Tender Wounds and Hearts
The practice of medicine is not only a privilege, it is an honor. Like any process or profession that aims to be more efficient, the “human” factor tends to be sacrificed. Nowadays, there aren’t enough hours in the day to get everything done. Between providing care, paperwork, meetings, and personal obligations, the week can become overwhelming. We get so lost in the grind that we forget that Mr. Jones celebrated his 50th wedding anniversary or that Ms. Thomas welcomed her 3rd grandchild. We also fail to see that Mr. Peterson isn’t purposely being non-compliant about leg elevation. Rather, he values and prioritizes social time and activities, which means that he’s sitting up in a wheelchair with his legs dangling for longer than we’d ever recommend. The point is that our patients aren’t one dimensional. They are people with lives, relationships, and stories. Understanding that impacts their care insomuch as the treatments we order. Medicine isn’t provided in a vacuum.
When people ask what I do, they’re surprised to learn that I work part-time in wound care given that my “normal” job is the polar opposite of managing wounds. For me, working for Vohra breaks up the monotony of providing care in a bubble. It keeps me grounded, reminds me that people should be treated with empathy and dignity, and fosters the continuous learner in me.
Wound care is a specialty that doesn’t get enough credit for the way it impacts patients and their families. It’s an unsung hero. Day in and day out, we champion for what is broken to be fixed. The industry spends millions of dollars a year to find provocative ways to manage wounds and improve outcomes. Patients are living longer with comorbidities that complicate their care, and skilled nursing facilities are home to many of these patients. Vohra has built upon a model that offers convenience and quality care to patients in an efficient way without sacrificing the human factor, and that speaks volumes to me.
Being a wound care doctor affords me the opportunity to be a more well-rounded physician. I get to work with great wound care teams while using our time to educate both patients and staff. I help shape outcomes that eventually allow facilities to become Centers of Excellence. Each wound is a work in progress, and it’s critical that we understand the things that make them better or worse to aid in clinical decision-making. But most importantly, I can positively impact a person’s life in a way that gives them back their independence.
As an anecdotal experience, I had only been seeing patients at a skilled nursing facility for a few weeks when I was consulted to evaluate Mary. A quick review of her chart reveals that she is a 78-year-old female with a past medical history of CAD, ESRD, HTN, CHF, and COPD who also has a stage IV sacral ulcer that had been present for several months. She had become deconditioned rather acutely, which resulted in her being hospitalized and eventually admitted to the SNF for skilled services. My mind immediately created this impression of her, as I expected her to be withdrawn and extremely debilitated. I quickly played out the conversation that was about to ensue in my head. My expectation couldn’t have been further from the truth.
As I walked in to the room, Mary’s warmth emanated from her bed. She greeted me with the familiarity of an old friend, and it caught me slightly off guard. After a brief introduction and confirming parts of her history, she revealed that she was embarrassed by her wound. It made her extremely self-conscious of her body and mentally put her in a depression as she couldn’t believe that she had let it get this bad. She also divulged that she was unable to go back to her apartment at assisted living until the wound no longer required care, which made her even more anxious. I reassured her that with time and patience, we would get there.
I tried to set reasonable expectations upfront and gave her my full and undivided attention until she had exhausted all questions and concerns. She got the sense that I was truly listening to her and, in that moment, she was all that mattered to me.
We proceeded to do a full skin exam. Examining a patient who is self-conscious reminds you of how vulnerable she is. As clinicians, it’s easy to remove that vulnerability and unintentionally make the exam purely clinical. I was respectful of her uneasiness. As I uncovered her bottom to examine the wound, I was astonished to see a 12cm hole facing me. I covered her back up and went around the bed to talk. I explained the treatment plan, and to keep her engaged and accountable, I explained what her responsibilities were since we all had a role in achieving a shared goal.
Over the next several months, Mary proved to take that job very seriously. She ate like a horse, was faithful about going to dialysis, worked with PT/OT until she was exhausted, and was compliant about off-loading. I looked forward to our visits because she made me laugh with her witty banter. Scooching down the hall with a Jimmy John’s sandwich perched on her walker, she would chase me down to offer me half to ensure that I was taking time to eat. Only she could make a plaid button down, frilly tights, and knee-high leather boots on a lazy Tuesday morning seem remotely fashionable and normal. Her mojo was clearly coming back.
I learned about her and her life and watched as she became increasingly independent. She always voiced appreciation to the wound care team, and we reiterated to her how important she was to us. This mutual respect created a bond that made her more than a patient to me. She was a friend. So it didn’t come as a surprise when she told me that discussions about transitioning back to assisted living were in the works. The wound was granulating in faster than I anticipated, and it was a testament to what a motivated patient is capable of. She was excited, and that excitement fed in to an even better idea–that she could actually go home instead.
We resolved her wound on 11/19, which was almost 6 months to the day I started seeing her. Even after I signed off, I still stopped by her room just to catch up. Mary was discharged to her home a few weeks ago. The level of independence and confidence that she attained allowed her to actually go home, where a lot of her adult memories were made. She reminded me that it wouldn’t be possible had we not only healed her physically but also mentally supported her through a difficult time in her life. For me, it was more than just treating a wound…it was about caring for the totality of the patient. The other day, I was consulted on another patient who has since taken up residence in Mary’s old room. I jokingly proclaimed that she had big shoes to fill. She smiled and quickly replied, “And so do you.”
And maybe that is what practicing medicine is really all about.
Dr. Nadja Colon is a Vanderbilt University School of Medicine trained surgeon. She works as a Medical Director and Cosmetic surgeon and is currently a Fellow with Vohra Wound Physicians.