(Snippets of a) Life with Bipolar Disorder Type II and Clerkship [Part III]

After five grueling months as a senior clinical clerk, my mind gave in to exhaustion.  I could no longer keep up with my responsibilities as part of the healthcare team and requirements for graduation.  Isolation seemed to have made itself more acutely and severely felt when I am in the presence of people than when I was alone.  My job has kept me almost always glued to my assigned patients if I was not called away by the staff or seniors.  We were supposed to be the “eyes and ears” of the attending, the walking monitoring and reporting machines (although we were vehemently discouraged to consider ourselves as such), the intellectual laughingstock if somebody needs to get a booster of self-esteem.  And then there were a number of shifts when I would only have one proper meal, barely two liters of fluid, and scarcely an hour to sleep or nap for 36 hours at a time.  But this is the routine I had learned to embrace and love long ago; this was the life I had chosen.  I could write as much but I would not complain.

What was relevant in that unhealthy routine was its significant impact on the prognosis of my condition.  The role of good nutrition and healthy relationships in the maintenance of physical and mental health cannot be overemphasized.  I can say much for disorders with both organic and functional components, such as mood disorders.

Let me lift a few lines right from my Psychiatry textbook.

Medications give hope but the time they take to achieve steady state levels and ultimately tangible clinical results and the necessity of regularly adjusting the dose and regimen is often frustrating.  After one year of depending on them for control, I got to the point of considering (slightly) maybe electroconvulsive therapy, which has more promising adverse effects than guaranteed permanent benefits.  But in this career, it’s all too risky.

Finding the right professional has always been a challenge.  The practice of psychiatry, among others, is deeply rooted in culture.  Forging an effective partnership between patient and healthcare provider requires certain skills, say empathy, that are not widely taught in medical schools.  It’s no wonder that when some doctors do not know how to meet their patients halfway in terms of values and health goals, frustration can result and patients are lost to follow up, or entirely lost.  Some doctors may be highly intelligent or skilled at what they do, but it requires talent to be able to work magic and truly “heal” people.

It took me more than a month to think really hard about my decision to take the rest of the year off.  But it was worth it.  I had been weak in denying I needed help.  I knew I was already falling apart.

Now I feel the urge to be vocal for all those who have been suffering in silence, afraid to come out because of the stigma and the inequity of distribution of the much needed resources, information and human. (Few realize the power of social media. It can transform lives.)  Not all mental illnesses are so debilitating that they hinder one from fulfilling his dreams and attaining his full potentials.

It’s very easy to ridicule or make sarcastic remarks about something that’s not readily understood.  Textbook descriptions may be accurate but they come nowhere close to the real experience of the illness.  When the community tries to downplay the symptoms, reducing them to the trivial ones commonly popularized in mainstream media, or to dismiss the reality of the internal struggles and relative disability, daily living can become incredibly difficult.

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The Perks of Being A Junior Clerk

BLOODY WEEKEND.  After two hours of exploring the hospital wards and units, I went down to the ER to embrace the life in that post.  I had observed a difficult central venous catheter placement converted to a bloody cut down of the brachial vein from 2-5AM, then two modified radical mastectomies from 7AM-12:30PM.  But the most heartbreaking part was being at the ER and seeing all those who could not be admitted mostly for financial constraints.

I saw the country in an undignified state. At any one time, the hospitals only see 1% of the entire nation. But even in there, maybe only half (more or less) of these patients are being attended to at any one time. Though I couldn’t fully understand yet how the health system works there and where precisely are the deficiencies, but I could feel the results.

At the OR, I was trying to blend in the background while observing a surgical operation when I overheard a consultant cheerfully address a senior resident in a quiet corner:  “I’m not only telling you what to do.  I’m teaching you HOW to do it. You are a senior. You can make them do what you tell them to.  But I hope that you will be able to TEACH them as I am teaching you now.”

Mentors are indeed real treasures. One does not have to copy his role models.  They are there to suggest designs for his life.  It is up to him to weave the unique patterns of his destiny.  If my hopes and dreams were spread out like well-prepped skin, three years of medical education and training has made a great incision deep enough, that in order to close the wound, certain procedures have to be carried out with finesse.

Of the many perks of being a junior clerk, my favorite is the ability to stand back and take a good look, a bigger picture, of the systems at work around him.  He is expected to learn the principles but not master the procedure just yet. In that way, he doesn’t have to get involved.  He doesn’t have to learn by committing the mistakes himself.  He is a space-occupying lesion, albeit invisible most of the time.  He is like a drape: he sits in the middle of a procedure, with a gaping hole through which all intelligence and skill of a team are passed.  Sometimes he is clamped with the others, secured at the sides; sometimes he goes alone.  But he can only watch and wait—try not to be in a way—all the while absorbing whatever essence drips within reach.

Cross sections of the Spinal Cord

descriptions will follow

Other Histology Slides

descriptions will be provided later

Epithelial Tissue

descriptions will be provided at a later time

Connective Tissue Proper

descriptions will be provided later

Cartilage & Bone

descriptions will be provided later

Muscular Tissue

descriptions will be provided later

Nervous Tissue

descriptions will be provided later