Chronicles of Boredom

Death and Lessons from Google

2011-08-27T13:35:00.002+08:00

I have a confession to make: I google-stalked someone today.

It all started out like this...

“Code! Code!,” someone screamed even before he was through the double swing doors of the critical care area of the ER I was manning about a week ago. The orderlies and triage nurse rushed through the doors pushing in a stretcher containing the limp body of a young man. As we’re programmed to do, we started resuscitation on the patient. While the code team was pounding away at his chest and continued to give life-saving medication through his vein, I had started the interview with the family to document what had led to the patient’s present condition. It was then that I realized that the patient was vaguely familiar to me. The patient was in his early twenties and he’d been in and out of the hospital for a hematologic malignancy. He’d undergone chemotherapy and radiation but remained sick. The latest development, and this I only found out that night, was that the cancer had already spread to his brain and the tumor wasn’t responding to radiation. I never knew the patient personally and had only seen him once or twice, but his name was familiar.

After about an hour of resuscitation, we had explained to the family that continued resuscitation efforts will be futile. The father was trying to compose himself but had agreed to stop the code. It was over, confirmed by the flat green line on the cardiac monitor. The nurses and orderlies started turning off drips and unplugging equipment. The lifeless body of the young man was perfunctorily cleaned and wrapped in a shroud, in preparation for the morgue. This scenario is not unusual at the ER and it happens almost everyday in the hospital. I was used to it. Just another day at work. It was a sad day to be sure, but just another day all the same.

This morning, some Facebook messages reminded me about that patient. Some of the floor nurses that had been friends with the young man had posted their goodbyes on their closed Facebook group. This piqued my interest and that’s when I started my google search.

The patient was an athlete and a student. I found pictures of him horsing around with friends, a genuine smile on his lips. One photo was of the patient with another friend, in sepia, both of them wearing barongs and looking up smiling at the camera. The pictures were accompanied by a blog entry by one of the patient’s close friends and through it, I caught a glimpse of a vibrant young man, about to begin his adventure in the world. In the article, the friend reminisced about their 9 years of friendship and lamented that he had lost a brother.

After one has done countless of codes and resuscitations, after many failed intubations and seemingly intractable arrhythmias, after handling the patient with stubborn low blood pressure that just wouldn’t go up after 5 vasopressors, it’s easy in Medicine to steel oneself from the realities entwined with one’s patient. It’s easy to detach oneself from all the drama and just focus on getting back a heartbeat or a breath, or even a continuous spike of electrical activity on the EKG. On some level, health care providers need to be removed from the emotion-laden realities of our patients so we can focus on the medical aspect, the main area we are called to address. We need to think and think quick. There is also the factor of seeing something too often that it becomes rote. Death and dying is such an integral part of the hospital, especially as a resident, and especially at the ER.

While each doctor and each health care provider will have a short list of memorable anecdotes about memorable patients, my google search reminded me that every single patient I see, whether at the ER, the floors, or outside the hospital, each one of them has a network of people who love them and will for certain be affected by any decision, wrong or right, I make in the patient’s behalf. In the hustle and bustle of the ER, such an obvious and instinctive thing can easily get lost, buried under piles of academic steel and medical jargon. My patient’s death reminded me that death is painful for those left behind and the grieving process for the family extends far beyond the confines of that little room I man in the ER. For us doctors, tomorrow means more patients to see and help get better. For my dead patient’s family, it means an empty bed and a quiet bedroom, a brother gone too soon, and one more grave to visit.

Sent from a BB.

Twentysomething No More

2011-08-21T04:51:00.001+08:00

One of my all-time favorite albums is that one by Jamie Cullum, entitled "Twentysomething." As I celebrated my birthday yesterday, the album came to my mind as I realized I officially am no longer a part of that twentysomething population. I still am surprised when children born in the 1990s, the little kids of my youth, are wheeled in to the ER as adult patients. When did they grow up to be adults? More importantly, when did I grow up?

As a little boy, I looked up to my kuyas and ates, twentysomethings and thirtysomethings, and I thought of them as Adults, spelled with a capital A, mature, self-sufficient, grown-up. It may be that I just wasn't privy to their personal struggles and issues but as I look at myself and my generation, I may have had, as a child, a too idealistic picture of being a grown-up. I don't feel like the grown-up I built up in my mind. I am immature, a hothead prone to temper tantrums, impatient, at times irrational. And as I look around me, every other adult I know is the same way, just in varying quantities of childishness.

I find it a little bit funny and a little bit depressing to ruminate on the fact that I am no longer a twentysomething. I haven't been able to fully wrap my head around living life as a thirty year old man. I don't know if I'm going through some form of delayed quarter life crisis but I've never had a birthday before when my age bothered me as much as this birthday. Thirty. Three zero. Such a round number. I don't feel like I'm thirty.

My preoccupation with my age-change should not be taken as a lack of zest or as fearfulness of the future. I face tomorrow headstrong, with my pack of dreams, filled to the brim, slung over my shoulder. I aim to leave my mark on this earth, and I mean to do it as excellently as I could and by the grace and blessing of the Lord.

It is a strange thing to be, thirty. But it's not so bad. Goodbye Twentysomething. It's been a great decade. But I'm positive the next one will be even better.

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Clichés and the End of R1 Year

2010-12-05T20:48:00.001+08:00

It has become a cliché to say that something you’ve been waiting for seemed to have arrived sooner than expected. “As if it was only yesterday that we were starting our residency training” is a statement I will not agree with. This year seemed to have passed too slowly and the end could not have come sooner. I am happy to report that I learned a lot this year, not only about Internal Medicine but also about the more important thing in my profession: interpersonal relationships. I learned that people handle stress in many different ways and sometimes, one needs to let things slide to attain some form of peace. I also learned the value of being quick to apologize and admit error. I quickly averted several potential disasters just by immediately admitting my mistake and promising to do better next time. It’s a work in progress but I’m slowly getting a handle on my temper and my impatience with incompetence, as I realize that I am incompetent more times than I care to admit, and in worse ways. Something Dr. Bengzon once said struck me and I think about it every time a patient (or family member) poses a “challenge”: our patients remind us of our humanity. We are all impatient, difficult, cranky, and demanding at one point or another. We are all apprehensive about death and disease, albeit in variable degrees. These thoughts help me to maintain my composure, take a quick breath, and move on with my work.

This year, I also learned some good Medicine, mostly from the people who took the time to teach. We all had virtually no time to read Harrinson’s so we were mostly learning by leeching: “leeching rounds,” as one pre-resident put it. At one point, I was reading ECG tracings from a treadmill stress test and I remembered the time when I was a clerk and I was so impressed by the cardiology fellows who seemed to have read these same tracings as if it were a book, almost efortlessly. My clerkship self would be proud of my resident self, I think.

The learning was there. But the learning came with a huge price tag. Late nights, sleepless nights, missed time with family and friends ... the list is substantial. The way I coped, however, was to always have my long term goals in mind. As another cliché goes, I “kept my eye on the prize.” I knew that sooner or later, R1 year would be over and I’d be moving on to more challenging stuff. But I’d be MOVING on and that means, pretty soon, the entire ordeal of residency would soon be over. The Lord has shown me grace upon grace this year and my friend Angel, just tonight, reminded me of how undeserving I am of the favor I received from Him. He has been my source of strength, my source of peace, and the One who stretched my limits even more when I thought I had nothing else to give. He has given me an excellent set of duty mates (and now great friends) the past few months. He has sustained me through the most toxic of duty nights and has given me wisdom enough that I don’t have screw-ups that endangered any of my patients’ lives. As an added bonus, I get to do something I love more than medicine: teach. It might well be my only drive to read and study up on my cases.

I may be looking back and seeing things through rose-colored lenses because I am at a high right now: it is my last day as an R1 (and all its accompanying baggage, like DS!) and I had a pretty good dinner (more like excellent, really). But as I remember the year that has passed, it strikes me as being an over-all very positive year. And this makes me extremely happy. If you will notice the description I post about myself in my blog: “An occasional writer whose current preoccupation is getting through medical training unscathed and unjaded.” I may have been scathed and stung the past year but I am as unjaded and enthusiastic about my work as the day I first started last year, considering everything that has happened. The ER and hemodialysis (and many more R2 issues) may quite possibly kill the buzz. But I say, bring it on.

An Encounter with an Old Mentor

2010-06-30T21:09:00.001+08:00

I saw my old med school mentor the other day. He was with his family at the photo printers. I was about to have my picture taken when, out of the corner of my eye, I saw him looking expectantly at me, like he knew I would recognize him. And I did. He's gained some weight but he seemed more cheerful and relaxed than when he did his rounds at the hospital way back then. I approached him and cheerfully said hello and asked him how he was. He asked me why I was still in Manila (he knew about my plans to leave for the US). I told him the plans fell through. Pleasantries. It was a timely meeting for several reasons.

I remember that on my med school graduation, I sent him a thank you letter where I said I considered him one of my mentors. But to be honest, I don't know if he fits the description of mentor. We weren't exactly close and I don't think he necessarily thinks of me a protege but ever since I met him in sophomore year, I knew I wanted to develop in myself the same love for teaching that he so generously exudes. He was very tough and most of my classmates were terrified of him. But I saw through the tough mantle and knew that at the core, he just loved to see his students understand medicine. My encounter with him was timely because I am at a point where I have started becoming involved in some form of teaching. And seeing him again after so many years reminded me of how much time he spent with the students and that, in a smaller scale, the same is expected of me. I do not aim to emulate his technique. A lot of students find his ways too abrasive. His passion for teaching, his concern and love for learning, these are the things I find inspiring in him. And I guess these are also the reasons why, in some small way, I can look up to him as one of my mentors.

Sent from a BB.

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Daydreaming at Starbucks

2009-10-27T11:39:00.003+08:00

I cracked open John Steinbeck's The Grapes of Wrath the other night. I bought it from a used-books store a few weeks ago, right when I was halfway done with East of Eden. For the first time, I noticed the writing on the book's inside front cover. In fat and neat American print, someone wrote "Tuan Grogman Mrs. K. C-24."

Someone, somewhere used to own this volume. As I sit here nursing my latte, my mind's eye starts spinning.

The image I have is of a classroom in a public middle school somewhere in the US, Kansas perhaps, or Arkansas. Mrs. K, a stout, bespectacled, little lady with curly grey-streaked white hair, hobbles into C-24, a class of eighth-graders. She is dressed in a white blouse with a lacy collar and a long skirt with small floral prints. Around her neck is a thin gold necklace. She squeaks more than speaks in her high-pitched grandmotherly voice, but most of her students pay attention.

Tuan Grogman sits on the third row from the front, right by the window. He is a thin boy with a shock of uncombed golden brown hair that cover his ears. Today, he wears the last pair of clean blue jeans he has, along with a striped blue and yellow shirt and tattered used-to-be-white sneakers. He squints at Mrs. K. He doesn't like wearing his glasses.

Judging by the condition of the book I'm holding, he hasn't read the assigned chapter. Instead, under his Trapper-Keeper, he has the Cliff Notes open. In the fat and neat American print I am familiar with, he writes a final few words on the paper summarizing Chapters 1-10. He takes the sheaf of papers the pretty girl behind is passing to him, places his paper at the very bottom of the pile, and hands everything to the kid in front of him.

Mrs. K collects the homework and keeps it in her folder. She sits down and in her tiny voice begins to talk about Tom Joad. Tuan Grogman looks to his left. He sees the open green fields, the grass swaying and the leaves of the trees shuffling along with the soft breeze. It is mid-afternoon and school is almost done for the day. He begins to daydream.

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East of Eden

2009-10-25T23:35:00.003+08:00

A few weeks ago, I bought a used and tattered copy of John Steinbeck's book, East of Eden. I've heard of Steinbeck before but I've never read any of his works. I knew that at some point he won the Nobel Prize in Literature. I also knew his books are classics and are read in elementary and high schools all across the US.

I had several books in my hand at the used-books store, the day I bought East of Eden. What made up my mind was the setting of his novel: Salinas Valley in Northern California. This was the same reason I read Dave Eggers' A Heartbreaking Work of Staggering Genius (set in San Francisco). Northern California holds a certain appeal to me, maybe because San Francisco (and by extension, the Bay Area) is my all-time favorite city. But I digress.

I finally finished East of Eden tonight. From the first page of that novel, I was in awe at Steinbeck's writing. His prose flows out of the page and into your imagination and the senses. He describes a stream and you feel the water running through your hand and you feel its coolness and silkiness. He describes a valley covered in grass and flowers and out from the page comes the scent of the dew and the freshly rained-on earth. It is a magnificent experience reading Steinbeck and halfway through East of Eden, I purchased Grapes of Wrath from the same used-books store.

At some point, I want to write something about East of Eden, its issues and conflicts, the theme, and its characters. It's an absolutely wonderful book. But right now, I don't think I'd do a very good job of it. It hasn't all sunk in yet.

The point of this entry: if you haven't done so, pick up a Steinbeck and read it. I'm going to start on Grapes of Wrath tonight, and maybe Of Mice and Men next. Let's see where the wind will take me.

New entry at Chronicles of Medical Residency http://bit.ly/1iobOJ

2009-10-21T21:57:00.001+08:00

http://imresidentdoc.blogspot.com

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Code #1

2009-10-09T22:54:00.001+08:00

New entry at Chronicles of Medical Residency.

http://imresidentdoc.blogspot.com

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New entry at Chronicles of Medical Residency: First Day and On Call. http://imresidentdoc.blogspot.com

2009-10-01T23:30:00.001+08:00

Sent from a BB.

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New Blog: Chronicles of Medical Residency

2009-09-29T00:24:00.001+08:00

While my main blog, Chronicles of Boredom, is still active, I have decided to officially start a blog called Chronicles of Medical Residency. All medicine- and residency-related posts will appear on the latter website and all other boredom and general interest posts will appear on the former. I hope you can all visit the new site soon: http://imresidentdoc.blogspot.com

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Thoughts on Dinner at Fuente Osmena

2009-09-14T19:14:00.001+08:00

There's something, umm ... weirdly romantic about having dinner alone at a Jollibee on Fuente Osmena. I think it has something to do with feeling out of place, a foreigner, while the entire world of the locals continues to revolve and move forward. It's the amused smile of the counter attendant as she hears the different language spoken; she realizes that I'm out of place and that I know it. It may also be because of the fact that I look exactly like the people around me, down to the flat nose and brown skin, and yet they live in a different world than mine. They speak a language vastly different and yet on some plane, completely understandable. It may be the way the lights on the street twinkle differently and how the cars that move along the large, busy rotunda move in a more disciplined way than I am used to.

Or it may be just me romanticizing my somewhat pathetic excuse for a dinner: sweet, red, hotdog-laden spaghetti, a small cheese-less burger with a generous dollop of pink mayonnaise, and greasy fries without the ketchup.
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The hotel I'm staying in...

2009-09-14T11:49:00.001+08:00

serves "breakfast." Hmmm.

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Unbelievable

2009-09-07T13:45:00.001+08:00

For quite some time, I've noticed one or two ladies walking around the Robinson's Galleria branch of Burger King, wearing scrub suits with the BK name tag on them. I've always assumed they were hired to clean up tables after customers. Just today, I found out that they offer backrubs and hand and neck massages to customers. I find that strangely inappropriate. And weird.

The photographic evidence will appear somewhere on this post. Sent from a BB.

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Twelve Things I Learned from Pixar's Up

2009-08-19T21:38:00.003+08:00

(I doubt you can consider some of these points spoilers but consider yourselves warned...)

1. Plastic garden hoses are made of very, very strong stuff.
2. Old men in canes are also almost as strong, apparently.
3. It is possible to rip wooden houses off of their foundations, with just the right amount of helium-filled balloons, and can be made to fly across two continents.
4. We all know that babies are delivered to their mommies by storks. What we didn't previously know is that all babies, human or animal, are made by chubby, cuddly, smiley Clouds (capital C) who delicately sculpt clouds (lowercase c) and electrify them into life.
5. If you don't want the magic to fade, you never want to spend more than a few hours with a person you idolize or highly respect. If you do, you find out sooner or later that they are faulty humans too.
6. It is possible for childhood friends to become lifelong partners.
7. Dreams and ambitions are good things to have but one must not forget to live out life in the process. Obsessing over our dreams may make us miss what made our lives the most meaningful, the most real, and the most happy.
8. Sometimes, the most boring things in life are what we cherish the most.
9. Unachieved dreams don't necessarily translate to failure.
10. The best way to go through life is to have your very own Adventure Book. Mine come in small, black notebooks called Moleskines.
11. No matter how old we get, as long as we have breath, there will always be new adventures for us to experience.
12. Growing old can be quite an adventure in itself.

Looking back through my 28 years of existence, I have no other way to describe it but as an adventure. Until recently, I've lived a mostly boring life; it was usually just about school, family, and church. But then I remember Lesson #8 and I realize I wouldn't change a thing, given the chance. As I look forward to the coming years, I'm sure the sovereign Lord has more in store for me. I know some events will be sad, some will be painful, and a good chunk will be happy. But each event should be taken as an adventure given as a gift by the Creator of Adventure. Each thing that occurs in our lives happen because He allowed it and He has a purpose for it, a place for it in the grander scheme of things. Each must be cherished and treasured, the most striking recorded into our Adventure Books. I look forward to having more adventures with my Lord. I still have many dreams and ambitions and I still want many things. But by the grace of God, I live each day trusting that He wants His absolute perfect best for me, which may not necessarily mean what I want for myself, and that He will lead me there.

Everyone must go see Up. It's an especially great movie to see on one's birthday.

It was, indeed, a happy 28th birthday for me, a happy 28 years that have passed.

Soli Deo Gloria.

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To celebrate my 28th birthday ...

2009-08-19T00:47:00.001+08:00

I unwrapped and cracked open a brand new Moleskine! This will be my new journal for the next year, chronicling my 29th year of existence. I can't wait to fill its pages. A decent birthday post is forthcoming.

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A Picture Exercise

2009-08-16T02:13:00.011+08:00

Got this from The Tangled Web. I thought it would be a nice look back through the past almost-28 years. I've included explanatory notes in some of them, but I'm leaving some for you to figure out.

Here we go:

1. A picture of you in your room - c/o Photo Booth (note my Starbucks mug collection in the background)

2. A picture of you very drunk - I have never been drunk so I just imagined I might look like this if that happened (c/o Photo Booth)
3. A picture of you on your birthday, or your favorite holiday - my 27th birthday dinner with med school friends, I believe.

4. The youngest picture you can find of yourself in digital form - This photo was used as the cover for my 5th (and my brother's first) birthday party.
5. A picture of you in one of your favorite outfits - my favorite traveling attire, a comfy Gap cotton shirt.
6. A picture of you making a goofy face at the camera.
7. A picture you might have edited to make yourself more attractive - keyword: might.
8. A picture of a night you regret - well, not really regret but I was very sad then.
9. A picture of you being truly yourself - with family at John Hay.

10. Your most recent picture - taken just before I posted this.
11. A picture of you being absolutely ridiculous - c/o Photo Booth
12. A picture of you showing off a new haircut/color - ID pic for residency application
13. A picture of a time in your life that's over, but you wish it wasn't.
14. A picture of a time in your life that's over, and you couldn't be more thankful that it is - UP Biochem, doing thesis lab work

15. A picture of you when you were anything but happy - My very first major allergy attack (I was still smiling at this time; I wasn't 10 minutes later)
16. A picture of you that you had no idea was being taken - Thanksgiving 2008 (photo courtesy of Jaemie Santiago)
17. A picture of you when you were a different person that you are now - with college friends

18. A picture of you with someone you love - with the people I love the most

19. A picture of how you'd like the world to see you

20. A picture that describes how you'd like to spend everyday.

21. A picture of a time when everything was changing - On the flight to the US, October 2008.

22. A picture that makes your heart hurt - This 6-month old baby had to undergo a major heart operation because of a congenital defect. Here, the anesthesiologists are having a hard time starting an IV line on her.
23. A picture that makes your heart smile - My nephew, Ady, a few months old. That's my finger.

24. A picture of one of the best days/nights in your life

Here's the list, if you want to do this on your blog too:
1. a picture of you in your room
2. a picture of your very drunk
3. a picture of you on your birthday, or your favorite holiday
4. the youngest picture you can find of yourself in digital form.
5. a picture of you in one of your favorite outfits.
6. a picture of you making a goofy face at the camera
7. a picture you might have edited to make yourself more attractive
8. a picture of a night you regret
9. a picture of you being truly yourself
10. your most recent picture.
11. a picture of you being absolutely ridiculous.
12. a picture of you showing off a new haircut / color
13. a picture of a time in your life that's over, but you wish it wasn't
14. a picture of a time in your life that's over, and you couldn't be more thankful that it is.
15. a picture of you when you were anything but happy
16. a picture of you that you had no idea was being taken
17. a picture of you when you were a different person than you are now.
18. a picture of you with someone you love.
19. a picture of how you'd like the world to see you.
20. a picture that describes how you'd like to spend every day.
21. a picture of a time when everything was changing.
22. a picture that makes your heart hurt.
23. a picture that makes your heart smile
24. a picture of one of the best days/nights in your life

The Philippines After Yesterday

2009-08-06T02:02:00.002+08:00

We all watched as the staggering events unfolded on our television screens, if we weren't there on the streets ourselves. We saw the tears pour down the faces of President Corazon Aquino's family and friends and even strangers off the street. We saw the massive lines that snaked around La Salle Greenhills and the Manila Cathedral as people lined up for hours to pay their last respects to that lady in yellow. We were reminded by video clips on TV and on YouTube about our country's troubled past and the miracle that restored our sense of nationalism and unity. Our collective grief and bereavement entranced the entire world even as the international press stood on the sidelines watching and writing about the outpouring of emotion and respect and sympathy, the likes of which were unseen in this country since the death of Ninoy. We have experienced it together and we have been united.

So what happens tomorrow?

The Aquino children will continue to mourn the loss of their mother and the Filipino people will remember, despite this nation's proven shortsightedness, how we have been transformed by the life of this lady. Inevitably, though, we will return to the routine of our lives as businessmen, teachers, lawyers, doctors, street vendors, journalists, beggars. The government will still be enmeshed in red tape, corruption, and personality and patronage politics. The activists will continue to stage rallies and demonstrations at the slightest hint of what they perceive to be injustice. The religious will continue to go to church. Congress will still pass laws and conduct committee investigations on the most pressing (read: popular and TV-grabbing) issues of the day. And the majority of the people will still be that, the silent majority. All this is part of the workings of real democracy and the fallibility of human nature.

That President Aquino restored democracy to our nation is above contestation. Students of Philippine history will know very well the stories about human rights abuses, the disappearances, and illegal detainment so prevalent during the dictatorship of Ferdinand Marcos. I am fortunate not to have been personally familiar with that time as I was born some years later. Some have sought to diminish the bloodstain on the strongman's hands by insisting that he was brilliant, that he had the best interests of the country in mind, that he was fighting against a Communist insurgency, and that it was his wife, Imelda, who was the rotten one. I say bull. And yet, even during the regime of President Aquino, there was widespread corruption in the lower levels of government (it is said that she herself was immaculate and I believe it), patronage politics still existed, and there were still people who hungered and were jobless. That corruption will always exist in one form or another in all governments around the world should also be a matter of fact. For those in our society who believe in God, we attribute this to the innate human condition called sin. However, corruption's persistence (and prevalence) in our society should not stop us good citizens from fighting against it however way we can, and to ensure that we ourselves do not propagate its practice.

Tonight, I read an opinion piece by Alex Magno tonight, published on the Philippine Star website. He concludes his essay with what I think is the best solution to the what-next question:

"As we rebalance our sense of national community, we should soon understand that the task at hand is not one of finding new heroes to replace the ones we lost. We should soon understand that what we need now, in building a stable and reliable future for our people, is to build heroic institutions so that we do not rely on the extraordinary heroism of individuals."

While in the course of our nation's story, we will witness the occasional heroic acts by extraordinary people not unlike Cory and Ninoy, we cannot keep expecting other people to sacrifice on our behalf. We must do our part to ensure that we have strong institutions in place, in government and out of, a tough and powerful framework against which we will build our futures on. For us common citizens, our first responsibility toward that end is to make sure we exercise our right and our freedom to cast that sacred ballot.

Using what meager Photoshop know-how I have...

2009-08-04T17:12:00.001+08:00

A few days ago, I tweeted this: http://bit.ly/1yn0Sl

The attached graphic is what I came up with and to be honest, I'm a little proud of myself. I don't know much Photoshop tricks and had to scour the internet for tips, especially on making things look silvery. This will look decent on any letterhead, don't you think?

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Wanted: Moleskine #3

2009-08-03T17:46:00.002+08:00

I need to buy a new small, plain moleskine in the next two weeks. Two years ago, I started a tradition to crack open a new moleskine on my birthday. I'm on my second moleskine this year and am about to start on my third one for 2009-2010. I expect that by the time I'm 40, I'll have 15 of these little black books on my shelf, enough material for a few chapters of the autobiography I plan to write. (Hah!) By then too, I hope to be writing with a 'big boy' fountain pen, rather than the starter pen I am currently using, a black Waterman Phileas I purchased on ebay a few months ago for $22.

I have always kept a journal since I was in high school. While I didn't write regularly until I was in college, I've always found the joy of recording my experiences using an actual pen and paper precious. I keep an electronic journal, using Journler, this nifty (and free!) Mac app I downloaded a couple of years ago. But Journler is for emergencies only, when I have no pen and (proper) paper. I've also written entries on coffee shop napkins, on the back of some of my books, and on the back of official receipts. I have some thoughts recorded on my blackberry's Memo Pad too. But for me, nothing beats writing on a good quality paper, using an excellent quality pen. Everyone should have a go at it sometime. It's really one of the simple joys of life one can easily experience.

Sent from a BB.

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Life Without Limbs

2009-07-31T22:37:00.001+08:00

via lifewithoutlimbs.org

Nick Vujicic was born without arms and legs, a rare condition called Tetra-amelia. His testimony is inspirational and reading about it on his website (link above) tugged at my heart. For a man who has undergone so much and yet have such a positive view of life and of God is a testimony to the Lord's all-consuming love.

I first found his video on Facebook and after a quick search on YouTube, I found this video: http://bit.ly/16hdoz.

If anyone out there is feeling like you're down and out and hopeless, if you feel like giving up, watch and listen to what this man has to say. It just might change your life.

Posted via web from karlmd's posterous

Same blog, new address

2009-07-31T21:46:00.001+08:00

I've wanted to change the URL of my main blog over at blogger.com for years because of its clunkiness (karlmd2006 is a mouthful). Well, tonight, I was finally able to do it. Please change your bookmarks (if you even have it bookmarked!) to Chronicles of Boredom's new address: http://karlmd.blogspot.com.

Posted via email from karlmd's posterous

Who wants a good middle-of-the-woods scare?

2009-07-30T14:58:00.001+08:00

via vision02.com

The idea is brilliant, the execution even more so.

I'm trying out the posterous bookmarklet app for the first time so I'm not sure yet if there will be a link. In case there isn't, here's the original website: http://vision02.com/hollow-man/

(link via @neilhimself on Twitter)

Posted via web from karlmd's posterous

Francis Collins' nomination to the NIH questioned

2009-07-28T23:16:00.001+08:00

The NYT Op-Ed piece by Sam Harris is here: http://bit.ly/3oeh2i

For those who aren't familiar with Dr. Francis Collins, he was the head of the US-government arm of the Human Genome Project (there was a private firm working on the project too). The HuGo Project attempted to map out the entire human genome, that sequence of letters that dictate the growth and development of our entire body. The project was completed in 2003, though partial results were unveiled during the administration of Bill Clinton. This guy, Dr. Collins, is a scientist's scientist. However, he also wrote a book in 2006 where he presented evidence for belief in God. He argues in "The Language of God" that there is a silent cluster (silent majority?) of scientists who continue to reject Darwinian assumptions that there is no God. He then presents several scientific evidence he believes points to the existence of a Supreme Being, a Creator, a God. He also narrated his own journey from being a hardcore atheist, to his search for God, and his conversion. I read his book a year or two ago and I absolutely loved it. His arguments may not be mainstream Christian but in the face of solid scientific evidence, these are definitely worth serious consideration. I am at present still sorting out my own thoughts on this. But Dr. Collins is, without a doubt, a born-again believer.

I am frankly appalled and disappointed that his nomination as head of the National Institutes of Health is being questioned by Mr. Harris, and possibly by the atheistic scientists. He writes from the perspective of a secularist scientist (which I'm sure he's proud of) and as Dr. Collins argues, not every scientist is that way. It is only the noise created by the atheists like Richard Dawkins that gives the world the impression that all scientists are godless people. But historically, there are many scientists who profess to believe in God. Even Einstein did, albeit an impersonal God who didn't meddle in the affairs of man. Dr. Collins' scientific accomplishments must speak for itself. I don't know a lot of American scientists but I believe President Obama couldn't have made a better choice in Dr. Collins. To me, he represents a balance, a middle ground. Nowhere is it written that the head of the NIH must be an avowed atheist.

Posted via email from karlmd's posterous

Ain't this the truth.

2009-07-28T18:45:00.001+08:00

Saw this at Powerbooks Shangri-La.
Sent from a BB.

Posted via email from karlmd's posterous

Posterous

2009-07-27T23:50:00.001+08:00

I'm loving this new thing on posterous.com. I only need to send a single email to them and they automatically post it (complete with attachments -- photos, mp3s, etc) on every possible social media website I could ever want. Armed with my blackberry, I can have my social media fix in a jiffy. Photos are automatically posted on my Flickr account, a status update is posted on my Facebook page, and a link is posted on my Twitter page. The best thing about it though, at least for me, is that I can autopost to my main blogger site, Chronicles of Boredom, something I couldn't really do with Tumblr (yes, I also have a microblog on that site -- what can I say, I'm turning out to be a social media aficionado [read: addict]). I don't know if the site layout on posterous is customizable. I still have a bit of exploring to do.

Anyway, check out my profile at karlmd.posterous.com. But you don't really have to. You'll see the updates on my other pages anyway. Hah.

Posted via email from karlmd's posterous

Untitled

2009-07-27T23:22:00.001+08:00

Test post on karlmd.posterous.com.

Posted via email from karlmd's posterous

Untitled

2009-07-27T23:06:00.001+08:00

I'm trying to get used to the "No Sign-Up" thing.

Posted via email from karlmd's posterous

The Astounding Implications of John 17:3

2009-07-08T16:50:00.001+08:00

“Now this is eternal life: that they may know you, the only true God, and Jesus Christ, whom you have sent.” John 17:3 (NIV)

The first time I encountered this Bible verse was when I was taking the Youth Evangelism Explosion course in 1998. We used this verse to define what eternal life is with the goal of sharing with others how to obtain that eternal life. I remember not really understanding the verse, even in its context in John 17. I was working under the impression that “life” is a noun (which it is), and it should be defined by adjectives and by other nouns. So I found it strange that the verse defines this noun “life” by an action word, “know.”

This afternoon, as I was reading the late D. James Kennedy’s book, Lord of All, this verse suddenly became clear and I finally understood what it means. And it had very little to do with what I was reading. It just came to me, like an epiphany, if you will. Now I’m sure my realization this afternoon is not new to a lot of you. I do not endeavor to disclose any new truths about Scripture and doctrine. I simply want to elucidate newly found connections in my mind. If you haven’t made the connections yet, I guarantee you, the implications of this verse are astounding.

I have always thought of eternal life as being used to refer to life, if you are a Christ-follower, in heaven after we pass on from this earth. I had egocentric notions about the term. It was my life with God in heaven, my salvation. So all these years, I thought that its definition should contain something with those ideas. But I had the wrong notions after all.

Knowing God is not confined to head knowledge or an intellectual understanding of who God is. The word “know” in this verse implies an intimate relationship that involves actually knowing God as a person. But it’s not as simple as it sounds.

Such is the awesome and majestic qualities of God that in this lifetime, He is wholly unknowable and incomprehensible, except through what He has revealed to us in nature and in His Word. The whole point and definition of eternal life, then, is to know and comprehend God. He is such a great, mighty, and awesome God that it will take all of eternity to examine every facet of His being, every feature and contour of His holiness. We cannot know Him except by spending eternity trying to understand His complexity and His wonder. Do you even have a concept of how long eternity is? It will literally take us forever to comprehend the very nature and being of this Supreme Spirit who calls Himself YHWH, I Am.

As incredible as that may be, that is not what is astounding to me at all. It is the fact that this same God -- the God of the Universe, the Creator of all matter and of Life, the Supreme Force that holds the vast firmament in its place -- this powerful God took it upon Himself to love us first, mere creatures, small-minded, finite, sinful. And in His infinite wisdom, He devised a brilliantly simple plan to save us from the sin that He had nothing to do with in the first place. That is astounding. And incomprehensible. And beautiful.

Soli Deo Gloria.

Jason Reeves' Similes and Metaphors

2009-06-21T21:50:00.006+08:00

I was surfing the web as usual and I happened to chance upon the website of one Jason Reeves, apparently an up-and-coming singer/songwriter. He has some videos up on YouTube, if you care to look. On his website, I read one of his blog entries and was just amazed at this guy's writing. I wish I could write like this!

"number six
12.01.08
my television set screams the troubles of the times. paying vague attention through the filters of my mind, words like "go hungry" and "crashing economy" and "turn for the worst" stab through like a blade in perfect clarity. it is strange for me to hear this with eyes locked in the other direction, lost in the patterns of the leaves. im going to change my machines and listen to music instead. im drinking tea from china. who knew the desperation of a race could disintegrate into the sipping of a simple drink. i am an old soul circulating. i feel like if i were perched on the peak of a pristine ridge, facing the mists of the mountains of asia, i would see the exact same thing that is printed upon the closed linings of my eyelids. i would hang like a hawk in the clouds that create them. watching for little signs of life. if i were a tree clinging to the dirt to survive, i would learn to love the light. i would dance in the rain. i would grow until i died and never once complain. i would do it all again. the green river of revelations. sip slowly. i would move north up the coast. and build a treehouse village bound by bridges. i would make a cabin home. lost within the trees to witness heaven's wisdom breathe and grow...."

Although it isn't what makes his writing great, I, too, have written some journal entries where I completely ditched proper capitalization, like he does here. It's cool sometimes, but oftentimes, it makes the writer seem ignorant and incapable of following proper rules of composition. With this one entry of Jason's, it's the former kind, I think.

I am not a trained writer and so I don't have the fancy names to point out what makes his writing good. I just know it is. The way his descriptions and metaphors and similes just mesh together, it just flows right out of the page.

Idealism, Pragmatism, and Jadedness

2009-05-28T16:34:00.000+08:00

A few days ago, I spoke with one of my dad's associates in the ministry. He is a military official formerly assigned to teach at the premiere military training institution in our country. He has one brother, a doctor now in Singapore.

He asked me about my training plans and I told him about how the US thing didn't work out and about wanting to do residency at the Medical City. He then told me about his brother and the story got me thinking about the events that transpired in my own life these past few months.

His brother and I share the same alma mater. After the medical board exam, he did his residency training in Internal Medicine at the same hospital. Back then, his brother was the type of doctor who, when his patient died, was devastated and cried for three days. He would spend almost all his money on his poor patients, buying them medicines or paying for their lab tests. This even caused some friction between him and his mother.

After residency training, he was supposed to go into fellowship training but then decided to go to Singapore to work on a Masters degree (non-clinical work, I think). After getting the degree, he worked for a Singaporean company that does medical research. He's been in Singapore ever since.

My dad's friend also told me about how his brother, over time, lost his heart for clinical work. Towards the end of training, he somehow became pragmatic to a fault - why save someone when it was futile - when in the beginning, he was all "save, save, save." He tried to return to Manila to practice Medicine but found that there was no space for him at our alma mater so he went back to Singapore.

When asked to describe myself in almost all social media sites, I give the same description: "An occasional writer whose current preoccupation is getting through medical training unscathed and unjaded." And believe it or not, I mean those last few words with all my heart. I am journeying through this medicine thing knowing that I have as much tendency to become jaded as the next doctor-in-training and I don't ever want to become jaded.

I believe there's a very thin line separating being pragmatic and being jaded. And don't get me wrong, there is a place and time for being pragmatic. That thin separating line, however, is more often than not blurred in clinical medicine. That's why I think it's best to stay as far away from that borderline as possible. I'd rather be called an idealist doctor but knowing myself, I probably am not.

In a few months, I will enter residency training and I believe that it is then when the real battle begins. I need to be able to strike a careful balance between pragmatism and idealism without ever once becoming jaded. But the truth of the matter is, it will probably take a lifetime before I ever get there.

Why I Love American Idol

2009-05-21T22:45:00.003+08:00

American Idol's eighth season has come to a close with Kris Allen winning the title. Kris is a 23-year-old worship leader and student from Conway, Arkansas. A few months ago, he was a nobody. And for the next few weeks at least, he will be one of the most photographed people in the entire world. His songs will be charted and analyzed and played by radio stations all over the planet. Such meteoric rise to fame can only happen when launched from the platform of the greatest show on earth at this time.

I personally know some people who have a disdain for American Idol (you know who you are, dear friend) and all it represents. While viewership of the show runs in the tens of millions in America alone, AI has a polarizing effect in some ways. I think this is best exemplified by the website VFTW. Such is their scorn for AI that the editors there have set out as their mission to try and catapult the worst singer to win the title. But for the overwhelming majority of viewers, AI is a more-than-acceptable form of entertainment. It wouldn't be the most popular show on television if it weren't.

I've been following American Idol for quite a while, I think since the third season when Fantasia Barrino won the title. I was in medical school then and the show provided a brief respite from the drudgery of school work. It was an hour (or two) of music, singing, and judging. AI wasn't as popular then, when I started following the show, as it is today. I read an article where Paula Abdul, one of the show's judges, was interviewed and she said that in the early years of AI, it wasn't *cool* to be watching the show. Now, almost everyone is in on the craze (its parallelism to Star Trek and science fiction as a whole deserves entry of its own).

There are, of course, less profound (PC for shallow?) reasons for tuning in week after week: it's great entertainment, it's fun to judge performances, and it's fun to follow favorites. But with Kris Allen's win last night, it dawned on me why I love the show so much. I love the idea of a nobody, albeit a nobody with talent and skill and (to borrow the much-overused-and-abused term on AI) artistry, being plucked out of obscurity and introduced to the whole world. To see that person crowned at the season finale, to see his journey from auditioning along with hundreds of thousands of people on through Hollywood week and the Top 12, it's an amazing thing to witness. One doesn't necessarily have to think, "that could be me," because it certainly doesn't happen to everyone. But the concept that dreams do still come true is, I think, the one thing that has the capacity to captivate millions of viewers each week.

Out of all the photos I've seen this season of American Idol, there are two that somehow represent what I'm trying to convey. The one below is of Kris Allen completely surprised that he made it through to Top 3.

And the other one, above, is of Kris embracing his wife after being declared winner. I think these photographs show with brutal honesty what is in the heart of this previously-nobody-turned-somebody. And that's what I love about American Idol.

An Ethical Dilemma on 24

2009-05-20T04:16:00.001+08:00

The final episode of the seventh season of the TV series 24 was aired on Monday night, US time. It's one of the few shows that I follow almost religiously (the others: American Idol, Fringe, and The Office). I caught the 24 fever from San Francisco, from my hosts there, the Moredos, and I've made sure to keep up with it after I came back home. I remember downloading three episodes at one time because I missed the shows at some point, and as I watched the 3 episodes one after the other, I realized I was palpitating for 3 straight hours too.

I'm not going to give out a lot of details, in case some of my (thousands of) readers haven't seen the season finale. But in that episode, I realized that I've come to develop great respect for the character Cherry Jones plays, US President Allison Taylor. She was confronted with very tough situations and had to make difficult but critical choices. More than all the national security breaches that she had to handle and the innocent lives she had to protect, what most earned my admiration was her decision toward the end of the episode not to cover up for her daughter.

The tension in that White House sitting room was compelling. Jonas Hodges, the villain excellently portrayed by Jon Voight, had a hand in having the President's son killed. Hodges was the same man who was killed as a result of Olivia Taylor's (the President's daughter) machinations. Henry, the President's husband, thought that she had sacrificed enough for her country and that she should destroy evidence linking her daughter to the crime. His reasoning: they've already lost their son, they shouldn't have to lose their daughter too. Not without agony, the President disagreed and gave up her daughter to federal custody. The President later said that she doesn't think her husband would ever understand why she had to do what she did.

I think this raises a very important question. If this situation were reality, do our national leaders have the conviction to make the same decision that President Taylor made? But I also think that an even more important question is one for me (and every single moral being) to answer: faced with a similar situation, will I have the same conviction, the same moral uprightness to make that difficult but absolutely right choice, even if it means harming someone I love?

Schmap Guide

2009-05-01T12:17:00.003+08:00

Just a quick post to let the world know that I am now officially a published photographer ... sort of.

One of my photos has been selected for publication in the Chicago version of an online tourist guide, Schmap. I uploaded the photo to my Flickr account and I guess that's where the publishers saw it. When my photo is clicked in the guide, it leads you back to my Flickr page.

The exact page where my photo of Chicago's Cloud Gate appears is here.

If you're too bored, here's a link to my Flickr page.

Flying to Hong Kong tomorrow for a 4-day vacation (as if I needed more vacation time, with all the bumming around I am currently doing). Plus, I'm finally getting my hands on my new Blackberry Bold. Can't wait!

Googlee, Googler, and Googling

2009-04-15T22:03:00.006+08:00

I would wager that almost everyone who's had an encounter with the Google search engine has "googled" their name in some way or form. I guess it's the innate human curiosity that drives one to look for the imprints one leaves on the world wide web. A google search of my complete name (karl evans henson) will lead the googler to (in order of listing) my LinkedIn profile, a website that someone from college made that has my horrendous grad picture on it, a link to this my main blog (that's Chronicles of Boredom, for my Facebook and Multiply readers), and the results of the August 2007 Philippine medical licensure examination.

I only mention the above because I recently found out that someone (from a place in the US that will remain unnamed) has been googling my name. "Karl henson md" to be exact. The results from those particular search terms will unfortunately lead the googler first to a paper, written by Leslie M.D. Helmus and R. Karl Hanson, dealing with treatment of sex offenders (there's even a PDF you can download). There is something seriously jarring about seeing the words sex-offender-treatment.org on the result page after a search of your name. "Chronicles of Boredom" appears only sixth on the list.

More interestingly, this same googler remained on my website for a little less than an hour (I'm assuming) just reading my entries. What intrigues me the most is that I know of absolutely no one who lives in the place where the search originated. And no, I'm not a psychic. I know about the search through my free visitor counter from SiteMeter (does the free plug qualify me for a Pro account?). A screenshot of the sitemeter record of the visit appears below.

Allow me to be clear though. I'm not freaked out (much) by this. In fact, I welcome all visitors to my blog. I just wish they left comments on the entries they read. Oh, and if that person from the unnamed place in the US and who's so engrossed by my entries reads this, I would love to pick your brains about it sometime (or maybe you were just sorely bored?). I assure you this is not an ego trip.

***

I've been tracking my website ever since I created it in August 2004 (I just realized my blog is about to turn 5 years old). Over the years, there have been search terms that seemed to recur and these terms are used by people scattered over a wide geographic area (Europe, the US, Africa, and Southeast Asia). Off the top of my head, these are some of the more common search terms that lead people to my blog (listed in no particular order):

1. chronicles of boredom (I am not aware that I borrowed the title of my blog from another blog or book or something else famous; I can genuinely say that I thought it up. Now it seems there are 2 or 3 other blogs out there so named. I make no claims, however.)
2. charity church mouse (people familiar with psalty and kids praise! would know who she is; people in the Midwest US seem to be most interested in her)
3. driving playlist (this comes up a lot; apparently, many are interested to build their own driving tunes list)
4. meritissimus (I'm assuming these are clerks from UST who are curious about the revalida grading system)
5. oral revalida UST
6. USMLE tips
7. my first autopsy
8. descriptive writing

Every once in a while, someone googles my name. Again, I wish they left comments on my blog. Hehe.

Before I round up this entry, I'd like to give a shout out to KayeFish and dancerinthedark (whose website has recently been abandoned in favor of tumblr. I don't know if she'd like it if I redirect you to her new site). Their blogs seem to send my website a handful of visitors and I think it's a symbiotic relationship.

***

Here's the sitemeter entry of the mysterious visitor (i.e. I'm not lying. Hehe).

Deconstructing the Past Six Months

2009-03-29T08:19:00.003+08:00

The shadows of an idea for this piece started coming to me about a month ago. I knew I had to somehow reflect on and dissect the past almost-six months, a journey that took me to places I never expected to visit, where I met people I didn’t expect to meet, and experience some growing-up that I never thought I would do , at least so soon. As I look back, I can now truly say that the past half-a-year has been the highlight of my 27 years and seven months of existence. There are a myriad reasons for this but it is not all because I got to travel through the greatest nation of our generation. My best attempt at a summary would be to say that the trip has been one bundle of tremendous blessing from the Lord, and even that sounds so deficient to describe what I think and how I feel.

The main reason why I came to the US in October was for my residency application and the Match. Before I left, I had expected to get some interviews, attend them, and wait for the Match results. Through all this, I had expected God to make everything fall into place, according to how I planned things. At the back of my mind though, I knew there was the distinct possibility that God would send me back home empty-handed. As I wrote in the previous entry, that apparently was the case.

I had a Plan B in the event that I did not Match. In my plan, I was to go back to the Philippines and start residency training at the Medical City. I do not know what awaits me at home but I was told that I would have to make changes to Plan B. I realized then that I was once again planning things on my own, without consulting my boss, (to borrow from this blogger) Big J. And so now, I come home with a semblance of a plan, but I have endeavored to seek an approval from the Big Boss upstairs first. I will have a talk with my parents and people whose counsel I consider important and we’ll see where I’ll go from there.

As I think back through the past six months I spent away from home, I am ever more cognizant of God’s perfect and absolute faithfulness to me. He was my comfort when I missed home and my family. He was, and continues to be, my provider and source of grace. Since the Match results came out, He has given me clarity of mind and a tremendous amount of peace, the kind that passes all understanding (Philippians 4:7).

Aside from all the things I have received from Him (and this is one of the main reasons why I wrote this entry), He had such grace to have sent me so many people who, along the way, have been pockets of strength and support, shelter and sustenance, and sometimes, just a good laugh when I sorely needed it. After the Lord, these are the people I would like to honor with this post. I broke down my list by geographical area to minimize the people I might forget.

Jacksonville, FL

The Ibarretas - my home in Florida. Tito Lito understood what I was going through and it made all the difference.
Dr. Pamela Rama - for allowing me a glimpse into the US health care system, for teaching me so much, and for strengthening my desire to go into Cardiology.
Jacksonville Heart Center doctors and staff - for the warm welcome and the fun and easy-going work environment you have
Pastor Ranola and CCAC - for their warmth and prayers
CCAC college group - for interesting (and intense) discussions about the Word, for new friendships; my special thanks to Elika and Jonathan for the drive to the airport.
Lola Lydia Dominguez - for giving me a small peek into my dad’s world before he was my dad

Chicago, IL

The Santiagos - for allowing me to experience a genuine American Thanksgiving and for their support, generosity, and prayers as I prepared for my interview
Frances Alvarez and Margie Amarga - the lunch meet-up was great! I ask again: who would have thought we’d someday be eating deep-dish pizza in Chicago?

New York, NY

Uncle Tito Campomanes - for arranging my accommodations in NY and for the prayers
Pastor Gerry Depano - for taking me in to his home, for driving me around, and for one of the best Italian meals I have ever had
The UST people in NYC (Reiner, Sherilyn, Nikki, Sarah, etc.) - while in med school, who would have thought we’d ever be having dinner (after a walk through pouring rain) in NY?
Jen Joaquin - for the tasty breakfast in that fancy place
Marj Golekoh - for the Step 3 advice and for putting up with my frequent calls as I prepared for Step 3
Colleen Jocson - for the friendship and everything that comes along with it. You’re one of my unlikeliest friends, and I mean that in a very good way.

San Francisco, CA and the Bay Area

The Guimbatans - for the tremendous support, love, and encouragement, and for Tita Pearl’s terrific spareribs adobo and her goofiness
DCFWC - my home church in the US. My deepest thanks for the prayers.
The Balambans - for making the holidays a little less sad and a little more memorable
The Taghaps - for opening their home for me when I needed it (especially to Menchie for giving up her room for me); for the prayers and the friendship between our families through the years
The Rodriguezes - for reminding me of home and church and for commiserating with me about missing the Philippines. I praise the Lord for His faithfulness to your family!
Mike Velarde and Kat Co - for memories of college, some of which I’d rather forget (e.g. Physical Chemistry)
Richard Lim - for the Step 3 materials and the advice
Ryan and Anna Aban - for the yummy Chinese lunch (with matching mini-ipis) and for the old-new friendship.
Ann and JP Riturban - for the coffee and for allowing me to be the first person in our circle of friends to know about the new baby; it was an honor.
Rodney Rivera - for lunch and catching up; you’re always in our prayers, cousin!

Washington, DC, Maryland, and Virginia

The Alpanos - for the rekindled friendship and their generosity and encouragement. Also for Ate PJ’s pag-aalaga while I was there.
Tricia Bes-Whitman and Dindi Patena-Martin - for the nice lunch but more so for the catching up. I was truly pleased to have seen you guys again.
Ross Baua and Oliver Arquero - for the company and the stories from med school
Mylene Moredo - for lunch and the new friendship.

Across the WWW

Carl Arenas - another surprise new friend, for the tips and tricks, and for the YM chats, which really were helpful.
High School friends - for reminding me of what I’m missing back home
Med school friends - for making me miss home more and for giving me one more thing to look forward to when I come home. A barkada dinner is definitely warranted in a few weeks.
SMPJ - for the friendship and the forthcoming FP. I am proud of your accomplishments.
Facebook and the people I interact with on the site - a precious companion throughout all these lonely and boring months
UCSF Library and Daly City Public Libraries - for giving me a cool place to study for Step 3.

Beyond borders, my greatest thanks

The Moredos - no words will ever be enough to express my deep gratitude to this family for everything that they’ve done and given. They shall always be home to me in the US. Thank you for allowing me to be your adopted eldest son, even for a few months. If there’s one thing that I’m sad about in leaving the US, it’s that I’m leaving the warmth and love that I found in your home.
Crossroads Fellowship - my home church, for the prayers and the tremendous amount of support. I am excited to finally see you all again.
My family - No words. Just my love and my eternal gratitude. I’m finally, finally coming home.

The Lord is sovereign. The Lord is loving. The Lord is wise.

On the morning of my flight home, Tito Norman Moredo prayed for me over breakfast. Out of all the things he said and prayed for, those three short sentences were quickly etched into my mind: The Lord is sovereign. The Lord is loving. The Lord is wise. I do not know what tomorrow will bring but I continue to affirm that the future is firmly in the hands of my God and wherever He will take me is where I will best be used for the glory of His name. There is no place on earth I would rather be than there.

Soli Deo Gloria.

Thoughts on Spring

2009-03-21T11:58:00.002+08:00

I have finally realized what all the fuss is about Spring. After months of overcast, grey skies, barren and bald trees and, in some places, inches and inches of snow, the coming of Spring seems to bring with it the very essence of life. The greys of Winter are chased away by the greens and reds and yellows of Spring. The air is crisp and while it is not as freezing as Winter, there still is a bite of cold, which I love.

Today is my last full day in Washington, DC. I spent the morning walking around the Tidal Basin, near the Jefferson Memorial and Washington Monument. I was told the Cherry blossoms have started blooming. There weren’t any full-bloomed cherry blossoms yet but the buds have begun to sprout from the tree branches. In the afternoon, I visited the Arlington National Cemetery. Near the Kennedy Grave Site, the cherry blossoms there are already in full bloom and it was a sight to behold.

There is something romantic about the recent turn of events, now that I think about it. I found out on Monday that I did not Match to any hospital, i.e. I didn’t get a job. The next several days found me calling up programs, sending out emails, and obsessively checking the NRMP website for developments. Through the entire exercise, I have been praying and seeking God’s heart and mind on what He intends for me to do in the coming few months. I have cried my heart out to Him and have pleaded with Him about this. In the end, I will come home jobless but I got something infinitely more precious. I received His peace and this Word:

“For I know the plans I have for you ... plans to prosper you and not to harm you; plans to give you hope and a future.” Jeremiah 29:11

In less than a week upon my arrival in San Francisco, I’ll be flying back home. I realized that, in a way, I’m coming home to a clean slate. I have my plans in mind but I have made a conscious decision to completely trust in God’s leading this time around. I have chosen to stop worrying about my career goals and where I’ll find myself in the next few years. Instead, I have decided to allow God to bring in Spring -- new life, new meaning, and a renewed purpose.

As I was gazing out towards Washington, DC from the Kennedy Grave Site, a thought crystallized in my mind and this has been something that I’ve known for some time. My six-month journey to the United States was never a waste even though I didn’t receive what I came here for. The past six months allowed me to experience new things, meet new people, and nourish old friendships. What a way to end my trip to DC and wind down 6 months of traveling in the US! I’ll be coming home with hundreds of pictures from my trip. But there’s one photo, which I took at the Kennedy Grave Site, that seems to represent the coming of Spring, and I shall close this entry with it.

Perfect Strangers, Perfect Time

2009-03-14T13:56:00.002+08:00

If you were old enough to watch television in the late 80’s, you would probably remember a sitcom on RPN 9 (if you lived in the Philippines; ABC if you lived in the US) about a struggling photographer, living on his own in Chicago for the first time, and his distant cousin, a recent immigrant from Mypnos. I can remember a lot of TV shows as a kid and Perfect Strangers, with Larry Appleton and Cousin Balki Bartokomous, was one of my favorites.

As I was whiling away the time tonight, I remembered this TV show and, of course, googled it. This gave me almost everything I needed to refresh my memory. Then I also remembered the show's opening theme, with the staccatos in the opening sequence and the synthesizers (and David Pomeranz's voice) that's signature 80's. A short search through youtube and google, a quick upload on imeem, and voila! I give you “Nothing’s Gonna Stop Me Now."

Nothings Gonna Stop Me Now - David Pomeranz

Listen to the lyrics carefully. It took awhile for me to understand why, for some reason, this song popped into my head but I figured out the serendipitous happenstance. Something big is gonna happen next week and this song just came at the perfect time. For good or ill, I’ll write more in the next few days.

Seat 10F (An exercise in descriptive writing)

2009-03-04T14:24:00.000+08:00

I look out my window. The rain is pouring over San Francisco. The sky is gray and bleak. There are airplanes waiting to take off, giant beasts of the air, now tempered and tame, and wet. I am on board a Continental Airlines Flight 1444, flying out of SFO to George Bush International in Houston, TX (IAH). I am the passenger seated in 10F.

Looking out from my window seat I see the outer glass is wet, the water droplets clinging stubbornly to the surface. By now, the rain has all but stopped. The occasional droplet of water from the gray sky falls on one of these droplets on the glass and together, they become a drop large enough to escape the hold of the window pane and slide down. I can imagine the water molecules interacting with the surface of the glass and I feel like a geek.

The plane starts moving.

Inside the cabin, it smells like stale air, air that has been in a switched-off air-conditioner for too long. It reminds me of the smell and the air that’s blown on one’s face when one rides the buses that plough Manila’s main thoroughfares. A baby girl, a few rows in front of me, Seat 6F I think, cries incessantly as she sits on her father’s lap. I am slightly annoyed and want to block the sound by plugging my ears with earphones. But I don’t.

There is a man to my left, on Seat 10D. He is reading a tattered copy of USA Today. A tall, caucasian man, he might be in his early or mid forties. Seems like the business-guy type. His tan corduroys remind me of my blue ones back home. There is no one in the seat between us, 10E. I then notice that the flight wasn’t full at all and there are plenty of empty seats. It doesn’t matter as I got the seat I wanted, window and near the front of the cabin. The man, finished with the editorial page, puts the paper down on the seat between us, folds his hands over his belly, and closes his eyes.

After some taxiing, the plane is still again and we’re in the middle of a side runway. Outside my window, on the tarmac, a yellow-and-white pick-up truck sits, its headlights turned on and, by the looks of it, the engine running. There is probably a driver inside, but I am not sure.

The pilot’s voice can be heard on the speakers. “Ladies and Gentlemen,” he says, “we’re flying out in five to ten minutes.” The delay is probably caused by the rain and the poor visibility. We’re moving again, turning left then right then left again, onto what I think is the main runway. The movement scares the little girl in 6F and she cries louder.

I was wrong. The plane continues to taxi down the runway, not the main one. We turn right. Another Continental aircraft speeds down the runway for take-off. We are parallel to the main runway, apparently. This aircraft is closely followed by a gray airplane, probably United Airlines. I’d describe the make of the plane (Boeing, Airbus, etc.) but I am not familiar with those things as much as my father and brother are.

I can no longer see the airport building. There is only this expanse of concrete and grass. The horizon is charcoal and vague. The rain has stopped.

The plane’s engines start to get noisy and I think we are about to take off. We make another right, the last one I’m hoping.

I am clearly wrong. Again. We are slowing down and the plane finally stops its forward motion. I am getting impatient. It is no joke to write without a table, using one’s lap for that purpose. My consolation is that I am writing using an excellent pen: a black Waterman Phileas fountain pen with blue ink. I also do not have proper paper and I am presently writing on the empty back pages of the book I’m trying to finish: “A Heartbreaking Work of Staggering Genius” by Dave Eggers.

The pilot is once again heard and he assures us that we’re flying out in five minutes. Right.

But this time, he’s really right, I think. The engine is revving up again. Could this be it?

No. Another United Airlines plane will go first, followed by what appears to be a white private plane. It’s been two minutes since the last announcement by the pilot.

We make a right turn and I realize that we’re finally on the main runway. The tarmac is clear, a whole stretch of smooth gray concrete lined by little yellow lights. The plane’s engine revs up, louder than what we heard earlier. The plane starts gathering speed, runs down screaming through the runway. I notice that the wind wipes my window clear of water droplets. I feel the nose of the plane rise from the ground. In an instant, we are in the air, gliding up to several hundred feet. Finally.

I feel my ears pop.

Musically Invigorated

2009-02-11T11:16:00.001+08:00

Let me start off by saying that I was recently musically invigorated. I had the opportunity to see Jamie Cullum's concert on DVD, "Live at Blenheim Palace." I was reminded of why I consider him as one of my all-time-favorite musicians. He was a spectacular showman, a little OA sometimes, but spectacular nonetheless. He is a master at the piano and has a voice that is at once both cool and raw. At one point in the concert, he used his Yamaha grand piano as a percussion instrument, like bonggos, only it was made of shiny, expensive black wood and strings. The percussion routine was used as an intro to one of my favorite songs of his, "Next Year, Baby." It was also in this concert that I was introduced to a song that I have heard often before but never paid attention to: the Beach Boys' "God Only Knows." I did a bit of research on this song (by reading this) and I find the background story of its origins fascinating. Although it is a love song, what made the song special is that it reminded me of home and how much I miss it.

Here's a video of Jamie Cullum singing his version of "God Only Knows." This was arranged for the string quartet by his bass player-slash-band leader, Jeff Gascoyne. Enjoy!

The City by the Bay

2009-02-01T17:15:00.007+08:00

It is the first of February and I realized that I have not written anything here the entire month of January. My friend/ex-resident/avid blog reader KayeFish suggested that it was about time I updated my blog. She was right.

The only problem is that I don’t know what to write.
By way of an update, I’m still waiting for things to happen. I still don’t know what tomorrow will bring and I certainly don’t know where God is taking me. So I wait. And wait. I’m slowly learning one of the big lessons God has for me: patience.

While waiting, I haven’t been fully unoccupied. I’ve taken the USMLE Step 3 after a 2-week study (for those unfamiliar, that time is extremely short to do any kind of serious studying). I’m waiting for my score to come out.

I have also gone around downtown San Francisco a few times. During these trips, I am surer by the moment that San Francisco is my favorite city thus far. Maybe after I visit Europe to see Rome, Paris, or London, I’ll know for sure (when this will happen only God knows). There is a certain homeyness about San Francisco that I did not feel in the other big cities like New York, LA, or Chicago. The winters here are not so harsh and the frigid, white stuff is never seen. Try as I might, my affinity and affection for San Francisco can't really be explained. I guess, except for Manila, out of all the places I've been to, this city is where I feel most comfortable.

One of my favorite spots in the entire city is in the UCSF Kalmanovitz Library. Starting from the third up to the fifth (top) floor of the medical library, you get a stunning view of almost the entire city, including the San Francisco Bay and the Golden Gate Bridge. On a clear day, one can see the crystal blue waters of the Bay reflecting the sun’s rays and the tips of the columns of the famous red Bridge.

Here are some photos I took while I was there studying for Step 3.

Some more SF photos on my Flickr account.

I have a few more places I’d like to visit in San Francisco before I come home. On my list are the Palace of Fine Arts and the Presidio area in the northern part of the city, Golden Gate Park and possibly the De Young Museum, San Francisco Museum of Modern Art, and a return visit to the Yerba Buena Gardens. One of these days, I’ll get myself some clam chowder on Sourdough Bread at the Fisherman’s Wharf.

I was recently listening to the new album of Tony Bennett, one of my all-time favorite singers. I love his original rendition of this one song that almost captures what I will most definitely feel on the flight back home to Manila.

I Left My Heart In San Francisco - Tony Bennett

Don't get me wrong, though. I can't wait to come home to Manila.

Only in the Philippines?

2008-12-10T04:46:00.002+08:00

You know the quip we Filipinos always like to use when we see something interesting or irritating about our country or a fellow Filipino? "Only in the Philippines!" This was the first thing that came to my mind as I was reading this article on the NYT.

Although this article does nothing to change the fact that our government is still heavily corruption-ridden, I'm happy to note that, certainly, it isn't "only in the Philippines."

Status Update and Reflection

2008-12-09T08:04:00.005+08:00

I am a big believer in a personal God. Unlike the god of Spinoza and Einstein, I believe that God is concerned with the affairs of men. He knows about and sees to the events of my life. I pray to Him and He answers in one form or another. This concept is a core belief in my life and world view. Having said that, I want to share with you, dear blog readers, what is going on with me at the moment.

I submitted my application to US hospitals for residency training in September 2008. I originally sent out 43 applications. As time went by, I added more hospitals to my list and I have sent out a total of 53 applications as of today. I don’t expect to be sending out any more. Out of the 53 applications, I received rejection letters from about half that number. I have also received one invitation for interview. I’m flying to New York tomorrow, from Chicago, to attend that interview on Wednesday.

This situation I am in, the lack of choices for hospitals, has led me to evaluate my options in light of that core belief I talked about earlier. I feel that I am faced with three possibilities at this juncture.

First, there might be more interview invitations to come in the next few weeks. I find this unlikely, to be frank about it. Most hospitals receive an average of 3,000-4,000 applications. At this point in time, most hospitals would have sent out all their invitations already. This scenario is unlikely but still possible.

Second, God has made my life easy and has limited my options to that ONE hospital He meant for me to work in. That means my interview will go well on Wednesday and I will either be offered a job (pre-match) or I will match to this hospital come March 2008.

Third, God wants me to go back to the Philippines for training. This last possibility is what I am least prepared for. After spending thousands of dollars on examinations and travel expenses, this option would seem like a waste of resources and time. On the other hand, I also believe that God is ultimately the Source of all the money I spent so it doesn’t really matter to Him. This is an important lesson I’ve learned from my chief financiers: my parents.

A wise old friend told me something, well, wise: “God is more concerned about your character than your career.” God is most concerned about my character above anything else, really. These past few months have been a testament to that. He has taught me so many important lessons, not the least of which is patience. If only for the character-transforming lessons I’ve been taught, this whole experience -- the 3 USMLE tests, the trips to the US, the tense and obsessive checking of emails for news about my applications, the living with other people and adapting to their way of doing things, missing home -- this experience would have been worth it. If God intends for me to stay in the US for training, that would be great. But if it turns out that God is indeed sending me back home, well, I’d be very disappointed, to be honest. But I would also be comforted by the knowledge that however things turn out, THAT is the BEST path that God wants me to take. In the mean time, I have nothing else to do but to wait on the Lord.

Doovde

2008-11-16T06:37:00.003+08:00

I am so bored these days that I start reading on the internet about obscure British comedy programs. One of them is called Fonejacker. The show features a series of prank phone calls involving a number of characters performed by Kayvan Novak, a British-Iranian TV actor. Fonejacker won the BAFTA award for Best Comedy Program this year.

Here's a sample. It's absolutely hilarious.

Extended Adolescence

2008-10-25T11:02:00.003+08:00

It has been two months since my last post on this blog. I can claim to have had nothing interesting to say these past two months but that would be a lie. So much has happened. The thing is, I refuse to publish most of my thoughts on it. It's all written in my moleskine. Who knows, I might get famous someday and my journals will get published.

It's been three weeks since I arrived in the US. The trip was uneventful but last minute changes in the ticket and $150 allowed me to arrive in the US in style -- business class all the way. Thank God for Northwest's generous frequent flyer miles policies. Jet lag was virtually nonexistent for me. A few days after arriving in Jacksonville, FL, I started my observership at the Jacksonville Heart Center. It's been fun so far and I'm really learning a lot.

Life in the US, the run-of-the-mill, daily-grind, non-vacation life, is difficult. I wash dishes (albeit most of the time with a dishwasher) and do my own laundry. I scrub the bath tub and toilet once a week. For the first time in my life, I iron my own office clothes (the others remain rumpled). I vacuum my own room and tidy up after myself. I wasn't a don back home but at least we had a wonderful house helper who did these things for me. It didn't take me long to adjust to the routine but I sure miss my life back home because of these changes. I also must say that I am not complaining. I'm blessed to be living with a family that opened their home to me without hesitation and I am grateful to them, especially considering the fact that they are not blood relatives. It's just the way life is lived here, I guess.

***

I was hanging out with our Physician Assistant (PA) at the hospital the other day. Note that this guy, a white American, is exactly my age, 27 years old. He was telling me about how they're looking for a new home, he and his girlfriend. He went on and talked about mortgaging and how much it would cost both him and his girlfriend to pay off the home loan per month. He also talked a bit about the student loans he was still paying for. He'll basically be in debt for the next 15 to 20 years. He mentioned some stuff about credit ratings and credit history and how he's already opened an IRA, a retirement account. He talked about budgets and having enough extra money to occasionally eat out.

This guy was my age and we worried about totally different things. I thought that I would never have to worry about the things he's worrying about if I would stay in the Philippines. And that's not something I want to happen. I don't want to add numbers to my age and still not know about paying off credit cards and other bills and budgeting my own money. In the words of one of my best friends, "You're too sheltered here." I won't argue with that. On the flip side, talking with him about these things made me count my blessings. I think it's a huge blessing from God to have finished college and medical school and still be debt-free. That's just a fundamental difference between the American and Philippine educational and cultural system. Back home, I wouldn't have had to worry about home loans for a few more years because I'm not pressured to move out of my parents' house at my age or, for some people, at any age.

Medical students really do undergo an extended period of adolescence. While our contemporaries were off looking for jobs, attending corporate meetings, and earning real money, we were slaving away inside a classroom for 4 years, reading thick books and taking periodic tests. After taking the medical board exams and as I was applying for moonlighting jobs, I realized that the issues I faced then, at 26 years of age, were the same issues that most of my high school classmates faced 5 years before. How should I format my CV? What should I wear to the interview? How much is the starting salary (or in my case, the PF per hour)?

I get to thinking, was Medicine worth all this extended adolescence? Absolutely.

No matter how this residency application turns out, whether I get to stay in the US for a few years or I return to the Philippines in a few months to start my residency there, I am certain that I'm turning a new page and starting a new chapter. I think I'm finally about to start facing what some people call the real world. And I have a lot of growing up to do.

Bittersweet

2008-08-24T00:46:00.002+08:00

I booked my flight to the US tonight. I'm leaving on October 4 for Jacksonville, Florida, where I'll be doing a month-long observership with a Filipina cardiologist. I'll be staying at the home of my dad's godson. Who knows where the Lord will take me after that. It depends on which hospitals invite me for interview. But I do plan to be based in California after my stint in Florida.

As I clicked on the 'purchase ticket' button at the Northwest Airlines website, a wave of melancholy swept over me. I realized that I'll be away from home for a little less than 6 months. This certainly isn't like your usual vacation or holiday. During this time, I will be dependent on the kindness of distant family and close friends for shelter and food. I will basically be living out of a suitcase for the better part of those 6 months. But the part that really saddens me is that this trip is a prelude to a longer, more permanent one. Should the Lord allow me to match at a hospital in the US, I'll make one more trip back to Manila in March. Time enough to fix my visa, take a short break before toxicity creeps back into my life, and say goodbye to family and friends. Come June 2009, I'll be handing a one-way-ticket to take me back to the US, where I will stay for about 7 years.

Don't get me wrong. This is my dream. This is what I've worked for this past year, with all that studying and the exams that I took. But now that everything is finally falling into place and it looks as if the dream might finally come true, I am hit by the reality that I'm finally leaving home. It's a bittersweet realization, this one is. One that came earlier than I would have preferred.

Catching up on current (WWW) events

2008-08-15T23:31:00.003+08:00

A woman was filming the landscape from her balcony as heavy rain was pouring down. On her left hand was the camera and her right hand was holding on to a metal railing. She was struck by lightning and survived unscathed (I have a bit of doubt about that but I'd have to review my physiology textbook and I'm too lazy for that now). Here's the video. It would be pretty funny if it wasn't so harrowing for that woman. My favorite comment by one of her friends: "Oh my god, I was laughing hysterically until I realized that it actually struck YOU! Now I am feeling totally morose. Can you imagine if we'd lost you?? I'm so glad you're okay."

Okay, okay. I admit it. I laughed pretty hard. :-)

***

Forget Michael Phelps and his run for 8 gold medals for a minute.

Ryan Lochte, world-record-breaker and 2-time swimming gold medalist for the US in the Beijing Olympics, said he's been eating McDonald's almost every meal since he got to Beijing. So much for Super Size Me.

All links via kottke.org.

The last time I got a bad case of palpitations

2008-08-06T23:18:00.003+08:00

... was when I received an email from ECFMG tonight telling me that my score report for the USMLE Step 2 CS exam was available for download. This was the practical test I took in Los Angeles on June 19. The minute I saw the sender (onlineservices@ecfmg.org) on my inbox, my heart started racing. I've been waiting for this email for a little over a month. And when it finally came, it was a few hours earlier than I had expected. I was expecting the email to arrive a little past midnight but I received it at 10:27PM. I was totally unprepared for it.

Logged in to ECFMG. Clicked on Score Report Information. When the page finally loaded after an eternity of waiting, I was met by this:

Without having to download the actual score report, I knew that I had passed the CS exam. My heart finally decelerated a little bit. If I had failed, I wouldn't have been ECFMG-certified. Being ECFMG-certified only means that I am now eligible to apply to residency programs in the US and that if I do, they'll actually pay attention to my application. It's a big step in some ways but I still have a long way to go in terms of trusting God and waiting for things to happen. My next uphill battle is the 2009 Match and all the procedures that come with it (residency application, interviews, etc). I get impatient sometimes but I know that no matter how things turn out, God's ways are higher than mine and that His plans are perfect. I just need to learn to trust Him completely. And that's not such an easy thing to do sometimes.

ERAS Documents Received

2008-07-31T22:17:00.004+08:00

Sent out my ERAS documents on Tuesday. I saw this on the UPS tracker tonight:

The only thing left to do now is to wait for September 2, when we can start electronically submitting our applications and residency programs can start downloading them. It's gonna be a long wait.

Dr. Randy Pausch, 47.

2008-07-26T23:32:00.002+08:00

Dr. Randy Pausch was diagnosed with pancreatic cancer in September 2006. He was told that he has a few months to live. While that is the story of the thousands of patients with cancer, the unique thing about Dr. Pausch was that he inspired millions of people to live with purpose and meaning. A month after his diagnosis, he gave a traditional "last lecture" to colleagues and students in Carnegie Mellon University. This video has been seen by millions through the wonders of the internet. He gave a brief version of this lecture on Oprah and it has also been published as a book.

I've been reading about Dr. Pausch's progress in his blog and I am saddened to know that he has finally passed on, on 25 July 2008, after battling with the cancer for almost 2 years. In a sense though, it is a good thing that he's died after suffering through so many cycles of chemotherapy. He was also fortunate in that while he was initially given only a few months left to live, he lasted 2 more years. He got to spend more time with his family and saw his 3 children grow up a little more before he said a final goodbye.

I honor the memory and the life of this man. I have seen the video of his lecture about a year ago and it was truly extraordinary. His punch line at the end made me cry. It is worth your while to spend an hour to see it.

Dr. Michael E. DeBakey, 99.

2008-07-12T23:33:00.002+08:00

Dr. Michael E. DeBakey, world renowned cardiovascular surgeon, died 11 July 2008. He was 99. He was a pioneer in cardiovascular surgery and is known for inventing many surgical instruments and devices. I best know him as the namesake of the DeBakey forceps. Apparently, he was more brilliant than just being an inventor of some dissecting surgical forceps. A NYT article pays tribute.

I'm Back Home

2008-07-06T20:24:00.006+08:00

Landed in Manila on July 1, 2008. I had a splendid 14 days in the US. I met some old friends in LA (thanks for the meals, Jen&Chey, and Mel!) and I was able to take a stroll down the streets of my beloved San Francisco. Can't ask for anything more.

Pictures from my trip: my Flickr account

I bought an album from Amoeba Records on Haight St.: Chris Sligh's Running Back to You. Posted a review on my Multiply account.

Also, waiting for me on my bookshelf:

Einstein: His Life and Universe by Walter Isaacson (currently reading this; I've wanted to get my hands on this for months. I'm not sorry I bought it. It's very interesting.)

One L: the Turbulent Story of a First Year at Harvard Law School by Scott Turow

Bancroft Strategy by Robert Ludlum (in hardcover, for $7!)

Bedside Manners

Post-Step 2 CS Catharsis ... Sort Of

2008-06-21T02:03:00.005+08:00

This entry was initially intended as the last of my catharsis pieces on my USMLE experience. I had written about my first two tests here and here and this was supposed to be the third one. However, a close family friend and my mom’s high school classmate, Tito Excy (I found out he and his wife are among the readers of my blog, now with a readership of a whopping 5 people in the entire world), brought us to this restaurant in Glendale for dinner, right after my exam in El Segundo. That meal completely overshadowed whatever doubts about and misfortunes I had on the test so I decided to talk about that first before the Step 2 CS catharsis.

Let me start by saying that I have tasted one of the best pesto dishes I’ve ever had in my entire life. And no, I’m not trying to exaggerate. My only regret is that I wasn’t able to take a picture of my meal. The pesto dish was even better than my own pesto (ha!). The restaurant is called Louise’s Trattoria (I highly recommend that you click on that link!). The branch we visited is along Los Feliz Blvd. near Griffith Park in Glendale, CA. They have 10 restaurants scattered across the Los Angeles area.

Louise's Trattoria on Los Feliz Blvd.

Now about this entry’s main event: California Fettuccine (it's a new menu entry so you won't find it on the website). The noodle was a rich egg fettuccine that will fill your tummy after the first few bites. The sauce was garlic pesto cream with whole pine nuts and shaved parmesan and romano cheeses. It had slices of grilled white chicken meat that literally melts in your mouth, if that’s possible. Making the dish even more satisfying were the grilled green and yellow zucchinis and carrots.

Fettuccine Chicken Pasta. I couldn't find a picture of the dish I ordered but this one's pretty close. Just imagine pesto cream sauce on this, instead of just cream.

Despite the intensity of this pasta dish, I regret to say that I was not able to finish it, not only because it was a large serving (and I only got the half portion), but more so because we were served some of the finest freshly baked bread I’ve ever had before the pasta came. (It is noteworthy at this point to say that I've had very little to eat for lunch, what with all the adrenaline pumping in my veins in the middle of the exam day. Yes ... I, too, was surprised that I had no appetite.) Now, my family and I frequent Italianni’s back home and we’re big fans of their appetizer breads. But this one here, this one just blew me away. They served foccacia and ciabatta with a herbed garlicky coating reminiscent of the garlic bread of Sbarro, but 100x better. It was served hot, along with a herbed olive oil-balsamic vinegar dip, and we were assured that it was freshly baked by their own staff -- I believe them.

Check out that quote on the upper right corner. That's absolutely true, only we didn't have to wait long for it.

Now, for portion size. I got the half serving because I was told they served large portions. If you’ve ever been to Italianni’s at the time when a barrel of crude oil was less than $100 and restaurant servings were bigger, you’d know their serving size. Add about 10% to Italianni’s full portion and you get the half portion of Louise’s pasta. So don’t blame me for committing the mortal sin of doggie-bagging some of the finest pasta known to man. Price? I think the half portion went for $13.99 without tax (don’t convert if you don’t want a heart attack). The full portions were a few dollars more expensive.

Okay, I’m officially done raving about Louise’s Trattoria (here’s the link again, just in case you conveniently forgot to click on the first one. I guarantee you, it’s a must-click.). I’ve used up all my creative juices praising that pasta dish that I now have only a few words to say about the actual Step 2 CS experience.

If you’ve been reading the forums and blogs that give out tips and tricks for CS, then I wouldn’t have anything much more to add to that. The exam was as unpredictable as it was predictable. You come in there, having watched the intro videos and orientation material, knowing what will happen. And yet, once you slide that plastic covering, copy the patient info, and knock on that patient room, you never really know what to expect. Unless you have a computer for a brain, you’re bound to forget some history question or a physical exam maneuver that you should have done. Learn to deal with it. Because when you’re there, going through the motions, there really isn’t any time to think back on what you missed and what might have been. A glaring example: I forgot to do the abdominal examination on a teenager who complained of 5 months missed period and was quite possibly pregnant because I was too focused on a hormonal problem that I forgot my primary differential. I didn’t run out of time. I really forgot to do it, and with a lot of time to spare. That’s just one of the many boo-boos I’ve committed. But as I always say, O well ...

To type vs. to write. I typed my patient note. For me, it was not a matter of legibility but of my cursed forgetfulness. I wanted the functionality of the cursor and the fact that I can go back and insert data at a point where it should appear, and not where I’m writing when I do remember it (does that make sense?). The cut and paste function wasn't bad either.

To wash hands vs. to wear gloves. Coming into the exam, I planned to just wear gloves instead of washing my hands, thinking it would take less time. On my very first patient, without thinking about it at all, I found myself asking permission to wash my hands because that’s what felt comfortable at that moment. Turns out I washed my hands 11/12 times. The one time I wore gloves was when the patient possibly had HIV and I was running out of time. I guess the most important take-home lesson, kids, is that you should do whatever feels comfortable for you. You may decide one thing before the exam but once you’re there, nothing else matters but what feels comfortable at that specific time. I mostly went with my instinct on pretty much all the cases (a lot of good that did me).

I’ll know my score in a few weeks. People ask me how I did. My standard answer: I don’t feel too bad about it but I’m not jumping for joy either. We’ll see in a few weeks, won’t we?

Post-Step 2 CK Thoughts

2008-05-23T23:53:00.002+08:00

*Warning: This is going to be a long post. Also, there won't be any tips on how to ace the Step 2 CK Exam -- I'm not even sure if I passed. If you're "down" with that, read on...*

I’ve been just studying for close to a year now. Doing almost nothing productive with my life (“So what do you do these days?” ... “Umm, I’m currently a bum.”). Just studying. Yes, there were the occasional 24-hour call days at a small hospital near my house or the covering for a physician at a free doctors’ clinic. But this past year, since I finished my internship at the Medical City (TMC) in May 2007, I’ve really only been studying -- for the local Boards, for USMLE Step 1, and most recently for Step 2 CK. I gotta tell you that Starbucks has made a lot of money off of me.

I reflect now on the fact that all that’s about to end in a few months. My life can go in two distinct and separate directions and it most definitely won’t involve just bumming around and studying. Should the whole USMLE thing pan out positively, I will have some interviews in the US come November and will have matched to a US residency program in March 2009. I will have a real job (my first, and with that, my own money) come July 2009. That’s option 1. The second option is when the US residency thing doesn’t work out and I will stay here to train as a resident at TMC, which officially takes in 1st year residents in January. I won’t go into the details that are factored in when I ultimately choose one path over the other but that’s the way things are looking these days. And I really am excited to finally be on the verge of making that decision. Here’s why.

Thanks to kayfish, a senior resident and my former interns’ monitor at TMC, I recently discovered a blog written by the Fake Doctor. I’ve spent almost my entire first Post-Step-2-CK day today just reading his blog right from the beginning, wherein he writes about his med school days (he’s a resident now so he has a new blog and almost 4 years’ worth of entries on this site). I don’t necessarily share all his views on things but I love (but, again, don’t necessarily share) his outlook and cynicism (I just needed that crystal clear. Hehe).

There’s one entry he posted in December 2005, entitled The Fade, that really made me realize how I’ve missed the hospital environment so much. At the same time, he reminded me how much of a whiner I can be while actually in this same hospital environment. I’m sure doctors-in-training everywhere (med students, interns, residents, and even fellows) can understand what he (and I) is (are) talking about. It’s a common thing for trainees to cry out for a “benign duty night” and to sometimes get disgruntled when a patient walks in to the ER with a seemingly harmless condition at 3AM (admit it, doctors reading this!). As clerks, we were upset when we had 8 patients to monitor hourly and your groupmate can sleep through the whole night with not one patient to visit. A nurse pages for you at 2 AM, just when you’ve finished all your paper work and have just also come out of the OR, because you need to read a skin test. Mundane things. Trivialities.

There’s a line in his entry that goes, “‘That's why it was so good?’, she responded quite innocently. ‘I guess I would have figured you'd say something like “I saw an interesting case” or “I met an interesting patient.” ‘“ (how’s that for quotation marks?). This was a friend’s response to him when he said he’d had a “good day” because he got to visit the mall for a few hours during the work day (confusing, but you have to read the linked post in order to get what I’m saying). I realized that in a way, I’ve started to become jaded because of these trivial things, the very thing I set out not to do in the first place (see About Me). It’s like it has snuck up on me, this being jaded thing. It’s really easy to get lost in these trivial things and to forget why I’m here in the first place. But if I’m to really consider these things, most of them (not all, if you’re reading this, Marc) are really integral to our jobs and roles as doctors.

The way Philippine medicine is set up, especially in my experience as an intern in a private hospital, we don’t really get our own patients this early in the game. The residents do, and they have to round on these patients at least once a day, and know their case cover-to-cover. But for us (former!) interns, we see the patient for an IV insertion, and then we’re done. Back in UST, the truly memorable patients to me are those that I admitted and subsequently discharged. They’re the patients that truly stick to my memory because in essence, they really were my patients, under my care. In the fast-paced environment of clerkship and internship, that doesn’t happen a lot (I can count these "memorable patients" in my ten fingers). You admit a patient one night and before you know it, you’re endorsing him to the next guy who’ll take your place in that rotation.

I guess this is my long and winding way of saying that I miss the hospital environment because for almost a year now, I’ve been so drowned in review books and multiple-choice-questions that my jadedness might actually already be eating away at my ideals. The thing is, I don’t know -- and I won't know until I get back to the hospital and see for myself. Only then can I do something about it. I need to start caring for patients again, to admit them and run their labs and see how they progress and feel better with the treatment that I was a part of formulating, and finally to see them discharged improved and stable (although it doesn’t always end up that way).

I happily note that after almost a year of walking into that dark cave of tests and reviewing, I see the end in sight. I’m almost there. I’m finally about to make that important decision and finally move on in my career, and quite possibly, my personal life. I won’t have to make that decision yet, not until August, probably. But I can finally see the proverbial silver lining (did you notice how much cliche' I’ve already injected into this entry?!).

What’s next for me? A trip to the US in June for one final test. It’s going to be a practical exam that’s Pass/Fail and no numerical grade, thank God! Once I get all my scores back, I make my decision. I have a strong feeling how all this will turn out but who knows, God may still have something up His sleeve that will surprise me.

If you’re still reading this, thanks for being interested and lasting this long!

Verbalized Thoughts

2008-05-23T13:34:00.003+08:00

I Still Havent Found What Im Looking for - U2

I'll only go so far as to say that I was introduced to this great U2 song by David Cook, the new American Idol, when he sang this during the Final contest between him and David Archuleta. The lyric is brilliant. Listen closely.

***

Update: Found this on youtube after I posted the above entry.

What'd I say? Brilliant.

Lucia Micarelli

2008-05-16T09:58:00.003+08:00

Wow, I haven't posted in almost a month! My life these days has been reduced to multiple choice questions and coffee, pretty much. But I'm writing now to let anyone who could care to read this know of a discovery I made. The newspaper today had an article on one Lucia Micarelli. She's a brilliant American violinist who has toured with Josh Groban on Closer and Awake. I haven't been able to get a hold of a copy of her album.but I bet it's good. Official website's here.

A video of her playing Joshua Bell's violin solo on Mi Mancherai at Josh Groban's concert at The Greek -- very moving.

Plus, an video of her at the same concert, playing solo (Kashmir?).

Multiply

2008-04-17T06:57:00.002+08:00

A quick entry before I play medical secretary to my aunt today.

There's this magical little button on iTunes (and iPod) that can transform my library of 2600+ songs from an alphabetically arranged list into several million random combinations -- Shuffle Songs. It was in this mode that I found a song I never knew I had. Here's a listen.

The guy's Jamie Lidell and the song, Multiply, is part of the Grey's Anatomy Soundtrack Volume 2. I meant to google Lidell for a long time but was only able to do so this morning. A quick peek at the music video and I was surprised to find that he's white. I imagined a black man singing every time I listened to it. The song's currently on top of my Head-Bob-Causing Songs playlist. Here's Jamie Lidell singing Multiply live with Jools Holland.

The official website's here.

Vote for the 7 Wonders of Nature

2008-04-16T01:57:00.003+08:00

The New Open World Foundation is soliciting nominees for the New 7 Wonders of Nature. The New 7 Wonders of the World was announced on 7-7-07 in Lisbon, also after several rounds of online voting. The current Top 77 wonders of nature can be seen here. The Chocolate Hills in Bohol and the Tubbataha Reef in Sulu are in the 7th and 9th spots, respectively, as of this writing. The Puerto Princesa Subterranean River National Park is somewhere down the line, but not in the top 77. From 77, the list will be trimmed to 21, based on online voting (which ends on 12-31-08), and from the 21 finalists, the final 7 "winners" will be chosen. Voting for the final 21 natural wonders will continue on until the summer of 2010.

You can vote for your favorites (you will need to pick 7) here. You need to register with your

email address.

Here are my votes.

So Who Said Design is Dead?

2008-04-03T01:16:00.005+08:00

Matthew Dent is brilliant. He is a 26-year-old graphic designer from North Wales. The guy won a national competition in the UK for the design of its new coinage. His idea is simple and the results are beautiful. See for yourself.

Via kottke.org.

Coffee and US Politics

2008-04-02T00:40:00.004+08:00

Starbucks looks for a fresh jolt.

I'm a self-confessed coffee lover and Starbucks loyalist, and I'm glad to see them finally going back to their original purpose: good coffee. I can't wait to use my Starbucks card (free drip refills!). Hehe.

***

Chelsea Clinton refuses to answer questions about her dad's indiscretion as POTUS.

"It's none of your business," she says. I beg to disagree. The Monica Lewinsky scandal happened on "company time" and at the White House, not on some motel off the freeway. It should always be a factor in deciding who to vote for. People should be able to decide for themselves if the sexual misdeed matters to them or if they can vote for and live with a President whose husband is a philanderer. What Chelsea Clinton is essentially telling us is that it shouldn't matter to the voters at all, because it's "family business." Of course not. She can choose to say "no comment," but don't tell the voters that it's "none of their business." Because she's campaigning for her mother, who is running for the highest office of the land, she has to face and answer these uncomfortable questions. She should stay home if she's not ready for them.

Dream Bathroom

2008-03-31T21:38:00.006+08:00

Brilliant design, don't you think?

Via Christophe Pillet, a French designer.

Design is Dead?

2008-03-29T13:12:00.000+08:00

I don't get this.

I guess I'm still a believer. Maybe he just got jaded.

Love in the Time of Cholera (Film): A Review

2008-03-26T01:28:00.003+08:00

Not a few people have told me of how awful a movie "Love in the Time of Cholera" is. I was told that the book is one of Gabriel Garcia Marquez's best works and that the film did not do it justice. I avoided reading the reviews, except one, last year. I clicked the play button on the DVD player trying to be objective about the movie and to at least form some original opinions myself. I have immensely enjoyed the novel and have elevated it to my All-Time-Favorite-Books List. Now I must admit that everyone else was right.

I think that the best thing about Marquez's book is his prose -- it is flowing, melodic, and exquisitely descriptive. That man has a way with words. His ideas just smoothly fly off the page and into the deepest recesses of your imagination. There was none of that in the movie. I felt like I was watching a movie so amateurish it had to have been made by high schoolers.

Most of the actors had terrible accents and seemed too artificial and robotic. I've never seen any of John Leguizamo's films, except probably for Moulin Rouge (where I thought he was good), but this must be one of his worst films ever. He was so atrocious as Lorenzo Daza that I just had to laugh whenever he showed up on screen. Fermina Daza was played by the beautiful Giovanna Mezzogiorno. I would concede that she was somewhat believable. And her beauty excuses her, in my book. Javier Bardem, as Florentino Ariza, did a pretty decent job but I (obviously) wasn't blown away. Benjamin Bratt (Dr. Juvenal Urbino) was plain terrible. I think one of the few beacons of light in this movie is Hector Elizondo. He plays Florentino's uncle, Don Leo. Now he was at least entertaining.

Mike Newell botched this. Big time. I really hope someday, some other guy has the guts to pick up Marquez's extraordinary work, turn it into an excellent script that could be made into a film that's worth all of the novel's superlatives.

Official Film Website

Trailer

New Item on Wishlist!

2008-03-24T09:57:00.003+08:00

The 17th edition of Harrison's Principles of Internal Medicine is out. I can't wait to get my hands on it. It comes with a DVD with some 3000 pages of bonus text and images. Sigh. The introductory video at Amazon made me drool.

Geeky, right? Someday, when I get rich, I plan to acquire all the earlier editions of Harrison's, way back to the first edition. Think of it as my version of a comic book collection. I already have the 15th and 16th. I'll probably buy this 17th edition right before I start residency training. I will have to get all new editions after the current one in the interest of continuing medical education. I can't wait to see them all lined up on a shelf in my library. Haha!

Clooney on Esquire

2008-03-18T02:14:00.003+08:00

Read it. It's very funny and it's nice to see George Clooney isn't taking himself too seriously. Also, that video of the monkey they were talking about is posted below, for your viewing pleasure. I didn't attempt to look for the other video, the repulsive one.

Via kottke.org.

New Discovery: Paul Dateh

2008-03-16T23:23:00.003+08:00

As I was browsing through some of my friends' pages on Facebook, I saw this YouTube video showing a violinist and a DJ (on the turntables) playing some great music. The violinist intrigued me because I don't hear a lot of violins played with the "DJ-type" music. I am not one to go for RnB or hiphop (I apologize if I'm equating the two genres -- they're pretty much in the same plane in my book) but the music in this particular video was great. The violinist is Paul Dateh, a musician based in California. According to his website, he has 14 years of classical violin training under his belt (started at age 4) but decided to study Jazz at USC's Thornton School of Music, to the surprise of his colleagues. He has 2 songs available for download free on his site plus the YouTube video I was talking about earlier. There are a few more songs on his mySpace page. He has yet to release his own album.

For your listening pleasure, I embedded his 2 songs via imeem.com. "Celtic Blues" is a guitar and violin duet. In "Get Up" (a cover of Arnel Larrieux's song), we hear Paul on vocals accompanied by some guy on guitar. Enjoy!

myFlickr

2008-03-12T13:14:00.003+08:00

I resurrected my Flickr account and posted my first photo set there. Drop on by if you have time. It will take you to photos we took from the Las Flores View Point in San Diego. It's one of my favorite places in the US and it's only a strip of rest stop on this long highway. The best thing about it is that you have a stunning view of the majestic Pacific Ocean from there.

I have no words

2008-03-11T21:29:00.002+08:00

... Just a whole lot of laughter. Click here or watch the clip.

Pens

2008-03-08T22:44:00.005+08:00

I held my very first fountain pen, a plain blue Parker, when I was in second grade. My elementary school was a stickler for learning their way of writing -- they called it the Montessori Calligraphy. Unlike the usual slanted script most students are taught, the "Montessori Calligraphy" had stout and erect letters that are supposed to stand perpendicular to the lines of the paper. We would spend the first 20 minutes of every Monday morning just practicing our penmanship. I had to suck ink from an ink bottle to refill my Parker then. Nowadays, there are cartridges that you just stick into the barrel. I've never gotten used to those cartridges and have always thought sucking ink from the bottle is the only real way to go. I've always loved fountain pens but I don't have one now. I lost my green Parker fountain pen when I was in medical school for a ridiculous reason I won't even repeat it here.

Anyway, I was browsing through Montblanc's website and stumbled upon these mouth-watering limited Writers Edition pens. The featured writer's signature appears on the pen. My favorites are the Agatha Christie

and the Dostoevsky.

My birthday's not for a few months yet and those among you who are thinking of what to give me as a present, these are definitely on top of my wishlist. ;-p

Graduation Videos

2008-02-27T21:04:00.002+08:00

I've been meaning to post the videos shown during my med school graduation online but I just didn't have the time to tinker with them again. Some people have asked me to do it as early as 2 years ago. The original video was too large for YouTube and I had to break it down into two separate clips. I finally found the time today, prompted by a request from my classmate, Kim. I decided not to embed the videos here. Instead, I included the link to my YouTube channel. You, however, can embed away to your hearts content. Enjoy!

My Channel

Video 1

Video 2

LSS: New Shoes

2008-02-24T13:36:00.002+08:00

I have had Paolo Nutini's album, These Streets, on loop mode in Luke. It was released in July 2006. What can I say, I'm a late adopter. I can't get this song out of my head! It's an excellent driving song and it's the very first one on my Driving playlist (I bumped Better Together by Jack Johnson to second). You should listen to (and see) the live versions here and here.

***

Saw Vantage Point last night. Dennis Quaid and Matthew Fox stars. I think the film was very nicely done but it only got a 38% on the tomatometer. I have to admit, though, that it requires a certain suspension of realism because there was too much coincidence towards the end to make the story plausible. The trailer's here.

***

I'm hoping to infect you all with this just so I'm not alone:

Almost, But Not Quite

2008-02-19T23:29:00.002+08:00

From PostSecret:

I have to admit that I've been severely tempted to do this several times. I don't think I'm alone. I've never gone through with it, thank God.

Thoughts on the Ayala Rally

2008-02-18T00:47:00.002+08:00

This is one reason why the rallies and political demonstrations against the GMA Government would not succeed in forcing her out of office. The first two EDSA events were genuine outbursts of rage and frustration against the incumbent president of the time. Only a shake-up like Ninoy's assassination or the vote against the opening of the bank envelope (and Aquino-Oreta's infamous dancing shown on national TV) would cause the moderates and the rest of the silent majority to troop to EDSA (or Makati, for that matter) and demand change.

Blatant Irony

2008-02-15T11:26:00.004+08:00

My 24-hour stint at the hospital was coming to a close. It was 6:15 AM and I had just started eating my breakfast. The nurse, very calmly, tells me that there was a patient. From inside the room, I could hear very agitated voices. I went to the small ER and found two elderly ladies, one of whom was bearing a child. The child was a few months old baby boy. He looked very pale, almost blue. He was limp and was unresponsive. I could hear no heart nor breath sounds. I asked for oxygen and an ECG and seriously contemplated starting a code (CPR). The problem was I wasn't trained in pediatric cardiac arrest cases (Pediatric Advanced Life Support, or PALS) and I knew for certain that the baby was beyond salvaging. He was dead. The ECG confirmed it for me -- it was in asystole (a flat line).

I started interviewing the lady who brought the child in. She was the grandmother. Her story was very unclear and I guess she was still dazed from the urgency of the situation. The baby was found on the floor, so he probably fell there sometime during the early morning. He was already limp, unresponsive, and not breathing when his father found him. The dad, who I later found out was still quite young, rushed to his mother's house, a few houses away from where they were currently at. The grandmother was roused from sleep and was frantically asked to bring the child to the hospital. I don't know how they came to the hospital, whether they walked or rode a tricycle. About 30 minutes have probably passed from the time the child was found to the time he was brought to the hospital.

As I was writing the patient note, I saw that the baby was born on 12-15-2007. He lived a full two months.

At this time, a young couple came into the hospital. The lady was as pregnant as pregnant can be and she was carefully led by her dutiful husband to a seat. She came in for a consult because painful contractions began early that morning. I examined her and found her cervix to be dilated a little. She had started her labor and would soon deliver her first baby. Inevitably, the couple saw the dead boy on the ER bed next to theirs and would probably hear that baby's story from someone in the hospital. I hope they never get to experience what the dead boy's parents are about to go through: the burial of their young child. I have never seen such blatant and cruel irony. No parent should have to bury their child.

***
Theoden: Simbelmyne. Ever has it grown on the tombs of my forebears. Now it shall cover the grave of my son. Alas, that these evil days should be mine. The young perish and the old linger. That I should live to see that last days of my house.

Gandalf: Théodred's death was not of your making.

Theoden: No parent should have to bury their child.

Gandalf: He was strong in life. His spirit will find the way to the halls of your fathers.

-Gandalf and Theoden, from the film The Lord of the Rings: The Two Towers-

Rumblings from the Deep

2008-02-13T02:46:00.000+08:00

I was reading the paper this morning. The tension in the political landscape of this country was palpable. There's talk of rallies on Friday, the opinion page is filled with ideas of coup d'etat and unauthorized troop movement and monitoring of the media by the uniformed services and of replacing the incumbent. Too many names are being dragged down and tainted by corruption -- and rightly so.

The beginnings of the rumbling and growling that comes deep from the bowels of a society sick and disgusted with the status quo can be heard, faintly but very clearly. This is all too familiar -- surely we haven't forgotten the events that transpired in 2001, or even in 1986? I wonder if this will amount to anything.

I am sure of one thing. Should the ruling government be replaced by another, it will be just as corrupt, or perhaps even more so, but it will be much better concealed. I see no real hope unless all members of government -- down to the lowest clerk of the remotest village in the farthest city -- is replaced, and unless all members of society, from the richest to the poorest, willingly surrender their will to the laws of this land. And that is wishful thinking, of course.

I see no real hope save that found in the Lord. I see this as a time to start seriously praying for the nation.

Strike One

2008-02-10T22:43:00.000+08:00

It's been 3 days since my first 24-hour duty in a very long time. This is the first time I've seen patients in a hospital and ER setting since I became a licensed physician. It was also the time I committed my first real clinical error in judgment.

I was preparing to assist in a Cesarean section delivery that morning. I was in scrubs and was just waiting for the attending obstetrician, who happens to own the hospital where I work, to arrive. The nurse comes in and tells me that there's a patient who came in for consult at the ER. This was about 6:00 AM. So I went out of the OR complex and down to the ER. A six-year-old girl was waiting for me with her father. I greeted them and started taking the history. The girl, very early that morning, started vomiting and had already thrown up 5 times in a span of a few hours. She had no fever, no dyspnea (difficulty breathing), no cough or colds, no sore throat. She had no diarrhea. I asked her if her tummy hurt. She pointed to her epigastric-periumbilical area (that area just below her rib cage and around the belly button). She had not been ill previously and the father said that she wasn't a fussy child so it alarmed him that she had vomited that much already. I completed the history and began my physical examination of the patient. She had normal eyes, ears, and nose. She had no red throat or cervical lymph nodes. Her breath sounds were clear and her heart was fine. As I palpated her abdomen, she said her epigastric area was tender, even with just a slight touch. This made me doubt whether she really was feeling pain. The rest of the exam was normal. She was active and didn't seem sick at all.

I told the father that I thought this was a case of Acute Gastroenteritis (AGE). The history of vomiting and the epigastric pain was consistent with it. I briefly considered appendicitis but the patient had no fever and looked too healthy for me to seriously consider that diagnosis. Plus, in my mind, I had already minimized the epigastric tenderness and blew it off as the child's being OA. But that was essentially my short list of differentials: AGE or Appendicitis. The father asked whether it could be appendicitis (I did not tell him I had considered it) and I told him I didn't think so, and stated my reasons. I told him that I was sending them home with a prescription for Hydrite and an anti-emetic. I wanted to give Motilium but the bottle available at the hospital pharmacy was too big so I decided to just give them a prescription for Plasil syrup. I taught the father how to give the medicine and asked him to observe for progression of symptoms (if the pain got worse or if her daughter started having diarrhea, other indicators of appendicitis). I thought that if this was indeed appendicitis, the pain would progress and he'd have to come back to the hospital. I thought this was highly unlikely and felt confident that the hydration and anti-emetic would do just fine. I felt secure sending them home since they lived only a few blocks away. Also, I was, by this time, rushing to wrap up the consultation as I found out that the obstetrician and the rest of the OR team were waiting for me to return so I could assist in the CS. I thought that if it was appendicitis, my friend Angel, who was relieving me from duty that morning, would admit them and they'd be in good hands.

I later found out that the father and daughter had returned later that day. The little girl was initially able to tolerate the Hydrite but soon, her vomiting had worsened and she had to be brought back to the hospital. I think she was also running a fever by this time. Angel was smart enough to do a urinalysis and found that she had a Urinary Tract Infection. She was admitted to the hospital.

We were taught in Medical School that in a pediatric patient who presents with vomiting, the first three things that are to be considered are Acute Gastroenteritis, a sore throat, and a urinary tract infection. It's such a well known rule of thumb. The possibility of a UTI had never entered my mind so I never thought to ask for a urine sample. Had I done so, I would have seen pus cells and bacteria in her urine, I would have sent her home on an antibiotic and possibly an antipyretic, and she possibly wouldn't have returned to the hospital with worse symptoms because the antibiotic would have started its work sooner. As soon as I heard from Angel that the patient had UTI, I felt so incompetent as to never have considered that diagnosis. I received my MD with a cum laude under my belt, a Meritissimus in the Oral Revalida, a Medical City Most Outstanding Intern award in Medicine, in Pediatrics (in PEDIATRICS!!!), and Over-All -- and I missed such a simple diagnosis. I realized that I had bluffed my way through medical school and internship training. I'm really just playing pretend (doctor-doctoran, if you will). All the theory that I knew crumbled in the face of a 6-year-old patient and her vomiting. What if the patient had a worse diagnosis but had a lighter chief complaint? I probably would have killed that patient.

Maybe some of you reading this would think I'm just as OA as my patient (OA means over-acting, FYI). I don't think so. I'm not being overly critical of myself because any doctor can tell you that I should have considered UTI and should have done a urinalysis. My residents have always pounded that into my head. When I was finally left to my own devices, my brain turns to mush and I send her home with Hydrite and Plasil (PLASIL, for heaven's sake!). And here I was, scared of getting a code when I couldn't even properly manage one of the simplest pediatric cases known in the medical world.

Alright, I think that's enough berating of myself. I'm currently reading a book called "How Doctors Think" by Jerome Groopman, a Harvard doc and a staff writer at the New Yorker. He talks about the many cognitive errors doctors commit when thinking through their patients cases. I see myself in most situations that he writes about, and I'm sure all doctors would too. He reminded me that clinical medicine, for all its being evidence-based and research-oriented, is still an art. That means there is much uncertainty in the practice of healing and it doesn't help that the way one patient responds to a given therapy can be totally different from the next patient one sees. I am reminded that I need not only to thoroughly master my craft and know my stuff but also to consider each and every patient as a unique case -- this is where the art of medicine comes in. Doctors can't be trapped into conveniently fitting their patients into stereotypes or patterns or molds, as we're taught to do in medical school. It's true that most patients would probably fit into most of the patterns or molds available to us but there will always be that one or two who don't and since we're dealing with real God-given lives, we can't risk being careless. I never realized all this while in medical school. It seemed to me then such an abstract thing, something to be discussed in class in order to get a good grade. It's now all very real to me because now, I have a license that is at stake every time I see a patient and every time I sign a prescription or a patient record. More importantly, I am directly responsible in the care of patients, human beings and creatures of God. I'm filled with fear and awe that I have such a huge responsibility before me but I've chosen this life and I accept the responsibility glad-heartedly. It is my God-given calling. In this instance, fear is a good thing.

Pre-Duty Politics

2008-02-07T07:45:00.000+08:00

A few links and news bits before I leave for my first 24-hour duty in a very long time.

****

Philippine Star columnist Alex Magno slams the ousting of JDV. It would have been an unremarkable thing had he been just any other opinion writer. But Magno's always been intensely pro-government, at least in the economic and most other political issues, to the point that some people call him a government parrot. But as I said previously, there was something bitter-tasting in that business on Monday night.

***

Democrats still split, almost evenly, between Obama and Clinton. Clinton has a little bit more delegates than Obama and she won the delegate-rich states (California, New York) but Obama won more states on Super Tuesday. CNN analysts say that the drawn-out battle between the two Democratic candidates will probably be good for Obama. I hope so. There's also talk of getting them on the same ticket. I have no problem with it, as long as Obama's running for President. Here's why I think that way.

Thoughts on the JDV Vote

2008-02-04T18:55:00.000+08:00

As of this writing, the House of Representatives is voting on a motion to declare the position of House Speaker vacant, i.e., whether they will remove current Speaker De Venecia from his post. According to the ABS-CBN update (I won't post a link here as I think it won't be active tomorrow), the Yes votes (those against JDV) are leading.

I have always been a fan of Gloria Arroyo's economic policies and I've said so in this corner, several times, I think. But there's something about this business that bugs me. Will this finally be the undoing of GMA? Who knows what will happen tomorrow.

I have to admit

2008-01-24T06:38:00.000+08:00

that I feel the highest form of embarrassment and the worst kind of humiliation when I see this guy's video. I wish he was of a nationality other than Filipino. I hope I'm not alone in feeling this way. I didn't even have the heart to embed his youtube.com video here and compromised with this link. I know this video's been making the rounds and people find it funny. I find it absolutely disgusting.

Heath Ledger, 28

2008-01-23T17:31:00.001+08:00

The lead actor in such films as A Knight's Tale, The Patriot, and Brokeback Mountain, was found dead at his SoHo apartment yesterday afternoon. The body was discovered by the housekeeper face down and naked. There was no suicide note but two bottles of sleeping pills were found in the apartment. He had an appointment for a massage that afternoon. The family rejects the idea of a suicide.

One of his latest movies out is "I'm Not There," in which he "played one of the many incarnations of Bob Dylan." Cate Blanchett was nominated for best supporting actress for her performance in that movie. Ledger will be seen next in Batman playing The Joker.

Here's a slightly slanted piece on his supposedly wanting to destroy his own career.

A slightly more positive look at his life.

The Nominations are out

2008-01-23T01:53:00.000+08:00

for the Oscars 2008. Some interesting points (and my thoughts):

For best film: Atonement, Juno, Michael Clayton, No Country for Old Men, and There Will Be Blood. I'm interested to see at least one of them: Atonement.
Johnny Depp (Sweeney Todd) and Viggo Mortensen (Eastern Promises) are nominated for Best Actor. Others: George Clooney, Daniel Day Lewis, and Tommy Lee Jones.
Cate Blanchett is nominated twice, in 2 separate categories. Wow.
Casey Affleck is nominated for supporting actor, for Jesse James. Brad Pitt, the lead, is not on the list. Jesse James is also a film I want to see.
My vote for Best Animated Feature: Ratatouille, of course. It's my favorite Pixar movie (Finding Nemo's a close second).
Allan Menken and Stephen Schwartz are nominated thrice: 3 songs from Enchanted. Yes, I've seen the film (with my dad -- haha!) and I thoroughly enjoyed it.
Most nominated films (8 each): No Country For Old Men, There Will Be Blood. Atonement and Michael Clayton have 7 nominations each. And (surprise, surprise) Ratatouille has 5.

The Awards presentation will be on 24 February 2008.

On Luke: Driving Playlist

2008-01-21T01:06:00.001+08:00

I thought I'd share my driving playlist on Luke (my iPod). These are, of course, current favorites and not an "all-time" list. They are listed in no particular order.

(Edit: imeem.com previews for the Top 10 songs)

1. Better Together - Jack Johnson (In Between Dreams)

2. Save Me - Josh Verdes (Single)

3. These are the Days - Jamie Cullum (Twentysomething)

4. Grateful - Julianne (Single)

5. One Week Last Summer - Joni Mitchell (Shine)

6. Suddenly I See - KT Tunstall (Eye to the Telescope)

7. Heart of Mine - Peter Salett (Keeping the Faith OST)

8. All The Things - Rotari Klub (Mercedes Benz Mixed Tape 18)

9. Never Know - Jack Johnson (In Between Dreams)

10. Tulak ng Bibig - Julianne (Single)

11. Full of Voices - Maximilian Hecker (Mercedes Benz Mixed Tape 6)

12. The Song of the Heart - Prince (Happy Feet OST)

13. It Takes Two - Zac Efron (Hairspray OST)

14. Put Your Records On - Corinne Bailey Rae (Corinne Bailey Rae)

15. Stitched Up - Herbie Hancock feat. John Mayer (Possibilities)

16. How to Save a Life - The Fray (Grey's Anatomy OST Vol. 2)

17. Train Wreck - Elliot Yamin (Elliot Yamin)

18. Infatuation - Maroon 5 (It Won't Be Soon Before Long)

19. As - George Michael & Mary J. Blige (Single)

20. Cruisin' - Gwyneth Paltrow & Huey Lewis (Duets OST)

Suggestions for excellent driving songs are welcome!

New Treasures from Isteyts

2008-01-18T23:57:00.000+08:00

The LOTR Extended DVD boxed set
My hosts in San Francisco, Tito Norman and Tita Mae, bought this for me. It's a previously owned set sold in Amoeba Music for $50. I think I got a great deal with this purchase. The DVDs are pristine and the pamphlets are nearly so. The original price for this was $80. I consider this one of the best deals I made in the US. Also, buying the DVD resulted in my best discovery: Amoeba Music.

Amoeba Music has branches in San Francisco, Hollywood, and Berkeley. The San Francisco store is on Haight street, the Hippie capital of SanFo. The store is a huge warehouse-like place with all the CDs and DVDs you can ever imagine. A lot of them are sold cheap because they were previously owned. The DVD collection is vast and most are in good condition. It was a pity that I discovered this store on my last night in SanFo. I probably would have blown all my cash away here, if I had known about it earlier. On second thought, maybe it was best that I found out about it late. Hehe. If you'll be in SanFo in the future, you HAVE to pay this store a visit.

P.S. I started watching the extended movie. Excellent.

Love in the Time of CholeraI had my eye on this book even before I left for the US. I knew for a fact that books are sold cheaper here in Manila. After my first trip to the US, I vowed never again to buy books there. However, I saw this Marquez book in Barnes and Noble in Tanforan and it was on sale. I did a quick conversion and found that it was cheaper there, with the discount, than if I bought it in Fully Booked.

I heard that the movie (starring Benjamin Bratt, Javier Bardem, and Giovanna Mezzogiorno) isn't so good. I'd still like to see it though, but only after I've finished reading the book.

P.S. I think Barnes and Noble is one of the best things ever in America.

The Kite RunnerThis was bought on an impulse at the San Francisco International Airport. I had never heard of Khaled Hosseini before but the book was highly recommended by my tita. I also have not seen the movie. I intended to buy the book in Manila but as I was browsing through the airport bookstore, I saw this decided to buy it there at the listed price of $15. I was at Fully Booked earlier today when I saw the book. A quick conversion told me that I spent P56 more than if I bought it locally. Too bad. That's what lack of impulse control can do to you. Hehe.

"There's Something in the Air"

2008-01-16T20:47:00.001+08:00

Steve Jobs announced, at his Macworld Keynote address earlier today, Apple's newest toy, the MacBook Air. It's dubbed the world's thinnest notebook.

It is 0.76 inches at its thickest side and 0.16 inches at its thinnest. It has a full-size keyboard with backlight, a full-size 13.3-inch brilliant LED screen, and weighs 3 pounds. It truly is an engineering wonder. The best feature for me though is its elegant design, which is not surprising since this is an Apple product after all. The notebook, however, is not without flaws in my view. The hard drive is only 80 GB. True, there's provision for a 64 GB SSD, but that's still not built-in and it will cost more. The computer has no optical disc drive (for something so thin, what do you expect?). The processor, although an Intel Core 2 Duo, is only 1.6 GHz, with an optional 1.8 GHz for more money (Adam, my current MacBook, has 2.0). There's only 1 USB port. I have to admit that my perceived shortcomings of this product has been addressed preemptively by Jobs: this is a wireless wonder. It has one of the best WiFi features available and it has software that can "borrow" another computer's disc drive for software installations and suchlike, all via a wireless connection.

For its engineering feats and its truly exquisite design, I must give it a 10 out of 10. But given its functionality features (the hard drive, the lack of a disc drive, the lower-speed processor), I would not want this for myself at this point. I'm having a hard time, as it is, getting all my stuff crammed into my 80GB HD. My dream computer is still the MacBook Pro. Having an iMac along with that MacBook Pro certainly wouldn't hurt either.

I think Jobs' next challenge is to combine the functionality features of the MacBook Pro with the design of the MacBook Air. Now that would be the perfect notebook computer. Impossible? Bill Gates, in 1981, said "Nobody will ever need more than 64KB RAM." Look at the technology we have now. So much for 64KB. I can't wait for Keynote 2009!

Moderation in all things.

2008-01-16T15:43:00.000+08:00

I firmly believe in that ancient Greek saying. We could be talking about religion, politics, food, wine, partying, or anything you can think of under the sun. Although I also believe in the existence of moral absolutes, I think radicalism in all forms is to be shunned. It may take me a lifetime to work this all out for myself but that's basically one of my core beliefs. This brings me then to an interesting article that a good friend posted in our church e-group. This is a speech Sen. Barack Obama, now Democratic presidential candidate, made in June 2006. I have to admit that I am not familiar with Barack Obama's stand on other policy issues, domestic or foreign. But in this, I fully agree with him. This is my kind of politics.

I'm home

2008-01-13T16:18:00.000+08:00

Hey folks. After 19 days away from home, I'm back. I have posted some pictures on my multiply website (http://khensonmd.multiply.com/photos) if you're interested to see what I've been up to these past few weeks. I couldn't find our SD card reader so the San Francisco pics (there aren't many of them) would have to wait to be posted.

To those who know what I'm talking about, I've come home quite clear-headed and have finally made some important decisions regarding the future. I'll probably write about that in some future piece. Maybe. Hehe.

Anyway, I hope you all had a good holiday. It's back to normal for everyone, myself included.

Pre-Departure Post 2

2007-12-22T00:40:00.000+08:00

I thought this guy was kidding (and that this photo was a hoax) when he talked about a supposedly new hallucinogenic drug ...

I consulted the internet genius, Mr. Wiki, and Jenkem is apparently real. KevJumba (the guy in the video; he's very popular in the youtube community) claims it's now popular with kids in the US. According to this though, it's an urban legend (which makes the photo linked above a hoax, as I rightly suspected). But even BBC reported of its use in Africa.

Pre-Departure Post

2007-12-21T23:01:00.000+08:00

Got my Step 1 score exactly 3 weeks after my exam.

PASS/214/88.

Not bad, if I was an American citizen and a graduate of an American med school. Like all International Medical Graduates (IMGs), I was aiming for a grade in the 90s range so this is definitely not good for an IMG. Still considering my options (start with residency training here in Manila or pursue the US residency thing). There are some issues that I have to thresh out with God, especially about His direction for my life. Will take the next few weeks to think and seek God's will. I'll make a decision when I return home from the US. Don't worry, I won't forget to have fun. Hehe. I'm flying to LA tomorrow then on to San Francisco on Jan 2. I fly back home on Jan 10.

***
On to happier things.

Does this sound familiar?

She's Yael Naim, an Israeli singer. I hate both the song and the original artist, but Yael's somehow made it more bearable to listen to.

Update on the Hung(a)ry girl

2007-12-19T02:11:00.000+08:00

She's apparently the next Jessica Simpson.

See, I thought she was some random dumb blonde. I was wrong. A quick googling around revealed that she is, in fact, Kellie Pickler and she placed 6th on American Idol Season 5 (Taylor Hicks won that year). You should read the comments on youtube (click here and here for a sampling). The Europeans really went to town on this one and I don't blame them.

Lead, follow, or get out of the way.

2007-12-18T03:30:00.000+08:00

Thanks to Papua New Guinea, this quote by Thomas Paine is what made the United States change its mind on its staunch opposition to the Statement of the UN Climate Change Conference. After two weeks of almost getting nowhere partly because of a controversial preamble, the Bali Conference can finally be called a success, at least partially. The conference statement, and the US' (halfhearted) support for it, opens the door for two more years of talks that will culminate in 2009, in Copenhagen.

It must be remembered that as of today, the US is the only UNFCCC party that has not ratified the Kyoto Protocol. After Australia changed prime ministers, it left the US standing on that disgraceful rostrum alone.

***
FYI: Copenhagen is the capital of Denmark. Now, speaking of capital cities ...

The video is entitled Dumb Kelly.

Wisdom of the Ages

2007-12-15T02:14:00.000+08:00

In July of this year, an elite group of former statesmen and world leaders came together in Johannesburg, South Africa. The alliance, called The Elders, was formed at the initiative of British singer Peter Gabriel and entrepreneur Richard Branson, to tackle the world's most pressing issues: climate change, pandemics like HIV/AIDS, malaria, tuberculosis, and violence of all forms. Nelson Mandela, in his sort of inaugural address, says of the alliance: "This group can speak freely and boldly, working both publicly and behind the scenes on whatever actions need to be taken. Together we will work to support courage where there is fear, foster agreement where there is conflict, and inspire hope where there is despair." A veritable who's who in global personalities, three of my personal heroes are members of the alliance: Nelson Mandela, Desmond Tutu, and Kofi Annan.

I wasn't aware of the group until I saw a CNN Special tonight entitled "Wisdom of the Ages." A group of delegates to a UNICEF special conference on children met with three of the Elders (Tutu, Mary Robinson, and Graca Machel) via video conferencing. It was quite remarkable for me because the children who were in the panel in New York (the Elders were in South Africa) had already achieved much, considering their age. Take for instance Millicent Orondo. She is 15 years old and lives in Kenya. She helped establish a toll-free helpline for children in her community and goes around teaching other kids that sexual abuse and rape are crimes and should be reported (thus the helpline). She also addressed the UN General Assembly at the conclusion of the UNICEF conference. Imagine that. The other kids' bios (I can't find a webpage on it, for some reason) are equally impressive and the Elders who spoke with them expressed admiration for these kids' work.

I'll keep an eye out for a cnn.com page on this special (there's none as of this writing). Meanwhile, the Elders are seeking to have a billion signatures on the Universal Declaration on Human Rights. It's the 60th Anniversary of the Declaration next year and the global village has fallen short on its commitment to fulfill the tenets of this landmark document. Whether you read it in plain English or in its entire formal wording, I urge you to electronically sign it.

Font Talk

2007-12-14T09:43:00.000+08:00

More bumming around stuff.

Saw this video, got the link from my usual supplier of useless knowledge, kottke.org

From Goodie Bag.

Incidentally, I love Trajan. Whenever I do graphic layout projects (minor sideline), I will most of the time end up using this font, and a few other favorites, somewhere on the image or newsletter. I have never noticed though that it's widely used in movies until I saw this clip. Current font favorites include Helvetica Neue Light and Ultralight (that's 3 links for you, right there), Futura, Pristina, and Scriptina (this one's a free download link). When I was still using a PC, I changed my default Word font from Times New Roman to Calibri. I also had a Copperplate phase and a Footlight MT Light phase but I'm over them now. Haha. Here's a sample of one of my projects (this one was pro bono, of course).

The Upside of Being a Bum

2007-12-12T07:54:00.000+08:00

I'm loving my RSS Reader. Apple's Mail comes with a built in RSS reader (I can't remember if Outlook had one built in). I so far have about 6 blogs I've subscribed to. As long as I have a steady stream of wifi signal, I get the newest entries from these blogs, as soon as they are posted on the internet. Cool, eh? It makes for a less-boring bumming around.

Some interesting links from jason kottke (A very prolific blogger who, I think, does it for a living; how he does it, I don't know. He is also a twitterer.):

A list of references and in-jokes in Pixar's movies (a fun read).

A Vanity Fair article on the US media's apparent prejudice against Gore in the 2000 elections. Just goes to show how the media doesn't always present issues in a balanced way, as it's mandated to do. This should serve as a lesson for us consumers to be more discriminating about what we believe in the press. (Sorry, I just had to comment on that particular article as I do see the same problems in the Philippine media)

An 11-minute excerpt from Anhedonia. Annie Hall audio plus Getty videos make for an interesting film.

Free Rice

2007-12-08T00:46:00.000+08:00

Got this from Neil Gaiman's journal:

Donate 20 grains of rice for every correct answer. Here's the link.

For Those So Inclined ...

2007-12-05T08:52:00.000+08:00

Join the Trillanes Fans Club, launched recently by the Philippine Comedian (parodied version of the UP's venerable Philippine Collegian). Thanks to carlshark for the heads up.

I know people are sick of this issue so I promise that, barring new developments, this would be my last post on the Trillanes affair. But let us always remind ourselves that even in our disgust and eagerness to move forward, we must also be quietly vigilant. I believe these guys when they said it wasn't over. There'll be more unwanted political noise. But let's hope that's all there is to it, noise.

On the Trillanes Affair

2007-11-30T20:37:00.000+08:00

I wish I thought of writing this first. But I don't think I can ever come up with a piece that brilliant. I guess I'm not creative enough. Or as angry.

On second thought, I find that I am as angry as that. I just can't bring myself to say those expletives, at least in print. ;-p

As I am too lazy to think of making my own piece on this topic, here are some more thoughts (the Flotsam & Jetsam 11/29/07 entry).

Post-Step 1 Catharsis

2007-11-28T23:16:00.000+08:00

*Caveat: As the title says, this is a catharsis piece. This is more for me than for those reading it (at least the first half). However, some of my friends who will later take the same exam have asked me to describe how my experience went so this might be useful for them. Now, I don’t know how I did. It’s very possible that I might have done terribly. If I end up failing this test, then everything I write here would be trash, wouldn’t it? So take the tips I give with a grain of salt. A lot of salt, really.

It was surreal and it was difficult. That’s how I’d describe the USMLE Step 1 examination. Let me start this by telling you the events leading up to the exam.

I did some last minute reviewing the whole day yesterday and last night. I made sure to buy some biscuits to bring to the testing center, and a diphenhydramine tablet, which I took at about 8:30 pm. I thought I’d help myself to get to sleep earlier than usual by taking the most harmless sleeping pill I know. By 10:30 pm, I was feeling a bit groggy and sometime then, I finally fell asleep. I found myself wide awake by 4:45 am, a full hour before I was supposed to wake up, and I had a little bit of a headache. Great. Tip #1: Don’t take a sedative the night before the exam.

I was in Makati by 7:30 am so I had some time to buy a cup of Peppermint Mocha. My dad and I walked to a Starbucks store a couple of blocks away. I was in the testing center by 8:30 am. I placed my things in the locker (I was given a key after signing in), went to the restroom, and was finally called into this pre-testing area where they took my picture and made me sign in to a logbook. I was told I could start immediately and that I didn’t have to wait for 9:00 am.

Because I used the practice software that came with the USMLE CD, I skipped the whole tutorial part and before I knew it, I was answering the exam proper. I had a momentary feeling of depersonalization (for those studying for Step 1, you should know what this means) but had soon settled on a routine. My technique was to answer the question by knee jerk (the first thing that came to my mind). If I didn’t know it, I guessed. If I wasn’t sure about my answer but knew I could work out the question, I still picked an answer then and there. All guesses and all questions that I planned to work on later were marked (the check mark on FRED) and I tried not to leave any item unanswered before I moved on to the next question. I kept an eye on the clock and made sure I was past item 25 when the remaining time struck 30 minutes and that I was going through all my marked items with 15 minutes remaining. I was usually done with an entire block with about 5-10 minutes to go and I made sure I never ran out of time. I was that OC about time.

I took 2 breaks. I answered 3 blocks straight through then took a short lunch break. I didn’t have a watch with me so I hurriedly ate my food, went to the restroom, then returned to the computer. At this time, I noticed that I had about an hour of break time left. So I planned to go on break again after 2 blocks, and I planned to relax the next time. I answered what I thought were 2 blocks. By the time I was halfway through what I thought was the 2nd block, I felt tired and restless and wondered why the block took so long to finish. Finally, I finished with what I thought was the 2nd block. I took a break, ate a pandesal, and went to the restroom again. I took my time knowing I had an hour of break time to squander (I didn’t consume the whole hour of course). On returning to the computer, I started what I thought was my 6th block (or 2nd to the last block). However, as I finished that block and clicked to start on a new block, I was shown this screen that told me the examination was finished and that I was requested to answer a short survey. I was of course very confused by this time and I had to think back whether I had missed an entire block by mistake. I fumbled through the survey then finally clicked on the exit button. I had finished an hour and a half ahead of schedule. I was stunned and perplexed that the test had ended so prematurely. It was only later when I realized that I had actually finished 3 blocks during the post-lunch break set, instead of the 2 I’d originally planned to answer.

How did I find the actual test? It was difficult. Most questions were workable and familiar, which is comforting, but the time pressure really made everything much more complicated. I had to rely on my knee-jerk answers, quick associations that I’d made from answering Qbooks or from mnemonics I had memorized. But don’t get me wrong. There were also the occasional questions that were out of this world. I didn’t bother to work those questions out and I just gave it my best guess.

I considered the review for the local boards as my first reading so the videos reinforced that and also refocused my attention on the things that I needed to know the most. I officially began studying for this test sometime in late August. I went through the entire Kaplan video series, together with the Kaplan notes (outline form, not the 4-volume home-study edition). After that, I spent the last 2.5 weeks going through First Aid. Everything came together when I read First Aid and it was the book I used to memorize stuff. I spent the last 2 days before my exam as “Cram Days.” This was the time to memorize formulae and tables and flowcharts which have brain half-lives of less than 3 days. I also bought a subscription to USMLEWorld for a month ($90; this was in late October). Regrettably, I only got to answer about 30% of their banked questions as I chose to prioritize First Aid rather than answering their questions.

Having said all that, I have several observations-slash-tips:

I learned loads from the Kaplan videos. There were many physiologic and pharmacologic concepts that I’d never understood until I saw the videos. However, I don’t think the videos will be effective without the notes in front of you. I also don’t think the notes are effective without watching the video. But that’s just my opinion. My favorite parts were Physiology, Biochemistry, and Behavioral Science.
First Aid is really, REALLY HIGH YIELD. All the websites I’ve read that posted tips on Step 1 said so. Now I can attest to it. Those knee-jerk answers and quick associations I made? They were from First Aid. The tables are helpful. The figures are helpful. If you can memorize the book from cover to cover, you’d probably get a very high score (don’t try it, you’ll just frustrate yourself). BUT, and this is a big BUT, I wouldn’t have appreciated the tables and figures in First Aid had I not gone through the Kaplan videos or even the local board review books first (BRS, etc.). What First Aid does is integrate everything you know into bite sized pieces that can serve as short term memory boosters. Without really knowing, say, the biochemical pathway of Urea, the First Aid figure wouldn’t be of much help.
It would really help to review pathology slides, radiographs, and CT scans. They don’t just ask about normal anatomy. I got a question about a type of pneumoconiosis and was asked to identify which radiograph best fits the description. There were a lot of questions with patho slides (gross and microscopic). I got no questions with videos though.
PRACTICE. Use the Kaplan Qbooks, get a USMLEWorld account if you can, and use the software that came with the USMLE CD. I noticed that the Kaplan Qbook questions were structured very similarly to the way the USMLE questions were made. The content was also similar but more than that, it was how the questions were delivered that was more important. The USMLEWorld questions were very difficult and although it’s nice to have that as practice material, you can do without it if you really couldn’t get a subscription (I still highly recommend getting one). It gives you a graphical feedback on the areas you need to improve and it trains you to think through difficult problems.
More on Practice: It is important to practice answering questions with no time limit. This trains your brain how to think through the question stem and make analyses the way the USMLE wants you to. I used the Kaplan Qbook for this. After that, practice with a 1 hour time limit on blocks with 50 questions each. This will train you to think the way you need to think but quickly. It will allow you to practice making rapid associations and formulating your knee-jerk responses. This is where the USMLEWorld questions will help because it simulates FRED. If you have more time (I didn’t), you can even practice taking 7 timed blocks one after another so you can simulate the actual test day.

I think that’s it. My score comes out in 3-6 weeks. I really don’t know how I did. I made a lot of guesses and who knows whether those knee-jerk answers were even correct. I can only trust God’s leading on this and there’s really no use ruminating on what could have been. Hehe. For those who have yet to take the exam, I wish you all the best and God bless! For the many people who prayed for me, my deepest thanks. I now wait on God to reveal His will through this exam.

Cruel Sarcasm?

2007-11-22T02:43:00.000+08:00

My friend, dancerinthedark, pointed me to this. Here's my blog's readability test results:

Cash Advance Loans

I don't know if this is a joke or cruel sarcasm or if I should be completely flattered (I shouldn't be).

***

My apologies to the 2 or 3 people who visit my blog looking for updates. I know I haven't posted a real blog entry in a long time. My creativity these days is at an all-time low, at least in terms of blog entries. I've written pages and pages of entries on my journal, which I can't really post here if I don't want to be embarrassed. I hope to overcome this writer's block (feeling!) soon. Haha. Maybe after the Step 1 exam, which I take in less than a week.

Invention of the Year

2007-11-02T21:06:00.000+08:00

Time names iPhone the Invention of the Year.

I agree.

While reading the article, I noticed something funny? absurd? ironic? on the website:

The phones look like they're eons apart in technology, don't they?

Desperate Housewives

2007-10-04T17:40:00.000+08:00

I have seen on YouTube the "Desperate Housewives" scene currently causing an uproar in the Filipino and Filipino-American communities. I won't add to the downpour of angry comments. I'm too tired and sick (physically). I do have to say, though, that the "racial slur" notwithstanding, it was actually a very funny scene.

Nevertheless, I'm signature #56732.

The person who signed before me wisely said: "ABC needs to apology to all Filipinos." I absolutely agree, but probably in a more grammatically correct way.

Here's the link, for those inclined:

http://www.petitiononline.com/FilABC/petition.html

The Invisible Drum Kit

2007-09-13T10:24:00.000+08:00

Rowan Atkinson is very, very good. I think this is pre-Mr. Bean. If you have iTunes, subscribe to the podcast "Best of YouTube." It's where I got this.