An Old Patient's Demise

It’s been a gloomy and rainy Monday; the rain drizzled since late last night and continued until morning which somehow made me late in coming to the hospital. The early hospital atmosphere was filled with cold air ushered by the water drops from outside. Upon arrival at the office, loud chattering about yesterday’s events were heard all over, then the outgoing ICU resident entered and directly held my shoulder and told me news that somehow coincided with the gloomy weather outside. The patient situated on ICU bed no. 2 just died early today. She recounts that the nurses called her attention, a sudden change in cardiac rate, from tachycardia to bradycardia, was noted and eventually the patient went into cardiac arrest. Resuscitation was initiated, CPR done, epinephrine given, ambubagging and fluids adjusted were done. A couple of minutes later, inspite efforts to revive his heart, it did not respond and he was eventually declared dead.

Looking back 3 months ago, when I was still the IM resident assigned to the ER, the above patient was brought to the ER due to unconsciousness. On history and examination, the initial impression back then was that the patient suffered from a stroke. A CT scan was done which revealed a massive infarct on his left cranial hemisphere causing him to be down to GCS 3. A neurosurgery referral was made which booked the patient to a stat craniotomy to relieved the elevated intracranial pressure. He survived the first few critical days in the ICU. His sensorium eventually increased, bit by bit in the next days but a persistent fever caught him. Possible causes entertained were ventilation acquired pneumonia or a possible abscess formation on his surgical site. Diagnostic measures were planned however, due to financial compromised a repeat CT scan, blood, sputum and urine cultures were not done. In the next days, inspite of the occasional spiking fever, patient was noted with eye opening and occasional spontaneous movement. He was fighting the disease that’s been tormenting his body, but unfortunately the financial aspect didn’t give him a good fighting chance. During those days, how I wish for a better health care system here in the Philippines, for better health insurance that could cover all of a patient’s expenses form day 1 to the day of discharge. A health system that won’t inhibit a patient from seeking medical consult because of financial reasons. It might not be happening now, but how I wish it would be a reality in the coming months or in the coming years.

It his last few days, he was noted to have much improved sensorium with spontaneous eye opening. But the financial aspect of the family leads him to his untimely demise.