NDEXING TITLE: RCHAN’S MAR [5-03]

TITLE: Over a Bottle of Coke and a Plate of Chichakorn

PERIOD OF MEDICAL OBSERVATION: Feb 2005

NARRATION:

             I operated on a 13-year old patient who had an initial impression of a perforated typhoid ileitis. Upon opening up however, we discovered that she had an internal hernia, with 50 cm of her jejunum strangulated within the defect. After releasing the bowel segment, we observed and reassessed the bowel. It regained its pinkish color, had strong mesenteric pulses and had good peristalsis. We deemed the segment to be VIABLE. We closed the mesenteric defect and concluded the operation. I however informed the parents of the possibility of a second-look operation. They were amenable to whatever plans we had for their daughter.

            I diligently made my rounds on this patient and consistently updated my consultant. Their family was not “financially capable” so to speak. We had to find ways to provide her of her medical needs. There were times when her mother would have tears rolling down her cheeks when we gave her prescriptions from time to time. She would just tell me, “Sige po Dok, gagawa po kami ng paraan.” I made sure that the patient was monitored closely, had her medications on time, fluids adequately given and losses replaced. I talked to the parents unceasingly and explained to  them the condition of their child. To my dismay, the patient did not show signs of improvement. She was persistently febrile, dehydrated and eventually acquired pneumonia for the next two days. She had episodes of abdominal pain and tenderness on deep palpation. She was beginning to show signs of sepsis. I reassured the parents of their child’s condition the best I can but at the back of my mind I knew that there was still something wrong…did I miss anything? Did I check everything? Was it only due to the pneumonia?  Was it just referred pain from the pleura?

            My consultant dropped by and examined the patient. She was thinking of bowel perforation, most likely at the sight of strangulation. We booked the patient for the 2^nd look operation. Upon opening up, the patient had localized peritonitis at the right paracolic gutter. Indeed there was a 0.3 cm perforation of the jejunum at the site of strangulation. We resected the segment and anastomosed it. The operation went smoothly.

            For the following days after the 2^nd surgery, the patient improved dramatically. She never missed giving me a smile everytime I did my rounds. And on the faces of her parents, I knew they were happy and relieved that finally their child was out of danger. I continued to nurse her to recovery. I gave her the same amount of attention and care when she was toxic.

            One night, when hell broke loose at the emergency room, medicolegal cases left and right, noisy, rowdy and bloody patients strewn all over the place. It was 1 am in the morning and they just won’t stop coming! Everybody was cursing under their breaths. Everybody was busy as a bee. As I was doing the admitting chart of a patient, someone said in a soft voice..”Doktora.” I put my hand up, signaling whoever it was to wait for their turn to be attended to. Again, she called out my name…”Dok”. As I was about to say, “sandali lang po”, I held it back for it was my patient’s mother in front of me. In her hand was a bottle of 1.5 L and a pack of “Boy Bawang” chichakorn, “para pos a inyo Dok, pampagising, pag pasensyahan nyo na po.” I readily thanked her and told her it was not necessary. She smiled at me, “wala po yun dok, kami po and dapat magpasalamat, kulang pa po yan…”

            As she walked away, all the fatigue and the stress started to fade away that morning.

INSIGHTS: (DISCOVERY, stimulus, REINFORCEMENT) (physical, PSYCHOSOCIAL, ETHICAL)

            As government physicians, we are faced with indigent patients everyday, people who are homeless, jobless, peniless and as the suffix implies, just about everything they have is less than we have. But having less means that we should give more, not necessarily in terms of financial aid. We are here to take care of them, to serve them and to treat them of their illness. They may not be able to repay you for your services rendered but they appreciate and show you their gratitude in their own little ways.

            I was touched by the gesture of my patient’s mother. I knew they didn’t have much and still she offered me a simple token of appreciation. Ordinarily, I wouldn’t make a big deal out of a bottle of Coke and a pack of chichakorn but it was the most satisfying and delectable snack I had that day for I felt the sincerity in the gratitude she gave me along with her gift. Her gift was from the heart. Nothing can replace that feeling of fulfillment.