There are very few things I am willing to wake up at 3am for. A good book sale is one of them. 

When I heard that the Big Bad Wolf Book Sale was coming to Manila, I honestly hesitated to go because I am completely averse to crowds. When I started seeing posts of friends with their respective hauls (and the insane savings they made!) I decided to wake my family before the sun came up (much to their chagrin) so we could make the trip to the World Trade Center. Absolutely no regrets- At 5am we could have danced through the aisles because of how empty they were, and were able to go through every single section. It was a wonderful morning. 

I’ve spent the last few nights reading through my finds. It’s a pretty diverse selection, but I do think all these titles will satisfy any literary cravings I’ll have for the first quarter of the year. Just a quick disclaimer- I’m an avid children’s book collector, I read a lot of medical non-fiction (comes with the territory), and I have always been thoroughly interested in art, architecture, and food. Though these titles be completely different, they all do what books have always done for me through childhood- give me comfort. 

Emily Ley is best known for creating the simplified planner- one of the most empowering organizers I’ve picked up. The type A in me couldn’t leave this- it’s an easy read on finding balance and striving for grace, not perfection. 

The children’s book section at BBWBooks was THE BEST. It was necessary to practice self-restraint here the most. Great finds this year include Art for Baby interactive books (they teach you colors and expressions through the works of Klimt, Monet, Kusama!), Eloise (my favorite favorite childhood icon), I am A Droid from the Star Wars x Little Golden Book series, and T-Veg, an adorably watercolor-illustrated book about a vegetarian dinosaur. 

I picked up this great coffee table book on Doctors’ Practices. It has images of almost a hundred of the most beautiful clinics in the world. From zen dental clinics in the midst of bamboo forests in Japan to soft and playful facilities for children with special needs in the US, I’m taking this as a little inspiration and reminder to integrate patient-oriented design into my future practice, whatever it may be. 

I won’t claim to be a culinary expert, but I do love reading a lot of cookbooks and books on food- especially when they’re icons from a certain period or have great narratives about food history. Ginette Mathiot was a French food writer, who wrote Je Sais Cuisiner, France’s version of The Joy of Cooking. I’ve had my eye on her books for awhile- but because they were about P4500 (80USD) in the bookstore near home, I put off buying them. When I saw this at ONE FOURTH the price at the book sale, it immediately went into my cart. 

Second best haul from the fair would probably be from the medical/health section. Picked up more Oliver Sacks (whose work I regrettably only discovered a year before his passing)- Seeing Voices and Migraine. His voice, as with Siddhartha Mukherjee’s- is one I hope to be able to be as eloquent as someday. Jonathan Eig’s The Birth of the Pill was my win medical history find, and is a social, cultural, and scientific perspective on arguably one of the best and most important innovations in the last century. Finally David Agus’s A Short Guide to a Long Life (Currently my go-to quick read between lectures) and The Lost Art of Healing- Bernard Lown’s treastise on practicing compassion in medicine. 

It’s been an especially daunting week in my life- each day I find myself thinking repeatedly of home and what constitutes it. In the midst of quiet I found myself therapeutically looking through photos and found this set- an exhibit about home at LACMA, Los Angeles. Through different mediums, they asked artists to define home- and in the context of their own narratives and others worth sharing. There were those whose art spoke of contrasts- a father in jail after deportation and the room of his soon, wallpapers in baseball cards, a country away. Others showed the sterility, the almost spiritless modernity of having to shed color and culture for the simple in a place so difficult to set roots in. In many, there was a semblance of longing, of looking for what, where, who feels safest to be with. The very essence of home. 

Last Friday, I got to know the first of the 20 at 20 kids.

She was wearing a yellow shirt with a pink trim and a huge gap-toothed smile.

Coming in, I knew that she had Patent Ductus Arteriosus or PDA. We all start life with a Ductus Arteriosus- a little vessel that connects the heart’s main artery (aorta) to the main lung artery (pulmonary artery). In the womb this keeps the blood from flowing into the lungs. After birth, the Ductus Arteriosus normally closes because it is no longer needed. When it doesn’t, it becomes a Patent Ductus Arteriosus, which means more blood is pumped into the lung arteries than what is required. It makes the heart and lungs work harder and can cause lung congestion.

Her kind doctor asked if I could listen to her heart. There it was- a crescendo-decrescendo of a murmur, a soft wooosh, woooosh contrast against the more distinct first beats of her heart. Looking at her, you could never tell that there was something wrong- she was vibrant and more than excited to show me the performance of the field day ceremony she was missing (Anthem of all Philippine children: Baby Shark, with complete choreography). I knew however that the day’s procedure would allow her to keep dancing even in her old age.

She was a little shy to talk at first, though warmed up when we started talking about a common love- Jollibee. Eventually I asked her if she had ever heard her heart. When she shook her head, I taught her how to wear my pink stethoscope and placed it above where she would hear it the loudest. “Anong sinasabi ng puso mo?” (What is your heart saying?) I joked. “Gusto niya ng fried chicken.” (It wants fried chicken.) she replied seriously. I laughed the hardest I have in a long time, and she warmed up completely. Grabbing my hand she said “Dito ka lang sa tabi ko.” (Stay here beside me.) “Ay ganyan po yan,” (Oh she is really like that,) her mom said with a smile. “Malambing, hinahaplos ang gusto.” (She is sweet and likes to caress to show she likes someone.)

We spent the next half hour together waiting for her procedure. She told me about her big sister and the friends she missed at home. We took photos together (complete with silly filters she absolutely loved). I promised I would be there with her in the OR. Pag natatakot ka, anong kulay lang hahanapin mo?” I asked. “Pink!” she’d shout excitedly. “Kahit purple ang paborito kong kulay.” (Even if purple is my favourite color) she’d add mischievously, poking fun at my coral pink scrubs.

Soon the time for the procedure came. I was amazed by the nurses in the catheterisation lab- the way by which they did magic tricks to calm her down, the gentle way they spoke to and told her what they would do. We scrubbed in for the procedure, and while I was simply there to observe, the residents discussed what they were doing step by step, so a certain in-awe med student could learn. Moments like these leave me floored- one of the most humbling things in this profession is encountering physicians who are so open and willing to share their knowledge so you could become a better doctor too. The lead physician- her paediatric cardiologist, orchestrated the procedure in such an efficient and thorough manner that left me with my jaw open pretty much the whole time (thank God for the mask covering my face). To think about how they were doing this as a service, as a calling, was the best reminder about where I want to and should be going.

At the start of the cardiac catheterization procedure, we saw how there was extra blood being pumped into her pulmonary artery. After, because of the placement of an occluding device, the last image we saw was that of her blood flowing the right way.

Her cardiologist asked me to join him as he delivered the good news to her parents. “Success po ang procedure.” he told them. Immediately her parents were in tears.

We learn many things in medical school, a whole plethora of knowledge that we can barely cram into our heads to regurgitate for exams. One of the things we don’t learn (and one lesson I am still trying to train myself to do) is how to not cry in front of patients and their families.

The second I saw the joy on her mother’s face, the way her father gripped her hand to hold back his own tears- I couldn’t help but remember my own parents, who many years ago stood where they did, waiting to hear how about how my brother’s own procedures went. I was never allowed to the hospitals then- but only understood in that moment just how challenging and difficult a time it must have been for them. We may have lost Migi, but 20 years later I am grateful to be able to experience what it is to see families be reassured that the little hearts of their children can be fixed, to witness and share in their joy and relief. I will always be immensely grateful to the heart hero of a physician, Dr. Jonas Del Rosario who invited me to witness all this that day.  

At the end of the day, I returned to bid her family farewell and thank them for sharing their story with us. I took out my stethoscope one last time and placed it right where the doctor had taught me. This time barely able to keep the tears from my eyes, I told her mother “Wala na po yung murmur.”

Today I learned that she and her parents were able to return home to their province. In a short message, her mother let me know that they were doing well and that she was back to her rambunctious little self, her lips and skin rosier than they were before. Her final message melted my heart and will be something I carry with me always.

“Sabi po niya sa lolo niya pag-uwi na may best friend siyang doktor sa Maynila na naka pink.”

To the moments that remind us most of our why.

On February 21, our Migi turned 24 in heaven. June 3rd, 2018, will mark 20 years since his passing. To celebrate his memory and God’s faithfulness to our family these last two decades, we wanted to do something to help other little heart patients like him have a better chance at life. He may not have made it 20 years ago, but with all the advancements in medicine and technology, little children with broken hearts now have a better chance to heal. In partnership with Dr. Jonas del Rosario, and some of his colleagues at the Philippine General Hospital and Philippine Children’s Medical Center, we are looking at fixing the broken hearts of ten pediatric patients between February 21 and June 3, 2018 through the 20 at 20 project. We are looking for 20 kindhearted individuals, families, groups of friends, or organizations who are willing to donate 20 thousand pesos for each child. If this is something that moves you and you would like to help us out with, please feel free to message us on Facebook (Cathy Sanchez Babao or Pia Babao Guballa). Please also feel free to share this post with those you believe may want to help. We hope you can join us in helping heal little hearts and give them a better chance at life. Thank you very much!

The Medicine Mondays part of this blog is my attempt to document my life as a medical student. No assurance that it’ll always be entirely coherent- we have scheduled exams every week and this is simultaneously a (sleep-deprived) attempt to unwind- but I promise real stories and musings from the classrooms to the hospital halls.

I was at my Lola’s house yesterday, bringing over some gifts we had gotten her on our recent trip to Hawaii. Among these were a box of Hawaiian Host Chocolate Caramel covered Macadamias, something we knew she’d enjoy.

True enough, despite just having woken up, she reached for the box and immediately bit into a chocolate.

“Ang sarap!” she exclaimed.

We watched her with a smile, but exchanged slightly worried glances when she quickly reached for another.

“Ma ha, that’s enough chocolate. Naka-dalawa ka na.” (Mom, that’s enough chocolate. You’ve had two.) My mom joked lightly.

A few minutes later, my mom stepped out of the room. My Lola smiled smugly, slipped a 500 peso bill towards me, and picked up another chocolate from the box.

I laughed, and thought for a moment whether I should say something. I was immediately transported back to the clinic I worked at in Arizona last summer, a memory of a similar situation.

I did a quick enriching elective shadowing an internal medicine physician in Phoenix. I spent my days picking up clinical skills between cases from the doctor, getting tested about basic labs and physiology, and in some instances, getting to know the patients during history and physicals.

One morning a family walked into the clinic for consult- three generations of women. They were there that morning for a first consult for the grandmother, who was a recent immigrant who was only just learning English. The clinic of course had a medical assistant who worked as a translator, but my own Spanish was tested that morning after the doctor told them I understood.

After the consult, the grandmother looked at me nervously and said “El otro día vi algo en la televisión sobre la salud que me asustó. Tengo pregunta para doctor.” (I was watching something on TV the other day that scared me. I have a question for the doctor.”)

“El periodista en la televisión dijo que las papas fritas están matando gente. Me hizo tan triste porque esa es mi comida favorita! ¿Debo dejar de comer papas fritas?” (The reporter said French Fries are killing people. That’s my favorite food! Do I need to stop eating French fries?) she lamented.

I told the doctor about her concerns and fully expected him to launch into a lengthy explanation about trans fats and the perils of complex carbohydrates. He began by taking her hand, and just giving her a brief explanation for why there was such an uproar about carbs/fatty foods in the news. Then he looked at her with a kind smile and said “But in your case, you’re 93* and healthy. Eat what you want. Even French fries.”

She sighed with relief and beamed at the doctor. I had never seen a patient so happy.

Later that day I asked the doctor why he had taken that approach. He sat me down and told me about how it’s especially important to look at the different aspects of geriatric care- and as long as they’re in good health, to learn not to deprive them of what brings them joy. This is especially true in the case of food, where taste buds go awry towards the end of life and appetites begin to diminish.

In her mid-80s (actual age redacted as per instructions in her will), my Lola is still extremely healthy, only having started maintenance medication 2 years ago. She’s never had your usual wholesale package of lifestyle disease- no diabetes, no hypertension, no heart disease. Up until about a year ago she was running everyday (something she only began in her 40s), and her staple food item was and remains to be crispy pork, especially in the form of Cebu Lechon.

Back in Mama’s room, I watch her look at the caramel ooze out of the chocolate with such a sense of wonder.

Later when she’s distracted we place the box in her refrigerator and ask her caregiver to let her enjoy them when she pleases (but not eat the entire box in one sitting of course lest a bum stomach happen). Her memory may fade, but joy, spunk, and spirit- these are what keep her strong. If anyone deserves to have what keeps these going, she does. 

I make a mental note from here on to always carry a box of chocolate when I see her, remembering the way she lit up with a sweet in one hand. 

The Medicine Mondays part of this blog is my attempt to document my life as a medical student. No assurance that it’ll always be entirely coherent- we have scheduled exams every week and this is simultaneously a (sleep-deprived) attempt to unwind- but I promise real stories and musings from the classrooms to the hospital halls. (I realize today is a Thursday, but using jetlag as a justification for this mid-week musing). 

*PS- Some details changed with respect to HIPAA. Striving for ethical medical narratives always. 

 I was in the United States for almost a month this year getting some clinical experience by shadowing physicians in psychiatry and internal medicine. It was a working trip for the most part- but I was blessed to have family and friends who made the most of the downtime when not in the clinics by exploring art and food with me. 

A day after I had landed at LAX, my godmother (whom I hadn’t spent time with since a trip to Universal Studios in 1996) called and asked if I was willing to go on a spontaneous two-day adventure. She had planned for us to relive the Universal Studios trip 21 years prior on the second day (and we did, though we were sorely disappointed that the ET ride was no longer around) and told me to choose whatever I wanted to do for the first day. Without a second thought I picked what had always been on my art bucketlist: A trip to The J. Paul Getty Museum.

The J Paul Getty Museum at the Getty Center in Los Angeles houses some of the best European art in the US. Jean Paul Getty was an American industrialist, making his fortune in oil. He was an avid collector of art and antiquities, and at his death left the J Paul Getty Trust foundation as the wealthiest art institution in the world. The museum is in the Brentwood neighborhood in LA, an affluent area with homes with beautiful architecture peppered across the hills. A trip to the Getty begins with a tram ride that stretches uphill, showcasing just how lovely the area is. 

Then when you emerge at the top, this is what greets you. It was a perfect day- not a cloud in the sky, sun up, a gentle breeze blowing- and for a moment I completely forgot how jetlagged I was. 

Note that the Getty Center is HUGE. (Map for reference below). So before doing any exploring, we decided to fuel up at the Cafe. 

It needs to be said that the Cafe selection at the Getty is pretty great. It’s cafeteria style with multiple stations- deli, kitchen (full, farm-fresh, from scratch entrees), fiesta (it’s in LA), grill, oven, and a HUGE salad bar (again, in LA).