A Recipe for Disaster

When I was doing research on blogging, I noticed that there were an awful lot of blogs that had to do with food and recipes. They must be popular based on the sheer number of them out there. So, I figured, let me throw a recipe up on this website and see what happens.

Today, we’re making a disaster! The proverbial train-wreck! This is one of my favorite patients, Louise. I’ve known her for the past two years, and thankfully, she’s been getting better, but when we first started seeing her at the practice, she wasn’t the best of patients. 

For this recipe, you only need eight ingredients! This slow-brewing meal requires patience, but in the end, it’s completely avoidable if you were to just listen to your doctor’s instructions.

Ingredients:

1 seventy-two year old, non-compliant patient

1 history of uncontrolled insulin dependent diabetes

1 history of hypertensive renal disease

1 history of peripheral vascular disease

1 history of atherosclerotic heart disease

1 history of heart failure

1 history of diabetic neuropathy

And 1 sedentary lifestyle

Directions:

  1. You need to marinate your non-compliant patient for years with misinformation about how the medical system is out there to make you miserable. Tell her that taking medications are bad because of the side effects that you can get from them. Tell her that the government is trying to control her mind by giving her these medications; that vitamins will fix her medical problems!
  2. Next, Meet the patient for the first time and take her blood work and make sure that her diabetes is nice and pre-heated to a hemoglobin A1C of 14. The only way the patient can do this is if she stops taking the insulin that she was previously prescribed because it was making you feel weak, when in reality, she only had 2 or 3 doses of the insulin in total. It also helps to make sure that her renal function is no better than a GFR of 30, or stage 3 chronic kidney disease, which also isn’t being treated. And don’t forget to add the blood pressure of 165/90.
  3. At this point, the patient should feel dizzy and nauseous. It’s important that the patient stay non compliant, because if she weren’t, the disaster might be prevented! 
  4. After six months of noncompliance, the patient should be ripe for a foot ulcer given the combination of peripheral vascular disease and diabetic neuropathy. When she comes in to be treated, you tell her she needs wound care in addition to antibiotics. She won’t listen to you, stating that she’ll pick up the referral and wait and see. She’ll tell you that she’s taking extra doses of vitamins. Make sure that blood pressure stays uncontrolled!
  5. She’ll come back in 3-4 weeks  telling you that her foot really hurts now and that the antibiotics didn’t work, that you need to prescribe something stronger. At this point, the foot should be fairly swollen and have an unmistakable umami aroma. Tell her you think she should go to the hospital because the foot looks terrible and that her blood pressure is now 180/100. She’s still going to refuse, but this time she says she will go to wound care.
  6. At this point, the disaster is almost ready. Can you taste it?! After an additional ten days, The non compliant should finally be forced to go to the hospital after a caring daughter realizes that their mother isn’t well.
  7. Now, your noncompliant patient no longer has a foot ulcer, but a full blown osteomyelitis or a bone infection. Now, she also has sepsis or a blood infection, for which she needs to be on some heavy duty antibiotics.
  8. This is the most important part of the disaster. Overnight, the patient will then go into multi organ failure because her kidneys have failed and she goes into acute heart failure from a heart attack! Don’t forget that history of atherosclerotic heart disease, which also wasn’t treated! She gets placed on a ventilator and medications to keep her blood pressure from dropping and iv fluids.
  9. Now you have your disaster! Make sure you serve with hand sanitizer!

Of course, if this sounded terrible, it is intended to because it is preventable. It takes a special kind of patient to make it to the disaster phase. Thankfully, after several months in the hospital and rehab, Louise did pull through. Only now, she’s missing her legs due to amputation and is on renal dialysis every other day. She is now in the process of getting fitted for prosthetic legs. Of course, her heart is pretty weak now, but at least she’s alive. Her diabetes has never looked so good, as her A1C is now 6.3. It’s just too bad that it took the disaster for Louise to get it there.

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