It’s a shame

The joy of seeing your postoperative patients in the outpatient clinic, feeling much better than before you performed surgery on them, cannot be negated by the helplessness you feel whenever you tell the many others waiting in line that they can’t be operated on just yet, there is simply no empty bed, please come back in two weeks.

But it still breaks your heart a little, every time.

You are part of the busiest charity neurosurgical service in the country. Your team is in charge of eight intensive care unit beds and 24 ward beds. At any given time, you have 30 to 50 referred patients from Neurology, Pediatrics, and Trauma. You and your fellow residents do elective surgeries from Monday to Thursday, and emergency surgeries all day, every day, for as long as the patients who need emergency treatment keep coming to your hospital. That’s easily 1,000 to 1,200 charity operations each year.

Despite the figures, it is not enough. You and your co-residents just cannot take in all your underserved fellow men and women, who most certainly feel that they have nowhere else to go.

You ask your 34-year-old patient with Cushing’s disease where she lives. The tumor at the base of her brain is causing her blood pressure and blood sugar to rise, her skin to develop violaceous stretch marks, pimples to resurface on her cheeks, and fat to develop on her face and nape, while her arms and legs are thinning. She has become prone to recurrent infections, too.

“Sa Catanduanes pa po, Dok.”

Her sister and companion says they have been staying at her friend’s house in Taguig for the last four weeks, awaiting the results of the laboratory exams and imaging studies, and the schedule for surgery.

When you do the math, you easily realize how much more money they would have to spend just to cover their everyday expenses for sustenance while waiting to be admitted in your hospital. And that is on top of the amount of money you told them to raise for the supplies and medications that your patient will need for her operation and recuperation period.

Often, patients who travel to the city for treatment lose the income from their livelihood in the provinces, too. The spouse usually has to stop working in order to accompany the patient and make the necessary healthcare decisions.

The patient says their money has been running low.

You plead for her indulgence and understanding, invoking the hospital’s limited resources: “Pasensya na po talaga. Kung pupuwede lang ho, ooperahan na po namin kayong lahat, ngayon na, para hindi nyo na po kailangang maghintay. Pero alam nyo naman po, puntahan po talaga ito ng lahat ng pasyente sa buong Pilipinas.”

And it is true. You have interviewed and examined patients from the Ilocos, Nueva Ecija, Mindoro, Cebu, Aklan, Davao, and Zamboanga. Even overseas Filipino workers forced by their employers to return home because of their newly diagnosed tumors or cerebrovascular diseases end up in your hospital, desperately seeking treatment that would not have been affordable elsewhere.

You look at your watch. It is 8:30 a.m. and you are the lone resident in the outpatient clinic: Everyone else is either in the operating room or attending the department conference. On days like this, sitting in your cubicle, you wish you can just snap your fingers and rid all your waiting patients of their neurosurgical illnesses. You try to compensate with empathy and sincerity, but it is always with a heavy heart that you explain to your patients and their families the long waiting time for surgery.

How many are in the queue today? you ask the nurse at the receiving desk.

“Forty already, Sir.” She is unsure how many others will be referred by the other clinics.

You have long resolved to yourself that you have no right to complain. You may be tired and sleepless, but so are these patients, who have had to endure fatigue and hunger to secure a queue number. They will get up and rush to the commute at the break of dawn (some even camp overnight outside the hospital) to be able to spend five to ten minutes talking to you, hoping to be given hope for a cure, or at the very least, an honest disclosure on the prognosis of their illness.

Your next patient, a 56-year-old woman with a tumor on the frontal part of her brain asks if you can make another medical certificate and quotation (i.e., approximate expense for operating room and anesthesia needs).

“Bakit po, Nay?” you say, and ask what happened to the original certificate.

She says her fund has expired. She shows you her guarantee letters from the Philippine Charity Sweepstakes office and local officials. Indeed, today is past the validity dates indicated in the documents. The funds originally appropriated for her can no longer be used. She will have to ask for a reapproval, which will mean waiting in line. Again.

Patients who are unable to save cash for hospital expenses are advised to approach charitable institutions and politicians for financial assistance. They come back with guarantee letters, indicating the amount that can be deducted from the politician’s Priority Development Assistance Fund to be used for the patient’s treatment.

Usually, the amount allocated to patients is measly, in the range of P5,000 to P15,000—certainly not enough to defray the expenses of a patient undergoing major surgery. Patients’ families often have to approach several government officials to come up with the amount they have been told to raise. Sometimes, they will come in with guarantee letters amounting to P20,000 or more, and the families will later confirm your suspicion that they knew people “close to Mayor/Governor/Congressman/Senator.”

Expiring guarantee letters are not uncommon.

You pull out a blank clinical abstract form from the desk drawer and fill it out with your patient’s clinical information. You write a letter on a separate sheet addressed to the PCSO and local officials, detailing the tentative expenses she will incur.

“Nay,” you tell her, again begging her indulgence, that she will have to queue up again for the paperwork, “lakarin mo na lang ulit itong mga ito.”

You recall last night’s news and compute just how many patients you would have helped with P10 billion worth of pork barrel.

It’s a shame. If that amount, or even just a small part of it, had instead been used for the improvement of facilities and purchase of surgical equipment in regional hospitals, or to expand the health coverage of the marginalized so that their illnesses will not worsen only because they have no money for surgery—“Wala pa po kaming pera pampaopera, Dok”—how many families would have been spared the unnecessary loss of a breadwinner, homemaker, son, or daughter?

The economic progress you hear of every day will be more palpable, in the form of improved social services, to the Filipino people.

In another part of the world, a twentysomething Filipino woman is throwing lavish parties, flaunting her designer dresses and shoes, and posing with Hollywood celebrities, while your patients are waiting, dying a little each day.

The wanton greed is disconcerting. If only you can apologize to your patients for that, too…

Dr. Ronnie Enriquez Baticulon, 29, is a graduate of the University of the Philippines College of Medicine and  a fourth-year neurosurgery resident. He blogs at https://ronibats.ph.