As a busy podiatric physician, I’m exposed to many people facing hard times. Reactions to life challenges vary, but some folks stand out as examples of dignity. As I write this, I have two patient situations running through my mind, and the one thing they have in common is how graceful and dignified these people were in the face of really bad situations. Patient names and some details have been changed for anonymity, but you’ll easily understand the situations.

Mr Jones was a diabetic man who suffered from an infection of his foot after sustaining his first ulceration. Over time, the ulcer worsened, and the underlying bone became infected. This required me to do a partial first ray amputation that partly healed, but I had to return him to the operating room to revise the amputation due to continued infection. During his convalescence, his insurance company kept trying to deny coverage for advanced engineered tissues to cover the remaining wound, and this severely delayed his healing. Despite many weeks of insurance delays, negative pressure therapy complications, and home nursing issues, we finally managed to heal his wound. These delays must have been extra hard on this man because, other than his diabetes, he was a healthy and vibrant person who was previously very active both physically and mentally (he was a small business owner).

The other day, Mr Jones and I sat across from each other in my examination room experiencing that wonderful moment when I could tell him his wound had finally healed. His reaction was so consistently him – he just closed his eyes and sighed. He was very thankful for the work I had put in to help him, but without the calmness and dignity with which he faced his dilemma, I don’t think we would have been successful. It was a true inspiration to see how this strong man handled his adversity.

Mr Castro was also a man with a foot infection, but this one was much worse. During the first 50 years of his life, Mr Castro had never been to a doctor, so was surprised to find out in the emergency room of our local hospital that he was a diabetic. He had become profoundly neuropathic, couldn’t feel his feet, and ulcerated a plantar callus that led to gas gangrene affecting his entire forefoot. Unfortunately, this required me to perform a transmetatarsal amputation that I subsequently revised to a Lisfranc amputation. What was truly striking about this person was the way he handled this avalanche of bad news.

In my experience, I tend to see a bimodal reaction to the news that some part of a patient’s body would need to be amputated. They are either incredibly upset – out of proportion to the severity of their impending loss – or simply stoic and rigid. Despite the fact that, in many cases, we are saving the rest of their limb and sometimes a life, few patients initially maintain a balanced perspective. Loosing part of a toe to these folks has the same reaction as being told they have terminal cancer. They are rarely optimistic and thankful to those working to save them, and I have to spend extra time to educate them on the realities of their situations. These reactions are, of course, understandable given the bad circumstances.

Mr Castro, on the other hand, reacted to his parade of terrible news with such composure and optimism that I can only describe it as graceful.

“Hi Mr Castro. You’re diabetic, can’t feel your feet, will need medical treatment the rest of your life, and, by the way, you’re going to loose half your foot over the next week.”

If it were me, I’d likely react just as the rest of the patients I mentioned above, but Mr Castro remained pleasant, cooperative, and even maintained a small smile throughout his ordeal. I was amazed that every time I saw him, he thanked me for helping him – a truly rare occurrence from my amputee patients, at least during the initial treatment phases (people are often very thankful once they’re successfully healed).

As patients, both of these men have been absolute pleasures with which to work, simply because of the way they handled themselves under terrible circumstances. We should all be so strong as to live with the grace and dignity of Mr Jones and Mr Castro.

Best wishes.