abandoned

I heard on the news that a baby was found wrapped in a plastic bag, hanged on a tree. The people of the neighborhood came across the child because they heard a cry somewhere and followed it. Lucky that the baby was still alive. But thinking about this, whoever left her there, left her for dead. How can a mother have done such a thing?

It was one of those admitting days when you feel that all the people are sick. Our general medicine service was the admitting service that day of January. Mrs. Cruz came in for chest heaviness and difficulty of breathing. Before seeing the patient, we were given a heads up by her ER doctor that she doesn't have a companion, or bantay, with her. Of course this posed a problem with management. Who will buy her medications? Who will facilitate her laboratory exams? Who will consent to whatever procedure or directive she will need in the future?

Working in a government hospital, we've come to live with minimal resources and little manpower. "Overworked and underpaid" is something we tolerate everyday. The doctors are not just doctors. They become nurses, social workers and in Mrs. Cruz's case, her "bantay". She was then admitted in our female ward with the diagnosis of unstable angina- almost like a heart attack but not that severe. Her medications were shouldered by the resident in charge and by SAGIP BUHAY Medical Foundation, brought from the drug store by the intern-in-charge.

Three days after her admission, as we made rounds, we noticed that her breathing was more labored. There was fluid in her lungs upon auscultation. Blood exams and ECG were immediately done which eventually showed that this time she was having a heart attack- an NSTEMI. This is a kind of heart attack wherein the coronary artery is blocked partially. However her heart is having difficulty pumping out blood that fluid was beginning to fill her lungs. Her vital signs were still acceptable and the service started to diurese her to remove the fluids in her lungs.

Throughout her stay in the hospital, we asked her if she has a family member nearby that we can contact. She told us that she has 2 daughters. One lives in Nueva ecija and one lives in Laguna. When we asked her how they can be contacted because she needs to have a relative with her. She told us, with that obvious hint of bitterness, "hindi pupunta mga yun. Pinabayaan nila ako. (they will not come. They do not care for me)."

As the days go by, Mrs. Cruz eventually warmed up, telling little stories about her daughters. Eventually, she told us that she is estranged from her daughter in Laguna. She previously stayed there, lived with her, but they had a fight. That's the reason she left and became a vagrant along Manila bay.

Still, we have to contact the nearest relative. With the efforts of our social worker, she was able to talk to both daughters. The one from Nueva Ecija wanted to come and take care of Mrs. Cruz. But she didn't have any money for fare, so much so that her electricity was cut. She promised that she'll find some money, borrow some money, and come as soon as possible. Her daughter in Laguna was however firm that she doesn't want to come, despite the conversation with both the social worker and the doctor.

For us doctors, it was good news that a relative was about to arrive. It will mean less social work for us, and we can discharge the patient. We made rounds again and when we passed by Mrs. Cruz's bed, we told her that her daughter is coming to bring her home. To be honest, I thought she will be delighted to hear that. But with much pessimism, "hindi yun pupunta. Nakalimutan na nila ako (she will not come. They forgot me already)." "Pupunta po sya. Nakausap po namin. Sa sabado po sya dadating. At iuuwi nya po kayo (she will come. We already talked to her. She'll arrive this Saturday. And she will take you home)." Mrs. Cruz just shrugged and waved us off as she said she was having difficulty breathing talking to us.

Dawn of Saturday, our service was on duty. The ward resident was knocking on the door of our callroom asking for help to read an ECG tracing. It was a complete left bundle branch block. Seeing the name on the tracing, it was Mrs. Cruz's ECG. The events were quick to happen. She had sudden onset chest heaviness and difficulty of breathing. And now with the ECG, she has another heart attack. This time, a completely blocked artery, a STEMI. Running to her bed, her breathing was very labored. Her pulse was thready. And we cannot hear her blood pressure. Not only does she have a massive heart attack but her heart was not pumping blood, and she was in cardiogenic shock. She was immediately intubated, hooked on mechanical ventilator and given pressors (intravenous medications to increase the BP). Then we stood at the foot of her bed and stared at her.

Several questions were running in my mind. What else can we do? We were already treating her for her previous heart attack. And there was only one intervention left that can give her a chance- an emergency angioplasty. But this is very expensive and we cannot afford it. I cannot believe that I was at her bedside, watching Mrs. Cruz die.

Saturday morning came, and Mrs. Cruz's heart stopped beating. We performed advanced cardiac life support. Since there was no relative to provide advance directives, after 15 minutes, Mrs. Cruz was pronounced expired.

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As post-mortem care was rendered, the ward resident searched through her things to look for her admission card. As he opened her backpack, inside were several photos- photos of her daughters, her grand children, their family- these along with few pieces of clothing. It was a moment when we weren't sure what to feel. The resident simply closed her bag after finding her admission card. And filled up her death certificate. Mrs. Cruz was wheeled out of the wards and brought to the morgue. We informed the social worker of the events to relay to the family.

Mrs. Cruz died that Saturday morning. She died alone, in the company of strangers.

May 18, 2012

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“Perhaps family itself, like beauty, is temporary, and no discredit need attach to impermanence.”
-Gregory Maguire, A Lion Among Men