Maxwell Blue's Oubliette: |
Unlikely The Same |
Case Numbers: 3578 & 3595 He was an undocumented Hispanic who was shot in the left hand with a large caliber handgun, most likely the results of a defensive action. As a hand and arm specialist I only come into the hospital in the middle of the night when an injury cannot wait until tomorrow. The trauma attending, who called me in assured me it was going to be a long night. The hand and wrist bones were pulverized and both bones in the forearm were broken as well. It took several hours to mend the damage and remove bullet fragments that had nestled into the forearm. I am often late for my morning office when I am covering an emergency case and today was no exception. Avoiding what now must be a full and restless waiting room, I took the stairs up through the fire exit. After taking a moment to collect myself I was directed to my first patient of the day. She was a mortgage broker in her late 30s, referred to me by her primary care physician. Two months ago she dislocated a finger playing tennis. It was obvious that she needed a capsulotomy on her finger, so I directed the surgery scheduler to make an appointment next week. I explained that this procedure removes scar and tight tissues from around the joint to restore motion. But the motion achieved at surgery must be diligently maintained in the post operative period. During that same week the social worker at the trauma hospital called. Apparently, they made arrangements to transfer my gunshot patient back to Mexico. Now that he is stabilized they will be sending him to the university hospital in Guadalajara. But without follow-up care he will lose the use of his hand. I told the social worker that the hospital needs to support me when I take on severely injured patients. Begrudgingly, the hospital allowed the patient to stay for two repeat surgeries, including a skin graft to the hand. However, he was discharged with a self-administered therapy program because there were no funds for formal therapy. To his credit the patient made a tremendous effort to regain motion, which was more than equaled my own efforts. Four months after the mortgage broker's surgery she was back in my office visibly upset and this time I wasn't late. She was complaining to me about her finger. Somehow I was to blame for making it worst than it was before. While she vented I read through her file. I thumbed through multiple missed physical therapy and office visits. With a straight face I tactfully avoided mentioning her non-compliance, I then gave her a speech I have given many times before: This type of injury requires aggressive and timely therapy to maintain motion. You may do formal therapy with a hand therapist or do it yourself, but it must be done regularly. The success rate for this type of surgery is roughly 87%. In simple terms 6 out of 7 will be happy with the results. Repeat surgery has roughly the same success rate. She calmed down and resigned herself to the reality of a repeat surgery and repeat course of therapy. The only question she had was regarding her insurance, but my office manager said she had excellent medical coverage and there should not be a problem. The next time I saw the gunshot patient his hand was remarkably improved. I scheduled one last surgery, a capsulotomy, for his index and long finger. I could see he was very hopeful with his treatment so far. The night before I was scheduled to perform the same procedure on two very different patients the office manager pulled me aside to tell me there was no way I was going to be paid in full when that "Illegal" was deported. |