April Snow

Just as I thought the long awaited spring is here to stay, and it’s time to fire up the grill and hang out on my deck, then this happened.

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My expectation was buried, and it buried the sprouting bulb flowers too.

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But no wintry storm can totally quash our spirits, for underneath that snow, I know, hope springs eternal.

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(*photos taken this weekend)

Rolling Stone

(The following is an excerpt of a discourse I gave in a local congregation last month.)

We’ll be discussing rock and roll, and rolling stone, but in a way different subject matter the popular world knows today.

Mark 16: 1-3: When the Sabbath was over, Mary Magdalene, Mary the mother of James, and Salome bought spices so that they might go to anoint Jesus’ body. Very early on the first day of the week, just after sunrise, they were on their way to the tomb and they asked each other, “Who will roll the stone away from the entrance of the tomb?”

It was Sunday morning, and the women, the two Marys and Salome, were on their way to Jesus’ tomb. Their hearts were broken, yet they would like to show their devotion to their fallen leader by anointing his dead body with fragrances.

It was the custom of the Jews to anoint the dead. We may ask, was Jesus’ body not given proper burial rights before being buried? Let’s read:

John 19: 38-40: After this, Joseph of Arimathea, being a disciple of Jesus, but secretly, for fear of the Jews, asked Pilate that he might take away the body of Jesus; and Pilate gave him permission. So he came and took the body of Jesus. And Nicodemus, who at first came to Jesus by night, also came, bringing a mixture of myrrh and aloes, about a hundred pounds. Then they took the body of Jesus, and bound it in strips of linen with the spices, as the custom of the Jews is to bury.

One hundred pounds of spices. That’s a lot of spices! Twenty pounds of spices was the usual burial custom in those days. Forty pounds was for the rich. So 100 pounds was really extravagant. I read that it is estimated that the cost of 100 pounds of this mixture of myrrh and aloes would cost about $150,000 in today’s market. Those men, Joseph of Arimathea and Nicodemus, gave Jesus a burial fit for a king.

Then why did the women have to go? Do they think that Jesus’ body was not anointed properly that they have to do it again? Who can relate here, that what you have done is not enough? The dishes were not done right. The kitchen was not sparkling enough when you cleaned it.

I am not taking a swipe on the women. For I don’t think these women thought that the anointing of Jesus’ body was not done right or not enough, but rather they only wanted to show honor and respect to their fallen Savior, in their own little way. They wanted to show their love too.

The anointing of perfume was not to do mummification, but to put spice and fragrances to cancel the bad smell of decomposition. One of Jesus’ gifts when He was born was myrrh, a spice to anoint a dead body. Do you see the theme here? Jesus was a baby destined to die.

Back to our story. While the women were on their way, they asked: Who will roll away the stone? This implies that they alone cannot roll away this stone.

Archeologist have found many tombs around Palestine that they believe were first century tombs. Most of the time the opening of the tomb was blocked by a stone. It could be a large mill-like stone, though some experts say that it could also be a square rock that can slide. Though to me when the women said “roll” away, original Greek word apokylio, it must be circular that it can roll like a wheel.

The books of Mathew and Mark said that it was “very large.” If we say it should cover 4 to 5 feet of tomb entrance, then a disc stone would have a diameter of at least 6 feet. That rock could weigh 1.5 to 2 tons. That weight alone even though it can roll like a wheel, would be hard to move.

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me and a large stone in the Holy Land

But there’s another factor that was found by archeological diggings: usually the groove where the stone rolls is in an incline or has a deep ditch where it will drop. Meaning, it may be much easier to close it, but a lot harder to open it, as you have to roll it against an incline or lift it out of a deep rut, and put a wedge to keep it open. In a conservative estimate, you need more than 10 strong men at the least, to roll away the stone.

One more factor, according to Matt 27:66, it was closed with a Roman seal and thus cannot be opened without the permission of the Roman authority. Besides, there were Roman soldiers guarding the tomb. A usual Roman guard unit is 4-16 men, most of the time 4 men stay on guard while the rest sleeps, and they change shifts every few hours, to keep them fresh.

Despite all these factors, these women came to the tomb, and expect that they can somehow open the tomb. Do we have the determination and dedication of these women? Their faith may be imperfect as they did not expect that Jesus will be alive as He told them He will. But they were determined to go. They know that there would be barriers to do their mission, but they still continue.

Sometimes we feel unsure with our plans or mission. Should we carry it out anyway and hope that everything will work out fine? Just like those women did.

So they asked, “Who will roll away the stone?”

But when they came to the site, what did they see? The stone was already rolled away! How? Let’s read:

Matthew 28: 2-4: There was a violent earthquake, for an angel of the Lord came down from heaven and, going to the tomb, rolled back the stone and sat on it. His appearance was like lightning, and his clothes were white as snow. The guards were so afraid of him that they shook and became like dead men.

No need for ten strong men, one angel is enough. No need to put a wedge on the stone, for the angel sat on it. No need to contend with the Roman guards for they became like dead men. Only one angel, can be such a powerful force to contend with, how much more if God would send ten thousand of them!

The women seeing that the stone was rolled away, came in to the tomb, and the angel told them that the Jesus they were looking for was not inside the tomb, for He is alive!

Yes my friends, we serve a risen Savior. Our God is alive! The tomb is empty. That stone blocking the entrance of a tomb was rolled away!

I believe that the rock at the entrance of the tomb was not rolled away so Jesus can come out. What? Before you accuse me of teaching heresy, just hear me out first.

Remember when He appeared to the disciples when they were inside a house with closed-door? Let’s read:

John 20:19: On the evening of that first day of the week, when the disciples were together, with the doors locked for fear of the Jewish leaders, Jesus came and stood among them and said, “Peace be with you!”

Doors were locked, yet suddenly Jesus stood among them. He came through the walls! I believe Jesus when He was resurrected, can verily come out of the tomb even with the stone locked in!

But why was the stone rolled away? It was not that Jesus can come out. It was for the women and His disciples to come in inside the grave, and see that the tomb was empty. The stone was not rolled away for Jesus. It was rolled away for us, so we can believe.

Are we still asking the same question right now? Who will roll away the stone? The stone of our failing health and illnesses. The stone of our broken relationships. The stone of our financial difficulties. The stone of our addiction. The stone of our day-to-day struggles in life. The stone of our unbelief.

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If we are asking the question “Who will roll away the stone?” we are asking the wrong question. The answer is already clear.

The question for us, is: “Are we going to allow God to roll away our stone?” A large two-ton stone is nothing to God. It should be nothing for us as well.

For God have told us in Matthew 17:20, Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move here to there,’ and it will move. Nothing will be impossible for you.

God equipped us to move mountains. We should not be asking anymore, “Who will roll away the stone.”

(*photos taken in the Holy Land)

 

Chasing Phantom Fishball

Yesterday our temperature here in Iowa finally wandered above 50º F. Considering that we had snow last weekend, and even had some flurries the day before with subfreezing temperature, we’re just excited that finally spring has sprung.

I was able to come home early with the sun still way up in the horizon, so I decided to go for a run outside.

I wore my brand new cool running shoes that I bought as a birthday gift for myself. I also planned to wear my new colorful running shorts and nifty running shirt that my wife got me for my birthday, but I found out they were still in the laundry. You see, like a child I need all the enticements to keep me motivated in running.

I’m proud to say that I finished my first outdoor 5-kilometer run for this year. Though I would not deny that I was a little out of condition and I struggled to complete the run.

While I was doing my run and I was on my 4th kilometer navigating through our neighborhood, I suddenly caught a whiff of a very familiar scent. I took a deep breath and inhaled it in to confirm. It was the unmistakably glorious smell of fishballs being fried in a lake of oil on a deep frying pan.

Instantly, I was transported back to my days in Manila, as if I entered a Twilight Zone. I felt I was in Forbes Avenue (now Arsenio Lacson Avenue) in front of the UST Hospital. I could almost hear the jeepneys and buses plying that route. Most afternoons, there was a fishball vendor there with his push-stall near the entrance of the hospital.

It does not matter if health experts say that it may not be “safe” to eat street foods, like fishballs, as you can get hepatitis A and some other illness, especially if you dip the fishballs in those jars of sauces. The reason is that some people do “double dip,” that is after taking a mouthful bite of their fishballs on the stick, they would dip it again in the sauce, and that’s how a disease is spread. Could it be the tincture of slobber that makes it more tasteful?

But my courageous friends and I don’t care what the experts say.

After an exhausting day in the hospital working as medical clerks (4th year medical students), we would trek down outside the hospital in our white uniform and all, and buy those delightful fishballs. While they were still hot and floating in oil, we would make “tusok-tusok” the fishballs with the stick, then dunk them in the different dipping sauces. My favorite one was the black spicy concoction with floating onions and siling labuyo. Sometimes I would also dip in the tangy sweetish brown sauce. Sometimes I would dip in all the three jars of sauce. But I swear, I don’t do double dip.

Interesting enough, during our 25th graduation anniversary meeting and reunion held in our medical school two years ago, they served fishballs on a stick during one of the breaks. They have the authentic taste like the ones peddled on the street. It was definitely a hit!

As I reached the end of the cul-de-sac, I came back to the realization that I was on a street in Iowa, and not in Manila. I looked around to search if there’s a fishball vendor around. But there was none. Just the leafless trees, brown grass, and the empty street that I was in.

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Was I hallucinating? Was it because I was huffing and puffing that my brain was oxygen deprived? Or was it because I was hungry and my blood sugar level was running low? Has my brand new running shoes have anything to do with it? Or maybe I was plainly home-sick again?

Fishball, o fishball, why are you haunting me?

(*photo taken during my run)

Into the Next Frontier

I made it!

With another birthday under my belt, it is official. I have outlived my father.

After a certain age, people don’t like having birthdays anymore. I guess it is when the number of candles in your birthday cake is deemed a fire hazard, that getting older another year can also be deemed as a health hazard. Though a friend of mine send me this text message: “Birthdays are good for your health; studies have shown that people who have more birthdays live longer.” Hah!

But before you all wildly congratulate me on reaching such a significant milestone (at least it is for me), the bar that was set was really low. You see, my father passed away less than a month before his 51st birthday.

My grandfathers, on both mother’s and father’s side, did not walk that long on this earth either. My mother’s dad died when he was in his 30’s, and my dad’s father did not last much beyond his 50’s. That’s why I never had the chance to meet my grandfathers.

Come to think of it, my children did not meet their grandfathers too, as both my father and my wife’s father died way before our kids were born. In fact they died even before my wife and I met. We need to break this chain.

I may consider that I am now walking on uncharted territory. But I am eager and hopeful on what lies ahead on what my father and grandfathers were not able to explore. The frontier of growing old.

It is interesting though that what age we consider old depends on what stage in life were in. In one article I read, they asked different people on when do they consider the start of  old age. Here’s their answer:

5-year-olds: Old age begins at 13.
13-year-olds: Old age begins at 30.
30-year-olds: Old age begins at 50.
50-year-olds: Old age begins at 75.
75-year-olds: Never. And go away.

For me, I still would not consider myself old. Not yet. Not after another 50 years. And if you don’t agree with me, go away!

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I am not ready to slow down just yet. In my mind I believe that there is still enough bounce left in me. Though my joints may tell me otherwise.

It is spring time and getting warmer here. It’s time once again to run outdoors and start preparing for another half marathon. I need new running shoes though. Perhaps I can get a discount through AARP.

(*photo taken few months ago)

Ugly Topiary

(topiary |ˈtōpēˌerē|: the art or practice of clipping shrubs or trees into ornamental shapes.)

It’s officially spring time here, and its time once again to tend the yard and the garden. I have posted before that my wife love topiaries and we have them both inside and outside of our home (see previous post here).

However in our backyard is a line of evergreens that looked like hideously clipped topiaries. Don’t we have the artistic skill to trim them?

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However, we are not the one who trim these disfigured shrubs. We’re not thinking our neighbors are vandalizing our plants either, causing this unusual design. In fact, these evergreens are not even intended to be topiaries at all.

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Who’s responsible for this art work then? A drunk Edward Scissorhands?

No, it’s the pesky deer!

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During winter, when the grass and food is scarce, these evergreen could be a gourmet meal for them. They nibble on what they can reach, leaving the top untouched.

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Good thing we don’t have roaming giraffes!

(*photos taken with an iPhone)

 

 

No Chance Encounter

(The following is an excerpt from a discourse I gave in a local congregation. Thoughts were inspired after standing in a spot pictured below.)

Simon, after an 800-mile long travel, in a dream journey of a lifetime, finally arrived in Jerusalem.

He was warned of the large crowd especially during Passover time. But that day, he saw a different event. Even though the streets were crowded with lots of people they were making way for this unusual procession. There were no wailing sirens or flashing lights to warn people to make way, but there were Roman soldiers shouting with their glistening swords that part the crowd like the Red Sea.

Then Simon saw a man, so bloodied in his face, head, and back, carrying a beam of a cross, being led by the soldiers. Simon realized, he was witnessing a man being led to his death by crucifixion.

Crucifixion was not invented by the Romans, but they perfected it. Crucifixion was a punishment mostly reserved for those sentenced with insurrection or rebellion. Mostly people crucified were people subjugated by the Romans.

The weight of the whole cross was about 300 pounds. But usually the one being crucified carry only the cross beam, which in itself weighs about 100 pounds. They carry this to the place where they will be executed.

But even that weight of the cross beam was too heavy for this man condemned to die, as Simon witnessed. Perhaps he was weakened from all the lashes he received in his back. Perhaps he was already too weak from the blood loss from the wounds in his head and body.

Simon saw that the man carrying the cross fell under the weight and cannot stand anymore. Next thing Simon knew was that he was being ordered to carry that man’s cross.

But why was Simon chosen? Was it really random or by chance that he was picked? Romans will not let a Roman citizen carry the cross. They only let Jews or a foreigner do it. And Simon looked like a foreigner. He stood out of the crowd. He definitely looked like a stranger in Jerusalem. Was it the way he dressed? Or was it something more obvious?

Simon was most probably dark-skinned. In a more blunt way of saying, he was black.

First of all he was from Cyrene, a country in North Africa. We know that these people were descendants of Ham, the third son of Noah, who was believed to be the ancestral father of black people. The name Ham, many scholars believe meant “black.” This is supported by the Hebrew and Arabic evidences, in which the word “chamam” means “to be black.”

Another support is in Acts 13:1, it mentioned a man named Simeon (Simon) who was called the black man, who was one of the teachers in Antioch. Whether this was the same Simon from Cyrene who carried Jesus’ cross is hard to prove. What we know though, is that Acts 11:19-21 mentioned that the first Christians who preached in Antioch were from Cyprus and Cyrene.

In all likelihood, Simon was picked because he looked different. Discrimination is not something that we only have today. Even in those times it already existed.

But Simon was not pick by chance. I believe God has destined him to carry the cross for a special reason. Same thing that God picked those who were being discriminated and ostracized during those times: the Samaritans, the tax-collectors, the Publicans, the lepers, the sinners. God chose those who the world see as unwanted, and use them in a special purpose for his divine plan.

If God does not discriminate, who are we to discriminate people whom we think are different from us?

Back to Simon, when he was picked by the Roman soldiers, he was reluctant. The Bible said in Matt 27:32, he was “forced” or “compelled.” Meaning, he did not volunteer. Most likely he even refused!

But can you refuse the Romans? There was a Roman law called lex angeria stating that if a Roman soldier tells you to carry his pack or a load, you must carry it for 1000 paces (1 pace=2 steps), which is really close to our current mile. After 1 mile, you can bring down the load and you can go on your business.

But Jesus in his teaching in Matthew 5:41, said that if a soldier demands you to carry his pack for 1 mile (pertaining to lex angeria law), carry it for 2 miles instead. That was Jesus said! So if someone ask you a favor, do it beyond what you are being asked. Not out of duty, but do it out of love.

I am not sure Simon heard of this Jesus’ teaching, that he would be willing to carry the cross for more than a mile.

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Station V, Via Dolorosa: spot where Simon carried the cross

But I get it, not just because the cross was heavy, and it was not even his cross to carry, Simon has other reasons to be reluctant. One is that if he carry that bloodied cross, he would contaminate himself with blood and he would be deemed ceremoniously unclean by Jewish law. He then would not be able to participate in the Passover feast, which was the very reason he came to Jerusalem in the first place.

Sometimes we have our own plans, and all of a sudden we are being diverted to do something we don’t want to do. Just like Simon. But God has a plan for us. We just have to trust Him.

The other reason, why I think Simon was reluctant to carry the cross was, can you imagine the humiliation of carrying the cross of somebody you don’t even know? The humiliation of being associated to somebody condemned to die.

Simon’s experience was: from dream to nightmare, from holy to horrific, from going to the place of worship to going to a place of execution.

But as Simon followed Jesus carrying the cross and being led by the Roman soldiers, something happened to him. It changed him.

Simon have looked into the bloodied face of this man and their eyes met. The look that peered through his soul. The look of love and forgiveness, despite him being led to his death. Surely, Simon thought, this Man was different.

As he was following Jesus with the cross, he have heard him speak as recorded in Luke 23:28 “Daughters of Jerusalem, don’t weep for me, but weep for yourselves and your children.” Surely, Simon thought, this Man was different.

Something changed the heart of Simon. I believe that after they came to Calvary and he was told by the soldiers that he can bring down the cross and was free to go, he stayed in the crowd and watched what would happen to the Man whose cross he carried.

Simon witnessed of how this Man forgave those who were crucifying him, praying “Father forgive them for they don’t know what they are doing.” He saw this Man die and how He cried “It is finished,” and how he uttered “Father, into thy hands I commit my spirit.” Surely, Simon thought, this Man was different.

From an unwilling cross bearer, Simon became a willing faithful follower.

Simon realized the fact that his hands and his shoulders and his body that were stained by this Man’s blood did not make him unclean, but rather that very blood cleansed him of his sins. Simon can claim that he was literally washed by the blood of the Lamb.

How sure are we that Simon became a follower of Christ?

In Mark 15:21 it mentioned Simon’s sons, Alexander and Rufus. The book of Mark was written about 25-30 years after Jesus died. The fact that Mark mentioned the names of his sons, implied that his sons became known to the early Christian church. That means they became pillars of the church, because their converted father introduced them to the Savior whose cross he carried.

Also in Acts 11:19-21, which mentioned those early Christians from Cyrene, and we may wonder, why were the earliest Christians from a place 800 miles away from Jerusalem? I want to believe that those were converted by Simon when he returned home to Cyrene. Even Paul in Romans 16:13 greeted Rufus, Simon’s son, whom Paul said was ‘picked by God to be his very own son.’

Yes, Simon was not picked by the Romans by chance, but rather God picked Simon. And it was not a chance encounter, but it was a destined encounter.

May the story of Simon, inspire us for our own fateful encounter.

(*photo taken in Jerusalem)

 

Bad Night

We’re sleeping in the hospital now. It started this year. Our calls are now in-house as the hospital wanted us to physically man the ICU 24/7. This is besides the resident-on-call who is already in the ICU. Sleeping in a call room of the hospital about once a week, makes me feel like I’m a resident or a doctor-in-training all over again. But I understand, the times are changing, the practice of medicine is changing, and the liability of this profession is changing. We have to adapt.

Few weeks ago, I walked in at 5 in the afternoon to take over the call for the night. The moment I walked in, I was called by my partner who was in charge of the ICU all day, to meet her in the cardiac catheterization lab (cath lab) so she can sign out to me the patients.

When I came down there, I found out that there were two patients currently in the cath lab that were both going to the ICU.

One was a man in his 40’s with severe pancreatitis and was having multi-organ failure, including severe respiratory failure that was not improving even if he’s on mechanical ventilator. So large-bore catheters were being inserted in his neck and groin, so we can place him on Extracorporeal Membrane Oxygenation or ECMO (see previous post about ECMO).

The other patient in the cath lab was a man in his 70’s that had a cardiac arrest. He required prolonged resuscitation. The cardiologist was putting an Impella device in his heart, a device placed inside the left ventricle of the heart to help pump out blood. When that’s done, the patient would be transferred to the ICU. He was already on ventilator as well.

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Impella device (photo from Medscape.com)

Then my partner told me that there were two more patients already in the ICU that she was called to evaluate, but did not have the chance to see yet, as she was stuck in the cath lab for the last hour or so, assisting in this patient that require ECMO.

One patient in the ICU was a transfer from another hospital, he had fever with very low blood pressure. He also has advanced esophageal cancer and on chemotherapy. He has no immune system to fight the infection. After the initial work-up, he turned up to have Influenza A.

The other patient in the ICU to see was a trauma patient, who was in a vehicular accident. He had several broken ribs and a collapsed lung. The Trauma Team has admitted the patient, but they were having difficulty oxygenating him despite being on a ventilator, thus they were consulting us for assistance.

She also told me that we have 21 other patients in the ICU that were relatively stable at the moment, but can turn volatile anytime, besides the four new ones that needed my immediate attention.

Lastly, she said that she declared the patient in room 15 as clinically brain-dead, hence, legally dead. Patient was a young lady in her 20’s who overdosed on drugs, and unfortunately was not found immediately. When she was brought to the hospital, she was too far gone. The patient’s family agreed to have her organs donated, so she’s still on life support until they can harvest her organs. The Transplant Team wants us to do a bronchoscopy to assess if the lungs and airways were normal and appropriate for harvest.

Hearing the long laundry list, I thought to myself, this would be a long night. That’s not even considering more new patients that may come.

Shortly thereafter, I got a call from the Transplant Team asking me when could I do the bronchoscopy in room 15. I told them that I would take care of some more pressing issues, and when I get free, I’ll do it, but I already contacted the endoscopy nurse to come and set up for the scope. I thought, let me take care of the living first, before I deal with the dead. But I didn’t tell them that.

When I came up to the ICU, the patient from the cath lab who had a cardiac arrest and got the Impella device, also arrived in the ICU. I evaluated the patient, and it was obvious he was doing poorly. He was requiring 3 IV drips (1 drip is a poor sign already, let alone 3!) to keep his blood pressure up. This was despite the device in his heart to pump blood. He already looked dusky and gray.

I sat down with the patient’s family, and told them that the odds were not in our favor. I don’t believe he would survive the night. I also told the cardiologist that I felt bad for him as well, as all his efforts may be all for nought.

The patient died less than 2 hours after he came up from the cath lab.

While I was working on this patient, I got a call from the Emergency Department about a new patient that needed to come to the ICU. The patient was in her 80’s, with advanced dementia, and was from a nursing home. She was septic, perhaps from a urinary tract infection. I may think that she was not the best candidate to spend my limited time and resources at that time, but who am I to say who lives and who should not. A life is still a life. So I sent my resident to evaluate and admit the patient.

When the ECMO patient came up to the ICU from the cath lab, that was where I spent most of my time and effort. We even consulted Nephrology to start the patient on dialysis too. However, despite all intervention, with ECMO, dialysis, mechanical ventilator, and several IV medication drips, the patient continued to deteriorate. I felt like we’re just spinning our wheels without gaining any traction. I noticed that the patient’s heart rate and blood pressure were drifting down. Definitely an ominous sign.

I gathered the patient’s family and brought them at bedside to the patient. I honestly told them, there’s nothing else we could do.

The patient died 5 hours after he was hooked up on ECMO. I felt defeated and deflated with these events.

In between the deaths of my 2 patients, I was able to squeeze time to do the bronchoscopy on room 15. It looked healthy, so I relayed to the Transplant Team, they can perform their harvest.

After midnight my night quiet down a bit. I caught up and was able to see all the patients I needed to see. When I had some down time, I reflected on what I accomplished and those I failed to accomplish.

At least I was able to stabilize the elderly patient from the nursing home, right? She will get better from the infection, then she’ll go back to the nursing home in a few days, and spend the rest of  her existence in bed with very poor quality of life due to her advanced dementia. How about the patient with metastatic esophageal cancer? He’ll get better from the influenza. But he still have to deal with his cancer and more chemotherapy with bleak hope of a cure. And the sad list just goes on and on.

Nights like this, make me question if it’s really worth doing this. I got several more pages through the night, but I survived to see the morning.

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A couple of weeks after that disheartening night-call, I received a letter. It was from the Organ Donor Network. They were thanking me for my effort in assisting to obtain donor organs for transplant. Because of this, they informed me that a young man was given a new lease in life as he received new lungs. There were other patients too that received “gifts of life” with their transplanted heart, kidneys, cornea and so on.

I then realized that even in patients who died under our care, we can make a difference. It still worth it after all.

(*photo of dawn, taken with an iPhone)

Ang Lola Kong Adik

(Addict: a person who is addicted to an activity, habit or substance.)

Sang-ayon sa mga balita, marami raw adik sa atin sa Pilipinas. Pero nababawasan na raw ito dahil sa takot kay Duterte. Noong ako’y bata pa, kapag kami ay lumuluwas sa probinsiya, ay mayroon akong natutunghayan na kakaibang adiksiyon.

Sa bahay ng aking lola sa Norzagaray Bulacan, ay nakatira rin ang isang tiyahin ng aking tatay. Maaaring sabihin na kasama siya sa mga kumukunsumo ng adiksiyong ito. Hindi ko na sasabihin ang tunay niyang pangalan, at tawagin na lang natin siyang Nana Pula.

Aking pinapanood si Nana Pula na uupo na lang sa sahig sa isang sulok ng bahay. Tapos ilalabas na niya ang mga nakasupot niyang paraphernalia. Dito mag-uumpisa na siyang mag-gayat. Magdidikdik. At magbabalot.

Pero bago ninyo isipin na shabu o crystal meth ang kanyang dinidikdik, o kaya’y marijuana ang kanyang binibilot, ay hindi ito gayon. Ang kanyang ginagayat, dinidikdik at binibilot ay nga-nga.

Siguro alam ninyo kung ano ang nga-nga (betel quid). Sa mga nakababatang Pilipino na maaring hindi na pamilyar sa sinaunang bisyo na ito, ang nga-nga ay nginunguya. Hindi ito sinisinghot o hinihithit.

Ang nga-nga ay ang combinasyon ng: ikmo (betel leaf), bunga (areca palm nut), at apog (slaked lime). Gagayatin ang bunga, tapos papahiran ng apog, at ibabalot sa ikmo. Minsan dinadagdagan pa ng dahon ng tabako, para mas matindi ang tama.

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nga-nga (image from the web)

Matapos bilutin ni Nana Pula ang kanyang nga-nga, ito ay kanya nang isusubo at nguguyain. Habang nakasalampak, ngumangata at sumisipsip ng katas ng nga-nga, ay paminsan-minsan siyang dudura ng mala-dugong laway sa siwang ng sahig na kawayan. Para siyang kambing na ngunguya-nguya, pero kontento sa kanyang buhay. At pag-ngumiti si Nana Pula? Pula ang kanyang bibig at mga ngipin! Kaya nga Nana Pula.

Meron din kaming ninuno sa Bulakan na ang tawag sa kanya ay Tatang Puti. Pero hindi dahil sa puting ngipin, kun’di dahil siya ay tunay na maputi. Siya ay meztiso at dugong Kastila. Tunay naman na may lahing meztisuhin ang aking angkan. Pero hindi ako kasama sa mga mapuputi, dahil nakuha ko ang kulay ko sa aking nanay na dugong Ilokano. Teka, naligaw na yata ang usapan.

Balik tayo sa nga-nga. Ang tradisyon na ito ay matagal nang umiiral sa Pilipinas, bago pa man tayo sakupin ng Kastila. Nabanggit ito ni Jose Rizal sa kanyang nobelang Noli Me Tangere, kung saan sa unang kapitulo ay sinaad niyang inalok ito ni Kapitan Tiago sa kanyang mga bisita. Sa kapanahunan noon, hindi Skyflakes at softdrinks ang inihahain sa bisita, kun’di nga-nga!

Ang kustombre ng pagnguya ng nga-nga o betel quid ay hindi lang sa Pilipinas. Maraming bansa sa South at Southeast Asia, at sa kalawig na mga isla sa Pacifica ay kilala ang sinaunang tradisyong ito. Sabi ng World Health Organization, maaaring may 600 milyong tao ngayon ang haling sa bisyong ito.

Ang pag-nguya ng betel nut ay ipinamana sa atin ng ating mga ninuno. Sa katunayan, sang-ayon sa mga archaeologist, may nahukay silang bungo ng tao na may apat na libong taon ang tanda, at ang ngipin nito ay may bakas ng elemento ng betel nut. Ganoong katagal na ang nga-nga!

Gaya ng sigarilyo at iba pang bisyo, bakit kaya nakaka-adik ang nga-nga?

Ang bunga o “betel” nut, ay mula sa areca palm (scientific name: Areca catechu). Ito ay may natural alkaloid, na ang tawag ay arecoline. Ang arecoline ay mild stimulant. Kaya ito’y nakapagbibigay ng energy boost at feeling of euphoria. Sa madaling salita, nakaka-high! Kaya kapag ngumunguya na sila tatang at nanang, ay sumasaya sila at para na silang lumulutang. Tripping na si lola!

Ngunit parang nicotine mula sa dahon ng halaman ng tabako (scientific name: Nicotiana tabacum), ang arecoline mula sa areca palm nut ay nakaka-adik din. Kaya bago pa naging palahithit ng tabako, o bago pa magsipagbilot ng marijuana, ay ngumangata na ng nga-nga ang Pilipino. Lahi nga kaya tayo ng mga adik?

Maliban sa nakaka-adik ang nga-nga, may iba pa bang masamang epekto ito?

Sang-ayon sa mga pag-aaral, ang nga-nga ay maaring maging sanhi ng kanser sa bibig. Iyong ibang matatanda sa atin, nag-nganganga na, nagtatabako pa, tapos nasa loob pa ng bibig ang sindi ng tabako, kaya’t mataas ang insidente nila ng kanser sa bibig.

Dahil laging ngumunguya ang kumukunsumo ng nga-nga, ito ay maari ring magdulot ng oral submucous fibrosis. Ang kondisyong ito ay sanhi ng “stiffness in the mouth and eventually the loss of jaw movement.”*

Isa sa pinakamalinaw na sanhi ng nga-nga ay ang pamumula ng bibig at ngipin. Para silang nagpahid ng sangkatutak na lipstick, pero kasama pati ipin! Maari rin itong sanhi ng tooth decay, gum disease at bad breath.

Kaya noon pa man, kapag nag-nganga-nga na si Nana Pula, umiiiwas na akong pahalik sa kanya, dahil baka mag-amoy nga-nga at apog ako. Pero nagmamano pa rin naman ako kay Nana Pula.

Subalit kahit may kakaibang adiksiyon si Nana Pula, ay mapayapang mamamayan naman siya. Mapagmahal din siya sa kanyang mga kamag-anak at kaibigan. Maaring sabihin na adik siya sa pagmamahal sa kanyang mga pamangkin at apo, kasama na ako, kahit gaano pa ako kakulit noon.

Isang araw, matahimik na pumikit si Nana Pula, lumutang at pumailanglang sa walang hanggang kawalan. Wala sa aming nakababatang pamilya ang pumulot ng kanyang bisyo, kaya’t ito’y naglaho na rin sa pagpanaw ni Nana Pula.

(*from Journal of the American Dental Association)

Fevered Musing

I called in sick. I have not done that a lot. In fact, this is the first time I did it. Many times, I just grit my teeth and willed myself to work, even if I felt like I was ran over by a truck.

I have this notion that doctors should not get sick. For who will take care of the patients? But am I really be of help or be more of harm if I go to work, while I myself is sick? After much deliberation, and after foregoing the feeling of guilt, I made the call.

Don’t get me wrong, I am no superhuman. In fact, I get sick more often than my wife. She chided that I am built poorly and of cheap quality materials. During my childhood days in Manila, we call our classmates who get sick easily “Made in Taiwan.” We pride ourselves to be “Made in Japan” or “Made in USA” if we’re the only ones left standing. Nothing against products from Taiwan. Accept it or not, we Filipinos sometimes can be racist. I am sure being made in Taiwan nowadays does not have that connotation.

I am trying so hard not to get sick. I exercise regularly, and I try to eat healthy, and I even got my flu shot. But I still got sick. Being a physician, when you’re dealing with ill patients all day, and they are coughing in your face, it’s just a matter of time that you’ll get it too. Plus we are in the middle of the flu epidemic and it is particularly bad this season.

I am in bed for 2 days straight now. I know, that in itself can make my head hurt. I am popping Advil every 4 to 6 hours round the clock, just to get relief from the fever and the body aches, even though I don’t like taking medicine.

I isolated myself in our bedroom, as I asked my wife to sleep in another room, so she’ll not get what I have. This is not the time for ‘sharing.’ I also put on a mask whenever I go out of the room, and ate separately away from the table.

I was having chills and fever when my thoughts wandered into the times in the past, when I was also sick in bed.

I was in our home in Manila, with high fever. I was still so young, that I don’t go to school yet. My body was full of red spots that were very itchy, and I’m trying my best not to expose them. (Bawal daw mahanginan.) I believe I got the measles. My mom would continuously put a wet towel in my head to try to lower my temperature. But despite of that, I was to the point of hallucinating, that my mother said I was seeing things that were not there.

Then there was the time I was in Kindergarten, when I again had a fever, and one side of my face swelled up. I looked like a squirrel that has an acorn in one of its cheek. I had the mumps. My folks painted a bluish gooey something on my face. It is a concoction of clay, blue dye and vinegar, which was a popular folklore remedy for mumps in the Philippines. My classmates in Kindergarten stopped by our house to visit me, and they saw me with my painted blue puffed-up cheeks.

I know, I know, you may be asking, why did I get both the measles and mumps when I was a child. Why was I not vaccinated? Were my parents against vaccination? Not really. I was just born before the era when MMR (Measles, Mumps and Rubella) vaccine became available worldwide. It was later offered in our school when I was older, I think I was in Grade 2 or 3. My classmates and I lined up and I received those injections despite my silent protestation as I was scared of needles.

There were several other times that I was sick as a child with colds, and my mother would put Vicks Vaporub in my chest and back. Even in my nose, when my nose was clogged up and could not breathe. She would also put Vicks Vaporub in my feet and then put socks on me, telling me that will help my fever. For many Filipinos, Vicks Vaporub and White Flower ointment were a cure-all treatment for any ailment. To this day, I hate the smell of them.

Now that I have the MD degree after my name, I know that the blue paint on my cheek and the Vicks Vaporub on my feet perhaps caused nothing to help my sickness. But perhaps just the fact that I am loved and my parents were showing they care, the best that they know how, was enough to make me feel better. And that eventually healed me of my illness.

Many times, showing people that we care for them, is enough to relieve them of their malady. I know I have plenty of that in my home as a child, and in my home now. Even when I feel terrible with this illness, I know that I am being attended to, not necessarily by a medical team, but more importantly by people who really cared for me. In fact, I still have the cup of salabat on my night lamp stand that my wife brought me this morning, and I could already smell the sinigang that she is cooking.

I was having chills when I glanced outside the window.  Snow is now falling softly. I am not going anywhere. More reason to snuggle under the covers the whole day.

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(*These thoughts were concocted 3 weeks ago. I think I got influenza, and I was house-bound for 5 days. Photo taken with an iPhone.)