By Ronnie Enriquez Baticulon, MD
As if the anguish of having been raped by a drunkard were not enough emotional trauma, Ofelia Reyes found out–two months after the atrocity–that she was pregnant.
It was a memory she had been trying to suppress: She going home late because the mall where she worked as a cashier had a midnight sale; her heart beating fast and loud as she walked alone through the dark alley leading to their village entrance; a burly man with sweaty hands pulling her into a corner, punching her in the belly, and forcing her into submission; she partly regaining consciousness a few minutes later, only to hear him whisper in her ear with his breath smelling of alcohol, huwag kang magsusumbong, sisirain ko ang buhay ng pamilya mo (Don’t tell anyone, I will destroy the life of your family); she half-naked, tentatively sitting on the ground after making sure he was gone, wiping her tears, fixing her clothes, gathering her things scattered all over, removing the grass and grit from her arms and legs, not knowing which one she should do first, trembling, faltering, resisting the urge to call for help, becoming increasingly harder to stay still.
As the rays of the sun began to slip through the crevices of the surrounding walls, Ofelia stood up and continued her way home.
She was 24 years old and single. Could you blame her if she took pills in an attempt to abort her unborn baby? She did not want to give birth to his child, who would become a constant reminder of her helplessness and how she had been violated.
“Bakit hindi mo ipinakulong ‘yung nang-rape sa iyo?” (Why didn’t you send the rapist to prison?)
“Hindi na po, Dok. Ayos na po ito. Mas OK nang tahimik na ang buhay ko.” (No more, doc. This is okay. I like my life in peace.)
She was not the patient I came to see in the ward. My patient was her son, Eric, who survived the abortion attempt, but was later born with an abnormally large head.
Now six months old, his head circumference was 53 cm; normally, it should have only been around 41 cm. The cranial CT scan showed hydranencephaly, a condition in which both left and right lobes of the brain fail to develop, and the space inside the skull is filled instead with cerebrospinal fluid.
If you shone a pen light on Eric’s scalp inside a dark room, the entire head would transilluminate like a crystal ball. The pediatric service referred him to Neurosurgery for possible insertion of a ventriculoperitoneal (VP) shunt that would divert excess water from his brain into his abdomen.
Inserting a VP shunt is easy. It would take less than an hour to complete the procedure. However, caring for a baby with a shunt requires lifelong diligence. Complications, should they arise, can be devastating to both patient and parents.
I was especially cautious in discussing with Ofelia the possibility of doing surgery on her son. In Eric’s case, the only purpose in inserting a shunt would be to prevent further enlargement of his head.
“Hindi na lalaki ang ulo niya, pero kahit lagyan natin siya ng shunt ‘Nay, malamang hindi pa rin siya makakapagsalita, makakatayo, o makakapaglakad nang sarili ha?” (His head won’t enlarge anymore, but even if we insert a shunt ‘Nay, maybe he still can’t speak, stand, or walk on his own) (He did not have enough normal brain to mediate these functions.)
“Ganoon po ba, Dok?” (Is that so, doc?)
I was looking at her as I spoke, but she fixed her gaze on her intubated son instead. I could see tears welling up in her eyes.
“Opo, ‘Nay. At pagkatapos noon, kailangan mo siya alagaan nang mabuti para hindi magkaroon ng problema ‘yung shunt na ikakabit natin.” (Yes, ‘Nay. Then after that, you have to take good care of him so the shunt we inserted won’t have problems)
In all likelihood, even after a successful operation, he would remain bedridden, able to cry or coo, but fully dependent on his mother for everything else. To make matters worse, Eric had pneumonia and needed a ventilato to keep his lungs adequately oxygenated. He needed to be free of any infection, be it in the lungs, urine, or in the blood, before undergoing surgery. Because of his very large head and his systemic problems, he was at a high risk for developing a shunt-related infection.
The average lifespan of children with hydranencephaly is a little under five years, with many dying before their first birthday from respiratory complications. If I put in a shunt and the shunt, by some misfortune, did infect, I would condemn him to spending his short life admitted in the hospital, intubated with tubes inserted in all places, every waking hour interrupted by monitoring nurses and medical students, every vein punctured for countless blood extractions and antibiotic infusions. It would cost a lot of money, too.
I have seen this happen. When it does, the surgeon ends up regretting his operation, wondering if the child would have lived longer untouched.
Explaining the benefits and risks of surgery with Ofelia, I admitted to myself: I was afraid of operating on her son.
Still, I had to ask.
“Papayag po ba kayong lagyan ko ng shunt ang anak ninyo?” (Do you agree if I insert a shunt in your son?)
She asked for more time to decide.
So I waited.
“No consent for surgery at this time,” I wrote on the chart.
It took two months to wean Eric from the ventilator and several cycles of expensive antibiotics to treat his repeated bouts of hospital-acquired infections. When the Pediatric Neurology service finally gave him an acceptable risk evaluation for the contemplated surgery, I talked to Ofelia once more.
“Sige po, Dok. Payag na po ako,” (Ok doc, I agree now) she said.
“Naiintindihan mo ang napag-usapan natin ‘Nay ha? Kapag nag-opera tayo, kailangan tuluy-tuloy ang antibiotics, at dapat, aalagaang mabuti ang sugat para hindi maimpeksyon o lumabas ‘yung shunt sa balat. Kung hindi, masasayang lang ang operasyon natin.” (You understand our agreement, ‘Nay. After we operate, you need to continue the antibiotics, and you have to take good care of the wounds to avoid infections or the shunt from coming out of the skin. If not, we will only waste our operation)
“Opo, Dok. Hindi ko po matitiis na hayaan ko lang na lumaki ang ulo ng anak ko.” (Yes, Doc. I can’t bear seeing my child having an enlarged head)
I needed certainty.
“Opo, Dok. Pramis po.” (Yes, doc. It’s a promise)
Filled with doubt but with utmost care, I put a shunt on Ofelia’s son. I reassured myself thinking that if she had been able to take good care of him 24/7 during the last 10 weeks, she should be able to take good care of him just as well after our surgery.
After spending three months in the hospital, the Pediatric and Neurosurgery services were able to send Eric home, with a working shunt and breathing on his own. Playing, too.
Did Ofelia blame herself for her son’s congenital malformation? Was her decision to push through with surgery despite the attendant risks an act of redemption, to free herself of guilt from having attempted abortion? But who has a right to demand atonement from someone who had been a helpless victim of transgression?
These things I had wondered from day one, but I never got to ask Ofelia–she who had had to bear suffering much more than most of us would ever come across in our lifetime.
It’s a shame her son would never be able to fully understand the strength Ofelia has shown under such tormenting circumstances, as other people, even I, cower in fear and in doubt.
This is courage and this is love. Forgiveness becomes irrelevant.
Dr. Ronnie Baticulon is a neurosurgery resident, teacher, and writer. He blogs at http://ronibats.ph
Vital Signs Issue 69 Vol. 3, November 1-30 2014