Bottled ※ Brain

Taken last February, when Fred Ting and I rode the rickshaw in Mumbai, India.  Two days after my self-imposed hotel quarantine and in the absence of any symptoms, I decide to go home and continue my lockdown there--home, being my brother's small condo 7 km from Manila. I hail a yellow e-trike parked near the hotel entrance. There are no taxis. The special buses are out of the way. It is 5:30 am. The sky bears faint streaks of sunlight. The driver looks at me, head to toe, as he wipes the trike's glass window clean. I don't look like a thief--certainly not someone who will stab him. I have thick glasses, a clean surgical mask, white polo tucked in, navy blue trousers folded twice up to the ankles to reveal my striped socks and worn Adidas sneakers: my favorite get up. But, he must wonder, who travels this early, before even the sun rises? I introduce myself as a doctor in PGH, the best way to appeal to his senses--to other people's sympathies, in general. "I n

With nothing much to see, except the four walls of my room, I take a photo of my old Korean frames, without which I cannot see clearly. I learn that my friend, Roger, is also staying in the same hotel. We meet each other to get take out lunches and dinners at the nearby convenience stores. Over dinner, we talk of how much we miss our fathers (his father died a week before Tatay did), how our fellowship in Oncology has changed us (for the better), how we will miss the company of our friends. It's cathartic. I'm stuck at level 16 of Alto's Adventure : how does one do the triple backflip? Email me the tips, please. I pray for friends and loved ones. I read John Updike's The Christian Roommates . Memories of Kalayaan Dorm at UP Diliman come rushing in. I stay out of social media. I message my family: Sean is cooking pork humba at home, Manong is preparing pininyahang manok. They exchange photos. Meanwhile, I subsist on takeouts and sliced peaches. I think of studying fo

Garden in front of Ward 3 of the Philippine General Hospital. Tired after work, I head over to the nearby hotel where I'll be spending a few days for self-quarantine. I can easily come home, but I don't want to cause unnecessary risk to my brother, with whom I share a small space. Later.

COVID tent beside the Philippine General Hospital Out-patient Clinic.  My 24-hour shift as fellow-on-duty at Ward 3. It's great to be back at PGH after a long time. There's a feeling of impending doom and paranoia. Pop culture references in mind: Gondor in The Return of the King . Or the Game of Thrones ("Winter is coming"). The difference is that we're expecting patients in dire need of care, not orcs or whitewalkers. If they're COVID-19-positive, we may make special considerations. And yet, there's a pervasive feeling of hope. A strong sense of purpose. The bayanihan spirit. In the newly renovated call room behind Ward 3, the IM residents enjoy donations of food and snacks. Masks are not lacking. There's laughter and sarcasm. We feel that the nation is behind us. But there's the unspoken fear of the unknown: we know that our work  here can harm us. A number of our professors and mentors, people we know, have passed away. But we carry on. Pad

Fresher air in Metro Manila. My morning fiction reading: John Updike, “A Dying Cat, A Traded Car,” which was about a writer who visited his dying father and remembered their car. A beautiful portrait of a father’s love, and faith, and family. I still think of Tatay and wish he were here. His presence was calming, like nothing could go wrong. A friend's father died today. I message her to say how sorry I am. I probably know how it feels like. Another friend's wife died today, too. So many deaths—since the lockdown, this has been our reality. Tomorrow I'll go on 24-hour shift at PGH. I'm not sure if I can post something then. Later.

The PGH Cancer Institute playground.  Nothing much to say today. Please pray for me and my colleagues. I'm scheduled to report to work next week.

Getting a dose of morning sunshine. (Pero ang Pinoy, ayaw talagang mainitan!) There's the news that a senator, COVID-19-positive, went to a hospital with his pregnant wife, infecting healthcare workers and effectively closing down the operations of the said institution. I am angry. What pacifies me is the strongly-worded statement released by the hospital: it minced no words and, with clarity, rebuked the senator's actions. Whatever happened to leadership by example? There's also news that friends from church are hospitalized; one is critical. I am brought to my knees in prayer. *  *  * Dr. Albert Mohler, in his article, The Humbling of Civilization: Praying for the Mercy of God , writes: As image-bearers of the living God, even the most hardened secularists among us must deal with the most ultimate issues and questions—especially when faced by this kind of life and death challenge. I've been talking about death and dying, the ultimate questions, to a numb

Getting my dose of morning sunshine as I rewrite an excerpt from "Peril," one of the Puritan prayers in the Valley of Vision . (For the curious, the pen is a Platinum 3776, inked with Diamine Chrome. Notebook is a Victoria insert, which fits snugly in a Midori Traveler's Notebook.) I imagine that poems and stories will be written about this episode in our lives. As more and more people die in Italy and elsewhere in the world, including these shores, people are attempting to make sense of what's going on. This is the value of words, of literature. I suppose Dr. Raul Jara was fond of poems: he read one of his during the inauguration of the garden in front of Ward 3, what used to be old patch of land that surrounded the Gastrointestinal Clinic. He was  my college professor, one of the foremost cardiologists in the Philippines . He passed away. I never had the chance to be under his General Medicine service, but I had several opportunities to sit in hemodynamic confe

The streets are quiet. I am awake at  3 AM. I write the final sentences of the first draft of a story that will likely never see the light of day. It is too embarrassing to show. Perhaps I will come back to it after some time to write the second draft. The prolonged time at home has encouraged me to try writing fiction again for the sake of trying, sort of a proof-of-concept experiment to see if I can do it. The exercise has done me good, so far. My brother reheats the food we had for dinner then proceeds to work online. Careful not to bother him, I go to the balcony to get some sun and treat myself to Dr. Butch Dalisay's story, "Heartland." ( Google Books preview here. ) The protagonist is a surgeon named Ferrariz, jaded with death and dying all around him. I know people like him. Blood came with the business; it meant nothing now, the corpses piled in the wagon behind the camp, bloated and dripping; the physical fact of death was the first lesson any surgeon l

The MRT has shut down its operations. I worship at home, in front of the old HP Elitebook 2570p, which I've grown fond of. As I sing along the familiar tunes of Trust His Heart and Rejoice in the Lord , with Kuya Deni's guitar accompaniment, I imagine the warmth of fellowship through the firm handshakes, the warm smiles, the random consults as I walk in the small church sanctuary in Quezon City. It seems like a long time ago, when physically meeting together was the norm. Pastor Bob preaches on Romans 8:18-25 in a pre-recorded Youtube video. For believers, there is freedom from hopelessness. It's a message I need to hear. Despite the world's despair, there is sure hope in the Lord. The death of the "young trainee"  at the Philippine Heart Center reminds me that death can happen anytime. My friends fear for the loss of their lives. It happened to him, it can happen to anyone. Heart Center executive director Dr. Joel M. Abanilla said in a statement:

I wrote with fountain pens and paper today. Click on the image to enlarge.  The past few days have blended into what seems like an extended, perpetual weekend. Unless I looked at my calendar, I would not know what day it would be. I was, for instance, jolted at 4 AM by the realization that I had signed up for a webinar on cancer and COVID-19. I was relieved, in fact, to have been able to log in just in time. The house was quiet, my brother was in REM sleep (I could tell by his breathing), and, save for the computer glare, the room was dark. I did not stay too long to finish the teleconference. But that happened days ago. Today, I checked, is a Saturday. After lunch, I am greeted--no, not that cheerful word--shocked by the news that a doctor about my age has died. Complications from a severe COVID-19 infection that hit him. His patient did not fully disclose her travel history. He passed away doing the work he had been called to do. I learn from my friends that he was a kind man,

"...You're one of the people who will thrive in quarantine," a friend based in the States writes to me, just as I'm about to finish Mia Alvar's final story in her collection, "In the Country." To be honest, I don't know when my stamina for self-isolation can last. I attend the sarcoma multi-disciplinary teleconference through Zoom. A patient with a shoulder mass also has an occipital tumor, which can be meningioma or a solitary fibrous tumor. The discussion is lively. Surgery then radiotherapy, proceed with a whole-body PET CT, or wait for the final histopath?  A consultant coughs in the background. Laughter erupts. Nobody at the conference will be infected anyway. The wonders of technology! I have several questions at the back of my mind: (1) how will the patient afford the diagnostics and treatment?, (2) how will his treatment proceed, now that hospitals have been directed to stop elective procedures, in the hopes of redirecting all efforts tow

Remembering our round-table discussion on germ cell tumors at the PGH last year Staying at home, indoors, is becoming the new normal. Maybe that's a good thing, a part of the community's coping mechanisms: people are getting creative, finding ways to work from home, catching up on their reading backlogs, and so on. (At least, those who can afford to do so.) Because the lifting of the lockdown is still a few weeks away,  we need to create healthy habits for our body, mind, and spirit, and not let this so-called locked-down lifestyle push us into uselessness. The hardest parts are usually the beginning and the end. These final weeks of March mark the end of my fellowship training in medical oncology! I have been preparing myself and my patients for the inevitable goodbyes as early as January. I have told my patients that a new doctor will care for them the next time they will follow up. The release of the list of new fellows accepted into the training program seals the fac

I brew a fresh cup of coffee this morning. French press, coarse ground, strong. I have enough coffee to last me a month, thanks to my patients who gave them to me as parting gifts. Everyone is still on lockdown, and if you're reading this from Metro Manila, I say cheers to another day, my friend. I sit beside the window, plug my earphones, read the final books of Genesis and a chapter in Mark, the part where Jesus feels compassion toward the people because they are like sheep without a shepherd. I pray for friends and family. The end of the pandemic. A heart that trusts and depends on God. That I will have a ride to work when I report for duty next week. I write a story that's been brewing in my head, but it's in its infant stages and may never see the light of day. Toying with my imagination is a good way to pass time. If you're tired of reading toxic material in social media, try writing or journalling, practicing social distancing and social media distancing at

I wake up to a message from Fred, who's supposed to go on a 24-hour shift in the hospital today. It's all part of the skeletal workforce being implemented by PGH: as few health-care professionals at any given time. If a team on duty gets infected, at least others can still make it to work. "If things don't improve, I don't think we can travel anymore," he writes. He lives in Ortigas, a few blocks away from me. I'm scheduled to go on the same shift next week, plus the out-patient chemo sessions if our patients (or their oncologists) ever make it to Taft Avenue. The suspension of Grab, taxis, and other modes of public transportation is a problem for us, healthcare workers, who don't drive. I am considering my alternatives. Walking is one of them. I check Apple Maps: if I walk from home to work, it will take me an hour and 45 minutes. It makes me wonder: what about our nurses who live in Cavite? But the government's declaration to suspend transp

I Grab to work. It takes me 20 minutes to reach the hospital. Traffic is good, as if it were Holy Week. I pay Php 400-something. There's a sense of fear and paranoia. Nobody wants to linger. There are masks everywhere. Pedestrians even wear N95s; I wonder where they got them while my colleagues--pulmonologists, critical care specialists--couldn't. Ma'am Jo, our clinic's nursing assistant, hands me her own extra mask because there are no stocks in the hospital this morning. The delivery hasn't arrived yet, or so I am told. It's a quiet Monday, a far cry from the usual pandemonium. Follow ups are discouraged unless the patients are scheduled for chemo. There's humor, too, and teamwork. We take turns in seeing patients of our colleagues who are on quarantine. We pray that their tests come out negative. I want to tell you that, contrary to what the Presidential Spokesperson said in his briefing, there is no evidence linking bananas and gargling to COVID-

I watch the Sunday preaching video online . I am in a cottage by the pool. It is 9 am. I take notes. Colossians 1:15-20: [Jesus] is the image of the invisible God, the firstborn of every creature: For by him were all things created, that are in heaven, and that are in earth, visible and invisible, whether they be thrones, or dominions, or principalities, or powers: all things were created by him, and for him: And he is before all things, and by him all things consist. And he is the head of the body, the church: who is the beginning, the firstborn from the dead; that in all things he might have the preeminence. For it pleased the Father that in him should all fulness dwell; And, having made peace through the blood of his cross, by him to reconcile all things unto himself; by him, I say, whether they be things in earth, or things in heaven. What comfort during these troubled and troubling times! This is the first time in history that the Sunday worship services in chur

I finish season two of Kingdom (킹덤) in Netflix. It's about an epidemic that turns people into flesh-eating monsters. Once bitten, the victim becomes a monster. Unlike in other films, the zombies run. The protagonist is the Crown Prince Lee Chang (Ju Ji-hoon), who, in order to save Korea, must also ascend to his rightful throne and remove the usurpers, the Haewon Cho Clan, headed by Minister Cho Hak-ju (Ryu Seung-ryong) and the Queen Consort Cho (Kim Hye-jun). It has politics, conspiracy, deception, infectious disease, and epidemiology. It's beautifully crafted. It does not insult the viewer's intelligence. Don't watch it if you're prone to panic. *  *  * I do some laps in the pool. I read about Esau and Jacob in Genesis. I remember friends and family. I pray for negative COVID swab results of two friends very dear to me. *  *  * Work resumes on Monday. My patients from the provinces can continue chemo, provided they show proof that their travel to Metro

At the University of the Philippines - Philippine General Hospital Main Lobby The train is unusually quiet on my way to work this morning. The passengers, hair still wet from the shower, scroll through Facebook on their phones. A man holds on to the handrails and sings a Tagalog rap song I don't recognize. A lady's head is on her boyfriend's shoulder; it bobs and sways with the train's movement. She is soundly asleep, oblivious to the panic. There are masked people everywhere, as in an episode of Watchmen. A man near the train door sneezes. Everyone looks at him with contempt, as if he has committed a mortal sin. There is palpable relief when he disembarks on Ayala Station. As soon as I arrive, I head to the Cancer Institute where my patient, a 59-year old woman from Tondo, is confined for her second cycle of chemotherapy. She has stage IV rectal cancer. I tell her she can go home later tonight or early tomorrow morning. She has not heard the news last night. "

Colin Jost's New Yorker essay about his high school commute between Staten Island and Manhattan is a worthwhile read. (Jost's grandfather sounded a lot like my father, who did not hesitate to grant me permission to travel alone from Marbel to Baguio. He wanted me to learn how to be street smart.) I took a bus, then a ferry, then a subway—which, when you type it into Google Maps, looks like you’re emigrating from China to San Francisco in the eighteen-forties. I live an hour away (two hours, on bad days) from the hospital where I work. Commuting is a good time for thinking and praying. I would listen to Tim Keller's Gospel in Life podcasts  or the New Yorker Fiction podcasts (I find Deborah Treisman's voice soothing). There are days when I would feel like listening to the podcasts recommended by good friend Harold Tan: The Memory Palace being my favorite among them. I also read a lot of books on my Kindle. I finished John Calvin's The Institutes and Stephen

I started swimming again. I don't, and likely won't, do gyms, so this is my preferred cardio work out. I don't have to deal with sweat, and it's perfect for hot days (which is 90 percent of days in Metro Manila). It took longer for the cleaners to declare the pool clean enough for public use than what I had expected, about a month after the Taal became quiet. I think and pray when I swim. While air-drying myself up, I read the Bible and have my devotions. Inside my bag are my Speedo goggles with corrective lenses, a quick-dry towel, my Midori Traveler's Notebook, my cell phone (which has the ESV app), and my fountain pen; here, it's the TWSBI 580 AL. Sometimes, I bring a Kindle, too, for some leisurely reading. How do you exercise?

Kaweco Old Soul and Pilot Custom 74 with my Midori Traveler's Passport notebook, black.

While preparing for a meeting I'm moderating tomorrow, a girl about five years old came near me. "What are you doing?" she asked. "I'm reading." I was seated on a reupholstered sofa, my iPad and notebook on my lap, and pencil in my right hand. Her grandmother was a few meters from me, talking to someone on the phone. "Oh. What's that?" she asked, looking at the tumbler to my left. "That's coffee." "I don't drink coffee," she said. "I'm still a young girl." "Yes, you are." She left me for two boys who had just arrived--her friends from the neighborhood in sando and shorts. I would later overhear them playing doctor-and-nurse. They had fake stethoscopes and a doll.

Koalas are asleep for most of the day. When they're awake, they like to munch on eucalyptus. Cute!

Timely post I saw from a friend's feed. As doctors who (should) know more about the science behind the virus, this has been a personal reminded for me to v erify, verify, verify the facts before I would even think of posting them. This is true for the current COVID-9 epidemic. This is true for any cancer treatment.

The Entrance, New South Wales, Australia

Beautiful piece by Seth Lewis called "If God Can Be Trusted With Death, He Can Be Trusted With Life." The longer I live on this planet, the more I’ve been forced to learn the art of dealing with death. There were no classes on this in school, but I have a teacher who refuses to be ignored: Experience. Attendance is mandatory. One after another, with increasing regularity, the funerals come. During the service, those of us who remain remind each other of God’s promises, eternal life and resurrection, Heaven and perfect rest and happiness for all eternity. The crowd pauses to make time for prayers and Scripture while death is in the room, before life moves on. But life does move on, and then many of the same people who spoke of the promises go back to ignoring death. Along with him, many also ignore the God who made the promises. His blog has been a blessing to me.

Annecy, France

I've been doing some writing these past days, more than my usual emailing and blogging. There's been a slight discomfort in my wrist, largely aggraved by my use of the trackpad. To rest my wrist, I bought a cheap Acer wireless mouse (Php 450). To complete the experience, I also bought a mousepad (Php 50). These items are rare now. There was a time when malls were bursting with computer parts and gadgets. Now, it's mostly phones and accessories. The lady asked if I was a gamer. "No," I should've said, "just a writer who needs to stop typing to relieve the wrist pain."  But I just answered in the negative.

" Kontrabida ," the first of nine stories in Mia Alvar's "In the Country," is about a pharmacist from New York who comes home to a doting mother he loves and a dying father he detests. When he sees his father, the pharmacist Steve writes: "My father no longer resembled me. The short boxer's physique, a bullish muscularity I'd always detested sharing wth him, was gone. In fact he no longer resembled anyone in the family; he belonged now to that transnational tribe of the sick and the dying." His father had liver cancer. We learn that he was given doxorubicin and radiation—but these didn't do much. The oncologist in me realizes the story may have been before the advent of sorafenib or lenvatinib, targeted therapies proven to be better than systemic chemo. There's so much truth, so much talent, in Mia Alvar's story. I can't wait to read the next one.

I'm still largely in Instagram because of my friend Carla Barbon's stories  (her account is in private mode). I follow her feed with rabid anticipation. She makes stories out of tragedies. Months ago I sympathized with (and also laughed out loud at) her ordeals in her trip to Louisiana where the hotel she was supposed to check in was ravaged by a hurricane. Someone later adopted her in another accommodation so she never had to play the homeless role. During that trip, she would also win a prestigious award in a major lung world conference. But the greatest attraction is her commentary on her every day, especially when she talks about provincial life. She is the Alice Munro to rural Mindoro. She would post about her childhood, about her grandparents who raised her, about her father who had just discovered Spotify. These tales would warm my heart, make me grateful for family and friends, and encourage me to celebrate the simplicity of an uncomplicated life. But she is also an a

via Instagram

When I opened the MS Word file labeled version 1 this morning, I was overjoyed to read my colleagues' edits. The deletions, additions, and rewordings were thoughtful and reasonable that I was moved to say, "Oo nga, ano?" They cut out unnecessary phrases. They improved the flow of the statements. They worked like gardeners tending to a backyard that's been left untended for weeks. It is perhaps this joy of collaboration that makes technical writing enjoyable for me.

From our farm.

1. A book I ordered online may have been lost in transit. It was a secondhand copy. The bookstore emailed that I'd get a full refund. I'd been looking forward to reading that book. They don't sell that here in the Philippines. 2. I wonder which book I should bring during my commute to work. Perhaps a book on basketball, recommended by Chuck, a sports writer and analyst, or an anthology by Jeffrey Eugenides called "My Mistress's Sparrow Is Dead," or Jonathan Edwards's collection of preachings. I realize that it's not a matter of which book to bring, as they're all in my Kindle; but which book to read for the next hour. 3. I will need to submit a technical paper for journal publication soon. It's practically done. I just haven't found the perfect groove to reformat it based on the editors' preferences.

The Farm, Koronadal City, South Cotabato

Photo by Chris Clemente Dr. Fidel Nemenzo was my professor in a general education (GE) math class. Now he is the newly appointed Chancellor of the University of the Philippines - Diliman. His interview with Ces Drilon was engaging: I felt like I was listening to a private conversation. This in, in fact, how people actually talk. I was thrilled to hear Ces Drilon ask about his bracelets, which used to make sounds whenever Sir wrote something on the board to explain the Möbius strip .

There was overabundance of durian. The trees in our farms gifted us with so much fruit that we handed them out to our neighbors instead of selling them. When chilled, durian tastes like ice cream.