Outside that Room

March 13, 2017

Internal Medicine Rotator

I was outside the hemodialysis (HD) room, watching some videos on Youtube while waiting for my patient’s HD to start. A few minutes after I seated myself on a vacant seat outside, a woman came near me. I recognized her the moment she approached, she’s my patient’s mother. I could see her eyes weary, tired and full of questions. It takes only a few seconds to recognize a soul in search of answers to her endless questions. And this one is a definite example.

“Doc,” she started meekly, “Doc, tapatin niyo po ako.”(Doc please tell me)

“Po? Ano po yun, maam?” I asked, my earphones already removed for me to focus on her every word.

“Doc, ano na po ba talaga ang kalagayan ng anak ko? Di na po ba siya gagaling? Mamamatay na po ba siya?” (Doc, what is the real condition of my child? Will he still get well? Will he die?) her voice shaking with fear, full of anxiety over what she might find out.

I asked her to sit down beside me and calm down. Then I inquired how much does she already know about her son’s condition. She told me about it. It was a devastating event for their family, especially for her. Ace*, her youngest son, was diagnosed with Chronic Kidney Disease Stage 5 (CKD 5) last year at the very young age of 19. And now he would need to undergo dialysis at least 3 times a week. For the rest of his life. His condition is already a big shock to them, what more with the news of spending hundreds and thousands of pesos for his treatment. A few days before he was admitted, he developed edema on both feet, difficulty urinating, he started feeling weak and then had progressive difficulty breathing which prompted them to consult at PGH a month ago. They were admitted at PGH and it was then that he was diagnosed with CKD V. Hemodialysis was initiated and he started improving until he was discharged a a few weeks ago. They were advised on follow-up and to have Ace undergo dialysis in a nearby dialysis center at Bacoor. They had a hard time looking for a cheap HD center even when they use their PhilHealth benefits. And when they finally did find one and scheduled Ace for a dialysis, his symptoms started to recur, his body was failing again. It was then that they brought him back to PGH. 

I also learned that she was not around when the first event occurred, and it was Benjie* his second eldest son who told her everything about it.

“May sinabi lang po ang anak ko at di ko po naintindihan. Ang bata pa po ng anak ko, ba’t po siya nagkaganito?” (My son told me about it but I didn't understand. He is too young, why did he get this worse?)

Had it been a year or two ago that someone would ask me these questions, I might have been unable to answer that well. Gripped with nervousness and uncertainty of my answers, I might just humbly tell her how much I know and recommend that they talk to their doctor, the real one. Today, I will still be doing that: Answer what I know and tell them to ask their RIC (resident in charge) as well. But I am not that nervous anymore. I feel that I now have that responsibility as a member of the health team (at least, a part of it) weighing on me to tell her what her son’s condition is. And she as a mother, a close relative, at least have that right to know. And so I told her.

I told her about her son’s condition. I told her the little things I know: What CKD is, how it lead to that point, what are our options and that we are doing the best we can to help Ace. She had a few questions here and there, some I was able to answer and some I simply could not. She asked about what will happen to Ace now. And as painful as it may be for her, as much as I wanted to save her from that pain, I had to tell her the truth. It is her right to know, I told myself. I owe her at least that: to be honest to her, never to give her any false hopes. And so I did. I told her the painful truth.

There was a moment of silence between us...But no tears falling down. No weeps nor sobs, not even a whimper. All I could see were those sad weary eyes, deep in thought, trapped in an imaginary prison that I could never fathom to go in to. Perhaps her eyes were already tired of crying. Perhaps her heart had already known this fact, she simply needed someone to confirm it. And someone just did. And with a sudden sigh, she looked at me and slowly smiled.

“Salamat, Doc. Maraming salamat po.” (Thank you Doc. Thank you so much)

It was never easy to become a doctor. I am not yet one and I can already feel the weight of that responsibility. Had I known that it would be this heavy and painful...back when I was still deciding to take the NMAT... I might have reconsidered my choices. But Fate is not ours to simply decide on whenever we want it to be. It was Qadr. Predestined. It was Qadr that I am now here. It was Qadr that I met Ace and her mother, and the hundreds of patients I met, to teach me a lot of things. There is no turning back now. I no longer want to. I already faced a lot of battles wearing this hat and I have nothing in front of me but to push on. Fight on. Be the better physician I could be for the patients I will meet in the future.

Outside that same room, when Ace’s mother left me, I silently thanked Allah for this experience. And before I totally get lost in thought, the door opened and the HD nurse came out looking for me. 

"Sir," she said after recognizing me, "your patient's session is about to begin."

 I thanked her stood up. And then as if whispering to myself: “Another day. Just another regular day.”

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*Their names were changed for security ad privacy reasons.