Sunday, December 14, 2014

About to begin

RESIDENCY begins on the 16th of December. Last week, I was handed my schedule for the entire year. I'll be at the Pay Wards on December, the Charity Wards on January, and the Medical Intensive Care Unit, hereon referred to as the MICU, on February—that's all I can remember for now. I will have my out-patient clinics every Tuesday morning and Thursday afternoon. I will have 24-hour shifts every three days. Except for the seven-day “leave” (yes, it's in quotation marks because it doesn't really exist) on the third week of August next year, I will be doing rounds every single day of the year 2015, regardless of holidays, floods, or supertyphoons.

 

To do these things, I will have to cancel some engagements, postpone meet ups with friends, absent myself from reunions, and even miss church. That might mean fewer blog entries too.

 

Friends who've taken specialty training are unanimous in saying that first year residency, at least at PGH, is the hardest. But once you're done with it, you're good to go for the next two or more years. Dr. Alric Mondragon, the out-going chief Internal Medicine chief resident, told me to “take it one day at a time.” Thinking too much about tomorrow can get overwhelming, sometimes discouraging.

 

One can never be too prepared for residency; it is almost like med school but harder. One must find time to study, on top of delivering quality patient care and getting sufficient rest. One must also keep one's self humane, because residency often makes robots out of doctors, a tragic irony. It must be the non-stop work, or what pyschologists call “caregiver fatigue,” which government health care workers are often prone to.

 

I don't know how I will fare, but I pray that I always find strength and joy in the Lord. For the past weeks I've made a list of resolutions, inspired by Jonathan Edwards, which includes: that I always pray for my patients and be a kind and competent internist for them; that I be Christ-like in my dealings with them; that I be humble in my interactions with superiors and colleagues and that I think highly of them. I can do these only by God's enabling grace. And so my perspective must always be heavenward. I must immerse myself in the study of the Scripture. I must make every effort to fellowship with other believers. I must also put my theology into practice.

 

Dear Reader, do pray for me. And thanks for always sticking it out.

Saturday, November 22, 2014

Lila by Marilynne Robinson: a story of grace



YOU READ a book, expecting to have fun, the kind that your brother Sean, who hardly reads anything at all, save for his textbooks, won't ever understand. You begin with the first few paragraphs. Amazed at the craftsmanship of the sentences, you keep at it—the pleasures of reading, they call it. Then you lose grip of time; your head is up in the clouds of the story—a made-up world that, for a moment, seems more real than reality.

You wonder at how words—letters pieced together, their meanings defined by spaces or lack thereof—can have such an effect on your emotions. Apathy turned into concern, rage into sorrow, discontent into delight. Or maybe a combination of them, because a person, indeed, has the capacity to handle, though not completely explain, a wide range of feelings, like the spectral colors of the rainbow in the afternoons of childhood.

Monday, November 17, 2014

Soaring like the eagle in the light of the eternal sun

AS A SUPPLEMENT to my daily devotions, I'm reading "What Happens When I Pray?," a condensed version of the works of two not-so-famous classic Christian writers, Thomas Goodwin and Benjamin Palmer. My copy is published by Grace Publications Trust (London, England), and is a rewritten and abridged version prepared by Dr. N. R. Needham, in order to cater to a modern-day readership.

Thursday, November 13, 2014

Karl Ove Knausgaard on brothers

KARL Ove Knausgaard is a Norwegian writer whose monumental book, Min Kamp (My Struggle: Book One), is what I'm currently reading. Critics call the 3500-page autobiography monumental; I can see why. There's nothing so special about the subject--his life--but he writes in such a way that keeps the reader, any reader, hooked. Compelling: that's the word for it. He keeps us interested, finding meaning in the minutiae of life: his breakfast, his band, his first pseudo-sexual experience, his father's death. One of my favorite book critics, James Wood of The New Yorker, said that "even when [he] was bored, [he] was interested."

Wednesday, November 12, 2014

Laughing at politics

AS I WAS INUNDATED with news of the Senate Blue Ribbon Committee crucifying Vice President Binay for his alleged involvement in an overpriced parking space or airconditioned chicken farms, I discovered the HBO original production called Veep. Having resolved not to get too involved with national politics, I considered Veep a welcome diversion.

Saturday, November 8, 2014

To be the best for my patients

THIS IS an excerpt from my pre-residency admission essay for Internal Medicine - Philippine General Hospital. A set of guide questions where given. The essay reads like one of my blog entries, so here it is.

1

I'M LANCE, and unlike many people who go by other names, I'm simply “Lance” to most people I know—except perhaps my father who still calls me “Bon,” after the best sound I could blurt out when I was barely beginning to speak. My mother, then a voracious reader before her migraine attacks, named me after Lance Morrow, the Time magazine essayist who wrote about Imelda Marcos's shoes in the late 1980s. I emailed him ten years ago (I was 14), and Mr. Morrow jokingly said he and my mother were just “friends.” These days people call me “Doc,” so I guess I had better get used to that, too.

Wednesday, November 5, 2014

Undeserved

LAST WEEK I had the privilege of being one of three people to share my testimony during my church's Wednesday Prayer Night. Here's an excerpt:

The sovereign grace of God underlies and explains every believer's life experiences, both the good and the seemingly bad. The true Christian knows that God lavishes His children with His providence—all of it undeserved, unmerited, and overwhelmingly so. We who worship the true and living God are assured that all things work together for our good (Romans 8:28) and for our Master's glory, a realization we often arrive at on hindsight. We usually go through hard times without completely making sense of our circumstances. Only by looking back can we appreciate the tapestry of God's grace, beautifully choreographed like an ingenious master plan, the end of which is our prizing the Lord Jesus Christ above all things. We also become more like Him. And, like the writers and poets of old, our hearts are filled to overflowing that we can't help but sing of God's great love for us. It is therefore a privilege for me to “sing,” figuratively, of God's undeserved blessings in front of you tonight. Let me end with Isaiah 54:10: “'Though the mountains be shaken and the hills be removed, yet My unfailing love for you will not be shaken nor My covenant of peace be removed,' says the Lord, who has compassion on you.”

Thursday, October 23, 2014

My NBI Clearance experience

GOT MYSELF an NBI Clearance today. Took me the whole morning. I was exhausted, and my face looked like a convicted criminal. “You're lucky,” you'll probably say, given that for some, the process can eat up the entire day or more.

Roddy Doyle's The Commitments: listening to the soul of Dublin


Irish writer Roddy Doyle. Photo by Patrick Bolger, The Guardian.

I FIRST HEARD of Roddy Doyle through The New Yorker Fiction Podcast hosted by the magazine's fiction editor, Deborah Treisman. The guest on the show was Dave Eggers, a writer in and publisher of McSweeney's, a literary magazine. In that episode, Eggers read “Bullfighting,” Doyle's short story about friends from Dublin who go to Spain for a quick vacation. The story kept me entertained throughout my hour or so of commute from Manila to QC a few months ago. What intrigued me then was Eggers's statement that although he is not a completist, he has read everything written by Doyle.

Thursday, October 16, 2014

The second paid job of my life

THE SECOND paid job of my life will be at the Department of Medicine of the Philippine General Hospital. By God's all-sufficient grace, I made it through two weeks of competitive (yet surprisingly enjoyable) pre-residency, then a month or so of patient waiting and praying for the Chief Resident's call that should come on the third or fourth week of October, if I qualified for the top 21 slots.



Photo: Dr. Ralph Villalobos

Tuesday, October 14, 2014

The first paid job of my life

image

THE FIRST paid job of my life was in a small infirmary in a coastal town along Sarangani Bay. I started working as doctor-reliever yesterday. My father, excited to see his son finally face the real world after years of studying, drove me to the hospital. My mother insisted that I bring a towel and a blanket, in the loving way that mothers nag their grown-up children to do the most illogical things. Tatay dragged my grandmother and my two other uncles with us. To the casual observer we must’ve looked like a family on a field trip, sans the embarrassing tarpaulin.

Saturday, October 4, 2014

Reciting the Hippocratic Oath

Physician Oath-taking Ceremony 2014
With my internship block. Photo credit: Dr. Agnes Custodio

NO SURGE of emotions, no tear-stained eye, no passionate sighing overcame me when I recited the Hippocratic Oath this morning with most of the country's newest physicians, passers of the August 2014 Physician Licensure Examination. But what's done is done; I am, by the grace of God, a full-fledged doctor. Many thanks for your support and prayers. Special mention goes to some of my dear friends who visit this blog daily and to random readers who wished me well and sent me encouraging emails in the course of my board review. I thank God for you.

Friday, October 3, 2014

In which I list the books I've read, lest I forget them

THERE ARE moments when I find more comfort in the presence of books than people. Reading is one of the very, very few things I do that keep me quiet—the others include sleep and prayer, but even those sometimes have me saying things aloud.

I turned to reading during the last few weeks leading up to the Board exam; I went back to it after my application for residency. By reading, of course, I mean me tackling non-academic, non-medical pieces of literature; including my medical textbooks will inevitably bloat my reading list. When I read fiction (don't say “pocket books,” unless you're reading a Mills and Boon paperback romance), I am transported to other worlds created by the author's mind. Why that's so thrilling is something only readers will understand—a thrill that, in my opinion, should be experienced by all. But, alas, not everyone has the patience for the written word, let alone pages and pages of it. But the truth is that much is lost when one forgoes reading—a perennially recurring tragedy, what with the advent of smart phones and tablets, leaving people, especially impressionable children, more adept at computer games than self-examination and empathy.

Friday, September 26, 2014

Marilynne Robinson's Housekeeping: suicide, adolescence, being different, losing someone

MARILYNNE Robinson's Housekeeping is a work of art. Every word, carefully chosen, reverberates in one's consciousness. Every punctuation matters. One does not sense the struggle in the writing process, if there ever was, because she makes it sound so effortless. Her prose reads like poetry—quiet, calm, soulful. Her language is masterful, often restrained, but so packed with the written and the unwritten that one should read it carefully, slowly, never in a rush, in full concentration, lest the story dissipate elsewhere. She deals away with clich├ęs but makes use of the full armament of her vocabulary to illustrate something or make a point. The landscape she paints of the town of Fingerbone, Idaho, where much of life is built around the lake, takes the reader to its darkest, hidden corners.

Thursday, September 25, 2014

On "An Auto-Corrected Journal of Printing Properties: Selected Texts On A Contemporary, Art, and The So-called Elsewhere-Anywhere"

WHILE STUDYING for the Boards, I often hung out with Renan Laru-an, the founder and current director of DiscLab | Research and Criticism—he, working on a book to be launched in New York in the Fall; me, rereading my annotated textbooks. I felt so scholarly in the presence of a writer/editor.

Saturday, September 6, 2014

Chronicles of my passing (the Boards)

TWO DAYS before the Boards I trained myself to wake up at 4 am—not exactly a gargantuan task, since I'm pretty much a morning person. The exams would start at 8 am, but the call-time was set at 6:30, at the Manuel L. Quezon University in Quiapo—a dangerous place where snatchers abound, or so a friend told me. This friend related to me a story about someone she knew, a medical graduate ready to take the exam of her life, only to have her exam permit snatched away. That someone was disqualified from taking the test.

Before August 23 were three months of intense studying—not the most stressful period of my life, because reading and taking down notes and outlining are pleasurable for me, perhaps among the very few moments when I'm actually mum. (And, thankfully, preparing for the Medical Boards was not as discouraging as studying for the Bar Exam, where only one in five people passes). Finally I was making sense of concepts that were previously vague to me, things I always got wrong in tests, or sets of facts that didn't appeal to my academic interests but needed memorization anyway—like cancer staging. I remember, with regret, that in med school I had sailed my way through rounds by 15 minutes of cramming, or with the help of Medscape, the UP-PGH intern's most useful textbook app. What could I have done without it? There was hardly any time for rigorous personal study time then. So I welcomed the Boards as an "exclusive" opportunity to go back to my books, something my mother correctly said I should have done since Day One of med school. (She was reprimanding me for dwelling more time on my literary readings; mothers do know best.)

Friday, September 5, 2014

Pass

prc result

THIRTY MINUTES ago I woke up with a jolt, my eyes still adapting to the dark room, for I had already been asleep for some time. In a corner I saw my brother browsing his phone, then I heard him calling out to me, his voice pregnant with urgency: “Lance, Lance … you passed.”

I knew this time would come—I just didn't know when, or whether the results would make me jump for joy or seek a distant hideout. My first impulse was to thank the Lord for His goodness. What good thing can I do apart from Him, after all? In my heart of hearts, I knew I couldn't have done it without Him. He has seen me through med school; He has seen me through the Boards. All glory and honor to God Almighty!

Wednesday, August 20, 2014

PTSD

OUR class president, Jonas Bico, for whom I have the highest respect, told us that he has been having difficulty sleeping these past few days. He thinks a lot about the upcoming Boards, a preoccupation many of us share, an incessant personal battle waged with feelings of dread and worry and hope. He sleeps in the wee hours of the morning, only to find himself waking up again to a day closer to August 23. Our diagnosis: PTSD. 

Pre-traumatic Stress Disorder. That's not included in the DSM-V yet, but it will be in the sixth. 

.  .  .

HIS reply, via SMS, when I told him I had written about him:

"Waaah, ilang tumbling na lang. #Listeria"

Monday, August 18, 2014

Routine

THE SIGHT of my classmate Al sitting in a zen-like state at the Student Lounge the entire day reminds me of how many of us are creatures of habit. We may hate routine, but there is a sense in which all of us have been programmed to follow a certain order of things. We have the suprachiasmatic nucleus in our brain, the part that dictates our body clock. We have habits we can't do away with easily, like coffee. Some can't move on with their lives without taking a dump first. We are, indeed, funny creatures of habit—a fascinating fact given that we often complain of the drudgery of our existence.

Al likes his spot; it doesn't make him sleepy. Meanwhile I study in the library because I like being surrounded by books. These past days, whenever I take bathroom breaks—and I do it a lot (diabetes insipidus, perhaps?)—I make it a point to say hi to him (his spot is very near the toilet), just to remind him that there's a world outside of books. He seems to like the routine, but like everyone else I've talked to, he wants the Boards to be over. I'm not sure I do.

Wednesday, August 13, 2014

The Library

I AM, in a sense, back to the old grind. I have exhausted my tolerance for coffee shops, my room, the kitchen, or my favorite Dunkin Donuts store that serves excellent coffee. I will probably miss the cold airconditioning or the funny waiters who already know my name or what I will order. But there is a comfort in being with like-minded friends opening similar books or discussing similar problems or sharing similar mnemonics (the weirder, the better). The Boards is just a few days away. I will find myself huddled in a quiet corner at the Med Library today, surrounded by journals and books written when I wasn't around yet—or better yet, by friends who, like me, have tons of materials waiting to be read and highlighted. The day is long. May God be our strength.