When my son Dane texted me that my cousin Kuya Genie died, I felt not sadness but regret that I was not there when it happened. Do not get me wrong for it is not because I did not love my cousin that I did not feel the sadness usually associated with death. I can not deny the fact that there is something morbid and uncanny about death. In fact, the most harrowing experience any anesthesiologist can ever get through is patient's death on the operating table. The haunting memory would last forever.
I can still remember how my 13 year old "kuya" tried hard to revive our 3 year old brother but to no avail. Even though the latter had been fighting against a heart disease, his death left such an impact on me: the sight of my father beyond feigned composure breaking into sobs of regret and emotional pain, imparted on my young mind the dread of death.
But there is also something mystifying and liberating about death. I was 11 years old when I witnessed a death scene that gave me a different outlook on it. Except for few lucid intervals, "Inkong" suffered from memory loss which could be due to his stroke or Alzheimer's or both. Tall, handsome and aristocratic, I could not remember my strictly disciplinarian "Inkong" to be religious; but perhaps it was only because his brain had long been dilapidated by disease when we came to live with him. I was there when he breathed his last. Behind his labored breathing I could sense he came into one of his lucid moments; with glazed eyes fixed on the crucifix brought in front of him, he bent his head forward and put his pursed lips on the bleeding feet of the crucified image of Jesus Christ, then his facial muscles relaxed peacefully, his spastic limbs got limp and there was no more hunger for air. It was as if his ethereal body had been released from bondage.
I was there when Kuya Genie's father died from a long lingering disease. In between labored breathing his almost dilated pupils wandered as if they were looking for something or someone to fix them on. When Kuya Genie arrived from an errand, his father's eyes got fixed on the cross then he bent his head forward, pursed his lips to touch the feet of the crucified Jesus, then his body rested into an endless but calm slumber. We could not help but think of the significance of the yellow "mariposa" that emerged from out of nowhere and ceremoniously landed on the window's curtain. The atmosphere was serenely surreal.
Years after, Kuya Genie's mother fell and became comatose. She suffered from massive hemorrhagic stroke. With nil chance of survival at age 85, it was decided upon that she be brought home. All of us was at her bedside until her last breath. I could sense tranquility pervading in the air.
Kuya Genie was a jovial fellow with eternal smile planted not only on his lips but on his chinky eyes as well. There was not even a tinge of bad blood in him; everybody just gravitated to him. Then 3 years ago he got papillary thyroid cancer. His main worry was the post-surgical pain, but he believed when I told him managing his pain was my problem not his. He fought a good fight and won over the cancer cells. We were so thankful and elated but for whatever reason, his bone marrow got tired of producing red cells, white cells and platelets. Could it be due to radioactive iodine? He collapsed two years after his total thyroidectomy. Diagnostic workups revealed cirrhotic liver with a solitary nodule. Fine needle biopsy unearthed primary malignant cells in the liver (hepatocellular malignancy).
If it is inevitable that cancer would grow in your body, hepatoma should be among the last ones in your list. Kuya Genie told me he would not like to be subjected to another surgical procedure and/or treatment regimen. Maybe he had read somewhere that for his cirrhotic liver, simple resection would not suffice so a liver transplant was needed too. Would all the effort be worthwhile for his 65 year old diabetic body?
All the same he was enrolled to a case study on the latest innovation in the management of small sized hepatocellular carcinoma. Nevertheless, he still insisted on no treatment regimen. He averred that if this was how his life would end, he would willingly accept it without questions, without reservations. As if he had an alliance with God his platelet never went up to acceptable level. To appease his loyally devoted loving wife though, he dutifully took all the herbal concoctions that the latter painstakingly prepared for him. He lived for another year.
He had two pressing concerns: that he regretted not doing the things that he should have done when he had all the time to do it. He could have helped other people more. And of course, he had to face the one monster he dreaded the most: PAIN.
Kuya Genie, a certified food lover, had never tasted alcoholic beverage. He was somewhat devastated when he was advised to carve his food intake when he became diabetic years ago, but with malignant cells and cirrhosis overcrowding his shrinking liver cells, even the food he used to love did not water his palate anymore. As his obese body started to waste, his appetite became focused on family bonding. With his resounding phrase "this could be the last", he was able to attain this goal before he became bed ridden a month before his final adiue.
Ocean Park adventure could have been their last tryst around but his pathologic system forbid him to. If there was a need for confinement, he wanted it to be in their home in the custody of his loved ones. So I had to enter into the picture. Supported by both upper limbs planted on his sides in an effort to sit himself up, he struggled to show me he was okay. Such a brave front did not cover up the picture of a man with a belly more than the size of a full term woman's, breathing so fast as if he was being chased by a thousand lion. Definitely, nothing was okay with him. Just remove the pain, he begged of me. Yes it is my job to appease the pain...but only peri-operative pain. Unquestionably, it was not my job to give a medication that would send him peacefully to his death, as he had requested.
After the peritoneal fluid was excreted out, I could almost visualize where and how the huge stone-hard abdominal tumor had encroached and invaded its vicinity. Was I after all just prolonging his agony? Anyway, with the abdominal load gone and with the euphoric effect of Oxycontin, he started musing about visiting his mother-in-law in Pampanga, celebrating his birthday a week hence, and even boldly looking forward to our previously planned post-Christmas vacation in Dingalan. He even started humming the songs that he sang a month ago in our 2-day videoke sessions in Tagaytay. Deep in my heart I knew the syndrome of assorted ill feelings correlated with hepatoma still lingered on, but any feeling of doom was assuaged by the incessant presence of his family near him: holding his hands, gently stroking him. His five other living siblings were always at his bedside: two of them came all the way from Baler Aurora. Even the best HOSPICE care in the land could never be better than that.
Although there was already altered consciousness, I had to fulfill my vow to remove the pain. It must be a peaceful death but still I did not want to be an instrument in making it sooner than what was destined. With epidural morphine laced with low concentration of local anesthetic and intravenous infusion of low dose Tramadol, fingers crossed in prayers, I fervently hoped for a tranquil crossing over of Kuya Genie's spirit.
Kuya Genie chose to do that in presence of his only son Jerome.
WISH YOU WRITE A BOOK DRA. YOU WRITE SO CLEARLY.
ReplyDeleteSalamat Fely. God's gift has to be shared. I just do not know on what topic...maybe someday.
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