The reunion was like any other: it would not involve anyone else but instead only those who would make the gargantuan effort to just be there. The wives had been gracious and understanding enough to give the boys the “day pass” to become boys again – after all, love is a matter of trust, and given the company that they would be in for the day, the worst that they could expect is that more than enough would be spent on nonsense things like comic books, arcade tokens, and more food. That’s why as the budget enforcers (and guardians of the waistlines), they gave their husbands only enough money for food and maybe a small cup of coffee afterwards.

Despite the years that passed, the conversations remained the same, although those who have children have more updated information about the latest cartoons and toys. The other single men were not really outdated: one has two nieces and a nephew that require him to be at least aware if not knowledgeable about the latest kid stuffs, while the other has an enviable job as an animator for the empire of some famous rodent to be able to even brag about its up-and-coming products (except that he would not give any details or confirmation, lest he would have to kill us).

The topic shifted to another part that made them realized how old they have become: it was about money this time, and not really about them lacking it. In their high school days, it was actually a common topic especially when one has to go on a date and he has no budget and he would be asking those who have extra to maybe lend him some. This time it was about their kids’ tuition fees, expenses for maintaining a home, and investments. Yes, investments – as in possible business decisions (but not including the selling of insurance plans or recruiting members for some actual or imaginary products). Discussions on the cost of franchises, creating partnerships, and differentiating mutual funds versus index funds (and which ones to invest to) were brought up, until the elephant in the room was brought up.

“Why don’t you try going with us? We made it there, we know that you can make it there too.” Of the four people who were there, two were already successful expatriates in that country. One revealed that he was about to leave to try his luck there – not that he was earning poorly here: he’s actually working in the IT industry with a rather handsome salary. He decided that he had already had enough cow dung in the Philippines that he wanted to be in a place where his taxes are actually put in the service of the people and his promotion or non-promotion would be because of his achievements at work and not because of who he knows.

“I’m planning to get back to the Practice here. I’m just making my preparations. Thank you,” I replied, myself not even convinced of what I just said.

“Nonsense. You can get into the insurance industry there too and earn more than what you are currently earning here. You already know how to hustle. You only need the opportunity, bro.”

It was not the first time that I have been offered to go there: my former college roommate who used to work in a neighboring country had also gone there with his wife, who in turn left her practice as an emergency room physician to practice there instead. A former co-worker who worked in Dubai in an insurance company, had been planning to return there. Another high school friend, who moved to a South Pacific island, has established a successful practice as a professor in Pathology in a medical school there. All have asked me to go with them and try my luck there. They all have said that having known me all this time, they knew that I would make it there too.

I looked at my previous missed opportunities and pondered if this latest offer is actually the sign for me to finally leave the country and maybe reinvent myself again – if not as a physician then as someone who’s still working close with the medical industry. After a series of events in both my personal and professional life in the past year and early this year, I have come to realize how much I miss the Practice and I had been yearning to see patients again. After all, physicians are in demand there, and I do have several acquaintances who have moved their Practices there.

I remember my medical school days and I remember one particular conversation that I had with my bestfriend Allen. We had the same mutual interest about going to the barrios and practicing there – minus the flair and the elegance of high-tech medical equipment and the vacuum-and-polished floors of “internationally-accredited” hospitals. We would still be wearing white coats – or at least blazers – but instead of tailored pants and Italian shoes we would be wearing blue jeans and rubber shoes to make us move more comfortably. Instead of the well-lit air-conditioned halls of large hospitals, we would be walking on muddy trails of far-flung areas of the country. Instead of spoiled brat pediatric patients and people pretending to be sick and just wanting to have a medical certificate to get a night off work, we would actually be fighting tuberculosis, intestinal worms, and malnutrition in people who have no real access to decent medications.

Yes, in some way, we had been influenced by the late Senator Juan Flavier. At the back of our minds, we thought, if he could do (“DOH”!) it, we can do it even better!

Fast forward to the present. The dreaming is over, and we are where we currently are. My bestfriend and I rarely communicate as we used to anymore, but I have had the privilege to become his bestman on his wedding (and I made him swear to me that he will be my bestman on my future wedding). When we do get to converse, I would love hearing about his patients. Medical confidentiality would of course be observed, but more than the daily rounds, diagnoses, and courses of treatment, we would be discussing the things about Life (not just “life”) that we learn from our patients. I created my own term for it – “Evening Rounds,” as doctors’ visits are usually only made during daytime (unless the doctor had been very busy), and only relatives and people close to them get to be with them at night. Being alone again and being in the middle of the night somehow bring out the sentimentality of people, and they tend to be more open about talking about their lives at that time – and be more receptive to medical advice compared with formal hospital visits. Professionally speaking, besides establishing a better rapport with the patient, it also helped ensure their compliance to management, especially for those that involve lifestyle changes instead of just intake of pharmaceutical products. More than those, I would learn so many things from their points-of-view, which make me appreciate more the Beauty of Life.

Neither my bestfriend nor I have become barrio doctors, but he is in the province and he is serving the people – still close to our younger dream. At times, he would forego getting his professional fee and rely instead on the designated payment that PhilHealth had provided for the particular disease that he had just treated (and admittedly, it is usually too small) to help those less-financially-privileged to keep their money for buying their take-home or maintenance medicines. As a specialist, he acquired a better knowledge on diseases and this helped him become a better doctor.

I had not gone shabby myself. I have come to work for a company where I felt valued and – modesty aside – had provided me not just the financial stability that I wanted but also the opportunity to be with doctors and evaluate medical cases more thoroughly. More than that, additional privileges had been given to me – and extended to my loved ones. Still, there had been something deep within me that told me that there could be more to Life than what I already have.

Enter now this offer from my high school buddies. One had offered me his flat for me to stay on to for free until I find my own flat. The other promised to get me familiarized and street smart – as well as introduce me to his friends there. The only thing that I had to worry about is getting the tickets to get there, as well as my updated résumé. The one who was about to leave had offered me his agent (a friend of his wife), who could assist me in getting a new job and negotiating my desired salary.

I promised them that I would very heavily think about it, and despite their protests and playful (but still stinging) mocking of me letting the opportunity pass (especially with me being single and without having to think about leaving anybody here), I think they understood where I was coming from. I have never really thought about leaving the country, except to visit the Vatican or to make a pilgrimage in Israel. Those were ordinary desires wherein I would only be a tourist and be gone for maybe a week or two – not really a way of life that I would have. My work is at a semi-government corporation, and while it is far from my dream of directly serving the people – those who could not afford medical services, I have come to realize that my work still involves that – providing affordable healthcare and access to top-caliber physicians to people who otherwise could not afford them. Of course there would be limitations and exclusions as after all, the medical services provided would be determined by the employer, and my job would be to ensure that the services that had been guaranteed to the patients as needed would be delivered and they are able to utilize it correctly and efficiently.

Still, there is discontentment.

At the back of my mind, I thought about my desire to earn more – to be able to buy a huge house in an exclusive subdivision, a brand-new expensive car that would turn people’s heads when I pass by, buy all the stuff that my (future) wife would love to have, and send our (future) children to expensive schools. I could buy an iPhone on a whim and maybe that large-screen LED TV that I had been drooling about.

Then again, I thought about my younger dreams. Of course it is important to have my own house and to have my own means of traveling. Of course I want to spoil my wife and send my children to the same schools that my parents have sent me and my siblings, but do I really need to have a luxurious and extravagant lifestyle?

Do i really need to get out of the country to be able to afford the bare necessities and realize my younger dreams?

I remember what Pope Francis had said about Greed – that so much blessings are poured by God to our cups but instead of letting it overflow from us and on to others, our Greed tends to magically increase the size of that cup such that despite so much blessings pouring down, it would still not be enough to satisfy us.

Have I become like that – unsatisfied by what I have already have and still saying (screaming): it’s not enough! I want more! I deserve more!

For the week after our reunion, the unofficial updated lyrics of “UP Naming Mahal” kept playing inside my brain (yes, I took my pre-med course at UP). The lyrics go: “Malayong lupain di kailangang marating / Dito maglilingkod sa bayan natin / Dito maglilingkod sa bayan natin.” I then remembered the speech that Prof. Solita Monsod delivered to one of her classes about the cost of education and how much my country had shouldered mine: if Ateneo and La Salle (which, according to her, are the second and third best universities in the country, respectively) are charging so much for their education, how much more should UP charge, being the best university in the country?

More than that is the sense of social responsibility that I feel that I should have – not for anything else but because of the too many blessings that have been poured down on me: blessings that I may have overlooked because of my desire for something more, which I believe the world owes me.

My new passport had arrived and getting a ticket is just a click away. My résumé’s been updated and a resignation letter is too easy to write. It will be a new beginning for me, but I know that transplanting myself to another country would not be easy. Being a Filipino is already difficult in the Philippines, what more in a foreign land?

Will practicing as a doctor in another country compensate for my non-practice here? Would i finally become satisfied with Life?

In a recent conversation in Viber, my friend gave me some consoling words: “You might find her here.”

I laughed.


A Doctor’s Lamentation

"It is such a mysterious place, the land of tears." - Antoine de Saint Exupery, "The Little Prince" (Photo taken from

“It is such a mysterious place, the land of tears.”
– Antoine de Saint Exupery, “The Little Prince”
(Photo taken from

I came into his office a cynic. In my mind I was expecting another series of complaints about not getting paid what he thought ought to be paid to him given his stature and his tenure as physician. He was, after all, one of the oldest physicians in that hospital and he had been a great help in establishing our line of work not just in that hospital but in the entire province as well. I traveled to the south of the country from the urban jungle of Makati to establish rapport with the doctor and rejuvenate the company’s relationship with him. I had prepared to receive verbal abuse and maybe a few profanities, but instead I was greeted with a firm handshake and a smile.

I readied my “physician force field” – that mysterious, powerful energy I was trained to create during my internship that filters any transference of emotion from the person I was conversing with for me to remain objective and “professional.” I was telling myself that in case he’s angry, he’s not really angry at me but rather on certain… things and aspects. On the days prior to that meeting, I reviewed my old style of establishing rapport with a complete stranger using the weird combination of pathetic corny jokes (trust me – they actually work positively) and genuine concern about their plight, hoping that I had packed enough to diffuse the entire situation.

We discussed the success that his hospital had achieved, and how quickly it was expanding. I mentioned how it was pretty much at par with – and even better than – many of the hospitals in Metro Manila. He gave me a hesitant smile, but there was just this palpable loneliness in his eyes. We conversed about professional matters that I need not write about, but I could not help myself from asking him.

“Are you all right, doctor?”

“This… this has nothing to do with our relationship as physician and HMO, OK? I understand that you are a doctor too, aren’t you? I just need to get this off my chest,” he said to me as he looked at the pictures on the small cabinet near me.

I smiled at him and assured him that our conversation would just be between two men, nothing less.

“You know, I’m disappointed about the whole thing. I’m regretting this.”

“Doc… I-uh… I don’t understand.”

He was practicing in the biggest and most prestigious hospital in that province, and he was practically its top dog. Recently, the hospital went into a partnership with one of the biggest business groups in the country, and there was really nowhere for it to go but up. As I said, the hospital was expanding, and aside from the prestige, there would also be an expected financial success to go with it.

“Tell me: why did you become a doctor,” he asked me.

I had to point out to him that I was not in the practice – that I was “just” an employee earning a fixed amount every month. Still, I gave him my reason when I decided to become a doctor when I was young. It sounded too idealistic as I look back to it now, but I could not lie to him.

“You know, this hospital only started as an extension of our house,” he said. “My dad converted part of our house into a clinic, and he would see his patients there.”

“Well, doc. Look how far your father has gone,” I smiled. I was to tell him that he had brought his father’s hospital to greater heights, and they have become pretty much a formidable entity in the region when he interrupted me.

“No, no, no,” he shook his head. “You know, most of the time, people didn’t have anything to pay him that time, and he was all right with that.

“He was happy. He was practicing Medicine because it was his passion. The payment did not really matter to him, but still he was able to send us his children to good schools. I even became a doctor like him.”

I stayed quiet – waiting for him to just let everything out from his chest.

“To be honest, this hospital was still doing well before we entered into a partnership with the big business group. We were told that we could help more people with the partnership.

Right now, yes, business is booming and we are expanding, but at what expense?”

“You are not happy with that, doc?” I queried.

“Where are the poor patients now? Now, they could not afford being seen here. They have to pay for everything.

“My father’s legacy is that he would not turn away patients, especially those who are in need. That was his joy. He would often tell me that he would prefer those that could not afford to pay him because then he could charge it to Him,” he said as he pointed upward, pertaining to God.

I then told him about this hospital in Metro Manila that used to be run by nuns. A business group had to eventually drive those nuns away because the hospital operated at a loss. An investigation later revealed that they would frequently just ask the patients to pay whatever they could afford if they could not settle the actual bills. There were several rooms filled with crutches, wheelchairs, and other worthless personal effects that the patients gave in payment for their bills.

“Exactly. You know, my father and I used to do that here too. We also had nuns operating this hospital, and we would distract them and let the patients abscond when they’re well.” He let out a mischievous smile as he recalled.

“I’m sure that they were good nuns, but we have to face the reality, doc,” I said. “Without money, you can’t pay for the hospital’s other expenses. You can’t buy medical supplies and equipment with crutches and wheelchairs, and you can’t tell your nurses and hospital staff that you’d just pray for them.”

“I know, I know,” he said. “I just wish I could do more.

“I just wish I could turn back the deal and just get back to healing people instead of conducting a business.”

He then turned quiet as he got lost in his thoughts.

“I really wonder what Dad would say to me when we meet again.”

He paused again as he looked at the black-and-white picture of his father on his table.

“What’s that saying again? ‘What profits a man…‘”

“‘What good is it for someone to gain the whole world, yet forfeit their soul?‘” I quoted.

“So, what good is having the biggest hospital, if I lose the meaning of being a physician?”

From my seat, I noticed a glint on the side of his left eye.

“You know, it’s not really fear that feel when I think about the day that we would see each other again. It’s embarrassment. I’m sure he would ask me, ‘My son, what have you done?

“I’m an old man now, and everyday that’s what I think about. I’m embarrassed to see Dad again and tell him what I have done to his legacy.”

I tried to comfort him, but most of the time I remained quiet. It was a mysterious place, the land of tears, and part of me was wondering why he was telling me all these. Perhaps because I listened to him and did not dismiss the idealism that remained in him that I have come to realize as lost in many if not most of the doctors I get to interact and communicate with often. Don’t get me wrong – I’m still blessed enough to meet so many of these doctors – some of them are even my colleagues in medical school, but in several moments, it’s all about the money, even if we’re already speaking as two normal human beings talking about our lives.

I remembered the reply I gave him when he asked me why I wanted to become a doctor, and as I left the hospital, I thought about the conversation that my present-day self would have had with the young child that wanted to become a doctor back then. The old doctor was embarrassed to see his father again and explain what he had done to his legacy – but still, he did the best that he could. I was fearful about seeing my younger self again and explain why I lost his idealism.


Closed Sign by Artur84

Common signs seen during holidays… except in many private clinics and most hospitals. Illustration by Artur84/

I have since deactivated my social media accounts – including that in WordPress – except for Google Plus, but that’s only because I play video games in Android and to get some freebies, the user would need to have a particular account. I do not post anything anymore, but I will try to continue writing for the White Coat Chronicles as much as I could.

The last two weeks of the year is quite a haven for many people. Of course, students do not really feel it because sometimes their schools take their Christmas break as early as the 16th of December. December 24th and 25th are holidays because of Christmas Eve and Christmas, respectively; December 30th is Rizal Day, and December 31st and January 1st are holidays because of New Year’s Eve (or “Bank Holiday”) and New Year’s Day. For 2014 however, there were a couple of additional special holidays included: December 26th and January 2nd were sandwiched between the holidays and the weekends. The only “unlucky” day was December 29th, but several people have already filed their leaves on that day. Honestly speaking, it would not be too bold to say that most of those who actually went to work on the 29th only did so to hang out and chat with their coworkers. Including the 29th, that would make a 12-day vacation for most of us.

During my social media days, I would often encounter posts by doctors during long holidays feeling bad about not being able to take a vacation during this time at all. Holidays are just another day for them to go to their clinics and see patients. One clever physician even said that diseases do not recognize holidays and so doctors could not go on holidays as well. It is also not uncommon to read a post by a young physician during this time where he or she would say something about feeling sorry for him/herself about going to the clinic or hospital while everyone else gets to enjoy the break to be with their families and loved ones. There would be those who would post about patients who only go to the emergency room to get a medical certificate so that he or she could take the day or the night off work.The lamentations would go on, and the doctors would say that they would continue to be persecuted for taxes and they would have face patients who are too drunk and/or too stupid to understand that their medical conditions do not go on vacation and so drinking heavily, eating too much, or partying too hard could still take its toll on their bodies. Someone said that unlike employees, doctors do not get a 13th month pay or a Christmas bonus. Doctors also could not go on paid vacation or sick leaves, and it is so unfair to them, especially since their work involves saving lives and making people well enough to return to work.

Reading these posts somewhat evoke an ambiguous feeling for me. On one hand, I do understand the difficulty of the practice –  how the principle of “no work, no pay” very much applies to them. But this also applies to other contractual employees. There is no hazard pay, no insurance coverage, and no other benefit. They only get their daily payment with the taxes deducted as per the law. The difference perhaps is the salary: contractual employees usually receive only the minimum or slightly above the minimum wage per month while physicians definitely earn something more.

While it is true that doctors do not receive particular bonuses as much as employees, they are not confined to a fixed amount of salary per month. Employees receive a specific payment depending on their position in the company. Physicians, on the other hand, depend on the number of patients that they see in a day to determine the amount of money they take home. Specialists under health maintenance organizations (HMOs) are paid a fixed amount per consultation, while general practitioners earn a little less than that. Those who are not under HMOs can charge however much they wanted. Those who have a contract with clinics are paid a fixed amount of salary per day, but the contract only binds them to a particular length of time (usually about four hours a day) and they are allowed to take additional work depending on their schedule. While some may be allowed to take a second job by their employers, most employees are bound to work for a particular company due to the possibility of conflict of interest.

Employees are also tasked to work only at particular times of the day, and most are required to work 40 hours a week. The most usual shift is the 8-to-5 shift, with a one-hour break in between and another 15-minute break sometime in the morning or in the afternoon. There are also those who are in shifting duties (6am to 2pm; 2pm to 10pm; and 10pm to 6am, or their variations). The work is usually Mondays to Fridays or Tuesdays to Saturdays. Most physicians are able to determine the length of time and the day/s that they can hold their clinics.

Working on a holiday is not just a physician’s obligation. Nurses, medical technologists, police, firefighters, security personnel, and several key employees of certain establishments also need to go to work to ensure that peace and order is maintained and that workplace operations would continue to run smoothly by the time everybody returns to work. These people, like physicians, are also selfless souls who make sure that the world continues to turn and that there would be those who would care and give a damn in case something goes wrong. Also, like physicians, they do receive additional benefits: for special holidays, there is a 30% additional payment and for special holidays, they receive double payment. Of course, depending on the contract, some doctors receive only 30% additional payment whether it is a special or a regular holiday. Still, it points out the fact that doctors are not the only persons who need to work during the holidays.

Do not get me wrong: I admire those physicians who work hard everyday to ensure that they can provide for themselves and their families, but this admiration is just the same as that I feel for any hardworking person who takes on any type of job – whether that person is in an office, in the streets, or in the sewers. As long as it is an honest job, I look up to that person even if their salary is significantly lower than that of a company CEO or even if their job involves literally getting dirty to be able to do it properly.

The thing is, we all make choices: there are those who choose to work in the corporate setting, and there are those who chose to go to work on holidays. There is no need to grumble and be grumpy just because one “needs” to still get up early when everybody else is still at bed at eight in the morning. We all have our roles and tasks, and most of the time we choose where and how we are going to be. If the holiday cheer bothers that physician – or anybody else who had been tasked to work on these supposed-to-be-vacation days – then there is the choice to just walk out and join the other side.

Happy New Year, folks!

Medicine Maxims


Before you examine the body of a patient,
Be patient to learn his story.
For once you learn his story,
You will also come to know
His body.
Before you diagnose any sickness,
Make sure there is no sickness in the mind or heart.
For the emotions in a man’s moon or sun,
Can point to the sickness in
Any one of his other parts.
Before you treat a man with a condition,
Know that not all cures can heal all people.
For the chemistry that works on one patient,
May not work for the next,
Because even medicine has its own
Before asserting a prognosis on any patient,
Always be objective and never subjective.
For telling a man that he will win the treasure of life,
But then later discovering that he will lose,
Will harm him more than by telling him
That he may lose,
But then he wins.
― Suzy Kassem, Rise Up and Salute the Sun: The Writings of Suzy Kassem

The Good Doctor


be good, always

A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must love his fellow human beings in the concrete and desire their good before his own

– W.H. Auden 1907-1973

Patients and Patience

Yesterday I spent my only day off from work to accompany my girlfriend at the hospital, not because she’s on duty but due to the fact that her father is still currently confined at the Intensive Care Unit. She greets me with a smile and once we were permitted to do so, we came in to see how he was doing.

There was still a multitude of wires and IV tubes attached to him, monitoring his vital signs, providing nourishment, cleaning up the toxins. I told the resident on duty that day, I may be a doctor by profession but at that point in time, I was a just a another anxious visitor who wanted to know how the patient was doing, just like everybody else. The same goes for my girlfriend, her role for the past few weeks was not of a doctor on duty, but that of a daughter to her father. Even without saying, I know it is a trying time for their family right now. And contrary to what some people might think, just because a family member is a doctor, doesn’t mean he has all the answers. To paraphrase, we’re also human.

And as this story is still unfolding, kindly allow me to share an article I read about the matter, originally published in the New England Journal of Medicine by Dr. Louise Aronson.

patient asking doctor

“Good” Patients and “Difficult” Patients — Rethinking Our Definitions

Four weeks after his quadruple bypass and valve repair, 3 weeks after the bladder infection, pharyngeal trauma, heart failure, nightly agitated confusion, and pacemaker and feeding-tube insertions, and 2 weeks after his return home, I was helping my 75-year-old father off the toilet when his blood pressure dropped out from under him. As did his legs.

I held him up. I shouted for my mother. As any doctor would, I kept a hand on my father’s pulse, which was regular: no pauses, no accelerations or decelerations.

My mother was 71 years old and, fortunately, quite fit. She had been making dinner and said she dropped the salad bowl when I yelled for her. She took the stairs two at time. Something about my tone, she said.

Together, we lowered my father to the bathroom floor. I told her to keep him talking and to call me if he stopped, and then I dialed 911.

In the emergency department, after some fluids, my father felt better. My mother held his hand. We compared this new hospital with the last one where we’d spent so many weeks but which had been diverting ambulances elsewhere that evening. The doctor came in and reported no ECG changes and no significant laboratory abnormalities, except that the INR was above the target range. The doctor guessed the trouble was a bit of dehydration. He would watch for a while, just to be safe.

My mother waited with my father. The rest of us filed in and out, not wanting to crowd the tiny room. Then my father’s blood pressure dropped again. I told the nurse and stayed out of the way. She silenced the alarm, upped the fluids, and rechecked the blood pressure. It was better. But less than half an hour later, we listened as the machine scanned for a reading, dropping from triple to double digits before it found its mark. The numbers flashed, but the silenced alarm remained quiet. I pressed the call button, and when the nurse arrived I asked her to call for the doctor. When no one came, I went to the nursing station and made my case to the assembled doctors and nurses. They were polite, but their unspoken message was that they were working hard, my father wasn’t their only patient, and they had appropriately prioritized their tasks. I wondered how many times I had made similar assumptions and offered similar assurances to patients or families.

After weeks of illness and caregiving, it can be a relief to be a daughter and leave the doctoring to others. But I had been holding a thought just beyond consciousness, and not just because I hoped to remain in my assigned role as patient’s offspring. At least as important, I didn’t want to be the sort of family member that medical teams complain about. Now that I’d apparently taken on that persona, there was no longer any point in suppressing the thought. Although the differential diagnosis for hypotension is long, my father’s heart was working well, I had adhered to the carefully calculated regimen that we’d received for his tube feeds and free water intake, and he did not have new medications or signs of infection. Those facts and his overly thin blood put internal bleeding like a neon sign at the top of the differential.

I rested my hand on my father’s arm to get his attention and said, “Dad, how much would you mind if I did a rectal?”

We doctors do many things that are otherwise unacceptable. We are trained not only in how to do such things but in how to do them almost without noticing, almost without caring, at least in the ways we might care in different circumstances or settings. A rectal exam on one’s father, of course, is exactly the same as other rectal exams — and also completely different. Luckily for me, my father was a doctor too.

When I asked my crazy question, he smiled.

“Kid,” he replied, “do what you have to do.”

I found gloves and lube. I had him roll onto his side. And afterward, I took my bloody gloved finger out into the hallway to prove my point.

I realize that walking to the nurses’ station holding aloft one’s bloody, gloved hand is not an optimal tactic from a professionalism standpoint — but it worked. A nurse followed me back into my father’s room, saw my panicked mother holding a bedpan overflowing with blood and clots, and called for help. Within seconds, the room filled, and minutes later, when the ICU team showed up, I stood back, a daughter again.

In retrospect, what is most interesting is how much more comfortable I felt performing an intimate procedure on my father than demanding the attention of the professionals assigned to care for him. Abiding by the unspoken rules of medical etiquette, I had quieted my internal alarms for more than 2 hours. Instead, I had considered how doctors and nurses feel about and treat so-called pushy or “difficult” families, and as a result, I had prioritized wanting us to be seen as a “good patient” and “good family” over being a good doctor-daughter.

Although many physicians would have made different choices than I did, the impetus for my decisions lay in a trait of our medical culture. When we call patients and families “good,” or at least spare them the “difficult” label, we are noting and rewarding acquiescence. Too often, this “good” means you agree with me and you don’t bother me and you let me be in charge of what happens and when. Such a definition runs counter to what we know about truly good care as a collaborative process. From the history that so often generates the diagnosis to the treatment that is the basis of care or cure, active participation of patients and families is essential to optimal outcomes.

There will always be patients and families who are considered high maintenance, challenging, or both by health care providers. Among them are a few with evident mental illness, but most are simply trying their best to understand and manage their own or their loved ones’ illness. That we sometimes feel besieged or irritated by these advocates speaks to opportunities for improvement in both medical culture and the health care system. Culturally, we could benefit from a lens shift toward seeing more-vocal patients and families as actively engaged in their health care, presenting new, potentially important information, and expressing unmet care needs. At the systems level, we need to both count (using specially designated sections of the medical record) and reward (through diagnostic and billing codes) the time that providers spend talking to patients and families.

I’ll never know whether such changes would have altered my behavior or that of the medical staff on the night of my father’s massive intestinal bleed, and fortunately we all acted in time. I do know that 8 years later, the most vivid image I have of that night is not my father wobbling in the bathroom surrounded by cold, hard tile and angular metal structures, or a mustard yellow bedpan filling with bright red blood. The image is this, a worst-case might-have-been scenario had I not been there, had I not had medical training, had I not spoken up: my parents, sleepy because it was by then late at night, snuggled up together at the top of the gurney, my mother resting her head against my father’s chest, their eyes closed, their faces relaxed. His systolic blood pressure, usually 130, dropping to 80 and then 70. The monitors turned off or ignored. The lights dim. A short nap and they’d feel better. A little rest and maybe it would be time to go home.

To the new Doctors…

In the now rare moments that I go online and check what is going on in, I look into my social media news feed, and I happily came across this message of a former schoolmate in medical school and her message to the newest batch of doctors who have passed licensure examination.

To the new Physicians of 2014:

By now, most of you are sitting in front of your computer clicking on the PRC website and hitting refresh relentlessly. Relax. The moment of reckoning is at hand. I was exactly where you are 6 months ago. I am familiar with the anxiety and the restlessness gnawing at you right now. If you can, try to savor the sweet torture of the anticipation. Remember the promises that you made and resolve to keep them. If you are still making promises, include this: Promise to be a physician that will serve your fellowmen. Promise to be a healer with integrity. Find your moral compass and follow it, no matter what. Promise to remember that arrogance and achievement DO NOT go hand in hand. But if you find that you cannot help yourself, keep in mind that arrogance COMES AFTER achievement and not before. Congratulations, 2014! Whatever the results may be, you have done your schools proud with your hard work and integrity.

Well said Rocky, well said.

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