|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 1 | Page : 209-210
Mondo: My first patient
Dhanalakshmi Thiyagarajan1, Michael Vitez2
1 Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA; Bicol Clinic, Bicol, Philippines
2 Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
|Date of Web Publication||7-Jul-2017|
Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA; Bicol Clinic, Bicol
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thiyagarajan D, Vitez M. Mondo: My first patient. Int J Acad Med 2017;3:209-10
At the age of 5, my parents took me to India. I still remember seeing families bathing in the river as others went to the bathroom nearby. I saw people lying on the dirt in their huts of straw, too sick to get up, and yet, there was nobody to take care of them. This was my first inspiration to become a physician. I always assumed they simply did not understand the importance of medical care or it was not available to them. I wanted to be the one to help them understand and to provide the care they needed and deserved.
At the age of 22, as a 1st-year medical student, I went on a medical mission trip to a remote part of the Philippines. I was so excited. I had such high hopes that I could change their world. What I did not expect was that one of my first patients, on my very first day, would change my world. Mondo changed my entire dream as well as my understanding of global medicine.
It was a hot, humid day in Bicol, a rural village. Just before lunch, I was asked to see Mondo, 84 years, who had acute stomach pain and a history of heart disease. His daughter discharged him from a government hospital after a 22-day stay because she had no faith in his care there. Having difficulty understanding his story, I was frustrated with the translator's lack of English. I immediately began to recognize the limitations of global medicine and the impediment of a language barrier.
Suddenly, Mondo started to have severe chest pain. He went limp and became unresponsive. Another medical student and I gave him sprays of nitroglycerin, but he only got worse. We were almost certain he was having a heart attack.
I expected us to immediately transport him to the emergency department of the closest hospital, but instead, we just lay him flat on the bed in the clinic room. I was shocked and enraged, and it was not even noon on my first day! Why weren't we sending him to the hospital? The clinic raises money and receives donations to help patients without asking for compensation. Therefore, we only have limited resources and could not immediately send individuals to the hospital. We did not even have an electrocardiography (EKG) machine!
An American doctor told us to follow the standard treatment for an acute myocardial infarction by giving him morphine, oxygen, nitroglycerin, and aspirin. As we monitored his vitals, Mondo began to vomit. We quickly turned him to his side and gave him antiemetics. With the clinic's limited resources, there was no way to prop him up and avoid the risk of choking on or aspirating his vomit.
A local Filipino doctor arrived and told the translator to remove Mondo's oxygen supply. I could not understand why a physician would allow this, but I was afraid to say anything. I was only a first-year medical student and already overwhelmed on my first day in the clinic. In no time, Mondo vomited again, started coughing, and had troubled breathing. We knew it - he had aspirated his vomit.
Finally, there was urgency. A doctor told us to rush Mondo to a hospital. I will never forget the experience of holding my patient's intravenous bag in one hand above his heart and holding on for dear life with my other hand as the jeepney careened around corners and down potholed rural roads.
We arrived at the emergency room of the newly built Sorsogon government hospital, which looked like a typical American hospital building. Mondo's EKG was inconclusive for an acute myocardial infarction. He needed to be intubated, but there was no ventilator available. If we wanted a ventilator, we would have to transfer him to the closest private hospital, but our little clinic and foundation had no funding for that. We could intubate him and manually bag him until a ventilator becomes available in a few days or give him fluids, oxygen and observe.
The physician in the hospital advised us to allow nature to take its course. That's when it hit me. I was afraid for Mondo, but I was also afraid for me! I was frightened by how my career as a physician would change me. Mondo was a living human being. I saw no alternative to providing him with the best care that he could receive in this limited-resource setting. Would there be a day when I would think a patient's life wasn't worth trying to save? I did not want to become like that.
We wanted to help him with what resources were available, so equipment and medicines to manually bag him were purchased. We requested Mondo be placed in the Intensive Care Unit for monitoring, but the physician refused, so he was placed in a general ward room. The next day, we returned to the hospital to see Mondo. He was in a stable condition. However, no physician checked on him the entire day. I was furious, but I was trying to be understanding of the patient being in a government hospital with limited resources.
The following day, Mondo was in terrible condition with tears pouring down his face as he remained unresponsive. I checked his vitals and noticed that Mondo's skin felt hot. Perhaps, he had pneumonia which would change his treatment plan. I asked the hospital physician, “Does the patient have a fever?” He responded with, “I am the doctor not a nurse. I don't check temperature.”
I could not go back the next day, but our clinic manager did. She was unable to see Mondo, but the hospital physician informed her that our patient was “doing well” on a mechanical ventilator. The following morning, my fifth day at the clinic, at 7 a.m., we received a phone call from Mondo's family. He was dead.
My world turned upside down hearing this. Mondo should have lived. That's when I understood the people that I would see on my trips to India. Mondo did not and could not have the standard of care of a first-world country because resources in the Philippines and other third-world countries are severely limited. His family was beyond grateful. They thanked us repeatedly for all the help and care that we provided.
I will never forget Mondo or what he taught me. I went on this mission trip believing I could talk with patients and help them understand the importance of visiting physicians. I expected to provide them with knowledge that would change their behaviors and give them quality medical care. I expected to change their world. However, Mondo taught me how hard it is to save even one person.
I heard a story once about a little girl walking along a beach where thousands of starfish had washed ashore during a storm. As she walked, she took each starfish she found and flung it back into the sea. I wanted to be like that little girl, saving the lost and desperate.
People on the beach laughed at that little girl throwing starfish back into the sea. One man said to her: “Little girl, there are thousands of dying starfish on this beach. You haven't even made a dent in them. Why even bother trying?” The girl was crushed. She looked at the whole beach and realized that the man was right. However, then, she looked down at the single starfish in front of her, flung it back into the sea, and said: “I made a difference to that one.”
Mondo made me face reality: I am one person. I cannot change an entire limited healthcare system abroad, but maybe, I can make a difference to one person's precious life while working toward fixing a flawed system. I can and will always work hard to help the patients abroad who are not as privileged as we are and do my best to save or change their lives.
Accounts of the starfish story end by saying that all the people on the beach were touched by the little girl's determination. They all joined her and began throwing starfish back into the ocean until all the starfish were saved. I may no longer believe that I alone can save the world, but I still believe that we can. We, especially as those living in a more privileged country, have an obligation to contribute to efforts of global medicine by donating money to worthy organizations and going abroad ourselves to help those who are not fortunate enough to have the healthcare that we have access to here. I share this in hopes of inspiring others to help me change the world with a million small steps. Throw back your starfish, and I will throw back mine, and together, we can make a difference.
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Conflicts of interest
There are no conflicts of interest.