Up on the Wall

People hang pictures on their wall. It could be art photos or beautiful landscapes. Or it could be pictures of themselves showing their achievement, like graduation or wedding photos. Or it may be photos of someone we our proud of and like to remember, like our children or our parents, or even our pets.

In the corporate world, they hang photos of their founder, or top executives, or model employees. Maybe you have your photo posted as the best employee of the month. Or as the boss’ pet perhaps?

In the old days, especially in the wild west, they also post photos of persons on walls but for a very different reason. It has the words “wanted” and “reward” on them. That’s not what I am talking about here.

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(photo taken at Cody Wyoming)

In the company I am with now, they have a tradition, that after a doctor is with the group for 10 years or more, they would hang a photo of you up on the wall on the clinic’s main hallway. It is like an honorary gesture, that the organization is proud of, after that years of service you dedicated to them. It is like the wall of fame. Sort of.

Sure enough, since I am now with this organization for 10 years, they told me that its time for me to get up on their wall. No, they will not hang me! Just my picture.

Then I thought which picture of me would they hang? When I asked them, they told me it is a photo that they have taken when I joined the organization more than 10 years ago.

Wait a minute. Yes, I may look much younger then, and my youthful image would be immortalized on the clinic wall, but that photo does not look like me anymore. I got lots of hair then. People would pass by and see that photo and wonder, who is that doctor?

So I asked our office manager, to schedule me to have a photo session with the organization’s official photographer, so I could have my picture taken. I want a photo on the wall that has full resemblance of me.

In this day and age of photoshop, you can airbrush your image, or altogether alter your appearance to make you look more beautiful, or younger, or thinner, or more glamorous perhaps. Except that, it is not you anymore.

My take on this is, the closer to the reality the photo is, the better. If we cannot accept the truth about our own appearance, then what a sorry state we are in.

Never been more proud of the result of my new photo. And I can vouch, they did not have to retouch it much.

As I pass on that main hallway, I saw my picture up the wall. It certainly look like me. And there’s no “wanted” or “reward” underneath it.

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our wall of fame

 

Doctor’s Report

We were sitting in a waiting area of a posh Cancer Center building. This time I was on the receiving end of this business. I was not a provider (doctor) but rather a consumer (patient). I was accompanying my wife for her follow-up appointment with the Hematologist-Oncologist doctor.

It was a day of reckoning. We were going to get the dreaded results of her bone marrow biopsy.

Have you ever waited on a report before? A semester’s grade perhaps? Or a qualifying examination? Or a job application? Or a tax return? Nothing can compare to the anxiety level of waiting for a biopsy report.

As I looked at the people in the waiting room, I can easily identify the patients. To lighten up her mood, I told my wife that I look more as the patient than her, for I am the one with the thinning hair. Though I am not poking fun of the chemotherapy patients at all, for I only have admiration for their courage and resolve as they undergo this difficult treatment.

When we were called inside, we met with the cancer specialist. He reviewed the results of the bone marrow biopsy with us, including some fancy genetic tests that he obtained.

The doctor went into detailed medical description, for he knew I am a doctor too and speaks his language. He then concluded that the test did not show any evidence of Myelodysplastic or Myeloproliferative disorder. In simple terms, no evidence of badness to worry about. It was a good report overall.

It was such a relief!

For the past several days, we experienced silent and unspoken fear about our future. For my wife, for me, and for our family. But now, we will grow old together after all.

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my wife and I (photo taken last summer in Vail Colorado)

If there’s something good that came out of this, is that it made our bond stronger and our faith more steadfast.

As we were leaving the doctor’s office, I glanced once again at the people in that waiting room. One elderly woman who was in a wheelchair, was wearing a colorful bandana but looking glum. Another not so old lady who was wearing a fancy hat accompanied by few friends or family. One middle-aged man who looked frail and sitting alone. And some other ones I failed to describe.

What would the doctor’s report on them be? Would it be very good like ours was? Or not so good perhaps? Or would it be downright heartbreaking? I can only hope and pray for each of them.

Life. So unpredictable. Live it to the fullest. And celebrate it while you can.

Today we will.

 

Peace Be Still

A few days ago, while I was in my clinic seeing patients, I received a phone call. It was another doctor who wanted to discuss with me the results of a patient’s laboratory exam.

It is not unusual to have another doctor call me to discuss about a mutual patient. Except this one was not about a mutual patient. On the other line was the Hematologist-Oncologist (Hem-Onc) doctor. The patient he was calling me about, is my wife.

It started with a regular annual doctor’s visit. After having routine test, my wife’s Primary Care physician was alarmed by the results of the complete blood count (CBC). This prompted a referral to the blood and cancer (Heme-Onc) specialist.

After the evaluation by the Hem-Onc doctor and having the exam repeated, that’s when the specialist called me. He said that he was concerned about the elevated count of a blood component, and for some “funky-looking” cells. He recommended a confirmatory test, a bone marrow biopsy.

Bone marrow biopsy is not a very dreadful procedure but its not a walk in the park either. It can be done as an outpatient, usually under “conscious sedation” (meaning, light sleep). It entails drilling a long large bore needle into the hip bone down to the marrow, and aspirating and scraping a “sample” contents inside the bone.

The problem of being a doctor, is that you know “too much.” Too much than needed. So in my mind, I already ran down on the possible differential diagnosis. I started to play the different scenarios, their treatments and outcomes. And even though I know that it can be nothing or something benign, I couldn’t shake off the idea that it can be a myeloproliferative disorder. In layman’s term, leukemia.

My spouse’s family history was not reassuring either. Her father died of cancer in his 60’s. She has two brothers that died prematurely, one was barely 50, and the other one in his 40’s. Then her sister who was a little older than her, was diagnosed with cancer in her 40’s.

I tried to be nonchalant and positive about it when I spoke with my wife, but I think she can sense that it can be something serious. For the succeeding days prior to the scheduled biopsy, both of us were feeling the uneasiness, as if there’s angry storm clouds hanging over our heads ready to discharge their fury.

The fear of the unknown is one of man’s greatest fears. It terrifies us. It consumes us. It kills us even before we die.

Two nights before the biopsy, we both cannot sleep. My wife asked me point blankly, “Am I going to die?”

I don’t know how to answer that question. Or perhaps I don’t want to answer that question.

She told me that she’s really afraid. So in the middle of the night she asked that we kneel down in prayer.

As we prayed, I asked God to be with us as we go through this storm.

Suddenly I was drawn to the story of Jesus and his disciples when they were caught in a great storm* while crossing the Sea of Galilee. I saw myself struggling with the oars and the sail with the disciples. We were trying our best to keep the boat afloat……

The winds are howling. The billows are rolling. The thunders are cracking. The storm is raging. And I am terrified and trembling.

But where is Jesus?

He is asleep! How can he sleep, when we are about to be swallowed by the storm and the sea?

“Master, do You not care that we are perishing?” I cried.

When Jesus arose, he looked at me lovingly, yet he asked me why do I have so little faith.

Then he spoke: “Peace, be still.”

I looked around me. The winds are howling. The billows are rolling. The thunders are cracking. And the storm is even more raging.

But I am still.

image from here

(image from here)

(*Mark 4: 37- 40)

Kwentong Kindergaten

Noong makalawang araw, habang ako’y nagbibiyahe patungong trabaho, ay aking napakinggan sa radyo ang isang report tungkol sa mga leksiyon ng buhay na natutunan natin sa Kindergarten. Isa na rito ang simpleng pagpasok at magpakita sa eskwela. Ano nga naman ang matututunan kung lagi kang absent?

Bigla tuloy akong napabalik-tanaw sa makulay kong mundo noong ako’y isa pang kindergarten.

Ako ay nag-aral sa isang munting Kindergarten school sa Sta. Mesa na patakbo ng NFWC. Dalawang kalye lang ito mula sa amin. Ang aming klase ay sa isang garahe ng bahay na ginawang classroom. Maaring hindi ito kasing tanyag ng Montessori, pero maganda rin naman ang turo dito.

Naalala ko minsan, matapos ang sunod-sunod na ulan, pinasok ng baha ang aming classroom. Kaya mga ilang araw kaming sa simbahan ng parokya nag-klase. Nabulabog kaya ang mga Santo sa aming ingay?

Natatandaan ko pa ang aming guro, si Ms. Genova. May nunal siya sa noo, na parang “red dot” sa noo ng mga bumbay. Siya ay mabait at bihirang magalit kahit kami ay makulit, at hindi siya kagaya ni Miss Tapia sa “Iskul Bukol.”

Tanda ko rin ang ilan sa naging kaklase ko. Si Yaren, na taga kabilang kalye. Siya ay naging matalik kong kaibigan. Si Big Boy na makuwento. Pero hindi ko alam kung bakit iyon ang palayaw niya, dahil patpatin naman siya. May kaeskwela rin kaming kambal na nakatira sa likod bahay namin. Alam ko kung anong inalmusal nila, hindi sa dahil amoy ulam sila, kundi kadikit ng bahay namin ang bahay nila kambal, kaya amoy namin pati niluluto nila.

Sabik din ako sa mga gamit ko sa paaralan noon. Tulad ng krayola, kahit walo lang ang laman ng aking kahon ay masaya na ako dito. Iba sa aking kaklase ay hale-halera ang laman ng kahon ng kanilang krayola. OK lang naman dahil hanggang red lang ang alam ko noon at hindi ko pa maintindihan ang fuchsia.

Gusto ko rin yung pambura dahil amoy kendi. Kulang na lang ay nguyain ko ito na parang Bazooka bubblegum. Nandiyan din ang lapis. Iyong ibang kaklase ko, magagara at may borloloy pa ang lapis. Iyong sa akin, ay simpleng Mongol lang: yung may nakasulat na eberhard faber, tapos number 2.

Maiba ako, alam mo ba ang ibig sabihin ng eberhard faber at number 2?

Si Eberhard Faber ay isang German na nagtayo ng kauna-unahang lead pencil factory noong 1861 sa New York. Kaya nakapaskil ang pangalan niya sa lahat ng lapis na gawa ng kumpaniya niya. Iyong number 2 naman ay grado kung gaano katigas ang graphite core ng lapis. O ayan, may natutunan ka sa akin na hindi mo alam noong Kindergarten ka pa.

Marami rin masasayang karanasan sa Kindergarten. Natutong magbasa: a-e-i-o-u, ba-be-bi-bo-bu, Bobby is bobo. Ano kamo?

Natuto ring sumulat, mag-drawing, mag-kulay, at kumanta. Isa sa natutunan kong kanta:

“Pusa ko’y may nahuling daga, mukha niya’y nakakaawa,

Meow, meow, meow, ang sabi ni Muning, di na kita patatawarin.”

Ang maging walang-awa ba sa daga ang itinuturo ng kantang ito?

Paborito ko rin ang recess noon, dahil nakakapaglaro kami. Dito ko natutunan ang larong Dr. Quack-Quack. Kahit muntik magkapilay-pilay kami sa pagkakabuhol-buhol sa larong ito ay maaring natututo rin namang mag-isip at mag-solve ng problema. Pero maniwala ka, hindi si Dr. Quack-Quack ang naging inspiration kaya ako nag-duktor.

Gumanap din ako bilang Joseph sa aming dula noong Pasko. May pintang balbas ang aking mukha, tapos may dala-dala akong tungkod na mahaba. Pero mas gusto ko iyong role ng aking kaibigan bilang wiseman, dahil mas magarbo ang kanilang costume tapos may bitbit pa silang regalo. Bakit ba hindi ako naging artista?

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Christmas program, circa 1973

Sa Kindergarten rin ako natutong tumula. Sa katunayan ako’y tumala noong graduation program namin. Makaraan ang apatnapung taon, saulado ko pa ang aking tinula. Tungkol ito sa ibon na nakakulong. Ito ang dulo ng tula:

“Bagong pinta ang kulungan, may pagkain araw-araw,

Ngunit ibon di man lamang, umawit kahit minsan.

Ibon ay aking pinalaya, umawit ng tuwang-tuwa,

Tao’t ibon pala kapwa, maligaya kapag malaya.”

Tunay naman na kahit nasa Kinder pa lang kami ay ipinamulat na sa amin ang kahalagahan ng kalayaan.

Pero meron ding masasaklap akong karanasan noon. Tulad nang ako’y tumambog sa kanal galing sa paaralan at napuno ng burak ang aking buong braso. Pingot ang inabot ko sa nanay ko. Nasa Kindergarten din ako nang ako’y nabalian ng braso. Nakasimento ang aking kanang braso nang halos dalawang buwan. Kaya sa maikling pagkakataon ako’y naging ambidextrous, dahil natuto akong sumulat sa kanan at sa kaliwang kamay.

Tunay na pinahahalagahan ko ang edukasyon, lalo na ang mataas na antas na aking narating. Sang-ayon sa aking magulang, edukasyon lang ang maipapamana nila sa amin. Pero naniniwala ako na maraming mahahalagang bagay sa buhay, ay natutunan ko sa pinaka-mababang grado ng edukasyon – sa Kindergarten. Tulad ng:

Pumila ng maayos (siguro yung mahilig sumingit bagsak noong Kinder). Makinig sa turo ng guro. Huwag kunin ang hindi sa iyo, o magpaalam muna sa may-ari bago hiramin ang gamit. Mag-share. Huwag makipag-away. Huwag mangopya. Maging patas sa paglalaro. Huwag kainin ang baon ng iba. Huh?

(Oo naranasan ko na may ibang kumain ng baon ko, pero nasa Grade 1 na ako noon.)

Isa pa sa aking naalala ay mabilis maubos ang aking pambura noong nasa Kinder pa ako. Dahil nginangata ko ang eraser. Dahil burara ako. Dahil marami akong mali sa pagsusulat, kaya’t pudpud agad ang aking eraser.

Isa sa mahalagang leksiyon na natutunan ko sa Kindergarten ay ito: ang pagkakamali ay bahagi ng buhay. Hindi lahat ng ating sagot o gagawin ay tama. Ang mahalaga ay natututo tayo sa ating karanasan, at ituwid natin ang ating mga pagkakamali.

At kung ika’y nagkamali at ika’y naihi sa salawal noong Kindergarten? Hindi ito katapusan ng mundo.

(*This article is lovingly dedicated to Kindergarten teachers, and all other teachers, who showed us the way. Thank you.)

Cold Break

After being cooped up indoors for too long due to bitter cold, I finally went out today. And ran!

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most of the ground snow have melted away

Yeah, it was a bit chilly as we only peaked in the high 40’s to low 50’s Fahrenheit (and will dip below freezing tonight), but still, that was about 50 degrees warmer than 2 days ago.

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the pond was still icy

Today, I ran my first 5K (yes, I was slacking for months!) for this year. Albeit a little slower pace. OK, much slower than I use to. But hey, who’s watching?

Even if I was running slow, I was still chasing my breath. Do you suppose my breath was running faster than I was? Yet it was just exhilarating to be outside. To feel the wind in my face, the sunshine in my eyes, and the sweat in my brows. Even though I was panting and my legs were heavy, it is good to be alive!

I saw friendly neighbors outside as well. Some were walking their kids. Some were walking their dog. Some were walking themselves. Huh? And some were just sitting on their porch. All waved as I passed them by. So it was not just me who took advantage of this break from the winter blast.

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“tomorrow may rain (*snow*), so I’ll follow the sun” ….Beatles

I know winter is not officially over. And who knows what old Iowa winter still has in its sleeves? For arctic air can blow back and we can still have snow the next day, or the next week, or even the next month.

But this I know, spring is coming.

 

Pinoy Haiku

(Haiku is a very short form of Japanese poetry. Traditionally it has 17 syllables in 3 phrases, 5, 7, 5, respectively. I hope you enjoy the following, or better yet maybe try writing some on your own.)

Kubo

Ang pulitiko,

May mansyon. Simpleng tao?

Sa ba-haiku-bo.

*******

Syota

Seksing syota ko,

Sinimot at tinangay,

Pati ba-haiku.

*******

Gayuma

Tsurang kabayo,

Nilasing ako. Ngayo’y

Lab ng bu-haiku.

*******

Trono

Magarang trono,

Naupo ako. Surot!

Pesteng bu-haitu.

*******

Trapik

Grabeng trapik ‘to

Late na naman sa klase,

Kick-out! Hainaku!

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(*image from here) 

Heart Tones

I just arrived home one early evening when I received a call from the hospital’s Emergency Department. On the other line was the Emergency Room physician who said that he needs my help on a patient that he was admitting to the ICU. After hearing the severity of the situation, I knew I had to come back to the hospital. At least it was still early and not in the unholy hour of the night.

Our patient was a woman in her late 20’s, who was brought in by the ambulance after having a prolonged seizure. Her family noted that after the seizure, she was not breathing at all. Her family started CPR and called 911. When the emergency responders arrived, they continued the resuscitation efforts and worked on her for more than 15 minutes before a stable cardiac rhythm was established.

When I arrived at the hospital, the patient was already in the ICU. She was unresponsive, intubated and hooked to a mechanical ventilator. After examining the patient and placing orders, I assisted my medical resident placed a large triple lumen catheter for IV access in the patient’s jugular vein for better management.

Not too long after, two more doctors came to the room to evaluate the patient. They brought along a heart monitor, not for the patient herself, but for the “other” patient involved.

Other patient? Yes, our primary patient was 36 weeks pregnant.

I have noted that once in a while our patient was going into a “stiffened posture.” This posturing is a tell-tale sign of a probable brain injury. To be certain, we consulted a Neurologist who came in several minutes later to assess the patient as well.

With two lives hanging in a balance, the Neurologist, the two OB-GYN physicians, and me, arrived on a decision that an emergent Caesarian delivery was necessary.

All along during our discussions inside the room, on the background, we can hear the baby’s heart tones from the fetal doppler: blup-blup-blup-blup-blup-blup-blup-blup……

*******

I entered the ICU room and the patient was lying motionless in her bed. Taped in the railing of the bed was a paper with a footprint of her newborn baby.

It had been seven days since my patient had the seizure and the subsequent cardiac arrest. Seven days since she had the caesarean section and delivered her baby. Seven days, and she had not waken up.

As I performed a thorough neurologic testing with prodding and certain maneuvers, she did not respond at all. Does she know that I was examining her? Does she know that her family was all worried and praying for her? Does she even know that she had delivered a beautiful baby boy?

Sadly to say, she has no idea at all. For she was gone. And the only things that were keeping her “artificially” alive were medications and machines.

Life is precious, yet so fragile. One moment you are a picture of health with all the promise of joy and life, then the next moment you are dangling by a thread with nothing but loss and despair. May we value and appreciate every fleeting moment of our lives.

We met with the patient’s family in the consultation room outside the ICU. They were obviously distraught and heartbroken. After explaining the facts to them, including the EEG (brain wave tracings) and brain MRI results, we gave them the grim news. The chances of a meaningful recovery was nil.

Amid the crying and whimpering, the family related to me that they just wanted to have the patient’s baby brought to her ICU room to have some time to be with her. Then, they will take her off life support.

Before coming out of the consultation room, we gave the patient’s family a token in a small box. A keepsake for her baby.

*******

In a lonely nursery, a baby was being lulled to sleep by a rhythmic sound coming from a small box hanging in his crib. It was a recorded heart tones of her mother. A mother he will never get to know.

Lub-dub lub-dub lub-dub lub-dub lub-dub………

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 (*image from the net)

Shivering Tulips

Arctic blast is back in our area. After a few days of relatively warm days with some melting in our piles of snow, our temperature is again in single digits (Fahrenheit). The next few days does not look encouraging either. Afterall, we are still in the thick of winter.

As I was seeing patients in our clinic today, one of the constant small talk that I have with my patients is the cold weather. With most of my patients having significant pulmonary condition, this subfreezing temperature is such a struggle for them. My parting shot with them as they get out the door is “stay warm!”

The last patient I had this morning was someone who had been followed in our clinic for more than ten years. Ten years is more of a rarity to be followed by us, as most of them are with advanced lung disease and thus they do not last that long.

He is an old sweet man with a sunny disposition, but crippled with severe COPD, and had been oxygen-dependent for several years now. Damn cigarettes!

He is on maximum medications, inhalers and nebulizers we can place him on, but despite of that, he admits that minimal exertion, or even talking, makes him short of breath. Though he said that not talking much is probably good for him, as his wife who always accompanies him on his visits, laughed with his confession.

As we talked about the deep freeze, he stated that it was too cold outside that the “tulips were shivering.” I told him that it was not yet spring, and so it was not time for the tulips to get out anyway.

When I asked him how he was doing, he said that he was “ready to be planted.”

Was he still talking about the tulips? Or did he mean being “planted 6 feet under ground?”

I know he understands that we have not much to offer him, yet he always come to his appointments, even just to chat with me and my nursing staff. Sometimes I feel that a plain doctor visit gives some of our patients a chance to get off their mundane schedule and provide something to take their mind off their existential misery temporarily. And by merely showing up in our clinic, they let us know that they are still alive.

Don’t get me wrong, I am happy to see them. I know as well, that they are happy to be seen. Or perhaps they are happy just to be here.

Knowing that his condition will only get worse, our discussions wandered to what his advance directives might be. He said that if it comes to a point that he cannot breathe on his own, he does not want to be placed on a ventilator or a machine to keep him alive; and if his heart stops, he said that he does not want to be resuscitated. In other words, he just want to go gently and naturally into the night.

I even offered that I can refer him to Palliative Care Medicine or even Hospice, but he said that he was satisfied with my management and did not feel we need to do anything else at this time.

As I walked out of the exam room, I called out to him, “stay warm!”

He looked at me meaningfully, as if he expects something more.

Quickly realizing my comment, I said that I wanted him to “stay warm” from this arctic temperature. To “stay warm,” that is to keep his sweet and positive disposition. And to “stay warm,” that means staying alive and warm-blooded, and being above ground.

With that I added “I’ll see you in spring.”  I hope the tulips will not be shivering. Nor weeping.

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(*image from pinterest.com)

 

Snowplay

As the old adage goes: if life gives you lemons, make some lemonade.

But what if life gives you snow….IMG_5239

And snow…..

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And more snow!

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Then, make a snowman!

Coming from a tropical country, I admit, I don’t really like snow. I grew up in an eternal summer, and played tumbang preso and patintero in the heat of the sun. I never imagined playing in the snow when I was a kid.

But not my children. They like snow, and love to play in the snow. With “Frozen”-like enthusiasm, my kids built a snowman.

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After several minutes of joyful labor, here it is, our very own, snowman! Meet Bobby. (That’s what my son named him, I could have named him Buboy.)

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Our weather forecast for the next couple of days predicts that our temperature will wander way above the freezing point, so Bobby may not linger that long. In the meantime, we’ll enjoy his company before he turns into slushy.

I think Bobby, our snowman is now ready to play patintero. Who could have guessed that I will put snowman and patintero in a single sentence?

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(*tumbang preso and patintero are Filipino children’s street games)