Ice Run

It’s been two months since I ran the half-marathon for this year. But I am proud to say that I have not yet relented on my running for this season. Emphasis on the “yet.” Maybe I just want to stay trim for Christmas. Maybe I want to look good on my vacation photos. Whatever the reason is, I am still running even if it’s already winter here in our part of the world.

But hopping on a treadmill and running for a mile or two in place is really boring. Even running inside an indoor track in our local Y can be dull and uninspiring. So when I saw that the temperature outside this morning was 30º F instead of our usual single digits or teens, I cannot resist to run outside. Besides, there was no snow on the ground and more importantly, no ice. I can run on snow, but not ice (see older post).

When I got out in our front yard, I saw ice! But it was just in our bird bath, which was frozen solid (photo above). The sun was shining though, so it’s a wonderful day to be outside.

As I approached the pond in our housing community, I again noticed that the water was frozen. 

Should I try running on ice? Or perhaps put on a pair of ice skates and glide my way through?

Then I heard some honking. When I looked up I saw a flock of geese. 

They seems to be egging me on – “Run on ice! Run on ice!”

The temperature however was not in the deep freeze. I am not that foolish yet. Again, emphasis on the yet. So no running on thin ice!

As I kept on trucking, I was looking for my deer friends, but they were nowhere to be found. Have they gone some place warmer?

Instead I saw some polar creatures. A penguin and a polar bear! You don’t believe me?

Here they are:

The pengunin and the polar bear seems to be lost in place without the snow. Perhaps like my son they were praying for snow. Lots and lots of it. But for me, I’ll enjoy this relatively warm day without the snow and ice.

Overall, it was a decent day for a morning run. 

After about an hour outside, I came back in and warm myself with the leftover arroz caldo my wife cooked yesterday.

Again, I have my app to document my “cool running.”

(*all photos taken with an iPhone)

Batingaw

O aming minamahal na mga batingaw,

Pinagtanggol ang kalayaan kaya’t umalingawngaw,

Subalit pinilit supilin, kayo’y sa ami’y inagaw,

Sinakal at ginapos para hindi na makasigaw.

                 

Ngunit mga kampana ba’y mapapatahimik,

Alab ng puso ng isang bayan, ito ba’y mapipiit,

Kahit impit na ang mga tinig ito pa ri’y maririnig,

Patuloy na lalaban kahit buhay man ang kapalit.


O Inang Bayan, tayo’y kumanta’t sumayaw,

Kinalagan nang muli ang ating mga batingaw,

Kanilang mga boses muling hihiyaw,

Para sa kalayaan muling aalingawngaw.

(*A tribute to Balangiga bells. Above photo though is not of Balangiga bells, this was taken at Bantay tower in Vigan.)

Cold and Dead

Part of the duty of a medical resident in a teaching hospital is to formally pronounce a patient dead. When a patient dies, the nurse would call the resident-on-call to assess and examine the patient and confirm that he or she is indeed dead. Normally this is done in a timely fashion, within several minutes after the patient breathes his/her last breath, and the resident would chart the time the patient was pronounced dead. This would be the official time of death.

I understand that in a non-teaching hospital the attending doctor would be the one to call. If the doctor is not available, a nursing supervisor or a charge nurse can declare the patient dead. 

You may argue that it does not really take a lot of training to determine if a person is dead. Any reasonable person can discern this. Though there are some people you probably know who look like dead, but I’m not talking about that. So why do we need a doctor or an experienced nurse to pronounce a person dead? I think it is more for a medico-legal purpose.

Of course sometimes your judgement that a person is dead can be challenged  by somebody. The following is an actual exchange of questions and answers as recorded in a court documents:

A lawyer was cross-examining a witness, who was a pathologist.

Q: Doctor, before you performed the autopsy, did you check for a pulse?

A: No.

Q: Did you check for blood pressure?

A: No.

Q: Did you check for breathing?

A: No.

Q: So, then it is possible that the patient was alive when you began the autopsy?

A: No.

Q: How can you be so sure, Doctor?

A: Because his brain was sitting on my desk in a jar.

Q: But could the patient have still been alive, nevertheless?

A: Yes, it is possible that he could have been alive, practicing law somewhere.

Several nights ago, we had a very busy night in the ICU. I believe we had 7 admissions to the ICU in a short span of time. This is in addition to the 20 or more critically-ill patients that we already had in our unit. So “busy” may even be an understatement.

One patient that we had that night had been in the hospital for almost 2 months and had been in and out of the ICU a few times. This time around the family had decided that they would transition to comfort cares and the patient would be taken off life support. So death was imminent and expected.

For some reason, whether the medical resident was not called, or he was so busy at that time, or he was called but forgot to do it promptly, but the patient who was taken off life support was not officially pronounced dead right away. Of course everybody knew that the patient expired – the ICU nurses knew, the family members who were gathered in the room knew, and even the morgue and funeral personnel knew.

Perhaps it was assumed the he was already pronounced dead, so the body was taken down to the morgue within an hour or so after the patient died.

It was not after a few hours later that our medical resident learned that the body of our deceased patient was taken to the morgue without him officially examining the patient and pronouncing him dead.

So what would a diligent medical resident do? 

Our conscientious resident went down to the morgue in the wee hours of the morning to search for the body. He pulled out the body from the freezer. He opened the body bag. He identified the deceased patient. Then he examined the body and pronounced it dead. I know, it sounds like a plot of a horror movie. At least he had an interesting story to tell his co-residents the next morning.

A couple of days ago, I received a notice from a funeral parlor to complete and sign a death certificate. Part of the certificate is to write down the official cause of death. Since I had 3 death certificates to complete that day I checked each of the patient’s hospital electronic medical record to be accurate on what I would write. That was when I read our resident’s note on the chart and I could not help but smile: 

Patient examined in morgue. On exam patient did not respond to verbal or physical stimuli. No heart or lung sounds were heard and patient has no response to painful stimuli. Pupils were fixed and dilated. Patient pronounced dead at 0336.

Since the patient was only officially pronounced dead after a few hours in the morgue’s freezer, should I write “froze to death” as the cause of death?

Of course I did not.

photo taken with an iPhone

(I meant no disrespect to the dead, nor do I make fun of a rather serious situation. I am just relating a light moment in the otherwise morbid world of ICU I lived in.)

Math, We Have A Problem

Love it or hate it, you cannot live without math. It is not only the accountants and the mathematicians that live by it. If you go to the market, you apply math. If you’re a bus conductor or a jeepney driver, you really should know your math. Even if you’re an ordinary salaried employee, you need to know math. Or maybe that’s the reason your salary runs out before the days of the months do, is that you don’t know your math. We simply cannot disregard math.

A couple of weeks ago, a friend of ours shared a math problem in a group chat. This posed a challenge to us, as we all believe that we are math whizzes. Maybe it was more than math prowess that was required, but also some analytical ability and a sprinkle of common sense.

Here is the problem she posted:

What is your answer?

A. 30

B. 20

C. 15

D. 43

E. None of the above, this is a trick question.

F. I don’t know and I don’t care, I hate math.

Looking at the problem and applying the math rules that I remember in solving equations, I easily arrived at an answer. Me and my wife have the same answer,  making us confident that we solved it right.

When we show the math problem to our son, he looked at it intently and said that our answer was wrong. We checked our solution again, and we were positive we were right.

My son told us his answer that I thought was definitely wrong, but he was certain of his answer. He just smiled with a knowing grin, like a cat who swallowed a canary, but he would not divulge to us on how he arrived at his “ridiculous” answer. 

When our friend who posted the math problem gave out the solution, it turned out that our son’s answer was right. We failed math!

How could it be? We were the ones who taught this boy math (we homeschooled our children), and yet the student turned out to be better than the teachers.

Well, it just prove that we are not math geniuses that we believe we are and we are no Einstein.

Hint: It needs good eyesight too to solve this problem. And me and my wife were not wearing our glasses when we try to solve this problem. At least that was our excuse, and we’re sticking to it.

(*For the solution and answer please see the comment section. The image is not mine and I apologize to the owner if there’s a copyright infringement.)


Black Friday

Thanksgiving week is the busiest time for travel in the United States. Students who are in distant colleges and universities, family members who have moved away from their parents, and most people who have wandered far, all journeyed back to the place they call home to be with their family.

For a day the family gathered around the table with a spread of bountiful food and gave thanks. For a day the family was one again. Unless you have no family, or you don’t like your family, or you hate food, it is hard not to like this holiday.

Of course for some people this time is for vacation and some time off work. For some it is about parties. For some it is about parades. For some it is all about watching football. And yet for some they make this holiday time all about shopping – the Black Friday event. But primarily, this time is for families and about giving thanks.

I am in charge of the hospital’s ICU this week. I know there’s no good time to be sick and be admitted in the ICU, but being sick during the holidays is terrible. It is particularly difficult for the families involved.

We have one patient who was admitted in our ICU about 10 days ago. He is in his mid 50’s and he got really ill. He has multi-organ failure. Despite all the efforts, he did not get better. He is on mechanical ventilator, on continuous dialysis, and on several medications to keep his heart pumping and blood pressure up, yet he is sliding away. More concerning still is that he is not waking up.

His family would like us to continue our intensive management until many of his family, especially his children, who are in other states could come and see him and then they would say their goodbyes. For one more Thanksgiving, they gathered, though not in front of a bountiful dinner table, but in an ICU room, as one family again. Then today, Black Friday, they decided to transition to full comfort cares and let their father passed on after a final farewell. It’s kind of hard to give thanks in such circumstances.

Sadly to say, that story is not unique to that family.

In another ICU room, a mother who is only 40 years old, has metastatic breast cancer to the brain. She failed all surgery, chemotherapy and radiation therapy, and is now having frequent seizures. Family would like to keep her in the hospital until Thanksgiving day. Last night they took her home with Hospice to die.

In yet another ICU room, a man who is in his 70’s suffered a large intracranial hemorrhage a week ago. Even after surgery to the brain to evacuate the blood, the patient remains comatose and is in continued vegetative state. The family also would like to have family members from far away places to come on Thanksgiving to see him. Today, they took him off life support.

The saddest of all is in another ICU room. The patient is in his 60’s who had cardiac arrest and prolonged CPR four days ago. We cooled his body down (hypothermia protocol) to try to preserve any brain function. However after we rewarmed his body temperature and discontinue all sedation, he’s not waking up. There is no family members around and we cannot find any one except for a friend that said they don’t know any family of his, and perhaps he is estranged from his family. Both the cardiologist and I felt that continuing life support is medically futile given his significant anoxic brain injury. We let him passed on peacefully, with nobody around him except our ICU staff.

To many, today, Black Friday means bargain sales and wild shopping spree. But in this frantic place, inside these ICU walls, it has a different meaning. It is the solemn color of mourning.

For those of you celebrating this holiday time, may you cherish each moment you have with your family, and commemorate this season in it’s true essence.

(*photo taken with an iPhone)

Tag, You’re It

With fresh snow on the ground and with temperature of 14º F (-10º C) that we trekked down to the nearby tree farm. It’s that time of year again to choose a Christmas tree.

From our previous experiences, it usually takes us several minutes (though it feel like hours) to go up and down the line after line of trees, before we could pick the “perfect” tree.

Not this time.

On the first line of trees that we approached, we already made our choice. We did it in less than a minute! It is a record!

Here’s a close up photo of our Christmas tree with my wife tagging it with our name.

We’ll be coming back in two weeks to have this tree cut and bundled and for us to bring it home.

Since we did it so quickly, there was plenty of time for me to eat popcorn and sip hot chocolate inside the tree farm’s store. 

Actually I was looking for Santa, who usually is sitting inside this store, to give him my Christmas list. But he was not there. Perhaps he’s still busy preparing the turkey for the Thanksgiving.

(*photos taken with an iPhone)


New Nifty Gadget

Having the right tools is an important thing in order for us to do our work properly. You cannot build a house if you only have a hammer. You need a lot of tools and the proper equipment to do so. And if you have power tools, that would be great.

One thing that make humans rise above other creatures is our ability to create or invent tools and instruments to improve our lives. Like the invention of the wheel that started the era of mechanization. Or the development of the pointed weapons, like the spear and arrow, that started the arms race. Look how far we’ve come.

One duty that I have, or more so a responsibility, that I do every week, requires using the right gadget. However, the old one that I have is so worn out. I have even used duct tape to fix it to keep it working, yet it is plainly giving out. It is not as powerful as it used to. Afterall the equipment is almost 30 years old.

So I told my boss, oh I forgot I am my own boss, that I needed a new gadget to replace the old one. For how can I do a good job, if I am using a sub par tool?

But before you think, that my task is something critical or life-and-death undertaking, or something grand of a project that I needed some sophisticated power tool, what I am pertaining to is my mundane task of cleaning our floor, and what I need is a new vacuum system.

At least I can say that I own the floor that I clean. Even so, I take pride on doing my work.

By the way, the vacuum cleaner is not a modern machine. Its development dates back to the 1860’s. It revolutionized how we clean our homes. When it first came out it was more of a luxury equipment as it was so expensive. After World War II, with the drop in the cost of production, the middle class were able to afford the vacuum cleaner. Nowadays, it is in most households.

Here’s my old equipment that is dying on me:

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For my readers especially from my homeland, I want to let you know that we don’t have any house helpers here in the US. We do most of the house chores ourselves. If you have young children, please let them participate in house work and not rely every thing to the house help. Work is good for them. It builds character and it trains them for life.

So one weekend we headed out to the local vacuum store and I got a shiny and up to date central vacuum system. Here it is:

IMG_7330

I know it is just the same-old same-old vacuum that I got and not a high-tech or futuristic gadget. Yet it is still an upgrade of what I used to employ back in the Philippines, the walis and the bunot.

Of course I still have my robot vacuum, iRobot Roomba, that remains functional. But it’s too slow and in some areas of the house, the Roomba does not do a good job. So I still rely on good old human-powered cleaning machine. That’s me!

It is inaccurate if I would claim that I am the only one who is doing the cleaning in our house. My wife and my kids do as well. Except my eldest is now away in college, and not too long from now my youngest will be too. So I will be retaining the title of “floor manager,” that is in-charge of keeping the floor clean, for a long time.

For my new vacuum, “you suck!” And that’s a good thing.

Where Teddy Bear Dare Not Trod

A child’s Teddy Bear should not witness sad and painful experiences. Yet they do. Here’s a story for you.

I was working that weekend in the hospital for more than 24 hours already, mainly in the ICU, but still had a whole day to contend with. Then came Sunday morning, I was called to the Emergency Department (ED) for a CPR-in-progress. It was a woman in her 40’s who had a cardiac arrest. I was told she was still talking when she was brought by the ambulance. However she became unresponsive and her heart stopped few minutes upon arrival.

When I arrived at the resuscitation room of the ED, a team was furiously doing CPR on the patient, with the ED doctor directing the care. A Lucas device (a robotic contraption) was strapped on the patient’s chest doing the mechanical cardiac compression, while other personnel were hovering around the patient assisting in any way they can.

After about 30 minutes of CPR, which is already an eternity of CPR time, we still could not establish a stable cardiac rhythm. We probed the chest with an ultrasound while the Lucas device was temporarily paused, and it showed that there was no heart motion at all. In simple terms, the patient was dead.

But before we completely pronounce the patient dead, one of the team members suggested that we get the patient’s husband to the room so he can be present. So the CPR continued until the husband can be at the bedside. It is now acceptable to have family members in the room when CPR is in progress.

One study from France that was published in New England Journal of Medicine (a leading medical circulation) in 2013 showed that family members who watched CPR on their loved one have far less post traumatic stress disorder three months later. Similar later studies support this as well, stating that family presence can help ameliorate the pain of the death through the feeling of having helped support the patient during the passage from life to death and of having participated in this important moment.

When the husband came in to the resuscitation room, he was tugging along their son, who was clutching a Teddy Bear. The boy, I believe, was about 8-10 years old. The moment I saw the boy walked into the room, my heart sank. I felt that the boy should have been left outside and should have not witness this traumatic event. But it was too late.

Perhaps whoever spoke to them outside the room did not suggest that it was better for the boy to stay outside. Perhaps there was nobody who can stay with the boy outside the room. Perhaps it was the father’s decision to bring along the son to the room. Perhaps they have no idea of what they would witness. Or perhaps the father was not thinking clearly as he had more serious issues to grapple.

The boy was squirming while his father was holding him, and was shielding his eyes with his Teddy Bear. Finally he was able to escape from his dad’s grasp and he dashed out of the room with his bear. Was the scene too much for the boy or too much for the bear?

The father stayed in the room though until we finally stopped the CPR and pronounced the patient dead.

To lose a mother was already a tragedy. But to lose a mother at such a young age and witnessed it as she die was really heartbreaking.

Many of us feel that we should try to shield children from the painful facts of life. We believe that children should be all fun and play, sugar and spice, and everything nice. Yet for some kids, sooner or later, they have to deal with the ugly realities of this world.

I know Emergency Rooms are not for Teddy Bears. But I do not care about the bear. I care about the boy behind the bear. Besides the comfort from his cuddly companion, I pray that he finds lots of love and reassurance from the remaining family he has.

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(*photo from Pinterest)

Rico J, Isang Pagpupugay

Nitong mga nakaraang araw, ay namamayagpag sa aking pandinig ang mga OPM (Original Pilipino Music). Nalungkot ako sa balita noong isang linggo na pumanaw na pala si Rico J. Puno. Kaya para mabawasan ang aking pagkalumbay ay nagpipiyesta na lang ako sa pakikinig ng mga OPMs, lalo na sa mga kanta ni Rico J.

Isa si Rico J sa mga nagpasikat ng mga OPM. Siguro naman lahat tayong mga Pinoy ay alam ang kanyang mga kanta. Tulad nito:

“Kapalaran kung hanapin, di matagpuan, at kung minsan lumalapit nang ‘di mo alam.” (Kapalaran)

Sa totoo lang naisama ko na ang linya ng kantang ito sa isa sa aking blog, Bahala na si Batman.

Mayroon din siyang kanta na nakakapukaw ng damdamin. Tulad nito:

“Huwag damdamin ang kasawian, may bukas pa sa iyong buhay, sisikat din ang iyong araw, ang landas mo ay mag-iilaw.” (May Bukas Pa)

Nagkaroon din ako ng blog na ang pamagat ay mula sa kantang ito, May Bukas Pa.

At mayroon din mga kanta si Rico Puno na pinangarap mong sana ikaw rin ay kagaya niya. Tulad ng:

“Macho gwapito raw ako!” (Macho Gwapito)

Pero hindi naman ako naging macho dahil patpatin nga ako noong araw.

Nakakalungkot lang isipin na wala na si Rico Puno. Para sa akin na lumisan ng ating bayan at matagal nang wala sa bansa, parang bang ako’y nanghihinayang na hindi ko na mababalikan ang aking naiwan. Para bagang may kulang na sa Pilipinas na aking nakagisnan.

Pero sangayon din sa isang awit ni Rico J, eh talagang ganyan ang buhay:

“Sa mundo ang buhay ay mayroong hangganan, dahil ay lupa lamang.” (Lupa)

Hindi lang mga OPM ang namimiss ko kapag nabanggit si Rico Puno. Namimiss ko rin kung saan ako nanggaling at kung saan ako lumaki. Kung hindi ninyo po alam, si Rico J ay lumaki sa may Balik-Balik sa Sampaloc Manila. Iyong apartment kung saan sila nanirahan noon ay sa kabilang kalye lang mula kung saan ako nakatira doon sa Sampaloc. Siyempre naging proud ang mga naging kapitbahay niya nang siya ay naging sikat na.

Mabalik tayo sa mga OPM, lumaki akong nakikinig ng mga kantang Pilipino, hindi lang kanta ni Rico J. Nakakaaliw ngang isipin na iba’t iba ang mga OPM.

May mga awit na makatotoo:

“Isang kahig, isang tuka, ganyan kaming mga dukha.” (Dukha by Heber Bartolome)

May mga kantang matalinghaga:

“Patakan n’yo ng luha ang apoy sa kanyang puso.” (Balita by Asin)

At mayroon ding mahiwaga:

“Butse kik, ek ek ek.” (Butse Kik by Yoyoy Villame)

May kantang mapangutya:

“Beh, buti nga, beh, buti nga, bebebebeh, buti nga!” (Beh Buti Nga by Hotdog)

May mga kanta na garapal:

“Pahipo naman, pahawak naman, hindi na kita matsangsingan.” (No Touch by Mike Hanopol)

Kung sa panahong ito kapag kinanta mo ito ay pwede kang kasuhan ng sexual harassment.

Meron din namang mga awit na nakakatawa, pero may aral.

“Banal na aso, santong kabayo, natatawa ako.” (Banal na Aso Santong Kabayo by Yano)

Pero ang mga awit na tunay na napamahal sa atin ay iyong may kahulugan sa atin. Marahil may mga karanasan tayong hindi malilimutan na nakakawit sa kantang iyon. Para po sa akin, isa sa mga ito ay kanta ni Rico Puno:

“Alaala ng tayo’y magsweetheart pa, namamasyal pa sa Luneta nang walang pera.” (The Way We Were by Rico Puno)

Sa katunayan nai-blog ko na rin ang karanasan kong ito, Alaala ng Luneta.

Nakakamiss talaga. Kaya magsa-sound trip na lang uli ako at magpapakalunod sa mga OPM. Maraming salamat sa mga magagandang alaala, Rico J. Puno.

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(*photo from the web)