day 22: how to make the charity ward your home

If you're a watcher for a long-term patient at the charity ward of the Orthopedic Center, here are some helpful tips.

1. Secure a sleeping space.  If you share the bed with your patient you run the risk of falling off the high bed and become a patient yourself.  You can sleep sitting up on a hard chair.  You can sleep on a cardboard under the patient's bed, which is more comfortable, since some watchers have installed an electric fan under the beds.

2. Get up early to beat the bathroom queue, since bath time is only 6:00 to 8:00 am.  Bring your own pail and dipper (there is none in the bathroom), and guard your shampoo sachets zealously.  Become a master of quick baths, and be willing to share the cubicle if the line is long.  Dispose of your dignity; the shower curtain is a shredded garbage bag.  Take breathing lessons.  The line for the single toilet is usually longer.

3. Don't worry about food.  There is a woman who takes food orders before lunch and collects the payments afterwards.  You can order lunch for two people for P50 pesos.  The food is delivered in styro packaging, neatly labeled with what's inside: 1 kanin, tokwa baboy.  At merienda time there is a vendor who walks down the corridor, shouting, "Camote cue! Turon! Ice candy!"

4. Be creative about doing the laundry. You can dry them in the ward terrace, but only at night, and be mindful of the space you take.  You can dry freshly-washed underwear under the beds, while you sleep at night.  The electric fans dry them up nicely.

5. Make a budget.  A lot of little expenses add up.  3 gallons of drinking water should be enough for two people for one week, but you have to buy the water in those 24-hour drugstores outside.  You'll need plenty of tissue paper and alcohol, some laundry soap and dishwashing paste, sachets of sandwich spread, 3-in-1 coffee mix, instant cup noodles, and packets of biscuits that your patient can nibble at 2:00am when sleep is elusive.

6. Make friends with other watchers.  They can watch your patient if you need to run out to fill a prescription.  They can also lend Tagalog pocketbooks and glossy magazines with Coco Martin on the cover, for the times when you're dying of boredom.

7. Take advantage of the interns.  They come in jolly little groups, very cheerful and eager.  They offer to give sponge baths and give you tokens, such as face towels, soap bars, and alcohol.  They poke and prod and chat you up and try to look knowledgeable, but they're a refreshing sight from those surly older nurses who've been around a hundred years and have seen every broken bone you can imagine.

8. Learn to become invisible.  When the doctors make their rounds with their retinue of assistants and interns and nurses-in-training, you blend into the walls.  You don't speak unless spoken to, you don't get in their way, you don't offer information about the patient. On that note, you don't undermine the authority of the attendants, the cleaners, and the nurses, some of whom will look at you as though you're a lower species of mammal.

9. Lift your patient's spirits. You can always chat with the other watchers, and therefore learn their sad stories. In turn, you can share them with your patient, and you can highlight those who have a sadder story than yours.  You've been in the ward three weeks? Oh, cheer up. The next bed has been here four months.  The one beyond her?  Six months.

10. Be thankful for the little things.  This is hard, but this will keep you going.  Among the many unfriendly staff, there will always be one who is kind.  There are complete strangers who will smile and say hi.  There are people who hold Mass in the corridor on Sunday afternoons.  Be thankful for the one test that turns out normal, the antibiotic that turns out unnecessary, the nurse who actually explains the situation, the other watcher who would offer to buy water for you, the doctor who takes the time to chat and joke around.  Count the little kindnesses, the little funny things in your day, while you're waiting for the big thing.  Like finally getting out of the darned hospital.  

day 18: drapolene

The attitude in the ward makes me angry.

You wake up in the morning to the harsh voice of the nurse.  "O, yung mga bantay dyan, gising na! Magligpit kayo, wala kayo sa mga bahay nyo!"

In the evening, some watchers turn off the overhead fluorescent bulbs because it is hard to sleep in the harsh glare.  The nurse would come in and scold.  "Yang ilaw, buksan nyo!  Wala kayo sa condo, nasa ward kayo!"

Some nurses are condescending.  If I go to the nurse station well-dressed, and address them as 'Sir' and 'Ma'am,' the nurses answer my questions respectfully.  But I have seen the same nurses ignore a watcher who has come back twice to report that her patient has vomited and needed assistance.

Ate Malou developed rashes from wearing adult diapers.  I brought her a tube of Drapolene Cream one time.  We always have Drapolene at home.  Aside from diaper rash, it soothes heat rash and minor itches and kitchen burns, and it's a good remedy for rough elbows and knees.

When the nurse asked her how her rashes are, Ate Malou said they have dried up because she used Drapolene.  The nurse seemed surprised.  She said, Why do you have Drapolene?  That's usually used in the pay ward.  Here we tell the patients to use petroleum jelly.  She proceeded to advise Ate Malou to hide the Drapolene, so that the head nurse would not see it.  She said, if you have Drapolene, maybe you should be in the pay ward.

I told Ate Malou that the next time someone asks about the Drapolene, she should say she stole it from the pay ward.

The staff who attend to the charity ward all seem to be allergic of things they consider 'sosyal.'  Aside from Drapolene, they bestow suspicious looks on big bottles of lotion (Ate Malou has requested that I bring her a bottle of Jergens because she so hates dry skin), branded bags, and five-inch-heels on visitors who always manage to arrive outside of visiting hours.  I don't have to explain that the guards never ask me questions, although they hold back the throng of visitors who arrive early for the afternoon-only visiting hours.

The staff who bring in food are loud and rude.  The cleaners are always in a foul mood.  On Ate Malou's fifth day in the corridor I asked an attendant if there is a chance we can get a bed with those metal contraptions in it so her leg could be elevated.  He answered in a raised voice that some people need to have patience and that we have to wait for another patient to get discharged so he could assign a bed.  I couldn't argue.  I was afraid I'd displease him and they'd make Ate Malou wait another week for her bed.

Ate Malou has a roommate, an old old woman who also broke her leg and has been a long-term patient at the ward.  She usually does not have a watcher, so the other watchers help out in feeding her or handing her what she needed.  The Sunday I was there, the old woman was trying to eat.  She drinks water from a bottle with a straw.  And since she cannot sit up, the food particles are scattered around her on the bed.  There were some suman wrappings on the floor.  A watcher helped her open a packet of biscuits.  I cleaned up some dried rice on her bed and picked up her trash.  The other patients say that if the nurse arrives and she has made a mess, she gets scolded.  It is worse when she has soiled her diaper, because the nurse who comes to clean her up arrives angry.  I asked her if she's alright.  She said yes and called me 'Ma'am.'

If you ask for clarification on the long wait for the schedule of surgery, the nurse would remind you that you are in the charity ward and the waiting list is long.  If you didn't want to wait, you could transfer to the pay ward, where you'd have a higher priority.  The staff would tell you that if you find the room too hot or too noisy, you could always transfer to the pay ward, where the rooms are airconditioned.  I am almost sure that the same nurse who is angry to be called to clean up the mess of one old woman in the charity ward would quietly, willingly attend to the mess of another old woman in the opposite corridor, the pay ward.

I am sure not everyone in the hospital acts that way.  But it is very disappointing to receive that treatment from the very people who are supposed to take care of you.

If you are admitted to the charity ward of a public hospital, it means you have no money.  Does it have to mean you have no dignity?

day 17: the schedule

The schedule frustrates me.

At the emergency room on 1 February, the doctor said that as soon as we have the implant and the blood ready, Ate Malou would be scheduled for surgery.  I said ok, please commence with the necessary laboratory tests, so she could be scheduled as soon as possible.  And if you remember, we had everything ready by 4 February.

We waited a whole week to get all the results and complete the x-rays needed.  On 13 February we were told that Ate Malou would be scheduled on 18 February.  That's another week.  They repeated that we're on queue, the waiting list is long, and there are more urgent cases to attend to.

On 16 February Ate Malou was advised that there are two more laboratory tests that needed to be done.  One is for her calcium level; the other is for thyroid screening.  Unfortunately, the blood extraction schedule is only done Mondays.  And the test is not done in the hospital.  They will only extract the blood, and you have to bring it to another laboratory outside for testing.  Which means that the surgery will not push through on 18 February.  I asked the doctor to please drop by at the ward to explain the situation to the patient.

To his credit, the doctor did drop by and spoke with Ate Malou, and lengthily discussed the necessity of those laboratory tests which are part of her clearance.  The doctor was very pleasant.  But it was not clear why the tests were ordered only on Saturday, when surgery was supposed to be for Monday.

On 17 February, the request slip given to Ate Malou was for five, not two, laboratory tests.  The nurse wondered out loud why all these additional tests were being requested for a routine leg operation-- which added to the anxiety and confusion.

On 18 February, Ate Malou requested another watcher to bring out the blood sample to this other laboratory.  The watcher was familiar with the procedure, having a patient who is also waiting for surgery, and that patient was also ordered a thyroid screening test.  That patient, however, has been waiting for her schedule since November 2012.

The result was released the same afternoon, and this watcher also picked it up and brought it to the nurses.  Then the nurses came back to Ate Malou and said that one test needs to be repeated (because the result was not clear), so she has to fast again that night, and the test will be done the following day.

Today is Tuesday.  The level of my frustration is so high that I can feel white hairs sprouting on my head.  I texted the doctor before 7am today, informing him that the laboratory results are ready, and that I sincerely hope we would have no more delays.

He said, 'I hope so too.'

day 14: the agent

I hope you may never have to bring a patient to the Orthopedic Center.  But if you do, here is one of the things that will make you upset.

We met an agent for the distal femoral locking plate, and he offered some discount to the price.  Since Monday the supplier has been pestering me.  He would text me as late as 11:00 pm, asking when we could settle.  I told him the doctor has mentioned a schedule for the following week, so why was there a hurry to buy the implant?  He said it takes 3-5 days to prepare the implant and bring it to the operating room.  I said another supplier mentioned that the implant is brought to the hospital the night before the surgery, and in fact that supplier refused to sell me one on 5 February, because it was too soon.  He said that's how they do it, so it's up to me.  He also mentioned that it might be good to get the implant early, because a slot may suddenly become available, and my patient could be scheduled for surgery early.

I decided to visit Ate Malou on Wednesday, to hunt down the doctor and buy the implant.  I texted the supplier early that I would be in the hospital at 11:30.  He said yes, the agent will meet me there.  I texted him again when I arrived at the hospital.  Again he said ok.  But at 11:30 I called him, and he said the agent had to make a delivery to Cavite, and would be available at 2:00 pm.

We had a small argument over the phone.  I just took some time away from the office to meet him.  I had to be back in the office at 1:30 for a meeting.  After the initial aggression to sell the implant, the least he could do was inform me in the morning that the agent would be available in the afternoon, so that I didn't have to come for nothing.  We agreed that he would personally come at 2:00 pm to collect the payment.  I was to leave the money with my patient.

To soothe my ire, he asked if I would like to see Ate Malou's doctor.  He told me where I could find the doctor, and said he would call ahead to advise him that I was coming.  Over a week of trying to talk to the doctor, and it is an agent who will make an appointment for me.

I left Ate Malou with strict instructions on how to deal with the agent when he arrives.  I have heard that another patient was victimized by a budol-budol gang the previous day and the conman made away with P100,000 for the patient's surgery.  Then I went back to the office.

At 2:30 Ate Malou called.  It's a different person who came to collect the payment.  I immediately called the supplier to confirm the identity of the agent, since our agreement was that he would personally come.  I was angry again, because I deserved the courtesy of him letting me know who would be coming to transact with me.  I got Ate Malou to check the agent's ID, and to take down all information from the ID, including the company name and the contact numbers.  I also asked her to get an official receipt.

I spoke to the agent and asked him when they would bring the implant to the operating room.  He said, the night before the surgery.

What's maddening is that some people take advantage of the situation of a patient in the ward to make a profit, and does not have enough decency to treat paying customers with respect.  It has been a persistent feeling all throughout the transactions in the hospital: you are in the ward because you don't have money, ergo, they treat you like you're a little stupid, a little gullible, and a little ignorant.

If you need a bone implant, the doctors can give you the agent's name and number.  I hunted down two other suppliers to compare prices, which didn't change.  The prices are regulated, but it's your job to beg for a discount.  The agents are familiar with the doctors' schedules and the procedures inside the hospital, and it is more fruitful to chat them up than to extract information from the nurses.  In the OPD, the agents can sit with the doctors.  You need an injection of some kind for your injured knee, you can discuss the price with the agent right away.  Maybe next time I will ask how the agent's commission scheme works.

Today I'm the little teapot, short and stout.  I am slowly simmering to a boil and I have to pour it out, so I'm blogging.

day 10: the long wait

Today is Ate Malou's 10th day in the Orthopedic Center.  She is still waiting to be scheduled for surgery on her fractured leg.

A pin was surgically placed in her lower leg at the emergency room, but it took five days before her leg was put in a proper tibial traction because there was no available stirrup and frame for her leg, and the bed she was using had no frame.

The bed was in the hospital corridor, because there was no bed available inside the ward.  She was transferred to the ward only on the sixth day, when a patient was discharged.  The wards are badly overcrowded.  The watchers play hide-and-seek with the nurses and the security guards, because the hospital has a very strict policy on watchers.

At night, some watchers sleep under their patients' beds. Most of them stay in a waiting area in the hospital's grounds, where they are paged if their patients need anything.  They have large pieces of cardboard for their bed, and they cover themselves with blankets.  If you arrived late, you can spread your cardboard on the sidewalk and use your luggage for a pillow.  Some watchers beg on the streets around the hospital in the mornings.  Their patients have been in the hospital for months, they came from faraway provinces, and they have no more money to even feed themselves.

There must be about sixty patients in the female ward.  There is only one toilet for the watchers in the wards, and bath time is 6:00-8:00 am only.  There is no kitchen, no source of hot water, no faucet for drinking water.

A caregiver goes around the ward on weekends.  She charges P200 to give your patient a hair wash and a sponge bath.  I was there on a Sunday afternoon, and I was surprised to see a woman peddling turon and banana cue along the corridor.

There is a Social Worker's office in the hospital, but even as they help with the paperwork, the patients are at the mercy of the funding agencies.  It takes time.  If we file for PCSO assistance, Ate Malou is looking at a six-month stay in the ward, waiting for funds to be released before any surgery can be scheduled.

It is difficult to get in touch with the doctors.  The nurses tell you to just wait for the doctor's rounds, and they would not give the contact information of the doctor.

It is good if your patient has Philhealth and better if she was admitted at the charity ward.  You can hope for a hospital bill that will not give you a heart attack upon discharge.  If your patient has to wait, you have no choice.  The expenses still mount.

After the surgery, you are expected to go back for follow-up consultations in the Out-Patient Department.  I have seen the queue.  The lines snake along the corridor, dozens upon dozens of them waiting.  The people tell me we have to be there by 4:00 am to make sure you get a slot.  Otherwise, you come back on the following day.

We had been advised to get the blood and the implant ready, and they would schedule her for surgery.  We were ready by Monday morning, 4 February.  Today is 11 February, and we are still waiting.  I spoke to the doctor this morning.  Hopefully, they can schedule her on the week of 18 February.  Hopefully it pushes through.  Hopefully her condition does not worsen.  Hopefully she will not catch a cold or develop bedsores or get migraines in the hot ward; otherwise, she gets postponed.  It is hard to sustain yourself on hope, at the mercy of the public hospital system.

The hospital personnel try to be kind, but they manage to convey an unkind message: you are in a public hospital.  You are on queue.  You wait.  In the meantime you deplete your funds, your patient remains in pain, and treatment gets delayed.  In the words of a well-meaning (probably) staff, my patient doesn't look like she's dying, so we're not a priority.

Such is the condition in a public hospital like the Orthopedic Center.  Public hospitals are the providers of last resort for those in need of health care.  They do not refuse care, but you must be very patient, and in many instances you have to forget your dignity.

The government's first PPP (Public-Private Partnership) project in health is the modernization of the Orthopedic Center, and the pre-bid conference has already taken place.  They new Orthopedic Center will have 700 beds, with 70% of the beds for use of Philhealth members and indigents.  It will have state-of-the-art facilities.  Let's hope it succeeds.  Let's hope the social welfare system is in place.  Let's hope that there is a mechanism to provide trained health care professionals, and appropriate technology in a setting where the individual patient cannot afford the true cost of such technology.

In the meantime it is very frustrating to wait, and even more frustrating to realize that you are powerless to insist.  I left a note--in English-- on Ate Malou's bed, in the nurses' station, and in the OPD section (that one was refused) on 4 February, the day I couldn't find the doctor.  All I was asking for was that they let the doctor know that Ate Malou was ready for surgery.  They made fun of that note.  I am told that hospital staff who saw the note asked Ate Malou who wrote it, and why it was in English.  Maybe they thought the note was arrogant.

I could have told them that not everyone who is a patient at the charity ward of a public hospital is uneducated, and not everyone who speaks English has money.  Ate Malou is in Orthopedic Center because we cannot afford St. Luke's.  But it doesn't mean we cannot speak out, or request to be accommodated, or expect to be treated decently.

day 5: the paperwork

I went to see the Social Worker's office on Monday, to seek advice on how we could possibly get a discount on the implant and the hospital bill.  There was a long queue, but I went straight up to the office and asked to see the Head.  My aunt said the Head was her classmate back in college, and we hope she would be remembered, enough to give me a few minutes.

It worked.  If looks were real daggers, I'd have been dead in about ten seconds.  The Head let me in, got my references, and asked about my patient.  She asked about my work, my husband's work, my sources of income. I promptly got scolded.  She said I shouldn't be the one going to the offices, because I didn't look like I couldn't pay.  I didn't look pitiful enough.  And because it was my nanny, I really should pay because I was the employer.

But she was honest.  She said we could try filing for financial assistance.  There's the Sweepstakes Office, the ABS-CBN and GMA7 Foundations, and the various politicians who have medical funds.  But we have to be prepared to keep the patient in the hospital for about six months.  None of those agencies would do reimbursements, which means that the patient has to wait for the funds to be released before any procedure could be done.  I asked about the timetable.  The waiting time to be scheduled for a PCSO interview is 3 weeks; another 3 weeks for the processing of papers, and then you wait for the funds to be approved.  How long, she can't say.  The waiting list is long, and they also weigh the urgency of the situation.  The children get prioritized, because it's easier to pity a child who got run over by a tricycle than a 42-year-old woman with a fractured leg.  Senator's offices?  Sure, we can file the paperwork, but there are only certain days for filing.  Also, you see, it's close to election time, so they tend to be very busy.

She said that the way she sees it, we really have to buy the implant if we wanted Ate Malou to be treated soon.  She advised that I should make sure her Philhealth is in order.  That way, we could get discounts on the hospital bill.  I thanked her and suffered more dagger looks on my way out.

So today, Tuesday, I went to Ortigas early in the morning.  My plan was to go to the Philhealth office in Shaw Boulevard first thing, then go to the office to settle some pending work.  I was in Shaw Boulevard fresh and early--- then I learned that the office had transferred to San Miguel Avenue.  By the time I got there, it was past 8:00 am and there was a queue.  I learned that Philhealth is under new management, and so they weren't releasing new Philhealth IDs.  (This did not affect me, because Ate Malou already has her ID, but they sent quite a few disgruntled members away.)  They asked me to fill up a payment form, and when I reached the counter, I was told that there was a new rate.  Instead of P100 per month for the voluntary contribution, it was now P150 per month.  I paid six months' worth of contributions, because they only accept payments in Philhealth offices.

I had with me a form from the Philhealth office in Orthopedic, with a list of the documents that I need to attach.  Just to make sure, I made duplicate copies of everything, even Ate Malou's Philhealth ID.  I went back to Orthopedic, of course there was a queue, and the guy at the desk said he needed another copy of this and another copy of that, and once I had completed them, I was to come back to him.  I've had enough. I told him that their form only specified one copy of the application, one copy of the proof of payment, and two copies of the MDR (Member's Data), so that's what I'm submitting.  If they needed more than that, their form should say so.  He accepted the form with my attachments without another word.  If you have to deal with a public hospital, bring two copies of everything, including all the papers they didn't say you'd need.

Did I say Ate Malou was still in the corridor, her leg on a pillow?  We brought her an electric fan and an 8-meter extension cord, diaper rash cream and cornstarch-and-baking-powder mixture.  She was developing sores on her back because it was so hot in the corridor and she kept sweating, and the diaper irritates her skin.

On that note, my children are still in the neighbor's house.  We went back to Cavite, bought some groceries (the little kid has run out of milk), paid one overdue bill at SM, and came home.  I swear I can feel myself getting thinner from all the running around, but that is the least of my worries.

day 4: the blood, the implant, and the doctor

We are at the Red Cross office in Tramo by 7:30 am, waiting for it to open.  We have a cooler with ice in it. Fortunately, they have two units of Type O+ blood, exactly what we need.  I thank all the gods in heaven, and promise to be a better girl after this.  We had to bring the blood to Orthopedic Center within one hour, and we have to be careful not to shake it.  We had a companion who was a former taxi driver.  It felt like we navigated side streets which weren't even on the map, but we got there in time.  (Another item to add to my thank-you list.)  I don't know how fast blood spoils, or what will happen if got shaken, but after all the stress and running around from the previous day, I wasn't willing to risk it.

I had to detour to the blood collection office.  I wasn't going to gloat over my two bags of blood, but I was curious about how many people would be in the queue, just in case we weren't able to find blood.  There were about fifty people in line.  Had we been able to find donors, they'd balk at the prospect of being at the hospital by 7:00 am, just to be first in queue on a workday.  I could have hugged my two bags of blood.

The blood is in the blood bank.  Our former taxi driver companion was supposed to have friends inside Orthopedic who could direct us to suppliers of the implant that we need, so we could check for possible discounts.  We couldn't find the friends, so he took us to suppliers.  The implant costs P56,000.00.  I had the money, we couldn't get a discount, so we were ready to buy.  The supplier said they only release the implant a day before surgery, and we have to show the doctor's clearance.  Nobody at the hospital told us that.  The supplier asked about the doctor's schedule for surgeries.  Nobody at the hospital would give me that information, so the supplier asked their agent there to check the schedule.  The supplier suggested that we go back to the hospital, find the doctor, and inform him that we are ready for surgery, so that he can give the order to initiate the clearance.

I couldn't get the nurses to give me the doctor's contact information.  They keep telling us to just wait for the doctor to make his rounds so we could tell him, but they won't tell us when he was going to visit next.  I asked to speak to the doctor on duty, but he just said, "If I see him, I'll tell him."  I was losing my temper, and I'll be damned if I'll leave the hospital without finding a way to let the doctor know.  All that effort to find the blood, raise the money, and buy the implant, only to be told that we have to wait for the doctor to visit?

Ate Malou is still in the corridor, waiting for someone to get discharged so she could get a bed.  Her leg is still lying on a pillow, waiting for a traction to become available.

I prepared three handwritten notes, all saying that we are requesting that the doctor be informed that this patient is ready for surgery, and that we are just waiting for his clearance.  I taped one note to the foot of the nanny's bed, asked that one copy be pasted in her chart at the nurse's station, and carried the third note to the emergency room.  I flirted with the security guard so he could let me take a look at the emergency room schedule, and there I learned that the doctor was supposed to be in the Outpatient Department that day.  I went there, encountered a hundred people on queue for OPD, and encountered a few angry words for getting ahead of all the people in line.  All I wanted was for the OPD nurses to pin my note somewhere the doctor would see it if he came in.  They wouldn't.  They said it isn't done that way.  I insisted, and in the meantime I was suffering from dagger looks and snide remarks, and I was ready to distribute some more broken bones.  The nurse came out, saw that I wasn't leaving without any answers, and she told me that the doctor would be on duty the following day, and I should come back then to give him my note.  It was impossible to reason with them.

I went back to Ate Malou, said sorry, but I couldn't find the doctor.  But I had made sure that the message would reach him, in whatever limited way my love notes would work.  I have to go back to my daughters, who were in the neighbor's care again.  I will be back tomorrow.

day 3: the blood hunt

We are ready to leave the children in the neighbor's house again.  Their belongings are already in a big basket-- including the portable DVD player, the stack of Dora VCDs, the milk, and the clothes-- when my brother and his wife arrive, all the way from Commonwealth, Quezon City.  They will watch the kids for the day.  One less thing to worry about.

We go back to Orthopedic Center.  We are given a form that says we have to provide 3 units of Type O+ blood for the surgery.  We could opt to buy the blood from a blood bank, or bring donors.  We checked the procedure for donors.  We are told that we have to bring five donors by 8:00 am on Monday or Wednesday, and each one has to have a government-issued ID card.  The blood bank can only accept donors for thirty patients.  We are also told that we should come very early as there is a long queue on blood collection days. To expedite the surgery schedule, we decide to buy the blood somewhere else.  After all, it's Sunday, and Ate Malou's mother has arrived to watch her.

Two dozen phone calls to hospitals and blood banks, and not a single one of them has Type O in stock.  Somebody advised us that it may be better to go to the hospitals ourselves and check.  My husband and I went to seven hospitals in Quezon City and Manila in search of blood.  Only one of them sold us a single bag.  We rushed it back to Orthopedic Center and resumed the rounds.

We called it off at 6:00 pm so my brother and his wife could go home.  On our way back to Cavite, we still checked the hospitals we passed along the way.  They all said they don't have blood in stock.  In one of them, in fact the private hospital where I first brought Ate Malou on Friday, I casually asked where they get the blood if their patient needs it.  I was told, the Philippine Blood Center.  I already called the Blood Center earlier in the day, with no success.  I was told that they have a waiting list, and the waiting list is for hospitals, not individual patients.

The hospitals do have blood, but they're mostly reserved for their own patients.  The usual practice is to ask the patient to provide donors in exchange of the blood that they need.  In our case, we could round up possible donors, but it will take a lot of time.  Several hospitals gave us telephone numbers of other blood banks.

I have never been so ready to call it a day, but I have to listen to the children's little stories about their day, and wash the dishes, and straighten the house again.  I check the laundry basket and decide that we can survive another day or two on the clean clothes that we have.  We resume the calls to the relatives to see who can spare someone to stay with us in the next couple of weeks.

The last task for the day is to check Google Maps to see where the Red Cross offices are located, so we can plan our route the next day.

day 2: the corridor

My eleven-year-old is scheduled to take the entrance exams for seventh grade. I call my husband at 5:00am to ask another neighbor to take her to the exams venue, reminding him to prepare pencils, refreshments, and her exam permit.  I can only hope that she passes.  After that, he will feed, bathe and dress the four-year-old and take her with him to meet me at the hospital.

The ward has run out of blankets.  Ate Malou is using the blanket from the emergency room, and the nurse tells us to have someone bring a blanket and pillows.  I send my husband a text message, asking him to bring plastic spoons and forks, paper plates, bottled water, alcohol, and towels.  I go down to buy adult diapers.

In the meantime, the ward is waking up.  The watchers have started their noisy exodus from the rooms, to queue at the single bathroom.  The sign at the bathroom says bathing time is only at 6:00-8:00 am.  They came with pails and basins, to start washing up and to wash their patients.  One ward contains about thirty patients.  I think there were four wards for women.  Aside from us, there were two other patients in the corridor.

Ate Malou's bed is almost opposite the stock room.  This is where they keep the oxygen tanks, various metal tubes and contraptions which must be the accessories of an orthopedic ward, and the huge garbage bins.  The watchers now troop to the stock room, bringing their trash.  Soiled diapers, bandages, food containers.  The smell was far from pleasant.

The breakfast cart arrives.  The coffee is in a huge kettle, which you could pour on your own.  The patient gets one piece of bread and one boiled egg.  Because we didn't have a coffee mug, we didn't get coffee.  My last meal was lunch the previous day, but I am not hungry.  I had to go to the bathroom, though, but the line is still long.

The guard starts making the rounds to make the watchers leave.  The charts have notes on who needs watchers and who doesn't.  It is very hot in the wards.  When the doctors arrive to make their rounds, they come with a dozen interns in tow.  It gets very crowded and noisy.

I finally get a chance to go to the bathroom.  There are two cubicles.  The first one has a clogged toilet bowl, and the watchers use it for bathing and washing plates.  The single faucet is at knee level.  You have to squat in front of the toilet bowl to use it.  There is no basin or pail or tabo; you bring your own.  The curtain for the cubicle is a garbage bag cut in half and strung in twine, and it is full of holes.  If you plan to take a bath, you forget your dignity.  The second cubicle has the toilet, which, thankfully, flushes.  It has a shower curtain too, but it is gray and slimy.  I ask a woman where they brush their teeth.  She gives me a strange look and points to the first cubicle.  How stupid of me to expect an actual sink.  There are cleaners, and they do try to keep the bathroom clean, but there are just so many people and not all of them are careful.  For the most part, it is the watchers who try to keep the place as close to decent as possible.  I decide to hold my water.    

People stop to talk to us, asking us what happened, sharing stories of their own patients, telling us how long they have been in the hospital.  I go to the nurse and ask when Ate Malou's leg will be put in traction.  She says we have to be patient because there are no available beds, and her current bed doesn't have the required metal bar where they'd hang her leg.  The nurse sounds ill-tempered and I decide to hold my tongue too.  I figured it's not a good idea to get into an argument when you haven't slept, haven't eaten, and haven't used the bathroom.

Ate Malou's niece arrives before lunch to relieve me, and my husband arrives shortly after to pick me up.  He has our four-year-old with him, and she has a takeout bag from Jollibee.  She tells me that's her breakfast.  We buy takeout food from another Jollibee, and head home.

We arrive in the early afternoon, I take a two-hour nap, and start straightening the house.  We have a mountain of unwashed dishes.  I do the laundry, pick up the scattered Dora VCDs, and think about dinner.  I also think about the next day.  My husband cooks sauteed cabbage and fish, his first effort in about five years, and my four-year-old refuses to eat.

I try not to worry too much, but it can't be helped.

day 1: emergency room

An ordinary Friday afternoon for my child and Ate Malou.  They were on the street outside the house, playing.  Here comes a car, moving a bit too fast, and they rushed to get out of the way.  Ate Malou slipped on the street gutter and took a bad fall.

I brought her to the emergency room of a nearby private hospital.  The x-ray showed a badly fractured left thigh bone, and they said they would need to operate.  However, I will need about P120,000.00.  The other option, they said, was to bring her to the National Orthopedic Center in Quezon City.  They could help call an ambulance for the transfer.

I asked a neighbor to watch Ate Malou in the emergency room and rushed home to gather my wits.  I packed a bag for her, and realized that my children would be alone in the house.  My husband was at work and I could not reach his mobile phone.  I asked another neighbor if she would take care of my kids while I transfer Ate Malou to another hospital.  I packed their things in a big basket, moved them to the next house, and locked my house.  My eleven-year-old promised to behave.  My four-year-old cried when I left them.

We got the ambulance from Cavite to Quezon City.  We were at the emergency room of the Orthopedic Center by 8:30 pm.  The staff put Ate Malou on a metal bed with nothing but a sheet on it and put us on queue for the registration, assessment, and x-rays.

The hospital was full of Friday night emergencies.  They kept coming: road accident casualties, kids run over by tricycles, an old man whose buddy hit his leg with a metal pipe during a drunken argument.   There were crying mothers, crying children with broken bones, crying old women with more broken bones.  There was blood on the floor, a shoe left by a patient, a bloody towel thrown on the corner.

The emergency room staff were efficient, but it must have been a very busy night.  Compared to the other patients, Ate Malou seemed to be the least likely to die, so maybe that was why she was not a priority.  She kept lying in the metal bed for six hours, until I insisted that they find her a bed with at least a mattress on it.

The doctor ordered four x-rays.  I had to stand in line to pay for them first, before she could be queued for the x-ray room.  That took a couple of hours.  When the x-rays were ready, the doctor said she had two options: leg surgery, which could be done as soon as we had the implant and the money ready, or she could stay in the hospital for six months, her leg in traction, hoping her bone would heal itself enough to be placed in a cast.  I asked that the laboratory tests be started in preparation for clearance for surgery.  I signed papers to have her admitted to the hospital.

At 4:00 am on Saturday she was brought to the charity ward.  There was no space available inside the ward, so we had to stay in the corridor.  I borrowed a chair from the nurse station so I could rest.  At 6:00 am they gave me a prescription for painkillers, which I had to buy from the drugstores opposite the hospital.

By the time people would already be having their breakfast I started calling people to tell them what happened, either to help us find a companion for the kids, money for the surgery, or contacts at the Orthopedic Center.

We have just begun.