Guardians of the Galaxy: A Reminiscence

This is not a film review.

I know anybody can be a critic. Everybody has an opinion and everybody is entitled to one. You don’t have to be an expert to critique a movie. There are movies that we watched and discerned that they are good movies. Then there are those that we watched, and we felt duped and wanted our money back.

But there are films that we remember or even cherished, not because of the film itself, but because of the memories tied into them.

Maybe it was that animated movie that your whole family saw when you were young. Or maybe that romantic comedy that you saw with your crush on a date. Or perhaps that stupid action movie that you and your classmates cut class just to see it. Or maybe it was that boring drama that you watched after your girlfriend/boyfriend dumped you.

The film that I fondly remember as of recent is the “Guardians of the Galaxy.” (Spoiler alert, if you have not seen it yet.) I know a sequel is in the works and will be out by the middle of next year.

The reason I like the “Guardians of the Galaxy” was the personal events surrounding it.

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It was August 2014. I went home to the Philippines emergently to see my mother who got sick and was hospitalized. My sister sent me a message and told me that mom was gravely ill, and to come immediately if I want to see her alive.

Three days after I got the message, and after more than 24 hours of traveling, and about 8000 miles of airflight, and a ton of apprehension and jet lag, I got home.

When I came to the hospital, UERM university hospital in Quezon City, my mom came out of coma and actually was doing better. Maybe because she learned that I was coming home to see her. At least, that’s what I wanted to believe.

However, after few more days and more tests were done, it was found that her cancer from the colon, which was removed through surgery five years earlier, had come back. Now it had spread to her lungs and perhaps to other organs as well.

After evaluating all our options, we discussed with my mother asking her what she wanted to do. She firmly stated that she does not want to do any more therapy – no more surgery, chemotherapy, or radiation. She decided to just wait for the inevitable to come, and she wanted to go home. “Home,” has different meanings in so many levels.

So that day we decided that as soon as she is stronger, hopefully in a couple of days, we will take her home and set up a kind of hospice-like arrangement until her days here on earth is through. It was a sad day of reckoning.

I was the bantay (watcher or guardian) that day of my mother. I know in the Philippines, it is a common practice that patients in the hospital have a bantay, to assist in every need, may it be a glass of water or help with the bedpan. Unlike in the US, a patient is mostly left alone in his/her room with just a call light to summon for help.

When my older sister came that evening to relieve me as the bantay, I really don’t want to go home, but I don’t want to stay in the hospital either, for I need to clear my head.

So I went to SM Sta. Mesa (Centerpoint) which was just a block away from UERM, to pass the time. I just want to escape from the sad reality that was happening right before my eyes.

After wandering for a while, I decided to watch a movie. The movie I watched was the “Guardians of the Galaxy.” If there would be a movie about the hospital bantays would they entitle it “Guardians of the Bedpan?”

I like sci-fi movies. So its not a surpirse that I chose to see the “Guardians.” Besides I don’t remember the other movies that were showing that time. Definitely I would not watch a drama or a depressing movie given the circumstances I was in.

I thought the concept and setting of the “Guardians” was so out of this world, that it was hardly believable. But then again, at that time and what I was going through, the farther from the reality, the better for me.

I like the featured songs of the 1970’s in that movie, music that I grew up with. I also like some of the characters of the movie. Especially Groot, the man-tree who has very unique powers, even though he can only say one line: “I am Groot!” And of course the star of the movie, Peter Quill, an unorthodox hero, who calls himself Star Lord.

But maybe it was background of the story that has a soft spot in my heart. Peter Quill lost his mother, and what remained was only her loving memory and the old songs her mother left him.

On the last scene, Peter reads an old letter from his mother, and then unwraps a gift from his mom, a cassette tape of oldies songs. As he listens to the nostalgic music, it puts him on a kind of trance. It placed me on a kind of trance as well, realizing the similarity to my own state of affairs.

I thought I was escaping, but somehow the painful reality sneaked in.

Last week was my mother’s death 2nd anniversary. It so happen that the movie the “Guardians of the Galaxy” was being shown on TV that night. I couldn’t help it. I had to watch it again.

Sure enough, it brought back memories.

(*photo taken from the web)

A Somber Celebration

Last week, we had a patient in the ICU who was unwell. Unwell, is perhaps an understatement.

He was of an advanced age though, as he was in his 80’s, and maybe has already lived a full life. Yet he was still active, lives independently with his wife, and was in relatively good health, until he got sick and got admitted to the hospital.

He came down with a bad bout of pneumonia. So bad that he went into respiratory failure and had to be placed on mechanical ventilator. This was complicated as well, as he suffered a mild heart attack too. Furthermore, he also developed brisk bleeding in his stomach, but fortunately we were able to stop that bleeding, when we did the gastroscopy.

After several days of intensive support, surprisingly he got better. He got better enough that we were able to take him off the ventilator. He was going to pull through this. So we thought.

But less than 24 hours later, he was placed back on mechanical ventilator. His blood pressure dropped as results of overwhelming infection. He went into congestive heart failure. His kidneys also started to fail. His condition got worse than ever.

We sat down with the patient’s family and discussed with them the dire situation. They decided that they would like to continue the aggressive support and hang on for two more days. I thought it was kind of odd to have so specific timeline in their request.

Why two days?

Two days later, as we’re going through our morning rounds, I was told by my staff that we will be having a party later that day. A birthday celebration right there, in the ICU.

I learned that the family of our elderly patient have called all the family members that can come, to be there and visit the patient. They brought balloons and a large birthday cake. They even brought in the patient’s dog to the ICU! But of course they have to get a permit and confirm all the vaccination records of the dog.

I also learned that the family was planning to take him off life support that same day. They would like to transition to full comfort care, and let nature take its course.

The ICU staff got a birthday card that they passed around and asked us all to sign it. Honestly, I was stumped on what to write on the card.

Do I write “Happy Birthday,” knowing that it may not be really a happy event? Or do I write “May you have more birthdays to come,” which I know would not be true at all? Or should I write “Have a good last birthday?” But that sounds morbid! Or do I write “May you have peace on your birthday,” which I think is very appropriate, but it is as if I’m foretelling death before it actually happen?

Never did I have so much difficulty in writing a simple greeting on a birthday card before.

When the family were ready, we lightened the sedation and have the patient wake up, so he will at least have the chance to witness his own birthday celebration.

The ICU staff came and crowded inside his room and sang “Happy Birthday.” Though I guess, many of us we’re feeling rather sad than happy while singing that song.

We then extubated the patient and took him off the ventilator. He was able to speak after that, though very weakly. The family gave him a piece of his birthday cake which he tasted, even if it was just the frosting.

After a while, he started to show signs of discomfort. He was obviously struggling even just to take a breath. So after the final embraces from the family and a pat to his dog, we gave him medications to relax him and made him more comfortable. He slept the rest of his birthday celebration.

He later slept on into the eternal night.

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P.S. I wrote on his birthday card, “May you have a meaningful birthday.”

 

Tortured Soul

She was a tortured soul.

In spite of all the medical interventions and having a supportive family, she still was always extremely depressed. It seems that she cannot get rid of her demons and the tormenting voices in her head. The desire to kill or hurt herself consumed her every day.

She has been on different anti-depressive medications and was regularly being followed by her psychiatrist. She even had several admissions to the inpatient psych unit. Yet nothing really alleviated her condition. For a person who is barely in her 30’s, she already had a fair share of misery.

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She has attempted suicide a number of times in the past. Though all of those times it was not serious, resulting no grave medical consequences. It was mostly cries for help.

But this time, it’s different.

Her family found her unresponsive in her room after presumably overdosing on a bunch of different pills. Emergency responders were called and upon their arrival, CPR was performed. They were able to establish a stable heart rhythm and patient was brought to the hospital where she was subsequently admitted to the ICU.

She laid there in our ICU, hooked to several monitors and life support. Her chest would rise and fall as the ventilator bellows air into her lungs.

Three days have passed since her admission, yet she remained unresponsive. In addition she had this intermittent jerking-like activity, which I believe was an ominous sign of severe anoxic brain injury. I called the neurologist to assist in her care.

Then few hours ago, something happened.

Her vital signs became more labile. The continuous EEG monitoring which the neurologist requested showed a significant change. The jerking-like activity have quit. Her pupils were now fixed and dilated.

My suspicion was that she now is brain-dead.

Brain death is a complete and irreversible loss of brain function. Unlike in a vegetative state which could have some autonomic or brain stem functions left, brain dead means cessation of all brain activity.

I updated her family of this recent development. Then I proceeded to do my confirmatory exam for brain death per protocol.

After my evaluation, I determined that all her neurologic functions were gone. I even performed an apnea test, which involves taking the patient off the ventilator for 8 full minutes, while providing oxygen through the endotracheal tube. If there was no respiratory motion for the entire time, and this is associated with an appropriate rise in the blood carbon dioxide level, then this is one verification that someone is indeed brain-dead.

The neurologist independently performed her evaluation as well, and also arrived at the same conclusion.

When one is declared brain-dead, it is an indicator of legal death. Different from a person who is in a continued vegetative state, who can be sustained on life support indefinitely (which is controversial in so many levels), a person who is declared brain-dead is officially dead. All life support should be discontinued. Even if the heart is still beating. No argument. No controversy.

I gathered the family and told them of my findings. They were obviously distraught, but accepted the news without any questions.

I also told them, that based on the patient’s driver’s license, she indicated that she was an organ donor. I asked the family if they would like to honor the patient’s wishes.

The family said, that they totally agree to donate the patient’s organs per her wishes. That despite of the patient’s several mistakes in her life, this may be the best decision she have ever made, according to them. And despite of her cloudy and troubled mind, she have decided on this selfless act.

I called the donor network.

I know that somewhere out there, another person will be set free from the shackles of dialysis as he or she would receive a long-awaited kidney. Another person will be given a new breath of life as he or she would receive a new set of lungs. And another person out there will be given a new lease of life, as he or she would receive a new heart.

All because of the gift of a tortured soul.

Life Can Be a Lonely Highway

A few weeks ago we embarked on an ambitious summer drive that took us from farmlands and prairies, to mountains and valleys, to deserted areas and busy metropolis, to rivers, waterfalls and ocean.

We started off from our home in Iowa and drove to Glacier National Park in Montana where we stayed for 3 days. Then we continued our trip to California where I attended 3 days of conference and my medical school’s grand reunion at Long Beach, but we passed by Yosemite National Park first, where we stayed for 2 days.

The sceneries that we passed have been so varied that it changed drastically: from barren lands of South Dakota to lush forests of Montana, from farm lands of Idaho to deserts of Nevada, from wilderness of Yosemite to concrete jungle of Metro Los Angeles.

It was the drive from Glacier National Park to Yosemite National Park that we passed through very lonesome country roads. Though I would take the lonely highways anytime than dealing with the heavy traffic of Los Angeles.

Passing through Nevada on our way to Yosemite, we passed Route 50, a transcontinental highway, which is also named as the “Loneliest Road in America.”

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Indeed it was a lonely road. You probably can set camp in the middle of the road and not be bothered by a passing car for hours. While we were driving through Route 50, I was afraid we will run out of gas and nobody will come to our rescue. Until we saw this….

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Right in the middle of nowhere, is a sort of an oasis. They have a bar, a restaurant, a small motel, and a gasoline station – all in one.

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Notice the sign posted in the motel? It said, “Route 50: The Loneliest Road in America.”

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They even have an old phone booth, which of course is now obsolete in this age of cellular phones.

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So we pulled up to this place and filled our gas tank. We also took the opportunity of taking a bathroom break. Though in reality, I wonder how many travelers in Route 50 when they felt the urge, just stopped and took a leak at the side of the road?

We also check out their small restaurant, and we found that they have plenty of supply of ice cream! Who knew?

Life they say is like a road trip. Sometimes the journey is exhilarating as we go through scenic byways. Sometimes it feels boring as we go through mundane yet major highways. Sometimes we feel we are not going anywhere as we are stuck in traffic. And sometimes we feel alone as we go through lonely roads. But there’s always surprises and unexpected turns.

In the last leg of our trip, after the medical conference and reunion, we also took time to visit our friends and family in California, including my wife’s mother who was staying in Los Angeles area.

Sadly to say,  my mother-in-law got sick and was hospitalized while we were there. Her condition quickly deteriorated and was even transferred to the ICU. So part of my vacation was visiting the ICU, not as an ICU physician but as a patient’s relative. I can’t seem to get away from the ICU.

Despite the medical efforts, my mother-in-law did not improved. She died shortly after a few days.

It was not the vacation we imagined. But at least we can comfort ourselves that we were there during her last moments and we’re able to say our goodbyes in person.

Our family is surely going through a lonely road right now. Yet, we can find solace that even in the loneliest road, there’s always an oasis, a refuge, or a sanctuary if you will, waiting for us where we can find rest.

Lastly, an important thought to remember, that even though it seems we are passing through a very lonely road, we are never alone.

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P.S. Nanay, thank you for the love and the memories. From you “favorite” son-in-law.

(*photos taken at Route 50, somewhere in Nevada)

 

 

 

Spinning Plates

When I was much younger, I had a fascination for juggling. I learned how to juggle on my own. I could juggle 3 tennis balls, or toy blocks, or even plastic bowling pins. Though I did not and would not try juggling chainsaws.

Juggling is an art. The more dangerous and challenging the feat, the more captivating it is.

Have you seen an act of spinning plates, where the juggler spins several plates on sticks? He goes from plate to plate to keep them spinning or else the plates drop to the floor and break.

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Three weeks ago I had one crazy weekend duty. I think it would fall as one of my busiest calls in the ICU in my recent memory. It was so busy that my Friday to Sunday, kind of blended to one very long day with only a few hours of sleep in between.

In one particular stretch of that call, hell broke loose.

I worked on a very sick young man in his 30’s, who was admitted to ICU room 3. I intubated him, placed him on ventilator, placed a large neck catheter for IV access, and started several medication drips on him, all in one rapid succession. I was in the midst of trying to stabilize him when another patient, a lady in room 18, went into cardiac arrest. “Code Blue”* was called.

I have to drop what I was doing on the first patient and ran to room 18. When I got there, the ICU resident was already running the code. After 10 or 15 minutes of CPR and fast paced intervention, we were able to resucitate her back. With her heart rhythm semi-stable, I ran back to room 5, and continued what I was doing.

Not too long after, the patient in room 18 went into cardiac arrest again. I ran back to that room once more. This time I beat my resident to the room and took charge of the Code Blue. My resident who eventually arrived told me that she got hung up in ICU room 16 who was also crashing. I saw another resident who responded to the the Code Blue, but I sent him to room 5, to continue on what I was working there.

After more than 10 minutes of CPR we got our patient in bed 18 going again. It was heartbreaking to see that while the CPR efforts were in progress, the family was just outside the room crying and wailing as we work furiously on their loved one.

After we got the patient’s heart beating again, I gathered her family to a nearby consultation room and discussed with them the dire situation. I told them that there was no guarantee that her heart would not stop again. But given of how sick she was, especially after successive cardiac arrest already, I knew her chances of walking out of the hospital was close to nil, and continuing to do the CPR would be an exercise of futility.

I was talking to the family, when I was called emergently to see room 16 who they were about to call Code Blue. This was the one my resident told me about earlier. We got the patient intubated and hooked to ventilator, started several IV medications and got him stabilized, at least for the time being.

After getting out of room 16, the family of room 18 approached me and told me that they have decided that if her heart stop again, to let her go peacefully.

Less than 30 minutes later, she died.

The patient in room 16 that we attended to also continued to circle down the drain. And despite our efforts, he also succumbed several hours later.

I finally was able to concentrate on room 5 when there was a lull in the chaos we were in. I decided to place him on extracorporeal life support, also known as ECLS** (see previous post about ECLS here), as he would not survive without it. The ECLS team was mobilized, and around 2 o’clock in the morning, the patient was off and running on ECLS.

I have not even mentioned the other 17 ICU patients under my care, but were not actively crashing during that time, nor the other 3 new ICU admissions that came during that span of 4 hours of absolute craziness. I even accepted another patient from an outlying hospital during that period, for whom I ordered our flight crew to fetch. Though the patient did not make it to our hospital, as he was so unstable and our helicopter crew was reluctant to fly him unless they stabilize him more for the flight. I heard he died shortly then.

Spinning plates? Seems like it, right? Sometimes I wonder if I could  keep up with this pace or would I like to continue doing this. Don’t get me wrong I do like my job. But I don’t like the awful stress and the awful reality that comes with it. For it is not just plates that are falling and breaking.

About the patient in room 5? He improved after we placed him on ECLS. He eventually was weaned off ECLS and ventilator after almost 2 weeks in the ICU. He went home from the hospital the other day, walking unassisted and off oxygen.

Success stories like him, though few and far between, keeps us going. After all, I believe it is still worth doing this.

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*Code Blue: an emergency situation announced in a hospital or institution in which a patient is in cardiopulmonary arrest, requiring a team of providers (sometimes called a ‘code team’) to rush to the specific location and begin immediate resuscitative efforts.

**ECLS: extracorporeal life support (ECLS) is an extracorporeal technique of providing both cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. It is done by siphoning blood out of the body and artificially removing the carbon dioxide and giving oxygen to the blood by running it through a special machine.

Steak and Rye

It was late afternoon of New Year’s Eve, and I was rounding on our patients in the ICU. I came to one room and the patient was sitting upright in his bed. On his bedside table was a tray with a large piece of steak on a plate, a drinking glass, and a bottle of rye whisky. What? Is this a restaurant or hotel? Is this the new hospital food?

Most of our patients in the ICU are not awake enough to eat food, let alone have a solid meal like that. We provide nutrition through a tube in their nose that goes to their stomach and they feast on liquid feedings. Or if their gut is not working, we give them “gourmet” nutrition through their veins. In fact once patients can eat solid food, most of the time they graduate out of the ICU.

But what about this patient? A slab of steak? And is alcohol sanctioned by the hospital now? Here’s the story.

He presented to the hospital with worsening shortness of breath. After some imaging work-up, he was found to have a large tumor in his chest. I saw him several days ago when he was admitted in a regular room, not in the ICU. We were consulted for the lung mass and I scheduled him to have a bronchoscopy (a procedure putting a flexible scope to the lungs) and biopsy.

However before the scheduled procedure could be done, he suffered a cardiorespiratory arrest, got intubated, was hooked to a ventilator and was moved into the ICU.

Good thing was despite the circumstances, he improved enough that we got him off the ventilator. Yet we don’t have a tissue diagnosis to confirm that what he has is cancer, even though the signs indicated that it was malignant. But we needed to be sure.

So I proceeded with a bronchoscopy and got a biopsy, and finally established a diagnosis. It was lung cancer alright.

Unfortunately his condition got worse again. He again required ventilator support, though a non-invasive type, which is like a CPAP machine. I told him that the final pathology proved that it was cancer. And based on its extent, plus with his grave condition, he was an unlikely candidate for any surgery, or chemotherapy, or radiation to treat his cancer.

That’s when he decided that he wanted to go on his own terms. His own way. Like Frank Sinatra’s song, “I did it my way.”

He requested that we discontinue the non-invasive ventilator, even though he was struggling without it. He asked to have a New York steak and a bottle of rye whiskey for his last meal. So in between labored breath and heavy heaving, he chomped on his steak and sipped on his rye.

When I came to his room that afternoon, despite his terrible situation, he was even smiling while having his last supper.

After he had his meal, we transitioned him to full comfort care per his request. No more ventilators, nor machines, nor any more interventions. Only comfort medications. And while he was watching TV in his ICU bed, waiting for the ball to drop in New York’s Time Square, he quietly slipped into a blissful sleep.

Just before the old year ended, our patient went out peacefully into the eternal night. He exactly did it his way.

For us who made it through another year, may we find new aspirations, new hope, and renewed zeal for life, as we face this new year.

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When You Wish Upon A Star Wars

I entered the room and stood silently at the foot of his bed, watching him breathe. He was hooked to a small ventilator that is connected to a mask covering his face with straps around his head, that he looked like a jet fighter pilot. Beside the bed was his father and his mother who were obviously distraught, yet trying to hold off tears.

Luke* (not his real name) was one of our ICU patients. Even though he was only in his 20’s, he had his fair share of surgeries and hospitalizations than many patients in a geriatric floor combined.

He had a genetic disorder that prevents the development of various organ system. This affects the skeletal system giving them a peculiar look and stature, that some people coin the term FLK syndrome: Funny-Looking Kid. Though for me, there’s nothing funny at all. This disorder also causes heart defects, and can involve other organs like the lungs, liver, gastrointestinal tract, lymphatic and blood system. Even so some people with this genetic disorder could live to adulthood, some would succumb to this disease early in life.

Luke had a number of surgeries to fix his heart problem, and other procedures too many to recall. He had been treated in well-known hospitals like Mayo Clinic, for his disease. But despite of all the technology and medical interventions, his body continued to betray him.

For the last several months he had been in and out of the hospital, usually staying for several weeks at a time, including ICU stay. I have taken care of him a number of times in the past.

In spite of his illness, Luke tried to live his life as “normal” as possible. His family gave him the opportunities and the best care they could. His mother, who was a patient of mine too, had the genetic disorder as well, albeit with a milder manifestation, thus I knew the family well.

One thing I learned, was that Luke likes Star Wars, even though the first Star Wars movie came out more than a decade before he was born. Yeah, he was a fan of this movie genre, just like the rest of us, I guess.

In this last hospital admission, Luke came in with a lung infection causing respiratory failure, requiring intubation and mechanical ventilation. He came on Thanksgiving Day.

After several days in our ICU, we were able to extubate (take out the endotracheal tube) him, only to place him on a non-invasive positive pressure ventilator (NIPPV) with a face mask, as he cannot breathe on his own. This is like a CPAP machine. At least he can stay awake and not be sedated on the non-invasive ventilator, and he can speak as well. He can only tolerate a limited time off the NIPPV, and had to be hooked right back on it. He would not survive without it.

As I watched him with his “jet-fighter mask” with his bed as his vessel, what came to mind was that in a cruel twist of fate, this kid who likes Star Wars, now breathes like Darth Vader: whoooh….poooh, whoooh…..poooh, whoooh…..poooh. Every breath, there’s a gush of pressurized air coming out of the ventilator and through his mask.

After one holiday, another one is approaching. Christmas is just around the corner. And Luke remains in the hospital, ventilator-dependent, with no clear sight that he’ll get better. He knows it, and his family knows it. Luke’s days here on earth is numbered.

With wishful thinking, maybe he can linger a little longer to see the new Star Wars movie which he was looking forward to seeing for the longest time. But how? Him in the hospital? On a ventilator?

But wait, isn’t it Christmas season after all?

Wish granted!

After making elaborate arrangements and collaboration, Luke and his family will be going to a movie theater, to be accompanied by some medical staff, for a special private showing of the “Star Wars: The Force Awakens,” when it opens this weekend.

After that trip to the theater, Luke will be going home for Christmas with his family, on hospice care. No more hospitals. No more ventilators. No more pain.

Perhaps he could stay home until Christmas. But if not, Luke could soar into the heavens and once and for all, walk on stars. His final home.

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(*name intentionally changed for privacy)

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Update 12/22/15: after posting this story here, I learned that our patient was featured in the local news. See link here.

 

 

A Christmas Spectacle

One of the hallmarks of Christmas is the wonderful shows, parades, or spectacles that happen during this season. The second story I want to re-post is about a different kind of Christmas spectacle.

I originally published this story, “The Christmas Homecoming,” on December 17, 2011.

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The Christmas Homecoming

He arrived with much fanfare. Clad in a brightly orange suit, with two escorts on each side. He made a jingling sound with every small step he made. People turned around and looked as he walked and passed through the hospital corridors, for it was an unusual sight to see. But he did not mind their glaring stares. He came for a special purpose, and that’s what matters. He came to see his father.

His father laid in our ICU. He suffered an acute and severe bleed to his head. The bleeding was so extensive that he required a neurosurgical procedure to evacuate the large collection of blood inside his skull, and placed a shunt in his brain to relieve the high pressure, in an effort to save his life.

However despite of all the intervention, his condition did not improve. In fact, it even got worse. After the surgery, he had more bleeding and swelling to his brain. And no further surgery could fix or decompress the pressure that was squashing his brain. There were no “miracle” medicines that can be infused on him that would make him better. No further medical intervention left that could be done to save him. His condition was unsurvivable. Sooner or later, all the life-sustaining machines hooked on him would be deemed worthless as he would be pronounced brain-dead.

Due to the grim development of events, the patient’s family were all in agreement to discontinue all life support. Though they had one request before that happens. They pleaded for the patient’s son to come before he dies. A son who had not seen his father for a long time.

In the past 10 years that I have been an ICU physician, I have signed for diverse medical and non-medical requests – a disability form for a patient who was critically ill, a leave of absence for a relative who’s loved one was in our ICU, a letter to the military requesting for a deployed soldier overseas to be permitted to come home to be with his mother in her last days, or a letter to the US consulate for a patient’s mother in a foreign country requesting for a visa to see her son, who was in near-death.

This time I signed a request for a prisoner to be released briefly from jail, to visit his dying father.

And so he came.

The brightly colored clothes was not because it was the holiday season, but it was the standard issued jumpsuit from the prison. The jingling sounds as he walked, was not from trinkets or bells to announce some holiday cheer, but rather from the chink of the chains that binds his ankles. He brought no gifts as he came empty-handed, except for the handcuffs. There were guards that flanked him as he made his way through, and people watched and stared, but it was not a parade.

He was led into the ICU room where his father laid. Her mother who was at the bedside, cryingly welcomed him with open arms. It was an embrace of acceptance to their “wayward” son. Like a homecoming of a prodigal son, if you will. Yes, it was a sort of homecoming alright. A very sad homecoming indeed.

As the son stood silently beside the bed of his comatose and dying father, the tears began to flow from him. Prison, I supposed, did not harden him enough to be devoid of all emotions. If only his father can see his tears, but it was too late. Whatever demons he had in the past, and I don’t care to know, he was still human after all. Just like you and me.

Was the tears for his father, who he knew he failed, and who he would never see again? Or was the tears for himself, as he had caused his family such heartache and disgrace? Was it tears of painful loss and farewell? Or was it tears of remorse and repentance? Or maybe it was a combination of all of those reasons. Whatever it was, he alone knows.

After some time, he was escorted out of the room and back, I assume, to the penitentiary.

There will be no singing of Christmas carols, I’m sure, in his dark and lonely cell tonight.

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Post Note: I have not witnessed a similar spectacle since, nor do I have any word of what happened to the son afterwards.

(*photo was taken by my wife)

A Christmas Miracle

We have entered the month of December and Christmas is only 3 weeks away. For this month I would like to re-post stories that happened around Christmas, which I have witnessed first hand, and that I have written several years back.

I first published the following story, “Gift of Life,” on December 15, 2010.

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Gift of Life

Everybody said that her pregnancy was ill-conceived and ill-advised. But who are we to judge her?

Mary (not her real name) lies in our ICU. Her 21-year-old body looks frail and debilitated, her skin is pale and sallow, and her breathing is irregular and shallow. Attached to her sick body are a number of tubes, catheters and monitors. The regular bleep and tracings in the monitor screen above her bed tells me that she is still alive, although she looks otherwise.

Mary was born with cystic fibrosis. This is an inherited disease caused by a defective gene that causes thick mucus plugging of small tubes and ducts, mostly affecting the lungs and the digestive system. Patients suffer with frequent lung infections, digestive problems, and usually succumb with respiratory failure or liver failure. The disease is fatal that many patients will die in their childhood and adolescence. However, in the past few decades, with the improvement of care, patients who made it through adulthood has an average lifespan of 35 years.

Mary’s childhood was anything but normal. She was in the hospital or doctor’s office so often more than she was in school. She was on medications constantly. She had known more doctors than childhood friends. She experienced more than her share of suffering and disease. But she had beaten the odds. Now, that she made it through 21 summers tells me that she is a fierce survivor.

But now, this pregnancy. Her family doesn’t want her to have this. Her doctors told her that her body may not be able to tolerate the additional stress of pregnancy and that it will be very high risk to continue. But she made up her mind that she will keep this child whatever the cost.

Due to developing problems and complications, she was admitted to the hospital’s maternity ward on her 32nd weeks of conception, where she was expected to stay for the rest of the pregnancy. However, after a few days in the hospital her condition worsened. Her liver function deteriorated and she went into fulminant hepatic failure. Mary slipped into coma. She was then transferred to our ICU.

Because her baby may get compromised further, we had no choice but to deliver the baby, even if it was barely 33 weeks old (full term is 38-42 weeks). Mary underwent an emergency caesarean section.

Now, 3 days after her baby’s delivery, Mary still remains in our ICU. She continues to be comatose.

As I stand beside her bed to examine her, I see the pictures of her newborn baby posted on the wall of her room. Being a parent, I cannot help but feel a twinge of sadness. Will she ever know that she brought forth a beautiful baby, premature, but otherwise healthy boy? Will she ever hear the yearning cry of her dear child? Will she ever see the sweet smile of her son? Will she ever hold her baby in her arms, the life that she fought for so dearly to bring to this world, even if it meant going against medical advice?

I just hope that someday this precious boy would be grateful and proud to the mother, he may never know. And may he appreciate and realize the challenges, the difficulty, the sacrifices her mother went into, to give him the gift of life. Yes, even in exchange of her own life.

But wait. This is Christmas season. Time of miracles. Maybe there will be one here tonight.

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Post Note:

After I published this story, Mary did improved and recovered. She got out of the ICU and eventually went home to take care of her beautiful baby. I took care of Mary a few more times and I always asked her about her baby boy. Her son became her pride and joy.

Sadly, Mary eventually succumbed to her illness last year, leaving a very young son, who at least experienced a mother’s love, even for so short a time.

I’m Free

I was on-call last weekend, and it was busy. The ICU was full. Our patients list was quite long. I only got about 8 hours of sleep from Friday to Sunday, that by the end of my 58 hours shift, I was really exhausted. I felt deflated and defeated.

Days like those, I even wonder, “Why am I doing this?”

After having Monday off, I came to the office the next morning and found this on my table:

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flowers and a memorial service program

The flowers came from a patient, or should I say from his relatives. My patient passed away. I should be the one sending flowers. But in this occasion, it was the dead and the grieving who gave the flowers.

I guess the family was just grateful and appreciative of the care I gave their loved one. Even if the end result was death.

Day like this, reaffirms why I am doing this.

I have taken care of this patient for almost 10 years. And over the years I saw his constant struggle to breathe, and his progressive decline. By the past year or so I have been seeing him so often in the clinic or in the hospital, that I have come to know him very well. Yet, despite our efforts he continued to get worse.

At the end I knew I have nothing left to offer him, and so we have agreed to place him under hospice care.

He had Chronic Obstructive Pulmonary Disease or COPD.

Damn cigarettes! If there’s any young people here reading this article and are smoking and feels that you’re indestructible, I am pleading to you, please stop smoking. I am a constant witness of the destructive effects of cigarettes and the utter suffering they cause. Whatever pleasure smoking gives, it is not worth it.

Though I would admit, some of the nicest people I came to know were smokers. And that includes my patient. They are just slaves of a bad habit that may not be their own doing.

In the funeral program of my patient that they also sent to me, was a poem by Ann Davidson, printed on it. A poem so apt for my patient. It was entitled “I’m Free.”

Free from the pain. Free from suffering. Free from the disease that tormented him. He was indeed free.

I’m Free

Don’t grieve for me, for now I’m free

I’m following the path God laid for me.

I took His hand when I heard Him call

I turned my back and left it all.

I could not stay another day

To laugh, to love, to work or play.

Tasks left undone must stay that way.

I’ve found that peace at the close of the day.

If my parting has left a void

Then fill it with remembered joy.

A friendship shared, a laugh, a kiss,

Ah, yes, these things I too will miss.

Be not burdened with times of sorrow

I wish you the sunshine of tomorrow,

My life’s been full, I’ve savored much

Good friends, good times, my loved one’s touch.

Perhaps my time seemed all too brief

Don’t lengthen it now with undue grief.

Lift up your heart and share with me.

God wanted me now; He set me free!