Journal of a Lockdown No. 19

Taken last February, when Fred Ting and I rode the rickshaw in Mumbai, India. 

Two days after my self-imposed hotel quarantine and in the absence of any symptoms, I decide to go home and continue my lockdown there--home, being my brother's small condo 7 km from Manila. I hail a yellow e-trike parked near the hotel entrance. There are no taxis. The special buses are out of the way. It is 5:30 am. The sky bears faint streaks of sunlight. The driver looks at me, head to toe, as he wipes the trike's glass window clean. I don't look like a thief--certainly not someone who will stab him. I have thick glasses, a clean surgical mask, white polo tucked in, navy blue trousers folded twice up to the ankles to reveal my striped socks and worn Adidas sneakers: my favorite get up. But, he must wonder, who travels this early, before even the sun rises?

I introduce myself as a doctor in PGH, the best way to appeal to his senses--to other people's sympathies, in general. "I need a ride home," I say. He replies with an accent that reminds me of Mang Intay, our office assistant, who hails from Basilan. I negotiate a reasonable price for a one-way trip. My offer is generous. He agrees. My father, who took pains in teaching me lessons about being street-smart growing up, must be so proud of me if he'd seen how I handle the back-and-forth. I exude the same Catedral charisma admixed with the strong Garcenila indifference that I had when I bought the leather satchel at Marché aux Puces de Clignancourt from an old Moroccan man some years ago. (He smelled like a burnt cigar; I got the bag at half the price.) I could easily have called friends from work or church; they would have gladly fetched and brought me home, with no questions asked. But I don't want to cause inconvenience. Who knows what organisms are floating in the air? I might expose them unnecessarily. The driver scratches his head and confesses that he doesn't know the way. He worries that he may be stopped in the checkpoints. "I have internet; I can tell you where to go," I say. I show him my ID, proving I work in a hospital. I assure him that I will vouch that he is my designated driver for the day. I take the farthest seat behind him.

The trip reminds me of the rickshaw adventure I had in Mumbai last February, when the reality of the pandemic was too remote, too far away, too isolated, to be taken seriously in our shores. But I had a feeling that the pandemic would surprise us one day when the meeting in India was canceled just as my friends and I were about to board the connecting flight to Bangkok, then to Kolkota, then to Mumbai. But that's for another entry.

The 20-minute drive is leisurely: Metro Manila is beautiful in the morning, and in the absence of cars and traffic (both human and vehicular), the air is fresh and cold, like in my father's farm. The whirring of the trike's engine, powered by electricity, is calming. I look at the phone's app. I instruct the driver to turn this way or that. If not for the masks and the barricaded side streets, one won't suspect that a plague is upon us.

"We're here," he says. It is 6 am. I can see my building from a distance. I thank him profusely as I hand him the bill. He is a helper. I suppose he will spend the rest of the day waiting for potential customers outside the hotel in Manila, for people he can help.

Journal of a Lockdown No. 18

With nothing much to see, except the four walls of my room, I take a photo of my old Korean frames, without which I cannot see clearly.

I learn that my friend, Roger, is also staying in the same hotel. We meet each other to get take out lunches and dinners at the nearby convenience stores. Over dinner, we talk of how much we miss our fathers (his father died a week before Tatay did), how our fellowship in Oncology has changed us (for the better), how we will miss the company of our friends. It's cathartic. I'm stuck at level 16 of Alto's Adventure: how does one do the triple backflip? Email me the tips, please. I pray for friends and loved ones. I read John Updike's The Christian Roommates. Memories of Kalayaan Dorm at UP Diliman come rushing in. I stay out of social media. I message my family: Sean is cooking pork humba at home, Manong is preparing pininyahang manok. They exchange photos. Meanwhile, I subsist on takeouts and sliced peaches. I think of studying for the diplomate exam in Med Onco, but the schedule has been postponed indefinitely. A friend reminds me to make good use of my time. Lying around, submitting myself to gravity in this self-inflicted atrophy, seems like a good way to do it. I long for a good cup of hot coffee and remember the espressos I had in Milan. The mind wanders, even in areas already closed off to travel. Coffee in Milan, glasses from Seoul.

Later.

Journal of a Lockdown No. 17

Garden in front of Ward 3 of the Philippine General Hospital.

Tired after work, I head over to the nearby hotel where I'll be spending a few days for self-quarantine. I can easily come home, but I don't want to cause unnecessary risk to my brother, with whom I share a small space.

Later.

Journal of a Lockdown No. 16

COVID tent beside the Philippine General Hospital Out-patient Clinic. 

My 24-hour shift as fellow-on-duty at Ward 3. It's great to be back at PGH after a long time. There's a feeling of impending doom and paranoia. Pop culture references in mind: Gondor in The Return of the King. Or the Game of Thrones ("Winter is coming"). The difference is that we're expecting patients in dire need of care, not orcs or whitewalkers. If they're COVID-19-positive, we may make special considerations.

And yet, there's a pervasive feeling of hope. A strong sense of purpose. The bayanihan spirit. In the newly renovated call room behind Ward 3, the IM residents enjoy donations of food and snacks. Masks are not lacking. There's laughter and sarcasm. We feel that the nation is behind us. But there's the unspoken fear of the unknown: we know that our work  here can harm us. A number of our professors and mentors, people we know, have passed away. But we carry on. Padayon. Onward.

Our people need us.

I'm honored to be counted as a healthcare worker. But it makes me especially proud to be a Filipino. Lots of people make the mistake of generalizing our national character by looking at our politicians and government leaders. But we must remember what Mister Rogers said:

"Look for the helpers.You will always find people who are helping."

So my advice: keep out of social media. It's suffocating. It makes you angry and helpless. But look for the helpers. Random strangers who offer free rides to car-less healthcare workers (including me). Celebrities and unknown individuals who collect donations to help others out. Businesses that offer creative ways to offer assistance. Preachers, artists, musicians, and writers who help us make sense of things. Children who write the simplest letters of gratitude and encouragement that inevitably move us to tears.

It is inspiring to be a Filipino in these times.

I don a faceshield, an N95 mask, and clean gloves as I see and admit patients. I'm keen to disinfect my stethoscope. I scrub my phone with alcohol. I see colleagues wrap their mobile devices in ziplock bags. Fountain pen afficionados use disposable ball points that they can throw to the bin after the shift. But I decide to sacrifice my TWSBI Eco Rosegold (inked with Waterman Black): I rinse it with alcohol, which can potentially damage it. I don't mind. I'll look at the pen's discoloration and think of this remarkable moment in human history. The pen will have served its purpose.

So help us, God.

Journal of a Lockdown No. 15

Fresher air in Metro Manila.


My morning fiction reading: John Updike, “A Dying Cat, A Traded Car,” which was about a writer who visited his dying father and remembered their car. A beautiful portrait of a father’s love, and faith, and family.

I still think of Tatay and wish he were here. His presence was calming, like nothing could go wrong.

A friend's father died today. I message her to say how sorry I am. I probably know how it feels like.

Another friend's wife died today, too. So many deaths—since the lockdown, this has been our reality.

Tomorrow I'll go on 24-hour shift at PGH. I'm not sure if I can post something then.

Later.

Journal of a Lockdown No. 14

The PGH Cancer Institute playground. 

Nothing much to say today.

Please pray for me and my colleagues. I'm scheduled to report to work next week.

Journal of a Lockdown No. 13

Getting a dose of morning sunshine. (Pero ang Pinoy, ayaw talagang mainitan!)

There's the news that a senator, COVID-19-positive, went to a hospital with his pregnant wife, infecting healthcare workers and effectively closing down the operations of the said institution. I am angry. What pacifies me is the strongly-worded statement released by the hospital: it minced no words and, with clarity, rebuked the senator's actions. Whatever happened to leadership by example?

There's also news that friends from church are hospitalized; one is critical. I am brought to my knees in prayer.

*  *  *

Dr. Albert Mohler, in his article, The Humbling of Civilization: Praying for the Mercy of God, writes:

As image-bearers of the living God, even the most hardened secularists among us must deal with the most ultimate issues and questions—especially when faced by this kind of life and death challenge.

I've been talking about death and dying, the ultimate questions, to a number of my friends lately. It's a subject I'm comfortable discussing. Most of these friends are doctors and, like me, are used to seeing death on a daily basis. But no other time in my life--in our short lives--has the reality of death been so . . . poignant, so palpable: it can happen to us any time. We've seen it happen to our mentors or to people our age. There's so much uncertainty about the modus operandi of this virus that it is hard to say whether one will die of the disease or not if one gets infected.

 I pray that these uncertain times will make me (and them) think of eternity.

For Christians, this becomes an opportunity to translate some of the proximate questions into ultimate questions. True, we do not know exactly how far the virus will spread or how the history will be recorded. We do not know what kind of announcements will come in the days and weeks ahead. We pray, by God’s common grace through modern medicine, that an effective vaccine will eventually be used to restrain the virus and even conquer it, but we have no clue when that day will come.

The reality is that no vaccine nor human ingenuity will ever overcome the problem of human sinfulness. With all the uncertainty in these troubling times, Christians know that hope, refuge, and peace is found in Christ and in Christ alone. At this time, love for neighbor is pointing a world in chaos to the God who loved us so much that he gave his only Son to die for us.

Dr. Mohler concludes:

Our ultimate refuge is only in the true and living God. We must remind ourselves of that now. We must pray fervently for God’s grace and mercy. And we must share that love to our neighbors and point them to Christ alone as our hope—even if we now share at some distance.

Journal of a Lockdown No. 12

Getting my dose of morning sunshine as I rewrite an excerpt from "Peril," one of the Puritan prayers in the Valley of Vision. (For the curious, the pen is a Platinum 3776, inked with Diamine Chrome. Notebook is a Victoria insert, which fits snugly in a Midori Traveler's Notebook.)

I imagine that poems and stories will be written about this episode in our lives. As more and more people die in Italy and elsewhere in the world, including these shores, people are attempting to make sense of what's going on. This is the value of words, of literature.

I suppose Dr. Raul Jara was fond of poems: he read one of his during the inauguration of the garden in front of Ward 3, what used to be old patch of land that surrounded the Gastrointestinal Clinic. He was my college professor, one of the foremost cardiologists in the Philippines. He passed away. I never had the chance to be under his General Medicine service, but I had several opportunities to sit in hemodynamic conferences in Cardio on the sixth floor. The fellows would shake in terror when they discussed their echocardiographic findings with him: he had a stern, academic, no-nonsense presence. During lunch, they would laugh together as if nothing happened. He was a great mentor, a giant of a man young doctors have looked up to.


Joti Tabula penned a poem to remember the death of the young cardiology trainee.

MARSO 21: ARAW NG TULA
—para sa pumanaw na batang-bata pang manggagamot sa Filipinas sa panahon ng pandemiko ng coronavirus

Pinakamalungkot na buwan itong Marso.
Umaambon ng tula sa buong daigdig
Ngunit hindi ko mapanghawakan
Ng lakas at pananampalataya ang salita.
Bakit kailangang mauna ang mahal na anak
Na manggagamot na magbitiw sa mundo
Ng hulíng hininga at hindi akong ina
Na nagluwal sa kaniya? Napairi muli
Ako sa hilab ng pagdadalamhati.
Nagluluksa ang aking mga súso at matris
At walang mapagpahingahan ang aking isip.
Búkas wala nang ipagtitimpla ng kape
At wala nang ipagsasangag nang alas-siyete.
Nakakandado ang pinto ng klinika
At blangko’t walang pirma ang mga reseta.
Nakapahinga ang panukat ng presyon
At mabibingi ang istetoskop maghapon.
At ako? Nakatitig sa palábang buwang
Nakalambitin sa bukang-liwayway.
Naroroon ang aking pangungulila.
Hindi ako handang malasahan ang Marso,
Ang magkahalong luha ko
At berso ng mga makatang estranghero,
Ang talinghaga ng pagiging ina ng manggagamot,
Ang ligamgam ng alat-tamis ng sanlitrong dekstros

I enjoy reading Sir Joti's writing (I can't shake off the "Sir"--he was my in senior in internal medicine). If I could only write well in Filipino, a language so rich, romantic, and heartwarming! My favorite is PAG-ALAALA KAY PAPA (20 MAR 1956 – 3 MAR 1997). Here he relishes vague memory of his father. Without our memories, who are we, anyway?

Madalas at lalong-lalo na ngayong nása Burnham Park muli at tigulang na, pílit kong inaalala ang yapos ng aking ama at ang hawakan ng aming mga kamay nang muling nagkita sa parke. Gayumpaman, wala akong maalala. Musmos pa ngang marahil ang aking gunita.

Memory, death, and poetry today. The pandemic has brought us back to basics.

Journal of a Lockdown No. 11

The streets are quiet.


I am awake at  3 AM. I write the final sentences of the first draft of a story that will likely never see the light of day. It is too embarrassing to show. Perhaps I will come back to it after some time to write the second draft. The prolonged time at home has encouraged me to try writing fiction again for the sake of trying, sort of a proof-of-concept experiment to see if I can do it. The exercise has done me good, so far.

My brother reheats the food we had for dinner then proceeds to work online. Careful not to bother him, I go to the balcony to get some sun and treat myself to Dr. Butch Dalisay's story, "Heartland." (Google Books preview here.) The protagonist is a surgeon named Ferrariz, jaded with death and dying all around him. I know people like him.

Blood came with the business; it meant nothing now, the corpses piled in the wagon behind the camp, bloated and dripping; the physical fact of death was the first lesson any surgeon learned.

It is a powerful and moving story that would win the Palanca. Dr. Dalisay, a master of the short story, tells of his process (quote taken from his book, The Knowing is in the Writing):

I distinctly remember the thrill of just writing , in longhand on yellow legal pad paper, the first paragraph--a thrill intensified by having no idea what would happen next . . . That led me to a war and a doctor at war.

The story is unpredictable. It is all at once gory yet affecting, and I recommend it to any serious reader of fiction.

Heartland reminds me of the war we're waging against COVID-19. I just had to use the story as a metaphor for the present reality; thanks for indulging me. The only difference is that we don't see the enemy. The coronavirus is microscopic. But, like the enemies in battle, it spares no one, young and old (yes, even the young, as you will soon discover, and it will break your heart--ah, Makaraig!).

It is tragic if someone, especially a doctor, loses his compassion. A person called to save lives or palliate other people's suffering must never be indifferent to death and dying. This happens a lot, we have words for it now, like caregiver fatigue or burnout. The causes are multifactorial. But we must never lose compassion, we must always feel pain and sadness, even grief, when we see death . Medicine is kindess lived out: it is the art and science of human beings reaching out to another.

I pray that we never lose sight of this truth. I pray that God would instill in us, health care workers, compassion and strength, courage and protection. COVID-19 is a clear and present danger. The workload may burden us, make us feel jaded, even angry at this government that only remembers us when we're badly needed, that robs its people of the right to proper health care, that seeks to protect the powerful instead of the weak.

But we carry on.

Journal of a Lockdown No. 10

The MRT has shut down its operations.

I worship at home, in front of the old HP Elitebook 2570p, which I've grown fond of. As I sing along the familiar tunes of Trust His Heart and Rejoice in the Lord, with Kuya Deni's guitar accompaniment, I imagine the warmth of fellowship through the firm handshakes, the warm smiles, the random consults as I walk in the small church sanctuary in Quezon City. It seems like a long time ago, when physically meeting together was the norm. Pastor Bob preaches on Romans 8:18-25 in a pre-recorded Youtube video. For believers, there is freedom from hopelessness. It's a message I need to hear. Despite the world's despair, there is sure hope in the Lord.



The death of the "young trainee" at the Philippine Heart Center reminds me that death can happen anytime. My friends fear for the loss of their lives. It happened to him, it can happen to anyone.

Heart Center executive director Dr. Joel M. Abanilla said in a statement:

“We can only question why this young trainee with a promise of a bright future as a would have been cardiologist had to be the one to go. We have no answers.

“Yet we rest on God’s reassurance that He reigns Supreme and that He is in control. We need to collect ourselves, no matter how heavy are hearts are and move on for the sake of those who continue to need our services now more than ever,” he added.

How true his words are, how biblical and inspiring.

* * *

Some good news. My two friends, both very dear to me, are negative for COVID-19. I can't imagine losing friends at this time.

* * *

Been reading John Updike's The Early Stories: 1953-1975. The piece, "Persistence of Desire," is about a young love forgotten and remembered in a clinic.

I'm taking this quote, the story's final sentence, out of context, but this is how I imagine I will react when the pandemic is over.

He became a child again in this town, where life was a distant adventure, a rumor, an always imminent joy.

Journal of a Lockdown No. 9

I wrote with fountain pens and paper today. Click on the image to enlarge. 

The past few days have blended into what seems like an extended, perpetual weekend. Unless I looked at my calendar, I would not know what day it would be. I was, for instance, jolted at 4 AM by the realization that I had signed up for a webinar on cancer and COVID-19. I was relieved, in fact, to have been able to log in just in time. The house was quiet, my brother was in REM sleep (I could tell by his breathing), and, save for the computer glare, the room was dark. I did not stay too long to finish the teleconference.

But that happened days ago. Today, I checked, is a Saturday. After lunch, I am greeted--no, not that cheerful word--shocked by the news that a doctor about my age has died. Complications from a severe COVID-19 infection that hit him. His patient did not fully disclose her travel history. He passed away doing the work he had been called to do. I learn from my friends that he was a kind man, liked by everyone. He was his family's breadwinner. He put himself through college and med school by way of scholarships.

What happened to him could happen to us.

The best thing you can do is stay at home. If you need to consult with a physician, you may as well tell the whole truth.

* * *

Inspired by Dr. Butch Dalisay's story, Penmanship, I decide to write a draft of today's entry in pen and paper. In case you're interested, my notebook is a Veco Linear Journal Notebook (7 x 10 inches), 100 GSM. The pens and inks are TWBSI Eco Rose Gold, broad nib (inked with Diamine Oxblood) and Kaweco 70's Soul, medium nib (inked with Pilot Iroshizuku Bishamonten, limited centennial edition).

Journal of a Lockdown No. 8

"...You're one of the people who will thrive in quarantine," a friend based in the States writes to me, just as I'm about to finish Mia Alvar's final story in her collection, "In the Country."

To be honest, I don't know when my stamina for self-isolation can last.

I attend the sarcoma multi-disciplinary teleconference through Zoom. A patient with a shoulder mass also has an occipital tumor, which can be meningioma or a solitary fibrous tumor. The discussion is lively. Surgery then radiotherapy, proceed with a whole-body PET CT, or wait for the final histopath?  A consultant coughs in the background. Laughter erupts. Nobody at the conference will be infected anyway. The wonders of technology! I have several questions at the back of my mind: (1) how will the patient afford the diagnostics and treatment?, (2) how will his treatment proceed, now that hospitals have been directed to stop elective procedures, in the hopes of redirecting all efforts toward the pandemic?

I scribble on my notebook words of encouragement from Psalm 145:10 as I have my daily meditation.

He fulfills the desire of those who fear him; he also hears their cry and saves them.

I brew my second cup of coffee at 4 PM. It feels like a Saturday afternoon, except that it's supposed to be a regular workday. I want to get out of the house but decide against it. There are no friends to meet. The cafés are closed. I look at this photo I took in January and feel like it happened many years ago. This seclusion has warped my concept of time.



In a few days, I'll be reporting for duty. I wonder how I'll get to work. I'm thinking of walking for two hours if I don't get a ride.

Another friend suffers from cough and diarrhea. He has been pulled out of the rotation and has been advised to self-quarantine. "At least, there's no DOB,*" I text him.

Then I read this.

The University of the Philippines-Philippine General Hospital (UP-PGH) has been designated by the Department of Health (DOH) as one of its COVID-19 referral hospitals for the National Capital Region in line with UP’s mandate as a public service university.

UP-PGH is tasked with admitting COVID-19 patients within its cluster. This is according to a letter sent by DOH Secretary Francisco Duque to UP officials on March 19, 2020.

UP-PGH, a unit under UP Manila, is considered the biggest modern government tertiary hospital in the Philippines with the expertise and equipment to treat COVID-19 patients.

Servicing more than 600,000 patients annually, UP-PGH remains the only national referral center for tertiary care, providing direct and quality patient services to thousands of indigent Filipinos all over the country.

Kuya John writes me a message from Sydney. He tells me he has been enjoying Mavis Gallant's writing. He calls her Tita Mavis, which cracks me up.

---

*DOB: medical slang for difficulty of breathing

Journal of a Lockdown No. 7

Remembering our round-table discussion on germ cell tumors at the PGH last year

Staying at home, indoors, is becoming the new normal. Maybe that's a good thing, a part of the community's coping mechanisms: people are getting creative, finding ways to work from home, catching up on their reading backlogs, and so on. (At least, those who can afford to do so.) Because the lifting of the lockdown is still a few weeks away,  we need to create healthy habits for our body, mind, and spirit, and not let this so-called locked-down lifestyle push us into uselessness. The hardest parts are usually the beginning and the end.

These final weeks of March mark the end of my fellowship training in medical oncology! I have been preparing myself and my patients for the inevitable goodbyes as early as January. I have told my patients that a new doctor will care for them the next time they will follow up.

The release of the list of new fellows accepted into the training program seals the fact of this finality. The roster was made available many days ago, but I have only learned about this today. So much for social media distancing. I had never felt so left out (and it's largely my fault!). I'm thrilled for this new breed of medical oncologists and wish them all the best. They will not regret their decision.

I would have wanted to attend the send-off dinner, don my sablay for the official graduation portraits, or have the final group photo at Room 107. But the present extraordinary circumstances do not allow these rituals. And so fellowship training gradually ends, not with a bang, but with a quiet sizzle, eclipse by the greater global problem of this viral pandemic.  I don't know how I feel exactly: a combination of nostalgia (these past few years have been life-defining for me) and dread at the thought of a new life ahead.

I wish I were able to break the news face to face to some patients whom I had not seen in the past few months. But we are where we are: locked down inside our homes, the most heroic thing anyone can do at this point.

*  *  *

One-legged cancer patient walks from Masinag to checkpoint to get to PGH, at GMA News Online.

"May bone cancer po kasi ako, kelangan ko magpa checkup every month," she said.

From the checkpoint, Esperitu said someone will pick her up to bring her to PGH.

"May sundo naman po ako," she said.

Esperitu only has one leg and walks with the help of crutches.

*  *  *

A powerful video.
At the heart of Italy's Coronavirus outbreak, Giovanni Locatelli compares the obituaries page of local daily newspaper @webEcodiBergamo on February 9 and March 13. pic.twitter.com/DrnShYtrOF

— Naomi O'Leary (@NaomiOhReally) March 14, 2020

*  *  *

Also on Twitter.

Here’s your daily reminder to STAY AT HOME. 🙏🏼 pic.twitter.com/DLNK8IbnbE

— Ash Presto 💜 (@sosyolohija) March 19, 2020

* * *

Francis Collins, US NIH director, speaks about the coronavirus, his faith, and an unusual friendship (via the Atlantic). It's one of the best things I've read this week.

Collins also spoke about civic responsibility and the importance of selflessness in the midst of a pandemic. “I think we as a nation have to get into a place of not just thinking about ourselves, but thinking about everybody else around us, and particularly the most vulnerable people—those who are older and those people with chronic diseases. Young people may have a relatively low risk of serious illness, kids seem to have a very low risk, but if you want to avoid what could be the deaths of hundreds of thousands of people, then it is incumbent on all of us to severely limit our social interactions. We need to ask the question about every interaction we have, and whether it is necessary or not. I’m going to speak very strongly about that. Obviously, people do have to get food in the house and do other absolutely essential things, but beyond that, we should be volunteering to engage in the most stringent kind of isolation.”

The next parts of the article talk about his life and faith.

Collins once told me in a private conversation what those who know him best can testify to: Helping people who are suffering has always been a commitment. That was part of what explained his shift in focus from physical chemistry to medicine. “Although I loved the experience of working in quantum mechanics and wrestling with second-order differential equations, it was lonely,” he said. “It did not have that kind of human connection that I was beginning to long for. And that did drive me then to seek another way to explore science that was going to be more sociable, but also more devoted to outcomes that would help people who were suffering—and medicine was the perfect path to go down, even though it seemed like quite a dramatic departure from the career trajectory I had been on.”

It also talks about how he came to believe in God.

Growing up, Collins’s religious instruction was limited to being sent to the local Episcopal church choir to learn music, “instructed by my dad to ignore the rest of it, which I did,” he told me. In college and then graduate school, he found himself moving from the category of agnostic to atheist. “I would have challenged anybody who wanted to bring to the conversation some discussion about God. I would have asserted they were basically stuck in some past era of supernaturalism that is no longer necessary, because science has eliminated the need for it,” is how he put it to me. But the time came when, as a third-year medical student, he was no longer learning about the human body in a lecture hall; he was sitting at the bedside of people with terrible illnesses, most of which physicians had imperfect methods to be able to help.

The article continues

“Watching those individuals’ fates, what was going to be coming soon, the end of their life, I was trying to imagine what I would do in that circumstance,” Collins shared with me. “This was in North Carolina, and there were a lot of wonderful individuals, many of them having had relatively simple lives, but lives that were totally dedicated to helping other people. Many of these people were deeply committed to faith. I was puzzled and unsettled to see how they approached something that I personally was pretty terrified about: the end of their lives. They had peace and equanimity, and even a sort of sense of joyfulness that there was something beyond. I didn’t know what to do with it.”

“It made me realize that I had never really gone beyond the most superficial consideration of whether God exists, or a serious consideration about what happens after you die.”

* * *

Dr. Lei Camiling-Alfonso, a dear friend, offers her reassurance and professional advice. Do watch.

Journal of a Lockdown No. 6

I brew a fresh cup of coffee this morning. French press, coarse ground, strong. I have enough coffee to last me a month, thanks to my patients who gave them to me as parting gifts. Everyone is still on lockdown, and if you're reading this from Metro Manila, I say cheers to another day, my friend.

I sit beside the window, plug my earphones, read the final books of Genesis and a chapter in Mark, the part where Jesus feels compassion toward the people because they are like sheep without a shepherd. I pray for friends and family. The end of the pandemic. A heart that trusts and depends on God. That I will have a ride to work when I report for duty next week.

I write a story that's been brewing in my head, but it's in its infant stages and may never see the light of day. Toying with my imagination is a good way to pass time. If you're tired of reading toxic material in social media, try writing or journalling, practicing social distancing and social media distancing at the same time. It's good for the mind and heart.  I also read Mia Alvar's "A Contract Overseas," which appears in her collection, "In the Country." It is the first story in a long time that brings me to tears. It's written from a point of view of a college scholar whose brother goes to Saudi to support her education; her mother is a

traveling seamstress, making 'house calls' after church each morning in some nearby, nicer towns.

And yet, the girl sees her mother with contempt and admits it with regret:

After that, I had a terror of becoming [my mother], the multipurpose servant a few lucky scraps away from living on the street.

The images of people stranded in checkpoint areas come to mind as the background to this story. If they don't get to work because of the lockdown, their families will starve.

*  *  *

We now have a total of 200-plus COVID-19 cases. Epidemiologists predict it will increase to thousands more if the lockdown is not carried out. This is sound science that must be applied with compassion.

*  *  *

PGH nurse dedicated to her job walks part of the way to work, in the Manila Bulletin, features Ma'am Daisy Nietes.

Nietes was among the thousands of passengers trapped at the borders of nearby Manila provinces who struggle to find a means to report to work daily despite a massive suspension of physical work duties.

But her job cannot be made part of a virtual type of work arrangement as she is part of the skeletal workforce.

And in times of a global health crisis, medical health workers serve as the unsung leaders.

She said her normal duty shift, from Mondays through Fridays, starts at 6 a.m., and it usually takes her only an hour to travel from her house to PGH.

But on Tuesday, the first day of the implementation of stricter community quarantine measures, she was left with no choice but to walk.

“I know mahirap ang transpo kaya 2:30 a.m. umalis na ako dito sa bahay sa San Nicolas 1, Bacoor City going to Talaba. It’s a 40-minute walk and I just brought a flashlight and extra uniform,” she said.
(I know transportation would be difficult that’s why I left our house in San Nicolas 1, Bacoor City at around 2:30 a.m. going to Talaba. It’s a 40-minute walk and I just brought a flashlight and extra uniform.)

The distance between the two barangays is around five kilometers, around an hour’s walk.

Nietes said: “Wala po akong kasama sa 40-minute walk ko from our house to Talaba. I didn’t mind the fear, though my tears were rolling down because my daughter was worried when I left the house. Sabi ko lang sa kanya, ako ang bahala.”
(I was alone during my 40-minute walk from our house to Talaba. I didn’t mind the fear, thought my tears were rolling down because my daughter was worried when I left the house. I just told her I can manage.)

While many other workers are working remotely and some are finding it hard to productively function in the days to follow, Nietes, as a devoted health worker, just wanted to reach PGH even if she had no transportation.

For her, the real measure of public service is to be true to her duty in whatever crisis.

I remember Ma'am Daisy from the fourth floor. If I happened to make rounds during lunchtime and she spotted me, she would invite me to eat and wouldn't take no for an answer.

My heart swells with pride. These are the people I work with.

“Never lose hope. Let us all help one another in the service of our countrymen. Never get tired of our calling. Even if our situation looks gloomy, the little sacrifices that we make will make the biggest impact on our people,” she said.

Journal of a Lockdown No. 5

I wake up to a message from Fred, who's supposed to go on a 24-hour shift in the hospital today. It's all part of the skeletal workforce being implemented by PGH: as few health-care professionals at any given time. If a team on duty gets infected, at least others can still make it to work.

"If things don't improve, I don't think we can travel anymore," he writes. He lives in Ortigas, a few blocks away from me. I'm scheduled to go on the same shift next week, plus the out-patient chemo sessions if our patients (or their oncologists) ever make it to Taft Avenue. The suspension of Grab, taxis, and other modes of public transportation is a problem for us, healthcare workers, who don't drive. I am considering my alternatives. Walking is one of them. I check Apple Maps: if I walk from home to work, it will take me an hour and 45 minutes. It makes me wonder: what about our nurses who live in Cavite?

But the government's declaration to suspend transportation is sweeping. It's understandable: lock everyone in his or her home. The less physical human interaction, the better the virus can be controlled. But I wonder that idea has been thoroughly assessed. I wish our leaders were more understanding.

Fred writes a message to the local government unit: he lives in Pasig, but he works in Manila. Who should he write to? He doesn't get any response. He asks someone else to cover for his post. I don't know about his plans, but the clinical department where we belong is organizing a carpool of sorts. It's a creative idea that can work.

A friend offers his unused condo: "You can stay there if you have to, but I warn you: it's a mess," he tells me. I hope I will not be needing it, but his kindness warms my heart. The writer Jessica Zafra (from whom this idea of writing a daily blog during the lockdown came), writes:

Observe and remember the way the people around you behave these days, because that’s what they really are.

Dire situations bring out the best and worst in people.

EDSA is eerily quiet. I can hear the birds chirp.

Journal of a Lockdown No. 4

I Grab to work. It takes me 20 minutes to reach the hospital. Traffic is good, as if it were Holy Week. I pay Php 400-something.

There's a sense of fear and paranoia. Nobody wants to linger. There are masks everywhere. Pedestrians even wear N95s; I wonder where they got them while my colleagues--pulmonologists, critical care specialists--couldn't.

Ma'am Jo, our clinic's nursing assistant, hands me her own extra mask because there are no stocks in the hospital this morning. The delivery hasn't arrived yet, or so I am told. It's a quiet Monday, a far cry from the usual pandemonium. Follow ups are discouraged unless the patients are scheduled for chemo. There's humor, too, and teamwork. We take turns in seeing patients of our colleagues who are on quarantine. We pray that their tests come out negative.

I want to tell you that, contrary to what the Presidential Spokesperson said in his briefing, there is no evidence linking bananas and gargling to COVID-19 infection prevention or cure.  It's a shame that the source of medical misinformation is someone from a position of power. But I will not comment on politics: I tend to get fired up and might write offensive things.

Reading Dr. Edsel Salvana's Twitter feed helps me make sense of things.

I suggest you also follow the UP-Philippine General Hospital's Department of Medicine Facebook page. It's a source of useful, verified, and scientifically sound information, which you can disseminate.



DOH also has a useful website.

*  *  *

Developing story: Work suspended, establishments closed in Luzon as gov't places island under 'enhanced community quarantine' via CNN Philippines.

Work and public transportation are suspended, and establishments will be closed in the whole of Luzon as the government placed Monday the entire island under "enhanced community quarantine" to contain the spread of COVID-19.

Presidential Spokesperson Salvador Panelo told CNN Philippines that the enhanced measures against the viral disease are effective immediately, but the government will "give allowance to people who will have to go home from work."

Panelo said exempted are frontline health workers, authorized medical officials and those traveling to get basic necessities as well as for medical or humanitarian reasons. Government offices have to maintain a skeletal work force, he added.

All establishments will also be closed, he said, but supermarkets will remain open and ATMs at banks will remain operational.

* * *

Scenes from my neighborhood.

The dog looks tired.



Trains are empty. People wear masks.



On my way to grab something to eat (an essential task), the streets are quiet. The mall is closed.



I go back home and resume the quarantine.



Now to catch up on my reading.



More updates tomorrow.

Journal of a Lockdown No. 3

I watch the Sunday preaching video online. I am in a cottage by the pool. It is 9 am. I take notes. Colossians 1:15-20:

[Jesus] is the image of the invisible God, the firstborn of every creature:

For by him were all things created, that are in heaven, and that are in earth, visible and invisible, whether they be thrones, or dominions, or principalities, or powers: all things were created by him, and for him:

And he is before all things, and by him all things consist.

And he is the head of the body, the church: who is the beginning, the firstborn from the dead; that in all things he might have the preeminence.

For it pleased the Father that in him should all fulness dwell;

And, having made peace through the blood of his cross, by him to reconcile all things unto himself; by him, I say, whether they be things in earth, or things in heaven.

What comfort during these troubled and troubling times!

This is the first time in history that the Sunday worship services in church are canceled. Most churches in Metro Manila have gone online--this in compliance with the government's directives for community quarantine. I long for physical fellowship but remind myself this is temporary. It is wise to undertake these precautions. COVID-19 best spreads in large crowds.

Work resumes tomorrow. I advise patients not to follow up if they're not scheduled for chemotherapy.

*  *  *

Dr. Joey Lapeña shares that despite the Association of Philippine Medical College's directive to exempt interns from going on hospital duties during the COVID-19 crisis, many interns have volunteered to help out.

From UP-PGH interns:
“And we're 156 as of 2PM and more are being added to the ranks. All we're waiting for is the waiver from the DDHO before we start! (And the specific instructions per department) Surg, Pedia, OB, Ortho, NSS are on standby, Hahaha! It is indeed heartwarming!”

* * *

My good friend Fred Ting writes a passionate plea to Filipino doctors in these perilous times.

So Dear Doctor, even if most establishments are closed, everyone is advised to stay home, and yet here we are on skeletal duty, DO NOT BE AFRAID. We’re all in this together. Ten to 15 years of medical training has prepared us for this moment . . . .

We have been through a lot of tough and harsh times before; we will sail through. Remember: To serve your country is always an act of privilege and not a sacrifice.

Journal of a Lockdown No. 2

I finish season two of Kingdom (킹덤) in Netflix. It's about an epidemic that turns people into flesh-eating monsters. Once bitten, the victim becomes a monster. Unlike in other films, the zombies run. The protagonist is the Crown Prince Lee Chang (Ju Ji-hoon), who, in order to save Korea, must also ascend to his rightful throne and remove the usurpers, the Haewon Cho Clan, headed by Minister Cho Hak-ju (Ryu Seung-ryong) and the Queen Consort Cho (Kim Hye-jun). It has politics, conspiracy, deception, infectious disease, and epidemiology. It's beautifully crafted. It does not insult the viewer's intelligence. Don't watch it if you're prone to panic.

*  *  *

I do some laps in the pool.

I read about Esau and Jacob in Genesis. I remember friends and family. I pray for negative COVID swab results of two friends very dear to me.

*  *  *

Work resumes on Monday. My patients from the provinces can continue chemo, provided they show proof that their travel to Metro Manila is essential. At least, that's the news we're getting. There's also an announcement of a curfew at 8 PM, but the advisories are conflicting.

*  *  *

COVID-19 cases are now close to 100, according to CNN Philippines.

Previously, the majority of the 64 cases were confined in hospitals in Metro Manila, prompting the government to restrict travel to and from the region.

The DOH also disclosed that the Philippine Heart Center in Quezon City has limited its services since its health personnel were exposed to a COVID-19 patient – an 88-year-old Filipino who died of the disease this week.

*  *  *

This lockdown lifestyle is how I would typically describe my weekend: recuperating at home after a tiring work day, catching up on sleep and rest and books and TV series and films.

*  *  *

I subscribe to Apple TV Plus. "See" is gripping. It features Jason Momoa's best acting so far. His name is Baba Voss, the head of the Alkenny tribe. The world's population is decimated to less than two million after a virus hit 600 years ago. It reminds me a lot of Jose Saramago's Blindness, a book I read during my Opthalmology rotation in medical internship. The characters' names in this series sound musical, as in Frank Herbert's Dune (Benne Gesserit, Gaius Helen Mohiam, Leto Atreides--who doesn't like a good name?). I can't get over them.

*  *  *

Mitigation efforts like social distancing help reduce the disease caseload on any given date, and can keep the healthcare system from becoming overwhelmed, reports the NY Times. Full story here.


* * *

Sunday worship service is canceled tomorrow. I'll miss my church family.

*  *  *

Our hospital's director tells patients to avoid non-essential medical follow ups. The health workforce is now geared towards addressing COVID-19. Might get called to assist in the IM Clinic.

Journal of a Lockdown No. 1

At the University of the Philippines - Philippine General Hospital Main Lobby

The train is unusually quiet on my way to work this morning. The passengers, hair still wet from the shower, scroll through Facebook on their phones. A man holds on to the handrails and sings a Tagalog rap song I don't recognize. A lady's head is on her boyfriend's shoulder; it bobs and sways with the train's movement. She is soundly asleep, oblivious to the panic. There are masked people everywhere, as in an episode of Watchmen. A man near the train door sneezes. Everyone looks at him with contempt, as if he has committed a mortal sin. There is palpable relief when he disembarks on Ayala Station.

As soon as I arrive, I head to the Cancer Institute where my patient, a 59-year old woman from Tondo, is confined for her second cycle of chemotherapy. She has stage IV rectal cancer. I tell her she can go home later tonight or early tomorrow morning. She has not heard the news last night. "We're going to be in a lockdown," I say, reassuring her it won't be a huge problem for her since she only lives nearby. I tell her to take medications for her bouts of nausea as well as for the rectal pain that keeps her awake at night. I warn her to avoid large crowds, to wash her hands regularly--careful additions to my standard you-may-go-home script.

"Mahal po ba 'yung gamot sa pain, Dok?" she asks.

"May mga generic po. Baka mas mura po kung dito niyo na bibilhin sa PGH," I say. Her pain meds cost at most Php 15, but she has no livelihood; and her daughter, the family's breadwinner, is a sidewalk vendor.

My phone is, by now, flooded by inquiries from patients. I compose a brief reply to an email: my patient with stage III colon cancer asks if his final chemo session will push through next week. He lives in Leyte. To save money, he takes the bus to the hospital on Sundays so he can make it for his Monday appointments. After his sessions, which typically end after lunch, he takes another 24-hour bus ride home. I recall him telling me, "Di nga po sila makapaniwala na nagki-chemo ako eh." I don't know what to write him, except to tell him that I don't know yet, let's see what happens. I hope to see him soon.

My Viber and Telegram groups from work are busy with activity. A friend forwards me the news that a doctor about my age is intubated and is fighting for dear life. A colleague issues a plea for honesty: tell your doctors the truth, your travel history, your contacts with individuals possibly infected with COVID-19. The doctor in critical condition did not know he was dealing with a suspected case. On Twitter, I read "frontliners" everywhere. The word refers to doctors, nurses, other paramedical staff who risk their lives to serve the sick. It makes me uncomfortable, being celebrated like that. It's our calling: we're not doing anyone a favor. We couldn't live with ourselves if we shirk from our responsibility.

I receive the news that two of my doctor-friends, practically family to me, have been advised to get tested for COVID-19. It is hard when the news hits close to home. I clasp my hands in prayer, resolved to go to work like it's just any other day.

But these are not normal times.

* * *

The pandemic is bringing out the best and worst in people all over the world.



* * *

This post is largely inspired by Jessica Zafra's resolve to blog every day during the lockdown:

I’m going to keep a journal of the lockdown. This is a small notebook, I’m being optimistic.

Me, too. By God's grace, this, too, shall pass.

Oblation

The daily commute plus some podcast recommendations

Colin Jost's New Yorker essay about his high school commute between Staten Island and Manhattan is a worthwhile read. (Jost's grandfather sounded a lot like my father, who did not hesitate to grant me permission to travel alone from Marbel to Baguio. He wanted me to learn how to be street smart.)

I took a bus, then a ferry, then a subway—which, when you type it into Google Maps, looks like you’re emigrating from China to San Francisco in the eighteen-forties.

I live an hour away (two hours, on bad days) from the hospital where I work. Commuting is a good time for thinking and praying. I would listen to Tim Keller's Gospel in Life podcasts or the New Yorker Fiction podcasts (I find Deborah Treisman's voice soothing). There are days when I would feel like listening to the podcasts recommended by good friend Harold Tan: The Memory Palace being my favorite among them. I also read a lot of books on my Kindle. I finished John Calvin's The Institutes and Stephen Charnock's On Regeneration because I read bits and pieces of them on the train.

Swimming

I started swimming again. I don't, and likely won't, do gyms, so this is my preferred cardio work out. I don't have to deal with sweat, and it's perfect for hot days (which is 90 percent of days in Metro Manila). It took longer for the cleaners to declare the pool clean enough for public use than what I had expected, about a month after the Taal became quiet. I think and pray when I swim. While air-drying myself up, I read the Bible and have my devotions. Inside my bag are my Speedo goggles with corrective lenses, a quick-dry towel, my Midori Traveler's Notebook, my cell phone (which has the ESV app), and my fountain pen; here, it's the TWSBI 580 AL. Sometimes, I bring a Kindle, too, for some leisurely reading.

How do you exercise?

EDC (every day carry)

Kaweco Old Soul and Pilot Custom 74 with my Midori Traveler's Passport notebook, black.

Overheard in the lobby

While preparing for a meeting I'm moderating tomorrow, a girl about five years old came near me.

"What are you doing?" she asked.

"I'm reading." I was seated on a reupholstered sofa, my iPad and notebook on my lap, and pencil in my right hand. Her grandmother was a few meters from me, talking to someone on the phone.

"Oh. What's that?" she asked, looking at the tumbler to my left.

"That's coffee."

"I don't drink coffee," she said. "I'm still a young girl."

"Yes, you are."

She left me for two boys who had just arrived--her friends from the neighborhood in sando and shorts. I would later overhear them playing doctor-and-nurse. They had fake stethoscopes and a doll.

Koala

Koalas are asleep for most of the day. When they're awake, they like to munch on eucalyptus. Cute!

I only share verified facts

Timely post I saw from a friend's feed.

As doctors who (should) know more about the science behind the virus, this has been a personal reminded for me to verify, verify, verify the facts before I would even think of posting them. This is true for the current COVID-9 epidemic. This is true for any cancer treatment.

Circus

The Entrance, New South Wales, Australia

Trusting God in death and life

Beautiful piece by Seth Lewis called "If God Can Be Trusted With Death, He Can Be Trusted With Life."

The longer I live on this planet, the more I’ve been forced to learn the art of dealing with death. There were no classes on this in school, but I have a teacher who refuses to be ignored: Experience. Attendance is mandatory. One after another, with increasing regularity, the funerals come. During the service, those of us who remain remind each other of God’s promises, eternal life and resurrection, Heaven and perfect rest and happiness for all eternity. The crowd pauses to make time for prayers and Scripture while death is in the room, before life moves on. But life does move on, and then many of the same people who spoke of the promises go back to ignoring death. Along with him, many also ignore the God who made the promises.

His blog has been a blessing to me.

Red bag

Annecy, France

Mouse

I've been doing some writing these past days, more than my usual emailing and blogging. There's been a slight discomfort in my wrist, largely aggraved by my use of the trackpad. To rest my wrist, I bought a cheap Acer wireless mouse (Php 450). To complete the experience, I also bought a mousepad (Php 50). These items are rare now. There was a time when malls were bursting with computer parts and gadgets. Now, it's mostly phones and accessories. The lady asked if I was a gamer. "No," I should've said, "just a writer who needs to stop typing to relieve the wrist pain."  But I just answered in the negative.

Jacaranda, Sydney

The transnational tribe of the sick and the dying

"Kontrabida," the first of nine stories in Mia Alvar's "In the Country," is about a pharmacist from New York who comes home to a doting mother he loves and a dying father he detests. When he sees his father, the pharmacist Steve writes:

"My father no longer resembled me. The short boxer's physique, a bullish muscularity I'd always detested sharing wth him, was gone. In fact he no longer resembled anyone in the family; he belonged now to that transnational tribe of the sick and the dying."

His father had liver cancer. We learn that he was given doxorubicin and radiation—but these didn't do much. The oncologist in me realizes the story may have been before the advent of sorafenib or lenvatinib, targeted therapies proven to be better than systemic chemo.

There's so much truth, so much talent, in Mia Alvar's story. I can't wait to read the next one.

Why I'm a fan of Carla Barbon's Instagram stories

I'm still largely in Instagram because of my friend Carla Barbon's stories (her account is in private mode). I follow her feed with rabid anticipation. She makes stories out of tragedies. Months ago I sympathized with (and also laughed out loud at) her ordeals in her trip to Louisiana where the hotel she was supposed to check in was ravaged by a hurricane. Someone later adopted her in another accommodation so she never had to play the homeless role. During that trip, she would also win a prestigious award in a major lung world conference.

But the greatest attraction is her commentary on her every day, especially when she talks about provincial life. She is the Alice Munro to rural Mindoro. She would post about her childhood, about her grandparents who raised her, about her father who had just discovered Spotify. These tales would warm my heart, make me grateful for family and friends, and encourage me to celebrate the simplicity of an uncomplicated life. But she is also an absurdist like the writer David Sedaris who views life through a different lens. She is so funny. She articulates feelings or phenomena I couldn't find the words to. For instance, this post on her mother's dinnerware collection. I just had to reply that we have the same situation at home. And isn't the post downright brilliant?



I love Carla's wit and humor—and her person. She shifts her tone seamlessly—a well-traveled intellectual socialite and a street-smart, no-nonsense, wide-eyed palengkera. She can tell you why synchronized intermittent mandatory ventilation is warranted in an intubated patient with the same ease as when she makes her stand for or against one of the Barretto sisters. I don't know if she's for Claudine or Marjorie—but maybe that issue has lapsed and no longer deserves a commentary.



And if you knew her personally and if you had actually worked with her, you would find that she is among the finest internists and critical care and lung specialists you'll find. And such a joy to work with. She is bursting with stories—self-deprecating and humble, hilarious and insightful—that I just can't get enough of them. I can hear her speak when I read her.

So I'm a fan. Because of her stories I can't totally leave Instagram. Thanks for sharing bits and pieces of your life, Carcs.

Heto, may tissue ako. Alam kong mata-touch ka nito.

Glasses.

via Instagram

Nose, Bangkok, Thailand

The joys of being edited

When I opened the MS Word file labeled version 1 this morning, I was overjoyed to read my colleagues' edits. The deletions, additions, and rewordings were thoughtful and reasonable that I was moved to say, "Oo nga, ano?" They cut out unnecessary phrases. They improved the flow of the statements. They worked like gardeners tending to a backyard that's been left untended for weeks. It is perhaps this joy of collaboration that makes technical writing enjoyable for me.

Marang

From our farm.

Small, inconsequential problems

1. A book I ordered online may have been lost in transit. It was a secondhand copy. The bookstore emailed that I'd get a full refund. I'd been looking forward to reading that book. They don't sell that here in the Philippines.

2. I wonder which book I should bring during my commute to work. Perhaps a book on basketball, recommended by Chuck, a sports writer and analyst, or an anthology by Jeffrey Eugenides called "My Mistress's Sparrow Is Dead," or Jonathan Edwards's collection of preachings. I realize that it's not a matter of which book to bring, as they're all in my Kindle; but which book to read for the next hour.

3. I will need to submit a technical paper for journal publication soon. It's practically done. I just haven't found the perfect groove to reformat it based on the editors' preferences.

Little boy, Shoal Bay, New South Wales

Durian coffee

The Farm, Koronadal City, South Cotabato

Australian flags, Sydney

Interview with Dr. Fidel Nemenzo

Photo by Chris Clemente

Dr. Fidel Nemenzo was my professor in a general education (GE) math class. Now he is the newly appointed Chancellor of the University of the Philippines - Diliman. His interview with Ces Drilon was engaging: I felt like I was listening to a private conversation. This in, in fact, how people actually talk. I was thrilled to hear Ces Drilon ask about his bracelets, which used to make sounds whenever Sir wrote something on the board to explain the Möbius strip.

Durian, Banga, South Cotabato

There was overabundance of durian. The trees in our farms gifted us with so much fruit that we handed them out to our neighbors instead of selling them. When chilled, durian tastes like ice cream.

Old couple, Sydney, Australia