Pre, Duty and From Makeup

I just suddenly thought of this idea as I was waiting inside the jeepney on my way home.  Funny such ideas just pop out of nowhere all of a sudden.  But I kind of like this crazy idea of mine so I'm writing it now.

For those in the non-medical field, let me explain first to you what are these duty posts are:

• Pre - This is the Pre-Duty post, we usually call it "Pre" in our institution for short.  This post is described as the day prior to your "duty".
• Duty - This post is the most popular post even to non-medical field.  This post is well-known as the "24-hour" shift, which I think is an understatement because since I was a clerk, there's no such thing as a 24-hours post.  You get to stay up to 30 hours inside the hospital, so when I always thought the "24" hour duty is a misnomer.
• From - This post is the day after your "duty" post, people usually in this post are characterised as being "haggard", "tired" etc.

Now that all these terms are briefly explained, let's proceed to main content of this blog post...

Pre

I can describe this makeup as the most elaborate of all, during this post, you're most fresh of all in my opinion.  You get to go home, and you get to wake up from your home as well.  This is also the day when you get to have complete control of your time, you won't be disturbed by hospital calls when you're not inside the hospital (ideally, but not always the case for a resident).

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Hypothyroid Experience - Doctor's vs Patient's Point of View

I was searching through the net to see if the one who invented levothyroxine received a Nobel prize for his/her significant contribution to the field of medicine. Edward Calvin Kendall was the surgeon responsible for isolating thyroxine.  But he did not win a Nobel prize for this discovery.  Although he did receive another Nobel Prize for his other discovery.  Charles Robert Harington and George Barger were the two chemists who synthesized  thyroxine, also to my disappointment, they did not receive a Nobel Prize for this. Well from a doctor and patient's point of view, if I could travel back in time, I would have probably personally thanked them for their discovery.

I was supposed to try and attempt to go to hospital today and try if I can already function as a resident.  But as I woke up this morning, I felt really dizzy and nauseous that I've decided that it will be best for my sake to just stay at home for the day.

I underwent total thyroidectomy, and it's been more than a month since surgery.  I was contemplating if I should share my experience of being a thyroid patient.  One of my mentors commented in my Facebook page that I was chosen as one of the few surgeons to go under the end of the knife as a patient.  At that time I don't know if it's a good thing or a bad thing.  As a doctor and hopefully soon to be surgeon, I think I gained better understanding of how a surgical patient feels.

Doctor's Point of View:

We as doctors are taught in medical school what are the functions of thyroid hormones, its importance and what are the symptoms of hyperthyroidism and hypothyroidism.  We were taught on how to recognize the symptoms and how to treat them.  Since in this field, the pharmaceutical drugs have been developed, this has gained little attention in terms of its importance.  What I'm trying to say is that, when you diagnose hypothyroidism or hyperthyroidism, at the back of your mind, and you'll tell your patient, oh! that's ok, we have drugs for your disease and we can treat your illness.  We don't see it as a disease that can really affect a patient's daily life.

As a surgeon, you have no choice, you have to take out the thyroid gland because you're trying to save the body from a more grave disease or complication if we don't treat it now.  Once you take the thyroid gland out, we tend to refer the patient to endocrinologists and the endocrinologists will then be responsible post-op in the long term care of the patient since this is already their specialty.

As surgeons, we were taught that thyroid disease has a relatively good prognosis, as long as patient can take the thyroid hormones, and that our job besides the care of our patient's wound is to reassure the patient that the worst is over and that they're on their steps to recovery.

We surgical residents in UST when asked by other people, what in your life as a resident ang "Di mo na babalikan kahit bayaran ka ng P1 million pesos." All residents will answer the same thing, even consultants will answer the same thing, "Yun maging 1st yr GS resident ulit, kahit bayaran ako ng P1 million, d ko babalikan yun."  I had the same answer until recently.  For mine is changed, I'm willing to go back as GS resident even for 2 years, than to experience again my more than 1 month feeling of hypothyroidism.

Patient's View
I was hypothyroid for 32 days. I think this picture will pretty much summarize what hypothyroidism really feels like.

1st week Post-op
My neck was numb, I honestly couldn't feel a thing.  There's a little hoarseness of my voice. At day 3 postop I was discharged.  At home I feel like normal, except for the numbness, actually I had diarrhea and as a doctor also I just replace my losses with my regular diet.

3 days after having loose stools, I woke up in the morning really dizzy and nauseous, I was light headed and my vision is like spinning, but I know it's not vertigo.  No one was in the room, I had to go out to find some adult or someone who can help me.  And that's when things went wrong, I fell hitting my back to a corner of a cabinet or chair, I can't remember.  I was rushed to the hospital and admitted for electrolyte imbalance.  Moral of the story? Always have an adult or someone with you at all times.

2nd week Post-op
Now I'm beginning to feel the symptoms of hypothyroidism.  Everyday, you wake up differently.  You're unsure if you will feel ok, or you will feel dizzy, or weak, or you just want to vomit.  This time you'll realize in your previous years that I'm healthy pala that I can wake up everyday even with lack of sleep as a medical student, intern, resident and function as a normal person.  This is the time when I realized that we should be always thankful that we were able to wake up carefree everyday before we had surgery. You get hungry easily also, and you get fat easily also. Moral of the story? Thank God everyday for being able to wake up to a new life.  As a resident, we should always listen to our bodies and not abuse it.  We tend to push through and continue our hectic life as a doctor that we abuse our bodies even if our bodies are telling us that they're tired.  As a hypothyroid patient, we should listen to our bodies and not push ourselves too hard.

This is also the time, when I started feeling blankness of my thoughts.  I'm a type of person who always has something on my mind, whether it be worrying over stuffs, or daydreaming about some things in life.  This is the first time in my life that my mind went blank.  I can't think, I tried making myself useful by doing some research paper that I need to pass for a research paper contest, but it was really hard, I can't formulate a sentence properly. I was just staring blankly at the computer screen.

This is also the time you feel really weak, you can't open a jar properly, you body is so heavy you wish to just sleep all day, but you can't sleep.  During this time, I also had trouble sleeping, I would stay awake up to 2am with a blank mind, you feel really uncomfortable, you know something is wrong with your body but you can not pinpoint exactly what it is.  And what's worse, there's nothing you can do about it.  Sometimes you'll wake up in the middle of the night because you feel uncomfortable and you can't tell what it is, basta you feel there's something wrong with your body.

During this time mild depression also comes in.  I can still remember that I cry every night for losing my thyroid gland.  You come to think, how can I be a resident if I feel this way. How can I keep up with the challenges of being a doctor? Should I have chosen a specialty with less stress than surgery? As a female surgical resident, we exert extra effort vs a male surgical resident, because by default, females have weaker smaller bodies compared to male.  We have to exert twice or thrice the effort to keep up with male surgical residents.  But how can I do that if I can't think 4x or 5x more, how can I do that if I c don't have the strength to do it?

3rd Week Postop
I get weak more easily as time goes by.  Applying simple make-up can make you feel dizzy and want to vomit.  You started feeling the numbness of your neck to be less numb than earlier post-op.  This was also the time that I feel I no longer have my thermoregulation, meaning I get cold easily, your hands and feet will feel cold easily.  And it will take 3 layers of blanket to protect you from a normal air-conditioned room. You wake up in the middle of the night because you feel uncomfortable.  You get hungry and weak more easily.  You get fat easily.  These are the things you'll experience the whole day.

This time my mind is always blank.  I can't do anything academic anymore, you'll just get frustrated.   I watch lots of tv series during this time, since it's the only thing that can you can do. I even attempted to watch a movie with my sister.  She felt I was walking really slow compared to a normal average person walking.  After watching a movie, after walking out of the movie house, I felt dizzy that we had to sit and rest in a restaurant.  It took around 1 hour for me to recover and we just decided to go back home.

During this time you'll feel guilty as a daughter.  Here you are, a resident, a doctor, but you're salary isn't even enough to support your own daily living.  You can't even pay your own hospital bills, and as a resident you don't have any benefits given by your hospital in terms of hospital fees. You envy those nurses, cashier employees, lab technicians, they have benefits when they get sick that the hospital give them discounts, and they work on 8 hour shifts, while as a resident, you spend 30 hrs in the hospital and you get nothing when you get sick.  Thankfully doctors have their own norms that we don't charge fellow doctors, so I was able to save money from professional fees of all my attending physicians.  You're at the age where you should be the one supporting your parents financially or at least help them financially, but you can't do anything about it, and you still get sick and be a bum and a burden to them, because your body can't freakingly help you, you can't think, you don't have the strength to do so.  It's really so frustrating for a young patient.

4th week
I had my TSH results: > 100.  My gosh! I'm really really hypothyroid beyond reasonable doubt! When will this end?  Finally I was scheduled for RAI

6th week
I received my RAI and after 2 days I was allowed to take thyroid hormones.

After taking thyroid hormones
3  hours after taking thyroid hormones, I felt the heaviness lifted from my body.  Though still weak, I can feel lightness already.  I felt a really BIG difference.  After 2 days of taking thyroid hormones, I was able to wake up without feeling dizzy or nauseous.  I can now see a little hope on my condition.

I feel normal for the next 4 days, that I thought I can go back to the hospital already.  I've been on leave for more than a month already.  And gladly I was able to go back to crafting and I was able to little by little do some research paperwork.

Until yesterday, I woke up at 2am and unable to sleep after.  So I just surfed the internet.  By 6am I'm already feeling dizzy and nauseous.  I'm feeling the same symptoms of hypothyroidism again, my body is a little heavy despite taking my thyroid hormones.

This morning, I woke up feeling dizzy and nauseous that I decided to stay at home instead of attempting to go back to work.  One thing I learned from this whole experience is to always listen to your body and take your steps to recovery little by little.  If you feel weak and not comfortable you should take a step back and relax and rest first.  Because your body is no longer the same as before, you have to take care of it more and listen to it more than ever.  You wouldn't want to fall again for which if you hit again your back you may no longer be lucky again to have no fractures. And the spine is one of the things that can change your life when affected, you can be paralyzed just because you were so stubborn on continuing with your activity despite your body telling you to pause for a while.

I'm still battling my hypothyroidism, but at least I'm less depressed now than before thanks to thyroid medications.  I sincerely would like to thank people and drug companies who made these drugs available for the patients.

This is really long.... Sorry... but I hope this post can help fellow junior interns, senior interns, surgical residents, patients in understanding hypothyroidism especially after thyroidectomy.

Ate Resident's Tips to Junior Interns: Take Care of Yourself

I read it somewhere that we doctors are abused in our work.  I thought during that time that it was kind of an exaggeration and didn't believe it.  Whenever did you hear that doctors are abused? They're rich anyways, they have their parents to back them up on their very big tuition fee, they don't have anything to worry with their food, their family can afford it. These are the things that people see, so they disregard the overtime work, your dedication and post anything harsh and cyberbullying comes in.

We doctors tend to forget our own selves in our profession.  It may be because we feel guilty because we can see our patients who feel worse than our simple flu, our simple diarrhea and we tend to continue on working as doctors, you just need to place and iv line and continue your work. You can see doctors with IV lines connected to them and they're still tending to patients, they're still making their rounds. This is our job.  We can't afford to be sick, there are more patients that need our help.  

So you just continue and continue to go on.  You work 30 hrs or more when you're on duty.  30 hrs really? that's more than a day.  Well yeah, can you imagine? You come in at 7am, but you go home 5pm the next day.  That's like more than 24 hrs isn't it?  Whoever told you that 24 hr duty exists????  Don't be fooled like the common people... we don't work for 24 hrs on duty? We work for 30 hrs at on duty.  And we don't get any overtime pay, because we're not employees... We're trainees right? There's no law to protect us of being overworked.  

So we go on and on... We're young, our bodies can take it...

And then we fall...

I think my introduction is a mess here. Hahaha, well I can't help it, currently I'm sick, I can't really organise my thoughts like before.  As a currently sick resident, here's my tips not to only junior interns but to senior interns and residents as well.

Always remember to take care of yourself. And how do you do that?

1. Buy your own protective gear

Yeah, you heard me, buy your own.  If you're tending to a TB patient, buy your own N95 mask.  No complaints, just do it.  I know it's unfair to use your money to buy the protective gears, but that's life, you either protect yourself or get yourself some TB as well.  Either way, you'll pay for your own medications.  If you get TB from your patients, it's not the hospital nor the patient who will pay for your medications, it's still you, or your family.  

Have a pair of gloves always at your pocket.  You'll never know when you'll be handling something gross or contagious.  You choose... buy a pair of P5 gloves? or buy thousand pesos medications kung nahawa ka na sa kung anong meron run pasyente?

2. Wash your hands before and after handling a patient.

You don't want to pass a contagious disease to you nor to your other patients.  So always take note of your hand washing.

3. Be careful

How many times have we been accidentally pricked by needles from our patients?  If you get pricked from a needle from a patient who has  hepatitis B or HIV.  We're on our own in buying our own antivirals anyways.  The hospital nor the patient won't buy the medicines for you.  They don't have money to buy their own medicines na nga e, what more to buy your medicines.

4. Take a rest

It looks heroic to see pictures of doctors making rounds with IV lines with them.  You get millions of positive comments and likes.  But what if your body just gave up one day.  You fall down, your millions of positive comments and likes won't be there to help you.  You and your family are on your own to pay your hospital bill, your medications, etc.  Your patients will not be there to help you, you will not get discounts from the hospital bill.  Because there's no budget for it.  Kasalanan mo yan, bakit ka pa pumasok e may sakit ka na nga?

5. Give yourself a break

We tend to forget on how to give ourselves time to relax, because we worry about our patients, our conferences, our research papers... We just don't have the time to relax.  When you feel so stressed out, do you think your patients will be there for you? No.  They're busy with their own diseases already. Go have a massage, go to karaoke with friends or families, go to malls and have shopping therapy.  You deserve some quality time outside the hospital.

6. Don't skip your meals

We can't give our 100% to a patient if our stomach's grumbling.  And we don't want a doctor to fall down due to weakness from hypoglycaemia.

7. Take care of your family relationships

We doctors tend to forget our own families.  We can't go home to our own mother's or father's birthday celebration because we're on duty, because we have to study for a conference, because we have papers to finish. Patients always come first. We spend how many freaking hours inside the hospital working our ass off.  And when we fall, when our bodies fall, it's only our family who will be there with you when you're admitted, it's only our family who will be there to pay for your hospital expenses, it's only our family who will be there for moral support. So treasure your relationship with your families.

As a sick resident, from the bottom of my heart, I can say that Health is Wealth. Because when the doctor is the one who gets sick, then we'll have one minus person who can help our patients.  And mind you, not any person can do our job, so just take care of yourself.

Ate Resident's Tips to Junior Interns & Senior Interns: Don't Let the Patients Bully You

I'm always a pro-senior intern type of resident.  I may favour senior interns more than junior interns but I think this post will apply to both audiences.

In my 4 years as a surgical resident, I would always get irritated when some patients will bully my senior interns.  This usually apply to the private division.  There's a recent post here I read and discovered from social media of an intern writing about how the patient from a government hospital accused her or "Wala ka kasing Puso, Pinagpapapractisan niyo lang kami." Sometimes you even encounter patients who won't let you interview them. I was surprised actually that a patient from a government hospital would behave like this.  Because in our clinical division, we seldom encounter these patients.

We always encounter these patients in the emergency room.  Well you can understand, the stress of a patient or a parent for his/her child.  They would want always the best medical care be given to them. Because to them this may be a matter of life or death. So understanding their situation is a very important key area in these situations.

But you must understand also that being a junior intern and senior intern is a journey.  Every doctor undergoes this stage.  Even the most successful doctor in the whole wide universe did undergo that stage.  That stage when while young, your exposure to real patients after undergoing 3-5 years of theoretical books in medical school.  That most successful doctor you could think of will not be what he/she is today without undergoing this stage in their path of becoming a consultant.

Do you ever wonder why it's not the 1st year medical student, nor 2nd year nor 3rd year medical student who is inside the emergency room? or who is in the out patient department (OPD) interviewing the patient? Well it's because only a junior intern or someone who has completed 4 years of medical course is QUALIFIED to be inside the emergency room and inside the out patient department.  So don't feel too degraded when you're the youngest inside the emergency room and inside the  OPD. You're QUALIFIED to be there.

We all wished that we'll be in the ideal set-up, a 1:1 doctor:patient relationship.  But right now, in the Philippines, we sometimes can't always have the ideal set-up.  We're still a developing country.

So when a patient comes inside the emergency room and demands that he/she sees a resident or a consultant. Don't feel degraded or sad.  Because at that moment when your resident or your consultant is not around because they're attending to another patient or saving someone else more critical, or in the conference, you're the ONLY one there that's qualified to diagnose and to give first aid to that patient. Well you're the DOCTOR there right? You're the one in there that's most knowledgeable about diseases and how to treat them.

I'm not saying that you be arrogant.  You can always ask the patient, "Hi I'm Dr ____, I'm sorry but the resident/consultant is currently attending to a patient/attending a conference, is it ok with you that I attend to your concerns first before they arrive or are you willing to wait for their arrival?" Then let the patient decide.  For sure, if the patient thinks the condition is urgent, they will agree that a young doctor sees them rather than none. If they decided to wait, then let them wait, unless if it's critical.. like the patient has difficulty breathing or has a gunshot wound or a stab wound.  Do everything you need to do and render 1st aid and CALL your resident.

So don't let the patients bully you and let you feel degraded.  They're just as agitated because of their concern with their lives nor their loved ones.  You just need to remember, you're not an INTERN LANG. You're an INTERN NGA. There's a reason why hospitals chose to place you there in the first place. You're a Doctor there, and it's part of your job to treat these patients.

Residents and Interns are a team.  We back each other's back.  Be sure though that before you give your treatment that you verify this with your residents and consultants, because you're still under their care by law, and it's their license which is at risk of losing if anything goes wrong.

Always remember, You're the Doctor there, and Don't let patients bully you.  You're the one who is most qualified to treat them when your residents or consultants are not around.

Ate Resident's Tips to Junior Interns: Proper OR Attitude

I always start with a disclaimer.  These are all my personal opinions and tips for you junior interns as a surgery resident.  They're not in any way endorsed or rules implemented by the Surgery Department.  These tips are most applicable to the UST Hospital Setting, since I had my junior internship, senior internship, and residency in the UST Hospital. Different rules may apply to other institutions.

Greetings my fellow junior interns =D.  Welcome to Surgery Department, here you'll experience lots of fun things and sad events, and these are important in your process of becoming a physician.  They say, that this department is one of the coolest department (nagbubuhat lang actually ako ng sarili kong bangko/lamesa) hehe. Anyways, let's get to the tips and enough lame intros.

Every year, there'll be an incident when a junior intern will be asked to scrub out of the OR.  This is a common thing, ever since I was a junior intern, may napapascrub out na.  As  a junior intern, you don't know why pinascrub out ka??? Then you come in to conclusion, residents are power tripping.  This is the stupid "hierarchy" in UST.

Now that I'm a resident, let me tell you "MY" side of the story as a Resident.

Being inside the operating room is a privilege, you know why? Because of all the 400-500+ junior interns in your batch, you're the one chosen by God to be involve in a surgical case, whether it's appendectomy, knee replacement, nephrectomy, thyroidectomy etc.  Not all are given the chance to go inside the operating room and be involve in a case to save the life of a patient.  So do you get my point? Treasure every case you have.  Because not all junior intern can see a person opened up to cut out his kidney, thyroid, breast, etc. Who knows, this may be your last chance to witness this case, you may never be able to go inside the OR again if you will not choose the surgical field.  So treasure this chance!

Now that you see that every case is a privilege, you should also accept that this comes with a responsibility.  With every privilege comes with responsibilities (Parang iba ata to sa Spiderman quote, great power comes with great responsibility ata sabi dun).  As being the JIIC (Junior Intern in Charge) of the patient, you have the privilege to go inside the operating room and be part of the surgical team.  You're PART of the surgical team. The patient has entrusted his/her life to the 'surgical team'.  So it's your responsibility as part of the team to study about your case.  

Let me stress this out more:

If you'll imagine, you're the patient, "Kanino ka magpapaopera?" 

• To someone who is a summa cum laude who did not study about your surgery? or 
• To a normal surgeon who studied every detail of your surgery/case?

Every time I ask this, to my junior interns, I always get the same answer.  And yes, your answer is their answer.

So it's just fair and just to the patient that you go inside the operating room, and cut open a part of his body but YOU SHOULD Have at least an Idea of what you are doing! Because I personally would never let another doctor who knows nothing about the surgery to do any surgery on me.

So now do you get my point? Study every case before going inside the operating room.

What do I have to study as a junior intern you'll ask....

1. First of all, know your patient, meaning, you should have talked to the patient, interview him, why is he here admitted in the first place?
2. Study the anatomy involve in the case.  If you'll do a nephrectomy, study the kidney anatomy, if you'll do breast surgery, study the breast anatomy. - You spent 1 whole year studying human anatomy, you spent a lot to buy Netter, might as well use it now.

Those are the 2 basic things that EVERY JIIC SHOULD KNOW.  Knowing the process of the surgery, why the surgery is being done are plus things you should know.  If you know the first 2, I guarantee you that you will not be asked to scrub out of the case.

Another responsibility is being the JIIC, you should know the schedule of your surgery: Meaning, you should be the first one inside the operating room, you should be the one accompanying the patient from the ward to the operating room.  As a patient, isn't it nice to see that one of your doctors is with you all the way from the ward to the operating room??? This is what the UST Compassion is about.  You are how old already? 20+ right? You're an adult, you're freaking going to do surgery already, so you should be disciplined enough to be there on your own.  It's not the nurse's, not the resident's, not the consultant's responsibility to call you why you're not in the operating room yet.  It's YOUR OWN responsibility to be there on time.  For me, this is responsibility and discipline, this is NOT hierarchy. Besides the surgery can start without you, and it's not the residents nor the nurses loss that you lose that opportunity to see a surgery.

Oh yeah... another thing, please eat before you go inside the OR.  You falling down and contaminating the surgical field is the last thing the residents/consultants need to worry about.  Not eating your breakfast or your lunch prior to OR and going hypoglycemic will only endanger the patient and predispose the patient to infection if you fall down the operating field.  There's nothing martyr in not taking your food prior to the OR.

Lastly, bring your proper gear.  Be responsible enough to bring your own scrub suits, your own hair net, your own mask, and don't forget your smart phone.  Who knows you might need to call your runner to get some things needed.

These are some tips I could think of as of now.... I'll add more if I thought of more. Enjoy surgery rotation =D Remember, we've been there... Nagawa na namin yun kalokohang ginagawa ninyo ngayon. =D Naging junior interns din  kami dati =D.

Medical Clerk's Battle Gear

I was once a medical clerk 5 years ago, and this friday, a new batch of medical clerks or should I call Junior Interns will be rotating in the hospital.

First of all, welcome to the new junior intern, if you're a junior intern reading this post.  You feel so excited that after 3 years of reading and studying in medical school, you can now apply all the theoretical information in medical school.  Everybody will look up to you, since you're a senior when you were in 3rd year, and all the medical students will look up to you now that you are a junior intern.

To start off, I'll be putting up a disclaimer.  The tips that you will find in this post are all my personal opinions that you may need in your clerkship.  You would likely benefit from this post if you're a Thomasian, since I had my clerkship/Junior Internship in UST.

Let's start of with your battle gear:

1. Have a decent stethoscope 

This is one of the fundamentals of being a junior intern, so INVEST on it, meaning, buy a quality grade stethoscope.  Of course having the brand of stethoscope depends on your personality.  If you're the type of person who loses a lot of things frequently then I would recommend you get NOT a Littman stethoscope.

If you're the type who takes time before you'll lose something or you never loses things, then I recommend you get a standard Classic Littmann Stethoscope. 

Personalise your stethoscope, there's a man who goes around hospitals who can engrave your name into your stethoscope and that's great since most of you will have the same color etc.  You can also place any accessory into your stethoscope so you will not lose it.

2. Sphygmomanometer 

A great part of your junior internship life will be on measuring blood pressure (BP) of your patients. Buy something you can carry around with you.  You can buy the usual sphygmomanometers in Bambang.  No need to buy the expensive one.  Have it calibrated in Bambang when you buy one.

3. Pulse Oximeter

When we were junior interns before, we were required to just have 1 in a duty group, but I think this is one of the basics at present. You can buy in Bambang, if you can't go to Bambang, you can order at MD Gadgets

4. Thermometer

There are different types of thermometer, there's the axillary thermometer, which is the cheapest, and which I recommend as well.  They come in different kinds, choose the 1 minute thermometer since you need to work fast in monitoring all your patients.

There's also the infrared ear thermometer which is more expensive.  I don't recommend using the infrared ear thermometer unless you're the type of person who never lose anything.  In the hospital, when there's a "code blue", then you have to drop whatever you're doing and go respond to a patient and do chest compressions (CPR) to a patient. You can forget your things and you might lose them.

5. Med Bag

This is where you will put all your equipments, you can either have a waist bag or a shoulder bag.  It's very popular in Bambang to have the black OB bag, but in my experience, I only used it during the first day and during revalida.  That's the bag where I put all of my medical supplies.  The first three are the very basic things, you'll be needing them in ALL rotations. Choosing the right bag depends on your personality/preference.  I first started using the waist bag, the Le Sport Sac replica, because I find it lightweight and many things I can put in that bag, but over time the waist gave some sort of strain to my lower bag due to the heavy weight.  So eventually I switched to a shoulder bag, at around last 3-4 rotations.  

6. Special Equipments

Here are some of the supplies you'll need in certain rotations.  Meaning, it's ideal to have them all, but if you could borrow, I think it's cheaper that way.

ENT

You should have a sterile tongue depressor in your med bag, just in case you have a patient that you'll have to check their mouth.  Have tuning fork at hand. It's recommended that you have Diagnostic Set within your reach, to check for the ears and nose.  I recommend the Welch Allyn Diagnostic Set since it's more durable than the other brands, although pricier than the other brands.  I would recommend you borrow this diagnostic set, if you're not planning on going to ENT, Paediatrics specialty.

Medicine

This is one of the major rotations, you should have a mini notebook with you to list down the things that you have to do and to write notes on the lectures of your consultants and residents.  Have a reflex hammer &  penlight at hand, just in case you need it.

Paediatrics

This is also one of the major rotations, and you'll be needing a lot of special supplies here since your patients are children.  Have a paediatric BP cuff, penlight at hand.  Bring lots of bling-bling and put it in your stethoscope, so that children can play with them while you examine the patient.  Have some candies in your pockets as well to give to the children.  If you're at the pedia OPD, have mask always, those kids are highly contagious!

Surgery

Have clean gloves always at hand, because you'll never know when will be the next time that you have to hold a wound or any trauma patient.  Have a penlight at hand to check for the pupillary reflex and GCS of your neurosurgery patients.

OB-Gyne

It's important you have a good quality stethoscope so you can listen to fetal heart sounds.

Neurology

This is one toxic rotation, since your patients are toxic as well.  Bring your tuning fork, reflex hammer, mini snellen's chart, penlight, coffee granules, cigarette stick, vinegar (to check for the senses).

Ophthalmology

Mini snellen chart, penlight

This are the things I could think of as of now, just comment down below if I forget anything or any rotation I failed to mention.

Enjoy your clerkship/junior internship!