10.12.2011

another round of gnnnnaarrrrrgh!

Can i hazard a guess that it's universally annoying to all to know that one is right, but can't do a thing about it? Patients are lovely like that. they revive random sentiments every so often, just to keep me on my toes. Just yesterday, I had to talk to a 40 year old housewife in Mandarin to explain why her distal radius fracture really needs surgery.

Despite explaining that:
  • her bones would heal in about 6 weeks regardless of surgery
  • she would continue to have improving levels of pain until her bones healed
  • we would give her medications through the drip and tablets to control her pain
  • her arm would be out of action for the next 6 weeks until her bones healed
  • she would have poor function if her bones healed in a not-so-ideal position like they're in now
  • she may not have pain now, but may experience pain in the future with unsatisfactory positioning of the pieces
  • she will have no guarantee of finding an orthopod who will perform the required surgery up in sydney, let alone guarantee that the surgery will proceed at the latest, tomorrow
  • she doesn't even know where to find an orthopod
  • any number of friends she's got, unless they're in the medical system, will not even come close to getting her near an orthopod in Sydney (I was also thinking that it would prolly help if she had some English speaking friends in an English-based country but kept that thought to myself)
  • she is already fasted for more than 6 hours and is technically ready to go to theaters
  • she could be home in sydney by tomorrow afternoon if all goes well
  • she is lucky there wasn't much trauma on in theaters and we could fit her in within the next few hours
  • we don't advocate operations just because we like cutting people open and we have nothing better to do (shush, all you naysayers! *waits for the ortho-bashing*)


We traced lines and angles on her xrays to explain. We got her friend to explain (after we went through the above again in Mandarin because, much to my dismay, her friend couldn't speak English either. URGH!). We showed her what normal bone alignment was supposed to be like and what hers looked like. She obviously got it because there was a lot of tsk-tsking and shaking of her head along with her gasps.


And despite all that..



The lady refused surgery. 
And for what reason?


She was paiseh. Really, lady. You would rather live with a broken wrist that would very likely continue to collapse and shift in position (especially after you refuse a backslab because you were scared of pain) and cause you functional problems in the future, besides the possibility of pain and future corrective surgery or wrist fusion. You would rather live with that because you were too shy or polite or whatever you call it for not wanting to bother your friends by staying an extra night because you were only meant to stay one night. Really, lady? Really?


So, I got a bit shitty with her. I was right! She knew it just as well as I did. She knew I was being so persistent as her advocate, so she kept thanking me. That really made me more mad. I told her to stop thanking me because it wasn't going to help her wrist return to normal function. And then I launched into the consequences of declining surgery, making sure she understood them all. She said she did. Then she would start to thank me again. We went in circles and it drove me mad. My Aussie colleague could only roll her eyes as she figured out the gist of it without needing to understand a word of Chinese. Because nobody was happy, we got an ED intern that could speak Mandarin to reiterate everything again just to make sure the lady wasn't being daft because of my linguistic skills, or lack of.


By then, my colleague and I had had it. Why the hell were we wasting time with an obstinate idiot who obviously values "face" to avoid any "shame" (such as walking out with a backslab) more than her well-being, or that of her family's. So we left it at that and told her that ultimately, it was her body, her choice but she had to be put in a backslab as basic fracture management.


Imagine my surprise when I saw her name on the pre-op patient list this morning!!
She had some sense of self-preservation after all! Yay, there's hope.. but boo, she made me work for it dammit!

No comments: