What I Will Miss (And What I Will Not Miss) About Podiatry

I am in the last nine months of my 33-year career as a podiatrist. Every day of patient care is a cause for reflection. I know what I will miss and what I will not miss. I will not miss my most creative patients, those who are pursuing settlement of personal injury claims. Some have been legitimate but many have been pure fiction. My most memorable creative patient was a young man who lost his second toe in an industrial accident. He got his foot caught in a chain and sprocket, and lost the toe. I cleaned up the mess and he healed without problems. I received a request for his records from a personal injury attorney. My young patient began showing up for appointments with a great show of limp and pain. He continued to wear his postoperative splint shoe and used a cane. His attorney wanted photos and detailed reports on this kid’s disabilities. The patient’s main complaint was that he lost his balance by losing his second toe. He staggered artfully as he walked. I suspected that I was being made part of a sham. The patient filed a lawsuit against the manufacturer of the machine and there was a deposition in my office. The patient’s lawyer was well dressed and suave. The attorney for the defense was a crusty old guy dressed in a ski jacket and a pair of boots. The plaintiff’s attorney had a briefcase full of documents. The defense attorney had nothing. The patient’s attorney began asking me questions about my treatment of the injury and made a case that his client was severely and permanently disabled with severe loss of balance due to his missing toe. When it came time for the defense attorney to ask questions, he asked if I liked to ski. I said that I did not because it is too cold. He then asked if a person with a missing second toe and a severe loss of balance could participate in downhill skiing. I assured him that it would not be possible. The defense attorney reached into the pocket of his ski jacket and pulled out dated photos of my patient skiing down a steep slope. The dates were post-injury. My patient buried his face in his hands. I tried to stifle a smile. The defense attorney patted my patient on the back and said, “See you on the slopes.” I will not miss this type of patient interaction when I retire in December. However, there are some patient care experiences that I will miss terribly. I will miss the opportunity to participate in wound care and limb salvage. These are the situations in which I, as a podiatrist, have been able to save legs, save lives and return many patients to a quality existence. My most challenging case involved a 52-year-old man who had been hospitalized with wet gangrene of the fourth and fifth rays of his left foot. He was a non-smoker and circulation was adequate down to the margins of the wound. He was a heavy equipment operator for a lumber mill and a bachelor with no family support. His care team consisted of internal medicine hospitalists, a vascular surgeon, physical therapists and me. We ganged up on his illness and, over a four-month period, stopped the progression of gangrene, suppressed the infection, controlled his diabetes and brought his heart and hypertension problems into control. At this point, he had a large but infection-free defect where his fourth and fifth metatarsals and toes had been. The options were limited. We decided to shrink the defect with VAC therapy until it was small enough to cover with a split thickness skin graft. Progress was slow. I saw the patient weekly and physical therapy saw him nearly every day. We did not talk much about goals because he was still in danger of losing the leg. After three months of wound care, the defect began to shrink. Since he was making progress with the VAC therapy system, I held off on the skin graft. He came in one day with the wound completely closed. I signed him off to return to his job with no restrictions. He did not say much other than he would miss me and the office staff. He just assumed that saving his leg is what podiatrists do.Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.