“I'd rather regret the things that I have done than the things that I have not.”
― Lucille Ball

Tuesday, February 12, 2013

Shoulder Dislocation

Only 5 minutes before the accident, enjoying life at the porch
My mother is wintering here in the Philippines to avoid the cold months in Europe.

She joins us wherever we go and last Wednesday we went to my Dutch friend and his Filipino wife in San Jacinto, Pangasinan. They are there to visit their family and to have a family celebration next week.

It happened that my mother wanted to go to the CR (Comfort Room) and as she didn't see a little step between the kitchen and living room and hence stumbled, fell down on the tiles and hurt her shoulder and upper arm. The reason is that she has "macular degeneration", as a result she has a very limited sight, which is a big problem if you have to walk in a unknown place. So we should have assisted her, give her a hand or so, but we didn't and she did not ask for it. Pity!!

It was between 4 and 5 pm when it happened. I investigated her and my conclusion was that her arm was not broken, but probably dislocated, as you could see a small pit in her shoulder skin, meaning that the upper arm was not in the correct position and it stretched the skin so far that a pit was formed. She had a lot of pain and we had to fix her under arm in an upright position as to minimize the pain in her shoulder as much as possible.

As the house was far away from the end of the road, we had to carry her 50 meters or so to the car and hence bring her to a medical center, but given the pain she had and increasingly if her arm was moved only a bit, this was not really an option.

The only options we had were 1) get a doctor to the place of the accident and hoping he could undo the dis-location, or 2) get an ambulance, so that they could put her on a stretcher and then bring her to the ambulance.

We chose to go for both options. One of the family members went to San Jacinto by tricycle to find a doctor (physician) and bring him to us with or without an ambulance. It took him some time, but all doctors in San Jacinto were occupied or not at home. So finally he managed to get an ambulance to our place.

There is not a single phone number to get an ambulance,
as there is not a single emergency organisation
The ambulance arrived after an hour since the accident happened. The ambulance staff were fine and gentle people (a boy and a girl) and did a good job. Finally my mother was in the ambulance and they decided that she had to go to one of the better hospitals in Dagupan, the "Dagupan Doctors Villaflor Memorial Hospital (DDVMH)" or short Villaflor. I have been there already two times, and hoped for a fast emergency procedure.

I would follow the ambulance with our daughter and niece, my wife would accompany my mother in the ambulance. Around 6 pm we arrived at the hospital, the ambulance was there already 15 minutes. My wife told me that the boy, who was the driver, loved it to drive the ambulance and that he new a lot of shortcut roads. Probably I took the same as I know them as well, but not as fast as they did.

In the emergency room, which was quite crowded with many stressed people and family, some helpers, but no doctors; she got an infusion, they measured BP and took some blood. When I asked for a doctor, they said they called him, but it was not sure if he would come this evening. On my request they gave her a painkiller and then she was moved to radiology next door, for making an X-ray.

The equipment was rather old, I guess more than 20 years old and the result was a picture with not too many details. But anyway you could see that the upper arm bone was dislocated, but not broken. Still a lot of pain and I was concerned that she had to wait until next day in so much pain. They gave her a pain killer in the infusion needle in her hand.

Meanwhile I did the admission, so all kind of questions had to be answered and forms signed. I had chosen a room for the night, a single room with air-con and TV and a sofa for the family to sleep on. Indeed we decided to stay and sleep with my mother, as this is also hospital policy. Patients may not be left alone. My niece and our daughter went home with a tricycle to wait for further instructions.

I instructed my sister in the Netherlands to NOT inform my mothers sister on the accident, as it was her birthday anniversary that day and I didn't want her to worry too much about her sister (my mother).
In the hospital, waiting for a doctor, arm still dislocated

Around 9.00 pm doctor Ferrer Jr. came to checkup my mother. He told us that she was scheduled for help next day 12.00 noon. He was the son of the doctor who would do the "operation".

After this visit we got a visit from doctor Siapno, a cardiologist, who would do the clearance, a kind of general investigation to find out if her physical condition was good enough for having the required anesthesia and treatment. It turned out that her heart rhythm was irregular, but not bad enough to cancel the "operation" and the BP too high, but this was because of her "white uniform high BP syndrome. Finally I had to sign the paper that is required before they do any treatment and which will protect the hospital and their doctors for any consequential damages.

Regular checks by the nurse
We also had support several times from the midwife on duty for the regular pee sessions. The nurses did regular checks of the BP and pulse. and during the night when the pain was too heavy I asked for a new pain killer. The nurse asked how heavy the pain was on a scale of 1-10. Of course I said 10, what a crazy question if you die almost of the pain. This kind of methods they learn here in the nursing school.

I was constantly translating from the health workers to my mother and the other way around, as she doesn't speak English.

After a long and painful night and without any sleep, my mother got a breakfast at 5.00 am, after which she was not allowed to eat and drink anymore until the "operation", however she didn't want to eat as she was afraid for nausea after the anesthesia.

Suddenly I am ordered to go to the secretary of Dr. Ferrer Sr., to get a cost estimate of the whole operation and the partial payment I had to do before they will do the operation today. The estimate is 80.000 pesos and the down payment 10.000 pesos for doctor Ferrer's fee and 10.000 pesos for the hospital. So I have to go to the bank to get enough cash for today, as she might be released today.

The food that she was not allowed to eat
At 9.00 am she fell in sleep until 10.30 am, waked up by nurses and doctors checking up her. Her lunch is delivered at 10.30 am, while she is not allowed to eat!!! So we eat it for her.

At 11.30 am somebody enters the room with a stretcher, to bring her to the operating room. We move her on the stretcher with 6 people and I join her as her translator. There are 2 operating theaters on the second floor, so we go down from her room on the 3rd floor, via a slope/ramp as they have no elevators.

When we arrive there, they put me in surgery cloths, a hair-cap and rubber shoes and then I may enter the operating room, where doctor Perez, the anesthetist, and doctor Ferrer Sr, the orthopedic surgeon are already waiting for my mother. I answer all questions they have and tell my mother what they said to her. Then she gets a hose in her nose and slowly she disappears from this world. I may go to the recovery room and they start their work.

Only 20 minutes later my mother returns from the operation room, she is awake again and doctor Ferrer Sr. shows his thumb up and leaves with his sun, probably for lunch. My mother is moved back to her room and moved again onto her own bed. She feels good and has no more pain, and no nausea.

Preparing for release
The waiting begins, as she would be released today if everything went well. Finally I get the message that she may be released, but I have to do the full payment first. It is almost 60.000 pesos, a lot less than the estimate this morning. After paying and putting signatures on the release papers we are ready and the wheelchair comes to get my mother and bring her to our car.

So late afternoon Thursday, we are back home, home sweet home.

Next day is our wedding anniversary and luckily my mother can join us for the dinner we had scheduled. Even better, she wanted to pay the dinner. Thanks ma, we love you.

Next day at our wedding anniversary dinner she is fine again

Note 1:
My mother was disappointed that there was no immediate care given, no doctors available in the emergency room after 5 pm. Indeed it seems they have no 7x24 hours emergency service, although there are some medical assistants in the room.

Note 2:
During the weekend she found out that her hand/wrist was dead, no feeling, no movement at all, only the fingers could be moved a bit. So we went to the same doctor on Monday and after some testing they concluded that the nerve was squeezed but not cut off. So she should fully recover from the injury, but it may take months.


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