Your problems were simple then: how to pass the next exam, how to survive your current rotation, how to get laid, the last being the most difficult to solve without enlisting professionals.  It was the late Sixties and the early Seventies but free sex seemed confined to Woodstock and Haight-Ashbury.  In Manila, the culture of abstinence until marriage prevailed under a double standard, because only women were expected to abstain.  Men enlisted professionals or risked a shotgun marriage versus a gunshot to the head, because if they discovered a gifted amateur of good social standing, the rule of “You break it, you buy it,” was strictly enforced.  A guy’s odds of surviving after scoring a homerun were inversely proportional to the social status of his girlfriend.  If your girlfriend’s last name was the same as that seen in letterheads of large Philippine corporations, you would have been uninsurable by Lloyd’s of London, which insures Heidi Klum’s legs for $2.2M.  If you got lucky, it was incalculably worth the risk, because exclusive convent schools bred the most gifted amateurs.

Surviving your current rotation was less about knowledge and skill than it was about endurance.  You did not need to know that raltegravir (MK-0518) is an inhibitor of human immunodeficiency virus type 1 (HIV-1) integrase, and is active against HIV-1 susceptible or resistant to older antiretroviral drugs. *  The reason was not because HIV had yet to be discovered, rather it was because the most challenging tasks were drawing blood using blunt, reused needles with burrs that snagged vein fragments upon withdrawal, while you swatted mosquitoes drawing your blood; manually bagging a patient for hours because of the unavailability of a ventilator; and recording cervical dilatation, fetal heart rate, and duration and interval of contractions for hours until it was time to yell “Iri missis!” repeatedly, without electronic fetal monitors, ultrasound machines, or epidural anesthesia.

Scut work spawned innovation: making pregnant patients walk around the hospital until they were almost fully dilated, thereby shortening your progress of labor duties and creating a parade of pregnant patients walking around the hallways; filling out vital signs for the next two hours of your shift; and charting the patient’s CBC results without actually performing the CBC.  Dialectics subsequently prevailed and thesis gave rise to antithesis:  your patient delivered outside the delivery room so you had to take extra call; your patient died at 8pm but he had vital signs recorded until 11pm; and your ophthalmology patient had leukemia but you recorded a normal WBC.

Residency (Stage 2: Becoming an Overseas Filipino Worker, OFW).  You made it to America, but you were just a glorified OFW.  In the beginning you were frugal; perhaps, your wife cut your hair and used a black felt pen to cover up the accidental bald patches, a brilliant solution that mandated your passing up partially full elevators so you would not have to stand in front and subject your touched-up bald patch to scrutiny.  Your talent and hard work paid off and you were soon in Stage 3.

Practicing physician (Stage 3: Consumerism).  You made money so you embarked on conspicuous consumption, the core of becoming American, driving BMWs and Benzes; diving Grand Cayman with your Scubapro regulator and BC; skiing Aspen with your Dynastar  skis and Salomon boots; windsurfing Maui on your Mistral board.  Your children lacked for nothing and you later wondered why none of them wanted to become doctors.  Their desire “to find themselves” or “to find their true passion” boggled your mind and left you with conflicting thoughts of disowning them or being supportive. You fleetingly considered upgrading to a trophy wife: T = YVM/A-18 where T = probability that your wife is a trophy wife;  Y = your age in years; V = number of Viagra pills you have to take to enjoy your trophy; M = your assets in millions (US dollars); A = your wife's age in years; 18 = age of consent in California.  However, California is a community property state, and D=M/2 where D = divorce and M = your assets; so you reconsidered. You joined UPMASA to catch up with your classmates and schoolmates from med school, to share triumphs and tragedies and to reminisce about the good old days.

Medicare (Stage 4: Approaching eligibility for Medicare).  You or your classmates have had coronary artery bypass grafts, microdiscectomies, mastectomies, nephrectomies, and you take Lipitor to lower your cholesterol, Altace to lower your blood pressure, and Cialis to raise your joystick.  Because there are no atheists in foxholes, cancer wards and ICUs, you may have rediscovered your religion.  You nervously track the Dow and the Nasdaq, the price of oil, the subprime mortgage crisis and their effects on your portfolio, before sending your donation to the UPMASA permanent endowment fund.  Longing for simplicity, you consider retiring in the Philippines.  You have completed the circle.