Click, flash, and then darkness

We lost one of us today.. As the rest of the Philippines commemorate the death anniversary of Ninoy Aquino, the UP College of Medicine mourns the sudden loss of one of our co-interns.. Ads Mabalot was 23.

One week ago, we were duty-mates in the PGH Pedia Emergency Room, I was their Pedia OPD reliever. Nagkukuwentuhan pa kami noon in between seeing the patients. I wouldn’t have guessed that she was already sick at that time. We were both attending to a 15 year old female with craniopharyngioma who came in with seizures and decreased sensorium. We were trying hard to get IV access on this patient and did fluid resuscitation, pushing around 200 cc of NSS. The patient eventually died in the wards, due to an intracranial bleed.  But Ads looked fine to me, kahit toxic ang ER duty. Never rin siya mukhang haggard at that.

A few days after, some of our classmates recalled Ads going on triage in the Pedia ER (screening which patients are for admission, initially attending to them) even if she was already having high grade fever and diarrhea. She would just wear a jacket. But one thing was, she probably thought “I don’t want my blockmates to suffer if I’m absent today. Kasi wala naman magre-relieve on such short notice” as it would ruin the sliding duty schedule she herself had made. Apparently she had the fever symptoms 2 weeks prior but wasn’t one to complain about it.

How many of us interns have done exactly the same thing? Ignoring our own symptoms, our own pain, in order to attend to our patients. How many of us have gone on duty even if we had fever, body aches, sore throat, cough and colds? I bet all of us, at one point or another, have disregarded our own symptoms. Med students think this way “if fever lang yan, I could get Paracetamol for that. Diarrhea eh di Loperamide and Oral rehydration salts para hindi ako abutan sa ward.” After all, doctors make the worst patients.

Doctors and medical students alike act as demi-gods.. even tricking our body into thinking we are alright when we are actually not. Taking matters into our own hands.. Because our patients are our priority, first and foremost. So we tend to sacrifice our own health in the name of service. But at whose expense?

Yesterday, as I was having my dinner my roommate texted me, “have you heard? Ads was intubated this evening. GCS 3. sa 7^th floor of PGH, fever lang ang presentation! working diagnosis is complicated typhoid fever,but they’re looking into a Hema-onco component daw kc ang bilis. All services on board.  Nagc-code siya ngayon. They’re trying to revive her right now.”

And my mind went blank. “Ads whom I was just talking to a few days ago GCS 3!?" Glasgow coma scale 3 means no verbal and motor output, nonreactive pupils. "Could this be somebody’s idea of a cruel joke? Parang text hoax?” It felt surreal. So I asked Eileen where she got that information.  It was from a classmate who was on duty in the Medical Intensive Care Unit at that time. Then the messages started pouring in.

Sabi ko "Baka infectious? Kc ang bilis naman." After four days of confinement and her symptoms progressed and took a turn for the worst. Multiple system organ failure. Speculations started flying everywhere. She had SLE daw. Baka dengue hemorrhagic fever coz of hematochezia. Baka meningococcemia because of the recent admission of a patient in the Pedia ER who was later transferred to San Lazaro Hospital. Everybody was left in the dark. No one had the answers!

And then the same message was circulated. At around 1 am of August 21, Ads passed away. There will be a mass at 10 am in the PGH chapel after which she will be brought home to Baguio.

The PGH director, Dr. Carmelo Alfiler, issued a statement which was circulated via text message which read, “ Nina Berba’s and my conclusions: 1) complicated clinical typhoid 2) not meningo bcoz symptoms anteceded suspect case aug 8 to w/c group apparently exposed 3) obgyn resident dormmate now confined has dengue. Intern’s grp will be monitored by Nina. Please pass.”

I couldn’t sleep. This morning I passed by the PGH chapel around 7:30 am but she wasn’t there yet. I saw some classmates who were her batchmates from Intarmed and they too were just relying on text messages. Nobody knew what really happened. They said she coded 7 times. That she was about to have hemodialysis done in the 6^th floor and coded again. That TCVS would have placed an internal jugular vein catheter if she hadn't coded.  I couldn’t imagine the hardship Ads have gone through.

Sadness and disbelief was palpable during the mass in the PGH chapel. The mood was somber. The trickle of rain resonated with the quiet flow of tears. Consultants, residents, and co-interns alike gathered to mourn the sudden loss of one of their own and also to celebrate the life of a colleague. A 23 year old intern, 4 months into her internship in PGH.

As health workers, we are constantly exposed to infectious diseases in the hospital; There are many occupational hazards we have learned to live with because of our desire to treat the patients, to learn in the process. I talked to Dr. Berba, head of the Infectious Diseases Committee (PGH) and Ads' attending physician in a meeting set-up for the interns' block representatives by the PGH director and internship committee after the mass.  I asked Dr. Berba directly because of all the speculations and the sudden turn of events which left all of us in shock.  She said they had done all the laboratory tests possible to exhaust the possible diagnosis, a 2 week history of fever of unknown origin. CBC, blood cultures were negative, PT/PTT, ESR and CRP to document acute and chronic infection, ANA to rule out a possible immunologic process, CEA for possible malignancy even a bone marrow aspirate for blood dyscracias was scheduled for monday.  Ads was placed immediately on broad spectrum antibiotics and was only on day 2-3 of antibiotics.  Ads was even able to text back one of my blockmates and talk to some friends that morning.   But what was to transpire in the next 5 hours of Sunday evening was the worst thing anyone could imagine.

We were reminded of our own mortality. It was a cruel wake-up call. That God can take us at anytime He chooses. We take the little things for granted; a smile, a wave hello, a short and simple conversation, even everyday lunch meals together. We are all travelers on a journey in this world, like pilgrims trying to find their place... We're all on borrowed time because death comes like a thief in the night, when you least expect it. We may not have all the answers we need right now because only God knows why. However, it is in my sincerest prayer that all of us be able to move past this sudden loss.

As we saw Ads in a shiny white and gold coffin, resting peacefully, more tears were shed for our dear batchmate as the Med Choir sang in the background. She was wearing our white UP Med School uniform, with the red nameplate on the left breast pocket. A reminder of her dedication to the profession all of us have chosen. 

“I will remember you

will you remember me?

don't let your life pass you by

weep not for the memories” – Sarah Mclachlan