Gunita [EDITING]

cuarenta y tres

I wanted to call Uno so bad, but I needed to control and stop myself to protect him. Alam ko namang marami silang mata rito sa hospital, kaya kahit sa burner phone ko siya tawagan, kung may mga nakamasid naman sa'min, it'd cause more damage than I'd ever thought.

They're just that evil.

It was the 11th night of my night duty—bukas wala akong pasok. It's the only day off I'll ever have for the whole month, so I really had to seize it. Tapos sa susunod na week may 32-hours na naman ako. Pero wala rin naman akong plano para bukas, hangga't pakiramdam ko'y sinasakal pa rin nila kaming lahat sa leeg, wala akong ganang gumawa ng kahit ano.

Gusto ko na lang talagang matapos lahat ng 'to at tahimik na mag-residency. Gustong-gusto ko na ring mag-Neuro.

Ilang months na lang naman ako sa rotations namin sa general surgery, next year Neurosurgery residency proper na kami. Kaunti na lang din naman. Tsaka, masaya rin naman ako sa GS kasi marami ring natututunan... hindi rin naman kami pinapabayaan ng Neuro department since kapag may mga conferences, sinasama naman nila kami. Kailangan lang talaga naming matuto 'yung basic fundamentals ng surgery bago tumuntong sa higher learning—gano'n naman sa lahat when it comes to learning.

And although sometimes, it gets really tiring, sobrang fulfilling pa rin at the end of the day. Gano'n naman talaga ang Medicine, it's all about lifelong learning. You just never stop learning. Every day may mga bagong cases na dumarating—some may be common, and some may be rare cases. It's just all about the person's determination to learn and find a cure.

Referrals from the morning duty began—mostly common cases lang din naman. A patient was referred to the surgical outpatient, and the history seemed serious. We did the usual patient rounds for the night, tapos nag-kaniya-kaniya na rin kami. Tims went to the Laboratory to collect STAT results tapos didiretso rin sa ibang patients, tapos ako naman dumiretso na sa surgical outpatients.

I greeted the patient and did the usual physical examination—he seems to not have any signs of jaundice nor palpable lymphadenopathy. Hindi rin naman siya pale—everything seemed normal, except with this mass on his left upper quadrant.

"No injuries..." I whispered to myself.

"Opo doc... sinabi ko rin sa doctor ko kanina."

I nodded and excused myself to follow-up for the patient's blood results at para mai-enter at maipakita ko na 'yung diagnosis sa Chief namin. Enlargement of the spleen is often caused by overactivity of the normal functions no'ng organ... and there are lots of causes—it could be septicemia, HIV, leukemia...

"Myelofibrosis," I whispered to myself nang makuha ko 'yung lab results. When blood films and bone-marrow biopsy show teardrop-shaped RBCs—then it'd be myelofibrosis...

Blood formation in extra-medullary sites due to progressive scarring of the bone marrow.

Cause: Unknown

Myelofibrosis does not have a specific treatment, and usually, it just develops slowly in people who are aged 50 and above. After wrapping up the H&P Note and diagnosis, I had to consult the Chief if the diagnosis were right—feeling ko pa tuloy nasa defense ako since ang dami niya pang tinanong sa'kin, pati na possible treatment, since wala namang specific treatment para do'n.

"May bagong admit?"

Tims nodded, "19 years old na may Appendicitis. Na-assign lang mag-clock," he said. We went on with the reports we had to finish, hanggang sa may lumapit sa'king nurse na nagpapa-change ng cannula ng isang patient sa post-op. It was not a hard job to do so I got it done within 5 minutes. There was also a tachycardic patient so I also had to review their ECG results.