Earlier today, I saw two of my brain tumor patients follow up in the Neurosurgery outpatient clinic. While both have made good recovery from their operations, their families’ worst fears had just been realized with the piece of paper that they brought with them, bearing the official pathology report stating that the tumor removed from the patient–as suspected from the start–was brain cancer.
Teenager Ofelia Reyes was born with a protuberant, midline fleshy mass at the junction of her lower back and buttocks. When her parents sought consult in PGH during Ofelia’s first month of life, the mass was assessed to be a myelomeningocele.
In this condition, part of the spinal cord and some its nerves, which provide sensation to and move the lower limbs, are exposed on the skin surface because of failure of the bony spine to develop completely. The parents were advised surgery to prevent the mass from rupturing and causing recurrent meningitis, but because of financial constraints, the patient was—as government physicians are wont to write in patient charts—lost to follow up.
In medical school, the pun I would hear most often when friends find out that I was interested in Neurosurgery was, “Vegetarian ka ba?” Used to the punch line that would come after (“Kasi lahat ng pasyente mo, gulay!” or any of its variations), I would just grin in response, without ever feeling the need to justify my career choice.
The joy of seeing your post-operative patients follow up in the outpatient clinic, feeling much better than before you operated on them, could not outweigh the helplessness you feel whenever you 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 linggo kung hindi pa rin po namin kayo tinatawagan.” (I am sorry but we still do not have a hospital bed for you. We cannot schedule your operation yet. Please come back after two weeks if we have not called you by then.)
“Inubos na namin lahat ng naipon namin para makalabas ka nang maaga. Sana, magbago ka na,” she said.
I was doing rounds in the Post-Anesthesia Care Unit (PACU or recovery room) when I overheard these words — a compelling request that was deliberately calm, in a tone with no vestige of anger, almost bordering on affectionate. I momentarily stopped writing doctor’s orders and looked up to see who was talking to my patient.
“Bats, tinawagan ako ng Student Affairs. Mag-submit lang daw ako ng requirements.”
“Ha? Bakit ako hindi tinawagan? Paano nangyari ‘yun?”
I was talking to A, my classmate in the INTARMED program. It was the first month of our first semester and we were on our way home. From UP Manila, we took the same bus, his stop 30 minutes before mine (or 60 minutes during Friday night rush hour). Also a class valedictorian and Oblation scholar, he would become my roommate and best friend in medical school.
“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.
On December 2nd of 2009, after having spent the last six months being a part-time teacher in Anatomy and Histology lab, I served as exam proctor for the first year medical students of ASMPH one last time. In a month, I would begin my residency training in Neurosurgery.
It was my job to assign rest stations for the move-type exam. In one of the rest stations, I put a box containing sealed envelopes for each of my students. “Get one. Open after the exam,” the instructions on the station said. Inside each envelope were a copy of Gusto Kong Maging Doktor Dahil, and a letter, that I am posting in full below.