Saturday, September 22, 2018

In my mind



Jon Bryant's Carolina is stuck to my head. It's a song full of longing, distance, and detachment, and it's sobering. Days find me wishing I were somewhere else—at home, for example—but reality finds me back and clutches me with the reassurance that I am where I should be. Travel breaks the monotony of daily life, but so does music and books.

In my mind, I'm going to Carolina
Can't you see the sunshine?
Can't you just feel the moonshine?
And ain't it just like a friend of mine hit me from behind?
Yes, I'm going to Carolina in my mind

Thursday, September 20, 2018

Wednesday, September 19, 2018

Sunday, September 16, 2018

Steroids decrease efficacy of PD-1/PD-L1 inhibitors in NSCLC

Dr. Matthew Stenger, via The ASCO Post:

In a study reported in the Journal of Clinical Oncology, Arbour et al found that baseline treatment with corticosteroids was associated with poorer efficacy of programmed cell death protein 1 (PD-1) or programmed death cell ligand 1 (PD-L1) inhibitors in patients with non–small cell lung cancer (NSCLC).

Furthermore,

The investigators concluded, “Baseline corticosteroid use of ≥ 10 mg of prednisone equivalent was associated with poorer outcome in patients with non–small cell lung cancer who were treated with [PD-1/PD-L1] blockade.”

Baseline corticosteroids were associated with decreased overall response rate, progression-free survival, and overall survival with PD-(L)1 blockade.

What's the clinical impact for oncologists? Must we then avoid corticosteroids entirely? The authors recommend its "prudent" use.

Monday, September 3, 2018

Visiting Nella Sarabia's new optical shop at Acacia Dorm, UP Diliman

Composed September 3, 2018, but I've just only realized it was saved in drafts and not posted publicly. 

My commute to UP Diliman was brief. I took the bus, hailed a UP-Philcoa jeepney, and alighted at what used to be the UP Shopping Center, home to my favorite karinderya and optical shop, a block away from Yakal dorm where I used to live. The karinderya did not survive the fire, but the optical shop did. The new location was right across the street—the new dorm complex, Acacia, at the back of Kalayaan. Gone are the days when I bumped into familiar faces—classmates, groupmates, dormmates, labmates, my tsinelas-and-shorts UP community—busy with the same things as I was. An essay that needed printing, a provincial urge to munch on the acidity of a green mango, half-cut in the middle, dabbed with rock salt and chili.

The area at 2 pm was foreign and familiar. I savored all these, what used to be my every day walk, the treelined streets and the educated banter in the background.

Dr. Nella Sarabi, having emerged from lunch break, greeted me with smiles and a compliment. “Those are nice frames—are those from the shop?” she asked, to which I answered, “Of course.” Going to her shop reminds me of time that had passed since she had introduced me to the world of eyeglasses when I was in second year college. She asked about me and my brother; she remembered our names, picking them from her mental cloud of customers, her smile widening as she learned about the things I do. Cancer. Rounds. PGH.

I visited her to have sunglasses made. I made a shortlist, eventually zeroed in on the metal, bronze frames. Dr. Sarabia approved. I went through the ritual of having my eyes checked. “Read line seven,” she said. I knew the answer, even with eyes closed—D-E-F-P-O-T-E-C.

Friday, August 31, 2018

Wednesday, August 29, 2018

Why I love being married to a chemist

Cheesy, funny poem by Barbara Crooker. (HT: Jim Culleny, 3QuarksDaily)

Because he can still cause a reaction in me
when he talks about SN2 displacements,
amines and esters looking for receptor sites
at the base of their ketones. Because he lugs
home serious tomes like The Journal of the American
Chemical Society or The Proceedings of the Society
of the Plastics Industry, the opposite of the slim volumes
of poetry with colorful covers that fill my bookshelves.
Because once, years ago, on a Saturday before our
raucous son rang in the dawn, he was just
standing there in the bathroom, out of the shower.
I said Honey, what’s wrong? and he said Oh,
I was just thinking about a molecule.

Because he taught me about sublimation, how
a solid, like ice, can change straight to a gas
without becoming liquid first. Because even
after all this time together, he can still
make me melt.

Tuesday, August 28, 2018

Monday, August 27, 2018

John Cheever

Next on my list: The Journals of John Cheever.



Dustin Illingworth, writing for the Paris Review.

Cheever is a member of that rare group—Witold Gombrowicz, Anaïs Nin, perhaps Franz Kafka—whose private diaries comprise their finest writing. The route to Cheever’s journals is almost always a circuitous one – first one reads his exquisite stories, some of the finest ever written, followed by his largely disappointing novels, his voluminous correspondence, the memoir by his daughter Susan. One comes to the journals, then, ready for something safe and genial and above all expected, the improvisations of a suburban mystic. How thrilling to discover instead this offhand, extemporizing masterpiece, a storehouse of incomparable lyricism—no one writes light or water or fire better than Cheever—commingled with the greatest index of shame in American letters.

Sunday, August 26, 2018

Crown shyness


Photo credit: Dominyka Jurkštaitė, Boredpanda.com

James McDonald explains what crown shyness is.

In certain forests, when you look up you will see a network of cracks formed by gaps between the outermost edges of the tree branches. It looks like a precisely engineered jigsaw puzzle, each branch growing just perfectly so it almost—but not quite—touches the neighboring tree.

Some hypotheses as to why it happens, as summarized by McDonald.

  • Abrasion, which happens when trees rub into one another during a windy day, causes trees to maintain shyness gaps in order to minimize this contact (Putz et al, 1984).
  • But there's no difference between trees in windy areas than in not-so-windy ones (Rebertus, 1988), so there must be other factors that explain this behavior.

Saturday, August 25, 2018

Beatles

Notebooks given by Crizzy.

These are fountain-pen friendly, Beatles-inspired, unlined notebooks given by my super-smart colleague, Crizel Uy. Thank you, Crizzy! May you write your own stories, too.

Tuesday, August 21, 2018

Cancer Institute figures into Glenn Diaz's The Quiet Ones

Untitled

What with all technical papers I need to write and the oncology journals I need to read, I can't get my eyes off Glenn Diaz's The Quiet Ones (Ateneo Press), winner of the 2017 Palanca Grand Prize. It is a masterful work of someone who breathes the English language in Filipino atmospheric conditions. The book is about a call center agent who gets involved in a scam and who scrambles out of Manila to escape the authorities. The details that intersperse the story make the novel riveting: such as this scene at the PGH Cancer Institute. Alvin's mother had pancreatic cancer.

Sunday, August 19, 2018

Exhortation to move on

John Calvin's exhortation to live the Christian life begins with the reminder that we can't live perfectly in this world. How beautiful is the Christian faith! It is aware of man's limitations, does not burden him with back-breaking toil for an otherwise unattainable salvation, but offers him the assurance that all he needs is to put his faith not in himself but in God.

I insist not that the life of the Christian shall breathe nothing but the perfect Gospel, though this is to be desired, and ought to be attempted. I insist not so strictly on evangelical perfection, as to refuse to acknowledge as a Christian any man who has not attained it. In this way all would be excluded from the Church, since there is no man who is not far removed from this perfection, while many, who have made but little progress, would be undeservedly rejected.

But the young Calvin turns us back to God's Word, as if to tell us, "I know your frustrations." I wonder how much of The Institutes is autobiographical. I read the passage below and think that this mirrors my own experience: the struggle to worship God amidst the filth and dirt of sin, failing, but moving on, getting closer to the goal of Christlikeness inch by inch, until the time when God calls me home.

What then? Let us set this before our eye as the end at which we ought constantly to aim. Let it be regarded as the goal towards which we are to run. For you cannot divide the matter with God, undertaking part of what his word enjoins, and omitting part at pleasure. For, in the first place, God uniformly recommends integrity as the principal part of his worship, meaning by integrity real singleness of mind, devoid of gloss and fiction, and to this is opposed a double mind; as if it had been said, that the spiritual commencement of a good life is when the internal affections are sincerely devoted to God, in the cultivation of holiness and justice. But seeing that, in this earthly prison of the body, no man is supplied with strength sufficient to hasten in his course with due alacrity, while the greater number are so oppressed with weakness, that hesitating, and halting, and even crawling on the ground, they make little progress, let every one of us go as far as his humble ability enables him, and prosecute the journey once begun. No one will travel so badly as not daily to make some degree of progress. This, therefore, let us never cease to do, that we may daily advance in the way of the Lord; and let us not despair because of the slender measure of success. How little soever the success may correspond with our wish, our labour is not lost when to-day is better than yesterday, provided with true singleness of mind we keep our aim, and aspire to the goal, not speaking flattering things to ourselves, nor indulging our vices, but making it our constant endeavour to become better, until we attain to goodness itself. If during the whole course of our life we seek and follow, we shall at length attain it, when relieved from the infirmity of flesh we are admitted to full fellowship with God. (Emphasis mine.)

Saturday, August 18, 2018

On Mon Tulfo's diatribe at the PGH Emergency Room

The news of Mon Tulfo berating a tired Emergency Medicine resident made my blood boil. Nurses were talking about it when I made rounds yesterday, which was how I had learned about the incident. The journalist Tulfo brought a child who sustained minor injuries to the Philippine General Hospital's Emergency Department; the child was assessed at the Triage and was deemed a non-emergent case. The child was therefore not immediately attended to. Mon Tulfo lashed out invectives, and official accounts report that he even showed the physician the middle finger--all these, while the event was recorded illegally through a camera phone. Many issues surface here--patient privacy, physician-shaming, and so on--and if there's one good lesson to come out of this, it is that you never attack people mindlessly just because you're a media personality.

The issue of rendering service equitably comes to the fore. PGH medical personnel are called to serve the ill and dying, and we do so gladly, passionately, with all our hearts and minds and, when tough times come (and they do come often), even our pockets, even if we're discouraged, nay, forbidden to. How can we muster the strength to not spare our money to pay for mechanical ventilation just so our patients can avail of this life-saving intervention? How many times have we acted, not merely as physicians, but as social workers: looking for sources of funds so our patients get better and stronger? To deliver the best medical care to the steady influx of patients, we need to prioritize who needs help the most the soonest. This was the process that the child injured by Mon Tulfo's car went through: an evidence-based, pragmatic, and effective system called the triage. This was the process that Mon Tulfo, in a horrifying display of hysteria triggered by an inordinate supply of self-importance, wanted to bypass. 

So this is why the Mon Tulfo incident strikes a chord among my colleagues: it is a mockery of our daily struggles against sickness worsened, and even caused, by poverty. We do not have a shortage of compassion in the hospital, even if our hospital beds overflow with occupants. Mon Tulfo's outburst was a short-sighted, anger-laden, ignorant, uncouth diatribe. It is people like him who make our work harder than it already is.

But we carry on.

Friday, August 17, 2018

God's sovereignty and suffering

Cameron Cole on the sovereignty of God and the death of his child.

For me, one of the most comforting things in surviving and recovering from the death of my child was knowing that God was completely and fully in control in his death. Before he created the world, my God had marked the number of days that my son would live.

That means that his life was complete. That means that his death was not random; it was not accidental. That means that it has meaning and purpose.

And it also means that God is in control of my redemption and my healing.

Wednesday, August 15, 2018

Tuesday, August 14, 2018

Monday, August 13, 2018

Sunday, August 12, 2018

Saturday, August 11, 2018

New day, new coffee

Untitled

I love how the coffee maker mimics the sound of quiet thunder whenever I make a fresh brew at 5 am. I never have much use for alarm clocks, but this ritual of coffee making is part of my slow, graded, and gradual ascent to total wakefulness. Praise be to God for a new day.

Wednesday, August 8, 2018

Old friends

Untitled

Tears come to me in moments that surprise me: seeing a father walking his kid to school, hearing a blind man sing an old kundiman, and, this afternoon after work, reading Justice Antonin Scalia's eulogy for his friend, Martin Feinstein, then first executive director of the John F. Kennedy Center for the Performing Arts. Justice Scalia said:

"It is with the greatest curse of advancing years that our world contracts, as friends who cannot be replaced, with insights into life that are not elsewhere available to us, leave us behind."

His speeches, compiled in the book, Scalia Speaks: Reflections on Law, Faith, and Life Well-lived, reveal the brilliant mind of a kind person who loved his country, family, faith, and friends. I finished this collection today, after a grueling day at the clinics, with so many patients hoping for another day to dawn. Perhaps this is why I don't mind these packed train rides: I get lost in my thoughts and prayers and books, and in those precious minutes of wrestling with my thoughts and conversing with God and making sense of words in my Kindle, I find rest.

Something dawned on me, too, as I read of Justice Scalia's account of William Howard Taft, George Washington, and Abraham Lincoln—excellent leaders who propelled the United States into what she is now (but, as Justice Scalia pointed out, they were not just leaders but above all good men). It is that we lack leaders to whom we can look up to, leaders who inspire and not just command. I don't think we fall short of these kinds of men and women in this country; perhaps they're not just part of this government.

Monday, August 6, 2018

Readings on reading

Michael Dirda on small presses:

All of which said, I want to make a pitch for some works you aren’t likely to find in your local bookstore, no matter how extensive its holdings: small-press titles. In recent years, as trade houses increasingly gravitate to wholly commercial “product,” specialty publishers and independent presses have risen up to make available wonderful books, real books, of all kinds. Let me stress that I’m not talking about those generic print-on-demand titles, most of which are bare-bones ugly and little better than photocopies bound in bland paper wraps. Nor am I talking about self-published work, so much in the news these days. No, I’m thinking of legitimate small publishers with a mission to bring neglected authors back into print and to produce the kind of books that dreams are made of.

His column, Browsings, in the American Scholar is a delight
to read. Reading about reading is makes me want to read more. I just got myself of a copy of the book which is a compilation of his blog pieces.

Saturday, August 4, 2018

My colleagues at the Cancer Institute



This was snapped after an evening lecture, just minutes before our karaoke stint. It amazes me that doctors who work with cancer patients are among the funniest. I count it a great blessing to work with these kind people. They share my fascination for newly approved drugs by the FDA for this or that neoplasm, and they take lunch time orders for cold Serenitea to take the stress and heat off crowded clinic days.

From left: (1) Rich King (his real name; read my post on weird names of my classmates in med school), who sang heartfelt renditions of Michael Bublé and U2. (2) Bobby de Guzman (his real name, too), whose Basang-Basa sa Ulan was a riot—a mashup of L. A. Lopez and Adele. (3) Roger Velasco, who channeled Ariel Rivera. (4) Fred Ting, who knew S2pid Love by heart, and whose repertoire was mostly Filipino rock, which is great to listen to. (5) Ozzie So, who channeled Rihanna. (4) Pau Vergara, the singer that he is, moved us with his Hanggang by Wency Cornejo. (5) Crizzy Uy, guest speaker (a private joke), who also liked old songs, like those of Leonel Richie. This is amazing because she's the youngest in the group. (6) Norm Cabaya, who gave a soulful interpretation of Tootsie Guevara's Kaba! Our song choices dated us. Don't you agree with me that after the 90s, the quality of songs have mostly gone downhill?

A good restaurant experience is more than just the food



Annoyed by Restaurant Playlists, a Master Musician Made His Own by Ben Ratliff in the New York Times.

Last fall a friend told me a story about Ryuichi Sakamoto, the renowned musician and composer who lives in the West Village. Mr. Sakamoto, it seems, so likes a particular Japanese restaurant in Murray Hill, and visits it so often, that he finally had to be straight with the chef: He could not bear the music it played for its patrons.

The issue was not so much that the music was loud, but that it was thoughtless. Mr. Sakamoto suggested that he could take over the job of choosing it, without pay, if only so he could feel more comfortable eating there. The chef agreed, and so Mr. Sakamoto started making playlists for the restaurant, none of which include any of his own music. Few people knew about this, because Mr. Sakamoto has no particular desire to publicize it.

Here's the playlist.

Photo credit: Nathan Bajar of the Times

Friday, August 3, 2018

,

Dr. Butch Dalisay talks about medicine, literature, and what it means to be from UP

Dr. Butch Dalisay, who inspires me to collect fountain pens and write long blog entries, was the commencement speaker during the graduation rites of the UP College of Medicine this year. His speech is worth reading in full. I am inspired and moved by this speech.

Not all doctors can write—although many write prescriptions that can hardly be read. But one doctor who did write, of course, was Jose Rizal, one of my personal heroes whose travels and haunts I have tried to follow around the world from Dapitan, Singapore, and Hong Kong to San Francisco, Madrid, and Barcelona and, two years ago, to his medical studies in Heidelberg. When my creative writing graduate students in their mid-20s sometimes tell me that they have nothing to write about, or are too young and too new to strive for greatness, I remind them of Rizal, who many forget was only 25 when Noli Me Tangere was published. Twenty-five, and already by then approaching the perfect synthesis of the arts and the sciences in the one same person.

Rizal’s example underscores the need to embrace and imbibe art and science as corporal elements of ideal citizenship. To create a viable national community, we need to promote rational, fact-based thinking and discourse over political hysteria and hyperbole, just as we need to actively recover, strengthen, and sustain the cultural bonds that define us as a people.

He is due for retirement in a few months, and he used to opportunity to flesh out what being a UP student (and, extrapolating this further, UP graduate) means.

To be a UP student, faculty member, and alumnus is to be burdened but also ennobled by a unique mission—not just the mission of serving the people, which is in itself not unique, and which is also reflected, for example, in the Atenean concept of being a “man for others.” Rather, to my mind, our mission is to lead and to be led by reason—by independent, scientific, and secular reason, rather than by politicians, priests, shamans, bankers, or generals.

You are UP because you can think and speak for yourselves, by your own wits and on your own two feet, and you can do so no matter what the rest of the people in the room may be thinking. You are UP because no one can tell you to shut up, if you have something sensible and vital to say. You are UP because you dread not the poverty of material comforts but the poverty of the mind. And you are UP because you care about something as abstract and sometimes as treacherous as the idea of “nation”, even if it kills you.

Yes, even if it kills you. Hand me the handkerchief.

Thursday, August 2, 2018

Hiligaynon

I'm a fan of Wikipedia, which replicates for me the experience of browsing Encylopedia Americana while I was growing up. I loved that encyclopedia set at home—I still do. My curiosity today brought me to Hiligaynon, my first language, the one I grew up with and which I use to talk to family and friends from home. It is a beautiful language, quite melodic and sonorous, and it warms my heart to hear it from strangers.

The Hiligaynon language, also colloquially referred often by most of its speakers simply as Ilonggo, is an Austronesian regional language spoken in the Philippines by about 9.1 million people, mainly in Western Visayas and SOCCSKSARGEN, most of whom belong to the Visayan ethnic group, mainly the Hiligaynons. It is the second-most widely spoken language and a member of the so-named Visayan language family and is more distantly related to other Philippine languages.

The etymology of Hiligaynon, or Ilonggo:

Historical evidence from observations of early Spanish explorers in the Archipelago shows that the nomenclature used to refer to this language had its origin among the people of the coasts or people of the Ilawod ("los [naturales] de la playa"), whom Loarca called Yligueynes (or the more popular term Hiligaynon, also referred to by the Karay-a people as "Siná"). In contrast, the "Kinaray-a" has been used by what the Spanish colonizers called Arayas, which is most probably a Spanish misconception (as they often misinterpreted what they heard from the natives) of the Hiligaynon words Iraya or taga-Iraya, or the current and more popular version Karay-a (highlanders - people of Iraya/highlands).

Wednesday, August 1, 2018

,

Hotcake

Pancakes

The local crepe is called the "hotcake." It is lathered in margarine, drizzled with sugar, and is best eaten while hot. I remember accompanying my father during this February afternoon. We were about to go home from the mall, but he wanted to surprise Nanay with fresh bananas, so we walked to the nearby market, recently razed by fire. Going to the palengke never felt like chore for him; he liked the back-and-forth of kind words and niceties, the extrovert that he was. He had a community there. In his mind was geographical map of his suking tindahan—separate stores for green leafy vegetables, fruits, and other miscellaneous things. There was, as far as I knew, nothing extraordinarily special about these stalls: he just wanted to the tindera to be warm and smiling. Whenever I joined him, which I liked because it made me felt at home, he'd always take me to the stall of Junie Puada, my classmate from elementary who shared with me his baon of fresh fruit, so I could properly say hi to Junie and his mother.

Our fridge was never full. Unlike other households, we never did groceries to last the week. I guess this was Tatay's excuse to leave the house and visit the palengke.

Tuesday, July 31, 2018

Monday, July 30, 2018

Saturday, July 28, 2018

Organic material

Untitled

Fecal material was just about to emerge from the horse's ass (which reminds me of a fable we talked about in high school)—this from a vehicle we were tailgating in South Luzon Expressway, during our transit to Malvar, Batangas. I was with Casti Castillo and Carlo de Guzman, among my dearest friends from med school, and we visited Bon's idyllic hometown. It was so refreshing not to see photos of our reunion online; they're not those kinds of people. But the memory lingers. I hope to see them again in the future, during better, happier times.

Friday, July 27, 2018

Shoes my brother "gave" me

Sean

My kid brother Sean hands me some money and tells me, "Ibakal mo na sang sapatos mo ha." ("Use the money to buy new shoes.") Sentimentality runs deeply in the family, but with it is pragmatism. Our household has a rule: if you want to make a family member happy, tell him exactly what it is that you want—or better yet, give him the money so he can buy the item himself. This came to be because we never bought jeans for Tatay nor shoes for Nanay—they'd rather that they choose those things themselves. This practice sucks all the surprises in life, but we never liked to be surprised—at least, as a far as material goods are concerned.

My brothers are the most generous; they think of me as the doctor-in-training who borders on mendicancy, a fact I don't contest. I didn't make it to the Singapore trip with my brothers last month—I was too swamped with work, and I already took many days off the clinics to attend to my father's funeral. When they got back, Sean gave me money and said I should buy the shoes I told him to buy for me—he had no idea what they were.

Thanks, Sean! I thank God for my brothers. I see a lot of myself in them—we have the same facial expressions, hand gestures, and humor. It's unnerving sometimes.

Thursday, July 26, 2018

What the Bible teaches about sexuality

bible

Commenting on the Times article by Dr. Idan Dershowitz (The Secret History of Leviticus), Dr. Albert Mohler writes:

Every single text in the Bible that speaks of same-sex sexual desire and same-sex sexual behaviors condemns them. In Leviticus 18:22, the condemnation extends to the use of the word abomination. Dershowitz argues that Leviticus 18:22 is “the principal prooftext” against homosexuality, and that is true for the Old Testament. In the New Testament, Paul takes the argument far beyond Leviticus. Trained as a rabbi and a teacher of the Scriptures, in Romans 1:18-32 Paul goes beyond a condemnation of males having sex with males. He also condemns women who have sex with women, exchanging “natural relations for those that are contrary to nature,” even as in male homosexuality the natural use of the woman is exchanged for “shameless acts with men.” Paul also makes clear that same-sex passion and desire is also sinful, contrary to both nature and divine command. For Christians, the most significant realization is that the crucial moral teachings of the Old Testament Holiness Code that are binding upon us are repeated, and often amplified, in the New Testament. Christians may eat shrimp without sin, for example, but are fully bound by laws against any sexual activity outside of marriage, the covenant union of one man and one woman.

Dr. Mohler adds:

There is no real question about what the Bible teaches about human sexuality and gender. There is also no question about the influence of the Bible on Western civilization. Even now, the Bible exerts a powerful hold on the modern conscience, even when it is not acknowledged. That is extremely frustrating to the moral revolutionaries.

This very Christian view of homosexuality is alienating and offensive to the modern world, but we're called to stand by and with Scripture, to live in the world but not of it. Loving in the truth is the best way of showing love.


Photo: Samuel McAdam

Wednesday, July 25, 2018

Wokeness is the new fruit of the Spirit, according to a Galatians update

An update from the Babylon Bee, which always makes me laugh!

PORTLAND, OR—A coalition of progressive Bible scholars convened in Portland this week and agreed to add a new fruit of the Spirit to the biblical list in Galatians 5: “wokeness.”

According to the resolution, being “woke” is an essential part of being a Christian, and anyone who’s not on board with the social agenda and policies of the Left is not exhibiting the proper fruit of the Spirit in their lives.

It ends thus:

“Be on your guard, for fellow left-leaning social justice advocates prowl about like a roaring lion, looking for someone to call out for not being woke enough,” Patterson cautioned. “If you make one wrong move, we will eat you alive.”


I'm always grateful that my readers are the kind who don't need to be reminded of what satire means. [Use "satire" in a sentence. Response: "I'm satire." (Trans. Pagod ako.)]

Tuesday, July 24, 2018

Monday, July 23, 2018

,

Quiapo

Joseph Pascual is a favorite photographer. His Flickr collection, Quiapo Crowds, feels so alive. He is able to bring out the colors, grime, and humidity of old Manila.

1280px 0513quiapo_lrtblur

1280px 0579quiapo_quiapochurch

1280px 0573quiapo_vegetableseller

I pass by Quiapo when I travel from Manila to Quezon City. I know the place because of the optical shops where one can get frames cheaply. In first year med school, we interviewed vendors for a class called Medical Anthropology, where we were offered herbs and candles for almost any type of ailment. Concoctions for abortion, for increasing sexual performance, and for growing taller were also popular.

Sunday, July 22, 2018

Monday blues

Predator
Photo credit: SimonSCh, via Flickr

Mondays are not dreadful but are generally exhausting. Patients who didn't get to see their doctors over the weekend are likely to consult on the first work day of the week. Patients on follow up are also likely to pop up in the consultation rooms, usually to get over the inconvenience of things medical, leaving the rest of their weekly calendars clear of clinical obligations. The concept of Monday as a busy working day used to be an abstract idea--I never held out-patient clinics on Mondays during my residency in Internal Medicine--but weeks into my clinical fellowship in Oncology, I've relearned my lesson the hard way: don't pack my Mondays with chemotherapy sessions. This allows me more time to see new patients, see in-patient referrals, and finish some paperwork, without compromising the quality of the care I give (or so I believe).

This means I prefer staying at home on Sunday evenings, to catch up on sleep, reading (both for pleasure and work, which are not mutually exclusive), and other miscellaneous things weekends allow me to do. Sunday afternoons are when I write in this little nook of the Web; if I have the extra energy, I write blog posts in advance, in anticipation of days when I'm too tired to even open my computer.

So let me do a little introspection and share with you a useful and refreshing article by Pastor Oscar Villa, where he writes about work.

I used to think that work was a necessary evil—something that I had to do, instead of something that I got to do. I thought that there wouldn’t have been any need to labor and toil, if it hadn't been for humanity’s fall into sin. I imagined that if one were wealthy, then he wouldn’t have to work. Imagine my surprise as I sat under Bible teaching that pointed to work even before sin had entered into the world.

A couple of observations from the Creation narrative in Genesis 1-3 can help us think more clearly about work.

That God was Himself a worker is an important theological point that gives us, human beings, who toil under the sun, the comfort that He knows what we go through.

Reading can make you happy

A personal account by Ceridwen Dovey, where she also traces the history of bibliotherapy.

Several years ago, I was given as a gift a remote session with a bibliotherapist at the London headquarters of the School of Life, which offers innovative courses to help people deal with the daily emotional challenges of existence. I have to admit that at first I didn’t really like the idea of being given a reading “prescription.” I’ve generally preferred to mimic Virginia Woolf’s passionate commitment to serendipity in my personal reading discoveries, delighting not only in the books themselves but in the randomly meaningful nature of how I came upon them (on the bus after a breakup, in a backpackers’ hostel in Damascus, or in the dark library stacks at graduate school, while browsing instead of studying). I’ve long been wary of the peculiar evangelism of certain readers: You must read this, they say, thrusting a book into your hands with a beatific gleam in their eyes, with no allowance for the fact that books mean different things to people—or different things to the same person—at various points in our lives. I loved John Updike’s stories about the Maples in my twenties, for example, and hate them in my thirties, and I’m not even exactly sure why.

But the session was a gift, and I found myself unexpectedly enjoying the initial questionnaire about my reading habits that the bibliotherapist, Ella Berthoud, sent me.

I know this for a fact, but the practice is secondary to the object of reading. That is, what matters more is what you read. You can, for example, read a lot of nonsense, of which there is no lack, and the exercise can make you miserable. But if you turn to good books--materials that make you think, introspect, criticize, evaluate, cry, laugh, and best of all, wonder--then reading can potentially give you happiness.

On top of my head: Philippians, written by Paul during his imprisonment in Rome, Confessions by St. Augustine, An Artist of the Floating World by Kazuo Ishiguro. I'm sure there's so much more.

Saturday, July 21, 2018

The bar

Tokyo is on my travel wishlist. Japan fascinates me. Since my college years, and until recently, I've followed Lee Chapman's Tokyo Times blog, where he shares photos of the every day in one of the world's busiest cities.

His collection, The Bar, shows the warmth of human companionship and the familiar feeling of strangeness. 



I'm in no way endorsing smoking--if you're a smoker, please quit right away, for your sake and your family's--but there's something to this photo that I can relate to.  Maybe it's the tired, exhausted, but peaceful feeling of having done a day's job, and the chance to unwind a little before heading home. 

Saturday, July 14, 2018

Life, in photos

Almost halfway through July, my phone shows me snippets of my life: mostly from work (morning rounds, outpatient chemotherapy and follow ups), Thursday and Friday masters classes, and church.

I told the Grab driver last week, "I live a boring life, and I like it," when he asked me if I had ever smoked. I warned him that he might end up in my clinic someday, and that, at 39 years old, with a four-year old son and a working wife, it's not too late to quit. I slept through that ride, only to be awakened by honking buses in the glorified parking space called EDSA. The last thirty minutes of the trip was when we had a conversation and I learned that, like me, he had not yet eaten lunch. I gave him the sweet banana that my stage IV colon cancer gifted me.

The ride typifies my existence. I'm swamped in work and study. When I look out the window, life pretty much goes on for the rest of the world. I'm not busy--just exhausted. The exhaustion is of a good kind. And the good Lord provides strength each day.

*  *  *

Last week was the introduction of new fellows in the Department of Medicine. Here are my friends and colleagues from Medical Oncology: Roger Velasco, myself, Karen M. Mondragon, Rich King (his real name), and Fred Ting. I'm hashtag blessed to be working with them.

Clinical Fellowship in Medical Oncology

I spotted Roger and Anna talking in the corridor. They looked so happy. If you tease Roger, he will likely tell you that I'm making this up, and I won't confirm nor deny if this is, in fact, the truth.

Roger and Anna

Karen receives her publication award from no less than Mang Intay, who works in the Section of Medical Oncology office and who also doubles as a Grab driver at night.

Karen receives her publication award

After a grueling day at the clinics, we ate at a Thai restaurant. Freddie, where were you? Karen was already at home, playing with her beautiful daughter.

After a gruesome day at the clinics

Rog and Rich look on as Dr. Sacdalan discusses platinum analogs and their role in chemotherapy. On Fridays, Dr. Fernando meets us to help us with some difficult cases we encounter. This open, collegial, academic, and non-judgmental atmosphere is what I like best about where I train. No question is too stupid, and even our mentors ask each other questions.

Difficult cases conference

When it rains, it's four. (It was around four when this was taken.)

Flooding at Taft Avenue

Food usually marks the end of the day. At a hotel in Ortigas, my colleagues Norman Cabaya, Paulo Vergara, and Bobby de Guzman sample the food.

Food

My brother prepares dinner for me when I get back home. This tasted amazing.

Dinner

Where is thy sting?

Dr. John Macarthur on fearing death.

...Christians should not fear death. They should long “to depart and be with Christ, for that is very much better” (Philippians 1:23). That does not mean, of course, that they are to be foolishly reckless or careless with their lives; their bodies belong to God (1 Corinthians 6:19–20). But an obsessive concern for one’s physical well-being or a morbid fear of death is inconsistent with a Christian perspective. Believers should long for heaven like a prisoner longs for freedom, like a sick man longs for health, like a hungry man longs for food, like a thirsty man longs for a drink, like a poor man longs for a payday, and like a soldier longs for peace. Hope and courage in facing death is the last opportunity for Christians to exhibit their faith in God, to prove their hope of heaven is genuine, and to adorn their confidence in the promises of God.

Sunday, July 8, 2018

Scalia speaks

Scalia Speaks

Christopher Scalia, son of the late US Supreme Court Justice Antonin Gregory Scalia, wrote this about his father's death.

I also learned about his childhood. Although he had shared stories about playing stickball in Queens, he never went into much detail about the different ways he and his neighborhood friends entertained themselves. Perhaps, like me, you'll see these scenes play out in black and white, like something from a classic film. And perhaps, like me, you'll find his tributes to departed friends especially powerful. In those, my father conveys what he admired in other people and what he most appreciated in personal relationships. His sorrow at the death of one friend particularly moved me, as my father expresses regret at "not...say[ing] goodbye. But I have the sure hope that I will see him again where old friends will have an eternity to catch up and make amends." These words mirror my own feelings after the death of the man who wrote them.

I teared up in the early morning train ride as I read this. Tatay, too, regaled us with stories about his own childhood, growing up in Esperanza, Sultan Kudarat, before relocating to Polomolok, South Cotabato, where my cousins still reside. I missed Tatay because I imagined his personality--fun-loving, gregarious, jocular--was similar to Justice Scalia's. My father wasn't quite as articulate, of course--he asked me to draft his speeches for him, usually for weddings where he was requested to be a ninong--but he, too, was full of joie de vivre, still smiling during his final moments of consciousness.

Memories come like floods, washing over me, an incomparable feeling of sorrow, longing, and joy that perhaps only people who had lost precious people in this life would know. My hope is that, when the Lord takes me home, I'll see my father again, feel his embrace, and hear his warm laughter.

Meanwhile, I return to Scalia Speaks, a collection of Justice Scalia's speeches on topics such as the meaning of being an American, faith, and friends.

Saturday, July 7, 2018

,

Where I am

I'm almost finished seeing close to forty patients this morning, all of them with some form of malignancy in varying degrees of curability, some resigned to the idea that the days are getting shorter, and the end is near. It was a little past seven o'clock when I began my rounds. It rained outside: the sky was dark and sleepy, like winter mornings in Amsterdam, and the only thing missing was a cup of hot chocolate, a good book, and a pair of pajamas. The patients, too, were in good spirits, even if some of them felt pained. I met an entire family at the seventh floor. The children looked apprehensive for their age: they should be hanging out with friends instead of visiting their brother in the hospital for his third chemotherapy session. But cancer does that: not only does it distort the body in the cellular and molecular level--it is, by definition, a distorted version of humanity--it also transforms families and communities. I often wonder, as we all should, why I am where I am now. But wonder always gives way to fascination, hope, and faith in Providence whose hand is never too short to extend comfort, joy, and encouragement that transcends human understanding.

Dealing with grief

How to Discourage a Grieving Friend by Vaneetha Rendall Risner.

When we analyze grieving people, we add to their burden. Everyone processes loss differently, whether they are grieving the loss of a loved one, loss of health, lost relationships, or even lost dreams. Offering suggestions can feel like judgment, and careless words can cut deeply. We can become like Job’s comforters, who went on and on, speaking about things they neither knew nor understood.

She ends with this:

It’s easy to discourage a struggling friend. Trust me, I know. But I’m challenging you, me, all of us, to put down our expectations of our suffering friends. Let’s stop trying to “fix” them. Don’t bludgeon them with theology. Trust that God is working in them, and be patient while they process.

Instead, let’s sit with our friends. Cry with them. Support them as they grieve. They need grace to heal. Remember, we don’t need to be a savior for our grieving friends. They already have One — and so do we.

Friday, July 6, 2018

As long as you are glorified



As Long As Your Are Glorified by Sovereign Grace Music.

Are You good only when I prosper
And true only when I’m filled?
Are You King only when I’m carefree
And God only when I’m well?
You are good when I’m poor and needy
You are true when I’m parched and dry
You still reign in the deepest valley
You’re still God in the darkest night

What a God we serve.

Thursday, July 5, 2018

,

Security and confession

John Calvin on confession:



"Unless this knowledge be clear and certain, the conscience can have no rest, no peace with God, no confidence or security...."—this must be the reason why believers feel unburdened after coming to the cross. If our eternal destiny depended on us, John Calvin writes that we "are in a most miserable and deplorable situation." God, through Jesus' vicarious death and sacrifice, provides security of salvation, grounded on faith in him and not in our good works.

I'm more than halfway through The Institutes by John Calvin; it is a thick book. I read chunks of paragraphs during commutes, and it has added great riches to my spiritual life. It is one of my favorite books of all time.

Wednesday, July 4, 2018

Tuesday, July 3, 2018

Love, defined

Exhorting from 1 Timothy 1:1–11, Deni Koswardi said during the Sunday worship service that "love is expressing the standards of God in our treatment of one another." This resonates with Jesus' command to love others as we love ourselves. I've realized that most of the time I refer to love as a noun rather than a verb, when it should, I suppose, be the reverse.

Monday, July 2, 2018

Sunday, July 1, 2018

How to deal with emergencies during flights

I know of friends who encountered medical emergencies during flights. As doctors committed to helping others, they volunteered their services mid-air (a case of pulmonary embolism and acute coronary syndrome, as far as I can remember) and were surprised to be rewarded with round-trip tickets. None of my flights have been as memorable.

Dr. Rachel Zang's experiences are featured in an interview published in JAMA [1].

As a frequent traveler—she has been to 30 countries, including medical missions to Tanzania and Rwanda—Zang wanted to be better prepared when the next in-flight medical emergency crops up. She researched domestic and international laws and learned what those airline medical kits are supposed to contain and what they lack.

In fact, Zang amassed so much material that she shared it with her colleagues during a grand rounds on in-flight medicine.

“Lots of people were interested,” she says. “[I]t’s something everyone’s a little uncomfortable with … so they want to know as much information as they can about it.”

Problems arise because of body changes caused by high altitudes:

The airplane causes a lot of unique changes in the body that we're not really aware of. Being on a flight is the equivalent to being at 6000 to 8000 feet of altitude. At sea level, oxygen saturation in all of us healthy people is 99% to 100%, but when we go up into the air, most of us would be about 92% to 95%. So you can see how anyone who had underlying respiratory or cardiac issues, if their oxygen saturation drops lower, it's going to exacerbate angina or make their COPD [chronic obstructive pulmonary disease] or asthma worse. In turn, the very low humidity in the airplane has been shown to exacerbate asthma and COPD because of the increased dehydration and the increased mucosal dryness.

Some of her recommendations include the formation of a governing body to mandate the procurement of necessary medical equipment, lots of IV cannulas, lots of IV fluids, obstetric and pediatric medications, anti-emetics, and a glucometer.


[1] Voelker R. “Is There a Doctor on the Plane?”. JAMA. Published online June 27, 2018. doi:10.1001/jama.2018.6654

Saturday, June 30, 2018

America Is Not the Heart by Elaine Castillo. I’m gripped.



Megan O'Grady of Vogue summarizes the plot.

At the center of the novel is Hero (short for Gerónima), a daughter of privilege who was once destined for a high-status life as a doctor, but who ran away instead to become a medic for the New People’s Army, an insurgent Communist guerrilla group. A decade later, with a pair of broken thumbs (as well as less visible torments, like her rejection by her upper-class parents), she arrives in Milpitas, California, a San Francisco suburb where her favorite uncle, Pol, lives with his wife and 8-year-old daughter, Roni, a pugnacious playground feminist with a ravaging case of eczema. It’s the early 1990s, and as Hero comes slowly back to life with the help of Roni and her family (and eventually, a pretty makeup artist named Rosalyn), we see a larger community’s way of life, conveyed in the kind of sharp-edged noticing—“bruja” faith healers, Nestlé formula as breakfast staple, a clay model of a Spanish mission built on a pizza box—that’s second nature for those well-accustomed to code-switching between class and culture.

I hope she writes another book soon.

Thursday, June 28, 2018

,

Happiness and emptiness



Cancer Institute, where I go to work. Photo credit: CJ Tagal

Here's a beautiful piece by my friend and colleague, Fred Ting, whose blog is fascinating.

After long, draining days of seeing patients from different walks of life—people with different masses from different social classes, people whose tragedies became worse because of various herbal remedies, I realized that the discipline can not only lead to compassion fatigue but may even suck the life out of me—sometimes leaving me empty, but happy.

I don't feel empty but drained. I feel like I am where I should be.

Friuli Trattoria, an old haunt

Manong and I were in Quezon City last night and, while waiting for the traffic to die down, we had dinner at Friuli Trattoria, an old restaurant along Maginhawa Street. (By "old," I mean it was in existence during the years 2004 to 2009). The food tasted the same. During college, eating at places like this was a luxury, reserved for special occasions, with probinsyano friends from the dorm who had enough saved weekly allowance to buy the barbecue chicken pizza, ravioli, and a glass of Coke. It still felt like a luxury last night, but the issue was not money but time. How often do I get out of my way to visit old haunts like this after a long day at the clinic? The familiar waiters, the karinderya feel, the noisy chatter of UP students with tattoos and earrings and thick-framed glasses—I felt quite at ease. How far the Lord has brought me and my brother—and my probinsyano friends! I look at my life and see His hand designing the tapestry of my history and future.

Friuli Pizza at Maginhawa Street

Friuli Pizza at Maginhawa Street

Friuli Pizza at Maginhawa Street

Tuesday, June 26, 2018

,

The tragedy of today's education

Graduation season is around, and Patrick Deneen's piece is a thoughtful reminder.

My students are know-nothings. They are exceedingly nice, pleasant, trustworthy, mostly honest, well-intentioned, and utterly decent. But their brains are largely empty, devoid of any substantial knowledge that might be the fruits of an education in an inheritance and a gift of a previous generation. They are the culmination of western civilization, a civilization that has forgotten nearly everything about itself, and as a result, has achieved near-perfect indifference to its own culture.

It’s difficult to gain admissions to the schools where I’ve taught – Princeton, Georgetown, and now Notre Dame. Students at these institutions have done what has been demanded of them: they are superb test-takers, they know exactly what is needed to get an A in every class (meaning that they rarely allow themselves to become passionate and invested in any one subject); they build superb resumes. They are respectful and cordial to their elders, though easy-going if crude with their peers. They respect diversity (without having the slightest clue what diversity is) and they are experts in the arts of non-judgmentalism (at least publically). They are the cream of their generation, the masters of the universe, a generation-in-waiting to run America and the world.

He ends with this.

They won’t fight against anyone, because that’s not seemly, but they won’t fight for anyone or anything either. They are living in a perpetual Truman Show, a world constructed yesterday that is nothing more than a set for their solipsism, without any history or trajectory.

I love my students – like any human being, each has enormous potential and great gifts to bestow upon the world. But I weep for them, for what is rightfully theirs but hasn’t been given. On our best days, I discern their longing and anguish and I know that their innate human desire to know who they are, where they have come from, where they ought to go, and how they ought to live will always reassert itself. But even on those better days, I can’t help but hold the hopeful thought that the world they have inherited – a world without inheritance, without past, future, or deepest cares – is about to come tumbling down, and that this collapse would be the true beginning of a real education.

This is, I realize, the first time I've posted here in a while. Thanks for dropping by.

Wednesday, June 20, 2018

Saturday, June 2, 2018

, , , ,

The stark emptiness of the prosperity gospel



I've had the pleasure of reading Everything Happens for a Reason: And Others Lies I've Loved largely because of Bill Gates's recommendation.1 The book is written by Dr. Kate Bowler, assistant professor of the History of Christianity in North America at Duke Divinity School. In 2013 she wrote  Blessed: A History of the American Prosperity Gospel (Oxford University Press, 2013) where she explored the beginnings of the health-and-wealth teachings that remain entrenched in American religious life. These doctrines—mostly based on the premise that God's will for Christians is that they always hold financial blessing and physical well-being—have creeped in so many local churches, even in the Philippines. Prosperity gospel revolves around faith, prayer, positive thinking and speech, donations, and miracle crusades; by having these elements, people can persuade God to deliver them security and prosperity.

Dr. Bowler, in her deeply personal and affecting autobiography, reveals that these teachings are hollow when exposed to the scrutiny of suffering. This she realized when she was diagnosed with stage IV colon cancer. She would undergo chemotherapy and immunotherapy, would grapple with questions about her illness or whether she would live for her next cycle (on Wednesdays, in a hospital in Atlanta), and would question her faith in God.

The book attempts at being coherent; it is divided in nine chapters with a preface that begins with, "There's a branch of Christianity that promises a cure for tragedy. It is called by many names, but most often it is nicknamed 'prosperity gospel' for its bold central claim that God will give you your heart's desires: money in the bank, a healthy body, a thriving family, and boundless happiness." But cancer is hardly coherent. My patients tell me that suffering seems to go on forever; but it is a blur, a suspension of time, or, as Dr. Bowler wrote, "life interrupted." Amidst this mess,2 she takes us into her inner sanctum—her husband and son, her adorable friends, her colleagues at work (mostly pastors and would-be pastors)—and see that it is filled with a flurry of activity, laughter, sarcasm, and prayer. Central to her introspection is the belief that God was with her.

What would it mean for Christians to give up that little piece of the American Dream that says, "You are limitless"? Everything is not possible. The mighty kingdom of God is not yet here. What if 'rich' did not have to mean 'wealthy', and 'whole' did not have to mean 'healed'? What if being the people of "the gospel" meant that we are simply people with good news? God is here. We are loved. It is enough.

You don't read Everything Happens for a Reason for theology; if you do, you will be disappointed.3 I have a feeling that I will even disagree with the author on some points of Christian doctrine. However, you read it for its humanity. Dr. Bowler sounded like the charming, funny, self-deprecating, but strongly opinionated lady in church who made everyone feel welcome. Bill Gates wrote that she "has too much integrity as a writer to offer pat answers or magic solutions."

I have always found comfort in words. Books like these—along with friends and family—have been used by God to comfort me in my own suffering and in helping others in theirs. It goes without saying that the book resonates with me deeply in that as an oncologist I deal with cancer on a daily basis, both on professional and personal levels, the latter being more difficult. My father—a cheerful, kind, prayerful, and godly man—passed away two weeks ago. Gastroesophaeal junction cancer. I miss him every day.

The Bible, too, doesn't take suffering lightly. I agree with Tim Keller in his argument that Christianity offers the only unique, truthful, useful perspective on suffering:

... The Christian understanding of suffering is dominated by the idea of grace. In Christ we have received forgiveness, love, and adoption into the family of God. These goods are undeserved, and that frees us from the temptation to feel proud of our suffering. But also it is the present enjoyment of those inestimable goods that makes suffering bearable.

In another paragraph Pastor Keller writes that Christianity "empowers its people to sit in the mist of this world's sorrows, tasting the coming joy."

Like Dr. Bowler, I sigh and groan and anguish at the sight of suffering and pain. These lines moved me.

But I don’t want ice cream, I want a world where there is no need for pediatric oncology, UNICEF, military budgets, or suicide rails on the top floors of tall buildings. The world would drip with mercy. Thy kingdom come, I pray, and my heart aches. And my tongue trips over the rest. Thy will be done.

The God of the Bible promises another world free of sin and tears and conflict and cancer. Meanwhile, as we live in this fallen remnant of paradise, we sigh in hopeful helplessness and joyful sorrow: Maranatha. Come, Lord Jesus.


1I'm subscribed to his blog: so smart and humane and kind!
2I can't find a better word.
3Timothy Keller's Walking With God Through Pain and Suffering (Penguin Books, 2013) is among the best, contemporary works on the subject of human suffering. You should read it.
Powered by Blogger.