Of STEMIs, Sojourns, and Summonses

Nonfiction by | May 15, 2016

There is something transcendent in the arbitrariness of things that instigates in me a tacit appreciation that despite the hysteria and the bedlam of random life, there is a hand that steers my keel towards safe harbor.

Contrary to pervasive belief, Dubai can get really chilly during the winter months when the ambient temperature plummets to 14 degrees Centigrade. Despite the weather, the adrenaline rush of the Friday graveyard shift is on fever pitch. It is dark and cold outside. A fifty year old local complaining of severe chest pain has just been wheeled into the Emergency Department. Within the prescribed “golden hour,” nurses on duty should have taken the ECG, identified the critical rhythm (in his case, an ominous ST segment elevation), sent in the requisite labs, and prepared the gentleman for transfer to the Cath Lab. He is having an acute heart attack (in medical parlance, a STEMI – ST-segment elevation myocardial infarction). I am the Team Leader tonight and there is a collective whoop among nurses – Kabayans mostly – after the ED doctor complimented the group’s efficiency. The patient is in stable condition now. Still there is an unutterable twinge I could scarcely quench that takes the edge off the exhilaration of the moment.

This is one of the rare times when things sputter up out of my daily routine like fire out of ashes I’d thought were long since departed, and by the flickering, I envision things, or imagine I do, that for too fleeting a time may not count much in the ruse of events but just enough of a tug to linger in memory like a pleasant dream. And upon waking up, I begin to ask myself questions: Have you ever felt that there is something that you were supposed to be doing? Do you experience a nagging feeling deep inside you that you are not supposed to be in the time and place you are in now? Would you rather be the person receiving the patient at the Cath Lab and not the one endorsing him to further care?

I have always wanted to be a doctor.

Dating to as far back as four years old, I have long since been fascinated with programs on television that depicted how the human body is built like a sleek piece of equipment that is able to execute feats of strength, fortitude, and grace and still able to heal itself and adjust to the jagged edges of circumstances and ecosystems. I spent many hours in the library reading about the discoveries of the mind, the diversity of human race, and the accomplishments of extraordinary people who inspired, challenged and fascinated humanity through the ages. Among my childhood heroes were those respectable people in a white coat with stethoscopes proudly slung on their necks who attended to the sick and the needy, delivered babies, performed surgeries, and restored lives until the roll of the end-credits.

I completed Bachelor of Science in Nursing, a course that would groom me for medical school while allowing me a glimpse of how life would be like in the future. While waiting for the result of the Nursing Licensure Exams, I ventured into a thrilling world where most people my age with ample time, little money, a knack for technology, and huge dreams flock: the Call Center Industry. I was earning easy money, reveling in a newfound independence far from home, and meeting many interesting people with exciting lives. I discovered I had an aptitude for coaxing people out of their comfort zones towards achieving team goals. Soon I was vacillating with my career path; the BPO perks were luring me away from clinical life. My prayer for guidance was answered when a colleague had a hypertensive attack while attending to a call. She complained of dizziness and throbbing pain on her nape. My background as a nurse came in handy, an appropriate assessment was made, and my co-worker was safely given lifesaving measures on time. It became clear to me that I should be attending to patient needs instead of overseas calls.

I passed the Nursing Boards and soon found employment at St. Elizabeth Hospital back in my hometown in General Santos City. In a matter of time, I found my groove and every day was an utter delight when you are doing not merely a job you seek but something you love most: helping people and leaving a mark in their lives no matter how fleeting the engagement was. Yet through all of these pleasures, I was feeling empty inside.

There were days when life seemed without intent or meaning when I would be roused to a sense of turmoil like there is a monstrous scrounger gorging a crimson torrent out of my bloodstream. However obscurely, a burrow was beckoning me to explore its profundity, urging me to stir hurriedly, when a murmur was heard, and however precariously, I found myself training my ear to its direction. The rubble of an aimless life continued to gather, the tedium of the anxious months kept piling its refuse and much got submerged needlessly, but even beneath copious layers, the unyielding heart kept on throbbing still.

I was standing outside the chapel, whispering a hushed prayer when I sensed a tap on the shoulder. Dr. N, one of the consultants who would become a friend and mentor, asked me matter-of-factly if I was considering going to med school. While it seemed out of nowhere, that encounter nurtured in me the desire to pursue a long-repressed dream from childhood. Realizing that my family could not afford the cost of med school education, I considered applying for scholarship grants to fulfill my ambition. Sadly, my parents did not approve of my plans because of our financial scarcity, so the dream was relegated to the backburner.

I found an outlet for my thirst for learning by enrolling in a Master of Arts in Nursing program at Notre Dame of Dadiangas University. I figured that if I cannot proceed to medical school, I have an alternative route to my nursing career as educator and administrator. Life as a working student was hard, school demands and workload required a precarious balancing act. I had to keep focused on the day’s lessons while fighting stupor and fatigue from the previous 12-hour shift.

I was transferred to the emergency department and a whole new world of opportunity opened before me. I loved the adrenaline rush that the urgencies and emergencies demanded of each member of the team, doctors and nurses alike. Working closely with the resident physicians gave me a front-row seat to appreciating the responsibilities, power, resilience, even the shortcomings, and vulnerabilities of the medical profession, how split-second judgment calls can change the course of management and define another human being’s survival or morbidity. This fuelled my silent longing to be among these hardworking and efficient professionals in the future.

I took a detour.

Life has a precarious way of turning your dreams into a reality. After a year of being a staff nurse of the Emergency Department, I got re-assigned to the Corporate Planning Office, juggling functions as Training Officer and Human Resource Coordinator for the Nursing Department. With a new environment and its own set of challenges and rewards, I immersed myself in the daily arduous grind, and the longing to pursue med school was momentarily forgotten.

In a strange twist of fate as the requisite scrub suit gave way to the corporate uniform, I had turned basically into an office person, slave to the 9-to-5 routine away from patient care. What probably kept me in touch with my former life was my involvement with the Wounded Healer seminars that Dr. N had been conducting for nurses. While essentially a course on pain management and palliative care to orient the nursing staff about their role in providing care during the trajectory of advanced illness through the process of dying and in the respectful care of the dead person, I found a family of kindred spirits in the group. Soon I was heading the SOCSKSARGEN Oncology Nurses Association (SONA) that sprung from the seminars, we received grants to bankroll the program, and my outlook towards Medicine as a profession even gained a deeper ground.

Gleaned from the works of Dr. Rachel Naomi Remen, the concept of the Wounded Healer describes two people in a healing relationship who are peers, both wounded and both with healing capacity. Just by being in the moment and by accepting the fact that people are wounded, that they are imperfect, they realize that they also have the capacity for wholeness as part of their birthright. If the nurse or doctor and the patient are participating in the healing process together, it is the health professional’s woundedness that allows him to connect with the patient in his most vulnerable time. Each person knows what suffering is. He also knows that the patient may feel separated from other people by his suffering. The doctor and the patient are together in a nurturing relationship, both capable of suffering and both capable of healing.

Dr. N has always taught us about the importance of narratives in the daily lives of patients, their families and even among doctors themselves. What doctors do or did not do is incorporated into the family’s history whether the patient survives or not. He would often tell our close circle of friends that in dealing with patients in every situation, under the gentlest of times or the harshest of circumstances, a nurse or a doctor labours to move forward with healing and comforting, takes pride in being part of a profession that is well respected, and comes back to tell personal stories for others to learn from. Our favourite poet, David Whyte, sums it all in Mameen: “Admit that once you have got up/from your chair and opened the door,/once you have walked out into the clean air/toward that edge and taken the path up high/beyond the ordinary, you have become/the privileged and the pilgrim,/the one who will tell the story/and the one, coming back/from the mountain,/who helped to make it.”

In the seminars, I also learned to let go of the self-importance that I see sadly among few doctors. Everything must always about the patient’s best interest. The dehumanization of individual persons can occur even in the most advanced medical centers. Author Danielle Ofri MD wrote about the tendency of doctors to treat their patients as just cases with room numbers. “They exist only in our office, in our wards, in our clinics. We forget that 99 percent of their lives are lived – or suffered – without us. We often react as though their illness is a personal battle between doctors and patient, when, in fact, we, doctors and nurses, are bit players. The real battle is between the patient and his or her world: spouses, children, work, community, daily activities. It is within this grander tapestry that the threads and snags of bodily dysfunction introduce rents in the fabric, even wholesale unraveling.”

As a nurse (and imagining myself as a physician later), I share my patients’ stories to find connections that shall guide me through their daily care. To hew the realities of my life, to hoist and scrutinize underneath my personal narratives is to see flashes of my patients’ lives, of their every struggle to discover meaning in their suffering and pain, their stories whispering like a hymn through the prattle and buzz of mine.

I still want to become a doctor.

Two years ago I decided to finally chase after the medical school calling. I resigned from my job and set off to review for the NMAT. Reluctantly, my parents gave their consent, hoping that I could land a scholarship to realize my dream. But the plans were derailed when I was offered a job in Dubai. My parents persuaded me to reconsider putting off the plans as there were still loans that needed to be paid and finding job abroad could significantly help alleviate the family’s burden. At first, I was lukewarm to the proposal, defiant even, considering another delay as absurd. But I yielded to my parents’ entreaties to give Dubai a chance. Less than a week before boarding a plane bound for the UAE, I was able to overcome the hurdle of my Thesis defense for my Master’s program, a little comfort to ease the twinge of a dream denied.

Things went unexpectedly smooth after that. I was exempted from taking the Dubai Health Authority licensure exam and was accepted as an Emergency Department staff at Saudi German Hospital Dubai. Over the course of a few months, I found myself enjoying the daily grind at the hospital. Dubai is a cosmopolitan city with many sights and sounds that allayed the wistfulness of home and the frustration of passing up a shot at becoming a medical student. I found my second family among fellow Filipino nurses who bravely chose to be away from loved ones in exchange for the proverbial greener pasture in the middle of the desert. Like these Kabayans, sending a portion of my salary to folks back home every payday becomes my major refuge and my source of utmost joy.

Being an OFW has taught me a lot of valuable lessons. There is a stark disparity between the health care systems of the Philippines and UAE. Patients here receive world-class care as money is never an issue. Alas, the same could not be said with what I saw back home. Looking at my fellow Pinoys here, I am both inspired and saddened by the paradox that the most compassionate and hardworking people have to leave their loved ones at home for their very sake.

Slowly, the urge to become a doctor resurfaced. I am happy where I am now. To be able to provide for my family is something that not everyone has the privilege to lay claim to. I am truly thankful for this, but there is a certain longing inside me that remains unquenched. Sometimes I look past the opulence and patina of Dubai, beyond its sleek skyscrapers, flashy SUVs, and impressive architecture, and see the empty palette of a bleak Sahara, the extended sketch line of a desolate landscape, the lack of color, and absence of living creatures on the horizon. During my solitary moments, I realize that this perceived melancholia is actually a projection, a feeling that emanates from a meditation of broken dreams and diminishing hopes.

Oddly, in the stark desolation of my surroundings, I found my refuge. It felt like a certain amount of moving around is completed and this traveler can now make out a path through the dark of night and the fog of day, even in a blinding sandstorm. It does not mean that the road has ended and the journey is finished. In fact, it leads to another new trip, better and more exciting one, I pray. But choose I must, despite the understanding that I won’t be making the best choice always because no one knows for sure how the world behaves or the stars align. The risks may be too much but I have long learned that it is actually honorable to bear the shame and guilt of choosing and making mistakes, to change and tell oneself not to return to the same mistake again. Sometimes the choosing itself is even more important than the choice that is made.

The Road Less Travelled.

I have traveled so far and so long and hard to discern my path into the lives of people I meet, only to recognize there is a sojourn I ought to make inside mine. I have seen acute cases in emergency rooms and I have witnessed end-of-life care in terminally ill patients – including the permutations, pathos, and perspicacity in between the spectrum, and I have responded to many summonses in several directions which have enriched my life. But tentative as it may appear, I allowed myself to be hoodwinked for adventure’s sake although I can perceive a gentle voice dithering beneath the ground, hankering to make itself heard. I can hear the opening lines of Dante’s Divine Comedy summarizing my quandary: “At the mid-point of the path through life, I found/Myself lost in a wood so dark, the way/Ahead was blotted out.”

This year, I finally decided to pursue medical school at the end of my contract. I pleaded with my parents that while I am happy in Dubai, I could be happier in my own country, serving and taking care of my fellowmen. There is an offer of a promotion with all the perks that were difficult to give up, but I stood firm despite the dangers of coming home to an uncertain future. Would I be able to land a scholarship? Would my meager savings see me through the long years of medical school? And at a rather advanced age of 27, (most students enter med school at 20) would I still be able to cope with the demands and ordeals of the next five years until I take the boards?

I took the NMAT with feelings of hesitation and dread because I know I am choosing a path that could be treacherous in its uncertainty. I am now making preparations for the journey that I will embark soon. I know the transition will not be painless and the road ahead could be dimly lit, with roadblocks along its tracks. Medical school will test my fortitude and audacity, but I am impervious of its many perils. I accept the challenges ahead like a lover would: fervently, unremittingly, and sometimes heedlessly. But I am also trusting enough of myself to know which gate to unbolt, whose hand to take, what dream to luxuriate in, in such a way that it will make me bawl that it seems downright attainable, just a heartbeat away from one’s embrace, but at the same time as secluded as the farthest galaxy.

Winter in Dubai can be grueling in its ferocity and volatility. The cold spell numbs. Even the sand seems to freeze as life goes into a standstill like an ennui that both maims and cuddles. A few days ago, there was an unprecedented hailstorm in the afternoon. Sometimes the weather behaves in ways that confront reason. I have seen how man can be enslaved by forces of nature. In a metaphorical sense, I grasp this med school dream, no matter how elusive, as evocative of what George Bernard Shaw wrote about being a force of nature in his epistolary dedication to Man and Superman: “This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one, the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish little clod of ailments and grievances, complaining that the world will not devote itself to making you happy.”

It is not exhaustion or delay that propels me to overcome the many roadblocks before me, certainly not the impatience and the frustration that the many missed opportunities fomented. It is an urge, a passion, a summons more profound than simply wearing a white coat with a stethoscope slung around the shoulder or reaping the admiration of many or playing God with the lives of patients and their families. Getting to med school is a force of nature that no time, space and circumstance can simply contain away. Having been sidetracked so many times, I could no longer resist the very essence of this life, the expansive purpose of my presence in the here and the now. And the bright future I seek to build for my family, friends, and fellowmen.

In a way, could my Dubai passage be a rehearsal for a dream finally coming true? Could I trust myself enough to the same mysterious benevolent force that enabled me to see through personal derailment and scarcity? And amidst the darkness and chill of Dubai winter, could I rise up to many of my journey’s delays into the constant return to the world of hope?

The toxicity at the ED has waned a bit and I am comforted by thoughts of my family and friends back home in Gensan and here in the UAE who have been encouraging from the beginning, of my future patients who will be my inspiration and my True North, and of Someone greater than the sum of all my longings and my uncertainties who guides my course with absolute integrity. I can articulate in all candor what must have been bottling inside Shakespeare when he asked: “How like a winter hath my absence been from thee.”

I am taking the next step towards becoming a doctor. Something tells me I might just get there after all.

Efren T. Catimbang Jr. presently works as an Emergency Department nurse at Dubai German Hospital. He obtained his B.S. in Nursing at Notre Dame of Dadiangas University (NDDU) and, prior to his present job, worked at St Elizabeth Hospital in General Santos City.

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