numinous & epistemological

My teammates in LEAP 35  will be celebrating our 90th day as well as the culmination of the next team's walk.  Wont be able to join them.  To remember the highlight of our journey I am posting a piece that initially appeared in our newsletter.  Go, Team35, go!

The Force of Nature and the Fence in a Long Day’s Journey Into the Night

It was nearing midnight, hopes had ebbed and cheer had eddied, as the first three stabs at getting past the barrier were brusquely thwarted by gratuitous casualties, one can almost feel the strain of the muscles that were taut as the ropes that built the fence.  It was a long day’s journey into the night and the end was nowhere in sight. 

Then came the almost merciless caveat: the next one would be the last regardless of the outcome.  No more fifth attempt would be allowed.  Shoulders sank almost in unison although not as deep as the spirits would have gone under.  It seemed almost surreal as the task bordered on impossibility, what awaited the players beyond the fence seemed wretchedly out of reach.  Or even reason.

There was a huddle, a consensus and a prayer.  Strains on the wearied faces were evident despite the majority’s feisty attempt at putting up a courageous façade; everyone was simply exhausted beyond comfort.  How else can the group move past the immediate failures without even thinking of leaving someone behind, however figuratively it may simply seemed to have been one.

The group was up to its final challenge.  And everyone was back in no time at all to the familiar arena, the site of the past three failures.  When the door parted, the anxious faces on the opposite sides of the fence mirrored the disappointment and the hurts that once pervaded the perimeter of the fence.  But extraordinarily enough, something powerfully eloquent was also there, something else descended on the place like some grace from nowhere befalling quietly and soothing every restless heart, urging it to keep still and train each beat on the task that loomed ahead.  Bearing in mind the lessons of the past three attempts, the group started its final task of safely bringing everyone across the obstinate fence.   Strangely, people began moving in calculated circles, breathed in cadence with the rest in the room, the weary spectators included, and eyes collectively glued to the ropes, almost in trance-like glow as if fired by a single desire and fuelled by a solitary verve, to keep its communal promise afloat and fulfilled.   In a way, it was like surrender, a laying down of arms, to the sovereignty of the task’s essence.  In a kind of magical, meaningful, mysterious and mighty marrow of the moment, people started to care for each other in ways that were never lived through before.  Whatever each individual’s motive was on the air, whatever work a person was up to his ears in, whatever pleasures another was enjoying, whatever discomfort or pain or anxiety a person was in the midst of, everything was set aside, in favor of the task that was slowly unfolding that very moment.    

Pretty soon, people were streaming over the other side; the fence was reduced to a mere inconvenience that was both surmountable and marginal.  Instead of the usual rah-rahs, those who have gone through the fence were oddly quiet; it was more like the weird silence one falls into when something very beautiful was happening or something very powerful or very sublime.  There was the ahhhh! that occasionally floated up out of an engrossed observer similar to when one is witnessing the fireworks burst over the water across a dark December sky.  There were occasional stammers of pain at somebody else’s pain.  But more frequently, there was eloquence of joy at someone else’s joy.  People sighed, they cooed, some wept, everyone smiled even with tears streaming down their lightened faces.  Whatever words or sounds each person used for sighing over his own life, all of them resembled a prayer.  Each person had given up being the old solitary soul; instead everyone had put himself into the hands of the moment and was lovingly embraced by the radiance of another’s presence.

Pandemonium broke when the last person got through the fence.  There was so much shouting, laughing, crying, hugging, praying.  Underneath the surface, barriers were broken, hurts were mended, mere presence of the next person was recognized, and friendships were forged.  These were most likely the goals that the fence was constructed for in the first place.  These were the goals that power, success and security were only forlorn substitutes for, much like individual pursuits, personal satisfaction and exclusive sense of worth and importance are.  This was victory that not all human armamentaria of fame, fortune, titles, personality and even connections could win for a person or the group – not simply to be treated as human but to become truly human, one who is true to his essence and purpose.

George Bernard Shaw wrote in his dedication to the play 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 thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish little clod of ailments and grievances, complaining that the world will not devote itself to making you happy.”

Only a few in that room that night might have read about Shaw, but everyone embodied what he meant with that.  It was not exhaustion that propelled the group to overcome the fence, certainly not the impatience and the frustration that the narrow space between crisscrossing ropes fomented.  It was an urge, a calling, a passion more profound than simply finishing the task so that everyone can go home, have dinner and sleep the exhaustion away.  They were a force of nature that no fence, large or small, can simply contain away.  Having failed three times already, they could no longer resist the very essence of their lives, the expansive purpose of their presence in the here and the now.

In a way, the fence was a rehearsal for the final laying down of the arms, when a person eventually trusts himself enough to the same mysterious benevolent force that enabled him to see through the fence and to rise up to many of life’s long day’s journeys into the night – with renewed hope, with refreshed strength, with reinvigorated love – into the constant return to the world of light.

For the co-Healers, Ali, Curie, Dess, Lyonne, and the entire LEAP TEAM 35.  Miss you so much people!

Goodbye, Chiwa Girl!

Last night, my brother told me that my Chiwa Girl is already gone, poisoned by some thoughtless souls who really never understood what friendship and devotion really meant. A brother told me that one of the older pups initially was given the poisoned bait but being the loving and protective mother that Chiwa was, she licked the poison off her pup’s mouth; thus, saving her offspring’s life at the expense of her own.

 I mourn for my niece, aged 7,  and my nephew, aged 5,  who will never comprehend at such tender age why some people could be so cruel and hateful to cause the death of their favorite pet.  And I mourn even more for this loss of innocence that this unfortunate incident caused them.

Someday when they are old enough to understand, we will tell stories of how one mother gave up her life for her little ones, of this brown-eyed little friend that once graced their – our – lives with a gentleness that brought warmth and joy in the heart.

Goodbye, dear Chiwa Girl, sweet little creature of love!  When they say that all dogs go to heaven, I have never believed that as fervently as now. 

One year after her death, the lovely, loved and loving Ana still haunts the what-could-have-beens and the what-ifs of the subconscious.  Dear Ana, I don’t know a thing about making poems but thanks to you, I see them in the daily ordinary things that this life allows me.

Taladlawan

Sa suuk sa mga panid nga kina’og anunugba

usa ka lama ang nibansiwag sa iyang pagkamatin-aw

sama sa nag’inusarang bukya sa pughaw nga hunasan

nahimong tataw sa kaligutgut sa taliadlaw

unsang makalilisang hitabo

unsang mapintas nga panistis

dili matukib sa kapuangod sa kasingkasing

ang nagmando nga magpabilin

sinilsil sa sabakan sang

paghinumdum.

Sige na, pagbigyan mo na ako, subok lang.  And in your beloved adopted language, no less. 

Miss you, dear Ana!

Not Knowing The Road Ahead

The past week had been particularly hurting for me as everything that happened during the past 3 months has finally taken their toll on my equilibrium: Uncle Bodol’s sudden death, Nanay Betad’s passing, the demise of some of my dear patients including an old friend my med school who succumbed to malignant astrocytoma (brain tumor), the pressures from work, Masang being away, and people becoming cold and edgy as prices soar and life in the Philippines becomes more difficult.

There were times when I even questioned my choice of specialty or even of my profession.  Had I been a good doctor?  Because if I were one, why are my patients dying?  Do I care enough for my patients?  Do I see myself doing the very same things – listening to sob stories, seeing young men and women waste away because they cannot afford the cost of medicines, signing the death certificates, telling people that there is nothing more that Medicine could do – 10 years from now?  Can I just pack my things and head for Japan to try my luck there?  Will taking up Nursing be a wise decision?  So many questions, yet so little answers. 

By God’s grace, I came across this Thomas Merton prayer and was comforted by the assurance of an all-powerful God who guides my path and protects me from my enemies.  I may not know exactly what kind of road I shall be treading, but I simply take solace in the promise that He is with me every step of the way.

This morning, I woke up to the sad news that (1) a good friend is not feeling well and has been sick for some time, (2) a very dear colleague and friend who’s like a sister is “persecuted” by some people who believed that standing up for your rights is “sinful” (loosely used in the context of the healing profession as a ministry for God’s greater glory), and (3) a person can sometimes be shortsighted and only perceive malice in even the most noble of intentions.

Then I find solace in this Merton prayer:

My Lord God, I have no idea where I am going.  I do not see the road ahead of me.  I cannot know for certain where it will end.  Nor do I really know myself, and the fact that I think I am following your will does not mean that I am actually doing so.  But I believe that the desire to please you does in fact please you.  And I hope I have that desire in all that I am doing.  I hope that I will never do anything apart from that desire.  And I know that if I do this you will lead me by the right road, though I may know nothing about it.  Therefore I will trust you always though I may seem to be lost and in the shadow of death.  I will not fear, for you are ever with me, and you will never leave me to face my perils alone.

Why Do I Blog?

"The unexamined life is not worth living"

-- Socrates

Immediately after completing my ALC in October last year, I realized that there were a lot of things that I have long thought of doing but never really got enough courage to start them.  And those which I have tentatively initiated never really got to the end of the road, having been stalled midway by another task or by the convenient “loss of drive” to commit to completing them.

One of them is putting up a Multiply.  Some of my dear batchmates in the Dumaguete Workshop have been egging me to upload some of my accidental writings online, maybe to catch up on each other’s progress.  But I didn’t think I was good enough to actually “publish” my output online, or that my writing is worth sharing at all.

ALC however empowered me to think beyond mere comfort zones, to be never afraid of being passionate over certain things and to simply cast away my belief systems about my personal worthy and capacity.  I find joy and comfort in the eloquence and poignancy of words and while eventually words fail me in most of my daily encounters with patients with Stage IV cancer and their loved ones (How can you say your condolences enough to ease the grieving heart?  How many words are adequate to express your grief at someone’s death and how much is more than enough?) I take refuge in the embrace of the written word.  Just putting them down in a way that ideas are shared, barriers are broken down, and bridges are rebuilt makes excellent companion in a cold, starless night.  Like looking at stars, blogging is time well spent, you dream about a lot of things and may even wish on them foolishly, but you simply bask in the glow of the moment no matter how fleeting it may be.  To express one’s thoughts honestly is a gift; it becomes a touchstone for an examined life.

Thus, my first blog entry spoke of receiving this “gift,” the realization that whatever pursuit I take, whatever grace I receive, and whatever lies at the end of the journey, is simply all mine for the taking.

And I am still enjoying the gift until now.

At Wit's End

Mighty and dreadfull, for thou art not soe,

For, those, who thou think’st, thou dost overthrow,

Die not, poore Death, nor yet canst thou kill mee;

From rest and sleepe, which by thy pictures bee,

Must pleasure, then from thee, much more must flow,

And soonest our best men with thee doe goe,

Rest of their bones, and soules deliverie.

Thou art slave to Fate, chances, kings, and desperate men,

And dost with poison, warre, and sicknesses dwell,

And poppie, or charmes can make us sleepe as well,

And better then thy stroake; why swellest thou then?

One short sleepe past, we wake eternally,

And death shall be no more, Death thou shalt die.

- “Death Be Not Proud”

(from John Donne: The Divine poems, edited by Helen Gardner, 1952)

The doctor is not the central character in Wit, a 2001 HBO TV movie based on the Pulitzer Prize-winning play by Margaret Edson, and it is a verisimilitude that lends credence to the entire movie and even to the reflections it draws from the doctor-viewer because the fact remains that in any clinical situation, whether in the hospital wards/suites or in the outpatient clinic, the patients take center stage and are the focal point of the entire proceedings.  Approaching the movie from this thesis actually reveals a lot about the many BS (basic strengths, broad spectra, belief systems, even bullshits) of the medical profession, it even posits the doctor’s role as primarily, and that I believe will always remain so, supportive.  Considering how doctors delight in hogging the spotlight (one need not look beyond the bedside ward rounds or the Grand Rounds to realize how endemic it is in the community), some colleagues might find the movie a little unsympathetic to the profession.

In this intimate TV movie directed by legendary director Mike Nichols, Emma Thompson plays the lead role of Vivian Bearing, a professor of English literature with special interest on metaphysical poetry whose life suddenly takes a rueful turn when she was diagnosed with Stage IV ovarian adenocarcinoma. She has spent most of her life in the academe.  Unmarried and without kids, she also has no third-party person to refer to.

Vivian is known for her expertise on metaphysical poetry especially the Holy Sonnets of John Donne, those scholarly but intricate treatises on life, death and even the afterlife.  Holy Sonnet X (“Death be not proud”) is an essential device in the movie, both as a theme and as a counterpoint to what transpires on the screen.  It is often recited in parts during the film and heard in its entirety in the final voice over before the credits roll in the end.  Donne is considered the dominant figure of a school of 17^th century English writers known as the metaphysical poets.  These writers were linked by their style – their use of wit - rather than by any thematic ideology.  Wit as defined by scholar Louis Marz is “intellect, reason, powerful mental capacity, cleverness, ingenuity, intellectual quickness, inventive and constructive ability, a talent for uttering brilliant things, the power of amusing surprise.”    

The doctors are represented by pragmatic senior oncologist Dr. Harvey Kelekian (Christopher Lloyd) and his young research associate Dr. Jason Posner (Jonathan M. Woodward).

I first caught snippets of the film on cable several ago as I was then (I think) preoccupied with tidying my study up.  I vowed to myself that I must get hold of a copy on video as the perfunctory introduction to this inchoate gem fomented my curiosity enough to wish viewing its entirety.  Took a long while but got my wish a few months back when I saw a VCD copy in one of those bargains bins in the mall.

All those years of waiting were well worth the belated revisiting of the movie as it happened at a no better time than now: I am nearing the 5^th year of my practice as a Hematologist/Medical Oncologist (and have seen enough patients to know the subtleties of clinical practice that are not written about in textbooks and journals; the learning is endless, mind you), I have somehow learned even this late in life that prose and poetry can be poignant and uplifting and redeeming (now I  know who John Donne is and how relevant are his writings in my journey both as a physician and as a person), and I have never as passionately and thankfully appreciated this life that is both a grace and an accountability.

Wit starts with Dr. Kelekian’s face in extreme close-up and telling Vivian that she has “advanced metastatic ovarian cancer.”  The initial conversation was interesting enough to elicit a kind of kneejerk reflex to reach for the remote and push the pause mode:

Dr. Kelekian:  Now it is an insidious adenocarcinoma…

Vivian:  Insidious means?

Dr. Kelekian:  (Initially taken aback by the question, pauses for a few seconds, keeps a smug demeanor and chuckles.)  Insidious means undetectable at an early stage.

Vivian:   …insidious means treacherous.

And for the first time in years, I am compelled to brush the dust off my faithful Funk and Wagnalls dictionary, a gift from Tatay when I was still in grade 5.  So richly rewarding that it feels like reuniting with a long lost friend.

in-sid-i-ous adj. 1. Designed to entrap; full of wiles. 2. Doing on contriving harm.  3.  Awaiting a chance to harm.  4.  Causing harm by slow, stealthy, usually imperceptible means. (Funk & Wagnalls Standard Dictionary)

I am only aware of the 4th definition, and I found out that I have exactly been living the good doctor’s world:  my vocabulary like most of my colleagues has been limited to textbooks and medical literature.  It becomes a metaphor of how, in my experiences from med school up to the present, doctors can be so self-absorbed in their own world, complete with spots, shortages and surfeits, and not realize that there are other life forms in the universe other than themselves. 

Vivian is hospitalized for chemotherapy as she has decided to take part in a clinical trial that required her to receive 8 cycles of the antineoplastic regimen, full dose.  The tables are turned this time, the former stern professor and examiner becomes the specimen.  She sees her exact mirror among the hospital staff, emotionally removed, even haughty and indifferent. 

While there is a veneer of contrivance in the movie as Vivian frequently talks to the audience directly, the simplicity of the scenes without the formulaic clichés draws the viewer to Vivian’s world as she suffers not only through the various side-effects of the chemotherapy (alopecia, nausea and vomiting, febrile neutropenia) but also the seemingly institutionalized culture of indifference and apathy from among the hospital staff. 

Doctors can be complacent about improving their people’s skills, contentedly blithe with merely memorizing the results of the latest clinical trials down to the minutest statistical detail like p value of 0.098765 (when simply saying “not statistically significant” would suffice).  There seems to be a constant pissing contest about having the latest inside info on the most modern tools in the armamentaria.  Allow me to disclose this upfront that there is nothing wrong about statistics and gadgets and algorithms, these are the basic tools in every doctor’s search for detection of and cure for what ails the patients. But to forget about the human factor, especially about how the patients feel and think and believe, negates everything that is especially attractive and valuable in the profession.  Some physicians can get too casual with their language that they border on insensitivity and downright heartlessness.  I know of doctors who habitually finish off every sentence when talking to their patients with an exclamation point.  I say so!  Take this!  I know this for sure!  Believe me!  And worse, some senior (however that means in the context of the succeeding thought) doctors even communicate with PGIs, residents, fellows and nurses like some conquistadores dismissing the coolies.  Oftentimes, even worse.  And tyranny and subservience are supposed to be anachronistic in this century.

Cases in point

Case 1:  The Nephrologist

During my first 24-hour duty at the CENICU in PGH during the first year of my residency I was asked by the senior resident to relay a lab result to this nephrologist because she  (the senior resident) was not on speaking terms with one of my co-residents (who’s supposed to relay the result). 

01 February 1994, 9 PM (I will never forget this date, my V Day – verism, that is):

Me:  Good evening, Ma’am, I would like to relay…

Nephrologist:  BULLSHIT! Why are you calling me at this time… blah, blah, blah!!!

(Huh?  Was she in the middle of something orgasmic to mind that her patient’s pH was precariously getting lower?  Until that time I didn’t realize that doctors can be uncouth because I haven’t heard someone from Davao, bless them, and talk to younger doctors that way.  I had the urge to snap back NOEL PO PANGALAN KO, HINDI BULLSHIT.  PERO SA TOTOO LANG MAS BULLSHIT PO KAYO! but I was taught better.)

ver-ism n.  A style in art or literature that follows the theory that reality should be rigidly represented, even when it is ugly or vulgar. [<L verus true] – ver’ist n & adj

Case 2:  The Cardiologist

CENICU uli.  The consultants scheduled a meeting to discuss the decking policies, “First Decked, First Admitted” among them.  The following day, this cardiologist asked that I admit his patient to the empty bed STAT.

Cardiologist:  Pasok mo na pasyente ko! (Exclamation point talaga)

Me: Po? Papasok na po yung unang nakadeck, pangwalo po yung pasyente ninyo.

Cardiologist:  (Ever the pertinacious monster) PUTANGINA MO!!!! Di ka ba natatakot sa akin?!!! (Notice kahit tanong, exclamation point pa rin)

(Syempre, pag 1st year ka lang, matatakot ka talaga.  The following day I was on the verge of breaking the coffee mug or his face – even both – but my co-resident pushed me away seconds from committing the act.  The consultant did not notice, first year residents were supposed to be non-existent.  I wondered how can you insult someone else’s mother by referring to her as a whore and casually stand beside him the following day as if nothing occurred at all.  In some parts of the country, you run the risk of getting punctured on the chest if you do that. Was he plainly insensible or gravely insensate or downright insentient?  That would have been my last day at PGH.  Nowadays every time I see him at the conventions, I have this urge of telling him PUTANGINA MO, DI NA AKO NATATAKOT SA IYO! but I was taught better.)

in-sen-si-ble adj. Blunted in feeling or perception

in-sen-sate adj.  Manifesting or marked by lack sense or reason; destitute of sensibility

in-sen-ti-ent adj.  Inanimate

Case 3:  The Pulmonolgist

OPD this time.  At PGH there was this rare cultural phenomenon called “extensionitis,” a practice that allowed families and friends of PGH employees to take an imaginary express line at the clinic, seemingly oblivious to the long line of patients who have started filing in at early as 5AM.  (Don’t know if it exists until now.)  I was already at the clinic, seeing patient #9 in the list of 26 when this pulmonary medicine consultant called to ask me about his friend.

Me:  Opo, Sir, nandito lang po ako sa OPD.

Pulmonologist:  Hindi pupunta ang kakilala ko riyan, puntahan mo na ngayon sa office!

Me:  Sir… (it was past 4PM, there were 21 patients yet to be seen, and leaving the OPD complex to see his kakilala at the Central Block seemed absurd)

Pulmonologist:  PAPAHINTAYIN MO ANG EXTENSION KO?!

(Of course, the gods couldn’t bear to leave the sanctum sanctorum. The kakilalas included, kaya nga extension ang tawag. You come to us, we don’t come to you.   When I get to think about that episode, I can’t help but be awed of how great a doctor and a man the late Dr. Alendry Caviles had been.  That very same day, the kindly “Father of Hematology” called me in the morning if I can see a friend of his that afternoon.  Would you like me to see him at the Hema office at the MRL, I asked.  No, he told me, he can fall in line at the OPD to be fair with your other patients.  Wow, that’s THE man.  I call that respect for other people, integrity to oneself and to the profession, and conscious effort to avoid abusing authority (which that pulmonologist for all his credentials and positions, have yet to fully comprehend). Must be the result of all the years the blood gases accumulating in his brain? I have sat beside him three times in recent years - once at the airport, twice at a convention - and each time I searched my heart for some respect befitting his “academic” stature, sorry, wala talaga akong mahugot.  All I could muster was “Good morning, Sir.”  It would have been easier to ignore him, but I was taught better.)

sanc-tum sanc-to-rum 1.  Holy of holies.  2.  A place of great privacy; often used humorously.

The worst of this subspecies of this ilk was another cardiologist, but the least that he is discussed, the better.  Besides, the Hippocratic Oath is emphatic about keeping your mouth shut when you can’t speak something decent about another human being. 

And I am talking about top tier (whatever that means now I am not sure) consultants here, the purported crème de la crème of their subspecialties, the so-called movers in their respective societies, the ones who get to sit on the presidential table in conventions.  I remember reading an article by one of them on uplifting the status of PCP in the new millennium and how each internist should behave accordingly.  Look no farther Sir!

There is a scene in Wit that highlights the importance of punctuation marks in the sentences doctors use.  Not so much as a lesson in grammar, it underscores how messages are received when the medium is altered by subtle displacements of something trivial as a comma or a semi-colon.   As written by Nichols and Thompson themselves, it even had a metaphysical slant that invites an earnest reflection. 

Flashback to Vivian’s graduate school days with the imminent Professor E.M. Ashford, professor emeritus of English literature. 

 Vivian:  Oh I, ah…

 Ashford:  Begin with a text, Miss Bearing, not with a feeling. 

Death be not proud, though some have called thee

Mighty and dreadful, for, thou art not so.

You have entirely missed the point of the poem, because, I must say, you’ve used an edition of the text that is inauthentically punctuated.  In the Gardner edition of the text…

Vivian:  That edition was checked out in the library…

Ashford: Ms. Bearing!

Vivian:  Sorry.

Ashford:  You take this too lightly, Ms. Bearing.  This is Metaphysical Poetry, not the Modern Novel.  The standards of scholarship and critical reading which one would apply to any other text are simply insufficient.  The effort must be total for the results to be meaningful.  Do you think that the punctuation of the last lime of this sonnet is merely an insignificant detail?

The sonnet begins with a valiant struggle with death, calling on all forces of intellect and drama to vanquish the enemy.  But it is ultimately about overcoming these seemingly insuperable barriers of life, death and eternal life.

In the edition you chose, this profoundly simple meaning is sacrificed to hysterical punctuation”

And Death – capital D – comma – thou shalt die – exclamation mark!

If you go for this sort of thing, I suggest you take up Shakespeare.

Gardner’s edition of the Holy Sonnets returns to the Westmoreland manuscript source of 1610, not for sentimental reasons, I assure you, but because Helen Garner is a scholar.  I reads:

And death shall be no more, comma, Death thou shalt die.

 Nothing but a breath – a comma – separates life from life everlasting.  Very simple really.  With the original punctuation restored, death is no longer something to act out on stage, with exclamation marks.  It’s a comma, a pause.  This way, the uncompromising way, one learns something from the poem, wouldn’t you say?  Life, death, Soul, God.  Past, present.  Not insuperable barriers, not semicolons, just a comma.

 Vivian:  Life, death… I see.  It’s a metaphysical conceit.  It’s wit!  I’ll go back to the library and rewrite the paper –

 Ashford:  It is not wit, Ms. Bearing.  It is truth.  The paper’s not the point.

 Vivian:  Isn’t it?

 Ashford:  Vivian, you’re a bright young woman.  Use your intelligence.  Don’t go back to the library.  Go out.  Enjoy yourself with your friends.  Hmm?

 Vivian:  I, ah, went outside.  It was a warm day… There were students on the lawn, talking about nothing, laughing.  Simple human truth, uncompromising scholarly standards?  They’re connected?  I just couldn’t…

 I went back to the library.

Vivian, like some doctors, seems to have created a world that revolves around the library, the academe, oftentimes overlooking the simple joys of the company of friends.  She hasn’t learned to grasp fully the weight of Ashford’s lessons on life beyond the library until the end.

Dr. Kelekian like most senior doctors is authoritative, confident and unperturbed.  He is well versed with the subtleties of medical jargon and was most impressive when dealing with the disclosure process: precise, sympathetic yet uninvolved.  Yet for all his scholarship he had his share of flaws.  In one scene where Vivian was doubling up because of extreme pain and the nurse was suggesting immediate patient-controlled analgesia, he remains unmoved and even asks the patient if she is in pain.  To which Vivian remarked as she faces the audience:  I don’t believe this.

On the other hand, the idealistic but callow Dr. Posner symbolizes the young doctors’ insolence and indifference to the entire establishment.  Young Posner once got an A- in Vivian’s class in literature.  He prefers to pursue a career in research rather than remain a clinician.  “Clinicians are such troglodytes,” he would conclude; thus, his choice of cancer as the field of study.  He is enthralled by cancer and the many complex mechanisms on the cellular level, but finds talking to patients an annoyance. 

On Posner, Vivian laments:  The young doctor like the senior scholar prefers research to humanity, at the same time the senior scholar in her pathetic state of simpering victim wishes the young doctor would take interest in personal contact. Now I suppose we shall see how the senior scholar ruthlessly denied her simpering students the touch of human kindness she now seeks.

While they were unswervingly involved in the treatment protocol of the clinical trial, counting even down to the last milliliter of the urine output, both doctors failed in many cases especially in asserting another person’s humanity beyond the mere physiology of her body and her capacity to endure the assault of the toxic chemotherapeutic agents.    In their relentless pursuit to find an effective regimen for the disease, they have forgotten that the patient also has other concerns than merely being the guinea pig in this clinical experiment.  Talk about dehumanization in order to contribute to the improvement of humanity, that’s a common paradox that we often see in large teaching hospitals.  Doctors and students huddled around the patient’s bed, discussing her innards and her prognosis, even her personal and social history, nonchalantly oblivious to the fact that the person they are dissecting that very moment is also around.  Vivian learns about how it is to be at the receiving end of the steely coldness that she once forced her students to endure.  

Vivian (after an exhausting battery of tests):  It’s highly educational; I am learning how to suffer. 

Like in the scene where she was berating the high school jock for not coming prepared to class.

Vivian:  (Dryly) Did I say:  You’re 19 years old, you are so young.  You don’t know a sonnet from a steak sandwich.  By no means…

Except for the kindness of her nurse Susie, Vivian suffers from the terrible absence of human warmth and empathy in her ordeal.  In her life prior to the diagnosis of cancer, caring for others is something that is extraneous to her academic mind.  Her work was all that mattered.  She finally meets her match in the young Posner who regards people as mere lab mice, nothing more than processes and signal transductions and neoangiogenesis that need to be understood in the search for the perfect cure. 

In the end, the chemotherapy failed and Vivian has finally seen the significance of compassion. 

Vivian:  Now is not the time for verbal swordplay, what could be worse than detailed scholarly analyses of erudition, interpretation, complication… Now is the time for simplicity.  Now is the time for, dare I say it, kindness.  I thought being extremely smart would take care of it.  But I see that I have been found out.

Before the final scene, she has one visitor.  In town for her grandson’s fifth birthday, Dr. Ashford visits Vivian and learns about her former student’s grim situation.  Comforting Vivian, she asks her if she wants to listen to a Donne sonnet but Vivian refuses.  So she kicks off her shoes, climbs into the bed and takes out a book called The Runaway Bunny by Margaret Wise Brown that is supposed to be her gift to her grandson and begins reading.  The Runaway Bunny begins with a young bunny who decides to run away.  The mother replied “If you run away, I will run after you.”  The book traces the imaginary chase that the mother undergoes for her little one and no matter how cleverly the young bunny conceals itself in the many forms –a fish in the stream, a crocus in a garden, a rock on a mountain, his steadfast and unyielding mother has never failed to reclaim him.  (There is something Biblical, I discovered, in this simple children’s book, how God in His infinite love and boundless mercies would go at great lengths in order to find the lost shep.)

Knowing that the end is near, Vivian opted for a DNR.  Posner’s initial attempts to revive her despite the DNR status much to the disappointment of the nurse smacked of arrogance. 

Vivian Bearing finally learned in her deathbed the meaning of compassion. She found it in the arms of two people who represented the major phases in her life: her old professor Ashford from the academe, and her nurse Susie from the hospital.  Sadly, her doctors failed her in all accounts much as words have failed her (as they eventually must) and as Medicine has failed her doctors.  But she found her final redemption, by signing the DNR option and facing Death squarely and lovingly, thus, depriving it of its mightiness and misery.

This is my playes last scene; here heavens appoint

My pilgrimages last mile; and my race

Idly, yet quickly runne, hath this last pace,

My spans last inch, my minutes last point

And gluttonous death, will instantly unjoynt

My body, and soule, and I shall sleepe a space,

But my’ever-waking part shall see that face,

Whose feare already shakes my every joynt:

Then, as my soule, to’heaven her first seate, takes flight,

And earth-borne body, in the earth shall dwell,

So, fall my sinnes, that all may have their right,

To where they’are bred and would presse me, to hell.

Impute me righteous, thus purg’d of evill,

For thus I leave the world, the flesh and devil.

- “This is my Playes Last Scene”

(from John Donne: The Divine poems, edited by Helen Gardner, 1952)

Let’s Talk About the PMA

I remember writing 6 years ago about the Philippine Medical Association (PMA) on its centennial year.  Got the inspiration one afternoon while trying to find a ride back home after watching a movie at SM Manila.  Without warning as Manila’s weather was – still is - wont to, there was a sudden drizzle and I found myself seeking a momentary refuge at the Manila Medical Society building along Taft.  For the blog rounds, I rummaged through my files and found the essay still intact.