He Checked Out

It is a lonely world out there.

Yes, we have this modern technology of all the world being connected and wired through broadband networks, internet, Wi-Fi, and all platforms of social media, and yet the proportion of the population suffering from loneliness and depression is on the rise at a rate that we have never seen before.

A couple of weeks ago, a man suffering from Parkinson’s disease presented to the hospital for progressive weakness and failure to thrive. He needed to be placed on a non-invasive ventilator (BiPAP) for respiratory failure. He was admitted to the ICU by my partner the night before.

I went to see the patient the next morning. Before going in to the patient’s room the nurse at the station made a comment to me, “I think he just has no more will to live.”

I examined the patient and I spoke to him. Despite him on the BiPAP mask, he was still able to communicate. After learning more about him, he expressed to me that he wanted to be DNR (Do Not Resuscitate), meaning, to let him go peacefully if his heart stops.

I learned from the patient too that his wife passed away recently. He also had a son that lives in the area but he did not want him contacted. His next of kin that he put on record was his church pastor.

I tried to get him off the non-invasive ventilator but his oxygen saturation dropped so we had to place him back on it. But I told him that we could take him off the BiPAP mask briefly to let him eat, however he said that he had no appetite.

After our initial work-up, his condition was still a conundrum. He was not in congestive heart failure. He had no apparent pneumonia. He had no viral or bacterial infection. He was just unwell.

I think the nurse’s assessment was spot on. The patient simply gave up on living.

That night, a little past midnight, my phone rang. It was one of the ICU nurse telling me that our patient went bradycardic (low heart rate) and then went into PEA (pulseless electrical activity). The nurse commented, “He checked out.” He gave up the ghost and died.

The saddest part as I learned later, was that there were no friends nor family that visited him. There was nobody around, except for our hospital staff, when he died.

I don’t really know what was the story behind this patient. What I know is that he was lonely and that he did not care to live anymore. What if somebody was there for him? Could it have made a difference?

Please take time to show people, specially our loved ones that we care.

(*photo taken from here)

Sights and Sounds of Nashville

I had a short visit and spent two nights in Nashville, Tennessee. I went there for training. No, I am not changing career to be a country singer. My training was about navigational bronchoscopy.

Even though my visit was brief, I still was able to see parts of Nashville.

Here’s Gaylord Opryland Resort and Convention Center.

This iconic hotel offers guests all the excitement and energy of a music city like Nashville under one roof.

It has climate-controlled glass atriums with bending river, falls, fountains, rain forest and an extraordinary selection of dining, shopping and recreation options for a perfect getaway. 

I also visited downtown Nashville and explored Lower Broadway, a major entertainment district well renowned for honky tonks and live country music.

Here’s Johnny Cash’s joint.

Below is Kid Rock’s Honky Tonk place.

The one with the tower is the popular Bridgestone Arena, home to famous country music concerts.

What is a Nashville visit without hearing a live country music band? So I did. I skipped the line dancing though.

However, the best part of my visit to Nashville is not even displayed in these above photos. For the best part of my trip was that I was able to see my best friend in college and medical school. He is now practicing near Nashville as a Pediatrician, and we have not seen each other for more than 20 years. We had a lot of catching up to do and two days was merely not enough.

From Nashville y’all,

Pinoytransplant

(*photos taken with an iPhone)

Tag-lagas: Isang Balik-Tanaw

(Nais ko po muling balikan ang isang akda na aking isinulat walong taon na ang nakalipas, inilathala Oktubre 7, 2011.)

Lumalamig na naman ang simoy ng hangin dito sa amin. Tumitingkad na rin ang mga kulay ng mga dahon at nagiging ginintuan at pula. Unti-unti rin silang nalalagas, nalalaglag at kumakalat sa lupa. Dahan-dahang namang kumukupas ang mga luntiang kulay ng damo sa aming paligid.

Lipas na naman ang tag-araw. Hindi magtatagal ay tagginaw na naman. Lilipad na naman at babalut sa kapaligiran ang puting niyebe.

Nakaupo at nakahalukipkip sa isang sulok ng aming tahanan ang aking nanay. Siya ay dumadalaw sa amin dito sa Amerika, at mahigit dalawang buwan na rin siyang namalagi dito. Ito ay pangatlong pagkakataon niyang makarating dito sa aming lugar. Ang unang dalaw niya dito, mga ilang taon na ang nakalilipas, ay sa kalagitnaan ng tag-lamig, dahil gusto raw niyang masaksihan ang niyebe. Ngunit dahil sa sumusuot sa butong ginaw ng tag-lamig dito, ay ayaw na niyang manatili at maranasang muli ang tagginaw.

Dahil na rin siguro sa kanyang edad, ay hindi na siya mahilig mag-lalabas at mamasyal. Pinipili pa niyang umupo sa isang tabi at maiwan na lamang sa loob ng aming bahay. Masaya na siya sa panonood sa kanyang mga apo, o dumungaw sa bintana at magmasid sa kapaligirang mundo na patuloy sa pag-ikot. Maaring maligaya na siya na magbalik tanaw na lamang sa mga kasaysayan ng kanyang buhay.

Lahat ay nagbabago. Walang sinisino.

Malaki na rin ang ipinagbago ng aking ina mula ng ako’y unang tumulak parito sa Amerika. Hukot na ang kanyang tindig. Mahina na ang kanyang mga kamay: mga kamay na minsang panahon ay malalakas sa pag-aaruga sa aking kabataan. Malabo na rin ang kanyang mga mata: mga matang minsa’y kay linaw sa pagbabantay noon sa aking kalikutan. Purol na rin ang kanyang pandinig: mga tengang dati-rati ay matalas na dumidinig ng aking mga iyak at tawag. Mabagal na rin ang kanyang mga hakbang: mga hakbang na noon ay mabibilis sa paghabol sa aking kamusmusan, para ako’y malayo sa panganib.

Pana-panahon lamang ang lahat, ika nga nila. Ang oras ay tumatakbo, hindi naghihintay kaninuman.

Ilang araw pa ay tutulak na muling pabalik sa Pilipinas ang aking nanay, parang ibong manglalakbay na lumilipad patungong timog upang tumakas sa nagbabadyang masungit na taglamig.

Hindi ko alam kung ilang pag-kikita at ilang pag-papaalam pa ang nalalabi sa amin. Panahon lamang ang makapagsasabi. Sana ay nakapagdulot ako ng kasiyahaan bilang isang anak sa aking ina. Ito lamang ang pinaka-matamis na ala-alang maipapabaon ko sa kanya.

Hindi magtatagal ay mauubos at mahuhulog na rin ang lahat ng dahon sa mga puno, at matitira na lamang ay mga hubad na sanga at tangkay nito. Mananatili itong pawang tigang at patay…… hanggang sa panahon ng tag-sibol at muling magsisimula ang panibagong buhay.

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(*Post note: Ang aking ina ay tuluyan nang namaalam tatlong taon matapos kong isulat ang akdang ito.)

(**autumn photo taken from the web)

Bye at the Window

It’s autumn here in our part of the world and the leaves are changing colors. We see them everyday as we peek through our windows. In fact, we can watch the time go by through our windows and witness not just the changing of the leaves.

When our son was much younger, he would always tell us when we leave to wave goodbye at the window. So as our car would pull out of our driveway, he would be watching at the window and waving goodbye. He would feel bad if we would not wave back at him. It was his some sort of reassurance that everything would be alright. He would do this especially with his mom that it became their tender ritual. So when my wife would leave him even for a very short errand he would say, “Bye at the window, Mom.”

Children seems to have a hard time dealing with being left behind. Remember the first time we let them sleep alone in their bedroom? They would do all kind of delaying tactics so that we would not have to leave them in their room for the night.

Like, “Can you check for spiders on my bed?” “There’s none left, the monster under your bed ate them all.”

Or, “Can I have another drink of water?” “That’s your 5th glass of water, you will pee on the bed.”

I don’t know about you, but our kids did something similar. However we had to be firm in our actions so they would develop that sense of independence.

Maybe you remember when you dropped your kids on their first day of school in kindergarten. Perhaps some of them clung tightly at your skirt or perhaps they wrapped around your leg and would not let go. We have not really experienced dropping our kids in kindergarten since we homeschooled them, but I just wonder what kind of fiasco they could have done.

Our kids are grown up now. Our daughter has been gone for a few years and is almost done with college, while our son is a junior in high school. He still home schools, but he now attends some Advanced Placement classes in a community college nearby. He also drives now, and a couple of months ago his driver’s license was upgraded that he can drive all by himself but still has a restriction that he cannot drive alone after midnight or before five o’clock in the morning.

Few weeks ago, my son humorously told my wife (*in a deeper voice too*), “Bye at the window, Mom.” But this time it was he who was leaving, and my wife was the one waving goodbye at the window.

My wife said that it really felt weird and different this time. She felt so nostalgic as my son was pulling out of our driveway and she waved goodbye at the window for the longest time until the car made a turn at the street corner and disappeared from her sight.

There is definitely a twinge of sadness on these rites of passage. Yet, they must come to pass.

I think we had it wrong all along. It is not our kids, but it is us parents who have a hard time letting go.

(*photo taken by my wife as my son drives away)

A Landmark Run

The 2-hour time barrier to finish a full marathon was broken. A feat that was considered for long as impossible for humans, was conquered two days ago by a Kenyan runner, Eliud Kipchoge. He ran 26.2 miles in a blistering time of 1 hour 59 minutes and 40 seconds. What Kipchoge did was compared to Neal Armstrong walking in the moon and Sir Edmund Hillary reaching the summit of Mount Everest, for indeed it was a significant achievement. He inspired many that “no human is limited.”

I participate in marathons every year in the fall. I run the half-marathon event and I have already completed 7 of them. Except this year, I did not register to join as I did not have enough time to train. My excuse is that I am busy reviewing for my Sleep Boards which by the way is less than a month from today.

However, I did not stop running totally as I still do my regular 2 to 3 miles run at least twice a week. The longest run I made this year is only 5 miles. Since I have now a gadget that tells me my pace and monitors my heart rate continuously, I can even track if I may be pushing myself too hard.

According to experts, you should keep your heart rate between 70% to 85% of your target maximum heart rate during vigorous excercise. To calculate for your maximum heart rate, you subtract your age from 220. So for me my maximum heart rate should be around 170. Though sometimes my heart rate speeds up to 170-180 when I am running, so I have to slow down. It’s either I am pushing too hard or I am still not conditioned or trained enough.

I even brought my running shoes during my short visit in California. Besides, running gives you a chance to enjoy the sun outside and the view around you. My run may not be a landmark like of Kipchoge, but at least I can take photos of landmarks while I run.

Here’s the scenery when I ran in California where my aunt lives (photos taken 10 days ago):

Here’s the scenery here in my home in Iowa (photos taken yesterday):

I will never run as fast as Kipchoge, not even in my imagination, but I will keep on running. Maybe I should stop taking photos so I could run faster. Nah!

(* photos taken with an iPhone)

A Warm Lunch

I have been back to work this week after a brief break when I went to California to visit my aunt.

(photo taken when we drove to the airport to fly back home)

I have been seeing patients all day in the hospital for the past few days and it has been hectic. We have already seen the first case of the flu admitted in our hospital this season and we are bracing for a more brutal time ahead as the wintry air have started to blow.

I don’t like to bash hospital food, but if I have a chance to eat somewhere else besides the hospital cafeteria, I would do so. I wish there is something like the Manila Sunset Grille (see previous post) in the hospital grounds for that would be bliss.

But I have a busy schedule, and going out of the hospital to get lunch is much of a hassle plus I don’t have much time to spare. So regularly I just go to the hospital cafeteria to grab something to eat just to avoid hypoglycemia. I don’t care if it tastes like cardboard as long as the food is edible. Usually I would inhale my food and then continue my hospital rounds.

Yesterday I was in the hospital cafeteria to get lunch. It was still not that bad as I still had time for lunch for there were rare times that I don’t. The lines were long when I went there. As I head down to the cashier, I was getting impatient as the line was not moving as fast as I wanted. In front of me was an old frail lady who moves gingerly slow. She was taking a longer time as she dug deeply into her purse. It was like watching the character of the sloth who moves in slow-motion in the Disney movie Zootopia.

After the old lady handed her money to the cashier which felt like an eternity to me, she took a look at me. I was wearing my white doctor’s lab coat with my to-go box on one hand and a bottle of water on the other. Then the old lady softly told the cashier that she wanted to pay for my food, as she appreciates people who works in the hospital.

I felt like ice-cold water was poured on the fiery coals on my head. I was having unpleasant mood and yet this lady showed me goodness. Shame on me!

Since I knew the cashier as I am a regular in the cafeteria, I told her not to let the lady pay for my meal. I thanked the lady though but politely declined her offer. I told her that I should be the one paying for her meal, and that I really appreciate her gesture.

Yes, there is still goodness in this world. This old lady made me believe again in human kindness.

I still quickly gulped down my food. But I leisurely savor the warm affection I was served.

A Taste of Home

There are certain things that can evoke strong feelings of homesickness for Filipino expatriates like me. For some it may be witnessing the Manila sunset at Manila Bay. For others it could be the traditional Filipino foods. Maybe for some it is the “fragrant” smell of the kanal and estero (kanya-kanyang trip lang yan).

Last week, I ate some traditional Fililipino food and saw Manila sunset. Manila Sunset Grille, that is!

Manila Sunset Grille is a Filipino restaurant chain with branches mostly in California. I wish they would expand here to the Midwest. Maybe in Iowa?

I flew to California and spent a week there to assist my aunt who underwent cataract surgery. She did not really needed much assistance, except that she was unable to drive for a few days. Driving her around was not a big deal, except that her car is a stick shift sports sedan and I have not driven a stick shift for more than 20 years. But I managed.

It did not stop me either when she suggested that we go and eat at the Manila Sunset Grille even though it was quite a drive through heavy traffic and busy freeways. Stick shift and all, I was determined to go.

Below is what I ordered:

I know, lumpiang sariwa, bibingka and halo-halo may not necessarily go together, but that’s what I have not tasted for a while.

And while I was savoring these food, Jose Mari Chan’s songs were playing over head which adds more to the nostalgic feel. One particular song that stroke a chord was “Christmas in Our Hearts.”

Perhaps it was more than the traditional home food and the Manila sunset that I was really missing. And it’s definitely not the kanal and estero.

(*photos taken with an iPhone)

Brighter Sunrise After A Storm

We are blessed to have a scenic view in front of our home. Many times after a difficult day, all I want to do is sit at home and stare beyond the horizon.

When we were looking for a place to live 15 years ago, I made a decision to get this house after standing outside at the front, before even seeing what it looks like inside. For me, if you don’t like the layout of the house, you can always renovate or change it, but not the location or the view. You cannot just place an ocean or a mountain in front of your house. Or maybe you can, but that will be a great undertaking to create an ocean or move a mountain.

When we moved in, one of the movers complimented our view. He said that it be better still if a lightning would strike the two trees which are actually in my neighbors yard, and that would give us an unobstructed view of the river valley below. Though I told him we were already satisfied with what we have.

One thing that I really enjoy here is watching the sunrise right in front of our porch. It is just so magical (photo below, taken autumn of last year).

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However, there would be times of the year that the sunrise would be blocked by my neighbor’s trees. Because as you know the sunrise (and sunset) is not always in the exact location throughout the year. Remember our earth is tilted 23.5 degrees on its axis, so as it revolves the sun’s path across the horizon changes.

Here’s another beautiful sunrise (photo below, taken spring of this year). I know it is partially obstructed by my neighbor’s trees, yet it is still majestic, isn’t it?

Few weeks ago we had thunderstorms and gusty winds in our area. It broke some branches of out trees and flattened some of our plants. It downed some trees in our neighborhood too, including the one of our neighbors’. Yes, the one right in front of our house. So our neighbor has no recourse but to cut down the whole tree.

As I have said before, storms are part of life. We will go through some that will almost break down our will and flattened our spirits. But if we weather them we could have a brighter outlook, a more glorious sunrise, if you will.

I feel bad for the downed tree and for our neighbor, but not too much. For now that the tree in front of our house is gone, we have a less obstructed view of the valley (photo below). Storms can indeed bring brighter sunrise, literally.

Here is a time-lapse that my wife took of the magnificent sunrise.

Old Stomping Ground

In my last post, I already alluded that I went back to New York last weekend. Besides attending a program in honor of a retiring beloved Pastor, this trip also gave me the opportunity to visit my old stomping ground.

When we were in New York about two decades ago, we lived in “the Hamptons.” But before you think of that exclusive and ritzy place in Long Island for the rich and famous, I don’t mean that.

This is the Hampton I meant – Hampton Street in Queens, New York.

We lived in one of these apartment complexes.

My wife and I also visited “Ihawan,” one of the several Filipino restaurants in the neighborhood where we used to frequent before. We had a hearty (as in heart-attack risk?) breakfast here.

After breakfast, we walked to the hospital where I did part of my medical training. I even went inside and check out the place. There was much changes here since the time I left.

Then we hopped on the number 7 train of the New York City Metro. This line of train is on the top of the street instead of being underground, at least in this part of town.

We rode the train and boarded off here, the Grand Central Terminal in Manhattan.

People here are always rushing, and time seems to be incessantly fleeting in this place. Except for us now, as we had time to kill and just relax.

We then walked through New York City midtown and end up in Bryant Park. We were also in this place last December where our kids went ice skating. This place looks very different in the summer as instead of an ice skating rink, there is lawn grass.

We just sat down here and did some people watching. There were even some ballet dancers practicing at the park.

Then we headed down to Time Square area as we wanted to see a “new” establishment there. We heard it opened in October of last year. Was it an earth-shaking institution or such an epic landmark that it forever altered the face of Time Square? I don’t know, you tell me.

Perhaps we were just hankering for that certain taste of home. We were greeted inside by this happy guy.

That sums up our short visit to the city. Until next time…….

From New York City,

Pinoytransplant

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(*all photos taken with an iPhone)