“I know,” I said with a nod. “But I’d like to hear it directly from you.”
She was quiet for a few seconds then let out a put upon sigh. “I was carrying the baby and the dog. When I stepped off the bottom step, I rolled my ankle. Now it’s all swollen and I can’t put any weight on it.”
I pushed off, sliding across the floor so I was at the foot of the exam table. “Can I take a look?”
Margot nodded and waved a hand, but the expression on her face told me she thought I was being ridiculous. I’d encountered it before. Patients seemed to think that since it was my job to examine them it was weird when I asked them if I could. But I was a stickler for consent. Yes, it was implied since they’d come to see me, but I wanted to know it was freely given.
“Did your foot roll in or out?” I asked as I gently poked at her ankle. It was definitely tender, swollen, and a little warm. She held in a wince as I manipulated it, but I saw the way her face tightened.
“In.” Her voice was a little tense.
I nodded and gently laid a finger on the calcaneofibular ligament. “Okay, and does it hurt more here?”
Her breath caught. “Yes.”
“Okay.” I set her foot back down and slid across the floor again. “The good news is that your x-rays don’t show any breaks. It seems you’ve strained your ligament there. What you have is a really bad sprain.”
“Okay.” She said the word slowly, drawing it out. “So what does that mean?”
“Do you know about R.I.C.E?” At her blank look, I elaborated. “Rest, ice, compression, and elevation.”
“Oh. Yes. I do.”
“Great.” I took a few seconds to type a few lines of notes. “We’ll get your ankle wrapped and into a brace. I suggest you stay off it for a couple of weeks. We’ll send you home with crutches, but they can be a pain, so if you want, you can look into renting or buying a knee walker. Ever seen those? It’s like a little scooter that you can rest your knee on?”
She scowled at me. “I can use crutches, you know.”
I blinked. “Well, sure. But we’ve seen a lot of good success with healing since the knee walkers have come on the market. Patients are more apt to use them since they’re easier. But youcan do whatever you like, as long as you give your ankle time to recover. In the meantime, I’ll write you a referral for physical therapy—”
“No.”
I froze, then turned toward her. “PT will help you strengthen the strained ligament and make sure you don’t lose mobility in the ankle.”
“I’m not going.”
There was something in her tone, something I couldn’t quite catch. I pushed my glasses up my nose and slid away from the computer. I didn’t get into her space, but I made sure she saw that she had my full attention and that I was willing to listen when I asked gently, “Why not?”
Margot stared at me for a long moment, studying me maybe. After a few more seconds, she sighed. “I’ve gone that route before for a knee injury a few years ago. I’m not putting myself through that again.”
I opened my mouth to extol the benefits of PT but shut it before speaking. I knew patients who didn’t want to do physical therapy because it hurt, because it was expensive, because it took time away from their day that they needed. For a second there, I’d been ready to assume her reasoning. And that would make me not only a shitty human, but an even worse doctor.
“What part of physical therapy don’t you like?”
Margot scoffed. “The part where they tell me if I just lose weight, then I’ll be fine.”
Ah. Well that made sense. Not the reasoning because that was bullshit. An injury was an injury on any size patient and it needed the same care. Just because Margot was plus-sized didn’t mean she should be treated any less.
It was one of my biggest issues with healthcare in this country, only second to the way privatized health insurance screwed mostof the population. But the only thing I could do to fix it was treat every one of my patients with the dignity they deserved.
“Fair enough. Tell you what, I’ll show you some exercises you should do, twice a day, for the next couple of weeks. I’ll write it all up in your discharge so you have them. Then I’ll see you back here in, say, three weeks and we’ll assess your healing and discuss next steps. How does that sound?”
Margot squinted. “And is one of those next steps going to be a diet?”
“Margot, your vitals are outstanding. Your blood work from three months ago is perfect. If youwantto lose weight, we can discuss that, but I’m not going to make it an issue. You’re as healthy as a horse.”
She blinked at me and then let out a chuckle. “And you should know, with the last name Harrington.”
I laughed. “True enough. And really, it’s a stupid idiom because anyone who knows horses knows that one wrong move or even look at them funny, and they’ve got a problem. But really, you’re healthy and strong. You wanna try doing PT on your own and see if it improves, I’m all for it.”
