Manila, My Manila

I have spent my impressionable years in Manila, so there are images of the city that are forever etched in my mind. However, being away for long, those images of the city when I was growing up, may not be the same anymore.

Here are the images of the current Manila that I have witnessed, during my last visit home:

There are constructions everywhere I look. The old neighborhood has been changed with high-rise buildings and condominium complexes. This has altered the landscape of the city I used to know. You may argue that this is a sign of progress. Or is it?

Here is a ghostly image of the Manila skyline in the morning haze. Or in a more blunt term, in the polluted morning smog.

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Even the bay area looks different. For one, with all the land reclamation projects, the sea has been pushed farther and farther away.

Believe it or not, this is Manila Bay. It looks pristine and inviting, at least from the distance. Though I wouldn’t dare take a dip on it still.

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Many of the roads and passageways I used to go to, also looks different. Of course the traffic is the same if not even worse. But instead of posting a gnarled-up traffic scene, I decided to post a picture of a widely open road for a change. It is more refreshing, isn’t it?

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Even my old stomping ground, shows signs of progress. Here is the Metro Rail Transit (MRT) station in front of SM City Santa Mesa. This mall, which is formerly known as SM Centerpoint, had just opened when I was in college. Having lived near Santa Mesa, I frequented this place a lot, though the MRT was not there yet at that time.IMG_1606

I got to experience to ride the MRT and the LRT during my last visit, which I believe is the best way to travel through the metro, as it is faster and mostly unaffected by the unpredictable Manila traffic. The trains can be very crowded though, especially during rush hours, that you can almost exchange faces with the passengers beside you.

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Of course, I also rode the jeepney, and the tricycle once again, not just for the nostalgic feel, but that’s the only way of transportation where I needed to go.

I also visited places that have been a fond memory of my youth, like the Rizal Park or also known as Luneta. (See previous post about Luneta here.) Here’s the new dancing fountain of Luneta.IMG_1843

Even the more than 400 year-old university where I spent my college and medical school years looks different. Here’s the “new” look of the University of Santo Tomas.

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With all the new swanky shopping malls and eateries, there are even places in the metro that are pictures of opulence. Here’s a nice restaurant where my classmate from high school brought my wife and I out.

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Even old establishments have been updated and improved. Here is the lobby of the Sofitel Manila, which was used to be known as Philippine Plaza.

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It was in one of the ballrooms of this hotel that was converted into a testing center, where I took the United States Medical Licensure Exam (USMLE), about 20 years ago. Passing it was my ticket in obtaining post-graduate training in the US.

With the seeming images of changes, progress, and even luxury, it is hard to ignore the solemn part, that some facts have never changed. Like the state of the poor in the city.

Here is a scene I used to know, and sadly to say, still very much exists. If you note, the shanties are quite a stark contrast to the tall buildings in the distance in this photo.

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Among all the changes that I have seen, there is one thing that has not changed for me. Even after years of living abroad, Manila will always be considered my home, for here is where my heart is. 

Here is the paramount image of Manila for me: the street where I grew up in. This is where the dream started.

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I may have lived in many places after I left the city, and I don’t know where else will this life’s journey will take me, but I will always be the boy from Manila.

Alma Mater

After finishing high school, I entered an old historic university whose campus was located in Manila. There I spent the next seven formative years of my youth – three years in College of Science (Biology-Accelerated) and four years in College of Medicine and Surgery.

It was more than twenty years ago since I left the university’s portals, and I have not visited it again, until now…..

As we entered the main gate in Espana Street, the familiar Arch of the Centuries greeted me. I was back in University of Santo Tomas.

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arch of the centuries

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arch of the centuries in its original location when the school was still in Intramuros

University of Santo Tomas is the oldest existing university in Asia. It was founded in 1611. In 2011, it celebrated its 400th year anniversary. Many of the beautification updates that I found were perhaps results from that celebration.

As I passed through the roads and pathways that were brightly lit with beautiful lights for the holiday, I mused on the hundred of times I walked through these passageways in the past in my quest for illumination.

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The monument of Bishop Miguel de Benavides stands in front of the main building. His pioneering desire to establish an educational institution paved the way to the founding of this university. This statue was originally unveiled in 1891, when the school was still in its original location in Intramuros.

I remember many times in my school days that I passed and communed with this statue with doubt and discouragement of where my future lies, and he always directed me “up.”

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statue of Miguel de Benavides, with his right hand pointing towards heaven

The Main Building, which functions as the university’s administrative center and houses the Faculty of Pharmacy and the College of Science, is arguably the most imposing structure in the campus. It was built in the 1920’s and first classes were held in this building in 1927.

Because of the big cross on the center tower of the building and with statues perched on its rooftop, it is often mistaken as the university church by people visiting the campus.

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The Main Building with its holiday lights

During the height of World War II, when the Japanese Imperial Army occupied Manila, UST was converted to an internment camp for a couple of years. The university was finally liberated in 1945.

Who knows how many soldiers died in this hallowed building during the war? No wonder there were many stories that goes around about unusual occurrences as well as experiences by students that they felt they were being watched. Or maybe they were being watched to discourage them from cheating during exams.

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old photo of Main Building

Part of my precious memories were at the University Hospital, where my eyes were opened to the wonderful world of Medicine, but was also enlightened to the harrowing truth of sickness and suffering.

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University Hospital

On that clear December night, with all the festive lights and glitters, it was a solemn moment for me to return to the place where I received the light.

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(*old photos of UST taken from internet)

My Entourage

When you watch medical drama on TV, like House M.D. (no, I don’t watch medical drama, for that will remind me of work, and that is not relaxing), you will see a team of doctors round and deliberate on each patient. That may not be necessarily true everywhere, but that is the case in academic hospitals.

I remember when I was a 4th year medical student in the Philippines at UST, when a senior attending physician make his rounds on teaching patients (patients that are managed by training physicians), he takes with him all the residents, interns and medical students on service. This can be 10-15 people (it’s a crowd) all in all.

In our culture, the attending physicians are treated like demigods, and some of them act like gods. They command fear in our hearts and strike terror, that we, mere mortals would shake and tremble in their presence. The residents would even assign us duties during this fanfare rounds. One student will be fanning the attending (it could be hot and humid in the charity wards), one student will be carrying the patient chart, an intern will be writing all the orders in the chart, and we then have to take turns on asking relevant questions (which were rehearsed!) to the attending. Of course we should be ready to answer his questions too or else we will get demerits!

Now that I am an attending physician in a teaching hospital here in the US, I am surrounded by an entourage too, when I make my rounds in the ICU. Though, I am far from being treated as a demigod, and I don’t want to be treated as one. My rounds are more relaxed and has more of a collegial atmosphere. I don’t give demerits. During my rounds, no one is shaking, except for maybe the patient whose having shaking chills from a fever.

During this month, my team includes 1 senior resident, 2 interns, 1 medical student, 1 pharmacist, 2 pharmacy students, and a respiratory therapist. Of course the nurses assigned to each individual patient will join us once we are in the room of a particular patient. Once in a while the nutritionist and the social worker will join us too.

It is nice to have all the support and expertise I can get from the team, so we will not miss anything. But it is my responsibility to keep the rounds running smoothly and efficiently, as it can be chaotic at times with a big group of people, and not to mention all the excitement going on at once in the ICU. I want to call it controlled chaos.

During weekends when we are on-call, we don’t have a big entourage when we make our rounds. I am all by my lonesome. Of course there is a resident on-call, a respiratory therapist and pharmacist available, they just don’t join me for rounds. It does not mean it takes me longer to see all the patients, in fact, sometimes I finished much faster. Go figure.

Ayoko ng ROTC

Nuong ako’y nasa kolehiyo pa sa UST, ay gumugol din ako ng dalawang taon ng pagod, sakit ng katawan, at pagbibilad sa araw, para makapasa sa ROTC – Reserve Officers Training Corps (mandatory pa ito noon sa lahat ng kalalakihan sa kolehiyo). May saysay ba ang lahat ng paghihirap, pagpapawis sa init, at  pag-gastos ng maraming oras para makaraos sa ROTC?

Alam kong tinibag ng batas ang ROTC sa bansa noong 2001, at naging ‘optional’ na lang ito, matapos magbuwis ng buhay si Mark Chua, isang estudyante sa UST, matapos niyang isambulat ang katiwalian at baho ng sistema na nagpapatakbo ng ROTC sa UST. Ngunit noong nakaraang linggo lamang, ay may mga balita na gusto muling gawing mandatory ito sa curriculum ng lahat ng kolehiyo.

Kahit noong panahon pa namin ay garapalan na ang corruption (gaya ng inilantad ni Mark Chua) at alam ng lahat na nababayaran ang pagpasa sa ROTC. Hindi mo na kailangan magpakahirap bawat Linggo, magbayad ka lang, pasado ka na. Gusto ko rin sanang makaligtas sa hirap, ngunit hindi ako pinayagan ng tatay kong bayaran na lamang ang ROTC; sabi niya ay may matututunan din daw ako dito. Kaya?

Nag-uumpisa ang aming ROTC  ng sapilitang pagdalo sa misa (kahit hindi ako Katoliko) sa Grandstand ng UST ng alas-7 ng umaga. Bago mag-misa, marami sa mga kadete ang umiihi, este, nagdidilig sa mga halamanan doon (kasi walang pader). Hindi ko nga maisip bakit buhay pa rin yung mga halaman. Ang pagmimisa at pagdidilig ng halaman (minsan ko lang ginawa yun, peks man!) kaya ang natutunan ko sa ROTC?

UST Grandstand

Matapos ang misa, ay simula na ng walang kamatayang pagtayo at pagbibilad sa araw. Sinisimulan ito ng inspeksyon ng uniporme. Gusto nila makintab ang buckle ng aming garrison belt at ng aming combat boots. Sobrang kintab na pwede ka nang manalamin dun. Hindi ko nga maintindahan kung bakit nila gustong makintab ang aming boots, eh maaalikabukan at mapuputikan din naman ito matapos lang ng ilang minuto sa kakamarcha. Pati gupit at ahit kailangan “prescribed cut” ng militar. Pagpapakintab kaya ng combat boots ang natutunan ko sa ROTC?

Hindi rin naman pagtayo at pagmamarcha lang sa init ang ginagawa namin. May paminsan-minsan din namang mga lectures tungkol sa mga pamamalakad at taktika ng military. Meron ding konting lecture sa self-defense (kahit ang alam ko lang na self-defense ay pagtakbo ng mabilis). Minsan din naman kaming humawak ng totoong baril (isang beses lang sa loob ng 2 taon!). Ito ay noong pumunta kami sa Fort Bonifacio at doon nakahawak, sumipat at nakapagpaputok ng M-16 (kahit 10 bala lang ang laan sa bawat isa). Mga taktikang militar kaya ang natutunan ko sa ROTC?

Meron din namang Medic Battalion ang aming ROTC. Mas ‘cool’ ang kanilang uniporme. May puti silang arm band at helmet na may pulang krus. May dala rin silang first aid kit na nakasukbit sa kanilang baywang. Kung may mahihilo o mahimatay, tatawagin ang mga medic. Sila ay dadalhin at pauupuin sa lilim at bibigyan ng bulak na may ammonia para singhutin. May mga kadete nga na nagkukunwaring nahihilo para lang makatiwalag at makaupo sa lilim. Bakit ko ba hindi sinubukan iyon? Kasi ayokong suminghot ng ammonia na aming ipinasisinghot sa mga palaka, na aming dina-dissect sa Zoology. Ang pagiging maabilidad ba ang natutunan ko sa ROTC?

Pag-bandang alas-10 na, ay binibigyan kami ng 30 minutong break. Hindi rin naman pwedeng tumiwalag sa pormasyon, pero pinauupo naman kami sa damo. Tapos lalabas na ang “Refreshment Battalion”. Ito ay batalyon ng mga bading na nagtitinda ng sandwiches at softdrinks. Hindi ko alam kung bakit bading lang ang kinukuha sa batalyong ito. Buti pa sila hindi nakabilad sa init ng ilang oras. Minsan inisip ko na ring magpaka-bading para lang makaligtas sa init. (In this age of liberalism, equality and political correctness, I’m not saying I’m for or against gay, I’m just stating a fact.) Ang pagtanggap ba sa mga ‘gay’ ang aking natutunan sa ROTC?

Pag-malapit nang mag alas-dose ng tanghali, ay kaysa lang kinukuha ang attendance. Ito ay para walang umisip na tumakas. Hindi pare-pareho ang pag-kuha ng  attendance. Minsan ay mayroon na silang listahan at nilalagyan ng check kung ikaw ay present. Minsan pinapasulat kami sa papel ng aming mga pangalan at ito ay sina-submit (paiba-iba rin ang papel na ginagamit nila). Ito ay mga paraan para maiwasan ang pandaraya. Alas-dose impunto, kaysa lang kami pinauuwi. Ang pagiging tapat (sa kabila ng corruption) ba ang aking natutunan sa ROTC?

Pagkaraan nang mahigit 20 taon matapos kong pagdaanan ang ROTC, may kabuluhan kaya ito sa aking buhay ngayon? Aking aaminin, na tama ang aking tatay. Totoo na ako ay may natutunan duon. Dito ko natutunan ang disiplina sa sarili (na hindi nanggagaling sa ibang tao, kundi sa aking sarili mismo). Disiplina na gawin ang mga bagay kahit salungat sa aking kagustuhan, dahil ito ang tama at kinakailangan. Disiplina sa sarili, na gumabay sa aking buhay, at nagdala sa akin kung saan ako nakarating ngayon.

Ayoko ng ROTC. Nuon iyon.

Primum Non Nocere

That’s Latin for “First, do no harm”. This is one of the guiding principles of the practice of Medicine. I remember my Training Director in Internal Medicine making that point time and time again. He said that the first thing you do when you are called into the patient room, is to put your hands in your pocket. This is to prevent you from doing something or writing something without thinking it over first. However, even the simplest task or the most benign procedure can have the potential of disaster.

We were 4th year Medical students in UST. It was our first day in the hospital wards as Medical clerks. My first rotation was in the Neurology ward. We were not allowed to administer medications nor push IV meds. We were not to make decisions of our own without the guidance of our Medical Residents or our attending physicians. We were not to write any orders in the patient’s chart without the co-signature of our supervising Interns. We were not to do any bedside procedure without the supervision of our  seniors. We were there though to take medical history, examine the patient, help monitor them  and take their vital signs. Armed with just stethoscope, sphygmomanometer, and thermometer, how can we do harm? Well, you lack imagination.

As part of our duty, one of my classmates placed the thermometer in the mouth of the patient to check his temperature. This patient has seizure disorder. All of a sudden he went into convulsions with his whole body flailing. He bit the thermometer and crushed it into small pieces. Can you imagine the horror of my classmate! After the seizure was over, we helped our classmate retrieve the broken thermometer in the patient’s mouth (at least what is left of it). I’m not sure if we recovered the mercury or not. Did the patient develop oral lacerations from shattering the thermometer? Did he suffered esophageal or gastric ulcerations from the swallowed glass pieces? Did he develop mercury poisoning? Or did he become a human thermometer? God alone knows.

Over the years, I have heard, have witnessed, and have been involved in medical misadventures. So it is with great diligence and prudence that I perform my duties, and with humbleness I accept my limitations and mistakes. May I always be guided by the precept of “first, do no harm”. So help me God.

(I don’t use oral thermometers anymore. Neither do I use rectal thermometers. I can just imagine what catastrophe I can do with that!)

Once Upon a Starry Night

During my medical clerkship rotation in University of Sto. Tomas (UST), we had a patient in the Neurology ward, a girl named Melissa, who was about 7 or 8 years old. Her little body had been racked by illness, and every day she softly cries in pain,  “Tatay, nanay, ang sakit sakit po ng ulo ko” (Dad, Mom, my head really hurts). But in spite of her suffering she remained courteous to the nurses and doctors, always answering with “po” and “opo”.

Melissa’s family is poor and they can hardly afford the medications let alone the ancillary tests needed for her work-up. Because a head CT scan cost a fortune during those days (and still is today), this imaging study was not immediately performed until the necessary paper works from the social services (SAGIP) has been approved.

I was on-call that night when finally, Melissa was scheduled to have the head CT. It was around 10 at night when we accompanied her to the CT suite. Since she was in the Charity division of the UST hospital and the CT suite is located in the Pay or Main Hospital, we had to take her for a little trip across the campus.

It was a clear night and we took a shortcut across the parking lot instead of the covered hallways. While lying on the stretcher, Melissa saw the beautiful starry sky above us. She requested that we stop for a while at the middle of the open lot, so she can gaze a little bit longer on the glittery sky. And for a moment she forgot her pain while basking in the beauty of a starry night.

Upon entering the main hospital, the hallways were already empty and dimly lit. As we turned a corner we passed a statue of Santo Nino, which was flooded with lights, shining like a beacon in the dark night.

Melissa requested to stop again for a while in front of the statue, so she can linger a little longer as she laid there in awe. “Ang ganda ganda po ng Sto. Nino” (The Sto. Nino looks so beautiful), she stated. It was a sight to see, a frail sick child tortured with disease, finds restful peace by gazing at the face of the Blessed Child.

In the CT suite, our worst suspicion became reality. Melissa’s head CT scan did not just show a brain tumor, but multiple tumors of varying sizes giving the appearance of a starry night. It was a death sentence for the little girl.

It was almost midnight when we headed back to the Charity ward. Melissa’s father, who was with us, was holding back tears, hiding his sorrow from his daughter. We were all silent as we walked our way back, with our heads hung low, except for Melissa who was oblivious of the gravity of her prognosis, and continued to marvel at the starry sky.

When we arrived at the Neurology  ward, Melissa asked her father to sit with her by the window so she can again see the stars. They both sat there until her tired little body gave in to exhaustion and finally falling asleep.

Since then, for a couple of nights, you will find a feeble child in the Neurology ward, sitting by the window, suffering in pain, but finding comfort at the beauty of the stars.

Starry Night by Vincent van Gogh

One morning, as I entered the Neurology ward, I glanced at Melissa’s bed. It was empty, and the mattress was rolled up.

She passed away peacefully into the night.

Looking back after many years, in my dizzying and hurried schedule, I feel that sometimes, I need to stop for a while. Perhaps gaze up into the sky. Appreciate the small things that I have been taking for granted. A beautiful sunrise, a warm sunny day, a sincere smile, or a simple “thank you” from one of my patients. Perhaps I should see the world through the eyes of a child like Melissa – to see the beauty of this world instead of its difficulties; to see the faint light of the stars instead of cursing the dark night.

I was in deep thought when I was interrupted by my son, “Daddy, come outside, look at the full moon”. I cannot miss this. I have to go.