Yes, I still carry a pager or also known as a beeper. A system prescribed and hospital provided pager. Really? Really.

In this day and age of  mobile phones and smart phones, it is hard to believe that I still lug this dinosaur-like device on my hip. Why is this antiquated technology of almost half a century ago still exist and still being used?

Even though pagers are out of vogue in many professions, they are still being used especially in medical field. There are several reasons why a pager is still being used. First, in emergencies, an emergency signal or message can be sent to several pager units to respond to the call, like EMT, hospital code team and trauma team.

Secondly, inside buildings that are steel reinforced, or in part of the hospital like in radiology department, wherein the walls are lead insulated, as well as in basements, the cell phone receptions may be spotty. But pagers still works in these locations, making them indispensable.

Thirdly, there may be hospital equipments, especially in the ICU, that cell phones signals can interfere and disrupt. This is the reason why many hospitals do not allow visitors to use their cell phone inside the ICU, similar to why the airplane cabin crew orders passengers to shut off their cell phones during flight. But pagers are perfectly OK. Though I must admit, nowadays the restriction of using cell phones in the ICU is getting lax, especially when the doctors themselves (including me) use their mobile phones there.

Another advantage of pagers is if it goes off, you can read the message and have the option to answer it right away if it is really urgent, or you can delay answering it if it can wait, and continue whatever task you are engaged in. So it does not disrupt your workflow all the time.

But for me, the best thing about beepers is that you can turn it off when you’re not working or not on call.  It is harder to turn off the cell phone as it may not just for business but also for personal use. Plus if you are a doctor, you don’t want to give your cell phone number to your patients, right? That will be like tying a rock in your neck and jumping in a river.

Back to my dropped pager. After it accidentally fell, it broke into several pieces. Did I say accidentally?

Since it was the weekend I have no way of  replacing it right away. And since I was on call, I must have a working pager. So I tried to put back the pieces of my beeper together with duct tape! I tell you, duct tape can fix anything – fractured eyeglasses, broken toys, leaking pipes, loose gadgets, gossiping lips…..gossiping lips?

I was really surprised that after I taped my broken pager together that it still worked. It was actually working! Maybe in the back of my mind, I was hoping that my pager will stay broken, so I can be free from being on call. Wishful thinking.

It was a busy weekend and my duct-taped pager went off a hundred times or more. The calls kept on coming. My pager kept on beeping. I was really tempted to drop my beeper to the ground, this time more forcefully. But it did survive the weekend call. And so did I. Came Monday, I replaced it with a new one.

Maybe that’s another advantage of a pager. It can withstand the abuse of being “accidentally” dropped and still work. I will not dare do that to my i-Phone, which I also carry with me all the time.

fast lanes

The other day, I was really in a hurry. As I was preparing for the day, I hastily brushed my teeth and skipped the flossing (I know my dentist will not be proud of me) and was able to save about 2 minutes. I skipped breakfast altogether and shaved off another 15 minutes.

I zoomed down the Interstate pushing my car speed a little over the speed limit (OK it was only 5-9 miles/hour above the limit), and swerved through lanes, and was able to save about 3 minutes of commute. I arrived just in time for the early morning Grand Rounds. I snatched a banana at the foyer before entering the auditorium and ate it while listening in the meeting.

What followed the conference was a very busy day with lots of patients to see. During lunch I grab a fast-food type of meal in the hospital cafeteria and ate in front of a computer in the doctor’s lounge, while doing some of my paper works, office tasks and hospital documentation. I believe I saved about 20 minutes doing my work while eating (or inhaling?) my food, in my down time.

Call it fast (like Flash) or call it efficiency, but I did finish all my work in time and I was able to go home on time. Again I zoomed down the highway and again cut down 2 minutes of travel time. I am thankful that traffic in Des Moines does not crawl like in Manila, New York City or Los Angeles, where precious time are wasted sitting idle in traffic.

My wife asked me for an errand and so I stopped at the grocery store, on my way home. I was lucky for a car was pulling out of the parking lot and I slipped into its spot which was near the entrance, and thus probably saving 1 minute on searching for a parking slot. After getting what I needed at the store, I headed to the express checkout lane and saved 2 more minutes.

I arrived home safe and sound, after a fast and furious day.

All in all, I saved 45 minutes during that day. Now, what did I do with all those minutes saved? I spent it all – all 45 minutes, and then some more, another 75 minutes – in front of the TV! I usually don’t watch television much, but it is the NBA playoffs. At least, that is my excuse.

But this kept me thinking. Isn’t it ironic that we always complain that we don’t have enough time and yet we waste whatever time we have, recklessly? I think it is not as important how much time we save, than what we do to that time.

I really should spend my time doing more things of significance, like practicing that piano duet piece with my daughter, or work on my third language, so I don’t have to call the Spanish interpreter so often at work, or maybe just fix the long overdue pesky dripping bathroom faucet. I will. After the NBA finals.

(*photo from here)

Camping and mountaineering may not be a big cultural thing among Filipinos, but it has become a tradition in our family. In the school where I went to, camping is a yearly event. And I went to each one of them starting from 4th grade in elementary up until I finished high school. We had church camping as well. Going mountain climbing was also part of these trips. I have climbed to the peak Mt. Makiling, Mt. Makulot and Mt. Banahaw in the Philippines, and they were enchanting. A far cry from Smokey Mountain of Manila.

It is not surprising that I continued this camping and mountain hiking tradition with my own family here in the US. We went camping, almost every year, when we were living in New Jersey, New York, Florida, and now here in Iowa. It does not matter what season, for we camped in the spring, summer, fall and even early winter. Last weekend, my family, together with three other families (total of 11 kids) went for our spring camping.

Camping may not be appealing to many people. Who in their right mind would leave the comfort of their home, and their warm bed, and go and sleep in a tent with bugs and all, and freeze in the cold night? And call it fun? We do.

The weather was perfect during our camping, for it did not rain, though it dip down in the 40′s Fahrenheit in the early morning when we were out in the wild. But we were prepared and well-equipt.

We have a big and spacious tent, and I would not say that it is not without comfort.

our big tent, which can sleep 6 people comfortably

it can be cozy inside, especially when the campfire is near

We have air mattresses, so we don’t have to feel the rocks and uneveness of the dirt when we lay down. Our kids have warm sleeping bags that can be toasty inside even when the temperature is down in the 40′s.

plenty of room for our family of four

We even have a lantern inside the tent.

How about food and preparation of food? I would say that we are far from cooking like the cavemen did. Of course we can cook our food the old fashion way in the open fire.

roasting hotdogs

grilling in the open fire

Cooking in the open fire is fun, but it can take long and laborious. So for good measure we also brought a portable propane gas stove. The modern conveniences of camping!

our trusted propane stove

heating up water for the hot chocolate in the cold morning

We also brought lots of prepared food that we don’t have to cook, like adobo, brownies, cookies, and even cake. I know, I know, not your typical camping meal. So we have bountiful food that we are far from going hungry.

plenty of food on our table

What is camping without taking a hike through the forest and mountain? This year we went to the Backbone State Park near Lamont Iowa. It is Iowa’s oldest state park, dedicated in 1919. The park is more than 2000 acres and has 21 miles trail for hiking. It also has cliffs that climbers and rappellers can find challenging.

me and the trail sign

walking through the woods (“diwata ng gubat”- that’s actually my wife)

hiking under the shadow of a huge rock

open spaces overlooking a cliff

tight spaces between rocks

my best impression of Spiderman

conquering the rock

jumping from rock to rock

The trail even has a cave. It was not a big cavernous cave though. It was small and tight that you have to bend and crawl in the dark most of the way. Too claustrophobic and muddy for me. And it has bats. Yes, a bat cave! But no bat mobile in there.

climbing the trail leading to the cave

bending low to enter the cave

After crawling in the cave and getting dirty, we headed down the nearby creek to clean up. The water is clear and cold.

refreshing stream

We did not encounter much wild animals, just swarm of insects and birds flying around that filled the trail with their bird calls. No cougar, no elk, no bear (yes, there have been reports of black bear in Iowa), and no beaver that we spotted. (Though there are a lot of cows grazing in the prairie just outside the State Park.) But we did see sign of beaver marks around.

This tree was definitely chomped by a beaver.

After all the walking, climbing, jumping, and crouching, we needed some break time.

This type of break? (Don’t worry its all for effects. No fauna nor flora were endangered)

No. This type of break.

I know these camping trips and hiking can be exhausting, but they are also rejuvenating. Until the next call of the wild.

heeding the call of the wild

Isang gabing bilog ang buwan, ako ay lumabas at naupo sa aming bangko, doon sa harap ng aming bahay. Sa halip na ilaw ng poste ng Meralco, ay liwanag ng buwan ang tumatanglaw sa aking buong kapaligiran. Maaaninag din ang mangilan-ngilang bituin na kumikinang, kahit pa nasasapawan ang kanilang ningning ng maliwanag na buwan. Hindi mga dikit-dikit na bahay at lupon ng mga taong tambay ang aking tanaw kundi malawak na bakanteng lupain at mga punong kumakaway, ang sa akin ay nakatambad.

nagbibilad sa liwanag ng buwan (photo taken of the Supermoon 5/5/12)

Ibang iba na nga ang aking paligid, kumpara sa kinamulatan kong tahanan doon sa Sampaloc.

Imbes na maalinsangan na ihip ng hangin ng Maynila, ay malamig at sariwang simoy ng bukid ng Iowa ang humihimas sa aking buhok (may natira pa naman), mukha, at mga braso. Hindi masangsang na singaw ng nakaimbak na basurang hindi nakokolekta ang aking naaamoy, kundi samyo ng lilac at halimuyak ng bagong tabas na damo. (Hindi damo na sinisinghot ang aking tinutukoy.) Pero kung minsan ay nalalanghap ko rin ang hindi makakailang amoy ng mga baka at kabayo sa hindi kalayuang lugar mula sa aming bahay.

Hindi mga nag-kakaraoke na nag-iinuman sa kanto ang gumagambala sa himig ng gabi, kundi mga palakang naghaharana ang aking naririnig, habang  sumasabay din ang mga kuliglig sa kanilang pagawit. Hindi rin sigaw ng naglalako ng balut, kung hindi hiyaw ng kuwago ang paminsan-minsang bumabasag sa katahimikan ng aking madilim na paligid. Pero sana nga may mag-babalut na maligaw dito…….. Ipagpaumanhin ninyo, naiba ako.

Walang mga lasing na sumusuray-suray na dumadaan sa aming kalye, kundi mga alitaptap ang mga kumukuti-kutitap na nagsasayaw sa aking bakuran. (Meron ding “Alitaptap” doon malapit sa amin sa Sta. Mesa, na “patay-sindi” ang ilaw – pero ito ay beerhouse.) Walang mga tricycle na umaarangkada kahit malalim na ang gabi, kundi mga racoon at usa ang paminsan-minsa’y tumatawid sa aming walang kibo na lansangan.

Bilog na naman ang buwan. Alam kong maraming mga magkasintahan ang magkasama at nagbibilad sa liwanag ng buwan. Sila ay magkahawak kamay…..nangangarap…..nagsusumpaan…… sa ilalim ng buwan. Marami rin ang nabibigo, nababaliw, at sinusumpa ang buwan.

Nuong minsan, maraming taon na ang nakalilipas, ay dumadayo ako doon sa may Metrica, na bahagi pa rin ng Sampaloc. Dinadalaw ko doon ang isang magandang binibini. Hindi ko inaalintana ang mga panganib sa dilim ng gabi, dahil sa pagnanais kong makita ang dilag na naroon. Walang tambay, lasing, adik, trapik, prosisyon, mga demonstrador, brownout, ulan, bagyo, baha ang nakakaawat sa aking pagbisita sa magandang dalaga. May buwan man o wala.

Minsan din sa liwanag ng gabi…… sa lilim ng mga yero, linya ng Meralco, at mga sampayan doon sa Sampaloc……..sa magulo at masikip na kalye ng Metrica….. habang ang aming pabulong na usapan ay nilulunod ng ingay ng masalimuot na siyudad ng Maynila……doon kami ay minsan ding nangarap at nagsumpaan……..sa ilalim ng buwan.

Ano na ang nangyari sa magandang binibini doon sa Metrica? Narito, akin nang kaulayaw sa aming matahimik na lugar dito sa Iowa. Kasama ng aming mga anak. Sa ilalim ng buwan.

lover’s moon

Before she flew over, she scoured the bookstores in Metro Manila looking for a travel guide about Iowa. But she got disappointed. She did not find one. As far as Filipinos in Metro Manila, Iowa is not on their radar. It is not on the map. It does not even exist!

When I was about to move from Florida to Iowa many years ago, I told my friends about it. They asked me where the heck is Iowa, and the next question was if I was going crazy. Then I have to tell them where exactly is Iowa on the map. And as far as their second question is – I’ve been crazy for a long time, nothing new. When I told my folks in the Philippines that I will be moving to Iowa (after living in New Jersey, New York City, Los Angeles, and Florida), they asked me if Iowa is still part of the United States. Yes, many people think Iowa is in another planet!

After years of living here, many of our old friends still cannot recall where we really are. When we get in touch with them, they would ask, where we are living. Ohio? Idaho? Pluto? No. Listen, we live in I-O-W-A.

My friend stayed with us for only a couple of days, but it was enough to give her a lasting impact. After touring her around, she was impressed of the place we live in. After years of telling her of this place, and reading my blogs about this place, she finally saw it herself that Iowa is not just an artifact of my imagination. By the way, this is the friend of mine who encouraged me to start a blog in the first place.

My friend was so impressed that she even wrote an article in her newspaper column in the Manila Standard Today about this place, “A little patch of paradise.” Maybe it was the sight of the horses, and the smell of earth that inspired her to write it, as she is a horse enthusiast. Maybe it was the deafening sound of silence, and the velvety blackness at night in our place, that inspired her and cleared her head to write this. Or maybe it was the white chili soup that my wife cooked that inspired her. Whatever the reason is, I thank her for putting Iowa on the map, at least for Filipinos.

Maybe next time someone is looking for an Iowa travel guide at National bookstore in Manila, he or she will find one.

my patch of paradise (photo taken at one of the Covered Bridges of Madison County)

(*link of “A little patch of paradise” is from on-line edition of Manila Standard Today)

In the few days that followed after our painful loss, a friend of mine asked me if we should cancel the camping for the boys that has been planned for a while, before all the unexpected turn of events had happened. He told me that maybe our family needs to spend time alone in our mourning.

So I asked my wife about this, but she was quick and firm to say that the plans for the boy’s outing should push through. She added that she will be fine while I am away. Besides, my son, who was really looking forward to this trip will be very disappointed if the camping will be postponed.

Yes we grieve for our loss, but we should also continue to celebrate life. For life should go on. No, life MUST go on. I tell you that life can be like butterfly wings: beautiful, yet can be delicate and fragile. But there’s nothing more resilient and tenacious than the human spirit.

Thus me and my son, together with our friends – another father and son team, headed to a lake-side camp and spent two days in the wild. Well it was not really the wild, for we slept in a cabin, that has heat, air-conditioning and even a refrigerator. There were two bunk beds, spacious enough for the four of us. By the way, this trip was only for the boys, but in a few weeks, our whole family, together with other families, will go for a “real” camping, that is sleeping in tents.

One of the main activity in the camp was building a fire. We enjoyed gathering firewood and sticks and starting our own fire like skilled boy scouts. OK, OK, we cheated. We brought lighter and wood fire starter, so it was no sweat at all. We spent hours and hours sitting around the campfire and staring at the fire. We burned woods, sticks, barks, leaves, paper, plastic, paper plates – basically anything we can find to burn. A little open fire brings out the pyromaniac in anybody.

Of course we cooked our meal too in the fire: hotdogs and marshmallows! What is camping without hotdogs and s’mores? We could have sung “Kumbaya” as well, but we’re too busy munching on our “perfectly” cooked food. Well for assurance, just in case we cannot start a fire, my wife did not let us leave without bringing chicken adobo and cooked rice. So we are not really left alone in the wild to fend for ourselves and survive without provisions.

During the early evening, angry rain clouds with gutsy winds came over. Rain fell over our campgrounds . But the rain did not extinguish our fire nor did it dampen our spirits. The rainfall did not spoil our fun, it just made the night more interesting. My son and his friend grab the umbrellas (yes, we even had umbrellas!) and frolic and dance around the fire. It was a mix of Native American fire dance and Gene Kelly’s Singin’ in the Rain. Minutes later, the clouds rolled away, and the twinkling stars appeared up in the sky.

This experience just reminded me that in life, even when the winds blow and rain pours, if we just hold on for a little longer and keep our flame burning, we will make it through, and we will see the stars again.

We also spent at least a couple of hours biking (we did hauled our bikes along) around the lake which has a nice bike trail, a loop of about 6-7 miles. Along the trail there was a covered bridge, an old round barn, farmlands, parks, beautiful lake-side houses, and of course the lake. It was certainly a scenic bike ride. Halfway through the trail, there was even a cozy diner that serve breakfast, lunch and dinner. So we were far from starving at all!

We did not do any water activity like fishing, kayaking or swimming as it was still too cold for the season. There are many pictures hanging on the wall of the cozy diner exhibiting photos of people showing off their prized catch from the lake, indicating that this place is a prime location for fishing. Maybe we will do that when we return some other time, so we will have big fish stories to brag about. Or should I say “fishy” stories.

As we were going home, I asked my son if he enjoyed our trip. He gave me a wide grin. I don’t need to ask more.

Life indeed continues.

Why does a rainbow fades before it can show,

Why did you say goodbye before we can say hello,

We haven’t even embraced you, why do you have to go?

Why Ella Grace, oh why?

You came unexpectedly, and left more unexpectedly,

But you brought us expectant joy, even for so briefly,

You showed us how to dream again, and all the possibility,

That life indeed is wonderful. Yes, definitely!

Thank you Ella Grace, thank you.

We can never know your face, even how much we try,

We can only imagine hearing your laughter and your cry,

We wish to cuddle you close, and feel your beating heart,

A heartbeat that was snuffed out, not long after it start.

Goodbye Ella Grace. Goodbye.

We really don’t understand, but we submissively accept,

That you are not meant to live and be born on this earth,

But someday when all our tears and sorrows are taken,

Your mom and I will look for you, there in heaven.

We’ll see you, Ella Grace, we will see you.

*For all of you who shared in our family’s joy and sorrow, thank you.

As I ponder on my yet another birthday, I cannot deny the fact that I am not getting any younger. In a few more years, I’ll hit the big 5-0. Then not far along, I will be in the retirement age. And I wish to retire early too. Then after that, what? The “golden” years? Somehow this “gold rush” is nothing I want to rush into. Is it really all downhill from here?

But there’s a lot to be thankful for. I have chased my dream and is living it. Nothing more can I ask for. (Or maybe that one dream of being a rock star got away.) I have a wonderful wife. I have two wonderful kids. The kids are grown up and in a few years they will be off to college and off on their own. I am healthy, or I think I am, and I have never felt better. Except for some ache here, and there, and here, and here, and …….Sorry I digress.

Over the years I have received some awesome birthday gifts. A full army fatigue uniform with matching toy machine gun when I was three. Did I tell you I dreamed of being a soldier when I was a small boy? A battery operated toy fighter jet plane that run in circles and spread open its wings, given by my Ninong, when I was six. I love it, even though I wish it could also fly. A red bicycle when I was eleven. I rode that bike until I was in college, and I even spray painted it purple once with the help of my friends. Purple? Don’t ask.

My favorite birthday gifts though are not cool toys, or some preppy clothes, or expensive gadgets. It is far more priceless than that.

About 2 weeks before my 31st birthday, my eldest child, my daughter, was born. It was an early birthday gift really, and it was a marvelous gift. A gift that just gets more precious as the years goes by. What could be a better gift?

Then nine years ago, exactly on my 36th birthday, my youngest child, my son, was born. It is a gift that keeps on giving. Because my son shares the same birthday with me, since then my birthday celebration turned into a children’s party or pushed into a secondary event. But I don’t mind. I don’t mind it at all.

Life begets life. Wonderful gifts of life. Nothing else can top those birthday gifts, right? Well I was proven wrong!

On this most recent birthday of mine, or just about that time, my wife and I had a surprise. It knocked my socks off and sent me into a tailspin! Quite unexpected, but it is a pleasant surprise.

I know I am getting old, but nothing makes you younger than this kind of life changing event. My wife and I may have shock and apprehensions initially, but now it is turning into delightful anticipation.

My two kids are getting excited too, for they know that love is never divided. It only gets multiplied.

The flowers are blooming. The grass is growing. The birds are singing. It is spring time. Life begins again. In diapers.

spring time in our home

“Tulad ng isang ibon, tao ri’y lumilipad. Pangarap ang tanging nais, na marating at matupad.” (Tao, originally by Sampaguita)

Parang kailan lamang ay palaboy-laboy ako sa mga kalsada ng Maynila. Parang kahapon lamang ay kasa-kasama ko ang aking mga barkadang kinalakihan. Parang kailan lang ay mag-kakakuntsaba kami sa aming mga batang kalokohan.

Ngunit nang kami ay magkagulang na, kailangan nang salubungin ang mga hamon sa buhay. Namulat sa mundong malupit ang atas, at mabangis ang kumpetisyon. May mga panibagong mga resposibilidad na sa amin ay ipinabalikat. Kailangan itong tuwangin at harapin.

“Dapat ka bang mangibang bayan? Dito ba’y walang kang mapaglagyan? Bakit pa iiwanan ang lupang tinubuan, dito ka natuto ng iyong mga kalokohan. Baka akala mo’y ganun lamang ang mabuhay sa ibang bayan.” (Pinay, originally by Florante)

Matagal-tagal ko ring pinagtuos-tuos ang mga katagang iyan ni Florante. Ngunit dahil na rin sa mahigpit na pangangailangan, at sa mga pangarap na nais habulin, ay napagdesisyunang makipagsapalaran sa ibang bayan.

Magkahalong saya at lungkot ang aking nadama sa aking pag-alis. Saya, dahil mararating ko ang kabilang ibayo ng dalampasigan ng mundo. Ngunit lungkot, dahil kailangang iwan ang mga pamilya’t kaibigan at ang lupa kong kinamulatan.

“Ngunit ika’y maalala, sa mga kwento mong madrama. At hindi malilimutan ang iyong mga kalokohan. At ika’y pag-uusapan at pagtatawanan. Ngunit mangungulila, sa iyong paglisan.” (Ang Buhay Nga Naman, Noel Cabangon)

Lumipas ang mga maraming taon ng paninirahan sa ibang bansa. Subalit kahit sa pagdaan ng mahabang panahon, lagi pa ring sumasamagi sa aking isipan ang lupang aking sinilangan. At sa pagkakataong katulad nito, ay hindi pa rin maiiwasan ang lungkot at kurot sa aking puso na maalala ang mga iniwang mga kamag-anak, kabarkada at bayan.

Kamusta na kaya ang aking sambayanan? Saan na kaya ang aking mga katoto’t mga kaibigan? Tutuong pinakupas na ng panahon ang aming pagbubuklod. Kupas na rin ang aming mga kwento at alaala. Nalimutan na rin kaya ng kahapon ang lahat ng aming mga pinagdaanan at pinagsamahan? Huwag naman sana.

“Lumilipas ang panahon, kabiyak ng ating gunita. Mga puno’t halaman, bakit kailangan lumisan? Panapanahon ang pagkakataon, maibabalik ba ang kahapon.” (Kanlungan, Noel Cabangon)

Kailan ko kaya makikita muli ang aking mga iniwang mahal sa buhay? Kailan ko kaya muli makakasama at muling makipagtawanan sa aking mga kaibigan? Kailan ko kaya muli masisilayan ang lupang Pilipinas? Kailan kaya ako magbabalik sa ating bansa?

Heto na ako. Nasa himpapawid. Lumilipad, lulan ng eroplano. Bumibyahe pabalik sa aming tahanan.

“Huwag sanang hadlangan, ang aking nilalandas, sapagkat ako’y sabik sa aking sinilangan. Bayan ko, nahan ko, ako ngayon’y nag-iisa, nais kong magbalik sa iyo, bayan ko.” (Pagbabalik, originally by Asin)

Sandaling oras na lamang ay matatapos na ang aking paglalakbay. Ilang oras na lang ay lalapag na ang aming eroplano. Sandali na lamang at muling tutungtong ang aking mga paa sa lupa. Tatapak na kaya akong muli sa aking lupang tinubuan?

O hindi! Hindi pa rin pala! Sapagkat tahanan pala sa Iowa ang destinasyon ng eroplanong aking sinasakyan.

Sana naman, sa susunod kong paglipad, Pilipinas na ang aking lalapagan.

*****

(*thoughts from 30,000 feet during our flight from Boston to Des Moines)

(**all songs are quoted from Noel Cabangon’s album, Biyahe)

Ultrasound, which uses sound waves for imaging, is not by any means a new technology. Man is not the only creature to use sound waves to detect objects either. Whales, dolphins, and bats use sonar to echolocate and navigate their way. The term ultrasound applies to sound waves that is beyond the audible range of human hearing which is 20,000 Herts. The frequencies used in medical diagnostic ultrasonography is 2 to 18 mega Hertz (2,000,000 to 18,000,000 Hertz). These sound waves are really beyond what we can hear, even for bat ears, which can hear up to 120,000 Hertz.

When we think of ultrasound or ultrasonography, we usually think of the technology of imaging babies. This imaging using sound waves is invaluable in assessing the developing fetus as it does not use potentially harmful x-rays. Another popular medical use of this technology is imaging of the beating heart, which is called 2-dimensional echocardiography. But with the advancing technology, the ultrasound probes are getting smaller and smaller that they are now mounted on flexible scopes, and can be inserted to almost anywhere in the body. Yes, anywhere you can think of.

The course that I attended is about bronchoscopic use of ultrasound or Endobronchial Ultrasound (EBUS). The ultrasound probe, which is as small as a pencil eraser, is mounted at the tip of a bronchoscope. There are many other applications of ultrasound in my  field of specialty, especially its use in the Intensive Care, but that was a separate course that I took about two years ago.

Bronchoscopy is the procedure that uses a bronchoscope, a flexible fiber-optic tubular instrument, with a video camera and light on its tip, which is 2 feet long and half as thin as your pinkie finger, to visualize and examine directly the inside of the air passages and lungs without surgical incision. It is through this that we can also biopsy the lungs, or a lung mass,or a lymph node inside the chest cavity. This scope is inserted through the nose or mouth and is advanced down the throat (larynx) and into the air passages (trachea and bronchi) of the lungs. Of course the patient is sedated for this. We are not that sadistic.

With EBUS added to the bronchoscope, aside from viewing directly the inside of the lungs, we can also obtain ultrasound images to locate tumors (not babies!) and lymph nodes, and accurately biopsy them. It is really a neat technology.

bronchoscopy (photo credit from University of Iowa website)

Even though I am trained and already skilled with bronchoscopy, EBUS was not even developed or was in its infancy stage when I was doing my training in Pulmonary more than 12 years ago. However in the past five to seven years, this technology is getting used more and more, and is becoming mainstream practice in taking biopsy of lymph nodes or tumors that cannot be reached before, except through surgery by a thoracic surgeon. Therefore I want to learn this skill to be updated, competent and competitive in my field of practice. Who says “you can’t teach an old dog new tricks?”

When doing bronchoscopy and EBUS, we insert the fiber-optic scope with the ultrasound probe into the patient while we look into the video monitor. It requires a good hand-eye coordination, just like when you are playing a video game. I guess playing those video games when I was younger  have helped me with this skill. And they say that there’s nothing good that comes from video games? Just don’t let my son know this, or else he will use this against me when we tell him he is spending too much time playing.

I don’t know what other technology will be developed in the future that will affect and change the practice of medicine. Maybe they will develop an instrument that is handheld that is as big as the old Texas scientific calculator, that you can wave over the patient’s body and make an instant diagnosis. Just like the “tricorder” used in Star Trek. Yes, just like in Star Trek.

“Change is the essential process of all existence.” – Spock, Star Trek