THE HOLE STORY


PART 3: ON THE FLOOR - IF ONLY ALL PATIENTS WERE LIKE HIM AND SOME MORE LUCKY TWISTS


At around 2 am, we were led up to the Digestive and Liver Unit on the 3rd floor and into Papa's room. It was a regular room... hospital bed, bath, ref and tv. So I wondered why it cost so much. Maybe it's because their food was great, or at least the regular diet food was. Papa's food didn't look so great when they started feeding him after the operation. Or maybe it was because somebody came to give the room a clean sweep twice a day and made the bathroom smell nice all the time. Or maybe it was the view from the single, tiny window... a network of pipes and the back of another building with their moaning, droning ac units.

Papa fell asleep instantly. Darlene and I talked a bit and then she followed suit. I had my thoughts and couldn't sleep a wink. I kept watch.

At 7am, another doctor came in to see Papa, Dr. Henry Esguerra, the surgeon who was also a friend of Dennis and Rico. When I saw him, I felt some puzzled recognition of his features, like I knew him from somewhere... a classmate from college, also an Esguerra, only this time it was a Charlie. He felt Papa's abdomen, pressed, poked and said, 'OR na tayo. It's right there, I can feel it.' He said it in this cool, matter-of-fact way that made this thing that Papa had sound like a mild nuisance more than anything else.

He gave orders for Papa's pre-op and left. Before he did, I couldn't resist asking if he knew a certain Charlie Esguerra. He said he had a cousin by that name. I said he was my classmate in college and couldn't help asking because he looked just like him. And he said, 'Guwapo din?' I smiled at the feeling it gave me... that everything was going to be alright. The first lucky twist.

Again, the buzz of activities. Nurses came in to take Papa's baseline parameters... temperature, blood pressure, blood sugar levels. Incidentally, he was accidentally diagnosed a diabetic. This couldn't be confirmed cause the doctors said the body sometimes reacted in such manner during stress. And yet, it couldn't be ruled out either, cause even days after the operation, the levels remained elevated.

There were male orderlies who came in with a gown and told Papa to remove his clothes and wear it. Papa did as told but left his underwear on. The orderlies said the underwear had to go too.

I saw a definite look of consternation on Papa's face. It wasn't because he was too prudent or anythig like that. You know how he is from his blog... he's pretty cool about these things. I guess it was his last claim for control over his body... and he was being told to strip that off too. I know how it could be scary, to know that somebody, a total stranger, was going to be cutting into you... and you would have to acquiesce. Again, it had to be done, and I couldn't protect him from that.

A couple of hours later, they took him down to OR. I went with him. After he was received, I spoke to the OR nurse. Thus far, I've never said anything to anybody about my being a nurse cause I really thought that was of no consequence to them at all. But I was leaving Papa to their mercy and in a very brief, very intense moment, I direly needed to make sure he was going to be alright.

I said to her, 'Miss, I'm a nurse too. Please take good care of him.'

'Please don't worry Ma'am. We will.' And she squeezed my hand in reassurance.

They told me the procedure would last anywhere between 1-2 hours. But 11:00 came and went and I had no word from OR. I was getting a little nervous.

At 12:30, a nurse paged me in the room and told me that Dr. Esguerra wanted to see me down at the OR. That got me really scared and I asked why. She said she didn't know but that I was to come down immediately.

On wobbly knees, I went. When Dr. Esguerra came out, I almost punched him in the face. Apparently, he only wanted to show me the specimen and tell me what they had done in there.

Papa's appendix has ruptured and from the looks of it, has been for the past 48 hours. That's when he told me that Papa must have a really high tolerance for pain for being able to bear it for that long. When I looked at it, it was dead tissue indeed, already going black in some parts. The doctor said Papa was probably saved from poisoning cause with this dead tissue in him, his antibodies now saw it as a foreign body and attacked it. That served to encapsulate it, which in turn isolated it so that it didn't infect a larger area in his abdomen. However, when the appendix ruptured, it didn't go to where it should, which is somewhere in the anterior part of his abdominal cavity. It went posteriorly, toward his kidneys, so the doctor had to squeeze his way in there to clean out the dead tissue. This explained why he was still able to walk even when his appendix has come apart and why he was feeling the most pain on his flank, which made them think at first that it was UTI.

The doctor also said we had to stay in the hospital for another 4 days. During that time, he would be given a salvo of antibiotics to clean out the infection. That posed another, less immediate problem. That of going back to Singapore, cause I know our tickets would be goners by then... they couldn't be stretched for that long. I wasn't even sure if after discharge, we could board the plane right then. But I digress.

At 2pm, they brought Papa back to the room. He was awake, if lethargic. He looked really weak but uncomplicated. All he had was one IV from where a pain reliever dripped... no prongs stuck in his nose for oxygen, which was good. He had 3 incisions... one fairly-sized horizontal incision on his lower right quadrant, a much smaller one next to it, further to his right, where a subcutaneous drain was attached, and another small one below it where his Jackson-Pratt drain was inserted. All these mechanisms served to ensure that whatever water was left when they cleansed his abdominal cavity would have a way out of his body.

But he was back and he was safe. The worst was over.

The following days became a daily crawl to recovery... slow, yes, but sure. And it was all because of Papa's determination to regain his old strength. His first lucid thought was...

'See if we can get tickets to Singapore this weekend.'

'I don't think we can fly back this weekend.'

'But I have to go to LA next Saturday. The conference...'

There's Papa for you.

He slept mostly for the rest of the day. Friends and family called and wanted to come but I told them it might be a better idea to come the following day instead as he was asleep most of the time anyway and wouldn't be able to talk to them. He still couldn't take anything by mouth, not even water, and I had to wet his lips with a cotton applicator soaked in water every so often. I know he cheated and sucked on the cotton but I allowed it. I understood why the precautions, but I could also see that his throat was getting really uncomfortably dry and that he was awake and coherent. Certainly his gag reflex was back and less than 1mm of water couldn't possibly do his internal stitches, nor his resting stomach, any damage, if it even reached his throat. There was no need to put him through all that, unrelieved.

Monday, I was getting concerned that he still wasn't voiding. When the morning nurse came in, she told us that if he still wouldn't be able to void until afternoon, they would have to insert a straight urinary catheter. Papa wouldn't have it. He asked for the urinal and though he tried to do it lying down, he couldn't. So less than 24 hours after his operation, Papa stood up... and voided. It was only much later that I found out that on that very moment, he almost passed out because of the pain.

It was also on this day that we got our 2nd lucky twist. I had to call his boss to tell him what happened and that Papa wouldn't be able to go to LA with them, let alone work the following week. His boss told me to tell Papa not to worry about it and that the business at hand was to get him back on his feet. I thought that was nice, but it was going to get better.

A little while after, their admin sent Papa an SMS instructing him to put all official receipts, before and after hospitalization, in order. Apparently, he was covered by his insurance and the documents would be needed. Now we weren't counting on this cause with his hospitalization happening outside Singapore, we didn't think his insurance would have applied. We knew it was going to be tough but as we thought there was no other way but to shelve out the payment, we braced ourselves for it. Consider knowing in your mind that you will have to pay the whole cost and then finding out that somebody else was footing the bill and you would know how good that news was to us... well, actually, the second best news. The best being that Papa was well and safe.

Now, that was good. But then we had another good thing coming. Our air tickets, by this time, were already invalid for sure. But I called up the airline and a very nice lady, by the name of Myra Montecillo, helped us out so extensively that it felt like we had a personal secretary taking care of it and all we had to do was pay. And that, we didn't even have to do, cause she made sure we would be able to use Papa's flyer mileage to purchase the tickets. She even made special arrangements for Papa to be lugged around the airport premises on a wheelchair, at both NAIA and Changi airports. I guess she was just doing her job but with that matter taken off my hands and attended to by somebody else really made it so much easier for me that I consider it another lucky twist. We've been flying SIA since we moved here to Singapore and not once has anybody gone to such extent by way of assisting us. Maybe it just had to take a kababayan to do it.

They still weren't allowing Papa anything by mouth that day but in the evening, he was really getting so restless that he couldn't sleep. I repeatedly asked his nurse to refer it to his doctor and that night, our efforts were rewarded. Papa was allowed ice chips every 30 minutes. I know I haven't had any sleep for the past 36 hours or so but that made me so happy, to be able to give him something at least, that I stayed up another night giving him ice chips every half hour. It was rest enough for my spirit, if not my body, to be able to see him comfortably sleeping at last.

Tuesday, Papa was watching TV and I was trying to catch a few winks when he suddnely hollered, 'Yeah! Alright!'

I was suddenly awake, stumbled to his bedside and blurted out, 'What wrong?'

'Nautot na ko!'

And we gave each othe a high five. Yeah!

Later in the day, Papa was allowed small sips of water and we were both happy. But then, since he has passed flatus, it meant that his gastric activity was back and pretty soon, he would feel the hunger pangs. And feel them, he did. So now there was a new problem, Papa was hungry and again, I couldn't give him anything but water. Now this time, I wasn't so bold to go aorund the rules cause I'm afraid I would be putting Papa at too great a risk. He just had to go hungry for a while longer.

Wednesday, Papa was allowed water on demand and although he was happy about it, it did nothing to abate his hunger. That afternoon, his Jackson-Pratt drain was removed. This was what Papa referred to as his Freedom Day on his blog. That evening, he was given his first meal. It consisted of a clear soup that tasted like paper, a cup of strawberry-flavored gelatin, and a packet of Ensure. It wasn't much but Papa savored it like it was caviar.

It was also on this day that I first noticed him coughing and that the cough sounded productive. I knew that post-op patients should be assisted to cough and deep breathe while putting a pillow against the incision site to act as a splint so it doesn't get too painful. Coughing and deep breathing ensures that atelectasis (collapse of the lung), or the inability of the lungs to expand, which often occurs in patients confined to the bed, doesn't happen. But Papa wasn't confined to the bed at all. He was getting out of bed whenever it had to be made. He was getting out of bed whenever he voided. Still, there was the matter of the cough so when his doctor visited him that day, I told him about it. He ordered nebulization BID (twice a day) right there and then, without auscultating his lungs or listening to his breath sounds. So too, he ordered, 'cough and deep breathing exercises TID (three times a day).'. Eherm! Alright, a little slap in the face won't hurt me, I guess.

Thursday, Papa again had a clear liquid diet for breakfast and for lunch, they started him on a soft diet. This consisted of a saltless porridge, half a piece of daing na bangus, some veggies and minatamis na saging. A lot better, but Papa only ate a very small portion of the dessert, still bearing the thought of him being a probable diabetic and for fear of having hardened stools that would be difficult to pass. I guess having passed his first stool that morning since the operation, he didn't want to mess with it... err... in a manner of speaking.

That morning too, his subcutaneous drain was cut distally from its insertion site. It wasn't removed altogether to make sure that if there were anymore drainage left, it would still have a way out. We were to go home with that open drain in place, which was going to be removed on our follow-up consultation with Dr. Esguerra. That worried me a bit because by leaving a way out for the drainage, they've also left a way in for infection and since we'd be going home with it, it was up to me to prevent that from happening. More on this on part 4.

After we were done with his morning care, I asked his nurse for a robe so I could walk him the length of the corridor, while he did his deep-breathing exercises. Funny, for the first time ever, I found ourselves taking a walk with me leading the way and not trying to keep up with his pace. See, Papa has always had these long, quick strides that left me running breathless. Now again, I had to adjust my pace so it would match his. Oh well, I guess in no time I'd be running breathless again. For the meantime, there were these walks I could enjoy.

It was also on this day that his IV was removed. I've been noticing since the previous day that the IV site seemed bloated. I would touch it, press on it a little and ask him if he felt pain. He said there was none. I even pointed it out to the doctor who came that morning to cut his subcutaneous drain but he said Papa's veins were difficult to find as they were a bit collapsed. He said yes, it did look infiltrated but it might still be working and if there wasn't any pain, it might be better to just leave it on. Later, however, I came back from the chapel to find another doctor, an intern this time, trying to insert another IV to Papa. This really pissed him off cause the intern had to stick the needle twice, and on the second attempt, he did what we would call an 'embroidery' (nagburda)... he stuck the needle in and realizing that he hasn't hit the vein, he tried to find his way into it by moving the needle around the site. I know that was sorely painful because even Papa, with his 'high tolerance for pain,' felt it. Eventually, the intern stopped and said he would come back later to try again.

I didn't want him to, so when he left, I went to the station to request the nurse to ask Dr. Esguerra if it was possible to shift Papa's IV antiobiotics to oral meds since he has alredy resumed his diet anyway. I know this could be done cause back at the hospital where I worked, it was something that was up to the nurses to initiate following certain protocol. Be that as it may, I also knew that it was not a proper thing for me to make that request cause I could be 'upstaging' somebody, or pre-empting somebody's duties. But given the choice between being improper and having that intern back, I chose to be improper, if it would save Papa further agony.

Later in the day, the order came through. His IV was discontinued and he was started on oral antibiotics. After handing us the pill, Papa's nurse asked me if I was a doctor.

'No,' I said, 'I'm a nurse like you.'

She stopped a while to look at me, then smiled and nodded her head in acknowledgment, and went her way. I don't know how to put it into words, but that gave me a warm feeling that rose from my guts all the way up to my face, like a good brandy would. I'm sure I must have been flushed red all over.

That night, Papa was put on a regular diet and when Dr. Esguerra came to visit him, I asked if we could go home in the morning, like he said.

'Yes.'

It was hard. I was dead beat physically, mentally, emotionally. There were a million and one things that I had to take care of and I had to be constantly on guard to make sure that everything was done right, to the point that I even had to spot air bubbles in his IV tube, knowing that as benign as it seemed, it could cause a whole cornucopia of other problems from clogging up the tubing to pulmonary embolism, myocardial infarction and CVA. I almost never slept, at least not until I heard Papa snoring contentedly. But the very thing that kept me going was the knowledge that between the two of us, Papa was having the worse deal. He was the one who had the pain. He was the one who had to go under the knife. He was the one who wasn't allowed to eat for days. And through it all, not a word of complaint came from him, except a small wince whenever he made a wrong move. While enduring all that pain, he did everything that was expected of him... stand, breathe, cough, void, fart, defecate... all in the hope that he'd get back to his former self in the shortest time possible... and there was nothing I wanted more. So it was a little thing to endure it all with him.

The nurses who took care of Papa were all nice, but somehow, I felt that they weren't as aggressive in the care that they gave... at least not as much as I would have expected them to be. Nurses are the primary caregivers on the floor, they are even dubbed as the patients' advocate. But to be able to perform in such a function, they would have to know everything about the patient. Is he in pain or is he comfortable? What's causing him pain? What are his latest parameters? Lab results? How is he responding to the medications and treatments being given? If he's coughing, they should know why or at least initiate some means to know why so they'd know what needs to be done or referred to the doctor. They should even know the characteristic of the patients' urine and stool, when it comes to that. If you're a nurse, you don't take the patient's blood sugar level and then ask the patient what his prior level was. You should know. You don't wait for a relative to tell you the patient has fever, or that his IV site is bulging. You don't wait for the doctor to order some relief to a patient with diet restrictions and watch him going from hoarse to sore at the throat... you'd want to try to do something that will provide the patient some comfort and thus advance him toward recovery. A supervisor once said, 'The littlest thing that you fail to do to a patient could easily have you find him out of the bed and on the floor, face down.'

I could probably write a whole new blog about what a nurse should be able to do, but then who'd be interested in that? I was just thinking, if a hospital like St. Luke's can reserve the right to command such exorbitant fees, then they should also have the responsiblity to provide quality care to their clients. And then again, perhaps it is because the patients are paying exorbitantly, that the nurses tend to be very cautious in the things they do lest they find themselves swamped with lawsuits. I think that is very detrimental to their professional growth and seriously encumbers the development of their skills and confidence. Of course I may be wrong in my observations, but there is no denying the fact that during our week's stay, I've seen enough to make me have to go to the nurse's station every so often because something was amiss, or something wasn't being done thoroughly, or something wasn't being done at all. I could have helped, but hey, I was just the patient's relative... and I wasn't even wearing white.

But I am thankful for the fact that I remembered things even after being out of the practice for years. At least enough things that helped me do right by Papa. I am thankful for the resources that allowed us to act more decisively, and not have to slide down the seat of our pants and charge on not knowing where we'd get the funds. I am thankful for there being a Dr. Esguerra who has been thoroughly professional and efficient in dispensing his duties. I am thankful for the people, especially the friends, who helped us through that first day, in the ER, when we didn't know how to do stuff. I am thankful to Darlene, my sister, and Ana, our househelp, for taking out of my hands every concern that they could take into theirs. I am thankful to all the people who prayed for us. I am thankful to God for every lucky twist He sent our way.

Most of all, I am thankful that Papa is made of such stuff that he was able to make that week in the hospital such a breeze... lucky for him... lucky for me.