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
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