Walmart and Lilacs
By Clement Hanson DO (COL, RET)
It was four forty five in the afternoon last winter when Christine, a gray-haired Wal-Mart
employee, faltered into my clinic. She had no appointment. My front desk staff was getting
ready to leave for the day. This lady toted a tattered Walmart shopping bag with four volumes of
medical records that included an eight inch stack of x-rays and several MRI films, which, by her
account, were due to four separate on the job injuries.
I forced a smile, led her to an exam room, taking care that she didn’t strain her back with
her hefty bag. We sat down in plastic chairs facing each other. Her perfume smelled of lilacs,
which reminded me of my late grandmother. I hoisted the records and films out of the bag and
lined them on the exam table.
She bit her lower lip and looked me square in the eyes. Five months ago, she injured her
lumbar spine on the job when she and a coworker tried to move a nine hundred pound bookshelf.
Following her back injury, she sustained three additional work injuries involving her feet, left
shoulder, and cervical spine.
Her records showed that “Dr. Smith MD” had treated her with physical therapy and
numerous anti-inflammatory medicines including Percocet. The medicines and therapy provided
minimal if any benefit. She quit taking them because of upset stomach and constipation. Her
supervisor terminated her from work because she couldn’t perform assigned job duties. She
hired on at a local movie theater, but the income barely covered her rent, utilities, and groceries.
It seemed I was being “dumped” with this complex case. I asked her why she wanted me
to assume her care. She unloaded a dozen concerns, including Doctor Smith did not perform a
hands on clinical exam, he rarely asked her how she felt, each appointment lasted no more than
fifteen minutes, and to top it off, and he didn’t take time to answer her questions. She found my
name of the American Osteopathic Association website. She called her insurance adjuster, who
approved transfer of care to me.
She rambled on about her bowel movements, grandkids, and her well-meaning husband
who gave her foot massages. By her account, Christine’s pain overpowered her ability to tend
her garden and play with grandkids. I nodded, resisted the urge to look at my watch, and let her
vent.
My attention turned to the well-worn pink pages of her records. Dr. Smith had referred
her to a podiatrist, who found no specific foot problem except bilateral bunions. The podiatrist
recommended she take Advil, wrote a script for Percocet, and released her from care. Smith then
sent her to an allopathic pain management specialist, who scheduled her for an x-ray guided right
sacroiliac injection. However, when she showed up at the specialist’s clinic procedure room, he
found no evidence of sacroiliac pain on clinical exam and cancelled the procedure. Her pain
continued unabated.
I rubbed my chin and leaned back in my chair. This patient needed hands-on care, close
follow-up, and empathy. I decided to accept her case.
To let her change into a gown, I left the room. She sat on the exam table rubbing her feet
when I returned. She grimaced as she attempted to sit upright. Exam showed forward slumped
shoulders and neck, palpable spasm and tenderness of the right upper buttock, diffuse cervical
spine spasm with myofascial trigger points, and left shoulder tightness. Her feet bore bunions
that caused turning outward of the big toes. She wore cracked leather shoes had no arch support,
and her ankles rolled inward as she plodded across the linoleum floor.
She sat down and struggled to lay flat on the exam table. I applied traction to both
ankles. Her right leg was shorter than the left by two centimeters. I performed the Still
Technique stretching of her right hip and low back, then had her lay face down. Next, I used
muscle energy technique to stretch her right and left pelvic muscles. Repeat exam showed
improved lumbar spine range of motion and both legs were the same length.
I referred her to a different podiatrist for provision of custom orthotics, refilled her anti-
inflammatory medicine, discontinued the Percocet, and instructed her on home stretches and
exercises. She followed up with me every one to two weeks the next six months. Her foot pain
resolved, but her right sacroiliac pain continued. I referred her to an allopathic (MD) pain
management specialist, who injected her right sacroiliac joint under fluoroscopy. Her low back,
neck, and shoulder pain continued to improve.
Five months after her initial visit with me, I discharged her from care. Though she had
ongoing right buttock pain, she could work in her garden and play with her grandkids.
My experience with Christine reinforced the osteopathic principles I learned in school.
Take time to listen to the patient, perform a hands-on exam, and don’t hesitate to collaborate our
MD colleagues when necessary. It’s all for the good of the patient.
Source: Faber, W. (2011). The Osteopathic Medicine Difference. A Classic Osteopathic
Medicine Case History; Walmart and Lilacs (pp. 88-91.) Kirksville College of Osteopathic
Medicine Press.
For comments, contact Dr. Hanson at his website, OperationDesertSouls.com.