hydrocephalus and 3 stories

You probably heard this in the TV or in class. In simpler terms hydrocephalus is a condition where the head is expanding due to the increasing fluid in the head. It is because of a blocked drainage in the pipe system of the brain or an increased production of the fluid. In this case a child should undergo surgery as early as possible. This is to avoid seizures, increased pressure or any developmental delay. The surgery entails placing a pipe from the head to the peritoneal cavity pleuralcavity or the gallbladder. It usually is a series of surgeries either because the pipe/shunt has become dirty (infected) or the pipe doesn't fit the growing child anymore and needs to be replaced.
Any rotation or OJT to National Childrens' Hospital, would open up your eyes to the condition of hydrocephalus. But this three encounters I have are encounters in the emergency room and in the out-patient department. Read on.
1. A two-year old.
I don't remember whether it was during my internship or clerkship that this happened. In the early hours of the pediatric-E.R. rotation a family came in with a 2-years old girl. The family with the child is not her immediate family. The main character is the Uncle. He decided to bring the child to the ER because of the enlarging head. There was no immediate or urgent problem to the child. The urgency was with the uncle. He wanted to know if the child was to grow up normal if the child underwent surgery now. What he wanted to say was will the child still be a retard even if she underwent surgery. Will they have to take care of her the rest of their lives? Short of answering his questions, the consultant that day gave him every possible explanation. In short, YES to all his questions. The very sad thing was what he said last... "Eh di kung ganun din pala, hayaan na lang naming ganyan sya kesa pag-gastusan namin ng marami." Honestly, I don't know their status in life. But to go all the way from a province to one of the most expensive hospitals in the country and this done when the child was two years old is something that boggles me. Hydrocephalus is not a condition that suddenly presents one day. To tell you the truth the tape measure we had that day didn't even fit the circumference of her head. I don't know what consults they did before us. What I know is that at that point in time, I wish I had the power to turn back time and all the money in the world to give to the child so that she could undergo the best care possible.
2. 1 month old.
This happened just 2 duties ago. It's not about the child per se but the circumstances around it. The emergency room is the melting pot of personalities. That early morning a mother of a 22-year old male came in to the ER because her child had fever and chills that morning. She gave the child paracetamol. And kudos to her for managing well the problem. Her concern was if there could be something done further. In other words, could this be dengue. Dengue is of a viral cause and usually viral symptoms would entail high-grade fever and non-specific symptoms. And as for dengue, the first bout of fever doesn't give you a picture of dengue, it's the when the fever disappears where signs appear and the medical world can give a more or less appropriate diagnosis of dengue fever. But the 22-year old child in question is okay. In his words. ("Ma, okay lang ako, wag na tayong magpatingin"). To allay the fears of the mother, I ordered another complete blood count, the initial results of his blood count was far from the dengue/viral picture, it was normal, nearly bacterial in picture.
While they were waiting for the result, in comes a family from a class lower than them. Mother, father and a one-month old child with hydrocephalus. They came from a province and was led to the institution for further management. They didn't know what to do, they were in a slight disarray. The child was crying for food and the mother had to sit down and feed the child. Picture this. While she was feeding the child (breastmilk) the mother-from a-upper-class was looking at her (she was also with a side-kick), all eyebrows were raised. I would dismiss that as something else but what they did when the mother was led to the pediatric area was what raised my eyebrow, they smirked and laughed.
I'll leave this story at that.
3. Aaliyah.
During my neurosurgery rotation as a clerk, I had this encounter with a newly born child. The mother and father brought the child immediately to the OPD (charity section), for evaluation. Hats off to the doctor of NCH for catching the diagnosis immediately and for leading them correctly to the right people. :). The neurosurgeon was in doubt at first. But latter tests proved the diagnosis to be correct. In short Aaliyah underwent surgery early on. My encounter with her didn't end there. Even now I see them on my way to the hospital. The father calls out to me most of the time and updates me on what Aaliyah can now do. Last I saw them she is able to count to 5. They religiously follow their appointments with the pediatric and neurosurgery departments. After all that they have been through, a series of surgeries, spending Christmas and the other holidays a the hospital, I can still see their delight with gift of life. Aaliyah's development is delayed but the mother and father don't mind that, they are just happy that she is alive. They are happy that she is able to smile.

as long as i can

Last Saturday was a scheduled "babang-luksa" of my grandmother. It is scheduled on the one year death anniversary where the period of grieving supposedly ends. That's the reason for my sudden 7 hour bus ride going home.

It has ben one year since I made one of the biggest decision in my life. For months after the death of my Uncle, my grandma's son, her health deteriorated. She just simply let go of herself. For months we were in and out of the hospital. Of course, it came upon my shoulders to explain or simplify to my family the medical jargon that every specialist have thrown to them. Even returning the medical jargon and a full flight of english words to hospital admin for every other day giving us notice of payment of fees. Believe me, I do understand their point, but at that time of my life I am just a "relative of a patient" who's patience is wearing thin. At that point in time I was balancing my life between Baguio and Manila, Civilian and Doctor, Rest and Review for the boards.

A year ago, I went up to Baguio for one reason, the wedding of my cousin. To tell you it seems that fate played her hand at this. Just minutes after me setting foot and saying hello to my family, my grandmother went into arrest. You see, before I went home I was deciding wether to bring my steth and stuff. I brought them. I upped the O2 to 10. Listened to breath sounds. Gasping. Felt for pulses. I could barely palpate due to edema. Brought out my steth, normal heart rate. Called for transpo. Good thing someone other than me knew how to drive. Decided to bring her to Baguio Gen for intubation before transfer to SLU. I know I have ambu-bagged lots of patients before. But this one hits the heart.

Every nurse in the ER of SLU knew the face of my lola. But then and there she was unrecognizable with the tubes and everything. Every nurse in the cardio unit knew her as the "grumpy old woman". I do not know how they felt seeing her pass by tubes and all straight into the ICU. My grandmother had asked not to prolong her life, DNR. As I arrived for my shift at the floor, I saw my cousins there. they were leaving, "bukas na lang ako papasok, daming tao eh.". Of course, see you tomorrow. But that was before I went to look at my grandmother. She was moved to TPs a few hours ago. I told my mom I didn't like how whe breathed. And when I saw her again, her BP was down, her HR was slow... I asked my mom to go home. IT was almost 9pm. I asked my sister too to leave. But she chose to stay.

You see it was the dilemma of my mom. She didn't want to give the last decision. When my mom left I told my sister that we were not going to last the night. I gave my damn best to calm myself down. I didn't know what to do. Past 10 pm a code red was called into the ICU. The curtain was closed.

an angel smiling on you

By Catherine Pulsifer, © 2007

Tears streamed down my face as I sat at my grandmother's funeral. My grandmother lived a very full life, and was full of energy, love, and wisdom. She always said the right thing for the situation. And, whenever we had a problem, we knew we could talk with Grandma.

As a teenager, I can remember many conversations where Grandmother would give us here worldly wisdom and she would always end up saying you have an angel smiling on you dear I know you will do the right thing.

Now, here we were at her funeral, and I was thinking of her saying of angels smiling on us. Now, I really knew I had an angel smiling on me as I am sure Grandma was in heaven smiling down and watching out for us.

I offered to help my Mum sort through Grandma's apartment. The next few days were filled with memories, and filled with laughter, and filled with tears. As we sorted through Grandma's stuff, it brought back some wonderful memories.

I was packing the last of the dishes when my mum called to me. I went into Grandma's bedroom, and my mum handed me a package with my name written on it. I opened the box and read the poem:

May this little Angel shine upon your home

Filling your days with cheer

Know that She stands on guard for you

To help you smile all year.

And Grandma had handwritten, "Hang this stained glass angel in your window to remind you of your angel Kate! Love Grandma"

To this day, I have the stained glass angel hanging in my bedroom window. And, every time I look at it I can hear Grandma saying:

"You have an angel smiling on you dear, I know you will do the right thing."

dream

This is one work of Rolando Carbonel that I like the most. This is taken from my Aunt's scrapbook. I'm glad that it survived through the years. I'm hoping to make my own scrapbook someday.

DREAM
-an excerpt-
Rolando Carbonel

Love... may not be you loving me but it may be me loving you,

despite that; it may be me, not being able to.

It may be me seeing your soul, though it could be me
feeling your soul's encompassing presence.

It could be you forever walking away from me,
yet never leaving me.

It could be me searing my soul with your mocking laughter,
you piercing my being with your deep tenderness.

Love could be you wandering at my futile intensity,
and I wondering why you wonder still.

This was sent to my aunt written on the back of a lovely card. She only "loved the poem, not the card". I hope that I could find the whole poem. I couldn't find ONE book with the collection of Rolando Carbonel.

what comes next?

Passing the boards could not bring you the joy that you would see in your parents or relatives' faces. You are happy, yes, but you could be happier. Hearing or reading your name among those who passed could only bring you a sigh of relief of "it's all over". It's the "load" being a little lighter, now you could employ yourself and find a not-so-well-paying job. And there's the "if only" everyone you knew have passed, you could feel a lot better.

But then the rewards you have now is all yours, and yours only to enjoy. Only you know the hardships you have to go through, only you could give meaning to what you have now. There's the "sigh" and "a little lighter load" but having that compared to nothing at all spells the difference. Take what you have, and enjoy it.

What comes next is only yours do make... Decide. There's the nursing stint, the USMLE, the Australia or Canada, or what residency to take, should I take what I really like or what they think is best. Or what do you really like? Or should you consider residency at this time? It's only yours and yours to decide. Because after all, its you life. But right now, enjoy every bit of perk you get with passing the boards. Congratulations.

do you have an attitude?

OUR ATTITUDES

Charles Swindoll 

American Author and Pastor

The longer I live, the more I realize the impact of attitude on life.

Attitude, to me is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do.

It is more important than appearance, giftedness or skill. It will make or break a company... a church... a home.

The remarkable thing is we have a choice everyday regarding the attitude we will embrace for that day.

We cannot change our past... we cannot change the fact that people will act in a certain way. We cannot change the inevitable.

The only thing we can do is play on the one string we have, and that is our attitude.

I am convinced that life is 10% what happens to me and 90% how I react to it.

And so it is with you... we are in charge of our attitudes.

last will and testament

In the pocket of an old ragged coat belonging to an elderly man in Chicago, there was found, after his death, a will. According to Barbara Boyd, in the Washington Law Reporter, the man had been a lawyer, and the will was written in a firm clear hand on a few scraps of paper. So unusual was it, that it was sent to another attorney; and so impressed was he with its contents, that he read it before the Chicago Bar Association and a resolution was passed ordering it probated. It is now on the records of Cook County Illinois.

I, Charles Lounsberry, being of sound and disposing mind and memory, do hereby make and publish this my Last Will and Testament, in order, as justly as may be, to distribute my interests in the world among succeeding men.

That part of my interests which is known in law and recognized in the sheep-bound volumes as my property, being inconsiderable and of no account, I make no disposition of in this, my Will. My right to live, being but a life estate, is not at my disposal, but, these things excepted, all else in the world I now proceed to devise and bequeath.

ITEM: I give to good fathers and mothers, in trust to their children, all good little words of praise and encouragement, and all quaint pet names and endearments; and I charge said parents to use them justly, but generously, as the deeds of their children shall require.

ITEM: I leave to children inclusively, but only for the term of their childhood, all, and every, the flowers of the field, and the blossoms of the woods, with the right to play among them freely according to the custom of children, warning them at the same time against the thistles and the thorns. And I devise to the children the banks of the brooks and the golden sands beneath the waters thereof, and the odors of the willows that dip therein, and the white clouds that float high over the giant trees.

And I leave the children the long, long days to be merry in a thousand ways, and the night and the moon and the train of the Milky Way to wonder at, but subject, nevertheless, to the rights hereinafter given to lovers.

ITEM: I devise to boys jointly all the idle fields and commons where ball may be played, all pleasant waters where one may swim, all snow-clad hills where one may coast, and all streams and ponds where one may fish, or where, when grim winter comes, one may skate, to have and to hold the same for the period of their boyhood. And all meadows, with the clover-blossoms and butterflies thereof; the woods with their appurtenances; the squirrels and birds and echoes and strange noises, and all distant places, which may be visited, together with the adventures there to be found. And I give to said boys, each his own place at the fireside at night, with all pictures that may be seen in the burning wood, to enjoy without hindrance and without any incumbrance of care.

ITEM: To lovers, I devise their imaginary world, with whatever they may need, as the stars of the sky, the red roses by the wall, the bloom of the hawthorn, the sweet strains of music, and anything else they may desire to figure to each other the lastingness and beauty of their love.

ITEM: To young men jointly, I devise and bequeath all boisterous inspiring sports of rivalry, and I give to them the disdain of weakness and undaunted confidence in their own strength. Though they are rude, I leave them to the powers to make lasting friendships, and of possessing companions, and to them exclusively I give all merry songs and brave choruses to sing with lusty voices.

ITEM: And to those who are no longer children, or youths, or lovers, I leave memory, and bequeath to them the volumes of the poems of Burns and Shakespeare, and of other poets, if there be any, to the end that they may live the old days over again, freely and fully without tithe or diminution.

ITEM: To the loved ones with snowy crowns, I bequeath the happiness of old age, the love and gratitude of their children until they fall asleep.