A few hours after her son, a nurse, died from cancer, Ofelia Reyes bled in her cerebellum. The stroke (“brain attack”) immediately put her in semicoma. There was just too much blood, too close to the part of her brain that controlled her breathing and heart rate. The devastating news of her son’s death almost led to her own, but I operated on her and saved her life.
To be honest, in the beginning I was not sure I could. When I examined her in the wards just before her surgery, she was already intubated. She would not open her eyes to pain and she could only move the left side of her body. Pupils were small and non-reactive. Her clinical course was that of rapid deterioration; without any intervention, she could die in hours — a second death in the family.
“50-50 po ang chance natin kung ooperahan natin ngayon si Nanay,” I told the son who was watching over her at that time. I did not want to raise expectations. “At kahit po operahan natin siya, nakatubo pa rin po siya paglabas ng operating room.”
“Gagaling pa po ba siya Dok kapag pinaoperahan po namin?”
“Kung makakausap niyo pa siya, o kung makakapaglakad, o kung makakapagtrabaho gaya natin, hindi ko pa po masasabi. Malalaman po natin 24 to 48 hours pagkatapos ng operasyon kung gaano siya kabilis mag-recover. Pero malamang sa hindi, alagain na po ang Nanay ninyo. Kayo ang magpapakain, magbibihis, magpapaligo araw-araw.”
“Ganun po ba Dok?”
“Opo. Pero ang mahalaga po doon, kung ooperahan natin, mabibigyan natin siya ng pagkakataong mabuhay.”
Her son signed the consent form at that point. And from that point until I reached for my knife in the operating room, I was rehearsing the steps of my contemplated surgery in my head.
Tube. Burr hole. Wash. Suction. Kerrison. Rongeur. Bipolar. Irrigate. Sponge. On infinite repeat, punas ng pawis included.
It was an operation where I could not afford the slightest mistake. There was no room for unnecessary moves; she could die on the table if I did not operate fast. On the other hand, rushing the procedure meant increasing the risk for post-operative bleeding or breaching the sterility of the operating field.
I learned from Neurosurgery that the exhilaration of being given a chance to somebody’s life at a precise moment is always weighed down by the fear of failure — be it from doing something really stupid, or from circumstances beyond one’s control.
Ofelia was lying face down on the operating room table, a clamp holding her head in place. Her son lay stiff in the hospital’s morgue. There I stood, afraid and filled with doubt, but with an overdose of adrenaline and a little extra prayer, “Cutting,” I said.
I met Ofelia’s husband two days later in the intensive care unit.
“Kamusta na po ang asawa ko, Dok?”
“Mas gising na po siya ngayon. Dumidilat na po at sumusunod na po kapag pinapataas ang kamay o paa. Nakikilala na po kayo kapag kinakausap ni’yo?”
“Naku, opo, Dok.”
“Mabuti naman. Sana po magtuluy-tuloy na. Para matanggal na po natin ang mga tubong nakakabit sa kanya. ‘Wag lang po kayong magpapalya sa gamot para hindi mag-impeksyon ang inopera natin. Mag-ready na rin po kayo ng pera pampa-CT scan.”
“Opo, Dok. Maraming salamat po.”
He told me he was a jeepney driver. He reminded me of the stereotype Filipino kontrabida — bronze skin, square face, thick eyebrows, slanted eyes, and a moustache — the one who kidnaps the leading lady and fires the armalite. But at his wife’s bedside, he thanked me with a wide smile and he was teary eyed.
I was relieved. If he only knew how much anguish I have had to bear in the last 48 hours, thinking of his wife and how she would recover.
Why is she febrile? Am I giving enough mannitol? How soon can I take her out of the ventilator? Can I remove the tube ventriculostomy now, before she develops ventriculitis? But what if she develops acute hydrocephalus?
The anxiety does not stop with the surgery. The steps are mechanical, but the process of thinking and re-thinking decisions on medications and interventions inevitably lead to lack of appetite, sleepless nights and seeming disinterest on what’s happening with everybody else.
For every life that we save, we lose a day of ours.
People trust us with their lives, or their loved ones’ lives, and this trust can only be reciprocated with a promise to do, with the best of our ability, what we think is right for the patient. It is never easy.
“Dok, umiinom ka ba ng alak?” Ofelia asked me in the outpatient clinic during her follow up. She still had some weakness on her right arm and leg but she was fully awake.
“Paminsan-minsan po,” I said with a grin.
“Hamo, dadalhan ka namin sa susunod.”
“Naku, kahit hindi na po,” I was content just to see her doing well.
“‘Di ba tinatanong mo kung may girlfriend na si Dok?” her husband interrupted.
“Bakit, dadalhan mo siya ng babae?”
I could not help but laugh. This was a good save.