New Year 12/31/2008 06:25:00 PM

2008 had its ups and down for me. I had to give up, give in, bear it, take it as it is, do more, be better. I've been involved, missed out, loved a lot, been excluded, lived my dreams and drifted back with nostalgia. Now, the new year is here, and i'm this close to turning the big 3-0!

What's in store for me then?

Stay tuned!

When My Brother Topped the Board Exams 11/02/2008 02:13:00 PM

A few days ago, I became both the daughter and the sister of board exam topnotchers. My brother found out that he got 4th place in the recent ECE board exams. He somehow bettered the 9th palce finish of our own father in the Chemical Engineering booard exams several decades ago.

Just as the results were about to be released, our phone lines and internet access died. We had to rely on text messages from an aunt for news.

My youngest sister (forever at odds with the brother, the place I held before I "matured" and stopped quarreling him myself ) couldn't care less. She couldn't understand our concern about not being able to get to the news first. We were all going to find out about the news the following day anyway.

A little past midnight, my mother woke me up with the news that my brother had passed the exams and was in the top ten placers. He learned about it from the text messages of classmates. One of his classmates also gave him a call which woke him up. The rest of the family was already awake and celebrating: Mama, Papa, my brother and my other younger sister.

We decided to let the youngest in the family sleep it out in the couch.

The next day, when I asked if she had congratulated her brother, she said nothing.

I still owe my brother a tub of ice cream though.

Congratz, Joven!

HAPPY? 10/12/2008 12:27:00 PM

For a long time, I have been wanting to blog about this, maybe to overcome my melancholic-phlegmatic temperament... or maybe this is just another aftermath of the crying session I (again) had last night for another irrelevant reason?

I have my ups and downs, my insecurities, worries, concerns and I am the typical maldita... Yes, things can get to me the moment they occur... And in retrospect, I have done several things I wish I never did (mostly things that come out of my mouth....) And yet, I am at a point of my life that inspite of all the external things going on, I am happy and at peace (yup, the real deal "gaudium cum pace").

I remember being asked in a high school English class what everyone of us wanted to have the most. I answered, "Serenity." I must have been at another highly stressed near-depressive episode at that time... And now, I can say that, I have finally found it.

Joy and peace comes when you know that you are doing the right thing at the right time, although mistakes may be forecoming along the way. It is knowing that you care for a lot of people, and you are being cared for as well. Someone will guide you as you also guide others. When you stumble and fall, you can run back into the confessional and get up again. It is leaving all the silly fears behind since anyway, when you make a mistake, you will be told and helped to make amends.

It is alright that you aren't perfect. The important thing is you are striving to atain heaven.

Everyday, I see people in the hospital, people I work with and work alongside with and I sometimes wonder if those seemingly cheerful faces have a sadness to hide. In one way or another, I find out that at times everything is just a facade, and this or that person seems to have no idea where his/her life is headed... Another party, another ball game, vices, pleasures... I would sometimes just shake my head, and silently pray (I'm not the type of person who will say things unless that audience is at an apt time to listen) for that soul's concerns.

And all these wrong notions about how one has to live one's life... I know that if I shall ask them: "Are you happy?", they would probably say "Yes", but as a lie. When will they wake up and realize that things can get so much better?

Once again, I shall say, "I may not be prefect, and oh, I have so many defects... Yet deep inside I am secure in the love of God for me... And that brings with it all the joy, peace and serenity that I need for myself and to be shared with those around me as well."

The Senior Citizen as Patient 9/21/2008 08:52:00 PM

In the course of 9 months doing residency, I have encountered several patients in the twilight of their lives... I think I already described my impressions of three such persons in a previous post, which can be my entry for this edition of "The Blog Rounds". If I ever live to that age, I wish I can be as gracious as the second patient and as grateful as the third. God-willing I won't be acting like the first one.
Read rAdIoLoGy NoTeS 06 to see why.

rAdIoLoGy NoTeS 13 9/12/2008 10:52:00 PM

It's a busy month: a mid-year convention, in-service exams, trying to get applicants to then start pre-residency mid-November.... And I just realized that I'm no longer going to to be the most junior resident of the department... I can now say goodbye to being responsible for supervising the work of the medical interns... I more or less already know what I am doing, although I still make an occasional inexcusable mistake (i.e. Do not fail to look at the skull base bone destruction and subtle mass lesions, especially with symptomatic patients with known primary malignancies! -> Major note to myself!!!).
Next month I shall assume office as the secretary of the local radiology resident's organization. I was elected in absentia (I had to get back to the hospital that night for a referral. I later ended up doing the preliminary reading of the brain CT-scan of that certain boxer all the other residents saw lose that night on national TV). The main reason I was elected was again, my gender. I guess I have already mentioned in a previous post that I am only one of two current residents in this part of the country who are female (she's already about to graduate!). I can't wait for the new resident to start though. Currently all the applicants are female so there's a good chance my junior will be a she.

Bisperas (The Day Before) 9/06/2008 10:31:00 AM

Tomorrow, I will be celebrating my 28th birthday. Since, I will be the radiology-resident-on-duty at the hospital tomorrow, I'm writing my birthday post on the eve of the day itself. I'll be cooking for the staff of the department (yes, those guys I have been occasionally ranting about who have appetites of epic proportions!) and my co-residents for breakfast tomorrow. They are planning a maƱanita (dawn serenade) which I am strongly opposed to! I don't know yet if they will really carry out their plan...

Anyway, I used to celebrate my birthday by writing a poem with the exact number of lines as my age when I was in college. I think it is about time to revive this custom...

~@ ~ @ ~ @ ~ @ ~ @ ~ @ ~ @ ~ @ ~ @ ~

Twenty-Eight Verses

With the night at end

Ane the day begun

The sunlight glides

To break the dawn

And allow the rain

To pause and think

Of puddles that muddy

The path one takes

Or rainbows to usher

The day's delight

And I pause to wonder

Of the things to come

Be they lights or shadows

Joys or adversities

And see that the difference

That lies beneath

Depends on one's perspective

Of what is at hand

Thus, I resolve to wear

Those rose-colored glasses

That I may see

The world anew

From the optimistic perspective

Despite the hurts

Or the ills that come

The darkness shall fade

And the light shall come

With the rising sun



Why I'm Pro-Life, Anti-Artificial Contraception and Think That Reproductive Health Bill is Totally Unecessary 9/01/2008 07:06:00 PM

I'm already bracing myself for a lot of violent reactions to this post... I know I'm not the only pro-life physician in this country (I know several others just like me, a few, but I would like our tribe to definitely increse), yet perhaps I will be the lone voice of dissent in this edition of the blog rounds. Do allow me to explain myself though.
Since I was in high school, the issue of contraception has been my pet peeve. I had to write an assigned article, elaborating on the artificial methods of contraception as well as the reason why it was immoral. Pretty hard to digest for a teenager then. But I did get the point of the Church's teaching on it: Separating the procreative and unitive aspect of sex from each other was what made it against the natural law and therefore immoral in itself (the same principle applies to the immorality of doing an in-vitro fertilization procedure, but that's a whole other story).
In college, I once mentioned to a friend (who happenened to be a physician as well) that I had to write a paper on a topic for my ethics class. She suggested that I take it up artificial contraception as using abortion as my topic would be too easy (the act is already banned by our constitution). Thus I found myself reading books that explained why this was so not in terms of the teachings of the Catholic Church but in terms of the nature of the sexual act. Unfortunately, I have lost my original soft copy of the paper I made, but I shall reiterate here the little that I remember in my own words.
The sexual act is a means of a very intimate form of communication between the man and the woman, essentially indicating that they are giving their whole selves to each other. Artificial contraception in whatever form it comes is tantamount to saying "I give you my whole being, except that I hold my fertility back." Thus in this most intimate form of communication, the man and woman are lying to each other (the same principle applies to the immorality of pre-marital sexual relations, but again, that's a whole other story).
When I finally went to medical school and did my senior clerkship, I found out that a lot of times, patients were not actually giving informed choices as they were not in the first place fully informed either. A lot of physicians seemed to not take the time to explain to patients the real pros and cons of one family planning method and the other. For instance, how often does a woman hear that an IUD and oral contraceptive pills can cause induced abortions as one of their mechanisms of actions as sited in even the latest OB-GYNE textbooks. Do people ever hear that the natural family planning methods are the only ones without any side-effects and are upto 99% effective if they are employed to the letter? I have also witness illeterate mothers berated into signing the consent form for Caesarean sections plus bilateral tubal ligation once it has been noted in their history that it is their third C/S? Is this even mandatory? I have heard of at least 1 woman who has had 5 C/S (In one ethics book, it states that there are cases of 9 or more C/S without maternal or fetal complication). I heard some of my then OB-Gyne residents say that the uterus gets too scarred the third time around. Well, if the uterus gets too scarred, they should remove it as a diseased organ and not tie the perfectly healthy fallopian tubes. This violates the ethical principle of totality and bodily integrity. I also find it apalling that it seems people think that people are incapable of periodic abstinence thus sterilization is the easy way out. It seems to close to saying that we are like, let's say those dogs who have to be spayed or neutered as they cannot control themselves either. I think there is also a tendency for many to selfishly see child as a burden, not as a real gift from above.
Unfortunately, there are so many Caholic physicians who have as little knowledge of some basic teachings of their faith as they are well-versed of their subspecialty. In one online article, I read about this Catholic doctor who didn't know that it was a mortal sin to consel a woman to use artificial contraceptive methods. I also remember the shock of one of my doctor-friends when I told her that even assisting in a bilateral tubal ligation is a mortal sin as it publicly signifies that you are approving of the act (I have at least once refused to assist my resident in a C/S + BTL while she was doing the BTL part). If the reader has had no previous knowledge of the above facts, at least I have now stated the obvious for your benefit.
Pope Paul VI was quite prophetic when he wrote these words in point 17 of the landmark encyclical HUMANAE VITAE in 1968, and I quote:
Consequences of Artificial Methods
Responsible men can become more deeply convinced of the truth of the doctrine laid down by the Church on this issue if they reflect on the consequences of methods and plans for artificial birth control. Let them first consider how easily this course of action could open wide the way for marital infidelity and a general lowering of moral standards. Not much experience is needed to be fully aware of human weakness and to understand that human beings—and especially the young, who are so exposed to temptation—need incentives to keep the moral law, and it is an evil thing to make it easy for them to break that law. Another effect that gives cause for alarm is that a man who grows accustomed to the use of contraceptive methods may forget the reverence due to a woman, and, disregarding her physical and emotional equilibrium, reduce her to being a mere instrument for the satisfaction of his own desires, no longer considering her as his partner whom he should surround with care and affection.
Finally, careful consideration should be given to the danger of this power passing into the hands of those public authorities who care little for the precepts of the moral law. Who will blame a government which in its attempt to resolve the problems affecting an entire country resorts to the same measures as are regarded as lawful by married people in the solution of a particular family difficulty? Who will prevent public authorities from favoring those contraceptive methods which they consider more effective? Should they regard this as necessary, they may even impose their use on everyone. It could well happen, therefore, that when people, either individually or in family or social life, experience the inherent difficulties of the divine law and are determined to avoid them, they may give into the hands of public authorities the power to intervene in the most personal and intimate responsibility of husband and wife.
I would like to end this post by stating his particular appeal to those of us in the health care sector in point 27 of the same encyclical:
To Doctors and Nurses
Likewise we hold in the highest esteem those doctors and members of the nursing profession who, in the exercise of their calling, endeavor to fulfill the demands of their Christian vocation before any merely human interest. Let them therefore continue constant in their resolution always to support those lines of action which accord with faith and with right reason. And let them strive to win agreement and support for these policies among their professional colleagues. Moreover, they should regard it as an essential part of their skill to make themselves fully proficient in this difficult field of medical knowledge. For then, when married couples ask for their advice, they may be in a position to give them right counsel and to point them in the proper direction. Married couples have a right to expect this much from them.

Here, There or Anywhere... 8/26/2008 05:58:00 PM

In the middle of a relatively quiet holiday duty, I’m contemplating TBR’s topic for this edition. The brain drain is taking center stage. Yet, who decides where you want to work, anyway? We do have free choice in this country, and if I have the means to do so, I can always decide to establish my practice in another corner of the world.
I think this might be a question for those who trained in government-subsidized medical schools. The taxpayers can demand their money’s worth by demanding that one renders service to the country that paid for most of one’s tuition fees. On the other hand, who can compel the rest of us graduates of private medical schools with exorbitant tuition fees paid for by parents (the nearest of kin in my place) when we decided that it is best to seek greener pastures abroad to easily recoup our investment? Will the government compensate us for staying on to serve the country another 2 years the compensation that we would get if we were practicing abroad?
I decided to take a quick poll by looking at the Friendster profiles (60+ out of 90+ were listed) of my batchmates (CIM PBL Pioneers ’05) to figure out where we stood in the “brain drain”. Approximately 1/3 of us have already taken the USMLE/medical licensure exams in other countries, waiting to be matched to hospitals or starting residency. The rest of us are either in first or second year residency training in various subspecialties or moonlighting here in the country. Greener pastures is the usual reason or to join family and friends. I also have one batchmate who is about to leave her residency training at the end of the year to join her husband (not in the medical field) in the UK.
The numbers I came up with are pretty significant though the sample is quite small. I think it is quite representative of the whole country as well. I don’t think that creating laws to keep people from leaving are going to be helpful in the long run though. What is necessary is for young doctors to feel that they are justly compensated during training and actual clinical practice in our country. That way, they will have more reasons to stay than a feeling of obligation to serve the country.

Some Changes... 8/14/2008 11:23:00 PM

I'm taking this breather from a hectic, tension filled day after having been on duty.... I'm doing some template tweaking as you have noticed (now my multiply, friendster and blogspot are all butterfly themed...) It's just in time for my 28th birthday as well. I will be posting my 100th post here at blogger as well... Watch out for it! In the meantime, I leave you the link to the general get-together with St. Josemaria's current successor during his recent visit: Opus Dei Prelate's Pastoral Visit to the Philippines

The Untold Fable 7/31/2008 05:36:00 PM

A mouse once found its way into a rat hole. Oblivious to the animosity of the rats that lived there (perhaps thinking that they are so much like him, since they essentially looked similar to him), he decided to partake of a small nibble of cheese from a pile in the corner. The rats just stared at the little mouse as he ate a little.

He thought he was indeed welcome in this company of other rodents thus he decided to ask, “Is it possible for me to taka a little to my children at home?”

“Take as much as you wish,” they obliged him.

As he was about to leave the entrance of the rat hole though, he heard them whisper to each other, “Who does he think he is, this lost mouse taking his fill amongst a company of rats?”

It was only then that he realized that he was never welcomed in the first place.

Moral of the story: Tongues only wag when the unwelcomed guest leaves.

Sometimes, the only way for you to find out how people really think about you is to be away for awhile. For sure, you will be the one talked about. That’s why at times, one is tempted to be the last one to leave the party so one hears all the grisly details about those who left first.

Maybe, there was another reason for me to have been given the chance to have that one-day-away break from the hospital. I finally found out the very same thing I had been long suspecting the whole time. There are people who loathe me. And now, I try to remember one of the last things the Father (Bishop Javier Echevarria, the Prelate of Opus Dei) told us before he left the get-together yesterday,”… not to keep grudges or resentments.” It’s hard and I will be lying if I say that I am not holding back my tears, but I will have to give it a try, with a sincere smile on my lips.

A Second Chance 7/22/2008 12:40:00 AM

I never knew I would be writing about her for this edition of the blog rounds, but I guess she deserves it because of giving me another chance...

~ 0 ~ 0 ~ 0 ~

It was almost 11 years ago when this high school freshmen did the unthinkable by literally kicking the shin of one irritating classmate. Naturally, she was shocked, and so were the 50 or so other classmates who saw it all happen while they were lining up for the next class. The consequences of that one act of passion redounded to many things, including possible expulsion.

Her homeroom adviser asked to speak to her. She was naturally nonchalant as they spoke about what happened, maybe she was still seething in anger at what the classmate had commented on in the first place which led to the incident. In the end, the adviser decided to issue no sanctions at all, not even a censure as the mildest warning.

Past forward to a few months later, when this high school student found herself sitting in the school auditorium and about to line up onstage to receive an award as an honor student. Suddenly, she found her homeroom adviser sitting behind her. She whispered, "You know, I fought for you to be here. They wanted to ban you from the honor roll this year for that incident, but I begged them to give you a second chance." The student didn't know what to say, but just nodded in agreement.

For the next three years, this student found herself in the high school auditorium, lining up on stage to be in the honor roll. Eventually, she graduated 3rd in a batch of 200-something.

On getting her credentials for college, she found no mention of that long-ago incident in her freshman year, even in recommendation letters for good conduct. Somehow, her homeroom adviser then had managed to convince everyone else to give her that clean slate, a real second chance.

She graduated Magna Cum Laude from her college course in biology, finished medical school and is currently doing her residency training in radiology.

~ 0 ~ 0 ~ 0 ~

Mrs. P isn't my favorite high school teacher. In fact, I think she is a little over the top at times... Over-acting is the word we often use to describe her. But on returning to my high school for our 10th year reunion last year, I wanted to see her, to formally thank her for that second chance a long time ago. I wanted to show her how things turned out afterwards for this once-upon-a-time short tempered teenager. Unfortunately, she was not around at that time. I guess this blog entry will serve as my tribute to her and a reminder to give erring individuals a second chance.

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Lantaw 7/13/2008 04:42:00 PM

Lantaw na lang sa

Hunas na baybayon

Samtang wala pa

Nibalik ang dagat

Na mo-anod sa

Imong kagul-anan


(c. 2008)

rAdIoLoGy NoTeS 12 - Dra. 6/28/2008 05:20:00 PM

The subtitle of this post happens to be one of my less irritating current pet-peeves. A certain radtech has started calling me "Dra." (Yes, you do pronouce it in the way you spell it... Not "doktora", but "dra") and everybody else in the department is joining the bandwagon... Of course, it means "doktora", but alternate meanings are as follows: "drama queen", "dramatics", "hydra"... Oh, the list could go on with a lot of smart-alecky staff around you (although, the last one actually came to me in a conversation with the radtechs... ). I guess that's precisely what you get if you're the only female resident in the department training for a male-dominated specialty...

I studied elementary and high school at an exclusive girls school. I took biology as a preparatory undergraduate course for medical school in a female dominated class. In medical school, approximately 70% of our class consisted of female students. My senior clerkship group (in my part of the country, we usually refer to it as internship), consisted of five females and only three males. When I did my internship (in my part of the country, we refer to it as post-graduate internship or pgi), my first group was all-female. In my second group (I did PGI mid-year) I had only two male groupmates (and one of them is an outed homosexual, the other one, people had been speculating on for a time, though he now has a girlfriend). I have more female friends than male friends. I also lend a hand to a foundation that specifically caters to female youth. I was definitely in for a culture shock of sorts...

I actually applied for residency at two hospitals, and at both hospitals, they asked me whether or not i was married, or had plans to get married, musing on the possibility that I might get pregnant while doing my training (the other residents will have to cover for a pregnant radiology resident doing and supervising radiographic procedures due to fetal risks). Then, at the other hospital I applied to (not the one I am currently working in), one of the interviewers specifically stated that in a span of two or so years, they had two residents resign, and both of them happend to be female. At the back of my mind, I was already thinking that they won't accept me (which was a blessing in disguise since I was more keen on doing residency where I currently am now). That was exactly what happened although I think my gender was not the main reason (I think they were more keen on accepting the other two applicants who had their PGI in the same hospital).

When I did begin residency, I had to adjust to a predominantly male work environment. There is only one female radtech in general radiology (the rest of them are in the women's imaging center), and only one female interventional radiology nurse. I answer to only one female radiology consultant. The receptionist and secretaries though are all female. At our monthly meetings with radiology residents training in our city, I found out that only two of us are female, and she is already about to end her training while I am just starting mine. Hopefully, more females will take up radiology in our place in the years to come. Otherwise, I will have to contend with the fact that I'll be the only female radiology resident in the years to come.

I still detest having to listen to my seniors and other staff comment on the way certain females look/dress/etc. Sometimes, they start talkig about their night out at some lewd place (Do they sometimes forget there is actually a female working nearby or is it just to irritate me?) I still put my foot down on any joke or conversation in any shade of green (Totally inappropriate in any working environment, or any environment for that matter even if to some, the mere fact we are in the medical field, anything goes in that direction...).

The equipment are actually more tailored to be handled by male staff. The fluoroscopy machine's image internsifier is bulky, heavy and a little difficult to manipulate, more so if it gets stuck in one place ever so often. The lead gowns are heavy. The cassettes are also heavy. Giving an intravenous push of contrast also requires some degree of force. Preventing a hematoma after taking out a femoral catheter also requires some force (Perhaps that's why the interventional radiologist has not yet asked me to remove a femoral catheter from any of his post-coil embolization patients?) In the first few months, our chief resident has occasionally joked that I consider working out to build some upper body strength.

Not having had a female radiology resident for the past three years has sort of confused the nursing staff. Just one of the many cases to point:

Department Receptionist: Doktora, telephone call.

Me: Hello, Ma'am?

Nurse: Who's this? I'm looking for the radiology resident.

Me: Ma'am, this is Dr. J.A., the radiology resident.

Nurse: Hello, Ma'am, we have a referral for Dr. --- at room --- for ultrasound-guided liver biopsy.

Me: Who's the primary atttending physician?

Nurse: Dr. ***

Me: Ok, I'll inform, Dr. ---.

Nurse: Who's this again, Ma'am? Are you going to tell the radiology resident?

Me(now a little bit irritated): Ma'am, this is Dr. J.A., the radiology resident.

Nurse: (Pause) Ah, ok, Doctor.

Some female patients undergoing more delicate special radiographic procedures (i.e. a hysterosalpingogram) do appreciate that the resident around is female. At one time, a patient did request for a female resident. It was a good thing that it was also my assigned day for special radiographic procedures. I have no qualms about doing a urethrogram on an adult male patient though. It is part of my job, and anyway, more likely that not, the staff around are also male. At one time though, while supervising a voiding cystourethrogram, I decided to leave the room while the radtech was doing overhead films as I thought that the young boy might have inhibitions on urinating while an unrelated female was around.

I still get a little irked when some patients still refer to me as "Miss" or "Ma'am" while I am wearing a doctor's coat. I guess the average Filipino mentality still thinks females in white at a hospital are nurses while males in white at a hospital are doctors.

A Doctor's Value 6/07/2008 10:28:00 AM

I am relatively young in the world of the medical profession, having just received my license to practice a little over a year ago. And with that came automatic membership into the local medical society under the Philippine Medical Association. Until now, I actually have no idea what their activities for doctors is, although I recently heard about some symposium in our place, which I'm not sure any of the other young doctors were able to attend. For most of us residents, the next time you usually here talk about the PMA is when someone is about to take the specialty board exams (i.e. the chief resident in our department) and finds out he/she needs to pay the requisite membership fees for the past 3-5 years which he/she was not faithfully remitting to the society. After that , probably you won't hear much about the PMA... you'll hear more from the specialty societies...

I'm sorry that I still have to figure out for myself exactly what they are doing for us and what we are doing for the Philippine Medical Association in turn. Honestly I'm clueless... So, I really can't say anything more based on personal experiece.

I hate to say it but the fact that a lot of the doctors in their mid-30's to early 40's are taking up nursing to seek greener pastures seems to say volumes about the state of the profession. Maybe they don't feel their family will be secure with them staying and practicing their first profession in the country?

Fewer students are deciding to take the additional 4 years of medicine plus one year internship to get that M.D., and of these, probably 3/4 (I'm stating this as a reality in terms of my own class- CIM 2005) will be aiming for the USMLE and other foreign board examinations with the intention of settling elsewhere for good.

The few of us left doing our residency training are probably also thinking of doing further studies abroad (that's one option I'm personally inclined to) and probably settling somewhere else in the near future (Personally, I'm not inclined to the option of permanently renouncing my citezenship, but it's not something I'm totally ruling out either).

So, what's the value being put on us? Maybe it isn't that much. I know residents in the capital are paid a paltry. In our part of the country, most of us are paid a little higher (can't complain about my own salary as I get to save since I work pretty near where I live with my family and can save on some expenses) yet there is still a general dissatisfaction about the income that pervade (i.e. a co-resident of mine having plans to get married next year is taking up a side-line job just to afford to pay for the wedding expenses). When you go into sub-specialty training locally, you still get paid a paltry sum... Then, when you start your practice, it's another story... A friend and college classmate of mine, also planning to go into residency training in radiology stated it plainly when she told me: "You know, we will probably have to set-up a diagnostic center together..."

So... Maybe I am a bit worried with regards to the financial side of this profession. Still, I think it is a pretty noble endeavor, although reaping the rewards of the time, effort and finances you have sacrificed are a long time in coming or won't come at all. Afterall, we touch on something basic in a person - health. Sometimes, it is not just the physical side of the person that you touch but also one's mental, emotional and spiritual well-being. Still it is a way for one to earn a living so one has to be able to determine the pros and cons of determining the right professional fee for one's services, or maybe decide to charge nothing at all.

Somehow, I have always sort of counselled most of my younger friends not to enter medical school by presenting the hardships that are in the way. My advice though is seldom heeded as just this school year, I happen to have two good friends who are not about to heed my advice by beginning their freshmen year of medical studies.

I'm keeping my fingers crossed that my youngest sister (about to start 3rd year high school) won't follow the footsteps of this eldest sister... I still don't want anyone else in my immediate family to go through everything that I did to become a doctor and whatever difficulties I have yet to undergo to establish myself in my chosen profession.

rAdIoLoGy NoTeS 11 - The 10 Things Which Explain Why I Am Lucky To be Where I Work Now 6/03/2008 05:10:00 PM

I think it is about time I stop ranting and raving about the difficulties now that I am about to end my first six months of residency training... So here's a short list of why I am lucky to be doing my residency training where I am now surrounded by the people around me now in my work place.

1. I have only 4 consultants to whom I am answerable to and I already know their quirks and personalities.... I get along with all of them for the most part, and know that I can relax around them. If I make a mistake, I know for sure I will never be yelled at... mistakes will be pointed out to me as calm as possible.

2. I can vouch that my three male seniors care for me in their own way although they will try to get on my nerves at certain times. They sort of look out for me and advise me at all times.

3. As I am in-charge of the interns a.k.a. senior clerks rotating every fifteen days at our department, I also get to look out for two or three persons and help them to understand the intricacies of the different imaging modalities, though I don't entirely understand things myself either. I have always wanted to influence people in a positive way,a nd this is it.

4. By sometime next month, I may get an assignment to lecture before the second year and third year medical students of the affiliate university of the hospital where I work. It reminds me of my first career choice which I wrote down way back in second grade- to be a teacher, like my mother (who used to teach grade school before she chose to be a housewife). My father, an engineer by profession also used to teach mathematics part time to business and accountancy students of the university I went to in college. It sort of continues the tradition -> now I'll be teaching medical students, and for the first time, they will get to listen to someone who has gone through the entire process of problem based learning (PBL) give them a lecture. As one of our consultants just mentioned today, it's a practice for when you'll be "lecturing" the examiners when taking the oral examination for the specialty board.

5. Even if the mostly male staff (from the chief radiologic technologist of the hospital down to their probees... well even the rad tech interns occasionally...) will tease me to no end, I guess that somewhere beneath everything, I have already sort of gained their trust in my ability to take care of the work done... I'm starting to believe that everything they say is only part of their..."pag-lambing". And today marks the first time (I still can't believe it has happened though!) that none of them had made a teasing comment at all!

6. The secretaries and receptionists will talk... Then again, what else will they talk about now that I have told them point blank the real reason why I have no intentions of getting married (sigh!). As usual, people can't seem to grasp the concept of someone not being a nun , not living in a convent or wearing a habit and still not getting married for loftier reasons.... Maybe I still have a lot more explaining to do through my actions as well, which is a lot harder since the staff can get on my nerves.

7. Mama still packs me a great lunch everyday. I do need it. And so I am grateful.

8. I still get some occasional lull time wherein I can relax at my workplace.

9. I am at the coolest department in the entire hospital.... It has somewhat calmed me when I am particularly busy and moody at times.

10. The Blessed Sacrament is reserved 24/7 at our hospital's chapel... I can always go there to seek solace, or if I cannot do so at once, I can "fly" there in my mind's eye.

I guess, there is no more reason for me to be ill at ease, to be frazzled, annoyed and worried if I always keep in mind these 10 thing.s

Blogging For Me... 6/01/2008 06:24:00 PM

I started blogging when I read an article in the Philippine Daily Inquirer all about it. It was my in-between period after passing the board exams and beginning residency training then. And, so, I got hooked. I have been blogging more or less regularly for a little over a year now and nearing my 100th post.

I have always loved to write ever since I was a kid->stories, poems,essays, even some short novels, mostly unpublished. I became literary editor of our school paper in my senior year of high school. I also kept a diary more or less daily from high school until early college days. I now edit the semi-annual newsletter of Banilad Study Center. Though I never thought I would make it a career, writing was always my hobby, something I would have pursued if I didn't want to become a doctor in the first place.

The switch to the realm of the blog came natural for me who have long mastered the intricacies of doing things over the internet and emailing back when I was in college.

When Dr. Clairebear extended the invitation to "The Blog Rounds", I naturally gave it a try and came out with my first entry in its 5th edition, giving in more of my contributions and eventually hosting the 11th edition.

I like the idea of the blog rounds, writing on a theme and making it your own, setting your own boundaries. Somehow though, I find the once weekly schedule a little tight (even if one may or may not choose to blog on the weeks's topic anyway). Maybe a bi-monthly schedule for us doctors is more feasible?

I also like to read up on other people's thoughts on the different topics as it is a great way to find out more about someone you may not have yet met in person. You get a lot about his/her personality from the things he/she writes about and more or less find out more about the persons values and way of life.

I hope the blog rounds continue their discussions indefinitely into the near future with the hope that more doctor-bloggers will join our rounds.

Post-Script to My Best College Friend's Wedding 6/01/2008 05:32:00 PM

It's kind of odd that I only got to met her then husband-to-be in person (he's based in the UK where they plan to settle down eventually) when they were already sending out the wedding invitations. But judging from all I heard about him, I already had an inkling that the first guy to catch my choosy friend's heart would be the last one as well.

I would have had a chance to be at the wedding to (one of my seniors said that he would cover for me...), but I decided to finish the last special radiographic procedure for the day and miss the 3 o'clock wedding. If I had been there, I swear I would be crying my heart out.

She already knew I would be late for the reception, (my early Friday evenings are fixed for activities at Banilad unless I'm on duty...) but it didn't matter since I came to the wedding reception eventually.

Seeing her in that gown really tempted me to comment on its style (I had already warned her to wear a bolero at the church-she ditched that at the reception, though... but forgot to warn her about showing more skin elsewhere... ), but I decided to hold my tongue until later...

I then started to reminisce on how a friendship developed some 11 years ago when this other four-eyed girl in loose jeans and a shirt (just like myself) started hanging around my arm (literally!) and sniffing my hair (literally as well!).

On one jeepney ride in between classes (and campuses) I learned the telenovela of her family life, quite different from the normal humdrum one that I had. I was amazed that amidst it all, this was a girl who was determined to rise above her family's past.

We officially quarrelled for the first (I think, it was also the last time) from the stress of working on our baby thesis together for Ecology in 3rd year college. We patched up almost immediately.

I wrote several poems for her, but I still wonder if she was able to keep them all.

We started attending activities at Banilad together. She was one of the few people who new I was about to become an associate and let me go my own way. I'm sure she did not understand my decision entirely (eight years ago, I'm sure she'll agree how immature she was then....).

In medical school, she made more new friends, had different interests while I focused on my studies and slowly adjusting to my vocation. Somehow, we drifted apart, but still a certain connection was there whenever we start up a conversation again, just like we just talked yesterday.

I'm going to miss her when she moves to join her husband definitely, but right now, I savor the times we still text with each other now that we are doing residency training in different cities.

I guess, Angie, I'll always remember you as that four-eyed girl attached to my arm and sniffing my hair over my shoulder...

TIME TO GO ON A FOOD TRIP! 6/01/2008 04:58:00 AM

It’s just about time for us to cut the chitchat short, say grace and dig in! This banquet is officially about to commence!


MerryCherry, MD gives us a glimpse of how Kapampangans do their cooking in “Mangan Tamu”


Joey MD gives us a glimpse of her food choices in “Around Robinson’s Place Manila in 5 Days”

Noel gives us a sampling of international cuisine in his entry “Recent Acquaintances: Pastitsio, Kulfi & Cherry Garcia”


Dr. clairebear takes us down memory lane with this oh-so-familiar street food in “Fishball Memories”


Kittymama shares how Lasagna became her comfort food of choice in Garfield’s (Kitty)Mama”

Dr. Tes glorifies the quintessential Pinoy fiesta favorite and mainstay in “Lechon of my Life”


Got meloinks shows us his sweet side as he savors the sweetness of muscovado in “The Case of the Skin-Rejuvenating Chicharong Bulaklak and the Evil ‘Kamay’, which turned out to be Muscovado”

Ness teaches us the intricacies of cooking this native kakanin the old-fashioned way in “How to Cook Palitaw”


Your host, J.A. presents you with her favorite drink, on the house in “Ice Tea Girl”

I hope you all had your fill of our sumptuous feast. Thanks for joining TBR 11!

P.S. My apologies for failing to earlier cite Abner M. Hornedo, M.D.'s entry "Picky Eaters".

Iced Tea Girl 5/25/2008 11:23:00 AM

I don't drink coffee. For some strange reason, this medical doctor doesn't even like the smell of this brew which has aided generations of medical practitioners in their quest to be awake while serving 35 or so hours in one shift. In other words, I abhor the drink. What kept me partially awake the whole time (and still does today, although I am an unusually light sleeper when on duty...) is iced tea.

I'm not exactly an iced tea addict, more like a connoisseur of sorts. I don't take it everyday. I don't crave it all the time. I do fully enjoy a little sip or a long slurp every time.

When eating out with family, friends or colleagues, its my usual drink of choice.

At home, I'm the one you see mixing up a pitcherful of any instant iced tea flavored mix for household consumption. Occasionally, there's some lemonsito (Philippine lemon) in the mix as well. It could also be half an iced tea mix and half another fruit flavored mix. It depends on my creativity (or the supply in our refrigerator).

Sometimes, I take my tea hot as well, or brew it hot then place it in the freezer. Occasionally, I'd brew some tea, then add powdered milk or some powdered fruit juice into my hot beverage, take it as is or chill it as well.

Now that I seldom have the luxury of time to mix things up, one usually finds me with a bottle of C2, Lipton or Sola with my afternoon snack, bought from the hospital's pharmacy/convenience store.

TBR 11 Goes on a Food Trip ! 5/22/2008 07:16:00 PM

There is a young Vietnemese-American doctor about to end his rotation in our department, and about to start residency training in Washington State. As part of Filipino hospitality, he has been invited by various doctors to dine out in various restaurants in and around Cebu City as well as sample home cooked meals in their homes. This goes to show that Filipinos just love too eat! This brings me to the topic of this week’s TBR: All about food! What’s your favorite dish/meal/cuisine/drink? Do you have some particular food cravings? Do you have any unusual food choices? Do you cook, or do you just eat well? Do you have some special/secret/unusual recipe you would like to share? Please leave your links as comments to this post or send me email : jaaraf [at] yahoo [dot] com. Deadline for submission is May 26, 2008 11:59 pm, Philippine Standard Time.

The One and Only... Doctor! 5/18/2008 11:52:00 PM

I'm the only medical doctor in my immediate family and my immediate extended family (no other medical doctor among cousins, aunts, uncles and their wives/husbands). I wasn't even planning to be a doctor until the 4th year of high school. Then, I was planning to take up medical technology, but decided at the last minute to take up biology as a pre-medicine course, a decision I won't ever regret (I made their the friends I know I will have for the rest of my life!) Anyway, when my mother found out of my decision to become a doctor, it was supported all the way even to the point of having one of my aunts in the U.S. take care of my tuition fee in medical school. It seemed like it was a dream come true for her to have a daughter as a doctor. My father's attitude was more of "If you want to do so, go ahead. Whatever you like." I wasn't forced to go to medical school, but boy, did I get all the encouragement to go through the whole process!
I feel like nobody in my family understands what I went through or am going through, and about to go through. I only have my friends and the members of my "other family" (see my previous post) who are doctors or who were then in medical schoool to talk to.
It's a little odd that they would all consult me in some matters but would not listen to me in others. My mother who's a diagnosed diabetic will still let her sweet tooth go when my father tempts her with goodies. My asthmatic brother will leave his inhaler at home when going on an overnight trip. Yet, my younger sister will always want me to check on her sore throat. I get texts from my cousins about medical stuff.
Still, I know they all love me and support me, especially my mother who is back to making me breakfast early every morning (I always go to early morning mass so I have breakfast at 5 am) and packed lunch everyday (I don't want to get in line in the cafeteria if I happen to be eating between performing to barium enemas.)

rAdIoLoGy NoTeS 10 - rEaLiZaTiOnS 5/11/2008 04:46:00 PM

I'm almost midway to my 1st year of residency training, and it seems like I just started yesterday... I have already begun to adjust to the work schedule (which can range from doing nothing the whole day to being so busy that you get out only at 6pm when your previous or not have a single wink of sleep the entire night you're on duty...) and, maybe a little bit to the teasings of the male staff, which I have begun to adjust too (I still put my foot down on their "green conversation" and so-way-back-in-high-school types of comments and teasings...) But in the midst of it all, I am happy, serene, and I love my work. I'm still looking into the possibilities of giving a little extra to the people I work around with... whether it's a smile, a greeting, a word of advise, or maybe just listening and praying for what the other person needs. I'm grateful that I have found fulfillment in what I do, even this early in further studies in my chosen profession... I hope that everyone else does so as well.

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To all the MOTHERS out there: HAPPY MOTHER'S DAY!

Encounters of the "Dean" Kind 5/06/2008 04:08:00 PM

[Taken from the Frindster site of CIM with the original captions: Recognize the white figure inside the library? ]

Our newly retired Dean, Dr. Josefina L Poblete has been a defining icon of sorts for all of us graduates of the Cebu Institute of Medicine ever since she has been at the helm of our medical education. She's one of those persons who leave an impression on you. I think it can be summed up by this one thing comment I remember in a conversation with her daughter, Dr. Poblete-Chan, who was then my Problem-Based Learning (PBL) group preceptor when she asked me, "Are you (referring to me and my groupmates) uncomfortable with me just because I'm the daughter of your dean?" I have never felt uncomfortable around Dr. Poblete-Chan, but her mother makes you uncomfortable when she's around just because you know that she is dead serious that she wants you to become THE "Physician With a Heart"

I remember a panel interview with her and the deans of the other local medical schools as part of the application for the regionalization program of the UP College of Medicine (I never pushed through with applying there due to non-compliance with a requirement though). She was the only panelist I remember who rarely ventured a smile throughout the interview.

Everyone was always careful when she was around. Maybe it's because she has the tendency of spotting something awry with one's uniform (i.e. too short skirts for females, wearing earrings for males). She would tell it exactly to your face when you did something wrong/inappropriate/not to her liking. She also makes you want to be somewhere else when she was around. Interns (senior clerks in local parlance), PGI's (post-graduate interns), and residents literally disappear from the OPD's hallway when they spot her coming through the door from a mile away.

One time, at our stay-in community rotation, she caught one of my co-interns walking around sans uniform in the primary care center. She saw him running into the male quarters to hide, so she went right up there to talk to him, ask him why he was running and to give him a piece about being properly dressed when assigned to the center and not to loiter there when not on duty.

Another time, at the same community rotation, she noticed that I buttoned my smock. She really came up to me and told me to unbutton the smock as it is more becoming to look at us in uniform that way. I was quite taken aback. I am until now still uncomfortable with buttoning my now long-sleeved resident's white coat.

For an entire two weeks, in my internal medicine rotation, our sub-group was on our toes when she was house consultant and would annouce house rounds almost daily, and even a surprise ward rounds on a Sunday morning which caught even the house resident by surprise.

Charity cases were presented to her on a one-on-one basis directly by the interns for her approval. You never know whether she would focus on the socio-economic background of the patient in question or the intricacies of the treatment modalities the patient would be subjected to. I had the misfortune to once present to her the only charity case which to my knowledge was unapproved (mostly through the lack of foresight of the admitting resident, and the lot just falling onto me to present the case). I felt like dying on the spot when she said the words, "..., and that's why I'm not going to approve this case!"

One thing that I do appreciate is her effort to help us learn to practice medicine in an ethical manner through lectures, though I guess it has sometimes fallen into deaf ears. I also appreciate her emphasis on modesty and dressing in a manner in which people would regard you with more respect, which a lot of my peers have tended to disregard.

There are people you won't forget your entire life. Dean Poblete is exactly on one of these people in my life.

An "Exercise" Confession 5/03/2008 04:54:00 PM

Physical Education has never been my favorite subject. Ever since early in grade school, this klutzy nerd has had a hard time coping up with the intricacies of a modern dance routine or playing any ball game. Later on, sometime after having had swimming lessons, I developed a distaste for dipping my self into any large body of water (i.e. swimming pool, sea, river, waterfalls) because of a certain incident which I would rather not mention... I then became adverse to any form of regular physical activity with the exception of a nature hike or long walk. Unfortunately, I seldom have the opportunity or the time to indulge in this activity nowadays.

In short, I don't exercise regularly. As a medical doctor, it's something I'm a little reluctant to actually admit. I have never set foot in a gym, and neither do I plan to in the future. I am already living such a tight schedule in my first year of residency and attending to other family and social obligations that this has been at the end of my set of priorities. Frankly, it's the only thing in the healthy lifestyle list that I am unable to do (aside from the usual lesser number of hours of sleep all doctors are subjected to in the course of their training and profession).

I still wonder when I will ever incorporate a regular routine of physical activity into my schedule...


I was probably in second grade when one of our projects was a needlecraft sampler with the Phlippine flag stitched on it and the words "I love God and my country". Somehow, this childhood memory resurfaced in my mind when the topic for this week's TBR came up.

I can't deny the reality that our homeland has its share of problems, yet I can't imagine living and working anywhere else. Sure, in the future, I may have the chance to train further in my field somewhere else, but ever since, I knew deep in my heart that I would still go back and practice here, nevermind that probably half my med school classmates are setting their sights elsewhere around the world with a mind on permanently living there for good.

There is no where in the world where you find people who find humor in the most serious of situations and who would venture a smile at a camera or a friendly wave even if they are waiting to be rescued on a rooftop from rushing floodwaters brought by a raging typhoon. There's a different kind of optimism and faith there.

We have so many places of interest, both typical and atypical from beaches to waterfalls to trekking sites to caves. The natural wonders these islands have to order are amazing. There's a wide variety of food choices as well wherever you go.

I have spent most of my life in this country, and I'm sure that if I go away again, I will long be back with all my heart.

Dorothy is right: "There's no place like home." Even if it is this grey, dreary one called the Philippines.

rAdIoLoGy NoTeS 09 - Of Barium Enemas, Hairsticks and Guardian Angels 4/20/2008 04:00:00 PM

You'll get the point of my subtitle once you read through this post.

A funny, odd thing happened to me while doing one of the most common special radiographic procedure: a barium enema. This consists of introducing a liquid contrast through the rectum to visualize the large intestine upto at least the cecum and appendix, at most to the terminal ileum (the distal small intestine). We usually have the contrast up in a bucket with a rubber tubing at the bottom hanging from an IV stand. I already moved the IV stand a little behind me and was through with introducing the contrast, but was still visualizing the large bowel using fluoroscopy. Suddenly, I heard a clang, and the next thing I knew, the IV stand fell to the floor spilling the bucket of barium. I guess my hairstick (I usually get my curly locks out of the way when doing a special procedure with this, a clip or scrunchie) hit the bucket and sent the whole set-up crashing to the floor. The radiologic technologist thought I was soaking wet, but thankfully, the contrast only slightly splashed the sandals I was wearing and my exposed toes. Neither my patient, the fluoroscopy machine, the monitor nor I were hit by the contraption consisting of an IV stand and a bucket full of barium contrast. I had a laugh and got back to work after the housekeeper cleaned up.

Upon mentioning it to a friend, she commented that my guardian angel must have been at work. I believe that she's right. The whole thing could have crashed anywhere but the floor and yet to the floor it went. Nobody was hurt and no equipment was damaged. And the thing was, I didn't need anymore barium at that time because I was through with infusing contrast. Lesson learned though: No hairsticks for my curls at my next scheduled barium enema.

Thank you, Guardian Angel for keeping me, and those around me safe...Again!

"Angel of God,

My Guardian Dear

To Whom His Love

Commits me here

Ever this day

Beat my side

To light and guard

To rule and guide


So, Who's to Blame? 4/20/2008 06:37:00 AM

TBR 6, Here I come!

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It was my rotation at the local regional government hospital, and the first time I had a patient under my care die right before my eyes.

CC, single mom, early 20's, was one of the patients I inherited from the previous group of rotators at the department of medicine. Her mother, probably in her mid-forties, was quite frantic, not knowing where to get money for the labs and medications... To make a long story short, we called a code a few minutes before her case was presented by my resident for weekly ward rounds and then revived her. After the presentation, we called another code and the patient expired. A little girl lost her mother...a mother lost her daughter.

I felt awful afterwards as I talked to friends about it. But what could I do? And then I started to ask... Who's to Blame?

We can always say that it is the system, but behind the system, it all goes back persons. Graft and corruption is so rampant, one feels no need to raise eybrows when another anomaly comes to light. Values seem to get askewed along the way when millions of pesos are at stake.

Health is often times not a priority to people as well and since the cost of health care from trained professionals is astronomical to the everyday Filipino, people go to the oftentimes well-meaning local "mananambal" (translated-> healer) who can sometimes just complicate the matter before the case is finally brought before the doctor.

Then, there are the health care professionals who become so anesthesized to the human suffering around them... Overworked and underpayed, what incentives do they get to provide the best care to those entrusted to them? The call of greener pastures then comes and off they go to find more appreciation and fortune in foreign shores.

I could go on and on and on and on about all the other things that come into play.... In the end though, it starts with each one of us in the health care profession to find even small ways of bringing health care closer to everyone.

Rural Service Project- Last Summer's Memories 4/15/2008 05:08:00 AM

I'm re-posting here my blog originally titled "Doctor In the Kitchen" for TBR 5 since it's exactly what I was up to last summer!
I wasn't officially part of the recent Rural Service Project in Sitio Ibo, Brgy. Pondol, Balamban , Cebu until the penultimate minute.... When I was asked to make room in my schedule to be part of the Rurals, my first reaction was "Ok......" When I was asked to take care of the kitchen, my reaction was "Hey wait a minute!..." Then I was also asked to take charge of the finances so I said "This is the job I really hate!!!!" Yet, I still went to the rurals....Now what was I thinking? My first rural service project was in the summer of '98 in Kibawe, Bukidnon. I enjoyed the experienced immensely, never mind the inconveniences. It's not only work but there was also a lot of "laag" galore! Friendships were formed too! Since then, I have been helping out in the rurals as my schedule would permit. April 2007 in Balamban also marked my first as a licensed physician....and my first as being totally in-charge of the kitchen...Incidentally, this also happened to have the most number of shall we say...."incidences"... The van got bumped into, the faucet had to be replaced, allergy attacks, toad invasion of the sleeping quarters, visits from the "tuko"(gecko) ..... ....And here's generalized view of my kitchen woes: perennially changed schedules, stored smelly garbage, dogs on the prowl, lack of time management, spoiled meat, leaking water dispenser, no refrigerator!, late food deliveries, "delivery multicab" a no show, "delivery tricycle" going around in circles, surpluses and unexpected expenditures, undercooked rice, overpriced fruits..... ...But nothing, absolutely nothing can top the fire from the leaking rubber hose connecting the gas tank to the stove.... and getting 1st degree flash burns while I was supervising 3 high schoolers! Will I ever volunteer to take part of the rurals again? Of course! My catering service is BOOMING!!!! These are my realizations: Guardian angels exist! The damage to property and person from the fire could have been worse... We would have made headlines burning down the whole school! My profession is still much needed in so many out of the way places. The work of the home is something imbued with dignity...and inspite of all the difficulties that came my way during this rural service project, I have fallen in love with this work.... and perhaps in the not so far off future, i can dedicate my time and effort to it. "Omnia in bonum" -> "All for the good", as St. Josemaria would say. This eventful 6 days of work and fun, difficulties and successes surely proves this point!