Love and Life on a 3-day Road trip (8 Magazine 2nd quarter 2012)

Metamorphosis

The brush was dipped into the palette of brow powder and then swept across my grandmother's eyebrows.  It contrasted against the beige foundation which was sponged smoothly from her face to her neck, and rouge the color of crushed roses tinted her cheekbones.  But my grandmother wasn’t going to a party, her body was being prepared by the mortician for viewing, and I was there to help dress her.

Given that I barely slept a wink in the last forty eight hours, I could have just collapsed from exhaustion right there in the morgue, but I was determined to hold my composure.  I did not even weep that morning in the hospital when she passed away, nor here at 2:00 am waiting on the mortician as he embalmed her body.

I bought a simple white dress, stockings, and a pair of fancy silver sandals.  It was as though she was on her way to a dance, and Nanay being someone who loved shoes, would have approved that I placed very beautiful footwear upon her feet.  It almost did not fit because rigor mortis had set in, and the heeled sparkling sandals required the feet to be arched.

The whole thing went as a blur: the funeral, working on the paperwork which was surprisingly complicated, the interment, the nine day novena, and the forty days prayer for the dead.  It only hit me when I went home one day, after all of our neighbors had gone home, that we arrived at an empty house.   I will definitely miss Nanay feeding the doves outside in the yard in the morning, or watching TV while we are having dinner, talking about what our relatives were up to.  During the summer of her death there were days when I engrossed myself in projects so I would not dwell on our loss, yet somehow this profound sadness would catch up with me, triggered by seeing a picture of her, or seeing the walking cane I gave her.

One afternoon, I was telling a story about Nanay to a friend when out of the blue I just started crying.  I don’t know, crying because I missed her, because I missed my parents too, who left this world not too long ago, crying out of exhaustion, self-pity, despair, guilt, and relief.  I was irked because she never “came to my rescue”, unlike so many times she stepped in to defend or rationalized others’ shortcomings, confused because I was in favor of her mastectomy operation to remove the tumor, which unfortunately triggered a heart attack leading to her demise, frustrated because I felt like I could have done more.

But in that same afternoon, beneath the soothing canopy of butterfly trees in my friend’s garden, I came to accept that it was over- that all I could do now is just whisper to the wind and allow all of the pent-up emotions and frustrations to surface. 

I think I did find some sort of closure, after being able to explore how our loss affected me.  Losing one’s support system that you’ve had since your childhood isn’t easy; I knew I was changed forever.  But I also knew I became stronger and more self-reliant.  I remember during the funeral people who drop by to give their sympathies would tell me, “It’s going to be alright.” It does not really happen that way- like your grief will just vanish in a few days.  The truth is, you alone know how and when the grieving process takes place. 

One day, sitting in our terrace, I smiled to myself remembering some of the funny moments I’ve had with Mama, Papa, and Nanay.  Right then, instead of feeling sad again, I was filled with nothing but gratitude for having those memories with them.  That was the day I knew I was going to be alright.   

Esse Quam Videri

It is a Latin phrase which means "To be, rather than to seem (to be)", from Cicero's De Amicitia.  This phrase holds quite a big meaning for me, or any dreamer for that matter, who harbors a lot of aspirations.  I'm not going to complain about how hard medical school is, because that's just passe.  The initial shock had worn off, the reality set in.  I finally got my grades, and though they we satisfactory and even above average I felt that I could have done better.  Someone once told me the capacity is there, it's just that the effort wasn't enough.  But given the recent vicissitudes in my life- losing a loved one to cancer, financial troubles, I think it has not been smooth-sailing for me exactly. 

The good news is that this is only 1/4 of the overall General Weighted Average for my MD, and there is still chance to achieve the dream of graduating with honors from medical school.  Sometimes one really needs to ask oneself the values of certain things in life, really look into what is important and why it is important, in order not to feel lost when the going gets tough.  I need to perform well because my med school isn't among the top in the country, and achieving a good rank in class is tantamount to a ticket to the best training hospitals in the country.

Let me set one thing straight: all I want to be is a good doctor.  Compassionate and capable of giving the best care to my patients.  I'm running out of words to say because that actually sums it up- the hardest part is the day to day struggles in medical school.  Well, at least I am clear on what to achieve, and taking the steps toward it would be the next, most tedious thing.  But as I promised to myself and my late parents and Nanay, I'll endure all hardships to make that dream a reality.

Classes are about to begin next week, and I'm ready to face sophomore year.  This time I'm not going to be satisfied with just one or two readings. I've learned from first year, that the best thing to do is to actually summarize and integrate the lessons using concept maps and illustrations- whatever it takes.  The best part about this is that those notes are useful during midterms and finals.

Writing, leadership roles and everything else takes a backseat- besides, I don't think I'll ever lose those skills at all. I have a good feeling of this coming years because the same things happened in Nursing school.  My first year grades were not stellar- I was just among the ranks of about 50 Dean's Listers, but it was during the OB/ Psych/ Medical Surgical and clinical exposures where my grades rose steadily and finished 4th in the graduating class.

I'll miss traveling, going out with friends, and all that but as long as I have the basics: family, my partner who supports me, I know I'll once again look back and say all the effort is worth it.  Be it public speaking in case presentations, tracing and explaining pathophysiology, deciphering those slides on the microscope- I'll do it.  I'll do it with gusto until it becomes part of me, because the only way I can be a doctor is to get the MD degree with flying colors, and there is no more Plan B.

Silver Linings

Looking back at the life of an extraordinary woman I call Nanay Luming, my grandmother who had been our wellspring during the days our OFW parents worked abroad, I could not help but feel gratitude.  For almost 32 years she had been a beacon of love and wisdom in my life- ready with a gentle smile or an upturned mouth when she was displeased.  Even now, I still can not believe she’s no longer around- because usually the first thing I do when I get home and she greets me at the door is pagmano, a Filipino custom to show respect to elders. 

Like most of the women of her generation, she was conservative and strait-laced.  She raised us all to be respectful of others, to obey our parents and never talk back, to pray, and hear mass during Sundays.  But she had a funny side too, she loved the attention we lavished her as she told her stories.  Born in pre-war Philippines, she had lots of tales to tell, but mostly we get our guffaws from our parents’ and our own misadventures as kids which she told with such fondness. 

She was very protective of her children and grandchildren, and would even rationalize or play down their mistakes and indiscretions.  For some reason however, she was quite strict with me.  In my mid-twenties she would still get mad at me if I came home late for dinner without prior notification; in the meantime, a teenage female cousin would get home at 3 AM without the slightest reprimand.  She was generous with praise of everyone’s littlest achievements, yet she simply gave a curt nod when I told her of my many plans.

I did not think she knew, but she had a huge influence on my life’s trajectory.  I was a half-hearted Nursing student who cared nothing more than making good marks, but as her 80’s approached and she became ill more often, I realized the value of what I was learning in school about health care.  It was not unusual for me to be roused late at night or early morning, to check on her blood pressure and administer her medications.  In a way, Nanay gave me a reason why I had to learn about the action of drugs for hypertension, understand the principles of nursing, or master the procedures of bedside care- she became the paradigm for all my patient interactions in the hospital. 

During the culmination of our journey in nursing school, she was beside me as we walked up the stage beaming- my comrade and parent-figure in one, who had been with me and shared both hardships and triumphs. 

She was heavily opposed to my plans of studying medicine in Iloilo or Manila, and once more that was a big factor for me to consider.  She was happy when I finally enrolled in a medical school in Tacloban and I told her jokingly, “Nay, we better get you another new dress, because we’re going up the stage again.”   From then on she would brag about me to her friends that soon she’ll have a doctor for a grandchild- which later resulted in ambush questions from relatives and friends about anything from body aches to laboratory interpretations.  I had to remind Nanay that I still had a long way to go, but she’d just give me one of those mysterious, knowing smiles.

When she was diagnosed with Invasive Lobular Carcinoma, it struck fear in our hearts, especially after losing our mother and father not too long ago.  The night the mass on her right breast started bleeding profusely, I knew it was something serious.  Nanay was so calm and brave as we drove to the Emergency Room.

She looked so frail during those days.  I reassured her I’ll be with her all throughout, and that we’d better start planning for her upcoming 86^th birthday which she was looking forward to.  I was in the Operating Room (OR) with Nanay as she was about to have her operation.  Normally, she was the chatty one but on that day it was me who was stuttering nonsense and explaining trivial things about the OR, while she remained quiet.  It is doubly hard when the patient you are attending to is someone you love- after the anesthesiologist intubated her it was as if my breathing was as forced as the mechanical respirator that gave breath to Nanay.

I always try to remember her during happier days, and for a woman in her eighties she had shown remarkable resilience battling breast cancer for more than three years.  Back when the lump was still small, she refused a lumpectomy fearing that she would die on the table.  But now the tumor had spread and a major surgery was what it took to remove it.  During those nights I hardly slept, thinking a lot about what ifs- what if she agreed to the lumpectomy three years ago, if we opted not to removed the tumor, would that help prolong her life?  Even during our final exams in medical school that same week, I kept thinking what else we could do.

There were a lot of us- her children, grandchildren, and great-grandchildren who were with her during her final days in the hospital.  During one of those sleepless nights, as we took turns watching over Nanay, making sure she was fed, bathed, provided with her many medications, and observing for signs of distress, I held her hand and told her it’s okay to let go if she could not keep on fighting.  She raised us well, strong and resilient as she was.  I held her hand- her skin was paper thin, almost translucent, her breathing was slow and labored.  In many ways, I thought, Nanay had lived such a full and well-rounded life.  Even during her last moments she passed away peacefully in the arms of her kin. 

How does one say goodbye to the three persons who have been such a huge part of one’s life?  Too bad Mama, Papa, and Nanay, you will not walk with me on my graduation, but I promise you I’ll endure all the hardships to see that all our hopes and dreams come true.  Failure is not an option- and like you have always said, we’ve worked so hard to get to where we are.

Sometimes, as I’m walking home, I gaze at our house at a distance and I remember the many happy memories of our family together.  I never once thought that we are alone, because every time I feel sunlight on my face, or the breeze caressing my cheek, or rain softly  falling on my back, I know it is them telling me they love me. 

 Image Source

Nanay

We mourn the loss of our beloved Nanay Luming, who joined Our Lord early this morning.  Nay, you took care of us since infancy and we have been through thick and thin. I thank God for giving us a wonderful woman and fighter for a grandmother- and a second parent.  We love you yesterday, today, always.

We the Waraynons

Kami nga mga Waraynon

(My original free verse form in Waray)

Nasiring hira nga an mga waray-waray mag-isug,
Nga pirme nakikipag-away bisan kan kanay.
“Taga Leyte-Samar ka?” nasiring hiya,
“Haguy ka isog mo nala.”

Dako kuno an amon mga boses,
Nagpapanlalabaw nga baga't dalugdog.
Tapos pag-tawa namon,
Mayor pa daw hit sim nga gin-gigisi.

“Hagi, pabay-i iton hira”, siring ko.
Basta malipayon kita nga mga tawo.
Oo, dako it aton boses, ngan
Magtig-a it panluwas.

Pero it aton gin yayakan
Dire man mara-ot.
Pwera nala han iba nga mga maglibak,
Kita nga mga waray-waray pirme la marisyo. 

We the Waraynons

(In sonnet form)

They say that we Waraynons are feisty,

that we spar will all but the deputy.

"You're from Leyte-Samar? They'd ask gravely.

"Oh dear, how brusque and feral you must be!"

They say our voices rumble like thunder,

so unlike the mellow pipes of Adele.

When we laugh and rattle like a chunker

they liken the sound to a banshee's yell.

But we bear no malice when we express,

with diction and accent ever so thick-

only thoughtful words we wish to impress.

It's true, when we are vexed we do not kick.

So fear not dear friend, and do shake my hand,

We Waraynons believe ardor is grand! 

Puppeteers want you to WaSH*! (Water, Sanitation and Hygiene to help Prevent Intestinal Parasitic Infections

Our group won the Creative Health Education in Community Medicine, held yesterday 9AM at the MASA building, performing a live puppet show as a unique communication tool.  The group also had a DVD output which made a television debut today at the local PRTV 12 station, and will be shown 2:30 PM every weekdays.  Congratulations to our group!! It was worth the effort of over 3 overnights and hours of working on the script, puppets and other outputs.  Our battlecry as a group was, we'll give it our best, and win or lose we'll get our food! hahah We love to eat. 

THE TASK IN A NUTSHELL

Communication is a powerful tool that physicians must be able to harness to be able to get through to his patients or to the community- it is only upon using the right approach that they are able to create positive changes in behavior.

Group 1 was given the topic Intestinal Parasitic Infections.  Taking cue from the Department of Health’s existing programs like “Garantisadong Pambata” which offer deworming as one of its service packages, as well as the Soil Transmitted Helminthiasis Control Program, the group created a unique communication tool that would help effectively raise awareness about Intestinal Parasitic Infections- the cause, signs and symptoms of infection, treatment, and methods of prevention.

THE TARGET AUDIENCE:  Pre-school and school-age children and their parents.

THE TOOL:  Children respond to colorful characters so the group decided to stage a puppet show with a simple story that young minds would appreciate and easily understand.  The challenge involved translating highly technical information into a presentation that would imbue the values of cleanliness to children with the message “WASH” (Water, Sanitation, and Hygiene) – the cornerstone of the STHCP.

            The puppet show will be in Filipino so that people from around the country will be able to understand the message.  During a scene, the group will show an actual preserved Ascaris lumbricoides var. hominis to add realism to the show.  A pamphlet will also serve to further the knowledge of people on the cause and prevention of intestinal parasitism. 

            An original song composition about hand washing will serve as the finale for the group presentation. During this time the group will distribute free soaps to encourage hand washing.

THE MATERIALS:  Old socks for intestinal parasites, and old dolls and stuffed toys for the main characters. 

THE OUTPUTS: Live puppet show with original song composition with the length of 5 minutes and 43 seconds, Pamphlet, DVD, and written output. An additional fun shoot consisting of bloopers and cast of characters will be shown after the presentation to fill in the time while soaps will be distributed. 

           

Fly High

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But it doesn’t stop there!  A vacation wouldn’t be a great one if you don’t have a great place to stay, hence hotel deals (as affordable as the flights) are also available.  Transportation is a breeze with car rentals in major cities.  Simply type the city/region and hit “Search”, or perhaps browse in the “by city” category.  Vacations have never been this fun and easy.

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Back on Track, In Time for Exams

Okay I'm giving myself 15 minutes to clear my head before Anatomy time again...

I've got a pretty good hunch (according to how I know myself and my body) as to what was really going on with my body for the past three days: fatigue, or even burnout.  I've had stool exams, urinalysis, serum amylase, CBC, physical exam and all of them came out normal.  That was physically.  But in my mind I trying to solve a lot, trying to make the best of the current situation- my nephew with a history of febrile convulsions was sick in the hospital, the construction in the house delayed, taking care of my two grandmothers, coping with med school, basically trying to run the household (for the past 6 years now) and try to do well in school and feeling bad when I didn't get the top score- I guess it all blew up.

I can relate to what Dennis Portnoy, a Phychotherapist said about addressing personality traits that foster burnouts- which had deep roots in childhood.  Here are some interesting quotes:

"Exaggerated responsibility often develops in response to difficult family circumstances. Kids who grow up in families where there is chaos or lack of predictability often cope by becoming super responsible..."

(This rang bells especially during my elementary years as the eldest of three- our Papa worked in Saudi that time and Mama was a night nurse in EVRMC so she was always tired.  By age 8 I walked to school by myself, by age 9 I was the one who enrolled my little brother in prep-school, before I was in high school I regularly woke up at 5am to prepare our baon.)

..."Your parents can be very caring yet preoccupied, causing you to rely on yourself at a young age to get many of your needs met. You may feel that it is your fault if problems arise and view your needs as further burdening your parents."

Like our father always told us, everything they did, they did for our best interest, and we always loved our parents even more for the sacrifices they made for us.  Still, the situation itself unconsciously formed these personality traits I had.

..."You learn to measure your worth and define yourself by being strong, competent and dependable. If you were encouraged to be strong and self reliant, being vulnerable or needing others may cause you to feel shame or less worthy. When you do not live up to a responsible self- image or if you let someone down, you may feel like a failure."

I guess having a sympathetic ear to listen (or a sounding board like this blog) does help, and recognizing my limits and realizing the need for other people and trusting them does help a lot.

Lastly, there's this quote about perfectionism:

"The pursuit of excellence is different from a relentless need to be the best. When you seek perfection and cannot measure up to your ideal, your self- esteem decreases. Developing realistic standards and self- compassion go a long way to counteract stress that leads to burnout... We live in a society that measures worth by what you do rather than who you are. We are taught the measure of success has more to do with your image and what you produce than on internal qualities such as honesty, humor, or perceptiveness."

I guess sometimes we are just too caught up in numbers- grades, ranking, achievements, that we forget that still, the most important thing in life is living it an honest, decent way.  Being a well-rounded person who possess a healthy relationship with people.

The 15 minutes is almost over so I'll close it now- human as we are, we really have those times when our strength fails and that's where faith comes in.  As the saying goes,"Work like everything depends on you, and pray like everything depends on God."  The Benedictine maxim- Ora et Labora.

The Sick Role

Sometimes, no matter how hard we try, our limitations just catches up with us.  Yesterday, during Histology laboratory I had to go home and ask for a prescription of Tramadol 50mg from our professor for severe abdominal pain.  Well, it started in the morning- a dull ache, a four, in a pain scale of one to ten.  It escalated and finally reached an eight on the pain scale and I couldn't help but grimace from the pain.  This is not the first time this happened to me, the first time was after a hike in Hidden Valley, the second time was in November 2010, weeks prior to the board exam.

The symptoms were the same-  abdominal pain on the left upper quadrant, no fever, Urinalysis returned normal results with no elevated WBC, an abdominal ultrasound revealed normal condition of the kidneys and ureters, non-distended bowel, and vital signs normal.  I was given analgesic for the pain, and eventually the pain disappeared as mysteriously as it had appeared.  Maybe it was just stress.

Now, I'm experiencing the same symptoms and plan to go to the hospital tomorrow for another round of laboratory work-ups.  It's just bad timing- my nephew is also sick in the hospital, the weather here is always raining and threatening to flood just like it did last year- and the carpenter/ mason I hired just informed me earlier they won't be able to work tomorrow but on Sunday instead (we needed to flood-proof our home the soonest possible time), I have three exams next week- Anatomy theoretical and moving exam on Thorax, Biochemistry quiz on nucleotides chapters 32-38, and Physiology, and I missed the meeting with the Alumni who is supporting the motion for the school publication.

I can't be sick!  I need to be strong to run this household and fulfill my goals, so message to my body, and my plea to God is to help me resume normal health.  We're going to rise from these trials, I am sure of that.

Anti-flood Measures

Photo by Gerry Ruiz. Palo Leyte Flood last March 2011.

The effects of climate change have been felt by our country throughout the past year, and we can only hope that such natural disasters like floods would be something we can prepare for when it happens again.  Marikina, Cagayan de Oro, and Iligan were among the hardest hit, and even our beloved home Tacloban experienced the wrath of flood waters.

Since my return from Manila, we have experienced 3 major floods which entered our home.  The first one caused our furniture to rot and the paint peel, and it happened before the first time we renovated our home.  The second was last March when on a single day, the triple amount of the average monthly rainfall fell in Tacloban and neighboring towns.  The first floor was flooded that we had to check-in at a hostel downtown for three days.  We were lucky because in V & G Subdivision some parts had water neck-deep and they had to be evacuated.  In Brgy. Nula-tula they had landslides.  The third one was Just this December- during the time the cities of Iligan and Cagayan de Oro were devastated.

My brothers and I decided to take action.  I researched about anti-flood measures (mostly though were applied in Netherlands and similar low-lying areas) but the idea I believe may be adapted here.  One such idea would be to put a barrier to prevent water from entering the house.  Our 1st floor had been filled and raised almost a meter from the street level in 2009, but we are creating a concrete porch which also serves as a barrier to the flood water (can't explain in detail) and our laundry area which is in the back area will also have a barrier.  In addition, we are building a new CR raised 1.5 meters above ground with its own septic tank.  This will solve the problem of the other water closets inside the house which are rendered useless during floods.  Our carport is also elevated.  We planted additions to the existing trees in our lot: 2 mahogany trees, acacia, mango, java plum, santol, guyabano, tamarind, a handful tall woody shrubs, ornamentals, and ground covers.

Tacloban bay area is relatively well-protected, and the mountains are a distance away. We just hope and pray that such an occurrence won't happen, or at least be prepared.