Best lunch I've had in a while

WHENEVER I overhear someone say he “enjoys” residency—as if it were as easy as window shopping or reading Danielle Steele—a part of me doubts him. Either he's exaggerating the ease of his transition into residency life, or he's not doing what he's supposed to do. Medical training is hard work—more so during the first year.

There are moments, cherished and unforgettable, that keep the stresses away, albeit temporarily—moments like that otherwise uneventful afternoon when the mother of my patient handed me a warm sandwich with iced tea. I had just finished checking up on her daughter, who was hooked on mechanical ventilator because of a lung infection, when she came to me with plastic bag full of food. She was profuse with thanks, and she wouldn't hear me out when I told her it meant a lot to me, her gesture, but she should've saved the money to buy medicine. They were hard on cash; her husband was a contractual worker. But the best thing I could do was to receive her gift—the best lunch I've had in a while. But true thanksgiving, I suppose, knows no bound. The heart of the giver overflows; the receiver is filled with joy to the brim.

I went home with a big smile.

Late entry for Valentine's

ON MY WAY out of the Medical ICU to catch a quick breakfast before I did my rounds, I was greeted by unusually giddy nurses, “Happy Valentine's Day, Doc.” I would've told them that Valentine's Day is a non-entity for me—and not in a romantically bitter way, for those emotions escape me—but I replied, in the interest of time, something like, “Happy Valentine's Day, too.”

No man is an island

ONE OF the greatest joys of my week, assuming I'm not on a 24-hour shift, is the Bible study (or cell) group I've been attending for months now. It's called Pilgrims, composed mostly of married, basketball-loving, middle-aged men. In terms of age, I'm in the minority—at 27, I'm among the youngest. We meet Thursday nights in church.

Libro

HANDFUL of quotes from materials, mostly books, I'm currently reading.

On the art of seeing and managing too many patients all at once.

To a medical student who requires 2 hours to collect a patient's history and perform a physical examination and several additional hours to organize that information into a coherent presentation, an experienced clinician's ability to decide on a diagnosis and management plan in a fraction of the time seems extraordinary.—DB Mark and JB Wong, In: Decision-Making in Clinical Medicine, Harrison's Principles of Internal Medicine, 18th Ed., Vol. 1

Part of the narrative

MY FIRST foray at the Wards as first year resident was made up of a whirlwind of experiences—a combination of frustration and fulfillment (mostly the former). I suppose my month-long stay there was an initiation to the tough, challenging world of residency training in Internal Medicine at the Philippine General Hospital.

Recap: first month

Service Six. From right: myself, Racquel Bruno, Josh Abejero (back), Julie Gabat, Raymond Lozada (back), Amy Lopez, Jing Lagrada, Bea Eusebio (back), and Mia Licyayo.

TWO DAYS left, and I'm done with my first stint at the Charity Ward as resident. It's where much of the action happens. The first year's roller-coaster life—victories and failures, recoveries and morbidities—essentially revolves around Wards 1 and 3.

Baffled

I HAD the immense privilege of helping Rich King, our batch head, compose the speech for the welcome ceremony for incoming first years in the Department of Medicine last week. His delivery gave this short message a more serious, determined tone; and he spoke like a seasoned orator. Here it is, in full.


Credit: Dr. Nemo Trinidad

It still baffles us: the fact we made it to residency in Internal Medicine at the Philippine General Hospital. When we look back at the rigorous pre-residency process just a few months ago, we had no way of knowing whether we were going to get in at all. There were so many applicants, many at the top of our own classes, all oozing with brilliance and compassion, so much so that in the end, we felt it was anybody's game. We wouldn't feel cheated if we didn't get in and they did. And yet, by God's grace, by a beautifully orchestrated miracle, we received the call one fateful afternoon. Some of us were still curled up in bed, or watching a movie over our laptop, and when we heard the resounding, “Congratulations! You made it!”, many of us couldn't believe our ears. Our lives finally took a new direction for the next three years.

How do you measure a year?

LAST THURSDAY night, during my time with the Pilgrim Men—the Bible study (or cell) group I've had the privilege of attending in church—we shared what made our year memorable. The question was, in effect, like this: what criteria do we employ to say that our year has been a success?

Basement boys at the Ward

MORNING always has us scrambling for charts—not an easy task at all, but one that requires the visual acuity of an eagle, the extraordinary flexibility of a snake, and the father's forbearance in the Parable of the Prodigal Son.

New Year's Eve, PGH, and 2015

I WELCOMED the new year in the hospital. I was on 24-hour shift at the Pay Ward, intermittently called up by nurses for referrals that ranged from possibly fatal complaints (difficulty breathing or chest pain) to electrolyte abnormalities easily corrected by telling the patient to eat a piece of banana. I had brief moments of rest, perhaps the longest ones I've had since I had begun residency two weeks ago. From the call room window I could see fireworks decorating the expanse above Manila Bay. I imagined that, if I were home on New Year's Eve, my street at St. Gabriel would be noisy too. I could see our dog, Benjamin, cowering in fear whenever our neighbors lighted fireworks. The Dizons, who live just right across us, would call us up and invite us to their home; I wonder if their family computer, which we always fantasized about, is still working. My parents would probably be asleep, especially my mother, who cannot tolerate staying up late lest she incur a migraine the next day. But Tatay would wake me and my brothers up sometimes—that much I can remember when I was in elementary school. He would give us firework sticks and light all three of them at the tips with a single matchstick, assuring us that our hands wouldn't need to be amputated because that hardly ever happens if one is careful. I was particularly paranoid; I liked my hands very much.

My Reading Year 2014

HERE'S a list (probably incomplete, and not in any particular order) of books I've read this year. I'm not sure which ones I like best; the top ten should include the works of Marilynne Robinson, William Faulkner, and, well, of pretty much everyone else in this roster. Jhumpa Lahiri was a surprising discovery for me; her simple prose evokes so many complex emotions. I read The Interpreter of Maladies once in a while, and I get a different insight from it every time. Roddy Doyle, the Irish writer, famous for The Barrytown Trilogy of which The Commitments is the first, is a happy addition to the Funniest Writers list I'm compiling—a list that already includes David Sedaris and PG Wodehouse. Also included in my 2014 reading diet are essay and short story collections, like Chabon's Manhood for Amateurs and Faulkner's Go Down, Moses. The New Yorker anthology, Secret Ingredients, features the best magazine articles about food; I enjoyed that immensely, too. Spiritually, I've benefited from Jon Bloom's Not by Sight—great retelling of Biblical stories Christians have come to love. Overall, a great year for reading.

Fellowship

ONE of the greatest blessings—and joys—of the Christian life is having a church family. Having been literally rooted out of our home in Mindanao to pursue further studies in Manila, my brother and I didn't have any immediate family members to go to, homes to spend the weekends in, aunts or uncles to visit. Yet the Lord, in His sovereignty, brought us to a small, faithful church where everybody knew each other. Over the course of many years we have developed meaningful relationships with many of the members who have always prayed for us and wished us well. Our local church is the closest thing we have to a family in Metro Manila.

About to begin

RESIDENCY begins on the 16th of December. Last week, I was handed my schedule for the entire year. I'll be at the Pay Wards on December, the Charity Wards on January, and the Medical Intensive Care Unit, hereon referred to as the MICU, on February—that's all I can remember for now. I will have my out-patient clinics every Tuesday morning and Thursday afternoon. I will have 24-hour shifts every three days. Except for the seven-day “leave” (yes, it's in quotation marks because it doesn't really exist) on the third week of August next year, I will be doing rounds every single day of the year 2015, regardless of holidays, floods, or supertyphoons.

Lila by Marilynne Robinson: a story of grace

YOU READ a book, expecting to have fun, the kind that your brother Sean, who hardly reads anything at all, save for his textbooks, won't ever understand. You begin with the first few paragraphs. Amazed at the craftsmanship of the sentences, you keep at it—the pleasures of reading, they call it. Then you lose grip of time; your head is up in the clouds of the story—a made-up world that, for a moment, seems more real than reality.

You wonder at how words—letters pieced together, their meanings defined by spaces or lack thereof—can have such an effect on your emotions. Apathy turned into concern, rage into sorrow, discontent into delight. Or maybe a combination of them, because a person, indeed, has the capacity to handle, though not completely explain, a wide range of feelings, like the spectral colors of the rainbow in the afternoons of childhood.

Soaring like the eagle in the light of the eternal sun

AS A SUPPLEMENT to my daily devotions, I'm reading "What Happens When I Pray?," a condensed version of the works of two not-so-famous classic Christian writers, Thomas Goodwin and Benjamin Palmer. My copy is published by Grace Publications Trust (London, England), and is a rewritten and abridged version prepared by Dr. N. R. Needham, in order to cater to a modern-day readership.

Karl Ove Knausgaard on brothers

KARL Ove Knausgaard is a Norwegian writer whose monumental book, Min Kamp (My Struggle: Book One), is what I'm currently reading. Critics call the 3500-page autobiography monumental; I can see why. There's nothing so special about the subject--his life--but he writes in such a way that keeps the reader, any reader, hooked. Compelling: that's the word for it. He keeps us interested, finding meaning in the minutiae of life: his breakfast, his band, his first pseudo-sexual experience, his father's death. One of my favorite book critics, James Wood of The New Yorker, said that "even when [he] was bored, [he] was interested."

Laughing at politics

AS I WAS INUNDATED with news of the Senate Blue Ribbon Committee crucifying Vice President Binay for his alleged involvement in an overpriced parking space or airconditioned chicken farms, I discovered the HBO original production called Veep. Having resolved not to get too involved with national politics, I considered Veep a welcome diversion.

To be the best for my patients

THIS IS an excerpt from my pre-residency admission essay for Internal Medicine - Philippine General Hospital. A set of guide questions where given. The essay reads like one of my blog entries, so here it is.

1

I'M LANCE, and unlike many people who go by other names, I'm simply “Lance” to most people I know—except perhaps my father who still calls me “Bon,” after the best sound I could blurt out when I was barely beginning to speak. My mother, then a voracious reader before her migraine attacks, named me after Lance Morrow, the Time magazine essayist who wrote about Imelda Marcos's shoes in the late 1980s. I emailed him ten years ago (I was 14), and Mr. Morrow jokingly said he and my mother were just “friends.” These days people call me “Doc,” so I guess I had better get used to that, too.

Undeserved

LAST WEEK I had the privilege of being one of three people to share my testimony during my church's Wednesday Prayer Night. Here's an excerpt:

The sovereign grace of God underlies and explains every believer's life experiences, both the good and the seemingly bad. The true Christian knows that God lavishes His children with His providence—all of it undeserved, unmerited, and overwhelmingly so. We who worship the true and living God are assured that all things work together for our good (Romans 8:28) and for our Master's glory, a realization we often arrive at on hindsight. We usually go through hard times without completely making sense of our circumstances. Only by looking back can we appreciate the tapestry of God's grace, beautifully choreographed like an ingenious master plan, the end of which is our prizing the Lord Jesus Christ above all things. We also become more like Him. And, like the writers and poets of old, our hearts are filled to overflowing that we can't help but sing of God's great love for us. It is therefore a privilege for me to “sing,” figuratively, of God's undeserved blessings in front of you tonight. Let me end with Isaiah 54:10: “'Though the mountains be shaken and the hills be removed, yet My unfailing love for you will not be shaken nor My covenant of peace be removed,' says the Lord, who has compassion on you.”

My NBI Clearance experience

GOT MYSELF an NBI Clearance today. Took me the whole morning. I was exhausted, and my face looked like a convicted criminal. “You're lucky,” you'll probably say, given that for some, the process can eat up the entire day or more.