Contemplations of a Restless Mind

Adventures and Tales of Jessie T. Ponce


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In Search of Lice

A Traveler's Tale

August 2013:  After two hours of navigating the scenic, winding road away from Davao City towards the mountainous villages southeast of the city; we arrived at Barangay Salumay, a sleepy community inhabited by some of the indigenous peoples of the region.

Having caught our breath from a brief stop, we then turned away from the main road and started negotiating a tire track that apparently has not seen much traffic in recent years.  The local leaders, excited about our visit, bulldozed the difficult sections of the track the previous day but a heavy rain the night before only managed to turn the track into an obstacle course of knee-deep quagmire.  For almost an hour, I pushed the 4×4 truck I was driving through the alternating mud and rocks over the hills and alongside deep ravines until we arrived at a small community of Matigsalugs.  Sitio Contract.

The Matigsalugs are…

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Tropical Fruit Facts and Legends: Durian – Asia’s Notorious King of Fruits

A Legendary Fruit

Jessie T. Ponce Photography

A pile of ripe durian fruits

Perhaps the most notorious of Asian tropical fruits; the durian (pronounced /ˈdjʊriən/) attracts both extreme adoration and intense disgust from fruit eaters.  The only ‘fault’ of this controversial fruit,  widely known and revered in Southeast Asia as the “king of fruits”; is probably its blatant violation of the common expectation that ‘great food always smells great’.

A legend in Thailand tells of how the durian was the most beautiful, fragrant, and delicious of all fruits when a wise hermit presented its seed to the king.  The king accepted the fruit but did not properly thank the hermit so, in anger, the hermit cursed the durian tree, and thence the fruit grew ugly thorns and began to emit a foul stench alth0ugh its heavenly taste and magical powers remained.  Other folktales in Southeast Asia such as the legend of Orang Mawas, the Malaysian version of Bigfoot, and Orang Pendek, its Sumatran version, claim that these fantastic creatures regularly  feast on durian.

Heavenly Taste

Jessie T. Ponce Photography

Cross-section of a durian fruit

The taste of durian (Durio zibethinus) is often described in superlatives.  This is true even among the early Western explorers who have tried this fruit upon visiting the Far East.  Indeed, one traveller from 1599 writes: “it is of such an excellent taste that it surpasses in flavour all other fruits of the world”. Probably the most-quoted description of the flavour of the durian is the one written by the British naturalist Alfred Russel Wallace in 1856:  “The five cells are silky-white within, and are filled with a mass of firm, cream-coloured pulp, containing about three seeds each. This pulp is the edible part, and its consistence and flavour are indescribable. A rich custard highly flavoured with almonds gives the best general idea of it, but there are occasional wafts of flavour that call to mind cream-cheese, onion-sauce, sherry-wine, and other incongruous dishes. Then there is a rich glutinous smoothness in the pulp which nothing else possesses, but which adds to its delicacy. It is neither acid nor sweet nor juicy; yet it wants neither of these qualities, for it is in itself perfect. It produces no nausea or other bad effect, and the more you eat of it the less you feel inclined to stop. In fact, to eat Durians is a new sensation worth a voyage to the East to experience. … as producing a food of the most exquisite flavour it is unsurpassed.”

Hellish Odor

Jessie T. Ponce Photography

The technique in opening a durian fruit

On the other hand, the odour of durian is often described with revulsion and has led to the fruit’s banishment from certain hotels and public transportation in Southeast Asia.  Wallace was probably being diplomatic when he said that “the smell of the ripe fruit is certainly at first disagreeable” but other westerners more graphically described the smell as: “like eating sweet raspberry blancmange in the lavatory”; “completely rotten, mushy onions”; “as if you’d been French-kissing your dead grandmother” and   “best described as pig-shit, turpentine and onions, garnished with a gym sock”.   Perhaps the phrase that summarises all these descriptions of the ‘king of the fruits’ is the one being used in the island of Mindanao in the Philippines: that the durian “tastes like heaven but smells like hell”.

A Large, Spiky Fruit

Jessie T. Ponce Photography

A durian fruit is large and quite heavy

Jessie T. Ponce Photography

The durian’s spikes are sharp and sturdy

The other characteristic that contributes to its notoriety, aside from its heavenly taste and hellish odour, is the combination of its large size and formidable thorn-covered husk. The fruit can grow as large as 12 inches long and 8 inches in diameter and can weigh up to 5 kilograms. Its round or oblong shell, usually green to brown in colour, is covered with sharp, sturdy spikes that further makes handling difficult. A faint line that marks the cell divisions converges at the bottom of the fruit.  Small cracks show at the convergence point when the fruit is ripe.  A knife is usually wedged between these cracks to break it open but, to the untrained, this can be a big challenge as the fruit’s spikes and its size prevent it from being held comfortably with bare hands.

Tall Tree

Jessie T. Ponce Photography

A young, grafted durian tree planted by a pond

Jessie T. Ponce Photography

Durian flower buds

Jessie T. Ponce Photography

Unripe durian fruit hanging from the tree

Furthermore, a durian fruit falling on a person’s head can cause serious injuries because it is heavy, armed with sharp thorns, and can fall from a significant height. The native durian tree can grow up to more than 60 feet high and usually takes 8 to 10 years to bear fruit but, in the last 10 to 15 years, modern technology has greatly improved the cultivation process and the quality of fruits.  Present grafted varieties bear bigger and better fruits within five years and, in a young tree, the fruits are usually within arm’s reach.  In old farming methods, durian farmers just wait for the ripe fruit to fall off from the tree and it is widely believed that the fruit falls only at night when there is less chance of it falling on somebody.  Thus, in those days, it was not advisable to loiter under durian trees especially at night as the fruit may fall on you and cause serious injuries but, at present, the danger of doing so also includes the possibility of actually bumping into the spiny fruit in the dark.  The old farming method was probably the context of an Indonesian saying, ketiban durian runtuh, which translates to “getting a fallen durian” or receiving an unexpected luck or fortune. A durian that falls off the tree continues to ripen for two to four days, but after five or six days most would consider it overripe and unpalatable.

An Aphrodisiac

Jessie T. Ponce Photography

Durian fruits on display in Davao City

It is also widely believed that the durian has aphrodisiac qualities.  A saying in Indonesiandurian jatuh sarung naik, meaning “the durians fall and the sarongs come up”, refers to this belief.  Southeast Asian folk beliefs, as well as traditional Chinese medicine, consider the durian fruit to have warming properties liable to cause excessive sweating.  The traditional method to counteract this is to pour water into the empty shell of the fruit after the pulp has been consumed and drink it. An alternative method is to eat the durian in accompaniment with mangosteen, which is considered to have cooling properties. Pregnant women or people with high blood pressure are traditionally advised not to consume durian. Coffee, brandy or other alcoholic beverages are also considered a big NO after eating durian.  Aside from causing indigestion and bad breath, taking alcohol with durian is believed to stimulate high blood pressure. Several medical investigations on the validity of these beliefs have been conducted with varying conclusions, although a study by the University of Tsukuba finds that the fruit’s high sulphur content causes the body to inhibit the activity of aldehyde dehydrogenase, causing a 70% reduction of the ability to clear toxins from the body.

Jessie T. Ponce Photography

A fruit vendor offering a large variety durian in South Cotabato, Philippines

The edible portion of the fruit, known as the aril and usually referred to as the “flesh” or “pulp”, only accounts for about 15-30% of the mass of the entire fruit.  According to references, the durian fruit also contains a high amount of sugarvitamin Cpotassium, and the serotonergic amino acid tryptophan, and is a good source of carbohydratesproteins, and fats. It is recommended as a good source of raw fats by several raw food advocates, while others classify it as a high-glycemic food, recommending to minimise its consumption.

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Flavoring Many Asian Dishes

Jessie T. Ponce Photography

Bags of durian candies on display in Davao City

Southeast Asians use durian fruit to flavour a wide variety of sweet edibles such as traditional Malay candy, ice kacangdodol, rose biscuits, and, with a touch of modern innovation, ice creammilkshakesmooncakesYule logs and cappuccino  Pulut Durian is glutinous rice steamed with coconut milk and served with ripened durian. In Sabah, red durian is fried with onions and chilli and served as a side dish.   Ikan brengkes is fish cooked in a durian-based sauce, traditional in Sumatra.  Tempoyak refers to fermented durian, usually made from lower quality durian that is unsuitable for direct consumption.  Tempoyak can be eaten either cooked or uncooked, is normally eaten with rice, and can also be used for making curry.  Sambal Tempoyak is a Sumatran dish made from the fermented durian fruit, coconut milk, and a collection of spicy ingredients known as sambal.  Unripe durians may be cooked as a vegetable, except in the Philippines, where all uses are sweet rather than savoury. Malaysians make both sugared and salted preserves from durian. When durian is minced with salt, onions and vinegar, it is called boder.

Other Uses

Jessie T. Ponce Photography

A basket full of durian

Other parts of the durian fruit are likewise useful. The durian seeds can be eaten whether they are boiled, roasted or fried in coconut oil, with a texture that is similar to taro or yam, but stickier.  In Java, the seeds are sliced thin and cooked with sugar as a confection. Young leaves and shoots of the durian are occasionally cooked as greens. Sometimes the ash of the burned rind is added to special cakes.  The petals of durian flowers are eaten in the North Sumatra province of Indonesia, while in the Moluccas islands the husk of the durian fruit is used as fuel to smoke fish. The nectar and pollen of the durian flower that honeybees collect is an important honey source, but the characteristics of the honey are unknown.

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Durian Producers and Name-Bearers

Jessie T. Ponce Photography

Durian City: a durian sculpture welcomes visitors at the Davao City International Airport

The durian is native to BruneiIndonesia and Malaysia but there is still some debate as to whether the durian is native or was introduced to the Philippines, particularly in Davao region in the island of Mindanao.  Interestingly, although the durian is not native to Thailand, the country is currently a major exporter of durian, followed only by Malaysia and Indonesia.   In these countries, annual festivals are being held with the durian as the main feature.  The World Durian Festival is held in Chantaburi in Thailand in early May each year; Penang’s Durian and Fruits Festival is held in June; Davao City’s Kadayawan Festival which strongly features the durian is celebrated in August; while the  Durian Festival in Tagum City (also in Davao Region) is held in September.  Other places where durian farms are located include CambodiaLaosVietnamMyanmarIndiaSri Lanka, the West IndiesFloridaHawaiiPapua New Guinea, the Polynesian IslandsMadagascar, southern China (Hainan Island), northern Australia, and Singapore.  “The Big Durian” is the nickname of Jakarta, Indonesia; Davao City in the Philippines is often referred to as “Durian City; and  the oddly shaped Esplanade building in Singapore is often called “The Durian” by locals.   


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Tropical Fruits Facts and Legends: Coconut – The Tree of Life

A Tropical Landmark

Jessie T. Ponce Photography

A mature coconut tree

A movie scene, still photo, or sketch about a tropical place is not complete without a coconut palm  (Cocos nucifera) dominating the view.  To an outside viewer, the coconut palm is at best just an apt symbol of the tropics but, to the natives of these places, it represents no less than their life. In Sanskrit the coconut is called kalpa vriksha: “the tree which provides all the necessities of life”. In the Malay language, it is pokok seribu guna: “the tree of a thousand uses”.  A proverb in the Pacific Islands says that “He who plants a coconut tree plants food and drink, vessels and clothing, a habitation for himself and a heritage for his children.”  In the Philippines, the coconut is commonly called the “Tree of Life“.

A Very Special Drink

Jessie T. Ponce Photography

Cross-section of a young coconut

A coconut legend in Guam tells of a young girl who was deeply loved by the whole tribe.   The girl became very ill and asked for a special drink that could heal her.  Despite the efforts of the tribesmen to search for and give her the first drink; she eventually passed away and was buried on a beautiful spot on top of a hill.  The tribesmen noticed a strange plant grow from the girl’s burial ground and they cared for the plant until it grew into a very tall tree.  One day, a strange round fruit fell from the tree which they immediately gave to the girl’s mother.  The mother asked that the fruit be cracked open then she drank the water collected from the fruit.  It was so sweet and refreshing and she knew that this was the special drink that her daughter was looking for.

Jessie T. Ponce Photography

A pile of young coconuts

The young green coconut (fruit or seed of the coco palm) or tender coconut is unique as natural refreshment because it offers both food and drink as the Pacific saying pointed out. In many cities in Southeast Asia tender coconuts are sold on the streets, strategic highway stops, and on beaches just like any other fruit.   Coconuts are cut in front of customers to ensure its freshness.  A portion of the outer husk and shell is cut to expose the fruit’s content. The young coconut meat  serves as the food and the coconut water serves as the drink. Coconut water is consumed first by using a straw or by pouring the contents into a glass. The water is mildly sweet with a dash of pungent, aerated feel when cut fresh. Depending on its size a tender contains 300 to 1,000 ml of coconut water.  Once the water is consumed, the coconut meat – the white, fleshy, gelatinous part of the coconut – is scraped from the shell then consumed directly or with a mix of sugar or condensed milk.

The Buko Halo-Halo

Jessie T. Ponce Photography

Buko Halo-halo and shaved ice ready for serving

In some parts of the Philippines, for example along the highway of South Cotabato in southern Philippines, the tender coconut is  emptied of its water (to be used as a drink later) then filled with halo-halo, a popular Filipino snack/dessert.  Most of the ingredients (fruits, beans, and other sweets) are first placed inside the tender coconut, followed by the shaved ice. This is then sprinkled with sugar, and topped with either (or a combination of) leche flanube halaya, or ice cream.  Evaporated milk is poured into the mixture upon serving.  While mixing the halo-halo, the coconut meat is scraped and gets combined with its various ingredients.  On the other hand, when prepared for several guests, the coconut meat is arranged like a fruit salad (called buko salad in Filipino).  The meat is grated in thin strips then typically combined with the contents of canned a fruit cocktail, sugar palm fruit (kaong), and condensed milk and/or cream then served as a cold snack or desert.

High Nutrient Content

Jessie T. Ponce Photography

Fruit-bearing young coconut trees in the Philippines

About 90% of the fat found in coconut meat is saturated, a proportion exceeding that of foods such as lard, butter, and tallow.  Like most nut meats, coconut meat contains less sugar and more protein than popular fruits such as bananas, apples and oranges. It is relatively high in minerals such as ironphosphorus and zinc.  Coconut water contains sugar, fiber, proteins, antioxidants, vitamins and minerals, and provides an isotonic electrolyte balance that can also be considered free of fat and cholesterol.  It has high potassium content and contains antioxidants linked to a variety of health benefits.  Cytokinins in coconut water may be among its most beneficial components.  It is also gaining popularity as isotonic sports drink.  There have been cases where coconut water has been used as an intravenous hydration fluid in some developing countries where medical saline was unavailable.  Coconut water can be fermented to make a different gelatinous product nata de coco also called coconut gel which likewise often finds its way to the halo-halo.

Jessie T. Ponce Photography

A Buko Halo-Halo snack house along the highway in South Cotabato

Aside from being consumed fresh, the coconut fruit has various other uses.  Coconut water can be processed to create alcohol. Coconut milk (to be distinguished from coconut water) which is extracted from mature coconut meat is part of the daily diet of many people being a dominant ingredient in Southeast Asian cuisines from meat dishes such as the widely popular curry to other fish and vegetable dishes and pastries and desserts like macaroons. Coconut milk can likewise be domestically processed into oil  which is commonly used for frying, cooking, making margarine and fuel in rural areas.  In the Philippines, coconut milk, known as gata, and grated coconut flakes are used in the preparation of dishes like laingginataanbibingkaube halayapitsi-pitsipalitawbuko pie and more. Coconut jam is made by mixing muscovado sugar with coconut milk. A rare occurrence among coconuts is the sport fruit  or macapuno where instead of separate meat and water, the contents of the coconut shell is a gelatinous, somewhat sticky white material which can be sweetened into a macapuno jam. Coconut flour has also been developed for use in baking and to combat malnutrition.  Coconut chips have been sold in tourist regions like Hawaii and the Caribbean. Coconut butter is often used to describe solidified coconut oil, but has also been adopted as a name by certain specialty products made out of coconut milk solids or puréed coconut meat and oil.

Jessie T. Ponce Photography

Mature Coconuts

Coconuts may help prevent  benign prostatic hyperplasia.  The Virgin Coconut Oil (oil extracted from fresh coconut) has recently been gaining popularity as a health product and has various applications in food, medicine, and industry.  According to studies with rats, virgin coconut oil reduced total cholesterol, triglycerides, phospholipids, LDL, and VLDL cholesterol levels and increased HDL cholesterol in serum and tissues. The hexane fraction of coconut peel may contain novel anticancer compounds and young coconut juice has estrogen-like characteristics.

The Coconut Toddy

Jessie T. Ponce Photography

Coconut Flowers

Coconut flowers bloom in clusters which eventually mature into bunches of between five to thirty fruits depending on coconut variety.  In lieu of the fruit, the sap called toddy that can be collected from incising the flower clusters is equally valuable to locals especially among the Pacific islanders. A young well-maintained tree can produce around 300 litres of toddy per year while a forty year old tree may yield around 400 litres. The toddy is drunk as neera also known as tuba (Philippines), tuak (Indonesia and Malaysia) or karewe in Kiribati. When left to ferment on its own, the toddy becomes palm wine which can be distilled to produce arrack. In the Philippines this alcoholic drink is called lambanog or “coconut vodka”. The palm wine can be also fermented to produce coconut vinegar. Furthermore, the toddy can be reduced by boiling to create a sweet syrup or candy such as te kamamai in Kiribati or dhiyaa hakuru and Addu bondi in Maldives. It can be reduced further to yield coconut sugar also referred to as palm sugar or jaggery.

The core at the tip of the coconut trunk where the palm stalks grow, the basically very young stalks (Apical buds ) are made of crunchy white material known as “palm cabbage” or heart of palm. They are edible and considered a rare delicacy as harvesting the buds kills the palms. Hearts of palm are eaten in salads, sometimes called “millionaire’s salad”, fresh spring rolls, or simply treated as another vegetable suitable for cooking with meat dishes.

The Copra

Jessie T. Ponce Photography

A coconut farm in the Philippines

The most common agricultural product from coconut is called copra or dried meat from mature coconut which is processed to industrial grade coconut oil.  When the coconut has fully matured and the outer husk has turned brown, it normally falls off from the tree but coconut plantations usually hire harvesters to pick mature coconuts. A full-sized coconut weighs about 1.44 kilograms and it takes around 6000 full-grown coconuts to produce a tonne of copra.  In some parts of the world, trained pig-tailed macaques (Old World monkey) are used to harvest coconuts. Training schools for pig-tailed macaques still exist both in southern Thailand, and in the Malaysian state of Kelantan.  Competitions are held each year to find the fastest harvester.  The Philippines was the biggest producer of coconuts in 2009 followed by Indonesia and India.

Tree of a Hundred Uses

Jessie T. Ponce PhotographyAs if these are not enough uses from a single coconut palm; the rest of tree also have their uses in everyday life in the tropics. The coir (the fiber from the husk of the coconut) is used in ropes, mats, brushes, sacks, caulking for boats, stuffing fiber for mattresses, and as potting compost especially in orchid mix. The husk and shells can be used for fuel and are a source of charcoal.  A dried halved coconut shell with husk can be used to buff floors, known as a bunot in the Philippines and simply a “coconut brush” in JamaicaTempurung as the shell is called in the Malay language can be used as a soup bowl and—if fixed with a handle—a ladle. Coconut shells are also manufactured into various handicrafts, including coconut shell buttons such as those usually found in the Hawaiian Aloha shirts. Certain musical instruments, including the Chinese yehu and banhu, along with the Vietnamese đàn gáo and Arabo-Turkic rebab; have bodies made out of coconut shell. In the Philippines, dried half shells are also used as a music instrument in a folk dance called maglalatik.  Foley sound effects  imitating the sound of a horse’s hoof-beats often use coconut shells to gain the desired effect.   A coconut shell used to grace the desk of U.S. president John F. Kennedy . On it was inscribed an important message sent out from  Motor Torpedo Boat PT-109 which he commanded when it got shipwrecked  in the Solomon  Islands  in  World War II.

790px-Coconut_Palace_Court WL

Manila’s Coconut Palace and Office of the Vice President of the Philippines

The stiff mid-ribs of coconut leaves are used for making brooms in India, Indonesia, Malaysia and the Philippines. The leaves also provide material for baskets and for roofing thatch; they can be woven into mats, cooking skewers, and kindling arrows as well.  In India, particularly in Kerala, Karnataka and Tamil Nadu, the woven coconut leaves are used as ‘pandals‘ (temporary sheds) for the marriage functions. Dried coconut leaves can be burned to ash, which can be harvested for lime.

Coconut trunks are preferred for building small bridges because of their straightness, strength and salt resistance. Hawaiians hollowed the trunk to form drums, containers, or small canoes.  Coconut timber  derived from the trunk is increasingly being used as an ecologically sound substitute for endangered hardwoods and has applications in furniture and specialized construction, as notably demonstrated in Manila’s Coconut Palace.

Coconut and Religion

OLYMPUS DIGITAL CAMERAIn Hindu tradition, a coconut (Sanskritnarikela) is an essential element of the rituals . The Hindu goddess of well-being and wealth, Lakshmi, is often shown holding a coconut. Coconut flowers are auspicious symbols and are fixtures at Hindu and Buddhist weddings and other important occasions.  In Kerala, coconut flowers must be present during a marriage ceremony.  Similarly in Sri Lanka coconut flowers, standing in brass urns, are placed in prominent positions during wedding ceremonies.  In tantric practices, coconuts are sometimes used as substitutes for human skulls.

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Author’s Note: I started my main blog “A Traveller’s Tale” with a series of articles about tropical fruits and the coconut was among the fruits I featured.  However, the site eventually evolved into a photo-heavy blog and my text-heavy articles have gone out-of-place.  And so I decided to create two separate sites, one for photography and one for whatever articles I have written.  I’ll be re-posting the articles about tropical fruits on this site in the coming weeks with an intention to make this site their permanent home eventually.  Thanks for viewing this post. – Jessie


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An Episode of Mental Anguish

5594656_f260Among the primary desires of any human being is a comfortable, worry-free life.  None of us wants to have a share of life’s heartaches, the anxieties of inadequate finances,  the humiliation of a career failure, the pain of sickness or death of a loved one.  But life is not always kind.  Every once in a while fate puts us in a situation that is an extreme opposite of what we desire.  A position where one has to endure extreme agony and mental torture. An incident that appears humanly impossible to control. The loss of a loved one, a business failure, an illness or an accident can lead us to plunge into a dark, distasteful, tormenting emotional state of anguish.   Many of us survive but, sadly, many likewise succumb mentally and physically to the torturous pressure.

A Parallel Ordeal

On March 3, 2009, my wife, Cindy, had a ruptured cerebral aneurysm. The rupture caused massive bleeding and accumulation of fluids inside her skull and the doctors gave her a mere 20% chance of survival.  But a surgery was not undertaken until 21 days after the rupture – as if we were just waiting for her to succumb to death. The thought of losing my wife and mother of our 3 kids, and the long, agonizing wait for the problem to go away were in themselves enough to have driven me crazy but these were not the only torturous things I had to face. While Cindy was fighting for her life; I was battling life or death decisions, huge financial obligations and a mounting pressure to protect the well-being of the kids.

Grossly Unfair

“If only my anguish could be weighed and all my misery be placed on the scales! It would surely outweigh the sand of the seas…” — The Holy Bible

5594680_f260The two most difficult decisions I had to make in my whole life were grossly unfair. There were very limited choices and none of them presented an assurance of life.  All of them seemed to favor death. They were mental torture in the truest sense of the word, tasks I thought could only come from hell.

The first decision involved deciding on whether to move Cindy from one hospital which had limited treatment capability to another which was more competent but was 2 hour’s drive away. If we did move her, stress from travel can cause another massive bleeding and she could succumb to comatose or death; if we did not, she can just deteriorate further and die while waiting for the condition that was within the present hospital’s treatment capability.

The second difficult decision was regarding the choice of treatment.  There were only two options: surgical clipping which involves opening a portion of the skull and closing the ruptured aneurysm by clipping its base and endovascular coiling where a catheter is passed through a major artery from the groin to the aneurysm then platinum coils are fed into the aneurysm to “plug” the leak.   None of these two procedures can assure complete recovery.  Both can result to comatose or death.

While I was spending sleepless, agonizing nights thinking and praying for the right choice among equally morbid, death-prone options; hospital bills enormously heightened the pressure.  The minute a ruptured aneurysm was diagnosed; bills shot through the roof then soared to astronomical proportions as days passed. At one point, the daily requirement for medicines alone was almost twice our monthly household budget.  My bank account was rapidly getting drained, assets had to be monetized, and financial assistance had to be urgently sought.

Gagged to Protect

“There is much pain that is quite noiseless; and vibrations that make human agonies are often a mere whisper in the roar of hurrying existence. There are glances of hatred that stab and raise no cry of murder; robberies that leave man or woman for ever beggared of peace and joy, yet kept secret by the sufferer /committed to no sound except that of low moans in the night, seen in no writing except that made on the face by the slow months of suppressed anguish and early morning tears. Many an inherited sorrow that has marred a life has been breathed into no human ear.” George Eliot

5594659_f260The kids (22, 19 and 16) were a serious concern. While they were not so young anymore, they have never faced a traumatic situation of similar intensity before.  How they were taking the traumatic situation was a real worry.  They had to be comforted and encouraged.  Two of them needed to continue their studies and maintain their grades while wanting to be by their mom’s side all the time. The situation was at the very least miserable but I didn’t want the kids to lose hope. So I tried my best not to show it even when I felt hopeless, totally helpless and almost in paralysis, wanting to talk of my pain but was gagged to protect my loved ones; aching to do something more to improve the situation but seemingly chained to the ground by helplessness.  I was buried deep and getting suffocated by my anguish.

About to Explode

“So great was the extremity of his pain and anguish, that he did not only sigh but roar.” Matthew Henry

On several occasions, I felt like I was about to explode and wanted to release the tension by screaming to the top of my lungs. The minute I heard the doctors’ diagnosis, my mind spun and I felt nauseous just thinking of the possible implications of the doctors’ findings. I managed to maintain composure while in public or in front of my kids but on the first opportunity I got to be alone in a room, I let out a long, agonizing groan, fell to my knees by my bed and cried my heart out instead, furiously asking God why He allowed this to happen but then meekly begging Him for mercy and immediate relief from this misery. And when I got out to the world, I had to be a calm and confident husband and father once again.

Invitation to Violence

“For my part, whatever anguish of spirit it may cost, I am willing to know the whole truth; to know the worst and provide for it.”Patrick Henry

I realize now that many senseless crimes have been committed by many a tormented soul unable to contain cooped up pain and finding misplaced blame either on themselves or the innocent people around them. Random shootings, workplace violence, unprovoked massacre of family members, and suicide are just some of the shocking things we find in the papers every now and then.

5594672_f260Having been in that dark state of anguish, I’ve seen how easy and almost psychologically acceptable it was to run amok and inflict harm to persons thought to be causing the pain or contributing to the misery. At some point for example, my patience almost snapped and I felt a momentary compulsion to attack a hospital guard who refused entry to a visiting young family member who might just help bring back my wife’s consciousness and memory.  The poor guy was just enforcing a hospital policy not to allow entry to children below 7 to protect them from potential contamination but that’s an explanation a desperate man wouldn’t listen to. Fortunately, I was able to control this urge, remain responsible and maintain my focus towards understanding the situation encircling the family.

In Search of a Refuge

Where is our usual manager of mirth?
What revels are in hand? Is there no play,
To ease the anguish of a torturing hour?”

William Shakespeare

I did however find a need for diversion, some respite from the constantly brewing pain inside my head. I did look for relief from alcohol on occasion and drunkenness had caused temporary amnesia but the resulting hangover only made life more miserable the next day and a blurred judgement was something I didn’t need.  On those long, dull moments however, when nothing of essence to solving the situation could be accomplished, I did spend hours and hours murdering whole armies of rampaging monsters from hell. With my son’s computer game volume set at maximum; the crisp crack of rifles and roaring boom of cannons temporarily transported me to imaginary worlds in dire situations where I had better control of my destiny and the best part was I can go back to previous scenes and rectify a wrong move at any time. But “temporary” was a word I did not want to forget because I knew I cannot continue denying the situation by blurring it with alcohol or seeking refuge in virtual reality.

Help from Heaven

“Here bring your wounded hearts, here tell your anguish; Earth has no sorrow that Heaven cannot heal”Thomas More

5594698_f260Twenty-one days after the rupture, my wife’s aneurysm was finally treated through a surgical procedure.  Another 26 days later, she was discharged from the hospital.  Now, three years later, she is enjoying life with minimal deficits in memory and motor skills but in a tremendously improved condition compared to the 20% chance of survival she was once given or to the majority of ruptured aneurysm patients who were not as fortunate to make it.

Looking back, the sequence of events that unfolded, the timing of corrective actions, and the amount of help received were just perfect and couldn’t have been better.  The most difficult decisions I claim to have made were not really mine because clear signs leading to the right choice were always there.  Resources had to be sought but they were placed in caring hands or in places where we can find or receive them just at the right time.  Strength of mind and body on the part of Cindy, myself and the kids almost always rapidly got drained but they were just as always renewed when we were about to give up.  This impeccable order of things was not by any human design but can only come from the ultimate Healer, Provider, and Source of Infinite Wisdom.   Indeed, earth has no sorrow that Heaven cannot heal.

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– o O o –

Author’s Note:  The previous article published in this site, How Cindy Survived a Ruptured Aneurysm, tells the story of Cindy’s ordeal in detail.  This article tells my part of the ordeal.

Image Credits:  All images used in this article were from Wikia.com.


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How Cindy Survived a Ruptured Brain Aneurysm

Deadly

It is fatal, could affect anyone, and yet very few have heard of or understand it.    In the US alone, around 6 million people have a brain aneurysm and as many as 1 in 15 people could develop this dreadful disease.  Half of ruptured aneurysm victims die within minutes of a massive hemorrhage and, of the 50% who survive; half will suffer delayed death while  the remaining survivors, depending on the level of the hemorrhage, usually live with severe long-term deficits (data from the Joe Niekro Foundation).

Cindy is one of those who compose the latter group of survivors.  Her ordeal with a ruptured cerebral aneurysm happened  in the Philippines where conditions for emergency treatment and care are often less favorable compared to the US.  This is her story.

Without Warning

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“It felt like my head was about to explode” (Image Source: http://www.sciencephoto.com)

Day 00, March 2, 2009: It happened in seconds and without warning. It has been a pleasant, normal day at our farm some three hours away from our main residence in Davao City. It was around 10:00 pm and we were having a leisurely time after attending to the needs of a group of guests who were now having some fun on their own in another section of the farm.  We were alone, having a small chat on a bench outside our cabin when our two dogs got restless so she stood up, got some dog food, and then stooped down to place the food inside the cage. It was as she stood up when she became unsteady and complained of a sudden severe headache. Persistently health-conscious and a nurse by profession, Cindy never had health issues or any known history of hypertension or major diseases so I did not expect anything serious.  Back on the bench, I massaged her head and nape but she weakly requested to be brought to the hospital complaining that the pain was unbearable and she felt like her head was about to explode.

When we got to the local doctor a few minutes later, she was already half-conscious, her eyes were half-closed, and she was vomiting.  The doctor, initially suspecting cardiac arrest, sent us to a local hospital where, after initial assessments, a specialist diagnosed a strong possibility of a ruptured cerebral aneurysm.  A computed tomography (CT) scan was needed to confirm the initial diagnosis and the hospital had this facility but the nearest brain surgeon was practicing in General Santos City (GenSan), the next city about an hour away.  So Cindy was transported by ambulance to GenSan to ensure that a surgery can be immediately undertaken by the brain surgeon if a ruptured aneurysm was confirmed.  By this time, Cindy was already under life support, 70% of her breathing was administered by a respirator and she was having seizures and stiff involuntary movements mainly in her right extremities.  While a doctor and two nurses were monitoring her vital signs, I had to apply pressure on her arms and legs to control the spasms as the ambulance sped through the now dark and deserted highway.

Day 01, March 3, 2009:  After a CT scan and several tests at Saint Elizabeth Hospital in GenSan, almost five hours after Cindy felt the severe headache, it was confirmed that she indeed had a ruptured aneurysm. She was admitted to the ICU.  Very carefully and in layman’s terms, the brain surgeon and a neurologist carefully explained Cindy’s medical condition to me and our three kids.

A Balloon in the Brain

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Brain Aneurysm (Image Source: modernhealthwisdom.org)

From the doctors’ explanation  I understood that Cindy’s aneurysm was congenital. Since birth, a major artery that supplied blood to her brain had an abnormally thin wall at a certain section inside her skull.   The thin wall, because of the constant blood pressure, gradually swelled over the years into a balloon-like bulge.  The presence of aneurysm is difficult to detect since its symptoms (fatigue, loss of perception or balance, speech problems, double vision) may not be pronounced and can be suspected to be due to unrelated causes.  This blood-filled “balloon” ruptured and caused a massive cerebral hemorrhage which increased the pressure around the brain tissues, caused the seizures and involuntary movements I witnessed, and affected major bodily functions including breathing. The resulting blood clot around the brain blocked some ventricles thus causing the accumulation of fluids (brain water) and aggravated the increased pressure inside the skull.  Because of these disruptions, the brain may shut down and then Cindy will  succumb to comatose or death in a matter of hours.  At that time, Cindy was doing only 30% of the breathing, the rest was being done by a respirator.  The doctors declared that she only had a 20% chance of surviving this fatal condition.

Possible Treatment

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Coil Embolization and Surgical Clipping (Image Source: brainaneurysm-symptoms.com)

I frantically tried to understand the possible treatments for Cindy’s condition.  Simply put from the surgeon’s explanation; there are only two ways to treat a ruptured aneurysm.  The older but allegedly more reliable method is called surgical clipping which involves opening a portion of the skull (craniotomy) and closing the ruptured aneurysm by clipping its base. On the other hand, the more recent and minimally invasive technique is called “endovascular coiling” or “coil embolization” where a catheter is passed into a major artery in the groin, through the aorta, into the brain arteries, and finally into the aneurysm itself then platinum coils are fed into the aneurysm through the catheter. The platinum coil fills up the ruptured “balloon”, initiates clotting and thus plugging the leak in the artery. The risk level is said to be the same in both methods but only surgical clipping procedures can be done at the hospital where Cindy was confined.

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High Level of Uncertainty

Day 02, March 4, 2009: It appears that Cindy was also subjected to another medical practice called “watchful waiting”.  None of the above methods were administered to her from the time she was admitted into the ICU.  The surgeon felt that, despite all the tests, there is still a very high level of uncertainty about the conditions inside Cindy’s head. Her already dismal situation can quickly drop to worst at any time and risks of undertaking a surgery outweighs the desired benefits. Of course, it was very difficult for me and the kids to understand this approach. To us, Cindy’s life was like a lighted candle that was rapidly getting shorter with every minute that passed.

Day 03, March 5, 2009:  Unconvinced that watchful waiting was the best way to manage Cindy’s case; I went to Davao City (our home city) to get a second opinion from another brain surgeon at Davao Doctor’s Hospital. This hospital has competent medical specialists, more modern and complete facilities, and a good track record in handling cases similar to Cindy’s.  But another issue comes into the picture if Cindy was to have treatment at Davao Doctors – travel.  The inside of Cindy’s head was so fragile at this time that even a small disturbance from the travel can trigger seizures, comatose or another bleeding.  The blood clot presently controlling further bleeding can be dislodged and a second, usually fatal haemorrhage can occur. The second expert opinion I got was to allow the morbid “watchful waiting game” to continue for another three days before transporting Cindy to Davao. We had no choice but to trust the judgement of these surgeons and pray that they recommended the right action. Only time will tell.

Extremely Fragile

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The CT Scan film showing the huge aneurysm inside Cindy’s brain

Day 06, March 8, 2009: Cindy’s condition actually showed some signs of improvement. She has been unconscious at the ICU since day 1 but there were brief moments on the sixth day when she showed signs of being awake and her dependence on the respirator for breathing was now down to 50%. It was a good sign and we thought that she might have felt that she was about to go home. But the extremely high risk associated with the two-hour trip to Davao was still a very grave concern.

Day 07, March 9, 2009: It was only on our faith in God and that small sign of improvement where we clung to when we moved out of Saint Elizabeth Hospital towards Davao City just a few minutes after midnight (I chose this timing so that the weather will not be hot and traffic along the route will be minimal).  I joined the medical team in the ambulance and positioned myself above Cindy’s head to help cushion it in case of bumps on the road while the kids, who I tried to prepare for any eventuality during the trip, did their prayers in a van following behind us.  The atmosphere inside the ambulance was tense during the first half of the trip but, thankfully, Cindy’s vital signs remained stable and, with great relief, we arrived at Davao Doctor’s Hospital without any incident.

Fatal Options

Day 08, March 10, 2009: My primary concern, now that Cindy will be subjected to a surgical procedure soon, was to make sure that the operation addressed as many of the problems as possible. In my mind, coil embolization was appealing because of its minimally invasive procedure but it only closes the ruptured aneurysm and does not address the problems with the blood clots and hydrocephalus or accumulation of fluids around the brain; whereas a craniotomy and surgical clipping can potentially address all these three issues. My fear was that if we subject Cindy to coiling embolization, another surgical procedure might be needed to remove the blood clots and fluids around the brain and that might be too much for her to handle. The brain surgeon agreed to schedule a surgical clipping operation as soon as the condition was right.

Day 15, March 17, 2009:  Though Cindy remained unconscious at the ICU, she has been receiving continuous medications to improve her condition and prepare her for a surgical clipping procedure which was scheduled on this day.  However, upon assessment by a number of specialists, the operation was not given clearance because she still had fever and some pulmonary infections.

Main Problem Solved

Day 17, March 19, 2009:  While waiting for Cindy’s condition to improve, her managing physician decided to conduct another set of tests to determine the status of the hydrocephalus and blood clots.  The tests showed that medications have successfully dissolved the clots and flushed out the unnecessary fluids around the brain. It was great news. Now we can agree to a coil embolization!

Day 21, March 23, 2009: Twenty one days after the rupture, time has finally come to fix the aneurysm once and for all.  The team of specialists has confirmed that a coil embolization procedure can now be undertaken with the least possible risk to Cindy’s condition. She was brought to the operating room at 2:00 pm and, for 3 hours, family members and friends waited and prayed at the waiting area until the surgeon called me into the operating room; directed me to the screen which showed Cindy’s arteries and the path that the catheter followed; pointed to the various frames which recorded the process as the aneurysm got filled by platinum coils; then declared that Cindy was safe and the operation was a success.   She was later returned to the ICU for further intensive care.

The Road to Recovery

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Home at Last: Cindy on the road to recovery

Day 32, April 3, 2009: Cindy’s condition continued to improve after the operation and she was moved out of the ICU into a private room.  She was having more frequent “waking moments” and her dependence on the respirator has totally ceased although feeding her solid food was still not advised.

Day 38, April 9, 2009:  A physical therapist has started working with Cindy to revive her motor skills particularly in her right extremities which seem to be the most affected by the massive disruption inside her brain.  Although she still cannot communicate, she can now take a few solid foods and even  showed excitement when I and the kids joined her during meals.

Day 47, April 18, 2009:  Forty-seven days after she had a ruptured aneurysm, Cindy was finally discharged from the hospital and we went home to the welcoming arms of family members and friends who were overjoyed and thankful that she had survived the ordeal. She was still in a wheelchair and we still needed to work with speech and physical therapists to help her recover her normal functions and minimize the deficits but we were confident that she will be able to overcome this part.

A Second Life

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Almost Fully Recovered: Cindy two years later

Day 1095, March 03 2012:   It is the birthday of our eldest daughter, Nikki, today and on that tragic day three years ago when it was confirmed that Cindy had a ruptured aneurysm.  But the day is bright and glorious and the atmosphere is a lot more festive on this day, far from the cloud of gloom and distress that enveloped the whole family three years ago.  Cindy is now fully functional at home, in social functions and even in the farm where her long ordeal started.  She still has a slight limp on the right leg and occasional lapses in speech and memory but she continues to amaze us with instinctive reactions to situations and sudden spontaneous recollection of things.  Even her doctors and therapists comment that, compared to other patients who have gone through the same ordeal, she appears normal – “as if nothing had happened” was the common comment.  Indeed, the meager 20% chance of survival she had in March 2009 has been fully reversed.   She is now 100% alive and, as a bonus, she came out from the experience with such cheerful, child-like innocence that made her more endearing to people around her with each passing day.