No apraxia

A FEW days ago, I took care of a patient admitted for a four-day history of generalized weakness—at least, that was what the watcher beside him had had told me. I wasn’t convinced. I spoke with another watcher, one of the extremely worried relatives, who said she only noted the weakness a day ago. Was this acute stroke? I performed a neurologic physical exam. I asked him to show me how he brushed his teeth; he slowly lifted his right hand where the IV line was inserted, and did an up-and down, back-and-forth, and circular motion, his hands clasping an imagined toothbrush. It was a good sign. I then asked him to demonstrate how he combed his hair. He refused to do it, saying, “Kalbo po ako ako. Bakit ako magsusuklay?”

May point siya.


I choose you

Dr. John MacArthur's preaching on the doctrine of election and predestination is a worthwhile read. It is a difficult concept to grasp: God choosing his elect even before the world had begun. Why do we, for instance, need to share the gospel when God has predetermined whom He will save? Why do we need to bother with evangelism, at all, if that were the case? And isn't it unfair of Him to not give us a chance, for him to say we will go to heaven or hell, before we have lived our time on earth? Difficult questions, indeed—I grappled with them when I was a young believer. Yet the Bible is clear about this.

Pastor John ends the preaching with this beautiful prayer. I hope it ministers to you, as it has to me:

Father, we are thrilled with this glorious truth, thrilled, stunned really that you’ve chosen us and we ask the question “why us?” Why us? We thank you, O God, for your gracious salvation and we thank you that that salvation, even though we can’t comprehend it, is open to anyone who looks to Christ and believes in him. Whosoever will may come. How you harmonize that with your sovereign election is for you to understand and not for us.

But we know Jesus weeps over those who will not come. We thank you on the one hand, for those who have not embraced Christ, may you awaken their dead souls, give sight to their blind eyes, may they see Christ irresistibly before them and run to him for salvation. We pray in his name. Amen.

The proverbial Outside

MILES away from Manila, and hardly having slept for the past 24 hours, Poring Porlas, Jerê Vallente, and I take an hour-long drive in search of the Outside World. It was providence that only brought some 15 patients to be decked to Internal Medicine at the Emergency Room last night, a far cry from the usual number of patients we attend to—about twice or thrice that number. Maybe because it was a Sunday, or maybe it was raining hard, what with typhoon Karen entering the country’s area of responsibility, forcing the ill to stay at home and wait for the sun to shine.

The coffee shop where we sit, all of us half-groggy from all the walking and window-shopping, is quiet. I’ve missed afternoons like these, when I could finish reading a book in silence, only to be surprised by the fact of the sun’s setting.

As we eat kaya toast and half-cooked eggs (“Don’t worry about Salmonella,” I tell them) in a corner, Poring makes fun of the way I assign our interns their tasks; he mimics my serious, stern, tone and wonders why, of all of us, our interns follow my orders first before theirs.

Wedding in Cebu

Cebu Mactan Bridge

I FLEW to Cebu last Saturday to attend Leeca—Lee-ann to many—Caro’s wedding. She finally married Matt Chang, her internship block mate who left her heart defenseless against romantic love. I didn’t stay too long—maybe just five or seven hours, some of it at the airport—but I was, and still am, glad that my friend (who occasionally reads this blog) is now happily married. May God grant them a fulfilling, lasting, and fruitful marriage.

Longer—yes, change has come

I HAD never seen Kuya Vio, my barber of seven years, so excited. From the glass pane, I saw him about to doze off on his barber chair. The shop was extraordinarily quiet, and save for the Indian man getting a massage, there weren’t any other customers. It was a rainy Saturday afternoon, the kind that made one think of pajamas and dark rooms and hot coco and study lamps and good books and feet curled up in bed.

“Bagay na bagay ang buhok mo sa ‘yo, Dok,” he said, literally jumping out of his chair when I had opened the door, my arrival signaled by the obtrusive jingling of metallic rods hanging over me.

“So okay nga ang mahaba sa akin,” I said.

“Oo naman! Mas bagay ‘yan dun sa semikal.”

“Talaga lang ah.”

“Mas mukha kang doktor,” he said proudly.

I had seen only him four weeks ago, then many weeks before that. It was only months ago when I had decided, after my friends’ prodding, to finally grow my hair. I was convinced that it was probably time I’d change something. My brothers have outgrown the semikal hairstyle since many years ago—Manong Ralph, when he had gone to college in 2002; Sean, when he got to high school at about the same time. I was what you would call stuck.

When we were growing up in Koronadal, Tatay would bring me and my brothers together—a so-called haircutting day that happened monthly—and we’d go to wherever Pastor Ray would be working. During those years, he’d transfer from one shop to another. He has seen us grow up and old, and since we have moved to Manila to study and eventually work, he would ask Tatay about our whereabouts. He was, as far as I knew, pastoring a local church in another town but had to support himself and his growing family financially. A clean cut was what my father was gunning for—he didn’t want his sons looking like “addicts.” Eventually, my father did grow his hair—it made him look younger—leaving me with the shortest haircut in the family.

During the transition from semikal to what it is now—a barbers cut with a straight hairline, my hair combed to my right—I had to get used to the fact that whenever I scratched my head, I had to arrange my hair back to what it had looked like. I had to learn new things, as well: combing my hair in the morning before I’d leave for work, even using hair products to keep my strands in place; or getting used to looking at the mirror to check if I look harassed; or learning the value of holding on to my head whenever the wind blew. The term, “bad hair day,” had now taken a new meaning.

Friends always exclaim with surprise at how different I now look and how well the new hairstyle fits me. I have difficulty reacting to those statements—until now, my hair hasn’t gotten any attention, save for some classmates who used to rub my head with their palms during lectures.

I’m writing this to tell you: change has come. I just hope that like my hair, my faith in and love for the Lord, too, would grow.

What’s a good shampoo? And how much conditioner do I need to apply?

New hair

What I should've written in my residency admissions essay

DAVID Remnick's profile of the writer-singer Leonard Cohen is an enjoyable read. Cohen said he had wanted to be a writer:

“raincoated, battered hat pulled low above intense eyes, a history of injustice in his heart, a face too noble for revenge, walking the night along some wet boulevard, followed by the sympathy of countless audiences . . . loved by two or three beautiful women who could never have him.”

Read the rest of the article here.

With trembling voices

THREE pre-residents1 came to the call room yesterday. They introduced themselves with trembling voices. One used to be our intern. The other two were from other prominent schools. They were to go on duty with my team. They seemed intimidated, as pre-residents usually are, considering that they find themselves in a rather precarious, awkward position—halfway between being an intern and an actual resident physician. I don’t blame them.

About a year and a half ago, I remember waking up at 2 AM every morning to catch an early cab ride, so I could arrive at 3 AM and finish charting all my assigned ward patients before my residents even saw the light of day. The goal of pre-residency was to impress, to show off, to demonstrate that I was better than the rest of them—and therefore I could survive residency. It was extremely competitive. Those were never my goals, however. I felt, at the time, that I just needed to be myself: if they didn’t like me enough, then it was probably for my own good that I shouldn’t get into the prestigious UP-PGH Internal Medicine training program.

First time: MICU Senior

I was the Medical Intensive Care Unit senior last night. No biggie for those who’ve been there, done that. But there's something exciting and frightening about experiencing New Things or Things Never Tried Before. Last night wasn’t quite the exception. It’s the idea that things always change—for better or worse—that prevents us from stagnating. The attitude we employ must be that of welcoming the changes and learning from them. I got a few hours of shut-eye last night. My phone was beside me all the time, and I was waiting for it to ring, for a nurse or panicking intern tell me, “Sir, may code po.” Praise be to God for guiding me through the number of referrals I’ve seen. I realize, as I write this, that I’m more than halfway through residency training in this bright, beautiful, sometimes depressing, world of Internal Medicine. I’m grateful that I am where I am, and that I’m doing what I love.

Another post about C. S. Lewis

Photo Credit:

PHOTOS of old people make me really happy. They fascinate me, like babies do. Maybe even more than babies. I like keeping old friends in my life. It's not a secret I want to look like C. S. Lewis when I grow old: that hearty chuckle, gentleness, and faith. And maybe that double-chin, too—give or take.

I found this charming collage in The New York Times Opinion page, in an article written by Peter Wehner.

C. S. Lewis was a great thinker—his Christian worldview is pervasive in church circles, even to this day. He spoke about many things but hardly meddled with politics and government. And understandably so. He believed in the separation of church and state. He believed, in a sense, that the goal of Christianity is not to reform government but to proclaim Christ and Him crucified.


For the love of Christ compels us, because we are convinced that one died for all, and therefore all died.—2 Corinthians 5:14

IN THE WEE hours of the morning, as soon as I wake up, I launch into a philosophical exploration of sorts. Why do I do what I do? Am I where I should be? Is it the Lord’s will for me to be a doctor? It’s amusing: I’ve had my PRC license for a year and half now, but I still wonder if I should be a physician at all. Do you find yourself asking these questions, too?1

But I am where I am and where I should be. And I trust in the comfort of God’s promises that all things work out for my good and His glory (Romans 8:28). I am thankful for the calling—this vocation of saving lives—that He has led me to.

Sweaty palms on bare metal

MY PALMAR HYPERHIDROSIS—sweaty palms, something I’ve had since kindergarten—has gotten worse. I’m not alone in this; apparently, I share this with more or less 2.9% of the US population1.

This afternoon I bought a transparent matte case for my laptop. The feel of sweaty palms on bare metal is too much for me to handle—too gritty, too uncomfortable. So goodbye to my well-loved, overused laptop sleeve for now. My palms are funny: if they’re not sweating, they’re peeling. Ah, they have lives of their own.

  1. Stratton et al. J Am Acad Dermatol. 2004;51(2):241. We don’t have local data on this condition. ↩︎

The professional food critic

Post-orals lunch at Café Ilang-Ilang, Manila Hotel

THE New Yorker’s profile of Pete Wells, The New York Times restaurant critic, is fascinating.

The front of the room was bare and bright, and filled with thirty-year-olds on backless stools at communal pale-wood tables—a picnic held in a cell-phone store. The noise level reminded me of Wells’s review of a Tex-Mex restaurant: “It always sounds as if somebody were telling a woman at the far end of the table that he had just found $1,000 under the menu, and the woman were shouting back that Ryan Gosling had just texted and he’s coming to the restaurant in, like, five minutes!” Wells is not peevish about discomfort. His columns make a subtle study of what counts as fun in middle age—loyalties divided between abandon and an early night. His expressions of enthusiasm often take the form of wariness swept away: Wells found joy in a conga line at Señor Frog’s, in Times Square. But after dining at Momofuku Nishi he returned to his home, in Brooklyn, and wrote in his notes about “a hurricane of noise.”

Being a restaurant critic is one of my dream jobs and is in the category of: “being a writer for The National Geographic” or “being a book critic for The New York Times” or “working in Shinya Yamakana’s stem cell laboratory.”


“For you remember, brothers, our labor and toil: we worked night and day, that we might not be a burden to any of you, while we proclaimed to you the gospel of God. You are witnesses, and God also, how holy and righteous and blameless was our conduct toward you believers. For you know how, like a father with his children, we exhorted each one of you and encouraged you and changed you to walk in a manner worthy of God, who calls you into his own kingdom and glory.”—1 Thessalonians 2:9–12

ON THIS SUNDAY morning, I thank my pastors and Bible study leaders in my local church, men who preach the gospel day in and out, in season and out of season, regardless of how many there are of us who listen. I thank these men who toil daily, searching and understanding scriptures to equip us to be God-fearing church members. Theirs is a difficult job and calling, and one that doesn’t start at 5 and end at 8. They labor to strengthen our souls, to lead us to maturity, and to leads us to see the beauty and majesty of Christ. Let's thank the Lord for them, and to pray that God strengthen them and their families, and provide for their needs.

The end of the day

Going home

THERE'S something about this photo that makes me sad and tired and comforted—a typical scene of Pedro Gil Street that one encounters after long, tiring moments at the hospital, a reminder that the day is almost over, and one can retire to one’s bed and read a good book or maybe have dinner with friends or go to church for Bible study. Every day ends, and regardless of how long it is, it comes to a full stop at some point.

Displaced: Outtakes from the AVR

THE SMELL of something burning brought us all out of the Second Year Call Room. I think it was a Thursday, and I was sleeping inside my dorm room when I got the text pass: vacate the call room now. It was later traced to a defective electrical wiring inside the bathroom. The Call Room has been declared a fire hazard.

Since the weekend we've been sleeping, rather comfortably, like refugees at the AVR Conference Room, where Mang Dan made a homey place for us to lounge around as we wait for the next referral.

Jason in the house!

Jason in the house

JASON Enriquez, my college roommate in Kalayaan Hall, still looks the same after all these years—save for the fact that he now sports more subcutaneous fat, his hair peppered with white strands of hair, his orbits barricaded by metallic frames that look comfortable on his face.

“Nearsightedness,” he told me. “Laging nasa harap ng computer.”

His fourth finger now bears a minimalist silver ring.

“How does being married feel like?” I asked.

“Masaya,” he said in perfect Tagalog.

He has been married for at least two years now, a ceremony I had missed because I was in the hospital, attending to my patients—a tragedy I have repeatedly come to accept. It wasn’t the only time something like it had happened.

I met Jason two nights ago, at 9 PM—a time of the day that, after all these years, he still remembers as the beginning of my descent into sleepiness. It was the only common time we had for his brief foray in Manila: a business trip in between which he planned to squeeze meeting family and friends before he goes back to Kyoto with his wife.