Ward 14-B

The ward was always a little dusty, the air stale, the routine quite tiring. Gyne-oncology patients were particularly challenging because of their extensive surgeries and chemotherapy.

I was assigned to “Nel,” a 53-year-old who had stage 4 cervical cancer. She hailed from Sogod, Southern Leyte, a place close to my hometown, so we spoke the same language. Sometimes I would humor her in Bisaya, telling jokes while trying with great difficulty to start an IV line.

She was always accompanied by her eldest daughter Marie, a dusky woman in her 30s and a mother of three herself. Finances were always an issue, especially in the past four years that Nel was in and out of the hospital. Nel’s husband was only a casual laborer who barely made both ends meet.

Most recently Nel’s x-rays had revealed pulmonary nodules, and she also had begun to experience low back pain with increasing intensity. The fellow in charge requested a metastatic work-up, and a CT scan was needed. I prepared Nel’s clinical abstract because the family’s funds had been depleted, and they wanted to seek help from a charity foundation.

I once talked with Nel about her illness. I asked her when she would usually experience vaginal bleeding, and she said it was when her husband “used” her.

I said it seemed unlike her to speak that way.

She covered her eyes with wrinkled hands and, sobbing, confessed to being regretful of the times she had treated her husband harshly. She perceived her illness as punishment, and harbored much remorse. If only she were given a second chance, she said.

Her latest lab results did not look good. The creatinine and blood urea nitrogen levels were elevated, which meant she had serious renal problems. The CT scan, which would make use of contrast material potentially toxic to the kidneys, was deferred.

Meanwhile, Nel needed to be constantly on morphine for the pain. She was also very irritable, unlike her usual pensive self; she made a lot of jerky movements—a sign that waste products in the body were accumulating and starting to irritate the brain. The only solution was hemodialysis, but it would require a cash deposit.

The mood was heavy that day. Marie told me her family did not have any money. We had explored every avenue, including approaching local politicians and the Philippine Charity Sweepstakes Office for assistance, to no avail.

Later that day I mentioned Nel’s case to my brothers. They told me I was too involved with my patients. A colleague also said I had done enough by helping with the paperwork and the necessary steps for them to ask help from agencies.

My heart was heavy the next day when I learned that the family had decided to take Nel home. Without funds for the work-up or dialysis, they could do nothing else. I made the necessary referrals to hospice care and comanaging departments, and jotted my final entry on her chart.

The next day, I hurried to the ward to say goodbye to Nel and Marie, but when I arrived all I saw was an empty, made-up bed. They had left in the afternoon of the previous day.

A few weeks later, I still could not shake off the feeling of melancholy. Then I received a text message from an unknown number, stating that Nel had passed.

Suddenly I remembered Nel, her short hair that grew in clumps from her last chemotherapy, her wrinkled hands, her quiet demeanor. During her last days her daughter said that she was unable to recognize her own family members.

To this day I wonder if Nel had found it in her heart to forgive her husband, and perhaps also herself.

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Thaddeus C. Hinunangan is a resident physician in pathology at the Philippine General Hospital.