Mending Damaged Feet And Damaged Trust
The middle-aged woman was a new patient in my office. Her sparse short hair told me she had recent chemotherapy. Her history confirmed she had been treated for breast cancer during the past three years. Then she slipped her shoes off and I immediately noticed severe hallux varus deformities on both feet. Her question was simple, “What has happened to my feet?”
She explained she had undergone bunion surgery in another state just before her breast cancer was diagnosed. The first toes protruded out at the first postoperative visit. Her surgeon was a well-trained young podiatrist whom she remembered screaming at a resident when she was coming out of sedation after surgery.
“He promised me my toes would return to a normal position but they never did.”
After her cancer was diagnosed, the breast surgery and chemotherapy became her top priority. She decided to deal with her feet later if she survived the cancer. By the time circumstances led to her move to my community, she was ravaged by the chemotherapy and impoverished. She was on welfare and living with friends. It was time to deal with her damaged feet.
People crippled by podiatric surgery are a difficult challenge. The first task is to rebuild trust. Many of these patients go to orthopedic surgeons and never trust podiatrists again. The orthopedists kindle this mistrust with smug self-righteousness. I am flattered and humbled at the same time when a podiatric cripple comes to me for help.
Part of rebuilding trust is not to point the blame at the other podiatrist. In this patient’s case, it was hard for me not to be critical. Complications happen to all of us but it angered me that her first podiatric surgeon lacked the courage to admit the complication and offer her a solution. Hallux varus would have been much easier to correct in the first weeks following her initial bunion surgery. She was not angry with him but only wanted answers and correction of her deformities.
I sent for her records from the first podiatrist and scheduled surgery to correct hallux varus. I attempted a fusion of her first MTPJ. I planned to do one side at a time so she could be off-weightbearing. Her severe osteoporosis made adequate fixation of the fusion impossible so I released the contractures of soft tissue at the medial aspect of the joint and secured correction with a K-wire. After I removed the wire four weeks later, her first toe was in a much improved alignment.
She seemed happy with the result and planned to have the other side done a few months later. When I had requested her records from the first podiatrist, his office sent a small unpaid balance from her care to a collection agency. She wanted my advice on whether to sue him. The forced collection angered her along with the realization that he had been dishonest about the complication.
I talked with her at length and, in the end, she admitted she would settle for an apology from the first podiatrist and wanted him to write off her unpaid balance. I promised to contact the other doctor and try to arrange this.
When I called his office, the receptionist told me he was too busy to come to the phone. I explained the call was crucial to his professional and financial future. He told me he did not remember the patient and performed the surgery through a clinic where he no longer worked. I told him about the hallux varus and told him what she wanted. He agreed to write off the bill and call her.
It has been nearly a year. I corrected the other side a few months ago. The patient has not heard from the collection agency again. The first podiatrist never did call her. She is not angry with him anymore. She has had to accept many hardships in her life and her foot problem was small by comparison.
That podiatrist probably doesn’t realize how lucky he is. Lying to a patient about a serious postoperative complication could have cost him his license. In my state, it would have. The malpractice settlement would have been six figures.
This woman who has suffered so much has been a wonderful example of strength and graciousness. It has been my profound pleasure to help her through this difficult, painful and unnecessary complication of a botched operation.
She knows I write for this magazine and all podiatrists receive it. She asked me to write this article to help her achieve closure. Patients injured by our care want above all for us to hear and understand them. This one’s for you, Cindy.
Dr. McCord (pictured) is a Diplomate wtih the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.