The year that was 2020

Alunan Avenue, Koronadal City

Feierabend

A beautiful word:

Feierabend isn’t just a German word for ‘work-life balance’. While it’s related, ‘work-life balance’ is a term that can often end up just as nebulous in meaning as the problem it’s trying to correct. Instead, the German approach seems to acknowledge that there will always be tension between the work self and the private self. Rather than attempting to reconcile the two, the disconnection that comes with Feierabend establishes boundaries between them. It also usually creates a path between the two states, like dressing for the office and changing after work . . . .

When I did my medical oncology fellowship in Manila, I made a conscious decision to live as far away from the hospital as was allowable. I got curious glances from people when I said I spent an hour or more of commute from Mandaluyong to Philippine General Hospital. I could easily have rented a condo unit nearby if I had so wished; a lot of my colleagues did that. But I wanted the clear separation of work and rest to be established. I did not want to see the hospital from my window. My experience in med school showed me that proximity to the workplace was a bad idea. Because the hospital was just right across the street from my Taft condo, I did not feel like I had gone home at all. 

In retrospect, those long commutes proved to be worth it. I finished reading Calvin's The Institutes, listened to Tim Keller's preachings, enjoyed New Yorker Fiction podcasts, and heard myself think. The view from the 20th floor did not consist of the hospital. Save for two or three incidences, I did not see anyone from work. My Mandaluyong neighborhood consisted of cafés devoid of medical students and doctors. The streets were cleaner. I could do long walks at night without fear of getting stabbed. I was anonymous. On Saturday mornings, when I did not have to report for work, I was like every one else, sipping coffee and reading with pleasure. 

I understand that for doctors, it is a challenge to separate work and life completely. I could not do that. My phone rings on odd moments. I receive SMS updates about patients that I must respond to. But the ritual of the long commute gives me the illusion of distance: I am home, and the hospital is elsewhere.

A cold drink

Hong Kong, 2016

Christmas Sunday

Sunday service in church this morning. Sermon was a survey of the Christmas message from Genesis to Revelation. Powerful preaching that began with God’s holiness, continued with man’s depravity, God’s mercy and grace through Jesus Christ’s life and death on the cross, His resurrection, our redemption.

Been thinking about God’s humility in the manger. A painful rebuke to my pride, as I have moments of self-entitlement. Must remind myself I don’t deserve what I have, and I deserve worse. Yet God, my Father, looked at a sinner like me with unconditional love, adopting me into His fold and calling me His own. I am not the captain of my ship; God is. And He chose to be born on a manger instead of a fancy inn in Bethlehem.

Lunch at church followed. Food preparation was a labor of love. Mother and Auntie Cecil headed the committee on food. The women took on the reins. Menu was overflowing—thanks be to God! Manong’s brazo de mercedes was a hit. Asked a kid what her favorite meal was; she pointed to the brazo. Auntie Judy’s macaroni salad was mouth-watering; Uncle Ramon said it took three days to prepare to let flavors seep into the macaroni. Pakô salad was refreshing. Pinakbet was a delight. Delved right into the menudo. Brothers placed a slice of lenggua on my plate—so soft and flavorful! Lechon was a hit, as usual. Not the biggest fan, but people said the skin was crispy. Visited a patient at the ICU. Happy to report he's been transferred to a private room. 

Slept through the afternoon. Writing this now before I start review on genitourinary cancers.

Smiley's People

 

When I should have been studying, I have been watching SMILEY'S PEOPLE, an old BBC series based on the novel of John Le Carré. George Smiley is played by Mr. Alec Guinness. Mr. Guinness is spectacular in this role! He is serious, methodical, and unemotional. I love his pair of thick-rimmed spectacles. I have a similar pair.

Merry Christmas!

"For to us a child is born, to us a son is given, and the government will be on his shoulders. And he will be called Wonderful Counselor, Mighty God, Everlasting Father, Prince of Peace." (Isaiah 9:6)

Countryside

One of Nanay's visits to the farm. She used her iPhone. I did some tweaking, adding a vintage filter through Flickr.

In our neighborhood, people drive to their farms on weekends to while away the time.

Croissants for the first time

Manong's first croissants. Not perfect, but good enough for me!

Peregrination

Nanay's phone is synced to my Flickr account. I've been telling her to take photos of her every day. I don't know where she took this shot, but I like it!

Teach me Your statutes

Light rain greeted me at 4 am. I meditated on Psalm 119 on this cool morning. I wrote the passages by hand to relish them, praying as I went along. In these passages, the psalmist extols God's precepts. He is a student of the Word, celebrating and relishing the greatest Book ever written, worshipping the Author of all creation. "You are good and do good; teach me Your statutes" (Psalm 119:68).

 

Home

Prof. Marj's Evasco's Farol de Combate is one of my favorites. It is good to be home! Here's an excerpt. 

I trust that beside the well which had been dug

By my elders, a storm lamp had been placed,

Lighting up the path toward home, the lamp-
Lighter minding the first law of neighborliness:

To help one another as best as one can in daily
acts of living, for if the lamp were put out, unlit,

Someone passing by might stumble or slide,
Fall into the neighborhood well and die.

When I pass by the well I will draw water and drink,
Give thanks to my unseen neighbor for the light.

Like Christmas morning!

For Christmas, Prof. Marj Evasco sent me a copy of Dinah Roma's poetry collection, "We Shall Write Love Poems Again." It is beautiful. Tinitipid ko para hindi matapos agad. Thank you for writing this, Prof. Dinah!



The mail came with a note from Prof. Marj. Her handwriting is exquisite, her message heartwarming! Like me, she also shares a fascination with fountain pens. 

My family thinks I'm the coolest because I know poets personally!

Sonic the Hedgehog

Alfie wrote these bonus items.

Regionals

Just received an email that the diplomate exam in medical oncology will be held in regional testing areas on January 2021. Suddenly I feel like an elementary pupil again, about to compete in a regional contest in Davao (when South Cotabato was still in Regional 12, and we had to defeat the smartest kids from Philippine Science High School - Southern Mindanao—but they mostly won!)

Apan-apan (grasshopper)

On our way back to Marbel, Sean and Hannah, his charming girlfriend, saw a stall in Barangay Paraiso. "Apan-apan, Manong, makaon ka?" (Game for fried grasshoppers, Manong?)

It brought back childhood memories: apan-apan is one of my favorite snacks. From Eat Matters:

Apan-apan in the Ilonggo dialect means grasshopper. Back in the days when the verdant fields of rice were still pesticide free, farmers would catch the deluge of grasshoppers infesting the rice crops with a large net.The grasshoppers are then cooked to be eaten as sumsuman( a drink accompaniment)when the farm folks gather to drink at dusk after a hard days work or, as a dish on the family dinner table. With some degree of hesitation I was able to taste this dish many years ago when somebody from Mindanao dropped us a bagful. It was crunchy alright but the discomfort of thinking that you are munching on a grasshopper somehow made the eating experience a bit stressful.

No stresses from me!

Fried grasshopper is a delicacy elswhere.

In southern Mexico, grasshoppers, known as chapulines, are eaten in a variety of dishes, such as in tortillas with chilli sauce. Grasshoppers are served on skewers in some Chinese food markets, like the Donghuamen Night Market. Fried grasshoppers (walang goreng) are eaten in the Gunung Kidul Regency, Yogyakarta, Java in Indonesia. In America, the Ohlone burned grassland to herd grasshoppers into pits where they could be collected as food.

On-site pathologic evaluation for lung cancer diagnosis

Congratulations are in order for my dear friend, Rich King and the team, for the study that looked at the use of on-site pathology evaluation in diagnosing lung cancer. The abstract is published in the Annals of Oncology. 

Access to biopsy services is a limiting factor to timely lung cancer diagnosis in many areas in the Philippines. On-site pathology evaluation allows for rapid diagnosis and helps ensure adequate specimen sampling. In our institution, its utilization and impact have not yet been evaluated.

By analyzing 112 pathology reports from 88 patients, King et al. had the following conclusions:

On-site pathologic evaluation was associated with an earlier lung cancer diagnosis, a reduced need for a repeat biopsy, and a higher proportion of patients eventually receiving treatment. Efforts should be undertaken to increase the utilization of this service in order to optimize the quality of care for these patients. 

Le Carré

John le Carré has passed away.

The author, who died on Saturday, “had a knack for language of every variety,” our critic Dwight Garner writes. “His books hum with the flavorful and recondite language of espionage.”

Here's a beautiful piece by Dwight Garner.

On a recent Saturday morning in February, two dozen or so scent hounds streamed through the streets of St. Buryan, a small village in Cornwall, England. Behind them drifted a loose formation of men and women perched atop well-groomed horses and wearing boots, breeches and hunting coats. As the fox hunt clopped through town, John le Carré, the pre-eminent spy writer of the 20th century, sipped from a paper cup of warm whiskey punch, doled out by a local pub to riders and spectators. At 81, he remains an enviable specimen of humanity: tall, patrician, cleanlimbed, ruddy-complected. His white hair is floppy and well cut, so much so that the actor Ralph Fiennes, who starred in the 2005 film version of le Carré’s novel “The Constant Gardener,” badgered him for the name of his barber.

Here's an old paperback of Tinker Tailor Soldier Spy owned by Auntie Badid, my mother's close friend and source of many books I read in childhood.

I miss Cancer Institute Room 107

It boggles people when I tell them that the Med Onco clinic was, in my experience, one of the happiest places at the Philippine General Hospital. Cancer is depressing as it is, but the people I trained with—my batch and those ahead of us—lightened the emotional load that inevitably came with oncology training.  Norman and Bobby, whose cubicle was beside mine, had scholarly arguments about clinical trials and general nonsense. Their verbal jabs were soft but pointed, producing laughter, not offense. Ozzie and Crizzy circulated a blank paper with the header, "Serenitea Orders," on days when we were flooded with patients. Papau (Paulo) saw to it that crowd control was implemented—one minute he'd be erupting with "Labas muna ang hindi pa tinatawag," the next minute he'd be singing a random pop song. Nobody demanded to be addressed with honorifics. Everyone saw to it that we—Rich, Roger, Freddie, and Kmomsh—were treated equally. They were warm and humble, kind and forgiving, fun-loving and adventurous, and they always knew where to hang out. Who wouldn't immediately warm up to those people?

Tonight, from various parts of the world and the Philippines, we met over Zoom. I miss them dearly.

Pencils

"The pencil is a wonderful piece of technology," writes Austin Kleon. I agree. For the past weeks, I've been using pencils for note-taking. 

From left: Mongol 482 (no. 2), giveaway pen from Marco Polo Hotel, and Faber-Castell Goldfaber 1221 (4B). Eraser is a Faber-Castell "special eraser for examination."

Green mangoes

Paying attention

I pay attention to the books in the background.

As 2020 winds down and we look back at our pandemic year, it’s possible, through the murk of loneliness and illness, to see the few bright spots that existed for people who love books. We had the chance to peruse a lot of strangers’ bookshelves — nearly every time we turned on the television or began a video call.

Remembering Ebola

Dr. Jennifer Mhyer, doctor-missionary in Uganda, writes about Ebola and advent.

On the 4th of December 2007, we were in this very place, surrounded by epidemic, and without our kids, facing uncertainty and loss. 2020 is not the worst we have seen.

13 years ago Ebola Bundibugyo boiled up in this little pocket of the world. Dr. Jonah was in his first year post-internship, and had been examining and treating patients with Dr. Sessanga, PA Scott Will, and us, all of us lulled by the negative Ebola testing into the assumption this was a particularly bad typhoid epidemic. However, it was a new strain of hemorrhagic virus, requiring a new test, and by the time the CDC announced this discovery Nov. 29, Dr. Jonah was already shivering with fever and depleted with vomiting in Kampala where he had gone to pick his daughter Masika up from school. We put our children and team on small planes on the grass airstrip to evacuate them from the risk of being near us if we also succumbed, and tried to keep on responding to the epidemic as larger organisations arrived to help. Dr. Sessanga also fell ill with Ebola, and Scott went to his home to check on him. On Dec 4th we received the stunning, unbelievable phone call from Jonah's brother: he was dead. Within a day, the toll for Bundibugyo health workers climbed, and five from the hospital died. We buried four of them in a memorial plot at the hospital together, only a few of us attending, the whole district blanketed by fear and grief. Those days were so raw, running on adrenaline, wondering if we would all die.

Fun days at the beach

Been scanning old photos. I long for the beach.

Having accomplished nothing at home, I headed to the nearby café to do some reading

Celosia cristata

Cancer and nutrition at the Philippine General Hospital

Congratulations to my dear friend, Roger Velasco, for spearheading this excellent study, now published as an abstract in Annals of Oncology. A notable finding is that "patients who did not receive chemotherapy, radiation, or surgery were more likely to be malnourished compared to those who previously received or were currently receiving treatment (chemotherapy: p < 0.01; radiation: p = 0.04; surgery: p < 0.01)." 

Quite interesting to find out that "Notably, only 17% of patients were referred by oncologists to the dietary service." Note to self: involve the nutritionists! 

Coronavirus cake

Manong's take on the devil's food cake, our favorite thing to order whenever we eat at Chocolate Kiss, Bahay ng Alumni, UP Diliman. The restaurant is now closed. Auntie Netnet skipped dinner to eat two slices of this.

Sweaty Van Gogh

52 things and some useless commentary

52 Things I Learned in 2020 by Tom Whitwell, one of the best things I read this week. Some notable items in the list (and a few comments).

1. Most cities plant only male trees because it’s expensive to clear up the fruit that falls from female trees. Male trees release pollen, and that’s one of the reasons your hay fever is getting worse. 

—In my city, trees are cut to make way for highways.

2. In China, 🙂 doesn’t mean happy, it means “a despising, mocking, and even obnoxious attitude”. Use these, instead: 😁😄😀.

—Not the biggest fan of smileys. Some friends use smileys as punctuations. I think they're overcompensating, making sure the person getting the message doesn't get offended. 

9. Money makes people happier than psychotherapy.

—Having three square meals a day and a roof over one's head takes off the stresses of daily life. But too much money might give more headaches than happiness.

11. Euro English is an evolving pidgin English used by EU administrators, for example: using ‘Handy’ to mean mobile phone (from German), ‘Non?’ to turn any sentence into a question and unusual plurals like ‘expertises”.

—Reminds me of the Mindanao version of Tagalog. Lots of people in Gensan and Davao now speak a combination of Tagalog and Bisaya. Linguists should do a thesis on this. 

14. The inventor of the pixel died in 2020 aged 91. He always regretted making pixels square, describing the decision as “something very foolish that everyone in the world has been suffering from ever since.”

—Round pixels, the cause of this world's suffering.

30. In Warsaw’s Gruba Kaśka water plant there are eight clams with sensors attached to their shells. If the clams close because they don’t like the taste of the water, the city’s supply is automatically shut off. 

—Best water I've tasted: tap water at Gruyère, "service water" at Garahe (karinderya near UP Manila and St. Paul University), and the "service water" at Mary Grace—with sliced lemon and ice. Water quality in Marbel is poor. 

38. 報復性熬夜 is a Chinese term that roughly means ‘Revenge bedtime procrastination’ — when “people who don’t have much control over their daytime life refuse to sleep early in order to regain some sense of freedom during late night hours”. 

—Matulog ka na lang!

44. A micromort is a one-in-a-million chance of death. Just being alive is about 24 micromorts per day, skydiving is 8 micromorts per jump.

—Micromort sounds way better than disease free survival!

Mushrooms

Mushrooms beside newly transplanted ferns. Took this photo in the morning. The mushrooms were wilted when I checked them again in the afternoon. The brevity of life.