Nephrology W1D4

Today we had a slower day and saw some of the patients we've been seeing on the wards. Most patients have improved and are ready for discharge. 

A majority of patients that Dr. Chen sees are older patients who don't speak at all. I'm not sure if it is because they can't or won't speak, but I think there is a level of deterioration that makes them completely dependent on others. I can't say what CKD patients are like in the US, but it reminds me of the elderly folks in nursing homes. 

Perhaps one of the most notable things here in Taiwan is the influx of "foreigner" helpers to assist the elderly and sick. There is a growing Indonesian population here that takes care of those who need an extra hand. Families hire them on to stay with them for however many months or years to help with an elderly population, or perhaps raising their kids. In traditional Chinese culture, children are expected to care for their parents when they are old. Filial piety is a big part of the culture. However, I can see that times may be changing as globalization takes its effect. 

We saw a patient today who could not speak and had only an Indonesian helper accompanying her. The Indonesian helper could barely speak or understand Chinese, and when asked to call her boss, she said that she did not even have his number. The patient's family is probably completely unaware that she is in the hospital. Other patients similarly had Indonesian helpers and the actual family was not there. I'm curious to see why this is an increasing trend - are people working more? less willing to take care of the elderly? Is modern medicine so successful that it can keep people alive for longer, but lower their quality of life and increase pressure on their children to take care of them? 

Another patient had not eaten in 11 days. He was antagonistic against medical staff and struggled whenever he was fed or given medicine. In the end they had to tie him down and force a NG tube in. The family member told us pragmatically, "You'll have to tie him down. He will fight you. Is that okay?" To me she sounded a little harsh, even a little cruel, as I looked at the helpless, malnourished patient who could not comprehend why he was in the hospital or why he was in pain. But reflecting upon it later, I began to think how frustrating it could have been for the family member who has spent years caring for him out of a sense of duty. I thought this was a unique feature of Chinese culture. In the US, most people send their parents to nursing homes for end of life care.