The Accident at Tashi Lapsa Pass – Part Ten: ‘Policies’ and ‘Procedures’

Having arrived at Basundhara hospital in chapter nine, the medical team begin to assess Louise’s injuries. Just when you thought things might not get any worse…

 

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The emergency room was small with only four little cubicles roughly separated by curtains, but it was clean and bright. I was quite agitated when we came inside and treated each person with suspicion until they explained who they were and what they wanted to do. A couple of doctors asked me how I sustained my injury and after I briefly explained the story, one said “oh, so you tripped over while trekking?”  This comment only served to annoy me further.

Then I met Lakpa Sherpa (different person to the one who carried me down in a doko today), a senior employee of the hospital who was responsible for promoting the facility and dealing directly with the insurance companies of foreign patients. He took a photo of me with my makeshift splint to support my travel insurance claim and then listened to my story in detail. He fully empathized with what I was telling him about how I was transported off the glacier as he had also trekked in those high places and understood the significance of my trip down in the doko.  It meant a lot to me that someone in that room really did understand what I had gone through and only then did I start to calm down. A doctor then gave me both a tetanus shot and finally, a pain-killer.

I then had the opportunity to finally empty my bladder which had been giving me pain since 11 am this morning. Emergency room staff seemed to think this was of a lower priority but I insisted I had to go and a commode on wheels was finally brought into the cubicle. At least three people were still standing there watching and the curtains were half open and it was again up to my husband to shoo people out to give me privacy. Being able to empty my bladder lifted my spirits tremendously as well as relieving the pain.

 

The emergency department at Louise's hospital (pic supplied by Hospital)

The emergency department at Louise’s hospital (pic supplied by Hospital)

 

Then I was ready to have x-rays. One of the junior emergency room doctors and the young man who turned out to be the radiologist said to me; “we need to find out if there is anything actually wrong with your leg.” My irritation came flooding back again. I said to them, “when my leg was pulled out from under the rock, the lower part was hanging limp at a right-angle to the rest of it – I think you will find something wrong.”

I was wheeled down into the basement to the x-ray department. In contrast with the crowds in the emergency room, there were only three people there – the radiologist, a technician and a nurse. The radiologist said that they would leave the makeshift splint on for the first x-ray until the basic nature of the injury was established. Only if there was ‘something wrong’ would they remove the splint.

They left the room but were back almost immediately and the radiologist said, “We need to remove the splint”. They were very gentle. They unwrapped the splint carefully (by this stage, the bleeding from the wound had gone through three inches of wrapped material) then bandaged my leg and placed it in a temporary immobilizing split before taking multiple x-rays. I got to see the x-rays myself later – both tibia and fibula were completely snapped about two inches above the ankle. The broken tibia bone had pierced through the skin creating a wound an inch across. My leg would require surgery to realign the broken bones.

When I returned to the emergency room I found that Bijay and Shanaia had disappeared.  I was told they were up in the hospital ward where I was about to be transferred. For reasons I didn’t understand, the surgery would not take place until the next day around lunchtime so in the meantime I would simply be admitted. Bijay re-appeared and then I was moved in my wheelchair into a very narrow lift and into the ward.

I actually had a suite of rooms that included my own room with its bed, lounge and TV, my bathroom and then an adjoining room with another lounge and kitchen facilities, plus guest bathroom. Lakpa said later on, ‘We only give this room to foreigners who come here with serious injuries and are well-covered by insurance.’  Shanaia was already there with Sarita, Bijay’s sister, who had come to offer support. They were all planning to stay the night in the hospital. One characteristic of many Nepali hospitals is that they don’t limit the number of relatives you can have staying with you, as long as they can all fit in and don’t hamper treatment.

That evening saw a continuous flow of medical staff into the room, each one of them introducing themselves so I at least knew why they were there. A more senior orthopaedic specialist came in and then spent almost half an hour dressing and re-splinting my leg. By the time he finished my leg was encapsulated in a splint from mid-thigh to toes. He did a good job – the leg was warm and comfortable and with little pain right up until the surgery the following day. He also told me that the way an injury was managed in the immediate aftermath of an accident was critical to a full recovery. I don’t know whether he got to see or hear about our makeshift splint. He also said that I needed to start antibiotics immediately because the wound on my leg had been caused by protrusion of the bone.

Later, I had a visit from the most senior orthopaedic surgeon who would do the next day’s operation. Bijay in fact knew him as he had treated his own mother for two separate injuries previously. He had a good reputation. He told me that he expected to put a pin through the tibia and a plate against the fibula and that the operation would take about an hour and a half. I suspected that the reason for the delay in surgery was partly due to reluctance of surgeons to work at night (I still hadn’t eaten or drunk anything since this morning so this wasn’t the reason) and partly because we were waiting for the insurance company to give approval for the surgery to go ahead. For reasons that I also didn’t understand, I also had an ECG that evening to look at my heart rate as well.

I was about as comfortable as could be expected overnight. I was finally given permission to eat and drink, although I wasn’t able to take in much, and I was told I had to fast again from 6:00am the following morning. Due to the incredibly stressful day, it took Bijay and Sarita close to two hours to calm Shanaia down enough for her to sleep. I then had nursing staff coming in regularly doing basic observations and checking the IV. After the events of the day my mind wouldn’t rest either and it was quite late before we were all able to get some sleep. Sanghe our guide, had gone back to his Kathmandu home hours before, but last thing before trying to get to bed, Bijay rang Lakpa in Lukla to see how he was. Lakpa said he had just gone to bed and that he was physically and emotionally ‘finished’ after the events of the day. He suggested Bijay ring again after my surgery.

Next morning, Sarita and Nani left for home. Bijay went back home to bring some supplies for us such as clothes, toiletries etc as he planned on staying in the hospital (sleeping on the couch) for as long as I was there. Given that I had already gone without a proper shower for three days when the accident happened, I was really keen for some kind of wash before proceeding with the surgery at mid-day. The nurse said that I could have a bed wash and wash my hair – but first, I would need to have all of my pubic hair shaved off! I actually had to stop myself from laughing and insisted on knowing why. I told them I was having surgery to correct broken bones in my lower leg, not gynaecology-related surgery. The nurse left for a while, came back and told me it wasn’t necessary after all. I had my bed bath and started to feel like a new woman.

 

 

About Louise Currie

Originally from Australia, although I have been living in Nepal since 2005. I worked for a long time for an international aid agency in Kathmandu. I am interested in community development and having adventures in remote places. I am married with one daughter.

Comments

  1. Hi Louise,

    I am sorry to hear how some of medical staff at the hospital treated you including the language they used. Do they speak good English?

    I have seen some bad communication between medical people and my western friend and her daughter here in Sapporo, Japan. Some people seem not to allow me to interpret and I was not happy with it and my friend was not happy either.

    I do understand how you feel as I have involved in such situations even if I was not the patient.

    I can see you are so brave and behave well.

    Thanks for sharing your story, Louise :)

    Yoshi

  2. Louise Currie says

    Thanks Yoshi

    I did learn much later that poor bedside manner is a problem in even the best Nepali Hospitals – and it’s not just directed towards the foreigners who end up there. Ordinary Nepali citizens also complain about the lack of disrespect from particularly more junior staff at hospitals.

    I am happy to report though that most of the senior medical staff (eg doctors, senior level nurses) are very polite and respectful on the whole.

    Louise

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