I would be a leap of faith just to believe I can be where I am today, but my family just made it all possible.

“Our family is everything to me. No matter how remote my actions and decision are before, today and in the future, you’ll find a “connection” between those actions and you, my family” -R.A., an excerpt from a letter to his mom and siblings, during the “hard times” of med school.

Third sibling in a family of four, the eldest of the boys, a father’s pet and the family’s nightmare, I am cut for an outrageous fate. Fate, it seems, is full of ironies.


The passing of a beloved father
My dad died when I was just eight years old and my family was plunged into an abyss of compounding problems fit for a telenovela.

And so goes the story of my re-education.

A cut for survival
It was surviving that was central to the family’s agenda. So, a “cut” is made in all the basic needs of the family- food, shelter, education, for us to survive.

It was education that was hardly hit, thanks to EDSA revolution back then. A sibling in college, another one entering college soon and a younger brother in elementary- all surviving and being supported by a single working mom. The loss of our dad has had the ripple effect in no time. But there were signs of disasters waiting to happen.

The grim reality
“You gotta have a scholarship in high school or you’ll not going to any school at all” this grim reality my mom told me with tears welling in her eyes. “We can’t afford to send you to school”. These words, sunk into the deepest recess of my brain and bled my heart to no end. It was a cut my mom made to ensure the survival of our family. And though, I sense the simmering helplessness and agony in her, she has shown a firm and decisive role to govern her family through the hard times.

“Why me? Was it because I was the third or was it because I was expendable to the family?” At a young age of 12, I knew a storm of hard ships is coming our way. But this was just the beginning. And I was one of the hardest hit.

One step at a time.
So, while gnawing in pain and agony for the luck I got, I took it on as a challenge. “I will loose nothing in this uphill battle. I have no way to go but up.”

My dad wanted a doctor in the family and this was his plan for our eldest sister early on. But he did not lived long enough to even see my sister step into college. The dire financial chaos my family is in only dampened the spirits of my sister to even enter premed. She went into accountancy instead.

Meanwhile, I was inching my way though high school scholarships. The initial taste of success emboldened me to “I want some more” type of aggressive academic greed. Daunting the challenges were at those times, I stood my ground and leaned on the “walls” of my family. If I was victorious , that is because I was so darn proud of my family. We were beginning to shatter all the gloomy expectations for our family

Undaunted and victorious over the challenges given to me in high school, I trained my gun next on college. Opportunity then knocked when UPCAT applications came into my mailbox. “A scholarship and a thick stomach is all I need” I jokingly told my mom and sisters. “You got to be nuts” said my sister. “Even if you get inside UP and get a scholarship, will you be able to survive on that alone, through college in a far away place? Away from us?” They’re afraid I’d land with the “great thud” when I hit the ground of failure.

“Give me just a year. If I fail, I’ll stop at my wishful thinking and go back here…” My family knew that with my initial success in high school, I am virtually unstoppable. So I got my way. Though afraid of what I might get into, they supported me all the way through, hugs and tears included. I am embarking on a path no one else in my family had gone into. So the benchmark is, unknown.

The Ebb and Flow Cycle
So that series of “one year” came and lead into another… and another. My family and especially my mom was an inspiration. She never spent a dime on my tuition fee, that is because I felt, she has had enough of her share of hardships. So I made it a point my mom would be proud of me, and she be proud of her self. That despite having to bring up all four ostensibly ambitious children, her hard work did pay off in thousand folds. So every year during my college, she has to travel from our place to my school, climb up the stage and receive an honor in recognition for growing up four fine and ambitious children, proud of their mom, proud of their family. It was a memento of her marvel for survivorship.

It was like these since then, the same story repeated through med school and even training. I, haughtily pursuing my medical career and my family giving the turbo charged after burners in times of chaos. I was busy carving a path for my career, and my family asphalted it for me.

Whether my decisions would run for and contrary to their wisdom, they embrace me and hug me though my journey. How I became a doctor despite all of these, is another story to tell. But my family is pivotal to all the decisions I made in the past.

I stood my ground through years. But I have shoulders to stand on- my family.

For most of us, the mentor-stimulus for learning is a unique experience. Our “receptors” for learning may accept signals from nice, approachable and likable professors. The feel-good- mentor attitude is irresistible.

But I learned most from the hard hitting, no holds barred tor-mentors. Not that I liked getting hurt or being hit upon for me to learn. But squeezing something positive from such “despicable challenges” always give me the “high”. Even if it was just for survival.

That’s what I think happened in these snippets of paradigms shifts during my college days.

“You got a 0.5 grade for your term paper?!” Grinning, my friend Joselito added “that’s higher than 1.0! You’re amazing!” and then he burst out in laughter. Already red in shame, I grabbed my paper Joselito was waving in air inside our classroom. I went into cold sweats and then froze humbled on my chair. “A 0.5? How the earth can that be?“

“That was for you’re ink Mr. Tito! To give credence to your ink! You wrote a reaction paper instead of a concept paper, you *@#$!” This scumbag professor just didn’t remembered my name right. He also insulted me in front of our class. Judging from his snicker, he was visibly satisfied with my agony. I grimaced in anger while wishing the earth will crumble and I can smash the face of this fag.

“How many times do I have to remind your weightless nut brain? You wrote a concept paper while I was asking for a reaction paper!“ So you get another 0.5 for your ink! Thats a 1.0 on a scale of 40 points!

Getting a 0.5 on two term papers and zero on the other two are not just pranks and whimpers. It is sabotage! For that I hated English and Communication as GE courses in Pre Med.

And then wished my bike would run over that darn professor.

That wish never came. I never had the chance to smash the face of that prof, nor I was able to wreck his neck. For some miraculous reasons, I did finish the course without having to take removals. On the last day of our our class (which was also a mini speech competition with chocolates and free cinema tickets as prizes), he walk straight to me and told me

“You were one of my most improved students. I never thought I could turn such charcoals into diamond snippets that you are right now, speech wise. You owe yourself some chocolates and a movie! Thank that 0.5 you nut brain!“

Just like that…

But I have this copycat habit of emulating some mentors in an attempt to incorporate their traits while forming my true self. Let’s face it, we take the values and personality we like and junk the others we deemed “crazy”. And mentors, are icons whether we like it or not.

“Is that him? He looks like a bodybuilder to me than a professor.” I whispered to my seat mate. “Good morning!” came the booming voice over the classroom speakers. “I am Dr… and you are entering blah blah” The tall, muscled guy sounded like he’s going to mince us one by one. “…nobody said med school is easy. And being in the premier state university, you are expected to excel. So study harder…” The cool, smooth voice of this professor is surprisingly boring and frank. He means business and he is a no fun fare teacher. “He’s definitely making sure I’m par the slot I got in this premier medical school, or he’ll kick me out!”

“Hell no! I wouldn’t want him to do that! Not ever!“

“I want to be like this professor.” No, not his macho image nor his stern look. His frankness and no holds barred attitude is worth emulating. I thought he was a surgeon. But he is not. He devoted his time after med school to learn how to make medical students learn. On a very young age, he’s quite making an impression. “You flunk any of the exams. You better study harder.” So coming in to his office means you’re in trouble. At least for the time being.

For one whole semester of listening to his human anatomy and dissecting cadavers to no end, I am both scared and emulative of this professor. His brutal frankness scare the wits out of my brains. On the other hand, I liked his habit of telling the truth first and only. No dicing. When he talks, I make sure all my ears, including my brain, is listening. Even if I can only absorb a handful of medical information.

But his frankness is coupled with fairness. “I only record and calculate what scores you give me. You do the studying I do the grade calculations. Plain and simple.”Making sure you reflect the “results” you store in, is his concern. “You are actually grading yourself”. He told us in one didactics.

For the next 5 years I marked my medical school days with attitudes I first stumbled with this professor. Frank, cool and fairness. “Keep your medical life simple. Study hard and you will get what you deserve.

Though medical life is never simple as I’ve learned later, the attempt to simplify it was a fulfilling exercise nonetheless. I had paradigm shifts.

These mentors were part of my paradigm shifts- changes in perspectives that saw the positive in every opportunity that knock in, scary and the not so scary. They were my windows to the new world.

Mentors or tormentors?

(I wrote this article while savoring the brutality of starting a practice and endless whining of a slow start.)

My struggle has always been between filling up my empty stomach or satisfying my impoverished brain. To the millions of hungry Filipinos like me, this our “class struggle”-an unarmed, non-violent but similarly aggressive perspective of seeing past our choices of everyday life.

To a proletarian who have gone to the bottom lowest of the pits, the best assurance one can get whenever you start a career or something is an old adage that says “you can go nowhere but up” or something to that effect. Like a messianic prophecy, I fanatically held on to this belief since high school days . The capitalist notion of incentive-driven success vis a vis hard work is as ironic as it is baffling to everyone in this “stomach” struggle. Yet, I survived half of my lifetime living in such altruistic ironies that neither my myopic deconstruction of choices nor the risky jumps I made could explain the extraordinary luck I had ending up being a physician.

The dream of donning a white blazer and treating a patient is as fascinating as it is exciting. I am so entwined with that dream I forgot I have neither the financial capabilities nor the intellectual giftedness needed to attain such lofty dreams. I went into this profession simply because I wanted to prove to myself (and to my less encouraging social caste) what everyone in my bunghole has failed to do before me- don the white blazer with the least expense I can- financially and intellectually that is. Everyone think it was suicide in the making. I thought I have nothing to loose. I don’t have anything to loose anyway.

That dream however grew into a vision, thanks to my alma mater. I practically crawled and bled to finish top of the line education for a career not everyone in my caste will experience- not even in their dreams. Fifteen years of Hippocratic studying did wizen my outlook about this noble profession. But it also shattered some idyllic notions I once have about doctors’ blissful life. More importantly, it brought my bourgeois upbringing to its knees and gave me the awakening of my comfortable life. My mission is never confined to the personal and financial self gratification kind of success. Because if it is that myopic, I could have never gotten this far.

Starting an upstream professional career is never an easy thing for the not so typical surgeon wannabe like me. I neither possess the inherited practice most other surgeons nor the coffers to buy a new one. Most people believe though, that having trained in one of the best medical schools in the country prepared me for one of the most formidable foe of the real life physician practice- an empty stomach.

Of course being out of the academe and starting your own practice has its exciting advantages. The thought of having to take control of one’s time and spend it according to what you want is exhilarating. I can spend more time with what I want most, or with my loved ones I neglected when I was still studying. Gone are the Sundays where you have to read and prepare for pre-ops instead of having to eat dinner with family. I see non emergency patients on a scheduled time I myself created. Most of all, I have time to take care of my body while taking care of patients as well. I can eat full meals in a day and exercise regularly to maintain a sound and fit body. It is ironic that while we take care of patients 24/7 in a hospital, I lost tract of my own health in the process.

I am into the practice of my profession for just barely two months, and it’s neither the blissful stride I once dreamed nor the catastrophic frustration I’m so afraid of before. Somewhere in between these extremes is the horrible spectrum of uncertainty where my minute practice existence resides. I wish my practice was as dramatic as the scenes in ER and Grey’s Anatomy or as wacky as unnerving as House’s one liner ass kicking. Nonetheless, the uncertainty gave me ample excuse to whine and be cynical about everything I get my hands on. Blame it on inexperience surgeon wannabe that is me. Everyone says that staring a career is shitty enough to make or break your soul. My soul has undergone so many breaks it neither can feel any shattering this practice has to offer nor enough time to recover form constant battery of changing lucks past choices.

I bet it’s easier to just look at it as the paradigms of opposites. The definitions of success (and failure) in ones’ professional practice defined by simplistic phrases like-great clinic practice, successful surgeries, acknowledged researches, magnanimous services to patients and yes, professional fees enough to buy what we need. In essence, the very opposite of such adjectives and superlatives defines failure . Of course almost everyone believes that such simple dichotomous definitions don’t exist in reality. The theory of relativity seems to apply even in the psychology of success.

So it seems. But that, I have yet to uncover.

(Photo credits: All photos were taken from Deviant ART, my favorite repository of artistic shots.)

“I think it’s Septic Arthritis.”

Twenty six years old male farmer with a history of fall from level ground, landing on his buttocks, able to stand up and walk immediately after without pain. The next day he felt excruciating pain in his swollen left hip, was unable to move his L thigh nor ambulate. He was brought to a bone setter who “massage” his L thigh but patient wasn’t relieved of the pain at all. In severe pain and febrile the next day, he was brought to the hospital immediately.

“It looks like septic arthritis to me.”

He was referred to a surgeon instead, who took x-rays and showed a less than 5% compression deformity of L5 . His differential count showed leucocytosis with lymphocytic predominance. He was started on Cefuroxime IV and pain meds. Four days after patient still has fever spikes and increasing trend of leucocytosis with lymphocytic predominance. Unable to move his swollen L hip and thigh he was referred to me.

“I’m leaning towards reactive synovitis or septic hip here, bacterial or otherwise”.

Short of doing formal arthrocentesis, I asked for an ultrasound of the hip-looking for water filled masses or pus filled joint. There was none according to radiologist. The white cell count is still increasing with lymphocytic predominance. I started the patient on Metronidazole and re -examined the patient carefully. He was afebrile for 2 days and noted an improvement in L hip range of motion. But there was still L hip pain and is unable to walk. The white cell count is still increasing. Lymphocytosis?Mature lymphocytes? Let’s call in an internist (we don’t have infectious disease specialist here nor a hema-oncologist)! See if it’s a possible lymphoproliferative thing!

“I still think its septic arthritis, but I have no hard evidence yet”

Instead, the IM gave more pain relievers and suggested patient be seen by a neurologist for a radiculopathy 2 herniated disc. The neurologist agrees triumphantly and advised more pain meds and bed rest. Sighed. Febrile, 26/male with L hip pain and elevated white cell count? Radiculopathy? I re-examined the patient. I courteously asked the patient if they can afford a CT scan of the hip and then asked the Radiologist to make the cuts up to the lumbar area and “peek” at possible herniated disc.

“I’m still convinced this is septic arthritis L hip”.

“No lumbar disc herniation nor radiculopathy. The L hip and anterior musculature is enlarged and fluid filled much more than the right. No fractures. Septic Arthritis highly considered”. Double sighed. Tomorrow I have to open up this patient’s hip joint, drain it’s pus, wash it carefully and apply traction. I gave enough time for guess making here.

So when In doubt, go back and re-examine your patient!

Just recently, The Department of Orthopedics at Davao Medical Center went under the sharp scrutiny of the esteemed Philippine Board of Orthopedics (PBO), for the department’s yearly accreditation as an orthopedic training institution. This process of evaluation and accreditation have very important goals namely;

1. to determine if the institution is capable of training aspiring orthopedic surgeons in the area or
2. was it successful in training current orthopedic residents and render orthopedic service to the region that is at at par with the board’s standards and the orthopedic profession in general.

Being a newbie to this institution (and as an attending at that) it was also an opportune moment for me know my DMC Orthopedics family and learn how I maybe of help to them in the light of the staff’s main thrusts and the boards recommendations . No, I am not with the board, but I am happy I will benefit from their efforts and recommendations.

The “board” is probably the best “external evaluator” of orthopedic training institutions within the national orthopedic community. Not only because the board are the ones who accredit training programs but because they are also in the best position to oobjectively assess our training program and give recommendations for its improvement. The board consist of elected and well respected orthopedic fellows from different training institutions around the country. Their collective experience simply equate to the “third eye” for any orthopedic training program.

The Department of Orthopedics is probably one of the best department here in Davao Medical Center, if we base our assessment on the latest P.I.A.D. conducted by the DMC administration. PIAD was a patient satisfaction survey of all the DMC departments, in terms of services, facilities, personnel among others. The Department passed this evaluation with flying colors (100% mostly) and garnered probably one of the highest “grade” according to patients surveyed, if not the highest. This form of an “internal” evaluation has boosted the moral of the Orthopedic (consultants and residents), medical and allied medical support staff, and gave us greater resolve to improve more of our services and training capabilities.

There is no doubt that in the DMC orthopedic community, talents and innovative ideas abound. The department graduates has been 100% passers on the Orthopedic Diplomate Exams since it started. It’s current residents also landing in the top of their batches in the in service training exams. On the national level, DMC ortho is probably at par with other training institutions, if not better. And we are just beginning to think globally and interact with foreign orthopedic community.

But like any government training institution, challenges to DMC Orthopedics’ existence and goals are enormous if not astronomic. We are perpetually lacking in funds to support our services, maintain our facilities and equipments, conduct innovative research and support healthcare delivery to our patients. This is where the staff’s devotion to providing top notch service, despite odds, become utterly heroic. One third of the consultant staff are voluntary, meaning they don’t have plantilla items and thus don’t get salaries despite seeing patients and breaking brains to render services. Our resident staff is dwindling every year (might be again, brain drain or pocket drain whichever applies) and the MD to patient ratio is bloating, which I peg somewhere between 1:50. Our allied medical support staff like the nurses so often changes we barely have time to train a permanent younger one.

Despite these odds, our department shines. Keeps us, the staff, smiling at the end of a tiring day. Thanks to the unwavering devotion of both the orthopedic and the non orthopedic support staff. We have so many goals to achieve, and so many ways of achieving it, but only one thing in mind(as our chairman will say)- give top notch patient care and train top notch residents. . We see a future in all these hardships. Maybe, the Orthopedics Department is after all, bound for greater heights.