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

Wedding Pic in Mama's Room

Larry texted me Tuesday night to expect a new caregiver Wednesday morning who would be taking care of mama on the day shift. Well, she never showed up or called to give a reason. I even prepared a few basic interview questions which I never got to use. Neneng, the night shift caregiver hadn’t had a day off since she was hired a few weeks before but never complained about it. She pulled me aside briefly and told me that the helper – Andrea, hadn’t been paid for the month. Well, Larry and I didn’t know her salary and Madie mentioned an amount. We decided to ask Mama, who of course gave us the correct amount. The helper got paid from money found by Madie in Mama’s handbags and other hiding spots in the apartment a few days before (more were found later).

Also on Tuesday evening, I sent a text message to Kuya Vic Pabellon saying that Mama had gone home. Well, gone home was ambiguous so he texted me back to clarify what I meant. I said Mama was back at her apartment.

When Mama was having so much pain on Wednesday, she told us to call Irene Hassan. Who was Irene Hassan? Mama never mentioned her to me in our telephone conversations and Madie didn’t remember meeting her either. We searched the Zamboanga telephone directory and a few of Mama’s address books but couldn’t find Irene’s name. It was Madie who found Irene’s number in another address book later. I gave her a call and it turns out Mama wanted her because she knew what to do with pain since she took care of her own mother who also had cancer. They were able to keep her painless to the end. Irene came to visit Mama the next day and gave us guidance about how to handle the pain and some spiritual advice as well.

                When Larry found out that the new caregiver didn’t show up, he contacted more people in Zamboanga by phone and managed to find another one. He was able to do this despite having to work that day.  Thankfully, Joanna showed up the next day and got to work right away. Finally on Thursday - Sept. 6^th, Mama had round the clock care in her apartment.

There were hardly any houses in this new housing subdivision

          I cut my upper lip shaving Thursday morning and when I went to see Mama, she asked me why my tooth was bleeding. I told her it was a shaving accident. That same morning I rode with Caloy while he drove his son David to Ateneo De Zamboanga High School. He also showed me the new housing subdivisions in the area. I was surprised at how sparse the housing was, because the way they advertised it on the internet gave you an impression that there were a lot of houses there already. Caloy said that people were wary about buying land and building houses there because they might be considered wealthy and thus a target of kidnappings. On the way back, I asked him to drop me off at Western Mindanao Medical Center so I could get some copies of Mama’s medical records. I put in the request and the clerk said the copies would be available the next day after 2 p.m. I took a long walking route back home via Governor Alvarez Avenue, Canelar Street, downtown, then back to Mama’s apartment. On the way, I stopped for lunch at Savory Restaurant. I had a bowl of lomi noodle soup which the cashier said was good for 3 people. Well, he didn’t know how much I was capable of eating and finished the whole bowl myself. I needed the fluids and calories after all the walking I did that morning. Their lomi was not as good as the one Larry and I had at the Aristocrat a few days before.

                I met Joanna, the new caregiver when I got back home (Neneng texted me that she showed up while I was at WMMC). She was a recent graduate of practical nursing school and was just waiting to get her license. Mama hadn’t complained of pain since the previous night and it appeared that the round the clock dosing of painkillers finally took effect. From that time on, she never complained of pain again. That made a return visit to the doctor unnecessary. We couldn’t say the same about how much nutrition she was getting because even though we encouraged her to have more intake, the next several days it was just mostly Prosure and medications.

                I continued my search for Tramadol and for a pill cutter. None of the pharmacies had a pill cutter. We also took a thumb mark of Mama for an authorization letter giving us permission to buy medications for her using her senior citizen card. Whenever the caregivers ran low on supplies, I did the shopping. That’s how I found my way to Southway, Gateway, and Mindpro malls.

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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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