A Physician's Integrity

That adjective that we demand of all people yet so hard to achieve. This came from a lecture in Physiology by the Physiology Sensei; you'll see why if you see him in person. Anyway, he has this habit of inserting guest speakers into his lectures talking about principles that future physicians should have. However, the downside is he is a bit religious; so during those talks I feel like a minority. Oh don't get me wrong; I agree with his intentions: strike them while they're still in 1st year Medicine and that's partly what the intention of SLCM - WHQM to begin with. We're not just taught Medicine but also values. Let's just say I tune out when the speaker mentions a god but the rest of the substance of the talks; I agree.

Anyway, what brought about this talk from Physiology Sensei is he was slightly disturbed when a very unethical practice was brought to his attention: the request of procedures that are not even needed so that PhilHealth has no choice but to reimburse the requesting physician. Did I scare you off from our Filipino physicians? Oh, this practice is not just limited in the Philippines; some physicians in the U.S. do the same principle. So yes, some physicians are a bit unethical that they value money over the patient.

So I better react to his talk while endorphins are pumping through my body. Sure, its unethical but let's take a look at the journey a physician-wannabe takes. After an undergraduate course in a college, he/she enrolls in a medical school (in the Philippines, medical education is for 5 years). And then, residency training so that he/she becomes a specialist. That takes an additional 3-6 years. And if he/she wants to sub-specialize, that is to add another segment of knowledge to specialization just attained, then it takes another 3 years at the most.  So let's add them all up: 5+3+3 = 11 years or 5+6+3 = 14 years. So take note, the average age of a medical student is 21; for the rest of his/her 20s are spent in books and studying. These are the prime years of a human's life. So if for some they have already earned their first million in their 20's; for us, we earn that in our 40's.

I haven't mentioned the cost and the effort and the stress that it entails in getting that MD and other initials after one's surname. And here's somewhat of a downside; we are expected to provide cheap service. Our attorney-brethren, on the other hand, have very high legal fees. Not that I have any problem with the legal profession but there is something inherently wrong if a person who saves lives is valued less over a person who exists to give honeyed-words. Sure, I agree with the cheap service provision. We exist to serve human life.

But I have to disagree if it is all the time. Excuse me, how much did we study, how much years of our lives did we give up and not to mention the stress? And in fact, I posited this question to 2 of my friends.

Me: So are you willing to provide the best of your abilities if in exchange it's only a "salamat doc"?

Them: Heck no!

Well to be fair, I asked them an extreme case. No physician in his/her sane mind would ever say yes to that. A "salamat doc" doesn't feed me, doesn't pay my rent and doesn't clothe me. So I posed this follow-up question:

Me: So are you willing to provide pro-bono work for some cases?

Them: Yes.

However, the downside is that it was based on the assumption they would be having a decent practice. That is one of the problems facing Philippine Healthcare: our physicians do not want to go to the provinces. Believe it or not, there are some people in this country who have not even seen a medical doctor. Our doctors are concentrated in the urban areas. Because face it; we have to eat, we might want to start a family and we have wants too.

Look at UPCM. Almost all of their graduates are abroad; so, part of your money goes into funding physicians for other countries especially the USA. But, don't get mad just yet. Have you been to UP-PGH? Are you aware of the burden on those dear 160 students, how much they have to study and what is expected of them? So, if you ask me; I don't really blame them for going out of the country. Sure, they got a cheap medical education but the UPCM environment is a very stressful one. Their clerks and interns face a different level of hell in PGH compared to private hospitals (not that its easier in private hospitals; it's more of the equipment is lacking and the increased patient load).

Oh you might think I'm going to be a money-grabbing physician; I assure you I won't be. It's just that I'm offering a pragmatic analysis. In fact, I'm a bit angry with then-Senator Noynoy's speech to the graduating class of UPCM (forgot which year, just go to pinoy.md and search for it there). It was the same "please, please serve our country!". No mention of health reforms, salary increases and manageable workload. So are we expected to just take it? Are we just going to easily sacrifice? So easy to say for those outside the medical field but for us in this field; it's a different proposition. Remember, our parents paid like a million pesos for our medical education; so are we just to sublimate our desires and their sacrifices? And not to mention, residency doesn't have a formal salary. Really, really being pragmatic over here.

To future medical doctors: yes, this is the dilemma you will have to face. If you want to walk away from your dream then better do it before your entry to a medical school rather than after graduation. If still you want to continue with our profession; you're like me, insane but committed and I commend you and I welcome you with open arms.

I really don't have the answers but I hope that at least some people will value our Filipino physicians instead of looking at us as automatons of diagnosis. Remember, we are human beings like you. We eat, breathe and get tired also. Get out of that self-entitled mentality Filipinos seem to have!

Reforms would be nice; getting paid the best salary eases our burden a bit because let's face it, we also need money. I'm not averse to providing free services but I have to limit it to "depends on the situation".

The Chameleon

Masks and that verb that accompanies it: judging. All of us have masks. Some don masks because of professional reasons. It lessens the dignity of, let's say, a doctor if he/she acts like a child while in the vicinity of his/her office. And some don them because they've been hurt so they wear a fake persona in order to avoid getting hurt. It's safer that people think you're an ass rather than show who you really are. A sense of laughter can be derived from the fact that you show a caricature of yourself.

Well, I've recently confessed to a former batch mate of my decisions and some revelations that you wouldn't expect of me. Let's see: there's this 5'10" guy who always smiles and is seemingly oblivious of the world...but  he contemplated on killing himself. I know, the irony still makes me smile. A very happy guy but had, once upon a time, suicidal tendencies. What, were you expecting me to be all dressed in black and depressed all the time?

Anyway, I also told her that I wasn't really being myself during my time in undergrad. I was scared and scarred because of prior experiences. Let's just say my dislike of a current classmate and my abhorrence for religion is connected. Both are unified by an act of judgement. Anyway, just recently did any lingering sense of self-loathing was washed away but still the caricature remains.

Part of it is my personality. I took the Enneagram Psych test and low and behold; it revealed I'm an Achiever/Perfectionist. Sure, it fit me because I'm always this driven guy but hates conflict and not in touch with his emotions. Believe it or not; really used to be mature thinking and acting back when I was a little kid but kids being judgmental ass-wipes took note and made fun of that. And one of the characteristics of Achievers according to Enneagram is that they are chameleons able to adapt. So adapt I did. My adaptability was so effective that my parents, brothers and close friends were not aware of my past suicidal tendencies. Heck, I even believe half of my classmates believe I am this oblivious jock-looking dumb-ass who is not capable of insight; but again that was the point. A caricature to shield one's heart from potential harm. A decoy so to speak.

Hence, the caricature was made. If you think I'm not aware of how annoying I can get; I'm aware. That is exactly the point. Better people think you're aloof, clueless and a dumb-ass rather than be involved with potential enemies and get potentially hurt. I know, a bit paranoid but when you were raised on a diet of nothing but judgmental bitches, girl classmates who did nothing but judge you and being in the Philippines and being born male you cannot physically nor verbally harm them; you sublimate your rage and anger and channel it into lies. I know, idiotic. We can all laugh about it right now but that was my rationale back then.

So yes, I lie. Everyone lies as Dr. House would say. In my case; I'm an effective liar. Well, maybe not a liar but an effective salesman. I know what to pitch to other people so as they have a "correct" impression of me. I can be friendly, formal and even flirty. Believe me, given the proper instruction, I can assume almost any personality-type. Looking back at it right now; maybe that was why I was so fixated upon finding a relationship. Because the caricature was getting tiresome. Putting up a facade gets tiring even with friends so you long for that person who you can be yourself and you're confident that whatever you say and do will not be met with judgement, only acceptance. Believe me, haven't been honest with any of you people (well except for Unexpected Friends).

Well, I did get that in the form of Tanduay Ice Person. Maybe not the relationship, I got friend-zoned after all, but the non-judgmental encompassing acceptance I've been searching for but sadly, haven't gotten in a long long time. So maybe that's why I'm not anymore caring if Prospect becomes Current Reality. Well, if it progresses into that; all well and good. But it's not anymore a priority. Relationship or friendship is acceptable. More positive energies and outcomes for me! The priority is the insane dream of physician-hood.

But I don't think I'm going to let go of the caricature. It's been a part of me for so long that I'll still be Gibs communicating with people through his Iphone (that was from "Ang Nawawala"; a great Cinemalaya film so watch it now!). So yes, still going to be a suplado but who knows; I'll gradually lift the facade little by little. Maybe a little less annoying but its great fun! Anyway, it's a work in progress and I'm not rushing.

To end it: this was written in response to Classmate code-named "L" who is near my height. And I blame the exchange gift; so effective.

The 3-lettered G-concept

God. Yes, that word. That concept that causes acts of devotion and love among his/her/its believers. Some of the greatest acts of love are done because of a god's name as evidenced by the many religious charities found in the world. However, it cannot be denied that religion is also responsible for the greatest atrocities the world has seen: the Inquisition, Crusades and the list goes on. Love and hate all because of a supernatural entity.

In this post, I delve into the intellectual reasons why I turned god-less. Let's start it with my journey towards godlessness.

It was during my 3rd year of being a student at the Ateneo that we had to take up our 2nd Theology class (we have 4 classes). And, because of my pride I picked the chairperson of the ADMU Theology department no less for my professor. Not to mention, he is a legend in his own right. I almost failed. But that's not the reason; my decisions, at least the major ones, are not based on something so petty.

Anyway, it was during this time I happened upon "Dune" by Frank Herbert. I read the narrative of Paul Atreides, of how he became the Fremen "Muad-Dib", as foretold by their religion. The irony of it was this religion was implanted by an order of highly skilled women called the "Bene Gesserits" due to their "Missionaria Protectiva". In short, they manufacture religions for their distressed Sisters to use when the situation calls for it. Reading it, I was struck by how easily manipulated the Fremen were by accepting a highly-skilled boy. Well, Paul Atreides was the Kwiswatz Haderach, what the Bene Gesserits called a man who can see both places at once. To keep it simple, let's just say; the Kwiswatz Haderach was a male who possessed great power. Safe to say, without the Bene Gesserit's "Missionaria Protectiva"; Paul Maud-Dib wouldn't have risen to great power even with his powers. And what was damning was that the novel was alluding to an earlier conflict that was partly driven by religion: the Butlerian Jihad.

And relating that narrative to the Church's early history of conflict; there wasn't any difference at all. Sure the characters changed but that doesn't make the butchery done in the name of religion any less real. But, because of Catholicism's insistence upon its doctrine of love and all that; I was still hooked.

However, while also taking that Theology class; I was also taking up Philosophy of Religion taught by another legend, a disciple of a legendary Jesuit. Here we were taught the inherent inconsistencies of Catholicism. For instance, we read the Proslogion by St. Anselm. If you wanted a definition of mind-fuck then this is the reading. Like, it talked about how a god was both just yet merciful. Compassionate, able to feel for others, yet beyond passion, because, after all, a god is a supernatural being and without a body. For St. Anselm, despite the inconsistencies of this god; he accepted him/her/it nonetheless. While me, I couldn't. I suppressed that part of me because still a bit devoted to the faith and taking up a class.

And while we were at it; we took up Theodicies, ideas that try to explain why there is evil in the world yet at the same time there exists a benevolent and omniscient god. And somehow, the answer to that was in the Book of Job. For those who are familiar, yes, he was that guy who got tormented by the Judeo-Christian god but got rewarded in the end by his devotion despite said god's torment. However, what we're not taught is that there is a 2nd part to that story.

After being rewarded by the Judeo-Christian god, the devil approaches god and tells him that his servant Job was devoted because he was sure that he, the Judeo-Christian god, was going to reward him in the end. So the devil proposed a challenge: to make Job suffer some more without any reason whatsoever. The idea being that Job will loose his devotion. So the Judeo-Christian god takes said challenge and inflicts further suffering (remember the 1st part of the story where he was already tormented). So Job looses his sons, daughters, slaves, property and wives; as in totally everything. When it got too much; he asked the Judeo-Christian god why. And the answer of said god can be simply summarized into: "who are you puny human to question ME, the all-powerful god who existed even before you!".

So, not really an answer, and in fact, in modern Psychology, said god can be classified as a sadist but let's not let modern Science ruin the fun.

So how did I survive that class? Well I cheated. Not in the Sotto-sense because its impossible to cheat for a Philosophy class; it's all essays and oral exams. I cheated by creating my answers based on this single premise: In the end, it doesn't matter that these inconsistencies are inherent; rather what we do despite these inconsistencies. Sure, I passed but if it was a debate I would have been berated by resorting to the "moving the goal-posts" fallacy. Notice, how I haven't addressed said inconsistencies of faith and resorted to deflecting it towards living an ethical life.

And now, Medicine proper. If some doctors have their faith strengthened by studying the intricacies of the human body; I lost mine along the way. For instance, some doctors would say that the human body is a wonderful piece of art. Sure, I agree but what they don't say is that it has some inherent imperfections. I'll list some (don't worry, I've dumbed it down. If I use medical terms; I'll translate. And, some points are not even from Medicine proper but from Biology).

1. Why can't we synthesize Vitamin C from glucoronate given that some animals can do it endogenously? (The glucoronate pathway is carbohydrate metabolic pathway that is responsible for producing glucoronides that is responsible for making toxic substances water-soluble.)

2. Why does the recurrent laryngeal nerve take such a long route (the left recurrent vagus nerve has to loop at the arch of the aorta) instead of going directly towards the cervical region? (the recurrent vagus nerves are responsible for innervating the muscles of the vocal cords, hmm can't remember exactly but safe to say; it innervates some muscles found at the neck region).

3. How do we account for the plantaris and palmaris longus muscles (both are vestigial muscles found in the leg and forearm respectively)?

4. Why does our DNA contain introns and exons, more especially more introns? (introns= non-coding part of DNA basically "junk DNA" and exons= coding part of DNA, can produce proteins)

5. Why is there reverse transcriptase present in our cells? (Reverse transcriptase is a useless enzyme that is responsible for converting RNA to DNA. Transcription is done DNA to RNA. And in fact, because of said enzyme; it is responsible for some viruses to infect us.)

6. In terms of infections, sometimes it is the own body's physiological responses that kill the patient instead of pathogens. (Example: Inflammation is basically to be avoided because it can block nasal passages, as what happens in anaphylactic shock. Basically, some medical interventions are done to avoid the inflammatory response. And in diarrhea, it is the gastro-intestinal tract's excessive motility, in an attempt to flush out pathogens, that kills the patient through dehydration not the said pathogen).

See, I can list so many more; so if theists are advancing for an intelligent designer, they will not find it in Medicine. In fact, I invite them to study Medicine itself and see for themselves how the human body is not perfect. Don't get me wrong; still think the human body is beautiful (I'm not asexual) but as for it being 100% perfect...hmmm not really.

I really tried holding on to my faith; believe me. But given the facts that were facing me and given the fact I am a scientist; couldn't anymore ignore these simple facts. Looking back at it right now; was already behaving like a godless person (not yet decided if I'm an agnostic or atheist or I'm an atheist, I don't know what scale I am at this point. Yes, there is a scale.). Like, I wasn't going to mass every Sunday. And as for Roman Catholicism's claim to provide a superior moral system; unfortunately, I couldn't buy it anymore after being introduced to Emmanuel Levinas, Gabriel Marcel, Jean-Paul Sartre, Edmund Husserl, Maurice Merleau-Ponty and other thinkers.

Yes, I'm aware that the first 2 were religious, Levinas was a Jew and Marcel a Christian, but the point was they weren't the usual thinkers associated with Catholic dogma. The usual candidate would be St. Thomas Aquinas and his Summa Theologica. And if there is a thinker that is close to my heart and influences my openness and provides a very succinct explanation of any philosophical point he was ranting on about, it would be Paul Ricoeur. He writes with a respect and openness that I really hope I'm channeling.

Anyway, that's it for now.