{"id":94,"date":"2018-10-22T11:34:04","date_gmt":"2018-10-22T11:34:04","guid":{"rendered":"https:\/\/hbmedicine.wpengine.com\/2018-10-22-if-you-have-a-hammer\/"},"modified":"2025-09-23T16:45:40","modified_gmt":"2025-09-23T14:45:40","slug":"against-medical-advice","status":"publish","type":"post","link":"https:\/\/www.heartbasedmedicine.org\/en\/against-medical-advice\/","title":{"rendered":"Against Medical Advice"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"94\" class=\"elementor elementor-94\" data-elementor-post-type=\"post\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7ca05c43 e-flex e-con-boxed e-con e-parent\" data-id=\"7ca05c43\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-be559f elementor-widget elementor-widget-text-editor\" data-id=\"be559f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div id=\"pl-94\" class=\"panel-layout\"><div id=\"pg-94-0\" class=\"panel-grid panel-no-style\"><div id=\"pgc-94-0-0\" class=\"panel-grid-cell panel-grid-cell-empty\" data-weight=\"1\"><span style=\"white-space: pre-wrap;\">My mother\u2019s beautiful face is etched in my mind, creased by a soft pattern of a million tiny wrinkles. A signature of a life spent smiling, happy.<\/span><\/div><\/div><div id=\"pg-94-1\" class=\"panel-grid panel-no-style\"><div id=\"pgc-94-1-0\" class=\"panel-grid-cell\" data-weight=\"1\"><div id=\"panel-94-1-0-0\" class=\"so-panel widget widget_sow-editor panel-first-child panel-last-child\" data-index=\"0\" data-style=\"{&quot;background_image_attachment&quot;:false,&quot;background_display&quot;:&quot;tile&quot;}\"><div class=\"so-widget-sow-editor so-widget-sow-editor-base\"><div class=\"siteorigin-widget-tinymce textwidget\"><p style=\"white-space: pre-wrap;\">Aged 85, with short grey hair and a healthy complexion, she warms the hearts of everyone who knows her.<\/p><p style=\"white-space: pre-wrap;\">Although she often takes small steps when she walks, bending slightly forward to compensate for some back and hip pain while she gets up slowly from her chair, she usually radiates good health and humour.<\/p><p style=\"white-space: pre-wrap;\">So it was a surprise when I received a message from my father to say my mother was in the hospital.<\/p><p style=\"white-space: pre-wrap;\">\u2018What happened Dad?\u2019 I asked as soon as I could free myself from the emergency unit at the children\u2019s hospital where I worked.<\/p><p style=\"white-space: pre-wrap;\">He explained that the previous evening as my mother had walked from the living room towards the kitchen, her right foot hadn\u2019t quite negotiated the doorstep and she\u2019d fallen into the kitchen.<\/p><p style=\"white-space: pre-wrap;\">My father had rushed to help her and had managed to help her stand, though she couldn\u2019t put any weight on her right foot. Dad had supported her and guided her to a chair where he examined the foot. Although it was exquisitely painful, my mother felt otherwise fine.<\/p><p style=\"white-space: pre-wrap;\">My father continued: \u2018We phoned Dr. Jo and he came to the house and examined her a couple of hours after the fall. He was concerned about her mental state \u2013 he felt she was confused, not her usual self. Your mother was complaining of a numbness on her right side, so the doctor referred her to hospital, concerned she may have had a stroke\u2026<\/p><p style=\"white-space: pre-wrap;\">\u2018Where are you now?\u2019 I interrupted, with some urgency.<\/p><p style=\"white-space: pre-wrap;\">\u2018We\u2019re in the emergency unit in the hospital next door to you. She\u2019s been examined and they\u2019ve decided she needs a brain scan, a bunch of lab tests and a 24-hour ECG. And she needs to go to the stroke unit tonight.\u2019 My father sounded worried.<\/p><p style=\"white-space: pre-wrap;\">\u2018How is she now?\u2019<\/p><p style=\"white-space: pre-wrap;\">\u2018Perfectly fine, although her right foot is still painful and swollen. Everything else has returned to normal.\u2019<\/p><p style=\"white-space: pre-wrap;\">\u2018Don\u2019t worry Dad, I\u2019ll come over as soon as I get out of here,\u2019 I reassured him, and hung up to attend another emergency. It was after 11pm when I finally left my ward.<\/p><p style=\"white-space: pre-wrap;\">When I arrived at the adult\u2019s hospital next door, the porter wouldn\u2019t let me in because visiting hours were over.<\/p><p style=\"white-space: pre-wrap;\">\u2018But she\u2019s my mother!\u2019<\/p><p style=\"white-space: pre-wrap;\">\u2018Sorry, sir. You\u2019ll be able to see her after eight thirty tomorrow morning.\u2019 The porter was not budging for anyone. I noticed my right hand had been squeezing my laptop bag just a bit too hard and was about to raise my voice when I realized how far apart we were. I lowered my eyes, struggled with my inner dispute and turned away, a big lump forming in my chest.<\/p><p style=\"white-space: pre-wrap;\">The next morning, I was on duty as usual long before visiting hours began, while the night porter was no doubt still resting at home. I called the unit for news about my mother and was relieved to hear her warm, clear voice.<\/p><p style=\"white-space: pre-wrap;\">\u2018How are you, Mum?\u2019 I asked, tenderly.<\/p><p style=\"white-space: pre-wrap;\">\u2018I don\u2019t know why I\u2019m in hospital, Jan. My foot hurts, that\u2019s all. Sorry, I need to hang up, the doctor\u2019s here.\u2019<\/p><p style=\"white-space: pre-wrap;\">\u2018No, wait, let me talk to him,\u2019 I urged.<\/p><p style=\"white-space: pre-wrap;\"><strong>The doctor kindly picked up my mother\u2019s phone and in the following five minutes I learned that they had run tests and scans on her half the night. <\/strong><\/p><p style=\"white-space: pre-wrap;\">As a result they\u2019d put her on medication for high blood pressure, raised cholesterol, stomach acidity and pain.<\/p><p style=\"white-space: pre-wrap;\">They\u2019d prescribed a blood thinner and she was now wearing a modern, light, but huge ankle splint. She was attached to a 12-lead ECG and an oxygen monitor, had a drip in her left hand and had been woken up every hour during the second half of the night for repeated neurological assessments.<\/p><p style=\"white-space: pre-wrap;\"><strong>The doctor reported that none of the scans showed she had suffered a stroke. <\/strong>He explained that she may possibly have an issue with amyloid, a specific protein in her blood vessels and iron deposits on the surface of her brain, which may have caused her symptoms and would require treatment with an antiepileptic drug on top of all the others. She\u2019d also torn a ligament in her foot and a bit of bone had been ripped off with the tendon.<\/p><p style=\"white-space: pre-wrap;\">Translated to my world, I was grateful to hear that she hadn\u2019t had a stroke, although she possibly had some \u2018electric wiring\u2019 issues and a tiny stable fracture in her right foot. The rest of it made absolutely no sense to me.<\/p><p style=\"white-space: pre-wrap;\">The doctor had planned to discharge her at 2pm but when I called my father at 6pm to find out how things were back at home, he replied, sounding exhausted: \u2018We are still in hospital.\u2019<\/p><p style=\"white-space: pre-wrap;\">I\u2019d had enough and rushed to the hospital, determined to pick her up. As I expected, my mother was displaying no signs or symptoms of a stroke and was perfectly well. \u2018Let\u2019s get out of here,\u2019 I urged.<\/p><p style=\"white-space: pre-wrap;\">\u2018No, we have to wait for the orthopedic surgeon\u2019s opinion on the fracture. They need to determine whether they want to operate,\u2019 my mother relayed to us.<\/p><p style=\"white-space: pre-wrap;\">\u2018What?!\u2019 I couldn\u2019t hold back my frustration any longer. \u2018You\u2019re prepared to wait another 6 hours for an opinion on an x-ray?\u2019 I glanced at the nurse, whose eyes told the whole story. She spoke quietly, \u2018They\u2019re still in theatre and will get out in about three hours.\u2019<\/p><p style=\"white-space: pre-wrap;\">I whispered to my mother and father, \u2018Just trust me on this, no one will operate on you tonight or even tomorrow. Let\u2019s get out of here.\u2019<\/p><p style=\"white-space: pre-wrap;\"><strong>Fifteen minutes later we left the hospital \u201cagainst medical advice\u201d. <\/strong>As my mother walked, the only thing causing her problems were the large immobilizing splint and the effects of all the drama and lost sleep of the night before. The new antihypertensive drugs were not helping either. My mother was an elderly woman who\u2019d been suffering from low blood pressure for 50 years and now whenever she stood up she felt dizzy and faint.<\/p><p style=\"white-space: pre-wrap;\">We settled Mum at home and I changed her splint for a light ankle aircast, which meant she was pain-free and could walk easily without crutches. The long list of prescriptions went straight into the bin and I advised my mother to discuss the hospital\u2019s recommendations with Dr Jo.<\/p><p style=\"white-space: pre-wrap;\">My father was curious. \u2018Why did you feel so confident about leaving and not taking the drugs and changing the cast, Jan?\u2019<\/p><p style=\"white-space: pre-wrap;\">I sighed. \u2018Because I know the game, I\u2019ve been in it for 20 years. I know how decisions are often made under stress in hospitals and I saw the signs that a large team of overwhelmed physicians were treating the disease and not the patient.<\/p><p style=\"white-space: pre-wrap;\">It\u2019s a bit like that expression &#8216;When you have a hammer, the world is full of nails!&#8217;<\/p><p style=\"white-space: pre-wrap;\">I explained further: \u2018When there\u2019s a drug you can prescribe for hypertension and the nurse tells you that a stroke patient has raised blood pressure while you are in ER sorting out a head trauma, what are you going to do? It\u2019s a quick decision to issue instructions to start the medication and protect the brain from further damage. It makes perfect sense when you think of it in terms of pathology. It makes no sense at all when you know who you are treating.\u2019<\/p><p style=\"white-space: pre-wrap;\">My father sat back in his chair. \u2018I feel like we\u2019ve just been put through a machine and have been spat out the other end!\u2019 he said with feeling.<\/p><p style=\"white-space: pre-wrap;\">\u2018Hopefully your kids will be lucky enough to receive next-generation medicine where time is spent getting to know the patient and personal care regains its importance.\u2019<\/p><h4 style=\"white-space: pre-wrap;\"><strong><em>That\u2019s why Heart Based Medicine was created.<\/em><\/strong><\/h4><p style=\"white-space: pre-wrap;\"><em>The story above is based on personal experiences. Places and names are fictional. <\/em><\/p><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Knowing when to trust your intuition and when to rely on medical wisdom is a delicate balance<\/p>\n","protected":false},"author":21,"featured_media":6295,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"episode_type":"","audio_file":"","podmotor_file_id":"","podmotor_episode_id":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","filesize_raw":"","date_recorded":"","explicit":"","block":"","itunes_episode_number":"","itunes_title":"","itunes_season_number":"","itunes_episode_type":"","h5ap_radio_sources":[],"iawp_total_views":34,"footnotes":""},"categories":[86],"tags":[307,261,282,173,309,277,234,176,108,254,310,263,308,253],"media-category":[437],"typ":[431],"class_list":["post-94","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-read","tag-against-medical-advice","tag-compassionate-healthcare","tag-emotional-intelligence-in-medicine","tag-emotional-well-being","tag-ethical-dilemmas-in-healthcare","tag-healing-through-compassion","tag-healthcare-transformation","tag-heart-based-leadership","tag-heart-based-medicine","tag-holistic-healing","tag-medical-decision-making","tag-mindfulness-in-medicine","tag-patient-autonomy","tag-patient-centered-care","media-category-stories","typ-intern"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"acf":[],"yoast_head":"<!-- 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