The Quest for Balloon Spray Paint

 

This afternoon, Marga told me she needed balloon spray paint and three meters of white velvet ribbon for tomorrow.

Tomorrow?!?

“When did your teacher tell you this?”

“Today,” she said.

I checked her assignment notebook, and sure enough, there was a new note from her teacher.

I was furious! Not so much because of the short notice, but because I DIDN’T EVEN KNOW WHAT THOSE THINGS WERE!

It was already 3 PM. I hurriedly Googled the items and figured my best chance of finding them would be at a party supplies or balloon shop. So, after Hannah was dismissed from class, we drove around General Santos City, guided only by Google Maps.

Shop #1 was along a busy street near the public market. When we got there, there was no parking available. I couldn’t possibly leave both girls in the car while I went inside to check if they had effin’ balloon spray paint!

Shop #2 was in an abandoned, partially demolished building. Damaged by the recent earthquake? I don’t know. The shop was no longer there.

So I drove the girls home, grumbled a little about how teachers should give parents enough time to find these things, and decided to continue the search by myself.

The thing is, I already had my entire afternoon planned. I was supposed to finish my backlog of echo reports and catch up on my Zone 2 runs.

Ngunit, subalit, datapwat…

There I was, slowly driving through parts of GenSan I very rarely visit, looking for balloon spray paint and three meters of white velvet ribbon.

BALLOON SPRAY PAINT!

Until this afternoon, I didn’t even know such a thing existed.

Finally, I found a store selling balloons, party supplies, Christmas decorations, foil papers, girls’ ribbons and scrunchies, cheap toys, trinkets, and all sorts of what-nots, all obviously made in China.

The kuya guard was already pulling down one of the metal doors when I arrived. I hurried inside and, to my delight, found everything Marga needed! I even bought some cute hair ribbons for Hannah.

At the counter, I excitedly told the lady how happy I was that they had balloon spray paint.

“Ma'am, dili man na pang balloon.”

“Ha?!? Unsa man diay nang lingin-lingin? Balloon man na!”

“Dili man na balloons, Ma'am. Circles man na,” she replied, sounding almost as exhausted as I was.

I looked at the can again. It was gold spray paint, all right. And there were colorful, shiny circles on the label that I had automatically assumed were balloons.

Apparently, they were just circles.

Forty-seven years old. A cardiologist. A mother of two. And apparently, someone who can no longer distinguish balloons from circles. In my defense, I was tired, stressed, and my eyesight wasn't what it used to be!

I decided to buy it anyway. At least my daughter would have something to bring to school!

When I got home, Hannah was ecstatic about her new ribbons.

Marga looked at her things and, with all the innocent sincerity of a little girl, said, “Mommy, thank you. I’m so excited to show these to teacher tomorrow.”

Hay, anak. You have absolutely no idea what your mother went through today.

Anyway, I’ll be going shopping again tomorrow. 

And oh the "velvet white ribbon" that I got? That's not velvet, that's satin. 

But I bought an entire roll, all thirty meters of it. 

Perhaps your teacher will be happy with that already.

Respect Goes Both Ways

 

        A few days ago, I began seeing the same headline on social media, in slightly different forms: “Masungit / Ma-attitude na nurses, bawal na sa public hospitals”. I understood immediately why it caught people’s attention. We have all had unpleasant encounters in hospitals, both private and public. Sometimes we get a curt answer, an impatient tone, or we encounter someone who seems too busy to explain. When you are sick, frightened, in pain, or worried about someone you love, even a small act of impatience can feel much bigger than it normally would.

        The headlines came from the Department of Health’s recently circulated 8-Point Patient Experience Standard, described as a “Commander’s Guidance” for government hospitals. Its first point is simple: agaran at magiliw na atensyon, which simply means prompt and courteous attention. There is nothing objectionable about that. Patients and their bantays deserve courtesy, kindness, and respect. They deserve to be spoken to as people, not as bed numbers, diagnoses, or annoyances in an already crowded day.

        What made me uncomfortable was how quickly the public conversation seemed to stop at the word magiliw, and more specifically, at nurses who were supposedly not magiliw enough. There are, after all, seven other points. The same standard also speaks of a pleasant environment, clean toilets, functioning lights, reliable social support, adequate equipment, organized queues, and updated information. Read together, the eight points tell a much broader story. They are not merely telling nurses to smile. They are telling hospitals to work.

        I practice in both public and private institutions, and the contrast between the two is not always as simple as people imagine. Public hospitals carry enormous patient loads with limited resources. Private hospitals may have better amenities, but they have their own frustrations as well, such as delays, unavailable tests, malfunctioning equipment, complicated processes, fragmented communication, financial concerns, and patients who are sometimes left unsure of what is happening or why.

        These are systemic problems. They are not things that a nurse, physician, or any individual healthcare worker can solve alone. Yet they shape the patient experience profoundly. They also shape the working environment of healthcare workers themselves, adding to workload, frustration, and the strain of caring for people within an imperfect system.

        Perhaps this is why I find the eight-point standard useful even outside government hospitals. It reminds us that patients experience healthcare not only through the treatment we prescribe, but through everything surrounding it. Was someone there when they needed help? Could they find the correct room? Did anyone explain the delay? Was the toilet clean? Was the hallway safe and well lit? Did the equipment work? Was there somebody to help when the family could no longer afford what was being asked of them? Did they know what was happening next? These things sound small until you are the patient.

        At the same time, there is another part of the conversation that deserves to be said plainly: respect and courtesy should go both ways. Healthcare workers must be respectful. A stressful day does not give us permission to humiliate patients, and being overworked does not make cruelty acceptable. Professionalism still matters when we are tired. But patients and their families also have a responsibility to treat healthcare workers as human beings.

        In my conversations with nurses, I have heard stories from the other side of the bedside as well. One nurse told me that a child’s bantay punched him after he was unable to insert an intravenous line on the first attempt. I have personally seen family members shout at nurses over matters that had little to do with nursing care, such as a leaking faucet, a television remote that would not work, an air-conditioning unit that was not cold enough. The nurses happen to be the people within reach, and so the frustrations usually land on them. Because the nurses are often the most visible people in a hospital, particularly when something goes wrong, they become the human face of problems they did not create and often have no power to solve.

        This does not mean that healthcare workers should respond to frustration with equal hostility. We are professionals, and illness makes people frightened, impatient, and sometimes unreasonable. Part of our work is to understand that. But compassion cannot mean accepting verbal or physical abuse as an ordinary occupational hazard. A patient's fear deserves understanding; it does not give anyone permission to punch a nurse. A family's frustration deserves to be heard; it does not make the nearest healthcare worker responsible for everything that is wrong with the hospital.

        We sometimes forget this because medicine is a caring profession. There is an assumption that because we chose to care for people, we should be endlessly patient, endlessly understanding, endlessly available. We should absorb anger because the patient is afraid, tolerate insults because the family is worried, and accept shouting because people are under stress. To a point, we do. Anyone who has spent enough time in a hospital learns to recognize that anger is often another expression of fear. But understanding why someone is angry is not the same as saying that every behavior is acceptable.

        Sometimes the complaint is justified. Yes, some nurses may be rude. There are doctors who are rude, too. There are clerks, guards, technicians, administrators, patients, and relatives who can be rude. No profession has a monopoly on kindness, and none has a monopoly on bad behavior. But I worry when a systems problem is reduced to an attitude problem. A nurse cannot make up for an understaffed ward by simply being nicer. They cannot speak gently enough to make ten additional patients disappear. They cannot personally fix the broken light, buy the missing equipment, create another bed, shorten the patient queue, speed up a laboratory machine, or invent a social worker when none is available.

        At some point, telling exhausted healthcare workers to “be nicer” just becomes one more burden to carry. One of my professors at the University of the Philippines, Dr. Nemuel Fajutagana, once expressed this idea in a way that has stayed with me: “If we truly value life, we cannot keep patching a broken system with the sacrifices of those who hold it together.” In the same statement came another line that may be even more important to this discussion: “The dignity of patients matters and so does the dignity of those who care for them.”

        Those two ideas are not in conflict. We do not protect healthcare workers by caring less about patients, and we do not become more patient-centered by treating healthcare workers as if their own humanity is irrelevant. A good hospital should be able to hold both truths at the same time: patients should be treated with courtesy, and healthcare workers should be treated with courtesy. Patients deserve to be heard, and healthcare workers deserve to be heard. Patients should not be humiliated, and neither should the people caring for them.

        That is why I hope we do not remember the DOH’s eight-point standard simply as the rule that said nurses should no longer be masungit. The real challenge is not merely to make healthcare workers kinder. It is to build hospitals, both public and private, where kindness has room to exist, where the toilets are clean and the lights work, where queues make sense, where information is available, where equipment functions, where social support is accessible, and where patients are treated with dignity.

        And where the people who care for them are treated with dignity, too.

The Stubborn Old Tree

A few days ago, I met an old friend I hadn’t seen in more than three years.

I was attending a conference in Manila and remembered his birthday was coming up, so I jokingly asked him for a birthday lunch treat before flying back home. Surprisingly, he was free. (I had forgotten Wednesday was a holiday. People in medicine don’t really have holidays.)

So we decided to meet in a posh restaurant near the airport. His treat, of course.

But while he was on his way, a motorcycle bumped his maroon vintage Mercedes and he had to go through all the tedious fuss of Philippine police bureaucracy. So naturally, our supposedly sophisticated reunion downgraded into uncertainty and logistical chaos.

I decided to head straight to the airport instead.

While waiting for the check-in counters to open, I completely lost track of time immersed in my worn-out secondhand copy of Truman Capote’s Breakfast at Tiffany’s. Then he called and said he was driving straight to the airport.

So after all these years, we ended up having our reunion at airport Chowking over glasses of water. No food ever arrived. Which somehow made the whole thing even more funny and appropriate.

We talked loudly about everything and nothing at all: faith, or its eventual demise; DDS and the dismal state of the country; death; loneliness; resignation letters; why I insist on drowning my existential angst with all sorts of busyness.

At one point he laughed so hard at me and said I was the only person he knew crazy enough to simultaneously collect so many jobs and responsibilities, as if I were voluntarily hitting myself on the head with rocks. Then after a pause he looked at me and said, “You enjoy it. You just pretend you don’t anymore.”

Only old friends can say things like that.

We are very unlikely friends. We met twenty-two years ago because of Friendster, brought together by our mutual love for the Beatles and books.

Since then we’ve weathered through the many seasons of our lives.

I went back home down south, got married, and now spend my days raising two beautiful daughters while balancing medicine, teaching, writing, and all the chaos in between.

He climbed the corporate ladder in the same airline company where he was already working when I first met him online. He remains single despite his good looks, extraordinary intelligence, and brooding charm -- qualities my PGH friends insist are visible only to me. Haha.

He still thrives in solitude and adventure. I, meanwhile, continue overcommitting myself to institutions and responsibilities in ways only he seems capable of seeing through.

Eventually I had to look at my watch and panic because my flight was boarding soon.

At the airport gates, we hugged each other. That long, tight, affectionate hug you give only to people you know will remain part of yourself no matter how many versions of you have already existed.

And somewhere in that absurd airport reunion, over fluorescent lighting and untouched Chowking trays, I realized how lucky I am to have friendships like this.

The older I get, the more I realize that love exists in many forms, and often escapes neat definitions and categories altogether. Some people arrive loudly and briefly. Others simply remain. Quietly, persistently, through years and seasons and silence.

Years ago, I wrote in this same blog that conversations with him always leave me feeling “Ondoyesque” -- a post-typhoon Ondoy analogy I coined around 2010. He had this way of unsettling me, making me contemplate my life, my choices, the dangerous what-ifs and could-have-beens. Back then, our conversations often left me with a strange ache I could never quite explain.

But this time felt different.

After more than two decades of steady friendship, I no longer came home with pain or longing or the urge to abandon the life the universe has so generously given me.

Instead, I came home overcome with immense gratitude -- for both answered and unanswered prayers. For the life I have now. For the husband and family I fiercely love. For old friendships that endured. For all the roads taken and all the roads mercifully left untaken.

And perhaps maturity is finally realizing that not every meaningful love story in our lives was meant to culminate in possession or permanence. Some were simply meant to accompany us through our becoming.

A day after our airport reunion, I greeted him for his birthday and sent him a caricature I made of him using ChatGPT (haha!) -- him with his books, mountains, guitar, backpack, beer, all the things that somehow became symbols of his existence through the years.

His reply was simple and deadpan as always: “Patience, you’ll get to be just as OLD soon, and yup, you can count on it, this much older friend will still be around.”

And perhaps that is one of the most beautiful things life can offer us: people who quietly persist through the different seasons of our lives like some stubborn old tree refusing to die.

And when you know what you have while it is still there, aahh, perhaps that is life’s greatest gift.

 

From FOMO to JOMO

 Today I woke up at dawn shivering.

I dreamt there was a very strong earthquake. As I ran outside tightly hugging my daughters, parts of the ground beside us suddenly rose, and our car rolled away, crashing into a broken wall. The earth shook violently beneath our feet. We cowered down, praying, my children screaming.

Then I woke up.

Two days ago, I submitted my resignation from the academe.

That initial wave of relief I felt has now slowly turned into dread. I have always been a teacher. I invested my time, my heart, and my soul into teaching. And while I felt so alive and at home with my students, I also felt myself slowly drowning inside an institution where I no longer felt aligned, understood, or at peace.

I had to make a choice.

Today, I felt FOMO. And it crept into me through a dream of earthquakes. I am being shaken and stirred.

But I know this much:

Institutions will forget. I will always be replaceable. My light will burn out someday.

But the students I taught will remember.

My children will remember.

My body and mind will remember that I chose to protect them.

And I know that what is meant for me will find me again.

Today, I have FOMO.

I will not resist it. I will sit with it for now.

Tomorrow, JOMO will come.

And I will still be there. Not a different person. Not a burnt ember of the woman I once was. Still me.

Because today, I chose to protect me.

Never a Prophet in One's Own Town

 Two years ago, I enrolled in graduate studies in Health Professions Education because I wanted to be better: for my students, for my institution, and for the kind of doctors we are trying to form. I paid for these courses, attended workshops and conferences (some of them international), read widely, reflected deeply, and returned home carrying ideas I believed were thoughtful, contextual, and doable.

I didn’t do this to collect certificates. I did it because I believed that if we understood learning better, we could teach better. And if we taught better, we could serve our communities better.

However, I learned another lesson somewhere along the way. We can never be a prophet in our own town.

When I began proposing changes: small ones, careful ones, grounded in evidence and lived experience, I realized that being prepared does not always mean being heard. Sometimes, the more invested you are, the easier it is for your ideas to be dismissed as “too ambitious” or “too idealistic.” Sometimes, institutions would rather listen to voices from outside than to those who have stayed, labored, and cared within.

This isn’t a story of resentment, although it seems like it is. I still believe institutions are made of people doing their best within constraints they may not fully control. And I understand that change is threatening, not because it is wrong, but because it asks something of everyone.

Still, it is quietly painful to realize that effort does not guarantee trust, and training does not guarantee influence. I’m learning to sit with that. But I will not deny that this fire within me, because it burns oh so brightly, is burning me out. This voice within me, which nobody hears, is tiring me, exhausting me. I've always thought that the brighter we burn, the faster we burn out. And here I am dragging my feet exhaustedly, trying to get through every long day, hoping that better days will come soon.

Perhaps this, too, is part of education: understanding that growth doesn’t always translate into immediate transformation of the spaces we love. Sometimes it simply prepares us for future conversations, for different seasons, or for places where our voice will land differently.

For now, I’ll keep learning, not to convince or to change things, but to remain whole. And I’ll trust that the work we do to become better educators is never wasted, even when it feels unseen. 

We have to keep going even when we are unseen. Perhaps someday, a new town will embrace us, and allow us to grow and make the changes we are destined to make. 

The Man I Met Because of The Beatles

 

I wanted to put this in writing because nobody really reads this blog anyway. And maybe that’s the point. Some stories aren’t meant to go viral, but they’re meant to be remembered.

Last weekend, while rummaging through boxes in my childhood home, I came across my old cassette tapes -- the ones I used to play on my Walkman during med school nights when loneliness hummed louder than fatigue. The music pulled me back, the way music always does: to a different version of myself, and to a person who once made the world feel gentler.

This is a story about him. I have written about him countless times in my older blog entries. This story is about us, though “us” was never quite the right word. I think stories like these need to be told, if only to remind us that not all great loves are romantic. Some are quieter, rarer, and harder to name.

He found me because of The Beatles.

It was the Friendster era, mid-2004, when the internet still felt small and full of accidental kindness. He said he’d clicked on The Beatles and my name appeared among the top fans. He wrote me a message, and I replied. That’s how it began -- not with sparks or fate, but with a click and a song.

He was eight years older, already working in the airline industry: handsome, brooding, confident, articulate, the kind of person who moved through life with quiet assurance. I was fresh out of med school, exhausted and uncertain, in the messy, sleepless blur of pre-residency at the Philippine General Hospital. Somehow, we met in that strange in-between space between his stability and my becoming.

We started exchanging emails -- not the short, distracted kind people send now, but letters. Long, thoughtful, unhurried. He wrote beautifully, with the kind of honesty that invited you to do the same. He wrote about travel, music, why he believes there is a God, and why Dylan’s voice was both unbearable and true. I wrote about the wards, my frustration about the health system, about fear, about trying to become a doctor and still be human.

When we finally met, I was already a second-year resident. It was a Black Saturday. The hospital was unusually quiet, the city half-asleep. He picked me up in my home ward: Ward 1. A tall brooding guy in a light blue shirt, or was it gray, walking in with a quiet swagger. As I stepped out from the ward half-full of patients, he gave me a half-smile and said, “Finally, we meet.” To me then, he was as handsome and mysterious as I had imagined him to be.  He handed me a CD he had curated himself: a collection of songs he loved and thought I might, too: Sting, Tracy Chapman, Beck, Radiohead, Tom Waits, the Beatles. 

That evening, we had dinner and beer al fresco -- the rare, crowdless Malate brought about by Holy Week spread out before us, the warm breeze drifting in from Manila Bay. We ended past midnight, talking about life, faith, music. Everything. But we were silent, too. In fact, we were silent most of the time -- that kind of silence so comfortable it felt like home. He drove my back to the hospital past midnight. 

I remember floating through Ward 1 as I walked toward the residents’ callroom -- weightless, dazed, and smiling to myself for reasons I couldn’t quite name.

I think I fell in love with him that day.

We met regularly after that. And by “regularly,” I mean once a month, sometimes once in three. But it was always the same: the conversations, the comfort, the ease. Perhaps because I was heard. Perhaps because with him, I could talk about my small, silly concerns about life without fear of judgment. He listened, really listened, and even remembered the tiny details.

We talked for hours, meeting for a late breakfast, moving somewhere for lunch, then drifting to another place for dinner and beer. I never knew when our next meeting would be, but residency passed quickly because I was always looking forward to every conversation, no matter how long the wait.

He never promised anything, but I stayed in Manila longer than I should have. I stayed officially for fellowship, but secretly for him. I didn’t know what to call it then. Maybe I still don’t.

During my first year of cardiology fellowship, his mother fell ill with metastatic breast cancer. We braved that storm together: the early admissions at Makati Medical Center, the palliative care at home, the long, uncertain weeks at PGH. On New Year’s Eve, while the world outside erupted in fireworks, we hid a bottle of wine in her room and drank quietly, while a blue moon illuminated the smoky air of Taft Avenue. A few weeks later, when her breathing slowed, I was the one who checked her pulse and said the words “time of death”. He curled beside her bed and wept.

That night, I saw the tenderness of his heart. The quiet strength that carried him through grief. And maybe that’s when I realized that love can also mean staying, even when you’re not chosen.

After that, life resumed its steady rhythm. We still saw each other. We watched concerts, had both simple and fancy dinners. But my favorites have always been the conversations over beer. I met his family; he met mine. His sisters brought me chocolates and trinkets from abroad. Once, he went home with me to Digos. My parents assumed he was my boyfriend. I laughed, but maybe a small part of me wished they were right.

Some time during fellowship, there was that one night he called, distraught. Someone he’d been seeing thought she was pregnant, and then it turned out to be a blighted ovum. He was heartbroken. I stayed on the phone with him. We met for dinner and beer, skirted around the topic, and talked about music instead. I sat with him, joining him in his sadness, even as my own heart quietly cracked open.

And still, I stayed.

Years blurred. I finished training and returned home. We kept in touch through short Facebook messages -- perfunctory ”how are you’s” and “we should have beer soon”. We rarely did, but the friendship endured like a low, steady hum in the background of our separate lives.  I remember staying with him when the clock struck midnight on his 40th birthday, sipping coffee in Ortigas, when I attended a cardiology conference in Manila. 

And then, one day, when my mother died in 2016, he appeared. He hadn’t asked for details and hadn’t even messaged. But there he was, flying in quietly from Manila to Davao City, standing at the edge of the funeral crowd in a white shirt and jeans. I saw him and smiled despite my tears. “You're here,” I said. He nodded. “Of course.” His unexpected presence broke the last thread of strength and composure in me.  He didn’t say much; he didn’t have to. He was simply there -- that same calm, steady presence that had once anchored me through the hardest nights of training. On one of the saddest days of my life, he came to grieve with me, wordlessly. He left the same day, after a long, tight hug that said everything words could not. And I knew then that this friendship is for keeps. Not loud, not constant, not defined by frequency or labels. But enduring. Certain. 

After that, the busyness of our lives caught up with us. We still meet for short catch-ups in Manila. I remember I met him at the airport once, before I set out for Japan. I told him about this man that I had recently met, but he was based in Japan. He said he was excited for me because I deserved to be loved. 

In 2018, I married the man I told him about. He was one of my secondary sponsors. He was supposed to carry the Bible, but at the last minute, he cancelled his trip because of medical emergency. It was so perfectly him: written into my story, even in absence.

Many months after our wedding, he visited us to meet my husband. It was awkward at first. The conversations were brief and less personal, as though we were both aware of the invisible weight of memory between us. We talked about travel, work, politics -- the kind of small talk people use when they are trying not to trespass into tender territory.

But there were moments -- fleeting, fragile -- when the old ease returned. When a shared laugh or an unfinished sentence would remind me of how naturally we used to speak, before life grew complicated with marriages, children, and unspoken histories.

He stayed for only a few hours, then left as quietly as he had arrived. We drove him to an obscure beach resort, the only one open to accept guests. He told us to not worry about him anymore. On the drive home, my husband said he seemed kind. I smiled. “He is,” I said. And that was all.

When I became pregnant with my first child, he was one of the first people I told. It felt right that the man who’d known me through my most uncertain years should also know this gentler, fuller version of me.

It has been eight years now, since I got married to a beautiful soul I can never live without. We have been blessed with two lovely daughters who keep our home lovely and bright. He has remained single, living alone in the house his mother left him. We still message sometimes: birthdays, quick updates, concerts we might like to watch together, and a song he thinks I might like.

Every now and then, I still dream of him. It’s never romantic, just familiar. In my dreams, we’re usually talking over coffee or over beer, of just sitting together with both our feet up, silently watching the sun set. After these dreams, I wake up smiling, the kind of smile that aches a little. It's the same unexplainable joy I felt as I walked back to the callroom that night I first met him. Only now, it's softer. More peaceful. Kinder.

Sometimes I miss him. And sometimes, because of the quiet fulfillment and completeness of my life now, I feel guilty for missing him. But I’ve learned that missing someone doesn’t mean longing. Sometimes it’s gratitude wearing another face.

Because the truth is not every meaningful relationship fits into the boxes we've been taught to name. The most important ones elude definition. Some never turn into love stories, but remain stories about love nonetheless.

And today, I found the CD he gave me -- buried deep in a box of memories. The handwriting is still there, looping along the edges of the disc: Two of Us. Karma Police. Shape of My Heart. Everybody Hurts. The ink has faded, the plastic is scratched, but the music still plays.

And as I listened, I remembered everything: the girl I was, the man who saw her, the friendship that held its shape even after everything else changed.

Maybe that’s how the universe works: we meet the most special people not through grand design, but through the smallest, most ordinary accidents.

And maybe love -- real love -- isn’t the fireworks or the ending we imagine. Maybe it’s two lives running side by side for a while, close enough to touch, never meant to meet, but changed all the same.

It is friendship, memory, and music. The letters exchanged in naked honesty between strangers, the long conversation with a friend that never really ends. The grace of being seen, once but completely, by another soul.

And as The Beatles sang, “Ob-la-di, ob-la-da, life goes on, bra… la-la how the life goes on...”

22 Years Old

I just lost another patient.

I watched over that patient, stayed at his bedside for more than an hour the night before. I had a conversation with his son and learned that he has just graduated from BS Biology. He told me he wants to become a doctor. He is thinking of applying at the school where I am teaching, and I encouraged him. 

I also learned that he is the eldest of two siblings. His younger brother is in senior high school. Their mother is an OFW, working as a housekeeper in Saudi. 

I did my best to save his father's life. He was showing improvement when I left for the night. When I made rounds early in the morning, he even recognized me. I went back at 2PM, shortly before I went to my clinic, and he was stable. Two hours later, he had seizures followed by sudden cardiac arrest that the team was unable to reverse. Because I was with patients at the clinic, I arrived at the hospital too late. He was already pronounced dead. 

The boys were on the floor, sobbing. Their hands on their faces, the floor wet with their tears. 

I didn’t speak. I didn’t try to explain. I just sat on the floor with them. In my scrubs. On the floor.

The eldest finally looked up and whispered the words that crushed me more than the silence ever could: "Doc wala pa kabalo si Mama. Doc, unsaon ko man ni?" 

He is 22 years old.

No one prepares you for that kind of moment in medical school, even in residency and fellowship training. We learn how to manage cardiac arrests. We memorize ACLS algorithms. We recite differentials like they’re poetry. But this -- this is the real medicine. Being a witness to the exact moment someone’s world splits open. And having no choice but to feel it crack inside you, too.

After some time, I stood up. I wrote orders for post-mortem care. Completed the paperwork. Scribbled what needed to be scribbled on the chart.

Then I walked to my clinic and saw my next patient. It was almost seven in the evening. They had been waiting for hours.

Because life, for most of us, must go on.

I hope, in time, it does for them too.

The Things We Cannot Heal

Last month, I received a new referral. As I dropped by the nurses' station to look at the patient's chart, one of the nurses told me, "Doc, nakahilak ko ana nga patient." I asked her why and she replied, "Basta doc. Uban ko sa imo ha."

So together we walked to the patient’s bedside. The patient was a young woman, a mother, her frail body swallowed by the sheets. She had oxygen support and was breathless after speaking short sentences. She had advanced breast cancer.

She told me she first felt the lump more than a year ago, but sought consult only three months back. I asked her why she waited so long.

Her answer broke me.

Her husband, she said, had been diagnosed with rectal cancer the year before. They sold their house to pay for his chemotherapy. When he lost his job, their children stopped going to school. She herself had felt the lump on her breast at that time but chose to keep quiet. She decided that all their attention and remaining resources must go to her husband.

Six months ago, he finished his chemotherapy and underwent surgery. He was back on his feet, taking blue-collar jobs wherever he could find them. The children returned to school. Only then did she tell her family about the lump.

But they did not immediately go to the doctor. By then, they had been stripped bare. It took several months before they could borrow enough money from neighbors and lenders for her to finally see one. At her first consult, the doctor suspected cancer. There were already lymph nodes in her supraclavicular area. Her chest X-ray showed lung metastasis. The ultrasound revealed liver metastasis.

As she told me her story, tears welled in her eyes. She said her two children are still in high school and feared that they would once again have to stop studying to help pay for her treatment.

She was currently admitted for severe back pain, weakness, and numbness of the legs. Imaging showed metastatic lesions on her spine. That was why she could no longer walk. She told me she was not afraid of dying. What she feared was for her family. What if her husband’s cancer returned? What would happen to her children if she died?

Her husband interrupted us. He told her not to lose hope. God had seen them through his own cancer, and He would see them through this one, too. I wanted to tell him that this was different. His case had been diagnosed early. But hers? Hers was stage 4 -- with metastases to the lungs, liver, and spine.

I chose to keep quiet, not wanting to take away that tiny shred of hope they were holding onto. Perhaps next time I’ll tell them. Or perhaps one of her other doctors will.

After hearing her story, the nurse and I went back to the station. We were both in tears. I told her, “Life is unfair, no? I can’t imagine the pain they’re going through. Some people are really just unlucky.”

The nurse was young. This was her first job, her first time encountering such a story. She asked, “Doc, how do you handle it?”

I said, “I just listen. And I pray for them. There are things I really can’t control, but I think just being there, just listening, already helps.” Then I told her, “Ma’am, you will be hearing more stories like this. You have to learn to be strong, and you shouldn’t despair. You're already holding up very well. You're doing something wonderful, more than you'll ever know."

The patient was sent home after receiving steroids and radiotherapy. I haven’t heard from her since. I’m sure her cancer must have progressed, but I pray that her children are still in school.

As for the nurse, I still see her often in the ward, patiently caring for our patients. I know that she is stronger now. I hope that she hasn’t lost her faith in what she can do for the world.

Sometimes, I cannot understand the justice system of this world. Why do people suffer? Why do others get lucky while some go through unimaginable pain? I really cannot understand.

But perhaps understanding is not what is asked of us. Because even if I cannot understand, I can listen. And I can help.

In medicine, we are taught how to diagnose, to treat, to cure. But stories like hers remind me that sometimes, our role is simply to witness: to stand beside those who suffer when the world has taken almost everything from them. Because when we listen, when we stay, we honor what remains of their strength and dignity. And perhaps, in moments when we cannot heal the body, we can still help keep the hope from breaking. 

And perhaps at that moment in time, that is the best thing that we can do.

On Delays and Healthcare Access

 “Nganong karon ra man ninyo gidala si tatay nga grabe na man?”

Sometimes we ask this question mindlessly, without malice. Not because we’ve grown callous, but because we care.

Just recently, I learned that this simple question can actually break some families’ hearts. As I sat by the bedside of my dying patient, talking with his family, I was reminded again of the painful realities of our healthcare system and that nobody really wants delayed medical care. It’s just that access is not the same for everyone.

My patient came from a mountainous community in Malungon, Sarangani Province, near the borders of Malita, Davao Occidental. Their place can only be reached by motorcycle or horse, crossing four hours of rough terrain and several rivers.

When he first felt the symptoms of his illness, his instinct was to wait it out. Endure until it passes. The virtue of “pagtitiis” is often the poor Filipino’s first line of defense against illness.

But the pain did not pass. It worsened. The next instinct was to ask for help. Their nearest neighbor lived almost a kilometer away. His neighbors carried him like a child for more than four hours, traveling by motorcycle on rocky roads to reach the nearest district hospital.

But before they could even decide to leave, they needed to find money, so they sold their horse and a few pigs. And now that they are in the city, with mounting hospital expenses, they have sold so much more than their animals. They have also sold their land.

As doctors, I know that we don’t mean harm when we ask that question. But maybe there’s a better way to ask.

Perhaps instead of “Nganong karon ra man ninyo gidala si Tatay nga grabe na man?” we can ask, softly, “Giunsa ninyo pagdala si Tatay diri?” or “Asa pa diay gikan si Tatay?” These questions are not accusations of neglect, but open doors to stories, not wounds.

Because more often than not, for the ordinary Filipino, behind every delay is not neglect. It is sacrifice. And while a single medical consult is ordinary for many, for some, it costs them their entire livelihood. Any accusation of neglect, even if unintended, robs them of their dignity and pride. And sometimes, that’s all they have left.

Buluan Lake: Through an Outsider's Eyes

Yesterday, my friend and I set out on a long drive in search of a scenic adventure in Buluan, Maguindanao del Sur. We imagined sweeping views of the lake, evoking similar images to Taal or Lake Sebu. From General Santos City we drove to Tacurong, crossed into Maguindanao del Sur, and entered its capital town of Buluan, the home to the vast and storied Buluan Lake.

Crossing the Buluan River bridge, we were struck by the unexpected sight of a promenade on both sides: red-bricked walkways lined with colorful buntings and banners, a mosque rising beside it, lending the place a quaint, almost picturesque provincial charm. Curious to find the best view of the lake, we asked around town. Vendors along the highway sold bundles of dried tilapia, a quiet reminder of the lake’s bounty. An old woman kindly pointed us down a cemented road that, she said, would lead us to the lake and on toward the “Landing Fish” -- a port we assumed to be the hub where fisherfolk brought in their daily tilapia catch.

For several minutes, we followed the narrow cemented road, which looked as though it had only recently been laid. On both sides stretched what we first thought were lush rice fields, their greenery half-submerged in shallow water that shimmered under the sun. It wasn’t until we began to see the familiar sight of tilapia spread out to dry that we realized we had, in fact, reached the lake itself. What we had mistaken for paddies were not rice fields at all, but thick growths of aquatic weeds thriving in the fertile waters of Buluan Lake, the third largest lake in Mindanao.

After a few hundred meters, we reached a small settlement. On both sides of the road stood shanties and the occasional sari-sari store, their stilts and walls half-submerged in knee-deep water. The lake had crept into daily life, blurring the boundary between land and shore. Soon, even the highway itself disappeared beneath the lake’s surface. We hesitated at first, uncertain if the road ahead was still safe. But then a few tricycles rattled past us, followed by a multi-cab and even a battered pick-up truck, all forging ahead without pause. Taking courage from them, we pressed on too, equal parts anxious and exhilarated by what might lie further down this watery road.

So we drove further on, slowly and cautiously. Along the way, we saw children splashing in the floodwaters, laughing as they bathed; adults soaping themselves and rinsing off with a tabo; old men brushing their teeth; women cleaning fish. All in the same water that lapped at their homes. As doctors, my friend and I couldn’t help but wonder about the illnesses that must quietly thrive in this place.

The flood bore all the signs of permanence. People had already adapted: narrow stilt bridges connected doorsteps to the road, and wooden canoes were moored outside houses like everyday vehicles. On the walls, faint lines marked past water levels, reminders of the ebb and swell of a lake that refused to recede. In some places, clusters of bright pink snail eggs clung to concrete walls, adding an almost delicate splash of color to the gray watermark of endurance. In between half-submerged shanties, lotuses drift calmly on the water -- a quiet proof that this flood is no longer a passing disaster, but a long-term way of life. But even in these images of despair, we caught sight of hope. A videoke machine stood proudly outside a sari-sari store, perched high on a sturdy table above the waterline. On the concrete wall of another store, this one selling vegetables and fish, hung a small box with a coin slot, which we assumed was for piso Wi-Fi.

Slowly, we inched along the submerged road, mindful of the car’s wheels, worried it might slip off the concrete shoulder, more worried still that we might hit one of the toddlers swimming freely in the water. It was Friday, 11 a.m., the sun already high, yet the whole community’s children seemed to be out there, splashing and laughing, with some floating in styrofoam boxes they had turned into makeshift boats. Many of them were completely naked, their faces smeared with mud, their bellies sticking out, conjuring images of Ascaris and hookworms. And yet they were happy, oblivious to the dangers of the flood that felt like a playground to them. The same waters that gave them so much joy might also bring the disease that could one day kill them. For a moment, it almost looked like play, until the question pressed itself on us: why were they here, in the floodwaters, instead of in school?

A few hundred meters further, our question was answered. On the right side of the road stood the community elementary school, submerged in mud and flood, its walls rotting, its corrugated green DepEd roof sagging in perpetual disrepair. It loomed like a haunted building, silent except for the distant shrieks of children swimming far away. Inside, there was no floor to be seen, only water, and not a soul in sight.

The flood had not spared the rest of the community’s lifelines. The mosques were submerged too, along with the government daycare center and the madrasa. Faded Arabic words still clung to the walls, faint reminders of the faith and learning these places once sheltered, before the deluge came and stayed.

Further ahead, a group of children, mostly girls, paddled cheerfully on a dugout canoe that had drifted across the road and blocked our way. Two of them balanced on its narrow edge, then leapt into the flood with shrieks of laughter, sending up great splashes as if the water were a playground. Their joy seemed unshaken, even though just a few meters away an old man, draped in a malong, squatted by the water, likely relieving his bowels into the same lake that both sustained and entrapped them, the same waters that had come to define their lives.

Up ahead, the road blurred into haze. We could no longer trace its outline; the horizon stretched before us, and it all seemed to be water. Slowly, we inched closer to the laughing children. Realizing we meant to pass, they pushed their canoe aside, clearing the way.

I rolled down my window, smiled, and asked, “Naa pa bay dalan? Pwede pa mi mo derecho?” The girls smiled shyly. One of the older ones hesitated, then gathered the courage to answer: “Derecho lang. Kaya lang man sa sakyanan.” She broke into a wide grin, revealing broken teeth, a smile as bright and fragile as the waters that had swallowed the road.

As soon as I rolled the car window down, a strange smell drifted in. We both caught it at once. It was the scent of decay, disease, and death. The same death we used to breathe in the ER and wards of PGH when we were trainees years ago. It was a heavy mix: the stench of rotten fish, soggy wood, human sweat, and bodies unwashed for days. I glanced at my friend; no words were needed. He knew. I thanked the girl softly, then closed the window.

We moved forward, inch by inch. A few hundred meters later, the houses and buildings grew fewer, until they seemed to vanish altogether. A quiet dread crept in. The road felt lonelier, unsafe. I opened the window again. The same odor floated back, but this time I realized it was not the scent of the children. It was the scent of the lake itself.

I was too afraid to turn back, so I clung to the girl’s assurance that the “Fish Landing” was still ahead, and no harm would come to us if we kept going, careful not to slip off the narrow road. So we pressed on, inch by inch, my hands tight on the wheel. My friend, sensing my unease, finally broke the silence: maybe we had already seen enough.

A few meters ahead, beside a small mosque, stood a concrete house. In front of it was a pick-up truck, its wheels sunk halfway into the water. To me it looked like salvation, a shallow spot where we could make a U-turn. Slowly, cautiously, I steered us around. Relief flooded in as we faced the way back.

We continued our drive back, our senses battered again by the same scenes we had passed earlier. My friend occasionally raised his phone to take photos, mostly of the place, never of the people. To capture their faces felt like a sin. It would have been poverty turned into spectacle, their lives reduced to images for our own consumption.

In that moment, we realized we were intruders: unwelcome outsiders peering into lives already burdened, as if they were specimens on display. To frame their hardship for our own record would have been an act of quiet cruelty. And so we chose to remember, not to capture.

We drove back in silence, each lost in thought. The scenes we passed were the same: the rhythms of daily life unfolding along the flooded road. Simple, ordinary acts: cooking, bathing, washing, waiting. Women gossiping. An old woman with a malong wrapped around her sagging body, peeling corn. And yet to us, they felt like an onslaught, not because of what people were doing, but because of the stark poverty in which they were forced to do it.

These were ordinary lives in an extraordinary setting. A setting so poor, so stripped down, that the mundane itself became almost nefarious, like a quiet indictment of a world that allowed it to persist.

Up ahead, the road stretched on, and we began to notice the water receding. Patches of dry land appeared here and there, breaking the monotony of the flood. On some segments of the concrete road, tilapia lay drying under the sun -- a quiet sign that we had finally left the waters behind. A sign that, at least for us, we had departed hell.

“Are you still up for some hiking? I don’t think I have the energy anymore,” my friend said somberly.

“Me too. Should we still see the rest of Maguindanao del Sur?” I asked.

He shook his head. “I think we’ve had enough for today. It’s hard to process what we just saw.”

On our way back to Koronadal, we crossed the Buluan River Bridge once more. The promenade greeted us again: red-bricked walkways, colorful buntings, fluttering banners. But this time it felt different. We realized it was all part of a vast machinery of deception, a way to cover up deep misery with superficial images of beauty and peace.

From my rearview mirror, I looked back at the lake, at the lives afloat in its waters. Why were they even allowed to stay in such a place? Why did they choose to? Perhaps because they had nowhere else to go. Perhaps this life, in all its simplicity, its fragility, and sickening poverty, and even its terrible stench, is all they have.

I left Buluan with anger burning in my chest. Anger at the shameless corruption of our government, which allows places like this to exist and fester. Anger at how human indignity has been normalized, buried in silence, until nobody dared to tell these people’s stories. Had we never gone there, we would never have known they existed.

But the world should know. The world should share this anger. Not the kind that divides, but the kind that unites. An anger so fierce it shames corrupt politicians into facing the evils they commit, the evils that reduce people to such a painful, sobering existence.

And yet, I carried with me a fragile kind of hope: that this unwelcome outsider, telling these stories and naming these injustices, might one day stir someone, anyone, to change what we saw. That someday, the laughter of the children of Buluan Lake, who now find joy in dirty, foul-smelling water, will no longer be drowned by the stench of poverty, but will rise from a place where they can finally live, and thrive, with the dignity they have long been denied.