Night out with my lunch buddies

FINALLY, we have proof that Casti Castillo is alive. Thanks to Carlo de Guzman who organized the meet up, I've reunited with some of my lunch pals during med school. How this group was formed is a mystery to me as well: perhaps it started one day in 2009 when, disinterested as we were in joining fraternities, we decided to eat lunch together, gathering at the BSLR Lobby to go to Chicken Charlie or Wham Burger at Robinsons. They were voracious eaters, fun to be with, and such great people that it did not take long for me to call them friends.

To CBC or not to CBC?
Lunch at Midtown Diner (ca. 2013), where Bon, Casti, and Brazy were discussing whether requesting a CBC was appropriate. We seemed to have all the time in the world then.

On Honor Thy Father

Honor Thy Father takes us to the northern city of Baguio, the country's summer capital, where people wear sweaters because of the cold. The scenes mostly depict pine trees, mountains covered in deciduous vegetation, houses on steep slopes—not the usual Philippine setting for films, yet they are familiar, reminding us of childhood vacations, of Burnham Park, and of strawberry jams.



Many controversies hound this Eric Matti film, but I had only learned about them about an hour before I went inside the cinema. Although still qualified to join the Metro Manila Film Festival, Honor Thy Father has been disqualified from the Best Picture category because the producers allegedly failed to disclose to the screening committee that it had been entered into a different film festival early this year.

We learn the story of a once-struggling family who are finally making it big in business, that which involves collecting money from local people, promising that the money go to big investments.  Edgar and Kaye attribute their success, their rise to financial freedom (and excess), to this business. They had once hit rock bottom when Kaye lost her second child and Edgar was penniless, but Yeshua answered their prayers through this money-making scheme based in Pampanga, operated by Kaye's father. Their testimony is unimpeachable; as such, Edgar (John Lloyd Cruz) and Kaye (Meryll Soriano) excel at what they do. In the first few minutes of the film we see them organizing a birthday party, which later turns into a conference of sorts. People are wary of the consequences: is the offer not too good to be true? Where will the money go? That scene felt real.

Manila is empty on Christmas morning: a documentation of our post-duty walking tour

AFTER NOT BEING able to sleep last night—there were few admissions, but they were difficult, complicated cases—my friend Jeremiah Vallente and I hurriedly rushed out of the hospital after the morning endorsements.

"So what do we do now?" we asked ourselves after we deposited our bags in our rooms.

"Let's find a good place to eat eggs," Jere said. Eggs are his favorite.

"I just need a good cup of coffee," I said.

Christmas at the ER

Christmas
Philippine General Hospital, Central Block—not the ER.


I'M ON 24-hour shift at the Emergency Room Department today, stationed here as the Physician-on-Duty. It also happens to be Christmas Day (in the Philippines, it has been Christmas season since September). This is the third year that I've spent it away from home. It's okay; we don't have established Christmas family traditions anyway: usually just a special dinner at 7 PM, with my mother's fruit salad as the dessert, something she has perfected in the past 10 years or so—salads, because she can't cook. The rest we order. We then sleep the night off, occasionally interrupted by worried calls from Auntie Elsie Dizon or Auntie Norma Cobrador, our neighbors, where they invite us over to their Noche Buena and karaoke sessions.

Stethoscopes

MY FIRST stethoscope was a Caribbean blue Littmann Classic II (3M), bought in 2009 at a sale of a local sorority. That special day in 2009 was a milestone: me, a would-be doctor, donning my first stethoscope on my way to the Neurology Ward, where I was to have my first preceptorial with Dr. Leonor Cabral-Lim. With bated breaths, my classmates and I waited for her to arrive; save for what we had read in DeMyer, we hadn’t had any idea what to expect. We were to demonstrate what we learned on the art and science of the physical examination. Yet we carried our steths—as we liked to call them—proudly, like a thick necklace. I remember trying mine out with my seatmates, the Catangui twins. I asked them to breathe deeply—ah, bronchovesicular sounds, no crackles, no wheezing. They, in turn, listened to my heart beat, alternating between a bell and a diaphragm to make sense of the S1 and S2.

My Reading Year 2015

Unlike my brother Ralph who finishes at least one book a week—at most three, he tells me—I didn’t even reach the 20 book count mark this year. Residency happened, you see; and since the start I’ve resolved to read more academic and medical books, less of fiction. But fiction keeps me sane and grounded. I undertook long reading projects, many of them remain unfinished, and chose short story collections to pass the time.

2015 has been a great year for reading, nevertheless.

1. My Struggle* by Karl Ove Knausgaard. I discovered the Norwegian journalist and writer through The New Yorker, where he was interviewed by Deborah Treisman, the magazine’s fiction editor. His work reads like a long, extremely well-written blog. Critics say that it’s funny to read the thoughts of a Scandinavian, an otherwise laconic, introverted people-group. I don’t know if that’s true. He takes us through his childhood, his drunk father, his friends, his discovery of writing. Why we keep on reading when the book is really all about the mundane—the author’s daily life—is a mystery, but they key is the great writing. I’m more than halfway through Book Two: A Man In Love. It deals with his relationships—his first and second (the current) marriages. I love the scenes when he meets with his writer-friend Geir, and they talk about philosophy and about other people. Knausgaard still cries a lot—in the vernacular, “mababaw ang luha.” The fourth volume has already been translated into English, released for distribution. I still have a long way to go, and many volumes to look forward to.

2. My Brilliant Friend by Elena Ferrante. This year I was introduced to the Naples-based Ferrante, whose real identity we don’t know. What we know is that she’s female, has been divorced, and is intent on keeping her anonymity. Let the books speak for themselves,the author is unnecessary, she seems to say. This book is the first in the Neapolitan novels, which star Elena and Lina—two characters who both hate and love each other. They consider each other best friends. They grow up in a small, provincial town. Elena is the studious student; Lina the deviant, but, to Elena’s mind, even more brilliant. They seem to idolize and despise each other all the same. I love how Italian this book is—when Lina’s father gets mad at her, he throws her out of the window.

Signing out of the wards

MY BATCH, fondly called the iMax for reasons that still escape us, just had a party at our callroom. In the spirit of togetherness, the party planning committee opted to hold it inside the hospital so that the people who were on 24-hour shifts could participate as well. It was a Christmas and Year-end gathering of sorts, and the theme was, “First Years Noon, Second Years Na Later.” After all, tomorrow will see us assuming new posts, new lives in a way—out of the wards, into the colorful, often dreadful world called the Emergency Room.

Second year residency is supposed to be easier, with more opportunities for leisure and rest. The duties are tiring, but they end almost as soon as they begin, and one goes home without the weight of the patient’s fate on his shoulders. This is what makes first year residency overwhelming—the idea that it is a marathon instead of a sprint. At the ER level, it’s enough to work on a reasonable diagnosis, to make sure that the emergent labs have been facilitated, and to find vacancies at the wards. Once the patient is admitted, say, to Ward 1, it is the first year resident who will polish the diagnosis, search for other contributing problems, ensure that the medications are being given, and plan for discharge, which, in some cases, never happens in this life.

A new look + a godly perspective

This site has a new look. The letters and photos are smaller. The posts are shown in two columns. Each post starts with a drop cap—one of my favorite features of this template. I was having trouble creating an archive page, though. The tutorial by blogger Sarah (adapted mostly from jhwilson's script) was particularly helpful.

Thanks for dropping by.

Afternoon meals

* * *

I'M sharing Charles Spurgeon's meditation on Psalm 16.8, "I have set the Lord always before me: because he is at my right hand, I shall not be moved."

This is the way to live. With God always before us, we shall have the noblest companionship, the holiest example, the sweetest consolation, and the mightiest influence. This must be a resolute act of the mind. "I have set," and it must be maintained as a set and settled thing. Always to have an eye to the Lord's eye and an ear for the Lord's voice—this is the right state for the godly man. His God is near him, filling the horizon of his vision, leading the way of his life, and furnishing the theme of his meditation. What vanities we should avoid, what sins we should overcome, what virtues we should exhibit, what joys we should experience if we did indeed set the Lord always before us! Why not?

This is the way to be safe. The Lord being ever in our minds, we come to feel safety and certainty because of His being so near. He is at our right hand to guide and aid us; and hence we are not moved by fear, nor force, nor fraud, nor fickleness. When God stands at a man's right hand, that man is himself sure to stand. Come on, then, ye foemen of the truth! Rush against me like a furious tempest, if ye will. God upholds me. God abides with me. Whom shall I fear?
A great week ahead!

Random scenes from Antipolo

HAVING just arrived from a two-day team building activity, I'm exhausted from the gut-twisting laughing spells (a phrase I've adapted from Racquel Bruno), the non-stop games and meals, and the clean and healthy fun that comes with the company of my colleagues—people I meet day to day, and those whom I now regard, after one year of living and breathing the hospital air, as family.

The place was Punta de Fabian in Antipolo, Rizal. It was overlooking Laguna de Bay.

Teambuilding

Congratulations!

Graduation IM

TODAY my seniors in Medicine are graduating. This day will be filled with celebration, thanksgiving, and remembering. I get emotional with endings, as graduations are often thought out to be, because these wonderful people have taught me and affected me in ways that go beyond making clinical decisions, diagnoses, and treatment. This means I will not be seeing any of them at the OPD anymore, will not be chatting with them randomly for a few minutes to pass time, will not hang with with them over food and videoke as often as before.

December 1

Christmas décors at the hospital

IT IS A minute past midnight. My intern shows me her proposed correction for some deranged electrolytes. She tells me one patient's serum sodium levels are going up. I ask her to compute for the total body water deficit. She scrambles hard for the answer but eventually gets it. I ask the nurses to carry out her orders. She'll make a good internist one day.

Christmas is upon us

Christmas décors at the hospital

CHRISTMAS is upon us, even at the hospital where I work. Here's the makeshift tree at the sixth floor. It's made of empty piperacillin-tazobactam boxes. How very medical.

Just so you know, my brothers and I never grew up with a Christmas tree in December. Our mother felt it a chore to put one up, always postponing, always "next year na lang." When she did decide to finally have one, we were already grown up, out of the house, in Manila or Davao, studying and working.

Now she tells us that her tree looks wonderful. "Yes, Mother, it probably is," we reassure her, as good kids do.

Second chances

My friends convinced me to watch A Second Chance, the movie sequel to the highly successful One More Chance (which I didn't watch completely—I saw parts of it, but couldn't stand it). I'm not too big on romance, and I don't understand it when people, even my close friends, sing their praises for John Lloyd Cruz and Bea Alonzo. Their chemistry on-screen is supposedly perfect, like they're meant for each other.

I said I'd give this movie a try; I had nothing else to do but read the chapter on Disorders on Rhythm in Harrison's to lull me to sleep. We watched it last night, after dinner. The crowd was less than I had expected, but the movie house was still full, save for a few rows of empty seats in front. 

I can't give an unbiased review, but the movie wasn't bad. I had a problem with its wordiness, though—it was as if Popoy (Cruz) and Basha (Alonzo) had to recite essays to each other every single time they quarreled. And they quarreled every 15 minutes or so, usually with tears or broken ceramics. The writers were painfully trying to make quotable quotes out of every scene. 

The movie is set seven years after they'd been married. The contrast couldn't have been more stark. Whereas they looked fresh and positive before, this time they look jaded, tired, fat, as if nothing was good in the world. It is a story of marriage struggles and a valuable object lesson that one shouldn't work with a husband or wife, if it can be avoided. Popoy is supposed to be a world-class engineer, Basha an architect, the two of them co-founders of a construction firm. 

Their company starts pretty well in the beginning, but problems emerge when Basha endures a spontaneous abortion. I blame the downward spiral of their lives to their OB-Gyn, who advises Basha to take a year off work because she should rest. The stress in the firm wasn't going to help in her pregnancy, her doctor must've told her. But for an entire year, with no work ups for APAS or other causes of secondary infertility?! As a result, Popoy is pressured to take over the company alone, hiding his failures from his wife, who wonders if it is she who is the problem.  

The film did have some redeeming qualities. I thought the cinematography was nice—Manila didn't look so ugly. John Lloyd and Bea had a certain chemistry; they looked comfortable together. Janus del Prado and his talkative specimen of a daughter offered welcome laughs to interrupt the heavy and verbose exchanges. Clearly Director Cathy Gracia-Molina has perfected the art of making formulaic romantic films that speak to the public—films that always have happy endings.  

The day when I (almost) lost it

I THOUGHT I’d end first year residency without ever getting mad at a patient or a watcher. At the hospital where I work, the watcher—or the “bantay,” a Filipino term which means to watch over, to guard and to protect—plays a key role in the care of the patient. We don’t have much staff to drag the stretchers, do the bed turning for our intubated patients, procure the medications from the pharmacy, or facilitate application for financial assistance. Majority of these tasks are handled by the bantay—usually the patient’s family member or a close friend who stay at bedside—and my experience is that more efficient the watcher is, the more likely the patient will survive.

Way past bedtime

Over dinner last night with Carlo and Glaiza de Guzman (not a married couple), and Patrick Abarquez; we spoke about the many crazy things we did in internship. Our conversations lasted way past 11—and to friends who know me too well, it was way past my bed time. It was definitely worth it, though: I missed the company. One can only laugh so much at the past.

Carlo is going on training for Radiation Oncology, which means he will be at the forefront of approving my requests for radiotherapy, usually for patients with superior vena cava syndrome. Glai is doing well in OB-Gyne, and has taken on a new fashion instinct—dresses, white coats, the works. Patrick will be taking up residency in IM.

So many things are happening all at once, and I'm thrilled to know that many of my friends are doing the things they're passionate about.

All smiles

I HOPE I’m not preempting anything, but when I visited my 70-year old patient—now with a tracheostomy tube, hooked to an oxygen mask instead of a mechanical ventilator—I saw a smile. He smiled back at me: he, my remarkable patient whom I had taken care of for a month or so. It’s nothing short of a miracle. I first handled him at the Medical ICU, where we treated him for a difficult-to-treat lung infection—the first he got before he had been admitted, the subsequent infections (the harder ones to treat) he later acquired during his stay at the hospital.

1,540th—and more

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Pagbilao, Quezon Province, taken in 2012

SINCE RESIDENCY has started, I haven't been as consistent in updating this space, my private space, in the Web. It was as if I got tired of writing on my charts—my patient's stories instead of mine—that I felt I had nothing else left to say at the end of the day. Even my private journal has suffered; I'm only halfway through filling up my pocked-sized Moleskine imitation notebook.


I must therefore make it a habit to write something here at least once a week, not simply keep this website alive, but to instil in me the practice of thinking and writing—the process, not the traffic, is the reward. I know fewer and fewer people have visited here since the advent of Facebook and Twitter, and that's okay. Maybe Jason Kottke, who owns one of my favorite websites (kottke.org), is right: the blog is dead. My friends, who started their own blogs around the same time that I did, have decided to move on. People now turn to micro-blogging sites to be updated, having developed an evolutionary irritation at lengthy articles. 

But, 1539 articles since I had begun in in December 2014, I realize I've invested too much in this little site to let it all go to waste. I will still write, and keep on writing, as long as I can. 

Thanks for always being here. 

Service 1 dinner

MOIZA is an unassuming Korean restaurant along Malvar corner Ma. Orosa Street in Malate, perhaps part of what still remains a busy, noisy, strip of bars and cafés. I almost got lost when  I looked for it last night. We had our mid-month "service dinner" there—a ritual consisting of eating out with the entire General Medicine service before the clerks and/or interns shift out.

My Facebook sabbatical

Espresso

THE NOVELIST Butch Dalisay writes, “For the umpteenth time, last week, another person asked me, with profound astonishment, why I wasn’t on Facebook. I told him that, in my seniorhood, I wanted to lead a quiet and peaceful life, and that Facebook was antithetical to that ambition.”

I’m on my third week of Facebook sabbatical; I want "a quiet and peaceful life," too. I made the decision when I realized that a lot of my idle time was spent checking for updates—a hobby facilitated by my ownership of a smartphone that can connect to the Web anytime, anywhere. At first I thought I could limit my Facebook immersion to once daily, but there was the itch to see what was happening in the world, to see the goings-on in the lives of my so-called friends, some of them I haven’t seen in years, some I haven’t even met at all. It got unhealthy. I would, in some days, prioritize checking Facebook over reading my Bible first thing in the morning. Something had to go.

Mervyn Leones's golden heart

Birthday boy, Mervyn Leones

MERVYN LEONES—pride of Legaspi City, distinguished alumnus of St. Agnes High School, internist-extraordinaire—celebrates his birthday today. I'm writing about him because he will be thrilled at the attention; he is very easy to please. In the photo above, we see him overseeing the consultant rounds at the Pay Wards (this was halfway through residency, I think, and he had mustered enough bravado to do just that). He looks intensely at us, making sure we all pay attention to the details—and we do, save for Roland Angeles, who looks at the camera anyway.

Starbucks for the old (in) Manila

At Hizon's Bakeshop,  Ermita,  Manila

At HIZON'S Bakeshop—an old restaurant along Bocobo Street in Arquiza Ermita, Manila—I'm enjoying a cup of perfectly delicious coffee partnered with grilled ensaymada, the store's signature dessert. The place is empty, save for two gray-haired men who look like they've been retirees for a long while now. I realize I like spending a lot of time alone: my thoughts become louder, and I'm able to think things through. I should've brought my Bible, or a thick book, because reading requires much solitude, perhaps the only time when I'm actually silent. Hizon's may well be the Starbucks of the old, and I feel that I fit right in.

Daily bread

PILGRIMS, my prayer and Bible study group, meets Thursday nights. You could say that since I've joined the cell, I've become very fond of and close to this funny, sporty, Scripture-loving group of middle-aged men in church. In our on-going series on the Lord's Prayer we discussed "Give us this day our daily bread."

"Bread" refers to our physical needs. "Daily" means we must ask God for these needs on a daily basis; He can flood us with blessings, but He wants that we depend on Him daily, the same way the Hebrews got manna every day. Praying for food, shelter, and clothing is necessary.

A key point in Kuya Vance's teaching is his emphasis on the fact that God does choose to provide us more than what we need at any given time. This fact rings true for many of us who don't have to labor 24/7 just to put food on the table. We have more than enough, when we think about it. Praise be to God for His manifold blessings.


Thankfulness

RAIN AND WIND are keeping people inside their homes. The typhoon is called Lando. No classes in Manila tomorrow, declares the local education department—a fact that leaves us, employees, salaried men and women of the Philippine workforce, wondering if we don't have to report to our offices as well. I spent the entire afternoon sleeping, relishing the bed-weather, hearing the howls of wind outside.

Watches, books, and tennis—a random update

I.

I WENT with Mervyn Leones and Danes Guevarra—friends and colleagues in IM—to an unassuming store for watches in a mall in Manila. It was raining, traffic wasn’t as bad as we had expected, and the drive was uneventful.

Carlos Cuaño
Carlos, when I made him wear my spectacles.

With us was Carlos Cuaño whose new-found calling is making sure we get good deals. He knows a lot about rotors, automatics, and quartzes, and has done extensive research on the subject, so much so that he can write an entire dissertation on Japanese Watches And Why People Who Live There Are Always on Time. He, by the way, is almost always late.

Nearing the end

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My view from Room 123, Gen Med Clinic, Out-Patient Department Building, UP–PGH.

THE END of first year residency is coming—this fact I had realized when Ma’am Lia met with my batch to ask us how were were. We seemed to be doing well, she said. She was pleased with the fact that we seemed to have adapted and adjusted to the culture of residency training at PGH–IM.

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.

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 fiancé—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. 

Regrets

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."

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.

20150822_133412

On pre-residency

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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.

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.

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Art installation in front of the Singapore National Museum.

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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.

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Books at a library in Somerset Road.

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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.

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.

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.

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.

Tagaytay

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.

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.

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.

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.

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.

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.

Domesticated


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.

Pregnant

Roddy Doyle's The Snapper

THE SNAPPER, Roddy Doyle's second novel in the Barrytown trilogy, is about a middle-class family in Dublin trying to cope with an unexpected pregnancy of the 23-year old daughter, Sharon. Living up to his title as the virtuoso of casual, conversational dialogue; Doyle spins a masterful tale about the noisy Rabbitte family. They almost sound like the typical Filipino family—so bonded together that someone's business becomes everyone else's.

Meditations on a fine, cloudy morning

I WAKE up to a cloudy morning—a little cold but not hot, like most mornings the past months. It rained last night. The soil has been dry, the air extremely humid, and the people irritable—we needed the rain. The room is dark and quiet, save for the clickety-clack I make on my keyboard. I haven't drawn my curtains yet. In a few minutes I will head to the bathroom, don my stethoscope, and make rounds. I have a few ECGs to read, too, so I mustn't forget that.

Sagip is featured in this month's Health and Lifestyle magazine

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MY ARTICLE on Sagip Buhay Medical Foundation is featured in the June May issue of Health and Lifestyle magazine. Many thanks to Abi Roxas for giving me the chance to write for Sagip, a go-to place for us, internists, when we're faced with patients who have absolutely nothing inside their pockets. Grab a copy, and learn how you can help our patients at the Philippine General Hospital.

Ode to our clerks and interns

I REMEMBER the morning when I did rounds earlier than usual. I am a morning person, and I like the peace and quiet of the wards at 6 am, still devoid of the usual crowd of fellows and residents looking for the same charts. I saw one of my clerks pushing our patient's stretcher. I learned that he came in at 5 am to make sure the patient didn't miss the cranial CT scan schedule. I was so moved by his dedication, realizing I wasn't like that at all when I was a medical student.

At night, when everyone is asleep

24-hour shift at the Pay Wards

WHILE CATCHING my breath after two flights of stairs, I looked out the window from the 7th Floor and saw the Central Block Atrium from a distance. I have come to terms with the fact that my life will never be the same as everyone else's. Whereas the rest of humanity sleeps and dreams around this time, I wander along the dimly lit corridors of the Philippine General Hospital, shooing away the angel of death by making sure the patients are all chest pain-free, able to breathe optimally, their hearts still beating, ready to face the new day. The life of a doctor is almost poetic.