Overhaulers Wanted

Meet Dr. Clairebear.

this custom made South Park self-portrait was built on this great site.
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The cartoon above is a pretty good approximation of what I used to look like on a good day at work.

You would have bumped into me coming in from my morning commute, lugging my huge Hedgren backpack, iPod earphones in place. My hair would usually be in a cool and practical - if somewhat disheveled - up-do, and I would almost always be in pants (jeans when I could get away with it) and a scrub top. The whole ensemble would be set-off by my favorite soft as butter, 3-year old Bass slip-on moccassins - which used to be tan, but now look like the canvas of a Jackson Pollock painting.

This was hardly an ideal attire for any up-and-coming medical resident.

Obviously, I have been on the Fashion Police's most wanted list for the past three years.

The environment in my training hospital wasn't exactly conducive to dressing up. For someone like myself, who has always lived by the adage "comfort before beauty" when it comes to fashion, it was a haven. The rigors of 24-hour duty allowed me to wear feet-friendly shoes that I could slip on in seconds. My clothes had to be CPR friendly because had to be ready to jump on hospital beds to take my turn at chest compressions anytime. Scrub tops conveniently had several pockets to hold the other essential tools of my trade - a penlight, a calculator, my PDA, my phone - and thus were acceptable as well.

The fact that I could wake up in the morning and be ready in 15 minutes tops (already inclusive of my morning shower) was pure joy.

Unfortunately, this atmosphere of anti-fashion freedom has made me into a complete fashion dunce. While I still live by my "comfort before beauty" philosophy, my present age and status now require a certain amount of dressing up that I am not capable of. I am a fashion disaster tabula rasa. I would be a challenge even to the fabulous 5 of Queer Eye.

In short, I am in desperate need of an make-over. And I seriously need help.

Any takers? I don't have any money to offer, but I promise to give free medical services for life to anyone who can actually pull this miracle off.

*******

A Completely Unrelated Post-script:

Megamom tagged me a few days ago to answer questions about my blogging life.

I'm not quite sure that what I have is an actual blogging life. Regular readers (do I have those?) notice how my posts are usually from all-over the place, and it's probably because I haven't quite decided how serious about blogging I really want to be. But I'm going to answer the questions anyway because: a) my underlying obsessive-compulsiveness cannot leave on-line tags unanswered, and b) I have an addiction to these quizzes.

1. How long have you been blogging? On an off since 2005 - mostly off, though.

2. What inspired you to have a blog and who are your mentors?

I set up this blog when I was a first year resident so that I would have an impetus to keep writing. I also planned on using it as a means of keeping in touch with friends without having to write collective emails. I also thought it would be interesting to keep a record of my growth as a doctor as I went further in my training. Unfortunately, I wasn't able to work on it then.

I haven't really sought any serious advice on blogging because I'm still in the process of figuring out what I want out of it, but I will probably need advice soon!

3. What 3 things do you love about being on line? Meeting people from all over the world who have common interests, easy to access information, makes for hours of entertainment.

4. What 3 things do you struggle with in the on-line world? Its unlimited potential as a tool for procrastination, information overload, and addiction

I tag anyone who wants to answer!
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New POEA Policy on Direct Hiring - How Will This Affect Us Doctors?

I posted this message on the Pinoy MD forum last night, in the hopes that more fellow doctors will be made aware of this new policy on Direct Hiring. I know that most of my contacts and most of those in my extended network are young doctors like myself, who are considering going overseas for training and employment opportunities.

As doctors, most of us who seek work abroad do not go through recruitment agencies but rather apply on our own and are hired directly by hospitals we are matched to (in the US) or are accepted into (in other countries). Since I see no provisos in the copy of the memorandum (you can get to read the full document over here) for doctors, this will definitely affect our own bids to leave the country through direct hiring. This will be particularly problematic for colleagues who have been given H1b visas to the US. The rest of us who are to be sponsored on temporary employment visa will be greatly affected as well.

How it will ultimately affect us (and our chances for being matched and hired by hospitals abroad), I don't know. But its effects will likely be detrimental rather than benificial given the recent economic slowdown and the fierce atmosphere of competition in the world at large. The POEA has just given foreign hospitals one more good reason not to hire Filipino.

Here is the content of my post on the Pinoy MD forum:

Hello, everyone! I hope people will not be angry with me for cross-posting this in the Health Issues Thread and the Career Opportunities thread, but I feel that our community should be made aware of this new policy. Surprisingly enough, it was a doctor friend of mine already working in Australia who picked this story up and posted it on his blog for the rest of us.

http://www.gmanews.tv/story/77354/Warning-aired-vs-new-hiring-policy-for-OFWs

This is very much a topic of concern for doctors because most of the jobs and training programs we secure from abroad are a result of "direct hiring." We do not go through any of the recruitment agencies when we are matched, or when we apply directly to hospitals abroad for RMO positions and the like. I have already been to the POEA site, and you can download the guidelines in PDF form from the home page.

Among the new changes in the policy is the requirement of USD 11,000 as bond for repatriation and the like for every employee that a company hires through direct hiring. Given the extremely competitive atmosphere in the global market, what company would choose to hire a Pinoy worker directly for that much extra cost when he can shell out a lot less to hire some equally qualified worked through a recruitment agency or from another country all together?

Admittedly, this is all allegedly being done in the guise of "protecting" OFWs from being preyed upon by opportunistic direct-hiring companies abroad.

However, given our government's track record, I can't help but question their motives. I can't help but wonder which recruitment agencies managed to lobby hard enough and shell out enough money to have this change implemented. All the more fishy is how a change in policy this significant has not even generated a buzz in the OFW community - is the POEA keeping this under wraps? How could something with huge repercussions for the hundreds of Filipino workers trying to find work abroad and do not want to go through a recruitment agency (that will only get a huge chunk of their cash and process their applications at the same rate or even slower) have been enacted without a peep of protest?

All this has accomplished is to greatly diminish a Filipino OFWs chance of being hired at all - thus forcing him to resort to paying these so-called "legitimate" and "registered" recruitment agencies to help them find a job. In the end, who really has benefited from this policy? Is it the really the Filipino workers? Or the opportunistic recruitment agencies that prey on their desperation? Frankly, the fact that our own countrymen are preying on their own is even more disgusting and difficult to stomach. We continue to become our own enemy.

I know that a good number of people who frequent this board are taking the MLEs and other foreign licensing exams or have been matched already. Since this policy change was implemented January 17, this will all affect you as well.

I really hope that some form of collective action can be initiated and done on this manner. At the very least, the POEA and the DOLE must explain the rationale for this move to the public. It should be our choice to make to stay here rather than to have to unlock shackles of our government's making in order to exercise our right to seek employment in the way we see fit and work abroad.

I hope we all do our part in letting your classmates and friends (especially those with plans to go to the US and have already spent so much of their hard-earned money in the process) know about this new development.

The sooner we can generate enough noise to publicize this and its implications on our future, perhaps it will also be the sooner the government will take action on it. Thank you very much!

As a post-script, I would like to share with you the post of another member of the Pinoy MD forum, which he posted in this thread.

I just happen (sic) to inquire from an Australian recruitment agency. Nakakalungkot but I don't know if this is true for us filipino doctors. I just want to share his reply to me.

Dear Doctor

Thank you for your application, opportunities in Australia have somewhat narrowed for Filipinos. Filipino's (sic) if any are accepted and it is unlikely that they will be are now subject to a 10 000 USD bond refunded on completion of a 2 year contract.

We recommend you try America

Thanks

Doctors Recruitment

Thank you very much, POEA and DOLE, for shutting down the few windows of opportunity our desperate people already have.

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Of Men and Monsters

After six weeks of making studying my life, I can finally take a guilt-free break from it and catch up on my TV life.

I'm not a big television fan, but there are some shows that I reach my remote control for. Of the three CSI shows, I follow CSI:NY. I also enjoy Fox TV's Bones and the missing persons drama, Without a Trace. The Closer, a crime drama about a kick-ass woman police chief, is also a huge favorite of mine. Of course, crowd-favorite Heroes is on my list, as well as the paranormal hunk-fest Supernatural.

Unfortunately, the WGA Writer's Strike has made all of my favorite shows come to a dead halt mid-season - which means I don't have much in TV land to catch up on.

My solution? Find a new series to get hooked on. After shopping around and listening to the buzz, I decided on Showtime's sleeper TV hit, Dexter.

Dexter Morgan has a day job as a forensic blood-spatter specialist working for the Miami Police Department. Clean-cut, soft-spoken, and on the surface a really nice guy who seems to have everything going for him and dreams of having a "normal life." But he hides a secret that none of the people around him can even begin to imagine.

Dexter Morgan is a serial killer.

This piece of disturbia further draws the viewer in by throwing in another interesting plot twist -Dexter is a serial killer who stalks and kills other serial killers.

The show is intelligently written and stories are dispassionately narrated by Dexter himself as events unfold. Just like the rest of us watching him, the genuinely sociopathic Dexter grapples with understanding what he is and who he is - not quite human, but not quite the monster that others of his ilk seem to be. Dexter's conflict is at the heart of this show, his struggle to keep his mask of normalcy on while the restless energy of his compulsion churns beneath the surface.

Watching Dexter is like passing a terrible car accident on the highway - it's a horrible sight but you can't make yourself look away.

Dexter is hero and anti-hero rolled into one, and his existence challenges you into examining nuances of what is right and wrong. You know it's wrong to like him because of what he is - a murderous sociopath - but you find that you can't help yourself because he gives you glimpses of the humanity that lurks beneath the monster. You know it's wrong to root for him and hope he eludes capture - but when you examine him along side his choice of victim, you almost hope he can keep on doing what he's doing.

If you like watching shows where you know who the real good guys and who the real bad guys are, this show is probably not the show for you. There are no blacks and whites here. But if you're ready for a disturbing ride and a good piece of storytelling - grab your copy and meet Dexter Morgan today.
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Lost... Unfound: a Blog Review

Call me morbid, but murder mysteries in particular have always had a peculiar lure for me. Perhaps it's the challenge of a good puzzle waiting to be solved, or maybe it's the underlying compulsion to grasp a murderer's motives - whether to protect ourselves from becoming victims or becoming these very people we fear. Or perhaps it is a little of both.

Apparently, this is a fascination shared by millions the world over, if the huge success of TV crime dramas like the CSI franchise or the multi-million mystery publication business is anything to go by.

Fans of the immensely popular crime and suspense genre will probably find the blog Can You Identify Me? Do You Know Me?, a site I found through Entrecard, an interesting and compelling read.

In this blog, the reader crosses the line separating the gripping world of crime fiction, whether in the form of books or television, into the gruesome yet an even more fascinating reality.



This site brings into focus those who are lost - murder victims found without any identification, people who are alive but who have forgotten who they are - and are still waiting to be found. The blog's author serves the victims who deserve to come home and find rest, as well as the loved-ones they left behind who cannot mourn their loss because they have no closure.

Each blog post describes an unidentified victim in detail - when and where she was found, what she was wearing, what was with her when she was found. But instead of describing these facts dispassionately, the author taps into our sense of outrage and pity by writing each entry from the point of view of the victims themselves.

The effect of using a first-person narrative is both powerful and eerie, as the reader hears voices from the grave begging for anyone to at least give them back their identity even if they cannot give them back their lives.

There are also composite drawings or pictures of the victims themselves, as well as objects that could possibly help those who knew them identify them. Posts end with contact information of the agencies in charge of each case and where to find these unidentified victims.

The posts I've browsed so far are about people who were found in the continental United States. I know most of my few readers are from the Philippines or around Asia, but I'm sure some of you know more high-profile bloggers who could possibly give this particular blog the attention it deserves. Check out the site - then pass the word.

These people deserve to be found. After all they have suffered, they deserve to come home.


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Iska Memories

this great photo is by Marlon Hacla on Flickr

The main pitfall in attempting to study at home is my own lack of emotional quotient. The concept of delayed gratification (i.e. getting on the internet after I finish covering my scheduled material for the day) is something that simply flies out the window when temptation is too tantalizingly nearby.

I admit it, I am losing steam. I just want to get this exam over with. Not that I am ready for it, mind you, except maybe to flunk it big time. So, if I suddenly stop blogging on this site indefinitely and seem to have fallen off the face of the blogosphere, you can assume the worst.

But... I digress.

Thanks to my internet addiction and lack of focus, I've decided to answer this UP Centennial Meme I picked off my old friend Peng's page instead of trying to decipher my notes on colon cancer. Yes, like many other blogosphere wanderers, I'm a bona fide Iskolar ng Bayan from the University of the Philippines - from college in Diliman to medical school in Manila.

To other fellow Iskos and Iskas in the blogosphere, I'm sure the following questions will bring back a truckload of happy memories.



mga isko at iska, sagot na!

To commemorate our centennial year...
University of the Philippines

1. Student number? 95-22806

2. College? College of Social Science and Philosophy, Diliman. College of Medicine, Manila.

3. Ano ang course mo? (What did you Major in?) BS Psychology. Doctor of Medicine.

4. Nag-shift ka ba o na-kick out? (Did you shift majors/Courses or were you a kicked out of your College)? No. I was the quintessential goody two-shoes all the way.

5. Saan ka kumuha ng UPCAT? (Where did you take your entrance examination?) Far-away Math Building in Diliman, on a Sunday afternoon.

6. Favorite GE subject? (General Education classes) Humanities I; but PI 100 comes a close second because of our quirky professor who brought us to Mount Banahaw.

7. Favorite PE? Social Dance - despite the fact that there were only about 3 boys in our class, our teacher used to wear her jazz panties and tights Superman style, and it meant having to cut lunch short to commute to the gym by 1pm.

8. Saan ka nag-aabang ng hot guys/girls sa UP? (Where do you hang out to check out the hot babes/dudes?) At ISSI, while working as Registration Assistants in Diliman - we used to check the registration forms and return Form 5's to fellow students after they paid their tuition. Which means this was a semestral thing. All those periods in between? Seriously long dry spells.

9. Favorite profs? (Favorite Professors?) Dr. Nilo Ocampo (PI 100), the late Dr. F.G. David (Psych 160 - Neuropsychology), and Professor Sto. Domingo (Psych 118 - Field Methods)

10. Pinaka-ayaw na GE subject (least favorite General Education class)? Science Technology and Society - a completely useless waste of time.

11. Kumuha ka ba ng Saturday classes? (Did you sign up for Saturday classes?) No. Wednesday classes, though, yes.

12. Nakapag-field trip ka ba?(Did you join any field Trips?) Twice to Mount Banahaw for PI 100 and Psych 108, and to Taal and Anilao for Humanties II.

13. Naging CS ka na ba or US sa UP? (Were you ever a College Scholar and or a University Scholar) A few semesters.

14. Ano ang Org/Frat/Soro mo? (What Organization/Fraternity/Sorority were you a member of?) UP Pre-Med Society, The Philippine Collegian (for one semester), ICTUS, Psychology Association, Phi Lambda Delta Sorority (in the College of Medicine)

15. Dorm, Boarding house, o Bahay? (Did you stay at a dorm, boarding house or did you live at home during college? ) Mostly I commuted from our house.

16. Kung walang UPCAT test at malaya kang nakapili ng kurso mo sa UP, ano yun? (If you had your way, what was your dream course/major?) Creative Writing - which was actually my second course on my college application... but I passed Psychology, and the rest is history.

17. Sino ang pinaka-una mong nakilala sa UP?(Who did you first meet at UP?) You know what... I cannot for the life of me remember. :)

18. First play na napanood mo sa UP? (First play you watched in UP) Paulit-ulit na Pagguhit ng Bilog... or at least, I think that was the title of it. Great writing.

19. Saan ka madalas mag-lunch? (Where did you usually eat lunch?) At the PMS tambayan. But my favorite lunch was the Chicken Roll from CASAA and the porkchop that used to spill off the plate from Chinatown - also in CASAA. Best fishball stand? Mass Comm. Best Isaw? The one near Kalayaan.

20. Masaya ba sa UP? (Was it fun in UP?) Most definitely! My world really opened up when I went to Diliman. And besides, that's where I learned how to drink. *evil grin*

21 . Nakasama ka na ba sa rally? (Did you ever get to go to a rally?) Once in Diliman for a tuition fee increase protest, and of course I was there in my medicine whites at EDSA Dos.

22. Ilang beses ka bumoto sa Student Council? (How many times did you vote for Student Council elections?) You know, I'm not sure. But I'm sure I did a couple of times at least.

23. Pinangarap mo rin bang mag-laude nung freshman ka? (Did you ever aspire to graduate with honors when you were a freshman?) I was a girl who had plans of going to medical school in UP, too. Enough said.

24. Kung di ka UP, anong school ka? (If you didn't go to UP, what school would you have gone?) Probably De La Salle University, as part of their first BS Human Biology (straight medicine) program. I seriously thought about it after I passed the screening, but in retrospect I'm so glad I decided not to save up on a couple of years and turned it down.

In the spirit of fun and being a fighting Maroon, I'm tagging on-line buddy Manggy, my going-south mentor Chino, batchmate, Raymond, and Megamom for this one. And any other UP grad who feels like taking a walk down memory lane is free to answer this meme and link back!
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A Port in the Storm

I recently unearthed a book by one of my favorite spiritual writers, Henri Nouwen, while I was sorting out the mess I brought home from the call room. The book, Seeds of Hope, is a collection of excerpts from his compelling body of work.

There is a prayer from that book I would like to share with all of you. It was read to us by our retreat master some years ago, and it's been a favorite of mine ever since. It is a very personal prayer of his that resonates with me right now because of where I am (or, rather, where I am not) in my spiritual journey. It's a reminder of God's constancy in the face of my own flakiness - something that I really, really need right now.

A Prayer to the God of Ebb and Flow

Dear Lord,

Today I thought of the words of Vincent Van Gogh: "It is true there is an ebb and flow but the sea remains the sea."

You are the sea. Although I experience many ups and downs in my emotions and often feel great shifts and changes in my inner life, you remain the same.

Your sameness is not the sameness of a rock, but the sameness of a faithful lover. Out of your love I came to life; by your love I am sustained; and to your love I am always called back.

There are days of sadness and days of joy; there are feelings of guilt and feelings of gratitude; there are moments of failures and moments of success; but all of them are embraced by your unwavering love.

My only real temptation is to doubt in your love, to think of myself as beyond the reach of your love, to remove myself from the healing radiance of your love. To do these things is to move into the darkness of despair.

O Lord, sea of love and goodness, let me not fear too much the storms and winds of my daily life, and let me know that there is ebb and flow, but that the sea remains the sea. Amen.

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Homesick

Over coffee and our latest boyfriends of the past six weeks (a.k.a. Harrison), my batchmate Vicvic and I shared one sordid little secret we were surprised we had in common.

We actually miss PGH.


For three years, we had resented being so firmly shackled to the wards and not being able to go where we wanted when we wanted to, like other people our age were doing. We professed hating the long, long hours we worked - with no overtime pay, mind you - and the weight of being overused and unappreciated. We were stumped by frustration at every turn - with the incredibly red-tape laden system, with the patients we couldn't save for lack of money and resources, with ourselves for not learning what we had to do well enough or fast enough. We felt trapped in a world that had become exceedingly small, mostly revolving around our lives in the hospital and the pitifully all-to-fleeting times we could spend away from it.

But now, after over a month of relative freedom and idleness (our coming exam hanging over our heads like the sword of Damocles notwithstanding), we are actually missing that cesspool of misery we used to work in.

I can't speak for Vicvic, but I know I miss it not just because I miss the people I used to work with. I actually miss... the work itself. I miss being a resident.

I miss waking up in the morning and knowing exactly what I am going to be doing with my day. I miss working in a place where I learn something new everyday, and am taught just as much by my patients and my clerks and interns as my consultants and fellow trainees.

I miss working in a job where the framework routine does not mean each day is going to be exactly the same. I miss the energy of the hospital, the adrenalin rush it gives me when I meet up with unexpected toxicity. I miss the intellectual challenge of a new case, the exhilaration of being able to confirm you got it right and being able to do something about it. I miss the sincere, uncomplicated appreciation of patients I handle and am able to send home better.

No, I haven't suddenly forgotten the frustrations, the heartaches, and the hardships of residency training and am now looking back at it with rose-colored glasses. I guess this distance from it has allowed me to realize that despite everything, I had made the right decision to go into residency training.

Regardless of where my meandering journey will take me, I definitely do not regret the three years I have spent with the department. Maybe there have been opportunities I missed along the way, but all the experiences I have had as a resident have made up for it many times over.

* * * *

One of my lawyer friends dropped by where I was studying last night to see me, and we swapped notes about our respective crossroads. She's also in a middle-of-nowhere stage in her life. After 3 years in a firm she has worked in since passing the bar, she has made the decision to resign to pursue other things. She's thinking of taking the New York Bar, maybe getting a Masters degree in the US... or even maybe starting her own business.

We laughed because that non-plan sounded a lot like the non-plan I've been throwing around in my head for the past year... and, as such, it doesn't seem to show any sign of crystallizing anytime soon.

She says she counts herself lucky to be in a career where her future can be whatever she wants it to be. She can be a lawyer in government, work in a big firm, put up her own firm, go corporate, teach... the possibilities seem to be endless. A doctor, on the other hand... options tend to be rather limited.

I don't think that's necessarily true. There are doctors who are not practicing being doctors but are doing work in policy-making, in the pharmaceutical industry, research, serving in government, even doctors who are lawyers. Limits to what each of us can do only exist in our minds, and in the end it all boils down to what captured our imagination.

One thing I've realized, though, is that in the process of becoming clinicians, those of us who choose this path actually become defined by our work more than we realize. Maybe it's because so much of our training is so intricately woven into our lives that much of the people we have become are inexorably bound to that experience.

Once upon a time, I wanted to be a travel writer... a singer... at one time, I even toyed around with the idea of being a lawyer (another long story for another time). I've envied my friends who went straight to work instead of more school and are now high up the corporate ladder and are starting their own lives.

I guess a part of me will always want those things and re-visit those what-if's every now and then. Maybe I might even pursue those other things on the side, since I love them so much. But there's one thing now I know to be true, something I probably knew before but have forgotten in all the noise.

I actually like being a doctor.
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Salt in the Wound

I promised myself I wouldn't post another entry until after my exams on Sunday, but after reading this article ("Estrada: God is punishing the country"), I just couldn't help myself.

Apparently, the ousted ex-President insists on being akin to a Bad Joke on our country that simply refuses to go away.


He not only insists he is innocent in the face of overwhelming evidence to the contrary. He now has the nerve to thumb his nose at the people whose courage and conviction took them to the streets in the revolution that threw him out of Malacanang. He is now saying that the Filipino people are getting their "just desserts" because they refused to keep him, a blatantly amoral president, in power any longer than they had to.

It is a testament to the man's maturity and wisdom - or, rather, his lack thereof - that he continues to rub salt in an already festering wound. How can this man continue to style himself as "para sa masa" (for the masses) if he can throw their suffering in their face with impunity as he sticks out his tongue at them and says, "Beh, buti nga sa inyo, kasalanan nyo yan" (serves all of you right, it's all your fault)?

At the expense of repeating myself, I can only shake my head as I say, "Only in the Philippines."
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Reunions

One of my friends from high school, a fellow MD who is presently doing her residency training in Pittsburgh, came home for a 2 week vacation this month. We figured that it was a good excuse as any for our high school barkada to get together - something we rarely get to do these days - so we met up at Red Kimono in Tiendesitas last Tuesday to catch up over kamameshi rice and unlimited sushi.

It doesn't seem that long ago when we were doing the same thing over our packed lunches, sitting Indian-style on the Covered Court without caring what stains the dirty floors would leave on our golden yellow uniforms. When all we worried about was how to get our parents to extend our curfews, how to juggle exam week and Glee Club concert rehearsals without going insane, whether or not our crushes would go to the upcoming fair. When the future stretched before us, tantalizing us with its limitless possibilities, and we were so sure that we would find our place in it.

Our world has grown much bigger since then. We have grown older, if not wiser.


Our barkada has turned out its fair share of career women. Of the original eight in our group, four are medical doctors, one is a lawyer, and one is a bank officer. The other two are both based in the US, managing their own small businesses there. Two are married. Six are very single.(Can you guess which ones are which?)

Nowadays, when we get together, we talk about our classmates who have gotten married and how many babies they've had; who are still here and who are planning to leave for good. We talk about our jobs, the joy and the frustration we have with our chosen fields; we talk about "what if's" and "what could be's" and our vague plans for the future. We realize that for independent career women in our 30's, our plans are even more vague now than they used to be back in high school, and we wonder why this is so.

Nonetheless, despite the changes time has wrought on each of us, it is comforting to know that we have remained friends. It is a gift to have friends who know you as you were, know you as you are, and know who you are becoming - and stay by you regardless of who they see.

They serve as signposts in a world that has become increasingly confusing, as the blacks and whites of our youthful convictions have bled into each other to make a startling array of grays in different shades. They remain among the beacons that constantly show me where I can find home.

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Second Guessing

My dad is in the next room, and I think he has pneumonia.

I listened to his lungs, and it sounds like a pneumonia. He was coughing like there's no tomorrow, but the anti-cough medicines I've given him seem to have calmed him down. His respiratory rate is less than 30, and he says he's not having a hard time breathing. I've already started him on oral antibiotics with good coverage for a wide range of possible bugs.

So why am I still awake at 2:30 AM trying to decide whether I should bring him to the ER or not?

You'd think that after 3 years of training in Internal Medicine, I'd be sure of what to do next. After all, I've seen already so many cases of pneumonia, seen patients falling into the full range of the disease. As part of my training, I've evaluated these patients in the ER and in the out-patient clinic and have made quick rational clinical decisions about who can be treated at home and who should be admitted.

I've just finished reading the chapter on pneumonia as part of my review, and I don't think Dad needs to be admitted. Sure, he's a diabetic and hypertensive, but those two conditions are stable anyway. I guess he'll be okay here at home. I haven't even confirmed it's really pneumonia. Maybe I didn't really hear anything.

Or maybe I'm just in denial.

I'm bringing my dad to his doctor as soon as the sun is up. His doctor can decide whether to admit him or treat him out-patient basis.

This plan of action is sure to get my parents' goat yet again. We've had this argument too many times to count. They will play the "what's-the-point-of-your-medical-degree-
if-you-can't-treat-us-anyway" card. I will come out looking like their useless child but I will drag them to a doctor's office anyway.

What most people, especially my parents, cannot understand is that once you're dealing with diagnosing and managing your close family members, all that medical training goes out the window.

Objectivity, an essential element in the clinical decision-making process, is all but impossible. It's easy enough to make treatment decisions for people who you can hold at a certain distance, thinking in terms of likelihoods and probabilities. When you're this close to the ones you are treating, this second guessing simply cannot be helped. It doesn't matter that you're supposed to know better - in that moment, you don't.

So while I think my dad doesn't need to go to the ER right now, I still won't be able to sleep - because I could be wrong.

These are the moments when I have to say it really sucks to be the only doctor in my family.
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Meme: Drop Your Entrecard

Cardiogirl tagged me with this nifty little meme going around for Entrecard users. (To Cardiogirl: many thanks for the little plug!) I'm going to take you on a trip around my personal blogosphere to the Entrecard users whose blogs I read. But before that, here are the instructions for this meme started by Sam Freedom.

Simple Entrecard Meme Instructions

1. Read these instructions twice;

2. Drop your EntreCard at this site;

3. Drop your EntreCard at the 5 EntreCard users’ sites listed below;

4. Choose 5 other EntreCard users;

5. Copy these instructions to your own Entrecard meme article and tag (link) those 5 people;

6. Include a link to the Entrecard meme article of the person who tagged you;

7. Link to the original article “Sam Freedom’s Drop Squad - the First Entrecard Meme Known to Bloggers“;

8. Notify the people you choose that they’ve been tagged;

9. Comment below so even passers-by can drop their card at your site, too (it shows you are active and will likely return the favor)

10. (optional) IF you tag your blogs, use both “entrecard” and “entrecard meme” as tags so that others can find them AND so that we can find them all later as this grows. (If you don’t know what tagging is, don’t worry.)


Here are the people I'm tagging for this meme - all of them fellow Pinoys:

Prudence and Madness - a fellow medical doctor on the journey, she blogs by the adage, "Because doctors are human, too." She also has a very informative medical blog linked to this one.

Pulse - Em Dy is a lady doctor, too, but her blog shows that it is not impossible to have a real life outside the hospital. Her food reviews are right on the money, too! :)

So Far, So Good - Ian blogs on a very wide range of topics: medicine, social issues, being Filipino, entertainment, life. Here is another doctor who hasn't let med life suck him into its black hole.

Nappy Time Adventures - Ris is a young Filipina mom who writes candidly and eloquently about the challenges of being a mom and keeping herself.

So Marjienalized - a twenty-something Filipina based in the States blogs about anything and everything that strikes her fancy.

Enjoy reading them... and don't forget to find your way back here after! :)


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Toxic!

"Toxic" is one of the most-often used terms in the secret language of Filipino doctors and nurses. It is more a part of our everyday conversation than the abbreviations, acronyms, and the host of medical jargon that roll off our tongues when we meet. It is the catch-all description of our lives.

And it has become such a huge part of our consciousness that we forget that the rest of the English-speaking world uses it in a completely different way.

In the Merriam-Webster Dictionary, the word "toxic" is defined as follows:

1 : containing or being poisonous material especially when capable of causing death or serious debilitation
2 : exhibiting symptoms of infection or toxicosis
3 : extremely harsh, malicious, or harmful"

No wonder I am met by the long blank stares of my non-medical friends when I explain why I can't do something fun with them this weekend by saying, "I'm toxic." They probably think my stint in medical school has completely obliterated my lessons in English vocabulary.

But what do your friends from the Pinoy health-worker universe really mean when they use the world "toxic"?


Putting it loosely, we use the word "toxic" to describe people, places, or things that have the ability to cause inordinate amounts of stress and exhaustion.

A first-year medical student who says he's toxic could mean he's presently swamped studying for several examinations. In contrast, an intern who says he's toxic probably means that he's in charge of many patients that are difficult to handle. A surgical or obstetric resident will probably have a completely different idea of what is toxic compared to a resident training in pediatrics or general medicine.

A toxic rotation is one that is so busy and demands so much of someone - both academically and physically - that she probably won't get to go home longer than the time it takes to bathe and change into a new uniform.

A toxic duty is one where a doctor is called on to handle one patient-related crisis after another - with some occurring with different patients at the same time for good measure - that she barely has time to breathe. This may be due to his patients' sheer quantity (i.e. too many patients for the hapless doctor on duty to handle) or quality (i.e. unstable patients under your care, diagnostic dilemmas) or a combination of both. The toxic duty also goes under the name of "Duty from Hell."

A toxic consultant is one who could be: a) an exacting mentor with impossibly high standards who asks a lot of questions during rounds or small-group discussions; b) an obsessive-compulsive attending physician who is very particular about how you manage his patients and is only too happy to chew you up and spit your bones out if you interfere with his management; c) an intimidating, stern superior whose patients you must know down to the last intake-output determination or else...; or d) all of the above.

A toxic patient is a one who is unstable, with multiple problems that need to be addressed at the same time, and requires close attention and intensive think work. The toxic patient is one who demands a great chunk of our time and effort - but is only one of many other toxic patients you are also responsible for.

A toxic magnet (yes, believe it or not, these people do exist) are people who seem to be eternally cursed by Murphy's Law - to whom anything that can go wrong will go wrong at the worst possible moment. They are the ones whose duties are always toxic duties; those who are buried in an avalanche of "quality" patients. Medical disasters are attracted to their mere presence and occur with alarming regularity to them through no fault of their own.

I've tried to do some research on this particular piece of medical slang on the Internet, and I haven't been able to find an actual definition of "toxic" in the context in which we use it. Apparently, it is only part of the vocabulary of doctors, nurses, and other health-workers in the Philippines - or maybe even just Manila - who have trained or worked in the medical system in the recent past. I don't know how long it has been since the medical community took the word and ran away with it, but I do know that it's probably been around for at least a decade because friends who made it to medical school a couple of years before I did were already using it even then. Chances are, it's been part of the hospital sub-culture a bit longer than that.

To those of us moving within this particular world, "toxic" is more a concept than it is an adjective.

It evokes memories of common experiences and elicits a complex mix of amusement and sympathy when it's the current state of someone else. We have all been in fluctuating states of toxicity since we began our medical journey. We have all had our share of toxic duties, toxic consultants, and toxic rotations. And knowing that there are other people who understand what we're going through does not make our stress-sources go away, but it does make the burdens we bear lighter.

If you're a non-medical person reading this, it's enough for me to know that the next time I say that I'm toxic, your first instinct would no longer be to think of sending me a dictionary or giving me a vocabulary lesson. But I'd like to think that after reading this, while you may not have lived our toxic lives, you have a pretty good idea of what I and my other colleagues mean. Click here to read the rest of this post.

Music: Wanted

In order to make up for the vitriol of my last post, I've decided to make up for lost time (while our DSL was on the fritz) by putting up another post before returning to the monstrous black hole called Studying that is now taking up all of my time.

One addiction I haven't been able to indulge in lately is my voracious quest for new music for my MP3 collection. I don't claim to be a fan of any one genre; a trip through my iPod will show you that the only qualification a song needs to find its way is in there is the fact that I like it.

Songs in my collection range from classic to cheezy, easy listening to pop-rock. It's a well-represented mix of songs that spans several decades, with some centuries-old classical in the mix. It's a place where Pachelbel meets Parokya ni Edgar, Madonna is next-door neighbors with the Carpenters, and Frank Sinatra gets equal playing time as Earl Klugh and Smashmouth. Broadway belters like Lea Salonga and Idina Menzel are joined by a liberal dash of Usher, Babyface, and Corinne Bailey Rae.

I label my collection eclectic. A friend of mine, with curled lip and rolling eyeballs, derisively calls it Chick Music.

I think my very confused playlist has been heavily influenced by having parents who are relatively far apart in age and who both unabashedly enjoy music as much as I do. I grew up listening to the smooth, heart-melting voices of crooners from the big band era such as Nat King Cole thanks to my Dad; my Mom weaned me on the Beatles and the music of the late 60's and 70's. More of my musical fodder was provided by my aunt's collection of piano pieces, which I grew up singing to, and my stint as a member in my school choirs.

As I grew up, my own playlist has increased in size and variety as songs which I decide to call mine are promptly taken, stored, and find a permanent home in my personal music data bank. I get them from everywhere - recommendations from friends, off movie soundtracks and TV shows, mentions on various on-line forums I frequent (whose main topic of interest is NOT even music). If I like a song by an artist, I usually try to check out the rest of his or her work. Sometimes I fall in love with a song because of its melody, but most times it's the lyrics that hold my ear captive and gain my undying loyalty. (In my music, just as I am with the rest of my stuff, I am an hopeless pack rat.)

Since I continue to consider music as one of my greatest comforts and pleasures, my collection is still growing.

These days I'm addicted to what I call "pretty music." Music lover does not equal music expert, so I am at a loss for words finding a genre under which I can put these recent favorites of mine! Lately, the soothing, piano-driven melodies of Vienna Teng, Charlotte Martin, Corrine May, and Keri Noble, the heartbreaking voice and poetry of Sarah McLachlan, and the catchy, empowered sound of new-comer Sara Bareilles have taken up the most often played spots on my iPod. I also listen to a small selection of Kate Havenevik, Imogen Heap, and Dido. I've also been sing-along-addicted to songs from the hit Broadway musical Wicked.

You can get an idea of what I've been listening to lately by visiting my Last.fm dashboard. (All music lovers should have this!)

What's on your playlist? Do share. I'm always on the look out for new music to love.



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Steal Big, Steal Little

These past few days have blurred into one another for their sameness as I continue my frantic cramming for the make or break exam coming at the end of the month. The only difference is which Starbucks branch I choose to park the heavy backpack I use to lug my two volumes of Harrison's around Manila.

This hectic schedule has, ironically, made my world even smaller than it was while I was still working at the hospital. I haven't been watching any TV, nor have I been listening to anything other than my iPod as a means to drown out the noise. Fortunately, thanks to my parents' and Starbucks' newspaper subscriptions, I have been able to keep updated about what's going on.

Not that there's been a lot of good news going around.

After all, the last thing we need at the start of a hopeful new year is to hear that a convicted plunderer is planning to run for president for 2010.

Are we going to once more prove that when it comes to matters of justice, Filipinos' memories are notoriously short?

This man trying to play the semantics game so that he can leap through a constitutional loophole right back into Malacanang is the same man who was convicted of blatantly stealing 3.2 billion pesos from public funds while sitting as president. This convicted felon served his time in relative luxury for a few years; his peers, the hundreds of other convicted thieves, who probably cannot even conceive how much 3.2 billion pesos actually is, languished in inhuman conditions in overcrowded prisons. After a few years of token punishment, this plunderer, who has never once shown even a microcosm of remorse for what he has done and whose crime should be punishable by death, is now strutting free after being pardoned by an equally larcenous incumbent desperate to save her own hide.

Now to top it off, he is now making noise about wanting to be president again after being forcibly pried from his seat a mere few years ago.

And I thought I couldn't get more incensed about the Erap pardon than I already was. This harebrained scheme, hatched by the "forgiven" man himself, truly takes the cake.

To put it bluntly: Ang kapal talaga ng mukha.

Apparently, in the Philippines, there is a difference between stealing big and stealing little. Here's the lesson: if you're going to steal, be smart enough not to get caught. But if you're sloppy and do get caught, stealing little will only land you in jail. Stealing big, on the other hand, gets you a mere slap on the wrist and a get out of jail card for free and leaves you with enough loot to get back into a position where you can steal even bigger.

Only in the Philippines.


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A Toast to the Quirkyalones

For my first blog entry of 2008, I'm skipping the usual good wishes, list of resolutions, and hopes and dreams for the coming year. I'm skipping it because I know everyone else will probably be writing similar entries in their blogs about the above topics, and because I know you all already know I want only wonderful things for all of you who are reading this.

Oddly enough, I'm starting this year with a post about... being single.


I won't deny it... I am, at thirty, unabashedly and unapologetically single. Single with no prospects in sight, surrounded by many friends who have either taken the plunge and gotten married or are currently in serious relationships. Despite being alone, life goes on for me.

If I've managed to lose some romantic optimism in exchange for some hard-earned cynicism, I have gotten by. And, yes, I have learned to be happy. Being single, after all, is not without its perks. I like having the freedom to do what I want, when I want without having to consult anyone. I like the feeling of being independent and knowing I can take care of myself.

But I won't lie that I don't lie awake at night, staring at the ceiling and battling debilitating thoughts on growing old by myself, ruthlessly flogging myself and wondering why I've been singled out to be alone - because I do. I still fall prey to all the usual questions: What's wrong with me? Am I simply being too picky (not that there are men falling in line anyway)? What have I done to deserve this?

Over the past few years, these panic sessions have become fewer and farther in between, but I still have them. This year has been a bit harder than others for me because I celebrated a turn-of-the-decade birthday and have no definite plan in life.

A turn-of-the-decade year is always a bitch because it makes you look back and realize that you've already lived a big chunk of your life - and yet have nothing concrete to show for it. You wonder where the ten years have gone and what the hell you did with them. And you realize that for better or for worse that you can never have them back. Hitting a turn-of-the-decade year and a crossroads at the same time is a concept to try the sanity of even the most well-adjusted adult. Add being single with no prospects to the mix, and you very well have a mess on your hands - or, rather, in your head.

I am not, nor have I ever pretended to be, a well-adjusted person.

Thankfully, it has helped a lot that I am rich in friends (read: IM batchmates) who are in the same boat as me - hopelessly single for the moment. We've supported one another through heartbreaks and impossible unrequited romantic illusions (all ours) and weddings (not ours). They say misery loves company, and I am definitely grateful for the company. It makes me feel a lot less alone being alone.

Another single friend once forwarded an essay by a woman named Sasha Cagen as part of her New Year's greeting. This essay first introduced to me the concept of being a quirkyalone.

Quirkyalone: noun/adj. A person who enjoys being single (but is not opposed to being in a relationship) and generally prefers to be alone rather than dating for the sake of being in a couple. With unique traits and an optimistic spirit; a sensibility that transcends relationship status.

After sharing the essay with the rest of my single circle, we were comforted by the idea that there were more of us out there than we realized. It may just have been the whole misery-loves-company principle operating again, but we all connected to the idea of being Quirkyalones.

So for this New Year, as a gift to others who may be Quirkyalones and do not realize it, I would like to share that same essay with you.

PEOPLE LIKE US: THE QUIRKYALONES

I am, perhaps, what you might call deeply single. Almost never ever in a relationship. Until recently, I wondered whether there might be something weird about me. But then lonely romantics began to grace the covers of TV Guide and Mademoiselle. From Ally McBeal to Sex in the City, a spotlight came to shine on the forever single. If these shows had touched such a nerve in our culture, I began to think, perhaps I was not so alone after all.

The morning after New Year's Eve (another kissless one, of course), a certain jumble of syllables came to me. When I told my friends about my idea, their faces lit up with instant recognition: the quirkyalone.

If Jung was right, that people are different in fundamental ways that drive them from within, then the quirkyalone is simply to be added to the pantheon of personality types assembled over the 20th century. Only now, when the idea of marrying at age 20 has become thoroughly passé, are we quirkyalones emerging in greater numbers.

We are the puzzle pieces who seldom fit with other puzzle pieces. Romantics, idealists, eccentrics, we inhabit singledom as our natural resting state. In a world where proms and marriage define the social order, we are, by force of our personalities and inner strength, rebels.

For the quirkyalone, there is no patience for dating just for the sake of not being alone. We want a miracle. Out of millions, we have to find the one who will understand.

Better to be untethered and open to possibility: living for the exhilaration of meeting someone new, of not knowing what the night will bring. We quirkyalones seek momentous meetings.

By the same token, being alone is understood as a wellspring of feeling and experience. There is a bittersweet fondness for silence. All those nights alone—they bring insight.

Sometimes, though, we wonder whether we have painted ourselves into a corner. Standards that started out high only become higher once you realize the contours of this existence. When we do find a match, we verge on obsessive—or we resist.

And so, a community of like-minded souls is essential.

Since fellow quirkyalones are not abundant (we are probably less than 5 percent of the population), I recommend reading the patron saint of solitude: German poet Rainer Maria Rilke. Even 100 years after its publication, Letters to a Young Poet still feels like it was written for us: "You should not let yourself be confused in your solitude by the fact that there is something in you that wants to break out of it," Rilke writes. "People have (with the help of conventions) oriented all their solutions toward the easy and toward the easiest side of easy, but it is clear that we must hold to that which is difficult."

Rilke is right. Being quirkyalone can be difficult. Everyone else is part of a couple! Still, there are advantages. No one can take our lives away by breaking up with us. Instead of sacrificing our social constellation for the one all-consuming individual, we seek empathy from friends. We have significant others.

And so, when my friend asks me whether being quirkyalone is a life sentence, I say, yes, at the core, one is always quirkyalone. But when one quirkyalone finds another, oooh la la. The earth quakes.

—From To-Do List, July 2000, and Utne Reader, September 2000.

I am single. But I am happily single. Learning to love my life and live it to the fullest is a work in progress - but I'm getting there. And if I ever get to have my "momentous meeting," I mean it to be icing on a very fine cake.

This is my New Year's wish to the fellow quirkyalones who inhabit my life and make my singlehood richer by being there - and my wish to you as well:

Here's to a new year of discovering ourselves, enjoying our solitude, and living with the excitement that each new day could be the day when our world will quake.

Happy new year everyone! :)
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