“During the first year of my fellowship, I encountered a patient, a beautiful young woman in her early 20’s with a burgeoning career as a model in Miami, who was experiencing intense heel pain. She had been treated by other physicians for Plantar Fascitis and tendonitis without any resolution. I diagnosed her with Tarsal Tunnel syndrome and confirmed that with a neurology consultation for NCVS and EMG. The patient was taken to surgery for a Tarsal Tunnel release. During the course of the procedure, we encountered a tumor pressing on the posterior tibial nerve. The tumor was removed and the pathology report defined the tumor as a Synovial Sarcoma, Stage 4.
The patient was sent to Sloan Kettering Cancer institute in New York, along with lab results and 35mm slide photographs of the tumor. The Sloan Kettering team confirmed the diagnosis and recommended that the patient undergo a below the knee amputation with follow up chemotherapy. During the chemotherapy, she lost her hair, and the surgical site on the stump of her leg dehicsed. She dropped to about 60 pounds from an original weight of 120 lbs. However, in the end, she survived both the chemotherapy and the cancer. She kept in touch with me throughout the entire process. I developed a close relationship with the patient and her parents. After arriving back from New York, the patient related to me that the Sloan Kettering team had kept the 35 mm slides I had sent with her (in those days, it was not so easy to make photographic duplicates). When she explained that a podiatrist had made the diagnosis, they told her that podiatrists did not make diagnoses for cancer and that she should credit the neurologist who caught the abnormality on the nerve conduction study. The patient asserted to them that she credited the podiatrist with saving her life. The folks at Sloan Kettering told her that podiatrists were “not real doctors” and so had no real part in the process of treating her cancer. She later related to me that she found them to be arrogant and egotistical.
I remember being very much offended by what she told me, frustrated at being recognized as “only” a podiatrist. At the time, I was reading a book by Victor Frankl, “Man’s Search for Meaning”. Victor Frankl was an Austrian Neurologist and Psychiatrist during World War II. He was Jewish and became a concentration camp prisoner by the Nazis during the war. He was tortured and emasculated by his captors. One day, as he hung helpless before his tormentors he came to an amazing realization. In order to do what they were doing to him, they could not help but to hate a fellow human being. In a moment of remarkable clarity, Victor Frankl realized that while they could not choose to not hate him, he could choose to NOT hate them back. In this seemingly small thing, he had power over them to determine how he would react to the terrible things they were inflicting upon him. They could not choose mercy, but he could. In reviewing this, I came to a nexus moment question: “If I could do it all over again, would I choose to have encountered this beautiful young woman as an MD or as a DPM?” Two MD’s had treated her before I saw her, one an orthopedist, the other a general surgeon, and both missed the diagnosis. IF I had chosen to attend St. Louis University School of Medicine, instead of podiatry school, and encountered this patient, would she have lived or died because of this tumor? I realized at that moment, that I was totally, completely, absolutely content to be a podiatrist. If the only thing I would ever accomplish as a podiatric physician was to catch this diagnosis and intervene in a way that saved this young woman’s life, it was all worth it – four years of college, four years of podiatry school, one year of residency training and two years of fellowship. What a wonderful lesson, one that has caused me to be very happy in the practice of Podiatric Medicine for over 30 years now. By the way, my patient returned to her modeling career as a poster model for lower limb amputee snow skiers. She could be found in a number of ads for outrigger ski poles and single limb skiers. To this day, she has lived a good life and remains a good friend.”