Fevered Musing

I called in sick. I have not done that a lot. In fact, this is the first time I did it. Many times, I just grit my teeth and willed myself to work, even if I felt like I was ran over by a truck.

I have this notion that doctors should not get sick. For who will take care of the patients? But am I really be of help or be more of harm if I go to work, while I myself is sick? After much deliberation, and after foregoing the feeling of guilt, I made the call.

Don’t get me wrong, I am no superhuman. In fact, I get sick more often than my wife. She chided that I am built poorly and of cheap quality materials. During my childhood days in Manila, we call our classmates who get sick easily “Made in Taiwan.” We pride ourselves to be “Made in Japan” or “Made in USA” if we’re the only ones left standing. Nothing against products from Taiwan. Accept it or not, we Filipinos sometimes can be racist. I am sure being made in Taiwan nowadays does not have that connotation.

I am trying so hard not to get sick. I exercise regularly, and I try to eat healthy, and I even got my flu shot. But I still got sick. Being a physician, when you’re dealing with ill patients all day, and they are coughing in your face, it’s just a matter of time that you’ll get it too. Plus we are in the middle of the flu epidemic and it is particularly bad this season.

I am in bed for 2 days straight now. I know, that in itself can make my head hurt. I am popping Advil every 4 to 6 hours round the clock, just to get relief from the fever and the body aches, even though I don’t like taking medicine.

I isolated myself in our bedroom, as I asked my wife to sleep in another room, so she’ll not get what I have. This is not the time for ‘sharing.’ I also put on a mask whenever I go out of the room, and ate separately away from the table.

I was having chills and fever when my thoughts wandered into the times in the past, when I was also sick in bed.

I was in our home in Manila, with high fever. I was still so young, that I don’t go to school yet. My body was full of red spots that were very itchy, and I’m trying my best not to expose them. (Bawal daw mahanginan.) I believe I got the measles. My mom would continuously put a wet towel in my head to try to lower my temperature. But despite of that, I was to the point of hallucinating, that my mother said I was seeing things that were not there.

Then there was the time I was in Kindergarten, when I again had a fever, and one side of my face swelled up. I looked like a squirrel that has an acorn in one of its cheek. I had the mumps. My folks painted a bluish gooey something on my face. It is a concoction of clay, blue dye and vinegar, which was a popular folklore remedy for mumps in the Philippines. My classmates in Kindergarten stopped by our house to visit me, and they saw me with my painted blue puffed-up cheeks.

I know, I know, you may be asking, why did I get both the measles and mumps when I was a child. Why was I not vaccinated? Were my parents against vaccination? Not really. I was just born before the era when MMR (Measles, Mumps and Rubella) vaccine became available worldwide. It was later offered in our school when I was older, I think I was in Grade 2 or 3. My classmates and I lined up and I received those injections despite my silent protestation as I was scared of needles.

There were several other times that I was sick as a child with colds, and my mother would put Vicks Vaporub in my chest and back. Even in my nose, when my nose was clogged up and could not breathe. She would also put Vicks Vaporub in my feet and then put socks on me, telling me that will help my fever. For many Filipinos, Vicks Vaporub and White Flower ointment were a cure-all treatment for any ailment. To this day, I hate the smell of them.

Now that I have the MD degree after my name, I know that the blue paint on my cheek and the Vicks Vaporub on my feet perhaps caused nothing to help my sickness. But perhaps just the fact that I am loved and my parents were showing they care, the best that they know how, was enough to make me feel better. And that eventually healed me of my illness.

Many times, showing people that we care for them, is enough to relieve them of their malady. I know I have plenty of that in my home as a child, and in my home now. Even when I feel terrible with this illness, I know that I am being attended to, not necessarily by a medical team, but more importantly by people who really cared for me. In fact, I still have the cup of salabat on my night lamp stand that my wife brought me this morning, and I could already smell the sinigang that she is cooking.

I was having chills when I glanced outside the window.  Snow is now falling softly. I am not going anywhere. More reason to snuggle under the covers the whole day.

IMG_6308

(*These thoughts were concocted 3 weeks ago. I think I got influenza, and I was house-bound for 5 days. Photo taken with an iPhone.)

 

 

Peace Be Still

A few days ago, while I was in my clinic seeing patients, I received a phone call. It was another doctor who wanted to discuss with me the results of a patient’s laboratory exam.

It is not unusual to have another doctor call me to discuss about a mutual patient. Except this one was not about a mutual patient. On the other line was the Hematologist-Oncologist (Hem-Onc) doctor. The patient he was calling me about, is my wife.

It started with a regular annual doctor’s visit. After having routine test, my wife’s Primary Care physician was alarmed by the results of the complete blood count (CBC). This prompted a referral to the blood and cancer (Heme-Onc) specialist.

After the evaluation by the Hem-Onc doctor and having the exam repeated, that’s when the specialist called me. He said that he was concerned about the elevated count of a blood component, and for some “funky-looking” cells. He recommended a confirmatory test, a bone marrow biopsy.

Bone marrow biopsy is not a very dreadful procedure but its not a walk in the park either. It can be done as an outpatient, usually under “conscious sedation” (meaning, light sleep). It entails drilling a long large bore needle into the hip bone down to the marrow, and aspirating and scraping a “sample” contents inside the bone.

The problem of being a doctor, is that you know “too much.” Too much than needed. So in my mind, I already ran down on the possible differential diagnosis. I started to play the different scenarios, their treatments and outcomes. And even though I know that it can be nothing or something benign, I couldn’t shake off the idea that it can be a myeloproliferative disorder. In layman’s term, leukemia.

My spouse’s family history was not reassuring either. Her father died of cancer in his 60’s. She has two brothers that died prematurely, one was barely 50, and the other one in his 40’s. Then her sister who was a little older than her, was diagnosed with cancer in her 40’s.

I tried to be nonchalant and positive about it when I spoke with my wife, but I think she can sense that it can be something serious. For the succeeding days prior to the scheduled biopsy, both of us were feeling the uneasiness, as if there’s angry storm clouds hanging over our heads ready to discharge their fury.

The fear of the unknown is one of man’s greatest fears. It terrifies us. It consumes us. It kills us even before we die.

Two nights before the biopsy, we both cannot sleep. My wife asked me point blankly, “Am I going to die?”

I don’t know how to answer that question. Or perhaps I don’t want to answer that question.

She told me that she’s really afraid. So in the middle of the night she asked that we kneel down in prayer.

As we prayed, I asked God to be with us as we go through this storm.

Suddenly I was drawn to the story of Jesus and his disciples when they were caught in a great storm* while crossing the Sea of Galilee. I saw myself struggling with the oars and the sail with the disciples. We were trying our best to keep the boat afloat……

The winds are howling. The billows are rolling. The thunders are cracking. The storm is raging. And I am terrified and trembling.

But where is Jesus?

He is asleep! How can he sleep, when we are about to be swallowed by the storm and the sea?

“Master, do You not care that we are perishing?” I cried.

When Jesus arose, he looked at me lovingly, yet he asked me why do I have so little faith.

Then he spoke: “Peace, be still.”

I looked around me. The winds are howling. The billows are rolling. The thunders are cracking. And the storm is even more raging.

But I am still.

image from here

(image from here)

(*Mark 4: 37- 40)

Soaked from the Rain

During my recent short stint (only 7 days) in the Philippines, I have experienced once again the heavy rain showers of Manila. There were no typhoons, just run-of-the-mill soaking monsoon rains of the tropics.

In one instance while I was there, the heavy rains have caused flooding in Metro Manila that traffic crawled to a halt. I even heard in the evening news that my alma mater, University of Santo Tomas, was forced to close the school due to high floods in España. This brought a flood of memories as well, of my wading days in “water world” of Manila.

Our family have also experienced another type of rain. Rain that just not soak us wet but can bring us down to our knees. Yet these rains if we survive them, can make us strong.

I went home because my mother was not doing well. At one point she was even knocking on heaven’s doors.

I spent most of my stay in the Philippines inside the hospital, University of the East Ramon Magsaysay (UERM), where my mother was admitted. In fact, I slept a couple of nights in the hospital not as a doctor-on-call, but as a “bantay” or watcher of a patient. My mother must have appreciated that she have me as her bantay, not because I am a doctor, and an ICU specialist at that, but more so, that I was there as her son.

The system in the Philippines is kind of different that all patients have a family member, as a watcher, to attend to the patient’s need while they are in the hospital. In the US, rarely any patient have a watcher. They have a call light to summon the nurse if they need something. That’s it. No wonder, patients feel all alone.

One day while I was the watcher in the hospital, I went out to SM Santa Mesa mall, which was a couple of blocks away from UERM, to get lunch, as I was getting tired of the food from the hospital cafeteria. I have nothing against hospital food though.

Then it rained. Heavy downpour.

I got stranded at a waiting shed near SM during the rainfall. Of course I did not bring an umbrella. I think an umbrela will be useless in that heavy downpour anyway.

I was waiting for the rain to lighten up. But as I looked up in the sky it was getting even darker, and I may be waiting there for a long, long time. I knew I needed to get back to the hospital.

So I decided to run in the rain in full abandon.

I got wet. Though not really drenched. But to me the rain was refreshing as it cooled me off and washed away some of the afternoon heat.  It also helped clear my mind and realize what my real priorities in life were. Not getting wet was not one of them. Besides, why are we afraid to get soaked from the rain anyway?

We may prefer eternal blue skies and beautiful summer days. We don’t like the rain to spoil our fun. We don’t like the rain to wet our beautiful outfit. We don’t like the rain to ruin our perfect plans.

Yet, rain and clouds are part of our lives. I don’t mean just the weather.

I am back in Iowa now. And we are also getting unseasonable lots of rain here. We have plenty of rain that the grass here are still so green even if it’s almost end of summer. Usually by this time of year here, the grass has started to turn brown. But I’m not complaining.

This morning, I finally came out to run after fighting jet-lag for several days. I was trying to put back on track my training for the half marathon which is not too long from now, since my training was temporarily derailed by my emergent and unscheduled trip to the Philippines.

As I came out, the road was wet from the heavy rain last night. I have noticed thousands of earthworms scattered in the paved road. Why earthworms go out after the rain is not really clear. Some experts say the rain drive them out of their burrows so they will not drown, while other experts refute this, as earthworms don’t drown, and they can live totally submerged in water for few days.

IMG_4445

earthworms out after the rain

In any case, these earthworms who are now on the road, will die and will get baked in the heat of the sun, unless they get back to the soil in time. Are they afraid to get soaked from the rain too? But trying to run away from getting soaked put them more in harm’s way.

While I was running, the dark rain clouds gathered around above me again, taunting to pour down its contents.

I’m not an earthworm. And I’m not afraid of the rain anymore.

Let it pour.

*******

(*photo taken in our neighborhood, with an iPhone)

 

 

 

 

Paglalakbay sa Alapaap

Alapaap.

Iyan ang aking nakita, sa pagdungaw ko sa bintana. Muli akong nasa himpapawid. Lumilipad. Naglalakbay. Pabalik sa aking lupang sinilangan.

Isip ko ay lumilipad at naglalakbay din. Ngunit hindi tulad ng eroplanong aking sinasakyan na mapayapang tumatahak sa mga alapaap, ang biyahe ng aking isip ay maligalig at matagtag.

Mula nang ako’y lumisan ng ating bansa, dalampung taon na ang nakalilipas, ay maraming beses na rin naman akong nakapagbalik-bayan. At lagi sa aking pagbabalik ay may bitbit itong galak at pananabik. Galak na muli akong tatapak sa lupang tinubuan. At pananabik na makita muli ang iniwang pamilya’t mga kaibigan.

Kahit nang ako’y umuwi noong nakaraang Nobyembre bilang isang medical volunteer para tumulong sa mga nasalanta ni Yolanda, ang naramdaman ko’y hamon na may kahalo pa ring pananabik. Pananabik na makapagbigay ng lunas at ginhawa sa mga kababayang nasakuna ng bagyo.

Ngunit kaka-iba ang pagkakataong ito ng aking pagbabalik. Walang galak. Walang panananabik. Kundi pagkabahala sa kakaibang bagyo na aming sasagupain.

May katiyakan naman ang aking patutunguhan. May katiyakan rin ang oras ng aking pagdating at paglapag sa Maynila. Ngunit hindi ko tiyak kung ano ang aking daratnan. Hindi ko rin tiyak kung gaanong kaikling panahon pa ang sa amin ay inilaan.

Pero ganyan daw talaga ang buhay. Walang katiyakan.

Hindi ko sasabihing hindi ko batid na darating din ang pagkakataong kagaya nito. Ngunit katulad ninyo, ako’y nagnanais at umaasa na sana ay malayo pa ang takipsilim. Sana ay magtagal pa ang tag-araw. Sana ay hindi pa matapos ang awit. Sana ay mahaba pa ang sayaw. Sana……..

Subalit tanggapin man natin o hindi, ang lahat ay may hangganan at may katapusan.

Maraming bagyo na rin naman ang aming pinagdaanan. At kahit gaano kalupit ang hagupit ng unos, ito ay nakakaya ring bunuin. At kahit dumadapa sa dumadaang delubyo ay muli rin namang nakakabangon.

Hindi lang bagyong kagaya ni Ondoy o Yolanda ang aking tinutukoy.

Ngunit kahit gaano pa kaitim ang mga ulap na kumumubli sa liwanag, at kahit gaano kalakas ang sigwa na yumayanig sa pagod na nating katauhan, at kahit gaano pa kahaba ang gabi, ay ating tatandaan na lagi pa ring may bukang-liwayway sa kabila ng mga alapaap.

IMG_4347

Atin na lang ding isipin na sa ibabaw ng mga alapaap ay palaging nakangiti ang araw. Sa ibabaw ng mga alapaap ay laging mapayapa. Sa ibabaw ng mga alapaap ay walang nang bagyo. Walang nang pagkakasakit. Walang nang paghihinagpis. Walang na ring pagtangis.

Malapit nang lumapag ang aking eroplanong linululanan. Malapit na rin akong humalik muli sa inang-lupa na aking sinilangan. Muli rin akong hahalik sa mukha ng aking ina na sa akin ay nagsilang.

Sana ay magkita pa kami. Sana ay abutan ko pa siya………..bago siya maglakbay sa ibabaw ng mga alapaap.

*********

(*photo taken at 30,000 feet)

Post Note 1: nagpang-abot pa kami.

Post Note 2: delayed at on-hold ang kanyang “byahe.”

 

Little Girl in ICU

She was sitting in one corner of the room. With big headphones on her ear, and with an iPad in her lap, she appeared to be preoccupied and was in her own little world.

She was a 6-year-old girl, with beautiful blonde locks, sitting in one of our ICU room. Her back was turned from the door entrance and was facing towards the window. But she was not our patient. Her father was.

A couple of feet away from the little girl was her father, lying in the hospital bed. He was half-awake and half-asleep. He was obviously in distress. Every breath was a struggle that slowly zap whatever energy and life remaining in him.

He was 33 years of age, and for the past 6 years had been battling testicular cancer. And I would say that he gave a good fight. A hardy and courageous fight.

Sadly to say, the cancer was winning this battle. It now had spread to his lungs making it more difficult for him to breathe. His CT scan of the chest which I just reviewed prior to entering his room showed hundreds of big and small masses scattered throughout his lungs. The cancer had spread into his brain too causing him severe headaches.

For the past several weeks he had been in and out of the hospital. He continues to receive chemotherapy, though despite of this the cancer continues to progress. During this present hospitalization, he had been admitted to the ICU twice due to problems stemming from the cancer itself or from the complications of its treatment.

As I entered his room with my ICU team, I spoke to him and his young wife who was in his bedside, about the grim situation. We spoke in low tones, almost in whisper, keeping in mind that their little girl was in the same room.

I relayed to them that in spite of everything we have done, we have nothing more to offer, but one. And that is comfort. Meaning, we cannot cure him or treat him, but we can at least make him comfortable. We can offer medications that can take the edge off from his suffering. Something to numb his pain. Or something to blunt his sensation of air-hunger. Something to lessen the agony as he faces the inevitable.

I recommended that we transition to hospice care.

The patient and his wife agreed, as perhaps they know as well that it was time. The wife silently cried, though not so much, trying to compose herself and trying to show strength so not to upset her daughter, who was oblivious of our discussions.

As a parent myself, I can only imagine the predicament my patient and his wife were in. Oh how we wish that we can protect our young kids from the harsh realities of life. Yet I learned that it was the patient’s wish to have her daughter in his room as much as possible.

As we end our talk, the patient’s wife asked me how we doctors can deal with this kind of situations without crying. I softly answered her, “No, we do.” Or at least I speak for myself. Maybe not in front of our patients, but doctors do cry too.

When I exited the room, I glanced at the little girl. I don’t have the heart to disturb her. She was still quietly sitting in her corner of the room. Her back was still turned away from the bed and from us. She still had her big headphones on. Still busy playing on her iPad. Sheltered from what was happening a few feet away, or so it seems. And at least for now.

Does she know that her daddy will not be able to give her piggy back ride anymore? Does she know that he will not be able to chase butterflies with her again? Does she know that her father will not be able to comfort her anymore when when she falls from her bike and scrapes her knee? Does she know that he will not read her bedtime stories anymore? Does she knows that he will not be able to tuck her in bed anymore and kiss her goodnight?

Does she know that her father will not be coming home, ever? She will.

And I hope she has enough memories of what a father’s love is.

*******

slide.001

Post note: Two days after I had the talk with the patient and his wife, he suffered a grand-mal seizure and became comatose. He died a few hours later.

(*photo taken somewhere in Grand Teton National Park)