A Eulogy for Dr. Ramon F. Abarquez

Eulogy by Eugene F. Ramos Posted online 11:30 PM, 25 January 2018

 DR. RAMON F. ABARQUEZ (Photo by Dr. Jean Alcover-Banal)

Agnes, the children and grandchildren of Dr. Abarquez, good evening.

So many people have spoken and written about Dr. Abarquez since he died, but those are nothing compared to how we listened and looked up to him, sometimes in awe, when he was alive. Images–of how he would stand up, approach the microphone, and ask those insightful questions or share those aha moments–are still fresh in our minds and will stay alive in the years to come in conference halls where traditional thinking creates so much noise. We remember how he’d chuckle when people mistook his wisdom for mischief, and how he’d walk back to his seat with that characteristic gait and a grin on his face, perhaps amused that he was disturbing the equanimity of lesser beings. 

He was bigger than life when he was alive. He is now a legend to us and to the rest who will come after us! People like him don’t come our way often. He didn’t even belong to his generation. He belonged to any and every generation where innovative minds and game-changers find their niche. Which was why I would tell my residents and fellows in my hospital these last few months to go in there and immerse themselves in the privilege of his presence. I could imagine them claiming with pride years from now that they were there, they touched him, they learned from him even with his eyes closed. 

It had been so much honor and privilege to have been one of Dr. Abarquez’s attending physicians, in the hospital of his choice where I could do a lot more to ensure his safety, comfort and convenience. I did most of the talking. He listened a lot. But when it was his turn to speak, I and the rest of my team had to listen. His questions were direct to the point and were not easy to answer, because perhaps we were afraid of the follow-up questions. 

“What’s my ECG? What’s the ejection fraction based on the ECG? How’s my right ventricle? What is the evidence that blood transfusion at a hemoglobin of 7 would make a difference?"

His eyes were closed most of the time, but he’d speak my name when he’d hear me enter. His body was frail and shrunk, but his mind was clear. Very, very clear. How could such a small body host such a big mind? What was he thinking all those times when everything was quiet, and everyone was resting, but he was there immobile but awake? How could he manage to ask all these questions about his test results? And why would he ask for specific tests even with his eyes closed? Was he having fun asking the nurses and residents questions that required them to leave the room to ask for assistance?

It took me a while to realize that while he was lying still in bed with his eyes closed, he was assessing his body physiology, correlating it with his lab tests, asking for tests when he needed to validate his assessment, and making his own informed decision to go or not go with the recommended interventions. He was not being a bad patient at all; he was detaching himself from his body, and through his mind, he was watching it respond or not respond. But he was objective. There was not going to be any extraordinary measures to be taken if and when the time would come, he declared this to Agnes, and to me in the emergency room when he was brought in last November, hypotensive and with a new infection. 

“This might be it,” he whispered to Agnes in the car, on the way to the hospital from their house, with Agnes sobbing while driving. And just as quickly that I picked up his sense of surrender, he told me, “Watch out for the fluids, do an echo, and check my right ventricle”. 

He knew that he was dying; he was ready. But up until the very end as his body gave in, his active mind was still observing how organs were responding to each other. There was no role for evidence-based Medicine here, he was sucking in the moment for experience!

Every time I left the room because I thought he had drifted to sleep, he’d manage to mumble, “Thank you, Eugene!”. Such an authentic person and an elegant gentleman! We can never recall Dr. Abarquez express rage against anything or anyone, nor say anything malicious about people. But he had a mischievous way of grinning when he had to put up with people who were intellectually presumptuous. In his sick bed, he never forced an issue, and simply withheld consent when answers to his questions about certain procedures were not to his satisfaction. Against the wishes of his infectious disease physician, he refused intravenous antibiotics once. He didn’t think he needed them, and, indeed, he was proven right; he was off antibiotics for quite some time after that.

Dr. Abarquez always had something to contribute to any scientific discussion. His prolific mind was just as crowded with challenging thoughts as the slides he made for his lectures.  Giving a talk to a big audience that are not inclined to ask questions worries speakers who look forward to scientific interaction; having Dr. Abarquez in the audience was a relief because he was sure to be the first to approach the microphone, unless Dr. Dante Morales was also in the hall. His knowledge of the basic sciences was always expanding, in many instances catching up with truths in clinical medicine that eventually turned out to be untruths. He refused to be funneled into the way of thinking of Evidence-based Medicine as a discipline. He was ready to be proven wrong; but I think we can now say that he had not been proven wrong yet. He was a cut above the rest of us, willing to follow his own leads and impressively equipped with data to make us doubt our own conclusions. He really was different. Special.

One of a kind.

He was still in the ICU when I told him about the PURE study presented at the European Congress last August, that huge study that concluded that it’s not the fat but the sugar that causes coronary artery disease. He opened his eyes when I talked to him about it, and then managed that characteristic “I-told-you-so” chuckle  as he looked at me.

He had eggs and bacon for breakfast for all these years, ate sparingly, and for all intent and purposes was a good attribution to the current persuasion–ketogenic diet and intermittent fasting! Zero body fat and fully in control of his mental faculty until 89! One might foolishly joke that, perhaps, after 89 years of high-fat diet  his body wasn’t used to the low-fat PEG feeding that the clinical nutritionist prescribed! 

How best will we remember Dr. Abarquez? Just look back to the long past and to what we have all become. He was there at the different milestones of our individual careers, challenging our beliefs, getting us to think and rethink our premises, joining us in our journeys if and when we welcomed him to. He had mastered the art of thinking clearly. He had elegance of thought and behavior. He had no fear of challenging traditional norms. And he was always ready and willing to spar with anybody who enjoyed exploring truths and possibilities. 

He had a lightness of being that animated the practice of Medicine in the Philippines.

It has been truly an honor and a privilege knowing him up close–from my fellowship training over 30 years ago at UP-PGH, through my journey as a cardiologist and a physician-leader, up to the last days of his amazing life when he, the one scientist who aroused all of us with his provocative thoughts, could no longer be aroused by life as we know it.

(This eulogy was delivered last 16 January 2018.)

Dr. Eugene F. Ramos is a Past President of the Philippine College of Physicians.