by Will Liangco
BY HER COOL demeanor you wouldn’t think she has actually killed a person. Carla just stood in the ambulance parking lot, iPod earphones firmly plugging her ears, Our Lady Peace wailing as she puffed on a stick of Marlboro Greens. She coughed a little, cough accompanied by a tiny wheeze attributable to years of smoking. Initially there was dread, which made her run there in the first place, but after a couple of drags all the anxiety at having contributed to someone’s death wafted along with the smoke. It was a case of time healing pain, and in her case, time being eight seconds max. Carla removed the stethoscope dangling on her shoulders and rammed it inside her bag. She removed her dirty white blazer and hang it on an ambulance side mirror. Whenever she did something this stupid the last thing she wanted was a reminder that she was, barf, a doctor. She reached for her expensive Ysmault cologne and bathed herself with the stuff, but she didn’t know why she cared this time. Usually she would interview or do a physical exam on a patient while reeking of cigarette smoke, rationalizing that hey, the patients smell worse than me, their foul breath and blue collar stench rendering them undeserving to lay out judgment. But this time, she thought, it would probably add to the aggravation of the family of the deceased if she would smell like a cold, uncaring, bourgeois bitch.
It wasn’t her fault, she told herself. She was a trainee, after all, a resident in a congested public hospital. The patients would come in knowing very well that this was a training institution, although being extremely poor you wouldn’t think that they would have a lot of choice anyway. Mr. Bernabe was a cigarette vendor with severe pulmonary tuberculosis, his X-ray almost entirely eaten up by cavities upon cavities of infection. On top of it all the right upper area of his abdomen was very huge with a palpable mass. His wife and two young sons had brought him in weak and with a slight difficulty of breathing, having borne the condition for months on end until he was dusky and incoherent. When asked they didn’t know what to make of what had been happening to him for the past few months—in fact, it seemed that they didn’t know what to make of anything. As Carla was interviewing her when they came in quickly trying to get a grasp at Mr. Bernabe’s history Mrs. Bernabe would just stare at her with wide eyes further accentuated by her hollow, emaciated cheeks and temples. Occasionally Mrs. Bernabe would utter something, which most of the time irritated Carla to no end, foremost being her initial statement, “Hindi kami natakot dahil lahat naman kami sa bahay inuubo”. It had never been Carla’s practice to even try and get a nuance of what her patients or relatives were feeling, but for this particular person she could hardly get any emotional registry. She didn’t try and make sense of this seeming coldness by attributing it to hunger, thyroid problem, or genuine apathy, even, but the absence of emotion was thick, palpable, and strangely ensnaring.
Carla went back to the emergency room covered in Ysmault, although no one would have noticed with the thick smell of diabetic feet, crap, coagulated blood, vomitus, and the general aroma of human congestion. The nurse-in-charge smiled upon seeing her, relieved that she has finally appeared to fill up the death certificate. Death certificates have always filled her with trepidation, not because of the pain, or guilt, or whatever abstract thing it could bring her—she just found it too tedious to fill up that long blue form. She took a very short glance at Mrs. Bernabe who, to her, looked hungrier and bored than pained, and at their 18-year old son Mario who was texting, probably informing their remaining relatives of this news. A nurse was rotely removing the tube from the corpse’s throat, detaching the IV lines, the foley cathether, the cardiac monitor chest pads. Beside her was a nurse assistant preparing the body for delivery to the morgue. And behind the nurse assistant, bantays of other patients not very discreetly watching the body and whispering to each other. “Diazepam!” Carla heard her co-resident, Pocholo, scream as a morbidly obese woman in front of him seized, her arms and legs contracting and stiffening at the same time. And in the hallway, a young unconscious guy was being wheeled in by his panicked ka-tropa, a side-road construction bar impaling him where the heart should be.
Before the body could be wrapped in a cloth Carla ran to the body and checked it once more. Mr. Bernabe’s eyes were shut, his wife having dramatically closed the lids down with her fingers upon Carla’s pronouncement of the time of death. She didn’t know if it was the effect of the movies, but she noted that the relatives of the dead always do that, something she always forgets. Mr. Bernabe’s body was asthenic and perfectly pale, but his face was now totally puffy, in contrast to his withered look upon coming in just a few hours ago. She touched his chest once more and felt the small packets of air trapped directly under the skin, making a crackling sound as she pressed on them. They weren’t there either when he came in. And those ribs—they weren’t jagged and broken before. Carla just had to check once more and look at the evidence of her crime, but there was no time to waste—there was that long blasted form to fill up.
CARLA COULD still remember the first time she had filled up a blue form. She was an intern rotating then in the OB-GYN section, and she was surprised that she could clearly recall anything about having been there at all, her head always being razzled by a cacophony of residents screaming at mothers, prodding them to close their mouths, bear down, and for the love of everyone who hasn’t slept for 36 hours now, just fucking push. Perpetually there was the caterwauling, and the penetrating smell of all variants of lochia, and the constant calf pains after running all over the hospital swirling in this specific compartment of her memory. “Just fill up the details and let me sign later,” she recalled the resident tell her. It was a death certificate of the baby, and Carla then realized that she would have to ask the mother for certain information. One such detail was the desired name for the deceased.
“Ano po ang gusto ninyong ipangalan sa baby,” Carla had asked the delirious, disoriented mother prostrated on the labor table, her feet still propped up on the metal stirrups. The mother asked groggily for the gender, and when Carla said it was a girl the mother just answered, “Anna”.
Another option was the preferred mode of body disposal, the tick boxes bearing “cremation” or “burial”. Carla was feeling genuinely sorry about the entire episode then—she didn’t know how to deliver such a question, and to a sedated mother no less. And she wasn’t aware of the tagalog term for cremation, instantly assuming that this lady wouldn’t know any English word more than two syllables long. And as what always happens when you are nervous and are over-thinking something to say Carla had blurted out, “Ano po ang gusto ninyong gawin sa katawan, ilibing o… sunugin?”
BACK WHEN she was an intern she would only need to write the details she could copy from the patient information sheet, and she would always leave the most important thing for the licensed doctor to fill up: Probable Cause of Death. But now, she was the licensed doctor, and the horrible task of having to come up with the patients’ modes of exit rested on her shoulders. It has always been a struggle, with the clues not consistently clear and mostly elusive. In her few hours of care, with the blood samples for blood tests still lining up in the technician’s laboratory even as the patient has already expired, with the scant, conflicting details that the usually dazed bantay could bring to memory, her position would require her to be as accurate as possible in judging how this person has died. Add to that the rather annoying test to her integrity, with her doing a constant, repetitive self-audit, a voice usually screaming in her head: if this were your diagnosis and cause of death, why was this your management? With very few relatives being willing to have the deceased undergo autopsy Carla sometimes had to pull something from the air, but she couldn’t totally blame them for not consenting to having the body sliced, dried, disemboweled, and most importantly, be a cause for delay for the funeral. So she always had to come up with something—pulmonary embolism for someone who has been bedridden and with dark legs, fatal arrhythmia for someone who just suddenly died while he was in the X-ray room, and the ubiquitous septic shock for someone poor who couldn’t buy one vial of cheap antibiotics. In cases of frail 80 to 90 year old patients who have just died for no apparent reason whatsoever she has been tempted numerous times and almost always gave in to write cause of death: old age, but she could never muster enough chutzpah to actually do it. She secretly believed in it, that you could just die from having worn your body out in your katandaan, but the high and mighty intellectuals surrounding her would laugh and deride her. And in this institution, being a darn high and mighty intellectual was the norm.
THE COLD, MENTHOLATED SMOKE raging down her trachea provided much relief as she shifted back to first gear and then to a complete stop. Driving along Taft Avenue has always been a pain at this time of the day, and it didn’t help that she was encephalopathically sleepy after her long hours of duty. She decided to keep the aircon on, leaving her car window rolled down only a little to let the smoke out. She knew it was unsafe, but she always had her iPod on whenever she would drive to keep her awake. The next song to play was Our Lady Peace’s Innocent, with Raine Maida blaring We are, we are all iinnocent, we are all innocent…. “Cute,” Carla muttered in exasperation as she pressed skip and Billy Joe Armstrong started to sing Jesus of Suburbia. She took a quick glance at her side mirror and she noted a blue Ford keeping dangerously close behind her. And to her left, an ambulance with sirens blaring wildly as if it really had a patient inside. Thick exhaust smoke made its way to the slightly open car window by the devil’s seat, inducing cough, terrible annoyance, and rage. Incensed Carla snuffed out her half-burnt cigarette and rolled the windows all the way up.
Carla has always known: the eight second rule she would always give herself whenever she did something terrible was a lie. They were the deadline she would impose—eight seconds to get over that break-up with Ernest, eight seconds to forget about the third-degree she received from that high and mighty consultant, eight short seconds to cope up with the embarrassment of getting caught buying a porno DVD. Because as with everyone glimmers and fragments would slither their way into her sulci, rehearsals of the events would run repeatedly—the more reason to turn up Green Day to maximum sound “I’m the son of rage and love! The Jesus of Suburbia! From the bible of none of the above on a steady diet of… soda pop and Ritalin!!!”
A few more cars ahead and she would finally be able to turn right and escape the hell that is Taft Avenue, but the traffic has not budged a little since thirty minutes ago. A small drizzle went down last night, and of course certain corners were already flooded. And of all the blasted days too. Carla had never wanted to go home as much as she wanted to today. She could already feel the heavy shower drops landing on her head, the water running down her bosom, dragging all the grime and other people’s spit, blood, and bacteria down the drain. Taking a bath after every duty has always been a major event, and whenever she would lather herself with as much soap that her palms could contain she would occasionally recall those trite metaphoric post-rape spirit-cleansing shower scenes in rape movies. In a sense it probably wouldn’t be so different from that, Carla mused as she finally turned to a corner with much speed, pressed a break instantaneously, and almost got a terrible whiplash as a gaunt cigarette vendor suddenly crossed the street out of nowhere.
“PNEUMOTHORAX :(“ Carla texted Pocholo. She has been lying down on her bed the whole day, unable to sleep, not because her eight-second rule has extended to eight hours—in fact she has almost totally forgotten about the whole episode entirely, until Pocholo suddenly texted her inquiring as to what her sign out to the whole Mr. Bernabe thing was. She has deliberately left out the one word she knew Pocholo would be aware of: Iatrogenic. That it was a health-care induced condition. She has already gone through the usual cognitive acrobatics whenever these sorts of things happen as she was shampooing her hair earlier: that the patient came in very late in his course anyway, that even if she has secured the airway properly the patient’s family wouldn’t be able to provide for the long course of antibiotics that would save him anyway, that he had a liver mass which is probably cancer and therefore terminal anyway. And what about the other cases she received during the same duty? There was Mr. Dimatulac who came in with severe abdominal pain that couldn’t be alleviated by anything. All the other co-managing doctors who’ve seen him have all laid out their differentials and managed him accordingly, treating him for pancreatitis, a heart attack, mesenteric ischemia, and even prepping him for an exploratory surgery. But only she considered that it would be an aortic dissection, and it was confirmed in the ultrasound. She saved Mr. Dimatulac’s life from the disease and the whole team from embarrassment. What about that extremely yellow guy, Mr. Lim? Everyone insisted that it was some obstruction, but only she figured out that it was a blood disease that was turning him yellow. And Chester Domingo from Paranaque, only she bothered to ask about his sexual history and hence the possibility of AIDS causing the severe diarrhea. 3-1, that was her scorecard, but somehow this didn’t provide her with much comfort, not this time. Carla stood up, turned off the aircondition, threw her windows open, and lit a cigarette.
“Sorry to hear that. Iatrogenic yan ‘no? :)” Pocholo suddenly texted back. Carla choked on her own smoke as she read the message again. You insensitive twerp, she thought. Has this sort of thing happened so frequently that Pocholo would think that he could just rub it on? That it was the sort of message he could just stamp with a demented smiley face? Carla wanted to reply with “fuck you”, but the kind of person Pocholo was he would probably think that she would really want to have sex with him. She has been aware this whole time that she was at fault, but seeing someone else point it out directly has really caused her innards to turn inside out. Carla let out one small whimper, and in an act she would no sooner than eight seconds later to regret she snuffed out her cigarette on her left forearm.
IT WAS just nine in the evening but Carla was amazed that she could already coast along Taft Avenue with much speed. Aside from the usual enormous trucks and buses driving along as though they owned the street there were relatively fewer cars on the road than usual. She turned her iPod on, and thankfully the song that came on was something that could in no way drill back into her any aspect of the entire distressing Mr. Bernabe thing: Insane by Eminem, a tongue-in-cheek song about homosexual incest-rape. Try and connect something about guilt and absolution with that, Carla snickered. She rapped along with Eminem, she has heard this song numerous times but she still chuckled at the whole suburban absurdity of it. Her left forearm was now covered in sterile gauze. Dramatics, and definitely self-mutilation, she found totally repulsive, but Pocholo was a moron.
Sooner or later she would forget, she thought. This entire incident would most probably blow away in a matter of days, everyone would go on living, the residents would continue training, the administration would reprimand but forgive her, and so on. She probably wouldn’t even need to go through the entire drama of acceptance, self-forgiveness, and absolution—the endless bustle in the workplace, the new patients she would meet, all the rigorous requirements of training—they would sooner or later relegate Mr. Bernabe into a memory, a learning point at most. But, Carla decided, she wouldn’t allow him to turn into that. Earlier that day she passed by the hospital and tried to hawk back his medical records. She managed to find it in the Records section and copied his home address. Her car was already filled up and prepared for a long drive to the ends of Laguna or Cavite, but she noted that the family merely resided in a corner in San Andres Bukid. It was going to be a very short drive, which filled her with even more dread.
The clothes she chose for the occasion were what she would consider to be the least threatening for the situation—a white polo shirt with a running rose vein on the left side, a pair of run-down jeans, definitely no jewelries of any kind. The braces might betray her and make everyone feel inferior with her smile, but with her severely crooked, nicotine-stained teeth and tar-soaked gums she wouldn’t think so. But the Ysmault, and the pack of Marlboro Greens in her pocket, she couldn’t sacrifice for this.
As she parked in a dark corner a few meters from the house she could already see the funeral lights and the people huddled in mahjong and tong-its tables. An OPM song could be heard—someone went through the cost of renting a videoke machine. More than four times she has run the scene in her head—the tall cans of biscuits, the murky coffee in dirty cups, maybe even some pospas. And more importantly, Ms. Bernabe and her kids, and their extended relatives, and the neighbors. How someone must have probably already ran through them what this young, bourgeois, cigarette-smoking trainee has really done, and what chutzpah she must have to actually visit the wake. Maybe a couple of jeers, or a Vilma Santos-level facial slap even. And how to go about it—apologize immediately and cry? State things as they were? Relate back the risks and benefits of intubation? Magnanimously give an advice on how tuberculosis is spread?
Carla stopped caring as she slowly walked to the house, a pack of cigarettes in her pocket, and saw Mrs. Bernabe flash the widest smile at her in recognition.+
Originally appeared in The Philippines Graphic (2010)