UHC 25: Some Physician Stories in Hospital ERs, Wards

Below are notes by a physician friend, Doc Erwin Abueva, in his facebook wall, February-March this year. Real stories from physicians in emergency room (ER), wards, operating rooms. Some stories are funny, some are sad. Somehow they provide additional dimensions in the continuing discussions about universal health care (UHC). Thanks a lot for sharing these stories Doc. Non-physicians like me find them informative. 

11 stories, 2,000+ words, more than 4 pages long. Enjoy. Meanwhile the photos, I got from the web and just added them here.

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(1) February 6

2PM, HEMODIALYSIS Unit, Private Tertiary Hospital

Two male dialysis patients, both in their late 50's, were talking to each other. One patient is having his dialysis for 3 years already in the said hospital, while the other is a "first-timer", had his dialysis sessions in a hospital in Bulacan for 2 years.

PATIENT 1: Bago ka po dito, no? Ngayon lang kita nakita dito. (smiling).
PATIENT 2: Opo. Sa Bulacan po ako dati nagdadialysis. Lumipat na ako dito kasi sa anak kong panganay na ako nakatira. Sa kanila na lang daw kami ng asawa ko.
P1: Bakasyon?
P2: Hindi po. Naibenta ko na kasi yun bahay namin sa Bulacan dahil sa pagdadialysis. Ang hirap ng sakit natin, ubos ang pera. Ang mga naipundar kong konti unti-unting nawala na.
P1: Talagang mahirap. Mabuti na lang medyo marami pa ako savings.
P2: Buti pa po kayo. Maraming panggastos. Swerte nyo po.
P1: Ikaw ang swerte. Kasi ikaw kahit wala ka nang pera, nariyan ang anak mo nakasuporta. Ang asawa mo kasama mo ngayon, hindi ka pinapabayaan. Ako, iniwan na ako ng asawa ko last year. Pumunta na sa Amerika. Napagod na yata sa pag-aasikaso sa akin. Ang mga anak ko parehong nasa abroad. Ni tawagan ako hindi nila magawa. driver ko lang kasama ko lagi dito sa dialysis.
P2: Opo, kasama ko pamilya ko. Pero wala naman akong pangsustento sa dialysis ko. Hindi din ganon kaswerte.
P1: Tandaan mo, lahat naman tayo mamamatay din. Ang tanong lang e sinong nasa tabi mo sa huling sandali ng buhay mo...

(2) February 11

6AM, EMERGENCY ROOM, Private Tertiary Hospital

A 64 y.o. Male came in due to nose bleeding. With him was his wife and his daughter.
While the nurses are packing the patient's nostrils with gauze...

DOCTOR: Ano pong nangyari sa inyo sir? Bakit dumugo ang ilong nyo?
PATIENT: Napasubasob ako sa sahig. Mukha ko tumama diretso sa sahig.
DOCTOR: Paano pong napasubasob? Nadapa po kayo o natisod ba? Buti di kayo nawalan ng malay o napasama ang dapa.
PATIENT: Hindi naman ako natisod o nadapa doc. Napasubasob lang basta.
WIFE: Naku doc, ganito kasi yan. Pagkabangon nya sa kama, lumuhod daw sya para magdasal. Tapos bigla na lang natumba sa pagkakaluhod at tumama yun mukha sa sahig.
DOCTOR: Ibig sabihin nakatulog kayo habang nagdadasal kaya napasubasob kayo?
PATIENT: parang ganun nga yata nangyari sa akin.
DAUGHTER: Hay naku. Tatay, next time kasi huwag na kayo lumuhod pag magdadasal kayo. Pwede naman nakahiga kung magdadasal.
WIFE: At huwag mong masyadong habaan ang dasal mo para di ka antukin.

(3) February 17

3:30AM, Emergency Room of a Private Hospital
A 24 y.o. Female patient came and directly went to the Doctor's Table.

PATIENT: Sino doctor? I need to see a doctor.
DOCTOR: Yes ma'am. I'm the doctor here.
PATIENT: Bothered kasi ako.
DOCTOR: Sige po ma'am. Take a seat. Ano ba ikoconsult mo at napasugod ka sa ER ng 3AM na?
PATIENT: kasi eto o. An-an ba ito doc nasa leeg ko? Di kasi ako sure.

(4) February 22

An 11 y.o. female patient was brought by relatives due to asthma attack. He was exposed from dust while her mother was cleaning their cabinet.

DOCTOR: (to the mother) paiinjectan po natin ng antihistamine sa arm nya. And magbibigay din ng steroid thru IV. Sa ugat po papadaainin yun gamot. Magnebulize din po ang bata ngayon.
MOMMY: Sige doc kung yun ang dapat. Ok lang po.
FATHER: Ikaw magtutusok (looking at the nurse)? Galingan mo sa pagtusok. Pag pumalya yan, makikita mo.

NURSE: Sir, itatry po namin na 1 shot lang.
Unfortunately, the nurse missed his first try.
LOLO: Tsk tsk. Wala bang sharp shooter dito? Hindi ka naman pala marunong e. Yun sigurado. Yun magaling.
DOCTOR: Pasensya na po pero minsan mahirap maginsert. I understand ayaw nyo masaktan ang anak nyo. Ang mga nurses po dito experienced na maglagay ng swero. Pero wala pong hindi nagkakamali.
Another nurse tried inserting heplock but was also failed.
FATHER: Tsk tsk. Sinasaktan nyo lang ang anak ko e. Siguraduhin mo nurse! Huwag kang magtry kung di mo siguradong mashushoot mo. Ikaw Doc, ikaw na lang para 100% sure sa pagtusok
DOCTOR: Sir, kung 100% sure ang hanap nyo, hindi ko din magaguarantee yan. Sa totoo lang, mas experienced pa ang ER nurses namin sa paglagay ng swero kesa sa akin. Pwede po bang kami na lang muna at si mommy nalang dito?
MOTHER: Oo nga. Umalis na muna kayo Tatay (lolo). Doon muna kayo sa labas.
After the two men went out, the same nurse was able to insert "heplock" to the patient's hand, fortunately with 1 try only. Swabeng tusok, walang pressure.
LOLO: Buti nalagyan na.
MOTHER: Kanina pa dapat kung hindi kayo mga masusungit sa nurse.

(5) February 25

Several minutes ago, a 65 y.o. male was rushed to the ER due to loss of consciousness. The patient was with his wife strolling at SM Marikina when he suddenly fell on the floor unconscious.

The patient had 3 previous heart attacks and underwent open heart surgery few years ago.
The patient did not respond to CPR done, to all medications given. He was pronounced dead 40 minutes after.
Sad events like this makes me realize of my mortality.
Few minutes ago nag-uusap lang sila and nagtatawanan. In a matter of seconds, nawala na ang isa, permanently!
Maybe mas maraming nauunang lalaki kesa sa babae. There are more widows than widowers. I just hope when my time comes, hindi sudden, hindi biglaan... 

Lifestyle Diseases 6: Personal Care against NCDs

One of my friends in facebook, Dr. Erwin Abueva, has been posting a HEALTH INFO series in his wall. I find them useful, tips for personal care against certain diseases, infectious and non-infectious alike. But since most diseases afflicting the people now are lifestyle-related or the non-communicable diseases (NCDs), these tips apply more to NCDs prevention.

* NSAID means non-steroidal anti-inflammatory drug

HEALTH INFO 1: Not all dengue fever patients should be admitted in the hospital. But hydration of patients with intravenous fluids is important in the management of dengue fever.

2. Not all patients who had head trauma require to undergo cranial CT scan. Some of the important considerations in deciding whether to have it done or not are (1) loss of consciousness, (2) vomiting episodes, (3) decrease in sensorium, (4) persistent headache and dizziness, (5) incoherence, (6) blood or clear fluids dripping from nose or ears, (7) convulsions...

3. NSAIDs should not be used for pains associated with Dengue, as these pain relievers may decrease further the ability of the blood to clot.

4. The most common type of headache is related to stress or tension headache. The second most common is migraine headache. Headache secondary to brain tumors is rare. So before thinking of Cranial CT scan, ask yourself many times if it is really necessary...

5. Antibiotics have no role in the management of flu or "trangkaso". Paracetamol for fever and pains, decongestants for clogged nose, and plenty of fluids will be ok for you...

6. If you're a known hypertensive, avoid not only fatty foods but also the salty ones.

7. If you're hypertensive and a cigarette smoker, you have 5x more risk of succumbing to stroke than your friends who are also smokers but with normal BP.

8. If you're blood type is "O" and your wife's blood type is "B", your child's blood type must be either "O" or "B". If its "A", that child is not your offspring (napaltan sa ospital) or that child's father is not you (napindeho ka)!

9. One NSAID advertisement has its tagline "relieves ALL kinds of pain". It is not true and is MISLEADING! For NSAIDs (mefenamic acid, naproxen, ibuprofen, --coxibs, aspirin, meloxicam, diclofenac, etc.) are not used for abdominal pains in general. Instead of relieving, it will worsen the stomach ache and may cause gastritis and GI ulcers.

10. We all have tonsils normally. If your tonsils got inflammed, mostly due to infection, you're likely to experience sorethroat, pain upon swallowing, and usually fever. That is TONSILLITIS. So if you have sorethroat, better say "May tonsillitis yata ako", NOT "may tonsils yata ako"!

11. Inadequate calcium in the body can lead to osteoporosis. So intake of calcium-rich foods such as milk, sardines, cheese, yogurt, soybeans and its products is encouraged. But remember to also have Vitamin D rich diet (egg yolks, saltwater fishes, liver, milk) since calcium is poorly absorbed by our body if without enough Vitamin D.

12. As per guidelines, if you are bitten by a dog or cat, have yourself injected with anti-rabies vaccines immediately. Even if you know that those animals had been vaccinated against rabies, you should still go to a physician for proper advice and management. And DON'T forget to ask for anti-tetanus shots also!

13. No need to have antirabies vaccination if you're bitten by a rat. Only anti-tetanus and antibiotics for your protection.

14. There are many causes of hypertension. It may be due to stress, pain, fatty and high cholesterol diet, kidney disease, other metabolic problems, and many more. But the most common type of hypertension, affecting about more than 90% of hypertensive individuals, has no known clear cause. It tends to be familial and hereditary. That is also called "ESSENTIAL HYPERTENSION". So don't wonder much if your BP is still high even if you're practicing right diet and exercises. Maybe what you have is the "essential" type.

* Hindi mo kasalanan na mahirap ka. Ang kasalanan mo e tamad ka.
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A related note I wrote nearly two years ago:

Health is a Right, Health is Personal Responsibility

(This is my article for "Brigada News", a Pasay city-based tabloid, last February 19, 2010)

The concept of “Health is a basic human right” is popularly supported by many people. Both for its emotional appeal and for some international agreements, like the International Covenant on Economic, Social and Cultural Rights.

A sub-set or sub-topic then are the formulations, “Access to medicines is a basic right”, “Access to hospitals and healthcare is a basic right”, and so on.

Thus, others would extend them further and say, “Education is a basic human right”, “Decent housing is a basic human right”, “Cheap and abundant food is a basic human right”, and so on.

The term “right” implies and connotes entitlement. That is, regardless of the circumstances why one person or household or community has/have become sickly, they should be entitled to decent healthcare to be provided at a low cost if not free by the government, local or national.

This can be a big source of public debate between those who demand entitlement and those who question it. For the latter, for every “right” there is a concomitant “responsibility.” Thus, while people can demand that health care is their basic right, they are also expected to assume certain responsibilities about their bodies and their lifestyles

I personally believe that healthcare is first and foremost, a personal and parental responsibility. People should not over-drink, over-smoke, over-eat, over-fight, over-sit in sedentary lifestyle. People should not live in dirty places and should observe basic personal hygiene like washing hands carefully before eating.

Health inequity results not just because of income and social inequity, but also because of people’s unequal inputs in taking care of their body. A person may be poor but if he does not over-drink and over-smoke and observe personal hygiene in his daily life, he will have a better health outcome than a rich person who over-drinks, over-smokes, over-eats and over-sits. The former, even without a private health insurance, all other things being equal, will less likely develop lifestyle-related diseases like hypertension, high cholesterol and obesity.

These topics are timely as the drug price control policy of the government is now more than six months old, and there is no formal assessment made by the Department of Health yet, on whether it has achieved its goal or not – to make essential but deemed expensive medicines become more affordable to the poor.

In the absence of such formal study and assessment by the DOH, some sectors and industry players – drugstore operators, pharma companies, some NGO leaders – have already produced their own findings: the answer is No. The policy, supposed to help the poor, did not benefit the poor.

The main reason is that there was a relatively healthy competition among pharma companies in the country already, among innovator companies and among generic producers. So while the rich and middle class were looking at a branded amlodipine, for instance, at P44 per tablet, there were cheap amlodipine generics already, sold as low as P8 per tablet. When price control was imposed, the P44 became P22. But the poor did not buy the P22 a tablet, because it is still high compared to what they are buying at P8 a tablet. So the poor did not benefit, the rich and middle class did.

Instead of forcing private companies to give the discounts, the government should force itself to procure essential medicines at no-corruption price and dispense these for free to the really poor, especially children of poor households who have been exposed to dirty environment for several years, who now have weaker lungs and other internal organs. This is where government can possibly put its limited resources – giving essential medicines for free to these patients.

The best form of healthcare is preventive, not curative. People should not abuse their body simply because alcohol, tobacco and fatty foods are more available and more affordable compared to several decades ago. But should they abuse their body, then they should suffer some consequences later.

Meanwhile, the damage to the country’s investment environment as a result of no-time table drug price control policy should be big by now. Many revolutionary drugs, new disease-killer drugs that are available in other countries around the world, may no longer be introduced and sold in the Philippines. The most adversely affected then will be the poor and some middle class patients. The rich, the politicians and government administrators who pushed the price confiscation policy, will have the means and network to buy such drugs from abroad.

That is one example of the “law of unintended consequences.”
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See also
Part 5: NCDs Global Picture, September 30, 2011, and
Part 4: The UN on NCDs, September 25, 2011.