Outcomes

Because I have been attending a medical education workshop in the last two days, "outcome-based education" has been lingering in my mind. In today's trend of outcome-based education, I couldn't help but ask myself: I am the outcome of the UP College of Medicine. If my former teachers could see me now -- how I practice, how I teach, how I live, would they be proud of the outcome?

Coming Home to UPCM

I came back to the University of the Philippines College of Medicine yesterday, twenty-one years after graduation. The changes are staggering.

That old, vacant spot where the clay tennis courts used to be is now occupied by the towering Henry Sy Sr. Medical Sciences Building, ten stories high. It is pristine and state-of-the-art. You would think you were standing in a private medical school in some first-world country, not in a state university in the heart of the third world.

What used to be BSLR East and West, and my old tambayan, the medical library, is now replaced by an even taller and grander building. It rises above its predecessor like a monument to ambition: imposing, modern, and sleek, reflecting the lofty dreams of the medical students who walk its halls. I was once one of them.

And yet, some things remain unchanged.

The faint, familiar smell of urine, moss, and decaying cement still lingers along the sidewalk. The weathered iron-bar fence rusted with time, that fragile boundary separating the echelons of wisdom from the banal and numbing chaos of the rest of Ermita still guards the premises so steadfastly and quietly that passersby hardly notice it at all. The beautiful post-war architecture of the main College of Medicine building still stands with grace and wear, guarding its stories. The sounds of Pedro Gil, the hum of traffic, the distant chatter, still drift through the air. Inside Calderon Hall, footsteps echo the same way they did when I was a student, conjuring the shadows of all the great men and women who have passed through.

The air no longer carries the musty scent of formalin from the anatomy lab on the third floor. The lab is now fully air-conditioned, and I hear the number of cadavers has dwindled. As in many parts of the world, anatomy is now taught through plastinated specimens, digital platforms, and virtual reality. That old, eerie Pathology room, the one that felt like a dungeon, filled with formalinized anomalies: deformed fetuses that looked like sea monsters, headless torsos, organs that defied logic, is now gone. Once a chamber of marvels and grotesqueries for science and for the future, it has been moved some else in the UP Manila compound, to haunt another building. They used to do autopsies there, and as a medical resident, I have watched the pathologists silently and methodically remove organs from a cadaver, piece by piece, closely studying each one like a piece of a puzzle that would provide the cause of demise. 

But Lady Med is still there, standing proud in front of Calderon Hall, stoic and unyielding, a concrete testament to the triumph of science over death and disease.

Outside, the broken sidewalk along Pedro Gil still bears the scars of time. Tiles jut out, displaced by the roots of aging trees. I remember walking there in 1997, a wide-eyed probinsyana fresh from high school, visiting UP Manila for the first time with my parents for my INTARMED qualifying interview.

There are fewer vendors now. The sidewalk once crammed with sellers hawking pirated DVDs, phone chargers, and knock-off accessories now hosts only a handful, mostly selling fishballs, socks, and Divisoria knick-knacks.

The college is so different, yet so much the same.

And perhaps, so am I. I have been changed by necessity, shaped by technology, and weathered by circumstance. Like the college, I carry the burden of the years, but I continue the work. And I continue to hope. Time has not eroded that tenacity, nor that audacity to dream of something better for this country. One patient at a time. One student at a time. Because that is what the college molded me to be.

And when life robs me of that hope, I will come back to the college again, and pray that in its halls, I will find myself once more.

Reflections From a Snail on the Street

Early this morning, while jogging along a quiet stretch of road, I noticed a huge snail painstakingly crawling, inch by inch, seemingly determined to cross the street. Its movements were slow and deliberate, almost meditative, as though it had all the time in the world. Instinctively, I felt the urge to swoop in, pick it up, and carry it to the other side of the street. I worried that a passing car might crush it before it could safely finish its journey.  

But then I paused.  

What if I was wrong? What if the snail wasn’t trying to cross the street at all? What if it wasn’t chasing a goal or destination, but just enjoying the journey? What if my act of picking it up, something that seems helpful from my perspective, would interrupt its purpose entirely?  

And because our college graduation is just a few days away, this snail reminded me of our medical students. 

As educators, it is tempting to think that we know what is best for our learners. We often see ourselves as their guides, taking charge of their academic journeys, helping them move faster, avoid pitfalls, or reach the goals we believe are in their best interests. And when we think they are moving too slowly, or seem lost, we feel compelled to intervene, to speed things up, to point them toward the right direction, or even to carry them where they need to go.  

But who are we to know what they truly want?  

What if that snail, or my students, are perfectly content with moving at their own pace? What if the journey, slow and deliberate, is exactly where they are supposed to be in that moment? What if their goal isn’t necessarily to cross the street but to savor the process of crawling toward wherever they’re headed?

I realized then that my instinct to help may sometimes be misplaced. Perhaps my job, both as a teacher and a human being, isn’t to pick up that snail and carry it across the street. Perhaps it isn’t to define the destination for my students or assume control over their journey. Instead, my role might be simpler, quieter, just to make sure no car runs them over. This seems harder for the snail. I cannot stand there, in the middle of the street, all day, as it discovers its own direction. But for my students, this seems to be simpler and more concrete. 

As a teacher, this means creating a safe space for growth, where students can take their time, make mistakes, and figure out their own pathways. It means providing support without imposing direction, protecting their pace without rushing them, and walking alongside them without carrying them.

Perhaps being a teacher is not about forcing progress; it is about fostering possibility. It is about meeting each student where they are, letting them explore their unique journey, and ensuring that the road they travel is well-lit and free of unnecessary hazards.  

The snail may seem slow, but its movement is purposeful. The same can be said of many of my students. Each one moves at their own pace, guided by their own goals, and that is okay. My job is not to make them move faster or to assume they are crossing the street, but to ensure they aren’t run over on the way.  

In the end, maybe teaching does not mean carrying my students towards a direction that I presumed they would want to go. Maybe it just means making sure that their journey is protected and their path is clear. Maybe it's as simple as ensuring that they arrive safely, in their own way, and in their own time.

One Hundred Years of Solitude and a Life Put On Hold

There was a time in my life when I could write for hours.

Back then, I was single, unafraid of being alone, and full of angst - a perfect formula for creativity. I traveled solo with a small backpack and a large sense of introspection. I had Rilke’s lines about solitude practically memorized. I dined alone without shame, my notebook beside my plate, scribbling deep thoughts on paper napkins about finding Mr. Right and whether parallel lines might eventually meet in an alternate universe. My non-working hours were spacious. I read literature, both medical and non-medical, not summaries, not pasted quotes on Instagram, but real, full-bodied paper novels that stretched my mind and made me highlight things with purpose.

And I wrote. Oh boy, did I write. Essays, reflections, long metaphors about longing and absence and all the stuff of poetry. Most of it was about wanting a husband. Wanting children. Wanting someone to share long Sunday breakfasts with.

Spoiler alert: I found him. He is great. We decided to get married within six months after meeting each other, and had our beautiful wedding 3 weeks before my 38th birthday. Despite my age, we had two beautiful daughters. Contrary to my expectation, Sunday breakfasts were not about murmured conversations in bed, but now involve spilled milk, lost plushies, and someone crying because the pancake has a tiny burnt edge. 

And now, after everything I wished for came true, I can no longer write.

I mean, I still technically can (today's blogging attempt, for example). I haven’t forgotten how to string sentences together. But I haven’t been flexing my writing muscles in so long, they’re now mostly atrophied connective tissue and nostalgia. What used to be elegant rituals of reflection, red wine, classical music, and long journal entries are now 45-second bursts of thought before someone yells “Mommy, ate stole my crayon again!”

I used to read John Steinbeck. Now I read tsismis. Not even classy, but those juicy tsismis we read in Facebook. My literary diet has devolved from classic novels to knowing who cheated on whose best friend, with accompanying screenshots of sleazy liaisons. I haven’t touched a novel in years. The only books I read now are medical textbooks (because I have to), usually with one eye open and my phone in the other hand, checking if that viral post about a cheating husband has been updated or not.

My right brain? Infarcted. My last creative impulse was probably spent naming my daughter’s stuffed hedgehog and the best I though of was tadaaaa... "Hedgy". So creative of me, huh? If I took a quiz today, I wouldn’t know the themes of Jane Eyre or The Picture of Dorian Gray, but I would surely ace “Guess Which Influencer’s Husband Got Someone Pregnant.”

And yet, strangely, I don’t feel like I am a failed writer. Just a paused one. One with far messier source material than before. Because what I have now is life. Unfiltered, unedited, full of stretch marks and sticky kisses and moments that never make it to Instagram but live forever in my memory. I used to write about the love I longed for. Now I live it. Loudly. Sleeplessly. Joyfully. Exhaustingly.

And one day, when my brain isn’t full of to-do lists and Cocomelon songs, when my children no longer think that a closed bathroom door with me doing my morning ritual inside is just a suggestion, I will write again. About all of this.

About how I thought I was losing myself, but was really just adding chapters. Unpunctuated, chaotic, and beautiful.

And maybe by then, I’ll finally finish that novel I started reading in 2022, during that brief and surreal luxury of downtime after my C-section for my second baby. By some strange and poetic twist of fate, it’s Gabriel García Márquez’s One Hundred Years of Solitude which, let’s be honest, is also the estimated time before this mom gets real solitude again.

Forthwith

    There is no document posted in my home, clinic, or classroom that says everything must be done forthwith. There is no framed Magna Carta of Household Emergencies or a Bill of Mommy's RIghts. There is no Republic Act, no Constitution. And yet, somehow, the unwritten rule of my life is exactly that: all things must be accomplished with haste, urgency. Rarely, there are electives. But when dealing with toddlers, patients in shock, or a medical school about to release its first batch of graduates into the world, everything is stat unless proven otherwise.

    "Mom, wash my butt now!" Forthwith.

    "Mom, I want my milk now!" Forthwith.

    "Doc, you have a STEMI and he's having Vfib!" Forthwith.

    "Doc, you need to encode your grades now!" Forthwith.

    That is the state of my life. I live in a permanent state of immediate response. No one needs to define “forthwith” for me. I feel it in my bones, in my ligaments, and in the unblinking, bloodshot stare I give my to-do list at 2 am. And yet, in an institution where everything is supposed to be governed not by maternal instinct or a nurse’s glare, but by the Constitution of the Republic of the Philippines, the word "forthwith" has suddenly caused a national cognitive collapse.

    "Forthwith". That pesky little adverb has apparently become so confounding that a Senate impeachment court that is supposedly composed of highly educated and allegedly competent public officials had to halt its proceedings just to consult their collective understanding, or maybe a dictionary. Or perhaps ChatGPT. Or GMG. Google mo, gago! 

    Obviously, this farce is just a delaying tactic. That critical judicial process that is supposedly to give the Vice President a platform to defend herself or to be convicted, one that affects the public trust, the rule of law, and perhaps the very fabric of our democracy was delayed. Why? Because some senators were confused about what forthwith meant. 

    Every Filipino who gives the tiniest thought about this country knows that this wasn’t real confusion. This wasn’t an innocent lexical lapse. This was performative ignorance, the kind that insults every Filipino who passed Grade 4 English or owns a cellphone that can access Google. The kind that assumes that the rest of us overworked, underpaid, taxed to the max, and chronically exhausted ordinary Filipinos are too busy being moms, teachers, and doctors to notice the political theatre unfolding.

    Well, surprise! I may be on 3 hours of sleep and running on expired coffee, but I noticed. What is more disheartening is the contrast. I don’t have a constitutional duty to act with speed. But I do. Every day. Because people depend on me. I move not just with efficiency, but with urgency grounded in love, duty, and literal life-or-death decisions. I understand forthwith not as a vocabulary word, but as a lived experience, and a necessity of life. 

    So when our lawmakers, who are supposed to be public servants, pretend that they are stupid to delay justice, they aren’t just playing games with language. They are playing with the intelligence of the people they claim to serve. They are mocking the same urgency that drives teachers to check 100 papers over a weekend, doctors to respond to codes mid-meal, and moms to find a dinosaur costume in a mall that only pajamas and slippers. 

    If "forthwith" is too difficult to understand, perhaps we should help them out. Let’s use it in a sentence:

    

    "The people demand transparency and accountability, forthwith.”

    “We request for immediate action against corruption, forthwith.”

    “Please resign, forthwith. Yes, after you learn to use Google."

    At the end of the day, perhaps it’s not that they don’t understand the word. It’s that they understand it too well and what it demands terrifies them. At the end of the day, perhaps it’s not that they don’t understand the word. It’s that they understand it all too well. What it demands terrifies them. They fear exposing their stupidity and corruption to people determined to leave no stone unturned.

    As for me, I will go on living my forthwith life, responding to chaos with speed, grace, and occasionally, stress eating. I will do it without privilege, without fanfare, and without confusing adverbs. And when the stress eating becomes too frequent, I would have to remind myself that I need to lose weight forthwith. For that matter, I will feign confusion too, just like our honorable senators.

After 9 years

 After 9 years of hibernation, I am reviving this blog. So many things have happened in between. Sometimes I think I've totally forgotten how to write. The widespread use of social media has reduced my brain to mere spectator, no longer actively creating worlds of its own. It's like I have been so busy living that I failed miserably in imagining and creating, which I think translates into failure to live beautifully eventually. I hope this renewed interest in writing will jumpstart my brain into being creative again. 

Ten Things I Learned When I Turned Thirty-Five

After 35 revolutions around the sun, each round lasting for 365 and 1/4 days, I started writing about how my mindset has changed. This began as scribbles on scratch paper, ideas that came randomly and because I found them amusing, I etched them in the virtual notepad of my head, until one day, in a fit of those horrible mid-life blues, I opened my computer and started typing.

Here are some things that I realized now that I turned 35:

1. When I was younger, I learned to fight my battles. I’ve always been feisty, stubborn, and unyielding. Through the years, I have realized that I have to choose which battles to fight. And I have to choose wisely. Fighting every known battle means I will lose precious energy on efforts that are vain and I would eventually lack the energy for the more important ventures. This reminds me of the story about the big rocks and the pebbles and sand in a jar. For everything to fit, you have to get the big rocks in first. Some battles are simply not worth fighting for.

2.  When I was younger, I learned to help others. I knew then as I knew now that life is meant to be lived for others and that we only get what we give. I have always subscribed to that idea – to give and give until it hurts. As I grew older, I gradually discovered that it shouldn’t stop there. I realized I have to allow others to help me. Being on the receiving side is not a sign of weakness or helplessness. Sometimes, we have to allow others to give us something and to help us. That way, they will have an opportunity to share, to bless, to help, and therefore achieve their own purpose to be useful. Don’t be afraid to be vulnerable, to admit that we need something. Sometimes the best way to help others is to allow them to help you.

3. When I was younger, I learned to make plans and to eagerly pattern my life according to them. This time, I learned to make allowances for serendipity, to allow the universe to make unpredictable twists and turns in the story of my life. I learned to be thankful for the mishaps and the messed up plans, knowing that wherever I am at a particular moment is exactly where I am supposed to be.

4. When I was younger, I learned how to ferociously hold on to people and to things that I love. As I grew older, I found out that some people and things come and go no matter how fiercely you want them to stay. We must learn how to graciously let go of the things that refuse to be ours. Some relationships are meant to endure, some are meant to be ephemeral. Some are meant to wax and wane like the tide, or totally disappear like the sun, only to come back on another day. In our lifetime, we meet thousands of people, each one knowingly or unknowingly changing us in some ways. Somehow, at the end of our journey, it doesn’t really matter who we met. What would matter the most is who stayed.

5. When I was younger, I learned how to make friends and I appreciated the importance of having friends. Now that I’m older, I learned to treasure the few friends that I know are worth keeping. It doesn’t matter if I only have a few friends. What matters is that I know in my heart that these few friends I have will stay with me through good and bad, and will weather my life’s storms with me. A good friend once told me that he would rather be with the few people who know him well and who would tell him the truth even if it would hurt him, than be praised and applauded by a huge crowd who doesn’t really know him at all. As I grew older, I have learned to embrace this philosophy as well. This time, I derive more pleasure and comfort in the company of a few people that I trust, sharing seemingly ordinary moments that may be laughter-filled or quiet, mundane or profound, fast-paced or slow.

6. When I was younger, I thought that love is a feeling, the most wonderful feeling in the world they say. Now that I’m older, after so many dashed hopes and broken hearts, I know that love is a choice. It is what remains when the falling in love part is over. It is not dependent on mood or feeling. It is a decision to stick to your beloved regardless of feeling or thought.

7. When I was younger, I have always wanted to change the world. I told myself that I should live an extraordinary life and leave this world a little bit better than when I first came to it. As I got older, I realized that I don’t have to do great and extraordinary things to change the world. In fact, I stopped trying to change it. Instead, I decided to do little acts of kindness in my tiny insignificant corner of the universe, to put in a little bit of extra in everyday tasks, to welcome a few interruptions without complaint no matter how tired I am. Come to think of it, I know that I never stopped trying to change the world. I just stopped making a big deal about it.

8. When I was younger, I was taught that excellence is of utmost importance in everything that we do. Now that I’m older, I realize that excellence is good, but relevance is even better. While we aim for excellence in our job or in whatever we create, we also have to make sure that whatever we are doing is relevant for the community we serve. Excellence and relevance must go hand-in-hand. Excellence without relevance is empty. Relevance without excellence is unjust.

9. Now that I’m older, I realized I am beautiful. I have my imperfections, so many, in fact. I am fat, my legs are too big, my boobs are too small (even non-existent) and my butt is too flat. I have muffin-tops, and lovehandles, and cellulites. I have pimples, and scars, and my feet are hideous. I walk in a funny way, I have knock-knees, collapsed podiatric transverse arches. I am clumsy and I trip on imaginary things. A good friend affectionately calls me “slidey” because I slip and fall and sprain my ankles even when walking on level ground. But despite these physical peculiarities, I know I’m beautiful. In fact, everyone is beautiful. There are moments when I mindlessly stare at strangers, and I notice every face has its own brand of beauty. That mole on the nose, that arch of the eyebrow, or that wisp of hair stubbornly sticking out, that scar on the cheek. Every person is beautiful. I am too.

10. Life goes on. Even if we sometimes grieve, even if we don’t get what we want, it goes on. This reminds me of a line from a Rolling Stones song: “You can’t always get what you want but if you try, sometimes you find you get what you need.” Life has a way of unfolding according to an incomprehensible plan that is definitely not yours but that of a greater entity - God, a Law, Karma, whichever way you call it, it's an entity you can trust to go on. This also brings to mind some lines from the Bhagavad Gita: “Whatever happened, happened for good. Whatever is happening, is happening for good. Whatever will happen, that will be for good as well.” We lose, but life goes on. We throw tantrums, still life goes on. We rebel, and life goes on. We are specks of dust floating in a boundless universe, albeit loved by an infinite and incomprehensible entity. We stumble into each other for unknown reasons, in perpetual Brownian motion, and life goes on. We die. Life goes on. And I am so glad that it does.

I didn't learn these things overnight. They took 35 years of musing and rethinking and reshaping and deleting.  And I know these realizations will not be permanent. They are evolving and ever-changing. One day I will read these and I will probably laugh at myself for being too jaded, or immature, or shallow, or cerebral. People who read this now may also think differently. Some will laugh at me or hate me or tell me I'm wrong. Some will congratulate me while some will shake their heads and consider me petty. Some will not even give a damn.  Some will smile and say, "Poor Jean, she's really going through a tough mid-life crisis." But if I can write a note to my younger worrier self, it would be simple: “Dear Jean, everything will be alright.” No matter what people think, no matter how the world changes, everything will be alright.

Twenty-Five to Thirty-Five

It's new year's eve. The old 2014 is about to come to a close and the promise of an even better 2015 beckons. I usually sleep through new year's eve, but tonight I was startled awake by an unknown entity that has absolutely nothing to do with the noise of firecrackers and banging pots and pans.

In the middle of the night, I got up, opened my computer, and started writing. It was a Jerry Maguire moment, when that fuse suddenly blew in my head, cold sweat broke out, and I just had to write, uncaring about grammar or syntax. Write on, write on, you can edit this later. Let the thoughts flow, on and on…

I realized I had this in my subconscious for a while, and it just had to be expressed in due time. I’m suddenly in a state of panic. Palpitations, horrendous images of myself in oversized pajamas that used to be the lower half of my med school scrub suit, frown lines on my forehead, sagging belly, cellulites, my dying eggs, deviations from my planned timeline, and oh I’m am alone, always alone, still alone. In the midst of all this confusion, I am appalled. I am petrified. I realized that I will be 35 in twenty-five days. 

In less than a month,  I will be crossing that imaginary threshold, that thin red line separating the young from the middle-aged. It is the age that separates the "rejects" from the women who are beautiful and interesting enough to be desired by anyone enough to involve them as the other half in a committed (or even a non-committal so-so) relationship. It is the age that separates the old runners from the younger ones in marathons, the age that separates the "high-risk pregnancies" from those who can be seen in regular pre-natal check-up clinics. Hello, Mid-life. You better set up your banners and prepare your confetti for you are about to welcome this fat old Jean into your ranks soon.

I will be 35. I know I should be thankful to even reach this age. Many people die younger than that. Yeah, in the middle ages, or during the Greco-Roman war. But kidding aside, I should just look at the brighter side. I will be wiser. Yeah, right. Tanga ka pa rin sa love, for sure. There are fabulous single women way older than 35 out there who are having so much fun with their lives. Really, can you name anyone? Aaarrgh, these Jekyll and Hyde voices in my head are arguing again. I'm transforming into a Gollum - Smeagol mess. Perhaps I should just shut up and watch them lash at each other's throats.

The point of the matter is: I'll be 35 soon.  And I'm scared. Horrible questions start plaguing my head. Am I a disappointment? Am I a failure?  Will I end up miserable and lonely and bitter and ugly? Will I just be another shark in the big ocean? Another fat, greedy, nameless shark in an ocean of sharks? Does it even matter? If I am a speck of dust in this infinite universe, does one day even matter? Would my life even matter?

I guess I have to stop. I need to stop thinking and start living.

Ernest Hemingway once said, "Never go on trips with anyone you do not love."
It's been exactly one month since I left for an amazing journey, this time, for the first time, with someone. Mr. Hemingway turned out to be right. I hope whoever I traveled with has read this particular quote too.

Peanut Butter

One of the most popular quotes about unrequited love is that of Charlie Brown" Nothing takes the taste out of peanut butter quite like unrequited love." Being a huge fan of peanut butter myself, I can relate to this. During the past days, peanut butter tastes like paper. Well, everything tastes like paper.

I have been holding on to this silly kind of hope for the last few months, that maybe, just maybe, this is it. That perhaps, for the first time in my life, peanut butter would taste like peanut butter, in all its creamy, luscious, sinful, delightful goodness. But no, sorry Jean, you got yourself into a big disappointment again.

For the nth time in your life, get over it. You've been through this so many times before, you could walk out of this hell even with your eyes closed. Eat your bread without peanut butter. Stand up, walk on, and get over it!