OUT ON PASS
Thaddeus C. Hinunangan, MD
Out on Pass is a borrowed term used in hospitals, where a patient is temporarily sent home for a respite, with promise to return for definitive treatment. Dr. Thaddeus C. Hinunangan is a physician by profession, and a writer by heart. His work was published in several anthologies and he also contributes to Philippine Daily Inquirer Opinion column.
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We met outside the hospital with essentials in our hands: syringes and blood collection tubes, consent forms, masks, alcohol, and a little bit of optimism. It was the 6th consecutive day of duty for Team A, and that day, Dr. Sandy Maganito, Sir Jang Amizola and I were tasked to go on pre-donation visits.
In the time of a pandemic where all public transportation is suspended, the blood needs of the hospital continues. Patients who are on chemotherapy, who have hematologic disease, people undergoing surgeries- they all need blood. Philippine General Hospital (PGH) also had begun doing plasma pheresis for compassionate use for critically ill patients battling Covid. The donation process, which used to be pretty straightforward and done at the Blood Donor Center in the PGH complex, now had to be done with online questionnaires, home visits, and bleeding at a safe venue outside the hospital.
With the recent successful plasma pheresis donation by Ian Frias, a seafarer from Diamond Princess, and two nurses Gale Arranz and Kai Soriano, the Facebook post had gone viral with more than 19,000 likes and 16,000 shares. My inbox was inundated with messages inquiring about the process of donation, where was it going to be done, how long would it take. There were messages expressing support, there were people who expressed intentions of donating food, medications, and equipment. The Bayanihan spirit was real!
We went north first, somewhere in the Fairview area. Our potential donor was a co-worker of the first male plasma pheresis donor who was inspired by the bold move of his coworker and wanted to help out as well. We arrived at a quiet neighborhood and was greeted by a man in his early fifties. He related his story about how they contracted the disease from a passenger who boarded from Hong Kong and the saga of his hospitalization in Japan. We examined his documents and explained the procedure. Next, Sir Jang our medical technologist, examined the potential venous access. Plasma pheresis usually made use of a large bore needle and a good access is needed for the procedure.
Next came the extraction for serologic tests. A torniquet was applied to his arm, the antecubital area was disinfected, and a syringe was used to extract around 10mL of blood. The blood was carefully transferred to the three vacuum tubes. Our work was done, we asked him when he would be most free to donate so we could schedule and arrange his transportation, and then we bid him goodbye.
The roads were thankfully traffic-free, but the journey was long. The sun was beating down the wind shied hurting my eyes. We turned on several roads because of barricades. After going around in circles around one particular area in Quezon city, we decided to walk to the house of the next donor.
There were men huddled in the corner next to the gate. They watched us suspiciously as we approached, seeing our kit which was concealed by an ordinary eco-bag. Our PGH IDs were hidden in our pockets. We rang the bell and was thankfully received at the patio. Our potential donor who was a doctor, was committed to donating his blood to PGH. We did the usual procedure.
By lunch time my head was throbbing. Lack of sleep plus the blazing sun, plus hunger was taking its toll. We found a fastfood drive-through that was open, so we bought our lunch, parked and ate the box of chicken inside the car. I took some medication and downed it with water. We were ready to the next donor.
This time it brought us to the Green Hills area where the first cases of Covid-19 transmission in Metro Manila was reported. Some of the roads were also blocked. The sky had taken an overcast shadow, gray and foreboding. When we stopped at the check point, we had no choice but to introduce ourselves to the guards and show our IDs to let us in. After a couple more searching, we found the building of our potential donor and proceeded.
The last two were in Pasig City and Cainta, Rizal. We also had some difficulty searching for the house of the potential donor. We finally found the narrow gate which led to an apartment complex. The door of the first apartment opened and Sandy was asked if it was the residence of the donor. Turned out it was the last apartment to the left.
The neighbor asked me curiously what was going on.
I took a deep breath, tempted to conceal, but I told myself this is an opportunity to educate someone. I said, “Are you familiar with Convalescent Plasma therapy?”
She shook her head.
I took my time to explain, because I knew the moment she figures out that one of her neighbors had recovered from Covid, they might dwell on the covid positive part. I emphasized RECOVERED and carefully chose my words. I even tried explaining what PCR was and why it was superior to lateral immunochromatography, but I think I lost her at that. I drove home my point: there is nothing to fear in someone who had recovered and already tested negative and has been asymptomatic for two weeks. So long as everyone observe the same precautions: physical distancing, wearing a mask, washing hands. I wanted them to be informed because lack of knowledge can turn to fear, and fear can turn to discrimination.
By the time we reached Cainta, we had to call our team mates in PGH. We might get home late. Sandy was on evening duty at 5PM, I was on duty the next day (or a few hours from now since its almost 2AM now as I’m writing this). Our team mates covered for us as we sped home.
Today was one of the most exhausting days so far. As the car went over the bridge, the sun was setting in the horizon, bathing everything in sight with a gilded haze. I smiled and wiped my forehead as I looked at Sandy’s wrinkled white T-shirt with the dust of today’s drive, and watched Sir Jang dozing lightly at the back. Five possible pheresis donors- not bad! It was a good day, after all.