28/09/2020
"This tatay has been my patient for the past few months. He would travel 25 km via habal-habal to my clinic. Before his first consult, he already had an indwelling foley catheter (IFC) inserted due to difficulty in urination. Due to his urinary symptoms I managed him as a case of Urinary Tract Infection and Benign Prostatic Hyperplasia. And then one Saturday, I went to clean my clinic, to my surprise he showed up because he was having painless hematuria or bloody urine. Good thing I was there or else his 25 km drive would be in vain. I told him to stop taking one of his new medications because it may be causing the hematuria. Lucky for him, it was indeed due to one of those prostatic medications.
This afternoon he was again in my clinic in San Francisco. His case was simple yet very challenging. He has not replaced his IFC for three weeks now. He went to the only hospital in the island to have his IFC replaced. Normally, they were able to replace his IFC without any difficulty but it was not the case yesterday because after several attempts they were not able to remove it. If one would force removing the IFC, you may expect an injury to the genitourinary tract. He was advised to go to the main island of Cebu, which is 2 hours away via ferry, to have his IFC replaced there. However due to scarce resources and fear of getting COVID it was not his priority. Instead, Tatay was hopeful that we in the RHU can help him. But removing a foley catheter can sometimes be a challenge, especially when it is related to non-deflating balloons which represent most of the cases.
I feel guilty because the first thing I told him goes like this "If the doctors and the nurses in the hospital can't do it, what made you think I can do it?" as if telling him that I am not the right person to help him. But since he was there already , I have to at least try. So, I initially asked my fellow DTTBs in the region on what to do. Then, I performed the usual steps on removing an IFC, but I was not successful. I thought I can do it in 30 minutes, but I failed. 30 mins became 1 hour and 1 hour became 2 hours, still I cannot do it. I tried every technique I know but it was really stuck and if I force it, I may end up having a case of bladder or urethral injury. But this time I don't want to stop trying. I know if I am not able to do it, Tatay won't have any choice but to travel to Cebu, to have it removed there. I don't know how are they going to come up with the funds to travel and I am worried knowing the risk of getting COVID in hospitals there is high. And if he can't go, I would also expect a case of Catheter-associated Urinary Tract Infections (CAUTI) and so on and so forth. For the last time I asked one of the nurses to assist me because it was almost 5 pm. It really felt like the balloon was impacted and I cannot aspirate its content. Nevertheless, with our patience, persistence and prayers, I could finally see clear liquid filling up the syringe until nothing's left but air. With shaky hands and nervous heart, I slowly tried pulling out the foley catheter. When I felt that there was no more resistance, I knew we did it. As I pulled out the whole thing, the worry and fear in the room were replaced with joy and celebration. Tatay is safe and won't be needing to go to Cebu anymore."
Source&đź“·: Dr. Lehi Surio
