When the Smiling Death Visited Us

No one ever thought that at this day and age, one can still die from tetanus. I, for one, didn’t think it possible. It’s like tuberculosis. An old but deadly disease, preventable at this age, but somehow, someone still dies from TB. But unlike TB, whose medication needs six months of consecutive pill-taking, Tetanus can be prevented with just a shot, a vaccine. Unlike TB too, once tetanus hits you, few people escape from its death claws.

Last September, the Smiling Death visited our family. It was so called because the tetanus bacteria affects the muscles, including facial muscles. The pain, besides the uncontrollable spasms, is said to be so gruelling that patients grimace in it. Unfortunately, the bacteria paralizes the muscles, leaving the patients in perpetual smile-like grimace.

Ma and I, 1984

My lola died on the 18th of September, but only after suffering so much. Let me take you to the journey our whole family went through. This is as much as a remembrance of our departed this Christmas season, as an eye opener on the quality of healthcare we have in the Philippines, especially for those who cannot afford the best private hospital care.

11 September – My mom received a text message my lola is sufferring from high-blood pressure. She was rushed to the nearest hospital which is the district hospital. She lives in Orani, Bataan. My lola stayed there the whole day, from around 7 am until 9 pm. She was given two emergency tablets for high-blood pressure, the kind that you put under the tongue, to bring her BP down. By 9 pm, they discharged her, her BP already normalized. They gave her a diuretic which my cousin said kept her awake all night, going to the bathroom to take a pee. It was only fortunate that my cousin was in between jobs at that time so she stayed a little longer than she usually does in the province.

12 September – My mom received another text that they’re taking my lola to the hospital again, because her BP shot up. From my understanding, they first took her to the district hospital before taking her to a private secondary hospital, Bataan Doctors Hospital, in the provincial capital. A midwife-neighbor accompanied her to the hospital.

I only found out a piece about this journey when my lola was already dead. According to my cousin, my lola and her neighbor went to the hospital riding in a tricycle only! It was a good 15-30 minute ride from Orani to Balanga, and the patient was riding on a tricycle, screaming with pain the whole way. I don’t understand why the district hospital didn’t bother to send her away in an ambulance.

They arrived at the hospital around 12 noon. With my lola already in so much pain from the long bumpy trip, she had to wait for two more hours before a doctor attended her. It was in internist who took a look at her, seeing that her face is twitched up in a a grimace, concluded that an EENT doctor was needed, not an internist.

After two more hours, at 4 pm, the EENT arrived. The doctor reportedly held my lola’s face and pinched her frozen cheeks and realized a grave mistake. This is not a case for the EENT, it is Tetanus! Again, the internist was called to attend to her. My lola was finally diagnosed correctly at 6 pm, six hours after they arrived at the hospital!

Ma, as we call our lola, was sedated and given muscle relaxants among other things. These are too help with the muscle spasms connected with tetanus. There were times that she was awake and can be spoken to, but these were few and far in between.

14 September – Ma apparently had another seizure and had to be revived back to life. The doctors said that the muscle spasms are still so powerful that her lungs and heart wasn’t able to keep up with it at that time. Since that day, she never woke up again.

At this time, we were busy researching about this illness. We weren’t sure at first if it indeed was tetanus even if we were told that Ma’s face was already frozen into a smile. We were under the impression that tetanus attacks ver fast and the unfortunately victim dies in 24 hours. Our research showed that it was partly true.

Apparently, the tetanus bacteria upon contraction has 7-14 days before any symptoms appear physically. In my lola’s case, it has been more than 7 days. The days prior to her rising BP, she has been taking pain relievers for muscle sores and taking naps in the afternoon.

It was also an eye opener for us that the tetanus bacteria can be contracted only through rusty nails, but through any open wound. My lola once dealt with leprosy which deformed the small finger in her right foot. It smells bad and sometimes, the wound would still open and become fresh. That’s where the bacteria could’ve gotten in. She also lives near a rice field and the tetanus bacteria is very active in cultivated land. One plus one.

So, her BP must have been rising because she is fighting off some intense pain inside her.

On 18 September – the whole family decided to gather and visit her. It would also serve as a family meeting, primarily for her children, to decide whether she would be taken off the lung machine that’s keeping her alive. She hasn’t been awake for almost 5 days. A CT-scan was scheduled that day to see whether she has suffered from stroke during her massive seizure and is in a coma because of this and not merely under sedation.

That afternoon, my mom and my cousin who has been in the hospital the whole time my lola was there decided to take a rest and relax a little, since all her siblings have arrived and were willing to take their posts.

At 9 pm, they left the hospital for home and had dinner. The house was ringing with laughter and high spirits. Good news came before that my lola’s vital signs have improved and she even peed and pooped after almost 5 days of not relieving herself.

Around 10 pm, a text message arrived from my mom’s two siblings in the hospital. The machines are beeping like crazy and nurses are rushing in. After 15 minutes, the message said to come as fast as they could if they still want to see Ma alive as she might not last until morning the rate her vital signs are falling. My mom and the other who went to the hospital arrived a few minutes too late. Ma was already gone.

Incidentally, before her death, Ma and her sister she has been at odds with for the longest time made up. Her prodigal son, who hasn’t seen her for at least five years, and has not been on talking terms with her for longer than that, was also one of her children by her bedside when she expired.

Contrary to the pain that one would expect following the death of a family member, we were sad but also relieved. We were worried that she would suffer so much more if she survives tetanus. The doctors implied that at her advanced age, full recovery is impossible. Furthermore, Ma saved her children from the very difficult decision, and guilt, of taking her off the resuscitator.

It is a sad thing indeed that death visited our family this year, but it is an inevitable truth that sooner or later everybody would have to come to terms with. And it is not without lessons either. Lessons that can be as serious as life and death, and as funny and controversial as those found in Ded na si Lolo movie.

Today, we share nothing but fond memories of Ma. But the ordeal also left an indelible blot in the kind of healthcare that provincial hospitals can offer.

This is just one of the things that happened to me this year. But the others are not as “bloggable” as this. Some things are better left unsaid. Thanks to Jehzeel Laurente for sponsoring a contest that will get this incident of my mind and chest.