Tuesday, September 29, 2020

Dave and the cookies

Cookies

Since yesterday, Auntie Nanic's nine-year old, Dave, has been living with us. When Manong bakes, Dave watches. His school term starts on October, and he has a few more days for vacation before he goes home.

"Ikaw ang assistant ko, Dave," Manong tells him. (You will be my assistant, Dave.) 

Dave smiles, bearing his white teeth, the way children do. We hardly hear his voice. If not for his quiet running—from his room to the kitchen, where his mother spends her days; or the outdoors, where he meets kids from the neighborhood—we would not notice him.

As the first batch of cookies cools on the kitchen counter, Manong says, "Namit man?" (Is it any good?) 

Dave nods and grabs another. 

"Tagpila baligya ta sini?" Manong asks. (How much do we sell these for?) Ideal for dessert or afternoon coffee breaks, cookies can sell easily for a hundred pesos in coffee shops. 

Dave, who grew up in a barrio not far from Surallah town, hesitates, then says, "Tag-tatlo baynte." (Three for 20 pesos). 

Manong has found his food critic and business manager.

Monday, September 28, 2020

Sunday, September 27, 2020

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Miranda July's No One Here Belongs More Than You

Miranda July

The Shared Patio is the first story in this collection: a self-absorbed and insecure woman meets her neighbor of "Korean descent." When he experiences an epileptic fit, she pretends that he falls in love with her and falls asleep beside him. 

So riveting! No wonder why David Sedaris loves Miranda July.

(Pen: Kaweco 70s Soul, broad nib.)

Saturday, September 26, 2020

A good kind of sadness

Received a certificate of appreciation from Prof. Ron Baytan, director of the Bienvenido N. Santos Creative Writing Center of De La Salle University, for my work as panelist during Pathography: Writing the Pandemic. I don't care much for certificates—they get lost in the file, which I lose track of—but this one stands out because it feels undeserved. It is not every day that a poet emails me.

Grace. 

Keth, an internist based in General Santos City, was one of the doctor-writer participants. To the group she wrote:

I am sad that it’s now over. By the second round of stories, I’ve come to recognize each member's unique and distinct voice speaking to me through the pages, and it felt a bit like reuniting with an old friend. I may not know all the specific details of your life, but it’s probably not an exaggeration to say that I’ve gotten a glimpse of your heart through your stories. And I want to see more.

We still have not met for coffee, Keth and I. She is a dear friend from college. With happy-go-lucky friends, we founded UP SOX, a regional org in Diliman. UP Batangan's overflowing membership list and crowded tambayan made us envious. Even students from Davao had their own org. What kept us from making one? I remember that we had no big ambitions for it. The QuizMas Challenge, a quiz show for high school students that we would run for years, was an after-thought. 

I am sad that the workshop is now over, but grateful for the chance to meet Roger Velasco, Kenn Samala, Dane Sacdalan, Elvie Gonzalez, Will Liangco, Agz Chaves, Anna Arcellana, Loaf Fonte, and Noel Pingoy. My heart overflows with thanksgiving to Prof. Marj Evasco and Dr. Joti Tabula for the opportunity. Praise be to God from whom all blessings flow.

Thursday, September 24, 2020

Wednesday, September 23, 2020

Tuesday, September 22, 2020

Monday, September 21, 2020

Sunday, September 20, 2020

Saturday, September 19, 2020

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Happy birthday, Rac!

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

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

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

I miss you, Rac!
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Beautiful diligence

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

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

Friday, September 18, 2020

Where empathy fails

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

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

Thursday, September 17, 2020

Growing at the ends of the earth

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

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

Wednesday, September 16, 2020

A poem is a meeting-starter

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

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

We read a poem.

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

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

By the beach.

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

Tuesday, September 15, 2020

On medical humanities

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

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

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

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

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

Monday, September 14, 2020

Sunday, September 13, 2020

Life otherwise

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

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

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

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

Saturday, September 12, 2020

Friday, September 11, 2020

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Pathography: second night

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

Thursday, September 10, 2020

Wednesday, September 9, 2020

Happy birthday to our Chief!

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

Rich at ESMO Asia 2019 in Singapore.Untitled

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

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

Tuesday, September 8, 2020

Monday, September 7, 2020

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MCMMO

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



Karen

Rich

Freddie

Raj

Myself (misspelled last name—mukhang nag-autocorrect)

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

Sunday, September 6, 2020

Evensong

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

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

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

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

Saturday, September 5, 2020

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Writing the Pandemic

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

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

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

Friday, September 4, 2020

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Café business

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

Thursday, September 3, 2020

Verses for Bible study

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

Daniel 4:35

All the peoples of the earth

    are regarded as nothing.

He does as he pleases

    with the powers of heaven

    and the peoples of the earth.

No one can hold back his hand

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


Psalm 47:2

For the Lord Most High is awesome,

    the great King over all the earth.


Psalm 83:18

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

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


Genesis 14:19

and he blessed Abram, saying,


“Blessed be Abram by God Most High,

    Creator of heaven and earth.


Isaiah 37:16

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


2 Chron. 20:6

and said:


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


Isa. 43:13

    Yes, and from ancient days I am he.

No one can deliver out of my hand.

    When I act, who can reverse it?”


Eph. 1:11

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


Isa. 14:17

the man who made the world a wilderness,

    who overthrew its cities

    and would not let his captives go home?”


Rev. 19:6

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


“Hallelujah!

    For our Lord God Almighty reigns.


Rom. 9:18-22

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


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


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


Prov. 16:9

In their hearts humans plan their course,

    but the Lord establishes their steps.


Prov. 19:21

 Many are the plans in a person’s heart,

    but it is the Lord’s purpose that prevails.


Prov. 21:1

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

    that he channels toward all who please him.


Ezra 1:1

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


James 4:13-15

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


Phil. 4:6

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


Col. 4:2

Devote yourselves to prayer, being watchful and thankful.


Eph. 6:18

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


Luke 18:1

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


1 Thes. 5:17

pray continually


Rom. 12:12

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


Ps. 57:2

I cry out to God Most High,

    to God, who vindicates me.

Wednesday, September 2, 2020

Grounded

High school friends

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

Tuesday, September 1, 2020

Trapped in a church

Deacon John Updike

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

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

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

Monday, August 31, 2020

Sunday, August 30, 2020

Saturday, August 29, 2020

Heroism

S, my former intern, now a physician in a public hospital in Batanes, asked me about a patient. Difficult case—a young woman who might need dialysis soon. Reassured her that her management was spot on: a trial of diuresis to relieve pulmonary congestion and hyperkalemia. Asked her how she was doing: S is married, has a son, contemplates on specialty training, until the pandemic hit. She spent the past two years serving as a doctor to the barrio. S called me “Doc”—a telling sign that one has spent enough time outside PGH. “I’m proud of you, S!” I said, on the other southern part of the country, a proud former-IM resident. Doctors serving the underserved are heroes. 

Friday, August 28, 2020

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"Lose weight"

Stethoscope

New stethoscope, a Littmann III, olive-green with smoked screen finish, arrived by mail last week. Ordered it online from an Australian company. Design is unique; nothing quite like it. Saved money, even with shipping cost. Lost my stethoscope (same design) last year while doing rounds at Cancer Institute. 

My first patient for this stethoscope: Auntie Nanic (Nancy), mother's cousin who lives with us. Heard faint wheezing on the right lower lung field. Gave her a worried look. "HALA, ANO INI, AUNTIE?!" Laughed out loud—Auntie Nanic has hypochondriac tendencies. Reassured her it was nothing to be worried about. 

"What should I do?" Auntie asked. 

"Magpa-payat.

Advice not related to wheezing (which eventually disappeared when I listened again), but sound medical instruction, nonetheless. Fear is a powerful motivator, especially for relatives. Been telling her to cut down on rice. Now she limits herself to 1.5 servings. 

Thursday, August 27, 2020

The command to rejoice

Copied the verses sent in advance by Kuya Vance; these will be discussed in tonight's Bible study. Thank You, Lord, for Your Word. 

Ps. 32:10-11
Many are the woes of the wicked, but the LORD's unfailing love surrounds the man who trusts in him.
Rejoice in the LORD and be glad, you righteous; sing, all you who are upright in heart!

Prov. 3:5-6
Trust in the LORD with all your heart and lean not on your own understanding;
in all your ways acknowledge him, and he will make your paths straight.

1 Thes. 5:16-18
Rejoice always, pray continually, give thanks in all circumstances; for this is God’s will for you in Christ Jesus.

Phil. 4:4.
Rejoice in the Lord always. I will say it again: Rejoice!

Wednesday, August 26, 2020

Footage

Lockdown  
Scenes of hospital wards are regularly shown on TV. Wards 1 and 3 of the Philippine General Hospital have been converted to areas dedicated for COVID-19News on COVID-19 patients. But there was a time when these were the very places where we did teaching rounds with clerks and interns. On the tables in corners, we chatted and charted with colleagues. 

Tuesday, August 25, 2020

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The worth of human touch

"What is a physical examination worth?" Paul Hyman, MD reflects on his answers in his perspective piece, The Disappearance of the Primary Care Physical Examination—Losing Touch.[1] 
As our primary care practice has pivoted to telehealth and the physical examination has been ripped away from me, I find myself reflecting on what value the examination has. It is clearly needed at times to make a diagnosis. But I now realize the other ways I use the examination to advance care and its significance to my own well-being. It is a means through which I pause and physically connect with patients, I demonstrate my knowledge and authority, and is a tool I use to persuade patients and reevaluate their narratives.
Performing P.E. helps him as a physician, not just his patients.
The examination, though, is more than a tool that informs diagnosis and treatment. I now realize its value to me. The quiet moments when I am listening to a patient’s heartbeat and breath can be centering, similar to the part of a meditation where one refocuses on one’s own breathing. Abraham Verghese has commented extensively on the role of the physical examination as ritual and its importance to patients; he also has observed how this ritual brings physicians satisfaction through human connection. Only now have I come to recognize the examination as a ritual that is restorative and brings me calmness and confidence.
This resonates with me.
In an admission of my own insecurity, the physical examination remains one of the few domains where I maintain a sense of professional skill and authority. I have never been much of a proceduralist. The mainstay of what I offer to patients is the ability to listen to them, to use critical thinking skills, and to offer my knowledge and experience. But those skills are sometimes challenged in a world where patients research their own health and develop their own medical narratives. The physical examination remains a place where I offer something of distinct value that is appreciated.

But, as I wrote in a perspective piece, these are still good days to heal

Online interactions cannot completely replace actual human interaction between the physician and the patient, but through these remote meetings, we can able to offer communication bridges. With telemedicine, these are still good days to be a doctor. But I still wish for better days ahead when the pandemic is over, when I can talk to my patients face to face, hold their hands, and celebrate our shared humanity.


[1]Hyman P. The Disappearance of the Primary Care Physical Examination—Losing Touch. JAMA Intern Med. Published online August 24, 2020. doi:10.1001/jamainternmed.2020.3546

Monday, August 24, 2020

Dr. Karen sings

Learned last night that Dr. Karen Senen has passed away. She wrote in Facebook:
I have long been thinking of singing this song ["The Warrior is a Child"]. 
It is very personal to me because as a neonatologist I often find myself in situations where I have no other option but be the bravest person in the room. And it is never easy because I know that deep inside... I am terrified. 
The current pandemic has placed our youngest colleagues, the residents and fellows, in the hospital frontlines. Our beloved frontliners, we the consultants, recognize your bravery... your grit... your passion for serving others. We know that you fear this disease. We thank you for choosing to face the battle each and every day inspite of the fear. We want you to know that we will always support you and guide your every step... comfort you and see you through every trial. 
The Lord is our strength. We will get through this.

Sunday, August 23, 2020

Doctors dying

My creative non-fiction piece, "To Be Afraid Is Human," will be published in an anthology by UP Manila. It starts with a quote from Merrill Moore's Les Savants Ne Sont Pas Curieux:

Doctors must die, too; all their knowledge of
Digitalis, adrenalin, henbane,
Matters little if death raps again—
Once he may be forestalled, but their great love
Or little love of life is merely human:
Doctors must die like other men and women.

Saturday, August 22, 2020

Shadow play

August 2020 - post-quarantine

Shadows cast by plants that shade the living room from the sun. Marbel afternoons are stifling, but the foliage makes them bearable. 

Friday, August 21, 2020

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Trees in Lola's backyard in Banga

Trees in my grandmother's backyard

Yesterday, dropped by Lola's house in the next town. Pruritus and ear discharge not troublesome. Advised her to take her meds. Saw young cousins, bored by the prolonged vacation. Spent some time in the backyard, under the shade of the old chico tree. Can you identify the other plants?

Thursday, August 20, 2020

Confused

“Friday na ba subong?”

“Daw Thursday pa lang man.”

Days blend into each other—the comforts and frustrations of the unemployed.

Wednesday, August 19, 2020

Camus may well have been writing about the Philippines

 Revisiting Albert Camus's The Plague

[Dr. Bernard Rieux] had examined the old man and now was sitting in the middle of the dingy little dining-room. Yes, despite what he had said, he was afraid. He knew that in this suburb alone eight or ten unhappy people, cowering over their buboes, would be awaiting his visit next morning. In only two or three cases had incision of the the buboes caused any improvement. For most of them it would mean going to the hospital, and he knew how poor people feel about hospitals . . . As for the "specially equipped" wards, he knew what they amounted to: two outbuildings from which the other patients had been hastily evacuated, whose windows had been hermetically sealed, and round which a sanitary cordon had been set. The only hope was that the outbreak would die a natural death; it certainly wouldn't be arrested by the measures the authorities had so far devised. (p. 58) 

Tuesday, August 18, 2020

TWSBI Eco (White) is working now!

Image from page 6 of "English Review" (1916)

Sean fixed my first TWSBI Eco two days ago. Frustrated because I couldn't pull the stuck piston up, I retired the pen many years ago, previously condemned inside the plastic box I reserve for spare parts. I love TWSBI pens. Sturdy, charming, with a sizable ink capacity; they're also affordable. To make up for my "loss," I bought a Diamond AL 580 (1.1 mm stub) and, later, an Eco Rose Gold (medium nib). These pens have served me well. From time to time, however, I would open the plastic box and attempt the restoration of my original Eco, which I bought at the TY Lee Pen Store in Taipei. I used tweezers. I soaked the insides with silicone grease. My fingers hurt. I ended up doubly frustrated. 

Sean, a dentist/oral surgeon, loves to tinker with things. I tossed him the defective Eco. "Can you fix this?" I asked.

He opened his toolbox and got to work. He worked his magic. My Eco worked! It just needed a bit more lubrication.  In exchange, I gave him the Diamond 580 (I am downsizing; I don't need too many pens.) Pleased, he reminded me, "You should care for your pens, Manong."

Monday, August 17, 2020

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Reading Toni Morrison for the first time

Hilton Als on Toni Morrison:

When she looked at you and addressed you by your Christian name, she made it sound like a promise, one that stood on the side of everything that was juicy, smart, black, amused, yours. In the old days, when ladies were “colored” and she herself was just a child, she had learned from those ladies, probably, the same eye-rolling, close-mouthed look of incredulity that she employed when she recounted a glaring error of judgment on someone else’s part, or something stupid someone said or didn’t know they were about to say. After she gave you that look, you never wanted to say anything dumb again, ever. If she took you in as a friend—and this was rare in a world where so many people wanted her time and felt they had a right to her time, given the intimacy of her voice—she was welcoming but guarded. Then, if you were lucky enough and passed the criteria she required of all her friends, which included the ability to laugh loud and long at your own folly, and hers, too, she was less guarded, and then very frank: there was no time for anything but directness.

Also: 

As she described this or that, she drew you in not just by her choice of words but by the steady stream of laughter that supported her words, until, by the end of the story, when the scene, people, weather, were laying at your feet, she would produce a fusillade of giggles that rose and fell and then disappeared as she shook her head.


Finished The Bluest Eye, the first novel she wrote. Like Oprah, I feel I've been enhanced by her language. 

I enjoy watching her interviews. Her voice is soothing. Mavis Nicholson's 1988 interview with her is one of my favorites.

Sunday, August 16, 2020

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Lounging around

the spirit of the beehive Screenshot from The Spirit of the Beehive, film by Victor Erice. 

What's the perfect posture for reading? I can read in bed, in a chair, with a table, in bright or dim light. I can't read in a moving vehicle. I get nauseous. Good thing there are podcasts.

Saturday, August 15, 2020

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Tarps and COVID-19


Saw this in my feed. So Pinoy in many respects: 
  • the graduation photo
  • the tarp with three fonts: Monotype Corsiva ("Congratulations"), Arial (the girl's name), and the serif below
  • the papaya tree
  • the use of the middle name
  • the color scheme (pink in white)
  • the iconic Philippine countryside
It's the first time I'm hearing about Zarraga, some 16 km north of Iloilo City. Seems like a charming place to visit. Also COVID-free. 

Friday, August 14, 2020

Thursday, August 13, 2020

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"The books you read are the books you can easily bring with you."

Patrick Rhone, who owns the defunct Minimal Mac, now blogs at Rhoneisms. He published his reading plan for 2019. These are some of what he wrote. I have a few comments below.

Read more paperback books, specifically mass-market sized ones. The books you read are the books you can easily bring with you. And, especially in the winter months here, every coat I own has large enough pockets to easily slip one in.

My Kindle holds 90 percent of the books I've read for the last three years. Occasionally I bring a paperback or even a hardcover. This is the exception rather than the rule. I read more books because of my Kindle.

Replace boredom with books. In the check out line, in the waiting room, while my daughter is in her classes. Assuming I’m good about having a book within easy reach per above, I’ll fill these sorts of times with reading one.

Absolutely. The more I read, the less time I spend in social media, the happier I become. Reading books offers a peaceful distraction, encourages critical thinking, fosters concentration, and cultivates a special relationship reader and author. I read long works through this method (Tolstoy's Anna Karenina, Calvin's Institutes, Charnock's Doctrine of Regeneration, for example). 

Bias towards fiction. If you look over my reading list of the past several years, you’ll notice I tend to bias towards non-fiction. The reason is that I’m a curious learner and reading non-fiction fuels that. That said, every time I do read a fiction book for escape and entertainment, I always feel like i should do so more often but then fall back into my habits. The truth is, I read fiction a lot faster and enjoy the escape when I allow it. Therefore, I’m going to intentionally bias towards it and see what happens.

I read anything and everything. I'm biased toward fiction, almost as a default. Fiction allows me to delve into another human's imagination, which I enjoy. Over the years, however, I've discovered some gems in the non-fiction department. William Finnegan's Barbarian Days (on surfing) and David Remnick's biography of Muhammad Ali (on boxing) are some of them.

Read more classics (including ones I’ve read and would like to read again). Not the least of the reason being that many of these are easily available in a smaller, mass-market size where recent paperback are less so (in general, these are trade-sized).

I'm intentional in the classics I read. I'm biased towards works of Christian classics, especially the those of the early church fathers, including Puritan writers. Thomas Watson, Jonathan Edwards, and Stephen Charnock captivate me. St. Augustine uplifts me. There's John Calvin, of course. The language they use is beautiful, almost poetic. They may seem daunting. I admit that they need some getting used to. But my heart is stirred to more love for God, and my eyes look to heaven. They're worth your time!

Wednesday, August 12, 2020

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The 14-day quarantine: last day

Quarantine Hotel Quarantine rain Quarantine Hotel Woke up to thunder and rain. Afternoon nap done. There goes my day. 

Used to love rain as a child. Didn’t fancy it too much when I lived in Manila, when it meant leptospirosis, flooding, and higher Grab fees. 

Last day of quarantine today. Yesterday Sean dropped by to hand me food. Greeted him from an open window. He lost weight and looks more like me. Durian was moist, sweet, heavenly. Devoured everything in minutes. Room smelled like coffee and durian. No anosmia! Called mother about durian. She said, “Let me know if you want some more.” My family gets excited about tropical fruits—perks of living in this sun-soaked piece of paradise. 

Outside my window: trees swaying, soil soaked in watery goodness. Amazing is God’s creation. I feel artistic but can’t get my words out. 

Meditated on life of prophet Samuel and Psalm 23. “Surely goodness and mercy shall follow me all the days of my life, and I will dwell in the house of the Lord forever.” Spent the morning thinking about this. Prayed for friends and family and myself—career directions, and so on. 

Plan for tonight: watch some episodes of Scams (Japanese series) and Occupied (Norwegian series), pack things, write some emails.

Tuesday, August 11, 2020

Monday, August 10, 2020

Sunday, August 9, 2020

Saturday, August 8, 2020

Friday, August 7, 2020

Thursday, August 6, 2020

Wednesday, August 5, 2020

The 14-day quarantine, days 3-5

Work, meaningful work, is the antidote to boredom. Must remind myself to quit anything that bores me. 

Yesterday: spoke to friends and family. Tito Bong, my father's close friend, called me up. Felt like talking to Tatay. In many respects they sound the same. Told me that Tatay's gift of charming people rubbed off on me. Everyone knew and liked him, Tito said. In malls and restaurants, people were charmed. Heartwarming story: Tatay and his bike gang passing through chapel named after San Isidro Labrador. Tatay told Tito Bong, "Lance would be angry if I named him Isidro, so I used 'Isidore' instead." Tito said Tatay was always proud of me. I miss him every day. 

Worked on papers. Made me forget I'm in quarantine.

Metro Manila now in MECQ. Government listened to doctors this time, but I feel this is temporary. Doctor-friends relieved but pessimistic. Note to self: limit social media engagement. Atmosphere is anger and hopelessness. Must pray for wisdom for our leaders, who don't have much of it. 

Huge PhilHealth scam irks me. How can thieves do this to poor patients who can barely afford to pay for transpo to clinic, let alone their chemo meds? The depravity of human nature. Trusting that justice prevails in the end. God is just and merciful.

Technology makes quarantine bearable. Tita Mavis's essay on Marguerite Yourcenar intrigues me. Got myself a copy of Memoirs of Hadrian. Tita Mavis on English translations of French work: 

None of the books now available in English reveals anything of the quality and clarity of the French. English and French are not negative-positive images of each other, but entirely different instruments. The two languages cannot be made to work in the same way. A French sentence, transcribed exactly as it stands, means an English sentence with five words too many.

With barely a grasp of French, I'll make do with the English translation.

Tuesday, August 4, 2020

I think it's going to rain today



Current LSS: Audra McDonald's I Think It's Going to Rain Today. She's right on two counts. First, kindness is overflowing, despite humanity's depraved nature. Second, I think it's going to rain today.

Broken windows and empty hallways
A pale dead moon in the sky streaked with gray
Human kindness is overflowing
And I think it's going to rain today

Scarecrows dressed in the latest styles
With frozen smiles to chase love away
Human kindness is overflowing
And I think it's going to rain today

Lonely, lonely
Tin can at my feet
Think I'll kick it down the street
That's the way to treat a friend

Bright before me the signs implore me
To help the needy and show them the way
Human kindness is overflowing
And I think it's going to rain today

Monday, August 3, 2020

Sunday, August 2, 2020

ECQ is not yet over



Ate Lei sounds the alarm on increasing COVID-19 cases, reaffirms importance of physical distancing and wearing of masks, and empowers the public--"you are our first line of defense." The advice is firm and compassionate. Listen to her.

Dr Lei Camiling-Alfonso, technical specialist for the Philippine Society of Public Health Physicians, says the Philippines is far from return to normal. Camiling-Alfonso took part in the 'Frontliners for ECQ' online press conference on Saturday, August 1, 2020

Saturday, August 1, 2020

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The 14-day Quarantine, days 1-2

Day 2 of quarantine. Cloudy day. Rained all evening. Rooster’s cry woke me at 5 am. Could hear it over closed windows. Turned off the aircon. I get cold easily—an inconvenience in places with snow, but not a problem in Marbel, where it feels like an oven most days. Opened my email, wrote replies. Still dark outside. Before daybreak is the best time to get things done.

Last night, spoke with a couple from Dormitories Christian Fellowship over Zoom. DCF people are the best—bright minds, kind hearts from provinces meeting in the country’s best school. Or so we think. Among my dearest friends are DCFers. Call was a welcome distraction from the monotony of quarantine. Been itching to be productive all day. Getting the hang of online consults. With video, I could see facial reactions at least. So much of doctor-patient communication is nonverbal. Face-to-face consult, in the flesh, is still the best. Ended the call with my heart encouraged by their faith in the Lord. Miss talking to patients. Hoping to start a clinic here soon. Waiting for approval from a telemedicine provider. Doing remote clinics while locked in hotel room—why not?

Mavis Gallant—Tita Mavis, we call her—keeps me company. Paris Notebooks is delightful. They don’t print this anymore. Found a copy from Powell’s Books (Portland, OR). Delivered in post office last February but I picked it up few days ago. So worth the trip. Mother will reprimand me for risking exposure. Miss getting nagged. Tita Mavis writes she was neighbors with a med student. I love her more now.

Touchdown Marbel

Arrived in Mindanao last July 30. Flight was okay. Lady at NAIA checked my documents, stamped them. Remembered A Very Secret Service: “tamponner!” Man at PAL check-in counter asked, “You’ve been abroad, Sir?” He saw my Japan visa. Memory of cancelled trip. Will have to content myself with watching documentaries of Japanese old people. Might rewatch Kimi No Nawa. Throughout trip, wore N95 over surgical mask. Also: face shield. Felt like I had cataracts. Too much? Old med school roommate Bryan Jay wore complete PPE. Better safe than sorry.

Touchdown Marbel

Touchdown Marbel

Plane was 80 percent occupied. Fascinated by kids on board—they didn’t give a care to this world’s problems. Childlikeness, a virtue. Teared up as I remembered God’s goodness to me throughout all my years in Manila. Couldn’t wipe my tears lest I risk getting COVID. Tears dried on their own. Wala muta. Brothers tell me I’m a sosyal crier.

Touchdown Marbel

Nanay texted me, “Welcome home!” Auntie Net: “See you in 14 days!” Manong quite envious he was left behind. Sean asking if everything was okay, he’d bring me a coffee maker. I have the best, kindest, most generous brothers. Filled out some forms. Light snacks on designated seat in LGU bus. Driver started small talk, greeted everyone “good morning” in Hiligaynon. Sounded like one of my father’s friends. Felt like home, at last.

Touchdown Marbel

Touchdown Marbel

At Koronadal City Health Office, got tested. Old lady told me she remembered a speech I gave in high school. Someone from high school announced, “Amo ni ang valedictorian namon.” There went my wish for anonymity. Everyone calls me “Dok” now. Even the receptionist and the man who brings meals to my door. A small world.

Poignant scenes: six or seven-year old boy, before going to the rest room, asked if I could watch over their bags. Mother was away, interviewed by health care worker. The kid acted like an adult; he’ll reach places. In contrast to many kids these days—downright irresponsible, waiting for their overly doting mothers to feed them, while they play on their gadgets. Could be forgivable they had a book. But gadgets? Disastrous.

Another: old people asking the nurse, “Can we feed our dogs?” “Where can we hang our clothes?” “Can I walk around the garden? I have a fence and I live alone.” Nurse told us, “Be creative with your time.” Encouraged us to record Tiktok videos. So eloquent and heartwarming, with a reassuring voice that remind me of ninangs who sniff me during beso-beso.

Touchdown Marbel

Now settled in small hotel. Sean arranged for accommodation. Internet connection is good. Books keep me occupied—Thomas Watson, George Saunders, Tita Mavis, and maybe Hilary Mantel.
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