Why I Chose The Road Less Traveled

My patient was a 40-something, peroxide blonde, personal fitness trainer. It was her first visit and she complained, “You have to do something about my nails. I can’t have this flaw with my job.” Her nails looked nearly normal with only slight thickening and very faint yellow discoloration. She had a history of liver dysfunction. I explained that her problem wasn’t serious enough to treat and the oral medications for fungus nails were contraindicated because of her health history. At this point, Blondie screamed at me because I had nothing to cure her nails. I sat back and made a few notes in her chart while she vented. I learned I was a useless waste of her time and money. She wiggled her feet into her undersized pumps and stormed out of my office. I went to my desk to have a little talk with myself. I am 56 years old. My retirement plan is well funded. My investments out of my pension plan are producing a good passive flow of income. I have a young associate ready to buy me out and take over my 28-year-old practice. Quitting was an option. I always like to refer to my favorite poets when important issues come up. Thirty-two years ago, I let Robert Frost guide me when choosing between podiatry school or regular medical school training. “Two roads diverge in a wood and I took the road less traveled by. And that has made all the difference.” Podiatry was most certainly the road less traveled by. I caught hell from my parents, my pre-med advisor and several friends for applying to a podiatry college rather than medical school. Podiatry has been a great and noble profession. I’ve never regretted my decision. Robert Frost’s poem, “The Road Not Taken,” gave me valuable guidance. I wish he had written something about aging blonde cheerleaders with slightly aging toenails. I spent a few months searching for a reason to stay with my profession. Podiatry has not been easy during the past ten years. It has become more about CPT coding and CYA documentation than patient care. HMOs are making many of the decisions in care that used to be between doctors and patients. Patients like Blondie expect and demand cures for changes that normally occur with aging. An old homeless man helped me see a clear answer to my “retire early” question. The ER paged me one evening last week to let me know that a “train wreck” had been admitted. Since I was on call, he was mine. They suggested I wait until morning to see him since he had a lot of other issues to sort out. I never wait to see an ER admission so I got my coat and headed to the hospital. The old man wasn’t so old. He was about my age. He was a heroin addict with hepatitis C. He had been living in a tent by the river. It was January and very cold and wet. His right second toe was gangrenous and he had cellulitis in both legs from the feet to the thighs. He had infected wounds on his upper thighs. He was emaciated from malnutrition and looked to be near death. With the help of an internist friend, we went to work on our new patient. He was indigent with no insurance coverage of any kind so the CPT junk was not going to be an issue. We cleaned and cultured his wounds and started him on cefazolin, 1 gram IV, q6h. We addressed his nutritional problem and put him on a high calorie diet. A few weeks before, he had gone through heroin withdrawal on his own and was “popping” by injecting small amounts of heroin under the skin of his upper thighs to control the pain from his gangrenous toe. That’s what caused the cellulitis in his legs. The patient improved over the next three days. The infection was Staphylococcus aureus, which was sensitive to the cefazolin. We discharged him to a nursing home on the fifth hospital day. He gave the taxi driver an address near the river when he left the hospital. I hope he makes it through the rest of the winter. I won’t be paid for my services to him but I value the experience and he helped answer my early retirement issue. I’m not going to retire any time soon. Robert Frost wrote another poem called “Stopping By The Woods On A Snowy Evening.” It ends like this: “The woods are lovely, dark, and deep, But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep.” Dr. McCord (pictured) is a Diplomate wtih the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.