First of all, human.

As a sequel to my previous post which immediately evoked comments from two of my fellow-doctor-bloggers, I would like to elaborate further on how my being a doctor occasionally usurps the rest of who I am, at least in the eyes of other people.

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.

What's in a Name?

I love my profession. Despite all my incessant whinings and complaints about my lack of social life and leisure time, I know I wouldn't want to be doing anything else but be a doctor. During the past weeks, I had the chance to truly experience why I love this profession. I have regained that sense of purpose and that degree of enthusiasm I once possessed (or that possessed me)when I first received my medical license. Five years after I took that Hippocratic oath, I am again that young, idealistic, hopeful physician, a full-pledged graduated of the UP College of Medicine, with 101% faith in its vision-mission:

VISION:
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.

MISSION:
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.

Consistency

This weekend, I've been hearing the stern voice of my beloved boss, Dr. ADM, in my head again and again. "Jean, be consistent!" Irritated by my incessant lack of regularity and cohesiveness in my decision making, she has repeatedly reprimanded me and has given me constant reminders on my need for a stronger, more predictable and definite set of principles, and a less stormy reaction to circumstances.

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.

Anyway, my poor friend, one of the greatest I've ever had in years, and perhaps the gentlest and most patient person I've ever met in my 30 years of existence, became the unfortunate witness (or victim) to my verbal tirades and futile seething rage. There were no bottles broken or bleeding noses, but there were prides smashed and hearts bruised. Indeed, sticks and stones may break our bones, but words can break our hearts. The inevitable result was a relationship that's permanently scarred, or perhaps even fatally severed, a good friendship that is perhaps now irrevocably gone.

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.

Senior Moments

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 60^th 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.

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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.

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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."

On Relationships, Boundaries, and Definitions

Despite having practiced Medicine as a full-pledged physician in this country for more than five years already, I've never really had a member of my family as my patient. Sure, I check on my mom's diabetes once in a while and there was a time when I had to perform minor surgery on a superficial abscess she had a few years back, but my family has been relatively healthy, with no hospital admissions or acute illnesses that required expert, subspecialized care. So during this past few days, when the mother of one of my dearest friends got admitted at a nearby hospital for acute heart failure and severe abdominal pains, I had a brush with the terror of having to act as a doctor to someone I regard not simply as my patient, but as family, although in this case, well, it isn't really family, in the strictest sense of the word.

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.