Kailangang lumaban

By Dr. Saimah Lyn S. Mama

Anong petsa na nga ba? Ano na nga ba’ng bago sa labas? Nagma-mask pa kaya ang mga tao? These thoughts and more play in my mind from time to time when I think of emerging from the  two-year COVID-19 pandemic. But first, let me walk you through my journey as a Filipino internist in the making, while facing the different challenges brought about by the novel virus called COVID-19.

More than two years ago today, at exactly March 15, 2020, 7:00 pm, I received a call from our then training officer, who said, “Hello, Doctora. Ba bnar ah myaglock down a hospital?” (“Hello, Doctora. Totoo bang nag-lock down ang ospital?”) I said no, as I just finished seeing a patient in the ward. I asked around immediately. I was surprised to see nobody else in the otherwise crowded hallway of Amai Pakpak Medical Center (APMC) medicine ward. I went to the ground floor and was even more surprised to see only the guards in the hospital lobby. I realized later that perhaps the lockdown would really happen soon. On the following day, most of our patients requested to go home despite of health condition. Only very few decided to be left behind.

I was part of a team of residents, junior consultants, medical specialists and subspecialists who would go on duty for three straight days. I feared for my life. I felt the vibe of an apocalypse when I looked outside the window. I was not able to see the busy street outside the hospital. I was on my third month of residency training. I thought, “Kailangang lumaban … Be brave!”

It makes me smile to remember my first out of town, face-to-face conference in Baguio for the 23^rd PCCP Midyear Convention. I was with my two colleagues, my co-senior residents. Being in a different place, seeing more colleagues gather, felt like a breath of fresh air. It was overwhelming and surreal to see and have my picture taken with other physicians I only got to watch in webinars. That experience even motivated me to finish my residency training. I dream of attending other conventions in the future as a subspecialist, God-willing.

As I write this, we are now two years into battling and trying to get out of the pandemic. Have those years been considered lost time? Maybe. Is it worth it getting back on track? Maybe. Is fighting COVID-19 worth it? Definitely yes! For we want to see the end of it, start anew with our lives, and continue to fulfill our promise and oath of becoming better physicians. I believe we will come out of this pandemic stronger.

Dr. Saimah Lyn S. Mama is from Marawi City, Lanao del Sur and is a graduate of Mindanao State University - College of Medicine, Class of 2018. In 2020, she began her Internal Medicine residency training in Amai Pakpak Medical Center. She is now the Chief Resident of the hospital’s IM department.

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The roller coaster ride

By Dr. Glenn Grecia Jr

“Let’s do the roller coaster now!” my mother exclaimed as we entered the park grounds of the amusement park we have dreamt of visiting since the pandemic started.

“Are you sure we’ll do that first?” I replied, chuckling as I was pretty sure she would regret choosing the roller coaster first. My sister giggled on the side.

Almost three years into the pandemic, the bug still silently spreads, undetected. Yet, people have yearned to bring back the past, where they could be carefree to enjoy life’s pleasures without having any fear of getting infected—or dying.

And there we were, in the amusement park. I gave in to my mother’s desire to get wrecked early as we approached the humongous rocket ship: the roller coaster. I felt nauseous. I could feel the blood on my face drain, my heart beating fast, my palms sweaty. I was belching with reflux and fear.

What came to my mind at that instant was the first time I handled a dyspneic patient who consulted me in my poorly-ventilated clinic when the pandemic had begun. He had severe COVID-19 infection.  I checked his oxygen saturation: 77%. It screamed at me. My heart raced. That was the last time my heart beat that quickly.

In a few minutes, it would be my turn to ride the roller coaster. I would need to confront my fear of heights. Would I open my eyes and face the world as it spun, or would I close my eyes and wait for the end?

Some prefer to close their eyes, while others keep their eyes wide open. In the end, all roller coaster rides eventually come to an end. People emerge shaken, petrified, and just happy to have survived it. Still others could not contain themselves: they would scream with adrenaline, feel victorious, and, perhaps would want to repeat the experience.

As for my mother, she regretted going on the roller coaster early.

“So, did you enjoy it?” we asked her.

She gave us a thumbs up and smiled. “At least we survived,” she said.

She has learned her lesson: keep the most thrilling rides last.

Glenn L. Grecia Jr., MD

The author is a general internist and lecturer in Medicine and Dentistry courses in Iloilo City. He loves to teach his students and patients alike with an ounce of humor and a ton of empathy.

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The Most Uncertain Time of My Life

By Dr. Shadrina Tahil-Sarapuddin

Planning a journey

My journey out of the COVID pandemic has revamped my life and reset my priorities. It was a mixture of medical difficulties, physical challenges, mental stress, and intense emotional agitation. It was the most uncertain time of my life. Many of those who have fought in the frontlines must probably feel the same way.

Who would have thought that the world would be hit by another pandemic? Who would have thought that everyone, including the rich, would be forced to stay at home? Who would have thought that the air we breathe would be a threat to our health? These echoes in my thoughts somehow helped change my view of why the COVID pandemic happened.

Before the spread of coronavirus into the rest of the world, in December 2019, I was an excited mom planning for a long-due vacation outside the country with my four kids. Tickets and hotels were booked. The kids were counting the days and even started planning what to wear. Everything was going well, and we were just waiting for our trip on March 23, 2020, in time for my husband’s birthday.

Frustrated plans

When COVID-19 was finally declared as a pandemic on March 11, 2020, I knew our long-time dream of traveling abroad as a family was already far from possible. When I learned that one of the first two patients in the country died from COVID-19, I felt something was bound to get serious. The mixture of frustration at not being able to travel and the fear of what might happen next was the most unsettling feeling I had at that time. I consoled myself first and then talked to the kids, who understood the situation well.

In a province like Tawi-Tawi, where culture and traditions dominate, the battle against COVID was hardest at the outset because of the difficulty of making people believe it even existed. The locals believed it was a made-up enemy by a powerful country to conquer us. Many refused to wear a face mask until it was required by the police. COVID-19 was perceived by the old as divine intervention to cleanse the world. At the beginning, people did not seem to be affected by the news about COVID, until they saw a video of a newborn baby who allegedly spoke of a cure by eating a boiled egg. Supplies of eggs eventually ran out. It seemed absurd, but to the locals, it was a precaution they didn’t want to miss.

Giving back to my province

I have been working in my hometown province, in the same institution, for more than 14 years since I got my license at 24. It was my sworn commitment that I’d give back in service to my family and to the place where I grew up. So, after residency training, I went back home.

The provincial hospital has a 50-bed capacity but the bed occupancy rate sometimes reaches more than 130%. It has a well-built infrastructure, typical of a well-funded hospital in the provinces—a classic medical edifice in the GIDA area. However, it has suffered from a lack of doctors, medicine, and supplies, typical of an institution ruled by a personal bureaucracy based on political friendships, ties of kinship, and charisma.

Imagine your visionary and enthusiastic self in such a working environment. The feeling of unfulfilled dreams was incarcerating. The agony of going with the tide and throwing your own paddles in order to survive while doing what you love to do was burning.

The only internist

I was the only internist in the hospital at the time when the COVID pandemic hit. Another fellow internist was taking his specialty board in Manila and later arrived in the province. There were only 10 other doctors who actively handled patients for admission. Out of the 10, there was only one pediatrician and one obstetrician-gynecologist working.

We braved the ER and wards and stayed in the hospital 24/7, taking calls in the middle of the night and in constant fear of what might come next. The mystery of COVID-19 was ailing our minds and bodies. The lack of necessary supplies and improper administrative priorities were pushing us against a thorny wall. I kept losing my patients to infections that were mostly never confirmed.

At first, patients were strangers to us, but later, we were already getting patients that we personally knew. Many of us had to swallow insults from the families of those who died as a result of the dreaded disease. Several people in the community stigmatized the hospital as the main source of infection. This led to many patients seeking help in the late stages of their illness. We continue to struggle every single day with our duties in order to save lives. Our medical management was out of context because we had to settle on what was only available. There were patients who survived, perhaps from intense prayer and the team’s efforts to innovate.

As COVID evolved quickly, we were left way behind. We never caught up in terms of IPC protocols and testing accessibility, and worst of all, we did not have enough PPEs. We recycled disposable face masks by washing and ironing them. We even experienced using a half-cut empty six-liter water plastic bottle as a face shield. On social media, we begged for help: send us PPEs and alcohol. When the first well-designed, easy-to-wear face shields came out on everyone’s social media posts, we were envious. Thankfully, colleagues and friends from other places were quick to respond and share their limited supplies.

COVID kept us on our toes every day, and its mysterious course gripped us in our throats until we succumbed to one of its strains. There were twelve of us doctors who cried for help in writing and relayed our predicament to the ones in higher positions. Sadly, I was blamed for power-grabbing and plotting a coup to unseat the one in position. I faced allegations and slander for simply raising my voice to protect ourselves and the patients we handled. Our cries were heard but were brushed under the rug. The people who were supposed to listen to our pleas only listened to a sweet talker who was even partly responsible for some difficulties we faced. We were valued less.

Testing positive

On September 25, 2020, six of our doctors tested positive for COVID, and after a few days, more than 80 of the staff were also confirmed infected. The staff were improperly quarantined: ten people in a room, or six in a foldable tent with a shared bathroom. It was more than a week after swabbing before the results arrived, and the rest had already been exposed. The hospital closed. News came out that we were defeated by COVID.

We continued to stay in the hospital during our recovery. I was staying with my husband and my sister (who also tested positive for COVID) in the smallest room in the outpatient department of the hospital. I had a fever, sore throat, and asthma attack. My colleague, another internist, was also confirmed positive, so we had to manage on our own. There was no one and nowhere else to run to for safety.

COVID-19 has disrupted our lives, as it has done for millions of others around the country and the world. Yes, no one must be singled out as responsible for the spread of the virus and the death of anyone. But if only each of us had set aside our greed and hunger for popularity, some of us would have lived less miserable lives. However, the misery awakened my sense of seeking the right place for me. It made me long for a workplace where I could be of value and significance, a place where leaders would listen and take action.

Revisiting my life

As days passed, I thought, “What if I died from the infection?” That possibility frightened me for quite some time. This made me revisit my life and reconsider my priorities as a mother and a doctor.

My prayers and longings were answered when I got a call from one of my mentors in medical school. Without hesitation, I requested a transfer of service and agreed to a voluntary demotion to a lower position. I did not care about the demotion because what mattered to me was the value of the offer, the opportunity to work in a better environment, and the thought of  being valued for my potential.

Lessons learned

COVID hit me hard. I got infected and was accused of staging a coup for power-grabbing. It has been hard on all of us, and getting used to a new way of living does come with its challenges.

But we need to look at the positive effects that COVID has brought to our lives. We have learned to appreciate the clean air after periods of lockdown, the moments we have spent at home with our family playing games, and the peals of laughter over meals with colleagues. Those are the treasured moments.

We may not know the definite source of COVID, but why would that matter now? After all, this world was created to test us in so many ways. After what I have been through, I have learned to love life even more. I learned to appreciate the value of even the smallest things in life. The air that we breathe every single day and simply being able to have a sense of smell should be enough to keep us going. The distance and the time lost with our family and friends should bring us closer to those who are significant to our existence.

As we breathe the air of COVID endemicity, let us not forget that we are survivors who will have to continue to survive life’s challenges. We live in a world where there are constant threats. Why worry when life is never certain and only those who are meant to stay can stay? I do not despise the unwanted things that have happened in my life during the pandemic. I am still blessed because no one in my family died of COVID. Despite the difficulties of working in a rotten system, I was not corrupted. Instead, I have learned to trust the plans of the Greater One. It has not been an easy feat to emerge stronger as a better individual.

As I write this article, I recall the hard times at the height of the pandemic. I realize now that I was not a hero but a source of hope and comfort to those who needed me. I was among the proud who had the courage to speak the truth and leave the life I built with hard work to seek my worth. I emerged from the pandemic fulfilled by the outcome of my struggles. I may have learned some lessons the hard way, but I found a bigger piece to solve the puzzle of life.

Dr. Shadrina Tahil- Sarapuddin, MPH, FPCP, is a 40-year-old mother of four. She is a Medical Specialist IV, the Head of the Public Health Unit, Public Affairs and Customer Care Unit, and Office for Institutional Strategy and Excellence (OSM), Zamboanga City Medical Center.

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PAALAM

By Dr. Bill Ramos

Paalamayoko mang sabihin, pero paalam

masakit man isipin, pero paalam

marami akong tanong, pero paalam

di ko maintindihan, pero paalam

kahapon lang OK ka

kahapon lang kasama kita

kahit napansin ko malungkot ka

inisip ko lang ganun talaga

bakit ganun bakit ngayon

bakit di ko man lang naramdaman

bakit di ka man lang nagpaalam.

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