egcarlos

[egcarlos]

The Struggles of a Struggling Optimist

The Struggles of a Struggling Optimist I’ll always remember her face as I saw her taking care of her sick daughter in one bed, out of 20 other beds, in a compact open room that we called the Le Soins Intensif, “The Intensive Unit” while I spent my time in South Kivu in the Democratic Republic of Congo. Her daughter was one of the sickest patients we had encountered while I was there. She was likely born with HIV that she got from her mother (who likely got it from her husband, who I never saw). Due to her respiratory symptoms and having to need oxygen, we were treating her Pneumocystis Pneumonia, but coverage had to be given for bacterial and also fungal pneumonia because I had no way to confirm her diagnosis due to the lack of diagnostic equipment I was given. There were some days in which she looked better than others. There were days in which I saw her drinking the local porridge and awake. I would try to wean her off oxygen and lower her oxygen. There were days in which she was tired and sleepy all day and I would try to figure out, along with all the other local doctors I was working with, what else we could do. Her mother was always there though. She never left her bed. She was always happy to see me and happy to give us her trust. Because, in the boondocks, in that part of the country, we were the best chance that she got with her daughter. She was looking great despite recently starting her antiretroviral therapy for HIV. I struggled with this patient. I was emailing the advisors for Doctors Without Borders in Spain every day about this case and asking them what else we could do. So that day when her daughter passed away was one of my lowest points of that time. I was in some other part of the hospital when I heard the mother’s scream as I ran quickly to her bed. I saw her mother on the floor, flailing and yelling horrendously as I saw her daughter’s lifeless body laying peacefully on the bed. We didn’t even try to resuscitate and doing so is pretty traumatic and often futile since we had no ventilator support anyway. Her mother ran outside and I ran out there with her. She was crying, yelling and all I could do was listen and take it all in. I put my hand on her back and just sat down and heard the cries, the yelling and I tried to burn that moment into my mind and soul. I wanted that moment to stick with me for as long as I live because it was a moment that signified what it really means to be an optimist, to try to be positive in an insane and absurd world where blatant inequality is such a slap in the face for most of the world. With each cry, with each tear I wanted to feel her pain, to feel her struggle, to feel that sense of loss of a young child because nobody in this world should have to feel that. Her daughter’s death was a failure of not only her state, not only her government’s country, but it is a failure of this world. Each premature death is a failure on us. It is a shame on us. While we can’t imagine our own children dying and struggling in that way, dying from an infectious disease linked to HIV, for the rest of the developing world, this is their reality. This is just the way the world is. That is where my optimism brought me. I ended my mission prematurely at 3 months (I was supposed to be there for 6) because I couldn’t stay there any longer.

I wanted to be back home. I wanted to hold my son. I wanted to see his face and realize how extremely lucky I am that he may never had to deal with that kind of struggle his whole life. Back when I graduated residency in 2019, I gave the graduation speech at my program. I was an optimist then, and I still am now, despite all that I went through, but at that point I was still young and naïve. I talked about Nelson Mandela and his autobiography; how he had to spend 27 years in prison to eventually become the first Black President of South Africa. He says, “I am fundamentally an optimist. Whether that comes from nature or nurture, I cannot say. Part of being optimistic is keeping one's head pointed toward the sun, one's feet moving forward. There were many dark moments when my faith in humanity was sorely tested, but I would not and could not give myself up to despair. That way lays defeat and death.”

The struggle of being an optimist is that we live in a world that is not kind to those who consider themselves optimistic. The more good you want to do in this world, the harder it is going to be to actually do good. It is a lot easier to cheat, to be greedy and to be selfish than to do the exact opposites. Now, more than ever am I seeing this to be more apparent. The world is struggling now with wars, dictators, climate change, extremism and everything else that could make an optimist decide to go the opposite route. But as Mandela says, “… but I would not and could not give myself up to despair. That way lays defeat and death.”

[egcarlos]

Food, Faith and Family

As the end of June was approaching, the health of my grandfather started to deteriorate. So, I decided to set a trip to the Philippines to arrive on July 20, not knowing that he would pass away July 18th.

It’s not like it was totally unexpected, my grandfather is the type to not tell anyone what is wrong or what is bothering him. His pain tolerance is incredulously high, so for him to tell us that he wanted to go to the hospital around the second week of July, we knew something was up. It was a stressful 2 weeks for all my family, not only those who were actually present in the Philippines, but also for me as I was the one trying to coordinate and approve lab work and procedures for my grandfather. It was very difficult trying to communicate with doctors several thousand miles away in a different time zone. I regret having lost my patience with them at times and questioned their motives as the treatment they were offering my grandfather was sort of disjointed and scattered. At the end of the day though, that afternoon on July 18th that I got the news that he passed, I thought, It’s probably for the better.

He was almost 85 years old and lived a beautiful life filled with so many accomplishments, friendships and service to his community. His success and sacrifice in turn gave my mom the opportunity to find her own, starting the domino effect of leading me to where I am today. In the Philippines, it is custom to have a more extended wake filled with multiple services and prayers. For almost a whole week, I spent majority of my day in the chapel where my grandfather's body was being displayed socializing with my cousins (who slept in the chapel at night!), meeting relatives I haven’t seen in years and being able to spend quality time with some of my best friends from the Philippines who love and admire my grandfather as well. Despite it being a wake, followed by the funeral on the very last day, it really felt more like a party with laughter, lots of food and prayers. The only two things missing from making it a true Filipino party was the beer and the karaoke!

Faith, food and family are so intertwined in my culture. I guess you can say that about a lot of other cultures as well, but it is just so apparent every time I head back home. Churches, religious articles and catholic figures are everywhere. In Ususan, my hometown, today actually is the feast day of St. Ignatius (July 31st) and for the past week there has been a night market filled with street food to celebrate his feast day. It made me reflect and think about faith again, as I haven’t been the stand-up ‘good’ catholic the past several years. I’ll attend mass every now and then, but if I don’t have my family or my parents around, more likely than not, I probably won’t go. I don’t want to say that I’ve lost my faith, its just that I think my faith has changed or more so, the expression of my faith has changed. I am very thankful to grow up in the family that I have who grew up believing in God and going to church as my faith became a foundation for my life from the start. There were many times during undergraduate and medical school that I prayed so hard to be able to get through my classes and exams. Having faith gave me humility and gave me a reason to hope bringing me to where I am today. It's just that now, it just really feels like I’m actually able to live my faith out. I have the ability to serve God’s people; I am able to go to work everyday and give them the opportunity to be healthy and also serve God’s people as well. What touches me so much about the Chirstian faith is that we believe that God came down to earth and took up our own flesh and blood to live, suffer and sacrifice like us. It gives our humanity, our pain and our struggles meaning. There is significance in our everyday lives and struggles because God thought that it was significant enough for God to experience life as we know it. Each life is supposed to be significant, meaningful; each life matters. I think one of the gravest of sins is when we don’t acknowledge the humanity of a person. When countries (developing or developed) don’t acknowledge the significance, the importance and the holiness of one life, well, I think that this is when God gets the most mad and disappointed. Paul Farmer, infectious disease doctor and anthropologist and founder of Partners in Health said, “The idea that some lives matter less is the root of all that is wrong with the world.” When a 5 year old living in the Democratic Republic of Congo dies from malnutrition or malaria, or when an unhoused individual from Skid Row in Los Angeles dies from Hepatitis C or when billionaires make their money on the back of the poor- I think this is when God actually gets the most disappointed. I guess, at the end, one can say that my religious practices have changed, but I still think that my faith has always stayed the same. I am a product of my past and my past, being Filipino, is also filled with a lot of family, food and faith. One of the many beautiful memories that I have of my grandfather is that whenever we would talk in the phone, he would always make a point saying that

Lagi kitang pinagdadasal, or  I am always praying for you And yes, I believe that his prayers worked. And now, he is continuing to pray for me and my family up in heaven. We love you Lolo.

[egcarlos]

Opportunity

Opportunity

It’s been a whirlwind of thoughts and experiences since I last wrote. I am currently back in Bukavu and I’ve decided to cut my time away from home short. I’ll be back home next week, instead of May. Sure, I had a lot of complaints and concerns about MSF and the hospital I was made to work, but at the end, the bottom-line is that I miss home, I miss Yamini and I miss Rio. There was not one day in this trip that I did not think about him. I see pictures of him and try to talk to him daily, but its not the same. Deep down, I really wanted to complete my 6 months here, but well, I just couldn’t. Je suis faible. I am weak, is what I tell others. Being given the opportunity to be away and pursue my dream, while yet being also a father and a husband is a privilege. In fact, opportunity is the word I think I’ve been reflecting on my last several weeks in the project.

Opportunity. You can have all the potential in the world, but if you do not have the opportunity; if you were born to a broken family, or forced to grow up in a country marked with poverty and corruption- makes all the difference. The difference between me and the patients I helped and the local staff that I worked with was just a matter of chance. I say this all the time in my blog that I was born in the right place, to parents who stayed together and to a family that had the opportunity to move to the United States. I cannot confidently tell you whether shear hard work and dedication brought me to where I am today, sure it played a part, but this opportunity was given to me and made freely available. Where several billions of others living in our world long just to simply have the opportunity. I could feel that sense of urgency in some of the people I met. I went to a small town called Penekusu, it was about 4 hours away by motorbike from Kalole to give a few lectures on HIV/TB and check out how their program was running. There was one doctor who had so many questions. His level of curiosity was amazing and such a pleasure to see. He asked about the possibility of a vaccine for HIV. He asked about specific cases he has seen at this hospital and so many more. But, he also works in a setting where resources are limited and medications are prone to run out. When I did an inventory of his program, they had run out of phase I or medication for the initiation phase of tuberculosis and they had no HIV medication for children. His laboratory had a microscope to be able to run the Zeel-Neelsen test, a stain/coloration to detect tuberculosis, but besides that, the government, nor MSF had given him the tools for a successful TB/HIV program.

Back in the main hospital in Kalole, the main reference hospital for that district in South Kivu, a hospital where you could have multiple patients in one bed and about 10-20 people in one large room, it is so tough not to imagine seeing my family having to use this kind of facility. It is so tough not to imagine my wife having to take my son to a hospital like this, laying down on a bed with another sick child. Luckily, Rio will never have to experience this; God forbid- if he gets sick, he will be able to have his own bed, his own room, and the best medical technology that the US can offer, but these kids in Kalole, well, the best that they had was me. I guess that explains it, right? This absurd inequality is just accepted in the world as if this is how it should be. Why does this have to be the way it is? How can the world just sit back and accept this? How can we let so many people die as if their lives have no meaning or purpose. This is why the world is as shitty as it is today. This is why there’s so much filth, so much hatred, so many lies and deceit. Just imagine how much in terms of potential we are losing because we openly and blatantly allow suffering this way? Just imagine how many children die without an education, without the ability to dream and realize what they were made to do? After this project, my second with MSF, I feel worse than when I did leaving South Sudan in 2020. Its so hard to describe because its not really pessimism, I still have hope, in fact I know I should and I do, somewhere in my soul, its this sense of sadness; its another slap in the face about what reality is; it’s a wake up call to the fact that whatever problems we have now, whatever concerns, worries, failure we believe we have, it could really be worse. I’ll be back, stepping foot onto US soil this Thursday with, I believe, with a different mindset than I did before. I still consider myself an optimist, I still consider myself hopeful and bright-eyed, but because of what I’ve seen, the deaths I’ve had to observe, the mothers’ cries and howls after their child passes away, the frustrations and complaints I have with humanitarian work and all of its imperfections, I guess I am now a cautious optimist. I know that for the world to improve, idealism must lie with practicality. I can’t just hope that benevolence and the good will win in the end, I have to make sure that people are given the right and opportunity to do so. But anyway, that’s my rant. There is more where that came from, trust me. I don’t know where these thoughts and experiences will take me. All I know is, I have the opportunity and I must use it.

[egcarlos]

Why I Do This

          

    It´s kind of been a whirlwind of thoughts and feelings since I gotten to the first project that I’ve been assigned to fly into. I´ve had to change my perspective on my goals and objectives here in this project and my time overall with MSF. I was assigned to improve the HIV/TB program in each of the projects I visit, but along with that, I have also been making myself helpful by working in the pediatric wards, which has been taking up the majority of my day.               The town is called Kalolele, there are no major roads to get here, and it is only accessible via helicopter or airplane. There are no vehicles in sight, only motorbikes. There is a road supposedly that one can use through motorbikes that would take one back to the capital, but it is rarely used and expensive. Kalole is a very young place, I’ve read in a project briefing that the median age here is about 19 years old. The majority of hospital admissions are children, which is why I am always in the pediatric wards in the usual morning. I feel like I’ve assimilated well in their medical team here and I look forward to helping and rounding with the local doctors. I´ve seen some difficult tropical medicine cases, such as cerebral malaria and many vaccine-preventable cases such as tetanus and measles. I have gotten a handful of new TB related cases every week, pulmonary and extrapulmonary TB. The majority of extrapulmonary TB I have seen are TB lymphadenopathy cases and one probable peritoneal TB case.               As for HIV, I am seeing a new diagnosis at least every two to three days. They have usually been in children, a few very young children below the age of two, usually presenting for fevers and having a positive malaria test, but due to their malnourish state, get tested for HIV. It made me more alert to re-present the guidelines for MSF to prevent mother to child transmission of HIV, which I will be presenting with one of the local nurses next week Tuesday. The local HIV nurse in charge of their program is great; she is hungry for knowledge, capable and tries to be as organized as she can in this kind of setting. Mind you though, there is no Wifi in the hospital and all of her records are hand-written which can be very tedious work. We´ve also made it a habit almost every weekday to meet at 4 PM to discuss an HIV/TB topic and talk about it so that she learns something new.               There is one case that I´ve been thinking about and is a constant reminder for me why I should and will always make the time to work in these settings in the future. There was a 15-year-old boy presenting about 10 days ago for a large swollen abdomen. Family says that his belly has been gradually getting bigger for the past 1 year, parents have tried traditional local medicine with no relief. They come from a town about 2 hours away using motorbike. On presentation the boy is in moderate distress, emaciated and appears about 10 years older than his stated age. Due to the high prevalence of tuberculosis in this setting, our first instinct as a team was to discuss the probability of TB-related peritoneal/abdominal disease. My first project in South Sudan had quite a number of these cases as the people living in that region drink unpasteurized milk, so Mycobacterium Bovis infection was quite common, and the presentation was very similar. Cases that I have seen responded well to anti-tuberculosis medication, so we started him on them right away.              

For all patients presenting with TB symptoms, we also run a panel of other tests, which includes the rapid antigen/antibody test for HIV and the antibody tests for both Hepatitis C and hepatitis B. To our surprise, the hepatitis C antibody test was positive. The viral hepatitis diseases are very difficult to treat at this level in the Congo. MSF, despite all the good that it aims to do for the people it wants to help, does usually have a narrow scope of aid. Treatment for Hepatitis B could be started, but Hepatitis C is a completely different story. Due to the lack of (financial) interest by pharmaceutical companies to make Hepatitis C treatment more accessible to all people, this child will likely die from liver failure secondary to hepatitis C. Now, I have no way of confirming whether this patient does have active disease or not; the hepatitis C test that I have been given to use does not confirm active disease, it just says whether the person has been exposed to Hepatitis C or not. In fact, there is a chunk of patients that will clear the virus on their own. But, if he does have active disease and the cause of his abdominal swelling (or ascites) is hepatitis C due to the liver starting to fail, he will eventually die from the disease.               This family has no means to go to the capital and seek treatment. The best we could do for this child is continue the course of TB medication, as long as can he tolerate it, treat his symptoms related to Hepatitis C with diuretics and paracenteses (abdominal puncture to let out fluid). He will be sent home this upcoming Monday with follow up at the local Ministry of Health clinic by his home. Him and his family were thankful for our help and services, but we emphasized as a team that his symptoms may continue to come back and that it may not be curable at this level. It´s very difficult to communicate this kind of news considering that this is my first French speaking project and that this family only speaks Swahili so all communication had to be dealt with a translator. Despite this saddening news, he was excited to go home and asked when he can go back to school.               It´s these kinds of cases and people that I have met in my life that leave a kind of thorn hanging on my side. It makes me uncomfortable thinking that we live in a world so capable to accepting this kind of injustice. Having a growing son and a family now, I want the best. I want my son to grow up, go to a nice school, become educated and live a life of relative comfort, but, its theses kinds of cases and situations that leaves a sense of discomfort thinking about that. It´s not like I shouldn´t want that for him either, its just that, this is the kind of world that we live in.               It´s all a roll of the dice.               It´s the luck of the draw.               It´s an unfortunate truth.               I want my son to somehow realize this as well. I want him to see that what he has, others do not have and that this life is only worth living if we can find a way to try to right these wrongs. I shouldn´t have to accept that this 15-year-old boy will die here in the Democratic Republic of Congo, but if he were to be in my family, if he were my son, he would live and reach his potential in the United States.                 But… this is why I do this.               This is why I am here.               I choose to see this.

[egcarlos]

Why I'm Here

It's always wet and muddy here in Bukavu

This week has been slower than what I expected my first week back with MSF would have been. I am still in the capital of South Kivu, Bukavu. I had a meeting yesterday with the medical coordinator of the project and she said that I will likely be out into the projects hopefully by Tuesday, but most likely Thursday of next week, depending on when I will get my work visa approved. Nonetheless, I am making use of my time here in the capital by trying to improve my French with the other ex-pats in the house. I’ve made another friend, his name is Mamadou, a nurse from Niger. At least three times a day he sits in the balcony to smoke his shisha. I take this opportunity to sit next to him and blab out whatever French I can muster. He doesn’t seem to mind my broken French and we’ve had conversations about religion, family, and politics here in the DRC and in his home. The Head of Mission, Sebastian is from France; despite the rapidity of his speech, I find it a little bit easier to understand. He is usually pretty busy so I catch maybe 10 minutes with him in the morning. Juan, who also goes by Jose is from Spain. Initially, I got very self-conscious talking to him in French because I couldn’t really comprehend what he was saying. Come to find out, his French was no better than mine, which is the reason why I couldn’t understand him.

But anyway, outside of my French speaking ventures in the house, I finally got to speak to the doctor that I will be replacing. Her name is Alexandra from Denmark. I received a text message this morning on my Whatsapp asking if I wanted to talk to her today. I of course agreed without hesitation because I am hungry for more knowledge and to gain at least whatever familiarity I can about the projects. Around 9 AM I walk to the MSF office and find her waiting for me with another ex-pat. They both speak English to me, which was not completely welcomed because I want to improve my French, but I go with the flow and to build rapport, continue to speak in English. Alexandra and I walk out of the MSF office and into a hidden coffee shop just about a 10-minute walk from where we were. The coffee shop is a gem here in the neighborhood; it is called Bazima Coffee. It’s a rather popular place for NGO workers as I notice we were not the only foreigners enjoying a drink. I ask for a hot chocolate as she orders a cappuccino and an ash tray as we grab a seat. Her story is quite interesting, and I enjoyed the conversation I had with her. Aside from the formalities in the beginning about project details that seem more or less verbal diarrhea for now as she was naming abbreviations, I was not familiar with and names of nurses and doctors that flew by my attention, we got into the conversation about stigma and its continued harm in the community. Because of the problem of stigma and gossip that eventually comes with it, sharing the HIV status of a person, even among health workers, is risky, especially if the health worker is part of the community. For the project, only the clinician and the health worker performing the test will know the result. From what I was told, rarely will it be written in the person’s hospital charts, nor will it be known by all the medical teams involved (for instance, if the patient is also getting a surgery, it is up to the surgeon to ask if that patient is HIV positive, if relevant for him/her). To me, this is inefficient and creates even more of a stigmatization of HIV, but at the end, this is it. Long-lasting change is going to be a long and tedious process in a context where the ministry of health is almost non-existent, where war and poverty are the norm and where health education is lacking. Change can happen, but it will not happen in the way that I want it to. This is one of the things that I learned working in my first project working in a similar context in South Sudan; MSF, more so NGOs are not going to be the answer to the situation in where they are currently working. We are here to help and to contribute in the best way that we can, but it will not be perfect, nor should we expect it to be. Alexandra has been working with MSF for the past 30 years, both as a field worker and as a referent and she gave me an interesting representation of what NGO and humanitarian work is like. She had me imagine several boats that were trying to get across a body of water. We, as the field worker, are at the beginning with all of the boats as their captain. We can try to push one of the boats forward- if the boat is ready, prepared with everything it needs to move, it’ll start moving forward at the pace it wants to. If it is not ready, no matter what I do as the captain, sometimes it will just not move. My job for this mission is to observe what boat I can start moving in the projects when I arrive.

I know the table above is in French, but just to summarize, the current positivity rate for HIV in Kalole is 3.59%. To put this into perspective, the positivity rate of HIV in the United States according to the CDC is 0.5% in 2021. The positivity rate in Kalole is about 7 times higher than it is in the United States.

But anyway, she leaves to go back to Denmark Sunday morning. She tells me that she has two teenage boys waiting for her when she gets home. She will also be back to her regular job as a pediatric infectious disease specialist in a local university and she will also be practicing medicine in Greenland for a little while as well.

At the end, this is why I’m here. My work as a humanitarian worker will just be a tiny drop in a vast ocean and it is up to me to make my time here significant. I’m here because I am an optimist; I'm here because i know that the tiny drop that i can contribute, although miniscule, is necessary for things to keep afloat.

[egcarlos]

The past several times I had to travel, I was with a baby, so I didn’t really have time to think about things. But, after a 14-hour flight from Seattle to Doha, a 7 hour layover before my 6-hour flight to Kigali and another 6 hour drive to my final destination, Bukavu, one can’t help but reflect on life in general.

I arrived to Bukavu late Friday afternoon dead-tired. From what I was told in the email a week before, I was supposed to have a night to spend in Kigali to get some much-needed rest, but once I arrived to the guesthouse, the driver asked if I wanted to leave that very moment. I said yes without hesitation although I wish I hadn’t. I almost threw up on the ride. The route was beautiful; the weather was mild, everything was so green, and it was such a warm and welcoming sight back to the continent of Africa, but the route was also twisty and turny. My already empty stomach wouldn’t stop churning throughout the 6-hour drive. I was surprised I fell asleep at some parts of the ride which helped make things go by faster. When we finally got to the border crossing between Rwanda and the DRC, I thought I had to put my French skills to the test to get the necessary stamps and visas to cross, but luckily I traveled with another ex-patriate from Mali, Ali, who spoke perfect French, so he got us through quite easily. As we arrived to the office, we quickly got some of introductory formalities taken cared of and off we both went to the house. I’ve been so looking forward to working with MSF again. Ever since I left my first project in South Sudan in 2019, I knew I would be making plans to work my way back to another post. I luckily arrived on a Friday, so I have absolutely nothing to do over the weekend. There are about 8 other people in the house, I only got to speak to 2 other ex-pats. Ali was assigned to the other house unfortunately and this is not his first project here in the DRC so he knows a lot of the locals in the area, so I haven’t seen him since Friday. One of the ex-pats invited me to go out with the other workers to catch a drink, but I was dead-exhausted and I almost vomited just thinking about alcohol. The first thing I did Saturday morning, I went out for a walk. It rained the night before, so I was sloshing my way around in the mud. I walked about 5 miles in total. I bought myself a local ‘croissant’ which was more of a heavier, thicker version of pain au chocolat. My pants and shoes were a mess when I got back, but it didn’t matter to me; I used the same pants and shoes for my Sunday walk too. My Sunday walk was a lot better than yesterday’s because it hadn’t rained overnight. As I was welcomed back into the compound, the lady who opened the door already knew my name. I felt bad because I didn’t ask her for her name, but I will when I see her next time and ask her.

And now, I am here. Sitting down in front of a gorgeous lake front view of Lake Kivu. It’s a shame though because there is absolutely no access to the water literally 30 feet away from me. There’s a locked latch that I guess we are not supposed to try to open; there may have been some accidents in the past with ex-pats falling into the water? Ha, I don’t know. But here I am, thinking about life; missing my family, missing my parents, missing Yamini, and missing Rio. I was comforted this morning because after a video call with Yamini, Rio was doing his thing; active and mumbling as usual. He is well-loved at home, and I know deep in my heart that I should feel at ease. Once the work starts, I know that I will be immersed in it. I may not have this time to just sit and think for a while. I am still not totally clear on what exactly I am doing in these projects. I have yet to meet the person that I am replacing; all I know is that she is a female and that is that. She is away in one of the projects over the weekend, so I hope to meet her tomorrow, Monday. From what I read, MSF- Spain is in charge of 3 other projects here in the DRC; Kalehe, Samamabila and Kalole. As their ‘Flying’ specialist, I will be called to these projects on an as needed basis when there are patients to see and to evaluate the needs of these projects. Based on my reading, it sounds like getting to some of these patients can be a challenge and some are very remote. I was reading that I may have to not only go on foot, but also ride on the back of a motorcycle to reach some of these health centers. Safety and security will be on the back of my mind and will be one of the first questions I will have for the person that I am replacing. But anyways, that’s all I know. I can just focus on being here, in front of this beautiful lake for now. I can enjoy this time to think about life. All my other roommates are still asleep; it is about 8 AM this Sunday morning.

I read this beautiful line last night in Victor Frankl’s book, Man’s Search for Meaning, The Truth- that love is the ultimate and the highest goal to which man can aspire… The salvation of man is through love and in love. I understood how a man who has nothing left in this world still may know bliss, be it only for a brief moment, in the contemplation of his beloved. When I think about my family, when I think about Yamini and when I think about Rio, I am complete. I have all that I want in this world. God, the universe, fate, love has given me all that I have ever wanted and more. This is why I am here. This is why I am thousands of miles away from home, hoping to give whatever little I can offer to make this world just a little bit better- because I am complete and this universe has given me so much. I know that the next 6 months will fly by and at the end will seem just a drop in time. I have no idea what to expect and where I am going, but all I know is that this is where I am meant to be.

[egcarlos]

Doctors Without Borders

“Why would I want to see the world any other way than the way it is?” - The Imperfect Offering

James Orbinski, Canadian Physician, Doctors Without Borders President 1998-2001 There’s this book that I have read and reread several times in my adult life called The Imperfect Offering by James Orbinski. It is a highly intense book that gives a grave and often graphic account of his time in Rwanda during the genocide that took place between the main tribes, Hutu and Tutsi. The history between the tribes is very complicated and goes all the way back to the colonist rule by mostly Belgium. Tribal fighting is never as simple as we like to think. Politics, colonialism and pinning one tribe over the other by the colonists are just three out of a plethora of reasons why fighting and ultimately acts of genocide occurs.

Beyond that, he gives little hints and insights on to what drove him to a career in medicine; that includes his immigration from England to Canada, to his spiritual and mostly Catholic upbringing and to his questions about suffering, it’s existence and what he can do about it.

There’s this line in the book that comes up at a very crucial time after Orbinski returns from Rwanda back to Canada. In the paragraphs before, he discusses hints of PTSD that has eroded his mind from the inhumanity that he observed from his time in Rwanda. He talked about his meeting with his spiritual advisor, Benedict and how he also spent time in counseling talking through his experience. And then, after all that he drops this quote, Why would I want to see the world any other way than the way it is?

That line in the book has stuck with me ever since I first read it back in 2015. I love that quote so much that I placed it as a signature in the bottom of all of my emails. There is something so deep and profound to me after hearing that quote, because it gets me asking, why would I not want to see the world any other way than the way it is? I can see how easily I can live my life in a bubble; in pure, utter ignorance to the plight and struggles of the world. I could choose not to turn on the news or radio to hear about the disaster happening in Palestine. I could choose to not think about the suffering of this world and not wonder about how in the world did I get so lucky just to be able to eat, breathe and live. I could choose to continue to avoid unnecessary inconveniences and suffering for myself and live my life with comfort. But that quote, Why would I want to see the world any other way than the way it is? It hits so hard and so deep. The quote above makes me want to see suffering, it makes me want to feel suffering. It makes me want to feel the truth. Because really, at the end, the truth is that we live in a beautiful world that is suffering greatly. Despite all the good that is out there, despite the art, the beauty, the music, the altruism that I know deep in my heart that exists in our world also lies so much pain, so much suffering and so much unnecessary sadness. So many lives go unlived. So many potentials, goals and dreams go unnoticed or realized. Why would I want to see the world in any other way? --- In less than 2 weeks, I will be on a plane for my second project with Doctors Without Borders. I have no idea what to expect. I don’t really know exactly how I feel at the moment because the next few weeks will be busy filled with last minute things that need to be done and a lot of tennis (trying to squeeze in all the tennis that I can before I leave). I have a family who has always supported me to do the crazy things that I choose to do and a wife who understands the importance of not only dreams/goals, but the importance of Dharma and believes in me and my duties in this life. Last, but not least, it is going to be the hardest thing leaving my baby boy. He is 17 months now and he will be almost 2 years old when I get back. I don’t even want to think about not being able to see his smiling face in the mornings and kissing him before he goes to bed at night. Why would I want to see the world in any other way than the way it is? Most importantly is that I am just so lucky. I have been incredibly lucky to have the life that I have right now; to be able to breath, eat and live; the be able to laugh, love and play; to be able to grow, learn and suffer. There’s this obligation somewhere that I don’t really understand. Some people may call it an obligation to maybe God, or the universe, or to just something bigger than myself. I’ve just been given so much good in my life that I have to keep finding ways to keep giving it back.

[egcarlos]

Selfish

“All I know is I am very selfish. I want fulfillment in what I do. I want to know that this life given to me was meant for something.”

I wrote that line up there from a blog back on September 29, 2018. That was almost 5 years ago.

I am writing this blog, at 11 PM at night, everyone is asleep. I am currently back in Seattle, back in my parents’ house, you know, like old-times. Only now, I brought with me a wife and a son. Can’t get any more like old-times than that, right? Joking aside, fast forward to 2023 from 2018, I am now done with fellowship and subtly, but eagerly awaiting my next post with Doctors Without Borders. This evening, I downloaded about 50 pdf files from the WHO website on guidelines I should get caught up on. I am so excited and ready for another run with them because I know that this is where I can fully be the doctor that I always dreamed of myself being. I know, I’ve said it back in 2018, I am selfish. I’m married to the love of my life, I have a family that will support me in whatever I decide to do and now I have little baby Rio at my side and yet, I still have this… calling? Call me crazy, ha, colleagues around me have. Call me ungrateful, which is the exact opposite of how I feel. Call me selfish, which I have already labeled myself. I know that life would be a lot more simple if I decided to take a job here in Seattle, where my wife is now in fellowship, where my parents and sister is living and where my son can now settle and grow up. I know that there are so many people I can help out here as well; the United States, despite its economic and worldly success is still far-behind in actually taking good care of its people, especially those that are the most vulnerable. I could earn a decent salary, start saving for Rio’s college tuition and look forward to a life of reasonable comfort. But, I know that I’ve just been built with this sense of restlessness and dis-ease. I’ve written about this before. I feel like we all have been born with it. Some of us decide to live with that dis-ease and die before our own physical death. Others, at least I know with me, it has been fueling every move and decision in my life. I wrote this in another blog in September 7, 2017

“As for those desires and for the end goal, I have no clue of what it should look like. Whether it be to pursue life as a humanitarian doctor, as in Médecins Sans Frontières (Doctors Without Borders) or to stay in America and pursue underserved work here, I have absolutely no idea.”

Reading that quote above today made me smile.

Fast forward to now, 2023, I am still going with flow. My five- year plan does not exist; in fact, I’ve always hated that question in interviews and essays. I still have no idea where these goals and ambitions will take me.

All I know is that the time is now. The time is ripe. I am so grateful to have a family that loves me, and has supported me in all the crazy-stupid things that I have told them I wanted to do. It really cannot get any better than this. Sometime this fall, I will be leaving out to the Democratic Republic of Congo as a “Flying” HIV/TB Specialist for Doctors Without Borders. This will be a lot different from my first project as I will be going around to the different encampments that MSF is involved with in the DRC. I know that I am more than capable to do this job and I just can’t hold my excitement. Plus, I have to start using my newly found French, oui, oui señor.

I’ve shared these quotes from famous people in my blogposts in the past below: “When it feels like my dreams are so far, Sing to me of the plans that you have for me over and over again” Switchfoot “Who says it easy to be loved. When you look over your shoulder and only see the wasteland. You just got to carry what you can. Have the heart of a giant, but know you’re a man” Roo Panes “My mind inclines now, more than ever, towards hope. I’m constantly shedding the assumption that a skeptical point of view is the most intellectually credible. Intellect does not function in opposition to mystery. Tolerance is not more pragmatic than love. And cynicism is not more reasonable than hope. Unlike almost any other worthwhile thing in life, cynicism is easy.” Krista Tippet

“I wanted to…feel hatred and love, despair and tedium– all those simple, yet foolish things that make up everyday life but that give pleasure to your existence. If one day I could get out of here, I would allow myself to be crazy, everyone is indeed crazy, but the craziest are the ones who don’t know they are crazy; they just keep repeating what others tell them to.”Paulo Coelho

“Most men lead lives of quiet desperation and go to the graves with the song still in them”Henry David Thoreau

"I was not sure where I was going, and I could not see what I would do when I got to New York. But you saw clearer than I, and you opened the seas before my ship…And when I thought there was no God and no love and no mercy, you were leading me all the while into the midst of his love and His mercy, and taking me, without my knowing anything about it, to the house that would hide me in the secret of His face." Thomas Merton

“If you believe yourself worthy of the thing you fought so hard to get, then you become an instrument of God, you help the Soul of the World and you understand why you are here”- Paulo Coelho

--------------------------------------------------- These are just some of the examples of the quotes, the words and the voices that have been fueling me since I embarked on my journey into becoming the person that I am today. I’ve decided from the little that I started out with that I will always look at the brighter side; I will always believe in faith, hope and love and that I am more than what my doubt, frustrations and failings tell me I am. If there is one thing I could tell my 18-year-old self, starting off on this journey into medicine, leaving my parents’ home is to feel that dis-ease; feel it, think about it and wonder why it exists. Make it the reason why you get up in the morning and why you stay up at night. Understand that this yearning, this craving is what is making you more than a person, more than a human being, more than a life just taking up space on earth. Now, I am back full circle. I am back in my parents’ house, in their living room as if I have been here the whole time; with a little more hair on my head and on face, maybe now a grey hair or two as well. You know, as if nothing happened.

[egcarlos]

Restlessness and Letting Go

One thing that I’ve dramatically noticed as a parent is that once you tell people you have kid, you’ll be gathering multiple sets of advice from everyone: from your friends, from the internet, parents, books. The advice will keep rolling in because there seems to be this belief that there exists a formula to raising a child well. When, as I like to believe, there probably isn’t necessarily a right way.

One of the topics that my wife and I have received so much advice on is sleep.

Sleep is one of the more difficult aspects of Rio’s growing life because he has had such a hard time getting himself to sleep well. When he was born, we felt that these short 1-2 hour stretches of sleep was okay; he will eventually ‘learn’ to sleep longer by himself. And as first-time parents, we wanted give him all the love, support and comfort we thought he needed to get back to sleep by carrying him whenever he cried, feeding him at night and having him sleep next to us (yes, I know, shame on us, I don’t practice what I preach to patients).

As he started to get older, we got more and more concerned that his sleep was just not getting better. We were tired daily (my wife more than me, obviously). We started reading and getting advice about ‘sleep training’. When we first heard about sleep training we were taken aback. Frankly, it is allowing your child to just ‘cry it out’ and fall asleep by themselves, which sounded horrific to the both of us. We love Rio so much, how can we allow such a thing?

When I first heard about it from my wife, I was opposed.

No way am I just going to let him do this by himself. I want to give him all the comfort that he thinks he need. I told her that we’ll sacrifice our sleep for years if we must, he will figure it out.

Eventually we came to realize that this had to be done more so for him. He was the one suffering by not letting him figure this out on his own. We were the ones to blame for his lack of sleep. We had to go through the process of ‘letting him go’ for a little bit. It almost funny to say that during his first year of life, we had to already start letting him go, but yes, in a way this had to be done. It was a big realization for me, everything we do for him is so that he can start the process of doing things on his own, from eating, to walking and to sleeping. If we hold on too tight; if we are afraid of him having to suffer then, ironically, he will continue to suffer. The fault will go back on us as his parents.

So now, after several weeks of ‘sleep training’, I am happy to say that he is doing a lot better.

He is still a restless kid; he would give us a good stretch of up to 4 hours of uninterrupted sleep, but I’m okay with that. Eventually he will fall back to sleep himself. Sleep is challenging for him, and I think it has to do with his personality, overall, he is a fidgety, active restless baby.

When he grows up I want him to keep that restlessness. I want him to feel uneasy, unquiet and unsettled.

I like to imagine that this would translate to him feeling uneasy, unquiet and unsettled with the world we currently live in.

I like to imagine him in the future taking this personality trait and making something out if it, living his life for other people and trying to make this world something better than what it is right now.

I like to imagine him taking this restlessness and translating it to a life easing the restlessness of others.

 *Laughs* I know. For now, he is happily a week from becoming 11 months old; eating, playing, pooping and… now sleeping well.

[egcarlos]

“Dreaming with your eyes wide open”

“Dreaming with your eyes wide open”

My first Christmas with Rio is passing itself off as quiet. Yamini is at work all week. My parents are stuck in the snow in Seattle. So I decided to just take it easy for the weekend and enjoy time with someone I’m only starting to just figure out. It’s been such a joy to see him grow these past few months; he started off roughly around 6 lbs, helpless and monkey-like to now, he’s starting to try different table foods, flip himself over front to back on the floor and adding on to his vocabulary of babbles. I’ll admit that I was scared becoming a father, I’m sure everyone is afraid of becoming a parent, but honestly, it felt as if I was about to lose myself; I was about to lose time for myself to play tennis, hang out with friends and go on trips. There was this sense of, well, I don’t want to say regret, but maybe a kind of bitterness to having a kid, because, to put it simply, I was selfish. And now, spending days with him, see him develop, grow, babble, smile, hold my hand, smelling his head, feeding him different foods, having him touch different things, I just can’t get enough of it. I really can’t. It’s so amazing that it’s making me tear as I write this. I love being a father and I love him so much. The way I feel about life right now, it feels like I’m dreaming with my eyes wide open, from that song “Come Alive” In the Greatest Showman. There is nothing in this world that can make me happier, and I owe God, life, the universe, whatever you decide to call this sense of order in disorder, or how the whole is always greater than the sum of its parts or this sense of peace in a seemingly mad world. I look at my life and I know that I’ve been given so much that there will always be this sense of obligation that this life is not my own. I am living in Los Angeles, I have a beautiful wife who loves me for who I am, I have a family who have supported me through all the crazy things that I decide to do with my life. I know, deep down, that this life is not mine. I came to Los Angeles July of 2021 and went back into training at USC to become not only an HIV specialist, but more grounded and trained in underserved medicine. The past year and a half have been amazing and the experience I gained is priceless. I came here because I still remember my experience in South Sudan, my very first job out of residency and with Doctors Without Borders. I still think about my work, my time there, my colleagues and the people I was fortunate to help every single day. I came to Los Angeles and was given this opportunity to learn so that I can do something more, reach my potential so that I can give back to the very best way that I can. I know that I have a family and a son now. It’ll be the hardest thing leaving Yamini, and now Rio when it is time, but once again, I know that this life is not mine. I’ve been given so much. And there are those, by just a matter of luck and happen stance that are struggling to survive. I am here in the US, living my life, hoping the best for my son and my family, and yet, there are those, not only as far as the other side of the ocean, but also as close as a few streets from my apartment struggling to survive. What should I do with that knowledge? Should I take the blue pill and live a life of ignorance? Should I forget about what I have seen? I have no idea where these thoughts, these reflections will take me. I think about this every day. This will continue to influence my choices and decisions for the rest of my life. For now, I’ll spend my time loving Rio as best as I can. I’ll take him everywhere that I can take him and have him taste whatever I can put in his mouth. I’ll simply enjoy being the best father that I can. I know though, some time this upcoming year, the time is right again to get back out there; to pursue, what I believe God has put me in this world to pursue, to give back to the very best that I can to this life that I know that I can never deserve. Also, because, I decided to take the red pill a long time ago. I’ll continue to live my life as if I’m dreaming with my eyes wide open.

[egcarlos]

Rio

Now that I have him, I have this feeling like he’s always been in my life. Him meaning my son, Rio. It’s a strange feeling that is hard to describe.

This feeling of fatherhood, of being able to love and care for someone else has always been inside of me. Now to direct it to someone in the flesh, feels like I have always been loving him, even before he came into this world. Now, I can’t imagine my life without him. I can’t imagine this world without him being able to experience it. Now this is a scary world and a seemingly scary time to be in. Those couples that tell me that they do not want to have a child, especially in the kind of world that we live in now, bring up a very valid point. Waking up in the morning is a risky thing, especially with how seemingly distraught, meaningless, and hopeless things can appear at times. Feelings of guilt come to mind at times when I imagine my son, having to deal with this world in the future. Is it just me or where I live, but doesn’t it seem like the world cares less about others and our world? The rich are getting richer The poor are getting poorer. Respect, dignity and decency seemingly feel like foreign words nowadays. Last week, I was playing tennis at Echo Park and these two individuals started a fight, one of the men had his children right next to him as he was hitting and beating the other person. I couldn’t believe it. I yelled at both to stop and the individual with the children began threatening me for opening my mouth. I just couldn’t believe that was happening. Although I know these things happen every day. What kind of place, what kid of world did I bring him into? Sometimes I ask myself how this world will be 30 years from now when he starts thinking about possibly having a family (or not) and when he tries to find his place to contribute to this world. I am not asking questions like, what will he be? What kind of person will be become?

In reality, I’m actually asking, will he actually be able to live? Will he be able to dream? Will he be able to help the world?

Somedays, I fear that we brought him into a world that would not allow him to do exactly those things. To be able to dream, to be able to self-actualize and to find one’s way to contribute to the world should, at the end, be all our goals. It is a privilege to not only be able to dream, but to self-actualize and reach one’s potential. Imagine all of those, not just in other developing countries, but even here in the United States who struggle for food, security and shelter leaving out the capability to contribute to society in the best way that they can.

…But for now, he is happily 3 months old.

In the mornings, around 430 AM I take him from my wife so that she can get some sleep before I must go to work. What I love about the most about him is how he seems to already show an appreciation for music. My wife and I will blast bouncy Disney songs such as “Love is an Open door,” “The Family Madrigal” or “Hakuna Matata” and dance in front of him, which makes him smile. When I lay him on his back to change his diaper, I like to look into his eyes and sing to him lyrics from “A Million Dreams,” from The Greatest Showman.” It makes me melt so much when I see how open his eyes, look at mine and smile. I close my eyes and I can see a world that’s waiting up for me, that I call my own

It’s totally his song. I want to do all that I can to make sure that he can hope, that he can dream and that he will want to help save the world. I want him to be able to believe that one person can help, that one person can hope and that one person is capable to make a difference. I want him to know that despite this world that we live in, that despite the seemingly dreadful place that is barely hanging to survive, being able to hope is  choice that needs be made every day.

I think of what the world could be, a vision of the one I see , a million dreams is all it's going to take.

I want him to be like me.

[egcarlos]

The Bus

I’m just trying to make sense of my time here. Here, meaning Los Angeles; although you can really say that about here on earth, or in this universe or in this timeline. Although I am just in my second month, a sense of home; a sense of normality has been slowly starting to develop.

I’ve found 2 tennis groups to play with, a Filipino group and a Korean group. I have some set restaurants that I tend to frequent (I’ve really got to calm down on the burritos al pastor). I found a Costco that I aim to get to 6 AM in the mornings on Sundays to beat the crowds to the gasoline lines. Los Angles is starting to feel like home, as with the other dozen or so places that I have called home in the past. No matter where I end up going to, whether it is in Sub-Saharan Africa or here, in the city of Angels, with about 10 million people living in the LA county alone, a home has been made.

Due to the proximity of the hospital, I have been able to catch the bus to work. Sure, driving there in the morning would probably save me about 20 minutes one way, but I’ve been appreciating my bus rides during the week. It is a practice I have decided to take on purposely because, well, because I know I should. It’s the least I could do, knowing how terribly lucky I am with the ability to not only have food and a place to sleep, but to be able to live downtown and have a family that loves me. I do have my lazy days, in which I think about how my life could be a tad easier just driving to work, but catching the bus ends up being a sort of spiritual experience for me as well.

The way I started to think about it, most of my patients are probably catching the bus too.

LA county has made their transportation free… for everyone now.

For some, this is the only mode of transportation that they have, and I guess, this is the very least I can do to be in some sense of solidarity with them. Because, in all honesty, I won’t survive in their shoes. Our clinic has the largest amount of HIV positive patients in the whole state of California; HIV is not only a disease, but it is a disease that effects the poor and the stigmatized. There is a sense of helplessness that can occur when you know that medicine can only do so much for a patient; a patient is also a person- a human being- who needs a stable source of food, housing, love, and support.

My limitations as a doctor are seen and felt each and every day. The deeper I decide to go into the messy truth of life, the more helpless and small I feel.

Its so easy to live a life of ignorance. Everyone wants to help the poor, everyone is willing to give their time or money, but not everyone can stand with them and feel the vulnerability they live through each day. I know I can’t. Whenever I see a homeless person on the street, my initial sentiment is of fear and awareness, I’ll either move to the side or cross the street.

Sometimes I see a person talking to himself on the bus or on the streets and I’ll think to myself, maybe, when he was younger, no one took the time to listen to his thoughts.

Maybe this is why I became a doctor. I want to keep seeing the messy truths. I want to know how ugly life can be for some, so that I can hopefully find my place to make it better for others. It’s narcissism at it’s best really, but I just really want to help.

Life has given me everything I have needed to become who I am today; from a loving family, to a beautiful wife and for an opportunity to dream and self-actualize. The very least I can do is to give back the best and only way that I know I can, which is through medicine.

So for now, I guess, I’ll continue to take the bus. I’ll skip the car, walk the 10 minutes to the bus stop and attempt to make a feeling of solidarity. It really is the least I can do.

Because, at the end, I’m just trying to make sense of my time here.

[egcarlos]

Hope pt. 12314

My mind has been running around everywhere the past couple of weeks, especially since starting my program here is Los Angeles. To be back in a semi-academic role with lectures and discussions has been great at times and somewhat irritating during others. While I’m here in my costly apartment in downtown Los Angeles, I think about how my time could be better off working; better yet, back in South Sudan helping patients and experiencing life as it is, or in Chicago in that Chief Medical Officer Job, not only helping a South Chicago community, but also making money as well. I wonder sometimes about these decisions that I make, whether I get too passionate or too idealistic at some points. In theory, this program is great and I am training at a great institution, but there is a disappointing reality to the reason why this is so.  LA county is huge, giving its population so many pitfalls and obstacles to getting good care. It holds a large population of homeless, drug using and socio-economically disadvantaged people that are results of the system and lives that have been given to them. The program takes a lot of pride for giving their trainees the opportunity to manage severe HIV/AIDS cases and opportunistic infections, which is great for us, but not so great for the people experiencing them.

At the end of the day, I can get great training here, but I will barely be part of the solution. I want to help make a difference. I have this narcissistic, seemingly egotistical sense that I can help change the world; that there is something about me that the world is missing; that I can be the key to help unlock that difference. In my courses, we have had to introduce ourselves several times to other professors and other medical professionals and they always want to know what our interests are. When I speak and when I hear others speak about theirs, it sounds as if we are the key, that we are part of the solution, that in a way, the world needs us. When at the end, we are victims to the world and its circumstances; we are victims to the consequences of human greed cause by pharmaceutical companies, worldly insurance companies and the complacent, aloof governments.

Life is a struggle for the idealists and the optimists because there are so many apparent, visible and obvious reasons out there that exist in the world to tell you to not move forward, to pursue selfishness and greed just like the majority of the world. My life could be so much less complicated right now if I decided to just take a job. I could have taken a job, close to Seattle, live close to family, help those around me to the best that I can and when it gets too tough and when life starts to push back, I can merely give in and say oh, I tried and allow life to keep pushing me backward. And then, before you know it, I am old, crusty and ready to be buried, the end. The struggle is real.

Each and every day I try not to wonder, but some days are harder than others. There has to be something meaningful out there. There has to be something that wakes me up early in the morning and keeps me pushing back throughout the day. There has to be something that has kept me in the struggle for idealism, optimism and hope.

It’s so easy to just give in and to think that nothing can be done about anything.

But at the end, hope is real.

Maybe there is more to hope than I’ll every figure out. Hope, whatever you are, keep following, keep lighting the way, keep pushing towards non-sensical, interruptive decisions that could seem pointless in the moment, but eventually, meaningful for something, someone or some people.

[egcarlos]

Dine’

It’s a little sad to say, but I am going to miss working here. Because of the pandemic, I was not able to experience the special events that people say usually happen here in the reservation, such as the rodeos, the fall fair and the house gatherings, but as I have been saying to everyone so far, never say never. I’ve been working out here for a little more than 6 months now and I can’t really put to mind what I really feel. I’ve created such great rapport here, not only with the patients, but also the staff and their families. I’m getting requests to be their primary care doctor and to see their children, spouses and grandparents. It makes me really happy, but then again, I know I won’t be here for too much longer. The Dine’ deserve the best, but as a temporary worker, I am just placing a little band-aid on the grand problem here in the reservation. They deserve the best care possible, yet this clinic is so reliant on temporary and mid-level clinicians to provide them with the best primary care. Although it is definitely possible, not everyone will be willing (or capable) to make the effort beyond what they are called to do. I don’t know what exactly I am feeling, but I know I’ll remember this as I move on, because, as how it is looking, the road is going to be my home for a little while. I have no idea where I am going to be 6 months from now; in fact, the next 2 years of my life is all in limbo. I get tempted to just make the call and switch to finding a permanent place so that I can finally get some stability, so that I can have a family and be surrounded by those that I love, but then again, I know that time will come. There’s this restlessness that keeps calling me. This voice, this push, this drive, could it be just me with my overzealous and overambitious thoughts that I could help ‘save the world’? Could it be just the fact that I feel ill-prepared to settle down? Or could it be that ‘still small voice,’ the quiet that could be heard when we decide to listen; the restlessness that has been placed in all of us because we are all a vital part of the whole that could potentially help ‘save the world’? I mentioned in my personal statement to the programs that I am applying to about how much the world is missing out on because there are an insurmountable amount of people out there who will never be able to reach their potential, more so figure out what it is or what it could be. We are missing out on their dreams, their potentials and their special contribution to this world. I will never forget the first patient I really interacted with and made a relationship with several months in ago in South Sudan- he was in his late teens, early twenties, he presented for back pain which ended up being Tuberculosis of the Spine, or Pott’s Disease. He spoke great English and I was able to learn from him that because of the conflict, he had to stop school – despite of his dream of becoming a businessman. I saw him at least 2 or 3 more times before I left, but can you imagine all that potential inside that one person is at risk because of, not only his physical ailments, but also just the fact this he was born in a country with political instability, poverty and disease. I’ve been given this gift of opportunity and I can not put it to waste. All the sacrifice in the world that I have to take is worth it if I know that I can help make this world just a little bit better. It’s this restlessness, the ‘still-small voice’, this something that I can’t fully grasp that keeps calling me to keep going because, maybe, I have just become more open to it through the years. “Or we may be of the mind, that life in its essence, is not fixed, is not frozen, is not finished, but life in it’s essence, is fluid, is creative, that there is a dynamism in which all life is grounded; goals, dreams, ideals can fulfill themselves because of the fluid, flowing character of all of life, and if the latter is true, as I believe, then if a man is able to select a goal, a purpose, which to him is of transcendent significance, and on the half of which he is willing to put all of the resources of his life and thought and mind at his disposable then this is the kind of world that yields and responds to this kind of demand.” Howard Thurman

[egcarlos]

Captain America

“My faith's in people, I guess. Individuals. And I'm happy to say that, for the most part, they haven't let me down. Which is why I can’t let them down either.”

Out of all the things that I want for myself, the most that I truly want is to help save the world. Deep down, I think that is why we are all here. Every decision that I have made so far in my life, I have made because I like to think that it is leading me somewhere. Ever since I left home when I was 18, I really had no set path. Whatever plans I did try to make for myself got thrown out the window, so eventually, I just stopped making plans. But, again, deep down, despite me not knowing where I am going or what I am really here for, I believe that it is all for something to help save the world.

I guess maybe that is why I look up to Captain America.

All he really wants to do is to just do what is right. Right from the beginning in the first Captain America movie, despite his menial size and list of health issues, he continues to try to enlist to become a solider and to fight in World War II. He knows the importance of following orders and to have respect for his superiors, but he is a natural leader and leads from whatever position he is in. Ever since I watched that first movie, I was hooked on his character and his portrayal of the importance of knowing his values, doing what was right and for the better at all times, no matter what the circumstances or cost.

There’s this spiritual term that I like to think about that is popular in Catholic Jesuit circles, which is Magis. It is elusively defined as doing the more, the better and the greater for God. I translate it as every day, from the moment you wake up, until the moment you go to bed, you do everything to the best of your ability; you do everything with confidence, keeping true to your virtues and values and always for the greater glory of your family, your community and of the people around you. It’s not about trying to be the very best, or the greatest or the elite, but it’s about being the most of who you are, each and every day, despite of all knowledge of your own faults, past and limitations.

You know, I really think I have underestimated myself a lot in my life. Looking back through the past 31 years of my life so far, I feel like I could have done more. During high school when I played tennis, I could have won a lot more. During undergraduate, when I failed the MCAT twice before finally getting an acceptable score, I felt that I could have avoided that. And even during residency, I could have been more, I could have applied myself more. Maybe I’m just a late bloomer. Kind of like how Captain America was. Deep down, he was always capable and had the kind of spirit that emulated what Captain America should be, despite his original size and limitations. When he was finally given the super serum, his physical limitations were no more, but still, it’s his spirit of true heroism, his optimism and idealist leadership style that resonated far more than his brute strength.

 It sounds crazy to say it, but I want to help save the world; in whatever way, shape or form that could mean. I may not be the smartest, the strongest or the bravest, but I know who I am and where my heart lies. I want to have faith in humanity and I want to continue to believe that I am working towards something, despite not knowing what that could be.

[egcarlos]

Loopful

Life is supposed to be this endless, loopful abyss. We’d like to think that life is linear, that there will be an end, that when I get this degree or when I am able to save this amount of money or when I am able to have a family, that life is just supposed to ease up. Sometimes we wish to get to just that one certain point, then, happiness will set in; then we can finally rest in this life and life will absolutely be complete. The problem is though, that this isn’t the case. Unfortunately. At each and every goal reached, there has to come, consciously or unconsciously, something else. This pattern continues and continues and continues until the day that we day. Even when we are old, even if we cannot move the way we used to before or think as fast as we used to before, if there is a living,  fighting spirit inside us, no matter what age, there will be something else, another level to reach, another goal to accomplish, another thought, feeling or emotion to overcome. It just never stops. Now, we can decide to call life linear. We can decide to have an endpoint while we are living. We can, one day decide that after a certain point in my life; when I finish my degree, when my children are older or when I have enough money, then, I can relax. Then, I can finally take it easy. Then, I can finally live. But unfortunately, I am telling you that this is not the case. Unfortunately, the day we decide that there are no more goals to be reach, no more changes that need to happen or nothing else to fight for, not only our bodies, but also our souls start to die, slowly, little by little, every single day, until we are dead before we actually die. This is a death caused by suicide. It’s a suicide that we choose. Each and every morning when we wake up, we have to find that one thing, that purpose and that reason that wakes us up. We have to choose to live with passion, to live with purpose and to live with integrity. It’s never going to be easy, but it has to be chosen. You know, I don’t know if I could ever come to choose the settled life just yet. There is nothing more that I want in the world than to be around friends and family. There is nothing more that I want in the world than to be with my fiancée and my parents and my siblings. There is nothing more that I want than to be able to see my grandparents and my cousins each and every day. But I know that this is not what my life is about just yet. I’ll have my times and moments. I’ll have my times when I’ll be able to see family and spend time with those that hold significance in my life, but eventually, there will be this calling. There will be this pull telling me to push myself over to the familiarity of the unknown. This pull that I am talking about gets me up early in the morning and keeps me pushing through the questionable days. I have no idea where I am going. I have no idea what I am getting myself into. I have no idea how I am supposed to get where I am supposedly supposed to go. All I kind of know for sure is I don’t think I’m lost.

[egcarlos]

Intuition

We try to trivialize everything; We try to trivialize life, love, miracles and circumstance. We try to trivialize everything that would make us believe. I’m not the one to talk, honestly, Because I do the same thing. I’m currently thousands of miles away from those I love. I don’t understand why I keep doing this to myself. I keep telling myself that I want to be home and I want to be closer to family, but for some reason, I just keep leaving. It’s not like I am not happy to be here, it’s just that, I think I’ve totally lost capacity to rely on my own reason. I think my voice of intuition has gotten so much stronger and frankly, somehow, more sensible than my reason. If I relied on my reason, more than my intuition, maybe I would have played it safe. Maybe I wouldn’t have strayed too far from home and I would have gotten a safe job, with a safe income and a safe life. If I relied on my reason, more than intuition, maybe I would have been comfortable. I would have my support system around me; I would be able to be a tad more well-off and maybe even have my own house or at least my own apartment. If I relied on my reason, more than intuition, maybe I would have my life more put together. I would have maybe the next 5, 10 or 20 years planned out; maybe I could start saving for my retirement or working on investing money instead of losing it. But my intuition tells me that doesn’t make any sense. My intuition says you don’t need that just yet. My intuitions tells me to plan to be surprised. Intuition tells me that the universe conspires behind and for those who takes risks, who proposes challenges and who will step outside of the box. Intuition tells me that fate will be kind to those who’ll bend, shape and mold to whatever container it has in store. Intuition tells me that life will be amazing when it becomes more challenging, fruitful when I decide to go out in the barren field and sweeter when I decide to go out into the unknown. In fact, that’s all I’ve ever known. I’ve only failed when I fail my intuition. And it hasn’t failed me just yet.