The Boy Known as Brandon

Few days ago, during my 1-week break from the hospital which I spent south of the country, I was able to explore the darker side of Davao City and talk to a good man. A dear friend Nel, a single mother by choice, with another old friend Joe with his long-term gay partner Greggy dragged me into this small, dimly lit niche skillfully hidden along generally wholesome San Pedro Street of the city. It was an obscure gay bar ironically named Fame, a secret hangout of the city’s not so apparent and not so opulent members of the gay community, along with a sprinkling of today’s recently emerging collection of females hungry for any semblance of intimacy from the male kind.

We were ushered in by able-bodied, fierce looking males into the smoky alcove. Standing by some walls or lounging on threadbare faux leather sofas were brawny, crisp-looking young men dressed in red sleeveless tank tops and tight-fitting, crotch hugging denim really-short shorts. Their arms were well sculpted, not the gym-induce biceps, but those biceps toned and toughened by hard back-breaking labor. Their legs looked strong, with hamstrings that can make any woman drool. They looked bored, like a bunch of old women waiting for their favorite telenovelas on a warm uneventful evening.

Then the stage-lights turned on. The small, make-shift stage that appeared like a bathroom was suddenly flooded by red neon lights. As if on cue, they all stood up, walked to the small stage in front of the room, and started their small number. Moving their hips languorously to Mariah Carey’s “Open Arms”, almost 20 testosterone-laden, hot-blooded males strutted their stuff to the salivating audience. That was when he caught my eye. He was tall, with an empty, distant look in his eyes, and he shyly dropped his gaze when he saw me staring at him. I kept quiet. I was never the type to squirm from these types of situations and I never avert my eyes from this sort of taboo
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The boy ended up at our table, with my friends buying him a beer, for several minutes of “table” time. He started putting his arms on my shoulders, but I moved away and told him, “Hey, you don’t have to do that.” Instead, I ended up asking him about his life.

Perhaps they have a generic story to tell all customers. He said his name is Brandon and he’s 21 years old. He said his mom was unmarried when she had him, and his dad was an Iranian who ran away. Eventually, his mom married someone else, had 3 more children and the stepdad turned out to be cruel and alcohol-dependent. He said he had to go all the way from Butuan City to escape this bitter family situation. He ran away and stayed with his grandfather in Davao City. His grandpa tried to put him to school but he said he had to help out. So when an offer from a neighbor who’s employed in this bar came, he took it without batting an eyelash.

Yeah right. Straight out of a Maalalala Mo Kaya screenplay. Go on, Brandon. You’re telling me crap and you’re 19 years old, but go on. I’m listening...

He said they have a decent job, that they are not prostitutes. They’re just paid to give small talk to lonely people, some might touch them here or there, but there’s really no harm done. He said they really don’t lose anything. He said making lonely people happy is a decent job too.

Perhaps the boy was right. Making lonely people happy, no matter how short-lived or evanescent that happiness is, is a noble job. With this epidemic of loneliness around, perhaps the real heroes are those who are able to give small talk to lonely people during moments when they are most needed.

Sometimes I wonder if the prevalence of loneliness is exceedingly underestimated. If a certain percentage of our population thrives and even profits from the business of temporarily assuaging loneliness, does this mean that lonely people make up a significant share of today’s market economies? And if this hefty share of the market continues to be hiding in the dark, how many of these people actually walk among us during daylight? How many seemingly respectable people in fact lead double lives – acting reputable and upright during the day while in the evenings, they creep in the dark crannies of the city, lavishing in the excesses of the flesh, with their faces hidden by almost-opaque veils of anonymity?

When the evening came to a close, I said goodbye to Brandon, and in the gravity of my musings, forgot to give the poor boy a tip. So long, Brandon. I may never see you again. You may end up with HIV or you may end up to be a tycoon one day. Either way, I’m honored to have met you.

Now, as I work in the ostensibly decent comforts of this hospital, I sometimes think of Brandon. Brandon with those sad eyes, Brandon with that empty gaze. Brandon dancing under the lights. Brandon ravaged by hundreds of plundering, searching, lonely hands. Sigh. Wherever he is, whatever he does, and wherever fate may take him, may God bless him.

And then I know that Dr. Jekyll and Mr. Hyde are not merely stuff for novels. Dr. Jekyll and Mr. Hyde could might as well be anyone. Dr. Jekyll and Mr. Hyde could might as well be me.

After the PMS

I've been spending the past few days gorging on chocolates, red meat, oil, and yeah, evil carbs. I've been eating way too much that everyday, I'm probably consuming twice the recommended daily calorie intake for Filipinos. This is indeed a cause for guilt and alarm, considering that half of this nation's population is actually subsisting on a meager 1,500 kilo-calorie-days, which is below the recommended daily allowance, not because of vanity or health reasons, but simply because they could not afford to eat more. But emotional eater as I am, I'm left with no choice but to give in to my chocolate fantasies and carbohydrate addiction. True enough, the scales don't lie. I've gained 2 kilograms in a month's time, and I don't feel any better at all.

While I had PMS to blame for my lousy state of mind during the past weeks, I'm left with no other valid reason now, except for my sheer lack of self-control or my innate tendencies to fall for the phony and fleeting elation of a sugar rush. The monthly visitor has come and gone, and the changes in the hormones didn't do anything to abate the need for sugar. It only heightened the need for salt, a trap I readily fell for, of course.

And so today, I just woke up feeling more oafish than ever. I need a way to get out of this perceived need to eat. I need to free my mind from the clutches of evil carbs and the nefarious red meat. I need to get satisfaction from hunger. Ahhh, the glorious sounds an empty stomach makes - the gurgling, the hollow buzz - I need to hear music in those noises again.

I promise. I will start dieting tomorrow. But whether I'm serious or not, well, I guess that would have to wait until tomorrow too.

Clumsy

“So, what was your first impression of me?” - I once asked a recently discovered friend who I’ve been hanging out frequently with during this past few weeks. I was expecting something like, “You’re too big” or “Too tall”, or “Overweight!”, or “A bit intimidating”, or “Ahh, really smart!” (tehee!). But all I got was, “You’re too clumsy!” Aaaargh! Ouch! That stung!

But instead of pouncing on the poor guy and tearing him up into pieces for the unnecessary insult to my already injured self-esteem, I found myself awed at this unmitigated display of candor on his part. Few people dare to discuss my clumsiness with me, out in the open. And I appreciate his sheer lack of knowledge of the magnitude of my wrath or the peril of my tantrums. For this alone, I spared him.

You see I do not deny my clumsiness. This huge, amorphous physique that I’ve been so terribly gifted with could only come with a matching awkwardness in movement, a gawkiness in behavior that even my parents found irritating. For years, I have been dealing with a chronic lack of grace. I walk with an oafish, lumbering stride, so unfeminine and unbecoming. So, I do not move my head flirtatiously or fiddle with my hair the way most women do. My hips don't generate a lovely erotic sway. Ahh, I don't even have hips to speak of, much more a butt! Hah! But duh! So what? What's the big deal about being graceful? Why should women take pains in acting fluidly, with so much grace?

My mom once said that if I continue to move this way, I’ll never get myself a man. She said, "Jean, go find yourself some grace!" Hah! Grace, huh? I wouldn’t bother with men who only look at how women move, and forget about what they think and say and do. For me, grace isn't just a degree of beauty or form or style. It has to be more than that. And if there should be restraint for grace to exist, then I'd rather pass and remain clumsy as I am now.

Ok, excuses, excuses. My legitimizing this literally “awkward state of affairs” is not enough to remove my clumsiness, I know. But biologically, I do have an excuse that might be valid enough. God gave me feet with collapsed transverse arches. They make wearing heels an ordeal and they make my feet grow hideous corns right in between the balls of the feet. No matter how many foot spas I go to, my feet are as thick as farmers’ feet. They will always be huge Size 9s and I will never be able to walk on heels with enough grace that I won’t be mistaken for a transvestite. Because of the wrong shape of the feet, my knees just followed. I remember that at 4 years old, my mother was trying to massage my knees to reshape them. She said they look weird. Well, they are weird.

So these were the gifts I was born with: knock-knees, calves as big as logs, feet with collapsed transverse arches, corns and calluses that spontaneously spring up despite the absence of trauma, and a gait that can never survive high heels! Because of those in-born attributes, I have learned to carry a backpack like a high school boy, and walk around like a full-pledged overweight, drunken kargador. I don't subscribe to that well-accepted notion that girls should forever be sitting down with legs closed and slightly positioned to the side, and with their hands neatly rested on their laps.

I walk and talk as I please. Grace for me, is not merely the presence of dignified and restricted beauty, but beauty despite the lack of form or harmony - what the poet Robert Herrick called "delight in disorder". And I, being born ugly, should find beauty in what I was born with. Knowing that is grace in itself.

Ergo, I would like to believe that there must be a reason for this clumsiness. God must have thought I should be born this way. Ahhh, maybe He thought I would have to be loved that way too. And because clumsy people like me slip and fall down all the time, God must have already devised ways to catch us every time we do.

Dead Spot Issues

The recently concluded long All Souls Day weekend was a suitable opportunity for me to succumb to a long suppressed urge to fall into a stupor, where everything from the outside world ceases to matter and nothing else exists except the actual moment. To be caught in a dead spot, like a cellphone trapped in a signal-less cave, was paradoxically liberating. Isolation from the rest of the world unleashes parts of the self that have chronically stayed dormant, and inconceivable truths about the self suddenly become manifest, and the thought of what and who the self would evolve into becomes too frightening.

This brings to mind bits and pieces of the old stuff from pre-med days - Plato's Allegory of the Cave. What if everything that I have construed to be real is after all unreal? I imagine I'm a prisoner in a cave, staring at shadows on a wall, unaware that these are merely shadows and the real world is right behind me. Aargh! Too profound. My mind can't digest it now.

All I know now is this: I like this dead spot. The darkness and isolation of this cramped secret cranny brings comfort - that kind of comfort that comes from not trying to understand anything at all. While reality is a matter of debate, the moment is real. No signals from the outside world, no interferences of whatever kind - just me, the shadows cast on the wall, and the moment. Everyone deserves to stay in a cave once in a while. And even if it doesn't make any sense, I'll bask in this dead spot until I get kicked out, back into the real world again.

PMS and Medicine

Saturday morning. I’ve been ineffectively dealing with an unusually prolonged fit of PMS that has extended for a bit more than 2 weeks now, which is enough reason for me to speculate that perhaps this is the beginning of a malignant, chronic, and pathological depression. At 5 in the morning, I was already up and about, trying to stuff vital Cardiology information into my tired, resisting head. Everything was in vain. My intellectual queasiness has turned into a full-blown academic hyperemesis. I simply can’t tolerate anything that has something to do with medicine. This doctor who used to call Medicine her one great love is having a bad case of the I-don’t-want-to-be-a-doctor-anymore bug. This is an emergency.

After 2 hours of wrestling with my anti-medicine instincts, I gave up. I pulled out a non-academic book from my pile of unread paperbacks and tried to savor every non-medical word. I brought out my iPod, switched it on to my Everything But the Girl playlist and tried to enjoy the great music. Nothing. No joy at all. Not even a hint of interest or a slight upsurge in my monotonous or even downsloping happiness scale.

Something is missing. I need a remedy to this slump, before everything around which my life revolves totally collapses. Medicine is my life, the only attempt and experience with commitment that Fate has ever allowed me to have. Medicine is the man I married. He was the bandit that snatched me away from ordinary life, the craft I chose to spend the rest of my life knowing and perfecting. But now he is slowly slipping away. No, divorce is not an option. Perhaps with time, the fire will come back. Perhaps with time, I will remember why I fell in love with it in the first place.

But for the moment, I'm raising a Code Blue. I need some defibrillation stat!

And just like that...

Few weeks ago, I posted a short paragraph about Typhoon Ondoy that ended this way...

Indeed, some things, like yesterday's rain, have a way of "fumbling at your senses" and suddenly disappear, as if nothing happened at all. It's cruel. It's strange. It's wicked.

I guess calamities are always this way. They ruin your world, test your snapping point, and completely turn you inside and out, while the world goes on mindless about your predicament. Not all calamities come as typhoons. Sometimes they can come as landslides, or earthquakes, or lightning, or tsunamis. And sometimes they come as events, or people, or words. Or a moment that stuns you for the rest of your life.

A few days ago, I had the good fortune to encounter one of these moments again. It came, it conquered, it left, it came back. And just like that, the story has unravelled again. This is a typhoon I'll gladly live with for the rest of my life, even if it stuns me each time. And yeah, I will be patient. I will not ask for more. Lightning never strikes the same place twice. I guess this lightning did.

I'll borrow Emily Dickinson's words: He fumbles at your senses like the players at the keys. Before he turns full music on, he stuns you by degrees.

Some things are strange. Some things are wicked. They come unannounced, and leave without flair but with much grief. But when they come back, I will gladly be carried away. Again. And just like that...

Lessons on Impatience from my Patients

OPD day again. As always, an OPD day should start early, so that this struggling Cardiology fellow can cram all activities into one 24-hour day, 8 hours of which, should be dedicated to pure, undisturbed sleep. There were conferences to attend to, consultants to talk to, the leptospirosis epidemic to take advantage of (research-wise), students to deal with, referrals to see, residents to get mad at for the unnecessary referrals (oh, i wish i can do this!). And there's OPD.

Despite my resolve to start early, my post-duty status hampered me from accomplishing my planned daily schedule right on time. A consultant suddenly wanted to go over our pile of TET reports that has been waiting for his corrections for the past 5 months, so I had to take this opportunity and not allow the moment to pass. I suddenly had a surge of inspiration to create my data-collection form for my emergency ECG changes in leptospirosis study and I had to grab that chance too.

So at 11 AM, I was already one hour late from my OPD responsibilities. I called up the nurse and told her to instruct my patients to have lunch. I'll be there in 30 minutes, I told her.

So I typed and I typed and after 30 minutes, I was still in front of my computer, with my data collection form near completion. Suddenly, came a barrage of text messages:

Patient 1: Gud PM dra alcobar. san na kyo? dami nyo psynte dito antay sayo. gutom na kami. bilisan nyo na punta na kayo.

Patient 2: Dra. psensya na. Paubos na oxygen ni inay. bilisan nyo 11 na leyt na kyo.

Patient 3: Pupunta k ba bilisan mo dami dito antay syo

Ahhh ganun. I was so tempted to send these people text curses. Worthless, impatient, good-for-nothing, ingrates! Just who do you think you are? You don't pay me a single cent and here you are commanding me to come to my own OPD clinic! Darn you, people!

But I told myself, "Hey, be patient to your patients." I was able to keep my cool and walk to my OPD with my composure intact.

Almost three hours later, after several apologies, and smiles, and unnecessary explanations for my tardiness, I was able to finish my OPD with my patience intact.

Then another text message came. This time, it was from a patient I was trying to help to have his mitral and aortic valves replaced:

SMARTAlert: 09215419288 is requesting you to Pasaload P5.

I was just stunned. And then came that warm fuzzy feeling. Whaaatt?!?!? WTF?!?!?! What do these people think of me?

But then of course, I had to be patient. After all, perhaps that's why they're called patients. They probably have every right to teach their doctors a lesson on patience everyday.

Certain Reminders on Patient Care

One of my non-medical friends who used to join me and my doctor-friends in our travels once remarked that our life in this profession is extraordinary - deserving of a sitcom in primetime television. Not only do we live horrible schedules and gravely inhuman work hours, we also subsist on a totally absurd and unjust paycheck, inversely proportional to the extent of our labor and psychosocial and emotional burden. What he found most amusing, however, was the fact that we never run out of intellectual conversations. According to him, ordinary conversations in the outside world where he came from usually revolve on the mundane, the casual, and the superficial. Doctors, on the other hand, talk about life - what they try to save, and what they miss in the process.

This good friend, who is still, by far and without a doubt, the most amazing and profound person I've ever had the good fortune of running into, had the habit of listening to us while we rant and whine about our work and our patients, once in a while giving his trademark laconic comments or a wordless mocking grin. After being exposed to us for several instances, however, he concluded that doctors all over the world, no matter how diverse and strange, will always find something to talk about - their patients.

But while doctors occasionally consider their patients' cases gossip fodder for casual conversations, I realized patients also talk about their doctors a lot more than I expected them to. During yesterday's out-patient clinic, I overheard a bunch of patients talking about their own doctors, reminiscent of those Tito, Vic, and Joey sessions in Eat Bulaga's Bulagaan.

Patient A: Aba yung duktor ko, mabait yun! Laging nakangiti. Nagsalita pa lang sya, parang gumagaling na ako.
Patient B: Mas mabait yung duktor ko! Lagi akong binibigyan ng sample ng gamot! Eto may mga abstract at referral letter pa. Kaya nakakalapit ako agad sa mga senador.
Patient C: Pinakamagaling yata yung duktor ko! Mukha pa syang artista! Mabait na, maganda pa.
Patient A: Talaga? Anong pangalan ng duktor mo?
Patient C: (blurts out a gravely mispronounced name of someone familiar) Basta yung maputi na parang model. Tawag ko nga dun si Dra. KC. (probably referring to KC Concepcion)
Patient B: Yung akin, di ko matandaan. Basta yung mataba na malaki ang tyan! Kamukha ni Arnold Clavio. Nakakatuwa ngang kausap e.
Patient D: Yung duktor ko, yung kalbo na Inglesero. Ang sungit. Di ko maintindihan ang salita minsan. Dumudugo nga ang ilong ko lagi.
Patient E: May mga duktor dito na ang papangit ang ugali! Akala ang gaganda at ang yayaman, mukha naman silang mga katulong!

I was wishing Patient C was talking about me, though that would be highly unlikely. I'm probably more of Patient A's doctor. Ehem, ehem.

Few days ago, I received a text message I still didn't have the slightest gumption of deleting. It was from my greatest doctor-idol and mentor - the Great Dr. D himself! In my phone, I have created a folder made especially for inspiring messages from Dr. D - messages I go back to again and again, during those PMS-moments when I absolutely hate my profession and whenever i bemoan my pathetic white-coat state.

Anyway, it said, "Thanks for caring for my patients last month jean... etc. etc. BTW, you have great bedside manners. Don't ever lose that." Waaahh!! That's a compliment from the Compassion Guru himself! I was floating and high when I got it. Somehow it reminded me, that even during my most toxic moments, even when I'm most tired and ugly, I have to keep my manners. Empathy is the name of this game. First, do no harm. To cure, sometimes. To alleviate, often. But always, to comfort.

Anyway, going back to my topic. While I was busy scribbling in my charts yesterday, I overheard another OPD conversation.

Nurse: Nanay, sino po ang duktor nyo?
Patient: Hmmm, basta yung mabait po.
Nurse: Nanay naman, mabait naman lahat dito.
Patient: (To her companion) Sino nga ba yung duktorang yun? Ah, naalala ko na! Si Dra. Alcobar! Yung mabait! Malaking babae na mabait. Oo nga, si Dra. Alcobar - yung matangkad na mataba!

Ahhh, WTF! The grossly mispronounced surname, I can forgive. But mataba??? Somebody just burst my bubble.

Me (thinking): Nanay, di ako mabait! Masungit ako! At hindi ako mataba!!!

But of course, my patient was right. There's no way I can ever deny my hideous, giant, amorphous state. Ugh! Rub it in. Go ahead.

I stared at my poor patient, like I'm going to pounce on her and give her a defibrillatory dose of shock waves - all 360 joules of it. And then suddenly, her face lit up. "Duktora Alcobar, Duktora Alcobar!!"

I couldn't help but smile at her. And the old woman, using all her post-stroke effort, shuffled up to me, and gave me a hug. Sigh... Too much for my being big again.

On second thought, I wouldn't really mind being remembered as "matangkad"or "malaki", not even as "mataba". For as long as once in a while an old woman will smile at me that way, or a blind old man will claim with unblinking but blind certainty, "Duktora, ang ganda ganda mo", I guess I'll be all right.

Perhaps I'm doing fine, after all.

Excerpts from The Prophet

Except during rare circumstances, it is extremely pathetic for someone who writes her own blog to post words written by other people. Lately, however, I've been reminded about certain words from a book that a great proportion of today's literate population may have already studied way back in high school. Considering the events during the past few days as "rare circumstances", I therefore venture in posting excerpts from this book. After all, there was a time when I memorized this chapter, word for word.

Few months ago, I was having a rare beer with a friend. While arguing a point, I quoted a line from this book, and I was surprised because my old friend blurted out another line in response. Verbatim. I don't remember the issue then, but nobody ended up winning, or conceding. As my good friend said, "Conceding presupposes an argument, and we have none." I managed to arrive at a conclusion, though. I was so lucky to have such smart friends!

My flight of ideas, notwithstanding, I just need to post these excerpts from Khalil Gibran's "The Prophet". These may open new worlds for some of my readers, the way they once opened new worlds for me. And if you ask me if I still believe them, my predictably crappy answer is "Yes, I still do. Every crappy word."

Then said Almitra, "Speak to us of Love."

And he raised his head and looked upon the people, and there fell a stillness upon them.

And with a great voice he said:

When love beckons to you follow him,

Though his ways are hard and steep.

And when his wings enfold you yield to him,

Though the sword hidden among his pinions may wound you.

And when he speaks to you believe in him,

Though his voice may shatter your dreams as the north wind lays waste the garden.

For even as love crowns you so shall he crucify you. Even as he is for your growth so is he for your pruning.

Even as he ascends to your height and caresses your tenderest branches that quiver in the sun,

So shall he descend to your roots and shake them in their clinging to the earth.

Like sheaves of corn he gathers you unto himself.

He threshes you to make you naked.

He sifts you to free you from your husks.

He grinds you to whiteness.

He kneads you until you are pliant;

And then he assigns you to his sacred fire, that you may become sacred bread for God's sacred feast.

All these things shall love do unto you that you may know the secrets of your heart, and in that knowledge become a fragment of Life's heart.

But if in your fear you would seek only love's peace and love's pleasure,

Then it is better for you that you cover your nakedness and pass out of love's threshing-floor,

Into the seasonless world where you shall laugh, but not all of your laughter, and weep, but not all of your tears.

Love gives naught but itself and takes naught but from itself.

Love possesses not nor would it be possessed;

For love is sufficient unto love.

When you love you should not say, "God is in my heart," but rather, "I am in the heart of God."

And think not you can direct the course of love, if it finds you worthy, it directs your course.

Love has no other desire but to fulfill itself.

But if you love and must have desires, let these be your desires:

To melt and be like a running brook that sings its melody to the night.

To know the pain of too much tenderness.

To be wounded by your own understanding of love;

And to bleed willingly and joyfully.

To wake at dawn with a winged heart and give thanks for another day of loving;

To rest at the noon hour and meditate love's ecstasy;

To return home at eventide with gratitude;

And then to sleep with a prayer for the beloved in your heart and a song of praise upon your lips.

Then Almitra spoke again and said, "And what of Marriage, master?"

And he answered saying:

You were born together, and together you shall be forevermore.

You shall be together when the white wings of death scatter your days.

Aye, you shall be together even in the silent memory of God.

But let there be spaces in your togetherness,

And let the winds of the heavens dance between you.

Love one another but make not a bond of love:

Let it rather be a moving sea between the shores of your souls.

Fill each other's cup but drink not from one cup.

Give one another of your bread but eat not from the same loaf.

Sing and dance together and be joyous, but let each one of you be alone,

Even as the strings of a lute are alone though they quiver with the same music.

Give your hearts, but not into each other's keeping.

For only the hand of Life can contain your hearts.

And stand together, yet not too near together:

For the pillars of the temple stand apart,

And the oak tree and the cypress grow not in each other's shadow.

Making Peace

Today, I'm making peace with a lot of things.

First off, I'd like to make peace with the rain - that gift from nature which I've loved for so long, whose embrace I used to look forward to each time it showers the world with its bounty. To the rain, I know you didn't mean to do us harm. Or perhaps you gave us your warnings but we never heeded them.

Then, I'd like to make peace with the sun, whose fierceness I've always abhorred, whose presence I've always took for granted and whined about, and hid from. Perhaps I failed to recognize what life would be like if there was no sunshine. To the sun, thank you for the constancy, for being around even when I forgot to be grateful.

I'd also would like to make peace with Love. It is not your fault that you chose to be picky. It is not your fault that you never picked me. You will move on, sometimes in sheer joy, sometimes in sublime peace, sometimes in ultimate terror, sometimes in exquisite, unsurpassed pain. I will move on too.

And lastly, I'd like to make peace with myself. It is not my fault that I chose to love, even if Love did not choose to be returned.

Today, I will make peace with a lot of things. The beauty of the sunset lies in its brevity. An epiphany is knowledge seen in pure clarity. Clarity only lasts for a moment. And a moment is no longer a moment if it lasts.