To Practice Medicine is to Serve Justice

Uriel Cachero

UPCM 2020

This speech was delivered on behalf of the graduating class during Hiraya: The UP College of Medicine 111th Commencement Exercises. 

We’ve learned many things in our long journey through medical school. We’ve gained the skills required to understand the ills of our patients and piece together solutions in tandem with our residents, fellows, and consultants. We learned to listen to the stories of our patients and their bantay’s. In these stories, we understood the socioeconomic factors that led to the situations that we meet them in. I’m sure all of us mastered the skill of pushing stretchers and oxygen tanks at the same time. Keep quiet though, you know we’re not allowed to do that. But that’s okay, after all, it’s for the CT scan schedules we fought so hard to get approved. We know that it wasn’t the manong’s fault that we needed to do it ourselves. After all, they were just as tired as we were.

“Pagod na ‘ko.” 

We all know what this feels like; what these words truly mean – that tiredness brought out the monsters in some of us. There were times when we’ve snapped at a patient or a bantay, even though the situation that they’re in was not their fault. There were days when we’ve been walking around the hospital nonstop, dropping referrals, doing extractions, labeling laboratory requests and vacutainers – all because we have 16 patients in the ER and we still need to finish all of these before it’s our turn to monitor 30 of them. Sometimes, we only remember that we haven’t eaten, drank water, or peed all day just when it’s already time to endorse to the next duty team. These were the days when we felt burnt out, empty, and on the verge of tears. 

Then, a bantay approached me, smiled, and said, “doc, kain ka muna oh” and handed me a plastic bag with a burger from Wendy’s. Suddenly, the weight on my shoulders disappeared as if I wasn’t carrying anything in the first place. As I sat there, eating as if this meal was the most delicious thing I’ve ever had, I found myself asking:

“Ano nga ba ang ipinaglalaban ko?”

A question, I know most of us have asked ourselves at least once during med school. And during those brief times of reflection, I remember another question we were asked during the first weeks of medical school. It’s something I always go back to during times when I feel like I’ve lost my way. 

“What good is it to treat a person’s illness if the person goes back to the conditions that brought about the illness in the first place?”

I don’t believe there is only one good answer for it, and to be honest, it frustrates me to no end. But it’s given me a reason to continue on. Because someday, I want to have a future where no medical student will ever have to ask it again.

After all, times are changing on a global scale.

This pandemic made us wish for things to go back to the way they were. But I want to remind you that what was “normal” for us was not much better than how it is now. In truth, it was much worse. 

One of the most impressive things about someone trained in PGH was our immense ability to adapt to extremely difficult situations. But that was also one of our toxic traits. We could make neck braces out of cardboard boxes. We used gloves as tourniquets. We used syringe barrels as ampule breakers. But we also used these barrels as tongue guards tied to roughly cut up gauze so that our struggling intubated patient wouldn’t bite their endotracheal tube. These were the same pieces of gauze we used to tie up their arms so they wouldn’t pull the tube that helped them to breathe. They’d end up with fissures on the corners of their mouths where the tube rested and rashes on their wrists as the cloth rubbed their skin repeatedly. I can only imagine the pain they must have felt as air was being forced into their lungs.  What was “normal” made us forget that things shouldn’t be this way. Our “normal” was one where patients had to leave their homes at 3 in the morning so they could line up at our OPD at 5 only to be seen at 3 PM. Our “normal” was to line up patients in hallways and ask them to find a stretcher, or sit on a wheelchair for 3 days. Our “normal” was to ask our patients if they could buy badly needed glucose strips even though we knew we weren’t supposed to. How could we treat a patient in HHS if we didn’t know their blood sugar? We even asked them to buy more than they needed so we could use the ones left-over for those who couldn’t afford it. The hospital tells us not to do it. These patients should not pay for anything. But when adaptation has reached its limit, what else can we do?

A lot of these patients went to PGH because they had nowhere else to go. Who can blame them if they say, “sorry dok, wala na po talaga kaming pera,” or “pasensya na po, ito lang po ang kaya naming bilhin.” Most of our patients put off going to the hospital because they know how much of a financial burden it is to go here. And even if they do, and they get home safely, how can we ensure that they can afford the medications that we prescribe them? How long until they need to go back because their conditions have worsened again?

We have grown so accustomed to what “is” that we’ve forgotten that this isn’t what medicine is supposed to be. Our reality was a reflection of our patients’ realities. It was a reflection of inadequate resources. And there is not one person or entity to blame. We needed to adapt because it was a patient’s life on the line. We want to give the service that they deserve, but when we have so little, even our all is found lacking. 

We cannot allow ourselves to go back to what was. Instead, we must be advocates for true and lasting change. The Filipino people deserve more than just “pasensya na po” and “Ito lang po talaga ang kaya nating gawin”.  They deserve more than a tired and overworked healthcare system.

We soon-to-be-doctors will be in a position of privilege. Our culture sees our profession as the wise and noble, for isn’t it the most noble of causes to save another’s life? Some of us may deny it and think that we have done nothing worthwhile yet, and it’s true. It is hubris to think that we are better than other professions. We are mere hatchlings, barely able to flap our wings. But most Filipinos do not know that. The addition of two letters at the end of our names demand to be placed on a pedestal. And that’s okay. That means that we are in a position to influence change. But to influence change, means to acknowledge our own truths.

I know that we’re all thankful for what this hospital has given us. I don’t think I can ever find the right words to express my gratitude. But to acknowledge that also means that I need to embrace the things that I have lost because of it. 

During the second half of clerkship, my grandfather died and I could not be there for him during his funeral. I know my block mates would have understood if I had left for a while, but I didn’t. I wasn’t pretending that the reason why I stayed  was because I wanted to take the noble route (I’m not kind enough to do that), but I knew how difficult it was if even one person from the team wasn’t present. And more selfishly, I hated the idea of having to make-up for twice the amount of time I was gone. That’s also one of the things that this hospital has done to me. But I’ve accepted it. I know my grandfather would have understood.

I no longer regret the decision I made that day, but I do wish that I didn’t need to make that decision in the first place. And I hope that no one will ever have to go through what I have. Because it was difficult. It tore me apart. It was not okay. 

And that was the first step. I needed to understand the fact that not everything was alright. Not everything was bright and beautiful and “high-yield”. It’s okay to say that what happened within the hospital left some of us jaded, broken, and maybe even beyond repair. What we went through was more than just difficult. These hardships were enough to last us a lifetime. It could not have been possible if we didn’t have each other. These experiences will be our weapon. While we did not come out unscathed, we are now stronger. We can make things better for those who will come after us. We WILL make things better.

We’re almost at the finish line in a race that was never supposed to be a race. And yet before we know it, it’s time for us to take our next step forward. We’ll bring with us the bits and pieces that we’ve picked up along the way, and hopefully, we didn’t manage to lose anything important.

Don’t lose your way. Remember that health is a right, and that it is the government’s obligation to uphold the people’s right to quality healthcare. We are worthy of nothing less.

Don’t lose your voice. We must make ourselves heard and lend our voices so that others too may be heard.

Keep your visions sharp, 2020. We have eyes that will not remain shut towards the suffering of others.

Don’t lose your heads. We need them to stay critical. 

Don’t lose your hearts.  We need them to stay kind.

Hold on tight. We will need our hands to hold on to one another, and our legs to push us forward: to serve justice, to demand health, to fight for freedom. In essence, they are all the same – for to be a doctor is to join in the people’s struggle.

Our fight is just beginning.

Mabuhay ang mga doktor ng bayan, at para sa bayan! Padayon 2020!

Leave a Reply