Wednesday, May 3, 2017


may i just say…



and i have crossed over.

i don't drink coffee anymore because i have gastritis.

and i have crossed over some more!

i can't fall asleep when i drink coffeee!

far cry from med school!


I remember that much of the failure I got in medical school was with the renal modules.  In first year until the end, I got a complete renal failure in all of the examinations.  As much as I tried reading and absorbing it, and thinking that I understood it, I failed the examination.

As such, I made it a career to become a nephrologist partly because I wanted to conquer these failures.  But a bigger part why I became a nephrologist despite the failure in the basic sciences is that I loved the way the patients responded to renal treatment in the clinics.  Ang the biggest reason why I went into Nephrology is that during the last year of my residency, my mother went into chronic dialysis.

Theoretical Nephrology was never easy for me.  I failed all the written examinations in medical school, residency, and my first Nephrology Board Examination.  I excelled in seeing the patients and did well in the oral examinations and revalida given by consultants.  However, I believe I have prevailed and am happy with my career because of the following:

First, I really want to become a general physician and a nephrologist particularly because I want to be able to provide care to other patients the way this care has been provided for my mother.  I think that this very deep and desire helped me to finish this difficult path where I met a lot of mini failures along the way.  Also, prolonging life and improving the quality of life of the patients was very important.

Second, the environment was very supportive.  Although the topics were very hard, the people who were teaching were very kind and encouraged me to persevere.  Each of my mentors told me of the challenges that they faced.  When they finished training, they are very generous to share the benefits that they have reaped and promised that once we finished, we will be able to reap the same benefits.  Currently, my then mentors who are now colleagues are very helpful in helping each one advance in one’s career. 

Third, the topic was something I really liked.  I was fascinated by renal physiology, and how it affected all the systems.  Though difficult to explain (until now), I was fascinated by the electrolytes, the logic and the mathematical part of the theory. 

Fourth, I enjoyed how nephrologists are also educators.  They are very active in wanting to improve curricula in their respective societies.  They are trainers in their institutions.  And this is similar to who I think I am.

Lastly, I believe that I endeavor to teach nephrology to the residents and the students because I think it is beautiful.  Since I found the topic to be very difficult, I want to make a way to find it easier for other students.  And also, I want to serve as an example that I have failed so many times at each level, yet I am where I want to be. 

As such, I find myself in the training institution of my hospital and the head of the continuing medical education committee of our society.  I am utilizing camaraderie with other nephrologists and trainees to facilitate learning as well.  However, this motivation is not really selfless.  I endeavor to teach because I don’t want to become stagnant in what I know.  I think that ultimately, teaching is a way to keep sharp and learning some more. 

Teaching is a way for learning never to stop, and as a closet nerd, this is how I want life to continue to be.  It is very exciting! J


When I was a child, my learning opportunities came by very easily.  I distinctly remember when I was in nursery, I had a made-up classroom in my home where I would “do homework” with my sisters who were eight and nine years my senior.  Early on, I was adding and subtracting in my little classroom.  It was fun, not terrible.  I loved doing the problems, was persistent until I got the right and answer and reveled at the good feelings I got when I did.  As such, I brought this on continuously until high school.  Because of this, I believed that elementary and secondary school learning was effortless.

I wanted to share this love for learning and to teach early on.  A fresh psychology graduate, I decided to try my hand in teaching by coming back to my high school and becoming a biology teacher.  This decision was easy for me because I had the most inspirational biology teacher when I was in second year high school.  And I wanted to be just like her. 

I set out to make this learning effortless and fun for my students.  As a young teacher, I think that it was easy for me because I could easily relate to the students, utilize examples close to our young hearts and laugh with them while learning.   However, these were not enough for all the students.  My theory that learning was easy was tested by two students.  Let us call them Iris and Loren.

Iris had a failing mark in biology in the first quarter.  As such, I had the dreaded job of speaking to Iris’ mother about her performance.  She asked me how to better motivate Iris.  She saw that Iris would spend a lot of time doing computer games and not reading.  In retrospect, it was very difficult for a then 22-year old teacher to explain to a mother the answer.  I believed I was a kid myself and she knew her daughter better.  I went into a very unconfident answer that I would just work with Iris after school and see where that would take us.

Looking back on the experience and reading these motivational hand outs and notes, I realize that Iris was not interested in Biology.  She excelled in sports and was looking to go into athletics where Biology would not serve any utility.  I told her that this may be so, but the school system was trying to instill the discipline of being able to study different topics.  Persistence was also key in success.  So every day, after school, I would create practice questions for her to answer.  If there was a long test, I would review the questions with her once the feedback was given.  We would go through the books slowly and repetitively. 

I saw that for Iris, the goal was just the performance standard instead of the learning standard.  I just wanted her to pass the course at the end of the year so that she could be elevated to the next year level.  She was there with me through the recommended time, but the time was not well spent as she did a lot of self-handicapping, and was debilitated easily.  I persisted, but in a slower pace.  In the end, we did succeed for her goal in biology.  She had barely passing marks at the end of the year.  However, she failed in two other subjects and the school lost her as a student as she transferred to another learning institution at the end of the year.  This was difficult for me.

Loren, the other student, was a very excellent dancer in the school’s dance club.  However, she had a difficult time in biology.  During the first Parent-Teacher Conference, I also had to deliver the sad news that she failed.  The mother asked me one question: would she ask Loren to quit the dance club.  I replied that when I was in high school, a big part of me wanted to come to school because of the school choir activities and that I would not be motivated to come to school if the choir were not there.  Loren was already competing in the inter-school dance competitions.  Although this took time away from studying science, I thought that this was a good motivator for her to improve her science grade because one had to be in good standing in order to continue competing.

In this case, I used what she really loved as a reward to continue studying for biology.  I told her that we were not necessarily aiming for high marks, but passing marks.  But by continuing to encourage her, calling her out in class and affirming her, I saw her draw out of her shell.  Though she did not get A’s or B’s, she improved and passed her course and moved on to the next year.

I had not read the theory of Maehr at the time.  Looking back, both students lacked direction and persistence for biology at the onset.  However, when explained that they needed to pass the subject for different reasons, like passing the year level or continuing to dance, they prevailed.  For Iris case, though, her performance was barely passing because I think passing had no effect on her.  For Loren, her grades improved as she had more opportunities to dance and as the teachers and club mates constantly reminded her that she had to do well in her academics as well.  Loren possibly attached meaning to biology as that ticket to continue to dance.

Loren was more systematic in her trying to improve.  She would come to me when she had a difficult task and I saw her interacting more with her seatmates during class regarding the topic.  She had taken more of an active role because of her goal.  This worked out for her better than it did for Iris, who I had to constantly push. 

Looking back, I would have probably asked them, rather than directed to them, what their goals were in their life and related the subject to that.  Perhaps that would have been more powerful.  I would have pointed them to the right direction, been more persistent.  Persistence may have entailed my efforts and my encouraged their classmates to encourage them as well.  Perhaps I would have included more activities like groupings rather than just sticking to didactics and answering of sample questions.  I would have included their friends in the review, making it fun and designed tasks with clear objective endpoints per activity instead of just aiming for a passing mark. 

I hope that these experiences and study will help me with my next students that will have difficulty in being motivated.  I also hope, moreso, that this reflection will help me in the times that I am also unmotivated.  J


Ever since I was a young student, I always excelled in Math and Language because I never perceived them as subjects that you had to do “memorization.”  I favored analysis over rote memory.  I learned the multiplication tables not by memorizing them but visualizing multiple groups instead.

As a result, I passionately disliked Social Studies because of the memorization of dates, facts and events.  I did not like Physics and Chemistry because I did not understand the concepts and had to memorize the formulas.  

This dislike extended to even shifting my course from Biology to Psychology because of the fear of memorizing the different taxonomic groups.  However, I was not able to escape memorization because…I WENT INTO MEDICINE! 

Memorization is indeed a part of becoming a doctor.  I had a very difficult time in the first and second years of medicine proper during the basic sciences.  In fact, I think I repeated the Nephrology Board Examination the first time because of this failure to memorize.  Given these failures, I summarize how I coped with trying to remember by the following steps:

First, I had to put myself in the mindset that I do HAVE to study, to do the active memorization and repetition.  I had to devote my time to the memory work.  This state of readiness, I believe, made the difference of whether I would prevail in learning a new topic and making it a new part of me.

Second, I had to repeat, repeat, repeat and repeat!  The Medicine Board Examination was a constant example of this.  I remember studying from literally sunrise to sunset and patiently repeating all the terms and concepts.  There had to be acceptance of this need to repeat in order to learn. 

Third, I had to build on what I already knew.  I noticed that I had to master basic concepts before moving on the advanced ones.  In a sense, the concepts had to be a part of me and just not rote.  In order to do that, I had to utilize examples.  For the initial concepts that had much detail, I had to use mnemonics, make up stories, remember patients in order for me to remember. 

Fourth, review was always imperative!  There is no assumption that “I already knew that!”  For every new test, every new patient, I had to go back to the concepts in order to make sure that I already knew everything by heart.

Fifth, and most important, I realize that I am a group and an auditory learner.  I study best when I study with others in order to pace myself and focus.  I integrate much of the new knowledge by discussing cases with my friends, telling stories of physiologic concepts to my colleagues, and teaching my students.  I think in large part, I want to become a teacher.  In teaching others, I am forced to simplify the concept, teach in my own words instead of copying data from the book and integrating what I know. 

Currently, I really live on my fifth memory rule.  I really want to teach so that I will be forced never to stop learning. J


two weeks ago, i had a melt down.  imagine your 75 year old father wanting to get married to an 18 year old.

well, it wasn't really something like that, but kind of something like that in intensity.

imagine getting a piece of news of that magnitude while you are alone.

thankfully i wasn't.

the time i received that message, i was in the company of friends.  friends who laughed with me, cried with me, got surprised with me.

i was in the SMS company of siblings as well.

and just like that, everything was bearable.

as such, for the first time in a long time, i posted a single liner Facebook status update: friends, siblings, thank you.  you know who you are.

that post got very few likes.

but the response of my real close friends was overwhelming.  they realized, before i did, that i was actually sending out a mayday!

Mayday is an emergency procedure word used internationally as a distress signal in voice procedure radio communications.

i got dinner invites.
i got lunch invites.
i got text messages.
i got offers to print and submit my homework.
i got classmates handling my schedule for me.
i got fake phone referrals which are really disguised "how are you?"
i got long distance calls from london.
i got pizza parties.
i got coffee meet-ups.

all in a week.  all in that hell of a time.  in order to help me through it.  it was a miracle.

they knew me well.

and i realized, that sometimes, when my family cannot give me what i need, God gives a surplus of love via my family from other parents who never allow me to feel alone.

Lord, thank you for my friends and siblings.

now, if only i could go to a road trip or a plane ride with any of them…

that is another story!


I have a lot of thoughts today.

i wish to write them before i lose them.

So now i am busy pasting away my papers written for school.

it's sooooo hot.

the thoughts are gone now.

Tuesday, February 28, 2017

sibling love

 I know that over the past few days, my view of medicine has been dark (because of the toxicity).  However, there are daily events and commentaries happening within the wards and ICUs that are often miraculous.  These events make me want to continue going on becoming a doctor.  Such is the case of AO. 

No, I will not be sharing the clinical details of her case for a medical discussion.  I wish to share the vents because of the lesson beyond medicine that it has taught me.  

AO was admitted due to incoherence and was referred to me because of anuria or absence of urine output.  We went about our medical management.  But what was more amazing to me was that every time I went to attend to her, it was her brother who was with her.  I will never forget this brother.  For one, he had the same name as my dad.  And he watched over the patient.  Every day.  Each day.  With no reliever.

As time passed by, I began to know more about the family.  Yes, AO was married, but barely saw her only daughter.  I never got to find out what happened to her husband.   As circumstances would have it, she would now live with her brother, who would take her to the doctor and care for her.  And it was just the two of them left. 

I grew more and more amazed as the days passed because Mr. JL, the brother, was very much involved in patient care.  A kind man, very decent, he would always thank me every time I chatted with them.  I noted that he called ALL of the nurses by first name.  He would update me on every detail regarding her sister: what she ate and didn’t eat, how much urine was in the foley catheter, what stories and in what language she talked that day, how her shoulders were hunched today and so on.  There was such an involvement of this brother and such compassion that I have not seen of a sibling in a long time.  Spouses and children, yes.  But of siblings, this was very rare.  His reply was always the same, "Eh kami na lang po ang magkasama."

As fate would have it, Mrs AO would pass away after eight days of hospital confinement.  But in all that time, there was no angry word from Mr. JL.  At the end of it all, he would contact me and thank me for my services and for caring for her sister.  He would request for a discount because his hospital bill amounted to Php 500,000.  Yes, the cost of medical care.  But there was no hint of complaint in his voice.  Only an acceptance.  That it was fate.  That his sister was in a better place. 

As a token of my admiration for him, I would text him, “Thank you very much for devotedly taking care of Mrs. AO.  Where is the wake?”

I was more surprised with his reply.   “Wala pong wake doktora.  It costs Php __ for the direct cremation, no casket and no wake.  Simple lang po lahat.  Pinagdasal ko lang po siya sa church ng 9 days.  We are just waiting for the death certificate.  God bless and Buddha bless.”

I guess it is a pleasure for me to take care of patients like this.  In the brink of death and in sickness, I find that people can react in two very polarizing ways: forget family, or stick together until the end.  And seeing families stick together like glue, share kindness with others is always a sight to behold in this seemingly hopeless world of ours.

My lesson learned and relearned is this: in the end, it will always, always be your family.  And more special in this case is the love for siblings.

Many thanks, God bless and Buddha bless, Mr. JL and Mrs. AO.