nucleardreams’ blog

It feels good to pay it forward but I am of firm belief that is feels better to pay it back.

I am unabashedly La Sallian even if I have never received a loyalty award.  My contention that they did not accept females until the year I started my studies there, nor my contention that my total length of stay with the institution outnumbers the years of those who actually received the award, have been for naught.  The absence of the award however does not diminish my gratitude and appreciation to the three schools/campuses I have studied in.

Thus, it was one of my greatest frustrations to have helped improve facilities in other medical centers and not have been able to do so in my own home turf.  I wanted it to become one of the best.  I wanted to help it realize its great potential in what little way I could.  Unfortunately, red tape was everywhere and it felt that like there were hurdles around every corner.  It felt like half the administration was opposing our group.  It even felt like some of the Brothers were against us and at least one of them even admitted his concerns.  It was implied that I and my colleagues were in this for personal gain of the illegal kind.  A fellow La Sallian even accused us of being uninformed and backward.  Very hurtful given that we had nothing but the best intentions at heart.  And these were only the things that got back to us.  I don't know, and at this point I don't care, if there were more slurs. 

It took three years of ups and downs but early this year we finally achieved what we set out to do.  Worthy of full page ads in the major dailies.  It was a very fulfilling moment indeed.  We felt good when the hospital administration acknowledged our contribution.  We felt good when Br. Mawel thanked us personally.  I felt good showing colleagues, students, alumni and outsiders around our project.

It felt good enough that my colleagues and I agreed that we could finally lay low and take a breather after everything we went through.

No.  The pull is too strong and we find ourselves more ambitious than ever.  We are a bit nervous though because after the One La Salle shuffle, we are treading on different ground again.  Almost all of the personalities we have to deal with will be new.  Firstly, Br. Gus, whom I have been seeing and have heard about since HS days, but have never worked with before.  Even Sr. Francesca, the Hospital Administrator and Dr. Carlos, the Medical Director are new faces and forces to contend with. 

This means more prayers, sleepless nights and gallons of coffee.  I'm even more certain people will start saying things again.  I just hope that with our track record, we won't be given as hard a time as before.  If we pull this off though, it will all be worth it.  This is no longer just benchmarking.  It will mean being in front of the pack. 

Yes, paying back can definitely become addicting and this is one addiction I don't mind having.

I'm so excited.  I just got this in the email today:

RE:  Nominees for IAEA Training Course on PET

I will be nominating Dr. Wesley Llauderes of JRMMC and Dr. Rhiamar Gomez of MMC and DLSU. I'm still keeping in mind the others who asked to be considered in case Drs. Llauderes or Gomez for whatever reason becomes unavailable. Thanks.

 

This will prove very educational and I can't wait to share what I learn with everyone else.

Asela is currently in the USA for additional MRI training but she just sent an email saying that she will try to train for PET in USC while she is there.

Michelle will likewise be in Bangkok this November for PET Training.

How ironic.  By the end of the year, DLSUMC will have 3 PET trained physicians and no PET scanner.

I got this email with a picture of Mary saying I had to send it to 20 people otherwise I would experience great tragedy, etc.  You can check it out below and decide if you want to forward it or not.

Now, I'm p.o.'ed because I've received this particular letter at least 5 times already.  To which 20 people shall I inflict the burden of sending this on to 20 other unsuspecting individuals?

Does anyone honestly believe that the Blessed Virgin will kill off people who don't forward her image?  And this question isn't being asked because I lack faith or I don't believe or whatever it is some people would like to think. 

The image below is of the Virgin of Guadalupe.  Many believe that the original image is miraculous.  It may well be so since it has survived the last 500 years all the while maintaining its structural integrity.  This is stated in the writings of Giulio Guerra, "La Madonna di Guadalupe. 'Inculturazione' Miracolosa".  It has also survived ammonia spillage in 1791 and a bomb blast in 1921.  The Mexicans should be protesting this email because it implies that their beloved Nuestra Señora de Guadalupe, their most popular religious, cultural and nationalistic symbol, is a vengeful mother who punishes those who disobey instructions to forward emails.  Filipinos should protest this implication as well because Pope Pius XI proclaimed her a patron of the Philippines.

You know, I would much rather forward (if I do forward at all) the emails telling me to help or pray for someone in need than to forward the emails telling me I will either:
1) die,
2) lose my family,
3) go bankrupt,
4) receive bad luck,

if I don't continue the chain -- even if there is an added bonus of:
a) my wish coming true
b) receiving a surprise
c) Microsoft (or whoever) paying for someone's medical bill or better yet Apple sending me a free iPod

So, anyway, back to this email that I got.  It got me to wondering where this stuff was coming from (yes, just now, after years of receiving them) and if there was any truth to the stories of the ill-fated people who failed to forward and the lucky ones who did.

I quote "The President of Argentina received this letter and called it "junk mail", 8 days later his son died."  Using Google and Wikipedia, I have come across Carlos Menem, president of Argentina from 1989 to 1999 whose son, Carlos Jr, died during his presidency.  While the death of Carlos was sudden (helicopter crash), there is no evidence to prove that former President Menem did indeed receive the email and that if he had received it, he did so 8 days before Carlos died.

"A man received this letter and immediately sent out copies...his surprise was winning the lottery."  Which man is this?  Which lottery?  Visa Lottery?  Green Card Lottery?  Spiel?  El Loto 6/41?

"Alberto Martinez received this letter, gave it to his secretary to make copies but they forgot to distribute: she lost her job and he lost his family."  This particular line really piqued my interest.  Why does Alberto Martinez get named while lottery guy is just "a man"?  Which Alberto Martinez is this?  The Spanish cyclist?  The writer?  Or is it the Alberto Martinez who said, ""I even like Taco Bell. I love the beef burrito supreme. I don't like their tacos, but I'll go there every once in a while, sure." and "To us it's not important where the other guy is. It's important where we are and what our internal goals are. ... We're very happy."?  Nope, doesn't sound like someone who might have lost his family. Did they mean General Alberto Martinez who was a former Secretaria de Inteligencia de Estado (Secretary of Intelligence) of Argentina.  Unfortunately, records show that he served until 1973 leading me to doubt that he lived long enough to receive this email (or any email for that matter) at all.  Still, "making copies" might mean that this letter was originally in hand/type written form.

This did make me think of Argentina, however.  Perhaps the email originated from there.  The country is after all ranked third in Latin America in terms of Internet usage.  AND, should the Alberto Martinez in the email also be from Argentina, then maybe his woes and his secretary's job loss (poor secretary, she didn't even receive the email herself) were more due to Argentina's problems of inflation, external debt and capital flight than the Telecommunications Liberalization Plan of 1998 (coinciding with when Carlos Menem was president) and poor internet correspondence.  Or it could just all be a coincidence.

To end this lengthy post (which may have some of you thinking that you would rather have received the chain mail instead), let me make it clear that I am not making fun of the Blessed Virgin nor am I being un-Catholic.  The second of the 10 commandments states, "You shall have no other Gods before me."  It condemns superstition among other things.  How better to describe a belief in fortune or misfortune happening based on whether or not I click the forward button?  Oh, and I was quoting the Vatican.

So there, I refuse to force the chain email onto all 20 of you.  However, know that if you don't reply to this post in 60 seconds, your computer will shut down automatically and you will never be able to turn it on again!

E-mail:

Virgin of Guadalupe

A college friend who was in pre-law decided to forego law school and work in the field of banking instead.  His goal was to make his first million one year before the rest of us earned our law and medicine degrees.  He succeeded and left the rest of us wondering if we had made the right decision.

Throughout medical school, internship and residency I rarely attended reunions.  The main reason was lack of time.  Another was not wanting to hear about how successful all my other HS classmates were.  It wasn't because of envy, resentment or feelings of inferiority.  These were the years when I was buried in books, when I was going on 24-hr duties, when I was doing scut work, when I was being deprived of quality family time, when my firstborn was spending more time with her yaya than with me, when I could not even enjoy my time off because I'd be sleeping like the dead in an involuntary effort to counter sleep deprivation.  I didn't want to hear about how successful they were because I was afraid that it would weaken my resolve to follow through with what I had started. 

All throughout internship, my end goal was to pass the boards and practice medicine.  While the main purpose of treating patients and doing good for the rest of humanity was always there, likewise ever present at the back of my mind was a longing for a time when I would get paid enough to compensate for what I had gone through.  

After the boards, I quickly went to work as a GP moonlighting in different small hospitals and in clinics.  I affiliated with different insurance companies and this afforded me my daily "reasonably priced" P300 lunches.  College friend was by then rich banker friend and he was thinking of buying out one of the bigger multispecialty clinics and wanted me to help run it.  My income would have further improved but by then I was bored and unchallenged by my work. 

I refused.  Training over money.

Instead, I went into residency for further training and was forced to spend on "expensive" P60 lunches.  My specialty of choice was not as demanding of my time so it was then that I married and started a family.  However, my entire training allowance was not even enough to cover for my meals and my gasoline expenses.  My husband had to take on extra work to allow our family a decent lifestyle.  Towards the end of my residency, I was once again tempted to go straight into practice to help out with finances.  But the lure of the academe was stronger.  I decided that it would be best to go directly into subspecialty training. 

And I even did it twice.  Training over money.

Soon after I finished training, a colleague and I were involved in setting up two new facilities.  Money became my focus.  I was working extra hard on these projects because of the potential income I would receive once these were set up.  

Then I was sent a wake-up call.  And I slowed down.  Family over money.

Two years ago, I was asked how P300k/month sounded.  It sounded like heaven.  Then I found out that I had to work 11 hour days and be on-call the rest of the time, even weekends.  Very tempting but I was enjoying my personal and family time too much and I eventually withdrew my application.  Family over money.

Then things started to build up again and I started wondering "where did my lifestyle go?".  I endeavored to achieve a balance in my life.  Become a real super wife/mom.  Strive for family over money.

By the middle of last year, I found myself affiliated with 3 big hospitals, 2 small hospitals and 4 clinics.  Too much work once again and still I found myself taking on the biggest project of my professional career to date.  It eventually proved too much and come Christmas time, I had resigned from 1 big hospital, the small hospitals and 1 clinic.  At the start of this year I went on an extended leave of absence from 2 more small clinics.  Not so that I would have more time with my family but rather to allow me time to work on my big project.  

I was supposed to have gone back to work in the clinics this March but I've decided to give up one clinic completely and to cut my time in the other clinic in half.  You see, I was really happy with the way everything was going . . .

. . . until my daughter uttered the words, "I like it better when I'm sick because Mommy spends more time with me."

Hearing that was the worst thing ever.  It was as if my heart just stopped beating and yet there was a pounding in my ears.  Then I got this flashback to a time when I was explaining my choices of specialty and subspecialties.  I remember saying it was a lifestyle choice, primarily because it wasn't as demanding of time as the other medical specialties.  These were specialties that would allow me to spend quality time with my husband and kids, that would allow me "me-time".

Inspite of this I find myself in a situation where I only get to really talk to my husband when we take just one car to work.  A situation where my daughter is vocal about how I don't care enough and don't spend enough time with her.  A situation where my son would rather be with his yaya than with me.

My husband's cousin, who happens to be in the same profession, and whom I suspect my daughter may have talked to, also recently scolded me.  Quality time is not enough.  Quantity counts just as much.  She claims she only realized this when she was diagnosed with breast cancer.  She regrets not being there for her first two children and appreciates that her cancer made her realize how much she wanted to be there for the younger kids and how much she wanted to make up time with the others.

This time, I'm making sure I take heed.  I've sworn not to take on new hospitals or clinics unless they are replacements for existing ones.  No more additional work hours.  The Lord must be very patient with me to have given me several heads-up's.

Family over money.  Always.  I mean it.  This time, it's for keeps. 

For the clueless, Cebu Pacific is celebrating the completion of its refleeting and its 11th anniversary with a P1 price to any destination for the flying period of June to December 2007.

Asela and I were excited about this because the International Atomic Energy Agency is holding a conference in Bangkok this coming November and we were planning to attend.  The IAEA usually has funds to sponsor participants from "developing countries with low economic resources" and that means the Philippines has one (and only one!) grant alotted to it.  Instead of fighting over the single grant, Asela and I decided to take advantage of the P1 fare and just pay our way for the conference which will be about Clinical PET and Molecular Medicine.

Alas, all the P1 fares for flying dates before and after the conference have been taken.  (Bom says November is the start of the peak season.)   My only option now is to use on my FOC's and pray to heaven that I don't get bumped off.  I don't particularly relish the idea of getting bumped off again although I should start getting used to it.  The first quarter is almost over and I haven't even made a dent in my travel budget.

(everyone!  -- as in everyone)

Lastly, we would like to give honor to the great Frenchman, whom we all know as St. John Baptiste De La Salle.  For had he not persevered with his own “project” four centuries ago, we would not have had the opportunity to persevere with ours.

Today is a day to celebrate.  Ladies and gentlemen, on behalf of the De La Salle University Medical Center and the Department of Radiology, I would like to thank you all for coming and making this occasion all the more special for us.

Blessing Video

The project drained us of our resources so other than the speeches from key persona, we had nothing on the program except this short video.  Asela came up with the idea and we shot and edited in between seeing patients.

It was hard to get people to wave at the camera, except for the medical clerks who didn't even bother to ask what it was for or where and when it was going to be shown.  :-D  They just waved away.

After the video was shown, I went table-hopping for pictures and everyone wanted me to take videos of them waving at the camera.  CYY now wants a copy of the video to play in the lobby?!?!?!  He should just ask Mang Jess to reshoot the whole damn thing to get something of much better quality.  Otherwise, Asela and I plan to edit it in such a way as to make our segments longer.  Hahaha! 

Which reminds me, noone even noticed that our shots weren't in the hospital.  They were shot at Mocha Blends, where we spent countless late nights and early mornings working on the project.  Where we drowned our sorrows and celebrated triumphs with caffeine and not alcohol.  

The shots of us are in our favorite chairs, too.  The exact same tables and chairs where we learned how to do feasibility studies, how to use Excel, how to prepare income statements, how the bidding process went.  We were also in these chairs when we finally learned how to spell "Bill of Lading".

Even Milette wants a copy -- heaven only knows what for.   

Originally posted in

Gabriela's Crib

October 14, 2004

The Philippines has long been losing medical and paramedical professionals to other countries.  Doctors, nurses, physical therapists, radiologic technologists, medical technologists, caregivers, etc.  The lure of the buying power of the euro, pound or dollar being the most obvious reason for this exodus.

I remember something from the early days of the Little Miss Eat Bulaga contest or whatever it was called.  Vic Sotto asked one of the contestants, "Anong gusto mo maging paglaki mo?"  "Duktor po."  "Anong klaseng duktor?"  "Nurse po."

I remember laughing at the child's answer but look at how prophetic she turned out to be.

What used to boggle the minds of the medical community, let alone the rest of the society, was doctors training to become nurses.  Note the past tense.  "Used to".  It is now the third-year of this phenomenon that looks like it will continue at least up to the end of this decade.  It is no longer a mystery but an accepted reality.  A fact of life.

I graduated from medical school in 1994.  Passed the medical boards in 1995.  A year short of a decade later, I have been through moonlighting, practicing as a GP, 4 years of residency, 2 years of fellowship and 6 months of another fellowship.  I have contemplated leaving the country numerous times.  Initially, for further training abroad.  Last year, to work as a nurse.

Although I have changed my mind about the latter, leaving the country to work as something other than a doctor will still always be an option, albeit the last one, in my mind.

Why Leave?

Financial Woes

Not all doctors are rich.  Most of the ones who are were either born into or married into money.  There are, of course, the few who got there because of hard work and good luck.

Graduating from medical school with an MD degree does not mean anything financially.  You will still go through internship where you will earn an average of P1.5K/month.  Passing the medical boards will not guarantee you financial stability.  As a GP, you will be lucky to earn P25K/mo.  Your other career path would be to go into residency/fellowship where you will earn P20K at the most, the average being P5-8K.  This is for 24-hr duties every other day as well as working office hours in the intervening days including weekends and holidays.  Not to mention being on-call 24/7.  Passing your respective specialty and subspecialty boards will not guarantee you financial freedom either.  Which leads us to . . .

Actual Practice

Setting up your medical practice in big hospitals generally means that you will have to buy stocks (up to P2M worth).  This is for your right to practice.  This may or may not include your payment for clinic space.  I once read that financial capability is a major factor over credentials and clinical skills in the beginning.  Lucky those with parents or spouse who can give them the money.  For the rest, to go for this idea will have you deep in debt before your practice even begins. 

Even if you do find someone to lend you the money, keep in mind that you are only starting.  Does this matter?  Of course it does.  I know doctors who have finished more novels and cross-stitch projects than the number of patients they have seen at the start of their practice.  Do the math.  If you get a self-paying patient, you can charge about P300-500.  If you get an HMO patient, you will receive P200-250 -- after the 2 to 5 months period that it usually takes the HMO to pay you.  You will still have to pay off your debt, secretary/nurse, overheads, and that VAT/nonVAT tax.

Next option?  Apply as staff in the smaller hospitals or in a multi-specialty clinic.  You will still need to either invest (P300K upwards) or go into a profit-sharing scheme (40% to the clinic, 60% to you).  Still can't afford it?  Set up your clinic at home where most of the people who will consult are neighbors who expect to be treated gratis.

Stability Abroad

Financial stability first.  To a physician who earns an average of $450/month, the offer to work as a nurse earning $3500/month with a sign on fee of $7K will be tempting.  Add immigrant status and sometimes even job placements for the immediate family into the equation and what used to be a small ember of temptation suddenly bursts into flame. 

The Future

If there is someone/something that would make me leave the country in an instant it would be my children.  I have heard of chairpersons of specialty and subspecialty departments leaving the country to work as nurses, just so they can offer their children a better future.  I know of someone who went home to his province to practice as a specialist, treating indigent patients as best as he could.  Being indigent, these patients could only pay him in kind.  Had he just considered himself, he would have stayed, he said.  Still, he was forced to pack up his bags and take up nursing because produce, livestock and services could not be used as barter for utilities and his children's tuition fees.

Too, doctors have no pension.  At least those in private practice.  Aside from all the usual expenses, you will still have to set aside a portion for your retirement years.  One doctor I know cites this as a reason for leaving.  His practice is alright now but he worries about what will happen down the road.  As a nurse, he says, he will be receiving at least $1K in pension monthly.

The State of the Nation

Even before this fiscal crisis, the devaluation of the peso would have been enough cause for concern.  A patient once told me, "Ten years from now, doctora, the Philippine peso will be Mickey Mouse money.  Good only for this country but worthless everywhere else.  The key, doctora, is to earn in dollars or pounds and spend it here."  As we doctors love to say during research contests, point well taken.

Corruption is deeply rooted in this country.  It will take a lot of change not only in government policies but also in morals of the citizenry before this country will have a fighting chance at overcoming all the obstacles in its way.  Much as I love this country, I am realistic enough to know that the Philippines I want will not be a reality in my lifetime and quite possibly, even during that of my children.  To live in a country riddled with more problems than any country I may decide to migrate to, is not a legacy that I wish to leave my children.

Malpractice Bill

I do not deny that cases of malpractice exist.  Yes, doctors should police their ranks.  However, I disagree with this particular bill. 

Doctors are leaving the country, in droves if the statistics that are bandied about are to be believed.  Yet here is a bill that turns the remaining doctors into the enemy.  Not even the best doctors, here or abroad can guarantee that 100% of their patients will not have a turn for the worse nor will have a side-effect or idiosyncratic reaction.  Not even the best doctors can identify which patient will fall into the minority that do not respond to medical treatment the way the books and journals say they should.  Not even the doctor with the best of intentions can claim infallibility.  As I said in an earlier post on this subject, they call us men who play god, forgetting the point that we are but men and not dieties who can claim perfection.  The definition of malpractice in this bill is so vague that anyone can interpret both it and an unfortunate medical situation in such a way as to turn the doctors who opted to stay in this country from healers into criminals. 

Medicine in the Philippines

Most of the country has inadequate medical facilities.  Even a rural physician with the best intentions will find it difficult at best.  The health budget of this country is well below the recommended (3.5% of the GDP as opposed to 5%GDP).  There is not enough equipment or medicines. 

Contrary to what the laymen may think, there are still selfless doctors.  The ones who spend what little they have left to buy medicines for their patients.  A doctor I know, does not even collect some of his professional fees from his paying patients but instead donates these anonymously to his charity patients.  Residents who earn a pittance, will still shell out what they can.  The question is how long can they hold out?

Other Reasons
You can work as a nurse, save up and at the same time pass the USMLE (US boards), repeat residency and figure out a way to stay and practice in the US.

Why Stay?

Beyond Materialism

Healers do not become so to gain material possessions.  We are supposed to be full of compassion for the patients.  We should be selfless when faced with the ones who need us the most.  In this case, these are our poor Filipino countrymen who are hard put to seek even the most basic medical care.

The best feelings of accomplishment do not come at the time when you count the money in your hand but when your patient reaches out to you, looks into your eyes and thanks you.

This Country is Worth Fighting For

We are Filipinos and if there is a country we should serve, it should be our own.  If we prove ourselves worthy as citizens, it should be as citizens of our native land.

When Korea called out for help, it was the Koreans who had migrated to other countries who sacrificed and returned to their motherland.  Look at where Korea is now.  Definitely a tiger economy.

Financial Stability

If you are really after money, think of this.  With the exodus of doctors, there will be less competition in the country.  That will mean more patients per doctor.  More patients means a commensurate increase in professional fees.

You may earn more if you leave but your cost of living will also increase.

Psychological Factor

Some doctors who are practicing as nurses in the USA sometimes find it difficult to refrain from participating in the patient's management.  How does one get rid of something that has been ingrained into one's system?  How do you, as a former department head, step back and watch others do the job that you know you were meant to do?

Family

Think of the difficulties of leaving your loved ones behind.  You may be able to bring your immediate family but think of your extended family and your friends.

The Good Life

No matter how difficult life is nowadays, no doctor is ever so impoverished to not enjoy good times.  There will always be a means to earn a decent living. 

- 0 -

Funny.  I've decided to stay and yet all my best arguments are for leaving.  Go figure!  Practicality tells me to just go.  If I listen to my heart, stupid as it may sound, it tells me to stay.

And so I've decided to make my blog white.  Nothing nuclear and nothing dreamy.  Plain, ordinary, or as my sister describes it in relation to me -- aseptic.

This time I want to do things right.  A real journal. 

I wonder what I should do with the other one.  Download?  Leave it be?

It is already past 4 am and I can't sleep.  I think that's odd considering my schedule for the past week.  Or maybe it's my excitement over this new project.  Walang kadala-dala.  It gets harder each time, even if I try to convince myself that it won't be.  The hurdles make success so much sweeter -- and so much more addicting. 

I know I swore repeatedly over the past few months that after the project I would take a rest from it all.  Look at me.  The work was supposed to have ended yesterday and today I'm already contemplating a new project.  Less than 24 hours after!  Not to mention more ambitious.

It feels like I played into fate's hands.  That this is meant to be.