By By Vietrez P. David-Abella, MD
SURGERY 1
posted 9-May-2015  ·  
861 views  ·   0 comments  ·  
"Do you know how much you'll be getting here?" The Surgery Department Chairman was winding up the interview.  Back then, just to be accepted at a general surgery residency program was already a privilege granted to a few, so I blurted out,"No Sir, but I'm willing to work for free." And meant every word of it.

Until that time, apart from one summer that I got a job as a pharmaceutical representative, I HAD been doing everything and anything without compensation. After the medical boards, I volunteered in medical missions with COMMED to relocation sites in Pampanga and Zambales in the aftermath of the Pinatubo eruption. I also volunteered for a Medical Action Group-run clinic which provided medical checkups to workers for free, shouldering my own transportation money from UP Diliman to Taft Avenue, Manila. So, yes, I was willing to work pro-bono for training.

Leaving the Chairman's office, with assurance that I was one of 4 who were accepted into the 5-year program, my curiosity got to me. I inquired from the secretary: "How much would be my monthly salary?" She answered matter-of-factly, but I had shot up to the moon. After all the years of having to depend on my parents for everything, I would finally be able to take care of my own needs, and even help out the family in small ways.

And so the next phase of my life began: 5 years of going on 24-hour duties every 3 days; sometimes every other day. And 24 hours was just a term: it actually started from 7 am (not counting the wake up time, which was around 1 to 2 hours before) to after office hours the next day, around 5 pm, after endorsement rounds.

A regular 24-hour duty went on like this: 7 am was morning endorsement rounds, when the whole surgical service saw all the patients, private and service. New patients were seen and evaluated, plans and pre-operative preparations reviewed. It was our responsibility to see to it that every operation proceeded as scheduled without a hitch. Post-operative patients were monitored, diet and movement progressed. <Back then, we still followed the archaic Day 1, clear liquids; Day 2, general liquids; Day 3, soft diet; Day 4, diet as tolerated (DAT). By the time I finished training, we ordered DAT for most surgeries as early as the first post-operative day.>

Requested laboratory and other diagnostic procedures, referrals to other services, like pediatric or medicine, would have to be followed up, results and recommendations relayed to seniors and consultants. Some consultants insisted that we juniors accompany the patients to ultrasound or x-ray, not just to know the result firsthand, but to learn something of the procedure itself.

I looked forward to going to the radiology department with the patients, since I discovered that I could actually see the shadows and densities being described. To efficiently make use of time, I established rapport with the nurses and the radiological technologists, who would inform me once the patient was on the way, or already in, the radiologic suite. In between seeing patients, changing wound dressings, following up the availability of blood, etc., I would dash to radiology to catch the sonologist doing a whole abdomen ultrasound, or putting a drain to remove a liver abscess; other times I would be doing the t-tube cholangiography myself, injecting the dye to check if all the stones had been cleared from the hepato-biliary tract.

I also asked the ward nurses to call me when the cardiologist, gastroenterologist, or any other specialist, would be in to evaluate our patients. That way, not only did I get to know the results myself; I also got to discuss the case with the specialist, and relay the information to the surgical consultant: why this patient cannot be cleared for surgery just yet, why an additional diagnostic test is being requested, the assessment of a complicated geriatric patient.

At around 5 pm, when all the elective operations were done, we made rounds with our senior residents so we can report what had transpired the whole day, and our seniors could relay things to watch out for in the post-operative patients: excessive bleeding in the operative site, the hourly urine output of a potentially-toxic patient, quality and quantity of drain outputs. If things went according to plan, there would be time to eat a quiet dinner before the next barrage of ward referrals and emergency room calls came.

Some nights when there would be emergency surgery, I would be the first assistant for service cases. This was the time to learn firsthand the procedure, techniques, and maneuvers for the operation that would be our initiation into the general surgery profession: the appendectomy.  A few months into training, the first years looked forward to doing this as our first operation, so we were already preparing ourselves mentally.
I usually made my dressing rounds at around 5 am, before the ward nurses became busy for 7 am endorsements. We had to inspect all surgical wounds for any signs of infection, or redness around the edges. We also had to catch developing signs or symptoms, which might signal a complication, such as pneumonia. Of course this had to be reported during endorsement rounds. And if things went according to plan, I'd be able to have a leisurely breakfast before 7 am endorsement rounds.

Next: My very first appendectomy

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