Sunday, May 8, 2022

,

A day in contrast

Driving at 6 AM along the Gensan-Polomolok border, I see a tricycle on the outer line. It is jam-packed with five people, excluding the driver. As I inch closer, I notice that a motorcycle, propped up vertically on one wheel, is strapped on the tricycle's metal sidecar. Yellow ropes keep the motorcycle from falling off the road. The men reinforce the motorcycle to the tricycle with their arms. In their late twenties, wearing shirts and denims, they grin, smile, and laugh. Are they bringing home this brand new vehicle at home? If that's the plan, why don't they ride on it? Perhaps I'll never know. In the meantime, an olive-green Vios, which I'm presently trailing, slows down. A window opens. A teenager, her hair tossed by the wind, emerges with a camera phone. Realizing they are being recorded, the men wave in the light, intermittent rain. They are having a great time.

As soon as I arrive at home, in time for the Sunday service, I receive a text message that M has died. He was around my age. He had an aggressive kind of lung cancer. He has left behind a wife and two children.

Ours is a bittersweet existence.

Friday, May 6, 2022

,

Glory in the ordinary

My high school classmate and friend S dropped by my clinic to have her blood pressure checked. Told her she was a newly diagnosed hypertensive. It runs in her blood. These past months, she could only count the nights when she's had a good night's sleep. How could she if, at any given moment, one of her daughters would cry? Her maternal instinct does not allow indifference; her reflex reaction is to land on her two feet to be with her children. Mothers are amazing.

I thought of S when I read this passage from Glory in the Ordinary by Myra Dempsey:

Even in life’s mundane tasks, God is shaping us into a people who beautifully reflect his glory to the world. Left to our own devices, we will never naturally drift toward holiness. We rely totally and completely on God to rewire us and re-mold us, making us more like his son, thereby making us more and more holy. Because he loves us so perfectly and immensely, there isn’t a moment of our existence that he won’t use to accomplish just that. Those late-night work hours, those early morning feedings, those middle-of-the-day grocery store runs, they are all clay cutters in the hands of our perfect potter, wielded with precision to trim away all that does not drive us deeper into him. He knows that we are only alive in him, that all of the joy and purpose we crave is found in him alone. Nothing is wasted, dear friend, and you are not in a green room waiting for that call up to the main stage.

Thursday, May 5, 2022

,

"Life is surely muted and compromised...": on the pandemic life

From a blog I've just subscribed to, La Vie Graphite: an eloquent meditation on pandemic life:

Enduring these months is a learning experience of what to eliminate or change. There are shortages and there are pinched resources. Less money, in the face of inflation and reduced pay, but less to buy. Three full tanks of gas in my car, in six months. Having less causes a discipline of needing less. As the workplace began requiring a weekly on-site workday, I’ve simply treated my department like a quarantine: A straight-out eight-hour day, with granola bars and thermos of coffee. There are no places to go for lunch, anyway. Then it’s become two days on-site. More granola bars for the perpetual motion. I just want to get the work accomplished, plain and simple. Perhaps it’s an imposed austerity, but the workplace is the place to get work done; there is no more socializing, and it’s hard to tell how much longer the situation will last. I’ve noticed myself working faster and more strategically, as I cram all I can into those hours. Working from home is no less industrious, but it’s much safer. Most of us are under pressure to make the best of a bad situation. I’m grateful, at least, to be working. Life is surely muted and compromised, but I’m always brought to step back and consider this context when I see the clusters of those encamped in the city park with no place to call home. The pandemic forces us to learn to not take tomorrow for granted.

Wednesday, May 4, 2022

, ,

A surprise visit

A teacher from high school dropped by the clinic yesterday, just as I was about to close shop. She was surprised that turned out to be a medical oncologist. 

"I thought you took up neurology," she said. "But why 'Bottled Brain' then?"

Ma'am T said she visited my blog daily until her phone was stolen. She couldn't access it anymore. 

I'll help her bookmark this page the next time she visits. 

The Hiligaynon word for the day is ma'éstra. It means "teacher or instructor."

Tuesday, May 3, 2022

Sunday, May 1, 2022

,

Sane and wonderfully tender

I often get asked how I deal with patients who cry in the clinic. There are no easy answers. But I assume that most of my patients and their families know more than what they'd be given credit for. They might not know the nitty-gritty details of treatment and prognosis, but they carry with them a vague, often accurate, idea that what they have is "not good." When they enter the consultation room, I don't immediately get into the details. I warm them up with questions of where they're from and what they do. I establish a connection. Where I practice, that involves asking if they know a common person. It helps that I speak the vernacular for a more nuanced, intimate back-and-forth. They hardly get surprised when I break the news: that they have cancer. But my speaking to them confirms the fact of their disease. They cry, usually quietly, grappling for a handkerchief or tissue paper. I have a stack of napkins on my desk that I offer to them in a few minutes of silence. I assure them it's okay to let it all out.

There's a common belief that it is detrimental to the body and soul if one keeps the pain inside. Grief must be expressed and let out. I'm sure there are psychological and theological reasons for this. In my experience, encouraging outpourings of grief is cathartic and ultimately beneficial. 

This is a bit of a stretch, but this daily reality of my private practice seems to find resonance in Dr. Edward Donnell's The Christian Life, a chapter in the book, "John Calvin: For a New Reformation" (ed. Derek W.H. Thomas and John W. Tweeddale, Crossway, 2019). I love John Calvin. Each time I read him or about him, I learn something new—as a Christian or, in this case, as a cancer specialist. I must note that cheerfulness is not defined here as being happy-go-lucky. It is, in my reading of this text, a deep-rooted joy. 

Yet Calvin's humanity and pastoral wisdom shine out when he explains that cheerfulness can coexist with anguish. The point of a cross is that it hurts terrible, and this is is the paradox and glory of Christian suffering. He has no time for what he calls the "iron philosophy" of Stoicism. The Lord himself shed tears over his own trials and over the misfortunes of his disciples . . .  As Calvin describes, "If all fear is branded as unbelief, how shall we account for that dread with which, we read, he was heavily stricken [Matt. 26:37; Mark 14:33]? If all sadness displeases us, how will it please us that he confesses his soul 'sorrowful even to death' [Matt. 26:38]?"

Dr. Donnell concludes, 

This is sane and wonderfully tender pastoring. 

In practice terms, this translates to me saying, "It's okay to cry." I end with a word of encouragement, ask their permission if I can pray for them. As they leave, I take care not to give false promises of cure, but I don't withhold from them sufficient hope to carry them through the days before they see me again on their next consult.

An aside: napkin versus tissue paper

The main difference between napkin and tissue paper is that the napkin is a soft piece of fabric material, used to wipe the face before and after eating. On the other hand, Tissue Paper is a soft easily absorbent paper used for cleaning purposes. Both are available in different colors.

Friday, April 29, 2022

On blogging

I stumbled upon Alan Jacobs’s blog. I’d been there before, but I hadn’t read it with sufficient curiosity to keep me going. Until now. An author, university professor, and blogger, he writes about cultivating his blog as a kind of a garden. He uses his blog to “generate and try out new ideas, get feedback from readers, develop the ideas a little further…” He writes about blogging as someone who seeks to understand this medium. Reading him is inspiring and instructive.

Part of me wishes I’d thought blogging through. When I published my first post in 2004, I didn’t think Bottled Brain would live long—at least, long enough to be older than high school students. Had I been a wiser 16-year old in that internet café in the row of houses near the UP Shopping Center, I should’ve planned out what content to put out. I could’ve chosen to write about a niche topic rather than post flotsam and jetsam about books, pens, faith, family, travels, and medicine. I could’ve planned to turn my posts into book chapters, which I’d subsequently publish. 

But I didn’t. Today the blog looks more like an online diary than a well thought out website. Perhaps that is why I find it so charming. Because it is my space—my own dot com domain—I can write anything. My friends and family are my audience. There’s no pressure to please or impress. There’s a sense in which I write for myself; my delight in the writing overflows to delight others, too. That is my hope.

What I can learn from Alan Jacobs is to make sense of my logorrhea. One of these sunny days I’ll find the time to organize my posts. Surely, several themes will emerge: my experiences in medicine, my thoughts about Christianity, my fountain pen collection, and so on. Maybe I can do something about them.

Moving forward, I envision more posts more about medicine, medical education, medical humanities, biochemistry, and technology in this space. I should also post more quotes from books I'm curently reading. Who knows? I might just develop new material from these! 

Monday, April 25, 2022

A Blackwing Pencil (Palomino)!

Snapshot of a page from my journal, currently a Midori Traveler's Notebook (Passport):

Blackwing Palomino

I turned 35 last April 22. I went on a short trip to visit my godmother. My aunt and Nanay were with me. I could tell you many stories, but the short of it is: we had a blessed time. During the tour, I found my grail pencil, something I've been meaning to buy but I never had the chance to—until this trip!

It's a Blackwing pencil (Palomino). This is the favorite writing instrument of Mary Norris, the New Yorker copy editor, and Austin Kleon, the book author and blogger

I adore the writing experience! Praise God for this blessing—and for 35 years of His goodness and faithfulness.

Sunday, April 17, 2022

,

Christ is risen!

Sabado de Gloria

Woke up to a rainy Sunday morning. Drove Nanay to Rizal Park to buy flowers she subsequently arranges for the pulpit. She couldn't bear the sight of a flowerless pulpit, especially on Easter, the most joyous of all Christian celebrations.

Christ is risen! What a glorious, marvelous, and comforting truth! 

Meditating on the centrality of the resurrection to the Christian life, Dr. Albert Mohler writes:
As Paul well understood, Christianity stands or falls with the empty grave. If Christ is not raised, we are to be pitied, for our faith is in vain. Those who would preach a resurrectionless Christianity have substituted the truth of the gospel for a lie. But, asserted Paul, Christ is risen from the dead. Our faith is not in vain, but is in the risen Lord. He willingly faced death on a cross and defeated death from the grave. The Resurrection is the ultimate sign of God's vindication of His Son.
He quotes Dr. John A. Broadus:

It was the signed manual of the Deity, it was the seal of the Sovereign of the Universe affixed to His claim, it declared Him to be all that He had ever professed to be, and so it establishes the truth of all His teachings and the truth of the whole Christian society. The great fact that Jesus Christ rose from the dead is the central fact of the evidence of Christianity. 

Have a meaningful and Christ-centered Easter Sunday, dear friends!

*  *  *

Photo above was taken yesterday when the sun was up and the April shower plant was showing off its blooms.

Saturday, April 16, 2022

Friday, April 15, 2022

The coming-home ritual

Untitled

Coming home from work, where two lovely patients had just died, I am welcomed by Paul in the garage, his nose toward me, his body crouched near the ground, just as I open the car door. I give him a belly rub, which leads him to roll over, enjoying the sensation of human contact. "How are you, my boy?" I ask. He responds by choking on his saliva, his tongue wagging. After two minutes of this welcome, he follows me as I enter the house. Distracted by the clanging sounds in the kitchen, he leaves me and bothers whoever happens to be there. Paul's love language is bothering humanity.

Dogs are God's gift to us. Despite the nightly destruction of Nanay's cherished plants and cacti and the tearing away of shoe laces and chewing of electric cords, Paul brings to our home a youthful joie de vivre, a reminder to not take things too seriously. 

Now—where is he?!

Sunday, April 10, 2022

How to manage chemotherapy side effects: a guide to general internists


Yesterday I talked to some 1,200 internists from the Philippines on how to manage cancer-related treatment side effects during the Bootcamp of the Philippine College of Physicians. In that talk, I argued that, in an era where cancer is set to become the leading cause of mortality and morbidity in the world, general internists—and non-medical oncology specialists—can take part in the care of patients with cancer. One of those opportunities is the management of treatment-related side effects. I wish I had more time to speak about immunotherapy-related adverse drug reactions, but, with my 20 minutes, I focused mainly on chemo- and targeted-treatment-related side effects—hypersensitivity reactions, nausea/vomiting, diarrhea, mucositis, and many others. Dr. Julie Gabat-Tan—or Madame Julie, as I call her, because she was my first ever senior resident during my internal medicine residency—moderated the Q and A. It felt like being on rounds again at Wards 1 and 3. I'm sharing my slide set here. Feel free to share or use this, and it would be great if you can link to this site. 

PCP Bootcamp Image credit: Dr. Jeriko Aguirre, who took a screenshot.

Saturday, April 9, 2022

Do not make premature judgments

I love this line from the concluding pages of the chapter, The Fast Train to Canton, which appears halfway through the book, Riding the Iron Rooster, by Paul Theroux.

It made me think that you never really know anyone until you have traveled 10,000 miles in a train with them. I had sized them up in London, but they were all better and worse than they had seemed then, and now they were beyond criticism because they had proved themselves to be human.  

Friday, April 8, 2022

Notebooks and first chemo sessions

It's appropriate that my first entry in my new notebook is about my remarkable patient, a woman around my age, who gave it (and a few others) to me today. I love composition notebooks. In fact, I love notebooks in general. I use a Traveler's Notebook (passport size) for my personal journals. I use composition notebooks for my consultancy and faculty work. The wide lines are great for jotting down first drafts of my stories, many of which will never see the light of day. The pages are fountain pen friendly. See my writing sample below. I used a Pilot Custom 823 (Amber) with the classic blue Pilot ink owned by my brother Sean.

Notebooks and first chemo Notebooks and first chemo Notebooks and first chemo

Wednesday, April 6, 2022

, ,

Innovative ways of disseminating research: an argument for blogs and podcasts in cancer research

Podcast poster

I talked to Filipino medical oncologists about innovative ways of disseminating cancer-related research information last Saturday. I argued that, as part of knowledge translation/mobilization, it is important that researchers, clinicians, and people involved in knowledge generation and dissemination must creatively, proactively, and intentionally think about how to share their knowledge more effectively to their colleagues and the public at large. I talked about blogging—academic blogging—as a tool to accomplish that. I also spoke about podcasting—using recorded audio to tell stories—and conducted a workshop on how to record and edit audio files using Audacity. I've never done anything like this before—much less through an online interactive platform. Many thanks to Merck and to Dr. Mary Manalo, my boss in the research committee of the Philippine Society of Medical Oncology, for the opportunity to talk about a topic so very close to my heart. I love reading blogs and listening to podcasts. My presentation was an overflow of my fascination. 

Here's a copy of my slide set. 

Monday, April 4, 2022

,

Summer fruit

Untitled Untitled

The mango tree bears much fruit this summertime. Nanay snapped this on Sunday morning, 30 minutes before the start of the worship service, when the church parking lot was not yet packed. (It has been a long time since I had last shared Nanay's photos in this site. You see, years ago, I synced her phone to auto-upload photos in my Flickr account, an arrangement that gives me access to the goings-on in her life, which mostly revolves around family, friends, and church.) I love mango trees, not just because of their fruit but because anywhere they are planted, they offer a comforting shade and coolness, a respite from the tropical Mindanao heat. I look forward to see this mango tree grow up and flourish.

The Hiligaynon word for the day is búnga, which means "fruit."

Monday, March 28, 2022

,

Grace

Untitled
Since my brother Sean got serious in his coffee hobby, I haven't been to the coffee shops as often as I used to. I could get the same, even better, kind of coffee at no cost at home. Sean knows coffee growers from Kulaman, Sultan Kudarat and helps these farmers by reselling the beans. (If you're interested, drop me a message; I'll relay it to Sean.) He likes the process of grinding the beans, measuring them by the gram, and experimenting with various methods of coffee-making. 

If I have lunch in malls, I drop by the café chains to stave off sleepiness. I visited Coffee Bean at SM Gensan recently. I got a swirl card so I could access the wifi. The password was Ephesians 2:8. "This is one of my favorite verses," I told the lady behind the counter. 
For it is by grace you have been saved, through faith—and this is not from yourselves, it is the gift of God—
The Hiligaynon word for the day is grásya, which means grace or blessing.

Postscript: I dropped by Coffee Bean at Veranza, the other mall. The wifi password was Romans 8:28.

Sunday, March 27, 2022

Booksale on a Saturday

Untitled

I try not to see patients on weekends, but this Saturday, it was inevitable. I had scheduled an urgent chemotherapy, which went well. On the third floor, I gave discharge instructions to a patient—a friend's father—just before he left for home. I drove to Gensan to see a few more patients. I had hoped I'd finish just before lunch time so I could make it back home and perhaps join my brothers in watching a Netflix World War 2 documentary. But it was 11:30, I was hungry, and I had an intense craving for a decent burger. I dined at Army Navy in Veranza. Sleepy after the meal, I went to Booksale, this paradise of pre-loved books, the only one of its kind in Region 12, to my knowledge. 

The lady at the counter was oblivious to my presence. The silence was a relief; it was almost like entering a library at lunchtime. Outside the store, the crowd was massive. The mall's parking area was packed. People lined up in restaurants. Fathers and mothers carried their children or held their hands, as if telling them, "This is the outside world, kids!" The city was coming alive. If not for the ubiquity of face masks, one would think COVID was no longer a clear and present danger. 

It seemed natural for me to proceed in the clockwise direction. There were unopened boxes on the tiled floor. Could there be a Mavis Gallant collection inside them? But I was too excited to see what was on display that I did not bother the lady at the counter to open the boxes for me. On the shelves were many new books I hadn't seen before. The last time I'd been to Booksale was three months ago. 

I started with the religious section, with old leather bound Bibles and contemporary works, many of them about prosperity and marriage. I don't bother with these books most of the time, as I prefer to read Augustine or Calvin, whose works are almost never found in stores like this. But I was surprised to see Dr. Russel Moore's book, Onward: Engaging the Culture Without Losing the Gospel. It was a hardbound copy. Dr. Moore's books are rare finds, but I'm a huge fan. I even subscribe to Moore to the Point, his newsletter. Dr. Moore quotes Walker Percy's words on the first few pages: 

By remaining faithful to its original commission, by serving its people with love, especially the poor, the lonely, and the dispossessed, and by not surrendering its doctrinal steadfastness, sometimes even the very contradiction of culture by which it serves as a sign, surely the Church serves the culture best.

Amen, brother. I grabbed the book right away.

The next section was hardbound fiction. (A seasoned visitor of Booksale understands there are no strict sections: a work of fiction can be found among the boring, outdated books on pharmacology.) I saw a P.D. James thriller, Death Comes to Pemberley, and picked it up immediately. Carefully removing the first layer of books on third row, I found Joyce Carol Oates's novel, The Falls. I've only read Oates's short stories, not her novels, so it was a thrill to pick the blue but battered copy from behind. 

I turned to the coffee table books, the most expensive ones in the store (which means they cost Php 400-600), because they're printed in glossy paper, often with colored photos. I grabbed Julia Turshen's cookbook, Now & Again, to give to Manong Ralph. He reads much more than I do and has become what we call in the family a home chef. Thankful, he seemed excited to try out recipes from the Rosh Hashanah chapter. I've always envied Rabbi Shtisel when he devoured his meals. Shtisel is one of my absolute favorites in Netflix.

I largely ignored self-help books, magazines, and textbooks, and headed straight for the center table brimming with romance and autobiographies of people I didn't recognize. Imagine my delight when I found P. G. Wodehouse, a writer I turn to when sentences escape me, or when I need a good laugh. The book is called "The Gold Bat and Other School Stories." He dedicates this book to "That Prince of Slackers, Herbert Westbrook." What fun it must have been to be around him. 

My favorite find of the day was Paul Theroux's Riding the Iron Rooster, a travelogue about his trip to China by train. The copy cost Php 25, discounted from the original Php 35. I hadn't completed any of his books, but I watched the Apple series Mosquito Coast and started reading the novel on which it was based. But I'd read enough about him to know that he writes in longhand, he has a beautiful home in Hawaii, and he thinks about traveling a lot. He's also pretty cool. 

Untitled

I was getting sleepy around books and went to Coffee Bean to drink iced Americano because the Gensan heat was stifling, even with the gathering clouds. With no one else watching (the students were glued to their iPads and books; I wasn't sure if they were my students), I tore the brown bag filled with my new old books, smelled the pages, and began with the Theroux: 

The bigness of China makes you wonder. It is more like a whole world than a mere country....
The closest I'd been to the airport was when I picked up my cousin Hannah and Manong Ralph from their Manila trips. The book, which I'm reading now (along with Seamus Heaney's The Government of the Tongue, Makoto Fujimura's Culture Care, Elizabeth Bowen's Collected Stories, Haruki Murakami's Men Without Women, John Berryman's The Heart is Strange, among others), fills the void that travel can fill.
 
Untitled

Wednesday, March 23, 2022

Updates

Mike, miles away, reminds me I haven't posted anything new here. I said I've been preoccupied. It's not that I haven't written anything, but most of what I write these days land in my journals, which end up inside the baul Nanay had commissioned to be built for me. The trunk, which doubles as a coffee table in the living room, is made of old mahogany. Nobody suspects that it houses my journals, laptops, and paperwork. People in the house complain that my things land everywhere. I have a general idea of the  geographical location of where, say, I left my bottle of ink, or my copy of a Michael Chabon novel. It becomes problematic if people attempt to clean them up for me. My geolocation then fails. The solution: create a single space where I can dump my things, out of everybody's sight. The baul is the perfect solution.

What else have I been up to? 

Yesterday, I saw my students in the flesh for the first time. We met for their in-person long exam for biochemistry. The transition from virtual meetings to face-to-face was seamless. I was glad to meet them. I hope they did well in the test. 

A few days ago, I attended my first political rally. My clinic staff, all dressed in pink, waited for me to finish seeing my patients so we could go together to Rizal Park, where the Vice President was speaking. The afternoon was stifling, but people from Koronadal and neighboring towns gathered under the shade of the trees and tents. It was not the biggest crowd, but it was sizeable, given that there was no local government support. There were many young people, many of them first time voters. I met some elementary and high school classmates there. I would later read about my friends' experiences of joining her rallies all over the country, often volunteering as medics.

Democracy is fragile; we could lose it if we do not actively participate in it. Nanay would have wanted to go with me, if not for the heat, which leaves her skin burnt. She had become extremely photosensitive after the treatments she had received many years ago. 

I did not receive any remuneration for my participation. I even paid for my own printed t-shirt, which the doctors from city had designed and printed. On my way back to the clinic, I saw two old women in pink t-shirts and flip flops hail a tricycle to take them home. Bayaran? Likely not. They came out of their own love for God and country.

In this election, the choice for the best candidate for the job is clear—she who has an impeccable track record, honorable personal and family life, excellent mind, generous spirit, and compassionate heart. She who shows up when it's most needed. And so it baffles me how so many people can choose the alternative.  

I pray Leni wins! 

Powered by Blogger.