Ahmad Sampang ibnu Hajiri, MD

A Personal blog by a Tausug medical student (now a doctor!) from Sulu and the stories that inspired him.
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I have always wanted to go to Anawangin in Zambales. I have heard about the “hidden” paradise in the middle of mountain ranges, about the pine trees that grow on ashen-grey sands, the wonderful sunsets as the beach is directly facing the West Philippine Sea, and of course the crystal clear waters of Anawangin cove. And so, when such a golden opportunity of going there with fellow backpackers during my free weekend, I did not hesitate to grab it and go explore the wonders of Anawangin for myself. I even decided to cancel it hours before the trip! But I was glad I didn’t, Alhamdulillah! This is my account of that adventure. This is my Anawangin Adventure.

The Team
The team composed of eight adventurous backpackers coming from different walks of life living around Metro Manila. We met at this online group (meetup.com) where like-minded people meet and plan things out. This is not the first time that this group had organized a group trip around the country, but this is actually my first time to join them. So I was half excited and half anxious. I actually don’t know anyone from them!

But Alhamdulillah, I was indeed glad to be with these awesome guys. They are all professionals from their own fields. Plus they didn’t bring any pork nor liquors during the trip (yeay! No awkward moments of saying ‘No, sorry I can’t eat/drink that.”) And what I like best? The intelligent (and mostly funny) discussions we have once in a while.

Itinerary and Expenses
Here’s the group’s actual itinerary and our expenses per head:

Day 1:
·         4:00AM Group met at Victory Liner Bus Terminal-Cubao
·         5:00 The group left Cubao Terminal to San Antonio,
·         9:00 The group arrived to Olongapo City, they took their breakfast here.
·         9:45 I arrived at Olongapo City and met the rest of the team
·         9:45 We left Olongapo Bus terminal to San Antonio, Zambales
·         11:00 Arrived at San Antonio Public Market, met with ate Shella (tour guide and host)
·         11-12:30 rest at Ate Shella’s house, preparations, Lunch
·         1:15PM The group was divided into two: the Trekking Group A and the Boat Group B.
·         1:30 Trek team started trekking together with the tour guide.
·         2:00 Boat team: Boatride to Anawangin cove
·         2:30 Boat team arrived at Anawangin cove
·      2:30 to 4:30 Boat team: Clean-up of cottage, assemble tent, photos, rest (discussions) it was just too hot to swim, Zhuhur and Asr Prayer
·         Around 3:00PM Trek team arrived at Summit
·         4:30 Boat team started hiking uphill for a view of the cove and the sunset
·         5:00 Trek team arrived at Anawangin Cove, swim at the beach
·         5-6PM Sunset viewing, photos
·         6:15PM Boat and Trek team meet at cottage, cooked dinner
·         6:30 to 7:15 Dinner, bonfire, Maghrib and Isha Prayer
·         7:30 Night Swim at the beach
·         8-9:30 Chats, games, snacks, stargazing
·         10PM Lights off
·         10-12MN late sleepers like me are still awake haha

Day 2:
·         4:00AM Early birds’ waking up, Fajr Prayer
·         5-6:00 Explore rock formations, early morning swim while waiting for breakfast
·         7:00 Breakfast, swim
·         8:00 Trek Team went uphill as well for better view of the cove, photos
·         9:00 Swim while waiting for boat,
·         10:00 Boat arrives, pack-up, clean camping site
·         10:15 Left Anawangin cove to Capones island by boat
·         10:40 Arrived at Capones Island. Take a swim in the beautiful beach!!!
·         11:00 Left Capones island
·         11:40 Arrived at Ate Shella’s house in Pundaquit
·         12NN to 1:00 Bath, toilet break, rest, Zhuhur and Asr Prayer
·         1:00PM Lunch San Antonio Public Market
·         2:00 Left San Antonio Market to Olongapo Bus Terminal
·         2:30 Left Olongapo Bus terminal to Pasay (a lot of bus stops along the way)
·         7:00 Arrived at Pasay, Manila then separated destinations going back home.

The sunset scenes in Anawangin Cove are definitely among the best views any photo-enthusiast could ever wish for. (Photo by Jhoanna B.

My Expenses
Php per head
Taxi: Pedro Gil, Manila to Victory Liner Terminal,  Cubao
Bus: Cubao to San Antonio, Zambales
Tricycle: San Antonio Market to Brgy Pundaquit
Boat Rental (for 2 days, to Anawangin, Capones island and back to Pundaquit)
3 Meals in Pundaquit and Anawangin (lunch, dinner and breakfast), Php100 per meal payment for the cook
Tricycle: Pundaquit to San Antonio
Lunch at San Antonio
Bus: San Antonio to Olongapo Bus Terminal
Olangapo to Pasay
My Total Expenses

key chain souvenir (3 pcs)
Tour Guide fee for Trekking to Anawangin
Anawangin embroidered Tshirt
Cottage overnight fee, Php120/night
depends on number
Use of toilet in Pundaquit


The Funny Bus Encounter
As you may have read in my itinerary, our plans did not go as what was planned beforehand. We were supposed to meet at around 4Am at Victoria liners in Cubao so that we could catch up the 5AM trip to Zambales. Everybody was already there save for one person who woke up late: Me. Haha. But wait, here’s what’s funny: I told them to go ahead with the trip and that I might not join anymore (I was the last one remaining and the first trip was in 10 minutes!). But then I decided to follow them even though I was already an hour late, and to everyone’s surprise: we all rode the same bus to San Antonio! Haha. Here’s what actually happened:

·         4:00AM The team met at Victory Liner Bus Terminal-Cubao, waited for other team-mates to arrive; first trip leaves at 5AM.
·         4:30AM I woke up. Sooo late. Haha! I apologized deeply for what happened and told them to go on ahead without me. It was already too late. But then I decided to go on with the trip. Alone. I decided to take the risk: I’ll find my way there when I get there.
·         5:00 The group left Cubao Terminal to San Antonio, Zambales; I was on my way to Cubao yet.
·      5:40 I arrived in Victoria Liner Bus terminal, bought a ticket for Zambales. The next trip was 7AM but I took the 6AM bus to Olangapo instead. I was told to transfer to another bus going to Iba, Zambales because the bus I rode will stop at Olongapo only.
·         Around 9:00 AM the group arrived at Olongapo City, they took their breakfast here.
·         9:45 I arrived at Olongapo City and immediately transferred to another bus going to Iba, Zambales. I was the last passenger to ride. Fortunately, it was THE SAME bus where my team was in!!! (A fortunate accident or destiny? haha)

And I even had a funny conversation with one of my team-mates (who at that time didn’t recognize me. We only know each other online remember?). Here’s our funny conversation:

Seat Mate: (After hearing that we have the same destination): Brad, Alam mo ilang oras biyahe papuntang San Antonio? (Bro, do you know how long the trip to San Antonio would take? 
Me: Uhm, di ko rin alam eh. (Uhm, I actually don’t know.) *laughs*
SM: (noticed my backpack): aakyat ka din ba? Sa cove? (Are you climbing as well? To the cove?
  Me: Oo. (yes)
SM: Mag-isa ka lang? Astig ah. (And you’re going alone? Awesome.)
Me: Naku hindi hehe, actually may mga kasama ako, kaso naiwan ako. (Actually no, hehe, I am joining a team, but I was left behind.)
SM: Anung grupo ba to, online? (What group is this, online?)
Me: Oo online. Yung ano *failed to mention the right group haha*)
SM: I see. Magkano ba budget niyo? (How much is your team’s budget for this?)
Me: Ah, ano, Php 1,500 per person. (Php 1,500 per person)
SM: Ah talaga? pareho lang tayo ah! (Really? We have the same budget as well!)
SM: kasama na breakfast at dinner dun? Pati tent? (That already include your breakfast and dinner? Even the tent?)
Me: Ang totoo, di ko alam details eh hehe, magtatanong pa ako pagdating dun. (Actually, I don’t really know the details. I will ask them when I get there) During those moments, I was already considering the idea of asking this guy’s team to include me in their trip. After all we were going to the same place anyway.
SM: Wait lang, sabi mo naiwan ka, san ba kayo dapat magmimeet? (Wait, you said you were left behind. Where were you supposed to meet?)
Me: Sa Cubao sana. Kaso late ako nagising eh ahaha. (In Cubao supposedly, but I woke up late haha)
SM: Putik, ikaw ata kasama namin na naiwan! Anung name mo? (Fudge, I think you are the one we left behind! What’s your name again?)
Me: *mentions name*
SM: (turns at the people seated at the back while pointing at me) Mga tol, andito na 8th member natin! Haha! (Guys, we finally have our 8th member right here! Haha!)
Everyone: really? Haha! *awkward laughter*

WOULD YOU EVEN BELIEVE THAT!!!! Haha I can’t even believe it! LOL! I even considered joining their team if I can’t find my team in Pundaquit! Only to find out that I was already talking to my own team mate! Haha! Such miracles actually happen huh? Ma shaa Allah!

This is the same bus that brought us together. We happened to see it again before going back to Manila.

This post is went too long than expective so I’m going to cut it into parts. But here's a teaser for what you are about to see (^_^):

Anawangin, Part 2 of 3: From Pundaquit to Anawangin Cove

Anawangin, Part 3 of 3: Capones Island!

Salam Kasilasa!
Ahmad Hajiri
Clerkship Day 137: Anesthesiology

Assalamu Alaykum (Peace be upon you all!). It’s been 5 days since our classes resumed. Actually, I prefer calling it “training” than “classes” because we don’t have much “class sessions” compared to when we were on our first three years in medschool. We are spending more time in the hospital, shadowing our doctors, trying to learn as much as we can from them. So yeah, it should be “training”.
We are now training under the department of Anesthesiology and this will last for two weeks only. They told us that we are fortunate because there are only TWO medical schools in the whole country has clerkship trainings for Anesth. Cool! So it’s really best to make the most of our two weeks stay while we can. 

We’ve been to Surgery last time, so we are not that “alien” to the world of the Operating Rooms. Only this time, we are not working on the OR table anymore, but at the Anesth “territory”: that small, ever-present area where the anesthesiologist hide from everyone’s view. Haha!

So what do clerks do during these two weeks? After the orientation and skills training on the first day of the training, we are immediately brought back to the OR and apply what we learned!
The things to prepare during ET intubation,

"I can view the glottis now." -Future Dr. Molina

Taking turns. Practicing how to intubate while others fool around for awhile.

After the skills training, with Dr Castillo. Sorry for the poor quality of photo -_-

Call time!

First things first: The call time for Anesth clerks is 6:30AM! And believe me, their “time” is pretty way advanced than the usual clock so better sync your watch ahead of their time so that you won’t be late. It happened to me and 2 other classmates on the first day! The wisest way to do? Leave your place an hour before call time, and you’ll be safe, in sha Allah. They are pretty strict with coming on time and signing your attendance.

PS. Be sure to sign at the OFFICIAL CLERKS’ ATTENDANCE LOGBOOK at the ANESTHESIOLOGY LOUNGE (see photo) where “Mama Mary” is and not just the one in the SECRETARY OFFICE!

[photo anesth lounge, clock, mama mary]

The clerks share a single callroom with the Anesth Interns and ICCs. There's a separate dressing room as well. I am just glad that the callroom had a small space available that's enough for my sudjara. 

Happy me :) when I found out the direction of the Qibla is parallel to the long side of the call room :)
The OR Services

Then we are assigned into our respective OR services (General Surgery, ENT1, OB-LAP, ORTHO, etc.). The assignment of OR Services for the whole two weeks will be sent to your group usually on the second day of training. Most of the blocks who went to Anesth before us had General Surgery cases, but January’s not the best time to be clerks in Anesthesiology. Why? Because first year residents will also start their training this time of the year. So technically, most of the hard cases, especially “spinal” are given to them. So our block were assigned at the subspecialty OR cases for now.

The AOD and the Daily Grinder

Each OR service have at least one AOD (Anesthesiologist on Duty) for each said room. There are cases lined up per day, the first case usually starting at 6AM (that’s why you should be there earlier than 6AM!). All cases for each day will also be posted in the “Daily Grinder” found posted on the bulletin board at the Anesth Department hallway. The Daily grinder will also give you the details of the operation including the service, case number, time of operation, the name of surgeons and the AOD. Look for the name of the AOD in charge in your service and better check the cases on deck. Not all cases can be given to you. Pay patients, pedia and complicated cases are never given to us clerks. After having all the data you need the fastest you can, go immediately to your OR service and look for your AOD.

REMEMBER! Never forget to introduce yourself! The worst thing you can do is loiter around in the OR while the rest of the team are wondering what you’re doing in there!

The Preops

No Pre-ops, No procs. That’s one of the solid rules in Anesthesiology. After your AOD agreed to give you the case, you must accomplish your Anesthesiology Preoperative Record before the operation begins. Students have different strategies on this. The most diligent ones would do it the night before the surgery (meaning, they already talked to the AOD way ahead of time), others like me would wait for the patient to be brought to the holding area and complete the pre-ops. It’s a pretty straightforward list of questions that we usually do while charting patients, with a few emphasis on important things such as history of allergies, recent labs, etc. You can do it in 10-15 minutes. Although you can get most of the data from the patients’ charts, it is always good to repeat the questions for confirmation. This is another strong rule in Anesth: Be Vigilant!

The “Procs”

So what are these procedures that we are seeking to “scavenge” they say in the OR? There are only two of them: 1) GETA (General Endotracheal Anesthesia?) or GA (General Anesthesia) and 2) Spinal Anesthesia. By the end of the two weeks training, we are supposed to get 7 GA cases and 3 Spinal cases. That’s a total of 10 procedures. I don’t think I can’t give much details on the two aside from: GAs are easier to find but is far harder to do than spinal. GAs are also the best time to learn how to intubate properly. Don’t worry! Your AOD will surely guide you, just be confident and do your best. It’s important to review what you learned during the skills training on the first day.

During surgery, the clerk will do exactly what his/her anesthesiologist is doing: Monitoring vitals intraoperatively.

Alhamdulillah (All praise is due to Allah), my first two GAs were both successful (i.e. I was able to intubate the patient properly). The next ones were pretty harder that the first two, but my Anesthesiologist helped me out generously. The Anesth residents are most of the time pretty lenient and generous to clerks on their first week. But they do ask questions once in a while, so reading your notes is a must. There are residents who are generous in giving grades (yes! You are graded per procs!) so long as you show interest and willingness to learn, but some residents are not that “generous” unless you prove them that you are really worth giving that high grade. It’s a performance-based rating so it is expected that you get lower grades in the first week than the second.

A funny pin from: https://www.pinterest.com/pin/530510031076612223/
The “Hunger Games”?

Most of the past batches who went into Anesth Clerkship consider this rotation as “scavenging” for procs, a “hunger games” of sort as to who gets to complete the procs first. Our block would beg to disagree on this. We realized that competing for the number of procs will not bring us any further than just that: competition. So we decided to help each other instead: We make sure that most of us will have almost equal number of procs as much as possible. How did we do it? We coordinate with each other. If one of us already had a case and his next case is the same (say, another GA) and the other one needs it, he will give him the case. At first, you would think that this is counter-productive… like how would you be able to finish your procs if you are giving it to your team-mate? But actually it’s not. As proof, by the end of our fifth day, most of us already got 5 procedures which is half the number we need!

So yeah, working together is indeed better than competing with each other. We stopped the “Hunger Games” mania.

So what now?

I think I have been talking too much now in this post haha! I still have a lot of things to do, so gotta end this here for now -_- Hopefully I could write about what we usually do intraoperatively (meaning “during operations”). Honestly, I kind of started liking Anesthesiology as a practice itself. We weren’t able to appreciate this field of study the past years because we were not exposed to it that much yet, especially during ORs. We only often see Anesthesiologists as just sitting in their “territory”, looking at those weird machines all the time. We didn’t realize until now how important their roles are! Anesthesiology is in fact a vital part of patient health care and management before, during and after surgery. It’s not just about keeping your patient asleep and feel no pain during surgery, but more of getting the patient ready for the surgery, reassuring them that they will be safe, keeping them alive while the surgeons are doing their thing in the OR table. :D

They say you just have to love these three “P”s and you’ll be good in Anesth: Pharmacology, Physiology and a bit of Physics :P And if you hate clinics. Haha. 

Oh well, till our next post. Hope this one enlightened you with what we usually do.

Salam Kasilasa!
Ahmad ibn Hajiri

PS. I know I am supposed to publish the other “clerkship notes” during my past rotations last year (Surgery, OBGYN, Pedia, Family medicine, etc.) I’m working on them :) I just have to remind myself that I am doing 

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just saying. -Dr. Ahmad