It was late afternoon when a woman in office attire accompanied by her female co-worker arrived at the ER. The patient, a deadringer for Diana Zubiri, looked pale and drowsy. Her face was in noticeable pain as she was holding on to her stomach.
"Doc, kanina pa ho kasi sumasakit ang tiyan, namumutla na nga. Muntik pang mahimatay nung pauwi kami," the co-worker initially remarked.
The patient was immediately examined. BP was 80/50. Pale palpebral conjunctiva, cold clammy skin and tender hypogastric area were evident. She was quickly hooked to IV fluids.
"Grabe lang ho siguro buhos ng mens ko. Kung maari po pagkatapos ko masweruhan, resetahan nyo na lang ako't uuwi na ho ko," the patient reiterated.
"Teka, di ganun kadali yun, kelangan muna natin ng mga tests at i-IE pa kita," I responded.
Upon hearing the word "IE" (internal exam), the patient suspiciously looked like a troubled kid whose tooth is to be extracted by a dentist.
Upon IE, passage of blood and meaty tissue were noted. Cervix is conspicuously soft and dilated.
On a physician's clinical eye, the patient exhibited the classic picture of someone who just underwent an abortion----the bleeding, the acute abdomen, the cervical ripening and the patient in denial of her ordeal.
"Siguradong di ka buntis at nagpalaglag, misis? Kelangan kasi magsabi ka nang totoo para magamot ka nang tama," I explained to her.
Yet still, the patient denied, insisting persistently she was just having a menorrhagia (abnormal heavy and long menstrual flow.)
As per protocol, patient was subjected to pregnancy test. I had to insert a catheter to extract urine for the said test, for the patient was too weak to voluntarily void her urine.
The test was positive.
"Misis, umamin ka na kasing nagpalaglag ka!" vehemently interjected by our feisty ER nurse who happens to have a type A personality and is notorious for her Matutina-like demeanor.
Faced with such overwhelming physical evidence, the patient remained steadfastly quiet and just exhibited a poker face.
At that point, I felt like Jack Bauer of 24 confronting a captive terrorist who is stubbornly hesitant in divulging a pertinent information.
The patient's mother finally arrived. She frantically asked, "Anong nangyari sa anak ko?"
I have no course but to tell the mother of the real deal, "Mukhang nagpalaglag ho anak nyo pero ayaw umamin. Baka puwede nyo hong kausapin. Mahirap ho kasi sa pasyente pag di nagko-cooperate."
Upon getting the info, the mother suddenly looked dumbfoundedly astonished, as if a gun was held up against her at point blank.
Seeing "single' at the patient' chart, I then curiously asked, "May boyfriend o kinakasama po ba ang pasyente?"
The mother replied in her rattled voice, "Dalawang taon na hong nasa abroad yung mister ng anak ko."
I almost succumbed to an Ang TV moment and nearly uttered the catchphrase "Niyeeh!"
The dust was starting to settle. With the husband out of the country, it was either divine intervention or some other guy pulled a bantay salakay stunt and knocked the patient up. Obviously, it was the latter.
The mother angrily confronted her daughter. I could not help but overhear their conversation (ok...ok..I eavesdropped.)
"Ano bang ginagawa mo sa buhay mo, anak?!" the sobbing mother uttered as she stomped her foot in disgust.
"Buntis ka daw at nagpalaglag sabi ng doktor. Sabihin mo nang totoo, nanay mo ko," the mother continued.
The patient broke down into tears and finally admitted her deed.
"Sinong ama? Si ________ (some guy's name that the mom probably knew)?" the lamenting mother interrogated.
The patient nodded in affirmation as she wiped her tears with a hanky.
"Sabi ko na nga ba. Ilang beses na kitang pinagsasasbihan!" the mother sorrowfully scorned her daughter.
"Diyus ku pu, Lord!!!" yelled by the mother who highly reminded me of the panicking troublesome "Pris di Lurd" antics of Aling Dionisia (Manny Pacquiao's mom) as seen on a tv news coverage whenever there were a Pacquiao fight.
Apparently, the patient was a G2P1 who terminated her pregnancy by taking Misoprostol (Cytotec-an abortifacient) orally and vaginally. She then experienced a crampy abdominal pain and continuous vaginal bleeding thereafter. The pregnancy was a result of an extra-marital affair.
Upon referral to my OB-Gyn consultant, patient was admitted. D & C (dilatation and curettage-in Filipino, raspa) was done. Blood transfusion was administered. She was discharged four days after.
As the Soul Asylum song goes, "they say misery loves company." During her OFW husband's absence, the patient was lured into infidelity. And that infidelity resulted into a stoic casualty--the killing of an unborn child. True love was what the mother claimed her daughter has for the father of her aborted child for he was a kababata. Whatever it may be, people should be responsible for every action they take. In this case, the patient was not. I cannot help but aimlessly wonder what would be in store for her relationship with the OFW husband once he knows.
Doctors can read charts but we cannot read minds. It's a bummer that clinicians do encounter patients that are elusive despite having a threat to their well-being. Covering up for an infamous and shameful act is indeed human nature, even in the face of a life and death situation.
During the time when the patient was packing her things up as she was up for discharge, I jokingly and satirically confronted her.
"Misis next time magsasabi ka na nang totoo kung buhay na ang nakasalalay. Sabi mo nireregla ka lang. Parang ako ang niregla sa yo eh."
from: http://worldofalbert.multiply.com/journal/item/82/The_Abortion_Case_Of_The_Unfaithful_Wife
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