Dealing with patients who either can’t or won’t participate in their care can be a challenge for health care providers across all settings. In wound care, this lack of participation can result in greater financial costs, diminished quality of life, and suboptimal clinical outcomes. This is part...
By Michael Miller DO, FACOS, FAPWCA, WCC
RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 16
As I write my blog, I wonder whether anyone really reads it. I know that my wife and daughters do, because they have no choice. For all the foibles my 24 year old is quick to point out --Dad, you’re not really going to wear that; Dad, you have a stain on your shirt; Dad, you need to empty the cat litter (to which I reply, “why, they didn't eat what I poured them yet!”)--, she has commented on an occasion or two, “That was funny” or, “Yeah, it’s pretty good this time.”
My WoundSource editor dutifully sends me the latest stats on blog “hits” (a term that means either readers who have taken the time to cogitate on my verbal countenance or people who pound their keyboard in disbelief at the tripe spewing from it. Feedback, the lifeblood of a journali…maybe not. But occasionally, lightning strikes, a comment, a cry for salvation, Like Sally Fields’ acceptance speech in 1984 for her Emmy for Norma Rae, “And I can't deny the fact that you like me... right now... you like me." And so, secure in my knowledge that someone, other than my mother reads about the ramblings of an Itinerant Wound Care Guy, I offer an unpublished tale of woe or two that, and you gotta trust me on this, is a behind the scenes whiff of what I hear and read, after the blog is put to bed.
My PA, John, sent me an e-mail from a lady from the West Coast who had undergone a surgery months prior to writing us. Her abdomen (the product of too many children, and too little pulse raising activity), like her self-esteem, had fallen to the floor.
Recognizing that the key to salvaging her life was to salvage her abdomen, a friend had paid “in cash” for her surgery to remove the results of her life and give her some semblance of “before”. The surgeon professionally eradicated the offending tissue and assured her HE would see her in 10 weeks but that his assistants would do the short term follow up. When the incision began draining “seromma” (her pronunciation was truly medically-pronounced), his attempt to palliate it by repeatedly pouring a diluted bleach solution into the depths gave neither of them any relief. When a new wound tunnel appeared, his advice to “take a Q-Tip and rub it until it bleeds and then, pour bleach on it” did little to provide comfort to her or her maw of a wound. In frustration, he did what we all consider when our best fails…we blame the patient and blame he did. Everything from her smoking to lifestyle to failure to use the bleach in the strictly and specifically prescribed and described manner…anything to avoid the recognition that he had failed and in truly miserable fashion. In frustration, she turned to the internet and Googled, Yahoo-ed, and Asked Jeeves for the answer to her problem. She attributes divine intervention to the finding of a WoundSource blog that referenced the root of all her evil, Dakin’s Solution. An e-mail to the attached web site at the bottom of the blog led her to John’s e-mail address and her cry for help. At this point, the cavalry has been called, the Lone Ranger is on the way and Dudley Do-Right (of the Canadian Mounties) have all combined forces to get her the help she needs and hopefully educate her un-caring caregiver a much needed lesson in humility, compassion and potentially finance.
The 36 year old paraplegic had vexed, irritated, abused and cajoled her way into the edges of the care system. Like two Scotty dog magnets, she had repulsed any attempts at help with a banshee like shriek of defiance. No one would help her and all went out of their way to avoid doing so. She appeared in my clinic with four bedsores, two of which exhibited banners of dried, injured tissue proudly displayed on flagpoles of bone. Her slurred speech and inability to keep her eyes on the ball only added to my delight at seeing her. A look at her history showed a hodge-podge of muscle relaxants, a miasma of analgesics and far too many opportunities for help lost that would make even Drs. Drew and Phil throw up their hands and consider LSD to escape. Interestingly, not a single psychotropic medication made the list as she had “tried them all” and “none of them helped me a bit, just ask my friends.”
She played both the pity and self-defiance cards and the results were an angry, overbearing paraplegic who proceeded to tell me what she wanted in terms of medications and ultimately how she was to be cared for. I admitted her to my favorite LTAC and the fun began. Caligula’s antics paled in comparison to her treatment of the caregivers, my colleagues and the aids whose $9.23 per hour was pauper’s pay for what they endured. My own reward for daring to care for her was four phone messages per night, each left after 3 a.m. on the office phone. My love for AT&T’s unlimited calling plan was enhanced with each “To delete this message, Press 7” that I dutifully followed. During my twice-weekly visits, I chose to never acknowledge her splenic ventings nor did she. As the hospitalist reduced her version of the PDR, her calls lengthened and new combinations of profanity (some of which would make George Carlin roll over in his urn) were dutifully recorded by my carrier.
As discharge to rehab time came near, she was considerably more lucid and clinically showed significant improvement. Her angst and venom had subsided somewhat as the transfer time approached. As the next four week phase in an LTC came to a close, the search for a home health care agency became cacophonic. When one agency finally committed (the others had literally laughed me off the phone), the discharge process became photonic fast. Until, that is, when she got home and a week later, we all discovered that the agency nurses had recognized her name and elected to imitate Indiana’s democrats in 2011 by not showing up.
Steadfastly defiant, she told us that she could care for herself, until progressive weakness and worsening wounds (to her own admission) returned her to my office. This time, more lucid but still adversarial, she blamed all but herself for her situation. Fortunately, her father who had never been more than a confabulation was present and in Ward Cleaver-type fashion, convinced her that her problems were solely due to her and no one else. I can proudly tell you that now back in the LTAC, she has become a model patient, no calls, no cursing and her concerns now presented in lucid, adult fashion. Of course, finding her an HHC that is willing to experiment with masochism is still a crusade I have yet to commence. But, she has taken responsibility for her situation…I think.
Like wound care Robin Hoods, we instinctively punish those we perceive as bad and reward the good. Being a health care professional does not make us any more or less human than the next guy and, like our patients, we are burdened with the same frailties of ego, passion and self-righteousness. We believe we know what is best for our patients because we have to. Recognizing that expertise is controlled by both temporal and situational factors, why then do we punish patients when they in fact frequently know more than we do? Of course the converse also exists, why do they punish us when we know more than they do? Blind obedience versus rigid self-reliance? Like sexuality, there is a spectrum that we live on, with each thought, activity and encounter sliding us along towards one end or the other. We need not fear neither the defiant patients nor the loathing they may express when our perception of their needs is not their perception. By the same token, the foisting of our angst on them when our expertise is questioned or worse has resulted in pitiable outcomes and needs to be tempered.
The first patient will get the help she needs and her “accuser” the reward he deserves. The second one may yet realize that help need not be rejected merely because it is not the flavor she wants. As far as myself, I don’t have to worry about what others --or even I--think. I have a daughter whose sole purpose in life is to remind me that my happiness and self worth is solely dependent on what I wear and to not sing words to the songs on the radio that she likes. To you, my readers and those of you who have found my ramblings amongst the multitude of epithets inhabiting the internet, thank you for reading, thank you for commenting and if you don’t mind, let me know what you think of today’s shirt/pants combination.
Until we ramble together again.
About The Author
Michael Miller DO, FACOS, FAPWCA, WCC is the Founder and Medical Director of The Wound Healing Centers of Indiana and IndyLymphedema, as well as a clinical consultant, teacher, inventor, and published author.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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