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life lessons 101 in progress

life lessons 101 in progress

I’ve always wanted to become a doctor. My formative years were greatly influenced by stories of the men in white and episodes of E.R. I was eager to experience my very own episodes of Grey’s Anatomy, complete with all the interesting cases, hospital drama, and emotional soundtrack playing in my head.

But that was then. Fast-forward to today, where I find myself working in a tertiary government hospital where, everyday, we are greeted with suboptimal working conditions and huge patient loads. Kayod kalabaw.

I must admit I have turned into a grouchy person who easily snaps and bears his fangs at the slightest provocation. You know. It’s hard to put on a smile at 3am when you have been awake for more than 24 hours, you’re so exhausted because you’ve been running around like a headless chicken, you haven’t studied for an exam that same morning, and you have an unfinished report due that very day. All you want is to be left alone with the work you have to do. Like in my chosen field where, most of the time, the longest meaningful relationship I’d want to have with a patient is just as long as the time it takes to complete his or her abdominal ultrasound exam.

But every now and then, we’d get reminders of exactly why we do the things we do.

His name is Darren, an eight-year old kid from Bicol. His friends and family fondly call him Kamote, a term or endearment lovingly given by his grandfather. A cute little name for a cute little man. It’s barely been a month since I began my rotation in Radiation Oncology, a section in our department that deals with cancer patients.

“Ilan taon ka na?” I asked.

“Eight po,” he answered back, trying to hold up his right arm and feebly attempting to extend eight tiny little fingers. He had difficulty extending his right elbow, likely one of the effects of surgery to his brain. He had been diagnosed with craniopharyngioma, a benign tumor that has a malignant behavior.

He talked about his home and current living conditions, parts of the medical ordeal he went through, and his love for TinTin, his childhood playmate. He thanked us for being mabait, with the utmost sincerity only a child can show – a gesture which struck me because he barely knew us. We had only met a few minutes ago.

“Anong naramdaman or inisip mo nung sinabi nila na ooperahan ka?” I asked.

“Natakot po,” Kamote replied. “Pero tinalo ko ang takot ko para sa mga magulang ko.” My heart started to break. He said that with a smile, his face glowing as if nothing happened. Only the surgical scar by the hairline at the left side of his forehead gave clue to what this kid went through. His spirit was inspiring and his inner strength, palpable.

And just like that, my weariness went away. That heavy felling you get on your shoulders and the dull pain you feel in your legs and feet at the end of a tiring workday just disappeared. In the face of sleepless nights, of inhuman physical and emotional demands, and of incommensurate payoffs, this is why we do it. Why Surgery residents go on duties 3 or 4 days straight, giving beyond what’s expected of them. Why Obstetricians dedicate their lives in bringing new life into this world. Why Pediatric residents lose sleep, pumping Ambu bags which help their patients breathe. Why oncology specialists strive to make the lives of their patients better. And why most doctors miss out on family occasions, rushing back to the hospital to attend to their patients in need. Ordinary people doing amazing things. Darren is an example of the little things that make it all worth it.

“Bakit po kayo nalulungkot?” he surprisingly asked.

“Huh?” I quipped.

“Eh kasi po, bakit po namumula ang mata niyo?”

“Ah wala, yung hangin lang yun. Yung electric fan kasi nakatapat sa mukha ko.” I answered. Kamote smiled.

To all my brothers and sisters who have answered the same calling, here’s to more kamote moments.


About the author:

Toto Carandang, M.D. is a graduate of UERMMMC Medicine Class of 2003 and is currently pursuing post graduate training at UP PGH. Words and images are all Dr. Carandang’s.


Weathering the Storm


Image from the author’s original post

I woke up yesterday to the sound of rain outside my window and news that school and work had been cancelled. It had been raining since last weekend and parts of Manila were under water. I literally had to drag myself out of bed because we still had to go to the hospital. We still had patients to see and take care of at the Philippine General Hospital.

While a tropical storm above the northeastern waters of the country was enhancing the southwest monsoon and bringing heavy rainfall over Luzon, another storm was brewing.

My first patient for the day was Gibb, an 8-year old child who underwent brain surgery for a malignant tumor in his cerebellar region. He was scheduled for an MRI of his head and whole spine.

I saw his mother, Precy, hunched over in prayer, her fingers nimbly going through one rosary bead at a time. I began chatting with her about her son.

Gibb began exhibiting symptoms last year when his family noted that he was becoming cross-eyed. This eventually progressed until the little boy couldn’t stand or walk straight. They brought him to a private hospital in Cavite but decided to transfer him to PGH because of financial constraints. Something we usually hear from a lot of our patients.

Gibb soon underwent the operation he needed. Precy told me they had to use all of their savings and money given to them by her sibling for the surgical procedure. She used to work in manufacturing but had to stop. Her husband, Antonio, currently works as a regular contractual waiter in one of the restaurants in Manila. Both paid taxes. Both had very little. She said it cost them around 60 thousand pesos.

For the craniospinal MRI, Precy shared that she was able to get money from other relatives and from people in her baranggay. She said it wasn’t easy, but she was glad that they were able to come up with the money. I saw the sense of relief in their eyes when Gibb was wheeled into the MRI complex. It was another step towards getting better. Another hurdle passed. It cost them around 18 thousand pesos.

Like most cancer patients, Gibb and his parents were advised chemotherapy. For this, Precy had to approach people in government for help. And as people in healthcare know, it’s no easy task. The 34-year old mother had to secure requirements, papers, and had to take several trips to a number of government agencies and offices. It took her a number of weeks. Precy then began enumerating the Guarantee Letters she was able to secure: P10 thousand from Senator Pia Cayetano, P5 thousand each from Senators Recto, Marcos, and Trillanes, and P2 thousand from Senator Enrile. She also received financial help from her congressman, mayor, and vice governor. All of these, she said, will go to Gibb’s chemotherapy.

Aside from that, Gibb will also have to undergo radiation therapy. The young mother shared that for this, they had planned to sell some of their possessions like inherited jewelry. Papers for aid from PCSO and help from their governor were also being processed.

She sounded hopeful. She admitted that they didn’t expect to end up where they were right now. The whole process of giving their son the appropriate medical and surgical treatment he needed was long and arduous. She said they were tired. There were times she felt defeated. “Para ho kaming nanglilimos,’ she said.

Recently, Janet-Lim Napoles and the P10-billion pork barrel fund scam hit the headlines. I felt bothered, disturbed, and angry. As a tax payer, if things people have been saying are true, I am appalled with how my hard-earned money was ill-spent and allegedly stolen. As a Filipino, I am deeply bothered. I weep for my beloved nation.

If all of the allegations are true, I hope Napoles, her family, and all the other people involved can live a day in the life of our patients. Walk in their shoes. And see how difficult things are for most Filipinos, especially the marginalized ones. I hope they experience the panic and hopelessness our patients face when they are given huge hospital bills prior to a procedure. Or the discomfort of sleeping under the patient’s bed on cardboard mattresses. Or being confined in one of our wards instead of a luxurious suite, where privacy is almost non-existent and where every cough, cry, and sneeze is shared by at least 40 other people in the room.

There is now a movement calling for the abolition of the pork barrel fund. While I am for it, Precy’s and Gibb’s story reminds us of where part of our taxes go and the good that can be done if our financial resources are managed correctly.

Some people have been saying that P10 billion could have bought us new roads and bridges, built new school houses or railroad tracks, paid for badly-needed education or healthcare for thousands of Filipinos. I think that absurdly huge amount of money could have given us something equally important – hope. Hope that the government is investing in its people. That Big Brother has your back during your time of need. That politicians can put the interest of the majority before theirs. That things can get better – not just for some, but for all of us.

I usually just go about my business everyday, reading the headlines. Sure, I get bothered by the troubling things I see on the news. Predictably, I complain with my coworkers over lunch about how our country is going to the dogs, like a couple of rants on Facebook, and then eventually shrug things off. Like the pseudo-couch activist that I am. However, things resonate differently within me now. I’ve decided I’ve had enough and I feel I should do something, even if it’s a small thing. I asked Precy if I could share her story to which she agreed.

On August 26, Monday, people will gather in Luneta asking for an explanation from our government. I hope to be there. Things may not change and we may never uncover the truth. But I hope our voices will be heard. And hope, is hope.

Today, Tuesday, I woke up to the sound of rain outside my window. And while I prepare to go to work, I think about our countless patients like Precy, Antonio, and Gibb and the long journey they still have to take.

It’s still dark outside. A storm is brewing.


About the author:

Toto Carandang, M.D. is a graduate of UERMMMC Medicine Class of 2003 and is currently pursuing post graduate training at UP PGH. Our heartfelt thanks to him for allowing us to post his article on this blog.

Prescriptions & Prejudice


kindly include prayers as needed..

Part of what I do as an In-House physician in the hemodialysis center where I work is to review the patient’s list of medications and if needed, refill prescriptions for the said medicines, as we often limit them to a month’s worth as they may have to be changed later based on their response to the said medications. One time, the husband of a patient came to me asking if I could make three identical copies of his wife’s prescription. When I asked why, he reasoned that he was going to ask three different entities, namely, the City Health Service of the City of Angeles, the Philippine Charity Sweepstakes Office and the Office of the Governor, for the said medicines. Further reasoning that if all three gave him, he would have at least been assured of 3 months worth of meds, if not, he will just buy them instead. I pause and give a short sigh, but remember having read this letter from a woman who experienced prejudice firsthand, I would think twice before passing judgment.

Going back to the said letter, I was drawn to another website where it was also featured not to the article itself but the commentaries of the people who have read it. Some of them pointed out that true, there may be people who are actually in need of this kind of aid from the government, there are still those who abuse these kinds of things as well. Government aid, they argued, can be a bane or a boon depending on how we look at it and from whose perspective. Given the ongoing talks about misused funds and taxpayers money, I heave yet another sigh.

I remember when I was still a Junior Intern (or Clinical Clerk as they are known in some other institutions) during my rotation at the Out Patient Services, Charity Division of the hospital my then OPD resident told me to assist a patient to the Social Services office prior to their admission. The patient was a male in his early 20’s and with him was his father. Based on the planned surgery, he would be needing titanium plates and these would cost money of course. The question would be: will the hospital shoulder some or all of the medical expenses, given that this was a charity case. At the Social Service office he was asked routine questions about their family and the patient: Where they lived, source of income, etc. I was there so I know for a fact that the father claimed that he had no stable source of income, when lucky he would ply the streets as a tricycle driver. That they were living with relatives in Manila just for the time until the surgery can be done. He presented some documents for scrutiny, and after several minutes had his admission stamped with “class D” – meaning he was from the lower income bracket and was indeed qualified to avail of the hospital’s charity services.

So what has the above story connect with the first? It was only later when I went to see how the patient was doing when I accidentally overheard the father of the patient talking to another relative in the ward. He said, or rather boasting, that he wasn’t really poor at all, that they had just been from Hong Kong the month before, and that he just wanted to save the money he would have otherwise spent on the titanium plates had they known his real status in life. We have to be wise about these things he said with a laugh. I cringed. We all have been fooled, the people who just wanted to help, by some people who deliberately choose to deceive and get the upper hand.

What is disheartening most about this is not the fact that part of what was used to pay this particular patient’s hospital expenses came from our tuition fee as medical students, but that the same treatment could have been given to someone who actually did deserve and needed it. This happened several years ago, but with today’s current issues at hand foremost the circus that is the pork barrel scam still to find a resolution, I choose to abide by the oath that I have taken as a physician, and rather than be a critic, to just do what it is we hope to do best: to be a healer to the sick and afflicted no matter their race, creed or stature in life and hopefully in our own little way, be a catalyst for the change that we yearn for.

Smile Therapy

As doctors sometimes the work that we do becomes routine and mundane, but then something unexpected happens that makes us realize why we do the things that we do. The following is a status update on a colleague’s FB page. Couldn’t help but smile myself. 🙂

“at the clinic earlier, a patient who was biopsied back in 2011 and has seen a couple of nephrologists (and fellows) since comes in. She tells me that I gave her the best explanation regarding her condition ever. She had stopped seeing her doctors since late 2011 because they didn’t explain what they were doing and what they had been looking for in her labs. So yeah, I left the clinic and my smile was *thiiiiiiiiiiiisssssssss* big. hahaha”


About the author:

Tennille Tan, M.D. is a graduate of the UERMMMC College of Medicine Class 2005 and is a board certified nephrologist.

Chasing Dreams.. Again

[NB: This article was previously published in my other blog as chasing dreams sometime in 2008. This has been slightly modified and updated from the original article for this blog post]

nurturing the dream

While on board a bus in heavy traffic, this thought came into my mind: when we were still kids and the issues of global warming and the environmental concerns were already present, although not yet a tangible reality, we were told to plant seeds in the hope that it will one day become a majestic tree.

Needless to say, that was a long time ago.

Now all grown up, I realized that it was not entirely a lie but it was more of a half-truth if you please. I do not know if it was an oversight of my teachers then, but in hindsight and retrospect, they should have also taught us that it was not enough that you plant a seed and hope that it will grow. It should be nourished, taken cared of and even protected from the harsh elements. Or perhaps they were actually wise in letting us learn that fact of life for ourselves as we grew older. I will never know. What I do know is that seeds are pretty much like our dreams. It’s not enough that we have a dream, it should be protected, nourished, and nurtured until it becomes a reality.

And that’s part of the reason I am writing all of this again now. A good friend of mine once told me that his dreams of becoming a doctor are becoming blurry and his work in the hospital only make matters worse.

It pains me to know about his situation and not be able to do anything about it. He has the intelligence, the skills and most especially the heart and passion needed to be a doctor. Wait, no, a great doctor. All that bars him from being so is a piece of plastic that serve as proof that he has the license to practice.

How 1,200 questions divided among twelve subjects taken in a span of 4 days determines who is “qualified” or not to treat people of their medical ailments is not for me to judge. Why must his his dream of being able to help others through healing of the body and of the spirit so elusive in the first place?

During our freshman medical orientation talk, one of our professors told the story of a young and promising medicine student who wanted to quit his studies because as much as he wanted to become a doctor, he wanted to be a pilot as well. When he told his professor his dilemma, all he was told was “I don’t see anything wrong with that.” Whoever said you could not pursue both dreams? To make the long story short, the young doctor to be did not drop out of school, finished his degree and went on to pursue his other dream. The last time he saw him, our professor said that he maintains his private practice as a doctor while flying for a commercial airline twice weekly.

Likewise, I had the chance once to meet a fellow doctor that not only treats people with pills and prescriptions, but he also heals with the arguably best medicine there is: laughter. And no, he’s not Dr. Patch Adams, although I did have the pleasure of meeting him once when he visited the country. He is Dr. Carlo Jose San Juan creator of the medical comic strip callous comics.

But going back to my friend, he once wrote on his online post, that he was at a crossroad and had asked for a sign. In irony, I had hoped that he failed in getting the promotion so that he can be once again free to chase that dream of his. And I’m still hopeful that his dream will be realized one day.

Our dreams may be grand or otherwise, but what is important is that they are our dreams, not dictated upon us or simply borrowed from others. We may have others who share and support our dreams, but ultimately it is ours to fulfill.

The Sandwich, The Bananas and The Blind

image courtesy of 7bigspoons.com

A patient came in for follow up consult today after being confined in the hospital for elevated blood pressure. She was grateful that I took her case even though at the onset she stated that she did not have any money on her. I told her that if I didn’t take care of her when I did, she might have ended up with a stroke or worse a heart attack. Although she’s still not out of the woods yet she is thankful that she now knows what she has and with the right medications and motivation, she can still enjoy a rewarding life ahead of her. I told her that her consultation today was on me. She can pay me the next time she visits for consult. It was then that she said no, and gave me two bunches of bananas. She insists that she will pay me for my services as soon as she is able, that the bananas were a thank you gift. I could not say no and graciously accepted them.

It made me think of the time when I was still a clinical clerk (4th year medical student) doing rotations in the department of ophthalmology, I had come to see a patient who came in for consult at the outpatient clinics for a much needed eye surgery. When I saw her all she had was light perception, but if operated on there was a chance that she could see again. Being in the charity service, there was a lot of work to be done and papers to be filled out. I did all that I can to help her out. It took us almost half the day to finish, but it was all in a day’s work for me. She asked me what my name was and I told her. I won’t forget you she told me. And they went home to get some of the other requirements. I saw them a few more times in the OPD but then we were to rotate in general surgery already, so I never did know what happened to her after.

Until after a rather busy tour of duty, in the flurry of activity in the surgery quarters, someone called out my name and was handing me a package of what seemed like food. “Your breakfast” he said. “From who?” I asked. He mentions the name and in my half asleep, half awake state I realized that it was the name of the patient I had helped before. Apparently she was already admitted and was scheduled for surgery that day.

Eventually, I did find to time to visit her and see how she was doing. She was already in the ward, but still with bandages over her eyes. “Oh, it’s you” she said when I greeted her “did you get the food that I sent you?” I responded in the affirmative and advised her not to strain herself as she just underwent surgery. Again I thanked her for the kind gesture but she was quick to say that she was just giving what is due to her “doctor”.

At another time, as part of our rotation in the department of obstetrics and gynecology, we needed to complete a month of outside rotation from our private teaching hospital to a government institution, either at East Avenue Medical Center or at Quirino Memorial Memorial Medical Center. Half of the team went to the Quirino Questors while I was with the East Avenue Avengers.

At one time during my duty at the delivery room there was a patient who looked famished and asked, no she begged me actually, if I could call her husband for her. Since I couldn’t leave my post, I said no. But a feeling of guilt and sympathy took the better of me and I asked if there was anything else I could do instead. She said if it was possible for me to text her husband to bring her food. I obliged and a few hours later I found her eating a sandwich, presumably the one her husband brought for her. She had even offered me a bite which I respectfully declined, even if my body probably did need some form of nourishment as well. I was off to my other duties and between assisting in the residents, doing post op orders and generally just trying to survive, I never saw her again. She would just be another nameless patient I had encountered in my tour of duty, nothing of major significance. Or so I thought.

A few days before we were to leave the hospital I heard someone calling by an unfamiliar title “Doctor, doctor!” they said. It was a while before I realized who they were. It was the sandwich lady. I did not recognize her because she was in a much better state than when I saw her at the delivery room. For one thing she was cleaner and looked refreshed. And she did not look famished anymore. But the dead giveaway was that she could now afford to smile. “I’m on my way home. We’ve been discharged already. I just wanted to thank you” she said. “You were the only one who was kind enough to help me.” I was at a loss for words so just I bid them good luck and to take care of their most precious possession, but by the smile upon their face, I knew that whatever the day was still to bring, it was all going to be worth it.

They teach us all kinds of stuff in med school from how to diagnose diseases to what medications to give them, but here in the hallways of an understaffed overworked government hospital a patient has taught me that an act of kindness no matter how small or insignificant it may seem, goes a long way.

So whether it be a bunch of bananas, a packed meal, or simply just a smile and ‘thank you’ I will always be thankful to the patients who remind me why I chose to be in this profession in the first place and why I continue to do so.

Junior Intern On Duty

[NB: the following is an original article written by a batch mate  in medical school. We would like to thank the author for giving us permission to post the article  in this blog. ]

Maundy Thursday. April 8, 2004. 10:30 pm. 

It was my first week as a junior intern in UERM. I was doing my rounds in the Medicine pay section monitoring my patients’ vital signs when I got a message from the nurse that there was a patient who was transferring from the charity wards. He was JM, a 45-year old male, who came in due to bipedal edema of several weeks duration. He was previously diagnosed with Congestive Heart Failure, a condition wherein the heart could not pump enough blood to supply the body, causing him respiratory distress.

I did not attend to him right away as I was busy recording the vital signs of the other patients I was monitoring.

Maundy Thursday. April 8, 2004. 11:00 pm.

 I was in my station, 3 North 1, when Dr. Uy, the cardiologist of JM, together with Dra. Escasa, the medicine resident on duty, arrived to do their rounds. Guilty of not having seen the patient before their rounds, I was hesitant in handing them over the patient’s chart. I had no choice but to present it anyway. As they were discussing the case of the patient, I ‘slipped out’ to monitor the other patients assigned to me. However, Dr. Uy noticed that I, the junior intern assigned to his patient, was ‘missing’ and called my name. I reported right away. He asked me, “Have you seen the ECG tracing of this patient?” I answered honestly, “No, sir.” He showed me the ECG recordings and asked me to interpret it. I could not say a thing. Reading an ECG, a must know, was my Achilles’ heel. He was very kind for not humiliating me in front of everybody.

He then asked me, “Have you heard the patient’s heart sound?” I said no. He asked me to listen to his heart and come back and tell him what I heard.

I entered room 308, where the patient was confined. I saw an obese, dark-complexioned man lying on his bed. He was gasping for breath. A nasal cannula of an oxygen tank was attached to his nostrils. He was in moderate respiratory distress. He was sweating profusely and his skin was cold and clammy. His nail beds were cyanotic.

I lifted his shirt and placed the bell of my stethoscope over his chest to listen to his heart. I could not hear any heartbeat because his breath sounds were louder than the latter, thus, giving me a ‘noisy environment’. I used the diaphragm of my stethoscope but his heart sounds were overshadowed by his breath sounds. I did this for more than five minutes but I could not hear any distinct heart sounds. Then I went out of the room and reported back to Dr. Uy. I told him I could not hear anything so I could not describe his heart sounds. He accompanied me back to the patient. He auscultated the patient then he let me listen through his stethoscope. He told me to listen to the gallop sound. A normal heart sound is “lub-dub… lub-dub…” His was very rapid “lub-dub-lub-dub-lub-dub…”

Maundy Thursday. April 8, 2004. 11:50 pm.

The patient was a time bomb waiting to explode. I was beside Dr. Uy when he was explaining the condition of the patient to his relatives. Sooner or later he was going to have an arrest – he was going to die. That was the reason I have to monitor his vital signs hourly.

The relatives were faced with two choices if ever he went into cardiac and pulmonary arrest. Choice A was simple: Do Not Resuscitate. Choice B was to intubate him now so to avert a respiratory arrest and place him in the Critical Care Unit. His relatives were not sure if they would be able to afford his 100-thousand weekly hospitalization cost if ever he was placed in the CCU.

They were undecided.

Good Friday. April 9, 2004. 12:30 am.     

The patient was observed to have yellowish penile discharge. Pauline, a fellow junior intern who would help monitor some of my patients whenever my load was overwhelming, and I were assigned to get the tip of the patient’s Foley catheter for gram staining and culture. We were also instructed to put on a new catheter to monitor his urine output accurately. I was kind of excited since I had not done this procedure in my first week of being a junior intern. It would be my first time.

When the materials were ready, we entered the patient’s room. She told me that I was the one who was going to do the entire procedure, as she would be there only to assist me. I put on my gloves and told the patient that the procedure would be not comfortable. We were able to get the specimen and re-insert a new Foley catheter without much difficulty.

I also pushed Furosemide 80 mg IV, a diuretic, to help the patient urinate and lose much of the fluid he had retained which was contributing to his respiratory distress and edema.

Good Friday. April 9, 2004. 1:15 am.

I checked the patient’s vital signs which had not changed much. His BP was still 120/80 mm Hg, heart rate was more than a hundred, and axillary temperature was 36.5˚C. However, he was tachypneic as his respiratory rate was already 56 cycles per minute. His urine drainage bag was empty. He was diaphoretic – his two pillows and bed sheet were wet with sweat. I told myself that Dr. Uy’s assessment was correct, this patient was about to die soon.    I urgently referred his condition to Dra. Escasa, who promptly ordered another Furosemide 40 mg IV push.

Good Friday. April 9, 2004. 1:30 am.

I went to his room to check if he had urine output. There was none. “Did I insert the Foley catheter correctly?” I asked myself. Even his relatives called my attention to check if it was connected. I told them it was in place. I was sure that it was in his bladder. Pauline confirmed it. But the zero output despite the administration of two doses of diuretic agent made me wonder why he had not any urine in his drainage bag. I referred this matter to my senior intern.

Good Friday. April 9, 2004. 1:45 am.

A relative went into my station and informed me that the patient wanted to be nebulized. I checked his breath sounds but I heard no wheeze. I just explained to him that the reason he was having difficulty of breathing was not due to constriction of airways, which could be relived by nebulization. He was gasping for his breath because of pulmonary congestion. I told him that his heart could not pump blood efficiently so there was backflow of blood into the pulmonary arteries. It was causing fluid build-up, impeding proper expansion of his lungs for oxygenation of blood.

Good Friday. April 9, 2004. 1:55 am.

As I was going to leave the station to monitor JM, I saw Dra. Escasa approaching. She was now opening the door of room 308 and I immediately followed. As soon as we entered the room, the patient collapsed!

I sensed panic but I kept my presence of mind. I pulled the patient’s bed so I could go to the patient’s left side as Dra. Escasa was checking his heart and shouting instructions to the nurses, “Bring in the intubation and suction machine now! Call ECG technician now! Page Dra. Mabilangan now!”

A bloody frothy discharge came out from the patient’s mouth. She told me to do chest pumps so I immediately climbed onto the bed and knelt on his left side and performed chest compressions.

I could hear the relatives crying outside the room as the paging system announced repeatedly: “Dra. Mabilangan 3 North 1 NOW!” Dra. Mabilangan was the Chief Resident of the Department of Medicine. Announcing her name to go to 3 North 1, my station was a code that someone was being resuscitated. Seconds later she was inside the room. Some residents and senior interns were already helping Dra. Escasa in intubating the patient. A group of male junior interns were also outside waiting for their turn to do CPR.

The ECG technician also arrived and instantly placed the three electrodes to the patient. An ECG tracing showed that the heart was still contracting but failing. Epinephrine was administered while the residents and senior interns were intubating the patient. Chest pumps were resumed and after 20 or more pumps, I felt exhausted and I shouted, “Change!” Gio, the junior intern next to me, occupied my space and continued pumping. There were five of us alternating in giving him chest compressions.

A repeat ECG tracing done showed flat line – his heart was not beating anymore! Finally he was intubated but auscultation of the chest and abdomen showed the tube was in the stomach and not in the lungs. First intubation try was unsuccessful. A nasogastric tube was simultaneously being inserted to decompress his abdomen. It was now Yay, another junior intern, who was giving CPR as I pushed the sixth dose of Epinephrine.

After thirty minutes, ten doses of Epinephrine, countless chest pumps, a dozen flat ECG tracings and several intubation attempts, JM was pronounced dead by Dra. Mabilangan. All residents, senior interns and junior interns, exited one by one.

I remained inside as he was still my patient and my responsibility. He was the first person I had given chest compression, hoping that my effort would give him a new lease on life. He was the first person I had seen dying. All throughout his last moments, I was beside him. I silently prayed for his soul as I left the room to give privacy to his grieving relatives.


About the author:

Arbee Bascuna, M.D. is a graduate of the UERMMMC College of Medicine Class 2005 and is currently taking up residency training in urology at the St Luke’s Medical Center.

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