Persona

How to mend a broken heart

Or ‘how I started having cabbage and learned to love my Peachy’

The author at Philippine Heart Center in 2019 (All photos from Miclat family)

(On April 3, 42 minutes before the Day of Resurrection in 2021, Mario Ignacio Miclat, lovingly called Doc Mic, breathed his last after he was diagnosed with COVID pneumonia exacerbated by COVID myocarditis and fatal arrhythmia. He was 71.

Doc Mic had a quintuple heart bypass surgery in September 1998. It almost cost him his life. But he lived to write about it: “I searched my memory, and remembered me saying while I was profusely bleeding, ‘Supreme Lord of the Universe, I am sure you know my wife Alma, a strong-willed woman, and my two talented daughters, Maningning and Banaue. Perhaps my continued existence in whatever form would add beauty to our little garden in Antipolo. Alive, I could write my book in my library there. As ashes, I could help fertilize our atis, suha, papaya trees and orchids. Thy will be done.’”

He was given a new lease on life. For the next 23 years, he wrote books, taught, lectured, did research and administrative work, lived and loved….

After Doc Mic retired as full professor following 25 years of sterling service to his alma mater, the University of the Philippines, he continued writing and went back to his old love, photography….”—Excerpted from Alma Cruz Miclat’s introduction to Mario Miclat’s collection of essays, “Hundred Flowers, Hundred Philosophies,” to be launched in September, 2021)

The author and wife Alma in 2018 (All photos from Miclat family)

1998

It was hard earning my Peachy. My friend, Rio, demanded from me no less than an out-of-body experience if I wanted to write about this funny Peachy episode in my life. My father-in-law chastened me for not literally feeling God’s hand touching me.

For sure, it was my third operation in three days. The female nurse by my side gaily sang a song by Ric Segreto, he who died in a traffic accident, even as the male nurse cracked his private jokes while pushing my stretcher to the operating room. They were hushed up by people speaking in whispers, after which there was complete silence.

I would feel the now familiar surgical saw cutting through my chest, perceive my true ribs springing free from the sternum as the surgeon scissored the connecting cartilage, sense the flow of blood and fluid draining through tubes anchored at my false ribs. I felt a jet of hot air being blown to the long incision from just below my throat to just above my navel. My heart stopped beating. Still, the blood pressure cuff around my right arm regularly inflated and deflated automatically. I could hear the doctors breathing behind their surgical masks. They tossed the operating table up and down, sideways to the left and sideways to the right. All these were being done without a sound. The quiet was calming. My heart started beating again.

“Don’t know what to say …” the nurse burst into her song once more. Someone asked for a Coke in can. The gurgling sound of the drink in one’s throat was inviting, I wanted to ask for a can myself. But a breathing tube, endotracheal or ET in medical lingo was stuck in my throat while a nasogastric tube, NT, went down from my nose to the esophagus and into my stomach. Not only could I not speak, I would not be able to drink, too. “I don’t know what to say, don’t know what to do …” the nurse went on with her song with gusto.

Without warning, the surgical team started to disperse. And when the doctors were away, the nurses started playing a despicable game. They gathered around a table to play blackjack. It  was not the game itself which shocked me. It was what was at stake.

Now, a patient usually gets some dose of valium and morphine for an operation. I remember Ate Nora whispering to me just before I was brought to OR 2254 that those were the injections I received in each arm. The singing nurse and her cohorts kept some of the ampoules of the prohibited drug to use as stake for their game of blackjack. And tonight, she won the game, too. An old hand whispered to her how to encash her winnings from the drug syndicate. How could I entrust myself to these nurses? I swore not to sleep that night and watch them.

Sir, matulog na ho kayo!” The singing nurse reminded me. “Ako ho ang may duty na bantayan kayo. Hindi ‘yong kayo ‘yang nagbabantay sa akin!”

Well, not only that I was human. I was still under the influence of hallucinatory morphine

Such evil lurking in evil mind! Well, not only that I was human. I was still under the influence of hallucinatory morphine. No. There was not a third operation. And an emphatic No! Nurses never handled the highly restricted drug.

I disabused myself of the idea when I was brought to the surgical intensive care unit (SICU) from the recovery room (RR). (Oh, how a patient needs to catch up with so many abbreviations and acronyms hospital people use!)

When my bleeding stopped and I was freed from the respirator, I asked my nurse Nilo Hidalgo how this morning’s operations was. He said they did not operate on me that morning. Was it the previous night, then? No, he answered. It was three days ago.

Each patient was assigned a personal nurse at the RR, Nilo being my third. Until then, I thought he was a very conscientious and caring nurse (he fed me with my first liquid, and also my first solid meal in four days). But now I suspected that he did not read my history well enough.

At SICU, I learned that it was only about four in the afternoon, not the hour of midnight that I thought. I asked internist Doctor Estalilla if they opened me up again in the morning. “No,” he replied. I was only given a lot of blood, platelets and plasma transfusion. Neither did he know, I surmised. Lastly, I asked my sacrificing wife, Alma. She also answered in the negative. I slept. Then woke up from my dreamlike state.

WHEN I CAME TO at midnight after the operation, which started at around 7:00 a.m. and finished at 6:00 p.m., Dr. Oppus, the anesthesiologist was at my bedside. I realized she has been there all along. She could not leave until she was certain the potent anti-coagulant Ticlid tablet I took a week before no longer had its negative effect. I needed the tablet since it prevented blood clots bad for narrowed arteries characteristic of patients of heart attack (myocardial infarct, MI) like me. But blood needs to clot to close the incision after an operation. Doctors must strike a balance between the earliest possible time to perform the operation and the moment patients stop taking the tablet even as, without the medicine, they now face the danger of another attack. Chief surgeon Dr. Chuachiaco asked me to stop taking the medicine seven days before the operation. I had severe chest pain and was rushed to the emergency room on the fifth day. Now, I was bleeding. And profusely, too.

My first nurse Melissa whispered to me that I have used up 16 bags of pure blood, more than the usual six to eight bags held in reserve for normal patients. What I needed most were plasma and platelets. She assured me, though, that my wife already made contact with our relatives in Bataan and colleagues at UP for blood donation. The hospital’s blood bank ran out of reserves due to the dengue epidemic. Melissa said I might be opened up again to arrest the bleeding. That was how my dreams mimicked a second and third operation.

I found out later that the chief surgeon, Dr. Chuachiaco, indeed had his Coke in cans after every operation. I was not able to ask about the Segreto fan

Most patients just take a day or so at the OR and RR all in all. Since I overstayed until the third, my subconscious which retained the memory of the operation that I did not consciously feel, repeated the experience to me twice over. I found out later that the chief surgeon, Dr. Chuachiaco, indeed had his Coke in cans after every operation. I was not able to ask about the Segreto fan.

MY RECOLLECTION of the RR is that of a torture chamber, the room of all kinds of physical pain. Before my experience there, I did not think I could ever know how pain felt. When a dentist took about 12 hours to extract my lower first molar, I did not know when to shout “Aray!” When a toenail was to be cut due to a freak accident, I shouted even before the doctor could touch my cuticle with her scissors. It took me a whole afternoon before I realized I was having my first bout of gout. As the doctor slightly touched the base of my big toe, I did not quote my Shakespeare but shouted my loudest “Araykupuuuu!” Classic gout, he pronounced. When I had my angioplasty six months earlier, I thought I felt no pain. Ten percent of heart patients who undergo angioplasty experience restenosis, a recurrence of the blockage months after the procedure. It was painful to know that I am one of the elite ten percent. I am not quite sure if it is pain my wife and I should feel learning we just became instant millionaires, in terms of liabilities, to cover the expenses for two heart operations in less than a year.

From the OR, I was brought directly to the RR. My nose, throat, chest, arms, wrist and penis were attached to all kinds of tubes, drains, lines and the Foley catheter. The ET, about three centimeters in diameter, was stuck into my mouth and went down between the vocal cords. Every now and then, the nurse inserted a smaller tube into the ET to suction pulmonary secretions. I secreted a lot.

“You’re a heavy smoker, I’m sure,” the nurse admonished me. I wanted to protest. I stopped smoking nine years ago. Anti-smoking literature assured me that on the fifth year of quitting, it was as if one never smoked at all. Each time my lungs were suctioned, I got into a paroxysm of pain. Even then, it was me who often motioned to the nurse to suction the secretion when it uncomfortably filled my lungs.

I would gently motion to Melissa with my hands, restrained as they were by the many attachments. “Do you feel cold?” she would ask. If I nodded, she would turn the mattress warmer on. If I shook my head, she would ask, “Do you feel too warm?” Then she would put the mattress on the cooler mode. Or she would ask if I wanted to have my head raised a little, then promptly pushed a button. Not knowing what I exactly liked, I would nod or shake my head. Each time, though, I ended up being suctioned and convulsing in the process.

Sir, matulog na ho kayo!” The nurse’s admonition intermingled with my hallucinations. “Ako ho ang may duty na bantayan kayo, hindi ‘yong kayo ‘yang nagbabantay sa akin!”

However I tried, I could not sleep. One time, the head nurse whispered to me that a group of professors, representing the UP president, was there to see me. She had to raise me up a little, and I must look my best. To the left of my bed, a few meters away, there was a curtained window about half a meter wide. It was usually drawn open for a few minutes early morning and late afternoon. I could barely see four faces peeping through the thick glass window. The head nurse showed me the list of names: Dean Agravante, Gaying, Pam, France. I was told to wave at them. I did, with my encumbered left hand. On my own, and despite my ET, I tried to smile my smile of gratitude for everything the UP community has done to help my wife’s bid to keep me alive.

Mario Ignacio Miclat Ph.D graduation photo (All photos from Miclat family)

At the SICU later, provincial nurses training at the center wanted to see patient Miclat personally. “How could he be so popular?” asked Ms. Tañedo from Tarlac. “People kept coming to donate their blood for him!” They came, indeed—the UP ROTC cadets, young ladies from Miriam College, police officers sent by Col. Razon, coast guard graduate students of the Asian Center fetched by Lerma and Prof. Dagdag, Vangie’s colleagues from UP-MSI, young executives from DCDC Makati, Kuya Rene’s Edsa Central workers, Dodie and folks from Bataan, not to mention the platelets sent by PGH through Clemen and Cynthia. I was also told that my Banaue was the first to donate her Type A+ blood to her father as the crisis of my bleeding was announced.

When the UP contingent left, I noticed one of the seven other patients with me at the RR. Simon Pedro, across my bed, was freed from his ET. He seemed a lot stronger than me. I vowed to be similarly free.

“Your old friend from college days came to ask if you still needed blood,” the head nurse reported to me. “Who?” I wrote on a piece of paper. I forgot to ask, she said.

When at last I felt I could use some sleep, Sharmaine told me that I was scheduled to practice breathing on my own. I needed to be fully awake while being weaned away from the respirator. It was rather odd to realize that I was not breathing on my own. Now, I needed to breathe with, not in opposition to, the respirator. Then the respirator was turned off for a while. I had to continue breathing by myself, if with difficulty. Patients were warned in a pre-operative seminar not to pull the ET out, if we did not want to damage our vocal cords. But I wanted to adjust it as it was pressing the right side of my inner tongue. Sharmaine thought I was pulling it out and reprimanded me.

Much later, the head nurse removed my ET after consulting with the internists. I was placed on a high humidity face mask, while Nico coached me to perform the most uncomfortable deep breathing and coughing exercises. The coughing was to expel the lung secretions, otherwise suctioned through the ET. No, I must not sleep. Otherwise, fluid would recapture the air sacs I have been filling with air by means of the exercises.

It was this breathing/coughing training that brought Peachy to me

It was this breathing/coughing training that brought Peachy to me. When Nilo introduced her to me, I hugged her real tight. I was sure at that instance that we would always be together for a long time. Peachy is a small pillow, 20 cm x 30 cm in size, which “cabbaged” patients hug when they cough. “Cabbage” means coronary artery bypass graft surgery, which I just had, a quintuple one at that. Pressed tight to the chest, it helps absorb the pain. It prevents violent opening of the chest wound. It keeps the ribs, fastened by stainless steel staples, from springing free of the sternum. I noticed the letters P.H.C. for Philippine Heart Center, marked on the pillow case and promptly christened it its homophonic name.

At the Heart Center Art Gallery, Alma and Mario Miclat, Dr. Monzon, artist Jo Florendo (All photos from Miclat family)

At my nephew’s where I stayed after the operation, I would always be hugging Peachy, now dressed in a new pink case Lou had sewn. She, indeed, protected me every time I coughed. Little boy Mac-mac and his elder sister Marise made sure of that. I love you, my Peachy!

After the first ecstatic encounter with the little pillow, I motioned to Nilo. I pointed at my neck to indicate that I felt a smarting pain in my throat.

“We are through with sign language,” he announced. “You must start speaking to get your voice back.” I said my throat was painful. No voice came out from my throat. “Just speak, you must speak, to practice your vocal cords.” First, it was to relearn how to breathe. Now it was to relearn to speak. Later, it would be relearning to pee, to move my bowel, to sit up, and to walk.

Gina, the medical technologist, came and taught me how to suck humidified Ventolin to dry up the phlegm now accumulating in my lungs. After a while, Nilo whispered to me that Alma and my eldest daughter Maningning were by the visitor’s window. Only now could they come, busy as they were with the blood donors. They turned on the speaker so I could hear their voices. “Tatay!” they called. As I saw their faces peeping at me from afar, I started to have tremors uncontrollably. “You must pull yourself together,” Nilo advised.

Mario Miclat (far left) and his cardiologist Dr. Edna Monzon, sitting in the middle, with wife Alma and other friends. (All photos from Miclat family)

Dr. Edna Monzon, my cardiologist who became like a sister to Alma and me, explained during her early morning rounds, that Ventolin caused tremors to about ten percent of the patients. Here I am with the elite ten again! But I feared the tremors. I had to contend with more fluid in my lungs.

‘I’m sure your prayers were heard.’ When I did not readily answer, he asked, ‘Did you pray for your life?’

I REALLY HAD to contend with many other things since the operation. When Dr. Tomacruz announced that my situation was stabilizing, he declared: “I’m sure your prayers were heard.” When I did not readily answer, he asked, “Did you pray for your life?”

“Many people have been praying for my safety. I think they are more effective than me praying for myself.”

“But did you pray for your doctors?” He wanted to hear a positive reply. I searched my memory, and remembered me saying while I was profusely bleeding, “Supreme Lord of the Universe, I’m sure you know my wife Alma, a strong-willed woman, and my two talented daughters, Maningning and Banaue. Perhaps my continued existence in whatever form would add beauty to our little garden in Antipolo. Alive, I could write my book in my library there. As ashes, I could help fertilize our atis, suha, papaya trees and orchids. Thy will be done.”

This whole thing began at the emergency room where I was brought following a severe chest pain. People from UP came to greet me happy birthday and to congratulate the office I head, Sentro ng Wikang Filipino, for bagging a very prestigious award. Tia Bella wrote a note: “Here’s how one can have a happy birthday.” I scribbled a verse on a magazine cover:

To the operating table
I bring my naked soul
and a bunch of flowers
from family and friends.
As time comes to tell me
that indeed He has,
I offer no excuses, no apologies, no regrets
but just a naked soul.
Dissected and shown
to have a multiple of heart blocks
I hold nothing in my hands, hold nothing
but a bunch of flowers.

 I asked SICU nurse Apple of Antique where she got her spirit to serve her patients tirelessly. “The Lord, I’m sure,” she answered confidently.

CLEMEN AND Marla visited me at the MICU and promised to bring me a tape of relaxation routines which I could use. Zeus brought it with him the following day. I listened to its first part. It said something like “Think of your head and think of the word ‘relax.’ Think of your eyes and think of the word ‘relax ‘…  Think of your hand …”

I made use of the power of the tape’s suggestion during my immediate post pericardiotomy syndrome at the RR. My hands and body were still connected to monitors and I.V.’s when I was brought down to the SICU. Feeling pain all over, I asked Maningning to play the rest of the relaxation tape for me. It continued, “Raise your hands and think of the word ‘relax.’ Shake your hands and think of the word ‘relax.’” How could I possibly raise and shake my restrained hands? I laughed at my condition and felt the pain all over again.

How dare you, Tchaikovsky! I blamed him and cried without let up 

Maningning played Tchaikovsky for me. To forget my pain, I tried to relish the movement by trying to catch the few notes to a theme. But did the composer pack so many notes into his theme making the listener’s spirit soar? How dare you, Tchaikovsky! I blamed him and cried without let up.  BoyM sent me a tape of Filipino spirituals. With each piece confined to no more than two octaves, they were the most relaxing.

I stayed awake all night, or all day, or all evening—I could not exactly say what time of day. Save for one or two seconds of power interruptions, the hospital was so generous with its bright artificial light glaring at me all throughout my stay at the OR, RR, and the SICU. In the semi-private room on the last stage of my stay in the hospital, Alma turned the lights off when it was time to sleep. When I closed my eyes, I saw the most colorful Baldemor painting. It was in black and black, in all shades of black. I longed for the moment to be able to toss in bed again, if sleeplessly.

Almost 40 days later, Alma brought me to the rehab gym on the eight floor of the Heart Center. From the elevator, she pushed me on a wheelchair secured for me by guard De Piedra. Head nurse Jonee commented I no longer needed the wheelchair.

I tried to stand. I remember that after my first angioplasty I found myself reciting the names of long forgotten primary school classmates. No, this was not out-of-body, Rio. It was, in fact, an innermost-body-experience. And I have to tell my father-in-law that it was the medical attention, love from the family, prayers from friends, and the Filipino communal spirit to extend all possible help which formed together into a Godly hand that touched my soul and mended my heart.

I stood up and took several wobbly steps. My left leg was numb even with the anti-embolism stockings Dr. Maranan said I should be wearing for about six months. It was from this leg that Dr. Tomacruz harvested graft veins for my heart. Dr. Chuachiaco’s voice rang in my head. “Here at the Philippine Heart Center, no patient has the right to die.”

I took a deep breath and hugged my Peachy.

About author

Articles

An awarded fictionist, poet, essayist and translator, Mario Ignacio Miclat, Ph.D served as dean of the University of the Philippines Asian Center and retired as UP full professor and Associate of Likhaan UP Institute of Creative Writing. He has been given lifetime achievement awards, including the Gawad Pambansang Alagad ni Balagtas for fiction in Filipino and English, Patnubay ng Sining at Kalinangan of the City of Manila, and Kampeon ng Wika of the Komisyon sa Wikang Filipino. He has won the Gawad CCP, Palanca Award, UP Centennial Professorial Chair Award and UP Press Centennial Award. His books include ‘Secrets of the Eighteen Mansions’, longlisted for the Man Asian Literary Prize, and ‘Beyond the Great Wall’, National Book Awardee for biography. On April 3, he succumbed to COVIC-19. He was 71.

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