That sounds ridiculous, I know.

But I do.

I check the plate number first. Then the driver’s name. Then I prepare one or two topics in my head, just in case the ride becomes one of those rides where silence feels heavier than usual.

Weather is always safe.

Construction is safe too, because this is Edmonton and there is always a road being fixed somewhere.

The Oilers are usually safe, unless the loss is too fresh and everybody is still grieving in their own way.

If everything fails, I say, “How’s it going?”

That sentence lives in my mouth now.

Old me would probably laugh.

New me says it with almost no shame.

Almost.

This is one of the small things I noticed after moving to Canada. You begin to collect phrases. You collect habits. You collect tiny survival scripts for moments nobody warned you about.

Nobody tells you that immigrant life can include rehearsing casual conversation in the back of your mind.

Nobody tells you that your English, the one that sounds so clean inside your head, will sometimes betray you once it reaches your tongue.

In my brain, I am fluent.

Very fluent.

Maybe too fluent.

Then I speak, and suddenly my Filipino-ness walks out first.

Just an hour ago, I caught myself mid-sentence and heard my own accent. Nobody laughed. Nobody even reacted. Still, I felt it. That small internal slap. That quick reminder that confidence does not always survive sound.

I used to think I was an English wiz.

Canada corrected me.

Kindly, most days.

But still.

At home, I do not need to think about this as much.

My wife and I speak Hiligaynon most of the time. The words come out without needing to dress properly. No rehearsal. No self-monitoring. No sudden panic over vowels.

Just language.

Just us.

Maybe that is one thing I did not expect to learn here.

Home is not always a place.

Sometimes it is the language where your mouth can rest.

Most mornings, my day starts at 7:30.

My alarm used to be Radar. I changed it to Storytime because Radar felt like war. Storytime feels softer. I do not know if that says something about my current emotional state, but let us not diagnose everything.

The alarm rings.

I wake up.

Then I see my wife sleeping beside me, tired from her night shift.

I try not to move too much.

I try not to turn on the bright light.

Some people describe immigration through airports, documents, job applications, and snow. They are not wrong. Those things matter.

But on many mornings, immigration looks like this:

One person wakes up for work while the other finally gets to sleep.

No speech.

No dramatic moment.

Just two people trying to build a life in a place that still feels new on some days and strangely familiar on others.

I put on the Hoka shoes my wife bought for me before I left the Philippines.

They were the first shoes I wore when I stepped on Canadian soil.

Most days, they are just shoes.

I wear them because I need to go somewhere.

But sometimes I look down and remember that they carried me from one life into another. That sounds too poetic, maybe. But I mean it in the most practical way.

They were there.

Airport floor.
Canadian air.
First steps.
First confusion.
First cold.

My wallet and IDs go into my pocket.

That has become another small ritual.

Here, cards matter. Proof matters. Names on plastic matter. Sometimes I feel like I carry my new life in my pocket and hope I brought the right version of myself for the day.

Then I go to work.

Or I stay home and work from there.

Either way, the day begins.

Work That Feels Close to Medicine, But Not Quite

My work now is close to healthcare.

Close enough to feel familiar.

Not close enough to feel the same.

That is a strange place to stand.

There are days when I repair appliances. There are days when I print forms. There are days when I do laundry for my clients, cook food for them, order Uber, answer calls, attend meetings, or go to the hospital simply to accompany someone.

Simply.

That word does a lot of work there.

Because going to the hospital used to mean something else for me.

Back home, I entered hospitals as someone training to diagnose, treat, examine, present cases, write orders, and explain things to patients and families. Even when I was tired, even when I was unsure, even when I felt like I knew nothing, I still entered with a certain role.

Now, I enter beside someone.

I wait.

I listen.

I help explain if I can.

I carry information.

I advocate when needed.

I do not stand there as the physician.

Not here.

Not yet.

I try not to turn that into a tragedy because it is not always one. There is dignity in this work too. A lot of it, actually. Sometimes more than people realize.

There is dignity in making sure someone’s food is ready.

There is dignity in checking if the laundry is done.

There is dignity in knowing which form needs to be printed before someone even asks.

There is dignity in accompanying a person who might otherwise face the hospital alone.

Still, I would be lying if I said the shift never bothers me.

Some days, the old version of me taps my shoulder.

You used to do something else.

I know.

I remember.

My clinical eye did not disappear when I moved to Canada. It still shows up, sometimes without permission.

I still read about my clients’ conditions.

I still think about safety.

I still write progress notes with the seriousness of someone who believes documentation can protect people.

I still try to organize the team in a way that feels more healthcare-conscious, because I cannot help it. Maybe that is useful. Maybe that is pride. Maybe it is both, and I am just trying to make peace with that.

There are also days when I work from home.

People say that like it is always a gift.

It can be.

No commute. No rushing out into the cold. No slipping on ice while trying to pretend I am confident in winter.

But working from home also brings me back to the pandemic.

I remember clerkship through screens.

I remember studying while the world felt closed.

I remember the strange pressure of becoming a doctor during a time when even doctors looked tired in ways I had never seen before.

So when I sit in front of my laptop here in Edmonton, working from our apartment, I sometimes feel two timelines touching.

The present one, where I answer messages and help manage operations.

And the old one, where I was studying, worrying, trying to survive medical training through unstable days.

Maybe this is another mundane immigrant thing.

A room is not just a room.

A laptop is not just a laptop.

A workday is not just a workday.

Everything carries echoes.

And still, I do the work.

Because rent exists.

Because bills exist.

Because dreams do not excuse you from laundry.

Because becoming a doctor again in Canada is not a straight road, and while I am walking it, I still need to live.

That part is not poetic.

That part is just true.

Tim Hortons as a Soft Landing Place

Before work, if I have time, I go to Tim Hortons.

My order is usually a large Triple Triple.

I know. Very healthy. Very doctor-like.

Please do not report me to my future licensing body.

I do not know if the people at Tim’s recognize me already, but I hope they do. There is something comforting about becoming familiar in a place, even in a small, almost embarrassing way.

Maybe they do not know my name.

Maybe they just know the order.

That is fine.

Sometimes being known by your coffee is enough for the morning.

When I am going to work, I take it to go.

When I am with my wife, we stay.

That difference matters to me.

A coffee shop changes depending on who sits beside you.

Alone, it is a stop.

With her, it becomes a pause.

A small bench in the middle of a life that keeps asking us to move.

We sit there, sometimes tired, sometimes quiet, sometimes talking about groceries or work or what we will eat later. Nothing grand. No dramatic conversation. Just two people sharing coffee in a country where both of us are still learning how to pace ourselves.

I also notice the workers at Tim’s.

Many of them look like me.

Brown skin. Different accents. Names from places I can only guess. People who move fast behind the counter while half-awake customers wait for caffeine like it is a human right.

That quiet diversity does something to me.

Not in a cheesy way.

Nobody stands there saying, “Welcome to multicultural Canada.”

Nobody needs to.

You just see it.

A Filipino-looking worker handing coffee to a white construction worker.

A South Asian worker calling an order for a Black customer.

A newcomer trying to understand what someone meant by “double double” while everyone else pretends that term was born with them.

It is ordinary.

That is why it matters.

I think that is what I keep noticing here.

Belonging does not always arrive with ceremony.

Sometimes it is just someone handing you a paper cup and saying, “Have a good one.”

And you say, “You too,” even if the first few times you said it, you felt like you were acting in a Canadian training video.

Now it comes out more naturally.

That scares me a little.

It also comforts me.

West Edmonton Mall, or My Very Large Sari-Sari Store

Then there is West Edmonton Mall.

WEM.

The place is too big to be treated casually, which is exactly why I now treat it casually.

This is probably disrespectful to geography.

But in my head, WEM has somehow become our sari-sari store.

Not literally, of course.

No sari-sari store has an indoor amusement park, a waterpark, a skating rink, and a parking area that looks like it was designed by someone who did not believe in walking.

But emotionally?

Sometimes, yes.

My wife asks me to buy something, and my brain goes, “Okay, I’ll go to WEM.”

As if I am just stepping outside to buy vinegar, soy sauce, and a sachet of shampoo.

Then I arrive and remember that this “quick errand” may involve several entrances, long walks, two wrong turns, and the quiet possibility of forgetting where I parked, except I do not drive yet, so at least that problem has not found me.

There is comfort in WEM because it feels close to the malls back home.

Not the same.

But close enough.

Filipinos understand malls differently, I think. We do not only shop there. We cool down there. We walk there. We meet friends there. We waste time there with intention. We look at things we do not plan to buy and somehow call that leisure.

So when I walk around WEM, something in me relaxes.

The scale is Canadian.

The instinct is Filipino.

My usual route is simple.

Dollarama.

T&T.

Maybe Indigo.

Maybe London Drugs.

If there is time, Hallmark.

T&T is dangerous in a very specific way.

You enter thinking you will buy one or two things, then suddenly you see Chippy or Oishi and your inner child starts making financial decisions.

The first time I saw those snacks there, I paused.

Not because chips are rare.

But because recognition can ambush you.

You are in Edmonton.

You are wearing winter clothes.

You are thinking in dollars.

Then there it is.

Chippy.

A small bright object from home, sitting on a shelf like it did not cross an ocean to find you.

During my first months here, I kept comparing prices in my head.

This much for this?

Back home, this would be cheaper.

Then I would convert.

Then I would stop converting because the math hurt.

Now I do it less.

Not because things became cheap.

I just got tired.

That is another sign that you are settling, I think.

You stop converting every price into the life you left.

Not fully.

But enough to function.

After church, I enjoy doing groceries with my wife.

That has become one of our small married-life rituals here.

We walk.

We choose things.

We talk about what we need.

Sometimes we buy practical food.

Sometimes we buy food because being practical all the time is bad for the soul.

I like seeing her walk with me anywhere in the city.

That sounds simple, but it means a lot.

Back home, we had our own rhythms. Here, we are building new ones from scratch. A grocery trip becomes a date. A mall walk becomes exercise. A Tim’s coffee becomes a small celebration that we are both awake at the same time.

Immigration turns ordinary errands into proof.

Proof that you are adjusting.

Proof that you are tired but still moving.

Proof that you can buy Chippy in Canada and still miss the sari-sari store.

Both can be true.

That is the confusing part.

That is also the beautiful part.

I didn’t even start in that world.

When I first entered university, I was a Bachelor of Science in Business Administration major in Marketing student. A “safe” course. The kind that sounded good when relatives asked, “So, what are you taking?” I could answer confidently without having to explain too much.

But there was this nagging thought. A quiet pull toward something else.
I kept wondering—what if I became a doctor?

The more I sat in business classes, the more that question grew louder. It wasn’t a lightning bolt moment, more like a slow drip. And when I finally considered shifting, Biology seemed like the natural step. Partly because it’s a common pre-med choice, and partly because it was my mother’s pre-dentistry course. A sentimental echo.

I didn’t do a deep analysis of career outcomes or weigh pros and cons like a good business major should. I just thought: If I’m going for medicine, this is the way in.

So I shifted.

Early Fascination

My relationship with Biology actually started long before college.
I remember being in elementary and doing my first dissection—a live toad. That might sound cruel now, but at the time, I was fascinated. While some of my classmates were grimacing or holding their breath, I was leaning closer, eyes wide, watching the way life was arranged inside a body.

It was one of the few times I felt like I was doing something real in school. Not just reading about processes in a book, but actually seeing them.

That early fascination carried over into high school, where Biology was one of my favorite subjects. I liked the balance of memorization and understanding, of facts and patterns. You could study a system, learn its parts, and understand how they interacted. There was a logic to it.

I thought that logic would make Biology as a degree manageable.

I was wrong.

The Reality of the Course

Biology in college was a different beast entirely.
Sure, some subjects felt familiar at first—basic botany, introductory zoology—but they quickly evolved into something much more technical. Comparative Anatomy demanded hours of memorization. Cell Biology felt like diving into a microscopic ocean where every molecule had a story. Genetics challenged me in ways I didn’t expect. Histology made me doubt my own eyes.

Then there were the rotating exams, where you had seconds to identify a specimen, a structure, or a process before moving to the next station. It was a kind of academic pressure that felt like a trap—either you knew it in an instant or you didn’t.

Some days, I’d walk out of a lab feeling confident. Other days, I’d feel embarrassed, especially when I blanked on something I’d studied the night before. In those moments, you start questioning why you’re even there.

And yet, the professors kept me anchored.

Professors Who Loved the Subject

I was lucky to have teachers who treated Biology not just as a pre-medicine stepping stone but as a field worth dedicating a life to. They spoke about ecosystems, evolutionary processes, and research like these were treasures to be preserved, not just topics to be passed in an exam.

That passion rubbed off on me, even if I was more focused on medicine. I could see in them what it meant to truly belong to the discipline.

Still, passion alone doesn’t make you immune to doubt.

The Trap Feeling

There were times I felt like Biology was a trap. That if I didn’t get into medical school, I wouldn’t be satisfied with anything else. It was a narrow kind of ambition—doctor or nothing. And that made the stakes feel higher than they needed to be.

I had classmates who were natural achievers. Many of them treated grades like currency and research projects like personal milestones. I wasn’t competing with them. In my circle, we built community instead—helping each other, sharing notes, laughing off the stress when we could. It made the long semesters feel bearable.

I did join our official Biology organization, Microbia, but my real extracurricular commitment was outside strict science. I became active in our university student paper, Forum-Dimensions, eventually becoming its chief editor. Writing gave me a break from lab reports and practical exams. It was another way of studying life, but through people and stories rather than specimens.

Surviving the Coursework

People assume that because Biology isn’t as specialized as Nursing or as clinically focused as Medical Technology, it must be easier.

That’s not true.

All our Biology and Chemistry courses were demanding in their own way. They didn’t require the same kind of hospital exposure, but they drained you with sheer volume and precision. Hours in the lab. Mountains of readings. Plates that had to be labeled perfectly. Experiments that could fail simply because the weather wasn’t cooperating or because the equipment was older than some of us.

And then there were the “minor” subjects.

Teachers liked to say we took minors in other fields because we were expected to do well in them, too. As if our schedule wasn’t already stacked. History, literature, physical education—they were meant to balance us out, but sometimes they just added more pressure. I don’t even know how I survived them while juggling all the major courses.

There were nights I thought about quitting.

Not because I didn’t like Biology anymore, but because I was worried it was all or nothing. If I didn’t become a doctor, what was I going to do? Teach? Go into research? Neither felt like my dream at the time.

The NMAT and the Leap to Medicine

When NMAT season came, I didn’t prepare as hard as others. Some of my classmates enrolled in review centers, armed with thick binders of practice tests. I had… a reviewer. Just one.

I didn’t feel prepared, but strangely, I wasn’t too nervous either. Maybe because I had this quiet hope that all the years of studying life sciences would at least give me a fighting chance.

And in a way, it did.

Biology didn’t make me a perfect NMAT taker, but it taught me to face the unexpected. To look at a question, find a clue, and work my way toward an answer.

When I finally stepped into medical school, I thought some subjects—like Parasitology—would carry over seamlessly. I quickly learned that medicine was a completely different domain. The transition was less about applying what I knew and more about starting from scratch with a different set of expectations.

The Weight of Comparison

In med school, the comparisons began. Not official ones, but the quiet, internal kind.

I’d see classmates who were Nursing or Medical Technology graduates confidently navigate clinical terms I was only learning for the first time. They had hospital stories, practical skills, and a way of moving through patient cases that seemed instinctive.

It was hard not to feel insecure. I questioned whether I should have taken another course instead. Nursing was my wife’s (then-girlfriend’s) suggestion, but we couldn’t afford it at the time. MedTech was another option I’d considered in passing, but Biology had felt like the right choice back then.

Over time, I brushed those thoughts away. I realized that no pre-med course could fully prepare you for medical school. The playing field levels out eventually—what matters is how you adapt.

The Misconceptions

One thing I learned is that a lot of people underestimate Biology majors.

There’s the idea that it’s “just” one of the best pre-med choices and nothing more. That we’re not as busy as other science students. That the only fallback is teaching in high school.

Those assumptions erase the skills we actually develop: investigative thinking, deep appreciation of local flora and fauna, an understanding of conservation and preservation. We learn how to observe, record, analyze, and connect details.

And yes, it’s true—some of us go into research, some into medicine, some into education. But the field itself is richer than people give it credit for.

Lessons Beyond Medicine

Even now, I find subtle ways Biology has stayed with me. The way I think about systems. The respect I have for how complex yet fragile life is.

I still remember dissecting an oyster in class and, strangely, coming out of that experience appreciating it more as food. Biology is like that—it makes you notice things you wouldn’t have thought twice about before. It can even create a kind of reverence for life that parallels spiritual beliefs, even if the course itself is rooted in Darwinian principles.

It taught me that understanding life scientifically doesn’t have to cancel out the sense of wonder. In fact, it can deepen it.

The Emotional Baggage

When I think back to my Biology degree, the memories aren’t just about labs and lectures.
There’s a layer of emotional weight to it—delays, failures, and the constant shadow of “what if I don’t make it to medicine?”

I carried those questions everywhere. They weren’t loud, but they were persistent, like a low hum you can’t turn off. It didn’t help that I also felt the pressure of living up to my mother’s legacy. She had taken Biology as her pre-dentistry course, and here I was, walking the same path. It felt symbolic. But it also felt like a responsibility I couldn’t fail.

Another layer was trying to convince others that Biology was useful outside of medicine—even though I was headed for medicine myself. I knew its worth, but I also knew the perception. People wanted clear, linear career stories. Biology didn’t always give you that. You had to carve your own.

Why I’m Still Proud

Despite the struggles, I can say without hesitation that I’m proud of taking Biology.

It’s more than just a degree. It’s a way of seeing the world—rooted in observation, analysis, and curiosity. Even the Latin root of the word species, specere, meaning “to look” or “to observe,” speaks to the heart of it. That’s what we do. We look closely at life. We try to understand it, in all its forms and scales.

The course connected me to people, ideas, and experiences I wouldn’t trade for anything. It trained me to think about details, to see patterns, to respect the complexity of the smallest organism and the largest ecosystem.

If I had to choose again, I’d still say yes.

Advice to Future Biology Majors

If you’re thinking about taking Biology—whether for pre-med or not—know this: it’s one of the most remarkable and useful courses you can take.

But usefulness isn’t always obvious right away. It’s not like Nursing or Engineering, where the job title is in the degree. Biology’s gifts are in the skills it hones and the perspectives it gives you.

Whether you end up in medicine, research, conservation, or education, the field is rich. And I hope more people choose to explore it beyond the usual medical path—especially in research and environmental preservation. We need more voices there.

You’ll face people who think you’re taking an “easier” route. You’ll hear the fallback-teacher comments. But you’ll also discover moments that make you realize how much life there is to study, protect, and appreciate.

Closing the Circle

Looking back, the “woes” of being a Biology major weren’t just about the workload or the doubts—they were about growing into someone who could live with uncertainty and still move forward.

I entered the program with the idea that medicine was the only finish line. Somewhere along the way, I learned that the degree itself had value beyond that path.

Biology didn’t just prepare me for medical school—it prepared me for the unexpected turns in life. And maybe that’s what education is supposed to do.

At first, I was just writing to cope — putting my thoughts into blog entries, hoping someone out there might feel a little less alone. I called the series Overcoming the Odds, and it followed the story of how I tried, failed, froze, tried again, and eventually passed the Philippine Physician Licensure Exam.

But along the way, I realized I was holding back. There were more moments I wanted to include, more reflections that wouldn’t fit in a blog post. So I gave myself permission to open the story wider — and this eBook was born.

What the Book Is About

When You Think You Can’t is not a story of perfect study hacks or overnight success. It’s a story of:

• Delays that felt like defeat
• Burnout that nearly ended everything
• Superstitions that held me together when logic couldn’t
• Rituals like red boxers and semicolon necklaces
• A wife who believed in me even when I didn’t

This is a survival story — not just for exams, but for the self.

I’m sharing it not because I passed,
but because I almost didn’t.
And I think that matters.

Where to Read or Download

You can read or download the ebook for free or with a minimal fee at any of the following:

• Ko-fi (PDF, free or pay-what-you-want):
  Download via Ko-fi
• Amazon Kindle (KDP):
• Kobo (ePub + available to libraries via OverDrive):
• Other ebook platforms (Apple Books, B&N, etc.):

How to Support or Give Feedback

If this story helped you — even just a line, a sigh, or a tear — I’d love to hear from you. You can:

• Leave a message or comment on my Ko-fi page
• Share the book with a friend or med student who might need it
• Tag me on Twitter/X or Instagram (@ianleoj)
• Send a quiet email or DM — I read them all
• Or just keep going with your own story. That’s more than enough.

If you want to help me continue writing and sharing more stories like this, tips or donations on Ko-fi are deeply appreciated. But honestly, your presence here already means so much.

Why I’m Sharing This

Because someone out there needs it — the way I once needed a story like this and couldn’t find one.

Because not everyone who struggles is lazy or weak.

Because behind every success photo is a quiet, shaky, unseen climb.

And because maybe… maybe you’re in that place now. The one where you’re not sure if you can keep going.

This book is for you.

You’re not behind.
You’re becoming.
And you don’t have to do it alone.

Thank you for reading.
Thank you for staying.

— Ian
Download the free eBook

There are things people say to you that never leave.

Not because they were loud. Not because they were cruel.

But because they came at the worst moment—when you were holding on to your last bit of hope that maybe, just maybe, things could end gently.

You try. You reach out. You go out of your way to soften the goodbye. You think maybe this time they’ll see your effort, not just your condition.

Then they say something like,
“You only care about your depression.”

And suddenly, the air gets pulled out of the room.

You don’t even have the strength to respond.

Because that’s not just a comment—it’s a dismissal. A rewriting of the years you spent quietly suffering. The nights you didn’t sleep. The days you did your best just to function. The fact that you even reached out in the first place.

It takes one sentence to undo all of that.

You stand there, silent. Maybe furious. Maybe tired.
You leave, and nothing gets repaired.

That’s the version of the story no one tells.

Sometimes I think about this strange pressure we put on people who are struggling—to still be emotionally available, empathetic, understanding. To always give, even when they’re empty.

And if they can’t?
If they slip or disconnect or just survive?

We call them selfish.

I’ve spent so many hours wondering if I was.

Wondering if I failed to love well. If my sadness made me blind. If my silence hurt others more than I realized.

I’ve replayed those final conversations more times than I’d like to admit.

And still, even now, I don’t know the full answer.

But I know this:

I wasn’t heartless.

I was hurting.

And I did try.

What Depression Isn’t

Depression isn’t a card you play.

It’s not a shield you hide behind. It’s not an excuse, not a script, not a reason to avoid caring about others.

It’s not the absence of love.

Most days, it’s the presence of too much.

Too much weight. Too much noise in your head. Too many thoughts you can’t explain to people who think sadness is something you just shake off.

People forget that.

They think you’re being dramatic. Or lazy. Or, worse, self-centered.

They think that if you’re too tired to call, you don’t care. If you go quiet for a while, you must be angry. If you don’t show up to family gatherings, you’re avoiding them on purpose.

What they don’t see are the dozens of times you rehearsed what to say. The messages you drafted and deleted. The questions you’ve asked yourself that sound like:

“Am I a bad child?”
“Am I only ever sad around them?”
“Am I just too much to love?”

Depression is not a lack of care. It’s a body and brain that sometimes make it nearly impossible to show that care in the ways people expect.

Some days you’re just trying not to disappear.
And on those days, trying is everything.

But when you’re told that your trying wasn’t enough—or worse, that it wasn’t even seen—it cuts deeper than anything else.

Because it confirms the very fear that depression whispers to you all the time:

“You’re the problem.”

And that’s the part that’s hard to explain to people who have never felt this kind of hollow. They think it’s pride. Or moodiness. Or stubbornness.

They don’t know how often you’ve begged yourself to “be better.”

Or how many mornings you’ve forced yourself out of bed for them—because you didn’t want them to worry, or judge, or lose hope in you again.

It was never indifference.
It was exhaustion.

And honestly, you were just surviving the only way you knew how.

To Those Who’ve Been Told They Don’t Care

Maybe someone told you that your sadness made you selfish.

That your breakdowns were unfair.
That you only ever thought of yourself.

Maybe it came from someone you loved. Or still love.
Maybe it happened during a fight.
Or in a soft voice that made it worse because you couldn’t tell if it was pity or blame.

Whatever the case, it stayed with you.

You’ve probably questioned it more than once.
Maybe you even started to believe it.

Started wondering if your depression really did make you incapable of love. If your silence meant guilt. If your boundaries were actually coldness. If your need for space was abandonment.

You’ve tried so hard to explain.

But sometimes there’s no space to explain things to people who only hear pain when it’s loud—when it cries, shouts, storms out, or explodes.

They don’t recognize the quieter version of pain.

The one that’s careful.
Measured.
Trying not to break anything else because it’s already breaking inside you.

So if you’ve ever been accused of not caring—

Just because you were hurting, or tired, or healing slowly—
I need you to hear this clearly:

That accusation is not your whole story.

You were doing what you could with what you had.

You were trying, even when they didn’t see it.

You are not heartless.
You are not a burden.
And you are not wrong for needing care, too.

The Guilt You Don’t Owe

There’s a kind of guilt that clings even after you’ve apologized.

Even after you’ve said everything you could.

Even after you’ve cried in private, wondering if there’s something wrong with the way you love, or speak, or feel.

This guilt doesn’t come from wrongdoing.
It comes from being misunderstood.

From people who expected a version of you that could keep performing, keep pleasing, keep pretending everything was okay—even when it wasn’t.

So you start thinking,

“Maybe I didn’t try hard enough.”
“Maybe I should’ve said it differently.”
“Maybe my sadness did hurt them too much.”

But that kind of thinking only spirals.

Because no matter what you tell yourself, you can’t rewrite someone else’s refusal to see your pain.

You can’t fix how someone processed your illness, or your silence, or your exhaustion.
You can’t undo their conclusions.

And you shouldn’t have to carry shame for surviving.

You were not the villain for being tired.
You were not selfish for breaking down.
You were not inconsiderate for needing help, even if others needed help too.

You were human.
And being human—especially a hurting one—doesn’t make you wrong.

A Slow Kind of Hope

Some relationships never get repaired.
Some goodbyes stay sharp.
Some words never get taken back.

I used to think closure came from conversation.
From the other person finally understanding.

But sometimes healing has to happen without an apology.
Without a reunion.
Without anyone admitting they hurt you.

Sometimes healing just looks like this:

Waking up and remembering it less.

Getting through the day without shrinking into guilt.

Letting go of the version of yourself that always had to prove they were worthy of love.

I don’t know where you are in your journey.

Maybe you’ve been quiet for years.
Maybe you’re just now realizing that what they said wasn’t fair.
Maybe you’re still trying to forgive yourself for something that wasn’t even your fault.

That’s okay.

You’re allowed to still be figuring it out.

You’re allowed to move slowly.
To build peace in small ways.

You don’t have to rush toward reconciliation.
You don’t have to explain everything again.

Sometimes hope just starts with this:

Believing that even if they never understand you—
you can still understand yourself.

And that can be enough.

A viral post claims there’s “no evidence that depression is caused by chemical imbalances in the brain.” While the 2022 study cited does challenge the old serotonin theory, it does not mean depression isn’t real, that antidepressants don’t work, or that treatment is unnecessary. Mental health is complex, and reducing it to clickbait harms real people. Let’s break it down — with evidence, context, and care.

Introduction: The Viral Post and Its Impact

You’ve probably seen it by now.

A striking image of brain scans, followed by bold text:

“Study finds no evidence that depression is caused by chemical imbalances in the brain.”

It’s gone viral — shared across Facebook, Instagram, Reddit, and even TikTok. The original version credits Hashem Al-Ghaili / Science Nature Page, and it’s framed as a kind of scientific revelation. Some people react with relief. Others with anger. Many just scroll by thinking, “So… antidepressants were a lie?”

As someone who has personally taken antidepressants and experienced real milestones because of them, I find this post careless. Not because the study is invalid — we’ll get to that — but because posts like this are being spread without context, disclaimers, or nuance. That’s dangerous.

Especially in places where mental health stigma already runs deep.

Especially when we know that compliance to psychiatric treatment depends a lot on how people perceive its value.

And especially when lives are literally at stake.

Where Did the “Chemical Imbalance” Theory Come From?

Let’s rewind a bit.

The idea that depression is caused by a chemical imbalance — particularly a shortage of serotonin — started gaining traction in the 1960s and 70s. It wasn’t a single discovery. It was a combination of early drug trials, lab animal studies, and emerging neuroscience that led researchers to suspect a connection between mood and brain chemistry.

Then came the antidepressants.

Drugs like fluoxetine (Prozac) worked by increasing serotonin levels in the brain. Patients felt better. Naturally, people — and pharma companies — connected the dots: if boosting serotonin helped relieve symptoms, maybe low serotonin was the cause of depression in the first place.

The “chemical imbalance” theory was never formally proven, but it became a useful shorthand. Pharmaceutical ads in the 1990s ran with it. So did some well-meaning clinicians. It was easier to explain than the complex web of biology, psychology, and life events that actually drive mental illness.

But that oversimplification stuck.

And decades later, we’re now seeing a public correction — one that’s long overdue, but incomplete when taken at face value.

What the 2022 Study Actually Found

Here’s where the viral post pulls its core claim.

In 2022, a group of researchers led by psychiatrist Dr. Joanna Moncrieff published an umbrella review (a type of meta-analysis of meta-analyses) in the journal Molecular Psychiatry. Their goal? To evaluate all major lines of evidence behind the serotonin theory of depression.

They looked at:

• Studies on serotonin levels in blood and cerebrospinal fluid
• Serotonin receptor activity
• The serotonin transporter gene (SERT)
• Effects of artificially depleting serotonin
• Links between serotonin and stress

Their conclusion?

“There is no consistent evidence of an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.”[cm_simple_footnote id=1]

Sounds definitive, right?

But here’s the thing: this wasn’t new to most psychiatrists.

The authors themselves emphasized that they weren’t saying antidepressants don’t work or that brain chemistry isn’t involved at all — just that the serotonin hypothesis doesn’t hold up as a standalone cause of depression.

What This Means — and What It Doesn’t

So now we know: the “chemical imbalance” theory, especially the serotonin version, doesn’t hold up under scrutiny.

But here’s what it doesn’t mean:

• It doesn’t mean depression isn’t real.
• It doesn’t mean antidepressants don’t work.
• It doesn’t mean we should stop all treatment.
• It definitely doesn’t mean you’ve been “lied to” by your doctor.

What the Moncrieff study tells us is that depression can’t be reduced to one neurotransmitter. That’s not new in psychiatry — many professionals have already moved on from that model. But most people outside the field haven’t. So when a post says “no evidence of chemical imbalance,” it sounds like a mic drop, when in reality it’s more like a course correction.

Here’s the better way to put it:

“Depression is not caused solely by a serotonin deficiency. It is a complex condition with biological, psychological, and social roots. Serotonin may still be involved, but not as the whole story.”

Simple? No. Accurate? Much closer.

Why Oversimplification Is Harmful

The problem with viral science posts is they often skip the nuance.

This one, in particular, risks sending the message that chemical-based treatments are invalid — or worse, that people taking antidepressants have been tricked. That’s not just wrong. It’s harmful.

I’ve been on antidepressants before. I’ve felt the difference they made — not immediately, not magically, but meaningfully. It was part of a broader recovery plan. And seeing that progress dismissed by a social media post, years after the original study came out? It feels careless. Irresponsible. Unsafe.

When you’re struggling with your mental health, you’re already vulnerable. You don’t need your only lifelines questioned by people who haven’t read the footnotes.

Worse, this kind of oversimplified framing can:

• Encourage people to stop taking medications without medical guidance
• Reinforce stigma: “You’re not sick; you’re just weak.”
• Push people away from evidence-based care
• Make already hesitant patients more distrustful of their doctors

If we’re going to challenge old models, we need to do it with care — not clickbait.

My Personal Take — and Why This Matters

Let me be honest.

When I first saw that viral post — “no evidence of chemical imbalance” — my gut reaction wasn’t intellectual. It was emotional.

I’ve been on antidepressants. I’ve had days where I needed them just to get out of bed. Not because I was weak. Not because I believed in serotonin like a religion. But because I was surviving. Climbing back, slowly, from somewhere I didn’t think I’d return from.

And seeing that work — that healing — brushed off as if it was some outdated myth?

It stung.

That’s why I care so much about how this information is presented. Not because I disagree with the research — I actually think the Moncrieff study is important. It pushes psychiatry forward. But what worries me is how late this post went viral, how stripped of nuance it is, and how many people are seeing it without any context. It’s not just a science update. It’s a public health risk.

Mental health already lives in the shadows for so many people. We don’t need to make it harder to reach out. We don’t need more reasons to be skeptical of help.

If anything, we need more compassion, not less.

What Causes Depression, Then? A Broader Look

So if depression isn’t just a serotonin issue, what causes it?

That’s the big question — and the honest answer is: it’s complicated.

Here’s what current research suggests:

1. Biological Factors

• Genetics: Depression can run in families, suggesting a heritable risk.
• Brain structure and function: Changes in the hippocampus, prefrontal cortex, and amygdala are associated with depressive symptoms[cm_simple_footnote id=2].
• Neurotransmitters: Serotonin, yes — but also dopamine, norepinephrine, GABA, and glutamate all seem to play a role[cm_simple_footnote id=3].
• Hormonal imbalances: Cortisol (the stress hormone), thyroid dysfunction, and even inflammation have all been linked to depression.

2. Psychological Factors

• Negative thinking patterns, learned helplessness, and trauma can set the stage for depression.
• Early life adversity — such as abuse, neglect, or loss — can change how the brain responds to stress[cm_simple_footnote id=4].

3. Social and Environmental Factors

• Poverty, isolation, discrimination, chronic illness, and even global crises like the COVID-19 pandemic have all been linked to increased depression rates[cm_simple_footnote id=5].

So yes, brain chemistry is part of it — but it’s shaped by everything around and within us. To say it’s “just” about chemicals misses the point. To say it’s not about chemicals at all is equally misleading.

It’s not either/or. It’s both/and.

So… Do Antidepressants Work?

Here’s the million-peso question.

If depression isn’t caused by a simple chemical imbalance, do medications that alter brain chemistry still work?

Short answer: yes — for many people, they do.

Longer answer: it’s complicated, but hopeful.

Antidepressants like SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) don’t just flood the brain with chemicals. They modulate brain circuits, change the way we respond to stress, and may even promote neuroplasticity — the brain’s ability to form new connections[cm_simple_footnote id=6].

They don’t work for everyone. And they’re not always enough on their own. But research shows that:

• About 40–60% of patients respond to first-line antidepressants within 6–8 weeks[cm_simple_footnote id=7].
• Antidepressants are more effective when combined with therapy, especially cognitive-behavioral therapy (CBT).
• Their effectiveness varies depending on severity — they tend to help more in moderate to severe cases, less in mild cases[cm_simple_footnote id=8].

They’re not magic pills. But they’re tools. And for many people — myself included — they’re a turning point.

What’s more, newer antidepressants are being developed with different mechanisms: some targeting glutamate (like ketamine), others working on inflammation. This reflects a growing understanding that mental illness is not one-size-fits-all.

So no, SSRIs weren’t a scam. They were a starting point. And for millions of patients worldwide, still an important one.

Treatment Still Matters — Here’s Why

Here’s the bottom line: whether or not serotonin is the main player, depression needs to be treated.

The global burden of depression is staggering — it’s one of the leading causes of disability worldwide[cm_simple_footnote id=9]. Untreated, it can affect:

• Sleep
• Appetite
• Focus
• Work
• Relationships
• And yes, even lead to suicide

We can’t afford to let misinformation distract us from the reality of suffering — or from the tools that exist to help.

Treatment today is more flexible than ever. Options include:

• Medications, from first-line SSRIs to newer formulations
• Therapies, like CBT, ACT, EMDR, or interpersonal therapy
• Lifestyle interventions, including sleep hygiene, exercise, and nutrition
• Peer support, group therapy, or community-based mental health programs
• Emerging treatments, such as psychedelics, digital interventions, and rTMS

It’s not about one perfect cure. It’s about building a care plan that fits you.

And if antidepressants are part of that plan? That doesn’t make you weak. It makes you proactive.

The Real Risk of Posts Like This Going Viral

At first glance, it might seem harmless.

It’s just an infographic, right? A fun science fact for people to share?

But when posts like “there’s no evidence depression is caused by a chemical imbalance” go viral without context, they don’t just inform — they confuse. And confusion, when it comes to mental health, can be dangerous.

Here’s why:

• People in treatment may feel duped and stop taking their medication abruptly.
• Skeptical family members might use this to shame their loved ones.
• Online trolls will weaponize it to reinforce the old narrative: that depression is “just in your head” and doesn’t need care.
• Doctors and therapists might struggle more to explain the role of medication to already hesitant patients.

We’ve fought so hard for mental health awareness — for the language, access, and visibility people need. One post shouldn’t undo that progress. And yet, it often does.

Information spreads fast. Clarification doesn’t.

So let’s be careful about what we amplify. Let’s demand better science communication — the kind that respects both truth and the people living with it.

Call to Action

If you saw that post and felt shaken — I get it.

If you’re on antidepressants and now questioning everything — I get that too.

Here’s what I want you to know:

You’re not broken.
You’re not naïve.
You’re not wrong for needing help.

Depression is not just a chemical glitch. But neither is it just “in your head.” It’s a whole-body, whole-life condition — one that deserves care, evidence, and empathy.

So if you’re struggling, don’t let a viral post be your final word. Talk to your doctor. Revisit your care plan. Ask questions. Stay open.

And if you’re someone who shares mental health content — take time to read before you repost.

The people reading need more than headlines.

They need hope.

No one-size-fits-all schedule. No ultimate reviewer. No magic tip.

But there are lessons. Personal, hard-earned ones. And if you’re reading this while preparing for the boards, I hope some of mine can meet you where you are.

Study plans should fit you—not the other way around.

I tried printed schedules, sometimes customized. Other times, I let my gut guide me. Both had their place.

But one thing stayed the same: repetition. Reading notes again and again. Answering MCQs again and again. It sounds boring, but it built muscle memory.

I know some review centers advise against too much MCQ answering. But for me? It worked. Question banks were gold. The key was not just getting the answers right—but going back, rereading the rationale, and understanding the “why.”

If I got a question wrong, I made sure I didn’t just move on. I asked myself why I chose the wrong answer in the first place. What thinking trap did I fall into?

That kind of analysis—that’s what helped most.

Weak areas need priority, not pity.

Some subjects gave me headaches. So I didn’t avoid them.

I doubled or tripled my effort on them.

I used my performance in question banks to spot what I was bad at. It was more honest than waiting for a post-test result that didn’t reflect the real exam goal. Some exams felt more like memory drills than boards. So I tried to adjust.

This meant cutting through review center noise sometimes. Not everything they said was helpful. But I will say—ExpertMD deserves a shoutout. Especially Doc Toff and team. Their techniques for Day 1 of the exam were clear and effective. I owe them a lot.

Consistency is built, not wished for.

You don’t wake up disciplined.

You build it from a string of days that don’t feel like much. My version looked like this: sitting at the table, placing the notes I had to read in front of me, and refusing to move forward until I understood most of it.

That’s it.

Not glamorous. Not motivational. Just… showing up. Again.

My best days? They were 3- to 4-hour blocks at my desk, either watching a lecture or dissecting a topic. No phone. No breaks. Just focused absorption.

But that doesn’t mean I didn’t fall off. I did.

I stopped social media—thanks to my wife’s urging, and a mental health doctor’s advice. But leisure breaks, hunger pangs, sudden chores—they were sneaky distractions. I had to learn how to forgive myself after each slip and just start again.

One day, I noticed my mindset shifting. I wasn’t just studying—I started believing I could actually do this. That quiet attitude change made all the difference.

Ask for help early and often.

I was never alone in this.

I asked my friends—those from med school, and those I met during internship—for help almost every day. We sent each other questions, ranted, joked about our burnout, tried to explain weird topics, and reminded each other why we were even doing this.

There were also moments when I broke down and stopped studying entirely. I can’t even recall how many days I wasted just trying to get my mind back. Sometimes the mind needs to stop. And you have to let it.

That’s where my support system came in. My wife. My friends. Even in silence, they kept me grounded. I’d be lying if I said I did this alone. I didn’t.

If you’re just starting: don’t wait too long.

If I could go back to myself six months before the exam, I’d say:

Start now.

Yes, internship is hard. But squeezing in even just a few hours each week could’ve made the burden feel lighter. That way, I wouldn’t have had to wrestle with so much guilt and panic toward the end.

Better yet? If you’re still in med school, remember: every topic is fair game for the boards. The real prep starts the moment you step into your first anatomy class.

Still, if you didn’t do that—don’t lose hope. You can still survive.

You can still pass.

If you fail: you’re still in the game.

It’s okay to grieve.

You have the right to mourn the loss of something you worked so hard for. That doesn’t make you weak.

But don’t stop there. Failure can be a teacher—if you let it. It can show you where the cracks are. What you misunderstood. Where you overestimated yourself. Where you need to heal.

The boards don’t measure your worth as a doctor. If they did, we wouldn’t have licensed professionals hurting others in small or large ways.

What matters more is why you want this in the first place. What you hope to do with it. Who you wish to serve.

Yes, you can do this.

I believe this with all my heart.

Not because I’m trying to be motivational. But because I lived through it.

You can pass this exam.

But more than that—you can carry the kind of integrity and intention that makes you a doctor not just in title, but in presence.

If you’re struggling today, look inside you. Ask yourself: What do I want? Who am I doing this for?

Let that desire be your anchor.

And don’t isolate. Reach out. Let others in. You’re not weak for needing help. You’re human.

A Closer Look at Each Exam Day

The Physician Licensure Exam is not a single battle—it’s four full days of internal war.

Day 1 nearly destroyed me. Biochemistry. Anatomy and Histology. Microbiology and Parasitology. All my weak spots lined up like a firing squad. It was overwhelming, but not surprising. Everyone talks about Day 1 as the hardest, and in my case, it truly was. I walked out of the testing center unsure whether I had done enough. I kept replaying certain questions in my head, wondering if I had misunderstood basic concepts or misread tricky items.

Day 2 felt more bearable. It covered Physiology, Legal Medicine, Ethics, Medical Jurisprudence, and Pathology. It was still dense, but somehow the stress didn’t weigh on me as heavily as Day 1 did. I had some momentum, and maybe a sliver more confidence.

Day 3 was about Pharmacology and Therapeutics, Surgery, Ophthalmology, Otolaryngology, and Internal Medicine. These were broad and clinically rich—fields that I had tried to keep sharp during internship, so I wasn’t completely lost. But exhaustion was creeping in. I remember my hand trembling as I shaded those last circles.

Day 4 wrapped things up with Obstetrics and Gynecology, Pediatrics and Nutrition, and Preventive Medicine and Public Health. At that point, the adrenaline was gone. What was left was just… resolve. No energy, just a push to finish. I kept telling myself, “You’ve gone this far. Don’t collapse now.”

The Rituals That Helped Me Mentally Prepare

Before I left for the exam each day, I’d arrange my things on the table. Quietly. No fanfare.

There were no incantations, no special prayers. Just a few items that had followed me through the entire journey:

• A pair of red boxers, for luck.
• A handkerchief from my wife, soft and steady.
• A semicolon necklace, which I never wore, but always held.

The semicolon meant the most. I used to place it on my hand, let it rest like a bracelet. I never bought it as a fashion piece—it was a symbol. It said: “This is not where your story ends.” It reminded me to keep going. That the delay wasn’t death. That it was a pause. A breath.

Some people may think these tokens don’t help. And maybe they don’t, in the strictest sense. But they remind. And that’s what I needed.

I needed to remember that I had a goal. And that every little reminder—from a necklace to a song—was part of the fight.

What I’d Do Differently If I Had to Do It Again

If I could rewind and start this whole review journey again, I wouldn’t aim for perfection.

I’d aim for peace.

I wouldn’t try to devour every page or remember every rare disease. I’d focus on what matters—and I’d listen to myself when I was tired.

I regret watching too much anime. Not because anime is bad (it helped sometimes), but because it stole hours I could’ve used better. I regret eating too much out of stress, then falling asleep when I should’ve been reviewing. I regret being cruel to myself on the days I couldn’t finish what I planned.

The biggest mindset shift I wish I embraced earlier? That there must be no room for doubt.

Not pride. Not arrogance. Just a steady belief in yourself.

Once you doubt, you hesitate. And hesitation eats time. You can’t afford that.

Believe. Every day. Even on the days you feel like a fraud.

You Are Not Your Delay

You made it here.

To this sentence, at least. And that’s not nothing.

Whether you’re about to take the boards, thinking of giving up, or just surviving your own kind of waiting season—this is for you.

You are not your delay.

Not your late start. Not the year you had to pause. Not the moment you broke down. Not the time you thought you had nothing left.

Those detours?

They didn’t steal your dream. They shaped the kind of dreamer you are.

I’ve failed more times than I’ve admitted publicly. I’ve lost sleep, missed meals, and sat in front of notes I couldn’t understand. I’ve had days when I hated myself for not being faster, smarter, better.

But even in all that, something stayed.

A will. A reason. A small thread I kept holding onto—sometimes with both hands, sometimes just with my teeth.

If you have that thread, hold on. If you dropped it, go back. It’s probably still there.

Thank the people who didn’t leave. Forgive the ones who did. Thank yourself, even if you think you were slow.

You got here.

And I think that’s enough proof that you’ll keep going.

As for me, I’m still learning. I’m far from perfect. But I’m moving toward the kind of doctor I always hoped to be. The one who listens. The one who sees. The one who remembers what it felt like to have nothing—and still hope.

To the reader who stayed until now: thank you.

To my wife, who never let me collapse completely—thank you.

To the people who doubted me, unintentionally or not—you helped me dig deeper.

To God, who was silent sometimes, but never left.

I don’t know where this road will lead from here. But I know now that I was never walking it alone.

And I hope, truly, that you know this too:

You are not alone.
You are not behind.
And you are not too late.

This is the Last Chapter

This post marks the final part of my Overcoming the Odds series.

If you’ve read from the beginning—or even just picked a part that spoke to you—thank you.

I wrote these not just to remember, but to reach. I hope something in these pages helped you feel seen, less alone, or more certain of your path.

Whether you’re a future doctor, a student in any field, or someone fighting quiet battles of your own, I hope you found fragments of hope here.

Maraming salamat sa pagsama.

And wherever your odds take you next—keep going.

If you’re preparing for the PLE or facing a tough exam season, I’d love to hear your story. Drop a comment or message me on Instagram or Facebook @ianleoj or email me at hello@ianleoj.com — we’re all in this together.

It gets marketed as face masks, scented candles, and spa days—which can all be great. But self-care, when taken seriously, is far less aesthetic and more about intention. It’s not just about relaxing. It’s about surviving with dignity. Sometimes, it’s choosing to wash the dishes when you’d rather collapse in bed. Other times, it’s letting the dishes sit and giving yourself a break.

So what actually counts as self-care?

And what happens when it stops being a luxury and starts being your lifeline?

Let’s walk through that.

The Physical Side—Routine Care, Not Reward

Let’s start with the body.

• Skincare, for example, isn’t just vanity. Our skin is our largest organ. Caring for it—through hydration, protection, or treatment—can boost both physical health and confidence. A 2021 review in the International Journal of Women’s Dermatology linked regular skincare routines to improved psychological wellbeing, particularly among those with chronic skin conditions.[cm_simple_footnote id=1]
• Sleep is also foundational. Lack of it impairs judgment, mood, and immune function. The CDC recommends 7–9 hours for most adults, yet nearly one-third of Americans report sleeping less than 6 hours per night.[cm_simple_footnote id=2]
• Nutrition matters just as much. Not for dieting, but for nourishment. Balanced meals, hydration, and limiting processed foods can stabilize energy and mood. A study published in Nutrients found that higher intake of fruits, vegetables, and whole grains correlates with lower depression risk.[cm_simple_footnote id=3]
• Movement, whether a walk or stretch break, plays a big role too. Exercise releases endorphins, supports heart health, and has been shown to improve anxiety and depression symptoms.[cm_simple_footnote id=4]

So yes—moisturizing your face might be self-care. But so is brushing your teeth, stretching your back, or eating a meal with actual protein.

Emotional Hygiene—The Quiet Work of Journaling and Reflection

Now let’s talk about what happens inside.

Self-care often begins when we stop numbing and start listening—to what we feel, what we need, and what’s quietly falling apart.

That’s where practices like journaling come in. You don’t need to be a writer. You just need to show up with honesty. Journaling has been shown to reduce intrusive thoughts, improve memory, and even enhance immune response.[cm_simple_footnote id=5]

Some people write affirmations. Others vent.

The goal isn’t to produce something pretty. It’s to create a space where you can be real. And in the process, gain clarity about yourself.

Meditation is another tool that’s earned its place—not just in wellness trends, but in science. Mindfulness-based stress reduction (MBSR) programs have been widely studied. One meta-analysis in JAMA Internal Medicine showed moderate improvements in anxiety, depression, and pain.[cm_simple_footnote id=6]

You don’t need incense or perfect posture. You just need to pause. Breathe. Notice.

Both practices—journaling and meditation—ask for the same thing: presence. And in a world that pulls us in every direction, that’s no small thing.

Setting Boundaries—The Self-Care That Feels Like Conflict

Sometimes, the hardest form of self-care is saying no.

Not because you don’t care. But because you do—and you can’t keep showing up for others when you’ve got nothing left.

This is where boundaries come in. They’re not walls. They’re filters. They clarify what you’re willing to take on and what you’re not.

A 2019 study in The Journal of Counseling Psychology showed that people with poor boundary-setting skills were more prone to burnout and emotional exhaustion, especially in high-empathy professions like healthcare and education.[cm_simple_footnote id=7]

You might think:

• “If I don’t do it, who will?”
• “They’ll think I’m selfish.”
• “I’m letting people down.”

But what if protecting your peace is what actually helps you show up better, long-term?

Saying “I can’t talk right now” or “I need rest” might feel awkward at first. That’s normal. But boundaries are like muscles—they grow with practice.

Try this:

• Notice what drains you.
• Say no to one small thing this week.
• Check in afterward. Did it actually go worse than you feared?

Chances are, it didn’t. And you survived.

The Inner Voice—Self-Compassion Without Excuses

Another underrated form of self-care? Not beating yourself up for struggling.

Self-compassion isn’t about letting yourself off the hook. It’s about responding to failure or pain with the same tone you’d use with someone you love.

Think of the last time you messed something up.

Did you say:

“Of course I failed. I’m so lazy. I always do this.”

Or:

“That was tough. I didn’t do my best—but I can learn from this.”

The first voice adds shame. The second builds resilience.

Dr. Kristin Neff, one of the leading researchers on self-compassion, found that people who practiced it had greater emotional wellbeing, less anxiety, and more motivation to grow.[cm_simple_footnote id=8]

It might sound cheesy, but it’s real. Self-compassion isn’t indulgent. It’s how you stay afloat when everything feels like it’s sinking.

Start small:

• Replace “I’m so stupid” with “That was a hard moment.”
• Talk to yourself like someone worth caring for.
• Forgive yourself for not being at 100%.

Most people are doing the best they can with what they’ve got. And that includes you.

A Realistic Routine—What Does Your Self-Care Actually Look Like?

Let’s piece it together.

Self-care will never look the same for everyone. But here’s a sample list of non-aesthetic self-care that actually counts:

• Brushing your teeth even when you feel depressed
• Taking 10 minutes to breathe before doomscrolling
• Saying “no” to overtime so you can eat dinner with your family
• Journaling once a week—even if it’s messy
• Drinking water before your third coffee
• Scheduling that checkup you’ve been avoiding
• Making your bed even if the rest of your life feels chaotic
• Crying. Not hiding it. Letting it pass.

These don’t always feel productive. They don’t always get you praise. But they build the foundation for a more honest, functional life.

Because self-care isn’t just about feeling good.

Sometimes, it’s just about making sure you keep going.

What I Learned from My Own Burnout

A few years ago, I burned out so badly I couldn’t remember the last time I felt rested.

I thought I was being productive. I thought skipping meals and working overtime made me strong. It didn’t.

It made me sick. I didn’t lose weight and gained much but lost joy, lost motivation. And still, I pushed.

It took a friend to say, “You’re not lazy. You’re exhausted.”

Since then, I’ve had to relearn what care looks like—especially the kind you give to yourself. I had to stop seeing rest as weakness. And I had to stop measuring my worth by how much I accomplished.

Some days, I still get it wrong.

But now I pause more often. I check in. I write. I stretch. I let myself cry without calling it drama.

And it’s helping.

If You’re Struggling, You’re Not Failing

If you’re here reading this because you feel overwhelmed—you’re not alone.

Self-care isn’t a checklist you master.

It’s a relationship with yourself you tend to, over and over. With patience. With imperfection. With some missed steps.

Start where you are.

Breathe.

Pick one small thing. One gentle act of kindness to yourself.

And build from there.

The Myth of “Deserving” Rest

One of the most dangerous beliefs we carry is this:

“I’ll rest when I’ve earned it.”

It sounds noble. Responsible. Maybe even humble. But it quietly trains you to see rest as a reward, not a right.

That’s not self-care. That’s conditional survival.

Your body doesn’t ask if you’ve finished your to-do list before it needs sleep. Your mind doesn’t wait for permission to crash.

Rest is not a luxury. It’s a need.

In a 2019 study by the American Psychological Association, over 75% of participants reported health problems from chronic stress, including fatigue, sleep disturbance, and headaches[cm_simple_footnote id=9]. Many of them still said they felt guilty resting.

This mindset is especially common in high-achieving or caregiving cultures—where being tired becomes a badge of honor. But burnout is not a measure of worth.

What if you didn’t need to “deserve” care?

What if you simply needed it, and that was enough?

Imagine treating your own exhaustion not as something to fix—but as something to listen to.

Digital Boundaries Are Real Boundaries

There’s a reason your brain feels fried after a few hours of scrolling.

Social media, emails, messaging apps—they’re all designed to keep your attention, not to protect your peace.

We talk about boundaries with people. But we rarely talk about boundaries with our screens.

Try this:

• Turn off non-urgent notifications
• Set a “cutoff” time for checking messages
• Move distracting apps off your home screen
• Designate screen-free zones (e.g., bedroom, dining table)

One small study by the University of Pennsylvania found that limiting social media use to 30 minutes per day significantly reduced symptoms of depression and loneliness in young adults[cm_simple_footnote id=11].

You don’t need to go offline forever. Just reclaim small spaces in your day that aren’t tied to someone else’s dopamine design.

Even 20 minutes of disconnection a day can help you reset.

Self-Care for Caregivers (The Ones Who Always Give)

If you’re caring for someone else—kids, elderly parents, patients—you know how heavy invisible labor can be.

And chances are, you’re not giving yourself the same care you give others.

Caregivers often feel last in line. But self-care isn’t selfish. It’s how you stay sustainable.

In a survey by the Family Caregiver Alliance, 40–70% of family caregivers showed clinically significant symptoms of depression[cm_simple_footnote id=11].

That’s not small. That’s a crisis.

Some ways to help:

• Ask for help, even if it feels awkward
• Schedule “off” time each week—even short breaks matter
• Talk to someone (support group, counselor, friend)
• Recognize your emotional labor as valid, even if unpaid

You’re not being dramatic.

You’re human.

And if you collapse, who will take care of you?

Build a Realistic Weekly Self-Care Plan

Want to make self-care stick?

Treat it like a rhythm, not a rescue plan.

Here’s a sample template you can personalize:

Daily (5–20 min):

• Stretch or move your body
• Do one act of grooming (even small)
• Eat one intentional, not rushed, meal
• Journal 3 lines about how you feel

Weekly (30–60 min):

• Block one hour of solitude
• Turn off phone for 1–2 hours
• Watch or read something you enjoy guilt-free
• Reflect on one thing that gave you joy or stress

Monthly (90+ min):

• Declutter a space that’s been bothering you
• Revisit your boundaries: What’s working? What’s not?
• Schedule a health appointment, even basic (dental, eye, GP)

Don’t wait until you crash to start caring.

Start before the unraveling.

Self-care isn’t a grand gesture. It’s a steady beat.

I couldn’t sleep that night.

It wasn’t nerves exactly—just this strange mix of knowing and not knowing. The PRC usually drops results after 9 PM, sometimes later. But that day, every 15 minutes felt like a full hour. My phone screen was constantly lit from all the refreshing. I opened Chrome, closed it, opened it again, just to make sure it wasn’t cached. You know how these things go.

I was alone in my room. My wife was abroad for work, so it was just me. Just me and the weight of everything I had gone through to get here.

It wasn’t the first time I had waited for results like this. But this one was different. This one was final.

When the PDF finally dropped—hosted on one of those Drive links that PRC posts—I clicked it before the site could crash. It always does. The PRC site can’t handle the traffic and most of the aggregator pages are too spammy to trust.

My hands were shaking as I zoomed in.

I went straight to G. Then scrolled to GU.

There it was.

My name.

Not someone else’s. Not a near-miss. Not a cruel typo. Mine.

I don’t think I breathed for ten full seconds.

The Initial Reaction

I cried.

There wasn’t anything poetic about it. Just raw, ugly crying. Shoulders shaking, my phone slipping from my hands. I think I muttered “Praise God” before anything else came out, followed by a quiet, stunned “Thank you.”

It wasn’t loud. It wasn’t dramatic.

But it was overwhelming.

I had always done everything I could. I had studied until my eyes hurt, until my body gave up before my mind did. But when you’ve failed enough times in life, it’s hard to believe success is real—even when you see it with your own eyes.

I checked again. Then again. I zoomed in. Rechecked the file name. Looked for some kind of prank watermark. Nothing.

My name was really there.

I sent the screenshot to my wife first. She replied almost instantly. She cried too. Even though we weren’t in the same room, we were right there in that moment together.

We had worked for this—together. All the nights she stayed on call with me, all the days she bore the weight of my moods, all the little things she sacrificed while I studied. This wasn’t just mine.

I didn’t scream. I didn’t jump.

I just sat there in silence. Frozen.

Until my stomach growled.

“Langga,” I messaged. “Pwede ko ka order food?”

That’s how I celebrated—by feeding this suddenly ravenous, shaky body that had been tense for months. I don’t even remember what I ordered. But I remember it tasting like joy.

The Emotional Weight

They say when you die, your life flashes before your eyes.

That’s what it felt like.

Not just a memory, but a surge. A timeline collapsing all at once inside me. The seven years of college. The extra half-year in medical school. The stops, delays, detours. Every time I doubted myself. Every time I was told—not directly, but enough to hear it—that I probably wouldn’t make it.

The mornings I couldn’t get out of bed. The days when I thought of switching careers altogether. That one time I had to walk out of a study session because my brain just stopped absorbing anything. The hospital corridors I once walked as a student who didn’t feel like he belonged.

And yet here I was. I had made it.

I didn’t think of the people who doubted me. Not right away. Maybe I will eventually. But at that moment, I was too immersed in the quiet miracle of it all. Too stunned that I was still standing, still breathing, after everything.

Instead, I thought of those who carried me here.

I thought of mentors who looked past my fragility and told me to keep going. Friends who didn’t disappear even when I did. Classmates who made room for me, even when I had to join later batches or restart. People who didn’t laugh when I told them I’d keep going. People who never needed me to impress them.

I messaged them. Maybe not everyone that night, but slowly, one by one. They needed to know they were part of this.

And then, of course, I thought of my parents.

They knew. I know they saw the results, too. But in my heart, I just wanted a version of this story where they were right beside me, maybe hugging me, maybe crying too. I wanted to go down from the room, hold their hands, and hear, “We’re proud of you, son,” while still in that trembling state. I would’ve given anything to feel that—to offer this moment to them, fully present.

But life doesn’t always work like that.

Still, I imagined them smiling. I hoped they slept well that night.

There was a strange kind of closure that night. The kind that doesn’t erase the pain, but acknowledges it. Honors it.

Passing didn’t mean everything was suddenly perfect.

But it did mean one thing very clearly:

If you don’t give up, you still get there.

Even if it takes you longer than everyone else.

What I Did Next

I didn’t post anything right away.

There’s a certain silence that follows shock, and I didn’t want to rush out of it. Besides, how do you compress years of struggle into a Facebook caption?

So I waited until the next day.

I wrote an essay. Not planned, not drafted, just something that poured out. I wanted to thank everyone. I wanted to honor the story behind the name. And maybe, selfishly, I wanted to read my own words just to believe again that it was real.

“I was so used to being a failure,” I wrote, “that after reading my name on the roll of passers, I reread, then reread, and reread…”

That wasn’t an exaggeration. I literally reread it five times. Closed the tab. Reopened. Checked if it was still there.

People responded—more than I expected. Friends from different chapters of life. Mentors. Family. Even some who had quietly watched from a distance. There was joy. A few surprised me. Others I hadn’t heard from in years. A former classmate even messaged, “You deserve it, doc,” and I almost teared up again.

And it felt good.

Not validation, exactly, but recognition. That this thing I carried wasn’t invisible after all. That others saw how long it took me to get here, and didn’t judge it.

Later that week, I started clearing out my review wall.

Printouts came down. Notes were packed. I threw away some of the scratch papers but kept others. Some margins had doodles and words of frustration I wasn’t ready to throw away.

Not everything had to go.

I left the banner though.

That large banner I taped above my window that read #LicensedMDApr2024? It stayed. It earned its place. I printed it myself, taped it on the wall, looked at it every day for weeks while studying. I don’t know when I’ll take it down. Maybe never. (I did when I left.)

I even took a photo of my name on the list. Of course I did.

Screenshots, backups, good old Google Drive. I wasn’t going to risk it disappearing. I sent it to my wife, to my mentors, to friends who knew how much I wanted this. It was a little victory ritual. Screenshot as proof. Screenshot as closure.

Looking Back and Moving Forward

Passing the boards didn’t erase the fear.

But it did something else.

It reminded me that I wasn’t hopeless. That maybe—even if I still carried doubts—I wasn’t defined by them.

Something in me shifted. Not overnight, but slowly. I started to see myself with a little more kindness. A little more faith. I had spent so many years bracing for failure, I didn’t know what to do with success that actually arrived.

But I did know this: it wasn’t just about intelligence or hard work. It was about endurance. About showing up when it felt pointless. About choosing not to quit on the days I felt like a ghost.

And spiritually?

It brought me back.

Call it what you will, but passing reminded me that God was still weaving something even when I couldn’t see it. That maybe, just maybe, the waiting was not wasted time.

Even so, the fears didn’t magically disappear.

I still worry—about the kind of doctor I’ll be, about making mistakes, about living up to the expectations this license now carries. I still feel the weight of what comes next.

But I’m not frozen anymore.

If I had to sum up that day in one sentence, it would probably be this:

It was the best thing ever.

Not because it solved everything, but because it proved something real—I could make it.

And if I could speak to the version of myself back in med school—the one who was tired, slow, unsure—I’d probably say:

“You can actually do it. Don’t let the delay fool you. It’s long, yes, but it’s not the end. Remove the doubts. You don’t need them where you’re going.”

The Days After

The high didn’t last forever.

I thought it would—but it didn’t. Maybe two days. Three, max.

Then things started to settle. Life returned to its usual rhythms. The laundry still needed folding. My back still hurt from too many hours in bed. I was still waiting for what came next.

But I was different.

I woke up and didn’t have to review anymore. That alone was surreal. I didn’t reach for the Pomodoro timer. Didn’t check if the new Topnotch videos were uploaded. My body kept thinking it was supposed to be busy. But it wasn’t. For the first time in a very long time, I had no urgent academic task waiting for me.

And then something strange happened.

I felt… hollow.

Not entirely. But enough to notice. I had built my days around passing. Around the “one day I’ll be a doctor” fantasy. Now that the “one day” was here, I wasn’t sure how to move forward. I had passed, yes—but now I had to live in the passing. Become the person I’d been trying to be.

It wasn’t a clean transition.

I was still tired. Still catching up on sleep, on emotions, on conversations I had put off. I remember lying down one night, days after the results, and suddenly crying again. No reason. Just a delayed kind of weeping. The kind that only comes when your body finally believes you’re safe.

I think that’s what passing really gave me: safety. Not success, not fame, not immediate opportunities.

Just a little more safety in the world.

And from there, I could begin again.

What This Doesn’t Mean

Passing the boards was incredible.

But it doesn’t mean I’m more deserving than those who didn’t pass.

It doesn’t mean I’m suddenly confident or fearless or fully healed from everything that happened before.

It doesn’t mean I won’t make mistakes in the future. I will.

It doesn’t mean all the pain was worth it. Some pain just exists. Some of it just hurts, and passing doesn’t erase that.

It doesn’t mean I’m finished learning. If anything, it means the learning really begins now—and it’s heavier. It involves people, not pages.

It doesn’t mean my self-doubt is gone. It just means I’m learning to live with it, slowly.

It doesn’t mean I now owe anyone some perfect, polished version of myself.

What it does mean is I endured.

I kept going.

And maybe—for now—that’s enough.

In late June 2025, Microsoft unveiled MAI Diagnostic Orchestrator (MAI‑DxO). It achieved an 85.5 % accuracy rate diagnosing complex cases—against just ~20 % from human physicians under similar test constraints [cm_simple_footnote id=1][cm_simple_footnote id=2]. Costs? MAI‑DxO estimated a ~20 % decrease in test expenses [cm_simple_footnote id=3].

Right now, AI isn’t sci‑fi: it reads scans, sends alerts, handles admin—often better than humans.

But real‑world isn’t a lab. We’ll go through what’s real, what’s hopeful, and what we still need to fix.

Diagnosis That Rivals Doctors

What They Did

Microsoft used 304 challenging case records from New England Journal of Medicine. They ran cases through several large language models (GPT, Gemini, Claude, Llama, Grok) and joined them in a “chain‑of‑debate” orchestrator [cm_simple_footnote id=1][cm_simple_footnote id=2].
Doctors answered the same cases—no tools, no colleagues—to mimic ideal diagnosis conditions.

Results

• MAI‑DxO: 85–86% correct
• Human physicians: ~20% correct [2][4]
• AI cost per case: ~$2,396 vs. doctors’ ~$2,963 (≈ 20 % lower) [cm_simple_footnote id=3][cm_simple_footnote id=4]

Why It Matters

• Cases reflect real diagnostic complexity—not just basic illnesses.
• AI mimics human‑style reasoning: ask, test, review, repeat.
• Cost saving + accuracy = better resource use.

Cautions

• Doctors lacked real‑world tools—textbooks, peers, diagnostic aids were off-limits [cm_simple_footnote id=1][cm_simple_footnote id=2].
• No live trials yet—still need clinical evaluation [cm_simple_footnote id=1][cm_simple_footnote id=4].
• Ethical gaps: data bias, liability, transparency.

Safety Alerts & Medical Imaging

Real-Time Safety Alerts in the NHS

In June 2025, the UK government rolled out a world-first AI early-warning system to monitor NHS data.
It uses near real-time signals to flag increases in stillbirth, neonatal death, or brain injury, starting with maternity units in November 2025 [cm_simple_footnote id=5][cm_simple_footnote id=6][cm_simple_footnote id=7].

When anomalies arise—say, a spike in brain injuries—the system triggers Care Quality Commission (CQC) inspections immediately [cm_simple_footnote id=5].

Officials describe this as “turbo-charging patient safety” and part of a shift to data-driven care [cm_simple_footnote id=6][cm_simple_footnote id=7].

Flagged risks include maternal harm, brain injury, neonatal deaths, and even institutional abuse [cm_simple_footnote id=5].
Once a risk is detected, the CQC is notified and dispatches inspection teams for rapid investigation.

Why it matters

• This marks the first global deployment of AI for hospital-wide safety monitoring [cm_simple_footnote id=6].
• Data is live, not just retrospective—allowing faster response times.
• Oversight shifts from delayed audits to automated risk detection.

What we still don’t know

• Will it lead to real improvements in patient outcomes?
• Critics argue it could distract from deeper staffing and funding issues in the NHS [cm_simple_footnote id=6].
• Pilot evaluations begin in late 2025; long-term impact remains to be seen.

AI-Powered Medical Imaging: Mercy + Aidoc

In January 2025, Mercy Health System in the U.S. launched a full-scale rollout of Aidoc’s aiOS™ platform across all 50 hospitals and imaging centers, ending its pilot phase [cm_simple_footnote id=8][cm_simple_footnote id=10].

Aidoc uses FDA- and CE-cleared algorithms to flag issues like intracranial hemorrhage, pulmonary embolism, and fractures, giving radiologists early warnings [cm_simple_footnote id=11][cm_simple_footnote id=12].

Mercy’s leadership described the rollout as seamless. Radiologists, rather than resisting, reportedly embraced the AI assistant as a “guardian angel” for scans [cm_simple_footnote id=14].

Here’s what it did:

• Head CT scan diagnosis time dropped from 132 to 73 minutes on average [cm_simple_footnote id=12].
• Pulmonary embolism alerts achieved 84.8% sensitivity and 99.1% specificity [cm_simple_footnote id=11].
• Quality assurance tasks fell by 98% with AI-assisted workflows using AQUARIUS standards [cm_simple_footnote id=13].

Mercy also emphasized that patients don’t bear any additional costs for the added layer of AI support [cm_simple_footnote id=10].
The platform follows the ECLAIR ethical standards, focused on fairness and oversight [cm_simple_footnote id=8].

Key benefits

• Faster scans mean earlier interventions.
• AI acts as a safety net—not a replacement—for doctors.
• Radiologist fatigue and backlog are reduced significantly.

Chatbots, Ambient Listening & Admin AI

AI Scribes: The Rise of Ambient Listening

What if your doctor didn’t have to write anything down anymore?

That’s the promise of ambient listening AI—voice-based tools that quietly transcribe and summarize your doctor’s visit while you talk.
It’s already happening in major hospitals like Stanford Health Care, Mass General Brigham, and University of Michigan Health [cm_simple_footnote id=15].

These AI systems—built by companies like Abridge, Nuance (Microsoft), and Ambience Healthcare—listen in on clinical conversations and produce:

• Medical notes
• SOAP summaries
• Order sets
• Care plans

At Stanford, physicians using ambient AI cut documentation time by more than 60 minutes per day, reducing burnout and freeing them for more patient care [cm_simple_footnote id=15].

Why it matters

• Doctors spend over half their time documenting instead of engaging patients [cm_simple_footnote id=15].
• Ambient AI lifts that burden—but it has to be accurate.
• Some models even suggest medical plans, raising new ethical questions [cm_simple_footnote id=15].

Cautions

• What if the AI misunderstands?
• What happens to the audio data—who owns it?
• Patients need to be informed and consent to being recorded.

Hospitals are actively debating these boundaries while the tech keeps improving.

Admin Work: Faster, Cheaper, Less Human

Beyond the exam room, AI is replacing tedious healthcare admin.

At Mass General Brigham, generative AI now handles:

• Call screening for 40,000+ patients per week
• Automated triage suggestions
• Scheduling tasks
• Clinical follow-up reminders

According to the hospital, these tools saved time, reduced no-show rates, and even helped patients better understand where to go for care—like differentiating between emergency vs. urgent care [cm_simple_footnote id=16].

Other systems are automating:

• Billing code assignment
• Insurance pre-authorization
• Referral processing
• Medical records summarization

Some startups now claim their AI tools cut EHR interaction time by 40-50% per patient session [cm_simple_footnote id=17].

For overworked clinics, this means:

• Less time clicking
• More time caring
• Fewer after-hours documentation marathons

But again: caution.

One hospital found that its chatbot gave inaccurate advice in 15% of cases during triage testing [cm_simple_footnote id=16].
Another flagged hallucinated medical facts—wrong meds, fake guidelines—during audit runs [cm_simple_footnote id=17].

That’s why most AI tools still require a “human in the loop.”
The goal is to support—not replace—clinical judgment.

Real-World Examples

• Ambience Healthcare claims their AI saves 90 minutes daily for primary care doctors by generating full visit notes instantly [cm_simple_footnote id=18].
• Abridge works with over 2,000 doctors across 30+ health systems in the U.S. and Canada, producing real-time EHR-ready summaries [cm_simple_footnote id=19].
• Nuance DAX Copilot, now integrated into Microsoft Teams, is being adopted across U.S. health networks as a scalable scribe alternative [cm_simple_footnote id=20].

Hospitals are quietly transforming behind the scenes.
It’s not just about fancy robots—it’s about solving long-standing paperwork pain.

Drug Discovery, Mental Health & Predictive Analytics

AI in Drug Discovery: From Years to Days

Drug development usually takes 10 to 15 years.

AI is speeding that up—sometimes by months, even years.

One big player? AlphaFold, developed by DeepMind. It predicted over 200 million protein structures in 2023, accelerating pre-clinical research in cancer, neurodegenerative diseases, and antibiotics [cm_simple_footnote id=21].

In 2024, Insilico Medicine used AI to discover a new drug for idiopathic pulmonary fibrosis. It went from idea to Phase 2 trials in under 30 months—a process that normally takes 5–7 years [cm_simple_footnote id=22].

Other applications include:

• AI platforms like Exscientia designing drug molecules through reinforcement learning
• Target discovery in rare diseases using NVIDIA Clara + large-scale biological data
• Cost reduction: early-stage screening costs dropped by up to 70% in some AI trials [cm_simple_footnote id=22]

These aren’t just theoretical.
They’re reaching human trials—faster than anything in the last two decades.

Mental Health: Chatbots & Crisis Prevention

AI is also stepping into mental healthcare.

Tools like Woebot and Wysa offer guided CBT (Cognitive Behavioral Therapy) conversations.
A clinical study published in JMIR Mental Health found that Woebot significantly reduced symptoms of depression and anxiety in as little as two weeks [cm_simple_footnote id=23].

Some apps go deeper—monitoring behavioral signals and speech patterns to flag suicide risk.
For example, Ellipsis Health analyzes tone and language from daily conversations to assess emotional well-being—used by clinics in the U.S. since 2023 [cm_simple_footnote id=24].

Why AI matters in mental health

• Accessibility: AI therapy can be available 24/7
• Anonymity: some people open up more to a bot than to a therapist
• Affordability: many tools are free or low-cost

But there are serious limits.

• AI lacks empathy
• It can miss nuance
• Misinterpretation risks remain high for trauma cases or suicide ideation

AI should support, not replace, licensed therapists.

Predictive Analytics in Hospitals

Hospitals are also using AI to forecast problems before they happen.

At Mount Sinai, predictive models now alert nurses to patients at high risk for:

• Sepsis
• Falls
• Readmission within 30 days

The sepsis early warning system reportedly reduced mortality by 12–19% in high-risk units [cm_simple_footnote id=25].

Another system at Johns Hopkins uses the Predictive Analytics Monitoring Model (PAMM).
It flags patient deterioration up to 12 hours before standard vital sign changes [cm_simple_footnote id=26].

Other predictive tools manage:

• Emergency room overcrowding
• Staffing shortages
• Ambulance wait times

Even outside hospitals, predictive models help insurance companies and public health agencies design interventions and prepare for outbreaks [cm_simple_footnote id=27].

What this means for care

• Triage is smarter
• Beds and staff can be better allocated
• Patients get care before they decline—not just after

It’s not perfect. False positives happen.
But even a slight shift toward earlier care can save lives—and money.

Challenges, Ethics & What You Can Do

We’ve seen what AI can do.

But it’s not magic.

It’s not neutral either.

There are real risks—some that can’t be patched by code or updates. Let’s name them.

Data Privacy and Ownership

Healthcare AI feeds on data—millions of patient records, scans, notes, voice samples.
But who owns that data?

In the U.S., HIPAA covers basic privacy.
In Canada, PHIPA and PIPEDA do the same.
But with AI, things get murky.

In 2023, a lawsuit in Illinois alleged that a hospital’s AI vendor used patient voice data without explicit consent during ambient listening tests [cm_simple_footnote id=28].

Patients worry: Will their health info be sold? Will it be used to deny insurance?
Even anonymized data can sometimes be re-identified.

Clinics must tell patients:

• What data is collected
• How it’s used
• Who it’s shared with
• Whether humans review it

If you’re not being asked for consent, that’s a red flag.

Bias in the Machine

AI is only as good as its training data.

If models are trained mostly on Western, white, urban populations…
Then Black, Indigenous, Asian, and rural patients risk being misdiagnosed.

A 2022 study found that some skin cancer AI tools were 40% less accurate on darker skin tones [cm_simple_footnote id=29].

In 2023, the American Medical Association (AMA) warned that bias in clinical algorithms was harming care quality—especially for women, immigrants, and people with disabilities [cm_simple_footnote id=30].

Fixing bias isn’t easy. It requires:

• Diversifying training data
• Testing outputs across different groups
• Involving affected communities in design and audits

We can’t assume fairness. We have to build it.

Liability: Who’s Responsible?

What happens if AI gets it wrong?

• Misdiagnoses a stroke
• Recommends the wrong drug
• Tells a chatbot user to “walk it off” when they’re suicidal

Is it the doctor’s fault?
The hospital’s?
The AI company’s?

As of 2025, there is no unified legal framework for AI malpractice in most countries [cm_simple_footnote id=31].
That leaves frontline workers carrying the blame—and the fear.

Until regulation catches up, many providers still say: “I’ll use AI, but I won’t rely on it.”

Environmental Cost

Large AI models consume enormous energy.

Training a single LLM can emit as much CO₂ as five cars in their lifetime [cm_simple_footnote id=32].

Hospitals using AI at scale must factor this in:

• Where are the servers hosted?
• What’s the carbon footprint of the AI vendor?
• Are green computing standards being followed?

AI should help human health—not silently hurt planetary health.

What You Can Do

If you’re a patient:

• Ask your provider: Do you use AI?
• What data is collected? Who sees it?
• Can I opt out?

If you’re a clinician:

• Stay updated on AI tools in your field
• Push for transparency and informed consent
• Report bugs or biases—it matters

If you’re a policymaker:

• Fund AI literacy and community feedback
• Draft liability laws now, not later
• Require audits, not just vendor reports

If you’re a developer:

• Train models on real-world, diverse cases
• Build explainable, verifiable tools
• Think about how your code will affect someone’s life

Final Thought

AI in healthcare is here.
It won’t solve everything.
But it can help—if we guide it with care.

Not just by asking, “What can it do?”
But also, “Who might it fail?”
And “How do we make it safe for everyone?”

You’re part of that story, too.

Sometimes, it’s the quiet before.
The emptiness after.
The weight in your chest as you try to convince yourself you’ve done enough.

The Day Before: What Fear Looks Like When You’re Ready

I was still living alone in our rented apartment.
My review notes were everywhere.
Walls full of oversized printouts. Tables buried in handouts.

You’d think that with everything scattered around me, I would have felt ready.
But instead, I was afraid.
Terrified.

I tried to sleep early using the Headspace app—probably the only reason I managed to get some rest.
Before bed, I reviewed some coaching materials. But more than that, I played “Hashkiveinu,” that Jewish prayer of shelter. It comforted me. Made me feel less alone.

Breakfast was… Jollibee Yumburger.
Not because I craved it.
Because I couldn’t find the “lucky” Red Ribbon Empanadas or Jollibee Hotdogs that everyone said would help with board exams.
So I took what I could. A small compromise in the face of everything I couldn’t control.

Dressing Up to Survive

I took the April 2024 Physician Licensure Exam, a schedule often seen as designated for midyear interns and Seventh-day Adventists. Each exam day was a mental marathon. The board exams were spread across two Sundays and two Mondays. Day 1 was all about Biochemistry, Anatomy and Histology, and Microbiology and Parasitology. Day 2 covered Physiology, Legal Medicine, Ethics, and Medical Jurisprudence, and Pathology. Day 3 tackled Pharmacology and Therapeutics, Surgery and Ophthalmology, Otolaryngology and Rhinology, and Medicine. Day 4 wrapped up with Obstetrics and Gynecology, Pediatrics and Nutrition, and Preventive Medicine and Public Health.

I had my clothes planned like it was war.
Day 1: my lucky shirt, internship white coat.
Days 2 and 3: my clerkship uniform.
Final day: another lucky collared shirt, again with my white coat.
I also wore the red socks I got from KFC the previous Christmas. Anything red felt like a small layer of armor.

I wore red boxer shorts, bought specifically for the exam.
I brought four of my wife’s handkerchiefs, one for each exam day.
While I did not wear it, I held on to a necklace with wooden beads and a semicolon pendant.
I kept an angpao with ₱200 that I hung on my door since Chinese New Year.

Did I believe in luck? Not really.
But maybe desperation teaches you new forms of prayer.

Messages, Mindset, and Mall Directions

Before I left, I got messages from friends, co-takers, and of course, my wife.
They didn’t just cheer me on. They anchored me.

I was shaking.
But I also felt calm.
Not because I was sure of passing—but because I had done everything.

And I told myself that was enough.

The Exam Days: Four Rounds of Holding It Together

Day 1

Venue: A mall in Oton, Iloilo.
Far. Remote. No rooms—just rows of examinees filling an open mall space.

My group number? 5.
Seat number? 13.
Some would say unlucky.
I told myself it was the perfect number to do my best.

The aircon wasn’t strong where I sat.
Sometimes, direct sunlight would hit my chair and I’d start to sweat—not just from nerves.

The first question? I don’t even remember.
I probably got it wrong.
But somehow, I felt okay.

I pushed through the questions.
When panic came, I closed my eyes for a second. Then moved to the next.
Shading took time—I’ve always been slow at it—but I kept pace.

The hardest part?
Biochemistry. As always.

But Microbiology and Parasitology? Manageable. Confusing, but I felt sure of my footing.

I ended the day by going home, ordering food, and reviewing again.
Sleep was a must, so I forced it.

Day 2

Same process.
Yumburger again.
New handkerchief.
New questions.

After the exam, I ate, napped, then faced the fact that there were still two days ahead.
There was no celebration.
Just a quiet return to programming.

The Long Break Between

Five days between exams doesn’t sound like much.
But mentally, it was exhausting.

I didn’t talk to anyone, except my wife.
I stopped myself from rechecking answers—didn’t want to spiral.
The goal was simple: protect my peace.

Day 3

The venue hadn’t changed, but I had.
More tired.
More desperate.
But still determined.

This time, I wore my clerkship uniform again.
Another handkerchief.
Still bringing the same necklace.

Some subjects blurred together.
But every hour felt like survival.

Day 4

The last day.

I wore a different collared shirt—another lucky one—and my white coat again.
Seat 13, one last time.

I didn’t feel joy.
I just wanted it to be over.
I just wanted to rest.

When I finally walked out of that venue, I felt like someone who had recovered from a long illness—
Only to realize that pain had become part of my baseline.

Ritual Complete: Beer, Money, and Silence

I went to a convenience store right after and used the ₱200 from my angpao.
I bought food.
Drank a cold beer I had saved for this moment.
Messaged my wife.
And told my friends I did it.

Then I asked my wife if I could sleep.
I passed out for more than 12 hours.

The Aftershock

I didn’t cry. Not right away.
I felt a prick lifted from my chest—
But it was soon replaced by palpitations.

Relief came, but so did self-hate.
I felt worthless again.
Like maybe I didn’t do well enough.

My wife told me to rest.
To pray.
To hope for the best.
She saw right through me.
And I’m grateful.

What Helped Me More Than I Thought

I overprepared, it’s true.
I juggled Topnotch, ExpertMD, Focus, Cracking D’ Boards, MedQBank.
And all of it came in handy.

But the unexpected helpers?

• The Headspace app.
• My prayer playlist.
• My red boxers.
• That semicolon necklace.
• My wife’s handkerchiefs.
• And “Hashkiveinu,” which wrapped me in peace when my brain refused to quiet.

Also—my mind game.
Two weeks before the exam, I told myself: Try to top it.
Not because I believed I could, but because the effort might get me somewhere close.
It did.
Not to the top, but to a place I never thought I’d reach:
A quiet confidence.

If I Could Talk to That Version of Me

I’d tell him:
“You did great. Everything you gave was enough.”

“You would’ve been okay even if you failed. But you didn’t.”

“You survived in every way that mattered.”

[BONUS] Filipino Exam Superstitions: An (Un)Official Survival Guide

Because sometimes, surviving means doing whatever it takes to feel ready—even if it sounds ridiculous.

Food-Related Rituals

• Red Ribbon empanadas – Believed to bring good luck when eaten on exam day
• Jollibee hotdog – A common “lucky” snack
• Pancit before exam day – For “long life” and long memory retention
• Avoid eating chicken – Because “manok” pecks/scratches and is said to symbolize mental confusion
• Avoid tough foods – So the test won’t be “mahirap nguyain” too

Clothing Rituals

• Wearing red – For good luck and power
• Same shirt for all exam days – If Day 1 felt okay, no need to change the energy
• Undergarments turned inside out – Said to reverse “bad luck”
• Lucky socks, handkerchiefs, or accessories – Even better if gifted by someone special
• Red socks from anywhere – Because anything red counts

Objects & Charms

• Rosaries or crosses tucked in pockets
• Pencils sharpened by a previous topnotcher or important person – To channel their knowledge or an inspiring person’s belief in you.
• Angpao with money – Hung on doors or kept in wallets for abundance
• Photos of loved ones or mentors – Carried for strength

Environmental Preparations

• Printouts on walls – Not just for memory, but to saturate the space with purpose
• Big “#LicensedMDMonthYear” signs – Visual affirmations of success
• Avoid sweeping the floor the night before – So luck doesn’t get “swept away”

Behavior-Based Beliefs

• No crying the night before – Might “wash away” your knowledge
• Avoid talking about failure – What you say might happen
• Don’t revisit hard questions after exam day – So as not to “invite” failure energy

You probably have your own rituals.
Some weird. Some sacred. Some personal.
They might not make sense to anyone else.
But if they helped you believe in yourself—even just a little—
Then maybe that’s all the magic you needed.