The joy of seeing my post-operative patients follow up in the outpatient clinic, feeling much better than before I operated on them, cannot outweigh the helplessness I feel whenever I tell the many others waiting in line for their surgery:
“Pasensya na po, wala pa po kaming bakanteng kama. Hindi pa po namin kayo maooperahan. Bumalik na lang po kayo pagkatapos ng dalawang lingo kung hindi pa rin po namin kayo tinatawagan.”
It still breaks my heart a little, every single time.
Neurosurgery residents of Philippine General Hospital do elective surgeries from Monday to Thursday, and emergency surgeries all day, every day, for as long as the patients who need emergency treatment keep coming to the hospital. That’s 1,000 to 1,200 operations in the charity service each year.
Despite the seemingly large figures, these are not enough. Our team just cannot accommodate all our underserved fellow citizens, who most certainly feel that they have nowhere else to go but PGH.
“Saan pa po ba kayo nakatira?” I ask my thirty-four-year-old patient with Cushing disease. The tumor at the base of her brain is causing her blood pressure and blood sugar to rise, her skin to develop violaceous stretch marks, pimples to resurface on her cheeks, and fat to develop on her face and nape while her arms and legs are growing thin. She has become prone to recurrent infections as well.
“Sa Catanduanes pa po, Dok.”
“Ha? E saan pa po kayo nanggaling niyan?”
“Nakikitira lang po kami sa kaibigan niya sa may Taguig, Dok,” her sister and companion responds. They have been living with her friend for the last four weeks, awaiting the results of their laboratory exams and imaging studies, and their schedule for surgery.
If one does the math, it is awful to realize how much more money patients would have to spend just to cover their everyday expenses for sustenance while waiting to be admitted in our hospital. And that is on top of the money I have asked them to prepare for supplies and medications that the patient will need for her operation and recuperation period.
Often, patients who come to the city for treatment lose the income from their livelihood in the provinces. The spouse would usually have to stop working in order to accompany the patient and make the necessary health care decisions.
“Nauubos na nga po ’yung panggastos namin, Dok.”
“Pasensya na po talaga. Kung pupuwede lang ho, ooperahan na po namin kayong lahat ngayon na, para hindi n’yo na po kailangang maghintay. Pero alam n’yo naman po, puntahan po talaga ito ng lahat ng pasyente sa buong Pilipinas.”
And it is true. I have interviewed and examined patients from Ilocos, Neuva Ecija, Mindoro, Cebu, Aklan, Davao, and Zamboanga. Even overseas Filipino workers forced by their employers to come home because of their newly diagnosed tumors or cerebrovascular diseases end up in PGH, desperately seeking treatment that would not have been affordable elsewhere. PGH may very well be their only hope for a cure.
I look at my watch. It is 8:30 a.m. and I am the lone resident in the outpatient clinic; everybody else is either in the operating room or attending the department conference. On days like this, sitting in my cubicle, I wish I could just snap my fingers and rid all my waiting patients of their neurosurgical illnesses. I try to compensate with empathy and sincerity, but it is always with a heavy heart that I explain to my patients and their families the long waiting time for surgery.
“Boss, ilan ba ang nakapila ngayon?” I ask the nurse at the receiving desk.
“Kuwarenta na ito, sir. Hindi ko lang alam kung ilan pa ang mga hahabol na chart galing sa ibang clinic.”
I have long resolved that I have no right to complain. I may be tired and sleepless, but so are these patients, who have had to endure fatigue and hunger to secure a queue number. They wake up and commute at the break of dawn to be able to spend five to ten minutes talking to a doctor, hoping to be given hope for a cure, or at the very least, an honest disclosure on the prognosis of their illnesses. Some even camp overnight along Padre Faura, just outside the hospital.
With extreme reluctance, I find myself in the same position as the PGH doctors in Arturo Rotor’s short stories. Three decades after Dr. Rotor published his collection, little has changed. I decide who gets sent to the ER (immediately life-threatening conditions), who gets admitted to the neurosurgical ward over the weekend (ideal surgical cases with enough funds for the operation), who gets to go home and wait for much longer (minimal impairment of daily activities). This is playing god, and I hate it. At the end of clinic hours, I always leave the room with a hollow feeling, like I have been forced to empty out all emotions so I could perform my duty as objectively as I could.
My next patient, a fifty-six-year-old female with a tumor on the frontal part of her brain, asks, “Dok, puwede ba akong magpagawa ng panibagong medical certificate at quotation (i.e., approximate expense for operating room and anesthesia needs)?”
“Bakit po, ’Nay? Ano po ang nangyari doon sa dati?”
“Nag-expire na po kasi ’yung pondo ko, Dok.”
She shows me her guarantee letters from the Philippine Charity Sweepstakes Office (PCSO) and some local officials. Indeed, today is past the validity dates indicated in the documents. The funds originally appropriated to her could no longer be used. She would have to ask for a re-approval, which would mean waiting in line. Again.
Patients who are unable to come up with cash for hospital expenses are advised to approach charitable institutions and politicians for financial assistance. They come back with guarantee letters, indicating the amount that can be deducted from the politician’s Priority Development Assistance Fund (PDAF or pork barrel) to be used for the patient’s treatment.
Usually, the amount allocated to patients is paltry, in the range of 5,000 to 15,000 pesos, which is certainly not enough to defray the expenses of a patient undergoing major surgery. Patients’ families would often have to approach several government officials to come up with the money they have been asked to prepare. Sometimes, they would come in with letters guaranteeing amounts of 20,000 pesos or more, and the families would later confirm my suspicion that they knew people “close” to Mayor/Governor/Congressman/Senator so-and-so.
Expired guarantee letters are not uncommon.
I pull out a blank clinical abstract form from my desk drawer and fill it out with the patient’s clinical information. I write a letter on a separate sheet addressed to PCSO and some local officials, detailing the tentative expenses she would incur.
“’Nay, pasensya ka na ha? Lakarin mo na lang ulit itong mga ito.”
I recall last night’s news and compute just how many patients I could have helped with ten billion pesos worth of pork barrel.
It’s a shame. If that amount, or even just a small part of it, had instead been used for the improvement of facilities and purchase of surgical equipment in regional hospitals, or to expand the health coverage of the marginalized so that their illnesses would not worsen only because, as they often say, “wala pa po kaming pera pampaopera, Dok,” how many families would have been spared from the unnecessary loss of a breadwinner, homemaker, son, or daughter?
The economic progress the administration is fond of trumpeting would have been more palpable, in the form of improved social services, to the Filipino people.
In another part of the world, Jeane Napoles is throwing lavish parties, flaunting her designer dresses and shoes, and posing with Hollywood celebrities, while my patients are waiting, dying a little each day.
The wanton greed is disconcerting. If only I could apologize to my patients for that, too.
Author’s Note: This was written at the time of the pork barrel scam involving Janet Lim-Napoles. An edited version of this article was later published in Inquirer’s Young Blood.