Wednesday, November 28, 2012

What's the Plan?

Getting the Plan

He is a very, very large man.  He is not warm and fuzzy but instead outspoken and assertive.  He is disabled with the loss of one leg following a horrible accident almost ten years ago.

He was found in his home, during Hurricane Sandy in water neck high when his electronic wheelchair stopped working.  He yelled for his girlfriend to get to higher ground with their dog.  He waited there until he was rescued.  His rescuers brought him to a local hospital.  His girlfriend is still in a shelter with no place to go waiting for some help and direction.  Their beloved dog has been left to be cared for by others.
He met me, on this visit, in the lobby of the hospital in a new loaned electric wheelchair that he used to scoot around the hospital lobby.  While sitting and talking with him, he shared that his “good leg” was in a lot of pain but he wasn’t getting his pain medication.  When I looked down, I waited for him to remove his sock but soon realized it wasn’t a sock at all but his leg was turning dark purple or even black.
“What have they done for this” I asked him.  “Nothing” he told me.  He said he told someone about it two days ago but still no one has done anything about it.  I brought him in his wheelchair to the nurse’s station and asked for someone in charge.  The nurse told me she was in charge and would call the doctor to meet us in his room.
I asked the man who came in if he was the attending.  He told me he was a resident.  “What year” I asked.  “First year” he said.
I asked him to look at the patient’s leg and let him know what will be done about it. As the first year resident put his hand out to touch the elevated leg, I stopped him and said “please wash your hands before touching him”.  He complied and then took gloves and looked at the leg.  He said he didn’t know what the problem was.  I insisted he find out.  “Is there anyone who would know?  A vascular doctor, the attending, someone has to know before I leave what the plan is to treat this?”   The young man avoided eye contact with me but kept looking at the leg.  When the silence went on too long I asked him, “If this was your father, brother or child, would this be ok?”  I kept reminding him we need a plan of care but the resident tried to talk about the patients discharge and going to rehab.  He said this is where they would be able to treat this better.
I would not let him change the subject and told the resident that we are not discussing rehab right now, there is a problem right now that needs addressing and I can’t leave until I and the patient know the plan.
The resident said he would find someone with an answer and left.
He returned a few minutes later and explained that his leg needs to be elevated. “Now that’s a plan” I said.  I asked the patient if he understands that and asked what he will do?  “I can’t keep it up 24/7” he said.  The conversation was now between the doctor and patient.  The dark color was already fading.

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