Decrease, increase

May I decrease, so that Christ may increase—the Christian's prayer. Quite above is from F.B. Meyer's John the Baptist.

Written using my Platinum 3776, medium nib. Ink: Pilot Iroshizuku Bishamonten (100th anniversary edition).

One day

Scenes at the clinic today:

—My patient's sister, braving the Metro Manila traffic to tell me the news: my patient has died. He refused to be brought to the hospital, saying he was tired and wanted to rest. They buried him two days ago. She gave me unused chemotherapy vials (paclitaxel and carboplatin), hoping others could benefit from them.

—A colleague, inviting me to work on a research project. This was followed by another colleague, telling me we already have data to report.

—Some watchers at my research's focus group discussions for my breast cancer screening study, confessing they did not even know what a mammogram was.

—My colleague's mother, diagnosed with breast cancer, for whom I did chemotherapy. We later found out she had another cancer—a large mass in her kidney. She underwent surgery a few days ago. This afternoon she texted me:




Well, this happened the other day: longganisa (sausages) from Lucban, Quezon, a gift from a patient with breast cancer, whose hair has grown. I told her, "Mukhang sosyal!" She beamed.

I had the longganisa for lunch; I cooked it myself: I poured water onto the pan and heated it until the water evaporated and the natural oils came out—a literal case of being cooked in one's own juices. Naparami ako ng rice!



It's been a long day. Praise be to God for the strength.

Germ Cell Tumors: the UP-PGH Round Table Discussion

The hosting of the round-table discussion (RTD) bookmarks an important event in subspecialty training. Yesterday our Division sponsored the Philippine Society of Medical Oncology RTD. We discussed a case on germ cell tumor. As has always been tradition, the first year fellows took over the organizing, as we did last year.



Mervyn was picked to discuss the case, and he did so with ease and grace. He spoke with clarity and authority.


Photo credit: Berbi Berba

This did not come automatically, of course. He had to rehearse and study the material.



As with most events, the success of the RTD was largely due to the work behind the scenes. Berbi and Marvin, with laser focus, discussed the slide transitions and the LED screen (many thanks to Roche Philippines and Mundipharma for all the help they've extended in giving pizzazz to our stage design).



Berbi reviewed the slides and, with the technical team, made sure the sound transmission was good and the images on screen were clear. Weeks before this, the rest of the team members worked on the protocols, highlighted the guideline-based recommendations for management, polished the script, and contributed their ideas.



But the brainchild of the RTD, he who made it his life's work to make the event successful, was Marvin. He thought of the raised platform, the LED screen, the lapel microphone, the lights—his mind is a walking events-organizing machine—while remaining gracious and patient. He channeled, he would probably confess later, his inner "Dane Sacdalan."



Here were all the training institutions present, with our invited panelists, Dr. Carmela Lapitan (Urology), Dr. Johanna Patricia Cañal (Radiation Oncology), Dr. Rosario (Supportive, Hospice, and Palliative Management), and Dr. Ding Fernando (Med Onco).


Photo credit: Berbi Berba

I'm not joking when I say the the Cancer Clinic is one of the happiest clinics in the hospital. I'm grateful to work with these people. I wish for them success and happiness and more opportunities to touch the lives of people who need help the most. Congratulations, UP–PGH Med Onco!


From right (back row): Mark Ando, Harold Tan, Alfie Chua, Marvin Mendoza, Mervyn Leones, Berbi Berba, Aylmer Hernandez—our first year fellows. 
(Front row): Roger Velasco, myself, Rich King, Karen Mondragon, Fred Ting—second year fellows. Photo credit: Rich King

Sketchy

Made using the iOS app, Sketches Pro. It's such a fun app!

On our lives' purpose

Flowers on the road, Banga, South Cotabato—photo taken by my mother (April 2019)

F.B. Meyer wrote:

And when we read the words of the apostle Paul about John [the Baptist] "fulfilling his course," we may well ask for grace that we may fill up to the brim the measure of our opportunities, that we may realize to the full God's meaning and intention in creating us: and so our lives shall mate with the Divine Ideal, live sublime words with some heavenly strain, each completing each other. [emphasis mine]

Swimming updates

I was able to swim for four days. It has been refreshing. I hope to continue this for as long as I can.

I'm sharing a photo my mother took in one of her travels. Not sure where this is, but it's likely somewhere in Negros, where she went to visit some friends.

Shrink not from sorrow

Photo credit: Jan Pelz at Flickr

FB Meyer contemplated on the barrenness of Elizabeth and the reproach she had endured among men because of this. Nevertheless she remained faithful in God and trusted in Him.

FB Meyer's prose is a balm to the soul. Consider this passage about sorrow and how it applies to Christians.

Shrink not from sorrow. It endures but for the brief eastern night; joy cometh in the morning, to remind. I may be caused by long waiting and apparently fruitless prayer. Beneath its pressure heart and flesh may faint. All natural hope may become dead, and the soul be plunged in hopeless despair. "Yet the Lord will command his lovingkindness in the morning," and it will be seen that the dull autumn sowings of tears and loneliness and pain were the necessary preliminary for that heavenly messenger who, standing on the "right side of the altar of incense" shall assure us that prayer is heard.

Music in our hearts

South Cotabato, sometime in 2016

Treated myself to a book this Sunday morning, John the Baptist by F.B. Meyer, before I went swimming, part of this so-called lifestyle change I'm implementing for myself. In Chapter II, F.B. Meyer begins by quoting a hymn written by John Keble:

There are in this loud stunning tide
Of human care and crime,
With whom the melodies abide
Of th' everlasting chime;
Who carry music in their heart
Through dusky lane and wrangling mart,
Plying their daily task with busier feet,
Because their secret souls a holy strain repeat.

May that be true of us this week: carrying this music in our hearts through the daily stresses of life. Ours is a peace that transcends all human understanding.


Pagbilao, Quezon, taken sometime in 2012. That was Kuya Arbie, still unmarried, walking to the sunset!

On the Pilot Custom 74

This month, my pens for work are the Pilot Custom 74 (which appears above) and the Lamy Safari with 1.1 mm stub nib (something I got for myself when I went to Singapore this month). The Custom 74 is a wet writer, which I prefer, and it glides smoothly onto the page. If you're transitioning to the mid-price range fountain pens, and if you've developed a strong liking to gold nibs (as I have), the Custom 74 may be a good way to start.

Camotes Island

One of my mother's closest friends in dental school is Ninang Baby who has, for years now, been inviting us to visit her in Camotes Island, Cebu. My brother Ralph had some time off last April, so he visited and sent me these photos. I would love to visit some day.

Pinoy-isms

This announcement on the LRT has a distinct Filipino flavor to it: charming, funny, and youthful! (Click on the message to zoom in.)

On religious liberty

Thoughtful, well-written, and moving speech by Dr. R. Albert Mohler Jr., The Eclipse of God, the Subversion of Truth, and the Assault Upon Religious Liberty:

We must defend the right to believe in enough theology to get us into trouble with anyone, anywhere, in a secular age. We must defend the right of Christians, along with all other believers, to be faithful in the public square as well as in the privacy of our own homes, hearts, and churches. We must defend the right to teach our children in the nurture and admonition of the Lord. We must defend the rights of Christian schools to be Christian—and to order our institutions around the Word of God without fearing the crushing power of the state. We must defend the right of generations of those yet unborn, to know the liberties we have known and now defend.

Oddly enough, this will mean defending florists and cake bakers and fire chiefs, and pharmacists, and teachers, and preachers, and moms and dads who dare to resist the secular powers that be.

For Christians, eventually it all comes down to our faithfulness in preaching the gospel of Jesus Christ and nurturing biblical churches and raising our own children in the grace of God.

No God, no truth. No truths, no liberty. No liberty, and nothing remains but the heel of someone’s boot.

Congratulations are in order

Congratulations are in order for Drs. Bobby De Guzman, Norman Cabaya, Ozzie So, Crizel Uy, Paulo Vergara, and Ken Samala for making it to the written exams part of diplomate exam in Medical Oncology! I just had to write this down. The news made my day.

Swimming

I'm happy to inform you that I've started swimming again. Knowing I need physical exercise and understanding that I have an aversion to the gym, I figured I should start playing a new sport (tennis or badminton—something non-contact and uses rackets) or resume swimming. I was largely encouraged by a sister from church, Ate Yvette, who started swimming to help with her back pain, and by a colleague from work, Harold, who said I should have a go at it. I wonder how long I can sustain this, but I already have the necessary equipment: swimming shorts, Speedo goggles na may grado (with prescription lenses), and a quick-dry towel. If you have books on swimming, or biographies of swimmers you can recommend—those would be great, too.

Things become more real to me when I read about them.

Cherith

via Instagram

Cherith is a brook in the Bible, mentioned in the account of the prophet Elijah (1 Kings 17).

As an aside, the passage reminded me of Ma'am Cherith, who manages the Med Onco office’s front desk, and helps oversee all things academic and administrative. A kind and gracious lady, she also helps with our research documents and prepares, out of love, a fresh pot of brewed coffee daily. She hates it that my documents are crumpled; she hands me folders and envelopes to prevent that from happening.

The Giving Café and my second affogato

Found a comfortable, quiet café a couple of blocks away from home. I decided to work here for the afternoon, after a comforting Saturday nap.



The Giving Café (TGC): A Social Enterprise is surrounded by specialty coffee stores.





One gets the feeling that the management takes coffee seriously. But not too seriously: the place feels relaxed, almost like the cafés in Seoul, but more homey and familiar. The tables are long, there are plugs, and the internet is fast. The store offers free complimentary internet connection for an hour, and then it's Php 35 for each succeeding hour.

I'm surrounded by a couple who brought their charming daughter with them, working women deciding on a business plan, and friends who are catching up with life—it has a youthful, scholarly vibe, and it reminds me of old UP Diliman Main Library. My saucer features a quote by Steve Jobs.



The store closes at 10 PM, which is just about right—it's the time of the day when my productivity is at its lowest.

Before closing time, I'm having my second affogato for the week. I'm getting to love this dessert more and more.

Sleep and burnout

Kaye and Tia, resident physicians from Psychiatry, visited the Medical Oncology office to continue their series on mental health. It's a big thing these days—and for good reason.


From left: Kaye, Rich (big head), and Karen


Roger, Nathant, and Mark Andō

Topics like physician burnout, caregiver fatigue, and depression in the workplace have gained traction, the subjects of many medical conferences and discussions across specialties.


Credit: Medscape National Physician Burnout, Depression, and Suicide Report (2019)

Kaye spoke about burnout and how to avoid it. Based on the routine diagnostic survey they conducted, many of us oncologists suffer from burnout. One of the ways to avoid burnout is adequate sleep. There's no actual defined time, but it should result to a relaxed, rejuvenated, and refreshed state. She shared tips for regular sleep.


Credit: Mervyn Leones (@louismervyn), screenshot of his Instagram story

I don't have problems with sleeping, but I've come to appreciate the value of good sleep. In fact, these past months, I've been reading and thinking a lot more about naps and sleep. I asked my brother Ralph to get me comfortable cotton elephant pants when he went to Bangkok. I bought a pair of pajamas from Uniqlo, which were on sale. I looked at duvet and duvet covers last night and ended the day by ordering online.


Credit: Pinterest

But nothing compares to peace of mind as key to good sleep. I remember Isaiah 26:3:

You will keep him in perfect peace,
Whose mind is stayed on You,
Because he trusts in You.

I hope you've had a good sleep last night!

Affogato is Italian for "drowned"

Tried my first affogato yesterday at a café along Scout Rallos called Goffa. Affogato, Italian for "drowned," is a coffee-based dessert prepared by pouring hot espresso to a scoop of vanilla ice cream. I honestly don't know what to make of it, actually. I enjoyed it for a time, but when my tummy grumbled a few minutes later—I am, after all, lactose intolerant—I started to question my decision.

King Asa

Three days in a row of blog updates. I'm starting to get my groove back.

So allow me to share with you what I've been reading this morning. It's about King Asa of Judah (1 King 15 and 2 Chronicles 13–14) who is described as someone "who did what was right in the eyes of the Lord." The next passages described him thus: "...the heart of the Asa was wholly true to the Lord all his days." He went on to remove pagan worship, put away the male prostitutes in the temples, and remove all the idols. No slip ups, no return to sin—just straight up obedience and devotion to the Lord. When he came to battle, King Asa cried out, "Help us, O Lord, for we rely on you..." This portion of the Bible documents in rise and fall of the kings of Judah and Israel. It's amazing how the Bible never shies away from talking about the sins and shortcoming of the leaders of the land. Ah, to be like King Asa, who loved the Lord and obeyed Him all his days.

I leave you with this—a kid in shorts, walking alone. What was going on in his mind?

Looking for fountain pens in Singapore

During our trip to Singapore for a pre-conference workshop on clinical trials, Fred and I looked for Overjoyed at Golden Wall Centre, Bain Street. My brothers got me the Diamine Chrome ink I still use for journalling from that store. We found the store, but it was closed. The website told us it was going to open the week after our visit, when we'd already be back in the Philippines.

We searched for other fountain pen places and found Fook Hing near Bras Basah.



I got a 1.1 mm nib for my Lamy Safari and my favorite purchase for that trip: a 100th anniversary limited edition Pilot Iroshizuku red/pink ink called Bishamonte.
I couldn't resist the urge to try it and even indoctrinated convinced Kuya JI, one of our hosts, to have a go at fountain pens. I think Kuya is buying his own fountain pen soon!

Days after the trip, I got a message from Overjoyed. A soft opening! We'll definitely come visit in next few months when we'll be back, God-willing.

Titus 2:11–13

My morning devotion in the New Testament today as I wait for the "blessed hope, the appearing of the glory of our great God and Savior Jesus Christ." This is especially comforting as I prepare for the clinic where I meet people who grapple with impending death, present suffering, and excruciating pain.

Naps

When I'm asked if I have any regrets growing up, I say that although I like how my life has turned out, I wish I had taken more naps.

Now that I'm writing about it, I wonder if it is only Filipino children who have mandatory afternoon siestas. As an adult, it is that sweet spot between dreamland and reality—the cool indoors juxtaposed against a sizzling tropical afternoon. As a kid, these naps felt like torture. Never mind if it was too hot to play outside; the thrill of hanging out with the neighbors was sufficient to make sleep impossible.

Did you fake-nap, too, just to please the adults, to kill the time so that when the clock struck 3:30 p.m., you'd be allowed to go out? I wish I had redeemed those moments: I wish I had truly drowned in refreshing sleep if I had know adult life would be so hectic and sleepless in the afternoons.

It's the afternoons, after all, that get me . . . that make me long for the cool indoors, fluffy pillows, and a billowing electric fan on number two, with Daisy Siete on Channel 7 playing in the distant background. Because I see patients in the afternoon, this isn't a possibility. But whenever I travel, I drag my friends to take naps with me before, say, we head to Myeongdong or the Champs-Elyseés, so we'd emerge refreshed for the night. They tell me they like traveling with me because it feels so relaxed. The secret is to take naps.

Naps are mind-spas spread throughout the day, whatever state in life you're in.

Overly self-censored

It used to be that after a trip, or even a long day, I would compose in my head what I would blog about, almost as a reflex. This was the time when internet was not as accessible as it is now—that glorious, quiet, private era where the idea of smartphones was just beginning to gain traction. But these days, as in today, I would have to open Blogger.com with deliberate intent. I would reread the lines I've written, more as a scrupulous editor rather than a carefree writer. I suppose it comes with age. And experience. And wisdom. I keep reminding myself, in regards to keeping this personal space online—a personal blog that is, by human standards, already in its teenage years—that the things I put out here may only contribute to the noise and distraction that now plagues humanity. Perhaps I must cease this self-censorship, or ease out a bit on over-analysis. I've been guilty of these.

To glorify God through what I write, to edify and encourage others—these are the reasons why this blog exists. I realize that friends and some family members come to this site regularly, if only to check if I'm alive or not. It always warms my heart to hear them comment on my entries.

I write this today because I've missed the habit of blogging. And I should do it more often.

Before I leave for the clinics (I have a number of chemotherapy sessions scheduled this morning), I'll show you this photo taken by a friend during our Korean trip. During our tour of an ancient palace, I spoke with one of the Korean kids in English. I asked him if it was true, if the tree was really 700 years old as the sign said. He looked at me with surprise, smiled, and ran to his mother. He did not speak the language. Ah, kids.

“General cleaning.”

via Instagram

My workhorse pens this week: #lamysafari and #pilotcustom74 with #con70 converter.

Sample size calculation in a two-stage phase II trial design.

via Instagram

The sample size was calculated for me by Prof. Tai Bee Choo. Thrilled to be here at the SSO-ACORD Concept Development Workshop. I’ve been learning a lot from the other participants, too, mostly young physicians in the region with promising careers in medical and radiation oncology.