competence and kindness
On May 28, 2005 at about 9:45 AM in the morning, somewhere about 10km outside of Port Renfrew on Vancouver Island, I came face to face with a large pothole. I was racing in the BC Provincial Road Race Championships on the course formerly known as the "Gary Lund Memorial" -- a 140km out and back ride from Sooke to Port Renfrew to Sooke. It's a beautiful race, one that I'd done many times before. But today, I wouldn't finish it the way I'd hoped. I hit a pothole on a tricky descent after a steep climb, pitching me off my bike at 45kmh and shoulder first into the ground. Like most collisions with the ground, the ground won. I wound up with a broken right clavicle (collarbone) and a fractured fifth metacarpal (right little finger bone in my hand) and lots and lots of road rash.
The lovely road from Sooke to Port Renfrew: Greg Descantes photo.
After lying on the ground for a good 20 minutes, the fine folks from St John's ambulance came to attend to me. They asked me where I was. I responded with lots of profanity about being 10 f***ing km outside of Port Renfrew on a shitty piece of road and how my shoulder was "crunching."
They loaded me up, put me in an ambulance on a clam-shell stretcher, straight-jacketed me down, taped my head to the board so I wouldn't move on the twisty ride home, and waited for the "real" ambulance attendants to show up. They did, in another 20 minutes or so, then another 20 minutes after that we were on our way.
In a strange twist of fate, we ran into my coach on the way back. He had crashed his motorbike going between feedzones. We stopped, being "the only show on the road" according to my attendant, and dealt with his injuries, far, far more serious than my own. Another ambulance came, another hour passed, and we were on our way again, me in one ambulance, my coach in another.
It was a bad day. Really bad.
Some 4 hours after I had crashed, I arrived at Victoria General Hospital (head still taped to the clamshell, still strapped down), where I was treated for my road rash and broken bones. I was frozen, drugged, then scrubbed down with a variety of instruments to get the souvenirs of Port Renfrew's finest paving job out of my ass and leg, shoulder, elbow, arm, and knuckles. My torn finger pads were cleaned, sterilized, and bandaged. It hurt, but was only possible thanks to the freezing job they'd done prior to the clean.
Zoned on T3's, I shuffled gingerly to the xray ward, where it was confirmed that I had broken my clavicle and fractured my finger. In the age of digital xrays, it was a matter of seconds between the buzz of the machine and the "Oh yeah, she's broken!" of the xray technician behind the glass.
My ER doctor finally arrived back to my bed, sometime later on in the day, at roughly 5:00 or 6:00 PM after my scrubbing and xraying. He confirmed my injuries, walked me through what had happened, let me know there was nothing that could be done for my collarbone, and then moved onto my finger.
And that's when he gave me a choice.
"So here's the deal. We can do 1 of 2 things. Either we freeze your hand up right now and set your finger back into place and then cast it, or we can simply cast it as-is. It's only angulated 10 degrees, it's considered a "boxers fracture," and you'll be left with a normal functioning hand after it comes out of the cast, just with a small bump on the back of it."
Behind Door #1: Break it back, cast it
Behind Door #2: Leave it be, put it in a cast and get the hell out of there
After being straightjacketed on a clamshell stretcher in an ambulance, beaten, battered, bruised, and bleeding for 4 hours, your head taped to the board, then having been scrubbed from head to toe with plastic scrubbers to pull gravel and stones out of your skin.... which option are you going to go for?
This is not a difficult choice to make. I tell him that I've had enough pain for one day, thanks very much, and put the cast on. The nurse returns with the plaster kit and I get to wear my first ever cast. I leave the hospital at 7:00 pm that night, head home to Vancouver the following day, and live with my parents for 2 weeks because I can barely wipe my own ass. Getting up off the couch to have lunch is the big accomplishment of the day. A far cry from the 140km road race with BC's finest cyclists only a few days before.
Me, broken and sedated on T3's, with Mum.
Fast forward 3 weeks. I'm having my hand xrayed (through the cast) at UBC back in Vancouver. The xray reveals the fracture to be "closer to 30 degrees than 10 degrees" to which I'm not very impressed. Misdiagnosed in Victoria? Is it angulating while in the cast? I don't know, neither does my GP.
Fast forward another 3 weeks. It's July, Superweek of cycling is here in Vancouver. I'm sitting out, watching my teammates. I get my cast taken off at the VGH Hand Clinic. An xray at the 5 week mark has shown that my fifth metacarpal has now angulated to 50 degrees. But the good news: now it's fused. So much for "normal functionality" as described in Victoria.
The hand sees the light of day for the first time in 6 weeks.
Fast forward another 8 weeks. It's September 8th and I'm at the VGH Hand Clinic again. I've visited the surgeon after having done 6 weeks of physio, twice a week at a great clinic near my house. I've gone from being able to bend my pinky knuckle 40 degrees on the first day in there back to the 95 degrees enjoyed by people with regular hands. But it's not working quite right. It scissors -- meaning it runs into my ring finger beside it. The fracture has healed at an angle and my pinky points towards my thumb when I try to make a fist. It overlaps and feels awkward. It just isn't working right.
The VGH Hand Clinic tells me to wait a while. A year, to be precise, and see how it goes. If it's really not working for me, then hey, we can always break it back and put pins in it. But even that isn't 100% in terms of making sure it will be straight again. It's a long road of recovery following surgery like that.
So here I am, typing this with my 85% pinky, better than it was on May 28th, but certainly not functioning as it did for the 29 years before that day. And it looks like that unless I'm really pissed off about it and willing to take the risk, I'll be living with it like this for the rest of my life.
Big deal -- my pinky is slightly crooked. Hooray. This is a long weblog post just to get to this point. The thing that gets me in all of this is the decision that I made about the future of my finger. The doctor gave me the choice about how I best wanted to treat my fractured finger. And based on the two sentence overview of the options, whilst decently sedated, I made a decision. Now, I'm feeling none too pleased with that decision. In fact, I'm feeling a tinge of regret. Can you tell?
But there you have it.
I read a book while I was recovering called The Paradox of Choice: Why More is Less by Barry Schwarz. Deep inside this exploration into the world of how we make decisions, evaluate choices, and the resulting (un)happiness of those choices, he has a small excerpt on medical care and the choices provided to patients these days.
Schwarz, quotes New Yorker contributor Atul Gawande who writes this about the patient/doctor relationship of the recent past:
Schwarz goes onto say how this changed though. In large part due to a book entitled The Silent World of Doctor and Patient by physician and ethicist Jay Katz, published in 1984. The pendulum swung almost exactly in the opposite direction. Gawande feels this has gone too far. Another quote:
Indeed, that day in Victoria, choice was a blessing and a burden for me. Had the doctor informed me of the future non-functioning of my little finger, my inability to grip my handlebars of my racing bike properly, and the general frustration of having a body part not quite work the way it should, I probably would have chosen differently. Instead, my addled and exhausted brain, doing the best rational job it could at the time, said, "Gord, let's just go home. It's been a long day. Let's just make the pain stop now, okay?"
Not surprisingly, research shows that most patients want to have doctors make choices for them. Final quote from Schwarz:
Count this one as a lesson learned. And hopefully one I don't need to call upon again in the near future.
The lovely road from Sooke to Port Renfrew: Greg Descantes photo.
After lying on the ground for a good 20 minutes, the fine folks from St John's ambulance came to attend to me. They asked me where I was. I responded with lots of profanity about being 10 f***ing km outside of Port Renfrew on a shitty piece of road and how my shoulder was "crunching."
They loaded me up, put me in an ambulance on a clam-shell stretcher, straight-jacketed me down, taped my head to the board so I wouldn't move on the twisty ride home, and waited for the "real" ambulance attendants to show up. They did, in another 20 minutes or so, then another 20 minutes after that we were on our way.
In a strange twist of fate, we ran into my coach on the way back. He had crashed his motorbike going between feedzones. We stopped, being "the only show on the road" according to my attendant, and dealt with his injuries, far, far more serious than my own. Another ambulance came, another hour passed, and we were on our way again, me in one ambulance, my coach in another.
It was a bad day. Really bad.
Some 4 hours after I had crashed, I arrived at Victoria General Hospital (head still taped to the clamshell, still strapped down), where I was treated for my road rash and broken bones. I was frozen, drugged, then scrubbed down with a variety of instruments to get the souvenirs of Port Renfrew's finest paving job out of my ass and leg, shoulder, elbow, arm, and knuckles. My torn finger pads were cleaned, sterilized, and bandaged. It hurt, but was only possible thanks to the freezing job they'd done prior to the clean.
Zoned on T3's, I shuffled gingerly to the xray ward, where it was confirmed that I had broken my clavicle and fractured my finger. In the age of digital xrays, it was a matter of seconds between the buzz of the machine and the "Oh yeah, she's broken!" of the xray technician behind the glass.
My ER doctor finally arrived back to my bed, sometime later on in the day, at roughly 5:00 or 6:00 PM after my scrubbing and xraying. He confirmed my injuries, walked me through what had happened, let me know there was nothing that could be done for my collarbone, and then moved onto my finger.
And that's when he gave me a choice.
"So here's the deal. We can do 1 of 2 things. Either we freeze your hand up right now and set your finger back into place and then cast it, or we can simply cast it as-is. It's only angulated 10 degrees, it's considered a "boxers fracture," and you'll be left with a normal functioning hand after it comes out of the cast, just with a small bump on the back of it."
Behind Door #1: Break it back, cast it
Behind Door #2: Leave it be, put it in a cast and get the hell out of there
After being straightjacketed on a clamshell stretcher in an ambulance, beaten, battered, bruised, and bleeding for 4 hours, your head taped to the board, then having been scrubbed from head to toe with plastic scrubbers to pull gravel and stones out of your skin.... which option are you going to go for?
This is not a difficult choice to make. I tell him that I've had enough pain for one day, thanks very much, and put the cast on. The nurse returns with the plaster kit and I get to wear my first ever cast. I leave the hospital at 7:00 pm that night, head home to Vancouver the following day, and live with my parents for 2 weeks because I can barely wipe my own ass. Getting up off the couch to have lunch is the big accomplishment of the day. A far cry from the 140km road race with BC's finest cyclists only a few days before.
Me, broken and sedated on T3's, with Mum.
Fast forward 3 weeks. I'm having my hand xrayed (through the cast) at UBC back in Vancouver. The xray reveals the fracture to be "closer to 30 degrees than 10 degrees" to which I'm not very impressed. Misdiagnosed in Victoria? Is it angulating while in the cast? I don't know, neither does my GP.
Fast forward another 3 weeks. It's July, Superweek of cycling is here in Vancouver. I'm sitting out, watching my teammates. I get my cast taken off at the VGH Hand Clinic. An xray at the 5 week mark has shown that my fifth metacarpal has now angulated to 50 degrees. But the good news: now it's fused. So much for "normal functionality" as described in Victoria.
The hand sees the light of day for the first time in 6 weeks.
Fast forward another 8 weeks. It's September 8th and I'm at the VGH Hand Clinic again. I've visited the surgeon after having done 6 weeks of physio, twice a week at a great clinic near my house. I've gone from being able to bend my pinky knuckle 40 degrees on the first day in there back to the 95 degrees enjoyed by people with regular hands. But it's not working quite right. It scissors -- meaning it runs into my ring finger beside it. The fracture has healed at an angle and my pinky points towards my thumb when I try to make a fist. It overlaps and feels awkward. It just isn't working right.
The VGH Hand Clinic tells me to wait a while. A year, to be precise, and see how it goes. If it's really not working for me, then hey, we can always break it back and put pins in it. But even that isn't 100% in terms of making sure it will be straight again. It's a long road of recovery following surgery like that.
So here I am, typing this with my 85% pinky, better than it was on May 28th, but certainly not functioning as it did for the 29 years before that day. And it looks like that unless I'm really pissed off about it and willing to take the risk, I'll be living with it like this for the rest of my life.
Big deal -- my pinky is slightly crooked. Hooray. This is a long weblog post just to get to this point. The thing that gets me in all of this is the decision that I made about the future of my finger. The doctor gave me the choice about how I best wanted to treat my fractured finger. And based on the two sentence overview of the options, whilst decently sedated, I made a decision. Now, I'm feeling none too pleased with that decision. In fact, I'm feeling a tinge of regret. Can you tell?
But there you have it.
I read a book while I was recovering called The Paradox of Choice: Why More is Less by Barry Schwarz. Deep inside this exploration into the world of how we make decisions, evaluate choices, and the resulting (un)happiness of those choices, he has a small excerpt on medical care and the choices provided to patients these days.
Schwarz, quotes New Yorker contributor Atul Gawande who writes this about the patient/doctor relationship of the recent past:
Only a decade ago, doctors made the decisions; patients did what they were told. Doctors did not consult patients about their desires and priorities, and routinely withheld information -- sometimes crucial information, such as what drugs they were on, what treatments they were being given, and what their diagnosis was. Patients were even forbidden to look at their own medical records; it wasn't their property, doctors said. They were regarded as children: too fragile and simpleminded to handle the truth, let alone make decisions. And they suffered for it.
Schwarz goes onto say how this changed though. In large part due to a book entitled The Silent World of Doctor and Patient by physician and ethicist Jay Katz, published in 1984. The pendulum swung almost exactly in the opposite direction. Gawande feels this has gone too far. Another quote:
The new orthodoxy about patient autonomy has a hard time acknowledging an awkward truth: patients frequently don't want the freedom that we've given them. That is, they're glad to have their autonomy respected, but the exercise of that autonomy means being able to relinquish it.
Indeed, that day in Victoria, choice was a blessing and a burden for me. Had the doctor informed me of the future non-functioning of my little finger, my inability to grip my handlebars of my racing bike properly, and the general frustration of having a body part not quite work the way it should, I probably would have chosen differently. Instead, my addled and exhausted brain, doing the best rational job it could at the time, said, "Gord, let's just go home. It's been a long day. Let's just make the pain stop now, okay?"
Not surprisingly, research shows that most patients want to have doctors make choices for them. Final quote from Schwarz:
What patients really seem to want from their doctors, Gawande believes, is competence and kindness. Kindness of course includes respect for autonomy, but it does not treat autonomy as an invioable end in itself.
Count this one as a lesson learned. And hopefully one I don't need to call upon again in the near future.
5 Comments:
Great story. It reminds me of another Gawande story, the one about the relative quality of doctors as told by the relative performance of cystic fibrosis clinics.
The reason I think about this story is that your story also reminds me of what happened to my dad about 12 months ago: he went in for routine carpal tunnel alleviation surgery.
It wasn't routine. He's still not back at work.
Of course, we also have the problem that our expectations have risen with the capabilities of doctors. And it could have been worse: this could have been your x-ray.
By
Ryan, at 11:17 pm
You're a patient fellow. Having been around you a reasonable amount of time during this period, I've discovered you're not one to complain. To an information worker (typist) losing the 5th is like crippling your voice.
It must be like reverting to being on a typewriter without full reach to the backspace key. I counted that I used my pinky 17 times in typing this and backspaced 4 times in this paragraph. Maybe a spin-off will be that you become a more efficient cognitive pre-writer!
B.S.
By
Anonymous, at 9:30 am
I came across your blog entry while googling information on "broken pinky fingers." Mine, too, has healed at an angle, I've been frustrated with my medical care, and I'm looking for comfort (or at least similar stories) on the Internet. No one can understand how important such a little thing (such a little finger!) is until they can't use theirs properly. A tight fist is a terrible thing to waste....
By
Anonymous, at 9:32 pm
For shame about the Boxer's Fracture of the pinky. I, too, received one from less than an honest accident. I'm on my fifth day in a half brace and living in fear after reading your story along with countless others.
Unfortunately, these tales of medical malpractices are rampant. I have yet to find a personal account of Boxer's Fracture with 100% recovery. I fear I will be the next victim of malpractice.
I've already lost my job as a web designer and I have to sell my car to pay mortgage and other bills. Not so easy to find a job that only requires one hand, unless it's the cretinous telemarketing. I can't even sweep warehouses.
So it's highly likely that my career is gone and I will still be impeded from some of the average job requirements. My back-up forte was light duty mechanics, but if I can't grip tools then I have no hope of maintaining the high expenditure of owning a home.
I was told a hand specialist would assess the fracture in two weeks. That's great... I'm unemployed and my lower pinky bone could be rotated all along beforehand. If they unfuse the fracture or whatever the case may be, that's two weeks of useless healing that's been wasted.
Not funny how I remember the medical person joking about how my pinky will be able to touch my thumb better! He was obviously mocking the likelihood of my pinky arc being deficient after I read all these personal stories of having debilitation due to abnormal rotation from poor medical procedures. I wonder how many malpractice suits linger from the infamous Boxer's Break.
I'm honestly scared that I will become another statistic with a crippled hand due to negligence within the medical community. I know it's too early to tell in my case, but I fear the worse as it seems to be all too common.
One thing is for sure, I best be looking for a second opinion as soon as tomorrow. This may be my only chance to save my hand or at least salvage most of it.
My sincerest condolences on your hand. I know this blog post is old, but I shall head your past words of wisdom. You may have directly saved my hand by recanting your plight. I will most certainly go see someone else before waiting two weeks for the hand specialist. I deserve a second opinion while facing an impending disability.
By
/, at 12:21 am
Looks like I might be headed down the same road...I asplinted my pinky six weeks ago thinking I just had a jammed finger. Swelling is now worse and so is pain.....guess I better get to the doc!
By
Anonymous, at 9:18 am
Post a Comment
<< Home