Let me share with you a story of how the typhoon Yolanda (International name: Haiyan) affected us all the way in Manila.
A few days after the storm hit, we began receiving patients who managed to get out of Tacloban. They were weary, dehydrated, with some in obvious post-traumatic stress.
I received an elderly gentleman in the emergency room who had stomach pain. The emergency room physicians were at a loss because his pain seemed out of proportion to the physical exam findings. His preliminary tests also looked benign. But he was writhing in pain.
He was visiting Tacloban to attend his nephew’s birthday. While there, the typhoon hit. As the house was around 200 meters from the shoreline, he relates seeing the storm surge. It was sudden. It was strong. It pushed the house foundations. The houses around them disappeared in the aftermath.
As the floodwaters abated, he risked treading the muck to reach a house across the street. To help a neighbor, and to get food and water. Unseen debris ripped into his shin, causing a nasty looking gash.
The first two days went by quietly. Neighbors shared what meager supplies they had with each other. When it became apparent that no immediate aid was coming, the neighborly atmosphere began to change into something dark and menacing. It soon became too dangerous to venture out and risk being hurt.
After 3 days of having no food and clean water, they decided to risk walking to the airport to get out. He received first aid for his injuries, a tetanus toxoid shot, and antibiotic prophylaxis for leptospirosis.
He relates seeing a counter open in the airport, selling plane tickets to Manila. They bought tickets without looking at the price, without hesitation, amazed that they had enough money to do so.
The nephew who celebrated his birthday relates the other story of their ordeal. He was on another island that wasn’t in the storm’s path and was spared its wrath. He spent six days walking around Tacloban looking for his uncle and aunt. By the seventh day, he decided that if no contact was made, he would presume them among the dead. By the evening of the sixth day, he received a call that his uncle and aunt were already in Manila.
They reunited in Manila, and was preparing for the trip home to Australia.
Then after a simple dinner, his abdomen began to hurt. He could not eat. He asked to be brought to the hospital. And we met for the first time.
When the pain is worse than the exam findings, add the fact that he had just faced death a few days ago, an alarm went off in my head. If you had survived certain death, and were just feeling the effects of a wearing down of adrenaline, you can sometimes feel indestructible. And I saw this in his calm demeanor. What is a tummy ache compared to death? His response to the typhoon was of stoicism. So this really must hurt him enough to ask to be brought to the hospital.
I saw that he already had an appendectomy due to a faded scar on his abdomen. This was more than 10 years ago, he said.
During his stay in a ravaged Tacloban, he did not want to eat and drink. There were no standing toilets, and he refused to move his bowels. These events may have come together to change the way his bowels worked. Add the possibility of post-operative adhesions (a sometimes unavoidable complication of any abdominal surgery), then you face a possible bowel obstruction.
I explained to him what needed to be done. A CAT scan, a nasogastric tube, a surgical referral. He took all of this calmly, just accepting the facts as we knew them.
The tests confirmed the bowel obstruction, and he was scheduled for a stat exploratory laparotomy. A segment of his intestines was resected and his bowels reconnected. Although it was an emergency surgery, it was largely uneventful.
At recovery, as he woke up, he said he felt much better.
“Thank you, doctor, for taking care of me,” he said. “Thank you for figuring it out and fixing this. I do not understand why one tragedy after another should happen to me, but I am very grateful that I am here, and you are there for me.”
His message brought tears to my eyes, recalling the hardships of Job. How unfair it was to suffer two near-death experiences in such a short time.
Who watched out for him as the waters rose and kept him safe? Who whispered in his ear to start walking towards the airport, and protected his steps from a hungry, angry mob? Who opened an airline counter, allowing him to get on a flight to where he would get the care he needed, and not die painfully, needlessly in a place without a hospital? Who brought me to him, and set off the alarm in my head that things are not as benign as they seem?
“I am but a tool of Someone who watched over you,” I replied. “That things happen for sometimes an indecipherable reason, but is part of His plan.”