From DC

Hands & Feet The first time we met, the patient had come in for a refill of pain medications despite a well-established "reputation" among the residents and doctors. In fact, he had been turned away from a prior doctor for being non-compliant with his medical care and was simply given a polite letter stating something to the effect of, "Due to difficulties in our doctor-patient relationship... we regret to inform you that we can no longer serve as your primary care doctor." That was the kind of introduction I had: a profile of this patient as a non-compliant drug-seeker with a mind-boggling host of other medical issues. And so, despite his friendly attitude and appreciation for our medical attention, I harbored a deep mistrust for him underneath my own pleasant and cordial exterior. I had been charmed and lied to before. He had difficulty ambulating up onto the examining table with his extensive and painful leg ulcers. They remained hidden beneath layers of gauze and bandages, but I could smell them from the other side of the room. They smelled of gangrene: the scent of rotting, festering tissue. That kind of smell permeated and lingered in clothing, and I'd seen other medical students rush out of a patient's room to avoid doubling over in fits of nausea. I often wanted to myself. Today I had a residual head cold. It gave me a slight, throbbing headache but thankfully dulled my sense of smell. Today he returned to the office. I was hoping to avoid getting too close to his legs, but this time he wanted us to examine the ulcers themselves. The visiting nurses normally changed them once a week, but they had told him it smelled particularly bad now and that the doctors should take a look. For the resident and I, that meant unwrapping the layers of bandages covering the dead tissue and examining it closely. The patient had brought all of his wound dressing supplies into the office and talked about his legs the same way I talked about the weather. They swelled when he didn't take his meds but they leaked fluid when he did. The arthritis in the knees and the ankles made him want to stand, but he would sit so we could get this done. There was a large ulcer on the left side so I should be careful to pull off the bandage slowly; he would yell to let me know if it hurt. I knelt at his feet and, with gloved hands and a large pair of scissors, meticulously snipped at the old dressing. As it peeled away, more and more of the diseased and dead skin flaked off with it. What remained was a blotchy mottle of purple & angry red hues that stretched from below his knees to the tip of his scaly toes. The skin was swollen and crusty from the infections and inflammation, blistered and boiled like the cratered surface of Mars. And the smell... it was so strong that tears welled up in my eyes despite my own nasal congestion. The worst part had been his socks, which he admitted he couldn't change often because of his inability to reach down and touch his own toes. He said he usually just threw them away. The patient eyed the resident working alongside me and said, "You're scaring me." "What?" "That look on your face... you look scared. Surprised." "Well, this has got to be one of the worst cases I have ever seen." "Oh, really? Well, this is actually doing well now. It's normally worse." And the thought entered my mind that these two legs should be amputated. The patient had seen a vascular surgeon who said something similar, but that "so long as he could stand it", frequent dressing changes would keep the gangrene at bay a little longer. The patient desperately wanted to keep his legs. Though he didn't say it with much force, he didn't want to be wheelchair bound. He could still amble around well enough; it was just that these ulcers refused to go away. It was only a matter of time but he wanted all the time he could get. He was only in his forties. But still, the thought lingered in my mind: these legs should be amputated. And it wasn't because I thought it would make his life better. It was because it would make things easier for us: the visiting nurses, the vascular surgeon, the doctors, myself. I wanted those amputations to make things easier, to sacrifice those legs to lessen the overall burden of suffering - or at least my suffering - in this world. As I gingerly picked away at the remaining gauze and bandages, a story of St. Francis of Assisi came to mind: Francis spoke of how lepers filled him with disgust. Yet that very night in prayer, Francis heard a voice within telling him that the next day, he would meet a leper, and that Francis was to “run to him, embrace him, kiss him.” Francis knew it was the voice of God. The next morning on the road, they heard in the distance the bells that lepers rang to warn other travelers to keep their distance. Francis fought the urge to flee and as the leper emerged from the trees ran towards him with outstretched arms. “I came close,” Br. Leo recounts, “and gazed at [the leper] in horror. Half of his putrescent nose had fallen away; his hands were without fingers – just stumps; and his lips were an oozing wound. Throwing himself upon the leper, Francis embraced him, then lowered his head and kissed him upon the lips. Afterwards, he lifted him in his arms and, covering him with his robe, began to advance slowly, with heavy steps, towards the city,” [seeking a shelter in which the leper could be cared for.] [As we approached the city], “suddenly I saw Francis stop abruptly. He bent down and drew aside the robe in order to uncover the leper. But all at once he uttered a loud cry: the robe was empty!… It wasn’t a leper; it was Christ himself who had come down to earth in the form of a leper in order to test Francis.” [After some hours of stunned silence lying in the road, Francis spoke of what he’d learned]: “This Brother Leo, is what I understood: all lepers, cripples, sinners, if you kiss them on the mouth – they all…become Christ.” In that moment, I imagined that the diseased and scabbed feet I held were the feet of Christ. I thought about what it would be like to wash them and kiss them like the woman with her perfume and hair. I looked up at this man sitting before me, his face attentive and appreciative of the care we were giving. As I thought about all this, shame and love swelled inside me as my head swam among the putrid odors and silence. It made everything disorienting and holy, and I found myself deeply disturbed within my heart.