It was 3PM on a routine Wednesday afternoon, and I wanted to go home. As usual. I was so close; the clinic was nearly empty of people. I only had the census left to do. That is, until our clinic nurse knocked on our metaphorical door: “Dok, may dalawa pang pasyente.” (Doc, there are two more patients). It was a family of two.

Beyond 2PM, our doors normally close its doors to walk-in patients. We had to draw the line somewhere; we believe in healthcare workers going home before the sun sets. Families, or group consults, tend to take at least 1 to 2 hours for their first consult in particular. So I was curious why these two were allowed to cross that threshold.

Then they walked in –for a definition of “walked in”– and it became clear why we couldn’t turn them away to examine another day.

Meet Mister and Missus E

They made an interesting silhouette. Mister E and Missus E were both in their late 60s. Missus E was obviously blind: her eyes were grossly deformed, which I later understood to be from post-measles blindness in her infancy. She moved with steady and confident steps, one hand anchored to Mister E’s borrowed wheelchair. He was a jovial man with a tendency to shout at you or blankly stare at you in turns, only slightly out of breath every other minute. He wasn’t a difficult patient; Mister E had severe hearing impairment and heart failure.

It was a case of a deaf person leading the blind, or maybe the blind leading the deaf –except the deaf person also turned out to be visually impaired, with a thick cataract on one eye and severe presbyopia in another. I already counted their presence in the second floor of PGH a miracle all on its own.

According to our staff they had been waiting outside the clinic for SIX HOURS. With little experience in the PGH Outpatient Department and healthcare in general, they didn’t even know how to queue their names for consult. They would have waited for nothing and we would have closed our doors, if other patients on their way home didn’t stop to inform our nurse of the quietly waiting pair.

Filial impiety

I examined them for close to two hours. Or more accurately, we talked for the rest of the afternoon, until a light drizzle had started and the skies turned a little more blue.

While I worked through their acute medical concerns, I contemplated on several other things I didn’t think I’d confront on a random workday. I thought about filial piety, and the kind of communal respect we owe to our elders. I thought about privilege and the rights we take for granted. I know intellectually that people with disabilities can live independently just as well as any of us, but finding out my two geriatric patients were still pushing a makeshift cart to sell coconuts out in the street every single day –before his heart failure symptoms started to make themselves more urgently known the last couple of months– sparked a singular type of horror.

“Dapat sa edad niyo, nagpapahinga na lang kayo…” (At your age, you should be enjoying retirement). And they both agreed, before rebutting with a sharp, “paano naman ‘yun, doc?” (And how could we make that happen, doc?”) They had no children to take care of them –the first line of defense in the traditional Asian family; they had no pension or PhilHealth, as they lived a lifetime trading informal economy jobs; they had no connections in the persons with disability community or local health system. In short, all they had was each other.

And now –me. Or PGH, I suppose. This large and labyrinthine tertiary center that one of their nephews recommended, given their financial constraints. (And also to my subtle anger, also a place none of their nephews or grandnephews thought to accompany them to!)

Mister and Missus E had worked hard all throughout their youth, were still grinding in their twilight years, and are now somehow navigating a healthcare system that can barely accommodate their needs as persons with disabilities and as elderly patients. The elevator even closed after 5PM; their creaking knees had to take the ramp. And that was on top of their adventure home by way of Manila’s cracked streets and packed jeepneys.

My instincts as a granddaughter itched. And kinda wailed in pain.

I can only hope they got home safely, and that they’ll find their way back to better health (and back to us for followup). And that, maybe, my advise was enough to get them to their next step. I want them to enjoy more of their years together.

Until next time! ❤️

#WorldFamilyDoctorDay #FamilyMedicine #TheHeartOfHealthCare #Residency