Bottled ※ Brain

A beautiful word : Feierabend isn’t just a German word for ‘work-life balance’. While it’s related, ‘work-life balance’ is a term that can often end up just as nebulous in meaning as the problem it’s trying to correct. Instead, the German approach seems to acknowledge that there will always be tension between the work self and the private self. Rather than attempting to reconcile the two, the disconnection that comes with Feierabend establishes boundaries between them. It also usually creates a path between the two states, like dressing for the office and changing after work . . . . When I did my medical oncology fellowship in Manila, I made a conscious decision to live as far away from the hospital as was allowable. I got curious glances from people when I said I spent an hour or more of commute from Mandaluyong to Philippine General Hospital. I could easily have rented a condo unit nearby if I had so wished; a lot of my colleagues did that. But I wanted the clear separation of work a

Hong Kong, 2016

Sunday service in church this morning. Sermon was a survey of the Christmas message from Genesis to Revelation. Powerful preaching that began with God’s holiness, continued with man’s depravity, God’s mercy and grace through Jesus Christ’s life and death on the cross, His resurrection, our redemption. Been thinking about God’s humility in the manger. A painful rebuke to my pride, as I have moments of self-entitlement. Must remind myself I don’t deserve what I have, and I deserve worse. Yet God, my Father, looked at a sinner like me with unconditional love, adopting me into His fold and calling me His own. I am not the captain of my ship; God is. And He chose to be born on a manger instead of a fancy inn in Bethlehem. Lunch at church followed. Food preparation was a labor of love. Mother and Auntie Cecil headed the committee on food. The women took on the reins. Menu was overflowing—thanks be to God! Manong’s brazo de mercedes was a hit. Asked a kid what her favorite meal was; she poin

  When I should have been studying, I have been watching SMILEY'S PEOPLE , an old BBC series based on the novel of John Le Carré. George Smiley is played by Mr. Alec Guinness. Mr. Guinness is spectacular in this role! He is serious, methodical, and unemotional. I love his pair of thick-rimmed spectacles. I have a similar pair .

"For to us a child is born, to us a son is given, and the government will be on his shoulders. And he will be called Wonderful Counselor, Mighty God, Everlasting Father, Prince of Peace." (Isaiah 9:6)

One of Nanay's visits to the farm. She used her iPhone. I did some tweaking, adding a vintage filter through Flickr. In our neighborhood, people drive to their farms on weekends to while away the time.

Manong's first croissants. Not perfect, but good enough for me!

Nanay's phone is synced to my Flickr account. I've been telling her to take photos of her every day. I don't know where she took this shot, but I like it!

Light rain greeted me at 4 am. I meditated on Psalm 119 on this cool morning. I wrote the passages by hand to relish them, praying as I went along. In these passages, the psalmist extols God's precepts. He is a student of the Word, celebrating and relishing the greatest Book ever written, worshipping the Author of all creation. "You are good and do good; teach me Your statutes" (Psalm 119:68).  

Prof. Marj's Evasco's Farol de Combate is one of my favorites. It is good to be home! Here's an excerpt.  I trust that beside the well which had been dug By my elders, a storm lamp had been placed, Lighting up the path toward home, the lamp- Lighter minding the first law of neighborliness: To help one another as best as one can in daily acts of living, for if the lamp were put out, unlit, Someone passing by might stumble or slide, Fall into the neighborhood well and die. When I pass by the well I will draw water and drink, Give thanks to my unseen neighbor for the light.

For Christmas, Prof. Marj Evasco sent me a copy of Dinah Roma's poetry collection, "We Shall Write Love Poems Again."  It is beautiful. Tinitipid ko para hindi matapos agad. Thank you for writing this, Prof. Dinah! The mail came with a note from Prof. Marj. Her handwriting is exquisite, her message heartwarming! Like me, she also shares a fascination with fountain pens.  My family thinks I'm the coolest because I know poets personally!

Alfie wrote these bonus items.

Just received an email that the diplomate exam in medical oncology will be held in regional testing areas on January 2021. Suddenly I feel like an elementary pupil again, about to compete in a regional contest in Davao (when South Cotabato was still in Regional 12, and we had to defeat the smartest kids from Philippine Science High School - Southern Mindanao—but they mostly won!)

On our way back to Marbel, Sean and Hannah, his charming girlfriend, saw a stall in Barangay Paraiso. "Apan-apan, Manong, makaon ka?" ( Game for fried grasshoppers, Manong? ) It brought back childhood memories: apan-apan is one of my favorite snacks. From Eat Matters : Apan-apan in the Ilonggo dialect means grasshopper. Back in the days when the verdant fields of rice were still pesticide free, farmers would catch the deluge of grasshoppers infesting the rice crops with a large net.The grasshoppers are then cooked to be eaten as sumsuman( a drink accompaniment)when the farm folks gather to drink at dusk after a hard days work or, as a dish on the family dinner table. With some degree of hesitation I was able to taste this dish many years ago when somebody from Mindanao dropped us a bagful. It was crunchy alright but the discomfort of thinking that you are munching on a grasshopper somehow made the eating experience a bit stressful. No stresses from me! Fried grasshopp

Congratulations are in order for my dear friend, Rich King and the team, for the study that looked at the use of on-site pathology evaluation in diagnosing lung cancer. The abstract is published in the Annals of Oncology .  Access to biopsy services is a limiting factor to timely lung cancer diagnosis in many areas in the Philippines. On-site pathology evaluation allows for rapid diagnosis and helps ensure adequate specimen sampling. In our institution, its utilization and impact have not yet been evaluated. By analyzing 112 pathology reports from 88 patients, King et al. had the following conclusions: On-site pathologic evaluation was associated with an earlier lung cancer diagnosis, a reduced need for a repeat biopsy, and a higher proportion of patients eventually receiving treatment. Efforts should be undertaken to increase the utilization of this service in order to optimize the quality of care for these patients. 

John le Carré has passed away . The author, who died on Saturday, “had a knack for language of every variety,” our critic Dwight Garner writes. “His books hum with the flavorful and recondite language of espionage.” Here's a beautiful piece by Dwight Garner . On a recent Saturday morning in February, two dozen or so scent hounds streamed through the streets of St. Buryan, a small village in Cornwall, England. Behind them drifted a loose formation of men and women perched atop well-groomed horses and wearing boots, breeches and hunting coats. As the fox hunt clopped through town, John le Carré, the pre-eminent spy writer of the 20th century, sipped from a paper cup of warm whiskey punch, doled out by a local pub to riders and spectators. At 81, he remains an enviable specimen of humanity: tall, patrician, cleanlimbed, ruddy-complected. His white hair is floppy and well cut, so much so that the actor Ralph Fiennes, who starred in the 2005 film version of le C

It boggles people when I tell them that the Med Onco clinic was, in my experience, one of the happiest places at the Philippine General Hospital . Cancer is depressing as it is, but the people I trained with—my batch and those ahead of us—lightened the emotional load that inevitably came with oncology training.   Norman and Bobby , whose cubicle was beside mine, had scholarly arguments about clinical trials and general nonsense. Their verbal jabs were soft but pointed, producing laughter, not offense. Ozzie and Crizzy circulated a blank paper with the header, "Serenitea Orders," on days when we were flooded with patients. Papau (Paulo) saw to it that crowd control was implemented—one minute he'd be erupting with "Labas muna ang hindi pa tinatawag," the next minute he'd be singing a random pop song. Nobody demanded to be addressed with honorifics. Everyone saw to it that we—Rich, Roger, Freddie, and Kmomsh—were treated equally. They were warm and humble, kind

"The pencil is a wonderful piece of technology," writes Austin Kleon . I agree. For the past weeks, I've been using pencils for note-taking.  From left: Mongol 482 (no. 2), giveaway pen from Marco Polo Hotel, and Faber-Castell Goldfaber 1221 (4B). Eraser is a Faber-Castell "special eraser for examination."

I pay attention to the books in the background . As 2020 winds down and we look back at our pandemic year, it’s possible, through the murk of loneliness and illness, to see the few bright spots that existed for people who love books. We had the chance to peruse a lot of strangers’ bookshelves — nearly every time we turned on the television or began a video call.

Dr. Jennifer Mhyer, doctor-missionary in Uganda, writes about Ebola and advent . On the 4th of December 2007, we were in this very place, surrounded by epidemic, and without our kids, facing uncertainty and loss. 2020 is not the worst we have seen. 13 years ago Ebola Bundibugyo boiled up in this little pocket of the world. Dr. Jonah was in his first year post-internship, and had been examining and treating patients with Dr. Sessanga, PA Scott Will, and us, all of us lulled by the negative Ebola testing into the assumption this was a particularly bad typhoid epidemic. However, it was a new strain of hemorrhagic virus, requiring a new test, and by the time the CDC announced this discovery Nov. 29, Dr. Jonah was already shivering with fever and depleted with vomiting in Kampala where he had gone to pick his daughter Masika up from school. We put our children and team on small planes on the grass airstrip to evacuate them from the risk of being near us if we also succumbed, and tried to

Been scanning old photos. I long for the beach.

Congratulations to my dear friend, Roger Velasco, for spearheading this excellent study, now published as an abstract in Annals of Oncology . A notable finding is that "patients who did not receive chemotherapy, radiation, or surgery were more likely to be malnourished compared to those who previously received or were currently receiving treatment (chemotherapy: p < 0.01; radiation: p = 0.04; surgery: p < 0.01)."  Quite interesting to find out that "Notably, only 17% of patients were referred by oncologists to the dietary service." Note to self: involve the nutritionists! 

Manong's take on the devil's food cake, our favorite thing to order whenever we eat at Chocolate Kiss, Bahay ng Alumni, UP Diliman. The restaurant is now closed. Auntie Netnet skipped dinner to eat two slices of this.

52 Things I Learned in 2020 by Tom Whitwell , one of the best things I read this week. Some notable items in the list (and a few comments). 1. Most cities plant only male trees because it’s expensive to clear up the fruit that falls from female trees. Male trees release pollen, and that’s one of the reasons your hay fever is getting worse.  —In my city, trees are cut to make way for highways. 2. In China, 🙂 doesn’t mean happy, it means “a despising, mocking, and even obnoxious attitude”. Use these, instead: 😁😄😀. —Not the biggest fan of smileys. Some friends use smileys as punctuations. I think they're overcompensating, making sure the person getting the message doesn't get offended.  9. Money makes people happier than psychotherapy. —Having three square meals a day and a roof over one's head takes off the stresses of daily life. But too much money might give more headaches than happiness. 11. Euro English is an evolving pidgin English used by EU

Mushrooms beside newly transplanted ferns. Took this photo in the morning. The mushrooms were wilted when I checked them again in the afternoon. The brevity of life. 

  Thrilled to know we have new doctors! Congratulations! I remember taking the road to that almost elusive medical diploma, a process that involved micro-naps to get us through the day.

Dropped by a newly opened mall in downtown Marbel and was quite amazed at the typography.

Having grown up buying Hebi in sari-sari stores, I was surprised that hebi is a real thing. 

Met with Ronald and Althea yesterday. Ronald is a kind and brilliant internist who's deployed here for the meantime. We last met during Katrina's idyllic wedding, where he and John Mark left me at the reception area, leaving me no choice but to join in the games to represent the "friends of the bride." Well, anything for Kat.  Thea is a nurse of the highest order; she is also a college professor, mother of two, and is working on her PhD. Her husband and I might be related. I hadn't seen her for 16 years. She messaged if I had free time for coffee. I had just woken up from a postprandial nap. A few minutes later, her car was in front of the gate. I was surprised that she remembered where I live. She said her kids went to daycare at St. Gabriel, in the next block. The kids would go around the neighborhood during mini-parades. I was surprised that there was a daycare center.  We remembered Ronald, who I'd been meaning to meet. We used to ride the same sundô —the

De Vita is the go-to oncology textbook.

Around this time last year, we were in Singapore for ESMO Asia. Karen had to leave after the gastrointestinal cancer preceptorship, but Fred, Rich, Roger, and I stayed. This year, ESMO Asia 2020 has pushed through. True to form, our posters are up, albeit virtually. I have no first-author papers, but my friends—how I miss them—were gracious enough to include me in their research. Browsing through virtual platform, I read the banter between Roger and Rich. These appeared as comments below the e-poster,  Utilization of on-site pathology evaluation for lung cancer diagnosis in the Philippines' national university , with Rich as the principal investigator. With my batch, nothing is ever taken too seriously. The guys know how to have serious fun—even in international meetings. Did I tell you I miss them dearly?

While looking for vintage boxes to store my journals, I saw an album in a forgotten corner of the flea market. Black and white photos of a Japanese family on holiday were collated in its thick pages. This portrait of two children enjoying themselves at the beach struck me and made me long for the sand and sea. Here's to hoping that the Sarangani beaches open soon. 

Fifteen minutes after the fact, a friend called me up to tell me that her mother has died. Her mother was my patient. Her parents—kind, gentle, and who at one point told me when their hospital discharge was delayed, " Okay lang kami ah; wala problema maghulat kay senior citizens na kami "—reminded me of my own, which made this death harder to bear. After a short word of condolences, my friend and I talked about specifics: the death certificate, the paperwork, and so on. The consoling will come later, after the embalming and the funeral preparations. I told my mother the news. She knew them from her hometown. Nanay said, "There's a certain lightness to dying when you know the person was a Christian." There is.  And my patient is home with the Lord. I will tell my friend that.

Geneva, Switzerland

Old peopl at HK airport

  Crawford Market, Mumbai, India

This is one of those days when I'd much rather be at home, writing letters to friends by mail, with a good bottle of oxblood ink and cream stationery. I am, of course, reading The Letters of J. R. R. Tolkien (George Allen & Unwin, Houghton Mifflin), which encourages this distraction. I might make physical letter-writing a habit soon, but whether this is sustainable is a different question. It is certainly not practical. It is easier to send emails; they also cost less. But I go out on a limb to say this: the comfort of convenience is over-exaggerated. I need to be inconvenienced once in a while: make time to compose my thoughts, write them by hand with a fountain pen, and deliver the envelopes in person to the post office. Now I'm beginning to understand why my med school friends AAce and Chevs (they are AA and Everly, if you're so curious; I have this strange habit of conferring unique and affectionate nicknames to friends) have taken particular pleasure in sending me

November mornings feel like Christmas.

Tolkien's letter to his son about sex, with commentary from Dr. Al Mohler . The devil is endlessly ingenious, and sex is his favorite subject,” Tolkien insisted. “He is as good every bit at catching you through generous romantic or tender motives, as through baser or more animal ones.” Thus, Tolkien advised his young son, then 21, that the sexual fantasies of the 20th century were demonic lies, intended to ensnare human beings. Sex was a trap, Tolkien warned, because human beings are capable of almost infinite rationalization in terms of sexual motives. Romantic love is not sufficient as a justification for sex, Tolkien understood. Fascinated by handwritten letters, I looked up JRR Tolkien's handwriting. He must have used a stub nib in this letter , sold for auction at 8000 dollars. I read in a forum that the English professor used dip pen and ball points.

The script reads like textbook Filipino. I show this to Manong, "Daw hindi gid Tagalog ang nagsulat sini, no?" 

What a beautiful show !

Strong rain and winds knocked this bird's nest (Asplenium nidus ) off its pedestal last month. "The queen fell!," Mother said, then proceeded to give instructions prop her—the fern—up amidst the pouring rain.  Now, the "queen" comes back with a beautiful vengeance. These new leaves make us forget her past humiliation.  It's fascinating to hear my mother refer to her plants with a devoted familiarity. I have not heard her speak directly to them. But when talks about them, she resorts to anthromorphism. If you didn't know the context, you'd think she was talking about her friends. 

Cast irons at a local flea market. Manong soaks them in 1 part water, 1 part vinegar, and scrubs them with detergent and baking soda. Impressed that the rust flakes off, he says, "See? I know chemistry." In third year high school, he represented the school in a chemistry quiz contest. Not sure if he won!

Dr. Russell Moore on boredom: The Bible tells us to pray for our leaders—and we should—but all of that is a means to an end, and that end is “that we may lead a peaceful and quiet life, godly and dignified in every way” (1 Tim. 2:2). The goal is not that the arena of the state would be ground-zero for meaning in our lives—much less for excitement and interest. When the civic order is going well, we should pay attention to it out of duty—not out of constant existential crisis. Those are not always the times we have, but those are the sorts of times for which we should pray. The point is not that we should hope for a boring decade so that we can be bored. The point is that we should pray for a boring decade so that we can be rekindled with interest and affection and passion for the things that ought to fuel such things—the kingdom of God, the gospel of grace, the love of family and friends and community, the glory of the ordinary, which is where, after all, the best of real life happens

Manong's recipe.

Found my pencil of choice. A smooth writer.

New vintage frames from a Japanese surplus store in Gensan. This may well be my 20th pair. Had the lenses replaced by Dr. Farrofo at the Farrofo Eye Clinic . Who owned these frames before? I may never know, but I imagine that it could have been the Professor whom the dog, Hachi-ko, waited on. My timeline is off, but I'm free to imagine. 

View this post on Instagram “Reading is escape, and the opposite of escape; it's a way to make contact with reality after a day of making things up, and it's a way of making contact with someone else's imagination after a day that's all too real.” - Nora Ephron A man reading on a mountainside in South Island, New Zealand, 2015. A post shared by Steve McCurry (@stevemccurryofficial) on Nov 4, 2020 at 9:48am PST

Auntie Cecil and Uncle Rene, my parents' best friends and practically second parents to us, have relocated to Barrio Singko, about 15 minutes away from the city proper. Beside their property is this vegetable garden maintained by the local government (as far as I know). They get their greens from this patch of land. As kids, we looked forward to the peria in the town square. There we ate cotton candy and pop corn coated with salt and butter. Got my driver's license yesterday. Felt even more fulfilling than getting a medical degree, in a sense. Never in my wildest dreams did I imagine I could learn how to drive. My driving instructors, Sirs Jim and Mark, ran me through the process with patience. And there has been my kid brother Sean who is an excellent driver, much too defensive perhaps, who told me I should learn driving because it is a life skill. He suggested that I first learn how to operate a manual transmission vehicle, an idea that I entertained with suspicion—our fam

My prayers are with Tim Challies , whose son recently passed away. In all the years I’ve been writing I have never had to type words more difficult, more devastating than these: Yesterday the Lord called my son to himself—my dear son, my sweet son, my kind son, my godly son, my only son. The responses on Twitter are sources of encouragement.

One of the best things to read this week is this article on the caretakers (or wardens) of Britain's small islands .  Wardens have limited access to the mainland during the winter months, aren’t guaranteed fresh running water, and often live under the threat of harsh storms and perilous currents that can leave them marooned for weeks at a time. Food is delivered once a month by boat. It’s not a role that many are suited for. And yet a growing number of people are dreaming of this simple way of life, seeking to trade the madness of our busy cities for a self-sufficient life among nature. This excellent article (with beautiful photographs by Alex Ingram) reminds me of Larissa MacFurquhar's piece on the British Falklands : It is a place to retreat to in a time of plague. Outside the town are miles and miles of empty land, and few roads. Nothing anywhere but whitegrass, dark, scrubby bushes growing close to the ground, and rocks. Only low mountains and no trees, so there’s l

Uncle Glenn, Auntie Net's husband, invited my mother to visit his relatives in Lamba, a few minutes away from Banga town proper. The purpose of the trip was plant viewing. The underlying motive was to ask this relative if he would be willing to give some of his plants. The rarer, the better. A seaman contemplating retirement, Uncle Glenn has grown to enjoy domestic life. Gardening is his newfound passion. "Variegated" is now a household term. When he drives, he slows down, looks out the window, and appreciates the Pothos clinging on to old trees that were once ignored. They had a productive trip. My mother came back with pots of orchids. Such is the beauty of God's creation!