My kid brother, Sean, after sensing that a knob on my fountain pen was loose, decided to fix it on the spot.
"Do you need to apply grease?" I asked.
"No, it looks fine. It just needs a little tightening."
He has always been good with his hands—he is, after all, a dentist—so I wasn't surprised that he did a better job at fixing my TWSBI Diamond 480 1.1 mm stubbed-fountain pen than me.
"I read online that you shouldn't tighten the knob too much when you suction the ink," he said, warning me that there could be problems if I did so.
I asked for some ink; I didn't bring anything for this trip with me. Sean is a fan of the Pilot Irishozuku Iroshizuku, but I felt it too expensive for my present purpose—doodling and writing non-sense—so I had the Lamy black instead.
I've resolved that the next time I have problems with the pens I've accumulated, I'll just have Sean check and fix them.
This has been a good year for reading. I wish I had read more books, but in between chemotherapy, academic reading (which I don't count as reading, in the way that I define it here, i.e., reading for pleasure), I could only squeeze in a few. Which is not to say, of course, that reading DeVita isn't pleasurable—it can be. Nevertheless, here are my most memorable reads for 2018.
[Before I launch into my list, I asked some friends and family to list their favorite reads, so I can convince non-readers to try out the habit. You can read Kuya John's top seven, Manong Ralph's top ten, and Ate Liw's many recommendations, including those that had lasting effects on her. In a sense, you are what you read. Surely, you don't want to be defined by the fact that you only read pep.ph—that, too, is mildly entertaining, but there are greater joys to be had.]
1. Institutes of the Christian Religion by Jean Calvin
After a year, I finished reading volumes 1-3 of John Calvin's The Institutes of the Christian Religion. I mostly read it in my Kindle during my morning commute to work, a ritual that affords me the chance to read works of literature outside of my standard readings in oncology. The Institutes now belongs to my list of favorite books of all time, along with Augustine's Confessions (which was often quoted by Calvin). Calvin's main thesis is justification by faith alone through Christ alone. It is the "alone"—the exclusivity of faith, the rejection of good works (or good works with faith), as a means to salvation—that creates the major doctrinal difference between Calvin's faith and Roman Catholicism. More here.
2. Scalia Speaks by Antonin Scalia
This book is a collection of speeches of the late US Supreme Court Associate Justice Antonin Scalia known for his conservative interpretation of the US Constitution ("originalist") and his colorful and passionate opinions. At some point his book made me tear up when Nino—as his best friend, Justice Ruth Bader Ginsberg, called him—wrote about his father and his childhood. His tributes to his friends were also moving. I wish there were more like him in government. He once said, "“If I have brought any message today, it is this: Have the courage to have your wisdom regarded as stupidity . . . Be fools for Christ. And have the courage to suffer the contempt of the sophisticated world.” More here.
Watch this memorable interview.
3. The Emperor of All Maladies: A Biography of Cancer by Siddharta Mukherjee
I wrote, "It is a narrative that illustrates the value of the scientific process, and how basic sciences—molecular biology, chemistry, and physics—form the backbone of medicine's understanding of this disease. The book excels in outlining the doubts and worries of the scientific community, a reminder that uncertainties lead to scientific questions; and with the questions come the answers—not as an inevitability but as a possibility. In a situation where death is impending, any possibility spells the hope of relief, if not an actual cure." What an exciting time to be in the field of Oncology! More here.
4.5. Love to the Uttermost by F.B. Meyer
I quoted F.B. Meyer many times this year. This work is an exposition of the Gospel of John, highlighting the love of Jesus, a love that is to the "uttermost." I'll go back to this masterpiece of Christian literature to cheer and encourage my soul. If you find printed copies of any of his books, kindly alert me.
4.5. Browsings: A Year of Reading, Collecting, and Living With Books by Michael Dirda
These are reflections of Washington Post book critic and Pulitzer prize winner Michael Dirda about the joys of reading. These came out initially as weekly essays he wrote for The American Scholar. He is neither snobbish nor proud, but he exudes the childlike charm of a bookworm, and he loves reading so much that he wants to convince every person to get into the habit. Towards the end of this work, he quotes Franz Kafka, "The books we need are the kind that act upon us like a misfortune, that make us suffer like the death of someone we love more than ourselves, that make us feel as though we were on the verge of suicide, or lost in a forest remote from all human habitation—a book should serve as the ax for the frozen sea within us." Thanks to him, I got into a book-buying frenzy this December, having purchased Elena Ferrante's four Neapolitan books in one go because, according to him, to own a book is to own it physically. This was—and still is—a joy to read and reread. I imagine myself going back to Browsings to check his recommendations for what kind of fiction to read on holidays, what science fiction to enjoy, and so on.
5. Lincoln in the Bardo by George Saunders
President Lincoln and his dead child, in a gripping, heart-wrenching story about longing, death, and separation. What a delight—like reading an obituary in the backdrop of Dante's Inferno.
6. Dune Messiah by Frank Herbert
"Paul Artreides's sister Alia is now grown up, a sarcastic, powerful, intuitive Reverend Mother, trained in the ways of the Bene Gesserit. Paul is now called the Muad'dib, the Emperor of the known worlds in the galaxy, and he has to confront opposition, intrigue, and mystery that comes with his powers." More here.
7. The Quiet Ones by Glenn Diaz
"What with all technical papers I need to write and the oncology journals I need to read, I can't get my eyes off Glenn Diaz's The Quiet Ones (Ateneo Press), winner of the 2017 Palanca Grand Prize. It is a masterful work of someone who breathes the English language in Filipino atmospheric conditions. The book is about a call center agent who gets involved in a scam and who scrambles out of Manila to escape the authorities. The details that intersperse the story make the novel riveting: such as this scene at the PGH Cancer Institute. Alvin's mother had pancreatic cancer." More here.
8. The Left Hand of Darkness by Ursula K. Le Guin
This book challenges the notion of love and sexuality, the way only science fiction can question our reality. A representative of the Ekumen goes to the Gethen, in the hopes of convincing the leaders of the planet to join the confederation of celestial powers. The Gethenians are ambisexual—they change sexes after a period of time. Ms. Le Guin was a writer ahead of her time. She passed away this year. More here.
9. The Secret Diary of Hendrik Groen, 83 ¼ Years Old by Hendrik Groen
The old fascinate me. Mr. Groen is an 80-something man who lives in a nursing home in the Netherlands. A sensible, decent man, he likes to keep to himself, his diabetic friend who would lose his toes due to neuroischemic foot ulcers, and his geriatric gang that goes out once a month. He also falls in love. Asians would probably not get the point of putting their parents in these institutions, for we would rather take care of our old ourselves, in our own homes, but this book nevertheless adds to my understanding of the unique challenges posed by aging.
10. Four Princes: Henry VIII, Francis I, Charles V, Suleiman the Magnificent and the Obsessions that Forged Modern Europe by John Julius Norwich
There's so much that history can teach us, only if we allow it to. In this gripping work by John Julius Norwhich, he draws themes from history's most powerful men in Europe.
Other books I read
When We Were Orphans by Kazuo Ishiguro
An English detective, who lost his parents in Shanghai, finds the truth about his parents. The book reminded me of the old streets of Hong Kong, for some reason.
Where Europe Begins with Yoko Tawada
I didn't enjoy this as much, unfortunately. The stories seemed weird to me.
Codename Villanelle by Luke Jennings
Have you seen the BBC series, Killing Eve? It's about an awkward detective who looks into the murders committed by a trained, brilliant, beautiful sociopath. A short read but was just as thrilling as the series starring Sandra Oh. The series was painfully short. No season two yet?
The Berlin Stories: The Last of Mr. Norris & Goodbye to Berlin by Christopher Isherwood
These reminded me of long train rides in Europe, and the many conversations I overheard there.
Boys Among Men by Jonathan Abrams
I belong to a cell group in church called Pilgrims, which is comprised of basketball-loving and -playing men, with whom I share a love for Christ and the Bible. I wasn't gifted in the sports department, so what would be the best alternative way of learning about basketball? In this book, Mr. Abrams, explores the lives of players who transitioned from high school straight to the PBA, bypassing collegiate tournaments. NBA is brimming with intrigue and malice, apparently, and all of that happens during the drafts. The young are vulnerable, and they need the support of family and friends.
Everything Happens for a Reason by Kate Bowler
"The book attempts at being coherent; it is divided in nine chapters with a preface that begins with, 'There's a branch of Christianity that promises a cure for tragedy. It is called by many names, but most often it is nicknamed 'prosperity gospel' for its bold central claim that God will give you your heart's desires: money in the bank, a healthy body, a thriving family, and boundless happiness.' But cancer is hardly coherent." More here.
Theft by Finding by David Sedaris
Mr. Sedaris is among the funniest people alive. The books comes straight out of his diaries. The entries are absurdist. In reading this, I reminded myself to become more observant. Each day, each person is unique and could end up in my own journal.
Hillbilly Elegy: A Memoir of a Family and Culture in Crisis by J.D. Vance
The first book that made me realize that poverty creates a culture among those living in it that they can only go as far in life as their predecessors—until someone tells them otherwise. This is a biography of the lawyer, J.D. Vance, who is proud of his Appalachian, hillbilly heritage.
Ubik by Philip K. Dick
A group of inertials—men and women who have the special ability to negate powers of precogs and telepaths—is killed by a blast. The survivors go through a time warp and are subjected to rapid deterioration themselves. The panacea is a special spray called Ubik.
Ready Player One by Ernest Cline
By now, this must sound cliché, but the book is way better than the movie.
Any Human Heart by William Boyd
The journals of the fictional Logan Mounstuart, who comes from a privileged English background.
What I Talk About When I Talk About Running by Haruki Murakami
Mr. Murakami runs to fuel his writing. No wonder why he looks so trim!
Currently reading
What Are We Doing Here? By Marilynne Robinson
The Complete Father Brown by GK Chesterton
Too Much Happiness by Alice Munro
The Doctrine of Regeneration by Stephen Charnock
Never finished
Call Me By Your Name by André Aciman
At some point I could not take the language, as it bordered on the lascivious.
With Ate Milaine and Kuya Vance, among my dearest friends from church
Just when I've gotten used to spending Christmas alone, having been away from home for medical training, I got invited to a family gathering for the second time. There was food—Ate Milaine is a marvelous cook whose recipes pose a challenge to my self-imposed diet! There was music—cello and piano played by a wonderful home-based live band that played the songs I knew. I couldn't leave the party without a song rendition of sorts. I sang "On the Street Where You Live," among other standards, which unleashed the old soul within me—and in all of us, when I think about it now, because everyone chimed in during the chorus. There was conversation about cancer, fountain pens, and Christianity, where I learned various things about these brothers and sisters in Christ, all of whom left me with the feeling of being in heavenly company. Thank you, Espinos, Fernandos, and Gesilvas, for having me! (Photos by Ate Milaine)
Ate Liw, human rights lawyer and advocate, certified world peregrinator, once an English major and a dear friend, shares the most memorable reads she has had for 2018. Her global humanitarian work inspires me, but so does her travels, her book choices, and love for Jesus. She's one of the coolest, bravest, most elegant people I know, taking the road less traveled to champion the rights of the oppressed. She has has been a blessing to me and our family.
Three books with lasting effects on me
1. An American Marriage, Tayari Jones
My work allows me to witness the humanitarian consequences of overcrowded jails on persons deprived of liberty while on trial so I immediately connected with this novel. The way the story unfolds shows how each one of us can easily get caught up in a flawed justice system and how incarceration dehumanises. It is life changing to those incarcerated and alters their relationships with those outside, often in tragic ways. This novel should force us to start having conversations about punitive criminal justice systems and the lack of genuine restoration, reconciliation and rehabilitation.
2. Educated, Tara Westover
This fascinating memoir offers readers a door inside a life and world view dominated by extreme religious beliefs and how learning—culture, history, beliefs, travel—shines a light in a dark world. Definitely outstanding.
3. Last Girl, Nadia Murad
Another memoir about how holding on to extremist religious beliefs can destroy not only a single life but in the case of ISIL, trigger a genocide of the Yazidi race in Iraq. Having worked with young victims of sexual slavery and abuse, Nadia’s personal harrowing experience sadly wasn’t new to me- but the magnitude and how the entire world watched without intervention was truly shameful to read. Her resilience and her incessant quest for justice on what was done to her, her family, her community and her race will inspire if not rebuke us all from our inability to empathise and our propensity to dehumanise real tragedies happening in the world. Nadia’s extremely remarkable story should make advocates of us all against sexual violence, religious intolerance, armed conflict and injustice. Her 2018 Nobel Peace Prize Award is well deserved.
Books that gave me vicarious experiences
1. The Witch Elm, Tana French
What drives a person to kill someone and how violence and abuse affects a victim.
2 The Woman in the Window, A.J. Finn
Because we need to talk about mental health more.
3. Lilac Girls, Martha Hall Kelly
What populism brought Poland during World War II.
On worldview, perspectives and faith
1. Sapiens, Yuval Noah Harari
2. ISIS: inside the Army of Terror, Michael Weiss and Hassan Hassan
3. Scott Sauls on suffering (and his books)
4. The Sun and Her Flowers, Rupi Kaur
Héctor Abad, a Colombian novelist, answers this way when asked what literature can play in forming his country's historical memory:
I believe that novels are condensing machines for stories. In a farm, the history of a country can be reflected, because history passes through its terrain and leaves traces. The war leaves traces. In Gabriel García Márquez, one massacre stands for all the massacres. In Evelio Rosero, armies without a name can be the guerrillas, the paramilitaries or the regular army. In Juan Gabriel Vásquez, German Jews are treated like Nazis during the second world war. In Santiago Gamboa, sex is the substitute for many other frustrations. In my novel Oblivion, a good man murdered becomes the symbol of many innocent victims killed unjustly. Novels help us understand and understand each other.
I love Latin American novelists—they write a lot like Filipino novelists. We are related in more ways than we can imagine, having been colonized by Spain for many years and so on.
My brother, Manong Ralph, a human rights lawyer based in Manila, reads more voraciously than I do. In college he majored in English Studies, perhaps his best excuse to go the library and get lost in the world of stories and ideas. Analyzing stories of James Joyce wasn't a chore but a delight, which is why I wasn't surprised that he graduated top of his class. A lot of book ideas I gain from him. He introduced me to Michael Chabon, who appears in this list, and to many more authors who have made our lives and imaginations richer and grander.
At the beginning of the year, I decided to read Marcel Proust’s tome, In Search for Lost Time, beginning with Swann’s Way. A quarter into the book, 2018 is already about to end! I did manage to squeeze in a few books, having read them while stuck in traffic, waiting in court, or before bedtime. Here’s the top ten books I’ve read this year, in no particular order:
1. Lincoln in the Bardo by George Saunders
At the heart of this novel is a love story between a father and his son that goes deeper than the grave. President Lincoln’s son, Willie, died suddenly and he was buried in a cemetery. That night, he visited the crypt and grieved for his son. Ghosts of bodies laid to rest in the cemetery talk and interact with one another. Throughout the book, you could piece together their histories and their stories. This reminds me of Spoon River Anthology written by Edgar Lee Masters. It is a collection of poems—narratives from the epitaphs of the town’s residents about how they lived and treated one another.
2. Train Dreams by Denis Johnson
It is a quiet novella. There is no villain who needs to be stopped, no grand conflict that needs to be resolved. It is just a story of a man who lived a long life, and yet it is so compelling and sad and beautifully written. I haven’t heard of Denis Johnson until I saw a YouTube clip of Michael Chabon and Zadie Smith, two authors whom I admire, extol him and his work.
3. Hillbilly Elegy by J.D. Vance
Written by a self-confessed hillbilly who grew up poor, lived through adverse childhood experiences, and yet got into the military and then to Yale Law School, this book that is part biography, part critique, explores how it is to live in “middle” America. It also explains, unintentionally and in part, why people voted for Trump.
4. Amazing Grace by Eric Metaxas
This is a biography of William Wilberforce, an 18th-century Christian who was mainly responsible for the abolition of the slave trade in England. As someone who works on the issue of human trafficking, exploitation of children, and other forms of modern day slavery, this book reminds me that the road ahead is full of challenges and opposition, requires hard work, and is not possible apart from the grace and mercies of God.
5. Name Above All Names by Alistair Begg and Sinclair Ferguson
This is one of the books that benefitted my soul. This treatise is written by two Scottish pastors, Alistair Begg and Sinclair Ferguson. They write about Christ and examine key aspects of His person and ministry, from Genesis through Revelation. My favorite part is the last chapter where they talk about Jesus as The Lamb on the Throne—a wonderful and encouraging picture of a victorious King!
6. Autumn by Karl Ove Knausgaard
In this book, Knausgaard writes about the most ordinary things, as a way to introduce the world to his yet-to-be born daughter. There’s a section on chewing gum, bee keeping, toilet bowls, and the migration of birds.
7. A Man Called Ove by Fredrik Backman
About Ove, a grumpy old man who is the hero of this book: “Ove couldn’t give a damn about people jogging. What he can’t understand is why they have to make such a big thing of it. With those smug smiles on their faces, as if they were curing pulmonary emphysema. Either they walk fast or they run slowly, that’s what joggers do.” Ove is my spirit animal. This book is one of the funniest books I’ve read this year.
8. Moonglow by Michael Chabon
After I read the Amazing Adventures of Kavalier and Clay many years ago, I told myself I’ll read anything Michael Chabon writes. He has become one of my favorite contemporary writers. Moonglow is a bit different from Kavalier and Clay and his other writing in that it is sort of a fictionalized memoir about his grandfather. It is tender, exciting, and human.
9. Sing, Unburied, Sing by Jesmyn Ward
A black woman with her two children takes a car ride to pick up her white boyfriend (and the father of her kids) from prison. The book explores race relations and its dark history in America, particularly in a fictional town in Mississippi. It is also a story about a family and the forces that threaten to break it apart. I love the magic realism that is interwoven in this book.
10. Made for Friendship by Drew Hunter
This book explores the theology of friendship drawn primarily from Scripture. His main thesis is “friendship exists because God befriended us and created us to befriend one another.” Set against the world’s shallow understanding of friendship, Hunter argues—as did C.S. Lewis in The Four Loves—that friendship can be so much more nourishing and satisfying, and we should deliberately pursue deeper, godly friendships.
My friend, Kuya John Dasmariñas, based in Singapore, has spent a great deal of 2018 reading. I'm sharing his favorite reads. This was originally posted on his Instagram, but I'm sharing it now, with his permission.
My Top 7 books based purely on how I felt after reading them; because while details escape you, feelings linger.
7. The Corrections by Jonathan Franzen - A comedy on relationships with our family, money, our ambitions and the cruelty of the world we all need to live with. Only an avant-garde writer can curate a plot that resonates with our very own musings we all are embarassed to tell even ourselves or our closest friends.
6. Smaller and Smaller Circles by FH Batacan - Apologies for the cheap analogy, but it's a page turner like Crazy Rich Asians. This first Filipino crime novel in English should be mandatory reading for all secondary students in the Philippines.
5. Nocturnes by Kazuo Ishiguro - The short stories brought to life my introvert predilections towards finding joy in life's ennuis. Best read in an outdoor cafe when you're uncertain between having a cold beer or an iced latte.
4. Flights by Olga Tokarczuk - Best read when you feel like smoking some joint but you're not brave enough to try it. Only a genius can pull off a narrative as elegant as Flights. You are not certain what the author is talking about but you just drift with the prose.
3. Sapiens by Yuval Harari - Professor Harari walks you through the history of mankind and you feel like the most learned man in the house. Amazing how he causes you to marvel at all the major events in history and put your humble little space into perspective.
2. Atonement by Ian McEwan - I finished the novel while I was on a double-decker bus plying the expressway and all I wanted to do was sniff the brown, acidic pages so I could literally take it all in. Yes, it's that good!
1. The Confessions of Saint Augustine - Not to be religious but his written meditations on life just deserve so much appreciation for articulating for us what our innermost beings could not translate into practical, digestible packets of truths. Yes, the old english text needs some getting used to, but once you're immersed into its rhythm, it's like having a spiritual, physical and mental massage, all at the same time!
Today was extraordinarily gloomy, with overcast skies and the occasional drizzle—my favorite version of God-ordained weather, as I do not care much for the sun, given that I live in the tropics, and discomfort from too much heat is a daily reality. Today was extraordinarily relaxing, too, because I had no errands and therefore had the entire day off. I chose to spend it on intermittent naps, books (hardbound and electronic), and Netflix (currently on Silvana Sin Lana, whose Spanish-speaking characters have Filipino emotions and proclivities—highly recommended by mother, so how could I say no?). I came across this passage from T.H. White's The Once and Future King, where Arthur, called Wart, asks Merlyn the magician to turn him into a bird. Before Merlyn answers, T.H. White launches into a beautiful description of the landscape, the kind that makes me long for pure, black-and-white classic stories like the one I'm reading now, where good always prevails, and the trees are lovely. I love passages like this, innocent and untainted, a respite from a world gone wrong.
I was so glad to meet up with some friends from my batch in PGH-Internal Medicine—as if, of course, we need catching up, this despite the fact that we bump into each other at the hospital on a weekly basis. Jay is pursuing further studies in Maryland, USA. Roland is in Pulmonology. Everly will pursue further studies abroad next year, having just finished her colorful stint as the department's Chief Resident (congratulations, Chevs!). Bea is in Endocrinology. Carla is in Pulmonology. Racquel is in Endocrinology. Rich is in Medical Oncology. Jeremiah is in Hematology. Roger is in Medical Oncology, too. This was snapped during Kuya Dane and Jo's wedding last Sunday. I just wanted to memorialize this photo here to remind myself that a year has passed since we finished residency. We're in different fields now, busy with various careers, but inside, trappings and degrees aside, we're still the same noisy, sleep- and food-loving people who care for accurate diagnoses and properly-worded clinical histories.
I won some cash at yesterday's Christmas party and, before going home, I took some time reading my new copy of T.H. White's The Once and Future King, in a special hardbound edition by Penguin, at a café inside Robinson's. It opens with a foreword by Neil Gaiman who talks about science fiction/speculative fiction; he enumerates his favorite works, some of which I have already read, including Left Hand of Darknessby Ursula Le Guin and Dune by Frank Herbert. Seated across from me was a Japanese man copying sentences from an English newspaper using pencil and paper, reciting the words in a whisper as soon as he had written them—yet another proof that it's never too late to learn a new language.
Let the glory of Your name be the passion of the Church
Let the righteousness of God be a holy flame that burns
Let the saving love of Christ be the measure of our lives
We believe You're all to us
I'm grateful for the friendship I share with Kuya Dane Sacdalan and Jo Lucero who are now, as of today, husband and wife.
I've known Kuya Dane since our undergraduate days in Molecular Biology at UP Diliman. He was—and still is—one of the kindest people I know, and talking to him always uplifts me, like breathing fresh air after being stuck inside a stuffy room. I was glad to meet him again in med school; he graduated earlier and pretty much took up the same career choices as I did: three years of Internal Medicine (UP–PGH) and another two in clinical fellowship in Medical Oncology (UP-PGH). He was my senior at the Medical ICU and remains a lifetime member of the OPD Team B (a badge that I, too, proudly carry). Whenever opportunity presented itself, I would ask him for advice. I sometimes send him emails the old-fashioned way, to which he would write heartfelt responses. On the occasion of my father's death, Kuya Dane wrote to me:
Life is a sacrament of waiting—waiting for a train to come, for an infusion to complete, for a hurt to heal, for a reunion with a loved one who has left us, for a time. Waiting afflicts us with yearning. It is how we bear this longing—that emptiness you speak of—which gives meaning to our living and loving.
He told me to show compassion to patients because, as medical oncologists, we're probably the last physicians they'll see.
I've worked closely with Jo when she was chief resident of Internal Medicine. She asked me to become her assistant chief resident for undergraduate affairs, and after much protestations, she won me over. How could I say no to her—this paragon of efficiency combined with thoughtfulness, speed with grace, conviction with understanding? Working with her in that team, and interacting with her during meetings and gatherings, has changed me for the better. I was inspired to give it my all because she gave her all—what leadership she showed! Jo, now specializing in Hematology, remains an excellent physician. My style of charting—short and sweet—I largely derived from hers, when she was the Physician-on-Duty (POD) and I was a clueless first year resident who missed many salient points in my clinical histories. Good thing Jo's notes were always complete, her diagnoses sound, and her plans practical.
Seeing them together—these beautiful specimens of humanity, made more radiant by their symbiotic union—makes me glad. I wish for them joyful, meaningful, God-glorifying lives that overflow with kindness and grace to every person they meet.
Just in case you're wondering what to give me for Christmas
Here are some ideas.
— fountain pen with a 1.1 mm stub nib (notify me first so I can direct your attention on which brands I prefer)
— fountain pen ink (preferably Parker Quink blue-black, Pilot Irishuzoku of any color, and Noodler's black ink)
— an unlined pocket notebook (not Moleskine, which isn't ideal for fountain pens)
— any book by Marilynne Robinson, Kazuo Ishiguro, Ian McEwan, James Salter, and Jonathan Franzen
— The Institutes of the Christian Religion by John Calvin
— Systematic Theology by Wayne Grudem
— shoe leather conditioner
More importantly:
— four 50 mg vials of oxaliplatin
— three 80 mg vials of paclitaxel
— one box of sorafenib, regorafenib, or lenvatinib
— six vials of trastuzumab 600 mg
— one free whole body FDG-PET CT scan
And then there's always world peace. Or a round-trip ticket to New Zealand.
I’m rereading Elena Ferrante’s My Brilliant Friend, the first book of the Neapolitan novels, and it has given me enormous pleasure once again. I read this in 2015: my mother and her best friend, Auntie Cecil, went to the Lucky Chinatown Mall in Binondo, Manila to buy things. Meanwhile I preferred to stay at a Mary Grace café and read on my iPod.
Here's a passage that appears on pages 106-107 that shows the unique dynamics between Elena and Lina:
We were twelve years old, but we walked along the hot streets of the neighborhood, amind the dust and flies and the occasional old trucks stirred up as they passed, like two old ladies taking the measure of lives of disappointment, clinging tightly to each other. No one understood us, only we two—I thought—understood one another…There was something unbearable in the things, in the people, in the buildings, in the streets that, only if you reinvented it all, as in a game, became acceptable. The essential, however, was to know how to play, and she and I, only she and I, knew how to do it.
She asked me at one point, without an obvious connection but as if all our conversation could arrive only at that question:
“Are we still friends?”
“Yes.”
“Then will you do me a favor?”
I would have done anything for her, on that morning of reconciliation: run away from home, leave the neighborhood, sleep in farmhouses, feed on roots, descend into the sewers through the grates, never turn back, not even if it was cold, not even if it rained. But what she asked seemed to me nothing and at that moment disappointed me. She wanted simply to meet once a day, in the public gardens, even just for an hour, before dinner and I was to bring the Latin books.
This nature is changed in every believer; for it is impossible a man should stand bent to Christ with his old nature predominant in him, any more than a pebble can be attracted by a lodestone, till it put on the nature of steel. An unrighteous man cannot act righteously, it must therefore be God, who is above nature, that can clothe the soul with a new nature, and incline it to God and goodness in its operations. Now to see a lump of vice become a model of virtue; for one that drank in iniquity like water, to change that sinful thirst for another for righteousness; to crucify his darling flesh; to be weary of the poison he loved for the purity he hated; to embrace the gospel terms, which not his passion but his nature abhorred; to change his hating of duty to a free-will of offering of it; to make him cease from loathing the obligations of the law, to a longing to come up to the exactness of it; to count it a burden to have the thoughts at a distance from God, when before it was a burden to have one serious thought fixed on him, speaks a supernatural grace transcendently attractive and powerfully operative.
Don't you love Stephen Charnock's writing? Doesn't his words flow in poetic melody? Every time I read something like this, the more I am convinced to read classic Christian literature, penned by the Puritans and faithful believers of old, whose intimacy with the Lord seemed uninterrupted. Their circumstances then were different, but their struggles were similar. Never mind the fact that it may be hard to decipher the sentences. I suppose the effort is well worth it—there is treasure hidden in these works.
Today was especially tiring, so I treated myself to printed books, Europa editions, of Elena Ferrante's Neapolitana series of novels. I've read the first two in my Kindle, but I'd love to read them, and the last two, in print. These will keep me company throughout the holidays. My brother, thrilled to see them on the dining table, made a very good point, "And where do you plan to display these?" As with most of my books, they find their ultimate home in our St. Gabriel house, where Nanay will likely complain that she doesn't have enough shelves to have these on display.
Almost every Sunday service, after the closing song is sung and the crowd starts to move out of the sanctuary, I am asked about a medical problem before I descend the stairs—from a stomach ache from too much coffee, to an anterior mediastinal mass that screams malignancy. I love talking to these brothers and sisters who call me “Doc” despite my protestations (“Just call me Lance”), but I’ve long since realized that this is their way of showing their endearment, their filial pride. It warms my heart that they think I can enlighten them as to what bodily issues they have, if they have cause to be worried, or if their own physicians are doing the right thing. I feel that these random consults are, in a sense, an extension of the clinic.
Indeed, illnesses know no boundaries, and people close to us, even those with whom we share the same faith and theology, can suffer the humbling truth that bodies disintegrate, organs fail, and cells malfunction. Such is the bittersweet reminder that our time on earth is finite, and to go to Heaven we must die. Those who have cancer at least have an idea of how the Lord will take them home.
This Sunday I pray for these dear brothers and sisters—that the Lord’s healing be upon them, that He guide their own physicians to give them the best medical care possible, and that He use these moments of pain and suffering to bring them closer to a deeper knowledge of Him—the great physician of bodies and souls.
I had a great time moderating the PGH-sponsored PSMO Round Table Discussion on AIDS-related Malignancies. Our case was that of a 29-year old male with Kaposi sarcoma, presenting with cutaneous lesions as well as with internal organ involvement, i.e., lungs and liver. Rich King and Fred Ting discussed the details of the case and principles of management. Because I moderated the program, I had the chance to mine the clinical experience and expertise of our guests in the panel discussion. We were so grateful to have learned a great deal from Dr. Franscisca Roa (Dermatology), Dr. Dessi Roman (Infectious Disease), and Dr. Gracieux Fernando (Medical Oncology). Our colleagues from the seven other training institutions—St. Luke's, Makati Med, Veterans, Jose Reyes, Medical City, UST, and NKTI—were wonderful, answering spot-on the questions we threw at them, and sharing their institutional experience regarding the case. Here are photos taken by Norman Cabaya.
Update (as of November 8, 2018)
Some key learning points during the RTD:
There is no critical CD4 count that determines whether chemotherapy may be allowed; CD4 levels are largely unreliable for this purpose. As long as the patient is clear of opportunistic infections and has good functional status, systemic chemotherapy may be done.
Management of Kaposi sarcoma is largely interdisciplinary.
Presence of disseminated cutaneous lesions with internal organ involvement is an indication for chemotherapy.
First line chemotherapy is liposomal doxorubicin. If finances may be a problem, we may use plain doxorubicin instead.
I will be moderating the PGH-sponsored Philippine Society of Medical Oncology Round Table Discussion on AIDS-Related Malignancies tomorrow night. My friends and colleagues, Dr. Rich King and Fred Ting—rhyming, I know—will discuss an interesting case and some nitty-gritty details in the new approaches to these diseases. It will be followed by a panel discussion with the following experts: Dr. Francisca Roa (Dermatology), Dr. Dessi Roman (Infectious Disease), and Dr. Gracieaux Fernando (Medical Oncology). Some residents and fellows from Dermatology and IDS—and Hematology, I learned—will also be joining us. This is exciting news—having these great minds around—because management of these cases is largely multidisciplinary.
Christian theology goes against the grain of modern psychology, such as in the issue of self-esteem. Whereas we are taught that we are all good and should feel good (consider, for instance, the many Dove commercials, with self-esteem as the battle cry), Stephen Charnock, an English Puritan clergyman, wrote this about man as he pondered on the doctrine of regeneration.
In ourselves we are nothing, we have nothing, can bring forth nothing spiritually good and acceptable to God; a mere composition of enmity to good and propensity to evil, of weakness and wickedness, of hell and death; a farden of impotence and conceitedness, perversity and inability, every way miserable unless infinite compassion relieve us We have no more freedom than a chained galley slave till Christ redeem us; no more strength than a putrefied carcass till Christ raise us, an unlamented hardness, an unregarded obstinacy, an insensible palsy spread over every part, a dreadful cannot and will not triumphing in the whole soul.
In defense of light reading (and watching Netflix)
With the breakdown of the internet connection this weekend came more than sufficient time to take on leisure reading. During residency I resolved not have any internet connection at home to give myself time to study and rest. It proved a wise decision, as it helped settle my mind to rest, shielding me from unnecessary distractions. A distracted person is a bad physician.
Since I moved in with my brother, I've had steady internet connection. It sometimes proved a distraction, but only during certain days. It has been useful for academic reading; anybody involved in oncology knows how fast things change in the field. But work generally exhausts me, and I treat myself to a few episodes of Netflix shows (the latest: The Kominsky Method, which my family loves) or some light reading before I go to bed, usually between 7:30 to 8 PM. How geriatric, I know.
Light reading is not for killing time (that’s ungodly), but for refitting the mind to tackle life’s heavy tasks (that’s the Protestant work ethic, and it’s true)
You must find what refreshes you, as your senior editors have found what refreshes them. And if you will not accuse us of being wicked worldlings for our light reading, I will not accuse you for watching all those TV sitcoms and sports programs that so bore me. Fair? Surely—and Christian, too.
My light reading list includes: Nick Joaquin's The Woman Who Had Two Navels and Tales of Tropical Gothic, Dean Francis Alfar's A Field Guide to the Roads of Manila, Stephen Charnock's The Doctrine of Regeneration (certainly not a light read, but one that keeps me awake, as it is a voluminous study on the theological subjects of salvation and conversion), Michael Dirda's Browsings, and Marilynne Robinson's Why Are We Here?.
"Refitting the mind to tackle life's heavy tasks"--now I like the sound of that.
Just when I thought I had a hold over my impatience, the wifi connection at home broke down. For months I’ve dealt with patchy internet connection—this, given the fact that my brother and I are subscribed to PLDT Fibr, arguably the fastest connection available. It isn’t news that internet is more expensive in the Philippines than in most of the world; the internet service in this country has much to improve on.
But for the past three days the connection had died. I called the PLDT customer service, but I only received platitudes, excuses, and an assurance that a report is being written, which will be forwarded to the technical service crew. A lineman arrived at home yesterday. His diagnosis was that the PLDT connection was fine; the problem is with the conduit connecting the modem and the TTC. The wire needed to be changed, he said, and it was left to me to contact an engineer who can replace the wires. In a few hours I was able to get hold of an engineer. This morning, the cat. 5 internet cable was replaced—successfully, I suppose, given that the telephone connection was also restored. But the internet connection remains broken, even during the time of writing.
I called up PLDT again and received the same excuses. I handed the phone to my brother, who was more calm but who remained firm. He even laughed at seeing me so irritated, angry, and unable to do anything else because of the paralyzing infuriation. “No, I will not hang up until you assure me that a technician will come over today,” I overhead him say, this after an hour of receiving otherwise useless instructions from Donna, the hapless customer service representative who probably had no idea what was going on but who was paid to read from a script, to keep people like us appeased. There comes a point when one loses patience at the waiting, and I reached this point today. It makes me feel frustrated about feeling frustrated.
But there is a lesson in this somewhere. Patience, humility, losing my sense of self-entitlement. I am a work in progress.
I spent the Saturday afternoon reading Nick Joaquin’s The Woman Who Had Two Navels and Tales of the Tropical Gothic, published by Penguin. I even worked on a story.
I still wish we had better internet service providers. There’s much to be desired about PLDT Fiber, and if only I had a choice, I would pick another.
