11. Doctors’ Borders

  1. 01. Giving It Away
  2. 02. Mind Games
  3. 03. Customer Service
  4. 04. Getting Down to Business
  5. 05. …And Not a Drop to Drink
  6. 06. The Commission
  7. 07. Service!
  8. 08. Instant Celebrity
  9. 09. The Pinoy Diet
  10. 10. Life As We Know It
  11. 11. Doctors’ Borders
  12. 12. Poor, Poorer, Poorest
  13. 13. Half Empty
  14. 14. Me and My Leg
  15. 15. Always Be With You
  16. 16. Going Underground
  17. 17. Decisions, Decisions
  18. 18. I Shall Depart
  19. 19. A Volcano within a Volcano
  20. 20. A Nod and a Smile
  21. 21. Not Fighting City Hall
  22. 22. Stasis in Places
  23. 23. Fond Farewells
  24. 24. Parting Shots

“Well written,” my finance professor, Father O’Dwyer, scrawled on the cover of my term paper. “I pray to heaven you are wrong.”

It was 1980. The prime rate had just broken twenty percent, going up, with little sign of abating. Since the age of fourteen I had followed financial markets with the keen interest most boys reserve for girls. Now, at nineteen, I considered myself an old pro, a seer. My paper’s premise was there was no reason to think interest rates would ever drop back to “normal”. To the contrary, I cited several reasons to believe a “new normal” had been established. In my view, Father O’Dwyer and his ilk were the dying vestiges of a by-gone era, old men grasping at straws.

Being sick sucks. As if physical illness isn’t awful enough, after being sick a while I start a mental battle as to whether I might ever feel “normal” again. “This is the new normal,” my brain tells me, “get used to it.” Helpful brain.

Father O’Dwyer’s prayers were answered; interest rates came down. So did my fever. I started to feel normal again. It had been a difficult three weeks. Heck, it had been a difficult three decades. The face in the mirror each morning reveals increasingly sun-damaged skin and hollow eyes, a deteriorating new normal upon which the most favourable of interest rates has little effect. My brain had a point.

 

This recent viral episode gave me a first chance to explore the healthcare system here in the Philippines. I cannot complain about it, as I am 100% covered by the world’s most amazing insurance plan. Indeed, if there is anything that might make me consider spending the rest of my life volunteering, it is the insurance coverage. Not enough, I’m afraid.

The overseers of us volunteers are obsessed with providing the best health and safety amenities they can buy from a great distance. Much as I’d like to credit them for well-thought priorities, having been in government I know the decision to provide excellent insurance coverage would have emerged from a risk plan that identified “reputational damage” as the “catastrophic” consequence of a volunteer keeling over dead. The actual suffering and dying, well, that would be over when it is over. The embarrassment from killing a volunteer, on the other hand, can linger through an election.

We had planned a trip to Baguio, a northern mountaintop hamlet of just under four hundred thousand, where the air was rumoured to be clean and cool, the forests deep and lush. After two months, this was to be our first trip out of Metro Manila, or “this hopeless shit-hole”, as I heard wealthy expat Filipino call it. We purchased two nights at the Baguio Holiday Villas, and bought the deluxe bus tickets which provided both air conditioning and a toilet for the six hour ride up there. Needless to say, we were both excited about the trip.

At three o’clock in the morning before our departure I awoke to find I had, quite literally, shit the bed. I had never done that before, at least not in my adult life. I now can better appreciate the “shit the bed” idiom referring to one’s death, because actually dying would have been far less troublesome. It wasn’t an option, though. Once evacuated and cleaned up, I delved into the first aid kit we had been provided. There I found and swallowed two “GastroStop” pills as directed. Well-named, those pills. I didn’t poo for three days.

I probably should have stayed in bed. But I didn’t. Normally, the walk to the bus station would be a twenty minute saunter. With our bags and my tenuous condition, we decided to take a taxi, leaving an hour before the buses’ scheduled departure. Forty-five minutes later, stuck in traffic, we were still a fifteen minute walk from the bus station. I paid the taxi driver — it wasn’t his fault — taking our bags for a jog to the depot. We arrived just in time, dizzy and drenched in sweat.

The bus was lovely, with big comfortable seats, and an attendant serving snacks. Although I felt like hell, I was in heaven. I slept much of the way, and really enjoyed the scenery whenever I awoke. The bus climbed winding mountain roads, constantly overtaking slower moving trucks, jeepneys and tricycles, dodging other vehicles careening down the other side around blind corners. As we neared the top there were vistas over the foothills below, sometimes offering a glimpse of the South China Sea lapping fifty kilometres to the west.

Alighting into Baguio’s grubby Victory Liner bus terminal — let’s face it, every bus terminal on the planet is grubby — the first thing I noticed was that it was cool outside. I hadn’t experienced an outdoor temperature under 25°C in sixty days — and here it was, 17°C. I took a deep breath — and noticed a second thing: I couldn’t breath.

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Baguio City Hall

Baguio is a mile above sea level, so the air is pretty thin. The bus station is surrounded by ten thousand jeepneys spewing diesel exhaust, leaving very little air in the air. Ten minutes later the taxi dropped us at the hotel where we had rented a basic, clean and functional two-bedroom villa. Hot water!! I got my first hot shower in two months. Nice.

We had a late lunch at The Sizzling Plate, where Australian and American beef steaks are served on a sizzling plate, by gosh. We ordered a couple steaks, unable to determine from their carcasses which was American and which was Australian. It was reasonably priced mediocrity, as mediocrity so often is.

Finishing my steak and fries, I had hardly touched my beer, always a sign that I am not well. My appetite would persist through the bubonic plague, but when I’m off the booze, I know something is up. Sure enough, as I rose to leave, the building swayed over an ocean swell — unusual in a mountaintop restaurant. “I think we need to get me back to the hotel while the getting is good.” We did.

My travelling toiletry kit includes an old mercury thermometer which I stole from my mother when I packed for university in 1978. Oral, thankfully.  For those of you unfamiliar with body temperatures in Fahrenheit, 98.6°F is normal, with the possibility of brain damage arriving at about 104°F, and death setting in around 105°F. Mine was right at 100°F. Four hours later, 101°F. Two hours later, 102°F. By eleven o’clock in the evening I was looking at 102.5°F, and starting to get worried.

We are provided a medical hotline to call in just such circumstances. In minutes I was talking to a nurse in Sydney while her admin people tried to locate an all-night clinic in Baguio. No such luck, it was to be the hospital emergency room, or wait until morning. I decided to wait until morning.





Of course, the nurse could not endorse this approach. In fact the nurse could not endorse any approach, not being a doctor. All the nurse could do was make helpful suggestions for managing the fever, such as taking paracetamol (done), and if things got really bad, taking a cold shower. I couldn’t nail here down as to what “really bad” meant — 103°F? 104°F? Her reply was that I should seek medical assistance, which, of course, is what I thought I was doing. Regardless, I was not about to take a cold shower. I told Frank “really bad” was when I lost consciousness with my eyes open, at which point he should drag me under a cold shower before calling an ambulance. I took a sleeping pill, determined to wake up alive.

I did. In the morning the fever was back down to 100°F. I was pleased to see the hotline people had emailed a list of clinics I might attend, poached from the website of the American Embassy in Manila. The first clinic was that of Dr. Jose Roces at the nearby Saint Alphonsus University Hospital of the Holy Spirit, which opened at 9 am. A taxi delivered me there at 9:01am.

20160819_100250 (2)The hospital reception staff was flummoxed. “There’s no clinic here. What was the doctor’s name?” After some calling around, it was reported to me that Dr. Jose Roces was one of the most respected physicians in the Philippines — or at least he was until he retired at the age of eighty-something twenty-odd years ago. “He’s got to be dead by now…” the admitting administrator diagnosed.

“Look, I just want to see a doctor — any doctor. I have a high fever, aches, dizziness — the flu or something.” The reception staff shrugged as one, all pointing to the emergency room next door. “They can take care of you.”

Emergency rooms can be amongst the most unpleasant places on the planet. Usually they are filled with rows of bus-terminal quality plastic chairs occupied by people writhing in pain, bleeding and wheezing infections about the room. I didn’t see much choice in the matter, as I was having a difficult time standing up. I could sleep in a plastic chair at that point.

The security guard opened the emergency room door to reveal a complete lack of plastic chairs, or any chairs. A nurse greeted me. She was attired in classic 1950’s nurse garb, with a pink flowing skirt and a matching candy-striped blouse, a triangular cap with a red cross completing the picture. I half expected her to start blasting music on a boom-box to begin her striptease routine. Eager to prevent such a scene, I blurted “I don’t think this is an emergency, I just want to see a doctor.”

No questions asked, she took me by the arm, leading me to a comfortable corner gurney, right by the window. It was open just a crack, providing a wisp of fresh air, the warm sunlight filtering through the white cotton curtains, creating an ethereal ambience. I looked around the room. There were about twenty gurneys, only two or three of which were occupied.

Moments later a doctor showed up, a businesslike young woman dressed in scrubs. She closed the curtains around my gurney, creating a private space. “What can I do for you?”

I explained my predicament. She agreed it might be a flu, but to be safe, she would run a series of tests on various bodily substances. Blood was drawn, pee peed, and after some struggle with the powers of GatroStop, a small amount of shit shat. “We’ll have the results in about two hours.” she assured me.

I rose to leave, gathering my things. “Where should I wait?”

She looked at me as if I were nuts. “Stay here. Lie down and get some rest. You need it.” I did, falling asleep in an instant.

“…aaaaaaaaAAAAAAAAAAAAAAAAAAAUUUUUUHHHHHHHHHH!!!”

I was jolted awake by the scream of an elderly man on the adjacent gurney having a catheter shoved up his penis. I peeked out from behind my curtain to see the emergency room going full tilt, every gurney in use, blood splattered about the floor, the horrible cries of patients echoing about, anguished loved ones wringing their hands in uselessness.

A different doctor saw I was awake, and came over. “I am so sorry” he began, “we have had to prioritise, a stroke victim, a massive abscess, many others…”  His knee nudged a bag of bloody fluids flowing from my neighbours catheter.

Surely, I thought, they needed my gurney now; he is trying to break the news to me. Once again I rose to leave, gathering my things. “Where should I wait?”

“Oh, no, stay here. I just wanted you to know we will be with you as soon as possible. Your tests aren’t back yet anyway.”

Then he began to quiz me on decidedly non-medical issues. What was I doing in Baguio? In the Philippines? Where was I from? Why don’t I sound Australian? He lowered his voice before leaving me. “My wife and I are moving to the US next year.”

Then another doctor did the same thing — except he admitted he was headed to Australia. A third later confided she was migrating to Canada.

Here are some interesting statistics (draw your own conclusions):

Country                       Doctors per 1,000 people
Philippines                             1.2
Canada                                     2.1
USA                                            2.3
Australia                                  2.5
Cuba                                          5.9
Malawi                                      0.0

At one o’clock in the afternoon, I was released. They had tested me for an amazing array of maladies, including food poisoning, Dengue fever, malaria, typhoid, leptospirosis and Japanese encephalitis. All negative. The final diagnosis was “You are sick. Get some rest.”

The bill came to about fifty bucks. Cash only.

I was feeling a bit better. This often happens when a doctor tells me I am not about to croak. I decided to walk back to the hotel, only twenty minutes and mostly downhill.

20160819_110539Baguio is built around a mountaintop bowl with the expansive Burnham Park occupying the valley floor at its center.  Burnham Park was a lovely urban oasis— a rare thing in Manila — with pleasant gardens, kiddie rides, and paddle boats plying its centerpiece lake.  There, with the overnight rain having cleared the air, I managed to find a place to take a deep breath free of diesel fumes. This made the whole trip worthwhile.

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Cordillera Freedom Monument

Much of Baguio’s twentieth century growth can be attributed to the former rest and recreation facilities built for American soldiers to escape the heat. The presence of American military bases in the Philippines ended in 1992, nevertheless Baguio continues to thrive, not least from a strong influx of Korean immigrants. (The USA has recently re-established a military presence at five bases in the Philippines, largely a response to the rising tensions with China in the South China Sea.)

We got out for a nice lunch with some other Aussie volunteers.  Frank carried on into the night with them, but I spent the day in bed. We left Baguio the following morning, hopefully someday to return in better health to give the city its due.

This Saturday we were headed for Aringay to visit Vancouver friend Ian at his lovely beach front house. Ian’s cousin Mario lives in Baguio and owns the beach house adjacent to Ian’s. By pleasant coincidence, Mario was headed from Baguio to Aringay on Saturday morning, so Ian arranged a ride for us.

“So what do you do for a living?” Frank asked Mario.

“I’m a pulmonologist with the Saint Alphonsus University Hospital.” he replied. Small world.

“I spent yesterday in your emergency room.” I told him.

“What? Why? You should have called me!”

“Trust me — if I had known you were a doctor, I would have called!”

SK