Indexing Title: JPINGUL's Medical Anecdotal Report  [04-6]

MAR Title: Stress Test

Date of Medical Observation: September 18, 2004

Narration:

It was the night before our RITE (resident’s in training exam), which all surgery residents in the Philippines take every year, as preparation for the Board of Surgery exam after graduation.  This exam gauges how much theoretical knowledge a surgery resident has; moreover, it compares the ranking of each resident taking the exam.  If I fail in this exam, it will mean non-promotion in my surgery residency training.  So this coming exam added anxiety for a toxic night, which I was on duty at the ER.

On the average the surgery trauma had about 60 to 70 patients per duty, but that night we had 111.  Probably because it was a Saturday and it was payday weekend, so young professionals or the Manila work force are on a night out with their drinking buddies.  Then at 4 AM a two-year-old boy was referred by Pedia-ER because of a buldging mass on the right inguinal area, which was associated with vomiting.  When I read the referral my heart was pounding, and I hoped it was not incarcerated.  So I went to examine the patient and not to my surprise, it was incarcerated.  At this time, deep inside my mind, I wished that it would go back by itself, I even tried pushing it in, but the patient was crying, and there was no way that the hernia would reduce.

I referred the patient to my senior resident and the patient was directed to the OR.  I prepared the patient for operation, secured an informed consent, and gathered the OR needs.  With time ticking fast, I hoped that the hernia was just a simple hernia and proceeded with the operation. 

I thanked God that the terminal ileum which was incarcerated appeared viable and the operation went well, I finished at around 6 AM. 

At 7:45 AM, the traffic around UST was very heavy, there happened to be a college entrance test, and the stress of being late for an exam was terrible.  I took a left turn on a no left turn street, honked my horn, to get to where I want to go, I took the risk of getting pulled over by police, further becoming late or getting there earlier, it was a gamble.

At 8:10 AM, I was seated inside the examination room at UST, I felt tired, hungry, and dizzy.  I stayed still and recollected my thoughts.  I stayed still.  When in a middle of a storm, or a war, or in times of crisis, “Be still, and know that I am God.” Psalm 46:10.  I asked the Lord for strength to keep me awake through this exam.  Then I took the three-hour exam.

Insights: Psychosocial/Reinforcement

Life brings us different types of stress at different times.  As a government surgery resident it is usually related to the tasks of being on duty at the ER, and accomplishing the requirements as a surgeon.  But how do we respond to stress?  There were different seminars that discuss stress management or anger management, otherwise, stress would make people crazy.

There has to be some form of output to control stress, and each person must learn to deal with stress.  I handle my stress by passing my weakness to a strong and awesome God, whom nothing is impossible.  These life challenges actually make me stronger as a person. 

There are a lot of things or events that we don’t have control over.  About 80% of the time, we don’t get what we want.  Hence, it becomes stressful.  But there is still something we can do, by controlling how we react over the  circumstances will determine much of the outcome.

Hence as surgeons, we must learn to look at stress in the face, for the benefit of the patient, for the benefit of ourselves.