Living in my Now

with my race buddy, Adam

I did it! Number 824 finished her 10 kilometer run in one hour, nine minutes and change, and hardly winded at the finish line. Who'd have thought I'd be doing something like this just one year later? Certainly not me.

I know, I know, 10 kilometers is hardly a marathon - and, to hard-core running enthusiasts, not really much to crow about. But if someone had asked me this same time last year to put on a pair of track shoes and gear up for a 5 kilometer WALK, I'd have told them that they were out of their mind.

I've always been a big fan of metaphors for describing my life. And, to date, there's no better metaphor for my now than having finished a 10 kilometer course, running all the way. Something I'd never even dreamed of doing - and have now done.

My list is hardly be the stuff adventure movies are made of, given what a sheltered, limited life I've confined myself to so far. It's been a huge effort to lock away my inner mouse - that afraid, high-strung part of myself that's always telling me I should be serious and get back into the rat race because I'm running out of time - and to embrace my impulsive, fun-loving, i-can-do-anything inner goddess just looking out for the next new adventure.

The transition from being a mouse to goddess (ha!) takes a bit of easing into when one has been living the life of a mouse (and by choice) for far too long. My mouse and my goddess often have roaring fights, let me tell you, and I still find myself stuck and dithering smack in the middle. But I'm making the effort to choose the braver option more and more.

Like driving at speeds greater that 100 kilometers per hour. Flying off to the other side of the continent on impulse. Wearing a bikini top (but with board shorts, hey! I wouldn't want anyone to lose their lunch) at the beach. Exploring my new city completely solo - and loving the whole experience. Being utterly comfortable being on my own. Opening myself up to the option of uprooting myself once again and starting over in another city.

I've heard it said somewhere that the most important journeys lead us further into ourselves - and they usually happen exactly where we are at the moment. I had to travel 5,179 kilometers from home to take that journey - and while I haven't found all of myself yet, I'm slowly but surely getting there. And adding more to my list of never-would-have-dones along the way.

Yes, I can say that my middle of nowhere, as I live in my now, is a truly great place to be.

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A contribution to Ligaya's The TBR MD's: Their Lives and Letters.

As a post-script, to make this post fit in to what she's looking for - and for the curious to find out exactly where I was just a year before, I've linked some key blog entries chronologically leading up to this one - just so you guys have an idea what a long journey I've been on since a year ago, if you have the time to read. :)

Straight Roads
Arrested Development
Stop, World, I'm Getting Off!
Defying Gravity
Life Begins at 30
Breathing Room
Proud of Me
Nine Months

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Welcome to the Real World

To the new set of Clinician Wanna-Bes:

You've probably been waiting on this day for years. Some of you from the day you started medical school; most of you for even longer than that, from the moment you made that firm decision to become a doctor.

After years of hard studying, sleepless nights, and sacrifice, you finally have that crisp diploma in your hand, the hood symbolizing your new status pinned on your toga. Now you can choose to slip on that coveted white coat and apply what you've studied by beginning your practice as you've dreamed of doing.

Congratulations. You've made it through the easiest part of your journey. Welcome to the real world - where the worst is still to come.

Reality is that despite all your exposure and experience as a student, being a doctor is nothing like being in medical school. You will never really know what it is like to be a doctor until you have a patient who is entirely in your hands.

All at once, all the things you thought you knew recedes into the background and everything you know you don't know suddenly takes up center stage. Faced with a patient who hangs on your every word and takes everything you say as gospel just because you're finally wearing that white coat, all five years of learning the science of medicine is negated by everything you didn't learn about the practice of it. And when you need the most to deliver, you are appalled by the thought that 80% of the time, you're bluffing your way through it and praying with all your might that what you did, what you thought, what you said was right.

Reality is that we all have to start out this way... because medicine is about practice and experience, and that the mistakes we make with our patients along the way ensures that we'll be able to make a difference in more patients' lives in the future. Be encouraged by the thought that even the consultants we admire the most or are most impressed with started out exactly the same way.

The more patients you handle, the better you get - at learning, at practicing... and yes, even at bluffing. But despite the growth in your confidence and skill, that staggering terror at the weight of responsibility will never completely go away. Which is a good thing because no matter what we are doing or where we are practicing, it will keep us on our toes. It will drive us to keep our edge, to stay updated, to keep on learning.

You will not always be a young doctor. And doctors only get better with time. But you will have moments - many of them - when you will wonder if your heart can endure the seasoning it will take to become a good doctor... or even if that is what you want to become in the long run. There will be many heartbreaks along the way and your heart will sustain many scars before you are through. And reality is the process of becoming never really ends. It's a lifelong process.

But as real as the challenges are, the joys of practice are also there to be mined to the fullest as well. So take heart and know that it is actually in this real world of medical practice that the best is also always still to come.

Good luck and enjoy the journey!



A contribution to Gigi's TBR at hosted at The Last Song Syndrome - A Letter to the New Medical Graduates

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Landing with a Splat

Modern pop culture will never run out of material to peddle romantic love upon hapless, easily influenced people. Whether it's in the form of the ubiquitous boy-meets-girl-and-they-live-happily-ever-after rom com movie, the prolific body of romance fiction, the music we listen to, the ads we see... yes, the whole process of falling in love has been beaten to death - and yet, we all still suck it in.

What they don't tell you, though, is that for a good number of people in the world, the whole romantic love thing often ends with one landing with one huge splat.

It's so easy to be cynical about the whole love thing these days. How can't I be when I'm surrounded by long-standing relationships falling apart? I recently took care of a patient who had recently divorced his wife of more than 50 years - he's 73. How does anyone get divorced at 73? Talk about disposable.

I've always been pretty pragmatic about relationships, consistently leading with my head rather than my heart, whether I am viewing others' romances or my long string of never-was-es. Despite never being in one myself, serious or otherwise, I know it takes a lot of hard work and commitment to make things work. But even then, there are still no guarantees.

It makes me wonder sometimes why people even bother trying.

The odd thing is, though, there's still a part of me that believes it is possible. Possible to fall without landing in a big, messy splat. Possible to make things work and go the distance. Possible for relationships to survive even when the amorphous Hollywood love has faded away and grown to become the real thing. And when it does happen - and thankfully I've seen this, too - it's a wonderful thing to see.

Besides, as one wise friend of mine says, "No one has really ever died from a broken heart. You can cry a little, hurt a lot, and then you get over it. You always get over it - and come away stronger and wiser besides."

So maybe that's why, despite the odds, people still keep trying. Because part of us all want to believe it can be possible. And because anyone who is too afraid to let himself fall will also never experience what it's like to fly.

I hope someday I can meet someone who makes me forget all about the ground so far below, just waiting for me to crash land. It must be wonderful to leap off that edge and just let your heart fly.



A late, very late, submission to Em Dy's TBR Round Up on Love.
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Big Girls Don't Cry

photo by No More Love

I hate crying.

I hate it because it makes my nose all swollen, my eyes all puffy (and sting the whole day), and my nose stuff up. I hate it because once I get started I can't stop, I just have to ride it out - and that takes a good, long while, believe me. I hate it because I am incapable of crying all dainty and ladylike as they do in the movies, but instead let loose in a cacophony of snuffles, hiccups, and undignified sobs when I get going.

I admit it, when it comes to the crying thing, I've always been a little weird. Ironically, I find that it's much easier to let myself cry over a sappy movie or a sad plot twist in a book than things that happen in real life - which is also why I often resort to using them when I feel too pent up about my life but am unable to do some cathartic bawling. Even as a little girl, I've been a big practitioner of keeping a stiff upper lip. My combination of innate stubbornness and refusing to show any sign of weakness often serve me quite well.

Which is probably a sign of emotional constipation on my part.

Anger is a little bit harder to control for me than sadness or emotional wallowing, and most of my major public tear-fests have been induced by frustration and rage. Being unfairly railed at by someone more senior than me at work or undermining my work are examples of things that can really get me going. It gets really embarrassing and awkward, but crying is at least more career-saving for me than giving into the urge to plant my knee in a superior's groin. It can get so hard to hold in the impulse to physical violence sometimes that it has to come out somewhere - the tearducts seem like a fair enough place to start.

As far as crying goes, I can be obviously such a man. Unfortunately, I am a product of my conditioning and, until now, I often need an external stimulus not related to my life to get me going (with the exception of being triggered by the really major events - like death or long separations). If I'm really, really depressed and want a good cry without having to make excuses, I have, on occasion resorted to bottle-induced bonding - a time-old macho Pinoy guy ritual reserved for seriously broken hearts (which I may or may not have as my own reason for wanting to wallow at the time).

Does this mark me as abnormal? Is it just me, or has anyone else bought into the idea that big girls aren't really allowed to cry?

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Written for The Blog Rounds 20, hosted by Ness. :)

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Walking the WOC

See one, do one, teach one.

There is only so much medical knowledge that you can glean from reading the books. An internist's clinical eye can only be developed by actually seeing. A surgeon's hands can only gain their skill by actually doing.

And for doctors just at the beginning of our journey, the quality of practical knowledge often rests on the guidance of our teachers' wisdom and expertise. Our mentors spend time every week to see our patients with us, and share valuable clinical pearls with us - and many of them WOC - without compensation.

Having worked only in a training hospital and been reared in a culture where teaching is the norm all my years as a doctor, I admit that I never fully appreciated the time and the effort that our consultants put into our rearing.

It boggles the mind how these doctors, now leaders in their fields with busy practices, give precious hours of their time to teach despite the lack of financial return. How surgeons who charge a hefty fee for each procedure serve as first assists to surgical trainees doing a complicated procedure for the first time - and do it for free.

What's in it for them? Cynics will say that the prestige of being associated with a university with such a well-established reputation is motivation enough - but given how easy it is to get the hospital tagged to your name without having to give anything back, it cannot be the explanation. Maybe there are just people who simply love to teach. And then there are those who believe in paying it forward.

Whatever their reasons, these teachers continue to inspire and spur on struggling trainees to reach the standards they have set. And in doing so, they pass on their love of medicine and of teaching, so that despite the many challenges of a medical career, there will always be those who will walk the WOC with them.

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This is a contribution to The Blog Rounds 16 - Unsung Heroes hosted by Doc Gigi.

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Under the Influence

my co-resident Jill during teaching rounds with her students

Up to my 4th year of medical school, I was going to be a pediatrician after I graduated. Since I'd always enjoyed kids, I thought becoming a kid doctor would be a great way to spend the rest of my productive life.

Then I realized that liking children does not translate to liking treating sick children - it cut me up too much emotionally. Also that practicing pediatrics involved a lot of mathematics - medication doses, ET sizes, IV fluids were always based on weight - which I abhorred. Besides that, children and infants were notoriously difficult to line.

And, most importantly, I fell in love with Internal Medicine.

IM had always lurked in the periphery of my choices ever since we had our first lectures on it in 2nd year. As far as I was concerned, it was the subject that first introduced me to Real Medicine. The thought process of arriving at a diagnosis appealed to my inner nerd immensely. I enjoyed our 10 weeks of lectures in 3rd year despite the weekly Monday exams that completely negated our weekends for the duration. Our internist attendings never failed to amaze me with their clinical acumen whenever they would take us for bedside preceptorials.

But whenever people ask me why I decided to make it my specialty, my answer is always the same - because of my 8-week clerkship rotation in Internal Medicine.

Thankfully, I am a product of an era in medical education when intimidation and "terror tactics" at the bedside are no longer the norm. While my classmates and I faced the dreaded "morning endorsements" with a great deal of caution and respect, the senior residents who conducted them were more focused on milking each case for clinical pearls for the students' benefit than humiliating whoever was in front at the time. They taught us practical points on how to take a clinical history, what to ask, and even practiced us in the skill of arriving at a diagnosis.

I was lucky enough to have been assigned to residents who picked up on my interest and really took the time to teach. My senior resident in the wards would even ask me to research about patients under our care to help solve in dilemmas in their management. As a medical student, it was the first time I had ever been given any serious responsibility for any patient and the first time I felt I was really part of the medical team.

My clerkship experience gave me a pretty good glimpse of what working as an internist would be like, and, on top of the strong leanings of my inner nerd, clinched the choice for me two years later.

In a field where one of the cornerstones of education is "See one, do one, teach one," medical doctors at all levels in their training are obliged to teach. But, as anyone who has ever trained in a teaching hospital can attest to, this is a lot easier said than done - something I have grown to appreciate even more after having gone through residency myself.

I recently saw these seniors of mine at the PCP convention just this past week. They've all started practices in different specialties and are now scattered across the country. I always enjoy seeing them again and updating them on my progress. From being once their high-strung clerk, I am now an internist in my own right - but they will always be my seniors.

During these once-a-year encounters, I let them know, tongue-in-cheek, that I blame them for getting me into internal medicine. Still, no matter how disgruntled I pretend to sound about it, they all know otherwise.


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This is a submission to TBR-9 - Mentors, Tormentors - at Megamom's site.



(As a related post-script, Megamom was actually one of my Microbiology teachers when we were in medical school - and one of my classmates' favorites because of her clear lecturing skills and very practical examination questions. :)) Click here to read the rest of this post.

I Don't Smoke

photo from flicker

I don't smoke. I've never touched the stuff in my life, and I never plan to.

I don't drink often - maybe once or twice a month at most - but when I drink, I pull out all the stops. But any medical textbook will tell you that that kind of drinking really doesnt count.

But that's pretty much all I don't do.

I love to eat at fast food joints, I'd die without chocolate, and you all know just how much I love anything cooked with coconut milk. Meals are not proper meals unless there is a salt shaker just within reach, and I always dash a liberal amount. Apart from the occasional banana, I hardly actively look for fruits to supplement my diet. In my world, fruit is not counted as a dessert. Ice cream and cheesecake are.

I have had periods in my life when I've had regular exercise - but this period in my life is not one of them. I would love to swim regularly, but there aren't any pools anywhere near my house. Everything else is a no-no because I don't like to sweat and because anything that has to do with athletics makes me feel as graceful as a pregnant elephant.

This is a point of contention between my dad - the worst patient I have ever had - and me. He's diabetic, hypertensive, and his cholesterol is going through the roof. I constantly scold him about the contraband he insists on eating and the exercise program he refuses to start. He's always on my case about being a doctor but not living healthily. I glibly argue that I'm not the diabetic in the family - and by virtue of that being an irrefutable fact, he loses the argument soundly. Still, he refuses to toe the line.

But, thankfully, he's the only one who doesn't.

Apparently, this is one thing doctors get away with just by donning a white coat. My other patients don't really ask what my eating habits and lifestyle choices are like, so I guess they assume that as a doctor, I live clean. Their blood sugars and blood pressures are generally good and their weights are steady when I follow them up, so I assume they're following my advice to live a healthy lifestyle - even if I'm not living it myself.

Quite obviously, the advice works. I just haven't gotten around to following it to the letter myself.

I know that I have to start eating smart and improving my diet. I know I have to get my cholesterol and blood sugar levels screened soon. I know I have to get my requisite 45 minutes of exercise a day, three times a week regularly.

Maybe I'll start tomorrow. Or maybe next week.

But till then, I can still tell my patients with conviction, "I don't smoke."


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For The Blog Rounds 8th Edition - Practicing What We Preach, over at Dr. Emer's blog, Parallel Universes.



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The Lucky Ones

I grew up in the art and practice of medicine in one of the largest tertiary charity hospitals in the Philippines, the UP Philippine General Hospital.

As a leading charity referral center, we received patients coming from all over the country. Most of them, if not all, could ill-afford the medical services they sorely needed. Most, if not all, were riddled by diseases given free reign to wreak havoc on the landscapes of their bodies until they were all but unsalvageable. PGH, for these patients, often became the bastion of last resort.

Even as a medical student, I would see emaciated patients with lumps as big as a melons on various parts of their bodies who would tell me that they have been growing the masses for months. Or the elderly patients with feet all swollen and reeking of gangrene saying their wounds had been there for weeks. Or patients in severe diabetic emergencies who have not been taking any anti-diabetes medications since they were diagnosed. I have heard stories of the same kind from different patients, with different diseases, from all over the country too many times to count.

Frustration was my constant companion. While after so many years I would already know the answer, I couldn't help but ask them anyway. "Why did you wait so long? Why come only now, when there's not much more we can do for you?"

The response was constant as well. They would shrug almost apologetically and say without mincing words, "Ngayon lang po kasi kami nagkapera, dok."(We were only able to come up with enough money now.) Their silent gazes of mixed helplessness and painful hope were heartbreaking. Often all the more so because I knew that without capital and given the late extent of their diseases, there's really not much I could do to help them.

Sure as day, whatever little money these patients have with them runs out within their first day at the hospital. And while there are institutions that could be tapped for assistance, both by the families and by the residents (who are doctors and social workers at the same time), when working with disease, time is a constant and ruthless enemy.

While all of us has had many success stories, both through the generosity of benefactors or sometimes by sheer divine providence, we have also had to watch patients slip away all too often when all that would have been needed to save them was a regular dose of IV antibiotics or other medications regularly given. Or an operation that could not not be done on time because until the last minute, the relatives were still looking for the money.

It was always hard to lose patients this way, but it was a hard reality we came to live with - and had to learn to accept, if, as trainees, we were to stay sane.

On hindsight, I realize now that these PGH patients were actually the lucky ones - because they were the ones who were able to reach our hospital at all. Poor as these patients are, they are not even the poorest of the poor in terms of health care in the Philippines.

The poorest of the poor are those who live in remote places that are hours of travel away - whether by boat, by jeep, by tricycle, or on foot - from any form of health care delivery system. The poorest of the poor are those who live in areas accessible by transport in the heart of the city but cannot even muster the fare to come. The poorest of the poor are those who do not even know where their next meal will be coming from and live from day to day - and will certainly not prioritize a visit to a doctor who will only prescribe medicine they will not be able to afford anyway.

The reason behind this can be over-simplified into one painfully obvious problem: we simply have no budget for health care. Can I offer any solution to this problem? The answer there is painfully obvious as well.

So in the meantime, I and others of my ilk will continue to be small cogs in the wheel of the Philippine Health Care system - a system that does what it can, ill-equipped, severely underfunded, but always working with the best of intentions. But until things can be changed, inequity in health care will continue to be a fact of Philippine life. All that others can hope for is to be among "the lucky ones" as well.

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See the rest of The Blog Rounds, 6th ed, over at Merry Cherry's place.

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Loving the Open Road

my sister and my cousin in our mobile home
(summer, 1996 - location: aosta, italy)

A road trip is often more about the journey itself rather than it is about the destination.

As a child, I learned to appreciate the joys of traveling by car. My father hates to fly (with "hate" actually being a euphemism for "absolutely terrified"), so any place we would go to as a family would have to be accessible by land. So while I've had my share of plane rides growing up, I find that I still have a soft spot for long drives to distant places.

Despite the butt-numbing, leg-cramp-inducing torture of an hours-long drive, I'm convinced that it's still a great way to travel.

I've never actually driven farther than Batangas myself, but I have been on several long-haul trips with friends in recent years. The summer after internship, my blockmates and I made the grueling 13-hour trip to Ilocandia by bus. Once already there, we set about to exploring the territory with borrowed vehicles, guided by two friends native to the region. The time-consuming drives were definitely made faster by the great company and lots of laughter. Travel by car is, hands down, great bonding time.

block J and friends at Paoay Church, Ilocos Norte (summer, 2004)

While quality time with friends and family is a great reason to travel by car, for me the best thing about traveling by road is discovering places you never would have found otherwise. On one of my most memorable road trips ever, my uncle rented a mobile home and took my cousins, siblings, and me on an unforgettable, meandering drive from Aachen, Germany all the way south to Rome, Italy - with a stop at Pisa, Florence, and Paris along the way. We would park from camping ground to camping ground - all located in remote, unknown pockets of beauty in the European countryside.

When people ask me about that summer trip to Europe, they marvel at our unconventional itinerary - because despite being there a month, we weren't able to hit all the "must-see places." But I'm pretty sure that people who do "the grand tour" to cover all the highlights have not been treated to the gorgeous sight of Tuscany countryside in the early spring; or the breathtaking view of a medieval castle on top of a verdant mountain, its spires rising above the mist. That trip was, without a doubt, an awesome experience I would love to relive again.

our Europe road crew sans our driver (summer, 1996)

Any long-distance trip by car requires a good deal of patience and eyes on the goal. It also requires a healthy sense of humor - most needed when faced with the inevitable mishaps that crop up along the way, given the lengthy travel time and the many factors out of one's control. The best way to enjoy any road trip is to simply embrace every experience, making every one taken a life lesson in itself.

As I look back at my career as a budding wanderlust, I find that when armed with great company, the right attitude,and an openness to take detours along the way, going by open road can be the best way to see the world. And - at the expense of mixing my metaphors - when you choose to take the journey, finding yourself at a destination well-worth the trip ends up as merely icing on a really amazing cake.

worth the 12-hour journey
(caramoan, camarines sur)

So what are you waiting for? Gear up, tune your cars, and get going!



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For the 5th edition of TBR - "I know what you did last summer" at Doc Ness' place.


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The Blog Rounds 3 - At a Crossroads

Welcome to the Middle of Nowhere and the 3rd Edition of The Blog Rounds!

Before anything else, I'd like to thank all the medical bloggers who participated in this edition of The Blog Rounds for their enthusiastic response. Many new voices have been added this week - and I am hoping this won't be the last time they will be joining our particular chorus! Given the very personal nature of the topic for the week, the honesty and candor of all the bloggers have made it a joy to read the stories they have chosen to share.

Now, I would like to help them share their stories with all of you.

Without further ado, I bring you TBR 3 - At a Crossroads.

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The nitty-gritty of the pursuit to the elusive M.D. and beyond is a mystery to most. In Crossroads and Crossed Roads, Dr. Em Dy sets the stage by detailing the major crossroads in every doctor's life.

There are as many reasons behind the choice to pursue a medical career as there are doctors. But as Doc Tes skeptically points out in her native Cebuano, one favorite reason given by aspiring medical students in their interviews is the catch-all reason, "To Serve Humanity."

Given the difficulty of the journey, the choice to continue is presented to one time and again, and, ultimately, not everyone decides to go into clinical practice or even to finish medicine. Kitty Mama was once a doctor-in-training who made the choice to leave that life for a new one. In Margarita, she talks about her experience of being exposed to the hospital for the very first time - one event that she used to sustain her during her stay as a medical trainee. Bubbleman, on the other hand, chooses the Other road much later in his medical journey. In On Choices, he attempts to tell us why he is no longer practicing medicine and to connect the dots of his choices into a pattern that makes sense.

Being at the cusp of a new phase in your life, on a new road you have chosen, can both be exhilarating and terrifying. Merry Cherry, a young doctor to the barrio, recalls the terrifying feeling of anticipation before her deployment and shares her thoughts on where she is more than a year after she first began this particular journey. In Roadkill, new graduate Kai describes the feeling of literally being in the driver's seat for the first time and makes this experience a metaphor for her life in the near future. Doc Whisperer shares with us a poem about the changes that can follow making a choice in Crossroads.

The end of any chapter in a doctor's life always leads to a crossroad - which can sometimes translate into a dead end. In my post, "Stop, World, I'm Getting Off!," I explain my choice to slow down a career that is going too fast for my liking in order to figure out where I want to go. Manggy describes the end of medical school as his Pre-Life Crisis and draws a blank on what to do next as he stands at the crossroads of choosing where to practice medicine. Angel-No-More finds herself at a crossroads of a different sort, as she comes to some realizations upon reaching the big 3-0.

To others, however, coming to a crossroads when one reaches the end of their training causes their life to open up. Midnight Rainbow, in her post Ang Biyahe ng Buhay Ko, likens her life to a highway and talks about the stops and detours that have led her to where she is today - and a future full of possibility. In her first ever Blog Rounds post, Lei Si talks about why she chose medicine and the "everything else" she wants to do now that she's found her life's calling.

Sometimes the choice of the road to take is dictated by circumstance, Fate, or some Unseen Hand. Abner Hornedo chronicles his meandering journey from choosing one specialty and ending up in another in Fate Sometimes Decides. In Megamom's Two or Three, she recalls making a major life decision influenced by her being a woman of science - but whose final outcome was wonderfully orchestrated by God. Ness, a practicing anesthesiologist, shares her experience as a doctor who studied nursing as a second course - but is still practicing medicine in the Philippines.

Sometimes we try to reassure ourselves that we are going the right direction by looking for "signs" along the way. Prudence blogs about the "signs" she has looked out for during her journey through medicine and wonders if they are really worth watching out for.

There are some whose paths have led them to where they feel they are meant to be and are content with the choices they have made. Doctor Joey, another ophthalmologist, talks about some of the major crossroads in her life and her satisfaction with their outcomes. In his post Babies, Bulbuls, and Bonsai Trees, Doc Noel learns of the joys of coming home and the freedom of starting his own private practice in General Santos City. Bone MD recounts his long arduous journey through medical school to starting his present practice as an Orthopedic surgeon in the hinterlands of Mindanao in Nowhere to Go But Up.

We cannot touch on the topic of the choices doctors make and not touch on the controversial diaspora of Filipino doctors to other lands. Often, medical workers are perceived as "the bad guy" in the deteriorating health condition of the country today without being given a chance to have their say. But why do doctors leave? Their stories may be different, but their reasons are surprisingly quite alike.

Dr. Doray of Doralicious is now serving as a councilor in Quezon City - but two years ago she was actually planning to train abroad. Tongue-in-cheek, she shares with us the plans she made then and the reasons behind them, before Fate stepped in and changed them all. With dry wit, RG recounts his impulsive choice to begin a new journey in the land Down Under and the reasons behind his decision in All is Quiet on New Year's Day. Another young MD, AnnKat, talks about how a change in plans does not equal a change of heart in Exodus. Finally, Dr. Martin Bautista, Filipino doctor and former senatorial candidate, blogs about his choice to train and start a practice abroad and how his experiences and his desire to serve have led him back home.

The theme "At a Crossroads" was a bid to uncover the people behind the white coat for non-medical readers while at the same time giving us medical people a common ground from where we can find new insights into our own lives through the experiences of others on the same journey. I hope that this collation of posts was able to do both.

Many thanks for participating - and see you next week at Doc Tes's place for TBR 4 with the interesting topic of The Doctor as Patient!


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The Blog Rounds Visits the Middle of Nowhere

The Blog Rounds, a blog carnival for Filipino medical bloggers, will be coming to my middle of nowhere next Tuesday, April 1st, at 12am (Philippine Time).

As doctors, nurses, or members of the allied medical professions, we have all had to make hard choices in the course of our career. Our professions, being often tightly bound to who we are, in one way or another influence the paths we choose to take. Coming to a crossroads in our lives is an experience that we are all familiar with, yet at the same time something that is very unique and personal to each one.

The theme for TBR 3 will be "At a Crossroads."

Whether it is a choice between leaving the country or staying where you are, to give up one dream for another, to change directions of your career or to continue coming to work every day, I encourage you to share your crossroad experience with us.

If you've already come to a major crossroads in your life and chosen a path, why did you make that choice? Why did you take that road? How did your choice affect your life as you live it today? Do you have any regrets or what-might-have-beens? If you're just coming to it in your life, what has brought to you there? What are you struggling with and why?

These are just some of the many questions that we grapple with at these points in our lives - I'm sure there are more you can think of and answer as you tell your stories.

Posts may be in any form - even photoblogging or artwork is acceptable, as long as the photo or artwork was by you and is in keeping with the theme! I don't mind if your post wasn't written specifically for this blog carnival, as long as it fits the theme of the week. The more spontaneous, the better. :) Please email the URL of your post to dr[dot]clairebear[at]gmail[dot]com on or before March 31, 12nn. The other guidelines for submission are over here. (For those of you who are not very familiar with the concept of a blog carnival, the collated links will appear in a post similar to this one or my post on Single Pinay MD's.)

I chose this theme because I felt it was time we explored the more human side of being in our line of work. I really hope that more bloggers will participate in this coming week's Blog Rounds. I am certain that in this all of us have something to share, to learn, and to teach.


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The Filipina Doctor: Coming Full Circle

illustration by Sinagtala

Centuries ago, the babaylan served as seer and sage, healer and community "miracle-worker." They held an important and influential role in pre-Christian Filipino society as the primary mediator between the spirit world and the human world. While the role of a babaylan was open to both male and female, most babaylans from the pre-Hispanic era were female. These women healers were both revered and well-respected, and their value to their community well-recognized.

Today, after a long and arduous struggle, Filipino women in medicine have finally come into their own. Like their babaylan counterparts, the Filipina doctor has once more reclaimed her role in modern Filipino society both as healer and a force to be reckoned with.

As someone who made the decision to become a doctor at a young age, it is hard for me to imagine a time when my having been born a female would have kept this ambition of mine from coming true. While the opportunity to pursue medicine as a career is something that my generation of Filipina doctors take for granted, this was a privilege hard won.

The arrival of the Spanish in the sixteenth century marked the beginning of a long period of repression for Filipino women. Babaylanic practices were ruthlessly suppressed in the onslaught of mass conversion to Christianity. The role and power of the Filipina was much diminished in the male-dominated colonial society. From having equal stake in community matters, they became relegated to secondary citizen status. For over 400 years of Spanish rule, women's options were to either become keepers of home and hearth or devote themselves to a life of service to the Church inside a nunnery.

A similar way of thinking pervaded Western society, the home of modern medicine. Since medicine, like most intellectual pursuits, was considered the bailiwick of men, women penetrated this field against much resistance. In the United States, the birthplace of the Women's Rights movement, women lobbied for admission to medical schools and the right to train beside their male counterparts in the mid-1800's. It was in 1849 that the first woman in the US was given a Doctor of Medicine degree. In the Philippines, it would only be in 1932 when the first Filipino women students were accepted into the University of Santo Tomas - the premiere educational institution established by the Spanish in the Philippines at the time.

The coming of the Americans in 1898 ushered in the winds of change for Filipina women. Powered by the advances in women's rights in the mainland US and in keeping with their policy of capturing the Filipino mind with education, American established institutions opened their doors to Filipino men and women hungry for learning. This included the Philippine Medical School - what would eventually become the U.P. College of Medicine.

It is apt that the rebirth of the Filipina healer tradition came in the form of an obstetrician - a doctor who practices in ushering in new life. Dr. Honoria Acosta-Sison, who graduated from a Pennsylvania medical school in 1910, was the first Filipina doctor and the first Filipina obstetrician. She was soon followed by Dr. Olivia Salamanca, who also studied medicine in Pennsylvania but whose life was cut short by tuberculosis at 24. Dr. Maria Paz-Mendoza Guazon, who was the first woman awarded a Doctor of Medicine by the U.P. College of Medicine in 1912.

Both Dr. Honoria Acosta-Sison and Dr. Maria Paz Mendoza went on to have long, illustrious careers and paved the way for the other brave Filipinas to pursue their dreams of medical glory. By 1930, women comprised 25% of the 404 enrolled medical students at the U.P. College of Medicine. Today, the U.P. College of Medicine accepts an equal number of men and women to its roster of first year students every year. In all medical schools around the country, the number of Filipina women aspiring to become doctors is apace with their male colleagues.

Modern Filipina doctors have come a long way in the span of a few decades. Despite many obstacles, they dared to challenge the daunting odds against them - and won. Like their babaylan counterparts, a good number of them hold influential positions in their communities and are leaders in their own right.

The image of the Filipina doctor as modern-day babaylan is not far-fetched. In ancient Filipino culture, the babaylan is the epitome of balance, as primary mediator of the spirit world and the human world. While modern women are all too often pressured to conform into the stereotypes of domestic nuturers or aggressive career women, the Filipina doctors have transcended these two extremes by being able to be both and to excell in all aspects of their lives at the same time. Apart from being doctors, they play an an integral part of Filipino society as mothers, sisters, daughters, and friends.

Many of these women are now at the helm of their different specialties, standing equal to their male colleagues, and are helping to steer the course of medicine in the Philippines. They can be found in both medical and surgical fields. Some are practicing in law, in politics, in public service, in industry, and in research. They continue to make their mark not only within the country but have also risen to prominence abroad. Their contributions to their fields and their communities are well-recognized, and they are well-respected not only for being accomplished physicians, but also for being compleat women.

As the face of Philippine medicine continues to change, these pioneering Filipina doctors will continue to break perceived boundaries, practice medicine beyond expectations, and set the standards for the next generation - our generation - of Filipina doctors to follow. And while every new trail they blaze is a step forward into the future, for the Filipina healers it is a step closer to closing that circle first drawn by tradition many centuries ago.




My submission for the first edition of The Blog Rounds blog carnival.

This article won First Place in the recently concluded Philippine Encyclopedia Filipina Stories writing project in support of the Filipina Images campaign.

Related Links:
First Filipino Women Physicians
More than Just Being Physicians
Babaylan Rising

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Proudly Pinoy Blogger, MD

As a newcomer to the blogosphere, I am still amazed by the sheer number of medical doctors who blog. Despite their busy schedules - whether as clinicians, researchers, teachers, or trainees - doctors from all stages in the journey, coming from different parts of the world, take time to distill their lives and thoughts for anonymous readers on the world wide web.

The content of these blogs are as varied as the doctors themselves. While some aim to make lay people more aware of health issues or the latest medical innovations, a good majority of the doctors' blogs I've stumbled upon so far are about their lives as doctors or their attempts to make a life outside of medicine.

Given the sheer number of Filipino bloggers loose on the blogosphere, it comes as no surprise that there are much more than a handful of Filipino doctors who blog. Doc Em Dy of Pulse has done a great job of making a listing of other Pinoy doc bloggers on line. To consolidate this growing Pinoy medical blogger community, Bone MD of The Orthopedic Logbook, has also come up with a project called The Blog Rounds. The Blog Rounds is a blog carnival specifically for Filipino medical bloggers similar to the Grand Rounds started on Blogborygmi almost 3 years ago.

As a doctor who blogs, I know I am biased towards reading blogs written by other doctors. It's always fascinating to see through other colleagues' eyes and discover that underneath all the surface differences, beyond the different medical systems, we have much more in common which each other than we realized. The experiences, the struggles, the frustrations, the rewards - the journey to becoming a doctor - is the same. But more importantly, while it is often not explicitly stated, doctors who blog contribute to demystifying medical life for our non-medical readers and showing the world that, yes - "doctors are human, too."

I think that The Blog Rounds is a great way of fostering a community spirit among Pinoy doctors on-line - wherever they may be. There is much we can learn from each other that we cannot learn from our books or our practice; and, in the same way, each of us, regardless of where we are on our journey, has much to teach. It also welcomes non-medical Pinoy readers into our world and gives our collective voice the chance to be heard.

Fellow Pinoy doctors and health care professionals interested in joining in the fun can read more about how to do this over here. But for this project in particular I am tagging my other Pinoy MD bloggers The Doc Whisperer and Caffeinated Gurl to join in the fun.

Sulat na tayo, mga kapatid!

* * * *

Speaking of blog carnivals, I'm very pleased to share that my entry "Anything and Everything" was featured in this week's Grand Rounds hosted at ChronicBabe.com. This week's theme was about New Beginnings, and I felt that experiences as a temporary general practitioner after being an adult internist-in-training for 3 years was just what they were looking for. Many thanks to Jenni for including my post!

Next week's Grand Rounds will be hosted at Canadian Medicine (many thanks to the site owners for the link love and the mention!) and you can read about the guidelines for submission over here.

Readers who enjoy medical related content will definitely enjoy the Grand Rounds, which features posts from medical bloggers from all over the world. If you want to know what medical life is really like, beyond Grey's Anatomy or House, MD, you can find the upcoming schedule and archive for the Grand Rounds blog carnival on Blogborygmi.

Happy reading!
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