Erico Rio Lagpao is 10 years old and has never walked, talked, or done most of the things expected of boys his age. Confined in the intensive-care unit (ICU) of the Philippine Children's Medical Center (PCMC), he cannot even breathe by himself or take in nutrients the normal way.
His acute affliction with cerebral palsy was detected when he was only three months old. It was a burden that his mother Emily and her side of the family, especially her sisters, have learned to embrace, even if Emily, a former OFW, and her tricycle-driver husband do not find it easy to meet the expenses their son's special condition entails.
He is the perennial baby much beloved by everyone, endearing himself with a gift of empathy and emotional expressiveness that would shame many a "normal" person's emotional intelligence quotient.
According to Emily, other people have also noted that though Rico's case is more serious than most, he is more sensitive to his surroundings than many others who suffer from the same condition.
"Smiling face
sya. Pag aalis kami, umiiyak siya na parang humahabol. Pag di mo pinansin, iiyak din. At pag may nag-uusap, parang nakikinig, lalo na pag siya ang pinag-uusapan," his mother recounts.
His subsistence on the love and attention of those close to him is almost physiological. Emily remembers at least a couple of instances when Rico's condition turned critical while he was in the hospital after she and her sister failed to visit him for a few days.
"After 30 minutes, he was discharged from the OR.
Nakatawa pang parang nang-aasar e naglulupasay na ako sa labas," his mother recalls wryly.
The simple rhythm of Rico's life was disrupted only in 2006 when years of being limited in his ability to feed himself or do something so basic as swallow his spit finally caught up with him. The aspiration pneumonia he contracted was said to be the result of foreign matters like food and saliva accumulating in his lungs.
Since then, he has been in and out of the hospital and the ICU several times for recurrences of the pneumonia and other pulmonary complications. As of this writing, he is indefinitely confined in the ICU, breathing through a ventilator imbedded in his neck and taking in nutrients through percutaneous endoscopic gastrostomy.
His lower diaphragm has ceased working. Doctors are pinning their hopes on the hypothesis that it is only the presence of steroids, previously administered to treat his pulmonary problems, in his system that is suspending the function of his breathing mechanism. A previous operation on his dislocated cervical cord, thought to be the source of his breathing difficulty, did little to ease his condition.
Being bedridden for so long has also given him bedsores so serious that he might need skin grafts to replace the abraded skin on his scalp. The stinging pain of afflicted skin constantly rubbed raw brings on the grimaces and the quiet tears of suffering. So are the regular sessions with the needle to check his blood status.
Not able to vocalize pain, he nonetheless seems to have a high threshold for it. And fated with less than a fulfilling life, he is quick to seize each moment to be in it.
His mother speculates that once Rico's face finally reflects his pain and his body shows all the objective cues of suffering, like turning blue in the face as breathing becomes difficult, those are the times when the degree of pain he is in would have defeated someone else.
Despite all the tubes invading his body to keep him alive and the constant discomfort from his sores, a warm smile flits across his features once in a while, his moods not a great deal different from how they were in his healthier days when music he likes would send him not only smiling but ecstatically tapping on the floor.
"Fighter
ang tawag namin dyan. Alam nating masakit ang may butas sa lalamunan at sa tiyan, ilang beses na rin syang na-cardiac arrest
at nangingitim na pero nilalabanan nya ang sakit," says his mother.
He has also constantly surprised the doctors and his family by bouncing back to consciousness quickly after procedures that required him to be anesthetized.
As Rico's health hangs in the balance with no immediate prognosis for the better, those close to him worries about more pain in store, not for Rico but for themselves. "On my part, I've accepted and offered it to the Lord. But my sisters might not be able to take it if he's gone.
Mahal na mahal nila si Rico," she sobs.
A scalding experience
Little Jam Jamon went through a fiery experience that goes beyond the second- and third-degree burns she sustained when her young body was scalded in a household accident.
At her wit's end though not yet realizing the gravity of having a pot of boiling water splashed on the tender flesh of a two-year old, her mother Maritess did what common sense seemed to dictate at the time. She applied toothpaste to the affected skin to relieve the burning with menthol as the child cried her heart out in pain.
She saw her mistake when Jam's damaged skin in the abdomen and upper legs behaved like a misbegotten pizza crust instead. The blisters erupted and the skin peeled off, exposing hardening raw flesh. The introduction of the toothpaste, a nonsterile foreign substance, on her susceptible flesh also upped her risk for infections.
It was a pain to see and even more excruciating to feel, especially for someone so young. Ironically, she would have been more anesthetized against the pain if her burns went a bit deeper.
According to Dr. Allen Torin, her attending surgeon at the Quirino Memorial Medical Center (QMMC) burn unit, Jam mostly sustained second-degree burns. Since nerve endings are nearer to the surface of the skin, this made her condition more painful than if she got third-degree injuries.
The path to QMMC was an ordeal in itself. Shocked into realizing that her daughter needed professional help and fast, Maritess first sought the help of the rural health unit in Antipolo, Rizal where the family lives, only to be referred, after some first-aid treatment, to two other hospitals in neighboring Morong and Rodriguez, both of which do not have the special facilities to deal with Jam's condition.
In QMMC, the clinical rigor called for by her delicate situation required that she not be dispensed food and drink until it can be ascertained that her alimentary functions were not damaged by the extensive burns that affected around 18 percent of her skin surface. Her abdomen absorbed the initial hit from the burning liquid and sustained the brunt of the third-degree damage.
The exposure of sensitive parts to the burn also necessitated catheterizing the child to prevent urinary-tract infection and further pain when she urinates.
Before the burn wounds are directly addressed, the burn-unit staff had to work with a clean slate first, ridding her skin first of the gratuitously applied toothpaste-another procedure not without its own share of sting-before applying the antiinfectives.
Jam's burn pains would eventually be relieved by pain-control measures, and she would later show herself to be something of a pediatrician's dream, having quite a high threshold for pain and a lower tendency for hysterical tantrums for a child in her situation.
"Although she cries also, she presents her pain in a way that indicates she's not directly complaining about her wounds unlike other patients, with conditions even less serious than hers, who show an immediate reaction to the sensation of pain itself," Torin observes, noting that she didn't need to be anesthetized while her wounds were being dressed.
But the time came when the dreaded complication of infections caught up with her. She developed aspiration pneumonia, pseudomonas sepsis, hypokalemia, and necessitated blood transfusion due to a low blood count.
Her family's dire economic circumstances almost cost her access to the expensive antibiotic she needed to live through these complications were it not for the medical staff's intercession. At one point, she needed to take twice-a-day a pill that costs PhP2,800 apiece.
More than a month after the accident, the feisty little girl who eventually won over the hearts of the burn-unit staff at QMMC with her stolidity in pain and her gregarious ways lived to undergo the skin grafts that would pave the way for her to finally put this painfully fiery episode in her young life behind.
Except for putting up with the inevitable itching that comes as the burns dry up, and peripheral issues with the healing of the skin grafts, Jam is close to recovering her way out of her prolonged hospital stay. For this non-keloid former, the scars (the physical ones at least) are expected to fade away eventually.
Tragedy in the family
"How would you adapt to a problem like that and how will the parents talk about his leg when they were the ones involved?
Yun ang unang naisip ko," recalls Dr. Johnsel Espinosa, an orthopedics resident at the Philippine Orthopedic Center (POC) who handled the case of a little boy, eight months old and already deprived of his right limb by a freak family accident.
Rodelio and his wife Erlinda had much on their minds one late morning in January, cruising Muñoz, Nueva Ecija, with their infant son aboard a motorcycle. 2008 was not getting off to a promising start for them, with Rodelio, the sole breadwinner, having recently finished his contract as a security guard less than two weeks before.
After breast-feeding her son, Erlinda held him swaddled in blanket, a protective act that quickly swung the other way with almost fatal results. Whether she was temporarily drained and rendered careless by the strains of wet nursing or was distracted by more distant concerns is difficult to ascertain now.
What surely did occur was that she let go of a part of the blanket when she shouldn't have. This loose end got caught in the wheels of the motorcycle with a force more compelling than her hold on the child, as he followed the loose blanket to the pavement under the fast-grinding rear tire.
That the child actually got run over by the family vehicle was evident from the abrasions in the child's upper body, which followed the pattern of tire marks. These were the least though the most telling of the child's injuries, the worst of which took an irreversible turn to a most dreaded scenario after eight hours elapsed before the child can get appropriate help.
"Pag more than six hours
na ang injury, pangit na ang prognosis. Mas mataas sana ang chance
na ma-save ang limb kung mas maagang nadala ang patient," says Espinosa.
Before making the three-hour trip to POC, the couple tried but failed to get proper treatment from three medical centers in Nueva Ecija, all of which didn't have the facilities to deal with the child's condition.
According to Espinosa, the boy's ill-fated right leg, from the foot to the knee area, was already bluish in color and cool to the touch when he was first brought in. The baby's cries also indicated the absence of any pain-control medication although he was brought in supplied with intravenous fluid.
The chances of saving this leg, very slim to start with, diminished to zero when the child was unable to undergo a special vascular surgery and it was established that the blood supply to the leg was already inadequate.
Sedated and anaesthetized, the baby mercifully went through the amputation procedure the next day impervious to pain, his paracetamol-mitigated agony resuming only after the anasthesia wore off.
Although it was the right leg that looked most badly hit, the fractured left leg was also a source of great physical distress for the kid as the deforming muscle forces prying the leg bones further apart caused painful spasms. Because of the manifest damage to the right limb, it took some time for this other pain source to be addressed.
The solution looked as painful as the problem: inserting a device called a Steinam pin through the patient's leg and putting it up in a 90/90 traction. But these measures, says Espinosa, actually reduces the patient's pain in the concerned area and realigns the leg back to normal.
As of this writing, the baby is completing the required three-week stay in the hospital to ensure full recovery, all the time under monitoring for possible hospital-acquired infections because of his immunocompromised state. Coming in with a dangerously low hemoglobin count, the child underwent blood transfusion but is still below normal in this respect.
He is expected to have full use of his left leg when he grows up and his stump of a right leg can be attached with prosthetics when he is old enough, enabling him to have some degree of independent mobility. In the meantime, this sensitive part will continue to receive antiinfective care and the corresponding pain-management measure until the wound dries up ... physically that is.
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