BY THIS TIME next year, Teresita could be elsewhere, unmindful of the biting cold. She could see herself walking along a cobblestone path strewn with scattered leaves from maple trees that lined the streets. It would be October, and the foliage would be nothing short of magnificent. Surely her gloved hands would curl inside the pockets of a thick wool coat, and her shearling-lined leather boots would keep her feet warm and dry as she would walk unhurriedly under the midnight sun. Surely, everything would be kinder as she had hoped. By this time next year, Teresita was quite certain, she would finally breathe in the scent of cinnamon, the whiff of white lilies, the redolent smell of freedom.
But not just yet. Next year would have to wait.
Teresita glanced at the round clock hanging on a wall across the nurses’ station. It was less than an hour before her shift would end at four o’clock in the afternoon. She sat and already her slender body felt sticky as perspiration clung to her blue scrub suit. Outside, clouds became dense with the weight of water. The windows in the corridors were open, but air seemed to press insistently on each of Teresita’s pores. Behind her surgical mask, her cheeks began to itch from the sweat that she wanted to whisk her mask off. Teresita tried to remember whether she had packed her umbrella that morning before leaving for the hospital.
“Patient’s IV line at Room 302 out,” hollered Donato, a sprightly man in his early thirties who was so pale it was as if he had not gone outside his dormitory for weeks. “This is already his third time. Maybe we should restrain him on both arms.” He plopped his stethoscope and sphygmomanometer with a soft thud on the desk before hurrying to get the IV set near the emergency cart.
“Do you want me to insert it for you?” Teresita looked up from where she sat, surrounded by stacks of steel charts. She had been double-checking whether all doctors’ orders had been carried out in time for their afternoon endorsements. “I am nearly done, anyway,” Teresita removed her mask and drank from her half-empty AquaFlask bottle.
“Thank you but it’s fine. Hopefully, I can insert it in one shot. I need to polish my skills. You know why,” Donato winked at Teresita. He strode up to Room 302 with confidence, resolute to get the task done as his voice trailed off. In three months, he would be leaving for London. Donato left her in the nurses’ station where everyone else bustled about, oblivious to each other’s chores. Eager student nurses wearing white uniforms and nurses’ caps went in and out of patients’ rooms on the third floor of the hospital, alternately taking vital signs and reporting to their clinical instructor. The latter, a fastidious middle-aged woman with gold-rimmed glasses perched near the tip of her nose, sat across Teresita at the other end of the station. She was checking each of her wards’ progress notes, hypervigilant for any overlooked trifle.
Teresita wondered whether there would be student nurses who would also make life easier for her in Europe. The email she received from Norway two days ago did not mention whether the hospital was affiliated with a teaching institution. She knew that the hospital was small, with less than a hundred beds, that it was nestled in the old city of Bergen in the southwest coast of Norway. She searched for pictures of the hospital on the Internet. The hospital lay on an elevated spot near a busy port overlooking the surrounding fjords. It was near the UNESCO heritage town of Brygge where colorful wooden houses built in the 18th century still stood. Teresita even read in one travel website that if one were lucky, one could even witness the Northern Lights emerge like an apparition in that part of the world. She had always wanted to see the Northern Lights since she had read about it in an encyclopedia when she was a child.
By this time next year. Behind her mask, Teresita could scarcely suppress her smile, thinking of the palette of purple and green hues that resembled impressionist brush strokes she would soon see in the distant sky.
Some nurses who were to relieve Teresita and her duty mates soon began to arrive.
“How many admissions, Tere?” Grace, a big-boned woman who had a thin, shaky voice, asked Teresita as she tried to fit her backpack inside the locker. Teresita and Grace had been working in this private hospital since it had opened ten years ago. The hospital stood along the main highway of Iloilo City beside the long stretch of river that traversed the city. Parallel to the hospital was a one-kilometer linear park with brick paths and balustrades separating the water from the jogging path. During the day, water from the river sparkled with a shade of blue several hues darker than the sky. From the higher floors in the hospital, Teresita and the rest of the staff could see the water lined by palm trees and mangroves along the riverbank. From one of the floors on the third floor on a cloudless day, Teresita could even recognize the mountainous island of Guimaras, a fifteen-minute boat ride from the city. At night, the water appeared morose and somber, reflecting the dulled light from the lamp posts amid the darkened sky.
“Six patients in the morning. Three more going up anytime from the ER.”
“Not so bad,” Grace quipped as she tied her hair in a tight bun before changing in the adjacent dressing area.
Teresita was returning the charts back to their corresponding pigeonholes when she heard two consecutive shrill sounds from her cellphone inside the front pocket of her scrubs. It was a text message sent by her younger sister Nenita.
Hello, Manang. What time r u coming home? Nanay not feeling well. Has not eaten all day. Tnx.
Will be there in 30 mins. Pls tell her.
Teresita gulped the rest of the water from her flask then sat on a stool. She felt her heart pulsate in synchrony with the ticking of the clock. She thought of the email she had yet to answer. I must reply by tomorrow or else they might think I am not interested. Her thoughts shifted back to her sister’s text message. I will pass by La Paz Market to buy Nanay’s favorite mangoes from Guimaras. She will not be able to resist them, she thought decidedly, though she wondered if they were available since it was not the season of mangoes.
Teresita could not blame her mother for not having any appetite. For it was only a few months ago, right after New Year’s Eve, that she had noticed something peculiar. Teresita had been on her way then to the hospital when she saw the stooped figure of her mother in front of their house. Her mother was sweeping brown leaves and twigs with a broom made of dried buri leaves. The talisay tree in their neighbor’s yard kept shedding leaves, the wind blowing clusters off towards their yard. Her mother had always tried to keep the garden neat, but the imposing tree made it impossible. In her late fifties, Teresita’s mother was wearing one of her favorite cotton kaftans, her scrawny arms jutting out from her trunk like a marionette. She usually reserved that kaftan for special occasions like town fiestas or when her relatives from another barrio came to visit. Her mother’s build had always been slight, in contrast to her father’s muscular physique.
It was that morning when Teresita first caught sight of her mother’s protuberant belly despite the kaftan’s loose fit.
“It seems like you have gained some weight in your belly, Nanay,” Teresita spoke in a mellifluous voice and in a more melodious manner than usual, lest she should inadvertently slight her mother. Teresita kissed her lightly on the cheek.
“Yes, Inday. Most of my pants and shorts do not fit anymore. That’s why I’ve resorted to wearing my old dresses.” Teresita’s mother continued to sweep the leaves, gathering them on one side of the yard with her broom. “Maybe it’s time to use them instead of just being stored in the closet, gathering dust.” She then put the broom down, lifted the upper part of her kaftan with her thin fingers, admiring the fading hibiscus pattern on the white cloth.
“I will just go inside the house to rest. I have been getting tired so easily lately. See you tonight after your duty, Inday.” Teresita watched her mother retreat into the house with a slow gait, noticing right then her swollen ankles and feet just below the hem of her kaftan. This was a far cry from Christmas Eve when her mother had tirelessly scrambled in and out of the kitchen, preparing their Noche Buena feast as though there were half a dozen in the house, instead of just the three of them.
One week later, Teresita tried to convince her mother to consult an internist she knew at the hospital. Teresita’s mother was hesitant at first. “It’s just a waste of money,” she chided Teresita. “Maybe I am just worn-out from the holiday festivities. Who isn’t?”
It was only when Teresita pointed out that her eyes and skin seemed to have acquired a yellowish tinge that she finally agreed.
“What else have you been feeling, Ma’am?” Dr. Montelibano asked Teresita’s mother while she scribbled notes, her shiny maroon stethoscope visible between the starched collar of her white coat.
Teresita’s mother paused. “It is hard for me to sleep at night, Doc. I also observe that I feel full after only a few spoons of rice.”
“Doc, I noticed her abdomen suddenly become big. Like a full-term pregnant woman,” Teresita interrupted. “And her feet are now edematous.” Teresita pressed her index finger on her mother’s right foot, creating a small indentation. They all watched the skin slowly return to its original position, a few seconds later than normal.
Dr. Montelibano asked Teresita’s mother to lie on the examining table with her blouse pulled up to her ribs. As Dr. Montelibano began lightly pressing her hands on her mother’s abdomen, Teresita noticed blue serpentine veins around her mother’s navel. Teresita also took note of her mother’s bulging sides, her wrinkled hands, her sagging limbs. Ascites? Teresita wondered, as she thought of those she had encountered in the hospital with liters of fluid in their bellies. Tumor? Ovarian new growth? Liver cancer? Teresita shivered. Please God, no.
Dr. Montelibano ran several tests the next few days. There was no tumor in the abdomen. Instead, her abdominal ultrasound revealed approximately five liters of fluid that the interventional radiologist needed to drain. “Decompensated liver cirrhosis with massive ascites from chronic hepatitis B,” Dr. Montelibano told Teresita and her mother during a follow up.
When all laboratory tests came out, Dr. Montelibano apprised them that her condition was already advanced, that survival rate for this condition was low. Advanced. Decompensated. End-stage. Terminal. Teresita read about the different terms to describe her mother’s condition. She realized that although terms varied, all pointed to the same conclusion: her mother’s illness portended poor prognosis. Dr. Montelibano prescribed several medications and asked Teresita’s mother to refrain from eating too much salt and to consult every month without fail. Her maintenance medications ate an enormous chunk out of Teresita’s monthly salary, but she could not ask for any help from anyone. Her two older brothers already had their own families and moved somewhere in the northern part of the country years ago.
For the next few months, Teresita’s mother lay on the bed most of her waking hours. Her belly grew bigger and heavier, making it hard for her to breathe, much less walk around and do her usual household chores. Food seemed to be the farthest thing from her mind, but she would force herself to eat whenever Teresita would deliver a mini lecture on the importance of nutrition for one’s immune system and recovery. Every time Teresita was on duty at the hospital, Nenita, who had just finished high school, looked after her. Although Nenita told Teresita that she also wanted to study nursing in one of the state universities in the city, she volunteered to stay home for the time being.
CLUTCHING A PLASTIC bag full of yellow-green mangoes in one hand, Teresita opened the front door of their house. The living room was empty, except for their sofa and a clay pot of peace lily with browning tips in some of its leaves beside it.
“Nanay, Nenita…I’m home!” She went to the adjacent room where nothing seemed amiss: their small, round dining table covered with vinyl, four Monobloc chairs, a double burner gas stove, a small refrigerator, plates, and glasses mounted on a rusted dish rack. Teresita heard a faint moan from the far end of the room. She dashed towards the bedroom that her mother shared with Nenita and opened the door with the sense of urgency she often displayed whenever an alarm went off in mechanical ventilators or every time code blue was called.
Teresita saw her mother slumped against a limp pillowcase on the bed, her hair matted and spread around her face like vines creeping randomly on a wall. Her eyes rolled upward; incomprehensible sounds came out of her mouth, somewhere between a lion’s roar and a kitten’s purr. On the corner of her lips, a trickle of blood dripped.
“Nanay, Nanay…what happened?” Teresita rushed to her mother’s side. She noticed the pool of blood on the linoleum floor. She shook her mother’s shoulder, then tapped her lightly on both cheeks. “Nanay…please, please talk to me. Stay with me. Nanay…” Teresita raised her voice, but her mother continued to mumble incoherently.
“She just vomited. Lots of blood. Before you came home, ‘Nang.” Nenita trembled as she clutched a towelette in one hand. Her hair was disheveled, her face drenched in sweat.” I tried calling you. No answer.”
“Maybe I was inside the jeepney when you called,” Teresita tried her best to stay calm. She felt her mother’s pulse with her index and middle fingers. It was faint but palpable. Her mother’s palm felt clammy and cold.
“It does not matter now. We need to take her to a hospital. Her pulse rate is becoming fast and irregular. I’m sure her blood pressure is low.”
“Will she be ok, ‘Nang?” Nenita whispered as she gathered some of their mother’s clothes from their closet and put them inside a duffel bag.
“I will ask Mang Loreto if he can bring us to Don Benito Hospital in his car,” Teresita told Nenita in a monotonous way that sounded vaguely familiar to both. Mang Loreto had been their late father’s closest friend. He lived several houses away and had been working as a taxi driver for decades. It was Mang Loreto who brought them and their mother to the emergency room when their father died less than a month before she graduated from nursing, when the pump boat he was riding on the way to Guimaras capsized during an unusually gusty afternoon.
Teresita glanced at her mother. Her chest was rising unusually fast, becoming shorter each time as air blew from her gaping mouth. Teresita’s knees weakened, feeling an acute sense of déjà vu. She quickened her pace and headed outside where nightfall was slowly approaching.
“DID YOU NOTICE any changes in her sleeping habits lately?” A tall, lanky woman, wearing lavender scrub suit, with a protrusion of pimples on her forehead, asked Teresita. “Does she sleep most of the time? Even during the day?” They both watched Teresita’s mother who lay on a bare steel stretcher, making various contortions with her body, speaking a mouthful of words no one in the room could decipher.
“As far as I know, she has trouble getting to sleep, Doc. The last time I talked to her was before I left for my duty this morning. She looked tired but she was still speaking clearly,” Teresita replied as she recalled her last conversation with her mother.
“Doc, I noticed she has been sleeping more the past three days. Even skipping breakfast and lunch. She usually sleeps right after Manang Teresita leaves for work,” Nenita glanced at Teresita. “She has not eaten anything today. When she woke up this afternoon, she told me she was feeling nauseous. I could not get her to eat. Not even her favorite steamed okra and eggplant.”
Teresita remembered the plump mangoes she bought in the market on her way home. Some of them would have black spots by tomorrow morning, she thought regretfully. Some of the skin would still be green, their soft pulp ripening into sweet yellow flesh a few days more. She wondered whether there were mangoes in Norway in summer. Or whether they would be as sweet as those here. Now is not the right time to think of mangoes, Teresita berated herself, snapping back to the present.
“…CT scan, arterial blood gas, upper gastrointestinal endoscopy, possible intubation …” Teresita heard the doctor say, enumerating her plans. “We need to start octreotide drip and to transfuse blood as soon as possible. You must look for possible blood donors.”
Teresita swallowed, feeling a big lump in her throat. Her head began to feel heavy. She did not catch the drift of the rest of the doctor’s words. The doctor handed her a prescription she had to buy at the pharmacy outside the hospital. “The medications are not available here,” the doctor explained.
Teresita walked past the array of patients in stretchers and wheelchairs in the emergency room. Some sat down on the floor looking dejected but had to endure because there seemed to be no choice but to wait until there was a vacant bed in the wards. The emergency room had air conditioner, but the large volume of patients and watchers was too much for the AC’s capacity. On her way out, she caught the putrid smell of an infected foot, the pungent scent of an incontinent bladder despite the surgical mask she wore. Teresita gripped the prescription and put it inside the pocket of her blue scrub suit. She wondered whether the money she had saved up for her plane fare was enough to add to her mother’s days.
“By this time next year…” Teresita said aloud, her hands balled into a fist. In her head, she began to compose the email she decided to write that evening. Neither the thought of the magical lights that had so enthralled Teresita nor the promise of gold and crimson leaves consumed her as she headed towards the pharmacy. Her head bowed to the ground littered with brown leaves from the shedding banaba tree along the pathway—the same towering tree that in summer had yielded something more than this and, in a few months, something more to be had.
