May 29, 2003 - Seventh of a series

A price to pay

The series at a glance: 1 - It's the teachers turn 2 - Doctors bailing out 3 - Arthur's tale 4 - U.S. nursing shortage 5 - Nurses and recruiters 6 - Aries speaks up 7 - A price to pay C - The real war (and other views)

     "Kanugon sang propesyon mo. Kanugon sa imo" (translates to something like "your degree is such a waste").

     A familiar face I met at an Iloilo City mall sometime in September, 2000 uttered those words as we parted ways after a short conversation. She looked very sympathetic, looked at me as if I'm a big-time surgeon who just lost both arms in a freak accident. Those words I have come to expect, words that would be repeated a few more times by a few more familiar faces.

     Nine times out of ten, those words come as a response after I tell those few familiar faces what I do now. I don't see patients anymore nor do I go on 24-hour duties. I don't get scolded by consultants anymore nor do I get to scold interns (truth of the matter is, I haven't scolded anyone). I stare at a computer monitor all day, write lines of codes, attend meetings, and, whenever my idle time gets long enough, write silly columns for an alumni website.

     I haven't heard those words in the last two years or so, simply because I have never been to Iloilo since September, 2000. On my next visit, I plan to always carry a pen and a piece of paper with me so I can tally how many times I'll hear those words.

"What about if there's a question that asks me to identify a microscopic something, I mean, could be a breast or a kidney? I'd hear my classmates laughing again and see my professor's devilish grin in my nightmares, I'd be traumatized for life!"

     I can interpret this in two ways. First, as a compliment. I may be one heck of a doctor. My decision to stop practicing medicine may be a signal that the end of civilization is near. I may have been on track to discover a cure for AIDS. SARS may not even be a problem now, because I would have it renamed the Garcia Syndrome, after myself, a Filipino doctor who discovered the disease and its cure. The citizens of Beijing and Toronto, no doubt, would have given me a parade.

     Second, as an expression of pity and/or ridicule. There is no doubt that people tend to put doctors on a pedestal higher than most professions. If you are a doctor but doing something else, they start to wonder if your brain is in the right place. You are belittled, sometimes insulted, even if they have no clue as to the circumstances why. They don't want to know any circumstance, as it really doesn't matter to them.

     I'd like to believe the first one but my former professors at the College of Medicine may not agree. I am already hearing my histopath professor say, "That snapperhead could not even tell the difference between a breast and a kidney. Save the world? Please." It was one of those times when the professor would review the answers after a practical examination. I just felt so stupid that day, it's easy to remember. "Okay, number "3", letter "A", is breast," the professor announced loudly. After a dramatic pause and a devilish grin, as if on cue, he added, "...somebody answered kidney!" The professor was kind enough (kind? please) not to mention a name but the whole class erupted into the customary hysterical laughter, it was as if I was not able to identify a skunk mixed in with the Spice Girls and the rest of the class did. My classmates continued to giggle for the next hour or so, I have never felt so dumb (of course, I tried my best to hide it) in my whole life. Well, at least not since high school when I paid a lot of money for a pair of shoes with five stripes on them thinking they were Adidas.

     Expressing pity or ridicule may be a stretch but that's just how I look at it. A lot of people feel that going through medical school and spending all that money deserve nothing but to actually practice the profession. Anything less would be degrading and, as those old Gillette commercials would say, uncivilized. Many years ago, this wasn't even an issue but since more and more doctors are taking up nursing, these doctors are now the focus of attention not only by the people outside of the profession but by their colleagues as well.

     I don't know if people feel differently nowadays considering majority of Filipinos are feeling the economic crunch more than any time in the country's history. Pity and ridicule can easily be replaced by compassion and understanding. Looking around for reactions on the web, I have come across some interesting comments on Message Boards and online newspapers. A sampling: From an e-mail forwarded to me (not sure if the author is a doctor or not): "...Para sa akin, another 2 years of schooling with required duties in some hospitals is very traumatic, nakakahiya. Imagine, DOKTOR KA (30 to 60 yr old) tapos me duty ka to this hospital, you will go there not as a doctor but a mere student earning credits for your subject units and you will be supervised by a regular staff nurse of that hospital only 1/3 your age." From a doctor interviewed by the Philippine Daily Inquirer: "...Let's face it. We're not enrolled in nursing for the heck of it. We want to go abroad and earn a better income. When I learned that even highly paid consultants in Bacolod were taking up nursing, I asked myself, "why not?". I enrolled in nursing because it was a group idea. The Philippines is not a good place to practice medicine anymore because there is too much competition." It is also interesting to note that when the November, 2002 Nursing Board Examination was released, 37 students from a certain Dr. Carlos Lanting College made it into the top 20, occupying slots no. 2 to no. 15. Incredible? Yes, but upon closer look, these new topnotcher-nurses are also doctors. In fact, 48 doctors who graduated from that College and who took the board all passed. It must have been hard for the 11 doctors who did not make the top 20. I also got an e-mail saying that the University of Santo Tomas (UST) is protesting the inclusion of doctors among the topnotchers. Heck, their nursing graduates could not hack the top 10 anymore. I will have more of this and other reactions in the next 2 or 3 columns.

     Meanwhile, I feel the need to talk about myself, a little bit, to be fair. I am a doctor who stopped practicing and currently living in the United States doing something else. For the record, I did not take up nursing nor did I get any more education after I finished medical school.

     I was and probably still am a man of few ambitions. Growing up, I wanted to be a doctor not to be rich (if I get rich, that's more than welcome, too) but more of a professional fulfillment. My father wanted to be a doctor too but for financial reasons, and the fact that he was already married during that time (I'm not saying you cannot combined marriage and medical school), he stopped after his 1st year of medical school. Although he never told us once what course to take, we could feel that he has always wanted to have his children finish what he didn't. All three of us went on to finish medical school (my older brother, Robert, is now an orthopaedic surgeon, my younger brother, Ralph, is an Anesthesia resident at the Western Visayas Medical Center). If there is such a thing as a 'prodigal' son in every family, the easy pick in our family is me.

     You may find this hard to believe but even after graduation and post-graduate internship, I never thought for a second that I would go to the United States. I never contemplated on taking the USMLE. My future wife, a nurse, and I started dating during my post-graduate internship at the University Hospital. She was preparing her papers to go to the U.S. at that time while I was preparing for the board exams. Towards the end of my post-graduate internship, I was already building myself up to the U.H.'s Anesthesia consultants as I have heard they are opening up an Anesthesia training program (who doesn't want to work with Ike Lagon?). I told my girlfriend to see what life is like in the U.S. I also remember telling her I'll pass the board and try to finish residency in the Philippines. Now, if that's not professional fulfillment, I don't know what is.

     Until something went wrong, terribly wrong: I failed the August board.

     It came as a shock to me, and even though they're still laughing at my breast-kidney mix-up, it came as a shock to my classmates too (well, at least some of them). I, therefore, wish that you, my dear Readers who haven't taken the board yet, never, ever, experience this. It was so painful and devastating, I wasn't able to eat solid food for at least 2 weeks. I tried but it was as if I had some kind of esophageal atresia or the worst kind of anorexia, and I wasn't Karen Carpenter on a diet. I lived on water and Maalox alone for a couple of weeks and I wasn't Ninoy Aquino on a hunger strike. To really illustrate how painful that was, I would prefer any of the following over failing: 1) Run a 42-km marathon and instead of water, eat "polvoron" at the finish line; 2) Be in the middle of a desert with no civilization in sight, with only a gallon of milk whose expiry date is April 1, 1975; 3) Have all my teeth pulled without anesthesia, then be forced to eat blades and broken glasses for the next five days; 4) Listen to Dr. Mabunay talk non-stop for 72 straight hours (geez, I hope she's not reading this).

     (And you don't have to put yourself in a situation where you are looked upon by others as "scarred" for life. I know I have to carry this "stigma" with me forever. Just last year, a medical school classmate visited my sister-in-law 2 or 3 times (I did not say "courted"). He did not know that she was a sister-in-law at first. But the moment that classmate knew that and after he was told that I now live in the U.S., he looked surprised and said, "Ah, si Rolour...Paano na' s'ya nakapa-America, kay 'take 2' man na'?" Needless to say, that was his last visit.)

     I tried to put myself into seclusion but I never got discouraged. I just accepted the fact that I'll be taking the board again. I took the February board and immediately went job-hunting. That's how I ended up in the beautiful town of Manapla (read The Manapla experience, parts 1 and 2). The folks at Victorias Milling Company who used to run Manapla's St. Joseph Hospital were kind enough to employ me with my board results pending. I felt at home right away working there with mostly WVSU alumni, I even forgot I have yet to pass the board. I just knew one day in May (that's how long it took for board results to come out) while reading the Manila Bulletin that I passed. After that time, I seriously considered going to the U.S.

     I told my then-girlfriend, not even a year working in the U.S., not to bother herself about going home. I'll try to get a visa myself and go. I took advantage everytime I had a conference in Manila (drug companies paid for those, you know that, read Generics law) to line up at the U.S. Embassy. I never held my hopes high of getting one since my chances of getting a U.S. visa then (young, single doctor) was the same as Bin Laden getting one today, but I guess there's no harm in trying. Needless to say, I was denied several times, but it did not really affect me that much. I've been to so much pain before (read two paragraphs up), you could carve your name on my forehead using a dull scalpel and I won't mind it.

     Later in the year, my older brother got accepted at Western Visayas Medical Center (WVMC) Orthopedic department. He heard from Dr. Ceasar Gardose (1988) that the EENT department was splitting into Otolaryngology and Ophthalmology and were looking for residents. That's when I packed my bags back to Iloilo.

     I started my pre-residency at WVMC but decided that before I get my first paycheck, I'd try the U.S. Embassy one more time. The rest is history. I left WVMC. I have never apologized to Dr. Gardose for my actions (the people in the department were starting to trust me, really, I am not kidding) so I am officially doing it right now - "Ceasar, I apologize. It was not really a difficult choice for me and I know you'd understand. Besides, I could've been a liability anyway, so by leaving, I saved the department from total collapse."

     The choice was simple. My wife and I couldn't go on living separate lives so one had to compromise (sounds like a song, doesn't it?). I did and I have never regretted it since.

     Let's fast-forward and make this sob, heartbreaking story a little shorter. My girlfriend and I got married and applied for permanent residency in the U.S., which was approved less that a year later. Then came the fun part, at least for me - job-hunting.

     I am telling you right now that having an M.D. in your resume' means only one thing - it is awfully hard to land a job - either you are not qualified or over-qualified. Sure, I was contemplating on taking the USMLE but I didn't want to spend my wife's hard-earned savings. Besides, I started losing confidence in myself, if I had any to start with. Then this problem, what about if there's a question that asks me to identify a microscopic something, I mean, could be a breast or a kidney? I'd hear my classmates laughing again and see my professor's devilish grin in my nightmares, I'd be traumatized for life!

     One of my first interviews was with this nursing agency looking for an office assistant. I was thinking it's not bad for a start. As the interviewer browsed my resume', I could see his expression saying something like, "what the hell is this guy doing applying for this job?" I had to explain my situation, you know, being a doctor but couldn't practice..etc..etc. The bottomline is I was just looking for a job. He told me I'll get bored because I'll be working with 3 teenage girls whose I.Q. taken altogether may not exceed mine and all we get to do is arrange patient records from A to Z. Darn it. Don't I have the right to get bored? I get bored watching TV and I am not being paid for it. I never got the job, as if you need me to tell you that.

     I had to explain myself several more times to prospective employers and I was getting impatient. A doctor's clinic looking for a medical assistant called me up to schedule an interview after receiving my resume'. Apparently, nobody read the whole thing before scheduling the interview because when the doctor who owns the clinic started browsing the resume' in front of me, all he said was, "I should not be talking to you. This interview is over. Just wait for a call." Of course, the "wait for a call" was as phony as this doctor. In his mind he was probably thinking why would he employ someone like me who probably doesn't know how to take a temperature or who doesn't know what comes first, Wednesday or Thursday (It's Thursday, moron! You meant what comes first in the English dictionary, right?). I still have vivid images of that doctor in mind. I thought I would never see a creature uglier than Spongebob Squarepants, and his pants was way above his waist, you'd think his belt is also a pacemaker.

     All through this, my wife was so supportive, although she could not help asking me sometimes if I'm able to handle this. I still had pride left in me, that's for sure. Would I be able to work the things I am not used to working, like taking temperature, blood pressure, etc..? In retrospect, and in all honesty, I may not have handled it, emotionally, that is. And that is not to belittle the other professions who do it. I just wasn't used to it. Exactly what were those employers thinking when they refused to hire me?

     I figured that since employers did not like my resume', I should probably re-type it. We did not have a computer at that time, I was using my wife's Corona electronic typewriter (we donated it since to the Smithsonian). I was typing the part where it says Educational Attainment when I guess I ran out of ribbon after putting in just my Bachelor's degree. No, maybe I fell asleep or forgot to continue typing altogether, but who cares now? A close friend of my wife mentioned something about an opening in a company her husband was working for. I jumped at the opportunity and submitted the resume' anyway.

     I got hired and was first tasked to print labels, like the ones you see on big boxes delivered by UPS. After about two weeks, a man in coat and tie (turned out to be the Manager of the Information Services department, in-charge of computers and everything related to it) walked up to me and asked if I was willing to work for his department. He said one of his people left abruptly and he thought my resume' was impressive (I finally got someone to appreciate my resume' and it's not even complete), he'd hire me if I'm very much willing to learn. I said yes, after thinking for a few seconds. There's nothing like an office job. I didn't think they would be teaching Calculus or Advance Physics or How To Build A Car Using Toothpicks And Toilet Paper, so how hard could this be?

     My initial job was to run pre-written computer programs on a daily basis. Over time, I was able to write my own. I learned on the job, read books, made use of every company training, and with hard work and lots of common sense, I quickly rose from the ranks. A company vice-president once called my rise "meteoric" (that's bragging, but I swear it's true so, please, just take it for now). This is also where I learned to build web pages, my greatest work so far is the one I made for my alma mater's alumni organization. Why not, I am an alumnus of good standing. (Well, okay, an alumnus still standing.)

     My current position pays me as much as a nurse makes, plus a little bit of change, without the overtime and hard work. My wife is a nurse, and I do realize the pressure and hard work associated with her profession. So I try to do the rest of household work as much as I can. I cook, do the laundry, clean the house, mow the lawn, balance the checkbook, wash the dishes, plan the vacation, do the grocery shopping, babysit and drive my little girl to ballet school. Yeah, baby, I'm not kidding, I'm like Mrs. Doubtfire. You name it, I do it. For my efforts, I get to watch all the Los Angeles Lakers games, without being disturbed. Living in America is not easy, as you've been told many times by others, but it's rewarding.

     Still, I couldn't escape the curse that's destined to haunt me for life, the questions that are constantly asked of me. So when are you gonna be a doctor? When are you taking the exams? Have you passed already? blah..blah..blah. My wife, parents and brothers used to ask me those questions, too. And as I continue to interact with other people, I expect those questions to be asked. I really don't mind now, and I consider it too small of a price to pay for whatever decisions I made before. My wife and I are happy where we are now. When my older brother visited us last month from the Philippines, instead of asking the questions, which I expected, he even told me to forget about it. You don't need to aim for anything more, he said.

     What about professional fulfillment? I miss being a doctor. I miss interacting with patients. I miss interacting with colleagues. Besides, who doesn't like to get a paycheck that's 3, 4, 5 times more than what I make now? I'd like to take the examinations too and look for a residency position, but with the level of confidence I have now, I don't think I can make it past the examinations. Now, if only somebody can help me erase the painful memory of my breast-kidney slides mixup. Perhaps, when I visit Las Vegas, Dr. Art del Rosario (1980) who is a pathologist there, can show me a couple of slides. Or perhaps, when I visit Iloilo city again, a classmate, who, I was told, is now one of the big-time pathologists in the city (hi, Ann), can let me borrow some slides so I can give myself a little therapy.

     I'll say without hesitation though that the quality of life we have here is a lot better than if I chose to stay as a doctor in the Philippines. A sad statement but true. Success is relative and definitely not to be measured by material wealth, so I am not going to compare my situation to my contemporaries back in Iloilo. My brothers are there as well as most of my best friends. If you are contented with what you have and what you are doing right now, that's success in itself. I have to say though that I totally understand the situation right now where some doctors want to leave the country and would take up nursing just to achieve that.

     It's amazing how one's experiences can change one's outlook and directions in life. I don't bother myself with professional fulfillment anymore although I do love what I am doing for a living right now. My aspirations are now centered on my family, for us to have a comfortable life, and for my little girl to have a good future.

     Failures can be of help sometimes. I know it helped me. I notice I have mellowed. I notice I became a better man, a better husband. I have never uttered a single swear word in a long, long time.

     Until two weeks ago when the Los Angeles Lakers got eliminated by the San Antonio Spurs.

     Son of a @#$%^&*!

     Due to popular demand, I am bringing back my top ten list. If I get enough e-mails, I'll make this a regular feature of this column in the future. Here's my - "Top Ten Reasons Why I Went To Medical School."

1. "I wanted to know what Bonamine is for."
2. "Law school was 3 rides away."
3. "I couldn't resist the cute girl giving out the application forms."
4. "I thought Roxas Hall was a Ladies' Dormitory."
5. "I got excited when someone told me my monthly allowance is about the same as my professors' salaries."
6. "The ham sandwich tastes better at their canteen."
7. "I needed an excuse to drink coffee...and beer."
8. "Chicks dig doctors."
9. "Torturing myself used to be my favorite hobby."
10. "You could fondle a breast without being called a pervert."

     A special hello to Dr. Perry Juridico (1993), who e-mailed me last week with a bunch of basketball questions. I'll answer all of them in a column after this series. And to all Bacolod City/Negros-based doctors/alumni, thank you for browsing.

     Also to Dr. Gene de Jesus (1994), now with the Family Medicine department at St. Paul's Hospital, Iloilo. My best regards to all resident physicians at St. Paul's.

     This week's FINAL WORD comes from Dave:

     "...you are a god mate! fairplay for saying what we all feel! this has to be one of the best columns ive read in a long time."

     Thank you, Dave. I am pretty sure you are not one of my classmates because, first of all, I don't have a classmate named Dave. Second of all, my classmates would never say something that nice to me.

     Comments regarding this week's column are welcome. Please fill up the fields below and click Send to Author. Suggestions for future column topics are also encouraged.

     The author's e-mail address is at drgarcia@wvsumedaa.com

     Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members. For comments, please e-mail the author.