Sustaining severe injuries after his motorcycle collided head on with another motorcycle, Eric Reyes was in semicoma when I first saw him at the Emergency Room. He would not open his eyes no matter what I said or did. He moved his arms and legs only if I put pressure on his ribcage or pinched his fingernails. Although he could still breath on his own, his airway was in danger of obstruction so the trauma team intubated him on arrival at our hospital. Compressing the Ambu bag and having a hard time keeping up with the rhythm of Eric’s breathing was an obviously distraught Ofelia, his wife. Noticing that Ofelia also had scratches on her forehead and arms, I asked, “Bakit sugat-sugat ka rin?”
“Ako po ‘yung angkas niya, Dok.”
If Eric were awake or simply lightheaded from minor head trauma, the impulse would have been to proceed to my obligatory sermon on the dangers of riding a motorcycle. “Maswerte ka, buhay ka pa,” I would tell my patient, who either grins or looks down in shame at this point. If my patient belonged to the helmet-lacking, drunk-driving population, I would, in addition, turn to the parents, the spouse, or the children at bedside. “Pangaralan ni’yo ‘yang pasyente ni’yo. Sa susunod, hindi na ‘yan makakaligtas, maooperahan na ‘yan sa ulo.” As a government physician, I feel duty bound to castigate our motorcycle-driving public, one reckless driver at a time.
But seeing that my patient was on the brink of death, I felt no need to reprimand anyone. In these instances, grief would teach them their lesson.
I began to examine Ofelia’s husband in detail as I continued to ask her questions.
“Lasing ba ang asawa mo?”
“Hindi po, Dok. Pauwi po kami galing bayan.”
“Opo, Dok, pero natanggal nung tumilapon kami pareho.”
“Huwag masyadong mabilis ang pagbomba, Nay. Sabayan mo lang ang paghinga niya.”
I grabbed the Ambu bag momentarily and showed her how to do it properly. “Ilan po ang anak ninyo?”
“Tatlo po, Dok.”
Eric and Ofelia were in their early 30s; their children would probably still be in elementary, perhaps high school if they married in their teens. It eluded me how both father and mother could risk their lives in a two-wheeled killing machine, knowing that they would leave behind three young orphans.
Now, we had a breadwinner to save. You would not want three children growing up fatherless.
I looked at Eric’s CT scan films. There were scattered hemorrhages all over and a small hematoma on one side. There was no indication that he needed surgery; he was in semicoma because his brain was diffusely injured.
“Nay, sa tingin ko po, walang kailangan operahan sa utak ng asawa ninyo.”
“Naku, salamat naman sa Diyos.”
“Pero hindi pa po siya ligtas, Nay,” I was quick to caution her when I saw her worried expression evolve into that of relief. “Alanganin pa rin po ang lagay ng asawa ninyo. Hindi pa siya gumigising dahil sa tinatawag naming diffuse axonal injury. Ibig sabihin, nabugbog po ‘yung buong utak niya dahil sa pagkakabagok ng ulo sa aksidente. Marami pong bahid ng dugo at namamaga ‘yung buong utak, pero wala po kaming kailangan operahin.”
“Ganun po ba, Dok? Ano po ang pwede nating gawin?”
I then explained that our treatment for these cases was mainly supportive: assist respiration via mechanical ventilation, fluid resuscitation to avoid hypotension, adequate nutrition, and prevention of infection from pneumonia, urinary tract infection, or bed sores. I would ask my team captain to admit him to the intensive care unit, but I also needed to assess whether she would be able to provide the necessary financial and family support.
“May pambayad po kayo ng ventilator, Nay?” That amounted to 2000 pesos for the first two days, and 400 pesos every day thereafter.
“Wala po akong hawak sa ngayon, Dok, pero sige po, tatawag po ako maya-maya. Gagawan ko po ng paraan.”
That was a good answer.
“Sige po, Nay. I-aadmit po natin sa ICU ang asawa mo. Gagawin natin lahat ng makakaya natin, pero kailangan mong maghanap ng pera ha? Libre dito ang kama at walang bayad ang mga doktor, pero ikaw pa rin ang magbabayad ng mga laboratoryo, CT scan, tsaka gamot. Tawagan na lahat ng kamag-anak. Mangutang na kung kailangan mangutang. Kapag nawala ‘yang asawa mo, hindi na maibabalik ‘yan.”
“Opo, Dok. Gagawin ko po lahat mabuhay lang ang asawa ko.”
That sealed our agreement.
Working in a large government hospital, it is a reprieve to hear of family members willing to do their part in patient care. Often, people come to us not expecting to pay a single peso. In an altruistic society, we could try to pay for every one’s health expenses to save every valuable life, but that is impossible. It is hard enough to formulate a management plan and execute an operation without complications; family members should at least exert some effort to support their patient financially.
For a week, our team took care of Eric in our ICU. Ofelia did as she promised, procuring needs and medications as we requested. I learned later that they were mountain miners who sold small gold pieces in the town proper; it was a good thing they had some savings.
“Siya ang pinakamagaling na minero sa kanila, Dok,” she told me with pride.
I did tracheostomy and was eventually able to wean her husband from the ventilator. His neurologic status improved gradually; by the time we transferred him to the wards, he could already open his eyes and move his arms and legs spontaneously.
After another week, Ofelia already knew how to feed her husband through a tube inserted in his nose. She could clean his tracheostomy tube and suction it without fear. She also did stretching exercises for Eric’s arms and legs. We could now send him home.
“Ready ka na umuwi, Nay?”
“Kayo po ang bahala, Dok.”
“Basta ituloy mo lang ‘yang ginagawa mo ha? Hindi ko pa masasabi kung gigising siya nang tuluyan, pero hintay ka lang ng 6 months to 1 year. May mga pasyente kaming ganyan na pagbalik, parang walang nangyari.”
“Salamat po, Dok. Ang mahalaga po, buhay ang asawa ko. Hamo, Dok, pag-follow up namin, dadalhan kita ng sugpo at alimango, marami noon sa amin.”
“Naku, kahit hindi na po.”
But I did not see Ofelia at the Neurosurgery outpatient clinic.
Instead, we met two weeks later in one of the hospital’s pay rooms. Ofelia consulted a neurologist and was admitted for progressive headache, numbness of the arms, and blurring of vision.
“O anong nangyari sa ‘yo?”
“Hindi ko nga rin alam, Dok.”
Her mood was somber, far from the energetic wife I was used to seeing. The children were being taken care of by the in-laws, she said.
I reviewed her CT scan films and saw blood clots on both sides of her brain. Small blood vessels must have ruptured because of the head impact during the vehicular crash. The blood had gradually accumulated, and she only became symptomatic when the blood clots had become large enough to compress her brain considerably.
Unlike her husband, Ofelia needed brain surgery.
Knowing that they had limited funds, we transferred Ofelia to the charity service and I operated on her the next day.
Back in the wards, four beds away from the one she used to stay beside, Ofelia was glad to tell me that her husband was doing well. He was more awake at daytime, now able to swallow liquids and recognize family members.
“Pwedeng-pwede ka na palang maging Family Physician,” my consultant remarked when I told him about Eric and Ofelia.
Though I would never meet their children, it brings satisfaction to know that I have given them a chance to grow up with both parents.
As for Ofelia, I discharged her three days later with no complications. Looking back, perhaps she already felt symptoms in the days following their vehicular crash, but being the caretaker of her husband, she must have dismissed them, or hoped the symptoms would resolve on their own while she ran around the hospital to facilitate lab workups or buy medications.
Indeed, the self is forgotten for love of another.