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     Posted February 7, 2002. "Palanig-a". An "Ilonggo" word which literally means "hardening" as in "hardening of butter", or "hardening of the arteries". Not to be confused with hardening of a certain part of human anatomy that's sensitive to touch. That's a completely different terminology I won't dare mention.

     To a Junior Intern, "palanig-a" has evolved into a word of its own, worthy of several translations to the English language. Anxiety. Humiliation. Uneasiness. Confusion. Fainting spells. Depression. And while we are at it, PTSD - Post-Traumatic Stress Disorder.

     "Palanig-a" may be self-inflicted but this is highly debatable. No matter how hard you try to avoid it, you are doomed to experience it. If you ask me (nobody does), the best way to lessen the impact and the frustration that go along with it is to expect it. Don't walk into hell and expect to be served an ice-cream float.

     I may only be speaking for my batch of Junior Interns and things may have dramatically changed for the younger batches whose residents included Drs. Victorino and Maricar Salcedo (1992). You probably won't find more compassionate residents than these two. Try looking for compassionate in the dictionary and you'll find their pictures. Being my classmates and good buddies, I still wonder if they have this thing called temper. I just couldn't imagine them spewing obscenities and hurling insults even if an intern's I.Q. falls below 60.

"Gee, I wish I have at least tried doing the things that Aries et al did. It would have added a little spice to my junior internship years." - a Dumagueño

     Some good old friends (they're good and they're old) offered their own thoughts (not that I needed them) on this "palanig-a" syndrome. Just some passing thoughts on top of other silly things we talked over the phone. I'm not mentioning their real names for there is always that danger of misquoting or letting some things get lost in the translation.

     My good friend "Peter" believes the abrupt change of 'atmosphere' from the first three years of medical school to internship may be a factor in all these hardships. "You have teachers from first to third year, don't expect to have one during internship. It's every intern for himself. Residents, consultants, and for that matter, nurses are there not to teach you but to act as your facilitators and, well, fault-finders. If you are used to reading books and memorizing, you have to learn to adapt to a new environment which is basically procedural, clinical correlation and require skills on top of other basic things you have learned. Needless to say, most of these skills are acquired throughout your stay as an intern. IV insertion, knot-tying, even normal delivery in OB. You may seem like an idiot at first, making a patient's arm look like a dartboard before calling your resident that you couldn't find a vein, but hey, nobody jumps to being an 'expert' without passing the 'beginners' stage. Skills are learned and that includes arriving at a correct diagnosis using the data at hand. You may need a little guidance, but if you can 'hit' a vein without even palpating after a couple of weeks of trying and 'practice', the credit is all yours."

     "It won't help if you run away from cases, refuse to do procedures, never ask questions, easily get discouraged when humiliated, or worse, never read your references."

     This reminds me of PBL, Problem-Based Learning, a so-called 'revolutionary' approach to teaching basic subjects. I don't have the whole idea how this works because this was fully implemented right after we left Roxas Hall for the hospital. We never experienced problem-based learning during our time, we just have a lot of problems learning. How this works, I suppose, is (anybody can correct me if I'm wrong) instead of going through a chapter in a book, students are given a case which they will discuss in groups. The case should be related to a particular chapter in Anatomy or Physiology or other basic subjects. A clinical correlation of sorts.

     PBL may have helped lessen the impact, partly, of the 'culture shock' that "Peter" was talking about. I can't say if junior interns today perform better than interns ten years ago because of this program (perhaps somebody can tell me that). I said 'partly' because you still have to deal with individual personalities of residents, consultants, and yes, nurses.

     What about the nurses (ok, not all of them)? What about them "Paul"?

     "Can't get away from them, especially the veterans. They are as much a part of the University Hospital as that statue that's taking a bath in front of the business office. By rule, they are there to make the intern's life miserable. They are the third eye of the residents. They look at Interns as a nuisance. Somebody they have to go through before they get to the residents. Just take whatever they want to give you, just do what you are supposed to do, and sooner or later you'll earn their respect."

     "I think this has something to do more with individual personalities," Paul continued. "That's why it is unfair to say that all nurses do it. Only a handful of them. If they couldn't understand you, just try to understand them. You don't make sarcastic remarks just for the heck of it. It is already a part of their personality when dealing with interns. Overall, I would say they are good people. Come to think of it, they can only do this to you for a year. Sarcasm dramatically disappears when you come back to write orders without having to "per" somebody else."

     "Mary" doesn't mind the different personalities involved but she has a problem with the '24-hour duty'. "The 24-hour duty has to go. You can't go without sleep for 24 hours and expect your brain to fully function the next day, where you have to do endorsements, attend conferences, and do more paperwork. The patient may eventually suffer the consequences of a fully awake but brain-dead intern. And the interns may end up as the patients themselves."

     It's funny (well, not really) she said that. I had a classmate who collapsed the moment she entered the interns' quarters after completing 24 hours of duty. She hit her forehead on one of the steel bars of a bunk bed. I don't remember if she required stitches but she lost consciousness for a few minutes. We were told she was very pale at that time. It did not help that she either had a body of a ramp model or just plain malnourished. The pressure was just too much for her body to take.

     "Mary's" point is a problem for interns as well as residents everywhere. Some residents' association in New York actually petitioned hospitals to change their schedule from 24-hour shifts to 12-hours. In one study published in the magazine Nature in its February 10, 2000 issue, authored by researchers from the University Of California San Diego School Of Medicine, they have concluded that 'brain activity is visibly altered following sleep deprivation.' The authors wrote, "It is important to remember that sleep deprivation does have detrimental effects, which we sometimes forget as we push workers, students and others to perform even when they are functioning with a lack of sleep," The researchers speculated that the brain is adversely affected by sleep deprivation because certain patterns of electrical and chemical activity that occur during sleep are interrupted, impeding the brain’s ability to function normally. Oh, that's probably why a classmate of mine and a boardmate for a few years used to forget his real gender when you ask him after a 24-hour duty.

     Having said all that, I'd still say that Junior Internship is my best year of medical school. Every single day starts as a struggle and ends as a triumph and a big sigh of relief. Every single day is a story in itself. I planned of ending this series with my own take, my own personal survival story. After a few paragraphs, I figured it deserves its own series.

     Finally, I don't mean to undermine the efforts of our residents, consultants and our beloved nurses. This is just one side to the many sides of hospital duty which is, not surprisingly, the most interesting. It is also not surprising that I got quite a few interesting reactions to this series of columns. One letter-writer who identified himself (or herself) as a Dumagueño wrote, "Gee, I wish I have at least tried doing the things that Aries et al did. It would have added a little spice to my junior internship years."

     That's all it is, a little spice. A reason to remember junior internship. A reason to appreciate a little more your success of having survived medical school. A reason to get together with good old classmates and talk about the 'wonder' years. A reason enough for me to write a column.

     Overall, our consultants, residents, and, ok, our nurses, are all doing a very good and commendable job. This is a non-debate.

     Anybody with a brain knows that.

I am not making this up...

     Inside the operating room of Iloilo Doctor's Hospital (sometime in the early 80's), the Anesthesiologist-in-charge peeked through the drapes covering the patient and noticed that the urine bag was empty. He quickly browsed the patient's chart and immediately yelled at the Intern-in-charge to get a "a certain brand of diuretic".
     The Intern immediately disappeared from the swinging OR door. After a few minutes, the visibly agitated Anesthesiologist called the Intern again. Huffing and puffing, the Intern replied, "Hindi' ko (huff) makita' (puff), Doc." In a typical 'consultant' reply, the Anesthesiologist said, "Ano nga hindi mo makita'. Abi pamangkot to sa mga nurses."
     After a few more minutes the consultant was becoming aggravated. This time he shouted for all to hear, "Internnnnn..."
     Huffing and puffing again, the Intern anxiously replied, "D..d..d..doc, hindi' ko gid siya makita', Doc. Hambal sang mga nurses, nag-pauli' na si Dr. Berayon.."
     The consultant did not know whether to laugh or cry.
     "I asked for Frusema not Purisima!!"

     (My sincere apologies and best regards to Dr. Purisima Berayon-Atas.)

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