Internal (Eternal) Medicine: Part 3 of 4
November 7, 1998
Saturday
This is part 3 of Eternal Medicine, the emergency room. It is nothing like the clean, orderly emergency room on TV’s E.R., but it can be as fast-paced.
After 4 weeks in the wards, our block moved on to the AMMU for 2 weeks. AMMU stands for Adult Major Medical Unit, but it may as well mean Adult Major Market Unit as it is forever packed with people and confusion is its normal state. The AMMU is where patients for admission to the hospital are – well – admitted. Remember about getting decked? This is where the patients cone from. The AMMU is part of the department of Emergency Medical Services (DEMS) and this is where patients who are bedridden, have suffered a stroke, and have serious medical diseases are placed. This is in contrast to the “Ambu”, the Adult ambulatory care unit run by the Department of Family Medicine where “milder” emergency cases are seen: ulcers, headaches, diarrhea, etc. The key word there is “ambulatory”, meaning patients who can walk and can be treated with oral medications or mere observation are seen in the Ambu.
Overnight duty at the AMMU is every 3 days, and there is post-duty status (for instance, after overnight duty Monday-Tuesday, you’re off at 7 AM Tuesday up to 7 AM Wednesday, when you have to report for “work” again). And when you’re on overnight duty, you get a 6 PM to 12 midnight break, during which interns from Psychiatry and the Internal Medicine out-patient service relieve you. Some of these relievers come 10, 15 or even 30 minutes late – apparently they don’t believe in karma (“Do unto others….”). At 6 PM you’re itching to go home, and the reliever isn’t there yet – it is such a long 10/15/30-minute wait.
On pre-duty days, you’re in charge of scut work: monitoring vital signs, drawing blood, inserting tubes. No learning, all skill.* Schedule is from 7 AM to 6 PM, then the intern goes home and reports for [overnight] duty 7 AM the next day. On duty days, the AMMU intern interviews, examines and diagnoses the patients, as well as writes out a treatment plan. Now this is medicine… Terrible days are those on which patients come in 3 or 4 at a time and pretty-good days are those on which 1 patient comes in every hour or so. The usual number of “consults” at the AMMU is about 30-35 for the whole 24 hours, while you are considered extremely “toxic”^ if you have 40 or more (record is said to be held by an 88-consult day 2 years ago). As earlier stated, schedule for the duty group (3 interns) is 7 AM to 6 PM, break from 6 PM to 12 midnight, then overnight duty at 12 midnight to 7 AM. During the break you’re supposed to go home and sleep/bathe/eat, fortifying yourself for the succeeding 7 hours in which only 3 interns (in contrast to the 6 interns during the day) handle the AMMU (with residents, of course). It’s a must that if you go to sleep, you should wake up in time for the 12 midnight return – this was my greatest fear then, that I don’t wake up on time. I set an alarm clock, set my pager alarm, leave a note for my roommate to wake me up, plus have my mom wake me up at 11:30 PM. I am such a sound sleeper. As for the 12 midnight to 7 AM duty, only about 3-5 patients consult during that time, half of which come during the “early morning rush”. The early morning rush begins about 5:30 AM, when patients decide to come to the hospital “first thing in the morning”! Little do they know this was the “last thing in the morning” for us duty people. Therefore, you don’t get to leave the hospital at 7 AM, as patients who come at 6:59 AM are still your responsibility.
On post-duty days, I sleep. Or do errands. Or try studying for the upcoming Medicine orals. But mostly I sleep.
Watch out for the conclusion of this series, “It’s not Eternal after all…”
Notes:
* Retrospectively, there was some learning – taking vital signs and spotting abnormal values is something you get really good at when you go on monitoring duty. I was probably just too tired and stressed to realize that learning was happening.
^ “Toxic” at the Philippine General Hospital can mean many things, but all of them have the sense of being “not easy”. Toxic can be an adjective describing you having a hard time during a rotation/clinic day/duty day, and the opposite of “benign” (easy). Alternatively, it can be used in the sense of “you’re so toxic” (colloquially in Filipino: “ang toxic mo naman”) – you are making extra efforts to do something that you really didn’t need to go overboard for. It can also be transformed into a verb, “tinoxic” (i.e., to make toxic) – someone giving you a hard time. The state of being toxic – in all of its different forms – is “toxicity”.
Parts 2, 3 and 4 of Internal (Eternal) Medicine were all written on the same day, likely because I was catching up on writing about experiences and couldn’t do them in real time. Internal Medicine was just very, very busy plus I didn’t have access to my email for most of the weeks on this rotation.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
