We all have these patient horror stories and we usually share them after one drink too many. These stories fall into one of three categories: bragging, laughing or crying.
However, if we stop there, we have missed the point. These are the best cases to learn from. Please share some of your own and tell us what you have learned from yours. It is the professional version of “I will show you mine if you show me yours.”
After a meticulous repair of an Achilles tendon rupture, the 24-year-old man was eager to be discharged from our Connecticut hospital. It was summer and the weather was beautiful. I told him he had to be off his feet with his cast elevated and the whole nine yards when it came to post-op instructions. He was to follow up with us in two weeks.
“No problem, Doc,” he replied, a little more excitedly than I would have expected for a man who was headed home to his couch for the next two weeks. I should have suspected something right then but I was green. Oh so green.
This crying case came about when my patient returned to the clinic in two weeks and something else was green — his cast and his leg. He had a rip-roaring Pseudomonas infection from being immersed in seawater. Did you know that a person can fit a fiberglass cast into a water ski? No, I didn’t either. It took a little remodeling of the cast, of course, but where there is a will, there is a way.
After all, as the patient told me, “It’s my boat. I wasn’t going to let them go out on the water without me.”
What I learned from this experience is to expect that a patient can and will do whatever he or she wants no matter what you say. Therefore, you must protect yourself. I started having my patients sign a copy of the post-op instructions and keeping that signed copy in the chart. It wasn’t ironclad protection against legal action but it was one more layer between the lawyers and myself. This shows that patients received the instructions and that we had discussed it.
Another experience with a cast and the sea occurred when my patient was escorted in postoperatively in one of those orange jail jumpsuits. He had not come in for his surgery workup in that garb so I was interested in finding out what had caused this fall from grace.
His cast was hanging on by a thread and broken at the ankle joint. He had deep vertical cuts around the circumference of his upper leg beneath the cast. These exhibited signs of cellulitis.
Long story short, he had run out of money after discharge from the hospital and being a multi-talented individual, he had gotten work on a lobster boat and set out for a run. The work was hot and sweaty, and the cast irritated the entire situation. He carried a long pocketknife and had used it to go into the cast to “scratch at” the itchy skin. In the process, the skin had been lacerated and ultimately infected.
The law came into the picture when he and the owner of the boat came to loggerheads when there was some disagreement about his pay and my patient decided to settle it with his fists rather than with words. Never a good idea. Ultimately, this was definitely a laughing case.
A third case I will classify as a bragging case because no matter what this patient did, it turned out all right. It was through no talent of mine. The man upstairs had a lot to do with this.
I had worked up a very fragile patient with Type I diabetes, a 34-year-old woman, time and time again for bunion surgery only to get to the morning of surgery and find that her glucose had skyrocketed to 800 or more or had plummeted to 30 or 40. Her sugars were a nightmare but I knew that if I didn’t fix her bunion, there would come a time when she would develop peripheral arterial disease, a severe deformity and an ulcer. Then we would all kick ourselves for not having taken the time to repair the bunion when we had a chance. But when would we ever get that chance?
After months of trying, the perfect window came and we jumped through it. We went through all of the postoperative instructions. She expressed full understanding. She was an educated woman as well.
On the day of her postoperative visit, I was standing in the hallway working on a patient’s chart. I hear the staccato of heels coming my way. I casually look up, expecting to see a drug company representative. But who do I see walking toward me in four-inch heels?
Yes, it was my brittle diabetic on her first post-op visit. Yell. Scream. Throw things. I could not believe my eyes.
She had taken off the bandaging and had worn a shoe that was beautiful but not for her foot. She said it had been so long since she could wear an attractive shoe and she wanted to do so.
The amazing thing is that her foot did not get infected, we did not lose correction and all things worked out in the end. God is good.
This taught me to include photographs or drawings of shoes in the postoperative instructions, and not to allow patients to substitute their own shoes during the postoperative period.
What are some of your horror stories? Please share them with us. What have these experiences taught you?