Fear and pivotal moments

I promised myself a little over a year ago that I would write more. Clearly, I haven’t kept well to that promise. That doesn’t necessarily mean though that things have been in a slump – on the contrary, things geared up so fast there was barely time to pause to put it into writing. As I type, I am seated on a bench in a local park, watching parents, mostly fathers, running along with their kids and clearly having a good time, on the other side, a man fascinated with nature and clearly amused feeding the ducks.

Good times- i have had my fair share of those this year. It’s been spectacular, in fact. But I have yet to master the art of slowing down and enjoying life. 2 weeks since touching down here in Bordeaux, I am feeling the pang of dread having to leave this magical place pretty soon- this city whose people have welcomed me with open arms. I first came here with the sole purpose of learning and testing the waters before delving into a more specific career path. Little did I know, that my mentor would introduce me not just into the exciting world of Otology, but also in stripping down the bare necessities of life and challenging what one believes to be truly invaluable in living a full life.

I cannot help but look back at my journey into this realization. Once again, the road I have found myself in is a road I never even thought of taking some 5 years ago. But after several rejection letters from choices based on pragmatic deductions, I remembered a colleague telling me, “Maybe the reason why your plans haven’t unfolded as you wanted them to is because you are meant for something else.” That’s when I took my time and switched gears, switched directions, and switched my perspective. I chose a specialty that intimidated me the most and searched for mentors to see if I could last a few weeks in intensive training. Opportunity struck in a country whose language I had to learn in breakneck speed, in between attending to patients and teaching students.

I would want an idyllic life – one that would not require me to rush from one clinic after the other, worrying every month if there is enough money to go around, amd trying to keep up with schedules. As I grew more and more enamored with the idea of filling up my days so that I would never have to worry about that dreaded silence, I am now slowly discovering that in solitude I am more at peace, I become more alive. And it’s not the money that comes along with it that truly gives a person satisfaction nor security, it would be that at the end of the day you have become of use for your personal growth, or another being’s growth.

Looking at how choices and circumstances brought me to take a sharp turn, I have been forced to look Fear in the eyes and try to understand why it has been an obstruction all this time. As creatures of habit, at least based on my experiences, we fear the unfamiliar- not knowing what is going to happen next unsettles us. And ultimately, the fear of failure looms over us in whatever we do. But what is classified as a “failure”, anyway? Now in my 3rd decade of life — failure has been morphed into “an alternate outcome”; not necessarily unexpected, not necessarily favorable for the time being, but an outcome,nonetheless. As adulthood molds us into becoming our own person,  we (at least I’d like to think) become more and more aware of consequences of our actions. Gone are the days where we can blame impulsive decisions for bad results. And going back to the original issue of fear, only when we allow it to be roadblocks into discovering our true potential does it result to a true failure. 

I had to be isolated from everything that has come to be familiar in order to get over my fear of failing (before I even tried), and when my mentor casually asked right before beginning a surgery, “What are you so scared of? You know this. You know this well,” did I start to change the paradigm I have been living in. In a few weeks, I would have to go home to familiar territories, and I do hope I don’t forget what my time in Bordeaux has taught me. I doubt that though.. I have reached that pivotal moment, and I am in. I’m all in for the long haul.

Finding My Way Home

“Where are you off to, love?,” an Irish octogenarian asked me as I stared back and forth my mobile and the piece of paper bearing the address of my next destination “I’m actually not so sure. I think I’ll get off the next stop,” I mumbled to the bus driver and the concerned elderly. I said my thanks and as I stepped onto the curb with my ridiculously large luggage, the old man called out, “Don’t worry, love, I’m sure you’ll eventually get to where you’re supposed to go.”

Two months ago, as I passively sat through one of our mandatory hospital-wide conferences, I did a double-take upon hearing these lines from the guest speaker (quite embarrassing to note too that I forgot who she was), she said,

“Sooner or later, you will have to ask yourself the questions: “For whom am I doing all these things I am involved in now?” and “what for?”

Little did I know that those questions would haunt me in my idle hours in the weeks that ensued. I have thrust myself into a 7-day work week schedule by choice because I saw no point in idly sitting at home. My ideology was simple, I’ll work hard and allow myself to take breaks twice a year because I could be earning instead of just lying around at home. Is this physiologic? Definitely not.

And then I found myself in destination 4 of my journey – Belfast. It was day 13 since I left home on a mission. Most of us find ourselves in crossroads at different points in our lives. For me, into my 3^rd year of private practice, I found myself in the middle of a “too much, too fast dilemma”- I was offered a new job, I was looking forward to moving to my own place by the end of the year, financial security is within reach, it was good… it is good. But why did I find the need to pack my bags and leave everything behind all of a sudden?

I’ve been running away far too many times in my life, and for some unfathomable reason, I seem to find myself exactly in the situation I have tried (in vain) to avoid in the first place. I entered the academe short of 2 years ago simply because it came naturally and somehow, it sort of eased the pressure compared to doing surgeries. I told myself to try steering clear of doing tumor surgeries because of the physical and emotional toll that it leaves behind; me… me… and me… and then it started to feel that I was buried in my work simply because I thought that was what I am good at and it was the only thing that made actual sense. In the last 3 years, it felt as if 24 hours would never be enough. Every single day seemed routine, was I happy? At that time, it didn’t really matter. But then 2 weeks before I was set to leave for further training, I lost someone dear to me. For 8 days, it was a struggle between trying to find that delicate balance between being the supportive granddaughter and the objective physician. I went about every single day with my role as a physician to my patients and managing to visit my grandmother in the Critical Care Unit every single day; when she passed on, I did the same – work, attend the memorial, work. Little did I know that I was setting myself up for an eventual implosion. I hardly remember each day that passed leading up to my grandmother’s passing- but I do recall that in between patients, a certain cab ride, and for two nights I found myself crying uncontrollably and crippled by inward pain (self-inflicted again, perhaps) because I who have studied so much in the last few years couldn’t do anything within my capacity to help my grandmother in her condition. So my supposed 6-day training in the United Kingdom became a 3-week sojourn to heal.

In the streets of Amsterdam, I saw the difference between tolerance and acceptance ~ how those two can be mistaken for the other. An old college friend shared his story of coming into terms with his past and present- in which he emerged the victor.

14 years have come and gone, and it seems as if time has not changed us much- with Chris in Amsterdam

In Belgium, I met a cousin for the first time and it felt refreshing to engage with a relative just for 7 hours and have the experience seem as if you’ve known each other all your life.

with cousin Elisabeth in Brussels, Belgium

In Doorn, I reunited with my Dutch friend who has taught me this invaluable lesson, “having enough time doing the things you love most with the people you care about is what truly matters at the end of the day.”

talks about life, the future and mishaps over coffee with Maarten

In Ipswich Hospital, I found myself challenging the ideals I was taught to imbibe during my years of residency and open my eyes to different techniques that I initially thought as far-fetched.

Dr. Matthew Yung (Ipswich), Dr. Maurizio Falconi (Rome), Dr. Iain Swan (Glasgow), and Dr. Roger Gray (Cambridge)

But then that is how medicine is- constantly evolving, but it all boils down to our desire to provide cure and prevent diseases, regardless of school of thought. With the mentors I met, I learned that it is alright not to have a shotgun answer for everything, that it is human to pause, recognize error, to take a moment to regroup and be open for counsel from another set of eyes. It was also in Ipswich that I learned to be wholly present in interactions with people I just met at the train station, whose home was opened and shared with me, or a chance encounter at a bus stop. I learned that each person has a story to tell and that the most meaningful exchange happens to be the one that is unplanned and one that is not forced. I roamed the streets of Belfast, took a short trip to the countryside and conquered physical limitations I have stubbornly set for myself just because I was reluctant to fail or make a fool of myself.

Carrick-a-rede Bridge, Northern Ireland

But it was in Northern Ireland that I was able to fully grasp how broken I was or I allowed myself to be. It was there that I metaphorically left the guilt, hurt, and reservations that I have been carrying all these years – it was the breakthrough I didn’t know I was waiting for.

with Jono and Joana at Giants Causeway, Northern Ireland

It is hard to explain, but the best I can make out of it is this: the rose-colored glasses came off, but instead of reverting to my usual cynical self, I saw the world with inexplicable clarity. It isn’t a perfect world we’re living in, and we can only push ourselves so much to keep up with the changes that come along; that it’s not a sign of weakness to acknowledge your fears or that you’re hurt, and that you can only do so much. I didn’t have to have the super-hero complex because I am limited by my capacity as a human being; but it is better to be part of change and to choose to move forward than to cower and hide my imperfections. And life is more than good—because every single day I have the opportunity to invoke change to each person I come across with, either voluntarily or involuntarily. A few hours before I had to catch my flight back to Manila, I found myself in deep conversation with a hotel proprietor in London. He shared his life’s story – his former job as an auditor for a big firm, the trade-off of success in one’s career vs. family life and reaching the same crossroad I found myself before this journey. He told me that in his late 50’s he is still trying hard to maintain the work-life balance, I, too, find extremely difficult to figure out. And as we bid farewell to each other, he shook my hand and said,

“I hope you’ll find the answers you’re looking for.”

I smiled as I walked away. 7,000 miles… that’s how far it took me to be reborn. I have found my reason “for whom” and “for what”—and most important of all, I have found my way home.

Borrowed Life, In a Borrowed Time

Dear H,

“No more pain in waiting”…

your final words that will haunt everyone to this day. It’s been 4 days since I heard that ill-fated news that you have left us. As if you’re that hard to forget. I immediately resorted to social media to see how the rest of the world took this in. I admit, an open letter made by one of your childhood friends struck a chord and made me recount how  I first came to know you.

It was in 2009 that I was (with a venti-sized coffee as a/an bribe incentive from my predecessor) appointed to handle the 3^rd year medical students rotating in my department. Inwardly, I was grumbling as this meant more work, on top of my patient rounds, reports, and responsibilities as a resident surgeon. But it was in your batch that I discovered a love affair with the Academe. There you were, in your thick-rimmed glasses, always with a ready answer when I threw questions your way—and mind you,  four years later, your name would remain one of those I could easily associate with a face, a voice, an enviable candour in speaking your mind, and that smart-as-a-whip lad you are… you were.

Our second encounter in that same year was when you and your posse (J and P) bumped into me while I was on-duty at the Emergency Room. You asked how I was, and I simply answered, the usual drama queen that I am something forgettable and probably negative. Then you and your friends handed me a flower, and I asked why—your answer was, “Take a break, doc, Aromatherapy!” and we all cracked up. You have that effect on people— to portray that there was always an opportunity to pick out the light moments in life. And when I saw how you lived your life in your timeline, I would not have thought you were carrying something heavy in your life. We all have our own crosses to bear, but you were too good in concealing yours. I never knew you were in pain bigger than yourself—never would have guessed it. And for someone who knew you in passing, I hurt for those who knew you well. Perhaps to this day, they are beating themselves up in not being able to carry your cross with you.  Maybe it was your wish not to be a burden to those you loved~ I’ll never know. We’ll never know.

I do hope that in those final moments, you did not think that you would be easy to discount as a person.  Because you are NOT insignificant, you are NOT forgettable. My dad has always emphasized that we’re all living borrowed lives , in a borrowed time– you are sorely missed, by your family, your students, your colleagues, your patients, and by me—a passer-by in this journey called Life.  You taught me to “stop and smell the roses”; it’s ironic that way isn’t it- the teacher becomes the student.  I hope you are indeed in a safe place where hurt and pain will fail to find you~ you deserve that much, dear H.  Rest in peace

A

Mourning Before The Farewell

“We all live a borrowed life, in a borrowed time.” (Anonymous)

     I wish there was a single word to convey to another person the deep sorrow that you feel on their loss. “My sincere condolences”, to me, feels oddly generic… and not at all comforting.  Even when I encountered my own loss within the family years ago, I would hear it from friends and strangers. At that time, I felt oddly isolated from their attempt to empathize with me.  Not to question another person’s sincerity upon saying it, but maybe simply because— whatever pain or grief you feel is your own. People may see it on the surface as you show it, but they can never feel it the same way you do. They can only identify with you from their own history of loss.

     I have always been a strong advocate of maintaining a rigid doctor-patient relationship with patients. As much as I would like to get to know them, I try to mark that thin line that exists between us that would foster an attachment- by this; I mean a bond that might hamper with objectivity. But no matter how I try to raise that wall, the same is not true whenever I would meet a patient who is suffering from the dreaded cancer. I see them on initial consult, do their biopsy, disclose my findings—and from that moment on, we are never the same again. I do not show tears or any signs of weakness in front of my patients and their families during planning—it is the difficult task of maintaining the delicate balance between objectivity while trying to infuse some optimism in statistics (survival rates/remissions/drug trials or randomized controlled studies) that I go home with until the end of my care. And what they don’t know is that in grief, I am with them. With every unfavorable news that I deliver (be it as early as a biopsy result/a recurrence/ a non-response), like them, I am not the same person again.

     But this is not about me. It is about her story, how her courage has made an impact in my life and how her teaching has taught me how valuable each moment is. I am most certain that going through something life-changing such as being diagnosed with the big “C” is nothing compared to being in my shoes as the surgeon. I find myself unable to sleep and finding solace in writing at this hour because a former patient, I met about a year ago (who has had a recurrence and battled through 2 major surgeries, radiotherapy and 2 cycles of chemotherapy), said to me earlier tonight—“It’s okay, Doc. The hospital has sent me home.  I’m ready…”

     How did she arrive at that state of unruffled composure to recognize when it’s time to let go? Being her physician, I have been trained to react to whatever is thrown my way, find a solution quickly, stabilize things, and see that the patients are on the road to recovery. But the unrest that malignancy brings upon a patient and his doctor—that’s a different matter altogether. I wish I could do more….offer more….  And it is probably this limitation that has brought me to grieve even before she has said goodbye.

 

*** (jpeg courtesy of http://niagaragriefcenter.org/images_niagara_grief/hands_depression_grief.jpg)

What it has taken me 33 years to learn

Ahh… I heard someone say that 30 is the “new 20″… and I say, Amen to that! Your blog entry holds true to that statement, kind sir! 😉

The Justin McElroy Institute

-You can be funny and kind or funny and cruel. The second one is easier, but the first one is worth it.

-Dip the french fry in the Frosty. Go on, try it.

-Habit is a powerful force we forget about until it’s turned against us. Be careful which ones you create.

-You will remember the most embarrassing crap you do in your life forever and in perfect clarity. Everyone else will remember the kindest things you do. It all comes out in the wash.

-If you’re doing a remote podcast, it’s worth it to record audio locally and mix it together. Trust me on this one.

-You’re the only one who can let go of your grudges. It’s worth it, I promise. They’re not doing you any good.

-Doing the good, brave, kind things can feel silly if you let your internal critic get in the way. Reminder: No…

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What defines a Nation

http://i.telegraph.co.uk/multimedia/archive/02730/TYPHOON-aerial_2730045c.jpg

In the face of the events that have transpired in the previous week, it has been quite difficult to find the words to express the grief that has overwhelmed the entire nation, and put the world in a standstill. To this day, it is hard not to be choked up as we follow the developments in Central Philippines through the news.

http://www.globalpost.com/sites/default/files/imagecache/gp3_full_article/photos/2013-November/philippines_typhoon_haiyan_aftermath_nov_12_2.jpg

I believe, however

,… that Filipinos are stronger than we give ourselves credit for; that in the face of calamities, we are bound by the Bayanihan spirit

… that despite religious differences, we are bound in solidarity to help those in need; that kindness exists in all of us despite the curse of greed that has been exposed to us in the last few months.

… That no amount is far too much or too small when it comes to helping our countrymen who are in need.

photo courtesy of http://timeglobalspin.files.wordpress.com/2013/11/187748881.jpg?w=720

I have faith

… that we can get past this- we have braved landslides, earthquakes, countless storms, political uprisings, and terrorism in the past, how does it make any difference this time around?

… In our brothers in Visayas that they, too, will never lose hope in the midst of this tragedy. Rebirth is on its way, and while the scars of death, destruction and suffering will forever loom, it will be our badge of courage- that all of us – are one with our brothers and sisters.

http://www.calgaryherald.com/news/world/cms/binary/9150912.jpg

I have never felt more in tune with my heritage than in the last few days. The news may have presented so many faces of who we are as a nation (pardon the pun, but I think ‘The Good, The Bad and The Ugly” may be the most appropriate term), but I still choose to believe in the goodness that pushes us to do what is right. And what I know and believe to be right is to wholeheartedly accept the call to respond to our compatriots who need us more than ever at this very moment. We are not merely a population but a nation – one that will rise again and look forward to a promising future.

On Meter Sticks and Allowing Happiness In

On Meter Sticks and Allowing Happiness In.

“How should you measure your life?”

It’s been almost 2 weeks since that question was raised, and it resounds ever so loudly in my head as loudly as I heard it in the Chapel where I first heard it from. When the question of identity is being asked, others identify themselves in the career path or religious vocation they chose to take maybe a decade or so ago.

Flashback to 2010… My Campus Ministry Friends from DLSU (R to L: The Campus Minister, The ENT Resident, and The Seminarian)

It was timely to be asked that question, as I was with my peers with whom I haven’t seen since college and some with whom I’ve had the honor of meeting recently. With all the brouhaha of daily living (especially City-living), I don’t really get the opportunity to pause and assess if I am living my life the way it should be lived (not that I’m complaining), nor ask myself if I’m happy where I am.

After college, we set out in pursuit of fulfilling our dreams/our parent’s dreams/our generation’s dreams- and as the aspirations are being met (like that of a check list); there is an insatiable thirst to take on another one.

When do you stop and finally say, “Yup, I did well. I am finally content.” Me and a fellow Archer coined this as the Trimestral Syndrome (or Overachiever Disease, as a good friend who is an “Iskolar ng Bayan” aptly put it) – being trained to survive in a fast-paced collegiate lifestyle, we get bored easily, we live to compete.

Now this may be a good thing- but after a decade and a half since Freshman Year in College, can I finally say, “Yes, I am very happy and content.”? Satisfaction is not in the material things you have acquired- it’s a state of mind; and I learned along the way that it is not in the number of adrenaline-pumping surgeries I take on, nor the number of Friends I have met in social networks… In fact, I have pruned enough relationships/friendships  over the years than I’d like to.

I found some of my answers when a colleague made a post that was noteworthy and timely:

“From my experience, I realize that as much as we choose who to be close with, in the end Friendship is partly influenced by circumstances and also by choosing each other. Sometimes we end up with people we would not have expected, would be our friends.”

It’s all about choosing and being chosen- how true for friendships and how equally true for finding your own profession/vocation.

Forward to June 29, 2013… (R to L: the Lasallian Brother, the Surgeon, and the Franciscan Priest) Answering our different Calling- and doing nothing less than God’s Work 🙂

Now it’s been 15 years, for the first time, I stopped using titles and objects as measuring sticks. I stopped comparing myself to others. And I finally decided to pause- to look at who I was then, the person that I’ve become now and the people whom I have grown in faith with- Yes, I can finally say, this is happiness- this is what it feels to be loved 🙂

The Truth Behind Primum non Nocere

(The following is a re-post from my 2010 blog site, shortly after getting accepted in a surgical residency program in the country’s largest tertiary care center. Here, we deal with mostly complex cases referred to us by different provinces; and majority of our patients are indigent and the underserved. Something to mull over and I do hope you pick something up from this entry 😉 )

They all said we’d get used to it –  pain and death.

For almost five years of duties, from menial tasks to being given privileges to operate, you’d think we’d get used to them. If this was true, then why does this 27 year old find herself writing through tears at this hour?

While everyone around me thinks that donning the white coat is a glamorous career, I could only shake my head in response. At medical school we were taught the art of medicine- to foster the insatiable desire to find cure, alleviate pain, and see our patients through. And while I thought doing the thing I love everyday is enough, I guess it isn’t.

Primum non nocere means “first do no harm”. And despite the constant reminder of our mentors to continue to look at our patients as persons and not only as disease to cure, I must have forgotten that until today.

I joined my service senior in her family conference with one of our patients this afternoon. This man has a bleeding malignant tumor on the mouth almost as big as his head. As we discussed our options to him (surgery then chemo vs. chemo then surgery) – detailing how it will leave him physically maimed for life (we’ll be taking out his entire jaw, almost half of his face; a tracheostomy tube will be necessary as well as a gastrostomy tube), I literally watched him see his world fall apart. He is only 21 years old. His pregnant wife had to sit down for support. I watched his father fight back tears. His older sister asked me why do these things happen to good people? I had to look away. I had no answers to give. Suddenly, the best options we were explaining and offering do not sound enough. These are the things they do not teach you in medical school.

I have learned to shut off emotions while using alcohol as a crutch. Emotions tend to impair judgement, something I learned the hard way. And when it wasn’t enough, I tried to tune it out with books, trying to sound rational by studying epidemiology, prognosis, and treatment. The truth is, I’d still take home the emotional load of my patients, locking it up in that part of me because I was too afraid to show that I am just as affected as they are; that while they face their disabilities, I was struggling to maintain a professional doctor-patient relationship. How can one give assurance that things will work out fine when we’ve seen a lot of these cases and know for a fact that we can only extend his life at best for a couple of months? The issue of quality of life comes to mind, and discussing how his disfigured face will take on an even more maiming appearance was too much that he broke down in front of us. How does one make a choice given that the best options aren’t exactly reassuring? My senior and I took a moment, I told the family to take their time in deciding. This was, after all, something that will affect all of them.

As I sit to brood on today’s events, that ability to feel I have locked away since becoming a resident physician/surgeon suddenly resurfaced. For some time, I couldn’t write and express myself like I used to because I have grown accustomed to compartmentalizing- not thinking that emotions can be channeled into making one’s self not just a better physician, but a better person as well. I have no answers for the questions I was asked today. But I found that part of me I have shut off, I found a reason again why I chose to be where I am. And while numbers are just numbers, miracles are bound to happen at unexpected moments. Tonight, I am saying a silent prayer for this family and for all my patients who have taught me humility and realize that while my hands can be used by Him to cure, He is the true Healer.

Defining Who You Are

Defining Who You Are.

(the following is a re-post from another blog site I had in 2010. Thought I’d share my earlier posts— be inspired and be blessed, folks!)

His name is Mr. AC.. He’s 73 years old, works as a lay minister, well-loved by his children and relatives. He’s a cancer survivor and still fighting, probably the hardest battle of this life. And we met while he was at death’s door.

It was 2:15PM , December 16, when I received a call from one of our esteemed consultants to expect one of his private patients and assess his airway. Apparently, he is a cancer survivor who lost his larynx yet continued to live his life serving his community despite the maiming effects of a laryngectomy, chemo and 33 cycles of radiotherapy. His cancer recurred with a vengeance and he has made it his mission to fight this battle standing and without any shadow of fear. He was turning black from air hunger, the tumor has closed off the only airway my consultant established from his previous surgery.

Perhaps the best time to define who you are is when you are left alone, making the biggest decision that will affect your life; in this case, it was not my life but his. With barely 2 minutes, blood on my face and hands, i searched for any structure that resembles an intact trachea, praying hard and acting on instinct that with all his struggling and cyanosis, he won’t go into a cardiopulmonary arrest. I couldn’t wait for my consultant, notwithstanding that if he dies, it will be my responsibility.

I suppose, it was His hands holding mine– despite the pressure, my body and mind were cooperating and in tune with each other. Lack of sleep and skipped two meals, but my hands which sometimes shake could not be any steadier than it could ever be at the time… and then I found the airway. Barely 2 minutes… and then Mr.AC suddenly opened his eyes and turned pink.

He was rushed to the operating room for an emergency debulking, stomal widening and hemostasis. It was a blur, and as I leaned on the wall, there were no pats on the back, no thank you’s… but after 11 years (pre-med, medschool, and 3 years in residency), I truly felt the happiness of saving someone else’s life. A nurse I haven’t met before walked up to me and said, “ang galing niyo doktora.” (“you were great, doctor!”) Did that matter? To me it didn’t, it was simply responding to what was needed from me by my patient.

There was a time when all that mattered to me was getting good grades, getting promoted, striving to get published. But then, at the end of the day, none of these things ever defined who I am as a person – the person I was striving to become all these years.

I received a message from my consultant that evening– thanking me for what I did. Funny, I wasn’t expecting that because I wasn’t waiting for any affirmations- not this time, not ever. I went home that evening a different person.

I walked in Mr. AC’s room yesterday, a day after we met under the most stressful circumstances. I introduced myself and asked if he remembers anything about the day before. He said he couldn’t, all he could he hear were voices while he was in the E.R. And then his family told him what happened. He held my hand, and I felt the bond that we share. He has changed the way I perceive the world, the same way God’s hands worked in mine to give him another lease in life. I know it wasn’t just me standing there at the E.R., I wasn’t alone.