synapses

Zyrah Samar, a 26-year old aspiring internist who tries to write and travel to places. Ad astra per aspera

[zyrahsamar]

i would make a thousand paper cranes to fulfill a wish  you've been dreaming of  i would fly a hundred sky lanterns to shine light  in your world  oh, if i can, i would build a castle where you can rest your weary body  i would embrace your everything all the flaws all the beautiful things all that is you

Zyrah Samar

[zyrahsamar]

A Little Less Alone

“Ma, pagaling kayo. Kaya nyo ‘yang sakit nyo. Mahal na mahal ka namin.” 

These are the words from the daughter of an intubated patient who requested to talk to her mother admitted at the red zone. With tears falling down my patient’s face, she nodded—as if re-assuring her daughter that she is fine and that soon, they will see again see each other and feel each other’s warm embrace. 

The red zone is such a lonely place. Patients are alone and cannot be taken care of my their relatives. The hospital is also short-staffed and cannot attend to all the concerns of the patients. For patients, I know it is difficult for them to recuperate from their illness without their loved ones. 

It is unfortunate that COVID prevented our patients from being with their relatives while they are admitted. COVID robbed our patients from having a loved on to listen about their discomfort and a hand to hold them on difficult times of their hospitalization. COVID prevented our patient from feeling the warmth of the hugs of their loved ones when they need it the most.  

Honestly, I cannot imagine being sick and alone. So I told myself, that if a patient asks for my help to someone talk to their relatives, I make a way to make it happen. Whenever I do my daily rounds at the red zone, patients would clamor at me and would ask me to reach for their relatives. “Dok, pakisabi sa anak ko ok lang ako at saka padala ng jacket”, a patient would tell me. So I’d call the Social Service and relay their messages. Sometimes, patients would ask for a pen and paper to write their message for their relatives outside the red zone. This is the least I could do for my patients who cannot see their relatives and at the mercy of the hospital staff if they message would be relayed. 

 Social support is indeed an important part of the recovery of our patients. I realized that helping patients connected with their loved ones helped them emotionally. Seeing them smile after a seeing their relatives via a video call, after a long time of seeing hopelessness in their faces is priceless. Others, who already refused treatment and hospitalization, would agree to medical management after talking to their relatives. 

Communication both with the patient and to their relatives is also important. Patient’s relatives mostly relay on our updates on their patients. I have learned that through communicating well to my patients’ relatives about their condition and current treatment plan will enable me to establish rapport with them. 

The red zone has been my battle ground but it has thought me some of the most important lessons as a physician. One of them is that the presence of family—whether in flesh or virtually—is intricately entwined with a patient’s recovery. Hence, I commit myself to ensure that my patients would be able to connect to their family and loved ones and make them feel a little less alone. 

[zyrahsamar]

like waves in the ocean

patients come to the hospital seeking help for the ailment they have on some other time, people’s heart just stop b e a t i n g at most times, they get better they come back to their homes  but,  again,  you’ll see them in the hospital bed with the same ailment we try to move them away  from the shore but  patient would eventually  come back,  just like waves in the ocean

[zyrahsamar]

sa gitna ng napakalawak at napakalalim na dagat ng pagaalinlangan, pangamba, at mga katanungan; ikaw ang kapayapaang bumabalot  sa akin pumapawi sa kalungkutan  at nagbibigay liwanag sa aking buhay

[zyrahsamar]

To Harvey,

You always say that I am your little ray of sunshine but love, we both know that I can be a plump of dark clouds that could bring a raging hurricane. I don’t know what I did to you but you never fail to see the good in me. For that, I am immensely thankful to the universe of aligning the stars for us. We will be facing more obstacles in the future, for sure, but I know that as long as we love each other, we could overcome all those. I hope that we both endure for our love for the years to come. I hope that we both make our aspirations come true. I hope that we both find fulfillment in whatever career choices that we will make.  I hope that we both grow in love, as partners and individually. “I love you” is an understatement for all the emotions that I am feeling for you but I will say it anyway. I love you, Harvey-- always and in all ways. 

[zyrahsamar]

Life is amazing. And then it’s awful. And then it’s amazing again. And in between the amazing and the awful its ordinary and mundane and routine. Breathe in the amazing; hold on through the awful; and relax and exhale during the ordinary. That’s just living heartbreaking, soul healing, amazing, ordinary, awful life. And it’s breathtakingly beautiful.

L.R. Knost

[zyrahsamar]

What life has been for me during the past few months

It’s been eons ago since I’ve written here. During the past few months, I’ve been very busy with post-graduate internship rotating in five specialty hospital in Quezon City namely East Avenue Medical Center, Philippine Heart Center, National Kidney and Transplant Institute, Philippine Children’s Medical Center and Lung Center of the Philippines. During my rotations in those five specialty hsopitals, I’ve seen a lot of cases from the most simple to the rarest ones and done some procedures I might never do ever again like scrubbing in an open heart surgery. Although being a postgraduate intern of DOH-Philippine Centers for Specialized Health Care was exhausting, I am still grateful of all the experiences I had during the past year. 

After graduation, days were spent in preparation for the upcoming Physicians’ Licensure Examination (PLE). Everyday, I try to finish all the readings I’ve schedules but there were more days wherein I fail to do that. But then, I just kept on going hoping that some of the things I’ve studied would be asked in the PLE, The month of July was the review classes season. We’d usually go there at 8am and finish at 6pm or even until 8pm. Some days, because of exhaustion and lack of motivation, I didn’t go to classes just to rest a bit.

After the review classes, most days were spent the at the Quezon City Public Library or at the dorm. Since I am on a tight budget, I seldom go to coffee shops to study. I am thankful that there is such a library in Quezon City that is free and student friendly. Sometimes, my friends would also be at the library to study and we’d spend lunch together just to rant how the review season is eating our lives and sanity away. It was quite comforting to know that I was not alone in that battle. 

September was the month of the PLE. During the first day, I felt really frustrated because the questions were really difficult and I know that I’ve made stupid mistakes. Day 2 was quite bearable but I wasn’t able to study that much the night before due to exhaustion. I just slept and wished I’ll be able to answer some questions. During the next weekend of the PLE, damn boy, I was sick. I have cough and colds. Sometimes, I’d get headache. I just took a lot of medicine and hope it wouldn’t knock me down. The fourth day was the day I was waiting for. I just wanted to finish the exams, rest and recuperate. 

September 20, the list of passers was released. It was Harvey, the guy I’m dating right now, who called me to inform me that I passed the PLE. But I was deep asleep that I wasn’t able to pick up his call. I’ve learned about it at around 4am-- four hours late. I can’t explain how happy I was when I saw that my alma mater had a 100% passing rate. My father was so happy. My mother was crying. I know that they’re both happy that finally, their daughter is now a licensed physician. 

So yeah, I am now practicing as a general practitioner in my hometown. Probably next year, I’ll apply as an Internal Medicine resident in a public institution. For now, I’ll enjoy first being a free elf. 

[zyrahsamar]

Sunny days

Maybe the time of sulking inside my room Wondering why am I still alone is now over The sun shines bright and the flowers bloom Once again, the clouds over the sun uncover Days may still be exhausting, fill me with doubts But knowing that I am always in your thoughts Makes life a little easier, now I see the sun's rays So thank you for bringing me more sunny days.

[zyrahsamar]

Every now and then, I would ask the universe if I am really made for this. But everytime I do, the universe never fails to remind me of the greater purpose of why the dream of becoming a medical doctor has been ingrained in me--to be of service to people who needs healthcare the most.

To say that the past four years have never been easy is an understatement. Three years of classroom-based medical education meant three years of sleepless nights to read chapters of a book, of drowning myself in coffee, of trying to stay awake during lectures after pulling out an all nighter, of learning how to maximize my time to finish all my requirements, of missing important ocassions in my life such as baptisms, birthdays, anniversaries and weddings, of wishing that there are more than 24 hours a day.

Then, came clerkship. The past twelve months have been the most-physically draining, soul-wrecking days of my life in the field of medicine so far. We, clinical clerks, do most of the leg work. We can actually pass as a nurse, medical technologist and even a utility guy! But that taught me humility. I’ve done a lot of mistakes, been clueless countless of tines, cried in the hospital stairs before catching a baby, felt like crap a couple of times for not being good enough, and had my quitting moments.

But I am grateful to the Universe for providing me endurance, for dropping some inspirations at most difficult times, for letting me wake up every morning with hope anew, for making my soul filled with compassion to serve no matter how difficult the circumstances may be.

To the people who has been part of this journey-- my sincerest thanks to you. To my professors who have unselfishly shared their knowledge to us even if that means long hours of standing and giving lectures, thank you. To my residents who has not only been our mentors, but also friends, who has been patient enough to teach and train us, thank you. To all my patients who have let me be part of their lives, who has trusted and shared their stories with me, who made me feel appreciated, thank you. To my friends outside medical school who were very understanding when I would tell them that I cannot make it to dinners because I have to study or because I am duty, thank you. To my medschool friends whom I share the struggles of being a medical student, who made me feel that I am not never alone, who has been there in every coffee shop cqmping nights, in every 5-minute panic reviews in the hallway before our exams, in every stress-eating episodes, in every spontaneous out-of-town trips, thank you. To my family who has always been there since day one especially to my parents who have sacrificed a lot for me, who have always believed in me and my dreams, who unwavingly supported me all through these years, thank you.

In the years to come, may I be able to fulfill my purpose to dedicate my life for the service to humanity through the practice of medicine.

"Para sa pangarap, para sa pangarap na higit pa sa ating mga sarili."

Zyrah Lou Roman Samar, M.D. Doctor of Medicine, Batch 2018 Pamantasan ng Lungsod ng Maynila

[zyrahsamar]

Clerkship almost over!

My 36-hour duties as a clinical clerk has ended. For the whole month of April, we’ll be having our electives which means I just have to be int he hospital premises from 8 in the morning til 5 in the afternoon. The thought of waking up and not having to worry about another long and exhausting duty night is such a relief. Finally, I can have some time to catch up with life in general and some for myself. 

The past 11 months ha been the most-physically draining days of my life in the field of medicine so far. We, clinical clerks, do most of the leg work. We can actually pass as a nurse, medical technologist and even a utility guy! That’s how clinical clerks are trained in OMMC. The downside is that, you can’t really learn as much theoreticals as the other clinical clerk do from other hospitals. We seldom have lectures and conferences. I think that’s what we are lacking. A lot of work is still to be done when it comes to improving the learning environment of OMMC for its clinical clerks. 

Now, I am very proud of myself for surviving clerkship in OMMC. I’ve done a lot of mistakes, been tagged as someone who does not know how to respect her seniors, got a lot of demerits (324 hours for Surgery!!), been annoyed to patients and called as the “masungit” doctor, felt like crap at times and almost quit, cried in the hospital stairs after catching a baby, been reprimanded for a lot of things and many more shit. But I am grateful to the Universe for providing me endurance, for dropping some inspirations at most difficult times, for letting me wake up every morning with hope anew,  for sending people who understands and cheers me up, and for my family who has always been there since day one. 

JI Zyrah Lou R. Samar, almost signing off!!!!

[zyrahsamar]

Unsent Letter to J

Whenever I am alone in my own thoughts, I am always reminded of you wondering how are you doing without me. It has been months since we decided to part ways because of issues about time and priorities but I cannot help but regret the decision I’ve made. You see, our months of togetherness has been one of the happiest periods in my life. You’ve made me feel how valuable I am to you and how you admire me as a person. You’ve always made sure that I feel loved. A, you are such a beautiful person. You are smart and funny and generous. You are selfless. You are the man that showed me the mature kind of love. Until now, I am still missing you. I miss looking at your eyes while you are telling me all the things that you love. I miss holding your hand. I miss being held by you. It’s frustrating that the universe did not allow us to end up being together but I will always be grateful to the stars that they lead my path into yours. You blessed my life with who and what you are. Thank you, J. 

[zyrahsamar]

OMMC: Department of Surgery

Physically draining.

Yes, that would best describe my rotation in Surgery. I was really excited when I started my rotation in Surgery but at the same time, quite scared because it would be the first time that I would be really inside the hospital. I really looked forward to suturing cases in the ER and to surgical operations because I have been always amazed by human anatomy. 

My ER experience, well, it was exhausting but the turnover of patients is quite fast so I feel accomplished every patient that I would be able to send home.There were cases of vehicular accident with open fractures, sad people who would cut their wrists, kids who jumped from a fence and broke his radial bone as he fell, kids who were neglected by their patients and sustained injuries secondary to fall, gunshot would patients, patients who were stabbed, and of course, those patients who have a chief complaint of abdominal pain. 

Meanwhile, life in the OR was fine. I, as a medical clerk, would be the primary attendant to the patient, ease their fears by talking to them and assuring them that the surgeons will do their best, retract the skin of the surgical site, secure the specimen, and finally send the patient to the post-anesthesia care unit. I love it when consultants would throw random questions regarding the case during operations. What I don’t like about ORs is that my feet really hurt after standing for a prolonged time. 

And my most hated post, Wards and SICU. The Wards duty would do all the carry-outs from extraction, to ECGs, to referrals, to Anesthesia bookings, to imaging. Pretty much everything. The SICU duty would then be doing the monitoring of patients and referring the derangements in the vital signs of the patients to the resident-on-duty. 

Well, Surgery was exhausting. If you would ask me if I want to rotate again in this department, I would rather not.

[zyrahsamar]

OMMC: Family and Community Medicine

Six weeks. Six weeks of hospital duty and community exposure.

I’ve been rotating in my first ever department for medical clerkship which is Family and Community Medicine. Basically, the department caters the out-patient cases, some benign cases in the Ambulatory Clinic of the ER and the peripheral clinics outside the hospital like the Rosario health Clinic, Caritas Preventive Clinic and the Family Health Care Program of Brgy. 704. 

During the first 4 weeks of my rotation, I works in the OPD and the Ambulatory Clinic. During the first few day, I’ve already learned a lot from my interns and my residents. I’ve already felt how it is really like to talk to your patients, prescribe them their with medications and advise them regarding their health. I’ve learned a lot of skills and maneuvers that will be useful in the general practice. I really feel good about myself when my residents would just agree to my diagnosis and management. It gives me a sense of accomplishment because it means that I am learning. After a 36-hour duty, I would really feel exhausted but what keeps me going is the thought that I am finally doing what I’ve been dreaming of ever since I was a kid even if I am still a medical clerk. 

However, even during the first few weeks in the hospital, I’ve already witnessed how that the health system is really problematic making health care delivery difficult. I’ve seen how badly some patients are treated by health personnels and patients behaving badly to the nurses and even to doctors. Also, politics has a great influence how the hospital works. Some patients would present their government IDs to you for them to get prioritized which is unfair to other patients who have been waiting for their turn to have a consultation for hours. I’ve encountered patients who would ask if there are free laboratory services in the hospital because they don’t have the money to have those request processed outside the hospital. I’ve seen patients who seem very troubled and almost cried in front of me. I’ve talked to difficult patients, who would not be willing to take their medications because they do not feel anything and argue that they can live without the medicine. 

Fast forward to my Community Rotation which is a benign rotation. I’ve only seen a few patients during our first week unlike during my rotation in the OPD. However, what is interesting with the community rotation is that we get to do prenatal check-ups and well-baby checkups at Rosario Health Center. I’ve already administered vaccination to kids who would really cry loud at the time you inject the needle on their arms or thighs and would stop immediately after the injection. We also had consults at Caritas Preventive Health Center which caters Catholic families in Malate. This institution promotes preventive medicine and conducts annual physical examination for all the family members. We also did some home visits who are part of the Family Health Care Program in Brgy. 704. And next week, we will be implementing a project regarding the benefits of physical exercise in the prevention of cardiovascular diseases. 

So far, clerkship has been productive, full of learnings and realizations regarding the health of our people through my daily interaction with them. Slowly, I am appreciating the beauty that is medicine. There were really times that I still think if I am really made for this but always, just like before, the universe reminds me that this is the life that I would want to have. Slowly, it is sinking into my mind that I am now part of the team who provides quality healthcare to our patients. 

And no matter what happens, it will always be a beautiful day to save lives! 

[zyrahsamar]

To Clerkship!

The three years of classroom-based learning is already over. No more quizzes, long quizzes and shifting exams. No more hours-long lectures. No more struggling to stay awake during boring lectures. The past three years were terrifying and fulfilling, at the same time. Really, a lot has changed since I first entered medical school. I’ve turned into a shy, reserved girl from college into someone who can confidently say what is on her mind and assert for what is wrong. I even argue with people sometimes just to prove a point. From being  a lazy college student who would just study for her exams on her bus ride going to school, I’ve become this medical student who would always want to be prepared for every exam she will take. As much as possible, she wants to learn everything that she can for the benefit of her future patients. If before, she would wallow for her failures in school, she has become someone who rants about them for a while and then immediately gets up to her feet, ready to fight again.And, a few weeks from now, another chapter of my medical education will start: clinical clerkship.

Clinical clerkship is a year-long hospital duty wherein one will be rotating to the different departments such as Internal Medicine, Surgery, Pediatrics and Obstetrics to name a few. During clerkship, one would handle patients, interview them, conduct a comprehensive but focused physical examination, diagnose the case and plan for the management and treatment of the patient. Of course, clinical clerks are under the supervision of the interns, residents and consultants.

Almost everyone would say that clerkship will break your soul. My professor, Dr. Malijan, even told us that we should be prepared for at least one emotional breakdown. They say, clerkship will be very exhausting both physically, emotionally and mentally. It will push you to your limits. It will test how firm you are with your principles, how tactful you are in making decisions in the most crucial times. The hospital will be your battlefield and your knowledge, skills and passion to heal people will be your weapons. 

Honestly, I am both excited and scared for the clerkship. Excited because finally, I will be in the hospital doing what doctors are really doing. I’m excited to meet my seniors who hopefully, would be unselfish in sharing the competency they have acquired in their practice. I’m excited working with my future colleagues. I’m excited to meet my future patients, listen to their stories and make them feel better. However, I’m scared that I might do well in the first few weeks of clerkship because I don’t think I’ve already learned enough during the past three  years and I have zero experience of doing hospital duties. I just hope that I’ll be able to adapt to the new environment after a week or two or three or a month? I’m scared of doing mistakes that could harm my patients. But, surely, the fire inside my heart to serve the the people inflicted with illnesses would be the light that will drive away my fear.

Right now, I am one happy potato because of the two-week long vacation before the clinical clerkship commences. This is the time to  make-up for all the time I’ve been away from my family, to catch-up with my friends and to pamper myself for a while. 

To clerkhip!!!!

[zyrahsamar]

Attachments

I am an emotional being and I need attachments. However, for some people, attachments are not necessary in relationships. 

I was really dumb-founded when you told me that you don’t have any emotional attachment to me.We have been talking and seeing each other constantly for months now and you were telling me that you do not feel emotionally connected me. It was too painful for me to hear that from you. 

I felt betrayed-- that after investing my time and emotions for you, it is just nothing to you. I have been trying to squeeze talking to you despite my buy schedule and this is what I will get in return? It’s unfair. 

But maybe, I am also to blame. Maybe, I shouldn’t have expected anything from you. Maybe, I shouldn’t have believed that some time in the future, what we have will make sense. Maybe, I shouldn’t have opened my life to you.

I carefully thought about what you said. I even asked some of friends of their opinions. They said, “I deserve something better”. I wanted to stay but staying would mean getting more emotionally attached to you. And getting more emotionally attached to you would mean a more painful detachment. 

I took a chance on you but sadly, you are not willing to do the same for me.

[zyrahsamar]

Aaminin ko

Aaminin ko, ikaw pa rin ang naalala ko sa tuwing naririnig ko ang “Sila”. Sinabi ko sa’yo noon na gusto ko ang kantang iyon at nagulat ako nang tumawag ka. Sabi mo nasa labas ka pero kakantahin mo ang “Sila” para sa’kin. Sabi mo nahihiya ka kasi di naman maganda ang boses mo. Pero sa totoo lang, natunaw ang puso ko sa boses mo. “Walang papantay sa’yo, maging sino man sila”, ani mo.

Aaminin ko, lagi na atang ikaw ang kaakibat ng lugaw. Sabi mo, isang beses ka pa lang nakaka-kain ng lugaw. Kaya namn nang nagluto ang tatay ko ng lugaw ay iniinggit kita. Sabi mo, masaya kung sabay tayong kakain ng lugaw minsan.

Aaminin ko, pinapangarap ko pa ring makarating ng Batanes para ipakita sa’yo na kaya kong makarating doon kahit wala ka. Ewan ko kung ano ang pumasok sa utak mo noong sinabi mo na sa Batanes mo ako gusto alukin na magpakasal. Kaya naman, sa tuwinang mababanggit kung gaano kaganda ang Batanes, ang pangako mo sa’kin noon ang naalala ko. Ngunit, sa kasamaang palad, hindi naging maganda ang pagtatapos ng kung ano man ang mayroon tayo noon.

Aaminin ko, hanggang ngayon, mayroon ka pa ring epekto sa’kin. Siguro nga totoo ang sinasabi nila na ang isang tao na minahal mo gaano man kaikli o katagal, ay mananatili nang parte ng buhay mo. Hindi ko nga alam kung bakit lagi kita pa ring naiisip. Minsan nga ay nasa mga panaginip pa kita. Maaring may parte pa rin ng katauhan ko na gusto kang makasama pang muli. Pero hindi na pwede. Hindi tama. Kaya hahayaan ko na lang na lamunin ng panahon ang natitira pa na sakit buhat ng iyong pag-kawala sa buhay ko.

Aaminin ko, nangungulila pa rin ako sa’yo.

[zyrahsamar]

Post-1st semester thoughts

It has been an exhausting semester. I have to attend classes on most days at 7PM which usually ends at 4PM but at times, later than that. Added to the daily classes are the case reports we have to submit and case discussions in which we have to be ready to be criticized by our professors. What makes this routine worse are my groupmates who lack work ethics-- those who are not submitting their outputs on time, and sometimes, not even doing what is expected from them. 

So far, my grades are okay but I am frustrated with the turn-out of some of my exams. Some of the professors don’t give reasonable tests questions. We even have this one long quiz wherein most of the test questions were just taken from previous examinations. The questions were very objective. Honestly, I prefer test questions which would get you thinking. And it  is unfair for the students who do not have the copy of the exam. 

Unlike the first years and second year, us third years don’t have a semestral break. We’re now on our second week of second semester and I haven’t been productive since then. I usually sleep at 8 hours minimum which makes me kinda guilty because I should be studying or working on my papers. I hope I’ll soon find again the motivation to study. 

P.S. Hi, F.  Well, at times, when my schedule permits me to be idle, I still think about you and checks your twitter mentions. I’ve also unblocked you on Facebook. I hope you are doing fine.