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#AskAlvin Dying without dignity

Posted Apr 05 2013 3:41pm
#AskAlvin 002

I’m an RN who works in a regional hospital in the U.S. Pacific Northwest and a member of a great union that understands the importance of skill, training, and education to be an effective healthcare team professional, at the bedside. I greatly admire the efforts your organization is striving for, in addressing inequity and bringing modern healthcare to one of the most amazing people, I have had the honor to know and learn from. It is great to see RNs creating a voice for the Philippines. This, for the simple reason we are patient-centered and therefore their advocates- especially when they do not have a voice.

I was shocked and appalled when I spoke with the clinical physician on March 17th, 2013 at the Barangay Health Center (Rosario Rd, Pugo, La Union) on behalf of my wife’s brother Mario, who appears to be dying of end stage liver disease. When I spoke with the Doctor, being a professional nurse, I wanted to discuss possible treatment options: Hospice, palliative paracentesis, lab work, and adequate pain control- per reports of Mario being in “agony”. Within 2 minutes of talking with him, we all realized he was not going to be forthcoming with a consult on care options or even treatment. For Mario’s sake, I was finally able to persuade the Doctor to agree on lab work (I would like to point out, we offered to cover all medical expenses). The only feedback beyond this was an impatient “...yes, yes…he is very toxic.”
Ok, so no pain meds :O .
Maybe just a little lactulose to help flush out the bilirubin and at least allow him to have a bowel movement?
Nothing.
No, there was one thing. He made a joke to the staff about having to exercise his English, and then walked off.
He gave the phone back to my wife’s sister who reported the physician told her “There is nothing I can do for him”. His medical reasoning? Ah, he has “never seen this type of case”. So, an adult male presents to the clinic in obvious acute distress, barely ambulatory, jaundiced, a distended hard abdomen, unbearable pain, along with family reports of patient being positive for hallucinations. Hmmm, now how do we address this case? Well, I’m afraid we have never seen this kind of patient before. Therefore, from my clinical assessment and in my professional judgment, we tell the family, ‘yes, he is very toxic’ and recommend ‘there is nothing we can do for him’, while refusing all requests for medical help, alleviation of suffering, specialist referral, or even a follow-up. He did offer one recommendation: “Take him for a walk wherever he wants to go”. This is ironic as Mario was too weak to walk anywhere and so she took him home, where he is waiting to die.
I have to admit. Witnessing this level of critical thinking on the part of a Doctor of Medicine, in a clinical setting, left my wife and I- not to mention her sister (but not Mario as he was in too much distress to understand what was going on)- speechless. He left my brother-in-law, in a state of delirium due to hepatic encephalopathy- at least I think so, as this MD would not even allow anyone the courtesy of a diagnosis- with my sister-in-law, where the two of them had to leave.
Please. He is a good man and does not deserve to die like this just because he is poor. He has worked hard all his life. Please do not let him die like this.
I cannot in good conscience leave this alone. Maybe I am an idealist, but so was Jesus. I am a professional nurse and know how to perform research. I will seek human rights groups, Philippine politicians, the WHO, the Philippine Nurses Association, healthcare activist groups, the Professors at my university, my own union…anyone; to address such a vulgar and offensive injustice to the poor. If you do not have the time or resources to address this, I respectively request this email be forwarded to someone in your organization or another organization that can assist Mario in this urgent matter.
Is it really too much to ask for a Filipino gentleman, who has never hurt anyone, to die with a little comfort and dignity?
If there is anything I can do to help please do not hesitate to contact me.
Sincerely,
Joel Gatliff, RN

***
Dear Joel
Thank you for this very detailed letter. I must commend you for strongly speaking for Mario! Let me tell you that I am one with you on your struggles and that I feel very disheartened that such medical professionals treat their clients in such an unprofessional way.
Let me first commend you for being a patient advocate and for being the voice of the voiceless. Not many Filipino nurses are passionate patient advocates but we are getting there including being passionate advocates of our own rights.
I would like to tell the readers that no health professional treats client like what Joel described ideally. That no health professional should treat patients any lesser than others he/she serves. This decorum the medical doctor showed is unacceptable. 
Given that he cannot fully attend to the client because he is in a Barangay Health Center and the facility may not have the sufficient technologies for the client's condition, to respond "there is nothing I can do..." is indeed appalling and just unacceptable to me. The handling health professional should have referred the client to a nearby health facility that could handle the client's case. What he did was, for me, tantamount to neglect of duty.
Medical doctors and nurses can directly assess their clients and diagnose (medical & nursing diagnosis) from the results of their assessments. Therefore he should have known that the client is too weak for any mobility.
I do suggest that you go directly to a hospital and have him assessed there instead of going to a Barangay Health Center. I do not think that Mario's case can be handled efficiently by health professionals in a primary health care facility such as a Barangay Health Center. Mario's case should be seen by a specialist and must be managed immediately. 
I also advice that you document the incident with how that medical doctor handled Mario and the way he treated his significant others, including you. You may file a complaint on his incompetent patient handling to the Professional Regulation Commission, the national agency that regulates all professional practice in the country. You may also send the same incident report to the Department of Health so they could look into the efficacy and efficiency of health service given by that Health Center to the public. 
It is the right of everybody, including Mario, to be given quality care despite his condition (I think he should be given a more delicate care because of his physical condition). Filipino health professionals especially doctors and nurses are always one of the most in-demand professionals in the world. We are highly regarded for our compassionate care to foreign clients. I just do hope that our world-class health professionals offer the same to their countrymen.

Mario, just like any other Filipinos, has all the rights to be given quality health care because this is his right - according to the Philippine Constitution. And should experts fail to save him from his ailment, it is but humane to give him a dignified death.
All the best,
Nurse Alvin   
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