[IRL] LESSONS from the SURGE:OUR HOME EMERGENCY ROOM EXPERIENCE
By Menchu Aquino Sarmiento
Nearly five months after the COVID-19 vaccines reached the Philippines, less than 5% of all Filipinos have received their 2nd dose. Since some studies show that the efficacy of the prevalent Sinovac diminished just 6 months after the 2nd jab, health experts are studying the need for a 3rd booster shot with an mRNA vaccine instead. Meanwhile, 19 cases of the highly contagious Delta variant were detected. All recovered but one. Apart from the Variants of Concern such as the Delta, there is also the Lambda, known as a Variant of Interest. Over time, the ones in between: Epsilon, Zeta, Eta, Theta, Iota and Kappa, might become either Variants of Interest or Concern. Pray that none of them mutate into a horrific Variant of High Consequence.
It was only two months ago that Metro-Manila hospital ICUs were overwhelmed by thousands of COVID-19 patients. Desperate families drove all over Luzon in private cars or if they were luckier, in ambulances, to get their ailing loved ones (many stricken by the usual medical emergencies of stroke, heart attack or multiple organ failure) to a hospital. Some died while waiting for medical attention in a hospital E.R. tent. It was truly a living hell as daytime temperatures rose as high as 40 ◦C and rarely dropped below 30 ◦C at night.
Our ordeal of caring for an elderly patient during the surge started on Mother’s Day. She had inexplicably fainted and was found to have a high fever, but was otherwise unhurt, able to walk and to talk coherently. She had no comorbidities nor any of the usual COVID-19 symptoms. Her oxygen saturation was always 92 to 98. Lesson #1 – Make sure your family First Aid kit has a pulse oximeter, along with a thermometer, OTC meds like antipyretics, disinfectants, band aids, etc. If you can afford them, get a digital blood pressure machine and a nebulizer. Buying medical equipment online may be cheaper than getting these from a big chain drugstore or in Bambang. Check out the online reviews section for the more reputable vendors.
We called our patient’s attending physician who ordered us to immediately bring our elderly patient to his hospital’s E.R. (Emergency Room). The E.R. and all the wards had been full for weeks due to the surge, with no end in sight. Our patient, flushed with fever and too weak to sit up, would have to wait for hours, or even for days in the heat and dust, amidst throngs of possibly contagious strangers. The doctor quipped that anyway, if she had “an episode,” such as a febrile seizure or worse, the E.R. was required to let her inside, although she would probably have to bed down on floor of the E.R. corridor. She would have no family contact since she didn’t use a cellphone. Lesson #2 – trust your common sense and instincts. Since our patient didn’t have any comorbidities or the usual COVID symptoms and her O2 saturation was high, we rejected the attending physician’s risky advice. There was no basis for his insistence that we should unthinkingly accept “the tragedy of COVID-19” and subject our patient to a cure worse than her disease. Our elderly patient stayed in the comfort of her bedroom. Remember that COVID 19 has become a cash cow for many unscrupulous healthcare workers preying upon the anxiety, ignorance and fear of hapless families. PHILHEALTH gives a larger payout to hospitals for COVID-19 deaths.
We explored the various hospitals’ E.R. at Home options. One of the lower priced ones (P17K for one week with an RTPCR swab test included), required full payment up front. If the RTPCR test which was done upon payment, turned up negative, they would not monitor your patient for other possible ailments in the remainder of the week you had contracted for, but still keep the balance of your payment.
Fortunately, we found an E.R. at Home package (P12,000 for 14 days including the RTPCR) that suited our budget and the less urgent level of seriousness that our patient’s condition seemed to warrant. Her fever was lower by the 2nd day, when the E.R. at Home doctor, an internist-pulmonologist, had the first of four tele-consults included in the package. On Day 3, already fever-free, our patient had her RTPCR (negative), and tests which we paid for outside of the package, i.e., chest x-ray, urinalysis and blood chemistry. The hospital gave us a kit containing: a digital thermometer, a pulse oximeter, 14 disposable masks and pairs of nitrile gloves, and a banig of nutritional supplements that made no therapeutic claims but supposedly boosted immunity.
The hospital kit included a slender notepad and a ballpoint pen, both with the hospital logo, for regularly monitoring our patient’s vital signs. According to the contract, a trained call center agent, not a nurse or any kind of certified health care worker, would phone us every other day to note the vital signs we had recorded. Checking in on a patient every 48 hours was perfunctory at best, and useless in the event of a real medical crisis. Apart from the scheduled four tele-consults with the doctor, we were basically on our own. We hired a professional caregiver. To her credit, the call center agent assigned to us, went the extra mile and checked on our patient every 12 hours. She had recently lost her own father to end stage kidney failure, and fully sympathized with our anxiety and sense of helplessness. She was the saving grace during that trying two weeks.
Between the E.R. at Home experience with all its shortcomings, and bringing a patient who might actually get sicker in an overcrowded hospital tent, there is no single right choice. Fortunately, our patient didn’t have any COVID symptoms and quickly recovered. Like many older persons, it turned out that she had heat stroke and dehydration, but had not been seriously ill after all. That may be the only kind of situation when an E.R. at Home actually works.
Menchu Aquino Sarmiento is an award-winning writer and a social concerns advocate. IRL (In Real Life) are short verbal pagmumuni-muni, the essay equivalent of fast fiction--but in real life. She really wants more Filipinos to care, and to do something legal and non-violent about it, preferably together, so that we act more like a civilized country, a mature democracy.