1:33

So this weekend, I ran the 2016 Bay to Breakers.  At 1:33:04, my pace was a far, FAR cry from my most recent race, but whatever.  It's been a looong 6 years littered with multiple false starts (and injuries - don't forget the injuries), but I'm back.

My stats for the race.  Everything kind of sucks, but at least I "placed" within the upper 50th percentile.

I've wanted to run BTB after reading about it on a running friend's blog a number of years ago.  It seemed like a fun, slightly off-kilter race, a longer version of a fun run.  I won't belabor the point about how zany the race is, as a cursory google search will yield enough reports.  Personally, I did see some completely unexpected things, such as a group of pirates cheering from a rooftop and stormtroopers working out on ellipticals (!).  There was also a fair amount of nudity that I was able to snap pictures of... pictures that I won't post here out of good taste and fear of prosecution.

Not to make excuses for my deplorable finish, but my goal wasn't really to finish fast.  It was to finish, period.  The BTB was a "proof-of-concept" that I can still run long(ish).  Now it's time to step up my game and train to run fast(er).  Next up, a half.

Not to make any excuses for a future deplorable finish either, but I think I may have injured myself a bit during this race.  It feels like someone is stabbing the side of my left ankle whenever I put weight on that foot.  I honestly don't think it's anything serious - probably just tendinitis from trying to finish strong while running on the sloped portion of the road - but we'll see.  Hopefully I haven't inadvertently destroyed my chances of running 26.2 again at some point.

Provided that my foot pain isn't anything more serious like a stress fracture, my next race report will be about a half.  We'll see.

At the starting line.  The race runs from east to west, so I was staring straight into the sun when I snapped this selfie.

That's what I was looking at.

There's something odd about this picture... can you find what it is?

My neighbor showed up to run.

At the finish line.  I'm not really smiling, I'm just breathing hard.  Note the alar flaring.

Race bib and finisher's medal.

An Open Letter to the Mindanao Times

OK, so I am not necessarily a crusader against idiotic bloggers or columnists, but I cannot abide by their idiocy.

On July 20, 2015, the Mindanao Times published a column from Fely V. Sicam entitled, "Are resident doctors really doctors?" The answer of course, is yes, but since she doesn't know that, she went on a tirade about how a friend was recently humiliated during a trip to the emergency room. I'm writing this from my phone and I don't want to type too much, so here's the link to her article: http://mindanaotimes.net/loud-whispers-are-resident-doctors-really-doctors/

She raises some valid points about health care towards the end of her article, but being partly correct shouldn't excuse a "journalist" from basic fact-checking.

This may is may not result in some backlash heading my way, we'll see. Responses to these sort of people usually result in p!ssing matches consisting of ad hominem attacks and claims of "That's not what I meant, you need to educate yourself and read between the lines." In other words, I expect them/her to double-down instead of apologize. I hope to be pleasantly surprised. 

If anyone's interested in sending their own feedback, the Mindanao Times can be contacted at

times.editors@gmail.com and mtimes46@gmail.com.

---

July 21, 2015

To whom it may concern,

I am writing in regards to an article that was published in your newspaper and website on July 20, 2015, entitled, "Are resident doctors really doctors?" authored by Fely V. Sicam. (http://mindanaotimes.net/loud-whispers-are-resident-doctors-really-doctors/) Unfortunately I am unable to find Ms. Sicam's contact information, so I am forwarding my feedback to you.

The editors at your publication need to improve their vetting of what is published. Ms. Sicam's basic premise is wrong. Resident doctors are in fact real doctors. In her third paragraph, Ms. Sicam makes a distinction between licensed doctors and resident doctors. One cannot be a resident doctor without becoming duly-licensed first. Even if it was possible to do so, Ms. Sicam does not take any steps to verify her doctor's licensure - she simply makes a blanket statement about resident doctors predicated on her ignorance of this fact as well as assumptions based on superficialities. She's not even internally consistent. The resident said: "I'm a resident doctor," but she says he never spoke in English, which he just did.

In her fourth paragraph, Ms. Sicam gives her opinion of what she deems to be a "real" doctor. This is beside the point. Her primary question is, "Are resident doctors really doctors?" to which the answer is yes.

Because of her wrong premise, Ms. Sicam becomes incoherent. She is against fake doctors and inhumane ones. And ones who don't speak English (but really do). What about real doctors who she thinks are fake? It's unclear because she can't even distinguish.  While Ms. Sicam has some valid points regarding the expediency of her friend's care as well as the law punishing the illegal practice of medicine, the inadequacy of health care is a broad-based multifactorial problem that many people are trying to fix from various angles. Ms. Sicam can help with this fix... But only if she takes the time to check her facts first.

I would be happy to discuss this further if you or Ms. Sicam desire. Thank you very much for your consideration.

Yours,
JB Chong


*Updated on a laptop later at 10:10am, mainly to add text to a paragraph and improve formatting.  The text of the letter itself remains unchanged.

A New Hope

Five years later, twenty pounds heavier, and two inches wider - i finally ran three miles outside again today.

To put things mildly: my fitness has really taken a nosedive in recent years.  After my glorious finish at the Grand Rapids Marathon (not really) in 2010, i got saddled with one injury after another and was never able to run more than three miles again.  Looking back, my problem probably lay in trying to fix what wasn't broken.  After reading Christopher McDougall's "Born to Run," i tried HARD to change my stride from the "improper" heel-strike to the "proper" fore/midfoot strike.  Shortly thereafter, i got ITB syndrome.  When that settled down, i got Achilles tendinosis.  And whenever that showed signs of improving, i got posterior shin splints - bad.  One would think that my body would have gotten used to it, but it never did.  I would cycle between the tendinosis and shin splints every two weeks, all the time trying to get at least one 3-miler in.  Then i started my busy fellowship and BOOM, no more time to consistently work out.

Thankfully, my schedule as a third year fellow with budding senioritis has not been as punishing as the first two years of training.  So over the past few months, i've been putting in a few miles at a time on the treadmill, albeit gingerly.

A month ago, it hit me again.  Two miles into an intended treadmill-3-miler, i felt like someone put a knife in my right calf.  It was then that i just said TO HELL WITH IT and decided to go back to heel-striking.  The Tarahumara and their sandals be damned, i ran for five years and finished a marathon with my heel strike... i was going to go back to what worked before!

It was perhaps one of the best decisions i've ever made.  After resting for a week and recovering from my calf strain, i got on the treadmill and just ran.  I paid no heed to form or "proper" foot strike, but rather just dialed in a pace and did what came naturally.  Wouldn'tcha know - i've been able to go up to four miles now with NO PAIN.  I don't know if this should serve as a lesson to everyone out there who read the same book, or just to me - but if the heel strike isn't causing any problems, there's probably no reason to change it.

I only wish it hadn't taken me this long to realize that.  Now, time to see what the future holds.

About as fast as a jogging sumo wrestler, but it's a start.  

Dr. Ting's Response to "No Dr. Ting, Not Every Medical Graduate Should Aim to Do Internship at the UP-PGH"

"Hi Sir JB!

"Thank you for posting your personal opinion about your internship in UP-PGH. I agree with you that UP-PGH is NOT for everyone (for it is only for the brave ones who apply, the qualified who get accepted, and the patient and diligent ones who persevere), but I also believe in looking at the positive side of every situation.

"I apologize if by any chance you misinterpreted my article as falsely describing the realities in UP-PGH. And I am also sorry if, as an intern, you were "envious of your friends who did internship elsewhere", and if you felt the "absolute insularity of the people you met" here at UP-PGH. I cannot comment on the residency programs since I am not yet a resident, but as far as internship goes, I stand firm with what I have written down based on my own personal experiences.

"Also, I am not, in anyway, putting down or belittling graduates doing internship in other hospitals. I think it would be too immature and close-minded for one to interpret and understand my article as such. Because in the bigger picture, all of us regardless of where we are (private hospitals, government institution, etc.) have equal responsibility in uplifting the health status of the Filipino people.

"Yes, each of us go through difficulties everyday at PGH (and interns in other hospitals as well), but as I've always emphasized, everything is just a matter of perspective. At the end of the day, we are all still doctors, and the common end point would still be patient care and patient outcomes.

"I wish you all the best in your career and life in general!

"Cheers,

"Fred Ting

"-- 
"Domine Opus Tuum - Lord the Work is Yours! - Habakkuk 3:2 

 
"-Fred Ting
"Post-Graduate Intern
"Philippine General Hospital

"Health and Peace Advocate, Writer, Lasallian, Filipino."

No Dr. Ting, Not Every Medical Graduate Should Aim to Do Internship at the UP-PGH

Over the past few days, Dr. Frederic Ting's blogpost, "10 Reasons Why Every Medical Graduate Should Aim To Do Internship at the University of the Philippines - Philippine General Hospital (UP-PGH)" has been making the rounds on Facebook.  I am happy for his success and his completion of what was probably a very difficult year.  I do however disagree with him.

I commented on his blog, but the comments need to be vetted/moderated before appearing.  To date my comments have not appeared, so i am assuming i either: 1. submitted wrong, or 2. got vetted out.  If it's the former, i don't want to keep trying because i'm sure i'll screw up again.  If it's the latter, it's his prerogative.  However, i do think my comments merit some "airtime," so i've taken the liberty of posting them here, in their unedited glory:

"Hi Dr. Ting,

"Congratulations on completing your internship and good luck with your boards, with your positive attitude I am sure you will do well with your future endeavors.

"While I appreciate your sentiments I respectfully disagree with most of your points.  First and foremost I am unsure that "every" medical graduate should aim to go to UP-PGH; every person is of course different and no internship is a one-size-fits-all solution.

"Regarding your points:

"1. It's unfair to say that "we can’t deny the fact that the University of the Philippines is a place where most, if not all, of the brightest people in the country get accepted and enroll."  I am not sure if there is a registry where statistics back this up...?  If there is I stand corrected, but while I know that UP-PGH probably "accepts" the best and brightest (by their standards), this does not mean the best and brightest necessarily all try (or even want) to go there.  UP-PGH people will laud your statement, but it's somewhat insulting to people who actively decided to go someplace else.  The notion that not going to UP-PGH makes you somehow mediocre is just flat out wrong.

"As to points 2 through 10, I think you can safely replace "UP-PGH" with {insert hospital name here} and still be mostly correct.

"I see that the intern's job hasn't changed much since I finished my internship there in 2002.  Interns still mostly take vitals and draw blood, which is not bad as long as you know what you're getting into.  I think interns at other places are doing more though.  I turned green with envy when a friend of mine who went to Jose Reyes told me the story of seeing someone in the ER with pneumothorax, doing all the diagnostics, putting in a chest tube, and THEN calling the resident.  We can discuss safety issues surrounding this separately, but the fact is that he carried more responsibility and was more of a doctor on many levels than me dutifully running between wards 1 and 3 checking vitals, giving meds, and extracting blood.

"My main frustration with going to UP-PGH was the absolute insularity of the people I met there.  Every PGI was regarded with suspicion and they would be "shocked" when an outsider was actually even good.  (i.e. "Magaling siya kahit hindi UP, ha.")  Again, very insulting and condescending behavior.

"My personal approach to every medical graduate would be to carefully consider where they want to commit the year of their post-graduate life.  Look at all the facets of the internship: patient load, exposure to cases, quality-of-life, quality of the faculty - and decide if it's a good fit for you.  UP-PGH should be considered on those grounds as well, not just defaulted to because its graduates say it's "the best."  If you flatten out the playing field in your mind and stop looking at one institution through rose-tinted glasses, you might be surprised at what you find."

Comments are always welcome!

Link to Dr. Ting's original post here.

How is the Fellowship Going?

Going into fellowship has been one of the most humbling things i've experienced in my life.  It stripped all the facades i had built up over the last five years bare and exposed my glorious ignorance for all to see.

In all honesty, i thought i was a good hospitalist.  And maybe i was, which was the problem.  In five short years, i had mastered the ability to expedite a hospital stay (maximizing DRGs) and had memorized enough time-tested spiels to guarantee patient satisfaction.  I could come in at 8am, round on 16 patients, discharge 3 before lunch and admit 2 after, and still be at the gym to do a few miles on the treadmill by 5pm.  Unfortunately, in the pursuit of efficiency, i had allowed much of my deep medical knowledge and critical thinking skills to atrophy.

The first few weeks were an eye-opener.  As i pored through the books and papers that comprised my chosen specialty, i realized that a lot of what i had known in residency (and even medical school) i had already forgotten, and whatever had come out in the past few years, i had not kept abreast of.  It was basic stuff, but i had stopped paying attention because i had learned to distill it down to "what is the most important thing i have to know to improve my throughput?"  My mediocrity was laid bare; everything i had consulted a pulmonologist and intensivist for in the past, i was being consulted for myself... with me having only a rudimentary idea of what i needed to do.  My biggest shame was that i didn't even know how to read a chest x-ray anymore; for the past five years, my chosen method of "reading" an x-ray was to pick up the phone and ask the radiologist on-call what he saw.  I felt like an idiot, like an impostor pretending to know medicine when all i was good for was asking others for help.  The only point in my career when i felt lower was when i had just started out as an intern.  I considered quitting and going back to my old "cushy" job more than a few times because i wasn't good enough for a subspecialty.  But i slogged and putzed my way through.

Things are a little bit better now that i have a whole year under my belt.  I've read more journal articles and book chapters in the past twelve months that i have in the past eight years (yes, including residency).  I can now interpret chest imaging without talking to a radiologist.  I can translate PFTs into their appropriate clinical correlations.  I can discuss most lung diseases from physiology to the latest treatment options.  I can (almost) put lines in with my eyes closed and do a decent diagnostic bronchoscopy without getting huffed at for poor technique.  While i still feel moronic most days, "most days" has come down from 90% to around 60%.  Of course i still make mistakes, and i'm deathly afraid that my errors will cost (or have already cost) someone their life.  So i work hard to fill in the gaps in my knowledge and correct my bad behaviors.

Most importantly, my fellowship is not all about hardship and self-loathing anymore.  Ultimately, despite all of my perceived difficulty, i am on the whole enjoying myself.  I love learning about things, be it "old news" (such as the Fletcher-Peto curve from 1977) or "hot-off-the-press" stuff like edoxaban for PE.  I am tired and chronically sleep-deprived almost all the time from all the hard work and studying, but when my brain and my body are running on all cylinders, that's when i feel like i'm truly applying myself, like i'm doing what i was built to do.  And i am loving it.

So, how is the fellowship going?

In a word: good.

Love and Whatnot, Part 5

I have never been able to make any sense of these two statements:

1. "Live your own life, make your own money, and travel," and

2. "Collect before you select." 

The first is a mantra that older women pass on to their younger counterparts when they start having significant others.  The point (i presume) being - that the girl should stay single and not allow herself to be tied down so she can do her own thing and be happy.  Whether or not "travel" implicitly includes having naughty relations with various men from other countries (oooh, those sensuous Frenchmen) is beyond me. 

The second declaration is much like the first, although applicable to both boys and girls; that is, that you should "shop around" and date people of different shapes, sizes, and dispositions so that you're exposed to the whole spectrum of relationships before you decide what's best for you.  After all, it's impossible to know that you're "meant for" somebody if you haven't even tried the competition yet. 

Well -

Half my lifetime ago, when my girlfriend and i first got together, naysayers left and right tried to blast the idea to bits.  Different permutations of the above statements were thrown around and psychological warfare was declared.  Essentially, we were told (and compelled in not-so-subtle ways) to cease and desist.  The underpinning philosophy was that fourteen-year-old kids are not expected to understand their budding emotions, that it was easy to mistake a crush for True Love, etc. - essentially, that we were doing THE WRONG THING. 

Of course, being the antipatiko that i am, i brushed them off my shoulder (not enough room for both them and that big chip there) and did things my own way.  Making the long story short: although it was not a straight shot from there to here, my girlfriend and i stayed together through thick and thin, went against the "wisdom" of our elders, and never got it on with other people. 

The end result?  Now we're happily married.  

Before we got together, we seldom used to go out (no interest, no money).  Then we became an item and the whole world just came ALIVE; we started going out at night, discovered strange food in out-of-the-way restaurants (including turo-turo), watched plays and movies (we're not much for clubbing) and just overall had a grand old time. 

When we were single, we never used to travel for pleasure (too much work, not enough inclination).  Now we plan vacations together and explore every nook and cranny of this strange and wonderful world hand-in-hand. 

Back when i was much, much younger, i mused about the future with a sense of impending doom, wondering what the days ahead would bring.  Now i look forward to living and loving every single day with my wife and One True Love, flying off and disappearing into the wild blue yonder. 

There is no solitary way to live a life; no simple declaration that can teach you how to conduct relationships, no single piece of all-encompassing advice that can guarantee happiness.  No one should be able to force-feed a cliche down your throat and tell you that this is the way it should be!  We've spent half our lives proving that.  Still, there will be cynics out there who will look at my marriage with disdain and say that i settled too early, that i should have looked around more, that i don't know what i'm missing because i boxed myself in.   

But somehow, lying beside my wife at night, watching her sleep and feeling a little firecracker of love go off in my heart whenever i think of our lives together and all the days, weeks, and years we have left to spend with each other - i know i was right.