Pagkalinga
Paggunita
Pagninilay
First volume of the PGH Human Spirit Project
PAGKALINGA
Ang Pagtugon sa Pandemya ng Pagamutan ng Bayan
Alvin B. Caballes
Amanda Marie A. Cheong
Gabrielle P. Flores
Markyn Jared N. Kho
Alfonso Rafael G. Abaya
Marie Bernadine D. Caballes
Paul Miguel P. Perez
Editors
UNIVERSITY OF THE PHILIPPINES MANILA
Copyright © 2020 University of the Philippines Manila
First Edition December 2020
ISBN: 978-621-454-002-0
All rights reserved. No part of this publication may be copied or used without the permission of the individual authors,
photographers and publisher.
Book and Cover Design by Alfonso Rafael G. Abaya
Cover Photo by Brent Viray
Published by the University of the Philippines Manila
“To have compassion for those who suffer is a human quality which everyone should possess, especially
those who have required comfort themselves in the past and have managed to find it in others.”
- Giovanni Boccaccio, The Decameron
Contents
Foreword
i
Gerardo D. Legaspi
Prefaceiv
Alvin B. Caballes
“Ang Bagong Maynila”1
Cindy Pearl J. Sotalbo
Incubation
Countdown to Lockdown:
From Patient Zero to Community Quarantine Nefren Roy A. Lobitana
6
Prodrome
Hello again18
Sachiko S. Estreller
Walang Iwanan21
Paul Miguel P. Perez
My Cup Overflows
Amanda Marie A. Cheong
24
If28
Robyn Gayle K. Dychiao
Musings from a Pulmonologist at the Frontline
Jubert P. Benedicto
35
Shifting Gears40
Lily de Amor
When Nightingales Cry43
Paulo Ross B. Sison
Disease
A Battle of Silence52
Cary Amiel G. Villanueva
A Normal Day55
Viktoria Ines P. Matibag
Let me tell you about PPEs
58
Fish Out of Water: A Dermatologist in COVID
62
Ella Mae Masamayor
Amanda Christine F. Esquivel
Second Wind65
Erika P. Ong
The Long Trek to the Front
Justin Bryan D. Maranan
69
Empty Spaces75
Amanda A. Cheong
And In Return79
Robyn Gayle K. Dychiao
A Matter of Mantras83
Jill Olivia Bañares
Overcoming Inertia87
Fr. Marlito Ocon
Skin in the Game94
Justin Bryan D. Maranan
The Physician in Plastic100
John Jefferson V. Besa
Soldiering On102
Hilda Uy
Ashen104
Anna Elvira S. Arcellana
I don’t feel like a hero105
Ella Mae Masamayor
Side Effects
Sa Gitna ng Pandemya114
Ian Gabriel A. Juyad
Broken Spirits115
Cary Amiel G. Villanueva
Mama119
Gabrielle P. Flores
Lost to Follow-up122
Anna Elvira S. Arcellana
Uncarved Pieta126
Athena Mae Ibon
Laru-laruan132
Athena Mae Ibon
Suntok sa Buwan135
Athena Mae Ibon
From Fighting Cancer to COVID-19:
The Battle is Not Over137
Mikki Miranda
Pinagtagping Tahanan141
Gabrielle P. Flores
Finding a Path in Crisis146
Maria Angela M. Villa
Yet Another Uncertainty149
Vince Elic S. Maullon
Recovery
03.31.20156
Sachiko S. Estreller
The Persistence of Our Memories
Juan Raphael M. Perez
158
Science161
Trisha M. Salcedo
Hope of Easter162
Thaddeus Hinunangan
The Destination of My COVID Dreams
Howie Severino
166
“Kumusta ka?”171
Maria Keziah G. Legion
In Sickness and In Health175
Genry Criscel R. Consul
Life goes on180
Patricia Anne S. Basilio
Puhon182
Christi Annah Hipona
Glossary185
Contributors
196
Editors207
Photo by Brent Viray
12
Foreword
It is said, most especially in the scientific world, that what is not written
does not exist. There are those times I would discuss with my residents
unique observations in neurosurgery, or a personal innovation of a
procedure, and lose it into oblivion because we never got to write them
down. As a consolation, I would just tell my residents to “tell the story”
of that surgery around a bonfire, or during one of their future drinking
sessions. These ideas and stories abound in our daily lives and we never
get to immortalize them with words.
I can easily relate these experiences to the stories of the Human Spirit.
I’m so thankful that this has come about, and done justice to some of
those significant human experiences. Surely, all the pages of this book
will not capture everything, but it will leave us with enough cues to help
us remember the untold details that were also vital to the whole picture.
Nevertheless, let me add a few more.
After having gotten the concurrence of the UP President and the
UPM Chancellor for PGH to accept the role of being a COVID
referral center, we had barely a week to prepare. I assembled a COVID
Crisis Management Team composed mainly of surgeons who knew
what needed to be done and how to do it and do it fast. At the end of
that meeting on March 22, 2020, that was a Sunday, I was left in the
Director’s office with the COVID operations head. Probably seeing me
in deep thought, pondering on the commitment we had just made to the
public, he went on to say some of the most comforting words I would
hear during those times. “Boss, huwag kang magalala. Ang malaking advantage
natin, likas na magaling ang mga taga PGH.”
i
The frenzy of attending to all the details didn’t leave much time for us to stop and check our
bearings. Midway into the preparations, I realized that the PPEs we were expecting to come
were not available anymore. Our remaining two-week stock was a far cry from the one and
a half months supply we set as a minimum to start the COVID Operations. The logistics
coordinator was with me late during that day and I couldn’t keep the doubt to myself anymore.
I asked him, “ Magagawa kaya natin lahat ito?” Almost instantly he bantered back, “Wala tayong
choice brod, kailangan nating gawin ito!”
From that day on, we never looked back and just went full speed ahead. The rest, so they say, is
history.
Covering the COVID crisis will never be complete without dealing with the fear that pervaded
the initial days. In mid-April, more and more of our doctor-friends were succumbing to the
infection and the prevailing danger was very palpable. In one of our late night meetings, while
walking on the grounds of PGH, our “Voice of Science” in the team, obviously shaken, told
me, “Gap ayaw kong mamatay”. It completely caught me by surprise, knowing her as very steady
in her demeanour and confident in her ways. Of course it sent chills down my spine, but I had
to maintain my composure for the team. Almost instinctively, and naively I think, I retorted
“Walang mamamatay.” That was one time when fear gripped me too.
Everyday, we encountered stories that inspired us and lifted our spirits. There was a nursing
attendant wanting so much to report for duty who decided to walk from her home in the
northern part of the city. She was stopped three hours later at a strictly guarded checkpoint.
Undeterred, she went up to a TV Crew and convinced them to give her a ride to PGH. She
ii
was a news sensation that evening! There, too, were the countless employees who braved
the floods, vehicles, and the fact that it was their first time to do so on their bicycles, just
to get to work. There, too, were the donors, big and small, who believed in what PGH
represented and wanted to be part of those who gave hope.
This crisis has highlighted what Charles Dickens said in a Tale of Two Cities, “It was
the best of times, it was the worst of times.” Although, arguably, we have experienced
probably one of the worst times in our history as a people, we definitely have seen the
best traits come out. Never mind the worse part. It doesn’t serve anyone any good to be
punitive in a pandemic.
As of this writing, PGH has been a COVID Referral Center for almost eight months. In
the daily routine of hospital work, these stories of the Human Spirit continue. I can’t wait
to light the bonfire and open the bottle to start telling more of these.
Observing minimum health protocol, of course! (For now.)
Gerardo D. Legaspi
Director of the Philippine General Hospital
11- 10- 2020
iii
Preface
This life-filled tome was conceived 17 years ago, following a century-old crisis.
The seed came into being on a cold, dark, and rainy March day, when the streets of a bustling Asian city
suddenly became deserted. A new pandemic had taken hold. With hospitals shutting in medical staff with
their patients to contain the transmission, I decided to cut short my fellowship stint. I went home wanting
to keep a step ahead of the contagion. Fortunately, SARS did not spread readily in the country and seemed
destined to be but a footnote in local medical lore.
But even after the initial alarm had long faded, I strongly felt that we had simply dodged a bullet. The
SARS virus was, we got to know in time, a projectile that heralded itself by a rise in the body temperature
among those it had already infected. The next infectious disease may not have as obvious a presence, and the
established public health lines of defense may thus be rendered inutile. Having seen firsthand the resulting
disruptions with SARS on both the greater community as well as a better developed and organized health
system, I knew that the ensuing hardships will be much greater with a more potent virus. The instruments
of science will, of course, again be harnessed against any new threat. Except that the microbes are not to be
found and wrestled in isolated laboratory media but within us.
How would strands of foreign biological material affect individual psyches, if not souls? What would be the
bodily and mental scars left in the wake of a more severe pandemic? How would it affect us collectively?
How would such a cataclysm define a nation? What would humanity lose, and gain?
Our people had faced similar circumstances a little over a century ago. As recently reported by Gealogo, the
flu pandemic of 1918 had, over successive waves, swept over what was then a colony caught amid a world
war and so-called Filipinization of the government hierarchy1. The men being prepared for the conflagration
in Europe, having been marshalled from other provinces into a military camp in Rizal, provided a perfect
nidus for the spread of the disease. Soldiers ended up dying without ever reaching any battlefields, as the
armistice was signed before they could be shipped out while the local viral invasion remained unchecked.
iv
1
Gealogo FA. (2009). The Philippines in the World of the Influenza Pandemic of 1918-1919. Philippine Studies. 57(2), 261-92.
By the time the scourge subsided, an estimated 80,000 lives were lost across the islands, the most from any single
health calamity in the country. But aside from mostly administrative reports, not much else was written about the
catastrophe2. The tragedy seemed like a non-event in the country’s history.
The paucity in published insights on the 1918 pandemic is not peculiar to the Philippines. Even as it occurred in
relatively recent historical times, the world-wide crisis was not a prominent theme in contemporaneous literary
works. It is therefore often referred to as “the forgotten pandemic”3. The concurrent war, with its clash of empires
and pretensions of glory, may have made for a more compelling subject. Alternately, the pandemic may have
simply caused too overwhelming a suffering to instill enough creative inspiration.
It is now 2020. An infectious outbreak had precipitated what seemed to be unthinkable in modern times. A
lockdown sealed off the city of Wuhan, with its 11 million inhabitants, in January. The virus and the populationwide quarantine measures have since taken root elsewhere, including the Philippines. Following a few days of
panic buying and frantic exodus to supposed safer environs, the streets of Metro Manila became empty and silent
by the end of March.
It was a déjà vu moment, as this was the same eerie landscape that I had experienced in 2003. Except that what
was happening seemed to be much worse. And it was happening here, where my loved ones are, where deadlines
have to be met, where colleagues mingle, where people go for their regular burger dose, where students endure
classes, where friends gather to celebrate, where families leisurely pick out their needs and wants from store
shelves, where patients receive care.
Struggling, and dying, patients soon became the face of the newly labeled disease, COVID-19. To address the
fast-rising tide of afflicted patients, if not the intensifying sense of panic, the Philippine General Hospital (PGH)
was converted into a dedicated COVID center. The measure was not without controversy, more so as thousands
of other patients who depend on the institution would be deprived of much-needed services. The step also meant
that hospital facilities, resources, and processes, had to be re-purposed to amply address the vicissitudes of a still
2
3
Coutant AF. (1918). An epidemic of influenza at Manila, PI. Journal of the American Medical Association. 71(19):1566-7.
Vázquez-Espinosa E, Laganà C, Vazquez F. (2020). The Spanish flu and the fiction literature. Revista Española de Quimioterapia. 33(5):296.
v
enigmatic illness. Above all, it bore upon hundreds of individuals who, by obligation or choice, now had to hold
back their fears and apprehensions and confront the virus and its ravages on a very personal level.
The COVID-19 pandemic is already historic in many ways. But it would also be important for the current and
future generations to learn “not so much about how many people died or how it was treated.”4 These were our
history lessons from 1918, and even 2003. The rapidly evolving situation at PGH underscored the aphorism that
in times of uncertainty and adversity, everything rested on what every person at task felt, thought, and did. Above
all, therefore, the brewing crisis needed to be seen intimately, from the perspectives of the many who had to walk
into the miasma.
Thus, the seed was sown for what was to be called the “PGH Human Spirit Project”. A general call was made on
the 25th of March, 2020 for contributors for a literary compilation. The announcement read, “In this season of
difficulty, frustration, and even loss, there will be shining moments of selflessness, fulfillment, and hope. These
will have to be preserved for posterity, not to highlight the suffering, but, more importantly, to demonstrate the
resilience of the human spirit in the face of seemingly insurmountable odds.”
Before long, students, residents, nurses, faculty, and others, lent their imagination, time and talent. Though none
were professional writers, their sincerity shone through in their submissions. A core group was organized to
efficiently handle the accumulating material. Partnerships between authors and volunteer staff were forged to
refine the fresh but untamed works.
Many more, however, wanted to participate, particularly those who weren’t directly involved with PGH or only
had past associations with the university. Thus, the coverage was expanded, and the original PGH-centered book
evolved into a three-volume set. The compendium came to encompass the complex and the mundane, politics and
passion, tragedy and humor, divine and secular, a pinch of Defoe, and a good measure of Boccaccio.5,6
Ocampo A, as quoted by Vivas J. (2020). A history lesson on pandemics in the Philippines. Manila Bulletin. Retrieved from URL https://mb.com.ph/2020/09/24/ahistory-lesson-on-pandemics-in-the-philippines/
5
DeGabriele, P. (2020). Intimacy, Survival, and Resistance: Daniel Defoe’s A Journal of the Plague Year. ELH. 77(1):1-23.
6
Wallace DJ. (1991). Boccaccio: Decameron. Cambridge University Press.
4
vi
In keeping with the times, everything was put together remotely, and a social media page was even
set up for the project by a clever team of students. I have the utmost appreciation and admiration for
the dedication and enthusiasm of all those who came to be part of the effort. It is regrettable that,
with the mostly virtual interactions, I have been unable to directly convey my heartfelt gratitude to
them. The exceptional outcome of their individual, as well as concerted efforts, are manifest in the
succeeding pages.
Still, we may just have chronicled the beginning. The toll may yet exceed that for 1918.
Nobody knows what bodes for March 2021. Or for 2120. The streets may yet fall silent once again.
Pagkalinga, Paggunita, and Pagninilay have finally sprung from a simple planted idea. That many
heeded the call to nurture it has been a wondrous and humbling experience. The publications’
multitude of words and images now branch out and bask in the light of day — or the glare of
innumerable computer screens. The tales and tableaus will always remind us. A sickness came. Our
people suffered. But Oblation’s offspring looked up, raised their arms, and chose to help overcome
the despair. For a hospital, a university, and a nation, hope and purpose are rekindled.
Alvin B. Caballes
vii
Ang Bagong Maynila
Cindy Pearl J. Sotalbo
March 14, 2019
On a normal day, I avoided passing here, even if it was closer
to the house. This area, no matter what time of day, was always
an assault to the senses compared to the more peaceful path
through the UP campus at the back. Today, I had to take this
route because there was another PUI1 being received in the
triage area where I usually pass.
But there were no cliques coming home from a night of
drinking, no homeless people preparing their cardboard beds
on the sidewalk, no commuters waiting for PUVs2. It was odd
passing through here and not hearing the laughter and shouts of
the vendors, the noisy jeepney engines, the honking of the cars
stuck in between people crossing; not seeing PUVs waiting for
passengers, and pedicabs maneuvering their way through the
chaos. Even the characteristic, subtle, street smell-- typically a
mix of vehicle fumes, spilled petrol, sweat, vomit, other bodily
fluids and the distinct scent of the bay-- was absent.
It felt strange, almost eerie, being the only person in this
segment of the street. Is this going to be the new normal?
“It felt strange, almost eerie,
being the only person in this
segment of the street. Is this
going to be the new normal?”
Photo by Cindy Pearl J. Sotalbo
Copyedited by Amanda Marie A. Cheong
1
2
See glossary.
The Philippine General Hospital is at the southwestern edge of the district of Ermita. This and surrounding areas of Manila used to have mostly affluent residences.
Following the devastation of the second world war, the area underwent a transformation that reflected the country’s uneven development. High-rise buildings and
government facilities were interspersed with dilapidated houses and seedy establishments. Jeepneys-also called Public Utility Vehicles or PUVS-and other means of
conveyance clogged the streets, while commuters packed the coaches of the Light Rail Transit running over Taft Avenue, the main road artery. One can find all walks
of life on the streets on a regular night, from homeless people looking for refuge, students studying out, workers trying to avoid rush hour, to foreigners hoping to enjoy
the city. These establishments, along with public transport, were forced to close down with the imposition of quarantine measures on March 16, 2020.
1
Photo by Maria Keziah Legion
INCUBATION
3
4
Incubation
/iNGky ’bāSH n/ n.
e
e
The period between the entry of an infectious agent (e.g. viruses,
bacteria) and the onset of signs and symptoms of the disease. The
incubation period for COVID-19 is reported to be
between 1-12.5 days.
COVID-19 slithered into many countries, often from individuals
not known to already harbor the virus, with reports of overtly sick
patients coming out at increasingly alarming numbers in succeeding
days. The disease inevitably landed on our shores. The clock ticks and
the race to stem the tide is on.
5
2019
Countdown to Lockdown :
From Patient Zero to Community Quarantine
Nefren Roy A. Lobitana
The year started off ominously enough. January 2020 opened
with tensions rising in the Middle East. Wildfires reduced
Australia’s forests to embers. Indonesia was drowning for weeks
in continuous rain and subsequent flooding. Locally, Taal Volcano
erupted; and the massive ash fall descended on Southern Luzon
and the capital area. Nearly half a million people had to be
evacuated. An emerging outbreak in a province of China, first
noticed when the previous year was drawing to a close, seemed
but an inconsequential side story to these harrowing headlines. In
the weeks that followed, however, it quickly became clear that this
was no ordinary outbreak. It was coming for everyone, everywhere.
World Health Organization
DECEMBER
The Chinese
government reports
a cluster of forty-four
pneumonia cases in
Wuhan, their cause
unknown1.
Symptoms of Coronavirus
This novel
syndrome presents
with a combination
of fever, cough,
diarrhea, sore
throat, and
pneumonia, all of
varying severity.
Know the symptoms of COVID-19, which can in
Cough, shortness of breath or difficulty breathing
Center for Disease Control and Prevention
DECEMBER 31
Xie Huanchi/Xinhua Via AP
6
Muscle or body aches
Vomiting or diarrhea
WHO | Pneumonia of unknown cause – China. (2020). WHO. Retrieved April 2, 2020, from http://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-causechina/en/
Symptoms can range from mild to severe illness, and app
1
2020
JANUARY
JANUARY
JANUARY 12
The genetic
sequence
of the nowtermed Novel
Coronavirus
(nCOV) is
released4.
In the days that
followed, other
countries such as
Japan, the USA,
Nepal, France,
Australia, Malaysia,
South Korea,
Vietnam, and
Taiwan confirm
imported cases, all
traced to travelers
from Wuhan.
Li Wenliang, a Chinese doctor who tried
to issue the first warning about the deadly
coronavirus outbreak
People’s Daily, China
Attempts to warn the
public are allegedly met
with censorship2.
Chinese researchers confirm
that the disease is not a
re-emergence of the 2003
SARS. The outbreak is
caused by an entirely new and
different virus3.
The first case
outside China is
documented in
Thailand5.
JANUARY 13
JANUARY 6
UNESCO Bangkok
Coronavirus kills Chinese whistleblower doctor. (2020, February 7). BBC News. https://www.bbc.com/news/world-asia-china-51403795
Rose Carmelle Lacuata. (2020). TIMELINE: The new coronavirus outbreak. ABS-CBN News. Retrieved April 2, 2020, from https://news.abs-cbn.com/spotlight/02/04/20/
timeline-the-new-coronavirus-outbreak
4
WHO | Novel Coronavirus – China. (2020). WHO. Retrieved April 2, 2020, from http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/
5 Coronavirus Disease (COVID-19)—Events as they happen. (2020). Retrieved April 3, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/
events-as-they-happen
2
3
7
2020
JANUARY 24
JANUARY 21
In China,
there are 300
documented
cases of nCOV
infections and
four casualties. What everyone feared
turned out to be true:
Chinese scientists
confirm that nCOV can
actually spread between
people6.
The Philippine
government
deports 135
individuals from
Wuhan after
arriving at Kalibo
International
Airport.
The STAR/Rudy Santos
The deportation,
however, was a little too
late as these individuals
reportedly had already
gone around the locale8.
The number of new cases
continue to increase,
culminating in the lockdown
of Wuhan with other cities in
Central China following suit7.
This catapulted the
possibility of the
virus entering the
Philippines into
public consciousness.
Darley Shen/Reuters
JANUARY 23
China confirms human-to-human transmission of new coronavirus. (2020). Retrieved April 2, 2020, from https://www.aljazeera.com/news/2020/01/china-confirmshuman-human-transmission-coronavirus-200120162507948.html/
7
China new year plans scrapped as Wuhan coronavirus spreads—CNN. (2020). Retrieved April 2, 2020, from https://edition.cnn.com/2020/01/23/china/wuhancoronavirus-update-intl-hnk/index.html
8
Malasig, J. (2020, January 24). Philippine government’s order to deport travelers from Wuhan: Was it too late? Interaksyon. https://www.interaksyon.com/politicsissues/2020/01/24/160692/coronavirus-wuhan-deportation-order-aklan-philippines/
6
8
2020
FEBRUARY
JANUARY 30
The WHO
declares the nCOV
outbreak as a
Public Health
Emergency of
International
Concern9.
FEBRUARY 2
There were 7834
confirmed cases,
98 of them were
outside China.
One of those 98
showed up in the
Philippines. The
novel coronavirus
finally reaches the
country10.
David Montasco / Google Maps
Members of the health sector and several senators in
the country strengthen calls for the implementation
of a travel ban11.
The government issues a
travel ban on all Chinese
nationals from Hubei and
other affected provinces of
China12.
JANUARY 31
A 44 year-old Male
from Wuhan dies at
San Lazaro Hospital
in Manila. He is
eventually found
to be positive for
nCOV: the first
nCOV death outside
of China13.
DOH confirms a
third nCOV case in
the country14.
FEBRUARY 5
Office of Senator Sherwin Gatchalian
IHR Emergency Committee on Novel Coronavirus (2019-nCoV). (2020). Retrieved April 2, 2020, from https://www.who.int/dg/speeches/detail/who-director-general-sstatement-on-ihr-emergency-committee-on-novel-coronavirus-(2019-ncov)
10
Sabalo, 2020
11
Luna, F. (2020). Senators want “Great Wall” vs Chinese visitors amid first Philippine novel coronavirus case. Philstar.Com. Retrieved April 3, 2020, from https://www.
philstar.com/headlines/2020/01/30/1989051/senators-want-great-wall-vs-chinese-visitors-amid-first-philippine-novel-coronavirus-case
12
Duterte bans travelers from Wuhan, Hubei as coronavirus spreads. (2020). Retrieved April 2, 2020, from https://www.rappler.com/nation/250640-duterte-banstravelers-from-wuhan-hubei-coronavirus
13
First coronavirus death outside China reported. (2020). NBC News. Retrieved April 3, 2020, from https://www.nbcnews.com/news/world/first-coronavirus-deathoutside-china-reported-philippines-n1128371
14
DOH CONFIRMS 3RD 2019-NCOV ARD CASE IN PH | Department of Health website. (2020). Retrieved April 3, 2020, from https://www.doh.gov.ph/doh-press-release/
doh-confirms-3rd-2019-nCoV-ARD-case-in-PH
9
9
2020
FEBRUARY 11
The WHO announce
that the disease would
henceforth be named
Corona Virus Disease
2019 or COVID-19, This was meant to standardize
and the virus as SARS- nomenclature and prevent
CoV-2. racial stigmatization, following
racially-directed attacks in
some countries15. This was also
in the light of groups decrying
racism directed against the
Chinese 16.
For the rest of the
month, there are
no new cases are
reported in the
Philippines, but
cases and deaths
continue to rise
worldwide.
By the end
of February,
there is a total
of 85,403
confirmed
cases and
2,924 deaths
worldwide18.
Researchers from the University of the
Philippines National Institute of Health
develop a new COVID-19 test kit that is
cheaper and faster than the WHO test kits17.
FEBRUARY 14
DOST Website
Coronavirus Disease (COVID-19)—Events as they happen. (2020). Retrieved April 3, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/
events-as-they-happen
16
Groups decry racism against Chinese amid coronavirus outbreak. (2020). Cnn. Retrieved April 22, 2020, from https://www.cnnphilippines.com/news/2020/2/1/groupsdecry-racism-coronavirus-china.html
17
PH eyes local production of test kits for COVID-19 | ABS-CBN News. (2020). Retrieved April 3, 2020, from https://news.abs-cbn.com/news/02/14/20/ph-eyes-localproduction-of-test-kits-for-covid-19
18
WHO | Pneumonia of unknown cause – China. (2020). WHO. Retrieved April 2, 2020, from http://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-causechina/en/
15
10
2020
MARCH
MARCH 7
The 59/F wife
of the country’s
case number five
tests positive,
establishing
the first local
transmission
in the country.
Veejay Villafranca/Bloomberg
Two new COVID cases are
confirmed in the country,
from a 48/M Filipino who had
a travel history to Japan, and
a 62/M with no foreign travel
history19.
The notion of local transmission
begins to worry the public, leading
senators, such as Risa Hontiveros, to
point out the inadequacy of testing
in the country20.
MARCH 5
This prompts the
DOH to raise the
COVID-19 Alert
System to Code
Red Sublevel
1 due to the
growing number
of cases21.
COVID-19 cases in the
country reach 20, and the
Office of the President puts
the country under a
State of Public Health
Emergency
Public and
private schools
and universities
across Metro
Manila close
down22.
MARCH 9
Philippines records 2 new COVID-19 cases. (2020). GMA News Online. Retrieved April 3, 2020, from https://www.gmanetwork.com/news/news/nation/728576/
philippines-records-2-more-covid-19-cases/story/
20
DOH confirms first 2 Filipinos found with coronavirus locally. (n.d.). Rappler. Retrieved April 22, 2020, from http://www.rappler.com/nation/253584-doh-confirms-2filipinos-positive-coronavirus
21
DOH confirms 6th coronavirus case in PH. (2020). Rappler. Retrieved April 3, 2020, from http://www.rappler.com/nation/253696-doh-confirms-6th-case-coronavirusphilippines
22
Duterte declares state of public health emergency amid rise in coronavirus cases. (2020). Rappler. Retrieved April 3, 2020, from http://www.rappler.com/nation/253833duterte-declares-state-public-health-emergency-rise-coronavirus-cases-march-2020
19
11
2020
MARCH 12
52
MARCH 10
33
confimed COVID-19
cases in the Philippines
confimed COVID-19
cases in the Philippines
Reuters
Travel in and out of the Metro would be
restricted, but mass transport would still be
allowed given that social distancing measures
were implemented23 .
49
confimed COVID-19
cases in the
Philippines
MARCH 11
12
The Office of the President announces that it
would place Metro Manila under community
quarantine starting at midnight of March 15
until April 14.
In the Philippine General Hospital, clinical
clerks are pulled out from their posts.
This announcement disturbed
the already anxious public.
Metro Manila to be placed on lockdown due to coronavirus outbreak. (2020). Retrieved April 3, 2020, from https://www.rappler.com/nation/254101-metro-manilaplaced-on-lockdown-coronavirus-outbreak
23
2020
MARCH 14
111
confirmed cases of
COVID-19 in the
Philippines
Residents, fellows, and consultants
are suddenly left to carry on their
shoulders the enormous patient
load of PGH25.
The Association of Philippine
Medical Colleges issues a
memorandum ordering the pull
out of all medical interns from the
country’s teaching hospitals.
Metro Manila
is placed under
community
quarantine, and
the megacity is
transformed into
an eerie ghost
town.
People start to flock to
grocery stores for food
while others flee Metro
Manila out of fear of
being caught in the
community quarantine24.
MARCH 13
Reuters
MARCH 15
24
25
News, A.-C. (2020-b). Stop “panic buying” due to COVID-19, supplies can be replenished: Trade chief. ABS-CBN News. Retrieved April 3, 2020, from
https://lifestyle.mb.com.ph/2020/03/24/pgh-interns-volunteer-despite-apmc-order-to-pull-out/
13
The clock then ticked past midnight of March
15. Metro Manila transformed from a bustling
megalopolis to an eerie ghost town. Streets became
devoid of people. The daily din of cars, jeepneys,
and all other manner of noisy transportation
suddenly vanished into silence. Meanwhile, the
doctors, nurses, and other staff of the PGH tried
to make sense of what was happening, and prepare
for the coming days to unfold.
Copyedited by: Gabrielle P. Flores and Amanda Marie Cheong
14
Photo by Markyn Kho
PRODROME
15
16
Prodrome
/’prō,drōm/ n.
The period or state wherein early signs and symptoms are noticeable,
heralding the onset of a disease. The most common early symptoms
of COVID-19 are cough, fever, and malaise. However, many other early
symptoms have been reported, such as gastrointestinal symptoms
(e.g., nausea and diarrhea) and a loss of taste and smell.
The virus that caused the disease, SARS-CoV-2, was invisible. But
the perception that it was both everywhere, yet nowhere, pernicious
and spreading, was palpable. Like a low-grade fever settling in, the
disease’s worrisome presence was slowly being felt by the public. As
the country scrambled to respond to the pandemic, everyone at the
Philippine General Hospital--the director, staff, trainees, allied and
support workers--braced themselves for what seemed inevitable, yet
largely unknown. They kept a watchful wait, wondering if and how the
pandemic would change the institution, and its history.
17
Hello, Again
Sachiko S. Estreller
“Sinulat ko na po dito ang follow-up niyo sa clinic, ha, at ang mga kailangan ninyong gamot.”
She gave me a nod while I was doing a quick paracentesis to relieve her dyspnea from the malignant ascites.
Though she tried to smile, the worry in her icteric eyes showed through1: “Kailan po kaya tayo magkikita uli, doc?”
I shrugged and told her that this would probably take a month or so and we would be back. “Dalhin niyo lang ang
lab results ninyo para alam po natin aling mga gamot ang kailangang ituloy.” We went through her medications list one last
time and I quizzed her on the symptoms she had to watch out for. She thanked me. I did not say goodbye.
Earlier that week, the threat of a Manila lockdown had us scurrying. We were doing laboratories, writing
abstracts2, making phone calls, and explaining the hospital’s directive to our patients. In between errands, I
smiled apologetically at our students:
“Given the events, I think we’ll have to postpone our lecture over breakfast next time. Hindi ko makakalimutan,
nagpromise ako.”
I told them not to worry because we would definitely find time the coming week, but this never happened.
Orders for the pull-out of all clerks and interns2 circulated and we found ourselves in gloomy and undermanned
wards, devoid of the usual banter between colleagues while doing hospital work. Later in the week, the nearempty and eerily silent hallways witnessed the flurry of hurried changes as the hospital faced a huge transition—
that of being a COVID referral center2.
Messages from students flooded in, wishing us well and telling us how they felt bad about not being able to
help. I told them that we’re going to be okay, that safety was priority. Most of them volunteered for whatever
Our patient looks at the doctor with icteric or yellowish eyes, and an abdomen that’s large and taut, being overfilled with fluid called ascites. Dyspnea is when breathing is
difficult because the fluid in her abdomen also pushes against the diaphragm and lungs, restricting the space for air. Taken together, these symptoms point to an underlying
liver disease, possibly even cancer. The doctor conducts the paracentesis, a procedure to remove excess fluid from body cavities such as the chest and abdomen.
2
See glossary.
1
18
Sadness
breeds in the
uncertainty of if
and when, we’ll
ever get to say
hello, again.
work the hospital permitted them to do, given the limitations. I told them how thankful and
proud we were. See you soon, for sure, no goodbyes.
Back then, the changes seemed temporary, with an end in sight. Little did I know that the
coming weeks of lockdown and quarantine would be filled with farewells even to the small but
significant everyday things.
Morning commutes. Late night runs. Unmasked smiles and good mornings. Hands held and
pats on the back. A simple cup of coffee ordered before the day’s work. A chat over dinner
after clinic hours. Auscultating3 with our stethoscopes. Breathing without fogging your goggles.
Scratching that itch on your back. The small things overlooked, left unappreciated.
But also beyond these, the weeks of isolation and duties in a COVID-dedicated hospital has
made me see that there are bigger things at play as well.
The colleagues turned into patients after contracting the virus. Parents unable to keep their
children close. Families displaced, livelihoods on hold. The sunken eyes of beggars roaming
the streets looking for food to eat. The unemployed figuring out how to make ends meet.
Closed schools and cancelled ceremonies. Patients asking when they will get well and go
home. Anxious relatives asking for updates about their loved ones. The repeated apologies and
condolences exchanged with breaking voices and relentless sobs over the phone.
While the mundane allows us to have comfort in memories filled with gratitude and hope,
the bigger picture teaches us the hard lessons of missed opportunities, pervasive injustice, and
painful partings. We geared up for the most basic of needs to face this pandemic but nothing
ever prepared us for its longevity, nor the overwhelming loneliness. As the hours blur into days,
we find our weary hearts breaking little by little with each act of letting go.
3
Arguably the most iconic symbol of the medical profession, the stethoscope is an invaluable clinical tool. Auscultation, or the act of listening, most often with the aid
of a stethoscope, is an important and routine part of the physical exam. Those taking care of COVID-19 patients up close have to wear the full complement of PPE, with a
hood covering the head. Thus, stethoscope’s earpieces cannot be used while wearing the PPE, as this will mean possible contamination.
19
Photo by John Jefferson Besa
Before her discharge, I remembered asking my cancer patient
what she wanted to eat at home. Before their pull-out, I
asked our interns about their future dreams and plans. I
found myself always asking, what will I do? We ask relatives,
our patients, what do you want? I ask others, what do you miss?
Whats are the easy part, readily answered.
But the looming question in the midst of this pandemic
that stumps us all is–When?
For the time being, we have learned to answer with tales of
“at leasts,” “maybe tomorrows,” and “somedays.” Starting
sentences with “when this is over…”, ending them with
“…and never take it for granted again.”
I feel foolish now thinking that this was going to be over
in a month.
I wonder when we’ll get to run again, feel the sunshine and
the breeze on our faces and bask in the warmth of human
interaction.
I wonder how many more will be sick, how many more will
pass away. How many calls will I end up making? How many cries will
be there left to hear?
I wonder how my patient is now. Is she at home, safe and well? What
did she end up eating? I wonder when we’ll get to see our students
again, or if we’ll ever get around to having that breakfast.
Most of all, I wonder if I should have said goodbye.
But I guess at the end of the day, it is not in the unsaid
goodbyes where the most sadness lies.
Sadness breeds in the uncertainty of if and when, we’ll ever
get to say hello, again.
Copyedited by Iris D. Ditan
20
Walang Iwanan
Paul Miguel P. Perez
I was on the tail end of my ward rotation in Internal
Medicine1 when the pandemic hit us like a train. Although
I was not in the night duty team1 for that day, I stayed in the
hospital a bit later than usual to finish charting1 for some
patients. At around 9:00 p.m., the announcement came;
medical clerks1 were to be pulled out of their rotations for
safety concerns. It caught us all off guard. Since night duties
are done by a skeleton workforce1, losing three to four extra
hands would be crippling for patient care.
Interns and clerks1 have a unique role in the hospital
because we spend the most time with the patients, really
getting to know even their non-medical concerns. The
next morning, since I was among the more senior interns
of my service1, I took charge of redistributing the clerks’
patients among the remaining interns. The added patient
load made our work much more difficult. Aside from
having several other patients, we also had to take the
time to get to know each new patient and their problems.
At this point, however, we still did not know the full
extent of the impending pandemic. We were really just
struggling to get by.
Two days later, it was announced that we were to be
pulled out as well.
1
See glossary.
The first thing that entered my mind was relief, as we
would be safe and able to return to our families. The
second thought was concern, and maybe a little guilt, for
those whom we would be leaving behind.
In our rotation, we had become very close to the IM
residents1 and just could not imagine how they could
handle all those patients without our help; the wards were
packed! Moreover, the patients whom we had grown to
be quite emotionally invested in would suffer the greatest
if we were to leave.
For these reasons, when my co-intern Nick Tan pitched
a volunteer program to continue to serve in the hospital,
several of us immediately answered the call. Walang
iwanan. This was what we were being trained to do.
But we had no idea what we were getting back into.
When we returned to the hospital, it was a whole new
battleground. Physically, it was no different, but the
psychological landscape had changed. For one thing,
we did not know which patients might have already
contracted COVID-19. We could even have been
asymptomatic1 carriers ourselves without realizing it.
21
Most of us did not have the support of our parents in
volunteering, and we knew we could not go home after
being exposed. I guess I had not given these aspects
much thought until I was actually there, putting myself at
risk. My own fear tempered my initial enthusiasm.
But help came. We received a timely delivery of N95
masks1 from our dean, Dr. Charlotte Chiong, as well as
a separate delivery from the younger generation of UP
medical students who had raised funds to protect us.
We were overwhelmed by the amount of food donations
that came, most with grateful messages attached. On our
first few days back, our volunteerism had even made the
headlines! All of this came without our asking, and it was
then when I began to understand the true meaning of
bayanihan. In a time when our country needed it most,
we were humbled to be part of the People Giving Hope
(PGH)1, as our hospital director, Dr. Legaspi, named it.
Walang Iwanan. This phrase has galvanized us to join the
fray. This is the reason we take risks. We have chosen to
continue to serve, and, together, to give hope.
When it is all over and the dust has settled, I know that
we will pick each other up and together embark on a new
challenge – a new normal.
And in this new normal – sana wala pa ring iwanan.
Photos by Adrianne Alfaro and Mary Joy Beneciro
Copyedited by Amanda Marie Cheong
22
1
See glossary.
Interns who volunteered to come back and serve after the pull-out pose for some group photos in an emptied Medicine ward.
Photos by Paul Perez.
23
My Cup Overflows
Amanda Marie A. Cheong
“Ilan kayo sa duty1?”
I do not know.
These days, that has been my go to answer for nearly
everything. Which department are you volunteering
for? When will your internship1 resume? When will
you come back home?
I do not know.
Still, I hazard a guess: “Three?” I shrugged.
Two volunteer interns plus one resident1 doctor.
Everyone’s schedule lay on shifting sands. They
moved to where they were needed. Then, we medical
interns tried to fill in the gaps as best we could.
“Dala ka na ng tatlong siopao,” my roommate called out,
looking through her own volunteer schedule.
Interns volunteering to continue working in PGH
was probably not what the respective officials
anticipated when they were drafting the memo
requiring that interns be pulled out of all hospitals
during the pandemic. But before that memo was even
released, there was already talk of staying behind.
The spirit of a handful of interns favored action over
sitting on the sidelines. Meetings were scheduled
24
1
See glossary.
as plans were drafted, and then revised. Nothing was
set in stone. That evening, the department sent out a
waiver for medical intern volunteers to sign, detailing
how we understood the risks of what we were entering,
as well as what the Philippine General Hospital would
provide for us. A fair amount of interns zoomed in on
the fifth bullet point:
“I understand that the hospital shall be providing for
my meals 24/7 during this period…”
That group chat buzzed with laughter, with humorous
stickers to punctuate the conversation. “Don’t worry,
guys. Aside from that, we’ll definitely share and feed
you with whatever we have also,” our resident quipped.
Everyone was willing to help everyone else. It was heartlifting. While we usually faced daily uncertainties with
laughter, the apartment I lived in was strangely quiet. I
found myself contemplating the three pieces of siopao;
the seven interns working under the department for that
morning shift; the residents who have to feed us.
When you are trying to fill a gap, it is best not to be a
burden.
“Sige, dala na rin ako ng curry.”
The labor and delivery room would be our fortress for that week.
Storms might gather; the earth might shake; a pandemic might sweep across
nations—but babies still demanded to come out into the world.
What a world that would be.
I marched into my post, armed with my duty bag slung over my shoulder,
and lunch for sharing in a paper bag. The rest was routine. We start with an
interview, and if we are lucky, we end with a newborn baby’s strong cry. We were
lucky twice that day, and baby number three wasn’t due until late afternoon.
Storms might
gather; the earth
might shake; a
pandemic might
sweep across
nations—but babies
still demanded to
come out into the
world.
The clock read eleven, but hungry stomachs do not recognize clocks, especially
when your resident brought donuts for sharing. Oh, and I still had my three
pieces of siopao. Between sweet and savory, we felt full enough to delay lunch.
Perhaps, we would save the curry for an afternoon snack.
What we did not know was that lunch made the trip from the Pediatrics Ward
all the way to the labor room pantry. “Uy, kain kayo o,” our friend said as she
placed the set of meals on the table. “Marami pa daw sa baba.”
Our not-so-hungry stomachs could smell the soy chicken inside. “Saan ‘to
nanggaling?” we asked with not a small amount of glee, already opening up the
plastic spoons and forks.
“May nagdonate daw.”
25
All was quiet in the labor front. The only thing
making noise was our instant messaging apps. A
message from the class president - [N95 MASKS1
FROM DEAN CHIONG FOR INTERN
VOLUNTEERS] - appeared on the notifications. I
swiped it away—perhaps later, when we were off duty.
A little while later, there was another ping from the
group chat. Another set of donated food. This one
came with a picture taken right at the main entrance
of PGH. I showed it to my co-intern. We shared a
laugh. I swiped it away again.
Ping. Another set of donated food at the DEM
callroom1. Ping. A different set in the IM callroom, in
case anyone still hasn’t had lunch. Ping. Ping. Ping!
The group chat read like an SOS. “Who else
hasn’t eaten yet?” “Have we given the residents?”
Yes. “Have we offered the nurses?” Yes, and they’re
also offering more food. “The nursing assistants? The
manongs? The guards?”
Ping. Ping. Ping! Flash pictures of foods lined up in
stacks. Some of them come with selfies and what are
likely happy smiles beneath face masks.
We start telling each other to have dinner in PGH
instead. Bring some home for tomorrow too.
We never did get to eat the curry I brought over. Instead
we were given another meal set. “Ilan kayo dito?” Count
two volunteer interns, plus one pedia resident, and four
nurses. For a total of seven more burgers. A tray of
chicken karaage would come in later.
I marched out of my post, my duty bag heavier with the
extra food that was given, and my heart so much lighter.
My duty mate and I stopped by the pedia wards before
we went home. “Magbigay tayo ng food sa mga street children,”
invited our friend. There were still some sets of soy
chicken from lunch.
That day was just the beginning. The hospital was more
overwhelmed with preparations than with COVID
patients. This was the water receding before the crash of
the tsunami, and the three of us knew it as we walked
home. The street children who used to play in the area
were nowhere to be found. But there was always someone
to help, and we found him in an old man standing on the
sidewalk. “Pang-hapunan niyo po.”
That day, I felt like I witnessed a miracle. Someone took
a piece of bread, and tore off a bit to give to another.
And another. A piece of fish here, and another for you.
Somehow, five loaves and two fish became lunch, dinner,
and maybe even breakfast for the entire hospital.
At the end of the day, I prepare a table before me; my cup
overflows.
Copyedited by Amanda Christine F. Esquivel
26
1
See glossary.
Thanks to the donors and patrons of PGH, many of the hospital staff have received a steady supply of food since the start of the pandemic.
Photos by Janel Verceles, Edmond Bries, AJ Limbago, and Markyn Kho.
27
If
Robyn Gayle K. Dychiao
Another day, another meeting. While the Philippine
General Hospital director, Dr. Gerardo “Gap”
Legaspi, attended multiple meetings on a daily basis,
this particular gathering held heavier implications.
In attendance with Gap were Department of Health
officials and other hospital directors, all anxiously aware
that the pandemic has taken hold in the country. It was
time to ally and prepare for battle.
What if we appoint centers that can take in severe and critical
patients, while other hospitals focus on testing and regular
operations? Gap had been mulling over the idea of a
dedicated COVID-19 hospital, just like what was done in
China. Many hospitals in Metro Manila still had ample
time to get this running; surely, someone here will set
off to repurpose their respective facility. As Gap brought
this up, the officials jumped at this idea and exclaimed,
“PGH lang may kaya niyan, ikaw na!”
Gap was taken aback. It was a mere suggestion; the
prospect of PGH being on the line did not even cross
his mind. It couldn’t be, as PGH’s patients relied on its
specialized services—which would be less accessible
or unavailable elsewhere. The hospital was also in
the midst of its own little battles: the sheer volume of
people lining up daily at the out-patient department,
28
1
See glossary.
severely-ill patients in its temporary emergency room
spilling into the corridors, and operating rooms running
round-the-clock to make a dent in the unending queue
of patients needing urgent surgical interventions. Gap’s
job as director was a daily affair of putting out fires,
and in PGH, there were many. Converting an already
complicated entity into a singular COVID-19 referral
center will only sink PGH to the deepest of trenches.
The PGH was, to put it plainly, not the hospital of
choice. Gap ended the discussion without a clear answer
and said that he would propose it to the UP President.
In the days that followed, a sense of normalcy pervaded
the PGH. The Out-Patient Department (OPD)1, Cancer
Institute1, and operating rooms were bustling with the
usual overflowing number of patients. However, the
veneer of the routine was also perceptively giving way.
Like a fog creeping in to blur what was in sight, there
were rumors spreading of PGH becoming a COVID-19
referral center.
Was PGH the first pick? It’s not true until Gap says it is,
everyone thought. The hospital’s slow progress can only be
reversed with such a step. And even if Gap did say yes to this,
could the hospital hold together for the duration of the pandemic?
Thus far, nothing had been officially announced by the
hospital’s officials, yet news outlets already started to
banner PGH’s taking on the role. Residents’ 1 phones
rang with calls from worried parents, telling them to
come home immediately because PGH was about to be a
warzone — where the virus moved as a wayward bullet,
and everyone was fair game.
New schedules for the staff were being rolled out
each day, and some patients were transferred to other
hospitals for no apparent reason. More days passed, and
the strident rumors simmered down to an eerie silence.
Suddenly, a hospital normally bustling with passion and
fervor felt cold and uncertain.
In the middle of this usually busy hospital lies the
PGH Atrium. Tucked in the corner near the atrium is
an unassuming doorfront, the director’s office. Its shut
doors masked the chaos in Gap’s mind. The noise from
the outside was no match for the cacophony of thoughts
that preoccupied him in making this crucial choice.
PGH Director Dr. Gap Legaspi is interviewed in front of the administrative
offices. Photo by Brent Viray
1
See glossary.
Could the PGH structures truly handle this? The
emergency room was far from complete; its renovation
would have to take a backseat. Gap would need to
orchestrate a herculean effort to re-engineer wards.
PGH’s usual practice of fitting as many patients in need
of care as possible would no longer be appropriate for
COVID-19 cases. PPEs, ventilators1, dormitories: how
29
was he going to acquire these in a week to provide for
his staff?
As much as PGH was not ready for the change, its
patients also stood to be jeopardized by the transition.
Every year, 40,000 patients come from all over the
country to line up in the out-patient clinics. Each
month, some 2,500 cases underwent a plethora of
surgical procedures in its many operating rooms. The
1,500 in-patient bed capacity has never been enough to
accommodate all those in need of in-patient care. People
depending on PGH will lose these vital services. Was
this really worth it?
Everything and everyone seemed to be going against
PGH becoming a COVID center; Gap felt pushed
against the wall by dissent. Clamor from his colleagues
filled his inbox, “What will happen to the residents?”,
“The ER is not even fixed yet!”, “Why are you doing
this?” There were a few who were on his side, but Gap
still felt like the universe was conspiring against him.
Then the lines from a timeworn poem of a father to his
son came back to him:
If you can keep your head when all about you
Are losing theirs and blaming it on you
If you can trust yourself when all men doubt you
But make allowance for their doubting too
30
(From L-R) Dr. Kenny Seng, Dr. Hermogenes Monroy III, and Dr. Orlando
Ocampo meet in the Director’s Office to discuss the PGH COVID strategy for the
months ahead. Photo by Alvin Caballes
What was most at stake was the health and well-being
of the people who trusted him. He was taking a leap
of faith for 4,000 people. 4,000 lives.
ill COVID-19 patients, it would hold off the usual flood
of patients and buy the hospital some time to regroup and
reorganize.
And Gap knew that unspeakable things could happen
with a virus as unpredictable as this. Along with the
physical risk of treating COVID-19 patients everyday,
the mental struggle to stay “resilient and resourceful”
could aggravate pent-up frustration in the frontliners.
None of them were dispensable. The rising number of
COVID-19 cases spoke for itself: someone will catch
the virus in due time.
Again, the poet’s words filled him:
If you can dream—and not make dreams your master;
If you can think—and not make thoughts your aim;
If you can meet with Triumph and Disaster
And treat those two impostors just the same
If someone didn’t make it out alive, he acknowledged
that he would have to resign as director. The risks, the
consequences. All these he weighed, as much as these
also weighed on him.
For above all these considerations was the institution’s
avowed duty to the nation. PGH prides itself in caring
for the underserved, and this new formidable enemy has
placed all Filipinos in universal suffering. There had to be
a concerted effort against COVID-19, and the PGH would
not shirk from this responsibility. Hindi puwedeng hindi. This
was for the greater good — “the right thing to do.” And
so, Gap took the first step for the transition.
Yet there was an overriding thought. When the need for
action superseded all else, how could PGH say no?
Gap akins COVID-19 to a war. The PGH was being
recruited to battle in the country’s fight against an
invisible enemy. Private hospitals were just as eager
to help PGH, with the promise of equipment and
facilities if—once—Gap said yes. A “rare moment of
solidarity”, indeed. Gap also thought this could be a
good tactical move, putting PGH two steps ahead. By
being the referral center dedicated to treating critically
On 26 March 2020, Gap wrote “People Giving Hope1”, a
communique that defined the hospital’s new role, vitiating
the nascent uncertainties. The choice was made for the
patients, who trusted in the institution. For colleagues who
had passed on. For professionals and workers who have yet
to rise to the challenge. For the students of the UP-PGH,
so their aspirations can find their way into action. The
resilience and resourcefulness of all would be put to the
test, but Gap was counting on everyone to pitch in, and,
together, overcome the adversary.
How many people will Gap need to lose before
realizing this was a mistake?
1
See glossary.
31
The PGH COVID Command Team shows its support for the hospital workers at the newly renovated PGH Atrium.
Photo by Jonas Del Rosario
32
The official announcement for the hospital’s new status
came five days later. But this was almost taken for
granted, as frenzied preparations were long underway.
The on-ground physical transformation was sweeping
and extensive. Adjacent wards were re-engineered to
provide ICU care for upto 130 patients. An armada
started to take shape, assembling and orienting the
best soldiers, filling its war chest with armament and
supplies, and optimizing communication strategies.
Donations from the public poured in; six weeks’ worth
of PPEs were collected in four short days. As Gap’s
crisis team worked on the logistics, the frontliners
honed their arrangements and procedures for patient
care. Long-held divisions between medical specialties
and service disciplines were set aside. Doctors, nurses,
and allied health workers joined new platoons and
researchers deployed as intelligence teams to search for
effective treatments. If there’s one thing that COVID-19
has unveiled, it’s that mountains can be moved with a
united front.
The COVID-19 referral unit has become the new normal
for the PGH staff. Nonetheless, there remain nagging
issues. Was anything missed? Were the wrong choices
made? How many more patients with COVID-19 will
come? What about the other patients?
The contagion continues, but a hospital director’s vision
proved to be more infectious. Despite all the trepidations,
the PGH, through the sheer dedication of countless
individuals, perseveres and slowly rises above the fray.
For critically ill patients, disheartened families, imperiled
communities, and a desperate nation, it has become a
beacon of hope.
If you can force your heart and nerve and sinew
To serve your turn long after they are gone
And so hold on when there is nothing in you
Except the Will which says to them: ‘Hold on!’
Soon enough, everything fell into place. And the
patients came.
Copyedited by Gabrielle P. Flores
33
The Medicine and Surgery wards of PGH prepare their facilities for the COVID patients. Dr. Regina Berba, chief of the Hospital Infection Control Unit (HICU),
and Dr. Rodney Dofitas, Dr. Carmela Lapitan, and Dr. Dione Sacdalan of the Department of Surgery, brief the staff on the new protocols for managing patients and
layout of the wards. All around the hospital, plastic barriers are installed and COVID signs are hung, a stark reminder of the crucial role PGH was about to take on in
this pandemic. Photos by Brent Viray.
34
Musings from a Pulmonologist at the Frontline
Jubert P. Benedicto
On March 16—also my daughter’s 11th birthday—
the Luzon-wide ECQ (Enhanced Community
Quarantine)1 was suddenly declared by Malacañang.
We were all caught off-guard, since the Metro
Manila community quarantine had just been
announced four days prior. I never thought that
these three letters could forever change the way we
work, think and, ultimately, live. Confusion, and a
feeling bordering on panic, gripped me while I was
driving home with my daughter’s cake (which she
specified to be chocolate with moist icing) and her
favorite bucket of chicken. Along the way, my wife
and I were hearing disheartening news from the
radio and hopelessly watching the chaotic traffic and
commuter surge outside.
Earlier that day, PGH Director Dr. Gerardo “Gap”
Legaspi already floated the idea of the hospital being
one of the dedicated COVID-19 Referral Centers
for the National Capital Region. Unsurprisingly,
he received a barrage of queries from the heads of
the hospital’s various departments and units. These
impassioned inquiries involved the physical set-up,
the manpower needed, and our hospital’s general
readiness to take on such a herculean task.
Why did we even volunteer? PGH na naman? Paano na ang
mga pasyente natin? Kaya ba natin?
I lauded him for his composed answer then: “We
can not afford to NOT play an active role. This will
be so out-of-character for the so-called “mga iskolar
ng bayan2.” However, it was hard to be comforted
and encouraged at that point. I vividly remember
the dread, an almost surreal, uneasy gut feeling, for
what was about to come. The hospital was about to
bear the brunt of a scourge, yet we will be relying
not on firsthand knowledge or extensive experience,
but on the little that we were able to gather from
international literature. Was this enough preparation?
The sheer volume of reported deaths, the alarming
shortage of medical supplies, and even the rising
number of afflicted healthcare workers in developed
countries reported in the news were overwhelming
enough. Eh, paano pa kaya sa PGH?
As the head of all critical care units in PGH, I knew
that a greater part of the burden for the care
See glossary.
Translation: Scholar of the People. Students of the University of the Philippines system are, literally, scholars of the nation as their education is subsidized, in part, by
the government. But this title carries a heavier connotation— that of giving oneself to service to the nation.
1
2
35
of these severely ill individuals will eventually and
inescapably fall on my shoulders. Even at the time of this
writing, COVID-19 remains a clinical enigma. Much of what
was known about it, in terms of pathophysiology1, diagnosis
and management1, was tentative or inconclusive. However,
the hospital simply could not wait for the clouds to clear. We
were tasked, right away, to prepare for this unseen, poorlyunderstood enemy: assessment of potential intensive care
areas1 in the hospital, crafting of ICU policies and workflows,
preparation of all ventilators1 for deployment, and writing a
“wish list” for procurement of relevant institutional needs
and wants. Dapat meron sa charity1. Dapat meron sa pay. Teka
lang, matutuloy ba talaga ito o plano pa lang?
The next few days were for the books. We bore witness
to the fast-paced and unprecedented turn of events we
never thought possible within the lumbering institution
that is PGH. We suddenly had wards converted into
ICUs. Our established medical and surgical intensive
care units were transformed into facilities for confirmed
COVID-19 patients. Workflows were established,
which included the strict personnel adherence to a “one
way” route in and out the ICU. PPEs1 were stockpiled.
Complementary manpower was made available. All
clinical departments contributed their residents1 to the
frontlines, with their consultants1 on board and ready.
ICU equipment were prepared, including mechanical
ventilators with advanced modes. Donations of various
forms from all over the country flooded PGH.
36
1
See glossary.
Naku, wala na talaga akong lusot. Trabaho na!
The first challenge was to get everyone on the same
page. Admittedly, this was easier said than done. We
were navigating uncharted and tempestuous waters, and
fear and anxiety were palpable. I have to admit that I
was also scared— scared because of the many “what ifs”
and the lack of reassuring answers on sight. We really
did not know how to beat this unseen enemy. And,
ultimately, I did not want to get sick. I wanted to be with
my wife and children in such trying times.
Each time I encountered trainees, nurses, and
paramedical personnel, especially during preparatory
meetings, I made it a point to put on a firm demeanor.
While we shared the same concerns and fears, they
were more candid. “It seemed unfair that we did not
have a choice,” was one of the tearful yet unsurprising
sentiments shared in these meetings. Kami kasi yung nasa
ICU… pinili namin ang ganitong buhay. In an attempt to
give solace to my co-workers, I would always go through
my list of supposedly assuring statements: “PGH will
always equip us with adequate PPE”; “Remember, you
will have days off just to rest and monitor yourselves for
any symptoms1”; and, “We designed our workflows and
policies so that contacts with patients will be reduced to
the minimum possible.”
Until now I honestly do not know whether these words
achieved their purpose. I always end the meetings by
saying my personal source of encouragement: “Let us just
pray and ask God for strength, protection, and direction.”
I clearly remember my first day of being thrust to the
wards and the emergency complex to attend to the
suspected and confirmed COVID-19 patients with my
fellow1. I was meticulous with how I donned my PPE—
following the posted checklist and reviewing at least
twice to see if I did everything correctly, even under the
supervision of the safety officer. Mahirap nang malusutan.
The first patient I saw was an enthusiastic elderly
female diagnosed with a blood dyscrasia, suspected to
be infected after suddenly becoming short of breath
in the wards. I felt that the pressing symptom was
more attributable to her underlying anemia3. She was
trying the whole time to strike a cheerful conversation
as I attempted to double check the progression of her
symptoms. Each time I paused, she asked friendly
questions. What province is my family from? Do I know her
physician granduncle? I answered her with short phrases,
in adherence to the dictum that we spend only the
minimum necessary time with our patients. While I
tried my best to do a physical examination, it was made
extremely challenging with the double layer of gloves
1
3
and the hood covering my ears. The dripping sweat and
the fogged goggles added to the discomfort. I eventually
placed a pulse oximeter1 on her finger, which registered
an oxygen saturation1 reading of 92%— low for
someone already on supplemental oxygen via face mask.
However, instead of moving on to the next patient, I found
myself looking back at her. Instinctively, I proceeded to
answer all her previous queries. I even asked if she wanted
me to call a family member so I can give them updates
about her. She just smiled and thanked me for the thought.
I could not purge the value of being humane. I have
imbibed this through lifelong training—to see patients as
individuals first and foremost rather than mere cases of
clinical interest.
This virus, unrepentantly, was compelling us to be
substandard, uninvested healthcare workers. We simply
should not let it do so.
My realization right then was that one must really be
conscious of one’s conduct during these encounters.
There should be mindfulness and compassion for each
and every patient.
Hindi pwedeng sugod lang nang sugod.
See glossary.
A blood dyscrasia is a non specific term that refers to diseases of the blood and its components. When it affects red blood cells, it can cause anemia in a patient. This
anemia may manifest as sudden shortness of breath, which may be confused with the symptoms of COVID-19.
37
Photo by Brent Viray
Subsequent days became quite routine: morning endorsements1 followed by short
discussions with fellows before doing rounds1. All these should be done by 11:00 a.m.
since laboratory and imaging requests1 will be carried out right after. Meals from the
dietary department and donors were welcomed in between. We were all, fortunately,
becoming more accustomed to routine donning and doffing of PPEs. Donations
provided some needed emotional boost. They also strengthened the belief that this
pandemic—as with any calamities and disasters in the past—brings out the generosity
that Filipinos are known for. I really treasured the prayers, the letters of support, and
uplifting messages I regularly received through various social media platforms; a great
number of these were from people I have yet to encounter in person.
We were striving to achieve a sense of “normalcy” during this global crisis through
telemedicine1 (that we had to get a hold of quickly), Zoom1 meetings (which are the
bane of my existence), and myriads of webinars. Nevertheless, it was really challenging
to attend to all these affairs, let alone concentrate on one, considering that we were
always on our toes to manage afflicted individuals. It did not help that we were
leaving them, at least partly, clueless on what we could further do. The apprehensions
stayed with us, and the thought was always there; Did I miss anything?
38
1
See glossary.
BREATHE,
PRAY,
MAKE
ROUNDS,
REPEAT.
The unease remained even after I had left the hospital. Though exhausted, I struggled to fall asleep at night. I
seemed to have become fully dependent on melatonin tablets4 to ease the effort. I found myself checking my
mobile phone for messages at least once every hour out of concern of missing any urgent referrals1.
These trepidations doubled when we started admitting and caring for our own colleagues. Referral to our service1
was not exactly reassuring. It was, more likely than not, a harbinger of clinical deterioration1 necessitating further
intensive care. While we had protocols to guide us, my faith in their soundness was shaken when I saw familiar
faces, not as co-workers, but as patients: Were these guidelines updated? Do they offer the best options?
I tried to separate my role from being their physician-in-charge to my attachment to them as a co-worker by
being objective as much as possible. This was difficult though. I could not help but pause a little longer at their
bedsides and engage them in some light conversation or communicate with a few extra written words written on
whiteboards. I was also the bearer of cherished good news, and dreaded bad news, to their family and friends.
Inevitably, not all would recover. There would be colleagues-turned-patients who, all too aware of the downturn,
still expressed their gratitude for having done your best for them. The comfort would be fleeting, overshadowed
by the moment of passing that would inevitably come. There is a pause, a brief time to reflect on the struggle, the
seemingly senseless situation, the futility of the cards dealt by the universe. I soon push these aside, and I move
on.
We learned and are still learning our lessons. We take good notes and apply what our previous patients selflessly
taught us to the next. We give our best, wherever we are, with whatever we have. Despite all the odds, we valiantly
pursue our goals. I firmly believe that, when the dust finally settles, we will be victorious.
At the moment, we can just
BREATHE, PRAY, MAKE ROUNDS, REPEAT.
Copyedited by Aedrian A. Abrilla
1
4
See glossary.
A supplement that improves an individual’s sleep (i.e.commonly used for insomnia, jet-lag).
39
Shifting Gears
Lily de Amor
Life in the fast lane. That’s the title of a wellknown website covering all things emergency
medicine. As an emergency medicine
consultant1 at the UP-PGH, it’s a fitting
description for my life and my job, too.
In an environment where a successful
outcome is sometimes defined in seconds,
the ability to think and move fast is essential.
We aim to put order into chaos every time we
step into the fast-paced, action-packed world
of emergency medicine.
This hectic pace became even more
pronounced when the pandemic started to
hit in late January this year. For the first few
weeks, there was little sleep to be had as we
poured our time and effort into developing
plans, guidelines, and protocols, as well as
dividing the responsibilities that came with
them amongst ourselves. It was during these
times that keeping one’s head above water
took more effort than it usually did.
Does this patient have COVID? Should I do
chest compression? Is it safe? Should I intubate3
this patient? Would it be safe? Am I wearing
the appropriate personal protective equipment?
Would I be safe? How do I tell the family that the
prognosis for their loved one is poor ?
See glossary.
Triage. Identify. Treat. The Emergency Department is not a first come, first served system. Most people who arrive in stable condition would need to wait for some time.
The ED is designed to zero in, instead, on those who stand at death’s door. Because when the clock starts ticking, it is the ED’s resuscitation team that reels them back to
life by treating the long-established ABC’s of emergency. (Airway. Breathing. Circulation.)
3
If a patient cannot breathe properly by themselves, the resuscitation team may place a flexible plastic tube into the windpipe to push oxygen straight into the lungs. If a
patient’s heart stops pumping, the resuscitation team may start chest compressions in an attempt to get the heart beating again. Unlike in the movies, these attempts do
not always succeed. Sometimes, if the patient came in because of a respiratory virus, this may expose the resuscitation team to contamination risks.
1
2
40
Though most of us working in the
Emergency Department (ED) are trained
to adapt to any situation that could come
our way, this public health emergency has
pulled us in every direction. What used to
be a straightforward set of actions – triage,
identify life-threatening emergencies, and
treat2 – now seemed to be inadequate
for dealing with the issues and concerns
that came with managing patients with
COVID-19. Whereas before, a dying or dead
patient arriving in the ED would immediately
kick the resuscitation team into action, this
time there’s a perceptible pause. What used
to be an emergency physician’s automatic
response was now punctuated with questions
that would come in rapid succession.
During this time, patients in critical condition, and even
some who had already passed away, were arriving at the
ED in a constant stream. When I look into the eyes of
our young colleagues, the only parts of their face visible
under the protective gear, I try to gauge their emotional
state. With the constantly changing hospital protocols
and the difficult decisions to be made, it was easy to get
lost in this COVID storm. But I find a different kind of
fighting spirit in them. For still they possessed the desire
and determination to fight for their patient right up to
the very end.
But now, their spirits are tempered by the realization
that there may be times that the best decision for their
patient is to hold off aggressive management1 when
deemed futile, and let go. This scenario has become
more and more commonplace in this crisis, and it has
started to take its toll on our mental health. When there
are more questions than answers, even just a single
patient encounter can be emotionally draining.
Then, in March, the community quarantine1 was
implemented.
Suddenly, the world became quiet. Things moved more
slowly. The ED drastically shifted from what has always
felt like a motorcycle weaving through rush hour traffic
to a more sedate state. There were still outbursts of
activity, such as when a vehicular crash patient with
multiple injuries, a person experiencing chest pain, or a
COVID positive patient whose condition deteriorated
during transport from another hospital arrives and is
1
See glossary.
rushed inside for resuscitation and stabilization. Less
and less of the “regular” ED patients were showing up.
What used to be a crowded, noisy hospital unit, with the
number of patients exceeding its capacity many times
over, then became a strangely peaceful place.
One warm day in March, I found my way to the hospital
parking lot where tents were set up for the purpose of
swabbing COVID suspects1. By the time I got there
before the evening duty, the place was deserted. There
were no more patients, and the health care workers
assigned to the post had already left. Without the
cars, the place looked pretty, like a patch of a welltended city park. The ground was dotted with the tiny,
bright orange flowers from the narra trees, seemingly
an invitation to take a break and bask under the late
afternoon sun. Feeling the accumulated weariness of
the past weeks, I sat on a plastic bench, enjoyed the light
breeze, and allowed myself to relish in the tranquility
that was so at odds with my state of mind.
I have since developed a routine that has served to
fulfill my simple needs during this period. I now walk
the distance between my place of residence and the
hospital. The twenty-minute walk twice a day has been
wonderful for my physical and mental health. Walking
forces me to be in the moment and allows my mind and
soul to relax. It has become the highlight of my day. I’ve
always enjoyed climbing, hiking, and running. But now
I’ve been given an opportunity to enjoy walking without
having to deal with the bustling crowd and the terrible
air pollution.
41
I have also been able to reflect more on the role of emergency medicine in the overall health crisis. It
is often said that the ED is the safety net of the community’s health care system. The pandemic has
highlighted the need for emergency physicians like me to take on a more active role in public health
through engagement with local health authorities and agencies involved in managing emergencies and
disasters. There is a need to sit down with public health experts and discuss areas for cooperation. The
integration of preparedness and response plans, along with community involvement, will enable us to
be more ready to meet the major challenges to the health care system, such as what this major crisis has
presented.
The extended community quarantine period will soon end. I don’t know how the “new normal” will look
and feel like. I love my work as an emergency physician. I’ve enjoyed living in the fast lane. But I now
know that I have more to offer beyond serving at my chaotic, crazy but comfortable second home, the
emergency department.
It is time to shift gears.
Photo by Brent Viray
42
When Nightingales Cry
Paulo Ross B. Sison
“Meron daw sa 5th floor.”
It started with rumors that one of the pay floors1 was
catering to a COVID-positive patient. Hearsay of the
first known case entering the hospital premises brought
chills down our spines. Half-joking threats of early
retirements and AWOLs were heard in staff rooms
when the prospect of PGH being converted into a
COVID referral center1 was brought up.
Given the quantity and spectrum of patients we had
to deal with on a daily basis, we were confident PGH
wouldn’t overhaul its current structure. If we had to
handle COVID cases, we were certain that, at most,
only a ward or two would be allocated.
“Hindi yan aabot sa atin. Paano na lang mga pasyente
natin?”
We had never been so wrong, as I soon realized one
Friday afternoon. I was almost done with an exhausting
eight-hour shift, and I was preparing my logbook
for endorsements1 when our chief nurse called for
1
2
an emergency meeting. One of the wards would be
converted into a COVID Unit and every Chief Nurse
had to turn in one nurse to the Unit’s staffing personnel.
“Bawal ang may-edad. Bawal ang may sakit, lalo na sa
baga.”
I wasn’t that old. I’m actually one of the younger
members of our staff, but I have asthma, so I never
thought I would be inside the head nurse’s office, being
told that I would be our chief nurse’s ‘alay2’ to the
COVID Unit.
“Mahirap mamili sa staff ko pero sana maintindihan mo
bakit ikaw ang pinili ko.”
Oddly enough, the shock didn’t register then. It was
only when I started erasing and rewriting notes in my
logbook, hunched over the nurses’ station tables, that I
felt a creeping sense of unease. Suddenly, it hit: the idea
of being in direct contact, albeit in complete personal
protective equipment1 (PPE), with COVID patients was
becoming less illusory. It was now real.
See glossary.
Its literal English translation is “offering” or “sacrifice”. Duties in the COVID unit are necessary, but always accompanied by dread that created no pool of willing
volunteers. But someone has to be chosen; someone has to make a sacrifice for these duties to be carried out properly.
43
The succeeding week was a blur. All the nurses sent by the chief nurses underwent an orientation on the
COVID Unit – the unit’s physical set-up, a demonstration on donning and doffing of PPEs, and a debriefing
to process our emotions. Many were afraid and anxious of their predicaments. Some were angry at being
chosen. While a few were actually excited – a bright ray of light in the darkness enveloping our dear
Pagamutang Bayan.
“I know you feel fear. Anger. Anxiety. These are ALL valid feelings.”
Since the Spine Unit1 was still undergoing renovations, we were assigned to augment the staff of the units
already managing COVID patients—Ward 14A3 and 5RCB24.
“Endorsing 10 patients. Nine PUIs, one of which is intubated1. And one COVID-positive.”
On my first night as a COVID nurse, I was assigned to Mr. C, the very first COVID-positive patient of the
hospital. Despite listening to the news and reading the latest updates on the disease, nothing prepares you for
the first time that you have to face a positive patient.
We were advised to minimize exposure, so I made a game plan. I would enter the room only once for my
shift. In that period of time, I would do everything necessary in one patient interaction – getting the vital
signs1, administering the medications, checking up on the patient, and giving patient education, among
others.
As the clock struck five in the morning, I donned my PPE, making sure that not an inch of my skin would be
exposed. I prepared the medications, ran through the to-do list in my mind, and uttered a quick prayer. With
a deep breath, I knocked on the door, announced my arrival, and swiftly entered the room.
Mr. C was sound asleep. I placed my things on the table and as I tried to remember my to-do list, my brain
just went… blank. Maybe it was the fear drowning my logic or the hypoxia1 even as I hyperventilated while
wearing an N95 mask1, but I tried my best to snap out of it. “Deep breaths, Paulo,” I told myself, and my
mind slowly cleared up.
See glossary.
A ward in the Philippine General Hospital that formerly housed trauma patients. During the renovation of the hospital’s emergency room, this ward was converted as
part of the make-shift emergency room
4
An isolation unit in the pay admitting floors of the Philippine General Hospital
1
3
44
I approached Mr. C and woke him up to take his vitals, quickly assessed him, gave his
medications, and instructed him to always wear a mask and ring us if he needed anything. In
less than 10 minutes, the brief patient interaction was over. But I trembled as I doffed1 my PPE,
praying to the highest of heavens that I had followed each step correctly. Mr. C used to be just a
statistic in the hospital’s daily COVID census1 for me. Until that moment he became my patient.
The following night, I was pulled out and sent to the emergency department which acted as a
holding area for Persons Under Investigation (PUIs) awaiting disposition. Being sent to the ER
on a regular, pre-pandemic day was stressful enough, let alone to an ER catering to PUIs.
Given the high acuity of the patients in the area, we were advised to wear PPEs for the entire
shift. This meant eight-plus hours of shallow breaths beneath a stifling N95 mask that offered
maximal protection but minimal comfort; a limited visual field as my breath fogged up the
safety goggles; no water in and no water out; (not so) insensible losses via the sweat that
drenched me from head to toe; and mumbled prayers of staying strong and keeping it together.
Monitor1 patients at bedside. Administer medications. Answer questions left and right. Rinse,
wash. Repeat.
“Sinulit mo naman ang relieve mo sa amin, sir.”
We also had to attend to a patient who went into cardiac arrest twice that night. The patient
passed away, but I was still on duty1. I proceeded with the post-mortem care, a procedure so
routine, I could do it with my eyes closed.
Suddenly, I felt a stream of tears silently run down my cheeks. I was startled. I had always kept
myself strong, able to keep my emotions at a distance, as well as professionally console the
bereaved. But at that moment, the emotions overcame me, and I realized that I was but human.
I let the tears flow, and it was I who needed consoling.
“Magbubukas na ang COVID Wards.”
Copyedited by Gabrielle P. Flores
1
See glossary.
45
Photo by Brent Viray
I realized that I was but human.
I let the tears flow, and it was I who needed consoling.
46
47
48
Photo by Jay Almora
DISEASE
49
50
Disease
/di-’zēz/ n.
A condition that impairs the normal functioning of a living organism,
and is typically manifested by distinguishing signs and symptoms.
Inch by inch, the pandemic has begun to morph the familiar. Fear,
doubt and uncertainty lay in the background as the Philippine
General Hospital transforms into the COVID-19 referral center it was
promised to be. Changes are being made at a feverish pace, and, from
illness or demands of work, PGH patients and staff feel increasingly
short of breath. Duck, jab, sidestep - the battle is in full swing.
51
A Battle of Silence
Cary Amiel G. Villanueva
The Philippine General Hospital (PGH) is no
stranger to war.
During the Second World War in 1945,
its walls stood firm as shelling and savage
fighting broke out when desperate Japanese
troops refused to give ground to determined
American forces. Thousands of patients,
workers, and refugees sought shelter under its
roof1.
Seventy-five years hence, the hospital is
once again in the middle of another historic
struggle, this time against the COVID-19
pandemic. But unlike the Battle of Manila2,
which was fought with bursts of gunfire and
the din of explosions, the present war against
the coronavirus only has deafening silence.
We didn’t know that the Department of
Health (DOH) had assigned PGH as a
COVID-19 referral center until our relatives
and friends told us about this being announced
in the news. It took days before the hospital
administration communicated this officially to
the staff and employees.
Silence in the wards
Any medical resident, intern, or clerk3 would
know that Wards 1 and 34 are almost always
full, as patients would keep flowing in from
the Emergency Department. Yet in a matter
of days, the wards and intensive care units3
were totally vacated. The everyday sounds of
ventilators whooshing, monitors beeping, and
patients coughing were suddenly gone.
Dr. Honorato Quisumbing, was a medical intern who continued to work at PGH during World War II. He was shot and killed on February 17, 1945, while trying to get water from a
bomb crater near the Cancer Institute. On the same day, the PGH was liberated by American forces. Today, a residential dorm for PGH staff is named in his honor.
2
The Battle of Manila lasted a month and was one of the most destructive urban campaigns in the war. In an attempt to finally retake Manila from Japanese occupation, the
American and Filipino forces clashed with the Japanese troops in the city’s densely populated streets, resulting in thousands of military casualties and over a hundred thousand
civilian deaths. Entire city blocks were levelled, resulting in the loss of innumerable architectural and cultural landmarks that were part of the nation’s national patrimony.
3
See glossary.
4
Wards 1 and 3 served the patients of the Department of Internal Medicine. Prior to being a COVID Referral Center, these wards had a combined bed capacity of over a hundred
and catered to adult patients with diseases ranging from the more common infections, to rare and difficult to diagnose and treat entities.
1
52
Silence in information
The Philippine General Hospital (PGH) is no stranger to war.
Dr. Jairus Cabajar stands among empty beds in the Medicine Ward as the Philippine General Hospital prepares its staff and facilities to be one of the COVID Referral
Hospitals in Metro Manila.
Photo by Jairus Cabajar
53
Silence among comrades
Reorganizing the workforce into teams coming in for duty1 once every three weeks meant that fewer
doctors, nurses, and other personnel could care for patients. The reduced staffing served to add lines
of defense, sparing others from exposure. But this meant that many colleagues who had become close
friends and confidants would not see each other for weeks, likely months. The usual banter was no
more.
Silence inside personal protective equipment1 (PPEs).
The several layers of full-body protection that we had to wear in the COVID-19 areas made everything
more challenging: walking, writing, sitting, and typing. Hearing and being heard became difficult. We
have learned to listen to our own thoughts during most of the shift.
Silence at home.
After doffing1 the PPE and being relieved from duty, one left work in solitude. In order to protect their
loved ones, many were forced to make arrangements to live alone. We retired to our own solitude.
Copyedited by Amanda Christine F. Esquivel and Gabrielle P. Flores
54
1
See glossary.
A Normal Day
Viktoria Ines P. Matibag
On a normal day, I would go to the hospital at 5:00 a.m. to
do rounds1 on patients who were admitted under my service.
There would be at least 10 of them that I would have to
see. The three OB-GYN wards would be packed, each
having at least 50 patients. During peak delivery season,
there would be an additional 30 patients crammed inside
a small, make-shift recovery room upstairs, waiting
for available beds in the wards. I would make my way
through the wards to see my patients, hoping for a
smooth postoperative course so I could send them home.
On a normal day, we would all go to Summary Rounds,
which would start at precisely 7:00 a.m.
Obstetricians-on-duty for the past 24 hours would
endorse1 the cases that they had admitted to all the
residents, interns, clerks, and integrated clinical clerks1
(ICCs). When the chief resident chose to probe your
patient’s case, 30 minutes would feel like forever.
On a normal day, the out-patient department1 (OPD)
would be packed with hundreds of people, hoping for a
chance to be seen by a physician.
1
2
They would fall in line as early as 3:00 a.m., some of
them hailing from far-flung provinces. We would see
around 50 new patients in the morning before we
checked on our follow-up patients in the afternoon.
Lunch breaks were a luxury. Patients who braved
the sweltering heat in uncomfortable waiting areas
would be seen only for ten minutes, in order for us to
accommodate everyone before 5:00 p.m.
On a normal day, the OB Admitting Section2 would never rest.
Patients would come in one after another. For many
of them, it would be their first time setting foot in
our institution. “Saan po kayo nagpapacheck-up?” the OB
Admitting Section resident would ask. The answer would
almost never be PGH. Still, there would be a shopping
list of responses on why they came anyway: inadequate
local facilities, financial constraints, or a complete
naivete to prenatal check-ups. We would admit around
20 patients daily, regardless of their financial status. They
had gone to our institution because they had nowhere
else to go, and despite the lack of manpower and
facilities, we would take them in and ensure their safety.
See glossary.
The OB Admitting Section or OBAS for short is the emergency room of the Department of Obstetrics and Gynecology. While part of the bigger ER complex, it is
practically a self-contained unit where the department receives its patients with obstetric or gynecologic emergencies such as a mother in labor or a cervical cancer
patient with profuse vaginal bleeding. At the time of writing, the PGH ER complex was under renovation and the OBAS was temporarily located to ward 15 of the
hospital. This makeshift OBAS has 6 beds, but usually serves much more, extending its capacity by accommodating patients on extra stretchers and benches.
55
Today is not a
normal day.
Tomorrow will
not be normal as
well.
An OB-GYN resident and nurse deliver a baby in full protective gear inside the temporary OB Admitting
Section (OBAS).
Photo by Issa Matibag
56
On a normal day, the labor room would never be empty.
The Labor and Delivery Room (LR/DR) complex has
been under renovation for the past two years. Our makeshift labor room could only hold around eight patients,
but on a normal day, around 10-15 laboring patients
would occupy the room. Some would sit on monobloc
chairs in the corner of the room, even if they were in
labor. That was how crowded it was. It was neither ideal
nor comfortable, but these mothers endured for the sake
of their babies’ safety.
On a normal day, residents who had just finished their
24-hour duty1 would be in the gynecology operating
rooms (OR) to start doing elective surgeries1 on patients.
We would be inside the OR until past midnight to finish
operating on four or five more patients. It would be
another long day before we could finally get some rest;
however, our drive to improve our surgical technique
and to help our patients would keep us going.
Today, I don a bunny suit, an N95 mask, goggles, and a
face shield1. It takes a while before I get myself ready to do
rounds on patients. I waddle down the now-empty
hallway of the Emergency Room to get to Ward 15, the
one that used to house over 50 postpartum patients.
Today, that same ward has only five COVID-19 suspects.
Today is not a normal day. Tomorrow will not be normal
as well. We have not had any normal days since the enhanced
community quarantine1 started. Our wards have been emptied.
Our labor rooms are silent. Our delivery rooms are unused.
And today, I think about our patients. This pandemic
will not stop these mothers from having complicated
pregnancies. It will not stop mothers from having
hypertensive or diabetic diseases that will need immediate
care. It will not stop mothers from having preterm labor. It
will not stop cancer from growing on women’s cervixes and
uteri. The presence of the virus does not eliminate the other
illnesses that we used to treat; yet, our patients are not here.
Today, I ask myself: “Where are our patients?”
Copyedited by Marcela Mercedes S. Rodolfo
1
See glossary.
57
Let Me Tell You About PPEs
Ella Mae Masamayor
Let me tell you about PPEs1, or personal protective
equipment.
I’m talking about Level 4 ones by the way, the kind we
have to wear when we report for COVID ward duties.
We’ve used up an awful lot of them as health care workers.
I’m sure you’ve seen the seemingly unending stream of
social media posts appealing for donations. Believe me, we
still need every single donation we can get, so I thought it
would be nice to shine a light on what they are and how
we use them.
Let me first clarify that I am by no means an infectious
disease expert. I don’t know the answers to many
technicalities. What I can and do intend to do, though, is
walk you through the PPE experience.
This is all new to me, too. I never imagined that I would
have to wear something like this in residency. Yet here
we are.
First, scrub suits. We have to wear scrub suits before
we don the PPE. No other outfit is acceptable. You can
bring your own or use whatever hospital-issued scrubs
are available (no guarantee you’ll get one that fits you
though; today I got one that was three times my size).
58
1
See glossary.
Photo by Alla Tan
You have to bring a separate pair of shoes, too, worn
only when in PPE.
you put them on. Before I do, I always take a deep breath
to relish the air while I’m still able to breathe freely.
Before anything else, hand hygiene. You know the drill.
20 seconds. Over, under, and in between.
Once it’s on, it’s goodbye to breathing normally.
Next, we put on shoe covers. Yes, they are exactly what
they sound like. Shoe covers. Don’t confuse them with
your head caps, though, because they do look very much
alike. Tape them to your shoes since they’re pretty flimsy
and tend to fall off. If you want, you could add a layer of
plastic after the shoe covers, just for added protection.
After this, put on your first pair of gloves. This pair
should never come off for the entirety of your shift.
Up next is the bunny suit. It’s basically a thick plastic
onesie. They come in sizes, and a good rule of thumb is to
make sure that you pick a size that gives you ample room
to move around. Even better, grab one a size higher than
what you think is large enough. Trust me, you do not want
an ill-fitting bunny suit. Get in and zip up. Just so you
know, you’ll probably start to sweat at this point.
The N95 masks1 come next. It’s not the first time I’ve
ever had to wear them; we had tuberculosis patients on
a near-daily basis before COVID happened. But I’ll be
honest—I’ve never found these masks comfortable. They
definitely serve their purpose of defending us against
airborne infections and are a very, very scarce resource
these days. Still, breathing becomes extra difficult when
1
See glossary.
Goggles go on next. Goggles tend to make or break the
PPE experience. It’s a given that movement of all sorts
is difficult when you’re wearing the entire outfit, but
not being able to see clearly is a whole other battle. On
a bad day, goggles fog up to the point of zero visibility.
There are anti-fog sprays to counter this, thankfully, but
sometimes they fog up nonetheless. There are better
days, sure, but even on those days don’t expect your
vision to be crystal clear.
Next, put on your head cap. If you’ve ever seen a shower
cap, it’s pretty much the same thing. Again, don’t
confuse the shoe covers for the head caps and vice versa.
The bunny suit has a hood. At this point, you put that
hood on. You strap on a face shield, too. And finally, you
put on your outer gloves. Unlike the first pair, this one you
have to change periodically each time you see a patient.
Think of these as your disposable hands.
Just before you go, the safety officers check your PPE.
Thank God for them because like I said, all of this is new
to me, and I sometimes get confused with the steps. They
check if you’ve worn everything properly and tape you up
in strategic areas to ensure that there are no breaches.
59
Photos by Isabel Acosta and Alla Tan
Final touch: your name gets written on your bunny suit. Remember, when you go in, everyone will be in
a bunny suit. Without names, it will be almost impossible to recognize anyone. Even with these makeshift
name tags, sometimes I still end up talking to the wrong person. A printed picture of your face is optional,
but definitely welcome. Patients like that. It makes them feel like they’re not talking to just spacesuits.
60
After all of this, you’re good to go. Congratulations, you
are now an astronaut.
I have no way of sugarcoating it: It’s hard in that suit.
After I don the PPE on the ground floor, I head over to
my assigned area on the second floor. Once I reach the
top of the steps, I’m practically out of breath. When I
get inside the ward, the work itself isn’t so different from
what I’ve been doing before, but there are so many extra
layers of challenges with the PPE on. We don’t get to use
stethoscopes the way we used to, since the bunny suits
cover our ears. We make do with whatever physical exam
finding we can get from inspection and palpation. Pulses
are harder to check. Blood extractions are harder to get
right. My handwriting looks completely different. Even
reading and replying to texts becomes a struggle.
Come to think of it, sometimes it does feel like I’m an
astronaut. Not in the childhood-dreams-reaching-for-thestars kind of way. I’m an astronaut in the sense that I feel
alone, on an entirely different planet.
In the PPE, even when you’re with your fellow astronauts,
you still feel isolated. Distant. Voices are harder to hear and
every touch never quite feels the same. Everything, and
everyone, feels so far away.
At the same time, there’s that ever-present fear for your
own safety, as every breach in the PPE significantly raises
your risk of infection. I’ve been doing this for close to two
months now, but the anxiety never really goes away. Paige
Lewis captured that anxiety so eloquently when she said:
“I feel as if I’m on the moon listening to the air hiss
out of my spacesuit, and I can’t find the rip.”
(On the Train, a Man Snatches My Book, Reads)
This still feels surreal, even after several weeks in. It feels
like we’re a million light years from how things used to
be. I’m trying to adapt to the fact that PPEs are the new
normal for me, just as everyone else is struggling to find
their own new normalcy; our own equilibrium through the
constant change.
I don’t know what will happen from hereon, but I hope
we’ll keep finding ways to adapt, to carry on, to keep
exploring what remains uncharted.
In the meantime, back to the bunny suit I go.
Copyedited by Caeley Lois S. Hao
61
Fish Out of Water: A Dermatologist in COVID
Amanda Christine F. Esquivel
It started out as a simple conversation.
“This Coronavirus is getting out of hand,” one of
my dermatology co-residents1 said one February
morning. She was browsing her Facebook feed. It
was half past seven, and we were enjoying a cup of
coffee before the work day started and the deluge
of patients and students arrived.
“I know,” I said, sighing. I had just seen a report
that China’s deaths from the Coronavirus had
just exceeded those from SARS. “It’ll get worse.”
“I hope not,” she said. “If it comes to the
Philippines, we’re not ready.”
“I don’t think any country is ready.”
“May charts1 na,” our nurse called out with a smile,
distracting us with a thick stack of patients’ charts.
We residents shrugged at each other, and stood to
begin our day. Our conversation was tabled, only to
be recalled months later.
Our friends from other specialties started drowning
in work. Besides doing their usual resident duties
of doing rounds1 and charting for the patient, they
also suddenly had to carry their own orders out and
monitor the vital signs1 of their patients—work that
used to be done by clerks1 and interns1.
The Department of Dermatology decided to
volunteer and return to the emergency room to
help in whatever way we could, through whatever
way was needed. It hasn’t been an easy transition
though, as some of us haven’t been to the ER—
except to answer dermatology referrals1—in years2.
“Does anyone have an automatic BP app?” one of
my seniors called out.
“Donated my pulse ox3 last year,” another replied.
“Didn’t think I’d need it anymore.”
See glossary.
The practice of dermatology is largely out-patient based. They are usually in their clinic at the Out-Patient Department when they are not answering ward or ER referrals.
3
A small, portable, electronic device, clipped on to a patient’s finger to measure the oxygen saturation in an artery.
1
62
Looking back, I am stunned at what we were able
to foreshadow. A simple conversation; a shot-inthe-dark prediction. When we talked two months
ago, I never really thought it would come to this.
2
Doctor first and foremost.
Dermatologist, next.
“Where’s the ABG4 station now?” someone chimed in. “And where do
we get ice? Bantay-antayan1 pa ba?”
Eventually, things fell into place. The necessary monitoring materials
were scrounged up, found buried in the back of our cabinets. Words
of advice were passed on, with the first years informing the third
years of how things were in the makeshift ER. Dermoscopes were
traded for stethoscopes, skirts and heels for jeans and sneakers.
As the first of us headed to the emergency room, we wished them
good luck and jokingly said #dERma. The rest of us strove to pick
up the pace to cover the work left behind.
But that was only the beginning.
When PGH was designated as a COVID center, we were called in to help
man the triage5. Some of us were tasked to be Safety Officers for the COVIDcapable wards, but then, as the pandemic continued and the number of patients
rose, we were reassigned as COVID ward residents as well.
Through the humid and foggy layers of her protective gear, Dr. Mandy Esquivel writes down her
orders and notes on the charts of COVID patients.
Photo by Mandy Esquivel.
It snowballs, one thing after another; every week the schedule and
tasks keep evolving. Nothing stays the same for anyone, and everyone
learns to roll with the punches. If this wasn’t what you signed up for,
well, in the flurry of activity, you got over it fairly quickly.
As triage officers, we abandoned Fitzpatrick6, our bible, to study
COVID algorithms and their respective criterion and management1.
See glossary.
An Arterial Blood Gas (see glossary: ABG) requires quick processing (≤15 minutes) to yield accurate results; however, this quick turnover may not always be possible due to
the sheer number of samples that need to be processed. As a precaution to prevent inaccurate results, ABG samples are put in ice before being sent to the lab. Ice can usually
be bought at the sari-sari store next to the Bantay-antayan, a chair-lined area on the premises of PGH where watchers of ICU patients may rest while waiting for news.
Currently, the laboratory that is dedicated to processing Arterial Blood Gas samples can be found on the second floor of the Philippine General Hospital.
5
Triage refers to the prioritization of patient care based on their illness/injury, prognosis, severity, and resource availability. A triage system enhances the efficiency and
effectiveness of an emergency department.
6
Fitzpatrick’s Dermatology is a textbook that serves as the main reference for residency in Dermatology.
1
4
63
Guidelines changed weekly; everyone struggled to keep up.
As safety officers, we mastered donning and doffing1.
Mastering the reverse order was trickier, as doffing the suits
carried a higher risk of contamination.
As ward officers, we brushed up on pneumonia1, respiratory
failure, and ventilators.
“I’m studying ARDS7,” a co-resident told me. “We’ll
probably be in the wards next week.”
“I’m still a doctor, aren’t I?” Doctor first and foremost.
Dermatologist, next.
Early this year, in the midst of clinical and administrative
work, we had prepared for exams in March, journal reports
in April, research protocols in May, ward rotations in June.
We had control over everything; everything had been
scheduled and anticipated; everything had been prepared for.
“Me too,” another said. “Never thought I’d have to think about
mech vents again. Do you guys remember anything about
PEEP and tidal volume?8”
But then everything changed, and I was not prepared
anymore. We were not prepared. And while no one being
prepared can be terrifying, it is also, surprisingly, a comfort.
Because no one is prepared, we struggle together. With so
many unknowns and so much work to be done, all we know
is that we appreciate everyone who is willing to step up.
This question was met with blank silence, and we broke into
laughter. Humor helps us face the uncertainty.
Never mind if this is not our comfort zone—this pandemic
is no one’s comfort zone.
At home, my father came across me reading my internship
notes, and stopped to read over my shoulder. “Cardiac
arrest?”
I shrugged helplessly. “You never know.”
I have since put aside that I am training to be a
dermatologist. I am willing to bet that my colleagues from
other specialties have learned to put their specialties aside
as well. Perhaps one of my friends said it best: “We were all
doctors before we became specialists.”
People ask me how it feels to be a dermatologist called in
to help with COVID. The answer is bewilderingly simple.
And so, all of us who call ourselves doctors, all of us who
are licensed to heal, step up.
Copyedited by Sachiko S. Estreller
See glossary.
ARDS. Acute Respiratory Distress Syndrome.
8
Positive end-expiratory pressure (PEEP) and tidal volumes are commonly manipulated parameters on a mechanical ventilator. Dermatologists-in-training don’t often
use these parameters as the patients they treat rarely need mechanical ventilators.
1
7
64
Second Wind
Erika P. Ong
If this is it, Lord… game na.
This was the thought in Peejay’s mind whenever he, still
hazy from the medications, surfaced back into lucidity.
With his body too weak to form words, these thoughts
were confined to his own head, echoing when he was
conscious enough to think about his condition.
Peejay was 50 years old, working in a BPO, and was in
generally good health. He exercised regularly, and did
not take any maintenance medications. Nevertheless,
when there was news that one of his colleagues could
have contracted COVID-19, he chose to err on the side
of caution and went into a self-imposed quarantine1,
isolating himself from his family.
Initially, Peejay’s symptoms1 were very mild: only a low
fever. After five days, however, COVID-19 slowly reared
its ugly head. When his temperature spiked to 38.5
degrees Celsius, a physician friend advised him to seek
consultation. Peejay remembers panting in the shower as
he prepared to leave for his checkup. This was when he
felt the first tendrils of fear that he had been infected by
COVID-19.
1
See glossary.
After getting blood tests and having a CT scan done,
Peejay returned home. Breathing gradually became more
difficult. He was brought to a hospital in Quezon City,
where, from thereon, everything happened quickly. A
swab later confirmed that he had fallen victim to the
virus.
His health rapidly deteriorated. However, despite
being barely conscious, he was still able to convey his
abhorrence to being intubated1. His doctors had advised
this, which he knew would be a horrifying experience.
His family pleaded with him to reconsider this option.
With his family’s pleas, his doctors’ urging, and his
awareness of his own physical weakness, Peejay, with
trepidation, finally agreed to intubation.
For the next two weeks from then, Peejay was completely
under. He barely remembers anything that transpired,
but he heard the stories from doctors and family: of him
being in such a critical state, of his family being told to
prepare to let go, of his unconscious self clawing the tube
out of his own throat not once, nor twice, but four times.
Amidst the merciful drug-induced haze, he thinks he
remembers a glimpse of someone in his face, screaming,
“Sir, you have to cooperate!”
65
Though Peejay’s memories during these critical two weeks were, for the most part, blank, he remembers brief moments
of consciousness, waking up to pain and the constant incomprehensible medical chatter. He just thought, “I am going
to die.”
After two weeks, Peejay recovered his bearings. He found himself alone and restrained to the bed, with a tube down
his throat preventing him from talking. He did not even know that he had been transferred from the hospital in QC to
PGH because of the severity of his case. “I could not figure out what was happening and whether my family knew the
state of my condition,” recounted Peejay.
In hindsight, Peejay mused that his initial lack of consciousness and consequent amnesia were a small mercy. Peejay
would frequently do a scissoring motion with his hands, trying to communicate that he wanted the tube out. Breathing
with the ventilator1 was a challenge. He was advised, “sabayan ninyo ‘yong machine ”, which to him was easier said than
done: “I couldn’t understand. How does one actually do that with a tube stuck down one’s throat?” He felt very weak;
even the act of being turned in bed by his nurses to prevent bedsores further strained him.
But what was really difficult for Peejay, more than the physical pain, was the crushing isolation. Sometimes he would
be conscious for hours with his eyes closed, with only his thoughts to keep him company-Why did I get the virus?
How will I survive?
Will I survive?
Of all people, why me?
But the question that wracked him the most with terror was: Did I get my family infected?
Waking up to pain and the constant incomprehensible medical
chatter, he just thought, “I am going to die.”
66
1
See glossary.
Mouth agape with a ventilator helping him breathe, his mind conscious but his body too weak to do anything but
nod and shake his head, Peejay spent “two weeks na ceiling lang ang kausap.” Doctors greeted him and introduced
themselves, but they were also on rotation. Every few days, a different stranger tended to him. Nurses would
inform him of the date and of daily activities like feeding, but there was no one that Peejay could share his
loneliness with — no familiar face or hand to hold his.
All that distinguished one day from another was the light streaming through the window. Peejay recounted that
he really didn’t know where he drew his strength from during those weeks; there was only his faith.
Fortunately, a lifeline was thrown. He recovered enough strength to write, and he was provided a whiteboard
through which he could finally communicate. He requested for a mobile phone. This phone and its contents
provided the first sparks of happiness during this bleak time of his isolation. Family, friends, and officemates took
the time to record and send him messages.
When asked about any message that was especially moving for him, he explained that it was not the content, but
the sheer volume of messages and outpouring of support that touched him. “I did not realize so many people
cared about me,” Peejay explained. “We’ve been praying for you!” said many of the messages. His colleagues told
Peejay that they prayed for him together during lunch breaks. Around this time, he finally met a doctor whose
compassion he felt deeply. The doctor kept reassuring him, “Don’t worry! We’re taking care of you.”
These became the things he drew strength from.
Peejay, however, couldn’t be kept on a ventilator for long; his throat was already swollen and leaving the tube in any
longer put him at risk for other complications. They had to try to extubate1 and see if Peejay could breathe on his own.
If he couldn’t, he remembered being told that they would have to do a tracheostomy2. This would mean suffering
yet more weeks of being unable to speak. Bracing himself, Peejay prepared for another procedure. An empty bed was
prepared next to his, ready with a team to intubate him again if he proved unable to breathe without the ventilator.
1
2
See glossary.
Patients cannot remain intubated indefinitely. The tubes are a source of discomfort, and may get plugged with secretions. These can also be infected by new and more
virulent bacteria if these stay in for too long. The muscles of the chest can lose their tone, so patients may not be able to breathe on their own if kept intubated and
attached to a mechanical ventilator for some time. Sometimes, to enable a more stable airway access while minimizing further discomfort and other complications, a
tracheostomy may need to be done. Tracheostomy is a procedure that creates a hole in the patient’s neck, and a short tube is placed directly into the windpipe While it
can be attached to a mechanical ventilator, the machine is not necessary if the patient can breathe without it.
67
When the tube was removed, Peejay inhaled air
directly into his lungs for the first time in weeks.
To his immense joy, there was no need for a
tracheostomy. Peejay said, “From that time, I knew
that there was only one path I needed to go on, and
that was recovery.”
Not everything was smooth sailing. Peejay
was lucid, but his muscles were still weak from
weeks of disuse and he needed help doing some
essential things, like washing himself. During
these moments, he sometimes pitied himself, but
the far worse ordeals he suffered gave him the
certainty that he could get past these last few steps
to reach the finish line in his recovery. Hope had
appeared; each day was a little better. Peejay would
go from having to force himself to turn in bed, to
eventually attempting to stand all by himself.
After two more weeks of breathing and leg
exercises, Peejay had two consecutive negative
results for COVID-19, and he was finally
discharged in the third week of May.
Peejay feels that he was given a second chance at
life. He knows how close he came to not making it.
His doctors told him that a case like his had only
a 30% survival rate. At the time of the interview,
Peejay had just celebrated his 51st birthday —a day
he sees as a new beginning, a start of the “other
half of his life; a new cycle.” The second chance
he’s been given has imbued his life with new
meaning, telling him that he still has a mission in
life that he needs to fulfill.
What mission this is, Peejay doesn’t know yet. He’s
still searching for it. Meanwhile, he’ll just keep
doing what he always believed in doing: paying it
forward, starting with sharing his story of recovery
which he hopes can help others, especially those
who would find themselves in a similar position.
Though not completely recovered yet, Peejay
feels himself getting better day by day. Now, he is
working from home, taking it easy, and enjoying
another life-changing discovery: Netflix.
Copyedited by Gabrielle P. Flores
68
The Long Trek to the Front
Justin Bryan D. Maranan
By 4:30 a.m. every morning, Mary-Joy departs from her
small apartment in Parañaque. She rides with her husband
on his motorcycle all the way to PGH, where MaryJoy works as a security guard for the newly-established
“Bayanihan Na! Operations Center 1” (otherwise known as
the “PGH Hotline”).
Even though she does not have to report to work until
7:30 a.m., her husband needs to return to Parañaque
as soon as possible to work as a vegetable vendor. Like
Mary-Joy, her husband used to be in the security business,
working as a private bodyguard. However, much like
many other Filipinos during the lockdown1, he found
himself unemployed and in need of another job to
supplement their income.
Security guard Mary-Joy at the entrance
of the Bayanihan Na! Operations
Center in the PGH Nurses’ Home.
Photo by Justin Maranan.
1
2
Prior to the extended community quarantine (ECQ)1,
Mary-Joy used to take the FX 2 from Sucat to Pedro Gil,
which cost her only ₱35. Due to the shutdown of public
transportation, she has had no choice but to trouble her
husband for the early commute to work. However, their
current setup is much better than their alternative from
less than a month ago, when the couple were forced out
of their home in a small Parañaque subdivision.
See glossary.
Also known as UV Express, it refers to a type of public utility vehicle, oftentimes an SUV, or van. It was colloquially adapted from Tamaraw FX, which is an SUV model
that is often employed to function as a PUV.
69
“Pinalayas kami ng presidente nung subdivision. Mayroon daw kasing
memo na bawal ang mga nagtatrabaho sa PGH doon sa community
namin. Wala kaming magawa, so umalis na lang kami.”
While she was temporarily homeless, Mary-Joy spent her
nights at Alvior Hall3 along with her co-workers. Some
of them were also forced out of their homes due to the
discrimination against hospital workers. Others simply
could not find a way to commute between home and work.
Thankfully, people took notice of the situation Mary-Joy and
her fellow guards faced.
During the early days of the ECQ, Mary-Joy was instructed
by her supervisor to hold onto the key to Alvior Hall until
the arrival of a certain consultant1.
“Ayaw ko pa ibigay nung simula ” laughed Mary-Joy, recalling
when she was approached by someone asking for the key.
“Sabi ko, ‘Kay Dr. Tony Perez ko lang daw po ibibigay itong susi.’ ”
“Alam ko, ako si Tony Perez eh,” said the chair of the
donations arm of PGH’s Bayanihan Na! Operations Center1.
Not long after that first meeting, Dr. Tony Perez saw MaryJoy with her other co-workers, lying on makeshift mattresses
of cardboard.
1
3
70
“Nilapitan kami ni Dr. Tony… [and he asked], ‘Bakit kayo
nakahiga dyan? ’”
After learning of their plight, Dr. Perez talked with the other
administrative officers on how they could help out. Mary-Joy
and her coworkers were allowed to stay at Alvior Hall, and
were provided with mattresses and sanitary products.
“Kung may kailangan pa daw kami, sabihan lang daw namin
sila,” Mary-Joy recalled.
Another doctor, Dr. Lacambra from Family Medicine, had
checked in with the workers staying at Alvior.
“Tinatanong niya kami kung nakakakain ba kami ng tama, lalo
na kasi wala kaming lutuan doon dati. Sabi namin, ‘once a day
nakakakuha naman po kami ng pagkain galing kay Father.’”
The kind doctor threw the question back at them, “Isang
beses lang ba kumakain isang tao sa isang araw? ”
Thereafter, the workers started receiving at least three free
meals daily (from the Dietary department and from outside
donations), without fail. Mary-Joy was initially overwhelmed
by the support from the doctors, feeling almost guilty for
accepting their help. Despite the discrimination she has
faced as a hospital worker, she acknowledges that she has
been luckier than others.
See glossary.
Alvior Hall is a building on the UP Manila campus, in the area of the College of Medicine. The building itself is a landmark, being architecturally unique compared to the
more aged buildings adjacent to it (i.e. Calderon Hall, Lara Hall). It was converted into the donation hub for the Bayanihan Na! Operations Center during the pandemic.
“Swerte pa rin dahil nakakapagtrabaho kami ngayon,
inaalagaan pa kami dito sa PGH. Pero paano naman yung
mga tao sa labas; nagugutom din sila diba? Di man sila
mamatay sa COVID pero namatay naman sila sa gutom.”
Thankful for being able to go to work another day, MaryJoy walks to the Nurses’ Home1 building at 8 a.m. to start
her shift, right after the morning formation of guards at
Alvior Hall.
As the PGH hotline volunteers arrive for their stint,
Mary-Joy checks their temperatures and bags, while
asking those with personal gadgets (e.g., laptops) to log
their belongings on a ledger. She also texts Dr. Tony
Perez when she notices any shortages in supplies, such as
facemasks.
Beyond her official responsibilities, she also maintains the
cleanliness of the lobby outside the hotline facility, which
doubles as a dining area during mealtimes. At the start of
every meal, Mary-Joy ensures that there is enough food
for the call-center personnel on duty. This is how she
became a favorite among hotline volunteers—who usually
spend their meal breaks chatting with the friendly guard.
I asked Mary-Joy during one of those lunchtime
conversations: given the chance, would she take the
opportunity to work outside PGH during this pandemic?
“Di po siguro, Doc. Ewan ko bakit hinahanap ko PGH.
Kung gusto ko talaga umalis, nag-resign na rin ako agad nung
naglockdown.” She laments over how much the volunteers
and staff in PGH have given up for the fight against
this pandemic. “Sila rin may mga pamilya, pero inuuna pa rin
nila yung mga pasyente na kailangan sila. Lahat tayo dito, di ba
lumalaban tayo para sa ibang tao?”
Mary-Joy ends her shift at 8:00 p.m.. Before leaving,
she always ends up bringing home excess food-items—
untouched meals from the PGH hotline that volunteers
insist she take with her. She only keeps one of these for
her husband; the rest of the food, she gives away to the
homeless around their new apartment in Parañaque. She
is always careful not to disclose that she works at PGH.
It would be difficult to find another place of residence
during the ongoing pandemic.
At the end of the day, Mary-Joy silently recites a prayer of
gratitude. As a religious person, these daily prayers will
have to do for now. “Pagkatapos ng COVID na ‘to, una kong
gagawin ay magsimba sa Quiapo at magpasalamat sa Panginoon
para sa mga blessings na binigay niya sa amin.”
She then goes to sleep, ready for tomorrow’s work, and
blessings.
Copyedited by Iris D. Ditan
1
See glossary.
71
Lahat tayo dito, di ba lumalaban tayo
para sa ibang tao?
The dedicated security guards of the PGH Emergency Room.
Photo by Brent Viray.
72
Within days of their pull-out from the hospital, many soon-to-be doctors of the UP-PGH Interns Batch 2020 volunteered their time and resources into helping the
administration set-up the Bayanihan Na! Operations Center (BNOC). In the weeks ahead, the interns served as call-center agents who coordinated monetary and
material donations and responded to COVID-related queries from anyone who calls in to the hotline.
Photos by Yas Salces and Jonas Del Rosario.
73
Photos by Markyn Kho and Justin Maranan.
74
Empty Spaces
Compiled by Amanda A. Cheong
Disclosure: The piece contains the text exchange between two friends, and starts on the first morning of the ICU1
confinement of one of them. The names of persons and institutions have been changed for privacy purposes. Some
lines, which referred to transactional concerns that came up in the early part, were not included. Typographical details
were maintained.
Grief rests in places where loved ones used to stand—in the lonely seat at the dining table; in the quiet of a vacant office; in the empty space
where a reply should have been.
MARCH 21, 2020, SATURDAY
CHRIS 6:54am
Kamusta ang prison life?
RIC 7:04am .
Sakit sa likod hehe They’re giving me meds. I’ve been taking.
Hopefully the IV antibiotics will help
CHRIS 7:08am
Ok. Sana mabilis wifi diyan.
CHRIS 7:10am
Btw nagtatanong si Rosa kung kamusta ka. Ok to tell them PUI1 ka, stable naman,
pero admitted at PGH pending test result and for isolation purposes?
RIC 8:28am .
Ok to tell them, Chris. Thanks.
1
See glossary.
75
MARCH 23, 2020, MONDAY
MARCH 24, 2020, TUESDAY
CHRIS (edited) 5:41am
Good morning Ric. Hope things are better again
this morning. Friends from outside NCR are
asking about your status. Do I confirm, or baka
you want to do so? Okay lang if neither.
RIC 12:20am .
Chris, just in case I’ll be intubated , kindly call my sons & explain to them.
Just update them daily please. They know your number. Thanks
RIC 8:05am .
Sana tuloy tuloy na Chris. Ok lang. Thanks
CHRIS 8:16am
Post individually o sa Viber1 group: Ric is feeling
better & is eager to go home soon - after the
checkpoints and quarantine1 measures are lifted!
We all hope & pray for Ric’s as-fast-as-a-Harley
recovery, fortitude for his family, and the wellbeing of all our other affected colleagues.
RIC 8:17am .
Hahaha thanks
RIC 8:20am .
Sabihan mo rin ako kung nakapasok
si Joan sa medical school .
1
Huwag mo munang sabihin of course. Baka lang me mangyari sa akin.
.
CHRIS 12:22am
OK Ric. Do you feel worse? Anything else you need done?
RIC 12:30am .
Wala naman na, Chris. Thanks
RIC 12:31am .
Na istorbo lang ako hourly monitoring.1
Every time I sleep biglang gigising. Hirap na bumalik sa tulog
RIC 12:32am .
Stats is 95-96-97
CHRIS 12:33am
Really hoping for the better. Can only imagine how depressing &
distressing ang pinagdadaanan mo. Am not a religious person, but
do believe we are children (& often act like so!) of God - whose
presence we feel when we are most in need of comfort. Hope
you get to feel this despite the many disheartening moments. Do
not worry about your kids. Be proud & inspired w/ what they are
already able to do. Will be checking on them, while you work fulltime at getting better.
CHRIS 12:34am
Huwag mo na tignan pulse ox.1 Drops ng IV na lang bilangin mo
para makatulog ka na.
RIC 12:35am .
Hahaha
76
1
See glossary.
MARCH 24, 2020, TUESDAY
RIC 6:24am .
Do you think I should transfer, Chris?
CHRIS 7:38am
Ok. Prepare yourself Ric.
CHRIS 7:00am
Good morning Ric. Just read your message.
Why are you thinking about transferring?
RIC 7:06am .
Walang duty na fellow1 akong nakita
RIC 7:06am .
Paano kung ma intubate?
RIC 7:08am .
Puro nurses ang interaction ng Px sa gabi
CHRIS 7:09am
Don’t know if makakalipat ka, & where makakapunta.
CHRIS 7:10am
BTW, just Vibered your sons. Sabi ko just to keep in
touch.
RIC 7:30am .
Salamat. preemptive intubation is being discussed now
1
CHRIS 7:32am
Baka you will have to stay put there then.
RIC 7:33am .
Ok Chris. Pwede mo sila tutukan everyday? Thanks
1
See glossary.
RIC 7:45am .
Ok Chris
RIC 10:13am .
CHRIS 10:19am
Akala ko sedated ka!
RIC 10:20am .
Paki remind na lang that Huwag na patagalin in case
me improvement. Thanks
CHRIS 10:23am
You mean extubate ka soonest? Guess call nila.
Will relay updates only to your kids unless they say
otherwise.
RIC 10:24am .
Thanks, Chris 👍🙏
CHRIS 10:25am
Huwag mo na muna labanan ang sedation at matulog
ka na muna.
CHRIS 7:35pm
Sana ay may nag-re-recharge ng phone mo.
Sabi if need virtual company.
77
MARCH 25, 2020, WEDNESDAY
RIC 1:33pm .
Chris, is okay to checkout he cough if the kids. Ty
CHRIS 1:45pm
Will do. We will take care of the rest, you take care of yourself.
MARCH 26, 2020, THURSDAY
CHRIS 11:22pm
Don’t know if you have been told that Joan has been listed for interview @ med school.
There were no more forthcoming messages from Ric.
In the empty spaces where we can paint a picture of a loved one’s last moments, we can imagine the struggle —
a plea reaching out to ask “Chris, is it okay to check if the kids have a cough? Ty.” We can imagine the mental
haze that typed out jumbled words; but imagine, too, that unrelenting need to know that his children were safe.
In the empty spaces of this piece where a father can no longer write his thoughts, imagine love. Warm sunlight
instead of the lonely cold; laughter and stories over dinner instead of the incessant beep beep of too many
machines.
In the empty spaces where he might have seen that last text, imagine pride melting into peace.
MARCH 31, 2020, TUESDAY, at 6:25 am
Ric passed away from complications due to COVID-19
78
And In Return
Robyn Gayle K. Dychiao
A‌‌parent’s‌‌love:‌‌a‌‌deep‌‌fondness‌‌that‌‌lasts‌‌from‌‌birth‌‌to‌‌death.‌‌‌
A‌‌first‌‌love‌‌that‌‌leads‌‌to‌‌a‌‌lifetime‌‌of‌‌delight‌‌and‌‌warmth.‌‌
As‌ ‌a‌ ‌parent‌ ‌loves‌ ‌his‌ ‌child,‌ ‌so‌ ‌does‌ ‌the‌ ‌love‌ ‌of‌ ‌a‌ ‌child‌ ‌for‌ ‌his‌ ‌parents‌
‌abound.‌‌‌
‌
On‌ ‌September‌ ‌8,‌ ‌2020,‌ ‌Dr.‌ ‌Jonas‌ ‌del‌ ‌Rosario‌ ‌was‌ ‌invited‌
‌to‌ ‌share‌ ‌his‌ ‌COVID-19‌ ‌story‌ ‌on‌ ‌a‌ ‌Catholic‌ ‌evangelization‌
‌ministry‌ ‌Dominus‌ ‌Est’s‌ ‌online‌ ‌program.‌ ‌He‌ ‌spoke‌ ‌of‌ ‌his‌
‌battle‌ ‌against‌ ‌this‌ ‌unforgiving‌ ‌disease,‌ ‌being‌ ‌a‌ ‌doctor,‌
‌son,‌ ‌and‌ ‌patient‌ ‌through‌ ‌this‌ ‌pandemic.‌ ‌
‌
“Ako‌ ‌po‌ ‌si‌ ‌Dr.‌ ‌Jonas‌ ‌del‌ ‌Rosario.‌ ‌Isa‌ ‌po‌ ‌akong‌ ‌‌pediatric‌
‌cardiologist‌,‌ ‌at‌ ‌ako‌ ‌rin‌ ‌po‌ ‌ang‌ ‌spokesperson‌‌ ‌ng‌ ‌Philippine‌
‌General‌ ‌Hospital.‌ ‌Noong‌ ‌nagkaroon‌ ‌ng‌ ‌pandemya,
‌n
‌‌crisis‌
aging‌ ‌aktibo‌ ‌ako‌ ‌sa‌
‌team‌‌ ‌ng‌ ‌PGH.‌ ‌At‌ ‌dahil‌ ‌doon,‌
‌k inailangan‌ ‌kong‌ ‌magbasa‌ ‌at‌ ‌mag-aral‌ ‌tungkol‌ ‌sa‌ ‌sakit‌ ‌na‌
‌ito.‌ ‌Marami‌ ‌akong‌ ‌natutunan‌ ‌at‌ ‌naging‌ ‌malalim‌ ‌ang‌ ‌aking‌
‌kaalaman‌ ‌sa‌ ‌COVID-19.‌ ‌Ngunit‌ ‌l ingid‌ ‌sa‌ ‌aking‌ ‌kaalaman‌
‌na‌ ‌ito‌ ‌pala‌ ‌ay‌ ‌magiging‌ ‌isang‌ ‌personal‌ ‌na‌ ‌karanasan‌ ‌na‌
‌s‌‌will‌
abi‌ ‌nga’y‌
‌shake‌‌me‌‌to‌‌the‌‌very‌‌core‌‌of‌‌my‌‌being .‌ ‌
‌
“May‌ ‌tatlong‌ ‌buwan‌ ‌na‌ ‌simula‌ ‌nang‌ ‌kumalat‌ ‌ang
‌COVID-19‌ ‌noon.‌ ‌Sinasabi‌ ‌ng‌ ‌mga‌ ‌magulang‌ ‌ko,‌ ‌‘Ikaw‌ ‌ay‌
‌nasa‌ ‌ospital‌ ‌na‌ ‌maraming‌ ‌mga‌ ‌may‌ ‌COVID-19,‌ ‌at‌ ‌ikaw‌ ‌ay‌
‌mag-ingat.’‌ ‌Lagi‌ ‌silang‌ ‌nag-aalala‌ ‌para‌ ‌sa‌ ‌akin,‌ ‌at‌ ‌ganoon‌
‌rin‌ ‌ako‌ ‌sa‌ ‌kanila.‌ ‌Lagi‌ ‌ko‌ ‌sinasabi‌ ‌sa‌ ‌kanila‌ ‌na sila‌ ‌rin‌ ‌ay‌
‌mag-ingat.‌ ‌
‌
1
See glossary.
“Ngunit,‌ ‌noong‌ ‌July‌ ‌11,‌ ‌dinala‌ ‌ko‌ ‌ang‌ ‌aking‌ ‌ama‌ ‌sa‌ ‌PGH.‌
‌Siya‌ ‌ay almost 90‌ ‌years‌ ‌old.‌ ‌Dahil‌ ‌nahihirapan‌ ‌siyang‌
‌huminga‌ ‌at‌ ‌ubo‌ ‌siya‌ ‌nang‌ ‌ubo,‌ ‌pina-admit‌ ‌ko‌ ‌siya‌ ‌sa‌
‌PGH.‌ ‌Doon‌ ‌ay‌ ‌nakitaan‌ ‌na‌ ‌mayroon‌ ‌siyang‌‌ ‌COVID-19‌
pneumonia1. Talagang kinabahan ako. Alam ko na kung‌‌
‌
ikaw‌ ‌ay‌ ‌may‌ ‌katandaan‌ ‌na,‌ ‌maaaring‌ ‌maging‌ ‌malubha‌ ‌ang‌
‌COVID-19,‌ ‌at‌ ‌maaari‌ ‌nila‌ ‌itong‌ ‌ikamatay.‌ ‌
‌
“Ngunit‌ ‌t inago‌ ‌ko‌ ‌itong‌ ‌takot‌ ‌na‌ ‌ito.‌ ‌Kailangan‌ ‌kong‌
‌maging‌ ‌matapang‌ ‌para‌ ‌sa‌ ‌aking‌ ‌ama,‌ ‌dahil‌ ‌nakikita‌ ‌ko‌ ‌sa‌
‌kanyang‌ ‌mukha‌ ‌na‌ ‌siya’y‌ ‌malungkot.‌ ‌Ilang‌ ‌araw‌ ‌na‌ ‌lang‌
‌ay‌ ‌kanyang‌ ‌i-‌ce-celebrate‌‌ ‌ang‌ ‌kanyang‌ ‌90th‌ ‌‌birthday .‌
‌‌Ngunit‌ ‌dali-dali‌ ‌ko‌ ‌siyang‌ ‌dinala‌ ‌at‌ ‌pina-admit‌‌ sa‌ ‌PGH.‌
‌Kapag‌ ‌kayo’y‌ ‌nagka-COVID-19,‌ ‌solo‌ ‌lang‌ ‌kayo‌ ‌sa‌ ‌kwarto‌
‌ninyo.‌ ‌Ngunit‌ ‌hindi‌ ‌ko‌ ‌puwedeng‌ ‌i iwan‌ ‌ang‌ ‌aking‌ ‌ama,‌
‌kaya‌ ‌ako’y‌ ‌naglakas‌ ‌ng‌ ‌loob‌ ‌at‌ ‌sinuot‌ ‌ko‌ ‌ang‌ ‌aking‌ ‌PPE,‌
‌para‌ ‌ipadama‌ ‌sa‌ ‌kanya‌ ‌na‌ ‌hindi‌ ‌siya‌ ‌nag-iisa.‌ ‌Araw-araw,‌
pinupuntahan‌ ‌ko‌ ‌siya‌ ‌dalawang‌ ‌beses‌ ‌sa‌ ‌isang‌ ‌araw‌ ‌para‌
‌pakainin‌ ‌siya‌ ‌ng‌ ‌tanghalian‌ ‌at‌ ‌hapunan,‌ ‌at‌ ‌para‌ ‌na‌ ‌rin‌
‌makapag-kwentuhan‌ ‌kami‌ ‌nang‌ ‌malaman‌ ‌niya‌ ‌na‌ ‌ako‌ ‌ay‌
‌nasa‌ ‌tabi‌ ‌niya.‌ ‌
‌
“Napakabigat‌ ‌para‌ ‌sa‌ ‌isang‌ ‌anak‌ ‌na‌ ‌doktor‌ ‌na‌ ‌makita‌ ‌ang‌
‌kanyang‌ ‌ama‌ ‌na‌ ‌ganoon.‌ ‌Nahihirapan‌ ‌siyang‌ ‌huminga,‌
‌naka-oxygen‌ ‌pa‌ ‌siya.‌ ‌Ngunit‌ ‌ang‌ ‌tadhana‌ ‌ay‌ ‌parang‌
‌mapagbiro.‌ ‌Akala‌ ‌ko‌ ‌ay‌ ‌‘yun‌ ‌na‌ ‌ang‌ ‌pinaka-dagok‌ ‌ng‌
‌istoryang‌ ‌ito.‌ ‌Ngunit‌ ‌noong‌ ‌gabi‌ ‌bago‌ ‌ang‌ ‌90th‌ ‌
79
‌birthday‌‌ ng‌ ‌aking‌ ‌ama,‌ ‌ang‌ ‌akin‌ ‌pong‌ ‌85-‌year‌ ‌old‌‌ ‌na‌ ‌ina‌ ‌ay‌ nilagnat‌ ‌at‌ ‌inubo.‌ ‌
‌
“Nakikita‌ ‌ko‌ ‌sa‌ ‌aking‌ ‌ina‌ ‌ang‌ ‌pangamba;‌ ‌ninenerbyos‌ ‌siya‌ ‌na‌ ‌siya‌ ‌ay‌ ‌dadalhin‌ ‌sa‌ ‌ospital.‌ ‌Hinatid‌ ‌ko‌ ‌siya‌ ‌sa‌
‌kanyang‌ ‌kwarto.‌ ‌Pagkatapos‌ ‌noon,‌ ‌ay‌ ‌pinuntahan‌ ‌ko‌ ‌ang‌ ‌aking‌ ‌ama‌ ‌para‌ ‌batiin‌ ‌siya‌ ‌sa‌ ‌kanyang‌ ‌90th‌ ‌birthday ‌‌at‌
‌dala‌ ‌ang‌ ‌mga‌ ‌regalo‌ ‌at‌ ‌video messages mula‌ ‌sa‌ ‌aming‌ ‌pamilya.‌ ‌Hindi‌ ‌ko‌ ‌masabi‌ ‌sa‌ ‌kanya‌ ‌sa‌ ‌mga‌ ‌panahon‌ ‌na‌ ‌iyon‌
‌na‌ ‌ang‌ ‌kanyang‌ ‌asawa‌ ‌ay‌ ‌nasa‌ ‌PGH‌ ‌din.‌ ‌Nagtaka‌ ‌rin‌ ‌siya‌ ‌kung‌ ‌bakit‌ ‌hindi‌ ‌yata‌ ‌siya‌ ‌binabati‌ ‌ng‌ ‌aking‌ ‌ina.‌ ‌ ‌
‌
‌“Ang‌ ‌aking‌ ‌ina,‌ ‌pagkaraan‌ ‌ng‌ ‌tatlong‌ ‌araw,‌ ‌ay‌ ‌naging‌ ‌malubha‌ ‌at‌ ‌k inailangang‌ ‌ma-intubate‌1 at‌ ‌ilagay‌ ‌sa‌ ‌ICU.‌
‌‌Habang‌ ‌siya’y‌ ‌ini-intubate,‌ ‌ako’y‌ ‌nasa‌ ‌kwarto‌ ‌niya’t‌ ‌nakasuot‌ ‌ng‌ level‌ ‌4‌ PPE1.‌ ‌Binubulungan‌ ‌ko‌ ‌siya‌ ‌na‌ ‌huwag‌
‌siyang‌ ‌matakot‌ ‌dahil‌ ‌tutulungan‌ ‌lang‌ ‌siyang‌ huminga‌ ‌ng‌ ventilator 1.‌ ‌Hindi‌ ‌niya‌ ‌nakikita‌ ‌na‌ ‌ako‌ ‌ay‌ ‌lumuluha‌
‌sa‌ ‌aking‌ ‌suot‌ ‌na‌ ‌PPE,‌ ‌dahil‌ ‌k inakabahan‌ ‌talaga‌ ‌ako. Marahil, dahil alam ko na ang mga matatandang may
COVID-19 na nai-intubate ay maliit ang chance na maka-recover.
‌“Sa‌ ‌susunod‌ ‌na‌ ‌mga‌ ‌dalawa‌ ‌hanggang‌ ‌tatlong‌ ‌l inggo,‌ ‌maliban‌ ‌sa‌ ‌pagiging‌ spokesperson‌‌ ng‌ ‌PGH‌ ‌at‌ ‌paggawa‌ ‌ng‌
‌aking‌ ‌mga‌ ‌tungkulin‌ ‌sa‌ ‌ospital,‌ ‌araw-araw‌ ‌ay‌ pupuntahan‌ ‌ko‌ ‌po‌ ‌ang‌ ‌aking‌ ‌ama‌ ‌at‌ ‌ang‌ ‌aking‌ ‌ina.‌ ‌Magsusuot‌
‌ako‌ ‌sa‌ ‌umaga‌ ‌ng‌ ‌PPE,‌ ‌bibisitahin‌ ‌ko‌ ‌sila.‌ ‌Pagkaraan‌ ‌ng‌ ‌tanghali,‌ ‌ako’y‌ ‌maghuhubad,‌ ‌maliligo,‌ ‌magpapalit‌ ‌ulit,‌
‌magtratrabaho‌ ‌nang‌ ‌sandali,‌ ‌at‌ ‌bago‌ ‌maghapunan‌ ‌ay‌ ‌babalikan‌ ‌ko‌ ‌sila.‌ ‌Siguro‌ ‌dahil‌ ‌sa‌ ‌halo-halo‌ ‌na‌ ‌pagod‌ ‌at‌
‌pag-aaalala,‌ ‌hindi‌ ‌ko‌ ‌rin‌ ‌masyado‌ ‌namalayan‌ ‌na‌ ‌ako‌ ‌pala‌ ‌ay‌ ‌nagkakasakit‌ ‌na‌ ‌rin.‌ ‌ ‌
‌
‌“Kinailangan‌ ‌ko‌ ‌na‌ ‌ring‌ ‌magpa-‌admit‌‌ ‌sa‌ ‌PGH‌ ‌dahil‌ ‌ako‌ ‌ay‌ ‌may‌ ‌‌moderate‌ ‌to‌ ‌severe‌ ‌pneumonia‌‌ na‌ ‌dulot‌ ‌ng‌
‌COVID-19.‌‌‌So‌,‌‌kaming‌‌tatlo,‌‌ako‌‌at‌‌ang‌‌aking‌‌mga‌‌magulang,‌‌ay‌‌magkakatabi‌‌sa‌‌isang‌‌floor.‌‌Ngunit‌‌hindi‌‌ko‌
na‌ ‌sila‌ ‌pwedeng‌ ‌puntahan‌ ‌dahil‌ ‌ako‌ ‌ay‌ ‌may‌ ‌COVID-19‌ ‌na‌ ‌rin,‌ ‌at‌ ‌kailangan‌ ‌akong‌ ‌i‌‌isolate
‌‌ ‌at‌ ‌gamutin.‌ ‌Ni‌ ‌hindi‌
‌‌‌ko‌ ‌sila‌ ‌mahawakan,‌ ‌hindi‌ ‌ko‌ ‌sila‌ ‌mabulungan,‌ ‌at‌ ‌hindi‌ ‌ko‌ ‌sila‌ ‌mabigyan‌ ‌ng‌ encouragement‌‌ ‌ na‌ ‌lumaban.‌ ‌
‌
“Isang‌ ‌gabi,‌ ‌noong‌ ‌halos‌ ‌ako’y‌ ‌gumagaling‌ ‌na,‌ ‌ay‌ ‌bigla‌ ‌kong‌ ‌nakita‌ ‌na‌ ‌ang‌ ‌aking‌ ‌ama‌ ‌ay‌ ‌hirap‌ ‌na‌ ‌hirap‌ huminga.‌
‌Sa‌ ‌loob‌ ‌ng‌ ‌sampung‌ ‌oras‌ ‌binabantayan‌ ‌ko‌ ‌ang‌ ‌aking‌ ama sa remote video monitor ng iPad ko hanggang siya ay maintubate kinalaunan. Nakatingin po ako sa monitor, kausap‌ ‌ko‌ ‌po‌ ‌yung‌ ‌mga‌ ‌doktor,‌ ‌binibigyan‌ ‌ko‌ ‌sila‌ ‌ng‌ ‌instruction.‌
‌Sa‌ ‌kasawiang‌ ‌palad‌ ‌po,‌ ‌siya‌ ‌ay‌ ‌nagkaroon ng cardiac arrest at parang bigla‌ ‌na‌ ‌lang‌ ‌siyang‌ ‌kinuha‌ ‌sa‌ ‌amin.‌ ‌ ‌
80
1
See glossary.
A‌ ‌child’s‌ ‌love:‌
‌a‌ ‌devotion‌ ‌that‌
‌flourishes‌‌despite‌
‌the‌ ‌unbearable‌
‌struggle.‌
“Namatay‌ ‌po‌ ‌ang‌ ‌aking‌ ‌ama‌ ‌na‌ ‌kami‌ ‌po‌ ‌ay‌ ‌nasa‌ ‌ospital‌ ‌pa.‌ ‌Ako‌ ‌ay‌ ‌hindi‌ ‌pa‌
‌nakakalabas.‌ ‌Ito‌ ‌ay‌ ‌August‌ ‌8,‌ ‌2020.‌ ‌
‌
“Napakasakit‌ ‌at‌ ‌napakabigat‌ ‌sa‌ ‌pakiramdam…‌ ‌Ako‌ ‌ay‌ ‌doktor‌ ‌na,‌ ‌at‌ ‌g usto‌ ‌mo‌
‌sanang‌ ‌nandoon‌ ‌ka‌ ‌para‌ ‌may‌ ‌magawa…‌ ‌ngunit‌ ‌wala‌ ‌akong‌ ‌magawa.‌ ‌Ang‌ ‌nagawa‌
‌ko‌ ‌na‌ ‌lamang‌ ‌ay‌ ‌naki-usap‌ ‌ako‌ ‌sa‌ ‌kanila‌ ‌na‌ ‌kung‌ ‌maaari‌ ‌ay‌ ‌payagan‌ ‌nila‌ ‌akong‌
‌lumabas‌ ‌sa‌ ‌aking‌ ‌silid‌ ‌bago‌ ‌dalhin‌ ‌sa‌ ‌morgue‌ ‌ang‌ ‌aking‌ ‌ama,‌ ‌at‌ ‌makapagmano,‌
‌mayakap,‌ ‌magpasalamat,‌ ‌at‌ ‌humingi‌ ‌na‌ ‌rin‌ ‌ng‌ ‌tawad‌ ‌na‌ ‌hindi‌ ‌ko‌ ‌siya‌ ‌naisalba.‌ ‌ ‌
‌
“Pumunta‌ ‌ako‌ ‌sa‌ ‌kwarto‌ ‌niya‌ ‌dala‌ ‌ang‌ ‌aking‌ ‌‌cellphone‌,‌ ‌na‌ ‌aking‌ ‌inilapit‌ ‌sa‌
‌kanyang‌ ‌tainga,‌ ‌para‌ ‌marinig‌ ‌niya‌ ‌ang‌ ‌boses‌ ‌ng‌ ‌kanyang‌ ‌mga‌ ‌anak,‌ ‌apo,‌ ‌at‌
‌kamag-anak‌ ‌na‌ ‌dinadasalan‌ ‌siya.‌ ‌Ako‌ ‌ay‌ ‌nakatayo‌ ‌lang‌ ‌sa‌ ‌kwarto‌ ‌niyang‌ ‌iyon,‌ ‌at‌
‌doon‌ ‌ay‌ ‌nakita‌ ‌ko‌ ‌siyang‌ ‌nakahiga‌ ‌at‌ ‌wala‌ ‌nang‌ ‌buhay.‌ ‌Niyakap‌ ‌ko‌ ‌siya,‌ ‌binigay‌
‌ko‌ ‌ang‌ ‌aking‌ ‌rosaryo,‌ ‌at‌ ‌sinabi‌ ‌ko,‌ ‌‘ Tay,‌ ‌marami‌ ‌pong‌ ‌salamat,‌ ‌magpahinga‌ ‌ka‌ ‌na.‌
‌Kami‌ ‌na‌ ‌po‌ ‌bahala‌ ‌kay‌ ‌Nanay.’‌ ‌ ‌
‌
‌“Ako‌ ‌ay‌ ‌na-‌discharge‌‌ ‌‌soon‌ ‌after.‌ ‌Dinaanan‌ ‌ko‌ ‌ang‌ ‌aking‌ ‌ina,‌ ‌at‌ ‌siya‌ ‌ay‌ ‌gising‌
‌na‌ ‌naka-‌intubate .‌ ‌Hindi‌ ‌ko‌ ‌masabi‌ ‌sa‌ ‌aking‌ ‌ina‌ ‌na‌ ‌namatay‌ ‌na‌ ‌ang‌ ‌kanyang‌
‌kabiyak.‌ ‌Nagdadasal‌ ‌kami‌ ‌araw-araw,‌ ‌at‌ ‌lagi‌ ‌ko‌ ‌pong‌ ‌sinasabi‌ ‌sa‌ ‌tatay‌
‌ko‌ ‌na,‌ ‌‘alam‌ ‌ko‌ ‌na‌ ‌kayo’y‌‌
‌close
‌‌ ‌at‌ ‌lagi‌ ‌kayong‌ ‌lumalabas‌ ‌at‌ ‌magkasama.‌
‌‌‌Kumbaga,‌ ‘inseparable‌’. ‌Pero,‌ ‌huwag‌ ‌mo‌ ‌muna‌ ‌siyang‌ ‌kunin‌ ‌sa‌ ‌amin.‌ ‌Huwag‌
‌mo‌ ‌muna‌ ‌siyang‌ sunduin.‌ ‌Bigay‌ ‌mo‌ ‌muna‌ ‌sa‌ ‌amin‌ ‌si‌ ‌Nanay‌ ‌dahil‌ ‌napakabigat‌
‌kung‌ ‌pareho‌ ‌kayong‌ ‌mawawala.‌ ‌Bigyan‌ ‌niyo‌ ‌po‌ ‌kami‌ ‌ng‌ ‌pagkakataon‌ ‌na‌
‌makapiling‌ ‌pa‌ ‌siya‌ ‌at‌ ‌makabawi.’‌ ‌
‌
“Ngunit‌ ‌ngayon‌ ‌ay‌ ‌napakahirap,‌ ‌dahil‌ ‌ang‌ ‌aking‌ ‌ina‌ ‌ngayon‌ ‌ay‌ ‌k ritikal.‌ ‌Siya
ay comatose na.‌‌Sabi ng mga doktor, ‘Doc, maliit nalang po ang chance para siya’y
magising pa.’
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“Pero hindi pa kami nawawalan ng pag-asa. Kami ay laging nagdadasal, nananalangin na sana ay bigyan pa
kami at makapiling pa namin ang aming ina. Mula po ng pagkamatay ng aking ama, ay halos apat na linggo
na pong lumilipas. Kami po ay laging nagdadasal, Divine Mercy… At ang aming panalangin ay iligtas niyo po si
Nanay.
“Ako ay patuloy na nagpapagaling. Nilalabanan ko ang aking pagdadalamhati. Physically, ako ay halos
recovered na, pero mabigat ang aking dinadala. Alam ko na kailangan ko po bumalik sa trabaho at kailangan
kong gampanan ang aking katungkulan na maging spokesperson ng PGH.
“Paminsan natatanong ko kung bakit ba sa akin nangyari ito. Sabi nga nila, ‘There’s always a reason for everything.
Sometimes there’s a higher meaning to this that only God knows.’ Hinahanap ko iyon. Minsan nagra-rationalize ako na
siguro, gusto ako sabihan ng Panginoon na kaya po akong binigyan ng ganito kabigat na pasan dahil may gusto
siyang iparating sa akin. Ipagawa sa akin. Minsan’y mahirap isipin ‘yun dahil nangingibabaw ang pagkawala ng
aking ama, at ngayon, malaki rin ang pagkakataon na baka kunin din ang aking ina.
“Ngunit, kahit na ako ay doktor at lumaki ako sa siyensya -- ‘Man of Science’ ika nga -- masasabi ko na nagawa
namin ang what is humanly possible for my parents. Kahit na nandiyan lahat: gamot, mga doktor, at mga dalubhasa,
ang pinapanghawakan ko ay ang aking faith. Huwag bibitiw sa paniniwala na tayo’y mahal ng Panginoon at
maaaring in God’s time ang gusto Niyang mangyari. Masakit man kung minsan, ay dapat itong tanggapin.
“Ang COVID-19 para sa akin ay napaka-personal. Hindi lang ito na para bagang ako’y isang eksperto na
nagsasabi sa mundo na ganito ang COVID-19, dahil ako’y nagkaroon ng karanasan bilang tagapagsalita. Higit
sa lahat, bukod sa pagiging pasyente, ako’y naging isang anak na nawalan ng magulang dahil sa sakit na ito.”
Dr. Jonas del Rosario’s mother passed away from complications due to COVID-19 on the day of this sharing.
A child’s love: a devotion that flourishes despite the unbearable struggle.
Copyedited by Vince Elic S. Maullon
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A Matter of Mantras
Jill Olivia Bañares
I’ve been an emergency room (ER) nurse for the
past three years.
The Department of Emergency Medicine (DEM)
has always been on the frontline, its staff trained to
handle all sorts of emergencies. Bleeding. Breathing
difficulties. Heart attacks. Stroke. We deal with
different cases. Our patients entrust their lives to
us, and we do our best for them. Day in, day out,
I’d execute my tasks as an ER nurse to the best of
my abilities. It was the least I could do for both my
patients and co-workers. When things got tough,
I’d tell myself: Focus. Stay calm. Do your best. I’d repeat
my mantra until my task was finished and I was
ready to face another challenge. Most of the time, it
worked.
1
1
See glossary.
Last March, it didn’t.
COVID-19 caught us by surprise. Just like everyone
else, we were unprepared. There was a limited supply of
face masks, personal protective equipment (PPEs)1, and
face shields. Protocols were not properly laid out; the
government’s plans were vague. More importantly, we
knew so little about the virus. How does it work? How
do we know if someone is infected? What should be done
to keep people from getting infected? As a member of
the department that would face the first wave head-on, I
struggled to keep my anxiety at bay. We were all terrified.
An invisible enemy had waged a war, and backing down—
giving up—is never an option, most especially for us. After
all, we were—still are, and always will be—the gatekeepers
of the hospital.
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The makeshift emergency room triage stands before the entrance to PGH, where patients are screened for symptoms of COVID-19. Photo by Brent Viray.
The first few weeks proved to be the most challenging. Since the interns and other services1
were pulled out, ER doctors and nurses struggled to keep the ER running. Moreover, the fear of
admitting persons-under-investigation (PUIs) or COVID-19-positive patients made it difficult to
admit a patient to the wards, causing patients to pile up in our ER. We had to adapt to the situation
before it completely overwhelmed us.
For every eight-hour shift, there were two to three nurses assigned to man the PUI1 zone. We would
call them “alay” (“sacrifice”). Their main task was to monitor the patients’ vital signs1. However,
since their relatives or friends were not allowed in the ER, the nurses on duty1 also performed most
of the bedside care. This included bathing, wiping, lifting, and feeding the patient. We turn their
beds and change their diapers—no complaints.
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1
See glossary.
We worked harder. We tried to do better. Unfortunately,
the glaring reality was still present. We had limited
workforce, inadequate facilities, and insufficient
equipment. Even with our best efforts, it was still a
disaster. The scenario outside of the Philippine General
Hospital was not any better either. I had to constantly
remind myself that I was not walking through a set
of a post-apocalyptic movie. Deserted streets. Eerily
quiet nights. Whenever I walked along Padre Faura and
Pedro Gil2, I yearned for the deafening noise I’ve grown
accustomed to. My footsteps were quick and light, but
my mind was heavy. My heart ached as it held on to my
colleagues’ eyes—eyes that betrayed the fear they hid
with their smiles.
I was pushed to my limits. My mind was reeling with
fear and my body, beyond exhausted.
Drops of sweat stung our eyes. The N95 masks1 that
were meant to protect us made breathing painful. We
were so drenched in sweat we could squeeze out our
perspiration from our clothes. Our faces were not
spared either. The pressure points of goggles and masks
left scars. These marks earned the moniker “battle
scars”, and we wore them with unwavering pride.
Even if COVID-19 robbed us of social interaction
and the comfort of physical touch, seeing the
smiles on their faces and hearing the laughter in
their voices kept me going.
“Lilipas din ‘to!” my co-workers cheered. “Tayo pa?
DEM tayo. Kayang-kaya!”
I was blessed to be surrounded by such wonderful
people. Their indomitable spirits kept me going.
The situation was—is—tough, but we are
tougher.
Yes, our healthcare system is flawed. HCWs are
overwhelmed. There is so much disquiet and it is
saddening that some leaders still choose to turn
a blind eye towards their people. Despite this, I
still firmly believe that everything is happening in
God’s time; and that this, too, shall pass.
Until then, I will carry out my tasks with
diligence and discipline, replaying the mantra in
my head: Focus. Stay calm. Do everything with love.
Focus. Stay calm. Do your best. When it didn’t do the trick,
I’d add: Do it for them—my family, my friends, my co-workers.
Copyedited by Marcela Mercedes S. Rodolfo
1
2
See glossary.
The UP Manila - Philippine General Hospital complex is flanked by these two streets. Lined with colorful food establishments, massage parlors, shops, condos, and dorms,
Padre Faura and Pedro Gil, as well as the streets that intersect them, serve as an extended network of the experience of being a PGH worker and a UP Manila student.
85
Frontliners in the PGH Emergency Room work tirelessly round-the-clock as more and more COVID patients arrive from all around Metro Manila and the
surrounding provinces.
Photos by Brent Viray.
86
Overcoming Inertia
What moves us to go beyond our comforts and means?
Fr. Marlito Ocon
In Physics, an object can only be moved by a force greater than gravity or the weight of the object itself. What
greater force, then, can move us to do more and to be more for others, especially when the gravity that keeps us
in our comfort zones is naturally strong?
It is God’s grace!
It is God’s grace at work in each of us that moves us to go beyond ourselves. And when we move as one,
bringing our acts together as a graced community, God’s grace reveals itself to be even stronger and more
effective.
Our primary role as chaplains is to cater to the spiritual needs of the patients and the hospital staff. But in a
hospital that is committed to the care of indigent patients like PGH, opening one’s eyes to the spiritual needs
is a gateway to many other basic needs which yearn for a humane response. As chaplains, we cannot simply sit
down and comfortably say, “I am here only for their spiritual needs.” We find ourselves challenged to do more.
We look for ways to respond that are deeply divine and deeply human at the same time. That is how Jesus
responded when he encountered the multitudes. When they were hungry, he fed them. When they were sick, he
healed them. When they were sorrowing, he comforted them. When they were lost, he shepherded them.
When COVID-19 struck, our field of vision gradually expanded, and thus our sense of mission also shifted
with the emerging needs. We saw not only indigent patients but also the multitude of frontliners—nurses,
doctors, caregivers, security guards, janitors, maintenance, and utility personnel. At the outset of the community
quarantine1, when it became difficult to buy food after night shifts, we started to provide some 400 food packs
1
See glossary.
87
daily for healthcare workers on afternoon and
evening duties. We did this until the service became
unnecessary as the hospital was already able to
provide for them.
Then, another need came to the fore—the daily
sustenance of our outsourced personnel: the security
guards and the janitors. With the approval of the
deputy director for administration, we were able
to provide daily lunch and dinner to 125 security
guards and 143 janitors. Bread and bottled water were
provided to those in the COVID charity wards1 and
emergency rooms. For this service, we are grateful to
our generous and reliable meal donors2, all of whom
have pledged to help while community quarantine is
still in effect.
As we journeyed with the whole UP-PGH
community in day-to-day combat with COVID-19,
we discovered many other needs. As such, we
partnered with PGH to help fill the gaps. As
telemedicine1 emerged, so did telechaplaincy. The
telechaplaincy program, in coordination with the
medical social services, did online counselling,
1
2
88
provided spiritual direction, and prayed with families
of patients and healthcare workers alike.
Needless to say, we continued with our official duty
of providing for the spiritual needs of our patients
and health workers. We took turns with my brother
chaplains for the 24-hour shifts. We were all afraid
to get sick, but we could not and did not allow our
fears to dampen our compassion and our sense of
mission. We did room-to-room and bed-to-bed visits
to COVID patients.
When I visited patients, in chronic and critical
conditions, it made me wonder: Bakit sila pa ang naCOVID?
A stage IV cancer patient?
A diabetic patient on dialysis1 whose husband is in a coma due to a
stroke?
A psychiatric patient who harmed himself?
Isang matanda na may cancer sa mata?
O mag-asawang doktor na kapapanganak lang ng asawa?
Even a dutiful nurse tending to COVID patients.
Bakit sila pa?
See glossary.
Our generous donors include the Tanging Yaman Foundation-Simbahang Lingkod ng Bayan-Ateneo de Manila University through Fr. Manoling Francisco, SJ and Ms.
Marites Ingles, as well as Mr. Chips Guevara and friends of the Guevara family
At one point, it moved me to tears until my glasses, my
goggles, and even my face shield turned misty and blurred.
I could no longer read my prayers. I had to stop and say,
“Lord ikaw na bahala, alam mo naman na ang tanging dasal
ko ay para mapagaling sila at makapatuloy ng pagsisilbi sa
mga may sakit.”
Being around sick and dying people every day is draining,
especially when all feel helpless. The rich, the poor, even
I myself felt helpless. It can be so depressing. The patients
normally asked for our prayers. Their biggest concern was,
of course, suffering and death. We all want to live and live
happily, but death is also real, and we know it will come.
What helps us cope is when we feel that we have helped
them prepare well for any eventualities. We see them at
peace and become more accepting and trusting of the
Lord, even as the end draws near. It helps us to believe
that we have helped them rejoin the Lord.
At the start, simply seeing health workers in full
PPEs1 scared us, and thinking about visiting them
scared us all the more. However, as we reflected
about it more deeply, we realized that since it scares
us, there must be something in it that we must
respond to with courage, not fear. We feel that this
is the very essence of our mission and this is where
we are called to respond as the chaplains of PGH.
While we went around doing our spiritual work,
they would always say, “Huwag na kayo umikot father
baka mahawa pa kayo.” How can we do that? That’s
part of our work: to let them know that we are
with them. We cannot just hide in the safety of our
rooms; that is not what we are here for! We have to
take risks, just as they take the risks, because we are
together in this fight.
My face shield turned misty and blurred.
I could no longer read my prayers.
1
See glossary.
89
The frontliners asked for prayers too: that they
be protected all the time and that they remain
healthy and strong. But their needs went beyond
that; we heard them saying they didn’t have
enough masks, alcohol, and PPEs. Certainly the
hospital had supplies, but they were not enough at
the start.
I saw how the experiences brought about by
COVID-19 served to strengthen and deepen their
faith. They said, “Do or die, and with prayers,
nawala takot ko, Father”. Whenever I went around,
some nurses would raise their hands and shout
from a distance because I couldn’t come closer,
“Father, protected tayo ni Lord di ba?” I knew they
were all tired and afraid, but they served with a
smile and looked cool and calm, and we never
saw them faltering in their faith.
It is not easy, and it will never be easy. What
moves us to do this and go beyond the bounds of
our comfort zones, and even beyond our means is
God’s grace!
Photo by Maria Keziah Legion
Copyedited by Leander T. Quilang
90
Photo by Maria Keziah Legion
With PGH in sudden need of additional resources to care for its
patients and support its hospital staff, Fr. Ocon and his brother
chaplains take the lead in collecting and distributing food
donations to healthcare workers and outsourced personnel. They
also continue their ministry of seeing and comforting sick patients
not only in person, but also through the safer and innovative
“telechaplaincy” program.
Photos by Marlito Ocon
91
Photos by Marlito Ocon
92
Photos by Marlito Ocon
93
Skin in the Game
Justin Bryan D. Maranan
“There was definitely a ‘shifting dullness,’” confessed
Sofia Naval, a 2nd year Ophthalmology resident1, about
working in the COVID wards.
Anyone who undergoes medical training knows
the awkward feeling of rust and being “out of
place” during the first few days of shifting into a
new rotation—a phenomenon dubbed as “shifting
dullness,” a play on words, referencing a time-worn
physical exam finding
“Even the census1 [was different] …I’m sure it made
sense for an Internal Medicinea resident, but I was
definitely lost.”
Carl Uy, a 2nd Year Pathology1 resident, whose typical
work did not involve patient interactions, had to dig
out the IM Platinum book 2 he used during clerkship
and internship1. “This reference, on top of the revised
algorithms for COVID-19, helped me reconstitute
what little clinical skills I had despite spending more
than two years of residency training without direct
patient care.”
The need for this drastic move soon became clear
to Martin, however, when COVID-19 patients
poured into the hospital. The Department of Internal
Medicine’s patient census skyrocketed. Conversely, the
doctor-to-patient ratio of “cutting fields3” like ORL
and Ophthalmology skewed to the opposite extremes;
their wards emptied out and elective admissions1were
effectively reduced to zero. Interdepartmental
cooperation was needed to balance the collective
burden among PGH’s different residents.
“I soon realized,” Martin recalled, “that this situation
goes beyond what is expected from our respective
departments—everyone had their ‘skin in the game,’
and to conquer this pandemic, we all needed to do our
part together. With that mindset, I steeled myself and
entered the COVID wards without fear or hesitation.”
See glossary.
IM platinum is a book which serves as a condensed guide to internal medicine. It mainly references the famous book, Harrison’s Principles of Internal Medicine, as
well as includes local practice guidelines, and unique pearls of knowledge. It is written by Jamie Alfonso M. Aherrera, M.D., Marc Gregory Y. Yu, M.D., Marc Denver A.
Tiongson, M.D., Deonne Thaddeus V. Gauiran, M.D., Jose Eduardo D.L. Duya, M.D., and Enrico Paolo C. Banzuela, M.D., and is edited by Geraldine Zamora, M.D.
3
Cutting field is a colloquial term used to refer to specialties that involve surgical procedures.
1
2
94
Meanwhile, for Martin Ilustre, a 2nd year
Otorhinolaryngology (ORL)1 resident, diseases of the
head and neck were what he had expected to train
for when he applied for residency in PGH. “My first
[reaction] was to question why we had to go into these
COVID wards in the first place.”
Though not used to a medical ICU setting, many physicians and nurses from other hospital departments who were reassigned to the COVID wards selflessly took on
the challenge of caring for these critically ill patients.
Photos by Sofia Naval, Carl Uy, and Martin llustre.
95
Their duty schedules1—a PGH resident’s circadian
rhythm of “pre-duty,” “duty,” and “post-duty”—
were thrown out the window as a new system was
implemented to minimize the active workforce at any
given shift. They now needed to work eight-hour shifts
starting at either 6:00 a.m., 2:00 p.m., or 10:00 p.m., for
seven days straight.
“The anxiety was the worst part of that first shift,” said
Carl. “During the first few hours, I was functionally
blind. My glasses and goggles conspired against me as I
wasn’t used to wearing PPEs1 yet. It was only through
the guidance of the outgoing General Medicine resident
that I was able to get a semblance of the goings on in the
wards. ‘Shifting dullness’ was an understatement.”
“What the hell am I doing?” Sofia would think to herself,
as she tried to find her footing. The beeping ventilators1
were a far cry from the visual acuity charts she had
grown accustomed to in Ophthalmology. Even Martin,
who had primed himself to power through the haze,
remarked that every new update in protocols threw him
off balance.
In spite of these curve balls, they knew they still had
to fulfill the role of the resident-on-duty (ROD). “It all
happened too fast to process appropriately,” Carl recalls.
“There was so little information on what was expected
from us as RODs. So I used what little time I had to just
breeze through my references—-hoping to absorb as
much as I could.”
1
4
96
Sofia, on the other hand, admits that she had grown so
accustomed to the five-point eye exam4, a staple for any
ophthalmologist, that she had to revisit the basics of a full
physical examination.
Despite the need to brush up on the subject matter, Sofia
was especially grateful for the Infectious Disease Specialty
(IDS)1 fellows who rotated with her, citing a newfound
respect for the people whom she saw laughing, making
jokes, and bringing food to lighten people’s spirits despite
the gloomy environment in the wards. “These doctors have
been working non-stop since the crisis began. Our eighthour duties seem like nothing compared to what they do,”
she says.
And while fear and anxiety were rampant among the
residents manning the COVID-19 wards, so was kindness.
“I had not extracted blood or inserted an IV line1 in a very
long time. I was worried I couldn’t do it, especially with
all these layers of PPE hampering my movement.” Sofia
recounts. While she was talking to her patient, however,
Ma’am Jo and Sir Eric—her nurses on duty—stopped her.
“Doktora, dapat naka Level 4 PPE ka.”
“Kailangan ba talaga, ma’am? Kakasuot ko lang nitong Level 3,
sayang naman,” Sofia countered.
But Ma’am Jo looked at her with caring eyes and said, “Para
sa’yo rin ‘yan, Doktora.”
See glossary.
The basic eye examination done on patients in a general ophthalmologic consult. It consists of five components: visual acuity, gross examination, checking of extraocular
movements, digital tonometry, and fundoscopy.
And so she changed, with the nurses flashing her two thumbs up from the station saying, “Thank you,
Doktora! ”
“As if I was the one who should have been thanked!” Sofia said.
While extra preparation and help from others proved to be good countermeasures to shifting dullness,
Martin recalls a time when they weren’t enough. His patient’s body convulsed with a seizure during his
first duty1. “I referred to Neurology1, but the needed medication wasn’t available.
“I had no idea what to do. I felt so helpless just watching my patient,” Martin said. “I was displaced
from my comfort zone; I had to adjust and relearn things I had forgotten since internship.”
Facing challenges like these, shifting dullness became all the more familiar for our three residents. But
while Sofia, Martin, and Carl essentially performed the same functions and accomplished the same work
during their tours of duty, their experiences and takeaways were unique. Probably a function of the gap
that existed between the residency training they had signed up for, and the COVID-19 work they found
themselves in.
“As a Pathology resident,” says Carl, “to have been given the opportunity to handle patients again
during these troubling times is a worthwhile experience that I will forever cherish. To have been able to
reduce the burden on the services conventionally involved in managing this pandemic, and to have been
able to contribute what little I could as an out-of-place Pathologist-in-training, meant the world to me.”
Wildly displaced from his comfort zone, Martin says, “I had to adjust and relearn things I had forgotten.
“But while preparing to go into the COVID wards, I saw a video on Facebook about the pandemic, and
one thing stuck with me. They used this statement: ‘skin in the game.’ How I understood that is we all
have a stake in reaching a common goal, and we all have to risk something in order to achieve it. This is
what it means to serve the Filipino people: to put my ‘skin in the game’, and do whatever I can as we all
go through this pandemic together.”
Copyedited by Lorena Margarita B. Osorio
1
See glossary.
97
Surgeons and nursing staff continue to perform life-saving operations under the uncomfortable, restricting, triple-layer PPEs. An operating
room staff turns on the UV box as part of the disinfection protocols between procedures.
Photos by Brent Viray.
98
Photos by Brent Viray.
99
The Physician in Plastic
John Jefferson V. Besa
N.B. was an 81-year-old female who had gone through
multiple episodes of pneumonia1 and a stroke that
left her bedridden. She was dependent on her son and
granddaughter, who fed her and bathed her.
She was COVID-19 positive, for admission in our wards.
I was her resident1, decked in a plastic bunny suit. My
mask is suffocating, the layers of gloves are numbing,
and the goggles keep on fogging up. Walking is
awkward. I looked like an astronaut covered in plastic,
traversing an unknown planet for the first time.
She had to be admitted alone because relatives were
not allowed inside.
After being a resident for more than a year, we have
learned to recognize people who were in bad shape.
And she was in bad shape.
I called her family and talked to her son. I tried to be
objective in laying down the facts—what studies have
shown so far, what survival rates were, what we know, and
what we don’t know. I told him that she needed a tube
1
2
100
down her windpipe to help her breathe. I told him it wasn’t
a comfortable procedure. I told him what the chances of his
mother getting better were, despite that tube.
It is my duty to get an advance directive, as part of
protocol, from the family members of patients whose
prognosis we deem to be poor. In these uncertain times,
it is also my duty to confess the limits of medicine.
Her son accepted them.
“Do not intubate1” and “Do not resuscitate”. No tubes.
No CPR 2.
As the days went by, her condition worsened. Her
oxygen levels steadily went down, and she became less
responsive. My medical training said that I have to
hook her to a machine to help her breathe immediately,
but I had a document saying I shouldn’t.
I dialed her son’s number. I wanted to update him on
his mother’s status.
He did not pick up the phone.
See glossary.
An advance directive is a legal document wherein patients or their relatives specify the actions that should be done regarding their healthcare, in the event that they are
not able to make those decisions themselves. A “Do not resuscitate” (DNR) order, is a type of advance directive. Once a DNR form is signed, it signifies that they do not want
CPR performed on them if their heart stops beating. Another type of advance directive is a “Do not intubate” (DNI) order. This legal document is signed to indicate that a
patient does not want to be intubated, even in the setting of respiratory failure. The medical staff will respect these decisions to preserve the patient’s autonomy.
Photo by Brent Viray
The blood pressure apparatus did not register any
measurement.
Was it just the double layer of gloves or was there really no pulse?
Her chest was not rising and falling as it normally should. I
called my co-resident to double check, because to be honest,
I was doubting myself. He confirmed what I thought.
I called the time of death—8:45 P.M.
Her son was still not picking up.
I tried the other number in her records, and her granddaughter
answered. I made sure my voice was clear, calm, and empathic.
I broke the bad news. She wailed. I found myself out of words;
I had just introduced myself to her a few seconds ago—and I
did not know how to comfort her.
Her cry was deafening. I let it pass into silence.
Then we talked—of how her grandmother brought them
joy with her quirks, of how they took care of her at home,
of how she did while she was admitted, of how her son
arrived at a hard decision, of why they will never see her
body again. The morgue gave them the final instructions.
Being with patients with COVID-19, I realized that this
pandemic strips off the humanity at the core of the art of
medicine. N.B. died alone away from her family. When the
end of the line is reached, a physician’s role is “to comfort
always.” But with my gloved hands, I doubt that I was able
to do so. I have witnessed countless deaths as a doctor, but
this is different.
This is not how I want to take care of my patients. The
virus is inhumane.
Copyedited by Vince Elic S. Maullon
101
Soldiering On
Hilda Uy
It was Tuesday, on the 17th of March of this fateful year, when
PGH’s Department of Out-Patient Services (OPD)1 officially
closed under indefinite terms. While almost everyone in the
staff rejoiced in response to the unexpected break, I did not,
for something inauspicious was seemingly brewing.
The excitement quickly fizzled out when the grim reality
sunk in. If an entire PGH department closes, especially in
the middle of a national public health emergency, it can only
mean one thing: we, its workforce, are “going in” – quite
literally so.
Re-assignment to posts within the in-patient facilities
caused a lot of anxiety for the OPD staff. Placing nurses
like us, with professional years devoid of direct bedside
patient care, back in the hospital proper is akin to
deploying soldiers with old and unmaintained arms. We
were being called to the frontlines of war, nevertheless. We
were bound by our sworn pledge to pick up these likelyfaulty guns, pull the trigger when the right circumstances
arose, and hope that they fired.
Nurse Michelle in full protective gear as she goes
on duty in one of the COVID wards. Photo by
Michelle Palomar.
102
1
See glossary.
What we knew about the ravaging foe compelled the young
and healthy to lead the charge; it was no surprise, therefore,
that I was among those first sent to no man’s land.
It was still dark when I came in, riding a borrowed
bicycle, to work on my “new” first day. My feet were
weary with an unfamiliar ache. I parked my bike and
entered the anteroom of the Spine Unit1 where one of
the first COVID wards was located.
I knocked–there was no response. I knocked again and,
during that moment, a part of me hoped for continued
silence (as the door creaking away from me would be the
beginning of it all). Eventually, a nurse in a scrub suit
unlocked the door and swung it open.
She seemed to be smiling at me underneath the face mask.
“Hi, are you ready?”
“I need to be.”
Our 113-year old institution abruptly transformed into
this barely recognizable battlefield. Everywhere I was
placed for duty1 was uncharted territory: at the COVID
triage, then at the COVID general wards, and even at
a COVID intensive care unit1. We were shuffled often.
The agony of not knowing where I would be assigned
next every day for a whole week did nothing but intensify
my uneasiness for the unseen and for my own fate.
I didn’t have a choice but to take care of acutely and
critically ill patients outside my expertise, and to do
so very carefully during my first week. On top of
everything, the 8-hour shifts that we had to endure
without breaks and in sweltering heat while in a bunny
suit were unprecedented battles on their own. At the
end of each shift, I yearned for the first ambient and
relatively cooler wind that caressed my skin as I removed
my suit, the first unfiltered breath I took as I took off my
N95 respirator1, and the first drop of water that touched
my lips as I quenched my thirst.
These mundane routines of near-instinct, luxuries at
the heart of the moment, were my little victories – a
validation that I had withstood the restlessness, agony,
and discomfort of that day. Not even the thought of
having to go through all of this again tomorrow could
make these victories less sweet.
Perhaps, the greatest victory I can clinch for now is I
was helping those that had been scourged by this virus,
rather than being at the receiving end of such rendered
care. At the end of the day, I still get to realize what I
want and love – to be a nurse. Being in such a perfect
storm of circumstances is part and parcel of the oath
I took years ago, and I ought to keep it no matter how
uncomfortable, scared and uncertain I feel right now.
You see, we have always been in the line of danger, the
world just hadn’t noticed before. We are not heroes in
the truest sense of the word, and we never were. We are
just soldiering on day by day until this is all over.
Copyedited by Aedrian A. Abrilla
1
See glossary.
103
Ashen
Anna Elvira S. Arcellana
“Last seen well”
A moment not so long ago,
Now seemed like forever;
Fleeting as the wind,
Etched as a bittersweet memory.
It began with a treacherous cough,
Then a battle of spiking heat and chills, bone deep
Leaving the battered warrior weak and weary
Alone against formidable enemies
An arduous struggle in solitude.
A frantic search for cure
Unleashed a growing armamentarium.
Allies clad in white rallied him into battle.
Only, wars are not won with transient victories
Turning those once hopeful days into waning weeks.
All efforts overflowed
All aboard, pushing the limits of science.
Yet the fierce menace still engulfed him,
Waves of grief washed over their virtual reality
As distress beckoned to his loved ones.
He desperately gasped for air,
Clinging through the tube with his dwindling strength.
Ready aim. Fire the adrenaline, hot through his veins
To give him a final shot at life
Invigorated with prayers whispered from close hearts afar.
But with the battle eventually lost–
A ghastly face silently departed.
Devoid of all but embered companionship,
A fallen warrior sank to ashes;
A jar taking on the last embrace.
A loss made more painful
By insurmountable distance
That flowing tears could never bring back.
Yet, the memories stay even in deathly gray
The ruins of burning love.
Copyedited by Sean Kendrich N. Cua
104
I Don’t Feel Like a Hero
Ella Mae Masamayor
Right before we enter the donning1 area, there’s a sign above the entrance that reads: Welcome Heroes. It’s a lovely
sight to read in the morning; it reminds me of McDreamy’s2 famous line, “It’s a beautiful day to save lives,” from
Grey’s Anatomy. I don’t know who put up that sign, but I am grateful for their kindness. It was their way of trying
to lift our spirits before the 8-hour shift ahead.
However, if I’m completely honest with myself—I don’t really feel like a hero.
A sign saying ‘Welcome Heroes!’ hangs above the entrance of the COVID wards. Photo by Brent Viray
1
2
See glossary.
McDreamy is the moniker of Dr. Derek Shepherd, a character in the medical drama Grey’s Anatomy. In the series, other characters call Shepherd “McDreamy” because
the charming and attractive neurosurgeon is considered by most as their “dream man”.
105
I have nothing but admiration and gratitude for other
doctors like me, as well as our nurses, pharmacists,
medical and radiologic technologists1, utility workers,
service and delivery personnel, security guards—all
of whom show up everyday to keep the lights on. But
when I come back to myself, somehow, I don’t feel
deserving of the same applause. People have tagged
me on Facebook and thanked me online for being a
frontliner, a hero. But if heroes are strong men and
women with extraordinary powers and courageous
hearts, then I’m definitely not one.
I know very little about this disease; the unknowns
and uncertainties worry me a lot. There are still so
many questions unanswered and probably even more
unasked, and I don’t know how I’ll be able to fill in
all the blanks.
Before all of this, I was but a second year resident1, with
still much to learn and much to master. I’ve always had
this vague feeling of inadequacy as a trainee, and the
feeling has grown all the more palpable in these times of
constant change.
106
1
See glossary.
Every day, I ask myself if I’m the right person for
the job. I question if I do know what to do, if I can
deliver when the situation calls for it. And each time
someone dies or deteriorates in front of me, I wonder
if I have done something wrong, if I have made the
right decisions, or if the patient could have been
saved had someone else been in my place.
I am terrified, for myself and for my loved ones. I’m
scared of getting the disease and of passing it on, to
my mom, my dad, my brother. I cannot begin to tell
you the number of times I’ve wanted to sit this one
out. Before each duty1, I lie awake running through
every worst case scenario, not feeling any more
prepared. I struggle to look for things I can control,
and find myself horrified that there are very few. I am
drowned by the what ifs and buts and oh noes I have
to handle each day.
For the first time in a while, I have started to
question why I ever wanted to be in this vocation—
I’m pretty sure the little girl in me didn’t have this in
mind when she said she wanted to be a doctor.
It turns out I’m not so brave after all.
alongside them.
I am scared for my patients. For the ones infected
with the virus, I can only imagine how terrifying this
must be for them. The disease itself is horrific; the
thought of gasping for air, needing intubation1, and that
possibility of being an addition to that ever-rising list
of deaths. Then there’s the isolation, being all alone;
no one to assure you when you’re getting better and no
one to hold on to when you take a turn for the worse.
I imagine how scared they are of infecting their loved
ones, their little kids, or their aging parents. How they
place their hope on whatever drug or intervention could
work, never mind that the data is less than robust.
We’re all scared of this pandemic, and we wake up each
day with an eerie sense of helplessness. But going on
hospital duties, when I see all our patients and all the
hospital staff, I see people who refuse to give up on
hope---people who still want to give it their best shot. I
realize that I may not have the strength expected of socalled heroes, but I am blessed with the extraordinary
privilege to help, to fight this villain of a virus, and to
let our patients know that even until the end, we must
muster up the courage to not give up on them.
I am scared for our non-COVID patients, too. I think
of all the dialysis1 sessions missed, the chemotherapies1
skipped, the blood sugars and blood pressures that have
probably gone off the charts by now. I can hear my
patients asking, “Doc, paano na po kami?” The lack of an
answer adds up to even more fear.
Here’s a big thank you to those who believe in us, to
those who support us—those who cheer us on, those
who stay at home, those who donate their money, food,
or whatever they have to give. All this kindness and
care give us insurmountable strength. Thank you for
believing in us even when we’re scared, even when
we’re unsure, even when we don’t know what’s going to
happen.
When I think about it, I can always quit my job and
retreat to the sidelines. But I cannot find the heart to
turn my back on these people, all of whom are probably
more terrified than I am. It goes beyond just a call of
duty or an oath we’ve made to the profession. I realize
that our patients are fighting, and they need us to fight
I do not feel like a hero, and I can’t promise I’ll
eventually be one, too. But I will continue to try my
best, to fight my hardest, and most importantly, to hope.
Hope for myself, hope for my patients, hope with every
little bit of hope left. For courage and perseverance. For
better days ahead.
Copyedited by Sachiko S. Estreller
1
See glossary.
107
Hospital staff celebrate the recovery of a pediatric COVID patient.
Photo by Marlito Ocon
108
109
110
Photo by Brent Viray
SIDE EFFECTS
111
112
Side effect
/’sīd i-’fekt/ n.
A secondary, typically undesirable effect of a drug or medical treatment.
The casualties of our war with COVID-19 have stacked high and
each day brings more worries. Within, and beyond the walls of the
Philippine General Hospital, lives of patients, families, and workers
shift and tumble as the pandemic’s consequences reach further than
anticipated.
113
Sa Gitna ng Pandemya
Ian Gabriel A. Juyad
Isang bisikletang
Dala’y pagkaing hindi sa kanya
Mga estudyanteng
Naglilikom ng pera para sa iba
May naghahatid ng gamot
Sa matandang mag-asawang kapitbahay
May pawisang balot na balot
Umaaruga sa nag-aagaw-buhay
Mga maliliit na kaskaho
Sa malalaking blokeng bato
Magkakaisa’t bubuong
Isang konkretong kastilyo
Bawat sulat, tula’t kantang inilikha
Bawat pagkai’t kanlungang inihanda
Bawat panahon na ibinigay
Bawat dasal na inialay
Sa bawat patak ng ambon
May nagtatampisaw na mga punlang tutubo
Mamumuong panibago
Isang buhay na mundo
Ikaw at ako –
Isang tipak ng bato
Isang patak ng ulan
Sa iisang lupang pananahanan
114
Photo by Adrianne Alfaro
Broken Spirits
Cary Amiel G. Villanueva
Everything was unsettling.
We signed up for a noble profession, one committed to
serving humanity. We enlisted and took on the Oath of
Hippocrates. We promised to care for the sick to the best
of our abilities. But we never could have imagined that
being sworn as licensed health professionals—not too
long ago for some of us—would mean that we were being
drafted to fight skirmishes in this pandemic. And it is this
departure from what we had envisioned to become that
leaves us with broken spirits.
There is a medieval adage that speaks of the goals of
medicine: “To cure sometimes, to relieve often, to
comfort always.” Yet even the act of comforting can be a
herculean task in these trying times.
A dialysis-requiring1 father in the COVID-19 ward cried
in frustration as I did rounds1 one morning. As the family
breadwinner, he felt useless being unable to provide for
his wife and daughters. He longed to be of service to his
family and their barangay as a kagawad. Yet here he was,
detained for his illness. What words of comfort could I
have told him, other than to say that his cooperation and
confinement was for his family’s sake?
Photo by Isabel Acosta
1
See Glossary
115
On another occasion, I granted the request of a daughter to let
her dying father hear a voice message they sent in by phone.
Beside the unresponsive old man, I played the audio file on
loudspeaker. I listened to the daughter say, “Pa, sorry.” Her
voice cracked. “Sorry po na hindi kami makapunta diyan. Gustuhin
man namin makapunta, hindi kami puwede makapunta diyan.” Tears
flooded my eyes and dripped down my face. Being in PPE1,
I could not even wipe them. I sobbed as I listened to that
five-minute recording. I felt helpless realizing that there was
nothing I could do to comfort this man’s family. Under the
usual circumstances, we would allow the patients’ loved ones
to come in, to be by their side and to bid farewell. Yet in this
extraordinary situation, we could not afford to grant even that
simple request.
When the moral wounds are fresh, we may not notice
them because of the adrenaline. Only when we retreat and
confront what happened do we feel the pains. What else could
I have done? Was it a system failure? Guilt rings true; fear, anger,
and hopelessness can crush. The imposed isolation made it
even more difficult to process our emotions. As one nurse
in New York related crying in a viral video, sometimes
we cannot even process our experiences with our family
because they would worry, and we do not want to be a
burden to our colleagues who may also have too much on
their emotional plate. Who comforts those who are used to
comforting others? The truth is that the healer needs to be
comforted, too.
The patients die alone. They slip away without the solace
of their family, without a final hug, without a whisper of
goodbye, without even the last rites. We are left asking
ourselves: What more could we do? Our souls are disturbed. Our
spirits are broken.
Everything was unsettling
In recent years, this phenomenon has gained a name. It was
first described in soldiers who came close to real danger and
faced their mortality in ways difficult for the ordinary person
to fathom. It is called moral injury, and for us healthcare
workers, we face this when we “know what care our patients
need, but… are unable to provide it due to constraints that are
beyond our control”2 . Despite doing the best we can, we feel
that whatever we do will never be enough.
See glossary
Dean W, Talbot S, Dean A. Reframing Clinician Distress: Moral Injury Not Burnout [published correction appears in Fed Pract. 2019 Oct;36(10):447]. Fed Pract.
2019;36(9):400-402
1
116
Sustaining wounds while fighting may be inevitable,
especially in the present circumstances, but maybe we can
at least ease the pain. To do so, we first have to recognize it.
Pain, we were told in medical school, alerts us of actual or
potential damage. We are wired for preservation. Perhaps at
this time, we are being warned of the risk of losing things
valuable: our own humanity, our capacity to recognize
innate dignity, our ability to care for others, our capacity
for love. The cascade of pain signals cannot stop at the site
of damage. It must reach the head, else we will keep our
2
hand on the stove and burn. The reaction
to the noxious stimuli should not only be
initiated individually, but also collectively.
Our leaders and mentors therefore need to
attend not only to the physical requisites,
but also look after the emotional and
spiritual well-being of those grappling with
the somber realities of the COVID-19
frontline.
War is dehumanizing. In the raging battles
against COVID-19, what echoes is the
silence of inner suffering. The broken
spirits have to be mended, so we can
continue to live up to our calling to help
and heal others.
Copyedited by:
Amanda Christine F. Esquivel and
Gabrielle P. Flores
Photo by Brent Viray
117
Pain, we were told in medical
school, alerts us of actual or
potential damage. We are wired for
preservation. Perhaps at this time, we
are being warned of the risk of losing
things valuable: our own humanity,
our capacity to recognize innate
dignity, our ability to care for others,
our capacity for love.
Photo by Isabel Acosta
118
Mama
Gabrielle P. Flores
“Ito talaga calling ko eh,” he shrugged.
Under the scorching sun in the grimy Manila humidity, with nary a functioning fan in sight and
only a flimsy tarpaulin tent to offer shade, Dr. Krystark swabbed one patient after the other. Tark,
as friends call him, is a dentist. He is one of the first UP dentist-volunteers to augment PGH’s
workforce for COVID-19 testing.
When elective procedures1 were cancelled, Tark stayed in the comforts of his family’s home. But
this reprieve from dental duty did little to calm him—quite the opposite, actually. Every day, he
watched the numbers balloon. Every day, his unease grew.
“Hindi ako mapakali na nakaupo lang ako.”
Seemingly endless days filled with frustration and longing for purpose dragged on, until he received
a phone call from the president of the UP Dental Alumni Association.
It was a call to duty.
Without a second thought, he jumped at the opportunity to be a PGH volunteer for COVID
testing. Ironically, it was the prospect of being in the frontlines that calmed his frayed nerves. Like
applying a salve to an unbearable itch, it afforded him a sense of peace.
1
See Glossary
119
Tark’s parents are devout Catholics, and they prayed together
as a family every night. That evening, they prepared for
their nightly routine as they always did, but Tark knew this
night was different. Before a single word of prayer could be
uttered, he gently looked at his mother and said, “Ma, hindi
na ‘to kaya ng doktor lang. Kailangan na ng mas maraming tao.”
His mother had never prayed as fervently as she did that
night.
Tark soon after made his way to PGH, and joined the ranks
of the volunteers who took samples from patients. Though
fully decked in protective gear, and properly trained to
perform the procedure safely, the conditions were often
uncomfortable, and still carried some exposure risks. While
his mother stormed the heavens for her son’s safety, Tark
started off on his first shift.
One of his patients introduced herself as a PGH nurse.
Before Tark could start the process, she hesitated and
admitted, “Teka… iyakin ako.” True to her word, her fear
surfaced as her eyes welled with tears.
“May baby akong bine-breastfeed.“ Tears rolled down her
cheek—one by one, then all at once.
Photos by Brent Viray
120
“Pa’no ko siya papakainin? Sinong mag-aalaga sa kaniya?”
“Ito talaga calling ko eh.”
He was trained for the job. He thought he had
anticipated every possible situation, but he wasn’t
prepared for this. How does one comfort a mother’s
aching heart?
Under the scorching sun in the grimy Manila humidity,
with nary a functioning fan in sight and only a flimsy
tarpaulin tent to offer shade, a mother wept for her
child.
Miles away, a mother clasped her hands as she pleaded
with God to keep her son safe, each prayer was said
more fervently than the last.
These two women have never crossed paths, and yet, at
that very moment, they shared the same pain.
Photo by Krystark Gomez
121
Lost to Follow-up
Anna Elvira S. Arcellana
Mr. PM’s follow-up instructions read:
Last seen March 13, 2020.
To be seen at the OPD (Outpatient
Department)1 with laboratory
results on April 16, 2020.
The April 16 appointment never came.
Beginning March 16, 2020, the usually crowded
hallways of the OPD became deserted. Lines
disappeared. What used to be a cramped parking lot
filled with vans and ambulances carrying patients
from far-flung provinces became a glaringly empty
space, and the dusty windows gave passersby glimpses
of a now bare OPD.
Mr. PM, a 56-year old with thyroid cancer, was just
one among thousands of patients who felt the heavy
weight of the OPD doors closing in on them. The
fear of the department being unable to continue its
essential services due to the dangers of transmitting
COVID-19 had been lingering in their minds for
weeks prior to the lockdown1. And, as they had feared,
the doors had to close swiftly, one could say almost
harshly, in the interest of saving more lives.
122
1
See glossary
As April 16 drew nearer, Mr. PM sent anxious, almost
frantic, text messages to me daily.
“Lockdown po, paano na po ang follow-up ko?”
“Hindi na po nagawa ang post-therapy body scan, paano na po
mababantayan ang kanser ko?”
His burning fears emanated from the embers of his
recurrent and metastatic thyroid cancer; he had to
undergo radioactive iodine therapy twice, unlike most
patients in whom only one dose is enough. Patients
with differentiated thyroid cancer have relatively better
prognosis than patients with other types of cancers,
but this fact did little to allay Mr. PM’s fears. Because
of the lockdown, Mr. PM missed a test essential in the
monitoring of his treatment response. That missed
scan was a handicap in the management1 of his
disease. We could get by with the information that we
currently have, but his situation was still far from ideal.
Because of the closed OPD doors, struggling patients
like Mr. PM were not only bound to miss laboratory
examinations and clinic visits, more alarmingly,
they’re likely to miss medications as well. Mr. PM was
a determined individual with a strong health-seeking
behavior and a desire to conquer cancer, and he was
keen on battling his disease—whatever it took.
Mr. PM’s next text update was heart-rending.
With his elderly body scarred by cancer, he walked
four kilometers under the scorching heat from
his home in Sta. Maria to Bocaue, Bulacan to buy
Levothyroxine2 and calcium tablets. He has to rely on
these two essential medications for life, and walking
this overwhelming distance was his only recourse.
Pharmacies that were both open and well-stocked
were few and far in between. The long distances are
magnified several times over by the lack of public
transportation. With Mr. PM’s tragic message, I felt
powerless, fumbling for words of consolation and
comfort to offer a wounded soul.
With most laboratories closed, pharmacies running out
of stock, medical supplies reaching critically low levels
—patients, even those who are free from COVID-19,
are bearing the brunt of this crisis. Mr. PM may feel
desolate and alone in his struggle, but he is hardly
the only one. More and more patients are facing the
perils of interrupted care. Sadly, while they may all
be sailing against the wrath of the same enormous
storm, many still feel alone: in vastly different boats
kept at socially-distanced lengths from one another.
Meanwhile, there was Ms. MC, a 24-year old
pregnant woman with uncontrolled young-onset
diabetes mellitus and hyperthyroidism, striving to
cope with difficult medication adjustments because
of the absence of guiding laboratory tests. Everyday,
she worries about where she can safely deliver her
baby.
Some patients have had to put their definitive
treatment on hold. Ms. CP, a 34-year old female
with a large mass on her pituitary gland3 secreting
excess growth hormone, was slowly losing her
vision. She was also suffering from diabetes: the
metabolic consequence of the disease. The cure is
surgery, but it was postponed with no final date in
sight. The last time I saw Ms. CP, she was in tears.
The pituitary mass was already giving her bouts of
headaches, and she had already waited years for this
potentially curative surgery. I could only share her
tears because the end of her waiting time was still
so far out of reach.
Levothyroxine, L-thyroxine. A manufactured form of the thyroid hormone thyroxine (T4). This is a medicine used to treat a patient who is diagnosed with an
underactive thyroid gland (hypothyroidism) or has had their thyroid gland completely or partially removed.
3
The pituitary gland is a small mass of tissue nested in its own groove at the center of the base of our skulls. It controls important metabolic processes through the
secretion of hormones. Any growing mass within the skull would cause headaches that could bring anyone to their knees. A growing mass specifically on the pituitary can
disrupt carefully coordinated metabolic processes such as bone growth, and anatomical relations, such as visual tracts. There are no medicines that could permanently
take the headache and those vision problems away--only surgery.
2
123
Sadly, while they may all be sailing against the wrath of
the same enormous storm, many still feel alone: in vastly
different boats kept at socially-distanced lengths from
one another.
There’s also Ms. AR, a 53-year old breast cancer
patient with diabetes, striving not to miss doses of
her chemotherapy and insulin. Ms. AR works as an
elementary school teacher, and with schools closed,
her source of income was threatened amidst her
battle with breast cancer.
continuity of tertiary-level care. A video call cannot fully
replace a face-to-face encounter or a consoling tap on the
shoulder, but it still forges a connection that we commit
to never break.
These stories of arduous struggles continue to
unfold, and innumerable faces take part in an almost
never-ending narrative.
For some patients, however, the only answer we can
offer is deafening silence. Those stuck in far-flung
places, without mobile or internet connections, remain
unreachable. How about these patients whom we have
lost contact with? Their untold stories, the unknowns,
make us fear for the worst.
As doctors, we strive to comfort those who tell us
of their distress, and we labor to reach the unseen
and the unheard. Weeks into the ordeal, rays of
hope have emerged. Telemedicine resurfaced and
provided an avenue to hold consults, send words
of encouragement and support, and replenish
prescriptions while clinics remain closed. The various
subspecialties of Medicine, Endocrinology being only
one of many, opened their own hotlines to ensure the
124
“Paano naman kami?”
Still, each new day offers the chance of reconnecting
with another patient. There is still hope that the lost may
find their way back to care.
As doctors, we strive to comfort those
who tell us of their distress, and we
labor to reach the unseen and the
unheard.
Empty chairs line the emergency room hallway in preparation for the surge of COVID patients.
Photo by Brent Viray.
Copyedited by: Gabrielle P. Flores
125
Uncarved Pieta
Athena Mae Ibon
Alvior Hall1 is a modest building that has been used
for different purposes, in response to the exigencies
of the College of Medicine, over the years. It has now
been chosen to store the donations being sent to PGH.
The area’s location was strategic, being removed from
the main hospital and thus with less risk of exposure
of staff and donors. For a month or so, Alvior Hall
embraced the bulk of donations, with at least five
volunteer medical interns2 and doctors handling,
recording, and channeling these.
I found my way to Alvior Hall, having volunteered
to help out in the work there. I grabbed the golden
doorknob of a varnished wooden door. The door
opened to a crowded hall filled with donated supplies—
masks, isolation gowns, hazmat suits, handmade
face shields, hygiene kits, underwear, and a lot more.
My heart softened, seeing how people had selflessly
forgone their material wealth to respond to the needs of
frontliners.
As I entered the room, I was given a brief orientation
by a co-intern on certain tasks in the area. To be
honest, I had fun on my first day; it was a good change
from the lazy quarantine1 routines. “Guys, kuha kayo ng
food. Kain muna kayo ng breakfast. O, may juice at sandwich
pa!” offered one of our co-interns.
“Hello po,” I moved closer to her.
“Pwede ko po ba kayong makausap?”
Up close, she seemed warm and welcoming, but I
could feel her aura was that of a worn out machine.
Elvira is 54 years old with three children and two
grandchildren. Seated next to her was Jesusa, a 55
year-old woman with a boyish demeanor. Both
of them started working in PGH as maintenance
personnel in 2001: effectively rendering 19 years of
service.
“Kumusta naman po kayo sa trabaho?” I asked.
“Mahirap,” they both replied.
Alvior Hall. A building within the campus of the University of the Philippines - Manila, College of Medicine. It holds various housing conference rooms, and offices.
During the COVID pandemic, it was converted into a donation center for the Bayanihan Na! Operations Center.
2
See glossary
1
126
I was seated comfortably with my friend, Al, when
I noticed the middle-aged woman sitting down
on a plastic stool at the corner of the room to my
left. She was staring blankly while leaning back
against a cabinet. She was wearing a blue scrub suit,
a disposable face mask, and rubber slippers, with
her hair a little unkempt. But what really caught
my attention was her moistened eyes and pained
expression.
It was not merely the nature of work they found hard,
but the circumstance they were in. “Sa trabaho hindi
magkaparehas, minsan toxic 2 , minsan tamang-tama lang,”
they added. Before the pandemic, they were assigned at
the OPD2, which has been closed indefinitely. In the
meantime they have been assigned outside the COVID
wards, just so that they remain readily available once the
OPD reopens. Should they be exposed in the COVID
wards during their shift, they too would be quarantined,
leaving the staff even more undermanned.
“Ma’am? Sorry po?”
“Hindi na po ako umuuwi,”
she wistfully said.
“So, saan na po kayo natutulog?”
I questioned.
“Tatlong araw na po akong naglalakad, apat na oras din bago
ako makarating sa trabaho. Ganun din sa pag-uwi,” Elvira said
while pointing at her feet—swollen, with abraded marks
on each surface from the friction of her worn-out rubber
slippers.
“Nabasag ko na po ang aking pigg y bank,” Jesusa claimed.
She used the money to buy a bicycle online for ₱2,000.
By foot, she arrives to work in an hour or two; by bike,
her travel time is cut by about 45 minutes.
“May vitamins din namang naibibigay. Pero nakakapag-absent
talaga, lalo na sa unang araw ng paglalakad dahil sa pagod,”
Jesusa added. Working was the only option because
they had no paid leaves left. These institutional workers
claimed to not having received hazard pay, and they too
were denied eligibility of DOLE’s cash aid.
Soft mumbled words caught my ear, I shifted back to
Elvira.
2
See glossary
Photo by Gianne Pagulayan
127
There was a brief pause. A few days ago, our auxiliary
workers spent nights beside flashing red and blue lights
with the ringing of the ambulance sirens.
The first nights were traumatic and sleepless.
“Nagsisiksikan kami sa opisina. Natutulog kami sa hapag
ng karton. ‘Pag mamatay…’pag namamatay… at ‘pag patay
na… kitang-kita ng dalawang mata namin bawat pasyenteng
dumarating, nahihirapan, nagbubuntong hininga.” The dread,
concealed anxiety, and unexpressed trauma were
conveyed by the cracks and shivers in Elvira’s voice.
“Natatakot po kami.”
Being able to go home later, she recalled, was small
consolation. After having to walk for four hours, Elvira
arrived home. She remembers the event vividly.
She halts, then clings on to the bars of their gate. She
is now home—where her family is within view, a hand
wave apart, and six feet away from a warm and
tight hug. And six feet it must stay.
“Hindi po ako makakalapit. Hindi rin ako
makakapasok. Takot po ang mga residente sa akin.
Ayaw ko rin naman manghawa sa pamilya ko,” Elvira
spoke
Even the Blessed Mother was able to hold her
only son when they brought Him down from
the cross, her sorrow carved into immortality in
Michelangelo’s Pieta. But this mother, walking
back to the hospital, has no solace.
Heroes are the frontliners who, while bearing
their own crosses, bravely face the world in masks
and shields. In the midst of piles of medical
supplies in an inconspicuous building and away
from the tumult of the battlefront, I found them.
She halts, then clings on to the bars of their gate. She
is now home—where her family is within view, a hand
wave apart, and six feet away from a warm and tight hug.
And six feet it must stay.
128
Photo by Trixie Bacalla
Photos by Amanda Oreta
The Dr. Gregorio T. Alvior Hall, a small two-level annex behind Calderon Hall (UP
College of Medicine), was often used for alumni meetings, small department or student
gatherings, and office space. When the pandemic hit, it was designated as the PGH
Bayanihan Na! Donations Center. Everyday, volunteers receive, inventory, sort, and
repack countless boxes filled with food, PPE, and material donations coming from the
government, individual donors, public and private groups all over the country and abroad.
129
Photos by Denica Tan Yu
130
Photo by Trixie Bacalla
Photo by Ven Ponce
131
Laru-laruan
Athena Mae Ibon
“Doktora! Teka lang po, teka lang! Hinahabol po kami ng pulis!”
These pacing words rang over my ears on the phone.
The call was then dropped.
The sun had gone down. Streets were busy and crowds
were rushing in panic. “Lockdown1 na daw po!” People
chased time before the clock ticked six.
I entered my room, took my seat, immediately searched
for my phone to call again. I got to three rings, but the
phone on the other line wasn’t picking up.
I woke up early the next day, and tried again. Finally, this
time, I heard an answer. “Hello po, Doktora. Pasensya na po at
hindi ko po kayo nakausap nang maigi.”
Jonel, as she wanted to be called, was 30 years old, and all
by herself, took care of her widowed 73 year-old father,
a niece, and a nephew—Rose and Nick—both of whom
were orphans.
Rose, 14 years old, had been one of the patients assigned
to me during my pediatric internship1 rotation in PGH.
She was struggling to breathe when she was admitted—
dyspnea from severe angioedema and glossitis. She had
several excoriations from head to foot with discoid lesions
132 1See glossary
and thinned out hair. Everytime a question
was thrown at her, all she gave was a blank
stare. The only sounds she could make were
incomprehensible.
She was accompanied by her grandfather, who
stood slouched, and couldn’t walk properly due to
low back pain. He could hardly answer us when
we asked for details about Rose’s sickness. It made
my heart ache to see him walk in pain every time
he got back from hours of lining up to get Rose’s
medication. When I asked about Rose’s parents,
Tatay, as I called him, answered “Namatay na po
sila limang taon na ang nakakalipas. Nagkasakit, at
dahil wala po kaming pera, ay hinayaan nalang namin
hanggang sa sila na ay tuluyan nang pumanaw.”
Every time I approached her bedside, people
would stare in disgust as flies hovered around her
pungent space. “Tatay, punasan po natin ng basang
bimpo si Rose. Kayo po ba ay nakaligo na rin?” I would
ask, even as I wondered if there was indeed a
place for them to bathe and change.
After a series of examinations, Rose was diagnosed
with Systemic Lupus Erythematosus (SLE),
in flare, with concurrent pneumonia1 in an
immunocompromised host. She was treated with
antibiotics and steroids2. My resident-in-charge1 told
me how compassion can hasten healing—with Rose, I
got to see the truth of those words myself.
On the third day, Rose was already trying to form
words.
After five days, she gave a hoarse whisper, “Ate.”
After Rose’s first discharge from PGH, she was able to
work as a computer shop attendant—being paid two
thousand pesos a month with meals covered.
Rose got better. At least for a time.
“Doktora, pasensya na po, pinapaalis po kasi kami ng pulis.
Tumatakbo kami ng gabing iyon kasi pinapaalis na kami at
kinukuha po ang aming mga gamit,” she explained. Jonel,
along with her extended family, lived on the streets of
Blumentritt. I thought of Tatay limping away, his back
aching. Mostly, I thought of Rose.
During this COVID-19 crisis, they had been
affected by the shortage of medications, specifically
Hydroxychloroquine3. This was the medicine for
her SLE but was, at that time, being considered as
an off-label treatment option for COVID-19. When
I called, Rose had missed her medications for two
weeks already. Jonel said that they were about to
go to PGH for Rose’s readmission, but due to the
lockdown, couldn’t get past checkpoints. I had to
inform her that PGH had already been turned into a
dedicated COVID-19 hospital—her fifth admission
for therapy would likely be postponed.
I felt a surge of worry as I asked about their
situation, but before we could move forward,
the call got interrupted. There was a loud noise,
a commotion. We temporarily dropped the call
and when we reconnected, I asked, “Ano po ba ang
nang yari?”
“Nagtitinda si Nick ng laruan sa may tapat ng simbahan.
Apat na libo po sana kada buwan ang kita pero dalawang
buwan na, ay isang libo na lang ang binibigay. Kadalasan pa
ay hindi siya sinasali sa mga pinapakain.”
See glossary
Systemic Lupus Erythematosus (SLE) is an autoimmune disease where the immune system attacks the patient’s own body tissues. The widespread inflammation and
damage can cause the patient’s symptoms including the inflamed tongue (glossitis) and recurrent episodes of swelling of the face or the body (acquired angioedema). The
swelling can make breathing difficult. Medical interventions and lifestyle changes can help control SLE, but there is no cure for it.
3
Hydroxychloroquine. HCQ is one of the therapeutic drugs that has been studied for the prevention and treatment of COVID-19. When the drug was reported as a
potential treatment for COVID-19, many people bought this drug, causing a decrease in the supply. The treatment studies for HCQ were later discontinued because the
initial data showed no improvement in mortality rates.
1
2
133
“Wala na rin po kaming makain. Pinapalipas na lang namin ang araw.
Di na po kami nakakapagbenta at hindi rin kami nabibig yan ng ayuda.
Kahapon ay pumunta sa pindutan4 pero zero balance po ang card namin kasi
hindi daw kasali sa tutulungan yung mga walang mga anak na pinapaaral.
Lalo po kaming nahihirapan ngayong panahon ng COVID-19. Tiis-tiis na
lang po hanggang sa may darating na tulong.”
These scenarios are the painful scars that line the archipelago of
the Philippines, much like excoriations with discoid lesions on a 14
year-old child with SLE. These may be scars of endurance, but also
mean worsening disease.
The hunger games of this crisis cannot be overlooked. The poor
will get poorer; the hungry, hungrier; the sick, sicker.
“Teka lang po, teka lang!”
Hanggang kailan ang habulan? Hanggang kailan ba tayo maging larularuan?
Like how one person might call all photocopy machines “Xerox”, it is not uncommon to hear Filipinos substitute an object’s name with a word that best encapsulates
their own experience or associations with the said object. For this family, an ATM is pindutan, named for the number pad one has to press to make transactions.
4
134
Suntok sa Buwan
Athena Mae Ibon
Scattered leaves sweep through shriveled ground as
northern wind passes by. The surrounding air is warm
and dry, but the sweet, soft breeze sings along during
siesta. Mang Leigh, 34, sits on a wooden chair outside
his doorstep. He dons his mask and breathes deeply as he
listens to the subtle sounds of nature. The view is calm,
but he misses the loud cheers of children playing. This is
no longer one of the ordinary days.
Mang Leigh sits with apprehension as he recollects
events that started in 2009. “Napapansin ko na lang na
may nakakapa akong bukol sa bandang kaliwa ng tiyan ko,” he
started. The mass became bothersome. His older sister
advised him to consult a hematologist, and so he went to
PGH.
Mang Leigh, a tricycle driver and a father to three, was
diagnosed with chronic myelogenous leukemia (CML)1.
“Tinatabi ko ang konting pera galing sa kinikita ko para sa aking
gamot.” Mang Leigh only earns ₱500 a day, but he needed
to take a total of ten Imatinib 400 mg tablets2, costing him
around ₱14,000 a month. “‘Overshort’ na rin kami sa gastusin
at kinakatakutan ko talaga na mamaga ulit ang spleen ko,” he
adds, referring to the splenomegaly associated with CML.
He was scheduled to follow up on April 3, 2020, but the
circumstances changed due to the COVID-19 crisis.
“Ngayon na lockdown na, ay di na kami makapagbiyahe.
Nakakakain kami galing sa konting tulong-tulong dito sa
barangay,” he expresses. What worries him most is that the
unseen enemy attacks those with weak immune systems;
he himself is at high risk because of his cancer. Last
year, he had already been admitted due to pneumonia3-a consequence of his immunocompromised state. In
their home, meticulous preventive measures are observed
to avoid contact with the virus: frequent handwashing,
segregating items which could be fomites3, and observing
a healthy lifestyle.
Mang Leigh, a man battling cancer amid this COVID-19
crisis, and who barely has funds to support his family’s
needs, still manages to say: “Masaya po ako, na kahit ang
karang yaan man ay suntok lang sa buwan, huwag po tayong
makalimot sa Itaas. Maging masaya at magpasalamat sa arawaraw. Kahit papaano, masuwerte ka pa rin kasi nagigising at
nabubuhay ka pa rin sa bawat araw.”
We all have our own trepidations in these times. But a
humble man, faced with a more daunting situation, has
the serenity of acceptance, if not selflessness. “Kahit ako na
lang ang matamaan, huwag lang ang sino man sa aking pamilya,”
he said. “Bawat araw, kailangan nating magdasal at lumaban
para ang lahat ng ito ay ating malagpasan.”
Chronic Myelogenous Leukemia is a type of bone marrow cancer which causes the increased formation of abnormal white blood cells.
Imatinib is an oral medication that is used to treat certain types of leukemia and other disorders/cancers of the blood cells. It works by preventing the proliferation of
cancer cells.
3
See glossary
1
2
135
This man’s spirit made me realize that while those who
live comfortably can feel immense discomfort, simply
having a life to live, for those without such luxury,
becomes an absolute comfort.
Thank you, Mang Leigh. I needed this reminder.
Photo by Maria Keziah Legion
136
From Fighting Cancer to COVID-19: The Battle is Not Over
Mikki Miranda
I was halfway through my senior
residency when I was diagnosed
with cancer in 2019.
The night before my surgery, I called our chief resident1
telling her that I had to go on leave for an indefinite amount
of time. That “indefinite amount of time” turned out to
be nine months where I underwent six grueling cycles of
chemotherapy. And since chemotherapy1 rendered me prone
to getting sick, I couldn’t go to work and finish my residency.
I wasn’t able to graduate with my colleagues. All plans,
whether career or travel, were placed on hold — indefinitely.
I was optimistic, though. Maybe after fully recovering I can start
working again without fear of catching something.
Thankfully, I went into remission. I started writing a postcancer bucket list to celebrate the year 2020, knowing I have
a new lease in life.
Well, fast forward to this year: the COVID-19 pandemic
began. While most people were still getting used to the
“New Normal,” I realized I was already “quarantined”1 back
in 2019—before COVID-19 told everyone to stay at home.
“An Ode to Filipina Frontliners”
Mixed Media, 2020
By Mikki Miranda
1
See glossary.
As a cancer patient, I could not go out of the house without
wearing a mask. This was the time when wearing a mask on
the street was meant for sick people or celebrities. Also, I had
137
to stay clean every single day, every single time. When I craved food, I would have to buy from a delivery
service. I couldn’t go out and eat in crowded restaurants. And my parents had to ensure the food served was
neither raw nor under-cooked.
Too bad, I loved sashimi.
Apart from the physical toll caused by chemotherapy, there was the constant mental torture of having no
control over my own life. If I had to go out of the house, it was because I had to go to the clinic to receive
chemo or have blood tests or scans done. This meant I spent long, long days at home. Time felt really, really
slow. I had many days where I just stared out the window and watched the day eventually turn to dusk, then
to dark. I was able to witness seasons change. I saw how a tree slowly grew its flowers, then saw its leaves
wither and fall, and finally, grow new leaves again. Yesterday was the same as the next day; most of the days
looked exactly the same.
But then again being under “quarantine” had its quirks. I found ways to entertain myself. I watched so many
movies and TV shows that I grew sick of watching them. I tried “studying” again but didn’t feel any volition
if there wasn’t any guarantee of going back to normal. I was only allowed to take in a few visitors at home,
and they had to make sure they were not sick. Since most of my friends were doctors working at the hospital,
we had to carefully coordinate a visiting plan where everyone was healthy and cold-free. Their visits were
brief, yet fun, and I entertained them by showing my different wigs.
I discovered so many hobbies. I learned how to paint just by watching people on YouTube create art in the
comfort of their own homes or studios. I practiced painting all the mundane things I see in our house: our
family dog, the fruits and vegetables I eat, old vacation photos, and the flowers that grow in the garden and
on the porch. When my skills improved, I gave them to my generous patrons: my dad, my mom, my siblings,
my family relatives, and my friends. And then I gave one to benefit cancer patients like me.
Most people don’t know that some great painters of history thrived while being under “quarantine.” Frida
Kahlo was bedridden and battling a spinal injury when she started painting her powerful self-portraits. She
planned to study medicine, but she was severely injured due to a bus accident. During her lengthy recovery
from her spine and pelvic injury, she turned her energies into making provocative art. In order to adapt, she
had an easel and mirror attached to her bed. That is why she made a lot of self-portraits.
138
I guess that the arrival of the COVID-19 pandemic
made a lot of people turn to the same things as
I did during my mandatory quarantine back in
2019. Many have started their own “Frida Kahlo
moments” and started diverting their pandemic
anxieties into artistic endeavors. A some-sort-of
routine at home made them regain control over the
anxiety brought by the pandemic. Most friendly
gatherings are now brief, and most times done in
the online cloud. And like all cancer patients are
supposed to do, everyone started to wear masks in
order to protect themselves from acquiring a terrible
infection. In the two months of ECQ, time felt
really, really slow for them, too.
This pandemic forced a lot of us to contemplate
about time. Much like the “butterfly effect”, the
pandemic forced us to look at time in both ways:
retrospectively and prospectively. Retrospectively,
we contemplate on the choices and actions we made
in the past year and see how they have reflected into
our lives during this pandemic. Like, for example,
if a person had chosen to stay in a job that affords
work-from-home arrangements instead of resigning,
it would have made a difference in their ability to
financially survive this year. Or if I would have
been diagnosed with cancer this year, maybe my
family and I would have had a more difficult time
getting treatment.
The children’s playground in front of the Department of Rehabilitation Medicine
stands silent as fewer outpatients are allowed into the main building due to the
COVID pandemic.
Photo by Maria Keziah Legion
139
Prospectively, we contemplate on the decisions we
plan to make with respect to the following months
and years to come. All excitement about traveling
and exploring the world is very much replaced
with fear of traveling even to the nearest crowded
shopping center. We now think about making
decisions that could impact our lives in order to
survive in the long term.
It becomes even harder to contemplate on the
situation if you are a cancer patient. People with
cancer shouldn’t have to suffer and die because
protocols get delayed or they can’t get a scan
because of restrictions. Just like viruses, cancerous
cells don’t rest during a pandemic.
This so-called “new normal” is something people
will have to live with for a long time. And yes, this
new normal doesn’t feel new at all to me since I
was a shut-in for nine months. But for the most
vulnerable among us— we simply cannot let this be
their “normal”, too. And it depends on the majority
to be socially responsible in order for the rest of us
to survive. The battle is not over.
As of this writing, Dr. Mikki Miranda is a
graduating resident at UP-PGH.
140
Pinagtagping Tahanan1
Gabrielle P. Flores
“Are you sure you want to do this?”
“For heaven’s sake, Rochelle! I’m not even 60 yet!”
With a virus that hits harder the older you get, Dr.
Rochelle’s trepidations were fair. Dr. Boncan, head of St.
Luke’s dentistry department and father of five, had just
signed up to be a volunteer nasopharyngeal swabber2
in PGH. And Dr. Rochelle “Chelle”, his colleague, had
called him to question his decision for a third time.
It made sense for him to volunteer. He knew about
infection control—the subject of which he used to teach
at the UP College of Dentistry. He was no stranger
to occupational risks, either. Dentists have one of the
highest occupational risks for practically any infectious
disease—COVID-19, included.
Photo by Brent Viray
Despite the logic, the image of losing a colleague and
leaving five kids fatherless, under a program that she
facilitated as the president of the UP Dental Alumni
Association, left Doc Chelle with a bitter taste in her
mouth.
Doc Chelle had always been cautious. Her pre-pandemic
clinic was pristine: appointment-only, referral-only, and
with a pre-consult phone interview to boot.
Scenes from the COVID Triage and Swabbing Station placed just after the
Padre Faura entrance of PGH.
Photo by Jonas Del Rosario
Named after one of the songs produced by the author’s class UPCM Class of 2021, Pinagtagping Tahanan is about an unlikely family formed in the middle of Malate. The
song was part of UPCM Class of 2021 stage musical entry “P.I. (At Iba Pang Mura Sa Mundo)” to the annual interclass stage play competition in 2018.
2
See glossary
1
141
Her impressive safety measures in much fairer weather
should have been indications that she would not take
this volunteer program lightly. “She told me she wanted
to cry when I said I was volunteering,” Dr. Boncan said,
laughing and shaking his head.
And cry, she did. In the nights that led up to the
program’s launch, she was tearful and sleepless. Doc
Chelle could not deny, however, that she needed him
onboard. The team she had put together from a Facebook
post on the UPDAA page had swarms of interested
volunteers. But transportation, comorbidities, and cold
feet whittled the roster down to just four dentists: Dr.
Krystark “Tark”, Class of 2011 and civilian dentist for
the navy; college friends, Dr. Eula and Dr. Thea, Class of
2013 and a private dental associate and Masters student in
the middle of writing a thesis; and Eunice, Class of 2019,
a fresh grad just starting out.
This bunch was tenacious, one could say even
stubbornly so. Dr. Boncan, a gentle, soft-spoken
professor who seemed to always speak and move with
purpose, served to temper the team’s energy.
His addition proved to be invaluable when they saw
the initial state of PGH. It was chaos. Swabbing2
turned out to be only a tiny fraction of their job. The
mound of complex paperwork and logistical hoops that
accompanied each patient towered over the team. “We
had to do everything,” Thea recalls.
Their first home base was “Phi walk,” a small bricklined path at the entrance of Padre Faura St. that led to a
pavilion next to PGH’s Spine Unit2. Black wrought iron
rails sectioned the area from the driveway and parking
lot it faced, but besides the rails, nothing else served to
partition the swabbers from the elements of nature.
They all watched their lives jerk to a halt when the
pandemic peaked and most dental services in the country
were forced to close.
They were smart, voracious learners; quick to jump at the
opportunity to volunteer. But they were young.
Eunice, the youngest of them all at 22, confidently
declared, “I’m not 18 anymore,” when phoned by
Doc Chelle to ask if her parents were aware of her
volunteering.
Photo by Steff
142
2
See glossary
The breeze was welcome. “Iyong Level 4 PPE2, parang sauna suit,”
said Tark of the heat he felt under complete PPE. “Pati sapatos
ko puno ng pawis!” Any semblance of ventilation is a treat for
someone constantly hungry for air. But the viral media bottles,
clinking dangerously like chimes when a breeze blew past,
were less amenable to the gusts of wind.
And so they moved to the PGH Chapel. Then moved to
the spot outside the ER. And again to the lot outside the
Ambulatory Care Unit.
“The directives changed literally everyday,” Eula said.
Like pollen, they moved with the changing winds, with Dr.
Boncan at the helm. And just like the seeds, they bloomed
where they were planted.
Very quickly, they established their own little routine. Dr.
Boncan would always volunteer to swab first, setting an
example of proper technique. “It was like having a clinical
professor around,” Thea remarked. An educator herself, Thea
was equal parts embarrassed and grateful when Dr. Boncan
called her over to correct the angle at which she directed the
swab. Eventually, their hands grew accustomed to the process.
Despite the nasopharynx being “uncharted territory” for the
young dentists whose comfort zones were bordered by the
confines of the mouth, muscle memory kicked in.
When Eunice came in as a late addition to the team, Eula
and Thea made sure to show her the ropes. “Students her age
are usually my students, and she was such a trooper,” Thea
2
See glossary
Photo by Steff
143
recalled. With a propensity to fainting spells and a vicious intolerance to heat, Eunice pushed through a day’s work
in full PPE, all while trying to conceal the episodes of tunnel vision kicking in—a warning that she was about to
faint—from the rest of the team. While she may have succeeded at hiding the spells, her heat intolerance did not
go unnoticed. Laughing good-naturedly, Thea conjures the image of Eunice’s first time to doff2 the PPE. Her hair,
matted with sweat, clung wildly to her face as she emerged from the PPE’s hood; she looked like she had taken a
plunge in a pool.
Like a well-oiled, albeit makeshift, engine, they chugged along the days the best they could.
Day in and day out, a cacophony of spluttering, coughing, and violent retching serenaded the swabbers as they
inserted a long cotton swab into patients’ noses, pushing it back until it hits the sweet spot: the nasopharyngeal
wall, an exquisitely sensitive patch of tissue. They would deftly swirl the tip, triggering the nerve endings to go
into a frenzy of ticklish pain. They’d pull the swab out. Only to repeat the process in the other nostril, much to the
chagrin of patients who, at this point, are often gagging and in tears. “I’ll equate it to having accidentally breathed
in water from a pool,” Dr. Boncan said of the experience.
Photo by Ephraim Leynes
Photos by Brent Viray
Swab. Sign. Repeat.
144
2
See glossary
The monotony of the days was broken by Doc Chelle’s
regular check-ins.
“Doc, don’t worry! We’re big girls,” Thea assured her
through the phone. But old habits die hard, and when
Doc Chellle caught whiff of her alumni struggling to find
places that served lunch, a massive effort was coordinated
with other dental alumni to bring them cooked meals,
everyday, without fail.
“Tatawagan ko pa yung guard. Tatanungin ko: Guard, nadala
na ba?” Doc Chelle admitted. She steeled herself against
comments that she was babying her alumni, saying, “I’m
not going to deploy them like soldiers, unprepared for
battle. If I can cover all the bases, I will.” The meticulous
coordination that went on behind the scenes did not go
unnoticed by the “Swab Squad.”
“She’s the most protective person I know,” Eunice admits.
This unlikely grouping of people looked out for each
other. They had to. When their very profession was
suspended in limbo, and the nature of their normal work
far removed from that of the medical doctors in the
hospital, they naturally clung to the familiarity of each
other. In whispers outside his earshot, the younger dentists
would call Dr. Boncan “dad.” Perhaps unknowingly, he
took the role in stride. He picked up Eula and Eunice
when rides were scarce. He gave Thea a pep talk as she
was about to swab an important figure in the hospital.
Photo by Steff
And he always tried to volunteer first when a swabber
was needed. Knowing this, Eula recalls how they tried to
game the decking system to limit Dr. Boncan’s exposure;
they looked out for him, too. Doc Chelle never failed to
make her presence felt—even from a distance. In their
one-week stint that extended to almost two months,
Tark, Eula, Thea, and Eunice were regularly given getout-of-jail cards by Doc Chelle. “If at any point, even just
30 minutes in, you want to stop. Just tell me, and I will
pull you out of there,” she told each one individually. But
they all chose to stay. How could they not? Their sense
of pride in their duty was swathed comfortably in the
blanket of security Doc Chelle and Dr. Boncan gave.
And so, in the shade of the swabbing tents, basking in
the symphony of sounds, the air hanging heavy with spit
and snot and sweat, this family of dentists settled into
their new home: each other.
145
Finding a Path in Crisis
Maria Angela M. Villa
Last February, my chief resident1 asked me
to attend the PGH Physicians’ Association
(PGHPA) election as the representative of the
Pediatrics Department. There, I was voted the
PGHPA president. I thought to myself: given a
position of tremendous responsibility, what can I possibly
do to help our doctors?
The PGHPA stands as the collective voice of
more than 600 residents and fellows1 of the
hospital. How can we, as an Association, truly
represent our doctors and take better care of
their welfare? Less than a month later, the
COVID pandemic arrived in our country—and
this same question, and other equally pressing
ones, gained additional importance.
At the onset of the crisis, when PGH declared
war against COVID-19 by assuming the role of
a COVID referral center1, it was chaos. There
were numerous new policies, duty1 schedule
revisions, postponed lectures, fewer patients,
lesser colleague interactions, increasing anxiety
over an ambiguous future, and loss of daily
hospital routine. The fear was undeniable. The
grief of losing some of our beloved mentors to
the disease burdened our hearts even more.
In spite of the fear and anxiety, we heeded the call,
and attended to our duties. The work assignments
and routines had to be greatly adjusted, for which
we had to adapt to the best of our abilities.
See glosssary
Tao Rin Pala (TRP) is an annual program held by the UP Medical Students’ Society. It provides an opportunity for medical students, staff, faculty, and professionals to
showcase their talents in the performing and visual arts. There is a different theme per year, but the constant reminder that physicians are also human beings pervades,
hence the name, “Tao Rin Pala”.
1
2
146
The last time we saw the jovial and radiant Dr.
Sally Gatchalian, then President of the Philippine
Pediatric Society, was when she eagerly taught
doctors during bedside rounds1 with patients
in Ward 9. The next thing we knew, she was
intubated1, and eventually, lost to the very disease
she led her society to fight against. One by one,
other physicians, some of whom were also our
faculty, also succumbed to the disease. The
shock of our mentors’ deaths made it all too
real: COVID-19 could kill us. Gone were the
times that we could just go in and out of hospital
duties without fearing the infectivity of a simple
respiratory tract infection. Gone were the times
of going home to our families or roommates with
the peace of mind that our clothes or bags or even
our hands were not harboring deadly microbes.
This crisis magnified the exhaustion that is second
nature to a PGH trainee. Tired bodies made for
easier targets for this virus. It was a grotesque
reminder of the phrase “tao rin pala2.”
They say a crisis reveals what the core of a person
is. While heading the PGHPA, I had a unique
opportunity of seeing firsthand how selfless the
PGH doctors are during a crisis.
The PGHPA set up a Telegram group3 exclusively for residents and
fellows. It was a platform where doctors were able to voice out their
concerns and connect directly to the PA, who relayed these concerns to
the PGH administration in hopes of resolution. These issues ranged from
PPE concerns, residency/fellowship training-related questions, to better
communication with the PGH administration. There were also exchanges
on matters not directly related to training or services, such as concerns
regarding transportation, housing, salaries, and discrimination against
healthcare workers. It also became the “food announcement” medium.
We believed that no doctor should go hungry, especially when on duty. So
departments which received extra food donations sent notices and arranged
delivery to those who were less fortunate, or just more hungry!
There is nothing glorious in the process of becoming a doctor. We’ve
felt the demand to answer the needs of sick patients since the start of
clerkship1— when we learned how to weigh soiled diapers, push stretchers,
haggle for wheelchairs so our patients can sit while waiting in the ER, and
compress a dying patient’s chest in an attempt to rescue him or her from
the throes of imminent death. Now that we are residents in training, the
demand is the same, if not greater.
See glossary
Telegram is an electronic, multi-platform messaging application. Messages on Telegram are securely encrypted. It is one of the most frequently used messaging
applications in PGH at the time of writing
1
3
147
I distinctly remember one night when, while I was on duty, I received a message from a
doctor from a different department. I personally did not know her, and I doubt we had
met before. Her message was simple: “Thank you for doing what you do, for making
an effort to inspire us to help each other.” The message was an inspiration to help each
other. A reminder that we are going through this together. A certainty of hope that
something good can come out of this crisis.
As I write this, I still could not believe that only three months have passed. It feels way
longer than that. As the crisis slowly unfolds and evolves, I still grapple with the question
of how PGHPA can serve the doctors better. I am also reminded of my commitment to
serve, not just as the Association’s president, but first and foremost, as a doctor serving in
the frontlines. A part of me may sometimes be afraid and tired, but I am willing to hold
on to the truth that I am not alone in this struggle. Perhaps herein lies the answer, that of
holding a common resolve.
We may have differing opinions, diverse and strong Type A personalities, passionate
emotions, and altruistic epiphanies as doctors serving in one of the nation’s COVID
referral centers. But, together, I believe we will be able to weather this pandemic and take
pride in the fact that during this time of crisis, we became #OnePGH.
148
Yet Another Uncertainty
Vince Elic S. Maullon
“Oh mommy, dapat marunong ka na magdress ng wound ha. Magpapractical exam tayo bukas. Grade-an
kita.”
“Hala Doook, nakaka-pressure hahaha. Wait.”
Mommy V, a bantay1, is feeling the pressure. Not because she’s part of the “tough 10,” but
because she’s scared of dressing her husband’s non-healing wound. But Mr. V, a chronic
diabetic, doesn’t seem to mind. He’s actually pretty chill about it. I made sure to teach
Mommy V proper wound dressing, and instructed her how to change these twice a day.
News about the steadily increasing number of COVID-19 cases was at the back of
everyone’s minds, so I wasn’t entirely sure if we’d be seeing each other the next day. Mr.
V was my last patient, assigned under my care that same day when it was announced that
clerks1 were to be pulled out from PGH, to be followed by the interns1 a few days after.
Mommy V would probably be relieved that I won’t show up. Walang practical exam eh.
“Hoy! Kita-kita na lang sa June ha. Mamimiss ko mga pagmumukha niyo, hahaha.”
That “June” quip was made with an element of exaggeration. We thought things would be
normal by April, or May—a lockdown1 until May even seemed to be quite a stretch back
then. Little did we know that that was the last semblance of normalcy we were going to have
for the next few months.
I went back home to Quezon City the next day, and some of my classmates went home to
their provinces before Manila closed its borders. Our block’s typical daily noisy banter in
the callroom1 was now limited to our Telegram group chat (it’s like Viber1, but for the bagets).
1
See glosssary
149
Messages would range from the different hobbies
we were preoccupying ourselves with, to the status
of our mentors and colleagues with the virus, and of
course, to discussions on the almost-daily shows of
ineptitude in our country’s pandemic response, care
of our own national government.
By this time, everybody seemed to be preoccupied
with how the world was seemingly falling apart.
For many of us, however, the elephant in the room
remained: paano na ang clerkship natin?
You see, being a clerk in PGH is weird. We’re medical
students, yes, but we also actively take part in the
management1 of our patients. We see them on a daily
basis: taking their histories, diagnosing their diseases,
and even creating and carrying out management
plans for them, all under the supervision of our
seniors, of course.
As clinical clerks, we were among the “youngest”
(i.e., least experienced) in the hospital workforce.
We were also among the first ones to be pulled out
from the hospital. But even though we’re technically
on a “break,” after a few months, we were still to
go back to the hospital as interns, about to face an
unseen enemy. Like cadets being prepared to face the
battleground, training had to go on. We can’t fight an
enemy ill-equipped.
After weeks of ironing things out, the UPCM Dean’s
But at the end of the day, once we had finished our
academic requirements, turned off our laptops, and
everything went quiet, then we started entertaining our
own personal thoughts and musings. The uncertainties
of the future awaiting us soon-to-be doctors seemed
very daunting.
I always tell my friends that one of the things I hate
the most is uncertainty. But in the profession we chose,
uncertainties are a fact of life. Sometimes you may
know how to manage a patient and you’re able to do it
well, but there are times when you do your best, yet you
see no improvement, and you just… well, hope for the
best. Sana our patient can pull through. Sana kayanin niya.
Now, we’re faced with a challenge we haven’t seen
the end of yet. In a pre-COVID world, most of us
would have probably mapped out how our internship,
graduation, and post-med school plans would go. But
COVID made us scrap all that. We can’t even think of
what will happen next month. Even the next two weeks
can be a bit of a haze.
See glossary
An SGD or small group discussion is an academic activity wherein students gather to discuss a fictional or real case, usually with the help of guide questions. It is usually
facilitated by a consultant, who is there to answer any questions that may arise or emphasize any key points in the discussion.
1
150
Management Team made arrangements and virtual
learning activities commenced. For several weeks,
medical education at the comfort of our homes became
the new norm for us. “Yung tipong nag-e-SGD2 kayo tapos
tumatahol aso mo habang nagrerecite ka, gan’on.” “May dog
barking,” our consultant1 quipped as my dog started
yapping to his heart’s extent. Mukhang may gustong
makisali sa aking medical education.
2
Together with our current interns—who will be taking
their licensure exams later this year—our role as soon-to-be
newly minted doctors in the post-COVID world is another
uncertainty. The sick and those needing medical attention
for other conditions will always be there. The young child
with cancer, the pregnant woman, and the lola with diabetes
and hypertension will always be there. Our patients will
always be there.
But, at least for the immediate future, so will this virus.
These patients were the ones whom we used to face on a
daily basis, attending to their needs. But right now, as much
as doctors would want to face them, a virus remains in the
way.
How long would it take before things go back to normal?
How long would it take before we will be able to face our
patients again?
These are questions to which no one knows the answers.
All these are yet uncertainties. We can only do so much,
and sometimes hope’s all that’s left. Sana our patients can pull
through. Sana kayanin nila.
It is fairly easy to get demoralized these days, but I would
like to believe that not all hope is lost. Every day, patients
get extubated1, patients get well, and patients get to meet
their families again. Bit by bit, the familiarity of living life as
we know it is coming back, and we have our People Giving
Hope1 to thank for that: the frontliners, the backliners, and
everybody doing their part to keep us safe and make
our lives even a little bit easier to bear during these
trying times.
Indeed, during times like these, no matter how much
uncertainty there may be, it is hope which gets us
through. And for us medical students, the call of
duty to serve our fellow men beckons us to prepare
ourselves to fight the unseen enemy when it is our turn
to be in the frontlines. After all, this only happens once
in a lifetime.
“From the PGH-DDHO: For the next batch of Interns (20202021), Internship will start on July 1, 2020 until June 30,
2021. All Interns will report on July 1, 2020.” 3
Walang alarm, walang anything. Ito, literal na “call of duty” na
talaga. It was now the middle of May, and the inevitable
seemed to be closer. We were going to be interns, and
we’re going back to the hospital.
“Hala Doook, nakaka-pressure hahaha. Wait.”
Suddenly, I understood what
Mommy V meant.
See glossary
This was the announcement given at the time of writing. However, due to the volatile situation caused by the pandemic, many of these earlier announcements were
changed several times in consideration of safety.
1
3
151
152
Photo by Alla Tan
RECOVERY
153
154
Recovery
/r ’k v( )rē/ n.
e e e
The act of returning to a normal or healthy state.
The war against COVID-19 rages on, but the People Giving Hope1
remain steadfast to their duty to serve. They refuse to wait for the
smoke to clear and for the dust to settle. The hospital community
continues to protect and serve the people, most especially the
vulnerable. The country and the institution goes on the still difficult,
unsteady, and uncertain path to healing.
1
See glossary
155
03.31.20
Sachiko S. Estreller
I counted.
50 admissions. 27 discharges. 3
mortalities.
This was our General Medicine service
census for the month of March1 .
4:00 a.m. rounds. 3 residents.
2 admitting duties2. Unlimited inpatient charting and out-patient
consults in between.
All these before the half of March was
through. Before 6 General Medicine
services merged into 3 teams attending
to both non-COVID and COVID
patients. Before 24-hour duties turned
into staggered 7-day 8-hour shifts.
Before 2 internal medicine wards and
intensive care units re-organized into
COVID-dedicated facilities. Before life
took a 180-degree turn.
Veterans at dealing with an inordinate number of patients at any given point, it is not unusual for services (see glossary entry: Service) of the Department of Internal
Medicine to attend to more than 50 patients a month - the census categorized into those still in the hospital, those who went home, and those who had passed on. With
the wave of COVID-19 and the subsequent conversion of PGH into a COVID referral center, the numbers, and what they represent, have shifted.
2
Each department has their own way of assigning or decking patients. The Department of Internal Medicine, as well as some other departments, employs a winner-takesall system wherein all patients coming into the ER for a particular shift get decked to the service (see glossary entry: Service) on admitting duty.
1
156
Photo by Brent Viray
Now the numbers are not mere admissions and discharges, but confirmed cases and deaths.
16 days into this lockdown. 2,084 sick. 88 deceased. 17 colleagues. Many awaiting results, many
untested.
We counted.
Because in this time filled with ambiguities, where days are not measured by hours and the hospital
and our vocation are filled with blurred lines, maybe we can scavenge a little sense of control, a
little strength, by counting the numbers that make up our new reality.
And though the sick, homeless and hungry are innumerable, the tears shed unmeasurable, the
sacrifices made non-compensable, on this 31st day of March, we count 49 recovered.
One of the numbers that matters most.
Tomorrow, we welcome a new month. Filled with wishes and plans—all definite but uncertain at
the same time. Slowly. Surely. Cases and deaths rising, then hopefully lowering. That elusive curve
flattening. Ticking more days into isolation, counting down to when our efforts come into fruition.
In the unpredictable months that will follow, one thing is sure—we will count, and the nation will
remain counting.
Copyedited by: Iris D. Ditan
157
The Persistence of Our Memories
Juan Raphael M. Perez
I was having coffee with my friend from Occupational
Therapy when we saw the news:
we listened to while studying—reminding us that we
were studying medicine, but not entirely yet.
CLASSES SUSPENDED FOR THE REST OF THE
WEEK.
Despite how visceral these experiences were, I was
at a loss. I had sworn to serve the underserved,
but how? What could I possibly do in situations—
medical ones—I had not experienced before?
Our initial reactions were sighs of relief. Wala nang gagawin!
I distinctly remember how the coffee tasted slightly sweeter
than usual—the hint of bitterness is still there, but subtle.
It was naïve of me to think that the pandemic would change
only that week’s schedule. Instead, it would fundamentally
change how we lived and how we came up with reasons for
choosing medicine.
When everything started spiraling out of control, I
realized that the path of medicine wasn’t what I had
envisioned—a realization which forced a lot of heavy
introspection on the paths we had decided on.
Nighthawks (Hopper, 1942)1
Growing up, we were told stories of doctors akin to
how Gilgamesh and Lam-Ang were praised for their
heroism. A refrain of good fortune is ingrained in
us, should we show any sign, no matter how small,
of taking interest in med. Being a doctor (or lawyer)
is good, because you will get a lot of money. Being a
doctor is good, because you get to “serve.” Being a
doctor is good, because you can help your family.
I am pretty sure that when we pledged during the interview
that we would serve the underserved, we all had different
perceptions of what that promise would mean. PGH did not
fail to make us realize just what we had agreed to though.
Crossing the gates of Calderon Hall for the first time flung
us, INTARMED2 kids, into an entirely new realm. We
received text blasts when meningococcemia ran amok in
the ER. In our bedrooms, we became familiar with the
sound of the ambulance siren complementing the playlists
But these myths about medicine are inaccurate
depictions of reality.
An oil painting by American painter, Edward Hopper. It depicts a diner on a corner where two streets meet. As the viewer looks on to the customers inside, it evokes the
feeling of isolation and fear in an urban or new environment.
2
A program offered by the University of the Philippines that allows students to complete a Medical Degree in seven years instead of the usual nine to ten years, including
undergraduate education. It consists of two years of general education and five years of medical school.
1
158
Then, the rumors reached us. “Meron daw sa fifth floor.”
What the Water Gave Me (Kahlo, 1938)3
Being a child of INTARMED means being at a
crossroads. It means accepting, at very young ages, the
harsh realities of Philippine healthcare. It also means
questioning our capabilities during pandemics, since we’re
supposed to know what to do. We’re studying medicine
after all, never mind that we’re still in preparatory courses!
Anxieties about our futures constantly bloom. Did I make
the right choice?
Sometimes, being in medicine is demoralizing. We see our
ates and kuyas tired and debilitated after 24-36 hours of
duty4. We greet them as we pass by PGH, worried about
their visible lack of sleep. We hear about the ruckus in the
OPD4 and ER, remembering that just that morning, our
buddies5 talked about running duties in those parts of
the hospital. Being the observers in medicine is a constant
shout for “mag-ingat ka,” hoping that the people we care
for hear us.
And hasn’t this pandemic turned into a black hole of
“mag-ingat ka”? The same buddies are now frontliners,
battling an enemy that cannot be seen. The same
demoralizing structures are now ubiquitous: the
paralyzing exhaustion felt from duties, the extreme lack
of resources, the loudest cries for help.
Here, a change in perspective is a must. It is tiring,
but this demystification needs to happen if we wish to
move forward.
Medicine is not a perfect path. It will not always be
a glorious celebration of life and health. We will not
always save everyone. Frontliners are heroes, but they
are also human. We are not Gilgamesh or Lam-Ang
who will save everyone all the time—especially when
resources remain scarce.
Painted in surrealist style by the famous Mexican painter, Frida Kahlo, “What the Water Gave Me” also known as “What I Saw in the Water” is a meditation on the
many facets and emotions in life. The woman bathing in the reflections on the river suggests an acceptance of whatever is handed to us, and learning to adapt to new
predicaments.
4
See glossary
5
Referring to the buddy system, buddies are members of a “buddy line” wherein there is at least one representative from each batch in the UP College of Medicine. It is
meant to be a support system where one can ask their buddies for advice on school and life in the hospital.
3
159
The First Days of Spring (Dali, 1929)6
Medicine in the Philippines seems to be a vicious cycle of suffering. Day by day, we
discover new reasons to stray from the path. It might be the inadequate supplies, the
inhumane work hours, the expensive pills, even the harsh politics. But despite all of
these, we will go back to the lessons we learned before the white uniform, during
the time of the virus. Compassion. Respect. Love for humanity. These are the values
which the college and the hospital have equipped us with, and this historical moment
will be the strongest reminder of the pledge we took.
Moving forward, everyday must be an opportunity to discover a new reason to stay in
medicine.
It might be the support systems, the ates and kuyas who listen to our struggles while
attempting to study stacks of transes7. It might be the professors, who enliven
our classes with wisdom, all the while doing their best at saving lives. But most
importantly, and hopefully, it will be the patients, who fight for their lives all the
time, in a constant tug-of-war with darkness, even if medicine is imperfect. Through
our seven years (or more, due to uncertainty) of study, we will strive to inspire others
and contribute to a greater cause—one for humanity—against all odds.
The reason might be hazy, or foggy, or maybe uncertain as of now.
But, the reason is there. The reason is here.
We must not only accept it, but also embrace it.
To serve the underserved.
And hasn’t this
pandemic turned
into a black hole of
“mag-ingat ka”?
Copyedited by: Frances Dominique V. Ho
A famously eccentric figure, Salvador Dali painted this picture inspired by Sigmund Freud’s The Interpretation of Dreams. While a depiction of the association of
dreams, this is a painting that makes one appreciate that the light of day will still return no matter what nightmares are encountered.
7
Transes. Transcription. This is the product of a centralized, note-taking system within UPCM classes.
6
160
Science
Trisha M. Salcedo
We who pass through the roads of Pedro Gil know this all-too-familiar
sculpture: Scientia, the Triumph of Science over Death1. A nude
woman atop a skull, bearing a lit torch, welcomes us to the UP College
of Medicine. Much of the artist’s thought was devoted to creating an
imagery of knowledge, the transcendent arm of humankind. Carved
with reverent hands, this nude woman stands as the citadel of Science;
she gives us hope in the face of death. She is a concrete memorial in
every right — rigid, unyielding, austerely structured.
Yet, this nude woman’s creator has left voids and hollows within her
solidity. In how Science is far from immaculate, this corporeal work of
art has her own unholy parts. Science, transcendent as she is, has her
gaps. As I write, Science does not know.
As I write, we face Death. He hides in the guise of a plague seemingly
plucked from the sacred scriptures. When Science does not know, Death
surmounts all else2. As the plague hastily overwhelms Science, Death
holds his own chisel. He then proceeds with his sacrament: inscribing a
multitude of epitaphs.
We who pass through the roads of Pedro Gil know Scientia, a citadel of
Science. As we wait for Science to reincarnate her truth, we use her oftforgotten roots as our stronghold. Until then — in the uncertainty, in
the ‘not yet’, in the becoming — we hail her humanity.
Copyedited by: Iris D. Ditan
“science, a villanelle” by Trisha Salcedo
A sculpture by Dr. Jose Rizal, it depicts a nude woman, standing on a skull while bearing a torch high with both hands. While the original is displayed in the Rizal Shrine
Museum at Fort Santiago in Intramuros, Manila, a concrete replica of this sculpture, endearingly nicknamed “Lady Med”, stands proudly in front of Calderon Hall, the
main building of the UP College of Medicine. As its name suggests, it is meant to represent victory over death through knowledge and scientific advancement.
2
The sculpture “Triumph of Science over Death” has a lesser known counterpart, the “Triumph of Death over Life”. In direct contrast to the former, Rizal shows Death,
represented as a grim reaper, embracing a limp nude lady with uncanny resemblance to the woman in “Triumph of Science over Death”. It is a reminder that despite our
advances in science, Death is inevitable.
1
161
Hope of Easter
Thaddeus Hinunangan
April 12, 2020
Manila
In this pandemic, even when all public transportation
and means for donors to visit the hospital were
suspended, the blood needs of the hospital persisted.
Just because COVID began hogging all the attention
didn’t mean that other diseases took a vacation. Some
of them even felt like working overtime. Because
of this, the donation process, which used to be a
straightforward trip to the Blood Donor Center
in the PGH complex, now had to be done with
online questionnaires and home visits, with bleeding
performed at safe venues outside the hospital.
Responding to the needs of its patients suffering
from COVID, the Philippine General Hospital has
also started doing plasmapheresis for compassionate
use for critically ill patients battling COVID1. With
the recent successful plasmapheresis donation by
Ian Frias, a seafarer from the cruise ship Diamond
Princess2, and nurses Gale Arranz and Kai Soriano,
my Facebook post’s call for help had gone viral with
more than 19,000 likes and 16,000 shares.
Plasmapheresis is a process in which the plasma (the yellowish liquid component of the blood) is separated from the blood cells.
The donated blood is received by an apheresis machine, which separates the blood into the following components: white blood cells, red blood cells, platelets, and plasma.
The plasma is isolated and collected while the others are returned to the body. Usually, the collected plasma is replaced with another solution. During the COVID-19
pandemic, this is especially important because of its role in convalescent plasma therapy. Recovered COVID-19 patients contain antibodies against SARS-CoV-2 in their
plasma. Through plasmapheresis, they can donate it to critically-ill COVID-19 patients and help them combat the disease.
2
On 20 January 2020, the Diamond Princess departed from the Port of Yokohama for a round-trip tour of Southeast Asia during the Lunar New Year period. One passenger
boarded the ship despite having a cough. At the end of its tour, 567 out of the 2666 passengers and 145 out of the 1045 crew disembarked were infected. Fourteen of them
passed away.
1
162
COVID-19 survivors donate their plasma in the hopes that the antibodies within
may be used to give others a fighting chance.
Photo by Thad Hinunangan
Photo by Markyn Kho
Dr. Thad Hinunangan conducts a predonation visit at the home of a potential
donor of convalescent plasma. There, the
team interviews the donor and collects
blood samples for laboratory analysis.
Photo by Thad Hinunangan
163
My inbox was full of messages expressing people’s support along with intentions to donate food, medications,
and equipment. Most importantly, there were those who inquired about donating blood, and we set out to meet
them on Easter.
It was the 6th consecutive day of duty3 for Team A, and on that day my co-resident, Dr. Sandy Maganito, our
medical technologist, Sir Jang Amizola, and I were tasked to go on pre-donation visits. We would explain the
procedure, its risks and benefits, and answer the concerns of our five potential donors. Hopefully, we’d end up
with their consent to donate before we left. We gathered outside the hospital with the essentials in our hands:
syringes and blood collection tubes, consent forms, masks, alcohol, and a little bit of optimism, embarking on
our journey shortly after the sunrise.
Our journey consisted of going to Quezon City, Greenhills, Pasig City, and Cainta, Rizal. Even on a normal
day, a day trip like this would take several hours, not counting the time set aside for the actual visit. The roads
were thankfully clear with no traffic in sight. But many streets had been barricaded, so we had to look for
alternative routes and pass through multiple checkpoints, to arrive at our destination. Despite the wondrous
guidance of Waze3, and stopping every so often to ask for directions, we still took wrong turns and stopped
at the wrong houses. At one point, when it became apparent that we were just going around in circles around
Quezon City, we parked the car and decided to walk instead.
By now, my head was throbbing. The lack of sleep, the glare of the blazing sun, and the pangs of hunger were
all taking their toll. Our path eventually led us to a wary-looking girl who hesitantly opened her front doors as
she saw us searching for one of our prospective donors. We were directed to the last residence in the row of
apartments. We thanked the neighbor and were just about to go on our way when she asked me curiously what
was going on, eyeing our hospital kit hiding in an eco bag.
I sighed, gathered myself, and took a deep breath. This might be the best and only time to educate someone.
“Are you familiar with Convalescent Plasma therapy3?”
She shook her head.
3
164
See glossary
Motioning for my companions to wait for a bit, I took my
time to explain what this all meant to her, taking extra
care with my word choice because I knew the moment
she figured out that one of her neighbors had recovered
from COVID, she might dwell on the words “COVID
positive” and panic. I emphasized recovered and made sure
to keep things as simple as possible. Thankfully, she was
receptive to my explanations and, at one point, I even tried
explaining what a polymerase chain reaction (PCR)3 was
and why it was superior to lateral immunochromatography4
… but I guess I went a little too far.
the dust of today’s drive and watched Sir Jang dozing
lightly at the back. Today was one of the most exhausting
days so far, and yet Easter continued to give us the greatest
gift of all: hope. Though we now find ourselves journeying
into the night, a new dawn promises to greet us tomorrow.
Five possible plasmapheresis donors—not bad!
Copyedited by: Sean Kendrich N. Cua
Nevertheless, I drove my point home: there was nothing
to fear in someone who had already recovered, tested
negative, and had been asymptomatic3 for two weeks as
long as everyone observed the same precautions—physical
distancing, wearing a mask, washing hands, among others. I
knew first-hand that a lack of correct knowledge could lead
to wrong assumptions, and these, in turn, could bring about
discrimination.
We left the area having accomplished our initial task,
earning something just as valuable in between.
At the end of the day, as the car went over one of the
bridges traversing the Pasig river, the skies cleared as the
sun set over the horizon, bathing everything in sight with
a gilded haze. I smiled and wiped the grime from my
forehead, I looked at Sandy’s wrinkled white T-shirt with
Photo by Markyn Kho
See glossary
A method used to detect the presence of a target substance in a liquid sample without using specialized and expensive equipment. This is a technique used by several
test systems in order to detect the presence of antibodies against COVID-19.
3
4
165
The Destination of My COVID Dreams
Howie Severino
The place where they extracted the treasure from my
body was at the end of what felt like an impromptu
treasure hunt.
I was informed the procedure would be at the
Philippine General Hospital, but the actual venue
turned out to be an academic building at the UP
College of Medicine1. I walked down a lonely hallway
with desks stacked against the wall, a mute testament to
classes that were abruptly suspended until God knows
when.
Beyond the security guards at the entrance, there was
absolutely no one. I thought I was in the wrong place
until I saw the room number I was looking for. Inside
was a classroom converted into a makeshift clinic with
two young doctors.
In the weeks since I was hospitalized elsewhere for
COVID-19, this simple space with a special machine
was the destination of my COVID dreams. Reaching
it meant I had recovered and I could finally donate my
plasma2, and be of value to someone else.
Before that momentous day, there was a month of
suspense and anxiety.
Even after I was discharged from the hospital, the
uncertainty about my fate was not over.
My symptoms2 were gone, but I was still not
considered recovered until I tested negative twice
for the virus. It was not until then that I could end
my isolation and rejoin my family. Alas, after one
negative result I was stunned to learn that I had
tested positive again for the virus several days after
leaving the hospital.
The Dr. Maria Paz Mendoza Memorial Medical Building, commonly called Paz Men, is a structure found within the UP-Manila campus. Named after Dr. Maria Paz
Mendoza-Guazon, an esteemed medical practitioner, scientist educator, and civic leader, this facility houses classrooms which are used by medical students for lectures,
laboratory sessions, and small-group discussions (SGDs).
2
See glossary
1
166
Even as I was recovering, I had already been
receiving appeals for my plasma from doctors and
loved ones of desperately ill patients. There were only
a few dozen known COVID survivors by early April,
and not all of them were plasma donors. The official
survivors then were outnumbered by the deaths in
the Department of Health’s count, filling me with
the dreaded uncertainty of which column I would
eventually end up in. The appeals for my plasma felt
like a vote of confidence in my survival, and gave
me further motivation to eat well and boost my
immunity2 while in isolation so I could join the thin
ranks of plasma donors.
Had I been reinfected? Or did the PCR 2 test merely detect viral
fragments from the original infection, as the latest science now
indicates? New theories about this disease have unfolded
every day, sometimes upending conventional wisdom.
Now even the vaunted immunity supposedly bestowed
on recovered patients, the one major consolation from
suffering from COVID, was in doubt.
referral center2.
First, though, I had to be screened through an interview by a
pathology resident2 and a blood test.
After waiting for an hour, I learned I had qualified to give my
plasma.
Demoralized and lonely in my quarantine2 quarters, I
decided to go home where I saw my family but could not
get near them. But seeing them was enough. Perhaps the
solitude of quarantine, far from loved ones, was a source
of stress that was affecting my ability to recover, or at
least rid myself of the virus once and for all.
After a few days, both PCR tests yielded negative results,
officially making me a recovered COVID patient. On
top of that, I was positive for antibodies on two rapid
tests3, further proof that I had in my blood the anti-virus
warriors coveted in the battle against the disease.
I was now an automatic member of a growing club of
COVID survivors worldwide blessed with a special
power.
I think that was the reason I was met by looks of
appreciation by the PGH medical staff in that converted
classroom. They explained that they stationed the plasma
donation clinic in a classroom in order to be physically
separated from the hospital which served as a COVID
Photo courtesy of Howie Severino
See glossary
A rapid antibody test can quickly screen whether a patient infected with COVID-19 has developed antibodies that fight off the infection. Because the test does not detect
the virus itself, it is more useful for procedures like plasma donation than it is for diagnosis.
2
3
167
They sat me in a permanently reclined chair and casually mentioned that there might be some discomfort, an
occasional code word, I’ve realized, for pain. I proudly said, “Pagkatapos ng karanasan ko sa ospital, kayang-kaya ko
yan!” Truthfully, they were brave words said to mask a sudden unease.
A needle was inserted into a vein in my arm, a tube was attached to the needle, and I was then connected to an
apheresis machine, the equipment that would separate the plasma from my blood and return the rest of the blood
components – red cells, white cells and platelets2 – to the donor, me.
To divert my attention from any “discomfort,” I got into a long geeky conversation about Magellan’s voyage with
the baby-faced director of the PGH blood bank, Dr. Mark Ang.
As the blood components were moving back into my veins from the machine, I did feel a little sting, but it was
tolerable. I actually felt more giddy than anything else.
This was an important moment in my journey as a COVID patient—a kind of graduation with honors.
Photo courtesy of Howie Severino
168
2
See glossary
Not every patient survives, and not every survivor qualifies to donate plasma. I was able to do both.
But this personal achievement matters only because it can save the life of another person.
There are still many unknowns about COVID-19, but there’s a growing medical consensus about the lifegiving value of plasma that came from a recovered patient with antibodies.
That is why the doctors present during my donation called plasma “liquid gold.” With far fewer recovered
patients than confirmed cases, the plasma from the two or three donors a day at PGH are treated like
treasures. There is a great need for donors, which is why those who have already donated need to assure
fellow survivors that it is a safe process that will make the donor happy that they gave.
I dare say what I gave is even more valuable than gold. You can buy gold, but you cannot buy my plasma. I
was told that a committee of doctors would decide on the recipient, surely a patient with my blood type and
probably someone who may not survive without the infusion of plasma. This precious liquid would be given
for free.
As I sat there feeling the slight pang of blood moving out of and then back into my veins, I felt a sense of
fulfillment from having lived up to a promise. When I was still very sick in the hospital, I vowed to myself
and to the cosmos that if I survived, I would pay it forward.
After less than two hours, the procedure was over. The medical technicians2 handed me the small bag of
liquid treasure, the yellow plasma they had just extracted from my body, so I could hold it like a mother with
2
See glossary
169
her newborn. After all, from
my body just came this golden
symbol of life.
They had me pose with it as the
medical staff gathered around
me for photographs. I held it up
like a trophy as they applauded.
Returning home that night,
I reflected on the personal
significance of that event.
One of the worst things about
being a patient is the feeling
of being a burden. For all of
its terrible attributes, COVID
enables a beautiful epiphany: if
one survives this disease, that
feeling of being a burden can be
replaced by a sense of wonder
that you gave another patient
out there a fighting chance.
Just like others who have given before him, broadcast journalist Howie Severino volunteers his time
and plasma in the hopes it may benefit other patients infected with COVID-19.
Photo courtesy of Howie Severino
Copyedited by:
Amanda Christine F. Esquivel
170
Kumusta ka?
Maria Keziah G. Legion
“Kumusta ka?”
Animo’y ordinaryong mga kataga
ngunit may mas malalim na pag-uusisa.
Napatulala na tila huminto ang oras at pintig ng dibdib,
ni hindi na maulinigan ang iba pang sinambit
at ang tanging tumatak sa isipa’y, “Positibo.”
Unti-unting bumuhos ang luhang nangingilid
na ‘di mawari kung paano na ang hakbang na gagawin.
Naglakad nang may agam-agam sa isip, “Ako, positibo?”
at biglang napatingin sa langit, sabay sambit ng, “Positibo. Kaya ko ito.”
Isang maikli ngunit taimtim na dalangin para sa araw na iyon
sapagkat ikalawa ko nang pamamalagi sa ospital ‘pag nagkataon.
Hindi bilang isang nars na kumakalinga sa maysakit
ngunit bilang isang pasyente ng kinakatakutang COVID 19.
171
Nung una ay wari ako’y sinubok ng Panginoon
dahil sa aking pagiging asmatiko, ako’y nagkipaglaban.
Gumaling at patuloy na nagsilbi para sa bayan,
ngunit sa isang iglap lang ay nahawaan
nang ‘di kinakitaan ng anumang sintomas.
Sa pagkakataong ito’y ako’y napaisip,
sa sarili ay aking nasambit, “Kumusta ako? Kumusta nga ba ako?”
Mabuti na lang at maraming gustong dumamay
mga kapamilya at kaibigang handang umagapay.
Sa huli’y ang pagiging matatag ang naging sandata
di lamang sa puso’t isip lalo’t higit sa pananampalataya.
Natutong huminga pa ng mas malalim at magpatuloy,
sapagkat nais ko rin na ako naman ang makiramay
at magsabi sa dulo ng lahat ng ito ng, “Kumusta ka?”
172
173
With the Enhanced Community
Quarantine prevailing over
Metro Manila and many hair
salons and barbershops unable
to operate, ResCute Operations,
a team of barbers, stylists, and
their sponsors, set up shop at the
lobby of the PGH Outpatient
Department (OPD) and offered
free haircuts and hair styling to
hospital frontliners.
Photos by Harjoland Obenieta.
174
In Sickness and In Health
Genry Criscel R. Consul
“Walang ibibigay na hindi mo kaya.” Dr. Carlo confidently declared as he sat next to his wife, Dr. Mela, when asked to
recount the last two months.
Nothing had gone according to plan. As type A personalities, watching their carefully laid out plan burn to the ground
was a nightmare. The plan was for Carlo to be on duty1 in Tarlac as Mela enjoyed her maternity leave at home. It was to
go shopping for baby things, preparing to welcome the twins while surrounded by family. It definitely did not include
undergoing a role reversal from doctors to patients. Nor did it include giving birth a month before the due date, or being
COVID patients, stuck in a hospital for 52 excruciatingly long days.
To Have and to Hold
Meeting in medical school, becoming licensed to save lives, starting internal medicine1 residency, tying the knot, and
being pregnant with twins seemed like forever ago
He was on the line of duty, assigned to the ICU1, when Carlo first got sick. His 24-hour flu, three-day diarrhea, and an
episode of vomiting were nothing to his wife who nursed him to recovery. At that time, swabbing1 was exclusively for
PUIs1-- health care workers were not part of the priority. He went to the hospital to get checked and admitted but was
sent home for a two-week home quarantine1 instead.
A week later, she got sick too. Symptoms, which were worse than his, started showing. As the cough got worse, Mela felt
weaker. The couple opted to have an x-ray done. This showed bilateral pneumonia1.
Mukhang hindi ito COVID, he thought, not wanting to think of the worst.
Feeling ko positive na talaga ako, alam ko, she thought, as she listened to her body that housed two other lives. Even before
she got her result, she was already mentally preparing for it. Or at least doing the best she could.
1
See glossary
175
Photo by Alvin Caballes
They entered a private facility to self-quarantine. Not long after, she was swabbed and then brought to the hospital,
her and her husband’s place of work. This time as a horrified pregnant patient in an unstable state: gasping for air,
hot with high fever. As soon as she set foot in that familiar building, she felt suffocated and overwhelmed. She just
wanted to leave.
As doctors, beyond denial and panic, they both had the gut feeling that the swab result would come out positive.
Logic dictated that. At the back of their minds, behind all the thoughts of terror and trepidation, they knew.
For Better or Worse
From there, everything felt like a blur. While waiting for the swab result, she was transferred to the ICU for close
monitoring1. Her body was deteriorating—shortness of breath, desaturation1—she was not looking well.
“Iyak siya nang iyak noon,” she mused as her husband continued to narrate their story.
He couldn’t stop the tears as the results confirmed their nightmare. It was a plethora of emotions. He was distraught
1
176 See glossary
to see his wife in agony, worried for the other
people they shared a residence with, and afraid of
the possibility of losing the three most important
people in his life. As his duty as a husband never
faltered, he also did not abandon his duty as a son.
He immediately called his parents and did his own
contact tracing.
Dr. Mela was 28 weeks pregnant2. Giving birth
prematurely comes with a slew of complications
and the hospital did not have a neonatal specialist1
who could ensure adequate care for the twins.
Their consultants1 arranged the transfer to PGH,
and they were set to journey to Manila to seek the
best care possible.
Kriminal ba ako? She thought as she was swarmed
with stares from people in the hallway. The path
between her hospital room and the ambulance was
adorned with makeshift plastic barriers. As she
peeked through the window, she felt as if everyone
was staring at her.
In PGH, patients weren’t allowed to have
companions. She thought she could handle this,
but being alone within four walls during the
pandemic took a toll on her physical, mental, and
emotional wellbeing. Physically, she had general
body weakness and a high grade fever. Mentally, she
could not handle all the calls and questions being
thrown at her. Being ill alone whilst not knowing
exactly what lies ahead was torture. Emotionally,
she was afraid of not only her own health but also
of the lives she was carrying.
In another part of the hospital, a worried husband
merely wanting to comfort his wife waited endlessly
for updates. After four hours, he got word about her
current state. With the permission of the Infectious
Disease specialist on her case, he was finally allowed
to be by her side two hours later.
In Sickness and in Health
“Naisip ko lang lahat ng COVID patients na unstable,
kailangan talaga ng kasama,” he lamented. Not being
together during those vital hours put them both in
misery. After all, there was solace to be found in
being with a loved one or family, much more than
any hospital staff could provide.
“Manganganak ata ako nang wala sa oras dito,”
Dr. Mela laughed as she remembered the
ultrasound machine that malfunctioned every five
seconds in the PGH ER when she needed it most.
“Hindi ako gagaling agad kung wala siya sa tabi ko,” she
agreed, saying she felt secure and relieved when
he was finally allowed to be by her side. It was
heartwarming. He was her hands when she couldn’t
See glossary
A full-term pregnancy is a pregnancy that lasts between 39 weeks, 0 days and 40 weeks, 6 days. Babies born before the pregnancy reaches full-term are called “pre-term”
and are more prone to infections and breathing and feeding problems. They may have to be placed in the neonatal intensive care unit (NICU) where they will be properly
cared for by specialists.
1
2
177
move, her voice when she couldn’t speak, and her guardian during all of it.
It felt like their four-month old marriage aged in years with what they experienced together. Thinking out loud, he said that though
every relationship is unique, all have one experience in common—challenges to surmount. While most face these at the middle or
at the end, theirs was tested at the beginning. He smiled while saying he was only honoring the vows he made in front of God and
their loved ones. “Kailangan pangatawanan mo ‘yun… kapag may isang mahina, kailangan yung isa strong.”
Soon, he was admitted as a patient too. He was swabbed as part of routine contact tracing, tested positive, and got his minute
companion’s bed converted into a more comfortable patient’s bed. Their boxy hospital room turned into an exclusive apartment
where they bathed, cleaned, did their laundry, and lived for 52 days. They fully embraced a domestic life in a PGH room supposedly
meant for one. A few weeks later, the twins could no longer wait to come out.
Mela was wheeled into the operating room where an emergency cesarean procedure was done. Drifting in and out of consciousness
from the sedation, Mela heard someone say “Saan natin ilalagay ‘to, Doc? Formalin!” She could not believe what she was hearing.
Unsure if the formalin was for her children, she blacked out again, terrified of what she heard3.
She arrived in her room bawling. They knew nothing about their children except that one was intubated1 and the other was
connected to a CPAP machine1. The pain felt by these first time parents was unimaginable. They were not allowed to see their
children. There was an aching feeling in their hearts that could not be mended by medication. For the new mother, it was agonizing
to carry the twins inside her for eight months and for them to be away from her arms. The couple did not even know what they
looked like. In her head she thought, “kailangan na nila ng mommy.” Crying together and praying together became the couple’s way of
coping.
Two weeks later, they were finally allowed to see their miracles.
Immediately after they were discharged and cleared for visitation, they rushed to the Neonatal Intensive Care Unit, where her
twins were. Mela was overcome with emotion. Clothed in a full PPE suit1, she held her children for the first time. It was a touching
reunion, one that was long time coming, and happiness filled the NICU. They whispered to their children who were finally
bundled up in their mother’s arms, “Stay strong, keep fighting, and have faith in the Lord.” They will all be reunited one day,
See glossary
Formalin is a clear aqueous solution of methanol and formaldehyde. Since it functions as a disinfectant and an antiseptic, it can be used to preserve specimens for
further studies. Often, it is the placenta of a premature birth. However, a fetus that died within the womb may also be considered a specimen. To a mother coming in and
out of sedation, it’s not hard to imagine the worst.
1
3
178
hopefully soon, in God’s time.
Even with COVID, We Will Not Part
The shift from being doctors to becoming patients was enlightening for the
couple. They came to learn that only the patients truly know what and how
they feel.
During their time as patients, they promised to take a few things they have
learned back to their practice. Admitting that they have not always been
constantly passionate doctors, they vowed to emulate the health workers who
treated them not only skillfully but also compassionately. This experience
has changed them forever, and they will get back to their residency as better
versions of themselves, who aim to treat holistically, with compassion and
genuine care.
Dr. Carlo and Dr. Mela will traverse parenthood together hand in hand. Along
with their children, who gave them hope to persist amidst the adversities, the
strength and grit shown by this couple will touch many lives, with love and
devotion. Theirs is a family of fighters. In the lives of these young doctors, fear
is not welcomed, especially when their faith is bigger than the trials thrown
their way.
Copyedited by: Juan Raphael M. Perez
179
Life goes on
Patricia Anne S. Basilio
Life goes on.
That’s what you’ve learned, from hours of fitful sleep, staring out as the world flashes by, every raging
storm and sunny day, wishing you were everywhere and nowhere at once, afraid of time slipping past
your fingers before you’ve even lived—
Life goes on.
The fear sets in, once the unwanted visitor, knocking at your door when you least want it, when you
least expect it. It’s an old friend now. The one that tucks you in at night, the one that greets you when
you open your eyes and realize that it’ll be the same day over again, and again, and again…
Life goes on.
Perhaps it’s fate that brought you to this path, this bumpy road; fate that you’ve been witness to the
worst and the best, of love and hate, of life and—
Death. So much death. Oh, how easy it is to be swept and drowned in that torrent of unshed tears,
forgotten dreams, missed opportunities, never-ending regrets,
And yet.
Somehow, someway…
LIFE. GOES. ON.
180
Life blooms even in the darkest of places. Random acts of kindness. Family and friends. Quiet smiles exchanged with strangers
on the street. The warmth of home cooked meals. Those terrible dad jokes and puns that make you laugh (even if you try not
to).
Even when you can’t see past this day; even when things don’t ever seem to go your way.
Life goes on.
For you. For us. Another dawn. A chance at trying, and failing, and trying again.
Hope stays even in the saddest of places. The old tune you sang when you first learned to dream, through hours of fitful sleep,
impatient to see the sun rise again—
Things will get better. You know it will, maybe tomorrow, a new day.
So you keep singing that old busted melody. Belt it from rooftops. Let it echo until the sun sets and you’re tucked in at night,
To keep dreaming that,
To keep praying that,
Life will keep going,
On and on,
And on,
And on.
Copyedited by: Juan Raphael M. Perez
181
Puhon1
Christi Annah Hipona
Plucked from our familiar;
Removed from our normal;
We all tried to make sense of it.
Some of us stayed at home and learned to rest.
Some slowed down and meditated.
Some asked “Are we ever going back to normal?”
Some cried tears—not of weakness but of witness.
Some gathered resources resolutely.
Some stayed at the front lines and despite fear, stared death in the face.
Yet all of us prayed.
Puhon
We will heal.
Puhon
We will all be together again.
Puhon
We will see the goodness of God.
Looking upward with eyes of hope;
That when this evil shall pass,
We will grieve what we lost;
Pick ourselves up;
Pray new prayers;
And dream new dreams.
Puhon, we will live our lives in remembrance of how God has carried us through.
182
A Cebuano word that roughly translates to “soon”, it is an expression more akin to a prayer. Used in the background of hoping for a right, it is meant to convey “hopefully
in the future, God-willing”.
1
183
184
Glossary
185
A
ABG
Arterial Blood Gas. A laboratory exam that measures the pH and levels
of oxygen, carbon dioxide and other gases in blood drawn from an
artery. This is an especially important exam to accurately determine if a
person has enough oxygen in their blood.
Abstract
A document which summarizes a patient’s clinical condition, including
their diagnosis, medical history, physical exam findings, and relevant
laboratory result.
Asymptomatic
If in reference to a patient, this pertains to an individual who
may already be infected or have a disease but does not exhibit any
symptoms.
Bayanihan Na! Operations Center
Bayanihan Na! Operations Center. BNOC. It is a volunteer operation
that acted as a call center for incoming calls to PGH for COVID-19
related concerns and as an organizing body for the donations being sent
to the hospital.
C
Callroom
A room where health workers can rest and eat in the hospital. These
rooms will usually have bunk beds, workstations, and occasionally, a
bathroom.
Cancer Institute
A complex found within the Philippine General Hospital where cancer
patients are treated.
B
Census
A record enumerating the patients admitted to the facility at a specific
time.
Bantay
Companion. A relative or friend who watches over an admitted patient
and also facilitates certain hospital processes such as getting the
patient’s medication and discharge papers.
Charity
Charity wards. A hospital ward that is dedicated for the patients who
receive free services.
Benign
A colloquial term used to describe an easy or unremarkable duty or
shift; the opposite of “toxic” (See Toxic entry). As a clinical term, this
refers to a lesion or condition that is not cancerous.
Bilateral pneumonia
Pneumonia (see entry: pneumonia) in both lungs.
186
Chart
A patient’s document containing their healthcare team’s notes, and
therapeutic plans.
Chemotherapy
Although the term chemotherapy broadly means the use of a drug
to treat a disease, it is usually used to refer to the treatment of cancer
patients with anti-cancer drug.
Clerks
Medical students in their fourth year of education. They take active
roles in patient management including interviewing and examining
patients, facilitating laboratory work, and going on duties (see entry:
Duty).
CPAP machine
Continuous positive airway pressure (CPAP). A mode of respiratory
ventilation that is usually used to reduce the amount of effort necessary
to inhale oxygen properly in patients who find it difficult to breathe.
Clinical deterioration
The worsening of a patient’s condition as measured by clinical
parameters. Sometimes, the patients need to be admitted to the ICU
(see entry: ICU).
D
Consultant
A physician with usually the most senior rank on the team. They are
responsible for overseeing all patient care in their service (see entry:
Service), and teaching trainees, in addition to other administrative
duties they may hold.
COVID referral center
A designated medical facility that provides care for COVID-19 patients.
In the National Capital Region, the Philippine General Hospital, along
with Dr. Jose M. Rodriguez Memorial Hospital and the Lung Center of
the Philippines, are the COVID referral centers.
COVID suspects
New classification used by the Department of Health to refer to
a patient who presents with pneumonia-like symptoms with no
other disease likely to explain the condition OR a person with flulike symptoms AND a history of travel to a place with COVID
transmission or contact with a confirmed case of COVID-19. People
in the vulnerable group (i.e. elderly, patients with existing diseases
like hypertension) with respiratory symptoms may also fall under this
classification.
Desaturation
Short for oxygen desaturation, or the often sudden lowering of oxygen
levels in the blood. This usually indicates a severe pulmonary or cardiac
event. (see entry: Oxygen saturation)
Dialysis
A procedure done using a specialized machine to remove specific waste
products and excess fluids in the blood. This is done on patients whose
kidneys are not working properly.
Doffing and donning
Doffing is the practice of removing an item of clothing (e.g. PPE) while
donning is the practice of putting it on.
Duty
Part of the pre-duty, duty, post-duty cycle where each part of the cycle
denotes a person’s responsibilities for the day. Usually referring to the
night shift, duties range from 12 to 24 hours where one must be in
the hospital. Night duties involve taking care of all admitted patients,
including the patients of those who are not on duty.
Dyspnea
Labored or difficult breathing.
187
E
more senior colleague on a patient’s medical condition either for advice
on patient management or as an academic exercise.
Elective admission
An admission that has been arranged in advance (i.e. not an emergency
case).
Extubate
The removal of an endotracheal tube from the airway.
Emergency Medicine
A medical specialty dedicated to the diagnosis and treatment of
illnesses or injuries that require immediate medical attention.
Endorsement
In medical colloquial terms, this usually pertains to a discussion
between outgoing and incoming duty teams focused on pertinent
information on patients’ current conditions and important tasks to
be accomplished. It may also refer to a junior colleague reporting to a
more senior colleague on a patient’s medical condition either for advice
on patient management or as an academic exercise.
F
Fellow
A physician who has completed their residency training, and is
currently undergoing further training in a more specific field. For
example, a resident in Internal Medicine may go into Cardiology for
their fellowship training.
Extubate
The removal of an endotracheal tube from the airway.
Fomite
An inanimate object which can be contaminated by infectious agents.
When a fomite is exposed to pathogenic bacteria, viruses, or fungi, it
can transfer disease to a new host.
Elective admission
An admission that has been arranged in advance (i.e. not an emergency
case).
H
Emergency Medicine
A medical specialty dedicated to the diagnosis and treatment of
illnesses or injuries that require immediate medical attention.
Hypoxia
A pathological condition in which the body (or a certain region) does
not get enough oxygen into the cells and tissues.
Endorsement
In medical colloquial terms, this usually pertains to a discussion
between outgoing and incoming duty teams focused on pertinent
information on patients’ current conditions and important tasks to
be accomplished. It may also refer to a junior colleague reporting to a
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Photo by Brent Viray
I
IDS
Infectious Disease Section or Specialist. Can refer to the unit or the
individual specialists handling infectious conditions.
Imaging request
A form which specifies what imaging service is needed (e.g., x-ray, CT
scan, MRI, ultrasound) and for what condition or organ of concern.
Immunity
A state of having enough biological defenses to fight specific infections
or diseases.
Integrated clinical clerks (ICCs)
Medical students in their third year of medical education. They get
to have more clinical experiences, with more patient interaction and,
under the supervision of faculty, are introduced to providing care to
patients. They rotate through the hospital’s various departments.
Intensive care
Highly specialized and resource-intensive medical care which is
provided for seriously ill patients.
Intensive care unit (ICU)
Also known as intensive treatment unit or intensive therapy unit (ITU)
or critical care unit (CCU).A hospital unit where critically ill or injured
patients are given specialized care.
Internal medicine
The medical specialty dealing with the prevention, diagnosis, and
treatment of multi-system disease processes in adults. After completing
their residency program and becoming board certified, internists may
choose to subspecialize (e.g. cardiology, pulmonology).
Interns
Physicians in their last year of training, before taking the licensure
exam. One year senior to clerks, interns have additional clinical
responsibilities. They rotate through selected departments. Aside from
assisting in the care of assigned patients, they also help introduce clerks
to the nuances of patient care.
Intubation
Endotracheal intubation. A procedure which involves the insertion
of a flexible plastic tube into the windpipe. The tube is connected
to a ventilator machine which pushes oxygen into the lungs. This is
frequently done to critically ill or injured patients to help them breathe.
IV antibiotics
Administration of antibiotics through an IV line (see entry: IV line).
Intravenous antibiotics are used to treat infections that are resistant to
oral antibiotics or for infections that require doses of antibiotics that
cannot be administered orally.
IV line
Intravenous line. A soft, flexible tube which is connected at one end to
a fine catheter or needle that is threaded into a vein and to the other
with a bottle or container of fluids or medications. Solutions and even
blood products are infused directly into the vein through the line and
indwelling catheter.
L
Lockdown
An emergency protocol that prevents people from leaving an area, and
restricts their movement within that area.
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M
Management
A description of the interaction between the healthcare team and the
patient. This includes communication, evaluation, diagnosis, prognosis,
and intervention.
It may also refer solely to the healthcare team’s therapeutic plan for the
patient.
Medical Technologists
Med techs. Health professionals who perform and analyze the results of
scientific tests on blood and bodily fluids. They are also tasked with the
processing of specimens and running of the RT-PCR test systems used
to detect COVID-19.
Medical Technologists
The observation of a condition, disease, or medical parameter. It is also
often used to refer to the practice of regularly checking a patient’s vital
signs (see entry: Vital signs). Healthcare workers use medical monitors
and medical tests in order to check on a patient’s condition.
N
Nasopharyngeal swabber
An individual who is required to perform a nasopharyngeal swab (see
entry: swabbing).
Neonatal specialist
Neonatologist. A neonatologist is a medical doctor specializing in the
medical care of newborns, most especially those who are in critical
condition.
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Neurology
The branch of medicine that deals with the diagnosis, treatment, and
management of patients with conditions and diseases that involve the
nervous system.
N95 mask
N95 Respirator. A type of mask that can filter out at least 95% of very
small (0.3 micron) particles. These masks protect the wearer from
airborne particles, from small particle aerosols to large droplets, which
may contain bacteria and viruses.
Nasopharyngeal swabber
An individual who is required to perform a nasopharyngeal swab (see
entry: swabbing).
Neonatal specialist
Neonatologist. A neonatologist is a medical doctor specializing in the
medical care of newborns, most especially those who are in critical
condition.
Neurology
The branch of medicine that deals with the diagnosis, treatment, and
management of patients with conditions and diseases that involve the
nervous system.
Nurses’ Home
A building within the Philippine General Hospital premises that
serves as a dorm for employees of the hospital, and a function hall for
social events. It was converted into the call center for Bayanihan Na!
Operations Center during the pandemic.
O
Ophthalmology
The branch of medical science which deals with the anatomy, functions,
and diseases of the eye.
Otorhinolaryngology (ORL)
A surgical subspecialty dealing with the surgical and medical
management of conditions involving the head and the neck. It is
sometimes referred to as “ENT” for Ear, Nose, Throat. Also termed as
ORL-HNS, or Otorhinolaryngology-Head and Neck Surgery.
Out-Patient Department
Outpatient department (OPD). This is the hospital department that
provides diagnosis and/or treatment to patients in a clinic setting. The
PGH Out-Patient department is located along Padre Faura street.
Oxygen saturation (SO2, “sats”)
This is one of the several measures that can be used to measure
oxygen levels, often by a pulse oximeter attached to a finger. It refers
to the percentage of oxygenated blood in circulation.. A decrease in
oxygen saturation may herald clinical deterioration (see entry: clinical
deterioration).
P
Pandemic
A worldwide and rapid spread of a new disease.
Pathology
A branch of medical science that deals with the origin, nature, and
course of diseases. Pathologists examine surgically-removed organs,
tissues (biopsy samples), bodily fluids, and if necessary, the whole body
(autopsy) for diagnostic or forensic purposes. They may examine the
specimen with the naked eye or under a microscope.
Pathophysiology
The specific changes in the normal body functions associated with
a particular disease or injury. It seeks to explain the functional
changes that occur in an ill individual. Each disease has a different
pathophysiology, and at the time of writing, the pathophysiology of
COVID was poorly-understood.
Pay floors
Floors in the Philippine General Hospital with rooms reserved for
private patients.
People Giving Hope
People Giving Hope is the moniker given by the hospital director, Dr.
Gerardo Legaspi, to the Philippine General Hospital staff during the
COVID-19 pandemic. He used this to address them in a letter which
was released before the announcement that PGH would serve as a
COVID referral center.
Personal Protective Equipment (PPE)
Equipment and apparel which are worn in order to protect the user
against health or safety hazards. While commonly associated with the
“full” version with full-body suits, goggles and masks, less items are
needed for lower-level hazards.
Plasma
Blood plasma. The yellowish liquid component that is responsible for
about 55% of the body’s total blood volume. It carries the nutrients,
blood components, hormones, and proteins to the different parts of
the body.
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Platelets
Thrombocytes. A type of blood cell. Platelets help the body form clots
in order to stop bleeding.
Pneumonia
An acute inflammatory condition of the lung/s. It is usually caused
by viral or bacterial infections, which is usually spread via air-borne
droplets from a cough or sneeze.
Polymerase chain reaction (PCR)
A laboratory technique that is used in order to make multiple copies of
a DNA segment.
Post-duty
Part of the pre-duty, duty, post-duty cycle, each part of the cycle
denotes a person’s responsibilities for the day. Post-duty refers to the
status or a person who has just completed a duty (see entry: Duty). The
tasks that must be accomplished vary according to the service. The
cycle restarts after post-duty status.
PPE levels (1,2,3,4)
This is the scheme implemented in the Philippine General Hospital
during the COVID-19 pandemic.
Level 1 PPE - This is used for low-risk areas like the non-COVID-19
wards and the outpatient clinic. The staff can opt to wear either of the
two options:
1. Face shields and a surgical mask or
2. Goggles and a surgical mask.
Level 2 PPE - This is used for areas with bathrooms where healthcare
workers can shower after duty. They need to wear
1. Cap and goggles
2. N-95 mask
3. Gloves
4. Gown or coveralls
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Level 3 PPE - This is used by the staff who are assigned to man the
triage areas and parts of the hospital where PUIs are admitted. The
PPE consists of
1. Cap and goggles, or a face shield
2. N-95 mask
3. Gloves
4. Gown or coveralls
Level 4 PPE - Staff assigned to the COVID-19 wards and operating
rooms are required to wear the following:
1.Coveralls
2. Surgical cap
3. N-95 mask
4. Scrub suits
5. Goggles/face shield
6. Double gloves
7. Dedicated shoes
8. Shoe covers
Pre-duty
Part of the pre-duty, duty, post-duty cycle, each part of the cycle
denotes a person’s responsibilities for the day. Pre-duty refers to taking
the morning shift, usually lasting 10-12 hours, and precedes the duty
status. The specific responsibilities vary depending on the assigned
service.
Preemptive intubation
The intubation (see entry: intubation) of a patient. This is done not
because the patient needs it at that exact moment but because there is
a high chance that the patient will have to be intubated shortly. Often,
this decision is made because there is progessive worsening of the
patient’s condition.
PUI
Person Under Investigation. A term in the old classification system used
to pertain to an individual who has not yet had a positive COVID-19
laboratory test but has symptoms of COVID-19 (e.g. fever, shortness
of breath) in combination with a travel history to China or a history of
exposure to a confirmed case of COVID-19.
Pulmonary specialist
Pulmonologist. Pulmonary specialists are trained to diagnose and treat
diseases involving the respiratory system.
Pulse oximeter (Pulse ox)
A small, portable, electronic device, clipped on to a patient’s finger to
measure the oxygen saturation of arterial blood.
Q
Quarantine
A state of enforced isolation. During the COVID-19 pandemic, it was
used to keep someone who might have been exposed to COVID-19
away from others. This practice helps prevent the spread of the disease.
Those in quarantine were asked to stay home for two weeks while
regularly monitoring body temperature and watching out for COVID
symptoms.
R
Radiologic technologists
Rad techs, radiographers. Health professionals who specialize in the
imaging of human anatomy.
Red cells
Red blood cells (RBC) or erythrocytes. A type of blood cell. RBCs
contain a protein called hemoglobin which carries oxygen to the
different parts of the body.
Referral
A request from one department or service to another, seeking
consultation for their patient on a particular disease or issue. As an
example, an IM service may make a referral to the Department of
Ophthalmology for their patient with vision problems.
Resident
A licensed physician currently undergoing training in their chosen field.
Resident-on-duty (ROD)
The resident (see entry: Resident) assigned to oversee patient care
during that shift. Their tasks may include admitting patients, making
initial notes, and planning patient management.
Rounds
Done either by the healthcare team or the physician-in-charge, it is the
act of going from patient-to-patient to check on and/or discuss their
conditions as well as prescribe the succeeding course of treatment.
S
Sats
Slang. See entry: oxygen saturation.
Sedate
To calm an individual through the use of a sedative. When a person
is sedated, the medical management team can conduct medical,
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diagnostic, or minor surgical procedures which would otherwise cause
pain or discomfort to the patients. Patients who are being ventilated
are given sedative drugs, so they can tolerate the presence of an
endotracheal tube in their trachea.
Service
As a medical colloquial term, this refers to a team composed of
attending consultants, fellows, residents, interns, and medical students.
Patients are decked to a service who takes care of them when they are
admitted into the hospital.
V
Ventilators
A machine that helps a patient breathe by pumping oxygen into the
lungs and removing carbon dioxide through a tube, using a series of
controlled pressures and volumes.
Viber
A phone application used to call or message another individual.
Signs
Medical sign. An observable physical exam finding, unlike symptoms
which pertain to the subjective experience of a patient. Examples of
signs are rashes, bruises, and elevated blood pressure.
Virus
A submicroscopic infectious agent. Viruses infect living organisms
and cause diseases. For example, severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) is the strain of coronavirus that causes the
corona virus disease 2019 (COVID-19).
T
Vital signs
Clinical measurements of the patient’s essential functions (e.g. pulse
rate, temperature, respiratory rate, and blood pressure).
Telemedicine
The use of telecommunication technologies to enable long-distance
clinician and patient contact.
W
Toxic
A medical colloquial term usually used to describe a difficult duty or
shift, usually marked by an overload of tasks, patients, or patient deaths.
It may also be used to refer to the person in a difficult shift, or a person
with a reputation of being unreasonably strict.
Waze
A GPS navigation software application.
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White cells
White blood cells (WBC) or leukocytes. A type of blood cell. WBCs are
a component of the immune system, in charge of helping the body fight
infections and diseases.
Z
Zoom
Zoom is a software platform used for teleconferencing, distance
education, social relations, and the like. It gained popularity during the
COVID-19 pandemic where a lot of people had to work and study from
home.
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Contributors
196
Authors
Lily de Amor (pseudonym)
Anna Elvira S. Arcellana, M.D
Anna Elvira Arcellana served as the chief fellow of the
Division of Endocrinology, Diabetes, and Metabolism.
She has a passion for writing, which she hopes to use as
an instrument in becoming a better patient advocate.
Jill Olivia E. Bañares, R.N.
Jill Olivia E. Bañares is an ED nurse who graduated
from the University of the Philippines Manila College
of Nursing in 2016. She loves serving the underserved
and believes in the importance of quality health care for
all.
Patricia Anne S. Basilio, M.D.
John Jefferson V. Besa, M.D.
John Jefferson V. Besa aspires to be a clinician-public
health physician hybrid. Probably a journalist in an
alternate universe, he has a keen eye for the people
around him. In his eureka moments, he hopes to make a
difference one tweet at a time.
Genry Criscel R. Consul
From the mundane to the curious, Genry enjoys
stories— listening to them, reading them, and writing
them. At present, she is studying to become a physician
to pursue her call to serve the least, the last, and the
lost.
Robyn Gayle K. Dychiao
but ended up in Medicine. She dreams of working for
NASA one day.
Robyn is a second year medical student at the UP
College of Medicine. When she’s not buried in her
books, one can find her trying new recipes, running her
business, and catching up on medical dramas.
Jubert P. Benedicto, M.D.
Amanda Christine F. Esquivel, M.D.
Icia Basilio went to UP for Comparative Literature,
Dr. Jubert P. Benedicto is a certified pulmonary critical
care specialist based in Philippine General Hospital
(PGH) and Lung Center of the Philippines (LCP).
During this pandemic, he was primarily tasked with
mobilizing intensive care services and resources in
PGH, coordinating and addressing ICU-related issues,
and served as a consultant frontliner going on regular
24-hour duties with his pulmonary team.
Mandy is a graduate of the UP College of Medicine
Class 2019 and is currently a first year resident of the
Department of Dermatology. She has always been
interested in exploring the nuances of the art and
science of medicine.
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Sachiko S. Estreller, M.D.
Ian Gabriel A. Juyad
Sachiko S. Estreller, an internal medicine resident, is a
lover of prose, pastries, and positivity. She keeps a journal
of unhurried stories at happysleepysloth.wordpress.com.
Ian Juyad is a medical intern from the UP College
of Medicine. Growing up fascinated by stories, both
fictional and real (and everything in between), he finds
solace in writing about them - when he’s not busy
reading medical textbooks or in clinical rotations.
Thaddeus Hinunangan, M.D.
Thad Hinunangan is a pathology resident, a columnist
for Health and Lifestyle Magazine, and a contributor to
Philippine Daily Inquirer. His essays have been published
in various anthologies like From the Eyes of a Healer and
Youngblood 4.
Maria Keziah G. Legion, R.N.
Christi Annah Hipona, M.D.
Nefren Roy A. Lobitana, M.D.
Tia Hipona is a fellow in child and adolescent psychiatry
who loves to write about her God and the hope He offers.
UPCM 2020. A small town boy with big internist
dreams. Writes what will become history. Has a mind
full of thoughts but are mostly either food or Taylor
Swift lyrics.
Athena Mae L. Ibon, M.D.
Dr. Athena is a pure bred Cebuana, (a graduate of
Matias H. Aznar Memorial College of Medicine) who
was awarded for Academic Excellence, Best in Surgery
and Leadership in 2019 and Gloria Macapagal Arroyo
Medallion in Leadership in 2006. She is a compassionate
hustler for the community who always minds the welfare
of others. At the same time, she is a lover of music,
diving, and an obsessed mother of cats and dogs.
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A well-rounded artist. A loving daughter anchored with
Christian values. A compassionate nurse and peoplecentered leader.
Justin Bryan D. Maranan, M.D.
A recent graduate of the UP College of Medicine (Class
2020) who served as an intern of PGH at the onset of
the COVID-19 pandemic. Also a literary enthusiast who
hopes to read more books (and perhaps even write one)
in the future - if he ever finds the time.
Ella Mae I. Masamayor, M.D.
Erika P. Ong
Ella Mae I. Masamayor is an internal medicine resident,
blogger, and a believer in moving forward, one day at a
time. She writes her thoughts at https://ellathinksaloud.
wordpress.com/ or on twitter as @ellamimasamayor.
Intarmed student Erika Ong is constantly working on
improving herself to one day have a shot at improving
the world. Her favorite skills to level up include her
medical knowledge, stock trading ability, German
fluency, and discernment through reading poetry and
prose.
Viktoria Ines P. Matibag, M.D.
A third year OB-GYN resident trying to survive the
training program one day at a time.
Vince Elic S. Maullon
Vince Maullon is currently a medical intern at the
Philippine General Hospital. He really misses going on
hospital duties.
Mikki Miranda, M.D.
Dr. Mikki is from UPCM Class of 2016. She loves to
paint, travel, watch musicals, and visit art museums.
Fr. Marlito Ocon, S.J.
He is the head chaplain of the UP-PGH Catholic
Chaplaincy.
Juan Raphael M. Perez
Beyond being a struggling medical student, Raffy Perez
is interested in dissecting how the world works. They
believe in reason, virtue and compassion, and would do
anything to continuously learn as much as they can.
Trisha M. Salcedo
Trisha Salcedo is a public health graduate with a
penchant for marrying her degree with the humanities.
Howie Severino
Journalist H. Severino survived twice in the first
months of 2020 -- he was in his house on the shores of
Taal Lake as Taal Volcano erupted. Then, he survived
COVID-19 after 11 days in the hospital.
Paulo Ross B. Sison, R.N.
A guy in his mid-20s having a quarter-life crisis in the
middle of a health crisis. Takes care of patients for a
living.
199
Cindy Pearl J. Sotalbo, M.D.
Cary Amiel G. Villanueva, M.D.
Dr. Cindy Sotalbo is a specialist in diagnostic imaging,
and vascular and interventional Radiology. She is an
avid fan of street photography, creative hobbies, travel
and food adventures, and rock music.
Cary Amiel G. Villanueva, M.D. pursued internal
medicine residency at the Philippine General Hospital
after graduating from the University of the Philippines
College of Medicine under the Integrated Liberal Arts
and Medicine (INTARMED) program in 2017. He
enjoys #MedTwitter and evidence-based medicine,
and aspires to become a critical care specialist and
bioethicist. Amiel is also a project manager of
Universitas Foundation, a non-profit organization
dedicated to forming principled leaders.
Hilda Uy, R.N.
Hilda Uy is a Nurse III at the Department of OutPatient Services; but due to the pandemic, she was
assigned at the COVID wards for several months. She
is now having her duty at Telemedicine since June when
the Online Consultation Request and Appointment
(OCRA) System officially started.
Maria Angela M. Villa, M.D.
Dr. Maria Angela M. Villa is a graduating senior
resident of the UP-PGH Pediatrics. She is also
the president of the PGH Physicians’ Association,
representing the association in the healthcare workers’
advocacy group Healthcare Professionals Alliance
Against COVID-19 (HPAAC). She writes this article
especially for the Filipino healthcare workers.
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Photo Contributors
Isabel Acosta, M.D.
Mary Joy Beneciro, R.N.
Isabel is a 3rd year resident of PGH’s straight residency
training program in plastic surgery. Her first gift from
Santa was a film camera —and she has loved taking
photos since then.
Joy is a devoted mother, wife and nurse. She works at
PGH and is currently assigned at Ward 3 (Adult Male
Medicine Ward), enthusiastically rendering patient care
service to COVID-19 patients. She enjoys watching
series and forensic documentaries in her time away from
the hospital.
Adrianne Alfaro, R.N.
Adrianne, more commonly known as Adi, is a graduate
of the Pamantasan ng Lungsod ng Maynila College
of Nursing Class of 2014, and is currently taking up
a degree of Master of Arts in Nursing at the same
university. At the same time, she works as a nurse
at PGH, taking care of COVID-19 patients at the
Adult Male Medicine Ward. In her free time, she
enjoys playing game consoles, baking, crocheting, and
watching various series on Netflix.
Trixie Bacalla, M.D.
Trixie is a graduate of San Beda University Manila
College of Medicine Class of 2019. She had her postgraduate internship at PGH, and aspires to be an
OB-Gyne someday to serve in far-flung areas. She is
involved in sociocivic activities and is fond of playing
speed cubes and watching korean dramas.
Edmond Bries, M.D.
Edmond is a first year resident in the urology residency
program of PGH. His hobbies include jogging, listening
to new wave music and enjoying the finer things in life.
His Christmas wish is for this pandemic to be over.
Jairus Cabajar, M.D.
Jairus Cabajar is a doctor who served as a frontliner
during his last year of residency in internal medicine. If
he isn’t seeing patients, he spends a lot of time tweeting.
He can’t wait until he can tweet that this pandemic is
over.
Jonas Del Rosario, M.D.
Jonas D. Del Rosario, MD is a graduate of the
UP College of Medicine Class of 1991. He is an
interventional pediatric cardiologist who enjoys
photography, playing basketball and biking. He is
currently the spokesperson of PGH and UPCM.
201
Martin Ilustre, M.D.
Sofia Naval, M.D.
Martin is a graduate of the UP College of Medicine
Class of 2018 and is currently taking his residency
training in Otorhinolaryngology-Head and Neck
Surgery in PGH. Pre-pandemic, you would often find
him at the beach, playing ultimate Frisbee or hanging
with friends. During COVID, he now frequents the
halls of his condominium and enjoys long walks to
Ward 10 and back.
Sofia is a second year ophthalmology resident at PGH.
During her free time, she enjoys calming nature walks,
taking care of animals, and practicing yoga.
Ephraim Leynes, M.D.
Epi is a graduate of the UP College of Medicine Class of
2016, and is currently a family and community medicine
resident in PGH. He describes himself as a weekday
physician and a weekend musician, but his interests
reach photography and occasional videography as well.
AJ Limbago, M.D.
AJ is a graduate of the UP College of Medicine Class of
2019, and is currently a neurosurgery resident in PGH.
On the side, he enjoys trying out different kinds of food
as well as occasionally watching K-drama.
Mikki Miranda, M.D.
Dr. Mikki is from UPCM Class of 2016. She loves to
paint, travel, watch musicals, and visit art museums.
202
Harjoland Obenieta, M.D.
Harj is a graduate of the UP College of Medicine Class
of 2018 and is currently a resident of the Department
of Orthopedics in PGH. He’s a fun guy with a mean
streak, obsessed with anything Muji, soft sheets, and
Jollibee peach mango pie.
Amanda Oreta, M.D.
Amanda is a graduate of the UP College of Medicine
Class of 2020, and intends to pursue training in
the specialty of ophthalmology. As a form of stress
relief, she enjoys baking and cooking, sometimes
layout editing, and she has a passion for traveling and
experiencing different cultures — most especially
through food.
Ma. Michelle Palomar, R.N.
Michelle is a nurse from the Department of
Orthopedics and Spine Unit of PGH, and was also
deployed to the COVID units. She likes to watch TV
series, loves to travel and explore new places and things,
and values friendships and family ties very much.
Gianne Pagulayan, M.D.
Alla Tan, M.D.
Gianne is a graduate of the UP College of Medicine Class
of 2020. She enjoys photography and has been part of the
documentation team of various organizations she belongs
to like the Phi Lambda Delta Sorority, Regionalization
Students Organization, UP Medical Students Society, and
UP PAGSAMA.
Alla is a graduate of the UP College of Medicine Class
of 2018. Currently a dermatology resident of the UPPGH, she also works behind the scenes as part of
the COVID-19 IEC Committee, creating the official
infographics released by the hospital. Her favorite things
include photography, graphic design, spicy toro maki,
and her dog, RamboTan.
Ven Ponce, M.D.
Ven is a graduate of the UP College of Medicine Class
of 2020, and is currently an incoming resident at the
Philippine General Hospital Department of Medicine.
When the pandemic hit Manila, she volunteered at the
wards to help her seniors and since then, she found her
calling in medicine.
Trisha M. Salcedo
Trisha Salcedo is a public health graduate with a
penchant for marrying her degree with the humanities.
Yasmin Salces, M.D.
Yas is a graduate of the UP College of Medicine Class
of 2020, and is an incoming first year resident of PGH
Department of Obstetrics and Gynecology. She is a
proud member of the Mu Sigma Phi Sorority and UP
Medrhythmics.
Carl Uy, M.D.
Carl is a graduate of the UP College of Medicine (Class
of 2017), currently in his second year of residency
training in anatomic and clinical pathology at the
Philippine General Hospital. Beyond medicine, he
spends most of his time either buried in books or
indulging in the way of life that is football.
Janel Verceles, M.D.
Janel is a graduate of the UP College of Medicine Class
of 2019, and is currently rotating in general surgery as
a first year resident of the plastic surgery program of
PGH. She is a lover of dance and music, and enjoys
watching movies in her free time.
Steff (pseudonym)
203
Brent Viray, M.D.
Dr. Brent Viray is the father of two cute kids – Maya
and Mareon. He was a Doctor to the Barrio in
Dingalan, Aurora, where he was married to Nurse
Maycel and also found the marriage of public health and
surgery.
Denica Tan Yu, M.D.
Denica is a graduate of UST - Faculty of Medicine and
Surgery Class of 2019 and had her internship at UPPGH. She is currently taking a gap year enjoying some
sun and sand back at the province. Her life off-duty
would be spent immensed between the pages of a novel,
curled up on the couch watching TV, and travelling to
appreciate other cultures and meet new people.
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Editorial Assistants
Vince Elic S. Maullon
Assistant Editor
Vince Maullon is currently a medical intern at the
Philippine General Hospital. He really misses going on
hospital duties.
Denisse Ann L. Tiangco, M.D.
Assistant Editor
A newly minted physician, Denisse has great love for old
school music and cooking. She’s a doctor in the city but
an island girl at heart.
Copy Editors
Aedrian A. Abrilla
Ma. Ysabel D. Caballes
Sean Kendrich N. Cua
Iris D. Ditan
Caeley Lois S. Hao
Frances Dominique V. Ho
Manuel S. Ocampo Jr., M.D.
Lorena Margarita B. Osorio
Leander T. Quilang, M.D.
Marcela Mercedes S. Rodolfo
Ma. Chrielle R. San Pedro
Nikolai Nzar A. Tubog
Social Media Editors
Karen Bernasor Amora
Trisha Angelie F. Thadhani
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Communications Team
Pamela Bianca M. Pasco
Media Head
Alicia Anne B. Lantican
Content Editor
Karmel Althea L. Samonte
Content Editor
Alena Marie B. Mariano
Design Editor
Jemil Austin M. Lacson
Externals Head
Jean Rachel D. Ang
Photo Editor
Carlo Magno C. Vistro
Photo Editor
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Jana Marie M. Negre
Jeremiah V. Reyes
Nina Therese S. Domingo
Simoune Raphaella P. Licuanan
Arlyn Jave B. Adlawon
Editors
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Editors
Alvin B. Caballes, M.D.
Alfonso Rafael G. Abaya
Dr. Alvin Caballes is a pediatric surgeon and is
a Professor of the U.P. College of Medicine. He
developed an early penchant for creative writing, and
honed this by composing letters daily to woo his wife,
and conjuring bedtime stories for their three kids.
Rafa is a clerk-from-home of the UPCM Class of 2022.
If he’s not editing videos or making pubs, he’s probably
studying medicine.
Editor
Amanda Marie Cheong, M.D.
Associate Editor
Mandi is a newly licensed physician who enjoys writing
fiction on the side. She is living the plantita life with
her three pet turtles.
Gabrielle P. Flores
Associate Editor
Gaby is an intern from UPCM Class of 2021. She likes
going on leisurely walks and diving down Wikipedia
hyperlink rabbit holes.
Markyn Jared N. Kho, M.D.
Photos Editor
Markyn is a graduate of the UP College of Medicine
Class 2020, and plans to pursue a residency in General
Surgery. On the side, he enjoys covering events
through photography, binge-watching YouTube videos,
traveling to new and exciting places, and devouring all
kinds of food.
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Layout Editor
Marie Bernadine D. Caballes
Layout Editor
Marie is from UPCM Class 2021 and is an intern at
PGH. She spends her free time watching movies and
watercolor painting.
Paul Miguel P. Perez, M.D.
Business Editor
Paul is a graduate of the UP College of Medicine,
studying for the Physician Licensure Exam at the time
of writing and is now an Internal Medicine resident at
PGH.
The PGH facade was lit up in the colors of the Philippine flag on Independence Day 2020 to
honor the healthcare workers and hospital staff who have served during the pandemic.
Photo by WABS Lights and Sounds
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