Scrubbed Out

Chapter One

2012-01-27T13:15:00.000+08:00

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.

Reasons For A Sinulog

2012-01-16T15:50:00.000+08:00

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!

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

The Right Time

2012-01-06T20:10:00.000+08:00

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.

My Thank You to You, PSH

2011-12-29T13:58:00.000+08:00

Went through my 9th graduation yesterday! Haha, looking forward to next one, hopefully.

Happy to have had one of my highly held mentors feel like he was a pufferfish, bursting with pride at the sight of all the graduates in the chapel at 3A.

I thank the CME for giving me the honor of thanking everybody on behalf of the graduates so when they called my name, I stepped to the podium, adjusted the microphone, looked up, smiled and said:

Ladies and gentlemen, good afternoon.

Just lately, I’ve come to realize how amusing it is for people to think, that after achieving a milestone in life, things get a lot easier -- you get to catch a lot more breaks here and there, or things might even get handed to you on a better-looking platter. Conversations in the coming days will go like, “O, musta na ka?” (Oh, how are you) or “Asa naman ka ron?” (Where are you based now?) and you’ll gamely reply with a smile, “Bag-o pa graduate.” (I've just graduated) or “Magsugod pa tawon.” (I'll still be starting out), and the response will be, “Aw, pero hayahay na na.” (But, it's gonna be easier now) or “Aw, basta kay humana na ka.” (Well, at least you're done!)

Come to think of it, after every personal milestone in my life, which has included eight prior graduations, that has always been the case with the all the questions, but the answers were never really the right.

Has it ever really been any easier? For every step, there has been more responsibility and more at stake. Consequently, every step has been way harder than the previous and every year a bit more challenging than the year before.

Who can remember their first days of residency – the wide eyes, the nerves, the first calls to consultants, the first reprimands, the first deaths, their first operations, their first codes, their first deliveries? As the days became weeks, weeks became months, and months became years, in came seniority, more responsibility, more disagreements and more conflicts.

So no, it has never gotten any easier. It never does and it never will.

Actually, it gets harder from here on out.

And so, what do we have to thank for after 3 or 4 years in PSH?

We thank everybody for the training.

We came here to train, learn and be more confident in treating our patients in our chosen specialties, and, personally, I can truly say that I am coming out of this institution a better doctor than when I first came in. The knowledge taken from conferences, lectures, rounds, and even mistakes, is what my mother has always said about education when I was a kid – something that cannot be truly taken away from me. So the training, the medicine, and the education we will cherish and be grateful for wherever we go from here.

But more importantly, we thank PSH for the company in this stage of our careers and this stage of our lives.

It was one of the constants we had for the past 3 or 4 years in our lives. Here, we have made our shares of irreplaceable friendships and maybe some forgettable ones. Each of the individual graduates here have shared their lives in one way or another to our second home – some fell in love here, others found their freedoms, some gave birth, some got married here and some found somewhere else to be aside from being anywhere else. And we can’t deny that all the laughter, the tears, the pains and joys, the sleepless nights turning into endless dawns, the endless holidays spent away from our families to tend to our work and the company we kept here in PSH have helped us along our way to become better persons and helped us grow.

In the past few days, I’ve had a couple of people ask me, “Is your speech ready?” or even to the extent of a friend from another hospital, jokingly asking for a copy of what I was going to say in front of you today, I’ve continuously replied with a mixture of earnest questioning and surprise. I will never have enough paper to say how I feel about having been here the past 3 years. To truly grasp that idea, one would have to be here, train here, experience it and live it here.

So to PSH, we all thank you for everything.

To our mentors, and tormentors, to our consultants, and insultants, to the staff, from the nurses to the guards that watch our cars in the parking lot, our parents, families and significant others, our utmost and immeasurable gratitude.

We all yearn to be remembered.

From a few weeks to a smattering of years from now, some of you that will be fortunate to still be here will recall an anecdote, a blooper, a desirable and undesirable quality from each of us here that you might use to make a point to some goo-goo eyed first year resident. That is our imprint on the whole PSH experience.

But rest assured, we will remember your imprint on our lives and we will be forever grateful.

From the bottom of my heart, thank you and good afternoon.

Much was said about it -- funny, facetious, nice, quaint -- but I tell you it is three things, honest, heartfelt, real.

Thank you PSH

Flood

2011-12-20T23:50:00.000+08:00

When I was in elementary, our grade school principal usually referred to Dumaguete as a "city spoiled by God." It was a tropically beautiful city, relatively peaceful and always with the right balance of great weather.

That is why the first thing that came to my mind, when I found out that Dumaguete was one of the cities that did not fare well during Sendong's two-day havoc, I really didn't believe it at first. Then I found out on Facebook and the news and, the more important question came to mind, "What did you guys do to upset Him?"

Seriously, there has never been damage like this from a storm in Dumaguete in all my 31 years of existence. I saw a couple of houses float down Banica River when Ruping struck but that was it.

Here is a video montage I found on Youtube on the damage in my hometown.

Thankfully, my home and my family were safe and dry.

But not for others. Two of the people that help my mother in the market each lost their houses to the raging Banica river, along with everything they owned. Several bridges cracked while some collapsed. Lives were lost. Floods that carried disease increased hospital admissions. People stranded -- some missing, some worrying the people they cared about because there were no means of communication and transport.

I was finally able to come home and I saw some of the damage done by the storm -- trees uprooted, houses collapsed, and a shoreline full of debris and receding water levels in the Banica and Ocoy rivers.
There are still a lot of places in the province where there is no water and electricity available.

But, slowly, life goes on.

Some grieved for the lives they lost, some are still figuring out how to bounce back from losses of home and property, while for most, moving on begrudgingly because life doesn't stop for floods.

What is heartbreaking is that, when asked, where the families will go now that the water levels of the nearby rivers are receding, most replied that they will be returning there to start again. Not for the lack of options, but because they can't afford to be anywhere else.

The outpouring of love and compassion from other people remind us that we are capable of wondrous things when faced with adversity, but maybe if we can manage to continue the goodwill beyond these times -- beyond Christmas, beyond calamities -- we can truly say that we are making the changes that we want to see in this world.

Updates for those who call Dumaguete City home:
- Tejeros and Forest Camp are run over by boulders, mud and river water
- Shorelines are still a bit muddy but regaining the deep blue color that lace our province
- More property losses than actual lives lost, but even the lesser deaths (as compared to those in Cagayan De Oro and Iligan) still count, considering there has never been anything like this in this city
- Valencia is still struggling to get water to drink (fire trucks are making their rounds in the city)
- The spillway near Foundation University still cannot be accessed at this time, as it is still overrun by the river.

The spillway

How high do you think the water went?

That infamous stranded boat is getting a once over in the still sea.

The Rat Race? I Don't Think So.

2011-12-16T17:21:00.000+08:00

I recently ran into an old high school friend of mine along the walkways of IT Park, Cebu while going through the motions of ending another routine study day. We didn't expect to see each other but, meetings with old friends are always nice surprises.

So we took seats outside, a local fastfood chain while I waited for my wife's chicken jambalaya and she was waiting for her work shift to start. She had just moved to Cebu and was starting a new job there after leaving her former work in Dumaguete City with her husband. It was all about advancement and such and how it hadn't provided enough growth for her and her family.

We counted that it was fourteen years since high school ended and all of our ways had to part. We shared most of what were small disappointments and mostly happy memories.

But we all had to go -- grow up, choose careers, go to college, get jobs, live.

She has been happily married for eight years, with one son. She shared that in conversations with her husband, she found it tedious to have had to start again in a new career, when at 30 they were supposed to be slowing down and enjoying the fruits of their labors and seeing their kids grow up.

I smiled, nodded, not really in agreement but mostly sympathetic and supportive.

30? Slowing down and retiring? Hmm. No.

It must be a new age thing.

I've been married, as of this writing, 1 year and almost 2 months. Kids? God-willing in the near future. Job? Physician, and just starting out, including the prospects of getting fellowships. Travel? A few places, here and there. Car? Whatever my family loans me, for now.

Happy? Definitely.

I've maintained the stand, all this time, that this life isn't a race. I've politely smiled to everybody that has remarked and commented that I'm getting too old to enjoy and see what my kids will be doing when they enter high school themselves. I know some people mean it encouragingly, when they say start a family now, build a house, because all the people around you are, but hey, which begs the questions why and why not?

Happiness is relative. So just as politely as I nod and keep silent my disagreement and project my support, do the same.

Its happiness when I see that the woman who wakes me up in the middle of the night for me to drive her to the hospital for an emergency C-Section, is the same woman who I want to wake up every Sunday morning with for the rest of my life, and hopefully, with kids knocking on the door saying it's time for church already.

Its elation when you have a job that allows you the challenge of figuring out what ails a person and actually have that same person thank you when he leaves your clinic, and I intend to do it until the day I no longer exist.

Its satisfaction when you just take time to smell the roses, be able to sit in your own little corner of the world and drink a large caramel coffee ice-blended frappuccino while rattling away emotions on some obscure blog.

Just enjoying walking slowly in the race of life.

Nerdification

2011-11-27T13:19:00.000+08:00

I started watching downloaded episodes of The Big Bang Theory on my laptop a few months ago and it didn't take me long to realize, I had so much in common with these guys.

The realization that I was a nerd.

But what makes a nerd? Is it just wanting to be Lion-o of the Thundercats or be a member of the Silverhawks, or knowing that Patrick Stewart was Jean Luc Picard in Star Trek: The Next Generation (a series which I absolutely adored? Wanting to be MacGyver?

At times, I find myself laughing so hard at what Sheldon, Leonard, Howard and Raj talk about on the hit series and I find myself relating to everything they're doing. My wife apparently, who has come to grips with marrying one, laughs along as well.

The all knowing Wikipedia defines it as "a derogatory slang term for an intelligent but socially awkward and obsessive person who spends time on unpopular or obscure pursuits, to the exclusion of more mainstream activities." They are "stereotypically intelligent and but socially and physically awkward."

Hmmm. Hold up. Wait a minute.

If it means growing up intellectually inclined, I guess, yes, I'm a nerd.

But I'd like to think I didn't grow up as a social outcast. I'm not saying I was a jock, given how most of my life I've made it a dream to win big on Jeopardy! but I had more than my fair share of stage time, lettered in almost every sport I could think of, dabbled in writing for the school paper and some, so pretty much a non-social outcast life.

But still, whose fault is it, (aside from myself) that has me thinking I'm more a nerd than most people I meet?

As I read on its origins, I realize that society at large is to blame. Popular culture makes this so. The norm established by "normal" people setting trends refer to social status and inclusion by referring to people of lesser stature in terms of social interaction -- the outsiders, the "nerds" -- for them to stand out.

Well, in those terms, I'm glad I'm a nerd. Seeing it through my eyes, they're the ones not on my social radar. They are outsiders to me and I'm pretty happy with how I've turned out. Even if it means knowing who Brent Spiner is.

As Charles Sykes said, "Be nice to nerds. Chances are you'll end up working for one."

Stepping Out The Door

2011-11-06T12:04:00.000+08:00

On a bright sunny Tuesday morning, November 1, 2011, I glanced at the office's clock's second hand make its final turn. It was 7:30 am.

Flashback to the time when I first came in to this office 3 whole years ago. I arrived second that day, second to Mush, who would eventually become my competition for earliest to log in during that first year, and with whom I will proudly say, most of the time, haha, that we stuck through this residency gig and survived. It was November 1, 2008. 6:30 am. (Yes, I came in that early). A freshly minted and licensed physician armed with his stethoscope, sphygmomanometer and pen as weapons, and a trusty wooden clipboard as a shield, I went on duty.

I smiled as I sat in my usual place at the far end of the office table near the AC and the window. The early morning sunlight started peeking through the 3-year old curtains and the paging system crackled to life. I took a deep breath and lay back to stare at the ceiling. Mixed emotions washed over me as I took a mental picture of what would be the last view of this office as a medical resident at the same time, knowing I was a far cry from the physician I was when I first came here to train.

I reflected for a bit, standing up to put my things in order. I thought of the people that have come and gone -- patients who have gone home or have moved on to a better place, staff and personnel who have left for greener pastures or simply moved on to other fields, friends and colleagues who have come and gone as well -- and thought wow, it has been a great ride. The signs had been there the past few weeks -- new faces , new systems being put in place, new technology -- kind of heralding the culmination of a particular time in my life, and the beginning of another.

I finished endorsing every little thing I could think of to Pie, who is taking over my job, the night before. I checked in on the critical patient in 2A who was in severe congestive heart failure and I went on my last hospital rounds. I made sure to check the charts and the patients in each station before moving on to the next. I said my goodbyes to the hospital staff who were still on duty when I first took my first station (2C) and so with the personnel. Haha, most of them were happy to see me go, I think, for all the good and bad reasons, but hopefully mostly for the former.

I thought selfishly for a moment. I knew way before today, before I even first set foot in Perpetual Succour Hospital, what it would take to finish residency.

Just give a damn.

Yes, if you actually care and feel the need to improve, you will find a way to do so. If you give a damn that your patient receive the best physician-care possible, you will actually give more than what is asked for. The drive of actually wanting to do a good job, will, most likely, make you do so. It will make you walk faster, get labs faster, think quicker, run, jump through hoops, prove people wrong and ultimately get the result you want. It definitely got me through the three great yet bone-tired years. It made me learn to operate the CT scan machine, just in case the technician wasn't there to do it. It made me push stretchers and ICU beds without transport personnel just so I could get imaging within the prescribed time limits. It made me brave enough to stand up to anybody, and I mean anybody, and say, all that I was doing was in the best interest of saving a life of another human being.

Apparently, the powers that be thought I was doing a good job, because they dumped a whole departmentload of responsibility on me in my senior year. Teaching the new residents, administrative, defense, representative -- all in stride, done and finished. To the open minds, I've shared most of what I knew. I've defended even those that were not worth the time for others, hoping that the promise of something better came along. And well, I felt like I did a pretty bang up job of everything.

But there's always a critic, a dissenting opinion, another point of view.

I was finishing putting my laptop in and took a sip from my gray cup of water. I glanced at the white board, the tables, the files and thought of the tears that were shed in this office, the arguments, the scolding and reprimands given, the countless questions rattled off in many a morning report or ICU rounds and the countless blank stares. But for all those things were overshadowed by the comebacks, the smart replies and right answers, the laughter and joys and the growth that stemmed from taking every little comment constructively. But most of all, their was strength and joy in sharing with people who actually gave a damn. Some more than others, but who cared nonetheless, to improve themselves for others.

My bags were packed and my office cubicle emptied. I slowly peeled off the taped name under my space. I turned the knob and halfway out the door, looked back inside for anything I might have left behind.

Clear.

Just a whole load of wonderful memories and a immeasurable gratitude.

See you on the flipside, PSH.

The Blur of Residency

2011-09-16T22:52:00.000+08:00

Three years.

Almost.

As long as that as has been, I can still remember how I was during that day -- nervous but quietly confident they'll pick this newly minted physician from Dumaguete City, who knew nothing but hard work, who was naive enough to think he was going to make a difference in the world, and bullish enough to think he could do it.

It's during these times where things are kind of winding down that, it's always nice to take that proverbial time to smell the roses.

My first day: November 1, 2008. Floors assigned were 1A, 2A and 2B. I remember the mad rush for labs, the fear that my patients die at my hand, and the relief that washed over me when I turned my floors back over to the on-duty residents the next day. It was a skeletal duty day, and for those who aren't medically inclined, only those that were necessary to make the hospital function were on duty as it was, after all, All Soul's Day.

Wanting to be the upstart resident that impressed on the first day, I religiously went through all the rooms in my wards (as it should always be, wink) and did every S-O-A-P method I could think of. I had an ICU Set-up patient at floor 2B that I really really did not want to be the one to kill, so I did a more than meticulous PE. I was in there for a good couple of minutes, inhaled all the cold, musty hospital air, and then read the label on the chart.

All the precautions in place. Meningitis. Oh, crap. I was so sure I felt my neck stiffen once or twice during the whole 24 hour duty.

When that patient had episodes of dyspnea while on his ventilator, I did my best to do the troubleshooting of the settings. When I decided I needed help, I called my immediate senior, and I got the first revalida and grilling of my young residency. No worries, I learned. First, never call without actually having some idea of what I needed to refer. Nevertheless, I didn't kill my patient, and I grew to respect my senior as he would become a source of infinite learning to my batchmates and I as we went through the muck of residency together.

My first mistake: One can never get through training without falling down once, or twice along the way. I had my share. I made the mistake of sending a text message to one of my attendings about a patient who had gone into acute atrial fibrillation, became hypotensive, among other things. It turned out he was on his way to the patient, but his reply throught text reached me first -- ALL CAPS, telling me that I should call if I needed to update critical patients. That I was not being trained by his INBOX -- I laugh now, but the first time I saw that message, I thought my spirit left my body and I was looking at my pale, drained face from the next floor. Imagine my surprise when he, just as suddenly, appeared at the patient's door. I tossed him the chart and ran -- kidding, I actually survived and he was a bit more forgiving in person.

The next time he reprimanded me was for waking him up so early for an update.

He became one of my ninongs at my wedding.

I had other mess-ups, some my fault, some not entirely mine. But, like any good resident and any good friend, you take it all on the chin, put your head down then barrel your way through.

My first code: I was first year. I informed my immediate senior but after a really busy night, she was out like a light. She answered my call, said she would be down, but never got around to doing it -- where cases like the mind is willing but the body is too weak proves to be exceedingly true.

She was a Breast Cancer Stage IV with metastases to the liver and lungs. After several attempts at appraising the family on the patient's condition, they decided they still wanted the CPR even with the odds against them. The patient arrested and I quickly did a flawless intubation and manned my first code. I was the captain of the ship. Code Captain.

The only problem was that it was just me and three nurses. One nurse did the bagging, one to give the medications, and one to get everything we needed. I was left to do the chest compressions by myself and man the code at the same time. I was rattling out orders while doing CPR all by my lonesome for a good 1 1/2 hours. I didn't even notice that one of the patient's relatives was actually taking pictures and videos of the whole thing. After we saw her, I was quick to send her out. It wasn't that we were doing anything wrong, it was just plain weird.

Time of death: 4:30 am.

My small victories: There are so many among which are making admitting orders for a patient in congestive heart failure with an array of arrhythmias where all the cardiology fellow on duty could order on the chart was "attach copy of ECG tracing at chart," being able to actually win a bet against a consultant/fellow that the patient was having digitalis toxicity rather than just plain hypokalemia, and going through a whole month in the ICU with just 3 mortalities out of 61 admissions (granted, some of those transferred out per request and passed away peacefully in the ward with DNR directives.

One cannot truly count the small victories, all that matters is that you make them count.

My band of brothers/sisters: I will forever hold dear the times spent in the trenches with my batchmates. Things happen for certain reasons, people come, people go, and I could not have asked for things to turn out any better than they have, because despite our differences, we work like the best of machines do.

To these people, I will always be indebted.

For all his patented "bowl of lies" and "snail-faced" ways, Mush was there with me from the beginning. Albeit, with two attempts at quitting under his belt, and a two-month extension coming up, I salute the guy for braving two straight years without vacation leaves, and a whole slew of controversies. He has always been a steady friend, sometimes wavering, has really-hard-to-understand principles, but I couldn't ask for maximum effort.

Christie came in December. She is, as I fondly refer to, but she vehemently rejects, is the glue. She compliments all our personalities. She holds us together with her incessant tact/naivete, and laughs at nearly everything, but is quick to shed tears for the most corniest of movies. She is one of the more honest people I have met, and sometimes to a fault, but one thing is for certain, she will always give her best. And you really could not expect anything less.

Mercurial is just one of the many adjectives for Gladys. She can become moody and snappy one minute and rolling over, crying with laughter in the next. Dependable, she zones in and simply gets the job done, her way. She will keep you in line with a sharp retort but is quick to help you when you need a hand.

Jeffrey has always been quick to lend a hand, and reliably strong against the criticisms and trash thrown at us. Aside from being an infinite supply of food, Toblerone and Lay's, he provides a level head at viewing certain subjects/problems. You don't need to tell him what to do, he just goes out and does it. His dancing and singing skills are, no doubt, valuable in presentations, though it takes quite push to get him to show his talents, he will stand there, with skinny jeans and a tight fitting shirt, grin bear it, and finishes what he starts.

Ian is the elder statesman. Haha, no doubt about it, he provides that certain maturity -- a dose of reality + dry wit + sarcasm and humor = actually good advice. Thought he has a certain code of rules that he lives by, his laid-back (literally) personality, is a welcome change to our group. But when it comes to getting stuff done, he never fails to find a way to actually make things happen.

Ours will probably go down in PSH-IM history as one of the chilled-out, hatred-free senior years of residency, and I would have it no other way.

My quiet prayers and deepest thanks go out to the people along the way. The friends I've made, the enemies who hated my guts (thank for building me up to feel that someday, with just the right amount of work, I will be better than you), for the mentors and tormentors, and for all that made a jolly rockin' great time of a residency.

I'll see you all again -- who knows, more sooner than you think, or a bit later than what you expect.

Official time-out will be October 31, 2011. 7 am.

In A Better Place

2011-07-10T23:00:00.001+08:00

I was never really around her very long. Even on those days when she would come to visit us in Dumaguete -- on certain Christmases, on a few of her physician check-ups, or just to come see us -- I was not as close to her as grandkids to grandparents were. Maybe it was because of the distance between San Carlos City and my hometown, or maybe it was the time spent away from each other, I can't really put a finger on it but I was never really with her for very long.

Those times however few, were beautiful moments in themselves. I did not know her favorite color, her love story with my paternal grandfather, her favorite activities to pass the time away, yet I loved her with all my heart.

She passed away quietly last Saturday afternoon.

I knew she loved me too. I was the first grandson on my father's side and I knew she held me in a special light when she came all the way from San Carlos to attend my college graduation. I vaguely remember summer vacations where she would be concerned over my throwing up on the bus on arriving in San Carlos, getting us sheets for the beds I and my siblings would be sleeping in and asking my younger cousins to play with us and make us feel at home.

For that, Lola, and so much more, thank you.

I knew she loved me too, whenever I looked into her eyes from greeting her and seeing that familiar twinkle, matched with a smile that made you feel like you were the best grandson in the world. She looked every bit the wise and compassionate grandmother that I could always run to when times I needed advice.

For that, Lola, and so much more, thank you.

She was a teacher. And from the people that I know who knew her, she was a good one. She was just as great as a mother raising my dad and his brothers.

I wish she could have seen me during my wedding, one of the happiest days of my life, but she texted that she would be here in spirit, being that she was not feeling too good and probably would have been too tired from the travel and I thanked her. She was already diagnosed with Chronic Kidney Disease with all its complications, anemia, a fast-rising creatinine, hypertension, and deep inside I knew that it was a battle that could not be won. She had had several hospitalizations in hospitals near San Carlos and I kept in touch with my cousins all throughout these last few years trying to help in her treatments.

She lost that battle last Saturday, and is now in a far better place than where I am.

My Dad mentioned that an aunt said that even though I never got to see her during this last few years and despite our consults being short text messages through my cousins, Lola always considered me as one of her doctors.

I am 'la. And always will be.

You will be remembered. We love you. Rest in peace.

My Take

2011-06-15T01:38:00.000+08:00

ONE OF US

Someone I know is currently in the process of applying for Filipino citizenship. Yes, you read right the first time around. Somebody still actually wants to become one of us. That's what happens when, say, you're from China and you have been in the country for the better part of your life, long enough to finish medical school here, and now you're stuck with taking the Philippine Medical Licensure Examinations, one requirement of which is a Filipino citizenship.

He was in a bind because he had to have "show money" in the bank, let's say, half a million pesos, and processing, paperwork, fees, and a host of other red tape amounting to another half a million pesos.

I was shocked that if you wanted to become a Filipino these days, you'd have to shell out a million pesos for what? Poor healthcare coverage, a government system that's shot, a corrupt military that can't even defend itself, become part of the jaded, crabmentalized brown race?

Then again, we have to control the population somewhat, so I'm sure levying stupendous and exorbitant fees for immigrants is the way to go.

SUMMER MOVIES

Well, it's been disappointing so far.

The sequels are there:

Kung Fu Panda 2 - It isn't going to sneak up on you on how cool a panda looks performing Ip Man/Bruce Lee moves like how it did during the first movie. Sure the Jack Black one-liners are there and some scenes merit a few guffaws and snickers, but you get the feeling that the awesomeness is being stretched more than it should have. Maybe the 1st movie was perfect the way it ended, but then again, a buck is a buck in Hollywood.

Pirates of the Carribean Umpteenth Time - Milking the series for what its worth. And more probably coming. Honestly, I haven't seen it yet and I will, eventually, on a bootleg copy most likely. After the first few movies, you can honestly get excited to see Captain Jack Sparrow prance around for only a couple of more times before he gets annoying.

Thor - I was honestly excited to see how the Hollywood bigwigs would portray the superhero but, disappointing again. Maybe I was expecting too much? Some people I know liked it but it was dry to me. Lacking in personality and engaging conflicts, I walked out of the movie a bit dejected. I think it should be retitled Mjolnir. It was pretty much the hammer doing all the damage.

Super 8 - Well, it was okay. A homage by JJ Abrams to Steven Spielberg and it showed. The evident references to ET and Batteries Not Included and Cocoon was there. Perhaps, a more heartwarming touch would have done it, but otherwise the best storytelling of the summer so far. Great kid performers and Elle Fanning is legit.

Priest - I didn't expect to be entertained by this unheralded movie, but I was pleasantly surprised. It won't win any filmmaking awards but it engaged me from the start. Paul Bettany will always be a favorite of mine and the idea of the priests of the Roman Catholic Church as vampire-killing zen, kung fu master machines wielding weapons is a pretty fun thought.

There is still hope for summer -- I'm going to get myself a copy of Hangover 2, but it's hard to get excited about a bunch of guys getting dead drunk and forgetting what they did when I go out with my friends to do that. I end up remembering everything but they don't. There's of course, Green Lantern, Larry Crowne, Transformers, and Harry Potter.

I may rant and rave all I want, but I'm still going to watch them. In the end, Hollywood works. Hehe

THE BASKETBALL IS ROUND

I have been a Detroit Piston Fan all my life. And always will be.

But these NBA Finals have been the best in a while. The best since the Detroit Pistons shocked the Los Angeles Lakers in a 5-game sweep in 2004.

It was the talents of South Beach versus the boys from Dallas.

After what Lebron and Chris Bosh did this offseason, everybody outside of Florida hated the Miami Heat. Nobody in earnest could cheer for them save for those who were used to cheering for winners and bandwagon basketball fans. With their trio, they were going to win games and anything less than a championship would be failure.

Fail they did.

And oh the joy.

You see, I am one of those who despised James for doing what he did (leaving Cleveland, the team that will forever be associated with him since the Heat will forever be Dwyane Wade's team) and how he did it (playing around with teams, and announcing his decision on "The Decision" all over prime time TV).

I could go on and on about how the Heat classlessly handled themselves in this Finals like how they made fun of Dirk Diggler's wheezing, fever and sinus infection and foolishly enough did it on camera, Dwyane Wade's dig at Dirk after the 2006 championships, and celebrating like they won it all after game 1, but I won't.

Instead, let's dwell on the things that will make us smile:
1. The veterans finally get rings: Jason Kidd (after 17 years, and 2 tries with the Nets - I didn't like him then cause they went through the Pistons to get to 2 Finals but lost), Dirk Nowitzki (one of the truly great shooters to play the game), Peja Stojakovic, Shawn Marion, Brian Cardinal.
2. Rick Carlisle: He was once Pistons red, white, and blue. Congratulations to him for finally getting over the hump.
3. Mark Cuban: After trying so hard, he finally shut up and actually let his players play their games. Dallas is probably the only team in the NBA where the players tell the owner to shut up, and that's actually a nice problem to have.

And the best reason to be happy about these Finals?

The catchphrases, jokes, and gimmicks! Cavs for Mavs shirts are fast sellers in Ohio, the Loss of the Rings is pretty catchy, the Heatles versus the Last Roundup, you name it.

All in all, it was one of the best Finals in recent years. Let's hope that lockout doesn't happen, because I'm up for the NBA Draft and getting ready for next season.

Now....back to work!

Room Clutter

2011-06-04T22:24:00.000+08:00

The pharmaceutical and medical fields are inseparable.

Which is why, I find it hard to not smile in return at a medical representative despite my heavy ward workload or even when I'm in a hurry to get off work and go home, and a rep stands in front of my car to get my signature.

But what to do with all the room clutter that's left when all the dust settles, is kind of becoming a problem. All these giveaways -- large bags with their brand name logos plastered all over the front and back, large paper bags, folders with product endorsements and prices, cotton containers, soap, boxes of tissue paper both dry and wet wipes, pens, bookmarks, prescription and lab pads, clocks, you name it -- are taking up a chunk of space in our small, err, cozy room.

I love freebies as much as the next MD, but I don't go out of my way to collect them. Because more often than not, these thingamajigs all become room clutter -- space occupying lesions if you will.

Well if they're still giving them for free, I'm just gonna smile and bear it. After all, these are free. And freeloaders can't really be choosers (I wouldn't go so far as to say beggars, but let's not seem all too eager to line up sometimes?). But I wish I had space to put them where I'd actually keep our room immaculately clean.

But then again, that just wouldn't be our room, won't it?

So I'll still take the bags and give them to my mom and wife, give away the pens as nurse bribes to carry out my orders first (we get weak-a$$ pens anyway, and I have this thing about using my own pens that can actually spit out a thick black line of ink instead of gray), the prescription pads go to whoever wants them, the folders and envelopes to the office, and the sample meds to my charity patients.

All's well that ends well. The dust settles, the clutter is gone.

That is, until the next coverage day.

23rd of May

2011-05-24T12:47:00.000+08:00

I imagine I'm graying and old as I step out onto the veranda of my humble two-story home and marvel at the way the vines cling to the once-white trellis, adding a much needed green to the fading specks of white.

Every year on the 23rd of May, I sit here, look out onto the lawn and occasionally see my grandchildren running around with reckless abandon, laughing, playing tag, the wind blowing and picking up the freshly cut grass, and maybe go through the latest book I've bought, or like what I'm doing now --write.

It is during these pensive times that I think of the life that I have lived. My parents taught me early in life to live content with what I had and not really spend beyond what I could earn. Thankfully, the hard work of medicine paid off with a fari number of patients, and eventually, good friends.

I looked up from the glow of my laptop and the silent world of my thoughts to see the reason I couldn't really ask for anything more -- just to catch a glimpse of her smile everyday, hear her thoughts and exchange an intellectual conversation -- and I never let a day pass without telling her how much she means to me.

"Hey." she says "Writing again?"

"Yup." I reply, relishing the warmth of her touch as she cupped my head in her hands and kissed me.

"Okay, don't be too long, dinner will be served in a while." She said, in her half-ment, half-kidding tone.

"Yup, I'll be right down."

I sat back to right down my thoughts to the unknowing audience of Scrubbed Out. If I had more time and more money, what would I do with it? The question was posed on the week's Blog Rounds, and I couldn't help but smile as I remember Gaya asked the same question on the relaunching of TBR, back when they added Voice of the Filipino Doctor as a byline.

I typed in simply: I'm happy, and I could not ask for anything more.

I thought about it. I wasn't Trump-rich, but the money that I had were spent on
- the majestic grand piano now standing in my music room which I proudly say I've made
- 2 self-produced albums of piano instrumentals and a 12 track CD of original songs
- the decked entertainment room complete with the latest movies and classics and a TV with 4D capability, and your choice of video games, interactive of course.
- minority stock shares in the Detroit Pistons franchise
- a beachfront house with pristine deep blue waters off Zamboanguita, a few meters walk from our family beach home
- a small ultralight plane I can fly anytime

During the first few years of our marriage, I whisked my wife off to
- travel to the places where I've always dreamed of going -- swimming in the Maldives, rocking the samba in Rio, treasure hunting in the tombs of Egypt, marveling at the ancient heads of Easter Island, walk among the mysteries of Machu Picchu, chilling in Hawaii, and standing in awe of the beautiful Northern Lights of the Arctic circle.

Well, I did spread the wealth around
- The sports center in the middle of my hometown is a delight
- My educational fund together with a couple of friends from medical school has put 50 scholars through high school and college
- A small farm on a stretch of mountain land away from the city.

Well it took a lot -- A LOT of hard work, indeed.

The sumptuous smells wafted from the downstairs dining room, as well as the sounds of scurrying feet stopped my train of thought.

Well, this should be enough for the day. One can never keep the family waiting for food, I chuckled, and I could be facing a whole slew of stern faces if I was late for dinner.

I shut down my laptop and thought about time.

Opening the door, I saw my kids gather around at the foot of the stairs and waiting expectantly, "Coming. Coming." They had come to celebrate -- a gathering of families, and moreover to give thanks for so many blessings throughout the years.

I reached the lowermost step and was greeted with mano po's and good evening's

"Lola, eat na ta!" squealed the eldest of my grandkids.

"Wait, your lolo's still coming pa." She sat them down and looked up at me, smiling.

I smiled back, beaming back and realizing a most important thing about what to do with more time --
that time stands still in her eyes, so I plan to spend all of my spare time looking into them.

i Blog because i am

2011-05-15T19:20:00.000+08:00

I blog because I write.

I still blog because I still write (despite the schedule making me do the contrary).

I blog because I run little commentaries about the things that happen in my life while I'm living it but sometimes too lazy to put it on a pen and paper.

I blog because I am (sorry Descartes).

I still blog because I still am.

I blog to voice out, rant, shout out and say to the unknown audience what I think about the things I write about and the world we live in.

I agree that writing has become an art with dwindling ardent practitioners, and the blog, a once nice avenue for writers has slowly given way to the shout outs on Facebook, the tweets on Twitter and what have you. Some people have resigned their infinite thoughts and compressed them into the perfect tweet or the shortest FB post.

I blog to write.

I blog to write my thoughts while thinking about what defense I think about while preparing for the mortality and morbidity conference in the next week.

I write for the Blog Rounds and the fun I have reading and writing again.

I blog because I write.

I write because I think.

I think therefore I am.

I blog = I am.

A Place I Still Call Home

2011-05-15T08:50:00.000+08:00

The big yellow Ceres bus I was on lumbered towards the city I called home for the greater part of my life -- Dumaguete City, and which I still do.

I was coming home for the first time in three long years. To some, three years may not seem that long, but I can't even remember the last time I lingered in my hometown for more than a day. So, it was good to come home.

I had expected everything to stay the same. I got my usual attack of my allergies -- rhinitis, colds, runny nose, the works -- which has happened every time I came home ever since I left for medical school. But the changes were tangible as we rolled past the Sibulan airport with a Cebu Pacific jet taxiing down the runway, the heat was pelting the roof of the bus and the cement road endlessly.

As I passed by the buildings, I made a mental note of the changes but lost count by the time I reached the boulevard and got up to get my bags in the overhead compartments. The St Paul's First Gate lawn seemed a bit more crowded with more signs and oversized plaques, the infrastructure fronting the Provincial Hospital has seen so much growth that I don't even know half the stores in the area, heck even the bypass road now has a name and a really big hole right smack in the middle.

Some things still remained the same though. The tricycles and motorcycles still dominated the roads with bad Dumaguete City driving (every person who comes from somewhere else endlessly complains of Dumaguete drivers zipping in and out of traffic coming from out of nowhere). The pillars of the city were still standing -- Silliman University, Lee Plaza, NORSU, not to mention the Public Market, the churches and parks -- but somewhat grayed and older.

I marveled at the changes that have happened since the last time I was here. So much has changed. Stores have moved. A huge Robinson's mall now stands tall a stone's throw away from our house, with all the trimmings of big city life -- the KFC's, Crocs, iStore and an entertainment section. I'm sure the Dumaguete people are quite thankful for the decent cinemas we can go to for the latest movies.

But so much has been taken away from what I remember Dumaguete City to be. I zipped easily on that warm afternoon as sunlight was slowly creeping away, I noticed even my favorite place to buy Pan De Sal during early mornings when went to Silliman Beach when I was a kid was now closed, Gold Label Real street was gone, food places weren't where I expected them to be like Negros, Scooby's Silliman is back but on the other side, and even National Bookstore Portal Building has packed up and moved out to Robinson's.

One thing I religiously do every time I come home is go to Taster's Delight to eat what I know to be THE BEST burgers in the WORLD! But sadly, those days are gone (hopefully just temporary) because Taster's has closed down and orders can be placed at Howyang, but those burgers don't taste the same as those freshly cooked Taster's burgers wrapped in the yellow and orange plastic (mouth watering) and when you take that first bite...the best, indeed. Bring it back please.

My leave was coming to an end and work beckons.

But changes have also happened to me in the past three years -- first I'm seven months married to a wonderful woman who keeps me laughing, and strong, I'm in training in a profession I love despite the stress and hours without sleep, and new friends on top of the old.

I guess the people have changed so much as well.

Dumaguete City, despite all the changes, is still home to me. Nothing can keep from family. My parents are still there keeping busy, my brother is doing his thing, my sister is married with her husband and newborn son, Lucas (sorry ma, Lucas sounds more uhm sophisticated, i.e. sa ebanghelyo ni San Lucas).

And I'd still be coming back.

See you the next time Dumaguete.

3 am

2011-04-09T07:46:00.001+08:00

With the deafening silence of the dawn all around me, I sit alone in the office, with a blank computer screen, phones lying quietly at the side, and the overwhelming compulsion to write something for this blog which has been quite dormant the last few weeks.

I glance at the clock, it's 3:16 am, there is a pile of yellow and orange envelopes in front of me, piling evaluation forms to one side, and the books that need to be read on the other. I look at the 20 or so admissions written in a barely legible scrawl on the white board, reminding me of the census and logbooks that need to be completed before the end of this year.

The monster that is residency has been on my back for a full 2 and a half years now and it hasn't gotten any lighter and fellowship is right around the proverbial corner. A corner which consists of specialty board exams, oral exams, among other unique challenges.

In the meantime, I'll get started on the mountains of paperwork, the books that are laid out in front of me, these evaluations that need filling up, and the unenviable task of steering this ship.

Music and Lyrics

2011-02-21T17:05:00.001+08:00

The video speaks for itself...

In the spirit of the month of hearts, this one's for you -- a vacation from my numerous rants on this blog. Let's turn up the mush from time to time.

Just because it's Monday.

;)

Caritas

2011-01-08T06:25:00.000+08:00

This is not a post about health insurance, haha.

I've recently, uhm, "leveled up" and now have the unenviable task of handling charity patients. In residency training, these are the supposed learning cases where the residents can apply their knowledge of medicine and practice their own brand of healing.

Guinea pigs? Nope, I don't think so. Not when there are 2 or 3 consultants hovering over your management and questioning you. And let's not even mention the audit, somebody might get ideas. Haha.

For our training, charity means handling those out-of-funds patients who most likely have difficult cases being they've already exhausted their money.

For me, it's trial by fire.

For my patients, it's a chance at a really big discount for his care.

I've had the fortune of having had 4 charities so far, and it's a different feeling each time seeing patients go home a little bit better than how they came in because of my orders in their charts.

The feeling of holding that chart with your name on it, seeing the patient and talking with their families each time you go on rounds, and expecting them on follow-ups -- it's very doctor-y. Haha. It's a mixture of the anxiety of messing up, the fear of failure, the elation of getting something right and the power of healing another human being.

It probably isn't the most reasonable thing to hope that all my patients end up walking home through the hospital doors, but I'd like to keep that streak up as long as I can possibly can.

A Little Bit of Something Each Day

2011-01-03T01:47:00.000+08:00

I can't believe I've been away from writing this long. Well, I had more than a couple of things going on and I simply couldn't get away to write up a post here and there. But with the new year comes a new resolve to write more, sing more, live more, not to mention work more, but all in stride. After all, it's always the little things each day that makes up those moments that take your breath away.

SOMETHING SAD

I've written about so many things on this blog, and the seeming nearness of death to us all has always been an easy topic to expound on. With 2 full years of residency under my belt, the losses still matter to me. Most especially when some losses are closer to home. When we lose young patients with so much more to live for, and recently, a friend's mom passed away under our care (my condolences, Ver), I feel, more than anything, the fragile state of our mortality, and that sense makes each morning a better one than yesterday's.

SOMETHING TO LOOK FORWARD TO

I've done 2 years of my residency in Internal Medicine and going into the final stretch. It's going to be a heck of a year with seniorship, teaching juniors (that is if I have anything to impart, haha), and conferences and presentations, and hopefully, graduation.

SOMETHING SCARY

In line with the stuff to look forward to, there are exams, oral and written coming up and which I have yet to prepare for.

SOMETHING MUSICAL

I've finished a close friend's wedding song, but I never got to record it or present it at their wedding. Maybe I'll get up and do it once I'm done with all this residency stuff. And, that Christmas love song for you, you've heard. Haha

SOMETHING LOVE-LY

I'm married! Haha

With all these things, come the promise of a new year -- more blogs, more unforgettable moments, more music, less pain, more joy -- and the wish that it's gonna be a whole lot better from here on out.

HAPPY NEW YEAR!

A+ to F

2010-10-20T02:56:00.000+08:00

The funny thing about evaluations is that they often are not reflective of the body of work that you put out every single day in the ward and yet they label us for the rest of our residency lives.

It really isn't fair sometimes. I go on a 36-hour duty shift, minus stealing a few minutes to hours of some shut-eye time, weather another 24+ hours of actual work time and if I screw up for a few seconds during that time, those few seconds will become my evaluation.

Nobody really cares about the 24+ or so hours you did stuff right.

By whose standards are we graded?

I've always had standards for myself and I'm harder on myself than anybody else. Most of the time, I don't let the opinions of other people ruin my work which I know I did wholeheartedly. But yes, I do make mistakes, and it's a hard pill to swallow when those mistakes are made the sole basis of my grades. Nobody ever mentions the times you were right and shouldn't those count more than the mistakes?

Well, it should.

I've realized these past few days that in medicine, and life in general, one should:
a) evaluate oneself
b) if one is happy, content, and making the people around you better, treating them right, then you're bound to be doing something right despite all the claims otherwise.
c) realize that there are people who dwell on the wrongs than on the things done right, and that these are the people you can never ever please, (their opinions don't matter)
d) make a mental note that you only answer to the Almighty, to yourself, and to your patients.
e) come to grips that you cannot please everybody.

We are but reflections, parts and parcel of the teaching and handiwork of those that have come before us -- our seniors, our teachers, our consultants.

So if you've done a good job, we'll turn out okay. If you've done otherwise, then we might not be so good.

We are your evaluations.

August Rush

2010-08-31T00:51:00.000+08:00

RANT ALERT!(Don't say I didn't warn you)

Another month down.

At this point in any residency training, 2 months before I hopefully enter my third year in Internal Medicine, you come to the dog days -- days when you're dead tired, getting snide remarks about your work from people who do their best work from a distance, and you sometimes, do not feel the need to go on.

These are times when you feel that quitting is an option.

Believe me, these days come.

Often.

But I have come to realize that quitting isn't an option. It is a mirage. It looks like it's there but it really isn't. It's tempting, but it won't do you any good. Sometimes you get lucky and you find a casbah and a big pool of fresh water, but if only we can all be so lucky.

I wish an 80 hour work-week was in effect in our country but it isn't. We tally a total 100+ hours by my count (my brain isn't processing numbers at this time, so I could be wrong).

I've been working with people who say that I've been extra sensitive and touchy about how I work with my patients. And these are people who aren't even doctors and do not, in the first place, have any idea what is going through the mind of one.

So to them I say, BLESS YOU!

It's the only way I know how to work. I was raised by a mother who wakes up at 5 am to go to the market and sell meat, rush home, gets into her uniform to go to the bank and comes back at night to talk to us and help us with homework; a father who goes to the bank every morning and is dedicated to his organizations.

I take pride in my work and I will rant and rave in anger at any attempt to discredit it. You can break me down, tell me I'm ugly (I hope at least I'm average-looking), fat (I do need to lose weight), dumb (now wouldn't you want me as a doctor?) and other really bad adjectives you can think of, you don't get a free pass when you talk about my work.

I give you everything I have, everyday.

He who matters (pointing up) knows I do.

And His opinion is the one that matters.

The rush of August has come and gone.

Happy August

2010-08-17T21:51:00.000+08:00

There have been several things that have brought a smile or two to my stress-laden face these past few days. I’m not talking about the crappy one-liners that crack you up, but rather it’s all about those times that come up and surprise you – that box of chocolates, those life-affirming purpose-filling experiences and those moments that bring joyful memories and images that you just can’t help but radiate happiness.

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I’ve made it no secret that I fell in love with this line of work during my post-graduate internship. The endless diagnostic puzzles and the countless thanks we get when we see a patient walk out the hospital doors floor me now as much as it did then. And for every intern that has come through our hospital (two batches) I’ve always tried to impart that sense of awe, respect, and interest in the diagnosis and treatment of patients. One way of doing that is having them man the triage and outpatient consults (as we did then). After they see the patients and take their histories, they come to us, residents, with a plan for diagnosis and treatment. I have always given them a little free hand to do and get what they want as long as it is in line with the diagnostic possibilities.

A week ago, we were saddled with a patient with abdominal pain, mainly in the epigastric area with radiation into the back, noted after eating a meal of squid. There was epigastric tenderness and vomiting. My intern mentioned all the differential diagnoses and was hedging on Gastroesophageal Reflux Disease and Pancreatitis, ruling out of course an acute coronary syndrome with a negative ECG. I was already happy with the way she handled the patient. In the background of a previous history of GERD, it was highly likely just GERD, but she wanted to rule out Acute Pancreatitis.

I said, “Convince me to allow you to take a serum amylase.” She went into the doctors call room and brought out our text books and began to read from the symptomatology of Acute Pancreatitis. I laughed and conceded. Who couldn’t say no to that?

Serum amylase was negative. Endoscopy eventually still showed GERD.

She came up to me after the results came out and said, “Doc, I’m kind of disappointed and happy at the same time. Happy that my patient doesn’t have pancreatitis, but disappointed that I didn’t get it right.”

For someone to try that hard, to figure out a patient, and bounce back after getting it wrong is a lesson learned in itself.

That became a life-affirming moment for me. I love teaching whatever I can to those who listen and when you see it come together like that, it’s a wonderful thing.
I told her, “You can’t get all your patients right, you can hope to try, but you just can’t. It’s the thinking process that counts. And you are well on your way.”
She stood up, flashed a smile and went on to the next patient.

Small victories.

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I don't have any fangled camera DSLR's and whatnot, but I have my hearing and I've rediscovered my love for music -- thus, thanks to my mother (ever-supportive, she was the one who had us take lessons way back in kindergarten), I've been reconnecting with my love for music through a new keyboard. (thank you ma.)

As Gaya says, it's chasing giants that make this life worth living. Hahaha, if I didn't know better, I would have sworn those were lyrics. But that's just me.

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Broken

2010-07-12T22:24:00.000+08:00

It's been too long.

It feels like it's been too long.

I spent a whole 5 years on my pre-med course, a whole 4 years on studying medicine, a year of post-graduate internship and a nerve-wracking board exam. I got through it then moved onward to practice medicine.

I'm two years into residency -- seeing patients, greeting them, diagnosing and treating them, knowing some secrets, building relationships -- and it feels like it has been forever.

We get patients, walking, talking, breathing human beings in our ER and sometimes, it would just feel good to be able to say that "You're gonna get out of here in one piece," or "it's gonna be alright," but we don't. It's not that we don't want to say it.

It's because we can't.

We don't know what's lying around that corner. Some unforeseen complication, some undiscovered comorbidity that just lurks in there and takes you away from us.

Or sometimes, we do everything we can, yet it still falls short.

I spent the better half of the past 3 weeks pondering what I could have done more at that ER table while writing down the orders for my patients to change the outcomes of the certificates I had to sign. I asked people who knew more than I did, who had seen more than I did, yet they just smiled, comforted me with words like, "it wasn't your fault," and moved on.

You see, here in impoverished Philippines and I assume in the better part of Third World Asia, we get sick patients who most of the time, do not even have the opportunities for a cure. We get a patients who don't even get a chance to swing for that home run, or that open three-point shot to tie the game. Instead, we get patients and their crying families, and we have to look them in their eyes and give them the options, surgery, a thousand-peso antibiotic to be given for two weeks, an ICU stay, eight units of blood, and what have you, but all we get in return are more tears. Then they wipe them away and all that's left are faces with clenched jaws, and flushed skin, and the realization that this is the end for a loved one. The hand is dealt and they've lost.

It's hard to be the one on that other side.

I spent a week trying to convince a patient with a manageable cerebellar stroke to undergo a needed decompression -- wall, no money.

I started two large bore IV's and got blood without delay for a patient with an upper gastrointestinal bleed and stabilized her in the ER before sending her up, but she exsanguinated and bled out 3 days later on her rebleeding probably due to massive peptic ulcer -- she was awake the whole time until the last minute, where I stood from a distance knowing full well the Do Not Resuscitate form was signed.

I did my first child intubation two weeks ago, mainly because I was at my ER post when they came. He was blue, unresponsive, and severely dehydrated. Somewhere from the first hospital they went to until they reached us, that poor kid was lost to his mother and family, and the screaming, bawling was enough to remind us of how much pain we try to prevent each single day.

I lost another patient to a puzzling diagnosis that really can't matter now because his daughters have brought him back home for his funeral rites.

We've had so many losses.

And everything goes slow each time we do that I look around and I feel that it goes on too long.

The grief, the sadness, the pain...

Sure we are not your family, we are not your friends and we are strangers but that doesn't mean we don't care.

Walk one day in my shoes as you go through the wards and the hospital rooms and see how many people we try to bring back to health. See us as we break the news to more than one family. We feel the pain too, two, three times over.

And I do.

I hurt when I lose a patient.

Each time I walk out there to talk to someone about what treatment someone's wife, or someone's mother, someone's brother, or someone's boyfriend needs, it is from the deepest, most well-intentioned part of my heart, that they heed my advice. And if by some way fate deals us something that we can't overcome, well, I am not going to pretend that choosing or making a decision is easy, but I'll be there, and I'll listen, because I do feel pain. It might not be the same as their pain, but pain and hurt nonetheless.

Like the faults that people easily notice, losses seem to count more than gains.

Reflecting, I realize I admit as few as 10 to as much as 20 people in a span of a 12 hour duty and 1 out of those 20 might die, 2or 3 might need an ICU stay, and some fraction could refuse treatment, but nobody sees the 15 or so that I help cure.

I realize that.

People can say that at times doctors are heartless and cold because we move on so quickly from a death to the next patient that walks in our doorway, but the truth is, the losses do hurt, but more people are out there who need our help, and the only way to make it hurt less, is to make the losses matter.

If the time comes when losing patients doesn't hurt anymore, it would be the time to hang up the white coat and stethoscope and stop because to what end are we working for?

For Mrs C, Mr. P, it will matter. It will count.

I'm scared every time I take that ER floor. But it is easier to accept that I am there determined to have you smiling walking out the doors, handing in your discharge papers and knowing your free of pain and sickness.

And a faint fleeting flicker of memory flashes at the back of my mind, and I remember the losses and how I should make them matter, how I should count more the gains, and move on to the next patient because I am a doctor, and that's what doctors do.

realizations

2010-06-02T14:42:00.000+08:00

i realize that no matter how great one wants to be, and no matter how great you become, one would still be small in the grand scheme of things.↲

in residency, i have come to realize that my teachers are my patients, my books are my consultants, and how i learn is all entirely up to me and my desire to be a better doctor, nothing else.↲

i've come to realize you can serve two masters at the same time, but should these masters go on rounds at the same time, you might as well go into the emergency craniectomy and do cardiac monitoring.↲

i realize that we as a nation should have our heads straight, if all we could muster as an internet headline is that a local fastfood chain on Glee, then i should think we have either a) we do not have our priorities straight or b) we have nothing else going for us.↲

gasp, i just realized that in the above realization, it could be both.↲

i read, in a national newspaper that voters have become wiser because most senators elected in the last elections were pro-RH bill supporters. I hate to put us down, but seriously, whose leg are you trying to pull? Are you really that convinced that the first thing that came to the voters' minds was the candidates' stand on the RH Bill? Should that have been the case, in my opinion, we'd have a better cast of senators. But, i realize, that's just me.

Thanks For All That Matter

2010-05-27T12:46:00.000+08:00

My birthday came and went like any other day.

And I realized all my birthdays had a lot of things in common. One, it is always sunny. I don't think I've ever had a birthday with rain before. I think it's probably because it's right smack in the last quarter of May but I'd like to think that I've been blessed that way -- blue skies n gentle summer breezes included.

I woke up late, and went to work. The mood I was in was just like all my other birthdays -- reflective, subdued, pensive. There's something about another year of life that gets recorded in the books that gets one thinking, well about almost everything. I look at how lucky I am to have lived this long because I've had patients younger than I, who had the misfortune of losing their lives to disease.↲

I've never made a fuss about the day itself. If I'd meet you in the hospital hallways or text me a birthday greeting, I'd be equally touched and happy that you took time to remember, but I usually don't go shouting it out to the world.

I say a prayer of thanks to Him who has blessed me with all I need in this life -- the grace of love, the safety of family, the company of great friends, the luxury of talent, the challenge of work, and all that matters. Some people search lifetimes for most of the things going for me, and I'm eternally thankful to Him for letting me get some glimpses of heaven here. Sure, I know there still will be tougher times up ahead, but like they say, these never last, tough people do.

Who Wants To Be A President?

2010-05-10T14:05:00.000+08:00

Who do we choose as our next leader?

That question comes to the forefront of everybody's minds as they march to cast their votes at the polling precincts today here in the Philippines.

Sure we know all the candidates' platforms because these have often been recycled over the many elections I've had the fortune of taking part in during my lifetime -- create more jobs (how exactly they don't say), improve the economy (sure, sure), eliminate poverty (ugghh, how many times have I heard that). Do they really think they can do all these things and run a government of malcontents and selfish politicians only looking out for themselves? Or maybe they just want to think that.

But they are out there, asking for your votes and mine.

So we have the power to actually put someone in the driver's seat who steals and cheats the least.

So here's how I judge the candidates, not basing on their stands and platforms (because we all know that's crap) and not basing on achievements (topping a nationwide exam and passing or not passing a bill that doesn't make sense does not really count), but rather basing on the concrete things we know about our candidates.

Like:

COLOR: Primary colors are always a big hit in elections, in my opinion. They catch the attention of even the most dimwitted voter and perhaps sway them into thinking that because your giveaway (insert color here) shirts and wristbands match my (insert chosen apparel here), they'd be more likely to vote for you.

But the colors are important as often they symbolize some unattainable goal like, hmmm green for money, err, prosperity, or some save-the-environment cause, yellow for fear, err, freedom, democracy, red for bloodshed, err, power, and orange, well, I'm not sure what orange really stands for. How about a large-sized orange jumpsuit after your conviction?

3rd place: Orange, simply because it's weird and it would do well to serve as a warning to really be careful and not get caught so as to avoid having to dance Thriller and becoming the next Youtube sensation

2nd place: Yellow. Who doesn't like the bright and cheery yellow? Everybody seems so happy, and pretty and gay.

1st place: Green. It's the coolest looking color. It also provides the easiest defense for a color to the associated candidate -- environment, money and economy, development, and it makes a great looking wristband than a yellow one.

Point: Gibo

PARTNER: I don't mean the vice-presidency, because the Prexy and the VP relationship isn't what we would find in the dictionary right next to rock-solid. Ask De Castro. I mean the candidates' wives and girlfriends. It would help if you would have someone to draw the public's attention away from your receding hairline or your latest gaffe with a stunning and camera-worthy first lady/first GF.

The lineup would show:

3rd place, all the other first ladies-in-waiting.

2nd place goes to Councilor Shalani Soledad. Linked fo course to Mr Yellow Ribbon himself. Heck if she was running for VP, I'd bump Yellow Boy all the way to Numero Uno.

1st place to Rep Nikki Teodoro, who is fetching as the partner of Mr Green Himself. Not only is she a wife of the possible future president but a representative as well. Neputism all the way!

BEST SLOGAN: Catch phrases, rhymes, and really unrealistic claims plastered all over campaign posters hanging from our venerable electric posts and picturesque electric wires.

3rd place: Erap para sa mahirap. It brought him to power once, can it do it again? And that really is not a comforting thought.

2nd place: It's a tie! Toss-up between "Kung walang corrupt, walang mahirap" (True, true, are you?) and "Galing at Talino" (a lot of help if you don't want to get caught right?)

1st place: The Transformers. What can I say? You can't help but smile, stifle a laugh and imagine good old Mr Subic transforming into a bright yellow Camaro/Volskwagen and tweeting like Bumblebee. I'm thinking more Volkswagen for Gordon in Transformers 3 though.

THEME SONG: I'm a music guy so this one is a bit on the serious side so, let's go to the votes.

3rd Place: Rivermaya and Gibo with "Lipad"

2nd Place: If only for probably the only campaign song known to every kid in the Philippines, Manny Villar's Commercial comes in a close second. Now if only it had the slightest chance of coming true, I'd truly love this down to earth song and not treat it like another soon-to-be unfulfilled campaign promise. But when it comes down to it, I think the kids are singing for themselves and not for a particular candidate so, thank you Mr Orange Peel.

1st Place: I think the least heard campaign song is the best, and old Dick's supporters put this doozy of a song/jingle for Mr Subic. Enough to make me want to vote for the guy, who, realistically doesn't have a chance of winning (though a lot of people like him, they aren't voting for him, funny huh?)

So.....

All in all, we march to the polls today.

These criteria are shot. They really don't count. But it tells us that sometimes all that we have an idea about are the tastes of our candidates and what they're rolling out with to entice us to vote for them.

We know all those promises and platforms and programs aren't all going to come to fruition (hoping some of them do see the light of day), yet we hold on to hope and faith that somehow, someday, some President is going on that seat of power and realize that the Filipino people mean a lot more than just petty vote-buying and power-hunger, but people of a truly great nation.

Me? I'm voting for that guy named Wisely.

My Two Cents...

2010-04-04T19:10:00.000+08:00

Aaah, it's April. Another month, another post.

I could not make up my mind on what to rave and rant about so I just took a couple of random snippets from the eternal sunshine of my spotless mind.

RANT: I genuinely harbor a growing dislike for expats. I guess that's too much of a generalization. Let's narrow it down to expats who think that just because they've gone to work in a foreign country, make them authorities on how to best treat their sick family members.

One incident in the recent weeks was a nurse who worked in a 1st World country (as opposed to our country's glowing ranking in the world), came to tend to his sister who had a hemorrhage in her brain due to an aneurysm. She was awake with no motor problems whatsoever. She had an elevated white blood cell count and a slight fever. To placate him, one of the attendings had an infectious disease consult immediately, and even started antibiotics for prophylaxis, but we all knew that, given the paucity of other symptoms linking to a likely infection, her fever and white blood cell count was reactive in origin.

I went on duty at the ICU and he went on about blood cultures, and how it was standard in the country he worked in to get them before starting on antibiotics, the necessity of a sputum exam, among other things that we did or did not do that apparently was common practice in his country.

Feeling a wee bit insulted, annoyed, and concerned all at the same time, I got up, spoke in perfect and straight English as I could, and proceeded to go through how a cerebral hemorrhage can cause fever complete with pathophysiology of the breakdown of red blood cells and how it can cause irritation and further inflammation, how a blood culture though useful is actually a poor yield for isolates (but you can't dispute it if you have a growth).

He looked at me in disbelief, and even gave me a grin/sneer/smile that made me even more furious and said,"That's new to me. Really?" he chuckled and added,"You'll get killed if you mention that in the NCLEX."

I smiled, and calmly said, "Oh sir, I don't need to take the NCLEX, I'm a doctor."

I gave him a pat on the back and tended to the other patients.

Welcome home.

RAVE: This season of American Idol has not been as great as seasons past. I'm glad that my preperformance favorite Crystal has quietly emerged as the frontrunner (though I usually like the underdogs, so mixed emotions about that). And that her peformance of Midnight Train To Georgia was beautiful (what can I say, I'm partial to the piano).

There were only 3 voices I liked hearing this season -- Crystal, Casey James and Alex Lambert -- since then, Lambert is gone, James has been reduced to strumming his guitar and heartthrob status, so that just leaves Bowersox for me.

My two cents worth on AI:

Michael Lynche is somehow good because there isn't anybody else who is doing the whole R and B, Hip Hop thing, he sings too much on the consonants and not the vowels, there is something that annoys me about his voice and his antics, and I don't trust a performer when it looks like anytime he could break his guitar by just cradling it.

Siobhan Magnus is serial-killer, artsy chick, Bjork weirdo singer. Sometimes I like her (Rolling Stones week), and sometimes I don't (the rest of the other weeks). I've grown to hate inappropriate screaming and she's bordering on Adam Lambert Status.

Tim Urban should be gone. Aaron Kelly and his "aw-shucks" routine is getting on my nerves. Seriously, I really wouldn't want to listen to a whole album of his songs. Lee Dewyze and Andrew Garcia are redundant. Katie Stevens (despite her sometimes look-a-like to Lei, a close friend) remind me of a beauty pageant queen / evil mastermind at the same time. And she just doesn't know what to sing.

Aaargghhh, who cares right? I'm just one vote.

RANT: My Pistons....Oh the pain.

Looking forward to the draft. This season is over for me. I could not care less who wins the championship but they better look out, next season we're coming for you.

RAVE: Hooray for the Holy Holidays and skeletal duties. Nothing like a good day's rest to get you ready for the weeks ahead. It just rejuvenates the tired soul. With that being said, I expect it's going to be a really busy busy busy week.

Happy Easter everyone.

State of the Nation

2010-03-02T23:50:00.000+08:00

I have a bone to pick with this administration.

Why do all of you, when placed in a position of power (though how little power it is) seemingly change into pretentious, authoritarian know-it-alls who think so little of their constituents.

Why do you, madame leader, choose to point out all our flaws, and refuse to acknowledge that we are even assets to what we, the members of this coordinated effort towards success, are working for.

Followers are but reflections of the leaders who guide them.

Though it seems convenient to just cut your losses and choose the next best thing, you just can't go around firing people right?

You are supposed to lead not lynch, guide not gobble up.

But yet, there is that fine line between authority and leadership.

Some are gifted with the authority, use it, abuse it, bully people around with it.

But some are in positions of leadership where you actually give and get respect. And actually respecting the people who actually look to your position is the key to getting respect in return.

Turning your people on each other is not the way to go. Lynching your very own is definitely not a good thing.

Do not destroy the people you meet on the way to the top, because you very well might meet them when you are on your way down.

The National Elections are fast approaching and we are in dire straits. We act like everything is okay, but it is not. Leadership and authority can go together, believe me.

To our fearless head of state, do recognize that your leadership hinges on the very chains that hold this motley of people together. Do not break down each weak link but rather, strengthen it.

These are random thoughts running through my sleep-deprived mind right now. Too much politics everywhere, but when you get down to the nitty-gritty of everything, it's always about doing what's right. And you get that chance to make that difference that everybody is talking about.

Until then, we all are content to follow, endure, and pretend like it does not affect us. But there was once a time when the strength of many toppled a wise dictator, and we aren't as dumb as you think we are.

A Funny Thing

2010-02-21T21:12:00.000+08:00

When you're me, and you've been going on duty at the medical ICU for the past four weeks, you get to see front row seats to fate's gala performances.

Stuff just happens.

And it's crazy when it happens to you.

Just when you go off duty, the weirdest things happen -- arrhythmias (really bad rhythms of the heart that believe me, you don't want to be facing alone), spontaneous pneumothorax in a patient with a chest tube, an arrest.

Just when you're done updating an attending on how unremarkable the night went for his or her patient, she crashes and you get to call them again on how you had to stick a tube down their patient's throat to help them breathe.

Just when you say the pupils are equal, the consultant comes by 30 minutes after and orders a CT scan because the pupils are not reactive to the light shone in her eyes.

When these crazy things happen, you just want to smack yourself on the side of your head.

You can only do so much to not look like an incompetent fool and worse a liar, but that's how it plays out sometimes.

Stuff happens.

Like inserting a line a really swollen, twice-my-leg-sized arm after a gazillion attempts by trained IV therapists.

You make the right call in diagnosing the patient and you silently beam, puff your chest out a little, when the attending tries to find something to chastise you about.

You don't give a crap about critics' opinion of your progress notes when you know all the patients admitted are stable because you know their cases in and out.

Times that you actually order ahead for something the consultant thinks of two days after.

That's just how it is.

Stuff happens.

Just simple random stuff.

Fate is truly a funny wicked thing.

The Soundtrack

2010-02-01T19:20:00.001+08:00

In my previous post, I wrote about someone very very close to me is getting married to someone she really really loves (wink). (Aw c'mon, just play along, haha). And for that happy event, it's mainly her preparations and she runs stuff by me every now and then but she assigned one special thing to me -- the music.

So it's my job to come up with the bestest wedding soundtrack that says who they truly are and one or the other, these songs are going to be in.

TRAIN - Hey, Soul Sister

BOYS LIKE GIRLS - Two Is Better Than One

And one of their favorites

LOS LONELY BOYS - More Than Love

Embedding disabled for this one so click the link:

More Than Love

But here's live slower version with Ronny Millsap

No "Hopelessly Devoted To You" at this wedding. (Nothing against it though, haha, I happen to think it's a beautiful song, but not at this wedding.)

This is the music they share together and now shared with you.

You and Me

2010-02-01T19:09:00.000+08:00

Kudos to the Dave Matthews Band for this great number at the 2010 Grammy Awards

Got me singing and thinking music all over again...

The Proposal

2010-01-07T23:05:00.000+08:00

How do guys actually come to decide that the girl he leads out of the crowded moviehouse is the one woman he spends the rest of his life with?

How does a man realize that he guides the girl of his dreams by the small of her back to enter a restaurant and share dinner and a conversation?

What does a man feel when he is standing along that center aisle and watch the angel that is the reason for his existence glide to meet him with a radiant smile that reminds him he is the luckiest guy in the world.

Close friends have shared their memories with me, and more people dear to my heart are getting married and to me, these people, realized all these with a question they ask ... the proposal. And here's how one went...

There was a cool wind that picked up as they got out of the church attending the first afternoon mass and headed out to their car parked among the throngs of vehicles slowly filing out of the church grounds.

"Where to now?" He said with a wry smile, knowing full well it was her turn to decide the night's activities.

She let out a small laugh and said, "Hmmm, there's still some light out, do you want to check out the chateau?"

"Fine with me." He agreed opening the car door, "We don't have anything better to do anyway, and we could still use the light to check out the grounds."

Half of his consciousness was making conversation while the other half went back to when they first met and how happy everything was when he was with her. They had countless conversations of finally getting married and a proposal was just a formality. But what she did not know was that he had already gone out and bought a ring -- not just any ring, but THE ring.

He carried it in his pocket wherever he went just like he did now, waiting for an opportunity to come up where he could ask THE question. Sure, knowledge and familiarity laid things out as they were already set, but, he thought, at least the proposal would be something to remember.

A few months back, he consulted a few friends and suggestions came up from the conventional to the death-defying categories -- from a simple dinner with friends, to proposing while going down the zipline, to his own plans of go-fetch around town -- but none felt good enough for him, so he waited.

"Where is the chateau exactly?" he asked.

"Haha, I don't know uhm, exactly where it is, but I have vague idea." She laughed, which he always found irresistible.

"Gee that's a relief." He said in mock disdain, then laughed, "We'll still be able to get home right? I have to be at work early."

She punched him lightly on the arm, "Of course, we turn left at the fork in the road up ahead and it's straight on ahead. It's somewhere on the left I think, with a really big sign that we can't miss."

The last vestiges of day retreated behind the mountains on our side and the glimmer of the evening crept in. They were about to turn back when they drove up to a sign that said they were there at their chateau.

They exchanged a short smile and stepped out of the car. The same cool breeze swept through the hill and gave that all Christmas-y air.

Just before heading up, he turned around and to check the glove compartment, and took the ring and placed it in his pocket.

"She is beautiful tonight." He silently thought. "Just like any other night, and come to think of it, all the nights of the past few years we've been together."

He jogged up to her as she was already at the foot of the quaint bricklayed chateau and took her hand.

The view was breathtaking -- the city lights sparkled in the distance dotting the evening landscape, the wedding in the garden below them was wrapping up with lights hanging down from the trees like frozen yellow raindrops, and the faint hush of a man-made waterfall nearby.

She had inquired inside on the rates and was hurrying back to his side just as he was taking it all in.

"It's nice here." he said.

"Yeah, it's nice." she replied.

"You like it here?" he asked.

"I'd be okay if we have the reception here." she smiled.

They went around and went up the staircase to check the alternative venue on top of the house just in case it rained and found it to be suitable to their tastes. He felt around in his pocket and felt the ring there.

He realized that it is just not how you do ask, or when you ask, or even the years that have gone by with you together, but to paraphrase a popular movie, what matters
are "the moments that take your breath away."

And this was it.

At that viewdeck, on that chateau, on that night, he turned and said," Hon, I've tried so hard to come up with ways to ask you this -- from the weird, to the expensive, to the traditional -- trying to come up with some grand gesture to show you I love you and I want to spend the rest of my life with you, but none of them would have been me. So as we stand here, I realized that there is no need for grand gestures, because all that matters is the two of us. And there is nothing grander than that."

He reached into his pocket and took out the ring and placed it on her finger, "I've been carrying this around for a couple of months now and I've come to ask you this. Will you marry me?"

Tears had welled up in her eyes but still couldn't hide that bright twinkle as she managed to say, "I will."

--------------------------------------------------------------

They will be married this October 23, 2010.

We shared a laugh, because the blooming bride-to-be says she couldn't remember anything said that night apart from the visit, the ring, the tears then the happy ride home. So this is to refresh her memory.

Well, I realized, it really isn't always kneeling down on one knee, or some elaborate plan to propose in the middle of the day at the mall. Others realize it on the ferris wheel or some may do it on the front porch (right gay?, congratulations their wedding will be sometime october as well).

It's simply about two people knowing what matters most to them -- each other.

A Very MICU Christmas

2009-12-27T22:10:00.000+08:00

MICU stands for Medical Intensive Care Unit.

In our hospital, the second-year residents go on duty every three days at this section -- the last bastion for medical management in the critically ill.

Due to certain unexpected leaves, absences, resignations, and a lot of crazy, gaah, I don't even have a word for it, I found myself answering the phone at around 7 am to a directive to go on duty for 36 hours at the ICU.

A day after Christmas.

Not exactly my idea of the perfect Christmas gift, but here I was, standing in the doorway of a full ICU with a lot of critical patients.

MICU 1: Really bad case of Pneumonia and Pneumothorax in septic shock. Her X-rays showed really bad lungs that I could see the fissures (Normally it'd be dark and black).

MICU 2: A case of sepsis (really bad infection) due to an infection of the urinary tract and pneumonia coupled with hyponatremia (really low body sodium)

MICU 3: Admitted a case of non ST elevation MI. Glad to see her not in pain, and in pretty good spirits

MICU 4: A renal patient with weird breathing. Congested X-rays and treated with aspiration pneumonia as well.

MICU 5: Hypoxic ischemic encephalopathy + Seizure disorder and underwent tracheostomy earlier in the day.

MICU 6: Dilated cardiomyopathy probably due to doxorubicin cardiotoxicity after undergoing chemotherapy for Hodgkin's lymphoma and with weird drainage coming out of her nasogastric tube.

MICU 7: A massive right middle cerebral artery infarct and underwent decompression with a right frontal craniectomy. Glad to see him responsive and doing actually quite well post-op.

MICU 8: Cholelithiasis with cholecystitis who underwent open cholecystectomy coupled with bilateral pleural effusions secondary to hospital-acquired pneumonia.

MICU 9: Myasthenia gravis in crisis

MICU 10: Cardiac dysrrhythmia, non-sustained ventricular tachycardia. (I hate arrhythmias)

TELEMETRY 1: Severe infection due to UTI and pneumonia

TELEMETRY 2: Another case of a non ST elevation MI.

These are the cases I greeted at the outset of my skeletal duty at the ICU. My first ever.

I transferred out 6 patients, but sadly lost one to overwhelming infection and its complications.

All in all, I survived.

I'll enjoy these last few days where I don't have to go on duty at the Intensive Care Unit because in all probability, I'll be doing it regularly starting next month.

Surviving that will be another achievement worth blogging about.

Gulp, pray I don't mess up.

Life is short. Life is beautiful.

2009-12-18T23:35:00.000+08:00

Three days ago, I was reminded of the reality of how short this life truly is by a 24year-old patient who had just been out with his father, plying their trade as jeepney operators. Due to mechanical problems, they had to bring it in early and forego the rest of the day's trips. It was late afternoon when they finally solved the problem and went out to a machine shop to buy the parts. The father went down to buy the pieces and on coming back to the parked jeep, he was told that his son was out cold sleeping on the floor of their jeepney.

He was unresponsive.

He was rushed to our ER.

He was dead on arrival.

We had no idea what to put on the death certificate. We barely had anything to go on for our final diagnosis. No symptoms. No previous medical illnesses. Nothing.

It seemed like he just fell over and died.

I didn't quite grasp how his father reacted - seemingly unattached, seemingly afraid he'd be blamed, seemingly unbelieveling of what seemed to be another workday afternoon -- most likely in a state of shock. His mother wailed and fell to her knees when she arrived, exclaiming, "Wake up. Wake up, " vigorously shaking her son's body, "You said you'd just be out to buy food. Wake up."

That all got to us. Everybody at the ER felt for this family -- no parent should ever get to bury their child (John Q, beautiful movie!), let alone the prospect of having a very sad Christmas.

I took off the gloves, got my clipboard, and turned to go back to work.

24 years young. Now gone. Life is short.

As I went through my ward chores and charts, I kept thinking of life in general (profound noh?)- what I've done, who I am, how I've been - until I came to sit in front of my open laptop at our office. On the front screen of articles I came to read how Seal described his life as "the perfect life." (Hey, the guy is married to Heidi Klum, how can that not be close to something perfect? Haha.) But he described it as something happy, and having worked hard to get where he is today.

I sat back and looked at my own, and in another of the countless introspective sessions I've had with my own inner psychiatrist, I realized, I'm happy, I'm relatively healthy, I have a nice family behind me, I love the work that I do, and in a relationship where I'm unconditionally loved in return.

Perfection is hard to achieve and likely nobody will ever achieve it, but in all respects, like Seal aptly put it, it is the perfect life.

I didn't know that boy who died that day. There I was hoping he was happy, and that he had his own perfect life -- not the kind we have dreams of, but the kind, that considering everything around us, would be the life of happiness, contentment, shared with those that matter to us.

Life is beautiful but short.

No, life is short but beautiful.

Bits and pieces

2009-12-11T14:44:00.000+08:00

Christmas time is here...
Happiness and cheer.
Fun for all
What children call
Their fav'rite time of year...

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Forgive me for there is a lot of angst in this post

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It just hurts when people disappoint you. Just when you think, you have people around you who have the same direction, the same set of ideals and the same purpose, they go around and do otherwise.

Just when you're ready to prove all the speculation, skepticism and the negative pub about your group, they just go and prove all the critics' points.

Prove yourselves.

You're there for reasons, which right now escape my understanding (maybe I'm just a little disappointed and mad right now, but I'm sure you guys are all more than capable of thinking, and willing yourselves to make something out of your abilities).

And when that happens, I'll be as proud to be a friend as I am when I'm defending you.

I don't claim to be perfect, but let's just say that a fair share of the blows I take during evaluations are blows meant for other people, and it hurts a bit when you get blamed for the actions of others.

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Wants and needs are set apart this Christmas.

I wish I could get my hands on the money to buy a new piano/keyboard, but some stuff you just don't need. Maybe I'll get to buy my own grand piano someday, but for now, maybe I'll just save it up for something else.

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There are times when the Philippine culture/nation/government/people disappoints me. Enough to make me say I belong to a stupid race (yup, that's how depressing we get sometimes).

Maguindanao is under martial law for some stupid government official who thinks he is above the law. The press is all up in arms about protection of the press people (why? should being a press person exempt you from a madman's massacre? How about all the other people? Shouldn't they be spared?) It seems like the media is all up in arms about the killing of several media people, but let's keep it on the human side and say that it's not about what the profession of the people killed but condemn the killing itself.

Second, on the recent furor in Maguindanao. There is this something called martial law.

Well, people are protesting this seemingly well-intentioned declaration to facilitate justice for the murders. Sure, when you're apparently "safe" (that is assuming we are, right Madame President?) here in the cities, it's easy to protest right? But when you've just taken a bullet and lying face down in a ditch somewhere in Maguindanao, I'm sure you'd want the law to put its proverbial giant foot down on somebody, preferably the one who pulled the trigger.

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Candidates. Schmandidates.

Off with the lot of you.

People protesting our current president, when they should be looking at who is waiting in the wings. GMA is not that stupid. She won't risk an obvious grab at power since we've proven that the Filipino people are very very powerful when they come together. But it's just that, nobody among the gazillions of Filipinos will satisfy all the others in terms of leadership and good governance.

A really smooth talker politician playing on his rags to riches story (but you're rich now right?), a reluctant son who is riding a colorful family history of leadership, a cutthroat strategist and economist, a prayer rally leader, an unknown who just happens to have a brain and no viable party opponents, and a fat, washed up actor who was once powerful, got overthrown by the Filipino people from whom he obviously stole from (c'mon who are we kidding here right Velarde?) and he wants back in?

And there happens to be this national hero who wants to hurt his stature in Philippine history by meddling in politics just because he has the money, the women, and the fame. Tell me, what actual laws are you planning to pass? You kno?

I might as well run this country myself....

Now there's an idea.....

The doggone days...

2009-11-26T16:14:00.000+08:00

My thought for the day:

"My life has no purpose, no direction, no aim, no meaning and yet I'm happy. I can't figure it out. What am I doing right?

-- Charles Schulz

To This Day

2009-11-10T00:12:00.000+08:00

I gazed up sleepily into her eyes and she let out a small laugh as I cleared the cobwebs from my head.

Aaaaghh, I dozed off again, and she wasn't giving me a hard time about it. I was on duty last night and despite the malaise slowly overpowering my body, I urged myself to go out to a nearby coffee shop to get some reading done. Getting up, she said we'd better get a move on if we wanted to get home alive and not have me dozing off at the wheel.

I knew better than to argue.

While driving, flashes of the past few years go by.

I remember seeing her coming up to class with books clutched close to her chest, the early morning sunlight streaking down her shoulder-length hair, and that ever familiar twinkle of her eyes. She gives me a smile and moves into their room.

I remember hearing her humming softly and singing quietly in perfect tune.

I know of her quick wit as we shared a laugh over a joke no one else seemed to get.

I've always admired her for being smarter than I am as she often appeared to effortlessly answer questions on exams that she would never openly admit on knowing the answers.

I remember her quiet understanding about the upsides and the downsides of my life.

The flashes go by like the lamp lights outside the car window. She was quiet as we went home with sleep slowly setting in.

To this day, she is still the same smile that lifts my spirits.

To this day, she is still the laughter that picks me up when I am down.

To this day, she is the hand that reaches for me when I reach out for help.

In this instance, she is the angel that wakes me up at this nearby coffee shop and kept me from being sprawled across the floor, passed out in exhaustion.

To this day, she saves me every waking moment.

Happy birthday.

525,600 minutes

2009-10-31T14:52:00.000+08:00

A year ago, I was a scared, excited newly sworn-in doctor who was curious about his decision to train in internal medicine and fresh from a year of a great PGI-ship in Silliman (hence the title of this entry, piano music in the background).

I can't believe it has been one year. When they said time would fly by once you got into residency, they weren't kidding.

I'm done with first year.

Not that I'd miss having a ward with my name on it (as well as my phone number plastered all over the walls), the incessant nurses who page me every time anything went wrong from simple spelling errors on orders and deciphering unintelligible handwriting to actual codes, as well as the daily grind, DTR's (direct-to-rooms) among a whole lot of first-year stuff.

I'm moving on to subspecialties this year -- my first one is a personal favorite, neurology/endocrinology. I'll be going through a host of medical fields, cardio, gastro, nephro, you name it. Not to mention the added responsibilities of a second year medical resident.

And don't forget extended time at the ER and ICU - the dreaded rotations.

Sure, I'll miss my surgery dreams but I'll still practice shadow stitching and knot tying when nobody is looking, and I'll miss out on earning more and living the life moonlighting.

I guess I'm on my own adventure.

When I started out, I didn't get how people get into internal medicine. Yes, some part of it appealed to me then -- diagnosis, patient interaction, being in charge -- but I didn't get the dynamics of the field, the medication interactions, the fluid management and a whole lot of other stuff I could fill in but I won't. Now I have an idea of how much understanding it takes.

Not that I fully understand it yet, but trying to.

I'm one year in. Two more.

Two more and then the rest of my life.

My vote

2009-10-13T17:42:00.000+08:00

Elections are fast approaching, and each candidate who is hoping for a shot at the glory of the presidency are out there, reaching out to people through media -- written, radio, and largely TV.

I hate traditional politics but I cannot deny its entertainment value. When election time comes, you can't help but get the latest fix of who is stacking up the most dirt against who -- from affairs and corruption to digging up old unpassed bills.

Every election time, we renew the hope of reviving our country from traditional politics and the entrenched corruption, yet who do we have as candidates? The same breed of people who were running the country in the first place.

That is why I've always been drawn to candidates who offer a reasonably radical change from the usual suspects, the usual program of change and the usual traditional politics.

The last time I voted, it was for the late Raul Roco -- which was a good couple of years ago.

I don't know if I'll get to vote this year, with residency and all. But if I do get the chance, Noynoy will most likely be at the top of my list.

I think someone who is running that actually doesn't want to run qualifies as a good sign. Having someone who does not have a premeditated plan to grab the presidency is somewhat refreshing in this power-starved government.

Whether I change my current opinion and whether I actually get to vote remains to be seen. I challenge you to convince me.

I think Conrado de Quiros said it best that Noynoy would probably be the only candidate among the rest where people will not mind being cheated on.

I think that's funny.

It's probably true.

Deadlines

2009-10-09T20:45:00.000+08:00

Definition: Days I dread because I have to have something on that day to show for an effort spread out over a given period of time.

In the span of the next two weeks, I've had deadlines shoved in my face from a thick wad of census papers and evaluation forms, case reports, my first medical grand rounds, journal appraisals, and presentations for each one. I've driven myself crazy, sleepless over the past few days just to keep up.

I've caught a few breaks along the way -- a cancellation, being assigned to the Outpatient Department (though ER assist isn't really an easy rotation) and of course Tonette.

But all through the muck, I realized that it has almost been one full year of internal medicine residency under my belt.

And hopefully, hopefully, I'll move up a year level come November 1.

That's one deadline I welcome.

Deaths That Matter

2009-09-21T20:22:00.000+08:00

There were a couple of deaths that mattered this past two weeks -- well, it probably did not matter to the rest of the world who did not know them but, they were intertwined and I was right in the middle of it.

In my ward, I had this patient, Mrs N who was suffering from gallstone pancreatitis. She had a poor Ranson's Score on admission and on re-evaluation 48 hours after. Her abdomen was distended with fluid and she was starting to get a yellow tinge to her sclerae and skin. But she was a fighter and gave it all she had -- smiled through the air hunger because her diaphragm was being pushed upwards by the fluid in her abdomen, followed all the restrictions, and was an over-all good patient. A doctor could not have asked for more. Her husband was always there beside her, encouraging, making her laugh, and buying the expensive medications without question.

Over in the ward next to mine was another patient, Mrs R who just found out she had lung cancer and was suffering from malignant pleural effusion (fluid in the lungs) for which she had to undergo an insertion of a tube into her chest to drain out the fluid. Pneumonia was quickly setting in and the infection was overwhelming her defenses.

Last week, on one fateful day, their paths crossed.

Mrs. N's condition worsened. She underwent an ERCP to remove the stone which was done without a hitch but a few days after that, she began to bleed. She vomited and put out blood, her blood counts were still high indicating an infection and her blood gas measurements showed severe acidosis (yup, that's bad). In the hopes of monitoring her better, her attending physician wanted her transferred into the ICU but she was number 8 on the priority list, which was not too soon enough for the attending. She told me to ask a favor from the one on top of the priority list -- Mrs. R.

At the time, Mrs R was morbid but stable. Her blood pressure had not dropped in two days. I spoke to her attending and to her and she gave me a smile, "It's okay doc, you can give my spot to her, she needs it more than I do."

"Are you sure?" I asked again.

"Yes doc, it's ok. I feel fine at the moment. Maybe if, God forbid, I have problems, I'd like to ask the same favor from the other patients." she calmly said.

So I said my thank you's, and Mrs N was transferred into the ICU.

The next day, I learned that Mrs N gradually deteriorated and was intubated, and a combination of disseminated bleeding, severe infection, and shutting down of her kidneys were among the few problems she was facing and had to undergo dialysis.

What made matters worse, was that Mrs R's BP fell. Her vital signs were unstable and infection was also taking over her system.

I was tried in vain to find a spot for Mrs. R to take so she could be moved into intensive care and I managed to move her up from number 8 up to number 4 and all the way to number 2, but, alas, they had no more money. Their lands had all been sold to keep up with the growing hospital costs.

I didn't have the heart to face her again knowing I failed. I talked to my co-resident in charge of her ward and even found out, she had expressed the desire to be transferred into the ICU, but the family had decided on a DNR status knowing full well the prognosis of her condition and the financial situation they were in.

She passed away the next day.

Meanwhile, Mrs. N was also losing her battle with her pancreatitis. The infection, the bleeding, the acidosis all took its toll on her body and she gave in and passed away the next day was well.

Before she passed away, as what I heard from the ICU staff, she pulled her husband to her side and said, "Thank you for loving me. Even up to my death, you're still here by my side. Thank you and I love you."

Hearing that, I was awash with emotions -- sorrow, guilt, failure and then later admiration.

For Mrs R, thank you for showing me the meaning of what selflessness truly is.

For Mrs N, thank you for showing me the meaning of what loving and what never giving up and finally letting go should be.

I've long posted that there will be many deaths on the roads we've taken, some harder to accept than others, some easier to let go, but what matters most is how we let it affect us.

As I close, I want to say, you mattered to me. You have affected my life in more ways than you know and I will carry the memories of these past few days with you as I go on treating patients and helping them through disease and in living my own life as well.

Thank you. Rest in peace.

Lessons Learned

2009-08-30T16:04:00.000+08:00

Another month, another last minute last-day month post. At this rate, I'd be out of the blogging world in no time.

Well, August has come and gone the miles of hallways I've walked while doing rounds have officially crashed my body's odometer. Yet despite a fever (of unknown origin) and a depressed immune system, I forge on (jeez, the dangers we go through to take care of others, and sometimes forget ourselves).

Lesson number 1: Fate is twisted.

I've noticed that in a residency, there is always that certain consultant you mess up against. My co-resident Mush manages to get by with his slick hairdo and eyebrow-raising with most consultants, but goofs up against a certain cardiologist, who has corrected him several times from brand names to updates. Another co-resident Ian, drew the ire of a particular neurologist since I introduced him as a newly accepted resident, and since then he accidentally lost the signal of an important telephone call while updating him and he had vehemently emphasized they were not done talking.

For my part, I seem to spaz out with a certain pulmonologist from seemingly being nervous on updates (I try to talk fast, so I finish fast, so forgive me for seeming out of breath), to not intubating a patient in distress (the patient's family had opted not to intubate the patient, and he was sleepy-slurred in giving instructions).

Fate is truly twisted as much as it is wonderful sometimes.

Lesson number 2: The beating you get in a conference or some Q and A, is inversely proportional to the amount of preparation you had for the said event.

Faced with an unexpected turn at presenting a case at our weekly ICU Conference (which IMO is a bit weird being we present and defend management that are entirely not of our own choosing), I chose yet another doozy of a cardio case of Digitalis Toxicity. I wasn't ready having just prepared the slides the day before with Tonette. So basically, cramming was the only option. And that I did, thankfully, I managed to study the right stuff, and came up with some original facts for everybody to digest. (Hah! Hyperkalemia is protective for DigTox! But up to what level, I really don't know).

Lesson number 3: Sleep when you can.

I miss going back to sleep when waking up in the morning.

I vow to write more. But with the upcoming deadlines, aaggghhh...

Case reports, census (censi or censuses?), ECG's to read, books to read, reports...

September 30 it is. Hahaha
=========================================

Congratulations to Stephanie for passing the boards!

Here's to July...

2009-07-22T20:09:00.000+08:00

I can't believe I haven't posted for July yet. Not a single post -- until this one and on the last day of month at that (don't get fooled by the date)

It has been a busy, busy, BUSY month for me.

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Doctors have this end of the month thingy called a Mortality and Morbidity Conference where we discuss all of the bad cases and deaths and see where we could have been a bit better to save this patient or that, but mostly really just nitpicking at diagnoses and theoretical/diagnostic dilemmas.

I had the task of presenting that particular case. Oh and what a doozy of a case it was. They say it was a pretty hard case to present -- loaded with cardiology with a dash of infectious disease and nephrology -- and I got roasted at the podium. I was sweating in a fully airconditioned room trying to answer questions from mundane basics to intra-operative cardiac surgery!

Good news, I got through it without them telling me I failed.

Bad news, I have to do it again in a couple of months. Aaaagggghhh.

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A mentor once told me that a back-breaking residency is necessary to getting better in the chosen fields of medicine you want to specialize in (you still haven't told me why Doc Ness....hahaha).

I mean, I can understand the back-breaking part, the physical willingness to do all the legwork to get a few more tidbits of knowledge here and there, and I've always gone the extra mile to get that, but the veiled insults and sarcasm, the stereotyped first impressions, I don't see that helping me any.

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I Love You, Man is a funny, funny movie.

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Imagine seeing a teenager with a double outlet right ventricle and so much future in front of him, undergo a total correction of his congenital anomaly and walk out of the hospital on his own.

Small victories.

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We have to contend with Christie telling us she's not coming back after her scheduled vacation leave.

I meant when I said to her that, if she's better now than when she first came in to this residency, then no one can take it away from her. She's all the better for it. If she stops now, then no one can blame her, because that's a decision she'll have to make for herself. But Ate Christie, no consultant, no senior, no person, nor animal can talk down to you and make you feel any less than what you think you are.

We -- Mush, Len, Ian, Jeff, Gladys, moi -- think the world of you and would love to have you come back, not only because it would mean one more to share this load we have on our shoulders, but more importantly, you are our glue. You keep us together and for just that, we'd love to have you grace us with your crazy, zany humor on August 8.

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Love just gets you through the day -- sometimes you realize it, sometimes you don't. But when you have someone who lets you sleep when you've gone the past 36 hours without it, or helps you with work, well you just can't go too long before you realize how great it is, to have someone love you back.

Thanks hon. I wouldn't have survived July without 'cha.

We Will Remember

2009-06-28T22:35:00.001+08:00

I join the world in mourning as we lay rest to Michael Jackson.

I still vaguely remember, I was 8 years old running through our living room and my dad's stereo was blasting "Off The Wall" and "Wanna Be Startin' Something." We all had our favorite Michael Jackson song -- "Man in the Mirror" and "Human Nature" comes to mind -- mine will always be "Rock With You."

His death makes me feel, among other things, old.

His death renews my fear and my strength in my mortality.

We can only hope to be remembered once we pass, and Michael Jackson will live on in his music.

Thank you Michael, you made all of us who heard your music moonwalk together.

Getting Through the Day

2009-06-25T19:54:00.000+08:00

One of the best things about being in medicine is that I get to meet people -- some I get to like and even get to be friends with, while some I just can't stand to see the sight of.

As I arrive around 6:45 am and get off the elevator, I enter the ward rooms I give a smile to Lolo G who is finally going home after spending nearly a month in the hospital. Their family is pretty remarkable as they've pulled together to get Lolo G through obstruction, intussusception surgery, post-op stroke and hypokalemia, to finally going home. They aren't the richest patients, but as people they are just as wealthy as most people. They've never grumbled about the costs, or the treatments, but trusted us to do the best thing. Now I'm just happy to see Lolo G smiling, toothless as he is, as his wife and daughters share a laugh around him. We go through a hundred wars with disease, dilemmas, and treatment failures, but I'll take them all on to have even just one victory such as this.

I leave to go on with my rounds, I see Mr D's family. Their outlook is not as good. His disease is an intracerebral tumor bleed and with alcoholic liver cirrhosis, makes it impossible to operate on, not counting the money they don't have for the surgery. The hemorrhage, plus the encephalopathy has gradually taken over his consciousness and is slowly bringing him to the brink. I look at his mom, every so often tears flowing down her face at her beloved youngest son, and pleads to me to help her. My heart breaks knowing full well the prognosis. I give her a "hang-in-there" smile and move on. Mr D would pass away that night.

Each patient has his or her own story, his or her own life, and happenstance has made me a part of theirs.

I'm just amazed at this job sometimes -- I guess, it's just me realizing all over again, I love what I do.

There are times that I just feel really really tired, burdened by responsibilities and the demands that the residency program and the profession brings, but at the end of the day, when I get the chance to lie down and sleep, I realize, I wouldn't have it any other way.

Sabbatical Recall

2009-06-07T20:10:00.000+08:00

Today is the last day of my 1 week vacation leave -- a week where I didn't have a life in my hands, nor did I have to call and update any consultants on the condition and lab results of their patients -- and it nearly isn't enough to recharge the past 7 months of toil, sweat, and tears, and to come back and do it again for the next couple of months.

But it's definitely better than nothing.

My co-resident Mushar has his leave planned out already (though he did take a one-day "leave" to contemplate his life plans last month) and it consisted doing utterly nothing on the first day but a DVD marathon, the next day would be touring his hometown, the third would be a visit to the beach, and you get the picture -- relaxation and nothing remotely related to medicine.

Well, I'm a different animal, I guess.

June 1

I took a plane home, which was probably the more cost-effective way to travel, but there is always something relaxing, something spiritual with a long and quiet drive home. But after the reverie of Erving's wedding the day before (my heartfelt happiness and joy to Erving and Kay), I did not have time to prepare, so the plane it was.

I settled into my room, and brought out my reading stuff (yup, part of my idea of a vacation is doing some work without the pressure), and did what I sought most of the week to do...sleep.

And I did mostly that, and watch a little bit of TV now and then.

June 2

Frequently checked with all the blogs I follow, and it seemed everybody was taking the week off as well, except for Doc Ness of course. I attempted several times to write but nothing really came to mind (I failed in the attempt to make up for all my unblogging times by blogging everyday during this week), so I just let it go, content to browse the web for news and sports rumors about my beloved Pistons.

I got to starting on reading about my case, a supposedly rare case of Thrombotic Thrombocytopenic Purpura (everybody I've mentioned this to seem to be of the opinion that this isn't as rare as I thought it was, but well, it's incidence is 3.7 per million, I'd say that definitely isn't run-of-the-mill). I got to see SUMC again, and see a couple of friends.

Saw Kea as well, and she's pretty big now. We went to Manong Roy's despidida party, as he's finally off to Canada to join Manang Rhea as immigrants. See you guys when you come home.

June 3

Smoke tested the right car.

Pored over the charts of my case.

Transferred some notes into my trusty notebook.

Rode the afternoon away on the motorcycle -- gassed it up to a full tank and took a quarter off just riding around the city. It is another way to get a tan in Dumaguete without going to the beach. Sadly, Taster's (Home of the world's BEST BURGERS) is closed temporarily for renovations, as is much of the city's asphalt roads.

June 4

There's nothing like wind in your hair zipping through the city streets on the motorcycle. Couldn't find Ver or check if Aning was really pregnant na. Congratulations.(Though I've been hearing she is, she vehemently denies it. Nothing wrong with that Ann.)

Ai-ai arrived today. I missed my little sister (hehe, she's big time now)

June 5

The Magic got dumped on in Game 1. I've always rooted for the underdog, except when the Pistons are playing, but 25 points? In the NBA Finals? Jeez, c'mon Howard you can bowl over Bynum and Gasol on your off-days.

Jassen and Carol arrived. She's a cool girl, and I'm happy for my brother. Anybody who makes my brother happy is all right by me.

Most of the family got together to pray, and celebrate all of our birthdays. I saw my nieces and nephews running around all night, and the food was as sumptuous as always.

I'll be leaving in the morning. I have Tonette's Date and Walnut cake, Sans Rival for the people at the hospital, and Pianono and Chicharon all around (I think they ate the Pianono at the time of this writing na, Mama Gaya, next time na lang).

June 6

Back in Cebu. I got to ride on the extension all the way to Cebu and my back ached all over. Got some work done on my census, and took Tonette out to dinner.

The week is almost over.

June 7

The last day of freedom. I did my rounds of my ward and saw what kind of patients I'd be up against once I sign my name into the attendance logbook tomorrow.

I laughed quite a bit on the rumor that went around the hospital that I'm quitting residency (don't tempt me, haha), and was touched that a couple of friends (yup, brothers and sisters in arms, if you will) would call you up (wake me up, for that matter) and asked me to stay. Sorry if I played around a bit, but I'm stuck with you guys for the next couple of years, (or you are stuck with me, deal with it), that is until the next time I go on leave.

Right now

My back still hurts.

I feel like I'm still on the bus.

I lost to the Hornets while playing NBA 2K9.

I think I'd better get a good night's sleep so I can get up early.

The week was definitely good while it lasted.

On The Lighter Side...

2009-05-21T16:25:00.000+08:00

In my last conversation with my mom, she said she got scared while reading my last entry, (somebody has to do it, ma) but she also said she had a laugh at the juicy fruit comment. Whoever says that being an ER doctor or any doctor for that matter is a cool, profitable, and easy job, is dead wrong. It often comes to the point of arduous toil, and yeah sure you get some money out of it but not often commensurate to the effort unless you get a really really big practice and it is a big responsibility to have another 's life in your hands, yada yada.

Anyway, I've posted so much about medicine, residency on this blog, I guess I'd like to turn the attention of you who read this blog (however few you guys are, hahaha), to something, well, light...

Like:

Archie finally gets to choose!

Between Betty and Veronica that is. Yup, we all read the strips once or twice, and personally I'm a fan. I read in an article linked on msn.com that publishers are gonna make him choose between girl-next-door Betty Cooper and sophisticated-sassy Veronica Lodge.

I say he really can't go wrong.

And how about:

This guy.

Kris Allen pulls off the ultimate idol upset by upending apparent favorite Adam Lambert for the American Idol crown. Not to take anything away from the cool laid-back sound of Allen whose stylings I can definitely agree with, but I'm thinking there were a whole lot of people who didn't want Adam Lambert to win, than actually voting wholeheartedly for the eventual winner. Personally, I liked Danny Gokey's voice and got to appreciate the sound of Allison Iraheta's voice, but Allen's victory definitely sits well with me.

And finally:

Good night!

Hehe

ER Forays of A Newbie

2009-05-11T19:31:00.000+08:00

Our training program here has one quirk not found in other hospitals in Cebu (or so I think) -- first year residents get to go on duty at the Emergency Room.

Yup, First Year.

The reason given to us was that it would double our exposure to ER duties, and we get to see more cases, and get experience on how to handle these patients first-hand.

I get the logic, but that doesn't make the anxiety of being alone at the desk fronting the Emergency Room doors any less stressful. It takes triple the testicular fortitude to survive and conquer the fear of what comes in through those two swinging doors. So scared am I on nights prior to ER duty that I fear and depression drives me to my knees in prayer that everything would go smoothly (but it rarely does) and that He will be with me every step, order, and IV insertion of the way.

One thing for sure though, ER duties certainly have given me so many moments:

WORST: There was one time when, the outpatient consults were endless into the wee hours of the morning and right up to endorsement time, and after I got received (the next shift comes in) I literally had to run from room to room, ward to ward, get all my X-rays and scans, ECG's to get ready for endorsement (grilling time), and needless to say, I got fried to a crisp.

BEST: Just recently, at my last ER duty, we had someone come in, in severe respiratory distress. He was brought to the hospital by two of his neighbors after they found him knocking on their door for help, all blue and air hungry. We didn't know what he had because of a really poor medical background given to us, all the neighbors knew was that he smoked and drank a lot, was admitted the year before and a handful of medications in his bag. It was a cross between respiratory and cardiac, which is which we didn't know. He flatlined for about 5 mins. We treated him as best we could and revived him to full consciousness. To see him writing his name on a piece of paper, considering he was probably walking towards whatever light at the end of the tunnel he was in, is joy immeasurable to me. Now he has a second chance to be able to make peace with a family he has left behind, and that is just gravy.

FUNNY: An order on a referred patient's chart: "May eat juicy fruit - not the gum."

SCARY: There was a time where I had no activity at the ER whatsoever for the whole afternoon of a weekend duty, the calm before the storm if you will. Then it got crazy as first an arrested patient came in, probably a massive heart attack, followed in seconds by an electrocuted patient in ventricular fibrillation (a really scary heart rhythm). Needless to say again, everybody got plenty of action and exercise that night.

DRAINING: You get to take on really demanding patients from expats who think they deserve top billing because they earn dollars for a living to aristocrats and the psychologically-off patients who think they are the only ones in the ER.

COOL: I once said that if I could not become a surgeon, I'd be the one at the foot of the bed manning a code, shouting lines like "We need an ABG stat," "Start Dopamine 400/250 at 10 cc/Hr," or "This ECG shows an ST Elevation in Leads II, III and AVF, Morphine 2 mg now, O2 at 2 Lpm, ISDN drip at 10 cc/Hr, and Aspirin now."

And now I'm getting to do that.

Maybe not as confident, not as fluid nor as collected as I make it to be, but I'm definitely working on getting there.

It's been so long since I last posted that I'll be going on another ER duty in the next couple of days, so, gulp, here we go again.

The Lull of Lent

2009-04-11T20:11:00.000+08:00

Cebu is surprisingly quiet for Lent -- that is compared to the regular hustle and bustle of the regular work week. I still remember celebrating the Holy Week in Dumaguete and recall the near empty streets, the processions, and the one of the few days of the year, or if not the only day, where we don't open up shop at the market to sell meat.

I came from duty on Maundy Thursday and we were on skeletal duty (to the nonmedical people, meaning only those on duty would be roaming the hospital). After endorsement, I was on my way home, and I the lesser-than-usual number of taxis and jeepneys driving around, the malls were closed and the quiet was a nice change from the honking and the revving of engines.

I spent most of the day sleeping, enjoying the peace and the sedative effects of the mid-afternoon breeze and went to say a few words of thanks at the church.

Good Friday was even more serene and beautiful and I took time to breathe in the freshest air I've ever inhaled since I've been in Cebu. I took the time to do some long overdue cleaning.

This was always the best thing about the Holy Week -- the peace, the quiet, the time for reflections, and in the same way I've always ended it, a prayer of thanks for Him who came and saved me.

And of course gave me a schedule where I could enjoy two skeletal duties in a row.

In connection, a couple of my posts that I remember having fun making or just simply made my day:

1. Who Wants To Be A Superhero?

2. Some Good Things

3. A Pedestal For Mellie

4. It's A Little Bit...

5. Piano By Starlight

6. The Years Gone By

7. Death Becomes You

8. In Sickness and In Health

9. Behind the Half-Rimmed Specs

Behind the Half-Rimmed Specs

2009-04-05T18:43:00.000+08:00

Ahh, introspection. Where does one begin?

Lying down in my quaint rented bedroom, staring at the dirty-white paint on my ceiling, I paused to think how to write this next entry. As sleep slowly drifted and took away my conscious perception of the night, I took off my glasses and just stared into the blur.

There are two sides to my life at the moment, the one that exists and the one that exists in my head. The basics are out there -- Dumaguete City, Physical Therapy and on through medicine, though I never knew exactly why and how I came to be the doctor I am today and residency is the imposing and prevailing presence in my life at the moment.

I blink and pause to think about what I could do had I not chosen this path. I still love to lose myself in music and song as I float my fingers over a piano, or find solace and freedom in the lyrics I can make with a simple melody. Or had I worked hard enough, could I have played a sport for a living? Or anything remotely related to sports? How about movies? Me and showbiz...

I blink again and realize, I'm drifting off into slumber. Well, I guess while I'll do medicine, I'd do all those other stuff on the side.

Reflecting on the day that has passed, I still remember the mortalities that mattered, the mistakes and the right decisions, the days where I was too tired to think and the good days where going into a patient's room and giving good or bad news came easy. There those really depressing days where I'm tempted to stop and rest and those days where I feel really good that I did something right.

I twist in bed and accidentally roll over onto my glasses and I quickly remove it from under my shoulder and place it on my side-table.

These glasses don't hide a Superman, but I'd love to be a mild-mannered doctor and leap tall buildings in a single bound as well. I'd be the Philippines' alternative hero to Manny Pacquiao. I'd stop bad guys left and right, arrest corrupt officials, get rich, save lives, be someone, and the whole world will remember me....

And then I wake up...

Stare into the streaming sunlight...

Off to work again.

Maybe tonight I'll dream another dream.

I take a bath, stuff all my books and clothes in a bag, take my glasses from the table and got ready to go though another day. Oh the joy...

Medicines Are Funny Funny Things...

2009-03-17T08:57:00.000+08:00

I am a really funny doctor.

Most of the time, while I'm giving prescriptions to my patients, I find myself asking if the medications I'm actually giving really do work. I wouldn't go as far as saying I doubt every medication I dole out, but I find myself skeptical most of the time.

Take for instance, cough medications. I've given my share of cough medications over the years I've had in medicine from internship to residency, and none of them seems to really stop the cough. Mucolytics, expectorants, antitussives, antihistamines ugghh, they seem to just not do the job. So, if asked what medication I'd want to give to patients having cough, on instinct, I'd say water. After all it still is the best mucolytic, in my opinion.

Well, it's different if you know the problem, say TB or Pneumonia, for which we can treat the cause of the problem. Antibiotics are great drugs. But again, there are stuff to consider like resistance, the bacteria you're up against on whether they're wearing Amoxicillin shields or Cephalosporin-proof vests. So you end up with just a grand old time figuring out what to give until the sensitivity testing comes out, that is if there are discs to use or microbes that grow on the cultures. Which is why most doctors start out with really broad spectrum antibiotics nowadays and work it down once the testing comes out.

Neuroprotective agents for strokes? Hmmm, skeptical, though theoretically sound.
Appetite stimulants? Nothing more appetizing than a well-cooked and seasoned meal.
Vitamins? A good diet is still the way to go, in my opinion. Vitamins will not save your liver if you keep on drinking alcohol or your lung if you keep on smoking. Most people think all they need are vitamins, asking for them left and right, and I make a face, but when all that's said and done, what they need is a healthy lifestyle, a healthy diet, a good dose of exercise and proper hygiene.

Don't get me wrong, I'm not trashing medications nor am I trashing my own profession. I love my job (though it's been often described as having a degree in knowing nothing) as we often get to save lives provided we get the right medications to the patient.

And there are drugs I believe in, after all, I'm still in Internal Medicine, say adenosine. I marvel and I hold my breath at the same time while watching that long, long, really long pause on the scope and gradual return to sinus after a supraventricular tachycardia. There are others like beta-blockers, epinephrine, norepinephrine, and a host of emergency drugs.

There still is good old Paracetamol, which when combined with a properly done tepid sponge bath brings down any fever in a matter of minutes. The nebulizations are pretty dramatic as well. Cardiac-wise, warfarin and aspirin have been pillars of the medical arsenal for a very very long time.

Medicines are really funny things. Some work. Some don't. Some you just can't see.

I guess that's why doctors are around to figure stuff out.

If we ever do. Hehe.

Kaleidoscope World

2009-03-15T19:34:00.001+08:00

When Francis M passed away last week, I didn't think I'd be that affected, given that I never knew the guy, I didn't avidly follow his music nor did I patronize his clothing line.

But when news of his death broke out on the news, I could not help but feel the loss being shared by the members of the entertainment industry. It was more than just another showbiz personality passing away -- definitely, more than just that.

Well to me, Francis M played a big role in MY generation. Sure, we all did the dance to "Man from Manila" and "Mga Kababayan" way back in grade school. Some of my classmates even went as far as to imitate his clothing choices. At that time, he made rap cool. He was Philippine rap, hence his showbiz-imposed coronation as the king of Philippine rap.

What I most remembered about him during the days when I'd be playing marbles beneath the calachuchi tree in my grade school or sweating in the midday sun playing basketball with my worn Grosby rubber shoes or whether I'd just be sipping my Hi-C Orange drink in one hand and a 5-peso bag of spicy hot peanuts in the other, was that he championed the Filipino. And for that, I'd always feel connected to him in some way.

As I grew older, in my opinion, so did his music. I grew to like his Rap is FrancisM album and particularly liked "Meron Akong Ano" and the Royal Tru Orange jingle "Ito ang Gusto Ko."

But his masterpiece, in my opinion, had to be "Kaleidoscope World." It became an anthem for peace, equality, pride and a host of other things and it helps that it has great melody to groove along to.

I grew with Francis M. That is why in his passing, I can't help but be sad, not just because we've lost a pioneer in our entertainment industry, nor is it because I feel my age with his death, but it's more because my generation has lost an icon that championed Filipino pride, music and equality.

Rest in peace FM.

Truly, Every color, every hue
Is represented by me and you
Take a slide in the slope
Take a look in the kaleidoscope
Spin it 'round, make it twirl
In this kaleidoscope world.

A FreeMan with A Free Mind

Catching Up

2009-02-24T06:37:00.000+08:00

It's been a while since I faced the blogger screen and typed my thoughts away, but now that I have my own connection, (woohoo!) I'm looking to do it more often, not as often as Doc Ness does, but once in a while, as opposed to never. Haha.

Residency is all I've had on my plate since starting almost 4 months ago, and it is pretty evident that it's about all that's happening in my life because all my latest blogs are about it. I have to admit, that there are times when it's really hard to get up in the morning and letting go of 5 precious minutes of sleepytime and get dressed for work. But it has not come to the point where I hate going to work, so forge on we shall.

Random thoughts:

1. We began residency 4 months ago with initially 4 doctors. Of the first 4, one quit. The next 4 came in last January, 2 quit (after 1 24 hr duty! arrghh). It's hard to lose a co-worker, sort of a brother/sister-in-arms if you will, who came in with the same purpose as you did, and cover for the same person's workload after he/she is gone. But now, we are at full strength again, and hopefully we make it through together.

2. Residency has become survival of the fleetest (fastest walkers get labs first, and do the appropriate intervention and finish their rounds first). When I slow down, literally, from my regular walking pace, my fellow residents whizz past me. Everybody walks fast. Well, it helps that I take big steps.

3. I did not know Dr Madamba personally, but I knew him as one of the institutions of pediatric practice in Dumaguete City, and even had 1 check-up with him when I was a kid when my pediatrician was out of town. For him to go in the manner that he did (he was shot, for those who did not know) is a tragedy and I hope the perpetrators get brought to justice. Not only does the city lose its only allergologist albeit in pediatric practice, it loses one good doctor.

4. I sit here with the Eraserheads reunion concert CD on the player (thanks hon), and they still sound good. Some good things never do last.

5. Slumdog Millionaire wins Best Picture! Truly, one of the best films of the year. If you haven't seen it, you should.

6. Congratulations to old friends and classmates who passed the boards -- Jeanette, Laurje, Jouie, Rainier, Ver, Chiong, Pura, Dinkoy, Siao, Nevi and all those who took the February 2009 boards. Welcome to the club. With your license comes great....you know the rest.

7. I'd like to apologize to Nevi, Cindy, Baby Boi, Carrie the other day. They passed by the ER and I was busy as heck with a full house and I wasn't able to chat. Uhm, my mood was less than pleasing during that time, but I think I managed a smile in between writing orders. Congrats guys.

I'm off to catch up on some sleep, err, work with today being a skeletal holiday.

Oh the simple joys...

Good night...

Tales from the Residency Dark Side

2009-02-08T20:31:00.000+08:00

I had my first complaint this week. Or at least I think it was for me. And I don't think it was deserved.

I saw a patient the other day, something like a 29 year old female complaining of chest discomfort, squeezing in character associated with shortness of breath. I saw her a bit later in the afternoon and came into the OPD with an ECG in hand.

Nada, sinus rhythm, non specific ST and T wave changes (for lay speak, perfectly ok).

During the interview, I found out she has had this complaint fairly recently, she recently took the bar and was awaiting the results, and the night prior, she got into an argument with his brother.

No history of heart disease, high blood pressure, diabetes, and the like.

I pretty much came up with an anxiety reaction or a hyperventilation syndrome.

Sure, sure, it still could have been something more severe like a heart attack and the like but practicing here in the Philippines have forced doctors to sharpen their clinical skills and all the years of internships (though not much yet) told me that this was nothing like that. I could never, in my right mind, order for stress testing, angiograms or even cardiac enzymes for a clinical setting like that.

So I proceeded into what was like a 15-minute discussion of her symptoms, explained that her ECG was ok, and advised her to come back should she have any further problems.

I asked her if she had any questions, and she told me she was fine.

The next morning, while at the ER, the nurse received a call from the insurance coordinator relaying a complaint that someone consulting for chest pain the day before was not properly diagnosed.

I was pretty certain it was her.

Everybody can't be pleased. Would she have rather welcomed the news that she had coronary blockage rather than an acute stress reaction? And after spending the time I did to explain to her and her boyfriend, the nature of her reaction, I get that?

But I'll take that, 1 undeserved complaint in 4 months from a well-attended patient, that's a pretty good rate, I'd say.

Or maybe some people just have a funny way of saying thanks.

Small Blessings

2009-02-01T19:28:00.000+08:00

I think we've all received this text message:

Little birdie in the sky
Dropped a poopoo in my eye
then something like
I thank the Lord, that cows don't fly.

You get the message, right?

I couldn't help but remember this message as residency life goes on for me (gasp, going 4 months of Internal Medicine, who would have thunk it?).

I went on rounds with one of my consultants the other day and came to a really well-off patient in the suite room on my floor. While doing the usual check-up -- BP, physical examination, pulse rate, a random scan of the labs and ECG -- the usual chit chat came to discuss his many medical problems and previous hospitalizations. He had Coronary Artery Disease (fancy medical term for heart blood vessel blockage), hypertension, Diabetes Mellitus and had underwent bypass grafting, percutaneous transluminal angioplasty, and a pacemaker insertion all in the last 8 years.

He casually chuckled and said that he had too many problems and it was all because of how old he was.

My consultant shared a laugh and said, "Well, you have lived a full life."

My patient said, "Well, you know, life is like money, you can never have enough of it."

There it was, the lesson for the day.

Well, this statement was coming from a guy who owned companies (plural) and had loads of money, but he longed for more days to his life as well. It helps that you have money to spend during those additional days too, but what caught me was how simple a thought it all boiled down to: You can never have enough of life.

Then I was brought back to how I measured my own life -- the sleepless nights, the endless reports and assignments, the proddings from our superiors, the way we drag ourselves out of bed EVERY morning -- and stopped.

I realized, I didn't have to look at it that way. I'll try my darndest to look at the small blessings -- the extra hour of sleep I get for finishing work early, sharing a cup of coffee, studying with the beautiful woman reading William's Obstetrics across from me, helping people get well, the mystery and allure of diagnosis that got me into IM in the first place -- the small blessings.

It's true, you can never get enough of life. One would want to suck it's marrow for how many days we are given. But the funny thing about it is that we don't have that expiration date stamped across our foreheads, so even though how much likening the need for life to money, it isn't measured with the latter, it's measured in blessings -- the blessings of how we lived it.

So thank God for the small blessings.

Thank you for yet another day.

Off to do rounds again.

Tinseltown Gets Scrubbed Out

2009-01-18T11:57:00.000+08:00

Ahh, don't you just love the movies?

I know I do.

From my earliest recollection of going to the movies with my family, and the Betamax tapes stacked up in the corner of our bedroom when I was a kid, to the new-fangled special-effects laden movies and pirated torrents of today, I've always seen the imagination and cinema of movies as my refuge from reality along with books.

That is why I love the movies.

To narrow down 10 of the top movies of all time would be, difficult, in every sense of the word. I've seen too many movies, and loved most of them, hated some, laughed with and cried from, and each of them cleaves a place for itself in my wildly imaginative psyche.

But, like most of those submitting entries for this TBR, one has to try. And so Scrubbed Out's Top 10 movies are:

10. The American President - I happen to have the biggest crush on Annette Bening, but, I love this movie because it gives us a glimpse of how love works, even for the most powerful man in the world and it's just funny seeing a president find time to date.

9. Indiana Jones / The Goonies - Hidden treasure, adventures, and good times with good friends. What's not to love? I used to imagine myself riding a horse with a Fedora on my head and using my whip to swing over a crevasse of snakes and alligators, and finding a hidden pirate ship with loads of gold bullions and jewels beneath our house. Now, I don't think of those things as often as before, but the thoughts do cross my mind. I wonder what's under my apartment? Hmmm.

8. The Count of Monte Cristo - Betrayal, revenge, intrigue. So much weaved into the storyline and I loved how Jim Caviezel played Edmund Dantes in this movie --cool and calculating. Don't you just love it when the good guy who goes through heck get his due in the end?

7. A Knight's Tale - For the witty dialogue and the rags to riches story of a squire-turned-knight. It's a perfect blend of comedy, action, drama, romance and good music. I like how seamless the movie transitioned into modern and medieval times with great and fun performances from the late Heath Ledger as William. See ending line of #8.

6. E.T. - A score for imagination. Who doesn't love what ET brought to our world? I mean, aside from Drew Barrymore.

5. Braveheart - I loved this movie so much the first time I saw it that I was trying to speak Irish for a week. But I eventually gave up, but watched the movie again, and again, and again.

4. Shakespeare In Love - Yes, this movie stars Gwyneth Paltrow, but I don't like her as much as Annette Bening, haha. I think the movie is beautifully made and rightfully won the Oscar for that year.

3. Love, Actually - Great great movie. And well, this movie holds more meaning than just the actual movie for me. But several love stories being told, intertwined beautifully into one story involving among other people, the Prime Minister of England, his secretary, two porn stars, divorcees, a widower and his housemaid, in a story you just have to see to love. Oh Keira Knightley is in this movie too! Hahaha.

2. Mr Holland's Opus - I love music -- and music with movies are a plus. Here Richard Dreyfuss plays a music teacher who has, as a goal in life, to compose the perfect symphony, and keeps putting it off to teach and make an impact on the lives of his students. He is a music teacher with a deaf son and goes to war against the educational system that cuts art programs in school. He ends up retiring without his symphony but realizes that his each student became the notes of his real legacy and in the end, a fitting tribute as his students render him his completed masterpiece.

1. Hook - You have to love Spielberg's imagination in this movie. That Peter Pan grows up and goes back to Neverland and to save his kids, he has to find that Peter Pan again. Now why couldn't I think of a storyline like that? More than just the story, the fun, and the general makeup of the movie, this is the last movie that I can recall that I watched with my mom, dad, brother and sister at the local movie house in Dumaguete. And THAT is why it tops my list.

Honorable mentions are the sports movies I love to watch: Tin Cup, The Mighty Ducks, Major League, The Replacements, Rad and all those wacky, funny, inspiring, heartbreaking sports movies, I can't get enough of them from.

I'm sure I've left out some movie I love somewhere, but as of now this is the top 10 list I'm going with.

Oooh, Underworld is coming up...

Scroogey

2008-12-24T12:00:00.000+08:00

Jeez, people.

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

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

Bah! Humbug!

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

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

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

Bah! Humbug!

CHRISTMAS PAST

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

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

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

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

Now those were Christmases.

CHRISTMAS PRESENT

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

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

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

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

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

And that brings me back to reality.

CHRISTMAS FUTURE

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

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

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

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

RIGHT NOW

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

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

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

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

We can try.

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

Merry Christmas to one and all!

It's that time of the year

2008-12-18T20:17:00.000+08:00

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

How didn't I notice?!

People are nicer.

Exchange gifts.

Our seniors asking us less questions and offering more suggestions.

Lesser frowns on people I meet.

The cool breeze wafting through my curtains in the morning.

People talking about bundles of joy and bonuses.

How come I did see it until today?

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

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

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

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

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

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

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

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

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

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

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

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

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

It's definitely that time of the year.

Merry Christmas.

In Sickness and in Health

2008-12-03T19:38:00.000+08:00

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

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

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

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

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

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

I thought it was brain mets. CT scan negative.

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

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

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

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

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

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

But I'm thankful I realized I was wrong.

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

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

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

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

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

Pay, Check

2008-11-24T20:54:00.000+08:00

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

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

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

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

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

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

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

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

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

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

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

Crossed My Mind

2008-11-12T21:02:00.000+08:00

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

Gaya says it's masochism with a purpose.

Some thoughts that have crossed my mind have been:

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

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

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

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

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

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

Death Becomes You

2008-11-03T19:36:00.000+08:00

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

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

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

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

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

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

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

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

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

Growing Pains

2008-11-02T20:23:00.000+08:00

They warned me.

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

Lost is mildly putting it.

I didn't know patients.

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

I didn't know when to call my seniors.

I didn't know lots of things.

I don't know much.

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

I am disappointed in myself.

But I'm determined to become a better doctor.

So forge on I shall...

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

Ugghhh.

Gifts and Times on Santa's Porch

2008-10-26T06:43:00.000+08:00

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

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

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

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

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

Santa, indeed, knows best.

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

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

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

Headache? Bang your head against the wall...

2008-10-17T20:36:00.000+08:00

I am dead tired.

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

And I'm really tired.

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

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

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

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

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

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

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

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

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

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

At The Beginning

2008-10-14T20:14:00.000+08:00

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

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

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

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

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

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

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

Here goes nothing.

:)

Boys Don't Cry

2008-10-10T22:19:00.000+08:00

No way.

It's unnatural.

It's a girly thing to do.

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

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

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

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

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

No. Resist crying.

It's not a man thing to do.

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

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

You have to be strong.

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

No crying.

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

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

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

Don't

Let

Them

Win.

Sniff.

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

The Years Gone By

2008-10-06T01:56:00.000+08:00

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

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

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

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

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

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

See ya'll soon.

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

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

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

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

A Huff and a Puff

2008-10-05T13:20:00.000+08:00

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

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

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

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

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

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

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

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

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

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

Of Weight, Weddings and W(R)ent

2008-10-02T19:38:00.001+08:00

Uggghhh. My right knee is killing me.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Much Ado About Helmets

2008-09-30T11:46:00.000+08:00

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

Yup, no helmets here.

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

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

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

OK, settle down for just a minute.

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

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

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

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

Wow

2008-09-26T21:09:00.000+08:00

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

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

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

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

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

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

My goosebumps had goosebumps.

I was as slack-jawed as Simon Cowell.

All I could say was "WOW."

Check out tidbits of his story here.

The Road Less Traveled (Doesn't Exist)

2008-09-25T22:29:00.000+08:00

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

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

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

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

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

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

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

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

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

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

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

Enter me.

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

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

And I try my darndest not to ever be one.

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

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

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

Bittersweet Friday

2008-09-19T23:17:00.000+08:00

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

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

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

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

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

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

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

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

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

And for that we thank her.

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

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

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

Kitakits ha, I'm sure.

Spins on Sins

2008-09-19T09:57:00.000+08:00

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

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

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

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

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

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

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

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

Hmmm, What To Do...

2008-09-14T15:57:00.000+08:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

There. Lists of stuff I want to do.

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

That, indeed, is the question.

The Cards On The Table

2008-09-08T20:44:00.000+08:00

Ugghh.

I'm at a loss.

I don't know where to go from here.

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

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

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

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

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

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

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

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

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

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

The rest of the field:

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

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

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

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

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

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

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

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

I'm lost.

I'm sending out applications this week.

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

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

Piano By Starlight

2008-09-07T05:47:00.000+08:00

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

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

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

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

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

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

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

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

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

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

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

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

Applause.

Debriefing (My 76)

2008-09-04T21:36:00.000+08:00

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

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

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

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

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

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

Stuff I'd like to point out:

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

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

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

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

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

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

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

Ultraelectromagneticreunion!

2008-09-01T20:55:00.000+08:00

I was in high school then.

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

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

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

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

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

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

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

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

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

Much Ado About Change

2008-08-30T09:41:00.000+08:00

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

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

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

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

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

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

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

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

Much To Be Thankful For

2008-08-22T07:44:00.000+08:00

It's over. The wait that is.

I passed.

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

Thank you. Thank you. Thank you.

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

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

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

I realized I have much to be thankful for.

Some have less.

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

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

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

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

I passed!

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

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

Thoughts On My Way Home

2008-08-18T22:10:00.000+08:00

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

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

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

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

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

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

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

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

It was a nice day.

Me Thinking Not So Striaght Right Now Raelly

2008-08-13T08:41:00.000+08:00

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

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

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

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

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

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

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

Things I'm thinking of right now:

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

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

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

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

INDNJC

2008-08-08T17:10:00.000+08:00

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

It starts tomorrow. And I am terrified.

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

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

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

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

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

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

Here I am. Weak. Tired. Afraid.

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

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

In Nomini Domini Nostre Jesu Cristi

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

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

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

4 days more

2008-08-04T22:52:00.000+08:00

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

I tried to recall when I started to write.

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

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

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

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

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

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

Keep us in your prayers.

It's A Little Bit...

2008-07-30T21:25:00.000+08:00

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

It's a little bit:

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

Until After The Boards Then

2008-07-24T20:42:00.000+08:00

The board exams are 15 days away as I write this.

There isn't exactly any accurate way to describe what I'm feeling.

Scared. Anxious. Afraid. Bold.

Yes, I have studied hard as well, but I feel that I could be more prepared. Be more ready. But, I've heard endlessly it is truly impossible to be ready for the exams, which I'm inclined to believe is true.

The pressure is there.

The stakes are high.

Uncertainty fogs the next bend in the road I'm on and it's scary.

This is probably going to be my last post until after the boards, with hopefully uhm, a favorable result.

I ask you out there in webland, to please include us in your prayers. Me, Tonett, Ligaya, Jo Anne, Sherwin, Benjo, Chofi, Mel, Aning, Ria, Lei, Nelson, Barbs, Cheyenne, Arnel, Ellan, Tango, Jesi, Carmel, Nats, Macking, Erving, Aura, Tina, April, Domeng, JB, Baki, Tam, Dodong, Teofi, Shobe, Neil Wayne, NeilBac, Jet, Cla-Cla, Rolyn, Maricel, Lugie, Bordacks, Carie, Osang, Jhaphet, Chatie, JoAbs, Lionel, Ruthie, Sheila, Blesil, Shailyn, Amanda, Leslie, Candice, JeaMa, Siao, Pabs, Baby Boi.... (tried to stop Gay, but couldn't, hehe) all of us, to my knowledge, that are taking this August's Boards.

We remember that it's all for Him who made us.

This Examinee's Prayer

Lord, here I am.
I give to you the next chapter of my life,
And hoping to for You to make me Your instrument of healing.

I have gone through the years of school
Read the books and reviewed them
Treated patients in training and internship
And I feel I am ready

Lord, guide my way.
Doubts and fear await on every turn
I have studied my books but the uncertainty is there.
Why does it feel like I know nothing?
But there is a part of me that knows it's there.

Lord, be with me.
Take my hand and lead me.
I don't expect to answer every question right,
Nor for You to give me the answers.

Lord, I only ask for Your presence with me --
In me.
Grant me the presence of mind
To think and remember all that I've read
The clarity to analyze
The faith to decide
The strength to go on

It is in all humility I come before You Lord
To ask for Your grace and forgiveness
I am by no means the perfect Christian
But it is to the best of my abilities,
And part of my utmost desires
To become part of Your healing ministry on Earth.

Grant me the serenity to accept the things I cannot change
Courage to change the things I can
And the wisdom to know the difference.

With my friends, we pray to You

Our studies, our exams, our service...

We lift up to You

Amen.

A Pedestal For Mellie

2008-07-17T18:40:00.000+08:00

The Blog Rounds 16th Edition has called for us to bring forth into the spotlight heroes that we don't normally recognize in our daily lives -- the unsung heroes if you prefer -- those people who just fly by under the radar, and well, make things a little bit better in this world.

My "unsung" hero, shouldn't be unsung in the first place. In fact, to me she isn't and is at the same time. Why, you ask? Well she is on that pedestal as a hero in my life, but at the same time, I can never give her enough thanks, praise and appreciation for everything she has done, making her unsung in a hero kind of way.

It's no secret. My mother is a hero.

Not a knock on him, but my dad has his own points, but my siblings and I have always been drawn more to our mother. Yes, one could make the argument again that I should think of some other person who deserves recognition in the true unsung nature like, uhm, the garbage collectors who keep our streets clean, or the teachers that impart actual knowledge in and out of the classroom, and the like, but still, no matter how much I actually think (I actually did try), there isn't anyone with that stature in my life other than my mom.

She is the youngest of all 9 siblings (if I counted correctly, haha), and was brought up with less than what we have now (understatement, IMO). But that early on, my Lola Beatriz and Lolo Imoy stressed the value of finishing school. Back then, they had the market (selling meat) as their main source of income. She would tell us how lucky we are today because back in her day (yup, all you mothers out there do that) she had to go to the market to help, and sold plastic bags sometimes to add to her baon.

My mother finished Bachelor of Science in Accountancy at Silliman University cum laude after considering for other courses like Nursing, Math, among others (though she told me just recently before leaving for this review, that she had wanted to be a doctor, but was shot down almost immediately because of the finances. So added incentive to pass the boards for my mom.). Yes, she is smart. Her hands dance all over the calculator computing taxes, or balancing her day's work. How she can say that balancing all the numbers on the spreadsheets is easy is beyond me.

She took a job as a teller at the Bank of the Philippine Islands Dumaguete Branch and stayed there until last year, which is a good 30+ years. She was offered officership but declined it because of the chance that she'd be far away from us. Who would keep us on the straight and narrow? Ask all clients that trusted her, I don't think they'd have a bad word to say about the effort she gave in everyday. She doesn't have a blemish on her bank record -- no outrageous shorts, and any discrepancies she always found out where the money was. I remember one time, the employees were on strike, and I was like 6 or 7 years old, and she called us up crying because she couldn't come home because the strike would take them until the next day. That is my mom.

While she worked at the bank, she kept the family business going as well, selling meat at the market. She is as good a businesswoman as she is a mom. Stern, fair, and teachy. I should know. She made us help out early at the market like they did, and I'm thankful for it. She treats every customer like gold. Fairly. I don't think she's ever done anything wrong for any customer that came up and bought meat from us. If ever the meat has a bit more fat than the usual, she'd say honestly that she'd find something else for you. That's how my mother is. But work is work at the market, even we weren't spared from the proverbial lashings behind the kilos of meat hanging from the rings. I smile and thank her for that because, I'd like to think I work like her or try to, at least.

Her typical day before she retired from the bank last year? Wake up at around 5:30 am. Change and go to the market. At around 8:30 am, she'd literally be running home, eat really fast, grab a quick shower and change to rush to the bank where she spends the day, sometimes coming home for an hour-long lunch break at most. She comes home as early as 6 pm or as late as 11 or 12 midnight, after which she eats dinner, balances the books from the market and goes to bed to do it again the next day. She barely even takes a bathroom break, which I've talked to her about, but workaholic that she is, just won't give in. You can add in, doing homework with us when we were kids, or keeping us in line when we come home late without permission or do something wrong, running the household, you'd think she was Superwoman, but no, she's my mom.

She also had stints in teaching accountancy at Foundation University in Dumaguete City but gave it up once she had us. She gives up her wants and needs and always places us first. She'd be wearing her faded khaki shorts to my new pants, and she'd always appreciate it when I'd end up choosing a nice-looking shirt for me and my brother. Though it's my dad that dominates the microphone during sing-a-longs, she can carry a tune, and can dance as well. She'd always have some food ready when I have friends over at the house, even if I tell her don't bother.

She is married to my dad, who is nearly retired as a bank manager, and has three wonderful kids. My brother, a brilliant computer engineer (underachieving at the moment, bro, but you'll get through it), a soon-to-be bank manager sister, and a graduate of medicine. She has even helped some of my cousins through school.

She is quietly brilliant and humble in what she has done, probably thinking of us as her achievements, and is content to stay behind the scenes -- all of which I see in the significant other in my life.

To all of you parents out there, there comes a time when you have to listen to your kids, too. And in my case, my mom listens but hardly follows what I say even if I've already graduated med school (Haha). (It's called the Doctrine of Superior Knowledge, Ma, don't bend at the waist, you know you have a bad back).

To all you parents, yes, you end up kind of unsung to other people but never to the people that matter -- to your sons, daughters, husbands, wives.

My mother is unsung in so many ways.

But not to my brother, my sister, and not to me.

She is my hero.

Superwoman

The - Blog - A - Round

2008-07-13T14:56:00.000+08:00

The Blog Rounds. It was first brought up between a conversation I had with Doc Ness while she was doing her rounds, and she was ecstatic on finding out that a few of us, then interns at SMC, had taken up blogging. I have posted twice and Ligaya Solera has her post already up for the 16th TBR. Dr Ducay has declared her return after her storm as well. In fact, it was Ligaya who brought me into the blogging world. I was trying to write a comment to a post she had, and I didn't have a yahoo or a google password so I made a blog, and it took off from there. So I owe thanks to the one and only Ligaya Solera, who is older than me, uhm in wisdom. Haha.

Reading and writing have been a part of me since I was a kid, but it is a bit daunting for me to be writing amongst all of you who have accomplished more than I, but my purpose for writing is, like all people who write, to have a voice.

And with the blog rounds we have different people, different points of view. That makes all for a very fun read.

I wish to be an opinion, a view of change, information, a joke to make someone else's day, and be something to anyone who reads it. That is why I blog. And that is why I join the blog rounds.

P.S. I have no idea how to make the logo into a link. I have been trying it since Gaya told me how to, it just won't. Haha, it's either those idiot-guide instructions were not what they were or I'm worse than an idiot. Haha. Anyway, I know you still read us Dr Ducay, and whatever storm you're going through, as in real life, there's always that rainbow after. The boards are coming....Have to go back to studying.

TriviaL Pursuit

2008-07-10T22:17:00.000+08:00

I've always been fond of trivia and played the Trivial Pursuit board game with my cousins whenever we had the chance to get together on family celebrations. So, in the middle of reviewing the intricacies and demands of the law on the practice of medicine, I decided to try and break the tension of the upcoming Exams with a couple of random stuff we don't get to read in our books.

* Did you know that the antibiotic Erythromycin (Ilosone) was co-discovered by a Filipino doctor. Yup, he is Dr. Abelardo Aguilar and the drug is named after, well, Iloilo.

* Former US President Bill Clinton's personal physician was/is a Filipina, Dr. Eleanor Concepcion Mariano, who was the youngest captain in the US Navy.

* The gestation period for an elephant is 18 months, so aside from the weight, another reason why women wouldn't want to be them.

* We humans have about 10^13 cells in each of our bodies. Meanwhile, we have about 10^14 bacteria resident in and on us and all that bacteria weighs, give or take, 10 pounds.

* When a man ejaculates it shoots on average of about 45km/hr. You could kill a yak at that speed!!! Hahaha.

* When lights hits our eyes, a protein called rhodopsin therein starts a chemical chain reaction that lets us see. It's the fastest chemical reaction known to man.

* In 1888, pharmacist John S. Pemberton developed "Esteemed Brain Toxic and Intellectual Beverage," which contained: caffeine, "secret" ingredients, and cocaine. Modified for today's taste (and laws), the product is a staple, billion-dollar seller. What was Pemberton's concoction? None other than Coca-Cola.

* The symbol "Rx" is actually a corruption of the ancient symbol for the Roman god Jupiter, whose blessing was invoked upon every prescription to ensure its purity.

* The things doctors do in the name of science. Did you guys know that Barry Marshall, one of the doctors who found the bacterium Helicobacter pylori, the organism responsible for peptic ulcers, inoculated himself with the bacteria and studied himself. Together with Robin Warren, they revolutionized the treatment of ulcers and putting Kremil-S out of business. Maybe not out of business, but well, lower sales. Hehe

Oh well, the tension comes back as soon as I lift the hands of the keyboard. Back to the books.

P.S. Shout out to Gaya, who is studying her behind off at her house and probably won't read this until, give or take, one week from now. Dr Ducay, who has seemingly vanished, haha, Hi doc. Hopefully you include us in your prayers all of you at SMC. And to Hershe, apparently Gaya and I have a new reader, haha, great that makes all five of you with Doc Ness and the ever-radiant Tonettsky. Insert smiley face here.

Instruments

2008-06-28T18:01:00.000+08:00

As you all know, I am in the midst of reviewing for The Exams, and it is once again a scary time in my life. A scary time for anybody who has ever gotten wet, treaded and eventually forged through the sometimes calm, often turbulent, icy waters of medicine.

A couple of my classmates have taken time out from their busy schedules, to go on a medical mission to one of our friends' place in Sibonga, Cebu. And if you ask, why I didn't go, well, 1) I wasn't asked, 2) I didn't know until the last minute, and 3) I didn't want to put it on my friend to have to ask me to go. Maybe they had full slots, and I'd be dead weight. 4) Lastly, I think they were worried enough about the boards to let me study. (Rationalizing) Haha, don't worry, no problems here guys.

Anyway, I knew most of the guys going, since they were my brothers in med school, but there were other people.

After the mission, they were going to the church in Simala to pray and ask for the blessing of passing the boards. I haven't gone there but I keep hearing people say that they have to go to Simala before the boards. Others have gone, others are planning.

I overheard someone say that couldn't they just dispense with the medical mission and just go directly to Simala, so as to not spend the whole day and have some time for studying?

I was taken aback.

Here is a chance to be able to give back to others, the chance to show Him who grants us our licenses, that we deserve them by being instruments of His healing, and throw it away just to have some extra time to review? Isn't it a bit ironic that you choose to go to a church and ask help from the Divine and not help in return? Or maybe you went and helped grudgingly?

I am not the perfect Christian. Nor am I a perfect person. But I do know that my heart is in the right place, and I want this not just for me but for my family, for my friends, and for my would-be patients. Healing would not be possible without Him. I believe He said, "what you do for the least of my brethren, you do for Me," worded of course in a more profound-sounding Bible text.

I can't speak for that person, but I do hope she went, helped, for even a second, wholeheartedly, and helped in the healing of someone who has so much less than her.

I pray everyday that I, my friends, my classmates, my not-so-cordial friends as well, that we pass. 100%. But let's not forget why we get to do what we do. Let's not trade the Mission for just a few more minutes of what we probably won't remember come boards time, because it is impossible to ever be ready, right? Or so they say.

I do pray that God sees us worthy to be His physicians.

and I truly hope that we are.

Doc Hollywood and the Physicians Of The Silver Screen

2008-06-17T09:40:00.000+08:00

Doc Ness advised me to take a break in studying and so I'm but dutiful in listening to those infinitely wiser than I. Haha. Thank you doc, it is a welcome break. Though the August Medical Boards are drawing ever so near.

But you know what they say about all work...

So TBR 14 is about the Doctors of Hollywood.

Well, I really was not geared toward medicine in my high school and college years despite the fact I took up Physical Therapy as a premed course. And even though, I was in health care, I took more interest in shows that intrigued me like The Practice, those that made me laugh, like Friends, and of course, ESPN Sportscenter.

But I do watch TV a LOT, to merit an opinion in these matters. Haha, don't we all?

ER is the grandfather of all Doctor shows, I think. It spawned all those that followed like Chicago Hope (which I liked as an alternative to the IMO, too serious ER)among others. The thing that irked me about ER was that it got too heavy sometimes that I found myself dozing in the middle of an episode. Sure. Ming Na Wen could entice one to be more attentive, but it wasn't for me. Awards aplenty, it slowly marched into the backgrounds, and still enjoys quite a good rerun from daytime networks.

Chicago Hope, I liked because it was more layman-friendly to me. I was not in the medicine field then so I appreciated the idiot-guide to medicine.

As the years went by and I went into medicine, I gradually took an understanding to what it takes to be in the medical world.

I came across House MD.

And I loved it.

The humor. The character. The cases. The medicine. The diagnostics. The challenges.

Followed it from Season One to this date.

Here is a doctor that is in turmoil emotionally, but a brilliant diagnostician. And though he is depicted as a sick SOB (pardon my French), and with really crass bedside manner, he shows his heart is in curing his patients. He cares and not cares at the same time.

Forgive me for uhm, seeming like a House Geek but hey you asked for it. Hahaha

One episode that comes to mind is MATERNITY, season one. House gets caught up working pediatrics when almost all the babies born in the hospital get sick. Epidemic comes to mind. The preliminary diagnoses include bacterial causes and load the babies with antibiotics. But, no success. The ethical breach here was House decides to treat the two sickest babies differently, taking one off the two antibiotics they have them on and taking the other off the other one. He decides which gets taken off of which anti-biotic by flipping a coin. Love that stuff. Final DX: Viral infection.

My favorite episode by far would be DNR from season one. A musician is seemingly diagnosed with ALS. Everybody gives up including the patient, but House does not. The patient signs a DNR but House resuscitates him (you gotta love that). In the end, House was right. It was an arteriovenous malformation, intradural compressing his spine. A new lease on life for the musician. Another life saved for House and gets a trumpet in return.

I've gotten to know so many things from House. Hahaha, not the learning source my med school mentors would have recommended but I learned nonetheless. The intricacies of Occam's Razor, Cysticercosis, Hemochromatosis, Sleeping Sickness, AV Malformations, Tumors, Wegener's, the oft-mentioned "Vasculitis," Porphyrias and more. The 4th season isn't done yet, but I've seen a few episodes. House is looking for new minions after Chase, Foreman, and Cameron resigned. The way he turns it into American Idol / Apprentice is priceless.

I've come to like a few other series, Grey's Anatomy to see the surgeons at work. I don't really care much for McDreamy and McSteamy, but Katherine Heigl is probably more pleasing to this observer's eyes. Oh and you have to know who is Meredith going to be with to join in the EMO conversations.

An underrated medical show I secretly like as well is SCRUBS. Medicine has its share of funny funny moments and I love this show for showing them.

The way doctors have been shown on TV is a gut check for all of us. As evidenced by the awards, attention and fans these shows get, us included, people know a bit of how our world works. A double-edged sword if I ever saw one. As much as we are amused, we should be every bit as careful with patients. Doctors are not the "gods" they once were and these shows have contributed to a lot of the publicity doctors get.

I say, let's take all we can from these shows...relaxation, laughs, fantasies (for all the McDreamy fans)... and not lose sight of what's happening off the tube.

Hayy, back to studying.

Red, White and Piston Blue

2008-06-14T10:11:00.000+08:00

If there was anything I loved about the United States, it would be professional sports.

Yeah, yeah, echo all those stereotypes now, but yeah so what, I love sports. I'm a guy. Haha. I grew up on them. I've played almost everything from basketball, volleyball, tennis, softball, baseball, hockey, in-line skating, you name it (played soccer for a while until I broke my clavicle, I think), I've dabbled in it once or twice.

I write this one because I always get flak for cheering, uhm, loyally for my favorite basketball team, the Detroit Pistons.

I don't know but I'll always bleed the team colors. I really didn't care much for the time they wore teal green but cheered for them nonetheless.

From the first time I picked up a basketball at age 8, they were my team. The Bad Boys. Isaiah Thomas, Joe Dumars, Dennis Rodman, Vinnie Johnson, James Edwards, John Salley, Mark Aguirre, Bill Laimbeer, Rick Mahorn, coached by Chuck Daly, among others. They won two championships in 1988-1989 defeating the Lakers and 1989-1990 by defeating Portland, before they were finally knocked off by some guy named Michael.

After, I cheered through the doldrum years with Allan Houston, Grant Hill, Lindsey Hunter and the not so household names of Terry Mills, Ron Mercer, Bison Dele, Eric Montross, Christian Laettner. Good enough to make the playoffs but never a winner.

I really don't know why I follow them so much. I've tried endless times before to shift to cheering for a new team, but I still end up cheering for them anyway. BIRGing mama gaya? Haha. But I do and I will still.

Which is why when Joe Dumars rebuilt the franchise into the powerhouse that it is today, I felt, vindicated. When they toppled over the Lakers star-studded team in 2004, I was the only one cheering in Lola Inda's Eatery. Everybody was shocked when A TEAM beat THE team. A Five-Game Sweep, they say (For those not NBA-inclined a sweep is winning 4 games straight). They dominated every game except the overtime period in Game 2. Tayshaun Prince, Chauncey Billups, Richard Hamilton, Rasheed Wallace and Ben Wallace became household names. Then they got FAT.

I mean content, too content. Which have led them to lose in the last 3 Eastern Conference Finals after making the last 6. They've lost that hunger. They may have been the better team in all those times but they were beat by hungrier, bolder teams.

Changes have been promised. Well, I'm excited and scared at the same time. Who knows what next season will hold for Pistons fans everywhere. You have to love this image of the Pistons on the rest of the NBA landscape. Retooling yet still a great team. People will soon know the names of Rodney Stuckey, Amir Johnson, Arron Afflalo, Jason Maxiell.

And on why I wear #4 on jerseys I usually sport?

Joe Dumars was a guy I emulated. He wore that number. The NBA Sportsmanship Trophy is named after him. When the Bulls finally found it in themselves to beat Detroit, all the Pistons walked off the court, except Dumars. He found his way to #23 and shook his hand and said his congratulations to them. And #23 has always said Dumars was the only defender he had a tough time playing against.

My girlfriend, who doesn't mind the Piston fanaticism, haha, asks why people cheer on sports teams? She said that you can't really cheer players because they come and go, get traded, sign somewhere else. You can't really cheer for management. You can't cheer for the city. So, in essence, all you're really cheering for are the uniforms.

Well, for me those uniforms, are red, white and blue.

More To Life

2008-06-09T19:13:00.000+08:00

In a break while in the midst of books, cardiac outputs, respiratory function and Starling Laws (I'm reviewing Physiology right now), my mind drifts off to where I would be had I not chosen to take up Medicine.

My guess would be, I'd be in the United States, with two cars, a house and a steady job as a physical therapist.

Don't get me wrong, I love the work a PT does and I won't take away anything from having gone the US route. It is, after all, the well-beaten path to success as a PT. I hear of other former classmates and schoolmates having all the luxury, the prestige and the pride in answering the question, "Asa naman siya ron?" (Where is he/she now?) with some gusto like "New York", "LA", or "London." Even the less popular places get cred like "Missouri" or "Wisconsin" or "Nepal."

That is the mentality. Check that, that is the reality.

It not only is the glamour thing to do, it is now also the practical thing to do. Or should that be the other way around. I could discover the cure for cancer and fade into the background to a balikbayan nurse talking about an enema he/she gave a popular actor. Maybe an exaggeration, but is it really far from the truth? I don't know.

At a crossroads then, I realized, after months of self-inquiry and prayer, that I did not see myself there. I love being here. I want to be part of the solution here (if there is any). I wanted to make something of myself which I felt that being a physical therapist would not give me. The chance to make a difference. The chance to have an impact on other people here. Naivete talking again? Maybe, but 28 years of life on this earth would probably entitle me to refer to this as hope, however bleak it may seem.

Sure the cars sound nice (Jaguar X Series, BMW's, Benzs). A full-decked house with a pool and a den worthy of MTV Cribs would be a plus. The "prestige" of working abroad would be the icing on the cake.

Temporary high?

For me, I realize, the answer is yes.

Sure, I'll probably get a car someday, plan to travel to places nice and beautiful, get a house, have a familyl, and right now think of passing the boards and building a good career in medicine that challenges me and keeps me happy but in totality, I'd love to be just content.

Stacie Orrico said it best:

There's gotta be more to life
than chasing down every temporary high
to satisfy me.
Cuz the more that I'm
trippin' out thinking there must be more to life.
Well it's life, but I'm sure.
There's gotta be more...
than wanting more.

Time is a funny thing

2008-05-31T09:13:00.000+08:00

In fairness mama gaya (who is in most likelihood, as well, to be one of the very few people who will read this post) I've already had 4 posts for May.

Anyway, I write this in the middle of probably one of the scarier times I'll ever face in my life, preparing for the medical board exams. I can hear the "Gee, didn't you get enough of it the first time?" I'm 6 years removed from the time I took and passed the PT Board Exams and still I remember it to be really really tense.

Time really is a funny thing.

I say that because, med school was for the lack of a better word, an experience.

We had the boob model incident and hanging people out to dry (which Gaya loves to bring up every now and then), our basketball team competition and championship collapse(meant that we compete with ourselves rather than with the other team), the progress notes fiasco, the palpable but nonexistent Velez vs non Velez personalities, and coming together to put up one of the more successful Students' Night in recent memory "bleached" but who can forget all the stuff that happened behind the scenes with the dance and choir practices, organizing committee bickerings and the divisive Bass Amp Debacle.

Then internship came along and brought out, for most, the worst in us. We were under pressure, papers, procrastination, plasticky interactions, people angry at you for reasons that escape you and more (I ran out of P Mnemonics). I had my own personal issues with people in my group, leadership issues, work issues, personality issues, respect issues, ugghh you name it. We had it.

It has been a full year since our internship and all that stuff in med school. Blame it my reviewing pathology right now, but like an infarct that forms in the cardiac tissue after a prolonged ischemic episode, so does time slowly patches up those experiences you'd rather not have had.

Patches up, but never the same. An infarct will not make up for the normal cardiac tissue. But definitely better than damaged.

As I look up from my BRS Patho Reviewer, I see the other guys talking and catching up, planning and imagining lives beyond the board exams, I join in sometimes, smiling, tension palpable, but washed away by laughter, then comes back again. I see some of my co-PGI's now and then, as rattled as I am because our classmates have already made headway into their reviews.

Things have changed in the one year apart. All for the better, I think.

I get up, close my book and I'll probably turn in for the night. Tonett brushes her hair and gets her back and we walk through the mez, giving nods to Domeng, Dodong, Tam, April, share a laugh or two with Lugie and Chatie, and wave goodbyes to Neil and Cla-Cla.

I think we're gonna be fine from here.

P.S. Keep us in your prayers.

Arrividerci

2008-05-14T22:34:00.000+08:00

I can finally see the end to all the paperworks. Hopefully. It's been frustrating to not be able to get a signature to clear me from the Records Section of SUMC. I'm going through everybody else's charts to find if they've been hoarding my files. And once I'm done, I'm going through all the files they've returned, this way they would have no other excuses to put that scribble over the records section on that quadruple-copy clearance form.

I want to start studying already. I am starting to get scared facing the board exams so unprepared. But I'm relying on the fact that experience tells me, one can never be truly prepared for an exam of that magnitude.

So some parting words as I bid you until we meet again.

PEDIATRICS

I have no doubt that Pediatrics is not my strongest suit. Yet, when I rotated at Silliman Pediatrics, well, it seemed so easy. Despite my pedestrian scores in the final exams, I think I learned much and had fun at the same time during my rotation, after all, how can you not like working with kids?

The Residents

I'll remember Dr. Ang's brooding and penetrating gaze, teachy, firm, and fair at the same time. Oh and he smiles, jokes, and laughs way way way often that the first time I was under him at his former training hospital; Dr. Bonghanoy's smile, laughter, jokes, lessons and an IV helping hand; Dr. Sinda's IV misadventures, "'matic" pose, and how to report heart rates x 4; Dr. Calumpang's laughter and coaching as well as sharing my annoyance at nonsensical late night to early morning consults; Dr. Bondad's TMZ moments at the library and advice; Dr. Singco's food and laughter; Dr. Alo's wisdom, telegraphy and, late night rounds throughout the whole hospital.

The Consultants

I can't possibly write a post that long to include all of them but I will remember revalidas and computing feeding for preterms with the institution that is Dr EBOracion; "keeping my distance" and answering 4 am queries from Dr GFGAscano; assignments from Dr BYPFlores; marvelling at the patience of Dr GNNuico; endorsements and lessons with Dr RTOngkingko, among others, all of whom added to my knowledge of pediatrics.

The 4th Floor

Thank you for all the help and trust you gave me. I will remember how you gave me the benefit of the doubt when I ordered Diazepam per rectum in a seizing patient, I had to say it twice to clearly-puzzled faces but you trusted me nonetheless. I will also easily recall the way the milk for feeding was always ready everytime "Gatas" was mentioned. I will defer from mentioning all your names 'cause I might leave somebody out, hehe. Thanks for co-managing IV's and telling me.

INTERNAL MEDICINE

I grew to love IM here. I was intent on pursuing my dream field of Neurosurgery before I came to rotate at IM-SMC. Thanks to all of you, I am officially at a loss of where to go next. I loved the late night rounds, the collection of people during codes, and ultimately, I guess the challenge of diagnosing, and treating patients here appealed to the nerd in me. Haha. Me and my challenges.

The Residents

I'll remember Dr. Sat Paciencia's nosebleed ECG interpretations and slashes to the basket, but I'll let him take that 3 point shot any day; Dr. Ryan Cruz's rendition of September and videoke nights, and outings; Dr Gayle Opada's census; Dr. Charo Amasula's laughter, respect, and easy-to-get-along, we're-learning-together attitude, Dr. Dehuel Cuyacot's one-liners, impressions, petroleum jelly and of course, a venerable source of wisdom and enlightenment, Dr Jasmin Lubguban's work ethic, commander-in-chief attitude, rolled cotton and lessons; Dr Joel Borromeo's busy nights, trusting me in the ward, and learning at the ER; and last but not the least, my elder "sister" 'Nang Dr Venus Saceda, having known her before, I look to her as a model and listen to her advice, and I'll remember her for the kindness she showed all of us, work ethic and her green blue book and bright notebook.

The Consultants

Again, too many of you to mention but I thoroughly enjoyed having had a peak into the genius of Dr EGHMoleta and Dr MFUdarbe, who also happens to share a passion for sports like I do; I'll remember the suave Dr JGMagbanua, the cool Dr BGSy, the intimidating and imposing figure of Dr KTCoo, the dazzling beauty and brains of Dr SORosario and SODenura, the fanning of slides with Dr MDUy, the sharp mind of Dr JCCredo, the wisdom of Dr GBRosario, the cool Dr GNGarcia, among others whose contributions made IM fun for me.

The 3rd floor

Believe me, chaos was a mild way to put it. But yet, we made it work. Charts everywhere, sheets of paper anywhere, phones ringing off the hook, medications to be given and hallway admissions are a norm. Yet we made it work. Thank you for those who didn't get my charts when I laid them out in order, or those who got them and returned them so that I wouldn't know.

OB-GYNE / SURGERY

OB-Gyne here wasn't as stressful as in my previous life as an intern, and I thoroughly enjoyed it. Surgery was great as I often found myself being entrusted with suturing, incisions, assessing trauma patients which I loved doing.

The Residents

I will remember Dr. Bernadas' late night quizzes, rounds and fast OR times; Dr Sibul's patented chika endorsements, taray tirades and a really cute AJ, and Dr Badon's motherly and friendly companionship and especially deciding on dinner. For Surgery, Dr Sanico's last duty and my first, as the busiest it could possibly get with me alone outside with an anisocoric admission while he was in the OR; Dr Rebaya's captain-of-the-ship personality with questions, quizzes, and battlefriends; Dr. Jabines' laid-back personality, entrusting me with responsibility at the ER and amazing me with how sturdy a Nissan Sentra can be; Dr Guinto's do-it-all attitude and quick trigger to answering questions; Dr. Casamayor, the new guy on the block, well I got to know him before, and he has no air about him and carries his weight as a young aspiring surgeon.

The Consultants

Still too many, yet the mastery and the brains of Dr LSSerillo will not be forgotten and his revalidas during morning endorsements will be treasured; the institution that is Dr RVJandoc, steady, true, still in his "prime;" the orthopod encyclopedia and my PT anatomy teacher, Dr EPKatada; the smooth Dr MSBaviera; the brains and humor of Dr MTOzoa; the megaphone and the man in charge Dr CBRana; the fast hands of Dr MASingco; the sports enthusiasm and encouragement of Dr KLGubantes; the cool Dr STFlores; the prince of the province Dr PPAbsin, and the petite yet all-around Dr MCVera Cruz, and the bachelor Dr JAOccena. I will also not forget the never-rattled, always smiling, calm Dr VTreyes, the cool Dr GCAustria, the frantic pace and fast hands of Dr CDUy, the institution that is Dr MSKho, the young smiling Dr FPVasquez, among others.

The 2nd Floor

Dressing and late night food trips. Things were made easier in the 2nd floor from dressing to rushing to the DR and OR calls, thanks to all the nurses, aides and staff.

FAMILY / COMMUNITY MEDICINE

The Residents

I will not forget the advice, the head-bobbing, the late-night talks, the understanding, the making-children-cry, the signature of Dr Mona Ducay-Alota, Doc thank you. The voice, the gentle smile, and slow to anger, owner of the LTB Bar Dr Teng, the helpful Drs Mana and Sadjail, who has two really cute kids; the fiesty take-no-prisoners Dr Tulang, and a former resident, her coolness herself Dr Abam(b)onga.

The Consultants

Who can forget marathon rounds with sphygmomanometer in tow with Dr LTBandoy? The simple, quiet, effective Dr ELJuan; the voice of reason, and driven Dr MLUrsos, and the friendly, jolly, suave Dr RSArco.

The ER

Codes. Admissions. Toxic patients. Truly one of the best learning places in the entire hospital. I know I had my male aide moments but I thoroughly enjoyed the ER experience.

The Interns

Lost is putting it mildly. Piece of advice, listen to your superiors, know your place and check your attitude at the entrance. We may have come from different styles of training, but there is no place where you can teach humility, hard work, discipline but within yourself.

The People

From the admin, to the HR, to the dietary, to the Surebright, to the laundry, I cannot express enough how thankful I am with how great this year has turned out to be.

Until we all meet again we hope we all have your prayers.

Thank You.

I'm off to study now.

Relearning What I've Learned

2008-05-12T22:49:00.000+08:00

I have had great teachers in my life, some more mentors, some tormentors, and some just as clueless as I was.

But med school was a different story.

You see, I am a product of a new breed of educational style, the problem-based learning method of teaching medicine.

There are different opinions regarding the system -- the conservative and old school doctors have spelled doom for it, the flexible have embraced it, though the majority probably stand in the middle and don't know what to make of it. The last group includes me, those who had no choice but to go through it.

Yes, I admit that, going into my first year of med school, I did not want to leave the safe confines of the old traditional way of teaching. But as the four years went by, I realized (not having a choice of system, aside of course) I realize, it's not without flaws but it works.

Here, the entire class is broken down into small groups and we take on a module, raise learning issues about it, read up on them, dissect the management and talk about them with our fellow classmates. In short, we sort of, teach ourselves. You're asking where the teachers are in this set-up? Well, our teachers are quietly sitting behind us, grading us with how we share, how much we delve into the subject matter, and if needed, provide often-needed insight into the problem.

In our discussions, I was fond of saying, "If I'm not mistaken..." or "If I remember correctly...", and our group preceptor (what we called our teachers) called me on it. She said, "You should have more confidence in what you know and what you've read," and "It's either you know, or you don't. You get mostly right answers to the problems but being so defensive takes away from knowing you are right."

I made it a point to never be so defensive again.

There were some forgettable experiences as well. Like the time when I was part of a group reprimanded for touching a model of the female breast that we never knew we were not supposed to handle in the first place. After all, we thought it being our surgery module, what was a supposed breast model for, aside from practicing the breast examination? Some were having a little bit of fun with it, but there were some who were practicing in earnest.

I recently finished my post-graduate internship this past April 2008 and I'm hoping to be one of those who have learned enough to pass the August board exams, and for the past year, there have been no shortage of mentors and I thank them all.

I remember, towards the end of our internship year we had an orientation into the different specialties available for aspiring physicians like us and what one general surgeon said struck me and its a philosophy I've tried to live by as I go on my path of learning: Our greatest teachers as doctors, are our patients. What you learn from one patient, absorb it, milk it for all the learning you can get, because what you learn from your patient, no one else and can take from you. It is yours and yours alone."

It was in that context that I remember one particular "teacher", way back when I was a Physical Therapy intern. I was assigned to this incomplete spinal cord injury patient for a whole month. It took painstaking PT sessions to even get him to use whatever motor function he had left, preserve it and improve on it. I had grown used to calling me "Doc" though I told him countless times I wasn't. At the end of my time at that center, we had accomplished so much that he regained standing balance and begun his gait training. When he took that step, however, unstable it was even with the gait belt in my hand and a co-intern locking his knee, there was no mistaking the happiness in his eyes. His mother came to me after and thanked me, and that she wanted to continue her son's treatment with me. I told her that he would be in good hands even in those who will follow me. I certainly hope I was not mistaken.

It was one of those pure moments in my life where I realized I made an impact in someone's life.

In retrospect, I learned then that being in the service of people, being a physician, and making an impact in other people's lives is how I want my "job" to be.

Call me naive or young, but we all once felt this way, I think. I guess, we just have to relearn from our "teachers."

Some Good Things

2008-05-06T22:19:00.000+08:00

There have been too many goodbyes in my life.

As our PGI year comes to a close with mostly trying to clear ourselves from the hospital for more time for reviewing, finishing up paperwork and making discharge summaries, and packing stuff up from Abby or, in my case, from home, I find myself saying goodbye yet again.

For the record, I don't like saying goodbyes.

But slowly, surely, we have to. Arlyn has gone home to her son and family for a break before resuming her extensions, (though she would have preferred to take the boards this August), Emma is off having her own little vacation, Ligaya is saying goodbye to us tonight, as she is heading home and off to her Phuket vacation with Ria, and she most likely won't review with us (she's perfectly capable of passing without reviewing especially with that freakish brain of hers). All the rest of us left behind are left to fill up their spaces which are obviously hard to fill.

I lay in bed, feeling... well, "weak, small, and alone."

It feels like pieces of this nice year I've had are slowly being broken off into little pieces.

Removed from all other people in this life, I realized, we're simply alone. Single. Individual.

As I lay in my bed at 1:26 am, it hit me, this is ending. Should it have to? Can't it wait? Can't it go on? It was fun wasn't it? It was all about learning and helping and medicine? No answers to some questions. Uggghh, couldn't even think of something original. I had to borrow from all the other's bylines.

I slept.

I woke up.

I decided. It won't have to end. I will love my home for as long as I'll live. I'll remember SUMC and hope to come back again. I will take all those pieces and hold them dear to my heart. As they will be part of me.

It won't end, we'll see each other again guys, along life's trodden and not-so-beaten paths. I love you for being part of all this.

Though we are alone in this world, we gather strength in being together.

Some good things may never last, but sometimes, you just have to pick up where they left off.

No regrets.