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.


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


Shoeless Party


Not too long ago we held a gathering in our home. Though the above picture is not a typical image of a Filipino party, the photo below is.


I really did not demand my guests to take off their shoes when they enter into our home, but since almost all of them were Filipinos, it is a kind of unwritten rule in our culture, so they just did without being asked.

Filipinos and shoes have some kind of notoriety, when Imelda Marcos was found to have more than 2000 pairs of shoes that she left behind in Malacañang Palace during the People Power Revolution in 1986. But that is a different subject altogether.

Not just in the Philippines, but many Asian countries have this common custom of taking off their shoes when entering their own home or somebody’s home. The practice is more cultural rather than religious. It also has a practical reason for it, like in Japan, where they sit, eat, and even sleep on the floor, so keeping street shoes off would maintain the cleanliness of the floor.

I have read that other European countries also have this practice of removing shoes when entering one’s home, like Switzerland and Scandinavian countries.

Though in some culture, like here in America, it may be deem rude to order your guest to take off their shoes when they enter your abode. Unless they do it without being asked.

I remember when I was growing up in the Philippines, it is almost a must that we leave our shoes, street slippers, or bakya (wooden slippers) at the door when we enter a house. It is not that our floor is considered a holy ground, but it is considered the polite way, when we take off our shoes.

Whether the floor is concrete, hardwood, bamboo slats, or carpet (though I cannot remember entering a home with carpet floors in the Philippines), I took my shoes off just the same.

I have even heard of an old woman from the province who boarded a bus to go to the city. She left her bakya at the foot of the bus stairs when she boarded, only to find them not there when she got off.

So it does not matter whether you came from the market or a palace, or from playing tumbang preso, where you throw your slippers around. It does not also matter if your shoes are muddy or clean or even covered with antiseptic solution, or if you’re wearing a cheap footwear from Ukay-ukay, or a Manolo Blahnik or a million dollar shoes. Please take them off when you enter a Filipino home.

Except if the host told you “Huwag na, huwag na” which means it is alright to keep them on.

Lastly, a word of advice to our friends, when you are going to a Filipino house party, make sure your socks are clean and not stinky, or has no holes in them.

Unless of course, you want to be the talk of the party.