“Why did you come home? Don’t you have a nursing board review class tomorrow?” Nanay asked me these questions when I got home at 6 pm on April 22, 1993.

She asked those questions because it was unusual for me to come home in the middle of the week. We lived an hour away from the city and it was so uncharacteristic of me to leave the dorm for home on a school day.

I answered: “We have a review class tomorrow, but only in the afternoon. I figured I can come home and sleep in.” Truth be told, while we were fed well in the dorm, I was craving my Nanay’s home-cooked meal.

Tatay answered: “We are actually preparing to go to the city hoping that Dr. Apistar (Nanay’s cardiologist) can see her despite not having an appointment.” You see, Nanay has been diagnosed with heart disease for quite some time. At that time, she was having palpitations that got our Tatay worried.

• By the way, here is the link to the podcast: https://open.spotify.com/episode/6XOYpjfTja37itGbnh6Fpp?si=552c34674816455e

Almost, but not yet a Nurse

I was a senior nursing student then. In fact, we have already completed our academic classes and were getting a headstart on reviewing for the local boards.

I loved reviewing at home. After dinner, my brothers and my cousins studied for a short time, then they went to sleep. That was when I would start my study time, around 10 pm, and would usually last until the wee hours of the morning. As I constantly burned the proverbial “midnight candle,” Nanay would prepare fried peanuts and a bottle of Coke.

“Food for the brain,” she always said!

That day was different, however. Seeing how tired she was, I came with them to the city. Unfortunately, the cardiologist was so busy that her being on the waiting list was for naught. We asked her if she wanted to go to the emergency room (ER), but she said that she would rather go home to rest. I honestly felt that she just wanted to spend one last night with our youngest brother who was twelve at that time. Our other brother was a neophyte in the military academy, and she strictly forbade us from bothering him.

I was used to seeing her having respiratory symptoms. Nevertheless, I noticed that her sclerae were starting to have a yellowish hue. I mentioned that to her. She said that she may need to see an internist to confirm if she had jaundice.

Sometimes, looking back, I blame myself for not being cognizant enough to notice her Congestive Heart Failure symptoms. I was just resigned to the fact that she had Rheumatic Heart Disease (RHD).

April 23, 1993

Nanay and Tatay would always wake up early in the morning. They would start talking loudly and I found that to be annoying. I went home to sleep in, so I was bothered by how they would have a full-volume conversation.

That morning was different. Only Tatay was loud. Nanay was speaking meekly, with so many pauses, and was clearly gasping for air. After a few minutes, Tatay woke me up. He was taking Nanay to the local ER.

Without even bothering to take a shower, I got dressed, and off we went. The doctor of the day was my cousin. They started Nanay on two liters of oxygen via nasal cannula. I didn’t see any improvement in her. She was restless, unsure of what position to take for comfort. I told her to stay calm and do deep breaths but she said that she felt like she was drowning.

Our local hospital was very small and devoid of diagnostic technology. I didn’t think we even have a pulse oximeter back then. More so, Nanay’s palpitations were becoming so erratic that we couldn’t distinguish the regular heartbeats from murmurs. The clinicians all agreed that she needed to be transferred to a hospital with more modern tools. As there was only one ambulance, we had to wait for it to come back before we can use it

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My Very First CPR Experience

They arranged the transfer, gave a report to the recipient hospital, and sent us our way. No one was available to accompany us. It was the driver, my aunt, and myself with Nanay inside the ambulance. I was in charge of all the medical management for that hour-long trip.

Where was my Tatay, you wonder? He had to find money so that we can at least give a downpayment to the hospital.

Healthcare in the Philippines is a far cry from that in developed countries. There, the patient/family has to pay upfront before services are rendered. Luckily, we brought Nanay to the hospital where I was pursuing my nursing degree, so the nuns were very considerate.

When we arrived, Nanay got out of the ambulance and walked to the wheelchair. She was wheeled to the ER bed and was looked after by so many doctors from interns to attendings. Seeing that she was in good hands, I filled up the paperwork. I wasn’t even halfway through the first page when my aunt came out to inform me that they were resuscitating her.

So Many Questions

As the registrar knew me, she told me to just come back later. I rushed to the ER and saw everyone surrounding Nanay. They were all doing well-coordinated cardiopulmonary resuscitation (CPR). It felt like forever. Seeing that everyone was tired, I volunteered to take my turn doing chest compressions. In the midst of that, I was asked a barrage of questions:

• What were the first symptoms we noticed? What time did we notice them?
• What was her urine output since the morning?
• Was she really a hard stick? (as they cannot find any vein to insert an intravenous [IV] line on). (The one that we came with was infiltrated).
• How long has she been diagnosed with RHD? Any valve problems?

My head was spinning. I couldn’t recall the important facts about her heart problem. I felt helpless, but I was still trying my darndest to save my mother.

More than half an hour later, her cardiologist was in the ER. He was overseeing all the life-saving efforts. He asked to talk to me. It was a semi-clinical, semi-family kind of talk. He was cautiously hopeful but was also preparing me to be realistic. I recalled begging him to please call off the “code” because I heard her ribs being fractured. They couldn’t intubate her. They could not even insert a central line peripherally. I was not used to seeing her that miserable.

At that moment, I didn’t know my identity:

Was I a daughter who happens to be the patient’s nurse? Or was I a nurse who happens to be the patient’s daughter?

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Saying Our Final Goodbye

I went back to the cardiologist and begged again. Just as I was doing that, Tatay and Nene (his sibling who was like another mother to us) arrived. The cardiologist talked with them, while I went back to where Nanay was. I asked the ER nurse to please have Fr. John come to give my Nanay the last rights.

Fr. John was our hospital’s chaplain. I personally knew him because I would attend his early morning masses in the chapel whenever my schedule allowed. He heard my confessions and everything that I kept at heart.

I think the fact that Fr. John came before Nanay breathed her last gave me that sense of peace. I was not ready to let go by any means, but her receiving the last sacrament was appeasing. When all was said and done, they left us to grieve with her. I gave her a kiss, promised that I will take care of my brothers, and removed all of the tubes, tapes, and other things attached to her.

Just as I got done doing all of that, the school bell next door rang.

It was time for my half-day review class. The one that I was supposed to come back to the city for.