Free at Last

Free at Last!
Musings on the Occasion of my Retirement

In the past 2 years work had been in the way of the things that I wanted to do. In the past year it had been unbearable because of work politics which earned me a place as thorn on the side of administration and of staffing cut backs which impacted patient care adversely. I couldn’t quit and throw away retirement benefits I will be entitled to from the State which I will qualify to receive in 12 months. I felt trapped and suffocated, and helpless, and powerless. I had to harness support and strength from my friends and family to contain myself and protect me from my reckless impulses. And so when August 31st arrived I couldn’t wait to check out. I discouraged any farewell party plans, I was not cut out to be politically correct. When my colleagues looked at me with pitying eyes and made remarks as if I was going to be lost in long days of emptiness and boredom, I sent them a cheery card bidding adieu to the tune of
Evita’s aria, “ Don’t cry for me GRH-Atlanta, the truth is I couldn’t wait to leave you!”

After I signed off at Personnel, cleaned out my desk, and turned in my badge and keys, I rolled the top down of my Beetle convertible and drove off, my hair blowing in the wind, and my joy soaring with Beethoven’s Violin Concerto in D major playing on NPR. Free at last!

I had a grand retirement party planned for months. I had this idea that I will be a nomad for a while, living for months at a time in a single country and really getting to know the place and the people and experiencing how they live. It turned out that a lot of people are already doing this as a lifestyle. I started corresponding by email with one of them, Rita Golden Gelman. I wanted to meet her when she was passing through Atlanta, but our schedules didn’t merge. I’ll be a dilettante nomad, that’s how I see what I want to do . So I planned right away to be abroad for 2 months starting in September, with the first month to be my grand retirement party in Costa Blanca in the Spanish Mediterranen coast between Valencia and Alicante, where I rented a 5-bedroom villa for 4 weeks. I invited all my friends to join me and 23 made the trip. However, I didn’t get to experience the local lifestyle as Costa Blanca is populated by English expatriates who had transformed the coast into a homogeneous strip of high rise condominiums and covered the hills with cookie cutter luxury villas with individual swimming pools. With friends streaming throughout the 4 weeks, there was no opportunity to get acquainted with the local Spaniards. As it were the local population in the villages became the tourist attraction together with the Roman and Moorish ruins dotting the coast. So OK, this was a party, a great party with friends, and I haven’t begun my nomadic experiment yet.

I had booked a week in October in a condominium in Ischia, an island off the bay of Naples, across Capri, to be pampered in the hot springs and mineral springs fed by Mt. Vesuvius. The condo is high in the hills in the tiny village of Panza, however it is sequestered from the village and caters to German tourists. The nearby spa I went to, giardini Poseidon terme, is downhill, in the bay of Citara, is run by a German company, and similarly patronized by German tourists. I got a feel for the locals in the family owned restaurants in the village and in the internet cafe, where the local children hung out to play video games. When I took the trains to go around Italy, to Genoa, Milan, Verona, to Lake Coumo, Naples, and Sorrento, I was touring, and only got to mix with other tourists. When I returned to Spain for the Pueblo Ingles program in La Alberca, an English immersion week-long workshop for Spanish executives and professionals, which I signed up for as a volunteer in exchange for meals and lodging, then to Madrid, Toledo, and Salamanca, I still didn’t get the feel of the place, I was still a tourist. This is not the way to be a nomad. So I got to thinking while I was in Madrid, inspired by nationalistic fervor while retracing Rizal’s steps during his stay there, that I can put some structure to my nomadic plans. Instead of randomly picking countries, I will immerse myself in the countries that were former colonies of Spain and use my stay as a laboratory to observe and collect information. By this time I had an epiphany of an ambitious project for my retirement. I will examine the similarities and differences in the colonization experiences of all these former colonies vis a vis the Philippine experience, and understand how nationhood developed, and specifically explain why the Philipppines and Filipinos are the way they are now. Somewhere along this I will also explore the Filipino identity from a psychological and behavioral perspective. I also want to examine the relationships of these former colonies with Spain now, and the Philippines in particular. I wondered how the history of colonization is being taught to children in Spain, in the former colonies, and in the Philippines. A tall order indeed and for sure I dont’ know where I’m coming from. Obviously I have no idea about what’s going on in this subject. Since then I’ve superficially explored how to begin. I inquired from Georgia State and University of Georgia and Georgia Tech and Emory how I might go about this. I was referred to history departments and in some to their Hispanic studies. It is evident I have to develop a network, and I need to identify people of kindred interests. I still have to review what’s being done on the subject in the Philippine universities, who are researching and writing about this in the Philippines. Some Philippine studies are incorporated in Asian studies, a completely different curriculum. I will have to examine the contents of these curricula and do literature search on the subject. Immediately, a major challenge faced me. Hispanic studies require language competency. It is apparent to me now that this will be work, not leisure, and it is work that will take many years, and a thousand hours of reading and research. I recall the fear and panic of the Spaniards in being compelled to speak only English 24/7 in the Pueblo Ingles program and I question myself if I have the resolve and audacity to take Spanish on as they took English. But I must if I want to examine manuscripts and original documents.My medical studies which I approached with just the minimum effort required to pass the subjects pale in comparison with the labor involved here in my view. And although I’m very excited and energized by this, I will think about this tomorrow. This may remain as a wish. In the meantime, I could work on my golf handicap. If my sign and the heavens are well aligned, I might break 90 without dropping a sweat.

UPCM Computerization

Wellness, Wit & Winning at the Wynn
UPMASA 22nd Annual Grand Convention, July 1-5, 2007
The Johnny B. Pellicer Professorial Chair in Medical Informatics, UPCM

The recently concluded 22nd UPMASA AGC held at the fabulous Wynn Las Vegas was attended by over 600 registrants and over 300 University of the Philippines College of Medicine alumni. It is an annual ritual of bonding, earning CME (Continuing Medical Education) credits, and renewing allegiance and inspiration from the alma mater. One of the CME lecturers, Dr. Alvin Marcelo, UPCM ’99, TOYM Awardee in 2005, Director of the Medical Informatics Department in the UPCM and the head of the Buddy Works Philippine Tele-health Project, delivered the Johnny B. Pellicer Professorial Chair lecture on “ Integrating the Philippine Health Care System Through Tele-health”. This lecture excited a lot of the alumni. It was inspirational. It moved one alumna to direct her donation to the cause specifically. The project embodies all the ideals that a UPCM graduate holds, to offer the best of himself to serve the greatest need of the under-served Filipinos. This project brings to doctors to the barrios the capability to connect with UPCM and all its resources in the care of the local patient in remote areas of the Philippines. UPMASA has played a major role in its development.
Ten years ago, UPMASA visionaries headed by Wee Besa, UPCM ’67, who was the Computerization Committee Chair then and for several years after, doggedly persisted in convincing UPMASA leadership to support the computerization project in the UPCM. It was a struggle as 10 years ago the cost of internet connection was $550 per month, and a computer cost $1500 compared to today’s $400. Through graduated phases in the project UPMASA built the infra-structure slowly over a period of 4-5 years. The UPCM LAN Project distinguished the College to be the first in the Philippine academic community to link all its buildings and departments together with a broadband connection. Various components of UPMASA helped with the computerization. The Delaware Valley Chapter under Joe Pamintuan’s presidency in 1997 built the first Multi Disciplinary Laboratory used by the Basic Sciences Department where Anatomy, Physiology, and Biochemistry are taught and simulated computerized experiments replaced animal physiology experiments. Class ’71 donated the first 10 computers to the medical library and supported a subscription to Ovid/Medline database, through its EMERALDS Project. The Baltimore, Michigan, and Philadelphia Chapters held fund-raising events to support subsequent phases of the project. Delaware Valley Chapter has its Laptop project for needy undergraduates and post-residency physicians. It has extended its support to provide laptops to physicians in the Doctors to the Barrios program, an important piece in integrating the Philippine health system through Tele-health. Individual donors, Linda Gambito ’66, $50K, Nicki Nicdao ’67, $45K, and many alumni helped. The PEF (Permanent Endowment Fund) supports its maintenance by funding the salaries of 4 MIU employees and allocating an annual $17K budget for computer maintenance and replacement. Most recently, Class ’57, headed by its president Joe Peczon, had undertaken the computerization of the Orthopedics Department Health Records as its class Golden Jubilee project.
The Medical Informatics Unit in the UPCM developed a database system called CHITS (Community Health Information and Tracking System) in conjunction with the UPCM Community Health Department and the government of Pasay City where UPCM interns rotate. The software is in Tagalog, and barangay health workers are trained to enter data in the patient health registry. It asks, “ Ano ang pangalan mo?”, “Saan ka nakatira?”, etc. And true to Filipino ingenuity and frugality, MIU recycled old computers and introduced new technology and new skills to the barangay health workers. This Urban Community Based Health Program over the period of 3 years as a demonstration project, will ultimately reach 75,000 residents in 10 barangays, train 200 lay volunteer health workers, 100 community leaders and local government officials, and benefit 320 medical students, and 50 local health care professionals. UPMASA Southeast Chapter is supporting this project with $36K over the 3-year period. PEF donated audio-visual equipment for training health care workers. This project will lay down the infra-structure for the Pasay City government to provide basic health care to its constituents. CHITS has caught international attention as a model of medical informatics technology and was a finalist in the Stockholm Challenge in 2006.
Bringing the Tele-health technology to the barrios will require upgrade of the 10-year old infra-structure. When the cables were laid down in 1997, the MIU was young and had no experience in building a network. With subsequent increased demand, the LAN expanded without structure and order. The system had become congested and is constantly breaking down. It will require the services of a certified network engineer to evaluate and audit the system and recommend fixes. Upgrading into a wireless infrastructure with industry-grade connectivity is also indicated. The Dean had identified the UPCM Network Rehabilitation and Upgrade project as #1 priority. To have this system running smoothly will open up challenging opportunities for international collaboration in Telehealth. Already the Shriner’s Hospital in Hawaii is about to commence testing its system and many are waiting in the wings.
During the pre-convention activities, the Dean of UPCM Dr. Bert Roxas articulated his vision for the College in the next 25 years, in the Conversation with the Dean pre- 4 Doctor’s in Concert segment. He seeks to restore the UPCM in the forefront of technology, innovation, develop a research program, build academic excellence, nurture faculty and employees, develop sustainability, and produce graduates who are imbued with nationalism and social accountability, rendering service to his community and his country. When we entered the College of Medicine, we were all asked in our admission interviews why we wanted to be doctors. I bet we all answered because we wanted to serve humanity. We thought we’d train in the US and return and serve our country. But of course, life happened, and we got married, had children, acquired a mortgage and credit card bills, and we got stuck. We had good intentions and we wanted to somehow make things right. UPMASA allows us to give back to UPCM and PGH, and to the Filipino people. When we learn of how much colleagues like Dr. Alvin Marcelo make a difference because of the work they do, we become nostalgic of what it may have been for us if we traveled the other road. The next best thing then is to support UPMASA, because if we do, we help colleagues like Dr. Marcelo do the things that we would have liked to accomplish if we did our work back home. Ahh, C’est la vie. During this 22nd AGC, with its theme of Wellness, Wit & Winning at the Wynn, my Class ’67 had pledged to support the UPCM Network Rehabilitation and Upgrade Project as our Ruby Jubilee project. This is a winner!

Amongst Giants, California, the Beautiful

Amongst Giants, California the Beautiful

We had to get on a jet plane and fly 41/2 hours from Atlanta to walk under the spell of these giants in the pristine snow-covered Giant Forest of Sierra Nevada, in the Sequoia National Park, in California. My friend Mary has a conference in Palm Springs, and what fun would it be to take a side trip and catch the snow before they melt in spring and go snowshoeing among the majestic giant sequoia redwoods. Well, what we thought was a 2 hour drive from Palm Springs turned out to be over 6 hours. First of all we left Palm Springs without a map. We thought we could just get on the road and follow signs to the giants, surely everyone knows where they are, after all they are unique to this place, nowhere else in the world do they grow naturally. The car rental desk had only a Palm Springs map which showed us how to get out of Palm Springs and then we imagined how to go from there. The random routes we picked fortuitously gave us the full flavor of the California landscape. Outside of Palm Springs, I-10 offered the alien scenery of white wind turbines against blue skies and stark land . The San Gorgonio Pass is a wind tunnel, and there are 3000 windmills looking like they are made from the same polymer material as the Star Wars storm troopers, with their 3-prong blades reminiscent of the Mercedes-Benz symbol. These erect wind catchers are planted in rows 700 feet apart like an orange grove as far as the edge of the San Jacinto mountains or looming over the Coachella valley on top of ridges looking like sentinels from outer space. We get on I-215 and briefly on I-15 traveling on winding roads cradling the San Bernardino Mountain seeing nothing but the road and the bare mountainside. We turned towards Route 395 which cuts across the Mojave desert, with its miles and miles of shimmering road reflecting the glitter of the sun. We admire the fortitude of the Joshua trees surviving in that harsh climate. Then approaching Bakersfield on Route 58, we first passed Edwards AFB then it's suddenly green and fertile with orange groves heavy with ripe fruits ready for picking, many have fallen from the branch and lay rotting on the ground. There are rows of grape vines trained to grow formally on trellises, pastures of grazing cows, and cookie-cutter housing developments built smack in the middle of nowhere. Then we are in Tulare County, in the Sierra Nevada foothills. It is now dark. The climb to the Giant Forest was a mere 23 miles from the foothills but we didn't know it was a tightly wound road embracing the mountain with tight hairpin turns and convoluted spiral ascents that required intense focus and prayer especially in the darkness and there was no one else on the road but us and the prospect of a bear emerging from the forest hungry from its winter hibernation. It was unnerving to find out later that this road , Route 198, is carved overlooking deep ravines with snow embankments as high as 7 feet on its mountain side. It took us 2 ½ hours to reach Wuksachi Lodge at the 6500 ft. elevation, only to find out that the restaurant stopped serving meals 5 minutes ago, and the lodge had no room service and the nearest food joint is in the foothills, which we just left behind 2 ½ hours ago. But these were nice people and they called the kitchen, and they were only too happy to take our orders from their regular menu, and not to worry we can stay until dessert. We forgave the restaurant for touting in their brochure that they specialize in signature gourmet Sierra alpine cuisine. The snow covered forest outside our lodge window, the crisp 41 degree sunny weather and blue skies, the cedar scented air, and the friendly and charming lodge staff made up for the bland and limp pan seared red mountain trout, the unrecognizable meat loaf, the pasta special with Italian sausage and kalamata olives which I had to complain about because there were only traces of olives and 2 thin slices of sausage in the dish, so the chef was moved to send me a separate bowl of just sausage slices and olives, etc. Perhaps the restaurant is up to its advertised standards during their regular season which starts May 15. We booked in early April, which was at the end of the winter season and the resort activities shop had closed. There are no more rentals available for snowshoes, cross country skis and snow boots. The Crystal Cave with marble stalactites and stalagmites is closed and the road to Kings Canyon is off limits. But we can hike in the snow so we set out with excitement to see the big trees and headed to the Giant Forest Museum for information. We took pictures of the General Sherman Tree, the largest and oldest living thing at 52,508 cu. ft. and over 2000 years old. Wow! We asked directions to the Giant Forest trail, and set out on our own to be with the big trees. We underestimated the challenges of hiking on deep snow that had softened in 41 degree weather, and we didn't know that the trails are marked with symbols on trees and that trails are not alike. We were following a trails map to a grove of big trees named the Congress trail but we lost our direction. We found ourselves following footprints on the snow that are going up higher and higher which led us to a slippery narrow ledge against the mountain and we're looking down maybe over 200 feet of steep ravine. There were footprints so we figured it will lead somewhere so we continued, being careful to plant our boots so we will not slip. After rounding the side of the mountain we lost the trail signs and the footprints disappeared. We clambered over fallen trees hoping to pick up the trail but we fell thigh deep into the softening snow and suddenly it dawned on us that we could fall deeper into snow and we didn't know what's under them. And the fog was coming in and it was getting darker. I conceded to Mary's judgment that we should retrace our steps and return instead of continuing on trying to pick up the Congress trail from the Alta trail. When we emerged after 4 hours in the forest we realized that the Alta trail is an advanced trail, and we really had no business being there. From here on Mary didn't trust me and her decisions prevailed. So we just had safe walks which were boring, so in a way I was glad we got lost and didn't know what we're doing on that first day, after all all's well that ends well. Like everyone else we climbed the Moro Rock, 400 steps and 0.5 miles to the top of this granite monolith which was free of snow on that day so we went to the summit at 6725 ft., to view the vista of the Sierra Nevada range, the Giant Forest, the Kaweah River , the Kern Canyon, the great Western Divide, the whole breathtaking magnitude of it all. Mt. Whitney, the highest point in the US at 14,491 ft. crowns the Sierra. My brother Mike and Pilar joined us from Fresno on this climb and spent the day hiking with us and invited us to see the wonders of Yosemite, and he planned to return to Sequoia and Kings Canyon to camp in the summer.
After 4 days with natural wonders we're ready for the man-made wonders of Palm Springs. We took the quick route back on I-99 and I-5 , which eliminated the experience of the amazing and varied landscape of the place.
Approaching Palm Springs from I-10, we exit on Bob Hope Drive, then to Dinah Shore Drive to reach Westin Resort in Rancho Mirage. On one side of the road are gated luxury housing developments with multimillion price tags, imported shrubs and trees and grasses, and man-made lakes serving as hazards in verdant signature golf courses, over 150 of them in the area, absorbing thousands of gallons of water to maintain the greens. But not to worry. The Coachella Valley lies on top of an aquifer with bubbling hot springs and cool waters filtered from the melting alpine peaks of surrounding mountains. The Colorado River feeds a concrete aqueduct that irrigates the desert fields for produce worth over $500M annually. On the other side is Indian land. With only the road separating it from the lush settlement on one side, we see the authentic arid Sonoran desert landscape with the unrelenting sun, tumbleweeds, mesquite shrubs, and the multi-purpose creosote . We learned that the Cahuilla Indians of the region are the richest today because of 3 smart women who went to Washington DC during the homesteading era and did the paperwork to cement a deal that gave them 40% ownership of the desert when the railroad came calling to build. They lease the lands, own banks, businesses, and the casinos and the biggest, the Agua Caliente Casino Resort and Spa is currently undergoing a $300M expansion.
I couldn't wait to visit the San Andreas Fault, the cosmic point where 2 tectonic plates, the Pacific and the North American, slip and slide about 35 mm/year in opposite directions creating tremors in the earth or great earthquakes that can decimate Palm Springs and the rest of Southern California anytime between 1 year or 300 years, and can rearrange mountains and lakes and coastlines and push California towards Canada. I have imagined a deep dark chasm to the core of the earth, but instead the rupture is a ribbon of tropical oasis encircling the bottom of the San Jacinto mountains, with gurgling streams, palm trees, and many birds and creatures including rattlesnakes and tourists. For a different adventure we took the Palm Springs
Aerial Tram, the largest rotating tram car in the world, an engineering marvel constructed in the rugged Chino Canyon with the use of helicopters, and literally, a breathtaking ride to the summit of the San Jacinto Mountain, bringing us to 10,804 feet in 10 minutes and offering a spectacular 360 degree view of the entire Coachella Valley below. For the rest of the time we did our usual thing, play golf, tried Valley cuisine, attend corporate parties, and on the last day of Mary's conference, we had a novel treat. The corporate closing event was at the Empire Polo Grounds, one of 16 in the area, each grassy expanse the size of 9 football fields . We dressed up to attend an abbreviated polo match demonstration complete with an enthusiastic fast-talking announcer, got to meet the horses and their riders, then dined under Arabian-like tents with live music entertainment and pretended Prince Charles was in attendance and we were like ladies of the court and what not. A perfect fantasy in a town where streets are named after Hollywood stars and electricity bills are sky high to cool fancy homes built in the hottest and driest place in the USA. That's desert living.
On the flight back to Atlanta we were flying low in Skywest's 76-seater CRJ 100 to Salt Lake and beheld a panoramic and mesmerizing aerial view of the golden sands of the Sonora, the Algodones Dunes. I've never realized before that California is this beautiful!

My Sugar Daddy

My Sugar Daddy
January 8, 2008

I finally got my alternate proof of age with the receipt of my baptismal certificate from the Philippines. When I first requested my birth certificate from the Philippines National Statistics Office, the Office of the Civil Registrar sent me an official document verifying that they have no record of birth of one Fiameta Rosa Ricafort Vargas. It took 6 months of back and forth transaction through a local representative before I can get proof that I do exist and that I was born on such and such date. That’s the only way my Sugar Daddy, Uncle Sam, will acknowledge me and my entitlement to lifetime support and dole out my social security retirement payments and qualify me for medical care through Medicare.

Since it took 6 months to submit documentation and Social Security only keeps an application open for 60 days, I was instructed to file a new application and show documentation in my nearest SS office, which is behind South DeKalb Mall, by the Post Office, near my work. So I hied ho to the site thinking I’ll be there for an hour, and I can return to work in a jiff. I confronted a mob scene, with all 36 chairs occupied in the small waiting chamber, and the rest of the multitude spilling out into the hallway and sitting or spread out on the floor. The lone person you can talk to is a policewoman stationed in a guard cubicle by the door, who is selectively mute when you approach, and merely points you to a counter marked, Take a Ticket. You press keys on a machine depending on what your business is with the SS office and it spits out the number. I was O638. The
office staff is behind glass windows which you cannot approach without the proper number. They were calling D237 on my arrival. There was no way to determine when you will be served. There was a young woman with her 2 elementary aged children who was there to change her name because she just got married, and she wanted to know if she can just leave her papers, and she was curtly told by the policewoman that she’d have to take a number to get her question answered. Another woman politely explained that she was there earlier and now she’s back with the documents needed and she only wanted to hand them to the staff who served her, and could she leave them, and she was told to take a number. She protested and the policewoman hushed her, which ignited the lady, and so she raised her voice and told the policewoman she has no right to talk to her like that, and that she was supposed to be of service to her and instead she’s just rude and unhelpful, etc. The room erupted in applause with murmurs of Hear! Hear! and Yeah, Amen. The policewoman was unmoved and the lady left in disgust, angry and spewing fire. I asked a lady near me and she said she’d been waiting there for 3 hours! I was determined to not leave empty-handed, figuring it would be just as crowded if I returned on another day, so I stayed put. My work kept calling me, and the policewoman in the cubicle glared at me and sent me out because talking on cellphones is not allowed. I managed to get a seat, but at 3:30 PM, the policewoman called everybody waiting outside to get in because she was closing the doors and the SS office is no longer admitting new customers. There were over 60 people crammed into that waiting area designed for 36, and there was no circulating air after she closed the doors. The customers are all African-Americans except a family who looked like they came from a Mideastern country, the Caucasian young woman with the children, a Hispanic woman, and myself. I felt strange, like I was in another country. I felt closed in for the men were huge and obese, many are limping, or swinging on crutches, there were several on motorized wheelchairs. There were many disabled children on wheelchairs or looking like they have congenital anomalies. The women similarly were obese, panting for breath, and their smell just filled the room. There was a group of young women in tight blue jeans and exposed cleavage, smacking gum and giggling, and I wondered what they’re doing there. I was thinking, most of these people are probably there to file for disability claims or SSI, and will get more out of SS than what they put in.
When my turn finally came after 2 hours, I was told that this contact was for screening purposes only, and I will have to wait until my name is called so a staff can take my application. I was suffocating in that room when my name was called at 4 PM, and I was told to go to window #7, in the back. Fortunately the young African-American staff who served me was very accommodating. I was there to reapply for Medicare part A only, since I’m still working full time and couldn’t apply for retirement benefits without being penalized, however I asked whether I can kill 2 birds with one stone since transacting business with them seems to be characterized by long waits. She said early application is only accepted 4 months before actual date of retirement and I will meet that requirement in February, but she will take my application now, and file it and activate it in February, if i don’t mind waiting for Medicare at the same time too, because she can do both together, but not one first and the other to follow. Oh brother, that’s government red tape for you. She informed me that I paid the maximum into SS since 1973, and I will get top benefits and quoted a sum just on the upside of $2K per month. I was grateful that she was well-informed about their procedures to be able to accommodate my request, and so my application is filed and ready to go in February.
Wow, I was thinking, how rich I will be, my Sugar Daddy!

Walking for Breast Cancer

The Madhatters Send Metty to the Avon Breast Cancer 3-day Camp


You may have heard of the Avon fund-raiser. It’s now in its 3rd year in Atlanta and has raised millions for breast cancer worldwide together with 3-day walks in Los Angeles ,New York, Boston, Chicago, Washington DC, and San Francisco. The Winship Cancer Institute of Emory University and Grady Memorial Hospital received $15.3M from this fund last year. So it’s seems like a worthy cause considering I had a personal friend and medical school classmate who have succumbed to it and several friends are still fighting valiantly to conquer it, and yet some have triumphed and completely vanquished the disease, thanks to new treatments and understanding of the importance of early detection and education.

Well, I’m not much of a goody-2-shoes but walking 60 miles for 3 days from Lake Lanier to Atlanta and sleeping in tents at night and having catered meals and massage from volunteers and foot care from podiatrists and hot showers from a truck with all the complimentary Avon products you can use sounded like an adventure to me. So I signed up on the spot and only realized too late that walking my 3 miles on Buice Road does not even come a teeny bit close to walking 20 miles a day for 7 hours over hills and gravel and heaven knows what else.I hear that there’s a truck sent to comb the route at the end of the day to pick up wasted bodies by the roadside. What should one do? I signed up at Bally’s Fitness and now I’m pumping 10-lb weights and surviving 25 minutes on the cardio machines. Do you realize that it’s easy to squander away 1 ½ hours or more just doing the weight circuit, repeating ab curls and gasping at the cardio machines? Now walking 6 miles is a cinch, not to mention what I walk playing 18-holes on weekends. How many miles is a 5200 yard golf course driving off from the red tees? So I figure I can survive the walk on October 5-7 with probably nothing worse than blisters on my already bunion-deformed sorry feet, the legacy of miles covered making patient rounds in the halls of UP-PGH in 4-inch stilleto heels.

It turned out the physical preparation is the easy part. Again I found out too late that I need to raise at least $1900 to be able to have the privilege of walking 60 miles and torturing myself. Although I know I can stick up some of my rich friends and I’d get that $1900 in a blink it’s not fun, is it? Besides I got serious and I said I’d do this right , after all I’m already putting in tremendous physical effort . I might as well send the fundraiser message across, i.e., breast cancer awareness. So a light bulb flashed in my head, the Madhatters !

Now you are going to hear about the Madhatters. When they put on their hats they can do anything, but on one condition: they must have fun while doing it. So once again I fell into a rabbit hole one lazy afternoon and I dreamt I would have a party on my birthday and have an auction-fundraiser. This is how I saw it in my dream:

Before I leave this decade
I want to make a point
Attitude is what a growing girl must have
Getting better not feeling older
Is what I intend to serve

So I’m walking 60 miles for 3 days
You may have heard of the AVON walk
From the calm waters of Lake Lanier
The first steps begin
And the last rests in the bosom of Atlanta
In between are a thousand steps
And maybe blisters and bloodied feet
But first I must bring $1900
So hope can flourish for us
Who happens to get the B-disease
Breast cancer that is

Please come to my birthday party
Bear no gifts but bring something you already have
Someone’s junk maybe somebody’s treasure
Bidding for these will give everyone pleasure
And we’ll collect all the bids into a fund
To send me to the AVON 3-day camp
That would be the greatest birthday gift
And the knowledge that my friends
Have got the right stuff with ATTITUDE

So how will the Madhatters pull this off? First they met for high tea at the Four Seasons on 14th Street to figure out what to do with the hats they’d wear. The Whimsical Madhatter is I since I dreamed this all up and all the hats everyone will wear so everyone can help me make this for real. We have 2 Culinary Magical Madhatters and those are Nene and Eudy who will plan the menu and set up our table real nice. We have 2 Martha Stewart Wanna-Be Madhatter, Tess and Bonnie who will decorate the party space (which is my backyard) with originality and select a theme or motif. Our Party Madhatter is Gloria who will plan potions to serve so we’ll really have fun. We need 2 Money-Handler Madhatters Didi and Susan who will collect bids at the auction and fill out pledge forms and send them to the fund headquarters and endorse auction items to the highest bidder. Nene wears 2 hats but she took offense at the title of her other hat as it was originally the Hustler Madhatter who will be in charge of the auction together with Precy. They will make sure that the bidding is enthusiastic and everyone is involved and getting carried away. They were also asked to go to auction school to learn how to talk fast without breathing and to learn how to entice the audience to bid to their heart’s content. Nene thought that the title is contrary to her demure and sweet nature and she was adamant not to tarnish her reputation and flatten her coiffure with such unflattering title so I changed their title to Madhatter Scarlett. She and Precy are now happy and back into the fold. And last but not least Marites is the Commando Madhatter. She will plan completion time lines for everyone and make sure every Madhatter knows what she’s supposed to do and she’s the authority who during the party will organize the schedule of events and make them happen without a hitch.
We had a lovely afternoon sipping tea and scarfing the finger sandwiches. We were so hungry. By the way high tea at the Four Seasons is definitely a more divine experience than the Ritz. The Madhatters have spoken.

So folks if you get an invitation to my birthday party on August 25 we sure would like for you to come and have fun and share the adventure of 2000 friends who will walk from Lake Lanier to Atlanta on October 5-7, 60 miles 3 days, each one bringing $1900 so breast cancer will disappear from the face of the earth.

Supportive Living

Supportive Living: The Commune
Musings of a Whimsical Mad Hatter


Our lives are at a crossroad. We are mulling over ideas about retirement, life style changes ,re-evaluating core values to guide our vision for our future, anguishing about decisions/choices and exploring ways to make things happen. Oh boy! Do wereally get this thoughtful and analytical about how we do things or don’t we just muddle through and try to make sense of what’s happening to us and make the best of or who knows maybe make worse of what life has given us. These days I feel like a muddler more than a planner but the other day Bonnie and I were addressing this and we got all excited about a plan!

The new millennium is trite now the way everyone had made such dramatic expectations from entering the new century but nevertheless it got us thinking about a V----s Millennium Convergence. And the reunion of the siblings bring the realization that we are all getting along in years, and of course we have been aware of how mama is getting older and had raised the question, what shall we do if mama gets sick? We have not inquired of mama if she has contingency plans about getting sick but certainly we assumed it will be our problem. Can we assume it will be others problem if any of us get sick or get very old? Maybe it is my depressed state at this point but I cannot think of anyone who I believe care enough about me to make my infirmity his/her problem. I do not look to my children to be obliged to care for me for love or duty for as the prophet said our children belong to tomorrow and cannot tarry with yesterday. I cannot look to a husband for care for as we know a marriage can disenchant or end in divorce, and neither can I look to friends for that’s just not expected of friendships. But I think like a Sicilian, I can understand the godfather’s affirmation of family and blood relatedness. Blood is thicker than water is truer to me now more than ever. So I’m convinced that when all is said and done we as siblings have the most vital bonding and we should look to each other for support and care. We are the original family and we started out as children living together and it would not be inconceivable to see ourselves in the dusk of our lives reuniting and living together again, experiencing the original togetherness as a family sharing the same blood coursing through our veins.

When I started out I have all sorts of dreams. My soul actually craves more adventure and passion than what my competencies and opportunities can provide. I constantly hunger for new experiences, to know more, to try new things, to taste whatever is exotic ,even strange. I have said my motto is, unless potentially fatal by all common sense deduction, “I’ll try anything once.” I want to be amongst kindred spirits. But I’m also enamored of history. During this VMC we are looking at our family history and we are getting desperate because mama is the only living link and we have not mined her knowledge yet of our family history. History helps put our present in perspective. It is playing out in very familiar form, the more things change, the more they stay the same. Our brilliant plan, Bonnie’s and mine, given birth during a moment of madness, in retrospect, is not original at all. It’s as old as the sands around Virac and Pasacao.

This all began when the neighbors began circulating a protest for a zoning request on Buice Rd. to build a dozen houses on 31/2 acres. Why that’s the acreage I have on our property. I never realized you could put that many houses on 3 acres, although I had a dream when we built our house here that I’ll build a gingerbread Victorian guest cottage in the woods behind the tennis court and when the kids have their families and we’re retired we’ll pass along the big house to one of them, most likely Jay-Jay, and Johnny and I will move into the guest house. Now, that’s exactly how mama and papa planned it when they built the apartment complex on Ateneo Ave. They envisioned keeping us all together, just like papa’s generation of Vargases have that family compound in Virac. Without thinking about this I had the same ideas for our own children. You know how these kind of plans turn out. No self-respecting child wants to live with parents in the childhood homestead, the children all want to see and live in the world.

I had envisioned keeping this house, with romantic family fantasies of being a permanent place to come home to, for the children and grandchildren, a solid, reliable physical haven, which will always be there no matter where they’ve been in the world. But no one is interested. Not the children towards the parental home.

But it’s a completely different matter for siblings in the empty nest phase of their lives to regroup and live together again. We are all looking for a place to build to retire to, we have already broached the idea of buying property adjacent to one another or at least be closer to each other, this is where the light bulb switched. I can subdivide my property into 5 or 6 building lots, get an architect or a developer to draw a really nice cluster housing plan with shared common areas like the swimming pool, transform the tennis court into a shuffleboard area or something, or have a lawn installed for croquet or for the grandkids to romp about, have an area for flower and vegetable cultivation, landscape with footpaths around the various cottages, for I see the cluster homes as cottages maybe Victorian or farmhouse style in feel with front porches and open plans with one-level living with master on the main floor and maybe a loft with extra bedroom or two for the kids and grandkids when visiting. Each sibling will own his/her own cottage and build according to the master development plan. The big house will be the center of shared family activities. I am envisioning that we will have evening dinners together and on certain nights may dress nice, have guests, we’ll have music or movies or mahjong. Holidays we may have grand reunions with our kids and grandkids. We’ll hire a cook and housekeeper and groundskeeper and assess each family a sort of club association fee. We can form a corporation and have bylaws to regulate our fiscal behavior.We’ll elect officers and have quarterly business meetings since we will surely have a complicated financial relationship which we would not want to interfere with our personal relationships. And being a corporation, we can start entrepreneurships. There’s so much talent and ideas for a business between us siblings, I don’t see why we shouldn’t pursue this in retirement. Just think how exciting this would be. I’m also thinking we can plan vacations together and get special group discounts. All these joint activities does not preclude personal time and privacy as we all have our own private homes and it’s up to us to decide whether to have company or enjoy solitude. As siblings age and retire they will be joining this group and eventually all of us will be back in the fold. Come to think of it this may also address our dilemma about mama. She can join us in this venture and she will be the first to build a cottage since she’ll be the first to qualify for supportive living. As we start getting infirm, we can add a nurse to our employees. We can stay in our homestead until we die, no one among us has to go to a nursing home and no one among us has to put any pressure on our kids to take care of us. When we die the subdivided property can be passed on to our heirs, then they can decide for themselves. You know, Martha Stewart is not the only one who can invent a life style and profit from it.

Woman Doctor

Woman/Doctor, Where Does The Twain Meet?



It was the last semester of pre-med and I was having second thoughts about entering medical school. Many of my classmates were changing majors, signing up for BS Chemistry, or Zoology. Medicine was intimidating. It was hard to qualify for a spot in the University of the Philippines College of Medicine and the study was too long and hard. Out of over 500 applicants only a little over 100 were accepted and among these women figure in less than 15%. I was having a crisis of confidence, but I didn't know it was about that then. I told mama I wasn't going to medical school, instead, I will continue towards a BS Chemistry degree. Imagine! Well, mama was unhesitating, she put her foot down and there's to be no argument. I will go to Medical School and I will be a doctor. And so it came to pass, FRV, MD, UP Class '67.

When I think of how I experienced folk medicine in Pasacao when I was growing up, I shudder! I could have died, I could have aspirated and have a collapsed lung or I could have had an embolus and died of a stroke. I had asthma in childhood and when I have an attack I feel like I'm drowning. I feel like I'm going to die. The folk remedy is to drink blood directly from the gushing neck arteries of a baby crow. Four grown-ups would pin me down, force my mouth open to gulp the fresh blood. I'd resist, thrash about, and fight with everything I have. If I had a fever the treatment is to heat suction cups and place it on your body to suck the fever out. I also remember leeches; they suck out whatever was poisoning your body. Well, I survived these and amazingly without apparent post-traumatic stress injury.

The interview in medical school ironically, was the traumatic one. I didn't know how to label it then but it was the first encounter with the many varied presentations of sexual discrimination. It becomes operational when you enter the world populated by men and begin to take away from their share. Up until then I was in my proper place. In undergraduate school its good for a woman to be educated so she can marry upwards socially and economically. She will not take away from a man's share because once she's married she's expected to stay home and take care of the family. But Dr. Katigbak, bless his soul, he's now dead, the Secretary of the UP College of Medicine who interviewed me for admission to the college, put it very clearly to me, "Why would you take up a slot in this class when it can be filled by a man and not be wasted, after all, you will get married and stay home and never practice medicine!" And perhaps he thought it was a compliment to me, so he added," Why don't you work in a bank, or become a stewardess, you'll meet eligible, ambitious young men and get married." In those days, women who work in these places were mostly mestizas, supposedly alluring and beautiful women, educated in Catholic private schools, sought out in marriage by eligible ambitious young men. I didn't know what to think then but I had a very uncomfortable feeling, a mixture of shame, anger, insult, and confusion. I must have mumbled some inane stock reply like, " But no sir, I'm dedicated to a career in medicine because I want to serve humanity!" When I think about this today and can see it for what it is, I become livid! I should have slapped the jerk across the face, kicked his balls and tied him to a tree and cut his penis off and feed it to the buzzards! And there were many more encounters to come. The obvious ones are easy to handle, but those that come disguised as compliments or gestures of caring are really difficult to confront.

I take pains to present myself professionally but men and invariably women don't hesitate at all to make a comment on my appearance during hospital rounds, meetings or during patient contacts. My male colleagues do not get greeted with " My, you look nice, where do you shop for your clothes" or " What do you eat, you never gain weight" I understand these are intended as compliments, but very subtly it undermines my professional status and trivializes my influence. I notice patient and staff take my time with an attitude of entitlement, unlike my male colleagues whose time is more guarded from frivolous intrusion. It appears one can chat up a woman doctor and not be thought of at all as being interrupted from her work, whereas a male doctor is perceived as doing serious and important work whose time should not be wasted. I have patients who can't address me as Dr. V, all the while knowing I'm their doctor, instead they address me as Miss or Mrs. Occasionally I play a game with this and remind them to call me with my professional title, they apologize and correct themselves but before you can say boo again, they lapse into the lay title. Male colleagues are addressed with the professional title Doctor automatically. Older patients or veteran hospital staff have called me "Honey", and treated me in a childlike or patronizing manner. Others had an outright belittling attitude challenging my decision or professional opinion. I had to rely more on formal accreditations such as Specialty Board Certificates or Citations and Diplomas to establish my professional authority. I also find that I need to give more educational information to patients for them to trust my recommendations and medical opinions not so much because they seek the information to understand for themselves but for them to hear that I know what I'm talking about. In quasi-social situations where spouses are included, it is assumed I'm the spouse and John, the doctor. I have to exercise high level diplomacy to be accepted by the female spouses, to avoid any antagonism, at the same time avoiding being encircled in their midst, otherwise I miss valuable networking opportunities and professional identification. It's a catch-22 dilemma. Professional networking is most effective in these quasi-social situation, people are more forthcoming with information, you get the early rumors, you get to know people better. The men invite other men without any qualms, to their homes or to have dinner or a drink in a public place and discuss business. I find that I have to befriend my male colleague's spouse so everyone will feel comfortable in this situation. It helps tremendously also that I am married.

The response I get when I do something exceptionally well has bewildered me. In this professional accomplishment people have behaved as if I have done something so extraordinary and they are elated and very proud of me. I was president of the Hospital Medical Staff at a time when we were facing many challenges; corporate control, budget cutbacks, staff lay-off, declining insurance revenues, medical staff discontent, and professional peer review problems. What I did was keep the focus on the issues, maintain dialogue, keep everybody involved, adopt a realistic and down-to -earth perspective, and hang in there with everyone. I did a good job and I avoided ego trips for myself and for others. But the effusiveness to acknowledge this gave me mixed feelings, because men are not fussed with in this manner. It is assumed they can do this as an ordinary matter. Frankly, I thought it was patronizing, but what am I supposed to do? Of course, I have to play my role right and smile and thank everyone, and be nice like a woman. It was the very same flavor I tasted when I returned with 11 male colleagues from an Outward-bound Wilderness Bonding Exercise in the North Carolina Grandfather Mountain. It was 4-day program. I carried a backpack as heavy as the men's and I weighed half of any of them. They elected me to lead the hike across mountain ridges with only a compass for orienting to our direction and they also elected me to lead the crew in our raft when we descended the white water rapids on our last day. I accepted these because I wanted to avoid being relegated to cooking and setting-up camp duties. When I look back there were 12 of us and I didn't need to have all these responsibilities, but to a man I believe they unconsciously conspired to set me up. If I fail, nobody loses face because I'm a woman, but to have me lead them avoids the possibility of failure for any of the men. Interestingly this group of men is particularly mindful of not appearing sexist by studiously avoiding offering me any kind of assistance. There also was no concession at all to physical privacy, I slept in the same group tent with them and performed toilet and grooming functions in their midst. I was thankful I did not have my menstrual period that week. I've always been a good sport in the company of guys. I've survived medical school by behaving like one of the guys, and growing up in Bicol I was a tomboy. The individual challenges posed by Outward-bound, like walking a log twenty feet high or free falling from forty feet or scaling a forty-foot wall, were familiar adventures from my childhood. When we returned, the buzz about the weekend filled the hospital. It seemed everyone knew about it from administration down to maintenance and later on among the spouses of my male colleagues. Everyone, male and female was just elated and tickled and so proud of me, they were so amazed that I did it! I was confused, bothered, and bewildered, but I was programmed to be nice, so I smiled and thanked everyone. Just try and protest and call this sexist, and see what kind of response you'll get. I didn't dare, I have too much to lose. It was early in my career, and for a woman this condescension was a necessary evil to get your goal. The glass ceiling may be raised in this generation but it's not broken yet. In many ways we're still living in Mary Ann Evan's time when she had to hide behind a male pseudonym to publish her " Adam Bede" as George Elliot in 1859.



To be a woman doctor and have a career that's competitive in professional prestige and financial success and networking power, and to have a life, I'm convinced, is not the same for my male colleagues. It is easier for them because first of all they have a wife. We all know wives are worth twice their weight in gold for the way they facilitate and enable their husbands to succeed in their careers by allowing them to focus on their work and taking stress away from them by dealing with family and life problems. Johnny has been very supportive but he is a husband. I have to be the wife and simultaneously, the doctor too. To make it as a woman doctor one must have a solid sense of oneself, have a toughness within as well as having a tough hide, competitiveness, an Attitude, and a solid grounding in nurturing relationships with other women.


I was going to be an architect and being a Colegiala I was planning like all good catholic girls to go to the University of Santo Tomas for college. But mama had a different vision for me. She saw me as a Doctor who will graduate from the premier institution in the Philippines, the University of the Philippines. I was amazed, I never had enough confidence in myself to see me going to medical school in the University of the Philippines. But mama was so certain about me and I'm glad that she was so decisive and held fast when I wavered later, indeed seriously considering shifting to BS Chemistry, because My Life would have been very different otherwise. Still sometimes I wonder, where would it have led me, the road not taken?

Debutante's Ball

The 4th Fil-Am Triennial Debutante’s Ball


The Marietta Conference Center & Resort was abuzz with giggles, gasps, and the swoosh of full-skirted ball gowns on September 20,2003, as flushed and excited Fil-Am debutantes find their places for the formal picture-taking before the cotillion. I am reminded of Dega’s paintings of ballerinas. And indeed these 12 young Filipina-American ladies in the peak of their youth is a picture of loveliness, of health, of self-assurance, of boundless expectations, and full of joie de vivre. Gaite Parisienne, the theme of the Ball, how very apropos.

It took long preparation to produce this Debutante’s Ball. First, there is the search for debutante’s which happily is an easy task since the Debutante’s Ball had become a much-awaited event every 3 years since it’s introduction by 1994 Fil-Am President Gloria Sabiniano. Little girls have seen their older sisters or family friend’s daughters participate and have dreamed of one day being a part of this sparkling and joyous occasion. Word had gotten around among young people about how wonderful the camaraderie is and how one discovers so many fun and accomplished peers who like them are of Filipino heritage born in America and have unique experiences to share. Romances have been ignited and many lasting friendships have been formed. It has become a family and community event and fulfills its mission of proudly introducing young ladies and gentlemen to our Filipino-American community. For our youth it brings them awareness of their Filipino identity in a milieu they can be proud of, and for our elders, it provides an occasion to mentor on the cultural traditions, mores, values, and history of the Filipino people.

This 4th triennial bash is a transition of sorts, indicative of it’s progression and maturation as a tradition. The old guard remains and continue to paint their strokes on the event but there’s a lot of new talent and new ideas are being incorporated in the production as we witnessed this year’s Cotillion. When our second generation Filipino-American youth comes of age, the daughters of previous debutantes, we will all have replaced the founding managers and who knows what surprise is in store for us! I’ll wager we will continue to be delighted and entertained and amazed.

The first 3 Cotillions bear the hands of Didi O’connor, who was Choreographer and Director. The debutante’s danced an Austrian quadrille, the “Laendler” for the 1994 Cotillion and waltzed in their father’s arms to Johann Strauss’ Blue Danube. In 1997, they danced a cotillion of graceful Filipino Dances and brought their audience to the nostalgia of old romantic Philippines. The Debutante’s Ball of 2000 was a Houdini-like production of magical transformation, marking the Centennial year with the Cotillion theme “ The Filipina: A Century Ago and Today”. The debutantes made their grand entrances in elegant Maria Clara gowns and at the end of their Cotillion re-emerged with their gowns sans the flowing Maria Clara sleeves, looking the luminous and confident young ladies of this century.

This year’s Debutante Ball brings the audience to the global community, in a cotillion themed “ Gaite Parisienne”. The backdrop mural, by Lilok artist ----Alberto, a tryptich with the Eiffle Tower in the skyline, is unmistakably Paris. Our cake artist, Elsie Vidanes, is not to be outdone with her calorie-laden but melt-in-your-mouth multi-layered buttery confection, centered in a tableaux of arches and bridges, for the debutante cake ceremony. Twelve enchanting well-rounded young ladies with amazing accomplishments in school, in church, in social activities, and community involvement, together with their similarly accomplished and good-natured gentlemen escorts were announced by 2 of our lively and smooth-talking youth volunteers, ----Pascual and Joel Salgado,who seamlessly emceed the program along with quips and oops!, with a few jokes that fell flat as a doormat. But they were having a good time and the audience of parents, families, guests, and supporters is felling very indulgent and proud of their young people on this night. Many have come from far and wide to share this special occasion. Hours of practice and hard work have paid off in a production that was pulsating with energy, enthusiasm, and style. Everything came together. Even the parents danced their number with pizzaz before the debutantes were presented , a good thing since once the young ladies came on, nothing can command attention from them. And this is a magical moment for fathers, with their daughters, and it showed when they took the floor for a spin accompanied by “You Make Me Feel So Young”. Why mothers do not have these precious rituals with their sons is a shame, for this will be repeated in even more exquisite fashion, when fathers give their daughters away in marriage. But let us not begrudge the fathers, for their daughters were floating and beaming in their arms, a perfect picture to capture forever in our memories. Here are our dozen stars and their escorts: Jamie Alberto and Henry Estacio, Mia Burns and Christopher Elliott, Cindy Caranto and Roy Alberto, Christine de los Reyes and Cris Dizon, Brittney Elliott and Bobby Peterman, Melissa Estacio and Kevin Hagler, Pria Faraon and Mikko Mamagat, Jihan Kamalvand and Ashton Uppaluri, Jennifer Petty and Michael Jirasakhiran, Jessica Prosianos and Rodell Ocampo, Stacey Sado and Brian Bray, Lauren Soriano and Marc Buenventura.

The evening also honored former debutantes ( insert names here) and recognized all the parents and Fil-Am Association of Greater Atlanta officers and volunteers who produced this event.

Insert here the names and titles of the production crew and officers, and all those you want acknowledged, Nene.

Then with “ I Love Paris” spinned by DJ Erik Mojica, it was dance the night away and bask in the glow of affection of friends and family. C’est Magnifique!.

Surviving State Hospital Employment

Lessons From My Clinical Director
The First 4 Weeks: State Hospital Psychiatric Admissions Chronicles

I’m the new Admissions Unit doctor, having been reassigned from the Children’s Unit which was closed by the State on June 30, 2002. The state decided it will no longer hospitalize children and closing the unit will be the best way for the hospital to stay within its budget. The Admissions Unit had been without a doctor for almost a year. When the assigned doctor quit, the position was not filled. The thinking was that this will narrow the budget deficit. To continue operating the Admissions Unit the other doctors were asked to cover the enormous workload on rotation on top of their more than full schedules on their respective Treatment Units. So my arrival was met with great relief and earnest anticipation that the perennial and myriad problems in admissions will be solved, once and for all. This great expectations of course doomed my chances of integrating smoothly into the milieu from the beginning.

I wanted to meet jointly with the Clinical Director and the Program Manager for orientation to my new assignment before my arrival but this was never scheduled. On my first day I expressed my request again to the Program Manager asking her to schedule a joint meeting with the Clinical Director. Then the Grady van arrived dropping off 9 patients which occupied me for the rest of the morning, skipping lunch until very late because another group of 4 patients came after them. Earlier before the patients arrived I expressed my preference that the staff complete their contacts with and have the PE ( physical examination) ready before I see the patient. In this manner I will have on hand the necessary information I will need to evaluate and decide on the patients admission to the hospital. With 9 patients in the waiting room and 1 staff out on sick leave and another out on personal leave and 1 nurse practitioner to complete physical examinations, it took a long time before the completed contacts were turned over to me for evaluation. It was obvious that I will just have to go ahead and see the patients and let everyone catch up on what they have to do to complete the admissions process. Somehow the waiting room was cleared and each patient was evaluated and sent to their respective destinations.

The next day my Clinical Director wanted to meet with me to orient me to my new position. But it appears the Program Manager had already met with him and her own Supervisor to discuss my first day at work. My Clinical Director wanted to be helpful and wanted to advise me as to what qualities I should develop so I can perform well in my position. He said that I should be flexible. It seems I trespassed on some inviolable principle when I said I wanted all preliminary information and processing completed before I see the patient, never mind that I actually violated my own declaration and accommodated to the situation when it became apparent quickly that it was not going to work given the shortage of staff and the volume of patient.

Within the same week I was called again by my Clinical Director because it seems I’m making a lot of non-admit dispositions. Apparently this puts a lot of stress on staff because they have to make several phone calls to complete discharge recommendations for outpatient follow-up and in some cases they have to look up resources for transportation or housing. But what’s most stressful it seems is when a patient makes repeated inquiries from staff as to when they can go home or when they request to make phone calls to tell families and to arrange pick-up, and when some of them became really impatient and became belligerent and demanding. My clinical director again wanted to help me become successful in my new position and offered his advise that maybe I should not make too many non-admits in one day and if I have to maybe I should not tell the patient first until staff had made their contacts and completed their paperwork and was ready to attend to the patient. I felt caught in a bind now with this advice because he just told me to be flexible, and in being flexible I was seeing the patients before the staff had seen them when there are several waiting and pacing up and down in the waiting room. I said I can follow administrative directives to make admit/non-admit decisions based on what’s not stressful for staff and maybe outside the clinical criteria for hospitalization but I wanted a written policy which applied to all doctors. And as far as not telling patients about a non-admit disposition until much later, I said that may be hard to accomplish as feedback is given to the patient in the course of the evaluation to help the patient gain an understanding of the problem and simultaneously education is provided in the interventions necessary to apply to the problem. If the patient is waiting without information about his disposition, it seems to me he might be more anxious to know and approach the staff repeatedly anyway to find out what the doctor decided. This to me does not solve the problem of stress for the staff because a patient is asking or demanding when he can leave to go home. Besides it does not respect the patient as an equal partner in the decisions made about him, and also it does not respect patient wishes to be in touch with significant others right away who might be waiting to know and many are anxious to notify for pick-up right away as some may have to come from great distances, and many may have to call several sources to find someone able to pick them up, or they may have to use public transportation and desires to leave before traffic gets bad. That’s why they want to have as much lead time as possible. So I said I cannot comply. However, I told my clinical director that I was mindful that the Admissions Unit is short-staffed and that is the reason there is a back-log of processing patients and, therefore I inform patients that there are other procedures we have to complete before they can be sent to their destinations and for them to please wait until the staff can attend to them But the back-log in admissions can be 6 hours on some occasions and surely that’s unreasonable for anyone to wait patiently.

Then there’s these 2 children who came within the 2nd week of my assignment. You must remember that the State decided not to hospitalize children anymore and the Children’s Unit is closed. There is an involved policy governing the admissions of these children requiring pre-certification from several agencies and division heads, and no children should present themselves in admissions without going through this process. Both these children managed to by-pass the process so they were at our door. With one, after lengthy and multiple phone calls involving numerous department heads, administrators and myself, a resolution was provided by the community agencies.The patient was returned to be managed in the community. The Community Mental Health System took active responsibility in this instance because the child was developmentally disabled and the State mandate is to serve these children in the community primarily. This was not well-received by the parents but they were assured by the community agency director that the necessary service will be provided. This was appropriate clinically, the child’s interests will be best served outside of the hospital. However, the final outcome was not achieved until after several hours of negotiations. And when the decision arrived the child was very restless and the parents frustrated.
The 2nd child came because her local community agency did not know that the State no longer hospitalizes children. Her case manager thought that we admit children to the adolescent unit then send them to Central State. She did not know that she has to obtain pre-certification from her Director and 2 other State division people before sending any child and it was a Friday and her supervisor was gone and she had no one to consult with. The child was a previous patient on the Children’s Unit so I know her and the problem well. She needed to return to her previous medications and does not need hospitalization, it is a non-admit. But the mother could not pick her up, she was exhausted, she will have to drive from a distance, but she’ll call her case manager and see what is possible. Since the situation appeared uncertain I decided to admit the child for 24 hours to allow for discharge planning. In the meantime the child was very restless in the waiting area not designed for children to wait in and had become very hyperactive and impulsive and started grabbing at anything she can find. She found a pin from the crevices of the floor and started to put it in her mouth, she saw a cord dangling from the TV and she pulled it. She did not respond to verbal structuring. Then the mother called and said she found a resource and someone will pick up the child, but clearly it will be several hours more as they were coming from another county. I cancelled admission and wrote medication orders to manage the child in the waiting area until her pickup arrived. The child balked at taking the medication but finally cooperated and in half an hour she was calm and able to sit still and watch TV as she waited. I understood when I returned Monday that the child waited a long time and the medication effect was wearing off by the time her pick-up arrived. That week I was summoned to a summit meeting to address these two situations. In attendance were the hospital CEO, my Clinical Director, the Nurse Executive, the Program Managers for the 2 Developmental Disabled Units, the Adolescent Unit Program Manager, and my Program Manager. The Adolescent Unit psychiatrist should have been there also but no one informed him. It seems, the discussion suggested, that the particular situation could have been managed better in admissions if I had ordered medications sooner or just admitted the patient. Thankfully, the group also recognized that the Admissions Unit is not set-up with children in mind and the staffing pattern does not allow for supervision tasks. Until the Children’s Unit closed these children were routed to the unit directly for processing, bypassing admissions and therefore there were no procedures in place in the area to manage them..The meeting ended with a task for me to write a policy on the management of children in admissions.

During this first 2 weeks I was also getting calls from various areas in the hospital to take care of patients from the Treatment Units and was sent an employee 10 minutes before my scheduled departure to evaluate for work-related injury. I requested a meeting with my Clinical Director to clarify what my duties are. He said that the unit psychiatrists actually should be available to take their staff calls and if they are not around the 2nd call doctor takes the call but if the request will only take up a few minutes of my time that I should just take care of it rather than have the staff spend time tracking down where their doctors or the 2nd call are. And regarding employee work injury there are assigned doctors on a workmen’s compensation panel who are supposed to be called but only until 3:30 PM to give them enough time to complete evaluation without delaying their scheduled departure at 4:30 PM. The admissions doctor will be called after 3:30 PM, the policy states, never mind that the admissions doctor has the same departure time of 4:30 PM as the other doctors. I requested a review of these policies and suggested an equitable change and asked that the procedures be disseminated again for staff and doctor review. My Clinical Director declined changing the policy at this time but suggested that if I didn’t want to satisfy the improper request I can tell them so. What I learned from my Clinical Director here is that as admissions doctor I should develop graciousness so staff and other doctors are not inconvenienced and if I wanted to follow policy I take the consequences of being unaccommodating.
I was reviewing the previous day’s census when my Program Manager rushed into the consultation room to ask me to drop everything and come check this patient about to get off the ambulance because she thinks this is an inappropriate patient to be admitted here. I said the ambulance can let her off and I’ll evaluate the patient. She said I have to decide before the ambulance leaves so if I didn’t admit the patient the ambulance can just take her back, and that the previous admissions doctor did it this way all the time. She was so insistent that I go with her to confront this situation at the ambulance level. What was so problematic apparently was because the patient was in a wheelchair and “ we don’t admit patients in wheelchairs here”. When I went out to the ambulance dock I met a patient who was about 300 lbs and uses a motorized wheelchair which had run out of batteries and needed recharging. She can ambulate short distances and was not in any acute physical discomfort and did not have any acute medical problems, but I couldn’t evaluate her psychiatric status by just eyeballing her so I said the ambulance can go and they can leave the patient. Besides the ambulance crew wanted to know if they did not leave the patient where would they take her? They clarified that their responsibility was only to transport the patient safely.
The patient didn’t met criteria for acute psychiatric hospitalization. She had a complement of outpatient resources with regular psychiatric follow-ups and case management from her community mental health center and in fact she had a clinic appointment that afternoon. The patient was agreeable with the decision to go home, and wanted to keep her clinic appointment. However, she needed transportation since her wheelchair did not have sufficient electrical charge to allow her to get on the bus, which she was accustomed to using. The staff effort to secure transportation for her failed. No cabs would take her, and an ambulance was out of the question since this was not an emergency. In the meantime she was charging her wheelchair batteries while waiting in admissions and may be able to use it briefly. The staff devised a plan to transport to the bus stop just outside of the hospital gates but this required navigating a road uphill for about 500 yards The staff thought that hospital security police may allow the use of their handicap-equipped van which they agreed to do however, the van was outside the premises and they had no idea when it will be available. In the meantime, we were planning for the patient to keep her 2:30 PM outpatient appointment and by this time it was way past. Now the goal is for the patient to just get on the bus before dark so she can get home safely. The staff thought they could push the patient manually in her wheelchair if they can get assistance from security police to manage traffic on the main road so the patient can cross to the bus stop opposite the hospital gates. The police chief said it can’t be done as she won’t jeopardize her officers’ lives exposed to that dangerous traffic in front of the hospital. I became aware of all these maneuverings when the staff, in frustration came to me for help because, they didn’t know what else to do. As what seems to be always the case, these types of novel situations present themselves when key managers are not available and the staff did not have information as to who is covering in their absence. I stepped out of my role and became involved and tried to accommodate the staff. In the nick of time before the staff pushed the patient up the road, a handicap-equipped van became available from one of the hospital departments. The Program Manager arrived after all these was resolved and immediately she was displeased by the way this was handled, even before inquiring as to what efforts her staff had applied first and intimated that it was a problem because of my actions, after all she thought that I shouldn’t have let the patient off the ambulance in the first place. When my Clinical Director summoned me the next day it was to review what I presumed was the Program Managers critique of my part in the situation. I came away feeling that the report was accepted as is because his advice was for me to essentially stick to my function as a psychiatrist and limit myself to merely evaluating patients and making clinical decisions and I gather not to get involved in anything else.
You know working in admissions is like what Forrest Gump said, “ It’s like opening a box of chocolates, you never know what you’ll gonna get!” And I wonder what Forrest Gump would say about my Clinical Director. I don’t’ know if he’s wise man or a fool, but one thing is for certain: he’s definitely a State Bureaucrat!

Diary of a Mad Doctor

Diary of A Mad Doctor: The State Hospital Psychiatric Admissions Chronicle #1


They all come here. Emergency rooms and the police and mental health clinics and doctor’s offices out there send them here. Private psychiatric hospitals who had exhausted managed care’s authorized hospital days send their patients here. Jails and homeless shelters and families themselves, they all send them here. Children and adolescents come here. The mentally retarded come here. The addicts, alcoholics, the homicidal and suicidal come here. Mentally ill individuals of all persuasions come here. Gay, heterosexual, the elderly, men, women, the medically ill, black, white, Asian, Hispanic, those who speak different languages, their own autistic language or tongues of nations far and away, the few rich, and many in poverty, they all come here. They represent the multitude. They all come here, we cannot turn them away, we are the last resort, the end of the line.

This past weekend the hospital was 35 over census. The nursing administrator can’t find enough nurses and nurses aides to man the units. Sleeping cots had to be brought in. Social workers and doctors had to scramble and force discharges of still very sick patients but stable enough not to be an immediate danger to themselves or others. Many of them had no place to go but to shelters, and the mental health centers more than likely will not be able to provide intensive outpatient support services to maintain their gains. There are no resources for supportive living for the chronically mentally ill. Soon the 5-day medication supply that the hospital provided would run out and they are back again in admissions, transported by the sheriff or police, decompensated, and we’re back to square one.

Admissions Unit is the gate to the hospital. Everyone passes through here. I’m the gatekeeper. The workload can be intimidating at times, like when the Sheriff, who is mandated by law to transport legally committed patients to emergency receiving facilities, brings in a dozen patients all at once in varying degrees of agitation or dyscontrol, even violence. But there are times when meeting some of the patients bring awe and wonder, or insight, or humor, or inspiration, or disbelief and outrage, or an awakening to the realization that human beings everywhere are indeed made in god’s image. These are gems of experience that are priceless and I bet you won’t have the opportunity unless you are working in this setting.

The other day a young man was brought by the police. He hasn’t slept or eaten for days. He was wandering the streets, mumbling, preoccupied, earnest, but disturbing the neighbors. He had bruises, someone assaulted him. He said he was looking for himself, he wasn’t sure of his name. He looked puzzled when I called his name and hesitated to respond. He was very polite but very tense, he couldn’t sit still. He was clearly accelerated, dehydrated, and exhausted but he couldn’t rest. He said we are on the edge of a revolution. So I said, “Tell me more.” And he went on to describe how he is the center of a music revolution that the world hasn’t seen the likes of yet, not even the Beatles, or Elvis can come close. He believed this with all his heart and had been telling everyone and had been announcing the revolution with religious zeal, at the same time feeling lost in his identity. He was anguished. He was not mean or violent. He was quite sincere. His beliefs decided his actions .He was committed and dedicated and single-minded in his purpose, just like any high-achieving scholar, researcher, politician, inspired leader of a cause, or multi-national business executive. I admitted him. In the Treatment Unit he’ll be prescribed medications and in a week or two he’ll be aware of the world as you and I see it and he’ll be no longer doubting his identity. He will leave the hospital somewhat depressed and clearly lost in his spirits because he no longer has a mission.

I didn’t have any patients waiting so I chatted up a man who was dropped off by the police after being arrested because he posed a danger to himself and others wandering the Interstate highway. He had been traveling from FL, hitch-hiked to GA, and he was tired. He was looking for a place to rest until he can be on the road again. He spent the night under the I-20 exit ramp. He was not on drugs or alcohol. He used to hear disturbing voices but now these voices are just a faint background in his consciousness, nothing malignant as before when they scared him or made him do bad things or spoke all at once which made him scream and lose control. To stop these deafening voices, he used to hit himself or hurl himself into walls or destroy objects or even hit other people. Now the voices just comment on what he’s doing, they keep him company. He used to be in and out of hospitals, and he hasn’t taken his medication for years. He had been all over the continent, left FL because he was ready for a change. His face was lobster-red, badly sunburned, his hair, shoulder length and frizzy and matted, his beard likewise, down to his chest. He didn’t want to come into the hospital, he felt fine, he didn’t need any medication. He liked being homeless he said. He is free. To eat, he panhandles or if he can find odd jobs he works, and he knew where the shelters and soup kitchens were. He is free. The hospital can offer nothing that will change the outcome for him. He is in the residual stages of chronic mental illness. What will impact his situation is obtaining disability benefits, supportive group living, psycho-social programming, a sheltered work environment, case management and psychiatric medication monitoring. All these will be cheaper compared to the cost of several days of acute hospitalization multiplied many times over the years, but despite the much-heralded political de-institutionalization of the mentally ill, the community support services have not materialized. It reduced the numbers of hospitalized patients and closed down many State hospitals and reduced State budgets for mental health, but we also saw a dramatic rise in the numbers for the homeless. So I let my man go, advised him to stay away from freeways, and wished him the best.

Homelessness does not discriminate. Next I had a woman who had been without any address for a year. She lived in abandoned cars, in buildings under construction, occasionally in shelters, or in “cat-houses”, the latter abandoned houses often occupied also by drug addicts and dealers. She was an addict. She was sober for 7 months until she slipped again a year ago and she had not emerged from that yet. She keeps herself clean. You wouldn’t know just by looking at her that she’s homeless. She knows where to get donated clothes from charity organizations, and where to get food when she can’t find odd jobs. She was adamant that she does not steal, to eat or to support her addiction. If she can’t find work, she sells sex. For her that is a commodity she possesses and can barter by choice and she thought that out very clearly. Her value system about such things were unambiguous and her actions were consistent. Unfortunately she did not practice safe sex. I admitted her. Her drug screen was positive for cocaine and she was crashing. She was trying to kill herself by walking in front of traffic. The police picked her up. She also said she’ll shoot her brains out. She used to be a member of a gang and she knew how to get her hands on a gun. During her periods of sobriety, she was competent in the regular life skills. She had an education, she was a computer network technician, she had an apartment, nice clothes, a car, friends, and she saw her family. When she’s using she lives in her homeless world, she didn’t want to upset her friends, and family. Medical science has cracked the genetic code and can mix and match gene characteristics in a dish, but hasn’t found a way to treat addiction effectively yet.

Well, tomorrow is another day.

Methuselah,hello!

Our Aged, Elders, Ancestors

(Excerpts from a Lecture delivered at the Annual Meeting of the Organization of Chinese-Americans)

Methuselah, hello! He lived to be 969 years, the oldest person in the world, the grandfather of Noah, of the Ark’s fame. It’s possible to live this long again. Some optimists claim the science can be achieved to do this by the middle of this century. All we need to do is control the 10 leading causes of death; cardiovascular diseases *at the top then cancer and stroke , AIDS, and non-disease factors like accidents and suicide. After this we need the science to control aging or organ deterioration, and we are getting there. We know that loss of antioxidant enzymes, failure of protein synthesis, and failure of DNA repair mark the cell deterioration process and we are discovering new things everyday that gets us close to influencing these processes. But do we want to live this long? With the current trend in world overpopulation it is staggering to think what problems in resource utilization this will present.

*With improved health care and health-conscious lifestyles, life expectancy has increased dramatically from between 30-35 years in the 17th century to 76-80 today. In the USA we all know that the elderly population is rapidly swelling in numbers with the maturation of the generation of baby boomers. In the year 2030 there will be 70 M older persons, more than twice their number in 1990. Minority population elders represent 25% of this number. Women will continue to outlive men; 7 out of 10 babyboomer women will outlive their husbands. Women can expect to be widows for 15-20 years. This is quite significant because women are the caregivers for children, spouses, and parents.

Searching the internet on the subject of Filipino elders in the US yielded very minimal information. Filipinos are lumped together in the group Asian Americans and Pacific Islanders and we know how diverse this group is and how very little we resemble this group. Included with us in this group are Asian Indians, Cambodians, mainland Chinese, Guamanian, Hawaiian, Hmong, Japanese, Korean, Laotian, Samoan, Taiwanese, Vietnamese, and others. You know, we don’t identify with this group and I don’t believe this group considers us Asian enough either and mainstream America doesn’t think of us either as Asians or bonafide Americans . Many of us have Spanish surnames and mistaken for such or Mexicans, but most of us doesn’t speak Spanish. So we are neither here nor there. Just think what that does for our identity. For our young growing up Filipino in America, that can be very confusing and I’d love to be able to have a forum on that subject someday. But who are the Filipino elders?


Currently there are about 500,000 Asian American and Pacific Islander elders in the US representing 6% of that minority population compared to 12% older adults in the general US population. The recent wave of Asian refugee immigration will swell this number to more than 7M in 2050 representing 16% of this minority population. The first wave of Asian Immigration began in the mid-1800’s with the importation of Chinese men to work in the railroads, farms, and mines in CA, Hawaii and other Western States. Then came the Japanese in the late 1800’s after Chinese immigration was stopped by the Chinese Exclusion Act of 1882. As this population increased, they were again subjected to discrimination leading to the Asiatic Exclusion Act of 1924. This paved the way for a dramatic increase of Filipino immigration since the Philippines was made a US territory after the Spanish-American War and Filipinos were exempted from the restriction. The Filipino immigrants were primarily men seeking work in agriculture and the canning factories. With the onset of the Depression anti-Filipino sentiment became widespread because of intense job competition. This led to the passage of the Tydings-McDuffie Act of 1934 which restricted Filipino Immigration to 50 people per year. Many of the young Filipino men who immigrated earlier remained alone living in hotel rooms and rooming houses in urban centers. They could not marry and have families because of anti-miscegenation laws. Most of these Filipino men were recruited as cheap labor by the agents of the Hawaiian Sugar Planter’s Association. In the 1920’s Filipinos comprised the largest ethnic group working in the Hawaiian fields. Many eventually moved to California after two major strikes in the Hawaiian plantations. In 1930 there were 30,470 Filipinos in California .These men were viewed as outcasts and since the ratio of Filipino men to women was 14:1, many remained unmarried and those who tried to date white women were persecuted leading to anti-Filipino riots in California. In 1930 a judge handed down a ruling classifying Filipinos as members of the Mongolian race which invalidated mixed marriages in California These elder’s education levels and English skills tend to be low and they are predominantly poor. By the mid80’s there were 50,000-60,000 older Filipinos in the US with men outnumbering women 4 to 1.These elderly men were the survivors of the earlier immigration era and experienced much hardship. When the quota was abolished in 1965 there was a second surge of immigration from the Philippines composed largely of young educated professionals. With them also came some elderly, predominantly women, who tended to live with their children’s families in the middle class suburbs.. By the year 2010, this second surge of mostly professional and middle class Filipino immigrants will join the US babyboomers coming of age. Currently this group is dealing with their parents, elders who lived their lives in the Philippines but has now joined their children to live in the US.

The current elderly, our parents’ generation mostly live in extended family units with their mostly employed or professional children and are mainly supported by private funds or their children. If they need care most are receiving unpaid care from family members and they remain at home. A very small percentage live in nursing homes or institutions. Compared to the Anglo elderly who are institutionalized in 23% of cases Asian and Pacific Islander elderly are in institutions in 10% of cases. The difference can be explained by cultural practices and beliefs about the elderly that are deeply rooted in tradition and religious beliefs. The extreme practice is repesented in ancestor worship. There is strong influence also from Confucian philosophy of the importance of order within families and society, so roles, responsibilities ,and status in the family is clearly prescribed. I can see this influence in Filipino practice even if we are also strongly influenced by catholic principles. We are raised to respect and honor our elders ,authority and responsibility are assigned to the oldest. Many of us who came to work in the US sent the bulk of our paycheck to the rest of the family back home. The oldest who was sent to college at great sacrifice by the parents and extended family is expected to help support the younger siblings when he graduates. It is just expected that parents will be taken care of by the children when the time comes. This expectation continues to the extent that immigrant families become assimilated or adapted to the American experience. This can develop into varying degrees of intergenerational conflict depending on the extent that immigrant families have become Americanized and have loosened up on the observance of tradition. The presence of elders among the young born in America can be very enriching and helps the young in incorporating their culture and heritage in their identity and consolidate their image and self-esteem positively.

So how does one try to live long? Factors have been identified and in fact in use in actuarial statistics used by insurance companies. You can assign certain points to each item and come up with an estimate as to how long you can expect to live. So if we live so long how do we live well? Maintaining optimum mental health is the key. Studies have shown that there are recurring factors that foster optimum mental health in the lives of elders. Notwithstanding physical health or financial circumstances so long as the basic necessities are met, some of these factors I have listed below, and take note , nothing is revolutionary and all is just plain common sense. To observe these practices are all within our power and ability. These are:

*Control Blood Pressure, Diabetes, Total Cholesterol, HDL Cholesterol
*Avoid Cigarettes and 2nd hand smoke
*Exercise and Strength-Building
*Sensible diet low in saturated fats, Supplement of Vitamin E, Vitamin C and Folate *Abundance of fish and fruits and vegetable in the diet and regular Breakfast
*Control driving speed ( accidents, # 5 cause of death)
*Manage Stresses
*Stay married or have a significant Other
*Stay Productive
*Maintain a social group where you see a friend regularly at least once/month
*Maintain sense of humor and optimism
*Treat Depression and
*Have the right parents (genetics)

You may just live as long as Methuselah.