closures.

“Thank you, doctor, for giving us closure.”

That was what the patient’s sister said, in between shedding tears, as she gathered with the rest of her family inside the humid, overcrowded emergency room of the country’s biggest tertiary hospital. A frantic call in the middle of the night relaying news of her brother’s moribund state had forced her on the first flight back to the Philippines, and her weary face was at once a tapestry of mixed emotions: denial, grief, desperation, guilt, and finally, acceptance. Earlier that morning, I had engaged the family in an exhaustive talk that entailed a detailed explanation of the patient’s condition (best summarized as terminal cancer, comatose, poor prognosis), available options (to resuscitate or not, to continue aggressive medical management or not), and continuous reassurance (whatever your decision is, we will still provide the best possible care.) In the end, everyone settled for a quiet, non-intrusive approach that allowed the patient a peaceful death; no hefty measures.

Medicine in the new millennium has always focused on the quest for innovation: new drugs, new tests, new surgeries. These advancements in health care enabled doctors to work at a faster pace and deliver better outcomes, but somehow at the expense of less patient interaction. In an age where speed is king and efficiency is the rule, barely enough time is spent explaining the nature of the disease, offering diagnostic and therapeutic choices, providing ample reassurance – things which are incidentally just as important as their biomedical counterparts.

I, too, used to believe that the magic formula of “subjective-objective-assessment-plan” – so lovingly imparted to us in medical school – was the celebrated panacea to all my patients’ complaints. There’s the stirring fire of youth and idealism, plus the messianic way Filipinos often regard their doctors (As one patient entreated with supplication, “Kayo na po ang bahala sa lahat.”) During my residency training in Internal Medicine, I was stationed inside a government institution bursting at the seams with patients from all corners of the country. A lot of these were intriguing, complicated cases, and I was determined to push for gallant interventions no matter what. Many times, however, after an overwhelming rollercoaster ride that cost my patients an arm and a leg, I ended up tired and frustrated – a good number died despite my best efforts, and I further faced relatives who were just as confused, angry, and depleted to the hilt of financial and material resources. What happens when even the most exacting principles of science cannot give us solutions? What happens when even our noblest intentions fail to prolong life?

And then, my patients slowly taught me the value of the talk.

By talking, I mean a frank, honest, no-frills talk: A talk that raises no undue expectations; only real ones. A talk that might sting with the intensity of freezing water, but which will lead to a much-needed, much-yearned closure.

The realm of medicine is a rapidly evolving one, with mysteries lurking at every corner, answers waiting to be unearthed in the depths. Dr. William Osler, the pioneer of modern medical teaching, often preached that the role of a doctor is “to cure sometimes, to relieve often, and to comfort always.” Cure is perhaps the most tangible concept, manifest in the myriad breakthroughs and discoveries of medical research. Relief, too, comes in the form of alleviating pain and affording a more acceptable health-related quality of life. But comfort is rooted deep in empathy, the embodiment of an innate desire to help a genuinely suffering person. Despite the inherent shortcomings of our relatively resource-poor health care system, I realized that proper and meaningful communication seemed to raise the bar each time I sat down with a patient and/or his/her relatives, making the experience much more personal and profound. I eventually learned to throw away the proverbial coat of invincibility and omniscience and lay down all my cards: As physicians, we may not always have the remedy to every ailment – but we are there to reach out a hand, to walk every step of the way.

It is a task both daunting and difficult, especially when you find yourself confronted with a visibly distraught husband, a daughter transformed into a huge bawling mess, or several passionately argumentative family members. And perhaps quite understandably so. For how could a star athlete suddenly succumb to a heart attack? (“Hindi ito posible,” his bereaved girlfriend pronounced.) How could someone walking and laughing a few minutes ago abruptly collapse from a massive stroke? (“Paano nagkaganyan?” The horrified brother countered.) Discussing advanced directives, in particular, is a delicate matter. Many family members are unwilling to make decisions for an incapacitated patient even though they possess the legal right to do so. “Ayoko masisi ng mga kapatid ko,” reasoned the eldest son. “Hintayin na lang natin ang aking manugang,” begged the elderly wife. It takes a lot of patience and perceptive acumen to guide the surviving family members through the crucial process, but it is a necessary means for closure – and the result can prove both enlightening and empowering.

More than anything, helping people achieve closure made me marvel at the unique strength of character, the tightknit closeness of kith and kin, and the earthshaking, resounding faith in God that proudly characterizes the Filipino spirit. I met families who chose to have their loved ones spared from traumatic intubations or fractured ribs from excessive chest compressions during resuscitation. I met families who chose to forego gargantuan procedures bordering on the futile, with a firm decision not to pursue the farfetched moon and stars. I met families who nodded with understanding, who managed to smile despite the grim reality, who offered gestures of gratitude for words well-spoken and time well-spent. I met families who saw the value of dying peacefully.

Looking back at that pivotal moment in the emergency room, I may have failed to keep the patient physically alive, incurable as his disease is. But it warms the heart a little to know that I was able to share what little time I had with the family he left behind – now coming full circle, now cloaked in mourning, now bonded in closure. I am reminded of Dr. Osler’s fabled words to “cure sometimes, relieve often, comfort always,” and just like that, I learned to find it in myself as well – a certain kind of closure no amount of medical training can ever give.

graphic tales (part III)

Another short story published in Graphic today! I must say that this is turning to be quite a yearly tradition - in reality, more of a personal goal - just to goad myself into getting those creative juices flowing amid the doldrums of residency life (and believe me, the intense scientific atmosphere can get quite nauseating at times.) I find this story, "The Broadway Covenant", particularly close to my heart as it is a loving tapestry of two of my cherished passions: literature and musical theater. Set amid the backdrop of the blockbuster musical Phantom of the Opera, the story chronicles the pursuits of a Filipino theater actor in the glitzy, gaudy world of Broadway. Here's hoping for another score at an awards night!

Below is an excerpt from "The Broadway Covenant":

At the back of his mind, he had other favorite musicals, of course. Les Misérables was definitely a stroke of genius, with its poignant songs and stirring patriotism. He remembered keenly devouring the Victor Hugo classic in high school, and had always wondered how it would feel to play the part of the perpetually torn Jean Valjean, the infatuated Marius, or the morally tragic Javert. His mind then flew to Evita, with its elegant air and quiet sophistication, and somehow fancied himself portraying the celebrated yet largely misunderstood Che Guevara. But no, he reckoned playing the ambivalent Dan Goodman in the Pulitzer-winning masterpiece Next to Normal would be so much better, where he could easily show off his acting chops and singing prowess to the delight of the spectators. Other times, he acquiesced to the classics, thinking it immensely rewarding to slip into the shoes of the debonair Emile de Becque in South Pacific, the nomadic El Gallo in The Fantasticks, or the sweet-tongued Billy Flynn in Chicago. Of course, no one came close to Phantom – with its magnificent, operatic tunes and timeless plot of romance and betrayal, the epic tale of a man eternally disfigured by the gruesome ills of society. 

graphic tales (part II)

In the midst of a hectic first-year residency, I got a nice surprise when my short story "Scars" was selected as part of the long list of this year's Philippines Graphic-Nick Joaquin Literary Awards. "Scars" was my first foray into the realm of horror fiction, and eventually appeared in Graphic's Halloween issue. With a sprinkling of Gothic and Filipino-Chinese religious elements, I thoroughly enjoyed writing it very much - so much that I had to scratch the writing itch inside an impromptu internet cafe of a mall! To cut the long story short (pun intended), I didn't make it to the top three, but what the heck - literary awards nights are always magical. Congrats to this year's winners, and heaps of thanks to the ever-fabulous Joti Tabula for accompanying me!

An excerpt from "Scars":

When war broke out and the Cantonese boss was abruptly dragged off by the ruthless Kempeitai for interrogation, the family was forced to evacuate to safety. How Vladimir managed to survive the war with nary a bruise or an injury puzzled many people. According to one account, both his parents were shot dead by belligerent Japanese sentries as they were fleeing from the city, but the bullets only seemed to whizz past the boy’s puny body as he raced for the hills. Another bystander claimed that the bullets indeed hit him and he swiftly crumpled to the ground, only to rise seconds later as if nothing happened. A third account contained more grisly details. Seeing his parents sprawled motionless, the young Vladimir, not more than twelve years old by all appearances, flew into a fit of rage and single-handedly strangled the Japanese soldier with incredible superhuman strength, lifting his burly frame off the ground. When the dust had cleared, the ill-fated soldier was found slumped in a pool of blood, reddish froth oozing from his mouth.

a leap for lauriat.

Finally, the table of contents for the upcoming anthology "Lauriat: A Filipino-Chinese Speculative Fiction Anthology" is out! The book, edited by speculative fiction champion Charles Tan, includes my story "Chopsticks" (which previously appeared in Graphic and subsequently won a Nick Joaquin award) as well as other stories rooted in the richness and vibrancy of Filipino-Chinese culture.

The stories are:

“Two Women Worth Watching” by Andrew Drilon
“Ho-We” by Erin Chupeco
“The Chinese Zodiac” by Kristine Ong Muslim
“Pure” by Isabel Yap
“Dimsum” by Christine V. Lao
“August Moon” by Gabriela Lee
“The Captain’s Nephew” by Paolo Chikiamco
“The Stranger at my Grandmother’s Wake” by Fidelis Tan
“Chopsticks” by Marc Gregory Yu
“Fold Up Boy” by Yvette Tan
“The Tiger Lady” by Margaret Kawsek
“The Perpetual Day” by Crystal Koo
“Cricket” by Kenneth Yu
“The Way of Those Who Stayed Behind” by Douglas Candano

Can't wait for the book's release - and congrats to everyone!

a hundred years of excellence.

(The piece below was written for the official coffee table book in commemoration of the Centennial Founding Anniversary of my high school alma mater – Iloilo Central Commercial High School (ICCHS), now renamed Hua Siong College of Iloilo.)

The French have a term for having the right word to express something. They call it “mot juste” – “exact word” – the embodiment of the proverbial tip of one’s tongue. And that, I suppose, is precisely what defining Hua Siong is anything but. There are no exact words to define an institution that has stood ground for a venerable century, the spectator of a brutal war, a cruel fire, the iconic rise and fall of democracy, the advent of a new millennium. There are no exact words to describe her generations of alumni, the motley lot who have flown out of her nest and affirmed themselves as citizens of the world. Most importantly, there are no exact words to gauge her tradition of excellence, stalwartly championed and peerlessly untarnished even after a hundred years of existence.

To speak of Hua Siong merely as a place where I received my kindergarten, elementary and high school education would be a glaring understatement. In fact, the correspondence borders on being pied-a-terre, a second home. My grandfather, the late Gregorio Yu Sr., was Chairman of the Board of Trustees sometime in the 1980s, the bony but big-hearted old man who juggled official duties in between introducing his toddler grandson to colleagues in school. That scene, I believe, fondly remains etched in perpetual wisdom: Toothless gums and a generous smile, crisps of red and gold crepe paper, a battalion of studentry cheering their hearts out as an entourage of distinguished guests entered the pearly red gates. So goes the funny anecdote that I was mistaken for one of the guests, and was even dubbed the progenitor of the mythical Shaolin with my nearly-shaven head!

Hua Siong was certainly privy to my formative years in life, bearing witness as I reached milestone after milestone. As a wide-eyed preschooler, I cavorted with a lovely peacock dancer from China and portrayed someone else’s little son in a play. These eventually paved the way for more ample opportunities and achievements. My thirteen-year stay in ICCHS allowed me to expand horizons and harness hidden talents – joining interschool competitions, assuming the editorship of The Chain, being part of the historic Constitutional Commission, giving politics a shot during my stint as City Mayor of Rotary Club’s Boys and Girls Week.

I sometimes look back and wonder how these years had truly been an incomparable experience. More than simply being overwhelmed with a soaring, sweeping sense of nostalgia, our Hua Siong education stretched far beyond the confines of the measly four walls of the classroom. We recall her rallying motto of “Diligence, Sincerity, Loyalty, Courage” – the unseen conscience that pervaded everyone’s hearts and minds, the much-respected reminder to give it your all, do what is right, stick to your side, and face the music without fear. As if somehow breathing life to the slogan itself, activities inside Hua Siong translated to service personified: We took required scouting subjects in the elementary grades, went through the “hok bu” system from first to third year high school, and had regular CAT instruction in fourth year high school, the emphasis on discipline and industry rubbing off quite handsomely.

The enormity of this outstanding legacy goes on further to include the awareness of a dual heritage, as only the second oldest Chinese school in the Philippines can. We left Hua Siong enlightened persons with a heightened social consciousness, courtesy of an intensive Chinese, English, and Filipino curriculum that highlighted Buwan Ng Wika as much as the Mid-Autumn Festival. What took place was even more significant: the seamless integration of Chinese and Filipino values that guided us to our rightful place under the sun. We learned the invaluable ropes and the myriad highs and lows that came with being at the crossroads of two equally rich cultures, exposing and enabling us to appreciate a culture that is uniquely Chinese-Filipino.

Our celebration of Hua Siong’s centennial means saluting the sterling individuals who have selflessly played a crucial role in the school’s robust existence – from a fledgling barely holding her own in 1912 to a defiant bastion of anti-Japanese resistance, razed to the ground in the 1966 fire and reborn from the ashes, cruising onwards to meet the challenges of the 21^st century. In particular, we honor our teachers, the unsung heroes of the classroom, relentless warriors in the crusade against ignorance and indifference. I remember most vividly the late Mr. Ty Eng Liong, hailed as one of the best Chinese teachers of all time. Out of the corner of my mind’s eye there he stood, the gentle giant greeting students at the gate during dismissal time, his stature a fitting semblance to his reputation as a noteworthy pillar of Hua Siong.

With the auspices of time, these pillars have only grown stronger, taller, and sturdier, and the school transformed into a gleaming oasis of pedagogy with a spanking new building, a swanky elevator, and a sea of unfamiliar faces. But looking beyond this pristine exterior, I shall always choose to see the Hua Siong I knew and loved, the enduring vestiges of yesteryears quietly tugging at the senses and the catacombs of memory lane: Peeking hues of rusting red-and-white paint, strict bespectacled teachers roaming the corridors, black-and-white computer screens that evolved in sync with my journey from youngster to teenager.

In the same way, I would quite like to believe that for every Hua Siong student nurtured under the vigilant eyes of his Alma Mater, this journey shall always be fashioned out of the same substance every well-lived life is made of – a saga of unforgettable moments, of unending departures and returns, of the vibrant intertwining of memories and experiences that have molded me into what I am today: a product of her long, epic past; a testament to her glorious present; and hopefully, a part of her expectant future.

Who knows? “Mot juste” might just get to mean a hundred years of excellence, no less.

fairy tales and not-so-happy endings.

Glad tidings arrived today in the form of my very first story published in the Philippines Free Press (the other magazine great that regularly publishes literary works, apart from Graphic.) I was notified via email by no less than literary editor Joel Toledo himself - whose Palanca-winning poems are simply lovely. The story, entitled "Fairy Tales", was an experiment in the use of the female voice which I actually found quite enjoyable, a refreshing departure from my usual writing style. Add to that my childhood fascination with fairy tales and presto - as I wrote in my cover letter - read the story "as you would read a fairy tale." 

Here's an excerpt from "Fairy Tales":

The stories of my childhood come alive in my daughter’s mind, weaving in and out of her days, as only creative five year olds are wont to do. Seeing her engrossed in the intricacies of a fantastic tale, the rest of the outside world shut out at the corners, it occurred to me that Sam truly is her mother’s daughter, but that she might be only coping with her father’s progressively protracted absences. She pretends to be Thumbelina, impishly flitting among the flowers in the yard, with the glittery cardboard wings Elmer made her for a neighbor’s masquerade party. Other times, she is Goldilocks with a blue gingham frock and an abandoned blond wig she found in the attic, Esmeralda with dangling earrings and a hanky for a turban, the Little Matchgirl with a patched-up petticoat and some leftover matchsticks in the kitchen. She would indulge herself in the company of her animal friends from the forest – Simba, Bambi and Puss in Boots – “who are intelligent talking creatures, Mommy,” she would tell me with broad, enthusiastic eyes. “They make me happy when I am sad or lonely.” Sadness and loneliness, those two deadly foes, treacherous cousins that took me forever to distinguish.

(Postscript: At the time of the story's acceptance, Free Press went strictly online leaving me no chance to go out and buy copies of the magazine for keeps. Unfortunately, things didn't quite get a happy ending because Free Press - with all its online stories, including mine - eventually ceased to continue operations soon after. There goes my shot at a possible Free Press Literary Awards night. Sigh.)

fluidity.

“What goes in... must go out.”

Dr. R Alonso

The domain of fluids, electrolytes, and complex countercurrent mechanisms has always been a feared and daunting one, the undisputed Achilles heel of medical school. Time and again, we have continually persevered and grappled with its intricate theories and mechanisms, poring over mammoth books in vain and groaning in frustration over seemingly incomprehensible concepts. There’s supporting evidence to boot: Just recently, it has been pointed out in a survey that renal topics were the ones deemed most important by medical faculty and students alike, yet ironically were also the ones considered most mind-boggling and difficult to deal with.

I guess that perhaps, part of its notoriety stems from the fact that Nephrology shuns the straightforward scheme of things and painstakingly pursues our unseen inner workings, stripping us bare to our most fundamental functional elements – fluids, molecules, and the myriad physiological and biochemical interactions that govern them. In time, I found myself growing a soft spot for its web of challenges, lack of candor, and rush of adrenaline that overwhelms you as you carefully tip the scales and juggle cations, anions, and their ilk in an effort to preserve the impeccable rhythm of life, weaving a seamless balance that reverberates through the entire human body in striking fashion. One step turned wrong, and the whole system might just go haywire. A nephrologist, after all, isn’t called an internist’s internist for nothing.

Two weeks of rotating in the section exposed me to the fluidity of our wonderfully structured kidneys, and conversely, to the remarkable, sometimes even dramatic, clinical results that materialize in their stead. I  must admit that I never fail to get short of amazed whenever I see a previously confused, drowsy, and disoriented patient zap back to sanity and reality with just a mere few sessions of hemodialysis, or a previously wan and weak-looking patient suddenly appear with the rosy touch of health after a quick correction of sodium and potassium deficits. By delving into the root of the problem and going molecular, we consequently trigger nano-ripples of change that eventually translate into meaningful overt clinical outcomes and manifestations.

Unfortunately, I also got to realize that many, if not most, patients hardly recognize or are even aware of kidney disease at all. A good number dismiss it as something similar to and as trivial as an uncomplicated urinary tract infection – and thus tragically arrive only for consult when they have already been plagued to unbearable lengths by anemia, breathlessness, and extreme bodily discomfort – with no possibility whatsoever of fully reversing the damage save for a lifetime contract with dialysis. Which is why, marching down the streets and waving balloons and hollering cheers on World Kidney Day couldn’t have been timelier to serve as the rallying cry for such an endeavor. In the lay forum that followed, we tirelessly promoted the relevance of CKD to the public and felt immensely satisfied when a few patients and watchers came up to us to show their appreciation, casually stating that the activity inadvertently pushed them to acquire a newfound change of paradigm.

What goes in must go out. As I entered this rotation exactly two weeks ago less informed and less confident, so I emerge from it more assured and armed with extra ammunition of knowledge and food for thought (getting to observe catheter insertions were definite bonuses.) At this point, I am still far off from being a perfect master of fluids and electrolytes, just as Dr. Alonso’s CRRT talk still keeps me mildly at a loss. But I know I’m getting there. All I need is to focus, plod down the long winding path, and let the fluidity of things take over.      

first aid(s).

I still remember that fleeting moment way back in ICC year when we had our very first lecture in HIV/AIDS, handled ever so unpretentiously and so ingeniously by the tireless Dr. Lim, with matching “Wildfire” games and mock condom demos (using a banana to represent the, ahem, thing) to boot. At the end of the session, seeing us sated and sedated with a plethora of information ranging from “retrovirus” to “non-nucleoside reverse transcriptase inhibitor”, he decided it was time. He finally brought her in.

The very first HIV-positive patient I encountered in medical school.

“I want you to hold her hand. I want you to know that she is just like any one of us.”

I was one of those who readily shook hands, although deep inside still half-harboring the slightest hint of reluctance as to the true extent of such a feared disease and wondering about its consequences. Of course, textbooks and common sense would easily tell you now that you don’t contract full-blown AIDS from a mere handshake alone, but what I realized that fateful morning stretched farther than just a sheer mechanical dialogue on retroviral genetics and pathogenesis: They are simply one of us – walking, talking, breathing human beings with their own lives to live.

And now, two weeks after and nearing the tail end of my Infectious Diseases stint, I must say that the single most significant thing about this rotation was the way it exposed me, in all honesty and openness, to the burgeoning spectrum of HIV/AIDS patients and thus continued the crucial legacy left off after ICC year (History actually repeated itself when I attended the same HIV/AIDS lecture given by Dr. Lim, who also facilitated a “Wildfire” activity, this time among the unsuspecting fellows.) My rotation aptly came at a time when I was fresh off watching the blockbuster musical “Rent” with its bohemian and HIV/AIDS awareness themes. It was as if cryptic skeletons finally tumbled their way out of an invisible closet, where I had to face the reality of seeing call center agents, bank employees, massage therapists, teenage students, and even an Ateneo professor congregate in pursuit of a common goal – to confront the disease squarely in the eyes, at the same time seek timely help in the process of rebuilding the momentum of their callow youth, shattered so abruptly by the stigma of a society that fears what it does not fully know. There’s no denying the clarity of the message, though: HIV/AIDS is quickly becoming a global epidemic, and it’s closing in on us faster than we can say “PCP pneumonia prophylaxis”.

I was fortunate enough to be working alongside a bunch of feisty fellows who knew their stuff, and knew it well. This was manifest in the way the patients rendered their trust and starkly divulged even the most sensitive bits of information, without so much as a trace of hesitation. In all aspects of the past two weeks, from the wards and OPD to the pay floors, peripherals, procalcitonin lectures and PPRISM conferences, I have to admit that it had been quite an enjoyable and insightful experience. The nature and practice of infectious diseases has indeed grown on me, with its corresponding nuances and peculiarities. What initially seemed a drab, dreary realm of boring antibiotics and culture studies was revealed to be so much more with a closer, more discerning look – what with my share of exciting mycoses and unconventional TB cases, not to mention the handful of STD patients that destiny unwittingly transported to my doorstep.

And by bringing to fore the clarion call of giving first “aid” to “aids”, I thank the world of Infectious Diseases with all my heart for these unwritten lessons, and for igniting in my head the rallying cry of such a relevant endeavor. 

breathing space.

We inhale oxygen, and we exhale carbon dioxide. This has been fundamental knowledge taught to us in grade school, brought up again in biology class, and resurrected in clinical parlance during medical school. It is the most basic respiratory process there is, and yet, every single minute, or fraction thereof, is a continual affirmation of the dynamism of life, as we take in and give off each specified quantity of air in a repeated process that we so easily take for granted in our daily humdrum.

For my part, I guess all it takes is one glance at a bedridden patient, stricken with end-stage lung cancer and/or COPD and perpetually hooked to an AC mode mechanical ventilator, to realize the fact that the ability to breathe – fully and freely – is tantamount to being greatly fortunate.

It is all about breathing space, I thought. Hypoxia, hypercarbia, ventilation-perfusion mismatch, shunts, and similar mechanisms lend themselves to a host of airway diseases, parenchymal pathologies, and other pulmonary aspects of systemic disorders, the result almost always a harrowing, inhuman sense of difficulty to breathe. As pulmonologists, we can’t always bring our patients back to the fullness of normalcy (COPD and lung cancer being hard or altogether impossible to reverse, for instance) but we can at least alleviate their difficulty and help them avail, in one way or another, of this basic respiratory instinct of humankind.

Of course, there are the usual culprits. PGH as a whole continually reeks of PTB; in my two week rotation alone, just when I thought TB couldn’t surprise me any further, I was able to witness the metamorphosis of this dreaded mycobacterial disease in all its notorious forms and stages: from the completely asymptomatic suspect to the patient with active disease to cases of relapse, retreatment, and multi-drug-resistance, on to tuberculomas, tuberculous effusions and heavily disseminated cases. Even with the earnest efforts of the TB-DOTS programs that abound in the country, I believe much is still to be done and overcome in the long, hard battle against TB, in changing preconceived notions and false practices, and in the due encouragement of both collective and individual vigilance.

These diseases, I saw engraved on paper, thanks to the spirometry sessions that provided a breath of fresh air from the atmosphere of wards and clinics. My PFT sessions were a joy in themselves, as we went about trying to instruct patients on how to blow properly and then gradually seeing the graphic lines evolve on paper. It didn’t take me long to recognize the power of such a simple procedure. By merely looking at values and ratios alone, one could already determine the general pattern of pulmonary dysfunction and consequently take steps in further addressing and preventing functional deterioration.

But perhaps the most significant moment for me was when I stood inside the endoscopy unit keenly observing the conduct of video-assisted bronchoscopy being performed on a patient with a bullet to his chest. From an ordinary bystander, the airways seemed to look like ringed tubes with occasional streaks of mucus here and there, and I reckoned this is where one must submit to a flawless mastery of pulmonary anatomy, the scope poking and scouring the sturdy bronchi for potential problems.

Emerging from that endoscopy unit, I can’t help thinking how pulmonologists, in treating respiratory ailments and helping our patients to breathe, can create so much impact and difference in their quality of life. My meager experiences are but a slight preview of what lie ahead, the long road towards flawlessly performing endotracheal intubation, doing thoracentesis dexterously, or tinkering with the finer points of MV settings, but I hope I’m getting there. All it takes is one simple, genuine desire to help patients get better – and assure them their share of ample breathing space in the world.

graphic tales.

Just when I thought winning second place in the Palanca six years ago was the ultimate feather in my writing cap, the venerable muse of literary graces treasured me with yet another orgasmic delight: my short story "Chopsticks" - submitted to and which apparently got published in the Philippine Graphic last year - won third place in the 2010 Philippines Graphic - Nick Joaquin Literary Awards. First place went to Kit Kwe for "The Fires of the Sun in the Crystalline Sky" while second place went to Easy Fagela for "Deadlines."

Now I've always considered myself more of a creative non-fiction person, and "Chopsticks" was actually my first genuine foray into the realm of short stories. The spark came from out of nowhere, and before I knew it I was writing of silly feng shui anecdotes, painful memories, and your typical Filipino-Chinese family fussing over chopsticks. With a twist, of course. While this year's first and second place winners were both Silliman veterans, I am yet to sail the night boat to Dumaguete - that is, if I even get to. First timer's luck? Maybe. But then again, maybe not just.

Thank you to the judges: the trio of eminent writers Krip Yuson, Susan Lara and Charlson Ong for believing in my work. Thank you also to the equally eminent Marra PL Lanot - Graphic literary editor last year and also my brother's Palanca judge - for deeming my work worthy of publication. And many thanks to the awesome Pete Lacaba for taking time to personally inform poor old clueless me of the great, great news.

Last but not the least, thank you to dear old Mang Nick (wherever you are) for serving as the hefty inspiration and the indelible spirit behind our colorful literary journeys – and victories.

Beyond the numerous congratulatory remarks and handshakes, everyone summed it all up with a single piece of advice: "Keep writing. Keep writing. Keep writing." Oh yes, I definitely will (As if this year's generous prizes aren't more than enough motivation, haha.)

Kidding aside, here's to the future of writing. Here's to the future of Philippine literature. You'll be seeing more manuscripts from me.

An excerpt from "Chopsticks":

When I was five, I thought chopsticks were an absolute pain in the neck. The first time I held them, they kept slipping from my fingers, and I fumbled about gripping them awkwardly, each stick bumping into the other every time I twisted them in the wrong direction. Mother always made it look so easy. The chopsticks would lithely rise in her hands as she directed them into a plate of steaming noodles, securely clipping a reasonable amount and bringing them to her plate – or straight to her mouth.

“You have to hold them like tongs,” she demonstrated. “And by all means, grasp them firmly. You don’t want to end up with nothing.” It was understandably a test of control and coordination, and somewhere at the back of my head I recalled her narrating that five thousand years of practice made China home of the world’s best surgeons, her voice swelling with pride.

(Postscript: "Chopsticks" was eventually republished in Lauriat: A Filipino-Chinese Speculative Fiction Anthology, which came out in 2012 - see blog post.)

a joint affair.

Flashback to LU4. During our very first lecture in Rheumatology, the lecturer (the indefatigable Dr. Penserga) stepped up the podium and uttered her first sentence: A joint is an organ. Right away, there was a personal moment of epiphany. What I had previously believed to be a mere site of connection between two bones was, in fact, an active organ harboring a host of cells, cytokines, and everything in between.

Three years seems an awfully long time when one looks back at that definitive split-second and pauses to consider the potential array of knowledge (and yet to be discovered knowledge) that lay beyond the simple fabric of a joint capsule. Joints, as I later found out, only comprise a minute fraction of this exciting field. In rheumatology, it was always about recognizing patterns and asking oneself: “Could it be?” with surefire gusto and the confidence of an acrobat on a tightrope, hovering between a particular diagnosis and its really close mimic, never mind that one or the other appeared nothing like the classic textbook illustration. Dermatomyositis, polymyositis. Scleroderma, scleredema. (And you have overlap syndromes, too.) For the unwitting novice with the untrained eye, the difference could only stretch a little farther than a syllable – and the subtle signs that come with it.

Add that to the fact that the Philippines only has about 90+ rheumatologists wracking their brains off a plethora of syndromes and one rare disease after another. In my two week rotation alone, I was lucky to have seen both ends of the spectrum – from the almost symptom-free individual in remission to the barely conscious, intubated patient; from several cases of Behcet’s disease to Takayasu’s arteritis and polyarteritis nodosa – and smugly went home knowing something has piqued my intellectual curiosity and slaked my inner thirst for the unconventional and the unfamiliar.

Two weeks slowly gave me insight into the palpable difference between rheumatology and most other specialties. Rheumatologists seek not an ultimate cure but rather, an acceptable functional capacity and health-related quality of life for patients. And this is where tinkering with steroids and NSAIDS comes into the picture – the same old drugs with brand new tricks.

Even now we are already being ushered into the age of biologicals. Meeting IL-17 – the latest kid on the block – had been a real pleasure and so is trying my hand on the ultra-modern MSK UTZ. I thank all the consultants and fellows for a time well spent and for generously accommodating me into the world of inflammation and autoimmunity, where SLE and SSc are close cousins with everyone else. When all else fails, I guess there will always be your friendly neighborhood rheumatologist to help solve that rigged diagnostic dilemma.

Now I say: ankylosing spondylitis, anyone?

(Postscript: I eventually did my internship research on ankylosing spondylitis, which went on to win second place in the Annual Interns’ Research Forum for that year, got accepted for poster presentation in an international conference in Granada, Spain, and was eventually published in the Philippine Journal of Internal Medicine.)

reading dan brown.

Just as he had done for the past two times, he did it again.

I reluctantly pushed my nocturnal limits to an ungodly two-thirty in the wee hours of the morning, eagerly devouring the last few pages of Dan Brown’s latest novel The Lost Symbol. In the who’s who of bibliophiles, I don’t classify myself as a sprinter; but perhaps it merited some measure of braggadocio to have also wrapped up two of his other books in record time: The Da Vinci Code in ten hours, Angels and Demons in about twelve – apparently good enough response for someone whose writing has been dubbed by critics as clumsy, and whose works have been diversely labeled as inaccurate, fanciful, abstruse, slanderous, even sacrilegious.

The question is not what causes us to gravitate to the pull of his fiction, but rather, why we gravitate to them. Like millions of readers, I turn to Brown’s books for the primary purpose that he wrote them: entertainment. His masterful thrillers provide a sought-after adrenaline rush, and a much-welcomed change from the humdrum of deadened routines. Through his stories, he has concocted a delectable compendium of just about everything that piques my interest – history, geography, art, literature, science, mathematics, even religion – seamlessly crafted into one gigantic, smashing, rollercoaster ride. Best of all, he toyed a bit with my fascination about Harvard (although I more than duly content myself with being currently schooled in the Harvard equivalent of the Philippines.)

Reading Dan Brown is, in every sense, experiencing the inexperienced, expecting the unexpected, initiating the uninitiated. Villains become heroes, and heroes become villains. When I first plunged head-on into the then uncharted waters of the polemic The Da Vinci Code five years ago, I was instantly thrown into his clandestine world of arcane symbols, antediluvian legends, mystical phenomena – the plot thickening with every page, the secrets revealing themselves with every twist of the story. The thirst for unbridled momentum was infectious. As I picked up Angels and Demons and The Lost Symbol later on, a hazy pattern began to emerge.

Somewhere that’s neither here nor there, Brown writes of a well-loved savant getting killed or kidnapped. He brews forth a terrifying madman, the unraveling of an ancient controversy, the pursuit to solve the mystery hurtling at full speed towards an electrifying climax. The meandering paths seemingly trail and coalesce downhill to an incredibly simplistic resolution, interjected with a handful of profound lessons that leave you thinking much more than just the way his fantastic tales ended. Because yes, there’s more.

In a world beset with societal woes and plagued with problems from every side, Brown’s irrepressible characters have given us hope that we can always be unlikely saviors of our own generation. With his protagonist, Robert Langdon, he successfully painted the image of a renaissance man, the embodiment of someone imbued with messianic potential without actually realizing it. Langdon is hardly the epitome of a perfect individual. A noted historian and cryptologist, he waxes idiosyncratic philosophical for the greater part of his presence, oftentimes bordering on being overly quixotic. Desperate times call for desperate measures, however. Langdon promptly springs to action at the flick of a finger, whipping up a plausible solution faster than you can mouth “Eureka!”

Fortunately, his moments of epiphany are as good as ours. Not content to sit back and let fate steer its sinister course, we gamble the odds with his every move, brainstorm with his every impediment, and silently rejoice with his every triumph. Indeed, Brown’s novels are thoroughly enjoyable not so much stark anthologies of facts as they are exercises in ingenuity. You exit his enigmatic world with no exact objects, locations, or explanations in mind; only the pleasant aftertaste of an enriching, gratifying, cerebral experience.

I should know. Once upon a time, I, too, sat down in Philosophy class blatantly asking for the moon and the stars. What is truth? What is man’s destiny? What’s after forever? In the end, much like Brown’s novels, I was trained instead to strip myself of any existential pretensions and focus on the intangibility of human inquiry, to proffer the questions without waiting for the answers.

In this regard, his novels incidentally helped me discover that hindsight can only yield so much insight. A stir of familiarity struck me upon mention of German painter Albrecht Durer, evoking unmistakable images of Humanities class as our professor engaged us to probe deeper and to scrutinize each artwork beyond what’s merely concrete and abstract. In between lines of an archaic riddle, in between elaborate depictions of The Louvre or The Washington Memorial, I surmise that this is what Brown tells us with overwhelming audacity: To look. Heightened observation, after all, serves as the very antithesis of perceptive mediocrity.

There are heaps to be learned in the minutest and most puzzling of details, in the most insignificant of entities. There is more than meets the eye in those picture-perfect postcard panoramas of St. Peter’s Basilica, Westminster Abbey, or the soaring dome of the US Capitol. There is more than greets the mind behind the Mona Lisa’s captivating smile, the obscure markings on Raphael’s sculptures, or closer to home, the sacred texts of The Bible. Who knows? Our world is a world of possibilities.

Yet akin to the celebrated Holy Grail or the fabled Ancient Mysteries, Brown’s works have never been about claiming that coveted trophy of the ages or that proverbial pot of gold at rainbow’s end. The spotlight is always fittingly passed on to something of far humbler, far higher substance – a quest for prayer, an affirmation of belief, an attempt to rescue an honorable reputation. Most importantly, his novels have aptly demonstrated that it takes a person of solid, unwavering faith to effectively hold his own against the persuasive tides of crafty reasoning, against the evidence-based debates of logic and scientific thought. What is faith, as Brown candidly put it, but the “acceptance of that which we imagine to be true, that which we cannot prove”?

In literary context, I guess it takes a similar amount of faith, then, to keep the real from the unreal and still accept, albeit fleetingly, that which is imagined to be true, yet which cannot be proven. When all else stands unlocked and laid bare, Dan Brown’s saga of codes and secrets ultimately boils down to shedding light on the world as it is – rich, vibrant, unique – and being supremely thankful for it.

And just like that, just as he had done for the past two times, he did it again.

gold, spice, and everything nice.

Now we're talking.

beyond yellow.

I first saw Cory Aquino in person during the premiere night of “Cory: The Musical” last November 2008, that loving tribute of songs and stories written in the eyes of and exclusively penned for her by close family friend Bing Pimentel. At the end of the production, when lead star Isay Alvarez and the rest of the main cast led the way for a thunderous applause, the 75-year old former president struggled up from her seat to give a few words of thanks and inspiration. It was almost clear then that her fragile state could not anymore hide the fact that this icon of democracy was, in fact, suffering from the terminal stages of colon cancer. It was almost clear, too, that I may well be seeing her for the first and the last time alive.

My parents were not even married when Ninoy Aquino was killed at the height of the Marcos regime in 1983. I can plainly say with all honesty and naiveté that I never went through the odious years of Martial Law era, never felt the stirring emotions of a unified People Power in EDSA I, never experienced the harrowing loss of democracy in the dead of night – only to have it resurrected by an unlikely heroine-of-a-housewife more than a decade after. To stretch the gap even farther, I never had the privilege of shaking hands with the woman once famously chosen by Time Magazine as Person of the Year, never knew how it was to work alongside this Fulbright Awardee for International Understanding, never had an inkling on how it felt like to be a doting grandchild to “one of Asia’s most influential leaders of the 20th century.”

What I have, beyond a few surreal meters of plush theater rows, is the lingering memory of having been able to vicariously trace her origins back to the old ancestral home in Quanzhou, China, eight years ago. More matter-of-factly, her husband Ninoy was also my exact natal predecessor of 55 years, a boon we share together with our noteworthy ears, academic inclination, and keen literary fervor (the idea of assassination has not occurred to me in my wildest dreams – yet.) Ninoy was the yang to Cory’s yin, the articulate voice to her lending ear, the convivial soul to her kindred spirit. With his death, she had to be yin and yang at the same time. As he watered the tarmac with senseless blood that fateful day in August, so must she sensibly redeem it three years later with a bloodless revolution in February. As his death sparked the flames that sent irate millions into a quest for democracy, so must her death fan the same flames that brought back the lessons of history.

And so I write, because to write is sometimes all one can do in the aftermath of a nation’s sorrowful outpouring, in the aftermath of unabashed, unexplained grief. Because to write is to proffer the humble gift of words, served on the simple platter of reminiscence and tendered in the hope that heaven reads the muffled lips of a now orphaned people. Most importantly, because to write of the life Cory Aquino lived is to write of snippets of each and every Filipino’s life – and incidentally, mine as well: grim shadows of the past, firm reminders of the present, hopeful exhortations of the future.

Fr. Catalino Arevalo, SJ, in his poignant eulogy, quietly pointed out how “selflessness, faith and courage” have always remained at the forefront of Cory’s life, the indelible trio of principles that constituted the bedrock of morals by which her whole life was founded on. Selflessness, manifested in the concrete hierarchy of “God, country and family”, has been her battle cry for living for others, for the continuous betterment of those around her even in her darkest, most painful days. It is with this realization that I marvel at the frail gallantry of Cory as a human person, and if only to generalize – to the extent by which the lot of ordinarily extraordinary persons make themselves extraordinarily ordinary. Courage, by way of defying fraudulence and a feared despot with the striking candor of truth and sincerity, places her in the league of a modern day Joan of Arc – shining sword traded for rosary beads, blazing red for canary yellow, final martyrdom on the stake with serene acceptance of disease.

Cory, however, is not Cory without the unwavering and almost saint-like faith that shook mountains with a single prayer, and yet, in itself, was virtually unshakeable. (If a “Hail Mary Squad” so much as existed, she would have been, hands down and without question, ringleader of the gang.) As someone once put it: “Before, I was not too entirely convinced of a woman who brandishes prayer as her prime weapon; but it never budged under duress, and now she has made me a total believer.” Even as she reluctantly ascended the silver steps to Malacañang, and even as she voluntarily exited the chief commander’s throne with paramount grace, she knew her real power – and wielded it effortlessly across an archipelago mobilizing an army of sorts that rejoiced as she rejoiced, wept as she wept, and fought on even as her strength slowly succumbed to the dreaded Big C. We again swarmed out to the streets when she called for a defaced president’s ouster. We rallied behind her as she sought asylum for rebelling soldiers. We marched with her, church to church, school to school, when she took a stand behind the reputed underdog of a boiling political scandal. And now, more than ever, we raised the cudgels for her with her recent denunciation of the infamous Con-Ass, read aloud by a grandson as she lay stricken on her pristine hospital bed. All of which prompted me to ask: What is it about her that moves us? Rather, what is it about her that moves us into action?

The celebrated Pablo Picasso believed that “some painters transform the sun into a yellow spot, while others transform a yellow spot into the sun.” Yellow, of all colors, permeates the darkness the easiest and the most; the veritable, elemental mother of light. Cory, who took up painting in her twilight years, must have wisely understood the connection and so chose yellow to initiate the illustrious spectacle that dramatically engraved itself across the surface of our nation’s history, conveying a people’s shared sentiments and brilliantly capturing that tearful moment of joy once victory has been claimed. In a country barely holding its own under the dark for so long, yellow was a refreshing change, the gentle impeding strand that could, the provident beacon slowly but surely leading the way out of the proverbial tunnel. Yellow depicted the outrage of the angry throng of two million escorting Ninoy to his grave, and yellow, too, emblazoned the banner bearing our tireless crusades for deliverance. For all she’s worth, and for the “crosses and roses” patiently borne for the sake of an ailing nation, we thank Cory Aquino for transforming a yellow spot into the yellow sun of Philippine colors, for her legacy of light and the things that stood beyond it.

But even in the light of one’s best and most noble intentions, one cannot please all, and at all times. There are those who attack her feeble handling of fiscal policies, the lackluster response to communist insurgents, the burgeoning energy crisis, the way she opted to tread the path of honor and hard work by politely shunning the World Bank’s offer to absolve us of our debt-rigged dilemma. Even then, in the midst of a thousand detractors, it is all too easy to single her out with her signature smile, shrugging her shoulders as if resigned to the fact that she was, and will always be, limited. A classmate of mine, a not-so-ardent fan in the spectrum of Cory fanaticism, once dreamt of her “on her knees, pleading for forgiveness for whatever errors she may have committed.” And it occurred to me that perhaps, it has always been her nature to forgive: Gringo and the numerous grisly attempts to throw her out of office. EDSA II and the eventual reconciliation with Erap. Bitter factions right smack in the Cojuangco clan. Daughter Kris and her rocky romances. Conrado de Quiros, the very same writer whom Kris once rued as being “so mean to my mom”, would later mean what he said and say what he meant when he called her “one damn good person.”

With her passing arose a great many speculations about the theory of goodness, goodwill, good people. Sometimes, it meant introspectively looking at the fundamental basis of human nature and discovering that moral lodestar deep within. Other times, it rested on the more profound grounds of relativity, on cautious, unbiased deliberation of graded evilness: greater evil, lesser evil. In his speech at the start of “Cory: The Musical”, Sen. Benigno “Noynoy” Aquino III described his mother as being “so different from the powers that be that govern us today”. Without being unjustifiably cynical, I have come to consider her death as the unofficial end of an era, of bygone days where public service was an untarnished honor and personal integrity was still in vogue. No one would argue when I propose that for most of her life Cory played the part of a much lesser evil, her flaws a mere speck in the rancid frays of the contemporary political arena already marred and marred still, her shortcomings presumably given in to inexperience that had much to do with coping with gargantuan responsibility and generic demands at the same time. I once fielded such a question to my aunt: “How good was she?” To which she readily answered, “Well, I say she was good enough, wasn’t she?” For most of this country’s 80 million denizens, there was no doubt. She was good enough, damn good enough.

In burying Cory, we give tribute to her simple yet significant contribution to the restoration of a free Philippines, tainted as it is by the unbecoming forces that threaten to break its cornerstone of nobility. In accompanying her for a straight, sacrificial eight hours to her final resting place, we commit ourselves to the perpetual cause of upholding democracy that she so adamantly fought for for much of her widowed lifetime. In braving the corporeal embodiments of searing sun and roaring rain, we testify our solidarity as a Filipino nation cloaked in mourning, sealed in love, and bonded in hope.

“It is good to see the (people power) spirit still alive,” one person commented, no less than struck short of awed at the heartwarming sight of a million Filipinos flooding the flooded streets of the metropolis in a desperate attempt for last minute glimpses, tributes, and farewells (plus photo-ops.) It was definitely larger than life; the wonderful frenzy now fondly referred to as “Cory magic”. I was inclined to think that in this age of ephemeral transitions, just as pages yellow away and persist beyond the mortal days of their venerated authors, so shall the robust yellow of “Cory magic” elude death in its agelessness. After all, way after she stepped down as president, I was a personal witness to how a catchy Hiligaynon jingle (sung to the tune of a then popular jukebox dance hit, the title of which I cannot recall) continued to gain popular acclaim back home, ingeniously crafted as follows:

“Everybody/saka sa lubi/
Kung mahulog/singgit lang kay Cory…”

(“Everybody/climb the coconut tree/
If you fall down/just call out for Cory…”)

The creator’s first intention, I would suppose, was certainly and primarily for amusement (as if anything else mattered more to a five year old kid.) But for those who knew better, it was more than an act of endearment, more than an acknowledgment of trust that goes well beyond embracing her as president, wife, and mother. With her passing, it is in confidently affirming that we can always count on the Tita Cory we knew to bring the country back to its feet, albeit in spirit, and to bring us Filipinos back to our feet, whenever, wherever, and always with a pleasing, soaring sense of heightened national consciousness.

Twenty-three years ago, as the newly-instated president of a republic on wobbly knees, she beseeched the joint Houses of Congress to “join us, America, as we build a new home for democracy; another haven for the oppressed so it may stand as a shining testament of our two nations’ commitment to freedom.”

Twenty-three years later, as a medical student of an institution sailing past its centennial year, I entreat my fellow countrymen to “join us, Philippines, as we build a new home for democracy; another haven for the oppressed so it may stand as a shining testament of our two heroes’ commitment to freedom.”

homeward bound.

“It would be good to get away for a while.”

Perhaps that statement concretized what I felt upon deciding to have an off-campus elective in Iloilo City in the summer, in lieu of taking one within the four PGH walls that had housed me for the past three years. Not that I had grown tired of the green, green grass of old, but I figured that if I were to stay within the same four walls for the next two years or so, a change of scenery might be a welcome diversion. I wanted something different, yet something relevant. Taking an off-campus elective close to home was a tempting idea: Aside from the relative convenience, it would give me the perfect break I needed right smack in the middle of clerkship year. And it would definitely be, in itself, another unique opportunity to hone skills, acquire new knowledge, and survey the health system in the province.

I was homeward bound.

I chose to pursue my inclination for the intricacies of Internal Medicine at the West Visayas State University Medical Center (WVSU-MC) – fondly called by many as the “PGH of the South”, as most of the top honchos are themselves UPCM alumni. Living up to its name, the institution aims to be a center of quality health service in Southern Philippines, catering to a diverse population with patients hailing from as far as Mindanao. The analogy is palpable: PGH patients primarily represent the urban poor; those at WVSU-MC comprise mostly the rural poor – some from the far-flung, remote regions who must have deemed themselves lucky enough to have availed health services in the nick of time. And I realized that this will be a scene repeated over and over again throughout the country – the same indigent patients, the same bleak, wearied faces yearning even for just a shot of relief from sufferance.

Unlike the two massive wards of PGH-IM that served around a hundred, there was only one Medical Ward at WVSU-MC. There were no fancy callrooms, but a workstation that served both nurses and medical students. WVSU-MC can certainly pride itself in having fairly adequate facilities, but we got to appreciate PGH facilities more in a different light, as we once again turned to plain resourcefulness and clinical acumen when suddenly left without the aid of MRIs or DEXA Scans at the click of a finger.

The atmosphere was less contrived and more informal, which I guess can be attributed to the fact that it was so much less congested at WVSU-MC, allowing for ample breathing space and interaction. Without a language barrier and armed with a home advantage, we thought we had it all – but were quickly humbled upon discovering that there were some Ilonggo words we couldn’t quite fathom out (terms for “chest tightness” and “lymphadenopathy”, for instance.) Two weeks at the OPD and two weeks at the wards – with a smattering of ICU and ER exposures – taught me that, and much more. The daily morning endorsement rounds refreshed my rusty and decidedly modest knowledge of medicine, while exposing me to my first case of tetanus. The grand rounds, on the other hand, caused me to marvel at a case of Takayasu’s arteritis and learn all about basic pacemaker technology. Of course, nothing beats witnessing your first actual pleurodesis, plus the anchovy-like consistency of an amoebic liver abscess during ultrasound-guided aspiration.

Just like PGH, there’s no escaping TB and the stigma that goes with it. The whole gamut of afflicted patients remained at the fore – from those mistakenly-diagnosed via chest X-ray to those still taking meds on their ninth month. In the wards, pneumonia and stroke claimed the upper hand with victims ranging from GCS 15-ers to those on the brink of falling into coma. For those hovering along variable levels of consciousness (and prognoses), it amazed me how effective, empathic patient-doctor-family interaction can be palliative in as much as it is informative. There were patients who appeared jovial the first day, but suddenly turned up on the mortality audit the next day. It reminded me of the extreme fragility of life and the delicate role that we doctors play, akin to a tightrope. The first time I performed CPR on a patient who underwent cardiac arrest the third time, even science could not muster the courage to summon the whys and hows that dictated the circumstances surrounding life, death, and what goes on in between.

As elective period slowly rolled by, I came to believe that everything was all about realization and reinforcement. Realization, in the sense that how things run at WVSU-MC more or less strike a similar chord back at PGH: The kindly medical resident who offered to pay the lab fees of an ailing patient. The overworked clerk. Too many patients, not enough equipment. Reinforcement came with the resolve to pursue more knowledge, better skills, richer interactions. All the while trying to keep to heart the multifaceted characteristics of a five-star physician – a practitioner, educator, researcher, leader, and social mobilizer. Four weeks proved a short time for getting to know my own backyard well enough to run the mill; nevertheless it gave me a sufficient overview of how the health system works in a medium-sized urban community, 500 miles beyond the confines of the metropolis, one called home.

Because who knows, he may just find himself homeward bound yet again – and maybe yet for good.

the speech that almost was.

I could have very well titled this entry “The Speech That NEVER Was,” and it would still be 100% accurate.

But on account of good ole Schultz philosophy, I chose not to.

Traditionally, the honor of delivering the valedictory speech in behalf of the entire graduating class goes to the undisputed summa cum laude. No one but the revered intellectual among intellectuals deserves such a privilege for finishing with the highest honors in the country’s premier school of hard knocks. It was an honor I had always dreamed of achieving, yet knew well enough that being in an especially formidable course puts the stakes at close to sheer impossibility.

But – surprise, surprise.

UP Manila has NO summa cum laude this year.

When I was informed by Ate Lucy last month that I was one of the four University magna cum laude chosen to vie for the title of valedictory speaker, my heart palpitated in leaps and bounds. The record for the College of Medicine last belonged to a certain Vince Faustino who made the cut way back in 1997, and since then the College has been suffering from a jinx for the longest time. If you were in my shoes, you’d be as giddy as Mary being showered heavenly tidings by the Archangel Gabriel.

I have been speaking before audiences with surefire gusto for as long as I can remember. I was the bibo kid eagerly clutching a microphone in kindergarten school, tasked with and happily giving the opening remarks, the closing remarks, or coaxed by a prodding teacher to host the program altogether. I was the precocious declaimer in grade school, the starry-eyed narrator and storyteller, the unwitting performer of various shows and productions that had me gripping the limelight even in its wake. High school refined the fringes of my presumably verbose future. I spoke before teachers, students, and fellow citizens as editor-in-chief of the school organ, as a CAT officer, as a youth city official, as a young leader awardee – minute-long instances that taught me about the workings of the world as much as I imparted my own thoughts to others.

Upon entering medical school, however, I found that the predominantly academic thrust somehow keeps you indefinitely holding your piece, save for the generic reports and case presentations that required more austere objectivity than artful eloquence and technique. Whenever I was tasked (or allowed) to speak, I felt “like a bird being finally freed from its cage,” and my classmates (particularly those in my own block) would readily attest to the palpable change in my stolid demeanor. Deep inside, I hungered for the sporadic opportunity to do non-scientific talk, once again.

Now my multi-awarded brother recently delivered three excellent speeches to three different audiences last month, all within a week’s time from each other. The constellations must have decided that my turn had come.

To cut the long story short, there was simply no blowing my chances away. I was determined to bring the honor back to the University’s oldest and perhaps most venerable College, to prove my mettle not only as a budding medical student but as one tendering a self-styled return into the realm of public speaking. I completed the page-long draft of my speech in just a couple of hours – on Black Saturday, to be exact – the sophisticated result of a premature burst of ideas that spontaneously fired like missiles the previous night. In stark contrast to many of my earlier, rawer, more heavyset speeches, this one was surprisingly light and humorous – even poking fun at a common and well-loved University emblem.

I had always believed that a good speech informs, entertains, and enlightens at the same time. It must have an impact, one subtle and substantial enough to leave the audience sufficiently satisfied, yet gut-wrenchingly wanting for more. At the slightest hint of boredom, the speaker understands that he teeters on the road to perdition. This philosophy guided me in the days that followed, as I constantly buzzed around improving my finished product – reading and rereading, editing, reconstructing sentences and paragraphs, reciting lines in the shower, practicing before a whole body mirror, making sure equal emphasis was placed on diction, clarity, projection, modulation, facial expressions, eye contact – just about the entire gamut of essentials said to comprise the perfect, foolproof, winner’s speech.

And then…it was time.

Barely a week into summer break, I soon found my way back to the big city, part-nervous and part-excited. Hopping on the first plane at the crack of dawn, I was up and about before the appointed time, fussing over and fumbling for a smart enough attire, rushing my way through the perpetual Taft traffic threatening to send my hopes down the drain. Only one thought raced through my mind that sweltering April day: Get yourself late, and there goes the promise of a good impression. I wasn’t about to gamble what could be a lifetime’s bet over something as trivial as a petty temporal malfunction.

That fateful afternoon, in the glaring sunlight, the hallowed interior of the UP Manila Board Room became a menacing microcosm of its magnified neighbor, the real life Supreme Court. Four “judges”, all smug and poker-faced, will decide the fate of four contenders in a miniscule audition now clearly reigning supreme over the current hit, hot American Idol season. Having arrived early, I took the prerogative to go second with the coy excuse of “a little jet lag”, retreating to the back room for a few uneasy minutes before a sharp knock on the door cut my introspective musings to a halt. As the first speaker wrapped up his stint, I silently took a breath, looked all four “judges” in the eye, and opened my mouth.

There is something almost romantic about the way you start the first word, or the first phrase, or the first sentence, for that matter. As the spotlight furtively moves into view, you are left alone to contemplate the veil of muted silence, a baptism of fire into the vicious verbal arena. I caught a hint of a smile quivering at the corners of the lips of one “judge” as I delivered my first two paragraphs, which had previously sent both my mom and my aunt in ROFL mode. The rest, however, remained attentively impassive. I turned the game a notch higher as I settled comfortably into gear, confidently going about the remainder of the speech, stressing main highlights, nimbly swinging the mood from serious to comical and somewhere in between, rolling slippery syllables with so much as a smooth, clarion lisp. At one point, I saw all four “judges” nodding, exchanging cognizant glances, and took it somewhat as a good sign. Three minutes is all I have to make it happen.

The following morning, Ate Lucy’s words were the first to greet me upon waking up.

As her voice cracked over the phone, my groggy disposition was in no state to probe what would happen next. And so when she awkwardly spilled out the disheartening words – “Nalulungkot ako”, “Better luck next time daw” – I rhythmically nodded, rubbing excess sleep off my eyes, and told her I understood. The conversation was over in less than one minute.

It was the longest one minute of my life.

What took place thereafter was a surreal pattern of events. The world around me seemed to spin as I stared into space, motionless. And then the full brunt of the realization hit me like cold, heartless iced water: I was well headed for Elizabeth Kubler Ross’s inevitable five stages – and mind you, it takes me a very, very long time and perhaps twice the amount of effort (plus thrice the amount of pain) to reach that last, definitive stage. It was hard slaving away four years of medical school; harder still, to have had ignited a hope so fervent and killed it just as instantly. Everything flashed before me in blinding reminiscence: The pursuit of the rare privilege to speak before the vast populace of the country’s flagship university; sacrificing a day of entertaining vacationing classmates; getting myself sick; spending thousands on promo airfares; sparing myself a week’s worth of extra appointments on the side. Suddenly, the little piece of paper that could remained a little piece of paper for good, tragically destined to become part of the dusty, yellowing family archive.

Like a neurologist localizing an organic lesion, I searched high and low for a possible gap in the master plan: What went amiss?

Theory # 1: I should have crafted a speech in Filipino.
(Theory debunked. The instructions read: You can deliver the speech in English OR Filipino. Since the issue comes down to giving your best, I naturally chose to draft one in my preferred métier.)

Theory # 2: I should have memorized the entire speech.
(Theory debunked. Oh yes, I did memorize my speech and can ruddy well measure up to the job if asked. But the thing is: I was asked to READ.)

Theory # 3: I should have delivered a more serious, more radical, more bombastic speech.
(Theory debunked. A speech is different from an oration. Julius Caesar can fire away all he wants, but that won’t cost him a seat in the Roman Forum if his speech is as vacuous as a wailing siren. Contemporary times call for contemporary measures.)

Theory # 4: I should have served the main dish, not just a sleazy appetizer.
(Theory debunked. From what I understood, we were asked to make “a speech”, not “THE speech”. And all in three minutes.)

Theory # 5: I should not have included Jesus Christ in the picture and committed undue sacrilege.
(Theory debunked. By all means and intentions, Jesus had been depicted in the best of light – as a noteworthy academic, as a forerunner of truth. This I swear by the Second Commandment.)

Theory # 6: It is time to give chance to others.
(Now this one I have yet to disprove.)

But back to Schultz and his ideals.

For all his life, the famed Snoopy creator advocated the idea of looking at the glass half-full, instead of half-empty. Upon reaching that unmistakable halfway mark in a marathon, one must consider the fact that the battle is already half-won and the race half-finished, instead of saying that the battle is MERELY half-won and the race ONLY half-finished. “To be happy,” my grandmother stressed, “is to look at the less fortunate.”

What could have happened had I not been offered the chance to formulate a speech, at all? Unlike Mikaela Fudolig, I am no 16-year old summa cum laude graduate of the State University. Unlike Patricia Evangelista, I am not an English-speaking world champion. Unlike my brother, I don’t have 11 gold medals in public speaking to my name.

After I sloppily remarked that they “now have one less reason to attend my graduation,” my mom reprovingly shook her head and replied, “Remember that we are attending for the sake that you will be graduating, and graduating with honors at that. The speech is just extra icing on top of the cake.” But for the proud, prodigious denizens of a record-smashing INTARMED class (at least for those who knew the real story), news of a fallen flag-bearer stirred a perceptibly more intense reception:

Reactor # 1: “Argh. Eh di sino ang napili?”

Reactor # 2: “Weh. Whatever. Sigurado akong luto yan.”

Reactor # 3: “Dapat si Greggy talaga ito. In our books, you’re still the speaker.”

I clearly remember that in one of his impromptu speaking conquests, my brother was adjudged the silver medal to everyone’s open-mouthed surprise. However, it was hardly the end of the story. The audience’s general dissatisfaction at the unexpected outcome bypassed the official verdict when he was given a rousing standing ovation during the awarding rites, far eclipsing the proclaimed champion’s meager applause (no audience factor here). True, he may not have gone home with the golden bacon dangling around his neck, but in the eyes of many, it rightfully belonged to him.

Fast forward to the big day where, clad in my black toga, I had just settled onto my seat after graciously shaking hands with UP President Emerlinda Roman. After basking for a few seconds onstage and receiving a glinting gold medal, after the numerous (and exhausting) smiles and photo-ops (some of which embarrassingly featured my beneath-the-toga matted hair resembling Javier Bardem in No Country For Old Men and Drew Barrymore’s creepy stalker in Charlie’s Angels), it was time for my personal moment of truth.

The chosen student speaker took her place on the lectern and the reel rolled away before my senses.

Yes, her speech was in Filipino. But it was neither near bombastic, radical, or memorized. She took off with a short narrative about ceramics and clay pots, how these supposedly undergo thousand-degree centigrade transformations before emerging into the light as objects of high human intrinsic regard. “The same can be said of UP students…”

And then it hit me.

There are times in our lives when God wants us to listen, even when all we want to do is talk. There are times in our lives when He wants us to pause, even when our voices are screaming for unbridled momentum. And there are times in our lives when He wants us to look inside – when all we want to do is focus on the shady exterior. With the student speaker’s message, I realized that He was bringing me a message of my own. I was about to enter one of, if not the most challenging phase in a medical student’s life, one that brings along with it a multifaceted challenge: physical, mental, emotional, social, even spiritual – a key turning point in the long, arduous journey towards becoming a licensed healer. I was the clay pot, clerkship is the fire – no, inferno – that threatened to make or break me. The message couldn’t have been more apt and timely for one who is about to (and who dreaded to) be a clerk in, well, a little over a month’s time.

Ergo I wasn’t this year’s student speaker for the 100th Commencement Exercises of UP Manila, but I learned something else. Beyond clay pots and ceramics and the series of thousand-degree transformations awaiting me, I learned to be a little less afraid. The speech that never – or rather, that almost was – lived up to its job: It made all the difference.