That Saturday was cloudy. The waves were furious and the water not a clear blue. The medical station was under this tree that bred a million caterpillars that kept falling on us, so we had to find a different station. It was windy but the 150 new guests that day didn’t seem to mind. Miss Siren, the HR Supervisor, was a hands-on woman who oriented me with the place. It was the beach area where I would be stationed standing by for any possible injuries or medical concerns from our guests. Hmm, a *stretch* from my previous work on the island. When they started off with their team building games, I went double-hmm-it’s-a-stretch-from-my-previous-work.

I knew trauma seems to follow me, because within 20 minutes of going back to the station, a victim was brought to me. He was pale, confused and refused to move his left arm. Looking at his shoulder blade, I saw some hematoma formation but no deformity. I still considered a clavicular fracture and he was immediately brought to the nearby hospital. We later found out it was indeed a fracture and he decided to return to Manila to have his operation done there. Ulk. After that, there were no cases. And the guests didn’t push through with their Amazing Race activity. So sad.

Last Saturday was my 2nd weekend in this resort. Unlike the previous week wherein it was cloudy, the sun now was smiling down at me. The skies were blue, the pavement dry, the birds were singing and the water was calm. I had my breakfast in peace while reading my new Milan Kundera book. I later went to the medical station in the best of moods and smiling at my nurse. I couldn’t help but tell her all the positive things surrounding us – the sun, the calm water, the skies, the guests kayaking and taking pictures, and the white sand that was more obvious now than before.

“Oo nga. Ang pangit ng tubig ngayon!”

*blink. Blink* (huh?)

I forgot that my nurse is hearing impaired.

I felt so sad that most of my friends have left. I know the purpose of staying behind is to oversee the people left here. Still, I was too busy sulking.

So when I was fetched by a whole bunch of frantic people at 1:30am because Roy, a local teen, was stabbed, I instantly recognized that this was God’s challenging way of making me realize the purpose of why I had to be left.

Yes, God, I got it.

And as if God wanted to rub it in, He did it the subtle way.

On the speedboat ride to the capital city, I was constantly checking on Roy’s vitals and IV line. When I was checking his pulse under his sheets, Roy caught my hand and held it. I have held a lot of my patients’ hands before. I do this because I cannot give false hopes to my patients, but I can give them some sort of comfort and strength. But not too many actually initiate the hand-holding like Roy.

He held on to me. I squeezed his hand a bit and he stroked my hand back.

You’re welcome, kid.

Photo borrowed here.

On the speedboat ride back to the Land of Enchantment at 4am, I realized that I was semi-complaining this afternoon that I wasn’t able to see the capital city in 45 days and wondered when I would be back. Who would’ve thought it was only going to be within a few hours?

As soon as the boat slowed down as we approached the port, I looked forward to thoughts of a warm shower and a long sleep. However, what greeted us at the port was a frantic group of people.

Dennis, a 27 year old, figured into a vehicular accident. He used the boss’ car and apparently slammed on to a post. The door on the driver’s side was a wreck. The boss was the one who saw Dennis unconscious in her car. She advised Dennis’ friend not to move him. However, she left him momentarily to get help. When she returned, Dennis was missing.

I advised that we split up in 2 groups – 1 group who would be looking for Dennis, and another group fetching the Ranger so that we can use his facilities for whatever is was that Dennis would need. But searching for Dennis wasn’t easy. There was word going round that he was in hiding. Probably because he now realized what he did to someone else’s car. So we went around asking people.

Suddenly, a white Toyota corolla. I was suspicious, but then you can never be suspicious with all cars. When a number of people saw us behind the corolla, they immediately told us that they see Dennis was on the passenger seat. Our driver had to chase him and stop him. We finally convinced him to come with us to the Ranger station.

At the ranger station, Dennis was alternately unruly and calm. In other words he was his usual self when drunk. We strapped him on to a spine board and put him on a boat.

While all this was happening, he was saying things like, “Boss, I love you, but I’m broke!”

(Reason why he was hiding and refused medical care.)

Later, at the hospital back in the capital city, he was telling The Girl, “(The Girl), I love you, but I can’t afford your love!”

Mwehehehe!

Oh yeah, 3 visits to the capital city 45 days after first coming here, and all within a span of hours.

Rule of 3’s again.

Epilogue:
Roy was discharged a day after. So was Dennis. They’re both doing well now.

P.S.
Rob, I know you want to be a part of the story, but I couldn’t quite fit in there that you drove us around the capital city for a few minutes this particular afternoon. Peace!

At 1:30am, true enough, there was a knock on the door. I spoke in Tagalog thinking it was either Art Director or Adventure dude. However, there was no reply. I thought nothing of it and opened the door ready for some invitation to party. Instead, I see an unfamiliar face by the door – a local teen.

“Doctor, the police is looking for you. Someone got stabbed.”

That ended any thoughts of a party.

I told him that I would just change into something more comfortable and would be downstairs. Two minutes later, another knock on the door, this time with someone speaking in my native tongue. Since there were only 2 people who knocked on my door and that the night was quiet, I never expected to see some 10 vehicles parked downstairs of where I live with a crowd of people surrounding the vehicles!!

Whoah. You all panicked and came looking for me???

Roy is 17. He was stabbed on the back and has been coughing out blood since. He had some difficulty breathing but he was stable. I still advised on getting some x-rays and monitoring him since at that point nothing was sure.

During the speedboat ride back to capital city, he remained stable which was slowly taking away thoughts of an internal hemorrhage anywhere.

Upon arrival at the port, there was a new cause for me to be excited – I get to ride a real ambulance for the first time.

Our country prides itself on its health care and our skills as medical professionals. But there aren’t too many of these ambulances you see in 9-11. For the most part, we have vans that have been customized to be ambulances. So riding a real one for the first time in a foreign country got me excited.

But let’s set my ignorance aside now.

At the E.R., the attending was a Filipino anesthesiologist. It was thus easy for me to endorse the patient to her. However, the ranger said we should be leaving, hence, knowing what would happen to Roy would be something I would have to find out later.

On the way back to the port, I told my companions that back in the Philippines, a medico-legal case such as this wherein an injury sustained on the back signifies that the perpetrator has unsettled score with the victim. His fury is so bad that he had to do it from behind, like a form of betrayal. Like the secret enemy you wished you never had.

“Oh but here in (this nation), friends stab each other on the back.”

(To be continued)

tatawagin natin itong lugar na ito na naak, cavite.

may in-examine kami ni doc jiggs na isang nurse na naniniwalang nakulam sya dahil sa dami ng pigsa nya sa lugar kung saan ayaw mong magka-pigsa. tinapalan pa nya ito ng gumamela. marami nang mga doctor ang nagpahiwatig na gusto nilang pigain at gamutin ang mga pigsa nya ngunit ilang beses na nya tinanggihan ang mga ito. ako pa lamang ang babaeng doctor na nag-alok gawin ito sa kanya. nag-sales talk pa ako na kesyo magaan ang kamay ko, pero ayaw pa rin. binilog ko na lang ng konti ulo nya para man lang mag-simula ng antibiotics at para malanggasan ng maayos ang sugat nya. napapayag ko rin.

nakaka-gulat na may mga nurse pa pala na sumusunod sa mga kasabihan ng mga matatanda at naniniwala pa sa kulam.

mahirap tutulan ang mga ito dahil sa tindi ng paniniwala nila. sarado na ang utak ng iba. lalo na dito sa naak kung saan mayaman sila sa tapal…

… at ang kapitbahay ng ospital na ito ay ang bahay ng albularyo at tawak.

doc zoe: ano po yung tawak?

doc jiggs: yun yung manggagamot na naninipsip ng sakit.

doc zoe: ah, yung pag may bukol sa suso, sisipsipin yung suso…

doc jiggs: …o kung may pigsa sa pwet, sisipsipin nya yon…

doc zoe: … o kung may snake bite sa paa, kahit ang dumi-dumi pa nun, sisipsipin pa rin nya?

doc jiggs: ganon nga.

doc zoe: ew.

doc jiggs: pag ganon kasi, di mo na sila pwedeng kontrahin pa. e yung anti-venom natin ay ide-deliver pa from 20 minutes away. e kung pinigilan mo pa yung dala nilang tawak, baka ikaw pa ang sisihin ng pamilya, kesyo dahil di mo pinayagan ang tawak kaya namatay yung pasyente nila.

doc zoe: oo nga naman. may na-encounter ka na ba na ganon?

doc jiggs: oo. pinayagan ko lang, bahala na sila kung saan nanggaling yung paang yon at ang dumi-dumi… sasabihin ko na lang na pwede habang wala pa yung anti-venom pero di na nila pwedeng higupin yon pag nalagyan na ng anti-venom. syempre, papayaga na sila sa compromise ko.

doc zoe: nagkaroon ka ba ng case na kung san dinala na nga nila sa e.r., nagsama pa sila ng tawak sa e.r., ginamot ng tawak, tapos iinsist na iuwi na, tipong ginamit lang yung e.r. at yung tawak ang nag-take ng place mo?

doc jiggs: marami! minsan nga pipilitin pa nila na wag na lang magpalagay ng anti-venom kasi sabi ng tawak ok na yon. pag ganon, pinapa-pirma ko na lang. e di sila mapapakali kaya magpapalagay na rin sila ng anti-venom.

doc zoe: mostly ba ang kaso ng mga tawak ay yung mga natuklaw ng ahas?

doc jiggs: oo, yun talaga ang karamihan sa kaso nila.

doc zoe: bakit? may powers ba sila? as in, may powers ba ang laway nila?

doc jiggs: parang ganon na nga. hindi naman kasi yan ina-applyan. mana yan. kung tatay mo ay tawak, magiging tawak ka din. pag mamamatay na sila, dadasalan ka nila kaya may powers ang laway nyan. bukod don, may parang training din yan. kasi, example, alam nila na pag may singaw sila ay di sila pwede mag-sipsip, ganon.

doc zoe: ayos! buti na lang pala di ako pinanganak na anak ng tawak! may natutunan ako: na it really sucks to be one!
(pun not intended)

I went on duty starting on a Black Saturday and began with E.R. duty.

The next couple of hours was pretty much standard E.R. drama for me – 3 consecutive VA (vehicular accident) patients, a couple of UTI patients, a dog bite, a cat bite, a couple of vertigo patients, a probable dengue patient, and, to cap off my E.R. duty, a gun shot injury. That was it.
By 12 midnight, my partner took over E.R. duty and started Easter morning with a DOA.

Let’s retract a bit.

This, being a beach town, has seen a lot of drown victims, mostly out-of-towners on vacation on a holy week. In fact, just before I assumed my E.R. duty, the outgoing doctor has seen 3 consecutive drown victims.

There really is something interesting here. Notice that events have been happening in 3’s so far.

So we pretty much didn’t want to have 3 mortalities in our 48 hours of duty.

The man who was brought in (DOA) was another out-of-towner who allegedly died in his sleep. It was unfortunate that he died on early Easter morning while on vacation with his family… and we later found out, with his whole barangay. This truck…

…was filled with families who were on a vacation. I was told that these families had to pool all their resources so that they can rent this truck, go to this beach town and spend the night here. What was supposed to be a happy happy weekend for them ended abruptly and morosely.

That was taken at 1 or 2 in the morning. The staff and I were hanging out at the french fries/fishball stand right across the hospital capping off our night and welcoming Easter. And that was how Easter started for us – with coffee and death.

Come morning, my partner again received another DOA/drown victim, this time a 6 year-old girl.

(Still praying it doesn’t come in 3’s.)

By lunchtime, I assumed E.R. duty once more. Again, it rained with the unusual cases… just the way I like it. (I hate seeing another pedia patient with cough or another hypertensive oldie).

Then, my first interesting case of the night came – another VA patient. This time, a case of drunk driving and needing to have a CT Scan for a possible head injury and a possible eye injury. This hospital has nada. So I advised to have him transferred to another institution. They left willingly.

A few moments later, the nurse came in saying that a 3 year-old has just been brought in because he went curious and put in a battery in his nose. He was reportedly brought in 3 other institutions before he was brought to us. (Why would they even think we’re capable?) Apparently, the other 2 institutions lack the appropriate instruments for it and do not have an ENT on duty. Unfortunately, we have neither as well. In fact, our ENT resides in Manila, some 2 hours away.

Oh well, I guess the handy dandy paperclip MUST work this time.

After minutes of struggling with a very irritable 3-year-old, I was successful with extracting this…

….out of this kid:

He was understandably pooped after that.

I was prepared to have a quiet evening afterwards. However, while seeing a potential missed abortion patient some minutes after battery kid left, the drunk driving guy came back. This time, he was awake and lashing out at us, accusing us of lying about not having a CT Scan. He even accused me of being prejudiced. I asked security to take care of him. You can’t talk sense into a drunk dude. The last we saw of him, he drove off in a motorcycle leaving us with words of wisdom: “Makakarma kayo!”

But wait – didn’t all of this start with him driving that motorcyle? Sheesh. Good luck.

Then, almost at the same time, I was informed that my partner was having a difficult time with a patient’s father at the wards. Apparently, daddy couldn’t accept the fact that his son was for surgery whereas it was clearly explained to his family the possibilty of being operated, hence, his son’s admission.

Thank God for a quiet morning after that. We were able to sleep and not care about what was happening outside. What was noticeable was the lack of “fishball time” to cap off the evening. We just wanted to forget the lashing out at us last night.

However, we did have our 3rd mortality this morning. Once more, it was my partner who had to pronounce it at the ICU.

3 drown patients. 3 VA’s. 3 mortalities.

If I were superstitious, I would wonder what criminal act have I committed before I went on duty to set this off. But I’m not superstitious. What I am is well-compensated camper for this toxic weekend.

And that is what I left behind for the meantime. Now I look forward to a week of TV duty. Tee-hee!

This blog fell on 2.1.07
Bong is 19. He was working late with his cousin-in-law. Seated behind the driver of the 10-wheeler truck, he had his right leg up and was asleep. A van suddenly cut in front of them then stopped. The truck driver tried to avoid the van, thus, swerved and slammed onto a huge tree. Bong was thrown forward and sustained multiple lacerations, abrasions, and an open fracture on his right leg.

But that wasn’t the worst of it.

He had a straddle injury. Posting a picture here is too graphic. But to give you an idea what it looked like, he had this huge laceration on his man balls so that those balls were hanging out. The left testis was non-viable and had to be taken out. The right one was ok. You couldn’t appreciate a butt hole there because the adjacent structures were so damaged that it took some time for us to discuss how to reconstruct that whole perineal area.

We spent an hour washing whatever debris was present. Then, we started with wound debridement, perineal repair, anoplasty, orchiectomy of the left testis, orchidopexy of the right testis, drain. In other words, we fixed what needed to be fixed on the outside. That was Part 1

While the staff prepped the patient for part 2 of his surgery, our team had breakfast.

Part 2 involved creating a colostomy – a hole through the abdomen where the shit will pass through. Not very pleasant… But this was because we wanted to be assured that no fecal material will pass through the anoplasty, or else it won’t heal. This was also a controversial move (we learned that later). Anyway, we were done in 30mins. <oh yeah!…>

Part 3 was all about suturing the other lacerations. That was mostly me. In fact, when orthopedics came in for Part 4 which was fixing the fractured sites, I was still by his left elbow suturing a large laceration there. (It was kinda cool that I was there while ortho was doing his fracture on Bong’s right leg).

Epilogue:
It’s been 11 days since that operation. Bong is doing well but has undergone wound debridement on his right leg and scrotum 3 days ago. His remaining man ball is exposed. This was because when the service consultant for urology saw him 4days ago, he said we shouldn’t worry about cutting too much skin down there. At present, his general condition is getting better. He’s smiling more (which is a good sign), and most of his sutures are out by now.

Epilogue 2:

Bong was sent home eventually. And he lived happily ever after.

This photo got passed on. They assured us this wasn’t photoshopped and the one who took it was the chief resident of pediatrics. Although nuns aren’t an unusual site in our hospital, our nuns do not wear white and yellow, and certainly will not wear that inside a sterile area as the NICU which was connected to the operating room complex. They will wear a smock gown whenever they were in the premises.

Stories of the supposed nun surfaced since. There were stories of a nun walking through the O.R. complex doors. When a staff member or a doctor would go after her (it is a sterile area), they would discover that the nun would just disappear inside the complex.

Again, I’m not a fan of the supernatural, so I just thought it was interesting and just proceeded to focus on the next patient.

Remer stood on my right side while we were doing a major operation in the dead of  night. From my peripheral vision, someone walked past our operating room. Immediately, Remer whisphered if I saw that. He had a terrified look in his eyes. I replied with a quizzical look. He said it was a nun in white and yellow.

Uh-oh.

Having just completed a toxic 48-hour duty, I just realized the diversity of the patients I saw:

- A 68-year-old woman with a severe case of nosebleeding brought about by elevated blood pressure.

- A woman whom I suspect must be suffering from an incomplete abortion.

- A couple of vehicular accident patients.

- A patient with a stab wound to the chest.

- And the usual medical cases.

And then, I was in the operating room after the first 24 hours for a series of operations that lasted till the afternoon.

The events that transpired in the last 48 hours reminded me of a time back when I was a surgical resident when I spent 20 hours in the operating room complex. It wasn’t because of just one surgical procedure (although I have experienced that as well, but let’s save that for later). This was because of  6 procedures.

It was the last day of my clerks and interns. This batch was so memorable because they were tight.  And they were tight with me. Everywhere I went, they were there. They did paperworks the same time – and eventually, at the same rate – as I did. When I had my meals, they had it with me. When I woke up, they’d wake up as well. You get the picture. On their last day, however, things started to turn out to be toxic in the early afternoon.

That early, the whole surgical team on duty was divided in two teams doing procedures one after the other – 2 thoracotomies, a couple of appendectomies, an exploratory laparotomy, and a wound exploration. By 3 or 4 in the morning, we were all so exhausted that we slept for an hour in the operating room complex along with the anesthesia residents. Each one of us occupying a different table, stretcher, floor, or bench. Afterwhich, we resumed work and were done with everything by 10 am.

Doctors have their own superstitions. And it is in this case that this particular superstition involves the fact that it was the last day of our clerks and interns. We called it “The Last Duty Syndrome.”

However, as for my last 48 hours, I don’t know what particular superstition I will attach that with. Honestly, though, I wouldn’t want to associate it with anything.

Mr. S had this stab wound to the abdomen. The transected part of his stomach-bowel was anastomosed. And there is always that complication that it would leak, and it would usually happen on the 5th post-op day. On that day, his drain output was more than usual.

Possible leaking anastomosis? Maybe.

Normally, to be able to diagnose it, he would need an Endoscopy. But since this was a Service case and this is a third-world country, it would be better that the money he would spend for endoscopy be spent on medications and materials needed to hasten his recovery.

So guess what our ingenious plan was?

Gatorade. Grape flavored ha.

If it was truly a leaking anastomosis, his drain output would be purple after taking in Gatorade. And that was my responsibility that one morning.

And that morning, Rumer came in with breakfast.

I was telling him about Mr. S and the Gatorade plan intrigued him. I don’t remember who’s idea it was to see him, but we just found ourselves figuring out who he would be. And besides, why would be seeing our patient?

“Well, you can always be a Service Consultant.”
“In this outfit?” (He wasn’t wearing a long sleeved shirt.)
“You’re a Service Consultant, one whom we asked to visit the patient for second opinion. One who, with enough reverence given, would be convincing as a Consultant.”

And just like that, despite some palpitations, he went for it.
All he had to do was be all authoritative, pensive, and ask three questions:
1.    How old is the patient?
2.    How many days post-op?
3.    How many cc’s?

It’s that simple.

And he didn’t need to understand what those questions meant.

He even repeated said 3 questions over and over.

When he came in, he probably didn’t notice it, but Mr. S’s family stood in attention and gave him the same reverence I was giving him.

“How old is the patient?”
“37, sir.”
“How many days post-op?”
“5th day, sir.”
(pause.)
“How many cc’s?”
(Fumbling through my census, with a bit of panic) “50cc’s, sir.”
Rumer was nodding.
Awright!!!! He was so convincing!
Then I was demonstrating the ingenious plan with the Gatorade.
“How old is the patient?”
(Huh?) “37, sir.”
“How many days post-op?”
(Omigod!… what are you trying to do?) “5th day, sir.”
(Do not friggin’ ask how many cc’s!!!….)

He didn’t.

He was so nervous, he probably didn’t realize what was going on! When we were on safer ground, we were laughing our butts off at his performance!

Oh yeah, Gatorade worked. He wasn’t leaking. He went home safely after some time.