they say that unforgettable moments occur on the most normal days. last monday, as I was still basking in the news that I passed the boards and the next big thing to do was read harrison's, I was faced with the reality that comes when you are actually a real doctor.
beware...this is really long.
my uncle (let's call him...Tito J) has been sick for almost a year and during the days when I was able to go home during internship I have been always asked by my relatives (who live next door), to give my opinion on what was happening to him. I remember them asking me why he developed pruritic generalized plaques during one of my post duty days to which I replied sleepily...
"anong kulay? parang silver ba? may dugo pag kinaskas? dalhin niyo sa derma ng pgh...zzzzzzzzzzzzzz. "
and then I told them to ask my tita (who was the "more" senior doctor in the family...dahil...siya ang nauna. hehe. ) what to do. over the course of the year and many post duty-duty-preduty days later I learned that Tito J has been lost to follow up in PGH, sought consult at a local albularyo, had himself checked at another government hospital, and was again lost to follow up there, and again sought consult with another albularyo for more...dahil wala daw nangyayari sa mga test niya at puro normal naman daw. so there I was lost in the world of internship while my aunt treated my uncle (who now refused any hospital based treatment) symptomatically for recurrent infections and edema.
tapos nagboards at kinain ako ng mga libro at nung minsan paglabas ko ng bahay namin...nakita ko si Tito J with 50% weight loss. i then told my doctor aunt who we will now refer to as Dr. Tita to convince my tito and his family to have him checked in a hospital, para ma-work up, etc. dahil at this point feeling ko...OMG. baka may cancer. and then Dr. Tita continually bugs them to bring him to the hospital buth for some strange reason my family has this thing against hospitals...meron silang pamahiin na...if you go to the hospital, you will die! so dahil doon...wala pa ring nangyari.
and then monday came....as everyone was hooked to their television screens watching the hostage taking...I was at home waiting to go out to our batch victory party for the boards while facebooking to kill time...at para rin magpatila ng ulan. and then, habang nakikinood kami sa kapitbahay ng pagbabato ng mga pulis sa windshield ng bus, nakasalubong pa namin yung isa kong tito dahil nagkakagulo na pala sa bahay nina Tito J. Soon we were all there to witness him having dyspnea at rest with a HR of 120s, RR of 60s and BP of 90/60. and Grade III edema. All my cousins and my aunt (na asawa ni Tito J...na tatawagin nating Tita N) pati rin si Dr. Tita ay tumingin sa akin at tinanong ako kung ano daw ang gagawin...I suddenly felt the world closing around me.
"BAKIT AKO?!?!?! WHY ME?!?!?! ISN'T THERE ANYONE ELSE WHO CAN MAKE THE DECISION?!?!? "
I could literally hear them wait in bated breath as I just stood there trying to make myself remember that I am a doctor.
...so I just pretended that I was in PGH and proceeded to examine Tito J and ask a medical history. I then remembered that Tito J had a massive MI 26 years prior, that he was hypertensive with poor compliance, and that he had a 40pack year smoking history and a diet full of fat. Then Tita N tells me that he has a family history of heart disease and that he has been having on and off edema for the past 3 months, poor appetite, 3 pillow orthopnea and PND, and Dr. Tita tells me he had an infection 4 days prior and she gave him Azithromycin. I then looked at Tito J and saw that he can speak in phrases, was awake and somewhat oriented to 3 spheres, with paper white conjunctivae, anicteric sclerae, + NVE, (-) TPC, (-) CLAD, ECE, dull and distant breath sounds, + fine crackles, + retractions, AP, tachycardic, (-) murmurs, flabby abdomen, NABS, (-) tenderness, faint pulses, pale nailbeds, (+) grade III edema, + leathery skin, (-) cyanosis.
As I was slowly examining Tito J, I calmed down considerably as I was systematically looking and examining him. Parang pakiramdam ko isa akong makina...na tuloy tuloy lang umaandar. Walang emosyon. puro lang tanong. The suddenly my mind was working fast...admit or not admit...bring to the hospital or not...basta at that moment, my mind was screaming...HINDI NYO NA KAYA YAN SA BAHAY!!!!!
So i told them they had to bring him to the hospital. then of course ayaw ni Tito J. Ayaw daw sa hospital. Dito nalang daw sa house. So sabi ni Dr. Tita, sige magbigay nalang tayo ng Furo....40mg IV then I said hindi pwede 40 dahil baka magdrop BP...at kelangan imonitor yan like q15 at baka maghypotension. So,I run to the house to get stash and msg HTGOF on FB to ask what I'm gonna do. I'm so thankful there were many people online because at the moment I felt so alone. Ang hirap pala ng walang pagrerefer-an na senior. buti nalang OSIIM si HTGOF...ahaha.
so, I then IV my super edematous uncle and thank God for the many patients in Burn and Ward 1 and 3 who taught me. and then I ask Dr. Tita again if we were doing the right thing. but she said we had to follow Tito J's wishes. buth! BUTH! my cousins and Tita N were now asking if we should bring Tito J sa hospital.
and now, I am so freakin TORN. ANO BANG GAGAWIN KO? Will I follow Tito J's wishes or admit him because HELLO?!?! dapat syang i-admit!!!!
Then, the logical part of my brain said, if this was your patient in PGH, what would you do? so I again reminded Dr. Tita that he had to be brought to the hospital. So biglang ok...to hospital of choice na ang decision. so now, they suddenly asked me if I knew any doctors pero mahirap talaga maging mahirap dahil ang mga pay hospitals ay PURE MAHAL. so we decided to bring him to a hospital not far away na private na maliit...at tapos nun nakahinga na ako dahil alam kong I have done my part. I-mamanage na siya sa hospital thank God. Thaaaaaaaaaaaaaaank God.
Then I texted my brods and sisses that I can't make it sa party at baha sa labas at dadalhin namin si Tito J sa ospital. As we neared the little private hospital I was so eager to leave Tito J there and have the responsibility taken off myself and when they suddenly told me na wala silang ICU....parang gumuho talaga ang mundo ko. SHEEEEEEEEEEET. what will I do now? Then Tito J's eldest son decides...we'll just bring him to PGH. at nag-alarm bells na ang utak ko! NOOOOOOOOOO. they're just gonna turf you to somewhere else. and I don't want to use extensionitis powers kasi hindi na ako parte ng PGH at nakakahiya. OMG. so I start texting my friends and ask for numbers of pay consultants while praying at the same time na sana may room nalang sa pay. I didn't dare show myself when we got to PGH the first time. I just kept texting people. and then...after a really long time. umuwi nalang din dahil naturf sa PGH at walang room sa pay dahil may dinalang na-hostage. BOOOOOOOOOOO.
I was going out of my mind with worry. I then saw Ate Smoketh calling me as I arrived home and I then didn't know what to do. HOW THE F#*% WILL I MANAGE A PT WITH MASSIVE PLEURAL EFFUSION AT HOME?!?!?!?!? She then told me, anong nangyari at nagkwento na ako...and then ate smoketh goes...q1 na ba yan? to which I tearfully replied...OPO! HINDI KO NA PO ALAM ANG GAGAWIN KO. and then ate smoketh tells me, make a decision. will you bring your tito to PGH...cause if you will....I'll call the POD. and pagtingin ko sa relo sa bahay...130am na bigla....and I remember the last time I looked at the clock ay 830pm palang.
At this point, I grudgingly drag myself back to Tito J's house to see him get worse. ngayon, may mga episodes of incoherence...gusto niyang magpapicture...gustong kumain...tapos natutulog. and then Dr. Tita tells me, what are we gonna do? and then Tita N also asks me...what are we gonna do? and then my cousins also ask me...WHAT ARE WE GONNA DO?
and I want to explode from the sheer stress I am getting. OMG. IS THIS HOW IT FEELS TO HAVE THE LIFE OF ANOTHER PERSON ON YOUR HANDS? Why weren't we trained for this? gustong gusto ko na at that point magpaka bratinella at magsabing dalhin niyo na kasi sa ospital at bahala kayo...pero at that moment I am reminded that I am now responsible for the life of Tito J. It's in the oath. It's part of earning that 6 numbers that will make you a licensed physician. F*@% wala pa nga akong license number. And so, I call Ate Smoketh to tell her that I will be bringing back Tito J to PGH and cringingly ask if I should wear my uniform.
5 minutes later, I am once again Intern BOTD, complete with red nameplate...and in my sheer stress I forgot that hindi OBAS ang pupuntahan ko kundi ER...at dapat scrubs ang suot ko....ngunith! naka-white ako. IKR! I get a small bag which I hurriedly fill with my remaining stash from internship...vials, foley, syringes, etc. I come to the ER filled with dread and my tail between my legs...so unsure and scared of having to resort to being an extensionitis because poverty sucks. I gather all the kapal ng mukha that I can and tried to talk to the triage officer who happened to be Jean-Duke P who shouts at anything that moves. I felt so stressed I literally had to call Ate Smoketh back crying kasi sinisigawan na ako ni TO Jean-Duke!
then, I talked to the POD, who called Ma'am K (the other POD), who I feel so indebted to up to this very moment for looking at Tito J. Then I felt I was an SIC again, with me running up and about the hospital facilitating labs and paying lab fees while BRP-ing in between. then I look outside and see that it was now morning. time for x-ray! only to discover that nasira siya nung scheduled time na namin. I just couldn't take it anymore. I needed to leave the hospital. I was so tired. tired of explaining why a post intern like me who just passed the boards is again wearing the white uniform. tired of explaining every single process and purpose of every single test. I had to go home. at least na-admit na si Tito J. Takot na takot pa ako noong unang umalis dahil baka hindi ko na-carry out lahat when I realized that...hindi nga pala ako ang SIC.
3 days later, Tito J was somewhat improving. i have learned na-thora na siya with 1.2 L of fluid aspirated and na BT pa...dahil 79 ang hgb!!!! I learned that he had decompensated heart failure secondary to IHD/HHD, pleural effusion B, resolved, anemia, multifactorial, and COPD. If he continued to improve, he would go home with an O2 tank and an NGT dahil pangit na talaga ang prognosis niya.
And then, after a day of pushing myself to read harrison's again for the impending pre-res exam that coming saturday...I learned that...nag-code daw si Tito J at 7pm. So once again, I rushed to PGH...and saw that he might not make it. After 10 mins pa bago na-revive si Tito J after the first code. When I got there, he had 60palp na BP and faint pulses. Reactive pa naman ang pupils. I was even able to bring his ABG and schedule his post intubation CXR (at 12mn pa dahil yun na ang earliest!) Then, nag-usap na about DNR at tinanong na naman nila ako...buti nalang sila na rin ang nag-decide na wag munang magDNR. When all of Tito J's children (those who were in the Phils) arrived at nakapagbless na si Fr. Barbero...nag-code na sya ulit. I then knew I had to be with Tito J until he left us. So, I volunteered to ambu-bag. Until 30 minutes later when he expired.
In the past two years that I have been working in the hospital, I have seen and have been part of the code team numerous times...pero iba talaga kapag kapamilya mo ang nawala. I felt so numb because I knew the doctors did everything but I also knew that my cousins will no longer have their father, and that my tita will lose the person she has loved since she was 10 years old. I will always remember seeing them cry because I have seen those emotions more than 50 times in people who I don't know. Pero ngayon na sa kanila ko nakita hindi ko maexplain. Parang gusto ko rin umiyak pero hindi naman pwede...parang gusto ko sabihin sa kanila na ganyan talaga kasi medically pangit na ang prognosis, masyadong matagal na walang oxygen sa brain pero hindi naman nila maiintindihan. So again, I felt like a machine, going around and discovering for the first time what happened to those patients of ours after they were cleaned up by the NA and wrapped in the green PGH linen. I went home at around midnight, after the funeral parlor claimed Tito J from the morgue, really drained and wishing there were still tears left for me to cry...but I just couldn't. I was too tired.
I was never close to my Tito J...but because of him, I will always remember this week. The week that I understood what it means to be a doctor.
Thank you so much to all those who helped my Tito J. Ma'am K, Sir G, Ma'am L, and Ate Smoketh, to the clerks and interns duty that night na nag-code si Tito J. I am forever indebted to you.
