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  • Notes to the knife II: The opposite of humility

    Again? Yes. Again and against.  I will write about humility in knife wielders until this amazement transforms into a virtue. In the professions of demigods, any opportunity to get enlightened on humility doesn’t come by so easily .  So when it knocks, one should not wait for two or three knocks before opening the door.  The great student doesn’t need the winds to howl before opening his heart to learning. Humility, I should say, comes right into your face before you even knew it did. Like what happened to me recently. When I took the role of patient..

    My mortal lessons
    Notes to the Knife II

    It probably was just a viral infection but before the lab result got out and the diagnosis made, I took the role of the patient religiously and found time to interest myself with observing people around me. A physician admitted in room 204 is something a phenomena to everyone else. Including myself. Not the fondest role any physician would want, but certainly the most engaging. Of course, not until some real patients ask you about this ‘anomaly’.

    Being the patient, in the reversal of roles, is it really that easy for you? You know, relative to us, real patients, you (the actor patient) have almost everything you needed within your reach.(Unlike us patients, where we often cry for help on this and that..)- real patient X.

    Hell, NO.

    When this  knife wielding body go awry for one infinitesimal  reason, our chaotic hordes of Hippocratic knowledge put more distress on thyself than any other patient could ever think. Let me exaggerate. A hundredth decimal change in our body temperature would trigger a bazillion neuro impulses on our cerebrum that would then, extrapolate a gazillion more differential diagnosis that are rarely confirmed that is true. In short, we have more worries because we knew a bit more. Yes, my dear patient, sometimes, ignorance is bliss. Knowing something worse than just cold, flu or skin allergy as a differential diagnosis is no fun! It burns our distress horns more than you can imagine.

    Knife wielders are good actors. But we are not that good as a patient. We are the worst patient a doctor can get. Of course we really wanted to act like we’re patients when we are the patient. But it ain’t easy when you know for example, that a skin test is more painful than a deep laceration. I for one would rather sew myself up  than have someone stick a needle into my arm. There’s too much pain when you know whats coming right into your skin.

    IV bottle
    Opposite of humility

    Okay you try to act like the patient, but does your doctor treat you like your the patient?The nurses?The x-ray man?How many times did you peek at your own chart? In fact, most physicians of physician-turned-patients never mutter a single piece of conjecture to this patient until he or she is 101% sure about the diagnosis. The convoluted fear of the so many possibilities is staggering.   Easy patient huh?

    Last, and probably the most interesting phenomena I’ve noticed- when the knife wielder gets sick,  other people  would then say “he’s got it!he’s got it! We’ll get it too!’ This ‘when-doctors-get-sick, its going to be doomsday-on-us’ charade is very annoying. Exaggerated? Maybe. Got something related to the profession’s supposed infallibility. But then again, is it really that way?

    Where does humility stand in all of these?I’d say below your humility our dear patients. Doctor turned patients swallow a large chunk of their infallibility grid to be treated adequately. It takes humility to accept diagnosis a mile away from what you knew. It takes a hundred more strength just to keep shut your mouth instead of whining in pain  receiving a cut not from your own knife. It takes humility to be just a patient for even one second. It takes more humility than just humility.

    Bottom line is this. When doctors get sick, the implications creates waves more than what a regular patient will. Sort of a celebrity thing but more than that. The ripples are often beyond entertainment. Some even wreck havoc on some patients perception of their health. So maybe this is why some knife wielders need to be good actors and actresses whenever they exchange roles with their patients. Celebrity easy?!Obviously not.

  • Mortal Lessons for a surgeon, my notes on the knife

    I rarely write book reviews.  For one, I don’t read reviews myself before reading any book I’m interested. Two, I  usually end up not flattered of the books I’ve read, something like bitin and wanting for more. Thus, recommending (or not) any book I’ve read is difficult for me.

    Before I got into med school, I use to read (everywhere-rest room, bus ride, nooks etc) books to entertain. Then the rigors of medicine reduced this reading to a scientific exercise– that rigid, boxed, get-the-gist-then-memorize-acumen needed for medicine man like me. Now into semi leisurely private practice, I’m slowly picking up what’s left of my literary inclinations by reading books that entertain. Books, that put medicine in a literary perspective.

    So when Gilbert Tan gave me this book- Mortal Lessons: Notes on the Art of Surgery, I was in for my big ‘reawakening” read. Time to jump start those comatose, literary brain cells that hibernate in my right hemisphere. I told Gilbert I would wait for my reading ‘groove” before starting to read this book. As soon as I got inside my car however, I took a sneaky a peek on some pages of the book.

    Richard Selzer, is in fact, one of the author of our anatomy bible, that large book that could qualify as a 10kg dumbell,- Grays Anatomy Vol II.  Selzer also wrote for the New York times on one occasion, pondering about the tribulations of a malpractice ordeal.  The fact that he was a medicine man didn’t surprised me. I can name a few good books written by doctors turned famous writer. What brought my eyebrows up was the fact that Selzer is a surgeon. These steel cold knife wielders are one hell of writers. This is aside from the fact that there are only a few of them who actually writes about medicine in a modern Shakespearean (is there such?) style.

    Well, try to read the table of contents or the introduction. The introduction page is entitled “The Exact Location of the Soul“. That got me into a frenzy of reading.

    I’m not going to narrate what I read here. Go find yourself a copy. Or find your own Sir Gilbert. But I will tell you my thoughts when I’m done reading it. It would aptly be titled “post mortem of a literary corpse”.

  • Gambling on the broken Kristo (Christ)

    Once in a while, in our busy and chaotic medical life, a few patients would come by and jerk you off your comfort zone for empathy and go bonkers on  the absurdities of life. They come into your clinic like the usual patients complaining of  this or that disease. The moment you ask these patients about their history however, you pause at one point in awe and be moved for a while. Something hit you and had hit you hard. You are, in medical numbspeak, “infected” with their moving story.

    One of my few personal favorites is the story of Mang Pedring. Mang Pedring, is a fifty something bread winner of his family. The father of four and a laborer, he frequents and works part time inside these gambling site to earn his living. He barks (as kristo) in a cockfight,  a tayador in a tumbo (I wont bother expounding on this because I really have a vague idea what this coin gambling is) and a meron in a card game called Pusoy or tsikitsa. He broke his left arm after falling off a motorcycle. He was on his way to the cockpit- the gallery for cockfighting.

    (kristo)
    A cockfighting match barker or kristo doing his stunt in the game to earn his living (Photo credits to the original owner)

    It was almost a month after his injury when he sought consult at my clinic. Prior to this, Mang Pedring went to a number of bonesetters, a doctor, and was actually admitted in one hospital for 5 days. His last closed reduction and casting didn’t went well for some unknown reason (I learned later, that he took off his mold because it felt so tight for him, without consulting his previous doc). What’s worse is, he drained his funds going through all these unsuccessful attempts at “fixing” his broken arm.

    Funds, which he revealed, was a pool of money earned from gambling- from the throw in of his fellow gamblers when they learned of his predicament, and (the most disheartening was) what he earned as a cockpit kristo or barker while his right arm is strapped in a sling and a cast. That helpless ironic sight, as I imagined from his story, made me twitch in empathy. I cannot imagine raising my broke arm in an attempt to earn my living, much more do it in a gambling site. He came begging me to fix his arm so he can go back to his ‘work” and earn for his family.

    What I was trained of course, is not to give weight on his conflicting circumstances but focus more on his ailment, which is his broken arm. Orthopods were trained well to aim at a holistic treatment of a “broken” patient- to return the patient to his functioning, pre injury status. In Mang Pedring case, to his gambling  “work”.

    I owe it to Hippocrates and to mankind to do just that and leave the morality of his gambling work to the society’s judgment. In fact, I never pass on judgment unto Mang Pedring. I simply wanted to bring him back to his pre injury level. Whether his work qualifies (or not) as a job for many of us, that is not my concern and is not what struck me in his story.  It is his struggle to earn a living while still on the mercy of a cast over his left arm. The ghastly scene is further brutalized by having to work as a barker in a cockfight. What suddenly flashed in my mind? A wounded gladiator.

    Funds depleted, and totally frustrated at his broken arm, I reapplied his cast ( as a temporary “fixation”) while we where looking for funds for his operative treatment. I said I could help finding a sponsor for his metal implant and negotiate for a “free surgeon”. He only has to look for his medicines needed during the operation. Right there, I saw Mang Pedring’s eyes beaming with happiness. He cried in front of me. Cries, which really whacked me out of my objective senses for a minute. I saw his desperation. I saw his hope. Now his desperation is mine too. His hope, lies in what I could do to ease out his predicament. I have to fix his broken arm. Soon. Fast.

    Then what he said (in hiligaynon) before leaving struck me the most:

    “I gotta get back  to the cockpit and the tumbuan doc and ask again for a “throw- in” for my surgery. I know people there would help me”

    I scratched my head in disbelief. Mang Pedring was and even in dire needs, look up to his gambling and fellow gamblers for help. Whatever our society has passed judgment as morally wrong wouldn’t matter to this guy for as long as it saves his limb and and put food in the table for his family. For once, I thought Jesus, the kristo, was disguised as a gambler. Mang Pedring is and will probably be a gambler. But his aspirations and dreams were similar (or parallel) to the non gambling patients I’ve treated. He wanted to return to his job and feed his family. Whether his method or job is morally wrong to some of us that is not my hemisphere of expertise. I simply wanted to return him to his pre injury functioning level. Period.

    After 2 more casting sessions, Mang Pedring didn’t come back to my clinic anymore. While in the process of “pooling” funds for his surgery, he felt his armed healed already and removed his cast. Of course I wanted to confirm that with an x-ray. I also wanted to see if the money he pooled is really safe in his piggy bank and not to the gambling aficionados. I didn’t get that chance. One gambling insider later told me Mang Pedring is back in the cockpit again, without his cast and seem to have a functioning arm. I just smiled. Perhaps my work has ended successfully there.

    Perhaps, I made a gamble on Mang Pedring.

    (Photo credits goes to Islander in the City, here)

  • Where’s health and education now Mr. President?

    I had mixed feelings after reading the text of  your recent State of the Nation Address (SONA) Mr. President.

    On one part, I got excited when you detailed some of what many of  your countryman (which you gracefully called your Boss) knew years ago- corruption is rampant among many of the government agencies. That however, is old story to us Mr. President. My eardrums has thickened hearing all those  exposes that ended up in the waste can for “lack of evidence” and so many legalese gobbledygook. Put the corrupt officials behind bars and recover the peoples money and we will be all excited and happy. Including my eardrums.

    The other part of me had this bad feeling about what might happen to your other priorities mentioned in your campaign. Your tone on corruption is very much aligned with your campaign tag line, but you spoke less on health and education. Where are they now in your priorities Mr. President?

    Yes, the statistics on Philhealth coverage is confusing. But so is our health care system. You mentioned correcting the coverage statistics and expanding Philhealth coverage  to every Pinoy. It sounds good on our ears but personally Mr. President, its not enough to heal the woes of our health care system. Many of your Boss, cannot survive Philippines with Philhealth coverage alone.

    And education? I can barely make anything of what you mentioned, yet. Frankly,I spent half of my lifetime in school and yet I barely can put food in my table. That’s why i doubt prolonging  years in school actually translate to a quality life.

    I understand you’re trying to paint a picture of a negative starting point for your term. (Give thanks to the previous administration by the way, they made that painting an easy task for you with all those nauseating scandals). But that is the same reason we put you in charge now Mr. President. We believe you can be a good president even if you start from a negative starting point. We believe you can save us,  your boss,  from lingering in the kamote fields.

    You asked for our support. If you noticed, there are many uprisings we supported in one way or another-rebellions, coups, edsa and even green revolutions. The people have shown their support to the presidency in so many times already. The people rallied to support so many crusaders but most of them failed us in many respect. Look at us now, we’re back to square negative. Maybe its high time you give us results already. You are the president. You weave power enough to do all of these reforms. Results is all we’re after now.

    In all of this Mr. President, my prayers is with still with you. Give back health and education to the people .  Make them your priorities. And give us results.

    You cannot fail us. We forbid you.

  • A cliche to settle…

    Barely two weeks ago I got the news that a good friend’s dad died of complications from an untreatable disease. In the few times we interacted, I instantly liked the bare realism of tatay. Tatay, as I fondly call him, reminds me of my dad’s astute stubbornness and brute witticism. The down to earth jolly individual who grew out of the market’s daily grinds, never fails to surprise me with his “i am in control attitude”. He is after all a dad to his children. When the news of his death reached me, I found myself groping with sadness..

    Me, a doctor, a surgeon. Born into the hard life, molded into steel (so my story goes) still…and still, I am groping with sadness.

    When we lost our dad to liver cirrhosis three decades ago, i barely had any idea what grief means. I was only eight years old. I never knew a thing in this world but “play”. When I grew enough to miss my dad, I began to use that missing as a source of inspiration for pursuing my dad’s dreams for us. Together with my mom’s unwavering love, I drew inspiration from that ‘missing” and strength from my dad’s memories. In a way, I never really faced off with sadness before.

    Until again this time, when another semblance of my dad came along…and left.  He reminded me what once my dad’s fondest “cliche” for us.

    Live today as though it will be your last.

    Seek the best in all that you do.

    Never put a thing off for tomorrow what you can do today.

    Dream small, dream big, above all, never fail to dream…

    Yes, they are cliche today. But in my job where I rub elbows with a “dead man walking” almost daily, the only cliches are those “cliches, you need to settle”…

    RIP, tatay. Thank you for reminding me of my dad. Please pass this to him when you guys meet up there: “I love his cliches“