my heart is aglow, and you cannot dim it.
As part of the periodontology workshop I've been attending for the last three weeks, we were tasked to analyze a case randomly assigned to us. We drew lots to determine the order in which we would present, and because I'm not usually a lucky person, thought I'd end up picking #1. Whaddayaknow, out of 12 people, I was lucky to be able to go last! We were handed the cases that were numbered according to the lots drawn, and I had to laugh because I saw that my hypothetical patient was Guatemalan. Sabi ko sa sarili ko, "Talagang pang-bonggang big time ako't talagang foreigner pa ang binigay sakin ni Lord, 'no?" (Yes, that's really how I think in my brain now, sadly.)
I was annoyed that we were given only one night to prepare our discussions, but being as pasaway as I am, instead of going home straight from the workshop, nagpagupit pa ako at nag-dinner na rin sa labas. Haha. Once I got home, natulog pa ako because I really wanted to put things off. I hate having to do reports. Which is why I sometimes wonder where my dream of becoming a teacher comes from. I don't like speaking in front of people, but I do want to share my knowledge. So, screw it. I'll do it even though it scares me.
I slept for three hours and I finally dragged my ass to my computer to get my report together. I became friends with one of the girls at the workshop, Anne, and we were chatting on YM about our case discussions. She was almost done with hers, but was stuck at one part - case prognosis - so she asked for my help. I explained to her what I myself was planning to do, which I had picked up from our lecture on treatment plans and prognoses. We both agreed that it was too much work, so she proceeded to just invent stuff ("Nag-iimbento ako dito :)"), pero ako, pinaninindigan ko na rin yung suggestion ko sa kanya. I could see how it would help me anyway.
We were taught at the workshop that in order to come up with a probable, and of course, favorable prognosis, to not just consider the patient as being one entity, but to consider each of the teeth in the mouth as individual patients. This idea stuck with me, and I intended to integrate that into my discussion. The idea was to consider nine parameters in the determination of a tooth's prognosis. And when I say nine parameters for a tooth, I actually do mean nine things to look at for each of the teeth present in the mouth. My case had 25 teeth present in the oral cavity; I needed to check 225 parameters by 9 in the morning, and it was already 1:30. Ano ang nakain ko at talagang nagbigay ako ng ganyang advice sa ibang tao? What's my guarantee that I'll go through with it myself? Lo and behold, I came up with a whole table on Microsoft Word just for this which ended up taking up almost three pages of long bond paper. I took the tooth numbers and their prognoses and put them into a more easily digestible 14 columns and two rows in PowerPoint, deciding to not show my analysis of each tooth because baka pagtawanan pa ako if something was apparently wrong with my system. Peering at the low-quality panoramic x-ray to see whether there was loss of jawbone at the point where the roots of a tooth meet and trying to figure out whether this point, called the furcation, was located more towards the crown of the tooth or more towards the ends of the roots... it was not easy. Besides that, I had a treatment plan to design. For that, I was lucky to have my friend, Randy, help me out.
Needless to say, I didn't get any sleep that night, and went to class light-headed, groggy, and nervous as all hell. Anne told me that another dentist, Valery, had only four slides in her presentation. I checked mine and saw I had prepared 38. Was I over-compensating for something by preparing 38 slides? I didn't want to be all sizzle and no steak! I kept hoping that the other dentists would take at least an hour and a half each just so I'd have to present on another day. And the other presentations did take a while. To be honest, I was expecting more from everyone else because they've been practicing dentists for years now. Even Anne had been practicing for, I think, about two years already. I always felt I was at a disadvantage at this workshop, having graduated only a year ago with next to zero clinical experience. Anne and my seatmate, Renoir, believed the opposite, however: they felt I was lucky that I was a new graduate because a lot of the things I learned in college were supposedly still fresh in my mind. I guess both arguments hold the same weight. I had also been told that it was good that I knew which branch of dentistry I wanted to specialize in so early in my career. I guess that's a really good point as well.
So the day was dragging on with questions from the seasoned practitioners of the specialty going unanswered by the perio hopefuls. A lot of the questions were honestly pretty basic, and I must say that even though I found that I'd be at a loss if some of those were asked of me, some other questions had answers that I thought was supposed to be common knowledge. I soon realized I retained more information than I had thought, and that maybe I shouldn't be too scared to present.
Throughout the day, when it was obvious there was something we didn't quite understand and the periodontists would explain it in greater detail, I would edit my presentation accordingly. It wasn't so my report would be the most "perfect"; it was so 1) they wouldn't think I wasn't paying attention after all this repetitious correcting of errors, especially since one of the panel members was a professor of mine in college and another was a teacher at another workshop, and I didn't want them to think I was unteachable; and 2) I wouldn't have to stand in front of the group for too long - kung ano ang mali sa kanila, iiwasan ko na para matapos na lang agad. That said, I was making so many changes to my presentation that a lot of it changed significantly. I ended up altering much of the treatment plan Randy helped me formulate, but kept some of his points in even though I was, at that point, already unsure. When I would be furiously writing down a new treatment plan and possible final restoration for the patient (I ended up with three versions of the treatment plan and four possibilities for restorations - ie dentures and implants), Renoir would tell me to stop working and to stop worrying; he knew I was gonna do fine. When he saw the chart of parameters I made, he even joked that I was gunning for valedictorian. That was when I realized how much work I really did put into this; it was certainly more than anyone else put into their presentations. I stopped for a while and wondered where all this energy, as draining as it was, was coming from. I had never felt so determined to do so well at something ever before - not in high school, not in college, not even in my preparation for my board exams. But I was feeling it, and I wanted to make the most of it. More and more members of the society arrived throughout the day, which meant more and more corrections to my presentation. More and more my body was acting the way it was in the days before the boards: my blood vessels were impinging nerves in my brain, my esophageal sphincter wanted to release acids into my throat, my heartbeat was pushing my body forward with each "lub" and pushing it backward with each "dub". I was surprised with how seriously even my body was taking this.
My turn finally came. I was running my opening lines through my head: "I know this is unjustifiable, but I'm a fresh grad and I've never practiced so pardon me if my treatment plan might seem idealistic or enthusiastic..." "I'm a fresh grad, but I can guarantee that I prepared this presentation to the best of my understanding of the concepts that have been taught to us here..." I set up my laptop, fired up my presentation, and took a deep breath. "Hi, good afternoon. I'm lucky last." I don't know where it came from and it made zero sense. Is there even an expression that goes "lucky last"? I stopped for a while, laughed at myself, and dove in.
As I was speaking, I found myself looking for Dr Nannette in the dark, seeking her approval of my ideas. Dr Nannette is a pioneer of periodontology in the Philippines, and is well-known in the community throughout South-East Asia. She didn't teach at my school, but she had been one of the lecturers at the implantology workshop I had recently attended. In fact, it was through her that I learned about the perio workshop. She first attended the perio workshop on its third day. Between the first and third days of perio, we had one last meeting left for implants. That day, I had presented my implant case to her, so during the perio workshop, I didn't know if I should be thinking that she would expect more from me because, for all I know, baka hindi naman nya ako mamukhaan or maalala. To my surprise, the first time she came in to the workshop, it was she who made the effort to say hello. It was just a quick wave because it was between lectures, but the smile on her face, I'll never forget.
It was the same smile as I was giving my presentation. So long as she wasn't frowning in confusion or squinting to make sense of my data, I knew I was doing well enough. When I made certain points about my hypothetical Guatemalan patient (ie "The case history doesn't state how long he'll be staying in the Philippines, though it does say he is here for a study fellowship. I'm aware that these fellowships take years, but for all we know, he could be at the tail end of his fellowship and decided to go for some quick dental treatment before flying home. Time for procedures is always a factor in periodontal cases, so I just went ahead and formulated my treatment plan on the assumption that he will be in the Philippines for at least one or two more years after his first visit to my clinic." and "This case is really, really, difficult to restore. Nahirapan po talaga ako. I was consulting with my friend who does a lof of prosthodontic work, and even he says that this is a really difficult case. In fact, the first time I looked at the x-ray, natawa na lang po ako because it's really so, so hard to restore." And yes, I really do babble when I do presentations.), it felt good to see her nod in approval. And it kept me going.I finally reached the part of my presentation that involved the nine parameters of tooth prognosis. Onscreen was the simplified table that looked like I threw a bunch of numbers and the words "good", "fair", "questionable", and "hopeless" onto the PowerPoint slide. Dr Nannette had been standing against a wall throughout my presentation, and at this point, she walked to the middle of the room to get a better look at my chart. Behind her, I saw that Dr Melanie, another periodontist who had lectured to us only the day before, had also stood up to get a better view. They were wondering what the hell it was that I was showing them, and I started stuttering, not knowing how to explain this information. So I showed them the whole table in Word, and that's when my world seriously turned around.
I explained my "system" to them, and was worried I'd be stopped mid-sentence to be corrected about one erroneous observation or another, but they just let me go on talking. All the periodontists were nodding their heads at this point, and I felt like my heart was nodding along with them. Lub-dub lub-dub. I finished explaining my table to them by saying, "These parameters were part of Doc Mike's lecture kasi, so I thought we all had to do this, pero no pala... I wasn't sure kung tama 'yung ginagawa ko but I went ahead with it anyway..." And Dr Nannette spoke up and said, "No, no. You did a really, really good job," with Dr Melanie chiming in, "This is really good. We commend you for your effort." And she started clapping, and Dr Nannette started clapping, and everyone joined in until I couldn't bear the sound coming into my ears. I seriously pretended to be looking back at my slide when I was really holding back tears. I had done good! "Putangina! Ganto pala ang pakiramdam ng pinapalakpakan!" Dr Melanie went on, saying, "If this is how you handle all of your cases, then you'll be a very good periodontist." I answered with a quivering, "Thank you. I really hope so."
They let me continue with the rest of my presentation, then they asked me some very minor questions and corrected some mistakes in the treatment plan that would have been overkill in a real patient. Dr Nannette intended to wrap up my presentation for me by asking the other periodontists if they had any questions. I then saw Dr Mike, the current president of the periodontal society, asking her in a low voice, "Where is her clinic?" Dr Nannette gave a huge laugh, and answered, "She's not practicing yet!" I can't even describe Dr Mike's reaction to that; he didn't want to believe her and asked me again, "Where is your practice?" "I just graduated po..." "You're a fresh grad?" "Yes po, I graduated a year ago, nung October." "And you don't practice?" "No, I haven't practiced since." "Wow, just wow." And Dr Melanie laughed, joking, "Magrerefer na sayo si Doc Mike!"
So my presentation was over, and we were all free to go home. Dr Tonette was my professor for about 4 weeks in college (kachorvahan ng UE with our Special Studies classes was to make siksik three subjects into one module in one semester; she taught the endodontics component that semester) I had never really worked with her as my supervisor, but I guess I made a good impression on her when I approached her at the endo workshop I attended about the school she went to in France for her masters degree. She came up to me after the presentation, gave me a huge smile, and told me, "Very good!" It was a great pat on the back. What I really didn't expect was for one of the other periodontists, who had only visited the workshop starting on the fifth day (the presentations were held on the sixth), came up to me, saying, "Good job, doctora, good job! So you really don't practice yet?" "No po, I don't." "I have two clinics in Pampanga. If you're interested, baka gusto mo mag-associate. Where are you from?" "Um, where am I from po?" "Yeah, where do you live?" "In Quezon City po." "Sayang 'no, malayo masyado?" "Malayo nga po, actually, but thank you for the offer." "Of course! You did a really good job, it would have been good to work with you." With that he shook my hand, and left me glowing in the wake of my first ever job offer.
So maybe my memory is playing tricks on me and is making me make it sound like I came up with the most epic, most radical tooth prognosis classification system ever, and of course I didn't. Will those teachers go home and re-run those moments in their heads the same way I have in the last 24 hours? Of course, they won't. But I'd like to think they at least saw potential in me, maybe saw a "kid" to take under their wing whose skills they can help hone. I keep praying now that Dr Nannette would become my mentor. That maybe she'll offer to help me get into a good masters program, or even ask me to work with her (to that, I'd probably really throw my plans for my clinic away and say yes). I know that's just expecting a lot. But I also know that they'll be expecting a certain level of performance from me from now on. Even Dr Mike told the rest of the group to base our next round of presentations on my work. "Next week, when you do your presentations on your actual patients, this is exactly how you should do it. This is exactly what we want to hear from you." I set a standard, even in a small way, and I just can't believe it.
I had lunch with my parents today, and the whole time, I kept debating with myself about whether I should tell them about this one great achievement of mine, and decided to just mention that I was offered work because I knew they wouldn't be able to process all the details. The moment I opened my mouth, I knew I was negating all the good things that had happened yesterday with just one simple sentence today. I came away devastated and lost all over again. It made me realize that even though I've convinced myself na ang lahat ng mga pangarap ko ay akin lang talaga, at hindi sa mga magulang ko, I guess I still have hope that they'll see the importance of what I've finally decided to do for a living. But for that to happen, I'll just have to keep working until they finally decide to open their eyes to what their daughter is worth, if she is worth anything to them at all. And that I will do with all the energy I felt coming from deep inside me yesterday.