Four Fractures, One Enema, and a Whole Lotta Thailand

On May the 8th of this year at approximately 9:45 am, my wife and I were in an accident on my scooter; a lil 125cc Honda Click doing about 35kph (22mph). It was a sunny morning, the roads were dry, traffic was minimal. I wasn't driving too fast or in any way anyone would say was "unsafe." As we approached an S-curve in the road, this man came around the corner going the other way. He was on a motorcycle and was in my lane. I had to slam on my breaks and swerve to miss him. My wife and I ended up falling and I obtained a pretty serious injury. My wife got some bad road rash on her knees. 

People nearby came out quickly to offer us help. One called the hospital for an ambulance, one called the police. I lied on the pavement for about 30 minutes before the ambulance got there in pretty intense pain fearing I had dislocated my left hip. I told the medical professionals that, and did so in the Thai language to prevent misunderstanding. Forty minutes or so after the accident, we're at the local hospital. Thirty more minutes and I had an x-ray that, apparently, showed no breaks or dislocations. Surprisingly, this news did nothing to decrease the intense pain in my hip, groin and leg. In fact, I couldn't move my leg and was in tremendous pain, so they decided to admit me. 

I have to be vague here with further details so as to avoid getting into potential legal trouble for telling about my experience at that hospital. You'll notice I haven't named the place or told you where it is. As far as the care team was concerned, I had a negative X-ray and no reason to be in such pain, so one might argue that they treated me more like a lying pain in the ass instead of someone with a legitimate injury. My pain was intense enough to keep me awake all night (about 8 on a 1-10 scale), despite the "pain" medication I received. Those who gave it to me acted like I was a liar who seriously inconvenienced them. 

Had the doctor done a physical exam of me and listened to me detail my symptoms, the doctor would have assumed I likely had a break or breaks in the same area I originally complained about. Such a prognosis would have resulted in a different plan for pain management and, perhaps, better treatment from my care team. 

I've tried everything to upload photos and it simply isn't working. Suffice it to say I had dark purple bruising from the bottom of my butt cheek to the middle of my back on my left side. 

Next day, I was still in serious pain and couldn't be discharged so they called the doctor. Doctor ordered a CT scan of the hip to see if the x-ray missed something. The x-ray (or whoever reviewed it) missed four fractures in my pelvis; two large ones in my iliac crest, one from the front to the back of the acetabulum (hip joint), and a smaller one elsewhere. The nearby private hospital wanted $58,000 I do not have to fix the problem, so I opted to go to a public hospital 35 minutes away that could do the surgical repair.

Let's say my prep for transport was an unnecessary series of indignities and utter disregard for the pain I was in by the "care" team. 

When I got to the second hospital, they got me into surgery that night to drill a metal rod through my lower leg to create traction that reduced tension and pain in the left hip. I didn't know it at the time, but they were giving my wife the very same pain medicine for the road rash on her knees that I was getting for worse road rash on my ankle and side, and four confirmed fractures in my pelvis.

My care didn't start off so great. My average pain level was about 7.5 even on the medicine they were giving me, and since the doctor only left a particular list of medicines for me, they either couldn't or wouldn't believe I was in so much pain. They kind of acted like I was a pain in the ass. On my 2nd day there (four days after the accident), I had an opportunity to speak with my surgeon. I took maximum advantage of it. 

My mother and my sister are both career nurses. I'm not a nurse or a doctor, but my working knowledge of medicine is a bit better than the average person because I've been around it most of my life. I asked the surgeon to look at the bruising on my side. "Does it look like I might be in considerable pain?"

"Yes."

"You said I have four fractures through a very large bone directly involved with many of my body movements. Wouldn't that be considerably painful?"

"Yes."

"Is it reasonable to think that my left buttocks, my left hip flexors, my left quadriceps and groin muscles might be heavily inflamed and reacting to the fractures in my pelvis, creating additional pain?"

"Yes."

"Doctor, is it reasonable to presume that a muscle relaxer and strong anti-inflammatory medicine would help alleviate some of that pain?"

"Yes."

"Thank you. Because I am in considerable pain and what I'm getting is not enough to even take the edge off. I've been at a consistent pain level of about 7.5 with spikes up to 9 when I cough because the coughs set off muscle spasms in these groups that last for five to 20 seconds. Can we please revamp my pain management? Your nurses seem to think I'm faking, evidenced by their attitudes when they provide me care. I'm not a liar or a jerk, sir. I'm just in a lot of pain and my current medications are not helping at all."

God bless my surgeon. Imagine being a doctor and having a patient telling you what's what... but he handled it like a total champ and my meds immediately changed. My next round of meds included an anti-inflammatory, a muscle relaxer, and one that helped disrupt pain signals to the brain. The nurses came in and started an IV to provide me 2mg of morphine every two hours. This brought my average pain level down from 7.5 to about 5.5. This still wasn't great, but it was a world of difference. 

My care also changed dramatically and immediately. The nurses were much more gentle, much more kind and much more attentive as well. With reduced pain, I could communicate with them better and everything massively improved. 

Protocol in Thailand is for you to have a pre-op enema about 12 hours before surgery. I don't know why, but it took three nurses being there to give me my enema, and four of them to... clean up afterwards. People kept coming in and out of my room and they left the door wide open all while I'm there fully exposed with three women wiping my ass. Concern for patient dignity here is not the same as I'm used to. That was the most embarrassing experience of my life. 

Surgery happened on the 6th day after my accident. It took just under five hours and I'm now the proud owner of three titanium alloy plates and a lot of screws all nestled tightly into my hip and pelvis. The surgery was complicated, but the team pulled it off with no mishaps or complications. The first 20 hours post-op sucked, but I got excellent care. Around the 21 hour mark after surgery, my consistent pain level was much closer to 4.5, even without the morphine. I made friends of my care team; P'Noo and Nong Fon both asked me to please come see them when I returned for follow-up care. I've got pics, but am still failing to upload them for some stupid reason. 

When I left the post-op floor for the longer-term care, I returned to the same folks who cared for me before surgery. This time though, they were happy to see me. They were so kind and friendly, so helpful, careful and gentle. 48 hours after surgery I was on my feet, or on my right foot anyway. They gave me a walker and I was able to walk around a bit using it. And by God the next time I pooped, I did it in private and handled everything myself. 

I got discharged Saturday, perhaps rushed a day because of the growing number of Covid cases showing up at the hospital. I've been home since and feel like I'm well on the way to recovery. 

I am extremely grateful for many, many things. First, this whole thing could have been much, much worse. Second, my surgeon had the humility and cared enough to actually listen to me and make needed changes in my pain management. Third, once understanding was achieved, I really got to see the caring and professionalism of the Thai nursing staff. I wish the accident had never happened, but I'm very grateful for the people I met, and for the experience as a whole; good, bad and ugly. It opened my eyes to what Thais experience when they go to the hospital. 

Gratitude is preferable to (righteous) anger. It does a lot more to help me get better and feel better than feeling pissed off all the time would. 

I'm sure you're curious what such an ordeal cost. 11 days in a hospital, intensive surgery, pre and post-op care, 50 minutes betwixt two ambulance rides, multiple x-rays, medicines,  a CT scan, three square meals a day, wound cleaning, changing bandages, and my nifty new walker... I paid about $4,300 cash. 

Thai culture makes it taboo to question authority, and a doctor is most certainly a respected authority. Doing or saying anything that causes another to "lose face" is a major faux pas, so when I complained at both my nurses and my doctor, well... you can imagine how it might have been received. I asked questions almost no Thai person would ask either for lack of similar knowledge or cultural reasons, but that's what self-advocacy took here. Once they understood me though, no one treated me like a know-it-all foreigner crybaby, and my care was excellent. I even turned some of my care team into friends who hope I come back to see them when I have follow-up appointments. 

This accident is going to change my life in significant ways. I can expect osteoarthritis in my hip at some point in my future, along with a probable full hip replacement. The next six months are a slow and painful battle to rehabilitate which puts quite the wrench in my plan to get into my best shape ever. And I endured this all because someone else was driving in the wrong lane. But... I'm alive, I'm not hurt worse, and recovery is possible. My wife is alive, not hurt worse, and soon she will be pretty much back to normal as before. 

Count your blessings, everyone. If you read this far, thank you very much. Please let me know what you think in a comment below. I'd love to know where you're reading from.