Death and burial—Calvin's encouragement

Letter CXXXIII—To Monsieur de Falais. Directions for his conduct towards the Emperor Charles V. Geneva, 31st May 1545. An excerpt:

It matters little what we have to endure in this world, considering the shortness of our life. And if length of days should be granted us, it is well that the Son of God be glorified by our sufferings, and we be participators in his glory. Since, for the love of him, you have begun to die to the world, it will be necessary to learn henceforth what it is to be buried. For death is nothing without burial. This is the consolation which it becomes you to take, that you make not deceive yourself, but prepare to endure even unto the end. And yet the cross you bear is very easy compared with that our of Master. When it shall please him to impose a heavier burden on you, he will give you, at the same time, shoulders to bear it.

John Calvin's letters are a breath of fresh air, balm for the weary soul, and encouragement to the heavy heart. 

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Tatay's fruit trees

Two years after Tatay's passing, we still receive fruits from the trees he had planted years ago in the farm. This is guyabano (Annona muricate), or soursop. When we were kids, Tatay would bring home pasalubong—kakanin, fruit, snacks—each time he went out of the house. The fruit harvests remind us of him. 

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The Philippines' first Olympic gold

Waterman rollerball inked with Pilot Iroshizuku (blue). Writing pad is Veco steno notebook, which I love!

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Fountain pen ink refill in a rollerball/ballpoint pen (Waterman)

Here's the tutorial. I used Pilot Iroshizuku, one of my favorite blue-black inks in the market.

Erratum—my Waterman is a rollerball, a bit like a ballpoint, but not quite.

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Not an easy story, but wildly enjoyable

Peter Orner on Mavis Gallant (via The Atlantic):

That's why "In Plain Sight" is not an easy story. It's wildly enjoyable to me, but to get to know another person, to really know them, you've got to be patient. That's why I pick up a book, after all. Fiction is one of the few ways I get that slowed-down feeling. Everything else in my life is moving so fast. But when I read, especially when I read Gallant, I pause. What I want to do is immerse myself in someone else for a while.
Gallant says stories are for shutting out the world, this way, for just a moment. "Stories are not chapters of novels," she says. "They should not be read one after another, as if they were meant to follow along. Read one. Shut the book. Read something else. Come back later. Stories can wait."

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Recording podcasts

Kuya Imay was one of the first people who knew that I was commissioned to record a series of podcasts about cancer. The first episode is now out in Docquity, an app for doctors. 

Many years ago, at the Matulungin apartment, I recorded a few podcasts which would never see the light of day. I turned on my laptop's voice recorder app, brought it near him, and threw at him a barrage of questions in English. "Kuya, this is being recorded. What are you doing now?" He would speak in English at first, but would conclude his statements in Bisaya, and eventually, in laughter. I still have those files, Kuya, so don't you dare cross me. 

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4 am prayer group

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Weekly update

Guest speaker

Been asked to speak in an online graduation ceremony of my former high school. Initial thought: what have I accomplished in life, really? Agreed to it in the hopes that I don’t get invited again. Perhaps I need to tell the kids I, too, graduated last year in an online ceremony, and I know that not everybody pays attention to his/her screens. What do I know now that I wish I had known when I was younger? Many things. Experience sucker punches youthful boasting. My years outside of high school taught me there are far smarter people than me. Listening to counsel from family and church goes a long way. Read your Bible, pray every day. Trust in the Lord with all your heart, and lean not in your own understanding; in all your ways acknowledge him, and he will make your paths straight. Read and read and, perhaps, avoid the internet, if you can. Study hard. Invest in fountain pens. Find good friends. My message will be recorded this Wednesday, so I’d better start writing. 

Sunday rounds

Drove to the hospital after Sunday service today. My patient, a Christian woman who sings hymns during chemo, was admitted for bacterial and fungal pneumonia five days ago. She feels better today. Told her I was sorry I didn’t see her in the morning. She brushed off my apologies and said, in the most loving voice, “Akigan ta gid ka, Dok, kung gin-una mo ko. Di ba, ‘Seek ye first the Kingdom of God’ dapat.” My patients are blessings to me. 

Reading extravaganza

E. M. Forster’s A Passage to India. Breathtaking. Glad I was able to visit India before the pandemic. Liked to think my experience created a background for the novel’s sights and sounds. A Passage will end up as one of my favorite novels. Couldn’t wrap my head around it entirely. The language is glorious. 

Alice Munro’s Something I’ve Been Meaning To Tell You has stories that are, in brief, the textual distillations of her imagination. Now on the tenth story of the collection, “Winter Wind.” The stories are so good that I reserve them for later. 

Anthony Bourdain’s Kitchen Confidential sounded like the TV show host. He wore desert boots, hated vegetarians, loved to cook, kept a close set of friends, was a professional. Book has tips on when to eat seafood in New York. The reading experience was aspirational for me, as I don’t see myself traveling elsewhere any time soon. He wrote about a person he knew who killed himself. Knowing what would happen in the future, it sounded ominous. 

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When I learned about PNoy's passing

I was doing chemotherapy when I heard President Noynoy Aquino has died. The television inside the chemo room was tuned to DZMM Teleradyo. My patients, young women diagnosed with breast cancer, were asleep. I asked Ma’am She, the nurse, what the cause of death was. It was hard to say if I spoke too loudly—with the mask and face shield, I could not calculate my volume accurately—but I must have stirred my patients awake from their diphenhydramine-induced stupor. They had heard about PNoy’s passing an hour ago. I am always the last to know. The 37-year old mother with metastatic disease told me, “You never know when God will take you home. At least I know I will die because of cancer.”

For many months, PNoy has been out of my consciousness. I have not heard from him. I’d later learn he liked to keep to himself. His introversion was misinterpreted as coldness, nonchalance, indifference. But he was keen on details. He remembered the important numbers. He drank Coke Regular and smoked cigarettes and liked Aiza Seguerra. He said his I-love-you's to his favorite nephew, Josh. Later that day, I read Twitter, that marketplace of bright ideas and fake news, cute cat videos and expletive-infused rants. Someone confessed that his Araling Panlipunan teacher used to give them an assignment to write an outline of the President’s State of the Nation Address. “‘Yun ang mga panahong naiintindihan ko pa ang mga sinasabi ng Pangulo.”

I chuckled and mourned.

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Afternoon rains

With nothing else to write about, I will tell you about the weather.

Since two weeks ago, it has stared to rain in the afternoons. The clouds thicken at two o’clock. As the cumulus becomes nimbus, a soporific gloominess descends upon the Valley. The streets are quiet. A cool breeze enters the living room, already emptied of people. It is siesta, the lowest point of human activity during the daytime. The occupants are inside the bedrooms. The indoor plants sway with the wind, as in a lullaby. The tropical warmth, accumulated during the morning, is pushed out of the house. Above, the gathering of water vapor—from the southern Philippine seas many kilometers away, the Allah River that cuts through the province, the great lakes in the Upper Valley, the smaller, shallower streams that nourish the farming lands and towns—is gradual but sure. Nobody notices the God-designed chemistry of the water cycle in the atmosphere, save for people on motorcycles who realize they must find shade and shelter, albeit temporarily. There is a general aversion to getting soaked in the rain; it can lead to illness. Those at home, deep in their sleep, may be awakened, dreamless, by the successive peals of thunder, a prelude to a soft drizzle that turns into downpour. It lasts for minutes, sometimes hours. Those inside rush to rescue whatever hangs on their clotheslines. The rain pounds on the roof, waters the plants, wets the dry earth. In these brief moments of respite from the uncomfortable heat, nobody misses the sun. It will be a cool night later.

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Alternative meds

Nanay wakes up, distraught, getting hold of a memory that is becoming elusive with every second gone. As she makes her bed, she tells me, "I was telling a group of people to stop taking MX3!"

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First chemo, remembering H

Spoke about this verse to a woman, 62, on her first chemo session. She teared up, told me about how her church family is praying for her back home. She spoke as if she were about to die tomorrow. Patients with cancer realize they can go anytime. She referred to God as her Father. "He knows what's best, though I may not understand completely," she said. Encouraged her with a line that I remember from Tim Keller's preaching—that suffering is never wasted for God's redeemed children; He always has a purpose in mind. I learn so much from my patients. Their stories wean me from my love of this world. I remember the song: "And what can this world offer / when all I desire is You?"



But this world has so much suffering. Yesterday, woke up to an online thread. My high school classmate, H, has died. H was a newly minted lawyer, was married for 7 months, with a baby on the way. Hadn't spoken to him in years, except with random greetings in a Messenger group chat. H was my classmate in Notre Dame; in high school, we transferred to KN Special Science Class, where we were in the same class for four years. Our hearts are heavy. His child will be born fatherless. May God's comfort be upon his family left behind. Life is a vapor. 

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Displeasing the world to obey God's pleasure

Letter of John Calvin to Monsieur de Falais, Geneva (1543):

...I could not refrain from reminding you, that the benefits which God hath bestowed upon us, indeed require that we should prefer his honour to all the world besides, and that the hope of salvation which we have by his Evangel is so precious, that we ought readily to forego meaner considerations, in so far as they hinder us from reaching forward to that hope, and that we ought to have such contentment in conforming ourselves to his will, that whensoever the question arises of our displeasing the whole world, that we may obey his pleasure, it is good for us.

I derive much joy and instruction from Calvin's letters. 

You can betake yourself to a covering shelter from the storm—for we have no other retreat than that of our God—let us then hide ourselves there, and we shall be in security. 

Amen to that.  

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Between two kingdoms et al

While I had the stamina to post something every day in 2020, I barely have the energy to sustain the habit this year. It’s not for the lack of things to write about. After the eventful beginnings of the pandemic, whose end is, at present, far beyond our line of vision, I’d much rather read and watch and think quietly. 2021 has so far been a year of introversion—a time of keeping it all in, making sense of things, praying, and meditating. This year also marks a major career transition—from medical training in Metro Manila to starting my private clinical practice in South Cotabato and General Santos City.

But I’m keeping my one post a week quota, if only to get me writing again.

Early this morning I finished Between Two Kingdoms: A Memoir of a Life Interrupted by Suleika Jaouad. The author writes about the experience of being diagnosed with leukemia, and how that has reshaped her life and relationships. The second part of the book is about her land trip around the US. When she wrote a column for the New York Times during her bone marrow transplant and chemotherapy, she received mails from readers all over. After her treatments, she decides to drive her friend’s Subaru and visit some people who reached out to her. The book is honest, sensitive, and inspiring. But reading about the topnotch oncologic care, clinical trials, and the sheer convenience of getting a port for chemo access made me wish for a better, more humane oncologic care in the Philippines, where a cancer diagnosis can lead to financial catastrophe. I pray for the author’s continued remission. And may she find God in her suffering and illness.

Last week I finished Bird by Bird by Anne Lamott. It’s practical, inspiring in its pragmatism. This year is proving to be a great one for books.

My driving is markedly better. I can do reverse parking parking now—more hit than miss. Hitting the right parking spot, not other vehicles; otherwise I’d be in big trouble. In a hospital in Gensan, I befriended a security guard who hails from T’boli town. Calling me “kasimanwa,” he would come to my aid when the parking spaces are packed. I offered to drive him to his home town if he ever needed to go home, but his family is in the city, and he is happy where he is.

In a few days, it’s going to be June! We’re halfway through the year. Let's all keep safe and get vaccinated.

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Week ahead

Not much happening with the lockdowns and new COVID cases here and elsewhere. Grateful to be alive and well.  Finished Anne Lamott's Bird by Bird, started on Isaac Bashevis Singer's short story collection, received packages of books ordered from Book Depository since last year, including Piercing Heaven. Read the first prayer after dinner last Wednesday, during our weekly family prayer time. All victories against this pandemic seem short-lived. We take what we can. For instance, there's my second dose of vaccine—praise be to God. Will head over to the hospital at 8 am, drive to Gensan to see some patients, head back to Marbel for lunch, then visit a patient in another town on her final day of chemo. In oncology circles, we call it "graduation." 

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Delightful rosal (Gardenia jasminoides)

The rosal delights us with its first flowers on this rainy tropical morning. Grown by Uncle Glenn in his home garden in General Santos City, its branch was transplanted onto rich soil with coconut husks from our Banga farm, and was given to my mother as a gift. The plant occupies a small, quiet space beneath the kamuning tree [(Murraya paniculata (Linn.) Jack].

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Mentoring

Had a refreshing conversation with a medical resident a few days ago. She was also a mother, wife, and daughter who had lost her father many months ago. Told her I miss my father, too. We both agreed that suffering somehow made us empathize with patients more. 

Gave her tips on doing rounds on the floors, the same ones Sir Nemie Nicodemus taught me when we checked on his referrals. He taught me and my friends to see check the medication list, the I and O, the vital signs monitoring sheet, and the latest entries before marching inside the patient's room for a full physical exam. Mentors impact trainees to a degree greater than they can imagine. I'm grateful to have met Sir Nemie and my other mentors. I'm nowhere half as brilliant, but their advice were, and I took good notes so I could share them with the younger doctors. 

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Shtisel, my new favorite show of all time—among a few others

Not exaggerating when I say Shtisel is simply one of the best shows I've seen in my life. It ranks alongside Breaking Bad, Veep, The Office (US), Derry Girls, and The Mandalorian.

“Shtisel” is generous, lighthearted, and nostalgic—even when the origins of its nostalgia remain elusive. It is also a little old-fashioned, not only because of its subject matter but because of its situational structure. Things happen and cease to happen to the characters within a single episode: an illness, a robbery. It’s drama dressed as a sitcom. The show’s center of gravity is the father-son relationship between Shulem and Akiva, who are usually seen sitting around their cramped kitchen table, with its waxy tablecloth, eating sliced vegetables in their shirtsleeves and prayer shawls.

Love the characters. So fascinated by them that I find myself reciting Old Testament verses as they pray. Enjoyment is cloaked by sadness—these people reject Jesus Christ. While Christians are awaiting the Lord's second coming, they are still expectant for the first coming of the Messiah. While Christians believe that salvation is by God's grace through faith in Jesus, they believe that they must obey the law to the letter in order to be saved.

Still—the series displays so much humanity in a secluded, ultra-religious community we almost know nothing about. 

Brothers to me: "Watching Shitsel again?"

"Not Shitsel. SHTIsel!" 

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Do not be condescending

Marilynne Robinson on thinking highly of her reader:

My main concern is to be respectful always of my reader’s intelligence. I tell my students always to assume the reader is a better person than he or she is. I tend to assume that good prose simply is accessible, and that condescending to the reader obscures meaning.

Same principle applies in medical communication. Be condescending to the patient, and you lose his trust.

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Heartbreaking work of Dave Egger's staggering genius

Teary-eyed at 9 am on a Monday, at Starbucks along Santiago Boulevard. Arrived too early for my clinic and had time to spare—the story of the young doctor starting his practice. Nobody else noticed me, the solitary man, sipping coffee, al fresco, reading a white Kindle. But who cries at 9 am on the first day of the work week?

It was the book’s fault. Dave Eggers’ novel punched me in the gut. A Heartbreaking Work of Staggering Genius spoke to me the way people who’ve gone through similar suffering communicate a common language, populate the same neural network. Dave wrote about his mother, dying of gastric cancer. Feeling an emotional proximity to writers, I refer authors on a first name basis (Mavis Gallant is Tita Mavis, for instance). “While reclining on the couch most of the day and night, on her back, my mom turns her head to watch television and turns it back to spit up green fluid into a plastic receptacle.” He brings her to the hospital, despite her earlier instructions on the contrary. I could see myself in the situation, could hear and smell and feel its mundanity and extraordinariness, could imagine that “loss is accompanied by an undeniable but then of course guilt-inducing sense of mobility, of infinite possibility, having suddenly found oneself in a world with neither floor nor ceiling.” Succeeding chapters narrate what happened after—Dave stands as his brother Toph’s legal guardian, drives him around town in a red Civic, brings him to school activities. Hilarious, self-deprecating, heartbreaking, and staggering, but also compassionate and affecting. Do read it.

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