Heartburn

Pity is the suckiest feeling.
It must be worst than heartburn.

today, i had one of my really masunurin patients at the unit.
sadly, last week, when trying to initiate dialysis on this patient, there was a problem with her access.
as routine work would have it, i got the necessary information and referred the patient back to the institution where her dialysis was initiated.

endorsement went something like this:
 me: hello, refer ko lang po si patient so and so.  xx year old female, on chronic dialysis.  wala pong outflow ang venous port ng patient.
resident receiving referral: ano po ang history
me: history history history.
resident: ok po.
me: yung meds on board pala bla bla bla.
resident: kelan po naadmit
me: nung august. (thought bubble: ang galing ko mag endorse! complete na complete!)
resident: health card po ba siya nung naadmit?
me: ha?
resident: health card? cash out? philhealth?
me: (awkward pause) ah, waith lang ha.  tawagan ko po yung husband.  (i call husband and whisper while covering the mouth piece) dad, cashout po ba kayo o healthcard?
husband: healthcard po, pero naubos na ang budget namin.
me: ahh, ok.  (back to phone) maam, health card po daw.
resident: waith, paka usap lang natin sa health budget specialist (or something of that sort).
me: (hands over phone to husband)
husband: mhmmm.  mhmmm.  eh, wala na po kami pera.  hindi ba pwede papalitan na lang nang di naadmit? (looks at me, and gives me the phone).
health specialist:  maam, parang wala na pong budget si dad.
me: sige lang, kausapin ko muna siya, tawag ako later. (i hang up phone)

me: dad, gusto niyo po ba sa ibang ospital na mas mura (of course, bilang government lang ang exposure ko)
husband: eh, dun na lang po sa ______ (old hospital), para po the best para kay misis.

with a heavy heart, i sent the patient to the hospital where knew that the care was more pricey, but ultimately, the same from other institutions.  minus the unnecessary trimmings.

today, i learn that they spent 11800 for a service that they could have gotten for less than half the price at another institution.  but it's okay.  dialysis was resumed.

or so i thought.

prior to initiating dialysis, again, there was no outflow from the cathether.

argh.

thought bubble: another 11800?

i called the surgeon who did the procedure, and sent them there.  again.  after less than two weeks.  with the husband softly whispering "ay bakit naman ganon?".  but he had no complaints.  they even gave me a smile on their way out.  for more heartburn.

on my way out, i see them by the mall doors, standing and waiting for the heavy rains to stop so that they could head to the clinic.  and try to catch the doctor during his clinic hours.  in the heavy rain.  i rushed out with my umbrella handing it to them so they could reach the clinic on time.  t

it seemed to be real theatrical.
it added more heaviness to my heart.  i thought i was having an anginal attack.
i ranted for minutes on end to my colleagues.  who like me had no other choice.

why is health care in the philippines so unfair?
11800 in one hospital, 2500 in another.
medication in a vial sometimes sell for 600, at other institutions 1800.
same same,  but different different.

why do bad things happen to good people?

man, i wish i knew.

to end, i blurted out to my colleague: pano ba patayin ang awa.
he said: buti na lang naaawa tayo, because we are human.
but sometimes, it just doesn't feel that way.