No eye has seen any God besides you, who acts on behalf of those who wait for him. Continue reading
No eye has seen any God besides you, who acts on behalf of those who wait for him. Continue reading
Found this speech while I was reading through my journal… Lots of things re-learned and realized while going through it again…
Department Graduation Speech
Allan D. Corpuz, MD
Chief Resident Department of Medicine UP-PGH
21 February 2013
Dean Agnes Mejia, Dr Rody Sy, Distinguished members of the EXECOM, Section Heads and Consultants and Faculty of the UPCM, Ms. Cecile Pena and Members of the Nursing Staff, Graduating Fellows and Residents, Family and Friends – I have always looked at acceptance speeches as “make or break” situations. Make or break because at this point of the program, many people have probably left, and those who remain are probably bored from the long ceremonies or are itching to have lunch with their family and friends. The acceptance speech, being part of the closing ceremonies, is the last hurdle before people head for home. At this point, people are usually groggy and less sharp. That raises the challenge a bar higher for the speaker, who, could either continue boring them to death or give them one last dose of inspiration, giving each one a send-off message that will stick to everyone’s mind like Velcro. It is my humble prayer that at the end of my talk, I will have accomplished that. Well, anyway, at least, Aubrey gets to speak after me. So truth is, the pressure is on her.
I’m very much honored to be in front of you today, in a gathering of some of the finest doctors in the country. Truth be told, and I’m not saying this to diminish myself, but I wasn’t considered among best or the finest residents in my batch. I was a supporter, a sideline cheerer; I wasn’t one of ‘The Residents.” In fact, I was only nominated as most outstanding resident on my senior year and at honestly at that time I felt I was only included because I was going to be chief. I had ok grades, minor administrative positions, small supporting roles. I wasn’t always like that of course. But for the most part, that was me. But I was always passionate about the things I did, even in the small things. And in the end, that was more than enough to bring me back.
Today I am going to share with you 3 lessons I’ve learned through my years of Residency then Chief Residency. That’s it. No big deal. Just 3 things.
Today marks the end of our “struggles” at PGH. For some, like me, it will commence again on March 1 as we start our fellowship training. But today, we are all graduating as residents or fellows of the institution. I chose the acronym E-N-D to highlight my points this morning.
When I was in first year, somewhere around October, I had 12 mortalities. That was 2 more than the total number of mortalities I had for the past 9 months. I was devastated then. I felt incompetent, inadequate. I was afraid I had set the record for the most number of mortalities in a given month and that was something no resident would ever be proud about. And while we were taught not to blame ourselves for death of our patients, especially for those who have come beyond the point of salvation, I still felt that I was mostly responsible for the lost lives. I wasn’t reckless or irresponsible then. I knew about and read well about my cases; I tried to see to it that they were getting the best medical attention possible. But they just kept dying. My senior then was this great guy named Mikey Reyes. He is graduating today with us. Sir Mikey had always talked about encouragement and empowerment. But he didn’t just talk about them, he lived them out. At my most vulnerable moment, Sir Mikey didn’t lecture me about patient management nor did he reprimand me about losing so many patients. Neither did he say that it was okay to lose so many patients in a month. He understood what I was going through, and patiently taught me and guided me without necessarily taking over. I was neither condemned nor condoned. There was no need to mention where I had gone wrong, or what I needed to do; he allowed me to realize that, and I did, in a better way than I could have had, if he had just simply taken the helm. In my second year, we had a great Chief Resident, Ma’am Ging Racaza, who is also graduating today with us. I have always read about principle-centered leadership but I have never seen it so beautifully executed until I met her. Her principle of “Killing with Kindness” was something radical in a department that was more used to merits and sanctions. She was criticized heavily about it, for being too soft and too kind, but in the end, she was well-loved by everyone, even the hardest of hearts. “Killing with Kindness” was so effective because it appealed to the residents’ inner good rather than to superficial responses, motivated by fear.
These 2 stories bring me to my first lesson – EMPOWER, ENCOURAGE and EMPATHIZE. At the Chief Resident’s Office, you’ll find a sign Hannah made for me. The sign reads: SPEAK THE TRUTH IN LOVE. It keeps me reminded about the lessons I learned from these 2 stories I just told you. Many times during the course of my term, I had complaints raised against residents, or even fellows. And at each time, as chief, I had to make decisions regarding these. And when I talk to the residents, much like Sir Mikey and Mam Ging taught me, I try not to condemn nor condone. Whenever I am told to blast a resident for misbehaving or to sanction them right away for doing something wrong, I talk to them first, learn about what they have to say. They are adults, and are supposed to be treated as such. And when one resident wasn’t performing well academically or clinically, I wasn’t quick to judge. I don’t point out mistakes. I realized that if you just talk to them, listen not to reply, but to understand, you will find that they themselves would come to realize the roots of their own problems and you’d even be treated to the joy of hearing them come up with concrete and creative solutions to their issues.
We will all lead our own communities as we walk out of the halls of PGH. And as we do, may we remember this lesson in empowerment, encouragement and empathy. If we divest ourselves of power and invest it in others in such a way that they are empowered and encouraged, and if we do this with a sincere attempt to understand them first, then we can transform people and communities and our reward is ending up with the greatest power of all, the power of seeing ourselves reproduced in others.
My second point is to NEVER REST. It was around October of last year. September to November are among the busiest months for a Chief Resident because of the Oral Exams, Preresidency and Annual Review. It was a very tiring and busy afternoon. Tarobs Razo, who frequented the office for different reasons was coming over. I was tempted to stop him in his tracks before he even sat down because I was really preoccupied with so many things then. In retrospect, I’m glad I didn’t. That was one essential lesson I learned during my term – always find time for people, even for and especially for the ones who are most difficult to deal with. Peoplework must come before paperwork. The great Mark Sandoval taught me that. He said I should not fall into the trap of becoming a glorified secretary because I was something more than that. I should become the chief of residents. I never let that slip out of my mind. So, that afternoon, Tarobs and I talked. And while all that time I thought that I was going to mentor him, in the end, it was I who got mentored. I was telling him about how busier I was getting every day and how I felt at that time, that the better I handled my tasks, the more work flowed in. I felt, that because I was reliable, many tasks which were not mine were being passed on to me. And it was becoming tiring to the point of burnout. He told me about the parable of the talents. Most of you know the story. It was a about a Master who was leaving. He gave each one of his three servants 5, 3 and 1 talent, given according each servant’s ability. Upon his return, the one who had 5 doubled his talents to 10, the one with 2 already had 4. But the one with a single talent, simply buried it and did nothing about it and just returned the talent to the Master. You probably know the ending. To the first 2 servants, the master said – “Well done! Because you have been faithful with a few things, I will put you in charge of many things.” And the servant who rested and did nothing – his one and only talent was taken away and was given to the one who had 10.
Tarobs pointed out the lesson to me, and it was something I still remember to this day – “The reward of good and faithful work is more work.” And it is not something to be sad about. God gives us opportunities and responsibilities according to our abilities, not so we could rest, but so that we could maximize them in a relentless pursuit of excellence and in turn create more opportunities for others. Never resting doesn’t mean that we don’t sleep or play. It means to never stop working towards being the best, in whatever situation we are or wherever we are placed. It means taking more and more responsibilities as we continue to improve because we understand that the more capable we become, God expands our “borders” so that we can touch more lives and help more people. It means keeping on doing great work despite the weariness and frustration because we know that this is the only way to be truly satisfied and because this will create ripples of influence that will reverberate to our future successors. It means, as the late Steve Jobs would say, “Staying hungry, staying foolish, and never settling.”
This leads me now to my last point. To accomplish great things, one must DIG DEEP, DREAM BIG. When Mam Diana told me early August that I was nominated as Chief Resident, I had mixed emotions. To be included in an elite company was great, but honestly, I was more fearful than excited at that time. It was something I never expected, much less dreamed about. As I said, I wasn’t among the chief residentiables from the start. Considering how I got into trouble during first year which made me controversial and unpopular, the chances of me being Chief Resident was as high as the chances of Jaime Aherrera playing for the Philippine Basketball Association. I just wasn’t cut out for it. In my first year of residency, I attempted to quit twice. I almost didn’t make it. But I did.
It is said that when God wants to do something great, He always starts with a difficulty. But when He wants to do something truly magnificent, He starts with impossibility.
So, inspite of the improbability of being chosen, I said yes when asked if I was going to take the job, knowing fully well that the learning curve would be steeper and the adjustment period shorter than usual. Digging deep for me means having faith in a personal God, trusting Him to accomplish what he has set out for me to do and not worrying about the outcome. I knew the responsibility was going to be tremendous, but after praying about it, I wasn’t afraid anymore. I took the plunge knowing that my God will deliver the right outcomes. My job was to work with all my might. His job was to see to it that his good purpose is accomplished in me and in the people I deal with. Dreaming big means me embracing the responsibility of leading the department because it was something I was deeply passionate about. I might not be the most brilliant among my peers, but I knew this was something I wanted to do – lead.
I believe in the principle of 360 degree Leadership – that position is immaterial, and one can lead from below, lead across and lead from the top. It is this principle that allowed me to do the right thing and do it excellently with or without recognition.
Most of all, after much prayer and reflection, I took the job because I knew it would give me a chance to work with one of the brightest stars in the field of leading – Dr Agnes Mejia. Not a lot of people would have this honor and privilege to be mentored by one of the finest. I fondly kept the text message she sent me the day I was told I was going to be chief: “Allan, thank you for accepting a most challenging task, one that is always looked upon with awe and respect. I look forward to a memorable year with you.” Every time I am filled with weariness and my mind is beaten by disappointments, I always go back to those words and they never fail to bring comfort and refreshment. And learn from the master I did. The sweet strict cadence of working on a clock, the precision of a surgical blade when it comes of carrying out the task at hand and the strong uncompromising devotion to family are but a few of the pearls passed on to me. I couldn’t ask for more. Mam Agnes and I share a special bond. I look up to her with deep fondness and respect, like a son does to a mother. I fondly remember us having her iPad lessons closed door, in her office. In a less than a month, she was sending email through her iPad, much to the delight and amazement of her contemporaries. How close was I to her? Only I know her new email’s password ☺ We still text and email each other once in a while, sometimes just to greet and say hello. She still updates me about Jimboy’s latest accomplishments in track and field, and still goes to me for consult regarding computer stuff. As you all know, I was blessed to have served under two chairs. I dreaded the prospect at first because I thought the adjustment would be difficult. But not everybody had the same opportunity as I had. It is said that no man can serve two masters. But I did. And it was the best experience I ever had. Under Dr Sy, I learned selflessness and humility. Dr Sy is a very busy person, and yet, he always has time and with a ready smile, for everyone, who comes to his office. He never preached about these values, but the way he lived them out spoke louder volumes. One time during Christmas, when no one was at the office Hannah said she saw Dr Sy entertaining watchers who are asking questions at the office. He was guiding them where to go and what to do. A few minutes later, while we were fixing decors, some fell down at the floor. Dr Sy stood up and helped pick up some of the decors. He didn’t consider these tasks too menial. That, is worth emulating. Dr Sy was always open to suggestions and he always asked everyone’s opinion about matters in the department. He was a brilliant strategist, yet always saw to it that our inputs were considered. He didn’t necessarily follow them, but he heard each one of them out. He always tried to be present in our activities, including small resident-level ones. And he always has food during meetings much to the delight of everyone, of course.
Chief Residency was both revealing and redemptive to me. Revealing because it showed me that it is in my emptiness that I have the capacity to be filled. I have much yet to learn. Redemptive because, despite being the least expected to be chosen, it gave me a chance to do something I like to believe I am good at.
There are times, however, when an overwhelming feeling swoops through me and there are moments when I have doubted my own capacity to deliver. Chief Residency in PGH gives you a lot of that. The name, the title, is nothing compared to the responsibility that comes with it. It is in times like this that I dug deep and drew more on the love that I have for what I do and for the people I lead – and it never failed to bring an oasis to me. I realized that it is not through my successes or victories that I was able to lead well. It is through the difficulties that I experienced as a resident that allowed me to empathize with people, understand and relate to what they are going through and provide comfort to them.
Had I been popular, I wouldn’t have understood how it felt to be left out and unnoticed. Had I been always on top, I wouldn’t have understood how it felt to struggle and would never have learned how to lift others up. Had I been the obvious choice, I wouldn’t have appreciated the post and loved it with a passionate and undying dedication. Because I counted myself unworthy in the first place, I finish the race with both feet planted on the ground, the position never getting into my head… Unworthiness taught me to be humble and grateful.
I hope it’s something I will leave to all of you. Let’s stay away from entitlement mentality – the thought that the department, the training committee, our leaders owe us everything. That’s a very “me-centric” type of mentality, something I spent much of my time trying to demolish during my term.
As I join the elite company of chief residents who preceded me, I am deeply humbled. I would like to dedicate this award to the following:
1. To my Lord and Savior Jesus Christ. You have provided me the opportunity to minister to the department of medicine and have given me the grace to persevere amidst the tough challenges.
2. To my Mom and Dad who are here with me today and my sister Annalyn. As Dr Jubert Benedicto taught me, “No amount of success will ever compensate for failure at home.” Im glad I have a beautiful family. Thank you for putting us, your children, as your top priority. You have been very patient and understanding, and have continued to support my endeavors. I am only successful because you have grounded me well in faith and values. I hope I’ve made you proud today. I love you with all my heart and soul.
3. To my ACRs – Mike, Jaime, Joyce, Arthur, Gelza, Abby and Herb – Im extremely proud of you guys. From you I learned this lesson: Small dreams are reached alone. Great dreams require others. You cannot succeed alone no matter how talented or skillful you are. I’m glad I have you as friends. Thanks for the teamwork that made our dream work.
4. To the Medicine Office Staff – Mam Gina, Mam Cris, Mang Dan, Sir Jerome, Mam Liway, Mam Minerva, Mam Chrismie, Mam Melissa and Mam Nilda – I never thought you’d like me much because I was serious and robotic. But you did, and I’m ever grateful. Thanks for the friendship that gets better with time. I’ll miss our photoshoots at the office.
5. To the graduating class of fellows and residents – for bearing with me as your Chief for 2012. And for playing your roles to the utmost of your abilities making it, as Dr Rey Tan would always say – a good year.
6. To Mam Agnes, Sir Rody – for the trust and mentoring. To have worked with both of you was truly the icing on the cake.
7. To the consultants, especially Dr Dans, Dr Nicodemus, Drs Rey and Iris Tan, Dr Palileo, Dr Ona, Dr Tranquilino, Dr Benedicto , Dr Manapat-Reyes and Dr Alejandria – for the snippets of wisdom through my term.
8. To the residents – who stayed with me through the highs and lows of the year, for trying to behave in a manner worthy of an IM resident and for sharing their talents and creativity to make 2012 great.
9. Finally, to the love of my life and bestfriend, Hannah. It was difficult enough to be first year endocrinology fellow –with all the tasks and responsibilities. It was even more difficult being in a relationship with an equally busy chief resident. And yet you never complained. And you always found time for me. Thank you for never skipping lunch with me, even if we had it at 10 am or 4pm. You cried yesterday when I read parts of my speech because you said that could feel each memory coming alive again as a recounted them. For you were there in the direst and toughest situations and you lifted my spirits whenever I came to the point of breaking. And you celebrated each milestone with me. It was amazing how you juggled your responsibilities so you could spend time with me, to hear me out, to talk with each other or just so you could help me and fill in for my deficiencies. You did it all behind my shadow and yet you never asked for anything in return. I never could have done it without you. Thank you for the sacrificial love. I am ever grateful and I love you for all time.
Last year I read an interesting story which I shared with the preresidents during their orientation. I would like to share them with you today, as I end.
“In every police department, a yearly proficiency test in marksmanship is conducted to ensure that every police officer can use his weapon accurately. During the test, an officer is instructed to fire 12 shots in 18 seconds into a target from a distance. He is then evaluated with regards to how accurately he hit the target in that short span of time. It was a warm, humid day come day of examination. A young police officer who had recently been fitted with a new pair of trifocals stepped into the target range, sweating heavily, filled with so much anxiety and pressure. He has to pass this test if he wants to be retained in the department and to be promoted to a higher rank. He took his gun, loaded 12 bullets and set aim. It was a hot day, and sweat was dripping heavily on his brows. To his dismay, the new set of trifocals was more of a liability than of use to him today. The humidity coupled with his heavy sweating formed a fog on his lenses obstructing his vision. 18 seconds. The clock started to tick. His heart began to pound. Time was running out. It was then when he remembered what his senior officer told him during his early days in training. When you can’t see your target, remember your position. He aimed his gun again, grounding his feet steadily into the ground, keeping balance. By this time, he had less than 18 seconds left. He fired his 12 rounds rapidly, steadily. By the time it was over, he walked over to the target. To his and everyone’s surprise, he had hit the bull’s eye 12 times.
When you can’t see your target, remember your position.
This is the final message I would like to leave to everyone in this room. Eventually, we will all leave the halls of this institution to venture into new horizons, take increasingly difficult asks and brave new challenges. And a day will come when we will be overwhelmed and our vision obscured by doubts, frustrations and failures. And when this happens, may we be able to overcome by digging deep – remembering the grounding that our training institution and mentors have given us. May we keep this in mind always so that our aim may be steady and true.
When we can’t see the target, may we remember our position – remember our roots, remember how we were grounded. The values we learned are the same ones we can draw strength, fortitude and guidance from. May they always stay with us.
Empower. Encourage. Empathize. Never rest. Dig deep. Dream Big.
WHAT IS LUPUS?
Systemic Lupus Erythematosus (SLE) or simply “lupus” is a condition that can cause inflammation in many different parts of the body. It affects people in different ways causing symptoms in different parts of the body – joints, kidneys, skin, heart, lungs and nervous system. Usually 2 to 3 parts of the body may be affected.
There is nothing you could have done to stop yourself from getting lupus. You cannot catch lupus from other people or give it to others.
Lupus is an illness that may go on for years, or for your entire life. It is unpredictable with times when your symptoms are worse (we call this a “flare”) and at other times when you may have few or no symptoms.
WHAT CAUSES LUPUS?
We don’t know what causes lupus but we do know that it involves the immune system. Our body uses the immune system to protect itself from harmful things such as bacteria and viruses (bugs).
We are not sure why some people have an immune system that does not work properly. However, we do know that when some people get sick, it is caused by the system being overly active and causing harm to itself. This is called autoimmune illness. Lupus is one of these illnesses.
Females are more likely to get lupus than males, approximately in a 9 to 1 ratio. Sometimes, there is family history of lupus or other autoimmune conditions.
WHAT ARE THE SYMPTOMS?
Lupus can be hard to diagnose as there are a lot of different symptoms that people may have. You probably won’t experience all of them, most people only have some. You generally need to have 4 or more specific symptoms to be diagnosed with lupus.
The usual symptoms are a butterfly shaped rash,photosensitivity (sunlight and lights can cause rash), fever, kidney problems, fits/seizures, fatigue and tiredness, headaches, hair loss, mouth ulcers, shortness of breath, painful or swollen joints, chest pain and memory loss.
Symptoms can change over years and can come and go.
You may have periods of symptom flare up and periods of wellness.
HOW IS IT DIAGNOSED?
Go and see your doctor. He or she will take a history of your problems and symptoms which can give clues to your condition. It is not uncommon for people to have lupus and its symptoms for sometime before they get a diagnosis. Your doctor will do a physical examination and order some tests (blood and urine tests usually) to help decide whether you have lupus and to see if your immune system is working properly or is overly active.
If you do have lupus, regular blood tests will be done by your doctor to monitor your illness and keep you healthy.
If you are being seen by a GP (General Practitioner), he will refer you to a specialist. Lupus involves different types of care because it affects any organ in the body. The symptoms you have show what parts of the body are affected and need special attention. A Rheumatologist is the primary doctor who is specialized in treating autoimmune diseases, including lupus. He will occasionally work together with other types of specialists as he sees it fit, according to your symptoms, like a nephrologist (for kidneys), a dermatologist (for skin), a neurologist (for the brain, spinal cord and nerves), a cardiologist (for the heart), a pulmonologist (for lungs), an endocrinologist (for hormones and metabolism) and a gastroenterologist (for the stomach, liver and intestines).
HOW IS IT TREATED?
Everybody has different symptoms so your treatment will be based on your symptoms and problems. Your doctor (Rheumatologist) can explain which ones can help you.
The most commonly used drug is Prednisone. This is usually given to you at a high dose when you are first diagnosed and maybe to help you when you have a flare. The dose is gradually reduced at times when your illness is quiet and when new drugs are given. Other drugs may be given to help reduce the steroid dose (Steroid Sparing).
There are many other drugs that are effective in treating specific symptoms. Your doctor will talk to you about these.
Most drugs work by helping to balance the immune system.
There are some health supplements and aids that can be used to reduce symptoms, for example soap substitutes, eye sprays, and special oral care items of mouthwash and toothpaste.
Both patients and their friends and relatives need to be educated well about lupus to avoid unnecessary stress and unhelpful comments and advice.
There are some things you can do to help make things easier for people with lupus…
Things that may be helpful:
Lupus can be well managed and most of the time your life can be relatively normal. “Flares” may be associated with certain triggers such as stress, infection, sunlight or something else. You will, get to recognize what the triggers are to your symptoms. Knowing this will mean that you can deal better with them. Between “flares” you may feel well and be symptoms free.
You will need to find out what works best for you.
Know about lupus and how you can help reduce the effects of lupus and its symptoms. Consult your rheumatologist.
“unwell…too tired…unable to keep up…”
Looking healthy is NOT equal to being healthy in lupus.
Fatigue is a real and significant issue for these patients.
Working too hard can trigger a flare.
Lupus is unpredictable.
Patients need focused and specialized medical care.
(Video adapted from Lupus UK: http://www.lupusuk.org)
from the lecture of Dr. Frederic Houssiau delivered during the #LupusACA 2017 Convention at Melbourne, Australia
It takes an average of 5 years before patients with Rheumatoid Arthritis become diagnosed with the disease. By this time, they have contracted significant disability or disfigurement.
Most patients are mistaken to have gout or osteoarthrits and are given medications which take away the pain temporarily but don’t prevent progression of disease.
When in Gout, consult a Rheumatologist… 😊
Gout is an episodic, severely painful form of inflammatory arthritis caused by increased uric acid. It afflicts 1.6% of Filipinos and has increased in prevalence over the last decade. It primarily affects men, starting in their 20’s. Women, mostly those who are post-menopausal, may become victims as well.
Left untreated, gout becomes more severe and attacks more frequent as time goes by. It may be triggered by eating purine rich foods. It also can be seen in patients on various medications like aspirin, diuretics and some anti-TB medications.
During gout attacks, pain is extreme. Even lightly touching affected joints can be intolerable. Patients are unable to walk or put any weight on painful joints for days. This leads to missed days at work, anger and depressive symptoms, and overall poor quality of life.
Later on, chronic gout can frequently lead to kidney stones, joint erosions and deformities, large visible joint and soft…
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A friendly reminder/warning to our dear patients (From the Philippine Rheumatology Association)…
The Philippine Rheumatology Association warns the public against the use of UA Block, an unregistered herbal supplement for arthritis. The Philippine Food and Drug Administration (Ph FDA), through advisory no. 2015-035, has declared this drug to be potentially dangerous to health. Rheumatologists have observed serious medical complications which may be associated with this product among some patients.
Selling of this product is in direct violation of the Food and Drug Administration Act on 2009 (Republic Act No. 9711). To ensure public safety, we call on everyone to remain vigilant and report establishments selling these products to firstname.lastname@example.org or (02) 807-8275.
Link to Philippine FDA Advisory No 2015-035 here.
The Official Site of the Section of Rheumatology, UP-Philippine General Hospital
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