I’m Free

I was on-call last weekend, and it was busy. The ICU was full. Our patients list was quite long. I only got about 8 hours of sleep from Friday to Sunday, that by the end of my 58 hours shift, I was really exhausted. I felt deflated and defeated.

Days like those, I even wonder, “Why am I doing this?”

After having Monday off, I came to the office the next morning and found this on my table:


flowers and a memorial service program

The flowers came from a patient, or should I say from his relatives. My patient passed away. I should be the one sending flowers. But in this occasion, it was the dead and the grieving who gave the flowers.

I guess the family was just grateful and appreciative of the care I gave their loved one. Even if the end result was death.

Day like this, reaffirms why I am doing this.

I have taken care of this patient for almost 10 years. And over the years I saw his constant struggle to breathe, and his progressive decline. By the past year or so I have been seeing him so often in the clinic or in the hospital, that I have come to know him very well. Yet, despite our efforts he continued to get worse.

At the end I knew I have nothing left to offer him, and so we have agreed to place him under hospice care.

He had Chronic Obstructive Pulmonary Disease or COPD.

Damn cigarettes! If there’s any young people here reading this article and are smoking and feels that you’re indestructible, I am pleading to you, please stop smoking. I am a constant witness of the destructive effects of cigarettes and the utter suffering they cause. Whatever pleasure smoking gives, it is not worth it.

Though I would admit, some of the nicest people I came to know were smokers. And that includes my patient. They are just slaves of a bad habit that may not be their own doing.

In the funeral program of my patient that they also sent to me, was a poem by Ann Davidson, printed on it. A poem so apt for my patient. It was entitled “I’m Free.”

Free from the pain. Free from suffering. Free from the disease that tormented him. He was indeed free.

I’m Free

Don’t grieve for me, for now I’m free

I’m following the path God laid for me.

I took His hand when I heard Him call

I turned my back and left it all.

I could not stay another day

To laugh, to love, to work or play.

Tasks left undone must stay that way.

I’ve found that peace at the close of the day.

If my parting has left a void

Then fill it with remembered joy.

A friendship shared, a laugh, a kiss,

Ah, yes, these things I too will miss.

Be not burdened with times of sorrow

I wish you the sunshine of tomorrow,

My life’s been full, I’ve savored much

Good friends, good times, my loved one’s touch.

Perhaps my time seemed all too brief

Don’t lengthen it now with undue grief.

Lift up your heart and share with me.

God wanted me now; He set me free!

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………


 (*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.


(*image from pinterest.com)


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.


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 of 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.

Crash the Board

One late afternoon, when I arrived home, I noticed something lying in our driveway. It was not the fallen autumn leaves that needed to be swept, that caught my attention, but something more strange.

It was a dead bird.


My son was actually the first one to see it and pointed it out to me. As we looked at it closely we have concluded that it was a robin. It also looked healthy and well nourished, so we wondered what caused its demise. Its feathers did not look ruffled so it was unlikely that it was attacked by a predatory bird, like hawk, which abound in our area.

Then like detective Sherlock Holmes and his friend Dr. Watson, we looked at the evidences available to us and formulated a theory of what caused the poor bird’s death. We could have done an autopsy but there was no need for that.

We looked at the dead bird’s body location and its relation to the other surrounding structures. The hard driveway pavement. The soft grass lawn. The nearby garage. Our big oak tree. And the fiberglass basketball goal.

The bird was lying right underneath the basketball goal. And there was some smudge in the fiberglass.


Here is our conclusion: it was a clear sunny day; the robin was flying spiritedly heading to our oak tree; the bird mistakenly looked through the clear fiberglass and flew directly into it; the robin fell to the hard pavement and died.

That, or Dwight Howard swatted it down from its flight.

We know that skyscrapers have caused several birds to crashed to their death when they fly smack into the glass windows. The wind turbines that we erected to generate energy has caused many winged wild life deaths as well. On the reverse side, there are several reported airplane accidents, especially small aircrafts, crashing down when they hit a flock of birds. I suppose that still is unfortunate on the part of the birds.

I like my basketball goal though. I am not going to take it down. It has given me and my son so many hours of fun playing on it. But to this poor creature, it caused its death. Life can be cruel at times, I guess.

In basketball, there is a term “crash the board,” which means to get the rebound, or the act of rebounding the ball. This little birdie gave that term a whole new meaning.

I will remember and will pay respect to this poor soul, every time I play and crash the board.


(*all photos taken with iPhone)

Huling Paalam

Paalam na sa mga kamay na nag-ugoy sa ‘king duyan,

Nag-aruga, kumupkop, humaplos at nagpatahan,

Mga kamay na gumabay sa aking mga unang hakbang,

Hanggang sa lumaki’t naging responsableng mamamayan.


Paalam na sa mga paang walang pagod sa pagsunod,

Humahabol sa akin para ‘di mahulog at matalisod,

Hanggang sa ako’y makatayong matatag at matayog,

Mga paang wala rin sawang ako’y iniluluhod.


Paalam na sa mga matang laging mapagmasid,

Mula sa aking kamusmusan, ako’y inilayo sa panganib,

Mga matang dumanas din ng luha at pasakit,

Ngunit ngayo’y nagpahinga na at tahimik nang pumikit.


Paalam na sa mga labi na sa aki’y humalik,

Humimok, pumuri, at sa aki’y tumangkilik,

Mga labing ‘di rin nagkulang sa bigay na pangaral,

At lagi akong sambit sa kanyang mga dasal.


Paalam na sa mga tengang sa akin ay duminig,

Mula sa sangol kong iyak, hanggang sa lumaking tinig,

Nakinig sa aking mga talumpati, awit, hikbi, at hinaing,

Ang tulang handog na ito, sana ay iyong marinig.


Paalam na sa pusong labis na nagmahal,

Sa akin at pati na rin sa aking mga minamahal,

Ang pusong ito, ngayon ay tuluyan nang namayapa,

Ngunit pag-ibig na dulot ay hindi maluluma.


Paalam na, paalam na, o aking ina,

Alam kong hindi na tayo muling magkikita,

Kundi doon na sa pinagpalang bagong umaga,

Doon kayo, pati na ni ama’y, muling makakasama.


(*this poem was written and read for my mother’s eulogy)


You are a formidable foe. That we will admit. For five years we bask in the glory that we have defeated you. That we have eradicated you!

Or so we thought.

But you came back. Even with a vengeance. Now your are in a stance to take what was denied of you for the past five years. You are so ready to take your kill. You are again victorious.

But you are wrong!

You did not defeat us. We did not cower in your presence. We have fought a good fight. We looked at you in the eye and in spite of you always lurking in the shadows, we lived our lives to the fullest.

Our faith grew deeper. Our hope soared higher. Our ties grew stronger. We laughed. We loved. We lived!

And that you cannot take away from us.

So tell your friend, Death, that we are not afraid of him too. “O death where is thy sting, o grave, where is thy victory?”

The body may be broken, but not our spirits. As for you, Cancer, you never conquered us! slide.001 * Invictus is Latin for unconquered. It is also a poem by 19th century English poet William Ernest Henley. He wrote the poem while he laid in a hospital bed battling a life-threatening illness.

** Dedicated to my mother, on her last dance.



Iyan ang aking nakita, sa pagdungaw ko sa bintana. Muli akong nasa himpapawid. Lumilipad. Naglalakbay. Pabalik sa aking lupang sinilangan.

Isip ko ay lumilipad at naglalakbay din. Ngunit hindi tulad ng eroplanong aking sinasakyan na mapayapang tumatahak sa mga alapaap, ang biyahe ng aking isip ay maligalig at matagtag.

Mula nang ako’y lumisan ng ating bansa, dalampung taon na ang nakalilipas, ay maraming beses na rin naman akong nakapagbalik-bayan. At lagi sa aking pagbabalik ay may bitbit itong galak at pananabik. Galak na muli akong tatapak sa lupang tinubuan. At pananabik na makita muli ang iniwang pamilya’t mga kaibigan.

Kahit nang ako’y umuwi noong nakaraang Nobyembre bilang isang medical volunteer para tumulong sa mga nasalanta ni Yolanda, ang naramdaman ko’y hamon na may kahalo pa ring pananabik. Pananabik na makapagbigay ng lunas at ginhawa sa mga kababayang nasakuna ng bagyo.

Ngunit kaka-iba ang pagkakataong ito ng aking pagbabalik. Walang galak. Walang panananabik. Kundi pagkabahala sa kakaibang bagyo na aming sasagupain.

May katiyakan naman ang aking patutunguhan. May katiyakan rin ang oras ng aking pagdating at paglapag sa Maynila. Ngunit hindi ko tiyak kung ano ang aking daratnan. Hindi ko rin tiyak kung gaanong kaikling panahon pa ang sa amin ay inilaan.

Pero ganyan daw talaga ang buhay. Walang katiyakan.

Hindi ko sasabihing hindi ko batid na darating din ang pagkakataong kagaya nito. Ngunit katulad ninyo, ako’y nagnanais at umaasa na sana ay malayo pa ang takipsilim. Sana ay magtagal pa ang tag-araw. Sana ay hindi pa matapos ang awit. Sana ay mahaba pa ang sayaw. Sana……..

Subalit tanggapin man natin o hindi, ang lahat ay may hangganan at may katapusan.

Maraming bagyo na rin naman ang aming pinagdaanan. At kahit gaano kalupit ang hagupit ng unos, ito ay nakakaya ring bunuin. At kahit dumadapa sa dumadaang delubyo ay muli rin namang nakakabangon.

Hindi lang bagyong kagaya ni Ondoy o Yolanda ang aking tinutukoy.

Ngunit kahit gaano pa kaitim ang mga ulap na kumumubli sa liwanag, at kahit gaano kalakas ang sigwa na yumayanig sa pagod na nating katauhan, at kahit gaano pa kahaba ang gabi, ay ating tatandaan na lagi pa ring may bukang-liwayway sa kabila ng mga alapaap.


Atin na lang ding isipin na sa ibabaw ng mga alapaap ay palaging nakangiti ang araw. Sa ibabaw ng mga alapaap ay laging mapayapa. Sa ibabaw ng mga alapaap ay walang nang bagyo. Walang nang pagkakasakit. Walang nang paghihinagpis. Walang na ring pagtangis.

Malapit nang lumapag ang aking eroplanong linululanan. Malapit na rin akong humalik muli sa inang-lupa na aking sinilangan. Muli rin akong hahalik sa mukha ng aking ina na sa akin ay nagsilang.

Sana ay magkita pa kami. Sana ay abutan ko pa siya………..bago siya maglakbay sa ibabaw ng mga alapaap.


(*photo taken at 30,000 feet)

Post Note 1: nagpang-abot pa kami.

Post Note 2: delayed at on-hold ang kanyang “byahe.”


Sa Dating Tagpuan

Nasaan ka na aking mahal,

Ako ba’y iyo nang nalimutan?

Ako sa iyo’y naghihintay,

Dito sa dati nating tagpuan.


Kamusta ka na aking sinta,

Ikaw ba ay mayroon nang iba?

Hindi sa ako ay nagdadamot,

Ayaw kitang maging malungkot.


Sumasagi pa ba sa ‘yong isipan,

Ating makukulay na nakaraan?

Hanap-hanap tunog ng ‘yong mga yapak,

Matamis mong tinig, pati na halakhak.


Nasasabik sa iyong halimuyak,

At sa dala-dala mong bulaklak,

Matagal-tagal na silang nalanta,

Ang samyo nila ay nawala na.


Dito sa taas ng tahimik na burol,

Sa lilim ng malalaking punong kahoy,

Dito sana’y muli mo akong dalawin,

Huling hantungan ko’y muling dungawin.

IMG_3674(*photo taken at a nearby small cemetery)