55 Word Short Stories

55 Word Trios

These 55 word short stories were written after a month long rotation in an emergency department in Manila, Philippines.  This developing nation was beautiful in many ways, but the things I saw in the ED gave me a lot to think about.  Some of these experiences make me ashamed to relate – ashamed of how I acted and what I thought.  Ashamed of how little I could do.  Each story is just a blurb in the whole experience, and there is much more behind each one.

 Blood, Sweat and Tears

Blood

Shannon poked him three times. We just don’t perform phlebotomy back home, we’re unpracticed.  Finally the syringe filled with dark maroon blood. No time for gloves.  As I held the vials for her all I could think about was the HIV and Hep B that is rampant here.

“You’d better not stick me.”

“I know.”

 

Sweat

She had no pulse.  Code.

Hands locked together, pushing down 2 inches required. 

My sweat was dripping on her, I was embarrassed. 

I felt her breast through her thin shirt and knew it was in the right spot, over the heart. She shouldn’t have to die like this. 

It’s hot. 

More sweat dripping.  Still embarrassed.

Tears

“They just don’t show any emotion.” 

Most of us observed this.  We’re used to patients who yell, scream, complain.  Families who cry, beg, annoy.  These patients were different – accepting, grateful, stoic.

But, when the CPR was over, I realized her daughter was crying.  The family had lost a matriarch.  They felt loss. They had tears.

 The Hospital

The Hospital

Open air wards.  Cats slinking in the alleys, in the halls.  Peeling paint, hand-painted signs, broken chairs. Hard steel cots, unpadded wheelchairs.  Family members crowded around in hallways, on cardboard mats – not visiting but vigilant.  Responsible for labs, transportation, ventilation, feeding, laundry.  5 nurses for 60 patients. 
“What’s your hospital like?”

“It’s not like this.”

 

Oxygen

The old man needed oxygen. Septic. There was no tank nearby. The tubing didn’t reach, he leaned back.  No IV pole so he shared, arms outstretched.  Uncomfortable. 

The woman behind him became pulseless.  CPR for 20 minutes, to no avail.

For the first time I thought it: “She’s dead.  Now he will be more comfortable.”

Breast Cancer

“Have you ever seen a breast cancer?”

“No”

“She stopped chemo in April.  Hasn’t walked since December.”

“It’s February.”

Angry, red volcano on her chest, putrid liquid pooling.

I wore my mask to avoid the smell.

Her husband leaned down to carefully wrap it back up.  Hide it.  Lovingly.  He didn’t even wear a mask.

 

Breath

Goiter

I’d never seen anything like it before.  No one in the US would let it get this bad.  The goiter on her neck was completely overshadowed by the large, red, tense, tender parotid cyst.  Disfiguring.

“Masakit?” – Tagalog for pain.

A mild head nod.

“Six days” she said.  “I can’t eat.”

Later, she couldn’t breathe either.

CPR

1 and 2 and 3 and 4 and…..

“Staying Alive” running through my head.

Hands locked, I kept my eyes and ears on the monitor, seeing how effective the compressions were.

When 20 minutes were up, and she was dead, I thought “ Oh good, I wanted my first time with someone who would die.”

 

Intubation

“Are you ready to intubate?”

“Yes, I’m ready.  When will they start coming in?”

“Oh, they’ll be in alright. “

The first was dead when I intubated her.  We worked for a while, then quit. Her husband leaned down to cry, say goodbye.

“Excuse me, sir.  You need to sign this form.”

I walked away.

Manila

Manila

A taxi winds through the narrow, curving, crowded streets  Various transportation modalities crushed together.  Roosters crow.  Houses made of tin, scraps of wood, cardboard.  River beds dry, filled with trash.  Smell of urine, feces, sweat, sun-rotting garbage.  High end shops next to dingy produce stands.

Children dart between traffic.

“They’re renewable resources” the residents said.

Beggars

Walking down the street we passed the children every day.  The girl about 12, the boy a toddler.  Siblings?  Mother and son?  God, I hope not.  The same cardboard mat every day.  The same dirty grins.  Reaching hands.  Begging.  Playing games on the sidewalk.  A smile, a coin, a cupcake.  Accepted, but still not enough.

Pharmacia

I felt guilty using their supplies.  Stopping at the pharmacy on the way to work seemed strange.  Vials cost mere pennies, IV catheters even less.  I bought $30 of supplies – two large shopping bags full.  It would keep the ED going for a day, maybe two. 

“Did you get any Foleys?”

“No.”  I had forgot.

Staying in Milwaukee

For those of you who don't know yet, we're staying in Milwaukee.

I matched into Emergency Medicine at Froedtert/MCW - my alma mater.  It will be nice to know a little bit before I start residency.

Now for moving.  We're moving to a new (bigger) apartment on Memorial Day weekend.  Crappy, yes.  But many hands make light work so if you want to help you are welcome.

Bry's finally about to start back in Watertown - he's pretty excited.  Abi is on vacation basically until July 1 and has been knitting up a storm.

MATCHED

Well we found out today that I officially matched.  We will find out on Thursday WHERE we will be living and WHAT specialty I'll be in.  We're getting pretty excited.  Will update on Friday.

Back in the USA

Well we're back in town.  Not going to lie, it's been a rough couple of weeks.  We finally uploaded photos to Bry's computer so there will be some additional Palawan photos coming up.

I started my new class: Art of Medicine through the Humanities.  I'm loving it!  We're discussing poetry, books, plays and all kinds of non-medical things.  Last night we went to the Milwaukee Repertory Theater and saw a play (free!) that was interesting.  Bry got to come along too.  We also met with Edo de Waart, the newest conductor of the Milwaukee Symphony Orchestra who is world renowned, as well as with a wonderful basoonist from the Symphony.  It was an awesome day, and I can't wait to go to the Symphony on Friday (also free!).

In other news, Bry's mom broke her right arm (radius and ulna) on Monday.  She's going in for reduction today and isn't sure if they'll have to put metal in to hold it or not.  Bummer - she'll be out of commission for about 6 weeks.

I'm supposed to be keeping a journal for this class, so I might just give my teacher this blog link so she can follow along and I don't have to type things up twice.

Palawan - Underground River

Our third and final day trip in Palawan was to the Puerto Princesa Underground River tour. The river itself is called the St. Paul River. Roughly the final 8 km of its length is through the cave of limestone and marble. The Puerto Princesa Underground River is vying to become one of the New 7 Wonders of Nature. Everyone should go vote for it. I think it's in 13th or 14th place right now out of 28 finalists.

Our Underground River trip began at about 8. It is about a 2 hour drive to get the river from Puerto Princesa City proper, although the entire trip and the river itself are technically in city limits. In fact, Puerto Princesa City covers a large portion of the central part of Palawan from one coast to the other. The road to the river took us past Honda Bay again and then wound up through the hills and eventually across the island to the other side and to the north. Our tour guide joked with us when we started out that there was a free 5 minute massage included in our trip-part of the road isn't paved, it just has mostly gravel and larger rocks. Actually, I was impressed with the condition of the road in general, especially closer to the city proper. There were guardrails when necessary and most of the road was paved with concrete, however, some of the turns were a little tight. My legs and arms were definitely a little tired by the time we got to the river and when we got back to our resort in the afternoon because I was using them to balance myself the entire time.

When we arrived at our destination, we registered and were told that our boat from the Sabang Wharf to the mouth of the river would be leaving at 1:30. It was only 10:00, so we went to another river nearby, within walking distance. Here the locals give tours in small boats to the people waiting to tour the underground river. This river water is brackish (essentially a mix of fresh and saltwater) and therefore Mangrove trees line the banks of the river. The tour lasted about 25 minutes and included our tour guide singing the Mangrove tree song complete with the Tagalog and English versions just for us that has probably been passed down in their culture for many years. After that we ate dinner which included more Pansit (which I like), pork, chicken, fish, and of course rice. Then it was about time for us to walk back to the wharf and get on our outrigger boats for the 20 minute ride to the mouth of the river. This ride on the South China Sea was definitely in the open more and was a lot more wavy than our ride in Manila Bay to Corregidor or our ride in Honda Bay. Once we got to the mouth of the river, we waited about 10 more minutes and hopped on a much smaller boat. Once again it was just us and our tour guide. Our tour guide was very good and made sure to point out the formations inside the cave that have been named over the years. There was the Virgin Mary, the Three Kings, the Holy Family, and yes, the Sexy Lady. There were also a lot of bats. Abi had her big flash along that worked sporadically, but we still have probably 20-30 good photos inside the cave. The tour itself last 45 minutes and tourists are only allowed to go into the cave up to 1.5 of the 8 km. From there we got back on our outrigger boat and headed back to the wharf. Once there, we bought some drinks from the vendors, jumped in our vans, and headed back to our resort.

That night we decided to stay in at our resort and spent some time in the pool. Our resort opens to the public most nights, and there was a birthday party there at the pool with kids running around with noisemakers. One of the boys liked us and was trying to show off for us at the pool and while we were eating with his noisemaker. They were all pretty cute kids.

Palawan - Honda Bay

We woke up right on time at 6:30.  We had breakfast set for 7am, then were getting picked up around 7:30.  We weren't sure which tour we were doing so we had to double check, then go change into swimming suits for the Honda Bay tour.  Our breakfast choices were 'Filipino' or 'American'.  We both played it safe with the American breakfast - toast, scrambled eggs, ham (spam) and coffee.  Yes, Bry tried the Nescafe fake coffee and he actually liked it. 

Our van picked us up a little after 7:30.  We were #'s 5 and 6 to get in - a group of 4 Filipino accountants from Makati joined us.  We headed to the Honda Bay wharf which took about 20 minutes.  At the wharf we bought bread to feed the fishes, an underwater camera (Erica- they actually had them here!  They were like P900 though) and rented snorkel gear from our tour guide, Gloria.  Then we loaded into a small banca or outrigger with two balancing bamboo branches on either side.  It had a questionable motor and two questionable banqueros, but we made it out to the middle of Honda Bay. (BTW, Honda is pronounced " 'Onda", drop the H.)  For those of you astute readers, Honda Bay was the site of an Abu Sayyaf kidnapping raid a few years ago.  They targeted a ritzy resort in the middle of the Bay, all by itself. We have been totally safe and are staying in town just to be sure.

Our first stop was not an island but a large area of preserved coral reef.  Dynamite fishing has been banned in this region so the reef is pristine.  This area is part of the coral triangle and has some of the best snorkeling and diving sites in the world.  We dove right into the water and didn't have to swim far to find an amazing variety of fish and many colored coral.  We got to paddle around here for about 45 min and had the place to ourselves for over half of that time.  It was really neat.  Bry enjoyed his first attempt at snorkeling.  We had to wear our life jackets the whole time so that no one could dive down and disturb the coral.  (Our tour guide mentioned Koreans by name.....maybe they're more prone to disturbing the coral???!)

Our second stop was Pandan island.  Pandan is a type of tree that is common here in the Philippines.  The island is one of the only ones in Honda Bay to have its own water supply.  The whole island is set up for tourists with canopies and huts to use.  Soft, white sand beaches with crabs, shells, crystal clear water.....it's perfect.  We left the other guests to take pictures and have a walk on the beach.  We found sand dollars and crabs all over the beach.  Then we hopped in and went snorkeling again.  This time we passed people who were surrounded by hundreds of fish - they were feeding them the bread!  Our guide and the rest of the guests joined us in a little bit and they gave us some bread to hand out too.  Hundreds of fish would swarm around you - many different varieties and it was pretty neat.  Here we didn't have to wear our life jackets so we had some more freedom.  The only problem was that the fish couldn't discern between pieces of bread and white-people-toes - we got a few nibbles ourselves.

We ate lunch next and had a great meal of rice, pork, fish, squid, chicken, and sea grapes.  While these veggies look amazing (like long bunches of mini green grapes) they burst in your mouth leaving a stringy, salt-watery clear mucousy goo behind.  Not too appetizing.  Bry DID try some - so be impressed.  He also got to try some coconut - for P25 I bought him a coconut and he had a true island experience.

After lunch we headed to Snake Island.  We only had about 40 minutes here since the other people had to catch a flight.  We shared our bread with them and were once again surrounded by fishies.  The water was clear again, super nice.  We really had a nice time and enjoyed the boat ride home.

When we got back to Kawayanan we realized one mistake:  While applying our sunscreen liberally to our faces, we forgot that we would be on our BELLIES the whole day.  Both of us had burned the backs of our legs pretty good, Abi's shoulders too.  Duh!  And let's go sit on a plane for a couple hundred hours now too!  Oh well, hopefully the burn won't last too long.

For dinner we headed into town.  This was another adventure since the local transportation is a Tricycle.  This is a motorcycle with a Larry-Boettcher-type contraption attached to it to hold other people.  We sat in the cramped space and bargained with the driver to take us to three stops: 1) the bank to get some cash 2) the grocery store to buy some water 3) Badjao Seafront Restaurant.  Once again, it's a good thing I had a map along because there are 2 places named Badjao - and we had to turn around.  This tricycle thing is a little scary, especially since Abi's back was facing front.  In case of accident, I told Bry, I would most definitely be paralyzed.  Anywhoo, we made it to the restaurant.  This place wasn't kidding when they said "seafront", it is built on stilts out ON the ocean.  There are tons of Mangrove trees growing along the walkway and it's a gorgeous place for sunset.

Palawan - Day 1

We made it!  We're in Palawan.  It is truly gorgeous - reminds me of the Big Island on Hawaii except larger and more mountainous.  We have already been able to see a lot and are having a terrific time.  My pictures aren't uploaded yet, we're focusing on our vacation, but I wanted to update the Blog a little bit so my mom doesn't alert the authorities......

The flight was short and sweet.  Of course, our taxi driver tried to cheat us - I asked to use the meter and he got pissed so he kept on adding cost to the trip - I could see him!  I was so mad at the end that I wanted to say something very mean, but I didn't want Bry to leave me so I reigned it in.  The domestic terminal is brand new and SUPER nice so we enjoyed our 2 hour stay there before the flight.

Palawan is a series of islands that just jut up out of the sea.  It's pretty incredible from the air.  The airport is a single runway and single baggage claim, pretty rustic.  We had a very nice reception from Joy from Kawayanan Resort.  Kawayanan means Bamboo in Tagolog.  The driver was very nice and Joy pointed out some landmarks as we drove to the resort.  We got a double bed with private bath and A/C.  The pool is super large and very nice - pictures to follow.  We dove right into the pool and had it all to ourselves on Thursday morning.

At 1:00 we were picked up for the Puerto Princesa City Tour.  We were joined by a very nice Filipino couple - she was a flight attendant.  We visited the wharf, the bay, a church, the site of an American massacre during WWII, a weaving place, Irawan crocodile farm, Irawhig Penal Colony and a large ranch overlooking Honda Bay. Yeah, it was a lot, and we kinda felt rushed to get out, snap a photo, buy a souvenir and get back into the van.  It took just over 3 hours so we got back to the resort in time for dinner.  We ate dinner right there in the resort and it was pretty good.  Bry was introduced to my dear friend, San Miguel Pale Pilsen.  He also became a fan.  We were feeling pretty beat so we hit the hay early on - around 7:30.  Not to worry - we had an alarm set and enjoyed almost 11 hours of sleep before waking up.....

Corrigedor II

We got up early at 6:05.  We quietly got ready to go so the roomies could get some sleep on their last day.  We left for the ferry around 6:45 and this time Bry saw Manila  in daylight.  The street-folk didn't disappoint and he got the full feel of morning in a developing country with whole families eating breakfast on the sidewalk.  The traffic was a bit crazier this time too.  We got to the ticket place just after 7 and then waited for the boat to leave at 8 am.  (They say to be there at 7 so that people on "Filipino Time" will show up by 7:45.)

Bry enjoyed the boat ride and got to see just how big Manila is.  The skyline is HUGE - like if you took downtown Chicago and stretched it out for over 5 miles.  Awesome.  As we got out further we could see the smog line too. The rest of the boat ride we spent outside on the back of the boat, enjoying the view.

Arriving at Corrigedor is pretty neat.  It was once a US base - a pretty sweet gig before the war.  They said over 15,000 US and Filipino troops and Civilians once lived there.  Our guide was again Steve - the same on I had before.  He was terrific and we were happy to join his tour.  Well, Bry was, anyways.  Who could have guessed that the first day I see my husband he finds a history loving - conservative - Twins baseball fan --- in the Philippines???  Bry and Steve hit it off and they had a wonderful "date."  (Abi nearly asked where Mrs. Steve was so she could have someone to talk to too!)  Bry really enjoyed the whole tour, and a lot more sank in for Abi her second time around.  Got some great photos because there were hardly any people there to ruin my shots.

After the tour (with lunch and a light-and-sound-show in Malinta Tunnel) we headed back to Manila.  Bry got to meet the Roomies and Abi got to pack her big suitcase to send back with them.  The roomies were split about where to get dinner so 3 went to TGI Fridays and 4 (Bry too) went to Kashmir - our new favorite Indian restaurant with the best Mint Chutney in the entire world.  We had a relaxing time and then walked Bry through PGH grounds.  I took him into the ED just to see it - his eyes said it all.  He was a little shell-shocked from all of it - the filth, the beggars, the cracks in the sidewalks and roads, the population - and we realized just how natural it had all become in the past 4 weeks.  Bry hit the hay around 7:30 and Abi stayed up until 9 to say goodbye to the roomies.

Girls - it was a great month and I enjoyed staying and traveling with all of you.  We made a great team and a lot of great memories.  Anybody who wants to play Up-and-Down-The-River just give me a call!

Tuesday

Tuesday morning we all took it pretty easy.  Some of the girls were avoiding the sun due to some late "i'm-going-back-to-the-tundra-better-get-some-sun" burns.  Only poor Carol had to go into PGH.  We kinda lolled about - went to Robinson's Mall, ate a lot of eggs and toast and random other items to clear the fridge.

The evening was a bit more fun - we had another pizza party.  This time we ordered from Yellow Cab Pizza and it was SUPER good pizza.  Unfortunately, the only US branch of the chain is in Cincinnatti, OH.  Before, during and after we tried to finish off our liquor.  We also had another game of up-and-down-the-river that was fun.  Around 9 pm some girls headed to Ka Freddie's to hear a band that Schuckit told them about.  Apparently there was some on stage dancing and much frivolity - I've been forbidden to post photos......

I left for the Airport around 10:30.  Bry's plane was supposed to be in at 11:05pm and I wanted to be there and waiting. Just to give you an idea of the language barrier I will repeat my conversation with the driver:
Me: "Did you start the meter?"
Him: "Yes, Ma'am"
Me: "How long will it take to get to the airport?"
Him: "Airport?"
Me: "Yes, how LONG will it be to the airport?"
Him: "Airport, Ma'am"
Me: "No, no, what is the TIME to the airport?"
Him: (looking at the clock) "10:30, Ma'am"
Me: "Um, thank you."
Me: dead silence for the rest of the 20 minute ride.

So I get to the airport and I have to wait outside in a sea of others expecting loved ones.  Luckily, I was one of only 3 white people, and by virtue of being 5'2", also one of the tallest in the crowd.  It took Bry about 45 minutes to come out and I was so happy he'd kept it simple with the Twins baseball cap and matching sweatshirt - hard to miss.  It was good to see him and he got a glimpse of Manila at night - disappointingly though the traffic was surprisingly good.  We got home and he met most of the roomies and we went to bed.

Last Day at PGH

We started out our last day....late.  We strolled into the ED around 9am.  We saw a few patients, but it was really slow, as Monday's tend to be.  We put in some IVs and NG tubes - I hate that I'm just NOW "getting" how it all works there, and then we leave.  Shannon was an IV pro even on old man rolling veins.  I put an NG tube into a guy, I only knew his name.  When a BUNCH of blood started pouring out I totally freaked.  I asked the resident about his history and he had liver disease - I had just ruptured one of his esophageal varices.  Nearly sweating, I was worried that now he'd bleed out and I'd have killed my 5th person in a few days.....but the resident said "I expected a lot of blood, now we know it's an upper GI bleed and not a lower one."  Well....the next time you know something important like that how about you let ME know too!! Needless to say, the guy did NOT bleed out so no harm done.

We left for lunch around 11:30.  We opted to get dressed up (like going to a funeral) for our presentation at 12:30.  Our presentation was about Thyroid Storm - a literal 1:1,000,000 event in the US and a daily occurrence at PGH.  The consultants went pretty easy on us and it was over pretty soon.  The next girl was not so lucky - she got pretty much grilled on her presentation.  The thing is, the stuff they nit-pick over is stuff like protocol, procedures, not following rules.  They can't really grill the residents on things like not having supplies, not ventilating someone because there is no mask, not seeing someone for 30 minutes who has an emergent problem.  These things are beyond the control of the residents.  We wonder what it would be like to present one of those cases at a Froedtert M&M. (M&M means Morbidity and Mortality - you give a talk on a patient who had a bad outcome and supposedly learn what to never do again.)

After our presentation we left and just chilled for a few hours.  I washed my clothes in the sink - my quarter eating washer and dryer is looking pretty good right now.  Then we got dressed to meet with an esteemed Pediatric Geneticist, Dr. Padilla.  She had us come to PGH and provided us with an early dinner of Filipino fried delicacies and pancit. (Pancit is a term for a noodle dish, this one had seafood and eggs, pretty tasty.)  Then she talked to us about how she's struggling to get Philippino health care to a more developed state.  The obstacles are numerous, as I'm sure you've figured out by now.  She says that over 60% of babies are delivered at home, so there is no way to enforce getting newborn testing done.  She's now working on training Midwives to go out into the provinces and spread the news.  She's hoping to increase newborn testing for things like PKU, Maple Syrup Urine Disease and other congenital problems.  She's a pretty incredible woman and sounds like she has her hands stirring many pots. 

Afterward I went to the Mall (a daily occurrence here) and bought some treats for us.  I gave some cupcakes to the two homeless kids that we pass by every night.  Sad.  Imagine occupying a 1 year old on a 2ft square cardboard mat with hundreds of people walking past and cars and motorcycles just a few feet away.  Awful.  So at least the cupcakes gave them something to do for a little while.

Went to bed and started counting down.  Bry is currently flying somewhere over Alaska or Russia.  He'll be here in less than 12 hours!  Can't wait.