Wednesday, September 23, 2020

Tuesday, September 22, 2020

Monday, September 21, 2020

Sunday, September 20, 2020

Saturday, September 19, 2020

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Happy birthday, Rac!

Service 6Service Six. From right: myself, Racquel Bruno, Josh Abejero (back), Julie Gabat, Raymond Lozada (back), Amy Lopez, Jing Lagrada, Bea Eusebio (back), and Mia Licyayo. (Related: my first month of internal medicine residency).

My dear friend, Racquel Bruno, celebrates her birthday today. I have so many things to say about her: her brilliance, kindness, grit, and strength of character. But what people don't know is that, at some point, she and I were champions in the Department of Medicine table tennis doubles. We won because our opponents' smashes almost always landed outside the table. We looked on like passive observers, while the points were credited to us.

She is now an internist and endocrinologist practicing in Iligan City. She was a vital presence in my residency training experience at PGH. This photo was taken at Ward 3 (now converted into a COVID-19 ward) with our senior, Madam Julie Gabat, whose mentorship was instructive and life-changing. Josh Abejero, the January rotator, is now a neurologist based in Cebu City. Seated on the bench were our amazing interns: Amy, Jing, Bea, and Mia. Raymond (who was my med school classmate), was standing behind. 

I miss you, Rac!
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Beautiful diligence

Tim Challies reflects on the duty of diligence in the Christian life (1 Thessalonians 4).

Under this heading of “diligence,” [Paul] tells the Thessalonians to live quietly, to mind their own business, and to work with their hands. When he tells them to live quietly, he means for them to be content to be unknown and unnoticed, to make it their ambition to be free from worldly ambition. They are to be content with their lot and to know that this contented diligence is how they can best honor God. When Paul tells them to mind their own business, he means for them to focus on their own work and to avoid being busybodies. And when he tells them to work with their own hands, he means for them to carry on in their work, even (or especially) if that work involves manual labor. He could call them to all of this because their work had intrinsic value simply because it was their calling—their God-given vocation. 

Friday, September 18, 2020

Where empathy fails

Sandro Galea's Art of Medicine piece in The Lancet (Compassion in a time of COVID-19):
And yet, it is worth reflecting on the extent to which our response to the COVID-19 pandemic has been informed by an understanding that we are all in this together, that the virus does not discriminate, and that as a result it benefits us all to comply with physical distancing guidelines to protect others and ourselves. Our empathy, our capacity to envision that we too could be affected, has been a powerful tool in the public health arsenal. But, in large part, it is hard not to notice that our empathy is informed here, as it often is, by an appreciation of our own personal risk. We feel regret and feel terrible about those who are suffering, in no small part because we can imagine that suffering being our own.
Just when you think it's going to be one of those corny essays laced with motherhood statements, Galea jolts you:
But is it true that this suffering is our own? Is it true that COVID-19 does not discriminate?
He unpacks his reply: 
It turns out that COVID-19 does discriminate, and that those who are already vulnerable—for example, the unstably housed, people on low income, those with poorer education, and individuals with less access to reliable nutritious food—are more likely to both become infected with the virus and die from COVID-19. 
And this is where empathy fails. 
His solution is not merely empathy but compassion.
This calls ultimately for compassion as the animating force behind our thinking about health, and our thinking about how we go about informing the decisions we make to contain a novel threat like COVID-19. Compassion extends beyond empathy. It does not motivate our action because we too may be harmed. Compassion motivates action because the phenomena we observe are unjust, not worthy of the world we would like to live in. Martin Luther King Jr spoke often of compassion, enjoining us to see that compassion ultimately motivates not to “[fling] a coin to a beggar” but to “see that the edifice which produces beggars needs restructuring”. Compassion pushes us to understand how we have structured the world, and to ask how we can structure it better, not because we may suffer but because others are suffering and that is not how the world should be.

In the final paragraphs, Galea reimagines a different, more compassionate world. It is an honest and refreshing perspective, massively different from the toxic self-absorbed rants on Twitter. I encourage you to read it.

Thursday, September 17, 2020

Growing at the ends of the earth

Early morning treat: At the Ends of the Earth by Jenny Erpenbeck, translated from the German by Kurt Beals.
There is nothing better for a child than to grow up at the ends of the earth. There’s not much traffic there, so the asphalt is free for roller-skating, and parents don’t have to worry about any bad guys roaming around. What business would a bad guy have on a dead-end street?

I often look out the street where I used to play games with the kids. It used to be a dirt road. Ours was an unassuming, working class neighborhood, in a quiet and almost unheard-of part of the country. So much has changed since I left to study in Manila. But kids, I'm happy to say, often roam around, usually in the afternoons, perhaps after their online classes. As I was reading a book in the porch, hidden by the overgrowth of white bougainvillea that has remained untrimmed since the pandemic, I overheard a conversation between friends, "Siguro marami kang jowa, 'no?" 

Wednesday, September 16, 2020

A poem is a meeting-starter

How Poetry Shakes Up the National Desk’s Morning Meetings by Marc Lacey of the New York Times

When the National desk gets together to discuss stories, it can be a grim half-hour. We dissect natural disasters. We reconstruct mass shootings. We delve into political scandals and all manner of domestic tumult. Recently, though, we added a new feature to our morning meetings aimed at inspiring us and boosting our creativity before we embark on another long day of editing the news. 

We read a poem.

I don't have morning meetings today, but I treated myself to poetry, anyway. It's a poem written by my dear Kuya John D. called "Bundeena" in 2019.  

The southern beaches are quiet
Their shores unruffled
The sea breeze is thick with the muffled sound
Of the scattered rippling of waves
And the chirping of birds
Of random unfamiliar muted chatters in Mandarin and French
And the solid staccatic barking of the moneyed's white boat engines --
I did a little bushwalking, too
Passing thru 2000 year-old aboriginal arts engraved in stones
Finally stopping by Jibbon Beach
Laid down my handwoven mat
Pressed my left ear to the ground
As I slowly walked my fingers to the sand
Holding a pinch and forming circles
Until the crystals fall off
Shifting my head to the sky
Squinting my left eye
Followed by the closing of the right
The vastness of the curved blue sky
Consumed by the pitch blackness
Of a quiet sleep

By the beach.

The nearest beach (the peaceful coasts of Sarangani and General Santos) is at least an hour away from Marbel. I think of beaches as places to nap. 

Tuesday, September 15, 2020

On medical humanities

In my background research for a book chapter I'm contributing to, I came across Dr. Salvatore Mangione's editorial, The stethoscope as a metaphor. He argues that "the link between humanities and the bedside remains crucial."

The stethoscope is too closely bound with the doctor’s image not to be a metaphor for something larger. To me, it’s a metaphor for medicine as both an art and a science, wherein the humanities are—and of right ought to be—a fundamental part of the education. Hence, if we want to rekindle the bedside, we must rekindle the humanities. After all, this is what both Lewis Thomas and Sherwin Nuland have urged us to do. My hunch is that this would need to be done sooner rather than later, because if it is possible to make a scientist out of a humanist (it was done for centuries), it might be considerably harder to make a humanist out of a scientist. The experience of the past few decades seems to support this conclusion.

The alternative is a future full of tricorders and technicians, but sorely lacking in healers.

Stethoscopes are crucial to my practice. I remember my Littman II (med school to residency) and my lost Littman III (residency to fellowship). I celebrate my new Littman III, which arrived in August

But I can say the same thing about books and stories; they make me a better doctor. 

Monday, September 14, 2020

Sunday, September 13, 2020

Life otherwise

Trisha explores the evolving concepts of home and ambition in her essay, My Life Otherwise. Her blog, TM Chronicles, takes you all over the world, including her home. The photographs are delightful.

There was a time in my youth when my hopes for the future were uncomplicated. My world chiefly revolved around my hometown and the towns and cities in its vicinity. I never imagined leaving Marbel for good, much less leave the country altogether. Marbel did not become a city until the turn of the millenium so I figured I would at least go to the next big city for college. I had a perfectly crafted vision in my head of how I would go to the Ateneo de Davao to study accountancy because my grandparents always said accountants make good money and I was better in math than in the sciences anyway. My friends whose dreams more or less resembled mine would also go to Davao for college. We would rent an apartment together because we thought the fun shouldn’t have to end in high school. The idea made us gleam with excitement. Our first real taste of freedom and escape from the invisible leash our parents had us on. Though to be fair, we were always accorded some liberty on account of our being responsible star-section kids. I’d like to think we gave our (grand)parents a fairly easy time. Manila was out of the question. We didn’t have family there, it was too far and my retired grandparents couldn’t really afford it with their modest farming income. Of course, it would come to me later that it really does take a village to raise a child.
Ateneo de Davao was an option for me; its proximity was an advantage. Another school was West Visayas State University. Tuition was affordable. If I wanted to become a doctor, I could get a BS Biology degree and study medicine there. It was well within our means. Friends would later tell me they knew of Catedrals from that city—doctors and classmates and friends-of-friends—but I hardly know any distant relations from Panay. Manila was almost out of the question. Like Trisha, I had no relatives in the capital.

Manong paved the way two years ahead of me, so I had my life planned out.  He got into UP Diliman, whose tuition our parents could at least afford. Ateneo and La Salle were out of the question; they were too expensive. In those days, one semester in UP cost about 5000–6000 pesos. 

Tatay and Nanay didn't have a leash on us—they just let us pursue our dreams. And the Lord so graciously provided. We never lacked any good thing (Psalm 34:10).

Saturday, September 12, 2020

Friday, September 11, 2020

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Pathography: second night

Second session of Pathography. Five pieces of creative non-fiction up for discussion—so much humanity and compassion in those pages. Learned so much from the crowd. Felt close to the participants despite the distance: ah, the wonders of technology. These meetings: my kind of Friday night fun. Professor Marj and Dr. Joti made insightful comments—so many aha moments for me, the first-time panelist. The thrill of literature is its intricacy. So many layers to unpack, analyze, interrogate, but beneath all the scholarly criticism is the childlike enjoyment for the written word. What a blessing!

Thursday, September 10, 2020

Wednesday, September 9, 2020

Happy birthday to our Chief!

Rich King (his real name) celebrates his birthday today. Rich was our chief fellow during medical oncology fellowship. Through the years, I've known him to be a kind, energetic, and smart man who prioritized our interests more than his own. I admire him greatly: he is a prolific researcher, a terrific and compassionate physician, an organized administrator, and a loyal friend. What others might not know about him is that he walks out of the room when it gets noisy; incessant babbling disorients him. When I sit beside him, I restrain myself from talking. When I do, he often starts the conversation. I often reply by praising his flat abs. That gets him in a laughing fit. Such scenes defined our mornings at the Onco Clinic.

Rich at ESMO Asia 2019 in Singapore.Untitled

Trapped in heavy rain, Rich sits on a bench. We were on our way to a fountain pen store in Singapore. In that trip, he'd treat himself to a TWSBI Eco. 
Untitled

In one of his most energetic lectures in a graduate classroom. He opens with a spiel about Miss Universe. 
Untitled

Tuesday, September 8, 2020

Monday, September 7, 2020

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MCMMO

Yesterday was UP Manila's first online university grad. I streamed the ceremony on YouTube. My congratulations to all graduates, especially to my med onco buddies! (Screencast credits: Rich)



Karen

Rich

Freddie

Raj

Myself (misspelled last name—mukhang nag-autocorrect)

Missing the rowdy clinics and this stress-free company. February 2020
(Photo credit: Raj)

Sunday, September 6, 2020

Evensong

Listening to Evensong: A Collection of Hymns and Lullabies at Close of Day, the newest album of Keith and Kristy Getty. 

Kristyn Getty says, “These are lullabies and hymns we have sung to and for our four daughters. Singing God’s truth into both the more quiet and vulnerable moments of the day has been a centerpiece of raising our own kids. I know I need true words spoken into my heart and mind to help de-clutter all that presses in upon me from day to day. I hope these songs help people dwell on the Lord and His promises; to release a burdened mind, to calm a restless heart and point us towards real peace in Christ.”

“The Bible has long encouraged believers through the ages to sanctify the night to the Lord,” Keith Getty says. “And the church’s ancient tradition called “evensong” is for spending time before the Lord in prayers and songs at the end of the day. The album is in some ways an echo of that tradition; the songs and the album were born out of the thoughts and conversations, the prayers and songs that fill our home, particularly when the sun goes down.”

Praise be to God for these modern-day Psalmists! You can stream the songs in these channels

Saturday, September 5, 2020

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Writing the Pandemic

I'm honored to be a panelist in an online creative nonfiction writing workshop organized by the Bienvenido N. Santos Creative Writing Center (BNSCWC) of De La Salle University, Manila. It's called "Pathography: Writing the Pandemic." 

My gratefulness overflows towards Prof. Marjorie Evasco, the Filipino poet, writer, and fountain pen enthusiast, and Dr. Joti Tabula, my former senior in Internal Medicine, poet, book editor, publisher, and enabler of many things literary. Knowing them has opened a welcoming community of doctor-writers to me. "Thrilled" doesn't quite cut it; I am looking forward to the two-hour intimate online meetings where we will discuss the creative works of our select participants, doctors from all over the Philippines. Some of them are very dear friends I've not met in years. It is, in a sense, an excuse for a reunion. 

I'm basking in joy as I read the submitted pieces.

Friday, September 4, 2020

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Café business

Sean's new fascination: coffee. New espresso maker arrived last week, his treat to his 30-year old self. He likes to tinker with things. We're opposites in this regard: I like all things automated. Sean says good coffee must not taste too sour or bitter. I should at least experience some sweetness. Savoring the espresso in a demitasse, I imagine the sweetness and enjoy the bitterness anyway. Kitchen is now the busiest part of the house. Next week, when Manong comes home from quarantine, the oven, left dormant when he is in Manila, will be used to full capacity. I propose a food business: Sean will be in charge of coffee, Manong will make the pastries, and I will manage branding. We'll call our products alternative cures for cancer and charge a thousand pesos more. I whisper this joke to my brothers. Mother will be furious when she hears this kind of talk. 

Thursday, September 3, 2020

Verses for Bible study

These are some verses we will be discussing in tonight's Bible study. I'm posting them here for our encouragement. 

Daniel 4:35

All the peoples of the earth

    are regarded as nothing.

He does as he pleases

    with the powers of heaven

    and the peoples of the earth.

No one can hold back his hand

    or say to him: “What have you done?”


Psalm 47:2

For the Lord Most High is awesome,

    the great King over all the earth.


Psalm 83:18

Let them know that you, whose name is the Lord—

    that you alone are the Most High over all the earth.


Genesis 14:19

and he blessed Abram, saying,


“Blessed be Abram by God Most High,

    Creator of heaven and earth.


Isaiah 37:16

16 “Lord Almighty, the God of Israel, enthroned between the cherubim, you alone are God over all the kingdoms of the earth. You have made heaven and earth


2 Chron. 20:6

and said:


“Lord, the God of our ancestors, are you not the God who is in heaven? You rule over all the kingdoms of the nations. Power and might are in your hand, and no one can withstand you.


Isa. 43:13

    Yes, and from ancient days I am he.

No one can deliver out of my hand.

    When I act, who can reverse it?”


Eph. 1:11

In him we were also chosen,[a] having been predestined according to the plan of him who works out everything in conformity with the purpose of his will,


Isa. 14:17

the man who made the world a wilderness,

    who overthrew its cities

    and would not let his captives go home?”


Rev. 19:6

Then I heard what sounded like a great multitude, like the roar of rushing waters and like loud peals of thunder, shouting:


“Hallelujah!

    For our Lord God Almighty reigns.


Rom. 9:18-22

Therefore God has mercy on whom he wants to have mercy, and he hardens whom he wants to harden.


One of you will say to me: “Then why does God still blame us? For who is able to resist his will?”  But who are you, a human being, to talk back to God? “Shall what is formed say to the one who formed it, ‘Why did you make me like this?’” Does not the potter have the right to make out of the same lump of clay some pottery for special purposes and some for common use?


What if God, although choosing to show his wrath and make his power known, bore with great patience the objects of his wrath—prepared for destruction?


Prov. 16:9

In their hearts humans plan their course,

    but the Lord establishes their steps.


Prov. 19:21

 Many are the plans in a person’s heart,

    but it is the Lord’s purpose that prevails.


Prov. 21:1

In the Lord’s hand the king’s heart is a stream of water

    that he channels toward all who please him.


Ezra 1:1

In the first year of Cyrus king of Persia, in order to fulfill the word of the Lord spoken by Jeremiah, the Lord moved the heart of Cyrus king of Persia to m


James 4:13-15

Now listen, you who say, “Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.” Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes. Instead, you ought to say, “If it is the Lord’s will, we will live and do this or that.”


Phil. 4:6

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.


Col. 4:2

Devote yourselves to prayer, being watchful and thankful.


Eph. 6:18

And pray in the Spirit on all occasions with all kinds of prayers and requests. With this in mind, be alert and always keep on praying for all the Lord’s people.


Luke 18:1

Then Jesus told his disciples a parable to show them that they should always pray and not give up.


1 Thes. 5:17

pray continually


Rom. 12:12

Be joyful in hope, patient in affliction, faithful in prayer.


Ps. 57:2

I cry out to God Most High,

    to God, who vindicates me.

Wednesday, September 2, 2020

Grounded

High school friends

Angeli (leftmost) and her husband (not in photo) hosted a housewarming dinner and invited us. Impromptu mini-high school reunions ground me, reminding me of my happy teenage years in a quiet community in the south. Saw Willie, Kathy, and Hazel. Hearty and bittersweet laughter over evening primrose, labor, and delivery. We had to leave at 10 PM, to respect the city's curfew. Angeli drove us home. If she can drive, perhaps so can I. See you all soon!

Tuesday, September 1, 2020

Trapped in a church

Deacon John Updike

John Updike's Deacon before bed. The story is about a churchgoing 50-year old named Miles (the deacon) who finds shelter in an empty church during a storm. 

Yes, the deacon sees, it is indeed a preparation for death—an emptiness where many others have been, which is what death will be. It is good to be a home here. Nothing now exists but himself, this shell, and the storm. The windows clatter; the sand has turned to gravel, the rain has turned to sleet. The storm seizes the church by its steeple and shakes, but the walls were built, sawed and nailed, with devotion, and withstand. The others are very late, they will not be coming; Miles is not displeased, he is pleased. He has done his part. He has kept the faith. He turns off the lights. He locks the door. 

I believe death is not emptiness but a passage to fullness and glory. But I love this story—the language of faith and solitude, the descriptions of Protestant churches and liturgy, the sense of community. In the story's final paragraphs, I pictured being alone inside dark halls during rain storms. 

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