The Grand Dream, Part 1

Initially appeared on doktorko.com 1/2/2005.

Being relatively new to the US and still not having acquired a taste for the brash culture and bland diet, my long-term goal at the present is to return to the Philippines within the next 6-7 years (i.e. as long as my J1 Visa permits). Whenever i make this declaration, i can almost HEAR the older-timers (that is, those who have been here longer - not necessarily my elders) rolling their eyes. "Bakit pa?" they ask in disbelief. "Ano bang meron 'dun?" Then they proceed to the litany of why the US is better than the RP: everything is so convenient, the standard of living is higher, the air is cleaner, blah-blah-blah. Of course, these points always give me pause; on the surface, they appear to be correct. But upon deeper examination, the arguments are fairly easy to deconstruct. Consider:

1. Convenience. Here in the US, almost any thing can be bought at any place at any time. What you can't find at your local Walmart, Target, or Costco, you can certainly buy online. Convenient - to a point. However, back home, what could be more convenient than giving the helper or driver a list then coming home to find your pantry neatly stocked? Sounds coņo, definitely, but i think the convenience of having someone to do something for you (don't complain - this creates jobs, after all) beats the convenience of buying something YOURSELF any day.

2. Standard of living. True, people here seem to have more things. That, however, is the proverbial tip of the iceberg. As i soon found to my dismay, the reason why people here have so many nice and shiny things is that they are all in DEBT. They take out loans with exorbitant rates for big houses and cool cars; they revolve huge sums of debts on their credit cards to buy the cute mini-ipods... and spend the rest of their natural lives paying off the lenders. The standard of living is higher BECAUSE PEOPLE LIVE ABOVE THEIR MEANS. They like living it up despite the cost. I daresay that if they lived within their salary brackets, they would have fewer things - but then that would make them less American (i.e. less bling), and we can't have that. The US itself is deep in debt to the tune of almost a trillion dollars and keeps flushing money down the drain with such noble causes as the occupation of Iraq. One day the debtors will come to collect from the indebted - and everything will rip apart at the seams.

3. Clean air. If only what you couldn't see couldn't kill you - but even though there are fewer smoke belchers here, the overall pollution is higher. And this is a nationwide thing. True, the RP has a lot of smog and such, but that's only in Metro Manila.

I could go on and on with my OWN litany... but i won't. 'Nuff said that there are more things for me at home than here. So what's the point of training abroad? Well... money.

The whole point was to short-circuit the financial low point of going through residency and establishing a medical practice (a process that could take anywhere from 5-10 years). At roughly $38k a year, i make around 2 million pesos every 12 months. This is while working 70-80 hours a week with 30-hour calls. In the meantime, my Filipino counterparts earn minimum wage while being run into the ground with scutwork from consultants who seem to relish bashing their residents' egos at every opportunity. The better deal seems obvious.

The POINT? Well, the way i figure it, i have to make at least $100k before going back home. At that point, i will place the money in a bank (or an investement vehicle), and earn 50k pesos every month IN INTEREST. That's money begetting money while i sit ON MY ASS. If everything goes according to plan, this should happen before i'm 40.

Then WHAT? Well, that's only the beginning.

The Grand Dream, Part 2

Initially appeared on doktorko.com 1/4/2005.

Of course, crunching the numbers makes me look like a greedy SOB, but the money is not the endpoint; it is the means to an end.

Like Peter Parker, i believe that with great power comes great responsiblity. To whom much is given, much is required and all that blah. MDs have a lot: we are blessed with natural gifts such as intelligence (memorizing Harrison's), physical endurance (staying awake through 48-hour days), and mental toughness (absorbing a consultant's beration without crying or fainting). Many of us (myself included) even come from the top economic brackets of the population. Being ahead of the pack this much only means that more is required of us: we, the most fortunate, must help those who have less in life.

Truth be told, this is nigh-impossible in the Philippines, where the medical system is all screwed up. Having been sucked dry by the exorbitant medical school tuitions, we proceed to residency training where we earn just enough for daily jeepney rides and food at the cafeteria (which the hospitals charge us for even though we serve them as - essentially - slaves). Afterwards, we work in a private hospital where we pay a small fortune to "buy into" the practice (through purchase of stocks or rights to practice). That's when we buckle down to the real work: seeing a small number of patients a day who ask for discounts at every turn (implying that the "rich" doctor can afford to lose a peso here and there), sacrificing quality time with family and friends TO EARN A PITTANCE. Then some idiot politicos try to ram a malpractice bill penalizing doctors for committing any mistakes (including honest ones) through Congress so they can make big bucks through the malpractice insurance companies that they own.

Somewhere along the way, between trying to stay afloat and trying to earn a decent living for oneself and family, the desire to help one's fellow man gets lost. Survival is, after all, the primal instinct (procreation being the second primal instinct). And forced to choose between WORKING as a doctor to make money and PRACTICING as a doctor to help others, it's now wonder that the harassed MD most often chooses the former.

I COULD harp on how the government could give us more support, about how they could start investing in the intellectual capital that will someday turn our nation a profit. And well they should. But i was never one to look to somebody else to fix the problem. I came up with my own plan.

Consider: short-circuiting the whole process of trying to establish one's practice (like i detailed the last time). Consider again: earning an executive's salary on interest alone. The possibilities! You would be able to practice medicine without any regard for how much you were making. You would be able to charge indigents nothing and not feel remorse at not earning enough to pay your kid's next tuition. Any money made through the practice would be a bonus. Of course, this doesn't prevent you from charging rich people (and politicos) a premium, but that's beside the point.

THAT is the grand dream; to make a way for the medical practice to be selfless again. To not need to look at patients and see peso signs. To help the helpless and tend to those who have been otherwise abandoned. To become once again the noble healers that we were always destined to be.

Deconstructions, 1

Initially appeared on doktorko.com 1/10/2005.

This is a post that circulated around the web early last year. It's been belabored to death on other forums already, but i'd like to put in my two cents' worth. Analysis to follow. Enjoy!

'The Philippines is a nation of starstruck ignoramuses'
by Don Pedero
Philippine Star 29 October 2000


Last July 23, I wrote about Nasty (short for Anastacio), a balikbayan from Los Angeles, who, while vacationing in Manila, had nothing to say but negative comments about the Philippines and the Filipinos. The article elicited a deluge of comments from our readers. Though some agreed with his curt observations, most were enraged at the repulsive way he acted and whined.

For me, he was the classic epitome of the "crow perched on a carabao," thinking and acting nauseatingly superior just because he has become an American citizen, inequitably comparing everything here to how they are in the first world. I was particularly irked by his repulsive "know it all" attitude and peeved no end by his irritating Waray-American twang.

Those who have not read that article may access philstar.com and click archives, then select July 23 and click Lifestyle. The article is entitled "Little Brown Americans." As a backgrounder, here is an excerpt:

The next day, I took them on a little city tour and accompanied them to do extra shopping at the duty-free shop. They were to leave two days later for their respective provinces (Randy is from Pampanga, Nasty, from Samar).

"God, ang dilem-dilem naman ditow (it is so dark here)!" screamed Nasty in his characteristic Taglish slang, "At ang inet-inet pa (and so warm)!

* * *

All throughout the day, Nasty complained about everything. He griped that all Filipinos he encountered were dense and inefficient (I hope that didn't include me!); that the traffic was horrendous and drivers "drove like they were late for their funerals"; that the pollution from the smoke-belching vehicles was irritating his dainty, surgically-pinched nose.

He was disgusted that water closets didn't work; horrified that there was no toilet paper in public toilets ("God, how do you people do it?" he bewailed); petrified by street children begging while soaking wet in the rain ("Where are the parents of these kids?" he nagged).

He moaned about the proliferation of slums, people crossing the superhighways ("There should be underground or overhead walkways for pedestrians!" he demanded), the potholes on the streets, the disgusting garbage and filth all over the city, and the annoying floods! And all these he observed in just one day!

Weeks after the publication of the article, I took Nasty's silence to mean that of contempt and anger. I must admit that I didn't care because I was really turned off by his arrogance. The good news is, Nasty has finally decided to break his silence and give us his side, loaded with a big piece of his mind. The bad news is, he hits more sensitive chords and it stings.

* * *

Nasty's E-Mail
Dear Dero,

My Zen master says, "Never fight fire with fire." So, I sat in a lotus position, imbibed the ethereal qualities of cool mountain water and stoically resisted the temptation of answering back to defend myself in rebuttal of your article. I kept quiet while you and your readers had a charlatan holiday, dissecting and fanning sarcasm on my every comment about your country and your people.

I am not mad at you for writing that piece. I was never upset at any point, even after your readers from all over the world e-mailed in their two-cents' worth. In fact, I found it rather amusing and carnival-like.

I even felt happy that people still came to the defense of your Philippines!

If you noticed, I now refer to the Philippines and Filipinos as your country and your people. Every time I went back there for vacation, my Filipino-ness always took the better of me (blame those damn green mangoes smothered with bagoong!) and made me forget that I am, in all reality, what you aptly called a "Little Brown American." I have come to terms with my own identity- I am, after all, an American citizen carrying an American passport!

What precipitated my quick decision to sever my ties with your country (aside from your ***** of an article) were the Abu Sayyaf abductions (que barbaridad!), the Payatas-like downslide of the peso (eat your hearts out, I earn sweet American dollars!), the "devoid of conscience" graft and corruption in your government (this has gone on for the longest time-how shameful!), and lately, the stupid "Juetengate" and juicy but enraging "Boracay" mansion gossips. With all these, who would be proud to be a Filipino? Besides, to tell you frankly, those Erap jokes are no longer funny- they are pass?and leave a bad taste in the mouth and heart. No Apology If I sounded brash and insensitive with the way I threw my comments, well, I cannot do any-thing about that because that is the way I am, and I offer no apology. Here, in America, you have to tell it like it is or you'll never be taken seriously. I have learned to drop my "Pinoy sugarcoating" because out here, you get nothing done if you are meek and sweet and pa-api. Hindi puwede mag-Anita Linda dito!

When I commented about your pollution, street children mendicants, slums,potholes, toilets that don't work, garbage, floods, and most of all, the Pinoys' chronic lack of discipline, I was merely putting into words what I saw. I can't blame your being blind about your country's situation.

My Zen master says, "One cannot easily see the dirt in one's eye." I am sure though that you are aware of those sordid details, but have grown accustomed to them (like most Manile?s have). All the complaints I aired may have hurt your pride but what I wanted you to realize is this: The things I pointed out are all symptoms of a failing, falling nation!

Suffering A National Karma?

Could yours be a country cursed with a huge national karmic debt? It could be payback time, you know. Look back into your history, look deep inside your hearts-what could you have done as a nation to deserve this fiasco you are in today?

What you are faced with didn't just happen overnight-it developed and grew into a monster in the course of time. Deeply imbedded in the psyche of the Filipino is the amalgamation of the characters and events that have impacted your lives - Dona Victorina, Dona Concepcion, poor Sisa as well the other hilarious and tragic characters of Dr. Jose Rizal... Stonehill...the notorious gangsters immortalized by your Filipino movies like Asiong Salonga (hmmm!), et al...the killers in your (I thought they'd never end!) massacre movies...those cheap, appalling titles of your movies...those staged "religious miracles" that your naive masses believed...family men with pushy queridas (mistresses)...your crooked politicians, undependable police officers and greedy customs collectors...your bribe-hungry court judges...Imeldific, gloriously smiling and crying at the same time, bejeweled. (How very Fellini!)

What you are is the sum total of your history, your heritage and culture,your education, the crap that your press sensationalizes, the bad icons that your movies glorify, the artificial values your advertising extols, the bad examples your leaders and role models project. What you feed your country's mind is what it becomes. You have become the ugly monster that you've created. You are now crying all the tears your sickeningly sentimental movies wailed out for years and years! Your Biggest Fault If there is one thing that comes to mind, I think your biggest fault would be your individual greed. "Ako muna!" seems to be the national mantra. The trouble is, very few people think for the common good in a deplorable "to each his own kurakot" festival. Coupled by your crab mentality of pushing down others, this can be fatal. You think barangay, not national. Hello, everybody else around the world is thinking global! Europe is unshackling her national boundaries while you are building fences around your nipa huts.

Do yourselves a favor and look at your nation as a ship. All of you are in it and it is sinking! Realize your oneness-what hurts your brother hurts you, too. Think about the future of your children and the succeeding generations, and do something about it quick before your poor little banca plunges forever into the irretrievable depths of despair.

Star-Struck Nation

You are a nation of star-struck ignoramuses. You are easily awed by your movie stars who are usually nothing but uneducated, aquiline-nosed and light-skinned ******** picked up from some gutter somewhere. I have seen what these artistas illusionadas can get away with. They just flash their capped-tooth smiles and policemen let them get away with traffic violations; they bat their false eyelashes and customs officers impose no duty on their suspicious balikbayan boxes.

Worst of all, with the Filipino movie industry taking a nosedive, hordes of actors and show personalities went into politics. It is, as they say, the next best "racket"-there is more money to be made in the politicking business than in show business! (And what is this I hear that in the coming elections, more are jumping into the arena? Mag-hara-kiri na kayo!) How can you expect these comedians and actors, who only know how to take directions from their directors, to direct your nation? For them,politics will just be an "act". No big surprise here, for they are mere actors with no original scripts to speak, no original visions to share. So what can you expect but a government that is a comedy of errors. Serves you and your star- struck nation right!

My Zen master says, "Give unto Caesar what is due to Caesar, but keep Charlie Chaplin on the silver screen to make us laugh." To survive, you must teach your citizenry to say no to three things - no to drugs, no to stealing and graft and corruption, and no to artistas in politics. I hope you've learned your lesson by now. (Yours is the only country where Mexican soap stars are received like royalty in the presidential palace. How shoddy! God forbid-Fernando Carrillo might end up being your next president. At least he has great abs and doesn't wobble like a penguin when he walks!)

For those artistas who honestly believe that they can make a positive difference in the Filipino masses' life, they must first study law, business and public administration, and immerse themselves in the life and passion of Mother Teresa. Politics is not an art for dilettante artistas to dabble in. It is called "Political Science," hello?!

Educate Your Masses

Educate the masses - especially your electorate. What you need is an intelligent vote aside from, of course, intelligent candidates. The University of San Carlos in Cebu City, founded in 1595, and the University of Santo Tomas in Manila, established in 1611, are the oldest universities in Asia, and are even older than Harvard. But the standard of Pinoy education has deteriorated so much that the Philippines ranks among the poorest in the educational hierarchy of Asia.

Education, education, education-that's what you need in this age of information, information, information.

If all your social, religious and political sectors don't sit down now and decide to take the Right Way, the Philippines and your children's children will be grand losers in the worldwide rush to the future. Education is one sure way to salvation. Teach what is right, good, beautiful and beneficial.

Downplay all negativity if you cannot eliminate it altogether.

The Ideal President

I've got news for you. (As if you didn't already know.) No matter whom you put up there as your leader or president, it will be the same banana. Even a holy man can turn into another J. E. (Judas Escariot) for a few pieces of silver. Kumpares, alalays, relatives and cronies will encrust like flies and maggots on his cordon sanitaire. And it will be the same despicable "Sa amin na 'to!" hullabaloo all over again.

Take an advice from Aling Epang: "Pumili ng matanda, mayaman, mabait, at madaling mamatay." Get a president who is old - so that he is full of wisdom, rich - so he won't need to steal more money, goodhearted - so he will render heartfelt service to his people, and is in the sunset of his life - so that he will think of nothing but gaining good points to present when he meets his Creator. And may I add: At iisa lang ang pamilya! This is, of course, asking for the moon. Just pray fervently for an intelligent leader with a pure heart who genuinely loves the common tao!

Magpakatotoo Kayo! Wake up and look at the real you. Enough with looking at your reflection in glorious, self-embellishing mirrors. The tropical sun can play tricks, you know. Do not wait for darkness to fall before you take that much-needed long, hard look at your real situation. Magpakatotoo kayo, ano? This isn't a wake-up call-it is the final alarm!

Save the ship while you still can. Don't wait till your people have no more dreams left to hang on to, no more hope to sustain their broken spirits. I came home, spent my penny-pinched savings so that even in the minutest way I could help your bruised economy. Your politicians sit on their fat,farting butts and get balatos (kuno!) in the millions. Receivers are as guilty as the givers. Now, tell me, who is really nasty?

I Have Made My Decision; So Should You.

My Zen master says, "Life is all about decisions, not choices." I have made a decision which I know will be very hard for me to keep- You will never hear from me again (not in this vein) and I will not even think of visiting or buwisiting your Manila ever. This is my way of letting you know that I have given up on you. Bahala na kayo! Only you can help yourselves because at the stage you are in, nobody would want to help you. My Zen master says, "You have to fall to learn to rise again." How much lower do you want to go?

Anyway, regarding the Philippines as a tourist destination, you have a lot of cleaning up and face-lifting to do before foreigners would dare go to your islands again. The Abu Sayyaf episode has done your tourism industry more damage than you could ever imagine, and it will take a long time before the world forgets. (By the way, your tourism projects are lusterless and have no global impact. If you want real business, spruce up your infrastructure and do aggressive marketing on the World Wide Web!)

Of course, I would gladly reverse my decision if someone offered me exclusive lordship over lotto, bingo, jueteng, pintakasi and the jai alai.Think about it: this will be to your advantage because I never give tong or blood commission to anyone! (If only your president used the millions he received from those gambling lords to build homes for the masses, you wouldn't have any more squatters. Huling hirit: defrost those Marcos billions, pay off some debt, place the rest in high-yield investments, feed your hungry, and spread bounty and joy to every Filipino! Are you stupid or what? - That's your money sucked from the blood of your people!)

I have made my decision, now make yours. I would hate for the day to come when I'd have to say, "I told you so!" Good luck! (You need it.)

An ex-Filipino,

J. Anastasio "Nasty"

P. S. My Zen master says, "Vox populi is not always the voice of God."

P. P. S. Come over to L.A and I'll show you a great time!

P. P. P. S. Our friend Randy says hello! We will be going to Vancouver to feast our eyes on the colors of autumn. Wish you could join us.

P. P. P. P. S. The new Miss America, Angela Perez Baraquio, is of Filipino ancestry. Dero, her parents hail from Pangasinan just like you! But keep in mind that she is an American (in case some wise fools over there claim her to be Filipino like they always do whenever someone becomes successful).

Wait for the girl to say it- don't put words in her mouth!

P. P. P. P. P. S. Mabuhay kayo (SANA)!

P. P. P. P. P. P. S. Sa totoo lang, MAGDUSA KAYONG LAHAT! (Don't you just love my Waray-Kano accent?) He-he-he!

- Same

* * *

My Short Reply

Dear Nasty,

Thanks for your e-mail. I swear you sort of stole the words from right under my tongue. Now, I am utterly speechless.

Send my regards to Randy. Wishing you the best!

On Gmail

Initially appeared on doktorko.com 1/18/2005.

I was never really one to hop on the bandwagon. My cellphone was always three models behind the current craze, i never played any MMOG (starcraft doesn't count), and i adamantly refused to open a friendster or myspace account on the grounds that it was too "bakya." I had heard about gmail before and had an inkling that it was "the next big thing," but i never had any interest in finding out more because it seemed like just another fad. Imagine - people paying thousands of dollars on ebay to get a gmail account?! Almost as crazy as thousands of dollars for the Virgin-Mary-Grilled-Cheese-Sandwich, but not quite.

Anyway - my kuya sent me a gmail invite the other day, and having nothing better to do, i googled it (hmmm - is google turning into the new microsoft?) and found some reviews raving about the program. Which i though was weird; email is such a basic thing - how much tweaking can people do, and how great can it actually be? Out of curiosity, i decided to follow the link and open my own account.

Now, i most definitely will not be raving about how great gmail is, because 1. i'm not the raving type, and 2. i'm not being paid. What i will say is this: it's the fastest web-based email that i've used ever, bar-none; i had been using mail.com for a while, and while it gave me a doctor.com address and was decently fast, the speed is nothing compared to gmail (think PC-XT vs. pentium 4). While the GUI will need more work in the days to come (it's still in beta, after all), it is very functional and probably has near-infinite possibilities for the power user. 1gb worth of storage space, multiple ways to file your mail, and the ability to follow threads by subject and sender - pretty amazing stuff. Seems like nothing, but like one review i read said, once you start using it, you won't know how you got along without it.

Check My Lifestyle - Please!

Initially appeared on doktorko.com 3/5/2005.

This week the BIR announced that it would conduct "lifestyle checks" on MDs working in the top hospitals in the RP. In other words, it wants to ferret out those who under-declare their incomes in order to generate bigger profits that will fund their posh lifestyles. Here are a few links (apologies; you'll have to cut and paste onto your browser):

http://news.inq7.net/opinion/index.php?index=4&story;_id=27352

http://news.inq7.net/opinion/index.php?index=1&story;_id=27349

Don't you just love it when people defend themselves by pointing fingers? It almost sounds like Bin Laden claiming innocence because Hitler killed more people. IMHO, doing so is tragic and just downright stupid. "Why doesn't the BIR look at big business, politicos, and other professions?" [paraphrased] - whines one MD. Well, isn't the proof of innocence the best defense? We love it when congressmen are investigated - because we just KNOW that they're dishonest. Corollary: if we OURSELVES are clean, law-abiding citizens, why should we loathe showing our books to the authorities? It boggles the mind.

Since when has fiscal transparency become unjust? Some MDs are now crying foul, gnashing their teeth, and protesting at the top of their lungs about how doctors are being demonized. The malpractice bill was the first salvo, they claim; this will be the death blow.

Frankly, this is LIGHT YEARS away from that idiotic malpractice bill, which implies that many (if not most or even all) doctors are loose cannons - incompetent, half-trained buffoons just waiting for the proper opportunity to kill their patients. Now THAT is dangerous, simply because it undermines and second-guesses doctors' abilities and makes clinical judgement subject to unfair and misinformed scrutiny by laypersons. Doctors' competence should be judged by their professional peers (i.e. those who understand the real issues involved) - period. All doctors make mistakes but not all mistakes should be penalized.

In contrast, lifestyle checks do not call competence into question, but rather INTEGRITY. Given all the heat our profession has been under recently, i would have thought that we doctors would be falling all over ourselves at the chance to prove our honesty - not fighting tooth and nail to keep our sources of wealth hidden and therefore questionable. I have no qualms about anyone questioning MY integrity (although i admit that it would throw me off at first), because i know that it will remain untarnished through any investigation. But these people who refuse... Jeez, WHAT ARE YOU HIDING?!

Someone claimed that this would lead to the eventual demise (i.e. serve as "the fatal blow") of the profession in the RP. And why, pray tell, is that? Because prospective MDs know that they WON'T be able to make a DISHONEST living??? I sincerely hope that's not what you meant, kind sir, because if it is, then it says more about you than it does about the profession. True, young minds DO need inspiration, but wouldn't it be MORE inspiring to show that we are law-abiding citizens who have merely been unfairly singled out? Wouldn't it be better to show the whole world that we have NOTHING to hide? That we have only been unfairly and unjustly accused of wrong?

Having the medical profession acquiesce to the lifestyle check opens the door to the investigation of other professions (if the doctors can do it, why can't the lawyers? or the actors? or even - gasp! - the politicians?). It lets the tax evaders know that they can't keep hiding forever. It gives us doctors a chance to lead the way, to show that we are not as haughty as other people think. More importantly, it blasts through the stereotype of rich people not wanting to be accountable, and restores confidence that we have - despite some claims to the contrary - always been (and always will be) a noble profession. If not the noblest.

And refusing to be fiscally transparent? THAT would be the fatal blow.

WORST of all, it would be self-inflicted.

Healing

Initially appeared on doktorko.com 3/12/2005.

Last week i took care of a morose, elderly male with T12 paraplegia from a spinal tumor as well as FAR ADVANCED Coronary Artery Disease. Seriously - all his major coronaries were pretty much scarred up, with precious little more than trickles of blood squeezing through. Obviously, he needed a Bypass. Problem was, he didn't want it.

Fine; he's old and high-risk anyway. Maximize medical management, tweak his other systems, and send him home. So i went to his room and went through the usual rigmarole.

Any more chest pain? No.

How about shortness of breath? No.

Belly pain? Nausea? Vomiting? No. No. No.

And so on and so forth.

I don't know what possessed me, but after running through a full review of systems, i just looked at him and quietly asked: Well, how are you doing overall? How do you feel?

Deep sigh. Not... too good.

And just like that, he broke down. Apparently, he had lost his parents at a young age. Later on, his wife died. Last November, his daughter passed away. Everyone he ever loved had been systematically taken away with no rhyme or reason.

His eyes watered over but his voice remained firm; this was a man who was used to keeping his pain to himself.

Silence. Then i say: i'm sorry. You probably don't know me from Adam.

Another sigh. It's just that no one's ever asked me how i FEEL.

Well eventually, i got the name of a close friend of his who just happened to work in the Heart Center, extracted her number from the operator, called her up, and asked her to please come up to see him. She happily agreed.

Later that night, when i dropped by to check up on him, he was GLOWING - blocked arteries and all.

We changed over the next day, so i never knew how his situation turned out. In all probability, he got a couple of prescriptions and went home to wait for the Big One.

In the final analysis though, it doesn't even matter. Because even though we didn't fix his coronaries, i'm sure we fixed his heart.

First World Medicine

Initially appeared on doktorko.com 3/12/2005.

Three patients on my list:

1. A middle-aged male who came in because of an INTENTIONAL multiple drug overdose; had Multiple Organ Dysfunction Syndrome, was admitted to the ICU, underwent continuous hemodialysis for a more than a week, now SIGNIFICANTLY improved. We're setting him up for outpatient rehab, but from the look of things, he'll probably get back on junk right after discharge. Incidentally, he slaps his mom around when she won't give him money for drugs.

2. A middle-aged male who killed his liver with beer, STILL doesn't want to quit drinking despite having end-stage liver disease, came in with ascites, who ALSO has hepatorenal syndrome. Now we're talking about transhepatic shunts, million-dollar medicines, dialysis, and maybe even a liver transplant just to keep him alive.

3. An elderly female who has end-stage emphysema, continues to smoke DESPITE all medical advice to the contrary, COMPLAINS that because she isn't getting the right treatment, she isn't getting better. She wants all the free samples, and home oxygen so she can keep on doing what she wants at home.

What's wrong with this picture? Call me a cynic, but i've seen too many people DIE back home for lack of enough money to buy even FIRST-GENERATION (i.e. low-level) antibiotics. Organ transplants, regular dialysis sessions, and STAT interventions were things we only read about in books. Here, i see people doing the dumbest things because they know that their FIRST-RATE medical system has a safety net for people JUST LIKE THEM.

Where is the justice? What is the point of moving heaven and earth just to keep these "people" alive? They made their choices and made their lives a living hell. If that's what they want, maybe we should just let them BURN.

Sometimes it takes a superhuman effort NOT to get jaded.

The "Animal" Story

Initially appeared on doktorko.com 3/12/2005.

Some people, despite being brilliant, are still incredibly stupid.

Case in point: back in Medical School, i did a presentation on DYSTOCIA (abnormal labor). I lifted the history off a delivery that i had handled, whipped up some slides, cooked up a spiel, and dished it out to a room full of clerks, one OB consultant, and one first-year OB Resident.

After presenting the H&P;, i was getting into my groove; warming up to the topic, i started my discussion by asking the room, "So what do we know about this ANIMAL called DYSTOCIA?"

The consultant's face darkened. "What did you say?"

Grinning widely at my use of creative metaphor, i repeated what i said.

Consultant, in a gravelly voice: "What ANIMAL?"

I was mystified. "This... animal... DYSTOCIA. Never mind." I then proceeded with the brief discussion that i had outlined the night before. Not a brilliant presentation, but in my opinion, at least halfway adequate.

All this time however, the consultant's face contorted with rage. He opened his mouth and began bombarding me with questions; each query i answered would be confronted with a new one, on and on, at times going off-topic and beyond the scope of my presentation until i had nothing else to say. Then he would let me proceed to my next bullet point - and REPEAT the process. I countered gamely, never losing my grin with each answer i gave (which seemed to infuriate him even more), but of course my meager knowledge was a booger compared to his mental cyclopedia and in the end i was spent and defeated.

At the end of my presentation, he stood up in a huff, and with the righteous indignation of an elephant who has just squashed a gnat, stormed out of the room. The OB Resident shot me a nasty glance and, sniveling, trotted off after her master. I, however, had no idea what just happened.

Light was shed on the matter few days later, when i noticed that i was getting shoddier-than-usual treatment from the OB Residents, who told me in no uncertain terms that i should APOLOGIZE. For what, pray tell? For demeaning a patient and calling her an animal.

Wha-a-a-a-a-t?! WHO called WHO a WHAT?

Clerk chong (that's me) called the patient an animal.

Shortly thereafter, the Clerks' monitor called a meeting to drop not-so-subtle hints about how a certain clerk had made unethical remarks recently and offended the sensibilities of a MORALLY-UPRIGHT consultant. Well, during the meeting i owned up to saying what i said. To which she concluded that i SHOULD go and apologize. To which i replied that the consultant heard wrong and was probably deaf. The room full of clerks agreed and confirmed what i had actually said.

The Resident looked confused. But... you should STILL go and apologize.

Which made absolutely no sense. Not being a subscriber to nonsensical theories, i left the issue for dead and never did become contrite and apologize for something i didn't do. In retrospect, that was probably the reason why they treated me shoddily for the rest of the year, LOL.

It's just incredible that someone who has reached a professional level so lofty as to actually become a GYNECOLOGIC ONCOLOGIST could misunderstand such a basic metaphor. I have the greatest respect for the man's MEDICAL talents (he's a great surgeon with an EXCELLENT knowledge base), but as far as his LITERACY is concerned, he doesn't know beans. In other words, he's just a dumb $h!thead who ab/used his stature to knock down a lowly subordinate because he couldn't understand what he said.

Riddle me this: how could any half-brained person construe what i said to mean that the patient was an animal?

Hayop talaga.

Schwang-Schwang

Initially appeared on doktorko.com 3/12/2005.

Despite: 1. studying in private schools my whole life, 2. watching American movies and TV programming my whole life, and 3. having worked in the US for over eight months now, i STILL haven't gotten my nasal twang (derided as "scwhang-schwang" by some), down pat. My accent still quite frequently lapses into those weird low-timbred vowels, espcially when faced with the dreaded letter A (i.e. UHPOL vs. EPOL). It's at its worst when i'm post-call - i begin to lose my grip on my tongue and start sounding like those teachers we used to poke fun at in high school.

Early on i learned that i needed to speak English like the Americans do - i'm a doctor after all and need to make myself understood with crystalline clarity - but the moment i leave the hospital and start spending time with my wife and friends, the accent slips and you'd swear i never spoke a word of English in my life. Not exactly JOLOGS, but i try my best. Call me weird, but i just think it's unnatural to speak in a foreign tongue. Isn't that why they call it FOREIGN?

Which is why it p!sses me off so much when i hear kababayans speak FILIPINO in an AMERICAN accent. It just sounds extremely ABnormal.

Consider: how can you have lived in the Philippines your whole life, spoken _____ (insert local language here, but i myself speak TAGALOG/FILIPINO) your whole life, then move to the States, speak English for 1 or 2 years, then seem to COMPLETELY just lose the ability to speak _____ correctly?

I've had a couple of foreign-born-or-raised friends (wow, imported!) back home who tried their darndest best to speak Tagalog; true, many never got beyond the point of basic intelligibility, but some actually got quite good at it. Interestingly enough, regardless of how well they spoke Tagalog (even if they retained a slight schwang), they could always drop effortlessly back into their native English, and you'd think they never spoke any other language.

In fact, i've had a couple of bilingual friends who were brought up to speak BOTH languages. Enviably, they spoke English and Tagalog with nary a misstep. A few minor slips here (mostly with vocabulary) and there, but not much more than the usual; overall OK.

So why is it that many people I've met here who are so OBVIOUSLY Filipino who MANGLE the English language left and right with the hard tongue (matigas na dila) PERSIST in speaking English, claiming to have lost the ability to "think" in Tagalog? Why do they speak to their kabayans in the alien tongue? Worst of all, why do throw their schwangs around when they return to the motherland, as if it somehow makes them transcendent over their brown-skinned countrymen?

It's a mystery. Is it a lack of aptitude (i.e. KATANGAHAN) for retaining more than one language? Is it the pressure of living in a foreign land? Or is it colonial mentality - thinking single-mindedly that everything American (including the language) is just downright better than anything Filipino?

Whatever it is, it's just plain STUPID.

Raving about FireFox

Initially appeared on doktorko.com 4/7/2005.

I never really encountered any major problems with Internet Explorer. I've had a couple of glitches here and there - notably with MapQuest after installing SP2, where the browser would just mysteriously crash - but otherwise nothing major to gripe about. IE is ubiquitous after all, and i thought that it was just something i had to live with.

Recently, i've been getting more and more annoyed with Microsoft - which is a whole different story in itself. Suffice to say that yesterday i decided to replace most - if not all - of my MS-based desktop software with open-source alternatives. MS Office has become OpenOffice.org. No way i'm changing to Windows to Linux, but IE is definitely up on the chopping block.

Googling "alternative browsers," i managed to come up with a couple of good leads. Among these, one called FireFox seemed to be the most promising. Integrated pop-up blocker and search bar, stripped-down interface, and a low profile which translates to it not being a target for spyware/adware and virus makers (i.e. increased security). With smug thoughts of me shafting Microsoft for a change, i went ahead and downloaded the browser - and changed the way i browse the internet forever.

As i said, some idiosyncrasies of IE i've learned to live with: the occasional crash here and there, the constant annoying pop-up ads, and the slow load times. Before FireFox, i never knew there was an alternative.

I've been using the new browser for only a couple of hours now, so i can't really say much about its stability, but i CAN say that i've had no crashes with the usual websites i go to (yes, including MapQuest!). Also, even with the BASIC configuration, it is already a little faster than IE. The pop-up blocker works pretty well, and the tabbed browsing makes shifting between windows easier than i ever thought possible.

Here's the big thing: while googling for some FireFox tweaks (you can increase functionality with "extensions" and even apply themes), i came across the program FireTune, which "tunes-up" the browser according to your particular system and internet connection. The claim is that it speeds up browsing. Prior to downloading/running the program, i wondered just how fast it could get.

OMG, it is LIGHTNING FAST! I never knew surfing the internet could be this fluid. Pages load in 1-2 seconds; the fact that i have a broadband connection might be partly responsible, but i NEVER EVEN THOUGHT THIS WAS POSSIBLE WITH IE. I rarely use the word, but this is just AWESOME!

Anyone with broadband connection and a reasonably fast computer who wants to amp up their browsing experience, do yourself a favor and download Firefox. After loading that up, download FireTune, run it, and blaze down the information superhighway.

FireFox: http://www.mozilla.org/products/firefox/

FireTune: http://fileforum.betanews.com/download/1111041458/1

New Testament

Initially appeared on doktorko.com 4/25/2005.

Last night i downloaded a tweak for my Firefox browser called "StumbleUpon." Essentially, you click the icon and it links your browser to a top-rated website, based on the personal preferences that you tick off after loading it up for the first time.

Anyway, i just HAD to post this link. It's a hilarious piece of independent film work that is either damnably blasphemous or brilliantly incisive - depending on how you look at it. You COULD take it at face value and say that it parodies The Son of God, but you COULD also look deeper and say that it parodies the COMMERCIALIZATION of the The Christ (i.e. The Passion and those long-winded TV Televangelists). Either way, if you're religiously conservative or faint of heart, don't even bother taking a look at it. You have been WARNED.

The link: http://www.undergroundfilm.org/films/viewer.tcl?wid=1000968&oftype;=lar

I ASSUME that it's better if you have a broadband internet connection and have the latest version of Quicktime installed, but i can't be sure since i have both.

Calling All Filipino Doctors

Initially appeared on doktorko.com 5/7/2005.

Crisis and Hope for the Medical Profession
(Invitation to May 28 Meet)
By Willie T. Ong, MD

“Never in history have thousands of Filipino doctors given up their profession to become nurses in a foreign land, ” laments Dr. Tony Acosta, the 81 year old and eldest official of the Department of Health.

Never in the history of the medical profession has there been a crisis of this proportion. “It’s a medical apocalypse,” says Dr. Bu Castro, president of the Philippine Medical Association. “It’s not brain drain anymore, it’s brain hemorrhage,” says UP Vice Chancellor for Research, Dr. Jaime Galvez Tan.

The facts are undeniable. PMA estimates that 12,000 doctors have and are taking up nursing. Many hospitals are on the brink of closure from lack of resident doctors. “Half of our class are deferring medical practice and going into other more lucrative businesses,” says Dr. Gan Montenegro, the president of FEU Class 2003.

If you want to assure yourselves that more doctors are coming in, think again. Fact: the enrollments in medical schools are down 20%. The youth do not aspire to become doctors anymore. The issue is not just brain drain. But the issue of the lost glory, the fall from grace, and the end of the golden age for Philippine medicine.

The conclusions are frightening. Doctors are giving up on the profession in droves. New applicants are not coming in through the medical schools. Who will care for Juan De La Cruz?

And need we even mention, “medical malpractice bill.” A crisis in its own right. As Senator Richard Gordon comments, “The solution to the medical crisis must come from doctors themselves.” These bills have arisen from public perception of doctors, which can partly be blamed on the profession itself. Apathy, lack of concern, and inner squabbling can destroy any profession.

Moreover, there is a third looming crisis: the conflict of interests between the senior doctors and young doctors. Young doctors, a silent majority, are beset with obstacles to practice imposed by senior doctors. For example, before one can practice in a hospital, there is the prerequisite of expensive stocks. If you have the money, you must still pass stringent requirements that may border on the bosses’ whims. And there’s this turf-war to get control over patient referrals and admissions. Is it any wonder that young doctors, helpless and frustrated, quickly leave the country?

These crises have hit the profession at its heart, now bleeding, and near collapse. Who is to blame? And can doctors find their way back? It’s easy to blame the government and the medical societies, but we too share the blame. In reality, doctors can either be part of the problem or part of the solution.

Our group wants to be part of the solution. We cannot stand idly by as the profession goes down the drain. And thus we formed MIND: an advocacy and support group for doctors. Our goal is to help other doctors to the best of our abilities. For in keeping doctors here, we believe we are helping care for patients as well.

On May 28, 2005, we are asking you to come to an informal meeting where you will find other like-minded colleagues, doctors who have not given up on the profession. Let me introduce you to a number of our supporters.

Dr. Philip Cruz started his Give-a-life foundation when he was a pediatric resident. Philip has one single-minded goal: not to let a Filipino child die if he can help it. Give-a-life foundation has since given away tens of millions worth of medicines and equipments to 12 hospitals all over the country.

Dr. Amiel De La Cruz has devoted several years seeing charity patients at Our Lady of Peace Hospital, a hospital founded by Fr. James Reuter and Ramon Magsaysay Awardee Sr. Eva Maamo. Amiel started as a volunteer, and has become the Assistant Medical Director of this “Hospital for the Poor.”

Dr. Mike Muin and Jojo Ferrer, both based abroad, have started Pinoy MD in 2003, a website for Filipino doctors. This website has since connected 750 Filipino doctors from across the globe in the spirit of helping and camaraderie.

Dr. Robert Gan, a young and accomplished Filipino neurologist, is a supporter and part of the group’s think-tank. Dr. Gan’s research accomplishments (all published internationally) are truly phenomenal.

For my part, I have always wanted to help doctors ever since I wrote the first edition of the Medicine Blue Book in 1995 during my residency. I have also been the medical director of the Pasay Filipino Chinese Charity Health Center for 8 years, a center which has benefited thousands of indigent patients. I write these things not to boast, but only to inform you, our dear colleague, that we are serious in helping our fellow doctors and patients.

In our first meeting last March 2005, 40 doctors came. One doctor confided that she initially had plans of going abroad but “changed her mind” after hearing my talk. Since then, more than 20 core group of doctors have given their support.

I sincerely thank all those who have pledged their time and resources for our cause. I also thank the 120 doctors (and counting) who have trusted me with their cell phones and e-mail addresses to be updated on our cause. And finally, I thank God almighty, for giving the strength and the time to fulfill His mission for me.

We believe there is hope for the medical profession. There is a solution. And it must start from each one of us. Join us for our grand meeting on May 28, 2005. It’s free.

Why You Should Come:
1. This is just an informal dinner meeting. No commitments.
2. Catch up with old friends and meet new ones. You can network.
3. Air-conditioned venue doubles as medical museum with rare picture archives.
4. Two talks will be given by Dr. Willie T. Ong on (1) testmanship and (2) doctors’ issues and problems.
5. Free, signed 2005 edition of the Medicine Blue Book.
6. Dinner to be served by Verleo Catering.
7. No registration fees.

What: Informal meeting of doctors to talk about Philippine healthcare issues.
Where: 4th Floor, Sonlie Building, 2652 Taft Avenue, Pasay City (between LRT Libertad and EDSA station). Parking is available.
When: May 28, 2005, Saturday, 5 - 8 p.m.
How: If you or your friends would like to come, please text us your names. List of names will be given to building guard.
Who: Drs. Willie and Liza Ong (Cell: 0917-387-6750 & e-mail: willietong@netasia.net).

USMLE Stuff (Open Letters, 1)

Initially appeared on doktorko.com 5/10/2005.

Q: I'm about to take my step 1 this May 27, then step 2 ck and cs around early august. Hopefully I receive ecfmg certification around late october then take step 3 by november. I aim to make it to the programs' deadline of dec. 31 (for step 3 results).

Have you already taken step 3? How does it go about exactly? I've read information about it on fsmb and usmle, but frankly its all still fuzzy to me. How did you go about preparing for it? does someone like me who hasn't taken up residency yet have a chance to pass?

I'm looking for commendable IM residency programs in Florida (Orlando, Tampa or Jacksonville). Do you have any recommendations?

A: good luck on your upcoming exams. madali lang yan. if you passed your local boards, the usmle should be a snap. just remember to study 1. preventive medicine (e.g. what screening tests do we give to an otherwise asymptomatic person just based on risk factors?), and 2. the weird diseases that we never see but are extremely common in the states such as sicke cell anemia and idiopathic thrombocytopenic purpura.

regarding step 3, the websites are pretty nebulous. go to a forum site such as www.usmle.net. you will be able to dig up good pieces of advice as well as find a support group you can sound off to if you're so inclined. what i can tell you is this: first you have to apply to take the step 3 (i think you have to prove that you passed steps 1 and 2, though) in a certain state. they each have their own fee and their own requirements. the easiest one to apply to is connecticut. don't worry, you can take the actual test anywhere you want - it's just that one state who will process your papers.

i found the actual step 3 tremendously difficult, mainly because i arrogantly thought that my 1 year of moonlighting experience gave me enough of a clinical acumen to answer clinical questions. focus on outpatient stuff and the things i mentioned above. use that knowledge to top off your stocked knowledge from the local boards and steps 1 and 2 and you should pass with flying colors.

the exam is divided into 2: the first part is a multiple-choice-type-thing much like steps 1 and 2. the second part is a clinical exam where you are given a case you have to manage (like an adventure game).

don't worry about step 3 right now. focus on getting smarter than you already are so you can blast through steps 1 and 2 and make your resume a testament to your brilliance.

i do not know which programs are top-rated. try googling "best residency programs" or "best hospitals" and you should get a rough idea of where you want to go. but take note that your "fit" with a program doesn't hinge on its prestige but on a number of intangible factors (which i can't name precisely because they are intangible). take into account the location (i don't think you'd want to work in downtown brooklyn or the bronx), cost of living, etc. btw, i've heard terrible things about florida. people here say you can't find a good doctor over there. and i think you have to be fairly fluent in spanish because they have large hispanic population.

speaking of spanish, if you can learn it while you're still in the rp, that would be a big plus.

USMLE Stuff (Open Letters, 2)

Initially appeared on doktorko.com 5/10/2005.

Q: Planning to cram 4 exams in one year really is a pain. Try as i might to concentrate on step 1 (which i will FINALLY take on may 27) my mind keeps on crossing the bridge. But anyway, would 2 months be enough to study step 2 ck? some people say its a lot like step1, and taking it as soon as you finish the latter is the key.

I have no idea how to prepare for step 3. My clinical acumen is as rusty as a nail in the sea. bahala na siguro.

BTW, how did you get your letters of recommendation? Did you approach your clinicians personally and picked the lors yourself? coz i saw the cover letter and it instructs the physician to mail it to ECFMG. I think that's asking far too much from the writer.

I saw this great website, residentscafe.com and scutwork.com. In the latter, they post reviews of different hospitals and programs. they're entirely biased, of course. But then promdis like me have no other basis for choosing other than hearsay.

A: onga, cramming for 4 exams is a royal pain. but trying to study for a joram exam is even more difficult; if you were able to get through his exams, you should be able to coast through at least steps 1 and 2.

in terms of content, steps 1 and 2 are very similar. step 1 focuses mainly on basic concepts (biochem and pharma) while step 2 focuses mainly on clinical approach. they ask about the same diseases but inquire about different aspects. for example: multiple myeloma: what is the cell responsible and what does it produce (step 1 question)? what tests do you do to diagnose it (step 2 question)? take note that "the initial diagnostic" and "the best diagnostic" are two totally different things. this semantic difference is touched a little bit in step 2 but addressed heavily in step 3.

if you study really well for step 1, think you can take 2-ck within a few weeks. honestly, i think the reason i fared so well in step 1 and relatively poorly in step 2 is because i took step 1 three months after studying for the local boards and step 2 six months out. if i had taken them in rapid succession i daresay i would have aced both.

step 2-cs does not require you to study anything. if you're a medical graduate worth your salt who can go through a complete history and physical in 20 minutes in fluent english, it'll be a cakewalk. they send you a cd containing sample cases and how they want you to do things (knock on the door, confirm the patient's name, shake hands, ask open-ended questions); even if you watch it 1 hour before the exam, you'll get all the relevant info.

you mail the [recommendation] letters to ecfmg (or nrmp) then they fax this off to the programs you applied to. be sure to get letters from people in power. it's all about titles; if you can get a letter from a doctor in the upper echelons of the world health organization, that's sure to turn heads.

never underestimate the power of connections. do you know any [of your school's] alumni in directorial positions in any residency programs in the states? get in touch with them. talk to your dean and your mentors, they should be able to point you in the right direction.

another thing: start writing your personal statement asap. it should be a snapshot of your life that will evoke a lot of emotion and give them an incisive glimpse into your soul (naks). the more tear-jerking and less clinical it is, the better. a good personal statement can make a mediocre application shine like gold. a bad ps can kill a good application. i thinkt there's a lot of samples on the internet. mine sucked to high heavens; buti na lang i didn't get penalized for it.

btw, if you're looking to raise a family, the midwest is a better place to apply to. cleveland, oh, while extremely boring, has the 4th or 5th best hospital system in the states.

USMLE Stuff (Open Letters, 3)

Initially appeared on doktorko.com 5/10/2005.

Q: I'm thinking of brushing up on my (hopefully retrievable) goldmine of clinical skills by undertaking 2 or 3 moonlight opportunities. I just hope i'd be wellversed enough to explain to the bewildered patient why his dry cough necessitates a neuroexam.

But like i said, i'm getting way too ahead of myself. i'm almost eating up the internet to search for programs and learn the ropes way before i even know if i'll make it. i guess i'm just buoying my self esteem. besides (i rationalize), psyching one's self will really make a difference.

my problem is, i'd be in the states to take ck through step 3. i don't know how i'll be able to solicit Lors then. Can i ask for Lors even without registering with eras yet?

i'm still torn between florida and new jersey. and yes, i'd look into your midwestern advice. moral decay and hedonism are such huge and adamant issues.

A: do not - i repeat, DO NOT - think that moonlighting in any way prepares you for the real world of medicine. it'll help you polish your history-taking skills if you work at it, but by and large what it will do is make you think de-kahon (i.e. come up with the simplest/cheapest diagnostic and treatment plan possible) and expose you to lazy consultants who don't even bother updating themselves on the latest developments. if anything, take one moonlighting gig in a reasonably large hospital with a consultant staff who are in the academe. that way, you get real-world experience with consultants that are knowledgeable enough to stimulate your intellect. plus, you make more than the usual training resident does. this is if you want to get smarter. while making money. if your priority is just to make big bucks, apply to some far-flung hospital in batangas where they pay you oodles of cash to go on duty but mismanage patients horribly (i've seen a "consultant" give a blood transfusion as a "cure" for URTI).

so psyched up ka na para sa exams, which is good. try to answer the sample step 1 exam on the usmle.org website. if you score above >70% correct, you should be right on track. this is equivalent to a 99 rating already (at least it was when i took the exams).

get your LORs now (or at least ask for them now). as long as they are relatively fresh (i.e. written within 3-6 months of your interviews, which would be right about now), there should be no issue. try to have everything on hand by october 1. if you don't have step 3 scores by then, ok lang as long as you have taken step 3 (if you're applying to h1 programs) and can say "i'm just waiting for them to mail me my high grade." i cannot stress this point enough: EACH DAY AFTER OCTOBER 1 THAT YOU WAIT TO HAND YOUR APPLICATION IN DECREASES YOUR CHANCES OF GETTING INTERVIEWED EXPONENTIALLY. unless you have 99-99 scores, were class valedictorian, and have a slew of research papers (you as the primary researcher) to your name.

there is also a dean's letter required. this is different from the LORs, mind.

USMLE Stuff (Open Letters, 4)

Initially appeared on doktorko.com 5/10/2005.

Q: I plan to ask for Lors from [my school's] physicians. I was able to download the cover letter. You think i can start soliciting even if i haven't registered with ERas? i'm just afraid that without having read Eras instructions (i think i have to be registered before they give me the entire lowdown. at this moment, instructions are extremely vague), i might give the wrong instructions to my letter authors and cause more aggravation in the end. is it really that simple? ask them personally, give them a copy of the cover letter, and pick it up after a few weeks?

and who gets to write the deans letter? when is it done? it's an extremely taxing document.

A: typically, you (not the consultants) mail the letters in, not the other way around, which means that you can send them in whenever you want. just have them on hand asap and mail them in when eras asks for them. that's what i did, i don't know if you guys follow a different protocol at [your school]. i don't even know if you need that cover letter. just go up to the consultants and ask if they can write you one. most likely they'll
ask you what you want them to put in there, etc. consultants are usually very helpful when they know that they can give your american dream a boost.

your dean's office should have a standard dean's letter written out. after all, they've been writing them for years. if not, here's a link: http://www.aamc.org/students/eras/support/mspeguide.pdf. if your dean is kind, he'll let you embellish it before signing it. there isn't any standard letter of recommendation, but be sure that they include personal stuff like how easy you are to work with, how much of a "team player" you are, etc. everyone's resume will be beefed up with high scores and clinical stuff; they want to know how your intangibles are.

read the eras faqs at: http://www.ecfmg.org/eras/

USMLE Stuff (Open Letters, 5)

Initially appeared on doktorko.com 5/10/2005.

Q: its hell to apply for visa here, especially since last year or so. they assume everyone is out for TNT unless proven otherwise. they don't give a damn if you spend millions and millions shopping there and boost US revenue 500% overnight. if you can't prove youre coming back, you might as well tell the consul you intend to go TNT. everyone i know (or my friends know) who presented the letter of assistance for visa by ecfmg was denied. also, they don't issue multiple entry anymore, except for those who are just seeking for renewal. and the maximum they give is six years. if you by chance are lucky enough to be granted a visa, you have only 3 months to leave. that's why i'm racking my brain thinking of proof that i will be coming back. evidence of current employment would likely do the trick. unfortunately, i actually NEED a job first.

that h1 sponsorship is my dream, along with several thousand others. yes, i will apply to j1 programs too. i plan to apply to mayo clinic in jacksonville and to cleveland clinic. if i do get a 6month visa i could stay in the USA only till december. will the programs be the ones to contact me if they're interested to interview me? if that's the case, is it possible to request an early date so that i could finish all interviews by december, or is the interview date nonnegotiable?

plus, cleveland clinic requires at least 2 months US clinical experience. so hopeless na ako dun? should i still bother applying there?


A: it should be fairly easy to get that experience through "externships" or "observerships." that is, just look for someone you know (and preferably like) and just follow them around for 2 months. that should be sufficient "clinical experience" to meet the criteria.

although i cannot predict what the consul will do, i'm 2 for 2 in interviews, so i think i might be at least a little qualified to give advice on this matter.

i was actually urged by many people to apply for a us visa on the pretext of "wanting to tour the states," but in the end i decided that it would be best for all concerned if i was forthcoming about my plans to train abroad from the start. my logic was: if they give me a six-month visa because i said i'd just be touring, the chance that they'd approve my visa the next time would be exponentially lower because i would have proved that i lied by taking a test and doing interviews "while on tour." my general gameplan was to admit that i wanted to train in the states but to make it look like it didn't matter whether or not i got in, since i was "rich" enough in the first place and didn't need their sweet dollars. to that end, i "bulked up" on assets to "prove" that i didn't want to be TNT. this is a song-and-dance routine that has been going on for decades - just ask anyone who's applied for a us visa. btw, there is a shortage of doctors in the states now; i don't know how that would affect the interview process, but it's a tidbit of information that you might want to insert into the conversation somehow.

even if they give you a visa worth only a month, you can extend it ad infinitum (at least i think so - i've never actually done it, but i know a couple of people who have) once you're here - as long as you can prove that you have a valid reason for wanting/needing to stay. again, if you tell the consul that you'll be touring but apply for an extension because you're actually interviewing, that might not be looked upon favorably.

be mindful of how many programs you apply to. some advocate fifty. some advocate a hundred. it'll cost you a small fortune but hopefully it'll be worth it in the end.

The Idol

Initially appeared on doktorko.com 6/17/2005.

A few weeks ago i attended the graduation of Internal Medicine residents. Our venerable Program Director made it a point to read from the "Personal Statement" each resident turned in before entering the program. The purpose (i assume), was to show to the audience what each graduate's original goal was - and how far s/he had gone towards realizing that goal.

One of the residents hailed from a Third World country, and once i heard his PS declaration i had to pick my jaw up off the floor: he wanted to "work part-time in the US and work part-time in his home country to help the underprivileged."

OMG! WORK PART-TIME IN THE US AND WORK PART-TIME IN HIS HOME COUNTRY TO HELP THE UNDERPRIVILEGED! WOW! Here is someone who has NOT been blinded by the "American Dream," someone who is actually WILLING to spend a significant part of his life working towards the betterment of his countrymen! Someone who has RETAINED the idealistic purpose that EVERYONE purports to have once they go abroad but somehow "lose" in the shuffle once they "come to their senses" and realize how much better life is (earning sweet dollars, of course) in the LAND OF THE FREE.

With my mind in a frenzy, i thought: Brilliant! This is the SOLUTION to the PROBLEM of viability! This is a way to serve the TRULY underserved while NOT neglecting my loved ones! I have to touch base with this guy - i have to find out what makes him tick! I HAVE TO KNOW how he figured out the monstrous logistics of traveling back and forth! I MUST learn what he did so i can do it myself! This essential knowledge must be SHARED! But he and the other graduates were beaming on stage so i decided to bide my time.

The next day, i had my chance. I was in the cafeteria having lunch and he was chatting away with one of the interns. So i plop my plate of food on the table and sit beside this man - what man? this GOD, my IDOL.

Smiling like an idiot, i blurt out: "So... Dr. X read your PS at the graduation. You really want to work part-time here and back home?"

Chewing on his food, he says: "What?"

"How did you figure out working 6 months here and 6 months at home?"

"What are you talking about?"

"Well, your PS said that you wanted to work part-time here and part-time in your home country."

He smiles. "Oh yeah. I don't even remember what i put in my PS. I can't believe Dr. X even remembers that stuff."

I get a sinking feeling in the pit of my stomach. Still, i press on: "So how do you plan on working here part-time and working there part-time? I mean, the logistics..."

He cuts me off with a chuckle. "No, i think you misunderstood. What i MEANT was that i wanted to practice medicine here and then occasionally do medical missions back home. I don't think it's possible to work part-time here and part-time there."

Every muscle in my face rebels against the smile i have plastered on. Through sheer force of will, i keep my expression frozen. "Ok, sorry about that."

He laughs like my concept is the most hilarious thing he's ever heard. The intern laughs too. They go back to talking about inane things. Slowly, i turn back to my food, stick my fork in my mashed potatoes, and shovel it into my mouth.

But the food tastes like ashes and suddenly i feel very alone.

The Silent Passage

Initially appeared on doktorko.com 7/13/2005.

Almost two weeks ago as of today, i unceremoniously made the transition to full-fledged Residency. There were no parties or ticker-tape parades; just a silent passing of the torch to the a new batch of physicians who just finished the initiation year called Internship.

These are really just semantics - an "intern" is also a "resident," only at the bottom of the food chain, doing more paperwork, more second-guessing, and more running around trying to tie up loose ends. To a certain extent then, i guess becoming a second-year resident is a kind of promotion.

I say "kind of" because there are no added benefits or perks. There is less 24-hour call (approximately 2 per month), which - while it seems good on paper - ALSO means that's there's no post-call status and that i have to come in every day to round. Then there's the added responsibility: having gone through a year's worth of US clinical experience, i'm now expected to know more than the tyros, to know what to do in most situations, to be a fountain of knowledge to the new interns who are still tripping all over themselves just trying to find the bathrooms. I'm expected to be more proactive with patient management, to make major management decisions and run the patient service like it was my own.

Unfortunately - i don't feel all that smart. The more i read and study, the more i realize that there's a wealth of knowledge out there that i still need to learn. With great power comes great responsibility. Well, here's the RESPONSIBILITY - where's the POWER?!

To wit: if i'm expected to know so much, how come i feel like i know so little? I hardly know anything.

But then there are moments like this: like my call on the 4th of July when someone came in with a GI Bleed, a history of CAD, and Afib. No other Residents around; just me and my Intern. She takes her time doing the history and physical; i waltz in and finish mine in 15 minutes. She putzes around trying to figure out what's going on; i synthesize the data and formulate my differentials almost immediately. She wonders aloud what she needs to do; i rattle off the appropriate diagnostics, drug doses, and consults off the top of my head. She asks me a pathophysiologic question; i answer with a confidence and nonchalance that surprises even me.

When the dust settles, i step back and survey my handiwork. Everything covered, nothing missed. Staff with the attending, and he agrees.

I stop for a moment as it dawns on me what i've become, and i smile. Wow.

Homesickness, Part 1

Initially appeared on doktorko.com 7/17/2005.

Over this past year, i've had many discussions with different people regarding my plan of eventually going back to the Philippines. Often, these conversations are thrust-parry-thrust situations, with both sides presenting valid arguments; attacking, defending, and riposting deftly with equal skill and fervor.

The naysayers often start out with "Gusto ko talaga bumalik sa Pilipinas, pero..." then proceed to their litany: traffic, pollution, plain inconvenience, and a gajillion other reasons besides. I work my way from the other end, beginning with "[Insert fault here] sa Pilipinas..." and ending with "Pero gusto ko talagang bumalik."

Over time i realized that these arguments can have no reasonable end. I'll never understand what they want me to - because I DON'T WANT TO STAY. In the same vein, they'll never understand what i want them to - because THEY DON'T WANT TO GO BACK. Let's break down the arguments and lay the true reasons bare; everything else is just salad dressing. The age-old adage holds true: "Pag gusto, maraming paraan; pag ayaw, maraming dahilan."

Different people work with different paradigms. They can call me stupid; i can call them self-centered. We can argue until our faces turn blue, but in the end we'll have changed nothing and just spewed a whole lot of hot air. People will do what they want, when they want.

The Philippines is a lover calling out to me. I know she's homely, cross-eyed, a little plump, and has crooked teeth. She's also poor as dirt and will probably suck me dry. But it's her tender kisses and caresses that i miss. No one else will do, not even someone richer, prettier, or with straighter teeth. It's not something i expect anyone else to understand, but understand this: i have given her my heart, and i have no intention of taking it back.

My Resolution

Initially appeared on doktorko.com 8/15/2005.

The report was about the sad state of prisons in the Philippines. Specifically, it showed "Navutos Prison," (i assume they meant "Navotas") and how the prisoners have to be packed like sardines, how children are put in the same cells as pedophiles, and how petty thieves are lumped together with murderers. Then they proceeded to show how living conditions are pretty much the same (sometimes even worse) outside the prisons: picking out sellable or useful things in dumping grounds (a la Smokey Mountain) and surviving on the streets from day-to-day.

I felt a turmoil of emotions go through me, and very softly, i felt my heart explode.

Back home, people are starving for lack of money to put a cup of rice on the floor (they have no tables); they steal simply to get by and get thrown in prisons with hellacious conditions (think Abu Ghraib) when they get caught; they get sick from unsanitary living conditions all around them; they die from diseases that we can easily cure with modern (but expensive) antibiotics. These people - MY people. My fellow Filipinos. Meanwhile, here i am 8000 miles away, playing poker and shopping for new shoes, enjoying my money and free time, wondering how i can make more than the cool million (in pesos) that i already make every year.

There really is no justice in the world. What have i done to deserve more than my fellow countrymen? Nothing. I have been given more - which means nothing, only that i have more to give back.

I can imagine many of the Filipino-Americans here watching the same show. Likely the predominant sentiment will be: "Grabe talaga sa Pilipinas. Ayoko na talaga bumalik dun/Buti na lang nandito na ako." As usual, there will be pointing of fingers, pointing to the government, the rich, the elite - the ones with the means to make things better, but do not for reasons of their own.

Of course, no one will point at the legions of professionals who leave the motherland to seek their fortunes abroad - people who are born, bred, and educated in the Philippines but end up enriching other countries where they eventually settle. Mayhap the thought is that these people should not be singled out, because they DO make charitable contributions - say $1000 out of the $200,000 (0.5%) that they make in a year. Or maybe they donate up to 336 out of the 8760 hours (0.04%) in a calendar year to do some sort of mission work.

Is this enough? Maybe, maybe not. Who's to judge? After all, no one should be expected to save the Philippines on his or her own. (Except maybe PGMA, who everyone blames for everything.) And if the living conditions really are as bad as people claim - who can blame others for running away and making better lives for themselves?

To each his own. As for me, i take ownership of this problem.

I WILL go back and fix our country.

The truth is: i will likely not be honored nor remembered. I will be laughed at many more times than i already have (which, at this early stage, is already a lot). I may not even be able to save one life. In all probability, i might just be chasing after some pipe dream, going on a foolish quest of trying to save mankind, doomed to fail and die in obscurity and disappointment.

But at least i will have tried.

Thinking of Getting an International Drivers' License?

Initially appeared on doktorko.com 8/20/2005.

Well, think again.

The word SCAM is a fighting word, which is why i won't use it.

At any rate, before i flew to the US some thirteen-odd months ago, i was concerned about whether or not i'd be able to drive a car here. After all, Filipinos are notorious the world over for being bad drivers (we call it "diskarte"), so for all i knew, brandishing my Filipino license in a foreign country might elicit dagger looks and a spit in my general direction. With this in mind, i inquired around on how to procure one of those "International Licenses" that some tourists rave about.

A couple of people i talked to said that it was a fairly simple procedure; go over to Aurora Boulevard, find the Automobile Association of the Philippines (AAP), and apply for the license. Voila, you'll be certified to drive almost anywhere - especially in the US.

Without much ado, i found the office on Aurora. I inquired about "International Licenses," and was given a form to fill out. I penned all my information in, submitted a couple of ID pictures, plunked down around PhP500 (not the exact figure, but my recollection of numbers can get a little muddy sometimes), and within half an hour had my "International License" in hand. Perhaps there was some foreshadowing in the fact that it stated that it was a "Permit" and never once admitted to being a "License," but what they hey. I smugly stowed it in a plastic bag with my most valuable possessions (Passport, ECFMG Certificate, Diploma, picture of my wife) and was content in the fact that i was now licensed to drive in the United States of America.

To cut the long story short: after entering the US, i NEVER used the AAP Permit - NOT EVEN ONCE. I tried to rent a car at Alamo - LO AND BEHOLD, they do NOT accept International Driving Permits as a solo form of identification! In fact, they look for the OFFICIAL DRIVERS' LICENSE provided by your country of residence (in my case, the Inang Bayan) - and accept this as sole proof that you can drive cars in their country!

Succinctly: if you want to drive in the US and are already duly licensed in the Philippines, the "International License" is just a useless piece of scratch paper. YOUR DRIVERS' LICENSE IS GOOD ENOUGH. Information i would have appreciated receiving before actually applying and paying for it. Of course, the people who you buy it from would be the last ones to actually say it doesn't mean anything.

(Caveat: this is information specific for Alamo Rental Cars in Grand Rapids, Michigan, USA. But i guess it's safe to say that if something like this holds true for our little town... that it might hold true for the rest of the country (and maybe even others) as well.)

To be fair, AAP membership DOES come with SOME perks, such as "emergency roadside assistance," "emergency ambulance service," and so on and so forth. But if you're thinking of investing your money in something useful for your trip abroad - just go to NBS and buy a good book to read on the plane.

Homesickness, Part 2

Initially appeared on doktorko.com 8/26/2005.

It's four AM in the hospital; all's quiet on the Admissions front and i'm hanging out in the library - studying, surfing the internet, and listening to Internet Radio on Windows Media Player.

Invariably, i typed "99.5" in the Radio Tuner's search box. Now i'm listening to RT.

The DJs' inane chatter makes me smile; they interview phone-in callers (voices thick with the peculiar Filipino English accent that i've tried so hard to unlearn) and hand out prizes.

Details about the concert at St. Scho. Manila are given out.

Traffic report: Taft Avenue is blocked up this afternoon - as usual. This AFTERNOON? And it hits me belatedly that they are almost twelve hours ahead.

A Petron commercial.

A commercial for "Aruba Bar and Restaurant."

An old Eraserheads song: "Drive."

I close my eyes and for a moment i can almost imagine myself back home. Back where people look like i do (pango ang ilong), where they speak my language - where everything just feels RIGHT (even when things are going horribly awry).

I open my eyes and realize that i'm 8000 miles away from where i belong.

I feel a twinge in my chest and i choke a little bit.

Just a few more years.

VOIPing

Initially appeared on doktorko.com 9/21/2005.

There's been a lot of hype lately about the Voice-Over-Internet-Protocol (aka VOIP).  A few weeks ago, Google launched Google Talk, a stripped-down voice chat program; Skype and Vonage have been around for a while; and more recently, Yahoo has been promoting Yahoo Messenger With Voice (supposedly an "upgrade," but i'm sure that the voice chat function has been around for longer than a few weeks).  Anyway, last week i decided to give these a try and find out what all the fuss was about.  I downloaded Yahoo Messenger and called my cousin T (identity withheld for her protection) back home.

The call to the Philippines lasted almost an hour.  Overall, there was a lag of 1-2 seconds between statements, but otherwise the audio was crystal clear.  IMO, it sounded exactly the same as my usual phone card connection without the annoying crackles and tendency to drop the call.

My verdict?  If you are a cheapo (like i unabashedly am) and wanted to talk to somebody Long Distance, this is definitely a viable option.  It is a good alternative to talking to somebody back in the Philippines, as the quality is the same or even slightly better than a phone card's.  Plus, you can leave voice mail.

The downside?  Right now, it's only computer-to-computer (i think Skype and Vonage can make calls to actual phones, but i'm to cheap to try those two out).  Also, both parties need to have a broadband connection, so i guess the cost-effectiveness would depend on how many calls you make.  A broadband connection in the RP costs roughly 2000 pesos a month, which is around $40-50.  If you spend almost this much on phone cards anyway, consider spending that money on getting your folks a decent internet connection.  What if they have the connection already?  Then download the software and stop springing for the phone cards, you dolt.

The cheapest option would be to have a predetermined time when you want to talk and just have the other person stroll over to Netopia (or a similar Internet Cafe), where using the broadband connection usually costs around PhP35/hour.  Use the communal mike (or bring your own - at least then you wouldn't have to smell other people's panis na laway).  Then you can have a decent conversation with your loved ones for less than the cost of a Happy Meal.

My Browser Adventure

Initially appeared on doktorko.com 10/1/2005.

On the 20th of this month, Opera - which is regarded by some to be the best Internet browser of all turned free.  For reasons beyond my comprehension, the vendor dropped all revenue-generating ads from the browser and started giving it away ad-free.  Brilliant marketing strategy?  Echh - beats me.

At any rate, i've always wanted to try it but was turned off by the ads and the claims of Firefox (FF) users that it was "bloated."

Apparently, the "bloatedness" of the browser has been much exaggerated.  In terms of the hard drive footprint, it's very small (around 20MB) considering that it's both a browser and an email client in one.  Installing Mozilla FF and Thunderbird on your CPU will take nearly twice that size.  I agree can be a tad too feature-laden - if you're used to running your browser with minimal add-ons, but with half an hour's worth of customization, i had removed the unnecessary toolbars and modified the look to resemble my beloved FF.  Visiting the Opera homepage, there was the noticeable absence of any pluggable (my word) third-party extensions, which is probably the reason why they tried to pack it full of features in the first place.

My impressions:

1. In terms of speed, it claims to be faster than FF.  True, it did render text very quickly and arguably faster than FF in default mode.  Unfortunately (or fortunately for me) i have FF Firetuned, which makes it almost impossibly fast - mas mabilis pa sa alas-quatro.

2. Email client integration is good; you don't have to bring up Outlook Express or Thunderbird when composing or receiving mail, which is extremely convenient - if you use a POP3 client.  However i use Gmail myself and have an always-on cable internet connection, meaning i can pull up a tab and check my email at any time.  Really no need for integrated email.

3. As mentioned, Opera is jam-packed with features; FF comes out of the box bare-boned and has to be customized to the user's taste.  Two extensions i almost cannot live without are StumbleUpon and the Gmail Notifier (the browser version allows multiple users), which have no equivalent in Opera; this almost made me quit right there.  I must say however that i was extremely impressed with Opera's "Wand" feature, which makes logging-in to password-protected websites as easy as waving a magic wand (ouch).   Another interesting feature was Voice Control, wherein i could say into my microphone, "Hal, speak," and the computer would actually phonate the highlighted text on the screen.  There was also a variety of other statements that could make the CPU compose an email, close a tab, etc.  Pretty nifty, but not really practical.  Half the time it could not understand my Manila accent, and honestly - i'm not that lazy that i can't point, click, or read.

4. The deal breaker was page compatibility.  True, FF has always had trouble rendering some pages optimized for IE, but it's gotten better in 1.5b and has a workaround extension called IEView.  Opera, on the other hand, had trouble rendering doktorko.com (intolerable!) as well as shutterfly (which my wife Gianina uses quite frequently).  And there is no functionality to render with an outside browser.

And so, after nigh eight hours of intensive use, i had to give Opera the boot.  I've always considered myself to be an early adopter, but in this case i guess i'm too heavily entrenched.  Once you've tried Firefox, you'll be hard pressed to switch to anything else.

POSTSCRIPT: Eventually i learned that i couldn't do without the "Wand" feature.  I eventually learned to make do with what was available on Firefox.  For more on that, read my related article: The Firefox Wand.

The Firefox Wand

Initially appeared on doktorko.com on 9/21/2005.

OK, so i did ditch Opera 8 in favor of my beloved Firefox, but it's not an all or none deal - there was something in that browser that i never knew i couldn't live without: the Wand.

In short, the Wand is an autofill feature that stores logins, passwords, and logs you into the website in question automatically.  FF die-hards claim that this is the exact same functionality offered by FF's autofill feature - which only reveals their ignorance.  In my experience, the autofill feature leaves a lot to be desired (it doesn't seem to work on all websites) and causes problems once multiple users (with multiple login names, natch) start using the same website.

Case in point: GMAIL.  My wife and i have separate accounts, which necessitates logging-in individually, filling in the corresponding password fields, and clicking "login.".  I realize that this doesn't  really take a lot of energy, but i AM a lazy-butt on top of being a cheapo (two of my more endearing traits), so a few more key/mouse-strokes than necessary is too much for me.  The Wand (for the eight-odd hours that i used it) worked as so: navigate to the website (www.gmail.com), click the wand, and select your desired login.  It fills in the forms and logs you in automatically.

What could be simpler than that?  But again, Opera and i didn't really mix, so i had to look for a similar function in FF.  What i found was an extension called "Roboform," an add-on to FF that performs exactly as the Wand does.  It was unwieldy at first - coming with its own toolbar which restricted my browsing space even more - but with a little tweaking, i managed to compress it into just one little "logins" (not a typo) menu beside "help."  A little more tweaking, and it was running perfectly.

I navigate to GMail and the little Roboform window pops up and asks me who i want to log in as.  Double click the appropriate name and voila! - i'm in.  I navigate to doktorko.com, Uptodate, etc. and it has the same simple interface.  On websites where i want more security (e.g. Ebay and Amazon), the logins are protected by a "master" password.  And on sites where i don't want my numbers lying around (bank sites, notably), i disable Roboform and enter stuff manually.  No muss, no fuss.

The only caveat to this would be version compatibility: FF 1.0.7 is only compatible with Roboform 6.4.2.  Plus, all of the present versions are unstable with FF 1.5b (i've had a couple of crashes).  So if you're going to try it out, make sure you've got the right stuff.

Lazy-butts of the world - UNITE!

Smoking Toads

Initially appeared on doktorko.com 10/9/2005.

In the course of my extensive Web-crawling, i've sometimes come across the term "toad-licking."  Rotating on Toxicology last month and reading about a wide variety of poisons and recreational drugs, i decided that there was no better time to find out what the whole brouhaha was all about and Googled it. 

The recreational use of amphibians actually dates back to the time of the early Greeks.  In fact, there is much literature and quite a few edifices in Central and Southern America devoted to toads themselves which seems to suggest that the people who lived in these places used them extensively for both religious and recreational purposes.

The toad in question is Bufo alvarius - also known as the Colorado River Toad - which is native to the southwestern United States.  This toad secretes a variety of different chemicals via its parotid gland, not the least of which are Bufotoxins (supposedly cardioactive poisons) and the serotonin-like chemicals Bufotenine and 5-Methyl-O-Dimetheyltryptamine (5-Me-O-DMT for short).  The actual hallucinogenic component is the 5-Me-O-DMT.  Bufotoxins and Bufotenine have many different and interesting effects, but hallucinations are not among them.

The concept of "toad-licking" is really a myth.  Apparently, back in the 1960s some potheads got wind of the ages-old recreational use of toads and started popularizing the concept of licking these hapless animals.  Whether or not anyone actually got high or became frankly psychedelic (or even psychotic) from licking toad skin is unclear.  At any rate, there is so much bad stuff on the toad's skin (the other chemicals mentioned above as well as god-knows-what) that you are apt to get sick and even die from running your tingling taste buds over it.  More importantly, 5-Me-O-DMT is orally inactive, as it is metabolized by the liver and degraded by MAO.

The proper way to use Bufo alvarius is to milk the secretions from its parotid glands, let the liquid dry out, gather the crystals produced, and smoke them with a pipe (almost like shabu, i suppose).  The onset of action is reportedly very quick (ranging from instantaneous to fifteen minutes), and the effect can last for up to half an hour.  A variety of sympathetic nervous system effects are produced as well as the much sought-after parade of hallucinations - which is claimed by some to rival that produced by LSD.  The full range of effects and dose-responses can be found here.

As mentioned, Bufo alvarius is the only toad that is known to produce 5-Me-O-DMT.  Can this wonderful chemical be extracted from the common palakang kokak?  It might be, but honestly - i have absolutely no interest in finding out.  Kayo na lang.

Legal Stuff: DMT, which sounds like and is chemically similar to 5-Me-O-DMT, is considered an illegal substance in the USA.  In addition, possession of Bufo alvarius is considered a misdemeanor in California.

Disclaimer: This article in no way condones the use of psychoactive drugs for recreational purposes.  All information contained herein is intended for educational purposes only.

Everything I Learned From High School

Initially appeared on doktorko.com 11/2/2005.

When i was in high school (at Zobel - Animo La Salle!), i fancied myself quite the smart aleck.  Although i was a member of the so-called "Honors Class," i was a royal pain.  My attitude was horrible: i would ignore my teachers' lectures, make fun of their probinsyano accents, and slack through my classes with wild abandon.  I would read adventure novels instead of textbooks and watch TV on a school night.  I would memorize guitar chords in favor of facts and figures.  But still i coasted through high school with flying colors.  I would cram a Quarter's worth of readings into the night before the exam and still manage to eke out a high grade.  I would engage my Science and Christian Living teachers in heated debates about their subject matters - and still come out smelling like roses.

In sum, i was not a student that my teachers liked at all.  Every year - without fail - one teacher would pull me aside and tell me that i had great potential... but that i had to clean up my act.  Through the grapevine, i heard that my teachers hated me, that they thought my girlfriend (who is now my wife) was too good for me, that i would get her pregnant and ruin our lives forever.  Well, this served as reinforcement, and the more i felt their seething hatred, the more of an @$$ho!e i became.  Hate begets hate, after all.

(To be fair, they weren't all bad.  Some were actually pretty supportive.  But there were enough bad apples to spoil the lot, so to speak.)

Eventually, i graduated from high school, went on to DLSU, and finished Medicine.  That should have been the end of that, but whenever i thought about my high school teachers, all my youthful angst came rushing back.  I started seeing red and felt fire burning in my veins.  It made me want to piss in their coffee cups and kick their faces in.  All those years of putting me down and trying to rein me in - well, who has the last laugh now?  Who has the MD degree and will be making more money than you've ever dreamed of?  Answer me, you [expletive deleted]!!!  I wanted to go back there, storm into the faculty room, and start screaming at them like a bad soap opera.  For one reason or another, i never actually did it.  But it was always a secret desire that burned within me.

However –

Before coming to the US, i taught Anatomy in my alma mater for just over a year.  It was then that i understood how my own teachers had felt. It was then that i realized - clear as day - why they were so negative towards me all those years.

Standing in front of a hundred students with a meticulously-crafted lesson plan and train-of-thought, you dread those little distractions that divert the attention of the class away from you.  You hope that you know enough to teach these young minds - that you actually know enough that you'll be able to answer their questions when they pop up.  You admire the brilliant student who is able to answer all your questions - but you're also a little afraid of him because you might not be able to answer all his questions.  You're afraid that you'll slip up, that the little chink in your armor will be exposed, and that the students will lose respect in you and label you tanga.  And whenever the smart aleck speaks up - you hate him just a little more than before and try to put him down to impose your authority, to show him that it's you and you alone who are in charge.

We think of our figures of authority in terms of archetypes; not humans, but rather immutable icons with only one facet to their personalities.  The Congressman as Manhik-Manaog, the teacher as Miss Tapia, the Medical Consultant as - well - a Medical Consultant.  As up-and-coming youngsters we try to impose ourselves, bending others to our will; everyone else is dumb and irrelevant, i'm the only one that matters.  It's easy to feel oppressed, like the world has wronged us somehow, that people need to understand us and not the other way around.

But as we grow older (and hopefully wiser), the shoe gets put on the other foot.  We watch the new up-and-coming younger people impose themselves and try to bend others to their will, thinking that we are dumb and irrelevant and that they are the only ones that matter.  At once we admire and cringe away from their terrible power and arrogance.  Then - and only then - do we realize how narrow our worldviews really were.

So what i really learned from high school (and perhaps the better part of my early life) is this: that we are all human; that we all harbor secret hopes and fears; that no one - no one! - is immune to insecurites.  No matter how brave the front that we put on - for our students, our clients, our patients - at the end of the day, we all come home battered, broken, and spent.