Tuesday, 4 September 2018

A tale of two patients

It's been over two months since I wrote anything, which is by far the longest interregnum I've ever taken.  And by "interregnum" I mean "I've been too goddamned lazy and/or distracted to sit down at my computer and get some writing done".  Sure, I've seen many blog-worthy patients in the past 8 weeks, but I've just had some trouble framing them into what I thought would be an interesting story.

Until now.

I'd like to present a pair of patients whom I admitted on the same date just a few hours apart.  Both were seriously injured and both spent considerable time with me recovering.  But I found the differences between the two rather startling.  So for this post I've decided to do something a little bit different and see who can spot the differences.

Ready?

Let's begin.

Patient 1: Ivan (not his real name™) was the victim of a hit-and-run pedestrian accident.  He was walking home from work when a car struck him at high velocity.  He suffered a complex fracture of his left tibial plateau, a right humerus fracture, an open right ankle fracture, several broken ribs, and a ruptured urinary bladder.  I performed an exploratory laparotomy and repair of his bladder laceration, and an orthopædic surgeon performed a surgery for his humerus, two surgeries for his right ankle, and 3 surgeries for his left knee (so far).  He had an external fixator on his left knee for several weeks while his œdema improved before his final two surgeries, he had an uncomfortable urinary catheter in his penis for several weeks while his bladder healed, and he was unable to bear any weight on his right (dominant) arm and both legs for 2 months.  In short: he was broken.

Patient 2: Tera (not her real name™) was driving her car down a dark road at night with a blood alcohol level over twice the legal limit when she went off the road and struck a tree.  In the process she fractured her left acetabulum (the socket of the hip) and a bone in her right hand.  She required one surgery on her left hip and was unable to bear weight on her left leg for 6 weeks (no surgery was required for the right hand).  In short: she was mostly fine.

Every day that I went to see Ivan, he was kind, respectful, and polite despite his multiple injuries and significant pain.  "Thank you, doctor" was his closing statement each morning as I walked out of his room.  Even though I had cut him open and inserted a large, uncomfortable tube into his penis, he thanked me.

On the other hand, every day that I went to see Tera, she had nothing but complaints.  The nurse took too long to get my medicine (20 minutes), the nurse took too long cleaning me up (15 minutes), it's too hot (it wasn't), my leg is swollen (it's broken, of course it is), my splint on my hand is too tight (it wasn't), it took too long getting back from getting X-rays (30 minutes), no one is telling me what's going on (yes I was), I want to be transferred to another hospital.

Anyone see the difference yet?

I sure did.  As I walked from one room to the other day after day, the difference in their attitudes astounded me.

Tera (who you will remember caused her own injuries by driving drunk) did nothing but complain.  She even refused physical therapy on multiple successive days because of pain despite the fact that it was the only thing keeping her in hospital.  I wanted to suggest to her nicely (read: scream in her face) that she had a team of people whose entire job was to take care of her so she could try showing some basic gratitude, but I didn't.  No, I just listened.  Standing there and listening to her many grievances was a far, far better thing that I did than I had ever done.  And yet she never once said "Thank you".  She showed no appreciation or gratitude at any time before I finally was able to send her to rehab.

Ivan, on the other hand, who was much more severely injured through no fault of his own, who was completely unable to walk, who had a catheter hanging out of his penis, who had three broken limbs, and who had a huge incision on his abdomen, was still able to smile and cooperate and participate with his own care.  No matter what was asked of him, no matter how much pain he was in, Ivan simply gave a weak smile, said "Ok", and then did it (or at least tried).

Look, I understand that no one wants to be in the hospital.  My patients are in pain and I'm asking them to get out of bed and walk.  I get that.  But all I ask for is a little civility and a little gratitude.  Trust me, I don't want to be seeing your obnoxious drunk ass in the trauma bay at 2 AM either or repairing your bladder at midnight, but here we both are.  So let's try our damnedest to make the worst of times into the best of times.

32 comments:

  1. one more question: am I correct in guessing that there were times when Ivan speculated about things he could have done differently that might have avoided his accident, while Tera made no such speculations?

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  2. Can I see the difference? Well, one was a boy and the other was a girl.

    Did I get it right, doc?

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  3. One is a responsible adult. The other one is an entitled drunk and a jerk.

    Wednesday

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  4. Missed you Dude!

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  5. Hes alive! Missed your stories. Its been part of my weekly routine for years now, and always felt weird not being able to read more stories from you.

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  6. Don't tell me, lemme guess. Ivan was a man age 40-55, whereas Tera was an entitled little guttersnipe under 30? Am I right?

    Glad you're back, Doc! I thought you & Mrs. B had taken the kids & gone off for an extended summer holiday.

    And again I ask (because I've forgotten what your answer was previously): When someone ends up in the ER for a DWI, which is documented by the blood work, don't you or the head nurse or the EMT who brought the patient in report it to the cops? ER staff ALWAYS report gun shot wounds to the cops -- isn't it the same for DWIs? Did Tera at least catch a case for her efforts?

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    1. where I am, if there is a DWI crash, the cops already know. and if they can't get a breath sample, they have a judge on speeddial for a warrant for blood or urine testing.

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  7. Attitude is everything... Welcome back Doc

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  8. I always try to be a 'good patient'.. it's not really in my nature to complain, and the doctors are busy enough without dealing with trivial complaints.

    Physiotherapy can be hard when none of your limbs work properly, though.

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  9. It takes a lot of discipline to hold your tongue in the midst of an ungrateful attitude. If I were in your shoes, Doc, I doubt I could hold my tongue, in fact, it would probably be the worst case of Tourettes Syndrome you ever saw. Thanks for your stories and perspective. (nautipirate)

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  10. Character is the difference.

    My brother was run over by a truck, fractured pelvis, who knows what all else, no pulse at the scene, 6 weeks flat on his back.

    All through, he was like your Ivan-polite, patient, thanked everyone. He certainly had his challenges but he dealt with them with incredible grace.

    One of his room mates (he was there 6 weeks, he had loads) sticks in my mind. He had stolen a lawnmower and broken his leg trying to get away when the owner pursued him. He was rude, abusive, foul-mouthed, had horrible takeaways brought in by his rude, abusive foul mouthed teenage girlfriend (he was in his 30s); was set up in a special wheelchair so he could go outside and smoke, and was generally obnoxious. He was convinced he had outwitted the 'pigs' ie police who were there to interview him.

    There were also some lovely people through-including the tradie giving quotes while high as a kite on pain relief after his motorbike accident.

    Character comes through in hard times.

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    1. those had to have been some interesting quotes.
      "I can do it, but it'll cost you a ton and 50 pounds, and a tin of biscuits"

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    2. Indeed. To this day my mother still oh so casually asks where tradespeople are when she's talking on the phone.

      I hope he was able to get back to work properly, he was pretty banged up.

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    3. I saw a guy who was predicted to never walk properly again go back to climbing trees.

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  11. I have to apologize to many doctors; I am a PITA when i'm in discomfort. I was hospitalized for a collapsed lung, and not only was I in great discomfort from the chest tube going out my back, the general pain made it nearly impossible to sleep for longer than ten-fifteen minutes at a time. I will confess to being more than a little short with the nurse I asked to give me a painkiller so I could try and sleep. I have since had it explained to me that "I'll be right back with that" equates to 10-60 minutes, and not actually "right back."

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    1. And it's great to see/read you again!! Welcome back!

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    2. I worked on a surgical unit many years ago. By far, at least it seemed to me, the patients in the most pain were those with chest tubes. The tubes are sutured in place on the outside of the torso, but they shift every time the patient moves or takes a breath.

      OUCH! Sometimes grouchiness is warranted. To a point.

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  12. As someone who is under 30, I take offense to your insinuation that someone 40-55 is mature and responsible, while someone under 30 is an “entitled little guttersnipe”

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    1. age is not relevant to maturity. I have seen people still be an entitled little guttersnipe at 70.

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  13. I don't think you did Tera a favour by holding your tongue. Not in the long run - by not letting her feel the true resonance of her actions and words upon others - and not in the short run - by allowing her to abuse nurses and other personel alike.

    I am a teacher and I often find myself correcting stuff with teenagers that their parents simply were too lazy to do.

    In one word: Letting them feel that their actions and words always have CONSEQUENCES! Be it positive or negative. It's their choice.

    It's hard work and a pain in the ass. But in the end, they are so glad that someone cares. No icy indifference like at home. They fit in more. And that in itself is a rewarding feeling. They feel someone cares.

    In short: If you need to put someone like Tera back to the ground, if you need to stop that self-centered whiny behavior, hire a teacher!

    S/He'll deliver the speech of Tera's life. S/He'll make a list of allowed behaviors, and not allowed behaviors, that will be ignored or kicked out. It's as simple as that.

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  14. The folks that call in to pick up their vehicles after DUI arrests are the absolute F'n worse.. Those shitbags are stuck up their own asses..
    I had two back to back call in one day and it took every ounce of self control not to come thru the phone and break their useless necks..
    I already have a disdain for them assholes but lord have mercy when they speak as if it's everyone else's fault they got themselves in to this shit-show, I want to address them as "yeah-okay Mr. Or Ms. Narcissist"..

    I released one DUI car personally, I got sent down to the yard because I was the senior on duty.. That bitch wanted to run her mouth and call me a whore and a bitch, those names to me are kiddie names, let's call me as it is.. I stood up and grabbed a metal activator bar and asked her nicely to call me a cunt (American style not the damn uk meaning) because I am a grown ass woman not a 16 year old fighting over a boyfriend. She shut her mouth, I told her you haven't seen evil til I say she was drunk again trying to pick up her car and i refuse to release it..

    Self entitled pricks that you can bank they have drove drunk many times and thought they were above the law because they were never caught, til they kill someone.. Now that I work with 30+ tow companies I see a whole lot more DUI fatalities and it makes me bitter..

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    1. can't go into detail, but in theory, there are a few less who fit the profile on the road, today.

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    2. One can hope but I took three in a row for a certain company last night, and had 3 in a row for another company across the states Friday night

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    3. hopefully a least a couple of yours will be in alternate lodging for a while.

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    4. Cali, gotta ask. You asked the nasty woman to call you a cunt "American style, not the damn uk version".

      UK version? Please enlighten this American. Is there something worse in your vocab cache? Might prove useful over here as well!

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    5. finally, the media released that we got ONE drunk driver off the road - at least temporarily, friday night.

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    6. Anon: the UK usage is milder than the US usage. hence cali was challenging the woman to go all-in on the offensiveness.

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    7. I hate the C word. It is crude slang for the vaginally, it is more commonly used as a insult, a nasty insult, describing someone as a C word is to mean the lowest of the low, nasty, disgusting. It I'll cause a fight in many cases

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  15. Sometimes (not often) patients can overdo Ivan’s approach.
    A few years ago, I remember getting a telephone call at 2am from farmer...

    ‘Sorry to bother you doc, if you happen to be passing could you drop by the farm, I’ve had a bit of an argument with the bull. It’s ok, it’s safe, I’ve penned him’... I quickly gathered a few brief details of the ‘argument’...

    End result:
    75 year old farmer, pelvic fractures involving acetabulum (still don’t know how he penned the bull), class 2 shock, stabilised, admitted to rural hospital, operated on by (very) General Surgeon and was back at work a few months later.

    He still apologised for disturbing my sleep when I saw him later.

    Scots Farmers can be crazy Ivans but overall Teras are more common.

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  16. Gotta share this. Someone might get a kick out of it.

    I work on a postpartum unit, teaching new moms and babies how to breastfeed. A couple years ago, went to see a mom, as requested. There was a weird vibe in the room; the dad glared at me angrily and wouldn't speak to me, even as I tried to draw him in to the discussion. The mother was polite but rather curt. She did not seem interested in anything I had to say. I wound things up quickly and got the hell out of that room! My average time spent is 45 minutes to an hour; I was in there less than 20 minutes.

    Months later, my boss calls me to her office. Uh oh. There has been a complaint from a patient. I looked at the record and remembered this couple immediately. Asked what the complaint was about.

    Are you ready? She complained that "all the nurse was interested in was groping my breast". Umm...I teach breastfeeding. The consultation was a request from the mother. Fortunately, this couple had made a name for themselves in that they griped about everyone they met at our hospital, from the triage staff to the docs.

    Entitlement? When I was a kid, we just called it being "snotty".

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  17. I feel you doc. Sometimes it seems that I am the only person left in the world who says "please", or "thank you", or actually looks you in the eye when saying it. Even (especially) the hubby gets a sincere "thank you, that was nice" after each and every meal that he cooks (I work full time, he's retired). By the way, did you ever find the lost ring?

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  18. Politeness costs nothing and a simple thank you can make someone's day a whole lot better

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