Pissed Off

4am. Two more hours at work. Not a good time for me- I was tired, intermittently sleepy, easily scared, jittery from excessive amounts of caffeine, mentally not there (I guess my backup subconscious mechanism takes over when I'm in that state), and impatient.

No new patients. I sat down and tried to read my molec cell bio textbook. The lady in bed 8 caught my attention.

B*tch:"Excuse me sir"
Me:"May I help you?"
B:"What's going on?"
Me:"Excuse me (Huh? That question is really vague. Please approach me in a smarter manner.)"
B:"What's going on, Is my boyfriend gonna get admitted? How long are we gonna stay here? Howblah blah blah blah blah...blah?"
Me:"Let me talk to your nurse. I apologize-he's not my patient"

The nurse directed me to the doctor. Found out that we were waiting for the hospitalist to call back so we'd know if he needs to be admitted or not. I went back to bed 8.

Me:"So we are still waiting for another doctor to call back. We don't know if he needs to be admitted or not."
B:"So the doc is waiting for a second opinion?"
Me:"Uhhh...I don't think its that (You idiot. Our ER doc is not asking for a second opinion about your boyfriend's case- he wants to find out if the hospitalist wants him admitted. Intiendes?). We are just waiting for the other doctor's call to see what he wants to do (You have no clue. I am trying to tell you that the hospitalist will decide- not the ER doc. The ER doc makes the diagnosis and then he decides on a disposition. This is the disposition stage. This requires him to call on the hospitalist to make a disposition. Get it? I figured you won't. So I didn't bother saying all these.). So let's wait a bit more, okay?"
The Douchebag Boyfriend:"WHAT DO YOU KNOW? WHAT ARE YOU HERE?"
Me:"I am just a tech, sir. If you have any further questions about your disease and condition, I'd be more than glad to call your nurse (who doesn't want to talk to you...just like me)."
B and TDBBF:(They stared at me condescendingly)
Me:"Alrighty then (Screw you. And you. Don't talk to me.)".

And as I stepped outside, I heard giggling followed by clusters of words that are indicative of backstabbing and mockery. They were pretty good at it. That moment awake me more than my red bull did.

"OKAY YOU MOTHERF*CKERS! PAYBACK TIIIIIIME! ENJOY THIS (I SPLASHED 5 GALLONS OF PURE METHANOL ON THEIR BED AND I LIT IT WITH MY FLAMETHROWER...I FOLLOWED THE ASSAULT WITH AN M-16 AND I DROPPED AN ATOMIC BOMB)! YOU CAN GO TO HELL!!!"

Okay, that was impossible. This is what really happened:

"Okay. (My head hung low as I walked out and just sat down, pretending to not have heard anything and just buried my head in my textbook... I cried. Just kidding. I didn't give a crap.) Whatever. All in a day's work."

Less than two hours later, I was walking out the hospital double doors with a huge smile. It's time to go home.

Why You Should Not Go To Public Gyms

Ugh. The freaking gym is packed like a marketplace. I waited for about 15 minutes to get to use a treadmill and got stopped automatically 20 minutes into my cardio...dammit...I looked behind and there were a couple people waiting for me to get off the machine. Of course I could have sneaked in another 20 minutes but the overhead announcer didn't help- "ATTENTION CUSTOMERS, THE MACHINES HAVE A 20-MINUTE LIMIT WHEN THERE ARE PEOPLE WAITING".

I got off and tried to hit the free weights. Unsuccessful. Still packed.

Because of this, I only got to use a couple machines. Hence an incomplete workout. Since I haven't really had that much of weights, I decided to survey the basketball court.

Holy cow. A full court game (10 persons) plus about 10 more bystanders and hopefuls stealing some shooting time while the players are not using that half of the court. If I went in, they probably won't let a small asian guy play with them: tree-tall figures and refrigerator-built physiques. Maybe they'll have use for someone as small as a shoebox (me) when they need to pick on someone (i.e., if they can't shoot, they can always block my shots and get vindicated). Or maybe I could be their waterboy.

Whatever. Time to head to my favorite coffee shop (It's A Grind Lakewood!!! Wooot!!!). Of course I didn't want to appear like an unkempt, sweaty bum and smell like my shoe when I head out there to study. This will make the coffee people quite unhappy. So I took a shower, of course.

A full shower room. Dammit. Fuck. Oooh, there's an empty cubicle!

I went in and because it's a shower cubicle, one is supposed to get naked (I dunno how girls' locker rooms are, but this is how it is with male lockers...everywhere). I followed the norm. Nice and warm water. Feels grrrrreat.

HAVE YOU EVER HAD THAT FEELING WHEN YOU THINK SOMEONE IS LOOKING AT YOU AND WHEN YOU LOOK AROUND, YOU REALIZE THAT SOMEONE ACTUALLY IS LOOKING AND YOU MEET THAT PERSON'S EYES?

As I was lathering, I had that weird feeling that I only encounter in places outside a shower cubicle.

Oh my...WHAT THE HELL? This old man-whore was staring at me!!! The awkwardness, surprise, anger, and disgust suddenly made me finish my shower sesh as fast as my sneeze. I managed to dry, dress up, and pack up in less than 5 minutes.

I do hope that he was just waiting for me to finish so he could use the cubicle. Standing right outside and looking at the person using the shower wasn't necessary at all though, don't you all think?

Dream On...

"I stared at my schedule. Hmmm...classes M-F. Then study afterwards. Then I work F and S, 6pm to 6am. Oh wait where do I put in my tutoring hours? Friday afternoon looks okay. Oh so that means I'm gonna be in school M-F before 8am (because parking sucks in the morning) until about 5pm (except Monday, I get off at 2...woohoo!). Dammit. This is pretty packed. I forgot I have to put in sleep time and extra study time. Oh and maybe some time for basketball. Read a non-school book. Or just jog. Holy cow. Whatever, it's okay...gotta go to med school, right?"

While I was thinking about the whole thing, another Reinier, in a cosmos that is just exactly like earth but perhaps a gazillion galaxies away, was saying something similar.

"I stared at my schedule. Oh, I have class only on mondays and wednesdays. Oh and guess what, I'm gonna be in school from 12-5 only. And I just won the lottery, so I'm not gonna work anymore. What should I do with all my free time? I'll probably sleep in everyday, oh but I gotta get an apartment a mile away from school, then walk to class, sleep in class, pay my teachers so I'd get all A's. Oh and after that? I'm gonna study...not. I'll join the eta theta epsilon gamma beta fraternity! I'll drink a lot and get hammered and bang sorority girls. Not just one, but maybe two or three...a night. Oh and I won't tell my girlfriend(s) about it. Then maybe I'll surf. Spend time at Frog's fitness. Workout, get buff, and hit on the hot girls. Did I pack my schedule yet? Hmmm...so M-Su drink, M-Su frat parties, M-Su sleep in, M-Su freetime. And M and W school. Gotta be a combined art history/accounting/marketing major, right?

Then I realized that the whole Reinier thing in another cosmos was just impossible and stupid. So I just looked at my schedule again, sighed, and entered PH2-110. It's Physics time.

Pure Ranting-1

*I page you a thousand times. You call back two hours later to tell me that you don't know the stuff I'm ordering and that you don't have anything to do with hospital equipment and supplies. Your lair in is the fucking basement, in the central supply room, where all the stupid hospital stuff are. And guess what? That 16f catheter I needed is right there. Can't you read labels? You come back after transporting the patients and you just leave the gurney unlocked with the dirty sheets and the portable monitor on it. How fucking hard is it to dump the stupid linen in the cart, put the monitor back on the crash cart plugged, and to step on the goddamn brakes that is conveniently located by your feet? Oh by the way, I am not human resources- you should not tell me how bad the nurses are to you, how low your wage is, and how unsatisfied you are of the ER. Well guess what? You are in the wrong fucking workplace! And stop telling me what to do with my future.

*Stop asking me to cover your shifts. I've always covered you because you had to go somewhere and because you have to do something that concerns your other job. Hey, why not quit your job here (you only work once in a blue moon) and concentrate on the other? I asked you to cover my ONCE- and it was for a pretty damn good reason and I told you TWO FUCKING WEEKS before the shift- you told me a day before that schedule that you can work it a week after I cancelled my conference. Oh, and mind you, I was just one of a handful of people invited to attend that fucking statewide conference. I missed that chance. So fuck off.

*Stop being too nice. You waste a lot of my time. You're no different from the others. I hate you.

*Don't talk to me like you know everything. You are still at the bottom of the totem pole. Don't talk to me in front of the patients like you're teaching me. If I were an asshole I could have humiliated you everytime. So don't patronize me. I OWN YOU.

I'm Upset

I spent close to $450 for my textbooks, readers, and manuals. And I need one more piece of shit manual.

Enough said.

What I Want, I Get

"What I want, I get."

Only two types of people say this. One, those spoiled brats who are used to getting their way. Always. Grew up getting anything they wanted. People catered to their desires no matter what. They get what they want to please themselves.

The other type, which is worth elaborating, are the persons who get what they want because they work their way through it. No one would feed them their desire. It is usually proven in adversity- these persons maneuver and power through whatever labyrinth they're in to get what they desire. They deliver. They get it. True, it may not happen a lot. But the minority of these instances greatly outweigh the majority of failures.

These people fight. These people hold themselves responsible for the consequences of their actions. These people are often in control. They are known to be stubborn. To them, this certain kind of relentlessness is life. Everything else not pursued this way is not worth having. As a by-product, these control freaks are very appreciative and protective of their gains.

But what happens when these people don't get what they want?

Hopelessness and helplessness stand prevalent in their midst. They tend to put themselves in solitary confinement; they tend to dive into a melancholic reflection. They tend to analyze. Sometimes in excess. They think of how things may be different. They often dwell into their own version of reality- the visualization of the "what if" and the "what could have been" had the circumstance sailed in their direction. Yes, they cry. Yes, they fall in despair. Yes, they summon the Supreme Being. And they slowly succumb to defeat...but not entirely.

As they reach the depth of their gloom, they start analyzing again. They look for possibilities. They realize that, while they may have no control over the entire situation, they still have control over some parts of it. And they grab that opportunity. They take advantage of the pieces that fell apart. They use these pieces to rebuild the different "whole" that they never saw in the first place. Although despair, loneliness, and anguish may occasionally visit them, as they have always lurked around, they tend not to prevail again for long.

However weird the circumstance may be, or however taxing the whole thing is, or however big the risk may be...they still go for it. They strongly believe in the adage that tells us "...when you are hardest hit, then you must not quit". They have always believed in their resolve. In their instinct. In their desire. In the future that one day, their wish will cease to be a mere thought. One day...one day...

"I finally got it."

Double Whammy

Sunday, about 1 or 2 am. It wasn't a packed ER. I then grabbed the next chart in line.

"Generalized weakness cough cold congestion for 24 hrs PTA (prior to arrival)"

The guy is pretty young and his vitals were okay. What the hell is he doing here? He's just having flu-like symptoms. Whatever. I took the guy inside, got him a bed. He's gonna be discharged in a few minutes.

"Hey broah, can I get a blanket? I'm cold..." His looks- similar to a tough construction worker cum football linebacker and lumberjack- didn't match his Neil Patrick Harris/ Doogie Howser MD voice. What a pussy. I still got him a blanket.

The same day, about 12 pm. I was in The Queen Mary, having a great time with my family and the food. We went to the Sunday Brunch thingy for my grandparents' golden wedding anniversary.

The food variety was immense and enticing, but I found myself glued to the salad section- I devoured the raw and semi-raw fishes. I feasted on the seared smoked salmon, pickled herring, and ahi tuna with wasabi. It was heavenly! Plus I consumed about 6 (or maybe 7?) glasses of their really nice free-flowing champagne. I was happy!

That night, I developed flu-like symptoms. I had diarrhea too, and I vomited once.

Today- I am glued to my bed and computer. Double whammy. Flu and gastroenteritis. What a way to end my winter break.

Betting On Abdominal Fluid

Bed 12. Eric hasn't assisted in a paracentesis before, so he called me to "teach" him. I told him to gather the following materials: thoracentesis/paracentesis tray, sterile gauze, betadine, sterile gloves, and evacuation bottles (vacuum bottles). I wasn't sure how much fluid we'd be draining this time- I didn't know how many bottles we needed for the procedure (a bottle can contain about a liter of drainage)...so I entered the patient's room.

"kumusta po kayo? (how are you doing?) Can I take a quick peek at your abdomen?"

Our patient, a skinny Filipino gentleman in his 50's, was kind enough to let a lowly emergency room tech observe and palpate his very painful and obviously distended abdomen.

"Okay Eric, maybe 4 bottles."

After setting up everything, we called in Dr. Ho to perform the procedure. After the entire shebang of abdominal poking, we were ready to drain. First bottle down. Then another. Then a third.

This time on the third bottle, the drainage rate got slow and a little bit predictable.

"Hey Reinier, do you have a dollar?" asked Keith, the RN for bed 12. "Eric?"

"Uhuh. Why?"

"I'm betting this will stop at 2.3L total."

Eric bet 2.4.

Me? Well it was a great opportunity to get two bucks. Understanding the great implication of getting $2 tonight, I had to gather my intelligence, experience, power, magic, lust, gut-feel, and hunger. I needed to make a crucial decision- getting two dollars meant a burrito from the vending machine downstairs or maybe a twinkie plus two quarters for gum. The extra bucks will have a profound economic impact on me, as well as a physiological (digestive) one...I was hungry, and I had no money on me!

"Hmm...considering the rate of flow and the consistency of the fluid, I'll go with 2.250." I had to be more accurate. I used Poiseuille's Law and Viscous Fluid Mechanics. The flow rate was reduced. It seemed reasonable that it would not fill at least half the bottle. Plus the urine-looking fluid turned red and more viscous. Drainage would be halted anytime soon-the diameter of the tube would not be able to accomodate the dense, almost pus-like fluid. I can't go wrong with this.

A few seconds later, it was clear...I AM GETTING F*CKING TWO DOLLARS! WOOOOOT!!!

Although I got my prize, I saved the two dollars. Didn't go downstairs to get that heavenly burrito or that magnificent twinkie. I just decided to appease my hunger by eating the free oreos from the social worker, the stolen bagel with cream cheese from the operating room, and ingesting copious amounts of free coffee and soda from our breakroom.

It was a great situation to be in. Getting money and free food. Thank you, physics and physiology lectures!

BOREDOM 101 Lesson2- Induce Sleep

It is 2 in the morning. You are bored as hell. You are still awake. Your alertness is not any different than this morning. How do you make use of this time? The obvious! Sleep! It's very physiologically productive.

After all possible means have been exhausted and you still could not sleep, the best thing you could do is to induce it. You have two options. One- kill yourself, hence in a state of perpetual sleep coupled with nonexistence. Not really great. Or two- PILL it! How?

We are talking of chemical terms here. Take melatonin tablets. Melatonin is a harmless hormone secreted by the pineal gland. The concentration of melatonin in our bodies normally reach its peak during the night, where there is minimal light, and it dwindles down during the day. Increased concentrations of this compound is inversely related to alertness.

My physiology professor, Dr. Rourke, told our class that interestingly melatonin has antioxidant properties but it also decreases reproductive capabilities. This is deducted from comparative physiology- note that when some mammals hibernate, there is a significant increase of melatonin and decreased sexual activity. This parallel should somehow be related to our physiology. After all, we're mammals too.

I think because I frequently work graveyard shifts, my sleep-wake cycle is messed up. Too bad. Maybe it's time to take melatonin. I, however, am not dependent on it.

BOREDOM 101 Lesson1- Learn a Song

After unsuccessful attempts to put myself to sleep, I've found myself in front of my laptop, my camera, and my guitar. I was bored.

To address this annoying issue of unused time, I decided to learn a song (find out the whole thing for myself- no aids, no tabs, no sheet music- just the song.) on my cheap-ass electric guitar. I came across Jinky Vidal (a Filipino pop/rnb artist) on youtube and she sang a nice rendition of Angela Bofill's "Tonight I Give In"...Cheesy? Yes. But screw it, the rhythm simply captured me I had to listen to it multiple times. I love this song!

THIS IS NOT AN IMMACULATE RENDITION OF THE SONG. YOU WILL ENCOUNTER UNPLEASANT SOUNDS AND OFF-NOTES. It's just practice playing, after all.

Welcome to the first of many lectures in my new class, BOREDOM 101. I am your professor. Enjoy.

Can't Go To Sleep

This is killing me
3am and still awake.
Tomorrow, I intend to flee
Things to do. I can't be a flake.
Procrastinated during the break.

Melatonin might help me
Taking it won't kill me.
Eights hours I'll be down.
But wait, 3-11?
I planned a long day, and so I frown.

Whatever. I wanna sleep now.

Needlestick

"Bro, go back to bed 16. I'll cover you here."

"Yesss!" I told myself. I haven't seen a chest tube insertion before and It's time I learned to how to assist in one just so when the rare occasion arises, I'd be ready.

Our patient, a gentleman in his early twenty's, has pleural empyema (accumulation of pus in the pleural cavity). It is important to drain the pus via chest tube drainage. If it doesn't work, then surgical intervention is necessary- a thoracotomy (yes, open the effin thorax!).

The tray was set-up and Melissa was already assisting Dr. X, one of our respected Cardiothoracic Surgeons. Shiet. Now what? I was hoping I'd get to do it this time. I wanted the action! And it seems like I missed 1/3 of the procedure...dammit. The patient has already been anesthetized. At least the surgeon hasn't stuck the tube in yet. Oh well.

Luckily though, I wasn't assisting him. As Dr. X was looking for a smaller scalpel, he buried his hand into the tray, and bam! Lo and behold- the syringe he used for anesthesia-was stuck to his right thumb. He threw the damned syringe. Picked up another instrument and slammed it into the tray. Picked up another. Slammed it into the tray. My face turned pale. The guy was mad. I hope I don't have a scalpel stuck to my forehead.

Melissa shrugged. And the beast in Dr. X. was unleashed. "That wasn't funny. I'm on Chemotherapy!". The crowd went silent. "Order an HIV antibody test!". The nurses scrambled to kiss his ass.

Oh holy snaps. The poor surgeon is recovering from cancer. Hence the absence of his hair. Hence his long absence in the hospital. Hence the absence of his temper control. Wow...

Worse, a 28 and a 32 size tube didn't drain anything. He scheduled an emergency surgery right away. This guy has to work against his physical condition, the pleural empyema that the young man is suffering from, and the uncertainty of this potentially fatal mistake.

I hate being philisophical at work but this is one time where I had to step out to the smoking area and ponder the severity of the circumstance. What's gonna happen to Dr. X? Now that he's immunocompromised, a potential opprtunistic disease is within the horizon. More importantly, I thought of myself. I thought of the risks-including my own life- that comes with this chosen profession. I thought of the challenges that one has to undergo, especially that of foregoing important personal issues to be able to address a stranger's immediate needs. It seemed too much. It seemed too taxing. It seemed very heavy.

I stepped back into the ER. After a brief conversation with myself, I thought...

"It's just a needlestick. It happens...This cannot stop me from keeping my calling. This cannot stop me from saving lives. This cannot stop me from getting my MD".

Nine more hours and it's time to go home.

"The One That got Away": Hmmm...Does This Sound Like Bull?

Ciara, a friend of mine, sent me this. Thought I'd share it to everyone.
Credit goes to whom it is due.

People, feel free to tear this apart. My comments section are open.

My take: a great literary piece. Very catchy and well written. No wonder it became popular. The ideas of the author are clear, concise, and well-developed. A great thing to read in the office or when you're bored.

Oh, and the message? Hmmm...whatever.

The one that got away

In your life, you'll make note of a lot of people.
Ones with whom you
shared something special, ones who will always mean
something. There's the
one you first kissed, the one you first loved, the
one you lost your
virginity to, the one you put on a pedestal, the one
you're with...and the
one that got away.

Who is the one that got away? I guess it's that
person with who everything
was great, everything was perfect, but the timing
was just wrong. There
was no fault in the person, there was no flaw in the
chemistry, but the
cards just didn't fall the right way, I suppose.

I believe in the fact that ending up with someone,
finding a longtime
partner that is, does not lie merely in the other
person. I can actually
argue that an equal part, or maybe even the greater
part, has to do with
the matter of timing. It has to do with you being
ready to settle down and
commit to someone in a way that goes beyond the
little niceties of giddy
romance.

How often have you gone through it without even
realizing it? When you're
not ready to commit in that mature manner, it
doesn't matter who you're
with, it just doesn't work. Small problems become
big; inconsequentials
become dealbreakers simply because you're not ready
and it shows. It's not
that you and the person you're with are no good;
it's just that it's not
yet right, and little things become the flashpoint
of that fact.

Then one day you're ready. You really are. And when
this happens you'll be
ready to settle down with someone. He or she may not
be the most perfect,
they might not be the brightest star of romance to
ever have burned in
your life, but it'll work because you're ready.
It'll work because it's
the right time and you'll make it work. And it'll
make sense, it really
will.

So that day comes when you're finally making sense
of things, and you find
yourself to be a different person. Things are
different, your approach is
different, you finally understand who you are and
what you want, and
you've become ready because the time has truly
arrived. And mind you,
there's no telling when this day will come.
Hopefully you're single but
you could be in a long-term relationship, you could
be married with three
kids, it doesn't matter. All you know is that you've
changed, and for some
reason, the one that got away, is the first person
you think about.

You'll think about them because you'll wonder, "What
if they were here
today?" You'll wonder, "What if we were together
now, with me as I am and
not as I was?" That's what the one that got away is.
The biggest "What
if?" you'll have in your life.

If you're married, you'll just have to accept the
fact that the one that
got away, got away. Believe me, no matter how fairy
tale you think your
marriage is, this can happen to the best of us. But
hopefully you're
mature enough to realize that you're already with
the one you're with and
this is just another test of your commitment, one
which will just
strengthen your marriage when you get past it. Sure,
you'll think about
him/her every so often, but it's alright. It's never
nice to live with a
"might have been," but it happens.

Maybe the one that got away is the one who's already
married. In which
case it's the same thing. You just have to accept
and know that your
memories of that person will probably bring a nice
little smile to your
lips in the future when you're old and gray and
reminiscing.

But if neither of that is the case, then it's
different. What do you do if
it's not yet too late? Simple...find him, find her.
Because the very
existence of a "one that got away" means that you'll
always wonder, what
if you got that one?

Ask him out to coffee, ask her out to a movie, it
doesn't matter if you've
dropped in from out of nowhere. You'd be surprised,
you just might be "the
one that got away" as well for the person who is
your "the one that got
away."

You might drop in from out of nowhere and it won't
make a difference. If
the timing is finally right, it'll all just fall
into place somehow and
you know, I'm thinking, it would be a great feeling,
in the end, to be
able to say to someone, "Hey you, you're the one
that almost got away."

Looking Back- The King-Drew Medical Center Closure

I remembered writing this for one of my classes. This was my take on the chaotic turn of events for King/Drew Medical center. It has been a while since this has happened, but it's worth pondering. Now, what is the aftermath? What did our health authority do about this?

Feel free to refute, verbally abuse, condemn, or commend me.


To Close King-Harbor or Not

After a series of management mishandlings, clinical practice errors, unmet minimum care standards, and a lot of unhappy people, Martin Luther King Jr. - Harbor Hospital had to be shut down for an indefinite period of time.
The Los Angeles Times editorial article on August 15, 2007, a few days before the finalization of the closure, commented on and justified the then-impending closure of the said institution. It seemed that the Los Angeles County Board of Supervisors has failed to use its wealth of resources and extreme capability to save King-Harbor Hospital and the needing communities of South Los Angeles. The people in charge of the ill-fated center demonstrated poor competence in running hospital operations. Clinicians and practitioners have been practicing below good standards of care. This unfortunate chain of incompetence leads down to the patients and the community- the ones who will end up suffering most of the blow.
The persons who possess the power to close the hospital were not even able to exercise this authority totally when it seemed fit. “They instead play games with the very definition of "to close." Half the staff of 1,600 remains on-site, on the job, at outpatient clinics and an urgent care center. Capacity to perform surgery is being expanded”(“Close King-Harbor”). In essence, the said medical center still operates even though it is doing a lot less than it used to- and probably committing the same mistakes on a smaller scale. The county supervisors are now looking for a private purchaser with strong hopes of coming back as a full medical center in less than two years. Technically, King-Harbor is not really closed at all.
Dealing with the internals of the institution, particularly concerning patient care, there have been a lot of accounts pertaining to poor clinical care, medical malpractice, and staff incompetence. “Just walking into the building, inspectors saw that patients were in immediate jeopardy. Further probing showed that staff failed to track records, properly mix medicine and sterilize equipment”.(“Close King-Harbor”). There was also one incident as specified in The Los Angeles Times that during one of the hospital’s major inspections, a patient who at that time were writhing on the floor for almost an hour was just ignored by the nurse. There also have been numerous accounts of misdiagnosis and maltreatment of patients that have occurred in King-Harbor’s “treatment” phase.
On management issues, the said article presented its concerns on the hospital executives being more focused on corporate issues rather than the much-needed medical care the institution have originally stood for. “It is painful to say it, but the truth is that preserving an African American-run institution took precedence over providing competent care. The interests of staff came before the needs of patients.”(“Close King-Harbor”).
The points seem to be convincing and rhetorically powerful. However, in reading the article, one may find that some, if not most, of the arguments point to very particular instances that are existent in other successful medical centers- which doesn’t really back up the argument for justifying the closure of the institution. Concerning the patient lying on the floor for over an hour and the nurse ignoring him/her- did the inspectors know about triage (where patients are seen in order of the nature and urgency of the disease/injury)? Probably the patient was just having abdominal pains without other severe symptoms accompanying it- digestive problems fall on the lower priority on the triage. On medical malpractice and errors, King-Harbor is a teaching hospital. Errors like these are a commonplace in the medical community, and these clinicians are not robotically perfect. There are disciplinary actions for these incidences that are hidden behind curtains to the commoner, such as Surgical Service Reports, Morbidity and Mortality Conferences (M and Ms), and attending physicians putting the erring clinician in the hotspot, constantly testing its knowledge and skills, known in the medical community as “pimping”.
Concerning management issues, the point that “…preserving an African American-run institution took precedence over providing competent care” is really ambiguous. Are they implying that the corporate ladder took precedence over patients or are they implying something else with regard to a particular ethnic background?
Thomas Scully, then-administrator of federal Medicare and Medicaid programs and presently a Washington law firm senior counsel, contradictorily thought about the issue. In the June 15, 2007 issue of the Los Angeles Times, he claimed that closing the medical center is not the answer.
The problems that King-Harbor Hospital was facing were no different than any other inner-city hospital. Economics, being one of the major problems, would be very difficult to run in a medical center serving mostly uninsured and Medi-Cal patients. “The LA system is almost totally funded by the federal government, and, with that support, L.A. has to deal with the hand it has been dealt — and make the most of it.”(Scully) Given the ample financial capability of the government, successful operation of the hospital is really possible. It just seems that the said medical center does not receive the amount of funding it deserves. Scully also pointed out that King-Harbor Hospital should try to pattern itself to various city hospitals in similar-situation places. “There are many different big-city models to look at… Jackson Memorial in Miami and Grady in Atlanta are huge public hospitals in very poor neighborhoods that do a pretty good job of saving lives, and I would feel confident there as a patient. Philadelphia has no public hospitals yet serves at least as tough a population through private hospitals that get public support and provide great care.”(Scully) King Harbor has a lot of “mentor” hospitals in this case then, and it seems fit to have its administration imitate or at least seek help from these thriving systems. The mere fact that if these big urban medical centers- with situations similar to our dying local hospital- can handle the work, then so could King-Harbor too.
Keeping King-Harbor is extremely important since it is, unfortunately, the only best health care access for the urban underserved in the area. Although Saint Francis Medical Center, a level II trauma center, in just in nearby Lynwood, King-Harbor is a public hospital and it thereby caters more to the uninsured and the poor. The medical center is also significant in medical and allied health population, housing the prestigious Drew-UCLA medical program and the Charles Drew University training programs for allied health. Shutting down the hospital means shutting down a great community resource.
“The best thing for patients is to stop looking for blame, apply the best ER Band-Aid available to King-Harbor and get back to fixing the whole L.A. public hospital system.”(Scully) By saying this, Scully made recommendations-channel more of Los Angeles County’s financial resources to the medical center, downsize the Hospital more hence making services more controllable and efficient, and stop pointing fingers.
Analyzing Scully’s perspective on the issue brought an optimistic light to the matter. As empowering and hopeful his arguments seemed, his points, in general, are vague and somewhat introduces red herrings. How could King-Harbor possibly model itself to other big urban underserved hospitals when those mentioned are operated by different leaders with different objectives, located in different environments with possibly an entirely different underserved population, and enjoying financial and community resources different from what we have in Los Angeles? How does him bringing up what he did to Greater Southeast Hospital in Washington help King-Harbor if that very idea has not been tried out in this problem? What did he mean when he said “Given the situation, the best the federal government can do is to poke, prod and push the hospital — and the county — to improve.”(Scully)? His recommendations were not really specific- they would of course apply to similar hospitals with similar conditions. None would cater to the particularities of this chaotic situation that is King-Harbor Hospital.


Understanding and analyzing both sides of the issue helped me shaped my prior convictions into an educated and well thought-of stand. Empathically reading and actively doubting the articles gave way for a deeper analysis of the issue at hand, especially with the intricate particularities in each perspective.
Taking a stand on the matter, as blunt as it may seem, considering the harsh and chaotic situation King-Harbor Hospital is in, it would be reasonable to close it. Completely cease operations. Period.
Defibrillate the chaotic cardiac rhythm in the Los Angeles County Public Health system that is the Martin Luther King Jr.-Harbor Hospital. Why? The institution has humiliatingly failed inspections and supposed “makeovers” over and over again. This just implies that the hospital just did not improve and implementations for renovation were simply ineffective. It became a total waste of resources. The same people trying to make desperate changes are the same ones that have been part of the demise. Same ideas will be surmised, and they are the same nonproductive ones. There has to be some new, better light in the administrative heads hence shedding fresh, effective, and more responsible planning and implementation. Current operations are causing more harm than help to the community. Much needed services are being provided ineffectively and inefficiently. Medical education and patient care in the institution is becoming counterproductive, jeopardizing quality physician and health care professionals’ education and experience and straining community access to public health services.
Closing the hospital does not necessarily mean curtailing the much-needed health access for the local urban underserved population. There are a lot of things to do for this community in dire need of quality health care, and there are myriad ways to deal with the transition period between the closure or King-Harbor and opening a new institution.
A good recommendation would be to start fresh with a new culture, a total rebirth. “It would be ideal to create an independent committee outside the bureaucracy to assess what really went wrong and to oversee the construction of a new policy to minimize medical errors, improve patient care and to restructure the operational system. Hence, a better medical institution” quoting Omar Hernandez, a UC Irvine pre-MD/ pre-MPH student. It would be a really wise move to learn from successful and experienced models and integrate them for a while in the system, just like what the county is planning to do- find a private partner institution and take the new King-Harbor under their wing. Or if it would be feasible, have administrators from other hospitals get together and re-form a new medical institution. Another part of the solution, concerning patient care and clinical standards, would be to hire and get more faculty appointments from accessible top-tier medical schools like The David Geffen School of Medicine at UCLA and The Keck School of Medicine of USC to advance and to further residency training programs as well as push patient care to its optimum.
As for the moment, an urgent care center is just enough to temporarily provide basic family medicine and public health services. The county should also develop a better transport system to channel needing patients to nearby hospitals for more specialized care, and it seems also necessary to increase emergency medical system access to the area- more ambulances, more paramedics, and more stations- in order to provide for prehospital emergency care in a trauma-abundant community. Probably another good community resource would be active student-run clinics from Charles R. Drew University of Medicine and Science, UCLA, USC staffed with enthusiastic soon-to-be doctors and allied health professionals who would be more than happy to provide care for free. It would also be good to have more frequent and more comprehensive health fairs.
Simply put, close King-Harbor. Build one that would be better able to address the needs of the urban underserved community.

Sound Bits

Clair Marlo's 'Til they take my heart away...enjoy

Sound Bits

I learned this song when I was at Guitar Center Cerritos. There's this bossanova guitarist that happened to be there, and I played along with him. He probably enjoyed the mini-jam session and he ended up sharing jazz guitar techniques, including this song.

Sound Bits

The way you look tonight...enjoy!

Sound Bits

I was drunk and I had my guitar around...So I played part of "Someone to watch over me".
Want to hear the entire song? Good luck.

Enjoy!

What's Up With Liquor?

What is up with liquor? I'd like to look at it from a physiological perspective...Yes I am fucking drunk while typing this. So understand if I make errors. Or go F yourself.

Take for instance the substance of my choice, Jack Daniel's. In what way(s) is it similar to a neurotoxin? I have noticed a slight paresthesia in my laryngopharynx upon consuming 3 12oz. glasses of heineken and my first shot of JD with iced tea (there's no Coke in my fridge, so fuck off) alongside the compromised balance and noticeable drop in respiratory rate my fucking midbrain should be concerned about... let's wiki the contents of this absolutely wonderful liquid....

Wikipedia has no uselful facts about it! I need the chemical composition! Let's try something else...

So it's 40% alcohol by volume. If you know what that means. Vol by volume, idiot! Learn general chemistry!

Let's check this site...credit where it is due: http://chestofbooks.com/food/beverages/Adulteration-Origin/Composition-Of-Whisky.html

So whiskey has more than ethyl alcohol in it- it has aldehydes (excess of this are the prime cause of hangovers) and....FUCK I'M TOO DRUNK TO THINK...I gotta SLEEP

The Search For The Perfect Yakimeshi

Ever since I left the Philippines, I've never had any legit YAKIMESHI yet...yakimeshi is japanese fried rice. It has this unexplainable taste that only authentic and probably geographically proximal restaurants to Japan can make. I've devoured yakimeshi from Tokyo Tokyo, Teriyaki Boy, Saisaki, and Sugi- all in the Philippines- and so far in the United States, nothing has paralleled this gastronomic delight.

One came really close- Tokyo Hibachi. This is in Lakewood, right across Elephant Bar. But still, it didn't afford that quality japanese rice I've been craving!

The search is on!

yasui- a poem in fookien

"Yasui"Wei Fu Ren

yasui
gwa um tsai nia
goon
lam pieng yiu, du pieng yiu...
hao siao. hao lak.
tue pu chu.

tan che- gua ai di

I Got A Questionnaire

I was part of a great pipeline program at Cerritos College: Project HOPE. They sent me a questionnaire asking for advice for the current program people. I thought I'd share my two cents to everyone. Here's the entire answer form:

Answers in bold blue.
Thank you for the communication.

john reinier f. narvaez

xxxxxxxxxxxxx

r e s f i r m a , m i t e s c e r e n e s c i t . . .

--- On Wed, 1/7/09, xxxxxxxxxxx@Cerritos.edu> wrote:

From: xxxxxxxxxxxxxxx@Cerritos.edu>
Subject: Project HOPE Alumni
To:
Date: Wednesday, January 7, 2009, 4:35 PM

Dear: Project HOPE Alumni

Project HOPE would like to have a moment of your time to answer the following questions, we appreciate your time.

What is your status?(I'm not sure how to approach this question, so...) A college senior planning to take another extra year to finish up my upper-division classes and to complete the medical school application cycle.

What school are you attending or have attended? Cal State Long Beach

What is your major? Biological Sciences-Physiology, Chemistry Minor

What is your current GPA? (I'm not publishing my response to this)

Where are you at this moment in life? At the hardest part of being premed- studying for the MCAT while studying for everything else, doing research, working at a hospital, tutoring science and math classes, and trying to balance all of these with non-academic pursuits.

What are your strengths and weaknesses you have encountered? weakness- overwhelming myself with a lot more than I could handle. strength- being able to prioritize my activities and being able to manage my time

If you have had any difficulties, how where you able to over come them?
By prioritizing, doing risk-benefit analysis on things. Learning to use on-campus resources for academic help when needed, GOING TO OFFICE HOURS, pestering my professors, and thinking long-term: visualizing the dividends that I am going to reap with all the hard, seemingly bitter investments that I am making.

Are you part of a support group?
Yes. I am glad to be part of UCLA-SMDEP. Although we attend different schools, we still take time out to get together and study, call each other for support, party when able, and remind each other of why we are all traversing such a hard path.

If you were to give advice to a Project HOPE student, what would it be?

• GO TO OFFICE HOURS.

• GO GET TUTORING EVEN WHEN YOU DON'T NEED IT.

• READ, READ, READ! I CAN'T STRESS THIS ENOUGH! YOU WON'T BELIEVE HOW MUCH YOU'D GET OUT OF JUST READING YOU TEXTBOOK.

• Join clubs like CCM.
• Hangout with like-minded people. Avoid those who will bring you down.
• YOU are still in a COMMUNITY COLLEGE. HOW DO YOU GET OUT? GET A HIGH GPA! Extracurriculars are great only when you can balance it. You can always do extracurriculars later on, or maybe on an academically tolerable schedule.
• Prioritize!
• There are a LOT of great resources at CERRITOS COLLEGE. PLEASE take advantage of those! Frequent the Project HOPE building. Frequent the math learning center. Frequent your professors (we have a great chemistry department- don't be afraid to abuse Bradbury/Zewail/ Shimazu- in so doing, I ended up tutoring OChem at CSULB- you can do it)
• VISUALIZE YOUR FUTURE when you feel weak and discouraged. You HAVE to get there. Don't quit for dumb reasons.

I hope this helps. I'm glad to have been part of Project HOPE.

Please email me back your responSes, I would kindly appreciate it.

Thank you,

xxxxxxxxxxxxx

xxxxxxxx@cerritos.edu

So to my dear JC student-readers...make use of this!

Why You Should Not Drink And Play

"Okay! Second pitcher's on me!"

"Amber bock, please."

This was after a pitcher of newcastle. Our selection was erroneous. We could have settled for budweiser, thus allowing us three for maybe about 4 pitchers of it. The decision was not cost effective. It yielded the same fun nonetheless. After another round, given that I am an occassional drinker, I found myself gulping down from the pitcher, NOT my own glass. And we were playing drunken billiards. After the realization that we were all broke college students, Sam, Tom, and I decided to suspend the fun and decided to walk over to Albertaco's and eat. We ate a lot out in the cold and we suddenly felt the need to pee. The bar was really close, we figured we could go back in and use their clean restrooms. We got up and tried to traverse that 30-second walk. In the middle of the strip mall was a passageway to Target's back wall. Instead of walking straight, we turned right into the pass and we have found refuge in Target's plants. Yay. We decided to sober up for about an hour in Tom's car. I thought I was okay enough to drive. So I took off. The next thing I knew was I was already in my bed about to pass out.

"Hoy gising na! (hey wake up!)"

It was my brother. Holy shit I have a basketball game at 10am! It's 9:50!

I zoomed to Cerritos Regional Park.

My brother, who's really superb at basketball, was telling everyone that I'm "good". Holy cow. How about playing basketball with a hangover?

So there I was. 3 half-court games. One full court. I thought I'd be okay. So far: infinite number of airballs. Costly turnovers. Screen-and-rolls that were never executed, thanks to me stopping at mid-play figuring out where that heck I was standing at. I thought I got better at pull-up jumpers. All of them were nothing but air. I kept sliding down the slippery court.

12pm and I'm done. I hated basketball. I was having a headache. It was from the hangover, the humiliation, and the frustration.

No more drink and play.

Oh Man Not Again!

Is there something wrong with my demeanor? My face? The way I talk? Oh man...People still find me funny in times that I choose not to be. And their reactions can be quite surprising, sometimes involving buccal/oral contents...

The first time it happened was when I was in grade six (that's sixth grade in the Philippine educational system). I was gonna tell my buddy Rafael something. I tapped him on his huge shoulder and he turned around, saw my face at an unlikely time, and he accidentally spit out all the delicious brownie particles in his mouth. And they had a safe landing on my face. All I wanted was to find out something, probably for our homework. Instead, I got brownies from his mouth that I really didn't want.

During my ex's birthday party. Camille was drinking sprite when I told her something random about my sleep habits and my sense of how late I allow myself outside home. Again, this seemed funny to her and I didn't only illicit laughter. I got somethind tangible, this time in liquid form. It was not fun. I had "recycled sprite". Her nasal and oropharynx became uncomfortable from the acidity of sprite.

I thought that was the last episode, until early today...

Eye-riz had to get her car serviced, and I happened to live around the auto mall. We had lunch at one of my favorite places to save her from boredom, and we ordered old-school filipino favorites: bulalo (a variation of beef soup...?) and crispy pata (deep-fried pork leg?). Oh man. I loved the food!

For some reason our conversation decided to get a bit serious. I offered my advice- I was dead serious and I had so much wisdom brewing in my brain, wanting out. In mid-sentence, the inevitable happened.

She thought I was funny (my face? my expression? dammit what is effin wrong with me?). And so, in addition to the garlic rice, meat, and soup I was having...she involuntarily shared hers.

A bowl-ful of apologies followed concurrently with a blushing face and that really charming laughter that I found annoying at that instant.

At least I, I meant literally and physically, made you laugh. Ha. Ha.

Patient/Colleague Feedbacks

If my memory would serve me correctly, here is an account of what people- patients and coworkers- had to say about me in my face. I just thought about this last night at work and I thought it would be a great way to actually think about how I impact people. Probably a good preview when I finally get to practice medicine.

It would be very important to note that, since the comments were very diverse in flavor, I was very ambivalent towards my recollections. This is as accurate as it gets...



"You have a very commanding presence" (Some old guy I was transporting)

"Thank you, doctor" (skater boy with broken arm I just finished splinting)

"Oh." (after I told him that I wasn't a doctor)

"Are you an intern?" (person who didn't realize that our hospital doesn't have residents and interns. She must have been to UC Irvine Medical Center a lot)

"I like your smile" (An old lady with Alzheimer's)

"I admire you, young man. You have aptitude for the sciences" (this UCLA alumni that I was talking to while dressing up his wound. Blood was spurting from the sliced radial artery. I had to change my scrubs after.)

"You needed new scrubs? Why? Did you shart on your scrub pants?" (Linen lady in-charge of the scrubs)

"You're gonna make a great doctor" (old lady with dementia)

"You wanna go to medical school? DON'T DO IT" (ER doctor last night)

"I don't mean to discourage you, but medicine is hard here in the US. You should be a nurse" (my family doctor, Dr. Panganiban)

"You ask too many questions, you smartass" (Dr. Sviland)

"You're a weekender at work, huh. Just like cialis!" (Dr. Zarate)

"You crack me up!" (Dr. Wetzel)

"You crack me up!" (Sarah Nugent, RN)

"This is his first day" (Dr. Ho, when I fumbled and made a mess out of the laceration tray.)

"You're a bio major? ARE YOU KIDDING ME?" (Sandra, RN)

"Get to work!" (ER tech)

"You are funny" (EMT student who was following me around and annoying me)

"You're such a fag" (Jack, RN)

"Hey shortbus!" (Secretary)

"You're a big dork" (another nurse)

"GODDAMN YOU! GODDAMN YOU!" (Old man at work. I didn't give him what he wanted- coffee)

"FUCK YOU" (Drunk guy/Heroin addict I was helping out)

"AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWWWWW! Can't you be more careful?" (Some stupid pussy who was riding a motorbike without a shirt on. Road rash. I had to scrub his CHEST and arms with clorhexidine gluconate and betadine. Understandable.)

"YOU, are an ASS" (She wanted me to work her shift. I didn't return her phone call)

"Are you mexican?" (some white dude)

"Tonto!" (old man who thought I didn't understand spanish)

"Hijo de puta" (same deal, different guy)

"You look too young to be doing this" (some asshole who doubted my competence)

"Don't uncover them, my legs are hairy!"(25-year-old girl who thought she was hot. My response- "I've seen worse")

"HURRY UP, WHAT ARE YOU DOING???" (idiot guy who's saying this and holding my arm restrictively at the same time when I was trying to bring her hypoglycemic mom inside the ER)



Great looking back. Patient care is cool. I could get used to this. Albeit the majority of unpleasant feedbacks.

I Screwed Up

There I was at work, still feeling like a zombie due to the effects of yesterday's workload (which includes lab chores, MCAT studying, and the ER midshift I covered) and the usual lack of sleep. What's worse is that I am not working my regular graveyard shift that I am not certainly accustomed to. The midshift, 1pm to 1am, is certainly a different environment. A busier atmosphere owing to the volume of patients being seen by the morning people and the constant influx of new cases to be seen. Couple that with the morning shifters who are at the top of their game and who are less laid-back than the people I am so used to working with and the unusual energy associated with that entity called "daytime". Man. It's a killer.

"Hey Reinier, they need a wheelchair to the breezeway."

I went to grab a wheelchair and as I was making my way outside the ER, I was contemplating on what the problem this patient may have, and what I am supposed to do. The bread and butter things went through my mind. Breathing problems? Grab the patient right away and get a bed, page respiratory, get O2 sats, and give O2. Chest pain? Go to triage, get an EKG right away. Drunk? Don't even. It's not the night shift yet. Assault? Not the night shift yet, too.

A pulled-over ford taurus was waiting for me. The young lady frantically opened the passenger's side and showed me what was going on. Her co-worker's right foot was wrapped in a thick bloody sheet, with her sock inside soaked entirely in blood. Shiiii-et. How much blood did this lady lose? She's not showing signs of hypoxia. I instructed the victim's er, the patient's friend to register her information in the lobby while I took the poor lady inside the ER.

As with any workplace, there is always that one manager that every person, be it a menial worker bee or a collegial equal has respect for, and that no one dares to fuck with. This is by virtue of that manager's authority, expertise, and unparalleled experience. No one can dispute whatever that person has to say. No one cannot overpower that person. That person is the epitome of workforce dominance. That person in our ER is A.B. (can't reveal true name for fear of being unemployed at an unlikely time and manner).

I brought the lady into bed 6. It so happened that A.B. was on, and she was in close proximity. I told her the patient's history that I've managed to find out- varicose vein got hit by the side of a wheelchair step and it popped, causing the huge bleed.

She went to check it...

What were the things that were going through my head at that instant A.B. was inspecting the patient?

"Shit, I did the right thing because she bled a lot and it seems like a serious thing. What if she goes into shock (highly unlikely, 5L of blood volume versus approximately, I dunno, less than a cup?)? Or what if it were actually an artery that may be spurting blood (you dumbass!!! she said it was a varicose VEIN! listen to the fucking patient!)? Hmmmm (oh no you idiot...this is apparently non-life threatening, and there are patients waiting in th lobby ahead of her with more emergent issues!)..."

After a thoughtful percollation of events, it was clear. I SCREWED UP.

A.B. told me to dress the wound and transfer the patient to the eye chair- where the least emergent cases are seen, if there are no ophthalmology cases. After executing her orders, I knew it was time for my execution.

"Airway, breathing, circulation. You know the prority. Sometimes things are not as worse as they look. This is not threatening...get her vitals now." Her non-yelling demeanor manifested the seriousness of her remark. I knew right away that this was no time to give a life-saving bullshit apology.

As she was saying these, I remembered how a regular slice of bread turns into toast. I was the bread, she was the oven. And I became T-O-A-S-T.

I finished up on her orders and I offered more help. "Anything else, A.B.?"

"YOU have done enough already" plus a jestful whack on my head/back with the patient's chart. Luckily it wasn't attached to the clipboard. I just smiled.

When I got off the hook, I laughed to myself. I sucked. The rest of the workday became even more hilarious- everything I did that caught A.B.'s attention was greeted by a "what the hell" look (of course I know A.B. was kidding, or at least half-kidding.).

Thank God I'm back to working nights.