Selective Reduction

As a medical graduate from a third-world country, I have to rely on foreign references to study. Even outside of medicine we rely heavily on the west for our source material.

Thats why it really did not feel right when I read about Selective Reduction, which in Obstetrics essentially is choosing 2 out of 3 or more fetuses and leaving only these two to grow the full pregnancy.

The logic here being multiple gestations (babies in one pregnancy) could lead to preterm birth and low birth weights because of too little space to grow in the mom. Save two only because as a whole they could all die of prematurity.

Of course there is a risk of losing the whole pregnancy in the process of reduction itself.

Its “logical” yeah but is it righteous?

May the remaining days before our exams and the rest of our careers remind us to protect the sanctity of life always.

As they (hippocrates?) say:
“To cure sometimes, relieve often, comfort always.”

Musings

Without my realizing it, my PGH clerkship and internship experience shaped/changed the way i interact with patients..

You find yourself asking “nakakain na po ba kayo?” To the bantay patiently ventilating his mother via ambu bag.
You’ve almost memorized all common lab exam prices because you prioritize the labs. You need to leave enough money for them to eat.
You push the stretcher yourself to radiology because the UW has 5 other patients to conduct.. And your patient’s only watcher is his very pregnant wife.
You ask about the small things.. Is it ok for them to travel far 2x a week for rehab? Whos taking care of the kids?
You call CI patients by name when monitoring them, theyre just a few anyway, and they deserve as much.
You say “salamat” and “pasensya na” often.. because you know youve sent the watcher back and forth to the cashier, labs, radiology already.

Truly, in medical school, books will help you a lot. But as we’ve often been told, books aren’t enough. Not just because they’re at least 5 yrs behind.

So much is learned through interaction with patients and their relatives. It’s the human side of medicine; a side we at times overlook, but is as important as the biomedical aspect.

7 months

I had a young patient today who felt normal until 7 months ago when she had esotropia ("duling") and extremely blurred vision on the right (she compensated with the normal left). 

she had already consulted then and was seen to have an mass behind her nose which was biopsied as TB. 

Then one day 3 weeks ago she was coming home from a ffup when her vision became total darkness on the left (NLP). A week ago she had decreased hearing on the right and peripheral facial palsy.

I can’t imagine how scary this all must be for her..