Very normal

NOTHING much happens in Tom McCarthy’s Satin Island. An anthropologist, who works in-house at a big commercial firm, writes about Claude Lévi-Strauss, parachutes, oil spills, his love life, and his modern-day theories about civilization. The novel reads like a diary. The prose is magnificent.

“The terminal’s interior, despite its new façade, was dingy. Parts of it were boarded up, awaiting repair. The smell of popcorn, hot dogs, pizza and donuts hung about the concourse, impregnating air that was much warmer than the air outside—cloying and heavy, too. People were milling about, waiting for the ferry: normal, everyday folk who commuted on it daily. A few of them wore suits—cheap, polyester ones, the standard-issue outfit of the low-white-collar ranks; but most wore plain, casual clothes. They looked bored, frumpy, tired, unhealthy, overweight, and generally just very, very normal.”

Adding it all up

I see "345" in the cash registry—three digits flashed in green light on a dark background, like how they had appeared in old calculators in the nineties. I’m in a queue at Wendy’s, buying bacon mushroom melt with friends and Coke Zero—my long delayed lunch. I hand two one-hundred peso bills, and two twenty-peso bills to the nice lady behind the counter—confidently, as if had, in fact, added them correctly in my mind. “Sir, kulang pa po,” she tells me. I rectify my error, a realization that although I like mathematics, I do not like arithmetic.

Admit

While I was leisurely reading my morning paper, @dindindinny and @ninolator—the Instagram rockstar—sat in front of me and joined me for breakfast. The music playing. was John Mayer's "Love On The Weekend." Our morning chat was a pleasant surprise; but ala

WHILE I was leisurely reading my morning paper, Din Floro—my senior in IM, now a gastroenterology fellow—and Niño Lucero, the plastic surgeon who doubles as an Instagram rockstar, sat in front of me and joined me for breakfast. The music playing was John Mayer's "Love On The Weekend." Our morning chat was a pleasant surprise; but alas, duty called. It's admitting day today.

Too early, too soon

Untitled

A young doctor almost my age—plus-minus a year or two—has died. Someone shot him one night: a bullet that killed him right on the spot, piercing his heart. Four years of medical education, one year of internship, all these on top of the four or five years of college undergraduate education—and then this: an armed man who, for whatever reason, pulled the trigger at him, leaving him defenseless as he lost blood and eventually his consciousness.

He was, I later learned, a gentle soul: a towering six-footer but whose voice was sonorous, whose ways were charming. And charm the entire Lanao town he did: the people he served loved him, for who would leave his family to ease the suffering of his lowly Mindanao community, many of whom hadn’t met a doctor in the flesh until his arrival?

There is no escaping death, but there are good ways to die—and his came too early, too soon.

My first General Medicine Service

Service Four — March 2017

THIRD year residency reaches its pinnacle during the four months of being a service senior. Under a General Medicine service are two or three first year residents, interns, and clerks, plus the second year residents who go on duty at the Emergency Room. The responsibilities are overwhelming. Aside from being a clinician, the Gen Med senior is also expected to take on administrative tasks, which include, among others, assuming primary care for patients previously handled by other specialties; providing clear-cut dispositions to patients; setting short- and long-term goals for problematic cases.

March is the first time I'm taking on the role of a Gen Med senior. I'm working with Drs. Nico Pajes (first year IM resident) and Clare Enriquez (our Neurology rotator), and it has been a pleasure to struggle with them thus far. Every night I ask the Lord for wisdom. I pray for my residents that God continually sustain them. I also pray for our students: that they become battle-tested, compassionate, competent physicians in the future.

We had a service dinner last night, something that has become a tradition during the Ward rotation. With us were our interns, Chacha Mercado, Gerald (Baby G) Mendoza, Jeff Manto, Marz Marquez, Athan Lozano, and Joan Lampac. Two of our bubbly clerks also joined us: Ichi Nakamura and Carl Marquez.



Onward, Service 4.

Abroad

The subject of my blog came up as we wrapped up our evening ER rounds—five patients so far; three we could potentially send home. But the night was young, and the ER has been notorious for getting jam-packed in the wee hours of the morning.

Our JAPOD, Chacha Mercado, whose voice resounded loud and clear at the Acute Care Unit, and the senior intern with her, Gerald Mendoza—someone we had taken to calling “Baby G,” because he does look pediatric, save for his small stubs of facial hair—asked me about my blog. I usually respond cautiously to these questions: a person having read my website must have already known a lot about me, and I must’ve overshared some points in my life during my more irresponsible, younger years.

I learned that one intern who grew up abroad had discovered UP because of my blog. At the time—and I haven’t checked it yet—there was probably no functioning website for the hospital, perhaps the least of the administration’s concern, given the other, more desperate problems in the health care system it was facing. While she was searching for “UP Medicine” online, my blog came up. She hasn’t confessed anything to me yet; she’s rotating with the Department this month.


Off to Guazon

It's a rainy morning today. I'm headed to Guazon Hall to spearhead the morning endorsements of the students. I spoke to some of them this morning as they were gathering at Ward 3: they were tired; their shift was eventful. As in: two simultaneous codes just as they were being endorsed to. My Vietnamese coffee[1] is warm, just the way I like it. Praise God for this day. Happy Saturday, dear reader!


[1] Many thanks to Bea Uy, who gave the beans to me last year.

Boring update of my monthly weekend off

COMING home late from Lea Salonga’s Songs from the Stage, I had a good rest, so good I had almost overslept—which means, I woke up at seven. My parents, hardly getting any shut-eye, rushed to the airport to catch their early morning flight. I wasn’t able to say my proper goodbyes, though I did feel Tatay kissing my head and fixing my blanket to make sure I was warm.

Tatay texted me at 10 am to tell me that they’d just landed; this, while I was sipping coffee. Sean would meet them at the airport. They’d have brunch at Auntie Net’s charming home in Gen San. The apartment seems quieter without them.

After his morning French class, Manong still hummed Hamilton’s “Burn,” which Lea sang so well last night. We all thoroughly enjoyed the show: a mix of the old and the new, the classic and the contemporary, but still the same Lea Salonga we’ve all, as a nation, loved and adored.

Our plan then was to eat seafood in one of the busy restaurants along Macapagal Boulevard, but it was nearing midnight, and Tatay, who, even in his drinking and smoking days, confessed to hating coming home late, would hear none of it.

Typing

I’m writing this piece using an old desktop, recently resurrected by the more technologically-minded among us. The computer has been lying around beside the call room’s front door. It’s immediately on my own desk’s posterior.

I like the staccato sound of the BenQ keyboard, still dusty after many months—probably years—of storage. The computer reminds me of my first desktop, the first one I’d ever owned, which I bought in 2005, cheaply at 25 thousand pesos at a store in Gilmore Street. My friend Luther, who would eventually graduate summa cum laude in electronics and electrical engineering, accompanied me that morning. I didn’t care what the specs were—processors and RAMs were his thing, and choosing the best one for me, at a price range I could afford, thrilled him. What I was really after was how the entire ensemble would look like. I wanted my keyboards to have a clean font.

At the time, all dorm rooms had actual desktops, with heavy monitors that had to be detached from the CPU box. Residents would assemble them at the beginning of the semester. They’d be dismantled during semestral or Christmas breaks, when the dorm would be closed. Only very few people owned laptops then.

I miss that desktop. I would eventually ship it back to Mindanao, where my brother Sean would use it as his own, mostly for gaming and playing music—things I didn’t have much interest in that the time.

These days I own a very slim laptop—an 11-inch Macbook Air—which is lighter than my Internal Medicine textbook. How technology has grown indeed. I place it inside my satchel and sometimes forget it’s there.

Books I’m currently reading

St. Lucy’s Home for Girls Raised by Wolves by Karen Russel. Stand outs from this short story collection: “Ava Wrestles the Alligator,” “The City of Shells,” and “Z.Z.’s Sleep-Away Camp for Disordered Dreamers.” “Out To Sea,” where a beautiful girl named Augie visits an old retiree, was romantic but lonely.

Between You & Me: Confessions of a Comma Queen by Mary Norris. She’s the copyeditor of The New Yorker magazine. She’s so passionate about her work that she refers to punctuation marks like they were human beings. A very endearing work that, aside from telling us how Miss Noris got into her job (it is primarily an autobiography), she also tells us the difference between an em-dash (—), an en-dash (–), and a hyphen (-).

Is Everyone Hanging Out Without Me? (And Other Concerns) by Mindy Kaling. I had tons of laughs with The Mindy Project, a show written and produced(?) by Miss Kaling herself. The hilarity was in the depiction of an Ob-Gyn who had all the time in the world. In real life, my friends in that profession could barely attend dinners, with their cesarean sections and all. Very light reading but quite insightful, too.

Ending my Toxicology rotation

I HAD never talked to so many strangers over the phone as I did this month. Generally my interactions with the callers, mostly physicians, were pleasant. There were few that stood out:

-- a man from Mindanao who asked about pesticide poising. "Sino po ang nalason?" I asked.

He said, "'Yung saging ko po. Hindi ko alam kung ano ang nangyari kasi hindi na ganoon karami ang bunga niya."

-- a physician calling from Mlang, North Cotabato, who, when he asked who was on other line, recognized me. "Dr. Lance Catedral?!" Apparently he was a classmate of one of our interns last year.

My month-long Toxicology rotation would not have been half as enjoyable had I not met the following:

Toxicology

From left: Drs. Bitoy Bongon (Tox fellow), Reg Lactupo (Emergency Medicine, PGH), Leslie Garcia (Tox fellow), Jem Agnes (Emergency Medicine, Ospital ng Makati), Racquel Bruno (Internal Medicine, PGH), JP Ner (Tox fellow), Jela Matibag (Emergency Medicine, Makati Medical Center), and Nowell Catbagan (Tox fellow).

It was so fun that I understand Jela's reaction when all of us parted ways.

Jela leaves Toxicology.

See you around, dear friends!

On sinkholes and homelessness

Commute

FOR THE past four weeks, I have left my dorm room and started commuting daily from Quezon City, where my brother lives, to Manila, where I work. It has taken me about an hour--two hours tops--to traverse Quezon Avenue into the perpetually congested España Avenue, which flows either to Lacson Avenue (which is, after office hours and at night, populated by huge delivery trucks and is almost rendered impassable), or to Quiapo, where the jeepneys use half of the road as parking space.

The SRO

I'M glad my second year of residency is over.

Second year callroom
Last few days as second years


Since the start of the year, I've transferred to the Senior Residents' Callroom (SRO), literally in the landing between Wards 1 (on the first floor) and 2 (the Surgery ward, on the second). Just when I thought the Second Year Callroom was going to end up in my book as the best quarter of my residency years—we transfer callrooms every year, if that isn't obvious to you yet—the SRO has emerged as the eventual winner: it's more spacious, it has a bathroom of its own. Natural light seeps through in the mornings. The PGH Wifi connection is arguably faster, too.

New table at the Senior Resident Callroom

I inherited Kevin Bismark's desk, a testimony that he has lived his final year in IM with travels, trips to the dentist, and a lot of studying. I had to set some of his things aside to let mine in (he is, as far as I know, still traveling): a few books, my laptop, toothbrush, a desktop sharpener, a collection of pencils inside a Malacañang mug given by an OPD patient, my actual coffee mug given by a different patient now dead—the same patient who called me "the best doctor in PGH" and gave me a plaque for it. Embossed on it is his artistry: he made caricatures with colored glues on various surfaces for a living, and despite being easily fatigued, he took the time to remember me. I miss seeing him in my clinic. You'll see another plaque, too—one that bears "Best Doctor in the World," which my aspergilloma patient gave me two years ago. I don't believe that I deserve these plaques at all, but I'm grateful. Truly.

Give us a call

ONE thing that excites me in Toxicology is the ringing of the phone and what the other person on the other line might ask next.

I've been manning the National Poison Management and Control Center since the start of the month as part of my rotation in Toxicology. The duty schedule is hectic for my senior year—24-shifts every three days, with no true post-duty (or "from-duty," as my non-PGH colleagues say) status. My stay entails that I provide telephone support and medical advice to physicians and laymen all over the country about all things related to poisoning. This means, of course, that I must know the active substances of popular products. My knowledge, I've realized, is limited. Thankfully, however, beside the three phones in the office are the Pandora's boxes of precious toxicologic knowledge. Whereas online databases can only give us so much information, this collection of 6x8 cm index cards, many of them dirtied by the patina of time, provides the answers as to the active ingredients of katol (pyrethrin), Johnson's cologne (phenoxyethanol), and glue gun (non-toxic at all).

I've received calls about a farmer who swallowed a sachet of pesticide after fighting with his wife. Many such ingestions fill our daily census, which the office forwards to the Department of Health at the end of the year. There are cobra bites in Bohol, sodium hypochlorite (Zonrox being the most popular brand) ingested by depressed people all over the country, noxious gas exposures of elementary school students in Central Luzon, and, the most memorable of all, a petroleum ingestion by a cat owned by a horrified, distressed young lady.

The most important detail I ask is the type of poison, if the substance is poisonous at all. The next details I ask are mainly related to the circumstances leading to the exposure: whether it was accidental or not, where it happened, and how the patient was doing. The rest of the information are for the completion of our census.

Receiving calls from complete strangers feels like being a night-time radio talk show host. The simile stands: people really phone in to get sound advice, knowing they'll get better with the knowledge that an expert has heard and processed their concerns. I suppose, if we broadcast these calls—barring expulsion from the practice of medicine due to disclosure of confidential information—we'd be a hit. Imagine the possibilities: The Toxicology Radio Program! You have broken hearts? Don't swallow a thousand of those pills—just give us a call!

CAT

Untitled

Untitled

YESTERDAY was my first Adult Medicine CAT presentation, as senior, with Jaja Saliba, Butch Roque, Berbi Berba, Josh Cruz, and Racquel Bruno (in absentia). We tackled mortality in transfusing short- versus long-term storage blood [1]. A great, fruitful discussion. (There's no difference in mortality rates.) It was also wonderful to have Dr. Tony Dans back.


[1] Heddle et al. Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion. N Engl J Med 2016; 375:1937-1945

Just words

Some words or catchphrases—many of them made up—sound terrible to me; therefore I’ve endeavored never to use them, except now, where I list them:


  • millennials — Just another word, I suppose, for self-absorbed people. I think this distinction—calling people Generation X, Y, or millennial based on the year they were born—is all made up.
  • netizens — I prefer “internet users,” or “people” in general. Everyone I know has encountered the internet at some point.
  • twinning — Use “twins.” This is acceptable, though, when talking about some process after fertilization.
  • adulting — It sounds so immature. I’ll only use this if pediatric-ting becomes a thing, too.