Through Ofelia Reyes, a 36-year-old laundrywoman and mother of two, I would get to know the resident physician who I’d never want to be. To this day, remembering what transpired that night in Ward 1 still makes me shudder, for I had never thought anyone could commit such atrocity to a patient spending whatever was left of her short life confined in her charity hospital bed, not knowing whether the next attempt to take a deep, painful breath would be her last.
Ofelia Reyes was sent to the ER from the OPD because of difficulty of breathing. I was a clinical clerk then, and Internal Medicine being my first clinical rotation, she was among the first patients I took care of as student-in-charge (“SIC”) in the IM wards. Ofelia’s physical examination and imaging studies revealed pulmonary and neck masses. Her right upper limb was also markedly swollen. What doctors originally thought to be inadequately treated tuberculosis was becoming more compatible with stage IV lung cancer. She was showing signs that the tumor’s uncontrolled growth had begun to obstruct blood flow from her affected arm.
Her every breath was punctuated by chest pain. Wary of giving narcotics that would depress the part of her brain that controlled breathing, my resident and I were giving her both oral and intravenous pain medications round the clock. Still, it hurt every time she tried to breathe.
But worse than chest pain, Ofelia told me, was air hunger — inhaling without air getting into your lungs, a constant sensation of drowning, except you are not submerged in water. Her bed was at the right corner of Ward 1, farthest from the ceiling lights and thus darkest at night, but nearest the hospital windows so that she could take in as much unadulterated air as she could.
We needed to prove the diagnosis of cancer. Pulmonary tuberculosis could be treated with antibiotics, cancer couldn’t. Hence, my resident referred Ofelia to a surgical department for biopsy of her neck masses, which were more accessible and posed less risk than attempting to biopsy her lung mass.
I was preparing to endorse my patients to the medical interns and clerks on duty when Dr. X, the resident who answered the referral, came to see Ofelia. It was past 6 pm. Most people who were not on duty had already left or were getting ready to leave the hospital, but because I knew that he would obtain tissue samples that needed to be sent to the laboratory, I led Dr. X to my patient’s bed. Watching over my patient at that time was her 12-year-old son.
There was no “Magandang gabi po.” Dr. X didn’t even introduce himself, proceeding instead to get a quick clinical history and physical examination.
“Gaano na katagal ‘yan? Bakit ngayon ka lang nagpa-admit?”
The tone was stern and devoid of any pleasant emotion. My patient responded with slow answers; breathing alone was difficult, speaking more so. Still, Dr. X asked one question after the other, often not letting my patient finish her sentences.
Why bother asking if you’re going to dismiss the answers anyway?
“Payag ka bang tusukin natin ‘yung leeg mo?”
“Kung ‘yun po ang kailangan, Dok.”
Dr. X prepared his biopsy needs and asked my patient to sit straight up. He donned his gloves, applied the antiseptic, plunged the needle into my patient’s neck mass, and attempted to aspirate its contents.
“Aray, aray ko po, Dok.”
“WAG KANG GAGALAW!”
I was startled.
“Dok saglit lang, masakit po!”
“SINABI NANG ‘WAG GAGALAW. HINDI NAMAN MASAKIT ‘TO.”
My patient could not maintain her position. She kept shifting and moving away, making the procedure understandably difficult for Dr. X.
But did he really have to shout?
Exasperated, Dr. X pulled out his needle.
“Bakit ka ba galaw nang galaw? Hindi naman to masakit!”
My patient was gasping and crying and could not even say a word anymore.
“Nakikita mo ba ‘yang naka-drawing sa dibdib mo? Alam mo ba kung ano ang gagawin diyan bukas? ‘YAN! ‘YAN ANG MASAKIT!”
Now that’s foul.
My patient was also referred to Radiation Oncology for radiation treatment, which we hope would kill the tumor cells obstructing blood flow from her right arm to the major vessels of her heart. That morning, radiology residents put markings on her chest, to serve as landmarks for the next day’s procedure.
Radiation treatment is not painful at all. It’s just like getting an x-ray, so I was perplexed, why the hell is this resident threatening my patient?
My patient sat still, trying to suppress her crying as Dr. X re-plunged his needle into her neck. He pulled out the syringe and walked away with his specimen.
During the entire ordeal, Ofelia’s son stood at her bedside, watching.
I was seething with anger. This resident had just abused my patient, and being a clinical clerk — belonging to the lowest rung on the health workforce and only two weeks old in the hospital — I felt helpless. I could not even tell him that what he did was wrong.
He could be exhausted and he could have many other things to do, but nothing could justify what he just did to my dying patient. In front of her son.
In medical school, I was often asked to identify doctors to whom I looked up and who I aspired to be. Dr. X was the antithesis of that.
I remember staring at Dr. X’s back as he prepared the slides for submission to Pathology at the nurses station.
That was when I said to myself: if one day I find Dr. Ronnie Baticulon acting the way he did, perhaps I should stop being a doctor altogether.