Snow
“It’s my first snow. So cold!” That was my simple narration of the fulfillment of a childhood aspiration. To me, seeing little wisps of white flakes fall from the sky and melt on my hands and was a dream of 20 years. To my Japanese colleagues, it was a source of mild amusement. “Eh!?” They would exclaim.
Back when I was around 5 years old, the four seasons was my favorite subject to talk about. And of all of the seasons, my favorite was winter. Air conditioning was still a luxury for my family back then and we rarely used it. To live in a place where the air con is on all the time was not just a childhood dream, it was yearning. Just imagine my disappointment when I asked my parents when winter would start and they laughed at my innocence. To my surprise, I was not born in a country with four seasons, I was born in a country that had only two. They’re not even the ones I liked: wet and dry. “Is that summer and winter?” I asked. “No, it’s just lots of rain and no rain.” That was probably my first experience of media or cultural imperialism: Where what I see or hear doesn’t necessarily match what I experience. A phenomena so prevalent in Filipino society that it almost ingrains a cultural inferiority complex. At TV commercials, they would end with “consult your doctor.” Only for me to find out in the coming years that that statement usually refers to family doctors, something only <10% of Filipinos have. A concept I was only lucky to have back then because I had relatives who were doctors. The pinnacle experience of the Filipino is realizing that whatever we consume in media is often manifested with a half-baked version in our reality. I think that’s why our people often overcompensate claiming that we’re the most hospitable or that foreigners will have “more fun in the Philippines.”
Four months earlier on my final year of medical school, I was one of three who were accepted into a two-week clinical observership program in the Department of Neurosurgery of Dokkyo Medical University (DMU) in Japan. When I was deciding which institution to apply to, it was actually between Japan or other institutions in the United States (US). The US has a pretty controversial public health system heavily marred with socio-economic problems. Though I know that the Philippine healthcare system was directly inherited from the US system, I picked Japan because of their strong collectivist culture which translates to into achievements that we can only imagine. Our first choice of dates was around December of 2025. But they moved it to February 2026: Peak Japan winter. At first, I didn’t realize the implications of that date. I was too busy with the written revalida (which did lead to some hiccups with my scheduling). My desire to maintain excellence in medical school mattered more to me than a 5-year-old’s want to have a temperature below 10 degrees Celsius.
I guess a lot of other things started to matter more ever since I started my accelerated medicine program. From a high school in Nueva Vizcaya, I was suddenly placed among valedictorians, salutatorians, and olympiad champions from different walks of life. My batch of 70 had all of them. Not only that, the pandemic put a hold on most things, especially travel. Suddenly, all of these people and all of their different backgrounds, including myself, were equalized. We were all deprived of our movement. Dreams of experiencing snow were put on hold. The most important thing (and the only thing) to do was just to study.
DMU’s closest train station was Omochano-machi station or “Toy town” station. If in the Philippines, people would go to the cities to get medical care, In Japan, it’s the opposite. Their best hospitals are often situated in the outskirts or their “probinsya.” At first, we even thought we were in the wrong place because of the jarring… lack of human activity. There was an abundance of houses and condominiums around but probably just 1–3 people seen in the first 2 hours that we were there walking around trying to get to DMU. Coupled with a temperature of around four degrees, I felt like I was walking in Chernobyl. There was no one there!
“Kumusta kayo!” An old security guard greeted us on our arrival to the Sakura dormitory of DMU which would be our home for the next two-weeks. As guests, we were flattered by the warm welcome. By that time we were quite exhausted after traveling around five hours by train while bringing along two big luggages each. Considering the distance, it was a little bit farther than Manila to Nueva Vizcaya, only that you didn’t have to drive at all. At dinner, we were just at awe and thinking what if the Philippines had a great rail system. I could visit my grandparents every month and check on them.
“What are we doing tomorrow?” I asked Zea and Kurt. DMU expected us to be there two days earlier than the actual observership so that we could tour ourselves around and so that we could be settled.
“Have you guys ever seen snow?”
That’s when it hit me. I was finally going to see snow. Maybe that 5-year-old’s yearning led to this very opportunity. As a matter of fact, I did have an experience with snow before. Because I really wanted to experience snow, I asked my OFW tita to bring me snow from where she lived in New York. She laughed but obliged. What I received was a bucket of instant snow. Just add some water and it could mimic the texture. Of course I was grateful for the pasalubong, but it didn’t really strike me as snow at all. It felt like touching sharp sand. I was, again, reminded that I lived in a country with only two seasons: Hot, and wet and hot. It seemed that disappointment is a prerequisite for the Filipino existence. I never rehydrated a bucket of that thing again and eventually just threw it away.
The next day, it was a frosty zero degrees Celsius in DMU and we hopped on the train to Gala Yuzawa, a famous ski resort about an hour away. I wore extra layers because I had no plans of coming back to DMU as a patient instead of a student. I took the time to just admire the landscape wondering if I enjoy more the solar farms of Nikko versus that of the rice fields of Nueva Ecija or Pampanga. Then at an instant, the yellowish-green fauna were covered in a white glaze. It was snow. It was snowing. It took a few more transfers from train to train but eventually there I was, standing on soft powdery snow while my arms were outstretched trying to catch the snowflakes. The old science books I used to read over and over again were true. Each one really is unique. I looked around seeing roofs all covered in white and mountains tipped with ice. I was handed two poles and two skis. I was no longer looking at a screen nor reading a book. The childhood dream did not disappoint.
“Why did you pick neurosurgery?” My consultant asked.
It was my first day under the department of neurosurgery. But before that, we were toured by Mr. Peter Kwami and Ms. Sachi Matsuoka all around campus. We were amazed by their three story library and multiple cafeterias. How lucky the students are to have all of these amenities. I joked to Zea and Kurt, “if we had a library that big, I wouldn’t have any excuse to fail.”
I was ushered earlier than Kurt and Zea to the operating room. I have to say, I really was nervous about going immediately to the operating room on my first day. The thought of making a mistake in a setting so intimate with life and death in a land where you are alien wasn’t exactly the best position for you to be. I revealed my feelings to Mr. Peter and he assured me that mistakes are best made in the presence of mentors. Mistakes are prerequisites for good doctors becoming great doctors. Mr. Peter wasn’t a doctor himself. He taught medical English to budding 2nd year medical students. In Japan, their mode of instruction in medical school is still Japanese. However, they keep themselves acquainted to English terms as not to isolate themselves from the vast knowledge found in English texts. I had to do the opposite. In order not to isolate myself from whoever I’ll meet, I had to learn a little bit of Japanese. Not enough to read an entire case report but enough to not make a fool of myself and brand my nationality as a bunch of rude “Gaijin.” I was fetched by Dr. Kei Iwamoto, a neurosurgery resident, in front of the sliding doors of the OR.
“Hello my name is Kei”
“Hi my name is Hermenegildo Dumlao but you can call me Thirdy. I’m the international exchange student.”
He did not understand what I said. I guess there really is a language barrier.
“We go inside now”
“Will I scrub in?”
“Yes” I bid my good bye to Mr. Peter and Ms. Sachi. The clueless fourth year foreigner med student was going in.
The layout for the OR was actually about the same as ours. I was hoping to be impressed by some sort of innovative architectural scheme but entering their OR reminded me of entering our OR. The only difference was the stack of different machines they had just lying around that do who knows what. I entered OR number 14 and there they saw me. I was greeted by what I assumed was the head consultant neurosurgeon.
“Hello! I’m yususususus morinkaka. Are you from University of Saint Thomas?”
Gosh they speak so fast I can’t keep up. But thank God he can speak good English.
“Hello I’m Hermenegildo Dumlao or Thirdy. Yes I am from the University of Santo Tomas. So excited to learn from you all.”
At that point I forgot to greet everyone in Japanese first as not to stick out like a sore thumb or be that one foreigner that expects everyone to adjust to them.
“Here we have a patient with a non-functioning pituitary tumor undergoing a sphenoidal approach. The ENT is now giving us access so that we can take the tumor out. Have you seen this before?”
The surgery was endoscopically done so I could see the entire thing happening on the monitor.
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“Yes doctor I have seen this surgery before.”
“What did you do last weekend?”
I thought we were in study, teach, mentor, mode already but apparently they were more interested in my activities in the last few days.
“Oh doctor, I went skiing yesterday. I saw snow for the first time.”
“Oh! First time snow? Wow you went skiing already? With instructor?”
“No doctor, no instructor hehe.” Then I showed pictures and videos of Zea, Kurt, and I skiing (but failing).
“Why did you pick neurosurgery?” He asked.
Surprisingly, I hesitated to answer. For someone who picked neurosurgery as their first choice department, you would think that I had a solid answer. If I were being honest, I actually didn’t want to become a neurosurgeon anymore. I picked that department back at around September-October where I was still fresh from my surgery rotation and I haven’t experienced the other rotations. I found myself enjoying the intellectual rallies and back-and-forth discussions of internal medicine and neurology more than the 4–6 hour long silent surgeries. You would think that I prepared a long answer like that it was my dream to become a neurosurgeon and to do surgeries. I think I prefer the questions about skiing and snow again.
“Because it’s the coolest one” I said.
“YEEEEEE, welcome to neurosurgery.” I’m glad I got on his good side.
I met a few more consultants and other co-medical students as they came by the surgery. They were more interested in what I did last weekend and they all shared the same amusement when I told them that it was my first time experiencing snow. Strangely, none of them have ever been to Gala Yuzawa. I guess it’s really more of a tourist spot. I was also starting to notice a pattern. It seemed that the consultants were more fluent in English than the residents or the med students. Probably because they regularly present in international conferences.
By lunch time, the main consultant instructed the other medical student, Bitetsu, with me (who I didn’t realize was also a med student) to take me to the cafeteria and have lunch. There was a bigger language barrier here. I had to speak in simple words and short sentences akin to speaking to a toddler for us to be able to communicate. Luckily, Google translate was there to solve any linguistic pickle we got ourselves into.
“Do you want Japanese food or Italian food?” Bitetsu asked me.
“Japanese food of course!” From then on, what I usually ate as a reward in the Philippines became my daily lunch in Dokkyo. For half the price!
Sometimes I wondered if they, too, get disappointed on the daily. If they also consume media that does no fit their country’s context. Do they also read about two seasons? Or learn western iconography only to realize that it doesn’t exist there? Or were these problems so alien for them. I look at their books, their commercials, their signs. It’s all full of a lexicon everyone else but I, can understand. When you go to the Philippines as a foreigner, the signs are in English and in the Latin alphabet. It’s as if the motherland was made for foreigners to be comfortable. Is this Filipino hospitality manifest?
I started talking to more of the new friends I encountered, about how it was in the Philippines and compared how we did medical school. I showed them pictures of my experiences of Jose R. Reyes Memorial Medical Center because they rarely responded to codes nor did procedures. Maybe that was a source of disappointment for them?
“This was the actually first snow in DMU in two years” said Kanata, a co-med student rotating in neurosurgery with me.
“We must be lucky then”
“Haha yes, you are lucky”
Note the “you” are lucky. The culmination of a childhood dream come true for me was a hassle and inconvenience for the average Japanese. I guess they get disappointed too. What I did realize after interacting with them for two weeks is that it was just like looking at a mirror. The time I thought was going to be spent comparing our experiences was short-lived and eclipsed by the time laughing about how similar our experiences were. They gossip about the scandals that happen in the hospital. They become irritated after standing in the OR for 4 hours. The method of history and physical exam isn’t even that far from ours. I am even confident enough to say that we might even have it better in UST. What we lack in imaging, we make up for in sheer accumulation of knowledge and skills. Slowly, they started looking more… us. Med school is the great equalizer.
I wasn’t satisfied by my answer to Dr. Yusuke Morinaga (I finally knew his name). Not really a good idea basing life-altering decisions on vibes or just because “it’s cool.” I knew I wanted a neuroscience-related specialization. It was a matter of choosing to base my life on cutting up a patient or letting someone else do that for me. In a sense, I was still thankful for my past self choosing Neurosurgery. To give me more time to decide and realize things about myself. What better way to do that than in Japan. Here, Neurosurgery is divided into three “paths.” Open neurosurgery, Interventional Radiology (Minimally invasive neurosurgery), and Radiation Oncology (GammaKnife). We regularly rotated around all of them and neurosurgeons are expected to know all three modalities of treatment. I frequently asked my consultants questions and they were happy to answer. I think they also started using me to practice their english as they would sometimes just go straight to me to explain whatever is going on. I learned that in Japan, their national insurance system leaves the patient just paying for 30% of the cost of their care. In the Philippines, it’s the opposite. After my surgeries, I would sit in with either Zea or Kurt’s sessions in Generalist Medicine or ENT, respectively. Often, I would hear a 98–100% follow-up rate (yes they monitor how often the patient comes back). I am reminded that care is still a two-way street. A partnership. The cure is only as good as the patient’s compliance and acceptance. We’re not that far off with Japan in terms of standard of care anyway. It wasn’t hard for me to keep up with our daily rounds. Zea could converse with their top specialists. Kurt could assist with complex surgeries. I could interpret imaging and explain to my co-med students. Now translate that to ~350–400 students every year. Why is the Philippines still sick?
The feeling was familiar. It was like I was 5 years old again. I have read hundreds of pages of notes and books, listened to hours of lectures, created close to 50 thousand Anki cards. And yet, despite having this opportunity to see how medicine is like abroad, I have not yet answered two questions that I was supposed to answer in these two weeks. Why did I pick neurosurgery and why is the Filipino patient sicker than the Japanese patient?
“Konnichiwa Thirdy!”
On our stay in Dokkyo, our trio developed a relationship with a renowned doctor specializing in parasitic diseases particularly Schistosomiasis. Dr. Chigusa told us that one of his greatest achievements was taking part of eradicating Schistosomiasis in Japan. That’s why he has visited the Philippines 74 times to continue studying it. The Japanese patient was cured. What about the Filipino? I can only look at Japan’s public health and disease prevention efforts with a mix of admiration and envy. What do you mean you no longer have cases of dengue nor malaria? I was confined in the hospital by Dengue more than 10 years ago. Zea was placed in the ICU by the same. My stay in the neurosurgery OR revealed to me that the Japanese bleed red too. Meaning, our situations were not a matter of human physiology, but by geography. If only the 750 Filipinos who die of Dengue every year (half of whom are under the age of nine) were born in Japan. They could still grow up without the disappointment of two seasons. In Japan, they only need to talk about the usual adverse reactions to treatments. In the Philippines, almost all treatments come with the ADR of poverty.
The Filipino is sicker than the Japanese because she is a known case of geographical ailment and socio-economic disease. With the risk of sounding stupid and my Medicine 1 professors grilling me: The sickness itself is a symptom of things far more sinister.
Why did I pick neurosurgery? It was because I had to expose myself to the human condition when faced with the final last ditch effort. Neurosurgery is rarely a first-line treatment. It’s the solution to diseases caused by years of increased stress levels, obesity, hypertension, accidents, and poor preventative medicine. All of which are far from neurological. These diseases are outcomes of ineffective or poor health measures which should have been done earlier in their lives. The result? Tumors, aneurysms, hernias, strokes, poverty. My exposure in DMU fostered an admiration and aspiration of what could be. If it was easy to move provinces. If it was easy to follow-up care. If you didn’t have to feel alienated by culture. In medicine, we correct deranged values, remove cancerous growths, or add missing enzymes. We have transformed defying death into an intellectual exercise and daily routine. All this time, disappointment was just a symptom of a social issue to correct, a systemic inefficiency to remove, and innovative ideas to add. Jose Rizal was right. The Philippines is sick of a social cancer. So doctors should do what they do best: Treat the Filipino patient. Is it hard? Very. Impossible? I don’t believe in that word. If a 5 year old in an equatorial country can dream of touching snow. A 23 year old med student can dream of doing his part to treat the Filipino patient.
That was my first experience touching snow.
