WHEN I trained in diseases of the skin, hair and nails a decade back, the field was not the lucrative
business enterprise that it has grown to be today. It was simply a specialty by which doctors chose to
render their service and share their expertise. Being a dermatologist meant treating balat a
manggatal, mete kuku, melagas buak, mengalbag, mengalutu, meg-allergy, mengutli, mikakutu---the usual
stuff. Dermatology, as a field of specialization, is the mecca of physicians (many of them mothers or
mama-wannabes) who wanted easy, planned, laid-out lives, immune to emergency calls and odd hours.
It would be some years later when the terms chemical peeling, microdermabrasion, and tumescent liposuction would waft into our consciousness; when Botox®, IPL, fillers, and glutathione would become for many the necessity that they are now.
It is as much a blessing as it is a burden (occasionally) that a trained dermatologist can make at least one diagnosis within seconds of being with someone, patient or not. I plead guilty to doing academic exercises while riding in jeepneys and buses. I had my fair share of commuting in the early days of my Pampanga practice. In those days I took the bus from Retiro-Makiling in Sampaloc and got down at Guagua-Sta. Rita, held clinic in Guagua in the mornings, four times a week. Then I boarded a jeep at Plaza Noli and moved on to San Fernando for the afternoon, passing through either Olongapo-Gapan Road or dalan Cabalantian. Training my eye to note lesions, I would mentally jot down possible diagnoses and propose treatments for my co-passengers, all in my mind, all in the time it took my jeep to reach either Pampanga's Best at the intersection or Palawe. Misan mitagun pang atin makakilala at manatu kanaku, "O Doktora, obat migjeep ko pu yata?"---and I would find myself in the awkward position of having to decline their offer to pay for my fare, while wondering if I stared too much.
In unexpected ambush consultations during parties, reunions, wakes, and masses, acquaintances and friends bombard me with questions that range from "Nanu la rening mengalto keng lupa ku?" to "Nanung masanting a panulu ketang apu ning siping ming bale? Matua ne rugu ena na agyung munta keng klinika." Oftentimes I greet these queries with good-natured humor and patiently oblige with an answer. But then I do have my share of bad falling hair days, when the only reply I could grant is "Pota pu malyaring lawen ku ne pamu bayu ku mamie panulu o pakibat."
Because the skin is very accessible both by touch and by sight, at times it is difficult to determine when a conversation ends and consultation begins. Kalupa mo neng makipagkwentu ku kareng matuang kakilala o kaluguran. Makalukluk kami mo, mipangaya lalam kaimito, kaibat kabud nya mung maglislis ing matuang atiu siping ku, ngana: "O, inang, nanu la mo reni keng lawe mu?"---showing me some near-private, normally-clothed and concealed body part. Siguru kaya ala man ita, pero neng misan marine ku mu rin. I'd have to take her to some secluded area in the yard and give my diagnosis/treatment/prognosis/practical tips in the few seconds we hide behind the gumamela bushes.
If I had my way, I would conduct every consultation in the confines of the office where---in utmost privacy---I could obtain a full medical history and perform a total skin examination. It is recommended that when a patient consults for a dermatologic problem, the total skin surface be examined in order to see possible related, as yet undeveloped, skin irregularities or lesions. In truth, however, it is very difficult to make a patient reveal more than the segment of skin he or she is complaining of. Sometimes they do not show at all, making the job difficult. That's why I like babies so much, ala lang problemang papalto buldit; pota na mung aisip dang ma-injection la, kanita la magumpisang mangaga ampong mangulisak.
But then such a rigid, structured manner strips the whole experience of its flavor. Provincial practice, close to the ways of kith and kin, bears unique delights. Deng Kapampangan kalupa tamu, malugud la kareng kapara ra. Isn't that why when we meet kabalens out of Pampanga, atna ka tamu ka-excited, nung pakisabian ta la balamu maluat ta na lang kilala? Culturally, we tend to share our stories, sometimes even our woes. In a discussion, one woman might say "Mika-ringkels (wrinkles) ku," and another rejoins, "Ay wa, aku man…" and the rest of the group would pitch in their share. Friendships have been known to develop that way; that too is how, I guess, support groups for all kinds of symptoms and problems are born.
Medical histories for dermatologic complaints tend to be more interesting and colorful in the land of lahar, kamaru and Christmas lanterns, if I may be allowed to compare them with my Metro Manila database. These are highly painted with folk belief and rural ways. For example, paying last respects to the departed is commonly blamed for recurrences and exacerbations of eczematous lesions ("Mekabawu la pung mete inia mibua la"). Madalas la mu naman detang pasyenting papagulis paltik; it is believed that an imaginary circle drawn around herpetic lesions limit their eruption and spread. Herbal and traditional remedies abound in this enclave of Central Luzon: bawang, kalamunding, byabas, pakayungkung, asupri, tawas, larung ngungut, serpentina, makabuhay. Aku ping mamiru kareng akakasabi ku: "Kulang namu pu sibuyas, migisa na kayu." I have the impression that elderly women from the more rural areas tend to try out home measures before they seek professional care. And that they feel a little defensive about wanting to enhance themselves cosmetically: "Pota pu sabian da reng anak ku, nung kapilan ku metua, kanita ku meyarti." That is why it takes many years before one consults for menuling a pisngi ("Inia la pa pung mibagsak ing lahar, ana kasi kapali ing singo ning gabun") o memeklat a bitis ("Paburen ku na lamu sana, era no man akakit.")
I like being a dermatologist, and not only because usu ing magpalagu. Truth be told, I enjoy more the pathological part of it than the cosmetic one: treating real disease and seeing relief in people who come for help and advice. More than prescribed medications, the dermatologist has the privilege of informing and influencing patients on lifestyle and behavior modification, more so when these habits impinge on the disease in question. Then there are the little liberties: a dermatologist is least likely to be asked to make the generic medical clearance that we know so well, say, for PE class or employment. Little chance too for kapitangan-bengi o galing-aldo ICU admissions (except for really bad drug reactions that slough off the skin in sheets, Heaven forbid!).
I always say, give me a tree under whose shade I can stay, and I will do my thing---receive consultations, whether they be ambush or not.
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