Tatang’s comfort care

For 20 years, he worked in Saudi as a driver-operator for a mixer truck. He had four children, two following in his footsteps to look for greener pastures overseas: a son in Saudi, a daughter in Taiwan. Two stayed in the Philippines, a daughter working with a memorial park, and a son, whom I will call Lem to protect his privacy. Lem works with me as my son’s tutor and driver while pursuing a master’s degree in sports science in UP.

I didn’t meet Tatang until last week. I knew he had been seriously ill for some time, so I told Lem I wanted to visit him in their home village in La Union. We drove past the sea and the mountains to a village marked by rice fields and meadows. Unlike the often tempestuous seas that surfers love so much, the village was placid.

Tatang’s house was quiet, so I was startled to find several people, mostly children, in the living room. I figured they had learned to keep noise levels down for their Lolo, who was in an adjoining room.

Three years ago, doctors had diagnosed him as having tuberculosis, based on a “spot” in his X-ray. I’m always aghast to hear how TB is still diagnosed that way, given that there are more accurate detection methods, some of which have been around for decades.

By then, I had learned the father had a chronic cough, and that he was a heavy smoker. He would stop after being hospitalized, but pick up the habit again.

Over the next few months, Lem would take leave to go home, because his father was being hospitalized. I was not surprised to hear, in 2018, that the father was now diagnosed with COPD or chronic obstructive pulmonary disease, which covers chronic bronchitis, asthma and emphysema. Antismoking campaigns concentrate on the threat of cancer when more should be said of emphysema, which, when it becomes serious, is a constant struggle to get air, described to me many times by patients as “like you’re drowning.”

A few months ago, the doctors said he had a “bukol,” a term that Filipino doctors now use generically to refer to suspected cancer. (Can you imagine a bukol in the lung?) A biopsy two months ago finally yielded a new diagnosis: lung cancer.

When I visited him, he was so weak he couldn’t even sit up without assistance. He could speak, ever so softly. He would repeat how painful it was, even just to breathe. He was constantly on oxygen.

I sat with his son and his two caregivers: a daughter and a granddaughter. They knew Tatang’s days were numbered, and I introduced the term “comfort care,” which they had been doing for some time now, concentrating on alleviating pain and discomfort. It was all right, I assured them, if he refused medicines, especially the vitamins and a so-called appetite stimulant (actually an antihistamine). The painkiller was now the most important treatment, and I was amazed how he was managing on a low dose of tramadol. In Manila, they would have put him on morphine.

But it was as well that he was home with his loved ones. He had a TV in front of his bed, and had been following the UAAP games, but it was getting harder for him to follow the games, or anything on TV.

I sat awhile, trying to keep good cheer. I could tell he was better off than many terminally ill patients in hospitals, mainly because there were people who cared so much, and so well, for him. His granddaughter had passed the teachers’ licensure exam but had postponed work to be with him.

As I left the house, I found a cigarette pack in their veranda, with a warning label about smoking causing asthma. I knew it wasn’t his. Later that week, in one of my classes, I asked the class how much cigarettes cost now, and they told me it was P7 each. They joked about how it used to be P1 each; I told them when I was a student, it was 5 centavos each!

Smoking’s still cheap — too cheap in the Philippines. Yet its costs accumulate, in terms of people’s lives, not just of the patient but of his or her family, of people they love.

Last Friday morning, his family found Tatang kneeling at his bedside, hands clasped. Everyone wondered how he had managed to get out of his bed to pray… and to pass on.

He was 65.

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