So off we went on a whirlwind of a tour. Our 7-hour flight turned into 9 hours – we were delayed 2 hours because we decided to leave Philadelphia at the exact same time as the pope. I was unable to elevate my leg for the entire 9 hours, which meant continuous discomfort and edema beginning to set in. Add this to tackling Paris and Barcelona in a week and walking 10 miles a day, I resigned myself to the fact that my leg would be swollen for the entire length of the trip.
The dermatologist had ended up placing purse-string sutures into my leg, trying to close the wound a little bit. Unfortunately, the edema led to the sutures cutting into my leg, which led to my friend and me removing the sutures with a pair of tweezers while sitting on the bathroom floor of our Paris hotel. What’s more is that the open wound led to copious amounts of leaking sanguinous fluid, which required constant bandage changes. I now know how to ask for gauze in 3 different languages.
I spent the trip living in perpetual fear that my wound would get infected, and I would be stuck trying to purchase cephalexin from a pharmacy using my broken Spanish or nonexistent French. The pain was controlled by taking ibuprofen every 6 hours. But if I was late on a dose, it was unbelievable agony. I could go on for hours about the difficulties of trying to take a shower with a 4 cm wound in my leg.
Unfortunately, I think what happened was a complete breakdown of communication between my dermatologist and myself. We needed to have more of a conversation before the procedure was done.
I don’t think my dermatologist realized that my vacations involve being on my feet for 10 hours a day. I didn’t realize that I would have no clue what to do if my leg became infected while I was thousands of miles from home. Had we talked more, I’m fairly certain both of these subjects would have been brought up and addressed appropriately.
I write about this story because I too am guilty of telling patients they will be fine without asking them about the finer details of their lives. Finger laceration? You’ll be fine. Broken leg? You’ll be fine. After taking this trip, I now ask patients probing questions, trying to figure out just how fine they’ll be: “What kind of work do you do? Do you use your hands a lot?” I now find myself volunteering work notes for them without them having to ask.
In addition, I try to tell patients what to expect with their injuries in painstaking detail: “You will have discharge, and that is normal. You will have swelling, and that is normal.” I go into even more detail about what isn’t normal and when they should come back. As providers, we really need to dig deeper into our patients’ lives to give them the best education possible. We need to open the lines of communication as much as we can to get a better understanding of what our patients will be going through.
Photo courtesy of Jillian Knowles.
Looking back, I am still incredibly glad I went on this trip. My friend and I laugh about the fact that we went to Paris during fashion week, and all I could wear were sweatpants and sneakers. We went through Spain telling everyone the bandage on my leg was the result of a fútbol injury. The wound became such a big part of the trip that we decided to name it Margot, and we celebrated the news of my clear margins by marching up the steps of the Eiffel Tower.
My leg will take 5 months to fully heal, but I’ve already got 1 month (and several life lessons) under my belt.
Jillian Knowles, MMS, PA-C, works as an emergency medicine physician assistant in the Philadelphia area.