It's all coming back to me

       Do you remember that time in high school when you have to meet up with your guidance counselor and discuss your potential college course?

       My daughter is now a junior high school student. She's a bit confused. She loves music but she is afraid that if she pursues this passion, she'll end up playing her violin in the sidewalks or the subway stations of some big city to earn a meager income. She's looking up to us to push her into some direction, but my husband and I promised ourselves that we will never do that. We will guide and support her to pursue the work vocation that God has destined for her. Easier said than done. This brought me back to my past.

       My father is a doctor and my mother a nurse. So back then, it was automatic that my siblings and I would either become a doctor or a nurse. I remembered taking an exam and I was offered a full tuition scholarship by IBM to take up Computer Science in Cebu City. I turned that down. My English teacher, on the other hand, encouraged me to take up Journalism in UP Manila, having worked with me in the editorial staff of our high school paper. I, personally, would have taken Fine Arts major in advertising because of my artistic inclination (having won in many poster-making and art contests) but my father would not hear of any of these. In terms of aptitude, I had it in me to become a doctor and take up nursing as a pre-med course. That was his thought. His one practical reason --- in case I don't end up proceeding to medicine, I have a decent degree which I can use even as a housewife. I can take care of the kids without getting into panic mode when they get sick. That was pretty logical and practical so I heeded his advice. And that was how I ended up with a BS in Nursing degree and got into medicine after two years of soul-searching.

       Now, my past is haunting me. I feel I have neglected that artistic side of me and now it's back with a vengeance.

       After writing and publishing my book, "Running the Millionaire Lane," a memoir of sort, I knew I wanted to spend the rest of my life pursuing a writing career. It has been literally just that -- an endless pursuit. I didn't realize it would be a steep mountain to climb. I've had a lot of hiccups along the way. One writing course after another only served to confuse me. From non-fiction to literally works, technical to medical writing, online health articles to inspirational, now, I got lured to copywriting and grantwriting.

       It's not until I enrolled in this free online course offered by UC Berkeley at Edx.org that I realized I've been trying to pursue journalism all along. The past that has been haunting me has finally caught up. Have I finally found the right mountain to climb?

What do I want to be when I grow up?

       So I just celebrated my 45th birthday. Am I in midlife crisis because until now, I still feel this inner restlessness?

       Serendipity brought me to this blogger account that I have somehow neglected again. And it's not because I was too lazy. We moved to a different state! My husband just got promoted again and his new role required relocation for the whole family. Caught in between boxes and movers, realtors and mortgage loans, buyers and sellers, we've finally settled down. Kids are now back to school and I am happily tinkering at home. I made a lot of Filipina friends, which is a delight. It's just funnier to talk in my own native tongue -- bisaya and tagalog. Everything is falling neatly into place.

      I feel happy and contented being a fulltime homemaker. I have made a nice routine for myself. Most days you'll find me cooking Pinoy dishes like dinuguan, kare-kare, and monggo guisado, baking pan de sal and ensaymada, catching up with household chores (when will the laundry ever cease to pile up? The answer is never), driving the kids to school and their other activities, attending mass, and gardening.

       But I know the itch to write is an itch I need to scratch, sooner or later. I have finished the first book of my trilogy novel at the last quarter of 2015. And I know I need to start typing the first few words on that empty page of Chapter 1 for book 2. I will get there soon.

       For sure, I know what I want to be when I grow up (;b). I want to earn from my writing. I have started the copywriting course, have helped a community-based organization in Uganda with grantwriting, and just today, got enrolled in the journalism online course at UC Berkeley.

       You know you're in the right track when the restlessness settles with a certain task at hand. For me, it has always been writing but I am still in that phase of finding the niche that I enjoy most. I have tried medical writing as a freelancer with Demand Media Studios, inspirational writing with Examiner.com, research writing from my previous job as a research nurse (oh yes, that's the job I took when I left dialysis nursing. It was a pretty neat office-hour-weekday-only job. I got to experience how pharmaceuticals develop drugs prior to being marketed to the public. I will write more on that if anyone is interested.), and even resume and informed consent writing. So you see, I really love writing. And I feel this is where God wants to use me. How? That is something that I still need to discover.  

       

     

     

The Resurrection of the Blogger

       After 5.5 years, I'm back! I can't believe it had been that long since I last posted in my blog. Well, I did try to publish something back in 2011 but I forgot my username and password! For some reason, today, I scrolled through my old emails filed under the folder "Writing Submissions" and found the blogger account information I have long been searching for.

       I am so excited to share my journey in the last couple of years. After that glitch in 2010 when I thought I would go back to the MD track, a lot of interesting things had happened to me and my husband. At that time, I was still employed as a dialysis nurse for the acute dialysis service while my husband was unemployed and a stay-at-home dad.

       Now, our roles have switched! He is fully employed with an MD degree after his name without going through the tedious process of USMLE licensure, while I am a full-time stay-at-home mom.

       How did this happen? I will tell you in the blogs that would follow. It is Sunday after all and the weather outside is pretty. As much as I want to start hammering on the keys of my laptop, I want to enjoy the morning sun. Spring has finally come (I hope!), after winter's multiple resistance to leave the scene.

       For now, let's just say, God has been faithful to His promise.

       "For I know the plans I have for you," declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future." - Jeremiah 29:11.

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.