The one with tophi on a saturday morning

My preceptor is a family physician in a suburban-ish town about 20 minutes from my house. I usually go in to work with him on tuesday afternoons. For the most part I am his bitch and he is my pimp. He tells me to do stuff and I try to get it done properly, lest the wrath of Dr. Randy descend on me. I'm making it sound worse than it is, in reality Dr. Randy is an awesome person and I learn a ton at his practice. I have seen/done more procedures with him that I would have ever thought possible at a family clinic. The only problem I have with Dr. Randy is that since I go in on Tuesday's, there are only so many patients I get to see a week. Tuesdays are not really busy days, especially from 2-5 pm. So to change this up I decided to try going to preceptor on a saturday morning a couple weeks ago.

Holy crap.

As I walked in that morning Debby (head nurse at the clinic) ran up to me with a very excited hop in her step. "I'm really glad you came in today, you're gonna love looking at Frank." Frank as it turned out was a patient with some VERY advanced gout. Gout is a condition where uric acid crystals start to become deposited within your joints. This means that you get swelling around all of your joints because they start to fill up with these crystals and become whats known as "tophi." As a result you get gouty arthritis, it is painful to say the least. Now gout is a condition that is very treatable and with diet and medication it can be kept under control.

Frank's gout was definately NOT in control.

My first reaction when I saw him was "HOLY SHIT HOLY SHIT HOLY SHIT!!!!!!!" followed quite closely by "I'm gonna throw up." Imagine if you will a baseball, now put a baseball each on your elbows, neck, and knee. Add to that some seepage of white tophi fluid from said baseballs. Finish it off with little ping pong balls of seeping tophi fluid on the ears and eyebrows. That was Frank and this is what happens when gout gets really really out of control.

Dr. Randy told me that most physicians see this type of gout perhaps once in their career because it is so rare. The reason for it is simple, most people seek out help lonnnnng before gout gets this bad.

After seeing my reaction to Frank, which was mostly mental since the only physical reaction I had was a widening of the eyes, Dr. Randy decided that I should spend some time alone with frank getting his history. This was a pointless endeavor because they already had his history, but because I saw that Mr. Miyagi look in Dr. Randy's eyes I decided to suck it up and let the wax on wax off begin.

Frank was actually a pretty cool guy. He started talking to me as soon as I was alone with him and gave me the full breakdown of his current gouty condition. Frank was diagnosed with his gout by Dr. Randy about fifteen years ago. With the help of his wife he had been able to keep it in check without any flares of gouty arthritis. Frank's wife passed away about four years ago and ever since then he has been in depression. The depression wasn't what you might think it was. He was still the jovial person he normally is, he just stopped taking care of himself. It started small with skipping meds everynow and then until finally he quit on that altogether. Some time passed and without realizing it his gout had flared up to the stage where he was today. I asked him how he was able to bear the pain for so long without realizing the severity of it, but Frank was a 'Nam vet who was already used to dealing with massive amounts of paint. Thus his pain threshold was drastically higher than most peoples'.

What actually caused Frank to snap out of this depression was when he realized that all of his friends were no longer stopping by to visit and they were starting to shy away from him in public. This did not bode well for Frank because I imagine that like me he lives to entertain and be the life of the party. In this manner Frank found himself at Dr. Randy's that morning looking for a way out of his condition.

I was dumbfounded by Frank's story because it was completely unexpected. For the most part when you see someone with an illness, you tend to separate them from normal society and begin to treat them differently. This is what is known as "disease." It is a social condition, not a medical one. Illness can be treated, disease cannot because it is equal parts social as it is physical. The most debilitating part about disease is that once we associate somebody with it, they become just another statistic. We forget that they are people as well and that their lives have meaning.Dr. Randy was treating him with an IV dosage of medicine and I was in charge of monitoring his status; this worked out really well for me and over the course of the morning Frank continued to tell me about the ins and outs of his life.

I left Dr. Randy's clinic that morning with a newfound appreciation for medicine because not only does it help us cure an illness, it can help us begin the fight against disease. Frank showed me that just because a person might look grotesque, it does not mean that we should shun them. The treatment of disease begins by overcoming the mental barriers that society puts AGAINST helping the diseased. Once you start to peel back the layers of the patient, it becomes apparent that they are just another person with an illness. As people in the medical profession, it is our duty to go out and overcome these barriers so that we may better help out patients.

I have seen Frank a few more times since that first encounter and I am pleased to say that he is looking drastically better. His baseball tophi are now ping pong balls and the ping pong balls are now peas. His friends have started coming over again and he has confided that this turn of events is what is keeping him on his medication now. Frank no longer has a disease, he is merely ill.

PS: I have obviously changed the names of everyone involved. HIPAA bitches!