Psalm 92


We sing a song patterned after Psalm 92 in church. With the flute, keyboard, and the excellent singing of our church’s worship team; I can’t help but be overwhelmed. It is a beautiful song. It is a beautiful psalm, full of gratefulness and joy.

The Psalmist exclaims, “How great are your works, O Lord! Your thoughts are very deep!” (Psalm 92:5). It comforts the Psalmist that although he doesn’t understand everything that’s going on, he knows that the God he worships does great work and is great! He is so full of awe that he wants to “declare [God’s]steadfast love in the morning and [His]steadfast love by night” (verse 2).

That the righteous are rewarded by the Lord in the end also brings comfort to the Psalmist. The righteous “flourish like the palm tree and grow like a cedar in Lebanon” (verse 12). “They still bear fruit in old age; they are every full of sap and green” (verse 14).

I often wonder what will become of me when I grow old, if the Lord allows it. But I surely hope I’ll become fruitful, my lips forever praising my God, my heart bursting with thanksgiving and joy.

Getting old by the day

MY FATHER complained he wasn't feeling too well. Days ago, he let himself be dragged by my two other brothers to a bowling match. Of course I didn't care to join; I was sleepy, having just left the hospital after a 24-hour shift. My brothers thought I just didn't want to end up the lowest pointer. They were all insistent that I join. My father even volunteered to be on the same team with me. Tatay's first shot was a strike. When we got home, he complained of back pains.

"Your Tatay is getting old," confessed my mother. "I shouldn't overwork him."

"Yes, Nay. You make all sorts of demands," we said.

My mother smiled.

The fact is that my parents now carry their senior citizen card, a badge of distinction for them, an excuse to buy that extra dessert or watch that new movie. They're getting older by the day.

How do I encourage them, as well as the rest of the old people I work with?

R. Paul Stevens writes:

Aging people experience progressive losses: parents, friends, colleagues, career, driver’s license, and perfect health. Then life-threatening health challenges are encountered, usually heart disease or cancer. And finally, there is the certainty of death.

In these realities, though, there are implicit spiritual incentives to grow. Here are three ways to encourage and exhort the aging.
It's summarized in three points:
Experience intensification
Embrace simplification
Cultivate (practical) heavenly-mindedness
Read the rest of the article here.

Ash turned to diamond

The quiet was disturbed by the sound of chisels striking stone. The gravediggers removed a metal plaque, then a cement wall, and, finally, a brick façade. More than an hour later, they hit what they were looking for: an oxidized copper urn, filled with the ashes of Luis Barragán, one of Mexico’s greatest architects, who died in 1988. They removed the urn from the cavity, brushing off dust and ants. Then they opened the vessel and presented it to Magid, who scooped out half a kilo of what looked like dirt and transferred it to a plastic bag, which she then put into a box. The next day, with the box in her carry-on, she flew home to New York.
The famous architect, Luis Barragán, was turned into a diamond. This created a lot of talk regarding morality, ethics, and such. The plan was to exchange the diamond for the precious archives of the architect's work, now heavily guarded by a private entity based in Switzerland. This is an excellent piece by Alice Gregory in The New Yorker.

Social media fast, and you miss nothing much

One of my web heroes, Jason Kottke, writes about his social media fast.

"Last week (approx. May 7-14), I stopped using social media for an entire week. I logged out of all the sites and deleted the apps from my phone. I didn’t so much as peek at Instagram, which is, with Twitter and old-school Flickr, probably my favorite online service of all time. I used Twitter as minimally as I could, for work only. I didn’t check in anywhere on Swarm. No Facebook. As much as I could, I didn’t use my phone. I left it at home when I went to the grocery store. I didn’t play any games on it. I left it across the room when I went to bed and when I worked."
He continues, as a footnote:
"Still one of my favorite tweets is from Scott Simpson: “My new standard of cool: when I’m hanging out with you, I never see your phone ever ever ever.”"
He concludes:
"After the week was up, I greedily checked in on Instagram and Facebook to see what I had missed. Nothing much, of course. Since then, I’ve been checking them a bit less. When I am on, I’ve been faving and commenting more in an attempt to be a little more active in connecting."

On memory

Memory is a mutable element, fickle in its suggestibility. It can be tricked to expand far beyond its true bounds, and yet, if overburdened, is liable to shut down altogether.—Alexandra Schwartz, "The Unforgotten: Patrick Modiano's Mysteries"

I'm reading Honeymoon by Patrick Modiano. I'm almost halfway through the book. The sentences are clear; it's quite an easy read. Jean B. tricks his wife and colleagues into thinking he's going to Brazil; but he stays put and hides in Paris, planning to uncover the mysteries of a woman named Ingrid, who, years before, had committed suicide in a hotel in Milan.

I was reading about Patrick Modiano and found the quote about how memory is mutable and trick-able. Who was it who said that pen and paper is better than sharpest memory? That's the reason why I blog and write on journals, too. The same reason that God ordered the Israelites to make memorial stones, lest His people forget Him.

Why so many blogs are awful

I've been blogging since 2004, and Tim Challies' article, "Nobody Respects A Blogger," is a beautiful reminder of why I do the things I do.

So why do people blog? In many cases, it’s to build a platform, to gather a following that can then earn the right to graduate to one of the more honorable media. Many people consider blogging a means to an end, not a worthwhile end in itself. Blogging is a kind of minor leagues, a proving ground, and those who prove themselves as bloggers may then advance to the big leagues—book deals, plumb conference spots, columns in magazines. The blog is the necessary evil, the rising platform that eventually elevates them from obscurity to respectability. 

And this is exactly why so many blogs are so awful.
Read more here.


To the present hour we hunger and thirst, we are poorly dressed and buffeted and homeless, and we labor, working with our own hands. When reviled, we bless; when persecuted, we endure; when slandered, we entreat. We have become, and are still, like the scum of the world, the refuse of all things.—1 Corinthians 4:11–13

Who was this man Paul—perhaps one of the smartest, wisest men who ever walked the earth—and why did he write these things? Whenever I read his letters, I wonder how he must have been like in real life. I imagine Paul to be very intellectual and academic, perhaps a bit intimidating, a no-nonsense man who was well-connected and famous in the most elite of circles. He was, at one point, feared because he led the prosecution of the early Christians; so I imagine Paul as a very serious man, who got quite scary when he was proving a point.

He had everything the world could offer, and he threw these all away, when the Lord Jesus Christ revealed Himself to him. He would leave everything behind to follow, live for, and even die for Jesus; and his epistles would form much of the New Testament, and offer direction and guidance to the establishment of the church.

Despite his accomplishments in the faith, Paul knew that the world would think him foolish. He didn’t mind being called a fool. The present reality is similar in that Christianity—biblical, orthodox Christianity—is folly to the world, standing in opposition to the current tides of thinking and way of life.

Smart kid

If, theoretically, you had a gifted child—someone who could solve problems mentally, without pen and paper; who already knew calculus before her classmates could even read or write—would you hide her under the radar or let the entire world know about her? Would you send her to a normal school or enroll her to prestigious institutions, where she can be mentored by the world’s best?

I’m asking these questions because I had just watched Gifted. Nothing is spectacular about it, story-wise—it was as predictable as Maalala Mo Kaya episodes in ABS–CBN—except that I really, thoroughly enjoyed it.

To see a kid get bored by one-plus-one drills in class; standing up for a bullied classmate by smashing the nose of the bully; keeping quiet in moments when her intellect is called for, just because her uncle had advised her to keep her mouth shut lest she look like a smartass—that was fun. She is an adult trapped in a kid's body, but a kid, nevertheless. Who is this toothless kid? I love her. (I searched: her name is McKenna Grace).

On call


THE NIGHT before her flight, Nanay tells me she has low back pain.

“Is it just my posture?” she asks at 11 PM. “It aches when I sleep with my back flat.”

I tell her I’ll have a look. “That’s nothing,” I say. I see a faint redness near her lower spine that’s painful when pressed for a long time. The lesion can be musculoskeletal, or probably a consequence of her prolonged steroid use, which is notorious for making her bones weak. She’s been taking dexamethasone for months now.

But Nanay has a healthy doubt for all the things I tell her, always interpreting everything I say with a grain of salt. This, after med school and residency training. The thought comforts me, like the fact that she still revises everything—speeches, notes, letters—she makes me write for her.

She and Tatay land safely in General Santos. Sean, my younger brother, meets them at the airport and drives them back to Marbel. While at the ICU, I hear my phone vibrate—my mother, calling in the afternoon, a highly unusual occurrence, because she knows I’m busy.

“It looks like shingles,” Nanay says. “It’s painful.”

Sweltering heat

THE website was down for a few days. My domain host failed to receive any notices from me that my renewal fee had been paid a day before deadline. But now it’s up and running, and my blog is 13 years old, give or take two months. Thanks for being here. It still amazes me to know that this space here is older than many kids I see in church. They were still being contemplated, while I was already posting selfies, and “selfie” wasn’t a thing yet.

My traffic has markedly gone down after I’ve decided to quit posting links from Facebook, a platform that I’ve long felt to be antithetical to my dreams of living a quiet and peaceful life, what with the many, many things being posted there—namely, people eating in restaurants, political view points I can only disagree with, and a few useful ones, which are the exception rather than the rule. I’ve logged on occasionally to communicate with old friends or to honor my mother’s wishes of checking out the latest about her batch mates from high school.

It is so hot in Manila that I need to hydrate myself once in a while. It’s a good thing I’m at the ICU now, where temperatures are friendlier, and the air-conditioning hasn’t bogged down—not yet. Please, not ever; not in this heat.

Still, we have plenty of reasons to be joyful, like this fun-looking, friendly man I saw inside a café's bathroom.

Such a fun-looking man. Anyone knows who he is?

Out at night


AT 9:30 PM I was still outside, with street names I couldn’t read properly, at roughly 4-10 degree temperatures, until I found an inscription that read “Mustak,” a train station. My feet hurt. From Charles Bridge, I wanted to hit Old Town but got lost. My guide, whom I’d meet a day later, would tell me the Czechs don’t know how to define squares. (I suppose the Austrians are the same—the platzes aren’t exactly isometric and four-sided).

Nove Mesto

Central European men, most likely drivers, were smoking outside, their taxis parked on an alley I hadn’t been to before. Or maybe I’d been there already, only that it was already dark. Groups of tall college students were shouting in the middle of the street—they seemed very happy, as I was—and were probably drunk, and I wasn't.

Touchdown Prague

IN GRADE TWO I prided myself for being able to spell “Czechoslovakia” without batting an eyelash. I liked the sound of it and picked it for a school project in celebration of the United Nations. Its flag was a lot like the Philippines’, sans the sun and stars. I looked down on my classmates who picked Japan (too easy to spell, and the flag was too simple) or France (for the same reasons), but couldn’t quite feel superior towards a classmate (I forget who) who picked USA. Cutting up fifty or so stars from a piece of art paper impressed me.

Many years have passed, and now I’m here—my side trip in Central Europe—after a comfortable three-hour train ride from Vienna. It goes without saying that the country has split into the Czech Republic and Slovakia; so I don’t have reason for boasting anymore. It’s much easier to spell.

I arrived at 3 PM, checked in at my hostel in Národní Street, and took a nap. At 5 PM, I walked around the city. I had wanted to get lost, the best preliminary way to imbibe the city, and found Charles Bridge. For dinner I ate at a burger stand near the Old Town. I had mulled wine—quite sweet, but its warmth was soothing—and trdelník with chocolate for dessert.

Tomorrow I’m joining a walking tour.

Bubbly welcome

Prague Metro

View from my room


Mulled wine


City center


“You have put more joy in my heart
than they have when then their grain and wine abound.
In peace I will both lie down and sleep;
for you alone, O Lord, make me dwell in safety.” —Psalm 4:7–8

“For I have been crucified with Christ, and it is no longer I who live, but Christ lives in me. And the life I live in the flesh I live by faith in the Son of God, Who loved me and gave Himself up for me.”—Galatians 2:20

What grace you’ve given me all my life, O Lord, and what delight you’ve made me enjoy in your presence. There’s nothing else I can wish for, no other thing I desire. I am grateful—eternally, most of all, for all the things that you’ve done for me, for showing me who you are.

You know my innermost thoughts, my restlessness—and you know all too well that, if left on my own devices, I will never turn to you. But you sought me ought, and you found me, and you’ve never let me go.

What a story it is to tell the world, and if every life is, in fact, a story, then mine would have you as the centerpiece around which everything resolves. May it always be, O Lord, that you will always occupy the throne of my heart—not my family, my ambitions, my worldly desires. May I behold you so dearly that the entire world—no, the entire universe—pales in comparison to you.

Remove from me the vanity of the world. Restore to me the joy of your salvation daily, and help me be cloaked with humility, because I am a truly proud man. My pride manifests in so many ways—in my irritations, my unholy thoughts, my wicked actions, my feelings that I deserve more than what I have. But I look to Christ, who left everything and became man, and when he was a little past 30—around my age—bore my sins, accepted your wrath, and died the most brutal death imaginable on that wooden cross. May I be reminded of this daily—the cross, your suffering, your death, your life.

Take good care of my family. Give more good years to my parents and provide for my brothers. Bless the church, and nourish it with your Word. Show my friends the way of your salvation so they will know you, too. Heal my patients, and comfort them.

And may this be the narrative of my life: that I’ve lived—and will joyfully live—my next remaining, most fruitful years, for you.


I PLANNED ON doing nothing today—at least nothing as touristy as going to the Schoenbrunn Zoo (ok, maybe in two days). Of course, I had my usual coffee at the local café—Kaffee Melange and salami sandwich—where I greeted the kind people behind the bar. The old lady already recognized me. “The English-speaking kid,” I overheard her say in German. Don’t make me translate that.

As I soon as I was done reading Morning and Evening by CH Spurgeon for my devotions, I chatted with a fun-looking family of five—three children, all of them girls, aged 11, 8, and 2, and they were on break for Easter. I recognized them from yesterday, as I am now in the habit of baby-watching. Their mother, probably a little older than me, told me they came from Munich. I said I was from Manila. “Our au pair was from Manila,” she said. They kids smiled; they missed their yaya.

By my side

MAVIS Gallant’s stories have been with me for the past days. Paris Stories, selected by the writer Michale Oondatje and published by NYRB, has kept me entertained during my moments of “idleness.” (Rest has been a part of my itinerary, which is why I cannot stand paid three-day tours with a crowd. The itinerary is regimented, with hardly room for sipping tea comfortably. And I probably won’t afford them.) Consider, for example, the 11-hour train ride I had subjected myself in a few days ago, and the quiet moments at the cafés, both in Paris and Vienna.

What she does with the stories is nothing short of magical. She comes from a position of omniscience. She tells stories, sometimes in hushed tones, so one must pay attention. It helps that the stories in this collection are set in Paris—at least I got the imagery right. Miss Gallant doesn’t insult the reader by telling everything: one just knows.

For instance, this line from the story, “In Plain Sight,” about an old romance that never came to be.

Years of admiration, of fretting about his health and, who knows, of love of a kind have been scraped away; yet once she had been ready to give up her small and neater flat, her wider view over Boulevard du Montparnasse, the good opinion of her friends (proud widows, like herself, for the sake of moving downstairs and keeping an eye on his diet.


This morning I overhead at the Schoenbrunn Palace, the Habsburg summer house, a family who looked brown and noisy and happy enough for me to consider they were Filipino, and as I went close to them—I had no intention of opening a conversation, because I like to keep my anonymity—I listened to their conversation.

“Ma, ayusin mo ‘yung picture. ‘Yung pang-I.G.” said the teenager, as she was posing for the camera.

“Yung upo mo—‘yung relaks lang, ‘yung parang tambay,” said the lady who looked like her mother. “Bilisan mo! Iiwan na tayo ng bus!”

Yet another reason why I prefer to travel alone, or with people who detest taking photographs of themselves all the time. But I belong to a nation that has made selfies and Facebook-profile-picture-taking a national pastime, if not entirely a science. I love my people.




Mozart concert with Vienna Concert Orchestra at Karlskirche

DESPITE the snow, I emerged out of my bed in Hütteldorf to take the U4 to Karlsplatz, where I could walk my way to Karlskirche. I was going to watch a 65-minute performance of the Vienna Concert Orchestra that would start at 8 pm. I arrived just in time, my body frozen to death because the snow never stopped falling outside. I loved their rendition of G. F. Händel's Oueverture. Natalia Stepanska, the soprano, gave a heart-stopping performance of Largo from Xerxes. Of course, Mozart's Requiem (Lacrimosa) and Divertimento in D Major were played, too. When I got back to my room, the songs were still playing in my head.


TOUR guides always refer to Christianity as if it were something distant: something that needs mentioning, but not too much. Talk about anything else—the food, the culture, the lifestyle, but not about politics and religion—or so the modern thinking goes, because you'll make enemies if you do. But Christianity has formed much of Europe; as Christianity flourished, so did the rest of the world. Tour guides have a job to do, nevertheless: not to evangelize, but to show us around, so we forgive them.

And while Europe is pretty much a post-modern, post-Christian world, it's been interesting for me to see a few of its remnants in modern culture. Like the musical Jésus, de Nazareth à Jerusalem in Paris.

Jésus, de Nazareth à Jérusalem

And a page from the leaflet of my OBB train from Stuttgart to Munich: a celebration of the Reformation. Martin Luther is my hero.

Martin Luther on the OBB train

First snow


Nothing arouses playfulness like the first experience of snow.

From Gare Paris Est, I took an 11-hour train journey to Vienna, crossing Germany (Strasbourg, Stuttgart, then Munich), then Austria (Salzburg, Linz, and Wien Mielding). Taking this ride, with the greenery and quaint German houses and snow-capped Alps in my view, has been one of the best decisions I’ve made for this tour thus far—never mind the hipster-looking Frenchman behind the information counter at Charles de Gaulle who, when he asked me how long I was staying, to which I answered, “Just for a few days, then I’m taking the train to Vienna,” couldn’t stop himself from saying F***!

Waiting for my train

Café at Gare du Nord

IN A few hours I'm hopping on a train that will take me to Munich, Germany; then to Vienna, Austria, where I'll be staying for a few days. God has graciously provided for everything I need and has kept me safe. I thoroughly enjoyed my two full days in Paris, where I've spent the day walking then having desserts in the bistros, occasionally whiling away time and praying along the Seine. It's been a good chance to brush up on my basic French again, a skill that was challenged when, hungry, I barged into a Subway store right across the Gare du Nord station, and the man behind the counter, who spoke very little English, got confused with my orders.


“My God, my God, why hast thou forsaken me?”—Psalm 22:1

Were here behold the Savior in the depth of his sorrows. No other place so well shows the griefs of Christ as calvary, and no other moment at Calvary is so full of agony as that in which his cry rends the air—“My God, my God, why hast thou forsaken me?” At this moment physical weakness was united with acute mental torture from the shame and ignominy through which he had to pass; and to make his grief culminate with emphasis, he suffered spiritual agony surpassing all expression, resulting from the departure of his Father’s presence. This was the black midnight of his horror; then it was that he descended into the abyss of suffering. No man can enter into the full meaning of these words. Some of us think at times that we could cry, “My God, my God, why hast thou forsaken me?” There are reasons when the brightness of our Father’s smile is eclipsed by the clouds and darkness; but let us remember that God never really does forsake us. It is only a seeming forsaking with us, but in Christ’s case it was a real forsaking. We grieve at a little withdrawal of our Father’s love; but the real turning away of God’s face from his Son, who shall calculate how deep the agony which it caused him?

— CH Spurgeon, Morning and Evening

Get a copy of "From the Eyes of a Healer: An Anthology of Medical Anecdotes" where my story appears

"From the Eyes of a Healer: An Anthology of Medical Anecdotes" will be released on the third week of April. I had the privilege of contributing to this collection, and this will be my first book publication to date. Many thanks to Dr. Joey A. Tabulá—poet, internist, and now book editor—who has realized that medicine and medical training are minefields of stories about the human condition. I'm excited to read the rest of the stories myself; I know and have worked with many of the authors, too.

Each book sells for Php 249 and is released by Alubat Publishing. You may reserve your copy through this link.


I give thanks, O Lord, with my whole heart;
before the gods I sing your praise;
I bow down toward your holy temple
and give thanks to your name for your steadfast love and faithfulness,
for you have exalted above all things
your name and your word.
On the day that I called, you answered me;
my strength of soul you increased.—Psalm 138:1–3 (ESV)

Bad News and Good News

I TREATED myself to a novel yesterday—Edward St. Aubyn’s “Bad News,” the second of his Patrick Melrose novels, where the twenty-something Patrick, after learning about the death of his father whom he had despised, flies to New York City to claim the remains. In what reads like a blow-by-blow documentation of his descent into drug addiction, St. Aubyn paints the portrait of a rich man who has everything the world desires—money, sex, influence, women—but who remains empty despite these earthly possessions. We read of Patrick showing up to dinners high with concoctions of heroin, Quaalude, cocaine, and alcohol, which he took shots of inside washrooms, hotel rooms, and dark alleys. His hatred of his father burns him inside out.

Today's Sunday sermon couldn’t have been more timely. Pastor Bob spoke on John 5:1–16, “The Healing at the Pool on the Sabbath.” In this gospel account, the apostle John takes us to a place in Bethesda where a healing pool was. It was widely believed that when the angels would stir the water, the healing would take place. In the area were five roofed colonnades, shielding the blind, lame, and paralyzed from the sun and rain. I imagine this place to be a lot like the hospital where I train, where there is no shortage of illnesses, loneliness, and desperation.

March has ended

All the things I’ve learned and struggled with and suffered through the past two years—yes, all of them—have found their ultimate utility and fulfillment in my first stint as a General Medicine service senior. It was as if everything was meant to prepare me for this: leading the team of residents and students to sound dispositions, focusing the direction of management, and even arguing for or against certain clinical impressions.

Very normal

NOTHING much happens in Tom McCarthy’s Satin Island. An anthropologist, who works in-house at a big commercial firm, writes about Claude Lévi-Strauss, parachutes, oil spills, his love life, and his modern-day theories about civilization. The novel reads like a diary. The prose is magnificent.

“The terminal’s interior, despite its new façade, was dingy. Parts of it were boarded up, awaiting repair. The smell of popcorn, hot dogs, pizza and donuts hung about the concourse, impregnating air that was much warmer than the air outside—cloying and heavy, too. People were milling about, waiting for the ferry: normal, everyday folk who commuted on it daily. A few of them wore suits—cheap, polyester ones, the standard-issue outfit of the low-white-collar ranks; but most wore plain, casual clothes. They looked bored, frumpy, tired, unhealthy, overweight, and generally just very, very normal.”

Adding it all up

I see "345" in the cash registry—three digits flashed in green light on a dark background, like how they had appeared in old calculators in the nineties. I’m in a queue at Wendy’s, buying bacon mushroom melt with fries and Coke Zero—my long delayed lunch. I hand two one-hundred peso bills, and two twenty-peso bills to the nice lady behind the counter—confidently, as if had, in fact, added them correctly in my mind. “Sir, kulang pa po,” she tells me. I rectify my error, a realization that although I like mathematics, I do not like arithmetic.


While I was leisurely reading my morning paper, @dindindinny and @ninolator—the Instagram rockstar—sat in front of me and joined me for breakfast. The music playing. was John Mayer's "Love On The Weekend." Our morning chat was a pleasant surprise; but ala

WHILE I was leisurely reading my morning paper, Din Floro—my senior in IM, now a gastroenterology fellow—and Niño Lucero, the plastic surgeon who doubles as an Instagram rockstar, sat in front of me and joined me for breakfast. The music playing was John Mayer's "Love On The Weekend." Our morning chat was a pleasant surprise; but alas, duty called. It's admitting day today.

Too early, too soon


A young doctor almost my age—plus-minus a year or two—has died. Someone shot him one night: a bullet that killed him right on the spot, piercing his heart. Four years of medical education, one year of internship, all these on top of the four or five years of college undergraduate education—and then this: an armed man who, for whatever reason, pulled the trigger at him, leaving him defenseless as he lost blood and eventually his consciousness.

He was, I later learned, a gentle soul: a towering six-footer but whose voice was sonorous, whose ways were charming. And charm the entire Lanao town he did: the people he served loved him, for who would leave his family to ease the suffering of his lowly Mindanao community, many of whom hadn’t met a doctor in the flesh until his arrival?

There is no escaping death, but there are good ways to die—and his came too early, too soon.

My first General Medicine Service

Service Four — March 2017

THIRD year residency reaches its pinnacle during the four months of being a service senior. Under a General Medicine service are two or three first year residents, interns, and clerks, plus the second year residents who go on duty at the Emergency Room. The responsibilities are overwhelming. Aside from being a clinician, the Gen Med senior is also expected to take on administrative tasks, which include, among others, assuming primary care for patients previously handled by other specialties; providing clear-cut dispositions to patients; setting short- and long-term goals for problematic cases.

March is the first time I'm taking on the role of a Gen Med senior. I'm working with Drs. Nico Pajes (first year IM resident) and Clare Enriquez (our Neurology rotator), and it has been a pleasure to struggle with them thus far. Every night I ask the Lord for wisdom. I pray for my residents that God continually sustain them. I also pray for our students: that they become battle-tested, compassionate, competent physicians in the future.

We had a service dinner last night, something that has become a tradition during the Ward rotation. With us were our interns, Chacha Mercado, Gerald (Baby G) Mendoza, Jeff Manto, Marz Marquez, Athan Lozano, and Joan Lampac. Two of our bubbly clerks also joined us: Ichi Nakamura and Carl Marquez.

Onward, Service 4.


The subject of my blog came up as we wrapped up our evening ER rounds—five patients so far; three we could potentially send home. But the night was young, and the ER has been notorious for getting jam-packed in the wee hours of the morning.

Our JAPOD, Chacha Mercado, whose voice resounded loud and clear at the Acute Care Unit, and the senior intern with her, Gerald Mendoza—someone we had taken to calling “Baby G,” because he does look pediatric, save for his small stubs of facial hair—asked me about my blog. I usually respond cautiously to these questions: a person having read my website must have already known a lot about me, and I must’ve overshared some points in my life during my more irresponsible, younger years.

I learned that one intern who grew up abroad had discovered UP because of my blog. At the time—and I haven’t checked it yet—there was probably no functioning website for the hospital, perhaps the least of the administration’s concern, given the other, more desperate problems in the health care system it was facing. While she was searching for “UP Medicine” online, my blog came up. She hasn’t confessed anything to me yet; she’s rotating with the Department this month.

Off to Guazon

It's a rainy morning today. I'm headed to Guazon Hall to spearhead the morning endorsements of the students. I spoke to some of them this morning as they were gathering at Ward 3: they were tired; their shift was eventful. As in: two simultaneous codes just as they were being endorsed to. My Vietnamese coffee[1] is warm, just the way I like it. Praise God for this day. Happy Saturday, dear reader!

[1] Many thanks to Bea Uy, who gave the beans to me last year.

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.


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:


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


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.


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!




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, 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.


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.”