Monday, December 28, 2009
Occasionally, my friends call me up for medical problems - their own or their family's. Sometimes, after years of absolute loss of contact, some friends just resurface, come to me for some bodily complaint or medical requirement, and then disappear like some evanescent rash afterwards. I never hesitate to help, whenever I can. I do this for them because I have previously sworn the Hippocratic Oath, that "I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby..." But above all, I do this in the spirit of friendship, of mutual understanding and affection, and of old times shared and better times coming.
I can only wish they understand that.
Sometimes I wonder if my friends will still need me if I'm not a doctor. If not for my capabilities as a physician, will I ever be called on? Will I have something to give? While I know I will never stop taking care of people in my capacity as a physician, I do wish I'd be given a chance to love, and to take care of someone, not only as a doctor, but as a human being as well.
Sunday, December 27, 2009
A Community of scholars
Highly competent in the field of medicine with a heightened social consciousness; Imbued with moral, ethical and spiritual vigor;
Dedicated to a life of learning; Committed to the development of Philippine society;
Inspired by love, compassion and respect for the dignity of human life; and
Anchored on the principles of Truth, Freedom, Justice, Love of Country and the Democratic way of Life.
Guided by moral, ethical and spiritual values, we commit ourselves to excellence and leadership in community-oriented medical education, research and service, using the primary health care approach, intended especially for the underserved.
Tonight, however, as I am typing this entry in the solitude of my quiet Cardiology conference room, I realize why this profession that I love - my source of immense joy and fulfillment, is also my source of agony and almost unbearable pain. It's not the long working hours or the lack of monetary compensation. The most hateful thing about being a doctor is being a doctor itself.
Hmmm, I know I'm not making sense. But let me put it this way. Sometimes, being a doctor just prevents you from being seen for who you are as a person, with your entire identity being overshadowed by the glamor and esteem of the white coat. After you get your license, people, even close friends and family members, seem to have forgotten your name and start calling you "Doc". I'm sure they never meant to be offensive. "Doc" is meant to be some sort of a pet name, an affectionate or even playful label that society expects you to wear with pride. But sorry to disappoint you people, doctors would rather be called by their names.
I am not generalizing my kind, but I'd rather leave the title "Doctor" where it belongs - in the hospital, with patients, with acquaintances, during formal or business gatherings, or patient encounters. It's alright to be identified as "Doctor" during casual encounters with strangers,during academic activities, or civic-political necessities society requires. But please, leave my old friends and my family out of it. "Jean" sounds so much sweeter than "Doctor". For these people, I need to be more than my white coat or my stethoscope, or my title - I am me - failures, ugliness, imperfections and all.
Tuesday, December 22, 2009
While I have long discarded my control-freak-obsessive-compulsive-stickler-for-schedules-and-itineraries attitude, I occasionally get bouts of this disease. Each time I get this, I hear Dr. ADM again, "Jean, be consistent." Hence, I have decided to be patient, to move away from rigid routine and schedules and be more flexible. I have decided to be lenient, to tolerate the imperfections others, to never get mad, and to be gentle at all times. I have to stick to this decision. And I have to stick to this decision consistently.
This weekend, I had a terrible bout of this dreaded disease of mine. A good friend became the unfortunate witness to the appalling inconsistencies of my personality that I almost lost him completely (something tells me I already did). The characteristic temper that made me smash guitars, break mirrors, or even shout curses at shocked, unsuspecting patients overpowered me again. Yes sir, this "shy" lady did not get a formal complaint filed at the Commission on Human Rights for nothing.
No apology can ever be enough. No explanation or justification can soothe the hurt I caused. I have inflicted wounds I don't have the capacity to heal. Will forgiveness come? Sigh, I can only wish for it, and wait, and wait... Que sera, sera...
On second thought, I realized there's that one pervasive, recurring distinction in my life, thank goodness! That L sign on my forehead - I guess that's my enduring, constant, unrelenting feature. Haha! Loser! In that aspect, I AM unbelievably consistent. So perhaps, well at least, I'm not that unpredictable after all.
My father recently turned 60. Due to the unfortunate circumstances of my current professional undertakings, I missed this momentous occasion. When I called him up during his birthday, he said there was no party. After all, a 60th birthday is just another day. My mother, on the other hand, was more keen to celebrate. She said Papa should celebrate his induction into the ranks of those with dual citizenship – Filipino and senior citizen. Very funny, Papa said. Through the phone I can see my mother beam with pride at the joke she had just cracked, something she must have heard somewhere else but already believed to be her original quip. As they chided each other, I was lovingly jealous. I hope I can find someone who can laugh at me after 33 years of imperfect togetherness, someone who would be there to remind me I already have dual citizenship and love me anyway. Ahh, wishful thinking, indeed.
Last week, while I was at a nearby hospital keeping a good friend company while his mom was recuperating from heart failure and other diagnostic dilemmas, I realized that sometimes the difference between excruciating, almost fatal pain and total comfort and relief is nothing more grand or fancy than a simple fart. After hours of being on morphine drip, the old lady suddenly woke up with another bout of severe abdominal pain. Her abdomen was almost rigid, she was hunched over in bed, her face contorted into an indescribable picture of suffering and pain. We gave several morphine boluses but they didn’t work. My friend was in so much anguish too, he was hugging his mom while his eyes were closed in what I believe to be a passionate supplication for his mom to be spared from more agony. The sight of mother and son in so much misery was so heartbreaking it devastated me into a state of helplessness that’s not supposed to be characteristic of a doctor. Unable to do anything more, we resorted to the good old menthol liniment, massage, and the tried and tested only-in-PGH improvisation of a warm compress (warm water in a mineral water bottle). After a few minutes, the big one started to come. It was indeed a loud explosive moment, a massive liberation of all constrained suffering, all packaged in an extravaganza of a thunderous, deafening, odor-free flatulence. After the audacious release of pent-up intestinal gases, an awkward silence engulfed the room. And suddenly, there came another aftershock, and then another, and then several other smaller explosions, creating a heavenly symphony of low-pitched guttural sounds. Feebly, the old lady muttered, “Sorry doktora ha”. My friend and I just looked at each other in mute understanding, “It’s OK. Everything will be alright.”
After about five minutes, the old lady called softly to her son. “Jit, can you sit me up? My pain is gone.” And then she looked at me and with a huge smile on her face said, “Doktora, utot lang pala ang kelangan ko.” And then she laughed, and I laughed, and my friend laughed. And the three of us ended up laughing until we were pretty much farting too.
I've been constantly talking to my oldest consultant lately. At 81 years old, this professor emeritus of the UP College of Medicine is still very active, attending every conference, passionately teaching fellows and residents about the latest journal articles he has read and the scientific conferences he has attended all over the world. His memory is still so sharp that he can accurately identify the journal issue of his recent favorite medical article. Because of his persistence and kakulitan, sharp memory for incomplete tasks and promises, and stubborn adherence to his traditional beliefs, several of my younger consultants and more senior fellows are avoiding him whenever he lounges around at our conference room trying to find someone to talk to. I, on the other hand, have developed this strange fondness for the elderly in general and a strong reverence and fascination for this old man in particular, that I can't resist just being around him, no matter how slow he speaks or how often he repeats his stories. Sometimes, he shows me his Powerpoint slides from his old lectures or future talks for society conventions, while I just sit, nodding my head, occasionally making brief stupid comments or asking my foolish questions.
Here are some things I learned from him: Loners have shorter lives than ordinary people. Cheerful people die younger too, because they tend to have willful disregard of their body's complaints. Optimistic people, on the other hand, have longer lives and have a greater sense of satisfaction at the end of it all. Single women have a 3 times higher risk for developing cardiovascular disease. Therefore, women must marry to prevent a heart attack. A good man, however, is hard to find. So if you find one, you better stick to it. Men die younger than women. But good men will want to stay healthy so they can take care of their women.
Hours spent with my 81-year-old professor takes away my time from my rounds and my prescribed job. But this is a special opportunity to learn from one of the greatest cardiologists in the country, and I'm loving every minute of it. This morning, he showed me a slide for his February 2010 talk and it said, "Quo Vadis?" And then he turned to me and asked, "Jean, quo vadis?"
And I just humbly said, "Sir, I don't know. I really don't know."
Sunday, December 13, 2009
This brings to mind several unexplored issues on the nature, definitions, and limitations of certain relationships. Society has an organized, typical way of looking at things. While there are well-described roles for people involved in certain types of relationships, I realized that these roles become limiting and the boundaries are not as well-defined as they should be. For instance, my good friend and I have been friends for years, but the nature of our friendship has always been undefined. Undefined because it is extraordinary, as atypical as my friend itself. It is atypical because it does not follow the usual temporal and geographic probabilities, it is extraordinary because despite these strange and almost absurd circumstances, the basic elements of mutual knowledge, esteem, affection and respect that constitute friendship are undeniably present.
Of course it's a pointless discussion trying to dissect the nature of these things, as I have vainly and almost fatally contemplated on it for the longest time. I have recently resigned to accepting things the way they are, with no definitions and no expectations, but several times during the past days, during my stay in the hospital, I couldn't help but be asked, not just by myself, but by other people as well.
Scenario #1: Resident sees me and suddenly endorses the case. (Hey doctor, don't worry, I'm not an attending!)
Scenario #2: Friend's mom/patient wakes up in the middle of the night and sees me. Surprised, she asks, "Oh, duktora, why are you still here?" (Sorry maám, I don't know too. Maybe you can tell me?)
Scenario #3: Attending physician calls me, "Jean, I didn't know she's your tita! So, how are you related?" (Long story maám, but it has nothing to do with bloodlines and genes.)
So before stories get mixed up, my good friend and I agreed on the simplest explanation: I'm a cousin. Alright. Fair enough. Most people accept the explanation without batting an eyelash. And somehow, I've gotten used to answering "Oh, she's my aunt" without batting an eyelash too.
So there I was, the fake cousin in the white coat, trying to be a good friend and a good doctor at the same time. And then the issue of my role as a doctor in "the family" comes in. During my past five years in the business, I know how irritating it is to have some other doctor sniff around the tracks of your diagnostic and management strategies and mess them up like he's the master of the universe. It took a great deal of patience and restraint but I somehow managed to have enough empathy and self-respect to keep from making bad comments about the management plans or even poring around the charts scrutinizing other doctors' plans and prescriptions (whether they allow that in private hospitals is a question I didn't even bother to ask).
So for all this grappling with the mysteries of my roles and limits as a doctor, or my functions and boundaries as a friend, I'm somehow stumped in the end. The roles and expectations society sometimes imposes are as puzzling as the diagnostic cul-de-sac we are pretty much in right now. So despite the occasional ravings and protests of my mind, I let instinct win. Intuition and instinct - they make medicine an art. Love - they make this art, not just a chance to heal, but an opportunity for goodness.
Last night I went to the hospital again. I purposely stopped wearing my white coat. I just went there as me - fake cousin, distant relative, close friend. Just Jean without the white coat, holding a sick old lady's hand.
Monday, November 23, 2009
We were ushered in by able-bodied, fierce looking males into the smoky alcove. Standing by some walls or lounging on threadbare faux leather sofas were brawny, crisp-looking young men dressed in red sleeveless tank tops and tight-fitting, crotch hugging denim really-short shorts. Their arms were well sculpted, not the gym-induce biceps, but those biceps toned and toughened by hard back-breaking labor. Their legs looked strong, with hamstrings that can make any woman drool. They looked bored, like a bunch of old women waiting for their favorite telenovelas on a warm uneventful evening.
Then the stage-lights turned on. The small, make-shift stage that appeared like a bathroom was suddenly flooded by red neon lights. As if on cue, they all stood up, walked to the small stage in front of the room, and started their small number. Moving their hips languorously to Mariah Carey’s “Open Arms”, almost 20 testosterone-laden, hot-blooded males strutted their stuff to the salivating audience. That was when he caught my eye. He was tall, with an empty, distant look in his eyes, and he shyly dropped his gaze when he saw me staring at him. I kept quiet. I was never the type to squirm from these types of situations and I never avert my eyes from this sort of taboo
The boy ended up at our table, with my friends buying him a beer, for several minutes of “table” time. He started putting his arms on my shoulders, but I moved away and told him, “Hey, you don’t have to do that.” Instead, I ended up asking him about his life.
Perhaps they have a generic story to tell all customers. He said his name is Brandon and he’s 21 years old. He said his mom was unmarried when she had him, and his dad was an Iranian who ran away. Eventually, his mom married someone else, had 3 more children and the stepdad turned out to be cruel and alcohol-dependent. He said he had to go all the way from Butuan City to escape this bitter family situation. He ran away and stayed with his grandfather in Davao City. His grandpa tried to put him to school but he said he had to help out. So when an offer from a neighbor who’s employed in this bar came, he took it without batting an eyelash.
Yeah right. Straight out of a Maalalala Mo Kaya screenplay. Go on, Brandon. You’re telling me crap and you’re 19 years old, but go on. I’m listening...
He said they have a decent job, that they are not prostitutes. They’re just paid to give small talk to lonely people, some might touch them here or there, but there’s really no harm done. He said they really don’t lose anything. He said making lonely people happy is a decent job too.
Perhaps the boy was right. Making lonely people happy, no matter how short-lived or evanescent that happiness is, is a noble job. With this epidemic of loneliness around, perhaps the real heroes are those who are able to give small talk to lonely people during moments when they are most needed.
Sometimes I wonder if the prevalence of loneliness is exceedingly underestimated. If a certain percentage of our population thrives and even profits from the business of temporarily assuaging loneliness, does this mean that lonely people make up a significant share of today’s market economies? And if this hefty share of the market continues to be hiding in the dark, how many of these people actually walk among us during daylight? How many seemingly respectable people in fact lead double lives – acting reputable and upright during the day while in the evenings, they creep in the dark crannies of the city, lavishing in the excesses of the flesh, with their faces hidden by almost-opaque veils of anonymity?
When the evening came to a close, I said goodbye to Brandon, and in the gravity of my musings, forgot to give the poor boy a tip. So long, Brandon. I may never see you again. You may end up with HIV or you may end up to be a tycoon one day. Either way, I’m honored to have met you.
Now, as I work in the ostensibly decent comforts of this hospital, I sometimes think of Brandon. Brandon with those sad eyes, Brandon with that empty gaze. Brandon dancing under the lights. Brandon ravaged by hundreds of plundering, searching, lonely hands. Sigh. Wherever he is, whatever he does, and wherever fate may take him, may God bless him.
And then I know that Dr. Jekyll and Mr. Hyde are not merely stuff for novels. Dr. Jekyll and Mr. Hyde could might as well be anyone. Dr. Jekyll and Mr. Hyde could might as well be me.
Tuesday, November 10, 2009
While I had PMS to blame for my lousy state of mind during the past weeks, I'm left with no other valid reason now, except for my sheer lack of self-control or my innate tendencies to fall for the phony and fleeting elation of a sugar rush. The monthly visitor has come and gone, and the changes in the hormones didn't do anything to abate the need for sugar. It only heightened the need for salt, a trap I readily fell for, of course.
And so today, I just woke up feeling more oafish than ever. I need a way to get out of this perceived need to eat. I need to free my mind from the clutches of evil carbs and the nefarious red meat. I need to get satisfaction from hunger. Ahhh, the glorious sounds an empty stomach makes - the gurgling, the hollow buzz - I need to hear music in those noises again.
I promise. I will start dieting tomorrow. But whether I'm serious or not, well, I guess that would have to wait until tomorrow too.
Sunday, November 8, 2009
“So, what was your first impression of me?” - I once asked a recently discovered friend who I’ve been hanging out frequently with during this past few weeks. I was expecting something like, “You’re too big” or “Too tall”, or “Overweight!”, or “A bit intimidating”, or “Ahh, really smart!” (tehee!). But all I got was, “You’re too clumsy!” Aaaargh! Ouch! That stung!
But instead of pouncing on the poor guy and tearing him up into pieces for the unnecessary insult to my already injured self-esteem, I found myself awed at this unmitigated display of candor on his part. Few people dare to discuss my clumsiness with me, out in the open. And I appreciate his sheer lack of knowledge of the magnitude of my wrath or the peril of my tantrums. For this alone, I spared him.
You see I do not deny my clumsiness. This huge, amorphous physique that I’ve been so terribly gifted with could only come with a matching awkwardness in movement, a gawkiness in behavior that even my parents found irritating. For years, I have been dealing with a chronic lack of grace. I walk with an oafish, lumbering stride, so unfeminine and unbecoming. So, I do not move my head flirtatiously or fiddle with my hair the way most women do. My hips don't generate a lovely erotic sway. Ahh, I don't even have hips to speak of, much more a butt! Hah! But duh! So what? What's the big deal about being graceful? Why should women take pains in acting fluidly, with so much grace?
My mom once said that if I continue to move this way, I’ll never get myself a man. She said, "Jean, go find yourself some grace!" Hah! Grace, huh? I wouldn’t bother with men who only look at how women move, and forget about what they think and say and do. For me, grace isn't just a degree of beauty or form or style. It has to be more than that. And if there should be restraint for grace to exist, then I'd rather pass and remain clumsy as I am now.
Ok, excuses, excuses. My legitimizing this literally “awkward state of affairs” is not enough to remove my clumsiness, I know. But biologically, I do have an excuse that might be valid enough. God gave me feet with collapsed transverse arches. They make wearing heels an ordeal and they make my feet grow hideous corns right in between the balls of the feet. No matter how many foot spas I go to, my feet are as thick as farmers’ feet. They will always be huge Size 9s and I will never be able to walk on heels with enough grace that I won’t be mistaken for a transvestite. Because of the wrong shape of the feet, my knees just followed. I remember that at 4 years old, my mother was trying to massage my knees to reshape them. She said they look weird. Well, they are weird.
So these were the gifts I was born with: knock-knees, calves as big as logs, feet with collapsed transverse arches, corns and calluses that spontaneously spring up despite the absence of trauma, and a gait that can never survive high heels! Because of those in-born attributes, I have learned to carry a backpack like a high school boy, and walk around like a full-pledged overweight, drunken kargador. I don't subscribe to that well-accepted notion that girls should forever be sitting down with legs closed and slightly positioned to the side, and with their hands neatly rested on their laps.
I walk and talk as I please. Grace for me, is not merely the presence of dignified and restricted beauty, but beauty despite the lack of form or harmony - what the poet Robert Herrick called "delight in disorder". And I, being born ugly, should find beauty in what I was born with. Knowing that is grace in itself.
Ergo, I would like to believe that there must be a reason for this clumsiness. God must have thought I should be born this way. Ahhh, maybe He thought I would have to be loved that way too. And because clumsy people like me slip and fall down all the time, God must have already devised ways to catch us every time we do.
Tuesday, November 3, 2009
This brings to mind bits and pieces of the old stuff from pre-med days - Plato's Allegory of the Cave. What if everything that I have construed to be real is after all unreal? I imagine I'm a prisoner in a cave, staring at shadows on a wall, unaware that these are merely shadows and the real world is right behind me. Aargh! Too profound. My mind can't digest it now.
All I know now is this: I like this dead spot. The darkness and isolation of this cramped secret cranny brings comfort - that kind of comfort that comes from not trying to understand anything at all. While reality is a matter of debate, the moment is real. No signals from the outside world, no interferences of whatever kind - just me, the shadows cast on the wall, and the moment. Everyone deserves to stay in a cave once in a while. And even if it doesn't make any sense, I'll bask in this dead spot until I get kicked out, back into the real world again.
Sunday, October 25, 2009
Saturday morning. I’ve been ineffectively dealing with an unusually prolonged fit of PMS that has extended for a bit more than 2 weeks now, which is enough reason for me to speculate that perhaps this is the beginning of a malignant, chronic, and pathological depression. At 5 in the morning, I was already up and about, trying to stuff vital Cardiology information into my tired, resisting head. Everything was in vain. My intellectual queasiness has turned into a full-blown academic hyperemesis. I simply can’t tolerate anything that has something to do with medicine. This doctor who used to call Medicine her one great love is having a bad case of the I-don’t-want-to-be-a-doctor-anymore bug. This is an emergency.
After 2 hours of wrestling with my anti-medicine instincts, I gave up. I pulled out a non-academic book from my pile of unread paperbacks and tried to savor every non-medical word. I brought out my iPod, switched it on to my Everything But the Girl playlist and tried to enjoy the great music. Nothing. No joy at all. Not even a hint of interest or a slight upsurge in my monotonous or even downsloping happiness scale.
Something is missing. I need a remedy to this slump, before everything around which my life revolves totally collapses. Medicine is my life, the only attempt and experience with commitment that Fate has ever allowed me to have. Medicine is the man I married. He was the bandit that snatched me away from ordinary life, the craft I chose to spend the rest of my life knowing and perfecting. But now he is slowly slipping away. No, divorce is not an option. Perhaps with time, the fire will come back. Perhaps with time, I will remember why I fell in love with it in the first place.
But for the moment, I'm raising a Code Blue. I need some defibrillation stat!