Monday, July 13, 2020

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My last duty at PGH

Lockdown

Saw Lennie and Carlos, block mates from med school on my last duty stint at PGH. Lennie C. is a neurologist, taking her fellowship in stroke. Carlos C. is a gastroenterologist, with special interest in bourbon, English shoes, and bespoke suits. I'm proud of them. (This is a screenshot of Lennie's Facebook post).

This was in March 29, after my last 24-hour stint at UP-PGH as a trainee. I've been out of the hospital, and of work, since then. I look forward to what the Lord has in store for me. Please pray for me as I seek His direction career-wise.

We've come full circle may well be the caption of this photo. My first clinical exposure was in LU3 (first year in medicine) at the Neurology ward (Ward 5), with Lennie, Ching, the Catangui twins, Jegar, Casti, Marv, Dalvie, and Joreb. I had no clue how to remember the spinothalamic tract! (Carlos belonged to the other half of the block; their preceptor asked easier questions!) It seems fitting that in my final day at PGH, I got to visit Ward 5 and was reunited with dear friends who, like me, are wiser and better physicians than when we had started out.

Sunday, July 12, 2020

Saturday, July 11, 2020

Friday, July 10, 2020

Thursday, July 9, 2020

Wednesday, July 8, 2020

Tuesday, July 7, 2020

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Unto the shore, the rock of Christ



Each time I read the news, I'm assailed by bad news. It takes a lot of commitment to see the world from a biblical perspective. Christ our Hope in Life and Death, a stirring modern hymn, spurs me to think about my sure hope--not in medical science, not in human government, not in familial relationships, not in my own abilities. But only in Christ, my Savior and Redeemer.

Unto the grave, what shall we sing?
“Christ, he lives; Christ, he lives!”
And what reward will heaven bring?
Everlasting life with him.
There we will rise to meet the Lord,
Then sin and death will be destroyed,
And we will feast in endless joy,
When Christ is ours forevermore.

Words and Music by Keith Getty, Matt Boswell, Jordan Kauflin, Matt Merker, Matt Papa

©2020 Getty Music Publishing (BMI) / Messenger Hymns (BMI) / Jordan Kauflin Music (BMI) / Matthew Merker Music (BMI) / Getty Music Hymns and Songs (ASCAP) / Love Your Enemies Publishing (ASCAP) / adm at MusicServices.org

From the YouTube channel:
"What is your only comfort in life and in death?” For centuries, believers have learned the Christian faith beginning with that question. It’s the first article in the Heidelberg Catechism of 1563. Why start there? Because death is our common fate. Unless Jesus returns first, we will all die. To find comfort in life, we must know how we can face death. Hope comes only in trusting the one who died to take the curse of death and who crushed the power of death by his resurrection. “Christ has been raised from the dead” (1 Cor 15:20). That is the only statement that can transform how we live each day and how we prepare for our earthly life to end.

Monday, July 6, 2020

Associate member of the PSMO

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I was officially inducted as an associate member of the Philippine Society of Medical Oncology last night. The ceremony was prerecorded. The video clip began with our replies to the question, "What is the most important lesson you learned during this pandemic?" I gave a short but truthful reply, "I learned to trust in God alone." Others gave fascinating answers, most of them quotable soundbites. Fred gave the Korean heart sign at the end. Rich spoke about the politics of health. Karen alluded to the distance and nearness of human company. Roger talked about the "mess" of this Covid-19 crisis, the most exasperated version of him on camera. Kgel from the University of Santo Tomas threw in the word, "plasticity," clearly an offshoot of her readings in DeVita about the defining characteristics of cancer. Marge, also from UST, talked about valuing the things and people that matter the most. It amazed me how many new fellows were comfortable in front of the camera. Toni sounded like a morning show host! Congratulations to all the new associate members! I feel so honored to be counted in your company.

Sunday, July 5, 2020

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Pens in films: The Spirit of the Beehive

Watched The Spirit of the Beehive (El espíritu de la colmena) yesterday. You can watch it by following the instructions here. It's a quiet but disturbing film about childhood and imagination. What I found most interesting were the fountain pens. This was set during the time when fountain pens were commonplace.

Jessica Zafra writes:

The Spirit of the Beehive is set just after the end of the Spanish Civil War, and the house is paralyzed with sorrow, or fear, or both. Franco the dictator was still alive when the film came out, but maybe it was too enigmatic to incur the ire of the censors. Or else the censors counted on the audience not getting it. Today it is hailed as a masterpiece, its eerie quiet the appropriate soundtrack for a nation traumatized by war.

Some screenshots of pens. If you can identify them, please let me know!

the spirit of the beehive

the spirit of the beehive

the spirit of the beehive

I should compile films with fountain pens in them!

Saturday, July 4, 2020

Friday, July 3, 2020

Thursday, July 2, 2020

Wednesday, July 1, 2020

Tuesday, June 30, 2020

Monday, June 29, 2020

Sunday, June 28, 2020

Saturday, June 27, 2020

Friday, June 26, 2020

To incoming interns: the harder one is usually the right one

Dr. Glenn Wakam, surgical resident at the University of Michigan, gives five tips to incoming interns. These are gems.



#1 Ask for help. Call your chief. The goal is to be safe, not right. The value this enforces is humility—a cornerstone of the “new” surgical personality.
#2 If you come to the fork in the road and their (sic) are two choices, the harder one is usually the right one. Get out of bed and check on the patient. This is integrity: doing the right thing.
#3 Lean into your education. The difference between being passive vs leaning in could be as much as 2-fold. This doesn’t mean working longer, it means making the most of the time you are working.
#4 Learn to apologize. If you have a bad interaction, and you are not your best self, don’t fall into the trap of blaming someone else, e.g., “that was a dumb consult”. You will be tired and stressed, and you will snap at someone. This job is hard. Go back and apologize.
#5 It’s never too early to think about leadership. You will be leading a team soon. Pay attention to team dynamics and prepare. Always look out for the most vulnerable team members.

The culture of your team will be yours. You will own it. Prepare for it.

No. 2 tip is so true. There were days during training when, as I went to bed, I'd realize I didn't do a complete physical exam (forgot the rectal exam or crammed the cranial nerve exam) or I missed out on a crucial diagnostic test. Because I lived in a hospital dorm during residency, it was easy to go back to the patient's bedside and do all those things. I don't regret the moments when I went back.

The worst thing a doctor can tell himself is, "What if I'd done better?" If you're in medicine, doing your best is the smartest, kindest thing to do for your patients and for yourself—you will sleep soundly. You'll end up tired, even exhausted—but it's the good kind.

"The harder one is usually the right one." Thanks for these wise words, Dr. Wakam!

Thursday, June 25, 2020

Ma'am Jane at the Registrar's

Caused a ruckus at home when I looked for my med school diploma. I called mother, who panicked when she couldn't find it. Important documents are kept in my father's attaché case or hidden in the console table; my diploma wasn't there. I emailed and called UP Manila, spoke to Ma'am Jane who said the diploma wasn't there anymore. "I graduated in 2014," I said, just in case the staff overlooked. It turned out my diploma was in the flat all along, hidden in an undiscovered box. I called the Registrar's Office to apologize. "My mother will scold me," I said. Ma'am Jane, ever the accommodating lady over the phone, laughed and said, "It's okay, Doc." 

Wednesday, June 24, 2020

Tuesday, June 23, 2020

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The Virtual Graduation

Of all the graduations I’ve had, today’s virtual ceremony will stand out in my memory. I was in bed, my ears plugged to bluetooth earphones linked to my laptop. I logged in Zoom at 8:58, two minutes before the rites began. On the opposite side of the small condo was my brother, who was in a separate online meeting. We could hear each other mumble, but not enough to make out the actual words.

Drs. Vanessa Co (Gastroenterology) and Deonne Gauiaran (Hematology) hosted the event. They were, at some point, my senior fellows when I was a fledgling Medicine resident. They’re consultants now, official members of the Department of Medicine’s stellar faculty. I remember that Ma’am Van sat with me and my friend Carlos Cuaño (who would himself proceed to gastroenterology training) to help us prepare our end-of-rotation report on pancreatic pseudocysts. Sir Deonne was our chief resident when I was a first year IM resident. (He has done so much and so excellently, and we’re only about the same age.) I looked up to them then, and still do today.

There was the invocation and the singing of the National Anthem. Should I stand? I was, by now, propped up by two comfortable pillows. I was in a white shirt and comfortable shorts. I pulled the curtains to block the morning sunshine. I decided to lie still. Nobody could see me anyway.

Dr. Carmencita Padilla, the UP Manila chancellor, spoke about the Covid-19 pandemic and World War II. In both these events, she said, UP PGH continued its operations. There was never a lockdown. I imagined that there would be applause, had Dr. Padilla addressed us face-to-face, but I cheered for her in my mind. I felt blessed to be part of this hospital; PGH would always be a part of me.



Dr. Gerardo Legaspi, the director of the Philippine General Hospital, challenged and encouraged us to see what’s ahead, to imagine the best for the country.



Dr. Charlotte Chiong, dean of the UP College of Medicine, applauded the bravery and resolve of everyone in the virtual room.

Dr. John Añonuevo, the chair of the Department of Medicine, said that the “only thing we are certain of is that there is a future for you.”



Dr. Ester Penserga, distinguished internist and rheumatologist, quoted Proverbs 16 in her keynote address.  I am proud to say that I was once under her Gen Med service, even if it was towards the tail end of my training. She liked asking the basics, things I thought I knew but only knew partly—which was just as worse as not knowing entirely. When she announced that she would do teaching rounds with the students, I would study my books in a corner. If the clerks and interns could not answer her questions, she’d ask the junior residents. If they couldn’t give a satisfactory reply, she’d ask me, the most senior resident of the team. If I couldn’t answer her, she’d say, “Read.” But it was always with a motherly tone, an encouraging rebuke. She proceeded to talk about her seemingly accidental foray into rheumatology when she had wanted to be an endocrinologist. She saw God’s hand in this. I was so blessed and encouraged.



Our names were called. If this had been an actual ceremony, there’d a contest of the wittiest introductions. But without the exchange of energy that speakers get from the audience, the tone was generally subdued. There were no hilarious moments on stage, no pakuló, no shameless selfies. But I took photos of my screen. My friend David (endocrinology) messaged me that I could do screenshots instead, with the Shift + Command + 4, but I said I liked the raw quality of the photos. It felt like a ritual: taking the photos, storing them, and revisiting them in search for possible blackmail material.

There were the once-first year residents I used to work with. Special shout outs to those with whom I had the pleasure of being a service senior: Nico Pajes (who is the department’s brilliant and indefatigable chief resident), Harold Chiu, Greco Malijan, Ray Ragasa, Inah Coronel, and Josh Torres. (If I missed anyone, please alert me: faces blend in my memory. I have worked with them at some point, at MICU, the ER, and so on.)

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Photo credit: Inah Coronel's Facebook account

[Related post: notable blog entries during my Gen Med years: My First GenMed Service, Sticking Our Necks Out, Counting the Days, and Ode to Our Interns.]

I only took photos of my residency batch mates and co-fellow graduates from Medical Oncology, unfortunately.

Bea Uy (Endocrinology)

“prolific researcher and strong woman”
Fellowship Virtual Graduation

David Francisco (Endocrinology)

“a scholarly and brilliant man”
Fellowship Virtual Graduation

Racquel Bruno (Endocrinology)

“a woman leader”
Fellowship Virtual Graduation

Carlos Cuaño (Gastroenterology)

“a resilient individual”
Fellowship Virtual Graduation

Danes Guevara (Nephrology)

“savvy scholar whose muscles are as big as his brain”
Fellowship Virtual Graduation

Grace Penserga (Rheumatology)

“determined to forge her own path; a ready resource for clinical decision-making”
Fellowship Virtual Graduation


Roland Angeles (Pulmonary Medicine) 

“with great resourcefulness and humility”
Fellowship Virtual Graduation

Carla Barbon (Pulmonary Medicine)

“with incredible proficiency." 
Notice Dr. Ralph Villalobos's comment below: "Stay safe and negative." (These days, negativity—COVID-negativity—is a positive thing!)
Fellowship Virtual Graduation

Laya Zamora (Pulmonary Medicine)

“clarity of mind and strength of character”
Fellowship Virtual Graduation

My Med Onco batchmates!


Rich King

“Rich is quiet and serious. He is often immersed in his work but shows empathy and compassion towards his patients and colleagues. As the chief fellow, he was able to juggle administrative duties with clinics and research endeavors. He relaxes with video games, YouTube gardening channels, and music. He sings well. He plans to practice in Metro Manila and Central Luzon.”
Fellowship Virtual Graduation

Karen Mondragon

“Karen is practical and level-headed. As a mother, she was able to juggle family responsibilities with work and training. She made it look so easy. She likes good coffee, spoken poetry, and creative stories. She enjoys playing with her daughter, painting, and staying at home. She plans to practice in Metro Manila.”
Fellowship Virtual Graduation

Fred Ting

“Fred is determined and productive. Although he operates on a strict schedule, he can easily be dragged to random coffee breaks. He has numerous research outputs, especially on supportive care and access to oncologic treatment. He loves connecting with patients. He reaches out to them and seeks to understand them. He likes to travel, tinker with fountain pens, and write essays or commentaries. He plans to practice in Bacolod City.”
Fellowship Virtual Graduation

Roger Velasco

“Roger is compassionate and adventurous. His patients love him. Each morning, they form an impenetrable crowd outside the clinic. But he takes his time to talk and listen to them. He takes the extra mile to extend comfort and care. He likes to travel, though he often gets lost. He also likes to take photographs of sunsets and of his growing plants. He plans to practice in Metro Manila.”
Fellowship Virtual Graduation

There was a sweet shoutout from the amazing Dr. Cecile Jimeno!
Fellowship Virtual Graduation

The awardees were called. This was the surprise prepared for the expectant crowd—that is, us, mere mortals. Harold Chiu (third year), Amiel Villanueva (second year), and Ella Mae Masmayor (first year) won the Most Outstanding Resident Awards. Harold, who also topped the diplomate IM exam, is a brilliant and resourceful doctor, having published several researches even in his first year. I experienced being his service senior, a privilege I’m thankful for. Amiel, the quiet and contemplative doctor from Davao, holds a special interest in medical ethics. His Twitter feed is a great resource for his thoughts. Ella maintains a blog herself. One of my favorite pieces she wrote is When Sadness Has No Name. In this piece, she shows her humanity. I think the most humane doctors are the best doctors.

Laya Zamora (Pulmonary Medicine) is the most outstanding fellow. Also nominated in this category were Karol Camonayan (Allergy and Immunology), Louis Villanueva (Cardiology; he would later win the award for the most outstanding fellow for research), Aids Bacena (Endocrinology), Racquel Bruno (Endocrinology), Miiya Babaran (Gastroenterology), Rachelle Alfonso (Hematology), Joanne Sandejas (Infectious Diseases), Danes Guevara (Nephrology), Fred Ting (Med Onco), and Karen Cortez (Rheumatology).

Greco Malijan gave the speech in behalf of the graduates. What struck me was how on point Greco put everything in context. He said that health is political. The pandemic has uncovered the pervasive inequalities in Philippine society. Always a voice of reason and compassion, Greco is also an excellent clinician. I’m also proud to say I was one of his senior residents, but I absolutely don’t take credit for any of his greatness.



This will go down in the books as one of the best graduations I ever had. I praise God for His enduring faithfulness and goodness.

Monday, June 22, 2020

Sunday, June 21, 2020

Walk to the mall

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Since Tatay's death, Father's Day has become a day of remembering. After streaming the church sermon on Boaz and Ruth, my brother and I walked to Podium. I wanted to see if I could replenish my collection of acid-free paper. Manong wanted to get on with the walking: some 2.6 km from the house. Sweaty and thirsty, we had lemongrass juice at a Thai store. Manong bought pastry for snacks, then we walked home.

Malls remind me of Tatay. He liked being with people. He preferred crowded malls where he could bump into a random person and talk with him. He had a way with people, a certain warmth that made them say things to him. He liked getting to know others. In the afternoons, he dragged me to KCC Mall, so I could join him and his friends from the local biking club for coffee.

Happy Father's Day!

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Nineteen

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Mary Grace Café, SM Manila. I took the photo last year, when lounging in a cafés was not a matter of life and death.

Saturday, June 20, 2020

Friday, June 19, 2020

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Trips

PMA

I went to the Philippine Medical Association office in North Avenue to get some certifications. Before I booked a car, I called the office to be sure. It was my first time in three months to be in Quezon City. After a few minutes I got what I needed: certificates proving I am a member in good standing. I hailed a taxi that took me to the PhilHealth office in Pasig. The driver wasn't familiar with the building. I coached him with the instructions from Google Maps. We missed a turn because he couldn't hear me through the plastic wall. I got my professional accreditation in 15 minutes. It was starting to rain. I hailed a taxi that took me home. The driver sang. I was just in time for lunch. 

There were people everywhere: in the streets, in malls, in the roads. Traffic was terrible along EDSA-Cubao. If not for the masks, one would think the pandemic is over. Far from it, actually. More people with Covid-19 are getting admitted at PGH. If you don't believe the DOH census (I have lost faith in that a long time ago), at least believe the numbers from the hospitals. 

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My cousin Hannah and my friend Carlo celebrate their birthdays today. I thank the Lord for their lives.

I spent 40 minutes talking to JP Leo over the phone. JP is a historian and lawyer from Isulan. He teaches law in a university in Davao. We lived in the same floor in Kalayaan Residence Hall. He lent me his copy of One Hundred Years of Solitude by Gabriel García Marquez. The last time I talked to him was last year, over a video call while I was in Singapore and he was in Lithuania. When we had extra money, we ate at Chocolate Kiss at Bahay ng Alumni, UP Diliman. Blueberry cheesecake and devil's food cake were our favorites. Together with friends from Gensan and Koronadal, we established the provincial organization called UP SOX. JP was in my room, giving comments, when I designed the logo. (It was terrible.) He borrowed my leather shoes when he joined Game Ka Na Ba?, the game show in ABS-CBN hosted by Kris Aquino. He lasted two rounds. He's now high up the ladder in his career, but I'll always remember him as the guy who wore a t-shirt, denim pants, and flip-flops to class.

Thursday, June 18, 2020

John Calvin on Ephesians 1

I dragged my friend and colleague, Harold, to visit the Reformation Museum in Geneva last December. This was after the poster presentation at a major immune-oncology conference, which we had the privilege of attending. On our way to the museum, we dropped by the Reformation Wall where John Calvin's monument was in the middle. John Calvin holds a very special place in my spiritual growth. The Institutes of the Christian Religion is one of my favorite books of all time; it is in the same place as St. Augustine's Confessions

I was surprised to read Calvin's commentary on Ephesians. The internet is an endless source of fascination. Here he writes about Ephesians 1:3a, "Blessed by the God and Father of our Lord Jesus Christ."

The lofty terms in which he extolls the grace of God toward the Ephesians, are intended to rouse their hearts to gratitude, to set them all on flame, to fill them even to overflowing with this thought. They who perceive in themselves discoveries of the Divine goodness, so full and absolutely perfect, and who make them the subject of earnest meditation, will never embrace new doctrines, by which the very grace which they feel so powerfully in themselves is thrown into the shade. The design of the apostle, therefore, in asserting the riches of divine grace toward the Ephesians, was to protect them against having their faith shaken by the false apostles, as if their calling were doubtful, or salvation were to be sought in some other way. He shews, at the same time, that the full certainty of future happiness rests on the revelation of his love to us in Christ, which God makes in the gospel. But to confirm the matter more fully, he rises to the first cause, to the fountain, -- the eternal election of God, by which, ere we are born, (Romans 9:11,) we are adopted as sons. This makes it evident that their salvation was accomplished, not by any accidental or unlooked-for occurrence, but by the eternal and unchangeable decree of God.

Wednesday, June 17, 2020

Tuesday, June 16, 2020

Monday, June 15, 2020

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