Majesty

Mt. Pulag It was on a day like that when my father’s notion of the whole being greater than the sum of its parts moved from my head to my heart. The view from my sycamore was more than rooftops and clouds and wind and colors combined.

It was magic.

And I started marveling at how I was feeling both humble and majestic. How was that possible? How could I be so full of peace and full of wonder? How could this simple tree make me feel so complex? So alive.

Flipped by Wendelin Van Draanen, 2003 December 20, 2014. Sunrise on the summit of Mount Pulag, Northern Philippines

Paranoia

Hello. We were just talking about you.
We love how time flies and goes,
And then, poof, you’re someone we barely knew
Where are you now, nobody knows.

Yes, this is your validation
For the voices you hear in your head
Whispering thoughts of provocation,
Keeping you from the peace of your bed.

Then again, it’s not always about you.
We’re talking about someone we care about.
So sleep well and tight, won’t you?
Just curse your dreams of doubt.

The Great Pagliacci

I went to a play by Pagliacci,
He was recommended by my doctor.
So I went to his play to truly see,
His proven cure with sharp wit and humor.

In came with flair The Great Pagliacci,
Rotund, vacuous, clown on a bike riding,
His appearance filled the crowd with glee,
As he regaled us with inane rambling.

“I sure would like to be Pagliacci,
Seems he never loses his wit and smile!”
Said the people beside and behind me.
I found my cure with his devilish wile.

I left with mem’ries of Pagliacci,
How funny the world through his sight may be!
He takes life with zest and security,
How happier can a person ev’r be?

One day I chanced passing by the theatre,
To my surprise there was no queue, no line,
No people demanding that they enter.
“Pagliacci is dead” was on a sign.

I mourn for him, The Great Pagliacci,
I wonder how the world without him will be.

I dedicate this to Mr. Robin Williams (1951-2014), a great man who made the world laugh, cry, and think.

Fine

We pass one another everyday
You ask me how I am
And scripted I would always say:
“I’m fine.” (But I don’t give a damn.)

We go about our separate way
Ignoring the flowers and the music
At dusk I go home alone and say:
“I’m fine.” (I’m going to be sick.)

On the pillow my head I lay
And decide to let myself feel
I think I’m going to be okay
“I’m fine.” (But I don’t want to feel.)

It always goes the same way
I don’t want to feel
It hits me like a truck and everything turns black and I say it’s all going to be okay and lie and say:
“I’m fine.” (I’m not still.)

I’m happy and I’m grieving and I’m hurting and I’m okay
I just want to turn it all off
I just want to lie to myself and say
“I’m fine.” (But I won’t.)

On Homosexuality

I used to be a homophobe.

I studied in an all-male school for 13 years. As can be expected in a school full of confused teenagers, there would be bullying among the batch. I once bullied a classmate who was gay. Her name is Angel.

I don’t know where it all began. I guess if you put boys together, the ones who “aren’t like the rest” get treated differently. It started out subtly enough. I was weirded out by Angel. Where we would have dirty bathroom jokes, Angel wouldn’t laugh. Where we would curse and banter like sailors, Angel would just be quiet. Where we would play basketball, Angel would be at the bleachers, opting to play volleyball instead.

Then there were others like Angel, who would openly strut their stuff in the hallways, who would have rumors saying that they had a crush on a fellow classmate, who would group together and be noisy in a way that bothered me then.

Then the teasing started. It would be subtle at first, such as ignoring the person intentionally. It would then escalate to name-calling, to outright mocking of the person. I remember being such a condescending piece of shit those days. Angel was a good person. One day she just ignored me. She kept being herself despite the hurtful words and deeds we did. She even seemed happy with her friends. We who were looking down on her found ourselves being looked down by her.

Why did I do this? I realized then that I did because I felt inferior. I too, was bullied when I was a kid. I was a scrawny, wimpy, nerdy kid who got picked on by the bigger kids. That produced an anger within me that I projected to those I perceived as “weaker”. How foolish have I been! Angel is one of the strongest people I know. Angel was a better person.

I apologized to Angel for what I did. I asked for forgiveness for the taunts, the jabs, the harsh words. It was at a hallway in our school. I told her these rather awkwardly. She didn’t say anything, but from then on, I got to know her better and found out that she was like one of us, in that she eats without a tomorrow and she’s strong as hell (she once dislocated my right thumb during an accident).

My Christian Living teacher once told us how she boarded a bus full of passengers that she had to stand. Near her were two seats occupied by two men; one was the typical “macho” guy, and the other was a gay man. The gay man promptly stood up and offered her seat to my teacher.  Our CL teacher then posed the question: “Who was more of a gentleman of the two?”

The standards we live by are no longer confined to “What is manly? What is feminine?” The standards we live now should answer “What does it take to be a decent human being?”

Homosexuality is not any threat to the concepts of manliness, or femininity, or family, or society. It is merely a question of which we have miserably failed to answer.

In Russia, there is an anti-homosexuality law that represses this minority from being themselves. “You could say that being gay in Russia is like living in the closet, a very big and very comfortable closet.”, so says Alexey Mukhin, Director General of the Center for Political Information under Putin. But then again, a cage is still a cage.

In the Philippines, being gay is still seen as being taboo. Some parents are ashamed that their children are gay. Some of my gay friends are ashamed they’re gay, and don’t want to admit it to their parents. I won’t be surprised if there’s still bullying in my former school for being “different”. It’s not only a problem of boys being boys, but of the milieu these boys live in.

Where do we find the answer? I come from a religious family. I used to teach catechism for Sunday school. I once preached that homosexuality is a sin “because the Bible said so.” I didn’t teach it just for the heck of teaching it; it’s in that syllabus we use for teaching children. Yet I was not a decent human being, for I preached denying someone their right to be themselves.

I found my answer in the many gay friends I’ve made along the way. I found the answer in the shoulders I could cry on, upon ears that would listen, and the in arms that would give a tight embrace. That my fears were unfounded. That I had been very, very wrong.

That I could change. That we can, too.

Surviving Medical School: The Second Year

I write this entry with these people in mind: my unborn child, who [might] consider being a physician someday, for my future students [mwahahahahahaha!], and for myself, that I may be reminded of who I was as a student. This is the second part of the series. 

It’s a Marathon, not a Race

thehealthybackblog.com

I wrote earlier that going to medical school is like running a seemingly never-ending marathon. In the second year, you will feel out of breath, out of strength, and out of willpower. This is normal, and you’ll experience it every once in a while. But if you took my advice and took care of yourself and your studies, you’ll be very surprised at what I have to say.

The Parable of the Snowball

I will never forget the advice told to my college roommate by his uncle, a medical doctor:

Take the basics seriously.

I was told how his uncle regretted not taking the first year subjects seriously, and how he struggled with catching up on the higher subjects. I would have to say that this advice is one of the best I followed, and I wish to emphasize this with a parable.

redbitbluebit.com

On a mountaintop, a boy rolled over two snowballs. One snowball rolled downhill and became larger in size. It unfortunately slowed down when it hit some rocks, and stopped completely when it hit a tree. The other snowball rolled resiliently, and despite opposition from jagged rocks, it accumulated more snow and turned into a mighty avalanche that carved the mountainside a path of destruction.

Moral #1: Avalanches are bad for your life.

Moral #2: During the second year, I’ve found out how Medicine is like rolling a snowball on top of a mountain. When you begin the path towards becoming a doctor, you start out as a tiny little snowflake. During the first year, you accumulate the language and grammar of medicine, just as a snowflake rolls over more snow and turns into a snowball. Eventually, this turns into a powerful avalanche  that becomes unstoppable.

A practical illustration would be that during a subject you will take in second year, Pathology. This subject builds upon the knowledge you have of Histology and Physiology, and some Biochemistry. If you don’t know what a kidney looks like under the microscope, and you don’t know the three phases of renal physiology, you will have a difficult time understanding why a kidney looks weird in a case of renal failure.

Practical Tips Section

leadershipfreak.wordpress.com

I realized that my posts up to this point aren’t really about practical stuff for medical school. Hehehe. The reason is that no two medical students learn the same way. These are some techniques I’ve come up so far to learn medicine effectively and efficiently. My disclaimer is that I’m more of a visual-kinetic learner, but I’ll put in some feedback from audio-learner friends:

  • Take care of yourself: body, mind and spirit. This is the foundation that you will build your character as a professional.
  • Know what you don’t know: I’ve once ploughed through a chapter of a book without understanding a single word of it. Never again. I’ve learned that when I don’t understand something, stop, look for the concepts that I don’t understand, review those concepts, then continue learning. It’s no use reading the different mechanisms of diuretics if you don’t know the renal pumps.
  • Write stuff down!
    • For processes (such as the RAA cascade or the fetal circulation), you can use flowcharts to illustrate how things are interconnected. This really comes in handy during Pathology, where you can see the disease processes simultaneously. Also works great for Pharmacology, for learning the modes of actions of drugs.
    • For info-overload subjects, use tables! This especially comes handy for Pathology, where’ you’ll be asked to compare the different types of cardiac failures (Left vs. Right, Systolic vs. Diastolic) and the different types of cancers (the bane of every medical student).
    • For memory-retention, use index cards. This is especially useful for information that requires one to memorize numbers *shivers* such as equations for Epidemiology, Pediatrics, and Medicine. I also use index cards to summarize some chapters from Harrison’s such as “Approach to a Patient with Rash”, writing the important points to be found when faced with a patient with a rash (Number one: watch out for meningococcemia!)
  • Say concepts aloud: my audio-learner friends tell me that in order to learn, they sometimes talk to themselves aloud to get aural feedback. They also said that they like listening or talking to people about the information they need to learn.
  • Realize that there are a ton of material that can help you learn!
    • YouTube, and other Video sharing sites: can’t understand a concept? Look for videos! I learned the intricacies of the renal countercurrent exchange mechanism *puts nerd glasses up* that way.
    • Board Review Series, “Dummies” books, etc.: I remember in Biochemistry that I understood nothing reading up on the Central Dogma on the prescribed text *puts nerd glasses up*. So I read a simplified book on Biochemistry. When I attempted to read the prescribed text again, I understood it. Disclaimer: simplified books are no substitute for the big books but are a great place to start if you have any difficulty.
    • Your colleagues: this includes your medschool friends and your teachers. A medical student is not a John Rambo cutting through the vast forests of medical knowledge. A medical student is a part of a community that works together for the advancement of medical knowledge.  It’s better to look like a fool asking a question than doing a foolish action that could cost someone’s life.
  • Practice makes perfect: Throughout second year, you’ll learn skills that will help you diagnose disease. Skills are attained through constant practice. I practice my physical examination skills by checking up on my father every other semester; to my unborn child, I’d be willing to be your dummy.
  • Expose yourself to experiences and opportunities: During the second year, you’ll start doing paperwork (at least in the medical school I’m attending), which, while it adds to the workload, exposes you to the drama of the human condition. There are some things that my patients taught me that aren’t in the books. There are also conventions and medical missions you can participate in to hone yourself further.
  • “See one, do one, teach one”: This is a tenet of Surgery, in which one progresses from being a passive observer, to an active learner, to a teacher when learning surgical skills. The ultimate form of learning is teaching. Help others understand a concept that they have a difficulty in. After all, our professional oath exhorts us: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

Learn to be a Doctor, not Study to be one

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There’s a fine line between studying and learning. Studying, according to the MW dictionary is “the activity or process of learning about something by reading, memorizing facts, attending school, etc.” Learning, on the other hand is “to gain knowledge or skill by studying, practicing, being taught, or experiencing something.” On these definitions, one can discern that the former is a passive process and the latter an active one. Strive to be the latter.

Let’s face it: medicine is a competitive profession. In pursuit of good grades and high marks in order to secure good training programs, I’ve seen how the pursuit of knowledge becomes a rat-race in which only one person wins. Medicine should not be like this; it is a profession where teamwork is of utmost importance. The foe of an aspiring doctor is not the subject matter; it can be learned. The foe of an aspiring doctor are not the marks of his peers; it won’t affect him in any other way anyway. The foe of an aspiring doctor is the self.

It’s quite existential, but second year is a continuation of the struggle against yourself. You see in your everyday medical school life forks in the road that diverge into paths that you will never cross again: “Will I spend 2 hours discerning the intricacies of the protozoa, or will I spend 2 hours playing this awesome video game?” “Will I go out this weekend or will I use it to learn the difference between the different types of cardiac drugs?” I’m not saying this to tell people to become hermits, only to emerge into medical prodigies without a social life (read the first post again); I’m asking you, a future doctor, to make choices. “To be a doctor, will I study, or will I learn?”

Keep going towards your dream! I’ll see you along the way.

Concept

ConceptJonas hesitated.

“I certainly liked the memory, though. I can see why it’s your favorite. I couldn’t quite get the word for the whole feeling of it, the feeling that was so strong in the room.”

“Love,” The Giver told him.

Jonas repeated it. “Love.”

It was a word and concept new to him.

The Giver by Lois Lowry, 1993

March 31, 2009, in a messy room

I Know Not How

I know how the body heals
After it is cut by a blade
Yet I know not how the spirit is strong
In the face of undeniable defeat.

I know how consumption
Takes its victim
Yet I know not how the human spirit
Moves on with a loss of its own.

I know how to heal broken bones
When they are shattered and bent
Yet I know not how the spirit
Mends that which I cannot.

What I Want in a Teacher

I’ve always wanted to be a teacher. I’d be a Social Sciences Professor who’d rave and rile my students into opinionated individuals. My dream is not but a passing melancholy; one day I will be a teacher.

I’ve had the honor of being under the tutelage of great teachers in my life. I write this entry while I am a student that I may never forget what qualities such great people had. I aspire to be such when I realize my dream. This list is in no particular order.

1. Competence in the Field

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I think the foundation of successfully teaching is knowing the subject matter itself. This is what differentiates a teacher from any other individual. Someone may be nice, good natured, and kind, but that’s just the base where one adds other qualities that make the person stand out, or in this case, a professional.

When I speak of competence, I do not only desire a teacher who knows the inner workings of the mitochondria (the “powerplants” of cells) ; I want a teacher who applies such knowledge clinically in all aspects. I once had a teacher who always made my jaw drop when she explains those tiny details you miss but are very crucial for patient care.

I once took care of a baby with Biliary Atresia. Children like them have bloated abdomens (ascites). When she asked how my patient’s breathing was, I was stunned. I didn’t consider that fact. She explained that the condition can cause difficulty in breathing because it can mechanically compress the lungs when the child is lying down. So the best move would be to put the child in a side-lying position to ease the breathing. Bam. Competence at its finest.

Competence is a dynamic quality that must be constantly developed. I want a teacher who maintains competence by practicing the profession, taking continuing education courses, keeping up to date on the literature, and those things I’ll *probably* be complaining about in the future.

2. Ability to Communicate Well

Communication

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All knowledge is for naught if a teacher is unable to communicate ideas effectively. In retrospect, the best teachers I had were those who had the ability to make me understand things I didn’t want to understand.

Communicating ideas is in a way, selling these ideas. Communicating effectively requires getting the attention of the student, stoking the flames of interest, and leaving the student craving for more.

The best ways I find effective in communicating ideas from great teachers are:

  • Providing Analogies. Instead of saying that a heart attack occurs secondary to a block in the coronary arteries by an emboli, a teacher can liken it to a bad traffic jam (or a pile-up) that disrupts the flow of supplies. From that concrete image, a student would be able to translate it into an abstract thought.
  • Telling stories. I had a Psychiatry professor notorious for this. She would tell the natural courses of the diseases of her patients, and through these vignettes, I was able to understand the diseases better than reading the prescribed texts.
  • Analyzing and Correlating. An adage I picked up through the years: “Analyze, don’t memorize; correlate, don’t reiterate.” It is one thing to provide facts, but it is another to transform these facts into tools one can use. Besides, I think that it is by analysis that one can discard useless information and better “memorize” concepts. Learning is further strengthened by correlating ideas with one another, which forms a “web” of concepts that mutually strengthen each other.

3. A Person of Noble Character

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I mentioned awhile ago that being “nice, good natured, and kind” are the base where other qualities and abilities are added. Nobility far exceeds these aforementioned traits. It is hard to define what a noble character is – so I will just describe what a noble charactered teacher made me feel.

These are teachers, when I meet them, I feel that I can trust. When I approach them, they welcome me and  take time to hear me out. When they answer, it is with equal curiosity as to the manner I inquired; they are not condescending. When out of the classroom, they smile and greet their students, a great bonus if they know our names. When I think about them, I want to be just like them. When we part ways, I feel afraid, but incredibly inspired to be better.

I guess for my future self, the closest concept would be the Golden Rule. Do that which ennobles the self and others.

4. Strives for Excellence

cartoonmotivators.com

A teacher becomes outstanding when the students feel that they are  in school to become better people. It’s one thing to treat teaching students like a factory, and another to help every student maximally achieve their potential.

I want a teacher who continuously grows and becomes better, and who doesn’t accept mediocrity from the students. I want a teacher who says bluntly: “You’re not living up to your full potential. I know you can do better, but you just don’t want to.”

And lastly, on the flip side…

5. Never Forgets What it Means to be a Student

bbc.co.uk

Often I find teachers who act all high and mighty with their students. They forget that they, too, were those same scared clerks who didn’t know the difference between that crumdumgeon Nephrotic and Nephritic Syndrome (it’s the spelling. DUH.) A teacher always remembers their roots, and accept, that they too, are students who are also learning and making mistakes.

I remember one instance when I  taught a strict professor a lesson. She was then helping a classmate of mine collect a urine sample from a bedridden old lady in the ICU. After all preparations were done, I noticed that they didn’t drape the cover curtain around the patient, so I just walked over and closed it for them. I heard her saying “Oh yeah… [we forgot that detail].” Mind you, I love that professor, but boy, was it sweet.

Those who can, teach!

Every Writer’s Mind

Every writer’s mind
Has a village
Where one will find
A certain spillage
Of quirky characters.

There’s the bright boomer
Who sings and smiles
And then the gloomy doomer
Who stinges and riles
On the village square.

There’s the pensive dreamer
On the bridge reflecting
As the monotonous tasker
Goes about trudging-begruding
Past an uncaring soul.

The curious inquirer
Sits upon the branches of a tree
As the stoic planner
Plots where to place the lee
For the winter coming.

At last the child
Who writes this poem
Who sees the ruckus and antic-wild
Village he calls his home
He who grows through them.

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    -Jian Narag, 2005-2017