I Don’t Know. But That’s Alright.

Not too long ago, I diagnosed a patient with sarcoidosis. She asked me what was the cause of her disease and I offered her that I have two versions of the answer: a short one and a long one. She requested for the short one, which I said “I don’t know”. I went ahead and gave the long answer too, as I can read in her face that she was not satisfied with my short version.

I told her that sarcoidosis results from a specific type of inflammation involving lymphocyte and mononuclear cells forming caseating granuloma, which in some theories said could be triggered by occupational or environmental exposures, while other theories implicate infectious agents, some think it is an auto-immune disease, and some believe it has genetic association — but all theories are not proven, so we really don’t know. I think I made her more confused after that, but she was satisfied with my answer.

There are so many things in this world that we still don’t understand and we don’t have answers to. Of course there are more things that have answers, but you and I, as an individual, may have not just learned it yet. And I think there’s nothing wrong to admit if we don’t know them.

I have been asked by patients questions that I don’t know the answer, and I tell them so, but promised to looked them up and study to provide an explanation for them. I also have been asked by my medical residents and students during hospital rounds, questions that I don’t know the answer and I admit to it. So I tell them I’ll read up on it, or better still, I tell them to research on it, and give us an informal report the next day, so they could learn it better (we tend to retain information better when we read it ourselves rather than hearing it from somebody else) and so I could learn from them too (students can teach their teachers more ways than one, you know).

I remember our Principal during my high school days saying: when we finish high school, we think we know everything; when we graduate from college, we find out that we know something but not everything; after graduate school, we realize we really know very little, but so does everybody else. I find that statement very true, for the more knowledge we gain, the more we discern how little we really know.

Einstein explaining how to draw circles and squares?

I don’t think we show our weakness when we admit that we don’t know. But we show our strength when we do something about what we don’t know. We show our true ignorance when we don’t admit that we don’t know, and worse if we don’t do anything about it, or even pretend that we know.

So what is that theory of relativity again? I don’t know. But I’ll look it up (though it does not guarantee I’ll understand it!).

Lesson From A Limping Deer

It was a lazy weekend afternoon. I was just relaxing sitting by the window, and my thoughts were wandering beyond the confines of my dwelling. In fact, one of my favorite form of relaxation (aside from blogging), is just staring blankly beyond the blue. It’s transcendental daydreaming.

My quiet musing was disrupted by the sight of familiar visitors intruding and frolicking in my yard. Even though I’m used to seeing deers in my lawn, something was quite different this time.

As I observed them more closely, I noticed that one of the deer was limping. I hurriedly grabbed our camera, and zoomed in to see closer.

I was surprised that one of the hind legs of the limping deer was rotated backward. It appeared that it was dislocated from the hip or fractured above the knee. (Maybe I’ll have a career in veterinary orthopedics.) Perhaps she had a close encounter with a speeding car: got mesmerized with its headlights and did not move out of the way quickly enough. But she lived and did not become a roadkill. And she had the evidence to show of that tragic encounter.

My first reaction was I felt sorry for the deer. That must be a painful experience. And perhaps more painful to struggle with everyday existence with her injury.

Deers are agile animals. They are fast runners and strong leapers. Thanks to their powerful hind legs. But with only one good hind leg, this deer was in a great disadvantage. How could she survive in this cruel world?

I thought of giving her food by bringing it out in my porch. However, something stopped me. First, I may just scare them away when they see me go out. Second, my wife would probably get mad at me, as I know she really hate those deers, for they massacre her flowers. And besides, by providing food for that deer, would I help her situation or just make it worse?

That deer did not asked for my pity. What she asked for is time and chance, to show me and the other creatures, that she is fine and that she can rise above this tragedy and survive on her own (three) feet.

How about us? Do we gripe that life is unfair and cruel? Or maybe we already had been wounded and injured. Do we give up and wallow in self-pity? Do we continue to parade our open wounds so people would show us mercy? Or do we lick our wounds and rise to the occasion and overcome the adversities that life had dealt us with?

I noticed that the deer was moving with ease and had no apparent distress despite of her injury, telling me somehow that her accident was quite a while back already. As she scurry and bounced away gracefully, albeit with a limp, somehow she showed me, that she had learned to adapt to her condition and that she had already conquered her disability. She had three good legs left, and that’s all she need to survive.

Slow Place, Quick Opinion

I drove to southern Iowa a few days ago to my new outreach clinic, which is about 70 miles (1 hour and 15 minutes drive) from Des Moines. After seeing all my patients there in the morning, I headed then to my other outreach clinic (still in southern Iowa) for the afternoon, which is about 30 minutes away from the first one. I visit these satellite clinics, outside of Des Moines, once every other month. (Most specialty clinics from bigger cities in Iowa reach out to many surrounding small towns to provide services.)

On the way to my afternoon clinic, since it was lunch time, I decided to get food. I passed a small rural town (estimated population: a couple of thousand people) and searched for a place to eat. I looked for something familiar and a restaurant that I knew would be accepting credit card, as I had only a few dollars in cash. Come to think of it, I rarely carry more than $20 in my wallet, as I exist by the swipe of the card.

small Iowa town (photo from New York Times)

I saw a Subway franchise restaurant and stopped there for lunch. The place is quite small and I thought to myself, since it was a small town, it must be a “slow” place. I wondered how can this franchise survive in this “remote” place. Sure enough, when I entered, there was no body sitting in the tables, though there were 2 people in the counter placing their order to-go, ahead of me. That would be OK, I would be eating in my lonesome, but at least a quiet meal.

After I got my order, I sat by the window in an empty restaurant all by myself.  However, I soon observed that one after another, cars started pulling up in the parking lot. A wave of people came trickling in non-stop. In a short period of time, the restaurant was bustling and full of people, and I felt like I was in a crowded downtown joint. Must be a popular place to eat. What did they do, invite the whole community for a lunch party?

As I left the place, there were several people seated in the tables, and there were 42 people (yes, I counted them!) in line, waiting to make their order. A “slow” place huh?

How many times do we quickly form our opinion and judgement on many things, just based on our first impression? And many times it turns out to be wrong.

Treasure in the Junk Mail

buried in junk mail

Few days ago, my wife cleared out all the letters, and junk mail in our table. As we received a lot of materials in the mail, most of them junk mail, they just piled up in our counter. Most of the time, I will separate the bills from the rest of the mail, and put it to my important mail pile. (Yes, all I am searching for in the mail are bills!) How funny that the only “important” letters we receive nowadays are bills.

As there are some personal information on the letters and even in the junk mail, my wife decided to shred them before she toss them away. As she was sorting the pile of papers and envelopes, she found an envelope with a check inside that amounts to more than $1,500 named to us. Yes, more than $1500! The check was sent to us more than 4 months ago. It was from our previous bank lender and it was given back to us, when we refinance our home to a new lender. We have mistakenly stacked it in the junk mail pile.

I cringe at the thought that we almost shred  and throw away  a nice sum of money. We have never thought that there’s something precious buried in that pile of junk letters. And we never even knew that we had it.

Sad to say, there are also other precious things in our homes that we are not aware of, or worse, pay no attention to. Treasures that are buried in the clutter of our busy lives. Valuable moments that are stacked upon by our preoccupation and distraction to “junk mails.” Constant deadlines, overtime at work, games and amusements, TV, computers, and other forms of entertainments heap over and bury this simple treasures.

A quiet family meal time together, a moment reading with your child, tutoring them with their homework, or time just playing with your children — these are the treasures I am talking about.

My son just entered the room with a chessboard in hand. I think I should finish this piece and heed my own advice.

Failed New Year’s Resolutions

Today is already the end of the first month of the new year. We blink and time will pass us by.

How long does a new year’s resolution last? A lifetime? The whole year? How about a few days to a few weeks.

Yesterday, I went to the gym. It was notable how different a couple of weeks made. It was not as crowded as it was a few weeks ago as I wrote in a blog before. Does that mean the people with resolutions to go to the gym and exercise, fizzled out already?

This is a classic example of human endeavor. We just cannot sustain our initial enthusiasm, nor can we finish what we started. Are we doomed to fail? Maybe this is the very reason why some people (that may include me) don’t make new year’s resolution at all: the fear of failing.

However, if we don’t at least make an effort to commit ourselves to change or make resolutions, then I believe that it is more dangerous, for we will not care at all. For me, it is better to make a resolution and fail, than not make one, or not care to change at all. I know no one can claim that he/she has no more room for improvement. For we all do.

Go ahead, try to quit smoking for the thousandth time. Try to exercise more regularly instead of once a year. Try to live more healthy. Try to stop chewing your fingernails. Try to blog everyday (I’m still working on this). Try to take a bath everyday or at least once a week (you have to, for the sake of the people around you). Try to be more patient and loving. Try to make more time for your family. Or just try to be a better person.

If we fail? There’s always the next year. We only really fail, if we completely quit trying.

By the way, who said you can only make resolutions during new year? Start one today.

Walk Fast, Live Long

(The original article is written for a local church newsletter.)

Fish were created to swim, birds were created to fly, and men were created to walk (although some are born to run). Even though most of the land creatures crawl or walk in all fours, human beings stand upright and walk on their two feet. From the dawn of history – from evading our predators, to the present – to strutting on the catwalk, moving on our feet is key to our survival.

We may not think of it much, but there is a lot of science, physics and physiology in standing and walking upright. How a creature can remain vertically steady against gravity without tipping over is already a marvel. And to move by shifting our weight from one foot to the other like an inverted pendulum and remaining perfectly balanced and straight up while walking is really amazing. Sometimes this equilibrium malfunction, like people who suffered stroke, and walking becomes a challenge. Indeed, we are fearfully and wonderfully made.

The most physiologic way of going from point A to point B for humans is by walking (not Segway). It is estimated that an average human being will walk 65,000 to more than 100,000 miles in his lifetime depending on his level of activity. (65,000 miles is almost 3 times the distance around the world.) The thing is the more we walk, the better. Unlike cars, humans last longer with higher mileage.

Studies have showed that the more active we are, the healthier we become, and the longer we live. In one study, researcher analyzed more than four decades of data from the Framingham Heart Study. They found that life expectancy at age 50 for people with medium activity was 1.5 years longer than those with low activity, while the high activity people live 3.5 years longer.

For most people, the optimum walking speed, that is the speed where our kinetic energy  is balanced with our potential energy, is around 3 miles per hour. We may not consciously think on how fast we walk, but our walking speed can be a simple reflection of how healthy we are, or how well our body systems are doing.

In a recent study that was published in Journal of American Medical Association this year, it stated that walking speed predicts life span and health. It was a meta-analysis of 9 separate studies of individuals 65 years or older. The study measured the walking speed of more than 34,000 seniors. They found that for every one-tenth of one meter per second increase in walking speed, survival rates for additional years increased exponentially.

Thus walking faster just not make you reach your destination earlier, or just make you appear that you are a man with a mission. It is also an indication of your longevity.

Let’s walk. And a little bit faster please.

Ang taong naglalakad ng matulin, (kung matinik malalim)………..buhay nama’y mahaba ang aabutin.

Winter Driving

Driving in the winter, especially in snow and ice, can be very challenging. There is no scarier moment in driving than when you turn the steering wheel to one direction but your car heads the other way, or when you hit the brakes but you continue to skid forward, or worse you start to spin. (I have experienced all of the above.)

We had snowstorm again yesterday and today, and the roads were dangerously slippery. There were few minor accidents in the road, that it took me more than an hour to drive to my work both days, a distance that I usually cover in 20 minutes. (I should not complain too much, for in Manila it takes an hour drive, a distance you can walk in 10 minutes.)

In one particular icy stretch of the highway today, I saw several vehicles that have fallen into the ditch. I have noticed that most of the vehicles in the ditch are either pick-up truck or SUV, which is counter intuitive. You would think that these type of vehicles will have an advantage in the snow. I guess the drivers of these vehicles had false sense of security and invulnerability and were driving at speed limit of normal road condition.

In my opinion, in winter driving, more important than the high ground clearance (like in truck and SUV), or the 4 x 4 or all-wheel drive, or by being equipped with winter tires — is using some common sense and a bit of caution.

Retiree’s Regrets

Few nights ago, our group had dinner with one of our former partners who retired a couple of years ago. He appeared healthy and fit than ever and he sounded like he was really enjoying the retiree’s life. After being in practice for over 30 years, he is content for what he had accomplished. When we asked him for some advice, he stated that he had only one regret: that he did not build better and deeper relationships. More meaningful relationship not just with patients, but with partners, other doctors, co-workers, employees and others.

Relationship. This got me thinking. How profound is that advice. Very true, that in our busyness, we don’t really take time to know people that we work with. We don’t know them enough nor we do care enough to know them. We are driven by our productivity, our deadlines, and accomplishing our jobs, that we have no time to build relationships with people.

I don’t think anybody at the end of their career would say, I wish I could have work more days in the office, or submitted one more project on time. Nobody in their deathbed would say, I wish I could have earned another hundred dollars, or another million for that matter. Our regrets would be something much deeper than these. When we are in our deathbed, our 401K, our financial portfolio and even our estate does not mean anything. It will be the relationships we establish with people, that will be treasured.

definitely not my estate

And it is not just the relationship with people at work that is suffering with our busy lives. Even the relationships that really matter, the one we have at home. Many times we forget why we work, and that is to provide for our family. Work is the ‘means’ to support the ‘end’ – our family. But sometimes the ‘means’ becomes the ‘end’, and the supposed ‘end’ (our family), becomes “the end.” How many families have broken because of too much work? Somehow our priorities are mixed up.

I know I will never be the best doctor in the world. I may never be the best doctor in our group. I may not even be the best doctor in our home (who knows if any of my kids will become a doctor someday). But I can be the best husband to my wife, and the best father to my children. And that is what I will strive to be.

I am thankful for the advice of an old and wise doctor. I wish at the end of my career, I will not have the same regrets that he had. Maybe mine would be: I wish I could have played more golf. But I don’t even know how to play golf!

Suwail sa Pamahiin: Barok Edition

1. Huwag ka kanta harap kalan ku ikaw dalaga, baka ikaw asawa tanda lalake.

Hindi masama ang umawit sa harap ng kalan o kapag ikaw ay nagluluto, at walang kinalaman ito sa pag-aasawa ng matandang lalaki. Ang katotohanan ay nakakaalis ng pagod at yamot ang pagkanta. Maliban na lamang kung saksakan ng sintunado kang kumanta; iwasang kumanta ng malakas lalo na’t may mga nakaririnig, at baka itulak ka nila sa kalan.

2. Huwag ka hakbang bata higa. Hindi ito laki.

Hindi totoong kapag ang batang nakahiga o natutulog ay hinakbangan o linaktawan ay magiging bansot ito. Sangayon ako na hindi magandang ugali ang laktawan ang iyong kapwa; subalit kung hindi maiiwasan, mas mabuti namang hakbangan mo sila kaysa iyong tapakan .

3. Ikaw salubong pusa itim, ikaw malas.

Hindi lang mga Pilipino ang naniniwala na malas ang makasalubong ng pusang itim. Ngunit sa Great Britain, para sa kanila, ito ay tanda ng suwerte. Kaya ipamigay o iligaw na ninyo ang lahat ng itim na kuting ninyo sa Britania.

4. Huwag ka kain kambal saging ku ikaw buntis. Baka ikaw anak kambal.

Wala po itong katotohanan. Ang panganganak ng kambal ay walang kinalaman sa iyong kinakain. Ang pagbubuntis ay wala ring kinalaman sa saging. (Hindi kasama sa usapan ang ibang klaseng saging na iniisip mo.)

5. Huwag ka walis ku me patay hangga hindi ito libing.

Hindi ko maintindihan kung bakit ipinagbabawal ang pagwawalis ng bahay kung may nakaburol na patay. Paano na lang kung isang linggo nang nakaburol at gabundok na ang alikabok at dumi sa bahay? Hindi ba mas masama kung hikain na ang mga taong nakikiramay dahil sa dumi at alikabok? Kung vacuum cleaner kaya at hindi walis ang gamitin mo? O baka naman magulantang ang mga naglalamay pati na ang patay sa ingay ng vacuum!

6. Huwag ka kain ku wala ilaw.

Ang pamahiin sa pag-iwas na kumain sa dilim ay sa paniniwala na baka may masamang espiritu kang makasalo. Bagama’t hindi ako naniniwala sa pamahiing ito, ay may praktikal na bahagi ito. Maaaring ikaw ay matinik o makasubo ng bubog, o butiki, o balyena, kung madilim at hindi mo nakikita ang iyong kinakain.

7. Huwag ligpit plato pag dalaga kain pa. Baka ito tanda dalaga.

Hindi magandang ugali ang pagligpitan o urungan ng mga plato kapag kumamain pa ang isang tao. Ito ay pagwawalang galang sa kanila, ngunit walang kinalaman ito sa kanilang hindi pag-aasawa. Pero may mga taong sobrang b…a…g…a…l…  kaya naiinip na ang mga kasama nila at sila’y pinagliligpitan na. Dahil sa kanilang kabagalan kaya sila laging napagiiwanan (pati kaya sa pag-aasawa?).

8. Ikaw sugat Biyernes Santo, hindi ito galing.

Walang katotohanan na kung ikaw ay nasugat sa Biyernes Santo ay hindi ito gagaling. Kung ito ay totoo, di sana lahat ng sugat ng nagpi-pinitensya tuwing mahal na araw ay hindi pa naghihilom hanggang ngayon. Wala na sanang mga nagpipinitensya kung ganoon.

9. Ikaw laki tenga, ikaw haba buhay.

Isang obserbasyon na ang matatanda ay may malalaking tenga. Marahil ito ay dahilan na pagtumatanda ay nawawala ang “elasticity of the skin and tissue”. Kaya pati tenga ay lumalawlaw at nagmumukhang mahaba o malaki. Ngunit hindi dahil sa malaking tenga kaya humaba ang buhay nila, kundi lumaki ang tenga dahil mahaba na ang buhay o tumanda na sila.

10. Huwag ikaw gabi suklay, baka ikaw kalbo.

Huli na ang lahat ng malaman ko ang buwiset na pamahiing ito. Maniwala ka, kahit sampung taon ko nang sinusunod ito at hindi na nagsusuklay sa gabi, ay naubos pa rin ang buhok ko!

Mga Payo Ni Barok

Bago pa naisulat ang makakatang tula ni Balagtas, at bago pa nalikha ang mga malalalim na salawikain ng mga matatanda, ay nauna muna ang kasaysayan at mga payo ni Barok. Dito kaya hinugot ang ating mga salawikain ngayon?

1. Pili ikaw pili, ikaw tapat bungi.

Nasambitla ito ni Barok matapos niyang mapangasawa si Gondina.

2. Ako tanim, ako, bayo, ako saing, iba kain.

Matapos ubusin ni Gondina ang sinaing ni Barok.

3. Ikaw ubos-ubos biyaya, ikaw bukas tunganga.

Nang simutin lahat ni Gondina ang lahat ng kanilang pagkain.

4. Ikli iyo kumot, ikaw tuto baluktot.

Matapos sarilining lahat ni Gondina ang kanilang kumot.

5. Ikaw a gipit, ikaw patalim a kapit.

Nang maghirap na sila Barok. Para kumita ng pera, sinubukan niyang kumain ng espada sa peryahan sa Korokan.

6. Diyos a awa, tao a gawa.

Natutong mag-sikap ni Barok. Naisip niyang magtayo ng sariling negosyo.

7. Huwag mo bilang manok, hangga hindi pisa iklog.

Payo niya nang mag-umpisa ang kanyang negosyong manukan (poultry).

8. Sino a putak, siya a anak.

Matapos mangitlog ang kanyang mga alagang manok.

9. Bayani asugat, lalo atapang.

Matapos masugatan si Barok sa pagtatangol sa kanyang mga manok, nang salakayin ang kanyang poultry ng mga asong gubat.

10. Ikaw wala tiyaga, ikaw wala nilaga.

Matapos maging matagumpay si Barok, at matapos niyang lutuing hard-boiled ang mga itlog.

Tumikwas kaya sa libingan si Balagtas? Itakwil kaya ako ng mga matatanda? O ipahuli kaya ako ng aking Pilipino titser sa aking kapangahasang palitan ang kasaysayan? Abangan sa mga susunod pang mga kabanata……..