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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