Note to readers who follow the Johnny and Sharyn stories: This episode follows chronologically after the episode called “Johnny and Sharyn: Quite the Pair” where we learn that Johnny has injured his feet and I, Sharyn, have fallen and injured my right wrist. It might be helpful for you to reread this to refresh your memory before reading “Medical Appointment.”
After a few weeks of antibiotic cream and a regular soaking regime, Johnny’s feet were still swollen and tender and his skin itched. Despite home treatment and prescribed painkillers, the pain in his feet could keep him awake at night. His friend, Dr. Jeff, recommended that Johnny consult a podiatrist for further treatment. Johnny does not want to go to the doctor, partly because doctor visits are expensive, partly because Johnny prefers to live his life free from the advice of others, and partly because Johnny has a fear of medical procedures. I will come to learn that Johnny, smart and dextrous as he is, is incapable of changing a dressing, or even inserting eye drops in his own eyes. Luckily, he has been blessed with general good health and vigor for most of his sixty-seven years.
I trust Dr. Jeff and so I encourage Johnny to make an appointment with my podiatrist.
“Dr. Hiatt’s a good guy,” I say to Johnny. “He knows what he is doing. He fixed my ankle when no one else could. If you need to see a podiatrist, he’s the one to see. I always tell people with foot problems to go see him.”
“I don’t have insurance.”
“Neither do I, Johnny. He’ll see you anyway. You’ll have to pay out of pocket and there’s a prompt pay discount. You can pay in cash if you want.”
That suited Johnny, who operated with cash as much as possible and often carried lots of bills, meticulously arranged by denomination in his wallet.
“How much will it cost?”
“The initial consultation will be about $100.00, I think.”
“I can pay that,” Johnny says.
“Yes, you can. And you need your feet to get better.”
This is how I met Dr. Hiatt. I had been working as a substitute recreation leader at Willard Park, assigned to help integrate children with disabilities into after school recreational activities. I was supervising an active little girl who loved to run and to climb trees. One day, as I ran across the grass chasing her, I caught my left foot in a hole in the lawn and wrenched the entire foot inward, spraining my left ankle. I hobbled into the Willard Park Clubhouse, sat to fill out an incident report and went home on the bus.
The next time Carl at Willard Park called me for a substitute shift I explained that I could not do it, that my ankle would not permit me to be on my feet for a three-or-four hour shift, that it was still swollen and painful. Carl told me I could still go see a doctor through the City of Berkeley’s Workers’ Comp contractor.
I went down to Alta Bates where I received an x-ray (no fracture) and saw a nurse practitioner. She taught me the basics of sprain care — rest, ice, elevation and compression — and encouraged me to draw the letters of the alphabet with the toes of my left foot. I was dubious about this, given that I have little ability to move my left toes (My entire left foot is affected by cerebral palsy).
“I’ll try,” I said.
Furrowing my brow and looking at my toes, willing them to move, I did my best to draw a capital “A,” “B,” “C.” After I completed the tiny movements I looked at the nurse practitioner.
“Go ahead,” she said.
“I just did it,” I said. “That’s as much as I can do. I have cerebral palsy.”
She blinked.
“I’m not familiar with cerebral palsy,” she said.
Long story short, for the next six years I iced and elevated my left ankle frequently, and often wore an ace bandage wrapped around it. I consulted an orthopedist and got a custom-made brace for it, a plastic orthosis whose edge dug into the back of my calf while the my sore ankle banged against the rigid device whenever I made a movement it was meant to prevent. The swelling went down when I wore the orthosis, but, as soon as I stopped wearing it for any length of time my left ankle swelled to the size of a tangerine. I went through courses of physical therapy and acupuncture as well. I popped ibuprofen tablets like Chiclets, hoping to reduce the inflammation and swelling. Nothing worked: six years after the accident my ankle hurt whenever I walked and was especially painful when I had to walk on a slanted surface or stand for more than half an hour at a time. By this time I had acquired a permanent half-time position as a recreation leader and was required to be on my feet a lot, going on field trips, pushing children in wheelchairs, supervising art projects and taking part in sports. The medical professionals who could not bring me relief said things like “Well, you are getting older” and “Well, you have cerebral palsy.”
I would say in response, “I’ve had cerebral palsy all of my life, but it doesn’t cause pain or swelling. Before I had this accident I could hike, dance, walk four miles. Now I can’t do any of that.”
Eventually I decided I needed to see a sports medicine specialist because sports medicine doctors are dedicated to getting their patients back to their pre-injury condition. A receptionist at a Berkeley acupuncture clinic gave me the number for the Center for Sports Medicine in Walnut Creek. I called and explained that I had an unresolved Workers’ Comp injury, an ankle sprain, and the appointment clerk gave me an appointment to see their foot doc.
Doctor Hiatt was a former basketball player, young, friendly and an excellent listener. I sat on an examination table, telling him the sad tale of my ankle sprain, enumerating all of the things I could not do anymore and all of the things that caused pain. When I finished my recitation, Dr. Hiatt examined both of my feet and ankles, and gently worked my left foot through its limited range of motion. Then he looked up, watching my face as he said, “What if I told you I could make your pain go away and stabilize your ankle?”
I had pursued every treatment anyone suggested while waiting six years to hear those words: when I heard them I started to cry.
Dr. Hiatt had made my left ankle better. After prescribing custom-made orthotics for my shoes, enrolling me in a program of physical therapy and electronic stimulation, after having my nerves tested (all viable), and after an MRI that showed a “mangled and shredded” tendon, Dr. Hiatt received approval for a tendon transfer surgery. He split the tendon that runs by the inside of the foot into three sections, leaving one third of it in place, running another third across the top of my foot and wrapping the last third around the outside of my ankle. After surgery and follow-up physical therapy to restore my strength my ankle was back to normal strength and stability.
Johnny gave me permission to make an appointment for him to see my foot doc at the Center for Sports Medicine in Walnut Creek, a city to the east of San Leandro with a per capita income of $69,000. I usually take public transit to medical appointments, involving a combination of buses, trains, shuttle buses and walking, but Johnny cannot walk at all without pain, so he gets a guitar student to drive him to his appointment. I will meet them at Johnny’s house and go along to provide encouragement and moral support. It is the third week of September and I have not seen Johnny since making a surprise visit to his house in July to check to see if he was still alive after no one had seen him since the end of June.
I watch Johnny hobble down his front step, down the walkway. At the driveway, he supports his weight with an arm on the cyclone fence, crosses slowly to the curb. When I open the car door for him he grabs the outside roof of the car to help lower himself into the passenger seat. I climb into the back seat and sit directly behind him, resting my forearm on the top of the front seat so that he can hold my hand while we drive. Rob parks in the garage beneath the medical center so that we could take an elevator up to the lobby to save Johnny as many steps as we can.
I don’t remember what Johnny wore on his feet the day of his first appointment. I think by then he had bought himself a pair of shoes in a larger size to accommodate his swollen feet, but I don’t remember if he came in wearing socks, slippers or flip-flops. I don’t think he walked in barefoot.
Johnny didn’t own any clothing beyond the basics: black jeans, black long-sleeved dress shirts, black socks, black leather shoes, a heavy black cotton sweater, a black knit watch cap, a black leather jacket and belt. He did have ties in red, green and purple, but he seldom wore a tie. To facilitate the doctor’s examination of his legs and feet, Johnny has taken a pair of scissors and cut off his oldest pair of jeans just below the knee, leaving a raggedy hem. Although he has shaved and showered and combed his silver hair, he looks tough and disreputable in the blue-chaired, carpeted suburban waiting room with his self-fringing pants. He sits as much as possible, getting to his feet only when he is called to the front counter to sign in as a self-paying patient. Today Johnny has no banter for the friendly front office staff and no energy to summon it. I don’t know what is going through his head, but I suspect it is a potent brew of hope, fear and shame, seasoned with foot pain. Johnny hates medical appointments and medical settings and medical terminology — only fear and pain would cause him to consult a doctor for any reason.
Doctor Hiatt greets Johnny with a smile and a firm handshake and introduces himself. Then he focuses on Johnny’s story, watching Johnny’s drawn face. To his credit, Johnny tells Dr. Hiatt that he had sat and slept slumped on a couch with his shoes on for the better part of several weeks before he had removed his shoes and found himself in pain. He tells him he had consulted a physician, who had prescribed an antibiotic cream and then recommended an additional consultation.
Dr. Hiatt listens. Then, as gently as he can, he examines Johnny’s swollen feet and calves.
“You have cellulitus. Your doctor gave you good treatment. He told you to do the right things. I would have done the same things. You are going to get better. What I’m going to do is wrap your legs and calves. The compression will help the swelling go down. When the swelling goes down, the pain will lessen.”
“I’ll prescribe some pain medication for you. And I’ll need to see you once a week for awhile. Do you have any questions?”
Johnny shakes his head. He does not like medical conversations. He does not want to talk about any of this. He just wants to walk pain-free the way he used to.
I listen carefully to everything the good doctor says, listening for telltale words such as “sepsis” and “necrosis.” Thankfully, I didn’t hear any of them. In true Harper fashion, Johnny has dodged a bullet.
Johnny doesn’t say much while Dr. Hiatt wraps his legs and feet, although he winces from time to time and shadows of pain cross his face. I can see that he is tired from the excursion. I do think he appreciates Dr. Hiatt’s positive attitude and he makes a follow-up appointment for the following week.
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