The Sagacity of Persistence Albert Mensah, MD by naq52275


									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.
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.

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