Car crash - help please

[cheese]

My parents were in a car crash in Jiangsu province (300Km from Shanghai) a few days ago. We don't know whether to send them to Shanghai (is the standard of care good enough?), which is a 6hour journey by car which might not be safe, or leave them in Jiangsu (it's an out of the way small-town province, but the Australian Consulate in China says it's adequate for their injuries), or medi-vac them to Singapore (where they live, and where medical treatment is consistently high quality), which'll cost $120 000 (we can raise the money but that's not even including hospital stay and surgeries), or even medi-vac them to Sydney which'll cost $180 000 - but treatment here is free, as long as they move back here permanently.

They are not covered by travel insurance.


We don't know:
- the full extent of their injuries, since they keep discovering new ones every day
- (as a result of the above) whether they're actually safe to fly
- the standard of medical care in small provinces (maybe the Consulate is comparing them to Afghanistan or something, who knows whether it's actually acceptable)
- the standard of medical care in Shanghai

Shanghai will be as expensive as Singapore, but Singapore will provide some small amount of medical coverage for my mum (public servant). But they won't need to medivac for Shanghai (although the 6hr ambulance will probably cost a heck of a lot as well, though surely not the same), which means Shanghai may work out cheaper.

Their injuries are (so far):

Mum
- 2 broken ribs
- 2 broken bones in arm
- one broken bone in leg
- dislocated/broken hip
- concussion
- internal bleeding, which stopped on the first day
- blood/fluid in the lungs?
Mum is unfit and had 2 epileptic fits in the last 3-4 years. She has had a plate put in her arm by the Jiangsu doctors.

Dad
- dislocated, fractured shoulder, floating bone fragments
- broken/fractured rib
- fractured hip
- fractured ankle
- broken toe
- pocket of fluid in the lungs?
Dad is quite fit and has had a pin put through his knee.

Neither of them have (so far!) any spinal cord injuries or brain injuries (aside from the concussion, which I've heard typically resolves by itself).

The doctors are not operating at the moment because they're expecting us to take mum and dad back to Singapore. They were injured on the 7th.


Anyone with any relevant information, please share.

 

[ApostateAbe]

You may want to call a medical accountant to help make the right decision. Any fee such a service incurs will likely be small compared to what is at stake.

 

[EvilScientist Trainee]

I'm no medic, and thus cannot give a very adequate assesment of their situation. But here's a couple of things I have thought to be important:

- First, your mother had problems with epilepsy in the past, and now, had a concussion.
- Unless we're talking about the fibula, leg bones are hard to break. The accident may have been a hard hit.
- Nanjing, as you've said, is a small-town province. It is better to place your mom with the best medical resources available.
- Your father seems to be going to be better soon. The damage your mother suffered is something we need to pay attention.

With this in mind, i'd suggest them to go to a more resourceful place. Either Shangai or Singapore will may work. They both seem to be stabilized, so I can't see any immediate life threatening problems.

I'm just a stranger on the internet, but I offer you my most sincere condolences.

Everything will work out fine, as it's the likely. Keep us up with some info.

Edit: And take ApostateAbe's advice into account.

 

[cheese]

Thanks Abe - I looked medical accountants up and couldn't find anything though. It's certainly a useful idea.

EST, yes it was a hard hit I think, the driver's dead and the four passengers in the back (parents in front) are not too badly hit but one has fractured vertebrae and a few other things, one has a broken sternum, blah blah. Parents quite traumatised.

Of course we'd all PREFER the best resources... but it is a fuckton of money just to get them out of China. We can't just keep shelling out money. There've been a few medical emergencies the past couple of years and damn, 120 grand just for a flight! Shanghai would be best imo but I've been reading up on them and the hospitals have lower quality equipment, and while care is generally competent, the level is of expertise/education/experience is quite variable. Blah blah blah.

Thanks for the well wishes (I've never really understood 'stranger on the internet').

 

[EditorOne]

I have no expertise or advice, Cheese, just extending best thoughts for you and yours.

 

[Cognisant]

With internal injuries the less you move them the better, the only reason they should be moved is if their condition isn't stable (still bleeding internally for example) and surgical attention is required.

Then again I'm not a doctor, if the medical professionals there tell you to send them to Singapore, I'd do it.

 

[Lobstrich]

Did you take all this time to post this giant thread on a forum to get an answer for this, instead of just taking a decsision?

 

[Solitaire U.]

You've made no mention of your parents wishes in this matter. The impression I get from your op is that they're hanging in the ether pending your ultimate decision of what to do with them.

Meanwhile, the caregivers in Jiangsu province appear to have assessed their respective conditions quite thoroughly. Assuming they are equipped to attend to all your parent's needs, what is your rationale to assume they will do so incompetently?

120,000 is an enormous price to pay for the dubious comfort of quelling your third world hysteria...

 

[Reluctantly]

Do you think the medical care they are getting isn't adequate where they are?

This is a tricky thing, you have a lot of complications. Unless a condition comes up that the doctors don't think they can handle, they will most likely suggest to leave them in their care. Other hospitals are just going to deal with the problems as they come up as well.

If you think the hospital has a bad track record with these things, then you should move them. Have the doctors given you any kind of recommendations? Have you asked any of the staff about what types of things they deal with and how successful they are with these types of patients? Sometimes it isn't as much about the care, but the experience of the doctors in these matters. In a Jungian sense, a good Te dealing of the situation.

I don't know, I'm not a doctor either, but this is what I would probably do.

Good luck.

 

[Awaken]

I dont know what advice you want as you did not really ask a question.


Broken ribs: Probably wont do anything about it unless she has >2 contiguous ribs broken in two different places causing flail chest
Broken leg:You did not really describe all that well but I imagine she may need an ORIF.
Broken pelvis:Not a particular good injury to have. Predisposes to clots and whatnot.
Fluid in lungs: Probably a pleural effusion. Depending on the amount of fluid, she may need it drained. Small effusions will be absorbed by the body, but if she is continuously bleeding from a vessel this will need more medical attention as it could restrict her breathing enough to put her into respiratory failure.


You did not mention whether they had any imaging done or what the results of said imaging were, but from the extensive list you have given it seems to have been a pretty significant accident. Did they lose consciousness? If so, did they get a CT scan of the head? Have they had a CT of the chest to rule out any type of aortic injury(possible in deceleration injuries). Im not really sure what else you want to know, but these are not injuries one would want to sit on. You say the internal bleeding has stopped, but how do they know? Do either of them have bilateral femur fractures? Do they have any abdominal pain? Are they actively short of breath? What are their vital signs(which would tell how stable their fluid status is) for example: low BP, tachycardia, tachypnea are all bad signs. Also, multiple bone fractures would predispose someone for fat emboli. They are also most likely immobile, so they should be on some type of DVT prophylaxis.

 

[cheese]

Thanks EditorOne and Cog.

Lobstrich, I'm not the only one making a decision, this is spread across three different countries and we are all trying to work out what to do, based on limited information. The scanning/testing process seems to be relatively inefficient, taking days to determine the extent of injuries (to the point where the doctors were actually worsening their condition). The uncertainty meant we have been unable to make any moves of course, since they have been in no position to move. The doctors were still assessing them yesterday to determine if they were capable of any transport at the current time.

Solitaire U:
Perhaps I forgot to mention the hospital said they are not equipped to deal with my parents' injuries. From what I've read in China the medical system is quite self-contained; hospitals/clinics treat or refer patients to different tiers (three in total) based on their own discretion, so while the Australian Embassy may have assessed their facility as adequate according to some external criteria, I would assume the doctors know better. Rural doctors generally have less education and experience, both of which vary a lot in China, according to reports I've read.

Additionally there is no nursing care provided, no food provided, no control on visitors (villagers keep swarming into the room - nicely and with the intention of being helpful, but it's quite exhausting - and making lots of noise). None of this is devastatingly bad imo, except perhaps for the nursing care, but it's bothering my parents and mum's sister.

Of course my parents are not helplessly waiting for us to do whatever we want with them. They are as involved as they are able to be given their present state (both conscious and lucid, though exhausted). Seeing as this will be a financial effort much beyond any single one of us though, the decision does not rest solely with them. If we could have found a reliable equivalent that was cheaper we would prefer that; the family in Australia has actually been trying to work against an emotional/fear-driven response to this, especially a hugely expensive one - it's just hard to get reliable information.

They would prefer to go back to Singapore, and it looks like a support network is quickly forming, so that's good, especially given that the medivac fee has dropped AGAIN to $86 000US (from $280 000 originally). [We think they just quote whatever price they want to get it out of insurance companies, if possible.] We are estimating medical costs to be around the same as the medivac itself, (although it's nearly impossible to know) and ongoing physiotherapy will continue for months, plus the loss of income as neither of them are fit to work at all currently - though Dad thinks he'll be up and running in a few weeks... we'll see.

Reluctantly and Awaken:
It's very hard to get any information across the international and language barrier. It's also hard to get a 'reputation' or 'track record' of a rural hospital. I think it's been a pretty inefficient process tbh, on both sides. We've been talking round and round in circles, across the embassy/foreign affairs/family/hospital/other doctors/SOS (medivac)/various contacts, trying to determine the best possible course of action. And it's hard to translate culturally as well as linguistically - that medical jargon was helpful in one sense Awaken, thanks, but mostly useless as far as Chinese goes - the doctors don't speak English and the translators aren't much better. Although I can say they've had a CT scan done, and since my aunt has gone over (who speaks fairly good mandarin) things have gotten clearer. They've had a bunch of other tests done as well, but afaik they aren't that interested in sharing information - different culture, different system. They've told us the extent of injuries as far as they can determine, but vital signs ... I think they are not equipped with sufficient staff to bother with that as frequently as in the West, but there's nothing untoward at present and they're mostly stable, I'd guess.

Could just be that we suck, not being doctors, and didn't know to ask the right questions.

My mother finds it a little difficult to breathe because of her ribs, but she was speaking fine on the phone.

Awaken:
Mother has a broken femur I think. I'm not sure if either of them lost consciousness, yes they have had a head CT scan done and the results are apparently not cause for concern, there have been other tests but I assume all the relevant information has been relayed to us. We're not sure about the internal bleeding actually, that's one of the bigger concerns but I think they found it resolved on the first day.

Thanks, I will look up the terms you used and see if they can help us.

Mostly I wanted to know if anyone had any information on the reliability of the medical system in rural places, or cheaper medivac services, or recommendations on shanghai hospitals including typical prices, or knowledge on efficiently dealing with chinese doctors or accidents involving those injuries - anything that could help us navigate a more or less foreign system better. Actually the medical information would be very useful if they spoke English; I was looking for that as well.

I've seen surprisingly useful information on this site before about getting by in other places, and it's a community I know, so I was hopeful for that.

I think I've been extremely useless so far in this matter and I want to do more but I'm not exactly sure what needs to be done especially as the data is often garbled and contradictory (the account of their injuries changed day to day - not just increased, actually changed). It's like playing chinese telephone, or whatever that game is.


ANYWAY:
Thanks for the help and well wishes; I was quite surprised and touched with PMs and VMs and posts. Looks like they are just going with the medivac to Singapore, so fingers crossed nothing happens on the plane - we've already had one crash.

 

[cheese]

For anyone that's interested, they've now LOST the medivac flight because someone got in ahead of them. The next available one is on the 17th - too far away - or 2 single-seater planes, which of course would mean twice as much.

(I'm not sure if anyone's interested at all, but it helps to grumble a little.)

 

[Stoic Beverage]

I'd think it wisest to leave them in Jiangsu. Aside from floating bone fragments in your dad and the lung fluid from both, it's all just broken bones. Unless they're both extremely elderly, the bones shouldn't be too big of a deal to get fixed. Any hospital I can think of can set/relocate/cast a broken/dislocated bone. Once further diagnosis is given on the lung fluid, then you could move them.

 

[EditorOne]

My wife and I have just come off a long spell of dealing with parents stricken by serious disease who were some distance away, far enough to require air travel. It wasn't a bolt out of the blue like you're dealing with, but I can imagine the frustration and relative helplessness you're experiencing, and it's no fun to deal with. Please keep us posted on how things go. I think sharing, even sharing the frustration, is probably good for you, and responding might be helping you work it out, even if obliquely.

 

[cheese]

Stoic Beverage, they are getting bedsores and not being properly attended to, plus the doctors don't think they can handle the conditions (both require surgery).

Thanks Editor, and I'm sorry to hear about the illnesses. I hope that's going alright, or been resolved.

I've just had some fantastic news though:

MY PARENTS' CHURCH HAS DECIDED TO PAY THE ENTIRE MEDIVAC FEE!!!!!!!!!!!!!!!!!!

And I got other good news today: according to some singaporean doctors I spoke to, the costs of their treatment should be quite low and easily handled!

This is such a weight off our minds. Regardless of what way it could've gone though, I'm very grateful for everyone's support and well-wishes. Thanks a lot, I appreciate it and it's helped.

It's going to be so much easier, knowing all this. I would've had to handle whatever came, but this is definitely preferable, and I feel more up to meeting it. Yay!

Again, thanks, and I'll keep updating here if there's anything important.

 

[cheese]

Update:
(in singapore now) Final procedures today; surgeon said they should be home in about a week, much faster than any of us were expecting. Father was demanding pizza after regaining consciousness so I'm guessing all will be well with him.

Sorry to anyone I haven't gotten back to yet - I will once I'm less exhausted. Merry christmas if I'm not back before then.

 

[Inappropriate Behavior]

Good news! Just now seeing this thread and glad to see it progress to a satisfactory conclusion.

 

[EvilScientist Trainee]

Indeed, that's great news.

And how is your mother? It seems like she's healing well too. I found your dad wish to be very funny :P. Have you talked to any of them yet?

Anyway, if you happen to be unable to return to the forums before christmas, I wish you Merry Christmas as well.

 

[Polaris]

Great news!

Merry Christmas, Cheese

 

[echoplex]

Thanks for the update cheese. Wow, a week is much faster than I would've thought, though I know very little about these kinds of things. Hope your dad gets his pizza.

Hope your xmas is merry. I will attempt to have a reasonably merry one myself, but I promise nothing.

 

[Minuend]

I'm glad to hear it, cheese!

 

[Oblivious]

It's good to know everything is finally going well for you cheese.

Oh, and Merry Christmas.

 

[cheese]

Thanks everyone

They're at home now, after two weeks in hospital.

Dad's got a drop foot (mangled nerves, so he can't move it and it's in a cast), broken hip, and broken shoulder with a severed nerve - which has been operated on and 'fixed', though healing will take time. Plus a broken rib, but that's negligible.

Mum's broken every rib in her back, and has a broken thigh and a broken wrist, both of which have been operated on. Her recovery will be more straightforward than Dad's, because he won't really be able to use his foot for months (possibly not ever, but we're hoping the nerves will sort themselves out) and his hip's a mess and arthritic. He's praying for a divine hip replacement though - hmm.

Both are in wheelchairs, and we have two walkers, two walking sticks and a commode (basic wheelchair with a hole in the seat - the whole thing can be fitted over a toilet bowl).

The only reason I'm managing to write anything today is because:

*drum roll*

MY MUM USED THE COMMODE OVER A TOILET BOWL TODAY, INSTEAD OF A POTTY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

That means no cleaning the potty out, no worries about anything getting on the floor, no extended sanitising process, and of course the general absence of the ick factor, though that's been semi-ok... it doesn't really make sense for this to be such a big deal to me, and I still feel like there's a huge stone in my chest, but god this is making me happy.

PLUS - Dad took a few steps (hops) with the two walking sticks today. Because both parents have diagonal injuries (right arms and left legs), walking is fairly difficult, but we were all pretty encouraged today when he managed a couple of metres.

He also slept last night without pain! Though the mattress sucks so he woke up with his back paralysed, but I masssaged it and fixed that.

They're both up and about (in their wheelchairs), having a lovely romantic time together, and being much more generous with us than I'd expected, Dad especially. It's so easy to thoughtlessly and thanklessly demand more of your family than you would anyone else but Dad is trying so hard to avoid that and treating both of us (brother and I) as people with their own lives, instead of just mindless servants or extensions of themselves.

We've also got people helping us (providing wheelchairs etc), plus a maid (who'll have to leave on the 29th, along with brother who's going on a holiday to Vietnam, but we'll get other people in) so it's a lot better than it could've been.

I've still been having a lot of trouble internally though. God I suck at serving people. It's funny how easily the resentment/anger/something sets in. I think it'd be so much easier if they weren't related to me, plus it's surprisingly hard seeing them incapacitated like this, especially Dad who is really active and loves long walks and mountain-climbing. It's sort of similar to the way I miss people - I think I'm fine most of the time, but every now and then I remember that there's xyz I can't do with them, and that it'll be a really long time (if ever) before things go back to some semblance of 'normal'.

All the small things - emptying the potty, cleaning it out, cleaning out the bottles, washing the pails, adjusting their clothes, getting them food, lifting them in and out of chairs; the invasions of privacy, sponging them, washing their hair, the sanitising and 'endless' to-and-fro - are fine, while you're doing them. It's the bits in between, where you get to think about what you've done, and what you'll have to do, inescapably, unavoidably, no matter how infuriated you become, that get to you. Or me anyway, because I'm weak/selfish (it's a relative thing, and I don't know where I stand in the scale of humanity, but there is a significantly large number of people with more patience and smiles than I have). It's all worse because I KNOW them - they're still themselves, and whatever tension is between them, and us, is still there, all the grooves of interaction that have been laid down over the years still dictate the majority of life.

I've also been really down for the past couple of months so I suppose that's worsened my reaction.

Plus there's their own experience, especially Dad's, of being helpless and needing to rely on other people. If they were paralysed, or had some other kind of permanent damage, I don't know what any of us would do. Even like this, knowing he's going to get better, Dad has sometimes hoped to die (mostly during the intense and excruciating pain). I can't imagine how Clayton (the guy who wrote that extended suicide note ApostateAbe posted) and people like him get through even those two years he lasted - with no hope of recovery, just the same dreary physical loss day after day. How could you deal with it? It's easy to say you just do when it happens, but some don't, and that's the most terrifying part, knowing there're things out there you can't tolerate and can't handle, that you'll either kill yourself or just snap. How do you prepare for stuff like that? (lol INTP) Again, I'm so glad it's not worse.

I'm pretty surprised by how I'm dealing with all this, actually. I was pretty optimistic at the beginning, and patient, helpful, generous with myself, whatever - but that was when they were sickly and totally helpless. Now that their personalities and spirit are more or less back to normal, I think part of me feels like the help isn't that necessary and resents them for being needed, or something. Then I see them *truly* helpless, and am reminded that I AM needed, and can't escape it. It's so easy to offer help when you know it's not your responsibility, and you can leave when you need. It's easy to do the hard slog when you're volunteering, when it's your own choice. Plus they're my *parents*! I think I'm sadder over this than I thought I would be. Actually I don't even know what most of my feelings are.

It's really helpful being able to get all this out here. I can't really talk about it freely outside, I guess.

I don't need advice, or sympathy; I've probably heard it all before, unless it's a personal story (which you're more than welcome to share). It's just useful getting to say all this stuff - being selfish, resentful, angry, sad, miserable, whateverthefuck - and knowing some might hear.

I really suck and I don't care, and I don't care what anyone thinks. It's really freeing, actually. More and more I've been realising that I can't control what anyone else thinks of me and I just don't care anymore.

Aaaaargh, positive and negative are clashing within me with such force. I'm so grateful they're getting better, for selfish and selfless reasons.

Another bit of usefulness from this: I decided several years ago not to have kids, and this has helped reinforce that decision.
Also, I think this accident will help make all of us better people. Parents are hardly fighting, which is really nice.

 

[cheese]

My ankles and feet feel shot to pieces. My heels feel like there're knives poking into them. The thing is, this is probably all pretty standard for any job on the feet, it's just that I'm soft and lazy.

Being out is barely any relief at all, because I'm exhausted all the time and I know I can't escape.

I can't tell if this is about the accident or if I'm just depressed, and this is aggravating it. I haven't felt this hopeless for months, and it's annoying having it back.

Things could be so much harder than this. I feel like such a loser for being so weak. I don't think I'm actually doing all that much, it's just that I get worn out and ache really easily, and maybe I've just done so little hard work in recent years that I can't manage anymore. It's probably also the psychological component I guess, having the people I rely on become weak and powerless, and then becoming a tower of strength myself while not actually possessing the resources to be so.

Again, it'd be so much easier if this were a job, or volunteer work, that I could walk away from anytime. Just knowing that I could walk away would make it easier, even if I never did.

And then there's them, suffering through the day and feeling the disappointed hurt that comes from realising your fears are right, your children really don't love/respect/care about you that much, and when you need them they aren't there, at least not 100% cheerfully. And I know a little about pain, and while it's helped me empathise and granted me extra patience it's also just made everything worse in my head. How horrible it must all be for them.

I'm really angry and resentful that my brother is going out so much, which I feel guilty and wrong about. I feel like he should try a little harder since he's going overseas for a 5-day holiday on Wednesday. Who cares that he says he'll put me 'off-duty' when he gets back - he will have missed the worst of it. He says he's tense and angry and needs a break - he's not the only one. Just because I'm not an extravert doesn't mean I don't need off time, but because it's mostly at home I never get much. I'm so exhausted and depressed I want to die.

He's not a duty-shirker at all though, that's more me. I'm quite possibly being terribly unfair, or at least a little. He just doesn't seem to be approaching this fairly, at the moment. I've been unfair enough times in my life that it probably evens out though.

Honestly, the stuff I have to do isn't that bad. I'm not *eating* shit, or even cleaning anything out anymore. No one's abusing me, I don't have to worry about laundry or food, both parents are more or less intact mentally and physically, we've got offers of help from everywhere, etc. While I'm doing things I really barely mind at all, most of the time not at all. I think it's just the tiredness that gets me down, and I suppose I've been sort of depressed for a while, so that worsens it.

Like I said, it's (often, not all the time) worse when I get to think about it. Which makes me wonder about a lot of the INTP "depression" we hear about it. Maybe if we just shut up and did stuff... but that's a very old and basic idea, so I'll stfu.

It can't just be that though. Last night I felt too depressed to sleep, although eventually I did and woke up feeling a lot better. Little things have got to me throughout the day though.

People put up with so much more than this. I think I'm weak and selfish and spoiled. Look, I even have time to write this post!

 

[cheese]

I wonder if taking care of a baby would be easier or harder. They're easier to manage, size-wise, and nappy-changing isn't a major hassle, but there're a bunch of other little niggly things. I don't know.

Things will get better, and rather quickly, I suspect. This isn't really a problem at all, I'm just in a notgreat mood. Thanks forum for not having a no-grumbling rule.