Charles was dumbfounded when I told him he had gangrene in his left big toe. He’d had pain in that toe for several days and earlier, some redness, but, being a lifelong stoic, he hadn’t come to the ER until the redness of that toe became blackish purple and the tip of the toe became rock-hard.
Unfortunately, that wasn’t all the bad news I had for Charles that night. Gangrene of a digit doesn’t usually happen spontaneously—so we must look for a cause. His cause was diabetes. He had never been diagnosed before—Charles hated going to the doctor—he’d had symptoms of frequent urination, severe thirst and ravishing appetite for several months—all pointing to elevated blood sugar—in the ER his was over 600 (normal is 70-100). At 62, because he had ignored the messages his body had given him before the toe gangrene began, Charles was relegated to living with and treating (or not) his diabetes the remainder of his life—however long that may be.
I spent a goodly time talking to Charles and trying my best to convince him—or at least scare him to take the problem seriously and become pro-active (healthcare buzzword) in learning how to give himself insulin shots and eating healthily (although, the healthy-diet talk loses something in the translation when it is being administered by an overweight doctor). I related horror stories like John, a diabetic fellow I knew in South Texas who had had both his hands and both his feet amputated and was on dialysis 3 times a week for 4 hours at a time (he was completely dependent on others for his every need).
I started Charles on insulin, began fluids and made arrangements for him to be admitted to the hospital that night. The next day his left great toe was amputated at the first joint.
What happened after that, I will never know. ER docs almost always lose follow-up with patients—that’s a good thing—and bad (if things go well and their health problems are taken care of or get resolved and we don’t see them back, it’s good, but if they become like John and have to often return to the ER [we used to call them “frequent flyers”], it’s bad). Hopefully, Charles followed up with his primary Dr and used his own agency to do his best to control his disease. I really hated being the bearer of such ominous news to Charles that night, but if he’d waited another week, his whole foot could have been his loss instead of just part of his toe.
ER Docs often get to bear bad news to patients and family—but that’s a topic for another time.