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.
