A year ago, there was this patient that came to me with diabetic foot wound. He had an oval ulcer on the sole of his foot measuring around 5x5cm all the way deep down to his bone. He had been carrying this ugly wound since the past 6 months and had been doing dressings elsewhere to no avail. Finally he came to me on a friends suggestion..
He was a lower middle class person, not very affordable for surgical treatment, so I offered to start treatment at 0 cost. The wound looked a bit challenging to me and I wasn't sure how it would respond so I told him, he can pay me whatever he feels like once the wound heals. Till then, no fees. my principle was simple, if I'm taking money from him then he should have benefitted from my treatment or else there's no point. At the same time, never do anything for free for someone cos they will never have any value for your hardwork.
So I started off by debriding the wound (he did not even require local anaesthesia, his feet were that numb due to neuropathy) on a regular basis and removed all the slough step by step, then I applied a VAC dressing, a kind of a suction dressing, that pulled out all the dead tissue. I combined that with appropriate antibiotics and good debridements until I saw granulation tissue growing. Slowly, step by step I saw the wound was responding.
I was doing this dressing every alternate day spending around 20 minutes on the procedure. I strictly told him he needs to keep his sugars in control during this period or else my work becomes difficult. He never bothered. always gave lame excuse as to how he dint find time to meet a physician to change the tablets. When I used to check his GRBS, it used to be in the 300 range invariably..
I told him to buy or get made custom offloading slippers so that he dosent damage the wound by weight bearing on it. He promised he would but never did. Always had excuses of not having enough money.
This went on for 6 weeks. 6 weeks I debrided and cleaned every alternate day while he dint bother to control his sugars or get good footwear. And still, the wound was healing until it reached a stage where I was able to stitch and close the wound and it stayed sealed.
Few more days down the lane and I could remove the stitches and his foot would have only a faint scar where there was once a hole. Treatment was 99% done. By then neither was his sugar in control nor did he buy offloading footwear. His contribution? Nil..
Before I took the stitches off, I told him it was time to pay my fees. Any amount was ok, whatever he felt was right in his eyes for healing his foot. I also told him if he dosent get the necessary footwear, it can recur.. He said he would surely pay the next time he came and also buy the shoes. He had just paid his daughters fees and so was out of cash, but he would surely pay on the next visit.
He never came back. He took the opportunity and disappeared. I ofcourse felt bad. I had put in a lot of effort to heal this, it was a good challenge for me and I succeeded, but the patient has 0 gratitude. Patients like these make me feel I should always charge first and then treat.
I once saw him after a few months near a supermarket near the same hospital where I treated him. He was keeping some packet into his scooter. He saw me, I saw him, he quickly looked away, sat on his bike and sped off in the opposite direction. No smile, no acknowledgement, just guilt.. No dressing on his foot either. Probably got the stitches removed by someone else..
Now comes the karma part:
Fast forward 1 year, I get a call today from the hospital saying this same patient is admitted and is in the ICU. He is in sepsis and the focus of infection is a large pus filled diabetic foot wound on the sole of his foot!!