Monday, December 31, 2018

Miniso unlined notebooks and fountain pen knobs


I recommend this unlined journal from Miniso—great paper for notes and doodles! It costs less than 300 pesos and is widely available. Jessica Zafra, a rabid note-taker, recommends this, too, having broken up with Moleskines because the company no longer distributes unlined notebooks in the country. I don't mind lined notebooks, as long as the paper is good.




My kid brother, Sean, after sensing that a knob on my fountain pen was loose, decided to fix it on the spot.

"Do you need to apply grease?" I asked.

"No, it looks fine. It just needs a little tightening."

He has always been good with his hands—he is, after all, a dentist—so I wasn't surprised that he did a better job at fixing my TWSBI Diamond 480 1.1 mm stubbed-fountain pen than me.

"I read online that you shouldn't tighten the knob too much when you suction the ink," he said, warning me that there could be problems if I did so.

I asked for some ink; I didn't bring anything for this trip with me. Sean is a fan of the Pilot Irishozuku Iroshizuku, but I felt it too expensive for my present purpose—doodling and writing non-sense—so I had the Lamy black instead.

I've resolved that the next time I have problems with the pens I've accumulated, I'll just have Sean check and fix them.


Sunday, December 30, 2018


Saturday, December 29, 2018

Birds and bees at home



Happy birthday, Roger and Fred!

First years at PSMO RTD

From left: Roger, Fred, Karen, myself, and Rich. They're my colleagues and friends from Oncology.


Friday, December 28, 2018

My Reading Year 2018

This has been a good year for reading. I wish I had read more books, but in between chemotherapy, academic reading (which I don't count as reading, in the way that I define it here, i.e., reading for pleasure), I could only squeeze in a few. Which is not to say, of course, that reading DeVita isn't pleasurable—it can be. Nevertheless, here are my most memorable reads for 2018.

[Before I launch into my list, I asked some friends and family to list their favorite reads, so I can convince non-readers to try out the habit. You can read Kuya John's top seven, Manong Ralph's top ten, and Ate Liw's many recommendations, including those that had lasting effects on her. In a sense, you are what you read. Surely, you don't want to be defined by the fact that you only read—that, too, is mildly entertaining, but there are greater joys to be had.]

My Reading Year 2018
My Reading Year 2018

1. Institutes of the Christian Religion by Jean Calvin

After a year, I finished reading volumes 1-3 of John Calvin's The Institutes of the Christian Religion. I mostly read it in my Kindle during my morning commute to work, a ritual that affords me the chance to read works of literature outside of my standard readings in oncology. The Institutes now belongs to my list of favorite books of all time, along with Augustine's Confessions (which was often quoted by Calvin). Calvin's main thesis is justification by faith alone through Christ alone. It is the "alone"—the exclusivity of faith, the rejection of good works (or good works with faith), as a means to salvation—that creates the major doctrinal difference between Calvin's faith and Roman Catholicism. More here.

2. Scalia Speaks by Antonin Scalia

This book is a collection of speeches of the late US Supreme Court Associate Justice Antonin Scalia known for his conservative interpretation of the US Constitution ("originalist") and his colorful and passionate opinions. At some point his book made me tear up when Nino—as his best friend, Justice Ruth Bader Ginsberg, called him—wrote about his father and his childhood. His tributes to his friends were also moving. I wish there were more like him in government. He once said, "“If I have brought any message today, it is this: Have the courage to have your wisdom regarded as stupidity . . . Be fools for Christ. And have the courage to suffer the contempt of the sophisticated world.” More here.

Watch this memorable interview.

3. The Emperor of All Maladies: A Biography of Cancer by Siddharta Mukherjee

I wrote, "It is a narrative that illustrates the value of the scientific process, and how basic sciences—molecular biology, chemistry, and physics—form the backbone of medicine's understanding of this disease. The book excels in outlining the doubts and worries of the scientific community, a reminder that uncertainties lead to scientific questions; and with the questions come the answers—not as an inevitability but as a possibility. In a situation where death is impending, any possibility spells the hope of relief, if not an actual cure." What an exciting time to be in the field of Oncology! More here.

4.5.  Love to the Uttermost by F.B. Meyer

I quoted F.B. Meyer many times this year. This work is an exposition of the Gospel of John, highlighting the love of Jesus, a love that is to the "uttermost." I'll go back to this masterpiece of Christian literature to cheer and encourage my soul. If you find printed copies of any of his books, kindly alert me.

4.5. Browsings: A Year of Reading, Collecting, and Living With Books by Michael Dirda

These are reflections of Washington Post book critic and Pulitzer prize winner Michael Dirda about the joys of reading. These came out initially as weekly essays he wrote for The American Scholar. He is neither snobbish nor proud, but he exudes the childlike charm of a bookworm, and he loves reading so much that he wants to convince every person to get into the habit. Towards the end of this work, he quotes Franz Kafka, "The books we need are the kind that act upon us like a misfortune, that make us suffer like the death of someone we love more than ourselves, that make us feel as though we were on the verge of suicide, or lost in a forest remote from all human habitation—a book should serve as the ax for the frozen sea within us." Thanks to him, I got into a book-buying frenzy this December, having purchased Elena Ferrante's four Neapolitan books in one go because, according to him, to own a book is to own it physically. This was—and still is—a joy to read and reread. I imagine myself going back to Browsings to check his recommendations for what kind of fiction to read on holidays, what science fiction to enjoy, and so on.

5. Lincoln in the Bardo by George Saunders

President Lincoln and his dead child, in a gripping, heart-wrenching story about longing, death, and separation. What a delight—like reading an obituary in the backdrop of Dante's Inferno.

6. Dune Messiah by Frank Herbert

"Paul Artreides's sister Alia is now grown up, a sarcastic, powerful, intuitive Reverend Mother, trained in the ways of the Bene Gesserit. Paul is now called the Muad'dib, the Emperor of the known worlds in the galaxy, and he has to confront opposition, intrigue, and mystery that comes with his powers." More here.

7. The Quiet Ones by Glenn Diaz

"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." More here.

8. The Left Hand of Darkness by Ursula K. Le Guin

This book challenges the notion of love and sexuality, the way only science fiction can question our reality. A representative of the Ekumen goes to the Gethen, in the hopes of convincing the leaders of the planet to join the confederation of celestial powers. The Gethenians are ambisexual—they change sexes after a period of time. Ms. Le Guin was a writer ahead of her time. She passed away this year. More here.

9. The Secret Diary of Hendrik Groen, 83 ¼ Years Old by Hendrik Groen

The old fascinate me. Mr. Groen is an 80-something man who lives in a nursing home in the Netherlands. A sensible, decent man, he likes to keep to himself, his diabetic friend who would lose his toes due to neuroischemic foot ulcers, and his geriatric gang that goes out once a month. He also falls in love. Asians would probably not get the point of putting their parents in these institutions, for we would rather take care of our old ourselves, in our own homes, but this book nevertheless adds to my understanding of the unique challenges posed by aging.

10. Four Princes: Henry VIII, Francis I, Charles V, Suleiman the Magnificent and the Obsessions that Forged Modern Europe by John Julius Norwich

There's so much that history can teach us, only if we allow it to. In this gripping work by John Julius Norwhich, he draws themes from history's most powerful men in Europe.

Other books I read

When We Were Orphans by Kazuo Ishiguro

An English detective, who lost his parents in Shanghai, finds the truth about his parents. The book reminded me of the old streets of Hong Kong, for some reason.

Where Europe Begins with Yoko Tawada

I didn't enjoy this as much, unfortunately. The stories seemed weird to me.

Codename Villanelle by Luke Jennings

Have you seen the BBC series, Killing Eve? It's about an awkward detective who looks into the murders committed by a trained, brilliant, beautiful sociopath. A short read but was just as thrilling as the series starring Sandra Oh. The series was painfully short. No season two yet?

The Berlin Stories: The Last of Mr. Norris & Goodbye to Berlin by Christopher Isherwood

These reminded me of long train rides in Europe, and the many conversations I overheard there.

Boys Among Men by Jonathan Abrams

I belong to a cell group in church called Pilgrims, which is comprised of basketball-loving and -playing men, with whom I share a love for Christ and the Bible. I wasn't gifted in the sports department, so what would be the best alternative way of learning about basketball? In this book, Mr. Abrams, explores the lives of players who transitioned from high school straight to the PBA, bypassing collegiate tournaments. NBA is brimming with intrigue and malice, apparently, and all of that happens during the drafts. The young are vulnerable, and they need the support of family and friends.

Everything Happens for a Reason by Kate Bowler

"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." More here.

Theft by Finding by David Sedaris

Mr. Sedaris is among the funniest people alive. The books comes straight out of his diaries. The entries are absurdist. In reading this, I reminded myself to become more observant. Each day, each person is unique and could end up in my own journal.

Hillbilly Elegy: A Memoir of a Family and Culture in Crisis by J.D. Vance

The first book that made me realize that poverty creates a culture among those living in it that they can only go as far in life as their predecessors—until someone tells them otherwise. This is a biography of the lawyer, J.D. Vance, who is proud of his Appalachian, hillbilly heritage.

Ubik by Philip K. Dick

A group of inertials—men and women who have the special ability to negate powers of precogs and telepaths—is killed by a blast. The survivors go through a time warp and are subjected to rapid deterioration themselves. The panacea is a special spray called Ubik.

Ready Player One by Ernest Cline

By now, this must sound cliché, but the book is way better than the movie.

Any Human Heart by William Boyd

The journals of the fictional Logan Mounstuart, who comes from a privileged English background.

What I Talk About When I Talk About Running by Haruki Murakami

Mr. Murakami runs to fuel his writing. No wonder why he looks so trim!

Currently reading

What Are We Doing Here? By Marilynne Robinson
The Complete Father Brown by GK Chesterton
Too Much Happiness by Alice Munro
The Doctrine of Regeneration by Stephen Charnock

Never finished

Call Me By Your Name by André Aciman

At some point I could not take the language, as it bordered on the lascivious.


Christmas celebration 2018

Christmas 2018
With the Espinos, Fernandos, and Gesilvas

Christmas 2018
With Ate Milaine and Kuya Vance, among my dearest friends from church

Just when I've gotten used to spending Christmas alone, having been away from home for medical training, I got invited to a family gathering for the second time. There was food—Ate Milaine is a marvelous cook whose recipes pose a challenge to my self-imposed diet! There was music—cello and piano played by a wonderful home-based live band that played the songs I knew. I couldn't leave the party without a song rendition of sorts. I sang "On the Street Where You Live," among other standards, which unleashed the old soul within me—and in all of us, when I think about it now, because everyone chimed in during the chorus. There was conversation about cancer, fountain pens, and Christianity, where I learned various things about these brothers and sisters in Christ, all of whom left me with the feeling of being in heavenly company. Thank you, Espinos, Fernandos, and Gesilvas, for having me! (Photos by Ate Milaine)

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Tuesday, December 25, 2018

Liw's Reading Year 2018

Ate Liw, human rights lawyer and advocate, certified world peregrinator, once an English major and a dear friend, shares the most memorable reads she has had for 2018. Her global humanitarian work inspires me, but so does her travels, her book choices, and love for Jesus. She's one of the coolest, bravest, most elegant people I know, taking the road less traveled to champion the rights of the oppressed. She has has been a blessing to me and our family.

Three books with lasting effects on me

1. An American Marriage, Tayari Jones

My work allows me to witness the humanitarian consequences of overcrowded jails on persons deprived of liberty while on trial so I immediately connected with this novel. The way the story unfolds shows how each one of us can easily get caught up in a flawed justice system and how incarceration dehumanises. It is life changing to those incarcerated and alters their relationships with those outside, often in tragic ways. This novel should force us to start having conversations about punitive criminal justice systems and the lack of genuine restoration, reconciliation and rehabilitation.

2. Educated, Tara Westover

This fascinating memoir offers readers a door inside a life and world view dominated by extreme religious beliefs and how learning—culture, history, beliefs, travel—shines a light in a dark world. Definitely outstanding.

3. Last Girl, Nadia Murad

Another memoir about how holding on to extremist religious beliefs can destroy not only a single life but in the case of ISIL, trigger a genocide of the Yazidi race in Iraq. Having worked with young victims of sexual slavery and abuse, Nadia’s personal harrowing experience sadly wasn’t new to me- but the magnitude and how the entire world watched without intervention was truly shameful to read. Her resilience and her incessant quest for justice on what was done to her, her family, her community and her race will inspire if not rebuke us all from our inability to empathise and our propensity to dehumanise real tragedies happening in the world. Nadia’s extremely remarkable story should make advocates of us all against sexual violence, religious intolerance, armed conflict and injustice. Her 2018 Nobel Peace Prize Award is well deserved.

Books that gave me vicarious experiences

1. The Witch Elm, Tana French

What drives a person to kill someone and how violence and abuse affects a victim.

2 The Woman in the Window, A.J. Finn

Because we need to talk about mental health more.

3. Lilac Girls, Martha Hall Kelly

What populism brought Poland during World War II.

On worldview, perspectives and faith

1. Sapiens, Yuval Noah Harari
2. ISIS: inside the Army of Terror, Michael Weiss and Hassan Hassan
3. Scott Sauls on suffering (and his books)
4. The Sun and Her Flowers, Rupi Kaur


The role of novels in society

Héctor Abad, a Colombian novelist, answers this way when asked what literature can play in forming his country's historical memory:

I believe that novels are condensing machines for stories. In a farm, the history of a country can be reflected, because history passes through its terrain and leaves traces. The war leaves traces. In Gabriel García Márquez, one massacre stands for all the massacres. In Evelio Rosero, armies without a name can be the guerrillas, the paramilitaries or the regular army. In Juan Gabriel Vásquez, German Jews are treated like Nazis during the second world war. In Santiago Gamboa, sex is the substitute for many other frustrations. In my novel Oblivion, a good man murdered becomes the symbol of many innocent victims killed unjustly. Novels help us understand and understand each other.

I love Latin American novelists—they write a lot like Filipino novelists. We are related in more ways than we can imagine, having been colonized by Spain for many years and so on.


Monday, December 24, 2018

Manong Ralph's Reading Year 2018

My brother, Manong Ralph, a human rights lawyer based in Manila, reads more voraciously than I do. In college he majored in English Studies, perhaps his best excuse to go the library and get lost in the world of stories and ideas. Analyzing stories of James Joyce wasn't a chore but a delight, which is why I wasn't surprised that he graduated top of his class. A lot of book ideas I gain from him. He introduced me to Michael Chabon, who appears in this list, and to many more authors who have made our lives and imaginations richer and grander. 

At the beginning of the year, I decided to read Marcel Proust’s tome, In Search for Lost Time, beginning with Swann’s Way. A quarter into the book, 2018 is already about to end! I did manage to squeeze in a few books, having read them while stuck in traffic, waiting in court, or before bedtime. Here’s the top ten books I’ve read this year, in no particular order:

1. Lincoln in the Bardo by George Saunders

At the heart of this novel is a love story between a father and his son that goes deeper than the grave. President Lincoln’s son, Willie, died suddenly and he was buried in a cemetery. That night, he visited the crypt and grieved for his son. Ghosts of bodies laid to rest in the cemetery talk and interact with one another. Throughout the book, you could piece together their histories and their stories. This reminds me of Spoon River Anthology written by Edgar Lee Masters. It is a collection of poems—narratives from the epitaphs of the town’s residents about how they lived and treated one another.

2. Train Dreams by Denis Johnson

It is a quiet novella. There is no villain who needs to be stopped, no grand conflict that needs to be resolved. It is just a story of a man who lived a long life, and yet it is so compelling and sad and beautifully written. I haven’t heard of Denis Johnson until I saw a YouTube clip of Michael Chabon and Zadie Smith, two authors whom I admire, extol him and his work.

3. Hillbilly Elegy by J.D. Vance

Written by a self-confessed hillbilly who grew up poor, lived through adverse childhood experiences, and yet got into the military and then to Yale Law School, this book that is part biography, part critique, explores how it is to live in “middle” America. It also explains, unintentionally and in part, why people voted for Trump.

4. Amazing Grace by Eric Metaxas

This is a biography of William Wilberforce, an 18th-century Christian who was mainly responsible for the abolition of the slave trade in England. As someone who works on the issue of human trafficking, exploitation of children, and other forms of modern day slavery, this book reminds me that the road ahead is full of challenges and opposition, requires hard work, and is not possible apart from the grace and mercies of God.

5. Name Above All Names by Alistair Begg and Sinclair Ferguson

This is one of the books that benefitted my soul. This treatise is written by two Scottish pastors, Alistair Begg and Sinclair Ferguson. They write about Christ and examine key aspects of His person and ministry, from Genesis through Revelation. My favorite part is the last chapter where they talk about Jesus as The Lamb on the Throne—a wonderful and encouraging picture of a victorious King!

6. Autumn by Karl Ove Knausgaard

In this book, Knausgaard writes about the most ordinary things, as a way to introduce the world to his yet-to-be born daughter. There’s a section on chewing gum, bee keeping, toilet bowls, and the migration of birds.

7. A Man Called Ove by Fredrik Backman

About Ove, a grumpy old man who is the hero of this book: “Ove couldn’t give a damn about people jogging. What he can’t understand is why they have to make such a big thing of it. With those smug smiles on their faces, as if they were curing pulmonary emphysema. Either they walk fast or they run slowly, that’s what joggers do.” Ove is my spirit animal. This book is one of the funniest books I’ve read this year.

8. Moonglow by Michael Chabon

After I read the Amazing Adventures of Kavalier and Clay many years ago, I told myself I’ll read anything Michael Chabon writes. He has become one of my favorite contemporary writers. Moonglow is a bit different from Kavalier and Clay and his other writing in that it is sort of a fictionalized memoir about his grandfather. It is tender, exciting, and human.

9. Sing, Unburied, Sing by Jesmyn Ward

A black woman with her two children takes a car ride to pick up her white boyfriend (and the father of her kids) from prison. The book explores race relations and its dark history in America, particularly in a fictional town in Mississippi. It is also a story about a family and the forces that threaten to break it apart. I love the magic realism that is interwoven in this book.

10. Made for Friendship by Drew Hunter

This book explores the theology of friendship drawn primarily from Scripture. His main thesis is “friendship exists because God befriended us and created us to befriend one another.” Set against the world’s shallow understanding of friendship, Hunter argues—as did C.S. Lewis in The Four Loves—that friendship can be so much more nourishing and satisfying, and we should deliberately pursue deeper, godly friendships.


Sunday, December 23, 2018

Kuya John's Reading Year 2018

My friend, Kuya John Dasmariñas, based in Singapore, has spent a great deal of 2018 reading. I'm sharing his favorite reads. This was originally posted on his Instagram, but I'm sharing it now, with his permission.

My Top 7 books based purely on how I felt after reading them; because while details escape you, feelings linger.

Kuya John's My Reading Year 2018

Kuya John's My Reading Year 2018

Kuya John's My Reading Year 2018

7. The Corrections by Jonathan Franzen - A comedy on relationships with our family, money, our ambitions and the cruelty of the world we all need to live with. Only an avant-garde writer can curate a plot that resonates with our very own musings we all are embarassed to tell even ourselves or our closest friends.

6. Smaller and Smaller Circles by FH Batacan - Apologies for the cheap analogy, but it's a page turner like Crazy Rich Asians. This first Filipino crime novel in English should be mandatory reading for all secondary students in the Philippines.

5. Nocturnes by Kazuo Ishiguro - The short stories brought to life my introvert predilections towards finding joy in life's ennuis. Best read in an outdoor cafe when you're uncertain between having a cold beer or an iced latte.

4. Flights by Olga Tokarczuk - Best read when you feel like smoking some joint but you're not brave enough to try it. Only a genius can pull off a narrative as elegant as Flights. You are not certain what the author is talking about but you just drift with the prose.

3. Sapiens by Yuval Harari - Professor Harari walks you through the history of mankind and you feel like the most learned man in the house. Amazing how he causes you to marvel at all the major events in history and put your humble little space into perspective.

2. Atonement by Ian McEwan - I finished the novel while I was on a double-decker bus plying the expressway and all I wanted to do was sniff the brown, acidic pages so I could literally take it all in. Yes, it's that good!

1. The Confessions of Saint Augustine - Not to be religious but his written meditations on life just deserve so much appreciation for articulating for us what our innermost beings could not translate into practical, digestible packets of truths. Yes, the old english text needs some getting used to, but once you're immersed into its rhythm, it's like having a spiritual, physical and mental massage, all at the same time!


Saturday, December 22, 2018



Today was extraordinarily gloomy, with overcast skies and the occasional drizzle—my favorite version of God-ordained weather, as I do not care much for the sun, given that I live in the tropics, and discomfort from too much heat is a daily reality. Today was extraordinarily relaxing, too, because I had no errands and therefore had the entire day off. I chose to spend it on intermittent naps, books (hardbound and electronic), and Netflix (currently on Silvana Sin Lana, whose Spanish-speaking characters have Filipino emotions and proclivities—highly recommended by mother, so how could I say no?). I came across this passage from T.H. White's The Once and Future King, where Arthur, called Wart, asks Merlyn the magician to turn him into a bird. Before Merlyn answers, T.H. White launches into a beautiful description of the landscape, the kind that makes me long for pure, black-and-white classic stories like the one I'm reading now, where good always prevails, and the trees are lovely. I love passages like this, innocent and untainted, a respite from a world gone wrong.


A year since finishing residency

IMax Jo Dane wedding

I was so glad to meet up with some friends from my batch in PGH-Internal Medicine—as if, of course, we need catching up, this despite the fact that we bump into each other at the hospital on a weekly basis. Jay is pursuing further studies in Maryland, USA. Roland is in Pulmonology. Everly will pursue further studies abroad next year, having just finished her colorful stint as the department's Chief Resident (congratulations, Chevs!). Bea is in Endocrinology. Carla is in Pulmonology. Racquel is in Endocrinology. Rich is in Medical Oncology. Jeremiah is in Hematology. Roger is in Medical Oncology, too. This was snapped during Kuya Dane and Jo's wedding last Sunday. I just wanted to memorialize this photo here to remind myself that a year has passed since we finished residency. We're in different fields now, busy with various careers, but inside, trappings and degrees aside, we're still the same noisy, sleep- and food-loving people who care for accurate diagnoses and properly-worded clinical histories.


Thursday, December 20, 2018

Where King Arthur is called Wart


I won some cash at yesterday's Christmas party and, before going home, I took some time reading my new copy of T.H. White's The Once and Future King, in a special hardbound edition by Penguin, at a café inside Robinson's. It opens with a foreword by Neil Gaiman who talks about science fiction/speculative fiction; he enumerates his favorite works, some of which I have already read, including Left Hand of Darkness by Ursula Le Guin and Dune by Frank Herbert. Seated across from me was a Japanese man copying sentences from an English newspaper using pencil and paper, reciting the words in a whisper as soon as he had written them—yet another proof that it's never too late to learn a new language.


Wednesday, December 19, 2018

Some say apples are better than coffee

... in keeping one awake—I say, why not have both? This was snapped after my leisurely morning rounds which rarely happens these days.


You're All To Us

Let the glory of Your name be the passion of the Church
Let the righteousness of God be a holy flame that burns
Let the saving love of Christ be the measure of our lives
We believe You're all to us


Sunday, December 16, 2018

Congratulations, Mr. and Mrs. Sacdalan!

Dane and Jo

I'm grateful for the friendship I share with Kuya Dane Sacdalan and Jo Lucero who are now, as of today, husband and wife.

I've known Kuya Dane since our undergraduate days in Molecular Biology at UP Diliman. He was—and still is—one of the kindest people I know, and talking to him always uplifts me, like breathing fresh air after being stuck inside a stuffy room. I was glad to meet him again in med school; he graduated earlier and pretty much took up the same career choices as I did: three years of Internal Medicine (UP–PGH) and another two in clinical fellowship in Medical Oncology (UP-PGH). He was my senior at the Medical ICU and remains a lifetime member of the OPD Team B (a badge that I, too, proudly carry). Whenever opportunity presented itself, I would ask him for advice. I sometimes send him emails the old-fashioned way, to which he would write heartfelt responses. On the occasion of my father's death, Kuya Dane wrote to me:

Life is a sacrament of waiting—waiting for a train to come, for an infusion to complete, for a hurt to heal, for a reunion with a loved one who has left us, for a time. Waiting afflicts us with yearning. It is how we bear this longing—that emptiness you speak of—which gives meaning to our living and loving.

He told me to show compassion to patients because, as medical oncologists, we're probably the last physicians they'll see.

I've worked closely with Jo when she was chief resident of Internal Medicine. She asked me to become her assistant chief resident for undergraduate affairs, and after much protestations, she won me over. How could I say no to her—this paragon of efficiency combined with thoughtfulness, speed with grace, conviction with understanding? Working with her in that team, and interacting with her during meetings and gatherings, has changed me for the better. I was inspired to give it my all because she gave her all—what leadership she showed! Jo, now specializing in Hematology, remains an excellent physician. My style of charting—short and sweet—I largely derived from hers, when she was the Physician-on-Duty (POD) and I was a clueless first year resident who missed many salient points in my clinical histories. Good thing Jo's notes were always complete, her diagnoses sound, and her plans practical.

Seeing them together—these beautiful specimens of humanity, made more radiant by their symbiotic union—makes me glad. I wish for them joyful, meaningful, God-glorifying lives that overflow with kindness and grace to every person they meet.

Photo credit: With Joy (their wedding registry)


Just in case you're wondering what to give me for Christmas

Here are some ideas.

— fountain pen with a 1.1 mm stub nib (notify me first so I can direct your attention on which brands I prefer)
— fountain pen ink (preferably Parker Quink blue-black, Pilot Irishuzoku of any color, and Noodler's black ink)
— an unlined pocket notebook (not Moleskine, which isn't ideal for fountain pens)
— any book by Marilynne Robinson, Kazuo Ishiguro, Ian McEwan, James Salter, and Jonathan Franzen
— The Institutes of the Christian Religion by John Calvin
— Systematic Theology by Wayne Grudem
— shoe leather conditioner

More importantly:

— four 50 mg vials of oxaliplatin
— three 80 mg vials of paclitaxel
— one box of sorafenib, regorafenib, or lenvatinib
— six vials of trastuzumab 600 mg
— one free whole body FDG-PET CT scan

And then there's always world peace. Or a round-trip ticket to New Zealand.


The innocence of childhood friendships

I’m rereading Elena Ferrante’s My Brilliant Friend, the first book of the Neapolitan novels, and it has given me enormous pleasure once again. I read this in 2015: my mother and her best friend, Auntie Cecil, went to the Lucky Chinatown Mall in Binondo, Manila to buy things. Meanwhile I preferred to stay at a Mary Grace café and read on my iPod.

Here's a passage that appears on pages 106-107 that shows the unique dynamics between Elena and Lina:

We were twelve years old, but we walked along the hot streets of the neighborhood, amind the dust and flies and the occasional old trucks stirred up as they passed, like two old ladies taking the measure of lives of disappointment, clinging tightly to each other. No one understood us, only we two—I thought—understood one another…There was something unbearable in the things, in the people, in the buildings, in the streets that, only if you reinvented it all, as in a game, became acceptable. The essential, however, was to know how to play, and she and I, only she and I, knew how to do it.

She asked me at one point, without an obvious connection but as if all our conversation could arrive only at that question:

“Are we still friends?”


“Then will you do me a favor?”

I would have done anything for her, on that morning of reconciliation: run away from home, leave the neighborhood, sleep in farmhouses, feed on roots, descend into the sewers through the grates, never turn back, not even if it was cold, not even if it rained. But what she asked seemed to me nothing and at that moment disappointed me. She wanted simply to meet once a day, in the public gardens, even just for an hour, before dinner and I was to bring the Latin books.

“I won’t bother you,” she said.


Friday, December 14, 2018

A nature changed

This nature is changed in every believer; for it is impossible a man should stand bent to Christ with his old nature predominant in him, any more than a pebble can be attracted by a lodestone, till it put on the nature of steel. An unrighteous man cannot act righteously, it must therefore be God, who is above nature, that can clothe the soul with a new nature, and incline it to God and goodness in its operations. Now to see a lump of vice become a model of virtue; for one that drank in iniquity like water, to change that sinful thirst for another for righteousness; to crucify his darling flesh; to be weary of the poison he loved for the purity he hated; to embrace the gospel terms, which not his passion but his nature abhorred; to change his hating of duty to a free-will of offering of it; to make him cease from loathing the obligations of the law, to a longing to come up to the exactness of it; to count it a burden to have the thoughts at a distance from God, when before it was a burden to have one serious thought fixed on him, speaks a supernatural grace transcendently attractive and powerfully operative.

Don't you love Stephen Charnock's writing? Doesn't his words flow in poetic melody? Every time I read something like this, the more I am convinced to read classic Christian literature, penned by the Puritans and faithful believers of old, whose intimacy with the Lord seemed uninterrupted. Their circumstances then were different, but their struggles were similar. Never mind the fact that it may be hard to decipher the sentences. I suppose the effort is well worth it—there is treasure hidden in these works.


Monday, December 10, 2018

Neapolitana novels -- complete!

My stack of fiction reading. 

Today was especially tiring, so I treated myself to printed books, Europa editions, of Elena Ferrante's Neapolitana series of novels. I've read the first two in my Kindle, but I'd love to read them, and the last two, in print. These will keep me company throughout the holidays. My brother, thrilled to see them on the dining table, made a very good point, "And where do you plan to display these?" As with most of my books, they find their ultimate home in our St. Gabriel house, where Nanay will likely complain that she doesn't have enough shelves to have these on display.


Sunday, December 9, 2018

After the closing song

Almost every Sunday service, after the closing song is sung and the crowd starts to move out of the sanctuary, I am asked about a medical problem before I descend the stairs—from a stomach ache from too much coffee, to an anterior mediastinal mass that screams malignancy. I love talking to these brothers and sisters who call me “Doc” despite my protestations (“Just call me Lance”), but I’ve long since realized that this is their way of showing their endearment, their filial pride. It warms my heart that they think I can enlighten them as to what bodily issues they have, if they have cause to be worried, or if their own physicians are doing the right thing. I feel that these random consults are, in a sense, an extension of the clinic.

Indeed, illnesses know no boundaries, and people close to us, even those with whom we share the same faith and theology, can suffer the humbling truth that bodies disintegrate, organs fail, and cells malfunction. Such is the bittersweet reminder that our time on earth is finite, and to go to Heaven we must die. Those who have cancer at least have an idea of how the Lord will take them home.

This Sunday I pray for these dear brothers and sisters—that the Lord’s healing be upon them, that He guide their own physicians to give them the best medical care possible, and that He use these moments of pain and suffering to bring them closer to a deeper knowledge of Him—the great physician of bodies and souls.

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Thursday, December 6, 2018

Second years na!

I had a great time moderating the PGH-sponsored PSMO Round Table Discussion on AIDS-related Malignancies. Our case was that of a 29-year old male with Kaposi sarcoma, presenting with cutaneous lesions as well as with internal organ involvement, i.e., lungs and liver. Rich King and Fred Ting discussed the details of the case and principles of management. Because I moderated the program, I had the chance to mine the clinical experience and expertise of our guests in the panel discussion. We were so grateful to have learned a great deal from Dr. Franscisca Roa (Dermatology), Dr. Dessi Roman (Infectious Disease), and Dr. Gracieux Fernando (Medical Oncology). Our colleagues from the seven other training institutions—St. Luke's, Makati Med, Veterans, Jose Reyes, Medical City, UST, and NKTI—were wonderful, answering spot-on the questions we threw at them, and sharing their institutional experience regarding the case. Here are photos taken by Norman Cabaya.

Update (as of November 8, 2018)

Some key learning points during the RTD:

  • There is no critical CD4 count that determines whether chemotherapy may be allowed; CD4 levels are largely unreliable for this purpose. As long as the patient is clear of opportunistic infections and has good functional status, systemic chemotherapy may be done.
  • Management of Kaposi sarcoma is largely interdisciplinary.
  • Presence of disseminated cutaneous lesions with internal organ involvement is an indication for chemotherapy.
  • First line chemotherapy is liposomal doxorubicin. If finances may be a problem, we may use plain doxorubicin instead.

PSMO RTD PGH pic with buddy


Korean pose in which I hide

PSMO RTD myself with panel

PSMO RTD with guest speakers

PSMO RTD pic with consultants


Wednesday, December 5, 2018


I will be moderating the PGH-sponsored Philippine Society of Medical Oncology Round Table Discussion on AIDS-Related Malignancies tomorrow night. My friends and colleagues, Dr. Rich King and Fred Ting—rhyming, I know—will discuss an interesting case and some nitty-gritty details in the new approaches to these diseases. It will be followed by a panel discussion with the following experts: Dr. Francisca Roa (Dermatology), Dr. Dessi Roman (Infectious Disease), and Dr. Gracieaux Fernando (Medical Oncology). Some residents and fellows from Dermatology and IDS—and Hematology, I learned—will also be joining us. This is exciting news—having these great minds around—because management of these cases is largely multidisciplinary.

Tuesday, December 4, 2018

Christian theology is not too big on self-esteem

Christian theology goes against the grain of modern psychology, such as in the issue of self-esteem. Whereas we are taught that we are all good and should feel good (consider, for instance, the many Dove commercials, with self-esteem as the battle cry), Stephen Charnock, an English Puritan clergyman, wrote this about man as he pondered on the doctrine of regeneration.

In ourselves we are nothing, we have nothing, can bring forth nothing spiritually good and acceptable to God; a mere composition of enmity to good and propensity to evil, of weakness and wickedness, of hell and death; a farden of impotence and conceitedness, perversity and inability, every way miserable unless infinite compassion relieve us We have no more freedom than a chained galley slave till Christ redeem us; no more strength than a putrefied carcass till Christ raise us, an unlamented hardness, an unregarded obstinacy, an insensible palsy spread over every part, a dreadful cannot and will not triumphing in the whole soul.

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Sunday, December 2, 2018

In defense of light reading (and watching Netflix)

With the breakdown of the internet connection this weekend came more than sufficient time to take on leisure reading. During residency I resolved not have any internet connection at home to give myself time to study and rest. It proved a wise decision, as it helped settle my mind to rest, shielding me from unnecessary distractions. A distracted person is a bad physician.

Since I moved in with my brother, I've had steady internet connection. It sometimes proved a distraction, but only during certain days. It has been useful for academic reading; anybody involved in oncology knows how fast things change in the field. But work generally exhausts me, and I treat myself to a few episodes of Netflix shows (the latest: The Kominsky Method, which my family loves) or some light reading before I go to bed, usually between 7:30 to 8 PM. How geriatric, I know. 

Being able to relax and unwind makes me a better physician--this I have long since realized. By light reading, I mean the enjoyment of non-academic literary works, regardless of whether they are high- or low-brow reading materials. I love the fact that even J. I. Packer does some light reading himself, and he includes GK Chesterton's Father Brown stories to his list. 

Light reading is not for killing time (that’s ungodly), but for refitting the mind to tackle life’s heavy tasks (that’s the Protestant work ethic, and it’s true)

You must find what refreshes you, as your senior editors have found what refreshes them. And if you will not accuse us of being wicked worldlings for our light reading, I will not accuse you for watching all those TV sitcoms and sports programs that so bore me. Fair? Surely—and Christian, too.

My light reading list includes: Nick Joaquin's The Woman Who Had Two Navels and Tales of Tropical Gothic, Dean Francis Alfar's A Field Guide to the Roads of Manila, Stephen Charnock's The Doctrine of Regeneration (certainly not a light read, but one that keeps me awake, as it is a voluminous study on the theological subjects of salvation and conversion), Michael Dirda's Browsings, and Marilynne Robinson's Why Are We Here?.

"Refitting the mind to tackle life's heavy tasks"--now I like the sound of that.


Saturday, December 1, 2018

Poster at 7/F elevator proves existence of hospital grammar police.

Internet frustrations

Just when I thought I had a hold over my impatience, the wifi connection at home broke down. For months I’ve dealt with patchy internet connection—this, given the fact that my brother and I are subscribed to PLDT Fibr, arguably the fastest connection available. It isn’t news that internet is more expensive in the Philippines than in most of the world; the internet service in this country has much to improve on.

But for the past three days the connection had died. I called the PLDT customer service, but I only received platitudes, excuses, and an assurance that a report is being written, which will be forwarded to the technical service crew. A lineman arrived at home yesterday. His diagnosis was that the PLDT connection was fine; the problem is with the conduit connecting the modem and the TTC. The wire needed to be changed, he said, and it was left to me to contact an engineer who can replace the wires. In a few hours I was able to get hold of an engineer. This morning, the cat. 5 internet cable was replaced—successfully, I suppose, given that the telephone connection was also restored. But the internet connection remains broken, even during the time of writing.

I called up PLDT again and received the same excuses. I handed the phone to my brother, who was more calm but who remained firm. He even laughed at seeing me so irritated, angry, and unable to do anything else because of the paralyzing infuriation. “No, I will not hang up until you assure me that a technician will come over today,” I overhead him say, this after an hour of receiving otherwise useless instructions from Donna, the hapless customer service representative who probably had no idea what was going on but who was paid to read from a script, to keep people like us appeased. There comes a point when one loses patience at the waiting, and I reached this point today. It makes me feel frustrated about feeling frustrated.

But there is a lesson in this somewhere. Patience, humility, losing my sense of self-entitlement. I am a work in progress.

I spent the Saturday afternoon reading Nick Joaquin’s The Woman Who Had Two Navels and Tales of the Tropical Gothic, published by Penguin. I even worked on a story.

I still wish we had better internet service providers. There’s much to be desired about PLDT Fiber, and if only I had a choice, I would pick another.

Do you have other recommendations?


Where can I get one?

Blue book bag

This reminds me of college. (Photo credit: Michael Dorado via Twitter)


Wednesday, November 28, 2018

A favorite hang out place

By "favorite," I mean a quiet place where I can sip coffee, read books, and hear my own breathing.



I love this charming restaurant in Tomas Morato called Uno. I go here on Thursdays, usually before my cell group in church.  The staff are kind and cheerful, and they leave me pretty much alone unless I ask for the bill or for a glass of water.


Sunday, November 25, 2018

Death at 26

A life well-lived is how I would call John Allen Chau’s story—a 26-year old American missionary who was killed off the coast of India. He “attempted to share the gospel with the most isolated tribe in the world.”

News like this gives me hope. To the rest of the world’s eyes, this is a waste. From a spiritual perspective, this is just the opposite. John Allen Chau’s death has adorned the gospel. He loved the Lord Jesus Christ so much that he chose to preach the gospel of salvation to the unreached, choosing this path in life over the comforts of a first-world home.

May the Lord use his example to remind us that there are many people groups in the world that have not yet heard of Jesus.

(Photo: Daily Mail)


Morning routine

Bagyong Egay

My body is jolted into wakefulness at 4 am, around the time my bladder signals that it’s time to pee and get ready for work—my natural alarm clock. These morning wee hours are the most precious—the time I use to write on my journal, pray, read the Bible, meditate, and read some more. Tim Challies wrote in his book on productivity that one must work on the most important things first. A favorite song from Sunday School had lines that went, “Read your Bible; pray every day.” This morning habit I largely derived from Tatay, who woke up before everyone else did and head over to my room, turn the lights on, read his Bible aloud, and some passages from a book by AW Tozer, his favorite. This used to irritate me, but now that he has passed on, I miss it—it was as if he was reading for me passages about the sovereignty of God.

If I have extra time, before I catch my 6 am train, I read the news, go to The Old Reader to check if the blogs I follow have posted new things, eat a quick breakfast, brew a nice cup of Sultan Kudarat coffee (still the best, a soothing reminder of home), and say goodbye to my brother, Ralph, who usually leaves later. I try to stay away from social media unless there’s an important announcement to watch out for—like cancellation of work. As if, of course, it matters. I also check my phone to see if I have new in-patient referrals to see, to read messages from patients who email me their lab results from time to time, and do my best to reply to them during the train ride. Sometimes I just ignore the phone and come to terms with its existence as soon as the train arrives as Pedro Gil Station at 7 am, or thereabouts—there’s too much uncertainty because you know how trains in Manila are: as unpredictable, and occasionally as disastrous, as the weather.

I hope I encourage you by writing about my morning routine. Doing my quiet time, sometimes forcing myself to do so, has been a fruitful investment for me. It aligns my mind and heart to the day ahead. It exposes my fears and anxieties to the comforts and reassurances of God. I fail many times in this respect—sometimes I forget it entirely, in light of the many things I need to do for the day—but, as in most aspects of the Christian life, I need to carry on. God’s mercies are new every morning.

Wednesday, November 21, 2018

Mr and Mrs Ferrolino

As you all know, I don't relish attending wedding ceremonies but take particular exception to invitation from close friends. Imagine my surprise when Brian (whom I still, after all these years, refer to as Aljur—a long story), asked me to join his wedding entourage because someone else, his cousin, as I recall, could not make it to the ceremony. Aljur is a quiet, kind, and introverted man who was part of our lunch group in med school. Over the course of many years, I've worked with him on several cases, especially head and neck tumors; he is about to finish residency in otorhinolaryngology (ORL) this year. Mayi is a fascinating specimen of a human being with so much energy, grace, and joy packed in a petite frame. Talking to her is comparable to a satisfying shot of espresso. Our internship blocks had many overlaps in the rotation, and during downtimes, I enjoyed stories of her extraordinary and accomplished family and her love of books. She is now doing residency in OB-Gyn. Brian and Mayi, now Mr. and Mrs. Ferrolino, had a beautiful wedding in Tagaytay. I wish and pray for them a beautiful and joyful life, and I'm grateful for their friendship.


Monday, November 19, 2018

Looking back

Sinclair Ferguson on what he would say to his younger self.

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Sunday, November 18, 2018

Meditation on God's love

I've been quoting FB Meyer unabashedly. His book, Love to the Uttermost, is a compilation of his preachings on the Book of John. It is a masterpiece of good writing and good theology. It has been a blessing to my soul, as it has proven useful material for my daily devotion.

This Sunday I'd like to encourage you with FB Meyer's vision of God's love. This is the concluding statement of his preaching on John 18:4, "Then Jesus, knowing all that would happen to him, came forward and said to them, 'Whom do you seek?'"

If it moved Him to endure the Cross and despise the shame, is there anything that it will not withhold, anything that it will not do? His love is stronger than death, and mightier than the grave. Strong waters cannot quench it, floods cannot down it. It silences all praise, and beggars all recompense. To believe and accept it is eternal life. To dwell within its embrace is the foretaste of everlasting joy. To be filled by it is to be transfigured into the image of God Himself.

I've long since resolved to read Christian literature, especially classic literature, more intentionally. After a year, I've finished John Calvin's magisterial work, The Institutes of the Christian Religion, and am also now plowing through Stephen Charnocks's The Doctrine of Regeneration. As I do this, I take to heart my cell servant's exhortation to our Bible study group, "Read Christian books!"


Tuesday, November 13, 2018

We're now the Philippine Cancer Center

Senate OKs bill on national integrated cancer control program, reported by GMA News:

Voting 18-0, the Senate approved on third and final reading Monday a bill seeking to institutionalize a national integrated cancer control program... 

The bill will establish a National Integrated Cancer Control Council whose sole focus is to implement programs that will not only provide comprehensive, accessible and affordable cancer treatments for all cancer patients, but will also work on minimizing the incidence of preventable cancer cases...

The bill shall also mandate the establishment of the Philippine Cancer Center, under the control and supervision of the University of the Philippines-Philippine General Hospital (UP-PGH), for the treatment and accommodation of cancer patients. The center shall also initiate research, in collaboration with other universities, hospital and institutions, for cancer prevention and cure...

Likewise, regional cancer centers shall be established nationwide for the treatment and care of cancer patients. The center shall also undertake and support the training of physicians, nurses, medical technicians, pharmacists, health officers and social workers on good practice models for the delivery of responsive, multidisciplinary, integrated cancer services.

This is a step towards quality care of patients with cancer in the country.


Birthday poetry

This moves me. A Happy Birthday by Ted Kooser.

This evening I sat by an open window
and read till the light was gone and the book
was no more than a part of the darkness.

I could easily have switched on a lamp,
but I wanted to ride this day down into night,
to sit alone and smooth the unreadable page
with the pale gray ghost of my hand.


Monday, November 12, 2018

The world's hatred

From F. B. Meyer, "Love to the Uttermost":

It is not difficult, therefore, to go through the world and escape its hate. We have only to adopt its maxims, speak its language, and conform to its ways . . . Ah, how many pleading glances are cast at us to induce us to spare ourselves and others, by toning down out speech, and covering our regimentals by the disguising cloke of conformity to the world around! “If you do not approve, at least you need not express your disapproval.” “If you cannot vote for, at least do not vote against.” If you dissent, put your sentiments in courtly phrase, and so pare them down that they may not offend sensitive ears.


Thursday, November 8, 2018


My package from Amazon arrived, the first of its kind I've received. It's a pair of chukka boots, my early Christmas gift for Manong. Another one is arriving next week, also a pair of chukka boots (same brand, different leather color) for Sean. I have the same pair of shoes, too. We dress the same way, my brothers and I, and share many interests. Over the years they've become fans of automatic wristwatches, fountain pens, and eyeglasses. When I met the UPS delivery guy at my building's lobby last night, I felt, upon receipt of the box, like it was "Christmas morning." I remember my friend Rac, who calls happy days "Christmas mornings." The chukkas and the wristwatches were due to my friend Carlos's rabid interest in their items, a fascination that infected me throughout these years I've known him.


Wednesday, November 7, 2018

Pakô salad

Salad greens picked from the backyard

I'm not impressed by farm-to-table restaurants. I suppose that's because I grew up eating vegetables plucked from the farm, our neighbor's garden, and our own backyard, that I find the concept ordinary. For lunch at home, we had the pakô salad—picked from Auntie Lisa's farm—drizzled with vinegar, and to which mother added slices of fresh mango. This wasn't the main dish; for that, we had tuna pangá and a mouth-watering serving of rice (store-bought, not from our farm. The harvest season won't be until a few months).


Tuesday, November 6, 2018



Kung ano ang bigkas, siya rin ang baybay. Pomme frites stall at Golden Valley Memorial Garden, Koronadal City, South Cotabato.


Monday, November 5, 2018

Books that fit in one's hand

Dwarsliggers–these are called. They are developed in the Netherlands and will be adopted by Penguin, targeting the young. I'm no longer as young, but whatever gets me reading, I will try at some point. The design makes sense, and I'm excited to try one of these books as soon as they become available locally.

Glad to read this quote from Carl Sagan:

“A book is proof that humans are capable of working magic . . . It’s a flat object made from a tree with flexible parts on which are imprinted lots of funny dark squiggles. But one glance at it and you’re inside the mind of another person, maybe somebody dead for thousands of years.”

It goes without saying that I've been doing most of my reading in my Kindle (I named it John Ames—one has to during device registration) because of storage limitations where I live. I still read paperbacks, especially old ones, because I like how they smell.

Photo credits: NYT


Sunday, November 4, 2018

November adventures

I took the earliest flight to Gensan. I was at NAIA at 2 AM. Traffic from Mandaluyong to Pasay was light. There weren't long queues at the airport. I read a book on my Kindle, did some academic reading in my laptop, and slept throughout much of the flight. It was the perfect arrangement.

Flying over Cotabato City, dawn

My kid brother Sean picked me up from the airport on November 1 at 6 AM. In my family, apart from my father who had already passed away, he remains the only one who can get behind the wheel. We passed by the fruit stands in Tupi, where we bought papaya, mangga, pinya, and melon, to give to mother.


We visited Tatay's grave at 8 AM and chatted with old friends and acquaintances. Nanay hosted a party for close family and friends that evening. November 1 felt a lot like a family reunion.

The next day, Sean drove Manong Ralph to Auntie Lisa's property in Banga. Manong spoke at the church's youth camp, exhorting the participants, who used to be in Sunday school (how times flies!), to a saving knowledge of Jesus Christ. Sean and I roamed around Auntie Lisa's beautiful property. Praise be to God for her hospitality and generosity.

Huge dog house

Rice paddies


I spent my third day at home watching Season 6 of House of Cards. Sean drove us around the city and treated us to afternoon snacks.

Today, we're going to church in the morning. Sean is driving me to the airport for my 3 PM flight to Manila.

Thanks, Sean! What would your brothers do without you?


Saturday, November 3, 2018

Less is not more

Here's a helpful comment by Drs. Filho and Burstein.

The PHARE, HORG, and SOLD studies also failed to demonstrate non-inferiority. To date, only one of 5 trials of shorter vs longer durations of adjuvant trastuzumab – the PERSEPHONE study of 6 vs 12 months – has demonstrated non-inferiority for a shorter regimen. All the others showed a measurable 2-3% reduction in recurrence risk with the longer duration of trastuzumab therapy.

The conclusion is that, for Her-2 positive breast cancer, 12 months of trastuzumab is still better than a shorter duration of giving the said drug.

But based on the data in Short-HER2 and four other trials of treatment duration, we believe that 12 months of trastuzumab, including 3 months of concurrent administration with taxane-based chemotherapy, remains the standard of care and the optimal duration of therapy. Lesser durations of trastuzumab maintenance treatment appear associated with a greater risk of disease recurrence.

The article's final statement is well-worded.

One year is a long time, especially when getting treatment for breast cancer. But for most women with HER2 positive tumors, that looks like time well spent.


Friday, November 2, 2018

Superlative blessedness

F.B. Meyer's Love to the Uttermost has been used by the Lord to encourage me in my daily devotions. In his preaching, "Heaven Delayed, but Guaranteed," he expounds on John 13:36:

"Simon Peter said unto Him, Lord, wither goest Thou? Jesus answered him. Whither I go, thou canst follow Me now; but thou shalt follow Me afterward."

To celebrate the lives of those who have gone before us, this is an assurance of heaven, where God is. The presence of God makes it so. It is the love that Christians long for. F.B. Meyer erupts in praise of this love.

There is no love like His—so pure and constant and satisfying. What the sun is to a star-light, and the ocean to a pool left by the retiring tide, such is the love of Jesus compared with all other love. To have it is superlative blessedness, to miss it is to thirst forever.

Read Love to Uttermost for free here.

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Thursday, November 1, 2018

Love is quickest to detect failures

F.B. Meyer, in Love to the Uttermost: Expositions of John XIII - XXI, writes:

The highest love is ever quickest to detect that failures and inconsistencies of the beloved. Just because of its intensity, it can be content with nothing less than the best, because the best means the blessedest; and it longs that the object of its thought should be most blessed forever. It is a mistake to think that green-eyed jealousy is quickest to detect the spots on the sun, the freckles on the face, and the marring discords in the music of life; love is quicker, more microscopic, more exacting than the ideal should be achieved. Envy is content to indicate the fault, and leave it; but love detects, and waits and holds its peace until the fitting opportunity arrives, and then sets itself to remove, with its own tenderest ministry, the defect which had spoiled the completeness and beauty of its object.


Wednesday, October 31, 2018

Don't worry about inspiration

Frank Herbert on the so-called writing block:

A man is a fool not to put everything he has, at any given moment, into what he is creating. You're there now doing the thing on paper. You're not killing the goose, you're just producing an egg. So I don't worry about inspiration, or anything like that. It's a matter of just sitting down and working. I have never had the problem of a writing block. I've heard about it. I've felt reluctant to write on some days, for whole weeks, or sometimes even longer. I'd much rather go fishing, for example, or go sharpen pencils, or go swimming, or what not. But, later, coming back and reading what I have produced, I am unable to detect the difference between what came easily and when I had to sit down and say, "Well, now it's writing time and now I'll write." There's no difference on paper between the two.

Tuesday, October 30, 2018

Ramen weather

Ramen weather


Keeping God's Word

In our local church we're asked to memorize bits of Scripture. At the end of the Sunday service, a person or a group of persons (such as cell/Bible study groups) is asked to recite the passion verse for the week. Someone had the idea of making Instagram posts out of them—they're beautiful! For instance, the passion verse this week is:

Here are other passion verses. I love the typography, color, and most importantly, the message these convey.

Higher Rock Instagram


Monday, October 29, 2018

The best of two worlds

Hari Balasubramanian's essay at 3QD resonates with me. It's a beautiful, beautiful piece that brings warmth to my heart and helps me make sense of the things I currently do. Like him, I'm in a very technical field of medicine (one may of course argue that it is both science and art, but the science part takes years of formal training, and a lot of objective multiple choice exams), but I spend a lot of time with the humanities, mostly literature, during my free time.

I’ve always thought of myself as someone who is more drawn to the humanities than to math or the sciences. This can seem very puzzling to someone looks at my career details: degrees in engineering and a career in academia in a branch of applied mathematics called operations research. Even I am stumped sometimes – how did I get so deep into a quantitative field when all my life I’ve held that literature (literary fiction in particular), history and travel are far better at revealing something about the human condition than any other pursuit?

Read the essay here.


Sunday, October 28, 2018

Old Office Building, Manila

Old Office Building

Manila is sometimes charming but is often frustrating.


Saturday, October 27, 2018

I found Book 2 for 50 pesos!

After church last Sunday, my brother had his shoes cleaned, and I found myself lost in Booksale, the second-hand book store that holds, within its walls, a vortex that traps me and removes all sense of time and place. The short of it is: nawili ako. Imagine the thrill I had when I found a copy of Dune Messiah by Frank Herbert! For 50 pesos!

My friend Juanchi Pablo introduced me to Dune, which I wrote about in 2014. It is a book that opened my eyes to the joys of reading science fiction and fantasy.

Dune Messiah

Paul Artreides's sister Alia is now grown up, a sarcastic, powerful, intuitive Reverend Mother, trained in the ways of the Bene Gesserit. Paul is now called the Muad'dib, the Emperor of the known worlds in the galaxy, and he has to confront opposition, intrigue, and mystery that comes with his powers.

St. Alia of the Knife: from Dune the Messiah


Friday, October 26, 2018

Where are the great minds?

Dr. Butch Dalisay asks the question many of us often wonder about, when he browsed through copies of printed materials from the 50s: Where have all the great minds gone?

I’m taking stock of my latest acquisition of old books and magazines, delivered to my office by a seller who seems to have hit upon a trove of scholarly materials from the 1950s and 1960s, very likely from the estate of one or two of that period’s leading academics.

They include copies of the Diliman Review, a prominent journal of the University of the Philippines since the early 1950s; the University College Journal, from the early 1960s when UP still had a University College in charge of implementing its General Education Program for the student’s first two years; the Philippine Social Sciences and Humanities Review, established in 1929; and Comment, a liberal quarterly from the late 1950s. There’s a special issue of the Philippine Collegian from 1957 devoted solely to the topic of academic freedom. A unique bonus is a copy of the Golden Jubilee issue of the Diliman Review from 1958—UP’s 50th anniversary—a handsome hardbound volume I didn’t even know existed.

His essay reflects a degree of frustration.

I see that even government bureaucrats then were expected to be literate and to be able to articulate their policies beyond press releases and interviews. The 1958 DRissue includes essays by Amando Dalisay, then Undersecretary of Agriculture and Natural Resources, on “Economic Controls and the Central Bank” and by Sen. Lorenzo Sumulong on “The Need for Economic Statesmanship.”

Where have all the great minds gone? They're probably around, and very, very few of them are probably in government leadership positions.


Thursday, October 25, 2018

Art at Bahay ng Alumni