Friday, April 30, 2010

My first case of Pseudocyesis (2nd of 2 Parts)

There she was, the patient, lying on the IE table.  She had an average build, not obese and not thin.  She was set for the Internal Examination.  The lower part of her dress was lifted up to the waist, her underwear has been stripped off, exposing the sensitive part of her female anatomy, and her feet were firmly positioned on the stirrups.


What overwhelmed me was the flabby abdomen which flattened, as if to pay its respects to the law of gravity,  while the patient was in the supine position.  What is even more overwhelming is the sight of nurses tinkering with the flat abdomen using the Doppler probe.  I know that the Doppler is used to amplify the fetal heart sounds but the sight of the nurses using it on an ultra-flat and flabby abdomen puzzled me for a while.  What are they trying to do?  Are they trying to amplify the patient's bowel sounds using the Doppler?  Those questions flooded my head.


I immediately wanted to ask the patient, "Nang, buntis gyud ka? (Ma'am, are you sure you are pregnant?)"  Instead I asked her when her last menstruation was, one of the questions which I usually ask patients who come in.  "September 2009," came the answer.  That was around seven months ago, I thought.  I asked her if she had regular pre-natal check-ups.  She admitted she was initially seen by a physician, and only once at that,  but she eventually opted to be checked up by a midwife from the rural health center in their place because she lives quite far from the city. 


The nurses handed me the patient's chart and at the same time told me the patient came in because she already felt labor pains.  "Okey," I screamed - inside my head. I tried to digest what the nurse said while I was looking at the nurses who were trying with all their might to capture fetal heart sounds through the Doppler.  I was at a loss for questions.  That was totally unexpected for someone like me who has been admitting pregnant patients for years now.  I looked at the patient's data on the chart.  She's 50 years old.  That somehow explained the skin that was beginning to lose turgor and the lines that marked her face.  Still at a loss, I stared for a few minutes at the nurses who were more like busy elves this time.  Thank God, they surrendered and realized their efforts were futile.  "Wala man gyud mi madunggan, Doc (We could not hear any fetal heart sounds, Doc.)" they declared.


I approached the patient, and asked, "Nang, nagsakit na imo tyan?  Asa man dapit? (Ma'am, are you having labor pains?  Can you point to me where you are feeling the pain?)Okey, that question might sound absurd for you medical people out there, knowing that labor pains are felt on the abdominal area, more on the lower part, and the pain usually radiates to the lower back.  But, I asked it anyway.  Probably the patient read the confusion peeping  from the behind my head, and she told me that her entire abdomen was painful, hovering her hand over her entire abdomen to send her message across.  She was already starting to be confused herself.


"Naa kay napamatian molihok ang bata, nang? (Do you feel any fetal movements, Ma'am?)", I asked.  "Oo, Doc," she replied yes without batting an eyelash.  The nurses and I stared at each other. 


I took a deep breath before I started to explain my side to the patient.  I told her that I will not do the Internal Examination this time because I am not quite convinced that she is pregnant.  In the aim of dispeling any frustration my comment might bring her, I added, "Cge lang, nang ha, naa ta mga examinations na buhaton para mahibal-an gyud nato.  (Don't worry, Ma'am, we will do a series of laboratory exams so we will know her exact condition.)"  I told her, we will be transporting her to the Emergency Room (ER), where I will make the admitting orders.  I paused for a few seconds to pass to allow everything to sink in then I exited from the room. 


I saw the patient again at the ER where I did my Physical Examination on the patient.  Abdominal pain was poorly localized and there were no pertinent findings that would point to pregnancy.  At one point I asked her if she does believe that she is pregnant.  She answered a resounding "Yes."  Later on, she would admit that she never had a positive pregnancy test result but still she went on to have regular check-ups with the midwife at the heath center.


One of her companions is her sister so I called her over for some questions.  I had to be a little direct this time.


Me:  "Ma'am, para nimo, buntis gyud ni sya?" (Ma'am do you think your sister is pregnant?)  I realized this is the second absurd question I asked that time.  God, those were two absurd questions in an hour!.


Sister:  Oo, doc. (Yes, Doc.)  Another resounding yes.  Me No.1 talking to Me No.2:  Doc, don't you ever get it?  Me No.2:  Did the gods just sent me a family of psychotics or something to punish me for trying to sleep early while on duty?  Is this a dream?  Wake me up, please...! 


Me:  Wa mo natingala, nga wa nidako iyang tiyan? (Didn't you ever wonder why her adomen did not grow big?)


Sister:  Natingala pud doc. Kay ang ako anak na iya pag-umangkon, kadungan dungan man to nya ug buntis dayon nanganak na man.  (We were puzzled Doc.  My daughter, her niece, got pregnant at arounthe same time when the patient apparently did, and my daughter already gave birth.)


Then I turned to the patient and asked, "Ikaw, nang, wa ka natingala nga wa nidako imong tyan?"  She answered confidently, "Kay di man pud ko hingaon, doc." (I don't eat a lot, doc.)


 Wow.  I thought and gave out another deep breath. 


Upon further inquiry, I knew, through the sister, that the patient has a foreigner-boyfriend.  The boyfriend is out of the country right now and they are still very much together because the boyfriend still sends money to the patient.  If  that is their idea of togetherness, then I don't have the right to object to that.  My goal then was to know if the patient had any history of mental illness such as depression and the like, or recently went thorugh a life changing event that triggered her to believe that she is pregnant.  Unfortunately, the patient did not have any of those.

I did what I had to do.  I called the Attending Physician to inform her about the admission.  I told her about my impression of the case and I told her about my plans in the management.  We both agreed on the impression of pseudocyesis.  Our plans included a Complete Blood Count, a Pregnancy Test, and a Transvaginal Ultrasound in morning.


The patient was sent to her room and I retired at the Doctors' Quarters.


I was not able to get my much needed sleep when I returned to our quarters.  After about an hour or two, I called the Nurses' Station to ask about the results of the laboratory exams. 


It did not come as a surprise at all that the Pregnancy Test turned out to be Negative.


(Coming up:  Dissecting my first comeuppance with Pseudocyesis)

Wednesday, April 28, 2010

My first case of Pseudocyesis (1st of 2 Parts)

Pseudocyesis - pseu·do·cy·e·sis [soo-doh-sahy-ee-sis] -  the medical term for false pregnancy; also called hysterical pregnancy.  It is a term coined by John Mason Good  in 1923 from the Greek words pseudes (false) and kyesis (pregnancy).  It is a condition in which the patient firmly believes herself to be pregnant and develops objective signs of pregnancy such as missed periods, an enlarging abdomen, breast enlargement and milk production, labor pains and sensation of fetal movements.  It has all the signs of pregnancy except one: the presence of a baby.



The clock just struck midnight when the phone rang again.  "Arggh!"  I screamed inside my head.  I just got into bed and I haven't even unfolded my blanket yet.  I thought, "When will this fucking phone ever stop ringing?"  Its ring is worse than tinnitus, but yet, maybe even tolerable than Kris' Aquino's singing voice.


I picked up the receiver.  The nurse on the other line was looking for me.  Shit. I cursed - again inside my head.  The possibility of another sleepless night dawned on me.


It was a call from the Labor Room.  "Doc naa ta'y admission.  Buntis.  (Doc, we have an admission, a pregnant patient),"  the nurse on the other line told me.


"Okey Ma'am," I replied.  "Kapila man na niya? (How many times has she been pregnant?),I asked.  A woman who is pregnant for the first time will undergo the process of labor for a longer time compared to those who have been pregnant for the second and third time.  A shorter  course of labor would mean more sleeping time for everyone who's on duty while you know what a longer one would mean.


"Una pa daw nya ni Doc.  Pero murag gulang na man sya  Doc, dayon kinagamayan ang tiyan.  (This is her first pregnancy Doc.  But she seems old and her tummy is flat.)"  Kinagamayan - that's a Boholano slang, the superlative equivalent of very small, or for a patient whom you would expect to be pregnant, it could pass for very flat.  Boholanos use the prefix "kina-" and attach it to any adjective to give it an extreme effect.  Kinakapoyan (Most or very tiring), kinalamian (most or very delicious), and in this case kina (very) + gamayan (derived from the word gamay which means small), would then mean very small. 


"Okey, Ma'am," I answered.  "I'll be there in a few minutes," I added then replaced the receiver.  "Let's get this over and done with," I thought to myself.  I  immediately got up from my bed and went straight to the bathroom to splash cold water on my face to wash off all hints of sleepiness which was written all over it. I fixed myself a bit and took a very quick glance on the mirror as I passed by it on my way to the door.  




The Doctors' Quarters is just adjacent to the Labor Room and just when I got out of it, three persons were on the hallway.  The patient's accompanying, I thought. I walked past them.




It is a standard operating procedure by the way, in Obstetric Departments of hospitals all over the world that  the first thing doctors do in admitting a pregnant patient is the Admitting Internal Examination (IE).  Yes, that is the part where the doctor sticks the second and third finger into the patient's vaginal canal and feel for the dilatation of the cervix, the mouth of the uterus.  The progression of the cervical dilatation and the increase of frequency and intensity of uterine contractions are the two main factors that govern labor.  Once the contractions are strong enough to cause full dilatation of the cervix which is at ten centimeters, the baby is ready to go out of the mother's womb.  




It is for the purpose of the IE that the nurses made our new admission - yes, I mean the patient - - lie on the IE table.  It is not just some table.  It is actually a bed which, I don't know how, but along the way, evolved into being called a table.  It is shorter yet more elevated than the usual bed and uhmm, yes, the usual table, and it is equipped with stirrups on which the patient positions her feet while the physician is doing the IE.  The IE Table is found in another room called the IE Room (Yeah, what else should we call it? Hahahaha!) to ensure the patient's privacy.  In the case of our IE Room, the IE table is specially surrounded by curtains, creating a small room within a room to reinforce the patient's privacy.




As I walked into the IE Room, I headed towards the IE table and got hold of the curtains, and  swept it a bit to one side, creating a breach through the sheets, just enough for me to enter.  And when I stepped into the room within a room, I could not believe what I saw.








Friday, April 16, 2010

A Bwahaha moment

While I was on duty, one of the nurses asked me what intravenous (IV) fluid to hook up next for a certain patient.


Actually it's a question that did not necessitate any asking because they usually would follow the same kind IV fluid as the one being replaced or just consumed, unless it was specified that the IV line should be terminated once the fluid is consumed.  If there are incorporations in the said fluid, such as potassium and oxytocin, they would need to refer that to us. 


Anyway, back to the scene I was talking about, the other nurse on duty even said something in jest to the nurse who asked me, that it's already a general rule that they follow the same IV fluid.  We all laughed because there was some truth in it.
 

This made me playfully formulate 2 Rules for them when they need to hook up a new IV fluid - in hospital slang, that is called, 'following an IV' or 'IV to follow' - after the current one which is hooked is about to be consumed:

Rule No. 1.  Always follow the same type of  IV fluid.

Rule No. 2.  When confused on what IV to follow, refer to Rule No. 1.


At least that is for moonlighting.  Where the burden of residency is a little bit lighter.  Bwahaha!


Wednesday, April 14, 2010

Missing Lola Sisay

". . . Her mother also came along.  Her name is Teresa. Coincidentally, I had thought of Mother Teresa's ministry as one of my reasons of finding a mate from the Orient.  Now, I have found out, my future wife's mother's name is Teresa."        

                                                                      - John Dumont Hudson, my American Uncle, describes in his book,  Alligator John D: My Testimony,  how he first met my maternal grandmother



She was dearly known to me and my cousins as Lola Sisay.  She passed away exactly one year and six months ago when she contracted pneumonia, a common culprit that sends most elderly patients to the grave.


If somebody tagged me in a note on Facebook, asking me to say 25 Things About Myself,  my No. 1 would be that my greatest influence is my maternal grandmother.  I have kept this list of 25 Things in the active notes app in my mobile phone, just in case this note rotates again in Facebook.


I practically grew up with my grandmother even though I was living with my parents.  They were out to work most of the time, leaving me with my Lola at home.  When I look back, I believe I spent more time with my grandmother than with my mother.  I am not complaining though, because my parents had to work to feed the family.  I don't see that as an unfortunate event in my life because I had the greatest grandmother a grandchild could ever have. 


I could go on and on describing how this noble woman created an impact in my life.  She was born poor and was ostracized by the righteous community for having children with different fathers.  She eventually settled with my grandfather who loved her until his last breath.  When she became a widow, she worked hard and did everything she could to feed her eight children.  Without the privilege of an education, she was backed up with perseverance, humility, resilience, and most of all, her undying faith in God, which I think is her greatest secret for emerging triumphant after all the unsurmountable trials she went through in her life.


While I was growing up, I could vividly remember that the first words I learned to spell orally was Lola.  I could picture the scene in my mind right now, with her telling me, "L-o-l-a, Lola...," pronouncing the letters playfully and with a musical tone to them.  Yes I learned to spell the word Lola first - not Mama, not Papa, but Lola. 


During times when I got scolded or spanked for being mischievous, I would run to her room and cry on her shoulders.  Oh how she made me feel loved and accepted.  Her words, which were calmly spoken to comfort me, and make me understand why I had to be reprimanded, had a magical effect on me, like an arrow stabbed straight into my heart.  She was always there, ready to listen to my dreams, my successes, even my failures. 


She was senile and had Alzheimer's in her later years.  During her twilight years, though she was with us physically, she was already different from the grandmother I grew up with.  It is true, indeed, and I say this out of experience, that Alzheimer's disease, when it affects your loved one, robs and takes that loved one away from you, even though they are still alive, because they do not know you anymore.  They don't remember your name and they don't have the slightest hint on how and why you are related to them.


She stopped holding on to dear life in the Intensive Care Unit in one of the big hospitals in our home city.  She waited for me and my mother to arrive from the other side of the world, before she finally decided to go home to the Creator.  She was 98 years old.


Some would say that it's okey, implying that old age is a ripe time to die.  But I say, I will never be ready to lose a loved one.  If old age was a ripe time to die, then why admit the elderly to the hospital when they get sick?  Why don't we just leave them wallowing in sickness until they lose breath?  What is the fucking point of having a Geriatrics specialty?  Doesn't that specialty dedicate itself to the caring of the sick elderly?  I could rant on and on and further solidify the fact that I am and will always be a failure when it comes to grieving.


I see the point that it was her time to rest.  My being a failure when it comes to grieving is another point, though I am not sure if both points are mutually exclusive or not.


Battered with some frustrating events recently, I wish of only one thing.  I wish I could run to my grandmother's room and find her there, just sitting on her bed, ready to listen to me as I pour my heart out.  If I had the power to stop time, I'd freeze it for her,  during that time when she was already old and wise, but not too old, not too weak, and not too senile, to be stolen away by Alzheimer's Disease, and worse by, death.


I have longed many times for her visit me in my dreams but she only did that once.


There is no way for me now to lay my head on her shoulders, or feel her hands touch me, or hear her words comfort me.   There will always be this void that nobody could ever fill.  Not even the the tears that I cried tonight - the solemn witnesses of how terribly I am missing my dearly beloved Lola Sisay.








Friday, April 9, 2010

Unborrowed speech: Forever and a half by A. R. L.



The following is the valedictory address of my consultant's son.  I've seen him a couple of times, usually busy with what I thought was mainly school work,  and I have heard of how brilliant he is as a student.  I was shocked when I knew just recently that his right eye is blind ever since.


I got nostalgic when I read his speech.   Not that I ever gave a valedictory address myself (I wish),  but  this one made me remember my days in high school which were all spent with almost careless abandon.  Everything was just in the raw then, brimming with potential and awesome wonder of things and days to come.


When I read through this, I realized that this young man may be deprived of the complete gift of sight but a bright future awaits him.


Here is the speech he wrote himself, not borrowed from anybody else, and purely from the heart.


It's better late than never, so, to all graduates of 2010, congratulations to you all!!




All over the world, miracles are happening right now.  Let me humbly state one.  Speaking before you is this batch's valedictorian.  Unknown to many, my right eye has been blinded for most of my life.  It's hard to live with only one eye to depend on.  I lack balance.  Line of sight, depth perception, and visual strength.  Many times I was discouraged, humiliated, and wounded - literally speaking.  Nevertheless, God sent me angels without wings, people from different origins, with remarkable abilities and distinct weaknesses.  From then on, triumph in spite of deficiency proved to be difficult but not impossible.


Ladies and gentlemen, allow me now to speak not as the valedictorian but as the representative of this (pronoun mine) school, Batch 2010.  Receiving honors and seeing colors fly is only an icing to the cake we have all baked meaningfully and well.  After all the work we have done, we finally reach the summit where we crown our efforts and thank the people who gave us sparks of inspiration along the way.


Life is a matter of choice.  True.  But we never chose our parents and our parents never chose us.  Someone up there made the decision for us.  It wasn't by chance.  It was God's choice - His significant plan.  Dearest parents, with full sincerity, we thank you for your relentless love.  We apologized for the times we talked back; the times when we demanded too much, sightless to how hard you have been working for us; the times when we spent more time with gadgets than with you; the times we lied because we could not openly and directly explain what was going on.  However we deeply thank you for bearing with us despite all those I've mentioned and have failed to mention.  We thank you for all the emotional comfort, financial support, and spiritual guidance; for sending us to a wonderful school and for choosing to be with us on this glorious occasion.  We are all proud of you.


A great deal of our gratitude goes to our teachers who shared their expertise in various fields - Mathematics, the Sciences, Written and Spoken Arts, Music, Technology, History, and Culture.  For about a decade, we have been under different educators who all have different personalities, teaching styles, ideals, and influence.  Thank you for opening our eyes to the world and making our responsibilities in it.  For the times when you went beyond what was asked of the curriculum and what was written in the lesson plan; for the times when you shared your personal experiences,hoping we would not learn them the hard way - thank you.  These extra little things from your efforts which have accumulated through time are the things which shape the stroke of our destiny.  Always be proud of your work, that your craft is the educationof our nation's hope.


My fellow graduates, as your companion, I am witness to how beautifully you have grown as you developed your talents and skills.  Together, we learned, we bonded, and sometimes competed.  Within and without groupings, we have shared the load of school work, the story of our lives, and even our mischievous, childish folly.   Sometimes our principles clash and we find it hard to properly express ourselves.  We cannot deny that there had been arguments but because of those bitter moments we have learned how to handle ourselves and amidst criticisms and controversy, how to manage stress, how to resolved conflict, and how to tame our passions.  We laughed, we cried but we survived and filled our tears with life.




Disease, discomfort, defect, danger, defeat, despair - these are but some of the harsh realities humanity is always up against.  They are a part of life - inevitable, attached, and constant.  But let us flip the page and put on our eyes.  We'll realize that God sent them not to crush us, not to corrupt out character, not to jeopardize our relationships, not to prevent us from being the people we are called and sent to be.  If we ask courage from God, He does not give us courage.  Instead, God gives us a chance to be courageous.  God is sending trials as opportunities to exercise and to give muscle to our values and it's worth recognizing that most of our personal growth is attributed to these difficulties.  The next step is to level up and make the progress national - if not universal.


"Don't cry because it's over. Smile because it happened."


There will be more mountains to climb and more than a hundred different paths to make.  For a very long time, we won;t be seeing each other.  Surely, we will miss a lot of things about this school, its gates, its high walls, pentagon, and classrooms which have hosted pools of immortal memories.  More than that, we will all miss the people we were used to seeing, talking, and laughing out loud with.  We might meet each other in college, we might hold frequent reunions, and we might, in the near future, do business with each other.  But basically it won't be as complete as it is now.  Yes, it would be difficult to unite everyone in the batch, but again, never impossible.  Thanks to advances in media and technology, there's always Facebook, complete with Farmville and Plants vs Zombies.  If you like, you can throw pillows too.  Just keep in touch.




Let not distance bother you, my friends.  It had always been God's plan and we had always been designed to disperse, do different missions, spread the good news, and pass on distinct legacies.  Don't cry because it's over.  Smile because it happened.




Life is random.  We never know what's coming after us.  The Santino craze and the Boys Over Flowers fever might have cooled down.  Fireflies, Tick Tock, and Speechless will soon leave the airwaves.  The limelight will eventually move away from Taylor Swift and the Jabbawockees.  Combi and G-tec will soon cease to be the favorite snack and pen, respectively.  Applause will die.  Medals will tarnish.  Certificates will rot.  Trophies will bend and break.  Power will vanish.  Wealth will fade.  Fame will be forgotten.  Things permanently change.  But what remains stable even after forever and a half, is God's love.  Always celebrate it.




Plot it in your head.  Sing it with your hand.  Let it flow from your heart. 




Monday, April 5, 2010

Xandra's story and my quest to know where in the world is Trinidad


I met Xandra (not her real name) exactly a week ago.


When I first met Xandra, she impressed me as someone who is carefree.  She easily warmed up with me and talked to me like it was not really the first time we met.  I felt she had no airs and because she was bubbly, I almost believed that all the bones in her body are funny ones.


You might wonder how our paths crossed.  My friend is her uncle's private nurse.  Her uncle, let's name him George, is actually an Australian who married Xandra's aunt.  The couple has been residing in one of the remote towns of Bohol for ten years now, but was recently forced (as per George's doctor's advice) to stay and rent a place in Cebu City because of George's very fragile health.  He underwent a major abdominal operation, had a tracheostomy, and as if those were not enough, George had two episodes of myocardial infarctions (or what is commonly known as a heart attack) while recuperating at the hospital.  


It may seem impossible but Xandra's uncle is better now and is on his way to a full recovery.  George and his wife went home to Bohol last weekend and decided to stay in their place for just a few days before they fly to Australia where George will have his cardiac procedures.  They are actually kind of forced to fly to Australia and have the cardiac diagnostic and interventional procedures done there so that George could take advantage of his insurance.  It will be the first time that Xandra's aunt will step on foreign soil.  When she married George, living abroad was actually the last thing in her mind.


The patient's decision to visit his home in Trinidad, Bohol, had a ripple effect on the nurses.  They had to cross the seas between the islands with him.  My friend had to tag along too, and you know how clanish Filipino families can be, especially when a family member gets sick.  You'd find one big contingent coming in that you have to ask who is the patient among them.  


That is how Xandra and I met - through a common friend.  My friend asked me if I could go with them since they, Xandra included, were treated to a tour in Bohol's major tourist attractions.  I said yes.  I also wanted to visit  the patient's place in Trinidad.  It is a good two hours away from the capital city where I am working and I thought it would be great to visit other places in this island aside from the major tourist attractions like the Chocolate Hills.


I was also thinking it would be a way for me to know how far that town is.  It would come in handy when a patient from that place would come in for a health complaint in the middle of the night.  Sometimes, you wouldn't believe it but the complaint has been going on for years and they just happen to choose the perfect timing of going to the hospital in the middle of the night, after all this years of tolerating the condition, and I just happen to be the lucky one to be on duty.


If the complaint can be managed on an out-patient basis, it would be easy to tell the patient to come back the following day and go to a clinic.  However there are cases wherein the doctor needs to advise admission especially when the patient has no place to stay and comes from an area which is worlds away from the hospital.  Admiting him or her into the hospital would be the right move if a doctor would pose more risks to the patient if he or she is ordered to travel back home.   In the case of most people here in Bohol, they usually have to travel back home riding a  habal-habal, a motorcycle that could carry approximately eight persons.  That is only found here in the Philippines.


To cut the blabbering, yes, I went with my friend's touring crowd which included Xandra.  I did the zipline for the second time.  On this side of the country, it's called the Suislide. Yes, you guessed it, it's a terminology created by combining the words suicide and slide.


I stayed at the patient's house with the whole contingent and the festivities went on. I forgot that I was miles away from  the comforts of city living.  I was in a remote town then but the warmth of its people whom I just met, Xandra included, made me feel that I was at home.  We videoked the night away and drank a few glasses of beer just enough to make us feel good.  We laughed and gave away as many high-fives as we can.  We forgot about the world and all its shit.  And mind you, we felt good.  Never better. 


It was on the second and last night of that weekend rendezvous when Xandra told me her story.  No, she was not sexually abused.  Nor is she hearing voices speaking to her and telling her to do weird things.  She also did not end up as a contestant in Wowowee either in one of its episodes.  She just recounted to me one of the most inspiring stories I ever heard in this lifetime.


Xandra presently works as a janitress in one of the big hospitals in Cebu City.   She  earned a high school diploma but her parents could not support for her college education so she decided to get janitorial jobs.  (George's wife is her mother's cousin and is also supporting the whole family.  Xandra does not want to include herself in her aunt's long list of  financial liabilities.)  




Xandra was originally employed in one of the beach resorts in Bohol but was among the many employees who were laid off  when the resort was turned over to a new management.  


Xandra was devastated.  At a young age of 18, she was already the bread winner of the family.  Both her elder brothers already have families of their own, leaving her to support her aged parents.  She needed to find a way to feed her family.


She decided to try her luck in the Queen City of the South.  You would think it would be easy for her to land on a janitorial job with all her experience to back her up.  However, not this time for Xandra.  The maintenance agency had a stiff height requirement for its employees and  Xandra, who stands at barely five feet tall, failed in that department.  But Xandra was not about to give up this time.  She cried and begged the manager as much as she can so that he would hire her.  She promised as hard as she could that she will be a very good employee and that they will never regret taking her in.  


It was just Xandra's luck that, the hospital where she is working in now, urgently needed a janitress - yes, they specified the gender - in its clinical laboratory.  Xandra's tears and acts of begging all worked in her  favor.  She got the job - inspite of her height.  




Landing on the job is just the beginning of Xandra's challenges.   Barely two weeks away from receiving her first salary, she had to make ends meet with a whooping five hundred pesos.  That was all the money she had for her food and her travelling expenses.  


She was staying in Cebu City with another distant aunt who lives two jeepney rides away from the hospital.  That already takes off around 30 pesos everyday from her meager budget.  Xandra was not about to give up this time so to cut on her expenses she would walk half the distance then just take the a jeepney ride on the other half of the way. She would also ride a tartanilla when she sees one, instead of taking a jeepney.  The ride on a tartanilla costs a peso or two less than a jeepney ride.  Today, tartanillas or kalesas - carriages carried around and pulled by horses - are not as common in Cebu City anymore, unlike when I was younger, but one does see them sometimes in the downtown area. 




As for Xandra's meals, here is the heart-breaking part.  She had to thrive on one serving of rice and a serving of monggo (mung) beans everyday for two weeks.  She would eat half of the serving of rice and another half of the serving of mung beans before she goes on duty.  At the middle of her eight-hour duty, she was already tired but she had to put her best foot forward always to impress her bosses so fatigue is a forbidden word in her vocabulary.  She would eat the remaining part of her meal then to sustain her for the rest of her shift and her walk back to her aunt's house.






The vendor from whom Xandra buys rice and mung beans knew her already as her regular buyer or  colloquially speaking, her suki.   The vendor must have pitied Xandra, a hardworking woman trapped in a grade schooler's body.  She would gladly offer to Xandra all the scorched rice that she had.  




I would like to quote exactly how Xandra's conversation with the food vendor went, as she recounted it to me.




Vendor (showing Xandra the almost empty rice pot):  Mokaon ka aning dukot day?  Kay ako ni ihatag nimo.  (Do you eat scorched rice?  I'd gladly give this to you if you want.) 




Xandra:  Oo, nang, mokaon gyud.  Salamat kaayo.  (Yes, Ma'am, I do eat that.  Thank you so much.) 




Xandra thrived on the same meal everyday for two weeks.  She also walked long distances  from her home and back in order to save her fare.  




 At last, her first pay day arrived and Xandra was filled with excitement.  The problem was, she had to withdraw her salary from the ATM machine.  Xandra never pressed the buttons of an ATM machine before but she had to try or else she would finally go hungry and penniless this time.  Her first attempts were unsuccessful that she had to call her employer to confirm if they deposited money into her account.  They were sure that they did.  Xandra tried tinkering with the machine a lot of times until finally, money popped out from the machine.




Xandra immediately went to the nearest restaurant and ate the most decent meal her money could afford her.  She ate two pieces of chicken and two cups of rice, and brought it all down with a bottle of soda.  You could just imagine how Xandra ate that meal with great fervor.  A choir singing "Hallelujah" while she was having her meal would have made the scene absolutely perfect.




Xandra now continues to be the diligent employee that she is.  She tells of how tedious her job is as a hospital janitress, mopping a great hallway which could accommodate around twenty-five cars, and racing with time when she is assigned to clean patients' rooms.  I had no idea could the job could be as tedious as that until I heard it from a janitress herself.  I'd probably fall flat on the hallway out of exhaustion right after cleaning one private room in the hospital.




Xandra is not complaining though.  With all her efforts, she has managed to convert their wooden house to a concrete one.  Sometimes she is able to give a little of her earnings to her brothers.  Recently, she ordered a refrigerator for her mother in Trinidad so she could sell ice and ice candy to the neighbors, a good way to augment the family's income. She also takes jobs of cleaning the rooms of residents physicians.  For cleaning the rooms of doctors for two hours, she earns a generous two hundred bucks.  




Today, Xandra doesn't have to take long walks back home.  She doesn't need to ride a tartanilla at all because she already lives in a decent boarding house which is just a stone's throw away from the hospital.  She doesn't get to meet the kind food vendor daily because she can somehow afford to eat various menus aside from mung beans.    




Xandra's story is so far the one and only modern success story that I have heard.  Surely there are a lot of success stories out there and I would love to hear them.




We slept late that night after hearing a very unique and original bedtime story, unmindful of our early trip back to the city the following day, and in my part, unmindful of the hospital duty that was waiting for me.  I closed my eyes to sleep, truly inspired and mindful of the things I have in life which most of the time I take for granted.  I wondered, how many Xandras are out there?  What treasury of valuable lessons can we learn from their lives?  Those thoughts, those questions. . . then I drifted off to dreamland, sleep never erasing my eagerness to hear more stories from other Xandras. 














Friday, April 2, 2010

Caption this: The Search for the Funniest Caption



Let's play a game!


Can you think of a funny caption for this picture?


If you have a funny caption in mind, type it in the comments section.  The search for the funniest caption will go on for two weeks.  In order to be considered, captions must be brief (as long as they are not as long as a novel, that would be fine), and may be in English, in Tagalog, or Visayan dialect.


I plan to do more of this in the future and give away some prizes too.  I am thinking of giving away books as prize for the winner.  I'm also thinking of giving away shirts with designs that I have in my mind right now.  I plan to print the designs by myself.  It will be a labor of love if I decide to give away shirts since I have to buy a plain colored shirt and print the design from scratch.  However, since I plan to do some me-time at the mall next week, I might grab a good book at Fully Booked or at National Bookstore.  Something that could be sent easily through the courier, I guess would be a good reward.  Hmm, let's see. I will update you on that in the following days.  Any suggestions? 


While you think of what prizes would be suitable to be given away, do type the funniest caption that you think fits this picture best.  By the way, my cousin took this picture of me last February, in one of the tunnels in the Animal Kingdom at the Disney Theme Park in Orlando, Florida.



Buds and New Beginnings


BUDS AND NEW BEGINNINGS.  The two are quite the same.  These buds seem to say, 'Start Here.'  Even before the last bloom wilts, the tiny buds emerge.  Right after you reach the Finish Line, you are off to start another race.  Buds and new beginnings - the two are indeed quite the same - with life itself.  (Photo by Shing Camps)





Thursday, April 1, 2010

A lonely daisy in mid-day


A LONELY DAISY IN MID-DAY.  Planted in a forgotten corner of the front yard, this daisy caught my attention inspite of the scorching heat of the sun. It stands alone yet its beauty overpowers it surroundings, even overcoming the soreness of the peeling layers of the concrete fence behind it.    That's how you know that something is truly beautiful - you don't need an elegant backdrop because true beauty will always have a commanding presence.  Just like this daisy.  It is so beautiful, you'd think you are witnessing an apparition.  (Photo by Shing Camps)


 

Silver Linings: Favorite Moments in Residency Training and Beyond

                   An article I read in the New York Times somehow transported me to a warehouse of memories in my psyche.        A...