“Paano po iyon Dok, wala pong mga kwarto ang aming bahay?”
It was almost 4 pm and I was about to pack my things. My workday had been filled seeing patients with all kinds of chronic, noncommunicable conditions – gout, hypertension, diabetes. They were not really my patients, in the sense that I did not see and diagnose them first. But they came to ask for a prescription for their maintenance medications or to have a new set of labs interpreted because their original doctors had not yet re-opened their clinics. Our two-storey polyclinic was, after all, one of the few health facilities open in this part of the city. For every prescription I dispensed and each test I interpreted, I would always end with the same line, “Kapag nagbukas na po ulit si Dok, mag follow-up po kayo kaagad sa kanya.”
I had already removed my face shield when a middle-aged woman – perspiring, looking anxious, and appearing to catch her breath – came through the door.
“May doktor po ba kayo? Magpapakonsulta lang sana,” she inquired with our secretary, her voice slightly muffled behind the cotton face mask she was wearing.
I put my face shield back on.
Within a minute, the nurse came to my room, her tone audibly different.
“Dok, si Ma'am po may fever. 38.9. Inuubo din daw po.”
Perhaps this case was different.
“Good afternoon Ma'am! What can I do for you?”
“Tatlong araw na po kasi akong nilalagnat. Mawawala po pansamantala 'pag nag-paracetamol pero babalik po ulit. Inuubo rin po ako, walang plema.”
Beneath my gear, I felt chills run down my body. Underneath my gloves, my hands grew slightly cold. I wish this was an exaggeration, but the fear was palpable. For any patient with a history of fever and dry cough, COVID-19 is, of course, a differential.
Mrs. X was certainly not the first patient who came to us with fever – or cough, or shortness of breath. But every time, the apprehension was the same. My apprehension was not for myself. I am single, I have no kids, my dreams are not that many; if the virus kills me, so be it. But my parents, with whom I still live, are not exactly the healthiest. I would never forgive myself if anything happened to them because of me.
Mrs. X was 47 years old, with no known preexisting conditions. She wasn’t as of yet experiencing labored breathing. Mrs. X was no doubt a Person Under Investigation (PUI), but because she was non-elderly, had no known co-morbidities, and her presentation was not classifiable as “severe” or “critical," the Department of Health’s recommendation for cases such as hers is to observe home quarantine for 14 days. Fundamentally, she was not (yet) eligible for testing.
“Paano po iyon Doc, wala pong mga kwarto ang aming bahay?”
At that moment, all the guidelines shattered. Indeed, they looked good on paper, but they were hardly implementable. At that moment, they seemed silly and absurd.
The search for meaning in the face of the absurd
Mrs. X’s response is disconcerting not just in the obvious sense that she will find adhering to her quarantine extremely difficult, if not impossible. More importantly, it is disconcerting because of the ramifications it underpins – not just for herself, but for me, her family, and consequently, my own.
If she, indeed, had COVID-19, could she have already spread the virus to her family? Did my PPE adequately protect me? If not, could I have already spread the same virus to my parents? The very circumstances of Mrs. X’s arrival are disconcerting. She had been to 3 different hospitals in two different cities since 7 am but was unable to receive care every time simply because the emergency rooms were already overloaded. (READ: Doctors anxious as high-risk hospitals open doors to COVID-19 patients)
My work pales in comparison to that of my colleagues, seniors, and mentors who are directly in the line of fire. I have friends in internal medicine who are directly seeing the sickest of the country’s COVID-19 patients. I have friends in anesthesiology intubating such patients who have acceded to acute respiratory failure. I have friends in emergency medicine and critical care who attempt to resuscitate some of these patients. (READ: Emergency 'triage' takes on grim urgency as virus strains hospitals)
These are my friends: friends I’ve grown up with, laughed with, cried with, drank with – and the possibility of losing them is palpable. At any moment, at an instant, the virus can sweep any of us away, and all our schedules, plans, and dreams with it.
Juxtaposed with these are narratives of a health care worker being doused with bleach on his way to the hospital where he worked, of a house being stoned after the family’s patriarch died from COVID-19, of asymptomatic politicians being tested while testing kits were scarce. These narratives – taken individually or collectively, separately or in contrast – are irrational and inhumane. They are inhuman. (READ: NCMH chief gags exec over hospital's coronavirus response)
They are absurd. This whole pandemic is absurd.
To surrender, or to revolt?
In the face of this absurdity, this seeming meaninglessness, it is easy to succumb to the nihilistic alternative of surrender. French Algerian philosopher Albert Camus, however, asserts that, on the contrary, man’s response to life's absurdities should be revolt: “to live without escape and with integrity, in defiance, maintaining the tension intrinsic to human life.”
The pandemic has, thus far, revealed the worst of us, but it, too, has revealed the best of us. People and institutions have put their differences aside to raise funds for health care workers. We have realized once more the centrality of family in our daily lives. We have realized that the differences and arguments which once divided our schools and offices were, actually, meaningless.
Going back to the case of Mrs. X, after a minute or so of deafening silence, she agreed to take her two sons and one daughter to their grandmother’s house while she and her husband monitor her condition, day by day, or perhaps hour by hour, for the next 14 days.
From a cynical, calculated point of view, Mrs. X’s predicament seems bleak and absurd. She is poor, vulnerable, and sick. The probabilities are against her. The same may perhaps be said of doctors and nurses charging at the pandemic head-on, risking their lives in the process. The same may perhaps be said of hospitals which, despite running steadily out of ventilators and health resources, continue to give every living soul under their care a fighting chance. The same may perhaps be said of humanity who, even in the face of annihilation, simply refuses to perish.
That is absurd.
That is revolt. – Rappler.com
Jose Ma. H. Zaldarriaga, MD-MBA, a graduate of the Ateneo School of Medicine and Public Health (ASMPH), divides his time as a general practitioner in a polyclinic, a company physician, a moonlighter in a public hospital in Pasig City, and a data analyst for the Department of Science and Technology.