Back in elementary school one of our first quizzes in grammar involved supplying the correct article of a word. I got a zero, because “a elephant”  and “an crowbar” sounded mighty fine to me. My seatmate, Frannie Martinez, got five out of five. She was the only one in class who got a perfect score so the English teacher, Mrs. Bahuta, handed her a tiny star of excellence. Everyone clapped for Annie. I congratulated her and asked if I could see the star before she stashes it in her box of stars. The star was special–it was cut out from gold velvety paper and not just from plain, colored cartolina. It had texture. It had scent. I smelled it with envy. My parents got me a private tutor, Mrs. Serena Kathryn Harris, who helped me with my assignments for a grand total of two weeks before she hurriedly left for a more stable job. I did get to learn my a’s and an’s eventually, impressing Mrs. Bahuta and getting me my own velvety star. A few years later Annie and I transferred to another school.

                  Decades later Frannie went on to become a nurse in Delaware. I went into medicine. Mrs. Bahuta retired after teaching grammar to generations of students before succumbing to endometrial cancer. I hadn’t seen much of Mrs. Harris, but as she lived in our small baranggay I would occasionally see her  in the mall, the church, or walking on the street. Sometimes she would buy something from our sari-sari store, and I would frequently nod and half-smile in recognition of the brief encounter we’d had decades ago.

                  A few months ago my mother mentioned that she had seen Mrs. Harris buying fish in the wet market, and that she had asked if she could consult me at our house for constipation. I told my mom that she should see me in the clinic. I don’t really like seeing patients in the living room anymore. There was a time when my mom interpreted the term “house visit” to mean that the patients would visit the doctor in his house. I corrected her and explained that it is the doctor who goes to the house of the patients on certain occasions, particularly when they are bedridden.

                  I didn’t immediately recognize Mrs. Harris when she arrived one Sunday afternoon. I was on my knees, painting over the peeling portions of our parking garage gate. She was wearing a pair of sunglasses, and she was on a pink bicycle that looked like a toy bike. She said that she was very happy to finally see me. When she removed her sunglasses her eyes looked pale, her cheeks gaunt. She had been having severe constipation the past few weeks, that she had lost all appetite for food. Her arms and legs were thin, her abdomen was a bit distended. A quick once-over made me suspect that she could be suffering from metastatic colorectal cancer. Of course I was biased, she could indeed be having constipation from lack of dietary fiber, or irritable bowel syndrome. Her weight loss could be from a congenital heart disease, or an eating disorder. Or any number of disease conditions that would require a comprehensive history, physical examination, and laboratory tests to figure out.

                  After making sure that there was nothing emergent I told her that I could see her in the clinic the following morning. I told her that I would need to make her lie on an bed, listen to her abdomen with a stethoscope, do a rectal exam. I needed to ask her a lot of questions, like how these symptoms came about, if she had any pre-existing diseases, any medications, and so on. I felt like I was over-explaining more to myself, essentially, why I couldn’t do a “check-up” there and then. She nodded and asked again if I remembered her and I said of course I did. She snickered nervously. To calm her down I told her names of neighbors we both knew. She smiled weakly without confirming if she remembered them. She said thank you and got back on her bike.

                  “Magkano ang subida sa clinic?” she asked before leaving. I wasn’t familiar with the term, but I took it that she meant professional fee. I told her not to worry about it, and said goodbye.

                  Back when I was younger I was much more accommodating to those who did “snap consults”. I would ask them to come inside the house, or at the very least talk to them in greater detail about  their symptoms. Eventually I discovered that not only was it counter-productive, it could also lead to all kinds of troubles. There were no records, I could make a fatal mistake, be slapped with a lawsuit. Not to mention that I’d slowly gotten to begrudge arriving home late at night, exhausted from the hospital, only to discover four neighbors or distant relatives waiting for me at the gate for consultation, issuance of medical certificates, requests if I could talk to this doctor for a discount, requests if I could help with a transfer to a government hospital.

                  “It is not unkindness to define boundaries,” Smoketh had told me once.

                  Mrs. Harris didn’t show up in the clinic the following day. After two weeks my mother told me that Mrs. Harris had recently died, but that she hadn’t gotten any details yet. I immediately went into full self-audit. Should I have been more accommodating? Could a few more minutes have allowed me to save her life? Her abdomen looked swollen that day, she could already be having gut obstruction, the tumor big enough to completely block the intestines to the point of rupture. Or maybe she had cancer of the ovaries. These could also get gigantic, rupture, and lead to internal hemorrhage and death. I was so caught up in my attempts at self-care, prioritizing boundaries, adherence to protocols, protecting work-life balance, all these concepts conjured for my convenience, over the opportunity to do good. It takes a lot for patients with long-standing symptoms to seek consult, and instead of saving her I decided to paint.

                  Slowly bits and pieces of news came out, from social media, from the neighbors who knew her best, from common friends. Mrs. Harris and her husband were in their living room when gunshots were fired from the ceiling. Or were the shots made through the window, nobody knew, because no formal investigation happened. The couple died on the spot. It was said that they were killed while they were sleeping at home at 2 PM and we believed it, until news emerged that they were killed while they were using drugs, in some version they were re-packing crystal meth. A neighbor said that Mrs. Harris had been introduced to the substance by her husband, and that a cycle of violence, poverty, and addiction had prevented her from leaving. The wake of Mrs. Harris and her husband was held in the town mortuary, and when I drove past it on my way home from work the mortuary was empty. People were afraid to be associated with them, we were told, and that many of their friends and relatives were also in hiding. A few days later their son, who was in his twenty’s, was also shot to death.                   And then it hit me. The constipation, the weight loss, the photophobia, the anxiety, they weren’t from an undiagnosed cancer. I wasn’t party to her death, and for two-seconds I felt relieved, until guilt took over for making it all about me and my feelings. Come to think of it, she could still be having cancer, it could co-exist with substance abuse problem. In any case it wasn’t a tumor that killed her, but a bullet to her head. Eventually any guilt was overcome by shock, and rage. And in my naiveté I was expecting the rage to be collective and loud. It should be, I thought, because this was happening nationwide. But watching all these government officials bending over to explain away their master’s behavior, or the audience snickering and knee-slapping and cheering at direct references to rape and murder, I realized that I shouldn’t bet on it.

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Tags: cancer, doctors, ejk, health