To the woman I love the most

Last November 1, we went to Quezon for All Soul's day. We went to see our deceased relatives especially our aunt who passed on earlier this year. Everything was nothing but an ordinary day of laughter and jokes. We were kidding around and being our usual selves.

At around 5 in the afternoon, my brother called my sister and I and told us that Mom's not feeling well and was having a difficult time speaking. We immediately went back to our relatives' house. I assessed her the second I got there. It's not just any hypertensive episode like what she had in the past. There were obvious neurological affectations and these alerted me. Despite Mom's refusal to be brought to the hospital, we all insisted otherwise.

As soon as we got to the ER at the community hospital, I took her blood pressure (200/140). She had a projectile vomiting and I thought this would give her relief because usually after vomiting, she would feel better. But she didn’t. I monitored her from time to time. Asking her who I was, where we were, but I got no response; nothing but murmured words. I was checking her pupillary light reaction and comparing it with my sister's. (I'm not really thorough when it comes to neurological assessment. All I know were the basics which was taught during nursing school years ago.) It was reactive and normal. She was spontaneously following verbal commands which is a good neurological sign. Minutes later, I noticed that she was snoring. It was very unusual because she doesn't snore when she sleeps. I tried waking her up again but she nodded when I asked if she wants to rest. And so I stopped bugging her.

Later on, she had an energy surge. She opted to go the restroom even when I insisted that she use a bed pan. But she was stubborn, she got up walked herself to the restroom. My sister and the ER nurse followed her. And there she shouted (still with slurred speech) that her deceased sister, was asking my mom to go with her.

As soon as she went back to her bed, I checked her blood pressure; still at 200/120. But this time, she was drowsier than she was minutes ago. There was noted lethargy and right sided weakness. I assessed her pupillary light reaction and noticed that it wasn't reactive anymore. It was already pin point. I referred it to the resident on duty, and she verbalized that Mom's GCS went from 15 to 7 abruptly. She was deteriorating fast. The doctor already made referrals to consultants and insisted an ICU admission. But the community hospital didn't have a CT scan, which indicates the need for my Mom to be transferred to the City Hospital. Before transportation, the doctors informed me the need to establish an airway; intubation. I refused because she was breathing on her own and I didn’t' see the point of it. But with a fast deterioration in her GCS, she might stop breathing in the middle of the highway during transport which will make intubation harder to do. And so I consented. The doctor said that it was her mother in the same situation, she would agree with the intubation.

It was so difficult and nerve wrecking on my part that my Mom's life would depend on my words and decisions. Hey world, I'm just 21 for crying out loud.

They intubated her and facilitated transfer. I was making calls that time; contacting my dad who was in abroad that time and our uncle, Mom's brother, who was at Manila that time.

I was already trembling deep down my core. I wanted to lose my sanity but I need to toughen up. I keep on wishing none of these was happening; but it was.

In the van, they were bagging my Mom to help her breathe and keep her oxygen saturation levels up high. As soon as we arrived at the city hospital, CT scan was immediately done. The neurologist was there waiting. My sister went with my Mom inside and I stayed outside as the doctor asked the events that happened prior to admission.
When the doctor got the results, he explained it to us. The results showed that there was a massive subarachnoid hemorrhage at the left hemisphere due to a ruptured aneurysm of the left midcerebral artery causing the brain to herniate. With minimal chances and an ounce of hope, I told the doctor to put my Mom up for an OR procedure to evacuate the bleed. He told me that even if I talked to the neurosurgeon, he wouldn't clear my mom for the operation. With a critically low GCS, she is a poor candidate for any procedure.
I suggested to clip the aneurysm if that was causing the bleed. And the doctor told me, that there's nothing left to clip because it is already ruptured.
And with defeat I begged him,
"Just save her."
"I can't."

And as he uttered those words, my world came crashing down. My white flag is ready to be surrendered. We are all up for a battle we are destined to lose. But I had to be strong for my brother and sister and the whole family. I had to tell them the news. When they saw me tearing up, they already knew. But they were still hopeful, and I wasn't because I know. My knowledge and my faith were clashing against each other. It was during this time that I wished I wasn't a nurse. I wish I didn't know what was happening exactly. I wish I was hopeful. But I was on the other side of the road.

At around 2am, we lost her, she was in an irreversible coma, GCS 3, there was no spontaneous breathing, and no brain activity  was noted as manifested by fixed dilated pupils on both eyes.

My siblings and I decided that the only means of revival to be done was the use of inotropics. We didn’t want to hurt her any further. We kept her heart beating until her loved ones see her for the last time.

We gave her a promise ring last October 16 during our parents' 25th silver wedding anniversary. We vowed to be with her forever, "til death do us part." But I guess forever ended way too fast.

Wherever you are now Mom, I know you're in good hands. You are home now with your family and Papa God. No goodbyes, I will see you soon. I miss you so much. And you will always be the woman that I will love the most.

kea ortega

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