Category Archives: medicine

Dearly Departed

10 September 2020

2 Comments

I was standing in a small countryside cemetery. With me were seven other people, and we were hovering around a newly covered grave. It did not even have a tombstone or a headstone yet, just a temporary marker placed on its foot end.

It was a beautiful, warm summer day. Nice day to be out, though I’m not sure if there’s really a good day to visit a grave site. Near the cemetery was a small country church. Surrounding the graveyard which was on top of a small hill were endless fields of corn whose stalks were swaying gently with the breeze. Once in a while a car or a truck would whiz by the country road where the cemetery was located.

IMG_3674

Buried in the grave we were visiting was a work partner of mine. He was a little past the traditional retirement age but chose to continue working, although in a slower pace. Yes, he was working until the time of his sudden death.

Due to this age of COVID pandemic and physical distancing, we were not able to attend his wake nor his funeral, as his funeral was a family-only affair. Visiting his grave was the closest way to say goodbye to him formally.

I know he chose this small country cemetery which was off the beaten path because not too far from here was a farm that he bought. But instead of making it into an agricultural farm he planted trees and turned it into a little forest. He even had his colonies of honey bees in that patch of land. This is were he escaped to, which was about 45 minutes drive from the city, when he was not doing doctor duties.

He had a brilliant mind, and he delved into different interests. Besides being an arboculturist (forestry expert) and a bee keeper, he was also a certified scuba diver. These were among other endeavors that he had dabbled into. But most of all, he was a diligent and dedicated physician. His patients vouched for his passionate work and many of them claimed that they were literally “saved” by him when their lives were on the line. He was a great teacher too. He encouraged me to pursue my certification in Sleep Medicine.

He and I were the only Board-certified sleep experts in our group of 10 Pulmonary and Critical Care doctors. Perhaps we just love to sleep so we were both fascinated with the science of it. Now I am left to carry on.

We are missing him not just because we have become more busy and we’re down one body. It does not help that this COVID-19 is still running amok. In fact a week ago we were in the news as Iowa was the number one hotspot in the whole USA with the highest infection rate. We are missing him for his wisdom and advices from years of experience which we could use in this difficult time.

As I stood in that cemetery, I was thinking of my own mortality. What do I want to be remembered when I am gone? A bungling pianist? A slow but persistent runner? An amateurish writer? Or an OK (just OK) physician? Maybe a good father, I hope? Or a loving husband? Or a trust-worthy friend? How much time do I have to direct this narrative?

When I moved to Iowa and joined this group 16 years ago, I remember my first day at work. I was in the office and I finished early as I don’t have any established patients yet to see. I hang around in the clinic as in the last group I was a part of in Florida, they frown upon and make you feel guilty if you leave early, especially if the senior partner still have patients to see. So most of the time I would not go home until after 6 PM or even later.

But it was different in this new group that I joined. It was only about 2 o’clock in the afternoon, but I have nothing else to do on my first day. That’s when this partner found me still hanging around. He asked me if there’s any other patients I need to see. When I said no, he told me to go home and rest, and that I should spend time with my family.

My departed partner, it is my turn now to tell you that you can go home. Rest, and have a peaceful long night sleep.

(*photo is of a nearby cemetery where I live, not the site where my departed partner was buried)

A Room with a View

6 July 2020

6 Comments

Our planned trip to Canada this summer went kaput. Because of this COVID-19 pandemic, the northern border is still not open for tourists. Instead of giving back the vacation days that I already took, we scrambled to look for an alternate local getaway.

As we were booking for a hotel or a lodge, we were looking to have a room with a view. I for one is really particular of having a view. Even if I spend the whole day doing nothing, as long as I enjoy looking outside the window, that’s more than enough for me. Thus on many of our trips we hunt for a room with a view. And if we checked in to the hotel and we’re given a room that was different than what we imagined, we would request to be moved and not settle until we get the room that we wanted.

Who wouldn’t like a room with a view?

I don’t know if this can be applied when being hospitalized. First of all you cannot really pick your hospital room. Second, most hospitals don’t have a view. And lastly, if you do have a beautiful hospital window view then you may not want to leave at all, which is counterproductive.

I am not saying that hospitals should not have a good view if they can provide it. After all I believe a serene setting or view could be in itself therapeutic to patients. In our hospital we have a central garden with pretty flowers and some rooms overlook this garden. While a few of the rooms have a view of our city’s skyline. While many rooms in our hospital have brick walls for their view.

Recently, one patient of ours told me that he was surely glad that he was referred to our hospital. He was transferred from a small regional hospital to our tertiary medical center for further management of worsening respiratory status from COVID-19. He told me that besides the advance medical care we can provide in our facility, the view from his window at the regional hospital where he came from was not “reassuring.” In fact he said it was downright depressing.

A couple of years back, we started going to that regional hospital once a month, which is an hour and 45 minutes drive from our main office, as part of our outreach clinic, so I fully understand the comments of that patient. Across the street of the regional hospital is a very “serene” park, though it is probably not what you want to see when you are sick. The said hospital, believe it or not, is overlooking the town’s cemetery. That could be depressing. Though it could be an incentive to get better too, or else you end up across the street.

I remember a story* I read years ago about two hospitalized men who were sharing a hospital room. Both of them were suffering from serious illnesses. One patient was by the window and the other one was across the room. The one far from the window was unable to get out of bed, so everyday he would ask his room mate what he sees in the window. Every time the patient who was lying by the window would tell the other one the beautiful view outside. Like how the sun was shining in the sky, or the children playing at the park, or the pretty flowers blooming in the garden, or the ducks swimming at the pond. This lifted the spirit of the other patient and gave him encouragement to get well so he could go outside and see for himself the beautiful view.

Then one day the patient who was by the window died. The one across the room felt very sad for his room mate, yet he felt good at the prospect that he could transfer to the bed by the window.

When he finally got transferred to the bed by the window, he was terribly disappointed. Why? The window of their hospital room was facing a brick wall. No view of a park, nor of a beautiful garden, nor a pond.

He realized that his former room mate made it all up to inspire him and to keep his hopes alive. That hope that sustained him through his illness and pain.

The next day, there came a new patient who was laid in the bed far from the window. This new room mate ask him what he sees outside their window. To this he replied, “Oh, there were children merrily picking flowers……”

**********

(*Original short story is by Harry Buschman, “The Man by the Window.” I added the last twist.)

A New Normal

25 May 2020

4 Comments

I have been going to work now with a mask and a shield. No, I did not become Captain America, nor did I become an Avenger. What I meant is I’m going to work with a medical face mask and a face shield. This has become the new normal for me.

If I am going to do a procedure that is at risk of aerosolizing the virus, like putting an endotracheal tube or doing a bronchoscopy on a known or suspected COVID-19 patient, then I even use my “powered suit.” Not a powered suit like that of Iron Man, but it is a battery powered air-purifying respirator or also known as PAPR.

I rarely take my temperature before. Now, it is taken at least once a day and sometimes more. This daily temperature probe is not to determine if I’m ovulating or not, for the last time I checked I am a male. For your information, the “temperature method” is a family planning method that takes the woman’s daily basal temperature to determine if she is in her fertile or infertile periods of the menstrual cycle.

I am having my temperature taken whenever I enter the hospital, with additional screening questions of “Do you have fever, cough or shortness of breath?” If from the hospital I would go to the outpatient clinic building, I would get my temperature checked again and have the same screening questions, with an additional inquiry of “Were you exposed to a person with known COVID-19?” The last question is tricky to answer, for if I say yes, then they might not let me enter the building. But how else could I answer that question if I have just seen patients with confirmed corona virus in the hospital? Lie, if we must.

Photo by Ketut Subiyanto on Pexels.com

I don’t know if we have flattened the curve in our community. I am not talking about the bulge around the waist, for that has definitely ballooned more in many people with the stay-at-home order and the uncontrolled eating, plus with the gyms being closed. I guess a mask can help with this, as it is impossible to eat when you’re wearing a mask. But I digress.

We still have lots of COVID-19 patients in the hospital, though it maybe less compared to two weeks ago. Yet I still saw 15 COVID patients in the ICU this weekend, and many of them were on ventilators. I say it’s less, for at one point we had more than 20 COVID patients in the ICU and had a steady admission of 1 to 3 more a day. Good thing was many recovered fast, although some also died. There was also a time that we registered close to 50 admitted COVID patients in our hospital, both in the ICU and wards. So are we really flattening the curve?

Even though it is terrifying, we as physicians, have gained lots of knowledge and experience taking care of the critically ill COVID-19 patients. One thing we learned is that not all COVID patients with severe hypoxia needed to be on ventilators. Placing them on humidified high flow (pressurized) oxygen via nasal cannula can prevent intubation, and in fact they have faster recovery and less complications with this. Of course there are still patients that would require ventilator as a last resort, but we probably avoided more than half of our COVID patients from getting on a machine. Our experience in our hospital was extremely good that it was even featured in the local news. We might be publishing a paper on a medical journal about this experience in the near future.

Our hospital has also gained so much experience in placing patients on prone position if their oxygenation is failing. Never have I seen so many ICU patients on their belly. If the patient is awake and not on mechanical ventilator, we instruct them to lay not on their back if able. If they are sedated and on ventilator, we avail a team to flip them on their belly. And based on our experience, this really improves their respiratory status – belly down prevents them from going “belly-up.”

Photo by Miguel Á. Padriñán on Pexels.com

There are also interventions that have rapidly fallen out of favor, at least from our experience. Like giving hydroxychloroquine, the anti-malaria medicine, which we initially give to all our infected patients at the onset of the pandemic, but stop doing so. I don’t want to be political, but there is currently no robust data supporting it. We are also part of the on-going study of giving convalescent plasma to our patients, that is transfusing blood from a person that has recovered from COVID-19 and thus has presumed antibodies. We are also giving other drugs like Remdesivir and Tocilizumab, agents that are still under investigation. We are even conducting our own small trials using other novel drugs. At this time, no one really knows which medicine works. It might turn out that all of these medications are worthless.

As we open our communities more and more, I am anxious that we would see a second wave of infection. Yet I have to accept the fact that we cannot keep the world close indefinitely, for that is not considered living either. We just need to embrace the new reality.

For simple recommendations, first, we need to keep a distance from each other. At least 6 feet they said. But is that distance scientifically sound when we know that a sneeze or a cough particle can travel much farther than that? That is why wearing mask is helpful, for it protects us from each other if we cannot keep a safe distance.

So another new normal is that we need to wear a mask when going out. I know it is a barrier for communication as we cannot see the facial expressions when we talk to people. It is really bad for the deaf or for those who read lips. Probably good for people with bad breath, for they can be accepted back to the society. And perhaps sad for many, as we cannot see anymore each other’s beautiful smile.

Photo by cottonbro on Pexels.com

Lastly, no more handshakes. This act of shaking hands evolved from an era when nobody was trusting anyone, that people have to approach each other with an open hand to show that they were not holding a dagger as they meet. This developed into the custom of a handshake. Maybe now we need to greet each other with a bow, like some Asian cultures do. Or maybe a curtsy. That would be cute. Or perhaps some kind of a salute. Just not the “Italian salute.”

Stay safe everyone.

A Beautiful Night

11 April 2020

2 Comments

I did two overnight in-hospital ICU call in a span of three days lately. This has obviously derailed my circadian rhythm. Normally in our group of intensivists, a doctor only do 24-hour duty once a week or less. But this is not normal times.

So on the day I was off after my back to back calls, I woke up in the middle of the night and cannot sleep anymore. My body was fatigued yet my mind was awake. Instead of tossing and turning in bed, I got up and went to another room so not to disturb my wife who was fast asleep.

I pulled up a chair and sat by the side of the window and stared outside. The night was still and the moon was halfway through the horizon in the sky. The warm glow of the moonlight bathes the whole surrounding and it was quite enchanting. It was after all the super pink moon – the biggest and brightest full moon of this year 2020.

Ah, year 2020. Who could have predicted that this year would be this challenging? At my work we have more than 30 ICU beds, but with the predicted patients surge from COVID-19, our hospital has a contingency plan that we could convert other parts of the hospital into temporary ICUs and that we could potentially take care of 90 critically-ill patients on ventilators. The good thing is we have not seen that kind of surge like what is happening in New York City and New Orleans. At least not yet. I hope we never will.

We do have several confirmed COVID-19 patients on ventilators though, and they are pretty sick. But they are getting better, and the truth is many of them are getting off ventilators after a few days. Even our first ever confirmed COVID-19 patient that ended up on mechanical ventilator improved and got off of it after almost three weeks.

There were deaths though from this virus, even in our ICU and we cannot deny that. In fact the other night that I was on call, there was one patient that was a COVID-19 suspect and I placed him on a ventilator that night. Of course I had my full protective gear when I intubated him. Yet despite of our best efforts he died. But testing came back later that it was not the novel corona virus, but he had positive blood culture for a bacteria and he died from an overwhelming sepsis. People die from other causes as well, not just COVID-19.

As I gazed outside the window, I uttered a prayer for strength and protection not just for me, but for all the healthcare workers that continue to fight this battle. I also prayed for my family and all the families of frontliners who are at continued risk of contracting this disease from us when we come home. More importantly I prayed for the patients and their families that are going through such a woeful and difficult time.

The saddest part of this pandemic is that patients in hospitals are going through their ordeal alone, as family and friends are not allowed to visit them. And for those people who succumbed from this COVID-19, they die alone with nobody to hold their hands even in their last dying breath. It is really heartbreaking.

I looked at the radiant full moon and it was glorious. I observed that the light of the moon cast long shadows on the lawn from the trees. I was unaware on how the trees around us had gone so big and tall now. The evergreens that stayed lush and strong through the cold months and had survived many bitter winters. The deciduous trees that were currently barren but the leaf buds were beginning to appear for it is spring time after all, reminding us that life begins again. I also noticed that there were faint stars in the sky, though their light were subdued by the bright moon, yet they were twinkling whether we see them or not.

All in all, it was a beautiful night.

Photo by David Besh on Pexels.com

Then a thought came to me as if God was answering me. Even if we are going through the night, if we don’t dwell on the shadows and focus on the light, there is still beauty around us. Many times darkness heightens our senses to appreciate the light and other lovely things that we may have taken for granted. Yet the most reassuring thought is that even how dark the night is, morning is surely coming and a new day will emerge.

Yes, we may have lost many in the night and we should remember them, but for most of us, we are going to be alright. Have a blessed and meaningful Easter everyone.

Coming to the Dark Side

7 April 2020

2 Comments

Because of this COVID-19 pandemic, as a defense it is now advised that everybody wears a mask when going out. However, there is a shortage of masks available and other personal protective equiptment in many hospitals. Dark times indeed.

Thus, I’m wearing my own respirator mask to work.

“You are unwise to lower your defenses.” – Darth Vader

(*Warning: not a true protective mask. Rest assured for I am donning an officially prescribed PPE when dealing with patients.)

To Immunity and Beyond

29 March 2020

Leave a comment

(I was asked to do a 5-minute health talk for our local congregation. Of course our church is doing virtual service now, so it was on-line using Zoom platform. Here’s what I presented.)

In this time of pandemic scare, we can wear a mask to prevent the virus from entering our system. In the hospital where we have confirmed or suspected cases of COVID-19, besides mask, we also don gown, eye goggles, and gloves. But what happen if the virus breaks through these barriers and invades our body? Since we really don’t have good medicine to fight the virus, we have to rely on our immune system to fight it.

How can we then boost our immune system? Here are some basic recommendations that we all can do. Let’s talk about the NEWSTART.

N– nutrition. That means eating the right kind of foods. Scientific and medical studies have supported that eating vegetables and fruits can improve our immune system and of course our health in general.

The more colorful the fruit and vegetables – like red, purple, yellow, green -the better, which means they have more anti-oxidants. Antioxidants help repair damaged cells and tissues. Vitamins are antioxidants.

There’s some pilot studies that they are giving mega-doses of Vit. C intravenously in COVID-19 patients. For us, we don’t need Vit. C intravenously, just eat the whole orange or some strawberries. That will taste better too.

There’s also some data that N-acetylcysteine (NAC) helps boost our immune system. NAC is needed for our body to manufacture gluthathione which is a premier antioxidant. NAC is found in legumes, like lentils, beans and peas. You can get NAC supplement in stores too.

E– exercise. Now that it is not too cold outside, go for a walk. Use common sense though and follow the recommended social distancing. Still practice the 6 feet distance from the crowd or don’t walk in a crowded area. But we are in Iowa, we have lots of open fields to exercise. 30-60 minutes of moderate vigorous exercise can release extra immune cells into the system. Exercise will make you look good too.

W– water. The best and the only hydrating fluid you really need. Our body is about 60% water. The brain 70% water. So if they call you airhead, that’s bad. Waterhead? That’s fine. We constantly lose water in our sweat, urine, even through our breath. We lose more water when we have a fever. When we fight an infection, we need to be properly hydrated. Many of our systems needs adequate water to be functioning properly, including our immune system. It is recommended to drink 2 liters of water a day, roughly 8 of 8-ounce glass of water.

S– sunshine. The sun rays can boost our immune system. Besides helping us produce Vit. D, the sunshine can also kill germs. That’s why we place that stinky shoes under the sun to kill the germs and the smell. OK, you don’t have to give that look to your family member, just tell them nicely – how about let’s go out in the sun.

T– temperance. In other words self control. I don’t have to tell you that smoking and alcoholic drinks can be detrimental to our health. As you can surmise, smokers are more susceptible to lung infection.

A– air. Fresh air. Stale air has more CO2 content. We need to replenish the stale air inside our home. Go ahead open the windows. Or go outside and breathe in fresh Iowa air. I hope you’re not near a cattle or pig farm. Or not near somebody who is coughing. Oxygen which in air of course is essential not only for the immune system but for us to live. Practice taking deep breaths. Better yet exercise and so you’ll breathe deeply.

R– rest. We need to have adequate rest or sleep. It is recommended that an adult person sleeps 7-8 hours a night. I know many of us are not getting that. Teenagers who think they don’t need sleep, actually needs 8-9 hours of sleep. Younger kids even need longer hours. Sleep deprivation can weaken our immune system.

T– trust in God. Many scientific studies have shown that people who believe in a higher power, recover faster when they are sick. But we don’t need medical or scientific studies to tell us that. We know that our God is bigger than our world’s problem.

There’s a story in the news about an atheist Italian doctor, and with what’s going on in Italy, he became a believer in God. As the saying goes, there’s no atheist in a fox hole. It’s important that in times like these that we put our trust to the One who is still in control.

Stay safe and healthy everyone.

**********

PS: To get a glimpse of how our immune system fights a virus, you can read my previous post, “A Battle Within,” (read here).

(*image from astroyard.com)

Fearless

23 March 2020

14 Comments

I am fearless. But that’s not true. It’s not that I’m scared of spiders or cockroaches. It’s more than that.

I think we all know that we are in a middle of a war. The casualties from this COVID-19 pandemic continues to rise and it is devastating. More devastating are the news that healthcare frontliners are becoming casualties themselves. The news of doctors – from China, Italy, France, Indonesia, Philippines and more – dying from getting infected with the novel corona virus from patients they are trying to save, sends shivers to my spine.

I know there are risks from my chosen profession. From being overworked and being sleep deprived to being cursed by patients and being sued, that goes with the territory of our duties. I can live with that. But to risk your own life from contracting a possible deadly disease and even worse, to endanger your own family from passing on the illness at home makes me afraid. Very afraid.

For those people who are not taking this pandemic seriously and continues to party or not follow the recommended social distancing and community quarantine, or for those who think they are strong and invincible, please think again. If it’s not you who would be severely affected, it may be someone that you love that could suffer, because of your foolish actions.

Today, I came face to face with only my mask in between, with this deadly disease in our ICU. As I place an endotracheal tube to the patient’s passageways to hook her to a ventilator, I can only pray that my personal protective gear will be enough shield from this invisible enemy. Though I pray even more that heaven’s hand will be my shield.

I know this is only the beginning of my daily battle and confrontation with this foe. And it is expected that the worse is yet to come.

Fearless or not, I swore an oath to do this job. So help me God.

(*photo taken at Jardin du Palais Royal)

The Hero Who Told The Truth: A Tribute

10 February 2020

Leave a comment

The Wuhan coronavirus, also known as 2019-nCoV, has claimed its ultimate victim. Chinese doctor, Dr. Li Wenliang, the first one to raise the alarm of the spreading epidemic, died on Feruary 7 from the virus that he tried to warn the world about. Instead of heeding his warning, the authorities tried to silence him, as back in December last year, he was arrested for being the whistle blower who is ‘spreading rumors’ about a mysterious virus. Now we can only speculate if the course of the epidemic could have been different if his government had listened to him.

Dr. Wenliang continued to care for patients in Wuhan until he himself got infected with the virus and paid the ultimate sacrifice for his work.

I found a poem in Chinese that was translated in English circulating in the internet, claimed to be penned by the doctor himself. Though I cannot confirm its authenticity, yet I’m sharing it here in honor of Dr. Li Wenliang.

“The Hero Who Told The Truth”

我不想當英雄。
我還有爹娘，
還有孩子，
還有懷孕臨產的妻，
還有許多的病人在病房。
盡管正直換不來善良，
盡管䢛途迷茫，
可還是要繼續進行，
誰讓我選擇了這國這家，
多少委屈，
等打完這仗，
垂淚如雨仰天遠望。
“I don’t want to be a hero.
I still have my parents,
And my children,
And my pregnant wife who’s about to give birth,
And many of my patients in the ward.
Though my integrity cannot be exchanged for the goodness of others,
Despite my loss and confusion,
I should proceed anyway.
Who let me choose this country and this family?
How many grievances do I have?
When this battle is over,
I will look up to the sky,
With tears like rain.”

我不想當英雄。
只是做為醫生，
我不能眼看著這不明的病毒，
傷害著我的同行。
還有那多無辜的人們，
他們盡管已奄奄一息，
可眼睛裏總望著我，
帶著生命的希望。
“I don’t want to be a hero.
But as a doctor,
I cannot just see this unknown virus
Hurting my peers
And so many innocent people.
Though they are dying,
They are always looking at me in their eyes,
With their hope of life.”

誰成想我競死了！
我的靈魂分明在天上，
望著那張白色的病床，
床上分明是我的軀體，
軀體上還是那熟悉的臉龐。
我的父親母親在哪？
還有我親愛的妻子，
那當年我苦苦追求的姑娘。
“Who would have ever realised that I was going to die?
My soul is in heaven,
Looking at the white bed,
On which lies my own body,
With the same familiar face.
Where are my parents?
And my dear wife,
The lady I once had a hard time chasing?”

天上有一道光！
那光的盡頭是人們時常說起的天堂。
我寧願不去哪裏，
我寧願回到武漢我的家鄉。
那裏有我新買的房子，
每月還要還貸的賬。
我怎能舍得，
我怎能舍得！
沒有兒子的爹娘，
該有多麽悲傷；
沒有了丈夫的寶貝，
該如何面對這未來的滄桑。
“There is a light in the sky!
At the end of that light is the heaven that people often talk about.
But I’d rather not go there.
I’d rather go back to my hometown in Wuhan.
I have my new house there,
For which I still have to pay off the loan every month.
How can I give up?
How can I give up?
For my parents without their son,
How sad must it be?
For my sweetheart without her husband,
How can she face the vicissitudes in her future?”

我分明死了。
我看見他們把我的軀殼，
裝進一個袋子。
在袋子的近傍
有許多死去的同胞，
象我一樣，
在黎明時分，
被推進火的爐堂。
“I am already gone.
I see them taking my body,
Putting it into a bag,
With which lie many compatriots
Gone like me,
Being pushed into the fire in the hearth
At dawn.”

再見了，難舍的親人。
永別了，武漢我的故鄉。
但願你們在災難過後，
還記得曾經有人，
努力地讓你們盡早知道真相。
但願你們在災難過後，
學會正直，
不再讓善良的人們，
遭受著無盡的恐懼，
和無奈的悲傷。
“Goodbye, my dear ones.
Farewell, Wuhan, my hometown.
Hopefully, after the disaster,
You’ll remember someone once
Tried to let you know the truth as soon as possible.
Hopefully, after the disaster,
You’ll learn what it means to be righteous.
No more good people
Should suffer from endless fear,
And helpless sadness.”

“那美好的仗我已經打完了，
應行的路我已行盡了，
當守的道我守住了。
從此以後，
有公義的冠冕為我留存。”
《聖經》提摩太後書4．7
“I have fought the good fight.
I have finished the race.
I have kept the faith.
Now there is in store for me the crown of righteousness.”
2 Timothy 4:7

Hospital, Cafeteria, and Sanctuary

26 January 2020

Leave a comment

I was in charge of the ICU that day and it was quite busy. Though it was not that up-to-my-eyeballs hectic for I still had time to go down to the hospital’s cafeteria for lunch. Many times I would grab meal to-go and head back to the ICU work station and inhale my food while doing some computer charting. That day I had the luxury of eating my lunch more leisurely in the cafeteria itself.

Our hospital’s cafeteria is by no means a fancy place to dine in. It is after all a cafeteria serving hospital food. Nothing against hospital food, but if I have time to spare, I will eat somewhere else. Our cafeteria though has a section that has glass wall and ceiling that gives you an atmosphere of being outside. Yes it is still winter and there’s snow on the ground, but the sun was shining that day, so I went there so I could soak up the sun for a change.

However if the hospital cafeteria is as inviting as the photo below, once I settled there they have to pry me like a barnacle from my seat for me to go back to work.

(photo taken in the Philippines at Manila Bay, a few years ago)

Besides the obvious of getting food to eat, there is another reason I stay a while in the cafeteria. That is, it gives me a chance to be away, even for a short time, from ICU work and from the constant hounding from the patients, residents, nurses, and other doctors. Though almost always, when I’m on a lunch break that is when I am called to the Emergency Department for a new admission.

But that day was different. I was enjoying my lunch alone and my phone was unusually silent. I guess the cafeteria gods were smiling at me. I consider these lunch escape my sanctuary – away from the chaos and the harsh reality of the ICU.

The hospital has a chapel too. But that is not the kind of sanctuary I am talking about here. I just needed a place to take a breather.

Then while I was savoring my food, but more so my silent interlude, a man approached me at my table. How dare him interrupt my break time? Who was he to disturb my lunch? Of course I did not react that way and instead I looked up and gave him a smile. It may be forced, but a smile nonetheless.

The man introduced himself and said that he recognized me from a previous ICU encounter. I learned that I took care of his mother in the ICU several months ago. After he gave me some details, I remembered her mother – she had cancer and became septic after receiving chemotherapy. She got very ill very fast and stayed in our ICU for several days. But she recovered.

The man then pointed to his mother, my previous ICU patient, who was sitting in a table a few paces away. They have an appointment with their oncologist at the Cancer Center and that’s why they were in the hospital.

How many patients have we taken cared of in the ICU who was as sick as she was, and have a chance to meet them later after their discharge and were doing relatively well? Sadly to say, that is a rarity. For many of them even if they get out of the ICU, they were never the same. And some don’t even get out at all, I mean not to the world of the living.

This man just stopped by to thank me. It was an interruption that I would appreciate after all.

Then when I was about to leave, a man that I met in the ICU earlier that day sat in a table near me. He was absorbed in his thoughts while eating by his lonesome. Like me he was also taking a break. Perhaps the cafeteria was his sanctuary too, an escape to the sobering truth in the ICU.

Though this man’s predicament was much different than mine. His daughter was our patient in the ICU, and she was not doing well. She had a tumor in her brain that was surgically removed, but even after more than a week post surgery, she remained on life support. Her life was hanging in the balance with uncertain future. Worse part is, she was only 20 years old.

It is very understandable for her family to be heartbroken. No wonder her father rarely leaves her bedside, except for a brief cafeteria break. As a father who has a daughter with similar age, I can only imagine the agony he’s going through.

I needed to go back to the ICU. We needed to help this young lady and her distraught father.

Auld Lang Syne: A Look Back

31 December 2019

Leave a comment

I am reposting an experience I had several years back. Original piece published December 2013.

**********

I was on-call that New Year’s Eve. As I remember it, even though it was the holiday season and no patient wants to be in the hospital, it was still very busy for us.

It was a time of a bad flu season and our ICU was full. In fact there was even a pandemic that year of a bad strain of influenza A, the H1N1, or otherwise known as “swine flu,” and we had confirmed cases in our hospital. The hog farmers here in Iowa detest the name “swine flu,” as it was detrimental to their trade.

Despite of my toxic duty, I was able to finish my rounds and saw all our hospital patients for the day (took me 12 hours or so), and made it just in time to a gathering of some Filipino friends for the New Year’s party.

I was only warming up with our friends when I was called for a “stat” consult that I have to see right away. Before I left, my friends told me that if I finish the consult and it was still before midnight, then I should come back to the party. It was around 10 o’clock when I drove back to the hospital.

The patient that I came back for was a woman in her 40’s. She had breast cancer and sad to say, despite all the surgery, radiation, and chemotherapy that she underwent, the cancer had spread to the lungs and pleura (covering of the lungs).

The patient was obviously struggling to breathe when I examined her. The chest x-ray that was done that night, which was requested by the oncologist showed hydropneumothorax. That means there was collection of fluid and air in the space surrounding the lungs. And that was the reason I was consulted, to surgically place an additional chest tube (as she already had one in place) to drain the fluid and air.

After reviewing the chest film and comparing it to the previous chest x-rays, I determined that the finding of hydropneumothorax was old. In fact the chest x-ray was unchanged compared to films from few weeks ago.

That meant that the worsening of the patient’s respiratory status was not from the collection of air and fluid primarily. Placing another chest tube would not matter as the lung was trapped and would not expand further. I surmised that her further deterioration was from the advancing cancer itself.

Maybe the patient and her family was hoping against hope that there was still something that can be done. Maybe they were grasping for straws for a possibility that she could see another New Year.

I explained my findings and I then solemnly, but respectfully told them that in my viewpoint, placing another chest tube would not matter, and that would not relieve her breathing difficulty.

Right after hearing my opinion, that was when the patient and her husband made the somber decision that it was time. Time to end it all. Time to let go. Time to transition to comfort measures only. It was time for her to rest.

The patient’s husband went out briefly, maybe to talk with other family members who were outside the room. When he came back, I bid them goodbye and left.

As I went out of the room I saw two girls, both were probably not older than 12 years of age. They were crying, while an older woman was comforting them. I assumed those young girls were the patient’s daughters. I think it would be safe to say that they were not having a “happy” new year’s eve.

I looked at my watch. It was less than an hour to midnight.

By that time the rest of the world was partying while waiting for some fancy ball to drop. At that time most people were celebrating while waiting to welcome the New Year, while another family was also waiting – waiting for suffering to end. Waiting not to welcome, but to say their final goodbyes.

I did not go back to the party. I went straight home to reflect, while the song Auld Lang Syne (translated as Times Gone By) echoed in my head.

Should old acquaintance be forgot,
And never thought upon;
The flames of love extinguished,
And fully past and gone:
Is thy sweet heart now grown so cold,
That loving breast of thine;
That thou canst never once reflect
On auld lang syne.

**********

Post Note:

For us who will be welcoming another new year, may we face it with hope and optimism, and embrace with reverence this precious life we are given.

(*Auld Lang Syne is traditionally sang to celebrate New Year at the stroke of midnight, but it is also sang in graduations and funerals; photo taken at Musée d’ Orsay.)