Methodist Journal

FEATURED GUEST EDITOR

ISSUE INTRO

The Burgeoning Field of Cardio-Oncology

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RECOGNITIONS

Barry H. Trachtenberg Leads Issue on Cardio-Oncology

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REVIEW ARTICLES See More

Heart Failure in Relation to Anthracyclines and Other Chemotherapies

Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics

Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity

Cardiovascular Toxicities of Radiation Therapy

Electrophysiologic Complications in Cancer Patients

Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment?

Future Directions in Cardio-Oncology

CASE REPORTS See More

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do Not Pass Flow: Microvascular Obstruction on Cardiac Magnetic Resonance After Reinfarction Following Primary Percutaneous Coronary Intervention

CLINICAL PERSPECTIVES See More

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 12, Issue 3 (2016)

Humanities Full Text

ESSAY ON BEING A DOCTOR

An Answered Prayer

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Article Citation:

Jackson JM. An Answered Prayer. Methodist DeBakey Cardiovasc J. 2016;12(3):190-192.

doi: https://doi.org/10.14797/mdcj-12-3-190

Through the generosity of Charles R. Millikan, D. Min., vice president for Spiritual Care and Values Integration, an annual award competition was established at Houston Methodist Hospital among the resident staff. To enter the writing competition, residents must submit a poem or essay of 1,000 words or less on the topic, “On Being a Doctor.” A committee of seven was selected from Houston Methodist Hospital Education Institute to establish the judging criteria and select the winning entries. The following is the second-place winning entry for 2016 written by JaMís Monet Jackson M.D.second-year Neurology resident. The third-place winning entry will be published in the December issue.

“I don’t want to lose my leg!” I couldn’t blame him. Our patient walked into the Emergency Department with a putrid, gangrenous foot wound the night before. The necrotic skin and muscle were hanging off of the exposed bone of his great toe, oozing with pus and blood. He said this all happened over the course of a few days, but it wasn’t likely. He hadn’t seen a doctor in more than 20 years, and here he was with a blood glucose level above 400, uncontrolled blood pressure, and the possibility of losing his right leg.

“I know you don’t want to lose your leg,” I said, “but this is life-threatening. If you don’t get the amputation, you could lose your life, and we don’t want that to happen to you.” We tried to make him understand the risks of not going forward with surgery, but he was still very hesitant. Who wouldn’t be, though? I couldn’t judge him. I took for granted that I had two legs to carry me. Then I considered our patient. He too relied on his legs for so many things. This was not an easy choice by any means.

“Look, maybe you can just cut off the bad part and leave the rest of my leg so the antibiotics can work on it,” he proposed. It was a reasonable request, except that the “bad part” appeared to be extending past the forefoot up to the ankle, and there was concern that the bone was also affected. Based on the extent of the damage, the surgeon recommended below-the-knee amputation (BKA) and could not offer any other alternative. The patient was not a candidate for amputation of the foot, and we were told that even if they could amputate the foot alone, he would eventually end up with a BKA. We contacted the Palliative Care and Social Work departments for assistance. Everyone tried to reason with him to make him understand the gravity of the situation.

“I understand what you’re saying, but give me a couple of days to think about it and keep the antibiotics going, then I’ll decide.” He didn’t have a couple of days. The infection was not getting better and his foot could not remain intact much longer. What made things even more complicated was that he didn’t have insurance, and the family could not afford to pay out of pocket for any procedures much less the amputation.

He and his wife were in tears about the whole situation. They prayed for some other possibility than death versus losing his entire right leg. He eventually rejected the idea of BKA, and we were at a loss as to what we could do to help him. There was no way our team was going to discharge him in this condition. We had to find a way to save him from the poison that was leaching into his bloodstream from the infected limb. Someone suggested contacting an acute care surgeon who specialized in similar cases; she saw many patients with severe diabetic foot wounds, and the doctor who recommended her said she was an expert in this area. We contacted her, and she came to see the patient that same day. She and the palliative care physician spoke at length with the patient and his wife, helping them understand their options. The acute care surgeon, to all of our surprise, said that she in fact could amputate only the patient’s foot, but it would require his full cooperation and compliance with the plan. She explained everything in detail: she would amputate around the infected area and provide the patient with wound VAC therapy (vacuum-assisted closure). He would have to agree to follow up in her clinic regularly, stay off of his foot after the amputation, and adhere to a diabetic diet to help control his blood sugars.

Our patient eagerly agreed with the demands while his wife shed tears of gratitude. The amputation took place, and soon after he was beaming with joy, pleased that the surgeon was able to salvage his leg. The wound VAC remained in place, and the foot was healing beautifully! He was discharged to his home with a plan in place for postoperative care, and they were even able to apply for insurance through his wife’s employer, which would be approved within 30 days of the application being received.

A few months later, I saw the surgeon on my way to visit with another patient. I inquired about our mutual patient, and she told me that he was doing very well. She even showed me pictures of his foot since the amputation. He was adhering to the plan and his foot continued to heal. I was so grateful for her selflessness in caring for our patient. There had appeared to be no other option besides amputating his leg, and in all actuality it was the safest and most affordable option for him as he had no insurance coverage at the time. She offered time from her very hectic schedule to talk at length with the patient and his wife about options that no one knew he had. She took the case on as charity despite of the extent of the work she would have to do to help save his leg, and she continued to support him throughout the entire postoperative recovery process. I was so inspired by this physician because she went beyond what was expected of her and gave more than what was necessary to save his life, all to save his quality of life. This was not an easy choice, but thank God there was a doctor who stepped in with a heart filled with compassion, offering an answer to a prayer.