Bottled ※ Brain

 "Sir, disiplina lang kita sa accelerator , no?"

 

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. 

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. 

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!

  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. 

"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, simil

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.

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.

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

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?

“Friday na ba subong?” “Daw Thursday pa lang man.” Days blend into each other—the comforts and frustrations of the unemployed.

 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) 

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 Taipe i. 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

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

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.

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. 

Posing with medical oncologists from Japan!

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, encoura

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. P

Got to see John Calvin's handwriting! I was so thrilled!

Walking tour in Geneva, Switzerland with Harold, after the poster presentation at ESMO Immuno-oncology Conference.

Best karinderya in town!

At Auntie Cecil's farm in Banga, South Cotabato

I felt like I was in a movie!

Lovely exteriors, Taj Mahal Tea Place, Mumbai

At Taj Mahal Tea House, Mumbai. Loved the ambience here.

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 o

Maharashtra, Mumbai, India

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

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

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 patien