Larry's Transplant And What Happened Afterwards

There is nothing routine about surgery and that is a given. It doesn't matter how skilled the surgeon is and how many he or she has done, you can never predict the outcome. Every patient reacts differently to the procedure. You hope that everything comes out well with minimal or no complications.

                Thursday mid-morning, which was about 1:30 a.m. in the Philippines, I got a text message from Ninette. I had been waiting for an update about Larry’s kidney transplant but didn't expect it that late, so it must have been urgent. I called her back and Ninette’s sister Tika answered. I don’t exactly recall the chronology of events as related to me by Pica, but she told me that Larry had complained about having difficulty urinating and they found out that a blood clot was blocking the urethra. While the surgeon was taking care of that problem, it was discovered that Larry had some bleeding from an unknown source and had to be rushed back to the operating room. This is where it gets confusing to me. As I understand it, when Larry’s anesthesia wore out in the recovery room, he woke up confused and started tearing out his IV lines and whatever else was attached to him. Because of this, the nephrologist thinks that the donated kidney from Ninette might have been traumatized that it would take longer for the graft to heal. The surgeon later informed Ninette that when they were taking care of the bleeding, they noticed some unidentifiable fluids which was not blood. Could it be leftover bile from Larry’s gall bladder which was also taken out at the same time as the kidney transplant?

                Larry was then sent to the ICU after the bleeding was stopped and was kept sedated. An endotracheal tube has remained in place and at that time he was considered to be in stable/critical condition, which sounds like an oxymoron. I hardly slept that night worrying about his condition. I received another text message Friday morning requesting me to call. This time I was able to talk to Ninette and she said Larry needed more blood transfusions plus dialysis because the electrolytes weren't clearing fast enough even though the new kidney was already producing adequate urine. Otherwise he was more mentally alert. That was a brief relief which enabled me to pass out Friday night and sleep till early Saturday morning. When I turned on my phone, there was a text message from 4 hours earlier. I immediately called back and Ninette said that during Larry’s dialysis, his blood pressure dropped to 80/60 so they had to stop. He was also having tachycardia (rapid pulse) going up to between 160 to 180 beats per minute. To add to that, he had developed a slight fever, which in his immunocompromised state is not good news. Remember he had to take a lot of immunosuppressant medications prior to surgery to lessen the possibility of rejecting then donated kidney. However, his doctor said that using signals, Larry had asked him how the new kidney was doing. The doctor told him that it was working, which apparently brought tears to his eyes.

                Ninette appears to be recovering quite well physically. She had been allowed to sit up in bed the day after the surgery. But of course she is experiencing a lot of emotional duress due to Larry’s condition. To make it worse, she couldn’t visit Larry in ICU because she had developed a cold. I continue admire her for her love and courage despite what is happening. In case you don't already know, she donated one of her kidneys to Larry.

The last six months or so, I was concerned about my brother ever since he said he had end stage renal disease, but only in these past few days that I've worried so much because of the challenges for Larry which keep on popping up. Just like last year with Mama before she died, I dread every phone call, text message or email that comes bearing news of another setback. I have to remain positive for my brother because if he is fighting, the least I can do is keep myself together. It's just a helpless feeling. You want to solve it but you can't. In my mind, I keep on exhorting Larry to keep fighting, hoping that mental telepathy works with prayer. Otherwise, what else can you do except trust the medical staff to do their job in trying to make him well? Larry has already made so many major lifestyle changes so he could qualify for this transplant and it seems unfair that he has to go through these complications. It makes me scared to think what else is coming around the bend. I’m hoping for better news at the next update. Please…
          Newsflash 7/28/13 8:47 A.M. : Robynne, Larry's niece just posted an update on Facebook which I'm copying and pasting here: Hi everybody. Ninong is doing so much better today. The slight fever he had yesterday is now gone, his BP is back to normal, he is responding really well everytime they lower the pressure on his ventilator, although his heart rate is still irregular, it is not zooming up anymore. If he continues to respond well to the doctors lowering the pressure on the ventilator, they will take it out tomorrow morning and he will be out of the ICU in the afternoon and if he stable after that. His new kidney is doing well too. Thank you so much for all the prayers you have been offering for him. My family and I cannot even begin to express how grateful we are. Please do continue to pray for him. Thank you again!
Also, I know that he is feeling better because he already did a silly face out of nowhere when I visited him earlier in the ICU and nodded like there is no tomorrow when I asked him if he is bored .

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ESRD and The Younger Brother I Admire

          Now that my brother Larry has decided to make his condition public via a new blog he started (ikidney.blogspot.com), I feel that I am free to disclose it as well, though with a heavy heart.
          It was with much surprise last month when my sister in law informed me that my brother was in the hospital. After all, last time I saw him, he didn't exhibit anything that would show he was sick. Yet there he was, confined at the National Kidney Institute in the Philippines. I've always tried to avoid asking him about his health because I assumed that if there was something wrong with him, he would take care of it with the help of my sister in law. It was already bad enough that people who haven't seen him in awhile always mentioned his weight so I didn't want to be impolite and add to what my brother was already aware of. With his weight and our family history, I already suspected that he might have high blood pressure and diabetes, but I was confident that he was at least keeping those under control. So when I was informed that his kidney function was down to 5% and he needed a blood transfusion plus regular kidney dialysis for the duration, it was shocking news to say the least. The first questions in my mind were what was the rate of survival and is he still able to produce urine. Next question was what other alternatives he had other than hemodialysis.
          While my sister in law Ninette gave me updates via email and MagicJack calls, I really didn't grasp the severity of the problem until Larry started writing about it. I have a tendency to be stoic which most times comes off as being cold, detached, and unfeeling, so my initial response is to get the facts and try to digest them objectively even though it involves loved ones. That was the same way I responded to my mother's illness. But when I read it from Larry's own perspective, the cold reality started to hit hard. Life has thrown another curve at our family. As his doctor has told him in no uncertain terms, it's dialysis or death.
          I may be older than Larry by five years but I admire him because of what he has accomplished despite inauspicious beginnings. With my parents, he survived the 1974 conflagration of Jolo. But like me, he had troubles adjusting to life in college in Manila while away from our parents, however he was able to surmount that. After that initial bump in the road, everything seemed to have worked well from college in Western Mindanao State University, Masters in the University of the Philippines, working in Zamboanga, then Xavier High School in Metro Manila in the last decade or so, most recently as a New Technology teacher. He was also able to do some extensive traveling with Ninette which is something I've never been able to do due to financial constraints. I also admire him because he inherited the public relations skills of my father and the compassion of my mother. This is not to discount my admiration for my sister-in-law who has a Ph.D. in Mathematics.
          Since I moved to the U.S. in 1980, my brother and I were in touch infrequently and because of our age difference, I was already gone from home when he was just 10 years old, so the normal close bonding between siblings didn't really materialize, which is regretful now. It was only during last year's visit to Zamboanga in the last days of our mother that we achieved that connection in the short time we were together. There, I learned how to appreciate him more for being someone you can confidently rely on. Mama had the perfect idea when she said it was one of her last wishes.
          Now, Larry is facing this challenging new journey in dealing with end stage renal disease. The cold hard fact is that with dialysis, the usual life span is 4 to 5 years, so the better option is to find a kidney donor. With the abundance of her love for my brother, Ninette has offered one of her kidneys. This is something that is being explored at the moment and we can only hope and pray that it plays out and works out well for both of them. So with strength and determination, Larry and Ninette are forging ahead together.
          Hey, here's a message to you Bro: I love you and you've got to outlive me because after all you are the sole beneficiary of my assets now that Mama is gone, so you better get well despite the odds, okay? I'm not sure if that's a proper message to send but that's just my irreverence talking again as a defense mechanism.

The Zamboanga Chronicles

I went to Zamboanga City, Philippines at the end of August to see my mother and brother and to face end-of-life issues, and came back to the U.S. two weeks later. This is a compilation of my posts about that trip. Some of them, I can't bear to read again because they are too emotional for me. I hope some of you who have dealt with the similar situation can appreciate how that feels. Thank you.

A Zamboanga Trip To Visit Mama

Pilar Nono De Las Penas - A Eulogy

The rest that follow are more or less chronological.

Los Angeles To Incheon To Manila

Manila To Zamboanga

Momsie In Weemsie In Zamboanga City

Zamboanga - The First Day: A Day of Two Reunions

Sunday - A Fateful Decision Day

Walkabouts In Zamboanga

Searching For Tramadol To Supplement Morphine

Missing Caregiver, Irene Hassan, Ateneo High School and Zamboanga Malls

Pilar's Last Days

Setting The Funeral Wheels In Motion

Returning To Los Angeles From Zamboanga

These last two are just random thoughts that were not addressed in the previous posts.

Random Thoughts About Zamboanga - Part 1

Random Thoughts About Zamboanga - Part 2

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Returning To Los Angeles From Zamboanga

Goodbye #59 Pilar St. - My home for two weeks.

(Cue music: J. Cole’s “I’m Coming Home”)

Thinking back to the night before I left Zamboanga City, I am hoping we had met all our dear Mama’s wishes before she died. I can’t think of anything we missed so I’m comfortable in thinking that we had done all she asked for in her last days and the few days that followed. Would you believe that a couple of years ago, Mama told me her goal was to reach at least the age of 80? Well, she planned that perfectly too. Incidentally, that happens to be my goal also. That evening, Larry and I invited the Pabellon and Tupaz families to dinner at the Grand Astoria Hotel Lotus Restaurant. Other than the children, this was the same group that planned Operation Pilar two weeks before and executed the plan to a T. As I mentioned before, these two families were the source of moral, emotional, spiritual, and physical support of Mama in our absence. We cannot thank them enough for what they have done to help Mama the past few years and especially the last few months, when the demands of her illness most likely also put a strain on those two families. We will owe them a debt of gratitude forever.

Dark and early Thursday morning, it was time to catch my 6:45 flight from Zamboanga to Manila. The compulsiveness to exercise will have to be satisfied later in the airport terminal hallways. Larry drove me to the airport taking a slightly circuitous route along Cawa-Cawa Boulevard. If I only knew that going all the way down Governor Lim Avenue took me to the seaside boulevard, I would have made that one of my exercise destinations too. Maybe if I ever make it back to Zamboanga, I’ll be able to run or walk along Cawa-Cawa. Larry dropped me off at the airport and and I felt sad as we hugged each other goodbye. He was staying a day or two more to tie up any loose ends. I was left to fend for myself one more time. You won’t, and I can’t believe how much dependent I had become on other people in the two short weeks I was there. Taken out of my element, I had become helpless and useless in Zamboanga.

Pretty soon Airphil Express departed Zamboanga City and landed in NAIA (Ninoy Aquino International Airport) Terminal 3. I had plenty of time to make it to Terminal 1 as I had a four hour layover. I asked an airport worker and a desk police officer where I could catch the shuttle bus. They pointed me to a certain direction. I went there and boarded the bus which left quickly because I filled the last seat. During my arrival a couple of weeks before, I had taken the shuttle from Terminal I to Terminal 3 without any problems. A few minutes into the trip, I noticed that we appeared to be going farther away from the airport so I asked my seatmate where the bus was heading to. She said Baclaran. Oops, that’s not where I wanted to go so I approached the driver to make sure. Sure enough the bus was heading downtown, so I quickly jumped off. How was I to know there where two kinds of shuttle service (one that went around three terminals and one that took you downtown)? I hailed a taxicab and asked to driver to take me to Terminal 1 where I was supposed to fly on Korean Airlines back to Incheon and L.A. I requested the driver to please turn on his meter since he hadn’t in the few seconds I was in the back seat. He started a conversation about his missed opportunity to move to Italy a few years back. Without being too specific, I told him why I was in the Philippines. Thankfully, the conversation was short because I had not been dropped by the shuttle bus too far away from NAIA. It was an 85 peso taxi ride (about $2.00).

I entered Terminal 1 and looked around for the Korean Airlines counters. Owing to my disorientation, I lined up behind a couple of people not noticing that one of them was in a wheelchair. Another oops because this was the handicapped line and I was redirected by an airport worker to the proper line. After checking in, I headed to the nearest money changer and except for a few hundred pesos for the terminal fee (550 pesos) and in case I had to buy food, I exchanged everything back to dollars. It was about that time that Leonard called and offered condolences. He only heard about Mama’s passing that morning via Facebook (the same way he heard I arrived in Zamboanga two weeks before). We chatted briefly and wished each other well. He said he may visit the U.S. again soon.

After that, I queued in the Immigration line and when I got to the counter, the lady asked me if I had changed the spelling of my last name because it didn’t appear in their database.. I said that when I became a U.S. citizen, I connected all the letters of my last name. I was then cleared to enter the departure area. I walked past the duty free stores and snack concessions and found my way to the Korean Airlines gate. I had about 2 hours to kill so I went back up front to get some food. I ate some overpriced arroz caldo with tough to bite chicken leg and a siopao. With still more time to kill, I decided to put in my walking workout by traipsing up and down a long hallway between the concession stands and the departure gate. Each way took about a minute and 15 seconds so you can do the multiplication on how many laps I had to take to finish 35 minutes. As usual, I was pulling my luggage while walking, just like I did at Incheon and Terminal 3 a few weeks before. The airport workers who were at their permanent posts were probably thinking how crazy I was (they were not completely wrong). At least I was able to satisfy my obligation to my body for the day and not miss a workout.

I don't know exactly what this was but it appeared like people depicting a wedding party was walking through Incheon Airport

The three hour flight from Manila to Incheon was pretty uneventful other than an old lady behind me getting mad at me for reclining my chair too far back which almost spilled water on her. I tried to get some zzz’s to no avail. I initially had the row of three seats all to myself until a man transferred from his more crowded row to take the window seat in mine. We had a couple of hours layover in Incheon so I connected to their wi-fi to check email and Facebook. I was out of cellphone range with either my U.S. Virgin Mobile service or Philippines SMART service so when the flight from Incheon to L.A. was delayed almost an hour, I had no way of contacting my neighbor who was supposed to pick me up at the airport. Since she works for Southwest Airways, I was hoping she was tracking my flight online. With that delay, I got a little peckish so I looked around the airport and found something familiar: Subway sandwiches. First I asked if they accepted dollars and how much the tuna sandwich was. The half sub size was $4.00 which I think would be similar to the U.S. price.  At least the Koreans did not overcharge, not like the 10 plus dollars hotdog, chips, and soda I got at LAX.

Before we boarded the plane to L.A., we went through another security check and this was probably because it was the anniversary of 9-11 and also because of the killing of the diplomat in Syria. This was slightly more rigorous since the x-ray machine wasn’t used but rather, security people opened our bags. Having passed that, we left rainy South Korea. Another 12 hour endurance event for the buttocks stuck in a 36 inch wide seat. At least that was better than the 32 inch seat of domestic planes. Speaking of buttocks, I noticed that despite the downsizing of toilet paper through the years in the U.S. the Koreans still appeared to have full sized ones. Or maybe the TP just looked bigger because the plane lavatories were too small. While the majority of passengers went to sleep between meals, my mind was constantly turning on and off, thus denying me the pleasure that others were too glad to partake of. Lack of sleep would be my norm to this day regardless of airplane seat or my own bed. My sleep patterns have been majorly destabilized.

When we arrived in LAX, we had to take a shuttle bus from where the plane dropped us off to the main terminal which was about a couple of miles away. Interesting twist there. While still on the plane, I texted my neighbor Colleen that we just landed and when I was at the Customs line she texted back that she was circling the airport while waiting for me. Fortunately, Customs didn’t hold me up and was soon waiting for Colleen outside the arrival area. While waiting there,  a lady asked to borrow my cell phone to call her daughter. They spoke in a language I didn’t understand. Was I happy to see Colleen and her son Kenny driving up. Finally, something and someone very familiar. I was back home. (Cue music: Randy Newman’s “I Love L.A.”)

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Setting The Funeral Wheels In Motion

Minutes following Mama’s passing, Kuya Vic, Ate Chit, Caloy, Madie, and I gathered around and contemplated our next move. Vic called La Merced Funeral Parlor to consult with them what to do next. We then went to La Merced and told the person in charge that we needed to transfer Mama to their facility. He summoned another worker and they brought a guerney to their truck and followed us home. There, they transferred Mama on the guerney and took her back to the funeral parlor with me riding shotgun. Mama was placed in a room next to the embalming area. I guess they had some regulation that required them to wait a certain number of hours before they can start the embalming process. Someone mentioned that it was to make sure there was no spontaneous resurrection. Caregiver Neneng and helper Andrea arrived at about 3 a.m. to keep watch over Mama while I went home to contact my supervisor and rebook my flights. Kuya Vic mentioned earlier that it was important to keep watch because there have been instances in the past where organs were harvested illegally. The ubiquitous stray dog(s) was also seen hanging around the funeral parlor so that was another cause for concern in case their hunger got the better of them. Sorry about being so morbid here. In the meantime the Pabellons and Tupazes gathered information on the proper paperwork to fill out and submit to authorities regarding Mama’s death. Nothing else could be done until after 8 a.m. that morning.

Sending an email to my supervisor wasn’t a problem. My Cebu Pacific Airlines ticket wasn’t refundable or rebookable so that was as good as lost. Scouring the Korean Airlines website, I didn’t find a page which allowed me to rebook. Instead, a message popped up saying that the Philippine government does not allow online booking for international flights. I had to find the Manila phone number of Korean Airlines and promptly gave them a call. Telling them my situation, they were able to rebook me for Thursday with the same schedule as my Monday flight. Just after the rebooking was confirmed, the load on my cell phone ran out! Thankfully I already received the confirmation number, although I was still doubtful. It wasn’t until a few hours later that I felt reassured, when an email confirmation with a new eticket arrived.

I returned to La Merced at about 7 a.m. to relieve Neneng while awaiting the arrival of Larry. The other caregiver – Joanna arrived shortly to join Andrea and I. I was relieved to see Larry walking down the hallway towards us. Together we went to look at Mama. Quiet prayers were said, then Mama was taken to the embalming room. Larry and I went to the office to find out options for visitation rooms and caskets and that was taken cared of at that time. Caloy and Madie arrived with a government social worker who came to verify the demise of Mama so that a medical officer could issue a death certificate. The Pabellons came shortly and together with Larry, we picked a casket for Mama based on her prior instructions. Then they had to leave to follow up with more paperwork. Larry said he even had to obtain a cedula. I added some load to my cell phone at a store across the funeral parlor, then a chain of text messages was sent around to relatives and friends regarding Mama’s passing and Uncle Dante and Auntie Lita came by the funeral parlor to join us.

After the embalming process, Mama was dressed in the clothes that were chosen two days before, then placed in the casket. Initially, the workers brought the wrong casket, so we had to show them the one we picked. Mama was then brought upstairs to an air conditioned visitation room (only one of two, I think). By afternoon, flowers and visitors began to trickle in. The chain of text messages had done its job.

We had decided beforehand that the visitation would only be two days so the burial was scheduled for Wednesday afternoon. Prayers and masses were arranged, the details of which were pretty much a blur to me by that time because I hadn’t slept in more than 24 hours. I just assented to what people were telling me. About 9 p.m., as Ate Chit was saying something, I felt dizzy and had to excuse myself to go home. As usual, I didn’t sleep well despite my exhaustion.

I managed to do my walking workout on Tuesday morning after which I humped it all the way back to La Merced (running and walking) because I was running late, and I had told Larry beforehand that I would be back by 8 a.m. to relieve him. I was running low on pesos but found a money changer nearby which was also a booking agent for Airphil Express Airlines. That took care of two things at once and saved me time. Visitors came and went thru late Tuesday evening. I met relatives and family friends whom I haven’t seen in years or met for the first time, and got phone calls and text messages from the rest who were not in Zamboanga. Thank you all for your condolences and offerings of prayers.

I left briefly and went home to get a small pillow and my earplugs because I planned on staying at La Merced that night. It was Larry’s turn to get some shuteye  at the apartment, but he stayed with us that night too. So it was Larry, Neneng, Mary Cate, Andrea, Erning’s family (sorry I forgot your names), and I who stayed overnight with Mama.  We secured the visitation room door, barring the two handles with an umbrella just like Larry did the night before, then took turns sleeping on the pews.

When I awoke at 5 a.m. Wednesday, Larry was already up. It was raining outside and I had no raingear. I also only had one pair of running shoes which I also wore for the rest of the day. I couldn’t get those wet because I had to wear them for the funeral later that day, so I mentally prepared myself to missing my first workout in 30 odd years. Then I started walking in my slide sandals, doing laps around the second floor of the funeral parlor and pretty soon added the stairs (only one flight though) until I reached my requisite 30 minutes, then added 2 more for good measure. My exercise streak lives on! If it was still a running streak, I'm not sure if I would have been able to continue it since running inside a funeral parlor seemed inappropriate.

I went home for a quick shower then returned to La Merced bringing the clothes I brought from the U.S.  for this particular purpose. Even though anticipating the death of a loved one is difficult to think about, and of course you don’t want it to happen, I still had to be realistic based on reports I received before travelling back to Zamboanga.

Prayers led by the Mother Butler group

Hours passed, relatives and friends came, a rosary was recited and pretty soon, it was time to transport Mama to St. Joseph’s Cathedral for the funeral mass. Remember I said I thought I may not be seeing my Notre Dame classmates again real soon? Well, some of them showed up that day too. I can’t say much about the funeral mass because it was another moment of blur for me.

Funeral Mass at St. Joseph's Cathedral

 The video that our cousin in law took pretty much portrayed what happened accurately. Thanks again Boni Salinas. I shall post that video again below. We were transported to Forest Lake Cemetery after the mass where I saw Papa’s burial site for the first time since I attended his funeral. I thought that happened 11 years ago and I was grossly mistaken when I saw his headstone dated 13 years prior. Brief services and blessings were conducted and Mama’s casket was soon lain on top of Papa’s.

While the workers covered up the grave, snacks were passed around to the attendees (thanks to Ate Chit for taking care of this). They were purchased from and delivered by KFC (yes, folks – Kentucky Fried Chicken). Mama would have been smiling about that blend of Filipino tradition and American commerce.

Goodbye Mama. We Love You Very Much. Thanks For Everything You Have Given Us.

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Pilar’s Last Days

Uncle Dante and Auntie Lita

Mama hardly said anything if at all from Friday through Sunday even though visitors came in and out through the day.  Uncle Dante and Auntie Lita were there every day. Others who came to visit were baby Annika and her mom, Carmela Marfil, Leonardo Wee, Irene Hassan, Vic and Chit Pabellon, the Mother Butler group, Caloy, Madie, and their children of course, who just lived upstairs, and other people who escape my mind now, so please forgive me if I forgot to mention you.

Annika - Apo sa tuhod

We purchased a bulb syringe to try to clear Mama’s throat of phlegm or saliva when she started choking from drinking fluids. She was also having difficulty swallowing by this time and took all her energy just to sip water from a straw when taking her medications. Because of the heat and humidity, the caregivers changed her clothes frequently which was no easy matter because these were house dresses and not hospital gowns. Under the circumstances, we did our best to keep Mama as comfortable as possible.

Mama was on oxygen by nasal cannula all day and night. By Friday, the oxygen was running low and Caloy with his trusty handyman, Erning found a wrench in case we had to switch the regulator from one oxygen bottle to a backup one if the delivery of a new bottle didn’t come on time. It turns out that the regulator came with its own wrench as Larry told us. We just had to find the box it came in. I tried transferring the regulator to the backup bottle but heard some hissing indicating a leak. Fortunately, the oxygen company delivery guy came shortly and showed us how to detect a leak by using soap bubbles. It turns out, I only had to put more muscle into it to tighten the valve. Well, we can always learn something new every day, can’t we?

With Madie and Ate Chit present on Saturday, they went through Mama’s dresses to pick out what she would wear at the end. They knew Mama’s preferences very well and picked out a pretty cream colored ensemble that Mama would have approved of.

With Notre Dame classmates at Palmeras Restaurant on Notre Dame day.

I had to leave Mama for a couple of hours Saturday night because my Notre Dame of Jolo classmates invited me to dinner at Palmeras Restaurant. It was going to be a mini reunion on Notre Dame Day!  Mimi and her son picked me up and we encountered the worst evening traffic on the way. The car could barely move at the corner of Nunez Street and Governor Alvarez Avenue. What normally would have taken 10 minutes took half an hour. The same group that met me at Amil’s the week before was there minus Nayda, but plus Delia and Fatmawati. Earlier in the day, Delia sent mangosteen, homemade durian preserve, native organic Jolo coffee, and itlug payukan (I will not translate that last one because it’s supposed to be illegal obtaining them anymore), to Mama’s apartment. We had Japanese cuisine that evening which I offered to pay for but my classmates declined again. An equivalent of less than 75 dollars fed 10 people Japanese food with much left for doggie bags! A great time was had by all but we had to say our goodbyes pretty soon. People don’t spend too many late nights out in that city. I thought it would be a few years before I would see my classmates again.

I was driven home by Mimi and her son after dropping off Delia at her hotel. I checked on Mama and the caregiver said she hadn’t complained of any pain while I was gone so I was relieved to hear that.

Sunday, I was out for my early morning walk again then attended mass at St. Joseph’s cathedral, where I saw Mama’s doctor with her family up front. On my way back home I stopped by Morning Sun Satti House to say goodbye to Solomon because I was leaving early Monday morning. I invited the Tupaz family to lunch and we went to Lantaka Hotel’s Sunday smorgasbord after they went to mass at 11 a.m.

A view from Lantaka Hotel showing the Port of Zamboanga and Santa Cruz Island beyond

When we returned home, the morning shift caregiver – Joanna reported that she was concerned about Mama’s low blood pressure so we monitored that closely through the day. It went as low as 70/40 which was cause for much concern even though Mama’s pulse was strong and constantly in the 100 to 110 range. When Joanna got that low reading she burst into tears. I rechecked it and it was similar even though I got 82 for the systolic. We couldn’t really do anything about it. Mama was having what is called fluid volume deficit due to lack of fluid intake, not to mention food. I told her to hang on and that I was leaving the next day to go back to the States, and that Larry will be with her in a few days time. But I had a feeling at that point that Mama wasn’t going to let me get off that easy in leaving Zamboanga. I can only imagine what she was thinking (“oh no you’re not!”). So I made a mental checklist of what I had to do if the inevitable happened while I was still there. Since arrangements for Mama were already done, all I had to do was contact my work supervisor via email in case I had to extend my leave, and rebook my flights. I also made a backup plan for Auntie Beth in California to call my supervisor in case she doesn’t get my email over the weekend. As for Mama, we can only monitor her. Because of her difficulty swallowing, I told the caregivers to hold all her maintenance medications because those were inconsequential at that point. Basically they were blood pressure and acid reflux medications plus multivitamins. Her blood pressure was already too low and there was no acid reflux because she wasn’t eating. She had to reserve all her energy to take the pain medications because that was all that mattered now.

I tried going to sleep but because of the situation, I couldn’t. I expected a phone call or text message to come at any time, and it did at 1 a.m. The text message from Neneng just said “sir Noel”. I rushed to Mama’s apartment and saw that she had started gasping for breath. It was no longer the usual the respiratory pattern I had observed consistently during the past week that I had been there. I held her hand, felt for her pulse with the other and detected that her pulse rate had slowed down considerably. I whispered to her that we loved her and that it was okay to let go and to say hello to Papa for us. Part of me felt like getting a panic attack and getting out of there to avoid the situation. In Mama’s last few moments, I prayed to God to help her go peacefully and to give me the strength to handle the situation and not freak out. Thank you God for being so accommodating. Drawing one last deep breath, Mama left the earthy world and to her Maker’s hands, also reuniting with Papa, no doubt. The date was September 10, 2012, 1:05 a.m.

I called and woke Larry up a few minutes later and told him our Mama was gone, and he prepared to return to Zamboanga on the next available morning flight.

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Searching For Tramadol To Supplement Morphine

Mama went home Tuesday, September 4th

(*** This is a long post so please bear with me)

After consulting with Mama’s primary care physician and infection control specialist on Sunday and Monday, Larry and I decided to ask them to discharge Mama on Tuesday. For some reason, she was quite cranky on Sunday (Sept. 2) and even told some visitors to please be quiet or leave so she can rest. She said “Puwede ba umalis na kayo para makatulog ako?” Maybe because she was in pain earlier in the day and was finally started on Morphine tablets. Previously, she was only taking Tramadol (Ultram). When Larry arrived on Saturday night, she was still able to sit up on the chair and use the bedside commode. However by Sunday, she stopped doing so. I don’t know that was her way to finally giving in because we fulfilled her wish for us to be together, or not. When the Morphine finally caught up with her on Monday, she slept most of the day and said no to every treatment and food offered. Her doctor ordered a nasogastric tube for feeding but she refused, even after Larry had already bought the equipment.

Monday was a very busy day for Larry as he had to check on Mama’s burial plot, memorial plan, and mass services, among other things. I was so relieved that Larry was around because he knew his way around Zamboanga. I was pretty much useless and helpless in that regard so I just stayed in the hospital and let him do his thing unencumbered.

 By Monday night, upon learning of her possible discharge the next day, Mama started taking fluids orally again, and by Tuesday morning she bounced back, was in positive spirits, and started eating again. She actually asked for arroz caldo (a rice soup with chicken and ginger) for lunch and told me to get it from a restaurant across the street called A Taste of Asia (ATOA). Well, I’ll be darned. I was looking for the same thing a couple of days back because I felt I needed more fluids. We didn’t know where to find it and opted for a different kind of soup instead. Larry and I should have asked Mama first.

Tuesday was discharge day. Larry took care of the hospital bill and gave me an exit pass to show to the security guard on our way out. He then went back home to borrow the Tupaz’s car to transport Mama back home. With all the personal belongings that had accumulated in the hospital room, we were thankful for the presence of a few Mother Butler friends of Mama who helped us carry them to the car. An orderly came by the room with a wheelchair to move Mama to the parking lot. When we got to the elevator, a potential disaster came up. I had lost the exit pass! Thankfully, the orderly saw it on the elevator floor. I must have dropped it in the frenzy. We then headed to the rear parking lot of the hospital where Larry was waiting with the car. With remarkable strength and despite turning his ankle earlier that day, Larry transferred Mama from the wheelchair to the front passenger seat. We were on our way home and fulfilled another of Mama’s wishes. When we got home, Caloy got a wheelchair and Mama was wheeled into her apartment with Larry and I lifting the wheelchair from the front and behind, the two steps up and into the door. Earlier in the day, Larry and Madie had rearranged Mama’s room and moved the bed to the middle to accommodate an oxygen tank and so that the caregiver and helper could more easily assist her. Not too long after Mama had settled in bed, Larry had the unenviable task of telling her that he had to leave that evening for Manila, but reassured her that he would be back the following week. I was saddened to see him go later but I had to be resolute for Mama’s sake. After all, Larry was just a phone call or text message away if I needed his advice.

Early Tuesday evening, Mama’s appetite continued and asked for Chow King noodle soup. Well, the helper was new to the area and I didn’t know any better where to find the nearest Chow King. Thankfully, Neneng, the caregiver came to the rescue. She arrived for her shift and found a Chow King nearby. She fed Mama the noodles that evening. That may have been the last time that Mama ate a solid meal fairly well because on the days that followed she no longer had any cravings. She subsisted mainly on small portions of Prosure which Larry brought from Manila.

I don’t know if Mama ate too much solid food that day more than she can tolerate, because by mid-evening she was complaining of severe abdominal pain. The doctor hadn’t reordered the Tramadol and the Morphine wasn’t tamping down the pain. It was difficult to see her suffering and probably due to the extreme pain, even accused us of making fun of her.  We had to do something to help her. I asked Neneng what medications Mama had available and we found Rivotril (Clonazepam or Klonopin in the U.S.) which is an anti anxiety medication, but ordered by the doctor to help Mama sleep before her hospitalization. I asked the caregiver to give it to Mama in addition to her night dose of Morphine and we were relieved that it worked in taking the pain away for the rest of the night.

 I planned on seeing her doctor at the clinic the next day to reorder the Tramadol so Mama could have round the clock coverage for her pain medications. That was the least we could do for her. The doctor did reorder the Tramadol but I had a difficult time finding it in a couple of drugstores. The third one I went to only had a limited supply and it was days later when I found more at another drugstore.

 The doctor also said that if the Morphine doesn’t work initially and Mama was still in pain before the next dose of any pain medication, we could split a Morphine pill and give it to her as a rescue or emergency dose. Oh boy did we need that rescue dose later that day because Mama complained of extreme pain again mid-afternoon Wednesday. We were about to give her the half pill rescue dose but couldn’t find a pill splitter. The Morphine wasn’t even scored in the middle. Madie resorted to using a regular kitchen knife to cut the pill in two and Mama promptly received the half dose. We were hoping that the pain would finally go away but it didn’t. Mama was still in agony. So much so that she asked for more painkillers and said she would take responsibility for the consequences because she didn’t want to die in pain. According to her “ako na ang bahala”. None of us present at the time should be making decisions normally made by a physician or give a medication other than how the doctor prescribed it. But Mama was suffering too much, so with much reservation I asked the caregiver to give her the other half of the pill, hoping it would not O’D her. That was a very tough decision to make. I planned on seeing the doctor the next day again to ask for a faster acting Morphine, perhaps in liquid form which would also help because Mama was also starting to have difficulty swallowing. Thankfully the second half pill worked and Mama’s pain was relieved for the rest of the day.

A short anecdote before I continue. When I returned to Mama’s apartment after seeing the doctor, she told me her PLDT (telephone) bill arrived and I should pay it at Union Bank across the street. I saw the bill and noticed that there were several places that you can submit payment. Mama insisted that I just cross the street to pay the bill and even told me exactly how much it was. She was right, of course. She may have been under the influence of painkillers but her memory was still stunningly intact.

Still other things happened that Wednesday but this post is too long already so I shall continue some other time.

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Sunday - A Fateful Decision Day

Sunday Morning with Mama

After all the visitors left on Saturday night, Larry and I stayed in the hospital until visiting hours were over at 10 p.m. We went back to the apartment and for the first time since 1973 when I was 15 and he was 10, we were roommates again. I was too tired to do anything else so while he tinkered with his newly bought 3G (I’m guessing) internet connection dongle, I went to sleep right away amid 3 chihuahuas yapping away outside. The nightly yapping was going to be the norm for the duration of our stay.

 I woke up at the usual 3 a.m. and just tossed and turned in bed while my brother snored away. Just like the previous day, I was out the door for my workout by 5:30 and this time I was determined to reach Western Mindanao Medical Center (WMMC) by foot. I started walking in the right direction that morning and pretty soon started jogging. The sidewalks are small in this city and sometimes you have to step off due to an electric post blocking the way, but at the same time dodge vehicles on the street in addition to ubiquitous stray dogs and their resultant poop. I made it all the way to the hospital, went upstairs to Mama’s room, saw that she was still asleep and motioned to caregiver Neneng that I would be back later. I powerwalked all the way back to the apartment. So how far was it each way? My best guess based on my walking pace was only about a mile and a quarter. Someone told me the previous night he thought it was about 3 kilometers, which is much less than the 1 1/4^th mile I estimated.

Satti with Larry

When I got back to the apartment, Larry was already up and after I took a shower (actually, a pail and dipper type of shower), we decided to hit the satti place again for breakfast. We left for the hospital right after and when we got there, Mama reminded us that there was a mass in the hospital at 10 a.m. (it didn’t start till 11, more on Filipino time later). We got a call from the Pabellons  informing us of a meeting we should have with the Tupaz Family (Mama’s landlady) at 3 p.m. to make decisions about Mama’s care, since Larry and I were finally there. Those two families have been the go-to people whom Mama relied on in our absence. I reiterate that we cannot thank them enough for taking care of our Mother the past few years and especially the last few months when she started ailing badly.

The meeting was held at the Pabellon residence and it was to plan for the inevitable. What do you ask was the inevitable? Sensitive as the topic was, it was a necessary discussion. What were Mama’s wishes? Where would the wake and visitation be (La Merced) and for how many days (2)? She already had a burial plot, did she also have a memorial plan (yes)? Will she be buried side by side with Papa or on top of him leaving a vacant plot aside (on top)? Finally, are we going to keep her in the hospital and continue treatment for what may or may not be pneumonia with no assurance that powerful antibiotics might help?

The first of Mama’s wishes was already fulfilled the previous night and that was that she, Larry and I were together again. Her second wish was to get discharged from the hospital, and the third being that she not die in pain. Another wish she had was to have a decent casket worth at least close to 100,000 pesos and proper religious rituals and services that she can be proud of. She had already set aside money for that. As usual, Mama had planned way ahead of time. Assignments were given to who was to foresee the prayers, masses, refreshments and other food. Larry was going to check on Mama’s memorial plan coverage, the funeral parlor, and the burial site requirements as well as the funeral mass. I didn’t have anything to contribute because I wasn’t familiar with the ins and outs of Zamboanga City. The final decision to be made was what to do with Mama’s hospitalization. We decided to meet Mama’s wish to go back to her apartment while continuing her maintenance medications and her pain pills (Morphine and Ultram or Tramadol). Out of respect for some people and because of their extreme kindness, I shall not write about the proselytizing which happened afterwards. Although it may help some people, it was just not for me. So sorry about that. So with all the decisions made, Operation Pilar was set in motion.

Nurse checking Mama's vital signs

We returned to the hospital to see Mama and let her know that we were going to ask her doctor to discharge her but not before consulting with the doctor the next day. By the way, the doctor started Mama on Morphine on this day because she was complaining of pain and the Tramadol was not helping much any more.We stayed with Mama until the hospital was ready to kick us out at 10 p.m.

*A side note – I don’t remember if I met the Tupaz family for the first time on Saturday morning or Sunday morning.

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Zamboanga – The First Day: A Day of Two Reunions

I had asked my brother to make reservations for 9 nights at Amil’s Pension House which was directly across the street from our mother’s apartment. I stayed there my first night in Zamboanga but since Mama’s landlady offered a vacant apartment for us to stay in, I moved in the next day. That saved us a few thousand pesos. A few days later, I asked Madie, the landlady if we could settle the accounts for the duration of our stay and she declined payment. Thanks Caloy and Madie, for your generosity and hospitality.

 

The night I stayed at Amil’s, I was awake by 3 a.m. and watched the U.S. Open and when that was over, I tried reading an ebook. Still, I was unable to go back to sleep and couldn’t wait until dawn came so I could go out for a walk or a run. Exiting the hotel in the morning, I turned right. In my disorientation the night before, I thought that led to Veterans Avenue, the street my mom’s hospital was in. After a short block I saw Plaza Pershing. Hmm, I should not be in that area if I wanted to go to the hospital. So I turned around and on the other end of the street, I hit Veterans Avenue. Well, I only made it halfway to the hospital because I was rapidly approaching the time I allotted myself for exercise that morning. So I walked back to the hotel, took a shower and stepped outside looking for Jimmy’s Satti House to satisfy what I was craving for in decades. Well, immediately to my left from the hotel entrance was Morning Sun Satti House so I went there instead. The man there showed me some liver cubes skewered on a stick but I opted for cubed chicken meat instead. I consumed 10 sticks of chicken and 3 tamus (rice cubes) in my first taste of satti since 1989. When I went to pay, it only the equivalent of less than 2 dollars for the meal.

Fifth grade classmate Solomon - owner of Morning Sun Satti

I went back to the hotel to get myself ready to go to the hospital and as I passed Morning Sun, the man I ordered the satti from earlier asked me in the Tausug dialect if I was Noel. Detecting my surprise, he introduced himself as Solomon, a former elementary school classmate in 5^th grade. Of course I remembered who he was because there was only one Solomon who was ever my classmate. We exchanged pleasantries and stories. He also happened to know Mama lived across the street so he asked how she was doing. I told him I was just on my way to visit her at the hospital.

Just then, I received a text message from Famy, a high school batchmate that her husband (an esteemed Jolo judge, no less) was on his way to my location to deliver some durian. So I waited for him before going to the hospital and a few minutes later, he showed up in his SUV with a box on the roof. I was expecting durian in a plastic container that was ready to eat and not 7 whole unopened durian fruits in a huge box on top of a judge’s car! The durian was sent from Jolo by another batchmate, Delia, the previous day. Oh my, my classmates sure know how to welcome me back after having disappeared from them since 1973. The judge was on his way to play tennis so I took the durian and brought it to my mother’s apartment. The hotel did not want the fruit in their premises due to the smell. I took up Mama’s landlady’s offer and moved in to the vacant apartment after checking out from Amil’s Pension House. Then I took a tricycle ride to the hospital to see Mama.

Aside from the nurses, Mama was being cared for by a recently hired caregiver – Neneng, and a helper – Andrea. So they were there attending to her needs when I arrived at the hospital. Mama was not very talkative and was grabbing some shuteye here and there. I told her about meeting Solomon and the durian delivery and how her apartment now smelled of durian, so she won’t be surprised when she went back home. Neneng left shortly (she worked the night shift) and I was left with Andrea who was busy as usual texting with her boyfriend (Mama already informed me of this in our telephone conversations). Well, that’s better than having no helper at all so it was a compromise she was willing to make. Around noontime, I begged my leave from Mama to go to lunch and also told her I was meeting my classmates at Amil’s at 3 p.m. for a small reunion. I walked down Veterans Avenue heading towards where the apartment was, looking for a place to eat. When I reached Pilar Street, I was resigned to having another round of satti. That’s when I saw Fat Belly restaurants’ offering in pictures on their front window. It showed pyanggang, tiula itum, and kulma among the items,  and I felt as if I was in Tausug heaven. I immediately ordered one of my favorite Tausug foods – pyanggang with rice. I polished off the first cup of rice and ordered an extra one. Oh my, was that meal a gustatory delight! And get this, it was a low fat meal to boot. The cost? Less than two and half bucks. I vowed to go back to that restaurant to sample more of their offerings.

I went back to the apartment and tried to take a nap before meeting my classmates. I heard the doorbell ring and looked out the window. In comes Leonard whom I wasn’t expecting. Remember classmate Leonard who visited the U.S. two years ago and whom I toured around Shoreline Village? He just happened to check Facebook and saw that a bunch of classmates were meeting that afternoon and having known Mama’s apartment, took a chance and came to see if I was in. So we talked a little bit but he had to leave. He said he would be back for the reunion at Amil’s.

Just before 3 p.m., I headed to Amil’s and immediately saw a lone female sitting in the hotel’s eatery. It was no other than Mimi. We hugged each other then tried to catch up about goings on in life. The others slowly trickled in – Cecile, Lorna, Nayda, Salma, Dolly, Famy, and Leonard (did I miss anyone?). We left Amil’s and walked a short way downtown to look for a place to eat. Pretty soon we entered Love Life Snack House which specialized in pastil, empanada, and halo halo and that was exactly what we ordered. Incidentally, at least 3 of us in the group were unmarried, thus did not have a love life. I offered to pay for the snacks but my classmates kindly declined. The lot was already funny when communicating on Facebook and were even funnier in real life with their facial expressions. Since I couldn’t carry too much weight in my luggage, I passed around dollar coins to everyone as a souvenir. After the snack, they vowed to see me again before I left Zamboanga.

I went back to Mama’s hospital and saw that the Nono family was back keeping her company. Together we awaited my brother’s arrival from Manila. Well, the airline changed its schedule so Larry didn’t arrive till 8 p.m., about the time I texted him and he responded that he just landed.

Larry came inside Mama’s hospital room shortly and the three of us were finally reunited after thirteen long years. Mama mustered a weak smile when a photo of the three of us was being taken. What was left of Iking’s family was together again.

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Momsie in Weemsie in Zamboanga City

I approached the Western Mindanao Medical Center (WMMC - locally, they call it weemsie) front entrance and the security guard checked me for weapons. He didn’t inspect my bag when I told him I just arrived from Manila and was there to see my mother on the third floor. I then rode the elevator then asked the nurses at the nursing station where room 324 was. After all those years being gone, I was about to see my mother again, though not under the best circumstances.

The last time I was in Zamboanga City was for the funeral of my father 13 years ago. Mama was still very much in charge and choreographed the visitation, wake, and funeral with ease. At the time Mama portrayed strength and determination to see things through during Papa’s final farewell, as I’ve never seen her done before.

I knocked lightly on the door of room 324 then entered. My first glimpse was of cousins Mary Cate and Claire, and Uncle Dante and Auntie Lita. As I approached, I saw dear Mama to the left in bed. I excused myself from my relatives and greeted Mama first. In the best American accent I could muster,  I said “Mom, I made it!”, then held her hand and kissed her on the forehead. A faint smile came across her face. I wasn’t sure if she was expecting me to be there with her so soon. In her weakened state, she wasn’t able to talk very much but our shared silence spoke enough volumes of the gratitude we had being together again after more than a decade of separation.

I turned my attention to our relatives who until about a couple of months ago didn’t know about Mama’s worsening condition. It was through Facebook that I found one of my cousins (the younger brother of Cate and Claire) whom I never met in real life, and asked him to inform his Dad and Mom – Uncle Dante and Auntie Lita, about Mama. They had been visiting Mama frequently since then. Uncle Dante is the last remaining sibling of Mama who is alive.

Half an hour after I saw Mama, the Pabellon Family arrived. Kuya Vic, Ate Chit, and Jing came from the airport where they went to pick me up. But because of the plane arriving 10 minutes early and my quick exit from the terminal, we missed each other. Pretty soon, photos with Mama were being taken, knowing that the opportunities of doing this were dwindling in the coming days. These photos will be cherished forever.

Mama asked me what I had in my luggage, knowing full well I had brought chocolates as she requested. I opened my bag and unloaded a dozen 6 pack bags of fun size chocolates of all kinds (boy, have they downsized those things!). Mama proceeded to verbally dole them out to those present. I didn’t keep track on who got what and how many. They were Mom’s goods to give out however she desired.

My brother Larry arrived the next evening and we were able to fulfill the first of Mama’s last wishes – the three of us being together. Thank you, Larry, for asking me to come home much earlier.

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Pilar Nono De Las Peñas

Pilar Nono De Las Peñas 
14 October 1931 - 10 September 2012

Eulogy For Mama

Mama was the glue that held us together from our beginnings in Jolo, through Papa’s illness, and even when Larry and I moved away from home. I hope she never thought that we abandoned her in the last few years because even though we were not with her physically, she was always present in our hearts.

Mother Butler friends, family friends, and relatives, you have all been appreciated because she was able to maintain a social life especially after she started living alone. Yet she was never alone because of you. You had become part of her family.

Even though she had been ailing, she didn’t want to burden us. After all this time, she was still concerned of her children’s well being sometimes to the detriment of hers. A mother’s sacrifice for her children never ends.

My mother was a very astute bargainer. I used to not like going shopping with her because she would haggle with salespeople until she more or less got the price she wanted for an item. It’s a quality of hers that I admired a lot in later years and thereby fostered my thrift. God knows how thrifty she was. Most of you probably know that.

Mama was a very good cook when she was still able to do it. To this day, people still mention her pumpkin pie and chicken salad.

Mama used to dress Larry and I alike for church when we were kids. I’m sure all of you who have seen us in Jolo noticed that. I don’t remember when that stopped. Maybe when I got to high school? We are 5 years apart and dressed like twins. I never wondered why she did that or complained about it. It was something we just accepted. It makes for a good memory now.

It’s hard to imagine losing both parents. Even today, I still dream about Papa and I expect the same about Mama for the extended future. Only, I will dream of them when they were younger and in their prime.

There comes a point in our existence that if by the grace of God we are fortunate enough to get there with sound mind, we have to make end of life decisions for ourselves. My mother made hers. She made her peace with the Lord for awhile already. and now she is with HIM, with Papa and all the friends and family that went before us.

Finally, Larry's soulmate Ninette wanted  to contribute that what she admired most about Mama was her simplicity, strength of character, tenacity for survival, inner happiness, and contentment.

Thank you, everyone, for being present in Mama's life.