The ER

The Emergency Room (ER) of any public hospital is probably the greatest leveler in our otherwise highly unequal society. Here, it matters little how much money you have or how much influence you might carry. The ER cubicles and beds are never enough for the number of patients being admitted at any given time. Chances are you would be treated without leaving the wheelchair in which you were brought in.

Even in the best-run public hospitals like the National Kidney and Transplant Institute (NKTI) and the Philippine Heart Center, the ER is heavy with the miasma of sickness, poverty and despair. Medical personnel jostle with patients and their companions for precious space in a room that is reminiscent of the packed carriage of a commuter train during rush hours. One can only wonder what kind of bacteria and viruses are brought in and freely traded in this marketplace of diseases. Scenes like this exemplify the irony of iatrogenic illnesses — medical conditions acquired in the course of seeking treatment.

I write from experience. About three years ago, my wife and I had to rush my mother-in-law to the ER after she fell and hit her head as she emerged from the bathroom. Though she insisted she was fine, we decided to bring her to the ER and have her checked. At the emergency room of the NKTI, where we first brought her because that was where most of her doctors were, all the wheelchairs and stretchers were taken. People were literally spilling out of the door.

We might have a better chance at the Heart Center across the street, I said. All the ER wheelchairs were taken, but the security guard managed to fetch one from the hospital lobby. There was no vacant bed available. Mommy was transferred to a chair that a patient’s companion, who had been asleep, was requested to give up. As Karina filled out the forms and answered the questions of the admitting nurse, I scanned the room for a familiar face among the doctors.

A young intern came to her and asked what happened. Mommy could talk but she was not in any mood to answer. Karina patiently gave the same answers she had given at the desk. The doctor took Mommy’s blood pressure and heart rate and said they would be observing her for any effects of the fall. I asked if we could transfer her to a private room in the meantime. Someone politely told us that there was a long line in the lobby waiting for rooms to be vacated. But, I was assured, it was better for our patient to remain in the ER where doctors would be at hand in the event of an emergency.

In the adjoining cubicles, demarcated only by the thinnest sheets of white cloth, one could note the frenetic coming and going of ER personnel. Sometimes the silence was pierced by an ominous rattling sound. And then, wailing. Karina sat beside Mommy on the same chair and wrapped her arms around her to comfort her. I went out to get bottled water at the convenience store. I was gone for maybe about five minutes.

When I came back, Mommy was already lying on a stretcher. A male nurse was beside her feverishly pumping her chest. A heart monitor had been attached to her frail body. As I watched its green light flicker, I glanced at Karina. Mommy expired in her arms, quietly passing from what had seemed like a peaceful slumber to an abrupt moment of heavy breathing. A doctor asked for permission to intubate her. Karina said no. Her 96-year-old mother, she said, would not have liked it. Would she sign a form to that effect, she was asked. She nodded.

I don’t remember exactly how many deaths occurred in that little room in just those few hours before dawn. I marveled at how the overworked doctors, nurses and medical technicians of the ER could maintain their sense of purpose after repeatedly witnessing the end of life during a single watch.

In the years that followed, it was Karina’s heart condition that brought us back to the ER at least a dozen times. Only once did she have the chance to lie privately inside one of those curtained cubicles while waiting for the diuretic drip to take effect. This simple procedure pulled the excess fluid from her lungs that was making her breathe with difficulty. Her devoted doctor, Dr. James Ho, would tell her to come right away and not wait too long after she starts feeling the symptoms.

The whole procedure usually took no more than 15 minutes. Most of the time, Karina would remain in her wheelchair. It was the settling of the ER charges that typically took an hour or more, depending on the queues at the billing and cashier sections. Karina had to wait while I paid the bill, reminding her always to put on a face mask so as to minimize the risk of catching pneumonia. I have often wondered why ER patients can’t pay at a small window within the ER itself. But I realized that the more basic problem was that there were just too many people needing competent and reliable medical care who simply could not be accommodated in our overstretched public hospitals.

Our last visit to the ER of the Heart Center in the early evening of May 7 this year proved to be as typical as I could have imagined it. Karina had suffered a cardiac arrest while taking a shower at home. At once, a professional nurse and I tried to revive her while waiting for the ambulance from the nearby UP Infirmary. Within 15 minutes, Dr. Ho himself was attending to her at the ER.

She lay on the same ambulance stretcher that had carried her to the hospital. As I expected, all the cubicles were occupied. After the doctors unsuccessfully tried to revive her, I held her face with both my hands and closed her eyes. In the glare of the ER’s fluorescent lights she was as lovely as when I first saw her. She was at peace and young again. Perhaps she would not have minded being stared at by strangers.