**WHEN THE LAST BREATH BECOMES LIFE.

FRANCIS JAMES GATDULA, AN AUTOBIOGRAPHY

“T hose things done with effort, with time, with no price in mind; those are the most precious treasures.”

September eleven. It was a date to remember for a lot of people. It was a day of sorrow for the many lost souls in the twin towers
tragedy. It was a day of mourn for the many families especially the children whose fathers were taken away by the terroristic attack
in New York.

September eleven. It was a date to remember for on this day, I was born more than twenty years ago. It was a day to remind me of
the life I have been tasked to take charge and be responsible of; a day to thank, celebrate, and inspire.

September eleven. It was a date to remember for on this day, I buried my father four years ago. It was four days after he died, six
days after I took the medical technology licensure examination, and eight days before the preliminary tests of my sophomore year in
medical school.

It was all but a sudden glimpse of life’s dark milestones that stack together at the same place and at the same time. But who would
have thought that despite these major life changes which occurred in a split second come gratitude and faith towards something
better and something to look forward to?

One epigram that has always been circulating and traversing all eras is that, “what is destined to be, will be.” I’ve always lived by
an attitude that in life, if you want to be something of worth, you have to prove yourself that you deserve it.”

At the age of 3, I was already able to tell all the letters of the English alphabet, count from 1 to 100, and recite a number of nursery
rhymes that have been read to me by just looking at pictures in the book. Like my father, I started going to grade school at an early
age of 5. My mother was so confident that I could make it big especially that I was able to graduate on top of my class at a small day
care center in our barangay. When the first day of school started, my classmates who had been through formal education in nursery
and kindergarten were already constructing sentences in English, fluently reading long paragraphs, and correctly spelling difficult
proper nouns. I was overwhelmed. My mother and I recognized that I have to catch up and cope with a lot of lessons.

During the very first recognition day where the top ten pupils are to be awarded on the stage and are given certificates, I became
very frustrated and jealous of those who received recognitions. I remember asking my mother, “Why am I not given such award?”
She just touched my face and hugged me. “Someday son, strive to be better and you will be given too,” she said.

Since then, I became focused and competitive. But my father was always there to remind me of my childhood and the need to enjoy
and play. During weekends, he made sure we bond together in whatever activity—be it cooking, playing tennis or chess, watching
television or going to mass. Even as an only child, I did not yearn for the company of a sibling because my parents made sure that I
grow up being loved and at the same time responsible and sensitive to the realities of life.

Not later than a year, I was able to realize my goal and become part of the top ten performing students in my class; and another year
later, I was already first in my class until I graduated valedictorian.

But even as a child, I have learned that life has not been always graceful. Even as a child, I have experienced school bullying and
rejection. Even as a child, I’m given heavy weights to carry and be responsible of; continuing challenges to hurdle and to overcome.
I am very grateful that during these times, my parents were there to guide and hone me into someone valuable. During childhood, I
also learned that time is certainly an endless progress and there is nothing you can do but to move forward.

My father had the greatest impact in my life. He was always there to support, to care, and to love. He was not perfect. He was not
able to give me the world, but he was a father who sacrificed everything he had just to provide for his family. He did not live a life
of pleasure and glory but he was able to fill the hearts of his patients with genuine compassion and care that was expected of him as
a doctor. If there is one person I look up to as a physician, it is him.

My family lived a life of simplicity. I remember my father always telling me that as long as we get to eat right, have a place to live
harmoniously, and that he is able to provide for me and my studies, then we’re good.
Dad was the best father anyone can wish for. I kept nothing from him. It was how he wanted. That is why we were like buddies.
Sometimes, when we throw jokes at each other, we even use medical terms that mom could not understand and we just laugh
spontaneously without mom catching up why we were laughing. When I need something in school, I just tell him—“dad, I have to
pay school dues; dad, I need a book; dad, I have no ink; dad, my friends are inviting me for dinner.” I will just have to tell him and
he never hesitates to provide as long as he can. He never leaves for himself even if he would just have noodles for dinner because he
had already sent me all his money. He will still prioritize me even if his old pants are already fading or his underwear’s already
tattered. Even if he is clueless where to get money to send me to school, he just says, “anak, hanggang kaya ko, basta para sa’yo [I’ll do
everything I can son, just for you].”
We also used to play chess and cards together. He would always win. I even cheat sometimes when he leaves me for a while to
attend a patient. While he is out, I would get all the pieces that will make my deck win. When he comes back, I know that he knew I
cheated but he just smiles and lets the game proceed. What I noticed is that everytime he makes a move, he also makes sure that
every card, no matter how it may seem useless, still plays an important role. In the end, I would still lose. Then, he would say, “Anak
[Son], it is never right to cheat. And it doesn’t matter what cards you hold. You have to think every step that you make because it
will determine the succeeding steps and then the direction. Nasa diskarte ‘yan anak [It comes with your own strategy].”

When I graduated in college, he tried his best to go to Manila even if he insists that he isn’t fit to travel anymore. He still went
because I know he was proud of what I have achieved especially when he learned I got accepted as a writer and later on an editor of
The Varsitarian (UST’s official student publication). He told me, “cum laude is just a Latin name son. After a while, it fades away. Who
would remember you even graduated cum laude but only those people who are close to you. The fact that you were able to meet
cabinet secretaries, senators, Nobel-Prize winners, scientists, university administrators and internationally acclaimed doctors at such
a young age matters more. It is a rare opportunity that you have to be grateful for. But most importantly, it is a memory which will
never fade away.”

After graduation, my mom, dad, and I went to see the film Indiana Jones and the Tomb of the Crystal Skull. In my memory, that was
the last time we were together as a family in a movie house. When we went home, my mother was bugging me to tell dad of my
future plans of pursuing medical school. It was not easy to bring up the topic to him as he always discourages me to become a
doctor. “Being a doctor is hard, son. I don’t want you to experience all that I went through. And, I don’t know if we can still afford.”
At one point or another, I know I had to tell him and when I finally did, he just went to bed and said nothing.

I followed him while I was sobbing. I told him that I will look for a scholarship. During that time, I was already accepted in UST. I
never told him I applied because he would not permit it. I even saved my allowance then to pay for the application fee. I also
remember telling him that I will look for any job, even if it entails me to work as a gasoline boy, if the job can send me to medical
school then I’m for it. Finally, dad saw my determination and consented. He even told me teasingly that he may not be able to
breathe anymore because his debts were already nearing his nose. So I promised him not to worry because “when I graduate, you’ll
go up the stage prouder because I have achieved better.” He just replied, “Medicine is hard. It just depends on your determination
to succeed. Just make it big and do not repeat the same mistakes I made. When you graduate, your mom and your grandma will be
accompanying you up the stage because I can no longer make it.” I didn’t know why he said that. Maybe because he meant he can
no longer stand up to walk that far.

During the last Christmas that we had, we were not able to celebrate much. He said that as long as we are together, we’re more than
happy as those with all the money and delicious food in the world.

During his last birthday, he asked me what food I want to be served. I just told him to get some ice cream. Right there and then, he
ordered three gallons of ice cream that even his friends were able to eat a lot. It was not his grandest birthday, but I knew it was his
happiest because he felt he made me happy.

When I was about to go back to Manila for medical school, he was sad because I am again to leave him for a long time. It was
raining when the bus came. I forgot to kiss him so I went off the bus, ran, and hugged him tightly. I never thought it was the last
time.

The next time I saw him, he was already in the hospital. He was bed ridden, asthenic, with edematous hands and feet. He barely
recognized me but when I kissed him in the forehead, he was able to say my name, “Epjey.” He always addresses me as anak, jey, or
epjey. He fought for weeks in the hospital with a diagnosis of sepsis secondary to Burkholderia infection complicated by his
uncontrolled diabetes. When he’s on his way to recovery, he chose to be discharged and live with me in the apartment where I
stayed, along with my mom and grandmother. I noticed a lot of changes in him. He became irritable. It was only when we can no
longer buy his medications that his health became poorer. I also learned that he sacrificed buying his maintenance medicines for
diabetes just to provide for my education.
Even if he was sick, he was still asking about my concerns—when is your next tuition payment son? Your birthday is nearing, how
would you like to celebrate? Will 5,000 pesos be enough?
When he becomes lucid, I tell him of my plans of not taking the med-tech board exams anymore since I was not able to prepare
because of my medical studies and having the thought of him being sick. But he insisted and told me, “Even if you don’t get to top,
I will be happy. Take the exams and you’ll see that all you know will pop out from your head easily. Then you’ll tell yourself, tama
pala si dad [dad’s right]!”

The night before he passed, he asked me to insert an IV line and inject paracetamol because he was having fever. He wanted me to
stay beside him but I can’t because I had to review for an exam the next day. I told him I may not be able to properly insert the line
because of his collapsed veins. His last words to me were, “Anak, bakit wala kang tiwala sa sarili mo? [Son, why don’t you trust
yourself?]”

The next morning (September 7) when I woke up, my mom was already screaming because dad was no longer breathing. I ran off to
do a CPR. It was my first time. I started crying. His secretions were already dripping from his mouth. I asked my mom to call a taxi.
I did not go with her to the hospital. I stayed home and prayed since I can’t bear the likely outcome. When my mom called and told
me what happened. I just went to the bed where my dad used to lie and hugged his pillow. My mind and emotions felt empty. In
the afternoon, I learned that I passed the licensure examination. What an ironic day!

I prayed, talked to him, and tried to reminisce all his memories.

“Dad, I will miss you. When I go home from school, there won’t be a text message anymore asking me how my day went. I will miss
your messages everytime I will take an examination telling me I can do it. There won’t be that special person greeting me on my
birthday and telling me, “Anak, sana maging maligaya ka sa kaarawan mo. Wala akong maireregalo kung hindi ang panalangin ko na sana
magtagumpay ka sa lahat ng plano mo sa buhay. Happy Birthday Son! [Son, I wish you happiness today. I may not have a gift for you
but what I do have are my prayers that you’d be successful in all your endeavors in life.]”

Dad, I will miss our conversations whenever you’re tipsy—“alam mo, nasa med proper ka na [You are already in Medicine proper]. Be
responsible for everything you do. Make it good dahil ‘yan lang ang pamana mo galing sa akin [Make it good for that’s the only
inheritance I can give you];” whenever I get a high grade—“That is what I wanna hear from you son. Sorry I doubted you because
medical school entails a lot of sacrifices. Good work! Keep it up! Tumataba tuloy ang puso ko kapag nakakarinig ako ng ganyan [It is very
heartwarming when I hear of such];” and whenever I am down and frustrated—“Hayaan mo na anak. Mag-aral ka nang mabuti and
things shall be added unto you. [Let it go son. Just study well and things shall be added unto you.]”

Dad, though rich in friends, was not able to leave much. After he died, we struggled a lot. I did my best to apply for scholarships
and beg for people to help me to continue my medical education. I also worked through selling vitamins and contributing write ups
to magazines while simultaneously studying just to earn money for my everyday allowance. I also get from these the money I spent
in photocopying books as review materials during examinations.

Meanwhile, my mother tried to sell siomai at a food stand in a nearby school but because of her age coupled with prolonged
standing and frequent walking, she developed osteoarthritis The 200 pesos daily earning was not worth it so I told her to quit. [My
mother used to work as a hospital accountant/auditor but when she and dad got married, my father asked her to have an early
retirement so she could take care my needs at school and be a plain housewife.]

I worked harder—doing more articles for more honorarium payments and tried to sell more vitamins. That, plus the 5,000 pesos
pension of my grandmother and a help from few good-hearted relatives and friends kept us alive for so many months. Sometimes, I
felt not going to school anymore because I was too tired thinking and doing so many things apart from studying medicine. But, I
told myself that I had to for two things—to get my degree which I have always been dreaming of, and to make my dad proud and
not waste his efforts sacrificing for me just to finish Medicine.

I started to apply for scholarships. No one seemed to care. I was asked to write this and that; apply here and there. But in the end,
I’m back to nothing. I was hopeless until I was reminded of Dr. Noel Chua, who I met when I was still an editor of the Varsitarian. I
sent him an email explaining my situation. He redirected my concerns to the UST Medical Alumni Association (USTMAA).

From there, I was able to communicate with Drs. Stella Evangelista and Zita Yorro of USTMAA in America. They became like
mothers to me. When I first met them, they already hugged me and treated me as if I am their own. They never hesitated to help.
Since then, I was praying every night thanking Him that I was able to meet them. Drs. Evangelista and Yorro paved way for me to
meet and communicate with my dad’s former classmates from class 1972-Clerks Drs. Primo Andres, Zenny Young-Bhatia, Cyrian
Gonzales, Anita Lim, Jose Cristi, among others. They all covered for my entire tuition and miscellaneous fees until I was able to
graduate. They also served as my second parents. They became a bridge for my dad’s classmates to channel their support to my
education especially Drs. Andres and Young. To them, I am forever indebted and grateful. What and where I am now is mostly
because of their support.

Junior (formerly clerkship) and postgraduate internship came and I was able to spend most of my hours in the hospital, hardly
sleeping and eating—primarily due to work, but partly because I don't have enough money to buy food. Due to the huge amount of
time demanded from me in the hospital, I was barely able to write articles or sell as many bottles of vitamins that I can. It was still
not enough to pay the rent and supply the everyday expenses. Almost monthly, we get disconnection notices for electricity and
water and most often, I write relatives here and abroad asking and borrowing money to pay our rent, bills, and expenses. Some
would extend their charity but most of them don’t because they also have their own problems and responsibilities at hand.

During these times, I was not only losing hope but also losing much weight. Basically, it was due to stress and partly because of
thinking so much for things that worry me. Sometimes, I prefer to stay beyond hospital hours or pray for a bunch of patients
because these would make me forget that I have to eat and instead spend the money I have in my pocket for transportation or food
to bring home.

God is still good. Due to some sort of a miracle, I was able to finish Medicine, graduate, go through medical internship, and now, on
my pursuit to take and ace the Philippine Physician Licensure Examination this coming August. A lot of times I talk to myself—
Well, C’est la vie! I am still very lucky and grateful that a lot of people are continuously helping for me to reach this far. I just pray
that someday, it will be my turn to help because from what I went through, I know how hard it is to beg, seek, or knock. It has
always been a lot better and easier to give rather than ask.

When I look back, I see so many sacrifices and I begin to think--was it worth it trying to beat all the odds and continue my medical
education or was it more practical and achievable had I stopped and worked instead. Maybe what made me continue was my
ultimate dream to become a doctor. I never gave up despite everything. There were a lot of great people who helped me everytime I
stumble and fall along the way. And I am so thankful for without all the help I was able to get, I don't know where I am and my
family is now.

There has been so much pain, but's, and what if's; so many sorrows and regrets but despite all of those, I still try to smile, project
positively, and look forward to that day when I eventually beat all the odds and become successful. It's so hard and I know that
there will be more rocky roads to tread or bumps to hurdle but I can make it through because what I do know is that I will not give
up and I do not want to give up until I am able to reach my destination!

Who had ever thought I would reach this far? Who had ever thought I would be able to earn my medical degree from one of the
most prestigious schools of Medicine in the country? Who had ever thought I would come up with something from having nothing?
As I have said in the beginning of my story—those things done with effort, with time, with no price in mind, those are the most
precious treasures; and that, what is destined to be will be as long as you prove yourself that you deserve it!

INSERT TRANSITION PP HERE

Y ears later…
April of 2017, I resigned from being a neurosurgery resident at St. Luke's Medical Center.

Months before my resignation, the eagerness to quit grows as situations were gearing towards pushing me to do so. I was on my
third year of training in St. Luke’s Medical Center (SLMC)—second year Neurosurgery proper.

January of 2017, I was assigned in the Philippine Children’s Medical Center (PCMC) as part of Pediatric Neurosurgery exposure.
This rotation opened my eyes to a lot of things. For the past year, I had been on perpetual duty in St. Luke’s—technically a
“resident” of the hospital for 24/7 as it was known that only one resident per year is being accepted in the program. I have seen the
culture and exposed to all that is good as well as bad practices. Being a Thomasian, I am always inclined to the principles and
idealisms of what is righteous and what is not. And so I came into the conclusion that every training program is not perfect and it is
up to the trainee to get what is ideal and what is proper. We were tasked and polished to be tough because we need to—supposedly
to bring out the best in us.
At most times, I linger to why I did not pursue residency in the University of Santo Tomas Hospital (USTH), where I did my
internship. I have chosen St. Luke’s at that time because I wanted to see my limits and it opened a whole new dimension for me. It
widened my horizon. Like it or not, it served as my new home and provided me another family. For this, I had a lot to be thankful
for despite all the mishaps.

When I did my rotation in PCMC, I even gained a better glimpse of the life outside my comfort zone. People are a lot more
receptive. Consultants are much kinder. The most important lesion I have learned is that you do not have to be scolded each day,
hear hurtful things, or experience physical harm in order to learn and be good. I was able to study my cases well before and after
each surgery without worries. I was able to express myself freely during conferences without the fear of someone calling me
monkey. I was able to work peacefully less all the eyes watching every move I make and waiting for me to do something wrong and
not pleasing for them.
People in PCMC appreciate what you do, especially if you do it well enough.

Everytime I go back to St. Luke’s, it worries me so much—like a strong wind blowing the lit candle inside of me. I feel like I am not
the same person anymore.

Last January, I have been put in probationary status for three months. There has been no clear reason why—maybe poor
performance; maybe because I am not good enough to meet the standards being set? However, when I saw my final written
evaluation, my grade was even higher than my immediate senior! How did that happen?

I learned that one of the consultants wanted me out of the program but the others lobbied because to them, I deserve promotion. To
my knowledge, I have not done any gross misconduct or negligence. My performance was satisfactory to all the other consultants.
Even in PCMC, I perform fair enough. In fact, during my first year in neurosurgery, the general surgery service is trying to sway me
into shifting to their program because of my good performance and they were even giving an offer if I decide to transfer. But I
refused because I realized that in the long run, I still want to become a neurosurgeon.

I felt like I am not growing anymore. Yes, I am indebted to St. Luke’s for a lot of things that I know in neurosurgery. I was able to see
many procedures that most residents in other institutions have yet to see. However, it worried me that if they get to put me in a
situation I far less imagined to be into, what assures me that it would not happen in a much larger scale especially when I am
already a senior resident—like that of the fifth year resident that they have removed due to personal reasons that are beyond my
knowledge. To add that St. Luke’s did not produce any graduate for the past five years or so coupled with the unwritten reports that
they are known to extending the term of their residents depending on how they deem.

Finally, I decided to resign and look for a slot to transfer to—whatever institution that would accept me. Again, there is no perfect
program. I can take everything that has been thrown at me. I have endured a year of that in St. Luke’s in fact. But I would have
wanted to be in an institution that would appreciate my strength, lets me grow, call me their own, accept me holistically, believe in
me instead of bully me, and trust me instead of finding out the fault in me.

Prior to going back to St. Luke's this April from being in PCMC for an outside rotation, I filed my letter of resignation. I am living in
the idea that I do not want to be consumed anymore and leave myself some dignity and respect. I thought a lot about leaving
anyway.
After I resigned, almost everyone in St. Luke's—nurses, residents, fellows, and consultants from other services were concerned.
They were asking what happened. They were all puzzled because I am not the type of resident that would either quit or be kicked
off. Some even told me I am one of the best residents. Rumors began to float. I kept a low profile. Finally, I was able to talk to my
residency training officer. Her name's Dr. Ibet Sih. They put on my resignation on hold and prevent the medical education secretary
from submitting my letter to the medical director. They gave me time to reconsider coming back.

During our conversation, I told her the reasons for resigning. “I still want to pursue neurosurgery and I have always wanted to
become a neurosurgeon.” Nothing has changed. For the past year, I have been looking at the mirror. What have I become? I can see
that I have learned a lot of things but I also see myself being always afraid and trying to be perfect, as if someone is always gonna
want me fail. It is very difficult to prove myself anymore. I also told her that the PCMC rotation I had was a good thing, contrary to
what they were claiming that the consultants there were teaching mal and unorthodox. When I was there, I realized that I love what
I am doing and whenever I was wrong and being corrected, I make sure that I learn from it and then move on. They do not linger in
your mistakes and they do not rub it in your face like what consultants in St. Luke’s do.
Finally, it dawned—do I want to go back to St. Luke’s? Whenever I am in St. Luke’s, I feel so much burden. So much burden! I feel
this especially when I see my consultants and some senior residents. I hear them say bad words every day. And all they see is the
stupid me—like I am a walking mistake.

I was awarded the best resident in my batch in general surgery when I was a first year. But now, here I am, being always afraid. I
look back two, three or even four years ago and I am not even close to what I see myself now. I used to have confidence in
everything I do. I became so afraid of them to the point that I wish there would be no more surgeries so I would not see them; or I
would not hear the bad things they say or the harm they would do—the punches, the kicking, the trauma! It feels so wrong because
I am there to learn and surgeries used to excite me.

At that point, I had the courage to admit to myself—I am no longer happy.

I resigned. I did it to grow and to trust myself again. I cannot do that in there, where every single one of them looks at me so low.

Dr. Sih kept on stressing that she also had her own share of bullying during her time and that she had to overcome all of them. She
was urging me to go back and said that I should think about my decision carefully “dahil sayang yung slot mo.” She gave me at least a
week to decide. If I choose not to go back, she said she will not hold me back because she would not want to be the one to blame if
the future goes dark for me.

I accepted the break she offered but in my mind, I have already decided. I saw how their system works. There is a big possibility
that everything that has happened will just be like dé javu and when it does, it may be too late for me to start again.
Dr. Sih also said she has nothing against me transferring to another institution if it will provide a nurturing environment and if I
would still be able to finish neurosurgery.

I told myself that if I am gonna do this, I am gonna do it right. This time, I know a lot better.

I have thought repeatedly about what I am going to do. I am factoring in everything. My mother and grandmother are not getting
any younger. Of course, I still want them to see me settled at least—successful in my chosen path. I was not earning much. I get a
stipend of approximately 15 thousand per month which just goes to monthly rent and bills. Money is really a big of an issue, not to
mention time. I am my family's breadwinner and I always do my best to work, earn and provide for them.

There were still some people who are convincing me to go back to St. Luke’s because it is the practical choice. They were right. I will
be putting to waste all my efforts for the past three years if I leave.

Some see the courage I had—get out, hold up, and do what I think is best. I am a professional. I am a Thomasian. And I hoped I
made the right decision, with God’s will and providence.

After I resigned, I worked free-lance—doing duties and errands in some hospitals so I could provide for my kins. Last October, I
decided to apply in USTH neurosurgical program. The downside if I get accepted? I may have to repeat all over again.
I was accepted for pre-residency and did a 2-month perpetual duty (on call daily). I ate, slept, pooped, and bathed in the hospital for
2 months (as I did for a year in St. Luke’s). During those months, of course, I was not able to earn. I used the money I saved during
my free-lance jobs to sustain myself and my family. To cut it short, I finished the pre-residency. I am still waiting for a decision if I
will be accepted.

A lot of times, I get depressed—especially when I see a lot of my friends and former classmates already graduating from residency
and start their medical practice. And here I am, back to square one.

### 20 December 2017

CONTINUE TOWARDS MOONLIGHT THEN SPMC