Ronibats.PH Stories of a Filipino neurosurgeon, teacher, and writer

Waiting, Wanting

W

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.

About the author

Ron Baticulon

Ronibats is a pediatric neurosurgeon, teacher, and writer. In 2018, he won a Palanca award for the title essay of his first book, "Some Days You Can't Save Them All," published by The University of the Philippines Press. You can follow him on Twitter @ronibats.

46 comments

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  • dr. ronibats, all throughout your writings you are very much the little prince grown up. with all that you see, experience, and ‘resign to’, i pray you do not grow old, worn out by all these vicissitudes. God always be with you!

  • Nakakalungkot talaga na mas nakararaming tao ang gahaman. Marami ring tao ang kahit alam na nila ang kalagayan ng mga hindi nakakagaan, pinili pa rin nilang maging bulag.

    Truly, many politicians are simply concerned for themselves. 🙁

  • Hi Doc Ronnie,

    I agree with you and it makes me sad and mad at the same time how difficult it is for common pinoys to have access to what are rightfully ours, adequate medical care among other things.
    It makes me feel so frustrated that it went for 10 plus years before someone had guts enough to break the silence. Politicians embroiled in the scam are studiously washing their hands by saying they don’t know their pdaf was used for fraud. Sus! If I know they have kickback on their “donations”. They should be investigated and if they have delikadeza, they should resign but no.. one is still featured in the boob tube about his “amazing stories”. Sad how my 32% of my hard earned money is being used these scumbags.
    Your stories and your genuine care for your patients really shines through with every posts that you make. I’m a fan 🙂 keep writing Doc Ronnie!

  • Nakakainspire talaga mga blogs mo doc. Dami ko pang kakainin para marating pangarap ko. Currently 2ndyear med pa. Reading your blog after having a study break from patho.

  • That is the sad reality in charity hospitals. When I was a resident, I would sometimes lose patience with my patients who do not come on their scheduled follow up dates or who are unable to have their labs done. The sad fact is oftentimes, they simply have no money even for transportation. Numerous patients would just go on HAA because all their cash has been used up. How I wish our politicians would have compassion and empathy on thousands of Filipinos suffering or even dying just because they have no access to medical care.

    • Kapag resident ka kasi Ma’am, lagi kang nagmamadali. Gusto mo na lang matapos na agad ang lahat ng pasyente, not realizing how much effort they exerted just to see you. For a time, I was guilty of that, too.

  • It’s also sad to read in the news that another hospital (hospital B) received far more government funds than the tertiary hospital we come from. Hospital B was ranked 5th among the recipients of aid from the government (amounting to P1B compared to the P180M they received the previous year). While I understand the need to upgrade facilities, the funds could have been better allocated to serve more Filipinos. Many of our local hospitals do not even have a complete emergency cart to resuscitate patients.

    • Usually, patients from far flung provinces come to us because the local surgeons turned them down: “Dok, kulang daw po kasi sa gamit sa regional.”

  • Grabe Talaga. Ang sakit Sa puso . Thank you for reminding us why this issue is not politic or not just a simple case of corruption that we all got used to hearing . It so heart wrenching your blood boils just thinking about it . Sadly this will all be forgotten soon . Sana Lang maramdaman nila Ang nararamdaman Ng Mga pasyente natin .

  • sa lahat ata ng sinulat mo…dito pinakasumakit ang puso ko. totoo siya..sobra. Yung mga doktor lang na pinalaki sa public hospitals ang makakaintindi at magkakaroon ng ganitong sentiments. marami pang kailangan i-improve sa health system natin…hindi ko rin alam kung bakit hirap na hirap yung government natin na makita yun.
    i’m getting a lot of comments that PGH or public hospital trained MD’s are masungit sa patients or balahura…they don’t get to see this side of us. miss u friend! catch u soon!!!

    • Yung mga doktor lang na pinalaki sa public hospitals ang makakaintindi at magkakaroon ng ganitong sentiments.

      Tama. Thanks, Diagene53!

      P.S. Nung intern tayo masungit pa ata ako sa pasyente. Haha. 😛

  • proud of you Doc Ronnie and your co-doctors there at PGH..
    really hurting ang situation ng mga patients that can’t afford..
    can relate sa kanila..
    Doc may msg po ako sa inyo last June 24, hope mabasa nyo din..
    thank you very much..

    • Sorry po, I have been very busy. As I have said before, I do not accept consults through this website. Please try to understand.

      • very sorry Doc..
        naintindihan ko po kayo..
        at alam ko din na talagang very busy kayo..

        actually po Doc hindi consultation ang aking message sa inyo, peru ok lang po kung hindi nyo na yon nabasa, naintindihan ko ang inyong schedules..

        salamat po ulit..

  • And you know another sad truth? Us doctors who are working our butts off are the ones being hunted/haunted by the BIR. It’s us who have sleepless nights when a px doesnt have urine output or has unrelenting fever. We are the ones seemingly on their target. It’s as if we are not giving enough of our hard earned income to the government. Sometimes, it makes you think if it has all been worth it.

    • Well, this is the life we chose, didn’t we? I have no objections against paying the right taxes, but the law should be applied uniformly to everyone.

  • my sentiments exactly sir when I first heard the news about this girl’s extravagant lifestyle. I can’t help but think about our charity patients in PGH, who have to endure long lines, heat and hunger just to make it to the “quota” for the day. And our other countrymen who go to sleep hungry and wake up the next day, still not knowing where to find food. how very unfair. 🙁

  • wow… same sentiment! This happens in all government hospitals… In our hospital we see a lot of cardiac patients in need of a surgery. Wala naman silang nagawang kasalanan pero pinanganak silang may butas ang puso…sira ang valve…and they just go into heart failure, become a burden to their families, and they just die. Kawawa. We could’ve helped them if only the government would provide more funds/resources to help these people! These people would’ve been very willing to contribute to our society… hindi tulad nung mga wala namang sakit pero kung maglustay ng pera ng gobyerno sa ibang bansa eh parang katapusan na ng mundo!

    I wish people in the government could read this article…including Napoles and other government officials who’ve been involved in scams…I still believe may natitira pa silang konsensya (kahit konti)….or kahit papaano matakot sila sa karma.

    • To do something repeatedly and without regard for the welfare of others, you would sincerely doubt if there’s any bit of conscience left in these people.

  • Next time a politician is hospitalized, their doctors’ fee should cost not less than a hundred thousand and then be donated to charity. How dare they call doctors tax evaders.

  • Hindi ko maalalang nagsusungit ka sa patients, pwede exasperated but never rude. Great job writing this ronnie! When i read today’s headline in the Inquirer, nalula ako sa figures. And my thoughts exactly, our patients in PGH, hindi lang hand-to-mouth existence e, fighting for their lives pa. Corruption is killing them indirectly. Pati tayo na din, hindi ko na nga makuhang magalit, nakakapanghina na sila e. Is there hope? Siguro naman…. I salute all the residents & staff of PGH! Kakapagod, yes! But you are offering a bright spot to our poor patients’ dark way. Kahit sing simple lang nang i-rewrite mo ang abstract nila ronnie!

    • Hi Ma’am Karen! I just hope something good comes out of this exposition. Otherwise, without action, it’s all just sensational news. Nakakahinayang kasi maraming puwedeng matulungan sa perang ninanakaw nila. At alam yun ng lahat ng doktor na nagtrabaho o nagtatrabaho sa government hospitals.

  • may your compassionate tribe in PGH increase!!!!… at the end of the day, patients do not only go to their physicians to be cured but to have someone who would take time to listen to them and provide comfort…. sadly, it is true that sometimes because of numerous tasks that tend to overwhelm, doctors tend to forget the patient’s LIFE stories, focusing only on the medical histories. I am very happy that you are doing your part in seeing and treating your patients as persons not just medical cases….and i hope that more PGH trained physicians would continue to serve the community and the poor after they graduate and have completed their government subsidized training … lastly, local governments should focus in improving and upgrading their own respective provincial hospitals… i hope for the day that communities nationwide would be assured of quality medical services in their own respective towns so that they do not have to endure being displaced and separated from their families because they have to come to Manila to get the proper treatment they need.

  • Hi doc! I came across your blog just now and maybe just a coincidence that I am suppose to look for someone else blog but it is yours that I saw. I never thought that you are writing blogs like this. I am actually the daughter of your SUPPOSE TO BE PATIENT but because of the delay and long wait to be at the charity ward we decided to have my mother admitted to other hospital. Honestly, I felt disappointed before by your service because I thought that doctors there don’t have any care to their patients. Maybe I just expected too much from you because almost all of our friends and neighbors recommended PGH because they’ve been there and according to them you are offering good and quality service. We pulled out my mother from a private hospital just to transfer her to PGH but unfortunately we had difficulty in having my mother admitted there. Maybe this is just a way to clear everything and to change my perception to the doctors of PGH. All along I thought that you are just concern for your own title and don’t even have a heart to your patients. Well sorry for that. I remember you last time, your temper almost rises when you saw that there are many patients waiting for your consultation and only few doctors are there to attend the needs of your patients. You even begged one of your patients to buy you a donut :-). During that time I also grew impatient from waiting that I raised my voice to you and as far as I can remember you also replied in a different tone of voice. To be honest with you, I’d been cursing you in my mind (Sorry for that) that time. After how many months that I have a negative perception to PGH maybe this blog explains everything. I pray that you and your team will keep your mission as a doctor and to always be empathetic to your patients. God Bless always to all of you!

  • A nice article Ron! Nakakakulo talaga ng ulo pag iisipin nga na marami na sanang tao ang natulungan ng pera na sana ay para sa tao. PDAF should be very well spent to those who need them, kaso nga, ibinubulsa lang eh. I am not losing hope that one day, the health care system of the Philippines will improve, lalo na sa mga taong wala talagang pambayad. Accessibility of quality medical care to all.
    Let us continue to pray for that…
    Marami pa sanang katulad mo….

  • So heartbreaking. My daughter, herself a medical student now on her clerkship, tells of similar stories that are just so terribly, helplessly, hopelessly full of human angst. While government flaunts astounding growth rates that in reality only impact the rich and never the poor, tens of millions of homeless and hungry people, sick to the core are begging for help. I am so enraged with this bweset kawatan Napoles and her minions and peers who steal government money for posh, hollywood parties, while these people remain suffering, untreated, even as young doctors such as this writer try their damnedest to deliver service at the detriment of their own health and well-being.

  • I read this article in the Inquirer just about the time I had my thyroidectomy at the PGH. I wrote about my experience staying in the paying ward section but failed to write about the insights I had of the other patients who shared their woes. . . Someday, I will try to do my share in giving back to the hospital and excellent team of doctors and staff of PGH and charity patients.

    Thank you Doc!

  • Thank you for sharing. This is very well and sincerely written. I am crying as I read an re-read your post. You are indeed a blessing to our poor country. Sana marami pang katulad mo. I tried to share your blog in my FB account and emailed the link to friends. Hope and pray that this article will touch the hearts of many people.

    God bless you and your team at the PGH. You are few and unsung heroes of our country.

  • If the Government does not heed on People’s request to have a clean, honest and sincere government for all, then, we, the BOSSES, should take it over and implement the necessary changes. I prefer to struck down and tear appart our current Government and start from scratch, rather than do some band-aid solution for our complicated problems. We should replace all of the people that are linked on this government and replace them with leaders that is patriotic enough to have an accountability to the people. I know for a country with 100 million, we can find one with this characteristics.

    Nakakasawa ng marinig ang mga ganitong uri ng korupsyon, na kung saan hayag sa lahat ang ebidensya at ang mga sangkot, pero sa bandang huli ay malaya parin silang ipagpatuloy ang mga maling gawi samantalang ang mga mahihirap ay lalong naghihirap. This is the time for general house cleaning that should be lead by the people and not by politicians.

  • hi doc,

    thank god for doctors like you. i have an intarmed son dyan sa UP Manila. Clerkship na siya. his name is grabriel ozoa. oftentimes, he will make kwento about his duty sa PGH. minsan naiiyak ako kasi awang awa ako sa mga charity cases nila.

    i always tell my son to serve his kababayans. return the service dahil eskolar kayo ng bayan. It was his birthday last july 18. he is now 22 years old. we gave him small amount of money to buy something for his birthday. my husband and i were surprised when we went to his boarding house right across the college of medicine building on his birthday to have dinner with him (doc, di na siya umuuwi sa UP Diliman campus, where we are staying) when we found out that the money we gave him was spent for medical supplies for his clerkship kasi daw wala talagang pera ang mga patients and pgh sometimes has no medical supplies (ie gloves, syringes, tongue depressor, etc.) he was busy arranging it (boxes by boxes) in his small room. he bought all these stuff in bambang. taking LRT in pedro gil. wish my son would soon become a full pledge doctor, para marami pa siyang matulungan. god bless you doc. wag kang mag sawang tumulong.

  • Just reading the few starting lines, I really felt bad. And it reminded me of this this doctor (forgot the name) I’ve seen in the news during a convention of all the doctors I think here in the Philippines… he was unable to hide his sentiments and cried. He wanted to help all the patients but it’s just that they’re undermanned and the patients were just overwhelming… this is the common scene in most public health centres.. I hope our government sees this issue and try to help our fellow Filipinos.

  • As I ended with the last word, my eyes let go of the tears. It’s not merely an article, but a manifestation of the unending reality confronting those in need and those who can give. This is the first time I came across your blog, and I sincerely thank you for voicing out their screams, no matter how they reverberate, and their outcry that are forever left unheard.

Ronibats.PH Stories of a Filipino neurosurgeon, teacher, and writer

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