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.