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.

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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.

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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.

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(*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.

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

Invictus

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.

Alapaap

Alapaap.

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.

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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.

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(*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.

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Handiwork of Love

Do you like crochet? (Pronounced crow-shay.) No, it’s not a country in Southeastern Europe, that is Croatia. And no, it’s not something that you eat, that’s croissant. Crochet is a handicraft in which yarn is weaved into a patterned fabric using a hooked needle.

Now we’re clear.

Years ago when we were still in Florida, I received a dainty crochet blanket as a gift. It was made by one of my patients. She learned that my wife and I were expecting a baby boy, and thus she lovingly made a baby blanket for us.

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my son’s crochet blanket

Crocheting and knitting are endeavors that need basic skills, some appropriated time, and a great deal of patience. It also takes vision on how the finished piece would look like while you’re still working on it. Sometimes it is hard to foresee the beautiful final art when what you only have is a small knitted mess, an entangled needle, and lots of balls of yarn.

When my patient gave the baby blanket to us, she told me that it took her a longer time to finish it as she was not as fast as she used to. You may be amazed if I tell you that my patient was ninety-one years old at that time! And frail too. With her advanced age, failing eyesight and with her arthritic hands, it was really a labor of love.

The more amazing part was, according to the patient’s daughter, halfway through the project, she made an error on the pattern but realized it much later. So she uncrocheted (is that a word?) or undo the piece up to the area of the mistake, and weaved it back over again.

What have I done to deserve this gift? I am not sure.

My son is now eleven years old. The crochet blanket sits in our closet. But I cannot give it away, as I know how painstakingly it was created. It is like an heirloom now. Maybe someday my son will use it for his own baby.

More recently, I received another knitted piece. It was a lovely table cover. It was done by a lady that was recovering from cancer. I know that she just finished chemotherapy then, as her hair have not grown back fully, when she gave the gift to me.

However, the lady was not my patient. Her husband is. I diagnosed him with Idiopathic Pulmonary Fibrosis (IPF) – a deadly debilitating lung disease that has no known treatment at this age of modern medicine. Oxygen and comfort measures are the only things we can offer. Most patients die within 3-5 years after the diagnosis. And the sad part is as the lungs progressively fail, they suffocate to death.

Needless to say, my patient, like all other IPF patients, died within a couple of years. Yet his wife, who herself was sick, gave me this beautiful knitted item, which is definitely a handiwork of love. It now sits atop one of our coffee table.

Again, what have I done to deserve this? It should be me offering inspiration and comfort to them. Instead it was I who was inspired by them.

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my knitted table cover gift

Life can be difficult and downright harsh at times. Yet this knitted creations are testaments of human love. They are constant reminder to me, that people, no matter what the circumstances they are in, can be thankful and giving. And this makes this world wonderful, despite of all the ills we find in it.

We may not all learn how to knit or crochet. But maybe we can all learn to live kindly with one another and inspire one another in a loving knit of humanity. What a beautiful handiwork that would be.

The Dead Speaks

Part of the benefits of a physician practicing in a teaching hospital is that there are regularly scheduled academic conferences and meetings where you can attend and learn something.

This morning I attended the Medicine Grand Rounds which was a clinical and pathological presentation of an interesting case.

A senior medical resident talked about a woman admitted in our Intensive Care Unit several weeks ago, who came in very ill. Her condition deteriorated quite rapidly that she died in less than 24 hours after admission despite of all the efforts to save her. An autopsy was requested from the family, to know what caused the patient’s demise, and in addition it was felt that the information from it would help us care for future patients.

After the history and the hospital course was presented, the Pathologist revealed his findings. He showed pictures of the gross and microscopic features of the autopsy. He then gave the verdict on the cause of death. And it was something unexpected. At least for me.

For all the medical specialists, it is the pathologist that always have the correct and final diagnosis. When I was still in medical school, which was more than 20 years ago, I have heard this saying:

“Internists know everything but they don’t do anything.” (Meaning internist like me have all the knowledge but don’t open up and explore the patient to intervene.)

“Surgeons don’t know anything, but do everything.” (Meaning, even though they don’t know yet, they open up and explore the patient to find out.)

“Pathologists know everything, and they do everything, but it is too late.”

Though in fairness to the surgeons, nowadays, with the advent of all the high-tech imaging modalities, like CT scan and MRI, they almost always have all the information they need before they cut open the patient.

I would say that part of a doctor’s learning is from the morgue. In fact, when we have a patient that died and we were granted permission for an autopsy, I make it a point to have my medical residents rotating with me, to come down to the morgue during autopsy and learn what the findings of the pathologist were. I think this is essential for a good training.

I am not trying to gross you out, but that’s the reality of our line of work. Though with all the TV shows, like CSI and NCIS, anybody can witness an autopsy, whether it is real or imagined.

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scene from an episode of NCIS

My first exposure to a real autopsy was when I was a 4th year medical student in University of Santo Tomas, in the Philippines. I was rotating in Forensic Medicine at Fort Bonifacio. There was a victim with multiple gunshots, and two pathologists were performing the autopsy. It takes a lot to gore me out, so it was no big deal to me. Plus we have been exposed and even dissected cadavers in our Anatomy class. By the time we got used to it, we can even eat our lunch in the Anatomy Hall.

While the autopsy was underway, an army sergeant walked in into the morgue with several new army recruits in tow. The sergeant told the recruits to stand in the corner and watch the autopsy so they know what would happen to them if they were killed.

As the pathologists extricate the internal organs one by one to examine them, I have noticed that the new army recruits who were standing in attention started to sway. Their stoic faces started to grimace. Well, who wouldn’t? I guess it was a sort of cruel initiation for them.

Since then I have witnessed several more autopsies over the years, not including what I watched in NCIS. It is not that I enjoy them, but I have to admit, I learn from them.

However I have maintained my utmost respect for the deceased. These bodies that were cut open for us to study were once living individuals. They were persons. They have a name. A purpose. A life. But now gone. Yet in these hallowed halls, they still speak.

Inscribed over many entrances of morgue, medical examiner’s office and anatomy hall is the Latin maxim, “mortui vivos docent,” meaning “the dead teaches the living.” Yes, indeed.

 

Little Girl in ICU

She was sitting in one corner of the room. With big headphones on her ear, and with an iPad in her lap, she appeared to be preoccupied and was in her own little world.

She was a 6-year-old girl, with beautiful blonde locks, sitting in one of our ICU room. Her back was turned from the door entrance and was facing towards the window. But she was not our patient. Her father was.

A couple of feet away from the little girl was her father, lying in the hospital bed. He was half-awake and half-asleep. He was obviously in distress. Every breath was a struggle that slowly zap whatever energy and life remaining in him.

He was 33 years of age, and for the past 6 years had been battling testicular cancer. And I would say that he gave a good fight. A hardy and courageous fight.

Sadly to say, the cancer was winning this battle. It now had spread to his lungs making it more difficult for him to breathe. His CT scan of the chest which I just reviewed prior to entering his room showed hundreds of big and small masses scattered throughout his lungs. The cancer had spread into his brain too causing him severe headaches.

For the past several weeks he had been in and out of the hospital. He continues to receive chemotherapy, though despite of this the cancer continues to progress. During this present hospitalization, he had been admitted to the ICU twice due to problems stemming from the cancer itself or from the complications of its treatment.

As I entered his room with my ICU team, I spoke to him and his young wife who was in his bedside, about the grim situation. We spoke in low tones, almost in whisper, keeping in mind that their little girl was in the same room.

I relayed to them that in spite of everything we have done, we have nothing more to offer, but one. And that is comfort. Meaning, we cannot cure him or treat him, but we can at least make him comfortable. We can offer medications that can take the edge off from his suffering. Something to numb his pain. Or something to blunt his sensation of air-hunger. Something to lessen the agony as he faces the inevitable.

I recommended that we transition to hospice care.

The patient and his wife agreed, as perhaps they know as well that it was time. The wife silently cried, though not so much, trying to compose herself and trying to show strength so not to upset her daughter, who was oblivious of our discussions.

As a parent myself, I can only imagine the predicament my patient and his wife were in. Oh how we wish that we can protect our young kids from the harsh realities of life. Yet I learned that it was the patient’s wish to have her daughter in his room as much as possible.

As we end our talk, the patient’s wife asked me how we doctors can deal with this kind of situations without crying. I softly answered her, “No, we do.” Or at least I speak for myself. Maybe not in front of our patients, but doctors do cry too.

When I exit the room, I glanced at the little girl. I don’t have the heart to disturb her. She was still quietly sitting in her corner of the room. Her back was still turned away from the bed and from us. She still had her big headphones on. Still busy playing on her iPad. Sheltered from what was happening a few feet away, or so it seems. And at least for now.

Does she know that her daddy will not be able to give her piggy back ride anymore? Does she know that he will not be able to chase butterflies with her again? Does she know that he will not be there to teach her how to throw a baseball or how to shoot a basketball? Does she know that her father will not be able to comfort her anymore when when she falls from her bike and scrapes her knee? Does she know that he will not read her bedtime stories anymore? Does she knows that he will not be able to tuck her in bed anymore and kiss her goodnight? Does she know that her father will not be coming home?

She will.

And I hope she has enough memories of what a father’s love is.

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Post note: Two days after I had the talk with the patient and his wife, he suffered a grand-mal seizure and became comatose. He died a few hours later.

(*photo taken somewhere in Grand Teton National Park)

Autumn Leaves

It was a rainy foggy autumn morning. I accompanied my family to our local YMCA, where my children would practice their swimming strokes in the lap pool. My wife went with the kids in the pool area, while I went to the exercise/weight room. I prefer to run than swim. Besides, I feel intimidated when I swim with my doggie-paddle strokes.

After I had my morning jolt, I meant exercise not coffee (exercise is a much better pick-me-upper than caffeine), I went out to the gym’s lobby. I sat down in one of the lounge chairs while I waited for my family. I picked up the newspaper and leisurely read. I wish everyday was like this, where I could take my time, sweat up a bit, then relax and read the morning paper without worrying that I would be late for work.

You see, I have taken some days off for a badly needed break from the stress of work. Even though I was on vacation, we did not plan for any far-away travel, as my kids were doing school and they have many scheduled activities for the week. So I just spent time at home.

People say that sometimes the best vacation, is the one you stay at home (staycation). I agree. It is less expensive too. Much less. For many times we are forced to work more just to pay the expenses we incurred from the last vacation we had.

As I was flipping through the newspaper, I happened to open to the obituary section. I don’t usually read this section. But does anyone? Well, that’s not true. I have a partner who regularly reads through the obituary section and relays to our office staff which of our patients would not be coming back for their follow-up. Because they’re dead. Somehow this updates our record.

For some reason this day I read the obituary. Not surprisingly, I saw a name that was familiar. It was one of our patients in the ICU that we took care for a prolonged period of time. I knew he was really ill. He finally did succumb two days ago.

As I was reading our patient’s obituary, it said there that he was always been the “life of the party” with his “ridiculous jokes.” I did not know that. I have only met him in the hospital and I guess his illness sucked away the life out him, and it was hard not to be grim if you were in the ICU. It also said in the obits that he had a “fierce spirit.” No wonder he fought that long. Yes, the disease may have defeated him in the end, but he did fight a good fight. Beyond what we have expected.

Maybe that was one good thing you gain for reading the obituary – you learn more of the person that you never knew before. But again, it’s too late. They’re gone.

As we arrived home from the gym, the day remained gloomy. I knew the sun was somewhere up in the sky, but the dark clouds and the fog was covering it. It seems like it was still night. The weather was like a perfect setting for an eerie movie. It was Halloween season after all.

For me though it was more than the gloomy morning. I couldn’t shake the thought of our patient that died. In fact, I mused on all the patients that despite of our best efforts, still died. Yet I know and have resigned that that is beyond our control.

Do you think it is easy to forget them? Especially the recent ones? Including the one that died on my procedure table a few days ago? I tell you, it is not. And it can be haunting at times. Not the scary-type of haunting like the Halloween. But haunting, that is poignant like the falling leaves.

I looked out our window. The rain was pouring down. The wind was blowing. And the autumn leaves were falling. One by one to the ground.

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photo taken at our friends’ yard