CLINICAL BLOG NO. 26
This is a case of a female patient who was a diagnosed case of cervical cancer. After more than three years of battling her dreaded disease, she succumbed to the carcinoma that had savagely infiltrated her body. Before, I had never experienced the daunting trials of an illness--- until she became my patient.
When I was still a 4th year medical student undergoing clinical clerkship, my concern was mainly to play muchacho to my resident physicians and consultants. Playing second fiddle to doctors encompasses the duties of routinely checking vital signs, following up lab results, hooking tubes to patients, suctioning phlegm, cleaning poop and other biological wastes, doing case studies, and sometimes buying meals and yosi for the seniors. Basically, it is the stage in the life of a doctor when he is the lowest form of animal in the hospital. Being overworked with no pay, I had no social or psychological sensibilities in treating a sick person back then. I was preoccupied with finishing my tour of duty. Not until a patient who I'll call Nenita appeared in my life.
It was past three in the morning
After enduring the painstaking job of assisting in five operations for the past 18 hours, I became so fatigued that I was wishing for the earth to open up and swallow me whole. I was about to take my much needed rest when I was called to do another surgical procedure--- an explore lap. After entering the OR, I was ready to snap at my resident for treating me worse than a rape victim. She could have asked another medical clerk for the task. But my eyes became fixated on a woman lying on the operating table. Her face was gaunt and pale. Her body was frail. The patient's chart stated that her name as Nenita. She looked old for a 32 year old.
"Profuse vaginal bleeding. To consider malignancy. For TAHBSO," my resident informed the OR staff.
After the induction of anesthesia, with gloved hands, we began to cut her abdomen and explore her inner body. It was a case of cervical carcinoma. Further evaluation of her other organs revealed that the cancer had spread. Aside from resecting her whole reproductive system, part of her colon and few lymph nodes were taken out as well. A colostomy was done. It was where her fecal matter would be passed out from then on. What should be a four hour procedure became a grueling ten hour operation. Afterwards, being dead tired, I hurriedly went home thinking that the toxic patient I just had would soon become another name on yesterday's duty.
A few days had passed
During our daily rounds, Nenita who was recuperating on her bed was informed by my resident of the result of her biopsy. It yielded an adenocarcinoma, a malignant tumor arising from the glands. Her cancer was classified to be on the late stage. As she fixed us with probing eyes, Nenita was told that she had a poor prognosis and she had to undergo chemotherapy right away. There was a short pause of silence. Then tears welled up in her eyes. She had the exhausted and drawn expression that any person would have in her situation.
I was tasked to supervise Nenita's first chemotherapy session. All throughout the lengthy procedure, I had to monitor her vital signs and be wary of the drugs' adverse reactions. As the cytotoxic agents were being instilled, she gave me a look of apprehension.
"Doc, ayoko sana magpa-chemo. Natatakot ako sa mga side effects," Nenita anxiously stated. While barely containing her tears, she added, " Natatakot akong makalbo."
Maybe due to fatigue, I remained silent. She continued to talk despite me being a man of few words. Probably it was her effort to ease my boredom. Midway through our session, her husband, her 10 year old daughter and her teenage niece arrived with food at hand. I was graciously offered to join them for lunch. Despite I was starving, I hesitated.
With effort, pain maybe, Nenita got up from a supine position just to hand me a packed meal while saying, "Sige na, sabayan mo na kami."
As time went by
I became more comfortable with Nenita. I have come to like her--- the way she handled things, her spirit, her attitude, and her courage to nurture her family in spite of her sickness. I have met hundreds of ill people. But it was the first time I felt the connection between me and a patient.
One day, while I was changing her colostomy bag, she was keeping an inquisitive silence then finally said, "Feeling ko blessed ako pagdating sa pamilya pati na sa pamangkin ko (whom she had taken care of after both parents went to UAE for work.) Pero sana gawan ako ng milagro ni Lord. Para makita ko pang magdalaga ang anak ko at makatapos ng nursing ang pamangkin ko."
A weak smile figured accross her face. Then suddenly she started to cry, shaking as if sadness had jolted all over her body. While her niece was pacifying her, I held Nenita's hand--- a deed I have never done before.
After a month, my clinical rotation at the ob-gyne department of that hospital ended. I bid goodbye to Nenita and her family not knowing if it would be the last time I'd be seeing her.
A year later
I was taking up my post graduate medical internship at the same hospital. At the outpatient department, I saw a familiar face. It was Nenita.
"Doc Albert, kamusta?" she uttered happily. I was surprise that she still remembered my name.
I noticed how the areas below her eyes have darkened as if she was a zombie. Her head was now covered with a bandana. Exposed areas of which showed hair whose thinness suggested the effect of chemotherapy. Her physique became frailer. She grimaced as she moved. Pain was evident inside her. She sat cautiously with me on a bench. As she catches her breath, I awaited for what she had to say.
"Gusto na nila akong i-Hospice," she revealed.
Apparently her cancer puttered around. After achieving a short remission,. it came back more vicious than ever. Her latest CT scan showed new tumors---a few on her liver and two on her lungs.
"Nahihirapan ako sa chemo. Pero lumalaban pa din. Kelangan eh. For chemo ako ngayon," Nenita continued.
She exhibited no trace of defeat but seemed apprehensive about her future. I sensed the difficult edge between her sturdiness and her fear. After our short chat, Nenita together with her niece and daughter left and went to a room for her another cycle of chemotherapy. While holding hands with them, I imagined her metastatic neoplastic cells getting pummelled by the chemotherapeutic drugs, fueled by her will to live and love for her family.
It had been over three years
Since Nenita became my patient. At the hospital pharmacy, I chanced upon her niece buying Demerol. According to her, it was for Nenita. For her pain. She was already at the terminal stage of her illness. Currently admitted, doctors said that she got a few days to live. Although I had never done visiting a former patient before, I came to see Nenita. She was sleeping soundly when I arrived. Connected to a mechanical ventilator, she was already not breathing on her own. Her husband was beside her. Maybe losing hope, he informed me that they had just signed a DNR (do not resuscitate) consent form. When I came out of the room, my instinct told me that I would never get the chance to speak to Nenita ever again but I knew that in case she finally go, she would rise in another time and place to be there for her family.
Through Nenita, I was able to see that the daignosis of an illness, even the treatment strategy, has little role in the healing process. Becoming an intimate part of someone's sickness is better than just one's familiarity with the disease. For caring is the most powerful tool of treating a patient. Usually, it is how a healer changes a sick person to be better. With this patient of mine instead, it turned out to be how a sick person and her struggles have changed me.
After two weeks since my visit, cancer claimed the life of Nenita. She was 35.
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