From out of the blue, I received a greeting recently from a classmate in pre-med and in medical school whom I have not heard from for a long time. In fact I am receiving many thoughts and prayers from friends and family lately knowing that I am a frontliner in this war against COVID-19 especially in the ICU.

I wondered what prompted my classmate, but I was both surprised and touched that she remembered me and also my birthday. After hearing from her, I was reminded of our class party during our senior year in undergrad which was held in their upscale home in the Philippines.

In that party we had a game that was patterned to the old game show “Make Me Laugh.” The idea was that the “contestants” would try not to laugh as “comedians” do their best to make them laugh.

Being one of the jokesters during my college days, I was one of them who would attempt to make people laugh. There were 3 classmates of ours as “contestants,” and there were 3 of us “comedians.” If the first comedian was unable to make the contestant laugh, then the 2nd and the 3rd would give it a try. The contestant who would not crack a smile or laugh wins.

I was the first comedian.

I was a lanky kid in college, weighing 115 lbs in a 5’8” frame body. I look like Fido Dido. My gig was I borrowed an over-sized leather jacket (yes, there were leather jackets in Manila) from one of my burly classmates, and I filled the sleeves and the chest area with socks so I looked muscular. I also borrowed a heavy duty power twister bar from a classmate to show that I am trying to flex my arms. In other words, I am like the Filipino actor “Palito” impersonating Arnold Schwarzenegger.

On the first contestant, after I came out of the room and started walking to the contestant, she already burst into laughter as well as the whole class. I did not have to do much. Needless to say the 2nd and the 3rd jokesters did not even need to come out.

On the second contestant, I saw that she was trying so hard to keep it composed when I came out. But when I walked towards her and came face to face with her, she was red and to the point of bursting. After I tried to flex my muscles by bending the power twister (in which I really struggled), she finally lost it and broke into a laugh. Again the 2nd and the 3rd comedians did not have to do a thing.

On the 3rd contestant, I could sense that I would have difficulty making her laugh. She had this calm demeanor that was unperturbed by my nonsensical act. And while the whole class was already rolling in their bellies laughing, she just looked at me with a half-a-smile like that of Mona Lisa. After a minute of trying, I failed to make her laugh. I was a failure!

By the way, the second and the third jokesters did not succeed as well.

At the conclusion of the game, some classmates got hold of me, dragged me, and dumped me in the swimming pool. I had my full street clothes and shoes on! I was just the first one that was thrown into the pool though as what followed next was a pandemonium with many of the class being shoved into the pool. And we were not even drunk as there was no alcoholic drinks involved.

It was not supposed to be a swimming party. Perhaps they blame it on me, for not able to make that particular classmate laugh, that ended up into a pool-dumping frenzy.

On the side note, I know many of my classmates live in exclusive gated communities and have their own swimming pools. However, I pride myself that we have a bigger pool at our house in Sampaloc Manila, that is the whole street turns into a large swimming pool after a heavy downpour.

I admit, I was goofy when I was young, and perhaps I am still today though I may have mellowed. Maybe I just don’t take myself seriously. However at that time I wonder, were they laughing with me or were they laughing at me? It’s just funny that the kid who they probably would not take seriously before is now seriously taking care of people who are ill and in serious condition.

Life has a weird sense of humor.

(*photo taken a few years back at Petra Jordan)

Cold and Dead

Part of the duty of a medical resident in a teaching hospital is to formally pronounce a patient dead. When a patient dies, the nurse would call the resident-on-call to assess and examine the patient and confirm that he or she is indeed dead. Normally this is done in a timely fashion, within several minutes after the patient breathes his/her last breath, and the resident would chart the time the patient was pronounced dead. This would be the official time of death.

I understand that in a non-teaching hospital the attending doctor would be the one to call. If the doctor is not available, a nursing supervisor or a charge nurse can declare the patient dead. 

You may argue that it does not really take a lot of training to determine if a person is dead. Any reasonable person can discern this. Though there are some people you probably know who look like dead, but I’m not talking about that. So why do we need a doctor or an experienced nurse to pronounce a person dead? I think it is more for a medico-legal purpose.

Of course sometimes your judgement that a person is dead can be challenged  by somebody. The following is an actual exchange of questions and answers as recorded in a court documents:

A lawyer was cross-examining a witness, who was a pathologist.

Q: Doctor, before you performed the autopsy, did you check for a pulse?

A: No.

Q: Did you check for blood pressure?

A: No.

Q: Did you check for breathing?

A: No.

Q: So, then it is possible that the patient was alive when you began the autopsy?

A: No.

Q: How can you be so sure, Doctor?

A: Because his brain was sitting on my desk in a jar.

Q: But could the patient have still been alive, nevertheless?

A: Yes, it is possible that he could have been alive, practicing law somewhere.

Several nights ago, we had a very busy night in the ICU. I believe we had 7 admissions to the ICU in a short span of time. This is in addition to the 20 or more critically-ill patients that we already had in our unit. So “busy” may even be an understatement.

One patient that we had that night had been in the hospital for almost 2 months and had been in and out of the ICU a few times. This time around the family had decided that they would transition to comfort cares and the patient would be taken off life support. So death was imminent and expected.

For some reason, whether the medical resident was not called, or he was so busy at that time, or he was called but forgot to do it promptly, but the patient who was taken off life support was not officially pronounced dead right away. Of course everybody knew that the patient expired – the ICU nurses knew, the family members who were gathered in the room knew, and even the morgue and funeral personnel knew.

Perhaps it was assumed the he was already pronounced dead, so the body was taken down to the morgue within an hour or so after the patient died.

It was not after a few hours later that our medical resident learned that the body of our deceased patient was taken to the morgue without him officially examining the patient and pronouncing him dead.

So what would a diligent medical resident do? 

Our conscientious resident went down to the morgue in the wee hours of the morning to search for the body. He pulled out the body from the freezer. He opened the body bag. He identified the deceased patient. Then he examined the body and pronounced it dead. I know, it sounds like a plot of a horror movie. At least he had an interesting story to tell his co-residents the next morning.

A couple of days ago, I received a notice from a funeral parlor to complete and sign a death certificate. Part of the certificate is to write down the official cause of death. Since I had 3 death certificates to complete that day I checked each of the patient’s hospital electronic medical record to be accurate on what I would write. That was when I read our resident’s note on the chart and I could not help but smile: 

Patient examined in morgue. On exam patient did not respond to verbal or physical stimuli. No heart or lung sounds were heard and patient has no response to painful stimuli. Pupils were fixed and dilated. Patient pronounced dead at 0336.

Since the patient was only officially pronounced dead after a few hours in the morgue’s freezer, should I write “froze to death” as the cause of death?

Of course I did not.

photo taken with an iPhone

(I meant no disrespect to the dead, nor do I make fun of a rather serious situation. I am just relating a light moment in the otherwise morbid world of ICU I lived in.)