run/walk, read, laugh, heal

want vs need

2009-10-30T19:34:00.018+08:00

Things I WANT but don't NEED (right now)
1. Running shoes
There's a hole near the right toe of my current running shoes that almost lends credibility to my running efforts. Truth be told the hole is probably due more to poor shoe quality than the wear and tear of running. I think I'll postpone buying new shoes until I actually earn the mileage.

2. Earphones
The earphones that came with my iPod are almost 2 years old. More gray than white in color now it's exposed wirings have been taped over many times (with Micropore!). I can barely hear anything from the right earphone. I tend to compensate by increasing the volume which is probably bad for my left ear. I don't get to use them very often now since I have started running without music. However, I am looking forward to using them when I go on duty in the hospital. I'm over caffeinated and on an adrenalin high during my 24-hour hospital duties. When I do have to time for a nap I need to listen to soothing music that can lull me to sleep.

3. Laptop Sleeve
A nice laptop deserves a good laptop sleeve, one that allows me to just chuck the whole thing in my bag and not worry about damaging my laptop. My old sleeve is way too big for my (relatively) new laptop. It does not really offer that much protection. I need one that is light and fits like a glove.

4. ER Season 15 Box Set
Yes, DVDs of the full season 15. After going through season 1 to 14 since med school I'm determined to see the whole series to its end. I once considered going into Emergency Medicine but I decided I wanted more patient contact (and follow-up) than an ER stay of 24-48 hours can give.

5. Tree bookshelf
Just because it's so damn nice to look at. But I'll probably need a forest to shelve all of my books.

Tree Bookshelf from designer Shawn Soh.

Things I WANT and actually NEED
Harrison's Principles of Internal Medicine 17th ed

I have the 16th ed all highlighted, bookmarked and covered with notations. That's not to say I have read the entire 2 volumes. I still need to get the updated 17th ed though. I actually have the pdf of the new edition but there's nothing like the feel and smell of a new book to inspire me to study.

Yup, that's all I really need right now (and maybe a little less rain so I can run).

updates

2009-10-28T12:08:00.004+08:00

Too much has happened that I haven't been able to write about.

There's the week-long Cebu-CDO-Camiguin trip, my camera breaking down, the tan-lines and getting really, really dark during rainy season.

There's letting go of my laid-back lifestyle of work/vacation to go into unemployment, to feeling really stupid during pre-residency and then being accepted to another residency program.

There's momentarily losing sight of my running goals as rainy weather put a lid on my running for July and August, and coming home bone-tired during my pre-residency in September (I actually fall asleep on the commute home).

But I'm back now.

I'm getting used to running on a treadmill. I've set new running goals for October and am on the brink of achieving them. I am glad that all the walking (and commuting) I did for pre-residency kept my weight down. At least after a full month with no runs I won't have to concern myself about additional weight wreaking havoc to my knees.

I have plans for a last vacation before I start my residency training in December.

It's nice to have goals.

Yes, a slacker like me actually believes in goals.

revitalize

2009-08-27T09:18:00.002+08:00

I am currently shooting out cosmic death rays. Beware. Scary, but this too shall pass.

I am all dressed up with nowhere to go. Last minute cancellations are my pet peeve. Receiving three in a day has put too close to my tipping point.

MUST. REMEMBER. TO. CHILL.

maraming salamat po

2009-08-01T09:23:00.002+08:00

Whatever I write today will never be good enough. So I'm keeping it as simple as possible (but not simpler).

Rest In Peace President Corazon Aquino.

Maraming Salamat Po.

is it time to go to sleep?

2009-07-29T02:25:00.003+08:00

Mediocrity's like a spot on a shirt - it never comes off.

Haruki Murakami
Dance Dance Dance

sweet

2009-07-28T23:44:00.003+08:00

When two people I've never met before and communicate with only through SMS and blog comments tell me on the same day that what I've just said (written) was really sweet I must be doing something good.

this a rant/ this is a rave

2009-07-28T03:24:00.002+08:00

Okay.

I was just in the worst traffic jam ever.

I just got home. A bus ride from Alabang to Batangas which usually takes 1 1/2 hours on a good day stretched to what seemed like infinity. I left Alabang at a little before 3 PM yesterday and arrived at Batangas at 2:40 AM today. My butt is numb from sitting in the bus for 11 hours and 43 minutes.

Contrary to what most people might think, the bus was not filled with impatient and grumbling passengers. I surprised even myself by not complaining. We were at a standstill most of the time, what use was complaining going to do anyway. It was just going to be a waste of energy.

I got some sleep on the bus. Most passengers did. Some ate their dinner and snacks on board. We listened to 80's music (mostly classic rock and pop), watched the news about PGMA's SONA, watched Pirates of the Caribbean (the first movie followed by the sequel) and was already half-way through the Curse of the Black Pearl when the DVD player just stalled. We then watched another film version of Tomb Raider 1 and 1/2 times (not the one with Angelina Jolie and with really bad acting). In between all these I was reading Haruki Murakami's Dance Dance Dance and would've finished the book if the bus lights weren't switched off late in the night.

I'm not feeling too tired right now, which is quite unfortunate as I can't get myself to fall asleep. I keep thinking about alternate travel experiences. If I was going the opposite direction I would've reached Ilocos Norte by then. On a different day I would've reached Bicol already. If I was on a boat instead I would've already reached Romblon. If I was in Cebu, I would've been in Camiguin already. If I was going to work, I would've already gone back and forth to Mindoro twice.

For most part of the bus ride, this was my view out the window. Not exactly a view to die for, but I'm really not complaining.

In truth, I will probably remember this as the shortest 12-hour trip I've ever had. In truth, this will probably be the best "worst traffic jam" I'll ever be in.

Going down the bus at the end of Diversion Road in Batangas I couldn't help but smile when the passengers thanked the driver and the conductor for a safe trip. We all laughed when one passenger quipped "sulit ang bayad". Truly, the bus fare we paid was all worth it.

last words

2009-07-27T08:02:00.004+08:00

July has not been extremely friendly to me.

I'm back in Manila. I took an exam without reviewing and walked away hitting myself on the head. I must have written the most disjointed essay I've ever written. It's shameful. Now, I'm down to contemplating Plan C in my medical career path. Unfortunately, it's appearing to be just like the weather - gloomy, overcast and gray.

I should not be getting worked up. Saturday night I bought five Smiley stress balls, four of which I gave to my equally depressed and directionless friends. The last one is for me.

quickie

2009-07-06T15:28:00.004+08:00

1. If I haven't posted anything about work in the past month it's because recent turn of events have been upsetting I'd rather not write about them.

2. My best friend is doing flu research and is now currently very busy with AH1N1. One day she asked me if I wasn't worried about her health and safety since she was working on a highly infectious virus. I couldn't help but smile before saying "Oh, I do worry. But please remember that I'm a doctor and I work with infectious diseases everyday." We had a good laugh after that.

3. I'm starting to hate the rain. From running 3 to 5 times a week I'm down to 2 runs. I'm not adding mileage or improving my endurance. I feel like a loser getting winded and achy after an easy 5 km.

4. Day 4 of nape pains. I feel tired and sort of unwell. I feel silly not being able to take my blood pressure while on the road. I'm too young to get sick.

5. I miss playing tennis.

I am overdosing on The Velvet Underground.

her morning elegance

2009-06-29T12:00:00.002+08:00

Her Morning Elegance - Oren Lavie

Thanks to Aki for showing me this vid. Stop motion charms me no end.

I love it.

meant to travel

2009-06-05T09:18:00.002+08:00

I was at National Bookstore checking the travel section when the guy next to me caught my attention.

"You love to travel, too?" he asked. I smiled brightly and said yes.

"I'm planning to go to Australia," he continued, as he reached out to the Lonely Planet guide to Australia.

"Australia. Wow. Is this for work or vacation?" It was my turn to ask.

"Oh, I don't work."

And with that I was hooked.

Here was a very confident 25-year old businessman who was also an avid traveler. He talked about studying in Europe, ordering a gelato in Milan, the cold weather in Beijing and feeding needy children in South Africa.

All I could do was smile and ham it up. He was talking about previous travels while all I had to share was future travel plans - going to China with friends in a couple of years and plans to apply to Australia for further training. My recent islandhopping escapades and travel to HK and Macau certainly was not up to par. Nevertheless, we still had an enjoyable chat and we ended up exchanging contact information for possible "collaborations" in the future. (As a physician he thought I would be interested in his new anti-aging business venture, while his feeding the needy crusade was what piqued my interest).

We discussed the merits of the different travel guides (Let's Go, LP, Rough Guide, etc) - the no-ads stand of LP, the very specific travel info in Let's Go (how to order a gelato, recent political/economic development). I suggested he read Bill Bryson's In A Sunburned Country before he left for Australia although it wasn't available in the bookstore at the moment. In the end he chose to get a Let's Go guide to Australia.

More small talk then goodbye, with a "maybe we'll see each other in Australia", a handshake and a smile.

A conversation with a fellow traveler always leaves me buoyant. It's almost like I've actually done some traveling when all I've had was an eye-opening chat. And to put icing on this travel bug's cake the new edition (May 2009) of Lonely Planet Philippines is out now. I was fortunate enough to purchase it at it's initial price of Php 809 on the same day they increased it to Php 1,009.

What do you know, I am blessed.

I was meant to travel.

just doing their job

2009-06-04T16:58:00.007+08:00

Traffic was a little better today. It was kind of a lopsided day. It was human traffic that drained me.

It was still raining when I got off the bus at EDSA Central. As soon as I entered the building I got suckered into a conversation with a Chinese Amway sales agent. I'm not sure if he just did not understand what I was saying or if he just did not want to take no for an answer. For 15 minutes I went along and humored him. I took his card, gave a false number and hurried along.

Next stop I was accosted by a magazine saleswoman offering raffle tickets for a trip to Dubai. A few days before I had already filled up a raffle ticket for a trip to Australia that looked exactly the same as the Dubai ticket. I politely declined the offer and continued perusing the Asian Geographic Passport.

Walking across the mall I knew I was going to be a good target for a lot of sales agent. I had that "I'm lost" look on me, plus I was alone. I walked hurriedly along avoiding eye contact.

Barely walking a kilometer I must have said no to 7 sales agent already. Very politely, if I may add. You really can't harbor any bad feelings towards them. They are all just doing their job. I just wish that they wouldn't be so mean and demeaning sometimes.

manila traffic

2009-06-03T22:48:00.005+08:00

I will never get used to Metro Manila's traffic jams.

It took me 2 1/2 hours to commute from Quezon City to Bicutan tonight. It was not even raining hard and the bus I was on took the Skyway already. Two and a half hours - about the same amount of time it takes a mid-day bus to get from QC to Batangas.

I don't mind long bus rides if I'm traveling long distances. But to sit for hours in a bus that barely moves along EDSA is torture for me. I feel fortunate that I do not have to endure this torture everyday like the thousands of Metro Manila commuters.

After my 2 1/2 hour bus ride, standing in the rain waiting for yet another ride

Sitting sadly in the bus tonight I was reminded of what one tour guide said about Metro Manila traffic. We were in Hongkong that time on a city tour and Mr. Lee, our guide, was explaining that we might be a little late getting to our next destination on account of the rush hour traffic. I remember smiling and looking out the window as cars zipped past at 35 kph. That was rush hour traffic - cars just moving a little slower than the usual 80 kph.

Mr. Lee was right to say that Hongkong's traffic system is a little better than Manila's. He loved visiting the Philippines for vacations but had to shake his head at the Metro Manila traffic where you can sit in a bus, have a two-hour nap and not be afraid of missing your stop. When you wake up from the nap you're probably still in the same place anyway.

Even Lonely Planet's Tony Wheeler agrees that Manila's traffic jams are to be reckoned even beating out Bangkok. Although he does add that Shanghai still wins for the worst traffic jams (Tony Wheeler's World Worsts in The Titanic Awards).

I suppose there are still a couple of good things about traffic jams. I can attribute my love for walking to traffic since at times walking takes me to my destination faster than taking a jeepney. On occasions that I do need to take a jeepney the hour-long commutes present an opportunity for me to catch up on my reading. And of course, stuck in traffic one learns to appreciate the empty spaces and open roads of a provincial setting

dream

2009-05-30T00:07:00.005+08:00

I love this:

"Well, I had a dream I was running further than I've ever ran before"

*smiles*

pandan island: rain or shine

2009-05-02T22:53:00.020+08:00

I usually plan my travels weeks before I leave. At the very least I know a little about my destination. Not this time. I received the message confirming the trip to Pandan Island the day before we were supposed to leave. I took a peek at my Lonely Planet guide, read the half-page entry, and that was it. I had no idea what the trip had in store for me.

On that same day I had just finished reading The Beach by Alex Garland. I still had all these images in my head of an isolated beach - the perfect getaway. I had to stop myself from daydreaming so I would not be disappointed if reality fell short of this paradise.

* * *

It had been raining the past few days with a low-pressure area forecast off the coast of Mindoro. It was drizzling when we got on the boat to Abra de Ilog in Occidental Mindoro. Our group was split in the middle with regards to the weather. The ladies were continuously begging the sun to come out with their sun dance while the men were praying for overcast skies.

It was well and good that we were initially rained in on the trip. The open bus ride to Sablayan (3 hours - P113) would have been insufferable if not for the rain. The highway was like a jigsaw puzzle with 50-meter stretches of asphalt road interspersed with kilometers of dirt road. The rain had spared us from suffocating heat and asthma-inducing clouds of dust.

We met our host (a friend of a friend of a friend) at Sablayan and was whisked by a tricycle to the water's edge where we took a fifteen minute boat ride to North Pandan island. It was still overcast but it had stopped raining for a while. The view that greeted us could well have been paradise.

We had a hut to ourselves with a sleeping space in the attic, enough food to last us for 3 days, beer and a whole island to explore. Rain or shine we were determined to have some fun.

A short walk on the powdery white sand brought us to a nice spot for a swim. Aside from the occasional snorkler or passing boat we had the spot all to ourselves. After hours of soaking up the seawater we headed into the heart of the island. A short trek through coconuts and forest trees brought us to a lagoon where the waves had carved small basins into the rocks and corals. We swam in tubs of bubbling sea water as it drizzled. Another shorter trek brought us to a tinier cove with a rock formation the locals called the Spanish Nose.

We took a different route going back to the hut. We walked over sand and sea grass, sharp rocks and corals. A slight misstep would have inevitably resulted into multiple abrasions and lacerations. I was glad I was wearing rubber sandals which prevented me from slipping. A friend was wearing 3-inch platform Havaianas, it was a wonder how she got through without a single scratch.

It was drizzling the whole time. The cooling effect tricked us into believing that the 40-minute trek back to the hut was effortless. As soon as we sat down, stomachs grumbled, muscles cramped and we all gave out sighs of relief.

The rest of our stay in Pandan Island was more chill time. The sun finally came out on our second day and we basked in its radiance. The water was clean and clear. Fish kept swimming in schools near the water's edge and we were on constant lookout for pawikan.

Not far from where we were staying foreign visitors in the island's resort sunbathed. Kids played in the sand while the grown-ups played volleyball. A French guy caught his breath near our hut before turning around to continue his morning run. And I had my third cup of coffee as I stretched on a bench reading a good book.

When it was time to go our host gave us an added treat and took us around the island by boat. The ride lasted only 10 minutes, but it was a good and satisfying 10 minutes. We passed all the now familiar places and then some: our small hut with the "No Trispassng" sign in front, the small lagoon, the Spanish Nose, underwater caves, the sandbar, the island's resort and the stretch of white sand where the sea turtles (pawikan) lay their eggs at night. Rain or shine we had enjoyed our short stay in Pandan Island.

The rest of the afternoon was spent singing our hearts out at videoke while waiting for the van to take us back to Mamburao.

Boat from Batangas to Abra de Ilog, Occ Mindoro (and vice versa) - P208 (+ P42 for an aircon upgrade)
Terminal Fee - P30
Van to Mamburao from Abra de Ilog (and vice versa) - P80
Tricycle to the Bus Station - P8/passenger
Bus to Sablayan - P113
Van to Mamburao from Sablayan - P230
Tricycle to Van Terminal P10
Contribution for food and lodging - P800

still running

2009-04-27T16:49:00.000+08:00

Since I started running (jogging? or whatever you can call this slow shuffling gait) I've hit several road blocks.

Being overweight and unfit I could not even run for 5 minutes straight in the beginning. I searched for a newbie running program and decided to aim for a 5 km (The Couch-to-5k Running Plan). Getting to 3 km was easy enough. But after that I hit my first wall.

I mixed it up a bit. I run to the beach, not minding if I made several stops on the way. I run on a treadmill. Pretty soon I was running my 5 km. It was like sweet victory since it was something I never thought I could do.

Then I hit another wall. I could not get past 5 km this time. For a month I was only running 5 km/run. I took a tiny break, a vacation, then suddenly I ran a 6 km without even knowing it.

Then I hit yet another wall. After 2 weeks of doing short quick runs (to the point of feeling nauseous at times) and running out of safe roads to run on I was afraid I would never run more than 6 km.

Then I run 8 km. It took me totally by surprise!

All in all, progress may be slow but I can't say I'm not doing good. Except for a few misses I'm pretty much on schedule. Even the weight loss (which was never the primary reason for my taking up running) was surprising. As it is, it seems that I will be running a 10 km sooner than I expected.

* * *

Last night I run my last 2 km under pouring rain. I thought it was just going to be a light drizzle so I kept on running. Then it started pouring really hard. I kept blinking as water dripped from my brow into my eyes. Since I was already wet I decided to finish my run. And finish it I did - with my fastest km (mile) to date =D

It's good to know that even with road blocks I'm not running out of motivation yet. I still think it would be great if I could run with someone else, though.

I do need someone to run with. It would make all this running even more enjoyable.

Is there any one in Batangas looking for a running partner? I'm a slow and plodding newbie who refuses to believe her hyperactive (asthmatic) lungs and airways are not suited for mid-distance runs.

i dreamed a dream

2009-04-26T10:57:00.002+08:00

Gotta love this: Susan Boyle sings I Dreamed a Dream

[Too bad embedding was disabled.]

Makes me want to be so much better. At everything

2009-04-21T05:30:00.000+08:00

29!

all in a day's work

2009-04-19T12:08:00.000+08:00

Nights on duty:

A year-old baby arrives at the hospital - a referral from another hospital. She is febrile and weak-looking. She is severely dehydrated and is breathing with difficulty. Pneumonia. Within the minute she arrives she goes into a seizure. Right away you consider meningitis and then cerebral malaria. You admit the patient immediately slightly piqued that the referring hospital did not call or send an SMS about transferring the patient. After admitting the patient and sending the ambulance away an SMS arrives regarding the referral. You conveniently forget to reply as you go on with your other admissions.

Two patients arrive almost at the same time. Both hypertensive with systolic blood pressures over 220 (normal systolic BP is 120 and below). Motor intact, sensory intact, no change in sensorium, oriented to person, place and time. Not stroke. One is congested, you start diuresis to rid of the fluid overload and bring down the blood pressure. One is diabetic and on insulin, blood sugar is in the high 200's. You give another shot of insulin. You monitor each patient closely the whole night.

A pregnant woman arrives complaining of lumbosacral pains. She has just gone into labor. A check reveals her baby is okay, fetal heart tones are okay. The woman's blood pressure, however, isn't. At 230/160 she is in preeclampsia. You start her on Hydralazine, load Magnesium Sulfate and inform her OB-Gyne. Her blood pressure goes down a little. In two hours time you are holding her baby. She had undergone an emergency Cesarian Section. They were okay.

Another pregnant woman arrives. She has been having uterine contractions since that morning. It was her sixth pregnancy. You do an internal examination which reveals that her cervix is fully dilated. You admit her directly to the delivery room. She delivers her baby within 15 minutes. The NA stands beside you to catch the baby. Both of you cringe as you notice a pinkish round noodle-like thing come out of her anus after the baby is delivered. A worm - Ascaris by the looks of it. You put a side note on the chart beside your post delivery orders and remind yourself to inform the OB resident to give the patient a purgative on follow-up.

You finally get some rest before 3 in the morning. You lie down and try to fall asleep knowing full well that the adrenaline coursing through your veins is going to keep you awake. Twenty minutes later just as your were about to doze off a knock on the call room door jolts you back into wakefulness. There is another patient in the ER. A mother has just brought her eight year old son. He has been vomiting and having loose bowel movement since the night before. He looks on innocently and smiles at me as he stands straight in his blue and white striped pajamas. You advise the mother to have labs done in the morning (the med tech had gone home for the day). Even though febrile, the patient showed no signs of dehydration. His clinical picture was that of a urinary tract infection - not viral gastroenteritis, not intestinal amoebiaisis*. You prescribed an oral rehydration solution, an antipyretic and an antibiotic, said goodbye to the kid and went back to sleep.

Two hours later you are awoken by another patient for admission.

*Labs done the following day did reveal a urinary tract infection.

back to work

2009-04-12T08:30:00.001+08:00

I went on the trip alone. A colleague I usually go with had passed on work this month and was going home for a vacation.

I took an earlier trip. It was windy but the sea was flat and the sky was a clear blue. Another boat run almost parallel to the Baleno Otso before it veered a little to the left to head for Calapan. As the boat grew smaller in the distance I shifted in my seat and started reading.

"There is nothing nicer than doing nothing all day, then having a rest afterwards."

I agree. Take me away from the city any time. Take me away from the noise, the pollution, the congestion and anxiety. Give me space. Give me green trees and blue sky every day.

The boat docked at Abra in under two hours. I was lucky enough to get a ride on a passenger van that had gotten on the boat from Batangas.

I never get tired of the ride to the hospital. It is still a vision to see the clean green of rice paddies in the light of the setting sun. The coconuts frame the paddies in the distance. Only white cows and birds (egrets?) break the green sea.

Small towns always give me a warm and fuzzy feeling as I enter them. I always hope that this feeling of "home" is not replaced by a feeling of stalker creepiness. Small town people can be intrusive. They always know when somebody is new in town. In such a small place everyone knows what you've been up to.

After settling in and giving my dorm room a little clean-up I headed out to the hospital to chat up with the previous group of doctors. I had arrived just in time for a bon voyage party for two of them. After an unhealthy dinner of liempo and crispy pata we spent the rest of the night drinking and howling at each others videoke miscues.

I've never been much of a drinker. Occasions to drink don't come too often either. Recent R&R trips had me drinking more in a month than what I usually drink in a year.

At 2:30 in the morning I turned in earlier than the others. They would all be off in the morning while I was just going to start my work week. I made sure to hydrate and went straight to bed after I washed up.

I woke up early in the morning and run a 6k.

Reading:
Underwater To Get Out of the Rain: A Love Affair With The Sea (Trevor Norton)

reality check

2009-04-11T01:58:00.001+08:00

A few days after coming back from Cebu I am still experiencing what one can only call travel-withdrawal. I still feel the sun on my skin and the salty spray on my face as I rushed to welcome oncoming waves. I can still picture running at the beach. I can still hear the loud churning of the motor boat and the soft lull of the sea as we went island-hopping.

{I smile at strangers with beach-hangover as evidenced by the flip flops and board shorts they are still wearing in the city.}

I keep thinking I need a few more days of R&R after my week-long vacation to help ease me from vacation mode to work mode.

Tomorrow I will be traveling by sea again. The 2-hour ride to Mindoro will be my wake-up call.

Reality beckons. I shall welcome it.

motivation

2009-04-09T19:05:00.005+08:00

Maundy Thursday.

At midday, I was at Loyola Memorial Cemetery laying to rest my aunt’s sister-in-law. She had passed away due to complications of diabetes. At the funeral service I couldn’t help but shed a tear for the passing of a strong woman at such a young age of 53. Her own mother is the picture of health at 80. I cried as her 17-year old daughter said goodbye to her, describing her as their “home” – a place (person) where they were safe, provided for, comfortable and loved. With her passing the remaining family members needed to come together to rebuild a new home.

With each death in the family (there has been three for this month alone) my mortality haunts me.

I have enough motivation to keep me striving for health and fitness with my family history of hypertension, diabetes, coronary artery disease and cancer. I am glad that I’ve quit smoking and that I only drink occasionally. I suppose I’m also glad that even as I grow a year older in a couple of weeks my age cannot be considered a risk factor yet.

I’m lucky that I also have the added motivation of being a physician. If I want to continue to advise my patients to increase physical activity, reduce weight and eat right it would be hypocritical if I don’t do the same. I need to practice what I preach. I need to be the picture of health. My patients need to know and see the benefits of the advice that I offer.

By the age of 30 I’d like to be at my fittest, with a normal BMI, able to run a half marathon, able to swim a mile (or more), with updated immunizations, normal blood pressure and normal blood chemistry.

At this point I am confident it is not too hard to achieve.

R&R

2009-04-08T11:58:00.001+08:00

Cebu City and Bantayan Island
April 1 - 7, 2009

My last trip to Cebu was in August last year. For this trip I decided to stay longer.

After a nice dinner at STK (baked clams, grilled tangigue, mixed seafood and crab curry) a ride around the city revealed a very active bunch of graffiti artists.

In the morning, as the best friend headed for work I headed to McDonald's for breakfast. I sat in the roadside veranda trying to soak up the energy of the city. I read the local paper and calmly waited for things to happen Cebu-style.

On the weekend we started the trip to Bantayan Island.

On the early bus to Hagnaya: Thorntree discussions at Lonely Planet has called this ride as one of the craziest bus rides. I am almost grateful of the darkness before sunrise as I am spared of the scary cliffside view. The bus careens up and down the mountain road not even slowing down for blind curves. [Ceres bus ride: P80 - regular fare, ~3.5 hours]

First look at Sta. Fe: I was apprehensive at first about going to Bantayan Island just before the Holy Week. I was expecting a beach full of tourists on their holiday. I couldn't be more wrong. [Boat to Sta. Fe: P130 - ~1.5 hours]

Bantayan was wonderful. We stayed at Sta. Fe Beach Resort [aircon room for 3: P2000 - a really big room that could easily fit 5 or 6 persons, hot and cold shower]. After brunch we took a dip in Ogtong Cave, jumped the waves back at Sta. Fe and basically just soaked in the salty water. We had dinner at the D' Jungle [all you can eat for P300 with over 50 dishes to choose from]. After a long walk at the beach and divulging secrets over SMB we called it a night.

Sunrise at Sta. Fe looked like sunset everywhere else. We heard mass first thing the next morning (it was Palm Sunday), then took a habal-habal to Bantayan to buy seafood. We had chartered a boat to take us islandhopping.

We had earlier planned to go to Virgin Island but I'm glad we changed our plans and headed to Hilantaga-an (I think) instead. There were too many people at Virgin Island we wouldn't have enjoyed it.

Harry was our able cook and guide. We had an overabundance of scallops, shrimp, squid and tilapia for lunch all washed down with buko juice. [Islandhopping: P800; Snorkeling gear can be rented for another P100]

It was like we had the whole island cove to ourselves. The sand was white hot, the water was clear, it was so quiet you could speak at your normal voice and be heard a kilometer away.

Back at Sta. Fe I took a quick run around town. I couldn't help laughing when a sikad driver offered to give me a ride back to the resort in the middle of my run.

More pictures from Bantayan:

Flip Flops!

Late afternoon, taking a breather

Another sunrise at Sta. Fe.

Last look before we leave.

I don't think I would mind if I never went back to Boracay again. But I certainly would love to go back to Bantayan.

nike minus

2009-03-26T13:14:00.002+08:00

My iPod quit cold in the middle of my run last night. I'm not quite sure yet if it's the Nike+ sports kit that has a problem or if it's the iPod itself. I figured I was not running for the stats anyway. So I continued with my easy 5 km-run and forgot about time and pace.

I found out later on that the Nike + ipod system was still able to record my run. Goody!

In the end though, I was still frustrated with the system. I was not able to sync my run last night. This morning I found out that all my previous runs where deleted :( All records completely gone.

I think I need to start getting used to running without music from now on.

And until I figure out what's wrong, I think I'll be going back to logging runs using pen and paper.

home

2009-03-23T19:47:00.004+08:00

Home again, with so much to do and write. I don't know where to begin.

A. I have new-found respect for a colleague. I have always thought highly of her but this time she is my new role model for good patient care. I need to be reminded that doctors treat patients, not lab results, not side notes on charts.

B. I'm rethinking my choice for residency training. Having been assigned to the pedia department I'm starting to have difficulty managing IM patients. Pediatrics was always an option from the start, it's just that nobody thought I could handle children.

C. I went out one night with other co-residents, none of us on 24-hour duty. When we came back we were greeted by a truck unloading patients from an MVA. Just like that, the bottle of beer I drank disappeared from my system. A co-resident smiled as he waded through the bleeding patients. "This is ER medicine," he retorts. It really was ER medicine.

Head-on collision between a passenger van, an ambulance transferring a patient to our hospital and a ten-wheeler truck = a terrible, terrible accident.

D. These days I keep wondering what people do with money. My salary is pretty basic. I am able to live comfortably within budget. I do believe money offers a lot of opportunities for learning and travel. But just because money is not overflowing from your pockets does not mean you will lack for opportunities. Seriously, what do people do with money?

E. On that note, I have a colleague who was born with a silver spoon in his mouth. "More like titanium spoon", another colleague often interjects. He has a job, a 17M condo unit, a 2M SUV, beachfront property and still receives money from his parents. A former chief resident (when he decided to quit his residency training) with a 3.98 GPA in med school. And guess what. He's not happy.

F. Sometimes I think I'm stupid.

challenges

2009-03-11T09:19:00.003+08:00

"Sometimes the moment that challenges us the most defines us" - Joan Benoit Samuelson

I'm off to work again.

what is happening

2009-03-10T10:57:00.004+08:00

Two weeks post break-up, needing something to make me smile.
This definitely made me smile.

And seeing my four-year old cousin jump around and sing along made me smile wider.

Alphabeat sounds even better live!

drug for malaria loses potency

2009-03-02T12:27:00.005+08:00

Ok. I admit I'm pretty slow on reading up on developments in molecular biology and medicine. There is just too much literature at times that I can't help but feel overwhelmed. I'm so glad I have friends who can point me in the right direction. (Thanks Cat!)

I wish I could do a lot of the pointing myself, too.

* * *

In the International Herald Tribune, a month-old article warns about the developing resistance to artemisinin-based drugs. Working in Mindoro has definitely opened my eyes to this disease. I appreciate any new information I can get about treatment and management.

Malaria patients in the intensive care ward of the provincial hospital
in Battambang, Cambodia.(Thomas Fuller/International Herald Tribune)

Spread of malaria feared as drug loses potency

The recent studies show that artemisinin-based drugs are becoming less effective in removing the parasite from the bloodstream. While a few years ago it took the drugs 48 hours to clear the bloodstream of parasites, it now can take 120 hours.

Although this has only been noted in Tasanh located near the Thai border of Cambodia, it certainly heralds things to come. Malaria must be eradicated, eliminated before drug resistance spreads.

Artemisinin-based drugs such as artemether are used to treat Plasmodium falciparum-confirmed malaria. Falciparum is one of four types of malaria and is endemic in the Philippines. It is unfortunate that it also happens to be the most virulent.

In the Philippines, artemether is commonly used in combination with lumefantrine. Drug combinations allow for faster treatment and may slow transmission of the disease. It may also decrease the rate of developing drug resistance.

Read on the evidence of Artemisinin-resistant malaria in the The New England Journal of Medicine. Other articles on malaria are also in the same issue of NEJM (Dec 11, 2008).

more distractions

2009-03-01T11:47:00.014+08:00

Taking a peek at the list of books I've read so far (2009 Distractions on the side panel) I can't help but smile at the variety of the books. On any other day I would probably only read one out of the seven on the list (and that would be Douglas Coupland's JPod). Ever since I've tried reading different genres I find that I can pick up any book and just read. Reading may not always be as enjoyable as I would like. But I rest assured that after reading each book I've learned something new.

Having said that, the last batch of newly acquired books are a little up my alley this time.

China Syndrome:
The True Story of The 21st Century's First Great Epidemic
Karl Taro Greenfeld

Deep down I still want to be an epidemiologist. Plus, this hits closer to home than all the books on Ebola I've read.

From National Bookstore bargain bin - P200

The Principles of Running:
Practical Lessons from My First 100,000 Miles
Amby Burfoot

I do want to be a runner. But before I hit the ground running I would like to know more about what I'm getting myself into. I'm not as fit as I was a decade ago. I want to do running right and avoid injuries.

From Booksale - P 145

Piled Higher and Deeper: A Graduate Student Comic Strip Collection
Jorge Cham

The first of the grad student comic strip collection. It can be laugh-out-loud funny as it pokes fun at the trials and tribulations of being a grad student. At the same time it leaves you hopeful knowing that you are not alone :)

From Booksale - P70

The Poe Shadow
Matthew Pearl

His first book The Dante Club got me hooked. Although I was a bit disappointed at how it ended I'm willing to give Matthew Pearl another chance with The Poe Shadow.

National Bookstore - P150 (hardcover)

heartbreak music

2009-02-27T10:58:00.003+08:00

Walk Away
Ben Harper

Oh no- here comes that sun again.
And (that) means another day without you my friend.
And it hurts me to look into the mirror at myself.
And it hurts even more to have to be with somebody else.

And it's so hard to do and so easy to say.
But sometimes - sometimes,
you just have to walk away - walk away.

With so many people to love in my life, why do I worry about one?
But you put the happy in my ness, you put the good times into my fun.

And it's so hard to do and so easy to say.
But sometimes - sometimes,
you just have to walk away - walk away and head for the door.

We've tried the goodbye so many days.
We walk in the same direction so that we could never stray.
They say if you love somebody than you have got to set them free,
but I would rather be locked to you than live in this pain and misery.
They say time will make all this go away,
but it's time that has taken my tomorrows and turned them into yesterdays.
And once again that rising sun is droppin' on down
And once again, you my friend, are nowhere to be found.

And it's so hard to do and so easy to say.
But sometimes, sometimes you just have to walk away, walk away and head for the door.
You just walk away - walk away - walk away.
You just walk away, walk on, turn and head for the door.

for the 24th

road block

2009-02-23T21:32:00.001+08:00

I've hit a road block in running. I need inspiration. The 2009 STCAA is ongoing at the local Sports Complex. Maybe I'll drop by tomorrow.

shifting

2009-02-22T20:22:00.004+08:00

I just got back yesterday from another 10-day stint at a provincial hospital. As I lay in my bed completely maxed out all I could think about was that I was happy.

During my stay in the hospital I kept thinking I should keep a log of the cases I see. Common cases such as acute gastroenteritis, intestinal parasitism and pneumonia might not warrant too much attention. On the other hand, I certainly would like to look further into malaria, extensive PTB, TB meningitis, rabies infection, tetanus, sepsis, stroke and MI, and how to manage and recognize these diseases with limited resources.

X-rays and peripheral blood smears are readily available in the hospital. Ultrasounds can be scheduled or done on-call. Blood cultures are not available. For a 12-lead ECG you have to call private diagnostic centers in town for the technician to come to the hospital and do the ECG. Most of the time they are not available in the middle of the night. For a CT Scan you have to send the patient to Batangas. To get to Batangas the patient has to take a 40-minute drive, a 2 1/2-hour boat ride plus another 20-minute drive - a trip that not all of them might survive.

But I am not complaining. I cannot complain. At this point I am giving the best that I can give. It may not be the best care the patient can get elsewhere, but it is close to being the best they can get at that hospital.

People travel six to seven hours for a consultation. Some take a 4-hour trek down the mountain to bring their ailing children. You cannot blame these people for not coming to the hospital at the first sign of disease. You cannot blame them when they arrive at the hospital dehydrated, weak-looking or in cardiorespiratory distress. I know something has to be done to improve the health system. But at this point I am only capable of making do with the available resources.

This does not mean I am satisfied with what I'm doing. I know something more can and must be done. But I need to study more, train more and get more exposure to know what else can be done.

It is too early in my medical practice to make big changes. But it doesn't mean I'm not trying to make small changes.

Tired as I am, I'm looking forward to my provincial hospital shift next month.

run/walk + music

2009-02-04T20:54:00.008+08:00

I had a bad run/walk day today.

I was only planning to play ball in the afternoon to loosen up but since the ball mysteriously disappeared from the garage I was forced to run instead.

I hadn't primed myself for a run so early in the day. After two days of not running my muscles were tight. I was starting to get bored with my usual "house" run and was planning to take a different route. But as I started with my warm-up walk I kept getting phone calls about a relative's medication changes. In the end I decided to forgo trying out the new route.

An hour after the cool down my knees started aching a bit. As if the bad run was not enough, I had to make the mistake of having an inadequate pre- and post-run stretching. I hate to wake up tomorrow with sore thighs and knees.

There is one good thing about today's run though. I found new music to run to!

For some weird reason Uh Huh Her's brand of indie electropop is just right for my easy runs.

Too bad I couldn't find good videos of the electropop and synthy album versions. Here is the acoustic version of "Common Reaction" and a stripped down version of "Say So" instead.

what to read

2009-02-03T12:19:00.009+08:00

Somebody tell me what to read next. For this year I have started reading books I normally would not read.

I'm not the kind of person who would read on business/customer service,self-help or inspirational books. Either they never appealed to me (too cynical) or I never had need to read them before (I didn't think I was going to set up a business before). But lately I'm trying to figure out why other people read the books that they read. I'm trying to find out how all the supposed "words of wisdom" from these books make other people act like they do.

I need better people skills. Socializing has never been easy for me. When I'm tired at work I don't get crabby or cranky. I clam up. I may still be able to smile but I highly doubt that I sufficiently advise my patients when I'm tired. Maybe knowing a bit about why people behave like they do will help me develop into a better communicator. This would certainly be a plus for me as a physician and would also help me in running our group's small business.

I have more then a hundred books on my to-be-read pile but I can't figure out what to read next. Somebody tell me what to read :)

Currently reading: Baha'i Book of Prayers and Other Selected Writings

love your heart

2009-02-01T22:41:00.004+08:00

I may just be on week 3 of my running program but someday I'm going to run a marathon.

annuals

2009-01-31T18:00:00.009+08:00

I had no idea a couple of days doing annual physical exams for a company could be so tiring. I've seen more patients in one day before, but there's something about having to deal with all those stressed-out individuals in a hurry that is both emotionally and physically draining. Of course working from 7 am to 5 pm, with only a 20 minute lunch break could be one reason why I was so tired.

Here are just a few short notes:

1. I was correct to expect better dressed individuals there so I made it a point to dress up also.

2. With physical appearance a vital part of their business they also seemed more conscious about fitness and health.

3. I had expected that because of the stress level of meeting daily quotas and deadlines, more employees would be turning to smoking and drinking. As it turned out a greater number opted physical activity as stress busters. This included brisk walking, running, jogging, cycling and working out at the gym. I was surprised to note that most were involved in basic physical activities rather than more competitive sports.

4. As part of the OB-Gyne history I had to ask about recent sexual activity to determine if I could do a Pap smear. As the women themselves commented, corporate sex was "sex on schedule". That would be sex on a weekend or a Friday night when they didn't have to wake up early for work the next day.

5. The women higher up in the corporate ladder always wonder why I don't have an assistant helping me out when I'm doing Pap Smears.

6. Educated people ask educated questions.

7. Educated people who ask educated questions get comprehensive and educated answers.

8. Educated people take doctor's advice more seriously -- that is, if they think the advice suits them (read: convenient). Otherwise, they are as stubborn as a mule.

9. I've never had to explain as much about lifestyle modification as I had in two days. Same goes for the effects of coffee and tea.

10. Doctors aren't being intrusive if they ask too many questions. They just want to be sure they will give the patient the best possible care always.

happy heart

2009-01-26T21:32:00.002+08:00

The endorphin high of recent physical activities has been addicting. It's all I can do to stop from running/walking everyday. I know I have to take it slow.

This year I would like to find the focus and discipline that was missing for most parts of 2008. I have decided I am going to use running as a tool to regain them.

A few years back when I was still working in research, I found that with my efforts to increase efficiency by multitasking I was becoming easily distracted. I was efficient and always met deadlines, but the quality of my work declined as I started to lose attention to details. I could not concentrate on one task for long periods of time.

As a remedy I decided to take up a new hobby. It was something that required me to sit still for about an hour and do only one thing.

I painted stones.

One afternoon I picked smooth and flat stones at the beach near my workplace. I bought poster colors, a brush, a fine-tipped marker and varnish. I started turning the stones into whimsical animal families. I had blue porcupines, spotted toads, "ugly" stonefishes, blue and green groupers, bright red and yellow scaly fishes, furry orange tabby's, bespectacled owls, rainbow-colored snails and tiny ladybugs.

It was wonderful. If I cared enough about the quality of the outcome I had to stay put for an hour and do nothing else but paint. If I allowed myself to be distracted for even a minute the paint would drip, I would forget what details to add with a marker and the varnish would dry. I had the right chill out music playing and for an hour I was calm and focused.

It helped teach me to plan ahead also. If I didn't think things through I would end up waiting for 15 to 20 minutes doing nothing while paint dried on a single stone. It would've been a total waste of time. By planning which stones to paint, what colors to use first and which design to pen in I could work continuously.

Running may be totally different from painting but I think I'm going to get the same results with a happy heart and a healthy body as bonus :)

r/w

2009-01-24T23:10:00.001+08:00

Getting back to my run/walk routine after taking a break while working proved harder than I thought. I did have short 20 to 30-minute walks while I was in Mindoro. But I was walking with a friend most of the time and she wasn't very welcoming of the suggestion that we should walk with a quicker pace. We probably covered only around 2 1/2 kilometers for our half-hour walks.

While I was looking forward for the endorphin high of previous routines I wasn't exactly looking forward to the muscles aches that greeted me the morning after my first run.

Only on week 2 of my so-called beginner runner's program and I am faced with the sad realization that I have a bum left knee. On one end I blame it on all the weight I've gained, on the other end, I blame it on weak muscles that should have been enough to support my knee if only I had used them more.

I've always been on the heavy side but I used to be fitter. I miss being able to run or swim a mile and not feel achy afterwards. I miss being able to play tennis all afternoon and still have the energy to go out at night. I do feel better now that I've taken a step to becoming healthier and more active again. But I have to take things one day at a time so as not to be disheartened by what seems a very, very long road ahead.

Somebody please run with me.

getting the groove of things

2009-01-18T10:04:00.001+08:00

Three days was enough for me to get the rhythm going -- that was one 24-hour duty, a from duty status and a day as the OPD officer. It was enough to get my eating right, enough for me to know the general lay of the hospital, and enough for me to know that in the next seven days I would see more cases of acute gastroenteritis, intestinal parasitism and malaria.

It's almost sad to admit that the major diseases I see everyday can be easily remedied by good hygiene and proper sanitation. This may seem a straightforward solution for disease prevention for other locals but I understand a lot of traditional beliefs may hinder the minorities into taking positive action for better health.

A case in point: Most minorities in the ward do not think taking a bath is necessary. On the contrary they avoid taking baths because it goes against their belief. Any illness is brought upon by actions that have angered gods or from the ill will of spirits. A plea for cleanliness and hygiene with a gift of a bar of soap may not always get the desired result. A family given soap to bathe with was found the next day still oily and grimy. Not even their faces had lightened with washing. As it turned out, instead of using the soap for bathing, the family had used the soap to wash clothing.

When you are up against decades of tradition it sometimes feels like you are fighting a losing battle. It makes you feel that for every step forward you take, you take not just two steps back, but three. And then a day comes when you do the morning rounds and find out one boy was actually given a bath. It erases all the frustrations and pushes you to take one more step forward, only to find that you're still two steps behind.

Coming to the hospital I didn't think I was going see so many malaria patients. By the end of ten days I would admit 4 patients with blood teeming with Plasmodium falciparum. There were already three others in the ward receiving treatment for it. These are just the pediatrics cases. Internal Medicine had it's own share of malaria cases. If in urban Manila, Dengue was the disease to rule out for every febrile, flu-ey patient, in rural Mindoro Malaria was what I had to watch out for. I had no idea they saw so many cases. Although most patients came from far away towns I still felt unsafe without prophylaxis.

On a lighter more hopeful note, the workload in the hospital isn't all that heavy for the most part. I enjoyed walking trips to the center of the town and a short tricycle ride to the beach. I hadn't taken a camera with me since I wanted to focus more on the work part of the trip. But standing on the powdery white sand beach at Tayamaan watching two kids tumble into the water as the sun set I could not resist the urge to capture the moment with my phone camera.

Sometimes, life's a beach. All you have to do is breathe deeply.

first look

2009-01-13T20:08:00.001+08:00

When an opportunity to mix travel and work arose I jumped at it. I shrugged off comments about trying to find work closer to home. I let complaints about my not getting a permanent job fall on deaf ears. After five years of barely getting out of Quezon City I wanted some R&R and a chance to explore more of my country.

Day 1: It was a little after five in the morning when I took the10-minute drive to the pier. I had barely slept. My sleep-wake pattern was still a mess and I was unable to adjust it days before I was set to leave. I was planning to sleep through the 2 1/2-hour boat ride to Occidental Mindoro but the cold and windy morning woke me up. I was expecting some high waves as we hit the open sea but the ride was calm enough. I did not have a minute's worry.

The van ride to Mamburao took 40 minutes. The concrete road cut along the verdant greens of farms and rice paddies. There were stretches where only one lane was usable, the other lane was used for drying grains and corn. A good five minutes sometimes passed before the van came across another vehicle. The drive was both calming and revitalizing. It was truly a breath of fresh air compared to Manila.

The hospital is squat and white. At first glance it was almost intimidating. I had expected a rundown graying hospital. Instead I was greeted by a wedding-cake white building roughly a year old.

We got a tour when we arrived, meeting with other residents, getting introduced to the attendings. After a quick lunch we were taken to the Capitolio for a courtesy call with the governor. I sat down, smiled and tried to look professional as I introduced myself to the governor, vice governor and a mayor. As it turned out, someone I was going to work with happened to be the governor's nephew.

It's true what the Lonely Planet guide said. Mamburao is a dusty little town with a bad case of tricycle-itis. Tricycles are the primary mode of transport. There are few jeepneys. Like the vans, the jeepneys only seemed to operate to transport produce or to carry passengers over long distances. After the first ride through the town I was looking forward to exploring it on foot. Later in the day a group of doctors was going for a swim at a beach resort only 2 kilometers away from the hospital. Too tired to do anything but sleep, I declined the invitation to join them and just made a mental note to check it on a later date.

I slept soundly that night. I knew I needed all the energy a good eight hours of sleep would give me. The next day was going to be an entirely different day.