This story originally appeared in the Philippine Daily Inquirer on May 9, 2009.
Earlier this evening, I was walking along Padre Faura Street in Manila on my way home to the humble apartment where I have been living for the last six years. It was not an unusual night. There were many shoppers rushing home after spending the day at the mall. I saw resident doctors and a couple of fellow medical students either walking home or walking to the hospital, which really did not matter because they all looked tired and weary. The street was filled with cars and jeepneys tailing each other closely and honking every time the vehicle in front stopped.
As I was approaching the part of Padre Faura fronting the Outpatient Department of the Philippine General Hospital, I noticed the all-too-familiar huddle of patients camped outside the hospital gate. Most of the time, I would catch them sleeping on the empty boxes they had spread on the ground to temper the coolness of the hard ground. This time, I came upon them as they were eating supper and preparing for bed. I saw a couple of men and women, who looked to be at least 70 years old, bundled up in their knitted hats and sweaters, eating the dinner they had brought with them. As my eyes scanned these faces, the tiny hairs on the back of my neck stood up, giving me a tingling feeling that reached my fingertips.
These are our patients. Here are the people who patiently wait in countless lines just to be able to tell their doctors about their dry throats, backaches or the queasy, indescribable, bad feeling they have been having lately. These are the patients whom we sometimes end up scolding after we have to repeat the same question several times because they cannot give us the straightforward answer we expect.
As doctors at the Philippine General Hospital, we try desperately to be kind, sympathetic and extremely patient with them despite the many hurdles we encounter every day: the far-from-ideal patient load, the severe lack of supplies, the extreme poverty which comes in many forms, shapes and sizes. But even the most patient doctor has his limits, the breaking point, which when reached, causes us to snap at an uncooperative or agitated patient.
Definitely we are not proud of this. Nobody encourages us to react this way. Early in our medical education, we were taught time and time again that we should never become hardened and numb. But despite our many personal promises and resolutions, we always end up doing what we shouldn’t do. It could be because of a mother in labor seems to move too slowly. Or because another mother cries uselessly instead of pushing her baby out. Or because a son in the Emergency Room Triage pesters us to admit his unwell, though relatively stable, mother amid a sea of patients needing urgent attention. Or because a disoriented watcher cannot find a stretcher for his patient. Or because a man has allowed his mass to get so huge that you cannot imagine how he could have endured it for five long years. Or because a stubborn patient does not understand the meaning of maintenance medication. Or because a woman simply replies “siguro” or “medyo” to all our questions instead of giving categorical answers.
Whether it is because the supply of alcohol, cotton or linens has run out; or there’s a sign on the door that says, “Interns proceed to the bathroom behind the stock room” as if we were dirty, lowly people who were not worthy of using the toilet at the nurses’ station; or we are forced to push the heavy stretcher beds and oxygen tanks around the hospital as if we were born to do such work; or we have not slept in more than 48 hours; or somebody has made the scary observation that our ankles are swollen from all the running, pushing and crouching—somehow, no matter how hard we try to avoid it, we do reach that point when we become irritable, seemingly less sympathetic and harsh to our patients.
After observing that scene outside the OPD this evening, I realized that stress and pressure sometimes cause us to snap, it is during such hellish moments, more than ever, that we should remember that our patients entrust their health, and their lives to us, that they spend the night on a dirty, cockroach-laden Manila street just to be able to see us in the clinic the next day and that the last thing they want to hear is a surly employee telling them, “Sorry, puno na ang slot. Hindi na kayo umabot sa quota. Balik na lang kayo bukas.”
I am not the nicest, kindest and most patient intern. I have my own moments of impatience and irritation. But it is unforgivable to just acknowledge this and say, “Hey, this is PGH,” as if that explains everything. We owe it to our patients to always try—and try even harder—to be more patient, understanding and sympathetic, like every doctor should be.
