need to know how to lose 5 lbs in two weeks.

> that I don't want to be taken for granted.

> that depression is very very common in the geriatric population.

> that I miss Psych lectures, and if it were only an hour away (or 3), I'd go check it out.

> I've started studying for a big test.
> And that I love what I do. :-)

I'VE PLANNED:

> to be in Boracay on April 22! Iloilo/Boracay, here I come! :-) :-) < I'm going with the DOLE nurses from the hospital. :-)

I WANT TO SAY TO SOMEONE SPECIAL:

> Congratulations to "my little sister" Loreen, Weng, Loti and Ding, and Ann (Annex Blue!) for graduating. I hope 4 years of med school wasn't tough on your knees. haha :-)

> Thanks Vivz!

> Thanks Tita Clarie!

> Happy Birthday Farah-noid! :-)

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Piece of Me is a monthly game. Feel free to join in. Check out details at the ToothFairy's Blog.

Ok, good night!

:-p

~ S.

The Regina Coeli

                                                        The "Sugat". April 4, 2010. 4:30AM.

In Catholic Churches everywhere in the Philippines, there is a tradition called "Sugat", which, in my dialect means, to meet. This meeting is a reenactment of when Mary meets the risen Christ (who had died and then risen). It is symbolic, and in these reenactments, the "Angels" are called upon to sing. It is a familiar song to me because most of the girls in my town have, in one way or another participated in this (myself included, heck, i even participated from when I was 4 until I was 11..haha).

(It used to be just girls participating, but lately, they've been putting in boy angels too.)

The song Regina Coeli is sung in Latin, and everyone waits in bated breath while these kids sing. It is a solemn song, and has the nicest translation, but when we were kids, we were taught to sing it at the top of our voices (I sang Soprano, even then :-p) so we were just probably yelling it out without really knowing what it means.

It is an annual thing, and annually, it ends the same way... Because of the folk belief that the decorations of the stand are like lucky amulets, there is always a clamor for the flowers and branches on the stage. Once i even heard that when a fisherman attaches flowers to his net, he is sure to get a great big catch...(and who doesn't want that, right?). Happens every year, really.

Anyway, it was only this year that some sort of discipline was instituted. The priest firmly instructed people along at the end...it was made sure that the kids were safely off the stage first, before the "go signal" was given. :-p It was even a bit comical that for such a solemn, and religious ceremony, would become like rabid heathens just to get at amulets. But hey, people compromise...

I'm not all for it, but hey, it's tradition.

And like all traditions go...Happy Easter. :-)

Straight from the nose

"S., I'm referring to you a case of a 3-week old baby who is having skin desquamation...", so went another doctor from the town's local health center. She was sending over one of her patients because this one was from one of the mountain towns and would have a hard time following up is she was only put on oral meds, and would need to be admitted.

(She calls me by my first name because I'm a younger doctor and since we shared a bus conversation a few weeks earlier, it was a pretty comfortable working relationship.)

After getting the necessary information, and finding out that the patient was stable, I waited. I had some differentials in mind prior to seeing the patient, but the moment I saw the patient, I couldn't help but smile...a big Cheshire cat grin was slowly spreading across my face and I had to quickly stifle and hide it, otherwise, somebody who could see it would think I was going crazy. I whispered to myself, "Gotcha..."

It was a case of Staphylococcal Scalded Skin Syndrome (brief info here, medical journal here :-)), and my patient had clear-cut symptomatology straight from the book. Now, I wasn't happy that the patient had it, no, but it was kind of a triumphant "Yess!!" moment for me back there.

The story is that one time, when I was doing my internship rotation in Pediatrics, I happened to admit an 8 month-old patient who had sudden onset of skin redness and cough. The patient was said to have been placed under a mango tree (in bloom) before developing the redness, which prompted his parents to bring him to the hospital. Now, this kid had a history of atopy, and was prone allergies in the recent past. On physical examination, he was essentially well, only that he had the generalized redness.

In internship, it is customary to "endorse" newly-admitted patients in morning rounds; to state their history and physical examination (as complete as possible) from the interview you had done previously and to let the receiving team know of the patients they were receiving for the day. So anyway, when my turn came, one of the residents asked  me to endorse a patient, my "red" patient.

And so, I stated all the facts required, and in the end, presented my working diagnosis as that of a hypersensitivity reaction, which would resolve shortly after meds were given. One of the residents asked me how I came up with my diagnosis and if I was considering something else, like, maybe Staphylococcal Scalded Skin Syndrome. And I paused before speaking, because I wanted to measure out my words carefully, because one thing could lead to another and thus a neverending line of questioning would be started.

I quietly (most interns would, haha) answered, "It is possible, Doctor, but an allergic reaction would the more likely situation..." and then the chief resident's eyes go huge and his voice rises a couple of decibels higher and he goes, "Isn't that clear enough for you???"

"But..." I started to say, because I did a physical exam of this patient, and instinct told me anyway, that the symptoms didn't match up. "Why do you still insist???" he went again..

I think I got a nudge from my seatmate B., as a sort of a sign for me to back down. It was a better idea than to risk the ire of that resident by plodding on, perhaps. B., pulled me aside afterward and said, "You know, it never is a good idea to insist, just try to do your job, and try not to get in trouble next time. This is not the time yet to assert yourself, you know."

And so, with a bruised ego, and a partial annoyance, i let the matter be, but I did read up more on Staphylococcal scalded skin syndrome just in case I would need to have to defend myself again.

I never did get to, no other similar cases came up...

-----------------

The patient's mother was kind enough to allow me to take pictures of her baby so I could do more research. She gave me her [explicit] permission, which I'm thankful for. :-) This works both ways, you see...I'll get to know more about SSSS educate other people better, and correspondingly, she'll also get better treatment, and will also learn about and understand her child's condition better.

From Drop Box

It is characteristic to have tissue-paper thin peeling and bullae, with superficial desquamation, which heals within 5-7 days.

From Drop Box

This condition is caused by a toxin-producing Staphylococcus (a common agent of skin infections) which causes skin layers to separate, resulting in easy tears of skin layers, as noted in the picture above.

From Drop Box

Funnily enough, epidemics of these, are caused by being naturally affectionate. :-p  The patient's mother revealed that they had house contacts who had the sniffles and would repeatedly kiss and hug the baby.Research revealed that 20-40% of normal persons are frequently asymptomatic (meaning, they may have bacteria present in their nasopharyngeal secretions, but these don't cause any visible disease), or the skin, or the axillae or the buttocks.

The prognosis is quite good in young children, as long as meds are taken and there is constant follow-up, the condition should resolve in 5-7 days without complications (adults are a different story). Fingers crossed, hopefully we'll all do well in the next few days.

--------------

By the way, here's something I'd like to leave you with...

The attending physician of the "red baby" signed out the final diagnosis in the chart. Guess what she wrote?

"Hypersensitivity Reaction...(and etc etc)"

Gotcha. 

:-p

Pop quiz

From Drop Box

Pop quiz: Since last post, I have...

a.) gotten pregnant and delivered twins
b.) adopted a pair of twins, just 'cause
c.) decided I wanted to propagate
d. delivered my first pair of twins, without a hitch. :-)

(yes, of course it's D.)

:-) Now, before anything else, I'd like you to know that I had asked the mother's permission before posing with the little buggers. :-)

Anyway, it was a surprise delivery (i.e. she just came from out of nowhere), and there were many factors involved that I'm not at liberty to tell, but I'm just posting this picture to remember my first twin delivery, and to remind me to stress how important reproductive health and being aware of our rights and responsibilities as child-bearing women is to my patients.

I love delivering babies, no doubt about that, but at the back of my head, there is always this fear of the unknown, a realization that something could always go wrong, which is why I breathe a little prayer before starting for everything to go well. So far, I have been very lucky...my deliveries have gone off without a hitch.

(Somebody loves us up there.:-))

I'm watching you...

Peek-A-Boo. (Bus Ride to Dumaguete. March 23, 2010)

...lady.

             (I like taking pictures of kids. They're absolutely easy to please. And they love smiling for cameras. haha)

Smokers are Bad for your heart

...in one way or another.

 (Charming. March 17th, 2010)

Project 365: Day 4 "I know where it's at."

The Surgical specialties are where it's at. 

The big money, I mean. 

To illustrate a point, i got these props together to come with this picture. Some of them were borrowed, stolen, and collected, but I'm not telling which were what. :-p

I got to thinking about probably going into Obstetrics as a career choice, because the past several weeks, I found myself enjoying my Obstetrics work at the hospital. I delivered 4 babies in one tour and I enjoyed delivering babies immensely. It is a happy specialty, I told a friend once, because you get to deliver babies...AND contribute to their health while developing. (You can't get more hands-on than that.)

One of my distant cousins is an OB-GYN, and so far she is doing pretty well for herself. she is always busy...and oftentimes doesn't have a lot of time to spare. She is almost always busy, but does balance it well, though, so it's good. 

She didn't say anything about recommending that I go into OB...but she did seem pretty surprised that I wanted to get into neuropsychiatry. Like she thought I was a weirdo or something. lol.

OB usually is so...practical and repetitive, whereas, Neuropsychiatry is so...three-dimensional, no contest there. (And, it almost always made perfect sense.) 

And...also, just to insert a minor detail, Clinic hours were regular 8-5 (if without emergencies), so I'd have plenty of time for my 10 kids later.

jk. :-p

Project 365: Day 3 "The Coconut Oddity"

 

"Coconut Oddity." Manjuyod, Oriental Negros, February 15, 2010.

David Bowie did "Space Oddity", right? For some reason, I could not think of any other word more fitting. :-) It's a terribly provincial photo, but what can I say, I pass these by when I ride the bus. :-)

Anyway, this is a coconut tree about 30 minutes from where I work, and they say that at one point lightning struck it, and after that, the tree just branched out and grew another full head of coconut fronds.

These are coconut trees, not "Palm" trees, by the way. haha. So not L.A., California. :-) (Or should I really be calling it a tree? ooh, it boggles...)

It reminds me of the pair of conjoined twins featured on Life Magazine many years back about a girl born with two heads...or was it two girls with one body? Nonetheless, they both had distinctive personalities, as with this tree, which bears fruit equally on from both "heads".

Project 365: Day 2 "Red red roses"

 

there is something about red roses that's so juicy.

The concept of red roses for lovers only...is just so overrated. Regular people enjoy them too.:-p Patient P, a kind, middle-aged lady left this at the ward the other day. Flowers brighten things up, any day.

Someone added tamarinds with the arrangement, and now they call it, "Sweet and Sour" flowers.

:-p Just a so-so post for Project 365. :-)

Have a nice day!

Project 365: Day 1

Day 1:  This was a gas truck that (I heard), made a wrong swerve and ended up overturned. May parents told me that earlier in the day, the whole area stank of gasoline and traffic was up to the next town. This was in San Jose, Oriental Negros. I just realized how dangerous it was...what if someone had had a lighted cigarette and had been really careless that day? tsk tsk...

Now that's a thought...does it really happen like that in the movies?

I suppose it is not a good idea to start off my pic-a-day project with a spill such as this one, but nevertheless, it is a dramatic enough pic for posting. :-) I have many many random pictures on hand, actually, but since I'm not online everyday, I am going to be delayed most of the time.