This was taken just before one of our midnight call rounds at the Kings County Hospital(part of the SUNY system) in Brooklyn, NY, circa 1996. I don't know where Ann unearthed this forgotten picture. From left,that's me(JR) with my doofy looking eyeglasses ( I didn't have my Lasik procedure done until 1998), Dr. Marjorie Baltazar, and Dr. Joey Andrew Ugalino. Marj was our senior resident, she went on to become a pulmonary-critical care specialist. I don't know where she is though right now. Joey was my housemate(with Dr. Bayani Alberto Abordo) in NY. He went on to specialize in Geriatric Medicine and is now based in Texas with wife, Mara and son, Raphael.My stint in New York was a very unforgettable one. The world was at my feet and there were endless possibilities . It felt as if I had boundless freedom. I lived in a brownstone owned by a Filipina nurse in Bay Ridge, Brooklyn. Bay Ridge is a very dynamic and a bustling neighborhood filled with a hodge-podge of culture. There were Italians,Irish, Greeks, people from the Middle East, Jews, and Asians. I could have bagels or limpe with lox for breakfast, real Italian for lunch (or NY pizza) and Thai or Indian, Afghan or other Asian fair for dinner, right on the same strip where I lived. I did my own laundry at a laundromat down the street. And for my wools and shirts, a dry cleaner ran by a friendly Korean family is next to it. The fresh produce store owned by Italians is just a block away. The Swedish bakery and the Irish pubs were at the next corner. Less than 15 minute bus-ride away is Sunset area where there are more Chinese/Asian restaurants and grocery. My barber was a Syrian. Within a single block one may find a synagogue, a mosque, different Protestant churches, Orthodox and Roman Catholic churches etc.. Bay Ridge is also very close to Sheepshead Bay, Brighton Beach, Coney Island (home of the famous carnival and Nathan's Hotdog), and Parkslope which is a more chic-chic-hip place and where my favorite Thai place (Lemon Grass Grill) is located. Manhattan is about a 40-minute train ride on the N or R.
As a medical resident, I had to rotate in three different hospitals affiliated with the program: the Veterans Administration (VA) Medical Center, King's County Hospital and the Downstate Medical Center. The VA is also located in Bay Ridge, about a ten-minute bus ride from my place. Its background is very picturesque as it is situated near the water(the Narrows), next to a military fort (Fort Hamilton) and near the Verrazano suspension bridge which connects the boroughs of Brooklyn and Staten Island. Most of my outpatient clinic training was done there. I followed young and old vets for 3 years under the guidance of my attending/mentor, Dr. Edmund Bourke. He is an astute, caring, jolly Irish-American doc who is now the Chief of Medicine at SUNY Downstate. He was the Chief of Medicine at the VA when I was an intern and resident there. I also did electives in Consultation Liaison Psych, Endocrinology, Oncology, Rheumatology, Dermatology and ID there. I just loved the VA. There were a handful of Filipino-American staff-doctors, two Filipina chief nurses (one of them, I learned later, was Auntie Regie's classmate at UP)and other Fil-Am staff employees who were very friendly and helpful to us, the young "fresh off the boat"(FOBs) residents. There were 16 of us from UP Med Class 1994 at that time. There were other residents from more senior UP batches. Apparently, the SUNY Dept. of Medicine was so impressed with its previous residents from UP that they hired more from UP each year.
Kings County Hospital(KCH) in Flatbush (an inner city of Brooklyn), was what we considered the "war zone" during those exciting times. This was where we encountered the most difficult cases, most varied pathology in the wards. This was also where we had our emergency medicine training. KCH's ER is one of the busiest in NYC. This was also where we had extensive medical ICU and cardiac critical unit (CCU) training (where I learned procedures like Schwann-Ganz insertion and management, thoracentesis, endotracheal intubation and managing mechanical ventilators, stress testing, management of DKA, septic shock, etc.) We also had outpatient training at KCH for women's health (learned a one hand-glove only Pap smear/pelvic exam technique), breast clinic, hematology-oncology, STD, dermatology, endocrinology,etc.).KCH's complex of tall and huge brick buildings is pretty intimidating. Inside the facility is a prison ward where we also had to see patients. Some of these patients were hard-core inmates from Rikers Island. We had to go through a tight security check and several iron-bar electronic doors to do our rounds with a police escort in tow.
Right across KCH is Downstate Medical Center and the medical school. The library here is impressive. This is where the AIDS ward is also located. In mid 1990's the antiHIV cocktail with protease inhibitors and NRTIs was only in its infant stage. So during the early part of my residency, I still saw a lot of deaths from complications of AIDS, what I call now , the last big "tidal wave of deaths" due to AIDS. And I also saw how patients started responding to the cocktail and I started to see more and more survivors of the epidemic. This was partly what I considered to have inspired me to further specialize in Infectious Disease and HIV during my fellowship in California. In any case, further training in Cardiology and general medicine was also done here. The CCU-ICU is very busy since they do cardiac surgery at Downstate.
Most of my attending physicians(or consultants)in all three hospitals were outstanding. They're usually the who's who in their respective fields. Every month there's a change in rotation and a change in attending except in the primary care clinics where the attendings are constant for the three years of residency. At the end of each rotation the attendings would take us(the team of resident interns and med students) out for lunch or dinner in different restaurants in Brooklyn or Manhattan.
True, the training was tough and rigorous but I did not forget to enjoy and explore the opportunities that came my way. Only on my fourth month of my internship, I had the chance to tour Europe with a couple of friends( but this is another story). In Brooklyn itself, my favorite spots are The Brooklyn Botanical Garden, Parkslope Park and the park at the foot of the Verrazano. I went to Manhattan as often as I could, for shopping(Century 21 was my favorite store),for Broadway plays, meeting friends and other classmates who were training at other hospitals in NYC, visiting museums, dining, just exploring different sections of the city: Chinatown, SoHo, Chelsea, the business district, Greenwich Village, Little Italy, Upper East and Upper West side, Central Park, even up to the Bronx, and Queens.
Since I always had this fascination about bridges, I would would take trains to see or cross them (on foot, if allowed). I have crossed the Brooklyn bridge on foot at least thrice. The GWB is another favorite and at its New Jersey end is Fort Lee where I have a choice spot and I would sit and read there and watch the sailboats as they ply the Hudson.
On my third and last year, I gained even more independence when I got a car. It was a reliable 1989 gray Toyota Camry. Driving in Manhattan was at first, a bit intimidating too. But I soon got the hang of it and it wasn't for long that I was driving farther to places in New Jersey, Weschester, Upstate New York, Connecticut etc.. I visited places like Cornell in Ithaca, West Point(very pretty during autumn), Quail Hollow, Mystic(quaint and romantic)and many other interesting sites in the tri-state area.
There are still a lot of places that I want to visit and see in New York. But when I was there, I always thought that "they are always available and I still have time to explore them". I always thought that I would be in NYC longer and originally planned to pursue higher studies in the city. But just like what John Lennon once said, "life is what happens when you're making other plans".
Twist of fate. On my last year in NY, I decided to apply for a fellowship in Infectious Diseases. I got excellent recommendations from my previous attendings, I did well in the interviews and easily got accepted in 2 excellent ID Fellowship programs: one at Valhalla Medical Center and at the Memorial Sloan Kettering Medical Center. Valhalla first offered the position and I accepted it. About several days later, Sloan Kettering sent an offer. Between the two, I really preferred the latter. It was a dilemma. I finally decided to take Sloan Kettering on their offer and withdrew my acceptance at Valhalla. This upset the Assistant Program Director of Valhalla very much, saying that my decision to withdraw jeopardized their recruitment of a fellow as it was very close to the start of the training period. It turned out he was a former colleague of the Sloan Kettering Program Director who was then apprised of the situation and subsequently also withdrew his offer to me at Sloan Kettering. I ended up without a fellowship offer!
Needless to say, I was really devastated. I started to look for available positions outside of New York and luckily got scheduled for interviews at three very good programs that still had unfilled fellowship slots. They were at Brown University in Rhode Island, University of Southern California (USC) in L.A. and University of California at Irvine(UCI). The first interview was at UCI. I flew to L.A.. My friend, Anna Q. who's based in L.A., drove me to Irvine for my interview. I immediately liked the attendings who interviewed me, their newly opened research lab and the campus. And at the end of a series of interviews, Dr. Jeremiah Tilles, the Program Director, gave a proposal I could not refuse: cancel my remaining interviews in the two other prospective programs, sign up right there and then and I got a guaranteed fellowship position for 2 years(3 years if I want to do further research). I struggled and mulled it over for a day or two and finally decided to take the offer. It happened very fast, the transition from east to west coast. Sometime in May of 1998, I flew back from New York to San Francisco, passed my oral exam(two cases: Gastointestinal Bleed in an elderly and Diabetic Ketoacidosis in a pediatric patient) and got my California medical license. In July, I already had an apartment in Orange County and started my post at UCI and at the VA in Long Beach. And I never looked back. I had no regrets in taking the position at UCI. It was a wise and inspired decision. It turned out that the closing of the doors in New York was a blessing in disguise as it opened another one filled with new adventures waiting for me in the West Coast!
It was another very fruitful, fulfilling two years of training in sunny southern California. But this story will be for another entry.(See Go West, Young Man!)
