Boring update of my monthly weekend off

COMING home late from Lea Salonga’s Songs from the Stage, I had a good rest, so good I had almost overslept—which means, I woke up at seven. My parents, hardly getting any shut-eye, rushed to the airport to catch their early morning flight. I wasn’t able to say my proper goodbyes, though I did feel Tatay kissing my head and fixing my blanket to make sure I was warm.

Tatay texted me at 10 am to tell me that they’d just landed; this, while I was sipping coffee. Sean would meet them at the airport. They’d have brunch at Auntie Net’s charming home in Gen San. The apartment seems quieter without them.

After his morning French class, Manong still hummed Hamilton’s “Burn,” which Lea sang so well last night. We all thoroughly enjoyed the show: a mix of the old and the new, the classic and the contemporary, but still the same Lea Salonga we’ve all, as a nation, loved and adored.

Our plan then was to eat seafood in one of the busy restaurants along Macapagal Boulevard, but it was nearing midnight, and Tatay, who, even in his drinking and smoking days, confessed to hating coming home late, would hear none of it.

Typing

I’m writing this piece using an old desktop, recently resurrected by the more technologically-minded among us. The computer has been lying around beside the call room’s front door. It’s immediately on my own desk’s posterior.

I like the staccato sound of the BenQ keyboard, still dusty after many months—probably years—of storage. The computer reminds me of my first desktop, the first one I’d ever owned, which I bought in 2005, cheaply at 25 thousand pesos at a store in Gilmore Street. My friend Luther, who would eventually graduate summa cum laude in electronics and electrical engineering, accompanied me that morning. I didn’t care what the specs were—processors and RAMs were his thing, and choosing the best one for me, at a price range I could afford, thrilled him. What I was really after was how the entire ensemble would look like. I wanted my keyboards to have a clean font.

At the time, all dorm rooms had actual desktops, with heavy monitors that had to be detached from the CPU box. Residents would assemble them at the beginning of the semester. They’d be dismantled during semestral or Christmas breaks, when the dorm would be closed. Only very few people owned laptops then.

I miss that desktop. I would eventually ship it back to Mindanao, where my brother Sean would use it as his own, mostly for gaming and playing music—things I didn’t have much interest in that the time.

These days I own a very slim laptop—an 11-inch Macbook Air—which is lighter than my Internal Medicine textbook. How technology has grown indeed. I place it inside my satchel and sometimes forget it’s there.

Books I’m currently reading

St. Lucy’s Home for Girls Raised by Wolves by Karen Russel. Stand outs from this short story collection: “Ava Wrestles the Alligator,” “The City of Shells,” and “Z.Z.’s Sleep-Away Camp for Disordered Dreamers.” “Out To Sea,” where a beautiful girl named Augie visits an old retiree, was romantic but lonely.

Between You & Me: Confessions of a Comma Queen by Mary Norris. She’s the copyeditor of The New Yorker magazine. She’s so passionate about her work that she refers to punctuation marks like they were human beings. A very endearing work that, aside from telling us how Miss Noris got into her job (it is primarily an autobiography), she also tells us the difference between an em-dash (—), an en-dash (–), and a hyphen (-).

Is Everyone Hanging Out Without Me? (And Other Concerns) by Mindy Kaling. I had tons of laughs with The Mindy Project, a show written and produced(?) by Miss Kaling herself. The hilarity was in the depiction of an Ob-Gyn who had all the time in the world. In real life, my friends in that profession could barely attend dinners, with their cesarean sections and all. Very light reading but quite insightful, too.

Ending my Toxicology rotation

I HAD never talked to so many strangers over the phone as I did this month. Generally my interactions with the callers, mostly physicians, were pleasant. There were few that stood out:

-- a man from Mindanao who asked about pesticide poising. "Sino po ang nalason?" I asked.

He said, "'Yung saging ko po. Hindi ko alam kung ano ang nangyari kasi hindi na ganoon karami ang bunga niya."

-- a physician calling from Mlang, North Cotabato, who, when he asked who was on other line, recognized me. "Dr. Lance Catedral?!" Apparently he was a classmate of one of our interns last year.

My month-long Toxicology rotation would not have been half as enjoyable had I not met the following:

Toxicology

From left: Drs. Bitoy Bongon (Tox fellow), Reg Lactupo (Emergency Medicine, PGH), Leslie Garcia (Tox fellow), Jem Agnes (Emergency Medicine, Ospital ng Makati), Racquel Bruno (Internal Medicine, PGH), JP Ner (Tox fellow), Jela Matibag (Emergency Medicine, Makati Medical Center), and Nowell Catbagan (Tox fellow).

It was so fun that I understand Jela's reaction when all of us parted ways.

Jela leaves Toxicology.

See you around, dear friends!

On sinkholes and homelessness

Commute

FOR THE past four weeks, I have left my dorm room and started commuting daily from Quezon City, where my brother lives, to Manila, where I work. It has taken me about an hour--two hours tops--to traverse Quezon Avenue into the perpetually congested España Avenue, which flows either to Lacson Avenue (which is, after office hours and at night, populated by huge delivery trucks and is almost rendered impassable), or to Quiapo, where the jeepneys use half of the road as parking space.

The SRO

I'M glad my second year of residency is over.

Second year callroom
Last few days as second years


Since the start of the year, I've transferred to the Senior Residents' Callroom (SRO), literally in the landing between Wards 1 (on the first floor) and 2 (the Surgery ward, on the second). Just when I thought the Second Year Callroom was going to end up in my book as the best quarter of my residency years—we transfer callrooms every year, if that isn't obvious to you yet—the SRO has emerged as the eventual winner: it's more spacious, it has a bathroom of its own. Natural light seeps through in the mornings. The PGH Wifi connection is arguably faster, too.

New table at the Senior Resident Callroom

I inherited Kevin Bismark's desk, a testimony that he has lived his final year in IM with travels, trips to the dentist, and a lot of studying. I had to set some of his things aside to let mine in (he is, as far as I know, still traveling): a few books, my laptop, toothbrush, a desktop sharpener, a collection of pencils inside a Malacañang mug given by an OPD patient, my actual coffee mug given by a different patient now dead—the same patient who called me "the best doctor in PGH" and gave me a plaque for it. Embossed on it is his artistry: he made caricatures with colored glues on various surfaces for a living, and despite being easily fatigued, he took the time to remember me. I miss seeing him in my clinic. You'll see another plaque, too—one that bears "Best Doctor in the World," which my aspergilloma patient gave me two years ago. I don't believe that I deserve these plaques at all, but I'm grateful. Truly.

Give us a call

ONE thing that excites me in Toxicology is the ringing of the phone and what the other person on the other line might ask next.

I've been manning the National Poison Management and Control Center since the start of the month as part of my rotation in Toxicology. The duty schedule is hectic for my senior year—24-shifts every three days, with no true post-duty (or "from-duty," as my non-PGH colleagues say) status. My stay entails that I provide telephone support and medical advice to physicians and laymen all over the country about all things related to poisoning. This means, of course, that I must know the active substances of popular products. My knowledge, I've realized, is limited. Thankfully, however, beside the three phones in the office are the Pandora's boxes of precious toxicologic knowledge. Whereas online databases can only give us so much information, this collection of 6x8 cm index cards, many of them dirtied by the patina of time, provides the answers as to the active ingredients of katol (pyrethrin), Johnson's cologne (phenoxyethanol), and glue gun (non-toxic at all).

I've received calls about a farmer who swallowed a sachet of pesticide after fighting with his wife. Many such ingestions fill our daily census, which the office forwards to the Department of Health at the end of the year. There are cobra bites in Bohol, sodium hypochlorite (Zonrox being the most popular brand) ingested by depressed people all over the country, noxious gas exposures of elementary school students in Central Luzon, and, the most memorable of all, a petroleum ingestion by a cat owned by a horrified, distressed young lady.

The most important detail I ask is the type of poison, if the substance is poisonous at all. The next details I ask are mainly related to the circumstances leading to the exposure: whether it was accidental or not, where it happened, and how the patient was doing. The rest of the information are for the completion of our census.

Receiving calls from complete strangers feels like being a night-time radio talk show host. The simile stands: people really phone in to get sound advice, knowing they'll get better with the knowledge that an expert has heard and processed their concerns. I suppose, if we broadcast these calls—barring expulsion from the practice of medicine due to disclosure of confidential information—we'd be a hit. Imagine the possibilities: The Toxicology Radio Program! You have broken hearts? Don't swallow a thousand of those pills—just give us a call!

CAT

Untitled

Untitled

YESTERDAY was my first Adult Medicine CAT presentation, as senior, with Jaja Saliba, Butch Roque, Berbi Berba, Josh Cruz, and Racquel Bruno (in absentia). We tackled mortality in transfusing short- versus long-term storage blood [1]. A great, fruitful discussion. (There's no difference in mortality rates.) It was also wonderful to have Dr. Tony Dans back.


[1] Heddle et al. Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion. N Engl J Med 2016; 375:1937-1945

Just words

Some words or catchphrases—many of them made up—sound terrible to me; therefore I’ve endeavored never to use them, except now, where I list them:


  • millennials — Just another word, I suppose, for self-absorbed people. I think this distinction—calling people Generation X, Y, or millennial based on the year they were born—is all made up.
  • netizens — I prefer “internet users,” or “people” in general. Everyone I know has encountered the internet at some point.
  • twinning — Use “twins.” This is acceptable, though, when talking about some process after fertilization.
  • adulting — It sounds so immature. I’ll only use this if pediatric-ting becomes a thing, too.

Pilipinas

Pilipinas, limited edition, at Bo's Coffee

I discovered another quiet coffee place. It has wide, wooden, tables; chairs of the right height; adequate lighting; tolerable internet connection. It's devoid of noisy teenagers and hipsters. As with most shops, it offers discount cards, and this one was too beautiful to pass up. We live in a beautiful country. That's something we don't thank God enough for.

Lodged

WE get all sorts of referrals in Toxicology, where I’m rotating for a month. They're mostly non-accidental ingestions of people going through depression. One night, though, we received two referrals at the Pediatric ER. Two children, both around eight years old, were brought to the hospital because they had batteries lodged in each of their right nostrils. This was an actual battery that our friends from ENT took out. I hope the kids learned their lesson. But kids being kids, they probably didn't.

Battery lodged

The most compliant patient

Dessert at Bo's Café

Net, my youthful aunt, sister of my mother, texted me, “Can I call you?”

“Sure,” I replied.

“She’s trembling, Lance—your Lola Ugól,” Auntie Net, the librarian, said. Lola, in her early eighties, has been intermittently living with her in General Santos City, about an hour’s drive from Banga, South Cotabato, where our ancestral home is. Auntie Net would pick her up on weekends, then bring her back after two weeks or so, where Lola could be near her farm and friends.

“Has she eaten anything? That’s probably hypoglycemia,” I said. “Tell Lola to munch on a candy or drink a Coke.”

Good films

The Metro Manila Film Festival selection this year has been a pleasant surprise. For the judges to have done away with awful romantic, formulaic films, to have finally gotten rid of the recurring Filipino-Chinese family-problem themes (after, what, six or seven sequels?), to have censored supposedly funny superhero films whose only redeeming quality had been the large, gaudy entourage during the Parade—they have finally realized (or they’ve done so long ago, but only had the guts to do something about it now) that Filipinos, too, take pride and joy in watching sense and intelligence and good humor. Id est, good films worthy of our 200-plus-pesos tickets and a little less than two hours of our time.

I pleasantly whiled away time at the local cinemas and didn’t mind the long queues—I had, after all, a book, which temporarily removes any need for human company. This is how I prefer to watch movies: alone, lest I disturb the people around me. I have coffee or tea in between movie breaks, so I’m able to watch the next film in line without so much as a yawn.

I haven’t really favored the dichotomy between “indie” and “commercial”—they’re all films, and if they’re good, they’re good, regardless of who had produced them. There are awful indie films and commercial films; there are pretty good ones, too.

Die Beautiful
was hilarious and depressing at the same time. The crowd in the cinema howled in laughter. The man beside me, a college student in shorts, couldn’t restrain himself—I surmise that popcorn must’ve exploded from his nostrils. For a film that shows gay people in loud costumes, the movie surprisingly offers a sensitive approach to understanding the LGBT community: that they struggle with mockery and hatred; that they yearn for so-called love that society refuses them; that they are human beings, too, sinners like all of us—yet another testament to Pascal’s statement that there is a God-shaped vacuum in every man that only God can fill. They fill it with romantic love, ambition, and vices; only to realize that these cannot give them lasting joy. We Christians will benefit in watching the film, if only to realize that there is an entire community before us that needs the gospel. There are expletives, references to homosexual sex, but overall, these have been included in the script with restraint and care.

Saving Sally was a delight to the eyes. Ten years in the making, the animated film is worth the wait. The conversations are carried on in English—Filipino English, not the forced “Americanized” accent—that actually sounds normal. There’s not much to the story: a boy falls in love with a girl and saves her from her evil parents. But the novelty of seeing walking monsters, the house on top of a steep hill, the school whose façade resembles UP Diliman’s Quezon Hall, was fun.

Seklusyon was scary. Four would-be priests, a girl who spews what looked like abodong pusit paste and who performs miracles, a beautiful but indifferent nun beside her—all these in scenes shown in sepia tones—made for a startling experience. Of course, the doctor in me made me diagnose the illnesses of the sick (“Ah, acute symptomatic seizure, probably secondary to a primary seizure disorder, rule out metabolic causes” when a 20-year old man was brought to the albularyo girl). Watch this with friends who hate horror; they won’t be sleeping after. But I suppose no film, in my experience, has scared me more than Sadako.

Ang Babae Sa Septic Tank Part 2 was a riot. Eugene Domingo is one of my favorite actors: hey, I watched Kimmy Dora Part 1 thrice, in cinema! Oh, how that lady can act! She now has a Spanish assistant who fetches water for her and serenades her with his guitar. The humor is intelligent, which doesn’t diminish it at all. More, more movies please, Eugene! And that ending!

Go, watch. These are good films.

Consigned to hell?

Tim Keller, who pastors Redeemer Presbyterian Church, is interviewed in The New Yorker York Times ("Pastor, Am I A Christian?"). He's asked:

What I admire most about Christianity is the amazing good work it inspires people to do around the world. But I’m troubled by the evangelical notion that people go to heaven only if they have a direct relationship with Jesus. Doesn’t that imply that billions of people — Buddhists, Jews, Muslims, Hindus — are consigned to hell because they grew up in non-Christian families around the world? That Gandhi is in hell?

Read his wise response here.

Christmas in the hospital: an unexpected celebration

I GO ON 24-hour shift today, on this cloudy Christmas Eve, while the rest of the world celebrates with friends and families. It doesn't bother me. While riding the taxi this morning, surprised that traffic was going smoothly (Quezon City to Manila in less than 20 minutes!), I thanked God for Christmas: for coming to earth to become man to save me—all of us, sinners—from our sins.

John Bloom, one of my favorite bloggers, writes:

This Christmas, do not be surprised if you find yourself worshiping Jesus where you did not expect to find him.

He goes on to write that Jesus has always broken expectations. He ponders on the meaning of the celebration:

Jesus came into the world at a desperate time in a desperate way. It wasn’t the way people expected him to come. It wasn’t for the reasons they expected him to come. He did not come to meet their expectations but to love them in the ways they most desperately needed. 
For Christ, Christmas is not about tradition but salvation; it’s not about expectations but sanctification. Christmas is about love — earthy, gritty, sacrificial, even bloody love. When Jesus came, he did not come “to be served but to serve, and to give his life as a ransom for many” (Matthew 20:28). This was a love that no one expected — a love that exceeds all our expectations. 
And this is the way he comes to you this Christmas: to love you in the ways you most need. That may, in fact, be why some of your expectations are not met: they aren’t what you really need.