Puto Rounds

Sometime in the year 2000, in the heart of New York, New York. In the hallways of the intensive care unit (ICU) of Memorial Sloan Kettering Cancer Center, a world-renowned hospital, and one of the best cancer center of the world, if not the best. Five doctors – four were fellows-in-training and one young attending physician with a specialty in Critical Care – were in a huddle, making their rounds on the critically ill patients.

The doctors were scholarly in their discourse of each case, deliberating what the best management approach was for each individual patient. There was nothing really special in their rounds, especially given that it was a regular occurrence and practice in an academic center. Except that they were all speaking in Tagalog – deep in the bowels of New York City, a thousand miles away from Manila.

Of course English is the official language of the academe and of this country. And those Filipino doctors were discrete not to talk in their native tongue in the presence of other people. There were several other doctors-in-training as well as consultants of other races aside from Americans in that institution. But in this opportune time, with all of them Filipinos, they felt comfortable speaking in Tagalog. Who says Tagalog or Pilipino cannot be the language of the learned?

All of those young doctors finished their medical education in the Philippines. They came from different schools though: one from University of the Philippines, another from University of Santo Tomas, one from University of the East, one from Lyceum-Northwestern University  in Dagupan, and another from Saint Louis University in Baguio. That they  ended up in one place, at one time, is a happy twist of fate. And here they were all now, in an Ivy-league-affiliated hospital of Cornell University. Who said Philippine schools do not produce world-class graduates?

After a demanding few hours of rounding and working in the ICU, those Filipino doctors took a break. They did not go down to the hospital cafeteria for an american doughnut or for an English muffin. Instead they headed back to the fellow’s call room, and snacked on home-made puto (rice cake), brought by one of them. No one asked for dinuguan (blood stew) to complement the puto. I guess the gory sight of some of the ICU cases were deterrent enough to make dinuguan unappealing. So you’d think puto is only found in the streets and markets of the Philippines?

puto

Was the puto special? Does it have cheese on top? Or salted egg perhaps? Did only the Tagalog-speaking doctors eat the puto? Or did they share them to other people?Did the puto made the medical rounds noteworthy? Did the puto made the doctors more brilliant? Did the puto help cure the sick patients? Was puto prescribed to the patients to be taken at least once a day?

Is the puto even the focus of this story? I don’t know.

Twelve years have passed since those puto rounds. What has happened, you may ask, to those young Filipino doctors? The young attending physician then, is now the chief or Program Director of the said training program. One of the doctors after completing her training, went back to the Philippines, where she now practices her profession. She is also an elected congresswoman.

The other three physicians-in-training then, found their niche in different areas of the United States, where they are now specialists, involved in private practice as well as in some academic institutions.

How do I know this story as a fact? Because I was there. I was the one who brought the puto.

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(*image from here)

(**compliments to my wife for making the puto, and the story it inspired)

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Post script: This piece was later published in Manila Standard Today, on Oct. 2, 2012.

Battle Scar

Cancer. That’s one word that the mere mention of it can bring shivers through the spine for most people. (And I will mention that word here several times.) Especially if you or a loved one is on the receiving end of that word.

As a medical doctor, I have tackled with that word as part of my work. I have diagnosed, treated, cared, and sadly to say, lost patients with cancer. With my subspecialty, dealing with deaths from cancer goes with the territory. Lung cancer is the leading cause of all cancer deaths in both men and women. Though the most common malignancy for men is prostate, and breast for women.

Even with my daily exposure to cancer, including my training at Memorial Sloan-Kettering Cancer Center, nothing prepared me, when it was my mother who was diagnosed with it. It was always just part of my job before, but now we were on the receiving end.

I was home in the Philippines for the holidays, after celebrating 15 Christmases in a foreign land, away from home. It was then that my mother informed me that she was noticing blood in her stools for several weeks. It could be just hemorrhoids, I told her, but we needed to be sure. So I scheduled her to see a specialist. After a diagnostic procedure, my mother was diagnosed with rectal cancer. It was 2 days before Christmas.

Colorectal (colon + rectal) cancer is the third most common cancer, as well as the third leading cause of cancer related deaths in both men and women. What does Former President Corazon Aquino, Peanuts cartoonist Charles Schulz, and actress Audrey Hepburn have in common? They all died from colorectal cancer.

Former President Cory Aquino

With the advent of recommended screening for colorectal cancer, the mortality from this cancer has declined. The screening includes, yearly fecal occult blood test (checking for traces of blood in stools), sigmoidoscopy or colonoscopy every 10 years after age of 50 (or more often if high risk), and the dreaded (at least from my stand point) digital rectal exam. These screenings help diagnose colorectal tumors in their early stage.

For people who have close relatives diagnosed with colorectal cancer, they may need screening colonoscopy much earlier than age 50. I know my close friend who is a gastroentorologist, had already told me to have one, but I have not heeded his advice yet. But I would (doctors are the worst patients, you know).

Advanced age, strong family history, diet high in fat and low in fiber, smoking, heavy alcohol intake, and obesity are all related to increased risk for developing colorectal cancer. My mother has the first two risks, that is age and genetic predisposition. There is nothing you can do about that, as you cannot stop aging nor choose your family’s genes (maybe in the future we can).

After further work-up and more consultations with other specialists, my mother underwent surgery to remove her cancer. And that was twenty months ago.

Currently she is alive and healthy, and still enjoying life. In fact, she is currently visiting us here in the US for a couple of months. Though she has a constant reminder of her battle from cancer – a permanent colostomy. Yes, caring for a colostomy could be a nuisance, but for a survivor like my mother, she regards it as a battle scar. A scar that she dutifully embraced and is wearing it with pride. For she fought…..and won.

O cancer, where is thy sting?

There Are Places I Remember

Here are the pictures of places where we used to live, and hospitals where I did my training. It’s hard to believe that it has been more than 10 years since then. (Photos taken during our recent trip back to New York and New Jersey area.)