Monday, April 6, 2020

Sunday, April 5, 2020

, , ,

Journal of a Lockdown No. 24

Perhaps it is during Sunday mornings when the pain of separation hits the hardest. Christianity has always been in the context of the Church, God's redeemed people. During Sundays the Church is called to gather to worship, to fellowship with one another, to encourage one another with psalms, hymns, and spiritual songs.

That we have the internet to connect us virtually is a blessing during these extraordinary circumstances. But online worship services are not quite enough. Tim Challies, one of my favorite bloggers, writes:

Watching a church service online was novel the first couple of weeks. And while I’m grateful it’s an option, three weeks in I find myself grieving the necessity of it, and longing to be back with the people I love.

Dr. Albert Mohler, in this beautiful essay, carefully distinguished listening in from listening among.

No Christian should believe that meeting online offers the same spiritual benefits as if we met together physically, in time and space. Nothing can replace the people of God in one room, praising the Father, Son, and Spirit together in song; nothing can compare to the physical gathering of God’s people who together receive the preached Word. There is no substitute for this kind of gathering.

[...]

But there is a crucial distinction—indeed, a crucial theological distinction—between listening among and listening in. Listening in is a gift of God’s common grace. To be able to listen to thousands of sermons and theological lectures online is indeed a wonderful treasure for Christians. But listening in on these gifts is not equal to what happens when we listen among God’s people, physically present together as we praise God and hear his Word proclaimed.

Last week Tim asked his friends all over the world to document their private worship spaces. There are photos! It's beautiful and touching—a reminder that believers all over the world sing songs and listen to God's Word preached in various languages and contexts.

Sunday mornings are precious to me and my family. My parents gave a particular premium to honoring the Sabbath Day (and rightly so)—my father, especially, who was set on coming to church on time; punctuality, he said, was showing how much God was important to us. This meant that growing up, we should be sleeping early on Saturday nights (not a problem for us), wake up extraordinarily early on Sunday mornings (not a problem for us, either), and take showers earlier than usual (a problem for us, for which, among my brothers, I received the most number of reprimands).

As in the past three Sundays, I worship in the living room. I sing to familiar music. They're among my favorite songs in church. The preaching is streamed online. I imagine that I'm seated with Manong in the central row on the Third Floor of ESNA Building. I'm taking down notes; I memorize the week's passion verse (usually at the last minute!) lest Pilgrim Men, the Bible study group where I belong, will be called to recite. As I head out of the church building to find a good place for lunch in the Timog Area, I'm greeted with handshakes and hugs, small talks (mini-praise items, prayer requests), medical inquiries, and invitations to church seminars and events.


Pastor Bob's preaching is on Genesis 22:1-14, "On the Mount of Testing: God Tested Abraham."

Here are my notes from today's sermon.*

Lockdown No 24 Preaching Notes

Lockdown No 24 Preaching Notes

Lockdown No 24 Preaching Notes

Lockdown No 24 Preaching Notes

Lockdown No 24 Preaching Notes

How did your worship go? Do let me know through email or comments. I hope to see you, dear reader, soon—hopefully in better circumstances.


*For the curious, paper is from a random pharma-generated writing pad I found lying at home; pen is a TWSBI Eco Rose Gold Medium Nib inked with 25% Diamine Chrome and 75% Waterman Black.

Saturday, April 4, 2020

,

Journal of a Lockdown No. 23

Lockdown
Stray cat I saw today when I went out for groceries.

For All Mankind reminds me that I'm better off confined in my home on Earth instead of being stranded at the Jamestown Base on the lunar surface.

The series, produced by Apple TV+, is set in the background of the Cold War, in a revised history. I finished all 10 episodes in a span of a week. The space race between the USSR and the US is getting heated. Much to the horror and disappointment of the Americans, it is the Soviets who send the first man on the moon. NASA is under pressure to catch up. We learn of risk and ambition. We wonder if all the efforts to discover space is worth it.

But we continue watching. We observe the astronauts' private lives. We experience the anguish that their wives experience whenever they are sent into missions. We see the look of longing in their children's faces because they have been gone a long time. I'm sure parallelisms can be drawn between astronauts and healthcare workers in today's COVID-19 pandemic.

I find space movies particularly relaxing during moments of prolonged isolation. (I watched Ad Astra during a long-haul flight, for instance.) As with most of my peers, I wanted to be an astronaut when I grew up. It did not take me too long to realize that I could not. My aptitude in math was average at best, and I did not find physics fascinating.

* * *

The series' soundtrack is amazing.

Friday, April 3, 2020

, ,

Journal of a Lockdown No. 22

Lockdown April 3
(Pop) culture diet for the day.

There are days when I forget I'm on quarantine. Today is one of those days. It's a privilege not everyone gets to have. I delude myself that I have nothing much to do to. The truth is that I have a number of important things that need my attention: studying for my diplomate exams, writing my research papers. You know the drill. But I set aside every care in the world for a few episodes of a Netflix series only to be interrupted by multiple intermittent naps--a welcome distraction. There is a time for everything and a season for every activity under heaven. I realize I should snap back to a state of productivity. That should happen sooner rather than later.

As we spend our lives in our confines, the world carries on. People look for ways to feed their families. They work shifts in grocery stores, they act on our Grab deliveries, they attend Zoom meetings in their private living spaces-turned-offices. The world is changing and with it the dynamics of human interaction. The pandemic, experts believe, can last for months. It may no longer be appropriate to shake hands again. At this point, who knows?

The lockdown has freed up my time for private prayer and meditation. To make full use of this time is a daily challenge. I must "pray without ceasing."

Rejoice always, pray without ceasing, give thanks in all circumstances; for this is the will of God in Christ Jesus for you (1 Thessalonians 5:16-18, ESV).
This was the passage we discussed in my Bible study group last Thursday, the same message alluded to by a friend when she asked me how I was. "We really have no excuse not to pray," she said as a reminder to herself. It was a message I needed to hear.

2020-04-03 23:13:51
Notes during the Bible study.

You'll notice that I've been taking photos of my notebooks. I haven't gone out (I shouldn't), and there aren't any subjects left to shoot.

Thursday, April 2, 2020

, , , ,

Journal of a Lockdown No. 21

Lockdown No. 21

Lockdown No. 21

Lockdown No. 21

I love the cheap paper contained in this Miniso notebook that I often use as a scratch paper. I buy notebooks for no apparent reason; I just like the thought of having an unlimited supply of writing paper.

Writing on paper—this was, and remains, one of my favorite ways to pass the time. I'm posting this now because I seem to have all the time in the world—an illusion, I will soon find out, because I have a significant backlog of actual technical papers to write, edit, and publish.

I suppose I am inspired by Jason Kartez (Instagram: @jkartez) who has been posting his cartoons and handwriting since the beginning of the pandemic. You may want to check his feed and give him a follow—if that's ever a legitimate phrase to use!

Been reading the preachings of Jonathan Edwards, one of my favorite American thinkers and preachers. Finished watching the four episodes of Unorthodox in Netflix, a moving series about a 19-year old Hasidic Jewish woman who decides to flee her ultraorthodox community in Williamsburg, Brooklyn, New York. Started watching Parks and Recreation and have instantly fallen in love with the hyper-optimistic character of Leslie Knope!

Been trying to distance myself from Twitter and social media, in general. If anything good has come out of this pandemic, it is my newfound fascination for privacy and silence and expressing myself in longform—that is, blogging.

I hope you and your family are well. Let me know how I can pray for you. #


*  *  *

In case you're wondering: this is my scratch notebook. Pen is the TWBSI Echo Rosegold (inked with a combination of Waterman Black and Diamine Chrome).

Lockdown No. 21

* * *



I cheer my colleagues on!

Wednesday, April 1, 2020

,

Journal of a Lockdown No. 20

In a private chat group with my brothers, the topic of "What's Cooking for Dinner" came up. I was in a hotel then, my supposed mandatory self-quarantine, and it was the kind of accommodation that did not have room service. Even if it did, I would not be able to afford it. To get something to eat, I could head to the nearby 7-11; beside it was Ministop. While my brothers were sharing pictures of their culinary concoctions--Manong's pininyahang manok, Sean's pork humba--I salivated at the thought of a home-cooked meal. In front of me was reheated fried chicken from the convenience store and four cups of sliced peaches in syrup for dessert. Growing up, we did not have family traditions around the kitchen. We ate whatever Tatay thought of cooking for the day. And he was particular that we had a good dose of fruits, vegetables, and fish. For lunch, we'd usually have anything sinabawan (with soup): my parents operated on the belief that anything with sabaw was healthy--never mind the fact that oil was floating above it, or that salt was dissolved in it.

To have brothers who know their way around the kitchen is one of my life's greatest blessings. As I enjoy what they prepare, I am bombarded with reminders, such as, "You should learn how to cook; it's a life skill." Sean, three years younger than me, would say something like, "You're too old and you don't even know how to use a stove." Which is true. I am afraid of exploding stoves, largely because of a patient I cared for in clerkship. His wife and four children died after their gas range exploded. His wife was pregnant; the baby died, too.

But I'm not entirely useless. I am the designated taster. As he adds the seasoning as the final touch, Manong would tell me to come over, "Here, try this."

"Add more salt," I would say, to make his killer adobo even more delicious. I know how dishes should taste; I don't know how to create them. I am, in a sense, a passive culinary Machiavellian.

Sean would rather shoo me away. I disturb his process.

I have pininyahang manok for dinner. I reheat it using the steam from the sinaing, the closest I get to actual cooking.

* * *

Food doesn't run out for the healthcare workers, thankfully. Filipinos are wonderful. They are gifts that keep on giving. During my hospital stint, I was able to have free lunch thanks to an anonymous donation by a colleague's aunt. The staff at the Cancer Institute distributed the food packs to nurses, nursing aides, manongs and ates, and the admitted patients and their families.

Lockdown

* * *

And yet there are the poor and needy who are most affected by this pandemic.

Metro Manila (CNN Philippines, April 1) — Twenty-one protesters demanding food and other assistance were arrested Wednesday in Quezon City for staging a rally without government permit, police said.

The Quezon City Police District in a statement said the protesters, who are residents of Sitio San Roque, were arrested at a portion of EDSA in Barangay Bagong Pag-asa around 11 a.m.

A video posted by DZRH on Twitter shows the violent dispersal of protesters conducted by the QCPD. One of them can be seen being dragged by authorities, while being berated for participating in the protest.

They were protesting because they were hungry. Feed, not arrest, them.

*  *  *

It's day one of April. Thank you, Lord, for taking us this far.

Tuesday, March 31, 2020

,

Journal of a Lockdown No. 19

Rickshaw
Taken last February, when Fred Ting and I rode the rickshaw in Mumbai, India. 

Two days after my self-imposed hotel quarantine and in the absence of any symptoms, I decide to go home and continue my lockdown there--home, being my brother's small condo 7 km from Manila. I hail a yellow e-trike parked near the hotel entrance. There are no taxis. The special buses are out of the way. It is 5:30 am. The sky bears faint streaks of sunlight. The driver looks at me, head to toe, as he wipes the trike's glass window clean. I don't look like a thief--certainly not someone who will stab him. I have thick glasses, a clean surgical mask, white polo tucked in, navy blue trousers folded twice up to the ankles to reveal my striped socks and worn Adidas sneakers: my favorite get up. But, he must wonder, who travels this early, before even the sun rises?

I introduce myself as a doctor in PGH, the best way to appeal to his senses--to other people's sympathies, in general. "I need a ride home," I say. He replies with an accent that reminds me of Mang Intay, our office assistant, who hails from Basilan. I negotiate a reasonable price for a one-way trip. My offer is generous. He agrees. My father, who took pains in teaching me lessons about being street-smart growing up, must be so proud of me if he'd seen how I handle the back-and-forth. I exude the same Catedral charisma admixed with the strong Garcenila indifference that I had when I bought the leather satchel at Marché aux Puces de Clignancourt from an old Moroccan man some years ago. (He smelled like a burnt cigar; I got the bag at half the price.) I could easily have called friends from work or church; they would have gladly fetched and brought me home, with no questions asked. But I don't want to cause inconvenience. Who knows what organisms are floating in the air? I might expose them unnecessarily. The driver scratches his head and confesses that he doesn't know the way. He worries that he may be stopped in the checkpoints. "I have internet; I can tell you where to go," I say. I show him my ID, proving I work in a hospital. I assure him that I will vouch that he is my designated driver for the day. I take the farthest seat behind him.

The trip reminds me of the rickshaw adventure I had in Mumbai last February, when the reality of the pandemic was too remote, too far away, too isolated, to be taken seriously in our shores. But I had a feeling that the pandemic would surprise us one day when the meeting in India was canceled just as my friends and I were about to board the connecting flight to Bangkok, then to Kolkota, then to Mumbai. But that's for another entry.

The 20-minute drive is leisurely: Metro Manila is beautiful in the morning, and in the absence of cars and traffic (both human and vehicular), the air is fresh and cold, like in my father's farm. The whirring of the trike's engine, powered by electricity, is calming. I look at the phone's app. I instruct the driver to turn this way or that. If not for the masks and the barricaded side streets, one won't suspect that a plague is upon us.

"We're here," he says. It is 6 am. I can see my building from a distance. I thank him profusely as I hand him the bill. He is a helper. I suppose he will spend the rest of the day waiting for potential customers outside the hotel in Manila, for people he can help.

Monday, March 30, 2020

,

Journal of a Lockdown No. 18

Lockdown
With nothing much to see, except the four walls of my room, I take a photo of my old Korean frames, without which I cannot see clearly.

I learn that my friend, Roger, is also staying in the same hotel. We meet each other to get take out lunches and dinners at the nearby convenience stores. Over dinner, we talk of how much we miss our fathers (his father died a week before Tatay did), how our fellowship in Oncology has changed us (for the better), how we will miss the company of our friends. It's cathartic. I'm stuck at level 16 of Alto's Adventure: how does one do the triple backflip? Email me the tips, please. I pray for friends and loved ones. I read John Updike's The Christian Roommates. Memories of Kalayaan Dorm at UP Diliman come rushing in. I stay out of social media. I message my family: Sean is cooking pork humba at home, Manong is preparing pininyahang manok. They exchange photos. Meanwhile, I subsist on takeouts and sliced peaches. I think of studying for the diplomate exam in Med Onco, but the schedule has been postponed indefinitely. A friend reminds me to make good use of my time. Lying around, submitting myself to gravity in this self-inflicted atrophy, seems like a good way to do it. I long for a good cup of hot coffee and remember the espressos I had in Milan. The mind wanders, even in areas already closed off to travel. Coffee in Milan, glasses from Seoul.

Later.

Sunday, March 29, 2020

Journal of a Lockdown No. 17

Lockdown
Garden in front of Ward 3 of the Philippine General Hospital.

Tired after work, I head over to the nearby hotel where I'll be spending a few days for self-quarantine. I can easily come home, but I don't want to cause unnecessary risk to my brother, with whom I share a small space.

Later.

Saturday, March 28, 2020

Journal of a Lockdown No. 16

Lockdown
COVID tent beside the Philippine General Hospital Out-patient Clinic. 

My 24-hour shift as fellow-on-duty at Ward 3. It's great to be back at PGH after a long time. There's a feeling of impending doom and paranoia. Pop culture references in mind: Gondor in The Return of the King. Or the Game of Thrones ("Winter is coming"). The difference is that we're expecting patients in dire need of care, not orcs or whitewalkers. If they're COVID-19-positive, we may make special considerations.

And yet, there's a pervasive feeling of hope. A strong sense of purpose. The bayanihan spirit. In the newly renovated call room behind Ward 3, the IM residents enjoy donations of food and snacks. Masks are not lacking. There's laughter and sarcasm. We feel that the nation is behind us. But there's the unspoken fear of the unknown: we know that our work  here can harm us. A number of our professors and mentors, people we know, have passed away. But we carry on. Padayon. Onward.

Our people need us.

I'm honored to be counted as a healthcare worker. But it makes me especially proud to be a Filipino. Lots of people make the mistake of generalizing our national character by looking at our politicians and government leaders. But we must remember what Mister Rogers said:


"Look for the helpers.You will always find people who are helping."

So my advice: keep out of social media. It's suffocating. It makes you angry and helpless. But look for the helpers. Random strangers who offer free rides to car-less healthcare workers (including me). Celebrities and unknown individuals who collect donations to help others out. Businesses that offer creative ways to offer assistance. Preachers, artists, musicians, and writers who help us make sense of things. Children who write the simplest letters of gratitude and encouragement that inevitably move us to tears.

It is inspiring to be a Filipino in these times.

I don a faceshield, an N95 mask, and clean gloves as I see and admit patients. I'm keen to disinfect my stethoscope. I scrub my phone with alcohol. I see colleagues wrap their mobile devices in ziplock bags. Fountain pen afficionados use disposable ball points that they can throw to the bin after the shift. But I decide to sacrifice my TWSBI Eco Rosegold (inked with Waterman Black): I rinse it with alcohol, which can potentially damage it. I don't mind. I'll look at the pen's discoloration and think of this remarkable moment in human history. The pen will have served its purpose.

So help us, God.

Friday, March 27, 2020

Journal of a Lockdown No. 15

J Lockdown No. 15
Fresher air in Metro Manila.


My morning fiction reading: John Updike, “A Dying Cat, A Traded Car,” which was about a writer who visited his dying father and remembered their car. A beautiful portrait of a father’s love, and faith, and family.

I still think of Tatay and wish he were here. His presence was calming, like nothing could go wrong.

A friend's father died today. I message her to say how sorry I am. I probably know how it feels like.

Another friend's wife died today, too. So many deaths—since the lockdown, this has been our reality.

Tomorrow I'll go on 24-hour shift at PGH. I'm not sure if I can post something then.

Later.

Thursday, March 26, 2020

Wednesday, March 25, 2020

,

Journal of a Lockdown No. 13

Untitled
Getting a dose of morning sunshine. (Pero ang Pinoy, ayaw talagang mainitan!)

There's the news that a senator, COVID-19-positive, went to a hospital with his pregnant wife, infecting healthcare workers and effectively closing down the operations of the said institution. I am angry. What pacifies me is the strongly-worded statement released by the hospital: it minced no words and, with clarity, rebuked the senator's actions. Whatever happened to leadership by example?

There's also news that friends from church are hospitalized; one is critical. I am brought to my knees in prayer.

*  *  *

Dr. Albert Mohler, in his article, The Humbling of Civilization: Praying for the Mercy of God, writes:

As image-bearers of the living God, even the most hardened secularists among us must deal with the most ultimate issues and questions—especially when faced by this kind of life and death challenge.

I've been talking about death and dying, the ultimate questions, to a number of my friends lately. It's a subject I'm comfortable discussing. Most of these friends are doctors and, like me, are used to seeing death on a daily basis. But no other time in my life--in our short lives--has the reality of death been so . . . poignant, so palpable: it can happen to us any time. We've seen it happen to our mentors or to people our age. There's so much uncertainty about the modus operandi of this virus that it is hard to say whether one will die of the disease or not if one gets infected.

 I pray that these uncertain times will make me (and them) think of eternity.

For Christians, this becomes an opportunity to translate some of the proximate questions into ultimate questions. True, we do not know exactly how far the virus will spread or how the history will be recorded. We do not know what kind of announcements will come in the days and weeks ahead. We pray, by God’s common grace through modern medicine, that an effective vaccine will eventually be used to restrain the virus and even conquer it, but we have no clue when that day will come.

The reality is that no vaccine nor human ingenuity will ever overcome the problem of human sinfulness. With all the uncertainty in these troubling times, Christians know that hope, refuge, and peace is found in Christ and in Christ alone. At this time, love for neighbor is pointing a world in chaos to the God who loved us so much that he gave his only Son to die for us.

Dr. Mohler concludes:

Our ultimate refuge is only in the true and living God. We must remind ourselves of that now. We must pray fervently for God’s grace and mercy. And we must share that love to our neighbors and point them to Christ alone as our hope—even if we now share at some distance.

Tuesday, March 24, 2020

,

Journal of a Lockdown No. 12

Untitled
Getting my dose of morning sunshine as I rewrite an excerpt from "Peril," one of the Puritan prayers in the Valley of Vision. (For the curious, the pen is a Platinum 3776, inked with Diamine Chrome. Notebook is a Victoria insert, which fits snugly in a Midori Traveler's Notebook.)

I imagine that poems and stories will be written about this episode in our lives. As more and more people die in Italy and elsewhere in the world, including these shores, people are attempting to make sense of what's going on. This is the value of words, of literature.

I suppose Dr. Raul Jara was fond of poems: he read one of his during the inauguration of the garden in front of Ward 3, what used to be old patch of land that surrounded the Gastrointestinal Clinic. He was my college professor, one of the foremost cardiologists in the Philippines. He passed away. I never had the chance to be under his General Medicine service, but I had several opportunities to sit in hemodynamic conferences in Cardio on the sixth floor. The fellows would shake in terror when they discussed their echocardiographic findings with him: he had a stern, academic, no-nonsense presence. During lunch, they would laugh together as if nothing happened. He was a great mentor, a giant of a man young doctors have looked up to.


Joti Tabula penned a poem to remember the death of the young cardiology trainee.

MARSO 21: ARAW NG TULA
—para sa pumanaw na batang-bata pang manggagamot sa Filipinas sa panahon ng pandemiko ng coronavirus

Pinakamalungkot na buwan itong Marso.
Umaambon ng tula sa buong daigdig
Ngunit hindi ko mapanghawakan
Ng lakas at pananampalataya ang salita.
Bakit kailangang mauna ang mahal na anak
Na manggagamot na magbitiw sa mundo
Ng hulíng hininga at hindi akong ina
Na nagluwal sa kaniya? Napairi muli
Ako sa hilab ng pagdadalamhati.
Nagluluksa ang aking mga súso at matris
At walang mapagpahingahan ang aking isip.
Búkas wala nang ipagtitimpla ng kape
At wala nang ipagsasangag nang alas-siyete.
Nakakandado ang pinto ng klinika
At blangko’t walang pirma ang mga reseta.
Nakapahinga ang panukat ng presyon
At mabibingi ang istetoskop maghapon.
At ako? Nakatitig sa palábang buwang
Nakalambitin sa bukang-liwayway.
Naroroon ang aking pangungulila.
Hindi ako handang malasahan ang Marso,
Ang magkahalong luha ko
At berso ng mga makatang estranghero,
Ang talinghaga ng pagiging ina ng manggagamot,
Ang ligamgam ng alat-tamis ng sanlitrong dekstros

I enjoy reading Sir Joti's writing (I can't shake off the "Sir"--he was my in senior in internal medicine). If I could only write well in Filipino, a language so rich, romantic, and heartwarming! My favorite is PAG-ALAALA KAY PAPA (20 MAR 1956 – 3 MAR 1997). Here he relishes vague memory of his father. Without our memories, who are we, anyway?

Madalas at lalong-lalo na ngayong nása Burnham Park muli at tigulang na, pílit kong inaalala ang yapos ng aking ama at ang hawakan ng aming mga kamay nang muling nagkita sa parke. Gayumpaman, wala akong maalala. Musmos pa ngang marahil ang aking gunita.

Memory, death, and poetry today. The pandemic has brought us back to basics.

Monday, March 23, 2020

Journal of a Lockdown No. 11

Lockdown
The streets are quiet.


I am awake at  3 AM. I write the final sentences of the first draft of a story that will likely never see the light of day. It is too embarrassing to show. Perhaps I will come back to it after some time to write the second draft. The prolonged time at home has encouraged me to try writing fiction again for the sake of trying, sort of a proof-of-concept experiment to see if I can do it. The exercise has done me good, so far.

My brother reheats the food we had for dinner then proceeds to work online. Careful not to bother him, I go to the balcony to get some sun and treat myself to Dr. Butch Dalisay's story, "Heartland." (Google Books preview here.) The protagonist is a surgeon named Ferrariz, jaded with death and dying all around him. I know people like him.

Blood came with the business; it meant nothing now, the corpses piled in the wagon behind the camp, bloated and dripping; the physical fact of death was the first lesson any surgeon learned.

It is a powerful and moving story that would win the Palanca. Dr. Dalisay, a master of the short story, tells of his process (quote taken from his book, The Knowing is in the Writing):

I distinctly remember the thrill of just writing , in longhand on yellow legal pad paper, the first paragraph--a thrill intensified by having no idea what would happen next . . . That led me to a war and a doctor at war.

The story is unpredictable. It is all at once gory yet affecting, and I recommend it to any serious reader of fiction.

Heartland reminds me of the war we're waging against COVID-19. I just had to use the story as a metaphor for the present reality; thanks for indulging me. The only difference is that we don't see the enemy. The coronavirus is microscopic. But, like the enemies in battle, it spares no one, young and old (yes, even the young, as you will soon discover, and it will break your heart--ah, Makaraig!).

It is tragic if someone, especially a doctor, loses his compassion. A person called to save lives or palliate other people's suffering must never be indifferent to death and dying. This happens a lot, we have words for it now, like caregiver fatigue or burnout. The causes are multifactorial. But we must never lose compassion, we must always feel pain and sadness, even grief, when we see death . Medicine is kindess lived out: it is the art and science of human beings reaching out to another.

I pray that we never lose sight of this truth. I pray that God would instill in us, health care workers, compassion and strength, courage and protection. COVID-19 is a clear and present danger. The workload may burden us, make us feel jaded, even angry at this government that only remembers us when we're badly needed, that robs its people of the right to proper health care, that seeks to protect the powerful instead of the weak.

But we carry on.

Sunday, March 22, 2020

Journal of a Lockdown No. 10

Lockdown
The MRT has shut down its operations.

I worship at home, in front of the old HP Elitebook 2570p, which I've grown fond of. As I sing along the familiar tunes of Trust His Heart and Rejoice in the Lord, with Kuya Deni's guitar accompaniment, I imagine the warmth of fellowship through the firm handshakes, the warm smiles, the random consults as I walk in the small church sanctuary in Quezon City. It seems like a long time ago, when physically meeting together was the norm. Pastor Bob preaches on Romans 8:18-25 in a pre-recorded Youtube video. For believers, there is freedom from hopelessness. It's a message I need to hear. Despite the world's despair, there is sure hope in the Lord.



The death of the "young trainee" at the Philippine Heart Center reminds me that death can happen anytime. My friends fear for the loss of their lives. It happened to him, it can happen to anyone.

Heart Center executive director Dr. Joel M. Abanilla said in a statement:

“We can only question why this young trainee with a promise of a bright future as a would have been cardiologist had to be the one to go. We have no answers.

“Yet we rest on God’s reassurance that He reigns Supreme and that He is in control. We need to collect ourselves, no matter how heavy are hearts are and move on for the sake of those who continue to need our services now more than ever,” he added.

How true his words are, how biblical and inspiring.

* * *

Some good news. My two friends, both very dear to me, are negative for COVID-19. I can't imagine losing friends at this time.

* * *

Been reading John Updike's The Early Stories: 1953-1975. The piece, "Persistence of Desire," is about a young love forgotten and remembered in a clinic.

I'm taking this quote, the story's final sentence, out of context, but this is how I imagine I will react when the pandemic is over.

He became a child again in this town, where life was a distant adventure, a rumor, an always imminent joy.

Saturday, March 21, 2020

, ,

Journal of a Lockdown No. 9

Journal of a Lockdown No. 9
I wrote with fountain pens and paper today. Click on the image to enlarge. 

The past few days have blended into what seems like an extended, perpetual weekend. Unless I looked at my calendar, I would not know what day it would be. I was, for instance, jolted at 4 AM by the realization that I had signed up for a webinar on cancer and COVID-19. I was relieved, in fact, to have been able to log in just in time. The house was quiet, my brother was in REM sleep (I could tell by his breathing), and, save for the computer glare, the room was dark. I did not stay too long to finish the teleconference.

But that happened days ago. Today, I checked, is a Saturday. After lunch, I am greeted--no, not that cheerful word--shocked by the news that a doctor about my age has died. Complications from a severe COVID-19 infection that hit him. His patient did not fully disclose her travel history. He passed away doing the work he had been called to do. I learn from my friends that he was a kind man, liked by everyone. He was his family's breadwinner. He put himself through college and med school by way of scholarships.

What happened to him could happen to us.

The best thing you can do is stay at home. If you need to consult with a physician, you may as well tell the whole truth.

* * *

Inspired by Dr. Butch Dalisay's story, Penmanship, I decide to write a draft of today's entry in pen and paper. In case you're interested, my notebook is a Veco Linear Journal Notebook (7 x 10 inches), 100 GSM. The pens and inks are TWBSI Eco Rose Gold, broad nib (inked with Diamine Oxblood) and Kaweco 70's Soul, medium nib (inked with Pilot Iroshizuku Bishamonten, limited centennial edition).

Untitled

Friday, March 20, 2020

Journal of a Lockdown No. 8

"...You're one of the people who will thrive in quarantine," a friend based in the States writes to me, just as I'm about to finish Mia Alvar's final story in her collection, "In the Country."

To be honest, I don't know when my stamina for self-isolation can last.

I attend the sarcoma multi-disciplinary teleconference through Zoom. A patient with a shoulder mass also has an occipital tumor, which can be meningioma or a solitary fibrous tumor. The discussion is lively. Surgery then radiotherapy, proceed with a whole-body PET CT, or wait for the final histopath?  A consultant coughs in the background. Laughter erupts. Nobody at the conference will be infected anyway. The wonders of technology! I have several questions at the back of my mind: (1) how will the patient afford the diagnostics and treatment?, (2) how will his treatment proceed, now that hospitals have been directed to stop elective procedures, in the hopes of redirecting all efforts toward the pandemic?

I scribble on my notebook words of encouragement from Psalm 145:10 as I have my daily meditation.

He fulfills the desire of those who fear him; he also hears their cry and saves them.

I brew my second cup of coffee at 4 PM. It feels like a Saturday afternoon, except that it's supposed to be a regular workday. I want to get out of the house but decide against it. There are no friends to meet. The cafés are closed. I look at this photo I took in January and feel like it happened many years ago. This seclusion has warped my concept of time.

Untitled

In a few days, I'll be reporting for duty. I wonder how I'll get to work. I'm thinking of walking for two hours if I don't get a ride.

Another friend suffers from cough and diarrhea. He has been pulled out of the rotation and has been advised to self-quarantine. "At least, there's no DOB,*" I text him.

Then I read this.

The University of the Philippines-Philippine General Hospital (UP-PGH) has been designated by the Department of Health (DOH) as one of its COVID-19 referral hospitals for the National Capital Region in line with UP’s mandate as a public service university.

UP-PGH is tasked with admitting COVID-19 patients within its cluster. This is according to a letter sent by DOH Secretary Francisco Duque to UP officials on March 19, 2020.

UP-PGH, a unit under UP Manila, is considered the biggest modern government tertiary hospital in the Philippines with the expertise and equipment to treat COVID-19 patients.

Servicing more than 600,000 patients annually, UP-PGH remains the only national referral center for tertiary care, providing direct and quality patient services to thousands of indigent Filipinos all over the country.

Kuya John writes me a message from Sydney. He tells me he has been enjoying Mavis Gallant's writing. He calls her Tita Mavis, which cracks me up.


*DOB: medical slang for difficulty of breathing

Thursday, March 19, 2020

Journal of a Lockdown No. 7

Medical Oncology
Remembering our round-table discussion on germ cell tumors at the PGH last year

Staying at home, indoors, is becoming the new normal. Maybe that's a good thing, a part of the community's coping mechanisms: people are getting creative, finding ways to work from home, catching up on their reading backlogs, and so on. (At least, those who can afford to do so.) Because the lifting of the lockdown is still a few weeks away,  we need to create healthy habits for our body, mind, and spirit, and not let this so-called locked-down lifestyle push us into uselessness. The hardest parts are usually the beginning and the end.

These final weeks of March mark the end of my fellowship training in medical oncology! I have been preparing myself and my patients for the inevitable goodbyes as early as January. I have told my patients that a new doctor will care for them the next time they will follow up.

The release of the list of new fellows accepted into the training program seals the fact of this finality. The roster was made available many days ago, but I have only learned about this today. So much for social media distancing. I had never felt so left out (and it's largely my fault!). I'm thrilled for this new breed of medical oncologists and wish them all the best. They will not regret their decision.

I would have wanted to attend the send-off dinner, don my sablay for the official graduation portraits, or have the final group photo at Room 107. But the present extraordinary circumstances do not allow these rituals. And so fellowship training gradually ends, not with a bang, but with a quiet sizzle, eclipse by the greater global problem of this viral pandemic.  I don't know how I feel exactly: a combination of nostalgia (these past few years have been life-defining for me) and dread at the thought of a new life ahead.

I wish I were able to break the news face to face to some patients whom I had not seen in the past few months. But we are where we are: locked down inside our homes, the most heroic thing anyone can do at this point.

*  *  *

One-legged cancer patient walks from Masinag to checkpoint to get to PGH, at GMA News Online.

"May bone cancer po kasi ako, kelangan ko magpa checkup every month," she said.

From the checkpoint, Esperitu said someone will pick her up to bring her to PGH.

"May sundo naman po ako," she said.

Esperitu only has one leg and walks with the help of crutches.

*  *  *

*  *  *

Also on Twitter.



* * *

Francis Collins, US NIH director, speaks about the coronavirus, his faith, and an unusual friendship (via the Atlantic). It's one of the best things I've read this week.

Collins also spoke about civic responsibility and the importance of selflessness in the midst of a pandemic. “I think we as a nation have to get into a place of not just thinking about ourselves, but thinking about everybody else around us, and particularly the most vulnerable people—those who are older and those people with chronic diseases. Young people may have a relatively low risk of serious illness, kids seem to have a very low risk, but if you want to avoid what could be the deaths of hundreds of thousands of people, then it is incumbent on all of us to severely limit our social interactions. We need to ask the question about every interaction we have, and whether it is necessary or not. I’m going to speak very strongly about that. Obviously, people do have to get food in the house and do other absolutely essential things, but beyond that, we should be volunteering to engage in the most stringent kind of isolation.”

The next parts of the article talk about his life and faith.

Collins once told me in a private conversation what those who know him best can testify to: Helping people who are suffering has always been a commitment. That was part of what explained his shift in focus from physical chemistry to medicine. “Although I loved the experience of working in quantum mechanics and wrestling with second-order differential equations, it was lonely,” he said. “It did not have that kind of human connection that I was beginning to long for. And that did drive me then to seek another way to explore science that was going to be more sociable, but also more devoted to outcomes that would help people who were suffering—and medicine was the perfect path to go down, even though it seemed like quite a dramatic departure from the career trajectory I had been on.”

It also talks about how he came to believe in God.

Growing up, Collins’s religious instruction was limited to being sent to the local Episcopal church choir to learn music, “instructed by my dad to ignore the rest of it, which I did,” he told me. In college and then graduate school, he found himself moving from the category of agnostic to atheist. “I would have challenged anybody who wanted to bring to the conversation some discussion about God. I would have asserted they were basically stuck in some past era of supernaturalism that is no longer necessary, because science has eliminated the need for it,” is how he put it to me. But the time came when, as a third-year medical student, he was no longer learning about the human body in a lecture hall; he was sitting at the bedside of people with terrible illnesses, most of which physicians had imperfect methods to be able to help.

The article continues
“Watching those individuals’ fates, what was going to be coming soon, the end of their life, I was trying to imagine what I would do in that circumstance,” Collins shared with me. “This was in North Carolina, and there were a lot of wonderful individuals, many of them having had relatively simple lives, but lives that were totally dedicated to helping other people. Many of these people were deeply committed to faith. I was puzzled and unsettled to see how they approached something that I personally was pretty terrified about: the end of their lives. They had peace and equanimity, and even a sort of sense of joyfulness that there was something beyond. I didn’t know what to do with it.”

“It made me realize that I had never really gone beyond the most superficial consideration of whether God exists, or a serious consideration about what happens after you die.”

* * *

Dr. Lei Camiling-Alfonso, a dear friend, offers her reassurance and professional advice. Do watch.


Wednesday, March 18, 2020

Journal of a Lockdown No. 6

Untitled

I brew a fresh cup of coffee this morning. French press, coarse ground, strong. I have enough coffee to last me a month, thanks to my patients who gave them to me as parting gifts. Everyone is still on lockdown, and if you're reading this from Metro Manila, I say cheers to another day, my friend.

I sit beside the window, plug my earphones, read the final books of Genesis and a chapter in Mark, the part where Jesus feels compassion toward the people because they are like sheep without a shepherd. I pray for friends and family. The end of the pandemic. A heart that trusts and depends on God. That I will have a ride to work when I report for duty next week.

I write a story that's been brewing in my head, but it's in its infant stages and may never see the light of day. Toying with my imagination is a good way to pass time. If you're tired of reading toxic material in social media, try writing or journalling, practicing social distancing and social media distancing at the same time. It's good for the mind and heart.  I also read Mia Alvar's "A Contract Overseas," which appears in her collection, "In the Country." It is the first story in a long time that brings me to tears. It's written from a point of view of a college scholar whose brother goes to Saudi to support her education; her mother is a

traveling seamstress, making 'house calls' after church each morning in some nearby, nicer towns.

And yet, the girl sees her mother with contempt and admits it with regret:

After that, I had a terror of becoming [my mother], the multipurpose servant a few lucky scraps away from living on the street.

The images of people stranded in checkpoint areas come to mind as the background to this story. If they don't get to work because of the lockdown, their families will starve.

*  *  *

We now have a total of 200-plus COVID-19 cases. Epidemiologists predict it will increase to thousands more if the lockdown is not carried out. This is sound science that must be applied with compassion.

*  *  *

PGH nurse dedicated to her job walks part of the way to work, in the Manila Bulletin, features Ma'am Daisy Nietes.

Nietes was among the thousands of passengers trapped at the borders of nearby Manila provinces who struggle to find a means to report to work daily despite a massive suspension of physical work duties.

But her job cannot be made part of a virtual type of work arrangement as she is part of the skeletal workforce.

And in times of a global health crisis, medical health workers serve as the unsung leaders.

She said her normal duty shift, from Mondays through Fridays, starts at 6 a.m., and it usually takes her only an hour to travel from her house to PGH.

But on Tuesday, the first day of the implementation of stricter community quarantine measures, she was left with no choice but to walk.

“I know mahirap ang transpo kaya 2:30 a.m. umalis na ako dito sa bahay sa San Nicolas 1, Bacoor City going to Talaba. It’s a 40-minute walk and I just brought a flashlight and extra uniform,” she said.
(I know transportation would be difficult that’s why I left our house in San Nicolas 1, Bacoor City at around 2:30 a.m. going to Talaba. It’s a 40-minute walk and I just brought a flashlight and extra uniform.)

The distance between the two barangays is around five kilometers, around an hour’s walk.

Nietes said: “Wala po akong kasama sa 40-minute walk ko from our house to Talaba. I didn’t mind the fear, though my tears were rolling down because my daughter was worried when I left the house. Sabi ko lang sa kanya, ako ang bahala.”
(I was alone during my 40-minute walk from our house to Talaba. I didn’t mind the fear, thought my tears were rolling down because my daughter was worried when I left the house. I just told her I can manage.)

While many other workers are working remotely and some are finding it hard to productively function in the days to follow, Nietes, as a devoted health worker, just wanted to reach PGH even if she had no transportation.

For her, the real measure of public service is to be true to her duty in whatever crisis.

I remember Ma'am Daisy from the fourth floor. If I happened to make rounds during lunchtime and she spotted me, she would invite me to eat and wouldn't take no for an answer.

My heart swells with pride. These are the people I work with.

“Never lose hope. Let us all help one another in the service of our countrymen. Never get tired of our calling. Even if our situation looks gloomy, the little sacrifices that we make will make the biggest impact on our people,” she said.
Powered by Blogger.