Know your God

At ASCO Breakthrough 2019, Bangkok, Thailand

Morning situation

Singapore skyline

To incoming interns: the harder one is usually the right one

Dr. Glenn Wakam, surgical resident at the University of Michigan, gives five tips to incoming interns. These are gems.

1/6 Today I gave 5 pieces of advice to our new @UMichSurgery interns.
Dr. Glenn Wakam, surgical resident at the University of Michigan, gives five tips for incoming residents. These are gems.

First I asked them if they had a culture. “Not yet”

I suggested they would soon and when they were chiefs, they would own the culture of the residency. They will create it starting now.

So my 5 tips👇

— Justin (taken over by @DocWak) Dimick (@jdimick1) June 25, 2020

#1 Ask for help. Call your chief. The goal is to be safe, not right. The value this enforces is humility—a cornerstone of the “new” surgical personality.
#2 If you come to the fork in the road and their (sic) are two choices, the harder one is usually the right one. Get out of bed and check on the patient. This is integrity: doing the right thing.
#3 Lean into your education. The difference between being passive vs leaning in could be as much as 2-fold. This doesn’t mean working longer, it means making the most of the time you are working.
#4 Learn to apologize. If you have a bad interaction, and you are not your best self, don’t fall into the trap of blaming someone else, e.g., “that was a dumb consult”. You will be tired and stressed, and you will snap at someone. This job is hard. Go back and apologize.
#5 It’s never too early to think about leadership. You will be leading a team soon. Pay attention to team dynamics and prepare. Always look out for the most vulnerable team members.

The culture of your team will be yours. You will own it. Prepare for it.

No. 2 tip is so true. There were days during training when, as I went to bed, I'd realize I didn't do a complete physical exam (forgot the rectal exam or crammed the cranial nerve exam) or I missed out on a crucial diagnostic test. Because I lived in a hospital dorm during residency, it was easy to go back to the patient's bedside and do all those things. I don't regret the moments when I went back.

The worst thing a doctor can tell himself is, "What if I'd done better?" If you're in medicine, doing your best is the smartest, kindest thing to do for your patients and for yourself—you will sleep soundly. You'll end up tired, even exhausted—but it's the good kind.

"The harder one is usually the right one." Thanks for these wise words, Dr. Wakam!

Ma'am Jane at the Registrar's

Caused a ruckus at home when I looked for my med school diploma. I called mother, who panicked when she couldn't find it. Important documents are kept in my father's attaché case or hidden in the console table; my diploma wasn't there. I emailed and called UP Manila, spoke to Ma'am Jane who said the diploma wasn't there anymore. "I graduated in 2014," I said, just in case the staff overlooked. It turned out my diploma was in the flat all along, hidden in an undiscovered box. I called the Registrar's Office to apologize. "My mother will scold me," I said. Ma'am Jane, ever the accommodating lady over the phone, laughed and said, "It's okay, Doc." 

In the heat of summer

Laguna.

Not luck

Dr. Ester Penserga, in her keynote address in yesterday's virtual graduation, Department of Medicine, UP–PGH.

The Virtual Graduation

Of all the graduations I’ve had, today’s virtual ceremony will stand out in my memory. I was in bed, my ears plugged to bluetooth earphones linked to my laptop. I logged in Zoom at 8:58, two minutes before the rites began. On the opposite side of the small condo was my brother, who was in a separate online meeting. We could hear each other mumble, but not enough to make out the actual words.

Drs. Vanessa Co (Gastroenterology) and Deonne Gauiaran (Hematology) hosted the event. They were, at some point, my senior fellows when I was a fledgling Medicine resident. They’re consultants now, official members of the Department of Medicine’s stellar faculty. I remember that Ma’am Van sat with me and my friend Carlos Cuaño (who would himself proceed to gastroenterology training) to help us prepare our end-of-rotation report on pancreatic pseudocysts. Sir Deonne was our chief resident when I was a first year IM resident. (He has done so much and so excellently, and we’re only about the same age.) I looked up to them then, and still do today.

There was the invocation and the singing of the National Anthem. Should I stand? I was, by now, propped up by two comfortable pillows. I was in a white shirt and comfortable shorts. I pulled the curtains to block the morning sunshine. I decided to lie still. Nobody could see me anyway.

Dr. Carmencita Padilla, the UP Manila chancellor, spoke about the Covid-19 pandemic and World War II. In both these events, she said, UP PGH continued its operations. There was never a lockdown. I imagined that there would be applause, had Dr. Padilla addressed us face-to-face, but I cheered for her in my mind. I felt blessed to be part of this hospital; PGH would always be a part of me.

Virtual graduation today. Dr. Carmencita Padilla, chancellor of @UPManilaOnline, says UP Phil General Hosp has never been on lockdown since the COVID-19 pandemic. She says that even during World War II, the hospital was open to serve. pic.twitter.com/zUZDhCDrC4

— Lance Catedral (@lanceoncology) June 23, 2020

Dr. Gerardo Legaspi, the director of the Philippine General Hospital, challenged and encouraged us to see what’s ahead, to imagine the best for the country.

Imagine the best for your country, says Dr. Gerardo Legaspi, director of the UP Philippine General Hospital during the Department of Medicine (virtual) Pagtatapos. @UPManilaOnline @upsystem pic.twitter.com/YFRLZBlRXV

— Lance Catedral (@lanceoncology) June 23, 2020

Dr. Charlotte Chiong, dean of the UP College of Medicine, applauded the bravery and resolve of everyone in the virtual room.

Dr. John Añonuevo, the chair of the Department of Medicine, said that the “only thing we are certain of is that there is a future for you.”

Dr. John Añonuevo, chair of the Dept of Medicine of UP PGH, says the “only thing we are certain of is that there is a future waiting for you.”

Sir John was my late father’s cardiologist. Grateful for his compassion and leadership. @UPManilaOnline pic.twitter.com/aa9u23fcvT

— Lance Catedral (@lanceoncology) June 23, 2020

Dr. Ester Penserga, distinguished internist and rheumatologist, quoted Proverbs 16 in her keynote address.  I am proud to say that I was once under her Gen Med service, even if it was towards the tail end of my training. She liked asking the basics, things I thought I knew but only knew partly—which was just as worse as not knowing entirely. When she announced that she would do teaching rounds with the students, I would study my books in a corner. If the clerks and interns could not answer her questions, she’d ask the junior residents. If they couldn’t give a satisfactory reply, she’d ask me, the most senior resident of the team. If I couldn’t answer her, she’d say, “Read.” But it was always with a motherly tone, an encouraging rebuke. She proceeded to talk about her seemingly accidental foray into rheumatology when she had wanted to be an endocrinologist. She saw God’s hand in this. I was so blessed and encouraged.

Dr. Ester Penserga, distinguished internist and rheumatologist, quotes Proverbs 16 in her keynote address. “A heart of man plans his course, but the Lord directs His steps.” Such a blessing to know her! pic.twitter.com/iQl9Q9WRuZ

— Lance Catedral (@lanceoncology) June 23, 2020

Our names were called. If this had been an actual ceremony, there’d a contest of the wittiest introductions. But without the exchange of energy that speakers get from the audience, the tone was generally subdued. There were no hilarious moments on stage, no pakuló, no shameless selfies. But I took photos of my screen. My friend David (endocrinology) messaged me that I could do screenshots instead, with the Shift + Command + 4, but I said I liked the raw quality of the photos. It felt like a ritual: taking the photos, storing them, and revisiting them in search for possible blackmail material.

There were the once-first year residents I used to work with. Special shout outs to those with whom I had the pleasure of being a service senior: Nico Pajes (who is the department’s brilliant and indefatigable chief resident), Harold Chiu, Greco Malijan, Ray Ragasa, Inah Coronel, and Josh Torres. (If I missed anyone, please alert me: faces blend in my memory. I have worked with them at some point, at MICU, the ER, and so on.)


Photo credit: Inah Coronel's Facebook account

[Related post: notable blog entries during my Gen Med years: My First GenMed Service, Sticking Our Necks Out, Counting the Days, and Ode to Our Interns.]

I only took photos of my residency batch mates and co-fellow graduates from Medical Oncology, unfortunately.

Bea Uy (Endocrinology)

“prolific researcher and strong woman”

David Francisco (Endocrinology)

“a scholarly and brilliant man”

Racquel Bruno (Endocrinology)

“a woman leader”

Carlos Cuaño (Gastroenterology)

“a resilient individual”

Danes Guevara (Nephrology)

“savvy scholar whose muscles are as big as his brain”

Grace Penserga (Rheumatology)

“determined to forge her own path; a ready resource for clinical decision-making”

Roland Angeles (Pulmonary Medicine) 

“with great resourcefulness and humility”

Carla Barbon (Pulmonary Medicine)

“with incredible proficiency." 

Notice Dr. Ralph Villalobos's comment below: "Stay safe and negative." (These days, negativity—COVID-negativity—is a positive thing!)

Laya Zamora (Pulmonary Medicine)

“clarity of mind and strength of character”

My Med Onco batchmates!

Rich King

“Rich is quiet and serious. He is often immersed in his work but shows empathy and compassion towards his patients and colleagues. As the chief fellow, he was able to juggle administrative duties with clinics and research endeavors. He relaxes with video games, YouTube gardening channels, and music. He sings well. He plans to practice in Metro Manila and Central Luzon.”

Karen Mondragon

“Karen is practical and level-headed. As a mother, she was able to juggle family responsibilities with work and training. She made it look so easy. She likes good coffee, spoken poetry, and creative stories. She enjoys playing with her daughter, painting, and staying at home. She plans to practice in Metro Manila.”

Fred Ting

“Fred is determined and productive. Although he operates on a strict schedule, he can easily be dragged to random coffee breaks. He has numerous research outputs, especially on supportive care and access to oncologic treatment. He loves connecting with patients. He reaches out to them and seeks to understand them. He likes to travel, tinker with fountain pens, and write essays or commentaries. He plans to practice in Bacolod City.”

Roger Velasco

“Roger is compassionate and adventurous. His patients love him. Each morning, they form an impenetrable crowd outside the clinic. But he takes his time to talk and listen to them. He takes the extra mile to extend comfort and care. He likes to travel, though he often gets lost. He also likes to take photographs of sunsets and of his growing plants. He plans to practice in Metro Manila.”

There was a sweet shoutout from the amazing Dr. Cecile Jimeno!


The awardees were called. This was the surprise prepared for the expectant crowd—that is, us, mere mortals. Harold Chiu (third year), Amiel Villanueva (second year), and Ella Mae Masmayor (first year) won the Most Outstanding Resident Awards. Harold, who also topped the diplomate IM exam, is a brilliant and resourceful doctor, having published several researches even in his first year. I experienced being his service senior, a privilege I’m thankful for. Amiel, the quiet and contemplative doctor from Davao, holds a special interest in medical ethics. His Twitter feed is a great resource for his thoughts. Ella maintains a blog herself. One of my favorite pieces she wrote is When Sadness Has No Name. In this piece, she shows her humanity. I think the most humane doctors are the best doctors.

Laya Zamora (Pulmonary Medicine) is the most outstanding fellow. Also nominated in this category were Karol Camonayan (Allergy and Immunology), Louis Villanueva (Cardiology; he would later win the award for the most outstanding fellow for research), Aids Bacena (Endocrinology), Racquel Bruno (Endocrinology), Miiya Babaran (Gastroenterology), Rachelle Alfonso (Hematology), Joanne Sandejas (Infectious Diseases), Danes Guevara (Nephrology), Fred Ting (Med Onco), and Karen Cortez (Rheumatology).

Greco Malijan gave the speech in behalf of the graduates. What struck me was how on point Greco put everything in context. He said that health is political. The pandemic has uncovered the pervasive inequalities in Philippine society. Always a voice of reason and compassion, Greco is also an excellent clinician. I’m also proud to say I was one of his senior residents, but I absolutely don’t take credit for any of his greatness.

Health is political, says @grecomark, in his response in behalf of the graduates. The pandemic has uncovered so many inequalities in society. So heartwarming to listen to a voice of reason and compassion. pic.twitter.com/VbxiEOgowo

— Lance Catedral (@lanceoncology) June 23, 2020

This will go down in the books as one of the best graduations I ever had. I praise God for His enduring faithfulness and goodness.

Midori traveler's notebook

Alunan Avenue, Koronadal

Laurent Binet's HHhH

Walk to the mall

Since Tatay's death, Father's Day has become a day of remembering. After streaming the church sermon on Boaz and Ruth, my brother and I walked to Podium. I wanted to see if I could replenish my collection of acid-free paper. Manong wanted to get on with the walking: some 2.6 km from the house. Sweaty and thirsty, we had lemongrass juice at a Thai store. Manong bought pastry for snacks, then we walked home.

Malls remind me of Tatay. He liked being with people. He preferred crowded malls where he could bump into a random person and talk with him. He had a way with people, a certain warmth that made them say things to him. He liked getting to know others. In the afternoons, he dragged me to KCC Mall, so I could join him and his friends from the local biking club for coffee.

Happy Father's Day!

Nineteen

Mary Grace Café, SM Manila. I took the photo last year, when lounging in a cafés was not a matter of life and death.

Sarcoma multi-disciplinary conference

Friday mornings, monthly.

Trips

I went to the Philippine Medical Association office in North Avenue to get some certifications. Before I booked a car, I called the office to be sure. It was my first time in three months to be in Quezon City. After a few minutes I got what I needed: certificates proving I am a member in good standing. I hailed a taxi that took me to the PhilHealth office in Pasig. The driver wasn't familiar with the building. I coached him with the instructions from Google Maps. We missed a turn because he couldn't hear me through the plastic wall. I got my professional accreditation in 15 minutes. It was starting to rain. I hailed a taxi that took me home. The driver sang. I was just in time for lunch. 

There were people everywhere: in the streets, in malls, in the roads. Traffic was terrible along EDSA-Cubao. If not for the masks, one would think the pandemic is over. Far from it, actually. More people with Covid-19 are getting admitted at PGH. If you don't believe the DOH census (I have lost faith in that a long time ago), at least believe the numbers from the hospitals. 

*

My cousin Hannah and my friend Carlo celebrate their birthdays today. I thank the Lord for their lives.

I spent 40 minutes talking to JP Leo over the phone. JP is a historian and lawyer from Isulan. He teaches law in a university in Davao. We lived in the same floor in Kalayaan Residence Hall. He lent me his copy of One Hundred Years of Solitude by Gabriel García Marquez. The last time I talked to him was last year, over a video call while I was in Singapore and he was in Lithuania. When we had extra money, we ate at Chocolate Kiss at Bahay ng Alumni, UP Diliman. Blueberry cheesecake and devil's food cake were our favorites. Together with friends from Gensan and Koronadal, we established the provincial organization called UP SOX. JP was in my room, giving comments, when I designed the logo. (It was terrible.) He borrowed my leather shoes when he joined Game Ka Na Ba?, the game show in ABS-CBN hosted by Kris Aquino. He lasted two rounds. He's now high up the ladder in his career, but I'll always remember him as the guy who wore a t-shirt, denim pants, and flip-flops to class.

John Calvin on Ephesians 1

I dragged my friend and colleague, Harold, to visit the Reformation Museum in Geneva last December. This was after the poster presentation at a major immune-oncology conference, which we had the privilege of attending. On our way to the museum, we dropped by the Reformation Wall where John Calvin's monument was in the middle. John Calvin holds a very special place in my spiritual growth. The Institutes of the Christian Religion is one of my favorite books of all time; it is in the same place as St. Augustine's Confessions. 

I was surprised to read Calvin's commentary on Ephesians. The internet is an endless source of fascination. Here he writes about Ephesians 1:3a, "Blessed by the God and Father of our Lord Jesus Christ."

The lofty terms in which he extolls the grace of God toward the Ephesians, are intended to rouse their hearts to gratitude, to set them all on flame, to fill them even to overflowing with this thought. They who perceive in themselves discoveries of the Divine goodness, so full and absolutely perfect, and who make them the subject of earnest meditation, will never embrace new doctrines, by which the very grace which they feel so powerfully in themselves is thrown into the shade. The design of the apostle, therefore, in asserting the riches of divine grace toward the Ephesians, was to protect them against having their faith shaken by the false apostles, as if their calling were doubtful, or salvation were to be sought in some other way. He shews, at the same time, that the full certainty of future happiness rests on the revelation of his love to us in Christ, which God makes in the gospel. But to confirm the matter more fully, he rises to the first cause, to the fountain, -- the eternal election of God, by which, ere we are born, (Romans 9:11,) we are adopted as sons. This makes it evident that their salvation was accomplished, not by any accidental or unlooked-for occurrence, but by the eternal and unchangeable decree of God.

Waiting for the train

EDSA MRT station.

Annotations

Blue and pink inks.

My TWSBIs

In between cleaning and ink replacement—Diamond 580 and Eco Rose Gold, among my favorite writing materials.

Hushed tones

At the Medical Oncology Office, UP PGH.

Historical pen at Solidaridad Bookstore

Owned by the writer F. Sionil Jose.

Morning devotions

Laos Tea

From Laos.

Midtown Diner breakfast

With Fred and my book, Hermit in Paris, by Italo Calvino. I took the photo pre-pandemic, when I could while away the time in cafés. I miss Midtown Diner. I wonder whatever happened to Kuya Ruel, Ate Angel, and the rest of the Midtown Gang? 

Café essentials

A good book + fountain pen (a TWSBI Eco Rose Gold, medium hard nib) + single shot espresso.

Our intern rotator Joyce

Her report was on triple negative breast cancer.

Libing well

National Bookstore, SM Light Mall, Mandaluyong City

Pens and friends

In an unexpected stroke of generosity, my friend and colleague Fred gave me a Pilot Custom 823. Inside the Grab car, I couldn't believe my eyes as I opened the package. I'd been dreaming of owning this pen someday. It is elegant. The ink flow is wet and smooth, the way I like it. This is the same pen that the writer Neil Gaiman uses. Certainly, this will occupy a special and permanent place in my humble collection. My heart is brimming with gratefulness. Thank you very much, dear Freddie.

When I checked my draft, I realized I had misspelled colleague. I added the extra "ue." Here's the correction. I also want to demonstrate how thick the lines are that you're able to see the variation in ink flow.

After about a million signatures, it's time for Pilot 823 to get TLC. Should I go to Pilot or a pen repair place? pic.twitter.com/blHjDAkniJ

— Neil Gaiman (@neilhimself) March 23, 2016

"He will never see her again"

From Laurent Binet's magnificent novel, HHhH.

Balzac and the Little Chinese Seamstress

Short and sweet novel by Chinese-French author, Dai Jin.

Walk in the park, Seoul, Korea

Laguna

Empty

Dropped by the mall today. Relieved that physical distancing measures were in place. The lady guard was impressed when I shooed my brother away. "Social distancing! One meter! Move back!" I said. Then Manong treated me to Japanese takeout. Been craving for meat cutlets. Episode one of Midnight Diner Season 3 was about a singer whose husband loved pork cutlets. Not a good idea to watch it at night before sleep; you will feel hungry.

Colors

Parker Vacumatic, vintage.

Ampersand

Epilogue

I did not go out, not even for a morning walk on the eighth floor. Instead, I watched a series of online videos, including great speeches by American presidents, like President Obama's address to the British Parliament. It made me wonder why our nation's leaders don't give good speeches anymore. I watched a video of former President George W. Bush during the unveiling of his White House portrait. It felt like a lifetime ago when decency, respect, and kindness were celebrated. I also finished Barbara Demick's Nothing to Envy, and devoured the third chapter of James Wood's The Nearest Thing to Life, a collection of intelligent, engaging essays.

In the afternoon, I did some online catching up with close friends. Mike, who is based in Australia, shared a photo of the sourdough he made. My initial response was shock, followed by awe. I asked if he made the starter himself; he said yes. I asked further if he had a Dutch oven; he said he improvised. It was a Pinoy oven, then. I also did some catching up online with former work colleagues-turned-friends, with the usual string of nonsense and updates regarding our future plans. "What will we do now?" was our main topic. 

For the past 80 days I have written short entries in what I initially imagined was going to be a short Journal of a Lockdown, inspired largely by the writer Jessica Zafra, who did the same in her website. The lockdown evolved into many versions. There came a point after the first month when I stopped counting the deaths and new cases. I did not write about Covid-19 anymore. I was not disinterested; I just did not want to add to the noise. 

If you can read this, it means you're still alive after the ECQ and MECQ. It is something to praise God for. What has the pandemic taught you? 

In my case, it has taught me to trust in the sovereign purpose of God. My career plans are on hold. I don't know what will happen in the future. Will there be a second wave of viral infections? Will I be able to go home to the province to be with family? What will happen to our country?  

There's this beautiful hymn we sing in church: "Because he lives, I can face tomorrow / Because he lives, all fear is gone / Because I know he holds the future / And life is worth the living / Just because he lives." I pray that the song will point you to Jesus Christ, in whom there is eternal assurance.

The Journal of a Lockdown No. 80 is the final entry of this short quarantine project. Thank you for dropping by.