Hi folks. Dr Louella is back after a long break!!! I was busy getting married and settling into this new phase of my life (at this age).
I’ve always been looking for a new approach to this blog and I finally hit upon it. I plan to use my numerous unique patient experiences to teach about medicine, and by extension, life.
I have two interesting, touching cases to bring to you to demonstrate the title of this post and the medicine that goes along with it. The second case will be in the following post.
Now the part of medicine that I really enjoy is relating with the patients. I am different in this regard from many doctors I know. I take the time to find out about my patients and work with their situation. That’s one of the reasons why I am such a good family doctor.
Just yesterday (Oct 6, 2015) we had a chronic disease clinic on work. Clinic was practically over when a nurse came to ask me to re-write an insulin prescription for a diabetic patient. She was an amputee. He husband had broken her insulin vial. He had also put her out of the house and she was staying with a cousin.
I was about to re-write it when she also revealed that the patient had missed her appointment and had come to get a new one. She was in the car.
Well, I thought that the only humane thing to me was for me to attend to her one time. But it was not that easy because this patient believed herself to be inappropriately dressed and refused to get out of the car.
To speed things up I said I would go outside and have a look at what she was wearing. I thought it was fine, a dress with a tube top, and reassured her.
After the usual screening process, to get her blood pressure, glucose level etc. I saw her in my office, along with her cousin. I have no problem having a relative or two in the room.
This patient was young (ie around my age). All her hair was dyed blond. Her history was that of being a diabetic from the age of 25, following diabetes in pregnancy (gestational diabetes). Now 41 she had suffered the loss of her right leg through a below the knee amputation (bka), a year previously. She walked with crutches.
I adjusted her medication, wrote prescriptions and gave her a very short appointment (4 weeks instead of the routine 28 that we were forced to give.)
Then I heard something from her cousin about her foot, the left one obviously. Now the bacchanal start! I wanted to see her foot because I was hearing something about a lesion below it.
Well this patient refused my request point-blank! She was not going to lift her foot to let me see beneath it. I was shocked. This had never happened in all my years before.
Then were the excuses. She was attending to it privately. She was in hospital for it already. She absolutely refused to go back to hospital. I didn’t know the kind of stress she was facing. She couldn’t possibly be concerned about any more than that right now.
At first I scolded her (buffed her, as we call it in Trinidad). I lectured her. I explained the dangers of having another foot ulcer or infections. She could lose her other leg! Amputations are a sad but real and oh too common complication of poorly controlled diabetes in this country.
Her cousin chimed in. She had honestly only found out about that lesion this morning. But she did not want her relative to suffer another amputation.
Still no. So I changed my approach. I knew that I was not letting her leave that office without seeing that foot. So I declared that i was being too mean. I would be nice to her from now on. I rubbed her arm and talked sweetly.
With that, and a bit of begging, she finally conceded. There was definitely an ulcer there, about 5 cm wide. But there was healthy looking new growth inside. I buffed her up for having it uncovered and sent her to the nurses to have it dressed. There was no need for antibiotics.
In the end, I felt worn but good. I make it my business to go the extra mile or two for my younger patients, who are have many years ahead of them to manage these dreaded diseases.
I will discuss the next case, a sweet but gaunt elderly gentleman as my early morning emergency, in my next post… It’s great to be back!!! Dr. Louella, over and out!