Toy Houses

This is my (late) entry to this month's The Blog Rounds, Christmas edition, hosted by Doc Ness.

Lego.

Lego Lego Lego Lego Lego.

Ever since I received my first Lego set (a yellow bungalow with a kitchen and a bedroom, kind of cool actually), I've always wanted more. A whole town to play with. You see, I didn't get very many toys as a kid and I always thought that Christmas would be my time to rake it in. Every year I'd write to Santa for yet another Lego set. But I think it was only answered once out of maybe 5 or so times I asked for one (5 years may not seem like much-- but only a lifetime to a child). And it wasn't another house (or a hospital/firehouse/airport, what I really wanted), it was just a small set, probably a vehicle or a bunch of civilians. You can imagine how stupidly disappointed I was, when you compare the gift to the fantasy. The fact that we used to visit a Gift Gate branch (official dealer of Lego for quite a time) each week, where I'd ogle the universe as conceived entirely in multicolored interlocking blocks, probably made matters worse.

It wasn't until later on that I was able to truly comprehend the Christmas situation of the past few years. News flash-- Lego sets, especially when you want them to have a two-tier house, are fucking expensive. Thou-sandssss of pesos. Waaaay too expensive for me to buy, even if you don't take into account inflation and transport those old models with their prices intact to the present day. Probably worse for my parents back then, who had a kid who didn't want for anything except maybe the most extravagant thing, but once a year. I hope I didn't break their hearts back then. To be fair, I don't remember throwing a tantrum or seeming disappointed in receiving other gifts.

I wanted a toy house to build and make my imagination soar. Building blocks made of plastic. What I got instead was a real home, a happy family, more love than you could ever hope to receive in a lifetime. I dreamed of toys, but my reality was far more fortunate/charmed than what most had. The irony is that these days I get insecure and frustrated with how little I have to buy for my own family, not realizing that they are NOT the obsessive imps that children can be, like I was. Although it can be extremely pressuring to provide as much love as they do to me-- I'm not sure I can ever, but that doesn't mean I won't try.
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The Finger

During my cousin's wake, my niece and nephews-- his children-- were running around aimlessly and trying to annoy me intermittently (I was the youngest adult there, apparently). The youngest, J3 (6 years old), approached me, with his sister J2 (9 years old) and older brother J1 (11 years old) huddled around.
"What is fog?" J3 asked me.
"I'm not sure, but I think it's just a low-lying cloud," I replied.
"No," J3 said knowingly.
"Oh," I said, a little surprised he was quizzing me. "What is it?"
"Fog is a gay person," he said with a twinkle in his eye.
I was shocked for a split-second before I switched from accommodating to stern. "Don't use that word, it's a bad word," I said. I would have given them more of an earful but they had the attention span of a ripe zucchini and before I knew it they were running around again. That, and it would have been bad form to lecture them in a mortuary with their grieving mother just nearby, which is really what they should have been trying to do anyway. (But in trying to avoid rudeness, did I just pave the way for more rudeness from them?) No doubt J1 (my godson, egads) taught his brother some offensive words again.

But it's more than just manners and words. The word "fag" to me has no value; it merely serves as a hurtful word to belittle gay people and make the utterer feel superior for not being "different." It pains me that my own nephews are building up their own arsenal of words with which to wound other people, and at such a young age too (though I don't believe you can ever be too old to unlearn hatred).

Although it seems I may be in a minority. Yesterday it was almost confirmed from projections (not sure exactly how this will play out in the next few days) that Proposition 8 had triumphed in California. When I was in El Segundo I'd actually spied a few of the pro-Prop 8 advertisements and I am absolutely amazed how the actors and actresses don't throw up violently for having to say the lines. Even more astounding is the fact that some people feel that gay people are not entitled to the same rights that straight people have (or gay people who get married to the opposite sex anyway) in this day and age. Another amendment that apparently passed is one that prohibits unmarried couples from adopting children, which is another slap in the face of gay couples. Not to mention slaps in the faces of orphans all around the world. Certainly having no parents and no one who cares for you at all is better than having gay parents, right? Appalling.

Look, I'm pretty much a loveless bastard (er... kidding) with no ring on his finger and no prospects. But I do believe that anyone who is lucky enough to find love should be able to celebrate it and show it to the world without shame or fear of hatred. Today I share my friend Allen's anger, and I share his finger too.

Here's another one. I would have taken a picture of myself but not only do I have no ring, I also look like shit today.

Edit: here's me. This is fo all tha haterz in the... Oh, hell, I can't pull that off.
I don't want to hate on anyone either. Just know that the world's already too much of an awful place for so many poor people around the world. Why should we infect our own neighborhoods with prejudice and bigotry?
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Tears

Today my first cousin Jeffrey passed away from a ruptured intracranial aneurysm. He was only 33. His wasn't a very hopeful case, as he was Hunt and Hess category 5 or 6 on admission. We were only hoping against all odds as he was still very young. We weren't really close; he was a good 7 years older than I am and therefore was already past the silliness of childhood when I developed a consciousness. But still, I am the godfather of his eldest son; he had 3 children in all. I know that the children will be in very good care (thanks to our very tight-knit family), but I'm still troubled, since they're too young to know such pain-- or maybe more unfortunate that they're at the threshold of actually recognizing the pain.

I haven't yet cried. I might if I see the wife or children cry. I think people (at least my med school classmates) believe I'm fairly robotic. But I keep remembering this one time when I was rotating in Anesthesiology and we were preparing to operate on an infant-- incredibly cute, impossibly with a permanent smile and gurgle-- he had amniotic constriction bands that needed to be excised to allow proper development of his limbs as soon as possible. It was early in the day, so only the baby, the mother and I were in the operating room, and I was getting my notes ready. The mother was softly whispering to her baby, "Mag-pray ka kay Papa Jesus na alagaan ka, ha?" (Pray to Papa Jesus for Him to take care of you, okay?) While the baby was still impossibly cute, smiling obliviously, loving every minute of attention from his mother.

I guess it's because I'm not a parent. I found it completely wonderful that the mother was projecting a prayer-- basically talking to her baby, even though he couldn't understand a word. I ran out of the room and I broke down. I don't cry because of hard work or frustration. I never cry because someone yells at me or is disappointed in me. But to see such purity of love and faith was just too much to handle.

My friends were all freaked out (they'd never seen me cry) on the halls of the operating complex because I was crying, but even when I explained it, they still didn't get it. I consider myself to be a bit of a faithful person, but when you see such a shining example of it, it makes you realize how much of an infant you are, how little of the universe you understand. I guess faith is mysterious in that way; it's either the easiest instinct or the hardest, most elusive quality.

Outside the occasional stupid drama show or movie, I think I've only cried a fair few times for actual people; four of them about patients (including the one above). But the connecting thread between all four is that there was a mind-blowing example of faith, or unconditional love, even in the most difficult of times, even at the time of death.

Now the challenge has come to me, to be an example of faith and love to the children my cousin left behind. It's going to be okay. I hope so. I know so. I only wish that I wasn't relatively still such an infant. Taking those first steps can be extremely frightening. But I guess that's what faith is for.
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Geriatrics

In our group of ten interns, I had a friend who has always maintained that she wants to pursue a career in geriatric medicine. I never told her this but I've always commended her for her choice, especially since I don't think I can keep up with that line of work for a long time.

Geriatric medicine in the Philippines, I imagine, is not that easy. How did I come to this conclusion?
1. Most of the elderly lived in a time when the migration to Manila, the economic center of the Philippines, was not so crazy, and they opted to stay in the provinces. However, healthcare to the provinces is limited (few and far between) and they prefer to keep quiet about their problems (so as not to be a burden to the family) until it worsens to an unmanageable degree.
2. Lifestyle diseases, such as cardiovascular disease and diseases attributable to smoking, were not in the public consciousness during their time. Of course, there's plenty of old people who are very proud to be up and about even if they smoked two packs a day since they were 12 years old but the odd, sporadic check-up will reveal unbelievable findings, like blood pressures in the 200's/140's. Their reaction? "MEH."
3. Those who do have check-ups tend to several diagnosed diseases, and therefore a long list of medications. A delicate balance! Then there's always the question of finances. Most don't have a pension, so they rely on their children.
4. My voice is soft. It hurts at the end of the day. Figger it out.

Who knows, maybe by the time I'm a consultant, the current generation of middle-aged adults will already be of geriatric age and these problems won't be as severe as before. (Wishful thinking.) But what is easier in this country in terms of caring for the elderly is getting family support. You won't usually need a social worker to get in touch with someone to help with your elderly patient-- they most likely live with one of their children, who is ready to pack up bags and bring the whole clan to the hospital at a moment's notice. And that's something that I hope never changes.
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My Dream Last Night

I think the best kinds of dreams are also the worst-- the ones that make you feel sucky when you wake up because it's not true. Here was my awesome, awesome dream last night.

I dreamed I could fly. And I didn't dream that I'd recently discovered it; it seemed like I've been flying for all my life and it came naturally to me. So I can paint a clear picture: I could fly much like Cannonball does. I'd do a running start of a few meters, then shoot up into the air like a rocket, with a trajectory. I couldn't stop in the air and float, and neither was I invincible. I'd land somewhere then do another running start and try again. But I was soaring, and it was incredible. There were times when there wasn't enough room to do a good run and I kind of stumbled in the air clumsily, and sometimes there were roofs where I'd hit my head or face because there wasn't enough room to shoot through, but I wasn't flying fast enough those times, so it didn't hurt. (Also, it was a dream.)

In my dream I was soaring through various places in Manila. I didn't think I was going anywhere in specific. I landed on a beach that reminded me of Boracay, but I didn't soar over any seas, so it was really a shore in Manila. Roy (Lascano) was there and asking me if I knew where Anton lived. I stumbled plenty of times: I started to describe his old home in M. St., then I remembered he now lived in A., but then I remembered he was actually in our old dorm near PGH, then I (mistakenly) said that he had moved to a different dorm. Anyway, I shot out of there, then I landed in some office where there were other super-powered beings. There was this short, annoying girl who reminded me of Lindsay Price from Lipstick Jungle/ Coupling. She was lamenting the loss of Jean Grey, and wished that a particular form of hers would be resurrected. I shouted at her that she only wanted to deceive the Phoenix force. She tried to wrestle me but of course she was too tiny and weak to really succeed. I soared onto a rooftop Chinese garden, but there wasn't any room to run in, so I went inside the building and it was a giant conference room surrounded by glass. I didn't want to crash through the glass and I was afraid I wouldn't be able to fit through the panes, so I proceeded to go down into the street.

That's the dream. I wish you could've felt what I did in the dream. It was like I was looking down on Google Maps or something, with the wind in my hair. Fantastic.
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Identity Crisis

Though I can understand the mutual animosity that sometimes happens between nurses and physicians, I still hate it. One of the most annoying recurring themes of our emergency room is that the patient charts would be scattered among the four winds, and sooner or later various groups would need to either do their rounds or orders.
Me to a nurse: Sir, I just need to borrow the chart of (patient)...
Nurse to me: (Without looking up) Di ko siya patient tignan mo list ko (He's not my patient check my list)
(points to handwritten list of patients taped to a wall)
Me: Uh, okay. (I'm pretty sure you were decked to him, but hey, whatever.)
Later...
Nurse to another nurse: Ha ha ha, ay patient ko pala siya (turns out he's my patient)
Me, from afar: F&@@# s@#!
Listen, I don't know you and you don't know me. Wouldn't it be great if you had a default level of courtesy that you offered to any human being who crossed your path? Isn't that just a given as a citizen of the earth? Wouldn't it be moreso now that you're in a service industry?

The truth is, I'd rather not tarnish my memory of the dedicated nurses with these trolls, because there's a lot of the former. The problem is, even when they're golden, it turns out I still don't know them. One of the perks (for all it's worth) of being part of the physician's team is you get your name mentioned a lot during surgery, especially if the resident is one of your friends or the senior likes teasing you with questions about your life or about the case you're assisting on. So it's easy to pick up your name and soon the nurse assist will call you by name as well. So during a particularly long intra-operative T-tube cholangiogram we were all sitting ducks and this adorable nurse shares with me the full details of her love life (uh... She had a boyfriend whom she loved but was a bit stalker-y and embarrassing, and a romantic older suitor whom she kind of liked and she was torn). I thoroughly enjoyed talking with her and giving her advice about who sounded like a winner. The problem was, I had no idea what her first or last name was. Surgeons should really announce those things upfront for my benefit, ha ha ha.

As luck would have it, that would not be my last encounter with her, because the operating rooms they're assigned to are fairly consistent. And the more we talked, the more I was embarrassed not to know her name at all despite knowing her favorite song and her two lovers.

Outside the operating room, we have our nameplates for easy identification. The nurse receptionist at the outpatient department was a really nice guy, who for some reason I couldn't pick up the name of, despite him calling me by my first name all the time. The resident couldn't really help me out either, since he didn't call him by name. There were no other nurses working in that department, so no colleagues of his that would mention his name. I felt bad about it (again) because he was really friendly, sort of the antithesis of those bastards at the emergency room, and was always encouraging us with how many charts were left to look over in the OPD. "Fifteen na lang!!!"

So it's been more than a year since I graduated and I found myself wandering the registrar's office for some administrative concerns, and I happen to see him. "Doctor Mark!" He calls out to me. Shit. HE KNEW MY NAME!!! Without my nameplate and everything! That is fantastic. We shot the breeze for a while and he wished me well, and I him. You know, nurses should wear full nameplates all the time for my benefit, ha ha ha.

Being a courteous and amiable person, if you're lucky with your company, can really help lighten the load. I would still have been able to do my job with no problem if these kind nurses were replaced by dickheads but I'm pretty sure I would have been miserable about it (bloodshot eyes, hair sticking out in all directions, smoke pouring out of ears). Perhaps my lesson should be asking their name on my first encounter.

This is my entry to The Blog Rounds 16th Edition: Unsung Heroes hosted by Dr. Gigi.
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Five Stories of Sex

I have here a collection of 5 anecdotes relating to gender issues and medicine. Some are funny, some are poignant, some are controversial, and some don't even have a point. My only goal is to make you see things from a different perspective: Being a male physician has its own set of pitfalls.

1. When I was in my last year of college, many of the girls of my batch were worried because of the impending release of the list of people who had been accepted in the University of the Philippines College of Medicine. There's so many factors for this, but the primary reason is that the GWA curve is skewed to the right, and Biology students are not particularly known for high GWAs. They were afraid of being cut off simply because they had a more difficult course to begin with. I was listening to a classmate, a renowned worry-wart, when she asked me, "Well, aren't you afraid of not getting in?" She stops herself and says, "Oh, wait-- of course not." I thought she was going to say that I didn't have any academic issues, but she finished her statement with a look of such disdain-- "You're a GUY." Hah, people who put themselves on pedestals, that teaches me. Disgusted by the whole show, it was my turn to tell one of my friends, "Pustahan tayo, kahit may p*ke ako, makakapasok pa rin ako." (Translated: Let's wager, even if I had a vulva, I'd still get in.) It wasn't like me to get so angry or to be so vulgar (notice the self-censorship?), but what can I say, I had never been so insulted before (that has since changed, of course). Well, it was just a joke to make light of my disbelief. To this day, my friends love that soundbite of mine and forever associate me with the phrase "kahit may p*ke ako..." Emphasis on the second to the last word.

2. During our rotation in Obstetrics, I prided myself on never losing my temper with a patient, except once (what I shouted was (translated), "Stop staring at me, your baby's coming out!" Take a guess what was happening). Anyway, there was a particular gynecological patient whom none of my blockmates wanted to touch. Each time they looked at her, they would get annoyed, might I say they even looked like they were seething. Apparently she gave them hell each time they touched her, to do blood works and even take her blood pressure. Since I was the only one she hadn't yet annoyed, I sucked it up and it was my turn to be responsible for her. Strangely, she was all sweetness and light, purring in a weak, kindly voice, and always thanking me. I turned to my blockmates and asked, "What the hell are you talking about? She's so nice!" It'll forever remain a mystery if it was because I was me or because I am male, but she never wondered why no other intern ever touched her again.

3. When I first wanted to be a physician (I was very young), I wanted to be a pediatrician. There was vehement protesting from-- you guessed it-- my dad. He wasn't angry, but he always maintained that pediatrics is not a man's specialty. His justification was that women have a maternal instinct to which children respond well. But I could always read between his lines (though I am not going to mention what I thought, because he never said it and I don't want to put words in his mouth). There was even a time when I sought middle ground by aspiring to be a pediatric surgeon. I teased my dad that he's so old-fashioned, especially as I knew several gifted male pediatricians, and it's not even an issue to many people. I thought I related to children extremely well. Today my goal lies in internal (adult) medicine. Seeing young children struggle with their emotions-- whether they be frightened, brave, hopeful, angry, hurt, confused, or resigned-- it was all too emotionally taxing. Especially if they're crying but still trying to be brave, Lordy. I still don't know if a man or a woman makes a better pediatrician (can we just settle on equality? Ha ha), but I do know it takes a hell of a lot of guts.

4. One night shortly after the new year has begun and the new crop of surgery residents have settled, the department (at least the residents plus very few consultants) have this huge blowout where they drink beer (plus...?). I was on duty the night it happened, and one of the residents, a huge guy, came crashing in the dressing room of the operating room complex, absolutely smashed, and passed out on the floor that was littered with smelly shoes and cigarette butts. Shit. After making sure he was alive and seeing that at least a few of his friends knew where he was, I just let him sleep on the dressing room floor. Now, who says that surgery is a boys' club?!

5. I was one of only two male interns in our group of ten. I was in a small discussion group with four of my gorgeous blockmates with a preceptor-consultant. After every two sentences on his lecture, he'd ask a personal (harmless) question to each of my lovely ladies, like what high school they were from. My eyes rolled so far back so many times I must have looked like I was seizing (thank goodness he was so dense or I was so invisible to him that he never noticed). Needless to say, he barely knew I was there. At one point, since we were huddled so close together in his office looking at fine details of tiny pictures, he put his hand on the knee of one of my groupmates. "Oh my GOD!" I whispered to my other groupmate. "He just put his hand on her knee!" She was wearing trousers, but still. Not one other person noticed, including the touch-ee herself. "Well, this guy is clearly a maniac. I don't even exist to him!" Noticing that he might have been looking like too much of a lech, he nonchalantly threw me the question of where I went to high school. Bingo, it was his son's high school and he was fervently following the high school basketball championships. After that, the girls became invisible to him. My friends were all, "You were saying?" On a positive note, they were more conscientious of proper interaction after that. And on a bite-me-in-the-ass note, they always noticed when a female resident was getting chummier with me than with them.

This is my entry to The Blog Rounds 15th Edition: Sex and the Clinics
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This Is Your Life?

One of my co-interns (whom I admittedly dislike) was once raving about Dr. Gregory House, how he was her idol and how she wanted to be as sarcastic with her patients as he was with his. I said nothing as my distaste for her deepened. Apparently you're never too old not to know the very wise difference between what is acceptable on television and in reality. I would have been easier on her if she only wanted to emulate his diagnostic brilliance, but it seems like she has found her idol in cruelty instead. (For your information, this is the kind of intern who turns her back on patients as they're speaking, pulls out intravenous catheters without managing the bleeding from the venipuncture site, and looks with disdain on her co-interns. A real gem.)

For one thing, many of the problems detected on House (eventually, in the last 10 minutes of the show when the patient is near death and House's colleagues have lost their minds) can be deduced with skillful history-taking. Everybody lies, though, Dr. House might say. That's what rapport is for, asswipe. I did enjoy a few of the earlier episodes, though-- Damned If You Do (Season 1, Episode 5-- the one with the nun) raises some serious, poignant issues, and I'd be lying if I said it didn't think it was heart-wrenching.

Another show, Grey's Anatomy, came about during my clerkship year, and was hot news around the water cooler. I thought it was silly. My friends recognized it was silly, but they still couldn't deny that they were really just watching their fantasy of a hospital made up of attractive people. I didn't appreciate the barely 2-dimensional stereotypes of the show (dork, whiner, ass with a heart of gold, go-getter Asian, Barbie doll, stern resident with a heart of gold, blah blah blah), not to mention the excessive whining, unrealistic amounts of inter-office sex, and people taking everything too personally. It's exhausting.

Also, everyone looks way too old to be interns.

Of all the hospital shows I've seen (and I don't watch a lot, as compared to my other TV fetishes-- I don't like mixing real-life with tv-life), ER appears to be the most realistic and relatable. Unfortunately I also found it... Not very engaging. As slow as real life, apparently. My favorite exchange was this:
Rich-looking ER patient with what appears to be a sprain: I have been waiting here for five hours!
Character played by Maura Tierney: Sorry, we tend to lose track of time when we're trying to save lives.
Rich-looking ER patient with what appears to be a sprain: WAS THAT SARCASM?!?

... Sound familiar? Ha ha ha. It's also rude, mind you, but it's a more realistic kind of rude, the things you almost say when you're near the end of your tour of duty and dealing with a truly annoying person. But weirder things have happened in our ER (hey, it is the Philippines, after all...). Maybe that's the problem with ER.

Among those weird/normal things (note: these did not all happen to me in particular):
Stand-off between entire surgery team and a difficult watcher (complete with racist name-calling!)
Being clawed at by a delirious patient
Almost-catfights between obstetrics residents and patients in labor
Needlestick accidents with a known Hepatitis-B patient
Wrestling with a brain trauma patient in the ER who's lost it
Woman+family in denial of pregnancy even as her baby's crowning

Hey, maybe it's our experiences that should be televised!
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