The Other Side

What my Lolo's admission taught me about empathy.

As much as it’s difficult to do rounds as a doctor, it’s infinitely worse to be on the other side of that interaction—to be the patient or the patient’s companion, neither of which is a great place to be. Recently, I learned that the hard way.

A few weeks ago, my grandfather became progressively weaker and drowsier. He also lost his appetite, which was highly unusual because my lolo loves to eat, everything from hopia to humba to halo-halo. He looks forward to our Sunday family lunch because he knows I’ll order his favorites. Losing his appetite was a huge red flag for me. I just knew something was off. When his blood pressure dropped, I knew I had to take him to the hospital. That night, I became my grandfather’s bantay.

Bantay loosely translates to a “watcher,” as if the patient were a house or a piece of jewelry in danger of getting lost or harmed. But weird word choice aside, a patient is expected to come in accompanied by a family member, friend, co-worker, or caregiver. I recall the myriad times when, as a medical student or resident, I admonished a patient for not having anyone with them to fill out forms, pay hospital bills, run errands, answer doctors’ questions, or…just be there, waiting for instructions.

I recognize that as far as bantays go, I’m in a pretty privileged position. I’m a doctor and I work in a hospital I’m familiar with. I have a good grasp of hospital processes and am less overwhelmed when people ask me to fill out forms, sign documents, or go through this hallway, right on this corner to get to this office. When my colleagues come up to interview us, I know what to tell them. I know who to ask when something is unclear. I know who to refer to when I don’t know what to do.

And yet even with these advantages, being a bantay is not easy. It’s not that I never imagined it to be difficult, but I still get confused with all the instructions. Although familiar with most forms, I’ve never actually filled one out. Thus it’s also now that I have to answer questions like what my 97-year-old grandfather’s father’s name is, or what his mother’s maiden name is, or if I’m allowed to write myself down as his “guardian.” And when doctors and nurses ask me questions, I still give harried and out-of-order information. I go on numerous tangents and bring up unrelated details in the middle, afraid of missing anything. And even then I still forget something, mix everything up, or tell a different story every time I’m asked again (in my defense, I believe the story gets better each time I tell it). I was even reprimanded for sitting on Lolo’s stretcher bed. “Bawal bantay sa kama, ma’am.” I didn’t even know this was a thing. Was I expected to stand against the wall the entire night? And all this on top of the already dreadful experience of having a loved one brought to the hospital. Medical education be damned, I’m still a little girl fearing for her grandfather’s health, and no amount of medical knowledge could calm me down. I waited anxiously every step of the way.

That’s another thing, the waiting. So much waiting. There’s waiting to get inside, waiting for the Blue Card, waiting to have their vital signs checked, waiting to be seen by a doctor. Lolo’s been referred to three doctors, and we’re waiting for each one of them to see him. There’s waiting for a vacant stretcher bed. Waiting for a vacant room. Waiting for paperwork to be processed. Waiting for instructions on settling the down payment. Waiting for the nurse to do this, for the doctor to do that. Waiting, waiting, waiting, in a cramped emergency room, with other patients, their families, and healthcare staff coming in and out alongside our stretcher bed. I’m all for patient privacy and confidentiality, but there’s little sense in attempting not to eavesdrop when I could practically high-five the patient next to us. You hear bits and pieces of their stories, from the doctor’s interviews, conversations with their companions, and instructions given by the nurses. Two beds away from us, a thirty-something man, came in after being the receiving end of a truck-and-motorcycle collision, They say he was crossing the street when a six-wheel drive hit him. He had a neck brace, a cast, and bruises all over. A couple of doctors flocked around him, one interviewing him, the other asking him to wiggle his toes, and yet another doing an ultrasound of his abdomen. He’s awake, but is very much confused. Is it a concussion? Is it alcohol? Is there a bleed in his brain? Before I can figure this out, he’s soon taken out of the room. Something about a CT scan, or an X-ray, or probably both.

Right across from us, there’s another patient breathing through a ventilator. He arrived before we did. I learn that no one knows who he is because he came in with no identification, no companions, and no consciousness. They’ve temporarily called him Mr. X, and he has thankfully woken up in the last few hours. I see his blood pressure and heart rate displayed on the monitor. Stable, I say to myself, and so far that’s all I know, and apparently all that everyone else knows, too.

Another patient is wheeled in beside us. It’s a woman in her sixties, gasping for her life. Two doctors attend to her. They’re discussing if they should put a tube down her throat or if they should give her some drugs for her hear first. I vote intubation, I say to myself again. Drugs will not work fast enough for this. They talk to the patient’s daughter, who comes in with an envelope, a duffel bag, and a pillow. The daughter panics, not knowing what to say. She’s asking if there are other options. She calls her siblings, trying to explain what the doctor just said. By this time, her mother becomes more and more dyspneic and less and less awake. The doctors and nurses are more persistent now. The daughter is sobbing. She was fine yesterday, she insists.. “Mama, please calm down, mama!” she says through tears.

Before the family gets to decide, another patient comes in, no pulse, no breathing. The healthcare team turns their attention to resuscitating this new patient. A nurse starts chest compressions. They check heart rhythms. I watch from across the room. This woman, probably in her eighties, is pale, almost colorless. It looks like she’s been dead for several hours. True enough, after twenty minutes of trying to restart her heart, she doesn’t make it. A doctor makes the call. Time of death, 3:38 a.m..

Right after that, the patient’s daughter beside us, still crying, consents to intubation. The doctors and nurses crowd around her bed again. There’s a med student taking blood extractions, a nurse preparing medications, a doctor fetching the intubation set, another doctor requesting for an ECG. In the sidelines, the daughter looks on, crying, staring, trying to hold it together.

By then, it’s nearly 4:00 am. Another nurse approaches us and tells us we don’t have a room yet, but that they can transfer us to another bed, and that’s the last I see of Mr. X, who was just beginning to wake up; of the woman who came in dead; and of the daughter still looking at her mother and praying she made the right choice.

All of this—the chaos, the procedures, the protocols—I’ve seen all of this a thousand times. I’ve been a part of this a thousand times. As a med student I did blood extractions and took blood pressures. As a medical resident I interviewed families, gave medications, commanded code teams through resuscitation. I probably believed I understood it all; I was, after all, the supposed captain of the ship at the time. I knew what was happening and I knew what I was doing. I’ve been in every iteration of this—except for this one, of being the outsider looking in, of being the audience to death and disease happening right beside you. At some point you start to wonder if this was a bad omen, or if this kind of mayhem was transmissible, or if you or your family were next. I finally understand my ward patients who used to tell me how they couldn’t sleep, because the patient across from their bed died last night. Or how their blood pressure spiked, because the family beside them was sobbing. I probably told these patients that I understood, even when I didn’t. There are some things you only understand conceptually. There are some things only experience can illustrate for you.

My lolo was admitted for a week, and after a series of tests and sleepless nights, he finally got to go home. Lolo is much better now. His blood pressure is stable, his appetite is back, and he’s as talkative as ever. It’s hard to imagine that, a few weeks ago, he was frail and drowsy in the emergency room. I am eternally grateful to everyone who helped us—doctors, nurses, nursing aides, porters, friends, and colleagues. I know I was afforded privileges otherwise unavailable to others. I know we had it easier than most patients and their families in the hospital. I know my experience will never give me the full picture of what it’s like as a patient or their loved ones. But if anything, that night reminded me of precisely that: I will never completely understand what it’s like, which is all the more reason to consciously exercise empathy. To remember how frightening and confusing it can be in a frantic emergency room. To be kinder, to be more patient, and to understand that the hospital is a scary place, even when you’ve worked there all your life. On most days, when I do my rounds, I’m on the doctor’s end of the interaction, but I hope I never forget what it’s like to be on the other side.

Photo by Marcelo Leal on Unsplash