Why Did You Wait So Long?
On Sunday I arrived on call, and found casualties saturated with the unmistakable smell of Septic Leg. The source was a man who at thirty-six years of age seemed far too young to be in possession of a rotten limb, and he was in bad shape: pale and sweaty and septic. His leg was a shocker (and I've seen a few) - it was bloated and green, with a large chunk of black stuff hanging out of the side of his foot. When I squeezed his calf near his knee, bloody pus oozed out of a sinus near his ankle. Nasty.
He had no other diseases that he knew of (although his blood pressure was sky-high), and said he hadn't injured the leg. I asked him when it had started, and he said he wasn't really sure, but mumbled something about 'the last All Pay day' (All Pay is kind of like the dole). This kind of disaster doesn't occur overnight, and so I pressed him a little harder - had his leg been dodgy for days, or weeks, or months? Shrug, mumblemumble. Finally I asked, 'When last did you walk by yourself?' and he just looked at me and said, 'You know, so long ago that I can't even remember any more.'
What?
Let me get this straight: you're in what should be the prime of your life, and something so bad happens to your leg that you become bed-ridden, and you allow the situation to go on for so long that you can't even remember when it started? I'm pretty sure he was only brought to the hospital because his family couldn't take the smell anymore. Really, why did he wait so long?
This is a question South African doctors ask patients over and over again. Stage four HIV-sufferers who lie in bed for months before a family member hauls them to a clinic, people who allow huge burns to become septic before asking for help, men who walk on fractured hips and femurs for days before coming for 'a checkup', women who wait until their abdomens are full of pus before they tell someone about their 'discharge' - the list goes on. And patients can never give an answer, ever. They always just ignore the question.
For me, the most upsetting thing is that so many South Africans have such low expectations when it comes to quality of life, that they don't think there is anything abnormal about becoming bed-ridden at the age of thirty-five, or being pre-terminal at forty-two. Sometimes I wonder if they view hospitals in the same way that they did in the dark ages: a place to come to die. It makes our work harder, and more demoralising by far. I used to wonder if patients waited so long because our government hospitals are such terrible places to be, but really, they're not. Yes, you may have to wait a few hours to be seen, and the staff may be unfriendly, but after that you'll get a warm, clean bed and three meals a day. Surely that beats hacking your lungs up in some drafty shack with no running water? I would think so.
He had no other diseases that he knew of (although his blood pressure was sky-high), and said he hadn't injured the leg. I asked him when it had started, and he said he wasn't really sure, but mumbled something about 'the last All Pay day' (All Pay is kind of like the dole). This kind of disaster doesn't occur overnight, and so I pressed him a little harder - had his leg been dodgy for days, or weeks, or months? Shrug, mumblemumble. Finally I asked, 'When last did you walk by yourself?' and he just looked at me and said, 'You know, so long ago that I can't even remember any more.'
What?
Let me get this straight: you're in what should be the prime of your life, and something so bad happens to your leg that you become bed-ridden, and you allow the situation to go on for so long that you can't even remember when it started? I'm pretty sure he was only brought to the hospital because his family couldn't take the smell anymore. Really, why did he wait so long?
This is a question South African doctors ask patients over and over again. Stage four HIV-sufferers who lie in bed for months before a family member hauls them to a clinic, people who allow huge burns to become septic before asking for help, men who walk on fractured hips and femurs for days before coming for 'a checkup', women who wait until their abdomens are full of pus before they tell someone about their 'discharge' - the list goes on. And patients can never give an answer, ever. They always just ignore the question.
For me, the most upsetting thing is that so many South Africans have such low expectations when it comes to quality of life, that they don't think there is anything abnormal about becoming bed-ridden at the age of thirty-five, or being pre-terminal at forty-two. Sometimes I wonder if they view hospitals in the same way that they did in the dark ages: a place to come to die. It makes our work harder, and more demoralising by far. I used to wonder if patients waited so long because our government hospitals are such terrible places to be, but really, they're not. Yes, you may have to wait a few hours to be seen, and the staff may be unfriendly, but after that you'll get a warm, clean bed and three meals a day. Surely that beats hacking your lungs up in some drafty shack with no running water? I would think so.
3 comments:
June 24, 2009
You are brilliant! This is an issue I've often wondered about myself. My mother took forever to get her diabetes diagnosed. She just thought she was supposed to feel awful all the time, that that was what life was supposed to be like. For others I think it's a matter of pride, perhaps. As adults, we feel like we should be able to overcome something like a dodgy leg, that it's somehow humiliating to ask for help.
And then there are those who hope that by ignoring it long enough, the problem will go away. I fear I may fall into the latter category when it comes to lumps and lesions. Cancer is just too scary.
June 27, 2009
This is probbably a really stupid question (- I know a lady like this, and I have often wondered why she waits so long to say how sick she is feeling) ...But could it be because so many South Africans, in this case, have no experience, through previous generations, of being helped when help is required? An acquired passiveness in diagnosing one's own ills, usually diagnosed for one by a paternal, totalitarian baas figure or stand-in? This is what I think in my lady's case, because she is in her 60's and grew up as a farm labourer's child. I don't know about a 36 year old.
July 02, 2009
Honestly, I'm one of those people who wait till things are at their worst before going to the doctor. Partly because I can't afford a medical aid yet (hopefully that will change in a month or 2)and the thought of the State Hospital somehow scare you and partly you don't want to hear bad news.
I've got what some doctors have said to be an ulcer. Yesterday another doctor said she thinks it's gallstones. I can't afford the sonar or gastroscopy, so now I will just HAVE to suffer until I can afford it and worry about what it is that is causing me so much pain. Does that make sense?
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