Mar 22, 2016

Unboxing the Philippine General Hospital Charity Ward, Part IV: Life at the NICU

This is the last of a series of articles about my experiences at the University of the Philippines (UP)–Philippine General Hospital (PGH) charity wards. To read the first of this series, click here: Part I, The OB Admitting Section and Delivery Room.

The War Zone

Because I gave birth to my child two months before full term, we had to stay at the PGH neonatal intensive care unit (NICU) for about a month.

It is a grim place. The doctors seldom smile. If you're used to the warm cordiality of your private consultants, you will feel the chill here.

The nurses are coldly efficient, unsympathetic, and grouchy.

But soon I realized that the NICU, by its very nature, is not a place for kind words and gentle smiles. It is a war zone, and the medical staff are fighting for their patients' lives with worn-out tools and insufficient supplies.

In the one month that my baby and I spent at the NICU, I learned that sometimes, compassion is shown not by commiserating and holding hands.

In battlefield conditions, it is shown simply by showing up every day and doing what needs to be done.

Compassion in the NICU means not giving up the fight.

This post goes out to all the NICU fellows, residents, their attending, and the nurses and nurse aides who all fought to save my baby's life.

Facade of the UP-PGH. The Oblation statue is a well-known icon of the UP system. It is a symbol for giving one's all in the service of the nation. (Image by Faisal Hermogeno Jackarain via Wikipedia)

The NICU Doctors

My first glimpse of the NICU doctor's psyche was not in a face-to-face encounter. It was in a pharmacy receipt that my husband handed me as he told me an unexpected story.

In  the receipt was the name of NICU third-year resident Dr. A.* I learned that while we were out, our baby urgently needed meds that were not available on hand.

So Dr. A purchased the meds for us.

Note that Dr. A was not our personal friend. We had not met him before, nor did we ever meet him again since we left the NICU.

He did not know whether his expense would ever get paid back. (It did.) We were strangers, but he did it for our child who was his patient.

Now tell me again that PGH doctors have no compassion for charity patients.

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Dr. D was the fellow who was in charge of my baby. From the very first day, she constantly updated me and my husband regarding our son's condition.

She never showed optimism, nor did she ever show despair. She simply told us what the problems were and what were being done to solve them.

One day, on our third week, when my child was finally cleared of all jaundice and infection and was just waiting to be discharged, Dr. D said, "I am so happy the phototherapy worked. I was worried we would have to do an exchange transfusion!"

It was the first time I saw that much emotion on her face, and the emotion I saw was one of relief.

"I had no idea the jaundice was that bad," I said. "Why didn't you tell me?"

"Oh," she smiled. "I didn't want you to worry unnecessarily, so I held it in as much as I could."

Thank you, doctor, for carrying that burden for me.

-----

Dr. T was not directly in charge of my child, but aside from Dr. D, she was one of the first doctors to make me feel comfortable in the NICU.

She would approach me every day on my first week, and she read my baby's chart for me.

Thank goodness she did. Dr. D was out, and the nurses looked so busy, I couldn't get the nerve to approach them first to ask my questions.

"Is everything okay, Mommy?" she would ask me while I was doing kangaroo mother care (KMC). "Is there anything you would like to know?"

There was a million things I wanted to know. Why was my baby's breathing so shallow? How can I know he was still breathing when I could hardly feel anything? Was I doing this KMC thing right?

She answered all my questions patiently.

Thank you for the gift of your time, Dr. T.

-----

Among all the first-year residents who were assigned at the NICU during my son's confinement, Dr. N and Dr. B were the ones who seemed directly involved in my son's care.

They kept track of every 0.01 digit change in his weight. They relayed all my concerns to the nurses for me. (Yes, at the NICU, the residents advocate for the patients to the nurses, not the other way around). And they exulted with me at my son's every little victory.

To this day, we have kept in touch. I am honored that they have allowed me to call them my friends.

The NICU Nurses

If the NICU doctors were generally unsmiling, the NICU nurses were downright scary.

These guardians of the wards and enforcers of the rules don't mince words. If a child is in the NICU, that child is theirs, and you are just the parents.

If you, the parent, ever does anything to threaten the well-being of a NICU child – like if you enter without a hospital gown or forget to bring breastmilk for your baby – prepare for a harsh scolding.

"If you are concerned about the welfare of your child, we are even more so," Nurse L once told me me after I gave my child milk via the orogastric tube without her permission.

"That milk could have gone to your son's lungs. He could have died!"

In this place, nothing is ever sugar coated.

"How is my son, ma'am?" a father once asked. "Is he okay?"

"Sir, if your child was okay, he would not be in the NICU," the nurse said.

-----

But behind their frowning  facades, these nurses still have times when they show a warm beating heart.

Like that time when I had to do KMC under the extremely bright, headache-inducing phototherapy light.

The nurse saw me and asked, what in the world was I doing?

I explained: My son had been prescribed phototherapy. So he needed to be naked.

But the poor kid was shivering! The incubator, as I mentioned in my previous post, was not working, and they had run out of thermal blankets to at least warm the ambient air.

So I sat under the phototherapy light with my semi-naked baby on my chest, using my own body heat as a warmer.

The nurse shook her head. Then she rearranged the babies in the NICU so my baby could have an empty bassinet with an overhead warmer and a phototherapy light at the same time.

Do I blame her for not noticing that the baby was cold in the first place?

At that time, she was the only nurse in a room with over 15 babies. If I were in her shoes, I'm not sure I would have fared any better.

Not Perfect, But...

I realize this post may sound like a mere paean to the PGH medical staff.

It is not.

I can repeat to you all the bad things you've already heard before about PGH, and I can even add more. 

The hospital is so understaffed, there were times when a blanket or a phototherapy eye protector would slip off a baby and nobody would notice.

When we got home, I discovered that a working scale only costs P1,500.
There were occasions when the lack of facilities was truly outrageous. At the pedia ward (Ward 9), for instance, the weighing scale would give two different readings for the same child within the span of 30 seconds. 

In the marketplace, it is illegal to possess such a weighing scale. But at the PGH, medical decisions were made based on data from that malfunctioning scale.

There were residents who went above and beyond the call of duty; but I have also encountered some who looked at their patients and failed to see persons, only diseases.

Every place has its imperfections, and perhaps the PGH has more imperfections than others.

But maybe that is why I wrote this series: We have already heard so much of the bad.

It's time to strike a balance.

*Names are limited to single initials to preserve the individuals' privacy.

The Nanay Notebook is written by Blessie Adlaon, a work-at-home and homeschooling mom of five. Check out our About page to know more about this blog's author and our policies on advertising, press releases, and reposting.

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