Scroogey

Jeez, people.

It's Christmas Eve and it just so happens I am in one of those jobs who Bah-Humbug's all the major holidays of the year, simply because diseases do not have holidays.

Could that massive stroke wait 'til tomorrow please? Couldn't your asthma have waited just a few more hours? Or maybe you could have scheduled that family dinner next week so that your gastroenteritis wouldn't disrupt my family dinner?

Bah! Humbug!

So what if people are nicer during Decembers? So what if the cold weather makes you want to stay in bed in the mornings? So what if it's time to spend with people who are close to you?

Parties? Schedule disruptions.
Exchange gifts? Added costs.
Bonuses? Work during holidays.

And to boot, I'll be on duty on the 25th of December. At the ER. Uggghh.

Bah! Humbug!

CHRISTMAS PAST

Christmases at home when I was a kid were always a family thing. Yeah, yeah, I had my share of gifts. But the time spent for those Christmas Eve parties with my mom. dad, brother and sister with all the cousins and the whole clan, was a blast. I'd get excited as soon as Christmas vacation started and I'd get ready for the whole shebang. I knew there would be games, and trivia, and singing and dancing. And I wanted to win everything. And the food was good and there were plenty to go around.

Singing, drinking, and laughter filled the night as we waited for midnight to strike and wish each other a Merry Christmas. We'd go to midnight mass and the choir would sing like angels and we'd be right there singing right along with them.

Not only were the family parties a blast, but Santa would come along and drop by with some gifts as well! Who knew the guy actually existed?! My brother and I would get that Nintendo Family Computer or Playstation we wanted, my sister would get new dolls and other toys she liked, and our parents right there smiling with us.

And the next morning, we'd get to sleep in from the reverie the night before.

Now those were Christmases.

CHRISTMAS PRESENT

I have entered the whole new world of residency training. And in most hospitals, our work knows no holidays. Yeah sure we get skeletal duties (where those not on duty don't have to come to the hospital) but so often have I been the one on duty on those days that I've forgotten how it feels NOT to come to the hospital.

The parties are still there, but with new faces -- a new family, if I may. Surely they can't take the place of siblings and parents, but they are people who share with me the same special day -- people who, like me get to work on these days when the rest of the world is taking a break.

The gifts aren't as grand, but with more meaning. The singing isn't as orchestrated but more boisterous. The dancing is more zany than actual choreography. But the fun is still there.

Reunions and classmate gatherings goodbye. I just don't have the time. Christmas shopping? I hate it because I'd have to fight off two dozen people for a shirt and get in line for 2 hours to pay for a book I found in 15 minutes. The hassle is simply not worth it.

Yeah sure, admitted patients go home as much as possible around these days, but those that are left are those patients we really need to keep an eye on -- patients who could possibly die.

And that brings me back to reality.

CHRISTMAS FUTURE


I dream of a Christmas where family, friends, and happiness are all around me.

Yeah, Dickens had that morbid Christmas future where Scrooge gets buried without anybody going to his funeral, but this is MY Christmas Carol and not Dickens'.

Being with people you care about and love unconditionally is simply the best way to spend Christmas for me. Those days will come -- days where I will watch the smiles on my own kids' faces as they get their gifts from under that Christmas tree in the living room and run around with their new toys, getting hugs and smiles from my parents as they get their second serving of spaghetti, seeing my brother's and sister's families gather for gift-giving and sharing stories, and watch my wife's face glow as she puts on that simple but elegant necklace I got her -- days that will make Christmases worth waiting 11 months for.

Then we'd go to Christmas mass and sing with the choir, thanking Him whose birth we celebrate, for a day in the year where everybody are truly who they are meant to be -- people that care.

RIGHT NOW


As the blog spirits of Christmas past, present and future have brought me back to this keyboard and cubicle in this small internet shop beneath CIM, I've realized I've had a lot of Christmases to be thankful for, as I'm thankful for the Christmas I have this year, and for all the Christmases to come.

I've gotten this much-needed skeletal duty day off from Santa and I'm sure he's probably halfway to Brazil by now, and I spent it sleeping in, walking around the mall, and seeing Tonett at work. Simply put, doing nothing and being a bum. Yup, that's what I asked for Christmas, a break -- a day to be a bum, haha.

I'll be going on duty tomorrow, and I don't know what it holds for me. Yup, I'll be scared as heck at that ER desk, but I'd be in the company of people who are less scared or just as scared, and in that it's a better thing than spending Christmas day alone.

And I ask myself, why can't people care like this all year long? Is it that difficult to be nice for 525,600 minutes?

We can try.

And until that time comes, I'll take that one time in the year when everything glows a little bit brighter, when people care a little bit more for others than themselves, when everything is about giving rather than receiving, and, in this sometimes Scrooged mind, everything is how it is really meant to be.

Merry Christmas to one and all!

It's that time of the year

I know Christmas is coming but what I did not realize until a few hours ago is that it is just barely 6 days away. No, it is not my first Christmas away from home. In fact, I'm pretty much used to it now. But with this thing called residency training, I haven't really delved into the whole spirit of things.

How didn't I notice?!

People are nicer.

Exchange gifts.

Our seniors asking us less questions and offering more suggestions.

Lesser frowns on people I meet.

The cool breeze wafting through my curtains in the morning.

People talking about bundles of joy and bonuses.

How come I did see it until today?

I guess, I'm more preoccupied with adjusting to this whole residency thing. Following up laboratories, not killing people, getting ready for endorsements and actually learning as much as I can before I get another crack at the ER are what mostly occupies my mind during the waking hours.

It's just hospital-home-sleep and repeat-the-next-day for me right now.

Thankfully, an occasional movie and Tonett break that cycle but, as doctors, trainees, and residents, we all live life every three days.

As I'm nearing my second month of residency and being that time of the year, I'd like to offer some nuggets of wisdom for surviving two months in a residency program:

1) Make your seniors look good. Even if you end up looking ridiculously dumb. But if you are not ridiculously dumb, you'd find a way to make both of you look good.

2) Get a good history. There's just no substitute for a good clinical history and physical exam. Even if you don't know what the heck your patient is suffering from, I'm pretty sure you'd get killed in endorsements with a poor history and end up with something if you bring all your cards to the table.

3) Endorsements and morning reports are not easy things. Get ready for them and plan them in your mind.

4) Some allied medical professionals (nurses, PT's, OT's, etc) could be your best friends in the ward, helping you with patients and ward work. But a good portion of them can be the bane of your existence at times from reading too much into a simple order to not actually giving the medicines you needed to give or not referring nada to you at all.

5) Move fast. Sweat. Look toxic. Look busy.

6) Survive. Just take it an hour at a time. You'll be previous the next day, preduty after that, then repeat the cycle again.

7) Pray. Pray a lot. It helps if you have Him on your side.

As the day of Christmas draws near, I bid you all a Merry Christmas with trimmings of red, green and gold.

Somewhere in the middle of Cebu on the 25th of December, I will be on duty, at the ER, no less.

It's definitely that time of the year.

Merry Christmas.

In Sickness and in Health

Now that I'm a month into my residency torture err, training, there is a dearth of topics to blog about. But somehow, you always find something that will make you write and share.

There are two people whom I have come to admire these past few days and they aren't consultants, seniors nor doctors for that matter. They are ordinary, everyday, SO's (significant others) of patient's admitted here at the hospital.

They have given me a perspective of how "in sickness and in health" is supposed to work.

First, Mr. Tomas (not his real name, of course). His wife was diagnosed with Gastric CA since 2003 and underwent resection and chemotherapy. She was admitted for anorexia (loss of appetite) and body malaise.

She was everything you'd notice of a cancer patient -- bald, weak, pale. She had bruises all over that I could not explain because everything was normal save for the fact that she had cancer.

Yesterday, she suddenly started screaming at the roof, praying and was restless despite the sedatives I gave her. I've noticed that patients who suddenly start seeing stuff and screaming out Bible phrases have a tendency to start heading towards that proverbial white light at the end of the tunnel.

I thought it was brain mets. CT scan negative.

I thought it was encephalopathy. Nada. Nil. Zilch.

As I was going off duty, I walked by Mr Tomas outside their room. I stopped and talked to him for a few minutes and I talked to him about where we stood with treating his wife, and anybody could see the toll of taking care of his wife on his face. His hair was a bit mussed up, eyes bloodshot and teary, unshaven and worry crinkles on his brow. He was standing outside as his two sons tried to calm their mom down inside their room. He thanked me for whatever explanation or insight I could give, mustered a smile and I bid him good night.

Later that night, his wife was transferred to the ICU because of a probable seizure disorder probably with the cancer spreading to parts of the brain not easily visible on scans.

I can only imagine what he is feeling right now. Because as corny as it sounds, one could see how much he cared by looking into those teary, bloodshot eyes.

The other person is Mrs Cecilia (again not her name). I admitted her husband for the complaint of unresponsiveness and probable severe pneumonia and a stroke. They barely scraped by with money for admission, intubation and a CT scan, and let alone the mounting expenses for antibiotics, heart medicines and the ventilator to the point that she had approached me for a DNR.

Insensitive as I was at that time, I was quietly comforted knowing she would be signing that sheet of paper that would relieve everyone of us on duty that day, of any responsibility. I almost even groaned when the attending discouraged her from doing so.

But I'm thankful I realized I was wrong.

While I monitored everything about the patient that whole day -- his vitals, his sats, his weaning, his IV's -- she was always there beside him. I could tell she loved him even from the time she came up to me and tears trickled down her cheeks asking for that piece of paper.

I gave her a smile every time I came. She smiles back.

I was assigned to another ward at the start of the month, but still I see her from time to time walking in the hallways, bringing a bottle or two of IV fluid. I asked from my co-residents how her husband was doing only to find out they have not been procuring the IV antibiotics and some meds. Sometimes they have money, sometimes they don't.

But love, in sickness and in health, they have an abundance.

And to love like they do is how love is supposed to be.

Pay, Check

I got my first taste of a monthly salary last 20th of November and though I've never been given that kind of money in one setting, it felt like it wasn't enough for all the stuff I've been through.

I realized, I can't hope to have a life and raise a family on this salary. Nor can I hope to help my parents, pay my rent, and other stuff we use money for.

I offered to buy my dad and sister dinner, but my dad said I'd better save it for me.

Haha, I laugh silently because my brother and my sister earn much more than I do and I've been in school the longest. The return of investment in medicine really is not much. I'd be lucky to even break even in giving back to my parents what they've spent on my education.

Such is the state of this young medical doctor today -- wishing I have a cushy (by my standards) job like Gaya's, earning more by moonlighting like Chofi and Benjo, or simply being able to bum around rich like the Mittals and Bill Gates of the world.

They say it's bad to keep and save your first salary.

I do not know if there is truth in that or it's something people make up to get a gullible co-worker to shell out for a round of beers and pizza, but I did get some stuff for it.

- Went out with Tonett for dinner
- Treated my Ward 2C station to pizzas because one of my DNR patients went home, albeit HAMA, alive.
- Bought a pair of sandals
- Bought some groceries (I, as much as possible, will not use my mom's extension credit card)
- Saving the rest for stuff like a house, a car, land and whatnot (Hahaha, well, I have to start somewhere)

I'll be going on duty again tomorrow. Gaaaaahhhhh.

Our chief, Dr. Roa, says we will be flying solo next month at the ER -- that would mean facing acute coronary syndromes, hypertensive emergencies, endocrinologic emergencies, COPD exacerbations, cardiac dysrrhythmias ALL ON OUR OWN.

Uggghh, I'm dreading next month's paycheck already.

Crossed My Mind

It's been a while since I last wrote and a couple of things have crossed my mind since then. I've finished nearly two weeks of residency and well, I'm already stressed out as heck, my calves are aching from tiptoeing through the hospital halls everyday, not wanting to make a mistake, and getting grilled during endorsement.

Gaya says it's masochism with a purpose.

Some thoughts that have crossed my mind have been:

1. Mostly DEPRESSING. I've been thinking about how tired I've been these past two weeks. Still the first two weeks of a three-year residency and still a loooong way to go. It's not going to be a cakewalk through all the consultants' uhm "lectures" and "constructive criticism." Haha, but I'll take them as such. Hopefully I make it.

2. Sometimes FUNNY. Do you guys realize that karaoke or videoke is fun only when all of you who get a shot at the microphone, suck at it? I mean you go out with friends, some drunk, some sober, sing a couple of songs, and here comes someone with Beyonce vocal cords and sings the song right on key, it just defeats the purpose of videoke.

3. At one time INCREDULOUS. Did you know that over 400 doctors a year in the United States die of suicide? And a couple thousand more suffer from some sort of depression.

4. Of MOURNING. My uncle Bobby passed away last week. Despite asking nearly all of my aunts, I still don't know his disease. Rest in peace, Tiyo.

5. PUZZLING. Why did the Pistons trade Chauncey Billups, Antonio McDyess, Cheikh Samb for Allen Iverson? That was before I realized that Rasheed Wallace and Iverson's contracts are up after this season. And we have tons of cap space to sign at least two max contract players! Woohoo. Imagine...a starting lineup of Rodney at PG, Rip Hamilton at SG, Lebron James at SF, Amir Johnson at PF, and Chris Bosh at Center. With a bench of Arron Afflalo, Tayshaun Prince, Walter Sharpe among others. YEAH!

6. Right now SLEEPY. I'm going home now to sleep. Zzzzz.

Death Becomes You

It's a difficult thing to do as a physician -- realize and accept that there is nothing more we can do to make the patient well and hold out that sheet of paper that says D N R on it, waiting for a signature.

Yet there I was, using every imaginable term, showing every imaginable scenario, and explaining every minute detail in as layman as possible to the relatives of a patient with terminal cancer with metastases to everywhere.

It was disconcerting because the patient was relatively young for a cancer patient (<40 and some) and leaving behind a family. I talked to his brother who said the patient had a brilliant mind but it was sad that people would not see it again. His wife grew teary-eyed with every thought I injected into her mind with my appraisal. Finances were also becoming an issue.

Encephalopathy had crept in slowly during the patient's stay numbing his sensorium and taking away conversation with friends and family. Now he looks like he stares into nowhere and looks at people without a hint of recognition.

There are many cases where doctors stand in the middle of all the emotional, financial, medical, physiological issues of an impending-death situation, and I've faced some in the past as an intern, a PGI, and even way back as a student, but I realize, I still take it just as hard.

Some people are given the impression that doctors are heartless, money-driven and think only of themselves from their experiences, and yes, those people exist, but not all of us become death impersonate. Most, in fact, are considerate and compassionate but misunderstood with their approach to appraisal and getting relatives to see their points.

I appraised them, and with a heavy heart, hoped they would sign the waiver. For their sake, for the patient's, and for mine (I'm barely 3 days into residency), I hope they would.

To see the hurt and pain in a wife, son, daughter, parents or friends of a dying patient is one of the worst things to see in the profession, but we deal with it. It's easier for non-medical personnel in my opinion, but for us, I think we have to draw a piece of it, carry it with us for the rest of our healing days so that we are driven not to see that pain in our patients' eyes.

Death becomes a guy in a white coat. Well, not quite. Most of us in white coats and toting stethoscopes have hearts too.

Growing Pains

They warned me.

That I was going to be tired by the end of the day and they were right.

Lost is mildly putting it.

I didn't know patients.

I didn't know what to do when referred a simple blood sugar result.

I didn't know when to call my seniors.

I didn't know lots of things.

I don't know much.

Its a blow to one's confidence that after you've gone through so much of studying in med school and realizing during your first day of residency that real medicine in wards and duties are so different from texts you get from Harrison's or Cecil's volumes of medical knowledge.

I am disappointed in myself.

But I'm determined to become a better doctor.

So forge on I shall...

And in a special quirk from other training programs, I'll be on duty at the ER this next duty.

Ugghhh.

Gifts and Times on Santa's Porch

Sometimes, the best gifts are those not placed under the living room Christmas tree.

When we were kids, Santa would leave gifts on our back porch -- something for my brother, sister and me -- be it a much-awaited GI Joe, a Matchbox car set, a Barbie, the newest Hardy Boys mystery. It was always something we always looked forward to come Christmas morning, as we threw up our bedcovers and ran to the back porch, finding our new gifts, unwrapping them and playing with them until lunch time.

As years went by, the gifts weren't left on the porch anymore but Santa must have been in a wee hurry as he left them with our parents and they gave it to us in the morning. Still, we'd be playing in that back porch/storage area (as it was converted to store most of the junk in our house) for a while. My brother and I would be setting up GI Joe camps all over while sometimes my sister would play with her coffee/dining set and dolls.

The house got renovated and the back porch made way to a bathroom for my parents bedroom, we grew busy with school and eventually moving to different career paths. The gifts of Christmas still come but in a more traditional way under the Christmas tree in the new downstairs living room. Santa must be mailing in presents now as he would be too old to be riding his sleigh and Rudolph's hooves might need retreading.

But still, I remember that crowded back porch and spending time with my brother and sister. The laughs and the fights, I realize now, were the true gifts and not the toys we played with or the books we got to read. It was the time spent with each other that we received and that is what matters most.

Santa, indeed, knows best.

My grown-up Christmas list has not been written yet but as a postscript, it will be sure to include:

1. Tonett and me surviving our first years of residency
2. Success and contentment to all of our friends and siblings
3. Good health to all our families
4. Guidance in the work we do
(I reserve the uhm right to add more once the need arises)

Truly these won't fit on any porch, but I'll take it.

Headache? Bang your head against the wall...

I am dead tired.

I went through my first day of pre-residency -- pretty much just shadowing my senior residents at the ER and in the wards, getting the hang of doing rounds again, getting a feel for new consultants i don't recognize, and of course the sleepless nights.

And I'm really tired.

And maybe I could stay up long enough to cry and make this another post for Doc Ness' MUSH TBR edition.

I've been awake for almost 40 hrs now with only an hour or two of staggered naps.

I know this is still pre-residency so I sit there at the ER counter doing what I can to help, and shudder as I get a glimpse of what I will be doing for the next three years. And it's BUSY as HECK!!!!!

No interns to help you. Histories. Progress Notes. ER duties. Admissions. Ward IV insertions and other procedures. Updating consultants. Getting scolded by consultants. Learning. Studying. No sleep. Paperwork. Seniors. Rounds. Presentations. Research. Finding time for a bath or a decent meal.

Why do we medical creatures have to go through all the trouble?

If we want a headache to get better, we take away the pain, not add to it, right?

Well, maybe it is to make it all worth it.

As I type this, my eyelids are all droopy, a bit bloodshot, and tomorrow, I'll get up, hopefully on time, and do it all over again.

The workload is scary. The stress immeasurable. The demands near unbearable. But many have come before me and made it through, and so will I forge on with this life called residency training.

Though I've never really come to it in my life and never plan to, at least blogging will have made me a better resignation-letter writer. Hahahaha!

At The Beginning

All the roads that I've taken have come to a beginning, not an end, but yet another beginning. Another road that I'll soon be embarking on will be the way of the Internal Medicine Residency avenue. I don't know what it holds or whether I'll stay the course but I've never wavered and well, here we go again.

I've never really had a plan and admittedly, I've been winging it since high school, taking the courses I knew would pose reasonable challenges for me and keep me interested. The road took me through college, PT internship and boards, medical school and the medical boards -- with no regrets. I remember Michael J. Fox's movie, The Secret Of My Success, and I realized I've never had a secret, let alone a blueprint for whatever success I, we aspire for.

It's not that I'm questioning whether I love IM enough to make it a living, and I love the profession, but the uncertainty of what the future holds for everyone throws everything up in the air. But seeing most of my consultants (especially one monument of a gastroenterologist at SUMC) gladly peering over charts, taking joy in ordering TBDBIB, teaching interns like me on parenteral nutrition, and seeing the full trust in a patient's eyes when you explain a diagnosis, it all seems so worth it.

It has never been about the money for me. Yes, the naive idealism comes into play again, but truthfully, it never has been.

A couple of people think I should be in surgery because that's where the money's at, and I just politely smiled. Some have tried to convince me that money in the States is where it's at as well.

I can't say I've never dreamt of having a big house with a lawn and a pool, 5 cars, jetsetting all over the world, and living in a country where labor is more rewarded and a government that actually works. I have, but maybe I'll just take a vacation every now and then. It's about leaving something for the world to remember me by. Gaya calls it an impact in others lives for her. I don't know if it would be too much to ask for me to discover the cure for cancer or the common cold, would it? Haha, I'll just take making people remember me for the work I did as a human being, whether it be with a stethoscope draped around my neck or not.

I'm starting in exactly a day from now, and I'll be on duty on the first day. It's scary and exciting at the same time.

Here goes nothing.

:)

Boys Don't Cry

No way.

It's unnatural.

It's a girly thing to do.

It's not like we have lacrimal glands like all the women do. Nope, we are the emotional pillars of society. Men just don't cry.

If ever one of you people see any grown men crying, smack them right up on the side of their head and tell them they should come to their senses, and smack them right up on the other side for crying where people can see. It's one thing to be crying, but to be crying in front of people? Oh the shame...

Sad shouldn't even be an emotion for men. Come on you testosterone-laden drones! You are the rock, and should never falter. No tears.

It is not worth the tears to even think of crying for the anguish on Nicholas Cage's face when you come to the realization Meg Ryan dies just he, as an angel, gives up his existence and eternity to be with her and spends one blissful night. No. Not even worth the tears.

There really isn't any reason why your eyes should be welling up with tears when you watch Richard Dreyfuss' Mr. Holland's disappointment when he, as a music teacher, has a deaf son or when the moment comes that he takes up the baton, climbs up the stage, and realizes that after so many fruitless years of trying to make the perfect symphony, he sees that his opus was his students who loved him and played his concierto.

No. Resist crying.

It's not a man thing to do.

Don't allow your emotions to rule you. Even if you get to know a patient and his family, and realize at the time where signing the death certificate your words of empathy means a lot. Nope, no crying. Not even if you shared a joke, laughter and smiles during the good times when you visited his room. Not even if you're seeing a mother say her last goodbye to her child flatlining, and there's nothing else you can do.

No tears for the cute and cuddly kid on the respirator, or the 7-year old in dengue shock. None for the kind old lady who offered you her breakfast as she lay in bed for a week waiting for family to visit.

You have to be strong.

Sure, you're heart will get broken once or twice in this lifetime. You'll find out some people just don't get you or pick on you for no reason really. There will be times when you feel like you just don't belong and there really isn't a good enough reason to smile.

No crying.

You shouldn't even feel that wave of sympathy for Noah Calhoun as you see his love overflowing on the pages of your well-read and tattered copy of Nicholas Sparks' The Notebook. You shouldn't feel part of his love mixed with anguish as he tries to win back his wife every single day at their nursing home, bringing her flowers, and reading poetry every day wooing her. Jeez, what a sap.

I don't care if you are cooking with a hundred onions. Suck it in! Be a man! Men just don't cry!

In times where you feel that the downs of life, sadness, grief, and despair. Don't break down and let your tears flow. No. Don't.

Don't

Let

Them

Win.


Sniff.


(read again, this time, with a healthy dose of sarcasm)

The Years Gone By

When we were told back in the first year of med school at Cebu Institute of Medicine, to choose a batch name, we did not really know how big an issue it was.

We chose to name ourselves, Batch 1 Set A, for the endless exams we had to face at the beginning and eventually, all throughout, medical school.

Back in the 2nd year, I attempted to get a picture of everybody so I could make a video montage of all of us at the end of the journey that is, medical school. I could not get a good shot of everybody, so to those who don't get face time, I just didn't get a good candid mugshot of you, and by no means are you less remembered.

We're setting off on our own now. Each taking our own road, but I know those roads meet somewhere up ahead, and it will be great seeing how we turn out.

For all the good times and the bad, the happy moments and the sad, the times where we thought we'd never make it at all, I'm glad we always had each other to turn to.

The silver jubilee everybody keeps talking about is too long a time, jeez, but don't be strangers, keep in touch.

See ya'll soon.

********************************************

The great non-people pics are found at picture stock exchange. Thank you.

Other pics of the batch courtesy of the great Ligaya Solera (copyrighted na ra ba siya, sosyal)and our yahoogroups at Princess Giva.
A big thank you to Doc Ness for teaching a blog newbie the secrets of video embedding.

Soundtrack: "Oh How The Years Go By" by Amy Grant; I told Shailyn this would be a better song for the Oathtaking but there wasn't really much time to get to learn it so I'm using it here.

A Huff and a Puff

There has been a renewed effort in the battle against the dangers of smoking these past few days as medical societies all over the world, I think, have launched yet another Anti-Smoking Campaign against the addiction.

I've never smoked, nor have I ever felt the appeal to do so. And I guess, that's the key to stopping this habit -- Don't start at all.

The Philippine government enacted the Tobacco Law a couple of years back with several noteworthy stipulations for the average nonsmoking folk like me.

For one thing, it punishes smoking in public areas. But it has not stopped brazen smoking in the jeepneys of Cebu, in my opinion. Everybody, you are in line when you tell someone on a jeep to stop smoking. But rarely have I heard anybody do that. Nobody ever died from daggered staredowns, but so many die from lung cancer attributed to passive cigarette smoking. It's time for vigilance to step up, people.

The Law also bans cigarette brand advertisements. Not that it has completely prevented the "guerilla advertising" of cigarette companies by coloring a particular sari-sari store of its brand colors, but it certainly has tempered the invitations into the habit.

The next step getting flak is the placing of pictures on cigarette boxes. Pictures of diseased lungs, babies affected by the cigarette smoking, and even the effects on sexual function. I watched a smokers' rights attorney vehemently arguing the insensitivity of the move and asks "How would you feel if they put pictures of diseased livers on the bottles of beer you drink?"

I'd say I'd be downright fine with it.

There are so many factors going into the vice of cigarette smoking. Ultimately, it boils down to choice. One can choose not to do it. A smoker can choose to stop or go on (but please pray tell me, what are you going to do with the 4,000 or more chemicals you inhale into your body?).

It's all elementary now. You know it's bad for your health. It's addictive. It takes away a portion of hard-earned money. It affects your sexual potency, people! Wake up!

Seriously, do you really want to wait until you get a disease before you decide it's bad for you?

Of Weight, Weddings and W(R)ent

Uggghhh. My right knee is killing me.

Has age finally caught up with me? Am I supposed to be experiencing this at the tender age of 28? Hahaha. My ankles hurt too and often freeze up when I'm in the cold and when I suddenly bear weight.

That's the key word. Weight. I simply have to much of it. I think. Haha, doctors simply make the worst patients. Well, it's definitely not gout because I had my uric acid levels taken days before the pains started a few months ago, and they were all normal.

I can't be having osteoarthritis at 28 can I? Hmm, what about RA or juvenile RA? I hate having to diagnose myself. Hahaha.

So I'm chalking it up to being overweight. Way overweight.

Gone are the days when I was reed-thin. Ask all the people who saw me in high school and they'll tell you I used to be lanky dorky thin.

Gone are the sports I used to indulge in. I eat too much for my 28-year old metabolism to adjust to. Ugghh. I have to get back in shape. The best exercise these days for me is running to a code.

I vow to be in better and healthier shape. My exercise regimen always starts on the same day...tomorrow.

*********************************************************


I saw the movie Rent again today and I still am of the opinion that it is one of the better modern musicals made. Beautiful songs like Seasons of Love, No Day But Today, and I'll Cover You, all meld beautifully in the fabric of the message of the story --that our lives are simply lived better with people around us who share and care and love.

As the musical's flagship song put it, it's all about "measuring life in love."

*********************************************************

To all those who saw the movie "The Notebook" and did not bother to read the actual novel by Nicholas Sparks, are not only missing beautiful parts of the story between Noah Calhoun and Allie Nelson. For one thing, they didn't actually die at the end like how the movie implied they did.

It's one of the more beautiful stories I've ever read (nope, not gay, haha) and I'm not ashamed to say that. But the book is way better than the movie, that I have to proclaim.

Anyway, my cousin is getting married in a few days and after scouring the house and organizing some of my books, I found the sort-of sequel to The Notebook, entitled, The Wedding. It's just as sweet a story but different theme. You should read it -- second and third chances and whatnot, roses, weddings -- love story galore.

I have no part in my cousin's wedding, but a bunch of relatives and my brother is coming home, so it's always great to be in the company of people you care about.

I'll stop ranting now and tend to my aching aching knee.

Much Ado About Helmets

I've lived in semi-rural, semi-urban Dumaguete City for nearly most of my life. Part of the joys I take advantage of when I'm home is riding my motorcycle because, as much as a car offers shade from the midday sun or the occasional sudden downpour and you don't have to worry about getting an insect in your eye, nothing beats the wind in my hair and exhilaration of zipping along the city streets on a two-wheeled motorbike.

Yup, no helmets here.

From memory, I know some law-enforcing agencies have tried to implement the helmet rule years back but seemingly, Dumaguete is above that rule. Local officials even went as far as declaring that helmets are only needed for out-of-the-city trips.

Give or take a year before, Silliman University instituted a helmet rule in the campus -- meaning you'd have to be wearing a helmet if you were to drive a motorcycle inside the campus. It was funny because, being in a city where motorcycles are a main mode of transportation, students would hang helmets from elbows, handlebars, or keep it in their bags until they had to use it to get into Silliman.

Just a few weeks ago, officials from the DOTC and LTO launched an operation in the city to catch people on motorcycles not wearing helmets. Now, elected city officials have filed a complaint regarding the matter and that what they did is not constitutional.

OK, settle down for just a minute.

Helmets? Oh the joys of living in Dumaguete. Yep, Wall Street is crashing, terrorist attacks, economic turmoil, all that doesn't matter to us here.

I'd be the first to say that I hate wearing helmets when I'm driving. It takes away part of the fun I get when I drive (remember wind in my hair...). But I've also become a doctor and I've seen my share of deaths in the emergency room and seen more than a couple of lives saved by using some head-protective gear. Just because it's inconvenient to put on a helmet and drive a motorcycle a couple of blocks from Silliman to Lee Plaza, it does not mean that the risk that a 10-wheeler cargo truck could hit you while you cross any of the 3 intersections in between, is taken away. Sure that scenario could be a bit overkill and the helmet wouldn't protect you anyway, but I'll see you the next time in the ER when you would be regretting why you did not wear one when CT scans show a skull fractures or subdural hematomas.

Honestly, I probably will not wear a helmet while I drive around my city in my motorcycle. But I'm saying we should.

If that time comes, I'll be using the car.

Wow

I rediscovered the TV these past few weeks after spending the past years in med school.

I saw this recurring ad at a particular channel announcing the concert of Paul Potts in the Philippines. And I said Paul who? I didn't have any idea who the guy was, but it certainly piqued my curiosity.

I knew he didn't look much like an opera singer, but I got the idea he sang arias and whatnot.

I knew he must have come from a reality talent show but didn't know where.

I only got to search him recently and I am sharing his talent and story with you.

Paul Potts' audition on Britain's Got Talent singing Giacomo Puccini's "Nessun Dorma"

My goosebumps had goosebumps.

I was as slack-jawed as Simon Cowell.

All I could say was "WOW."

Check out tidbits of his story here.

The Road Less Traveled (Doesn't Exist)

Sorry Mama Gaya, I didn't have any original ideas as to what to blog about as I contemplated not blogging for the rest of September as I have already blogged more this month than I ever have before, but, I know you get cranky when you don't have anything to read so bear with me as I rehash your own blog topic.

What I'm saying is that the road less traveled does not exist. Yes, it does not.

All that is left is, simply, the road. Roads, in fact.

I know there are people better suited to studying this stuff, like shrinks and psych people, but I've simply concluded that the road less traveled is a myth. Or maybe, just maybe, I'm making this stuff up to make an excuse for my decisions, the lack thereof, or the doubting if I'd ever make the right one. With that blow to the credibility of this blog topic, I'd like to present my case.

Case one: Here's a young Filipino doctor, idealist, save-the-world, rookie, deer-in-the-headlights look on his face at the crossroads after facing the boards and emerging victorious chooses to go into residency right after to specialize and earn at the same time (not that it's much to live on). He stays in the country, and earns a living as a good clinician. Yet he wonders, what would his life be if he went to the US or UK to practice there? What would his life be if he enjoyed life a bit after boards and did a little moonlighting? What would it be like if he just wrote novels for a living or chose another specialty?

Case two: Here comes another Filipino doctor, strong-willed, brave, and chose to take the USMLE, or let's say fell in love with uhm, let's say, New Zealand, and after attending a couple of seminars and moonlighting jobs saved enough money to join the exodus of doctors to foreign lands in search of better pay and adventure. He has the time and resources to see the rest of the world out there, leaving friends, family and significant others, to come back a millionaire with dollars, euros and whatnot. Still he wonders if his life would be better off if he stayed and established himself here? Or had he went into residency or simply being with people who matter to you?

Case three: A third Filipino doctor, compassionate, happy-go-lucky, go-with-the-flow type of personality who knows that he wants to touch people's lives with his work. He does outpatients at a self-made clinic as a general physician, and is adored by the people he serves though most patients barely afford his services. Yet he still wonders basically the same stuff that all the other guys worried about (couldn't type all that again).


Can one really say to the other that "I took the road less traveled?"

Number one says I took the road less traveled because so few doctors stay, go into residency and build their careers from there. Num 2 didn't 'cause it's the trend to go out of the country, and num 3 is easy because he handles the outpatients and doesn't get the bad cases.

Number two gets up, and indignantly exclaims that he took the road less traveled because he was the one who braved the discrimination and insensitivity of foreign lands to build his own career. Num 1 got it easy because he stayed with family and friends and agreed to what num 1 said about num 3.

Number three argues that he took the road less traveled because he barely gets paid for his services sacrificed specialization and the call of going abroad to serve his calling to help people.

Enter me.

I come in and explain to them that the road less traveled does not exist. It is merely a road -- a choice that you make for yourself. A choice that you feel you most likely can live with and not necessarily, always feel good about. Sure, there will always be the intersections towards the roads you didn't take, and there will be times where you'll ask yourself, what ifs and what about ifs, but it's just another turn at the intersection or go straight ahead on the road your on.

Lately, the road less traveled has become an excuse for those with regrets.

And I try my darndest not to ever be one.

Sure, sure, any psychologist could make the case that this post could be my rationalization for my own crossroads and all the cases are me (just thought I'd all beat you to it), but ask yourselves, does the road less traveled exist? Or are you just saying it does just to prove a point?


Choices are hard regardless of the number of people who have come before you and made the same hard decisions whether to take the left at the crossing, go straight ahead, or the right at the fork.

Now that I got that off my chest, where's the map at?

Bittersweet Friday

I spent a good hour or so this afternoon with someone who means a lot to many people, and I'll tell you how much she meant to me.

When I came home to Dumaguete City last year as a graduate of medicine and ready to take on the responsibilities as a post-graduate intern at Silliman Medical Center, she was already there. We were newbies, my friends and I, to this whole medical jungle that lay before us. Sure, she intimidated at first, but I always got something else from her -- she actually cared.

Yes, she will most likely remain anonymous in this blog as it is not my place to talk about the stuff that happened, and all will reveal itself in time.

She was everything we needed at SUMC -- a friend, a mentor who taught us the ropes of medicine, a stubborn parent who gave stern warnings(haha, it's true, don't deny it), a patient who humored us that we could actually give her medical advice, a confidante who always had a ready ear, a doctor more than any of us can ever measure up to by touching our lives -- and she looked over our welfare as much as her own.

I know that all of us PGI's had special places in her heart, some more so than others, I think, but special nonetheless. The talks in the ER, the food we uhm, devoured, the laughter we shared, all of it will be a bond I will take and treasure.

I learned a few months back that she was planning on leaving SUMC and found out just today that she was leaving for good. I was a bit disappointed, and a bit crestfallen would be an understatement. Her influence was probably one major thing that even had me considering coming back to SUMC, and now she would be going away. But in a way, I guess life has its way of showing us where we belong or where we are needed. She said she was going home for a while and see what it holds for her over there.

While we talked this afternoon, I still saw the feistiness, the strength, the humor, the common sense, that we grew to admire in her. We talked about what lay ahead for all of us -- my confusion about what to do (and she gave me sound advice), Ligaya's quirks and closet rebellious nature, Tonett's plans, post-us SUMC, Benjo's return, among other things -- until I saw the time and I got up to go just as another friend came in looking for her.

We both made promises to see each other again in Cebu and in the future and hopefully we'll all keep in touch.

I don't know if she'll ever get to read this (wink), but if it were for somebody else and knowing her, she'd probably print it out and have that person read it. She was selfless in that way.

And for that we thank her.

From the bottom of our hearts -- Me, Tonett, Ligaya, our co-PGI's and all the people who don't know how much they should appreciate you.

We love you, and thank you for doing so much for us and for always being more than we need you to be.

So I spent a good hour or so of this Friday afternoon with someone who means a lot to us and because she made us become better persons, it was bittersweet to say goodbye. She'll be a bit farther than the casual trip home, but she'll be somewhere where she is needed and touching lives as she always does.

Kitakits ha, I'm sure.

Spins on Sins

I came by a snippet in Reader's Digest the other day about some "additional" sins the Catholic Church has come up with to keep up with the changing times. We know that there are seven deadly sins -- we all saw the movie Seven right? -- lust, gluttony, greed, sloth, wrath, envy and pride, along with that supposedly born-with mortal sin by Adam and Eve that they taught us all when we were young. Well, the church has conveniently added another 7 more sins, namely:

1. "Bioethical" violations such as birth control
2. "Morally dubious" experiments such as stem cell research
3. Drug abuse
4. Polluting the environment
5. Contributing to widening the divide between the rich and the poor
6. Excessive wealth
7. Creating poverty

Did I miss something? Who saw the burning bush? Did anybody see a couple of stone tablets appear anywhere?

I am a Catholic by birth, upbringing and by affiliation. But I prefer to be non-denominational Christian.

The thing with most religious affiliations nowadays, the Catholic Church included, is that it is now more often a clergy of men who dictate rules they come up with than followers of faith. I mean, seriously, it feels like that list was just made up. Just because they were the fancy clothes doesn't mean they can make the rules up as they go along.

The Church has become more of man and less in the praise of Him who matters.

By all means, I am a sinner. I am not perfect. But Jesus once declared that blessed are those who are poor in spirit, the sinners for the kingdom of God is theirs. With that said, anybody who uses contraception to curb the population explosion is a sinner (oh yes we are overpopulated, but that's just me). The boy whose life was saved by stem cell research and the doctor who gave it is a sinner. The drug abusers, well, res ipsa loquitor. Anybody who drives a car is a sinner. I really wouldn't want to be Bill Gates right now because he pretty much takes up 5, 6, and 7.

Someone, who we love and adore over most things on this earth once said to love Him with all our hearts, souls and minds and to love each other as we love Him. I think that pretty much suffices, doesn't it?

Hmmm, What To Do...

Over at Ligaya's, she brought up lists of books and her love for reading, and incidentally she also texted me, demanding a new blog, so here we are. Hahaha, we wouldn't want her to run out of reading material would we?

A few months back, I watched a movie starring Jack Nicholson and Morgan Freeman entitled "The Bucket List." Well, it was basically about two cancer-stricken guys doing together what Morgan Freeman's character called his bucket list. He said it was a list of things he wanted to do before he "kicked the bucket."

No, it's not some morbid way to think of up a topic for my next blog but, Gaya pressed me into it, so here it is. Hahaha.

It's not necessarily a "bucket list" but, a list of some things I'd like to do in the near or far future.

TRAVEL: I'm not really that much of a traveller. I hate having to pack up and leave the comforts of home, plus the allergic rhinitis of adjusting to a new place always gets in the way of enjoying things. But with that said, I still have a few places I'd like to go to in this lifetime.

1) Greece - Something about Greece just appeals to me. Whether it be staring in awe at Greek architecture or being in hillside villages and enjoying the views and sunsets of Santorini, I'd love to go there and just chill and read a book overlooking the sea.

2) Africa - There's just something spiritual about Africa. Plus there's the wildlife you can't appreciate anywhere else.

3) Brazil - I think Brazil's parties are the best. Plus the beaches and the women are beautiful (but they all pale in comparison to you hon, don't worry, haha).

4) The Pyramids, Stonehenge and Easter Island - I'm a big mystery guy so I'd like to see these mysterious structures up close. Who knows? Maybe I could figure them out.

5) Norway - I'd honestly like to see the fjords. I think they are magnificent structures. And it helps too that Norway is part of various countries in the Arctic Circle that have seasonal variations in sunlight, and there are times during the year that the sun never actually sets, hence, the name the Land of the Midnight Sun. How cool is that?

Lastly, Mordor. Seriously, wherever they shot the Lord of the Rings, they have breathtaking scenery.

Let's move into the near future as there are a couple of stuff to do before all the travel plans get, well, planned.

BOOKS: I've always loved reading. Recently, I've gone more pop culture with books and trying to cram as much as I can reading fiction before I actually get to reading all the real medical stuff (rolling my eyes as I wrote that).

1) Brisingr by Christopher Paolini - Yup, the 3rd part of the Inheritance series from Eragon (yup the movie flop of the same title was based on), to Eldest, to this Brisingr (if I recall correctly means Fire). I can't wait to see what happens with Saphira and Galbatorix's dragon. Hey, we all have to find our Harry Potter substitutes!

2) Eclipse and Breaking Dawn by Stephanie Meyer - Yeah, yeah, a teenage girl falling in love with a vampire, complications with werewolves and other vampires. I told you I went into the mainstream these days. I am pleasantly surprised at the series. It's actually engaging, thus all the fuss about the upcoming movie and the fifth installment.

3) What's after the 6 Sacred Stones by Matthew Reilly - Like I said, I'm a mystery guy and this series is all about the mysteries -- Pyramids, Stonehenge, Easter Island, Hanging Gardens of Babylon, etc -- I don't actually know the title yet, but Mr. Reilly better come out with the next book and fast.

MOVIES: I'm a big movie buff, and I like to see all the movies that matter when they come out. I guess that qualifies me as a critic. Haha, seriously, I like to watch movies because they tell stories, make me use my imagination an escape, if you will, to someplace, well, not here.

1) The Boy In the Striped Pajamas - I can't wait to see this movie. A holocaust movie seen through the eyes of a German child. This is a story about a German kid who befriends a Jew in a camp. One can just take the ramifications of this friendship and run it around the bases for a home run of a story.

2) Zack and Miri Make a Porno - Funny stuff. As crazy as the title says, I was all cracked up just watching the trailer.

3) Soul Men - Another comedy starring the late Bernie Mac and Samuel L. Jackson. Two over-the-hill musicians, trying to make a comeback, with funny consequences. Rest in peace Bernie Mac.

4) The Miracle at Santa Ana - I saw the trailer, and I want to find out what the miracle was, basically.

5) Burn After Reading - I'm sure all the women will want to watch this, but knowing the Coen brothers, this will probably be another witty, savvy comedy.

There. Lists of stuff I want to do.

Will I actually get to do, read, travel and see all of these?

That, indeed, is the question.

The Cards On The Table

Ugghh.

I'm at a loss.

I don't know where to go from here.

I realize now that, yes, life after the board exams doesn't get any easier -- more complex choices, more personal life-altering decisions, more difficult situations -- that's not including the lives we hold in our hands as medical doctors.

As much as I've admitted never really thinking about doing this for a living until I was soaked in the proverbial sea of my PGI-ship, I didn't also realize that it would be this difficult deciding what actually to specialize in.

Let's put all the cards on the table and let's see what we get (all of these are my opinions and formed (mis)conceptions, but insight is appreciated, haha).

SURGERY: Ah, the glamour specialty. Everybody knows the surgeons. They get the glitz of the profession from having your hands inside a man's insides to doing life-saving emergency procedures. I've had the fortune of being in the presence of good surgeons and great surgeons (haha, playing it safe).

I know that: I love of surgery (or at least part of it). Orthopedics comes easy to me being a physical therapist. Neurosurgery has always been a dream job for me and I love the challenge and rare skill set to be in the same boats as my neurosurgeon role models. I love the diagnostic part of General Surgery and actually doing something about the problem. Plus the scrubs, the sutures, the excitement of trauma, it makes one look so cool.

The thing about it is that: Though I think I'd do good in Orthopedics, it's just that I'm not really feeling it (as if that makes it clearer), not to mention too many orthopods in Dumaguete (that is if I end up practicing there) and Ver plans to become one as well. For neurosurgery, well there are no vacancies. I haven't really ruled out training in Manila, but I'd rather be nearer to home. I hate diabetes insipidus and my aversion to long OR's has long been established. As for GS, I don't fancy working on colon evacuation and colostomies and despise not being able to scratch my nose when it itches and wipe my brow when I sweat.

INTERNAL MEDICINE: The thinking specialty, as claimed. These are filled with the brainy doctors who, as the popular medical joke says, "know everything but do nothing." They find out what's wrong with you, tackle the diagnostic probabilities and give you the treatment you need.

I know that: I grew to love IM. It's probably because I've had my eye on surgery for so long that I never considered it, but after internship, I discovered a whole new aspect of IM that called to me. I've also had the fortune to have had the experience of working with great clinicians and diagnosticians over my few medical years. I love the thinking aspect, the constant diagnostic challenge, and the fact they often are at the frontline in ER's. I love mixing up insulin regimens, the coolness factor of nailing the reading of the ECG and of course, getting your diagnosis right.

The thing about it is that: Well, I've always appreciated what I could see. It's different just judging how much your good your doing by seeing a patient's O2 saturation pick up or an improvement in blood pressure than actually say, fixing a fracture or removing a mass. I can't see a hormone's actions on its receptors nor antibiotics donning armor and battling microbes. Sometimes, I wonder if that adage I mentioned is true -- it tends to be passive at times, just waiting for the medications to take effect (thank you for interventional subspecialties!)

Those are the two I've narrowed my choices down to.

The rest of the field:

1) Radiology: I don't know if I could take looking at X-rays all day, MRI's, CT's. It's just not my thing. I think I'd get even more obese thinking about it. (Dream sequence: X-ray. Eat. CT. Eat. MRI. Eat)

2) Pediatrics: I love kids. But I've never really quite gotten the hang of drugs and dosages for pedia, computing the fluids for every patient, immunizations and computing for the nutrition requirements for preterms. I can handle the kids but I don't have the required temperament and patience to deal with overbearing parents. Pediatricians are given that gift. I guess I missed out on it.

3) Family Medicine: I can't handle the genograms, family case studies, among other things. I have all the respect for family medicine specialists who manage their patients, but I guess I have been disillusioned by so many others who just refer to a specialist when the going gets tough (I think, they're required by law and ethics to do that, but it shouldn't ever reach that point, in my humble opinion).

4) Anesthesia: Hi Doc Ness, haha. I think it's a rare breed to be in anesthesia, as well. It's scary breathing for the patient like that. Just a slight overdose of pento and wham, I'd be out of a job. I'm more of out-in-the-wards kind of guy than an OR person, (except of course neurosurgery haha).

5) Obstetrics and Gynecology: Haha, I've drawn a lot of flak and praise by getting Best in OB-Gyne during my PGI-ship. I got it because I did well during exams, answered right during rounds, did my patient rounds almost 3x a day, and well, generally did my job well. Let's just face it, I'm not cut out for OB-Gyne. I shy away from primiparas and delivered the grand multi's so I won't have to do episiotomies, not to mention all the stress, anxiety and panic I get just mounting a fully dilated patient.(I'd die young). See previous post on this subject.

6) ER Medicine: I love the ER, but I've appreciated the art of following up patients in the ward too much to give it up.

7) Sports Medicine: I love sports. Aside from the fact that there isn't anything like this in our country (I think), there are too few leagues to matter. If I went abroad and did this for a living, I'd really question my dedication because there really is just one franchise I'd consider, haha, see previous post on this subject.

Again, I'd like to reiterate that I mean no disrespect to those who have come before me and have chosen to blossom in the fields where they have chosen to be planted. If you can enlighten me and the rest of the young doctors like me who are just as confused, we'd appreciate it.

I'm lost.

I'm sending out applications this week.

To where, I guess I'll just wing it.

If anybody out there knows where I should be, preferably with an address, a name to send the letter to and the requirements, suggestions are appreciated.

Piano By Starlight

The curtains were drawn back. The instrumentalists were ready in the shadows of the stage as the lights were dimmed for the introduction. Like the dark sky of night dotted with starlights and moonbeams, he thought.

There, standing in the wings, was the young composer ready to step out onto the waxed wooden floors of the Luce Auditorium to present his song. His singer stood beside him, crossed himself, and said something that was lost in the applause and the loud banging of his own heartbeat.

"This is it." he said to himself "Just like playing the piano in the house."

With that thought, he stepped out into the light and strode over to the grand piano, majestic and beautiful on the left side of the stage. He took his seat, took a deep breath and closed his eyes.

He started out young playing the piano, but never really that serious about playing someone else's songs. He wanted to make his own -- this performance would be a culmination of his belief in himself, a belief that everybody has a song to sing and music to share.

Applause came after lights were dimmed and the spotlights came on. In a split second, he saw everything that happened in the past 3 months -- submitting his raw entry of just a few piano notes tinkered over at home and a bunch of forlorn lyrics strung together to make a melody, to getting picked to rework it with an arranger, and deciding to stick with that same raw song and add a bit of strings in the choruses, to deciding to play it himself -- he smiled, cleared his mind, and with his hands gently on the ebony and ivory of the grand piano, started to stroke the notes of his song.

He became slightly aware of applause after the last notes of the intro faded out into words and vocals, and smiled, and thought, it was beautiful -- oh how the notes just flowed from the piano hammers striking the strings, and how the words just went well with mood and persevering message of the song.

The strings came in as the music built up to the chorus and to the bridge, with smatterings of applause in between. He closed his eyes and let his hands dance over the keys, gliding, caressing every note. He thought, "How perfect is this?" Knowing full well the answer to his question, he opened his eyes and risked a glance at the audience, taking in every smile and every teary eye.

He became slightly aware that the song was coming to its end. The strings were fading out, their haunting echoes resonating their last notes in the auditorium, and once again the piano was alone, in the spotlight.

He played the final notes, oblivious to the the dark sky slowly giving way to appreciating faces and applauding hands, and the starlight that shone on his piano dimming to give way to the house lights.

He couldn't help but close his eyes once more, not in awe of the beauty of the music that he was able to make, but in honor and gratitude to the One who made it possible. "Thank you Lord, it was perfect."

He said his little prayer of thanks, opened his eyes, stood up and took his bows and smiled.

Applause.

Debriefing (My 76)

I got my Student Performance Evaluation sheets back today. These letters are requested from the school when applying for residency and further training and sent to the offices of the prospective employers.

They contain tidbits on our character as students -- how we looked to our superiors when we were roaming the halls of CIM aimlessly -- and are purely subjective.

The problem with these evaluations is that they go on your permanent record. It's stuck with your applications to every hospital you apply to, and the next, and the next. It's like cattle getting branded.

My IM evaluation said as a leader, I was not good in unifying the group members, and secondly, I was not confident in answering questions during endorsements.

Well, it's quite convenient that I'm also thinking applying to IM. Aaarrghh.

I'm not really angry nor upset. What I'm feeling right now is more amused than anything else.

Stuff I'd like to point out:

1. We do not hold elections to see who leads the group during internship. With the 5 of us in the group, the fact that I was seen as a leader is kind of a testament to the kind of person I am.

2. The IM rotation is one of the more dreaded departments in Velez due to its patient load and paperwork, so usually, everybody tries to get their own stuff done on time. That may seem like non-unity to other people, but I'd like to say it's more survival than anything.

3. Confidence is in short supply when you're an intern. I've never backed away from questioning. I acknowledge that though I have strong points in certain subjects, I'm notoriously weak in some. In those cases, I choose to shut up, listen and wait for someone to teach me rather than blabber away in an attempt to cover up my incompetence. It doesn't help that the barrage of questions doesn't stop until you've finally run out of answers. I don't care if I'm berated, made insignificant or insulted, just as long as I get taught the right thing.

4. I acknowledge that our group did not have the best dynamic. But we did our jobs.

Out all the other stuff they could have extolled, they chose to put that in my evaluation. I didn't even merit the "satisfactory performance" cop out comment? Hahaha. Really? Out of my month-long rotation in Internal Medicine, that was all they remembered about how I worked? Jeeeeez, talk about selective memory.

Oh well, I don't really how hospitals go about selecting their residents, but I certainly hope they look at other aspects of a candidate other than a comment on a sheet of paper.

Well, to me, it's just another evaluation to prove wrong.

Ultraelectromagneticreunion!

I was in high school then.

When the noon breaks came, and again after classes ended, I remember Bagem or somebody else pick up a guitar and just strum an Eraserheads song and we'd all get worked up and sing along from the mellow "With A Smile" to the anthemic "Minsan."

I love music and I went through my 4 years of high school listening to Ely, Raimund, Buddy and Marcus. Those guys were OUR Beatles. I don't know if they set out to be the icons they eventually turned out to be, but their music spoke to almost the entire Philippines, especially the growing youth movement then. Which is why I've always seen them as UP's 3rd gift to us, along with dynamic minds and Ligaya Solera.

I had all the albums that mattered. Ultraelectromagneticpop! with "Pare Ko", "Toyang", "Ligaya", "Maling Akala", "Tindahan ni Aling Nena," was already a masterpiece. I wore out my tape as I played it over and over and over and then some.

Next came Circus with masterful and witty songs like "Sembreak", "Hey Jay", "Wishing Wells", "Magasin", "With A Smile", which I even brought along to the States so that I could play it over my cousins stereo while zipping through the freeways of California.

One of the biggest albums in Philippine music industry, Cutterpillow came next. It probably was the last Eheads album that mattered with the institution that is "Ang Huling El Bimbo", "Overdrive" and "Huwag Mo Nang Itanong".

So that is the reason why people were so hyped to hear that they were coming back together for a reunion concert. I, for one, was. When I think of them, I think how they usually have a song that I can hear as part of the soundtrack of my life. Yes, there were other bands that came along like RiverMaya (who only mattered when they had Bamboo as their front man), Yano (not so bad themselves) among others, but the Eraserheads were untouchable.

I couldn't go to Manila. I just looked at a couple of videos of "Alapaap", "Sembreak", and "Ligaya" and it was enough to wax nostalgic of all the Eheads songs. It was sad to know that their reunion concert was cut short because of Ely's health problems, which thankfully was stabilized.

How big were the Eraserheads in our lives? Well, our high school batch had "Minsan" as our unofficial graduation song. Tonett was not here during those years but still she knows them by their music.

This reunion will no doubt spark a search for Eraserheads stuff -- songs, torrents, album covers -- and I'll join them. I've long lost my tapes, but the songs, no way. Somehow their still playing "Wishing Wells" on that life soundtrack...

Much Ado About Change

By now, the world pretty much knows who this guy is.

He was standing in front of thousands of supporters at the Democratic National Convention at Mile High Stadium in Denver, Colorado, and so much was made of his historic acceptance of the Democratic Party's nomination for the next President of the United States.

I listened to his speech for the whole duration of it and said to myself, wow, this guy is good. A good speaker, that is. He has charisma and is able to deliver his stuff. This guy with a funny name can be the next US President.

So much was made of "The American Promise" and well, a platform all based on the notion of change, and with how he delivered his speech, he sounded like he could actually do it, sounded being the operative word. To actually do it, of course, is another thing.

As a Filipino, with no aspirations to migrate there (not yet anyway), I love looking at American politics (Philippine politics, gag, vomit). So much is going on with Barack Obama -- change, race, economy, his perceived weak military background, his platform on oil, environment, and healthcare, among others.

One thing is for certain, he is certainly a more able speaker than Dubya. Bush doesn't have the chutzpah to pull off a speech like that. It had sketchy spots, I think, but he made it work. I was sitting in my mom's bedroom and said to myself, this guy could actually pull this off. And there is nothing like the undercurrent of the first African-American presidential candidate rallying his supporters on the 45th anniversary of Martin Luther King's "I Have A Dream" speech. Now that is political manuevering.

As I write this, well, Republican Presidential nominee McCain chose Gov. Palin to become his Vice President, no doubt to secure the women voters and of course, the stranded Hillary Clinton supporters. Haha, now that's politics. I can't wait to see what the Republicans have in store at their convention, which I think, is next week.

Philippine politicians, throw away the mud and start making sense, please.

Much To Be Thankful For

It's over. The wait that is.

I passed.

Endless thank yous to all those who prayed for us. CIM Batch 2007 (Batch 1 set A) is 100% topping for the category of schools with examinees 50-99. That makes it 4 straight exams for the school with 100% (including February), first with a topnotcher (kudos to Shiela!) and a perfect rating, and a perfect slate for the CIM PBL program. Hahaha, we must be doing something right, right?

Thank you. Thank you. Thank you.

******************

While I was riding home on the ferry, two days ago, my mood was subdued despite having met up with my aunt and nephews at the terminal. I was thinking about how I am 28 years into this so-called life and I'm still riding the same trips home, and how others have done more with their lives by this age than I have.

I then tried to proceeded to walk through my memories and pick out things of significance and realized, there is much to be thankful for. I've travelled to the States, been to different places in the Philippines as part of my PT internship (Bacolod, Iloilo, Guimaras, Manila), swam the 1 mile and more of open sea in the Red Cross Water Safety Training, gone to Casaroro Falls, Guintubdan, camped out at Mount Tumikom the 2nd highest peak in Negros Oriental, played in my share of sports tournaments, and had my share of educational achievements, and so much more.

I realized I have much to be thankful for.

Some have less.

It never is how many times we go and do something remarkable, it's how we get it to mean something for ourselves. I could be just brushing my teeth and have it be a footnote in my life (saving the world from tooth decay).

Maybe I'll join Gaya and whoever she drags along with her on her Antarctica cruise (how about it, hon? haha).

Truly I have much to be thankful for. Sometimes, we just need to be reminded of that fact.

********************

I passed!

Lord, thank you. Can I ever thank you enough?

To those who helped us through this, Doc Ness, Dr Ducay, our parents, our friends, each other. Thank you.

Thoughts On My Way Home

I got out of my rented pad this morning to a relatively quiet holiday morning in Cebu. I had already made plans to go home and rest for a few days, awaiting judgment, and was going out to get some of my laundry done when all of a sudden, a series of successive honks scared the zonkers out of me. I thought I was done for. I quickly turned to see a taxi pulling up a few inches beside me and the driver asking me in taxi-driver sign language, if I wanted a ride.

What?! You nearly run me over (which I now realize was not going to happen, because I'd just be no use to him all crumpled at the side of Ramos Street) and you completely destroyed all semblance of a perfectly quiet and peaceful walk, and you ask me if I wanted to take a cab ride? Did I raise my hand or signal you in any way? What's it come to that taxi drivers hail passengers? Didn't it used to be the other way around?

I shook my head, and with the customary hand wave I said no, then another taxi comes and does the exact same thing.

On my way to the bus terminal, I was listening to the radio and it was all about the ongoing war in Mindanao between the rebels and the government (I'm pulling for peace), when this military official comes on and says they started launching offensives against the rebels early this morning, stationing the troops at some key points in Mindanao, and other strategies.

Uhm sir, I'm no military strategist but wouldn't those tidbits of information and military tactics be better off kept to yourselves? It's not like the rebels don't have radios. Then again, that could be the plan, say this over the radio and do another thing. Misinformation. Nice strategy guys. (Picture me nodding head in realization, in pure unadulterated sarcasm of course)

The bus was rolling along when one of those pasalubong vendors came up and tries to get passengers to buy his otaps and masa reals. He comes up to a couple and does his sales talk, "Ma'am otap, 3 for 100, ako ibutang plastic. Ako na ibutang plastic"

I silently thought to myself, what was that? Was that a threat? "Ako na ibutang plastic" Haha, I silently chuckled trying to say it myself. Or was it a reward, like now that you have bought these delicious biscuits, I'm gonna place them in plastic as a bonus!

On my way home, these random thoughts went through my mind. Maybe they are just facades to the anxiety I'm feeling. Maybe. But I do thank the heavens for taxi drivers who don't run me over and don't honk at me while I'm walking safely at the side of the street, the military forces who are risking their lives to achieve peace (I still think you can't talk peace and have a gun, maybe a bat would do), and those people who bring us otaps to bring home. They make a guy's trip home a bit more anxiety-free.

It was a nice day.

Me Thinking Not So Striaght Right Now Raelly

What I was thinking a couple of minutes before this post:

1) That the 2nd half of the boards are coming up this weekend, and I want it to be over, despite the fact that the results scare me more than the exams themselves.

2) Yes, as Gaya mentioned, by this time next week, things will have happened -- whether we all pass or not, whether we get to practice all of what we learned the past 5 years.

3) That I'm really having a difficult time studying for this final leg because there are 6 subjects, 5 days, and so many things to read. How do you fit a whole Pediatrics or Internal Medicine into one day? Not to mention the two subjects you'd have to fit in a day because 6 subjects and 5 days just don't agree with the basic principles of Math.

4) That I get visions of my testpapers getting all crumpled going into the machine that checks it and junks it. Well, I'm not saying that the score would be any better but I think I put a whole lot of thought into those answers and I'm hoping for a chance to get some correct.

5) That I'm praying for my friends and I to pass this test.

6) There are just 240-250 examinees in Cebu, a rumored 50 in Davao, reports of 1500 total examinees and some reports of 2100 in Manila. Either way, those figures pale in comparison to the 65,000 takers for the Nursing Boards and the 27,000 passers. Talk about a lopsided ratio.

Things I'm thinking of right now:

1) That the boards have been the main thing that has been going on in my life for the past 3 months, that I don't know what I would be doing after.

2) That I'm really scared of failing after realizing that I love doing this work, and I would want to do this for the better part of my life to come.

3) That if only the boards graded effort, desire, and service aside from the straight-from-the-hip-tricky multiple choice questions we would get a whole new breed of medicine. But there's just no grading system for that.

4) That I should be getting back to my books.

INDNJC

I woke up this morning, the 8th day of the 8th month in 2008 with more concern for the next day. Yes, the subject of my recent trail of posts -- the board exams.

It starts tomorrow. And I am terrified.

I woke up to the early morning sunshine streaming through my dust-lined screened windows, and realized it was as beautiful a morning as any. A cool breeze picked up and wafted through my room. It felt good just lying there. But like the countless mornings these past few months, I got up and took a bath, read a couple of paragraphs from a random book on my room floor and headed out.

Today we got our room assignments for the executions err examinations.

The reality of tomorrow starts to sink in and well, there's just no stopping it. People say it's better to relax on your last day, but I'm more for the cram-til-it's over mentality. So study again. As Gaya aptly put it, "habang may buhay, may pag-asa."

The texts flooded in. Beautiful prayers I all said quietly in my mezzanine seat. Chain messages, which I forwarded on my Sun phone. Bible passages to inspire. Everybody is turning to prayer at this point, as we should, but if all the rumored 1500 examinees pray, would all of us pass. We could try.

If I remember correctly from my days taking up Music Appreciation, Johann Sebastian Bach, one of music's greatest geniuses always wrote "INDNJC" on his sheet music when he composed his masterpieces. In Nomini Domini Nostre Jesu Cristi. His every work done in the holy name of our Lord Jesus Christ. A tribute. A covenant.

I used to do that once I learned of it. Write it on the top of my exam sheets. My notebooks. I don't know if I actually passed every exam, but it was taken with Him.

Here I am. Weak. Tired. Afraid.

I don't know if I'm ready or if I'll ever be, but I studied the best I could.

So many times in the past few months, the fear has crippled parts of my life, brought frustration and anxiety, and driven me to my knees in prayer and tears. Yet I look back and realize, it also brought me friends, forgiveness, reconciliation and the reaffirmation of the love of those close to me.

In Nomini Domini Nostre Jesu Cristi

As I end this day to retire to my room, I thank those all who have kept us in their prayers.

The uncertainty of the exam results are there, yes. I wish and shout it from the depths of my heart that I want to pass, I want my friends to pass.

We lift the boards to Him, not just leaving it there on that table, but rather, have it become a covenant -- that each shade, each letter, each dot, each number be all in His name. An exam that We take together.

4 days more

Something Gaya said in one of our marathon mock text questioning, struck a chord. We had gotten to a point where she said she realized that she loved writing more than probably becoming a resident after (Was it? I can't really remember Gay). I said, fine by me, because she writes great. I don't know how serious she is, but, there have been several medically-inclined people who have done that successfully like Robin Cook, Michael Crichton among a few. Though in all seriousness, I think she should go into training or practice while writing, because she is freakishly smart.

I tried to recall when I started to write.

Back in kindergarten, I started reading mysteries like Hardy Boys and the picture-filled Bible books. So by grade school, I began my attempts at writing my own mysteries. As I went through high school, writing was more journalistic reasons but I continued to read and write. Attempts were all they were as I never finished anything I wrote. HAHA.

Which brings us to one of my most treasured memories of College. I was taking up English 48, Introduction to Philippine Literature. I took it in the 2nd semester of my 2nd year in college and found out I was under Timothy Montes. I knew him by reputation as a Palanca Awardee and a cool English teacher. We took up the works of different Filipino authors -- Tiempo, Joaquin, Arguilla, among others. Before the Christmas break, he challenged us to write a short story. The best would be published in a literary publication and earn a pretty high grade I would think. So I ended up writing something, at that time, more for requirement than anything else.

It was a short story entitled Akeldama: Fields of Blood. I will never forget what he wrote on that cover sheet. The grade was a 3.7 and comments that said my story echoed the picture and some prose of Manuel Arguilla's Midsummer (which was one of the stories we read, so it likely had some influence haha) and that all in all, I could make a good short story writer.

I didn't get published. And for the record, I didn't even think it even came close to Arguilla's beautiful Midsummer, so it was definitely not plagiarism.

I came away happy with writing, a good grade, and a wonderful memory. I've come to love medicine too much to put writing ahead of it, but I guess that's what time management is for.

Anyway, the real theme of this post is in the title. The boards are 4 days away. Hope springs eternal that my friends and I pass.

Keep us in your prayers.

It's A Little Bit...

It's a little bit:

SCARY, with just, gulp, 9 more days to the board exams as I write this. Panicking might be an understatement. Will I ever be ready? I look at some of my classmates like Domeng, who answers every simple recall question with explanations on the answer; Barbs, who zips in and out of lectures to get to her books for probably her third reading; Nelson, who gives out trivia that even I've never heard of; Chofi, who probably is one of the smartest classmates I know; and Gaya (don't deny it), who claims she is layo pa ayo (not close) in her preparation and readings, but answers all my mock questions right. (OK, most of them, which is still pretty remarkable).

It's a little bit:

UNFAIR, when I realize that I'll be measured with how I do in this exam -- an exam that would probably be more of a test of what I do not know, than what I actually do. That may be an exaggeration, but I do hope I know enough to pass it, because I think I have the bare minimum, at least, to become a doctor. We all know the learning in medicine never ends, so I just want to continue on the journey.

It's a little bit:

FUNNY, at the mezannine of the Cebu Institute of Medicine, where I often study these days, that at one end, the reviewees are arguing on the hand intrinsics, muscle insertions, bones and anatomy whatnot and the first year medical students are on the other side studying the same thing.

It's a little bit:

WEARY right now after a long day of G6PD, glycolysis, glycogenesis, gluconeogenesis, TCA, among other biochemistry stuff.

It's a little bit:

OF A BUMMER, when I've been waiting since the end of the Pistons season for a big trade for a big-time player, and we sign Kwame Brown. Oh well, I still believe. (Had to put that in there).

It's a little bit:

NICE, when I space out and just think of life after the board exams. Hopefully we all pass, thinking about specialties, jobs, helping, and other cool stuff like a much needed vacation and a good night's sleep.

It's a little bit:

CRAZY, that I panicked yesterday and hardly got anything done with biochemistry when I realized that there were 10 days left. Then there was this blog where the entry was about suicide was an option, then I reread it and saw NOT in the title.

It's a little bit:

COMFORTING, that friends like Gaya, Tonett, Maricel, Neil Wayne sometimes come out and say openly that "I'm praying for all of us to pass," or "I'm praying for you." It's just nice to know that we are praying for each other to pass and get through this. It's more than enough to bring a smile to my face and give me comfort when I realize that these people are also pulling for me to pass like I am for them.

It's a little bit:

WONDERFUL, how the spirit of God can calm you like no anxiolytic can. I took the time to go to the chapel to accompany Neil Wayne to his meeting for celebrating a mass for the batch at the Divine Mercy Chapel (in Velez Hospital), and I slipped in for a conversation with Him. It was mostly me talking, but I know He heard. He spoke to me through Tonett, through Neil, through my friends, through Gaya's blog, and even through the gentle breeze to dry my perspiration down. I got down to studying. I may not finish it all, but I got some stuff down pat. I think. Wait, let's change that, It's WONDERFUL how even the faintest thought of Him gives one the strength to do more, to be more.

It's a little bit:

CONTRARY to my previous post that I am posting. I guess I couldn't wait. Hahaha