I submitted this piece to the 2025 Arturo Rotor Literary Awards for Creative Non-Fiction. It didn’t make it to the final list, but I remain grateful for the push it gave me to finish something I had been carrying inside for a long time. I spent weeks writing it, after a burst of inspiration one evening when a writer-friend visited Gensan and we found ourselves deep in conversation about the ills of our country’s healthcare system.
Today, I’m sharing it not as a contest entry, but as a small tribute to my colleagues and patients in our city’s public hospital — whose courage, endurance, and quiet acts of grace continue to inspire me every day. Sayang if this piece simply slept in my computer, unread. Recognition may have eluded it, but leaving it buried would feel like a great injustice for the people it is intended for.
I hope that in some small way, it finds its reader. And if it can stir even one person to take one concrete step toward making a lasting difference, then it will have done its work.
The City Nearest the Sun
The heat in the city’s lone public hospital doesn’t just press down, it sinks. It is invasive and relentless, seeping into every corner of the old, dilapidated structure and clinging to the skin of its tired occupants like an unwelcome second layer. By midafternoon, it gathers in the corners of the emergency room extension like a living presence, thick with humidity and the mingling scents of dried-up blood, urine, sweat, and impatience. As it clings to the skin, it rises into the air and merges with the constant hum of muted conversations, rhythmic beeping of machines, and the uneven shuffle of footsteps echoing against crackled floor tiles. I walk past the makeshift ward, a narrow stretch of hallway between the ER and the medical ward, lined on both sides with aging stretchers and sagging hospital beds. Adjacent to the hall, separated by a cracked concrete half-wall, is an open-air awning sheltered by a thin, corrugated sheet roof.
Beneath it, patients wait, sometimes for days, for a space inside the main hospital wards, a place some will never see. I regret doing this now, at this unholy hour, when the heat unsettles bodies and spirits like a punishment. I should have made my rounds in the stillness of the night, when the air is cooler, gentler, and the exhaustion feels like a more forgiving guest.
Today, as I have countless times before, I pass through this alley where a few patients have scavenged wheelchairs and have been sitting on them for days, their IV drips suspended from rusted metal stands or barely affixed hooks screwed haphazardly into the walls. Others lay motionless on ramshackle stretchers, propped against a pile of shabby, threadbare pillows or slumped forward, eyes raw and glazed by fever, jaundice, or a resignation so deep it’s almost otherworldly. Those who accompany the sick are scattered along the edges of this limbo, perched motionless on brittle plastic chairs, heads tilted back with mouths slack, caught somewhere between sleep and despair. Some surrender further to the heat, sprawling on flattened cardboard boxes spread across the bare concrete floor, their breathing barely audible above the murmur of moans, shuffling feet, and occasional cries for help. A fly circles nearby, its insistent buzz breaking through the humidity, before it lands on the untouched meal ration beside a child’s bed, a tray of cold rice beside a tiny piece of fried fish languishing with the same resignation as the faces clustered around it. Sweat pools under my collar, sticky and stifling. I wipe my neck, thinking, perhaps for the hundredth time, that this hospital is more than just understaffed and underfunded. It is suffocating, overcrowded, and teetering on the brink of an apocalyptic demise.
I have been the only cardiologist in this hospital for many years, and on that day,I was called in once again to see patients referred for their heart ailments, each of them lying or sitting in stretchers and wheelchairs meant only for emergencies, in a corridor that has long served as a ward by necessity. The air, as always, was heavy, thick with heat and a faint whiff of disinfectant, unable to hold back the far more human odors that lingered. Everything here feels impermanent, as though held together by hope and surgical tape, brittle and unsteady, always threatening to come undone. For the past seven years, this has been my constant reality. I have made rounds in this hospital long enough to see its struggles become as routine as the electrocardiograms I read. Over the years, I have watched waves of city leaders rise and fall, each one heralding promises of progress and delivering speeches heavy with visions of reform. But here, nothing ever truly changes. The hospital’s walls seem to have absorbed the weight of these betrayals: the paint continues to peel, the ceilings continue to sag, and the unrelenting tide of patients continues to spill into every available corridor. Faces come and go in the hallowed halls of government offices, but here, beds and wheelchairs still crowd the decrepit passageways, their occupants waiting, sometimes for days, for a proper space inside the main wards, and for relief that always seems to be out of reach. This place endures, not because it thrives, but because it must. Because for so many in my city, there is simply nowhere else to go.
I wiped the sweat from my brow, shifting the weight of my patients’ charts from one hand to the other, and stepped toward my first referral. There is no time to linger in frustration. Work must go on, not because the system works, but because the patients, lying here in the cracks of that system, need it. There is nowhere else for them to go, and there is no one else to do it.
Manong Ernesto was the first. A stroke had ended his years at sea, fishing harder and farther away from our country’s waters for one of the city’s major tuna companies. During his younger years, he and countless others like him had cast their nets much closer to home. Back then, the city's proud moniker as the country’s tuna capital seemed appropriate, as its shores teemed with yellowfin and blue marlin, providing a steady livelihood for its coastal communities. But in the past decade, things began to change. Tuna in the southern Philippines’ waters grew scarce, and the once abundant catch diminished year by year. Fishermen like Manong Ernesto and his crewmates were forced to venture farther, beyond Philippine waters, into international fishing grounds like Papua New Guinea or Indonesia, chasing schools that seemed ever out of reach. Hypertensive for as long as he could remember, it was during one such journey, far from any doctor or medicine, that his body gave out. The stroke hit him onboard while he and his crewmates were fleeing from the Indonesian Coast Guard, who had caught them fishing in the wrong territory. The confrontation and the escape had pushed his aging body past its limits, and by the time they reached safety, his life had already changed forever. He returned home half-paralyzed and full of stories he could no longer afford to finish. Tales of oceans and hauls, of distant shores and hard-earned wages that had once brought his family a measure of security. Now, despite a Manila envelope full of prescriptions for his blood pressure medications and blood thinners, which he took only when he could afford to, this was his third stroke. His three children, once sent through school by the strength of his back and the callused grip of his hands, now have families of their own. The demands of survival had pulled them away, leaving little
room to help with his mounting expenses.
At his bedside sat his wife, her thin frame bent by the years, her movements slowed by an arthritic knee that made fetching water or standing up to place a dry towel on Manong Ernesto’s damp and sweaty back an ordeal. She never complained. She only sat, watching him in silence, her hands folded in her lap as though holding together what little they had left. The heat bore down on her as relentlessly as it did on him, but she seemed to wait it out with a stubborn patience, as if her stillness would somehow cool the surrounding air and bring healing to both of them.
Then there was Analyn, young and swollen, her feet, legs, even her belly stretched tight with fluid that her failing heart could no longer move. Rheumatic heart disease had shaped her life, her hospital admissions recurring with an unsettling regularity, like waves returning to shore, each one coming closer and faster as time went on. She had memorized the phrase “double valve replacement,” even if she barely understood it, repeating it like a refrain from a song she could never afford to finish. When I introduced myself, she smiled softly, a fleeting brightness cutting through her worn fatigue. She recognized me, she said, from her last admission. Shyly, she asked if I could help her with the referral letters and medical certificates she needed for her
surgery in a hospital far away, a journey as distant as her hope. I promised her I would, though in my mind I thought the words I could never say out loud: that this surgery might already be too late. Her illness looked too far gone. I saw how cachectic she had become, her frame reduced to angles and shadows, her abdomen severely distended, a belly filled with ascites instead of vitality. And now, she had a raging pneumonia, and her breathing was deep and heavy, like an iron hand pressing harder on her heart that was already close to surrender.
Analyn could never afford the surgery, not just because of the daunting cost, but because their livelihood was already gone. She and her tribe had farmed a small patch of land that sustained them for generations, but in recent years their crops had been repeatedly wiped out by floods that came with the slightest rain. What was once their foundation for survival had become another casualty of a changing world. The fields that her family and their ancestors once nurtured now unraveled with every monsoon rain, the soil washed away before it could even catch its breath, as though taunting them with life’s fragility. For most of the year, the sun brought relentless heat, scorching the earth until cracks formed on the parched ground, and the crops stood sparse and feeble under its unforgiving fury. And yet, when the long-awaited rains finally arrive, they come not as a blessing but as torrents, sweeping away the soil before it could satisfy its thirst, leaving behind a haunting reminder of both nature’s power and its indifference.
I knew she might not make it through this admission. Still, I stooped towards her and listened to her chest. The telltale murmurs of her damaged valves rumbled like distant thunder. I added another note to her chart, a thick file already heavy with deferred promises and dashed plans. Before leaving, I reached for her hand, smiling as I gently squeezed it. “Don’t forget to visit me in my clinic when you’re discharged,” I said, my voice careful, trying to lend strength to a hope I wasn’t sure I could sustain. “I’ll work on your referral for surgery.” She nodded, her smile small but grateful. As I stepped away, I left her with nothing but a silent prayer in my heart, a whisper to whatever power that can grant her just a little more time, a little more strength, and a little more hope that she might return to her home, ravaged by both sun and rain, just one more time.
And finally, Christian. He is an inmate from the city jail, brought in for missed dialysis. His mother held his wrist tightly as I examined him, her grip firm, as though afraid someone might take him away again. I asked him about his cardiac symptoms, but his answers were sparse, barely audible. Instead, the real story spilled out in fragments from his mother’s cracked voice, a voice worn thin from years of carrying too much grief.
She told me how he was arrested two years ago. No charges filed; no hearing scheduled. How his friend had been less lucky, shot during a drug raid, just another anonymous death in the seemingly endless list of "nanlaban." Christian was the lucky one, she said, though the words felt so hollow they seemed almost cruel. She leaned in, lowering her voice, and confessed that although Christian denies it, she believes he and his friend had been using shabu. She added, almost with resignation, that his friend deserved what happened to him: “Sala nya man gali.” It wasn’t an opinion voiced to excuse Christian, but a reflection of how far punishment has become normalized, even accepted. And then, almost as if seeking comfort in the logic of consequence, Christian’s mother continued in a resignedly faithful tone that her son’s worsening kidneys, his heart failure, even his suffering were all, to her, part of his punishment. The disease was not seen as a failure of access or care, nor as a condition worsened by missed dialysis or incarceration. She saw it instead as a reckoning he had to endure. She loves him, yes, but her love struggles to separate compassion from the justice she believes the world demands.
And that, perhaps, is the quiet tragedy. In his mother’s tired words, I heard not just her love for him, but an acceptance of a world that blames suffering on sin, that treats brokenness as deserved. It was a logic that shaped so many in my city, where punishment, both state-sanctioned and cosmic, had become a convenient answer to complex suffering. In her eyes, Christian’s disease was not simply a condition of the body but a moral affliction, a cruel but righteous universe balancing itself out. His mother’s contradictions reflected the prevailing logic of the world around us: that violence is a small price to pay for order, and sickness is the inevitable wage of sin.
But still, her grip on his wrist lingered, holding him like a tether to the world, not an act of rebellion against this bitter system, but a quiet going along with it. She both loved him and believed he was burdened with this suffering out of some unknown divine justice, and perhaps she couldn’t choose which mattered more. “Swerte na sya subong,” she murmured again. Christian was lucky. Lucky to still draw breath, even when each one came through a failing heart and heavy lungs. Lucky to be alive, even if his existence was one defined by missed treatments and a wheelchair that almost didn’t fit his swollen body anymore. Lucky to have a disease his mother thought was deserved, and a world willing to let him carry it because it has already judged him. It didn’t feel like luck now. They stayed as long as they could in the public hospital because it was the only place where Christian could get dialysis. Outside the hospital walls, in the jail, there were no machines to filter his blood, and they did not have
enough finances to pay for the tricycle commute to the nearest dialysis unit. They knew it wasn’t fair to take up space for longer than necessary. They knew others were waiting for beds. But where else could they go? How could they leave?
Christian lay there in faded orange detention pants, his shirt emblazoned with the name of a senator who had visited the ward months ago. It was a shirt for a campaign, bright with slogans, handed out alongside promises that rarely reached lives like theirs. On that day, he had been lying on one of the hallway beds when the senator noticed him, photographed him, and handed his mother 5,000 pesos, a single act that overshadowed speeches and promises of reform. His mother still called it a miracle. That it was taxpayers’ money, not a personal gesture, didn’t seem to matter. What mattered was that someone had stopped, smiled, and handed them something. Anything.
They have been trying to stay in the hospital ever since, maneuvering the system of referrals, prolonging each admission as long as possible. Here, Christian could get dialysis. Here, they could get meals. Here, they could hope. Outside, in jail, his condition would deteriorate. So whenever he got better after consecutive dialysis sessions, he would start drinking more water. At first, I thought it was the intense heat that fueled his thirst. But later, I understood: he was drinking not just from thirst, but to survive. Because if he stabilized, he would be sent back to jail. And being back in jail meant another wrestling match with Death. Every day that Christian remained in the hospital was one more day he stayed alive. One more dialysis session that might keep him from drowning in congestion, one more reprieve from the slow unraveling that waited outside. But survival came at a price. Each day he occupied a bed meant another patient was waiting, another life put on hold. The unspoken weight of that truth settled heavily between us as I calculated his doses of inotropes and adjusted his medications, trying to make sense of the impossible equation.
Why must it fall on us, his doctors, to decide who gets to live? If we send him back to jail, he dies. If we keep him in the hospital, in this endless cycle of dialysis, decongestion, drinking too much water, congestion, then back again, he lives for a few days, weeks, maybe months. Then dies anyway. We are caught in a healthcare Catch- 22 dilemma, where we are asked to choose between justice and dignity, between the greater good for society and the little act of kindness that we can do now. We are mandated by the system not just to heal, but to decide whose suffering deserves to be seen.
Just two weeks ago, one of my braver colleagues decided to discharge Christian from the hospital and send him back to jail. Yesterday, as predictable as birds returning home because they have nowhere else to go, Christian and his mother were back at the ER to start the cycle one more time.
Christian is just one of the countless victims of scarcity, not due to the carelessness or indifference of people, but of a system forced to triage between those whose needs are equally critical. In this system, compassion and resources collide like mismatched gears grinding together, trying to move forward but breaking under the weight of their burden. I understood his mother’s desperation as deeply as I recognized its futility. In the arithmetic of scarcity versus care, there are no answers, only compromises, only losses.
I began to think that what we do here isn’t healing. It is managing collapse. The collapse of bodies, yes, but also of systems stretched far beyond their limits: the collapse of resources, of compassion worn threadbare, of hope curled up like a watcher dozing off on a flattened balikbayan box covered only by a flimsy malong. Everything feels fragile, as though one stiff breeze or one more patient could bring it all crumbling down. The heat makes it worse. It isn’t just an oppressive backdrop, but a pathology. It warps ECG leads, drains nurses, and prematurely spoils transfusing blood. It accelerates the faltering rhythms of failing hearts and slows the already staggering steps of exhausted staff. The heat invades even the silence, wrapping itself around despair until it feels like another pulse beating through the ward.
Just outside the makeshift ward stands the hospital's charity window, its airconditioning humming softly behind tinted glass, where paperwork is processed like prayers in an unyielding bureaucracy. The face of a senator beams down from the door: a smiling, oversized tarpaulin plastered across the entrance, a reminder of promises never intended to be kept. The charity window is both a monument and a mirage, a place where people, already desperate, are made to plead for help that should have been their right all along.
The tragedy isn’t just that patients must line up and beg for assistance inside their own public hospital. It is that they have grown to believe that they are receiving a gift. That some tiny portion of the taxes they have paid, shaved down to almost nothing and returned with a smile and a logo, is something extraordinary. They walk out clutching vouchers or guarantee letters, heads bowed in gratitude, rarely questioning why what should be basic has been reduced to charity. They are taught to call it benevolence. They are made to feel fortunate for crumbs. And when they return to the humid, overcrowded ward, where the heat presses relentlessly down, they happily and proudly carry their tiny victories like lifelines in a system that was designed not to heal, but to perpetuate the notion that politicians are gods.
In the meantime, healthcare workers like me keep working in hallways, improvising care in spaces that were never meant for healing. We write prescriptions patients will most likely not fill, aware that the cost of a single pill can swallow an entire day’s wage. To free up precious bed space, we hurriedly discharge patients back to the very conditions that made them sick: to the heat that suffocates, to the poverty that starves, to the policies that grind them down. Nothing ever truly ends here. The system doesn’t rebuild people’s lives; it only magnifies their suffering.
It spins in circles, a loop of patched-up bodies, deferred treatments, and temporary fixes that only delay the inevitable. We see the same faces return, their illnesses worsened, their hopes dimmed. Their beds and wheelchairs in the hallways don’t just hold their broken bodies. They carry the weight of the collapse itself, a failure so vast it feels insurmountable. Yet we keep going, because the alternative is unthinkable. Because for these patients, there is nowhere else to go. And for those of us who promised to serve the underserved, who made it our life’s mission to uphold this promise, there is no choice but to stay, even in the depravity of a system that seems designed to pull down lives, and not to lift them.
That afternoon, as I stepped out of the ward and into the open corridor, exhausted not by the amount of work but by the weight of my thoughts and frustrations, I noticed that the air had begun to shift. It was still warm. After all, this is the city nearest the sun, we like to joke, where summer isn’t just a season but a sentence, a reality we must endure and somehow thrive in. But this time, something was different. The suffocating grip of heat had eased, just enough to let the world breathe, and to let me breathe too.
And then I smelled it: that first, familiar trace of rain, rising from the concrete and curling into the air like the faintest of promises. It wasn’t the kind of rain that arrives in thunderclaps and torrents. It was merely a whisper, but even that was enough to stir something forgotten. Watchers shifted in their chairs, their movements slow and groggy at first, as though they too sensed this fragile change. A nurse wheeled out a fan from her station, pointing it toward the patients, letting what little breeze she could muster ripple over them. Nearby, a patient gripped his crutches, his thin frame trembling with the effort as he stood and began to amble toward the toilet, each step deliberate, as though testing this new softness in the air.
Somewhere down the hall, someone laughed. It was soft and unguarded, a sound so rare it caught me off guard. It was the mother of the child with the untouched rice, talking to her kumare, whom she had unexpectedly run into at the hospital. The kumare, her neighbor, had a patient of her own to care for, and yet, amidst the chaos of it all, they managed to find one another. It didn’t fix the sagging ceilings, the overcrowded wards, or the impossible triage of the hospital, but for a moment, it made the mess of it all feel survivable. That laugh was enough to remind me that hope, beaten down and exhausted as it often is, finds ways to rise like the scent of rain curling into overheated air.
And I thought that maybe this is how change begins. Not with sweeping reforms or grand political gestures, but in the quiet, stubborn acts of care that insist on a future: a mother who won’t leave her son’s side no matter the cost, a husband who patiently lines up at Malasakit centers for his wife’s chemotherapy, a nurse who shares the breeze from her fan, or the doctors who continue to treat patients in this hospital, not out of obligation, but because they know that in the absence of others, they must. Change begins in these small, persistent acts of humanity that refuse to give up, even in the face of a system built on scarcity.
Change also begins in the things that aren’t immediate and aren’t heroic but are so deeply necessary: more hospital beds funded for need, not politics, rural health units that are equipped with something as simple and essential as working sphygmomanometers, a public health insurance system that actually works, and that covers so much more than just the first few doses of broad-spectrum antibiotics. Students who are trained not just in diagnosis, but in dignity, so the health care profession becomes not only about proper diagnosis and treatment, but more about respect. Leaders who treat public health not as a podium, not as a campaign platform or viral social media post, but as an unwavering commitment to the lives that depend on it.
There is, of course, no easy cure for a system so fractured. The wounds run deep, and the healing, if it comes, will be slow. But even here, in this city nearest the sun, something keeps trying to take root. It is imperfect. It is painfully gradual. But it is real. Hope, fragile but persistent, exists even in this place where summer is not just a season but a condition of survival. Rain, when it comes, doesn’t simply cool the air. It offers something more. Relief, yes, but also the quiet, almost defiant possibility of change. It doesn’t last long, because rain never does. But it lingers long enough to remind us why we keep going.
And so tomorrow, we rise again. To toil under this relentless heat. To tend to the fractures, the bodies, and the stories that unfold in these overcrowded halls. And to find, in our tiny corner of shade here in this city nearest the sun, enough strength to wait for the coming of another rain. xxx
1 comment:
“The tragedy isn’t just that patients must line up and beg for assistance inside their own public hospital. It is that they have grown to believe that they are receiving a gift. ……… they are taught to call it benevolence. They are made to feel fortunate for crumbs” . 💯🥺🍂
When people lose the belief that they deserve better, the injustice becomes self-sustaining.
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