February 09, 2008

Five hours in the E.R.

Something Like Life
Feb. 8, 2008

I THOUGHT it was just another migraine which I could dismiss with a cup of coffee. I was talking to Francine, who had just come back from a vacation with her one-year-old boy, but even if I wanted to talk to her some more, I had to stop her rather abruptly telling her my head was starting to ache. I was already getting blinded by the light and the tum-tum-tum in the middle of my head was getting heavier and louder.

After a cup of java, I closed all the lights in my room, did my yogic breathing exercises and tried to get some sleep. But by 9 pm, I knew it was time to go to the hospital. The searing pain in my head just wouldn’t let up. It felt like a butcher’s knife had just split right through my medulla oblongata (a favorite word from grade-school biology class, yes), as an invisible hand tried to pry my skull open and, reaching inside, pulled and twisted every cerebral artery within its grasp.

I knew my blood pressure was high because of the throbbing pain at my nape, and a neighbor’s nurse confirmed it as 160/110. So off I went to the emergency room of the nearby government hospital, once a shining example of the greatness of the Marcos administration, now a shadow of itself, barely sustaining its ER with equipment and personnel.

The staff called my doctor who had prescribed, as I later found out, an anti-migraine drug. It was supposed to work within 30 minutes, but didn’t. But I sat patiently, trying to massage my head, and looked around at the bedlam that night. The people were basically spilling out of the E.R., with relatives trying to keep close to their ill loved ones. But there just wasn’t enough room.

A woman dressed in a stylish black-and-white top, and in heels, came in with her husband who could hardly move or speak. I wondered if they had just come from a party. As she tried to explain the circumstances of their trip to the E.R., he stopped breathing. The wife started jumping up and down, screaming, “Baby! Are you okay?” and to the nurse, “Is there a doctor?! Give him something! Oxygen!”

We’ve seen movies and TV shows where the E.R. staff is rushing about, treating patients, reviving them, the scene punctuated by loud voices from doctors trying to restrain relatives from breaking down. In this E.R., the staff moved quite slow and deliberate. It was as if there were no emergency. There was just a lot of people—the sick sitting in seats badly needing reupholstery with needles stuck to their arm for intravenous drips, and their relatives milling outside as the guard shooed them away. “Para sa mga pasyente lang ho ang mga upuan!” There were two doctors receiving patients in the reception area/lounge, while the rest were huddled in their inner sanctum doing godknowswhat.

I finally spoke up and told one of the doctors that I was getting no relief from the drug they gave me, and that maybe they should give me another dose. I told her I was used to taking two tablets of Biogesic or two capsules of Excedrin with caffeine when coffee failed to work its wonders on my migraine. (Okay, so I had underestimated this recent migraine attack and failed to down my usual drugs.) But they said they couldn’t give me an additional dosage because my blood pressure might drop substantially.

They come back to me saying that my doctor ordered a CT scan to check my brain. I was like, why? All I have is a migraine that has gone out of control, can’t you do something about it? Give me another drug or something to bring down my blood pressure at least, I pleaded. The doc on duty tells me, “We’re not sure if it’s the pain that’s causing the high blood pressure, or the high blood pressure’s causing the pain.” Which is why they were treating me with the anti-migraine medication first. But a CT scan?!?! Recent episodes of House MD started flashing in my head. (Where are you when I need you Hugh Laurie?!?!)

Okay then, let’s get the scan done now. Para matapos na. (I never liked sitting around doing nothing.) “Ma’am, we’ll call you. Pahinga muna kayo d'yan.” The machine was being prepared, they said. In the meantime, a female technician from the pathology department tried to get a blood sample, but she couldn’t find a vein. She stuck me with her needle twice before I told her that maybe we should move to the reception table which was well lighted and where she could position my arm properly. Of course, with her long hair falling all over her face, I had my doubts that the move was going to help. I’ve had CBC (complete blood chemistry) and FBS (fasting blood sugar) done before without a hitch. This girl was probably new.

I turned away as the technician poked yet another needle in my arm, and struck up a conversation with the chubby intern with a clear complexion dressed in her green gown. I noted that there was an unusually large number of ER cases that night. And then the damn broke. She told me that they were really under pressure trying to find rooms for the patients who had been admitted, but there were none available. Sweet girl, she was trying to hide her discomfort, and pleading for understanding. “So hindi po namin kasalanan na walang makitang kwarto para sa kanila. Kasi wala pong vacancy talaga.” She obviously was getting disheartened as patients and their relatives kept blaming her and her colleagues for the hellish long wait in the E.R. She pointed out a disheveled patient seated in one corner, his legs full of scrapes and cuts, who had suffered stroke and he was just resting with an IV dripping into his arm. Still no room for him. Truth to tell I was suddenly embarrassed that I even complain about the seeming neglect of the E.R. doctors in my case considering there appeared to be more patients with life-threatening illnesses than mine.

(I remember earlier going inside the rest room, passing all the other patients in bed. Some were sleeping, the others had their spouses or children waiting on them. The woman whose husband had stopped breathing was holding his hand. All the eight beds were occupied...it was a really small ER, I thought, compared with the ERs in private hospitals I had been to. In private hospitals, they have at least 20 beds and an adequate lounging area for relatives, so there’s no crowding. All I could think of was my taxes that were supposed to be supporting primary government facilities like this one were apparently still insufficient to push them to higher quality standards. Well, we all know why that is.)

The intern went on with her litany and then added, “Ma’am, pasensya na po kayo, darating na ho ’yung technician para sa CT scan nyo.” I wondered why there was no technician around in the first place. I saw the instruction in my file saying that the procedure was “STAT”—meaning immediately for those of us not in the medical profession. She told me that in the evenings, there was just a technician on-call but as if to appease me, she said he just lived nearby and was already on his way.

I arrived at the ER before 10 pm, I finally had the CT scan at about 2 am. By the way, this hospital asks you to pay for the scan in advance, even before you actually have the procedure. Segurista.

The technician was candid enough to explain his delay and said he lived in Sampaloc. “Alam nyo naman ho, gobyerno, ayaw ho magbayad [ng extra]. So on-call lang ako.” I marveled at the brand-new Philips 40-slice CT Scanner, which, according to the guy who wheelchaired me back to the E.R., the hospital got because Philips gave a free LCD TV. Superb marketing tack, Philips!

Anyhow, as the technician strapped my head and my arms in place, I closed my eyes and was wheeled into the huge circular machine with cameras whirling inside. I started saying my Our Fathers, Hail Marys and Glory Be’s, praying that they don’t find anything wrong in my brain. (I had a brother who passed away from a cerebral aneurysm, so you can imagine the litany of novenas I prayed.)

Well, at least the free TV was put to good use because as my brain was being photographed, my family was in the adjacent lounge watching Happy Feet. Actually, we didn’t want to leave the lounge anymore.

But the long wait continued at the E.R. The doctor who would read my CT scan result hadn’t arrived as well. Sigh. I would think that in government hospitals, with the large number of patients going there because of the relative inexpense, there would be more in-house staff to act on every complaint fast, treat the patient immediately, and get their patient’s butt out the ER door quickly.

By the time my CT scan was read, it was close to 3 am. The doctor in charge said she couldn’t get hold of my primary-care physician, presumably because he was sleeping already. But she said the result of my CT scan was “normal”. (Yay! I do have a brain!) So I decided to go home. I wasn’t about to stick around waiting for my physician to wake up and tell me whether or not I should be confined. In the first place, there were no beds available, and secondly, the drug they gave me finally kicked in after an hour. I signed a waiver and again prayed to God to keep me safe that night.

As my mom and sister went off to pay my bill, the guy with the stroke was helped on to a bed, to be carted off (finally!) to his hospital room. I caught the eye of the chubby intern I had spoken with a while back, and she gave me a tentative “hay salamat” smile. I could tell she was a good kid, just trying to do her job in the best way she could, and breathing a sigh of relief after being able to accomplish it well.

As for me, I was just glad to be out of there. Period.

(My column Something Like Life, is usually published every Friday in the Life section of the BusinessMirror. Cartoon from Pioneer Telephone.)

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