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on duty on Christmas Eve, Christmas Day, or New Year's Eve. He was quite human; he had been an
intern and he knew what it means to confine a young man, full of health and vitality, inside a hospital
while all his colleagues were dancing and eating and making merry at the numerous parties at those times.
Being on duty in the ward means that for twenty-four hours you are shut up in the Hospital. Your exact
whereabouts from hour to hour must be known to the information clerk and head nurse, so that when a
call comes for you they can get you at once. You cannot leave the premises even for a moment. Well, that
is no way to spend Christmas Eve, is it? This sounds rather serious and heroic. It really is not so bad in
some of the wards. In ours, for example, the female medical ward, an intern does not get more than two or
three emergency calls during the night, usually for newly admitted or dying cases. But is the surgical and
children's wards there are very many more calls. You are called to change soaked dressings, to do blood
or urine efflaminations for emergency operations, and to give injections that the nurses cannot give. When
we were there, it was terrible. One time I was on duty, there were so many calls that I got hardly an hour
of sleep. I know some interns who got sick or lost so much weight during their four months' stay in that
ward that they had to stop their studies for a time.
So the Senior Resident suggested that we draw lots. When I unfolded the slip of paper that I drew I saw
written on it, "Dec. 24th.” I crumpled it up right away in my fist and pretended that I got another date and
that I was very happy that I had been so lucky. But the Senior Resident asked to see the bits of paper we
had and one by one my companions showed him theirs. Christmas, New Year's Eve, New Year, Rizal
Day were all accounted for. I gave up my paper last and when they saw it they all laughed gleefully. I
guess they thought it funny. But later on when I considered everything, I decided my luck was not so bad
after all. Christmas would have been much worse because you miss all the crowds and the gifts and the
dinners and the strolling around. And of course the worst is New Year's Eve. You have the greatest
number of accidents and emergency cases on that night, and the noise of the city celebrating, the crowds,
the rockets exploding comes to you in the operating room as you assist in the reduction of a broken leg or
in your laboratory as you exāmine the urine of a case who suddenly fell unconscious after setting off a
firecracker. Perhaps if you are especially unlucky, you may, during odd moments when the racket in the
street is not so great, hear snatches of dance music at some party where you are sure your friends are
enjoying themselves.
Of course I would have been more glad if I had not gotten any of those dates, considering that there were
only five holidays to be divided among the twelve of us, but one is not always lucky. Some of my
companions were sympathetic in that manner that is a bit offensive, but I did not mind them much. One of
them however, was sincerely so and offered to relieve me for an hour or two on Christmas Eve, but of
course I refused.
That is the trouble with generosity, you have to pay it back with generosity.
Within the next half hour the hilarity subsided a little and we settled down to the morning's routine. There
were new patients to be examined, there was the work at the Dispensary and in the autopsy room. My No.
42 was to be prepared for a conference. (We always remember our patients by the number on their beds
or by the diagnosis of their case. Thus, you hear us speak of "my No. 42" or of "my diabetes,” “my
dysentery." A bad heart case we refer to as “my cardiac decompensation, advanced.” It sounds funny at
first, but one gets used to it, and it is lots easier and more convenient to remember your cases that way.
( The conference meant that I had to read up on the disease, look up the records and previous treatment of
the patient, and to finish all laboratory examination of the blood, urine, feces, and sputum. The Senior
Resident

91
wanted us to do all these things ourselves because he said it gave us a lot of practice and also enabled us
to know the case in its entirety.
Some of my patients were sympathetic too when they learned that I was to be cooped up there on
Christmas Eve, just like them. Poor people, they had long since resigned themselves to a Christmas in
bed, and their pity was more heartfelt, I suppose, because they were sick. Some of them were pretty bad
too; one at least I did not expect would see the New Year. As I made my rounds among them that
morning, I said to myself, heck, if these people can face the prospect of a Christmas much more cheerless
than mine, why can't I? Why, even my rheumatism, whose joints must pain her like hell and would surely
pain her more when it got colder at Christmas, didn't complain about spending the holidays in bed.
When I got to my room that night, I found my companions there already. Three others shared that big
room with me: Mariano, who is in the children's ward; and Dalmacio and Jose, who are in the surgical
ward. Mariano too was to be on duty on Christmas Eve and we lavished our pity on each other. At first
the other two made fun of us and boasted of the parties they were going to attend, but we didn't mind and
soon the conversation drifted to more familiar topics. Every night before we fell asleep we used to discuss
the day's work, the interesting cases, the funny incidents with head nurses and supervisors, the brilliant
diagnoses and astounding blunders. The blunders were the most entertaining, for there was nothing we
loved better than to see some pompous professor come to grief at the operating table or in the autopsy
room. We were young enough to enjoy their discomfiture, although we knew very well that we would
make the same blunders—and more, when our turn came. That night we were enjoying a particularly rich
item, the embarrassment of the entire Department of Gynecology over the case of a woman whose only
complaint was an enlarging abdomen. Every condition was considered, all sorts of diagnoses from tumor
and cyst to fluid in the abdominal cavity were given. Only one condition was forgotten because it was so
common, and when they opened her up in the operating room, they found that condition. The woman was
pregnant, had been pregnant all the while they were talking of tumor, cyst, water. That was a story we
were never going to forget, we all resolved. It was seldom that we got even that way with our supervisors.
Then Mariano started telling something which we thought would be equally funny but which didn't turn
out to be so.
"You think that the Dermatology clinic is the dullest in the Hospital just because you can't distinguish
between prickly heat and the skin manifestations of syphilis. You see nothing stirring or exciting
professional ability in scabies and ringworm, sunburn and freckles. Well, something happened out there
this afternoon. A girl came in accompanied by her mother. Spanish mestiza. Seventeen. Indescribably
lovely. Her skin was without blemish, but when we asked for her complaints she said that her legs felt
numb at times. She had tried applying liniment every night, and one night she must have made the
liniment too hot, for it burned her skin and she never felt it. Well, after that it was almost unnecessary to
ask anything else, but nevertheless we went on with the routine examination. We blindfolded her and
pricked the skin of her legs and hands and never once did she feel the point of the pin. When we had
convinced ourselves, we gave her a recommendation for examination at the San Lazaro Hospital. The
mother asked us what her daughter had. Hansen's Disease, we told her. That is what we were taught to say
when we do not want them to know what they have. Instead of saying T.B., for example, we say Koch's
Disease; instead of gonorrhea, Neisserian Infection, and instead of leprosy, Hansen's Disease.

92
Well, we saw nothing funny in that and we said so. We were pretty sleepy by then and I suppose most of
the details escaped us. But we talked awhile of leprosy and its diagnosis and treatment and how perhaps
Doctor Pineda was the only one who could diagnose itin its earliest stages.
Afterward I told them of my No. 40.
"I had a most interesting person assigned to me this week. A taxi dancer from Pasay. No, no longer pretty.
Cardiac decompensation, advanced. She was brought in by an ambulance. She had no companion, she
gave no address, and she came with nothing but a square box. I had a look at that box when I first
examined her. It was a perfume box, an expensive affair of green velvet and chromium-plated clasps, and
it contained about a dozen bottles of the most delicate and costly French perfumes you ever saw. That box
must be very dear to her, for she will not let it out of her sight. The poor thing clings with all her might to
the last remnant of a life she must have loved well, for although too weak to sit up or talk a long while,
she is not too weak to powder her face and pour scent on her clothes and bedding every evening. A sort of
habit or ritual-whatever you want. The head nurses objected at first, all except your Miss Basa, and they
tired to take away the box one night. But she couldn't sleep and they had to give her morphine. After that
they let her do as she pleased."
By this time I saw that they were all sleeping. I think they must have been sleeping for some time, for
they were breathing slowly and regularly. I myself tried to sleep then but found out I could not. My bed
springs creaked abominably, for one thing, for another I guess I was too tired. I had finished a great deal
that day so that my work would not accumulate toward the holidays. That insured that when December 24
came I'd have nothing to do except work on an emergency nature.
For a while more I thought of my patients, especially those about the diagnoses of whose conditions I was
not sure. One meets a lot of such cases in the Hospital. They come as the most obscure complaints—a
headache, a dull pain on the right side, a weakness. We question such a person minutely, go over his body
inch by inch with all sorts of instruments, examine all the secretions and excretions repeatedly, and yet we
find nothing. Sometimes he dies and even on the autopsy table, after we have dissected his flesh and
bone, we still do not find anything that could have caused death. His heart stopped beating, that's all. That
is why, when I hear people chattering about the wonders of medicine, it is all I can do to ask, Which
wonders? I have been told that my way of thinking is quite common among young scientists and new
graduates but that they outgrow it after a while. I'll have to wait to find that out.
Or maybe this attitude of mind is brought about not so much by contact with disease itself as by contact
with healthy persons in the presence of disease. The circumstance of illness is only one of the many you
are likely to meet in any hospital. The reaction of people to disease and death is one of the most
interesting things to witness. It is likely, however, that your first experience will make you sick. This
happened to me when a patient died on my hands while I was giving him oxygen inhalation. I was new in
the ward then and the struggles that the poor fellow made before he gave up his last breath, with his lips
and nails going blue, then black, his joints creaking, the luster going out of his eyes little by little, made
me so ill I had to leave the room. I couldn't do any work to speak of for two days. But it passed, and when
my next death came I didn't feel it very much. I have observed that most people die quietly; that is, if you
give them enough time to prepare for it. They become quite resigned and even religious. They don't
struggle and kick and make any great fuss. It is only the healthy and the strong who say "I don't want to
get sick, I don't want to die, I want to live, there is so much to live for." Those
93
who have been in bed, say two or three months, find out one day how wonderful it would be not to get up
at all any more, to lie down forever in peace. All the noise is made by those left behind.
Have you ever visited a sick friend in the Hospital? Or rather, I mean, have you ever been to the charity
wards during the visiting hours? If you have you will know what I mean by noise. The crowds stream in
as soon as the doors open at three o'clock, and you would hardly believe there are so many people who
visit the sick. It would seem that for every patient in the ward, there are ten visitors. They come bringing
flowers and fruits and eggs and all kinds of odds and ends. The flower shop right across the street from
our Hospital does a thriving business because of them. Even those little girls who sell strings of
sampaguita and champaka for two centavos a string find it profitable to wait at the gates just before this
hour. You see, two or three centavos for flowers is about all that many visitors to the charity wards can
afford.
Sometimes, observing these people as they crowd around the patient, asking him questions, trying to say
something cheerful to him, I think that if I ever get sick I will not allow any visitors in my room. For there
is something that they bring you besides flowers. They also bring you pity. Pity is in their eyes as they
look at you, in their very first greeting, in that smile that they try to make so hopeful. They pity you who
are in bed unable to get upwhile they are up and able to go where they please and eat what they like. I
look at it this way: If I were sick the last thing I would want is pity. I'd get well sooner without it. What
do people get out of seeing me sick? If they are really my friends, they feel bad and I see they feel bad
and I get worse. If they are not my friends, I see they are glad I am sick in spite of all they say to the
contrary, and of course that makes me worse.
Many of my patients feel that way; only, I think that they are too polite to say anything about it. They just
accept the flowers and fruits and eggs with a weak smile of gratitude. But I can see that they feel more
miserable after the visitors have gone. My cardiac decompensation, for example, had a few visitors the
first few days she was in the Hospital, but she was always worse after they had gone. I don't think it was
because she envied their health. It must have been something else. I can say this because I have studied
her condition so thoroughly day after day that I think I must have learned something of her character too.
Some of the patients we have are on our hands for one or two months; we talk with them several times a
day, ask them questions, take their pulse or blood pressure, note the effect of the medicine and see the
changes in their condition or the progress of the illness. So sometimes we become quite familiar and
intimate with them. The more congenial of my classmates strike up acquaintances this way that last even
after the patients leave the Hospital, but I have not been able to do this. I am too reserved, I suppose. I
can't chat away like some of them do to save my life. Even with the nurses I have never been able to
become intimate. I always envy my colleagues when I hear them calling the head nurses by their first
names, teasing them, going out with them.
I was wide awake early on the morning of the 24th. It was not yet five o'clock but I felt that I had had
enough sleep. I thought of going to the ward because I knew there was a great deal of cleaning up and
decorating to do, but I decided against it. You see, on the day before Christmas the whole Hospital is
always cleaned from top to bottom and the whole place made as cheerful as possible. Everybody is
supposed to help, for the work cannot be done by the nurses and servants alone. There are no orders for us
to do this, it is true, but we are supposed to forget for the time being that we are interns and lend a hand
with a broom or a dust cloth when necessary.
I saw that my roommates were still sleeping soundly and apparently had no intention of going out at their
hour to help, so I did not get up. I was afraid that if I went alone to help the nurses I would receive no end
of razzing. So I just pulled the blanket over me and settled more comfortably.
But I couldn't go back to sleep. I was thinking about the work that must be going on everywhere and the
nurses and everybody else working overtime. I got up. I'll just stroll around and see what they have
already done, I told myself.
When I got to my ward, I was ashamed that I had not come sooner. All available help was there, from the
supervisors to the probationers, all the messengers and the boys. Even the stronger patients were helping,
for I saw several beds empty, and when I looked for their occupants I saw them working with the others.
A whole squad of them was sweeping the floor, another detachment was scrubbing the walls and ceiling.
The beds, chairs, and tables were being taken apart, scoured, and touched up in the spots where the paint
and varnish had worn through. The entire ward, usually so quiet, was now one great workhouse where all
you heard was the swishing of rags and the scratching of brooms. Everybody looked bedraggled and
sleepless and tired, but they seemed to be happy in the work and continually exchanged pleasantries with
one another. The effect on the patients was most noticeable. I guess they were glad they were out of bed
at last and able to do some kind of work. Even those who were not strong enough to get up were engaged
in cutting paper flowers or ribbons. My goodness, I said to myself, Christmas is here already.
At the end of the ward stood an altar. Every Christmas there is a prize given for the best belen, a sort of
small stage where the story of the Nativity is depicted. Ours had been begun but the work was not one-
third through. It was just a pile of stones and plants and pieces of cloth. In the midst of this mess I found
Miss Basa, looking as bedraggled as the rest, busily building up her stable on top of what was supposed to
represent a mountain. She glanced at me impersonally wheri I stopped near her and I felt as embarrassed
as if she had reproached me. I've never quite understood her, although my fellow inters and the patients
think so highly of her that I could get them sore by referring to her as “Your Miss Basa" with an
exaggerated emphasis. Well, I decided, I'm going to help with the work right now even if my friends
catch me at it.
In an hour we two had accomplished a good deal. The mass of rocks and plants and empty boxes looked
more like a mountain now. It had been quite hard work to keep the mountain from toppling over, but by
putting down the flat stones first I was finally able to make a firm foundation for the smaller stones. The
potted ferns and palms I placed between the crevices and then I covered up the pots to the rim with grass
and moss. Together we made forest trails and empty river beds, for of course it was out of the question to
have actual mountain streams. We were able to construct a miniature lake, though, by utilizing an empty
pan. The three kings on horseback, loaded with treasure chests and gifts, we placed at the very bottom of
the mountain trail. I remarked to my companion that it looked as if they were going to have a long trip
before they reached the stable, and for the first time she smiled at me. I tried to follow it with something
equally bright or smart, but I could not think of anything more. If it had been one of my classmates, I am
sure he could have sprung more wisecracks to make her laugh and feel friendly. That is their way, and I
try very hard to be like them because I have been told it is necessary to cultivate a "bedside manner," but I
haven't gotten very far. What I am afraid of is that people will think I am getting too fresh and will snub
me.
Seven o'clock came and with it the morning shift to relieve the night shift but nobody thought of going.
Finally the Supervisor ordered the student nurses to go and take their

95
breakfast. If she he Resident came in soon afte the other interns came easy as possible. But
If she had not done that I don't think they would have gone. The Senior came in soon after and saw me
working. I think he was pleased because when er interns came he gave them all the work of the day and
made my assignment as
possible. But as I expected, my presence in the ward so early became the subject Little ioshing among my
companions and I was very much embarrassed. But they too Come soon helping in the work: I guess they
wanted to make a good impression on their Miss Basa.
The routine of the ward was upset for the day, but the Senior Resident didn't say anything. White-jacketed
interns were seen holding brooms instead of stethoscopes, and patients got up and helped the nurses scrub
the beds. The elderly Supervisor for once did not seem to be so forbidding and allowed her student nurses
to converse freely with us. I am sure she saw that we would do a great deal more work that way.
Late in the afternoon we finished our mountain and I was proud of what I had done. The forest was most
realistic though out of perspective in parts because I could not get the right size of ferns needed. It
towered seven feet above the floor and the cottage and stable perched on the top looked very real. To get
to it the three kings had to pass through dark forest trails carpeted with moss and lined on each side by
huge trees whose tops interlaced overhead. We had a lot of paper stars and a big silver moon and a comet
with a streaming tail suspended above the house to guide the kings of the East. Everybody looked happy
when the ward was cleared and the lights of our altar put on. Everybody said we were going to win the
first prize.
By six o'clock that night all resident physicians, interns, and nurses, except those who were on duty, had
left. I was alone in our ward and when later on I went to my room to take my dinner, I found it deserted
too. For the first time I realized how hard it was going to be that night.
Soon after dinner I was called on the first emergency case, and another one came about an hour later; but
they were not important cases and required only preliminary examinations. The third time I was called
must have been around eleven o'clock. I had had but little sleep and my head felt heavy.
The dormitory is a good two hundred yards from our ward. In the mornings we just stroll along that
distance and before we know it we are in the ward. But it's different when one has to walk alone. You
don't have anybody to converse with and because of this you notice little things which you have never
noticed before. I'd never noticed, for example, in the daytime, how big and grim the mango tree is that
stands almost across the walk. This night it seemed to tower right up to the sky and to cast a shadow all
out of proportion to its size and the starlight. As I stepped into its shadow I heard the leaves rustling and
some of them falling to the ground, and I was surprised that such a trifle should seem important enough
for me to notice clearly.
I walked fast because it was almost the coldest hour of the night and my jacket was no protection against
it. Although the whole Hospital was well-lighted, it was silent except for the occasional ringing of the
telephone at the information clerk's desk. What is it, is it the silence that makes you feel the cold or the
cold that makes everything silent? I thought I could hear voices singing a Christmas hymn coming very
faintly over a great distance, but I could not be sure whether the sound came from the Church of St.
Xavier or from the Church of Nuestra Senora de Guia. Soon the Midnight Mass would be over; people
would be coming out of the doors of all the churches of the city.
I found the patient I had been called to see in the isolation room. That is where we put the serious cases.
We cannot leave them in the ward with the stronger ones, you know. This one was already unconscious. I
had to get the history of the illness from her

96 companion, the mother, who herself was almost inarticulate. This is one of the hardest tasks we often
have to face: to try to reconstruct the history of a case from the incoherent remarks of a dying person or a
hysterical relative.
This case was not very difficult. From the older woman's answers to my impatient questions I got the
hunch that I was dealing with pneumonia in its last stages. And I was not far from right. The physical
examination showed me both lungs were gone. The examination cost a lot of effort. The patient could not
move by herself, and when I tried to run her on her side, she gasped as if for her last breath. But I did not
want to make a careless examination and so I had the mother help me. I think it must have worried her as
much as it did me, for she started to cry, but I explained to her that we could not give any treatment until
we had made a complete diagnosis.
After that I had to make the laboratory examination of the blood and urine. I wanted to put this off till the
next day, for I was tired, but I was afraid she might die before I had done it, and then my record would be
incomplete and I'd probably be marked down.
The laboratory was very untidy because those who had worked there late in the afternoon had neglected
to put their things away. I had great trouble looking for what I needed. There was not one clean glass
slide, and the microscope was covered with oil. There was nothing extraordinary that I found in the
examination of the blood; the picture I had under the microscope was what I expected to see. Gee, I
thought, what a brilliant diagnosis! In a few months, I would be out on my own practice, and I hoped
everything would be as easy as this; I wouldn't like those cases you couldn't diagnose. Of course I
wouldn't like to have them come to me in such a serious condition as this one; not for the first six months
at least. I wouldn't want to be signing death certificates right away. The old graduates always tell us that it
is a lot different when you practise alone, without the Hospital to provide you with nurses, laboratories,
and protection. Sometimes, they say, we don't know what to do in the simplest cases because we get
rattled, lose our sense of proportion.
All this came to me as I looked through the microscope. In a few months we would be out. I intended to
go to some remote region; there are so many physicians in the city already. Time and again I had
calculated my chances of succeeding. What was I to do with my first incurable disease? What should I tell
the patient who comes to me with the stamp of death on his brow? Should I lie, hoping that the little
encouragement it brought him would tip the balance toward the side of life, or should I tell him the truth
so that he might prepare for the end? Would I be very much upset by my first fatal case? Some of the
older doctors have told me that the "first patient they killed" always caused them to go without food and
sleep for weeks afterward. Suppose I had this pneumonia case, for example. Here in the Hospital we meet
Death several times a day and we just greet him with a familiar "Hello.” Every day we see two or three
cadavers opened up in the autopsy room. We have seen so many hearts stop beating and so many breaths
end in a last sigh, that it does not affect us any more. When we see somebody dying, we work over him
with everything we know till we see it is hopeless, but we don't wring our hands and rack our bodies with
sobs if we lose him. We just turn away when we see those around him-his mother, his wife-crying and
beating their breasts. We know that nothing more can be done and that they will get over their grief. It
may take a week or a month or a year or all their lives, but sorrow is something that does not outlast him
whom it overwhelms. If you let the stricken cry of the loved one affect you, most likely you will lose your
poise and serenity, and your judgment will be affected. That is the reason physicians do not treat their
own relatives. You must be as detached as possible. Your care must be for the living, not for the dead. A
lot of people live out their span of

97
life on this earth thinking and worrying and crying over someone they can no longer see or touch or talk
to.
This patient whose urine and blood I had examined not--if she died I was sure the mother would blame
God or fate. It was very depressing. What if she did die? What if she died on Christmas Day? We all have
to die some day; does it matter if it be Christmas or New Year? Of course it seems indeed an unhappy
way of celebrating Christmas, but what can one do? There are ways and ways of spending Christmas.
You can go to a party or to church or to a show. Some people give you presents, some extend good
wishes, some pray for you. I guess most people feel charitable and holy during this season. You can't help
it, it's in the air, everybody you meet and talk to seems to say "It's Christmas and we must be good to each
other and forget all our differences and ask pardon for our sins."
From the window of the laboratory I noticed that some persons were coming out of Saint Xavier. It is
quite near the Hospital and most of our nurses and students go there. Soon they will all come out. Some
will go to their homes, some back to the Hospital. These people will feel much happier and more at peace
with the world than we, because they have already heard Mass. I wondered whether it would not be
possible to have Mass right here in the Hospital, for the weak and dying, for my pneumonia case. I
supposed it was not possible, at least I had never heard of any Mass celebrated in our wards.
A nurse came in and asked me to help with an intravenous injection. When I went out to the ward I was
surprised to find that most of the patients were awake. They had their mosquito nets up and were talking
to each other. Some of them were openly sad and homesick. Our altar was a blaze of light and most of the
patients were regarding it a little sadly. From the tiny windows of the cottage on the summit, shafts of
light shot forth and lighted the whole world. For a moment I made believe that the three kings were
already halfway up, although of course the three figures on horseback had not moved an inch.
Most of the patients were talking about Christmas in their towns, the different customs and traditions. The
old woman I was called on to give an injection was just in front of my cardiac decompensation, who, like
the others, had her head turned toward the altar. I supposed she was homesick too. The old woman, while
the nurse was sterilizing her arm, became very talkative and told me a dozen Christmas stories. It took me
a long time to give the injection because I had to do it slowly and the nurse who was assisting was only a
student and new at the work.
When I was finally through and turned to go, I happened to glance again at the opposite bed. My cardiac
decompensation had not moved and I thought that she was sleeping soundly. But as I passed her bed, an
indescribably delicious fragrance rose from everywhere around her and enveloped me. It was so heavy
that I thought her bedding and clothes must simply be soaked with it. I looked at her. Her eyes were
closed, her hands lay on her breast in an attitude so peaceful and natural that it must have been minutes
before I was startled. I reached for my stethoscope, but I never used it; I never got it more than halfway
out of my pocket. Instead, I bent over her and gently disengaged her hands and laid them on each side. In
her right hand was a tiny perfume vial, the stopper out. The contents had all spilled out on her breast, and
as I took the vial the last fragrant drop ran down the neck, trembled for a moment on the rim, and then fell
on my wrist. Instinctively I brought my hand to my face and inhaled deeply. Then I sat down beside her,
not knowing what to do.