What remains of the day

“Pagod ka na ba, anak?”

“Kasi ako, hindi pa ako napapagod.”

I feel the tears welling up as I wipe the bloodstains off my postduty stethoscope. This has not been a bad day at all, but definitely a tiring one.

You eventually learn to know it when you see it — death. Even if you have no idea how, or when, and most especially why, it only takes a few minutes to recognize a lost cause. It was just my second referral of the day, and after examining the patient, I decided to invite her children to talk in private. I find myself mentally fumbling for my prepared script.“Hindi po maganda ang kondisyon ng nanay ninyo…”

The first time I had a family meeting for a patient, I struggled to find the words that were the exact mix of hope and matter-of-fact devastation. I ended up talking to the family thrice to discuss the condition of their mother because I didn’t know how to make them understand the limits of medicine and time.

Thinking about it now, I guess it was also my own inability to gauge the limits of our own profession.

Halfway through and after many, many deaths, I am reminded daily that we can’t play God.

And I tell them just that.

“Hindi po siya parang ubo’t sipon na mapapangako kong magbibigay ako ng gamot at uuwi kayo na parang walang nangyari. Kailangan ko kayong tapatin na mahirap pong habulin sa puntong ito ang sakit ng nanay ninyo. Mukhang doon po tayo papunta.”

At times it’s easier when the patient is old or has battled whatever disease he has had for quite a while. Other times it’s harder when, for instance, just a few hours ago, the same person on the brink of death was having a leisurely stroll in the mall with his loved ones.

Some take just a few minutes to understand, others probably never.

Like that man whose wife had aplastic anemia and has been going in and out of the hospital for the past three years in need of blood transfusion. His downcast eyes stand out among the fury of people in the emergency room. He nods at me, then looks at his wife.

One glance and I know this is going to be their last visit. I put a hand on his back and hold his wife’s hand. I was at a loss for words, but we didn’t need my script. I hear him sob quietly beside me.

Before I leave, he tells me, “Naiintindihan ko naman po, doc, pero hindi ko po natatanggap.” And this is when I learn that letting go did not mean understanding, and that even years of understanding may not ever lead to acceptance.

I was looking at my eighth referral of the day charting at 2 a.m. when I got another call from a coresident urgently referring their patient who had cerebral palsy, and who was profusely bleeding from her tracheostomy. Irritable, tired and sleepy, I questioned the urgency of the referral. It was only when I actually saw the amount of blood spurting out from the patient that I decided to drop everything and help them resuscitate.

Within minutes, we were losing her. The patient’s bleeding suddenly went from spurting to gushing and our three pairs of hands (mine, my coresident’s, and intern’s) could not move fast enough to get and do everything needed to make her oxygen saturation and blood pressure come up.

Within minutes, we were already doing chest compressions and rhythm checks. Within minutes, the father needed to decide if we were to stop all resuscitative measures.

No time to fumble for scripts. No time for lengthy talks. No time for understanding. No time for acceptance.“Tatay, ano na po ang desisyon?”

He answers us by cutting off our chest compressions and hugging his child’s blood-soaked body.

The patient’s mother, who was tasked to get the mechanical ventilator for her child, arrives. It takes her a few seconds to take everything in — the bloody mess on the patient’s bed, the sound of her husband’s crying, our avoidant eyes, and the lifeless body in the middle of it all.

I see her dive into the chaos of realizing that they have lost their child.

All the noise inside the emergency room quells, until all I hear is the mother crying for her child, saying again and again: “Pagod ka na ba, anak? Bakit ka napagod? Kasi ako, hindi pa ako napapagod. Hindi pa ako pagod, anak.”

When you deal with death every day, I will tell you that the faces eventually muddle into a basin of blunted memories. A speech will be in place, the condolences extended automatically, the chart entries on point starting with “Patient referred for unappreciable heart rate…” and ending with “Please render postmortem care.”

But even this daily ordeal has never prepared me for the different kinds of pain from each loved one left behind. The faces may become so jumbled that they are unfamiliar, but the pain — each pain — is always new and stabbing.

We resorted to tidying up the patient and her bed, in a mediocre attempt to make it seem like she just went off to sleep. I briefly explain to them what led to their daughter’s demise, unsure if it was just me trying to comfort myself with pathophysiology and technicalities.

Because who could explain why they had to go through 20 years of giving full care to a child born with cerebral palsy? Who can ever give them the reason why this had to happen despite their hearts filled to the brim with love for their child? What words could possibly bring comfort to a tireless heart?

Before leaving the hospital, I dropped by the family I had met earlier and learned that they had decided to bring their mother home. It was what the patient wanted — to be surrounded by her loved ones in the final moments of her life. Her three children hugged me goodbye, and this made me feel a little bit lighter on the way home.

I lie on my bed worn out but unable to sleep. Some days just feel tiring, but this one was particularly exhausting. I drown out all the light and noise, but the voice of our patient’s mother still echoes inside my head, asking:

“Pagod ka na ba, anak?”

And before falling into a deep slumber, I decide to answer: “Susubukan ko rin pong hindi mapagod. Hindi ako mapapagod.”

* * *

Sachiko Solis Estreller, 27, is an internal medicine resident in a government hospital.