Some Days Feel Like an Indie Movie Playing in Real Time

She could not stop thanking me profusely.

“Dok, maraming maraming salamat po sa lahat ng tulong ninyo sa anak ko,” she said, one hand clutching both handkerchief and rosary, the other stroking her son’s forehead. I had just signed the necessary discharge orders and I approached my patient to remove the thin tube sticking out of the back of his head. The tube was inserted in the operating room to drain excessive cerebrospinal fluid. It would serve no purpose now.

My patient is going home.

“Dok, salamat po sa pag-aalaga ninyo sa anak ko,” she said, half-smiling and half-crying, as we prepared to transfer her son to the stretcher bed that would transport him out of the hospital.

I took my place at the head end of the bed, the Manong took his at the foot end, and a nurse put all tubings out of the way. After making sure everyone was in position, I gave the obligatory command, “One-, two-, three!”

“Dok, thank you talaga ha,” she said again as we wheeled the stretcher and left the wards. I put my left hand on her shoulder, and gently pat her back. I could not say, “Wala pong anuman,” in return.

“Nandiyan na po ang sundo ninyo?”

“Opo, Dok. Parating na ‘yung service.”

We rode the elevator and made our way to the back wing of the hospital, other patients, watchers, students, and doctors moving to the side in respect and in fear, giving way to our mini-procession comprising stretcher, oxygen tank, and weary pilgrims.

We had to stop at the exit ramp, stretcher suspended between the ground and the elevated hospital building. There was no ambulance in sight.

I had to remind my team, “Kapit nang mabuti sa stretcher; baka mahulog ang pasyente.”

Then came the rain.

It was neither drizzle nor downpour. It was rain that fell and hit your skin at a seemingly calculated timing — each drop giving you just enough time to wince from its blunt jab, before another drop hit and hurt you elsewhere. We were only partly shielded by the hospital building’s roof. My patient was getting wet.

Then came the stranger with the white umbrella.

He had come from behind, but instead of passing through, he stayed beside the stretcher. From the scruffy face and crumpled shirt of our volunteer, I knew immediately where he was from. We were right across the Psychiatry ward, where non-violent patients were allowed to walk around and mingle with others. He held the umbrella high over my patient’s head, with a grin of satisfaction, pride even, on his face.

Then came the shouting from my far left, “Ofelia! Ofelia!”

Two middle-aged women, both panting, ran to where we were. I was afraid they were going to faint from a simultaneous heart attack when they started explaining to my patient’s mother. The hired vehicle had made a wrong turn, and thus had to turn back. It’s all right, I thought of saying.

It wasn’t long before a white L300 multicab pulled over.

With incredulity, I read the words printed in blood red on the passenger door: Funeraria Reyes. And then in smaller letters, an address somewhere in Bulacan.

So this was what they meant when they said “service.”

My patient’s mother stared at her son’s coach.

She looked back at me, “Thank you po sa lahat, Dok.”

Your son is dying but he is not yet dead, I wanted to tell her.

Instead, I proceeded to what I had been set to do. I opened the syringe in my pocket and put on my gloves. I gestured to the relative who had been compressing the Ambu-bag that was keeping my patient breathing: Stop. Using the syringe, I deflated the cuff that secured the endotracheal tube that had supplied oxygen directly into my patient’s windpipe since the day of his operation. I positioned my patient’s shaven head, midline and looking straight up. Without the slightest hint of hesitation, I pulled the tube out, mucus and blood oozing from its distal end. My patient did not even gag or flinch. I bent the tube in half, closed my right hand into a fist, and ungloved, taking the tube out of sight with a sleight of hand.

Umbrella man watched my every move.

“Dok, ako na po ang magtatapon niyan,” Manong offered.

On the stretcher, my patient began taking shallow, wide-spaced breaths on his own. I knew it wouldn’t be long before this breathing pattern changed into rapid, irregular gasps. We pushed the stretcher down the ramp and aligned it to the muticab’s back door.

“One-, two-, three!” I said.

We lifted my patient into the multicab and laid him on the vehicle’s floor. I made my way out as aunts and uncles scrambled to take their places.

I was surprised to see Ofelia on the front passenger seat.

“Nanay, ayaw mo bang umupo sa likod?” I asked, knowing that my patient would most likely die before they reached their destination. “Samahan mo muna ang anak mo.”

“Hindi na po, Dok,” she said. “Naaawa lang po ako.”

The calm voice with which she said this belied the turmoil that must have been going on inside her. Having understood the poor prognosis of her son, it was her decision to bring him home.

I extended one hand through the car window and held both of hers.

“Ok po. Ingat na lang po pauwi.”

“Salamat po, Dok.”

The driver started the engine.

I turned away and took slow steps back to the hospital. Intermittent pricks on my head and nape reminded me that it was raining.

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18 comments

  1. I can’t even begin to imagine how you (residents) feel.

  2. How do you deal with such situations?

  3. it’s good to know that after one year of hell otherwise known as 1st year residency…you’re back and writing again…hay…I remember there was this time during internship when i watched my 1st yr IM RIC do this and it was really heartbreaking for a mere expectator..what more if you’re actually the one doing this? Sheesh….I just can imagine…
    curious question though…what’s the diagnosis?
    it’s really nice to read something from you again my friend…and see you soon! 🙂

  4. Nice prose as usual. This one’s sad though. 🙁
    Keep writing this is the only blog na pinapansin ko on my google reader nowadays. 😛

  5. Thanks for posting this Ronnie. And I’m really glad to see you writing again.

  6. buti nagsusulat ka na ulit, sir. 😀

  7. russel aviles

    Hey Doc. You’re a good writer pala. You can publish real hospital stories which would inspire and touch lives your patients and their love ones. I admire your kindness and affection with your patients.

  8. this sounds too melodramatic. why didn’t you extubate the patient earlier? why did you choose to take the tube out just before he rides the ambulance? it’s not usual practice and not a very popular one too, i would think.

    • Hi Mayella! It may appear melodramatic to some, reaching perhaps the proportions of telenovelas and teleseryes, but these were the events of that afternoon. We see more drama in real life than TV shows and movies could ever portray. We don’t extubate in the wards. Almost always, the tube is removed before the patient is transferred to the ambulance. Otherwise, the patient might go apneic even before he reaches the vehicle. If there were a receiving doctor and the ambulance had a bag valve mask and oxygen tank, then we don’t extubate anymore. This is rare, though.

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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.