 Go, Manny, go! 06 December 2008 7:42 PM
Tomorrow’s D Day, couldn’t get to sleep. Praying for our man. Below is the Philboxing.com article written by Ronnie Nathanielsz on the eve of the fight. PACQUIAO IN THE FIGHT OF HIS LIFE By Ronnie Nathanielsz Filipino ring idol and national treasure Manny Pacquiao knows he is in the fight of his life against the bigger, taller “Golden Boy” Oscar De La Hoya. But the young man who broke away from the bondage of his childhood poverty to carve a name for himself and to redeem a country’s reputation internationally isn’t awed by the odds. Backed by the continuing confidence of his celebrated trainer, two-time “Trainer of the Year” Freddie Roach and by far the most astute promoter in the fight business, Top Rank’s Bob Arum, Pacquiao steps into the ring at the MGM Grand Garden Arena in Las Vegas knowing he has beaten the odds before and is perfectly capable of doing it again. With a nation united behind him out of gratitude for the respect he has earned for himself, his country and people through his incredible achievements in the ring and mindful of the power of prayer, Pacquiao is eager to prove that his fight against De La Hoya is not a mismatch as some critics have labeled it neither does a good big man beat a good little man, always. He need not go as far back as David and Goliath to prove his point. All he has to do is listen to De La Hoya’s business partner, Bernard “The Executioner” Hopkins who, despite picking De La Hoya to win for obvious reasons, referred to his own career in which he moved up 15 pounds to fight light heavyweight champion Antonio Tarver who was at his peak, but was still mauled by the much smaller Hopkins. To Roach and Arum the axiom that “speed kills” will come into play because Pacquiao’s blazing fists and his remarkable footwork give him an undoubted edge. Roach also claims that De La Hoya is “weak-minded” while Pacquiao has a strong will. But the telling factor which Roach intimated was a secret he discovered in the De La Hoya “World Awaits” megabuck fight against Floyd Mayweather Jr concerned De La Hoya’s inability to throw his stinging left jab after the sixth round which in the end cost him the fight. It seems that De La Hoya has problems with his rotator cuff in the left shoulder which he publicly mentioned after battering Ricardo Mayorga in six rounds. The use of acupuncture during training at his Big Bear camp nestled in the mountains of California and constant massage of his left shoulder provided an inkling of what may well be a problem. Our review of some of De La Hoya’s fights through the years have shown occasions when he has, in between rounds, rested his left hand on the shoulder of his trainer Floyd Mayweather Sr. He clearly did that after the eighth round of the Hopkins fight and got knocked out in the ninth. Pacquiao’s conditioning expert Alex Ariza said he watched De La Hoya run four or five laps around the UNLV campus oval and felt “he didn’t look right” whatever that meant. On the other hand Pacquiao went thirteen laps and wasn’t even breathing heavily at the end of it. Ariza also points out that when a fighter loses weight like De La Hoya did coming down from 160 to 147, there is a danger of injury because of vascular dehydration which may well be the case.. Pacquiao has trained like never before for this fight because he knows what’s at stake… another megabuck fight against Britain ’s Ricky “The Hitman” Hatton in England which could draw, according to Hatton’s father Ray Hatton, 100,000 fans who won’t need seats because they will be standing all throughout to watch what he predicted would be an explosive fight. While Pacquiao is explosive, the sensible fight-plan according to Roach would be to keep his focus and execute what they have worked on as a team. Roach has not just peeved De La Hoya with his comments, he is also seeking to mislead him by saying that Pacquiao will go after him from the opening bell which, by all accounts he may not do if the idea is to tire out and frustrate the ageing “Golden Boy” who is rusty and regarded as a part-time fighter with four fights in four years compared to Pacquiao’s four fights this year alone. Roach wants Pacquiao to dart in and out, throw flurries to the body and get to De La Hoya from all angles. Wear him down and take him out. That may well be harder to do since Pacquiao has never fought someone as big as De La Hoya. The use of eight ounce Cleto Reyes “puncher’s gloves” may work both ways It could well give Pacquiao a sense of comfort and quickness while also turning the bigger De La Hoya’s shots into more telling blows. Whatever the outcome, the fervent wish of an entire nation to whom Pacquiao is the only shining star in an environment of disappointment and deceit, is that even if he should lose he won’t get hurt. Pacquiao is indeed our only national treasure and over 80 million Filipinos, minus a handful of non-believers and skeptics in congress whose credibility is at the very least questionable, pray that he will triumph because his glory is shared by a grateful nation and people. |  | Three Saturdays ago, we visited Lola Daling, Nanay’s only surviving aunt. In fact, the last surviving family member of her generation. Already 95 years old but still blessed with keen memory and kindly smile. The area in Bo. 5 where her house now stands used to be dotted with plenty of coffee trees, the same ground where my parents’ wedding reception was held 44 years ago.
The picture with Lola Daling, Nanay and Tricia is priceless, like how generations can still be connected through time, place and circumstances in the spirit of family.
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The Dance  01 December 2008 12:42 AM
The second book, published in 2001, expanded on the wisdom that made THE INVITATION an instant favorite across the world. THE DANCE is filled with stories that show how people can discover the abounding gifts in their lives simply by embracing their authentic selves.
Prelude
What if it truly doesn’t matter what you do but how you do whatever you do?
How would this change what you choose to do with your life?
What if you could be more present and openhearted with each person you met if you were working as a cashier in a corner store, or as a parking lot attendant, than you could if you were doing a job you think is more important?
How would this change how you want to spend your precious time on this earth?
What if your contribution to the world and the fulfillment of your own happiness is not dependent upon discovering a better method of prayer or technique of meditation, no dependent upon reading the right book or attending the right seminar, but upon really seeing and deeply appreciating yourself and the world as they are right now?
How would this affect your search for spiritual development?
What if there is no need to change, no need to try to transform yourself into someone who is more compassionate, more present, more loving or wise?
How would this affect all the places in your life where you are endlessly trying to be better?
What if the task is simply to unfold, to become who you already are in your essential nature – gentle, compassionate, and capable of living fully and passionately present?
How would this affect how you feel when you wake up in the morning?
What of who you essentially are right now is all that you are ever going to be?
How would this affect how you would feel about your future?
What if the essence of who you are and always have been is enough?
How would this affect how you see and feel about your past?
What if the question is not why I am so infrequently the person I really want to be, but why do I so infrequently want to be the person I really am?
How would this change what you think you have to learn?
What if becoming who and what we truly are happens not through striving and trying but by recognizing and receiving the people and places and practices that offer us warmth of encouragement we need to unfold?
How would this shape the choices you make about how to spend today?
What if you knew that the impulse to move in a way that creates beauty in the world will arise from deep within and guide you every time you simply pay attention and wait?
How would this shape your stillness, your movement, your unwillingness to follow this impulse, to just let and dance?
The Dance I have sent you my invitation, the note inscribed on the palm of my had by the fire of the living, Don’t jump up and shout, “Yes, this is what I want! Let’s do it!” Just stand up quietly and dance with me.
Show me how you follow your deepest desires, spiraling down into the ache within the ache, and I will show you how I reach inward and open outward to feel the kiss of the Mystery, sweet lips on my own, every day.
Don’t tell me you want to hold the world in your heart Show me how you turn away from making another wrong without abandoning yourself when you are hurt and afraid of being unloved.
Tell me a story of who you are, and see who I am in the stories I am living, And together we will remember that each of us always has a choice.
Don’t tell me how wonderful things will be… someday. Show me you can risk being completely at peace, truly okay with the way things are right now in the moment, and again in the next and the next and the next…
I have heard enough warrior stories of heroic daring. Tell me how you crumble when you hit the wall, the place you cannot go beyond by the strength of your own will.
What carried you to the other side of the wall, to the fragile beauty of your own humanness?
And after we have shown each other how we have set and kept the clear, healthy boundaries that help up live side by side with each other, let us risk remembering that we never stop silently loving those we once loved out loud.
Take me to the places on the earth that teach you how to dance, the places where you can risk letting the world break your heart, and I will take you to the place where the earth beneath my feet and the stars overhead make my heart whole again and again.
Show me how you take care of business without letting business determine who you are, When the children are fed but still the voices within and around us shout that soul’s desires have too high a price, let us remind each other that it is never about the money.
Show me how you offer to your people and the world the stories and the songs you want your children’s children to remember, and I will show you how I struggle, not to change the world, but to love it.
Sit beside me in the long moments of share solitude, knowing both our absolute aloneness and our undeniable belonging. Dance with me in the silence and in the sound of small daily words, holding neither against me at the end of the day.
And when the sound of all the declarations of our sincerest intentions has died away in the wind, dance with me in the infinite pause before the next great inhale of the breath that is breathing us all into being, not filling the emptiness from the outside or from within.
Don’t say, “Yes!” Just take my hand and dance with me.
Burnout alert! 30 November 2008 11:12 PM
During my early years of practice I was totally unprepared for the world that I was eagerly looking forward to dwell in after training. The upsurge of scientific knowledge has changed the landscape of medicine, and the hapless clinician sometimes finds himself drowning in the overwhelming immensity of information that he has to cope with if only to keep himself up to date and offer the best possible therapeutic possibilities to his patients.
But beyond mere clinical competence, I realized that my training did not prepare me well for the equally crucial facet of doctoring as it failed to address the human and psychosocial aspects of caring for people with a disease as dreadful as cancer. I am grateful to my consultants who taught me the essential knowledge and aptitude to manage cancer. Evidence-based medicine with its emphases on unassailable research designs and protocols, on highly sophisticated machines and tests in the medical armamentarium, and on thorough analyses and peer reviews became our mantra, meant to convince patients and their families of gold standards and best clinical practice guidelines as well as to set the profession apart from mere quackery or folk remedies. Evidence-based medicine has become the benchmark by which doctors protect their patients and the profession from the immoderation of traditional healing practices and even “anecdotal” medicine.
Armed with the best training a doctor could possibly acquire, I went home eager and optimistic only to realize that even the most sophisticated targeted therapies and nanoparticle designer drugs were not enough to address the emotional needs of the patients and their families. Even the best and latest discoveries that conferences around the world have been enthusiastically talking about could not wholly assist the patients in accepting the truth about their diseases, in making rational choices on treatment and supportive care, and in adapting to the myriad spectra of signs and symptoms that breast cancer or leukemia or prostate cancer brings.
Dr. Lidia Schapira from the Beth Deaconess Medical Center in Brooklyn offers a solution that integrates the “disease model,” which embodies the medical diagnosis and the pathophysiologic mechanisms of the disease, with the “illness model,” which looks into the patient’s conceptual and experiential knowledge of cancer. She wrote “Training should be flexible and creative enough to allow us to weave there two perspectives into a unique narrative that completely captures the reality of each clinical encounter.”
Grief, futility, exhaustion, guilt and the existential aspects of being a doctor are harsh realities of practice that must be confronted by a medical oncologist. When I first dreamed of being a doctor, I pictured myself like I was Superman who is able to save the world from aliens and predators and resentful Lex Luthors, and even find time to rescue a hapless kitten up the tree. The road I’ve taken seems remotely detached from the picture-perfect reality TV fare especially when one thinks about the cold facts: that more than half of patients are usually seen in the terminal stage, that 43% of Filipinos die of cancer without medical attention, that one out of two Filipino cancer patients succumbs to the disease within a year, and that most Filipinos can hardly afford the basic treatment. In this setting, a medical oncologist is constantly besieged and sometimes crushed by tsunamis of bad news, untimely deaths, treatment failures and disease recurrence, patient suffering, medical futility and death.
Most people see doctors as caring, compassionate and honest professionals who are able to guide, educate and comfort them with their knowledge and training during the most trying times. Sometimes they forget that doctors are people too, given to their own flaws and prejudices, judgments and designs for self-preservation. Physicians as no less human than the average Joses and Marias, in fact many of them are drawn to the profession through their sensitivities to the needs and sufferings of others.
Unlike the other subspecialties like cardiology or pulmonary medicine, the care of cancer patients requires certain fortitude to get over the fact that patients will continue to die despite the best efforts and greatest intentions. Some of my mentors took this career path with a sense of optimism about the future and about the promise of medicine to alter the natural history of cancer from a debilitating and fatal illness into a controllable chronic disease for many patients. Most medical oncologists of my generation often view the subspecialty as an opportunity to look after the needs of people during periods of intense vulnerability.
While cancer doctors breeze through the day with unsullied dedication to the profession, they often have little time to debrief themselves, to process their own sorrow about a patient’s suffering and death. The next patient simply needs his time. Whatever time is left of him is appropriated for paperwork, guidelines, administrative matters and the fear of a litigious environment. Thus, personal unresolved emotions are shelved in favor of patient care and institutional demands. As in many of life’s invitations, these rain checks are bound to stack up, allowing these unresolved emotions to overflow. When compassion is exhausted and burnout is at work, the doctor becomes callous, distant and technical, and renders him ineffective.
Every oncologist must recognize these issues in order to achieve renewal and well-being. There are approaches through which doctors in danger of burnout could channel their emotions; journals speak about limiting workload, designing flexibility in scheduling, even developing coverage systems with colleagues. Other avenues include pursuing self-care activities, nurturing personal relationships, developing a life philosophy that promotes balance between personal and professional lives, and engaging in spiritual practices.
Over the years, I have learned to infuse my routines with generous doses of distractions, those activities unrelated to the practice of my profession that offer relief from the onslaught of grief, exhaustion, burnout and existentialism that I face daily. Mason Cooley, famous American aphorist, wrote about this once: “My mind is led astray by every faint rustle.” Talk about taking one’s mind off the niggling vexations of daily habits. I tried practice shooting once and realized that the sight, the nuzzle and the trigger should work in sync or one is bound to waste those blanks needlessly. Those rare times when I managed to hit the target occurred after I pictured this nephrologist’s mug staring at me from the bullseye. But then, that was an even more gratuitous misuse of blanks. So I moved on to other less frightening things that prevent one from recapturing a constant picture of her bloated visage. Sometimes, I take trips or photographs.
But I realized that I need not venture farther than my own office. I now find joy in every encounter with the patient and his family, realizing that each meeting shapes not only their lives but also mine. Each session has taught me that the fundamental tools in my trade are my senses: sight, hearing, touch. There are times when I am thankful to the late Dr. Alex Panuncialman, former dean of the Davao Medical School, for instilling in every medical student the value of fortitude, of looking beyond mere anatomy and physiology. With the most trivial things in life, he taught me how to look closely, to listen intently and to feel deeply, which are what he called the basic skills of a doctor.
In talking with my patients and their families I do not simply give medical options and technical expertise, but I also give of myself. These sessions that sometimes last for hours have a clever way of teaching me how to be truly human, how important human relationships are, and how powerful human connections can be.
| | Tricia just turned 7 last 24 November. Kids grow fast these days.
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Serendipitous
 Last minute rush for pizza at KCC yesterday. Passed by Booksale. As if by instinct, went straight to the magazine section (which I don’t usually do). Found on top the stacks of back issues on racing and yachting a brand-new-looking hardbound copy of Joan Didion’s The Year of Magical Thinking. Let out an orgasmic bellow! And the best part. Only thirty five pesos!
The Year of Magical Thinking is an account of the year following the death of the author's husband John Gregory Dunne (1932-2003). Published by Knopf in October 2005, the book was immediately acclaimed as a classic in the genre of mourning literature. It won the National Book Award in November 2005 and was a finalist for the National Book Critics Circle Award as well as the Pulitzer Prize for Biography/Autobiography.
I am a lucky man. Indeed.  | Lanterns | Nov 25, '08 2:39 AM
for everyone |
A Parent’s Pledge and Twenty-Five More Lessons for Life 24 November 2008 11:24 AM
Picked up an old book last night by Marian Wright Edelman. Lanterns tells of the author’s experiences from her life at the center of the civil rights struggles through persons who were her mentors (Martin Luther King Jr., Robert Kennedy, Mae Bertha Carter, Dr. Benjamin Mays, etc.) The book is a perfect counterpoint to where America had been in the past as it looks to the future with the election of its first Black president.
Strange, but I realized the last part of the book was also a fitting counterpoint to the hate and lies that some people in the vicinity have been sowing for weeks. In it she shared 25 lessons for life that had been taught to her by her parents and elders. The message was not about what adults tell the children; it is about what adults do and value as parents, citizens, educators, community leaders. It is about the need for adults to struggle to live what they preach, to say what they mean, to mean what to say, and to be what they seem.
A Parent’s Pledge I pledge to: Listen to my children.
Communicate with my children.
Teach my children right from wrong and be a good role model for them.
Spend time with and pay attention to my children.
Educate my children in mind, body and soul.
Work to provide a stable family life for my children.
Vote for my children to ensure them fair treatment and opportunity.
Speak out and stand up for my children’s needs and support effective groups that help children.
Looking back at my life, I can say that my parents had struggles with raising all of us in the face of several constraints. But together with my uncles and aunts, they have tenaciously fought life’s limitations to enable the children to grow up in a decent, respecting and loving environment. It is my prayer that my own generation (Senen and Lalaine, Francis, Odette and Edwin, Boyet and Beth, Lansel, myself) could also pave the way for the next to live in the same world as we did.
25 More Lessons for Life
Lesson No. 1 Always remember that you are God’s child. No man or woman can look down on you and you cannot look down on any man or woman or child.
Lesson No. 2 Don’t wait for, expect, or rely on favors. Count on earning them by hard work and perseverance.
Lesson No. 3 Call things by their right names.
Lesson No. 4 Don’t listen to naysayers offering no solutions or take no or but for an answer.
Lesson No. 5 Don’t be afraid to stick your neck out, to make mistakes, or to speak up.
Lesson No. 6 Keep your word and your commitments.
Lesson No. 7 Be strategic, focus, and don’t scatter your energies on many things that don’t add up to a better whole.
Lesson No. 8 Watch out for success. It can be more dangerous than failure.
Lesson No. 9 You can’t do everything by yourself but you can do a lot.
Lesson No. 10 Asking the right questions and measuring the right things may be more important than finding the right answers.
Lesson No. 11 Travel lightly through life and resist the tyranny of burdensome and unneeded things.
Lesson No. 12 Be a pilgrim and not a tourist in life and don’t confuse heroism with fame and celebrity.
Lesson No. 13 God has a job for all of us to do. Open up the envelope of your soul and try to discern the Creator’s orders inside.
Lesson No. 14 Follow the Golden Rule rather than the world’s silver, iron, bronze, and copper rules.
Lesson No. 15 Bear all or most of the criticism and share all the credit.
Lesson No. 16 Be real. Try to do what you say, say what you mean, and be what you seem.
Lesson No. 17 Avoid high-maintenance, low-impact people and life on the fast lane.
Lesson No. 18 God did not create two classes of children or human beings – only one.
Lesson No. 19 Don’t ever give up on life. It is God’s gift. When trouble comes, hang in.
Lesson No. 20 Strive to be a good parent.
Lesson No. 21 Be a god ancestor. Stand for something bigger than yourself. Add value to the Earth during your sojourn.
Lesson No. 22 Don’t let anything or anybody get between you and your education.
Lesson No. 23 Never judge the contents of the box by its wrappings.
Lesson No. 24 Take responsibility for your behavior. Don’t make excuses, blame, or point fingers at others or hide behind “everyone’s doing it.”
Lesson No. 25 Possessions and power don’t make the man or woman: principles, character and love do.
Edelman is the president of the Children’s Defense Fund and author of several bestselling books.
Lights to Remember Them By
22 November 2008 11:32 PM
 Sr. Lourdes and I are excited about a project we are spearheading for the Pastoral Care team at the Doctors Hospital. The Pastoral Care Team, composed of hospital employees who volunteer their time and conveniences to provide spiritual and psychosocial support to admitted patients especially those with terminal and chronic illnesses, has been meeting for the past months in preparation for the tasks ahead. The team sees a lot of opportunities for helping patients cope with their needs during hospitalization. Meetings were conducted to really define individual goals and motivations for volunteering to minister to patients.
The team is launching a project for this Christmas season which will not only speak to the community about the values of love, family and friendship, but will also raise some funds for the team when it goes full throttle with its activities in the coming year. We call this project “The Christmas Memorial Lights.” Any individual who wishes to remember a loved one, a family, a dear friend or even a patient can donate a specified amount to the team’s fund. The team will coordinate with the engineering department about putting up a wall or a tree where a bulb will be placed in memory and honor of the deceased. The memorial lights will shine throughout the entire month of December as constant reminder that in a season filled with love and hope we also remember the beloved departed ones.
The project was patterned after the fundraising activity at the St. Christopher’s Hospice which earns no less than a million pounds each year. The lighting of the tree gathers families and friends of former patients, supporters, local groups and congregations and the staff of the hospice for a heartwarming and sentimental celebration of life, love and leaving. It has become so big that during the first day, 2 blocks of Lawrie Park Road in Sydenham are closed to traffic.
First heard this song from the GREATEST HYMNS album of Selah that was released in 2005. Written by David Grow and featuring Jim Brickman on the piano, this simple song tells of the steadfast unyielding presence of the Lord in our lives. At a time when patience and perseverance are tested, this song offers both a refuge and an inspiration.
Oh Lord I come with heart here open,
For in my hour of darkness I’m in need.
Seeking the joy of love unspoken
Oh Lord be Thou near to me.
And the holy voices “Hallelu!”
Ever will Thy reign be.
As I wander through this life,
Oh Lord, be Thou near to me.
Though In this burden of my making
Yet in the shadows still a light I see
Maker whose love is not forsaking
Oh lord be thou near to me
And the holy voices “Hallelu!”
Ever will Thy reign be.
As I wander through this life,
Oh Lord, be Thou near to me.
And the holy voices “Hallelu!”
Ever will Thy reign be.
As I wander through this life,
Oh Lord, be Thou near to me.
Oh Lord
Be thou near
To me
| Be Thou Near To Me | | Greatest Hymns | | Selah | |
| Mentors | Nov 25, '08 2:24 AM
for everyone |
Daddy Copia 21 November 2008 9:04 AM Was having breakfast at Jollibee with Tricia when I chanced upon one person who made so much impact in my life way back in college. Mr. Romeo Copia (Daddy Cops to most) was my Catholic theology professor in Notre Dame who gave the most impressive and erudite lectures about the church. His grasp of the subject was so deep, listening to him was then a natural high. But he was also generous enough to allow students to ask probing questions and even personal issues. I was not even supposed to be attending his classes. Back then, non-Catholics were required 4 semesters of “Protestant” theology while Catholics completed 6 sems of theo classes. As a Baptist, I would have been OK with the requisite 4 units, but I took extra classes in Catholic theology just to be in Mr. Copia’s class. Among the things that I brought along with me now is the truth that priests could only be infallible if they speak through the magisterium; otherwise, they are as human as I am. (“Magisterium” – the word – became quite controversial recently when The Golden Compass was shown in cinemas. Some critics even went as far as calling the movie and the book from where it was based “blasphemous.”) Daddy Cops is a little frail now, moves a little slower, but still speaks with the voice that commands both respect and awe. I momentarily became an enraptured college student again in the presence of one of the persons I consider my mentor. I have been blessed to have mentors, men and women of courage, vision and integrity, who in their own way taught me the values of an excellent life, one that instilled in me the primacy of the here and the now and of the eternally faithful presence of God in my daily life. Mentor was the name used by Homer for the old and faithful friend of King Odysseus in The Odyssey. The goddess Athena impersonated Mentor to inspire and impart wisdom to prepare Telemachus, Odysseus’ son, for his journey in search of his father. Disclosures 20 November 2008 9:25 AM
Recently an old friend asked me about my views regarding the much-maligned doctor-medical rep relationship. He had heard a lot of stories about colleagues in the profession who “abuse” the benefaction and the reliance of drug companies. I was quick to correct such reckless generalization as I believe that majority of doctors still draw a sharp line between crass exploitation of and symbiotic liaison with the pharmaceutical industry. But it also cannot be denied that there were instances when that line is similarly blurred or crossed.
I was on my second year of practice (Inday had just passed the boards) when my youngest brother was taken by a promising local pharma company as a sales representative. Having grown up in a family of doctors, he had high regard for members of the profession through the conduct of his uncles, aunt and cousins. But he was not prepared for what transpired during the first day of work that he went home literally vomiting and having severe headaches. From disenchantment perhaps. Or from revulsion even. He was asked by one doctor to fetch a daughter from school, and then ordered to buy booze for the doctor. He resigned immediately. It probably scarred him for life. Seeing how difficult it was for him, I vowed to myself never to personally let another person from the pharma industry go through that humiliation again.
I have only but deep respect for the pharmaceutical industry. It has made it easier for me to obtain my subspecialties with the scholarships that they give to fellows-in-training. I was a Pharmacia “scholar” in Hematology until mergers enabled me to graduate as a Pfizer fellow after the multinational giant absorbed the smaller Pharmacia. Pfizer also supported me when I had my Medical Oncology fellowship. As to why they would sponsor someone from Mindanao was beyond me but I can hazard a few assumptions: (1) That they are committed to the improvement of the health status in the country as part of their company’s advocacy by making it possible for Filipino doctors to pursue subspecialty training; (2) That they see a win-win solution in earning “pogi” points from the consultants who are well entrenched in their practice in the metropolis and who patronize their products; (3) That they have been arm-twisted by powerful consultants into signing a memorandum of agreement with the section; and (4) That they see the trainees as potential “investments” who could well patronize their products when they become consultants themselves. I would like to believe that altruism is the driving force behind this sponsorship but I can also easily understand the economic side of things. In fairness to Pfizer, it has never made an outright attempt to remind me of “what I owe them” and then make references to their products. They are among the most respectable and respectful players in the industry and this is certainly among the reasons why Pfizer is one of the biggest, most admired and more dynamic companies in the world.
The relationship between the medical profession and the pharmaceutical industry in the Philippines is one that sparks a lot of controversies. Especially among those who are not doctors; oftentimes, this “friendship” is constantly eyed as one of the main reasons why drugs in the country are among the most expensive in the world. Doctors are wined and dined, brought to exclusive golf courses abroad for a round or two, even whored. That these things actually happen is a shame to the profession and actually negates the majority who maintains an unwavering commitment to the highest ideals of professional conduct. I believe it has become so rampant that both the Philippine Medical Association (PMA) and the Philippine College of Physicians (PCP) have provisions in their Code of Conduct about how members should behave towards the pharmaceutical industry as a whole.
There are certain issues pertaining to a doctor’s relationship with the pharma industry that I feel strongly about. These are personal beliefs that I have formed over the years. I make no pretense about these convictions as gospel true and right, but I stand by these codes in the clinical practice.
I view the pharmaceutical industry primarily as a business enterprise with social responsibility. I see these drug companies as for the most part business entities investing millions in the research, development, marketing and promotion of drugs that will answer the needs of patients worldwide. With each successful launching of a new drug, every company stands to earn megabucks in profits. I see no problem with that; they simply reap what they sow. Still, I would like to think that beyond mere economic remunerations, the company has a conscience that covers everything, from drug development to marketing, that the highest standards of research and ethics are complied with. I admire companies that do not only have the pulse for what the world needs (thus taking innovative, even risky, strides to address some of the world’s dreaded scourges) but also the heartbeat for what the needy world can afford and sustain. Simply put, safe, effective and affordable drugs are what every patient needs.
I agree with Jerry Avorn (Powerful Medicines, Knopf, 2004) when he wrote that “many pharmaceutical company researches perform vital work developing useful new medicines, and the industry can be one important source of drug discoveries as well as an innovation engine for the economy as a whole.” But he also cautions about the fact that “few benefit when the creative potential of the industry is diverted into promotion-driven distractions that produce overpriced products of little value, or into corporate efforts to protect dangerous drugs rather than the patients who take them.”
Economics plays a significant role in a doctor’s prescribing habits and in the patient’s compliance to medical advice. Reports say that drugs in the Philippines are among the most expensive in the world, and coupled with the lack of comprehensive government health care system, cost is something that an average Pinoy patient has to get through every day. Oftentimes when a doctor knows that his patient cannot afford the standard treatment, he prescribes against his best medical judgment an option simply because it is the choice that the patient could afford and sustain, while praying that somehow the patient responds after all. When I am confronted with this situation I couldn’t help but squirm with both discomfort and torture because it seems objectionable from an ethical perspective, dangerous from a political (public health) perspective, and irrational from a medical perspective.
As a medical oncologist I am fully aware of the power of the medicines to affect the survival and quality of life of many patients. The drugs that I give may alleviate a patient’s pain and even arrest the growth of his cancer, but these same drugs may also cause another’s discomfort and morbidity with its inherent complications and toxicities. A remarkably effective drug for one patient may be useless for another; thus, I appreciate drug companies that highlight not only the efficacy of their products, but the side effects as well. I value my relationship with the pharmaceutical companies principally on the premise that this interaction allows me to make informed choices for the benefit of my patients. The patient’s best interest remains the means and the end of this relationship, whatever is superfluous to it is of marginal consequence. Thus, it should be nurtured with utmost reverence and assiduousness. If it is something that becomes personal like sincere friendship and fastidious symbiosis, these are blessings that are an offshoot of mutual respect and goodwill. With the medical representatives, I keep a prudent distance that allows ample breathing space for deference and professionalism, but still close enough for unimpeded communication and openness. While considered endemic in the doctor-med rep landscape, obsequiousness is something that I couldn’t allow if only for my respect to other people and especially to myself.
Against my vehement dissent, one rep “serviced” me 2 Saturdays ago. That’s the actual term people use, and “servicing” is a word that makes me squirm with discomfort for its negative connotation in pop literature. In med rep jargon, it could mean anything that assists and addresses the needs of a physician from simply errands to food to transport. Whoever devised this term must have been clever enough to infuse a derisory subtext. But there I was agreeing to be “serviced” to Davao for the PCP contest. In the past I was more comfortable in taking the bus: just a short trip anyway, snugger seat, bigger leg room, I wouldn’t have to worry if I sleep (or even snore) all the way as I am wont to, etc. But Maam M was insistent, telling me that she faces a reprimand if ever I get to the venue late, so I reluctantly acquiesced. By the time we reached Tinagakan, I had to politely ask if it was OK to sleep as I didn’t have enough, re-reading the papers the night before. Woke up later in Padada and conversation went this way:
Me: (Upon waking up) Maam M, how come there are toys stuffed in many places in your car? Maam M (MM): They’re my kid’s, she 2 years old. She’s an angel, my Mom’s taking care of her now. Me: See, that’s what I have been telling you. MM: About what doctor? Me: You could have agreed not to service me today. You could have spent the weekend with her. MM: Doctor? Me: See how thoughtless this thing is? I deprived a 2 year-old of a weekend with her mother when I could have easily taken the bus… MM: Is this true Doc? May doktor pa bang ganito? Me: Oo naman, marami pa rin sa Gensan. Sa building lang namin marami. Kung sino yung akala ninyo suplado, yun ang may respeto sa inyo at sa sarili. You just have to know them…
Throughout my journey as a doctor (from clerkship to internship to residency/fellowship to present practice), there are certain limitations, certain “codes” that I set for myself as far as my dealings with the reps are concerned. These are purely personal and have nothing to say about the rest of my colleagues in the profession.
§ I haven’t sold a single tablet of sample in my life. My friends during internship and residency used to call it HB (“hanapbuhay”), but I survived training without resorting to it. Maybe I just understand the phrase “Physician’s Sample Not For Sale” for what it simply means. § I can’t ask a med rep “Bakit di mo ako kinocover?” It’s a matter of company policy and I just have to abide by that. I can’t take it against a particular rep if ever I am not in his list. Besides, I feel that it is part of a doctor’s commitment to giving the best for his patient to search the literature regardless of the drug company’s effort to provide him with one. Of course, I am grateful when pharma people bring me peer-reviewed articles, appreciate them more than the items that they give me. This is probably why I get easily irritated during coverage when a rep comes up to me and tells me, “Sorry, Doc, wala akong dala para sa inyo ngayon.” I usually tell him right away that “You are not required to bring me anything in the first place.” § Never once demanded “Pakain ka naman.” Somehow I am earning enough to buy my own food. Not so much about pride and arrogance, getting invited to dinner is one of the many genteel avenues in an adult life to derive honest and sincere conversation, one that is devoid of airs and conventions, but to actually put someone in an uncomfortable situation by openly asking for a free lunch or dinner is not at all respectful/respectable. The med rep can always refuse, why not, but in the context of MD-pharma politics, how can he? I have been faithful to this self-imposed rule for years now: when reps invite me out to dinner or lunch here in Gensan, I pay the bill; otherwise, the answer is No. If they are not comfortable with that, then we split the bill. Lately, I discovered the convenience of meeting reps at the hospital canteen. Beyond cheap and good food, it does not take me away from work for so long. At the canteen, stripped of our injudicious self-importance and of fancy expectations, we became real persons, as raw and as honest as we can be. I cease to be an arrogant consultant and the rep transcends his dignified salesman persona; instead we become equals, even friends, just having good-not-to-mention-cheap food together. Coupled with sincere conversation, it’s a relationship that is set for life. (The pun works here: “for life” may mean perpetuity, our patient’s lives, our lives.) Last time I had lunch with a rep from Cebu, we had dilis and pancit to go with rice. Nothing contrived, nothing fancy. Just simple comfort food, simple comfortable conversation, simple comforting afternoon. Out of Gensan, the rep can treat me out to lunch or dinner, I see no problem with that. There’s a caveat: in fancy restaurants, we choose the simplest or least expensive entry in the menu and nothing beyond 2 entrees. When McDonald’s was still not in Gensan, I was happiest with a BigMac. § I have been a commuter for months now, something that I am comfortable doing already. I have long discarded personal issues about taking a tricycle or a motorcycle or even a walk from one hospital to the next (even if some people find that unfortunate, that’s their issue, not mine). When a rep offers me a ride to the hospital, for example, I consider it as something borne out of goodwill and friendship, and not out of an “obligation” that is non-existent in the first place anyway. That is something that is too shameful to impose on them. And as much as possible “servicing” on Sundays is a no-no (reps have families too and I couldn’t begrudge them the joys of just being with loved ones on that day). § Trips are the perks in a doctor’s life especially to a medical oncologist. I have always viewed these trips as opportunities for professional/personal growth rather than “remunerations” for prescribing a company’s products. I am deeply grateful to the companies who make these trips possible. But I refuse trips when they are primarily junkets, reps know that. I don’t specifically ask for sponsorship for a specific trip, although I appreciate it much when they allow me to choose meetings that I would like to be part of. For example, I would prefer palliative care meetings over product launchings anytime. I fully understand that in the context of the pharmaceutical industry being a business enterprise, doctors who patronize a company’s products are rewarded with trips abroad. I see nothing wrong with that; in fact, I believe that is only fair and an integral element in free enterprise. Patients need the products, doctors prescribe them, company appreciates the patronage and rewards the benefaction (in the exact order of acts). What is revolting is when priorities change like: Company appreciates a patronage and a reward is dangled, doctors prescribe them, patient need is created for the products. Strange, but it can actually happen. I remember one conversation in my clinic: Supervisor: Doc, nasilip ko yung account mo, konti na lang pwede ka nang mag-ASCO (American Society of Clinical Oncology annual convention in Chicago) this year. Me: I have never been so insulted in my life. You know me from way back in residency, we are friends. But if you do that to me again, there are 2 things that I can do: I will politely ask you to step out of my clinic or I will throw you out of it. § I have a little personal “issue” with doctors dispensing medicines on their own. When I first set up practice in Gensan, I tried to help my patients with procuring chemotherapeutic drugs for them since none of the pharmacies carried the products here in Gensan. Until I found out I had difficulty concentrating on my clinical practice while going through receipts, reimbursements, rebates, refunds, etc. Knowing that this is one way of helping my siblings, I asked them to put up a legitimate pharmacy that shall carry the products that my patients need. I have also seen how patients and their families appreciated the support system that makes the drugs readily available to them. Thus, FNS pharmacy was established after going through the usual course (DTI, BFAD, local government, etc.) My brothers run the enterprise and I have always been too careful not to interfere in the daily affairs of the pharmacy. My only request to my siblings is to think beyond mere profit, that patients need these drugs and it is a great service to them if the prices could be kept reasonably fair. I often tell the reps “Kung clinical information, talk to me, pero kung business matters, talk to them.” I have no personal gains from the pharmacy. § I will never willfully and casually ask someone from the pharmaceutical industry for personal favors in exchange for my use of their products. I will not prostitute my profession even for the promise of money and personal conveniences. And I will never abuse my stature as a doctor vis-à-vis my dealing with the pharmaceutical industry. I return the flight tickets that I don’t use, I don’t ask for multiple sponsorships to a specific event with the aim of keeping the unused accounts for future use, and I don’t ban reps from their “coverage” for trivial reasons. I admit that I have in the past asked a couple of companies to keep a comfortable distance, “breathing space” I called it, for a period of time after what I believed was unprofessional conduct on their part. Despite these unfortunate instances, the companies involved could never accuse me of depriving my patients with their products. I could never allow my professional, even personal, issues with the pharmaceutical companies cloud my judgments and choices pertaining to patient care and accountability.
I only have respect for the pharmaceutical industry. I am sure they feel the same for my profession in general.
I told my friend not to worry about what he had been hearing about the MD-Pharma relationship, most doctors in this country are honorable men and women who can sagaciously discern the true from the false, the right from anything that puts the entire profession in a harsh, piercing light.
| Bo. 8 | Oct 31, '08 10:29 AM
for everyone |
 CHILDREN LEARN WHAT THEY LIVE by Dorothy Law Nolte
If a child lives with criticism,
he learns to condemn. If a child lives with hostility,
he learns to fight. If a child lives with fear,
he learns to be apprehensive. If a child lives with pity,
he learns to feel sorry for himself. If a child lives with ridicule,
he learns to be shy. If a child lives with jealousy,
he learns what envy is. If a child lives with shame,
he learns to feel guilty. If a child lives with encouragement,
he learns to be confident. If a child lives with tolerance,
he learns to be patient. If a child lives with praise,
he learns to be appreciative. If a child lives with acceptance,
he learns to love. If a child lives with approval,
he learns to like himself. If a child lives with recognition,
he learns that it is good to have a goal. If a child lives with sharing,
he learns about generosity. If a child lives with honesty and fairness,
he learns what truth and justice are. If a child lives with security,
he learns to have faith in himself and in those about him. If a child lives with friendliness,
he learns that the world is a nice place in which to live. If you live with serenity,
your child will live with peace of mind. With what is your child living? 
Source: Canfield, J. & Wells, H. C. (1976). 100 ways to enhance self-concept in the classroom: A handbook for teachers and patents. Boston: Allyn & Bacon.
Exciting November Am truly excited about the coming month. Dicang’s Dictum for the family council. Lectures in Cagayan de Oro for the residents and the nurses, then the PCP Research Contest in Davao, currently perusing through 19 accomplished papers for judging. Moving into a new apartment. And driving lessons. Writing classes for high schools. New directions for the local cancer society. Applying for a diploma course in palliative care at National Cancer Centre Singapore-Flinder’s University. Third issue of GSDH Stories from the Heart in printing. Book reviews for an international palliative care journal. Launch of the Cultural Center of the Philippines ANI Yearbook where an essay is anthologized. Boxing classes, hopefully. All in the first half of the month! This frenzy calls to mind my favorite dedicatory epistle from George Bernard Shaw’s Man and Superman. “This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being a force of nature instead of a feverish, selfish little clod of ailments and grievances, complaining that the world will not devote itself to making you happy. I am of the opinion that my life belongs to the whole community, and as long as I live it my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work, the more I live. I rejoice in life for its own sake. Life is no brief candle to me; it is a sort of splendid torch for which I have got hold of for the moment, and I want to make it burn as brightly as possible before handling it on the future generations.” Thoughts on Vulnerability While Riding a Tricycle
Sometimes the very things that we loathe strengthen the life in us. As with most of my patients, loss, crisis and even conflict goad the will to live in ways that are previously deemed unthinkable. People who used to think they aren’t good enough may even astonish themselves with random acts of benevolence and audacity. When it happens, people grow bigger than the impediments that box them; surprisingly too large enough to liberate them from issues that constantly nag and haunt, and consequently live beyond these limitations.
I learned a lot of lessons when I decided to become a commuter 6 months ago as part of austere lifestyle changes that I believed would define a simple life. In May I gave up my cable TV subscription, a few weeks later I had my DSL disconnected after reaching the minimum period of subscription. Would I say that my life had been more difficult, less exciting, even boring? Au contraire il est difficile de concevoir quelque chose de plus satisfaisant. Instead of spending countless hours in front of the idiot box munching insalubrious junk that augments avoirdupois as much as it encourages ennui, I buried myself in pages of printed wisdom, sweated a little of the excess pounds in the gym, or simply allowed my OC self more hours of sleep and rest that I initially thought were outrageous. Brushed up on my French which I have long forgotten while attempting to build up the fortitude to remember that the u in gozaimasu and desu is usually not voiced (rather unsuccessfully but ain’t giving up anyway). The amount that I used to spend for cable TV and internet surfing are instead diverted to the funds of the family council; thus, giving some measure to the things that could be easily given up in favor of certain meaningful pursuits that shape and strengthen relationships.
But nothing has taught me more about the wholeness of life than taking the public transport daily to and from work. I am probably the only doctor in Gensan who is fully dependent on tricycles and habal-habal (motorcycles that ply certain routes in the city, often using the backroads to elude the LTO cops) as I move from one hospital to another. When Billy the driver left without notice at the start of the year, I relied on Francis, dear bro who lives just a few meters away, for my daily rounds until he had to beg off to attend to more pressing concerns. However things are perceived now, I will always remember with deep appreciation and fondness the times together. Since I don’t drive I planned of getting a motorcycle myself to which most of the family and friends disapproved considering the incidence of accidents involving two-wheels in the city. Too unsafe, some said.
It was difficult at first but in time I discovered what matters and the value of a Spartan life. In due time the daily tricycle rides to work became my prayer-in-motion, even a sanctuary from everything that is not genuine in me and in the culture that I grew up to. Where was it written that doctors should drive the latest car models? That doctors who take public transport are kawawa or katawa-tawa? But some people I know believe that to be so. Sitting in a cramped sidecar, stooping so low that I fear my chin would brush my knees anytime the trike navigates a hump, I was simply Noel, neither the hematologist nor the medical oncologist, far from the image I have learned to imagine about myself. Inside that vehicle I often start my day taking my masks off and let go of my self-expectations (even self-importance). Some people I know have dismissed this as something that I don’t have another choice anyway and it’s true initially. But later I realized that however one goes to work does not really matter at all. I grew up in a society where image and extensions of it in the form of material possessions are valued highly. Sometimes over relationships. People struggle for self-sufficiency, abundance or mastery and in holding close these qualities become blinkered to deeper human truths like humility, respect and compassion, even contemptuous of anything in themselves and in other people.
This capacity to suffer and accept weakness is a virtue that I have long struggled to overcome. Acknowledging my vulnerability allowed me to connect to other people who too embrace their own vulnerabilities. When I stop pretending to be strong and independent, I draw out the instinctive kindness in other people. By showing this soft side, people tend to be more helpful, more generous, and even more appreciative of what they have. Simple endorphin rush! They feel good about themselves in a noble, unselfish way, just being able to hold on a door for someone to pass through it. I live in a village that’s a bit far from the city so that I try to avoid staying out late. Looking back at those 6 months, I realized how dear friends are, colleagues who are otherwise tired from their busy practice but take the extra pains to bring me home and see me step into the gate safely. Ruth and Toto, Jiji and Oliver, Uchie and Toto, Beth and Nonoy, Junjun and Gigi, Laurence and Elna, Jolyle, Naat and Fernan, Ems and Floro, Annie and Choy, Jo Ann, Bong, Naty, Amor, Dra. Viv, Donna, Allan, and to others who escape memory, salamat! In Medicine, it is often taught that part of being a professional is to allow for some space, even distance, to be objective. I learned from these people some truths, that to truly serve others one must do it not only with the hands and eyes, but with the heart and soul as well.
There is more to learn from life’s precarious edges than being in the safe comfortable middle. Taking the public transport for the past 6 months has definitely shuffled my belief systems like a deck of cards. While others might see this as something sad or pathetic, there is much wisdom about a card that had been at the bottom of the deck for most of my conscious adult life suddenly turning up the top card, the one that really mattered at the end of the day. My patients with cancer, and now the tricycle and habal-habal drivers, have enriched my life with their example: that no matter how carefully they sort their cards and repeatedly shift through their hands in the presence of death or material inadequacies, the top card is rarely possession or superiority or control. Some people call it respect or goodwill. Doctors who honor the Hippocratic Oath call it harmlessness. Others view theirs as integrity. I call mine love.
 By the River Pactolus
Looking at my niece Tricia the morning after her dad’s 37th birthday made me realize how ripe kids' lives are with the promise of infinite possibilities if we can only learn to touch their lives in ways that allow them to be their true selves, able to embrace what is good in this world without hampering their innate gift to choose for themselves.
Over dinner Boyet put it simply, I can only guide her through her formative years. However she decides to take on her life as an adult is beyond me but I can only hope that she wont forget what I am teaching her now. I can only but love and accept her. She need not be better than the next person as long as she knows what respect for other people, love for family, and goodwill to all mean.
This reminds me of the Midas story. As reward for a selfless act, the Greek god Dionysus granted King Midas one wish. Midas wished that everything he touched would turn to gold. The flower turned to gold, a simple stone became priceless when touched. Midas was rich beyond his wildest imagination. He thought he was happy.
Alas, the food that touched his lips turned to gold, so he started becoming hungry. Even his beloved daughter he reached to became golden. Heartbroken, Midas repented and begged the gods to free him of his wish.
The curse was lifted after bathing in the River Pactolus. He brought his daughter as well and restored her to life after a bath.
Midas had his beloved daughter back. He was able to eat. He was no longer heartbroken. He was no longer alone. And in his heart he felt he was indeed the richest man in the world.
Blessed are the children and even blessed are their fathers who nurture their greatest good. The River Pactolus constantly flows from their loving hearts.
[hamming for Tito Noel] Those hospital ads Hospital advertisements in newspapers used to be the bland, uninteresting pieces that most ad agencies would be ashamed to be associated with. In most cases, these half- or full-page placements announce the institution’s acquisition of new state-of-the-art equipment, a milestone that most consumers would really not bother about like an anniversary or an accreditation by an obscure evaluating body. Sometimes the picture of the hospital board in their whites, looking smugly as if they were made to do something against their will, beside the newly-acquired CT scan appears tacky. Recently, with cut-throat competition among the leading medical centers, ads have been improving much especially in terms of a well motivated campaign that adheres to basic advertising principles: more focused emphasis on consumer benefits and promoting an attribute or service that is simply much superior to the competitors. Among the noteworthy ad placements: St. Luke’s Medical Center has recently featured prominent persons who have gone through its doors and came out healthy, happy and satisfied. “… only hospital in the Philippines that is better equipped than 95% of hospitals in the US” “… boasts of both foreign trained and locally trained experts” Manila Doctors Hospital gathered some of its notable consultants are leaders in their respective medical societies and deans/associate deans in the country’s largest and most respected medical schools. “More than state-of-the-art equipment and the latest innovation, your doctor is the single most critical factor you must consider when in need of health care services. At Manila Doctors Hospital, we have just that, better doctors, under one roof. So, next time, before deciding on who will provide your health-care needs, think of Manila Doctors Hospital. After all, your health must be managed by those who are better than the best.” Ads even adorn some large buses that ply the major thoroughfares. I saw a colorful ad once along Paseo de Roxas with a smiling guy beaming with how he got the best treatment without the prohibitive cost that is associated with most large hospitals. Turned out to have been placed by the Victor Potenciano Medical Center. The swanky Asian Hospital and Medical Center, long known for its lobby that “looks like a plush hotel,” had an ad underscoring the primacy of its staff: “At Asian Hospital, we have with us leaders in the medical field who are well-respected – here and abroad – in clinical practice and medical academe. Aided by advanced medical technology and a highly focused staff, these medical leaders have taken steps to embrace new developments in health care.” But the hands down winner for me is the one placed by the Medical City which extolled patients’ rights over equipments, training and staff credentials. Its basic premise argues for “a unique perspective of the patient, not as a passive recipient of care who does what his doctor says, but as an equal and empowered partner engaged in the pursuit of his health goals.” It immediately grabs the reader’s attention and aided by a picture of a seemingly concerned patient in an earnest conversation with a respectable-looking but kindly Doktora, gives a patient a sense of security and sincere openness in a profession that has long been viewed with much suspicion of abuse, mismanagement and arrogance. Some gems: “Doctors can read a chart but they can’t read your mind. The more you share, the better they can help.” “Your life is unique and that makes your condition unique. When consulting your doctor, open up. Tell your story. The more your doctor understands you, the better he can tailor-fit your treatment to your needs. And ask questions. Because the more you know about your condition, the better the choice you will make. Remember, this is your health we’re talking about.” “Your health depends on you and me. Your doctors can prescribe, but it’s you who will decide. The more you know, the wiser your decisions. Ask question. Talk to doc.” Great ad bodies indeed, but an agitated voice inside my head tells me that something is wrong with hospital placing ads in the major broadsheets. Aren’t institutions supposed to upgrade themselves regularly as part of their responsibility to cope with the changing times, the advances in Medicine and technology notwithstanding? Aren’t doctors supposed to update themselves regularly with the latest in medical breakthroughs and basic clinical knowledge for the better management of their patients? Aren’t they expected to become leaders in their fields no matter how small the circles they move about in their respective communities? Aren’t doctors supposed to listen to patients, ask them questions, clarify their doubts, and at the end of the conversation, give the patient the right to decide for his own life? Isn’t patient autonomy and shared decision-making catchphrases that have long been regarded as minimum requirements in a patient-doctor relationship? So why advertise the obvious? These are great campaigns, I agree, and could translate to greater revenues and more respectability to the hospitals placing them. But in the long run, do these ads help upgrade the medical profession? And the whole medical care system in general. To some point I think it may turn out counterproductive after all. Is the Medical City reinforcing the jaundiced view of the public that doctors in their arrogance are actually difficult to talk to? Is Asian Hospital putting forward an idea that respectability abroad is synonymous with better patient care? And who cares about St. Luke’s Medical Center being 95% better than most US hospitals when 95% of the population in the metropolis cannot even afford the cost of hospitalization there? Is Manila Doctors really serious about flaunting its titled consultants when some of the most uncaring, cold and ego-tripping members in the profession actually get elected to positions that reinforce their uncaring, cold and ego-tripping selves? Come on, are we even half-serious here? Is economics all there is to these ads, the cynical self asks? I may not know the answers really, but am looking forward to them in due time. In the meantime, let’s enjoy the ads. (And we’re not even on the subject of doctors acting as spokespersons or image models for certain products.)
 Rope Burns: Stories from the Corner Amidst the feverish anticipation of the Pacquiao-dela Hoya fight, I discovered a richly rewarding collection of short stories by Francis Xavier Toole, “Rope Burns, Stories from the Corner.” Got it for a measly 50 pesos at the local Booksale. This is the 70-year-old former boxer/trainer/corner man’s debut collection of stories and it is amazing how the writer’s prose comes across like the rhythm of a seasoned prizefighter, precise, sharp and determined. In his introductory essay, FX Toole betrays his affection for a sport that most people consider barbaric and inhuman. “Ring magic is different from the magic of the theater, because the curtain never comes down – because the blood in the ring is real blood and the broken noses and the broken hearts are real, and sometimes they are broken forever. Boxing is the magic of men in combat, the magic of will, and skill, and pain, and the risking of everything so you can respect yourself for the rest of your life. Almost sounds like writing.” The 5 stories and the novella in this collection read like a fight card where every story is the main event, illuminating every fighter’s and trainer’s next move as an unrelenting battle for survival hoping that in the end they don’t get beaten and attain even an ounce of personal redemption. ''Boxing,'' says one, ''is an unnatural act. . . . Instead of runnin' from pain, which is the natural thing in life, in boxing you step to it, get me?'' The characters are ordinary humans, flawed as they are noble, and trainers like Con Flutey, Frankie Dunn and Joseph Mary McGee and boxers like Dangerous Dillard Fightin Flippo Bam-Bam Barch, Adolph Dashiki Jones, Cuba Kid Babaloo, Henry Puddin' Pye and Fightin' Maggie Fitzgerald fill the pages like real life neighbors rather than mere creations of the mind. 
Maggie is familiar to most as the Hilary Swank character in Million $$$ Baby, the 2004 Best Picture winner directed by Clint Eastwood and co-starring Morgan Freeman. M$$$B is the story of an under-appreciated boxing trainer, and his quest for atonement by helping an underdog amateur female boxer. The first story in the collection is The Monkey Look which first appeared in ZYZZYVA.. An excerpt: I stop blood. I stop it between rounds for fighters so they can stay in the fight. Blood ruins some boys. It was that way with Sonny Liston, God rest his soul. Bad as he was, he'd see his own blood and fall apart. I'm not the one who decides when to stop the fight, and I don't stitch up cuts once the fight's over. And it's not my job to hospitalize a boy for brain damage. My Job is to stop blood so the fighter can see enough to keep on fighting. I do that, maybe I save a boy's title. I do that one little thing, and I'm worth every cent they pay me. I stop the blood and save the fight, the boy loves me more than he loves his daddy. But you can't always stop it. Fight guys know this. If the cut's too deep or wide, or maybe you got a severed vein down in there, the blood keeps coming. Sometimes it takes two or three rounds to stop the blood, maybe more-the boy's heart is pumping so hard, or he cuts more. Once you get the coagulant in there, sometimes it takes another shot from the opponent right on the cut itself to drive the blood far enough from the area so the stuff you're using can start to work. What I'm saying is there are all kinds of combinations you come up against down in the different layers of meat. When a good cut man stays ahead of the combinations, he can stop most cuts, but not every one. Fights can be stopped for a lot of reasons. A football eye swollen shut can stop a fight. But fights aren't stopped just because a fighter is cut. It's where he's cut. Below the eye, or alongside it, that won't usually stop a fight. Neither will a cut if it's in or above the eyebrow, or up in the forehead, or in the scalp. Broken nose? Sometimes yes, sometimes no. A cut in the eyelid, because of possible damage to the eyeball and the threat of blindness, that can stop a fight quick. So will blood pumping down into a boy's eyes. Blood can blind a fighter, maybe cost him the fight, or worse, because when he can't see he starts taking shots he wouldn't otherwise take, and now he ends up on his ass blinking through the lights and shadows of future memories. Boy gets cut, I always crack the seal of a new, one-ounce bottle of adrenaline chloride solution 1: 1000. When it's fresh, it's clear like water but has a strong chemical smell. The outdated stuff turns a light pinkish color, or a pale piss-yellow. When that happens, it couldn't stop fly blood. I might pour adrenaline into a small plastic squeeze bottle if I need to use sterile gauze pads along with a swab, but I never use adrenaline from a previous fight. I dump it, even if three quarters of it is left. This way it can't carry blood over from another fight, and none of my boys can get AIDS from contaminated coagulant. I'd give AIDS to myself before I'd give it to one of my boys. Trainers and managers and fighters call me. They know me from when I used to train fighters. But I got too old and was walking around with my back and neck crippled up all the time from catching punches with the punch mitts. Boxing is a game of half steps and quarter inches, a game where old men belong as much as the young. Without us, there couldn't be fights. Fans think boxing is about being tough. For members of the fancy, the fight game is about getting respect. My first fight working the corner of Hoolie Garza came after his trainer talked to me, Ike Goody. Ike was a club fighter in the fifties, but like most first-rate trainers, he was never a champ. With the exception of Floyd Patterson, I don't remember another champ who ever made a champion. Hoolie Garza is a twenty-six-pounder, a smart featherweight Mexican boy who thinks he's smarter than he is. Ile was born in Guaymas, a port on the Gulf of California inside Baia. He was raised illegal in East Los Angeles, where he fought, with his big brothers for food. His real name is Julio Cesar Garza, but as a kid he was nicknamed Juli--in Spanish it's pronounced "hoolie." Juli was Americanized to Hoolie, the way Miguel, or Michael, is sometimes Americanized into Maikito. After the Korean War, I went to school in Mexico City on the G.I. Bill. I wanted to learn Spanish, maybe teach it. So I hung around with Mexicans rather than other Americans. Some of my friends were bullfighters. I had a fling with the daughter of the secretary to the president of Mexico, a natural blonde who drove a car with license-plate number 32. She, God bless her, was one of the ways I learned Spanish on several levels and in different accents. I usually keep my Spanish to myself, like a lot of Latinos in the U.S. keep their English to themselves. But if they find out and ask about it, I tell them I was a student in Mexico and Spain both, and I say, "Hablo el espanol solo si me conviene -- I speak Spanish only when it's to my advantage." They always smile. Some laugh out loud and wag their finger. A lot of Latino fighters coming to fight in L.A. use me in their corner; some fly me to Vegas. I'm as loyal to them as I am to an American or to an Irishman, which is why I never bet on a fight I'm working--not on the boy I'm working with, and not on the other fighter. This way, if I somehow screw up and cause my boy to lose, it can never be said that I did business. I simply love this book. Toole’s simple prose reminds me of Hemingway while the richness of his characterizations are worthy of a James Joyce. UPDATE: 31 October 2008. Sobrang swerte ko, found a hardcover copy of POUND FOR POUND, FX Toole's novel that was published posthumously, in the same bin that I got Rope Burns. For only 45 pesos, yes, Someone up there must have loved me so much.
Disordered Blood Clotting in Cancer and its Treatment: As Real As It Can Get  Through complex chemical reactions between the many substances in the blood, the human body is able to prevent or control bleeding by forming a blood clot. This jelly-like mass of thickened blood may become harmful if it blocks a blood vessel (artery or vein) and stops the flow of blood. Called a thrombus, it can cause a stroke if it lodges in the brain or a heart attack if it blocks an artery to the heart. We commonly read about deep vein thrombosis (DVT) which is simply a thrombus in the leg or pelvic vein. An embolus is a thrombus that has been dislodged from its original site only to find its way into the bloodstream and to the smaller blood vessels where it can cause a blockage. An embolus that had lodged in an artery in the lungs is called pulmonary embolism (PE).
In the general population, risk factors associated with thromboembolic events include decreased mobility and prolonged bed rest, indwelling venous infusion catheters, history of DVT, fractures, obesity, arteriosclerosis, oral contraceptives (birth control pills), and smoking.
This disordered coagulation is one of the most frequent complications in the blood among cancer patients, affecting approximately 15% of all cancer patients. A paper published in The Oncologist (Vol 4, No. 6 Dec 1999) claimed that it is the second leading cause of death for cancer patients although in many of these patients, thromboembolic diseases represents only one of the many complications of the end-stage patient.
Cancer and its treatment can affect all three arms of Virchow's classical triad of causation of thromboembolic disease: changes in the blood flow, damage to the cells lining the blood vessels, and elaboration of substances that unnecessarily promote the formation of clots called procoagulants. Certain tumors also cause thromboembolism by direct extension and blockage of neighboring vessels. Angiogenesis (the formation of new blood vessels) induced by many tumors causes the creation of complexes of blood vessels that have very disordered flow not only in magnitude, but also in direction.
The most common malignancies associated with thrombosis are those of the breast, colon, and lung, reflecting the prevalence of these malignancies in the general population. When adjusted for disease prevalence, the cancers most strongly associated with thrombotic complications are those of the pancreas, ovary, and brain. Idiopathic thrombosis can be the first manifestation of an occult malignancy.
In contemporary clinical trials evaluating antithrombotic agents, in which 20% of subjects have some form of cancer, the most common cancers involve the prostate, colon, lung, and brain in men, and the breast, lung, and ovary in women. These findings are consistent with the report by Levitan et al, in which lung cancer accounted for 21% of cases, colon cancer for 18%, and prostate cancer for 17%. While most studies support the observation that patients with mucin-producing adenocarcinomas are more likely to develop thromboembolic diseases, the most frequent types of cancers found in patients with disordered coagulation are those most prevalent in the population.
The treatment for cancer especially chemotherapy also increases the risk of DVT or PE. In a review of clinical data prospectively collected on the population of Olmsted County, Minnesota, since 1966, the annual incidence of a first episode of DVT or PE in the general population is 117 of 100,000. Cancer alone was associated with a 4.1-fold risk of thrombosis, whereas chemotherapy increased the risk 6.5-fold. Combining these estimates yields an approximate annual incidence of venous thromboembolism (VTE) of 1 of 200 in a population of cancer patients.
For example, controlled clinical trials of systemic therapy in women with early-stage breast cancer have shown this increased risk of VTE. Based on the B14 and B20 trials in the National Surgical Adjuvant Breast Project which involved women with estrogen receptor-positive lymph node–negative breast cancer, the 5-year incidences of VTE in women given placebo, tamoxifen, and tamoxifen plus chemotherapy were 0.2%, 0.9%, and 4.2%, respectively. In women with node-positive breast cancer on chemotherapy, the rate of thrombosis varies between 1% and 10%, with the highest rates of thrombosis in postmenopausal women. In these trials, chemotherapy plus tamoxifen increased the risk for VTE over chemotherapy alone by 4-fold.
Patients with cancer often receive central venous access catheters for administering chemotherapy, blood products, fluids, medicines, and also for drawing blood for diagnostic tests. There is good evidence that these create an increased risk for DVT of the ipsilateral upper extremity.
Signs and symptoms
DVT usually presents with sudden pain in the calf or leg muscle, with swelling, tenderness, discoloration, or prominence of veins. Symptoms generally depend on where the embolus travels and lodges.
If it reaches the brain, it can cause a stroke which usually presents as: 1. Sudden numbness or weakness of face, arm or leg, especially on one side of the body 2. Sudden confusion, trouble speaking or understanding 3. Sudden trouble seeing in one or both eyes 4. Sudden trouble walking, dizziness, loss of balance or coordination 5. Sudden severe headache with no known cause.
A heart attack is suspected if there is uncomfortable pressure squeezing, fullness or pain in the center of the chest, and it lasts more than a few minutes or goes away and comes back; pain or discomfort in one or both arms, your back, neck, jaw or stomach; feeling out of breath with the chest discomfort, or before the chest discomfort; and breaking out in a cold sweat, feeling sick to the stomach or light-headedness.
Classic symptoms of PE are coughing up blood, shortness of breath and chest pain. However, other symptoms may be present instead such as pain in the back, shoulder or upper abdomen, dizziness, fainting, painful respiration, new onset of wheezing, any other unexplained symptom referable to the chest. Sudden blindness in one eye is suggestive of an involvement in that area.
Diagnosis
A duplex ultrasound (Doppler study) is used to look for DVT by placing a transducer against the skin and then is pressed inward firmly enough to compress the vein being examined. In a normal study, the veins are easily compressible while in DVT, the veins do not collapse completely when pressure is applied using the ultrasound probe.
A chest x-ray is taken to look at the lungs, heart and ribs to obtain information in the region. When PE is suspected, the physician orders a ventilation-perfusion (VQ) scan in which a radioactive dye is injected into the patient’s vein and a camera takes pictures of how the blood flows through the lungs. A blockage in the flow of blood signifies a blood clot in a particular region of the lung.
Treatment
A patient, especially if on chemotherapy, should see a doctor immediately if he suspects the presence of a blood clot in the arm or leg. Watchful waiting – or taking a wait and see attitude - should never be an option as initiating the treatment right away could save the patient’s life.
The goal of treatment once diagnosis is confirmed is to thin out the blood to prevent further clot formation and its subsequent end-organ complications (stroke, hart attack, PE, etc.) This treatment usually is started in the hospital with close monitoring of the patient’s general condition and bleeding parameters. Anticoagulants that are frequently used are heparin (unfractionated heparin and low molecular weight heparin) and warfarin. Treatment is usually given for 6-12 weeks but some patients may need to be on anticoagulant for a lifetime.
Patients should take extra precautionary measures against bleeding while on warfarin or heparin. They should adhere to instructions on proper intake of the medications as well as on laboratory monitoring. Among these measures are:
1. Being careful when using razors while shaving. 2. Using a soft toothbrush gently to prevent bleeding from the gums. 3. Avoiding medications and even herbal preparations that might interfere with blood clotting and thus enhance the anticoagulant effect of warfarin. Chamomile and gingko biloba have been shown to interact with warfarin to enhance bleeding. Ginger, ginseng, kavakava and primrose oil inhabit platelet function and put the patient at risk for bleeding. 4. Carrying an identification that states the patient’s present anticoagulant treatment. 5. Calling or seeing the doctor immediately when symptoms like vomiting, diarrhea or fever may that affect the actions of anticoagulants. 6. Avoiding activities especially those that are risk for bruising or bleeding.
The risk of thromboembolic events can be reduced by avoiding prolonged bed rest, by a regular exercise routine and by smoking cessation.
An abridged version of this entry will appear in the next issue of the Big C Magazine.
 The Literature of Grief and Coping
“No one ever told me that grief felt so like fear. I am not afraid, but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing.”
 Thus begins A GRIEF OBSERVED, C.S. Lewis’ journal that has been a source of comfort and inspiration to millions who have lost their loved ones since its publication in 1961. The author of the widely popular books like The Screwtape Letters, the Narnia chronicles and the Perelandra space trilogy, Lewis was a confirmed bachelor until he met Joy Davidman, an American poet with two small children. After four brief, intensely happy years, he was alone again after Davidman succumbed to cancer. In his inconsolable grief, he poured in his journal the doubts, anger and realization of human frailty as a means of safeguarding himself from the loss of his faith in God. What came out was an eloquent testament to one man’s courage to rise above his fallibilities and a powerful celebration of rediscovered faith in the face of loss.
 Anyone whose life has been touched by cancer, directly or indirectly, can attest to the rollercoaster slew of emotions that he has gone through. For most, the mere mention of the word was enough to shake their balance, cause them to lose hope, and throw them overboard into spiraling grief and desolation. Patients and their families and friends primarily turn to each other for support and encouragement. Some go to their support councils and advocacy groups to pursue worthy causes and enrich the soul as much as the body is refreshed. Hobbies are started and old passions are rekindled. Movies like It’s A Wonderful Life, Field of Dreams, Ghost, City of Angels, What Dreams May Come and Frequency are life-affirming and inspiring. Some find meaning and strength in music. The Filipinos will definitely never run out of them, from Basil Valdez’ Hindi Kita Malilimutan to Saan Ka Man Naroroon, to Special Memory. People simply resonate to Eric Clapton’s Tears in Heaven, Patty Loveless’ How Can I Help You Say Goodbye, or Sarah McLachlan’s I Will Remember You, even The Beatles’ In My Life or Let It Be.
Then there are books that offer not only perspectives on preparing for the inevitable and on coping with the present/future losses, but also humor, warmth and joyful abundance at a time when the spirit is tested and even battered.
Perhaps there is no mo appropriate introduction on the subject than Dr. Elizabeth Kubler-Ross’ seminal work Death and Dying (Macmillan Publishing Co., 1969). This groundbreaking publication has brought comfort and understanding to millions worldwide coping with their own deaths or the deaths of loved ones. The well-known death stages (denial and isolation, anger, bargaining, depression and acceptance) were first discussed in this book and still resonate to most people even 40 years from its initial publication.
In Don’t Let Death Ruin Your Life (Plume, 2001), former CNN correspondent and Avenue magazine editor Jill Brooke revealed how to cope with grief and turn the time of sadness into an opportunity for growth and positive change. The early chapters deal with the power of memories, the sustaining presence of those who are no longer physically with the living, in making an impact on the lives of others. Later chapters deal with subjects male and female differences in grief, the link between loss and greatness, dealing with the possessions of loved ones, and holiday survival kit. Brooke concludes this useful book by stating that the healing process “does take time.” “The heart is not as elastic as one we would hope. But we don’t have to accept a life where we allow the emotional scars to disfigure. Instead, we have the choice to embrace strategies that will diminish the pain and enhance our appreciation of what we have left and what is still possible for us.”
Sister Joyce Rupp, osm, has penned a book Praying Our Goodbyes (Ave Maria Press, 1988) about the “experiences of leaving behind and moving on, the stories of union and separation that are written in our hearts.” Rupp focuses on the spiritual aspect of loss but keeps a sound theological and psychological grounding. She bases her reflections on scripture and treats several themes: the “ache” common to humankind, how to identify particular aches, Jesus and goodbyes, and the freedom of letting go. The last part of the book includes 24 prayer experiences that incorporate images, symbols and rituals as sources of strength and steppingstones toward healing.
Ten Menten is a nationally recognized grief counselor who has written  Gentle Closings: How to Say Goodbye to Someone You Love (Running Press Book Publishers, 1991) and After Goodbye: How to Begin Again After the Death of Someone You Love (Running Press Book Publishers, 1994), both widely popular books on coping with the death of the loved one. In the first book he described the process of saying goodbye to a loved one who is dying by imagining couples parting in a railroad station:
“If you have ever stood in a busy railroad station and watched people leave one another, you may have noticed that no two couples say goodbye in exactly the same way – but each does it perfectly. Some hug and laugh. Some cling silently to one another with tears streaming down their cheeks. Some simply hold hands and gaze into one another’s eyes, remembering the good times before this moment. And when it’s time to leave, they take one long, last look, and then they let go.”
After the publication of both books, Menten received thousands of letters from readers telling touching stories and asking complex questions. In Gentle Closings Companion (2002), he compiled some of these letters along with his answers, thoughts and reflections.
The death of a child can especially be traumatic for the parents and the entire family. In The Bereaved Parent (Penguin Books, 1977) Harriet Sarnoff Schiff explored the complex ramifications of losing a child: the exhaustion, the quarrels with mates, the sleeplessness, the panic, the inertia, even the horror of laughter – all the seemingly endless aftermath of sorrow and despair. In this slim volume, the author offers guidelines and practical suggestions to help parents cope with their grief, from facing the funeral to rebuilding the marriage.
On the other hand, how can one explain death and healing to a child who has just lost a loved one, even a pet? From the authors of The Grief Recovery Handbook, When Children Grieve (HarperCollins Publishers, 2001), offer a definitive guide to helping children deal with loss. John James, Russell Friedman and Leslie Landon Matthews address the needs of someone who has observed something in his child that was caused by a loss that occurred some time ago, someone who anticipates a loss that appears to be inevitable, someone who loves his child and wants to be able to help him, and someone with a genuine desire to do whatever it takes to help his child deal effectively with the experience of loss that has affected or will soon affect his or her life. In the early chapters, they debunk several myths that adults commonly use to supposedly help the child through the grieving process: Don’t Feel Bad, Replace the Loss, Grieve Alone, Be Strong, Keep Busy, and Time Heals All Wounds.
The literature of mourning need not be confined to self-help books written specifically on the subject. Some can even come from unusual sources like novels and children’s literature.
Dr. Luis Gatmaitan’s Sandosenang Sapatos (OMF, 2002) is a simple story of how one father’s love crossed his dreams while yearning for the “perfect” daughter that he was given. But it can actually be read in different levels, across different relationships, in different circumstances, and not lose the beauty of the narrative and the message it subtly aims to deliver. It becomes not only a children’s book but a cautionary tale that adults will greatly learn from. Acceptance, respect, fortitude, vulnerability, remembrance are some values that I learned from this simple book. At the end of the story, the narrator learned a lot about the true meaning of love after discovering a “secret” after her father’s death.
Even the widely popular Harry Potter books by JK Rowling have something to say about keeping memories alive in order to cope with losses. Wise old Professor Dumbledore addresses Harry in the following books:
Prisoner of Azkaban (Scholastic, 1999): “You think the dead we loved ever truly leave us? You think that we don’t recall them more clearly than ever in times of great trouble? Your father is alive in you, Harry, and shows himself more plainly when you have need of him.”
The Sorcerer’s Stone (Scholastic, 1997): “He didn’t realize that love as powerful as your mother’s leaves its own mark. Not a scar, no visible sign… to have been loved so deeply, even though the person is gone, will give us some protection forever.”
Suggested readings
Children’s Needs Explaining death to children, edited by Earl A. Grollman, Boston: Beacon Press, 1967. It’s okay to cry: A parent’s guide to helping children through the losses of life, H. Norman Wright, Colorado Springs: Waterbrook Press, 2004.
Literature In The Midst of Winter, edited by Mary Jane Moffat, New York: Vintage Books, 1982. (A collection of poetry, fiction, letters and diaries from the world greatest writers on death.) Remembrance of Father, Jonathan Lazear, New York: Simon & Schuster, 1994. The Father, poems by Sharon Olds, New York: Alfred A. Knopf, 1992. When A Loved One Has Died, poems by Earl A. Grollman, Boston: Beacon Press, 1977.
Memoirs Death Be Not Proud, John Gunther, New York: Harper & Row, 1949. A Mother’s Grief Observed, Rebecca Faber, Wheaton: Tyndale House Publishers, 1997. The Morning After Death, L.D. Johnson, Nashville: Broadman Press, 1978. She Came to Live Out Loud: An Inspiring Family Journey Through Illness, Loss and Grief, Myra MacPherson, New York: Scribner, 1999. The Wheel of Life: A Memoir of Living and Dying, Elisabeth Kubler-Ross, New York: Scribner, 1997. A Whole New Life: An Illness and A Healing, Reynolds Price, New York: Simon & Schuster, 1994.
Self-Help When There is No Miracle: Finding Hope in Pain and Suffering, Robert L. Wise, Glendale, Regal Books, 1977. The Farewell Chronicles: How We Really Respond to Death, Anneli Rufus, New York: Marlowe and Company, 2005. When Men Grieve: Why Men Grieve Differently and How Can You Help, Elizabeth Levang, Minneapolis, Fair View Press, 1998. How to Survive the Loss of a Love, Melba Colgrove and others, Los Angeles: Prelude Press, 1976. Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying, Maggie Callanan and Patricia Kelley, New York: Bantam Books, 1992.
| Batanes | Sep 29, '08 10:37 AM
for everyone |
 Sharing soul stories in Sabtang
Far over the right shoulder as the faluwa leaves Ivana Port in the main island of Batan to thread the treacherous waves of the Pacific Ocean that lead to Sabtang, one can easily spot the ghostly crest of Mt. Iraya looming in a cerulean distance, robed in an incessant pallor that mirrors the breathtaking beauty of this northernmost of the Philippines’ provinces. In a balmy May daylight, the waves glisten even as they briefly petrify the visitors with both their height and their unpredictability, surging onwards from out of nowhere when they are least expected, then remain like petulant juveniles to momentarily shake the boat and its stunned passengers, only to vanish with nary a whimper minutes later. And a peaceful ride is casually resumed. The faluwa is a seaworthy motorized dinghy that traverses the  vast expanse of thewaters of Bashi Channel and Balintang Channel, where the Pacific Ocean merges with the China Sea. The boat connects residents from the main islands of Batan, Itbayat and Sabtang to each other, providing reliable means of transportation for culture and commerce in the islands, the burgeoning tourism industry included. Midway through the trip, our group chances upon enormous waves that whitened the knuckles of some passengers as they held tightly to the railings while ardently mumbling entreaties to the deities. But the steady hands of the skipper and his crew effortlessly steer the boat to slither through the waves like a surgeon precisely and adeptly cutting through the tissue, smooth as a blade, that the faluwa barely trembled in its ascent. A solitary flying fish darts from a distance like some sinewy sliver of silver that skims over the surface as if to taunt the travelers about passing up the exhilaration of the moment just because of a tenuous unease. The trip to Sabtang takes a little less than an hour, our guide Roger tells us, so enjoy the ride. The group met him the day before, a proud Ivatan in his mid-fifties who knows the infinitesimal details of his proud heritage like the back of his hefty palms. A virtual repository of historical facts and folk trivia, including what sounds like indigenous yarn, he is at ease talking to both the visitors and the locals. The spirit of fun is there all right, but his animated annotations of facts, half-truths and downright trivia are nowhere near mendacity and pretense. Having reached college, his English is almost unsullied despite the obvious trace of the guttural nature of the northern tongues. Sometimes he appears to be chiding the boatmen about not skimming competently enough though this crest of a wave to obviate the vessel’s fretful shudder.
 The boatmen are hardy chaps, bronzed from relentless exposure to the elements, the almost mystical mélange of the sun, the wind and the saltwater enfolding the islands and their environs; they are a proud offspring of a race that has been molded by centuries of geographical solitude from the rest of the incessantly shifting world. The Ivatans are typically Malayan but whose features are softer, perhaps gentler is a better word to describe them, than the rest in the northern part of the country. The Ilocanos come across as edgier given the harsh landscape of undulating plains that are amplified by blistering winds, while the tribesmen of the Cordillera ranges are as morose and dour as the cold weather that they are attuned to.
Roger likes to talk a lot, probably comes with the job description I tell myself, but there is nary a trace of contrived earnestness or even perfunctory candor that I would expect from someone who has done this same routine several times in years. His enthusiasm is incredible, but his love for the islands he calls home is even more amazing. Near the end of the trip, when the novelty of the enormous waves is starting to wear out and most of the passengers are lulled to private introspection by the gentle lurching of the faluwa over the waves, Roger stops speaking with a far-off cadence in his voice, and for a long time we sit in silence listening to the waves that beat against the sides of the boat and the winds that thrash the jib. The eloquence of the moment simply distills every person from the frailty of words and everyone allows silence to take sovereignty when it really matters most.
With the near-noontime sunlight the sky is incredibly translucent and the ragged coastlines of Sabtang are now etched sharply against the azure west, assuming an overwhelming loveliness. An imposing lighthouse that stands pompously near the dock provides a picture-perfect preface to the many charms and surprises of the island, the off-white lookout hub sharply demarcating its russet top from the taupe base.
Over the next precious hours, the group will ride through the 4 towns of Sabtang and be amazed at the simplicity of the Ivatan way of life that has not significantly changed over the centuries, courtesy of its remote location, its tempestuous climate and the tenacity of its people to safeguard the indigenous lifestyle without necessarily preventing outsiders from taking an attentive peek into the heart of their culture. Traces of the old way of life, particularly the fortified mountain refuge called idjang where people hide sometimes for months during the bloody clan wars, are still preserved. Palek, a local wine made from sugar cane, is still consumed by the males to fend off cold and probably tedium especially during the stormy season when they could not head off the coast to catch fish.
This short essay will appear in a coffeetable book on Batanes that will be published later this year or next year.  | Guestbook | |
 | I have read most of your posts and got a lot from them. |
 | hello kuya noel..musta na? tani ma remember mo pa ako.. it's me Mary JaneGod bless kuya.... |
 | Thanks for the visit… I accepted Already you as friend ok! It is with God |
 |
rx823 wrote on Jul 23, '08 |
 | Hello! Thanks for visiting my site! I hope you enjoyed viewing. |
 | Doc, how are you na? You've been in my thoughts. Sending you much strength and love!
Claire |
 | doc noel,
hope you're ok na. TBR5 is up and TBR6 already has a theme. thanks for joining, doc. |
 | Friends,
I would like to tell everyone that I am very grateful to have each of you in my life.
My prayer is for everyone to have one day blessed.
It was difficult to decide who to send, because they all want prayer, but not all are praying.
I hope I have chosen the 12 people correct. Please return me this message (You will see why). Let all who receive this message are blessed. Remember to pray. That is all I have to do. Only send to 12 people. pray is one of the best free gifts we receive. There is no cost, only much reward. Ensure that will pray and ore believing that God will respond. What now realize everything you want. Let the Peace of God and the coolness of the Holy Spirit is in your thoughts, dominate the night in his dreams and be on all their fears. May God is manifest in a way never experienced by you. What are your wishes attended, including its most intimate dreams and their prayers are answered. My prayer is for you to have more faith. My prayer is for their spaces should be increased, My prayer is for Peace, Healing, Health, Happiness, Prosperity, Joy and a Truth and Love Eternal God. Now send this to 12 people within 5 minutes, including me, you will see why.
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| A beautiful text! To reflect
During the ice age, many animals died because of the cold. The
Pigs thorns, realizing this, decided to join in groups,
Therefore if agasalhavam and is protected each other.
But the spines of each feriam the closest companions,
Precisely those that provide heat. And therefore made to remove each
Others.
Again to die frozen and needed to make a choice:
Desapareceriam the face of the Earth or accept the thorns of similar.
With wisdom, decided to return and stay together. Learned well the
Live with the small wounds that a close relationship could
Cause as the most important was the companionship and especially the
Heat of the other.
The best tie of friendship or love is not one that unites people
Perfect, but one where each one accepts the defects of the other and can
Forgiveness by the defects. |
 | Welcome Doc! God Bless!!! |
 | thanks for the invite. yeah, i have downloaded all songs known in the world that has Glen Hansard and Marketa Irglova on them. hahaha. im such a fan. |
 | thanks for appreciating my work.. its a honor to have you on my list! |
| thanks very much !!!
add .ok. !!!
GOD Bless you !!! |
 | At least in Multiply, non-fiction is not a minority :) Miss you doc! |
 | Thanks for the invite.. cool page .. best regards! |
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