Signs of the Times

Time and time again, I am reminded of the futility of my profession and how, despite my efforts at self-improvement and compassion, I and all of my peers in Medicine are just skimming the surface, smoothing out little dents in the giant, deeply rooted evil of inequity and poverty.

Yesterday's Hemodynamics Conference brought to mind certain painful truths, how vain all our efforts are, how superficial our state of existence is, and yet, the possibility of being able to do something, even just an iota of a good thing, is so promising and so enthralling, that it erases whatever cynicism and fear of disappointment there is.

While most of us can afford to visit the classiest of hospitals and the most expensive of specialists at the smallest bodily ache, and even splurge on unnecessary cosmetic surgery or food and vitamin supplements, more than 75% of our population is still wallowing in the mire of neglect and poverty, with half of them dying without having seen a real doctor during their entire lives. Some of them will even suffer the most unimaginable of illnesses quietly and stoically, simply because they have nothing to spend for themselves.

Take this case, for example.

YS is a 28 year old male who used to work as a water delivery boy. He has a wife and a child, but he lives with his mother, being the eldest of 6 siblings. His mother is a laundrywoman, his two other brothers drive rented tricycles for a living. At the end of the day, they pool their income and somehow end up with P500 to spend for 8 people in the family. He smokes occasionally and drinks during special occasions, just like an ordinary 28 year old. He wasn't dirt-poor, but he was barely surviving.

One day, his legs suddenly became painful after his usual walk to his workplace. Gradually, he can no longer tolerate walking due to the pain. He also developed an ulcer on his left leg that slowly festered and grew in size.

Because the pain was so severe, bad enough to keep him from working, he consulted the country's biggest government hospital. The doctors were smart and kind. They treated him well, and studied his case carefully. He was seen by the best specialists from the country's premiere medical institution. Extensive work-up was planned: P2000 for an ultrasound of his legs, P750 for an ultrasound of his heart, P3000 for various lab tests that would screen for a possible autoimmune problem, P8500 for a kidney biopsy. He could not afford any of them.

His mom and his siblings begged from PCSO and politicians from all over Manila. His doctors were kind enough to sponsor some of his tests from their own charitable foundations, some even shelled out their own dough to help him. Because of their generosity, a logical, though still indefinite, working impression was obtained. YS underwent a vascular surgery which removed blood clots from his legs, spending only about P6000 for OR fees, anesthesia, and medications - an amount he and his family had to borrow from neighbors and the local money lender.

After a few days in the hospital, YS was walking again. He was well enough to be sent home. Due to the complexity of his illness, he had to be placed on a number of medications: blood thinners (P50/day), heart medicines (P60/day), steroids (P30/day) and he was advised close follow-up with his doctors. The medical residents managing him were even kind enough to give some of their drug samples so he can have a week's supply of medicines for free.

YS was back with his family, and he was walking again. He took his medicines religiously. But when the drug samples ran out, he had no more money to spend for his prescriptions. He also had no money for his commute to the hospital for his follow-up consults.

Two weeks later, the pains came back. His legs were again blue and cold. The pain was so severe he can no longer sleep and he was very weak. He could not eat even if he forced himself. He was begging his mother to take him to the hospital but his mom could not find people who would lend them money for the fare.

Few days later, his left leg again developed an ulcer. This time, it rapidly grew in size. His toes started to turn black and eventually dried out. The foot started to ooze a grimy, foul-smelling fluid that looks like garbage juice. In a week's time, the smell of the foot was so terrible and unbearable it was enough to make YS himself nauseous. One morning, he noticed that maggots have started to breed and feed on the necrotic debris of what used to be his foot.

But he had no money to go to the hospital. And he knew that even if he sees the best doctors, he has no money to spend for his medicines.

He was already prepared to die. And so he covered his dead leg with rags, to hide the ugliness and to reduce the stench. Lying on his bed, he wished that every day would be his last. But Fate played a wicked, absurd and painful trick on him. He was bestowed a slow and smoldering death - despite his festering leg, he continued to exist, all lucid and bitter, suffering his hideously pathetic and despicable state.

Three months later, he was still alive. A carcass breathing, a corpse still in pain, gradually and inevitably wasting away. After 3 months of scraping the barrel, his mother was able to save enough cash to take him back to the hospital and salvage whatever can be saved.

When we received him, his left leg looked like this...




How can any human being endure this? How can suffering and disease be tolerated this long? What type of person can have a single shred of respect for himself after going through all this pain and ugliness?

How can anyone with a single molecule of soul and compassion not be moved?

But what can a doctor do? When you and your teachers, who do not lack the knowledge nor the compassion, are faced with the certainty of the futility of your efforts because you know that the disease is more deeply rooted than what appears on the surface? You cut the leg. Fine. What about the entire body beyond that leg? What about the person with the body? You barrage him with all the free medications you can scavenge now, but what about next month? How could you send him back to a wretched existence, to a home that reeks of abject poverty, to a country that neglects the basic needs of its constituents?

P100,000 - a trip to Europe. P40,000 - the latest iPhone. P20,000 - a tour around Thailand. P5000 - new running shoes. P3000 - front seat tickets to a concert. P500 - dinner in a mall restaurant. P150 - a cup of coffee. But for some people, it could be a leg, a heart, a life.

Tell me, what can I do? What can you do?

What will you do?


(This is not a fictional character. The pictures are real and unedited. Special thanks to Dr. Kristine Tumabiene and Dr. Neil Bacaltos for the photos.)

Friday, I'm In Love

Friday afternoon. After a busy morning, I found myself lounging around the section conference room, alone. Everyone else has gone home, excited to go somewhere. The first year fellows are still scurrying around the floors, anxious to get their tasks done before the clock strikes four. It will soon be 4PM, time to leave the hospital premises for another weekend of rest. In a short while, everyone will be off to their own homes, to malls for dinners or movies with friends, or into the arms of their spouses or their lovers. 4PM, 5PM, 6PM. It doesn't really matter. I will still be here in the conference room -the one place where I shouldn't be - on a lovely non-duty Friday afternoon, doing nothing, just staring into space, or doodling on scratch papers, waiting for calluses to grow on my emaciated buttocks.

It's Friday afternoon. I'm sitting on my throne in front of the computer of the Cardiovascular Section accomplishing absolutely nothing. I'm the Queen of Procrastination, the Master of Doing Nothing, the Empress of Self-Deprecation, the Grand Dame of Anhedonia.

I don't care if Monday's blue
Tuesday's gray and Wednesday too
Thursday I don't care about you
It's Friday, I'm in love

Dressed up to the eyes
It's a wonderful surprise
To see your shoes and your spirits rise
Throwing out your frown
And just smiling at the sound
And as sleek as a sheik
Spinning round and round
Always take a big bite
It's such a gorgeous sight
To see you eat in the middle of the night
You can never get enough
Enough of this stuff
It's Friday, I'm in love

Oh Robert Smith, you have no idea. It's no big deal. Friday is really just another day you just have to learn to live through and get over with.

Anorexia, anyone?

This morning, my senior senior fellows, affectionately known as B1 and B2 or Whitey and Blacky, chided me about how I looked - "Jean, you now look like a senior fellow." My gaze went from them - two 250 lb, 6ft tall giants, with bellies jutting out of their torsos - to myself. Aaargh!!! So that is what i look like now. Awww! The freakin' mean bastards, hideous monsters who cant find anything better to do than bully me. Sir B1 and Sir B2, thank you very much. You break my heart, but oh boy, you are totally honest! I greatly appreciate your eye-opening but self-esteem shattering criticisms. Because of your insensitivity, child-like and refreshing honesty, I now realize how absolutely fat and ugly this training program has transformed me. A year after entering the program, I'm a glob of fat, a lipid-laden fatty streak, a plaque with a dense oily cholesterol-laden core. I look at myself on the mirror and I see a huge xanthoma, pale yellow and glistening with triglycerides. I have become the epitome of the metabolic syndrome I've sworn to eradicate.

In 12 months, I have gained 4 kilograms. Since entering this program, this Free-Food-Diet, the constant supply of free food, compliments this persistent threat of forever being unsalaried and penniless. The result was an insatiable appetite and a compulsion to be full all the time, in prepartion for the imminent famine - the famine that never came.

Broken and feeling like a big ugly loser, I hurried over to the drugstore and bought a box of Sibutramine and a month-supply of diarrhea-inducing Metformin. I have now brought down my dreams into one singular short-term goal - to be a genuine anorexic. I am 30 year old with one dream - to be pathologically anorexic.

Move over, Karen Carpenter.


(I may call the names but B1 and B2, I love them!)

El Nino for La Nina

It is indeed a time of drought - both outside and inside, literally and figuratively, physically and spiritually. This is a period of a dry spell, when the horizon is a mirage, the air unmoving, the ground arid. Nothing is happening. Time is the only thing that moves.

Perhaps it's always this way. When you've completely accepted the scheme of things, and you realize that life's great design is to leave you out of everything in it that's exciting and gratifying, you look at your own life and you realize how gray and how drab it actually is. And you don't even care. When you've let go of all your cherished fantasies, all your childish hopes, all your illusions of excitement and beauty and dreams of requited affections. You just acquiesce to the gentle, to and fro motions of your existence, and feel absolutely nothing. No pain, no sorrow, no anger. Just nothing.

El nino for la nina. It's a time of drought. And you don't even feel the scorching heat. Neither do you even dream of rain.

Groupie Blues

For the 4th straight week, my Tuesday nights have been devoted to Cowboy Grill Malate, worshiping this little-known band who plays excellent Queen and Pink Floyd covers. Oh yeah, I'm not a very big fan of beer joints like Cowboy Grill or anywhere else, since I prefer having my brew in the comforts of my own home. But since I heard this band's music some time in December, I could not resist but venture into this bar frequently, despite its mass appeal and not-so-fab reputation. The band is called Pryzm, a 6-man gang within the 30-50 age range. They have a front man that sings like Freddie Mercury, a balding guitarist with Mark Knopfler fingers, and a keyboard player who can do such an excellent falsetto that will make even Prince or Barry Gibb blush. Over all, the band is so good that all my friends that I brought along during the past 4 weeks, who, I'd have to say, all have a refined and brilliant taste in music, were hooting over Air Supply and Chicago songs, inspite of themselves.

I'm afraid I'm already a familiar Cowboy Grill persona every Tuesday night. Not that anybody would even notice, but it just feels weird how the security guard or the waitresses look at me as if I'm no longer a guest, as if I can find my way around the bar without their assistance. I don't blame them. It's not very often that a solitary lady, looking quite respectable and definitely plain and even ugly, wanders into a bar like Cowboy Grill, drinking a beer all by herself, in front of a stage that plays good old classic rock music. Oh no, I'm not a groupie. I just listen to the music and there's definitely no sex involved! That could be bad news, if seen from a different perspective. But anyway...

Even amazement dwindles down into plain appreciation if you do it 4 weeks in a row. Sure, it still feels great to hear Van Halen's Jump or Queen's I've Got to Break Free again. But sometimes all we want to hear is something different. Nothing will ever be as good if you get too much of it.

My groupie days are over. Moving on is a good thing.

Being Pluto

I have to admit it. I'm one of those crazy, bored, obsessed people who spend at least one hour devoted to Facebook per day. I don't necessarily check on other people's profiles. I just stare and stare at my computer screen and if I happen to find someone to chat with, well, the one hour becomes two hours, then three, or more.

I once read an article somewhere which claimed that people who spend a lot of time on the internet, outside of the necessity of their livelihoods, are people who have lower EQs, who tend to procrastinate, and are less likely to succeed in their careers. Well, I guess you have to count me in. I do have a low EQ (no need to take the test), I do procrastinate all the time, and I really don't care about a successful career. So there. Happy, functional people, judge me.

Despite taking too much of my precious time, I can't help but be grateful for the internet because it has afforded me several life-changing opportunities. These social networking sites, ridiculous though they sound, have enabled me to reconnect with old childhood friends and long-lost cousins and uncles. Severed relationships were reconciled. Life-long friendships were established. I met one of my best ever friends in the internet. I found my long-lost brother-cousin in Facebook after more than 5 years of searching for him. So at the expense of being labeled as "low EQ", I'm indebted to the worldwide wed and so I'll try to stay on-line whenever I can.

Tonight, as I was reading through my 800+ friends' status updates, I found out that Pluto is no longer a planet. Whaaat?!?! How could this happen? I've lived my entire thirty years knowing that there are 9 planets in the solar system, and suddenly, somebody posts in Facebook: "It's ok Pluto. I'm not a planet too." So, low EQ as I was, I hurriedly Gooogled this new found information. Indeed, some facts we hold dear since childhood are apparently fiction. Call it a semantic atrocity, but sorry folks, Pluto is not a planet at all.

This isn't exactly new information, stupid me. Way back in 2006, the International Astronomical Union met in Prague and created a consensus on the definition of all celestial bodies. The National Geographic reports that according to the new definition, "a full-fledged planet is an object that orbits the sun and is large enough to have become round due to the force of its own gravity. In addition, a planet has to dominate the neighborhood around its orbit."

photo from http://news.nationalgeographic.com/news/

Pluto is not large enough. Its moon, Charon, is about half its size. While legitimate planets, being bodies that dominate their neighborhoods, "sweep up" asteroids, comets, and other debris, clearing a path along their orbits, Pluto does not. Its orbit is unpredictable and somewhat untidy. Because of this, Pluto has been demoted to a particular class of solar system entities called "solar system bodies," which would apply to many asteroids, comets, and moons. Hence, it is remarkable enough to be something, but just not special enough to be called a planet.

This new-found information depresses me somewhat. How much of the truths I accept to be true are actually false? Now, there are only 8 planets in the solar system. One day, I might find out that living things grow in Mars, or that the sun is not a ball of fire, or the moon is not round, that Aspirin is bad for the heart, or not everything that goes around comes around and not everyone who loves will be loved in return.

I wonder how it feels to be Pluto - to wake up one day and find out you're no longer a planet. To be relegated to a lower kind, despite giving your best, simply because you no longer fit a certain criteria arbitrarily set by "the experts". How does it feel to be classified under the category of "etcetera" or "otherwise unclassified" or "others"?

I feel sorry for myself. I feel sorry for Pluto. But at least Pluto will always have Charon, her moon.

To the Crazy Ones...

Here's to the crazy ones: the misfits, the rebels, the troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward.

And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.



Here's to the crazy ones. And to the crazier ones like us, who still believe in the existence of people like them. Six billion people in the planet. And all we really need is one, that one crazy person, who will find us crazy enough to change this world with them.

The Strange Case of Dr. Jekyll and Ms. Hyde

Last week, Ms. Hyde killed Dr. Jekyll again. Dr. Jekyll and Ms. Hyde, aka Me, found herself in a 40th-day-after-death gathering of a dear friend's mom. Because this was a reunion of sorts of people she found strangely endearing and whose company she has learned to fondly treasure, Dr. Jekyll was evidently in control during the earlier part of the evening. After noticing certain unusual and unnatural circumstances and the sudden palpable change in the weight of the air she was breathing however, Dr. Jekyll, with a flick of a finger and a split-second glance at a despicable sight, was suddenly pushed to the side pathetically whimpering, and Ms. Hyde, the aggressive and nefariously shameless one took over.

To make the long story short, Ms. Hyde stole the show from the restrained Dr. Jekyll. For the rest of the evening, she showed her friends and her friend's friend how vile she could get. She smoked, drank an entire barrel of beer, danced like mad in front of a crowd, and shouted curses at people Dr. Jekyll adored. And as the evening came to a close, she was so wasted that she didn't even have the smallest memory of the supposedly wonderful music she heard and the slightest gumption to be grateful for the evening and the company.

In the morning, Dr. Jekyll woke up with a muddled head and a bruised heart. She hated Ms. Hyde so much. She hoped Ms. Hyde will never come back. Although she knows that one day, when somebody hurts her again, she will.

Depression Stage

In Kubler-Ross' Stages of Death and Dying, depression stage is probably the longest, most disgusting of all.

This is the time when you go to bed hoping tomorrow you're already dead, and when you wake up, you hate the sunlight simply because you feel it. You try to seek solace in your Bible, in your conversations with your God - that same entity that brought you so much hope and joy right before the tides turned. You try to run until your thighs hurt and you're out of breath, in an attempt to release endorphins, but you only feel pain, nothing else. You stand in the middle of a busy highway when the light is green, hoping some stupid driver will step on his pedals and crush you to death because you're dead anyway, but they just scream foul curses at you. You try to talk to your friends, hoping that some intelligent conversation might erase some bad memories off your mind, or momentary episodes of laughter will make you forget. What is there to forget?

The worst kind of human pain is that which we sustain during our most optimistic moments. It is during these times, when the worst part of being alive is knowing every moment that you still are.

The Quest for the Perfect Man Part 3

What if, just what if, that perfect man in the previous entry and the other one before that is just perfect - without the awful BUTs, hypothetical though they are, that I mentioned? What would you do? Using a biblical analogy, what if you found THE pearl? Like the merchant in the bible, would you sell all your belongings so you can buy this pearl that you've been searching for all your life? How far would you go to get this pearl? How far would you go to get this man?

This part of the quest for the perfect man is called "So..." As in...

So, you can read his mind. But can he read yours?
So, you listen to his music, but to him, does that even matter?
So, you can forgive whatever faults he has, forget all his women, accept all his imperfections, but does he even want you to?
So, you will cry when he cries, suffer when he suffers, bleed when he bleeds, but will he do the same for you?
So, he tells you his life stories and you believe them, but is he telling you the truth?
So, you will tell him your thoughts, share with him your passions and doubts, but does he even remember them?
So, you show him your work, your life, your memories, but does he even see them?
So, you think of him all the time, as you walk, as you work, as you eat, as you sleep, as you pray, but does he even have a fleeting thought about you?
So, you will give everything you can to make him feel better, but does he even thank you for it?

So, you found your perfect man. But are you that perfect woman he is searching for?

If you answer a "No" to any of these questions, then your perfect man is NOT FOR YOU! There is someone better. If your man in question is already perfect based on your checklist, can you just imagine the perfect man who's really meant for you?

Exciting, isn't it?

The Quest for the Perfect Man Part 2

Here's a hypothetical scenario. You review your perfect man must-bes and realized someone you've known for quite a long time actually fits the bill! You've scrutinized his life, seen his worst moments, explored his stupidities, but still, he scores 100% in your list. Exactly, as in, punto por punto! Your non-negotiables and your and-then-somes - your big rocks, and your pebbles, the sand, and the water, and even the jar - they're all just perfect. And not only that. He comes in a neat package, with a pretty face, a high IQ, and an excellent taste in books and music. He doesn't abbreviate nor misspell his text messages, his English, both written and spoken, is impeccable. He doesn't smoke or gamble, but he drinks beer during quiet moments and his favorite drinking partner is... yup, nobody, nobody but you.

So, what do you when you find him? BUT...

He has a wedding ring on his finger. Or...
A beautiful woman (not you!) in his arms. Or...
He has 3 kids and a wife. Or...
He has 3 kids with 3 different women. Or...
He has no job at all. Or...
He likes another man. Or...
He has major depressive disorder. Or...
He is 25 years older than you are. Or...
He has a girl's name (not his mom's) tattooed on his arm. Or...
He has a huge smoldering kiss mark on his neck.

Again, these are all strictly hypothetical scenarios. But I'm just wondering.

What would you do?