Mar 17, 2016

Unboxing the Philippine General Hospital Charity Ward, Part I: The OB Admitting Section and Delivery Room

Backstory

On September 30, 2015, the twenty-ninth week of my pregnancy, I went into preterm labor. My OB-gyn at St. Victoria's Hospital in Marikina advised me it would improve my baby's chances of survival if we went to a bigger hospital such as the Manila Doctors or the Philippine General Hospital (PGH).

She also told me that if my baby was alive at birth, he would likely need to stay at the neonatal intensive care unit (NICU) for a month or two.

My husband and I were financially prepared for childbirth but not for a month's stay in the NICU. So we decided that our best option was the PGH charity ward.

(Image by Trixiedawnie via Wikimedia Commons)

Entering the OB Admitting Section

I was brought to the hospital by an Ace Cor ambulance. The ambulance nurse escorted me to the OB Admitting Section's (OBAS) examination area.

One look around confirmed what I already knew: this was not The Medical City.

My stretcher was parked beside the examination table. The intern asked me to move into it.

It was an uncovered, unmattressed slab of stainless steel. 

But here's the part that shocked me: the surface of the table I was asked to move onto was still stained with a four-inch-diameter splotch of someone else's dried blood.

At the ambulance, I had been mentally preparing myself for charity ward conditions. I knew I had to shed my finicky, nitpicky, microphobic tendencies.

Still, I don't think anything could have prepared me for this.

In my most quiet, unaccusing, almost-conspiratorial tone, I said to the intern, "Doctor, I am not complaining. I know this is the charity ward. Still, doesn't that blood stain heighten the risk for pathological cross-contamination?" (I wasn't even sure that was the right term, but it sounded right, so...)

The intern was friendly and candid. In a similarly conspiratorial tone, he answered, "The truth is, ma'am, we expect everyone here to be dirty anyway."

Thus began my one-and-a-half months in the PGH charity wards.

The OBAS Interns

The Ace Cor nurse was very kind. He went to the front desk, asked for a bottle of alcohol and a wad of cotton, and wiped the examination table clean. Only then did he allow me to move out of the stretcher. (Thank you, nurse!)

Then the interns began my physical examination and preparation for admission. One of them brought out a soft rubber tube.

"Mommy, I need to insert a catheter. This will hurt," the young doctor warned. "Take a deep breath."

I steeled myself, waiting for the pain to come.

"Okay, you can breathe now," she said.

Was she done? Where was the part that was supposed to hurt? I voiced out my puzzlement to the doctor.

"It didn't hurt?" Her tired face took on a smile.

But I don't think she could have been as happy or relieved as I was. A catheter insertion that did not hurt – and to think, she was just an intern.

That kid will make one heck of a consultant someday. I already loved her as she was.

I soon realized that this "not hurting" thing was pretty common in this place.

When they took my blood sample, it didn't hurt. When they did an internal examination (the dreaded IE), it did not hurt. They had to reinsert my intravenous (IV) line – it did not hurt (well, not as much as it usually does).

One idea began to grow in my mind: this place may not offer decent accommodations, but if your main concern is to be in the hands of world-class medical practitioners, this must be a good place to go.

After all, look at how good their interns are!

The amazing interns were done with their work. My drug allergies had been checked, and I had on my catheter and IV.

Next stop: the delivery room.

The Delivery Room

Before I was brought into the charity delivery room, the physician in charge told me, "Mommy, I must warn you. It's very crowded in there. Are you very sure you want to enter as a charity patient?"

I was sure. So they wheeled me in.

It was, to my surprise, a well-airconditioned room. There were many stretchers, but the room did not look half as crowded as I expected. I told that to the resident nearby.

"You have not seen the other section yet."

The other section was a sort of waiting room for

  • mothers who had already given birth, waiting either to be sent to be sent up to the OB ward for recuperation or to be discharged directly, and
  • mothers who were still waiting for their C-section schedule.
I was wheeled into the second section.

It was like a refugee camp. 

In one bed, you would find three people. Some women who had just undergone CS were sitting on plastic chairs. There was no place to lie down comfortably to take a nap.

Having undergone CS several times in the past, I could not help but gape in awe at these women. Despite being a CS "veteran," I still much preferred spending my first 24 post-operation hours flat on my back.

These women sat, stood, and walked. Everyone was barefoot. Slippers were not allowed.

Imagine women who had just given birth walking around barefoot. Going to the bathroom barefoot, stepping on a cold, wet, and dirty floor. 

Apparently, PGH does not believe in ge lai.

A Day at the OBAS

At the OBAS, it was very important that you knew the schedule of your meds. The nurses were so busy with so many patients, it was often up to you to remind them it was time for your next shot of dextromethorphan.

My adult diaper needed to be replaced. I informed the nurse. She gave me an adult diaper and left me to take off the old one and replace it with the new.

If your IV line stops dripping, nobody will ever notice. It's up to you to get up the nerve to approach a super-busy nurse and ask him or her to adjust it.

Don't be scared. As busy as they were, the nurses at the OBAS were, in fact, the least grouchy bunch of nurses I had seen in the 1.5 months I had stayed at the PGH.

By the way, I almost forgot to tell you about the OBAS beds. 

Like the examination table outside, the OBAS beds were unsheeted and unmattressed slabs of steel. There were no pillows and no blankets, but you are allowed to keep your own blanket if you had the foresight to bring one.

My husband had a friend who worked at PGH. The friend lent me a blanket. In that over-airconditioned place, I don't know how I would have fared without it.

My attending physician sent me to the ultrasound room so the radiologist could check the remaining volume of my leaking amniotic fluid. Another doctor wheeled me there. 

"This is the only hospital I know where the porters have a medical degree," I kidded. The doctor laughed.

Back at the OBAS, they checked my baby's heartbeat for the fifth time since I arrived over 24 hours ago. On the monitor, I watched as my baby's heart rate dropped below 120 ... below 90 ...

The medical intern beside me spurred into action. She started manipulating my cervix, pleading, "Wake up, baby. Wake up." 

Her alarmed tone caught the attention of the other medical staff. Soon there was a circle of very young doctors around my bed. 

For one reason or another, baby's heartbeat normalized eventually. The young doctors drifted back to their own business, but the intern who had been with me earlier stayed with her eyes glued to that monitor for about half an hour.

Then, at around 4:30 in the morning, she made a cellphone call to my attending physician, another medical intern, Dr. A*, who had just gone home for the day. 

"Nonreassuring fetal heart rate," I heard her say. "You need to come back now."

It was time for them to cut me open and bring the baby out.

CS Time

If there's one thing scarier than the thought of being cut open, it's the thought of being cut open by a very young doctor who has already been on sleepless duty for probably 48 hours and had just gone home hoping to get some sleep, only to be called back immediately so she can cut you open.

But all that fear was needless, because as you can see, I am alive and well. Thank you, doctors!

Now let's back up a little. Before they wheeled me into the operating room, I wondered aloud where the postanesthesia care unit (PACU) was.

The nurse chuckled at my naivete. He pointed to the narrow hall leading to the operating room. That, apparently, was what served as the PACU for the charity ward.

The operation went as it should, as far as I know. It was pure bliss to hear my 29-weeker wail as they took him out. When I heard that cry, I was satisfied. I closed my eyes and went to sleep.

I woke up at the "PACU." There was nothing to do there, nothing to look at. So I went back to sleep.

The next time I opened my eyes, I was back at the "waiting room." Strangely, it was far less crowded now. Apparently, beds had been vacated at the ward upstairs, and mothers had either been transferred there or sent directly home.

My incision was starting to hurt. I asked the nurse for a pain killer but specifically asked for tramadol. I am allergic to ibuprofen, and on my last CS, I swore I would rather live with the pain of the incision than let anybody inject paracetamol into my veins again. That stuff burns!

The nurse came back with a syringe of paracetamol. I balked.

"Don't worry," she said. "I promise it won't hurt."

She inserted the needle. It did not hurt – yet.

And then she started to push the nasty liquid in. I winced and held my breath.

Something was wrong. The shot wasn't hurting. The evil paracetamol wasn't burning a trail down my arm veins. How was this possible?

Thirty seconds later, the nurse was still there. I realized she was slow-pushing the medicine. That's why it didn't hurt like before!

Bless you, nurse!

An hour or so later, I heard my name called. At last, I was to be transferred to the OB-Gyn charity ward upstairs.

Continued in Part II: The OB-Gyn Ward

*Name has been limited to a single initial to protect the individual's 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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