Sometimes, we're family

August 4, 2006

This difficult patient taught his doctor a lesson about empathy.

It's not hard to remember the patients who make us feel good at the end of a long hard day. But although the times I saw Thomas were never easy, I can't stop thinking about him. I first met him at the outpatient clinic during my first year of residency. There was a summary of his diabetes and his Charcot's foot in the chart, but the outgoing resident hadn't mentioned how difficult a patient he was.

Thomas showed up consistently every month with various ailments. He had an itchy mole on his face that needed to be zapped, purple toes that had to be tested, and a blood sugar reading of 310. He needed blood work every three months for his A1C's, as he always reminded me.

At each visit, Thomas told me what I "probably" should do for him. Each time, I listened dutifully and then did my physical exam. On most visits, he would take his boot off his Charcot's foot and show me his toes through the holes in his socks. But on one particular Friday he removed his sock and insisted that I look at his whole foot. When I did, I saw a dime-sized, clearly infected lesion on his ankle.

About two months later, Thomas had to be admitted because his skin infection had grown worse. I wasn't on the inpatient service then, but I did drop by a few times to see him. He told me he wasn't feeling well; in fact he'd never been this sick before.

"You know," he said, "I've always tried to take care of myself these past 10 years because I know that if I get really sick, I have no family to come and help. I do have a little brother, but I don't know where he is now. Besides, he has his own issues, and I don't know if he'd even bother showing up."

Then he told me about his father, a preacher: "He used to kick us with a boot bigger than mine when he was drunk; more so when he was sober. That was his way of teaching us to be men."

I told him about my own dad, who'd died when I was 9, and he told me he wished his had died.

A few weeks after he was discharged, Thomas was brought to the ICU, septic and delirious. His foot had become much worse. When I got there, a stranger greeted me, "Are you Dr. Paradela? I'm Greg, Thomas' brother. I don't know if he talked about me, but he sure talked about you. He told me you were the most caring and compassionate doctor he's ever had, and that you always listened. I just wish he'd taken better care of himself.

"When our father was dying last month," Greg told me, "Thomas spent two weeks looking for me so that we could see him one last time."

Thomas had a smile for me when I walked to his bed, but he looked weak, pale, and vulnerable. He closed his eyes and said, "I wonder if I'll see my dad when I die. Oh, you know what? When I see yours, I'll tell him 'Hi' for you."

Thomas was quiet for a few moments, and then he whispered, "Hey, don't let them take my leg. I want to die whole." He squeezed my hand as they wheeled him away to the OR. On my way down to the lobby, I heard a code called in the OR, and I knew who it was.