by carlocmd

he was 75 years old and in heart failure. he was out of breath, speaking in phrases. his fingertips would alternately turn from white to black due to cyanosis, a lack of oxygen. he had fluid in his lungs, with neck veins engorged up to his forehead, and puffy feet from edema. his blood pressure was unstable. his heart rate was irregularly fast. his heart’s ejection fraction was 15% (normal more than 60%). his potassium was dangerously high. his kidneys were failing. his blood sugar was up.

he was drowning and he was my uncle.

he called 911 twice over the past month, admitted both times. during one admission, his doctor had told him about the advance directive called Do Not Resuscitate. Bewildered, they agreed, only to reject from signing it when they saw the DNR already stamped all over his hospital chart. will they do nothing, then? his wife asked. why would they do that? i think his doctor did not explain the concept very well.

he was given medicines for heart failure, but had severe side effects from it. he had pain in his abdomen and was vomiting. as a consequence, when i saw him, he was not taking any more medicines.

quality of life, i agree with completely. if an intervention hurts more than it helps in a terminal patient, why do it?

you need to see your doctor now, i said, so he can replace your medicines. ok i’ll call for an appointment, he said. maybe someone will back out in a few days. no, i said, you need to see him today. at least give him a call. it doesn’t work that way, he said. why not? it’s not an emergency.

i wanted to shout. this is an emergency! you are drowning! it’s not as if the new medicines will hurt you! in fact, given the data, they might even help you! quality of life!

apparently, when you call them, they charge. when your insurance deems it a useless call, you pay. nothing is ever free here.

i was shook up inside, frustrated, unable to do anything despite all the medical knowledge in my head. you talk about universal access to health care… but here is someone who needs care, but doesn’t get it. free medicines, yes you get it. but you have to run around circus rings for it. how can a drowning man do that?

i spoke with my uncle who is a doctor here. yes, he said, that’s how it is here.

what can we do?

there was a pregnant silence.

what you can, with what you have. you know what to do, he said.

it’s not enough, i said.

i know, he told me. and there was no more.

my drowning uncle, sitting in his chair. we talked a long time. i got a hot water bottle to massage his tummy. i put his feet up. i told him to drink the medicines he had, and assured him that i would handle his vomiting should it happen (with what? i don’t know. maybe with just my words). i held his hands.

this is terrible. so, so terrible.

give me the medicine in my country where patients can call me anytime, and talking is equivalent to the cost of a phonecall. give me the type of medical practice where i can badger the residents, the doctors, the medreps to set aside medicines for a crippled patient, and nobody complains. give me the type of medicine where you do anything that is necessary (not just anything – there are priorities)… then when it’s time to go home, the patient says, “dok, wala na po akong pera (doc, i have no more money).” but he gives me a basket of fish.

i smile and eat fish for a week.

i would rather have all the heartbreak practicing medicine in the Third World, than immunizing myself from patients in this First World.