Saturday, September 26, 2015

Asking the right questions

IN THE DRUDGERY of an internist’s daily life, there are moments of surprises that come along the way. This happened to me two days ago. I checked on a fifty-something patient, someone my service and I were managing as a case of upper gastrointestinal bleeding secondary to a probable GI malignancy. I had told him during our first encounter that he should observe the color of his stool. It was to be his “assignment.” I wanted him to pay close attention as to whether it looks like asphalt or dinuguan—local descriptors of melena that I have found useful in my practice. Dark, tarry stools are a useful sign of acute or active bleeding anywhere in the GI tract.

Friday, September 18, 2015

Back to the basics

There's nothing new in Sana Dati. It is, for purposes of classification, a love story. A woman gets married to someone she doesn't quite know, just about a week after her fiancĂ©—a respectable, intelligent, rich man—had proposed to her. She gets the jitters, complains of stomachache, but looks disinterested during the video shoot hours before her actual wedding. We later get the idea that something is wrong: she loves someone else; that person, however, is already dead. 

The narrative is ordinary, but there's something refreshing as to how it has been told. Maybe that's the difference. It does not use the usual Star Cinema romantic film formula. The characters speak naturally, as normal people in Metro Manila do. There are no obnoxious best friends, character-less entities usually fielded as dialogue fillers in other films. We don't feel kilig; we feel sad and supportive and hopeful that things will turn out well. The scenes are solemn and contemplative, all expertly shot—a great feat, given that the film only had a little less than three million to be produced. The music, too, does not invite giggles.

It is a simple movie told extraordinarily, certainly worth your while. 

Tuesday, September 8, 2015


TIM KREIDER’s essay, “The Summer That Never Was,” captures the longings of someone who had laid out his plans for a trip to Iceland, a to-do list that never materialized. (I want to go to Iceland, too, partly because the landscapes look like they're from another planet, partly because I want to learn how to pronounce the weird names of places.) There’s a familiar tone to it, I suppose: the fact that the possibilities for travel, leisure, and adventure are endless; yet I am limited by my career, which, in a sense, is of my own choosing. The essay speaks volumes to me, a doctor in training trapped—by choice—in the hospital, wanting to do so much more.

He writes,

"I’m not old but I’m not young anymore, either, and if you’re a procrastinator and a ditherer like me you can manage to sustain until well into midlife the delusion that you might yet get around to doing all the things you meant to do; making a movie, getting married, living in Paris. But at some point you start to suspect that you might not end up doing that stuff after all, and have to consider the possibility that the life you have right now might pretty much be it."

Saturday, September 5, 2015

The Journal of Travel Research

LAST NIGHT I lulled myself to sleep by browsing through PubMed, the largest, most comprehensive database of medical literature. I searched for random things, keyed in "funny" as a Boolean free-text search term, and found a case report about a patient, chronically diabetic, who presented with extreme funny-ness. There is a wealth of material there, but it can read like a phone book if one doesn't know what to look for, and how to look for the material desired.

Now, on to the subject of research. Publish or perish still remains the dogma in academic circles, and it's a shame that in our country, the culture of research is still too young, too immature, to even take flight. We must congratulate our local scientists and researchers for keeping at it, despite the lack of support, resources, and encouragement.

If I had the chance to be editor of a scientific paper, with all its perks and pains, I'd probably want to work here: The Journal of Travel Research, which I found at the Singapore National Library. Imagine all the traveling I will do, for the sake of "knowledge." But then again, why write for a scientific journal when one can always do feature articles of magazines? Or maybe work for National Geographic? One of my dream jobs, definitely.


Sunday, August 30, 2015

On pre-residency

Garden in front on Ward 3, taken on a lazy Sunday morning.

NOTHING reminds me more of The End of First Year Residency than the prospect of seeing new faces applying for one of the 21 coveted slots in our training program. This limbo, called the “pre-residency,” is the worst of two worlds—the newly-inducted physician doesn't quite know whether he should celebrate his recent victory in the Boards or whether he should study again (as if studying ever ends in our line of work) to prepare. I do not want to go through it all over again. I will call a masochist anyone who claims otherwise. There is a reason why pre-residency is proverbially called The Hunger Games.

Thursday, August 27, 2015

Working it

Manila from my hotel room

I WOKE UP this morning with this view from my hotel room––a huge one, and all to myself. I was picked as one of the participants to the 8th National Writing Workshop and 1st Writeshop for Young Researchers at Sofitel, Manila.

Monday, August 24, 2015

Where everything works

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AS A CHILD I only knew of Singapore through its flag (there was a time when I memorized all the flags of the world—the era, for instance, when Czekoslovakia was still an entity) and through the hanging of Flor Contemplacion, then the highlight of national news. Since then I’ve had friends who’d visit the city-state occasionally, just for a few days, and never longer than that, to shop and dine and attend conferences, convenient excuses for free travel. For the last three to five years I’ve had friends, too, some very dear to me, like Kuya John, who have relocated there for work. The pay is better, the living conditions much more humane, and it’s only a three-hour plane ride from Manila.

I decided to visit Singapore on my week-long leave out on a whim, thanks to my brother Ralph who encouraged it. “What about Singapore? Let’s visit John,” he said. That night, without fanfare, and with the sole request that I must escape the country, lest I lose my mind; our tickets were booked—never mind that my passport was expiring and had to be renewed as soon as possible.

Weeks turned into days, and by the time I realized I hadn’t printed the tickets yet, I was already on my way to NAIA Terminal 1, carrying a light backpack, which could’ve been a metaphor for my leaving the excess baggage of my life back home. No more rounds, no more patients to see, no more charts to write on. Save for the hysterical cries of toddlers seated a few rows from mine (their ears must’ve been popping from the change of atmospheric pressures), the early morning flight went smoothly. I even got to sleep for a couple of minutes.

At Changi Airport, arguably the best in world, a fact made much more palpable by the fact that NAIA is the worst (and for good reason); my brother and I were greeted by our Singaporean hosts, Uncle Micky and Auntie Lydia Foo. My brother has known them through a close friend from work.

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They took us backdoor to eat at the employees’ canteen at the airport where we were treated to steamed vegetables with tofu, and satay—noodles with coconut milk.

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Sugarcane juice, which I got addicted to.

They drove us around the city.

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The Fullerton Hotel, an imposing landmark. 

What shocked me at first was how seamless the trip felt like, as if we were on expressways during the holidays. There were trees everywhere, too, with hardly any posters or ads or obnoxious photos of grandstanding politicians on the side. Clearly this was a place where everything worked—where sparks on the railway, messing up the train schedules, make for a national calamity.

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"They're always building things," said Auntie Lydia.

One of the highlights of this trip was getting to know the Foos. They are second/third-generation Singaporeans who still, in a way, remember what Singapore was like when it had started. “Like the Philippines,” Uncle Micky said, who stressed the importance of good governance and political willpower. At the Marina Barrage, where they brought us first, we saw feats of Singaporean engineering—the fact that they filter and recycle their used water for drinking because they don’t have much natural resources to begin with. They brought us to many places—the East Coast Beach where Uncle Micky told us about his fishing hobby; the nearby hawker center where Auntie Lydia lovingly insisted that we try everything, including the stingray and oyster-with-egg; the Punggol East Park where I saw the oil refinery stations and lights from nearby Malaysia—“Look over there,” Uncle Micky said—so near yet so far. The best thing, hands down, was being invited to their home, getting to know them, having meals with them, and seeing Rufus and Buttons, their two dogs. We are forever grateful for their warm Christian hospitality and generosity.

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Chicken rice, arguably Singapore's favorite dish.

On our second day we headed to Thomson Drive, near Sembawan Hills, where Kuya John lives. Uncle Micky, having the entire day free, drove us there himself. The condo—which Kuya John shares with his brother Jaja and his high school friends from way back, Kuya J. I. and Ate Fran—felt so homey that my first impulse was to lie on the couch and watch Kris TV, the show playing on TFC. “I watch Kris to relax,” Kuya John said.

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Kuya John and Manong Ralph at Books Actually, along Tiong Baru.

I had no other expectations for the trip; the fact of my physically and mentally leaving the hospital was already enough to uplift my spirit. I said I was already happy, too happy in fact that I could terminate my four-day stay and not feel bad at all. So when Kuya John asked what I wanted to do, I said, “Well, anything.”

And that launched our stress-free trips to the Orchard Road malls, to the Lower Pierce Reservoir, just behind their condo; to the museums and libraries where we saw bespectacled Singaporean children slaving away with their laptops and notepads; to Tiong Baru and the most hipster bookstore I’ve seen (“Books Actually”); to the Marina Bay Sands and Merlion, where I had my mandatory photo (and which I shall never publish here—too tourist-y), just to cross it off my list. We got home at around 7, and were asleep at around 8. I felt like I was in a coma.

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A silhouette of myself at an art installation at the Esplanade, the closest thing I had to a selfie.

Morning calm
Calm waters at the Pierce Reservoir, just a stone's throw away from the condo where we stayed.

Morning walkWala pa kapanghilam-os, nagdayan-dayan na dayon, as if if were UP Diliman all over again.

Art installation in front of the Singapore National Museum.

Gazebo at the Botanic Garden.

I would wake up at around 7 (very late, by my standards), pray and meditate, and do some leisure reading—Elena Ferrante’s The Story of a New Name and John Bloom’s Things Not Seen—before doing anything else.

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On the third day, we went to the Zoo, this time with Jaja, our resident veterinarian, so he could give us deeper insights into, say, the mating practices of flamingos, the neck bones of giraffes, and the shiny coat of the pygmy hippopotamus.

Singapore Zoo: the elephant show

On the fourth day, we went to the National Museum, the National Library, and the Botanic Garden. That night we met with the Cobradors, our neighbors from St. Gabriel, Koronadal City. Ate Tin and Kuya Edward Marquez have been working as doctors in Singapore for two years now. They treated us to ramen at Somerset. We mostly had fun reminiscing our childhood days—those sticky afternoons spent under the santol tree, and the delicious polvoron Auntie Norma would serve us.

Books at a library in Somerset Road.


We flew back to Manila this morning--the polluted, corrupted Manila where nothing works; a place we've nevertheless called home for the past ten years. As I’m writing this, I am just a few hours away from getting back to my old life. I am thankful for friends and friends who are practically family for hosting and touring us around. Most of all my heart is filled with gratefulness to God for this brief episode of respite, He being the Giver of true comfort and rest. “ . . . For He is good, for His steadfast love endures forever.” (Psalm 139:1).

More photos of the Singapore trip here.

Saturday, August 22, 2015

Elena and Lina

After a hearty breakfast of kaya toast, soft-boiled eggs, and sweet hot tea with cream at a nearby hawker center at Sembawan Hills, I leafed through the final chapters of Elena Ferrante's The Story of a New Name, the second in her phenomenal Neapolitan series. Lina Cerullo and Elena Greco's friendship is complex, set in Naples and occasionally Pisa and Milan, all of which which make for an interesting story. They seem to idolize, and outdo, each other. Elena, having just finished a university degree, visits Lina at the sausage factory, while avoiding and antagonizing the other workers' sexual innuendos. Elena writes this passage, a beautiful and appropriate description of their unusual friendship.

I understood that I had arrived there full of pride and realized that—in good faith, certainly, with affection—I had made that whole journey mainly to show her what she had lost and what I had won. But she had known from the moment I appeared, and now, risking tensions with her workmates, and fines, she was explaining to me that I had won nothing, that in the world there is nothing to win, that her life was full of varied and foolish adventures as much as mine, and that time simply slipped away without any meaning, and it was good just to see each other every so often to hear the mad sound of the brain of one echo in the mad sound of the brain of the other.

Tuesday, August 18, 2015

Day three

WHAT surprises me the most is the strange, unbelievable chasm of time between my waking up and my leaving the room. Light years away, that void, unappreciated by most, except the very few who hardly have time for anything else other than the painful, occasionally dreadful, sometimes joyful, reality of work.

The curtains are drawn, and my little bed is filled with sunshine. Everything is aglow. The house, in its stillness, beckons to be looked at, studied—its nook and cranny, the little specks of dust that have settled on the jalousies—just because I can. I have all the time in the world. There is time for contemplation, for prayer, for smelling the freshly brewed coffee as little drops of it falls from the machine. The phone is quiet, and I am not needed. 

So this is how it feels like. My heart sings, leaps, and dances at this strange, new, free world that has opened up.

Sunday, August 9, 2015

To Tagaytay and back—unscathed

THE PLAN was to spend the afternoon to study somewhere else. Madame Julie, my January Gen Med senior who has long since become a dear friend, offered to bring us, Racquel and I, to Tagaytay. She did not bother to tell us it was her first time to bring her car to the area, lest we back down. Because she had GPS, we did not get lost. The voice of a lady, possibly Siri's older sister, entertained us throughout the ride. "Turn right. This is an accident prone area." We were thrilled.


Wednesday, August 5, 2015


BLOCKMATES are forever, they say.

Blockmates H1N1

Saturday, August 1, 2015

The prospect of leaving

Yesterday afternoon, as I was checking my phone while lying on bed inside my dorm room, still wearing the same clothes I had when I did rounds that day, my roommate barged in, as if in a hurry. I felt spent, with all of me, hands and heart, feeling the heavy burden of the month that was.

“You’re not going home?” Tom asked—home being Quezon City, where my brother lives.

“Maybe later, when the traffic dies down,” I said. 

I watched him pack a few clothes and stuff them into his red backpack. He arranged some of his clothes in the closet before closing it with a sense of finality.

“When are you going on duty?” I asked.

“August 10 pa. Leave ko na kasi.” 

“Wow!” was all that I could muster, until I had gained the courage to ask him where he was spending it. I knew I would falter somehow—my envy would make itself manifest. He told me, and I kept a straight face. “Oh, the whale sharks,” I said, to make steady conversation.

Then I desperately wished for a chance to leave the hospital, too, even for just a few days, to recover something of my life that I’m losing because of my medical training. It is a price I pay for the many, many things I’m gaining and learning, like saving lives. 

As he headed out, excited by the foreign prospect of being away, I wished him safe travels. I continued lying on bed, killing time by doing nothing else but stare into the blank space that grew with the setting of the sun. I was so tired that I fell asleep, wishing for myself a chance, like Tom’s, to leave my real life for a few days of respite. When I woke up it was already evening. It was only then when it finally dawned on me that August is my leave month, too. 

And on the third week, I will not be reporting for duty. No charts, no patients, no urgent calls. Work is grace, but so are vacations. The Lord is good.

Sunday, July 26, 2015

My optometrist

While convalescing from a bad case of flu (upper respiratory tract infection, probably viral, if I should document that in my chart), I headed to my optometrist to get an eye exam and a new pair of glasses. It has been a while since my last visit—three years ago, when I was still a medical student. Now with long, black-brown hair but still brimming with a hippie vibe, she remembered me fondly, telling me, while checking her index cards, that she started seeing me in 2005. I was around 17 then, majoring in molecular biology, when I could still see my feet clearly sans the spectacles. These days, you could strip yourself naked right before me, and I wouldn’t recognize a thing.

Saturday, July 25, 2015

July so far

I'VE BEEN stationed at the Charity Wards since July. I'm sharing and annotating some photos taken randomly during my stay there.

Interns from Services 3 (where I've been assigned since, believe it or not, clerkship) and 6. They look fresh in this photo despite monitoring our patients nonstop.

July 2015 Charity Ward rotation

Saturday, July 18, 2015

Aga Muhlach

We rarely get patients with Down’s syndrome. This month I’ve been taking care of a patient with such condition; he is already 35 years old. His mother, in her early seventies, still looks after him. She cleans after him, changes his diaper, doesn’t mind that his feces has soiled the sheets, and makes sure he doesn’t fall off the bed. He has gotten better since his admission, and we plan to send him home in a day or two, God-willing.

Friday, July 17, 2015

The Pile

The nurse at the Out-Patient Clinic alerted me that I had a long list of patients to see. My pile was extraordinarily tall. Some charts were as thick as my books, brimming with paper made fragile and yellow by time. I was running late. I should have started seeing patients at 1 PM—it was already 10 minutes past two. I was also attending to one of my admitted patients whose course was getting complicated by the day. I couldn’t be at two places all at once, so there I was: sweaty and hungry and ready to save lives, one patient at a time.

Sunday, June 28, 2015

This is what our world has become

THE LEGALIZATION of same-sex marriage in all of the United States is the biggest news these days. It didn't come as a surprise that it happened at all—that the Supreme Court would issue a decision so final about an issue so divisive—but when I saw the news, my heart was filled with sadness. So this is what our world has become.

Wednesday, June 24, 2015

James Salter, 90

Photo by Jill Krementz, published in the NYT.

JAMES SALTER has died. He was 90. Considered a writer's writer and the "greatest writer you've never read," he has written novels, short stories, and essays that have brought me delight and inspiration. Not a lot of people, even avid readers, know about him. His books are a rarity in bookstores. I only find them in thrift or second-hand shops.

Monday, June 22, 2015

Happy 25th birthday, Sean!

WE CELEBRATED Sean's birthday yesterday at our favorite ramen place.

Happy birthday, Sean!


Luther and Mau. Photo by Mike Tan, not the UP Diliman chancellor. 

TWO MONTHS ago I hurriedly finished my rounds to catch a quick bus ride to Tagaytay. My dear friends, Luther Caranguian and Maureen Estacio, were getting married in a few hours, and I couldn't afford to be late. I was part of the entourage as one of the groom's men, which explained why I was in a white polo barong, carrying a well-made wedding invitation with the couple's caricature in the cover. If you had sat beside me on the bus, you would have noticed that I intermittently looked at the address, complete with the exact latitude and longitude (Luther's suggestion, I'm sure), lest I get lost. I knew it was going to be held at Sonya's Garden, a beautiful events place that serves flowers for salad. The dressing, I would later discover, would be heavenly.The wedding was to start after lunch. It was almost 11:30 AM. My friends, especially the ones who brought their cars, were already there.