FULL CIRCLE by Rene Samaniego MD

08 January 2022

In his meditations, Marcus Aurelius mused that we are all creatures of a day – the one who is remembering and the remembered both. Our memories and the objects of them are all ephemeral. We will have forgotten everything in time, just as time will have forgotten you and me...

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I dash out of the elevator into the fifth level of the hospital. I am now in the same institution where a quarter of a century ago I was putting on the finishing touches of my medical degree. I get off and swiftly stride in its corridors leading to the lecture hall where I will be delivering my talk for our alumni homecoming. My steps prompt a reminiscence of that particular point in time when I determined to pursue medical school.

Have you ever felt something calling out to you, seemingly pressing you to track a certain trail? You may call it a ‘signal moment’, an urge, a fascination that may come out of nowhere. Sometimes, the call brings with it a solid annunciation that burns with brilliance within you. At other times, it may be like subtle currents in the river with which you unsuspectingly drift towards a precise point on the banks. Whichever the case, you get a certain sense that something larger than yourself has had a hand in it. I thought to myself – this is what I must do; this is where I need to go from here.

It was a circumscribed moment in the late 1980s. I was in bed, my head buried in a book, the way I spent most of my teen and adult years. The setting of this particular book’s narrative was in the 1960s. Its protagonist was beginning to come of age amidst that turbulent stretch of Kennedy, Martin Luther King, Vietnam, civil rights, and political unrest. She was quite good-natured as a child. Unfortunately, it did not spare her from being belted early on. Born out of wedlock she was savagely raped during her teens by a stepbrother at a high school graduation social. Battered and bleeding, she disclosed everything to her mother, only to be reproached for fabricating lies. Yearning for deliverance and a decent life, she ended up graduating with a law degree at the cost of great sacrifices. This fictional character who picked herself up from the dump became my role model.

I would always deem my resolve in pursuing a medical degree as my very first willful step towards adulthood. Up until that point, it felt like I had just been going with the tide of least resistance. My days were far too long. My idle moments would mostly be spent sitting in our provincial garden, watching the leaves of our guava tree waving in the wind or the timeless clouds above rolling by. It was the age of innocence. I did not have a single care in the world. Committing and dedicating my life to something long-term and bigger than myself was far removed from my grasp. I was ruminating a great deal, but perhaps never really about and for myself.

I finally gained admittance into medical school, and so began the long and winding, arduous, seemingly endless road, the story of which I do not even know how to begin and end. Perhaps I could start with the drudgery of the classes, where you were constantly compelled to ingest and digest voluminous facts, and then regurgitate them during exams. I could also tell you about the endless hours of studying late into the night, nay, into the morning, trusting that you had given it your best but ending up barely passing the tests. These, for me, really constituted the entrées of medical school. Not uncommonly though, it came with the garnishing of competitiveness, and if it so happened that you were not amongst the sharpest of the knives in the cupboard, you might sporadically go into these periods of ambiguity, questioning if you could make it to the finish line, or even whether you still wanted to.

Nonetheless, I completed the grueling years of academics and advanced to clinical work. As a medical clerk – which is how one is designated during the last year of medical school – you are considered to be the lowermost form of life in the hospital’s medical stratum. You are a nanobe, one-tenth the size of the smallest bacterium.

At least, that was what it felt like for me, because as luck would have it, I was right off thrusted into a big, notoriously toxic government hospital. From the comfort of the four corners of a classroom, I was catapulted into a wilderness of hubbub, confusion, and disorder. Like a Tarantino movie, the only thing you could predict in the plot was going on a thirty-six-hour hospital duty. Okay, except maybe for the blood and gore, everything else was uncertain.

On my very first hour of duty, as I was performing an intubation on an elderly patient in respiratory distress, I witnessed a female resident physician-in-training fumble with her laryngoscope inserted into the patient’s open mouth. Suddenly I heard an unexpected cracking sound as she haphazardly went in and tried to maneuver the endotracheal tubing in place. Apparently, in the process she had broken the elderly patient’s tooth and fresh, bright, red blood instantly began to trickle out from the gums. I felt myself tense up and looked at her face. She met my gaze, and I knew she knew I knew something happened that shouldn't have had. For a moment I perceived a flicker of culpability in her eyes but it was instantaneously replaced by coolness and indifference. As if on cue, I followed suit and assumed an impassive stance. Oh, the emotional strategies we have to muster to guard ourselves and our egos from such threats. But still, it provoked extreme angst in me.

I remember one time during my post-graduate clinical internship when I had to go on-duty during Christmas Eve. Just a few minutes before the clock was to strike twelve I found myself in the medical wards in the middle of manually evacuating excrement from a patient suffering from fecal impaction. I must have spent a good thirty minutes completing my mission. The image of myself under those circumstances while my family, friends, and the rest of humankind were in the midst of the holiday merrymaking had me thinking, “This is truly shit”!  Full of self-pity, my eyes began to dampen, but right before they started to turn on the waterworks, I burst out laughing as all the crap I had harvested rested on the pristine white adult diaper, staring right at me. Literally, it embodied how I started to feel then—I was doing meaningful work, all part of the day’s job.

Yes, we should recognize the value of the absolute simplicity of owning up to what we think and how we feel at any particular moment, including those times when we are confronted by shit, literally and figuratively. We must accept the truth of our perceptions of what we are experiencing. If we are able to arrive at that level of understanding, I think we will become more grounded and being grounded will support us during times of senselessness and obscurity.

In life, we need to be tough. Not with callousness, but with the strength and resilience so we arrive at a recognition of the truth. And the truth may hurt us but in the end it makes the world and our lives clearer and more colorful, purely because we are responding to our experiences appropriately.

I feel so blessed that at 52, I have known and lived my life’s work, because one’s calling serves as an important vessel of life; a critical carrier of vitality. And even though I still do not fully understand everything; even though at times, I am dead certain of the path I am treading, and at other times I feel like a lost traveler incapable of comprehending the only map I carry – I no longer fear uncertainty and incompleteness as much as I used to.

Here I am, at this moment in time in the institution that has molded an important part of the person I am today. As I am about to deliver my presentation on how to find meaning in life’s second half, all of these memories come rushing in.

My colleague and friend of over twenty-five years formally introduces me and calls me to the stage. I stand up and feel a tad bit of discomfort in my lower back from sitting, and then hear the faint sound of a joint clicking, inadvertent reminders that twenty-five years have productively gone by. I go up and take my position on the podium.

Every so often, I come across a chance such as this moment to let other people know me better through my life’s work and calling. I am able to quietly and more clearly probe into who I was and who I have become, and from there hopefully begin to better understand myself and wherever it is I may still need to go. I can now convey with a deeper sense what it means to have been lost in the world; to search and find one’s purpose (or perhaps from a more profound paradigm, to be found by it). So many other experiences I am unable to describe because of lack of time—for example, what it is like to love, lose, and love again; to succeed, fail for the nth time, try once more, and rise up again. I can now tell my story and recount my journey more boldly, simply because it is no other’s but mine.

I have arrived in that settled place that I have come to embrace. Paradoxically, it has given me the freedom and courage to explore other places. As a kid, I used to feel sad about rains and be daunted by dark clouds but through time I have become fond of them and even find comfort in them. Now, everywhere I go, anything I do, I find something of interest and importance. Over and beyond the extensive years that I have spent within the confines of formal education, life has really been my greatest teacher.

I am positioning myself at the podium. I clear my throat and begin to tell my story, this time with my own distinct voice. I feel at home.


Dr Rene Samaniego is a psychiatrist/psychotherapist practicing at Makati Medical Center. A former president of the Philippine Psychiatric Association and Carl Jung Circle, he now serves as Secretary of the Asian Federation of Psychiatric Association and part-time faculty of Ateneo School of Medicine.


Josefina Laurel

14.01.2022 06:35

Dr. Samaniego has the gift of writing well. No wonder it is easy to connect with him. He was my shrink


11.01.2022 11:27

A mystic once said it is not the goal that counts, but the road there, because that is where we do all our learning.

Munawar Alam

10.01.2022 04:33

Very well penned down. God Bless