The day when I (almost) lost it

I THOUGHT I’d end first year residency without ever getting mad at a patient or a watcher. At the hospital where I work, the watcher—or the “bantay,” a Filipino term which means to watch over, to guard and to protect—plays a key role in the care of the patient. We don’t have much staff to drag the stretchers, do the bed turning for our intubated patients, procure the medications from the pharmacy, or facilitate application for financial assistance. Majority of these tasks are handled by the bantay—usually the patient’s family member or a close friend who stay at bedside—and my experience is that more efficient the watcher is, the more likely the patient will survive.

But I did lose my temper two days ago. My patient was a sixty-something woman admitted for a two-week history of cough with no fever. We treated her as a case of pneumonia—a lung infection—and the plan was to give a few days of intravenous antibiotics and to continue her hemodialysis sessions while she was admitted. She also had chronic kidney disease and was on twice-weekly dialysis prior to her admission. At the Emergency Room, the ER doctor already gave her the necessary documents to have her apply for financial assistance; she’d be a good candidate for approval, which meant that majority, if not all, of her hospital expenses, will not be charged to her. For the application to be approved, the only other requirement was that a family member should be available for interview and verification.

When she was transferred to the Ward, I was surprised that the application for financial assistance wasn’t in place yet. No watcher was around. The patient’s daughter wasn’t around. I later learned that she had left her mother as soon as she had arrived. The patient was, according to the interns who took care of her, lying alone on the hard metallic stretcher, with no food or antibiotics. I never heard from the daughter again, until five days later, when I personally called her over the phone and demanded her immediate presence at the hospital. We would supply her antibiotics from our personal stocks. We would subsidize her tests. We would look for units of blood for her. For three days, we did these things, but no family member was around, save for one or two neighbors who weren’t related to her at all, and who probably cared more for her than her children.

On the day when we were about to discharge her, she developed upper gastrointestinal bleeding secondary to uremic gastropathy, a complication when one hasn’t had dialysis for too long. We scrambled for IV omperazole, made sure blood products were hooked, and hemodialysis was done as soon as was possible. Thankfully, the next day the bleeding did subside. With my intern’s help, we were able to secure financial assistance for her.

But I wouldn’t let it pass. I demanded, over the phone, that the daughter or any family member come over and speak personally to me. I was so angered by what I felt was the family’s fault—leaving their mother in a hospital, with nothing, throwing all the burden to us, her medical team. At the time I did not care that her children probably had their own families to take care of, or that they had other valid reasons, assuming those did exist, for not coming over the hospital. I was prepared to give them a dressing-down, a 15-minute lecture about their lack of concern and love, and I was ready to make them hypotensive after they had cried buckets of tears.

Throughout this ordeal, I sought for God’s grace. I prayed that God grant me a discerning and understanding heart as I dealt with my patient’s family. The daughter arrived, relaxed, as if nothing was going on. “Sorry, Dok, sa Cavite pa ako nanggaling,” she said. With a lowered voice I told her she was wrong to leave her mother alone. Then I told them that from hereon, a family member should always be around.

"Sige po, Dok."

I walked away after a few minutes, lest I say something I couldn’t take back.

I never saw the daughter again.