Friday, June 11, 2021

Alternative meds

Nanay wakes up, distraught, getting hold of a memory that is becoming elusive with every second gone. As she makes her bed, she tells me, "I was telling a group of people to stop taking MX3!"

Friday, June 4, 2021

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First chemo, remembering H

Spoke about this verse to a woman, 62, on her first chemo session. She teared up, told me about how her church family is praying for her back home. She spoke as if she were about to die tomorrow. Patients with cancer realize they can go anytime. She referred to God as her Father. "He knows what's best, though I may not understand completely," she said. Encouraged her with a line that I remember from Tim Keller's preaching—that suffering is never wasted for God's redeemed children; He always has a purpose in mind. I learn so much from my patients. Their stories wean me from my love of this world. I remember the song: "And what can this world offer / when all I desire is You?"

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But this world has so much suffering. Yesterday, woke up to an online thread. My high school classmate, H, has died. H was a newly minted lawyer, was married for 7 months, with a baby on the way. Hadn't spoken to him in years, except with random greetings in a Messenger group chat. H was my classmate in Notre Dame; in high school, we transferred to KN Special Science Class, where we were in the same class for four years. Our hearts are heavy. His child will be born fatherless. May God's comfort be upon his family left behind. Life is a vapor. 

Sunday, May 30, 2021

Displeasing the world to obey God's pleasure

Letter of John Calvin to Monsieur de Falais, Geneva (1543):

...I could not refrain from reminding you, that the benefits which God hath bestowed upon us, indeed require that we should prefer his honour to all the world besides, and that the hope of salvation which we have by his Evangel is so precious, that we ought readily to forego meaner considerations, in so far as they hinder us from reaching forward to that hope, and that we ought to have such contentment in conforming ourselves to his will, that whensoever the question arises of our displeasing the whole world, that we may obey his pleasure, it is good for us.

I derive much joy and instruction from Calvin's letters. 

You can betake yourself to a covering shelter from the storm—for we have no other retreat than that of our God—let us then hide ourselves there, and we shall be in security. 

Amen to that.  

Saturday, May 29, 2021

Between two kingdoms et al

While I had the stamina to post something every day in 2020, I barely have the energy to sustain the habit this year. It’s not for the lack of things to write about. After the eventful beginnings of the pandemic, whose end is, at present, far beyond our line of vision, I’d must rather read and watch and think quietly. 2021 has so far been a year of introversion—a time of keeping it all in, making sense of things, praying, and meditating. This year also marks a major career transition—from medical training in Metro Manila to starting my private clinical practice in South Cotabato and General Santos City.

But I’m keeping my one post a week quota, if only to get me writing again.

Early this morning I finished Between Two Kingdoms: A Memoir of a Life Interrupted by Suleika Jaouad. The author writes about the experience of being diagnosed with leukemia, and how that has reshaped her life and relationships. The second part of the book is about her land trip around the US. When she wrote a column for the New York Times during her bone marrow transplant and chemotherapy, she received mails from readers all over. After her treatments, she decides to drive her friend’s Subaru and visit some people who reached out to her. The book is honest, sensitive, and inspiring. But reading about the topnotch oncologic care, clinical trials, and the sheer convenience of getting a port for chemo access made me wish for a better, more humane oncologic care in the Philippines, where a cancer diagnosis can lead to financial catastrophe. I pray for the author’s continued remission. And may she find God in her suffering and illness.

Last week I finished Bird by Bird by Anne Lamott. It’s practical, inspiring in its pragmatism. This year is proving to be a great one for books.

My driving is markedly better. I can do reverse parking parking now—more hit than miss. Hitting the right parking spot, not other vehicles; otherwise I’d be in big trouble. In a hospital in Gensan, I befriended a security guard who hails from T’boli town. Calling me “kasimanwa,” he would come to my aid when the parking spaces are packed. I offered to drive him to his home town if he ever needed to go home, but his family is in the city, and he is happy where he is.

In a few days, it’s going to be June! We’re halfway through the year. Let's all keep safe and get vaccinated.

Monday, May 24, 2021

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Week ahead

Not much happening with the lockdowns and new COVID cases here and elsewhere. Grateful to be alive and well.  Finished Anne Lamott's Bird by Bird, started on Isaac Bashevis Singer's short story collection, received packages of books ordered from Book Depository since last year, including Piercing Heaven. Read the first prayer after dinner last Wednesday, during our weekly family prayer time. All victories against this pandemic seem short-lived. We take what we can. For instance, there's my second dose of vaccine—praise be to God. Will head over to the hospital at 8 am, drive to Gensan to see some patients, head back to Marbel for lunch, then visit a patient in another town on her final day of chemo. In oncology circles, we call it "graduation." 

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Friday, May 14, 2021

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Delightful rosal (Gardenia jasminoides)

Rosal (Gardenia jasminoides Ellis)

Rosal (Gardenia jasminoides Ellis)

The rosal delights us with its first flowers on this rainy tropical morning. Grown by Uncle Glenn in his home garden in General Santos City, its branch was transplanted onto rich soil with coconut husks from our Banga farm, and was given to my mother as a gift. The plant occupies a small, quiet space beneath the kamuning tree [(Murraya paniculata (Linn.) Jack].

Tuesday, May 11, 2021

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Mentoring

Had a refreshing conversation with a medical resident a few days ago. She was also a mother, wife, and daughter who had lost her father many months ago. Told her I miss my father, too. We both agreed that suffering somehow made us empathize with patients more. 

Gave her tips on doing rounds on the floors, the same ones Sir Nemie Nicodemus taught me when we checked on his referrals. He taught me and my friends to see check the medication list, the I and O, the vital signs monitoring sheet, and the latest entries before marching inside the patient's room for a full physical exam. Mentors impact trainees to a degree greater than they can imagine. I'm grateful to have met Sir Nemie and my other mentors. I'm nowhere half as brilliant, but their advice were, and I took good notes so I could share them with the younger doctors. 

Monday, May 10, 2021

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Shtisel, my new favorite show of all time—among a few others

Not exaggerating when I say Shtisel is simply one of the best shows I've seen in my life. It ranks alongside Breaking Bad, Veep, The Office (US), Derry Girls, and The Mandalorian.

“Shtisel” is generous, lighthearted, and nostalgic—even when the origins of its nostalgia remain elusive. It is also a little old-fashioned, not only because of its subject matter but because of its situational structure. Things happen and cease to happen to the characters within a single episode: an illness, a robbery. It’s drama dressed as a sitcom. The show’s center of gravity is the father-son relationship between Shulem and Akiva, who are usually seen sitting around their cramped kitchen table, with its waxy tablecloth, eating sliced vegetables in their shirtsleeves and prayer shawls.
Love the characters. So fascinated by them that I find myself reciting Old Testament verses as they pray. Enjoyment is cloaked by sadness—these people reject Jesus Christ. While Christians are awaiting the Lord's second coming, they are still expectant for the first coming of the Messiah. While Christians believe that salvation is by God's grace through faith in Jesus, they believe that they must obey the law to the letter in order to be saved.

Still—the series displays so much humanity in a secluded, ultra-religious community we almost know nothing about. 

Brothers to me: "Watching Shitsel again?"

"Not Shitsel. SHTIsel!" 

Do not be condescending

Marilynne Robinson on thinking highly of her reader:
My main concern is to be respectful always of my reader’s intelligence. I tell my students always to assume the reader is a better person than he or she is. I tend to assume that good prose simply is accessible, and that condescending to the reader obscures meaning.

Same principle applies in medical communication. Be condescending to the patient, and you lose his trust.

Sunday, May 9, 2021

Heartbreaking work of Dave Egger's staggering genius

Dave Eggers

Teary-eyed at 9 am on a Monday, at Starbucks along Santiago Boulevard. Arrived too early for my clinic and had time to spare—the story of the young doctor starting his practice. Nobody else noticed me, the solitary man, sipping coffee, al fresco, reading a white Kindle. But who cries at 9 am on the first day of the work week?

It was the book’s fault. Dave Eggers’ novel punched me in the gut. A Heartbreaking Work of Staggering Genius spoke to me the way people who’ve gone through similar suffering communicate a common language, populate the same neural network. Dave wrote about his mother, dying of gastric cancer. Feeling an emotional proximity to writers, I refer authors on a first name basis (Mavis Gallant is Tita Mavis, for instance). “While reclining on the couch most of the day and night, on her back, my mom turns her head to watch television and turns it back to spit up green fluid into a plastic receptacle.” He brings her to the hospital, despite her earlier instructions on the contrary. I could see myself in the situation, could hear and smell and feel its mundanity and extraordinariness, could imagine that “loss is accompanied by an undeniable but then of course guilt-inducing sense of mobility, of infinite possibility, having suddenly found oneself in a world with neither floor nor ceiling.” Succeeding chapters narrate what happened after—Dave stands as his brother Toph’s legal guardian, drives him around town in a red Civic, brings him to school activities. Hilarious, self-deprecating, heartbreaking, and staggering, but also compassionate and affecting. Do read it.

Thursday, May 6, 2021

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My performance in Ganap

 

Was invited to read a piece for Ganap, a series of literary performances hosted by Likhaan: University of the Philippines Institute for Creative Writing. Thrilled to be part of this
Tao lang din ang mga doktor. Napapagod din sila. Anong klaseng suporta ang kailangan nating ibigay para matulungan silang kalabanin ang pandemyang ito? Sapat na ba ang pagbibigay ng mga PPE, face mask, at face shield? Mayroon nang bakuna, ngunit hindi natin alam kung naipapamahagi ba ito unang-una sa mga health worker na pinakananganganib sa virus. Malalaman lamang natin ang sagot sa mga tanong na ito kung tayo ay makikinig sa kwento ng mga doktor na kumakalaban sa pandemya halos araw-araw. Sa episode na ito, matutunghayan natin ang mga pagbasa ng mga doktor na nagmula sa iba’t ibang rehiyon at disiplina. Kasama natin sila Dr. Joey Tabula, Dr. Justine Yu, Dr. Elvie Victonette Razon-Gonzalez, Dr. Lance Catedral, Dr. Maria del Carmen Castillo, at Dr. Will Liangco. Huminga muna tayo at sumama sa isa nanamang makabuluhang GANAP. 
TUNGKOL SA MGA MAGTATANGHAL 
Joey A. Tabula is a general internist, anthologist, publisher, and poet from San Antonio, Zambales. He was the editor of three books including "Pagninilay: Hinga, Hingal, at Hingalo sa Panahon ng Pandemya" published by UP Manila last year. He has been a workshop panelist in the 2020 and 2021 CNF Workshop for Doctors by the Bienvenido N. Santos Creative Writing Center. He is the vice president and publisher of Linangan sa Imahen, Retorika, at Anyo (LIRA) and a board member of Unyon ng mga Manunulat sa Pilipinas (UMPIL). He is currently writing his thesis for MFA in Creative Writing at the De La Salle University.
Justine Yu is a neurologist and presently a fellow in training in dementia and related disorders at a hospital in Metro Manila. She was a creative nonfiction fellow in the Silliman Writers’ Workshop in 2007. Recently, she was a fellow in the Bienvenido N. Santos Creative Writing Center 2nd Creative Nonfiction Writing Workshop for Doctors. She comes from Dumaguete City.
Dr. Elvie Victonette Razon-Gonzalez is an internist-gastroenterologist from Iloilo City. She finished her residency and fellowship training in University of the Philippines-Philippine General Hospital. She completed her thesis for MSc in Clinical Epidemiology in UP Manila. Her poems and essays have been published in several magazines and anthologies (Philippines Graphic, Poetika, From the Eyes of the Healer, Ilongga Bicycle Diaries). Her collection of poems, Vignettes of Voyages, was published as an eBook last 2020. 
Dr. Lance Catedral is an internist and medical oncologist based in Koronadal, South Cotabato and General Santos City. His interests include precision medicine, global oncology, and medical humanities. His creative works have been published in the anthology, From the Eyes of a Healer, the Cotabato Literary Journal, and the Journal of Patient Experience. He has been a panelist of the Creative Nonfiction Workshop for doctor-writers hosted by the Bienvenido N. Santos Creative Writing Center.
Maria del Carmen R. Castillo completed her training at the UP-Philippine General Hospital. Her present practice is in both private and public hospitals in Las Pinas and Muntinlupa. Her poems were published in Caracoa 19: The Poetry Journal of the Philippines in 1988 as she was beginning medical school. Married, with two adult children who make fun of her gaming skills on Animal Crossing New Horizon, she continues to write to keep her sanity.
In 1998 Will used his one free elective to escape from pre-med subjects and took up The Short Story at the UP ICW. He claims that it has been one of the most fun and most formative courses he ever took, and since then he has always found it exhilarating to be in the company of storytellers. Practicing now as an oncologist, he writes stories and essays that try to find hope and humor in the frequently bleak landscape of patient care.

Friday, April 23, 2021

34—what grace is mine!

Kristy and Keith Getty's song is one of my favorite modern Christian hymns. The lyrics capture God's infinite love to me, once a "distant soul" whom "he called through the night." Thirty-four years of abounding grace—thank you, Lord, for making me live this long!

What grace is mine that He who dwells in endless light
Called through the night to find my distant soul
And from His scars poured mercy that would plead for me
That I might live and in His name be known

So I will go wherever He is calling me
I lose my life to find my life in Him
I give my all to gain the hope that never dies
I bow my heart take up my cross and follow Him

What grace is mine to know His breath alive in me
Beneath His wings my wakened soul may soar
All fear can flee for death's dark night is overcome
My Savior lives and reigns for evermore

So I will go wherever He is calling me
I lose my life to find my life in Him
I give my all to gain the hope that never dies
I bow my my heart take up my cross and follow Him
I bow my heart take up my cross and follow Him

Tuesday, April 20, 2021

When choices were limited

Paralyzed by the myriad of film choices in Netflix, I sometimes long for the early days of the nineties when video rental shops were popular. In Marbel, we rented VHS and Betamax tapes at the Notre Dame Complex, along Alunan Avenue. The store owner kept an index card for each customer. Listed were the movies rented out by each family. In those days, nobody seemed to watch films alone; it was a household affair that involved discussion and consensus.

Popular films—action movies, Disney animations, and Tom and Jerry episodes—could be leased for at most three days and must be returned immediately, or there would be a fee. Less popular films, like The Bridges of Madison County, could be rented out for a week.

My father would bring me, or any of my two brothers, with him to pick up the tapes. With instructions from my mother, who was partial to Harrison Ford, cowboy action, and historical drama, and generally averse to science fiction, we would visit the store, greet the owner (my father insisted on public courtesy), and proceed to the cartoons section. The tapes must have been illegally reproduced because they were covered in white cardboards labeled in the shopkeeper’s handwriting instead of the glossy, colored printed packaging of the originals.

When we got home home, we would have a say on what film to play first. The Betamax tape would undergo the prefatory process of rewinding—sometimes manually, but often by an electric machine given by aunts from Banga. This we did to ensure that the film started at the beginning. The shopkeeper often forgot to rewind the tapes before lending them. The film would then play in our Panasonic colored television connected to the Betamax player. Transfixed and transported to the dimension of imagination, we would all rest, content with the single movie of the week. If we behaved well enough, we could be treated to a Tom and Jerry film in the morning.

Saturday, April 10, 2021

With Uncle Boboy in Lake Sebu

Spoke too early about the paint fumes not affecting me. My nasal passages are sore, my mouth dry, my alveoli irritated. Everyone shares the general feeling of suffocation.

Decided yesterday morning to escape the house in exchange for cooler, fresher climate. Lake Sebu. Last time I visited the town was a decade ago. The prospect of zigzagging roads excited me, a new driver only used to city roads and straight highways. Dropped Nanay off to Banga, where she could spend time with Lola. Dragged Uncle Boboy, who had no plans that morning other than to fix the broken cabinet. Other aunts and uncles weren’t around. Sean was with friends. So it was myself, Manong, and Uncle Boboy for this trip.

Drive was pleasurable. Roads were lined with old but vibrant trees. The uplands reminded Manong and I of our trip to Banaue: a stark reminder of the beauty of God’s creation, and of the fact that we live in a piece of paradise in Southern Philippines. Arrived just in time for lunch at Punta Isla. Had sinugbang tilapia fresh from the lake; pork sisig; and pinakbet. While waiting for the food, we walked around the resort. Took touristy photos of Uncle Boboy with Lake Sebu in the background. Hearty lunch rendered us sleepy. Rain clouds hovered over us that we wished we had brought pillows and blankets. Nobody would notice us snoozing in the cottage; we were hidden from view.

“If your Tatay were alive, he’d love to go with us,” Uncle Boboy said.

“He’d do the driving himself!” I said, wishing my father were around. He loved adventures.

Uncle Boboy wanted to visit Traangkini Falls after midday coffee. Lady at information desk told us to turn right, head for the first bridge we see, then turn left. Parked by the dirt road’s shoulder when we realized the stream was too deep for the car to traverse. Walked all the way to the falls. Families rented cottages. It rained, and figuring we couldn’t go any further, we hid under a makeshift roof until the downpour was over. By three in the afternoon, we were on our way home.

Lake Sebu with Uncle Boboy
Lake Sebu with Uncle Boboy
Lake Sebu with Uncle Boboy
Lake Sebu with Uncle Boboy
Lake Sebu with Uncle Boboy
Lake Sebu with Uncle Boboy
Lake Sebu with Uncle Boboy
Lake Sebu with Uncle Boboy

Friday, April 9, 2021

Quick updates

1


Had a memorable time as panelist in the second creative nonfiction writing workshop for doctors hosted by the Bienvenido N. Santos Creative Writing Center (BNSCWC) of the De La Salle University. Extraordinary privilege to work with Prof. Marj Evasco and Dr. Joti Tabula again. They elevated the tone of the discussion. Inputs were academic but practical, laced with grace and understanding. Enjoyed close-reading the works of the other fellows: a celebration of literature and medicine. That participants could bond over Zoom meetings and get to know each other as if they had met face to face previously—it remains amazing to me. Closing remarks of Dr. Ron Baytan, poet and director of the BNSCWC, on the workshop’s final day were inspiring. He told us to be doctor-writers and writer-doctors, which sent chills down my spine. So this is what we are.

2


Some close friends in Manila have contracted COVID. Been asking them how they are, almost on a daily basis. So far, worst complaint is the loss of taste and smell with some cough and fever. What else to say to them but to drink lots of water, eat well, get enough rest, because, truly, there is no cure yet? Together we look to the Lord Who controls all things, and in Whom nothing is impossible. Other friends got vaccinated. Some good news, at least, but cases are rising. Even big people haven’t been spared: former president Erap, now in critical condition; singer Claire dela Fuente, who passed away after being turned down by many hospitals. Won’t get started talking about the Philippines’ pandemic response—it’s much too early in the day.


3


Started reading Don Quixote, the quintessential Spanish novel. Each time I start with the classics, I ask the same question: why didn’t I read this long ago? Truth is that life got in the way. Miguel de Cervantes’ foreword is self-deprecating and hilarious: he apologizes for not coming up with a more illustrious novel and tells of his friend who advised him to include remote references, Latin phrases, and pretentious footnotes to make the novel sound literary. Don Quixote, of course, is one of the best novels of all time. Wish I could have met the author; he seems like a fun guy to hang around with. Might take me years to finish the novel. The chapters read like short sitcoms.


4


Started private practice in General Santos City. Currently brushing up on my Bisaya, which I inevitably mix with Hiligaynon. “Unsa gibatì mo, Sir?” opens their hearts to me. Patients understand both languages well. Have gotten used to driving 60 kilometers, one way, in the morning, then another 60 at lunch time. Travels feel like my commutes from Mandaluyong to PGH, only more relaxed. I play pulpit preachings of Tim Keller and John MacArthur—the long roads now avenues for quiet meditations. On evening drives, I prefer arias and operas. Léo Delibes’ Lakmé, some Puccini and Tosca—pretentious, but nobody can see me. These songs keep me awake, at least. Whoosh of faster vehicles in the dark Tupi highway can lull any careless driver to sleep. Days ago, when I got home from late rounds, my family and Auntie Nanic’s kids were more than halfway through the new Godzilla movie that they hardly noticed my arrival.


5


House in St. Gabriel now being repainted. Fumes irritate everyone, except me. Might drive to Lake Sebu for lunch. Sean on his way to Gensan to buy new sneakers. Manong might go with me. He has books to read. Nanay might stay home to play a word game on her iPhone. Yesterday, I was her designated driver when we visited Auntie Susan’s home in Banga, beside Notre Dame. Could write a book in Auntie Susan's garden. Some photos of her home:

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Homegrown kadios for the quintessential Ilonggo classic, kadios-baboy-langka (KBL).

Thursday, April 8, 2021

Friday, April 2, 2021

Wednesday, March 31, 2021

Sunday, March 14, 2021

Driving milestones

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Driving at 110 km/hr, I opened my window shades to the intermittent whoosh of vehicles of early morning risers speeding by: my people. Sun was just rising as I passed by Tupi-Polomolok border. Fresh, crisp, hopeful air circulated in the car. Tim Keller's preaching played in the background—The Sermon on the Mount. From my view, I could see Mount Matutum. In less than an hour I was in General Santos City. My record time. An empty parking lot greeted me—an early Sunday reward. My patient said, "I feel better just seeing you." I said, "No, it is I who feel better seeing you getting better." I drive back home, in time for the Sunday worship service. To a person beginning driving in the real world, every distance traveled is an occasion for thanksgiving. 

Even in driving, I am a morning person. 

(Photo of Marbel-Gensan Highway taken last year, not today, because I was preoccupied. And I did not drive the vehicle shown.)

Thursday, March 11, 2021

Bedtime reading

 John Updike's The Bulgarian Poetess:

He spoke to her very clearly, across the fruit, fearful of abusing and breaking the fragile bridge of her English. "You are a poetess. When I was young, I also wrote poems."

She was silent so long he thought she would never answer; but then she smiled and pronounced, "You are not old now."

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