{"id":1782,"date":"2010-11-28T09:57:36","date_gmt":"2010-11-28T14:57:36","guid":{"rendered":"http:\/\/blogs.cooperhealth.org\/news\/?p=1782"},"modified":"2010-11-28T09:57:36","modified_gmt":"2010-11-28T14:57:36","slug":"meeting-of-the-minds-having-to-discharge-patients-without-treatment","status":"publish","type":"post","link":"https:\/\/blogs.cooperhealth.org\/news\/2010\/11\/meeting-of-the-minds-having-to-discharge-patients-without-treatment\/","title":{"rendered":"Meeting of the Minds: Having to Discharge Patients Without Treatment"},"content":{"rendered":"

By Sarah Woodrow, MD<\/a>
\nCooper Neurological Institute<\/strong><\/p>\n

This is part five in a series of updates from Dr. Woodrow’s mission to Ethiopia. View additional posts from her on the Inside Cooper blog by clicking here to view all posts tagged “Ethiopia.”<\/a><\/em><\/p>\n

\"\"

X-ray from a 39 year-old man who was suffering from compression of his spinal cord in his neck.<\/p><\/div>\n

It has been a bad 24 hours. \u00a0Yesterday we had to discharge home several of our spine injury patients – without treatment. \u00a0After sorting through the bits and pieces instrumentation that has been brought over over the years, there simply wasn\u2019t enough of the same parts to allow us to stablize even a single thoracic or lumbar spine. \u00a0There were screws but only enough rods to connect together the screws in one patient and no caps to lock down the rods into place after that anyways. \u00a0With no hope of surgical treatment these patients are considered a waste of hospital resources and get discharged home. \u00a0This includes 2 paraplegic patients and one with an incomplete spinal cord injury.<\/p>\n

The only way to treat these injuries now is bed rest \u2013 to allow the fractures to heal themselves \u2013 often in the incorrect position \u2013 and then hope that the spine does not collapse down around the injury site once the bone has healed itself. \u00a0It seems cruel to send them home but in some ways it is a relief for many of the families here \u2013 most patients have atleast one if not more family members that provide most of their care while in the hospital. \u00a0One is allowed to sleep at the side of the bed \u2013 on a mat \u2013 on the floor. \u00a0If the patient is from out of town as many are, the rest, I suspect, sleep on the streets of Addis. \u00a0At least with the patient home family members can resume their regular duties. \u00a0They will have no additional support \u2013 no nurse’s aid will come to the home to wash them, no access to special services to help them cope with the new disability, no rehab to undergo to help maintain or even improve mobility. \u00a0It\u2019s hard to imagine how much more challenging an already difficult life is made with such an injury. \u00a0For many who are the primary income earner for their families, and with their meager wages now lost, the situation will only become worst.<\/p>\n

Today, meanwhile, has started off as a mixed blessing. \u00a0The OR has agreed to allow us to proceed with 2 scheduled cases even though it is a Saturday. This is huge progress. \u00a0In past visits, I had difficulty getting them to allow me to proceed truly emergent cases on the weekend, let alone elective ones. \u00a0The first case is a 39 year-old man who has had progressive difficulty walking and using his hands due to compression of his spinal cord in his neck. \u00a0He has been waiting as an inpatient in the hospital for almost 3 months for this surgery. \u00a0He keeps making his way up close to the top of the list and then gets bumped down again by more urgent cases.<\/p>\n

Making the decision as to who gets their surgery when adds an extra dimension to practicing medicine here that is fraught with all the ethical decision-making dilemmas for which nothing can prepare you. \u00a0I am optimistic when I arrive at the hospital at 8:30 and see my patient in the operating room, awaiting the arrival of the anesthesiologist. \u00a0My excitement however is dampened when I learn that our second case \u2013 a 9-month old with a recently treated brain abcess and who was awaiting the placement of a shunt to treat her hydrocephalus – died overnight after having a seizure. \u00a0Although I don\u2019t know for certain, especially as the details were vague, I suspect this was a preventable death. \u00a0No doubt her condition wasn\u2019t considered serious enough to warrant admission to one of only 9 ICU beds available for the entire 800-bed hospital. \u00a0I feel guilty, knowing all that she had already suffered for her short time and thinking perhaps she was in a better place.<\/p>\n","protected":false},"excerpt":{"rendered":"

It has been a bad 24 hours. Yesterday we had to discharge home several of our spine injury patients – without treatment. After sorting through the bits and pieces instrumentation that has been brought over over the years, there simply wasn\u2019t enough of the same parts to allow us to stablize even a single thoracic or lumbar spine.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[198,421,422],"class_list":{"0":"entry","1":"post","2":"publish","3":"author-ddevenney","4":"has-excerpt","5":"has-more-link","6":"post-1782","8":"format-standard","9":"category-events","10":"post_tag-cooper-neurological-institute","11":"post_tag-ethiopia","12":"post_tag-neurosurgery"},"yoast_head":"\nMeeting of the Minds: Having to Discharge Patients Without Treatment - Inside Cooper<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.cooperhealth.org\/news\/2010\/11\/meeting-of-the-minds-having-to-discharge-patients-without-treatment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Meeting of the Minds: Having to Discharge Patients Without Treatment - Inside Cooper\" \/>\n<meta property=\"og:description\" content=\"It has been a bad 24 hours. 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