REMEMBERING DR. RAMON ABARQUEZ

On the morning of 10 January 2018, I received an SMS from my husband telling me that Dr. Ramon Abarquez had passed away. It set off a wave of memories, of things half-remembered but indelible. Let me write ten random things about him here, as a humble send-off for a great teacher!

1. SEX HDL.

Dr. Abarquez coined this acronym–Smoking, lack of Exercise, High blood pressure, Diabetes, and Lipids. At rounds he would say, You know what’s wrong with this patient? SEX HDL! While those who’ve not heard it before try to keep a straight face, Dr. Abarquez would rattle off what the acronym meant. He always emphasized that we should address these problems, pointing out that a healthy lifestyle is a family affair.

2. At a geriatrics conference, Dr. Abarquez commented that the lecturer’s definition of elderly (young-old, middle-old, oldest-old) was wrong. The audience gasped! He said that ‘old’ is anyone older than him! Everyone laughed.

3. I was in the Abarquez service as a first-year resident and again as a third-year resident in internal medicine. He often asked the same questions at rounds (depending on the case being discussed) and it was his habit to go round the table, from the clerks to the interns and to the residents asking them to answer. As these trainees rotate, newbies are often unable to answer his questions. I surprised him by knowing the answers. He said, Wow, you got that correct! He was so genuinely impressed that I had to guiltily confess that he had asked me the same question two years before.

4. I attended a grand rounds where his early research was discussed. [I’m not a cardiologist so pardon me if I get this wrong.] Dr. Abarquez, then a cardiology fellow at Cornell Medical School had helped develop a special electrode for exercise ECG.  I remember him humbly saying he did this ONLY because he was getting frustrated that the electrodes would fall off or not function properly with movement. He also talked about the Raised Arm Maneuver for taking the blood pressure which he jokingly said should be called the Ramon Abarquez Maneuver.

5. At another grand rounds, Dr. Abarquez discussed his love affair with digoxin. One slide was a picture of him beaming proudly beside a flowering shrub. It was the foxglove, the source of digoxin. The scientific name of the common foxglove is Digitalis purpurea.

6. I received the Ramon Abarquez Most Outstanding Fellow award in 2002. Part of the screening process was an interview by the man himself. I regret that I wasn’t able to get a selfie with him then. But the best part was at the graduation ceremony because Dr. Abarquez talks about the award and THEN introduces the awardee in his own words. It was a humbling and inspiring moment at the same time. I wonder if he knew that the last graduation (2017) would be his last, as he gave the award to not one, but two fellows.

7. As a first-year resident, I presented at audit conference a case of an elderly patient who died of a heart attack. This case was truly memorable because Dr. Shelley dela Vega stood up to say, Congratulations for presenting the first geriatric case at audit this year. Why would this be an audit case? Well, she had platypnea instead of orthopnea. She also presented with diarrhea and I, the quintessential first-year resident on ER duty, after correctly diagnosing her to have had a myocardial infarction, proceeded to order de-kahon (routinely) the MI regimen including (Can you guess?) lactulose!  At the audit, Dr. Abarquez asked me, Do you think that your patient had mesenteric ischemia and that’s why she had diarrhea? I don’t remember what my answer was!

8. If you’re presenting at audit, you should have the original ECG tracing to pass to Dr. Abarquez. I will sorely miss his amazing ECG readings. He’s seen metabolic acidosis, cholecystitis and appendicitis on the ECG, I kid you not! He even taught the residents an equation to estimate the ejection fraction from ECG parameters.

9. As the youngest consultant in the Section of Endocrinology (2004?), I was asked by Dr. Lantion Ang to represent the section at the Hemodynamic Conference. We had a pheochromocytoma case for whom we were requesting cardiology to insert an intraarterial line for intraop monitoring. Standing up in front of the cardiology consultants, I felt like I was back at audit. Not a consultant but a medical student. Dr. Gregorio Patacsil said to Dr. Abarquez, Monching kailangan pa ba ‘yan ng intraop? Di na!  Dr. Abarquez nodded in agreement. Dr. Patacsil looks me in the eye and says definitively, Hindi na. I sit down. Enough said. Now these two great cardiologists are gone. An era has passed.

10. As an endocrinologist, I’ll never forget Dr. Abarquez saying, The heart of a diabetic is like the heart of the non-diabetic who has had a heart attack. I say this to patients up until now. And I will always remember Dr. Abarquez when I do.