When Doctor’s Advice Is Ignored at Home

March 10, 2011, 6:00 am
By PAULINE W. CHEN, M.D.

One evening during my residency, I found a friend, another doctor in training, standing at the foot of his patient’s bed in the intensive care unit, shaking his head. The middle-aged patient was well known to many doctors and nurses in the hospital. Unemployed and living in one of the city’s rougher neighborhoods, he appeared regularly in the emergency room with his blood sugars way out of control.

This time, however, he was in with a different diagnosis: Fournier’s gangrene, a rare but life-threatening complication of his poorly controlled diabetes. The devastatingly aggressive infection of his groin and pelvic area was so severe that even hours after the surgeons had finished the emergency operation to cut away the infected tissue, people passing through the operating suites could still smell the overwhelming odor of pus and rotting flesh.

That night in the I.C.U., I saw the mounds of saturated gauze that covered the patient’s gaping wounds and the medley of machines and monitors that now supported his life. “We knew how to treat his diabetes whenever he came in,” my friend said, a tone of sad resignation in his voice. “But the problem was when he went home.” He sighed, shook his head again and added: “Every time he went home, everything went right out the window.”

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