Map of life expectancy at birth from Global Education Project.

Monday, August 16, 2010

Mr. Karakov

I did not exactly have a wonderful time while I was living in the hospital, but at least I could understand most of what was going on around me. My roommate, Mr. Karakov, wandered past my bed a few times on his way in and out of the room, pushing his IV pole. The pole has wheels on the bottom, so that patients can take it for a walk. Mr. Karakov would stop and talk to me brightly in Russian, holding the pole with one hand, gesturing expansively with the other. I would smile and indicate my incomprehension, but he was not deterred. I obliged by replying in English, not trying to connect in meaning, of course, but in affect.

"Yes, the latest red-shift survey certainly does imply a young age for the universe," I might have said, and "I am also concerned about the possible health effects of oscillating magnetic fields."

Mr. Karakov appeared to be in his fifties. He was rather fat. He wore the obligatory posteriorless smock, and paraded his naked and excessive buttocks without shame. Some exotic injury or disease had made his lower extremities pitted and darkly mottled. He seemed happy and healthy; he had not yet had his surgery.
I gathered from overhearing what Mr. Karakov could not that he was not in fact healthy. My doctors did not visit him on rounds; it was a different gang. The leader said, "This man is a pulmonary cripple." Mr. Karakov had Chronic Obstructive Pulmonary Disease. I have since looked that up. It's emphysema. He also was suspected of having bladder cancer. They brought in a translator to talk to Mr. Karakov about logistics, for example that he could have nothing to eat or drink, but noone told him anything about his condition or prospects.

Mr. Karakov had no visitors. He spent his days among gibbering incomprehensible strangers. He came back from his surgery making a lengthy discourse on what I took to be the subject of the intense discomfort he felt. Occasionally he would yell out in real pain. I could not see him as a curtain separated our beds, but I could hear more than enough. Nurses would rush in and grotesque activities would follow. One time, an experienced nurse was instructing a junior colleague in the procedures. They were somehow "irrigating his bladder", which from the sound of it caused gallons of water to drain into a bucket. The objective was to extract blood clots. It was the "long, ropy ones" that caused the major trouble.

Just after midnight Mr. Karakov had his worst attack. Nurses rushed in, followed in a few minutes by doctors. They shouted orders and vital signs at each other. More nurses rushed in pushing equipment. Doctors would ask Mr. Karakov questions, and when he didn't understand, they would ask again, louder. Then they would yell at him. Gallons, barrels, acre feet of water gushed. Mr. Karakov shouted in pain, discoursed angrily in Russian, then muttered and moaned. Someone cursed the hospital for admitting "these people" who could not speak English. Finally the crisis subsided. The Doctor in charge said, "I think he had pain from a clot and he vagled. He just vagled." (That basically means he fainted from pain. Not that I should even mention it but obviously all this commotion in the middle of the night is not conducive to my own restful recovery.)

He never vagaled again, but he started to piss all over the floor as soon as they took his catheter out. I didn't hear them warning him about this -- in fact, I don't think they brought in a translator all week -- and they certainly didn't do anything about it. I discovered it (the hard way) on one of my hourly trips through his half of the room. I called the nurse to see if we could get it mopped up, but apparently it was the wrong time of day to expect any mopping. When someone finally did come, she didn't mop the lavatory. "Oh, they won't go in there," said the nurse. I didn't blame them, frankly, but I had to go in there, twenty four times a day. (I'll explain later about my own situation at this point, which was not good.)

After a couple of days a nurse wandered over to Mr. Karakov's side of the curtain and started telling him, in English, that he was discharged. "You can go home now," she said. He answered in Russian, apparently indicating incomprehension. (Remember that I can hear perfectly, but I see nothing.)

She spoke to him more loudly. "You can go home. This is a taxi voucher. The taxi will take you home. Here are your clothes." As he continued, stubbornly, to refuse to understand English, she repeated herself more loudly. Finally concluding that deafness was not Mr. Karakov's problem after all, she strode out past me with the air of one who will sacrifice no further for the sake of the ungrateful.

Perhaps 30 minutes later she returned with a translator, an earnest young man. He was Russian born, but talked like a Certified Public Accountant from Alliance, Ohio. The dialogue which follows is reconstructed, but I have faithfully represented its essential substance and spirit. As I am ignorant of Russian, all speeches in that language, regardless of length or dramatic subtext, are represented by ellipsis in brackets, thus: [...]. Where not credited to a character, the ellipsis represents dialogue between Mr. K and the Translator.

Nurse: Tell him he's going home now. He can give the cab driver this, he doesn't need to pay for the cab. This is his prescription. He needs to get dressed and we'll take him downstairs.
Trans: He wants to know, will anyone tell him about his surgery, what was the result and what it will mean for him, and so on?
Nurse: Whatever the doctors have told him, I can't tell him more than that.
Trans: He says the doctors haven't told him anything, he really doesn't know what's going on.
Nurse: Oh for chrissake.
Exeunt nurse and translator. Thirty minutes later, they return, accompanied by an intern.
Trans: [...] Dr. Peachcheek [...]
Dr. P: Well, he has bladder cancer. We took out as much as we could through the urethra, but we just can't get it all that way.
Dr. P: Unfortunately, it will continue to grow. We think, in three to five years, it will be fatal.
Dr. P: We can't operate to remove his bladder because he has chronic obstructive pulmonary disease, and he couldn't survive surgery.
Trans: He wants to know, when the tumor grows, can't you scrape it out again as you did this time? They did it before in Italy, if you can just keep doing it...
Dr. P: (laughs nervously) Well, eventually he will run out of bladder wall.
Trans: You mean, every time you do this you use up some of his bladder?
Dr. P: Yes. I mean we could do it again but it would be futile. He will only live for so long, and we cannot get rid of the cancer ...
Trans: He says, what about the possibility he has an adenoma? In Italy, they told him it might be cancer and it might be an adenoma, that would be something different...
Dr. P: (surprised) An adenoma? Well, no, no it really doesn't seem to be an adenoma.
Trans: In Italy they told him perhaps it could be treated with radiation or chemotherapy, is there any possibility you could try some of these things they discussed with him in Italy?
Dr. P: Well, I mean those things could be tried, but I mean ... well, it just would be futile, we can't do surgery to remove the bladder...
Trans: He says for two days his right leg above the knee has been numb, he has no feeling here on his thigh ...
Nurse: Oh for chrissake.
Dr. P: Well, let me see. (sounds of bodies repositioning) Okay, now I'm going to touch him with my pen, like this. He just needs to tell me when he can feel it.
Trans: [...]
Dr. P: Hmm, Hmmmm.
Mr. K: Da......... Da.
Dr. P: Okay, I'm going to get a neurological consult on this.
Trans: [...]
Exeunt translator and medical personnel. Enter new Doctor, trailed by new intern, nurse and translator.
Intrn: I've been able to find out a little bit about him. He's a fifty-five year old factory worker, and lives alone. He says his legs have looked like that for twenty years.
Doc2: I understand from Dr. Glomerulus that he is a commercial airline pilot. Alright now, tell him this is sharp and this is dull. He is to tell me what he feels, whether it is sharp or dull.
Trans: [...]
Mr. K: (We learn the Russian words for sharp and dull)
Doc2: Well, this is something we see in patients with circulatory problems. You see it maps very cleanly here, this represents damage to the freeblemeyer nerve. It may have happened from lying on his side for too long. It may improve, in time, but usually it will not. He may feel some tingling or it may feel very cold.
Trans: [...]
Exeunt; Enter Translator and nurse.
Nurse: Alright, he's been discharged, he has to go now.
Trans: He says he can't hold in his urine. What is he to do, he can't get in the cab like this.
Nurse: Oh yeah. Well this is normal after the type of procedure he's had, it will improve in a few weeks. Uhm, we can give him absorbent pads, like diapers.... Excuse me.
[nurse goes and returns]
Nurse: Here.
Trans: He wants to know what he's supposed to do with them.
Nurse: They just fit into his underwear, he just puts them in his underwear.
Trans: He is concerned about going out, if he is out of the house for a long time will he be alright like this.
Nurse: Look, my shift is over, I've gotta get out of here. Oh alright. There's another system we can give him, hold on.
(Nurse exits and returns with apparatus)
Nurse: Okay, this goes over the end of his penis like a condom, okay? Does he know what a condom is? Then he has this bag around on the side of his leg, you see, with this garter belt-type arrangement...
Trans: He wants to know, won't there be a bulge, won't it show?
Nurse: Well it's up to him what he wants to do. Anyway, tell him he shouldn't use this when he doesn't have to. He needs to try to control his urine; if he relies on the apparatus he won't improve.
Trans: He says what about his drugs, can't he have his prescription filled here at the hospital before he goes?
Nurse: Oh for Chrissake. Look, we need the bed, there's somebody waiting in the ER for it and I don't have time for this, he was supposed to be discharged this morning. This is really getting ridiculous.
Trans: It's hard for him, he doesn't speak English.
Nurse: Alright, does he have his Medicaid card?
(nurse exits; returns in fifteen minutes with drugs)
Nurse: I had to lean on the pharmacy to get this sent right up. I'm out of here. Goodbye.
(exit nurse. Translator and Mr. Karakov exit a few moments later, conversing in Russian. CURTAIN.)

I withhold all comment. Res ipsa loquitur.


roger said...

so we're beating the russians in the field of weird bureaucracies. take that kafka.

robin andrea said...

Those are brutal scenes, cervantes. There's nothing worse than being in the hands of those who don't care, except by adding that they also don't speak your language. A situation straight out of nightmares.

kathy a. said...

so hideous. i imagine this experience [as well as your own during that time] influenced your interest in patient/doctor communications.

C. Corax said...