Total pages in book: 89
Estimated words: 83355 (not accurate)
Estimated Reading Time in minutes: 417(@200wpm)___ 333(@250wpm)___ 278(@300wpm)
Estimated words: 83355 (not accurate)
Estimated Reading Time in minutes: 417(@200wpm)___ 333(@250wpm)___ 278(@300wpm)
My nurse assistant for the day, Sarah, is already there preparing for our morning appointments. She’s a young woman with a bright smile and an air of serene competence that always puts me at ease.
“Good morning, Sarah,” I greet her as I set my bag down on a chair by the door.
“Good morning, Dr. Montreaux,” she replies warmly, looking up from her work. “Everything is ready for you. Our first patient is ready when you are.”
I take a moment to scan the room, appreciating the small touches that make it feel more welcoming despite its clinical setting. Potted plants perched on the windowsill bring some much-needed greenery and drapes hang over the windows.
My heart is heavy with the realities I face here. No amount of experience makes it easier to see people struggling with their health in such dire conditions. The shelter’s bustling with activity as volunteers and medical staff attend to the needs of the residents.
Sarah hands me the first file. “We’ve got a tough first case today. A man named Joe. He’s an alcoholic and has uncontrolled diabetes. His leg is really swollen and discolored. I’ve been trying to convince him to go to the hospital, but he’s refusing.”
I sigh as I flip through the sparse notes. Most of these folks won’t seek care so I don’t have a lot to go on. “Let’s call him in.”
Sarah leaves and when she returns, Joe shuffles in slowly behind her, his face twisted in pain. His clothes are tattered, his hair is dirty and his skin bears the jaundiced hue of chronic alcoholism. I have no clue if he’s a resident here because you don’t have to be to access the medical care we offer. I’m guessing by his appearance he’s out on the streets since the shelter has a strict ban against alcohol and drugs while in residence.
Sarah helps him up onto the exam table and I approach. “Good morning, Joe. I’m Dr. Montreaux. I understand you’re experiencing some issues with your leg.”
Slowly lifting his bloodshot eyes to meet mine, Joe grunts in confirmation. “Yeah, Doc. It’s been killing me,” he admits, wincing as he shifts uncomfortably.
“Can you show me what’s bothering you?” I ask calmly.
Joe hesitates for a moment before slowly rolling up his pant leg to reveal a grotesquely swollen and discolored limb from the knee down. The skin is tight and glossy, with patches of angry red and purple with one area rubbed raw with an open wound.
“Joe, this looks quite serious,” I state firmly yet empathetically. “This swelling and discoloration could indicate a bacterial infection known as cellulitis. It needs treatment and it’s bad enough, I think a trip to the hospital would be warranted.”
But Joe shakes his head stubbornly. “No hospitals, Doc. I just can’t do it.”
I understand the fear and reluctance many homeless individuals harbor toward healthcare, as well as their reluctance to leave the streets. Joe is likely worried about losing access to the alcohol he needs to avoid withdrawals.
“Okay, Joe,” I say softly, placing a reassuring hand on his shoulder. “I won’t force you to go, but please understand that this is a serious matter. I will do my best to treat it here, but it is not a good substitute for what they can do for you in the hospital.”
“Do what you can, Doc. I’ll be fine.”
I seriously doubt that, but I force myself to let it go. One of the things I had to learn early on as a doctor is that I cannot force people to do the right thing. I can only advise and treat as best I can.
“We’ll start by cleaning the infected area and then I’ll prescribe antibiotics to help fight the infection,” I explain while donning gloves. “It may be uncomfortable, but we need to do this in order to promote healing in your leg.”
Joe clenches his jaw but nods in agreement. “Understood.”
Carefully and meticulously, I cleanse the infected area with an antiseptic solution, trying my best to minimize any discomfort. Despite the pain, Joe remains still and doesn’t protest. Next, I apply a topical antibiotic ointment and cover the wound with a sterile bandage.
“In addition to this treatment, I will also give you a course of oral antibiotics,” I inform him as I rummage in the prescription cabinet, handing over a small bottle of pills. “It’s crucial that you take these exactly as prescribed, even if you begin feeling better. It’s essential for your recovery.”
He takes the bottle hesitantly and examines it before looking up at me with a mix of hope and apprehension. “Thanks, Doc. I’ll make sure to take them.”
I offer him a reassuring smile. “Good. And please, if your condition worsens or you start feeling very ill, promise me that you’ll go to the hospital. Your life is worth fighting for, Joe.”