Science Fiction and Fantasy

I had an interesting conversation with a patient recently. I guess the topic turned a bit friendly when he was satisfied with my explanations of the disease process and treatment.

Basically he said that he was giving a piece of unsolicited advice, that I should look towards writing a book because he apparently enjoyed the way I conducted my narrative, that I was able to  hold his attention unlike the stereotypical doctor dealing out scientific jargon not normally understandable to the lay person.

I thanked the dude for his compliments, but it really got me thinking... Could I really transition into writing an actual full-fledged narrative?

I mean, it wasn't for lack of trying. I recall sometime in grade school when I first set out to write my own science fiction novel (since I was still on a high from reading all the Robotech novels from my collection), but this project fell short because (in hindsight) I really didn't have a concrete story to build around. I thought that I had shelved that idea for good, until now.

Structure. That is the one thing great stories have which I didn't prepare for. We learn in school about how stories  are made, about the different parts and how the narrative should flow together, but since that just seemed like a random concept, it never occurred to me that I needed to apply it to my own work.

AS you can see, most of the stuff I write here on this blog are pretty much free-flowing. I just pluck the thoughts from my stream of consciousness and hope that the thought will be cohesive enough for my readers (or even myself in the future) to understand.

To be honest, the idea of making a structured story now kinda intrigues and excites me. The fact that I would need to craft a dramatis personae with their own backstories that would provide a logical flow to their actions has piqued my interest..

 I had been reading my way through the Dune novels since I passed the diplomate exams and is my constant activity during clinic downtimes, but to tell you quite frankly, it has lately become a struggle to keep myself engaged, since the latter original Dune novels dwell a lot more on political intrigue and the inner workings of a prescient mind. 

This entry also has "Fantasy" in the title for good reason. I have recently come across a D&D-based story entitled the Tale of an Industrious Rogue, which basically details an entire Dungeouns and Dragons tabletop campaign conducted by a flexible and creative Dungeon Master (DM) and played by an equally creative bunch of players controlling the colorful and devious characters that serve as their in-game alter-egos. This story has renewed my interest in old-school tabletop RPGs (I used to play the Sci-Fi equivalent of D&D called Star Frontiers which was also made by TSR, the company behind Dungeons and Dragons). I realize that this would present a set of challenges, since the people I would normally play with (the BNO guys) ave much difficulty organizing our nights out, much less a long term campaign requiring multiple sessions. The magic of the internet offers some promise however, especially with the advent of videoconferencing. All we would have to do is work out who controls the dice so that there would be no accusations of cheating. Hehe.

Seriously though, I think I am yearning for a return to the good old days, when adventure games were driven more by imagination and creativity than visuals and gimmicks. We'll just see what comes up. ;)

Ang bagyong hinde

A couple of weeks ago, the metro was hit by a torrential rainfall similar to what befell us a few years ago when the typhoon Ondoy rolled into town. Memories of being stranded on the road until 9pm was renewed in my mind as the downpour reduced visibility to near zero.

The day had begun quietly enough, with a bit of scattered showers falling unpredictably here and there. The local weather forecast showed that there were storms located outside the PAR (Philippine Area of Responsibility) but had the side effect of bringing in these monsoon rains. I had just gotten in the car with my Other Half when the downpour suddenly came. It was a good thing the mall was nearby, but I found myself suddenly fearing any flooding that would occur in the basement parking.

We went on the date as usual but it was ominously dark outside. I remember saying to myself that it looked like it was evening already but in reality it was just a little past noon. The rains raged on outside until we got the call from her mother to abort and come home since there was flooding already at different parts of the metro. We hurriedly left and I got her home safe before saying a little prayer and heading out. Luckily I made it home unscathed. Then there was the long wait... I spent a great deal of my time waiting for everyone else to come home. My brother arrived first after dinnertime, but my poor parents got home at 3 in the morning already due to standstill traffic caused by severe flooding.. :(

I was really thankful that they got home safe and that the water level in the immediate vicinity had not risen to alarming levels..

We saw the news the following day... The riverside communities in Marikina had to be evacuated, and the dams were forced to release water because levels had gone dangerously high.. :(

It was really fortunate that the rainfall was not as severe as what was previously experienced. The cost to human life and property is presumably much less than before. From a physician's standpoint though, we have to be an the lookout for an increased incidence of leptospirosis, as this may progress to outright renal failure and fatal pulmonary hemorrhage. 

Net Negativity

A lot has happened in recent weeks, and foremost among them was the blatant doctor-shaming by an infamous media personality who in my eyes has devolved from a supposed protector of the oppressed to just a plain old mean-spirited bully who pushes people around just to get what he wants. Seeing as all this negativity has had a substantial impact on my general mood as of late, I shall not be dwelling on that much-publicized incident here.

AS you can see, there have been so many ups and downs as of late. The internet has now turned into a hotbed of hostility and negativity which is spread far and wide through the (mis)utilization of social media. Foremost among these sites are Twitter and Facebook. The supposed freedom and anonymity of the internet has turned people into such jerks and assholes that it sickens me.. Then you have all these fake accounts pushing a particular agenda or orchestrating demolition jobs on individuals. Then there is also the abudance of fake news being circulated by uscrupulous individuals who are often in the payroll of one moneyed faction or another. It's just so sad... I guess this is human freedom at it's very worst..It is impossible to tightly control the entire internet, although I think China has been doing a helluva job with its own Great Firewall.

I just want to comment of this foul nature of humans, particularly the aspect that we manifest when we are behind the anonymity of the computer. Free access to the internet has led to an exlosion of apathetic individuals prowling online doing hurtful things just for the hell of it. Basic decency appears to have taken a backseat (or even no seat at all) for these people. It is sad that such a wonderful tool like the web is used merely to spread hatred and evil instead of fully utilizing its potential to help  better the lives of everyone though the sharing of knowledge and the ability to connect earnestly with people who are far away. I guess it bolis downto education, and I'm not talking about those fancy degrees here. What I am highlighting is the "manners education" that a person should receive as a child, the basic rules of decency and good moral conduct that would ideally be ingrained in every individual from a young age. I look across the internet now and see a general lack of empathy with others. I mean, you don't have to cry and sympathize with every sob story that you hear, but at least you could be decent enough not to act like a dick and make fun of those aggrieved.

I have observed that the supposed "nice people" on the internet are often drawn out to become angry lunatics because they tend to have very emotional responses that the so-called "trolls" are skilled at eliciting. This used to be the domain of the crazy obsessed fan, the nutty conspiracy theorist, or the blindly loyal staunch political supporter, but has now taken a more sinister undertone as the trolls are now for hire. This makes them much more dangerous since they are able to focus their attacks on anyone or anything going against their agenda (as opposed to individual nutjobs who people don't take seriously at all).

I guees that's enough about the negativity epidemic. I didn't want to get anybody down, but I just needed to have some catharsis from this rough couple of weeks.. 

To The Trainees..

I had a chat sometime ago with a promising junior who was struggling with the rigors of residency training. As I was drawing from my own previous experiences in figuring out what I had to say, it dawned on me that it would be of much better use to a greater number of people if I were able to condense that into a universally relevant message.. 

With that being said, this post is dedicated to all the residents- and fellows-in-training, no matter what your specialty or subspec may be... (although I guess it would be more relevant to the junior residents, since the fellows already know what they are getting into, having finished their own residency programs earlier. hehe)

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To all those struggling in their training, I say to you, don't give up!

There will SURELY come a time (or multiple times even) in your training where you would contemplate just giving up, abandoning everything, and just going home.. It's not exclusive to being a junior, because I have felt that compulsion too as a fellow-in-training..

The reasons are varied: they would often be those things that are beyond your control like hostile seniors or a hospital/department system that doesn't work well for you, toxic patients (or relatives of said patients), a heavy patient load, rigid academic standards, difficult batchmates, the list just goes on and on...

Having said all this, there is one thing you have to understand.. These things that you are experiencing, they will not go on forever.. The bad seniors will eventually graduate, the toxic patient will eventually get discharged, the patient and academic loads will stop once you graduate, and your won't necessarily have to deal with your batchmates again after you finish training.

So, to leave just because of these things would be a major folly.. Yes, sure, leaving the program might result in an end to whatever hardship you are presently going through, but you will deprive yourself of the proper training as a specialist, which would have led to proper certification and a fruitful practice for the rest of your life..

Another discouraging feeling I recall which could drive a person to quit would be the feeling of inadequacy.. A conscientious trainee would feel that he or she is not good enough to train when he/she would commit a lot of errors and understandably be repeatedly chastised by seniors or consultants. These feelings of shame and guilt would build up inside you and make you question why the hell you started training in the first place..

Having been on both sides of the coin first as a hapless junior on the verge of quitting and then as a senior trainee evaluating prospective juniors, I just have to say this: The training committee of your respective departments generally accept trainees because they see the potential in you, otherwise you would not be accepted outright. The personal challenge for you is to grow into that potential and be what they see you can eventually become. This would entail a lot of personal growth, not just academically, but emotionally (and even spiritually as well) if you are to survive to the end of your training.

Going back to the basics, being told that you made a mistake really sucks. Different people have their own ways of processing this. Some would get angry and lash outward, especially those who are so full of themselves and think that they are so much better than they really are. Others would get depressed and punish themselves internally, since they would see themselves as failures and this just validates their own insecurities about their abilities. Both of these methods are not only throughly useless, but are very destructive as well.. If left unchecked, continuing on with any of these would result to either an expulsion from the program or the trainee dropping out due to the pressure.

Being wrong hurts, I get that. The mindset is very important here though.. Undergoing training would expose you to the uncomfortable truth that you are still inadequate. It would render visible to all the deficiencies and gaps in your clinical knowledge. How you would respond to that would be entirely up to you.. You could just throw your hands in the air, say "I give up" and just leave, or you could take note of these deficiencies and use this as an opportunity to grow by filling in the identified gaps through study and research (if the need arises).Getting better in training is not an option, it is the only way to go. This growth would entail some degree of sacrifice. It is a well known cliche that nothing easy is ever worth it, and medical training is no exception. The hardships you encounter here will mould you into a better and wiser version of yourself, as long as you let it. You may not be comfortable leaving some facets of your past behind, like being comfortable with mediocrity or procrastinating 'til the last minute, but if you have the will to improve and be a better version of yourself, these "sacrifices" would eventually matter little to you since the better version of you no longer has need for them.

An image about training I thought of recently was that of a plant in a garden.. Imagine an untamed bush (which would represent the new trainee). This bush would have grown wildly since the prospective trainee had just probably finished medical school and have so many different bits of acquired knowledge but with little wisdom when it comes to application. When the trainee anters the program, he/she enters the custody of a gardener (which would represent the training program, seniors, consultants) which would trim the plant as it grows, removing unecessary branches and allowing other parts to grow.

Training does that to you. It removes any preconcieved erroneous/flawed.incomplete notions about disease entities including the diagnostic and therapeutic approaches which may have been misunderstood in medical school. It allows other necessary parts to grow by letting the trainess fill the gaps in his or her knowledge. New branches would also grow, which would repepresent new skills that would have otherwise not been learned under the wing of a program (advanced medical and surgical procedures for example). It would also create a change in the way you perceive the world, and the way you work and deal with people. All of these are part of your growth, so you don't have to fight it. More often than not, these adaptaions would result in changing you for the better. Eventually, the plant in the garden would grow to be a beautiful well-manicured tree which would bear much fruit for years to come, and thus be of benefit to a great number of people.

So when you are thinking of quitting, take time to step back and take a look at the bigger picture. This brief moment in your life is insignificant compared to the beautiful and complicated tapestry that lies far ahead and stretches as far as the eye can see, and all that is needed of you is to stay on this path.. Get better and grow if you need to. Acknowledge your deficiencies and work to fill in the gaps. Growth is never instantaneous and would sometimes require a great deal of effort. Keep your eye on the prize and never lose sight of what you want to become. Eventually though, you would be able to look back after everything has been said and done and tell yourself "Damn, I went through all that??". ;)

Good luck guys! I will be praying for you! :)

Medical Honorifics

I guess it's just common sense that a physician would be addressed by the general public with "Doc" or "Doctor" attached as a prefix to his or her name, in the same way that lawyers are called "Attorney" or priests are called "Father".

In medical school, especially during 4th year or the so-called Clerkship/Junior Intern year, one becomes a part of the hospital hierarchy and thus everyone senior to you is addressed accordingly.. or so I thought..

When I was in my clerkship year, "Doctor" was the norm, and everyone was fine with that, since it made perfect sense. However, during my Legal Medicine rotation where I found myself at Camp Crame, we encountered a senior intern from a different medical school for the first time. What struck me the most was that in their institution, senior doctors were addresssed as "Sir" or "Ma'am" instead of the conventional "Doc/Doctor". The rationale he gave was that the use of Sir/Ma'am was the highest honor you could give someone, plus I guess it came in pretty handy when addressing someone you weren't sure was a doctor or not.

"Ok", I thought "that seems reasonable." but something in me argued that "You can call anyone Sir or Ma'am, but you can't just call anyone Doctor". In hindsight, this seemed like a pretty arrogant thing to say, and to be perfectly honest, I am quite ashamed of having thought that way before.. :/

As I went further along the path of rising through the ranks, I encountered more people from different schools, and I discovered that there was such a heterogeneity of how trainees use the honorifics. Eventually I found myself using "Sir" and Ma'am" more often, as it seemed more comfortable and less awkward to say. Hmm, I guess you can also add the fact that I had unpleasant experiences as a junior in my alma mater which made me averse to any similarities to the way the hierarchy was run over there. :P

As I previously stated, everyone else calls you doctor anyway, so why do you have to require your juniors to say the same? It seems kinda redundant (and a little too pretentious if you ask me) to call each other "Doctor" all the time. I now wholeheartedly agree with the concept that "Sir/Ma'am" conveys a whole lot more respect when said by a junior to a senior, as it sets clear bounbdaries between the two of you. "Doctor" is more ambiguous can be used when talking to peers from other departments who you aren't close to, or even used sarcastically by consultants talking down to juniors. (In retrospect "Sir/Ma'am" can also work for the former. Hehe)

Sorry if this seemed long-winded and confusing.. The basic point I wish to get across is that the use of "Sir/Ma'am" as an honorific title when junior doctors speak to their seniors seems much better than addressing your bosses as "Doc" or Doctor". And yes, It really does come in handy when respectfully addressing someone whose medical status is unknown. Manners maketh man I guess. :P

Getting Started

After everything has been said and done, here we are at last...

I'm approximately two and a half months removed from the passing of the diplomate examinations and the start of my new life as a Pulmonary consultant.. Man, starting a practice is not as easy as it seemed.. Wait, let me rephrase that.. Starting a practice is HARD! :/

Despite now seemingly having all the time in the world to do my own thing at my own pace, things have gone by pretty quickly just the same.. Hospital and clinic applications, government registrations, training certifications.. the list just went on and on.. Looking on the bright side, at least I gave my life excitement and variety. :P

Now that I have finished all the startup stuff and have somewhat settled into a regular routine, I'm presently assessing gaps that I need to fill. These concerns could be academic, emotional, or spiritual.. I'm still feeling stuff out, and I'd be lying if I said I wasn't scared by all the uncertainty. This is a whole new ballgame for me, since I have been in school or training for almost the entirety of my adult life thus far.. The vastness of the possibilities terrifies me.. It's always a tossup between staying the comfortable and safe course, versus the unknown with possibility of high payouts..

I'm also concerned about how my decisions now could set the precedent of how things would turn out for the rest of my life.. I guess it boils down to my not wanting to have regrets in the future over wasted opportunities that didn't quite seem all that viable at the time, but actually would seem like a really good idea in hindsight..

Hmm, I guess it would all boil down to how you want to live your life and how you want to be known/remembered for..

Yeah, life is pretty scary business, but we all eventually have to face it.. and I would like to face it on my own terms.. ;)

A wide-open space..

True Freedom.

For the first time in my life, I can claim this with absolute certainty.. at least for a little while :P

It finally happened.. I am now officially done with training and its' associated culminating examinations.. All that remains is the oath-taking, but that is of little consequence in this context..

No longer do I find myself in pursuit of a particular schedule to adhere to a rigidly-defined set of goals as prescribed by a rigorous curriculum.

Yes, schedules and tasks are here to stay, but the academic burden has now been lifted from my shoulders.. Only to be replaced by the more awesome responsibility of life as a private physician.. There are no more safety nets, no more easy fallbacks.. Every move must now be more calculated than ever, as a wrong move could send all your hard work spiraling down the drain..

Scary? Yes, but exhilarating all the same. I am now bracing for a very different kind of lifestyle from what I had grown accustomed to in the past years.. Finally gone are the endless duty nights, the relentless need to study for yet another exam irregardless of your state of mind, the ceaseless errands.. But yeah, I will be missing mostly the kind of fatigue that is unique to residency and fellowship training..

Life will still be tough, I will still get tired, and sleepless nights will still be spent, but it is comforting to know that all these hardships will now be done mostly on my terms and not in partial fulfillment as a requirement for something and such..

I was never too much of an academic. I had a slightly different way of processing information, and thus classical techniques of learning and review didn't work well for me. I needed to understand concepts and construct them in my own words, otherwise all my efforts at memorization would come for naught. The caveat of this was that I tended to simplify things to the point that even though the knowledge would be usable, I would purposely omit long-winding (what i deemed) unnecessary details so as to make the information so much easier to digest and process. As a result, my exam grades were never really all that hot. :P 

This was often a cause for concern whenever I took examinations, since I tended to finish early. Just to be clear, this was not due to any sort of brilliance or intelligence on my part. It was actually more of my dislike of retaining the information longer than I had to. I wanted to finish as soon as possible so that I could finally release my mind from all those bits of knowledge I was fighting to retain for examination purposes. Granted, I never really got high marks, and even failed quite a bit, but at least my brain got some catharsis :P. Fortunately, some things do eventually get ingrained into my system with repetition, which is why I think having my residency at a public hospital worked so much better for me as compared to my experiences at private institutions. This is not a knock to the private hospital people. Its just that the program you have may not work for some people, and conversely, other residents are not suited to be in public institutions.

Hmm.. going a little off topic already there.. Hehe.

I'm presently in the middle of completing my requirements and sending my applications out to potential places of work. I never knew being this free could also be this much stressful. :/ Now I finally have my entire future to think about, and I can now think of my goals more concretely than before, since I have finished what there was to finish.. It kinda makes all the sacrifices seem a bit worthwhile.. ;)

Simply grateful..

I'd like to start off this blogging season with a shoutout to the people that matter..

- Firstly, I would like to thank the Lord (for the umpteenth time) as he is always there for me and comes through whenever I need him.. Thank you so much, as nothing would have been possible without you..

- My family, the most wonderfully dysfunctional support system a person can ever have.. :P Thank you for putting up with me and all my crazy idiosyncrasies..

- My Other Half, who was there every step of the way, cheering me on and encouraging me to get stuff done until I finally made it.. Thank you for keeping me together and inspiring me to push through 'til the very end. :)

- My BNO boys, thanks a lot for putting up with my crazy schedules and tailoring some outings just so that I could tag along. ;) 

- My mentors. It was such a great honor to have trained under such great minds and educators! Thank you so much for lending us your time, patience, and experience that allowed us to grow into the specialists we are today. I hope we will be able to make you proud someday..

- My batchmates. Here's to the most dysfunctional bunch of doctors that I have ever met! :P Despite all our un-cohesiveness and many, many interpersonal issues, we still managed to pull of the rare hat-trick of the entire batch passing research on time, taking the boards, and scoring the 100% pass rate! Congrats to us, and thank you as well.. Fellowship wouldn't have been what it was kung wala kayo.. (although it could have been better.. much, much better.. :P)

- My pulmo juniors. You saw a lot of me this past year, mostly being a nuisance at the OPD or just hanging out at the callroom. :P Thank you for being my sounding board of sorts when I was already freaking about as the date drew nearer.. and thank you for the graduation gifts! They are very much appreciated!!

- My co-fellows from the other departments. Alas, here we part ways.. Thanks for being there to answer our referrals (for the most part :P). I'll never forget you guys!

- The hospital support staff. Thank you for being a part of our journey, as we couldn't have done it without you as well! 

- Lastly, to all the patients that I handled, both living and deceased.. Thank you for teaching me to be a better person and physician...

 - To everyone else that I may have missed but has touched my life in one way or another to eventually help me get to this point.. Thank you so much! :)

2017 Retrospective (AKA 2018 "Yearstarter")

I had originally planned to write this entry in the waning moments of 2017, but I guess fate had other plans.. It seems like Im really doing annual retrospectives from this point on.

This has been a very unique year, to say the least. It is typical to find tremendous upheaval contained within the context of 365 days, but this marked a transition of sorts into a new era.. (for me anyway :P) 

Foremost among the  aforementioned changes is the acquisition of the family vehicle, and with it, the ability to safely go to previously inaccessible destinations on our own, what with a handful of trips outside the metro as we began to satisfy our long-standing wanderlust. :) I think the vehicle goes beyond just the thrill of ownership. It also brought along a host of new experiences which only served to enrich our pool of experience even further. Every aspect, from purchase to maintenance are now ingrained in our minds, making sure we won't struggle or panic through the process the next time around..

This year also marked the long-awaited end of my formal training as a specialist.. it was bittersweet in a way, since I had been looking forward to the end for as far as I can remember. The end was thankfully not anticlimactic as I haddread. Instead, it was kind of like going away peacefully, without much fuss or fanfare, just the way I like it.. :) I wasn't gone long anyway, since I spent the better part of my first two months post-fellowship stuck at the hospital in a bid to complete my research project and secure my final clearance from the alma mater. 

I guess I did have a bit of separation anxiety, since I found myself back there a lot more than I would have liked (since I did turn down the offer to extend another year if deemed worthy). I guess it's just my nature to never be truly gone from places I had once considered home..

Speaking of second homes, this year also granted me an opportunity to give something back to the Old Hospital as I was invited to give a short career talk regarding Internal Medicine to the outgoing PGIs..Preparing that presentation was definitely a lot more different..Having been trained properly in presentations by virtue of the workload during fellowship, speaking before a crowd was not a concern. This left me more time and effort to spend on preparing something that would get my message across to those impressionable minds and hopefully turn them into potential recruits. The actual turnout was quite disappointing though, with only a small handful of QC babies applying for pre-residency this past year..

This year also brought great blessings to my Other Half, who not only passed her examinations, but was also accepted into training in one fell sweep! :)

This has also been a year of good times with good friends, of outstanding movies and memorable bonding moments, of adventures with family and quiet times with loved ones...

Granted, this is also a year where I seemed to see the world unraveling before our eyes due to events and decisions both locally and abroad, but I on't dwell on that..

Here's to a bright new tomorrow! 

Welcome 2018! Be kind to us, please? :P