Case 6
With a heavy Polish accent, Sonia Jelenek refuses to allow the paramedics to transport her to the hospital. The 69–year–old resident of the Elmwood Assisted–Living Community was discovered on the floor of the chapel after having fallen. Although she has lived in the U.S. for nearly 30 years, she and her husband (now deceased) resided in a predominantly Polish neighborhood on the southwest side of the city where even the local stores, restaurants and banks conducted much of their business in Polish.
Only after considerable resistance and negotiation, does Mrs. Jelenek reluctantly allow the two paramedics to lift her onto the gurney and bring her to nearby St. Benedict Hospital and Medical Center. Elmwood social worker, Judy Carlson, LCSW, rides along in the ambulance with Mrs. Jelenek and the paramedics. Attempting to shed some light on Mrs. Jelenek's reluctance to accept care, Judy explains she had never been treated by a physician until she came to the United States. She also reveals that Mrs Jelenek's husband died from internal bleeding and infection after surgery for an ulcer. Since then, Mrs. Jelenek has adamantly refused to consent to any suggestion of medical care.
When they arrive at the emergency room, an X–ray confirms a hip fracture that will likely require a series of surgeries. After getting her pain under control, Mrs. Jelenek is told that she will need surgery to repair her hip. She begins to cry and demands to be discharged from the hospital. Eventually, Judy Carlson is able calm her down, and convinces her that she is in no condition to return to Elmwood. She later makes another failed attempt to persuade Mrs. Jelenek to consent to the necessary surgery.
Later that afternoon, Mrs. Jelenek is visited by a young surgical resident, Dr. Roman Dzabia. To her delight, Dr. Dzabia struggles through a few phrases in Polish. As it turns out, he grew up a few blocks away from the Jeleneks. Dr. Dzabia reminisces with a somewhat sedated Mrs. Jelenek for nearly an hour before he is called to attend to another patient. Before he leaves, she grabs his hand and asks him to come and see her later. As he walks out the door, Mrs. Jelenek smiles to Judy, and remarks on how much Dr. Dzabia reminds her of son, Jare, who was killed in active service in the Persian Gulf.
In a few hours, Dr. Dzabia returns to Mrs. Jelenek's hospital room, carrying a few Polish magazines and a local newspaper in Polish. Dr. Dzabia seizes an opportunity in their conversation to revisit her decision about the surgery. He eventually helps her understand that she needs to undergo the proposed surgeries if she hopes to be able to do the things she most enjoys, such as cooking and gardening. She finally agrees with Dr. Dzabia and promises to make him a traditional Polish meal when she's back on her feet again.
The surgery goes well, although Mrs. Jelenek is in extreme pain when she regains consciousness. Inadvertently, she receives 5 mg of dilaudid instead of 5 mg of morphine. The nurse quickly notices this and she is given an appropriate Narcan which reverses the overnarcotization. Mrs. Jelenek sleeps through the night and awakens with Judy at her bedside. Judy has been made aware of the mistake involving the dilaudid. Soon after, Dr. Dzabia stops in. He looks over the notations on her chart and seats himself on the corner of her bed. She smiles at the doctor. He returns the smile and says "good morning" in Polish. Mrs. Jelenek then complains of nausea. Dr. Dzabia assures her that although the surgery went well, nausea is common. He agrees to provide her with some anti–nausea medication.
Dr. Dzabia leaves the room and instructs a nurse, Jennifer Ramirez, RN, to give Mrs Jelenek X for her nausea. "Did you tell her about the dilaudid and the Narcan, Dr. Dzabia?" she asks. Dr. Dzabia pauses and looks at the Nurse Ramirez. "No. Are you kidding me?" Dr. Dzabia responds. Nurse Ramirez continues, "Shouldn't she know? Doesn't she have a right to know?" Dr. Dzabia lowers his voice and responds again, "After all we've been through with this patient, are you honestly suggesting that we tell her about something that was really of no consequence at all? Keep in mind that there is more work to be done on her so that she can get back to some kind of a normal life. I don't think we should jeopardize that." Nurse Ramirez nods and walks away. Nurse Ramirez bumps into Judy Carlson heading toward Mrs. Jelenek's room. She mentions her conversation with Dr. Dzabia. Judy agrees with the doctor that there's no good reason to tell Mrs. Jelenek about the mistake with the dilaudid.