Abandonment

I heard on the news that a baby girl was found in a plastic bag hanging from a tree. The people of the neighborhood found the child because they heard a cry and followed the sound. Luckily, the baby was still alive. But thinking about it, whoever left her there left her for dead. How could anyone have done such a thing?

It was one of those admitting days when you feel that everyone is sick. Our general medicine service was the admitting service that day in January. Mrs. Cruz came in complaining of chest heaviness and difficulty in breathing. Before seeing the patient, we were given a heads-up by her ER doctor that she didn’t have a companion, or  bantay, with her. Of course, this posed a problem with management. Who will buy her medications? Who will facilitate her laboratory exams? Who will consent to whatever procedure or directive she will need?

Working in a government hospital, we’ve come to live with minimal resources and little manpower. “Overworked and underpaid” is something we tolerate daily. The doctors are not just doctors. They become nurses, social workers and, in Mrs. Cruz’s case, her  bantay.  She was admitted to our female ward with the diagnosis of unstable angina—almost like a heart attack, but not that severe. Her medications were shouldered by the resident in charge and by the Sagip Buhay Medical Foundation, brought from the drug store by the intern in charge.

Three days after Mrs. Cruz’s admission, as we made the rounds, we noticed that her breathing was more labored. There was fluid in her lungs upon auscultation. Blood exams and ECG were immediately done, which eventually showed that this time she was having a kind of heart attack in which the coronary artery is partially blocked. But her heart was having so much difficulty pumping out blood that fluid was beginning to fill her lungs. Her vital signs were still acceptable, and the service was performed to remove the fluid in her lungs.

Later we asked Mrs. Cruz if she had a family member that we could contact. She told us she had two daughters, one living in Nueva Ecija and the other in Laguna. When we asked how they could be reached because she needed to have kin with her, she replied, with a hint of bitterness, that they would not come, they had stopped caring: “Hindi  pupunta  ang  mga  yun.  Pinabayaan  na  nila  ako.”

As the days passed Mrs. Cruz began to warm up, telling little stories about her children. Eventually she told us that she was estranged from the daughter in Laguna. She had previously stayed in that daughter’s home, but they had a fight. She left and lived as a vagrant along Manila Bay.

Still, we had to contact the nearest relative. Our social worker was able to reach and speak with both daughters. The one in Nueva Ecija wanted to come and take care of her mother but she said she was penniless, so much so that her electricity had been cut off. She promised to find money, perhaps borrow some, and come as soon as possible. But despite the conversation with both the social worker and the doctor, the daughter in Laguna firmly said she didn’t want to come.

For us doctors, it was good news that a patient’s relative was about to arrive. It meant less social work for us, and we could discharge the patient. We made the rounds again and when we passed Mrs. Cruz’s bed, we told her that her child was coming to take her home. I thought she would be delighted to hear it. But with much pessimism, she said no one would come, they had forgotten about her already: “Hindi  yun  pupunta.  Nakalimutan  na  nila  ako.” We said her daughter had promised to come on Saturday. She shrugged and waved us off, saying she couldn’t breathe just talking to us.

Dawn of Saturday, our service was on duty. The ward resident was knocking on the door of our call room asking for help to read an ECG tracing. It was a complete left-bundle branch block. I saw the name on the tracing: It was Mrs. Cruz’s ECG. Everything happened quickly. She had a sudden onset of chest heaviness and difficulty in breathing. And now with the ECG, she had another heart attack—this time, a completely blocked artery.

We ran to her bed and found her breathing very labored, her pulse thready. And we could not hear her blood pressure. Not only was she having a massive heart attack, her heart was also not pumping blood, and she was in cardiogenic shock. She was immediately intubated, hooked on a mechanical ventilator, and given pressors (intravenous medications to raise the blood pressure). Then we stood at the foot of her bed and stared at her.

Questions raced in my mind. What else could we do? We had been treating her for her previous heart attack. And there was only one intervention left that could give her a chance: an emergency angioplasty. But this is a very expensive procedure and we could not afford it.

I could not believe that I was at Mrs. Cruz’s bedside, watching her die.

Morning came and Mrs. Cruz’s heart stopped beating. We performed advanced cardiac life support. But because there was no family to provide advance directives, after 15 minutes she was pronounced expired.

As postmortem care was rendered, the ward resident opened her backpack to look for her admission card. Inside were a number of photos—of her daughters, her grandchildren, the family—and a few pieces of clothing. It was a moment when we weren’t sure what to feel. After finding her admission card, the resident simply closed the backpack, And filled out her death certificate.

The body was wheeled out of the ward and brought to the morgue. We informed the social worker of the details to relay to the family.

That Saturday morning Mrs. Cruz died alone, in the company of strangers.

Gelza Mae Almario Zabat, MD, a graduate of the University of the Philippines College of Medicine, specialized in internal medicine after residency training at the Philippine General Hospital.