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.