We report a not-so-rare case of Senioritis in a Third Year Pediatrics Resident training in a tertiary hospital. A previously-well, twenty-something resident presented with (an almost!) 3-year history of progressing back pain and accumulating backlogs. Since her initial presentation as a first year, she has been maintained on regular coffee runs with friends, and the occasional BRP takas runs to BGC/Makati/anywhere really outside PGH. A multidisciplinary team of high school classmates, life best friends, iMed jeje girls, and residency constants ensure survival of our patient on a regular basis.

HAHAHAHA, wow daming time mag-Case Report format

MeMaryan through and through, I guess what I’m getting at is: I CAN’T BELIEVE I’M ON TO MY LAST YEAR OF RESIDENCY!

If there was a way to talk to younger Marianne, and tell her everything I learned throughout Residency, I would have done so already! Because I remember the overwhelming anxiety of starting a 3-year commitment that only gets harder and harder, by and by. The uncertainty that comes with the acknowledgment of my limited skills and knowledge, and the constant second-guessing if I ever deserve to be entrusted with the job of deciding what happens with the lives of patients.

If there was a way to talk to younger Marianne, and ask her to be patient with herself, to trust The Process of growth, I would have done so already! But Time Machines have not yet been built. And so instead I turn to writing once more. I write a letter to my younger self, the First Year Marianne who was full of doubt, anxiety, and uncertainty.

But before that, I will insert a Gratitude Post because I am grateful to have been given the chance to lend my voice to a cause I genuinely believe in!

Dear First Year Maryan,

I remember your first ugly cry of residency (yes, the first of so many!)

You endorsed a patient for antibiotics but the request wasn’t approved. You were so disappointed because you thought it was such a disservice to your patient that you didn’t endorse their case well enough. You felt so bad you wanted to cry. And when the senior saw you they asked what was wrong. You said you were okay (like you always do!), and what they said next made you bawl

“I know something is bothering you, even if you won’t say it”

You went to the nearest rest room and cried.

Later on you realized that you cried because you were grateful for your seniors. That it took them only a few weeks to know you that way, that they cared enough to always ask how you were. And that without you saying it, they recognized that you weren’t okay.

Now, you’re a senior. You want to pass on that feeling you felt in that moment. You want to embody the traits of the seniors you were grateful to have. You’re struggling to do just that now. You always feel like you’ll never live up to the examples they set. But that’s okay. You also promise to keep trying anyway.

By your third year, you’re now realizing how hard it is to be a senior! Maybe you had an inkling before, but you only fully grasped it when you became one. The responsibilities suddenly on steroids, the balancing act to be sustained, the Calm you have to fake. It’s fun and scary at the same time!

Incidentally, your first rotation as a first year is also your first rotation as a third year: NICU!!!!

spoiler alert: You will break your heart more times than you thought was possible.

You still haven’t figured out how not to have your heart broken each time a patient dies. There is simply no getting used to the pain. You will look the parents straight in their eyes and tell them that their baby will not live long. They will say, “Thank you, Doc”, and you will feel undeserving of that Gratitude.

You still get the same tingly warm fuzzy feeling when you carry a baby in your arms. You still say “I love you” to these baby strangers and completely mean it.

You will be more confident in your UVC and UAC insertions (and you would even sometimes look for them HAHAHA!)

And you will spend it with such an amazing set of crazy people.

AND THEN, before you know it, you are now a Gen Ped Senior going on duty as POD on a regular basis!

Wasn’t it only yesterday when you were an APOD yourself trying to fight off sleepiness in the midst of endorsements? Now, you are in charge of a whole ward!

Every day as a Gen Ped senior will terrify you! Your juniors will look to you for guidance, and you will do your best to deserve that Trust.

You will also be blessed by such an amazing team of juniors! Even if you are super strict with them, they always make sure you get a cup of coffee every morning (HAHA, para di girl bad trip!)

You will invent baby names that will stick (I LOVE YOU BABY CHORI!!!) (…on hindsight, si Charity din mahal ko HAHAHAHA)

And you will share your love for coffee to everyone!

BUT ALSO, you will feel like you’re disappointing the world again. When patients under your care die, you will begin to wonder if they indeed received the best possible care that can be offered. You start asking what else you could have given, and where else you could have improved. And you will feel like everything was your fault.

So Dear First Year Marianne,

I am so proud that you chose to show up every single day. There is a viral post now that goes along the lines of, “If you only have 40% and gave your 40%, you gave your 100%”

You would have nitpicked the mathematical error in that statement. But you might have paused at the wisdom of it too. There were so many days you felt undeserving because you couldn’t give your all to your patients. You were at your wits’ end and your patients weren’t getting any better. You were giving your all, and it simply wasn’t enough. You will start to wonder if this feeling will ever end.

But every day you showed up meant you get to care for your patients every day too. That you get to learn from them. And that you get to improve yourself.

So thank you, for showing up, even on days when it felt like the hardest thing to do.

There are still plenty of months left in this Process. Dear First Year Marianne, I hope I make you proud.

Always,

March 2023 Marianne

***

Speaking of letters addressed to the younger self, here is a written work of mine. A commissioned piece conceptualized and produced at the end of med school. It was the raw feeling of losing the sense of novelty in this profession, the disillusionment from the baring of the unglamorous. It is the apology to the once-inspired self when “you’ve lost your muchness”, in the words of the Mad Hatter.

But it is also a Promise to remember the Why. A promise to keep trying no matter how hard it gets.

Tayong mga napagod at nakalimot – Mga napagod sumugal,
at nakalimot magmahal.
Halina’t sumulat tayo ng liham
At ipapadala natin ito sa nakaraan.
Panandaliang babalikan ang mga bagay na atin nang nakalimutan:

“Ikaw na dating ako,

Patawarin mo ako sa aking paglimot.
Hindi ko rin alam kung paano humantong dito
Parang kahapon lang naman, sigurado pa sa pinili ko.

Sabik pa nga sa bawat panimulang pagbati
Paborito ko pa nga yung ipakilala ang sarili,
Yung kakaibang kilig na halata sa aking pagngiti,
Yung sinusulit bawat sandali ng walang pagmamadali.

Hanggang sa isang araw, wala man lang babala
Hindi ko na napansin, nalimot na lang bigla
Pagod na lang ang natira
Lumisan na ang mga alaala.

Kung kunwari ba’y magkita tayo
makilala mo kaya ako?
Magugulat ka ba kung makita mo ang sarili mo
sa mga paang matagal nang gustong humakbang papalayo?
sa mga matang hindi na tanaw and dating naaninag na mabuti?
sa mga labing nakaligtaan na paano ba ang ngumiti?
sa pusong nakalimot paano ba ang umibig?
sa mga kamay na handa nang bumitaw kung maaari?

Baka kasi magulat ka sa laki ng pinagbago,
Kaya hayaan mong magpakilala ako
At para di ka mabigla ay kabisaduhin mo
itong mga paang hindi na sigurado kung saan tutungo
itong mga matang lumuluha
itong labing minsa’y nasambit na “ayoko na,”
itong pusong nagtatanong kung kaya pa ba
itong mga kamay na napagod nang kumapit pa

Ikaw na dating ako
Patawarin mo ako sa aking paglimot
Patawarin mo ako sa hindi ko pag-alala sa katotohanang ang Doktor ay Tao Rin Pala
Tao rin, diba? Tao, noon pa mang umpisa.

Silang mga napagod at nakalimot,
mga napagod sumugal at nakalimot magmahal
Tao Rin Sila.

Ikaw na dating ako
Patawarin mo ako sa aking Paglimot.
At papasalamatan kita sa Pagpapaalala.
Muli’t muli babalik sa umpisa.
Kakausapin ka para matandaan
Lahat ng mga nakalimutan

At kung sakali mang ang ating mga landas ay minsang magtagpo,
Kung Bukas ay baka hanapin mo,
makikilala mo ako
sa aking mga matang nanumbalik muli ang kislap
sa labing paulit ulit sasambitin ang taos-puso kong “Salamat”
sa aking mga kamay na di mapirmi sa saya
sa pusong higit pang iibig na.
Nagmamahal,oo, laging nagmamahal
Muli’t muli magmamahal
Araw-araw pipiliing magmahal,
Ako, buong-buo –
Nagmamahal, ako.”

***