700 November-December 2004 Family Medicine The Sagacity of Persistence Albert Mensah, MD During my endocrinology service am fortunate to have him working surgery, you can forget it!” she in my intern year, while working with me, and you will see much of spoke sternly. “Mrs E, could we just with the attending Dr C, I found out him.” I smiled. calmly talk for a minute? What are I was to be given responsibilities Mrs E was a diabetic patient of your concerns? What makes you so unparalleled relative to any other Dr C’s. The point of interest during resistant?” After 10–15 minutes of rotation. I, the new intern, would this day’s visit was to discuss the further banter, she acknowledged become the substitute physician for need for surgery due to the poor cir- that the potential complications of Dr C—his right-hand man. This culation in her right leg. Dr C ex- surgery paralyzed her capacity for was going to be great! plained to her that without this sur- rational consideration. “Bad things Dr C ensured my popularity, it gery the circulation would continue happen to people when they go un- turned out, by being consistently to diminish due to her peripheral der these days. They knock you out, busy and difficult to reach and by vascular disease. The eventual out- and you might not wake up. Oh no, referring all of his hospital pages to come would be gangrene and the I am not having it!” “Mrs E,” I re- me—his intern. “Page Albert,” was need for an amputation of the ex- sponded, “Let me explain to you the his typical response, often followed tremity. potential risks and pitfalls of this by the nurses’ initial reaction, “I don’t want no surgery,” she surgery, and let’s discuss it.” Our “Albert who?” “Dr Mensah,” he explained in a firm and grandmoth- conversation lasted well over 45 replied. Within 1 week, my pager erly tone. “But why?” Dr C in- minutes. Finally, she agreed to think number was well known through- quired. “I just don’t like it,” she re- about it overnight. out the hospital, and I was well plied. “You do understand what The next morning, I eagerly ap- known as one who would return could happen if you don’t have this proached Mrs E’s room with confi- pages quickly. done? What we need to do is to re- dence. Surely, my superior effort, During the third week of my 2- connect some of your blood vessels clarity of thought, mind, and expla- month rotation, while rounding so that you don’t lose your leg,” nation would yield the only possible with Dr C, we encountered her—a explained Dr C. “I just don’t want outcome—success. “Good morn- grandmother-type figure with the no surgery!” she exclaimed quite ing, Mrs E.” “Where’s my doctor?” certitude and conviction that no vehemently. she spoke in a shrill voice. “He will stubborn bovine could hope to “Dr C,” I said quietly when we be in later to see you,” I explained. match. Little did I realize that she were outside the room, “Are we just “I am here to check on you and to would soon become the focus of my going to let that woman lose her see how you are doing. Did you attention. leg?” “Albert,” he responded, “I’ve think about our conversation yes- As we walked into her room, Dr know her for a long time, and she terday?” “Yes, I did. I am not going C quite pleasantly greeted her and is a stubborn lady. She is hard to to have the surgery.” The once con- introduced me as his right-hand convince.” I said nothing but knew fident and understanding intern was man. “Mrs E, this is Dr Mensah, I the issue was not yet resolved. now perplexed and deflated. After After rounds that day, I returned all, had I not accurately progressed to Mrs E’s room. “Hello, Mrs E. through the algorithm of patient How are you?” “Where’s my doc- concern? First, establish rapport; tor?” she sternly inquired. “Right second, be supportive; third, make (Fam Med 2004;36(10):700-1.) now, he’s outside of the hospital,” I inquiries; fourth, listen; fifth . . . replied. “I would like to speak to Yes, I had indeed proceeded quite From the Department of Family Practice, Stroger you for a little while if you don’t meticulously and accurately. Yet, I Hospital of Cook County, Chicago. mind.” “Well, if this is about the failed. Impossible! Lessons From Our Learners Vol. 36, No. 10 701 “Perhaps I did not answer your and considered by what metaphysi- “Oh, pretty good. Thank you.” She questions appropriately,” I re- cal channel I would release the en- smiled. I relayed to her that I was sponded. “No, you did all right, but ergy within before my next patient on my way to see a patient. “Just a I just don’t want no surgery.” It was encounter. minute,” she said. “I want you to now time for the gloves to come off. After 3 days of return visits, in- meet my daughter. Dr Mensah, this The calm soothing baritone re- tellectual banter, and attempts at is my oldest girl, she brought me to gressed to a stern, unyielding bass. fear dissolution, Mrs E agreed to the hospital today.” “How do you “If you don’t have this surgery, your have the hitherto elusive limb-spar- do?” I smiled. Mrs E turned toward leg is going to be cut off. Is that ing surgery. I quite proudly in- her daughter and explained how we what you want? You won’t be able formed Dr C of the news. He in- fought for almost a week before she to walk without an artificial leg. You quired how I managed such a feat. agreed to the surgery. “Baby, this is will need to spend a lot more time “It was simply a meeting of the Dr Mensah . . . he’s my doctor!” and money trying to get adjusted. minds,” I stated. Not to mention, your family will not Two weeks later, I encountered Correspondence: Address correspondence to Dr Mensah, Stroger Hospital of Cook County, De- appreciate what you would put Mrs E in a wheelchair as she was partment of Family Practice, Faculty Develop- them through. All of this is unnec- being pushed by her adult daugh- ment Program Suite 1335, 1900 West Polk, essary!” Mrs E stared at me in si- ter. “Mrs E,” I said, “What are you Chicago, IL 60612. 708-275-8908. firstname.lastname@example.org. lence. “Well, I’ll think about it, doing here today?” “Oh, I’m going come back tomorrow,” she finally to Rehab for my leg,” she replied. said. I left her room quite readily “How are you feeling?” I inquired.
Pages to are hidden for
"The Sagacity of Persistence Albert Mensah, MD"Please download to view full document