After 21 Years

Hi everyone. This is a post for all the disgruntled souls out there.

I came across this article from PJIM while I was doing my research protocol. It's a speech by Dr. Dans some 21 years ago. Hope you'll have the time to read it, and somehow get some spirit-boost from it.

We can look at the state of things this way: it's sad because it seems that after 20 years, nothing much has really changed. PGH, in all its drudgery and imperfections, is still pretty much the same. But it's also uplifting since this is proof that it's possible to be passionate about a cause and still remain on fire after 20 years. Idealism, after all, may transcend age.=)

Phil. J. Internal Medicine, 26: 65-67, March-April, 1988

CROSSROADS*

Antonio L. Dans, M.D.**

Dr. Yolando Sulit, members of the executive committee, Dr. Ernesto Domingo, parents, fellows, residents, friends, good evening.

Crossroads are very important times in our lives when we stop whatever it is we're doing just to think. We look back at how much ground we've covered. We look around at what we've reached. We shake hands, bid farewell to old friends, then we go on in different directions, until the next crossroads, or until our sojourn ends.

Graduation is but one of the crossroads of life. But tonight's graduation has several problems. For one thing, our parents are probably beginning to wonder why we have to graduate so often more times in fact, than most of normal people. Unless there are objections, our average age is 30. We have been to approximately 12 to 14 graduations and still, many of us are either partially or totally dependent on our parents for support. The problem is very common, but it is easily overcome by their kind understanding.

More than that however, there is a bigger problem, a more painful one that all internists must face, especially after graduating. The problem is the irrelevance of Internal Medicine in the Philippine situation. The issue is not new, and in fact, it was the subject of a speech delivered by the Honorable Secretary of Social Service and Development, Dr. Mita Pardo de Tavera, when she was guest in last year's graduation ceremonies.

The irrelevance of Internal Medicine was a strange theme for a speech, considering the circumstances under which it was delivered. But her arguments were strong and convincing and full of painful truths, which we must face up to the present time. The problem is a depressing one, how indeed can Internal Medicine be relevant in a country where 90% of the population live below the poverty line, and probably cannot afford to consult at all. How can this specialty, which is dependent on western technology and medications, be relevant in a country whose major problem is an already enormous and malignant foreign debt?

The cost of living is going up, while life itself is becoming cheap. Filipinos are killing Filipinos, for money, for religious beliefs, and for political affiliation. Even our own soldiers war among themselves, and last week, a former cabinet member and a respected patriot, died of a profound frustration. The EDSA revolution, it seems, has produced no drastic changes in the situation, and the future of our children remains guarded and uncertain. In the final analysis, when our very existence as a nation is in danger then, how indeed can this gathering be relevant at all?

Secretary Pardo de Tavera's message was clear as it was painful and true. The incidence of disease in our country is only a product of deeper seated problems. By becoming specialists in the treatment of disease, we are merely treating symptoms of underlying social, economic, and cultural ills.

It was a terrible message to give a group of graduating internists and despite her apologies, a number of us resented her frankness. Her message stung for a few minutes, or a few hours, a few days at the most, being drowned eventually in the ups and downs of life in the Philippine General Hospital. Tonight as we look back at the years that passed, we ponder the irrelevance of the road we have taken.

Yes we learned of diseases that most physicians never see in a lifetime - footnotes in medical literature like - Castleman's disease, Noonan's syndrome, Refsum's disease, and Gardner 's syndrome. We also learned of common maladies and their therapy. But aside from these clinical lessons, we also learned a lot about the Filipino people, the majority of them, the 90% who live below the poverty line. We became close to them, and we learned from their hardships, their joys, their miseries, their aspirations and their frustrations. In this sense they became our teachers, and we were their students in life.

We all know Carmelita Ramos, a patient with chronic lung diseases. Aling Carmelita was a permanent fixture of PGH, entirely dependent on oxygen and our samples of bronchodilators and steroids. We will always remember her and her 14 year old daughter with whom she had to share her hospital meals. We will always remember the times when she could smile and breathe enough to actually say thank you. Her daughters' cries of agony filled ward 1 whsn she died this year, for she had lost the only person she ever loved. Those cries will be heard in our minds for years.

Encarnacion Gondra (Cystic Fibrosis), Flor Urabe (Chronic Renal Disease), Maribel Chavez (Takayasu's Aortitis), Vivian Magday (Systemic Lupus Erythematosus). The clinical lessons will always remain in our minds but our hearts will be filled with the stories of their lives; the halls of our wards will echo with their cries of anguish, their sighs of relief, and occasional laughter; our floors will be stained with their suffering, their blood and their tears. Yes, we understand that their woes are low priority for policy makers who are trying to get to the root of the problem. But the solutions are nowhere near in sight, and if we call these people's concerns irrelevant, then life itself must be meaningless and irrelevant.

The years in PGH have changed our perception of Dr. Pardo de Tavera's speech. Tonight it is no longer clear whether she was hurling an accusation, or a challenge. Irrelevance was never a problem inherent in Internal Medicine. Rather it has been a problem of the Internist himself. To be available or not, to the poorest of the poor; to be dependent or not on unavailable technology - these are decisions we faced daily in PGH; these are decisions we must make when we leave.

To be sure, the hospital has always taught us relevance, and it has taught us well. To diagnose by acumen and not by a battery of unneeded tests; to know when to treat and when merely to console; to first do no harm. These are lessons about relevance, and though we learned them in a strange environment, we learned them nevertheless. And yes, it is a strange environment. The country's premiere teaching hospital has World War II vintage equipment – that is strange. We often have to pay for own patients' medications - that is strange. Half the resident staff has no salary and still eat off their parents hands - that is not only strange, that is miserable.

Alas, the lessons in PGH by far outweigh the misery. And among its lessons, the lesson of relevance is both the simplest and the most fascinating. Think about it. The hospital doesn't run on equipment, for there is hardly any, and it certainly doesn't run on money. This hospital runs on the hearts and minds of the men and women who have chosen the art of healing, and healing well. It runs on patriotism and love for God and fellowman. The day these ideals become irrelevant, will be the day our dreams and aspirations end. On that day, the Philippine General Hospital will cease to exist.

It really is a strange hospital, as strange as it is dear. It is just partly a reality, and mostly it is a dream; we are proud to have been part of it, even if it was just for one brief shining moment. To those who follow us, we wish you strength and pride in your work.

On behalf of Badine, Benita, Beth, Don, Ed, Elmer, Joven, Raymond, Sullian, and 38 other graduating residents and fellows, we would like to thank our revered consultants for giving us the chance to be part of PGH, and for unselfishly sharing with us their wisdom and expertise. We would also like to thank our dear parents for the understanding they have shown and for allowing us to extend our dependence. To all our other friends in this room, we thank you for your support and your kindness. Most of all we would like to thank the Lord for His forgiveness and His love and His guidance. We pray for our parents, our patients, our hospital, our people and our country . . . That He may deliver us from irrelevance.

Until the next crossroads, thank you and goodnight.

* Speech dellvered during the Graduatlon Ceremonies for Internal Medicine Residents of the Philippine General Hospital on December 14, 1987

** Chief Resident. Department of Medicine, College of Medicine , Philippine General Hospital , University of the Philippines Manila

Stumbling upon this old masterpiece had a major impact on me. Finding it was serendipitous, almost impossibly and absurdly occurring at the perfect time and scenario. The best thing about it is the fact that Dr. D actually gave this talk BEFORE he went into Cardio! Perhaps my decision to train as a fellow in PGH Cardiology despite not having the ambition to be a cardiologist is right after all.

Kung kaya ni Sir, kaya ko rin siguro.

I pray that 20 years from now, my students will also have the same reaction as I did. My fear is that they'll read about what I've been ranting about during my youth and ask, "what happened?"

I'll end this post by sharing a part of an email from my good friend, beer buddy and dear IM residency batchmate. This is PGH fellowship in a nutshell, without the existential angst, or the passionate and youthful idealism. Just plain, everyday PGH life in unembellished, unexaggerated tones. And why despite all the ugliness and backbreaking, uncompensated labor, everything is worth it...

In here, we’re 30 y.o. with no money. But we have sinigang sa miso, dirt-cheap pirated DVDs, patients who speak your native tongue, families to go home to on weekends and leaders who eat like royalty. It’s a circus here, but it’s my country. Today, I’ve been thanked by a wife for treating her husband who died without receiving any drug; went through one masterals class by copying the assignment of my co-fellow; had lunch at Rodic’s for P60 and learned that i earned several $$ from my clinical trial! Everything is unpredictable here, but this everything is home.



All quoted works posted with permission from the original writers (Dr. AMLD and Dr. PST). My heart is bursting with gratitude. =)