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.

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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

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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

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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

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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

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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

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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.

Friday, June 1, 2018

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My stash of diaries

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On a sweltering morning in Marbel I took out the old, dusty boxes beneath what used to be my bed. Where was my stash of old journals, the very same diaries my father used to read secretly, much to my dismay, to which he told me, “They were good”? Looking for forgotten things in our St. Gabriel home was—and still is—laborious. My journals were no longer in the small Rockport shoebox I had put them in last year; they were already in the top cabinets, inside a carefully sealed plastic bag, its clean, difficult knot a reminder of my father’s obsessiveness to cleanliness and organization. Our caretaker, a close cousin of my mother, said, “Ah, your Tatay must have transferred them there.” (My inability to tie my shoelaces properly—at 30 years old!—must have frustrated him.)

I brought home with me two pocket journals—affordable Venzi notebooks with faux-leather covers—their acid-free pages already filled. The most recent had carefully written prayers, including one dated April 17 when I learned my father had an esophageal mass. I was almost certain it was malignant, but that did not keep me from asking the Lord for a miracle. No, the ink—my own concoction of 3/4 turquoise and 1/4 black Lamy—was not stained with tears, but tears were shed, albeit privately, whenever I moved my bowels or took long showers. My brothers are amused by the fact that I cry like someone from the upperclass—“daw sosyal”—while they caterwaul like the proverbial masang tao.

Tired, I placed the two journals in my collection inside the plastic bag in the top cabinet, my often careless scribbles safe from prying, curious eyes.

Thursday, May 31, 2018

Congratulations, IM batchmates!

I'll miss the Department Graduation at New World Hotel today. I need to be with my family in Marbel to help with the transition: new routines, new roles, a new chapter without my father around. Here are some photos of my IM family. Congratulations to us!

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The commute

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Café Ilang-Ilang 2017

Café Ilang-Ilang 2017

Now...what to do?

batch 2017 internal medicine residents, pgh.

Morning charting

Morning charting

Lunch

Bestfriends

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Afternoon discussions

I hate this pose.

Signing out of the wards--first year over

But I love these people.

Wednesday, May 30, 2018

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Mangga

With Nanay I share a fondness for ripe mangoes. A man delivered these to our neighborhood—sweet-smelling harvest from neighboring Tantangan, South Cotabato. I'll make fresh fruit juice. Maybe a smoothie.

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Tuesday, May 29, 2018

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The day after

The day after Tatay's burial, we went to Sarangani Highlands to tour close friends of my mother who visited Mindanao for the first time. Seeing the beauty of God's creation in our quiet, peaceful nook in Southern Philippines was a balm to our grief.

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From the garden we saw Sarangani Bay.

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Colorful shrubs grew in the garden.

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Because of the heat, the "senior citizens" opted to stay inside the air-conditioned restaurant. From left: Uncle Rene, my mother, Auntie Cecil, and Tita Mimi.

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We're grateful for these friends who spent time with us, giving us Christian comfort, during quite possibly the most difficult moment of our lives. From left: Uncle Rene and Auntie Cecil Jamison, Tita Hearty Cataluña, Auntie Liza Dayot, my mother, Tita Mimi and Uncle Nani Bañares. Photo was taken in our living room.

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Monday, May 28, 2018

Gratefulness

Still no words yet—we buried Tatay on Sunday morning—but there are many things I'm grateful for:

—Hearing my brothers and my mother give eloquent eulogies on Tatay's penultimate day before the funeral.

—Listening to tributes of his close friends who revealed hidden profiles of my father not apparent to us. My father's kindness and joy was something that they, too, will miss.

—The beautiful, gospel-centered preaching of Pastor Guilbert, who made use of the two nights and one day of funeral service as a series on the gospel, starting with sin, heaven, and how to be assured of one's salvation.

—Our church, Marbel Evangelical Fellowship, that hosted the funeral service. Our brothers and sisters in the faith have been sources of encouragement to us, demonstrating to us God's lovingkindness.

Friday, May 25, 2018

Tatay's speech

It's the little things that make me weep, the minutiae of life so permeated with Tatay's presence—such as this printed cue card. It bears the words he had uttered during Manong Ralph's thanksgiving party in May 15, 2011.

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