New Year, Old Receipts, and Memories

It was New Year’s Day. I woke up early even though I stayed up late the previous night and spent it with the company of friends, and did not sleep until past midnight to welcome the arrival of 2017.

What’s up with me? Even how late I stayed up the night before, I still wake up early the next morning. I think it is how I’m wired or just how I was trained – to wake up before the sun goes up. Though that morning, it was past 6 already, yet it was still dark. It was a Sunday too. No work, and no place I needed to go.

But since I couldn’t sleep anymore, I got out of bed, and searched for something to do. Besides, it is a new year, so better start it right. Plus in the Chinese calendar, this year is the year of the rooster. So we really should be getting up early like the rooster, right? Maybe I should have started crowing cock-a-doodle-doo or tik-ti-la-ok (that’s what Filipino rooster sounds like) to wake up the whole neighborhood.

I thought of cleaning up and vacuuming the house, but my wife and kids were still asleep, so I looked for something to do that was more quiet and muted. I found myself in the office room, where the computer and the file box of bill statements were, and decided to do the bills.

What better way to start a new year, than paying debts and doing bills?

Even though I do my bills on-line, I still keep paper bills and receipts on file. As my storage box was already bursting with old bill statements and receipts, I knew I had to get rid of some of the old ones to make room for the new.

As I was looking through the files and files of old bills, I came across the receipt and paperwork of our very first family car here in America. It was a second-hand Honda with about 50,000 miles mileage. We bought that car after I finished my training and after landing a real job. That was 17 years ago and we were still living in Florida at that time.

Having only one car at that time, and with no good public transportation system where we live, my wife and my daughter, a toddler at that time, would go with me when I go to work in the morning. They would wait in the car at the parking lot while I do my hospital rounds. From the hospital we will drive to my clinic and drop me off there. Then my wife would take the car to go wherever they needed to go, and just pick me up later in the afternoon. That way they will not be housebound the whole day, plus my wife could also do some errands like grocery shopping.

When we moved to Iowa in the middle of a harsh winter, we were ill prepared to drive in the snow, sleet and ice. And one snowy morning I ended up driving, I mean slipping, into a ditch that the car needed to be extricated. That was when I decided to trade-in our old Honda, and got myself a car with an all-wheel drive that can frolic in the snow.

While sorting old receipts, I also dug out a hospital bill from Scottsdale Arizona, issued about a decade ago. I attended a medical conference in that city, and brought my whole family along.

While in Arizona, my son who was 3 at that time, started to breathe heavily. He then also started to wheeze, that I could hear even without a stethoscope. Being a trained lung specialist, I knew that there was something wrong. That was the first time we learned that he has asthma, and that he was having a bad asthma attack.

We brought him to the nearby hospital. Not long after, he was given a nebulizer treatment (asthma medicine given via mist) in the Emergency Room. While the nebulizer was being administered with a “cute” pediatric oxygen mask that was shaped like a dinosaur snout, my son was crying. I asked him if he was in pain or if the treatment was bothering him, but that was not it.

When I continued to query what was wrong, he finally said, “It’s purple!”  He was referring to the “cute” oxygen mask that he thought was for girls. That was also the first time we learned that he does not like purple, nor does he like Barney.

I also found from my file box, stacks of old receipts from the gas company, including our very first one when they initially filled the propane gas tank of our house here in Iowa. We have gas tanks (LPG cylinders) too, when I was still living in the Philippines, but the gas tank we have here in Iowa is bigger. Much, much bigger.

Since we live beyond the outskirts of town, there are no gas pipe connection from the city to our home. So we have a large (up to 1000 gallons) underground gas tank, which needed to be filled regularly. Propane gas heats our home during winter, and powers the boiler for hot water. Even our fireplace is propane powered. Where we live, people could endure summers without air-conditioning, but would not survive winters without heaters.

When I was growing up in Manila, I wondered how could Santa Claus dropped by in a house without a chimney? I could have not thought that one day, I would be living in a house with a fireplace and a chimney, even though I don’t believe in Santa anymore. I could have not thought that winters could be this bitterly cold as well.

Even though gas was important for us, I am sure though that it was not just propane gas that kept us warm. In our home, the embers of love is much more important than the furnace and the fireplace. We have spent 12 happy winters in this house, and counting.

I was so absorbed in my thoughts that I have not noticed that the sun was already way up in the horizon. Who would imagine that a file box of bills would be such a treasure trove of nostalgia and memories?

Despite the sentimentality associated with them, I still have to make room in the file box for the new ones. Just like facing a new year – out with the old and on with the new. So I took out the old and outdated receipts, and toss them through the paper shredder.

As for the memories, I am keeping them.

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Steak and Rye

It was late afternoon of New Year’s Eve, and I was rounding on our patients in the ICU. I came to one room and the patient was sitting upright in his bed. On his bedside table was a tray with a large piece of steak on a plate, a drinking glass, and a bottle of rye whisky. What? Is this a restaurant or hotel? Is this the new hospital food?

Most of our patients in the ICU are not awake enough to eat food, let alone have a solid meal like that. We provide nutrition through a tube in their nose that goes to their stomach and they feast on liquid feedings. Or if their gut is not working, we give them “gourmet” nutrition through their veins. In fact once patients can eat solid food, most of the time they graduate out of the ICU.

But what about this patient? A slab of steak? And is alcohol sanctioned by the hospital now? Here’s the story.

He presented to the hospital with worsening shortness of breath. After some imaging work-up, he was found to have a large tumor in his chest. I saw him several days ago when he was admitted in a regular room, not in the ICU. We were consulted for the lung mass and I scheduled him to have a bronchoscopy (a procedure putting a flexible scope to the lungs) and biopsy.

However before the scheduled procedure could be done, he suffered a cardiorespiratory arrest, got intubated, was hooked to a ventilator and was moved into the ICU.

Good thing was despite the circumstances, he improved enough that we got him off the ventilator. Yet we don’t have a tissue diagnosis to confirm that what he has is cancer, even though the signs indicated that it was malignant. But we needed to be sure.

So I proceeded with a bronchoscopy and got a biopsy, and finally established a diagnosis. It was lung cancer alright.

Unfortunately his condition got worse again. He again required ventilator support, though a non-invasive type, which is like a CPAP machine. I told him that the final pathology proved that it was cancer. And based on its extent, plus with his grave condition, he was an unlikely candidate for any surgery, or chemotherapy, or radiation to treat his cancer.

That’s when he decided that he wanted to go on his own terms. His own way. Like Frank Sinatra’s song, “I did it my way.”

He requested that we discontinue the non-invasive ventilator, even though he was struggling without it. He asked to have a New York steak and a bottle of rye whiskey for his last meal. So in between labored breath and heavy heaving, he chomped on his steak and sipped on his rye.

When I came to his room that afternoon, despite his terrible situation, he was even smiling while having his last supper.

After he had his meal, we transitioned him to full comfort care per his request. No more ventilators, nor machines, nor any more interventions. Only comfort medications. And while he was watching TV in his ICU bed, waiting for the ball to drop in New York’s Time Square, he quietly slipped into a blissful sleep.

Just before the old year ended, our patient went out peacefully into the eternal night. He exactly did it his way.

For us who made it through another year, may we find new aspirations, new hope, and renewed zeal for life, as we face this new year.

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Waiting in Line

It’s 2014. Happy New Year!

During the New Year celebration in New York City, a million or more people flocked in Times Square to watch the fancy ball drop and ring in the new year. It was reported that many people began waiting and standing in the streets in TImes Square starting around noontime, to get a good location to see the ball drop, the fireworks, and the rest of the show. That’s about 12 hours of waiting and standing in the cold! Was it worth it?

In our recent trip to a theme park, it was so crowded as it was the holiday season. It was jam packed that we could hardly walk anywhere without pushing, shoving, or trampling somebody. It could rival a walk in Divisoria. And the lines to the attractions were ridiculously long that can push the limit of patience in any human being.

The only consolation in these long lines was that they post how long was the wait time – like 45 minutes, or 120 minutes, or gazillion minutes (!) – to the ride or show, so that you have some idea of how long your agony would be. They should post the wait time in the restrooms as well, as there were long lines there too!  How could this be the “happiest place on earth?”

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In one popular ride of the park, our resolve was tested when we stood in line for it. We tried to get a *fast pass, but the time it gave us to return was close to midnight! We may not even stay in the park by then, so we took our chances and waited in line. And we waited. And waited.

The line was long and winding. On top of this, a long portion of the wait, we were cramped in a dark, enclosed place, with hardly any “personal” space. If the theme of that particular attraction was going to outer space, they were succesful in mimicking that environment, as I felt there was not enough atmospheric oxygen for me to breathe. Perhaps more people got dizzy and light-headed while waiting in line than in the ride itself.

After standing in line for more than 2 hours, we finally got to experience the “thrilling” ride. All the 2 minutes of it. Yes, you read it right. A measly 2 minutes! Was it worth it?

Our real life experiences though involves the humdrum of waiting in line. We stand in line for the bus or the train to take us places we want to go. We wait in line when we apply for a certificate, or a license or even for a job, so we can do things we want to do. We stand in line in stores or groceries so we can get things we like or need. In almost anything we do we wait in line.

In truth we have even mastered the art and science of waiting in line. When you line for the check out counter, do you count how many people are lined up in the different lanes, or better yet even count how many items each person have in their grocery cart in front of you, to make sure you line up in the shortest and fastest lane? Guilty, huh?

Then, there are people who wait in line for their destiny to come. Like princes and princesses, waiting for their moment of prominence.

Prince Charles is standing in line, to be the next monarch for more than 60 years! And that is if his mother, the current queen, will not outlive him. Some even feel that he should give way the throne to his son, Prince William, who is younger and more popular. But that is a different issue in itself.

What I am trying to say is this: in this life we wait for something grand to happen. Most of the time the wait is long, and the exciting event can be fleeting and short. Was it even worth it?

I don’t know what you are standing in line for. Maybe for that dream job. Or for your special someone. Or for that memorable occasion. Or that fateful event. Or your appointment with destiny.

I hope that this new year will bring in that event you are waiting for. And if not, just be patient. For I believe we are all destined for greatness. And it is worth the wait.

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(*Fast pass ticket allows a guest to avoid the long line by giving them a pre-set time to return to the particular attraction.)

(** photo taken with iPhone)

Auld Lang Syne

I was on-call that New Year’s Eve. As I remember it, even though it was the holiday season and no patient wants to be in the hospital, it was still very busy for us.

It was a time of a bad flu season and our ICU was full. In fact there was even a pandemic that year of a bad strain of influenza A, the H1N1, or otherwise known as “swine flu,” and we had confirmed cases in our hospital. The hog farmers here in Iowa detest the name “swine flu,” as it was detrimental to their trade.

Despite of my toxic duty, I was able to finish my rounds and saw all our hospital patients for the day (took me 12 hours or so), and made it just in time to a gathering of some Filipino friends for the New Year’s party.

I was only warming up with our friends when I was called for a “stat” consult that I have to see right away. Before I left, my friends told me that if I finish the consult and it was still before midnight, then I should come back to the party. It was around 10 o’clock when I drove back to the hospital.

The patient that I came back for was a woman in her 40’s. She had breast cancer and sad to say, despite all the surgery, radiation, and chemotherapy that she underwent, the cancer had spread to the lungs and pleura (covering of the lungs).

The patient was obviously struggling to breathe when I examined her. The chest x-ray that was done that night, which was requested by the oncologist showed hydropneumothorax. That means there was collection of fluid and air in the space surrounding the lungs. And that was the reason I was consulted, to surgically place an additional chest tube (as she already had one in place) to drain the fluid and air.

After reviewing the chest film and comparing it to the previous chest x-rays, I determined that the finding of hydropneumothorax was old. In fact the chest x-ray was unchanged compared to films from few weeks ago.

That meant that the worsening of the patient’s respiratory status was not from the collection of air and fluid primarily. Placing another chest tube would not matter as the lung was trapped and would not expand further. I surmised that her further deterioration was from the advancing cancer itself.

Maybe the patient and her family was hoping against hope that there was still something that can be done. Maybe they were grasping for straws for a possibility that she could see another New Year.

I explained my findings and I then solemnly, but respectfully told them that in my viewpoint, placing another chest tube would not matter, and that would not relieve her breathing difficulty.

Right after hearing my opinion, that was when the patient and her husband made the somber decision that it was time. Time to end it all. Time to let go. Time to transition to comfort measures only. It was time for her to rest.

The patient’s husband went out briefly, maybe to talk with other family members who were outside the room. When he came back, I bid them goodbye and left.

As I went out of the room I saw two girls, both were probably not older than 12 years of age. They were crying, while an older woman was comforting them. I assumed those young girls were the patient’s daughters. I think it would be safe to say that they were not having a “happy” new year’s eve.

I looked at my watch. It was less than an hour to midnight.

By that time the rest of the world was partying while waiting for some fancy ball to drop. At that time most people were celebrating while waiting to welcome the New Year. While another family was also waiting. Waiting for suffering to end. Waiting not to welcome, but to say their final goodbyes.

I did not go back to the party. I went straight home to reflect, while the song Auld Lang Syne (translated as Times Gone By) echoed in my head.

Should old acquaintance be forgot,
and never thought upon;
The flames of love extinguished,
and fully past and gone:
Is thy sweet heart now grown so cold,
that loving breast of thine;
That thou canst never once reflect
On auld lang syne.

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(*Auld Lang Syne is traditionally sang to celebrate New Year at the stroke of midnight, but it is also sang in graduations and funerals.)

(**photo taken by my wife in our backyard)

Stray or Stay on Course

If you are reading this now, that means you “survived,” and the world did not end last December 21, 2012, as some doomsday prediction wants you to believe. Well that is good. But now what?

I tell you though that something is definitely ending in a few days. No, not the world but the year 2012.

Another year is done. Another year is gone. Another “Auld Lang Syne.” Time to party and get drunk. Is that it’s all about?

With the end of the year upon us, I believe this is the perfect time to reflect (drunk and reflect does not mix) on things. To look back if you will, to ‘what have been’ so we can face the ‘what will be.’

If you are on course, then by all means continue on the right track. However, as most of us do, we often stray off the course. This is the time we assess our bearings, adjust our sails, and right our direction, or else we will be forever lost.

May you have a happy and prosperous new year!

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(*photo taken with iPhone)

Tahimik na Bagong Taon

Walang mga luces at jumbo fountain na kay ganda,

Walang rebentador, super lolo at super pla-pla,

Walang sunog na gulong sa gitna ng kalsada,

Wala ring itim na kulangot na nakakaimbiyerna.

 

Walang nagkakaraoke’t  lasing na kumakanta

Walang nagpa-party, nagsasayawa’t tumatawa,

Walang magugulo at maiingay na kabarkada,

Wala kahit media noche at queso de bola.

 

Sa mapayapang sulok ng daigdig ko sa Iowa

Sa ‘king pagtulog, bagong tao’y tahimik na umentra

Sinalubong kong walang ingay, ngunit puso’y  masaya.

Ang mahalaga’y harapin ‘to na puno ng pag-asa.