Friday, April 4, 2014

Where It Counts

These past few days to weeks to months, I've felt a little bit more stressed than what I've been used to. And for someone well into the his second year of Adult Cardiology fellowship, that is going to be a little bit understated.

But yes, I have felt a little bit more strain on my resolve lately from worries about friends and family and work has not been doing me any favors. My country's tax arm is slowly taking aim at my profession and at the same time poking one of the world's biggest countries. Talk about a messed-up government.

But that's beside the point...

This blog was initially just meant to be an outlet of sorts -- a chronicle of life experiences and work situations where I felt I turned the corner, not just as a physician but as a person as well, and maybe have the chance to have these little life stories touch whoever reads them.

I have in my care, a female charity patient, 28 years old who came in for difficulty in breathing. She is reed thin and any lay person could see the cachexia was eating away a few minutes of her life each day. She developed pulmonary edema (fancy words for fluid in the lungs) so she couldn't breathe well and we had to intubate (that thing on TV where we put a tube in someone's mouth). She had severe mitral stenosis (the valve that guards the left atrium and ventricle of heart is half-closed, or half-open, depending on how you look at it) with severe pulmonary hypertension (the pressure in her lungs were really high). Her right side heart chambers were extremely dilated, there was severe leakage of her tricuspid valve, and because of the right sided pressure and volume overload, the left ventricle was reduced to less than half its normal dimensions.

She was in severe heart failure. To what, I couldn't really say for certain unless I did some more tests. I couldn't subject her to valve replacement surgery because sending her to the procedure would be sending her to death on the table due to the severely elevated lung pressures. We had to figure out why everything was what it was before doing anything else.

But how? They were in the charity service for a reason. They had no money. How do you tell a mother or an expectant sister that you could not do anything more? We could not do hemodynamic studies, they had no money for medications and we barely scraped by with our three free days in the ICU.

Now she is thankfully out of frank heart failure. I see her everyday with her mother, sisters, brother and aunts, and everyday I tell them of how her heart is failing her and that she could go anytime. Yet they smile, seemingly in denial and acceptance at the same time, and say that "Prayers are all we have, doc" and "It is in God's hands now." I nod every single time, knowing how true it was.

Today, I went up to them and told them that as of this time, this is the best we were going to get -- out of failure, able to walk a few meters, smile and entertain guests, her talking about getting a whole serving of her favorite halo-halo and the possibility of home oxygen therapy -- until such time we were able to come up with funds to do the next steps in her treatment. They nodded and I ended the morning signing my name on their discharge orders and take home medications

Sometimes, I feel helpless amidst all the poverty, all the economic ruin my country is supposedly in, all the stress of training and the emotional strain with every family member getting sick or a friend in trouble. With all this, it would be so easy to dismiss the troubles of patients who can not pay their way to even a decent diagnosis, but I don't. I would never want that for anyone.

I have never thought of going abroad and plying my trade there nor has there ever been the desire to do so. I will work and serve patients here, and continue doing my best for patients with whatever I have just like how every physician gives a part of themselves to each patient that walks through their clinic doors. Despite this messed-up country, I feel that I am where my life counts and giving back to where it counts the most.