A nature changed

This nature is changed in every believer; for it is impossible a man should stand bent to Christ with his old nature predominant in him, any more than a pebble can be attracted by a lodestone, till it put on the nature of steel. An unrighteous man cannot act righteously, it must therefore be God, who is above nature, that can clothe the soul with a new nature, and incline it to God and goodness in its operations. Now to see a lump of vice become a model of virtue; for one that drank in iniquity like water, to change that sinful thirst for another for righteousness; to crucify his darling flesh; to be weary of the poison he loved for the purity he hated; to embrace the gospel terms, which not his passion but his nature abhorred; to change his hating of duty to a free-will of offering of it; to make him cease from loathing the obligations of the law, to a longing to come up to the exactness of it; to count it a burden to have the thoughts at a distance from God, when before it was a burden to have one serious thought fixed on him, speaks a supernatural grace transcendently attractive and powerfully operative.

Don't you love Stephen Charnock's writing? Doesn't his words flow in poetic melody? Every time I read something like this, the more I am convinced to read classic Christian literature, penned by the Puritans and faithful believers of old, whose intimacy with the Lord seemed uninterrupted. Their circumstances then were different, but their struggles were similar. Never mind the fact that it may be hard to decipher the sentences. I suppose the effort is well worth it—there is treasure hidden in these works.

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Neapolitana novels -- complete!

My stack of fiction reading. 

Today was especially tiring, so I treated myself to printed books, Europa editions, of Elena Ferrante's Neapolitana series of novels. I've read the first two in my Kindle, but I'd love to read them, and the last two, in print. These will keep me company throughout the holidays. My brother, thrilled to see them on the dining table, made a very good point, "And where do you plan to display these?" As with most of my books, they find their ultimate home in our St. Gabriel house, where Nanay will likely complain that she doesn't have enough shelves to have these on display.

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After the closing song

Almost every Sunday service, after the closing song is sung and the crowd starts to move out of the sanctuary, I am asked about a medical problem before I descend the stairs—from a stomach ache from too much coffee, to an anterior mediastinal mass that screams malignancy. I love talking to these brothers and sisters who call me “Doc” despite my protestations (“Just call me Lance”), but I’ve long since realized that this is their way of showing their endearment, their filial pride. It warms my heart that they think I can enlighten them as to what bodily issues they have, if they have cause to be worried, or if their own physicians are doing the right thing. I feel that these random consults are, in a sense, an extension of the clinic.

Indeed, illnesses know no boundaries, and people close to us, even those with whom we share the same faith and theology, can suffer the humbling truth that bodies disintegrate, organs fail, and cells malfunction. Such is the bittersweet reminder that our time on earth is finite, and to go to Heaven we must die. Those who have cancer at least have an idea of how the Lord will take them home.

This Sunday I pray for these dear brothers and sisters—that the Lord’s healing be upon them, that He guide their own physicians to give them the best medical care possible, and that He use these moments of pain and suffering to bring them closer to a deeper knowledge of Him—the great physician of bodies and souls.

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Second years na!

I had a great time moderating the PGH-sponsored PSMO Round Table Discussion on AIDS-related Malignancies. Our case was that of a 29-year old male with Kaposi sarcoma, presenting with cutaneous lesions as well as with internal organ involvement, i.e., lungs and liver. Rich King and Fred Ting discussed the details of the case and principles of management. Because I moderated the program, I had the chance to mine the clinical experience and expertise of our guests in the panel discussion. We were so grateful to have learned a great deal from Dr. Franscisca Roa (Dermatology), Dr. Dessi Roman (Infectious Disease), and Dr. Gracieux Fernando (Medical Oncology). Our colleagues from the seven other training institutions—St. Luke's, Makati Med, Veterans, Jose Reyes, Medical City, UST, and NKTI—were wonderful, answering spot-on the questions we threw at them, and sharing their institutional experience regarding the case. Here are photos taken by Norman Cabaya.

Update (as of November 8, 2018)

Some key learning points during the RTD:

• There is no critical CD4 count that determines whether chemotherapy may be allowed; CD4 levels are largely unreliable for this purpose. As long as the patient is clear of opportunistic infections and has good functional status, systemic chemotherapy may be done.
• Management of Kaposi sarcoma is largely interdisciplinary.
• Presence of disseminated cutaneous lesions with internal organ involvement is an indication for chemotherapy.
• First line chemotherapy is liposomal doxorubicin. If finances may be a problem, we may use plain doxorubicin instead.

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PGH-hosted PSMO RTD

I will be moderating the PGH-sponsored Philippine Society of Medical Oncology Round Table Discussion on AIDS-Related Malignancies tomorrow night. My friends and colleagues, Dr. Rich King and Fred Ting—rhyming, I know—will discuss an interesting case and some nitty-gritty details in the new approaches to these diseases. It will be followed by a panel discussion with the following experts: Dr. Francisca Roa (Dermatology), Dr. Dessi Roman (Infectious Disease), and Dr. Gracieaux Fernando (Medical Oncology). Some residents and fellows from Dermatology and IDS—and Hematology, I learned—will also be joining us. This is exciting news—having these great minds around—because management of these cases is largely multidisciplinary.

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Christian theology is not too big on self-esteem

Christian theology goes against the grain of modern psychology, such as in the issue of self-esteem. Whereas we are taught that we are all good and should feel good (consider, for instance, the many Dove commercials, with self-esteem as the battle cry), Stephen Charnock, an English Puritan clergyman, wrote this about man as he pondered on the doctrine of regeneration.

In ourselves we are nothing, we have nothing, can bring forth nothing spiritually good and acceptable to God; a mere composition of enmity to good and propensity to evil, of weakness and wickedness, of hell and death; a farden of impotence and conceitedness, perversity and inability, every way miserable unless infinite compassion relieve us We have no more freedom than a chained galley slave till Christ redeem us; no more strength than a putrefied carcass till Christ raise us, an unlamented hardness, an unregarded obstinacy, an insensible palsy spread over every part, a dreadful cannot and will not triumphing in the whole soul.

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In defense of light reading (and watching Netflix)

With the breakdown of the internet connection this weekend came more than sufficient time to take on leisure reading. During residency I resolved not have any internet connection at home to give myself time to study and rest. It proved a wise decision, as it helped settle my mind to rest, shielding me from unnecessary distractions. A distracted person is a bad physician.

Since I moved in with my brother, I've had steady internet connection. It sometimes proved a distraction, but only during certain days. It has been useful for academic reading; anybody involved in oncology knows how fast things change in the field. But work generally exhausts me, and I treat myself to a few episodes of Netflix shows (the latest: The Kominsky Method, which my family loves) or some light reading before I go to bed, usually between 7:30 to 8 PM. How geriatric, I know. 

Being able to relax and unwind makes me a better physician--this I have long since realized. By light reading, I mean the enjoyment of non-academic literary works, regardless of whether they are high- or low-brow reading materials. I love the fact that even J. I. Packer does some light reading himself, and he includes GK Chesterton's Father Brown stories to his list. 

Light reading is not for killing time (that’s ungodly), but for refitting the mind to tackle life’s heavy tasks (that’s the Protestant work ethic, and it’s true)

You must find what refreshes you, as your senior editors have found what refreshes them. And if you will not accuse us of being wicked worldlings for our light reading, I will not accuse you for watching all those TV sitcoms and sports programs that so bore me. Fair? Surely—and Christian, too.

My light reading list includes: Nick Joaquin's The Woman Who Had Two Navels and Tales of Tropical Gothic, Dean Francis Alfar's A Field Guide to the Roads of Manila, Stephen Charnock's The Doctrine of Regeneration (certainly not a light read, but one that keeps me awake, as it is a voluminous study on the theological subjects of salvation and conversion), Michael Dirda's Browsings, and Marilynne Robinson's Why Are We Here?.

"Refitting the mind to tackle life's heavy tasks"--now I like the sound of that.

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Poster at 7/F elevator proves existence of hospital grammar police.

via Instagram

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Internet frustrations

Just when I thought I had a hold over my impatience, the wifi connection at home broke down. For months I’ve dealt with patchy internet connection—this, given the fact that my brother and I are subscribed to PLDT Fibr, arguably the fastest connection available. It isn’t news that internet is more expensive in the Philippines than in most of the world; the internet service in this country has much to improve on.

But for the past three days the connection had died. I called the PLDT customer service, but I only received platitudes, excuses, and an assurance that a report is being written, which will be forwarded to the technical service crew. A lineman arrived at home yesterday. His diagnosis was that the PLDT connection was fine; the problem is with the conduit connecting the modem and the TTC. The wire needed to be changed, he said, and it was left to me to contact an engineer who can replace the wires. In a few hours I was able to get hold of an engineer. This morning, the cat. 5 internet cable was replaced—successfully, I suppose, given that the telephone connection was also restored. But the internet connection remains broken, even during the time of writing.

I called up PLDT again and received the same excuses. I handed the phone to my brother, who was more calm but who remained firm. He even laughed at seeing me so irritated, angry, and unable to do anything else because of the paralyzing infuriation. “No, I will not hang up until you assure me that a technician will come over today,” I overhead him say, this after an hour of receiving otherwise useless instructions from Donna, the hapless customer service representative who probably had no idea what was going on but who was paid to read from a script, to keep people like us appeased. There comes a point when one loses patience at the waiting, and I reached this point today. It makes me feel frustrated about feeling frustrated.

But there is a lesson in this somewhere. Patience, humility, losing my sense of self-entitlement. I am a work in progress.

I spent the Saturday afternoon reading Nick Joaquin’s The Woman Who Had Two Navels and Tales of the Tropical Gothic, published by Penguin. I even worked on a story.

I still wish we had better internet service providers. There’s much to be desired about PLDT Fiber, and if only I had a choice, I would pick another.

Do you have other recommendations?

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Where can I get one?

This reminds me of college. (Photo credit: Michael Dorado via Twitter)

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