The Case For Asking

 

If we are shopping for a new phone, we ask first, "Magkano po ito?" If we are hiring someone to build our dream house, we ask, "Magkano kaya ang aabutin nito?" If we ask a lawyer to represent us in court, we ask, "Magkano ang PF mo, Attorney?" Even when we buy mangoes at the palengke, we ask the price before we negotiate.

So why is it so uncommon, almost taboo for patients to ask doctors, “Doc, how much do you usually charge for your services?”

Doctors don’t have standard rates across the board. Our fees are shaped by a mix of factors: complexity of the case, urgency and risks, type of institution, location of practice, years of expertise, scope of services, and even personal values and principles. And ahh yes, included in that list is the difficulty and attitude of the patient and the family members (I'm smiling, but not joking).

Some of us deliberately charge below the norm because we believe that healthcare should be accessible. Others match industry standards to ensure long-term sustainability: for themselves, their staff, and their families. And yes, some charge higher, and may have very good reasons for doing so. These could include the rarity of their specialization, the intensity of their training, or simply the number of hours they spend at work and in continued learning.

Over the years, various medical societies have attempted to standardize professional fees, releasing guidelines and tariff schedules to help physicians navigate the complex landscape of pricing. But our profession is unlike others, it is both a science and an art, a business and a calling. The truth is, in these offical society statements, the disclaimers are often longer than the prescribed rates. “Depends on the case,” “Depends on the hospital,” “Depends on the procedure”, "Case-to-case basic", "Upon the discretion of the physician". We’ve all said those lines before. Because pricing in medicine is never one-size-fits-all.

Every doctor is different, and so is every patient. Which is why transparency is key. And the best way to begin is to simply ask.

So my proposal to this perennial professional fee issue is simple: wouldn’t it be better if we normalized the question, “Doc, may I ask how much your PF is for this kind of case?”

It is not offensive; it is practical. It empowers the patient. It opens the door to a respectful conversation where the doctor can explain the range, the rationale, and any possible caveats, such as added procedures, complications, or extended care. It also avoids later awkwardness, or worse, assumptions of greed.

Surgeons and anesthesiologists can do this. Why can't internists?

Patients deserve transparency. But transparency is a two-way street. If a patient is expected to trust a doctor with their body, health, and sometimes even their life, then trust must also extend to finances. And when that happens, when patients ask before doctors render their services, and when doctors answer with honesty and fairness, we meet each other with dignity. There’s no guilt. No awkwardness. No insult. Just mutual respect.

It is true that the physician-patient relationship is a fiduciary one. It is built on trust, shaped by the ethical imperative that doctors always act in the best interest of the patient. And whether we like it or not, this relationship is inherently unequal. The physician holds the medical knowledge, the tools for diagnosis and healing, and often, the authority within the room. The patient, by contrast, is vulnerable: physically, emotionally, and sometimes financially.

This is precisely why transparency matters.

Even with this asymmetry, or in my opinion, perhaps because of it, we must strive to bridge the gap in all the ways we can. And one of the most accessible and respectful ways to do that is to talk about money: clearly, kindly, and early.

To empower patients is not to deny that the relationship is unequal; it is to acknowledge it, and then to offer clarity as a form of care. When patients feel informed about their treatment and about the costs involved, they feel safer, respected, and more in control. And when physicians are asked respectfully, not second-guessed or assumed to be greedy, we are reminded that trust can be mutual.

And once the patient and the family are informed, they can now be empowered to negotiate. To me, and I am not speaking for the entire profession, it is never wrong to ask if something can be made more affordable. But context matters. Timing matters. Tone matters. And assumptions, especially the ones made without knowledge, can bruise even the most compassionate hearts.

So if you’re a patient, ask first. I hope that while you trust us with your health and with your lives, you also trust that we are not doing what we do to enrich ourselves. 

As for me, I can promise that when you ask, I will answer clearly and with care. And I will listen to your negotiation with compassion and justice. 

A Healer, Not a Haggler

The truth is, I charge way below standard professional fees. Many times, I don’t even collect, and often, my patients happily carry a stash of medicine samples from my clinic, which cost more than my professional fee. I’ve had patients walk out of the clinic saying, “Hala, tun lang PF ni Doc?” Relieved, surprised, and maybe a little guilty. Some of the colleagues I have worked with have even asked the nurses, "Mabubuhay kaya si Jean jan sa PF nya?"  I take that as a compliment.

I chose this profession because I wanted to help people. And yes, because UP has "brainwashed" me into making serving the underserved my ultimate goal, I take that goal seriously.

So when someone assumes, let me emphasize the word "assumes",  that I must be charging too much, it stings. Not because of the money, but because of what it implies: that I need to be bargained with. That this profession I have loved deeply, trained for with both discipline and delight, can be haggled down like produce in a palengke. That something rooted in compassion and science, something I’ve poured decades of curiosity and care into, needs to justify itself before it is paid for.

Let me be clear: I understand that times are hard. I understand what it’s like to count coins for a consultation. I have waived my PFs many times, without being asked. In fact, I price my fees in such a way that patients can retain their dignity without needing to beg. Because if people are sick, and made poor because they are sick, then the least they deserve is to keep their pride. I feel sad when they have to set their pride aside to ask for discounts. So I have always made sure that my PFs are fair and lower than standard rates, rooted in the principles of justice, compassion, and kindness.

But what I struggle with is the assumption that I must be overpriced. That I must be earning too much because I am charging too much. That I must be made to prove I’m not greedy before I even open my mouth. 

This week, the internet lit up with a commentary from Ramon Tulfo, who called out a doctor at the Philippine Heart Center for allegedly “overcharging.” Many were quick to judge. Few paused to ask what the full story was. Medical groups stood by the physician, stating that the professional fee was fair, compassionate, and reasonable. That the doctor had, in fact, already lowered it.

We do this all the time. Quietly. Out of compassion. But that compassion is neither limitless nor owed.

Doctors are people, too. We have bills to pay, families to raise, and dreams to chase. What we do is a vocation, but that doesn’t mean we should be asked to live off vocation alone. We cannot keep patching a broken healthcare system with our own self-sacrifice. Compassion should not require self-erasure.

And when the system fails, as it often does, it is not just the patients who suffer. As my UP-NTTCHP professor, Dr. Nemuel Fajutagana, so powerfully put it: "If we truly value life, we cannot keep patching a broken system with the sacrifices of those who hold it together. The dignity of patients matters, and so does the dignity of those who care for them. If we want a healthier Philippines, we must fix the system, , not break the people who sustain it."

If someone took the time to ask, “Doc, how much is your PF usually?” And then, after hearing the fee, said, “Would it be possible to lower it a bit?” Now, that’s a negotiation. That is honest communication. And I appreciate patients and their families when they do that.

But asking for a discount without even knowing the price? That is so disheartening. And when it happens after the first or second visit, after trust has supposedly been built, it is even more infuriating. Because that’s like handing me a message that says, “I trust you enough to save my life, but not enough to pay you fairly.”

Worse, it feeds into a painful, misguided narrative that medicine is now just business, that those who took an oath to heal have turned it into a profit-making, self-serving machinery. That the profession I love, the one many of us have dedicated our lives to with sincerity and sacrifice, has somehow gone to the dogs and that we physicians have turned into the devil himself. It is unfair. It is untrue. And it breaks my heart.

So please. Ask first before assuming I’m too expensive. Don’t haggle before hearing me out. Respect my work the way I respect your pain. Stop assuming the worst of the people who are trying their best.

I am a healer, not a haggler. And I believe we can meet each other where kindness and respect live.

This is Not Where I Belong

 

Sometimes, I wonder if I am at fault.

I was raised -- academically, intellectually, emotionally -- by the University of the Philippines. And in UP, we are taught to speak up when something feels wrong. We are taught to question systems, to challenge the status quo, to hold authority accountable, not with disrespect, but with reason, with courage. We call our deans “Sir” or “Ma’am,” yes, but we speak to them not with fear, but with mutual respect. They teach us, and we teach in return. That is the heart of the university: a place where knowledge is shared, not hoarded behind titles and rank.

That was the culture that formed me. That’s where I found my voice. But here, in this current institution, things are… different.

Here, you are expected to stay quiet. To say yes. To go along. Because you are just a “lowly” faculty member. Because questioning makes you a target. Because the system values hierarchy above dialogue. The higher the title, the less accessible the person becomes. The farther away they sit, figuratively and literally, from the people who do the actual teaching.

The other day, I attended a meeting at the main General Santos campus. The architecture and ambiance reminded me so much of UP Diliman. But the feeling was not the same. There was no familiar thrum of shared purpose. No sense of being in a place where ideas are free to roam. For me, there was no pride, no love. And when the chancellor walked in, he was flanked by bodyguards, assistants, an entourage more fitting for a celebrity than an academic leader.

And I just knew: I do not belong here.

And yet, paradoxically, I do love this university. I love my students, fiercely and completely. I love the hope they carry, the questions they ask, the fire in their eyes. I love what this institution stands for: unity in diversity, peace and progress in Mindanao, respect for indigenous cultures. Those values matter to me. They are what keep me here, still trying.

What I do not love is the system. The worship of hierarchy. The silencing of dissent. The bureaucracy that mistakes fear for order. And the slow erosion of passion in those who simply want to teach and grow.

I don’t know how long I will stay. But I do know this: I will never apologize for expecting more. For believing that respect should not be earned through silence, but through truth. For knowing what it feels like to walk into a campus and feel love for it in your chest.

And for now, I carry that love elsewhere: with my students, in the classroom, and in the quiet work that I still choose to do well. To me, that's what matters the most. Perhaps for now, I do not have to belong. I only have to do the work that I signed up for, to the best of my ability, maneuvering away from the system that I feel is suffocating. I need to focus my attention on my purpose and my students. 

Then perhaps, soon, I will find a new home. 

The One Percent

 

As physicians, we have always been taught to follow guidelines. Weigh the risks against the benefits. Always be evidence-based. We are told that the complication rate is low. One percent. Sometimes even lower. It’s the kind of number that helps us sleep at night. We tell ourselves, “Most patients do fine. Most bounce back.” And they usually do.

Until one of them doesn’t.

And suddenly, that 1% stops being a statistic. It becomes a person. A patient whose name you remember. A woman who was stable, pain-free, and smiling when you last saw her. A patient you had tried to prepare for a procedure meant to help her, not take her away from this world forever. 

She had an NSTEMI five days ago. Her troponin shot up from 500 to over 40,000. Her ECG showed dynamic changes. We stabilized her. Started guideline-directed therapy. She improved. We recommended PCI early on, but consent took time. So did logistics. And money. The usual constraints. She was finally sent to the cath lab yesterday. The interventional cardiologist's hands were competent and steady and I know I can trust her with even my own life.

Her coronary angiogram showed three-vessel disease. Diffuse atherosclerosis, with eight separate lesions that looked amenable to stenting. CABG would have been ideal, but the patient had made it very clear from the start: no open-heart surgery. It wasn’t an option she would ever consider. So when the family saw the angiogram, they agreed to proceed with PCI.

But even before the first balloon could be inflated, she suddenly went into ventricular tachycardia. It rapidly degenerated to asystole. They tried to revive her. They couldn’t bring her back.

I wasn’t there when it happened. I was in clinic, seeing other patients. So when the resident called me that she arrested and they were currently in the middle of ACLS that has extended for almost an hour already, I was stunned. What did I do wrong? I followed the guidelines. Why did she die instead?

That’s the thought that keeps looping in my head. She was stable. Pain-free. Talking. Breathing better. Eating. She asked when she could go home.

You think of all the things you could have done differently, even when you know, clinically, you did the right thing. You followed the guidelines. You prepared her as best as you could. You didn’t delay, although the system did. But it doesn’t stop the ache.

Because we live in probabilities, but we grieve in absolutes. And no matter how rare the complication is, 1%, 0.1%, 0.01%, someone still ends up being that one. And this time, it was her.

Right after clinic, I went straight to her family. What I saw broke my heart. Her two granddaughters were sprawled on the hospital floor, crying like children in the middle of a tantrum. One of them was pounding her fists. The other couldn’t catch her breath. Her son just sat there, staring into space, stunned, unmoving.The first word he asked me was: “Why?”

And I told him, as honestly as I could: “I’m so sorry. I thought she would be fine too.” I stood there quietly. Sometimes answering their questions. But mostly, just quietly. Because sometimes there are no explanations, no right words. Just presence. Just grief, shared in silence.

Sometimes I wonder if God picks His 1% with care. Not randomly, not to punish, but for a reason we won’t understand just yet. I have to believe that. Otherwise, this would all feel unbearable.

Because here’s what no one really prepares you for: Medicine will teach you guidelines and protocols. But it will also confront you with mystery, with things you can’t predict, can’t control, can’t fix. And somewhere in that tension, between evidence and surrender, we do our best to carry on.

We do what we can. We show up. We care. We remember their names.

And we try again the next day, knowing full well we’ll never know who the next 1% will be.

Doctors are not gods. And while I do my very best for every patient, I know I have a God who knows better than I do. Whose plans I may not always understand, but whose grace I choose to trust anyway.

Ghosts

 

Lately, I’ve been dreaming of J.

Not in any romantic way. Not in the cinematic way, either. There’s no music, no slow motion, no lingering glances. Just fragments. A conversation over coffee or a few beers. A sentence unfinished. His quiet laugh, still familiar. His silence, still poignant and deliberate.

He was always the restless one. The wanderer. The one with plans that moved faster than his feet. Even back then, over shared conversations and stolen hours, I knew he wouldn’t stay still. He was inertia unbound. I was learning how to anchor myself.

He once told me, “You run towards stillness. I run away from it.” And we laughed, because it was true, and also because it hurt a little.

Now he’s 52, still single, still wandering. I have a husband, children, clinic hours, school pickups, echo backlogs. I have roots that go deep and loud mornings full of chaos and love. I am the still one. And I chose this life deliberately.

But the dreams have returned, like the storms I have always compared him to.

And I realized that maybe it’s not about J, not really. Maybe it is about that version of me that used to sit across from him. The girl who craved connection like oxygen. Who offered her words like currency. Who feared silence more than exhaustion.

Maybe J was the last echo of that girl. Or maybe he was the part of me that never needed a home.

J is a brilliant writer, even if he does not realize it. We wrote letters for almost two years before we met face to face. Maybe that’s why the conversations stayed with me. Maybe that’s why I miss them. Two minds throwing language back and forth like fire and rain. There was something sacred in that rhythm. Something not easily found again.

He was also the one who made me unafraid to travel alone. To wander, not for applause or validation, but simply for the sake of wandering. To explore without a map. To get lost on purpose. Before him, I didn’t know that kind of freedom could exist quietly, without needing to be posted, praised, or proved.

I don’t know why he’s visiting again. But when I wake, I find myself strangely grateful. For what was. For what never became. And for the path that led me here: to stillness, to chaotic mornings, to now.

To J who might be reading this: I may have taken a different path, but deep inside, I still carry a flicker of restlessness. Deep inside, I still crave those beautiful, deep conversations we used to have. And the music. The Beatles. And the sitting still, sipping our beers, saying absolutely nothing.  Let's do that again, soon, so these dreams will also run towards stillness the way I did.

Just Another Long Day

Today was a long day. The kind that begins before the sun is up and ends only when your bones start whispering, enough! 

I woke early to prepare for my 8 AM lecture, made pancakes for Marga, and squeezed in a few urgent echoes. After dropping her off at school, I proceeded to give my Physical Diagnosis lecture, then headed to the hospital for patient rounds. At noon, I picked up Marga, brought her home, quickly reviewed my slides, and drove to the university for my 1 PM Medicine 2 class, my first face-to-face session, which stretched to a full two hours.

As I was wrapping up, a text from my secretary popped up: there were already 14 patients waiting in my clinic. While I was hurriedly driving over, the ER called: two admissions. One intubated and with no blood pressure. So I rerouted to see the ER patients first and stabilized what needed to be stabilized. Then headed to the clinic.

Oddly enough, clinic was where I was able to catch my breath. I enjoyed conversing with my patients. My patience and energy were strangely maintained and I genuinely enjoyed my time with them. Despite the long queue, the time passed gently. I finished at almost 7 PM, and by then, a few pharma reps were waiting to talk. After the usual coverage and product detailing, I made my way back to the hospital to check on my in-patients.

By the time I started making evening rounds, my eyes felt like they were closing on their own and I was dragging my feet along the hospital hallways. I was drained. Completely.

And to top it off, it’s been five days since my last run. Seven days since my last strength session at the gym. I can feel it, not just in my stiff back or my sluggish steps, but in my spirit. If I continue a lifestyle like this, how long will my body hold out? How long will I continue to find joy in what I do?

Isn’t it true that those who burn the brightest often burn out the fastest too?

When I got home, my daughters needed help with their homework. I dug deep for one last push of energy. And only after they finished, only after the hugs, the endless curiosities, and the seemingly useless negotiations with children, did I find some quiet time to pause.

To sit. To reflect.

And there it was again, like a quiet but persistent whisper: the unread echoes, piling up in my inbox like a tide that never recedes. For every one I finish, three more seem to take its place. The to-do list stretches endlessly, like a thread I keep pulling but never reach the end of. And somewhere in the midst of all this, I can feel it: the version of myself I’m slowly leaving behind.

I know I need to make space. I need to let go of some things, not out of failure, but out of wisdom. I need to loosen my grip on the irrational FOMO (fear of missing out) and begin to embrace the sublime JOMO: the joy of missing out. Of choosing rest. Of choosing presence. Of choosing well.

Tonight, I can only muster a prayer to the heavens: for strength, clarity, and discernment. Strength to allow me to continue with the same level of energy, if this is what’s being asked of me. Clarity to let me see through the clutter that my life has now become. And discernment to identify those that hold the greatest value in the larger scheme of things.

I am tired. Very tired. Scared and confused. But I am listening.

To Academe or Not

 Lately, I have found myself at a quiet crossroads, the kind that doesn’t come with grand announcements or life-altering revelations. Just the slow realization that maybe something beautiful in my life needs to be set down. For now.

I have been thinking, really thinking, about giving up my academic post. Not because I’ve stopped loving teaching. On the contrary, I think the opportunity to teach is one of the most beautiful gifts life has given me. I love the quiet electricity of a good discussion, the way teaching demands presence, clarity, heart, and even a bit of performance. I know I’m good at it. I know my heart is in it.

But I also know this: that sometimes, finding your ikigai is not enough. 

Because this opportunity, this calling, came at a time in my life that feels painfully misaligned. I am, above all else, a mother. I have two school-aged daughters who need me not just in the abstract sense, but in the everyday: in drop-offs and pick-ups, in homework and projects, in bedtime stories and butterfly kisses, in mornings filled with misplaced socks and last-minute art projects. I don’t want to look back years from now and realize I was present in other people’s children’s learning but absent from my own children’s becoming.

And there is the practical reality that tugs at the heart of every working mother’s decision: time versus worth. Government academic work, no matter how noble or fulfilling, pays very little. The emotional and physical effort I pour into it does not translate into financial security. Compared to private practice, the imbalance is stark. I find myself exhausted from teaching, mentoring, managing, and planning, only to come home and feel the cracks of my own home life widen.

Adding to the weight of this decision is something even more personal: two years ago, I enrolled in a Master’s program in Health Professions Education. It was not a whim. It was a deliberate choice to grow, to become a better teacher, to serve students more meaningfully. But now I find myself asking: what was it all for? If I walk away from the classroom, from the very platform where I hoped to apply these learnings, will it still make sense? What becomes of all that time, energy, and hope I invested in becoming better?

So here I am, not quite making a decision, but circling around one. I haven’t filed any papers. I haven’t packed up my books. But in my heart, I am weighing the costs of holding on, and of letting go.

Maybe this season of my life is meant for something else. Perhaps I need to step away from the auditorium platform to sit more often on the floor, building castles out of blocks and memories. Maybe this is the time to strengthen our financial footing, so I can one day return to teaching with more freedom, and less compromise.

And maybe, if academic work is truly meant for me, God will open another door in a place more aligned with who I am and what I value.

For now, I hold all these thoughts with tenderness, not certainty. I let them simmer. I whisper to myself: it is not failure to choose your children. It is not weakness to prioritize your peace.

It is, perhaps, just another kind of teaching. This time, teaching myself how to live with gentleness and grace. Perhaps I can prove my worth better if I muster the courage to let go of beautiful things, so that I can spend time with the mundane, everyday things that matter the most.

Homecoming

 

I arrived home today after a three-day conference in Penang, Malaysia. I was part of a group sponsored by a pharmaceutical company. Yes, one of those trips with convention halls by day, sightseeing tours by late afternoon, and overfeeding sessions by night.

I’m not a big pharma kid. I don’t usually do these things. But I said yes this time, mostly because I knew I’d see old friends, especially Mark and Lowe, my junior fellows from PGH. We used to call ourselves The Fellowship of the Wandering Pacemakers, back when life was all cardiology, backpacking, and piso-fare bookings. Over a decade later, we’ve all gained titles and stopped being poorita, but I’m so grateful that they’ve kept their humility, their laughter, and that quiet way of respecting people. I love them even more for that. It was indeed refreshing to laugh with them again, talking about memories that used to induce anxiety, but now bring only cackles of joy. 

And yet, despite the change in scenery, the trip didn’t really feel like a break. I was constantly sleep-deprived, not just from the travel, but from chasing deadlines in hotel rooms. There were echo backlogs to read, lectures to finish, work that followed me across the sea. So when I finally arrived home, I wasn’t refreshed. I was exhausted. The torrential rains in Manila brought about by habagat also brought with it terrifying air turbulence during my plane ride home. The dread and the exhaustion gave me a pounding headache.

But when I arrived home, my dog Dolphy gave me a wet, sloppy welcome with his licks and cuddles. Then my kids ran to me. Their laughter, their chaos, their sticky little hands pulling me back into the world. I realized this was the medicine I needed.

I had gone away hoping to escape the noise. But in the end, it was the very noise I longed to escape that healed me.

Now I’m back in the mess of it all: the toys, the hugs, the unfinished breakfasts. And more than ever, I know that this is where I’d rather be.

The Magic of Vitamin O

Two weeks ago, I attended the launch of a new drug, a so-called miracle that promises 15–20% weight loss in just two years. The room was buzzing with excitement. The science was impressive. The potential impact, enormous. One injection a week, and the pounds melt away. Ozempic, initially used for diabetes, now also proven to have wonderful cardiovascular benefits, is now reborn as the golden child of weight loss.

A miracle? Perhaps, for those who can afford it.

But for the many who can’t? It’s not a miracle. It’s a dream. A distant, glittering promise glimpsed through the pharmacy glass, priced out of reach. For people already struggling to make ends meet, to put food on the table, to survive, this “miracle” may as well be magic. The kind that only works for the chosen few.

In a world where thinness is prized and judged as a marker of discipline, desirability, and even moral worth, this drug will become more than a medical intervention. It will become a status symbol. A badge of access. The final, gleaming wedge that drives the chasm between the privileged and the poor even deeper.

Because now, even health, one of our most basic human rights, is being commodified, branded, and sold to the highest bidder.

I sit with the discomfort. I acknowledge the marvel of the science, the promise it brings. But I also see the danger when medicine forgets its soul. When we forget that healing is not just for the wealthy, that weight is not the only measure of wellness but of privilege, and that dignity should never be tied to a price tag.

Sadly, however, it is.

Now, I’m not saying I won’t be using it. I’ve gained 20 pounds in the last two years. And yes, I can afford it. So let’s see if Vitamin O works wonders, shall we?

But even as I joke, I know this isn’t funny. Because for every one of us who can buy our way into better health, there are hundreds more who can’t. And that should make us pause.

I'm going to use it, out of desperation. And I won't feel guilty for it. But I do know that when medicine becomes a luxury, we risk forgetting its purpose. And that's another weight in my mind that I need to lose.

Only Twelve

 

Yesterday, our medical students graduated.

From the 55 students who were accepted into our program four years ago, only 12 walked up the stage. Just twelve.

They’re not doctors yet, not officially. They still have to complete internship, then hurdle the board exams. But what they’ve achieved so far is no small feat.

Those twelve carried with them the courage of fifty-five. They are a testament to resilience, to grit, to persistence in the face of sleepless nights, missed family milestones, heartbreaks, breakdowns, and the quiet burden of becoming. But they showed up, and they succeeded.

I am deeply honored to have been part of their journey, to have witnessed them grow, not just as future physicians, but as humans who chose to keep going, even when the road was unforgiving.

Congratulations, dear students. Padayon.

Crazy Good Mornings

 These days, my mornings are nothing like the ones I used to imagine.

I dreamed of slow breakfasts, with me holding a classic novel in one hand, a cup of coffee in the other. I pictured quiet moments, thoughtful conversations with my husband, a little peace before the day begins.

But no. Reality is two little monsters storming out of their bedroom wearing pajamas, crying loudly, "Mommy, come back to bed!"

Whenever I sneak out of bed in the wee hours of dawn to log in my morning runs or work on my echo backlogs, I hear sleepy voices demanding, "Mommy, don't go. Cuddle me!" They want to hug. They want to cuddle. And because there are two of them, they fill both my arms. Their sleepy bodies cling to me like I’m the only safe place they know. And I stay. Because they need me. And maybe, I need them too.

The rest of the morning unfolds in beautiful chaos: a kindergartener who insists on having pizza instead of a cheese sandwich, a toddler who refuses to take a bath for nursery school. There’s loud singing, hip-jiggling to songs they invent on the spot. Toys everywhere. Ribbons and scrunchies mark their tiny, joyful territory. Butterfly kisses. Bear hugs. Sticky hands and tearful goodbyes.

I am not rich in material things, and I am ordinary when it comes to career milestones. I cannot even have slow, quiet mornings. 

But in my life, joy overflows. These chaotic mornings, these messy little humans, this house filled with shrieks and laughter, show me that love thrives in both mayhem and drab. I offer a quiet prayer, take a deep breath, and soak it all in: the noise, the chaos, the mess, and the magic.

And I realize: I am the richest human being in the universe.

Writing on Water (Or the Blog That Nobody Reads)

 No one reads my blog anymore. And oddly enough, I take comfort in that.

When I started Walking on Water as an internal medicine resident at PGH, it was mostly a survival strategy. By the time I became a cardiology fellow, the blog had become a faithful confidante. Between rounds, referrals, and ECGs, I wrote frequently, feverishly, as if my survival depended on it. 2009 to 2012 were my golden years, when a few kind souls began to follow along, quietly rooting for my words from behind their own screens.

Then real life barrelled in.

From 2012 to 2016, the early-career hustle left little time to write, much less reflect. After that came the world of social media: quicker, louder, more fleeting. Instead of reading essays or poetry, I scrolled through Facebook comments. My literary brain, once nourished by Steinbeck and Tolkien, was now subsisting on digital crumbs. My writing muscles atrophied.

I stopped writing because I stopped reading.

I stopped reading because I stopped pausing. I had to hustle to live.

Now, after a five-year hiatus, I am learning how to pause again. To pick up my pen, well, technically, my keyboard. Clumsily, hesitantly, but with intention. I am writing again. This time, for no one. To write without the need for validation, without the imagined reader perched on my shoulder, judging the tone, the grammar, or the depth. That is oddly liberating.

There is no audience to impress. No applause to chase. No criticism to fear. Only the blank page and I, finally brave enough to return.

So I write again. Not to be read, but to be real. Sometimes I feel that I have stayed in the comforts of my boat for too long, and I am now too scared to walk on water. The stakes are just too high. The fears are heavier because my life is no longer mine alone. It belongs, in large and sacred ways, to my daughters, too. 

But maybe this time, I can just leave my boat once in a while when I want to. And learn to swim, or at least be still and learn to float. 

The Epidemic of Group Chats

        There was a time when news traveled through quiet conversations: at the corner sari-sari store, during random, unintended meet-ups in hallways, or a late-night phone call made without the dread of bad news. Back then, a ringing phone was not synonymous to an emergency, not an alert that someone is having unstable ventricular tachycardia. It was simpler, something to look forward to: a cousin’s story, a forgotten detail about a meeting, or a mundane laugh with an old friend from high school shared across the wires. Now, the way we talk has changed, and with it, the weight of every message we get. 

        Now, it comes through group chats. Viber, Messenger, Microsoft Teams. What used to be pinned to bulletin boards now floods into our phones: these pipelines of endless updates, flowing faster, louder, harder to ignore. They were meant to streamline communication, to keep everyone connected. But somehow, they have made life heavier, aggravating our already alarming technology-induced mental health issues. 

         Messages come at the unholiest of hours: in the middle of your lecture, during hospital rounds, while you’re in the bathroom trying to piss in peace, or worse, jolting you awake in the dead of the night when you are indulging in a rare deep sleep. And it’s always something: an announcement barely relevant, a document that could wait until morning, or a question someone could probably answer themselves (Google mo, gago. Or better yet, ask ChatGPT). Instead of convenience, the constant pings feel like chains, pulling you into conversations you never really asked to be a part of. 

        There’s a group chat for everything: family updates, the homeowners’ association planning yet another pointless meeting, colleagues arguing about politics, old friends debating who impregnated which celebrity, your batch trying to organize a dream trip abroad that will inevitably die at the polls. Like the old gossip circles, the messages spread. Every ding, every notification, piles up, and it becomes too much. Too much clutter, too much noise, too much of everything you wish you could ignore. 

        And then there are the generic messages, the high-tech version of verbal clichés: happy birthday, condolences, congratulations. They’re quick and easy. And dangerously empty. Instead of driving over to hug a friend who just lost a parent or sitting with someone whose world has fallen apart, we fire off a one-word “condolence” in the GC and pat ourselves on the back for being human. It is a hollow reassurance, a digital mirage of compassion, convincing us that we have done something meaningful when all we’ve really done is… nothing. And it doesn’t ease anyone’s pain. Not theirs, not ours. It only makes real connections harder to find. 

        These group chats were supposed to make everything easier. They were supposed to streamline conversations, keep us connected, and make announcements quick and efficiently. But instead of connection, they bring chaos: a never-ending stream of words, reminders, and updates that burrow into my chest like a stone, heavy and persistent. Maybe we thought technology could fix the gaps in the way we talk to each other, but all it did was make the talking endless. There’s no pause, no quiet moments, no space for meaning anymore. Sometimes, I think it was simpler back when people said what they needed to say, finished their story, and, as that old coffee commercial once said, “Let’s sit and talk awhile.” Now, it’s reduced to “Post mo lang sa GC.” And somehow, it feels like we’ve lost more than we’ve gained. 

        And so, to keep our sanity intact, we hit the snooze button. The group chats are muted, their constant clamor reduced to silence, checked only during the rare moments of downtime when life allows us to breathe. We skip the happy birthdays, scroll past the condolences, and slowly, deliberately, become selective in what we read, and even more selective in what we respond to. It’s the only way to survive, the only way to push back against the relentless tide of noise that threatens to pull us under. 

        We leave the group chats that no longer matter, the ones cluttering our screens with nothing of value. The toxic ones? We ignore them entirely. And as for me, anything posted in the GC is automatically filed under the folder: “non-urgent.” Because if it’s truly important, if it needs my attention, my time, my care, then call me. And if you truly care, come find me. Sit with me. Talk to me. The way conversations used to be.

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 sells 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.