The Pile

The nurse at the Out-Patient Clinic alerted me that I had a long list of patients to see. My pile was extraordinarily tall. Some charts were as thick as my books, brimming with paper made fragile and yellow by time. I was running late. I should have started seeing patients at 1 PM—it was already 10 minutes past two. I was also attending to one of my admitted patients whose course was getting complicated by the day. I couldn’t be at two places all at once, so there I was: sweaty and hungry and ready to save lives, one patient at a time.

I saw familiar names in my pile in the corner beside the windows. At this point in my training, I have already accumulated a substantial number of patients to keep me busy for the year. Most of them I inherited from residents who have already graduated. Some have been discharged from the ward, on close follow up with me so they don’t get hospitalized again. A few—one or two per clinic day, three at the most—are newly decked to us. They have come to PGH for further evaluation, usually as a last resort, after many unfruitful and expensive consults with private clinics elsewhere.

My computer, which houses the local Medicine database, was on its regular anti-virus scan, causing all programs to slow down, like an intern’s brain on a post-duty day. My files took too long to load, and its struggle to read a simple .docx file made me irritable. But all the irritation and the heat and the rush disappeared when I saw my patient from months ago come into the room after I had called him. I managed him as a case of decompensated heart failure. I remembered seeing him so fluid-overloaded. His entire legs were swollen with excess water, even his scrotum. He had difficulty breathing. Now, dressed in a light pink polo shirt, he looked radiant, already smiling, and breathing like a baby about to sleep. 

“Kamusta ka na, Tatay?” 

“Mas malayo na ang nailalakad ko bago ako hingalin.” 

His wife, among the loudest people I’ve ever met, was giddy with excitement. As was typical of her, she butted in: “Di na rin sumasakit ang dibdib niya, Dok, pero mainitin pa rin ang ulo minsan.”

To my mind, I saw a major sign of improvement. He spoke a complete statement without stopping.

His lungs were clear. His edema was gone. His blood pressure was under control. I was happy. I told him I’d see him after two months. I gave him a prescription and wrote the date of his follow up on his Blue Card, the PGH patient’s ID.

“Ang tagal naman noon, Dok. Mamimiss kita.”

I wished him well and relished the fact of his improvement. But I had ten more patients to see, all of them tired of waiting. I grabbed the microphone, already surgically connected by masking tapes, and called the next name from my pile.