Defying Gravity

Four days to a new year, and, as always, my thoughts turn to what lies in store for me in 2008.

The future is especially muddled for me this coming year because for the first time in my life, a yawning chasm called the Unknown gapes at my feet. For the past 12 years, I've been single-minded in my pursuit of a medical career, with a resolve that held through four years of college, five years of medical school, and three years of residency. I thought I knew what I wanted, but now that the end of this particular journey is in sight, I suddenly find myself standing at the edge of a high precipice, and life is inviting me to jump in even if I cannot see the bottom.


30 seems quite late to be caught in the throes of a quarter-life crisis, yet here I am smack-dab in the middle of one. At the expense of mixing my metaphors, it feels like I am in the middle of a crossroads with more than four roads branching from it, and I have no idea which of them to take. I've spent the past few years avoiding making the really big life decisions most of my peers have met head on a long time ago, and now that these decisions are here before me, I still don't feel ready to make them.

It's terrifying.

But at the same time, having made the choice to stop the careening course of my life to examine what it is I really want for myself in the long run, it feels for the first time that life is finally opening up for me.

I feel free.

Free to explore possibilities. Free to take risks that I have always been too afraid to take. And while the same problems and "what if's" that have kept me from doing this for the past few years still exist, I have to believe that in the end, all this will be for the best. I am hoping that after having made one brave choice in defiance of what is expected, everything else will follow.

Maybe I'm being an optimist - but despite the bone-deep terror and uncertainty, I have a good feeling about this coming year.

As a music addict, I have had the lifelong habit of choosing songs that mirror my life. The song Defying Gravity, from the hit Broadway musical "Wicked" captures the spirit of where I am right now.


Something has changed within me
Something is not the same
I'm through with playing by the rules
Of someone else's game
Too late for second-guessing
Too late to go back to sleep
It's time to trust my instincts
Close my eyes: and leap!

It's time to try defying gravity
I think I'll try defying gravity
And you can't pull me down!

I'm through accepting limits
'Cuz someone says they're so
Some things I cannot change
But till I try, I'll never know!
Too long I've been afraid of
Losing love I guess I've lost
Well, if that's love
It comes at much too high a cost!

I'd sooner buy defying gravity
Kiss me goodbye, I'm defying gravity
And you can't pull me down...

As someone told me lately:
"Ev'ryone deserves the chance to fly!"
And if I'm flying solo, at least I'm flying free.

So as 2008 comes rushing towards me, I meet it with open arms. And standing at the edge of Future's precipice, with hope and prayers in my heart, for the first time in my life, I am ready to jump.




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Starbucks University Library

Fact: I am completely incapable of studying at home.

Whether this peculiarity is because of my inherent lack of discipline or whether it is the product of conditioning, the bottom line is the same - in order to get a decent amount of reviewing done, I have to study OUT.

Believe me, in the interest of saving my dwindling funds, I've already tried locking myself up in an apartment unit away from all forms of temptation - no TV, no laptop, no internet - but to no avail. After only half a day, I was ready to climb walls and tear my hair out from the stress. In the interest of preserving my sanity, I packed away my books and my notes and lugged them all to Starbucks.

Leave me to do intense studying in an empty apartment with no one around, and you better come back for me with a straitjacket or I will not be responsible for my actions. Just a few days ago, my brain completely short-circuiting from my forced solitary confinement, I was compelled to throw an impromptu concert with my iPod as accompaniment, a hairbrush as my microphone, and the empty office room as audience. (Don't ask me to explain how that helped because I can't - it just did).

Life would be so much easier - not to mention less expensive - if we had easy access to public libraries that are open late into the night. School libraries close at 9pm at the latest and require ID for access. This poses a unique problem for people like me who are: a) no longer affiliated with any academic institution and are studying for make-or-break certification exams, b) at our absorptive best later in the day and into the wee hours of the morning, and c) need the stimulus of seeing other people around to facilitate the learning process. Besides, even if I could find a library that would let me study in it, the point would be moot because all schools are on Christmas hiatus right now.

Thank goodness for Pinoy coffee culture, which means there is an accessible open coffeehouse just a stone's throw away from anywhere in Manila. The ubiquitous coffee house has become a haven for eccentric and reluctant academics like me - reasonably quiet except during peak hours, the pleasant smell of coffee brewing hanging in the air, unlimited access to coffee (if you're willing to spend for it), the sight of other people to break your boredom, and store hours extending into the wee hours of the morning. Rising noise levels and annoying patrons in neighboring tables can be effectively drowned out by music streaming from MP3 players or - for those who don't like studying with music - with industrial foam earplugs which can be purchased from any hardware store for less than P50.

As a case in point... what library would be open on the day before Christmas anywhere in the Philippines? Yet on Christmas eve, my batchmate Vic-vic and I were still both in an almost-deserted Starbucks Libis, poring over our Harrison's like our lives depended on it - which they do. (That we were even studying on Christmas eve is something that deserves a full-length rant in another entry reserved for another time.)

If it hadn't been for the existence of these coffee places, I probably wouldn't have passed our Medical Boards. It might even have taken me reasonably longer to graduate from medical school.

I'm keeping my fingers crossed that the combined magic of coffee and luck will help carry me through the day again this time around.

That's it for now - I'm already behind schedule in my review as it is. I'm off to Starbucks!

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Christmas at Work

It feels odd that for the first time in a long time... four years to be exact... I will actually be able to attend all of our family's Christmas activities. No need to wake up after only 2 hours of sleep to drive myself to the hospital to go on duty. No need to suffer through a New Year's party bogged down by post-duty grogginess. No excuse to get out of the cooking because I was on-duty the previous day and would get home at the same time the guests are coming in. I've had to miss one get-together or another because of the perfectly reasonable excuse that my patients in the hospital just plain need me more.

It makes me realize just how my being a doctor-in-training has taken up a good chunk of my life. Our work as doctors simply does not leave much room for special occasions.

My family has gotten used to my chronic absenteeism over time, despite the fact that I have to explain to them every year that when I say I'm going on duty, it means I'm going to be stuck in the hospital for 24 hours and no, I cannot possibly find a way to get out of it. They have gotten used to the idea of my having to go to the hospital on weekends and holidays with very rare exceptions; of my having to forgo out of town trips because there is no way I'll be able to get home in time for my next duty. They are used to my having to hand-pick the occasions I will attend and actually swap duties for because no matter how good a friend you are with your batchmate, asking her to go on every-other-day duty for you is still asking for a huge favor.

Last night, while we were driving along Libis on our way to Noche Buena at our house, I was struck by the deserted feel of that otherwise bustling road. It felt more like it was 3am rather than 10pm given the paucity of vehicles on the road. Even the ever-busy Jollibee, usually open 24 hours, was eerily dark and silent as we passed. It was the night before Christmas and all through the town everyone was busily preparing for the midnight feasts inside their own homes.

Not so the doctors and nurses and other health care workers on duty, for whom life cannot stop on Christmas eve - because there will always be patients needing care and hospitals that must always be open to serve them.

I actually am one of the lucky ones whose family is here in Manila. Those among us who come from the provinces have not spent Christmas with their families for years. They are the ones who volunteer to go on duty on Christmas or New Year's to stave off the loneliness of being away by burying themselves in the immediate demands of work.

Nonetheless, those who have to be in the hospital during these occasions still get to celebrate Christmas on their own terms. Makeshift parties are thrown in callrooms throughout the hospital, with take-out pizza and lechong manok taking the place of the traditional ham and cheese, as those of us who cannot be home to spend Christmas eve with our families enjoy it with the substitute family we have found at work.

I know that this experience is not unique to those of us who work in the health professions. And what of the millions of Filipino workers abroad this Christmas, for whom a phone call or a chat session with their relatives in the Philippines will be the closest they will get to home?

So it is for all those of you who are spending Christmas at work that I wish especially hard today. May the blessings of peace and joy reach you whatever it is you do today, and may the love that the families and loved-ones you work for make itself be felt to you wherever you are. And may you all be kept safe in God's care until you can finally come home.

A Merry Christmas and a happy holiday to everyone!

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More Meme: 12 Months Tag

Oh, goodie, a meme I can do under 20 minutes...!

I've currently exiled myself to the apartment in order to get away from the Evil Being who Takes Away Study Time (a.k.a. The Internet Blogging Monster). I really had to get started studying and have been at it all morning. As a reward for my hard work, I have decided to get some internet time at the internet cafe on the ground floor of the apartment building.

I've given myself one hour. And I've already consumed 15 minutes, so I better get at it.

Here's a tag my friend and mentor, Megamom sent me. :)

The rules are:
1. Mention the person who tagged you and create a link back to them.
2. Copy-paste the traits for all the twelve months (see below).
3. Pick your month of birth.
4. Highlight the traits that apply to you.
5. Tag 12 people and let them know by visiting their blogs and leaving a comment for them.
6. Let the person who tagged you know when you’ve done it!


I am a May-born baby. :) And I am, strangely enough, a textbook May-born almost to a T.

MAY: Stubborn and hard-hearted. Strong-willed and highly motivated. Sharp thoughts. Easily angered. Attracts others and loves attention. Deep feelings. Beautiful physically and mentally. Firm Standpoint. Needs no motivation. Easily consoled. Systematic (left brain). Loves to dream. Strong clairvoyance. Understanding. Sickness usually in the ear and neck. Good imagination. Good physical. Weak breathing. Loves literature and the arts. Loves traveling. Dislike being at home. Restless. Not having many children. Hardworking. High spirited. Spendthrift.

Friends know I have a short fuse and a long memory, and once I have an idea, I tend to dig in. I hate change. I love to travel. I love music and literature. But, while I can occasionally be an impulsive shopper, I am generally super kuripot! (Probably a hold-over from not having had an allowance until college... an long and interesting story for another time.)

I can't think of 12 people I can tag off bat! My tag list: Raymond, Lala, Pepper, Doray, Manggy (though his blog doesn't seem to have room for it - it's too full of his sumptuous creations), and Honey (who just might be too busy for it right now, but never mind :)).


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The Twelve Months

JANUARY: Stubborn and hard-hearted. Ambitious and serious. Loves to teach and be taught. Always looking at people’s flaws and weaknesses. Likes to criticize. Hardworking and productive. Smart, neat and organized. Sensitive and has deep thoughts. Knows how to make others happy. Quiet unless excited or tensed. Rather reserved. Highly attentive. Resistant to illnesses but prone to colds. Romantic but has difficulties expressing love. Loves children. Loyal. Has great social abilities yet easily jealous. Very stubborn and money cautious.

FEBRUARY: Abstract thoughts. Loves reality and abstract. Intelligent and clever. Changing personality. Attractive. Sexy. Temperamental. Quiet, shy and humble. Honest and loyal. Determined to reach goals. Loves freedom. Rebellious when restricted. Loves aggressiveness. Too sensitive and easily hurt. Gets angry really easily but does not show it. Dislikes unnecessary things. Loves making friends but rarely shows it. Daring and stubborn. Ambitious. Realizes dreams and hopes. Sharp. Loves entertainment and leisure. Romantic on the inside not outside. Superstitious and ludicrous. Spendthrift. Tries to learn to show emotions.

MARCH: Attractive personality. Sexy. Affectionate. Shy and reserved. Secretive. Naturally honest, generous and sympathetic. Loves peace and serenity. Sensitive to others. Loves to serve others. Easily angered. Trustworthy. Appreciative and returns kindness. Observant and assesses others. Revengeful. Loves to dream and fantasize. Loves traveling. Loves attention. Hasty decisions in choosing partners. Loves home decors. Musically talented. Loves special things. Moody.

APRIL: Active and dynamic. Decisive and hasty but tends to regret. Attractive and affectionate to oneself. Strong mentality. Loves attention. Diplomatic. Consoling, friendly and solves people’s problems. Brave and fearless. Adventurous. Loving and caring. Suave and generous. Emotional. Aggressive. Hasty. Good memory. Moving. Motivates oneself and others. Sickness usually of the head and chest. Sexy in a way that only their lover can see.

MAY: Stubborn and hard-hearted. Strong-willed and highly motivated. Sharp thoughts. Easily angered. Attracts others and loves attention. Deep feelings. Beautiful physically and mentally. Firm Standpoint. Needs no motivation. Easily consoled. Systematic (left brain). Loves to dream. Strong clairvoyance. Understanding. Sickness usually in the ear and neck. Good imagination. Good physical. Weak breathing. Loves literature and the arts. Loves traveling. Dislike being at home. Restless. Not having many children. Hardworking. High spirited. Spendthrift.

JUNE: Thinks far with vision. Easily influenced by kindness. Polite and soft-spoken. Having ideas. Sensitive. Active mind. Hesitating, tends to delay. Choosy and always wants the best. Temperamental. Funny and humorous. Loves to joke. Good debating skills. Talkative. Daydreamer. Friendly. Knows how to make friends. Able to show character. Easily hurt. Prone to getting colds. Loves to dress up. Easily bored. Fussy. Seldom shows emotions. Takes time to recover when hurt. Brand conscious. Executive. Stubborn.

JULY: Fun to be with. Secretive. Difficult to fathom and to be understood. Quiet unless excited or tensed. Takes pride in oneself. Has reputation. Easily consoled. Honest. Concerned about people’s feelings. Tactful. Friendly. Approachable. Emotional temperamental and unpredictable. Moody and easily hurt. Witty and sparkly. Not revengeful. Forgiving but never forgets. Dislikes nonsensical and unnecessary things. Guides others physically and mentally. Sensitive and forms impressions carefully. Caring and loving. Treats others equally. Strong sense of sympathy. Wary and sharp. Judges people through observations. Hardworking. No difficulties in studying. Loves to be alone. Always broods about the past and the old friends. Likes to be quiet. Homely person. Waits for friends. Never looks for friends. Not aggressive unless provoked. Prone to having stomach and dieting problems. Loves to be loved. Easily hurt but takes long to recover.

AUGUST: Loves to joke. Attractive. Suave and caring. Brave and fearless. Firm and has leadership qualities. Knows how to console others. Too generous and egoistic. Takes high pride in oneself. Thirsty for praises. Extraordinary spirit. Easily angered. Angry when provoked. Easily jealous. Observant. Careful and cautious. Thinks quickly. Independent thoughts. Loves to lead and to be led. Loves to dream. Talented in the arts, music and defense. Sensitive but not petty. Poor resistance against illnesses. Learns to relax. Hasty and trusty. Romantic. Loving and caring. Loves to make friends.

SEPTEMBER: Suave and compromising. Careful, cautious and organized. Likes to point out people’s mistakes. Likes to criticize. Stubborn. Quiet but able to talk well. Calm and cool. Kind and sympathetic. Concerned and detailed. Loyal but not always honest. Does work well. Very confident. Sensitive. Good memory. Clever and knowledgeable. Loves to look for information. Must control oneself when criticizing. Able to motivate oneself. Understanding. Fun to be around. Secretive. Loves leisure and traveling. Hardly shows emotions. Tends to bottle up feelings. Very choosy, especially in relationships. Systematic.

OCTOBER: Loves to chat. Loves those who loves them. Loves to take things at the center. Inner and physical beauty. Lies but doesn’t pretend. Gets angry often. Treats friends importantly. Always making friends. Easily hurt but recovers easily. Daydreamer. Opinionated. Does not care of what others think. Emotional. Decisive. Strong clairvoyance. Loves to travel, the arts and literature. Touchy and easily jealous. Concerned. Loves outdoors. Just and fair. Spendthrift. Easily influenced. Easily loses confidence. Loves children.

NOVEMBER: Has a lot of ideas. Difficult to fathom. Thinks forward. Unique and brilliant. Extraordinary ideas. Sharp thinking. Fine and strong clairvoyance. Can become good doctors. Dynamic in personality. Secretive. Inquisitive. Knows how to dig secrets. Always thinking. Less talkative but amiable. Brave and generous. Patient. Stubborn and hard-hearted. If there is a will, there is a way. Determined. Never give up. Hardly becomes angry unless provoked. Loves to be alone. Thinks differently from others. Sharp-minded. Motivates oneself. Does not appreciate praises. High-spirited. Well-built and tough. Deep love and emotions. Romantic. Uncertain in relationships. Homely. Hardworking. High abilities. Trustworthy. Honest and keeps secrets. Not able to control emotions. Unpredictable.

DECEMBER: Loyal and generous. Sexy. Patriotic. Active in games and interactions. Impatient and hasty. Ambitious. Influential in organizations. Fun to be with. Loves to socialize. Loves praises. Loves attention. Loves to be loved. Honest and trustworthy. Not pretending. Short tempered. Changing personality. Not egotistic. Take high pride in oneself. Hates restrictions. Loves to joke. Good sense of humor. Logical.
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Meme: 10 Second Interview

I just sent off my last post and realized just how downbeat (understatement!) my past few posts have been. It's been an unusually morose past few days for me blogging-wise despite all the holiday cheer supposedly going around.

So in order to pick up the mood (not to mention the silliness quotient) of my blog a bit, I've taken a page off my Facebook application "10 Second Interview" and decided to share some of my answers here. Anyone who wants to play and blog about these questions, too, just post a comment and add your permalink to it. :)

On with the interview!

I wish I were a character in... Heroes. And before you ask, I'll answer: hands down, I want to be Peter Petrelli. (I also want Peter Petrelli... er, but we weren't talking about that, were we?)

How many songs do you have on your iPod? Over 2500 (7 days worth), and the library is still growing. You can see the weird mix of music I like to play on my iPod on my LastFM site over here.

What would your olympic event be? Sleeping. i would seriously rock at sleeping.

What was your worst fashion mistake? All Povedans in the house will unanimously say it was our high school uniform!

Milk chocolate, dark chocolate, or white chocolate? All chocolate, any chocolate, CHOCOLATE!

What's your dream job? Any job I am paid to travel.

I can't believe I lost my... 4 days old Tungsten E2 PDA at the PGH ER!

What's the latest gadget you've bought? please see above.

When you were a kid, what did you want to be when you grew up? A best-selling pulp-fiction novelist - who wants to be literary? Show me the money!

How do you like your coffee? I take sweetheart coffee - lots of sugar and lots of cream.

When do you normally go to bed? Whenever I can.

Would you rather have a fast forward or instant replay button for your life?
Definitely fast forward. I'm not very good at waiting.

In retrospect, do you wish you had studied harder or had more fun?
HAD MORE FUN!!!!


If you have other interesting questions to meme about - tag me! :) As I said, I love this sort of thing. :) There, I feel marginally better. :P
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Dreams for Sale

I was at Starbucks yesterday as part of my pathetic attempts to get started at studying, and, as part of my procrastination strategy, browsed through yesterday's papers. One header in particular leapt out at me from the middle of the Inquirer's opinion pages. It's a commentary by Juan Morales called, "Wedding Rings for Visas" and it explores another facet of the great Filipino Diaspora - that phenomenon of marrying to migrate.

Much has already been said about the fact that more and more Filipinos are on a steady march out of the country in search of a better life. They leave every day by the thousands, workers and migrants, pitting themselves against daunting odds in order to be able to earn for their families back home. Others, despairing that the system is no longer salvageable, leave their comfortable lives as they know it and take on jobs they are more than qualified for in order to be able to bring their children with them abroad to ensure their future. The rising desperation quotient has caused this tidal wave of emigration to be whipped up to a frenzy. Its battle cry is to get out of the Philippines by whatever means possible. But while I know that the practice of marrying for convenience for the sake of getting a visa has been around for a long while now, seeing the actual numbers is both staggering and depressing.

Forgive me, I am just trying to wrap my closet romantic's head around the concept of marrying for anything other than love. It is just hard for me to grasp the concept of a commitment that entails so much intimacy and trust and risk being undertaken for the most pragmatic of reasons. While I do not deign to question other people's choices, a part of me grieves that life for many here in our country has become so intolerable that they must to resort to this. Each one who has chosen to go by this path have reasons that are, no doubt, valid. And the closet romantic in me continues to hope that many of them, too, have found their happiness this way.

I don't mean to offend or sound patronizing. Believe me, there is no condemnation here. It is part of our being human to want to improve our condition, and I would be a hypocrite if I said thoughts of leaving for good have never entered my mind. (Part of my being in my "middle of nowhere" is the confusion about where to stake my claim and find my niche as a doctor. Commentaries about junior doctors' plight in the Philippines have been written by people with more eloquence than I, and you can read some of them here and here.) I know I am lucky because I have been given opportunities to develop skills I can barter for my ticket to go abroad. That people are actually bartering themselves in order to find their berth abroad is just reflection of the level of desperation we have ascended to. It is that that truly disturbs and makes my heart just a little bit heavier.

In truth, doesn't every overseas Filipino worker who risks his physical and emotional well-being by choosing to place his stake in the country he plans to work in do the same thing? In the end, after all is said and done, we all just do what we can to survive.

It is a sad reality that so few are able to achieve a level of comfort and security to realize that life is not just about survival, but living.
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Meet Scroogette

My mother loves Christmas. Once the "ber" months roll in, there's no stopping her rabid Christmas spirit from insinuating itself into our hapless household. She starts playing Christmas carols full blast on the living room stereo as early as September. Her Christmas shopping is done by mid-October. The tree, a mind-boggling confection of rust and orange this year, is up by early November, and the gifts are all wrapped and ready for opening by December 1.

I am the anti-thesis of my mother.

I don't know, maybe it's because my mom is such a fanatic about Christmas that she sucks all of the excitement unto herself and doesn't leave much for stragglers like me. But the truth is, I haven't been excited about Christmas since... oh, I'm not sure. Maybe it was when my mother started turning the tree into a decor showcase for Home magazine. Or when I stopped having Christmas vacations. Or maybe it was when I started to spend Christmas immersed in the misery of the patients I work with in the hospital. Having to work with people who have so little just highlights how much of what goes on during this season seems like such a waste.

Whatever the reason, I have become family Scroogette.

It's December 20, and I have yet to start shopping for Christmas presents - wait, I haven't even made my list yet! I look to the coming reunions with dread because I will be banished to the kitchen once more to cook for the posse of relatives who are coming over on Christmas day (with no hospital duty to shield me). Family reunions also mean having to parry the inevitable awkward questions that tactless relatives pose to a hopelessly single, thirty-something niece like me. Meeting up with long lost friends, while refreshing, also serve to remind me that we are no longer who we used to be and that for the most part we just have memories among us and that, under all the laughter, is just sad.

Don't get me wrong, I have nothing against Christmas per se. I do enjoy the parties, the gift giving, the taking time out to reconnect with friends and family. Like any other person, I am not proof to sight of the pretty lights around the city or the enticing smell of seasonal goodies in the air. I do appreciate that, for the first time in several years, I will not have to spend any of the major Christmas holidays on duty at the hospital.

But sometimes, even surrounded by all this happy activity, I can't help but wonder how much of this joyful energy is touched by desperation. It may be cynical, but I can't help but conclude that when it comes to celebrating Christmas, all of us are missing the point.

Whatever. I'm off to face the hopelessly snarled Manila traffic and give new meaning to the phrase panic buying.
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Inertia

I woke up late on December 17, and for the first time I had nowhere to go.

No need to scramble out of bed, cursing the fact that it was past 5 in the morning and I had to traverse a good portion of the Greater Manila Area to get to the hospital by 7. No frantic text message to be sent informing the co-resident I have to relieve that I just woke up and will be coming from my house in Rizal.

After the first 30 seconds of panic and the next 30 of dawning comprehension, I went swiftly back to Dreamland...

...And didn't wake up until past 10. For me, that is most definitely late.

You'd think it would be difficult for someone who's had her life full of hospital work to adjust to being an idle bum, but apparently, I have the talent for sloth.

This is not to say that I have no urgent things to do with my now-free time... of course I do. There are is a research paper begging to be re-written, two huge volumes of Harrison's begging to be read, documents required for certain applications to be picked up, all the bags of stuff I brought home from the call room cluttering up my room and begging to be sorted... you get the picture. Nevertheless, this sudden gift of idleness that fate has dumped into my lap is just too heavy to shrug off.

Going on Day 3 of my sloth-fest, ennui has yet to set in.

I know I have to get moving, really I do. At the very least get out of bed for other reasons than to take a bathroom break, shower, and eat. I've spent the past 72 hours lazing around and catching up on my on-line correspondence, web surfing on my computer, reading trashy novels, and generally doing completely futile, non-productive, self-indulgent things.

Life has suddenly ground to a halt for me, and I find that it's a lot more difficult to get moving again than I thought it would be.

I've resolved to get out of the house today to take care of my Christmas shopping, see my Dentist, maybe get started on studying at some Starbucks cafe. It's almost 11 in the morning - and I'm still here.

Now I know why they call it the LAW of inertia.
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The Worst Patients Ever

Doctors make the worst patients imaginable.

After several months of being told I should start myself on Metformin for my Polycystic Ovary Syndrome (PCOS), I finally caved and took my first pill this morning.

To be fair to me, I did try to take Metformin the first time my OB-Gyn friend (take note that this was not part of a formal consult) told me it would be a good idea, but I had the most horrendous bout of GI upset after only taking 1 pill... and I swore off the drug completely, advice from my Endocrinology and other OB-Gyn friends notwithstanding. All this despite the fact that I already knew I was a textbook case of PCOS and had the ultrasound to prove it. You'd also think that since we have a very strong history of diabetes and high cholesterol in my family, I would be more cautious. Not so. As a matter o fact, I also threw the advice about diet modification, exercise, and weight loss out the window.

When doctors get sick, it's not a matter of not knowing any better. I think it's part of our medical education to live in some form of denial when it comes to our own bodies.

Take, for example, all the doctors who continue to smoke incessantly despite the very strong evidence that smoking can lead to lung cancer, bladder cancer, and other malignancies, chronic obstructive lung disease, heart disease, and a host of other medical problems. We've all taken the same classes, read the same books, seen the direct evidence of how smoking wreaks havoc on the human body. We all advice our patients with hypertension and heart disease to quit smoking cold turkey because we all know it's sound medicine.

But my smoker doctor friends keep on smoking anyway.

There are many instances when illnesses among medical residents are picked up relatively late simply because they either ignore their symptoms or decide they know what's wrong with them and treat themselves.

There's an interesting article here about a study done in Australia about doctors' health seeking behavior. Participants in the study believed it was acceptable to self-treat acute conditions. A good proportion of the respondents believed doctors are also reluctant to attend another doctor when he is ill. In another article here from the British Medical Journal (BMJ), a review of existing evidence suggests that doctors are less likely than other professions to take time off work due to ill health. The alternative is often self-medication or consultation with colleagues about their illness.

The BMJ article goes on to point out that, "a culture of ‘not being ill’ is seen as inherent within the medical profession." Simply put, many doctors feel that they are ‘not allowed to be ill’, because it is seen as a form of weakness. Heavy workloads and staff shortages mean that for many doctors, it is virtually impossible to take time off for ill health. In our world, if you don't go to work, your already overworked colleagues must take up the slack or else your patients suffer. So you treat yourself and keep on working - until you get well or get worse, whichever comes first.

Ironically, this culture of ‘maintaining a stiff upper lip’ ultimately impacts on patient care - not only are they treated by a doctor who is less than 100%, but doctors with communicable diseases also run the risk of passing it on to their patients.

I've had at least two batchmates who nursed fevers and headaches for at least a week treating themselves with nothing but paracetamol who eventually were diagnosed to have typhoid fever. One of them was eventually admitted for a few days for IV antibiotics. A couple of years ago, an entire batch of neurosurgical residents were noted to be losing weight - a rather normal occurrence for toxic would-be surgical specialists in training. After one of them ended up being admitted for shortness of breath because of having fluid in his lungs, everyone else finally got themselves examined. All of them turned out to have tuberculosis and needed to be treated for 6 months.

But the biggest irony of all is that many of us, especially the junior doctors, are unaware how we would access support for ill health. My resident friends who had to be admitted had to pay for their expenses out of pocket (or their parents' pockets). The expense had a considerable impact on their finances, given their meager monthly salary, slightly discounted bills, PhilHealth, and waived professional fees from our attendings notwithstanding. Medicines are still purchased at full price, and we don't have any drug samples to cover our full treatment. I did an informal survey among my co-residents, and it turns out that none of us have medical insurance.

Is it any wonder why we are in such denial when it is our turn to get sick?
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Goodbyes

We had known the day was coming. We had spent the last few days leading up to it packing away or throwing away things that represented the last three years of our lives in the hospital - piles of our patient census, pharmaceutical company give-aways, copies of journal articles used for reports, print-outs of the latest theraputic guidelines.

If only it were as easy to pack away these feelings of sadness and loss at the thought of going our separate ways.

Just as it's harder for us to find friends as we grow older, it is also that much harder to say goodbye to them after finding them at this point in our lives. We have been around long enough to know that no matter how hard you try to keep your friendships as they are, you know things will never be quite the same again.

For us, who have practically lived with one another for the past three years of our lives, the idea of no longer having a callroom of friends to come home to for the first time is incomprehensible. And while a part of us is happy to finally be able to come home to our real families, there is an equal part of us that grieves because we are saying goodbye to our IM family.

Despite it being a half-day, there was a surprising number of people in the callroom on our last day, busily packing their stuff away in preparation for hauling them back to their own homes. Everyone seemed to be putting off leaving, but inevitably it was time to go for each one. And while we promised not to shed any more tears, every time someone took leave and gave the remaining people a round of hugs - we did.

While we are happy to see a chapter in our lives close, another phase in our training completed, our hearts are heavy at having to say goodbye to each other. I don't know if the batches before us also felt this strongly about parting, maybe this marks us as strange, but ironic as it is, it's the mark of true friendship we've forged with one another over the years - and we're grateful for it.

To end this post, I'd like to share the messages some of my batchmates sent everyone on our last day as co-residents.

I can't imagine how my residency life would be if you weren't my batchmates. Thank you for accepting me and my shortcomings and made me feel that I belong in this group. Love you all. :)

I was walking through the halls of PGH, and it was heartbreaking to know that you guys won't be there. :( Thank you for all the memories. But this is not goodbye.

Shet, di ko alam kung angina to o mabigat lang loob ko na maghihiwalay na tayo. Thanks for being my family in Manila.

Marami na rin tayong mga pinagdaanan. May mga oras ng kalungkutan, iyaka, galit at tampuhan, ngunit may oras din ng ngiti at tawanan... mga panahon kailanma'y hindi ko malilimutan. Sa lahat ng ating pinagsamahan, salamat, kaibigan.

We may drift apart at some point in our lives and eventually lose touch. But you know what keeps me smiling? I know that no matter what happens, we will always be friends.

We are sad to part ways because we know that things will never be quite the same again. We leave each other with no promises we cannot keep - only memories and love that we can. And we know that no matter what happens, we are who we are today because of all that we gave to one another... and that is something that goodbye can never take away.

Paalam, batchmates! On to the next challenge!






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My Miss List

It's hard to believe that after more than 9 years in PGH, I am finally going to be saying goodbye to it.

I am both excited and terrified at leaving the only hospital I've ever known. Excited because I am finally going to get to see how medicine is practiced out in the big, wide world. Terrified because I don't know if I am up to the challenge of practicing medicine in the big, wide world. More terrified because for the first time in my life, I will be hurdling the next stage in my life as a doctor completely alone.

And on the eve of my saying goodbye to my mother hospital, I realize that despite the love-hate relationship I have developed with it, there are many things that I will miss about it, both profound and mundane.

I will miss being able to go around the maze of its wards and buildings with confidence I will get to where I am going.

I will actually miss CO-OP food - especially the sisig.

I will miss knowing I am working with and am being taught by consultants who are among the most respected in their fields in my country.

I will miss working within a system that may not always work, but is one that I more or less understand.

I will miss the friends I have made over the years, who will still be working in the hospital long after I've said goodbye to it.

And, while I never thought I'd say this - I will also miss serving the patients of PGH, despite the many frustrations and many heartbreaking moments doing this entailed.

All of my memories and milestones as a doctor are intimately bound to this hospital's wards and corridors. The first time I delivered a baby. The first patient I cried over. My first mortality. These events and more like it have shaped me and defined the kind of doctor I have become today. And I know that whatever meager clinical acumen I have gathered in my years of stay here, I owe to the patients of this hospital, who, perhaps out of sheer desperation, have trustingly placed their lives in my hands over the years.

While I have often complained about the frustrations all residents encounter - lack of supplies, the slave-like work hours, the sorry condition of our patients' health and lives - I cannot deny that the underlying routine of a resident's life has always been a comfort to me. For the past three years, it has been good to wake up knowing what I will be doing for the rest of the day - working at PGH.

At this point, more than ever, the option to pursue a fellowship in the only hospital I've ever known is tempting. But I also know that for me to stay on at this point in my life will be taking the safer option, a refusal to go into the deep.

So despite the wrenching fear that grabs at me at the thought of saying goodbye to PGH and all that it means, I choose to leap into the unknown future with eyes tightly closed, and let myself be led on by fate. And hope that one day, if my roads lead me back home to this hospital, I will still be welcome.

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Blogthings

Confession: I am addicted to on-line pop psych quizzes. :)


It's an echo of my psychology background, I think. Or maybe it's just that inherent curiosity to figure out what makes one's mind tick. I would have pursued psychiatry just to satisfy my curiosity -- only I knew enough that I didn't have the mental constitution to work with psychiatric patients without losing it myself! So here I am, satiating my frustrated psychologist with pop psych quizzes.

These quizzes are as far from science as one can get -- but they're fun and do sometimes provide you with an insight about yourself or your friends you wouldn't get otherwise.

Well... at least that's my excuse. ;P What's yours?

You Are A Romantic Realist

You tend to be grounded when it comes to romance. Sure, you can fall hard... but only for someone you've gotten to know. And once you're in love, you can be a total romantic goofball... But you'd never admit it to your friends!

Are You Romantic or Realistic?

What Your Latte Says About You

You are very decadent in all aspects of your life. You never scale back, and you always live large. You can be quite silly at times, but you know when to buckle down and be serious. You have a good deal of energy, but you pace yourself. You never burn out too fast. You're addicted to caffeine. There's no denying it. You are a child at heart, and you don't ever miss the opportunity to do something playful. You are exotic and cosmopolitan, but you are never a show off.

What Does Your Latte Say About You?

Your Inner Muse is Thalia

You are most like this playful muse of comedy. Life is all about laughter to you, and you're a natural comic. You make people laugh until their sides split. And you're always up for some play time!

What Muse Are You?

You Are Cheesecake

Rich, sweet, and simply perfect. You're not boring - you're just the best!

What Dessert Are You Most Like?

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Confessions of a Pack Rat in Training

I began cleaning out my desk at the senior's call room the other day in preparation for moving out by the 15th, and I was amazed at the amount of stuff I had managed to accumulate over the past 3 years.

I was literally immobilized by my bafflement for a good thirty minutes as I pondered how I was able to fit in so many things in the small area that is my desk and how I was to go about bringing everything home.

The inevitable solution was not pretty... I was going to have to throw some of my stuff away.


I admit it. I am a pack rat of the worst magnitude. The thought of discarding anything that can still be remotely useful or sentimental (if only in my own mind) causes a twinge in my pack rat consciousness. This explains why my college chemistry and algebra textbooks are still taking up space on my already overflowing bookshelves at home, why my obsessive-compulsive notes from high school Spanish and cans of letters from friends written during elementary school are still somewhere taking up space in our bodega. My room at home is still recovering from the impact of all the things I couldn't throw away and hauled back home when I moved out of my apartment.

Very good reasons why I have to fight my primal impulse to simply bring everything home.

Simply put, I desperately need more room, but I just can't bear to part with the stuff.

I do try to clean out my personal spaces every now and then, but the effort it takes is tremendous -- there's just so much stuff that it takes me an entire day just to sort through all the clutter and the dust. It's a painfully slow process, made more so by the time I take to examine every little thing and debate the whether to toss it or keep it. In the end, I keep almost everything anyway, making the whole process an exercise in futility.

I have managed to clean out about 75% of my desk, and of the 75%, I've managed to chuck out about 30% of my stuff. I still brought home a good number of unused prescription pads and pharma company patient record pads for future use (yeah, right!) or as scratch paper. I wanted to bring home the little notebooks, too, but thankfully, one of my batchmates asked me for them so she can give them away to her nieces and nephews. All of my drug samples are still unsorted, but I've resolved to turn them over to the incoming 1st year residents so they can use the stuff for their patients in the wards. But looking through the remaining 25% left on my desk, I anticipate bringing the rest of it home.

Frankly, if I could bring my entire desk home with me, I would.

My pack rat tendencies extend to my computer hard drive (my heart broke when my dad threw out our old DOS PC before I could rescue my files from it) and my iPod (where I have 2600 plus songs - 10 Gig worth - and no plans of deleting any of them). It makes me wonder whether there are other things, thoughts, and attitudes in my life that I am compulsively holding on to.

Having been a student of human behavior made me curious, so I did a little bit of research on it. I found this article that fellow pack rats will find interesting. The scary part about it is, while I don't think I've reached the status of compulsive hoarder, there are glimpses of me in small doses all over that article.

Obviously, it's high time to start cleaning up and throwing useless things away - not just from my desk, my room, and my closet -- but from my life. And I'd like to think that I've already started on that by refusing to take the path of least resistance. It's painful work, but it has to be done. I sure as heck do not want to end up becoming the lonely old lady surrounded by and eventually buried by all her stuff!


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"Exam Na Naman?!"

One way of looking at medicine as a profession is by viewing it as a series of never ending examinations.


No matter how high up the training ladder you go, there is always one more.

You'd think that after the countless exams we had as medical students, our life would be free from them once we graduated! But the truth is, this constant evaluation is a curse we have to contend with for most of our professional lives.

Lawyers have the bar; accountants, architects, engineers, dentists, and other professionals have their own professional boards to contend with. But for them these major examinations are a once-in-a-lifetime thing -- unless they go abroad and have to take examinations for the country they are getting into. In fairness, doctors who opt to practice as GP's need only take our medical board exams before they hang out a shingle and start their practice. But for doctors who choose the option of specialty training, our medical boards are just the beginning.

It is baffling to my "non-showbiz" friends when I turn their invitations down for a night on the town with the unfortunate excuse, "I have to study."

So, yes, on top of our hospital duties, we still need to pull all-nighters to read our best friend Harrison's for our regular exams. And now, as we're reaching the end of this stage in our training, our reward is... yet another make-or-break exam. *sigh*

I am getting too old for this. Here is proof:




This is my single photo essay on how not to study.

Even the atmosphere and the coffee in Starbucks are not proof to the frailty of the human body - and the wonderfully sleep-inducing text.

Now I wonder how in the world I will be able to get past the next exam.

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Nostalgic

I just wanted to share this slide show I made for my batch on Windows Movie Maker (before I discovered the wonders of ULead).


Camera hams that we are, I think we've managed to document these past 3 years (the fun parts of it) in more than 5 GB of digital photos. I've assigned myself as chief compiler.

I hate goodbyes.

I'm really going to miss these guys.

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Stop, World, I'm Getting Off!

My parents think me all kinds of crazy for refusing to go straight into fellowship next year.

Who can blame them? I am (as they are) not getting any younger. Common sense dictates that the sooner I continue my training, the sooner I can get started on establishing a practice... ergo, the sooner I will achieve financial independence.

My parents do not put much store in detours.

To be honest, I have never been much of a detour person myself.

I think I've already mentioned somewhere that I am a pathologic planner. Having made the decision to pursue medicine as a career in 2nd year college, I have had a definite plan for myself since I started on this career path almost 8 years ago. I've had hiccups of discontent every now and then, when I've felt overwhelmed or frustrated, but I think it's safe to say that I never really seriously faltered in my pursuit of that elusive MD.

Before I started residency, I toyed around with the idea of taking a year off to take a break from the hospital, spend time to pursue other interests, maybe figure out what I really wanted to do with my degree. But the impetus that is also known as Common Sense (and also known as opinionated parents) prompted me to ignore the urge to dilly-dally and go straight into a training program. Voices of reason in my head applauded the decision -- after all, I had already made the choice of making Internal Medicine my life's work, so there was no point in putting it off. At the time, I had no plans of going abroad, so there were no exams to study for that would need so much time away from the hospital. I was fresh from internship, and figured the transition to residency would be less difficult. Besides that, it was a safe choice, and it would mean I didn't really have to think about the hard questions for at least 3 more years.

Looking back now, I realize it might have been wiser for me to have heeded the urge to take that year off.

I can't say I regret what I've learned and experienced during residency - despite the myriad frustrations, there were good days. Friends made along the way, the people I got to help, the feeling that in some way I have been able to make a small difference in my patients' lives - I don't think I would have gotten that from anywhere else. What I do regret is convincing myself I had to go through all the steps of my career choice without taking a break in between. There are a lot of things I can imagine myself doing. I've always wanted to write, to travel, to get some training in singing - things that are just not possible when you're tied to a hospital, going on 24 hour duty every three days, and spending all the time in between those duties on 7-5 days still in the hospital.

Would taking that break have changed things in terms of whether I would've wanted to continue on the straight and narrow path towards becoming a doctor? I don't know. I do think it would be crazy to switch careers at this point in my training... but I have decided to take that year off to reassess where it is I want to go. Maybe all this year will be in the end is just a delaying the inevitable, but I don't want to force myself into a definite niche when I have absolutely no idea at this point what it is I really want to do next.

I have been so immersed in my medical career that I can't imagine what life is away from the hospital. Despite the many frustrations in our work as lowly, under-paid, unappreciated residents, it is work that is not without its rewards, and I will miss it. That is what makes the idea of going straight into fellowship so very appealing - it's the safer choice, it's choosing the familiar, it's staying on the well-beaten path.

I have, however, for better or for worse, made the decision to get off that well-beaten path for a while.

I'm wracked in guilt, I feel like a potential parasite and to be honest, the thought of having nothing certain to look forward to (and no definite source of income) this coming year already keeps me up at nights. But I've refused to take the path of least resistance in order to take a step back and reevaluate where I am and where I want to be (the facts that I am 30, very single, and broke notwithstanding).

At this point, if someone were to ask me where I see myself ten years from now, I'd tell them, "Hell, I don't know." That's in how much of a flux I am in. For a doctor who's about to finish residency to say that is a really big deal. In the medical world world, I've already specialized and ideally at this point should be able to tell you straight out what I want to subspecialize in.

Which is why I refuse to rush to the next step. I know that you can never really be sure in the end, and every decision is a leap of faith, but I don't want to jump into another definite phase in my training with the spectre of "I don't know" hanging over my head. I don't want to wake up two years from now, unhappily stuck with a subspecialty I don't want to pursue after all.

I'm trying to break myself out of the mindset that it's too late in my life as a doctor to make a different choice. It's a really tough, especially when I feel that I've already invested so much in my medical career at this point. I think that refusing to go on to fellowship has been more a leap of faith for me than continuing with my training would have been.

So if you're like me, a doctor in flux, take that well-deserved sabbatical and find yourself. I dare you to yell, "Stop, world, I'm getting off!" Let's be terrified together.

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The Gift of Friends

People say that as you grow older, it becomes harder to make friends. Sure you get to meet more people once you start working, but many of these people you meet are mere transients in your life. Maybe it's because we rarely have the time to invest in building friendships once we've graduated from school; maybe as adults, we are more wary and less trusting, less inclined to open our hearts to strangers in the hopes that they can be something more to us. Or maybe it's because, as adults, we no longer have a common drama to share with others outside our homes, no common experience to tie us to others who are not a part of our families.

But sometimes, life hands us unexpected gifts.

My batchmates are my unexpected gifts.

I entered my Internal Medicine residency on my own, none of my good friends from medical school in tow. Most of the names on the roster of my batch were simply just names to me in the beginning. A few I had had rare conversations with in medical school. More I had never talked to at all, though I knew of them vaguely. A couple I had never even heard off until I saw them on the roster. I knew we would have to work together for the next three years, but I had no real expectations that they would come to mean as much to me as they have.

Boy, was I ever wrong.

It's hard to explain to someone who hasn't lived the life of a resident just how important the people whom you work with are to keeping your sanity intact. Looking back at these past three years, I cannot imagine how I would have made it this far without the support and the friendship of the 19 other people with whom I shared this experience with. At the end of a long exhausting, frustrating, emotionally draining day, sometimes knowing that there are people you can share this experience with who would understand even without words what you're going through is all you can look forward to, and we had this with each other.

Our batch is far from perfect. We're an uneasy mix of strong, eccentric personalities put into a highly stressed situation -- a potential recipe for disaster. But thankfully enough, over the years, we have managed to work around our differences, and instead have fed on these differences to become better doctors and better people from what we have learned from each other.

In the process, we have become friends.

The kind of friends you'll get to be the godparents for your children someday, the ones you know will be dancing at your silver anniversary with, the ones who will be at the forefront of causing trouble with you when you're little old people with canes in the same retirement home -- the kind of friends you never thought you'd find at this point in your life... but have.

All of us stand on the threshold of a new chapter in our lives. Some of us have opted to stay in the hospital to continue subspecialty training. A few are definitely going to be leaving for abroad for at least the next few years. One is going back home. Some still have no definite plans. All are solitary journeys.

We leave each other with the knowledge that things between us will never quite be the same again. We leave each other knowing that we will probably never find anything thing like this wherever it is we are going.

But despite these goodbyes, there is another thing that we know for certain -- we are better people for having been friends, and we will carry this unexpected gift with us no matter where we go.

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Arrested Development

Most doctors and doctors-in-training will agree -- committing to a career in medicine is akin to jumping voluntarily into a time warp. While our friends and contemporaries take more advanced steps into the world of responsible adulthood -- becoming financially independent, starting their own families -- those of us who chose to pursue further training in medicine are inexorably stuck in this very small but dramatic world called our training hospital. This is especially true of those among us who have chosen to take our residency training here in the Philippines.

Don't be fooled -- we may deal with life and death at work and are still able to think on our feet even after a 36 hour shift, but, for the most part, our personal lives show the emotional maturity level that is closer to adolescent than adult.

It's hard to make plans to invest in a new condo or to plan on getting married and starting a family when you barely make enough in a month to get from day to day. To be brutally honest, a good number of us are still firmly covered by our parents' financial security blanket even as we're pushing 30. It can get pretty frustrating, especially during those days when everything seems to be going wrong, you've done 48 hours straight and are still on the clock, and you can't figure out what insane impulse made you decide to make this your life. When you're pushing 30 and feel that you have nothing concrete to show for it, it seems so much easier to just give it up and be normal.

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