Today on rounds I was talking to a patient who was about to be discharged from hospital. She had initially come in with an acute airway obstruction - we didn't know why (still don't really). We did an emergency tracheostomy on her that evening. We think there was something infectious going on, though we never did figure out what. She got better, and her trach is now out, but she developed a really bad pneumonia after it all. She's been with us a few weeks, but today was ready to go home.
As I was giving her discharge instructions, I meant to tell her that if she developed another fever, chest pain, or difficulty breathing, she should come to hospital before her 2-week follow-up time. I said those things to her, and she looked at me and smiled in an amused sort of way. I stopped for a minute, and said, "Wait, how do you say 'breathe' again?" When they told me I realized what had happened. The Nepali word for "laugh" is "hass," while the word for breathe is "sass." I had said "hass" instead of "sass," thus asking her to come back if she developed a fever, chest pain, or had trouble laughing. Oops!
Some of you have been asking about little Sarik, the malnourished baby who we were worried had a bowel obstruction. Last week we realized there was really nothing more we could do for him, and so his mother took him home, not because he was better, but because we had no more options. She knew she was taking him home to die. I haven't heard any more since then, and I doubt that I will. My guess is that he's probably died by now, but I don't know that for sure and I likely never will. It's hard not knowing the final outcome, and we really don't have the opportunity to truly follow up on how our patients do after they've been discharged from the hospital. Even the ones who left and were seemingly doing fine could have complications we never hear about. And the final pathway for most patients who are dying is that their families take them home. They have other responsibilities at home, usually, and it's expensive to keep people in hospital, so if there's nothing more that can be done, they just go home. Very different than in Canada, where dying in hospital or some kind of institution is the most common thing. In some ways this is more "natural," I guess...just very foreign to our Western minds.
It also makes it difficult for us to know what our surgical outcomes really are. We discharge patients, and then often never see them again, either because they are better, or because they are worse or dead and never come back. Many of them come from quite far away, though we don't, for the most part, hear stories about people walking for days to get here like you do in some places in the world. But to come back requires quite a lot of effort on their part, and so we don't routinely schedule follow-up for most patients after surgery, unless there is something specific we're watching for. They get their wound care or suture removal done at the local health posts (small clinics run by nurses in the rural areas), and we typically don't see them again. Even if we did tell them to come back for follow up, many wouldn't come. It's just the reality of life here. Makes it hard to judge sometimes how well we are actually caring for our patients. But in the end, we do the best we can, and leave the outcomes up to God. It's all we can do, and we pray and trust that it makes a difference in people's lives and in this nation.
As I was giving her discharge instructions, I meant to tell her that if she developed another fever, chest pain, or difficulty breathing, she should come to hospital before her 2-week follow-up time. I said those things to her, and she looked at me and smiled in an amused sort of way. I stopped for a minute, and said, "Wait, how do you say 'breathe' again?" When they told me I realized what had happened. The Nepali word for "laugh" is "hass," while the word for breathe is "sass." I had said "hass" instead of "sass," thus asking her to come back if she developed a fever, chest pain, or had trouble laughing. Oops!
Some of you have been asking about little Sarik, the malnourished baby who we were worried had a bowel obstruction. Last week we realized there was really nothing more we could do for him, and so his mother took him home, not because he was better, but because we had no more options. She knew she was taking him home to die. I haven't heard any more since then, and I doubt that I will. My guess is that he's probably died by now, but I don't know that for sure and I likely never will. It's hard not knowing the final outcome, and we really don't have the opportunity to truly follow up on how our patients do after they've been discharged from the hospital. Even the ones who left and were seemingly doing fine could have complications we never hear about. And the final pathway for most patients who are dying is that their families take them home. They have other responsibilities at home, usually, and it's expensive to keep people in hospital, so if there's nothing more that can be done, they just go home. Very different than in Canada, where dying in hospital or some kind of institution is the most common thing. In some ways this is more "natural," I guess...just very foreign to our Western minds.
It also makes it difficult for us to know what our surgical outcomes really are. We discharge patients, and then often never see them again, either because they are better, or because they are worse or dead and never come back. Many of them come from quite far away, though we don't, for the most part, hear stories about people walking for days to get here like you do in some places in the world. But to come back requires quite a lot of effort on their part, and so we don't routinely schedule follow-up for most patients after surgery, unless there is something specific we're watching for. They get their wound care or suture removal done at the local health posts (small clinics run by nurses in the rural areas), and we typically don't see them again. Even if we did tell them to come back for follow up, many wouldn't come. It's just the reality of life here. Makes it hard to judge sometimes how well we are actually caring for our patients. But in the end, we do the best we can, and leave the outcomes up to God. It's all we can do, and we pray and trust that it makes a difference in people's lives and in this nation.
