LESSONS LEARNED AFTER A SERIES OF MISHAPS



The month of September 2009 was marked by the cunning arrival of a typhoon named Ondoy that struck and devastated Manila with its fierce claws that killed hundreds of lives and destroyed properties. Ondoy’s minions, Pepeng and Santi followed his tracks and finished the job of destruction. Following the old adage that when it rains, it pours; only the pouring that they did was a nightmare to behold, and the havoc they left was of great magnitude. For a time, dashed hopes were prevalent because the tragedy sapped the energy of life out of everyone especially those directly hard hit.

It was barely a month after that fateful disaster when people were slowly getting back on their feet when another mishap visited, not the entire country but our humble abode. A fire broke out in one of the rooms upstairs due to a system overload or what is commonly known as “faulty wiring.” Just to digress a little, I learned that the “faulty wiring” often used as the main culprit for most of the fire mishaps was inappropriate; that system overload is the apt term since no electrician with a sound mind would install a faulty wiring during the installation process. Going back, the fire crept in in an unholy hour when everyone in the household was in a sleep mode. It was discovered only when my nephew felt the urge to relieve himself and noticed the billowing smoke coming out from the corner room where my elderly auntie in her 80’s was soundly asleep.

To make the story short, after the more than two gruelling hours of putting out the fire, thankfully, the damage was not extensive. Although, it left our house in a complete disarray. Appliances, clothes, books, beds, pillows, ceilings and floors, and what have you, were all drenched with water. It was like Ondoy was resurrected and lashed out its last strength that created a mini flood in our house. Our house was like an open gallery where people from the neighborhood and strangers come and go, walked in and out, went up and down but all these scenario were met by us with maximum tolerance because we needed help and support from friends and strangers alike. Despite the seemingly chaotic and noisy pandemonium happening during those tense moments, we managed to keep our eyes open and our minds alert for any possible looting or stealing. Luckily, no one attempted to do such a thing.

Earlier on, I mentioned that an elderly auntie, my mother’s older sister was sleeping in the corner room where the fire broke out. If our house needed only a few repairs and a minor repainting job, the opposite happened to my auntie who sustained injuries on her face, upper and lower extremities. This auntie who lives in Batangas just stopped by in our house to have a health check up. Although she has other siblings and relatives who also reside in Manila, she prefers to stay in our house, the logical reason that I could infer is that my mom’s the only next of kin that she trusts and puts up with her fussy temperament. My auntie is childless and a product of a failed marriage. She is what you may call stingy with a smile.



HOSPITAL HOPPING


When the last trace of smoke was extinguished, my octogenarian auntie was brought out from the room, all wet and looking very frail. She was initially brought to the nearest public hospital, Ospital ng Makati in Malugay, Kamagong, but was eventually discharged the following day. She was next brought to a private hospital in Paranaque (Paranaque Medical Doctors) for further treatment of the burn injuries. I and my siblings visited her once in the hospital. It was the first time I saw the extent of injuries her body had sustained from the fire. Half of her face was black with burnt flesh, the skin covering her arms and legs and thighs seemed to have been scraped raw and exposed a large body of reddish and white flesh glaring before my eyes. It was a horrifying sight that looking at the wounds made me quiver, feeling myself a mixture of an unbearable and numbing pain of the exposed rawness of human flesh. I can’t help but moved with pity and wondered why it happened to her? For me, she was so brave to go through it all and her tolerance for pain was admirable. After being confined in a hospital for a week, she was released and was asked to return for a check up. On the day of the check up, the doctors announced a grim verdict that the burnt flesh got infected and the wounds got deeper especially on the leg part. This put my Mom in a panic mode and hastily decided that my auntie be transferred to Makati Medical Center, the 3rd hospital she was brought to. The proximity of the hospital to our place of residence in Makati made it convenient for her and other kith and kin to drop by and pay a visit. In Makati Med, the infected wounds were of prime importance. Doctors performed debridement, a medical term for cleaning and treating the wounds done with utmost expertise from the professionals. Being given a first rate treatment by a reputable hospital in Makati gave my mom peace of mind, except for one serious problem – the cost of the hospital confinement and the accompanying series of treatment procedures my auntie will undergo, not mentioning the professional fees of the doctors were a nerve wracking issues that my Mom had to confront. As an aside, she was informed that treatment procedure for burn injuries was the most costly and expensive treatment one had to undergo. As for the case of my auntie, treatment ranged from P500,000.00 to P1M as per doctor’s assessment. All jaws dropped to the floor, it was indeed costly. The main question was where to get money for the treatment?

My auntie’s financial resources was scanty. She had savings which she managed to set aside by living a very frugal life. Never in her wildest dreams that her money saved for years will be wiped out dry by the fire incident. Truly, a very sad reality. No immediate family that could be a source of an extension of financial help, no compensation, no pension, no source of income, no more real properties to sell, no jewelry that can be pawned, no insurance, no health care plan except the Philhealth card which was rendered useless as it was not renewed and so got expired. Before the fire, she was living quite comfortably, simply and with nary a care in the world, contented with the savings she had painstakingly kept in the bank and in her little treasure box. The occasional financial doleouts given by generous nephews and nieces kept her at bay.

The paucity of funds needed for her burn treatment led to a moral dilemma for her siblings and all nephews and nieces. Questions arose like, “(1) should we proceed with the treatment, (2) where do we get the funds, (3) who will take care of her during and after the treatment, and (4) if she survived the ordeal, how is she going to live her life with her savings all gone.” I was at liberty to hear and know the issues, courtesy of my Mom who bared it all to me and my siblings. My Mom being the major player and designated as the principal decision maker in this situation. I have documented some of the contradicting views on my auntie’s plight, some views ranged from looking at the lens of being practical and pragmatic considering her advance age, others argued that family, siblings and all “pamangkins” have the responsibility to help her fight and live. How much support in terms of caregiving and the extent of help they would provide, not only on the financial support were never thoroughly discussed. It later dawned on me that the bulk of responsibility would be relegated to my Mom. My mom who herself was also in her advance years but fortunate to be currently in a healthy state. But the enormity of the responsibility and the gravity of the situation eventually took a toll on her health. In the beginning, I was just a spectator watching all the moves and goings on initiated by my Mom and a few selfless “pamangkins” attending to all concerns related to my auntie’s condition. I was a distant onlooker and contributed only some form of financial help but when I noticed that my Mom was already being dragged to the brink of getting sick too, I decided I had to step in. I have to act lest my Mom would be hospitalized too due to stress. There were times while my auntie was still confined in Makati Med, her caregivers would call my Mom at home at any given time just to inform her that my auntie’s blood pressure went up. These all the more made my Mom worry to no end being a hopeless worry wart. It irked me that she hardly had any time for herself and trying to recoup her strength while at home so she could again attend to my auntie’s needs, and then the calls asking her to come to the hospital, was for me very insensitive. I instructed the caregivers never to bother my Mom while at home and just ring the nurse or doctors if something unusual happens to my auntie because they were the professionals who could help and would know what to do.

The tremendous pressure on my Mom proved to be a health hazard to her. Proof of this was an instance when my Dad called me in the office asking me to accompany him to bring Mom to the ER at Makati Med; the reason, CONSTIPATION. She hadn’t moved her bowels for days and this was triggered by her worry on the costly hospitalization of my auntie at Makati Med. The stress was compounded by sleepless nights, eyebags popping out, loss of appetite so much so that she had lost weight, she had attacks of hyperacidity, feelings of nausea and malaise, and I caught her several times looking far ahead deep in thought. The constipation problem was finally treated after spending 3 hours in the ER. We paid a hefty sum for the medical bill through my credit card for what seemed to me a simple case of constipation.

Going back to the issue of whether to continue her confinement at Makati Med or not, they, the major players arrived at a unanimous decision, to continue with the treatment but in another hospital. The exorbitant billing at Makati Med was a headache for them that wouldn’t go away. They planned to bring her out from Makati Med but they were still raising funds to pay the hospital bill and the doctors’ professional fees. Being a Sunday then, all banks were closed. Perhaps, an angel whispered to us because on that Sunday morning, I and my sister decided to visit my auntie and to follow my Mom in the hospital who was already there early in the morning. It was only then that I learned that “they” wanted to transfer the patient (my auntie) to another hospital, again. The only thing that kept them from not leaving yet was the funds to pay the hospital bills and the doctors’ fees. Sensing that each day in the hospital would make the billing jack up more, and knowing how panicky my Mom was, I suggested and offered my credit card to shoulder the hospital bills. And the professional fees of all the five (5) doctors were paid thru the issuance of my checks. I got all the names of the physicians and issued them all checks. Despite this, what I appreciated about the healthcare professionals is that they were willing for their fees to be negotiated. After all have been settled and done, my Mom requested from one of my Tia’s doctors for a hospital where she can be transferred and where the treatment procedure can be continued. East Avenue Medical Center at the Diliman, Quezon City was recommended. I had my silent protest knowing the distance of the hospital from Makati. In my dismay, I commented in jest that I wouldn’t want to hear another transfer after East Avenue because they might decide to bring her to a Pampanga hospital next because I have observed that we were going farther and farther. Finally, East Avenue Medical Center was chosen to be the last and 4th hospital my tia would be brought to, keeping our hopes high that the funds in our hands for her burn treatment would be just right to cover the medical expenses during the treatment duration.

East Avenue Medical Center is a ‘semi-private” hospital, but more like a government run hospital to me. I seldom set foot on a public hospital and I couldn’t help but compare it to the ease and comfort I often experience while in a private hospital. My tia was first taken to the emergency room since there was no available room yet. The ER was like a battlefield where a number of patients were lying down side by side; some were quiet, others were moaning, and some were howling while being treated. It was for me a room filled with indigent sick people. Call me irreverent if I label it as a hospital for the poor. Seeing them all in physical pain and needing immediate medical attention was depressing to me. But in all fairness to the hospital, I thought all patients were attended to properly and with prompt attention.

When the doctor recommended for my tia came in, I had initial doubts if he could do the treatment procedure since he appeared youngish to me. He explained to us the procedure she will undergo, like dressings, debridement and skin grafting. After the brief explanation, I thought he knew what he will do and was in command of the whole process; it erased my doubts and replaced with trust believing that our patient was in good hands.

The whole process of treatment went for almost 1 ½ months. Mom was constantly visiting her and monitoring her progress despite the distance. She was always on her feet whenever medical supplies were needed, either she instructed my male cousin to go to Bambang to buy the supplies needed or she would go herself with a companion. I went with her once at Bambang to buy all the stuff needed for the operation. Again, a first to me, seeing Bambang live and bustling. It was more fun to me feasting my eyes on a line of medical supply stores, it was overwhelming seeing them lumped in one place. I had the time of my life haggling and canvassing for reasonable prices. It was a learning experience to me also having known the use of the supplies and equipments I was buying. I thought, everything you need for medical supplies and equipments can be found there.

During the course of the treatment, my Mom was always itchy to go and visit my tia. Sometimes, I would volunteer to drive her to the hospital just so she would be pacified. The treatment procedure went well on schedule. If something got amiss, Mom would nag me to text or call my tia’s doctor. Without me knowing it, I became the official spokesperson of all their concerns regarding my tia’s condition and treatment. I communicated only with her doctor thru texts as I find calls to be too intrusive. I was grateful though that her doctor was patient and kind enough to answer all our queries and concerns, even the minor ones.

I realized the hospital wasn’t that far as I thought it was. When one gets to frequent the place often, you get used to it, and travelling wasn’t cumbersome anymore.

On the second week of December 2009, the doctor announced that she could be discharged already from the hospital and that she would only come back for her wound check ups. Thankfully, all of her burn wounds improved significantly, except for a minor wound on her leg that refused to be healed completely.



THE MAJOR PLAYERS


I can only count three (3) major players in this crisis. One is my Mom whom I perceived to be the principal overseer since day one of my tia’s confinement. Another one is an older female cousin whom I consider to be our rainmaker or ‘moneymaker.” Through her connections with PAGCOR, PCSO and some government officials , she was able to pull strings enough to garner sufficient funds, either through checks or cash for my tia’s costly burn treatment. And lastly, my older male cousin, a former nurse provided unselfish caregiving during her early confinement in the hospital. He also took errands in buying medical supplies and equipments. He did the scouting of blood donations from willing donors for our patient’s blood transfusion.

As for my role, I came into the picture quite late when my tia was already confined at the East Avenue Medical Hospital. In here, I was my Mom’s back up ally who assisted her, represented her, and spoken in her behalf to facilitate anything that concerned my tia’s overall confinement and treatment in the hospital. As mentioned earlier on, I was at first a distant onlooker and only stepped in because I felt the heavy burden welling up in my Mom’s chest while my tia’s treatment was ongoing. It would be doubly burdensome if she would succumbed to weakened resistance due to uncontrolled stress and worry. That, self serving may be, propelled me to contribute something to lighten everyone’s load and anxiety.

Although, my mom’s side of the family is a big clan, only a few of my cousins offered their spare time to do caregiving. Others offered financial support by chipping in to the funds we badly need for her treatment and medical supplies. Sometimes, out of sympathy for the major players, for the hardships and sacrifices they have endured, I would ask my mom where the other siblings and “pamangkins are?” That I thought, they should do their part too, that we should all be in in these critical times. They, the major players, through their constant movements were bogged down by various maladies. My mom had suffered from constipation problem, my older female cousin, the rainmaker, suffered leg sprain and was unable to walk for weeks and my older male cousin (the caregiver) had contracted fever and severe cough. I had the chance to voice out my grievance and issues regarding “shared task” to my mom’s youngest sibling. She understood what I was trying to convey and my point was well taken.



LESSONS LEARNED


At the time of our visit to my tia at Makati Med, I incidentally asked my cousin how much was the running outstanding billing. He did not have any idea but instead showed me a list of several requirements that must be submitted and complied if patient opted to leave the hospital under its Promissory Note scheme. The provisions that I took notice of was the need for a co-maker and a submission of a bank’s certification. My mom volunteered to be the co-maker. I find the requirements too time consuming and tedious to do. My cousin further informed me that the hospital would not proceed with the treatment unless patient moves additional more payment to reduce the outstanding billing. I got ahold of a copy of a partial billing from its collection department. The figures glared at me at P103,000.00 plus from the time of her confinement, from Nov. 3 up to November 7, 2009. Then I proceeded at the nurse station and inquired about the hospital’s policy of “no additional payment, no further treatment.” I told the staff in a very diplomatic way, that this hospital had become like a construction business where progress billing is a prerequisite before work could be resumed. This is not the policy of the hospital before some big shot businessmen took over Makati Med which was unfortunately was on the brink of bankruptcy. I overly dramatize my sentiments when I asked the staff, what happened to the oath of service and their sense of compassion, now that the hospital is being run like a business . I thought I hit the nail right on the head when the staff couldn’t provide an answer and somehow concealed her agreement with me. After my litany of dissatisfaction, I inquired how much should we pay for the treatment to proceed and I was immediately referred to the collection department through phone. Again, I reiterated my complaint about the new rules and the collector in charge explained to me with callous expression the reasons which I never bothered to listen, and only heard him say, “you should be paying a substantial amount so the treatment can continue,” so I cut him out and asked, “how much is that substantial amount, please quantify the amount so I would know.” He answered back, “50% of the current billing.” It caught me off guard, and just uttered, “Ok” then hung up. After conferring with the major players, a consensus was arrived to pull our patient out the soonest possible time and that was when I suggested to use my credit card and checks to pay everything and everyone off while we were still waiting for the funds to come.

In this instance, it dawned on me that Makati Med had become a first class, first rate hospital after undergoing several renovations and improvements but I felt that the “service factor” for patients as well as feelings of the family involved were set aside and /or disregarded. On the other hand, my business mind, tries to justify the new rule. The healthcare institutions have to survive through its collection of payments from patients/clients in order for them to continue to provide healthcare services. Somehow, they should be run like a business too, but I guess this must be toned down so as not to appear indifferent to the plight of the family and feelings of the patients who are already saddled with physical and emotional pain.

Since we were wanting in funds for the costly treatment of my tia’s burns, we were at the mercy of the so-called charitable institutions, like PCSO, Pagcor and public officials when asking for some financial help to cover the medical expenses. Although, we have gathered a fairly huge sum of money from donations from friends, siblings and all nephews and nieces, the money was not enough. My moneymaker cousin contributed greatly to ease the burden we had on funds. In a way, she was able to fill up our coffers with enough funds. We scrimped on everything, the funds and money of my tia were entrusted to me, so I kept track of how much more we have. I sound an alarm bell whenever I see that funds are dwindling.

The Philippine Charity Sweepstakes Office (PCSO) is one agency that extends financial help to those who need it. But if one is unaware how beaureucracy works, giving up and surrendering is likely. Firstly, the long list of requirements will be asked, one had to go through the long ques before submitting the papers/documents, the long wait and the constant pleadings and pleas to the PCSO staff for requests to expedite the application will surely test one’s patience and determination. I have discovered all these from the stories of people I know who have sought financial help from this agency, ”Tiyaga” was the key word. You have to be there at the PCSO at the crack of the dawn, so you would be first in line. Bring food with you so you wouldn’t leave your line. Be ready to stay in line for the whole day. Quite pathetic, whoever said, “the best things in life are free” is in for a surprise of his life for he has to go through the proverbial eye of a needle to get the free things in life when you deal with the PCSO.

In the last 3 hospitals my tia was confined, my rainmaker cousin readied her application for the PCSO help usually done a few days before patient is to be discharged. Since, she had applied 3 times for financial help from the agency, and since I have learned how it worked, we have perfected the technique of soliciting funds when we were already at the East Avenue Medical Hospital. We got the approval letter from the agency in just a matter of days and thus had the amount offsetted to the outstanding billing in the hospital.

Although, PCSO has categories or systems on how to avail of medical-financial help and each one is a different procedure from one another, I could only speak based on our experience. For those who would want to avail of a PCSO help, remember these pointers: (1) Ask the latest billing and request the staff, if possible there wouldn’t be any stamp marked “partial billing.” This is to give the impression that your patient is ready to be discharged anytime and that you were seeking immediate financial help for your patient to be released and cleared by the hospital. Also, this is to maximize the amount that can be approved. (2) Never pay the hospital bill yet through your own pockets while your application is pending with the PCSO. Why? Once, the PCSO had verified that you had already paid the bill, your application is cancelled. (3) If you have a pending application, even if your patient was already given the discharge slip, do not leave the hospital yet, and wait for the approval letter of financial help from the PCSO. That letter alone would be honored by hospitals. Never mind if you pay extra for the hospital stay, think of the amount you can get from the PCSO to pay off the bill. Just inform the hospital staff that you were waiting for the PCSO letter and that you were willing to pay whatever additional costs your patient may incur during her/his continued stay. If PCSO had checked that your patient had already left the hospital, your application is deemed waived. (4) Professional fees of the doctors are not included in seeking for a reimbursement of the medical costs. Just negotiate or bargain for their fees or if they would agree, execute a Promissory Note with them.

The most significant lesson of this crisis was the realization that life is full of uncertainties. So uncertain that the punches may knocked you out, either to debilitate or maim you or permanently snuff you out of this world. In my tia’s case, she was completely crippled physically, emotionally, psychologically, spiritually and financially. I find her circumstances an emotionally laden tragedy.

As stated earlier on, she does not have an immediate family. Caregiving was relegated to a few nephews and nieces who alternately give off their spare time before paid caregivers were hired. If not for the fire incident, her savings would have been enough to tide her over until her last breath on earth.


Sometimes, in her desperation and loneliness while stuck in a hospital for months, she would utter hopelessness by wanting to die. She had said several times how she’s ready to go. Perhaps, in her boredom just lying idly in her hospital bed, she would badger her caregivers to call her siblings and be at her bedside. The old age, the numbing pain of the burn wounds, the other illnesses that came up while on treatment and the emotional craving for care, love and sympathy, the myriad of medicines that were given to her orally and intravenously were all contributory factors that in a way addled her brain and made her irritable, sarcastic, suspicious, demanding and whiny.

As for her expensive treatment, we were like literally begging in her behalf for alms and money. It was a tough job, especially to my female cousin who I knew swallowed her pride to plead for any form of financial help to cover my tia’s medical treatment. My tia had barely an inkling that her savings had been reduced to a measly sum.

I looked at the other side of the coin and imagined the following: "What if my tia was properly and sufficiently insured? What if she worked and had her monthly pension? What if she thought of the future and invested on properties and other income generating instruments which could later on be her assets that can be converted to cash when emergency arises? What if she invested on nurturing healthy relationships with family and people, they would all flock to her and continuously give her encouragement and strength to defy hopelessness and boredom? What if she would have been kinder and lived her life with laughter and compassion?

She was given a second life now. A second chance perhaps to examine her life and amend her ways.

Nevertheless, I was happy for her that she is on her way to complete recovery because the fighter in her prevailed.

We, who have personally witnessed and took part in her struggle to live despite a mountain of odds, learned a lesson or two from the sad but neverthelss triumphant ending of her story of pain and misery.