Reentry-Burn Anxiety

"I don't miss work at all," I said to my husband a few hours ago, a little guiltily.

"I don't either, but I don't see why you feel so wrong about it. No one misses work."

"Sure they do. The passionate, dedicated people do. Don't they?"

"Even people who 'can't live without it' need to recharge their batteries once in a while. Stop feeling so guilty."

*Sigh*. I've barely given my job a moment's thought during this whole vacation, and when thoughts of it do float to the surface I quickly swirl them away again.

My profession and I are like a couple that's been through tough times. I do feel I have a certain dedication to medicine and to patients, because I care so deeply about taking care of people well, but am I madly in love with the work itself? After all the hurts and stresses, the rocky periods? (Though of course, my husband and I have had our share of rough times, yet some of our friends still tell us the world still seems to disappear around us when we look at each other. Go figure.)

I think few doctors keep the full ardor of the initial passion that might have drawn them to medicine. I think most of us are lucky if the warmth of a steady ember remains. I believe I have that, at least. But when I read passages like this beautiful one from pastry chef Shuna Fish Lydon, I think to myself: Now there's someone who's truly, madly, deeply in love with the work she does for a living. And I have to admit, while I get tremendous pleasure out of snapping a laryngoscope blade into place and executing a good intubation, and it was the actual physical pleasure of ventilating someone by mask that made me realize anesthesiology was for me, I don't think I have the fire she has, the kind of "attachment to the process" that makes her mouth water just thinking about it:

The Pastry Chef asked me how did I know it was pastry that I wanted and was meant to do. The question stopped me cold. I closed my eyes and reached deep.

How? Why? Why sweet things over salty ones? And how did I know? Really know?

Before cooking professionally I was at CCAC majoring in photography. In the darkroom, not at all a delicious place: surrounded by awful chemicals and worse fumes, I watched images wash to the surface from enlarger to developer to stop bath. In those black rooms, developing film or paper, my mouth watered and often my eyes did as well. I was attached to the process, to those images I was capturing.

I am the same when working with butter and sugar and eggs. It's a similar science, yes, but more than that it's an emotional experience for me. Although I started on the line, cooking savory food, it was with pastry that I found that spot, that place, where my heart met the process and my hands and heart follow suit.

And it's not as if work is all pleasure for her, either. With so many family members in the food business, I know at least second-hand that it's a tough taskmaster, requiring some strong mettle and tenacity as well as talent and creativity. Long hours, thankless labor, attention to detail, indefatigable service - I've often thought there were many similarities between being a physician and being a chef or restaurateur, and envied chefs their opportunity to see and enjoy a tangible product, the work of their minds and hands.

Do I like my work? Sure. Am I doing what I love? Within medicine, certainly. But am I looking forward to my first day back? Not so much...

I guess that's pretty normal, as my husband said.

(Photo: "emergency drug kit" brought to me by a friendly O.R. nurse)

***

I've been pretty silent about my oboe this trip, but she's here with me, and we have been bonding. It's amazing how fast reeds will dry up and need re-soaking in this tropical weather, though! I haven't been practicing every day, but I've tried to practice every other day, mostly with success, and I'm happy to say I've also tried to make sure not to neglect my scales, arpeggios, and left F here.

I don't know if it's the acoustics or high ceiling in my parents' living room or what, but I've actually been hearing the "oboe-ish" sound more in some of the things I play, whereas before this I was mostly relying on Kyoko to tell me if I sounded like an oboe or not (and not really hearing the difference when she said I was "right on" for the tone).

How do Filipino oboists deal with the reed-drying thing, I wonder?

Epiphany

Twelfth Night. Three Kings Day. The Feast of Epiphany. Though the church has rescheduled it, I still cling to a January 6 celebration. It's bittersweet for me - the official end of Christmas! Waaaaahhhhh! I still remember leaving my shoes out as a little girl in the hopes of one or two last treats from the kings as they passed by.

Yes, I know, they weren't kings, and there weren't necessarily three of them. I know what the scholars say. Learned all that my freshman year in Catholic high school: Jesus was probably born in Nazareth, not Bethlehem, and the star was symbolic, chosen by the author of Matthew as a sign for the newborn King of Kings, the Messiah as he understood Jesus to be, and in fact the infancy narratives in both Matthew and Luke were probably created to convey meaning rather than fact, hero stories about a signficant birth, a common device/genre at the time and in the culture in which the authors wrote. Fairy tales or not, I love the Nativity and Epiphany narratives anyway, and I believe in what they dramatize - concern over how to prepare for and raise a special child, fear over surrounding political dangers, a series of journeys during which a fledgling family had to figure out where they belonged and how they were to live in the world. The stories convey these very real challenges better than any long-winded, abstract reflections, and for this I embrace them, happily.

And I still enjoy the speculation over what the Star of Bethlehem could have been, if indeed it shone in the sky in real time all those years ago. Here's a fascinating article about the errors often perpetuated about the star in planetarium Christmas shows, and here a summary of star theories for folks who have fun imagining the possibilities - including the possibility that the very romantic story we all know and love, of a luminous sign in the heavens seen by wise men at its rising, did happen as we imagine.

Secret Garden Near Lake Taal

My oboe teacher emailed and mentioned it's 10 degrees in Boston. Yikes! I had a wonderful opportunity to take a walk through a beautiful garden today, where it was sunny and breezy with temperatures in the 70's. Here's what my visit to this Eden reminded me:

1. Doing "nothing" but doing it mindfully can be far more productive than scurrying around doing a ton of stuff.

2. Earning a living? $____ (fill in your own blank). Making a life? Priceless. I actually stopped to smell flowers with my kids - it doesn't get more cliché than that - and it's the best thing I've done in months.

3. Creativity is for everyone.

4. The best things in life are still the simple, little things. The details. Attention to detail is a treasure and a must.

5. Choose the good fruits and avoid the serpents.

6. Breathe. Listen, and breathe.

We've found the most beautiful and most romantic bed & breakfast within a couple of hours of Manila: Sonya's Garden, in the province of Cavite.

No TV. No computers. No electronic anything. Just books, cool breezes, and lovely, comfortable cottages designed by Sonya herself, with native touches like capiz shell windows that serve as reminders of pleasant country life in the Philippines. No traffic sounds here; just the occasional rooster crowing...

We ambled down garden paths surrounded by exquisite tropical flowers. Some smelled sweet, like jasmine or honeysuckle. There were purple blossoms that smelled like vanilla, and trees whose clusters of pink flowers gave off a strong aroma of butter (pictured below). Splashes of color caught our attention everywhere we looked. And though the place was beautifully landscaped, it had enough wildness about it not to look too manicured.

There were unexpected little meditation nooks here and there, to surprise and delight those who might be strolling through the grounds in search of a little tranqulity.

And for those interested in a little TLC, there is a spa...

Sonya's home-cooked cuisine and home-baked breads have delighted visitors to her lush dining area for the last 10 years. Now she also offers a separate reception area for weddings.

There is also a place for guests to explore their own creativity, through small workshops on "the art of doing nothing," though of course what guests end up getting a done is usually something lovely and artistic.

Sonya's attention to detail and aesthetic eye can be discovered in almost every corner.

It was a privilege to meet this gifted, funny, gracious woman and visit her truly gorgeous gardens, cottages, and restaurant. And just a stone's throw from her place, we got to take our breath in looking at this view (of Lake Taal, from the town of Tagaytay, where the weather is cooler and the pace of life slower):

Role Models

Photo: Marina off Roxas Boulevard, Manila, last night at sunset

Recently my daughter mentioned that students in her school's 7th or 8th grade class were asked to write essays about their role models. These essays were then displayed in the school cafeteria or library for all to see. My daughter tells me several of the kids chose Hannah Montana. When I asked my daughter whom she would have picked, she seemed unsure, then said, "Well, I like Ashley Tisdale?"

Maternal eye-roll. "Sweetie. Do you understand what a 'role model' is?"

Kid: "Um...not really. What is it?"

Maternal sigh. "Well...it's not simply someone who plays roles that you like. It's more like someone whose life choices you admire and whose behavior you'd like to emulate because of his or her courage and good character. Like Jesus or Gandhi or someone. Or Ninoy Aquino." I had just explained to our kids about Ninoy, who was my mother's cousin. "Or Corazon Aquino, for that matter."

Kid: "O-oh."

I feel like a loser-mom.

***

I've been reacquainted on this trip with some amazing women who have achieved tremendous things. My cousin, Suzette, who runs the most creative and unique dining experience in Manila. My Tita M, Ninoy's sister, a supremely generous person who's an extraordinary culinary and artistic talent - a visionary in more ways than one. My cousin Margarita Fores, a sweet, energetic, humble but confident entrepreneur and restaurateur whose restaurants and catering business have catapulted her to well-deserved celebrity. She and her staff accompanied our president to Spain to cater a state dinner for 400 guests, and when her menus show up on people's blogs I always drool over her creations. See here, here, and here to get a taste, so to speak.

Last night I spent an afternoon and evening with one of my favorite cousins, Kat, of whose work as a child advocate - really as a fighter for human rights, through her very public law practice - I am in total awe. Kat is a celebrity here, and she SHOULD BE. She is not an actress or a model or an athlete, but the people manning the Krispy Kreme stand at the Mall of Asia approached her with a huge guest book and asked her for an autograph and picture. She single-handedly took on a prominent congressman, prosecuted him for child rape, and won. She travels internationally to train law enforcement officers about recognition and evaluation of domestic abuse. She writes articles to inform women of the warning signs of abusive partners and the resources they can call upon to deal with such losers. She is now a professor at the UP College of Medicine teaching medical jurisprudence.

I am so proud of my brilliant, witty, noble cousin and her contributions to women's rights and child justice, in our country and across the world, really. I was happy to see her work recognized even in a little food court in a giant mall teeming with people. People like her should be celebrated, in every sense of the word - famous, but also rejoiced over, for being the true shining stars of our human race.

Hate to End the Year on a Rant, But...

I was going to post a list of new year's resolutions. One of the things that was almost on my list was to try not to be so peevish.

Then some of my pet peeves started crawling into my mind, and before long I was making a list of pet peeves. Somebody please smack me.

Fear not, I won't foist either my so-called resolutions or my list of pet peeves on anyone today, but I do need to vent about something on the pet peeve list. Let's call it Pet Peeve #5: being told what to do as a physician by an insurance company.

Because there is already a brilliant post about this topic on the well-written blog Counting Sheep, I will try to be as concise as possible on this particular subject.

You have two choices.

See that long, black thing I'm holding in the picture on the side bar at right?

Behind Door #1, someone is going to snake a device similar to that, but longer and larger in caliber, up into your rectum and all the way through your colon after giving you a dose or two of unpredictable, unreliable sedatives with unpleasant side effects such as grogginess, uneasiness, nausea, vomiting, and itching. The person operating the black scoping thing is trying to make sure you don't have an ugly polyp (see above) or anything life-threatening in your colon, but because you're half awake, you sometimes tense and buck, making it hard for him or her to pass the scope through, hard to find lesions in all the recesses, and hard to watch over any ill effects the sedatives might be wreaking on your system. When you come to, you feel groggy and perhaps queasy, and you might have vague recollections of a big tube being snaked up through you, causing some abdominal cramping...

Behind Door #2, someone is going to snake a device similar to the scope at right, but longer and larger in caliber, up into your rectum and all the way through your colon after someone gives you a small, calculated dose of a drug that removes any awareness of the discomfort associated with the procedure. This drug can actually make it easier for the person operating the scope to pass it (and detect those life-threatening problems) because you are totally relaxed. Someone highly trained to protect you from this drug's possible side effects is giving it to you and watching over your breathing and your vital signs. You wake up quickly, feeling refreshed and nausea-free, probably surprised that it's all over, and you will probably be ready to go home soon.

Let me guess - you'd rather take Door #2, right?

Oh, oops, I lied. You don't have two choices, actually. That is, if your health insurance is covered by Aetna, Humana, or WellPoint. Sorry. You get Door #1.

Call me uncharitable, but right now I think any insurance carrier who's making these medical judgments without anesthesia training, or any medical training at all, should first be required by law to undergo the prize behind Door #1 before imposing such regulations on doctors and patients. Happy New Year to you too.

Filipino Food II: Merienda (or, Pinoy Pood dat I mees)

"Hey, I remember that smell," my son commented at the airport. I interpreted his comment to mean that aromatic medley of pandan leaves, fried dough, bamboo, and jasmine that I associate with being in the Philippines. It's an aroma that leaves a pleasant taste in your mouth and makes you hungry, so I said without thinking, "How very Proustian of you," though in fact it was I who was being transported to the past.

My Filipino sensory memories are centered around food. Filipinos love to eat and eat as much as possible. To leave food out of any kind of occasion, large or small, is unthinkable. We are all foodies, and we are obsessed.

Let me explain about meriyenda, from the Spanish merienda, "la comida que se toma antes de la cena."

Filipinos can eat up to four or five meals a day. Breakfast (almusal), morning merienda (kind of like the hobbits' second breakfast), lunch (tanghalian), merienda, and dinner (hapunan).

Merienda is no mere afternoon tea or pre-dinner snack. Merienda - the word itself is delicious to say - is a meal that celebrates the pleasure of eating, a time when the rest of life stops and the savoring of yummy treats takes priority - including treats that one might have enjoyed at breakfast earlier in the day. Merienda can be as simple as a piece of buttered pan de sal with hot chocolate (made from dark cocoa tablets from Spain, of course), or it can be a huge buffet of appetizers, main courses (like kaldereta, or goat stew), snacks, and sweets, blurring the lines between merienda and early dinner, in fact morphing into "merienda-cena."

Let me start there, with pan de sal. Historically I think pan de sal was a lean bread, like the French baguette, with the simplest of ingredients - flour, water, yeast, and salt. Over time it became richer, with the addition of sugar and eggs. The current version is the most delicious bread I know - soft and doughy on the inside, my favorite part, with lots of little places for melted butter to seep into, and crusty on the outside with a tasty dusting of dry breadcrumbs that is its signature feature. The dough is rolled into a log, then cut, coated with dry breadcrumbs, and baked, so the final shape of each roll of pan de sal is round or slightly elliptical.

Then there's the queen of breakfast breads in the Philippines: the ensaymada. We took what Spain originated and made it 100 times better. Ensaymada is a bright yellow or golden brioche type of bread, soft and airy, topped with a melt-in-your-mouth mixture of finely grated cheese, sugar, and butter. This is the kind of thing whose last bite instills a little melancholy, because you know you can only savor the tastes and textures a moment longer, then the magic is over. My Tita (aunt) M, who is of Pampanga stock - and this is a Pampanga delicacy - makes THE BEST ensaymadas IN THE WORLD. Lots of people make this wondrous bread from scratch, and we've tried their versions, and they're good, even superbly yummy, but still no match for Tita M's, and once you've tried hers, you can't eat any other version and enjoy it as much. Hers are simply a culinary treasure. The 5 dozen she sent to our house on Christmas Eve are GONE. When my 7-year-old son got on the phone to ask her for more, and she asked how many she should make, he answered, "Hmm...maybe, a hundred?" She laughed her head off but said ok.


I could go on about other foods I miss when we're back in the States. Champorado, a chocolate rice porridge. Our version of chorizo, the sweet, garlicky longganisa, served with rice and eggs (above, middle). Green mangoes and bagoong, of course (above, top), and ripe mangoes which I've already waxed rhapsodic about before. Rice-flour sweets such as sticky, brown-sugar infused bibingka (above, left), the coconut-covered palitaw, and the tricolor sapin-sapin (above, right). Cylindrical wafers called barquillos. Savory treats like pancit palabok (above, middle), a noodle dish served on a large bilao, or woven basket tray, and salsa monja, an olive-and-shallot relish unknown outside the Philippines, it seems, but apparently served by Spanish nuns to Spanish friars back in the day, as a condiment to flavor their food. Yum! We also inherited merienda items from China: siomai (shrimp dumplings), siopao (steamed pork buns, below), and hopia (bean paste filled pastries, also below).

And I have to drool over two last favorites, the soothing taste and smooth textures of buko pandan (below), and our native masterpiece dessert, the cake known as Sans Rival. Tiers of almond or cashew merengue layered with a sweet, rum-tinged buttercream and covered with toasted almonds:

There are better pictures on flickr here, here, and here. I know I'm going to have to undergo a massive detox when I leave, but for now, I'm taking pleasure in every dish and savoring every bite of merienda, enjoying with those bites the very Proustian flashbacks to my happy childhood.