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 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)

 

Groundhog Shadow

It is Groundhog Day today.

If you have no idea what Groundhog Day is, you probably not alone. I admit, when I was still in the Philippines, I have no clue what is a groundhog. I know “ground,” and I know “hog,” but a groundhog? What on earth is that? And a day celebrating this creature?

When I came to America, I came to know what a groundhog is. I even came face to face with a groundhog. For he lives right underneath my porch! (See previous post)

Here is my neighbor groundhog, sunbathing in my porch. This photo was taken a couple of summers ago.

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I guess you only care for Groundhog Day if you live in a country with wicked winter, and you’re growing tired of the bone-chilling cold and shoveling snow. According to tradition, during this day, when a groundhog peeps out of its burrow and emerges out, that means spring will come early. However if the groundhog sees his shadow and retreats back to his burrow, that means there is six more weeks of winter.

The largest Groundhog Day celebration is in Punxsutawney, Pennsylvania where the famous resident groundhog named Punxsutawney Phil is watched by a large crowd as he emerges from his hole and predicts the coming of spring.

I woke up this morning and it was negative 6 degrees Fahrenheit outside. To say it is cold is an understatement. The weekend snowstorm just dumped more than a feet of snow in our area.

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Groundhog Day sunrise

I know it is beautiful when you’re inside looking out on this ton of snow. But when you go outside and even drive on this, then that is a different story.

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I had to drive on snow-covered unplowed streets early yesterday morning during the height of the storm, as I was on-call this past weekend. While driving to the hospital, I have noticed several cars stalled in the snow and in the ditch. Without the high ground clearance and all-wheel drive of my vehicle, I may have not made it to work. It pays to have a car that loves to play in the snow. Or you can opt for a reindeer-powered sled.

I heard one of the doctors in our hospital slipped into a ditch yesterday, and had to have her car towed out. She was alright, and made it to the hospital, albeit a little shaken and a lot late. It was such a hassle. I know. Been there, done that.

I even had a patient yesterday that I accepted for transfer to our ICU from an outlying local hospital, that on their way to our hospital, his ambulance fell into a ditch as well. But emergency responders came immediately and pulled the ambulance out of the snow bank. A rescue team rescuing a rescue squad, how about that! Needless to say, my patient made it to our ICU with no added injury to his already life threatening medical condition.

And so today, guess what groundhog Phil saw this morning? His shadow, of course! That means 6 more weeks of this crazy winter.

If I have my way, I’ll chase that nervous groundhog the hell out of his hole, that he will not even see his shadow.

 

 

 

Getting Around Getty

On our last California trip we visited the Getty Center. It is perched on top of a hill of the Santa Monica mountains in Los Angeles. This is one of the two campuses of the J. Paul Getty Museum. The other campus is called the Getty Villa.

Getty Center is a $1.3 billion project that opened to the public in 1997. Admission to the museum is free, though you have to pay for parking. It is like the dinner is free, but you have to pay for the fork and knife.

We parked at the designated parking area which is on the foot of the hill. Then we took a 1-mile tram ride up the hill to the museum. You can also walk from the parking area to the center, but it is a rather steep climb. IMG_5041 The building itself is a work of art. It was designed by architect Richard Meier. IMG_5048 IMG_5047 Below is the central garden of the Getty Center. IMG_5072 The museum houses priceless treasures of art. This includes European paintings, drawings, illuminated manuscripts, sculptures, and decorative art. It also have 19th and 20th-century American and European photographs. IMG_5052 IMG_5051 Below is my favorite subject for paintings. IMG_5050 Nudes? No.The cornucopia of fruits! Silly. IMG_9496_2 The works are from famous artists. From Rembrandt’s portraits… IMG_5054 To Picasso’s abstracts… IMG_9537 To Monet’s impressions…. IMG_9535 And van Gogh’s paintings. IMG_9538 Even if you are not really into arts, you can still enjoy the museum just by looking outside the window, for there is more to see than paintings. IMG_5049 The view from the center is picturesque. From the bustling downtown LA…. IMG_5044 Up to the rugged Santa Monica mountains…. IMG_5042 And to the serene Pacific ocean. IMG_5057 It is also a beautiful location for a photo shoot. IMG_5065 I enjoyed our visit to the Getty Center. And to cap the experience, we skip the tram ride and instead briskly walked down the scenic path back to the parking area. It was breath-taking. Literally.IMG_5061

5 years of blogging

A few years ago, I started on a trip all by myself.

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Then, a few of you followed.

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Later on, several more joined in.

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An adventure that has taken me to sail back to where I came from.

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And to soar to places I thought I can only dreamed of.

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After 5 years, and after more than 500 posts, and more than 130,000 visits, I am still enjoying this ride.

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For all my readers, followers, and even for the chance passengers, thank you for joining me on this journey.

(*all photos taken with an iPhone)

 

 

Looking Beyond X-rays

I looked at her chest x-ray, and knew right there and then that she didn’t have a chance. I have seen bad chest x-rays before, but this time, it was different.

I look at chest x-rays and chest CT scans every day. I review 30 or more each day. It is part of what I do for a living. And it is something that I become good at.

Ever since German physicist Wilhelm Roentgen discovered what he dubbed as “x-radiation” in 1895 we have used this technology in analyzing bones, teeth, and other organs in the human body. It also used to detect cracks in metal in the industry. Now we even use them ubiquitously in all airports for luggage inspections. That’s why bag inspectors know you packed in dried fish without opening your luggage.

But do you know that x-rays can also look into the future? It has nothing to do with radiation-emiting crystal balls.

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It was late August of last year when I went back to the Philippines, not for a vacation but for a medical emergency. The attending physician in the hospital, who knew that I am a doctor myself, led me to the radiology department to show me a chest x-ray of the patient.

It was also here in this same hospital, University of the East Ramon Magsaysay (UERM) Hospital, that 27 years ago, where I picked up a CT scan of the brain of another patient. But at that time I just started medical school. In fact I was only in my first month of my first year of medical school then. Yet even in my untrained eye, I knew that the word “tumor” is not good. Especially if it said it is in the brain.

Now I was back in that hospital, looking at a chest x-ray, one morning that August. I have gained more than 20 years of experience now as a physician. And interpreting chest x-rays has become my expertise.

The chest x-ray the doctor showed me revealed a large tumor, the size of a santol (wild mangosteen) fruit. Not just one, but three! A sign that cancer had spread. A sign of impending doom.

Somehow it felt like I was reading the patient’s obituary, way before her death.

The chest x-ray was my mother’s.

And the CT scan of the head that I picked up 27 years ago? That was my father’s. He died 3 months after I peeked on that head scan.

What is this that I was privileged to see the future through an x-ray, as it gave me an insight of what is to come? Is it a blessing, that I could have prepared for it? Or is it a curse, as I started mourning before everybody else did?

When I broke the news to my mother regarding the results of her chest x-ray, she was not surprised. It was as if she knew it already. She was serene and collected.

My mother was diagnosed with colorectal cancer 5 years ago, and underwent surgery for it. We thought we got rid it. We thought we kick cancer in the butt (no pun intended)!

But we were wrong. It came back. And with a vengeance.

My mother decided to not pursue any further treatment, like chemotherapy or radiation. For there’s no guarantee anyway that it will matter. Somehow she accepted her fate and was at peace with it.

When we took her home from the hospital she even willed herself even though she was weak to accompany me to the airport in Manila when I flew back here to the US. When I embraced her goodbye, I knew it will be our last embrace. Yet she told me, “Anak hindi ako malungkot. Masaya ako dahil nagkita pa uli tayo” (Son, I’m not sad. I’m happy that we saw each other again). She even added that I need not return for her funeral, it was enough that I saw her alive.

A little more than two months after I saw that foretelling chest x-ray, my mother died.

But there are things that the x-ray did not show. It did not show the inner strength and grace that my mother displayed on her last days. It did not show the peace and faith she had even when facing death. It did not show the confidence and hope that she had, that we will see each other again someday, in a glorious place where there’s no more grief and x-rays.