“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.
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.