First and Only

“Sir, pababa na po kami sa OR.”

“OK. Nasa office lang ako. 10 minutes,” I said, then quickly hung up on the junior resident. I would be operating on a 70-year-old male with a chronic subdural hematoma overlying the right half of his brain. Resulting from a vehicular crash two months earlier, the blood clot had gradually accumulated, causing progressive weakness of the left side of his body. During the last 24 hours, he became increasingly difficult to awaken, indicating that the brain swelling and compression from the blood clot were worsening. He needed emergency surgery.

But as I was about to get up from the couch in the Neurosurgery office, I received another call: it was my mother.

“Bakit, Ma?”

Since I started medical school, my parents have grown accustomed to my busy schedule, and my habit of not reading their messages or forgetting to return their calls when I get stuck in the operating room. Thus, over time, we have naturally learned to skip the pleasantries.

“Ron, Ron, dinala ko si JP dito sa (name of hospital). Kakausapin ka raw ng doktor, kilala ka.”

Devoid of the histrionic elation I am used to hearing, her voice was hurried and filled instead with panic.

So my younger brother is in the hospital?

Five hours earlier, at around dinner time, my mother called to say that my 18-year-old brother was complaining of chest pain. I was in the emergency room seeing patients, but I was able to talk to him over the phone. He was having a hard time completing sentences. Was it difficulty breathing manifesting as chest pain? No, it was pain, not shortness of breath, he insisted; it was definitely different from what he felt during previous asthma attacks. Still, I instructed my mother to give him his nebulized medication. The persistent pain prompted my parents to bring him to the nearest hospital.

“Hello, this is Ronnie Baticulon, brother ni JP.”

“Yes sir, good evening. This is Dr. Ofelia Reyes po, ER resident.”

She proceeded to giving me a history and physical examination, from which I had to filter the important details. Just before I answered the call, I was mentally rehearsing the steps I would take in doing my surgery. My brain could only process so much information.

“…chest pain… clear breath sounds… chest X-ray showed 90% pneumothorax on the left.”

“90% pneumothorax on the left?” I said with some incredulity, “Anong O2 sats?”

“Yes sir. 98 to 99% naman po.”

Our two lungs are each contained in their respective lung cavities. When a weak point in the lung wall ruptures, air escapes into the lung cavity with each inhalation. Instead of being exhaled, the accumulating inhaled air progressively compresses the affected lung, causing its collapse. My brother needed emergency surgery to insert a tube into the left lung cavity, providing an escape route for the enlarging pneumothorax.

“Teka, sandali lang ha,” I said to the ER resident.

Among five children, I am the eldest and the only one who pursued Medicine. Following my father’s lead, everybody else took the Engineering track. (If I didn’t get into INTARMED, I would have done so, too.) Among my grandparents, my aunts, my uncles, and my cousins from either side of the family, nobody is a doctor. I am the first and only. While there is definitely pride in the fact, with it also comes an implicit responsibility.

From the time I was a medical student, I have become the source of medical information for the family. I get the first consultation and give the second opinion. I even circumcise family members. My parents have long relegated to me decision-making involving the health of our nuclear family. It is a tricky process, trying to keep an objective view of the clinical data, when it is a loved one you are supposed to treat.

Time to think, neurosurgeon. Twenty minutes before midnight. What’s the plan?

My patient was on his way to the operating room. In 30 minutes, I was supposed to start operating. To delay the case was not an option; my patient needed surgery as soon as possible, to increase the likelihood of recovering consciousness and lost function. I did not want to endorse the case to another resident either, since I was the one who knew his history and did the neurologic examination.

I also wanted my brother transferred to our hospital for his surgery. I talked once more to the ER resident and she assured me that my brother was stable enough to be transported in our family car.

If the evacuation of the chronic subdural hematoma were uneventful, I would take at most two hours in the operating room. That would give my parents just enough time to transport my brother and get a hospital room. I had 30 minutes to arrange the transfer.

“Let me make a few calls Dr. Reyes, then I’d let you know kapag puwede na silang lumipat dito.”

I called the junior resident (“Bantayan mo muna ‘yang pasyente. Paakyat na rin ako.”), the thoracic and cardiovascular surgery chief resident (“Bai, kailangan ‘tong operahan ‘di ba? Ipapa-admit ko na lang kay Dr. L.”), the Pay Admitting section (“Ha? Wala pang bakanteng room?”), each nurses station from 4th to 7th floor (“Ma’am, Ronnie Baticulon po ito from NSS. May bakante ka bang small private room? Kailangan ko kasi ipa-admit ‘yung brother ko, for emergency surgery.”), and the anesthesiology resident-on-duty (“Ma’am, brother ko ‘yung ma-admit sa 424. Paki-inform na lang agad ‘yung consultant-on-duty ha?”).

I was already changing into scrubs in the dressing room when I called my father.

“Pa, mag-oopera lang ako. Hintayin niyo na lang ako sa kuwarto. Kapag may problema, tawag ka lang sa local 3305.”

Thankfully, the surgery proceeded smoothly without problems. Admittedly, I had to constantly remind myself to focus on the patient throughout the operation.

“O, brother ko ‘yung susunod na kaso ha?” I said to the nurses as I was leaving, with a promise to stay away from the emergency operating room complex when my brother is wheeled in. (Here in the hospital, we have a constant fear of extensionitis, i.e., unexpected complications during surgery on a relative of any member of the medical team; likelihood increased when the doctor or nurse is observing the surgery)

I went straight to my brother’s hospital room.

“O, anong nangyari sa iyo?”

“Sabi na sa iyo, masakit talaga, eh.”

I reviewed his chest x-ray before eventually falling asleep at his bedside. Two hours later, my mother woke me up because the utility worker who would bring my brother to the operating room had already arrived.

My brother would spend the next 12 days in the hospital and undergo two surgeries before being sent home. While my father and my sisters provided funding, I made all the decisions. Every day, I would talk to the doctors and to the nurses. I did not want to be pushy, but I wanted to make sure that my brother received timely and the best possible care, like every patient should. I continued to fulfill my duties as a neurosurgery resident, converting my brother’s room into a personal call room. For the first time, our family would spend my mother’s birthday and my own in the hospital.

My patient was discharged after five days. He was fully awake with no weakness. In retrospect, if it had been a more difficult operation, I would have endorsed the case to another surgeon.

For most doctors, family and duty are two of the most difficult balls to juggle. Although I have decided this early that I would not be performing any brain or spinal surgery on my parents or siblings, I realized that my family is getting old; this is but a preview of things to come.

When I confided this fear to a brod and good friend, who is also counselor, he was quick to point out that the burden should never the be the physician’s alone. I may certainly be the first and the only, but there will always be other family members and friends who would be willing to help and lighten the load. That was good advice.

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29 comments

  1. Jo-Anne Lucero

    That must have been difficult. Hug!

  2. So true sir, the part about family and duty! My sister had dengue seven years ago, and it is only now that my pediatrician mother confided in me that she only had my sister’s cbc done once for fear of what the results will be. All knowledge would go out of the window, I guess. And for a doctor, I could imagine that the worst kind of call would be one concerning a family member’s illness. I hope your brother’s fully well now :) P.S. Thanks sir for the extra biochem review :)

  3. I admire your being professional to your patients, being filial to your parents and being a great brother too at the same time. You made a nice time-management, focus on your surgery while attending to the needs of your brother in those hectic times. And things went well. I hope your brother is well now. Godbless.

  4. similar circumstances twice recently :) today makes it thrice :)

    thanks so much for the timely article sir.

  5. Ang galing galing talaga ni ronibats kaya nga favorite kita eh next to papa willy ha ha ha

  6. So proud of you. I admire you and your family from the time I’ve learned about you in the “Five Valedictorians” article.
    Happy also to see your UP student number, you’re in the same batch ng aking nephew, at hindi lang the same batch.. you are in the same list of Oblation Scholars.

    Hope to meet you.
    As a Neuro doctor, you are one of a kind. I really want to see you.
    Can I?
    My sister needs a Neuro doctor, not just a Neuro doctor, but somebody like you..
    Kakaiba ka Doc.
    Hope I can be accommodated.
    btw – my sister is the mother of your batchmate.
    thank you.

    • Sorry po Ms. Laure but as a matter of principle, I do not accept consults through this website. You may bring your patient, if you wish, to the outpatient department of PGH for consult.

      • thanks Doc for your reply.
        yes I know that, we’re from Cavite and I just want to make sure sana na kayo ang maka attend sa amin.
        am she Doc.
        thank you very much.

  7. Family and duty…parehong matimbang…thanks for inspiring filipino people doc ronie…you and your family are an inspiration really…

  8. ang hirap non dooooc stress!! hats off to you!!

  9. You’re one of a kind Doc Ron. Like others, I became a fan of yours since I read 5 valedictorians. Hope your brod is doing well. Btw- your aunt Agnes is my high school classmate in Quezon.

    • i salute you for giving any and all situations the best that you’ve got.
      the long years of education were all worth it for your patients, the humble yet devoted upbringing by your parents, a source of pride and inspiration for humanity! God bless you dr. ronibats …

      • Thank you, Peachy. Just paying forward the kindness I’ve received throughout my medical education. :)

    • Thank you, Romy! :)

  10. marie bonifacio

    Wow. Thank you for sharing. You wrote your experience so vividly we could feel the predicament you were in. I’m going to pray for you Doc, that God will always give you His supernatural wisdom, strength and grace in all that you do.

    My son had multiple brain fractures and had to undergo immediate surgery last 2005. He is 100% well and I still pray for his doctors to this day. I will pray for you too : >

  11. F Francis Cid

    Nice article Ron. This will be the first of many. The advice you received is very sound. Over the years, I have had my fair share of situations where I had to juggle my time between patients and family. I felt the most pressure when my mom expected me to remove her cataracts. I did both eyes over two consecutive days successfully. Through all those times, I have relied on family to help me bear the burden of caring for them. I am lucky that I have a sister and a brother in law who are both physicians but many times, knowing that your family members are there for you counts the most.

    • Thank you po, Sir. I just hope my parents would not demand the same thing from me. One of my consultants has operated on her father. And the reason for doing so? She believed that she was the person to do it. Nerve wracking, I was told. And understandably so.

  12. Nice story doc.
    You should heed your friends advise and distribute the “load” :)
    Your replies on comments in this thread speaks volumes about your professionalism. Keep it up!

  13. I’m a nurse and I constantly get the, “you’re a nurse…. what do you think about… etc” – I can only imagine being a doctor. There are times I joke and say, “it’s my day off”.

    Thanks for sharing and I do hope burnout, in both cases, won’t happen to you.

  14. I’m still a med student but soon I’ll be the first and only doctor in the family. I’m aware that someday I will also encounter situations like this and though I’ve already formulated future plans and strategies, I think when the real deal comes I’ll find myself in one of life’s biggest dilemmas. I salute you, Neurosurgeon, ’cause your words reached me and I gained wisdom from your experience despite the fact that we are total strangers to each other. Thank you so much Doctor! I’ve been reading your posts and I’ve been extracting strength from them especially in the toughest circumstances. You inspire me.

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