Early this morning I was tasked to do vitals rounds -- take blood pressures, check pulses, respiratory rates, and temperatures -- of patients in the recovery room. To say that we have a large volume of patients is an understatement, and often doing vitals is a medical marathon. To be more efficient, clerks usually multitask; we attach a pulse ox on one patient, quickly pump a sphyg to take the BP of another, zip by to do the rest, not paying as much attention as we could- or should- just to finish the tasks at hand before the next round.
As I was beginning to lay my BP app on the bed of the next patient, I stopped suddenly because I realized I was about to carelessly place my things on a curiously shaped object on the bed. Gray, shiny, and not moving. I realized it was a small fetus. It slipped out of a womb and into the world way too soon. Next to her, staring blankly, a young girl.
It wasn’t my first time in the last few weeks to see an abortus; there have been many. But to see one casually lying next to such a young mother was still jarring. I turned away to fix my things first and heard someone tell her “Ayan. Tingnan mo yung baby mo. Wag mong kakalimutan ang ginawa mo (There, look at your baby. Don’t forget what you have done).” A small hand lay by her side, evidently, to teach her a lesson.
Horrified, I walked to her side.
“Good morning, BP lang tayo ha (we just need a BP),” I told her, trying to use the gentlest tone one could muster. She held out her arm. “Ilang taon ka na (How old are you)?” I asked. “Fifteen po.” She replied. “Sinong kasama mo ngayon (Who’s with you today)?” “Asawa ko po at Tita ko-- nanay niya. Nasa labas (My husband and my aunt—his mom. They’re outside).” “Ilang taon na yung partner mo (How old is your partner)?” “18 po.” “May kamag-anak ka ba na kasama (Do you have an immediate relative with you)?” “Wala po (None).” “Pero alam
naman ng mga magulang mo na naospital ka (But do your parents know you’ve been hospitalized?” She looked down. “Opo. Pero hindi nila ako kinakausap (Yes, but they don’t speak to me).”
“Okay, gusto ko lang kasi malaman kung may kasama ka ngayon. Mahirap kasi yung pinagdaanan mo, dapat hindi ka mag-isa (Okay, I just wanted to know if you have someone with you. You’ve been through a lot and should not be alone).”
I wish I could tell you that I took this chance to do patient education, that I gave her a full engaging lesson on family planning and safe sex and changed health-related behavior for the better.
However, her situation, as with many like her we’ve met in this chapter of our training, is more complicated than what would appear at first glance. At 15, as a minor, she would need consent from a guardian of legal age to receive any form of family planning. What I could do in that moment-- asking her how she felt, what she knew about her options, what she thought about moving forward-- often feels like the bare minimum. In the grand scheme of things, it is. Feeling more than a little helpless, I slid the small blanket over the shadow on her bed and said a little prayer before walking away. “Pahinga ka muna ng mabuti, check ka namin ulit maya-maya (Rest well for now. We’ll check on you again a little later).”
Those close to me know that I have struggled a lot in the last few weeks. While physically exhausted, what I’ve grappled with most is trying to understand the complexity of what I’ve been quietly witnessing.
I’ve awakened every morning angry and upset, often not really wanting to go to work. I know why I am angry, and for whom I am upset-- for the women and children who deserve better, who need to be given choices, who need to be wanted, cared for, loved. But often, when I am dealing with all these big feelings, I keep wanting to find something, someone to blame- a place, a person, to direct all this anger to.
But how can I?
I can never blame teenage girls who find themselves pregnant so young, because it is never fair, and often cruel, to judge them so harshly. Some don’t even know exactly what causes a pregnancy. Many are raped. When you see them in labor, crying out for their mothers, screaming “Ayoko na (No more)” “Hindi ko naman to ginusto (I didn’t want this)” You see how little they understood about what pregnancy and motherhood would mean.
Some will speak in anger to the young fathers, saying they took advantage of the naivete of these girls. But you will see them in the wards, barely adults themselves, squished up next to the patients on the beds, playing some multiplayer game on their phone. They stare blankly as you mention words like “breast pump” or “birth certificate” or “newborn screening.” They are children too.
Neither is it to point fingers at their parents. To cry out “Neglect!,” to say nagkulang sila ng pagtuturo (they were remiss in teaching their kids), to say they mirror behaviors from parents who had them just as early in life. Could or should we pin the blame on those who probably focused on finding means to put food on the table versus sitting down with their children to teach them about family planning? How can someone teach something they didn’t have the privilege to learn themselves?
Do we then blame the institutions? So much of what we witness in hospitals is rooted in poor or a lack of proper systems. This becomes especially true with regard to sex education and reproductive health. For every step forward in the Philippine context, we take several steps back. On one hand, there is the argument that granting greater access to sex education and safe alternatives in women’s health tempts compromising morals. But how do we face the woman to whom you must break the bad news about the questionable results of her pap smear, knowing that she never had access to the protection or screening that could have helped her?
Or ultimately, are we, have we, in health care become the problem? Have we become quick to judge, too harsh in speech, slow to act in the moments that call us to be kind and deliberate? There have been moments when I wish I could just drown out the brash language I’ve heard said to patients. I am angry at what is said, but never at whom it comes from, because it is important to acknowledge that there are those who have chosen the more challenging path; those who face stretchers with 3-5 women in labor at a time; who for every one prenatal care they are able to carry out to completion will face ten who defy medical advice for no other reason than convenience. They attempt to make this world a little better for women, but face defeat every day. Compassion for and from doctors is inevitably compromised in a system such as this.
If you’ve read this far into this lengthy reflection, I wish I could end it with a nice heart-tugging conclusion of how this has all made me a better future doctor; how I will carry these memories with me, by inserting an inspiring message here. In the bigger picture I am but a wee clinical clerk, with only a year in the hospital under my belt. What do I know, really? I have so much farther to go.
Twelve months ago, I started clerkship, and as I write this, I sit, at 3:30 a.m., at my table at the end of a ward with 150 patients, quietly crying, significantly more broken than I was when I started. I think it’s okay to admit that. I think it needs to be said more. Perhaps this is the paradox of medicine: to break; to learn; to heal. To the questions that lie ahead. Padayon. Keep on.
Pia Guballa is a medical student at Ateneo School of Medicine and Public Health.
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