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 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.