The 36th Hour

Kids, before med school happened, I never knew that life would be this hard. First, let me tell you a realization that this 28-year old brain was able to conceive while inside the confines of a cold but well-lit operating theatre at 3 in the morning while waiting for an emergency appendectomy patient to arrive. Life will tend to pull you back so hard that your vision would start to tunnel blurring everything out to the periphery. Now you shouldn’t take that literally unless you have glaucoma. But kids, I’m telling you that there will come a time that you will not be able to see anything else but the complexity and unforgiving nature of this perplexed thing we call “life.”

You see, I grew up within the reach of your Grandpa and Grandma. Life has been so good and accessible. I’ve been used to a good life with nothing else to think of but what to do. Or what to do next. Hakuna matata. Sometimes, your grandmother would even scold your ol’ man for being too lazy. Nope, just because your Dad was lazy doesn’t mean that you guys can be lazy. You should always do your best and work hard. As I have read in a Rick Warren devotional yesterday: “If you are going to really reach your goals in life, sometimes you have to delay gratification. You have to do the tough thing instead of the fun thing, the right thing instead of the pleasurable.” Your Gramps and I share this same philosophy. Things become more fulfilling when earned, not when given. You should work hard for your dreams.

I know some people who constantly complains of the pain that this dreadful cyclic event occurring every seven days bring: Monday. I know the feeling. I experienced that too since grade school until 3rd year of medical school. But come 4th year until forever, I felt doomed every 3 days. For the first time in my life, I felt totally separated from my family. The hospital started to become my home and the home that I used to live in became a transient place for baths, meals, and naps. A new zone started to eclipse my comfort zone.

It broke my heart when one day, your Grandma sent me an SMS while I was trying to make adjustments regarding my December holiday schedule to sync it with theirs inside the Department of Surgery office where I was rotating that time. “Sa amin kahit ano lang. Kasi naka-set na mind namin na sa pinili mong propesyon, ganyan talaga. Palaging may options sa mga special occasions.” (We can go for anything. Your Dad and I have already accepted the fact that in your chosen profession, you will always be faced with options when it comes to special occasions.”)

In my first few days as a doctor, I was the happiest person on earth. Who wouldn’t be? I have that stupendous M and D attached to my name. Every member of the family was in a rejoicing spirit. Most importantly, I have made my Dad and Mom proud. You know that stuff. But later on, I realized that things as great being a doctor do come with a price. Kids, there is nothing else that a parent would like to see in their lifetime but their children’s success. That alone would tell the world a lot of things. That they have been good parents. That they never lacked support and admiration to their kids. That they believed in their kids. Being a doctor is a huge achievement. But that would also mean compromising a lot of hours with your loved ones.

When in duty, I counted the hours before I finally go home. Before I finally see them again. 36. 35. 34. To 17. 16. 15. Finally down to 4. 3. 2. 1. I checked on patients and ran on errands at 4 in the morning always intermittently glancing on my watch just to remind myself that I’ll be home in a few hours. The long hours was always worth it whenever I arrive home with your Grandma’s Pork Sinigang or any home meal that she’d cook for me. More importantly, it was always delightful to be with them again after the 36th hour. Being a doctor is not easy. But I believe that most of us are still standing tall, brave, and proud despite the long hours and everyday battles inside the hospital. It’s because of them – the bone fide superheroes behind our success. MD. Mom and Dad.

R.A.

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Dear Tomas

It started with a dream. The moment when my sister walked me around your ever noble grounds, I already fell in love with you. I tried to pursue you and you didn’t fail me. You called me to your arms. In your embrace was where I found myself next when I woke up. But no, it wasn’t a dream. It was a realization of a dream. I am eternally grateful.
In your balmy domain was where my dreams emerged. In your bosom was where some floundered. You nourished me and sustained me and sometimes struck me for my obstinacy. But hear me. There was never a time that you have abandoned me. For these, I am eternally grateful.
A few hours and I’ll be stepping out of your illustrious shadow. From Espana to Dapitan, Lacson to Noval, my heart bleeds ceaseless gratitude to you. You have raised me to what I am right now. Tomas, I am eternally grateful.
Thank you for everything. I’ll always be one of your thousands of valiant legions.

 

Love you always,
RA
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The Perilous Road to MD – Part One

Pa, I already thought about it. I want to become a doctor.” I told my father as my eyes were firmly stuck on the road as I drove us home from the airport. He was skeptical at first. “How would you survive medical school when you don’t even read your books?.” He asked. My parents were unfortunate to have witnessed all my “struggles” as a Nursing student back in college. Sarcasm? Yep. I never really liked studying. During those years, I was a cold-blooded slacker. Even if an examination is announced, I never studied. I was exceedingly dependent on the dubious game of chances and unmitigated luck. Sometimes I pass, sometimes I fail. Graduating on time was a huge matter to have a good muse on. It could be funny to some but no, I’m not proud of it.

Years went by and so did the good days of college. Spending four years of college in my dream university was the highlight of my life back then when medical school seemed to be found nowhere under a blanket of murky water. I met new friends — some were even really good ones that I still get in regular contact with in social media until today, seven years after.

I took a year off after college and started working for our family business back then regularly engaging in chatters with logistics and cargo boys at the airport whenever I ship electronic products to our small computer and electronics shop in the province. Having about a year to think about one of the biggest life decisions I had to make, 2011 felt like two years compressed in three hundred sixty-five days. I was able to convince my parents about entering medical school when I asked the Universe for “signs”. I’m not usually that kind person who depends on signs. But since luck and taking chances has always been my style of play, I didn’t have second thoughts in putting everything on the line.

A National Medical Admission Test (NMAT) percentile rank of at least 80th and qualifying for my dream medical school were among the first “signs” that I sought. For starters, NMAT is the first step that every aspiring Filipino doctor should make to become a physician. It’s an examination comparable to the United States’ Medical College Admission Test (MCAT), testing every aspirant’s knowledge on basic sciences, critical thinking, and problem-solving. Most medical schools in the Philippines has a cutoff percentile rank of their own. In my university, it was 80. I felt God’s grace when I saw the numbers 8 and 0 on my computer monitor upon checking the results online.

My alma mater, the Royal and Pontifical University of Santo Tomas Faculty of Medicine and Surgery, has an idiosyncratic way of selecting their students. Annually, about 2,500 aspirants from different islands in the Philippine archipelago apply for admission and only less than 500 qualifies. The admission process itself is a challenge to every applicant’s patience. Letters of recommendation are sent to four different recipients: a college professor, your college guidance counselor, a psychology professor, and your community parish priest. Once you’re done with the letters, you’ll now proceed to psychological testing consisting of a 50-item written examination with practical situational questions that an applicant should answer depending on his own insight. Some people I knew who made it to the Dean’s list back in college did not qualify. However, some average (or even below average) students like me did. Like I said, nobody really knows how the board selects their roster of students for the academic year.

After all the hustles that I had to engage with during the application process, I qualified. I saw my name on the list pinned on a huge corkboard enclosed in a glass pane just beside the windows to the Dean’s office. The feeling was surreal. Who would ever think that someone like me, a student who almost didn’t care about studying back in college, would qualify to one of the country’s top-performing medical schools? Even I couldn’t believe it. Maybe God placed me there to change some things that should be changed. Like being too carefree. Or being too dependent on chances and luck. And I was not wrong. Medical school was life-changing.

I made a pact to be a good student and realize my dream of becoming a doctor when reality began to sink in. It was a huge step that I had to make. Some of our friends in the United States even started offering for help to land a job for me there. But nah, I never bought ’em. That time, I already knew what I really wanted. Folks, things never changed since Kindergarten. To become a doctor is what I want to be.

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This was me with my squad back in the good ol’ days of college.

 

Que Deus nos bendigo y nos proteja,
Robbie

 

The Barça Effect

To call me a “fan” would be an understatement. I’m like a football’s annoyingly creepy stalker. Like someone obsessed and die-hard, never missing any day without watching highlight videos or just taking a few minutes scrolling on football memes spread all around social media. But okay, fine. For the sake of a more prudent and convenient way of communicating, I’ll just call myself a “fan” just for today.

My heart broke last February 14. It’s not that didn’t have a date for Valentine’s day. Well, okay. I can probably give you that as a secondary reason to be heartbroken on Valentines Day. But it’s primarily because my team lost big time in the first leg of the Round of 16 in the UEFA Champions League. Last Valentines Day, Paris Saint Germain (PSG) trounced my beloved FC Barcelona (FCB) at a score of 4-0.

If you’re not familiar with the format of the UEFA Champions League tournament, I will try my best to explain. In the tournament’s Round of 16, Quarter Finals, and Semifinals, the teams play 2 legs and the aggregate score of those will be the final score. For example, PSG defeated FCB at 4-0. It means that for FCB to advance to the next round, they should score 5-0 to make an aggregate score of 5-4. “Away goals” are also given importance. These are the high-yielding goals that the visiting team scores at their opponent’s home pitch. In the February 14 match, FCB wasn’t able to score a single away goal at PSG’s fortress. But if only we were able to score one to make it 4-1 that time, FCB would only need to tie the aggregate score to 4-4 to move to the next round because of the 1 away goal advantage. Since it’s 4-0, FCB needed at least 4-0 at home and prevent PSG from scoring an away goal to tie the aggregate and force extra time and penalty shootout if necessary, or 5-0 to knock PSG outright.

The second leg of the Round of 16 was played last March 9. Every Barça fan was hopeful though a comeback was deemed impossible by most experts and sports analysts. No other team in history has ever made a comeback from a 4-goal deficit in the Champions League. Let me remind you. This is the Champions League, where champions of different leagues from different European countries clash to take home the big silver cup. It means that every opponent is a tough contender. That includes Paris Saint Germain, the French champions.

The match started at Barcelona’s home ground. With a defending mistake from PSG, they allowed Suarez (FCB) to score a header from inside the penalty box making it 1-0 (agg. 1-4)for Barcelona as early as the 3rd minute. An own-goal from Kurzawa (PSG) forced by Iniesta (FCB) made it 2-0 (agg. 2-4) thirty-seven minutes after. After half-time, a penalty was awarded to FCB after Neymar (FCB) was fouled inside the box. Messi (FCB) took the shot and puts Barca to 3-0 (agg. 3-4), a goal away from to equalize the aggregate score. However, at the 62nd minute, Cavani (PSG) scores a thundering strike for Paris, making it 3-1. All hopes died for Barcelona. The aggregate score is now 3-5, with an away goal advantage for PSG. It means that FCB can only win this by making the aggregate score 6-5. Three goals in 28 minutes. Impossible.

The match continued. Barcelona struggled to put the ball in in the next few minutes. On the 85th minute, the clock was ticking to the dying minutes of the game. Neymar was fouled near the corner of the penalty box. He took the free kick and puts it in making it 4-1 (agg. 4-5). A few minutes later, Suarez was fouled inside the box and Barcelona was awarded another penalty. Neymar took the kick and made it 5-1 (agg. 5-5), still in favor of PSG due to an away goal advantage. On the 95th minute Ter Stegen was fouled near mid line, providing FCB a free kick which was taken by Neymar. Neymar then sent an overhead through pass from to the inside box which was received by Sergi Roberto’s right foot volleying FCB’s 6th goal at the back of the net, making it 6-1 (agg. 6-5). There was no time left for PSG to redeem themselves. The referee whistled, signaling everyone of the end of the match. Camp Nou exploded with cheers, chants, and amazement from its 94,000 spectators. FC Barcelona just made history.

For most, football is just a game. But for many die-hard fans like me, it’s more than a beautiful game. It’s a sport that speaks to everyone of us. What I witnessed that night was spectacular and truly one of a kind. I’ve been a fan of football for quite some years now but I have never seen such stellar historical night unveil in front of my eyes. That’s why I have collected photos and quotations from the players which struck me.

And Neymar’s was my favorite. “Enquanto houver 1% de chance, teremos 99% fé.” (“As long as there’s 1% chance, then we will have 99% faith.”)

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Congratulations, Barcelona. We have defied statistics. We have defied history. We have made the impossible POSSIBLE. Visca Barca!

Que Deus nos bendigo y nos proteja!
RA

No dueño estas fotos. El crédito va al dueño/s.
I do not own any of the photos. Credit goes to the owner/s.

 

Today, I Had My First Surgery

When I was a boy, I had a dream.

Everybody was busy attending and monitoring their patients on that sunny morning. Left inside the Surgery quarters for interns was me and another member of the rank. Some of us were deployed in the out-patient department while others were inside the medical school building to attend a lecture conducted by a Japanese speaker. The senior interns had their own “interns’ hour”, leaving them no choice but to endorse their work to us, juniors. Indeed, if only the two of you are left inside the quarters, you’d surely feel the pressure and lack of manpower all around the place. Dr. C, one of the seniors, passed me the torch embellished with three tasks: One. A scheduled emergency appendectomy requires me to find three junior interns to send to the operating room. Two. Inform each junior resident about the whereabouts of the patient. Three. Keep calm and hope for everything to be okay.

I was lucky to immediately get two junior interns to scrub in after the lecture. To fill in for the third, I volunteered. We got inside the operating room around five in the afternoon. In my mind, I was expecting to be the circulating intern, the one who goes in and out of the operating suite to get extra sterile materials, sutures, do errands, and even take pictures of the specimen. However, with the green doors closed, air-conditioners buzzing, and every other human busy preparing the patient lying steadily supine on the operating table, the surgery resident swiftly tells me, “scrub” as he entered the suite passing right in front of me. I was startled for a few milliseconds causing me to have a brief hang time before finally storming out of the operating room to scrub on a nearby sink. I hurriedly scrubbed hard using the clean hard brush provided beside each sink together with a liquid antibacterial soap. I rushed back inside the suite and grabbed my sterile gown and gloves. A few minutes later, the operation started.

The patient was a 19-year-old male who came in with a chief complaint of right lower quadrant pain. He was scheduled for an emergency appendectomy a few hours after he was admitted in our institution.

The surgery progressed. The knife slid laterally from the skin of the medial abdomen. Upon reaching the deeper layers, Dr. U started using clamps to separate muscle fibers and fascial tissue. Finally, after about half an hour, we’re inside the peritoneal cavity. The surgeon meticulously looked for the inflamed appendix. He poked and pulled and pushed the gut in and out of the incision in desperate search for our specimen. Finally, after almost an hour, we found it. He started isolating our patient’s unusually long and thin appendix. Along its course, we started ligating and tying blood vessels that may bleed profusely if not done. When we reached its base, Dr. U placed two clamps, one at the immediate base and another one a centimeter above it. He asked the scrub nurse for the knife, which was soaked in povidone iodine. Moments later, he handed me the scalpel and told me to cut the appendix just below the upper clamp. I carefully started cutting the appendix until I reached the end point and finally hearing the words “specimen out” ring in the air.

When I was a boy, I had a dream.

Today, I had my first appendectomy. (technically)

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Take a look at that massive appendix. It’s almost the length of a scalpel!

Que Deus nos bendiga y nos proteja!
RA

A Valentine’s Day Post

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WARNING: Slightly sad post. Read at your own risk.

It was an ordinary day. The first few minutes upon arriving home from the hospital has become a routine. I’d remove my shoes and properly store them on a metal rack next to my apartment’s door, unload my things in the usual spot where I place them so I wouldn’t forget, undress myself, try to hoop everything in my laundry basket, and then take my usual post-hospital-exposure shower. After those, I dress up comfortably, turn my laptop on, prepare my lunch, and finally eat while I catch up on new episodes of my favorite TV shows. The sun casting its warmth through my apartment window greatly concealed any melancholic feel that I was mandated to experience today.

During the past years, I have learned to love that baffling feeling of seeing people happy by giving them what I think would make them happy. It’s been a constant source of that enigma. That’s a reason why a lot of times during the previous years as an actually caring adult, I tried planning on surprising my friends with simple gestures just to make them feel special on Valentine’s Day. Like giving them something cute or girly. Or maybe a stem of red rose. However, I would always succumb to failing to execute everything on time. I’m good at planning. But doing? Forget it.

I always told people that I’m contented with being alone. I’ve actually mastered the art of it. I can happily drive alone while listening on my favorite tracks on my phone. That never became too hard for me to do. I can go to the grocery and pick up food for me to prepare and cook. I can soil everything in my apartment and clean everything up by myself anytime or any day I want. Moreover, being alone also has this perk that most people living alone might not realize: whenever I do something colossally stupid, nobody has to know. If ever I accidentally slip on the floor, or unintentionally char my meal, nobody would know. Whenever I feel that there’s a need to sing, dance, and cry like crazy, no one would see.

Anyway, I’m already blabbering about random things. Maybe this is just a manifestation of loneliness. Kids, being alone would inevitably make you feel alone. As a human, whether we like it or not, we have evolved intellectually enough to develop an instinct to find a person who we can always talk to about anything, or care about, or share affections with. Unfortunately, I lost that person a few months ago. The past eight Valentine’s Day were great. Ecstatic. Euphoric. Happiness-inducing. Or any other adjective that would express extreme elation and contentment. This is the first Valentine’s Day in almost a decade that I’m celebrating it back with my family. To be honest, this year’s V-day sucked helium so hard that it went all the way to the stratosphere without me noticing. You know, when I get home from a 30-hour hospital duty, no matter how hard I try to fight it, I always end up sleeping throughout the day. But I think it greatly helped. Skipping almost half of the day in slumber to flush every Valentine’s crap I see on my Facebook feed into oblivion isn’t actually bad. Perk!

Not everything bad can be that bad. Sometimes, bad things happen to make way for great things. Like in my case, I somehow started to rekindle my relationship with my family. Things got shaky before when there existed numerous differences among every one of us. Our beliefs, our personalities, personal preferences, and probably a lot more that I couldn’t have known or even noticed. But it’s over now. I guess I’m left with no choice but to think about what the future holds for me. And I believe that it will be great.

It takes 10,000 shots of alcohol to move on from a breakup according to Robin Scherbatsky. If you think about it, that’s a lot to consume. Not to mention that fettered with those are the countless number of hours that one should spend to move on. It’s a cliché of life. Only time can heal shattered things. One day, I’ll be fine again. One day, Valentine’s Day will become a thing again.

Que Deus nos bendiga y nos proteja!
R.A.

Cena Cita

One thing that I don’t like in being a rookie doctor is the inhumane hours spent inside the hospital. On average, we go on 24 or 30 or 36-hour shifts looking after our patients from time to time and carrying out orders from our senpai residents or consultants. Most of our free days are just spent on getting back the lost hours of sleep. That is if we’re not studying. A lot of times, it compromises the time for other things like family, friends, and leisure. It’s a sad fact of life but it’s for the dream.

Today is a new year for our Chinese brothers and sisters. Since my current status for today falls under pre-duty, I didn’t have to come to the hospital and do my everyday thing. As interns, we’re required to go to the hospital on holidays only if we’re on duty. That’s why as a temporarily free person for today, I didn’t waste a second on having thoughts on spending the whole day with mi madre.

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Mi madre is quite easy to please. She never wanted any other fancier maki sushi than California maki rolls.
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This artery-clogging skewer of azura bacon is amazing.
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Chashu ramen for a hot slurp.
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And. D*mn it. This amazing spicy sake (salmon) donburi.

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I hate Japanese food so much that I eat a lot of it so it could disappear forever in this world. Kidding.

See you next time, mother. Have a safe flight.

Que Deus nos bendiga y nos proteja.
RA

First Thoughts for ’17

It’s been a while. The last time that I posted here was a day after Christmas. The days were cold and sad and busy and everybody was bustling around buying gifts, food, and rounded fruits for New Year’s Eve. A week was left before we said goodbye to Pediatrics. Now, we’re off to Obstetrics and Gynecology.

Have I told you how much I hated Obstetrics and Gynecology since…I was in my mother’s womb? Exaggeration aside, yeap, I’ve been on a hatin’ streak with OB-Gyn since Nursing school and it never changed since then. I barely had a complete grasp of everything that one needs to learn on these sh**load of a subspecialty. (No offense to our great OB-Gynecologists. I know you have that one subspecialty that you also hate the most). However, to become a doctor, it would take about 4 months of OB-Gyn rotation in 2 years of internship. No matter how much I hate it, I’m left with no choice but to do it.

The previous year was a bona fide…thing that you see inside an infant’s diaper. I’ve been dragged to the deepest depths of the fiery trenches of hell last year. So would it be fair to the universe if I set my expectations to as high as possible for 2017? I’m claiming a lot of victories for this year. Restoration. Travels. That MD. New experiences. New patients and cases. First surgery. And probably a whole lot more. Just promise to make it good, 2017. Just make it good.

Okay. Let’s open the year with high-cholesterol food like chicharon and steak. What’s the use of synthesizing HMG-CoA reductase inhibitors if you don’t indulge yourself in fatty food, right? Nahh, I’m just kidding. Kids, always love your liver and gallbladder.

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Anyway. It’s 2017 and I’m still addicted to FIFA ’14.

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Cheers to a victorious 2017!

Que Dios nos bendigo y nos proteja.
RA

White Christmas

To be deployed in the hospital to function as a doctor is a whole lot of a different experience than how it was almost a decade ago when I worked in the wards as a student nurse. From the number of hours per shift to the overall role in the work place, the difference is a thousand miles apart.

This year, I got to experience my first birthday inside the hospital. Honestly, it wasn’t the schedule that I wanted. I would prefer to have a day off or from-duty post on my birthday but I didn’t bother to switch schedules with other members of the team since, let’s be honest, one would have thought about it as a fun new experience.

A few days after came Christmas eve. Everyone in the ward suddenly became extra busy last December 24 trying to balance the time for each admitted patient and decorating the Pedia Clerks’ Work Room for Noche Buena. To put it simply, “Noche Buena” literally translates to “(the) Good Night” where families and friends gather together a few minutes before 12 midnight of Christmas Day to dine and celebrate. It’s a common tradition among Spanish-influenced countries such as the Philippines, Mexico, and most of the Latin American nations. On that day, I was in the Neonatal Intensive Care Unit (NICU) attending to a preterm newborn patient delivered via Cesarean Section. The three of us assigned there only had intermittent chances to go to the ward where our Christmas dinner was prepared. Nope, that wasn’t fun at all. Imagine everyone else in the ward having fun taking a break from the everyday scenes inside the hospital while the three of us downstairs had to keep a patient inside the NICU alive and thermoregulated. Not. Fun. At. All.

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When I went upstairs, I was surprised to see the effort of all the ward people scattered all over the place. From the Christmas decors to the food in the table, it’s safe to say that the Christmas dinner that we had in the hospital was a good one. Though all of us weren’t with our families for Christmas, the team didn’t fail to somehow let us feel the spirit of Christmas inside the hospital.

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The career path that we chose is a perilous one. I’m aware that these firsts will have succeeding sequels. Despite the tight schedules that usually lead to occasional disorientation to time and date, the most important thing to consider here is the fact that I am enjoying what I’m doing. Celebrating a white Christmas (Christmas inside the white walls of the hospital) wasn’t bad at all. In fact, everyone had fun and got a click of revitalization, leaving the stresses and all the sleepless nights in temporary oblivion. It was Christmas away from home but near the company of great friends and mentors. I think I could get used to this. At the end of the day, no material thing would top a former patient’s Christmas greeting and endless gratitude.

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Feliz Navidad para todos.

Que Dios nos bendiga y nos proteja.
RA

The First Step to #Adulting

So this is what my parents would repeatedly tell me before. In reality, life could be really hard. One does not need to live in poverty to say that life is a bummer. Sometimes, just because of the big decisions and responsibilities, one could already say that it’s actually an obstacle course.

You know that you’re on your way to adulthood when little by little, big things like long-term decisions that one cannot simply make in a fraction of a second start piling up. That one decision that a tiny mistake would potentially make a huge difference and spark thoughts of regrets and frustration. I realized that what’s happening today cannot be compared your graduation day in Kindergarten where you’re tasked to simply share to your ambitions to the spectators, where you can say whatever you want as of that moment. Or to that moment where you’re asked by Professor Oak to choose which Pokemon would you take as a starter. Now, it’s time to settle things. It’s time to finalize the future.

Of course I’m aware that I am a long overdue adult. It’s been almost a decade since I first stepped on the age of being a “legal adult” in our country. But I think this is the biggest decision yet to make so far in my twenty…uhmm. Twenty-something years of existence.

December 7, 2016. This was the last day that our medical school had to set to submit all necessary documents for all internship applicants from our institution. At first, I though I was already sure about the hospital that I already had in mind. But the more seniors I chat with, the more options came popping up like stealthy assassins terminally blowing up their cover in the woods. I reconsidered. Right now, I may say that adulthood has started.

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So, there you go. I sent an application to just one hospital. No backup. No whatever.  I dreamed of becoming a surgeon and I think this is the best option for me to become a great one. Wherever God would take me, there I’d go. I already did my best. The rest is all up to Him now.

Que Deus nos abençoe y nos proteja!