First a Patient


FOUR MINUTES

DR. RONNIE ENRIQUEZ BATICULON

In no particular order, Ronnie Baticulon is a neurosurgeon, teacher, and writer. He blogs at http://ronibats.ph.


Not a lot of people know that many years before I became a doctor, I was a patient first.

It was a month after my high school graduation and the euphoria of getting accepted into the University of the Philippines (UP) College of Medicine’s INTARMED* program had not yet subsided. I spent whole days wondering about, dreaming of, and planning the next seven years that would lead to the fulfilment of a lifelong dream. I was excited to meet new friends who would come from all over the country. For sure, they must be just as I excited as I had been to dress in white, hold a scalpel, and learn how to use a stethoscope.

On that fine summer morning, I had to retrieve my chest x-ray from the hospital across our village; I was scheduled to go to the UP Health Service the next day. Nothing to worry about a routine chest x-ray, a universal requirement for incoming first year college students of UP. If anything, I was apprehensive about having to pull down my underwear and pants for the genital and rectal examination in Philippine General Hospital (PGH). I would later learn that I only had to indicate “No consent” in my form and the examining physician would defer this part.

Walking home, I was not prepared to read these three typewritten letters on the yellow sheet that contained the official report: PTB. And if that were not enough, the acronym was followed by the words “Moderately Advanced.”

I knew what the letters stood for.

I was aghast.

It was the very first picture of my lungs I could recall getting. If I had had any previous x-rays, I would have been too young to remember.

Instead of telling my parents, my instinct as soon as I got home had been to look for more information in our trusty 20-volume, royalblue-and-white New American Encyclopedia. I pulled out volume 19 (Topeka to Walter) and scanned its contents. Text and images merged to a blur. I could not turn the pages fast enough to counter the anxiety that was welling inside. Finally, I found the entry I was looking for—

Tuberculosis.

Etiology. Symptoms. Signs. Treatment. I could not comprehend how I contracted the disease. Weighing only 110 pounds, I was thin, but I had always been underweight. If I had lost a few pounds in the last couple of months, it could have easily been from Fridays and Saturdays spent in the field during citizen army training. I had neither fever nor cough, and I could not recall ever having phlegm with blood in it. Could there have been a mix up in the hospital, which then led to me being given the wrong x-ray result?

I was trying to prove to myself that what I was feeling, what I was reading, and what was seen on the x-ray did not fit the picture of TB at all. Published almost three decades earlier and now resting on my lap, the only source of information I had was hardly reassuring. I was naïve, 17 years old, and at that moment, quite convinced I could be dying from the same illness that killed President Manuel L. Quezon.

As I anticipated, it was my mother who worried more about the x-ray findings, her face ashen when I showed the result. My father just said, “Tignan na lang natin kung anong sasabihin nila bukas sa PGH.” (Let’s just see what they will tell you tomorrow at the PGH) Neither were doctors. All I could extract from my aunts and uncles was, at best, medical hearsay.

It was a long night’s wait.

The next day, inasmuch as I tried to move along the physical examination queue with nonchalance, the yellow sheet I was holding would immediately generate an alarming reaction from anyone who ever saw the findings, be it a nurse or a student volunteer helping out with enrolment. A muttering followed by a head-to-chest gaze. The indiscreet response was quite uniform.

I suppose that was when it started to sink in: I am sick and this is how it feels to be infectious. My optimism dwindled as I moved from one monobloc chair to the next, filling out forms and answering questions about previous illnesses and immunizations.

At the end of the line that snaked its way inside the UP Health Service, a family medicine resident waited to examine incoming freshmen.

“Inuubo ka ba?” (Are you coughing?)
“Hindi po.” (No)
“Naglalagnat?” (Fever?)
“Hindi rin po.” (No also)
“Meron bang may TB sa pamilya?” (Does someone have TB in the family?)
“Wala po.” (None)

Could the good doctor not see that I was perfectly normal?

After a series of inhales and exhales, I was told that I would not be allowed to enroll until I obtained medical clearance from a lung specialist. I also needed treatment. I expected the verdict, but that did not make it any less devastating.

Just like that, the future I planned with enthusiasm was put on hold. I spent the succeeding days pondering what I would do if I fail to get the medical clearance I needed. I could use the yearlong break, I repeated to myself several times while I lay in bed and stared at the ceiling. Perhaps I could try to do the things I have always wanted to do, such as swimming or riding a bike. I could even look for a part-time job to earn extra money while waiting.

I tried to formulate a ready response because soon, people would start asking why the class valedictorian did not go to college as planned. I was not even sure if I would still be able to retain my slot and my scholarship in medical school. I prayed hard and I bargained with the Supreme Being: I swear I would be a kind doctor to your people, if only you’d allow me to be one. Is this your way of telling me to slow down?

It was a difficult time. Most days, the uncertainty was just overwhelming.

My first pulmonologist was Dr. P. Her clinic was in the same hospital where I got my chest x-ray; it was easy getting an appointment. The room was cramped and dimly lit, or at least it felt that way. Now that I am trying to remember things, all seemed to be gray that afternoon.

Dr. P was soft-spoken and thorough with her examination. She looked at my x-ray, wrote a prescription for the TB medications, and ordered to have my sputum examined for three consecutive days. My parents and I went home with a reminder to follow up in two weeks. Looking back, I received the standard of care, but something was certainly amiss. I still felt heavy after the clinic visit. For days I had been trying to tell myself that I was absolutely okay, and yet there I was, feeling sick after having seen my doctor.

I told my parents I wanted a second opinion. We went to our family pediatrician and requested for a referral to another lung specialist, this time in a different hospital.

For good measure, I had my chestx-ray repeated, too. A view from the side was added but I now know that this set of x-rays was an unnecessary extra dose of radiation and only served to extinguish any lingering doubt about the reliability of my initial x-ray. I was still in denial.

The first thing I noticed walking into Dr. M’s clinic was how bright and airy (pun intended) it seemed. Dr. M stood up from behind his table and introduced himself.He was a big man with an even bigger smile. He might as well be Jollibee in a white coat.

“O, good morning! What can I do for you?”

“Dok, may nakita po kasi sa x-ray ko, eh.” (Doc, there is a finding on x-ray.)

He walked round to my side of the table, took my new and one-week old x-ray films, and forcefully snapped them into the viewer lit from behind by fluorescent lamps.

Pak! Pak!

“Ayos! Maganda ‘to,” (This is good!) Dr. M said with excitement.

It felt unreal and oddly comforting to hear him say this. For the first time, somebody was actually optimistic about my illness. I narrated my story and he performed his examination. He was impressed to find out that I got into UP and he listened with genuine interest to my plans in medical school.

When I disclosed my fear of not being fit to enroll for the incoming school year, he assured me with utmost confidence that six weeks ahead was more than enough time. That was uplifting beyond measure.

“Ipunin mo lahat ng pakete ng gamot mo,” (Save all your medicine foils) he said as he wrote a new prescription. “Next time you see me, bring them all because I need to make sure you are compliant to your medications.” He also wrote an x-ray request for every family member living with me.

I went home smiling.

True to his word, Dr. M signed my medical clearance when I saw him again three weeks later. Even though I had extensive lesions on my chest x-ray, my sputum results all turned out to be negative.

“Thank you po, Sir.” Dr. M ticked boxes in my health record.

“Uhmmm, ‘tsaka Sir, baka sakali, puwede po ba ako magpa-exempt sa PE at ROTC?” (Sir, if possible, could I be exempted in PE and ROTC?)

“No, TB is not enough reason to exempt you. You need the exercise.”

It embarrasses me to say this but that was my only disappointment. I was able to start college on time. I did not have any adverse reactions to the four TB medications I had to take every morning and I slowly gained weight. If I had a clinic appointment, I would be absent from my morning classes. Always, at the start of every visit, I would hand over a plastic bag full of medication foils as ordered. Dr. M would then try to squeeze the entire bag between his massive palms.

“I don’t count them anymore. ‘Pag hindi nag-abot ang mga daliri ko, ibig sabihin, (If my fingers can’t touch each other ) that’s enough,” he explained one time.

After a couple of months, I was down to two medications. My x-ray also showed significant improvement. And six months after I read the three letters that forced my college life to take a detour, Dr. M declared that I was cured of TB.

Still, I would insist on seeing him for my annual physical examination. On my third year, when I told him that I continued to receive discriminatory remarks from medical staff when they read my x-ray results, he wrote a furious note reprimanding the UP Health Service. I would learn in my internal medicine rotation that after two weeks of anti-TB medications, most patients are no longer infectious and could go back to school or work, without risk of infecting friends or co-workers. I still have Dr. M’s letter to this day.

Two years before I finished medical school, Dr. M said, “You do not need to see me anymore. You also don’t need to keep doing the sputum examination and culture. Magaling ka na.” (You’re cured.)

I tried to stifle laughter but failed. That was how the most influential doctor of my life kicked me out of his clinic.

Without knowing it, Dr. M taught me an important lesson on being a doctor. As a neurosurgeon, whenever I speak to patients and their families about a new diagnosis or a worsening outlook, I always remember the 17-year-old boy who thought that fate was playing a nasty trick on him, until he met the doctor who did more than just the right thing.

Dr. M gave me hope and that made all the difference.

*INTARMED stands for the Integrated Liberal Arts–Medicine program of the UP College of Medicine. Students only take two years of pre-med subjects mostly at the College of Arts and Sciences in Padre Faura, before going into four years of medical school proper at the College of Medicine in Pedro Gil and one year of internship in Philippine General Hospital.