Deer at Dusk

Iowa is one of the top five states in the US with the highest deer collision rate. According to one estimate from an insurance company, 1 in 73 drivers in Iowa have reported hitting a deer from July 2017 to June 2018. Oh deer!

Autumn has the highest risk of collisions with deer because that’s when the herd is mostly on the move, though it can happen any time of the year. And dawn and dusk are the most dangerous time of the day as deer are more active during these times.

One day last week, it was dusk and we were on our way home. In one lonely stretch of a country road I spotted a herd of deer standing at the side of the road. I believe they were planning on crossing the road. But it seems they were waiting for our car to be just close enough, and then they would dart off across the road when I have no time to hit the brakes. They can be that crazy, you know. They are also notorious to stop at the middle of the road with their proverbial “deer in the headlights” look.

However, I outsmarted them. I slowed down as I approached where they were standing and even came to a full stop just in case they still would jump right in front of our car. Since there was no other car on the road except us, it was safe for me to stop (even gave a chance for my wife to take photos).

I think I disppointed them, so they turned around instead of pouncing at my poor car.

Scat you rascals! I will not be one of the insurance’s statistics.

More than Tylenol

It was the height of flu season. I was working that weekend, and I was in the hospital for 36 hours straight. We had several patients in the hospital that had complications from the flu. There were five on ventilators due to respiratory failure from Influenza A in our ICU. Two of them were on ECMO.

ECMO is short for extracorporeal membrane oxygen or also known as ECLS, extracorporeal life support. It is an intervention to provide adequate amount of gas exchange or perfusion in patients whose heart and lungs have failed to sustain life. It is done by placing a large bore catheter in the patient’s central vein or artery, where the blood was sucked out from the body, then ran through a machine to bathe it with oxygen, then flow it back to the body.

Saturday morning, I got a call from another hospital for a woman in her 40’s who had Influenza A and who was rapidly deteriorating. She went into respiratory failure and was placed on ventilator. They want to transfer her to our hospital for possible ECMO.

We rarely have two ECMO patients at the same time in our ICU. Even one patient on ECMO makes us busy, so two was really demanding. But a third one at the same time? That never happened before.

I made some phone calls to verify if we have a machine for a third patient and if we have enough resources and staff to handle a third ECMO. After confirming, I was given the green light to accept the patient.

Additional ICU and ECMO staff were called to come in. I called the interventional cardiologist-on-duty who would assist us to put the Avalon catheter, a dual-lumen catheter half as big as a garden hose that goes from the jugular vein and through the heart. The cardiologist in turn called the cath lab to prepare for the arrival of this patient.

Avalon catheter in correct position (image from web)

The patient was flown in via helicopter to our hospital and went straight to the cath lab where me, my ICU and ECMO team, as well as the cardiologist and his cath lab team were waiting.

We were ready for the challenge and eager to make it happen.

While we were doing all this, our patient’s oxygen saturation was only in the 70-80% (below 90% is perilous) despite maximum ventilator support, so we knew we needed to work fast.

However problem struck. Working for more than an hour, we had difficulty placing the Avalon catheter in good position. We tried different approaches with different instruments, but cannot get the ECMO flow going.

I called my other partners over the phone and I probably disturbed their quiet Saturday afternoon off, but I needed some opinion of what else we could do.

After deliberation, we decided that we cannot sustain this patient on ECMO. Perhaps it was her vascular anatomy, or perhaps there was a big clot in her vein. Whatever the reason, we could not proceed.

I went out to the cath lab’s waiting room, and gave the sad news to the patient’s family that we couldn’t do the ECMO. All I could say was that we tried and gave our best, but it was unsuccessful.

I felt that we betrayed this patient and her family. After I thought I moved heaven and earth to get this patient to our hospital, only to end up like this was really deflating.

The worse part was, I knew that without ECMO, this patient had little to no chance of surviving and possibly could be dead in a few hours.

We transferred the patient to the ICU, but we left the big neck catheter in place even though it was not hooked to the machine. We have to wait for the heparin (anticoagualant) we gave when we attempted to start the ECMO, to wear off before we can pull the catheter out.

After about half an hour in the ICU, I was informed that the blood test showed that the heparin had worn off and I can remove the catheter with less risk of bleeding.

When I pulled the Avalon catheter out, I applied direct pressure in the patient’s neck to control the bleeding. I did this for 30 minutes. I was alone in the room with the patient most of that time, with the nurse intermittently coming in and out of the room to adjust the IV pumps or to check on the patient.

All along while I was holding pressure, I was watching the monitor which showed that the patient’s oxygen saturation was staying in the low 80%. I thought death was imminent.

During the time when I was alone with the patient, I felt helpless and defeated. I failed her. We failed her.

Then a thought came to me: I don’t save lives. It was not up to me. Only a higher power determines who will live or die. That’s when I fervently prayed.

With my hands on the patient’s jugular holding pressure, I turned my thoughts to heaven: “God I am nothing, but an instrument of Your healing hand. I failed. But You never fail. I don’t know this patient personally, but I am personally praying for her. Please heal her in my behalf, and let me witness Your awesome power. Amen.”

How many times have we prayed for a sick loved one? But do we really believe God would heal them? Do we add the phrase, “if it is Thy will,” so we wouldn’t get disappointed?

As a doctor, sometimes, I put more faith to the medical intervention than God’s healing. Like when I was bedridden earlier this year due to a bad viral infection, it seemed I had more faith in the Tylenol that I took than in God to take away my fever.

After 30 minutes of holding pressure the bleeding stopped. I left the room and went to see other patients, especially the new ICU admission, a young man in his 20’s who had a bad asthma attack, so bad we had to place him on a ventilator.

As I was busy attending to other patients, I was just waiting to be called back to that particular patient if she goes to cardiac arrest or expires.

More than an hour later, I went back to the room of our failed ECMO patient. I looked at the monitor and her oxygen saturation was 100%. I was amazed! The respiratory therapist told me that she even titrated down the oxygen level on the ventilator to almost half as the patient was really doing good.

I had no other explanation but one: God heard my prayer.

I went down to my call room to be alone. With tears welling in my eyes, I uttered a prayer of thanks. Never would I doubt the power of God again.

He healed my unbelief.

********

Mark 9: 23 -24: Jesus said to him, “If you can believe, all things are possible to him who believes.” Immediately the father of the child cried out and said with tears, “Lord, I believe; help my unbelief!”

*Post Note: Our failed ECMO patient survived. She even did better than the two patients we had on ECMO.

Six Pack

We are still in the midst of winter. Due to very cold weather, I have not gone out for a run for almost a month now. I even have not gone to the gym for several weeks as well, due to consecutive snow storms we had that piled up the snow and ice on our streets making driving a little tricky, especially when its dark.

But I have not been totally inactive even though I have not run or went to the gym. Because lately, I discovered my wife’s exercise videos and I was working out following them here at the comfort of our home. It’s better than not doing anything at all.

Since Jane Fonda produced those workout videos in the 1980’s, there’s a lot of them available. Are you picturing me doing them in my leotards? Sorry to disappoint you, but I am not donning those. Maybe pajamas, but not leotards.

I will not say that they are less intensive than running or doing cardio and lifting weights in the gym. In fact, I find my wife’s workout videos challenging.

One particular workout video series she has is the “Hip Hop Abs.” Yes, they are mostly dance moves, Hip Hop in particular. But if you do it for 30-45 minutes, it is really exhausting. Maybe even more exhausting than running 3 miles.

I also find it challenging since my feet have no rhythm at all. I can’t dance. I have two left feet!

My wife just laughs, for I lack the grace and coordination. But she let me do my thing and even joins me at times, exercising with those workout videos.

I think this Hip Hop Abs is really effective, as I feel the burn in my abdominal muscles and core muscles when I do them. Maybe if I do it long enough I’ll develop those muscular abs just like the workout video instructor. Or maybe I’ll do them until it is warm enough that I can run outside again.

Perhaps some people think that it is a waste of time working out or going to the gym, for there are more important things to do in life.

I remember a quote by Robert Mugabe, former Prime Minister of Zimbabwe. He said, “No girl will choose six pack over six cars….so stop going to the gym and go to work.”

Of course there’s truth to that. But I tend to disagree. What if you can strike a balance and get the best of those two worlds? What if you have both?

Just so you know, I don’t have six cars. I don’t have six pack either. But I’m working on it.

To be clear, I’m not referring to a six pack of beer.

Turo-turo, McDonald’s, at Jollibee

Namayagpag na naman ang mga commercial ng Jollibee nitong nagdaang Valentine’s. Huling-huli kasi ng Jollibee ang kiliti at sintimyento ng mga Pilipino, at siyempre pa pati na rin ang ating panlasa.

Paano ba naging pambansang tambayan ng mga Pilipino ang Jollibee?

Bago mag-bagong taon ay bumisita kami sa New York. Habang ang aming mga anak ay nag-a-iceskating sa Bryant Park sa Midtown Manhattan, ay nabanggit ng isa naming kaibigan na may bagong bukas daw na Jollibee sa lugar na iyon. Kuwento pa nila pinipilahan daw ito. Hindi lang mga Pilipino, pati mga Amerikano at ibang lahi ay nakikipila rin. Siguro curious lang sila kung bakit dinudumog ang Jollibee.

Jollibee in Manhattan (photo from New York Post)

Maraming beses din naman akong pumunta sa mga Jollibee branches dito sa Amerika. Napuntahan ko ang Jollibee sa may West Covina California. Ilang beses na rin akong kumain sa Jollibee sa Chicago. At kumain na rin ako sa Jollibee sa may Woodside New York.

Maliban dito sa Amerika nagbukas na rin ng mga branches ang Jollibee sa iba’t ibang bansa sa Asia, Middle East at Europa.

Nang maliliit pa ang aking mga anak, minsa’y nagbalik-bayan kami at nag birthday sila sa isang Jollibee branch sa may Pasay City. Natuwa naman ang aking mga anak at ang aming mga bisita sa isinagawang party. Maliban sa chicken joy at jolly spaghetti, naaliw rin sila sa pagsasayaw ng masayang bubuyog na si Jollibee.

Noong biglaan din akong umuwi ng Pilipinas, ilang taon nang nakalipas, dahil malubha ang kalagayan ng aking nanay, ay naging comfort food ko ang Jollibee. Kasi may malapit na branch mula sa ospital kung saan nakaratay ang aking nanay. O siguro miss ko lang ang lasa nito.

Hindi ako lumaki na pala-hamburger. Nang ako ay nasa high school pa (early 1980’s), hindi pa masyadong tanyag at iilan pa lamang ang Jollibee branches sa Maynila. Sa katunayan hindi namin ito tambayan dahil walang malapit sa aming eskwela.

Ang aming tambayan noon ay isang turo-turo sa tabi ng aming paaralan. Pero noong kami’y nagbalik para sa aming 25th high school graduation anniversary ay laking gulat ko na isang night club na ang nakatirik sa pwesto ng turo-turo. Ibang luto na pala ang inihahain sa lugar na iyon!

Isa pa sa tambayan ng iba naming kaklaseng pasaway noong high school ay isang esblisimyento na may pangalang “Halina.” Dito sila naglalaro. Isa itong bilyaran. Beer garden din ito. Hindi po ako tumambay doon.

Kahit nang nasa kolehiyo na ako, hindi pa rin Jollibee ang paboritong tambayan ko noon kundi isa uling turo-turo malapit sa UST. “Goodah” ang pangalan nito. Mas mura naman kasi sa turo-turo at lutong bahay pa ang putahe. Siguro mas marami pa ring mga Pilipino ang pipiliin ang turo-turo kaysa fast food, o adobo kaysa hamburger.

Ang unang branch ng Jollibee ay nagbukas noong 1978 sa Cubao. Mula noon ay isa-isa nang sumulpot na parang kabute ang mga branches nito. Kahit pumasok pa ang McDonalds sa ating bansa noong 1981, ay naging matatag pa rin ang Jollibee.

Sa pagputok ng katanyagan ng Jollibee, isama na rin natin ang McDonald’s at Wendy’s, ay nahilig nang kumain ang mga Pilipino ng hamburger at french fries. Naging westernized na ang ating panlasa. Pero iniiba pa rin naman natin ang timpla kahit na western food. Tulad ng spaghetti – ang pinoy spaghetti ay manamis-namis, na hindi tulad ng authentic Italian spaghetti na maasim-asim.

Nang ako’y napadpad na sa Amerika, ay aking natunghayan kung gaano kapalasak ang fast foods dito. Lalo na ang McDonald’s. Kahit sa mga hospital ay may mga branches ito. Sa isang hospital sa New York kung saan ako nag-training, ay may McDonald’s sa mismong floor kung saan ang cardiac cath lab. Kaya’t kung ikaw ay inatake sa puso habang kumakain ng hamburger, ay igugulong ka lang nila sa katabing cath lab.

Para sa inyong kaalaman ang McDonald’s, isang American corporation, ang pinakamalaking fast-food chain sa buong mundo. Sa katunayan lahat ng pinasukan nitong bansa ay halos patayin nito ang mga lokal na kompetisyon. Maliban sa Pilipinas, na Jollibee pa rin ang naghahari. Bakit kaya hindi kayang pataubin ng McDonald’s ang Jollibee kahit pa American hamburger ang kanilang pinaglalabanan?

Dahil kaya mas naaaliw tayo sa bubuyog kaysa sa clown (mascots)? O dahil walang panama sa chicken joy at jolly spaghetti ang kalaban? O nadadala tayo sa mga makabagbag-damdamin na mga commercials? O dahil alam natin na ang Jollibee ay katutubong produktong Pilipino kaya’t tinatangkilik natin ito kaysa sa kumpitensiya? O baka naman mas masarap lang talaga sa ating panlasa ang pagkain nito?

Ano man ang dahilan, naging pambansang tambayan na ng Pinoy ang Jollibee kaysa iba pang fast food chain o restaurant. (Wala po akong komisyon sa Jollibee sa artikulong ito,  pero kung gusto nila akong bigyan ng isang taon na supply ng chickenjoy hindi ko tatanggihan ito.)

Noong ako’y nasa kolehiyo pa, sa harap ng UST Charity Hospital sa may Forbes St. (Lacson Avenue na ngayon) ay may mga lumang bahay na ginagawang boarding houses. Isang araw nagkararoon ng sunog dito, taong 1990 yata iyon. Isa sa aking kaibigan ang nasunugan ng boarding house. Matapos matupok ang lugar na iyon, ang ipinatayong gusali ay hindi na mga bahay, kundi isang malaking McDonalds.

Bulung-bulungan ng iba, dahil hindi mapagiba ang mga lumang bahay para gawing commercial complex kaya raw ito sinunog. Hindi ko sinasabing totoo ito at wala po akong inaakusahan, at lalong hindi ko sinasabing may kinalaman ang McDonald’s o sinuman dito.

Maaring natuwa ang mga estudyante ng UST dahil may malaking McDonald’s na sa harap nito. Hindi nagtagal, isang malaking Jollibee rin ang itinayo katapat nito. Ngayon sangkatutak na fastfoods na ang nasa paligid at pati sa loob ng university. Nandoon pa kaya ang tambayan naming Goodah?

Baka sa susunod, mawala nang lubusan ang mga turo-turo at karinderya. Huwag naman sana.

Nakaw na Tingin

Kumakabog itong dibdib,

Pinagpapawisan ng malamig,

Direksiyon mo’y sinusulyapan,

Kahit pa nakaw na tingin lang.

Masaklap itong kalagayan,

Ako kaya’y mapagbigyan,

Sana ikaw ay mas malapit,

Nang ‘di na masyadong mahirapan.

Pasimple para ‘di mahuli,

Saloobi’y ‘di dapat ipakita,

Bakit kasi hindi nag-aral,

Ngayon sa test nangongopya.

**********

(*Sorry to disappoint you if you thought this poem is about love.)

(**Handog sa lahat ng mga estudyanteng natutuksong mangopya. Hoy, bawal ‘yan!)

Warm Thoughts on a Cold Day

Last Friday, I drove to our new satellite clinic. This was the most distant one so far compared to our other outreach clinics, as it takes an hour and 40 minutes to get there from our main office. I go to an outreach clinic at least once a month.

It was a very cold day for a drive. The outside temperature was -2 degrees Fahrenheit with a wind chill factor of -20 degrees. The wind was brisk and it was blowing the snow that was already plowed to the sides of the road back into the road.

The whole surrounding was white as we had fresh snow that had fallen the past couple of days. There was also a shiny glaze on the branches of the bare trees as in addition to the snowfall, it was preceded by a freezing rain that coated everything with ice, including the roads, which layered underneath the snow. This made the travel more dangerous.

In fact one of my partners cancelled his trip to another one of our outreach clinics a day before mine, due to the snow, sleet and ice.

But on the day of my travel, though it was very cold, it was sunny. Thus I decided to press on. Besides, there were many patients that were waiting and expecting to be seen. Plus, I felt confident in my driving and in my trusty vehicle.

I felt warm though while I was cruising along the wintry rural highways of Iowa. My favorite feature of my car on a very cold day like this was the heated seats along with the reliable heater. In some countries, like in the Philippines, a car airconditioner may be a luxury to keep you cool on a hot day. But where I live now, we can survive without an AC but not without a heater. It is a necessity or we’ll freeze to death.

But there was something more that was keeping me warm besides the heater, the heated seat, and the heated steering wheel. It was the warm thoughts and happy memories of a tropical place I still call home.

Playing on my car radio was streaming music sync from my iPhone from an on-line radio station. What was the radio station I was listening to? Pagudpud Beach Resort Radio Station! (Pagudpud is a place in Ilocos Norte, Philippines with a year round temperature of 70 to 90ºF.)

photo taken few years ago in a beach resort in Ilocos Norte

I could almost hear the lapping waves as they break into the sandy shore and the rushing breeze bristling through the palm trees. A stark contrast from the view of a slew of ice and snow surrounding me. They say that you could take away the boy from the island, but could never take away the island from the boy.

It’s true, I was feeling homesick. It has been three years since I last visited my motherland. Perhaps it is time for a journey back to that very familiar place.

I know I’m not the only one missing home. Most of us, in one way or another, have wandered away and left our comfort zones in pursuit of a dream. And many times in our quest, the path we crossed was not easy, for it was uncertain and unfamiliar.

I was deep in this thought when a familiar song played on the radio:

Hawak-kamay,

Hindi kita iiwan sa paglalakbay,

Dito sa mundong walang katiyakan,

Hawak-kamay,

Di kita bibitiwan sa paglalakbay,

Sa mundo ng kawalan.

That was all I needed to hear, a reassurance that we are not alone in this journey.

I glanced at my car’s GPS. It indicated that I still have 70 miles to go, and an hour more before I reach my destination.

Well, I still have an hour to enjoy this “beach.”

(*lyrics from Hawak Kamay a song by Yeng Constantino)

Mud (Mad) Runner

I am glad that January was over. For many, January is when they intensify their excercise activities as part of their New Year’s resolution of living a more healthy lifesytle. Not for me.

I was practically sick all January. I caught a bug that brought me down on my knees (see previous post) just after New Year’s Day. Then when I was recovering, I caught another virus that put me into another tail spin.

I lost my voice that made me talk in whispers. I am thankful that I did not totally lost my voice as I was still able to blog loudly and clearly. I was also coughing so hard that I think I pulled a muscle, or contused or even broke a rib. Coughing became a nightmare that made me double up in pain. I used a small pillow to push it against where my chest hurts whenever I cough. Breathing was literally painful.

But I am better now. I hope.

Besides me being sick, the weather here in Iowa last January was just plainly awful. Three days ago, our wind chill was – 40ºF. This they say was due to the Polar vortex. In that extreme cold, you can toss boiling water high into the air and it will turn into ice particles before it hit the ground.

However, today is different. Our outside temperature is 50ºF. That is almost a hundred degrees swing in temperature in a matter of few days! You barely need a jacket on.

So what did I do when I got the first chance to go outside? I ran!

Due to temperature way above freezing, all the snow that had accumulated in several weeks have melted and all that was left were a few patches.

The snow was rapidly melting that this created a small rushing spring from snowmelt at the side of this road here.

It was just not me enjoying this warm break. I saw a herd of deer roaming around in the distance. I don’t know where they take refuge when the weather is brutally cold. But no, I am not inviting them in inside my home.

Since it was my first run after about a month of inactivity, I chose to run in the gravel road which is a relatively flat terrain rather than the more challenging up and down hills in some part of my running route.

Yet the moment I stepped into the dirt road, I felt the ground to be soft and soggy from all the snow that have melted. In other words, it was muddy.

It probably was a mistake on my part to run on the dirt road, still I was determined to finish the loop back to my place. I literaly plowed through the mud. I just thought that it was one of the muddy obstacle courses in those Spartan races.

I finished a 2 mile loop albeit my pace was somewhat slow, perhaps due to my deconditioning. But I’m not admitting that, I am blaming the mud that caused me to run slow.

Perhaps I am a little crazy or mad, but I am also now a mud runner.

(*photos taken with an iPhone during my run)

Antarctic Freeze

Yesterday, while sitting in my car when I was parked at the hospital’s parking lot that I took this photo of my dashboard.

The outside temperature was -18ºF (-28ºC)! No wonder I was really cold. But at least it was sunny and it was already warming up. It was -26º F before the sun rose. The wind chill though made it feels like -40º F.

It was dangerously cold that most schools including colleges here in Iowa was closed yesterday. Even the postal service was shut down. Of course hospitals stayed open and I still had to go to work.

Do you know where else had -20º F yesterday? At the South Pole in Antarctica. North Pole was a balmy 5º F!

I should be on the look out for penguins that may be crossing my path anytime soon.

Bracing for Snow

There’s no question that snow is beautiful. It blankets everything in white. But shoveling and clearing your driveway, and worse yet, driving on it is something else. It is at the least treacherous, especially during a major snowstorm with more than a few inches of snowfall.

Iowa State Capitol Building (photo courtesy of KCCI)

However if you live in a place that has significant snow accumulation in winter, like here in Iowa, you need to deal with it. Driving in snow is a skill that you need to develop through experience.

Last week, we had consecutive days of heavy snowfall. There was a lot of cancellation in our clinic appointments as patients decided not to come as they deemed the roads were not safe.

I went home early and sure enough as I was driving down the interstate, there were several cars that were abandoned as they had fallen in the ditch. There were several reports of collisions too. Oh the joy of slipping and sliding in winter driving.

When I arrived home, the snow was still falling. With about 4 or 5 inches on the ground already and no sign of letting up, I called my son down. I told him that we were going to drive in snow.

My son got his driver’s permit a few months ago. He cannot drive alone, but only when there’s an adult in the car. Yet he needs to gain experience to drive in snow. He needs to develop the skill. I thought, this was the perfect opportunity for him to do so.

I am far from being the most expert driver or the most skilled in driving in snow. But I have several years of experience in driving in this weather, and my best qualification to teach him is that I am his father. I know what is best for my kids. Plus our car is an all-wheel drive with high ground clearance, built to play in rough terrain.

First we drove around our neighborhood. I let him slam the brake when we were going downhill and let him feel the car sliding. Of course nobody was on the road except us, so we were never in danger. When my son gained some confidence, we went out in the highway to let him experience real driving in snow with cars tailing and passing us.

After almost an hour of driving, we went home.

Yesterday, I received a phone call from my daughter who was in college a couple of hours away. She said that she was supposed to go somewhere but snow was starting to fall. I sensed some alarm in her voice and she was not feeling confident in driving in snow. She was asking if she should go or not.

My daughter has been driving for a couple of years, but have not driven in snow by herself. If I could only go to where she was, I would, but she was far away. So I did what I think was best. I advised her to drive slowly and carefully. I told her that sooner or later she would have to drive in snow but she should be fine. Besides the snow was a couple of inches only.

Even though I sounded convincing when I talked to her, in my heart I had some fear. But I know I had to let her fly on her own. I know she needs to build her confidence. I know she needs the experience to be independent.

I was relieved when she texted later that she made it to her destination safely.

As parents, we don’t stop parenting even if our children are grown-up. Their challenges may be different now. It’s not about the big spider on the wall anymore, or about a difficult math equation, or a bully in the playground. But their challenges may be bigger. Would I pass this college course, or would I find a job, or would my salary be enough, or would I find a niche in this world?

I hope I have equipped and prepared my children in facing the snowstorms in life. And I don’t mean just driving in snow.