SATURNINO P. JAVIER, MD, FPCP, FPCC, FACC
Dr. Saturnino P. Javier is an interventional cardiologist at Makati Medical Center and Asian Hospital and Medical Center. He is a past president of the Philippine Heart Association (PHA) and past editor of PHA’s Newsbriefs
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In a country where a sizeable number of its citizens find home, career, and sources of livelihood in other parts of the world, the Philippines certainly has countless family units where the members are oftentimes physically apart.
Quite frequently, this geographical separation, defined by thousands of kilometres of lands and seas, becomes a contentious issue when it enters a physician’s decision-making.
Fortunately today, technology allows us to communicate with each other anywhere in the globe more frequently, easily, and cheaply. Facetime and Skype, and other applications, even allow families to see one another anytime and (usually) anywhere.
Yet, even with modern technology, nothing can replace the actual and real physical presence. As such, one of the most relevant questions a relative based abroad would ask the attending physician of seriously ill patients is – “Should I come home?” (or any of its related variations – “Do I need to file a leave of absence, must I cancel my planned wedding, do I forego my next month’s cruise, do I renew my contract to stay on”, among others)
This question demands and exacts many things from a Filipino physician. The Filipino physician practitioner is like a member of the family to his patients – given the close interpersonal relationship that physician and patient nurture through the years.
This is quite a unique bond brought about by the kind of healthcare system that we have. Many patients can have their own preferred physicians – because of out-of-pocket payment schemes – so anyone with hypertension or chest pain can choose to seek any cardiologist anytime and anywhere.
If the bond is well-established, the relationship is forged – for many years, across many generations and through family affiliations and extensions. This essentially means the bond extends to the parents, the children, the next of kin, the friends, the drivers, the maids, among others. The physician is the central figure of this bond.
Thus, when such a question like “should I come home?” crops up from a critically ill patient’s relative, this acknowledges the central authority of and accords the ultimate respect for the physician who is at the core of these extended bonds and generational patronage. Such a query invites a summary assessment of many issues – the short and long-term expectations of the clinical condition (or the prognosis), the disease progression, the course of the illness, the practicality and realities of the other issues on hand.
The question may seemingly annoy – as it implies that even personal or private decisions still have to be passed on to the physician. One can view such as seemingly sharing the burden of the decision, or even the guilt, with the physician.
The question is outright annoying when the manner of the questioning reeks of irritation and impatience – when it becomes obvious that the clinical condition of the sick relative has become an impediment to the relative’s regular course of activities and routines in the land of milk and honey.
Yet, the same question can also be filled with deeply perceivable honesty and sincerity – and one that really begs for help and guidance. One can understand the difficulty of the decision when such is made amidst the uncertainty of say, a recent job appointment, the complexity of procedures in filing leaves, the impact on the schedules of co-workers, the effect on sales quota, among others. These practical realities have to be taken alongside the demands of the clinical situation back home.
The physician is unarguably made the ultimate judge of one’s predicament. He becomes the final arbiter of whether families become whole before one’s demise, or a sick mother wilts onto the throes of death with only a housemaid by her side grasping her hand, while a son spends a cruise with a family in the Caribbean, a daughter tends to a family in Washington and another daughter attends to other critical patients in an ICU unit in New Jersey. He becomes the sole mitigating circumstance whether or not one cancels a wedding, purchases a ticket, and books a flight. Tough indeed!
How does one handle such scenario? This entails a balancing act – where the physician juxtaposes the inevitable with the foreseeable, the unpredictable with the relevant, the tragic with the ironic, the practical with the pragmatic.
Through the years, I have learned to keep the rules simple. I stick to the facts – from what I can medically speak of. Such will include the prognosis or the expectations, the possible complications and the current clinical status. The overall clinical picture needs to be presented to the relative – as this will enable him or her to make the final decision.
The competing situations can both be challenging and mind-boggling, or it can also be a no-brainer sometimes. Which one to choose? A sick mother or a trip to Peru. A dying grandfather or the graduation of a son. A terminally ill father or an 18-year-old’s debut. A daughter with leukemia or a job that pays for treatment of leukemia in the Middle East.
But there is always one thing I never fail to express. I make it known that I always encourage families seeing each other when one can still enjoy each other’s comforting arms, feel each other’s touch and caress or embrace each other ‘s warmth. When the logistics of travel, or the demands of the job, or the pressures of family can be set aside for a while, I make it known that I prefer one to come home to a conscious, breathing and smiling patient than to a comatose, unresponsive, life support- assisted patient.
Many times, the choice becomes clearer.
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February 2015 Health and Lifestyle