“Inday, kakalbuhin ka muna ha?” Eric Reyes said to her 13-year-old daughter Ofelia as she lay restless on the operating table. I sat at the head end of the table, scissors in one hand while the other adjusted and focused the light on her shoulder-length black hair. Her hair was dry and full of tangles. Grit and oil clung to my fingertips as I parted and divided her hair into locks, making the strands more manageable to trim. But it was full and thick nonetheless.
“Tatay, mas gusto mo bang kalahati lang ng buhok ang tanggalin ko, ‘yun pong sa kanan lang, o uubusin na lang natin lahat para pantay ang tubo?” I asked Eric beforehand, as we wheeled her daughter into the OR.
“Kalbuhin mo na lang Dok, para mas madaling linisin.” This response was not unexpected; he worked in the army’s reserve command, he told me. Still, I could sense regret in Eric’s eyes as he watched the strands fall in clumps to the trash bin underneath Ofelia’s partly overhanging head.
Ofelia was diagnosed to have multiple congenital anomalies at birth, among which was hydrocephalus, for which a ventriculoperitoneal shunt was inserted when she was three months old. At age two, she also had to undergo open heart surgery and a series of limb operations to release the contractures on her legs and feet. She only finished kindergarten and stopped schooling afterward, but she could communicate intelligibly with her family. She could not walk but she could feed herself, and for the most part, required assistance for daily living, provided by cousins, uncles, and aunts while her father worked as a gardener in the army camp.
Friday morning however, she suddenly complained of severe headache followed by intractable vomiting. By the time she was taken to our hospital, she was barely awake, muttering incomprehensible sounds with new-onset weakness of her left arm and leg.
Imaging showed a large cyst in the right side of her brain. It did not appear to be malignant, but it needed to be drained to relieve her brain of compression, hence the referral to Neurosurgery.
“Pang-ilan niyo po siyang anak, ‘Tay?” I asked in the wards during history taking.
“Nag-iisa lang po iyan, Dok.”
He kept staring on the floor and his shoulders hung low, far from the snappy military stereotype. He walked with a limp, too. But one only needed to notice the burnt skin and the calloused hands to unravel the story of paternal sacrifice.
“Kailangan po niyang operahan, ‘Tay. Magkano po ba ang dala ninyong pera? Libre po kasi dito ang kama at wala pong bayad ang mga doktor, pero ang mga gagamitin po sa operasyon at ang mga gamot, sa inyo po lahat iyon.”
“Limanlibo lang po, Dok.”
“Kung makakakuha po ba kami ng libreng shunt (which costs Php 12,500), papayag po ba kayong ipaopera siya?”
“Opo, Dok. Tulungan niyo po kami.”
That was Saturday morning. I was not on duty and had been anticipating to go someplace quiet in the afternoon, to finish my long overdue research protocol and shorten my list of unread books, neurosurgical or otherwise. Perhaps I could go home at night or share frustrations with good friends over alcohol.
But seeing Ofelia, I knew outright that the plans would have to be put off. Among all neurosurgery residents in the hospital, I was the one who knew her best. I took her history, I examined her, I talked to her father and explained to him the risks and benefits of our contemplated procedure. In the words of one of my consultants, “I am now the world expert on Ofelia Reyes.” There was no question about it. I had just made an implicit commitment to operate on her in the soonest time possible, lest she deteriorate beyond medical care.
Ofelia was lucky: the Pediatric Neurology service had one remaining piece of the type of shunt she needed. But due to the heavy traffic of emergency cases in the OR complex, it was already past 10 pm when we finally had the chance to bring her up for surgery.
No doubt, I was dismayed. It was another free Saturday lost, just like many other weekends that had come before. Despite being on my fourth year of residency training (“Senior ka na, big time!” my classmates would often exclaim when we pass by each other in the wards), I was still bound to the hospital when duty called for it.
“Wag ka malikot, Inday,” Eric tried to restrain his daughter’s non-purposeful flailing of extremities. I was not sure if she could understand him, but from experience I have learned that the sound of a familiar voice eased the pain and anxiety of patients drifting in and out of wakefulness.
Ordinarily, I would have waited until the anesthesiologist had put my patient to deep sleep before shaving hair, but the assigned resident at that time had to run to an emergency case in another wing of the OR complex. Since Ofelia barely moved her head, I decided to start. I wanted to finish the procedure as fast as I could, so that I could minimize the risk of infection later on.
As I put down my scissors and reached for the knife blade to shave Ofelia’s now trimmed hair, it occurred to me that I forgot to ask Eric one question.
“‘Tay, nasaan po ang asawa ninyo?”
“Wala na po, Dok.”
I stopped, left hand on Ofelia’s scalp and right hand with the blade in mid-air.
Suddenly, I realized that this teenage girl lying before me was the only remaining family Eric had. He could not afford to lose her, not after all the surgeries she had to undergo, not now, not this soon, not for something that could be remedied in an otherwise ideal health care system.
“Ano po ang ikinamatay niya?”
“Komplikasyon po ng diabetes, Dok. Dito rin po namin dinala pero malala na raw po.”
I continued shaving, exerting just enough force and pressure with each definitive stroke, calculated by experience to remove hair without wounding the scalp — an ancillary skill learned only from years of hard work training to be a brain surgeon. “Ofelia, pasensya ka na ha, konting tiis lang. Aalisin lang natin ang buhok mo para malinis tignan pagkatapos.”
“Game na tayo?” I asked the anesthesiologist.
“Sige po, ‘Tay, tatawagin na lang po namin kayo sa ward kapag may kailangan po kami. Huwag po muna kayong aalis ha?”
“Kayo na po ang bahala, Dok,” like what all family members say before saying goodbye, which they know — though they would not say out loud — could be their last.
I started at 11 pm and finished a little past midnight. As I wrote my post-operative orders in the chart, I had to remind myself that the date had changed.
When I did rounds in the morning, Ofelia was more awake, able to answer questions and follow commands.
“Dok, pwede na daw ba siyang painumin? Nauuhaw daw po kasi siya,” Eric asked, still in the humblest of voices.
“Sige po, susubukan po natin. Titignan po muna natin kung kaya na niyang uminom ng tubig paunti-unti.”
Ofelia’s bald top and crown reflected the sunlight which shone through the ward’s wide open windows. Sunday morning, and I could hear Bono singing in my head.
It’s a beautiful day.