Thursday, February 28, 2008

At Least Five Hours Away

Today, I felt the weight of being the lone medical doctor in the vicinty with a vengeance.

The resort is on Pamalican Island, one of the smaller islands in the Cuyo Islands far north of the Palawan mainland. The small archipelago is divided into two island groups. Pamalican belongs to the Quiniluban group which is even farther north. The seat of the municipality is in Cuyo Island, which is also where the nearest hospital is. It is five hours away by boat, when the sea is not choppy. The trip may be even longer when the winds are strong, as they are during these months.

For people living in the Quiniluban group of islands, the nearest available doctor is the one in Pamalican.

Having lived in an urban environment all my life, where a hospital is just a short ride away, it is hard for my mind to embrace the fact that most Filipinos are hours away from any form of medical care. It would be simple enough if distance were the only problem they have to contend with. Unfortunately, most times, they must come from places with no real roads, sometimes on foot, or travel over the sea for hours in a fisherman's boat before they can even get to a nurse or a midwife.

I cannot even begin to imagine how barrio doctors practice in areas even more remote than mine, with no access to proper medical equiment or medication, no way of asking colleagues for advice, and no means of transporting their patients to centers where they can be better helped.

Most of my off-island patients come from Manamoc, an hour's trip away by fishing boat on a rough day, who usually have relatives or acquaintances who are working at the resort. There have been rare instances when medical emergencies have prompted the doctor to leave the island by boat to attend to a patient too sick to travel. One particularly harrowing story involved a complicated birth assisted by a midwife where the placenta had not separated from the uterus properly with the mother bleeding incessantly. The doctor on duty at the time had to go by boat to Manamoc to manually extract the placenta - which, fortunately, stopped the patient from bleeding to death.

Back to present.

They brought me a baby today, 3 months old, who has been having diarrhea for 3 days. She had sunken eyeballs and a sunken fontanelle, with a slightly sluggish capillary refill time, but at least she still had tears in her eyes when she cried. Since she was a baby with moderate signs of dehydration, the ideal place to manage her would be at least a secondary hospital.

She got me and my little clinic instead.

It was not with a little irritation that I asked the parents why they had waited 3 days before they brought her to a doctor. If they had seen a doctor as soon as the diarrhea had started they could have been advised on how to replace her losses, and she would not have been so dehydrated as to need intravenous replacement. They couldn't come earlier because the waves were too high for their boat, they said. They had to travel from another small island to Manamoc then, after a night's rest, to me. They had originally planned to take the baby to Cuyo, but there would be no boat leaving for the bigger island until tomorrow morning. I was their only alternative.

As I've said several times, I've been treating only adult patients for the past three years. And while I can tell you how to choose and adjust fluids for adults with different conditions, I am a complete blank when it comes to doing the same for children. Not to mention a baby! But none of us really had a choice in the matter, not the parents, not the hapless doctor, and certainly not the baby. However, thanks to the wonders of the telephone and my pedia friends, I managed to get a line going (with great difficulty!) and regulate it accordingly. Diarrhea with dehydration seems simple enough to treat, but when you're riding point with zip recent clinical experience, it sure as hell doesn't feel that way.

It's hard to believe that she's actually better off than a lot of other children somewhere else in the country at this moment in time.

So tonight the baby and her family are staying on our island, rooming with their utility worker relative, instead of staying in a hospital ward for observation. She is being monitored by her parents, who have strict instructions to make sure that the fluids I started are running properly. I will be checking on her in a few hours just to make sure I'm not replacing the fluids too fast. And I am hoping that one of the following will be true by tomorrow: a) that she no longer has diarrhea and is properly hydrated or b) the winds and the sea will allow them to travel to Cuyo tomorrow so the baby can get the medical attention she needs.

Wish us all luck.

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Tuesday, February 26, 2008

Island Postcards

I just wanted to share a few of the pictures I've taken on the island. These were just taken by an ordinary Sony Cybershot 5 megapixel digital camera - I have yet to dabble in the world of SLR. Still, despite my lack of special photography equipment, the natural beauty of this place shines through.

I took this shot at the Beach Club on the west side of the island. A friend of mine has commented about how it's a bit on the over-exposed side because you can't see the details on the sand, but I think that has a lot to do with the time of day I took it - high noon. The intense light of the noonday sun shining on the blinding white sand just makes the blues and greens of the sea and sky even more vivid.

Amanpulo's reputation as a romantic get-away is well-deserved. Aside from being extremely exclusive and being designed to maximize the privacy of its guests, the island is scattered with secluded spots ideal for private picnics and lovers' trysts. A couple of these spots can be found on the highest point north of the island, easily accessible by Club Car. Guests can make arrangements for a sunset dinner to be brought up here, and in the dark, the way is lit with torches. During the day, the way up looks like this.

There are only 40 casitas on the whole island, though the resort is in the process of building more on the southeast. 30 casitas are located along the west side of the island, each one with its own private beach. The casitas are built a good distance from the road and from each other, and because of this the beaches are never crowded. Most of the beach shots here are from the west side of the island, at different times of the day - but the beach is almost always deserted.

This is the picture of a casita from the side of the road. You have to walk a few meters to get to the doorway of each casita, and most are actually not visible from the road.

The casitas are also not visible from the beach since they have been built within the foliage. The beachfront of each casita has two very comfortable lounges from which guests can laze the day away.

Since the island is completely surrounded by a gently sloping white sand beach, it doesn't seem too hard to find your own secret, undiscovered patch of beach. But you would be surprised to find that the resort staff has already been there ahead of you, and prepared an extra something for you to enjoy your afternoon in.

Sunsets are best watched at the Beach Club on the west side of the island, lying back on one of the numerous lounges lying on the shore. Guests can also make arrangements for a sunset cruise. Regardless of where you view it from, though, dusk on the island is always breathtaking.

It's not hard to imagine why this beautiful island has been included in the list of 1,000 Places to See Before You Die. Addicts of champagne sugar sand and jewel-blue waters won't get enough of this little piece of paradise.

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A Soundtrack for a Walk on the Beach

My vision of an ideal afternoon is being able to indulge in two of my absolute favorite things - music and the beach. Any music junkie worth her salt has a playlist for every occasion, and an afternoon stroll on the beach is no exception.

Of course the music anyone wants to walk to on the beach is always a matter of taste. But I've always found that the lazy rhythms of reggae and ska and the soothing vocals of bossa nova are the perfect complement to the whisper of an afternoon sea breeze, the gentle lap of waves on the shore, and the stunning beauty of a summer sunset. I also include songs that are not bossa or reggae that are happy and carefree and give voice to my exhilaration at being somewhere I've always loved. It's great accompaniment to the watching the world go by.

What follows is the sample track list from my happy, hodge-podge seaside mix-tape.

Every Breath You Take - UB40
Baby I Love Your Way - Big Mountain
Summer Samba - Bebel Gilberto
Glorious - Natalie Imbruglia
Waters of March - Sergio Mendes
Wouldn't It Be Nice - Beach Boys
Everyday is a Holiday - Esthero
I Can See Clearly Now - Jimmy Cliff
It's Not Easy - Marcos Valle
Hey Look at the Sun - Sitti Navarro
Do I Need a Reason - D' Sound
Any Lucky Penny - Nikki Hassman
Copernicus - Basia
Ooh Child - Marvin Gaye
More Today than Yesterday - Spiral Staircase
Can't Take my Eyes Off You - Fugees
Say a Little Prayer - Diana King
Here Comes the Sun - The Beatles
Bliss - Alice Peacock
No Woman, No Cry - Bob Marley
Underneath It All - No Doubt
Getting Better - Smashmouth
Carribean Blue - Big Mountain
Violet Sky - Keri Noble
Angel - Shaggy
Breathe - Michelle Branch
Don't Worry, Be Happy - Bobby McFerrin
Like a Lover - Sergio Mendes
Before the Summer is Gone - The Company
Do You Believe in Magic - The Turtles
Just No Ordinary Day - Sofia
Beach Samba - Astrud Gilberto
Lemonade Afternoon - The Company
How Sweet It Is - Marvin Gaye
Waiting in Vain - Bob Marley

Yesterday afternoon, I finally got to walk around the island as planned - though I had to do it in two parts. I took the east side of the island early in the morning, then the west side of the island in the afternoon after work with a long, leisurely pause to watch the sun set on another day. To someone who grew up on the fever pitch and the unsettling stress of the rush hour commute, this is a form of heaven.

In my perfect world, I would live a stone's-throw away from a beautiful beach, be able to quit work in time for sunset, and be able to trade my white coat for the hat of a beach bum every single day.

Beach junkies will all agree.
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Sunday, February 24, 2008

Journeys from A to B

For the past few days, I've been promising to wake up really early so I could watch the sunrise and walk along the white sand beach encircling the island before I going to work. But, despite being generally an early riser, I've been finding it so difficult to drag myself out of bed.

This lazy morning start is such a stark contrast to the frenetic pace at which I used to prepare for another day at the hospital. It was always a race against time to get into the train before 7AM and start traveling before the rush hour crowd hit. In the hospital, so much has already happened by 9AM - over here, at 9AM, my day is just beginning.

I love it.

I've always suspected that I am really a Type B person hiding behind a Type A facade. This easy slide into indolence might be proof that this is true. Maybe it's just my way of recovering from almost seven straight years of Type A living. Then again, it could just be the influence of living on an island.

I find myself spending time in between consults planning where I am going to catch the sunset this afternoon. I spend my lunch break walking barefoot on the deserted beach under the noonday sun, fed by the sight of the cool turquoise-blue ocean and blindingly white sand as far as the eye can see. And I love ending my day by choosing a spot on the beach where I sit and watch the shifting colors of the sky at dusk. Nights are particularly beautiful out here, where the only "bright lights" are the moon and the light of thousands of stars you can only imagine seeing in Manila.

It's so refreshing to go through a day without any definite plan. To watch the world and the day go by, just waiting for something to happen. To be at ease in a state of "maybe I will... maybe I won't... maybe tomorrow."

I know part of the reason why I manage to stay reasonably sane in such a remote place is having a ready connection to the outside world and the comforts of city-living. I would probably be singing a different tune if I didn't have the internet or electricity for an extended period of time. I have no illusions about being cut out for a rural existence in the Filipino context. No amount of natural beauty would entice me to settle permanently somewhere with no modern plumbing. But I can imagine being happy living somewhere that is not quite as urban as Manila, but not quite as untouched and remote as this place before it was developed. And I am definitely developing a taste for this kind of back-to-nature get-away as a place to kick back and relax and find my center again.

I will come back to Real Life soon enough. But for now, I'm closing shop and am going to look for a place where I can collect another sunset. Maybe it will be a good night for stars. And maybe I will finally get to walk around the island tomorrow morning. If not... well. There's always the next day.

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Saturday, February 23, 2008

Anything and Everything

Being a resort doctor is a lot harder than it sounds for someone who has already been in specialty training for the past 3 years.

It's been often said that when you become a specialist, you give up knowing a little bit about everything for the chance to know everything about a little thing. After being used to thinking a certain way, diagnosing and managing a certain subset of patients with certain problems, it is disconcerting to be confronted by patients and problems that no longer fit into that smaller, more specialized box of clinical skills you tote along with you.

I've been working as an internist with adult patients for the past 3 years. As a specialist-in-training in an institution with an excellent referral system, I no longer needed to dabble in the other aspects of medical care that didn't fall under the aegis of Internal Medicine. After all, that's what the other specialties were there for.

I haven't had pediatric patients since I was an intern. The last time I sutured a wound was well over three years ago.

But being the only doctor on the island demands that I must once more be that doctor who knows a little bit about everything. The one who can give initial management to a patient having a heart attack as well as the one who falls off his sailboat and dislocates his shoulder. The one who can recognize the signs of appendicitis in a four year old and make the decision to fly him off the island. The one who can stitch up a laceration and immunize the patient against tetanus during the same visit.

It's hard to be confident doing something that you haven't been doing for the past 3 years. The adult patients with medical problems don't faze me - I've seen the worst that can be seen in my years in the hospital. But I'm a lot slower and more tentative when I am confronted with kids and their frazzled parents. I am even more stressed out at the thought of having to sew anyone up for whatever reason. And heaven forbid that anyone suffers from a major extremity trauma or has a complicated birth on my watch.

Sure, I've been reading up on all these things, and, sure, I already went through all those specialty rotations as a medical student. Sure, I had to know all this stuff to pass my boards. But those days when I handled all those other cases seem so very far away, and I would be a fool not to be a bit anxious about meeting them again.

I'm learning, though, that practicing medicine is just like riding a bike - it may be slow-going at first, but you don't really forget how to do it. Of course it helps tremendously to have a lot of friends in different medical specialities whom I can call for advice and to discuss my diagnoses and treatment plans with. It is also vindicating when they confirm I am right.

I'm optimist enough to hope that I will get the hang of being an island doctor as the days go by. But while I am enjoying my work here despite the difficulties, I also know that this is not what I would like to do for the rest of my life. Maybe it's because I've gotten used to working in a hospital or maybe I've become too solidly entrenched in internal medicine to change my perspective. Whatever the reason, I know I will enjoy going back to the clinical work I've been trained to do for the last 3 years when my stint here is done.

It takes a certain degree of courage to make this your life's work. So I raise my hat to the noble doctors who choose to be the only doctor in the middle of nowhere. The world is a better place because you choose to know a little bit about everything in order to make a huge difference in the lives of people who need it most.
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Thursday, February 21, 2008

Beach Club Car Adventures

While my friends would be the first to tell you what a lousy driver they think I am, I thought that my 3-year city driving experience was qualification enough to drive my club car. How hard could it be? No stick shift to be operated, just a forward-neutral-backward switch. Two pedals - one to go, one to stop. It would just be like driving a bump car. Easy as pie.

I should have known that kind of arrogance was a challenge to fate to prove me wrong.

Not everyone on the staff is assigned a Club Car, but everyone here knows how to drive one. The nature of my job as resort physician requires to me to get to any point on the island at the drop of a hat, so I've been assigned one all to myself. Until yesterday, I had been riding shotgun with the regular resort doctor since I arrived. Since I assumed driving the buggy was not a problem, I never once asked if I could try driving it under supervision.

Handling the Club Car on the island is quite different from city driving. For one thing, I need to kill the motor when I switch gears from forward to reverse. For another, I didn't realize how much I've come to rely on rear-view mirrors when I am backing up - and these buggies don't have one. Getting out of a parking spot has always been a challenge, and doing so in a Club Car has certainly upped the level of difficulty for me. In fact, I almost tipped my club car over yesterday when I shot out of my makeshift parking slot in reverse and went straight up the embankment across the road. (Of course it was still my own stupid fault for panicking, when I should have lifted my foot off the pedal as soon as I felt it going backwards.)

But biggest challenge of all when it comes to getting around the island is the complete absence of any obvious landmarks from the road. Since the villas, casitas and other infrastructure were all designed to blend in with the natural landscape and built far from the roads to ensure the privacy of the guests, the view from my Club Car is the same. And you can only imagine how much worse it gets at night. (No, there are no street lights.)

If this place were any bigger, I could end up driving lost around the island for hours. Thankfully, though, I've been lucky enough to drive by members of the staff who point me which way to go. And if all else fails, cellphone signal is great even here in the middle of nowhere. I have the option to call the clubhouse for one of the staff to escort me home - which I hope I never have to do!

It's early days yet, and I am, to my relief, becoming a bit more familiar with the roads in daylight. I can already get to and from the clinic to my bunkhouse even in the dark - an essential skill since I get called at night to see patients and have to pick up meds for them in the clinic and deliver them. But being somewhat direction impaired, I still tend to take roundabout routes to get from point A to point B even in daylight (to which my evil friends would say, "What else is new?")

It can only get better from here. After all, I'm going to be here for a while.

I just hope I never have to call for a rescue - I'd never live it down!

I think I promised you guys a picture of the beach on the side of the casitas - so even if it's not really related to my post, I've put it up anyway. You can visit the Amanpulo site if you want to see better pictures. I can attest that they're not advertising hype - what you see is really what you will get. If only I could ever earn enough to come back here as a guest some day!

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Wednesday, February 20, 2008

Hello from Paradise

Barely one day after I came home from rainy Bicol, I had to pack up and fly off to my next job - to a jewel set in the middle of the Sulu Sea called Amanpulo.

I've been here for two days now, and today is the first day the sun has actually come out! Since I am a part of the staff rather than a guest in this playground of the rich, I haven't really had a taste of the great (and very expensive) activities the resort has to offer. However being able to see what is, hands down, one of the most beautiful beaches I have ever seen in my life has made the trip worth it.

This is a picture of the beach on the eastern side of the island, near the clinic where I work. All the hotel casitas are located on the west side of the island, which is sheltered from the northeasterly wind we've been having for the past few days and is a safer swimming beach. The beach is pristine and deserted, the jewel-like tones of the turquoise waters and the cerulean sky made all the more striking by the blinding white powder-fine sand.

You can see how the sand is even whiter than my unexposed, un-tanned feet!

I'm working here as reliever for the next two weeks while the regular resort doctor attends a conference in Manila. The job offer just dropped into my lap because the doctors he usually asks to take over for him are attending the same conference he is. Knowing that chances are slim that I would ever get to see this amazing island out of pocket, I grabbed the opportunity in a heartbeat.

Now here I am, the only doctor on an island literally in the middle of nowhere, an hour and a half away from Manila by plane. The thought is terrifying, yet exhilarating in its own way. It certainly is a world away from the kind of work I would be doing in the hospital now, had I chosen to continue on to fellowship the way my other batchmates have.

My friends wonder how a person as decidedly urban as I am will cope in a place where there are no shopping malls, no gimmick places, and lights are turned off by nine o'clock. But being surrounded by all this natural beauty is a pretty good trade off for the bright lights of the city - and I think I'm going to do just fine.

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Tuesday, February 19, 2008

The Rain on Our Bicol Parade, Part 2

the rain magnet travel companions (minus one) at Bagasbas Beach

We woke up the next morning to silence, but the gloomy gray sky overhead didn't give us much to hope about. The night before, we had already heard from the locals that even the town fishermen had been warned against going out to fish in the rough Pacific waters. The chances of the low-pressure area suddenly disappearing and the sun coming out were slim to none,and we weren't quite sure what we would do with the rest of our day.

After a heavy breakfast (the food was the one thing consistently great about this particular trip), we went to Bagasbas Beach, just a five-minute drive from the heart of Daet. Bagasbas Beach is slowly gaining fame as a surfing beach, with its gently sloping shore and sandy bottom a good place for beginners to learn how to surf. But while the gentle sloping of the shore allows for swimming, bathers are warned to be vigilant because of the surprisingly strong undertow.

We had optimistically brought our bathing suits in the hopes that a morning frolic at this beach was still an option, but the sight of the frothy surf and whitecaps as far as the eye could see quickly dissuaded us. Given the turbulent waters, it would be easy to get pulled far from the shore towards the open sea regardless of how strong a swimmer you were. As a testimony to the dangerous state of the water, despite the abundance of waves, there was not a single surfer in sight, local or otherwise.

Despite this, the sight and sound of the powerful waves marching inexorably toward the shore was a compelling one. The indescribable clean tang of the sea mingled with the smell of the rain, and the strong winds whipped through our hair as we played tag with the waves. The dark-brown sand was surprisingly powder-fine beneath our bare feet, and we might have stayed there a little longer if it hadn't started to rain. Really hard.

It seemed as if the weather was determined to drench us wherever we went. The dark grey clouds raced with us as we drove from one destination to another. The torrential showers were so perfectly timed to coincide with each of our stops that we just had to laugh at how unlucky we were. Our stepping out of the car seemed to be a cue for an episodic downpour that would force us to move to another site. The rain would then stop once we were inside the car, already well on our way to another destination.

Our local guides brought us to a resort in the town of Basud fancifully tagged as "Little Tagaytay" by its owners. To get there, one must travel via dirt road cutting through several barangays and bordered by the coast on one side and farmland on another. The climb to the resort is quite steep but short, and the view of the gulf from the "ridge" is amazing. From across the deceptively calm dark blue Philippine Sea, islands with dreams of white-sand beaches beckoned and made us promise to go back and see them someday.

Our next stop was supposed to be the banks of the San Lorenzo River in the town of San Lorenzo, but we found the makeshift ford across one of its tributaries too deep for our car to cross. So we decided to stay where we were, dip our feet into the cool flowing mountain waters, and take lots of pictures under the rain.

A narrow steel hanging bridge connecting one bank to another was found a short walk upstream. The metal bridge was a vital connection between a settlement on the far side of a wide stream that would swell up during the rainy season and the main road to town. It is sturdy enough for motorcycles to drive over (we saw one do so while we were there), but walking on the wobbly bridge several feet above the rocks still made me quite nervous.

The bridge is barely wide enough to accommodate two people walking abreast of each other, and one would have to face sideways to let someone in more of a hurry than you pass. While we were taking these pictures, we had to stand aside more than once to let local folk transporting sacks full of small, sweet Queen Formosa pineapples from farms on the farther side of the bridge to a waiting truck on its way to the maket pass.

We left Daet early Sunday morning to avoid the northbound traffic, still persistently trailed by wind and showers. Making good time, we drove along the Quezon province coastline and cut through the majestic Quezon National Forest Park via Eme Road, a segment of the Maharlika Highway connecting the towns of Atimonan and Pagbilao. The zig-zag road and hairpin turns rival Baguio's Kennon Road, and park aides guide motorists in almost all the road curves using flags during the day and battery-operated flashlights at night. Vehicles going up are given the right of way at all times because of the road's steep climbs and sharp curves.

Despite the rain (which started, predictably, to pour once we alighted from our vehicle), we stopped at one point to appreciate the view of the rainforest shrouded in the mist, the air thick with humidity and filled with sounds of forest life.

All in all, while our Bicol trip did not turn out as expected - whether as a result of bad timing or maybe bad luck, we still got the much-deserved break from urban life that we wanted. It was a testimony how persistence and great company can turn a weather-cursed trip into an excellent experience.

We're already planning a return trip for this coming April. Want to come?

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Monday, February 18, 2008

The Rain on Our Bicol Parade, Part One

Just as we planned, a few of my quirkyalone friends and I took a road trip south to see Bicolandia for the first time. But our visions of soaking in some much deserved sun, sea, and sky didn't quite come true as expected as we found ourselves being chased by unseasonable rain instead.

Despite the uncooperative weather, no killjoy storm clouds were going to keep us from having our fun.

We left Manila last Thursday afternoon, a few hours before the Valentine's Day gridlock made driving anywhere impossible. Leaving early, we were able to escape the usual crawl on the South Luzon Expressway. After loading ourselves with several days' supply of chips, we were happily zooming down Maharlika Highway, blithely ignoring the implications of the ominously dark clouds outside. However, four hours into the eight hour drive to Camarines Norte, the temper tantrum the weather was throwing could no longer be ignored as rain began to pour in earnest. The rain and the howling wind dogged us all the way to Daet, which was to be our base for this trip.

Of course, the inclement conditions welcoming us should have given us an idea of what would become of all our grand plans for the weekend. After all, a half hour boat trip on a tiny outrigger to a virgin white beach island in the middle of the Pacific is not exactly advisable when contender conditions for The Perfect Storm award is holding reign. However, in particularly quirkyalone fashion, hope sprang ever eternal.

You can read a blog about what you can do on a trip to Camarines Norte (and what would have been our original itinerary) over here. I lead you this direction because the events that follow chronicle what happens to your travel plans when God decides to laugh at them and teach you all about milking whatever you can out of what's left.

We woke up to the sound of rain falling on the tin roof and brisk wind rustling through mango trees. After a hearty breakfast care of our generous hostess, we drove another two hours south to Camarines Sur to try our hand at cable wakeboarding at the Camsur Watersports Complex.

A cold, brisk wind blew across the man-made lake, creating big ripples over the water and whipping our hair into a frenzy. It was apt accompaniment to the overcast sky overhead. Despite it being a weekday, we were accompanied by a group of high school girls on excursion, who made us wish we were still that young and reckless. They were blithely sliding off the pier one after the other, heedless of the high wipe-out rate, rapidly moving from knee boarding to boarding upright in the space of an hour.

Being reasonably good swimmers and in the mood to try anything at least once, my friend Haydee and I decided to have a go. After paying the hourly rate plus the cost of renting a board, vest, and helmet - a surprisingly low total of PhP 165 - we excitedly joined the teeny boppers and fell in line for a very short lesson.

This is me, waiting to be pulled off the dock, moments before my first wipe-out just meters away. Despite being told to keep my head down, I reared up and summarily got thrown off my board into the very cold water. (I would have put pictures of my wipe outs, but Vic-vic has yet to give me copies of them).

The lake is around seven to eight feet deep in the middle, pretty easy to handle for an experienced swimmer. You're supposed to push or carry your board back to dock if you get thrown off - so knowing how to swim is a requirement despite the universal use of life vests. Since Haydee and I went one after the other and wiped-out almost simultaneously, I mistakenly latched on to her board (because it had blown closest to me) and she ended up cramping up and being rescued by a lifeguard.

While Haydee and I were normally confident in the water, we hadn't counted on the deconditioning brought about by our idle residency lifestyles, and the swim plus the strong wind factored in was more difficult than expected. After my second crash, I could feel my own a cramp coming on, and I decided not to go for another try. But we are most definitely going to go back to conquer that course (on a beginner board!) some day soon.

After our wakeboarding stint at Camsur, we set off on another two hour drive towards Albay to see one of the most famous sights in the Philippines - the perfect cone of the Mayon Volcano. Unfortunately, the weather conditions continued to taunt us. Despite having a great vantage point from the highway during the drive, all but the foot of Mayon was shrouded in towering monster clouds.

We made a pit-stop at the Cagsawa Church Ruins, located in the town of Daraga, Albay, nestled at the foot of Mayon. Cagsawa is another favorite postcard feature and can be accessed from the highway via a makeshift rough road cleared of debris and boulders. The coarse black soil and towering boulders spewed by the furious volcano are a stark contrast to the powder-fine gray sand-like material I had grown used to seeing in the aftermath of Pinatubo. Old houses destroyed by the last eruption and half-buried in the debris stand as a sad testimony to the helplessness of man against the forces of nature.

All that is left of the old church is the stone belfry, and it is the focal point of a pretty little park, an oasis of green growing among the ruins. The volcano with its deceptively gentle slopes serves as the belfry's scenic backdrop. After taking our requisite tourist pictures with the belfry, expertly assisted by the enterprising young budding photographers of Daraga - children with ages ranging from eight to sixteen - we continued our southward drive to Legaspi City, where we had our lunch.

A full view of Mayon remained elusive the whole time we were driving, but we took a picture with the best view we could get (with 75% of the volcano showing). This picture was taken outside the Daraga Church, which stands on a hilltop overlooking the town. Can you see the little bit of Mayon showing in the background?

We spent the four hour drive back home to Daet traversing slick roads thanks to the afternoon rain that began to pour once more in torrents. It was becoming obvious that our planned trip to the white-sand virgin beaches of the Calaguas group of islands was not going to materialize. We fell asleep to the roar of the rain singing a depressing duet with the wind howling outside.

(You can read about what happens next over here.)

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Sunday, February 17, 2008


Every year, three years of exhausting duties, sleepless nights, and hundreds of textbook pages read culminate in one make-or-break examination for each batch of internal medicine graduates in the Philippines. A pass mark would mean recognition as a member of the Philippine College of Physicians, the umbrella organization of all practicing internists in the country.

And... I passed!

I am now a certified internist, at least in the Philippines.

Apparently, all the Starbucks coffee I took by the gallon for six weeks really paid off.

Anyone who has studied for a major certifying exam knows how overwhelming the information you have to review in such a short time is. You just try to cover what you can and hope what you are able to review is what comes out. You also just hope against hope that whatever you weren't able to review you already have as stock knowledge. No matter how hard you study, you are never going to be prepared.

I took my internal medicine board certifying examinations last January 27, 2008. Last Thursday, I finally got the results - a pretty great V-day gift in lieu of roses. Just like my medical board exams, I don't really know how I managed to pass. I am just really, really glad that I did.

Congratulations to everyone who made it! (I'm entry number 81. :))


(Post script: I planned on writing about our crazy, rainy quirkyalone weekend in Bicolandia tonight; but having just arrived from the eight hour drive and given the pressing need to pack for another out of town gig I fly out to tomorrow morning, I simply didn't have the time. But I will write about it very soon!)

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Thursday, February 14, 2008

International Quirkyalone Day!

Uncompromising romantic singletons of the world celebrate! February 14 isn't just for the coupled-up anymore. Today - aside from being Valentine's Day - is also International Quirkyalone Day.

Being quirkyalone is not so much about one's actual relationship status but rather a state of mind. Even coupled-up people can be Quirkyalones, too. But regardless of whether a quirkyalone is single or in a relationship, being a quirkyalone is all about valuing oneself and celebrating all the kinds of love there is. It's also a movement that has caught fire as more and more people read the original essay and see themselves in it.

Quirkyalones may be single and perhaps dateless, but neither of those things can take away from what a great life they're living. They're holding out for the Real Thing, but they're not brooding or obsessing about if or when the Real Thing will come along. They're living fully in the moment and not In The Meantime. They appreciate themselves and by doing so are able to appreciate others all the more. (This part of being a quirkyalone is something I am still working on.)

Are you a quirkyalone single? You can read the original essay by Sasha Cagen and my thoughts about being a single Quirkyalone in my New Year post. Better yet, you can take this quiz to see how high you score in quirkyalone-ness.

If you answered a resounding yes to the above, here are a few suggestions on how you can celebrate International Quirkyalone Day:

Indulge yourself. One of the best things about being single is not having to justify ourselves to any one person. All of us have a guilty pleasure that we try not to get too much of. For some people it's shopping. For others, it may be lazing around in bed all day. For some, it may be as simple as polishing off a box of chocolates! Whatever it is, give yourself the green light to gorge on whatever it is that makes you feel great - and not feel guilty about it afterwards.

Pamper yourself. Date or no date, book an appointment at a salon and get treat yourself to the works. Soak in a decadent bubble bath with a glass of champagne. Drop by a spa and get a full-body massage or body scrub. You deserve to look and feel fabulous - for you and not for anybody else!

Escape. Turn your back on the city and give yourself some recharge time. Meet up with your other quirkyalone friends and spend a few days at the beach. Enjoy the solitude and silence of the mountains. It's your get-away - grab it tight with both hands and run away with it! Anywhere you want to go, anything you want to do... freedom is one of the best perks of being single.

A few of my quirkyfriends and I are going to go for option number three later today. We're driving away from the chaos of Valentine's Day traffic in the city and going to the beach for the next few days to indulge in some sun, sea, and sky - and a healing dose of quirkytogether friendship. Because while we quirkyalones value our solitude, we also consider friendship to be just as important.

Whatever you choose to do today to celebrate, I hope you have a wonderful time. After all, International Quirkyalone day encourages quirkyalones to create a great day for themselves, whatever it means to them, without necessarily having to conform to what society expects the celebration to look like.

Happy Quirkyalone Day!

This photo of Bagasbas Beach, Camarines Norte (our destination) was taken by lanclav.

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Wednesday, February 13, 2008

Dateless in Manila

This photo taken by endless beauty

Valentine's Day is a day that evokes a lot of strong and conflicting emotions in people, often an off-shoot of their romantic circumstances on February 14.

I'm not going to lie to you. I have, for most of my life, fallen under the "Kill Valentine's Day" category.

For those like me who are unequivocally unattached, without even an "it's complicated" to add to our Facebook profiles, this celebration of hearts, chocolates, flowers, and happy pairs playing kissy face was the same as having our faces rubbed in our aloneness. Valentine's Day is a nightmare for a young girl going through adolescence and young adulthood feeling as wanted as a cast-off rag, completely surrounded by friends who are all sought-after belles of the ball. All this love stuff was happening to everyone else but me, and V-day was a bitter reminder of my status as a social failure.

Many tears, self-recriminations, and much growing up later, after several years of indulging in an annual V-day rage-and-rant funk, I am able to face Valentine's Day with a certain degree of Zen.

No, my circumstances haven't changed. It's one day to Valentine's Day, and I am still dateless in Manila. Again. For the nth time in my thirty years of existence. But while I have yet to get to a point where I can shrug off being single on V-day without a lingering twinge, I'm learning to make peace with it in my own way. With a healthy dose of humor and an even heftier dose of denial.

But, really, there are up-sides to being single and dateless on Valentine's Day. Among them:

1. Since I don't have to spend on a V-Day gift for anyone, I can buy that pair of shoes I've been drooling over for a while.

2. I am not obliged to drive through the crazy, hideous Valentine's Day evening traffic.

3. I can buy myself that sinful box of Belgian chocolates at Valentine promo price and not have to share it with anyone unless I want to

I've come to realize that being resentful of this over-commercialized day devoted to coupledom and romance is a waste of time and energy. Besides that, I'm astonished to find that I've finally begun believing that my single state is not a reflection of my worth as a person - not just as a fact in my head, but in my heart where it really counts.

My being single simply is. Once I fully embrace that reality, I can finally stop taking each Valentine's Day celebration as a personal insult and view it as it is - just another February day. I haven't reached that point just yet, but I am getting there.

So, even if I am dateless in Manila, life goes on. Another V-day will come and go. And while the cynic in me doesn't see how things can possibly ever be any different, the closet romantic continues to hold on to that tiny hope that maybe... just maybe next year it will.

After all, life is all about possibilities.

* * * *

A little something I wanted to share to my fellow singletons:
After a while you learn the subtle difference
Between holding a hand and chaining a soul.

And you learn that love doesn't mean leaning,

And company doesn't mean security.

And you begin to learn that kisses aren't contracts,

And presents aren't promises,

And you begin to accept your defeats
With your eyes open and your head held high.
With the grace of a woman,

Not the grief of a child,

And you learn to build all your roads on today,

Because tomorrow's ground is too uncertain for plans.

So plant your own garden,
And decorate your own soul,

And stop waiting for someone to bring you flowers.

And you learn that you really can endure--

That you really are strong, and you really do have worth.

Author Unknown
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Saturday, February 09, 2008


That's the number of times I have graduated in my lifetime.

Considering that I'm batting at twice the average rate, it's logical to assume I would view this occasion with a lot less sentimentality.

You would be wrong.

Graduations always evoke mixed feelings - a sense of accomplishment that you've completed another chapter, a sense of sadness that you will once more be leaving something behind that has become a big part of your life. There's a complicated cocktail of excitement and apprehension at the thought of an unknown future ahead. There are the inevitable goodbyes as you and the friends you've made reach another fork in the road.

Gratitude is one staple sentiment in every graduation. Occasions like these bring to mind the people who have helped you get to where you are today. It makes you realize that while you may have been the one to offer the proverbial "blood, sweat, and tears" that is the prerequisite to conquering any challenge, you still would not have made it this far without the support and understanding of the people you love.

In the Philippines, it is often said that becoming a doctor is a family project. A wanna-be-doctor goes to medical school at an age when he should already be helping pay the bills around the house. If he wants to train further (in the country), he will be going into a residency program that will pay him a sum that will barely cover his living expenses.

Life goes on for these doctors-in-training - and some will get married and have children at this point in their lives. Despite the growing financial demands of adult life, there really isn't much they can do to catch up.

So it's the families - the mothers, fathers, sisters, brothers, (non-medical) wives and husbands - who willingly and lovingly take up the slack. They make up not just for our financial shortcomings but also for the emotional void we leave behind while we are working our asses off in the hospital, spending more time with our patients and our colleagues than those we love the most.

So tomorrow, graduation number six (number seven for the medical fellows!), we're going to take the time to say thank you to the people who have helped us, believed in us, and pushed us this far. We do not say it often enough - but thankfully, their kind of love understands without words.

(The following video is the reason why I haven't been able to blog regularly. :))

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Wednesday, February 06, 2008

Trike Ride in the City

This photo (Tricycle) was taken and uploaded by Mon Solo

This afternoon, I rode on the back of a tricycle for the first time in my life and saw my life flash before my eyes.

Those who have "commuted" in the Philippines know that it is quite an adventure. Anyone who wants to get from Point A to Point B anywhere in the country can choose from a dizzying array of public transport vehicles - from the conventional buses, taxi cabs, and trains to the distinctly Filipino flavored jeepneys and tricycles and horse-drawn kalesas that add to the chaotic and exasperating Manila traffic.

I've posted a picture of a tricycle in order to give the uninitiated an idea of what I'm talking about. (And, no, none of the above people is me. The busy street in front of the Libertad station is not the place for a photo-op.) This surprisingly useful little vehicle is a marriage between a motorcycle and a makeshift passenger cab attached to it. A standard sized tricycle is meant to carry three to four people - the driver and two to three passengers in the cab. But in some instances, the capacity can be stretched to six or seven - or more! - depending on the size and willingness of one's passengers.

The tricycle (aka "trike") is the favored public utility vehicle in many of the smaller cities and rural areas around the Philippines. Because of its small size, it can access roads that conventional rides cannot. In the rural areas, it is the bane of long-distance car drivers. As a primary mode of transportation, these perky little trikes are allowed to run with the big boys even on our national highways. In the heart of the city, the tricycles' use is often limited to carrying passengers in Manila's crowded side-streets.

Don't get me wrong, I've been a veteran Manila commuter since I was in college. I've been riding tricycles since I was a kid. I've even ridden tricycles on a highway during my many visits to different provinces. However, my experience with tricycles has always been limited to being inside the cab - and relatively empty roads.

Sitting behind the driver as you ride through a street where you can see vehicles that are a lot bigger and sturdier are darting around yours gives the tricycle ride a good dash of... flair. That vantage point, with no protective cab to serve as blinders, definitely forces a semi-newbie to view the trip from a very different perspective.

And in this case, ignorance is definitely bliss.

Why did I subject myself to this? I would like to say it was my highly-developed sense of adventure. But to be honest, it was really the punishing heat of the noon-time sun and the thick smell of exhaust fumes that made the decision easier. A trike ride was hardly a new experience for me, after all.

Or so I thought.

It was one of those trike hires that waited to be filled to capacity and charged the same fare for all passengers. There were already three people inside the cab and one passenger sitting behind the driver and riding sidesaddle, so to speak. The last vacant seat - see where the pair of legs behind the driver are dangling from in the photo above? - was mine.

Being a fool in a hurry, I climbed on anyway, all the while trying to push visions of the trauma patients from tricycle crashes that I've seen brought to our ER during my short medical career.

We are off after the driver gives us gruff instructions to hold on - not an easy feat for a passenger also trying to hold on to a long manila envelope full of important papers and keeping her unzippable handbag from slipping and scattering her stuff all over the street. For another thing, there weren't any actual hand-holds I could hang on to. However, in true Filipino fashion, desperation was the mother of invention. The fear of sure death helped my creativity along and had me clinging to the awning's thin metal frame during the whole trip and praying to God it wouldn't give way.

It didn't help things any that our driver seemed to have a motocross fantasy going - despite having five other hapless passengers at his mercy. The trike darted with astonishing agility among jeepneys, cars, SUVs and trucks as it weaved through the busy afternoon traffic. The sight of car doors and giant tires so close to my feet was not a comfort. Our driver illustrated the physical property of inertia several times with his sudden brake stops that literally pushed me to edge of my seat with frightening regularity.

The ride may have lasted a mere five minutes, but it was one of the longest five minutes of my life. Miraculously, I had gotten there in one piece.

Would I ride a trike again? Yes. Would I ride outside the cab again? Probably not. I may have a new anecdote to add to my archive of street adventures, and it may have been a strangely exciting experience - but I really would rather not know what my little trike is up against on the road next time around.

However, any seasoned Pinoy commuter worth his salt must try riding a trike this way at least once in their lives.

(Postscript: given my reaction to this experience, it's safe to say that my riding a motorcycle is completely out of the question. No. Way. Ever.)

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Saturday, February 02, 2008

Un-Doctor Esoteria

First time visitors probably scratch their heads in confusion as they go through my posts. Those who come to my blog expecting a real-life, blow by blow narratives akin to House or ER are bound to be disappointed by the lack of blood, gore, and heart-stopping medical drama perceived to be part and parcel of every doctor's life.

Despite the lack of medical posts, my life as a resident in training has not been uninteresting. I've participated in my fair share of great-for-TV medical moments in the course of my medical training. After working in a charity hospital in a Third World country, I have enough "When I was a resident" anecdotes to last me a lifetime. Code Blues conducted on the hospital floor, dramatic emergency blind intubations - who said only surgeons had all the fun?

However, my blog, like me, is presently in a state of flux.

Medical training is a time capsule until one is unceremoniously kicked out of it. It may help one grow in medical knowledge, but it stunts everything else. After nine years (4 years of medical school, 1 year of internship, 1 year studying for the boards, 3 years of residency training) of immersing myself in the medical world almost to the exclusion of everything else, I am now in between jobs - and feeling unexpectedly free. This state of relative idleness is too new to be boring. I am finally taking a well-deserved break and trying to navigate "normal" for the first time in a long time. Recently liberated doctors in training are starving for normal life.

This is still a medical doctor's blog - albeit an aimless one, at least for the next few weeks or months.

Don't get me wrong, I do have some career plans... I'm just not quite ready to talk about them yet. At the moment, I just want to concentrate on relaxing and having a little bit of non-medical fun while waiting for the next phase of my medical life to start.

* * * *

"Would you encourage your children to become doctors?" is a question that frequently comes up in conversation when I get together with my other doctor friends.

It may come as a surprise to non-medical people but most of the time our collective answer is actually a resounding, "No."

I would be supportive of my kid's choice to become a doctor if that was what she really, really wanted. On the other hand, I would be the last one to convince her to go into medicine if it wasn't on her list.

No, I am not contradicting my earlier post about liking being a doctor. But I'm also going to be the first to say that the journey is a very tough one. It can get so tough that even those who come in convinced this is what they want to be for the rest of their lives have second thoughts about what they are doing.

Sleepless nights, the physical exhaustion of going on 24 hour duties, emotional stress of dealing with life and death up close and personal, enormous responsibility - they all take their toll. We survive from day to day by ignoring these almost unrealistic demands on our time and our psyches and accepting them as a fact of our lives. But we can't help but see the stark contrast between our lifestyles and those of our contemporaries who have chosen other careers.

The intellectual gratification and emotional rewards are enormous. But the financial rewards? Non-existent until late in your career - if they come at all. As our consultants put it, hitting it big in medical practice takes more than brains, skills, and a good bedside manner. Just like in any career, being in the right place at the right time is also a huge - sometimes key - factor to success.

Choosing to become a doctor is not the same as deciding to take a job offer in the corporate world. By committing to a medical career you give your tacit consent to be changed, irrevocably, forever. It's not a job that you can shrug off when quitting time hits and you hang your stethoscope on a hook in the callroom. They key word here is "becoming." It's something that insidiously works itself into your consciousness as a result of your experiences until it is seared into your definition of who you are.

Would I willingly take that journey again, knowing what I know now? My answer: I don't know. It still surprises me sometimes that I have actually made it this far. But I don't kid myself into believing that I am all done.

For a career doctor, the process of becoming is a lifetime one.
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