The Glitch

One day, I woke up and decided that I wanted to take the USMLE. Factors that contributed to that decision were the conversation I had with my sister, my persistent low back pain which was job-related, and undesirable patients I got at that time (like pooping, cussing, and demanding patients). So, I surfed amazon.com and ordered the USMLE reviewers. I called friends who were in the process of reviewing for the exam. I facebooked (who would even think I could use this as a verb and get away with it in the same way that you could get away with the word "googled") colleagues and asked for their tips. I was excited. And then reality hit me when I started reading the reviewers and taking the sample exams. Step 1 covered basic sciences that I have long buried in the recesses of my mind. Unearthing biochemistry, pharmacology, histology, and who knows what, was akin to resurrecting Tutankhamun from the grave. I know I can, but the question was, do I really want to? I realized that I was beginning to hibernate from my family, from my work and from life itself in order to make room for this bold endeavor. Then the huge question hit me. Was this really what I wanted? The answer came while I was running with my 10-year-old daughter who was biking. It was an interesting conversation.

I asked her, "Is it okay if your daddy and I will become doctors again here?".

She vehemently said no. That caught me by surprise.

"Why not?," I asked.

"Because, then we won't get to see anymore. We hardly saw you in the Philippines when you were both doctors."

It was true. The times when the kids were not at school, they were at home with the nannies. My husband's time with them was limited to that one hour of traffic when he drove them to school. I think this was the only blessing that traffic in the Philippines brought. Although I heard that it made saints out of sinners because it made them pray especially when they were getting late for an appointment. And I can also blame traffic for our lack of time for the kids. We spent more time on the road than in the house. Whatever the reason, I have to admit that my daughter was right. We spent more time together as a family here in the US than in the Philippines.

So when I got home and looked at the reviewers again, it did not look as exciting as I initially thought. And when I got to the serious business of highlighting the material, I felt something very wrong deep within me. I could not put a finger to it but I knew I was not at peace. So I carefully arranged my desk and stacked the books up the shelf. I had a feeling that I may just need those books in the future, but for now, taking and passing the USMLE is not on my list of agenda.

When I got my first article on Livestrong.com published, (to date, the post had been updated and replaced by a newer post from a different author) I knew I was back on track. The pull to become a full-pledged writer is just too strong to resist. There is so much to learn about the art and craft of writing. My medical career ate a huge part of my life in the past. And now, that I have rediscovered my first love - writing - I don't want my MD degree to get in the way again. It reminded me of that man who found an unusually fine pearl and sold everything that he had and went back to buy that pearl.

And whenever I see silver-haired doctors still doing on-calls and rounds in the hospitals even on a Sunday, the desire to reclaim my MD degree just melts down. The MD head just pops up every now and then when I get pooping, cussing and demanding patients. But then again, when my day is over, I leave the patients in the hospital, go home to my family and live my other life -- cook, bake, tend my potted herb garden, sew, write, run, bike, read ...the list just goes on. I didn't have to "bring" home those patients with their diagnosis, treatment plans, emergency referrals, and what-have-yous.

The Turning Point

These past few weeks, after my back injury I had a major realization. Nursing job is more difficult than medicine.

When I biked with my husband, I realized that I biked faster using a different kind of bike (hybrid instead of mountain bike) and using my major muscle groups like the thigh muscles rather than my foot muscles. There was so much effort using the latter options and so little gain. That's like comparing medicine and nursing for me. Medicine is so much easier to tackle than nursing. Some people might find that surprising. But I guess that's how it is when God puts a vocation in your heart. It just comes naturally and with less effort. A long talk with Ate Joy affirmed this. And with the days that followed, God is speaking louder. Just yesterday I was made to realized that I may just have paid the cheapest price for medical school tuition fee. I only paid $0.02 per semester (P1.00 just for registration). Only God could make something like that happen. I did not have to struggle with medical school to maintain my scholarship. Again, it can only be grace from above.

God created us equipped with the skills and talent to pursue our vocation. He waits for us to act upon it and cooperate with the call. But He never forces us. He prods gently, constantly stirs restlessness in our souls and waits patiently. And He blesses our efforts once we respond. I can only smile with gratitude for this kind of Father that we have.

So I have decided to tackle the USMLE. If this is truly God's will, He will bless the review and the Step 1 exam. If not, then I'm sure He will redirect me to where He wants me to go. It's up to my husband if he wants to review with me :) I hope he will :) but I don't want to impose my call on someone else. Only he can discern God's call in his heart for himself. I can only pray and give my support. I did suggest that he review with me while he discerns and waits for the doors that he's been knocking to open. If these other doors remain closed, at least he has not wasted his time for nothing.

I am still waiting for the 2011 Guidelines for USMLE to be released by September 15, 2010. But I have already ordered the reviewers from amazon so we can start reading. The rough time table is to review from Sept 2010 to Feb 2011 for Step 1 (for the exam eligibility period of Feb-Apr 2011), Mar-June for Step 2 (2-part examination) Clinical Knowledge and Clinical Skills. This will make us practice medicine in the US under direct supervision. And then Step 3 to be able to practice medicine unsupervised in the US. Most residency programs accept Step 2 passers and Step 3 is taken during residency. But for fellowship programs, they require doctors to be Step 3 passers.

There is a financial investment for this but I think it is so much cheaper than taking an entirely new course (http://www.ecfmg.org/fees.html). I've checked in the past, that if I pursue a career as a nurse-anesthetist, I have to enroll in a 2-year masteral degree course to get certified. Each semester costs around $20,000-25,000!

I might as well try the road of less resistance. Grace is like a wind that blows the sail of our boat towards His destination. If there is so much struggle paddling the boat, then it can only be because we are paddling against the current of grace. My sister is right. The back injury is God's wake up call for me. Just so unfortunate that I have to endure this pain everyday. I just hope that a day will come that I will be pain-free. Perhaps when I am already practicing in the field of Pain Medicine. Not because I have treated myself, but because God has healed me. :)

Top 10 Money Saving Tips We Made

More than one year has gone by since my family and I migrated here in the US. Here are the Top 10 Money Saving Tips which we employed during our first year of stay:

1) We bought second hand family cars. Our first car was paid in cash from the money we acquired selling our cars in the Philippines. The remaining money was used to pay for our second car with the balance costing us $100/month payable in 5 years, interest-free from a loan made with a relative. To date, that is the only loan we have.

2) We rented a fairly new 2-bedroom apartment. We saved a lot in terms of energy consumption, maintenance and even start up furnishings. We get to use the gym (which is surprisingly well-equipped) and swimming pool for free. I think it will take a lot of convincing for me to decide to purchase a house. There is too much freedom derived from renting.

3) We paid our credit cards in full at the end of each billing month. We saved from paying hefty sum in interest rates. It taught us the discipline to live within our means. We only buy stuff that we know we can pay with our available cash. Within six months, our credit rating improved, from a no-credit history to a credit score of 750 (excellent). It also helped that we got an extension credit card a year ago which got us approved immediately by the same credit card company. The other credit card companies simply rejected us because of no-credit history on record.

4) We set aside at least 10% of our income for savings through the 401k. In less than a year of being employed, we've accumulated a savings of at least $4,000. We set aside another 5% for cash savings which we can access in times of emergency. Despite the fact that our annual income is just $40,000 - $50,000.

5) We bought all our furniture and appliances using our credit card to earn points and paid for it with the cash we earned from selling our stuff when we migrated. We bought most of our furniture from Ikea which made everything affordable, at the same time elegant and presentable.

6) We registered as parishioners where our kids were enrolled so we were able to avail of the discount and subsidy of the parish and still got a Catholic education for our kids.

7)We gas up our cars in Sam's Club where it costs $0.10/liter less than the going rate of the cheapest gas station in town.

8) We make good use of the public library. We avail of freebies and discounted rates offered by amusement parks and zoos which gets published in the free magazines in the public library. We borrow books, magazines, DVDs and CDs in the public library also. It's surprising to see updated copies of these, free for the taking.

9) Our cellphone plans are extensions of our relative's plan which in turn are needed in their work. We pay our minimal share of less tha $13/month while their rate is being paid for by the company they work for.

10) We buy stuff from thrift shops and discount stores like Big Lots, Dollar Tree, Gabriel Brothers and of course, Walmart. For non-perishables, we go for bulk purchases in Sam's Club. For perishables, I've learned that buying in small quantities is better because I just threw out 3 grocery bags of expired perishable products from my pantry recently. For rice, it is cheaper to purchase it in sack of 25 lbs from an international or Asian store which may be a long drive for most. So visiting these specialty supermarkets every quarter is an added treat without being expensive. We buy fruits and vegetables from a farmer's market and I usually blanch(immerse in boiling water for a few minutes) most of the vegetables to stop enzymatic degradation and put these in the freezer. That way, I don't get rotten veggies simply because I did not have the time to cook. We purchase chicken whole and I chop and segregate the parts before putting it in the freezer. Meat is also cheaper purchased in bulk from Sam's Club. I just chop it to desired cut and put it in small packages before freezing.

Benefits of Being an Employee

As a self-employed doctor in the Philippines, I did not have benefits. There was no IRA that I could invest in. But my husband and I were smart enough to save and invest some of our money in mutual funds since that was the best thing we could think of, rather than put all our money in a savings account where it will just depreciate with the inflation.

So it was totally foreign for me to be able to invest in a 401k or be receiving benefits from the company that I am working for. Since I was not yet sure about our expenditure, I chose to set aside 10% of my income to 401k. As soon as we are able to financially establish ourselves, I will increase that to 20%. Since I am still far from the retirement age of 65, I decided to invest 90% of that in stocks and 10% in bonds. Even if the stock market is not doing too well right now, eventually it will pick up. Now is the best time to invest because I can buy low and years from now, sell high. With the market plunge, there is no other way but up.

What I did not avail of, to my regret is the flexible spending account. I thought at that time that we were in a pretty good shape and the past years, we never really spent that much on health. But when I injured my back, I saw how a couple of doctors' visits could amount to a considerable amount of money. I only chose the basic health insurance for my family so my co-pay was also higher, at $40 per visit. Again, I am not so familiar with this because back in the Philippines, I don't really pay professional fees since I was a doctor myself. Either I self-prescribe or just call my friends. We do not charge PFs to our co-doctors as part of the professional oath where we treat each other as brothers and sisters. Most of my friends do not have health insurance. I decided to get one just for diagnostic coverage because that is something that will not be waived by the hospital even if we practice in that hospital. We are only given a 20% discount which is not really that much considering how expensive diagnostic work-ups can be.

Here in the US, our health insurance takes care of our bill but there is an out-of-the-pocket co-pay which can be reimbursed using the flexible spending account. In short, the FSA is a kind of health savings account. I can dictate how much I want for that, say $1,000/year. This will be deducted in my salary before tax. The advantage of having this is the immediate availability of the fund even if you have not yet contributed the full amount of $1,000. So all my co-pays for doctors' visits could have been reimbursed using the FSA. The only main drawback for the FSA is that you have to use it by the end of your eligible year or you lose whatever is left there. So it might be best if I start off with an amount close to my past year's health expenditures. I am just fortunate that my 3-week physical therapy was entirely covered by my insurance. I would have skipped it had I been required to give co-pays per visit. Then, just today, when I visited CVS to buy some stuff (not even medicine!), I saw a Flexible Spending Account Summary at the bottom of the receipt. It gave a $3.72 amount eligible for reimbursement. I can't believe how I missed out on this benefit.

But it is not too late because every year there is what you call open enrollment where you can opt to modify your benefits and health plans. So having learned my lesson, I plan to make some modifications on my benefits. I will definitely avail of the FSA and even the short-term disability so I do not need to use my paid-time offs for short term sick leaves due to disability. I just realized I am not so invincible after all. Experiencing this back injury and its initial debilitating consequences, I can never be too sure of what can happen in the future. No matter how prayerful or blessed I am, bad things can still happen because I am living in this imperfect world, inhabiting this imperfect body.

I also plan to include vision in my health benefits. Having an ophthalmologist for a husband, I thought, my family will not be needing it. Lo and behold, just early this year, we found out that my eldest daughter had an error of refraction. To think, my husband refracted her just before we left for the US last year and her eyes were perfect. Now, she's wearing glasses. We would have paid for the service of refraction if not for a very opportune moment when my husband went to a vision center in the mall and there was no optometrist on duty. My husband asked if he can use the instruments because he knows how to refract. Surprisingly, the manager allowed him. Well, he did get a customer anyway, because my husband bought my daughter's first pair of eyeglasses in that vision center. But this expense may have also been covered by an FSA if I had one.

As for our primary care provider, I like the Group Health Associates because of the MyChart feature where I can just go online and ask questions to my health provider. Just imagine having to pay $40 just to ask my rehab. doctor if I can bike or run. Rip off!

So a word of advice for new immigrants, never take your benefits for granted. Save as much as you can in your 401k, at least 10% if not 20% of your income. Get a Flexible Spending Account even if just for $500 or so, then modify during open enrollments as needed. Get a short-term disability benefit too. These are all pre-tax savings. Ask your co-employees which health plan work for them and why. For someone new to these things,the gravest sin you can commit is NOT to ask.

How I Got My Children to Eat Fruits and Vegetables

It is not a big deal that my children eat fruits and vegetables, though it used to be. I remember how my eldest daughter was as a toddler. Her nanny would run after her holding out a spoon just to feed her. It was always an ordeal. You will never guess that this same daughter of mine, now 10 years old eats any kind of salad as an appetizer.

When we migrated here last year, the recurring complaint that I would hear from my husband who was forced to be a stay-at-home dad is the difficulty of feeding my 4-year old daughter. She is so picky with her food and is such a purist. "I just cooked spaghetti with meatballs and she refused to eat it! She only ate the pasta with cheese." You don't mess her food with a lot of sauce. She can eat plain rice. My husband has resigned to giving her "wet hotdog" for lunch just to relieve himself of the stress of meal preparation. Truly, it is easier to open a can of vienna sausage knowing that she would eat it without question. Even when dining out, her order is a no-brainer. Macaroni and cheese and she's good to go. That's how picky she was, until lately. I noticed the gradual turn-around. Then I realized that my eldest daughter had the same transformation years ago too.

And I think this is how it happened.

Even though she was always picky and predictable with her food taste, we never gave up on offering her new food to try. At first it was such a struggle. When she sees her plate with food that is not to her conditioned liking, she would immediately say no. And the scenario would be the same. I would get a spoonful and put it near her mouth saying, "Try it first before you say no!" However, if my youngest daughter has made up her mind about the food , she would just clamp her mouth close and shake her head until I grow tired and simply remove the food from her plate and get her what she wants. She will sometimes console me with a remark like, "Don't worry mommy, I ate fruit earlier." Then a couple of months ago, she had modified her response. She was not as firm as before. After the initial no and shake of the head, she'd later open her mouth. Then she'd spit out the food. So I had to change her plate and get her usual staple food. Weeks ago, she was now more amenable and would chew a couple of spoonfuls then later on shake her head. Then just last week, when I was preparing a salad of halved grapes and sliced cucumber crunchers (the smaller variety of cucumber) and busy mixing it with sour cream, whipped cream, salt and pepper, she came near and asked, "What are you doing mommy? Can I help?" I gave her the mixing spoon and allowed her to do some messy mixing. "Can I taste?" she asked. I raised my eyebrows, surprised that she was even interested in eating it. When she tasted it, she asked for some more and some more. So I placed some on her breakfast plate beside her pancake. And she finished it with her pancake. The next thing I know it has become her favorite.

A couple of nights ago, I spooned out mixed vegetables on her plate without asking her. She ate it without a question. Then today, as I placed beef steak on her plate and a couple of onions, she asked for more onions on her serving. Now I can see that she may just have outgrown food pickiness. So was it just a stage then? Did my persistence pay?

According to Dr. Jean Mercer, a developmental pyschologist, there is indeed a stage in a child's life when she is pickier than the other children of different age group. "Toddlers and preschoolers are often 'picky', especially in contrast to their voracious and fairly indiscriminate appetites in their first months." She relates this to the growth spurts that happens in different stages in a child's life. The greater the growth spurt in a developmental stage as in infancy and adolescence, the less picky the children are. During childhood, food adversity may not be permanent as we sometimes believe. So it is good to continue offering a variety of foods to the kids so they do not grow up to be picky eaters. It also turned out that food pickiness of the mother may be handed down to a breast-fed baby because apparently the taste of the food that the mother eats while breastfeeding is passed on to the baby feeding on her breasts. The baby then becomes accustomed only to the food that the mother eats. Offering a healthy food that the mother herself is averse to might become a frustrating struggle between the mother and the child.

Well, at least I know that my children will never be averse to malunggay leaves, squash and green beans because that was my staple food while I was breastfeeding. I never realized that the benefit would extend beyond the breastfeeding years.

Worry-free and Stress-free Living

"Martha, Martha, you worry and are troubled about many things, whereas only one thing is needed. Mary has chosen the better part, and it will not be taken away from her." (Luke 10:38-42)

Months ago, I could easily replace Martha's name in the above gospel reading with my own name. But God had been dealing with this issue in my life for quite a while now that I could honestly say I have become like Mary, who has chosen the better part and indeed it will not be taken away from me.

And what was it that Mary had which Martha lacked?

Peace and contentment. Whereas Martha was filled with worries, Mary was at peace. Whereas Martha was feeling rushed, Mary was sitting contentedly. Martha's day was busy with a lot of things to do and her mind was getting muddled. She was getting overwhelmed with her tasks that she was starting to pick on other people, too, especially her sister who was not giving her a hand. Resentment, frustration, anger are evident in her complaint, "Lord, don't you care that my sister has left me to do all the serving?" And the Lord chided her. "You worry and are troubled about many things, whereas only one thing is needed." What was it? "Mary has chosen the better part". Mary was listening to the Lord. Mary was not immersed in the noise of the environment. Mary was at the Lord's feet. The Lord was not talking about the physical activities that these two people were doing at that time when He said Mary chose the better part. The Lord was talking about their inner dispositions. Who had the quiet spirit? Who could hear the Lord more? Even if the two characters had to exchange roles, Martha sitting by the Lord's feet and Mary doing the serving, with Mary's disposition, the Lord will still commend her. Mary will be silently serving the guests while listening to Jesus from a distance. How do you think Martha will be in this new scenario? I can almost hear her saying, "Lord, don't you care that my sister is out there serving the other guests and not entertaining you. She should be here." No doubt, the Lord would still chide Martha's comment aside.

Constantly reflecting on this Gospel scene help me in various ways to quiet my mind and heart. No longer feeling rushed, I am able to do my work serenely. Without worries visiting my mind, I am able to rest in Him even as I perform my obligations. Interruptions are not as irritating as before because I am able to focus on God's small voice within.

A good complement to this Gospel reading is a verse from Matthew 6:31-33. "So do not start worrying: 'Where will my food come from? or my drink? or my clothes? Your Father in heaven knows that you need all these things. Instead, be concerned above everything else with the Kingdom of God and with what he requires of you, and he will provide you with all these other things."

Again, this reading stresses on the attitude of worry. Instead of worrying, Jesus implores that we trust God to provide all these things as long as we do what he requires of us. So in every moment of everyday, I ask Him, "Lord, what do you require of me at this very moment?".

And this was the same prayer I was just asking today while writing this reflection. Interrupting my prayer and reflective thoughts, my daughter came to me saying, "Mommy, I want pancake for breakfast please." Normally, the interruption would irritate me but hearing God's small voice in the voice of my little girl, I knew that He just answered my question. I stood up, left everything I was doing, and followed God's voice in the kitchen and cooked breakfast for my family.

Since I usually finish ahead of the girls in eating my food, I was able to continue writing and reflecting, while I feed the small one. Because of the blessed interruption, I was able to add on my reflection and prayer a detail about this particular lesson and instruction. I would have missed it had I insisted on finishing my prayer and reflective writing and ignored the clamor of responsibility and obligation in the voice of my child, in the voice of God. And I realized I just did Martha's work with Mary's disposition.

The Faces of Poverty

I thought I have seen real poverty in the years that I have been in the Philippine health care industry. I've seen parents manually ambubagging their babies because there were no ventilators available. From sheer exhaustion, a parent would fall asleep and inadvertently cause her baby to stop breathing, then be awakened angrily by the nurse for falling asleep on her baby. As student nurses, we were luxurious helps to these parents when we volunteer to take their places so they could take a nap or two. I've seen several patients hooked to a single oxygen tank in an octopus-like fashion, sharing precious air because there were not enough tanks to provide each patient with. I've seen two mothers swim in a bed wet with each others' amniotic fluid, sharing a most precious space in order to bring out their babies into the world and five babies share one bassinet sucking each others' extremities. And I thought I have seen poverty.

Then I was confronted by an old man, lying in his own automated bed, with nurses asking him, "can I get you anything else?", looking at me with eyes filled with emptiness, hopelessness and despair. "I have no one with me. I want to die," he said. He lives alone and the last time he saw his son was five years ago. Then I see a different kind of poverty, far from the material poverty that I was accustomed to. It's a poverty that is more difficult to address, or so I thought. For how can you give faith to someone who has lost it? Hope to someone who does not believe? Love to someone who has no one to hold? Nurses who listen with their hearts are luxuries to these patients. Immersed in the business of charting and carrying out doctors' orders, the thirty minutes spent at bedside are hard to go by but may just be the kind of fresh air that this patient needs in his lonely world of existence. And I have that kind of luxury, having only two pieces of papers to chart on and three to four hours of bedside monitoring.

"Tell me what does God have to say to me, if there was a God?" he asked, in a plea of despair. I see a beggar pleading for the smallest grace that he can hold. And I find myself totally unprepared, the greater beggar that I am. Then I realized that I cannot be one of those girls caught by the bridegroom without oil in their lamps. In the health care industry that I am now in, the patients are hungry for the word of God. And although this man was receptive and wanted to believe, I could see the great struggle in him. The second time that he challenged me to let God speak to him, I was more prepared. I asked him to repeat after me. "Jesus, I accept you as my healer right now because I have no one else to turn to. I feel so crappy and sick. Please help me. In your name I pray." He obeyed like a small child, it almost made me cry. I realized that it takes as much generosity in my part to address this kind of poverty as the kind of poverty I see in my country. Time and presence are luxuries in this kind of world. The greater luxury is to share my faith to someone who is running empty because I needed to empty myself in order to allow the Spirit to move. In this kind of situation, I cannot depend on human wisdom and reasoning alone. It will take years for faith to grow that way. This is the kind of situation which needed divine intervention pronto because this man is nearing the end of the road. He needed the kind of opportunity given to the robber beside the Crucified Christ who stole heaven in a split second. And I think that moment of confession may just have been his moment. And even if I left him that day still hearing some harsh words coming out of his mouth, the apology that came after the act was enough for me to realize that the seed was planted. And in the kingdom of heaven, even a faith as small as a mustard seed will bear much fruit in the end. For it is the Divine Gardener who will make sure that the seed that was sown is not sown in vain.

Loving Summer

Summer is here. Groceries are teeming with fruits and vegetables in very affordable prices. Grapes, strawberries, blueberries, raspberries, cherries, pineapples, avocadoes, dewberries, melons, plums, peaches, pears, apricots, etc. It is so easy to incorporate all these fruits to our meal so the kids could enjoy it. I incorporate blueberries to their pancakes which burst as the pancake cooks. They put on whipped cream and fresh strawberries on top of the pancake and they're good with it. The key to keeping the freshness of the fruits is washing them only before they are served and eaten. Otherwise, the berries and grapes will easily rot. When the fruits get to that stage where it is no longer fresh, I just make a smoothie from it. Iced tea goes well with sliced strawberries too.

Last week I also discovered vegetables that I can use to substitute for veggies that are not available here. I cooked monggo with spinach instead of ampalaya leaves. I got to make kale salad which has the consistency of talbos ng kamote. The kids loved the salad with sesame oil, garlic salt, pepper, sugar and freshly squeezed orange juice with slices of fresh tomatoes and chopped onion leeks. It's good that I was able to grow herbs on pots. My deck is teeming with basil, rosemary, dillweed, parsley and tomatoes which are now in bloom. The onion leeks which I put on a glass of water is still growing leaves for more than a month now. If there's one thing I love about summer, it's the gastronomic experience that goes with it. Grilled foods are in. Since we could not have a grill on our deck because of state laws, I bought a George Foreman grill as a birthday gift for my husband. He loves it. Now we have a summer that sizzles.

Amazing Technology

Once more, I am amazed at how technology has made things very easy here in the US. I recently visited my new primary care doctor. She belongs to Group Health Associates. She holds clinic which is very near our place. When I registered I was given the option to fill out the myChart feature of their health care. It enables me to have a web account with them so I can view my appointments, make new appointments or even email my doctors regarding questions. I can also ask for prescription refills through this account.

Last Thursday, I had a severe low back pain which did not respond to NSAID intake. When I went to the GHA clinic to have my blood drawn, I asked the secretary if I could make a stat appointment with my primary care doctor because I just wanted a prescription for muscle relaxant. I was informed that she was only there in the morning so the secretary typed a message for her instead. After 10 minutes, I was told that she had muscle relaxants prescribed for me and that I could pick up the medicine at Walmart pharmacy (where I usually buy my medicines). I was impressed with the network that they have even with pharmacies. When I went to Walmart, my medicines were ready for pick-up and I just paid $4.00 for co-pay.

Then this morning, I went to my rehab/physical medicine doctor for a consult. He prescribed for an MRI and the nurse made an appointment for me for this procedure at Bethesda North. Then he prescribed a steroid and asked me where I wanted the drug picked up. My husband and I decided to get it from Bigg's because it is on the way to our house. When we went to Bigg's we saw that there was actually a drive-thru where you could pick up medicines but the pharmacist informed us that it will take 15 minutes for her to process the transaction because I was a new patient for that pharmacy. So the next time that I need to pick-up a drug from them, I can use the drive-thru already. Amazing.

This reminded me of the drive-thru at the bank which was very convenient especially during winter and when you have kids with you. You simply go through the drive-thru and they have canisters which you put your deposit/withdrawal slips. The canister is sucked by a vacuum which delivers it to the bank teller who communicates with you via an intercom.

In the hospitals too, a lot of technological improvements are put into place. One hospital that I go to, no longer uses paper charting. Everything is done through the computer software Epic Hyperspace. The main advantage is that doctors see all orders at a glance, even those given by other doctors. You also see all medications that are prescribed to the patient. It makes it easier for pharmacists to see redundant medications or drug interactions. It is also easier for nurses to see what medications are due at a particular hour. The doctors are also able to access the patient's chart even when they are outside the hospital. Hopefully, all these technological advancements will result in better patient care.

Give the Philippines a Chance

I have a new favorite CD. For a year, I have been listening to Sabrina's "I Love Acoustic" CD and it became so familiar that I actually associated it with driving from work and in between hospitals. My job requires quite an amount of travel. When I drive to the hospital, I usually pray the rosary first. When I have completed it, I turn on the CD and listen to Sabrina. One year has gone by now.

My husband happened to chance upon Charice Pempengco's CD in the public library. We listened to it and found it really good so we decided to buy it from Walmart. It's displayed conspicuously in both Walmart and Target and I felt proud about it.

Charice embodies the figure of a Filipino dreamer. She dreamt and achieved, but not without hardwork. She is one of those artists whose talent didn't get easily recognized in her own country. It had to take a Korean show in youtube for Ellen D. to discover her remarkable talent. The same thing happened to Arnel, another great talent that was initially ignored by his own country. There is also Lea Salonga who was discovered through Miss Saigon. It was only when she was recognized abroad that her country acknowledged her extraordinary talent.

When President Noynoy said that the people don't have to leave the country anymore to look for opportunities and find a better future, he made a very serious statement. It means providing a right environment for the Filipinos to grow and bear fruit. I have noticed that most Filipinos, when put in the right environment, usually bloom and bear much fruit. Take Subic for example, when it was still under the US jurisdiction, Filipinos followed traffic inside the base to the letter as though they were in a different country. Here in the US, it is easy to follow traffic rules because nobody will honk their horns behind you for stopping at a red light or a stop sign.

I was never the type of person who greet strangers in a hospital elevator but because I am in an environment where people do this, I have gotten used to it. I give a friendly smile to acknowledge the presence of someone. Common courtesy is so common that it naturally rubs on you. This is the kind of environment that should be nurtured in the Philippines so that Filipinos will bloom.

It is true that good governance is done by example. Filipinos are looking for a role model, a hero to imitate. I am hopeful that our new president is just what we've been waiting for. And I hope the media will try not to crush this hope in a nation that has grown tired of the rotten system. What we need at the moment is generosity of spirit. What will criticism accomplish that kind words cannot? What will skepticism achieve that faith cannot? The key to change is a change in behavior and attitude.

We have lived in poverty for so long that we see the world as a jungle where only the fittest survive. It's always a struggle to live. It was only when we migrated that I realized I had this kind of attitude, prone to criticism than praise, prone to competition than cooperation, prone to 'what can I get from this' than 'what can I give'. This is a poverty mentality that has long been ingrained in a culture where poverty was romanticized and spiritualized so that power could be kept by the colonizers. It has been so deeply inculcated that we lost our faith in ourselves and we look up to foreign superiority: the Americans, the Europeans and the Japanese.

As a child, I often heard about love for the country. I find it so intangible that until now I still ask "What is it exactly?"

What I know is that when Manny Pacquiao won in several international boxing competitions, my heart swelled with pride for my own color. When the Filipino chef of White House won the Iron Chef American competition, my spirit soared. When I saw how Lea Salonga and Charice Pempengco made it in the international scene, I was cheering with gusto.

When I left the country, I didn't feel guilty at all because I don't consider it abandoning my own country. Why, even Jose Rizal spent most of his heroic life abroad, writing and exposing the events happening in our country. Patriotism knows no physical bounds. It is in the heart of man. I think I love my country because I am now praying for the president rather than criticizing him.

When Jesus came to change the political system that burdened the poor, he didn't do so by power. He made sure attitudes changed that's why he spent most of his public life evangelizing and changing attitudes. It can only be that. Without change in the attitude of the people, there will be no government success in restructuring a system. We should let go of our pharisaical, holier-than-thou attitude. Look into the sincerity of the man. Learn to trust again. There will always be a Judas but he is a minority. Jesus didn't let that minority keep him from entrusting his kingdom to the eleven worthy but struggling apostles. And he didn't go wrong. A kingdom built on trust inspite of the weakness of man has grown into a worldwide belief from a small town in Nazareth. That is the mystery of the kingdom of God. It only takes a small mustard seed, one small action, one simple faith for something small to grow big.

That is what the Filipinos need now in order to see the fulfilment of the vision for change. Just one small faith to give a chance for that small seed to grow. Let's give the president a chance. Let's give ourselves a chance. Let's give our country a chance.

Media should focus its efforts in inculcating values, common road courtesies and saturate the consciousness of everyone until it becomes part of the system. Focus on what one should do more than what one shouldn't do. Post reminders everywhere. We are a country filled with so much billboards and ads. We should use it to generate a positive change in attitude instead of focus in vanity and immorality. For instance, 'drink Coke so you keep your cool amidst traffic and not blow your horn constantly', 'bring your i-pod to keep you entertained so you don't get tempted to cut in line', 'buy the combo meal in Jollibee so you stay on your budget and need not accept bribes from motorists', 'you don't need a wang-wang to make your presence felt. Just use Axe men's spray'.

There are so many ways to influence attitude by using commercial products. It's the best way to saturate the Filipino consciousness. What about putting a prime time news show where only good news are relayed and not the usual rape, murder, scandal news that only serve to deaden our sensitivity. We are a nation filled with so much creativity. I hope we will act as one in building our nation starting with our small efforts to contribute to a bigger whole.

Hands-On Dad

In a Philippine magazine some years back, movie actresses and popular career women proudly called themselves “Hands-On Mom”. The term evolved in the past decade as career women once more saw the value of being full time housewives, though not necessarily involved in the care of the children. Oddly, the term is only used by the women in the upper social strata. For women who belong to the middle income group, it is more economical to work and hand over the domestic role to the nannies. The women living below the poverty line have always lived that role because they lack college education and career options.

When our family migrated to the United States last year, my husband and I had to adjust to a life without nannies. In the Philippines, my kids were used to having their two nannies. I would merely supervise, making sure the nannies did their job right. So it was a major revamp of roles during our first few months in this foreign land.

But the biggest adjustment came for my husband. Back then, he had rarely spent time with the kids except when he took them to school or to the malls. So being left alone with the kids when I started with my work here in America was a scary experience for him.

“I’m often the lone male among mothers who pick up their kids from school,” he’d complain. “And it’s so difficult when one of the girls would go to the bathroom when we are in the grocery. Fortunately, some shopping stores have family rooms.”

Trying out his culinary skills was initially as stressful as competing in the Kitchen Stadium. It was just a pleasant surprise to discover that he can actually cook. He called me one day and excitedly announced, “I can’t believe I just cooked the best tasting Adobo I’ve ever tasted in my life. I just don’t know if I could do it again!”. Adobo is a Filipino cuisine of pork stew in soy sauce and vinegar and one of the family’s favorites.

Perhaps the most challenging part for him is dealing with our four-year old. “I want a pixie hair!” she demanded one day. It is a term she coined to mean pigtails. This requires a lot of fine motor skills. Unfortunately this seemed almost impossible with my husband’s rather brawny, masculine hands grasping those tiny clips for her very fine and short hair.

It became a common sight for me to go home and find a harassed look on his face as he exclaimed, “Your daughters are driving me nuts!” I think my four year old has a bigger talent for doing this to her father. I sensed a power struggle between them that can only be attributed to a similar genetic make-up of temperaments. The issue can sometimes be as simple as the clothes to wear for school, when the little girl insists on wearing a summer dress during the cold winter season or refuses to eat her lunch because she “wants mommy”.

It took a while for us to realize that the children were actually treating their father the way they had treated their nannies. They were trying to wrap him around their little sticky fingers. But being more intelligent and having a stronger personality, my husband later established his authority over them. He is still the head of the family even though he is not the breadwinner.

I think it takes a real man to be able to be a “Hands-on Mom”. Most men would resent this reversal of roles especially if they are used to bringing home the dough. So it became amusing sometimes to find my husband having more maternal instincts than me when it comes to caring for my two daughters. I sometimes wonder if he has grown ovaries and uterus too. For instance when my younger daughter had a fever, he patiently gave her a sponge bath. I usually just give an antipyretic and let the fever lyse.

I know he misses having a career of his own. Nevertheless he is making this sacrifice while we are still adjusting to our new life here in America. And I think this sacrifice was well worth it. After six months of coming here, he found a keyholder from one of his boxes which read, “The World’s No. 1 Dad.”

“This has been with me for quite a while but it is only now that I feel worthy enough to use it,” he said with pride in his voice. He then put his car keys to the silver-plated keyholder. I looked at him with love and respect knowing that he truly deserves to use it. And just the other day, I accompanied him in bringing the kids to school. When my four year old daughter undid her carseat buckle, she immediately went to hug her dad. She gave him a kiss then just jumped out of the car without even noticing me. I can’t believe she just totally ignored me! My husband chuckled with amusement at my disgruntled look. Now, when she goes to sleep, her only wish is to have Daddy beside her to tuck her in. But when she is sick, she still reverts back to Mommy’s care. The growing bond and attachment between my girls and their dad is a product of hard work on the part of my husband. His efforts were further rewarded when on Mother’s Day as my nine-year old presented me with a scrapbook and greeted me “Happy Mother’s Day!”, my four-year old happily ran to him and gave him a big kiss saying, “Happy Mother’s Day, Daddy!”.

He recently got interviewed for a job. That night he was tossing and turning. “I can’t sleep. I think I am having separation anxiety. I will miss the kids when I work again.” He compares it to the experience of a woman ending her one year maternity leave. That’s one thing that never crossed his mind when he adopted the full-time role of child care. He has definitely reinvented the term “Hands-on Mom”.

God Takes My Driver's Seat

I am seated on the deck tinkering with my laptop. The sun is out. The sky is blue. I see green trees everywhere. The cool breeze comes to visit every now and then. Summer is almost here. It's 80 degrees and it is just the comfortable temperature for me. We just had grilled turkey breast and corn for lunch. I love this time of the year.

I have also learned to deal with adversities. When you hit rock bottom with your emotions, sometimes it can be so dark that you get swallowed by it. I had that experience.

One Friday evening, as I prepared to leave the hospital from a long, tiring day as a dialysis nurse, I received a message from my manager. “The nurse scheduled to be on call for Sunday just resigned. You have to take that call.”

I felt my world crash as I saw a quiet Sunday with my husband and two daughters dissolve into smoke. I worked more than 70 hours this week, waking up at 5:00 am, driving from one hospital to another, pushing a huge dialysis machine with gallons of bicarbonate and acid and going home close to midnight. My back ached and my heart longed to spend time with my family.

Without thinking, I dialed my manager’s number but only heard a voicemail prompt. At the tone, I broke into plea, “I worked five days this week. Please don’t give me the Sunday call or I may get sick soon”. I hung up dispirited, walked to my car and slumped on the driver’s seat. Then I broke down and cried. "I am so tired, Lord! I am so tired! What have I done wrong? You've said You are my Savior. Then, please save me. Have mercy.”

I heard no booming voice. I saw no flashing light. He just came to me in silence and peace. A passage from the bible rose in my mind. `Come to me, all of you who are tired from carrying heavy load, and I will give you rest. For the yoke I will give you is easy and the load I will put on you is light.' (Matthew 11:28, 30)

Tears welled and I prayed, “I am offering You my burden and my yoke. Show me what Your burden and yoke is like.” When I arrived home, I was no longer worried about Sunday.

The next day, I called my manager again. This time she answered.

"Did you receive my message?" I surprised myself with my firm and calm voice.

“Yes,” she said.

"I am not taking the call tomorrow. I am only supposed to work four days a week. If you make me work this Sunday, I will not work on one of my regular days next week. I refuse to work another five days next week. That's too much."

She asked, “What's wrong with you?”

I felt calm and sure. I said, "I need to take care of myself. And I need to take care of my family, too.”

Then she said, "Ok. I will cover for you." And she did, just like that.

The week that followed was just as crazy. Our patient census soared. We were so understaffed that we got called everywhere. I worked the same long hours but things were different for me.

My yoke is easy and my burden is light.

From that time onwards, I started my day with this prayer. "Lord, I offer my day to You. Intervene as You must. Make things easy for me. Guide me and direct me. I offer you all my hardships. Grant me the grace to overcome this day. In Jesus' Name, I pray."

With that invitation, God was able to take control.

God controlled time and events. When I was given additional patients, He found ways to clear my schedule. Either one patient refused dialysis or another got discharged. Sometimes, the doctor moved the patient to another day or another nurse picked up my patient. In extreme cases, a patient died. During unholy hours or on Sundays, I didn't get calls.

God influenced people. Once there was a patient who was difficult and demanding. I prayed to God to give her a good mood. Not only did He do that, she actually warmed up and opened up to me. She was never difficult and aloof again. Some problematic patients stabilized during my shift.

God had power over technology, too. When one of the machines gave me trouble, God pointed out the problem. Sometimes, I just pray over the machine and it becomes functional again. When it breaks down, it only does after the treatment.

The best part of all, God changed my attitude. I no longer have that heavy feeling in my heart whenever I go to work. I face the day like a child waiting for her Father to manifest His power again. It gave me peace and joy amidst challenges.

I realized that I have a God who wants to be very much a part of my life. And for Him to do that, I have to open myself and say, "Lord, come to me this day and move in my life". I never thought that He actually needed my daily invitation and consent. Then He revealed the meaning of free will. He does not force His love on me. He does not impose His blessings on me. He can only give it to me if I allow Him.

So whenever I get another patient for the day, I ask the Spirit, “Is it God's will for me to work late today? If so, then please send me the energy to work with love and enthusiasm. If not, then please intervene”. The openness to accept His will helped me understand that I have created some of my stress with my controlling personality ad perfectionist attitude.

My fear of giving God complete control of my life diminished as I witnessed His caring love. It's like giving up my driver's seat for Him. He can't completely control the steering wheel unless I let go and let Him do the driving. I have to resist the urge to tell Him what to do.

It is irritating to have a backseat driver. I don't want to irritate God, my Driver, lest He say, "Okay, you sit here and do the driving." I'm tired of driving my own life. With my Master behind the wheel, I can relax, enjoy the view and appreciate the journey knowing that I am in good hands.

Lessons from the Trail

"Knowing what you want in life is the first step to achieving it."

That was the lesson I got when I went back to running on the trail the other day. It has been months since I've done that... run and learn from my Running Mate. Two years ago, I wrote the book, "Running the Millionaire Lane". I know Jesus the healer very well. I also know Jesus the teacher. But I never thought I would encounter Jesus the runner and Jesus the wealth manager. That was my book... a novice runner's spiritual journey in the material world. I wrote about my encounters with Jesus the runner and wealth manager and learned a lot of valuable lessons from Him. In the past, there was nothing that could motivate me to run 5 kilometers. But because of these spiritual encounters, I started writing and it became my motivation to run. I had nothing to write if I did not run. I was forced to go through the training until I was able to run 10 kilometers.

These past months, I missed running. My work got in the way. I have been working long hours that my off days were spent recovering. Consequently, I missed the encounters with my Running Mate. I was more in contact with Jesus my personal Savior, who has always been with me everyday, saving me from long hours of work, from weekend and night calls, from difficult patients, from machine mishaps, etc. And I believe the breather I got that day from my run was also a result of Jesus, my personal Savior's intervention. I was losing focus of why I am here. And the run brought everything back into clear focus again.

I know what I want in life. At 38, I am a retired anesthesiologist. I have no intention of going back into the field of medicine again. I am in a career transition. Obviously, with all the desolations I am encountering in the workplace, it is not my final calling too. My vision is to establish a career in writing.

I remember my Running Mate's first lesson from my book. "You need to pace yourself". There is no short cut to my goal. I may have published a book but I am still far from my goal of becoming a established author who inspires people to a more meaningful life. "It's all about enjoying the experience. If you try too hard to achieve something and be agitated because you do not immediately see the results, you might end up being disheartened."

"You must learn how to recognize an opportunity. You have unique talents. You know your interests. There is a great correlation between what you love doing and the opportunity to live an abundant life. Before you embark on something, you have to stop and assess the situation. Then create your plan based on your assessment. Then offer your plan to me. I cannot bless anything if you do not offer me anything."

I started discussing my plans with my Running Mate. And He showed me the light. I have started the first step in becoming a serious writer. I am currently enrolled in a 2-year writing course program. Now it is demanding more attention and focus from me. And that is what my Running Mate is reminding me of. Again, from the book, I remembered Him telling me, "Focus. Focus. Stay focused".

"It's all about the decision. When you finally decide to do something, the firmness of your resolve will push you to accomplish things that are initially difficult. But with your resolve to keep at it, you will eventually find ways to make it easy for you. You have to fix your eyes on the vision. It means delaying gratification. It means prioritizing the things that will help you achieve your goal. It means knowing which among your endeavors are really worth your time and effort. There are desires that only serve to satiate the temporary wants of the flesh. You must learn to filter these out. When you have decided, then things will move on in the right direction."

I wrote down my goals and objectives again, establishing clear time lines and daily activities that leads to accomplishing my goal and objectives. This is a lesson from my Running Mate too. "You have your overall vision and goal, but it might take some time before you see the accomplishment of all your endeavors. To keep you going, you have to make smaller goals that will break down the steps for you. These are your objectives. These are more achievable in a shorter span of time. This will encourage you and give you the energy you need to sustain your efforts, enough to make you accomplish your bigger vision."

The first step for me is to cut down my working days again. I used to do 3 days a week but ever since I started working 4 days a week, I've missed the things I truly love doing... reading, running and writing. It is slowly wilting my soul. I know it will make an impact on our family's income but I have to trust in my Running Mate's advice. If it is truly an advice coming from Him, He will give outward confirmations: 1) our income will be enough for the family, 2) there will be no resistance from my superiors and 3) there will be inner peace in me and my family about the decision.

I hear His words of two years ago echoing in my mind. "Seeking for what is always safe is not always good. It may point to a lack of faith. Do not bury your talent underground."

I just need to fix my eyes on my Running Mate the way Simon Peter fixed his eyes on Him. This prevented him from sinking in the stormy sea. Yes, trust and faith are what my Running Mate is demanding of me.

One Interesting Duty

Anthony Hopkins. That's who my patient resembled. But he was not the scary Hopkins of Silence of the Lambs. He was a sweet, old man.

While I was setting up the dialysis machine and programming it for his treatment, he started entertaining me.

"Do you like jokes?," he asked.

"Yes, why?"

"I've got some," he said.

"Go ahead," I said.

"What do you call the removal of the tonsils?"

"Tonsillectomy?" I thought I heard this joke before but I let him get on with it.

"Right. What about the removal of the appendix?"

"Appendectomy?" I began to smile knowingly.

"Yes. What do you call the procedure when a woman is turned into a man."

My smile vanished. This was not the joke that I know. I paused, thought for a while and answered, " Don'tdothattome?"

He blurted out laughing.

"I got it right?" I asked, surprised by my own answer.

"No. That's not the answer. It's Addthatdicktome," he chuckled.

"Oh."

"Dontdothattome..." he repeated and chuckled some more.

Seems like my answer was funnier than his.

Then I confessed that I had a different punchline in mind.

"I thought you'd finally ask... what is the procedure for someone who has bad breath."

"And what is the answer?"

"Donttalktome".

He laughed some more. We had an interesting start with his dialysis. I didn't expect to have an equally interesting end. As I finished with his treatment and cleaned up my machine, the nurse for the night shift came in and introduced herself. I was unplugging the hose from the water source at the back of the machine and I only heard my patient say, "Do you know that you look like Helen Hunt?"

I peeked behind the machine and saw the nurse smile and look back at him. "Actually, now that I have lost some weight, more people were saying that I look like Jodie Foster."

Oh my gosh, I thought. She was right. I was so thrilled that I just had to say, "I can't believe I'm amidst stars! You resemble Anthony Hopkins and you look like Jodie Foster."

Wait... this is not thrilling... this is a thriller. Silence of the Lambs, ICU episode. I'd better get out of here before I become the brain menu.

Of Web Scam and Hoaxes

During the first few months of our stay in the US, the days spent at home left me with so much time to surf the internet. Work from home deals, promos, get-rich-quick marketing, etc... the net is teeming with all these stuff. I was still gullible at that time. I got scammed a couple of times. And I have learned my lesson painfully. I had to call my credit card company a couple of times to cancel transactions that were not authorized by me.

Now, whenever I see an offer that is too good to be true, my initial reaction is... it is not true. There will always be a catch. And it is very easy to check out if the offer is the real deal or not. I simply log on to http://www.bbb.org/us. That is the website of the Better Business Bureau. It monitors all the established businesses in the US and rates them from A to F. If there are a lot of consumer complaints, they get a bad rating. So I know that I should avoid these companies at all costs no matter how grand the seduction is. Hey, I just received a free trip for two to the Bahamas via Caribbean Cruise Line. How cool can it get. Of course, I did not start jumping up and down, celebrating my luck. Where in the world did this free trip for two come from anyway? When I searched the BBB, at http://www.bbb.org/hawaii/business-reviews/sweepstakes/sweepstakes-and-prizes-general-information-in-honolulu-hi-22000317. I got my answer. It turned out to be one of those timesharing promos rated with an F.

The BBB is useful for monitoring charitable institutions, too. When I donated to one of the charitable institutions in the parish, I suddenly got numerous mails from other charitable institutions asking for donations. I guess my name was shared with these other institutions. Although these donations are tax deductible, it is still wise to choose where to give. I want to put my money where it will serve the higher purpose better. I just look up the name of the institution at BBB to make sure it is legitimate and doing what it claims to be doing.

The net is a very useful place to get information from. But it can also be a place where I get a lot of garbage. Spam mails and hoaxes can flood my inbox. Whenever I get these forwarded emails containing hyped up news of cancer-causing stuff, or cancer-curing stuff, I google the topic first to check the reliability of the material. The most useful website for me is http://urbanlegends.about.com/

I think it is our responsibility to filter whatever comes to our mailbox before we send out the information to the rest of our families and friends. Of course there is always the chain emails that we receive claiming to be originating from a particular saint and if you break the chain, you will receive bad luck. Just wondering which saint ever got to live to use the internet. Whenever I receive such an email, I don't even bother reading to the last because I know there will be a threat looming ahead. I simply hit delete with a prayer, "In Jesus' Name, I cast you out of my life." I don't know what could be more powerful than that.

Of course there are always materials worth circulating but before I hit send, I delete all the email addresses in the message to protect these names and use BCC instead of TO or CC because BCC will block the email addresses from being seen by other recipients. BCC stands for blind carbon copy. FYI.

The Learning Curve

When I was still orienting as a dialysis nurse, I encountered patients who were very supportive of my training. They allowed themselves to be stuck by me. Of course, little did they know that I am not a novice at all when it comes to sticking needles on patients. My training as an anesthesiologist makes me even more experienced than the one "teaching" me. But I do not advertise this fact. I was advised by people in the office that I should not tell my patients that I have a medical degree because they may start "consulting" me and I could be charged with practicing medicine. So I was very careful about this. It pleased me when patients thanked me after the session and told me that I did well.

When I was already doing dialysis on my own, it was a different story. I had to build my confidence along the way. There were good days when everything ran smoothly, from the machine to the treatment of the patient. And there were bad days.

I remembered one particular instance when I went into a patient's room, introduced myself in a nice way (I always try to be pleasant just to establish good rapport). The patient looked at me arrogantly and started asking questions. How long will his dialysis be, how much am I taking off him, how long have I been working as a dialysis nurse. Perhaps the biggest mistake I made was admitting that I have started dialysis just a couple of months ago. He started bossing me around, demanding I take off 6 liters from him despite my better judgment. When I stuck him with the needle, he started shouting that I was sticking his nerves and it was hurting. I got pissed off and raised my voice and said, "Hey, stop panicking. It's not like I just learned doing dialysis yesterday. I know what I am doing. I am not sticking your nerves. Look at that backflow of blood. Your nerves will not show that." He stopped and calmed down. But I was already hyped up and upset. I could stick needles to his neck if I want to, I thought. If looks could kill, he would have been dead by then because I was giving him dagger looks. I guess that must have scared him, despite his huge physique because he stopped talking and allowed me to do my work.

I usually talk to my patients and give them some sort of patient education while I do the dialysis, but with him, I just sat there quietly until the end of the treatment. You just know when a patient is too full of himself, it is useless to pour information to him. It will just overflow and spill out. Why waste my energy and saliva. Of course, he did not finish the treatment because he went into seizure after one hour. That was why he was admitted to the hospital. So I stopped his treatment and rescheduled him the next day. Those are the kind of days which leaves me unfulfilled as a dialysis nurse. But I learned my lesson.

The next day, when another patient asked me how long have I been doing dialysis, I merely answered, "Oh, long enough to be bored already." She merely laughed and I started giving her patient education.

Sometimes giving too much "information" can be detrimental to a patient's health and "sanity" because it makes them paranoid. Now, when patients ask me that question again, I look them in the eye and say with all honesty, "Almost a year now." And they leave me in peace to do my work.

When I encounter bossy patients who want to manage their own dialysis treatment and order me around, I merely bombard them with pathophysiologic basis of the treatment that I plan for them. The information overload is usually enough to gain their trust and cooperation. Now I've learned how to use information, i.e. when to give too much and too little according to patient's profile and needs.

Bias Against Immigrant Nurses

Spring is my favorite season. From the dreary, colorless environment, I found the different hues of green truly captivating. The sun which I usually took for granted while I was still living in a tropical country is now embraced with much enthusiasm. But Spring is not all blue skies and colorful flowers. The sunny weather is interspersed with rain and dark clouds. And that was how I have been the past months.

One moment I feel contented and happy, the next day, my heart is filled with dissatisfaction and angst. The negative emotion usually stems from long hours at work and the feeling of receiving unjust compensation for it. I think most new immigrant nurses feel this way. I have talked to a handful of Filipino nurses working in the hospital as ward/ICU nurses and my condition is not an isolated event. We sign a job offer in the Philippines with an hourly rate which is not reflective of the ones we receive when we start working. It is not usually divulged until when you start working already. By then, you have cut all ties from your previous "life", packed up your belongings and brought your family here. It leaves you with little choice but to endure the situation until your contract is fulfilled. The employer deducts the immigration expenses from your salary for the duration of your contract. So you will end up receiving a lower rate compared to your co-workers. Personally, I think this idea is garbage.

With the high turnover of nurses in the hospitals, having a nurse for two years should already help the hospital save in terms of training new nurses. In my company, I have seen new nurses get oriented and quit just after 3 months. Actually, in the 9 months that I have been employed, I have seen 10 nurses resign! Most of them did because of the crazy hours we work. If they could get me to stay for two years, they have already saved some money. That's why I could not get the rationale for paying an immigrant nurse lower salary compared to our counterparts. I just feel like cheap labor and I know I am doing a good job. There are some nurses under orientation who could not even get out of orientation. And that means expenditure again for the company. So whoever is sitting in the financial table is not getting his numbers right by treating immigrant nurses this way. Frankly when I came here, I had all the intentions to work as a dialysis nurse for the rest of my stay. But now, having experienced this bias, I have decided to do my time and get out of the job and find something else. And I know most immigrant nurses have been thinking along that line too. And it is such a waste because if only we were treated equally, we would have stuck with the position and done a great more good for the company.

For now, my daily prayer has been : Lord, grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference."

The Lord revealed His sentiments from Ezekiel 22:29, 31 - "The wealthy cheat and rob. They mistreat the poor and take advantage of foreigners. So I will turn my anger loose on them for what they have done." The Sovereign Lord has spoken.

An Immigrant's Woes

It's been a while since I last blogged in this site. The past few weeks have been very tiring both physically and emotionally.

When we decided to migrate here in the US, my husband and I made sure we were one in mind with our decision because we did not want to end up blaming the other should we experience hardships. Our Filipino friends who migrated were relating stories of that point in their first year in the US where they experienced the difficulty of adjusting which consequently put a strain in their relationship.

Our trial began when a couple of my co-workers started to resign from the acute dialysis team because of internal problems in the system which led to long hours of work and high job dissatisfaction. For them, it was easy to just hand in their resignation. For a migrant worker like me, you are bound to the contract that you signed. Besides, I really did not mind the internal rift going on. I simply did my work, went home and enjoyed my family.

But things started to go bad for me when I learned that a few more people handed in their resignation and we ended up working 17-18 hours a day because we were so short-staffed already. The management in turn had to hire new people for orientation to address the problem. Then I learned that I was being paid way lower than an orientee. I was burning out so fast and my morale was taking the deep plunge. I became very short-tempered at home. My kids were complaining that they hardly see me anymore. My husband had to listen to my constant complaints at work, my bodily aches and pain and whatever there was to complain about. Then I found my hope. I could transfer to a chronic facility without actually breaching my contract so I tried to arrange for this transfer to take place. Things became more frustrating when my request for transfer was delayed and a revamp of the acute dialysis program was implemented. The winter weather proved to be more of a foe than an ally as I fought to conquer the depressing state I was in. I felt I was plunged in a world of darkness where my only comfort was my husband's listening ear and understanding embrace and the peace I felt whenever I cried out in frustration to God in prayer.

Then one night, when I was once again on my endless tirrade of complaints, my husband told me to remember the time when we first arrived. He reminded me how grateful we were about all the blessings. He reminded me of all the graces we received these past few months. And I stopped and remembered. Just like that. I remembered. Then the darkness was overcome by light. All my resentment evaporated. I ceased to feel abused, exploited and victimized. God made me see that whatever they are doing to me, they are only able to do because God allowed them to. God is still in control of the situation. And I realized that this was precisely how Jesus thought of His passion and death. He went through the pain without grudge, knowing that justice and mercy will be served in the end. That realization was pure grace for me... and salvation at that instant.

Now I can talk about it, write about it and still feel peace. Because I know that God is in control. And everything has a reason and a purpose. And for some miracle, the moment I accepted the trial with an open heart and mind, things started to become better. Travel nurses were hired to replace the ones who left. Patient census dwindled that I did not have to work longer than 14 hours anymore. My kids are happier, my family is more at peace as well. And as though on cue, the winter weather lifted up to welcome the smell of spring. The sun is shining and the snow has melted. In three days, daylight saving time begins and spring will soon be here. Hopefully, by then, my situation will improve some more. I have a strong feeling it will.

Learning in a Technology-Advanced Society

As a US migrant nurse, there are a lot of things that I had to adjust to. Although I already practiced in a hospital which boasts of being hi-tech and fully equipped with state of the arts facilities, it was still different when I came here.

All nurses in the floors and ICUs have computer monitors which they just push and pull around as they do their rounds. Charting is done through this monitor. When they give medications, they scan patient's wristbands which has a barcode on it and then scans the medicine to ascertain that the right drug is given to the right patient at the right dose, time and route. I had to attend a one-day course, learning a computer software which one of the hospitals used.

As for the medicines that we give to patients, I had to get my fingerprint into the computer system called Pyxis so I can have access to the drugs. The process goes this way: the doctor writes down the order, the nurse scans the order sheet to the pharmacy, the pharmacist checks on the order to make sure that the patient is getting the right dose and has no medicine which interacts with the new drug as well as no history of allergy for that particular ordered drug. The drug is then encoded into the patient's computerized record so that it is made accessible in the system. There are drug stations for each unit which they call Pyxis. I automatically charges these medicines to the patient as soon as I get the medicines out of the Pyxis using a username and my fingerprint as "password".

There is also one hospital which is more advanced than the rest. The medical supplies are located in a central supply room in each floor. To gain access to the room, you need an ID badge which you swipe into this machine by the door. Inside the room, there is a scanner which you use to scan into the buttons which represents patient's rooms so it gets charged to the right patient, then you scan the buttons on the boxes containing the supplies which you will be using for the patient.

Sending blood specimen to the lab is just as fast. We just put the test tubes in a canister which we dock inside a pod. We press the key (e.g. LAB) where we want the specimen sent. This goes through the wall and we call it "tubing the specimen down to the lab". One hospital would also tube blood packs for transfusion using this system as well. Request for blood therefore takes only a couple of minutes. Laboratory results are also out in the computer system within an hour.

Another thing that I noticed also is that all nurses have their own hospital phones. When I needed to endorse back the patient to the unit, I simply call the unit secretary and she connects me to the phone of the nurse who is in charge of the patient. Sometimes, the nurse would leave her phone number so I could call her directly.

There are a lot of other gadgets which I had to orient myself with, because I never got to handle these in my own country. A basic one would be figuring out how to operate a bed with all its many features and functions. It had to be demonstrated to us. And all these technological advancements are supposed to provide better quality of care to the patients.

But one thing which I am really thankful about, amidst all these technological confusions and challenges is that people here make you feel that it is alright to be a little ignorant, it is alright to ask, it is alright to admit that you do not know. And that makes a lot of difference in my adjustment as a technologically-challenged nurse. Without judgment, I was accepted and understood.

And rarely do I see patients look down on a new nurse. They were encouraging. I even had one patient apologizing to me because I had difficulty sticking a needle on her. She said she was sorry for making my job difficult, as though it was her fault! And when I finished doing the dialysis, she was very generous with her words of appreciation. Then I realize that when it comes to showing appreciation, I was stingy. I am more vocal about criticism rather than appreciation. And so I came to learn to verbalize words of gratitude as well. I learned to be more generous with kind words. I then realized that I have improved my quality of care to my patients not so much from the technology that was available to me, but more from the kindness and appreciation that I learned from them.

Winter Running

I looked out and saw the sun shining. It seemed like a nice and warm day but I know looks can be deceiving because I saw from the SUV's thermostat that the temperature outside is 27F. I won't even bother converting it to Celsius because I know that it is going to give me a negative number. And any negative number multiplied to a positive number will still give you a negative result. If you belong to my generation, you would have remembered that TV jingle "subtract 32 from degrees Fahrenheit, the result keep it in mind. When you multiply that by 5 over 9 and you'll get Celsius just fine".

I promised myself that I will not let the winter season keep me from running. I've been thinking of going to the clubhouse to try that treadmill but I never got to doing it. Now, my brother-in-law and my husband decided to run and I thought, why not join them? It's gonna be my first time to run this season. It will surely be something to write about.

I donned four layers of shirt and three layers of pants. These should keep me warm. As I stepped out of the SUV, I smiled and looked at the vast expanse of white snow before me. I covered my nose and face with a scarf to keep the the air that I breathe in warm. I am very prone to hyperreactive airway and could not stop coughing if cold air gets into my airways. I wanted to keep a slow, steady pace so I was prepared to run alone as my husband and brother-in-law also wanted to run their own paces. After 1 mile, my Running Mate was already beside me. I guess that is the value of running in solitude and that is why I do not mind running alone anymore.

I had a huge prayer intention and I discussed it with Him. In the past, I would usually offer my sufferings and sacrifices for my petitions but now I cringe at the thought of it. This was a huge one and I fear that I may have to suffer and sacrifice a great deal just to have this prayer answered. But He shook His head and told me. "I do not need your sacrifice and sufferings. I need your acts of love. And you know what I mean."

I sighed with great relief. For I saw what He meant. The memory came rushing back like a movie rerun.

It happened two days ago, when I was giving dialysis to a difficult patient. I am usually kind and smiling to my patients, wanting to make the few hours I spend with them a very pleasant experience. But this time, it was difficult to put a smile on my face. And so I just performed my task without looking at him. He was just a patient and I was just a nurse doing my job in a functional manner. Then suddenly I stopped and looked at his face. I "saw"Jesus looking back at me on the bed, getting the dialysis. My heart softened. Now, this Man I know and I care about, this Man I can show great kindness and warm regard. And I did, without much effort. At the end of the dialysis session, when I looked at the man again and saw the patient and not Jesus anymore, he was a transformed man. His attitude towards me changed. I saw gratitude. It was a lesson taught by the Great Teacher. He taught me the easiest way to perform acts of love especially when I feel so unloving. And this is just what He is asking of me in order for Him to work on my petition... perform acts of love.

The thing about God is that He wants us to participate in His works. That is why some prayers are answered fast and some are not because some people are more willing to participate while others are more passive.

As I made my turn on the way back to the car, I passed by the huge tree which used to be clad in colorful hues of autumn. Now it was bare and naked. When you are running in solitude, it can be pretty natural to talk with nature also. So I greeted the tree (of course, just in mind) which still stood tall despite its dreary appearance. "Hi, Mr. tree. Don't worry, you will soon have your leaves back and I am looking forward to seeing your beauty again in a different form come Springtime."

Seasons change. Nothing remains the same forever. There are times when we have to shed some of our leaves, give up some things, let go of some people in our lives only to make room for new growth, new colors, new beginnings. We can easily adapt to changes if we open ourselves to it. I left the SUV and started my run clad on my blue fleece jacket with the mask on my mouth and nose. I ended my run with my fleece jacket knotted on my waist and my mask on my neck. I was breathing cold air without difficulty. I completed my 8km (5 miles) in subzero temperature. I have crossed that mysterious zone of winter running. I have discovered a new way of praying through acts of love.

Then I realized that there is still so much more to be discovered. There is still so much more that my Running Mate can teach me. I only have to run out and open myself to it, abandon my fears and embrace His ways.

Winter Adventure and Misadventure

My day started at 5:00am when the alarm clock rang. I was on duty today. I have showered the evening before so I just brushed my hair and dressed up in my 2 layers of thermal clothes before donning on my scrub suits. Breakfast for today: just coffee and Nutella sandwich. While munching on my meal, I boiled some water to cook noodles for the kids. At exactly 5:30 am the phone rang. Who could be calling this early? It was an automated phone message from the principal of the school of my 4-year-old daughter announcing that the school will be closed today due to severe weather conditions. Shortly thereafter, I received another call from the principal of my 9-year-old daughter. Another automated phone message announcing the same thing. So much for the warm breakfast noodles. Who knows what time the kids will wake up?

My husband turned on the TV to the weather channel. A snow storm will hit the city by noon according to the meteorologist. I hurriedly kissed him goodbye. Better to have an early start if I wanted to be home by noon. There was no trace of snow on my drive to the hospital but by 9am, it started to fall. I only had one patient to dialyze for the day and no add-on. By 1 pm I had already finished cleaning up and was leaving the hospital complex. When I opened my car door, I was wondering why there was a cover on my windshield. I then realized it was all covered with snow. For the first time I took hold of the brush scraper and started brushing off the snow. It was soft and feather light. I looked around and seeing that no one was around, I grabbed a handful and tasted it. It just melted in my mouth like some kind of cotton candy!

As I drove home, I made sure I was way below the speed limit. I was driving only at 40 miles per hour for the speed limit of 55. All the other cars were doing the same. I saw one car, not an uncommon sight, parked on the shoulder of the road... another casualty of the weather. I had my first taste of snow driving a day before and though it was really scary because I could not see the marks on the road, I was able to survive it without any accident.

Now, I felt the road was less dangerous because I was driving in broad daylight compared the other day. Then as I was approaching the stoplight some 500 meters ahead, it suddenly turned to yellow. Remembering my husband's advice to pump on the brakes a couple of times and not hit it hard all at one time, I did as instructed. I carefully pump on the brake. To my surprise, I felt the front wheel skidding to the left and my rearwheel skidding to the right. I released the brake immediately and turned the steering wheel to the right. Then I pumped on the brake lightly again, seeing the red traffic light looming ahead. The front wheel was now skidding to the right and the rearwheel to the left. Instinctively, I turned the wheel to the left now as adrenaline was rushing to my head. I felt myself zigzagging and was not sure if I could really make it just before the intersection. I was now holding my breath saying my prayers real hard. Just as I saw the barely visible line demarcating where to stop, I pumped on the brakes again and to my huge relief, the SUV just halted just at the margin of the line. I looked to my left. Fortunately there was no car on the middle lane. When I looked at the right, the red car behind me skidded to the shoulder and went through the intersection despite the red light. I was shocked. He could have hitted me from behind! I was still wide-eyed from shock as I fumbled for my cellphone and called my husband. I just needed to talk to someone. "I skidded! I skidded!"

I was glad I had my bluetooth on so I was able to talk to him, debriefing myself from that "near-miss" as I drove the rest of the slippery road going home. I was now just going at 20-3o miles per hour. Then the tricky downslope came to my sight. There was a truck to my left and a couple of cars in front and behind me. I could not skid again this time or surely it will be a huge accident for all of us. As I descended slowly, I felt my car gaining momentum. He adviced me to use the manual control to shift to a lower gear. I did and then I slowly half-stepped on the brake dreading to feel the wheels skidding again. It did not. I survived the downhill alive! Finally, I arrived home and saw a couple of kids sledding on the hilly part of the compound.

I was definitely shaken badly by the driving experience that I took on the kids' invitation to play in the snow. After eating lunch, we all dressed up warmly and headed to the backyard and played to our hearts' delight. We made snow angels and threw snow balls. But the best part of it all was just lying on our backs, looking at the snowflakes falling from the white sky and catching it with our tongue. There on the soft bed of cool snow, I felt safe and embraced by God.