Wonderfully unusual

NOTE: This post is my participation in The Blog Rounds 3.0, where doctor-bloggers write about a certain topic of shared interest. This week, a moderator suggested we write about this: what would have been my career if I didn’t choose to be a doctor? 

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College yearbooks here in the Philippines have this special quirk: not only does one have a picture dressed in academic attire, but also a creative shot, in which one could choose to wear anything, portray anything and be anything. Usually, it’s something else aside from the career one has chosen to study.

Being in a pre-medical program, it was almost certain that all of us would end up in medical school. So almost all of my classmates chose not to include anything “medical” in their creative shots. They imagined themselves as fairies, anime characters, or movie stars.

Always the class rebel, I chose one of the pictures taken of me while working in the hospital. It manifested how I really wanted to live my life as a medical graduate: that I’d rather live my life pursuing my passions than living life confined within the hospital. 

This is of course, not to denigrate those who have chosen to serve as hospital clinicians. I know what it takes to do so, and I have great respect for them. But as for me, I never liked life in the hospital. Because of this, in the course of my professional life I explored non-clinical and even non-medical career options. 

In short, I loved being a doctor, but I wanted to know how else could I become a doctor aside from being a clinician. Honestly, I initially didn’t have any concrete idea of what I wanted, and as a result I allowed myself to go with the flow of things. To my relief, these experiences led me to a greater idea of what I want in life.

So to answer the question: I think I would still be who I am now. 

How did it turn out?

Allow me to walk you through various stages of my life that allowed me to get to where I am now. It is actually a very opportune time for me to do this. In a week’s time I turn thirty. The added decade seems to tell everyone that this person has experienced a lot. For the past few years, I sure did.

After going through various difficulties and diversions along the way (which even included multi-level marketing at one point), I graduated from medical school at the age of twenty-four. I subsequently worked for the government health service in the rural areas of northern Luzon, and ended my stint as a rural physician at twenty-six, having done a lot of stuff in between: a member and eventual officer of a Toastmasters club, and a member of a charismatic prayer group. 

After my stint in government service, I was still not convinced that the hospital life for me. I then took on a personal journey that took me to a lot of places and situations, and allowed me to adopt various roles. 

Choosing not to pursue specialty training, I instead chose to become a researcher and educator, first in the state university, and later, in the college where I now work. Eventually, I tried out a live-in vocation discernment program, while trying out things like teaching morality and ethics to high school students, learning philosophy and theology, and writing assignments for literature class.

Perhaps by now this account has become a dizzying list of things that I’ve chosen to do instead of settling with a clinical specialty. Perhaps you’re wondering how I’ve been able to put up with all this; especially since every change of career represented the start of another journey. It’s always tiring to start something new. Why did I not choose something stable right away? I don’t know either. Maybe I’m free-spirited, a rebel without a cause. Or am I?

Notwithstanding, I’d say that I was able to go through all this as a way of learning how to live independently, to live alone and purposefully while not feeling lonely. It was more of force of circumstance than anything else. My family emigrated when I was twenty-five, four years too late for me to be included in the immigrant visa petition that allowed them to leave. It started quite painfully, having been raised in a deeply religious and tightly knit environment. 

But I felt that destiny had something in store for me with that event in our family. The nights I’d have to spend far away from family would have to be nights where I can dream and imagine how I can make a mark in the world. And thus, allowing me to try a lot of things.

In the mountainous region where I served, I was a manager by day, and visionary at night. I spent my nights dreaming for the best to happen to my area of assignment, looking at successful case studies, and thinking of how to make things better for the community I serve.

Back in Manila after that stint, I was a researcher and educator by day, and still a visionary at night. I wanted my research to impact on the lives of people I encountered as a rural physician. I wanted to speak on behalf of rural physicians and represent their interests in academia and policy. I wanted to soar and take the barrios with me. It was a tall order, and for me it was a sweet burden to bear. But destiny had another surprise. It led me to consider the possibility of living the religious life.

Under the tutelage of a prominent religious order, I joined a ten-month vocation discernment program, a sort of religious ‘aspirancy’, where I realized how important it is to get in touch with oneself, with all its quirks, emotions, desires, feelings and aspirations, which often come up recurringly in the frequent solitary prayer periods and the schedule I shared with my co-formands each day. It felt like heaven on earth, but it had difficulties too, which I felt were far outweighed by the spiritual advantages. At one point, I concluded that maybe this was the stable life I’ve always wanted. But at the back of my mind, I wondered what had become of my vision to soar and take the barrios with me. 

That question got answered after the ten-month program. I was notified that I was not to continue religious formation. Letting the dust settle after such a disturbing outcome, I knew they had good reasons for doing so. Perhaps they saw that I was better pursuing my rural-oriented academic goals. 

Nonetheless, I was devastated. Sometimes the pain can still be felt at times; it has only been only a little over the year since it happened. Frantically I prayed for answers, looked around and tried to zoom out of the situation. 

Thankfully, after getting back on my feet, going back to my halted academic career and reconnecting with friends and colleagues, I then realized that maybe, I’m better off in continuing my attempt to soar and lovingly take the barrios with me. And do so much more.

I rediscovered my passion for health care social media, and reconnected with dear friends at #HealthXPh. I learned how to write again, do public speaking, do research and teach again. But, armed with experiences of rejection and disappointment, as well as an enduring vision to do great things, I knew I wasn’t “crossing the same river” anymore, as Heraclitus wrote in a famous philosophical fragment.

Still, everything feels surreal.

“Surreal” would describe a particular experience that seems extraneous from mundane reality; in other words, something unusual. Something extraordinary. Modestly, I wouldn’t want to describe my life journey as extraordinary, but I do agree that it had been quite unusual. 

Wonderfully unusual.

And I can only be grateful and happy, for being the kind of doctor I’ve always wanted to be.

Removals

I have a confession to make.

Despite having the opportunity to study medicine through an accelerated program, I never felt fully convinced that a clinical career was for me. In fact, I felt that it was just a stepping stone towards a career that is more suited for me.

However, obedient son as I am, after having qualified for the program (which I did not really aspire for, I just did my best to get accepted to my dream college), I just studied to pass.

My way of studying at the time was through reviewers. I did not use books. I wanted to understand concepts from a bird’s eye view that reviewers offer. As a result, my grades weren’t as stellar as they were supposed to be.

As a result, exam after exam, I find myself near the bottom of the list. Growing up as an academic achiever back in high school, initially this was hard to swallow. I took it with much bitterness, but eventually I learned to let it go.

But I didn’t really study harder. Instead, I felt that I just had to strengthen my other skills. I joined the student publication of the medical school, eventually rising as its chief. I became active in some organizations and initiatives.

This was my way of doing things until reality caught up with me. Class standings were posted, from which I learned that I was to take a removal exam for Pharmacology.

Pharmacology was not really easy, but neither was it a subject impossible to excel in. There were a lot of things to memorize about mechanisms of action, the way drugs are metabolized and distributed to various parts of the body, and the variations that occur within drug classes. I knew that I hadn’t been doing my best, and I knew this was what I deserved.

Reviewing for the removals was a great pain, not just because of the regrets that accompanied the preparation, and not only because of the prospect of repeating this subject and getting delayed. It was also because of the realization that if I really had wanted to become a doctor in the first place, this would not have happened.

But it wasn’t time to hit the books and expect to learn a year’s worth of topics within a short time. Reviewers were precisely what was needed for this type of exam. With a chuckle I realized that my style of preparing for exams actually equipped me well to take removals!

We were sizable bunch of second year medical students who were to take the exam. During the examination I barely mustered the confidence to shade my answers, as question after question tested my so-called bird’s eye view of Pharmacology. The stress was palpable as we gathered in the examination room. To calm my nerves I said a little prayer to God: make me pass and I’ll make sure I won’t get to this point ever again.

Happily, I came to know a few days after that I passed. Not only that, I almost topped it. It was my first time to score near the top of any exam in medical school. Something that actually never happened again. Thankfully though, I likewise never removed a subject ever again.

It was a personal victory for me.

Additionally, I think this was my turning point: I developed a genuine desire for medicine, knowing that if I am to become a good doctor, I needed to have extensive knowledge of how drugs work.

Zooming out further, I think that this also made me think hard of what I wanted with my medical degree. Looking at things from a bird’s eye view made me think that perhaps medicine is just a vehicle through which I can sustainably ensure health for all.

There was something bigger to be achieved. But definitely, something that required me to pass Pharmacology. And something that demanded me to change my strategy in studying. I learned how to appreciate books, and the in-depth knowledge they provide. Though I continued medical school with a less stellar record despite my best effort, I did my best to make it up with extra curricular activities.

I found it a good balance to strike: a sustained effort to hit the books, while exposing myself to public health-oriented opportunities even as a medical student. Notwithstanding, my involvement in extra-curricular activities came with the responsibility to pass all my subjects. Thank goodness, I did, every time.

Now, as a professional, I was never asked about how I performed academically but how I made use of my knowledge and skills. Isn’t this what matters more?

Nonetheless, for all the medical students reading this, I cannot stress this enough: read your books. Before aspiring for a bird’s eye view of everything, know the material well. Master it. Live it. And imagine life putting the knowledge to good use: for the benefit of the patients and communities we ought to serve well.

Happy Easter everyone!

Soul-seeker

“What is your specialty, Doc?” I got asked this question by a wide-eyed, enthusiastic third-year student in the medical school where I teach.

“I think I can call myself a public health specialist,” I replied.

“But did you take up residency?” referring to the usual post-graduate clinical specialty track taken up by majority of medical graduates.

I relented. “No, but I took a master’s degree in public management for health systems. I’d say that would be my post-graduate training.”

“Then, Doc, you are a soul-seeker.” He explained that he considered as such those medical graduates who have not pursued residency. I tried to suppress a look of shock. “I guess I am,” I replied.

What disturbed me a bit in that encounter was this realization: that, as far as majority of people I know are concerned, the choice to exclusively pursue an academic or research career after pursuing a medical degree is still considered a transitional career choice towards a goal of eventually obtaining a clinical specialization. I cannot blame them.

To be fair, he is not entirely incorrect. I had just come from an almost yearlong hiatus in my academic career, having come from a live-in vocation discernment program for men considering religious life. I ended up not getting accepted to the religious order I had desired, but my experiences in discerning my true calling bolstered my conviction that my calling is in the academe. Soul-seeker I really was, in this sense. But I digress.

That encounter made me think hard. By now, and especially after my yearlong discernment last year, I now have a stronger conviction for my career choice; that, instead of pursuing the conventional career path of clinical specialization, I am choosing an academic one. Instead of aiming to become a specialist in, let’s say, surgery or psychiatry, I am aiming to gather enough academic exposure and experience to earn a professorial chair instead.

My colleagues in the medical school faculty, majority of whom have finished their respective residencies, have told me that I can do both anyway. But for the past few years, I realized that, as a medical graduate orientated more towards a population-health perspective, going through the path of clinical specialization would introduce bias in the way I would do my public health work and advocacies.

This leads me to one instance three years ago, when my former research institute director asked me this question: are you geared towards specializing in ‘content,’ or in ‘process’?  He further explained that specializing in ‘content’ would mean studying all aspects of that field, exclusively, with the expected consequence of getting heavily invested in a topic. If that would be a field like road traffic injuries, that would require studying factors that affect it, its special considerations, its prevalence, and even how it affects popular culture.

My director told me that doing so for a particular field would open up a Pandora’s box, and would lure me towards studying the field further, and potentially ignoring other important public health matters. I’d now call it an option of getting attached to a particular topic. Nothing bad with this at all, he said, but it represents a lost opportunity to study about other health concerns that pose similar risk to the general population.

On the other hand, it is his explanation of specializing in ‘process,’ that attracted me. It meant that I had to specialize in a particular way of analyzing public health matters, like epidemiology, health technology assessment, or even philosophical analysis.

By specializing in epidemiology, the study of how diseases spread, I gain tools that can analyze how much of the Filipino population would be prone to any health risk.

By specializing in health technology assessment, I gain the skill of assessing which intervention would be the most economical and answer questions like these: for instance, would implementing a large-scale healthy lifestyle program lower down the percentage of the population suffering from high blood pressure, or a government-sponsored distribution program of medicines? What is the more economical option?

Finally, by specializing in philosophical analysis, I can explore how lifestyle diseases, or any health matter in general, can ultimately come from the individual’s ability to reflect on his daily existence, to make logical and ethical decisions, and make sense of his role in the world at large.

These three modes of ‘process’ that I have been exposed to can be applied to any public health topic, which makes it possible for me to affect the lives of people millions at a time. When I decided to pursue medicine, my goal was to help as many lives as possible. I now feel that by choosing to specialize in ‘process’ and not ‘content,’ I can potentially contribute towards solving any health problem by using a particular way of analyzing the problem. I just had to know what problem needs to be analyzed. This required frequent introspection, zooming out from the situation, as well as sensitivity towards concerns that impact the general population. I know that by specializing in ‘process,’ I am becoming the kind of doctor I want myself to be.

However, I also realize now where specializing in ‘process’ led me. It eventually led me towards an appreciation of discernment, and even led me to think that perhaps a life of continual soul-searching within a religious context was for me. But events and circumstances led me towards where I am now, and I was never this affirmed of where I am called to serve.

Notwithstanding, my experience in specializing in ‘process’ also points to me that I have to free and zoom-out myself enough so that I can serve as many people as possible: my personal definition of why I am a doctor in the first place. Needs and circumstances change rapidly, however. This inner search should therefore be a way of life. Specializing in ‘process’ led me to be what precisely that student called me that fateful afternoon: a soul-seeker.

This leads me to pay attention to what is happening in the Philippines nowadays. I think that we are beset by problems that are mostly resolved by focusing and getting heavily invested on the situation, instead of looking at it from a non-biased, zoomed-out perspective. My experience in public service tells me that government can only do so much within its means, but my renewed perspective in studying ‘process’ also reminds me of the value of unbiased points-of-view.

Moreover, I think that as a nation we need to have a better sense of our identity. Specializing in a particular ‘process’ of resolving matters of national importance is one part of making sense of this identity, but I think that we need to search for what is indeed our soul and our purpose as a people. I learned that one leads to the other. Perhaps we need more people who specialize in ‘process’.

In sum, I never realized that such an innocent question from my student would set me off towards rationalizing my career choice and my reasons for choosing ‘process’ over ‘content,’ and realizing how the study of ‘process’ requires continual discernment. Continual discernment requires that, imperfect as I am, I should have the attributes of a soul-seeker in good faith: resolute, passionate and untainted. These are attributes that I am not so sure now if I can confidently claim them for myself.

I take solace that being a soul-seeker was who I am in the eyes of that student of mine. I hope he is right after all.