January 24, 2021, around 9:30PM, I received a call from the hospital that one of their patients at the ER had a reactive rapid antibody test result. She's an 83 year old woman, unstable, and needs to be referred to a higher facility. The hospital coordinates to us whenever there's a reactive RAT for case investigation and proper management of close contacts in the community.
NOD also requested for an ambulance in case the tertiary hospital gives them a go a signal that they can already accept this patient, she's still coordinating with them. Told her that I will call the transport team to give them a heads up, but I asked if a nurse will accompany the patient during the transfer since that's what they require. She sounded hesitant, and said she's just gonna call me back to give me an update.
Few minutes later, I received another call informing us that the Locally Stranded Individual (LSI) who is currently on quarantine at the Barangay Quarantine Facility, is experiencing vaginal bleeding. Said patient was diagnosed to have Cervical Cancer 2 years ago. She was supposed to be having her chemotherapy in Manila, but her body is too weak, so she refused and decided to just go home here in the province.
I coordinated with the hospital about this new case, gave them the details, called the ambulance and started donning my PPE.
We arrived at the BQF, around 10:30PM. I saw the patient lying on the bed, her eyes are closed, she's probably too weak to even open them. Her facial grimace shows she's in too much pain. Her diapers almost full of blood, and I can smell it even with my N95 and 2 layers of surgical facemasks. I checked her vital signs, then she was transferred to the ambulance. I asked the family where they wanted to be referred, and they opted to go to the public hospital. Relayed all the necessary information to the NOD, and we were instructed to wait. We cannot leave unless the tertiary hospital gives them a go signal that the patient will get admitted. The One Hospital Command (OHC) System is currently being implemented, and so we can't just go to the hospital without proper coordination (yes, even if your patient is bleeding and needs immediate management in a tertiary level hospital).
We were just parked at the highway, we waited for the NODs update. After about 10-15minutes, she called, said there wasn't still a go signal, so she instructed us to just bring the patient to their hospital.
Upon arrival, NOD immediately attended the patient, started an IV line and gave IV medications. Then she started coordinating again, tried the other public hospitals in the City, but all of them has the same answers - they're already full.
The family decided to just go to a private hospitals. They may not be financially capable but they'll try to find a way, they just wanted to get the patient be treated. We waited outside the ER while the NOD was coordinating with other private hospitals. She tried calling all the facilities, but gave us the same answer - they're already full.
As we were waiting for updates, she shared to us that the other two patient who are currently just outside the ER is also on the waitlist. One patient has been there for about 2 days already, and the other one, was the 83 year old woman who had a reactive RAT. All of them are for referral, but unfortunately, they needed to wait for availability as well. These patients are dependent with the public hospital services since they don't have the capacity to go to a private facility.
Also learned that there's only one staff nurse who is on duty per shift. There are only 4 nurses in total who are currently assigned in the Emergency Room, all the others has resigned because of fear of COVID-19 or the very low compensation rate. They're currently on a 12 hour shifting schedule just to cover the whole 24 hours.
Now I understand the hesitation of the NOD when I asked her if there will be a nurse who will accompany the 83 year old during the transfer to the tertiary hospital. If she accompanies the patient, who will man the ER?
We waited and waited. Until it was already past 1:00AM, more than 3 hours outside the Emergency Room. The family of the patient decided to just go to a private a hospital and take chances. Even if there's no assurance that the patient will get admitted, they wanted to try, they're already desperate.
Upon arrival at the first private hospital, we were asked the basic questions (as expected). The staff wasn't so happy with this uncoordinated referral. But when I told them what happened earlier, that this was already our last resort, the patient really needs treatment and the family is so desperate already. They talked to the family, explained the current situation and the hospital protocols, including the possible big amount of money that they will be needing to prepare. The family understood, agreed, and said they are willing to do everything for the patient.
Finally, she was admitted.
We went back to the ambulance, all grateful and relieved. We were feeling good as we were headed back to our town. It was 4:00AM, we were sleepy, exhausted but happy that finally, the patient will get proper medical treatment. It was a good shift.
On January 26, 2021, past 12 midnight, we received a call from the hospital informing us that the 83 year old patient died. She was still at the district hospital. She was supposedly for transfer because she needs tertiary level medical care, but she died while she's on the waitlist.
The hospital did post-mortem swab. She was diagnosed to have 'Pneumonia High Risk t/c (to consider) Severe COVID', following the DOH protocols in managing COVID suspect death, she was buried within 12 hours. All identified primary contacts were advised to be on home quarantine and all were scheduled for swabbing.
The result of the RT-PCR was released the next day, and the 83 year old woman turned out positive of COVID-19. She is our second COVID-19 death here in our locality.
Kawawa talaga mga matatanda at mahihina na resistensya tas ganyan pa sitwasyon, laking problema talaga idinulot ni covid. haist!