Indexing Title: CLEYSONs Medical Anecdotal Report [05-09]
 
MAR Title:  CONFUSED MOTHER

Date of Medical Observation: October, 2005 

Narration

This is a case of a 14-year-old, male, who sustained a gunshot wound on the right knee. Remarkably, x-ray plates revealed no evidence of fracture. The bleeding detected initially trickling down the exit wound stopped, and the site was dressed. All was calm when I noticed that the dressing was getting soaked with blood. We promptly undid the dressing and took note of bright red blood gushing out of the cartridge exit site.  We directed the patient to the operating room, where wound exploration was staged. Intraoperatively, we found a complete transection of the popliteal artery; and to our relief, the vein and nerve remained undamaged. We anastomosed the popliteal artery using a saphenous vein graft. After partially closing the wound, we realized that compartmentalization had set in on the leg; so, fasciotomy was done to release the mounting pressure.  On the first post-operative day, I had gotten the chance to talk to and explain to the patient’s relatives of his predicament. Subsequent days passed by unremarkably for the boy, he was gaining strength and his wounds were granulating well. When it was time to send him home, discerning that recuperation at home would do him a world of good rather than prolonging his stay with us here at the hospital, I cheerfully ordered MGH (May Go Home). Now, usually the reactions I get from the recipients of this powerful “MGH” had been heart warming, smiles and thank yous’ all around; sometimes even paired with a little token of their appreciation. Mind you, I was kind of waiting for some gurgle of excitement over my announcement of sending him home that day, but it never came.

I was taken aback when the mother blurted out “Eh paano yan doc, paglumabas sya, huhulihin at ikukulong na siya ng pulis. Pwede bang dito na lang siya pansamantala?” It seemed that she wanted to use the hospital to prevent her son from being arrested by the police, who have been suspecting the patient to be a member of a gang heist. I told her that what she was contemplating was not possible for a lot of reasons. I calmly explained the consequences of staying too long in the hospital: the complications and infections that her son might acquire. Besides, the hospital is no place for hiding. On the third day, I referred the patient to our service consultant who agreed to approximate the wound so we can send the patient home if the mother has qualms of cleaning a frank wound. I explained the plan to the mother and she agreed with it. The next day, she seemed to have developed amnesia and thrown out our discussion previously out the window. We were once again involved in the same topic of discussion. At that point, weariness got to me, I let my patience slipped away from my grasp. My voice increased an octave while explaining the same things I have explained for the umpteenth time. But after a while I realized that there was no point in being angry. It was a waste of energy. I took a deep breath in exasperation, then  explained once more the situation at hand, but this time, I instructed her to put in writing on the patient’s chart that she actually understands our discussion. I felt exhausted but relieved that finally we’ve reached a closure. The very next day, however, she pricked my bubble because we were at it again.

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements)  

In our country, family ties are very strong – we will protect our herd if it means fighting the wolves with our bare hands. In this case, the mother was caught in between keeping her child at her side and from the law. To prevent her child from being taken away by the police, she did what she can to delay her boy’s discharge. But in doing so, she was unconsciously putting her child’s and her own health on the line. In all honesty, I could not fathom her adamant actions of not going home even after explaining the consequences of long hospital stay. Either she really believed that her son is innocent or he’s guilty beyond reasonable doubt. My view on this matter, however, is to face the truth as soon as possible and be done with all of the turmoil. In dealing with ordinary people we should never expect them to grasp all of what we are saying in just one occasion. We should stretch our patience and be the one to adjust to their pace of comprehension. We should use the simplest form of words – the layman’s words. Although, in our profession, I can not fault any one who losses his patience once in a while, we are but human as well.

But we should give extra effort in holding up our patience. We should always show them that we are professionals and that they can trust us, because we have but best of intensions for their well being.