Midnight in the garden of good and evil

Even before I finished training in medical school, I have already felt a calling to work in the world outside the hospital. The promise of attaining better and sustainable health outcomes faster by engaging populations rather than individual patients led me to the world of community development and public health. The overpowering atmosphere filled with sickness and gloom, hospital politics, and stifling routine hastened my footsteps away from hospital work.

But as I've began to spend more time in the university hospital again over the last few days, there's this unshakable nostalgia of my previous hospital-based life: the flurry of activity in the emergency room; the stress of rounds and reports; the need to devour books and journals; the camaraderie among overworked and underpaid fellow health professionals; the adrenalin rush of a toxic duty in the ward; the extremely sound sleep after a toxic duty. What I miss most is the almost unbridled interaction with individual patients, as they and their families put their lives in my hands and they take on the unwitting role of my mentor and teacher.

One of them I will never, ever forget.

He wasn’t the nicest of sights to behold. With his not-thoroughly-bathed elderly scrawny body, yellow to the hilt due to his liver disease, I opted to ignore him during my rounds with patients. He seemed stable and comfortable enough; my presence was warranted elsewhere. And so I went to the beds of the more “toxic-looking” patients who were endorsed to the team for closer monitoring. I thought I can avoid him- until his shaky voice pierced the already rickety peace prevailing in the ward-

Dok, hindi ako makahinga.

I rushed to his bed to check what was wrong. Gasping for air, he looked at me with eyes wide open; it was a plea for help more than an FYI. I calmly reassured him that everything will be okay if he only relaxed. Right. I then whipped out my stethoscope and listened to his chest for any problems with his lungs. His lungs seemed okay so I checked next his oxygen support. There were no kinks on the tube delivering the oxygen to this patient; the oxygen tank was delivering a steady flow of five liters of oxygen per minute. And yet he hollered as if on the verge of death-

Dok, hindi ako makahinga.

And then it got worse. His wife began to cry. I thought it was out of fear that her husband was dying. But no- she was crying out of sheer anger and frustration at having been left to care for her husband all by herself. She lashed out at her sisters-in-law for leaving her to care for her husband, their brother. It was a real circus: the wife seemed more distraught than the patient who managed to bawl out-

Dok, hindi ako makahinga.

Other patients were beginning to stir from their precious sleep; I was worried that those patients much sicker than this wailing couple will turn for the worse because of this undue stress. After I reassured them that everything was okay and that they just needed to breathe deep and easy, I started to walk away from the bed so I can check on the other patients. But then the patient proved his scrawny hands were not as feeble as I thought they were: he grabbed my arm and wouldn’t let go. I eventually peeled his hand off of me, while gently explaining to him that I had to go see all other patients in the ward because the entire ward is under my care. I reassured him that he was ok, that he just needed sleep, that his hollering was an unnecessary expenditure of energy. I adjusted his bed, I checked his oxygen support again, and I instructed his wife to immediately call my or the nurses’ attention should anything go wrong. I was not more than two feet away from the patient when his all-too familiar voice rang loud and true-

Dok, hindi ako makahinga.

Throughout the night we did this sequence around six times. He hollers. I go to him. I reassure him, check his lungs, his tubes, reassure him, ask the nurses to adjust his bed or his O2 support, instruct his wife to inform the nurse or me about any trouble, reassure them that they’re ok. I believe that I handled his “outbursts” pretty well; I managed to bury my exasperation underneath my genuine concern for his well-being.

However, I am human, I err.

After checking him for the sixth time that night (only to find yet again that nothing is wrong with him), I was ready to resume my rounds when he let out that awful, almost deathly moan of

Dok!

I snapped. I lost it. I shouted back-

ANO?

Salamat po, was his quiet reply.

Si Dok naman ang biglang di makahinga.

Originally posted in my old blog, October 13, 2003, while doing my clinical clerkship in the UP-PGH Department of Medicine.