What can be more dreadful than cancer, Alzheimer’s or other diseases that can cut short one’s life? A young doctor recalls his internship days, and ponders on this question. Strangely enough, despite the enhanced connectivity with cellular phones and all sorts of gadgets, people feel and act more isolated as they get consumed by the clutches of seclusion and self-interest, seemingly unmindful of opportunities where they can make a difference in other people’s lives
By Thaddeus C. Hinunangan, MD
At the crack of dawn, with barely tendrils of light peeking through the morning sky, the Padre Faura street entrance to Philippine General Hospital Outpatient Department was teeming with activity. Ambulances from as far as Cavite and Nueva Vizcaya dropped off their patients in stretchers and wheelchairs, while ambulatory patients sat on the pavement waiting for the doors of the OPD to open. Security guards were giving instructions, and warning patients about predatory fixers. There were patients for every department: pregnant women with their husbands in tow, toddlers having tantrums, masked patients waiting for their turn at the Cancer Institute, and orthopedics patients with their halos and metal contraptions that held their bones together while they healed.
And yet for all these people in one place, they barely spoke with each other. People were fiddling with their phones or making calls, ignoring others around them. It was every patient for himself. I made my way through the crowd to walk to my apartment and change clothes. I was an intern then on twenty-four hours duty. My uniform was crumpled and my hair a tangled mess. I needed to shower before the morning rounds.
As I crossed Taft Avenue, I noticed a homeless family who slept on the cold cement floor which was a parking area for tenants. At night, the space turned into the bedroom of this family of four, complete with a teenager who I saw once wearing a faded high school uniform and a three-year old. They owned a wooden cart and sold fried bananas during the day. The toddler stirred in his slumber, and went back to sleep beside his father.
Regrets and remorse
“Hello po, Ma’am. Ako po si Dr. Hinunangan, ako po naka-assign sa inyo,” (I’m Dr. Hinunangan, I was assigned to handle you.) I told my patient.
She hailed from Sogod, Southern Leyte a place close to my hometown so we shared the same dialect. Sometimes I would humor her in Bisaya, telling jokes and chatting about her family while I was trying with great difficulty to start an intravenous line. Patients who have undergone repeated chemotherapies are very notorious to have shrunken veins that are almost impossible to find. After four attempts, I finally got it and later on she would have her daughter text me even when I was assigned to a different department to start her line, which I would always oblige to do.
Her constant companion was her only daughter Marie, a dusky woman in her 30’s. She was Nel’s eldest, and was a mother of three herself. Finances had always been an issue and for the past four years that her mother had been in and out of the hospital, and it had been very difficult for them. Mommy Nel’s husband was only a casual laborer who barely made both ends meet.
Most recently her x-rays revealed pulmonary nodules, and Mommy Nel also had begun to experience low back pain with increasing intensity. The fellow-in-charge requested a metastatic work-up, and Computed Tomography (CT) scan was needed. I prepared her clinical abstract. By then their Philhealth funds have been depleted, and they wanted to try their luck with a charity foundation.
I once asked Mommy Nel what she thought about her illness. She tearfully confessed being regretful of the times she treated her husband harshly. She perceived her illness as punishment, and harbored a lot of remorse. If only she were given a second chance, she would be a better wife, she said…
Forgetfulness and isolation
“Thaddeus, when are you coming to the States?” Asked my last surviving grandmother.
She and her only daughter, our aunt, lived in California for the last four or five decades. She was a retired worker from Silicon Valley, and I met her a few times as a child and as a teenager when they vacationed in the Philippines.
Things unfortunately had not been always rosy after my aunt had a heart operation which put her out of commission from work and had forced the two of them to live on our grandmother’s pension. This was disastrous because of California’s exorbitant real estate and living expenses.
“Lola dito na lang po kayo sa Pilipinas.” (Grandma, just stay here in the Philippines) I would always say. We were trying to convince them to go home so they can stretch my grandmother’s pension by living in the relatively low cost of living in the Philippines. I was months away from taking the Physician Licensure exam back then, and I assured them even Tacloban City itself already had an army of specialists like neurologists and cardiologists.
My grandmother had early stage Alzheimer’s Disease. Once my brother had been worried because she had wandered away from their apartment while my aunt had an appointment with her cardiologist and my brother was at work. They found her in the park wandering by herself.
I knew from readings that Alzheimer’s was a long and insidious disease, but as time progress, her forgetfulness would worsen. We had been trying to convince them to come home instead to the Philippines where everyone in our family lived. But instead of giving a response, she kept asking the same question: “When are you going to the States?”
I got the latest laboratory results for Mommy Nel and it did not look good. The creatinine levels and blood urea nitrogen were elevated which meant she had serious renal problems. The CT scan, which would make use of contrast material potentially nephrotoxic was deferred.
Meanwhile Mommy Nel needed to be constantly on morphine to handle the pain. She also seemed to be very irritable, unlike her usual pensive self and she made a lot of jerky movements. Such is a sign when waste products in the body accumulate and start to irritate the brain. The only quick solution was hemodialysis, but it would require a cash deposit of 10,000 pesos.
The mood was heavy that day. Marie confessed to me that her family did not have any money. We had explored every avenue, from approaching local politicians to asking help from Philhealth or from charity, but to no avail. Briefly I even considered asking help online but so many of those posting on Facebook are frauds so I decided against it.
Later that day I ended up mentioning my patient’s case to my brothers. My brother told me I was too involved and too emotionally invested in my patients. A fellow intern told me I’ve done enough by helping with the paper works and the necessary steps for them to ask help from agencies, and that was enough.
My heart was heavy the next day when I learned that the family had decided to just bring the patient home. Without funds for the work-up or dialysis, there was nothing left to do. I sat down, made the necessary referrals to hospice care and co-managing departments, and my final entry on her chart. The next day, I hurried back to the ward to say goodbye to Mommy Nel and Marie, but when I arrived all I saw was a clean, empty bed. They had left in the afternoon the previous day.
So near, yet so far
Loneliness has been on the rise in the recent times, and strangely enough, in a world of enhanced connectivity. Never have we felt more isolated as humans, social beings by nature, become more consumed by the clutches of seclusion and self-interest. We care more about looking good on social media than how we do in our real lives and relationships. We want to appear to be in loving relationships when we are not, posting only for show, and not for genuine affection which need not be broadcasted. This is the more dreadful disease of the decade.
A patient’s death
One day, I received a message from an unknown number. It read: “Hello Doc. Anak po ito ni Nel. Pumanaw na po sya kaninang umaga.” (This the daughter of Nel. She died this morning)
Suddenly I remembered my patient with her pixie hair that grew in clumps from her last chemotherapy, her wrinkled hands, her quiet demeanor. During her last days her daughter said, she was unable to recognize her own family members. I could not help but cry, fearing for what might happen to our grandmother in a nursing home somewhere in California. We had lost touch after they chose to stay in the US.
I walked home by myself on the familiar street to my apartment and saw the homeless family by the parking area. The toddler was playing with his father, laughing with squeals of delight as he was lifted in his father’s brown arms. The little one had no perception of sorrow, and the only thing that mattered to him was the strength of his father’s arms which held him.
The homeless father glanced at me for a moment, as I stepped into the glass doors of the lobby. As I turned to give a last look, they watched me curiously as I gave them a polite nod and a smile.
“We care more about looking good on social media than how we do in our real lives and relationships”
July 2017 Health and Lifestyle