beforethesunsetsinthesky
Thoughts, Dreams, Stories of a Young Doctor
"A man does not consist of memory alone. He has feeling, will, sensibility, moral being... It is here...you may touch him, and see a profound change."
-Luria.
35 posts
Don't wanna be here? Send us removal request.
Last Seen Blogs
jumpingjelliefish
Jellie :D
trashinyourpockets
Vinny's Corner of Shams
fryday13
Talking To The Abyss
atlantabaddies
Atlanta Baddies
taylorlynn-art
Taylor Lynn
Text
"Let's survive for today"
I used to judge my friend who would cry so easily over patient's death. I told her it was unprofessional. We should be better than that. I told her it's not wrong to feel sad about it. We can cry all we want when we're not in front of them anymore.
Well anyway, I ate my own words when the attending gave me the responsibility to discuss the prognosis of the patient.
They want me to tell them if it's still worth it to fight for the patient's life. They want me to tell them if it's still something worth spending a lot of money from--because if not, they'd rather just take him home so he can spend the next few days of his life at peace in the comfort of his own house.
I didn't know what to say. I just knew I didn't want to give up. Everything feels like a hundred shades of gray in medicine but I always err on the side where I fight. And I wanted to err on that particular side for this patient because of something I heard his wife said while I was trying to insert an NGT--and failing. The patient had been cooperating well during the insertion but there was just something blocking the opening of his esophagus. "Tiisinin mo na lang muna. Ngayon lang. Para lang makasurvive tayo today, please."
That simple statement just broke me. And she showed me pictures of him before the laryngeal cancer ate away half his neck. She showed me their journey. But I didn't really just see how the mass slowly grew into the fungating mass it was. I also saw how they fought hard with the little that they had.
So how can I have the heart to tell them to give up and take him home when they had come that far?
So his wife and I stare at the panoramic view of the hospital from the 4th floor. The night was quiet and peaceful but the rooms inside were filled with agony.
I tell her I can't tell her to give up. And as a doctor I will never be the first one to give up. But if due to financial situations they will opt to stop all medical treatments, we wouldn't blame them either. We all wanted the same thing but we won't suffer the same consequences.
I told her that I know--every single one of my actions will be another dime out of their rapidly depleting pockets. But my actions aren't empty either--I just want the best for the patient.
And I cried because the world was cruel. And it was so unfair we had to choose between life and death where money was the divisor.
There's nothing remotely glamorous about this job.
0 notes
Text
Lost paradise
I used to think one of the saddest things I learned about Heaven is our earthly relationships will be voided.
My parents won’t be my parents. My brothers won’t be related to me. My friends might not be my friends.
And funnily enough, a passing thought: we won’t know each other’s names.
For the longest time, this idea burdened me.
There is a place flowing with honey, where the streets are lined with gold, the houses can’t be eaten away by termites—but we don’t have our earthly names.
For some time, for a long time, it bothered me.
It felt weird to dread something in heaven. And at the same time, I wondered too: why do I treasure my earthly name so much?
But now.
Now, I get it.
As much as this short life is full of beautiful memories, there’s also equally, just as much pain.
And heaven is a place where no one will have to cry. It’s a place where there’s no tears or anguish anymore.
Memories are baggages. Names are labels. It carries all the sins our earthly bodies committed.
There’s freedom in anonymity.
So I ponder on this for hours.
I tried to imagine what paradise is like. What it’s like to be free from all those memories. What it’s like to be free to just love without questioning everything. What it’s like to love without doubt.
What it’s like to love without shame.
And so, my dear.
I hope you keep that heart of gold. I hope you keep putting God first in your life. I hope you never forget to hold His hand, like I did multiple times before. I hope you get through this earthly life with that much of you intact.
I hope I do too.
Because these days I feel like giving up on some things. I feel like accepting that there are some things that might never come true.
And so, I hope to see you in Paradise.
I won’t know your name. You won’t know mine. Hoping, there is a part of ourselves, our souls maybe, that will be able to recognize each other.
Maybe then,
maybe.
0 notes
Text
It doesn't get easier.
No matter how many times I say this. No matter how many times I have these conversations with them.
It never gets easier to skirt around that word.
It never gets easier to stop the tears from falling.
It never becomes less awkward to put a hand on their backs.
It never becomes less weird to hug them.
It never becomes less painful.
Maybe being forgetful is a gift. I won't remember their names. I won't remember where they live. I won't remember their relatives.
The tombstones in my graveyard are nameless.
But there's a story nonetheless.
And I don't hope it will become easy.
I don't wish for deaths to be easy. It's not supposed to be easy.
I know there are no right words--but I wish I can find them nonetheless.
0 notes
Text
I don’t know if this will reach you, but since this is my only public blog at this time, maybe it will.
I know you’re starting a new chapter in your life. Knowing what life like there is like, I’m terrified for you. It might sound like I don’t trust you a lot with dealing with the same if not a greater amount of stress I have experienced.
But to a certain degree, I know you. To me, you’re like a puppy. A puppy I need to protect no matter what.
And in times when you doubt the direction your life is taking, I guess…just remember this.
Remember, somewhere out there, there is a girl who regrets everything for the past 5 years of her life. There is a girl who wants to turn back the clock and change her own words. There is a girl who kept dreaming about you even when she no longer sees you.
And that girl is…me.
And as your life follows a parallel line with mine, the years that add up would feel more and more like a burden.
My apology hangs above my head like a dark cloud.
I’ll be all sunshines and rainbows then I’ll remember I hurt your feelings.
I’ll be all happy memories and adventures then I’ll realize you’re still not a part of my life.
I don’t know.
Maybe in your down time, when you’re not too busy, maybe you’ll remember this random meaningless text on my blog and assume it’s you.
I hope you assume it’s you.
I’m not sure about a lot of things but I just want you to know, I didn’t mean it when I said no. I didn’t mean a single thing I said back then.
And I’m still not sure what I want in the future.
For now, I just want to say I’m sorry.
And that I hopelessly, unabashedly…just want to be a part of your life again.
0 notes
Text
You were made to be you.
The reason Even Ducks Get Liver Cancer is so much more than just a book written by a consultant in the institution where I will be training came to me today. Why was reading about the misadventures of a doctor so comforting and entertaining at the same time? Was it simply because it was written in a clever and medical noir kind of way? Maybe.
But also because it reminded me of something I kept forgetting. In times of uncertainty, upheavals and chaos, writing was one of the things that kept me grounded. Writing redirects my chaotic, high-functioning anxiety-driven mind to a high road leading to inner peace. My own words may be meaningless on their own when they're just inside my head but when they're here, on this blank sheet of paper, in a blog I mostly read myself, it's like a declaration. A proof of some sort. Here lies Hazel's anxieties and doubts. Here lies Hazel's promises to herself. Here lies Hazel's...lies.
But I won't lie. There was a person inside my head I tried to say good-bye to years ago. She was crazy, ambitious and driven. Before I even knew Imposter Syndrome was a thing, she was already telling me I'm a fake. Before anyone can even say any form of constructive criticism, she was already ahead of them, with harsher, more unforgiving lines.
And I hated her. I told God I wanted to let go of her. She amplified my anxiety, made use of my insecurities and built some kind of image I can't even keep up with. It was a never ending cycle of self-destruction. And somehow, I feel like that person is coming back to life. Like she's saying, hey, it's me--I'm the problem, I know--but I'm also the solution. Somehow she's saying I would need her in the next few chapters of my life.
This realization reminds me of my friend's conclusion to my self-deprecation. There was a phase in med school where I did nothing but put myself down, question everything I have accomplished and doubt every single thing I did. I had a list of everything I hated about myself, about my personality, about my tendencies and preferences. I wasn't sure if my friend truly understood the depth of my frustrations with myself until my 22nd birthday. They surprised me with a cake that didn't say happy birthday, Hazel. It was a chocolate cake with icing that spells "You were made to be you". I remember reading that line out loud then seeing my friend's understanding face. I wanted to burst into tears.
So, no.
I don't need her. I don't need that voice in my head to come back in my life. I'll just run back to this blinking line on a blog and...write.
0 notes
Text
i owe you an apology
to my pediatric, obgyne and surgical patients--if you ever feel like my care for you is inadequate in any certain way it's probably because it is.
to be honest, when my nurse refers a patient to me and i see a child or a baby crying i just want to cry too--
when i see a patient in labor i feel like i'm in labor too
when i see a wound that would require sutures, my hand starts to shake even though they're perfectly steady all the other times.
but i am trying my best.
i am. i won't treat you any less good than adult medical patients.
i just owe you this explanation. you are the kind of patients that challenge me the most. i feel underprepared when i see you.
and well, i guess this is also a good-bye.
soon i'll get into residency and i won't need to deliver a baby, examine a crying child or suture wounds.
but for now
for now i'll do my best. i promise i'll always do my best.
0 notes
Text
i went to a stranger's wake...
to comfort a friend, but instead I went home comforted.
The man who died was a genuine Christian. His whole family was filled with God-fearing people. The service was full of teary-eyed eulogies but also heart-rending thanksgiving to God.
How strange, I thought, to be blessed by eulogies in a wake.
I found myself sitting there with tears streaming down my face. My own life seemed to flash before my eyes. A borrowed life. That was the term they used. The past few days I've spent overthinking about my life suddenly seemed so childish. What's the point of worrying about the future? What's the point of wasting our days away like this?
Lord, teach us to number our days, that we may gain a heart of wisdom.
I knew it didn't mean being ready for death the way I once drove in a rainy night with zero visibility. I knew it didn't mean computing for the number of days I've been alive -- 9, 373 days. It definitely does not mean getting a 2d echo looking for wisdom in my ejection fraction.
it means...
living each day, each moment, as if tomorrow I'll be facing God and offering everything I have done on earth at his feet.
0 notes
Text
for all my life
I was right.
When I was in my 2nd year med school, I felt like I was at the lowest point of my life. When I eventually overcame that, a daunting realization came to me: there are far greater heartbreaks waiting in the future.
And I was right.
It came slowly, steadily, like water pouring from a rusty faucet.
The pandemic. My entire family getting covid. My mom getting confined in the ICU. The cancelled internships. The online graduations. That crazy licensure exam. The scary moonlighting days. The deaths I pronounced. A close friend's death. Lies winning in the recent election.
But despite that leaky faucet, I never failed to see everything else.
The 1 year of fulfilling sleep at home. Our business remaining stable even during lockdowns. My mom recovering. Passing the licensure exam. Earning a lot of money for the first time. Reuniting with all my closest college friends.
And now, a brand new dream.
Taya's new song has these lines:
I won't lean on my own understanding
I will let go, follow, empty-handed
You say, "Your yoke is easy"
You say, "Your burden's light"
So I'll let You lead me for all my life
So I've decided to try. I've decided to pursue this newfound dream. And if it doesn't work out how I imagined it, I will still thank God. For who am I to assume I understand God's plan for me? For my family, my friends and my country?
I'll let go--and follow, empty-handed.
0 notes
Text
when i was 25 i rode an airplane for the first time
but that's not what I'm going to write about. There's an island north of mainland aklan in Visayas--a famous island that spans 10.32 square kilometers. Known for its fine white sand and cerulean waters, Boracay has been the subject of so much political and environmental issues.
Yet despite all that history, I never for once thought it was overrated. Not before I went there and not when I was there. I don't know-- I just didn't want to judge it that much before even going there. There's a reason why people flock to that place. There's a good reason why they keep coming back. I haven't even left the island yet and I was already wondering when I can come back.
I'm not that deep. It wasn't the sea or the sand. Those were background music to the main attraction: the restaurants, the stores, the coffee shops, the people, the events, the activities--we never ran out of things to do in the island.
And when we've done all we can possibly think of, we can sit back on the soft sugar-fine sand and be amazed by the beauty of the sunset. The sail boats and people milling about screams that life is flourishing in this island (albeit, the corals are most likely dead).
I lie back on the beach and replay all the long walks, the sandy feeling on my feet, the amazing food, the friendly locals and the dogs & other tourists we met, the laughter I shared with my friends and store them in my core memories.
I'm not certain about what's in store for me in the future but I will choose to live in the present for now.
0 notes
Text
always be kind.
When I started this blog I wanted it to be a reflection of my life as a physician and so far, when I read through what I have written all I see is death. All I read about is the dark side of this job. All I feel is helplessness.
Late in the year of 2017, when I was in my 2nd year in med school, I experienced a kind of helplessness so unfamiliar to me it almost broke me--but no one would remember that. I tried not to show that side of myself; thinking everyone around me was fighting their own battles--there's nothing special about the one I was in. The light had always been there but I chose not to open my eyes--I chose to dwell in that darkness for some time. Eventually, I did open them. I regret not following the light earlier on.
So when I tell my friends I'm okay--that I can handle this much grief--that I want to feel it and it's okay--I'm not lying.
Because this is not an unfamiliar feeling anymore. I know once upon a time I chose to dwell in it. But not anymore.
Now, when I wake up, the first thing I yearn for is God. I choose God. I choose to follow the light. When I stand behind my patients to intubate them, I send a prayer to God. When I comfort my patients' relatives after I tell them their loved one is gone--I send a prayer to God. When I sit alone in the resident's quarters alone trying to hold back my tears, God sits beside me and tells me it's okay to feel their grief. He tells me it's okay to feel sad. He doesn't tell me to stop crying. He tells me not to blame myself and if I knew I made a mistake somewhere--he encourages me to use it to become a better doctor. He promises me He has a plan--that all these experiences, so seemingly pointlessly painful--is shaping me to become the kind of doctor he wants me to be.
He also tells me, be kind. Always be kind. He gives me a picture: that as I grieve with my patients' relatives, they don't hold an ounce of anger or blame in their eyes. And even more, in the midst of his own pain, the husband tells me-- thank you for getting here so fast.
Something that came so thoughtlessly to me--get there as fast as I can--can matter that much in that moment.
And someday, when I look back to this metaphorical graveyard in my heart--instead of tombstones and endless grassy fields--I'll see a field of sunflowers.
0 notes
Text
"i'm sorry," i whisper as i close her eyes.
"am i going to die?"
no you're not we're the same age!
"but don't people with that disease usually die?"
yes but you're the same age as me! i can't imagine dying so why will you die?
They weren't my actual response to her question. It was my own projections.
It's driving me crazy--this was the 2nd mid-twenties woman I had a full code and pronounced.
So when I drove home, I imagined my own life ending at that age as well. I, of course, didn't want that to happen.
my imagination didn't went very far because i literally
couldn't.
imagine it.
0 notes
Text
and just like that, in a single duty every thing i love about my job suddenly came crashing back.
the patients i initially saw at their worst, fully recovered, saying hi to me in the lobby. the laughs during history taking. the life stories. the short anecdotes.
and then that elderly woman in the dialysis unit who always wants me to auscultate her chest and report my findings. with a smile on her face she tells me, "i'm preparing for my final journey you know." then she tells me all about her children, all successful by their own right, most of them abroad.
there was no sadness as i listened. she was a Christian. she knew she was going to a place with no suffering. she was religious for most of her life. she worked for an order. she loved that my aunt was a nun as well. i told her about how i spent a lot of the time in the convent. about the oddity of my mom being a pastor as well but we're all good.
I'm preparing for my final journey.
her expression reminds me of how i probably look like whenever i watch a sunset after a long day. happy, satisfied, in awe of its beauty and God's work.
she holds my hand, tells me my hands are so soft then bids me goodbye so i can continue my rounds on the other dialysis patients.
before this was what feels like the longest 2 weeks of my life full of death, loss, fatigue, anger---
and then there's a quiet reminder of why i chose this path.
and it's all good once again. i can go on another duty once again.
0 notes
Text
4 souls in 7 days.
maybe it's time to say this out loud like this: the past few days I don't feel like a doctor.
i feel more like the person who checks the pupils, looks at flat line, looks for a pulse, then calls attendings and signs death certificates.
and somewhere between those signings, someone calls me too and tells me someone dear to me died.
so today, when i stood at the foot of a patient's bed waiting for the reading on the ECG, i tried to drown out the wailings of the relative behind me. slumped on the floor, sobbing uncontrollably, demanding God to take her instead, her body's still warm maybe she's still alive--
but i wasn't "cool" like that. i wasn't "used to it". that was such a dumb advice--no one gets used to this life.
so i knelt beside her and hugged her, whispering no one deserves to die, i'm sorry, please don't say you want to die--
and then deep down, in the darkest parts of my thoughts, a crude girl glares angrily at the scene: tangina, hazel ano ba yan.
but what was i supposed to do? i wasn't even given the chance to do everything. when my patients' relatives sign DNI/DNR, they're making me promise as well, to watch and wait for that time.
so don't curse at me. i would have done everything. i would have intubated, done ACLS, i would have racked my brain for every medication i can possibly think of, the dose, the administration and whatever else school taught me--i would have done all those things I PREPARED FOR THOSE THINGS.
then the crude girl disappears and i'm left talking to myself--to my own shadow along a dark staircase.
they wanted me to do my best, actually.
but they couldn't afford it, you see.
they wanted it. i could see it in their eyes.
it pained them to sign that stupid waiver. it pained me to watch them do that.
schools didn't teach anything about the greatest contraindication in this third world country with the best corrupted politicians in the world-- financial limitations.
and no matter what reason is left, all i feel is the space those souls once occupied. i was never good with names but i remember their loved one's faces so well. their grief haunts me.
but this isn't about me.
this isn't about me. but it pains me all the same anyway. and i'm gonna write about it here because i can be self-centered here.
0 notes
Text
i read somewhere that doctors carry a graveyard in their hearts. with a name engraved on a metaphorical tombstone of all their patients who died.
i think. i think we all do. not just doctors, okay?
and now the line between the graveyard i carry as a doctor and as a person--as myself--has become too blurred.
my heart is heavy with loss. with so much loss. in such a short amount of time. all the deaths i pronounced. all the deaths i was informed of.
i look at the bouquet of white flowers we bought and i have no idea what kind of flowers they were.
but i have decided i hated it.
0 notes
Text
foggy glasses
Nothing can make me feel so young, so small, so powerless as when I stand in front of my patient's relatives telling them I need to intubate their loved one. Or worse, that we did our best, but he/she didn't make it.
I can't seem to catch my breath during this moment. I'm always out of breath. My own body temperature rises. And my breath tries to catch up. And pockets of air get trapped behind my glasses. Every single time.
I feel so small. So short.
"I intubated him and his O2 sat rose up to 89. I'll wait until it's greater than 95 okay?"
"Does this mean we won't lose him, doc?"
"I'm sorry. I can't promise that."
She crumples and sits down slowly as her sister cries with her.
"But I promise you we will do our best okay. We'll do the best we can."
But my voice is shaking. I tried hard not to make it shake. I wanted to believe what I was saying but her CD4 count is below a 100 and the COVID pneumonia involved >75% of her lung parenchyma.
I removed my glasses and excused myself to clean the fog away. It was also a lame excuse to get my voice under control.
I'm not a teenager anymore. I'm not a med student anymore. I have an actual role in this situation I can't just fold.
So I face them again, and with clear glasses and a steady voice I explained everything once more. I asked if they have any more questions. I listened to their queries and answered it as best as I can. When it was over, their tears were gone. Their sister is still alive at that moment. For a short moment, we all hoped for the best.
And as I walk away from them, I hear them whisper the name of my school at the back of the scrubs I wore. When I looked back they were smiling. I couldn't help but smile too. If it comforts them that I came from one of the best hospitals in the country well then I'll wear that scrub in all my duties.
As I drive back home, I pray for them. I pray for their loved one. I pray for less foggy glasses and more strength.
0 notes
Text
ER Blues of a Newly Licensed Physician
Do I care too much? Do I think about things that I have no power over too much? Is it wrong to care too much?
Oh but I don't want to change. And there are people who tell me not to.
In the midst of the noisy ER settings of hospitals, amidst all the voices inside that fast-paced place I hear all the people who mentored me over the years.
If you think what you're doing is right, don't listen to them. Trust your gut. Just do whatever you think is best for the patient.
As doctors it's never us who gives up first.
Oh this unexpected discovery that the hardest part of being the only doctor on duty in an ER isn't coming up with the correct diagnosis or knowing the right management. It's everything else. The patient's money. The hospital's capacity. The protocols. The paperworks. The logistics of it all. St. Luke's is so close to being an ideal hospital I forgot that's not always the case everywhere else.
Ahhh
what use is our knowledge if it can't be translated to the patient actually receiving the management?
So I go home a bit forlorn, a bit angry, a bit frustrated but all the same, determined to improve. Now I see I lack in this area--the willpower to see that management translate to actual healing and recovery; my inability to heed my own voice--my lack of confidence in my own decisions.
I'll work on this some more, I tell myself on every drive home. I see, this is what I don't know. I see, I lack in this area. I see. It's not always about the science.
There is an art.
An ever-changing, elusive but beautiful art to medicine.
And I pray everyday that I don't ever take advantage of this chance to make a change in the smallest of interactions in the ER, OR, Wards or wherever I may end up in.
I pray everyday that God may humble me enough to listen--but give me enough courage to be confident and firm in my own decisions.
I pray that he gives me peace of mind when there are situations I have no power over.
As the sun peeks through the translucent curtains in the doctor's quarters, I turn off the air-conditioning unit, I look at the world beginning once again as mine was actually about to end. I close my eyes for a second and pray for an inevitable future: that I may one day call someone's time of death. I pray that the future Hazel will be able to handle that well.
0 notes
Text
chronic anxiety
I think this is something we all have now. Years of pressure, high stakes exams, reprimands, critical mistakes and high expectations drove us to this kind of new normal.
We need medications to sleep. We wake up at weird hours. We palpitate for reasons we can't explain. We need to take deep breaths before entering a room, an OR or taking an exam. Coffee either puts us to sleep or keeps us awake, sometimes both.
Sometimes it grows to something that takes root and it becomes a section in DSM-V and we spend money on therapy, medications on yellow pads and we take leaves of absences to heal.
Sometimes it doesn't take root. But it's always...
Just.
There.
Loitering like a dark cloud in the sky that every once in a while the sun manages to chase away. And when it does, everything is well again. All is well again.
But it's not. Not really.
We will carry this dark cloud above us. We just choose to deal with it in different ways. Sometimes we put it in a box in our head where we reserve it to push ourselves. Sometimes it's in an open notebook where everyone is aware we're in that state again. Sometimes, it's a quiet shadow we don't even want to name. Or we are in denial of.
I began writing this because it was 3pm and I felt a heaviness in my chest I can't explain. I was palpitating even though I drank coffee hours ago. And I thought.
Right.
This is the cloud. It's back again. I take deep breaths, pour out my thoughts like this and pray--
pray that the sun will continue to chase my clouds away.
0 notes