Sunday, December 16, 2012

This Season

It's been a while.

This December has been unlike any other in all the years I've been fortunate to celebrate the Yuletide season.

First, the apocalypse is reportedly near. The Mayan Calendar pegged it on December 21 of this year and that is 6 days from now. Nostradamus has this prediction involving a calm morning, a dancing horse, and a couple of circles that insanely sounds like the beginning of a bad joke but at the same insane time, eerily comes together.

Second, I'm somewhere where I get to do what I love again.

Third, and most important, is that I have this pair of beautiful, round deep brown eyes that look up from the most adorable pink crib. She brightens my day when she breaks into a smile or giggles, and she gets me to bolt up every time she cries. As a doctor and as a father, I kneel down and say a little prayer every night that our little one be safe and sound, and that faith tides me over.

Life doesn't really follow how we think we want it to be. It is written by His hand with beautiful cursive handwriting, not in block letters, mind you, but long drawn out cursive strokes that end up with the most amazing story that is only ours.

These past few months have been representative of that. I am partly afraid, because I've seen so much in the couple of years I've spent on this earth and partly thankful, for the many things He has given me, my family and mankind.

I don't know if December 20 will be the last day of humanity. I don't know if I'll ever build a good practice. I don't know a lot of things.

But I do know, I have people who care enough in this world to be friends, that the gift of family is a precious thing, that doing what you love matters, and that at the end of the day, it's about being thankful with what you have.

This Christmas, it's all been about that.

Thursday, November 8, 2012


For all the daughters in the world.

Sunday, August 12, 2012

For Future Olympic Preference

In its Olympic history, I believe the Philippines has only 2 silvers and a couple of bronze medals to show for its efforts in the international sports event. This year, our country has been nothing but consistent, delivering a shining, shimmering 0-0-0 slate (I really can't call it disappointing, since it's been the norm for the country since joining).

The Philippines first joined the Olympics in 1924, and eventually became the first country in Southeast Asia to ever medal with Teofilo Yldefonso winning bronze in swimming the 200 m breaststroke. Since his win, we've had 8 more medals, 5 in boxing (2 silvers and 3 bronzes), 2 in swimming (2 bronzes), and 2 in athletics (2 bronzes in the hurdles and high jump).

Since then, the Philippines has been held without a gold medal for the past four Olympic meets and now holds the record for the nation with the most medals without a gold.

This Olympics O-Fer was sparked by efforts in swimming, shooting, archery, boxing, judo, weightlifting, cycling,  and athletics. However sterling these efforts may have been, it may just be that we haven't been sending the right athletes in the right sports. Or rather, we should train and send athletes in sports that we Filipinos can actually have a shot at winning.

Now, wait before you bring out the funny and suggest, patintero, palo sebo, or DOTA, I mean sports that our bodies are actually built for.

Sports like:

DIVING .Our Filipino stature is built for this sport. We are short, lithe, agile and we will be able to execute twisties and turnies before plunging into the deep blue of Olympic pools. I think of how if we catch kids at an early age and train them over at the diving pool in Dumaguete, I don't see how in four years we can't have competitive divers twisting and jackknifing into the diving pool in Rio. Maybe even a medal in 8 years.

FENCING. We are small and quick. How easy could it be for Italians, Chinese, and other nations, to hit us if we move as we know we can move. It might not be popular in the country at the moment, but I assure you, people will get into it once we can put some wins under our belt, as Filipinos are always good at BIRGing (Gayaism: Basking in Reflected Glory)

ARCHERY. I have to agree with this one. This year, it became one of the most popular events due to movies like Hunger Games and Brave, but I think we have it in our country to produce our own Katniss to the Chinese and Russians of the world. We need the support, the bows, the target practice and not just politicians showing up to BIRGe once we hit a bullseye.

BOXING. Now if only we can get officials to call fights as they should be or maybe we can ask them to cut us some slack after all the medals they've stolen from us all these years. The reputation of boxing as an Olympic sport has well been tarnished but it is still there. We have an advantage in the quicker weight divisions like light flyweight (where we have mostly gotten our bronzes) but forget about the heavyweights. We are Filipinos, we are built for speed, agility, endurance rather than power and strength.

ATHLETICS. Wait. I do not mean the 100 m dash or the running events, nor the hammer throws and javelins. I look at the guys doing the pole vault and say to myself, if I was younger, gotten the right training, and a really really long stick, I could medal in this event. It's just people running really hard and going over a bar using a long yardstick. Our race is light, small, and agile. All we need is the stick. Track for Filipinos -- we're fast but legs too short, Throwing -- we're weaklings. Long and Triple Jumps -- again, legs too short. But the pole vault is just right.

HANDBALL. No country has a claim to this team sport yet. Nobody watches it and if there ever was a team sport we could excel in, this is it. Sneak in while nobody is watching.

So please, Philippine Sports Commission. Please stop sending athletes in events that we have no hope of winning. Did you guys really think that our swimmers could hold a candle to the Michael Phelps and Ryan Lochte's of the world? Or that our lone BMX racer could out-RAD the BMXers from the US? Or that our track superstars could outrun the Kenyans and the Usain Bolts?

As much as I love basketball and volleyball, I know these will never be medal sports for us. In baseball, we have a chance but I don't think it is included yet. But still I place us a far cry from the Latin Americans and US sluggers.

But I'd like to see a university athletic program or government-sponsored fencing event, or an archery meet, or the pole vault.

We are Filipinos. We are short, we are resilient, we are quick, we are proud. And we cheer on anybody who wishes to wear the country colors and represent them in international athletic meets. To our athletes who tried, don't get me wrong, I am extremely proud to have cheered you on.

To the people responsible, do your jobs better. It wouldn't hurt if you guys can put us in positions to win.

Friday, August 10, 2012

Marketing Medical Faith

There are so many factors involved in the campaign of encouraging the use of new (and even old) drugs in the medical community that one can really make a career out of it. I've never been under any illusion as to the intricacy and complexity of the management that goes into promoting a single drug and I have no doubt that it takes a great deal of money involved, but it would take constant updates and reinvention to lead a successful campaign.

Given that  I've been privy to the thought process behind it recently, I just think that, although there still are too many factors to possibly ever have under control, it would help people in this business to take into account certain things into consideration.

DOCTORS: When it comes to approaching the use of new drugs, there is no greater avenue for promotion than to those that prescribe and practice medicine. But unfortunately, doctors are not created equal.

When it comes to brushing up on new drugs and new medical information, there are doctors that diligently read and keep up with medical breakthroughs and whatnot through established medical journals (no, not the ones that routinely pop up on your regular Wikipedia searches), know how to critically appraise articles, and know what the terms RRR (relative risk reduction), ARR (absolute risk reduction), hard and soft endpoints mean. You see, it's never just about what they point out in the conclusion sections of articles that counts. One has to look at how the trials are conducted, any underlying agendas and whether they are statistically hazy or statistically potent.

On the other end of the spectrum, there are doctors who are content with what they know and do not read quite as much. There are subsets of this group that become the hook, line and sinker types that believe everything medical representatives pitch to them at their clinics or those that think sponsored scientific "eatings" are law and incorporate them into their practice.

If you strategize, you'd have to wow the first group with a great medical trial to influence the inclusion of new drugs into their well-established arsenal of therapeutics. The second group will take a little bit more wining and dining, maybe a few more side offers, and you're all set. Not to make this sound all shady and unethical, but people have to know that these are drugs with trials about them having proven their effect with their target disease. In reality, use is largely a matter of marketing, and benefit takes a backseat, but if you can get both, everybody comes out a winner.

PHARMACISTS: Pharmacists in the Philippines play a unique role in the sales of medicines. And I largely suspect, not only here but all over the world. Patients would often bypass doctor consultations and go directly to pharmacies and ask for medications. I'm sure that they all know their stuff and exercise vigilant and compassionate dispensing of drugs, but somewhere out there is an argument that they should refer to doctors regarding drug prescription but that is the reality. Marketing-wise, it's a whole new avenue to cover.

MEDICAL REPRESENTATIVES: These individuals go into doctors clinics and make cases for their assigned drugs and have to keep smiles on their faces doing so. Imagine how hard that job will be if you have to drive doctors and hospital bigwigs around at their whim. But marketing drugs have to be launched off somewhere and for companies to have the perfect representatives will go a long way. They have to know how to play doctor types and personalities and know the intricacies of promoting drugs, when to play off humor, who needs the extra push, who responds to flattery, and who needs it straight up. So for those in the market of selling to doctors, make sure you have the best of them.

PATIENTS: The most important market for drugs are the people who actually use them. In this day and age, the information superhighway is a busy busy one and patients are not as uninformed as they used to be. They come into clinics armed with information, albeit a hodgepodge of medical jargon and not necessarily knowledge, but giving them information, guided and unbiased, for them to digest as they see fit, would go a long way. Just don't forget to add those words at the end "if symptoms persist, consult your doctor." Creating groups online of patients with similar experiences, quick drug study guides, and nearby support systems will go a long way in showing that your drug cares for patients and at the same time, promoting its use among people who actually know what it is like using them.

Selling people on to medications has never been as straightforward as it seemed. Through the ages, people have found ways to get around stipulations, advertising, succumbed to some degree of corruption, but it has always been about getting drugs to people that need them, given by people that actually know stuff about it. With that, you need belief in your drug, some medical faith. So if you are in the drug marketing biz, and you think that traditional folk healers are a way to get people to believe in your drug, go that way.

Sell the drug, not your soul.

Sunday, July 29, 2012

Flash Drive Movie Moments

I recently browsed through my collection of downloaded movies after a friend asked to copy them for her own. I'm a bit organized, so every movie was filed under their genre -- action, comedy, rom-coms, adventure, etc -- and I wondered if, after all this time, I'd be considered a movie critic. After all, I do love watching movies, and as a moviegoer, my opinion should count right?

What could be great for me, may not be good for you. What constitutes a movie worth sharing a laugh over, or shedding a tear for for me could be rubbish for everyone else. But I like to look at movies on moments and stories, and if they resonate with me, touch me, or entertain me in any sort of way, they can take their place in my external drive for replays anytime in the future.

Just looking through my collection brings back several of these movie moments.

I remember the beginning silent sequence of Pixar's "Up" which I think sold the movie itself. No words, just images and music yet nothing evoked emotions of happiness, grief and the beauty of life and love like Carl and Ellie's love story in a nutshell.

I laugh and sing in my head to "...Jamaica we have a bobsled team" and relive going to the Winter Olympics with the Jamaican bobsled team in "Cool Runnings." That movie had me dreaming I could start the bobsledding dreams of Filipinos everywhere. It was when they fell over during their last run and saw their medal hopes dashed, that they literally got up and carried their sled over the finish line to respect that I nearly stood up and applauded myself.

I have a lot of sports movie moments in my flash drive. Like when Gary Bertier and Julius Campbell finally yell, "Strong Side! Weak Side!" in putting it all together for their team in "Remember the Titans,"  when Keanu Reeves runs out onto the field his last day as quarterback Shane Falco in "The Replacements," feeling goosebumps as I listen and watch USA Hockey as they defeat Russia in "Miracle" with Kurt Russell pacing on the sidelines as the radio commentator shouts, "Do you believe in miracles?" or when Dennis Quaid throws his first pitch in "The Rookie" and Kevin Costner throws his last in "For The Love Of The Game."

Though I have a whole slew of sports movies, I have all the other genres too.

The rom-coms have their own category with the usual Julia Roberts, Meg Ryan, Tom Hanks fare. After all those are the cuddle movies -- the Harry Met Sallys, the You've Got Mails, the Runaway Brides, the Sleepless in Seattles -- that will have us saying all those "You had me at hello," "You complete me," "Love means never having to say you're sorry" lines that we all love to whisper in our loved ones' ears. But moments that got me are best exemplified in "Love Actually," where the all the types of love we share  are showcased and that by the end you realize truly that in a world where we think that caring for others has lost its luster, "Love, Actually Is All Around."

I remember all my "Lethal Weapon" movies and "Back To The Future" made me believe time travel was possible with a car and a flux capaciter. I loved the face-off between Samuel L. Jackson and Kevin Spacey in "The Negotiator" and the literal face-off in "Face Off" between John Travolta and Nicolas Cage. Feeling like I was sliding that endless water slide in "The Goonies" and cracking my whip with Indiana Jones on his adventures -- what a rush! Oh, and like James Bond, I ended up with the mission completed and the girl in the end.

I guess that appeal of bringing us stories that we can believe to be true for us has always been a prevailing pull to movies for me. I firmly believe that should The Sorting Hat be placed on my head that I'd be ushered into Gryffindor and that I'd give Harry Potter a run for his money. Perhaps that whole series could be about me instead! Or that I'd discover that I had mutant powers and join the X-Men.

So many movies so little time. Maybe one day when my kids are off to the futuristic 10D cinemas I'd say, "Oh, that's a remake kiddo!" I pull out this old dust-laden flash drive, "You should see the original!"

And they'd roll their eyes and I'd smile. What are we without our moments?

Monday, July 16, 2012

Changing The World, Eventually

A while ago, I came across an article published in the Philippine Star about twentysomethings and their continued education in the classroom of life. It struck a chord not simply just because I can relate to it somewhat, but because I came across it at this time in my life where I lose sight of things sometimes.

But I disagree.  Somewhat.

Let the record show that I've played both the jaded, depressed angry-at-the-world guy and the naive, heart-on-a-sleeve idealist at several times in my life.

To the ex-fresh graduate, I have been you too. After a bachelor's degree, a medical degree, a post-graduate internship, and an Internal Medicine residency training, I can definitely say I've played the part of fresh graduate a couple times over, and each time these had opportunities opened up for me to change the world. But I chose to toil even more in books and training, so as to be able to make my mark in the world -- specifically, make a difference with the future patients that will come knocking on my clinic.

Now a few months removed from graduating from IM residency and even passing the diplomate examinations, I find myself back at square one. Granted I'm waiting and wavering over and over again on the subspecialty that I want to go into, I've had the misfortune of not even being called for interviews to apply for junior consultancy in the hospitals I've applied to, and the clinics I attempted to see patients in. At this time, I work at a small diagnostic clinic in a mall that does employment medical clearances and physicals, and some consultation with patients coming in, malingering to get a medical certificate more than anything else. I've even accepted shifts at call centers in the city to augment my income. Heck, even some of my friends think I'm just suited for medical practice in the city and can't cut the rural/provincial hospital scene or that they think I don't like doing duties at hospitals.

It's my first real shot in the working world and I don't think I'm doing as great as I had planned. I have a memorized dialogue for my PE interviews, get frustrated daily with those that pretend to be sick just to get excused from work when I haven't missed a day of work since, well, I really don't know the last time I missed work. After a few hours of clinic duty, I go out to nearby call center to do a few more hours there.

Not exactly world-changing.

After reading that article, not exactly a difference-maker for the nurses I work with in the clinic as well. Those spiffy, twangy, sassy and young call center agents, did not have tedious graveyard shifts in mind when they wanted the chance to earn their first millions. Anybody who is not anywhere they want to be, or feel like they are owed more, will not have expected dealing with all this frustration and obstacles. Anybody who has had to settle, will want to be somewhere else. Somebody who has had to change themselves for something they do not want, will seek other more fulfilling things to ultimately satisfy them.

I wanted to touch people's lives and be an instrument of His healing -- to make difference, to change the world.

And I still want to.

The passion never really goes away -- it just gets lost sometimes.

Though the cases that have legitimate illnesses that come into the clinic I work for are few far in between malingering patients, there is the palpable spark of curiosity and the pure intention of helping them achieve a cure when they sit down and tell me their stories. The drive goes back on to scrounge up every rusty bit of knowledge that I have been hanging on to since finishing training and actually bring the patient back to health.

The key is always finding a reason to be happy where you are -- finding something that drives you. Whether it be money, fame, or the chance to change the world, for family, for love, for that extra bonus -- to each his own.

I remember Sanjiv Chopra's talk at the Philippine College of Physicians' Annual Convention this year admiring the work done by Paul Farmer (recounted in his book "Mountains Beyond Mountains") where he brought cure to an HIV-infected African man. He did it by never giving in. The big names in this world have somehow made their marks, because passion never really went away. So it can hold true for all of us as well. We hold it in our hands when we go out into the world from graduation and when we set it down to throw back the crap the world is slinging at us, we end up losing it. We'd have to go through the muck surrounding us, get dirty and find it again, and somehow just manage to survive.

I still believe I can change the world. I've never been the whole get-up guy in the spiffy suit so I don't have to worry about looking like a fresh graduate all the time. I say to young people everywhere, get your suits dirty, and so what if you got it off a rack at SM. At times, it takes the hardened, seasoned, weather-beaten, oft-insulted, underestimated individual to get the job done.

It takes passion to dream, fail and get up again. It takes passion to be able to get up in the morning, go to a job you don't totally like or dislike and work for something better. Such is life, and misconstruing hard work and its slow, deliberate toil as failure and irrelevance, is just so wrong. So I urge you to find passion wherever you can. It is normal to lose it at times, but for you to have any semblance of happiness and satisfaction, there has to be that drive to just go a little bit more.

Always remember that happiness and success are relative. It is not where you start nor where you end up, but, as a wise and good friend of mine put it, "when someday, you look around with satisfaction that you're exactly where you're meant to be," you got it made.

Wednesday, May 23, 2012


When seeing patients, one must remember that the physician's job is the discovery of disease, and not deny its existence.

Just a friendly reminder to myself that I thought I'd share with all of you.

So for our patients, the benefit of the doubt.

And to us, an unending supply of patience.

Monday, May 21, 2012

When The Training Wheels Come Off

It is a universal experience to have had someone teach you something, let you try it out, and subsequently let you go to fend for yourself.

I remember being a kid riding my first bicycle, it was red and was kind of modeled from a Harley with the long handlebars, and had two small training wheels on each side of the back wheel. I remember riding it in the house and asking permission from my parents to ride it outside for more space. Kids always want to go faster and farther, and I was not an exception.

I grew a year or two older, and the bicycle got smaller, and lesser of a challenge. I didn't ever fall. The training wheels were always there.

Then came the decision to take them off. I found that if I went fast from the get-go, I'd zip along fine on the bike and get it under control, and whenever I felt like falling to one side, I'd merely slow down and stick my foot out and stand. No sweat.

In the next months, I'd gotten a blue and bigger bicycle, BMX style. (RAD was in, 1986, with Bart Conner and Lori Loughlin). I figured, I got the stuff to do all the stuff they'd been showing on the movie. My Dad and I were out on the boulevard to try out my new bike and he warned me of how it would be harder. I was scared at first, but I was quietly confident. I got on and stood on the pedal and my Dad gave me a little push and let go of the seat. I felt my speed pick up, felt the wind in my hair, and suddenly, panicked. I was going to fast, realized I couldn't reach the ground when I swayed to each side, and I clamped down on the brakes and fell into the gutter in the next alley.

Thinking back on it now, I laugh. I got some scratches but no broken bones (there was another part in my childhood for that), pride got thrown out the window, but I was A-OK. I've gotten way better at riding bicycles since then (I rode again the next day without incident), graduating BMX to racing and mountain bikes.

But everybody remembers that time when the training wheels come off. Whether it be riding transportation, teaching in the classroom, or a life lesson.

In medical training, I was fortunate (sure, I look at it that way now, haha) to have been trained in an institution that started me out as an ER resident during my first year. Current residency training programs in Internal Medicine require first year residents to do ward work for one year, before becoming eligible to rotate as ER residents in their second years.

I went on ER duty on my 3rd day as an IM resident in a tertiary hospital admitting at least 20 patients a day on a slow day. Sometimes we had 20 patients in 4 hours.

It was crazy. I didn't eat. I didn't and couldn't sleep, and had ward work the next day. Not to mention the morning endorsements and numerous reports. I loved the challenge but it scared me out of my mind to the extent that I made it a point to go by the church before I went on duty.

The first duties, I had a senior who would back me up. But it was more like, he or she would just pass by the ER on his or her rounds, give me a pat on the back, say something like "Kaya mo 'yan kid!" or "You can do it!" and leave to tend to other patients. Occasionally, with the baffling patients, I'd confuse them enough on the phone to entice them to come down, but that was it.

There were no training wheels on this time. I'd gotten a big bicycle along with big shove down the side of the hill. Sometimes, I fell to the side but got right back up to ride again.

Then I became quietly confident again, I began to find the long labor-intensive hours taxing but challenging, and shhhh, quietly fun. I've said it again and again that I love a good puzzle. And those you-can-do-it comments were made in earnest now. It told me that I was doing something right when people said, "It's okay, we can relax, he's on duty at the ER." or when I called up my consultant and he says "It's okay bai, work him up and order the needed labs and start the needed medications, I'll see him in the morning." (It wasn't always said that nice, but the small victories always count, hehe)

It felt like the time when I was on my bike again, zipping through the lazy afternoon streets of Dumaguete with the wind in my hair.

It is an unspoken rule in medicine -- Observe, Learn, Do, Teach. For those studying and in training, observe and learn. Let yourselves be taught. Listen to those who have come before you. Stop trying so hard to outsmart them just to let yourselves think you're better. Do the work that needs to be done, so that when your time comes to pay it forward, you can teach those that come after you.

Just as easily as I can recall those training wheels on my small red bike, I recall the times when I was a medical student, my wife and friends were still studying our heavy, heavy books, listening at times to our medical teachers, watching in awe at our consultants do surgeries, diagnosing and examining patients with great ease, and rattling off medications at the top of their heads while doing their rounds. We've gone on into different fields in and out of medicine -- I still marvel at how we've come to grow into the doctors that we are. My wife doing her own surgeries on charity patients, my friends in general surgery taking out gall bladders now and names later, diagnosing patients in IM and Family Med, reading X-rays and CT's, and even copy-editing and medical advertising.

Just like how my red bicycle went to my brother for him to practice on, I pray we all learn to pay it forward and help those that come after us along as well. I don't care for a few falls along the way, but it's always getting back on that matters.

Friday, May 11, 2012

May Days

When the month of May comes around each year, it ushers along with it a more reflective time, as well as the scorching summer heat.

I think about chalking up another four weeks.

I think about how the title reminds me of May Day Eve by Nick Joaquin, and how I once got a 3.9/4.0 in a Philippine Literature class I took one summer, for writing my own short story that, as my Palanca-award winning English professor said, "echoed prose of Manuel Arguilla's Midsummer."

I think about summer vacations.

I think how 30+ years have gone by.

I think of how sometimes I still think I'm a teenager but realize a few minutes later that I'm not anymore.

I think about the time when I used to think about what I'd do when I grew up, who I'd be with, where I could go and then come back to reality, and discover that I'm way better off than I'd ever expected to be.

I think of the Detroit Pistons winning the number one overall pick in the lottery.

I think of the future and how I'm going to come to grips with it, how to move forward and realize that it's going to be alright with loved ones, family, friends along for the ride.

I think about a million ways things could go wrong and stop, then remind myself that there are always a billion ways it could go right as well.

There's just always something about May that makes me feel, well, just a wee bit older, wiser than the year before.

Oh, well, here's a toast to all the Mays of life, and all the years that come with it. May the joys outnumber the sorrows. May the laughter ring true more than tears. May dreams pair with reality than heartbreak. May friendship destroy bitterness. May love triumph hate.

These are the May Days my life, and more to come.

Tuesday, April 24, 2012


While doing a stint as an annual physical examination doctor at a local call center, I came across several conversations that amused me and not just because they were coming from educated people who answered my questions in fluent English, but that they all said it with straight faces.

Me: Any other medical concerns these days?

A: Sometimes, doc, I get these throbbing pains in my low back area. Maybe it's just "panuhot" because I sleep with the fan and the air conditioning on, and for most of the night, my back is exposed to it. So maybe that's it, siguro.

First, I really don't know what "panuhot" is anymore. I used to think they were muscle trigger points in myofascial pain syndromes. I used to think of it as twisted muscle fibers and micro-tears healing in really funny ways causing knots and felt as such in the broad sheets of back muscle. Now, people use it for anything they feel -- stomach pains, chest tightness, difficulty urinating, and a host of other bodily aches.

Second, I really don't know how an electrical appliance can cause anything. They get blamed for so many things -- fires, lost files, not working properly -- that they really shouldn't get an even worse rap for causing back pains. Except for maybe some bloatedness, I'd hate for appliances to be agents of disease because these past few days of summer have been really really hot, and most people are going to be in front of those fans and AC's for the most part of their days.

Most often those bodily aches and pains are probably muscle spasms or knots of muscle healing from microtears which heat, stretching, and proper body mechanics can't cure.A pain reliever or two won't hurt either.

Me: Do you have asthma?

A: No, doc. Well, I did when I was small, but my mother just had me play basketball and I was cured.

If basketball was a cure for asthma, I'd prescribe it 3x a day to cure asthmatics everywhere! But seriously, if I had to write down the pathophysiology of asthma and how modern medicine helps its exacerbations, this just wouldn't be a fun blog anymore. Exercise can trigger asthma. That's precisely why asthmatic athletes take their inhalers with them.

But I do know that people who exercise develop a certain, for the lack of a better word, tolerance to asthma attacks. It does this by increasing oxygen, thereby, decreasing the body's absolute need for it in times of exacerbations and what other theorists have put out there, but this does not address the airway hyperresponsiveness and inflammation that are the fundamental abnormalities in asthma.

The basic problem is, people labeling an assortment of things as hubak or asthma. Coughing = asthma. Difficulty of breathing = asthma. If you go up a flight of stairs and you are still trying to catch your breath, bouts of coughing and simply because your diaphragm is getting pushed by your full stomach after a good hearty meal is not asthma.

Me: Do you have asthma?

A: Well, I was admitted a year ago doc for pneumonia.

It doesn't really answer my question.

Asthma is not pneumonia. The former is a condition characterized by inflammation and airway hyperresponsiveness while the latter is an infection of the lung parenchyma.

Yes, it's my job to educate people so I did, and I do.

Me: Sir, after three blood pressure measurements, by definition you are hypertensive. You should cut down on your salt intake, modify your diet and change your lifestyle.

A: So I can't eat pork anymore doc?

What I usually say is that I'm a very lenient doctor and you can still eat pork, but not with too much salt or seasoning. For those of us who eat pork on a near daily basis, we pretty much know it's delicious. So I say, everything in moderation.

First, hypertension and cardiovascular disease have so much more going on than Kim Kardashian and Kanye West combined. There is salt, salt-retention, sympathetic overactivity, renal considerations, heart considerations, allowances for end-organ damage, and whatnot, that to worry about it all would be a sin to life. But let's take one small step by reducing the salt intake since it has a big role in elevated BP.

People say that eating red meat increases mortality. I say "to live is to incur the risk."

Cut down the salt, get exercise, cut down on fat, and if it doesn't help, take your medications without fail.

Me: Any other medical problems?

A: I used to have these skin allergies and wounds doc, on my hands when I was young, but it went away because, (in a hushed tone) I don't know if you believe in it doc, but my mother used the urine of a lizard with wings (tiki nga naay pako) and it just went away.

Me: ???

I just sat there with my puzzled face on.

The work, we new-generation doctors have to do is a long, long road.

Wednesday, April 11, 2012

What Not To Do When Seeing Your Doctor For A Medical Certificate

After doing some duties at an HMO clinic, I realized that the most common reason people actually come in for consults is to get a medical certificate, regardless of whether the claim of illness is legitimate or not. Mostly, these patients malinger (yes, we can tell) so that they can get their unauthorized leaves excused with pay, but some actually are sick and come in to get themselves seen, while others come in asking for a fit bill of health to return to work.

For the better part of things, I don't complain, and I'd like to give my patients the benefit of the doubt. But there are certain things that you should know when you come in for that piece of paper with the doctor's signature on it.

1. For a change, maybe you can actually see a doctor when you are actually sick. It will make our jobs easier.

2. If you're faking it, stick with subjective complaints. Saying that you have a fever with cough and colds, would work when only when we actually get a fever on a thermometer, when you're all stuffy with a nose swollen up like Rudolph, and barely getting through the history part of our examination because of a hoarse voice. With subjective complaints, at least you would have more luck if you come across a doctor who gives you the benefit of the doubt.

3. Please, if you've self-diagnosed yourself before you came in for a consult, do your due diligence and check it out. The Internet can be your friend in these things. I actually feel bad for electrical appliances everywhere, and the wind too. I think people have found them as causes of several body ailments more often than actual disease agents, like sleeping with the aircon or the fan on causing muscle pains and diarrhea to headaches. Yes we have traditional beliefs, and yes there are some truths and some baloney. It would help if you got some facts right already, so we wouldn't have to debunk everything you say.

4. Do not LIE. Or if you really really want to, do not let us find out, because if we do, it leads to number 5.

5. Probably the most important of all -- Do Not Piss Us Off. If you come in with an attitude, feeling like you've gotten the better of us, refusing laboratories and telling us how to do our jobs. Believe me, these do not help your case.

So, please, for everybody's benefit, tell the truth, give us something to work with, and don't piss us off.

This way, everybody is smiling when reaching for the door.

Friday, March 30, 2012

Mall Sell

When I was little, I always thought how cool it was to have a job in a mall.

Naturally, this was after the time when I thought that tricycle drivers had it good just going about town, enjoying the city air. I changed my mind after I learned how to drive a motorcycle. At first, and in some parts until now, the breezing through the streets on a motorbike was worth it -- the wind in my hair, the weaving out of traffic, the independence of getting to decide where you wanted to go on a 20-peso tank of gas. But getting drenched in the rain and scorched by the searing heat can make you feel the drag on some days. So then, I thought, maybe a tricycle driver would be a career choice I could eliminate. An alternate career maybe, but definitely not the one I will choose to make a living on, if I can help it.

I love going to malls in all their air-conditioned glory. It's fun just looking into the glitzy windows, the spic and span floors, and all the goodies that lie around. I used to think how lucky the mall owners were and how rich you had to be to own one. I know I don't have that much money lying around but I thought that the people working in the mall had it good as well. Just chillaxing the day away, waiting for customers to come into the stores or just plying their trades in the coolness. The mall will always be my first choice as a hiding place if either a band of renegades or a horde of zombies take over the city.

I now get the chance of in a mall during certain days of the week. It's not the prime doctor job I'd always aspired to have, but at least it's something. It's something until I ponder my next life-changing move. A neurology fellowship? A cardiology fellowship? A pulmonology fellowship?

There are a lot of things that have been keeping me irrepressibly happy these days, but as I walk through the carefully clean tiled mall floors, I realize it's not all its cracked up to be as well. Gone is the luster and glitz of mall shop windows and replaced by sale signs and commercialism.

But it's probably mostly, that I need money to actually buy things, and money I don't have.

I will always love coming to malls to look around, and I will eventually get to the point of bringing my kid(s) here and having them run around, buying them shakes from the fruit shake stand, watch movies and buy toys.

But for now, curse you Malls! You're not the mall of my childhood dreams and your jobs are not the stuff of my legends.

I will turn myself into a gazillionaire and maybe the displays will beckon to me once again.

But I will be back...often.

Just to look...


For sure.

Monday, March 26, 2012

Close Encounters of the Other Kind

While doing what seemed to be the hundredth physical exam for the day, I was still relatively upbeat as lately, I've been irrepressibly happy.

So in comes Ms. I'm-Better-Than-You (IBTY) for her pre-employment PE.

"Good morning ma'am." I greeted her as she enters.

"Good morning." I didn't mind the why-you-are-talking-to-me-is-beyond-me way with which she said it, and proceeded to do my job.

I was listening to her back when she just started yapping, in her New York-Negros Oriental twang, rather than New-York-City-slang, "...and my father has hypertension, but my mother's side has more of the diabetes, but me, wala, I'm oookay." Just imagine Kris Aquino's patented 'Oh My God' mixed with typical dumb blonde tone and nasal stuffiness.

I just smiled, "Well that's good. You sound like you're from a call center ma'am. But you also sound like you know your medical stuff." I gave up and slung my stethoscope around my neck and sat down to face her. "So tell me, what was your pre-call center course?"

"Well, I'm a nurse!" She exclaimed.

"Ah, ok. I'm a doctor, and what do you need from me today?" I replied with a big smile.

There are so many types of personalities that I've happened to come across in the last couple of years of residency and practice. Most of them, I've found out, are tolerable and I've often took the time to try and teach patients even those who come in for a routine PE. But there are just those that make, medical practice more challenging than it should be.

The type of people that think others, not necessarily just doctors, are beneath them are quite an interesting bunch. Through the years, I've employed the passive aggressive approach to these individuals and found it resoundingly successful and giving me more satisfaction than actually meeting them head on.

My friends have their own nightmare stories:

- A call center agent sought consult at the OPD and bluntly said to the resident on duty, "Doc, don't you know I make more money than you do?"


- A "VIP" patient came in to the ER and asking us to call her father because he would take care of everything. Then call her relative consultant because he would know her as well.

What seems to be the problem?

I had one encounter in the last few days of my residency at the ER triage area.

Ms. Red Eyes had conjunctivitis and came in to get a consult prior to her shift at a call center. Talking in call-center twang, she had berated the nurses at the triage because she wanted to be seen immediately, but there were emergency cases in the ER needing more attention than she did.

I came down to help and caught her profanity-laced tirade and that of her just-as temperamental boyfriend. The nurse asked me if I could see them so that they wouldn't cause any more of a scene than they already were, so I obliged.

It was conjunctivitis and I patiently went through the motions of explaining the possible causes and clinical course, gave her a medical certificate to rest and gave her two sets of ophthalmic drops.

"But doc," she wailed (imagine the Kris combined with Romy and Michelle),"My eyes are so itchy, like is there anything I can take? What do I do for the itchiness?"

After taking so much time to explain to her the cause of the itchiness, and the indications for her drops, I gave up and said, "Well, you can scratch it." Of course, with a big smile.

All doctors are not equal, nor are patients. I really don't see any reason why another person will not be treated as equal if respect is in the equation.

Friday, March 23, 2012

20 Reasons

A couple of weeks or so ago, a guy named Jimmy Sieczka posted an online video rant about 20 reasons why he disliked the Philippines that caused quite a stir. It went viral (for all of us in the Philippines, of course) and got a lot of attention. Jimmy has long since apologized for how his video appeared and that he did not intend for it to hurt so many people, going as far as to declare his love for the Philippines and calling it his second country, and Cebu his second home.

But quite a few say, the video is a wake-up call. You can see Jimmy in his f-laced glory in his video here.

The video actually brings up very valid points and while I agree with its spirit, the delivery could have used some more refining.

-- The holes in the street

There are countless -- potholes, open drains, canals without grates or covers but I'd rather have them filled or covered with a barrel rather than have someone fall into them. The local government watched this video and I hope they actually do something about it.

-- Street Cialis

Just because people over there in their country buy it over the Internet doesn't make it any less of a need for people with erectile dysfunction (ED) here in our country. But do you know Jimmy that those vendors, more often than not, sell it to old foreign geezers who can't get women to like them in their own countries so they come here. ED is a problem for those who have it, and you are adding to the stereotype of those who use the drugs. Sildenafil is a perfectly good drug with a good number of uses -- pulmonary hypertension, ED, and so on. And contrary to popular belief, there have been no adverse effects for use by normal, young individuals like you. So your secret is safe with us.

-- The street food

Well, I can't completely say that food and places in other countries are just as clean and sanitary. You came to the Philippines, which is right smack in the tropics, so you're going to have flies and whatnot. But I guess that's why foreigners get diarrhea more easily. I'm proud to be a proponent of the hygiene hypothesis.

-- MILF.

We really can't do anything about our local terrorist name. In my opinion, it's cooler than Al Qaeda.

-- Endless Construction

It's true about the seemingly endless construction. Seemingly. They usually get completed a few more years than the target dates. More jobs for people I guess.

-- White

I am a Filipino and I'm brown as can be. And for the life of me, I could never understand our obsession with looking more like Jimmy and our Caucasian friends while a good percentage of them try to get as tanned as possible to get rid of their pasty tones. I've always favored our natural skin tone over the more fairer complexions. Crazy Filipinos.

-- Small Plastics and Receipts

I wonder why Jimmy had to buy a whole pack of gum from a pharmacy in the first place? You could have just bought a pack from the guy who peddled Cialis so there would not have been a need for a plastic wrapper. I've bought small things from pharmacies and stores myself and I find that if I told them not to bother putting in plastic, they happily oblige. Oh, and in this part of the world, receipts are required by law.

-- Shitty drivers

Pretty much the same all over the world. There are so many more of these in your country Jimmy.

-- CR

I laughed at this bit because this was so true. I don't have a comeback for this. Everybody should really fix their CR's and bathrooms and toilets. The only thing, it's not all over the country, it's in a majority of the countries CR's, but not all.

-- Security guards

In a perfect world, our security guards would be just as good as SWAT's and Seal Team Sixes. But we don't live in utopia. I agree that most of our security personnel lack training and hmm, expertise. Sadly, it often is a job that they have to take because of the lack of other opportunities. Thus the poor job satisfaction, lounging and joking around. But give credit where it is due, there have been many security guards who have lost their lives to robberies and giving it in the line of duty even without the proper compensation.

-- Pissing anywhere

If my wife would become president of this country, the first law that she would pass would be to castrate men who pee anywhere. Sadly, this is a truth. Something that we, Filipinos, should really change.

-- Frisking

I'm not sure where security guards in malls get their frisking techniques either. I could hide a weapon in my sock and they couldn't find it. When you drive a car in a parking garage, they just check the chassis and the trunk. I could have a bomb in my lap and they probably wouldn't see it. But then again, I probably would mind if they turned the car inside out and did a full body cavity search every time I entered SM or Ayala.

-- Beeping

I've been to foreign countries Jimmy. I've been to your country as well. No, they don't just beep in emergencies. They're pretty much the same here -- beeping traffic, getting to close, stealing lanes. Gasp, are you Filipino Jimmy?

-- Napkin size

I had no idea they didn't come in that size. Maybe, if people ate a little less sloppily, they wouldn't have to use that much table napkins.

-- Beggars

True. But beggars in other countries are better off because they have sign boards, better boxes and newspapers to make their beds and a garbage can to light a fire in.

-- "Valet" Parking

My pet peeve. Yes, they do confuse more than they actually help. I'd rather they just watch the car or wash it. You get into your car suddenly they come out of nowhere and wave their hands to "guide" you out, and like Jimmy said, "Just waiting for the goodness." Mostly, I just give them a couple of pesos to not do anything to the car while I'm gone. People do expect tips for the tiniest of things.

-- Chickens crowing

Dude, you are in the Philippines, get used to it. Others have dogs, lizards, snakes, cats. Here we have chickens.

-- Top 40's

I wish they got rid of these as well. I can't bear to hear songs without discernible lyrics and just plain bass-driven beats all night. But just move away from the noise, err, music buddy. Discorrals are here to stay. It's the poor man's version of trance music.

-- On hot Filipino women being lady-boys, prostitutes

Jimmy, Jimmy, buddy. You just haven't been looking in the right places.

-- Cockroaches

It's a tropical country Jimmy. And yes, we have cockroaches here like you do where you're from.

-- Koreans

Do we have an agreement with the Korean government? I do agree with Mr. Sieczka on this one. We have foreigners here, but why is there a ridiculous number of Koreans over other nationalities? It's probably not a nice to generalize but they do tend to hang out in groups, obnoxious as hell, and loud. And them not speaking English is one of the most annoying of all. I walk around the malls and they just crowd the walkways and they don't give way nor do they apologize when they hit you. They whoop it up in my favorite coffee shops (granted it is a public place but, some respect for those who want to enjoy a peaceful moment with their drinks). Granted they've given jobs for those who teach them English, our local tourism, and prostitution rings, but seriously, when you're in Rome, be a Roman.

-- Motorcycles

What can I say? We ride our motorcycles here way better than you guys do in your country. Yup, I don't understand taking the muffler off to make it sound louder (I was under the impression, it should be more quiet), but we live on the edge here in the Philippines. No helmets, zipping in and out of traffic, habal-habals -- ain't nobody gonna beat us at that.

When all was said and done, I have to say I enjoyed Mr. Sieczka's video. I laughed at the funny things (the vendor touching his crotch, the ladyboys), agreed over the truths, indignantly disagreed with the inaccurate bits, and embraced the spirit with which he made his video.

What critics and non-critics alike should realize, that barring certain unique situations, it is mostly the same in every country of the world. I could go to the Vatican and make a top 20 list of why I dislike it. I could go to Jimmy's house and make a top 50 list of why I despise it.

But there are probably just as many reasons to like it.

The Philippines is more than this. We are a people who can get through a day smiling and laughing shirtless on a street corner while waiting for the sun to set and get a guitar and sing off our worries with friends. To extoll the values of our race would take so much more than just a video saying so.

In short, the Philippines is an experience for most people who come here and for those strangers in our own land.

For others like me, it's home.

Wednesday, March 14, 2012

The Price Is Right

Recently, I had the opportunity to cover at the clinic of one of my mentors while he was out of the country and it was a taste of how private practice would be like.

First and foremost, I was not under any illusions that the patients came to see me. It was my mentor's specialty they were there for. But I'd like to think he and all the doctors I was fortunate enough to learn from during my residency, taught me well. In my one-week stint as a pseudo-neurologist/internist, I had a day wherein I earned P3,500 for a two-hour stay at the clinic seeing consults (if the BIR is reading this, yes, I pay my taxes).

No, everyday wasn't like that, but that was the best day I had -- pay-wise and learning-wise.

I had a patient come in who was recovering from TB meningitis after suffering through it abroad. He had hydrocephalus and underwent an insertion of a ventriculoperitoneal shunt, a V-P shunt for short (a tube that drains the fluid from the brain into the tummy). He was doing fine, his mom was due to go back to Taiwan, and his meds were all in place. Another patient came in for her first follow-up since suffering a mild stroke. She was a pleasant lady and was fortunate enough to be walking and talking. She had a lot of questions and we went through all her medications one by one. She wanted her next follow-up to be with me, and I sheepishly said that my mentor would be back in a few days, and that she would be in good hands (later in the week though, she called the clinic to relay her INR looking for me and I adjusted her meds but her follow-up would still be with her primary attending).

But the prime case of the day was a woman in her late fifties who came in with her husband and kids with the complaints of memory loss and disorientation. She was a hypertensive who self-medicated with a beta-blocker with poor compliance (when she felt like taking meds only, like most people).

So I investigated and went through the interview and examination. I found out that just a few days ago she had dressed herself with a blouse and went out, but forgot to wear a skirt (thankfully, it was just up to the living room where her family brought it to her attention). She had, on occasion, used a banana instead of a spoon. She forgot the names of her kids and she was noted to be walking more slowly everyday.

Her BP was through the roof on 4 separate measurements (after the 2nd taking, I already ordered a wheelchair be brought up so she could be admitted). There was no obvious deficit in strength and no right-left asymmetry. By this time, I talked to her husband and eldest daughter that she really needed to be admitted or at the very least, undergo a CT Scan. I finally convinced them after giving them the worst-case scenarios (scared them into the decision, maybe, but I look at it as finally getting them to trust my judgment). While waiting, I proceeded with several more tests, she couldn't do serial 7's (100-7, 93-7, 86-7, you get it), calculations and had agraphesthesia (inability to recognize numbers or letters traced on the palm).

I explained that with all her manifestations, she could be having or had a stroke. Silently, I thought, most likely ischemic in origin, parietal lobe in location, of the dominant hemisphere. The wheelchair came and took her to the emergency room, where I hoped that the resident on duty would be astute enough to recognize the need for a CT scan as soon as she arrived (all stroke patients should be scanned within 40 minutes of ER arrival, as much as possible).

After finishing all the patients, I went to see the scan and found out I was right! An infarct in the temporal-parietal-ish lobe , or at least that's how it looked to me. It was a bit well-circumscribed so I wasn't surprised that the attending physician thought it was a mass. I asked the medical resident who had conferred with the attending, and they all thought it was a mass (I don't know if he was just relaying the reading, or if he had an opinion) and an MRI was done. I confirmed with the radiology resident, both the CT and MRI scans showed an infarct.

You see, I am a case junkie. I love my patients and I treat them as people, but, separating them from their diseases, I look at their cases in my mind as cool puzzles to solve. And when I get one right, it's gravy. It's like Tiger Woods a couple of years back pre-scandal, when he would do a fist pump to celebrate the birdie he just sank, or Michael Jordan sinking a jump shot over Bryon Russell to win the game.

If anything else, I feel the self-satisfaction of getting the diagnosis right to help other people.

I was going over the experience with my wife in the car and concluding the conversation with P3,500 I earned for the day and she calmly said, knowing the answer and more stating a fact than asking a question, "Well, which would you rather have, the P3,500 or that you got the diagnosis right?"

I smiled. I knew she had the right answer.

Thankfully, that day, I had both.

Sunday, March 11, 2012


When making life decisions, it really does not help things when you do not know what will happen.

Let's take my favorite example -- me.

I've always taken to running thoughts through my head when I come to something like the Amazing Race's Detour tasks, where one has to choose one path over the other. Writing them down is the occasional route being that mostly those that read this blog support "whatever I want to do," which is essentially what I usually decide anyway.

So, here I am. Still relatively young, at age 31, a medical doctor just a few months removed from finishing my Internal Medicine residency and a freshly minted diplomate, adding a few more letters to the end of my name.

So what do I do next or now?

The normal career trajectory would lead me into fellowship. Unfortunately, the fellowship/residency I want to get in to is full as of this writing, so that temporarily closes that door, until I'm gonna force it open a few months from now. Other career options would be to go into other specialties, but shouldn't we want to be in what we're supposed to be training in? A former senior resident/mentor always referred to choosing a subspecialty as picking out a mistress. It better be worth all the risk and it is going to stick with you all through your life. So, I'm waiting.

Case in point, a lot of unknowns here. I don't know if I ever get into that chosen field let, alone be accepted into another one if I don't get into my first choice. I don't know my chances get better if I actually presented myself there as an applicant.

Informed decisions are weighted luxuries we give to our patients. Life decisions just aren't as easy.

While waiting, I'm left without a job. Since I took and passed my exams, I've been mostly in limbo. Waiting in and out of coffee shops (tambay na sosyal), sleeping in at home (tambay na ok-ok ra), helping with research (research assistant, which I lovingly do by the way), driver (drayber), among other things. I've been called once or twice to cover at a mall clinic (mostly malingering patients looking for medical certificates and I swear, I get dumbed down everyday) and covering at a consultant's clinic (better cases and patients with somewhat actual problems). No luck with going on duties at the local hospitals yet, by friends have found it easy to get in (must be me.)

I keep getting questions like "Asa na ka ron?" (Where are you now?) or "Asa na ka nag-raket?" (Where are you racketing? -- I keep asking myself why oh why do we refer to earning our living with different doctor jobs as "raket"? I choose to use Gaya's reference to that with "gigs." "Raket" just sounds...illegal). Those questions are customarily answered with the truth -- jobless.

Moonlighting has taken several meanings for us in the medical field, but it still remains largely more profitable than those in regular residency jobs. By the time I finished residency, my friends had cars, DSLR cameras, and gadgets up the wazoo. So where to go to earn money? The local primary care clinics need doctors and pay by the hour, but hardly commensurate to the effort and the headaches of having to face mostly malingering patients. The hospitals in the city without residency training programs look for junior consultants but it's been mostly arranged internally between doctors. I've asked friends if there are hospitals in the provinces that they could get me into temporarily, and someone said I was too "fragile" for the rural scene (Really? Fragile?). My wife and I (when we were still unattached) had often thought of joining Doctors Without Borders, roughing it in Lebanon, Afghanistan, or some other war-torn, famine-stricken country but I guess, those are just the thoughts of someone not fit for the Philippine rural scene.

Then, there are those avenues not in the medical field. There are always those options up the creative streets, the arts, and even business.

All those things still do not have one certain thing about them. I don't know what happens or how everything turns out.

Life has a funny way of sneaking up on you and either giving you a jolly good scare, or a pleasant surprise. Either way, I guess I'm taking it one step at a time, enjoying friends and family. Laughing, loving, and living -- and because in a few months time, whatever it is I get into for the time-being, I'll have to leave for more training, more painstaking histories and physical exams, more work, less pay, more challenges, less time-off and simply, more things to do.

Or maybe the world really does end in December 2012...

Life's really sneaky, ain't it?

Sunday, March 4, 2012

Fashion Statements

I've always been the one to dress comfortably and have always chosen function over form sacrificing color schemes, coolness, and at times, sense, to be relaxed in what I wear. I laugh as this often means shorts, a loose fitting shirt, and sandals. I would definitely say that if you met me along the streets of Cebu or looking like a fool in Ayala, you would never think I'd look like a doctor.

Heck, even the salesladies and store owners in Ayala give me a once-over, before catering to their other customers. Most of the time, it doesn't bother me that the people at a sneaker shoe store don't really approach someone like me in thinned-out light brown Islanders as their first priority customers as compared to the decked-out well suited porma guys, or the Korean subtitle-speaking tourists (they do approach everybody eventually, but I'm not so sure if it's to keep an eye on me, shoo me away, or entice me to a sale). I don't quite get why the almost always empty layshu (sosyal) watch and jewelry places, don't have people with better dispositions (I've bought jewelry exactly twice in my life, the first was because it was what I could afford, and the second one was because they were the only jewelry store who smiled when I came in despite my appearance).

But that's really not the point.

Doctors are expected to look a certain way. I think people expect a certain look from not just doctors, but professionals in general.

Looking at this, there are the right down formal physicians who don the designer dresses and the cool long-sleeved shirts and expensive ties. They are head-turners and bring just-as-expensive bags and wear slick shoes. They don't necessarily make them better doctors, just better-looking. It creates an impression, even among those of us who don't and can't dress us good.

For most of us, we stay in the middle. Dressing up with the occasional jeans and slacks with a mix-match of buttoned shirts. There are those who practice and live in hospitals in the far-flung barrios of the Philippines and do rounds in sandals and whatnot, and for that I admire them. Imagine me just looking over a patient's chart wearing my basketball shorts and Pistons jerseys. Well, at least I'd have a really comfortable doing it. I'm just not sure other people will take my advice to heart though if I'm dressed in a shirt with the sleeves cut off.

The point is, doctors act like doctors -- they think, treat, cure, operate, sacrifice, charge and just simply are. It is not a function of fashion. We do not wear our profession. For some of us, we let our skills do the talking. So when you meet me, doing my rounds in cargo shorts and a shirt, it might help if you give me some credit, haha.

Monday, February 27, 2012

The Drive Home

I've always thought there was something sort of spiritual with long road trips. So when I got off the barge bringing me across the Sibulan to Santander, I fastened my seatbelt and revved the engine of the trusty Mitsubishi Lancer lent to me for its last tour of duty.

As I pulled out the dirt road and onto the highways of South Cebu, I couldn't help but smile as my iPod blasted out "I Still Haven't Found What I'm Looking For" by U2. You have to get that particular road trip soundtrack going. Just think Pierce Brosnan as James Bond zipping along the cliff roads with "I have climbed the highest mountains, I have run through the fields, only to be with you..." in the background. I got from 0 to 60-ish, looking out the car windows seeing the sun glint of the carpet of blue sea in the distance and just thinking, wow, what a great day, "And I still haven't found what I'm looking for..." sings along in my head.

It's a great way to think and run ideas through your head.

Like, what am I going to do now? Looking forward to further training. I laugh silently at both the notion of seemingly endless "training" I have to go through and finding myself at a crossroads akin to the one I faced almost 3 years ago. It is almost a certainty that further training lies ahead and I wish for openings, but if I have to wait, I will. In the meantime, I will most likely be doing clinics here and there, "covering", moonlighting.

I smile as I come to probably one of the most winding roads I've ever been on, and thanks to coincidence and because I loaded my iPod with songs from a bootleg copy of the Beatles' digitally remastered hits, "A Long and Winding Road," comes on.

My wind wanders off to thinking again while listening to the sound of tires whizzing along the asphalt. I laugh at the notion that Congress is trying to pass a bill that stops the portrayal of government officials as corrupt and villains in Philippine movies and television. I can't even begin to describe how dumb that sounds. From a million reasons ranging from simple creative license to how reality often breeds how we are seen on TV, I see no reason for them to actually be trying to pass this let alone come up with it. For this reason alone, I think that our officials are dumber than they appear to be. That may be a bit harsh. Maybe, it's them losing sight of what they are supposed to do, but I definitely feel dumber, just having even seen it on the news.

I zipped through Oslob, with their newfound whale shark tourism, Alcoy and their crystal clear waters, then Dalaguete, Boljoon, Argao, in whatever order they go.

A dozen thoughts come and go -- how Mike Ross is going to get away with being a lawyer in Suits, anti-heroes are the in-themes these days. How we find ourselves cheering for good bad people, is funny because we've come to the point where we think the ends justify the means. Maybe so, but one man's happy ending may not be one to someone else.

I come closer to Cebu, going through Sibonga and Carcar, and eventually found myself turning onto the SRP highway. Another Beatles' song comes on, "Here comes the sun," and I roll the windows and feel the wind in my hair. I look and see how I've gone through my bottled water and Mountain Dew, my pack of Nagaraya, and one bar of Snickers.

Hmm, weight loss, I know I can do it. The mind is willing but the body is weak.

How about that Jeremy Lin? It's amazing how Mike D'Antoni just has one go to play -- have the point guard run around the court until someone's open.

More thoughts for every mile

Sunday, February 12, 2012

The Wedding

It is Valentine's Day. Nothing like professions of love to make the world go round during these next few days, and for the most part, we all are. There is nothing wrong with one single day devoted to the expression of love for the special people in our lives. If not every single day, then at least, there is Valentine's Day.

The Proposal

I wrote of a proposal almost a year and a couple of months ago, and they got married a few months after that. They still are happily together and this is a chapter in their story.


The Wedding

It was a perfect night – the stars were finally out after four days of incessant rain and typical Cebu October weather -- the moon was full and draped moonbeams across the manicured lawns of the beautiful chateau where he, not so long ago, asked her to marry him.
He had held his breath as he peeked through the doorway, marveling at the reception that awaited them. Lights were trailing down from the treetops as rain would trickle down from parted heavens or the morning dewdrops rolling down a flower petal, a majestic red carpet rolled straight down the middle of tables adorned with umbrellas of different colors but lined with the familiar shades of green and purple.

The past few months were a blur – the preparations and planning all came down to this moment. He looked at his beautiful beaming bride holding his hand and she looked back her eyes twinkling, her smile radiant and felt that nothing could be more beautiful in this world.

“Shall we?” he asked, beaming back.

“Yes.” She managed to say while reaching out to take his hand. He marveled at how her hands fit comfortably into his and took it and led her in to him for a kiss.

He heard the reception host say their names over the sound system and he led her out to a rain of confetti and cheers. He heard her laugh and greet people as they strolled down the carpeted path to their table as he turned and smiled to dozens of familiar faces on his side as well. They came to a stop in front of the applause, smiles, and tears, as there was nary an uplifted heart in that garden of lights.

He stood and faced her, as the constant banter of the host kept the applause going, and held her other hand in his. She was laughing, giggling and effervescently happy as she gazed back into his eyes.

“Wow.” He said to himself, knowing no words could describe everything he felt.

“So this is it?” He said loudly, laughing, to be heard above the applause.

“Haha, yup,” she replied, laughing along with him. They had toyed with the idea of practicing the kiss after a meeting with their host, but it always ended up funny scripting their kiss. Their conversations had ended up with them laughing and hushed questioning of what they needed the practice for.

“Let’s see a 10 second, hot, steamy….kiss!” He heard the host say just above the din of his thoughts, and laughed. She laughed in return, her eyes still sparkling and moved closer to meet him, halfway for the kiss – sweet, tender, and as beautiful as any moment can ever be, while cheers erupted around them in a countdown that he wished wouldn’t stop.

Flashing through 10 seconds were the beautiful moments of the afternoon’s ceremony. The church aisle was adorned with majestic white flowers and balls, and recalled how he caught his breath while watching her come down the aisle. No tears, no sadness – just joy, as he serenaded her passing down the aisle to the silent whispers of admiration until he took her hand to sit and kneel with him in front of the altar. The frequent professions of love, leaning to each other and whispers that she looked every bit the beautiful bride, drew a smile every time. Everything was dreamy as the heartfelt vows were exchanged and the rings went onto each their fingers, and a union sealed with a blessing and a kiss.

They were married! He silently thought, as the count filled up to 10. She opened her eyes, and smiled and gave his hand a squeeze, “I love you.”

“I love you, too.” He replied, knowing nothing more certain or absolute in his life.

The night would go on with great food and music. There was never a dull moment – their host made sure of that. Her nephew had ran up and down the aisles with a big confetti stick in his hand, their friends and family had enjoyed the speeches and the videos and each other’s company, the squeals of delight and laughter filled the air again as the garter and flower exchange was made untraditionally, going to a classmate of theirs from medical school and a nurse from the hospital she worked in.

From their table, he glanced at the scene before him and leaned in to her and said, “Hey.”

“Hey.” She said, flashing him another smile, squeezing his hand.

“We’re married.” He stated, showing her the ring she had placed onto his hand earlier that afternoon. They had picked out their rings and kept it simple – white gold with each half of a heart emblazoned in the center, that it was complete when put together.

“Yup, we are.” She said, showing her own ring and setting her hand on his.

“I love you.” He said, as he leaned in more to kiss her.

“I love you more.” She replied.

He smiled. Normally he would have said most, but just let it pass. The thought that he was with someone who loved him, immeasurably, brought a smile to his face as she kissed him back.

Rain slowly fell from the heavens, just as the program was drawing to a close. It didn’t fall like the relentless downpour in the last few days, but the kind that lightly caressed your skin and felt more like a blessing than precipitation.

As they watched their guests bid their good-night’s and well wishes, they stood together. He placed his arm around her, and she did him one over by turning to face him and put her arms around his neck and kissed him.

It was there on that viewdeck, at that chateau, on that beautiful night, that he remembered the day he asked her to marry him. Now a few months older, he said, “Thank you for marrying me.”

She replied with a smile and that familiar twinkle in her eyes that never got old, “Thanks for asking.”

Wednesday, February 1, 2012

Medical Consults and Whatnot...

Cough. Cough.

Since arriving home, I've been asked not once, not twice but 3 times in the first day back about what to give for a cough.

Well, I'm a doctor that really doesn't like to give medications that aren't needed. So, my usual response is, to do what I usually do. Drink lots and lots of water.

A cough is not really a bad thing. It is a defense mechanism by our upper airways to expel any foreign particles or any foreign matter that triggers it. In essence, it's a good thing that we cough, so don't be too quick to suppress it.

Well, I've always maintained that the only indication for treating a cough is if bothers you. I mean interfere-with-daily-functions bother you. Like if you have to light the stove and you put the fire out with your cough. This includes if the cough is indicative of any underlying disease and other pathologic states.

I really don't want to go into the details of cough treatment, but the bottom line is not all cough is bad.

But please, don't take my word for it. Go see your doctor.


I've always wondered what philosophy our hospitals based the act of having family members remove an endotracheal tube from a patient on a ventilator from. I think some forward thinkers have already corrected this practice somewhat, with medical ethics taking a prominent role in what doctors do.

But still, most hospitals still stick to the practice of having family members take the ET tube out. Ethics aside, doctors stand by the hospital in this act, probably to save ourselves the trouble or to absolve ourselves from any act that, seems, to go against our oaths.

This is provided, of course, that a DNR has been discussed and signed.

During my residency, I found medical personnel having to take out IV lines, NGT's, stopping all medications prior to sending terminal patients home against medical advice to pass away peacefully at home, but leaving the ET tube removal for the family.

I don't get it. We put it in. Don't we have to take it out?

Fireworks Over Toccoa

Just because there are millions of stars in the sky, it doesn't mean you can't make your own.

Friday, January 27, 2012

Chapter One

The cardiac monitor beeped out another alarm.

He woke up but all he could manage was silence and the opening of his eyes to the white hospital overhead lights.

From what he could see with his remaining gaze functions, he definitely was in a hospital room -- cool, moist, subdued -- he couldn't feel anything, any sensation but he had the feeling that's what this room would feel like. And from what remained of his memories of hospitals, he probably had wires going all the way to the monitor by his bedside, IV lines and catheters, as well as an NG tube for feeding.

Meds usually came like clockwork in the ICU. This much he knew.

He knew that he was in his bed, motionless but alive underneath clean white hospital sheets. His feet were most likely propped up by makeshift water balloons from sterile rubber gloves, and in his hands were silly red stress balls he couldn't grip.
His was the world of bleeps and alarms, and the rush through each of his doctors' day or the nurses' shifts.

But nobody else knew that he knew.

He had lost track of how long he has been in the state he was in. To the nurses and doctors who have slowly and sparingly visited him, he was staring out blankly into space, not being able to show any signs of recognition or any semblance of higher cortical function. He was muted by his disease. A "locked-in" syndrome was tossed back and forth between his neurologist and pulmonologist at one time, and a barrage of medical residents had chalked him off as a vegetable.

He too had nearly given up screaming from deep inside. He knew all too well that he was not reaching through the barriers of what was human understanding anymore.

So he stared out blankly once again at the immaculately white hospital ceiling. He knew that if he was capable of feeling, his back would be hot from all the lying down all these months. Were there any bruising? Open wounds already?

He blinked. One.

Again. Two.

And Again. Three.

The anguish of each minute passing buy with silence screaming more often than the sounds around him -- it was more than he could take. More than a few times, his thoughts had turned to how he could catch that train that kept passing him by to go into the white lights of heaven, but even that was beyond his reach.

Not now. Not yet.

She was coming.

Monday, January 16, 2012

Reasons For A Sinulog

While I was hunkered down, trying to cram in what was going to be a few more days of miserable existence hoping to pass the diplomate exams, I wrestled with the reasons I found it somewhat amusing how Sinulog survives every year. Oh, and that's Sinulog in Cebu, for there really is no other.

10. THE SALES: The malls go on pretty good sales during this time of the year here in Cebu. Unfortunately, a lot of people go to the malls as well turning the often-comfortably-cool mall into a relatively warmer-slightly-uncomfortable-mall for me. But the sales are pretty good!

9. THE FASHION: Now, why would a guy like me care about that? Well, it's another reason to look at people and see what they come up with. This would be the time of the year where a guy can wear a bright pink cap with a neon green shirt and purple shoes and be straight, sane (until the alcohol or fashion police find him) and actually think he looks cool. This is the time where a girl can wear a short black mini-skirt with stiletto heels and a one-shoulder black blouse and walk the whole length of Mango avenue and thinks she looks hot. Well, one thing I'd confirm for everybody, she would certainly feel hot. People come up with a lot of wacky fashion sense during Sinulog, and you'd have to see it to make fun of it, err, believe it.

8. THE TRANSGENDERS: Well, if this wasn't the time and place for guys to look as good as girls and girls to look as fetching as guys, I don't know what is. Seriously, when Sinulog time comes every year, there are times when you really can't tell the difference. Oh, but those lording it over in the streets and directing the dances in the arena, there is no match for these guys. Makeup, fashion, celebrities, masks, dancing -- what more can gayness ask for?

7. THE CELEBRITIES: Really, the showbiz people come into town for the festivities. Homegrown talent and Manila-talent abound on floats and mall shows. If you really like the glitz and glamour of Manilalywood, then the stars are out in Cebu.

6. THE SHOW: People come from all over the country and from all over the world to see the Sinulog street dances and show. Once the drum corps, with the makeshift drums, get to beating out the rhythm, you'll slowly feel your head bobbing, and the next thing you know it you'll be swaying and just having a rolling good time. To those who aren't beat inclined, well, you can't help but actually be more fun when the guy next to you is just grooving to a beat without want for techno-crazed disco mixes and lyrics. The dancers in all their colorful costumes twirl and glide on the street and revel, whether in the sun or rain.

5. THE ECONOMY: Who doesn't benefit from the influx of people in the city? Except for the environmental technicians maybe, the local businesses, and heck, even the scam artists and pickpockets get a boost in income. The taxi driver I was riding home in at 5 in the morning had been driving for almost 24 hours straight to milk out more income from the fares of the crowds returning home from a night of partying. I was thankful that he didn't fall asleep at the wheel, which he expertly attributed to a coffee-laced candy he had taken earlier in the night.

4. THE ALCOHOL: It is endless. So are the people crawling home at 5 am in the morning. So are the people who get into fights and injured but heck, they sure had a good time doing it, albeit a bit drunk and memory-deprived in the morning. Beers, liquor, tequilas, cognac, gin, brandy -- every mind numbing drink is out in full force during the festival -- and well, what to do with a seemingly endless supply of alcohol? Drink it, of course.

3. THE FOOD: The food that Filipinos are known for, are out in abundance as well. The luscious lechons and the delectable barbecues, delicacies, fish, every mouth-watering aroma wafts in from everywhere. Every atherosclerosis-inducing morsel sumptuous to the last bit and the sweetness of the native fruits and mouth-watering desserts keeps you full and content enough to forget the need for angiograms and an HbA1c determination a few months from now.

2. THE GOOD TIMES: All the stuff that happens in Sinulog, stays in Sinulog -- not really. You'll remember it, once the alcohol wears off, and laugh again at the times with friends, family and people you knew for those fateful few days of revelry. You'll remember that once in a year, the streets belong to the people and no jeepney can take you down (albeit after a few shots). You'll want to come the next year to brave the searing heat and/or the drenching rains to jump up and down to the beats of the drums. For the lesser fortunate, you'll remember cutting yourself on the beer bottle that broke when you threw it on the sidewalk in glee! All in good fun!

1. THE FAITH: Let's not forget the very reason why it is "'pit Senyor" in the first place. It is the to celebrate the our unwavering belief in the Almighty that once took human form, and was a child (probably the coolest kid in the existence of humanity) and grew up to die on the cross for sins that were never His. It is this faith that we sangpit senyor to -- that we hold Him with the highest of regard and thank him, immeasurably, for all that He does for us. Nothing can make sangpit senyor more meaningful than a conversation with Him.

So here's to a great time during your own Sinulog!

'Pit Senyor!

Sinulog photo credits to: Karlo Matuguinas and Christopher Colinares (publicity ni bai, kung naa man gani mubasa!)

Friday, January 6, 2012

The Right Time

What is "The Right Time?"

This question came up again after a mishmash of decisions made and yet to be made have stacked themselves up on my table. Between that and upcoming exams and reports to be completed, I've simply come up with a short time frame to do every thing and hope for something good to come out of it.

Yet, there still is that question of when the right time actually is. Does anyone really know?

For the most part, I think it has been mostly used as a convenient excuse for not doing something. Like a what one says to a lover pining for one's affections but maybe there is just a better guy/girl out there, thus the jilting-the-lover excuse, "It's not the right time," and eloquently put to music by the Eraserheads (Pare Ko). One disregards the effort, weighted decisions, and sacrifice for that certain, or isn't it uncertain, time.

I've heard it used in other aspects of life, like careers (Oh, it's the right time for him to take that job.), and life moments (Oh, it's just about the right time for them to finally move in together), but that's AFTER things happen. Why not know the right time before we decide? Why not know it beforehand, because, I sure wouldn't want to be the one to wake up one morning and realize that the right time to read that chapter on heart failure was yesterday.

I've lived the most part of my existence with time-bound goals like a four-year high school, a five-year college course and the next years of medical school and slowly towards a medical career, but for the other parts, it has never been about a right time, but rather about right moments.

A man shouldn't propose to the woman of his dreams because the time is right, but rather because he feels the love they feel is right.

One shouldn't choose to go into medicine because it's just about the right time to go into an honorable career path, but rather it's because one decides its the right fit for him as a profession. (And quite frankly, if time is what you're worried about, it isn't medicine you want to go into).

The right time, doesn't exist.

The right people do. The right moments do.

And they count more than the seconds on that clock.