Endpoints

NO MATTER HOW MANY TIMES YOU DO IT, the task doesn’t get any easier. The circumstances vary. Every mother or father, son or daughter, husband or wife reacts in a different way. What you do know for certain is that whichever words you choose and however you choose to say them, they will always bring forth much suffering. And so after mustering enough conviction, infused with whatever amount of compassion that is left for the day, you say your piece with a straight face:

“Nanay, pasensya na po. Wala na po kaming magagawa para sa anak ninyo. Kahit po operahan namin siya ngayon, wala na pong mabuting maitutulong sa kanya. Hanggang dito na lang po tayo.”

It is both an explanation and an apology, wanting to temper expectations and provide comfort, but likely fulfilling neither in the sea of emotion.

The mother in her late 30s gives out an agonizing cry, silencing the ordinarily raucous Pediatrics Emergency Room as she tugs on your polo.

“Dok, please Dok. Gawan niyo po ng paraan, Dok! Parang awa ‘nyo na, Diyos ko.”

She wipes the flood of tears with the ruffles of her daster, clasps her hands and bows her head, as if in prayer. You are her only hope and she begs.

Across the room her daughter lies, dying. Eyes frozen, hands and feet full of puncture marks, a tube in her mouth to force air into her lungs. If the father were to stop compressing the Ambu-bag (they are unable to afford the cost of renting a mechanical ventilator), she would stop breathing altogether.

“Kung ooperahan pa po natin siya ngayon ‘Nay, baka lalo lang pong mapadali ang buhay niya.” Her blood pressure would plummet from the anesthetic and her heartbeat would become erratic, you thought of saying, but she would not understand, and the science would not matter at this time. You put your hand on her back. “Tabihan mo na lang ang anak mo. Yakapin mo. Kausapin mo habang naririnig ka pa niya.”

She takes another crescendo of inhales, pauses, and lets out a wail that echoes a mother’s sadness and anger and regret.

They are a family of scavengers. Earlier that day, her only daughter, who had been playing hide and seek in a cemetery, slipped and fell from a topmost tomb, breaking her skull in several areas and sustaining a large blood clot that rapidly compressed the entire half of her fragile brain.

“Pasensya na po, ‘Nay.”

Sometimes you wonder if saying sorry to the grieving alleviates the pain, even to a slightest degree. Or is it only a means to exculpate yourself? To rid yourself of guilt for knowing what to do and yet being unable to do anything?

You remember your mother. Put in the same situation, she would have cried harder. She would have gone hysterical. She would have thrown blood specimen vials and kicked the emergency room’s waiting chairs, refusing to be restrained or appeased. In all likelihood, she would pass out.

You would call her in the morning. She has to be reminded to bring your work clothes for the week, and to come late at night so that you could have dinner with her, and have time to ask about how your brother and sisters are doing.

 

YOU WANT TO SPEAK to your unconscious patient’s foremost caretaker, and it is the daughter in her 20s who steps forward.

“Wala po ba siyang asawa?” you ask.

It has been a habit to look for spouses when making crucial decisions in patient care. And even when somebody introduces himself or herself as the husband or wife, you still feel obliged to ask the next question, “Kasal po ba kayo?”

The right to refuse or give consent always belongs to the legal spouse. The elaborate structure of the Filipino family – common-law spouses, children and stepchildren here and abroad, hipags and bayaws, grandparents and second-degree cousins, wives who look like daughters and sons who look like husbands – has taught you that to cut the discussion short and to keep yourself from repeating treatment options to different people, you want to make sure you are talking to the right person the first time around.

So you always request for the spouse – the legal one.

“Matagal na pong patay ang Tatay,” she replies.

“Ah ganun po ba? Pasensya na po.”

The instinctive apology is for bringing up the dead, and unwittingly, a prelude for your discussion on the dying. You remove the CT scan films from their envelope and proceed to explain your team’s contemplated surgery.

“Hindi na po namin siya ipaoopera, Dok.”

“Ah ganun po ba?” you reply, surprised at the swiftness with which she gave her decision. “Sigurado na po kayo?”

“Opo, Dok. Pagkatapos po niyang maaksidente nung isang buwan, Dok, sinabi niya sa amin na kung kailangan siyang operahin, ayaw na niyang magpaopera.”

You scrutinize her facial expression and voice as she explains her decision. Most decision makers would ramble and falter at this point, requesting for more time to consult other family members, but not her. The words are mouthed with precision. The muscles underneath the eyes do not flinch, and neither do her nostrils. Her declarative tone has no trace of gloom or grief, containing only certainty and, you perceive, catharsis.

“Sigurado na po ako, Dok.”

She has spoken.

You replace the CT scan films in their envelope and take the patient chart from the intern who has been standing beside you all this time. You turn to the first empty page and begin to write:

“Prognosis, surgical option, risks and benefits explained to and accepted by daughter. No consent for surgery. Continue medical decompression and best supportive care.”

 

“GOOD MORNING, SIR!”

You were standing at the back alley of the hospital, waiting for one of your consultants to arrive. In an effort to pass time and pretend not to see co-residents and interns rushing to work that morning, you decided to turn to your iPod and read about brain tumors.

The greeting caught you by surprise, but you knew very well the owner of the affectionate voice that always seemed to sing even when she was just speaking. So you looked up, and with a grin said, “Late ka na!”

With a flip of her auburn hair, she smiled back. You returned to your iPod, only to look up once more after reading the same sentence on glioblastomas without the slightest hint of comprehension. You watched her back as she walked away, long hair dancing with the morning wind and all.

Then it occurred to you: it’s been a long time since she addressed you with formalities. You would wonder about it during the next few days, before eventually deciding to dismiss it as she being her child-like self that sunny Wednesday.

Now you know why.

She is looking at you across the table as you push around the pasta and chicken pieces on your plate using your fork. It is not a habit to toy with your food; you are just buying time before saying something. This is the part where you contemplate on what has just been said, think about the repercussions of actions past, and try to come up with a sensible, rational reply, sans the emotional baggage, and preferably one that you would not regret in the days to come. You could hear her sob. Whether from guilt, sadness, or disappointment, you could not tell.

“So what do we do now?”

Coming from a former champion extemporaneous speaker, that’s lousy. But what else is left to say?

“Ikaw ang bahala.”

You suppose you could be friends, perhaps have dinner or watch movies still if she wants to. But that is being optimistic.

“You know I liked you from the start.”

Day one to be exact. From the time she was introduced to you as the cousin of a celebrity, which you believed without a doubt, and the afternoon you went to mass together the first time you asked her out.

“I was waiting for you to say that all this time….”

She is right, of course. For the first time in a long time, somebody actually cared about how your day went, no matter how exhausting or how repetitive it had been. When you could not find time to buy dinner because of the all too many stab wounds, vehicular crashes, and gunshot wounds in the ER, she went out of her way to bring you something to eat. You could not always join her when she invited you to parties or events, but she had always said yes in the few times you could ask her out. Never did she complain about your work, and the schedule it entailed.

But the last three months had been unforgiving. You would not commit. You could not commit because you were waiting for things to settle. You barely had time enough for yourself, how much more for somebody else? And thus, you suffer the consequences.

“Tara?”

“Duty ka pa?”

“Yes.”

You would have walked her home, like you used to, but not this time.

“Sometimes, I ask myself whether residency is worth all the things I’m giving up for it. I rarely get to see my family. I don’t get to attend the weddings and birthdays of my good friends. I miss teaching, and reading my books—doing things that I used to do, just because I love doing them.”

You pause and take a moment to look at her. She is listening to your every word, as always.

“Tapos ngayon, pati ba naman ikaw?”

“I’m sorry.”

“Don’t be. It isn’t your fault.”

At the mall entrance, you both stand in silence, amidst the rush hour crowd wanting to get in and out.

You hug her, and she hugs back.

“Goodbye.”

You do not wait for her reply.

You walk towards the opposite direction, resisting the temptation to look up in a futile attempt to hide your eyes from hers.

 

YOU WAKE UP WITH A JOLT and discover that your cellular phone is ringing. But it’s not a phone call. It’s your alarm begging to be acknowledged after being repeatedly rejected with the snooze button. You have been dreaming, and in your dream you were running. Whether to the emergency room to see a dying patient or to the operating room to bring blood, you could not remember for certain. Too long a dream, too little time to sleep, and you hate it. You feel tired, more tired than when you retired to your bed earlier.

Except this isn’t your bed. This is your couch and you are still wearing the previous day’s work clothes. You remind yourself what day it is, and try to build a mental checklist of your things-to-do. You have to. As each day and each night blends seamlessly with the next, the passing of time is no longer marked by minutes and hours, but by the birth and death of patients, the coming and going of people you care for, the cutting and closing of surgeries, and the accomplishment of orders that need to be carried out.

The day and the date do not matter. Holidays, weekends, and special occasions do not exist.

There goes your cellular phone again.

6:06 am.

Damn it.

You rush to the bathroom to change into clean clothes and brush your teeth. Perhaps later, you would have time to take a bath.

Two cellphones on the left, iPod and keys on the right, wallet in the back. Check, check, check.

You grab your keys, ID, and rubber stamp on your desk.

And run.

Life goes on for the neurosurgeon.

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18 comments

  1. Hermes Baticulon

    Hi Ronron,
    As always I’m impressed with the quality of your writings. Please compile them into a book and publish it later on in the USA. I’m sure you’ll become famous and rich because of it.

    I also want to advise you to find a way to learn more of your specialty in the United States, specifically in New York. Let us know how we can be of help. It is my wish for you to someday be internationally recognized as one of the best neurosurgeons in the world.

    Lastly, I advise you to take some time off, and go somewhere to escape for awhile your hectic pace of professional life, so that you can prevent burnout and give your body time to recharge. You know these precautions you must take being a doctor, but you have to will it and not allow circumstances to rule your life. You have so much more to give and help others, but you need to be strong and healthy in order to fulfill your mission in life.

    Good luck to you, may the Lord also reward you with a happy personal life.
    Once again, keep up with your writings, and thank you for sharing your inspiring stories.

    Tito Hermie

  2. I can totally relate… My heart still bleeds and once in a while I have to breathe deeply and exhale, just to let out all the pain that this profession brings… Great writing. I am now a fan. 🙂

    • Pain is good every so often, keeps us grounded and makes us realize the gravity of what we deal with. It can get really tiring though, and sometimes, one resorts to numbing the pain just to keep going. Thanks, Arbie! 🙂

      • If only we could do so much… I know that people see us OB as bitches, and that we have one of the hardest residency training, and our juniors often pay for a LOT of things (but we also do, too)- but contrary to what people see, some of our patients do live, even if they hate us. More often than not, we are ‘forced’ to pay for our patients’ laboratories and medicines (if they’re not ‘available’), and I guess those are the times when we, as human beings also, aside from being doctors, tend to say things we regret afterwards. I guess that earned us the bad rep people seem to have of us… This is a thankless job we got into, but I’d rather know I did everything for my patients (even if sometimes I have to pay for their needs) rather than have this nagging feeling of guilt that I didn’t do (or pay) enough…I guess that’s just one way of minimizing the pain…

        • Marami rin akong nailabas na pera when I was in GS, but not anymore. We have funds for these emergency cases na kasi in NSS. Our consultants wouldn’t accept the answer “No funds” (kaya hindi na-CT/hini naoperahan) during conferences, so they did something about it. You can be Machiavellian about it (kahit ano gagawin, mabuhay lang ang pasyente), but at some point you will reach your limits and you will be of no help to your patient at all. Don’t worry, not all of us think you’re bitches. Trabaho lang. We know how hard a life you go through in your department. 🙂

  3. Great, as always, Ronibats. 🙂

  4. Intense writing sir.

    • Danni, I write to remember. When I’m 80 and I’m dying, it would be great to read about these things and remember the neurosurgeon I had been many years back. Are you ready for this kind of life? See you around!

      • Your stories are both inspiring and nerve wracking. My study breaks usually end after I read one. I’ll try and take an elective with the neurosurgery service. Hopefully they let me tag along with you guys so I get a taste of what it’s like. See you around sir.

  5. you have to learn to relax doc…please.

  6. Pulled some heartstrings there. Great job, Roni. 🙂

  7. There are things we have to set aside for now but that doesn’t mean we are giving them up for good. It’s all a matter of time. Things will fall into place, eventually. I believe even with the gravity of responsibilities our profession entails, we should not forget ourselves and the people and things that make us happy. Those things help “recharge” us and make us grow holistically. 🙂 Another moving story! Thanks for this! 🙂

  8. Nalungkot ako sa entry na ito. Oh the things we give up for this profession.
    Sir, I’m guessing 2nd year ka niyan eh 3rd year ka na ngayun so maybe you have more time to go out? Haha. 😉

    You deserve to relax a little.

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Names, dates, and events may have been changed to protect the identity of patients. The stories are not meant to provide medical advice for specific illnesses. The author neither accepts online consults nor gives medical advice online. Please consult your trusted physician.