It Takes Just One Person

At one point, I gave up on Eric Reyes. The 30-year-old was abandoned in the ward by family and friends. He had no wife or children. He was left to care for himself, which he could not do because of the severe head injury he sustained when he fell six feet, during an attempt to urinate on a cliff-side wall while he was inebriated. In the operating room, I had to remove blood clots and damaged brain from both left and right sides, else he would end up dead or debilitated from severe brain swelling.

Although he was awake after the surgery, the diffuse brain injury kept him confused and unable to follow instructions. Initially, it was his elder sister who took care of buying his medications and facilitating laboratory tests. He was no different from a child who needed to be fed, bathed, and dressed.

After a week however, I began to see the sister less frequently during bedside rounds. I noticed that he was no longer being given his medications regularly too. When I asked the nurses about this, I was told, quite simply, “Ay naku Sir, palaging wala ang bantay niyan.” At the end of two weeks, no family member or friend attended to his needs at all. You would see Eric spitting, urinating, or defecating in bed. One time, he even smeared fecal matter all over his body, a sight that was both gruesome and pitiful. It was the nurses and nursing aides who took over the responsibility of feeding him and changing his diaper on time, among other things.

To complicate matters, he began to have fever and chills, signs that his operative site might have developed an infection. We needed to start new antibiotics, run additional laboratory exams, and have his cranial CT scan repeated. When his sister finally showed up one morning, I talked to her about Eric’s medical problems and explained the plans of the neurosurgery service.

“Bakit niyo po palaging iniiwan ang pasyente ninyo? Hindi po pupuwede ang ganoon, Ma’am. Kapatid ni’yo po iyan, hindi po pupuwedeng walang mag-aalaga sa kanya dito.”

“Kasi Dok, naghahanap po ako ng pera panggastos namin dito sa ospital. Naubos na kasi ang hawak naming pera sa operasyon.”

“Kailangan ni’yo pong gawan ng paraan iyon. Hindi po responsibilidad ng mga nurses at nursing aides na alagaan ang pasyente ninyo. Akala ko sampu kayong magkakapatid?”

“Eh wala naman pong mag-aasikaso sa kanya, may mga sariling pamilya na po ang mga iyon.”

“May three thousand pa po ba kayo para sa CT scan? Kailangan kasi nating ulitin ang CT scan ng kapatid mo para malaman natin kung may namumuong nana sa loob ng utak niya.”

“Pambili nga ng gamot wala, pampa-CT scan pa!”

Infuriated by her retort, I said, “Eh ano po ang gusto ninyong mangyari sa pasyente ninyo?”

“Basta gusto ko lang gumaling ang kapatid ko.”

There was no point in arguing further.

As government physicians, it has become a necessary skill to keep finding ways to help our charity patients: pilfer spare antibiotic vials and operating room needs, request that the hospital waive the fees for laboratory exams, and refer family members to charitable organizations for financial assistance. However, these are just temporizing measures and would never fully cover the health expenses of any patient. For families to depend entirely on their physician for the care of their patient is, frankly, unfair and unacceptable. We could only do so much. There are many other patients to take care of, who have better chances of having good outcomes only because they have supportive families.

In the days that followed, no new watcher came to stay at bedside and no medication became available. Our service decided to pay for his imaging study and we referred him to the Infectious Disease Section for antibiotic assistance. I was frustrated and nearing the end of my rope.  As a last resort, through the hospital’s social welfare service, I asked the nurses to contact other relatives who might have more concern for Eric.

That was when Ofelia, his mother, came.

To her, I repeated my question.

“Nanay, ano po ang gusto ninyong mangyari sa pasyente ninyo?”

“Gusto ko po siyang gumaling, Dok.”

Her voice was dry and her tone was flat, perhaps still aghast at the state her son was in.

“Kung ganoon po ‘Nay, bakit ni’yo po siya pinapabayaan? Dalawang linggo na pong walang nag-aasikaso sa anak ninyo dito sa ospital.”

“Pasensya ka na, Dok. Hindi ko alam na ganoon ang nangyayari. Ang akala ko, inaalagaan siya dito.”

Ofelia looked at her son who stared back with blank eyes. He could answer simple questions but he could not carry a conversation. He moved only when necessary, staying in bed most of time–far from the functional welder he used to be. Right now, he kept his body curled under his blanket. He still had chills and fever.

“Isang linggo lang po ang antibiotics na ibibigay ng ospital sa inyo, ‘Nay. Pagkatapos po noon, kayo na po ang bahala. Apat na linggo pong gamutan ang kailangan natin. Kung paisa-isa lang po ang naibibigay nating gamot, sayang lang po lalo. Kung wala rin lang tayong maibibigay na gamot dito sa ospital, iuwi ninyo na lang po ang pasyente ninyo.”

“Huwag ninyo naman po sabihin ‘yan, Dok. Kaya nga po kami nandito, para gumaling ang anak ko.”

In that brief second, I felt ashamed for offering Ofelia the option of bringing her son home.

“Bigyan ni’yo pa po kami ng kaunting panahon, Dok. Gagawan ko po ng paraan, kaya nga po ako lumuwas na dito.”

“Lumapit po kayo sa Mayor o Congressman ninyo ‘Nay. Lahat ng kamag-anak ninyo, hiraman ninyo na po ng pera. Kung hindi po kayo gagawa ng paraan, lalo pong hindi gagaling ang pasyente ninyo.”

“Naiintindihan ko po, Dok. Mabait po ‘yang anak ko na ‘yan. Magaling pong welder ‘yan. Nagkataon lang talaga na naaksidente siya.”

It was a good thing Ofelia did not give up when I did. That was the turning point for Eric. From then on, sister and mother took turns watching over their patient while the other sought financial assistance from local government officials. Ofelia was also able to avail of a free cranial CT scan from the charity service of a nearby private hospital. With permission from the Infectious Disease Section, I discharged Eric on oral antibiotics to be taken for a month, and Ofelia promised to comply.

Five weeks later, I received a text message from the Infectious Disease Section fellow who handled Eric’s case. She was elated to report that she saw Eric fully recovered at the outpatient clinic. His latest cranial CT scan showed no sign of brain swelling or infection. I asked her to direct Eric to our ward so that I could see him in person.

He wore a green cap to cover his scalp incisions. I was pleased to see him in tidy clothes.

“Naaalala mo pa ba ang nangyari sa iyo?”

“Hindi na po, Dok.”

So I told him, and said, “Pasalamat ka sa Nanay mo.”

Tags: , ,

23 comments

  1. It’s always difficult, trying to save lives without money. Once in a while, out of frustration, you come to that point when the thought of suggesting the option of going HAMA “na lang” comes, unbidden… I know a lot of residents guilty of this, me included. Yet, it’s amazing how things would actually work out for some patients. And most of the time it’s always because of amazing “bantays” who never gave up. ^v^
    If only we can have more of them in PGH. Then life would be easier.

    • I only offer the HAMA option when I don’t see the family members doing their part. It’s that point when you see yourself too exhausted for a single patient while the relatives don’t seem to care. Otherwise, if the family is aggressive (and if they are willing to look for resources), tuloy ang laban. :)

      • and i heard that some people in government want PGH to be privatized..? where, then, the poorest of the poor can go to avail of the services one of the country’s best medical practitioners…?

  2. You keep on inspiring me, dok! =)

  3. They stayed true to their word, that they wanted their patient to get better! Such a good story to bring with me to the wards. :) Just to share: We had a patient in Ophtha who was enucleated for Retinoblastoma. However, she still needed chemotherapy due to extraocular extension. The parents were trying to look for money for chemotherapy. But after 2 weeks, they still had none. There was a point when the mother said that maybe it’s a sign that they should just accept that this is the only amount of time that God gave them to be with their daughter. I felt so sad and angry when I heard this. She was giving up on her 2 year old daughter! When I left the rotation, she was still there and still no chemo. :( Anyway, I’m glad that there are some people who still have so much hope and determination in their hearts, even if we have lost ours. :)

    • You begin to realize that as a resident. Medyo idealistic kasi tayo as medical students. We want to save everyone. Truth is, we just can’t. And if family members don’t bother, should we?

  4. What an inspiring story. I think it very sad that in times of need, people’s lives must translate to money. What a miracle it must have been, though, for the mother to wake up and regain her senses on the matter. :) Some people just need a little reminding, I guess. That man is lucky!

    I like how you write, btw.

    • Because that is the truth. The government cannot, as of this writing, fully subsidize health expenses, even of our poorest patients. That remains an ideal.

      Thanks, Cza!

  5. This story, and other ones, continue to break my heart and at the same time inspire me. I also work in a neurosurgical/neurovascular unit and couldn’t imagine not being able to have the scans and medications needed to provide the best possible care. We scan our patients a few times if we even suspect a slight neurological change at times and would probably feel frustrated if a STAT order was not done within an hour. :S

    Thanks for sharing your stories! It reminds me to not take anything for granted – especially our health care ( Canada)

  6. mahirap talagang magpagamot kapag walang pera ni isang kusing. pero kung may pamilyang kasama, lahat kakayanin. (pero nakakalungkot pa rin.)

  7. sometimes it wears you out, worrying about all aspects of your patients healthcare– the accuracy of the diagnosis, appropriateness of the treatments you suggest, and even the social/financial implications (which unfortunately carries over until private practice). you worry you’ll be heading to that blackhole of not caring anymore. But you’re right! just when you’re at the end of your rope, it takes just one person, one patient to remind you that your effort isnt wasted– then its back to that rollercoaster of health”care” again=)

    • I agree Ma’am Edhel. Akala ko dati, sa charity lang nangyayari ‘to. But now that I’m doing duties as pay resident, it becomes an even more complicated issue to tackle because you wouldn’t want to insult families when you try to assess their financial capacity to sustain treatment.

      Thanks for reading! :)

  8. Hi Kuya Ronnie! Wow, your writing just never fails to blow me away. I have recently decided to leave the clinical research industry and pursue Medicine as originally planned. Thanks for continuing to be such an inspiration, from way back during your Lightning Crashes days up to now. I will forever treasure that night of my debut where u gave such an inspirational speech, even if u didnt know who i was. Fan girl much, ahahaha. God bless you parati! :)

    • Hi Zai! Fan girl much? Haha, natawa naman ako dito. Good luck on your plans! I hope you find the happiness you wish for in Medicine. Find inspiration in the patients that you will get to encounter with each day. They are the ones who will remind you to keep going despite the hardships. Have fun! :)

  9. hi doc roni.. while reading…naaalala ko ang mga araw na nakaduty pa ako sa ward as a nurse…nakakamis mga eksenang ganyan…:) lalo na yung malaman mo nakarecover pasyente mo sa dami ng pinagdaanan nia….optimum level of functioning..:)
    i appreciate the stories and the things you write,realities of hospital setting and being a doctor…im now on my second year sa med school at nakakainspire mga entry mo lalo.:) God bless.:)

  10. doc ron, very inspiring stories like your other heart breaking story…entitle “husband and wife”. pareho ang pangalan ng mga tauhan sa kwento. eric reyes and ofelia.

  11. Hello Doc,
    Thanks for sharing your stories.You are such an inspiration.
    Im here at Arizona,US as medtech in one of the hospital.
    Keep up the good work!

  12. Hi Ronnie,

    I stumbled upon your blog on FB and got hooked…I remembered my own PGH Residency days and i’m glad to know that there are still residents like you who really has the passion for medicine…
    I cringe at the thought that patients like here in Aus or even in other developed countries just know only how to complain? Arent they lucky enough to have free or subsidised health care? Our healthcare system in the Phils still cannot even provide free or subsidised medications/investigations/ treatment even in the supposed-to-be government hospitals? Unless the whole healthcare system is changed, many of the poor Filipinos will not even get to reach hospitals on time.
    I admire your compassion and i do love reading your stories, it makes me teary-eyed all the time. Thanks for living up to your dream of becoming a TRUE Doctor! Godbless! Your parents are lucky to have you!

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>