In humility count others more significant than yourselves ~ Philippians 2:3

Josh visited the emergency department occasionally due to problems from his heroin use. His visits usually began in the parking lot smoking area-his unofficial waiting room-and then we would roll him into the emergency department in his wheelchair. He was paralyzed from his mid-back down.

Today, however, Josh and his wheelchair were in the actual waiting room. Unusual. He was sleeping, also unusual. His wavy, shoulder length hair begged a washing. His left leg and knee were swollen and red-I had never seen a knee effusion so large. He mentioned that it had been a bit larger he past few days. He did not realize that his temperature of 103 degrees, his low blood pressure, and his fast pulse could all be from that infected knee.

Tests and treatments began. We withdrew more than a cup of pinkish-tan fluid from his knee joint, finding not only that it was filled with pus, but also that both bones were shattered from some forgotten fall. We stabilized his temperature and blood pressure; however, he would not heal with antibiotics alone. The toxins from the infection were poisoning him, killing him. The specialist arrived and informed Josh that his leg needed to be amputated-now.

Josh was angry, “I’m leaving. Take this IV out.”

I was surprised. Was it not clear to Josh that he was dying? He felt that the specialist was demeaning him, did not care about him, and had not considered saving his leg. “I would rather die, than have my leg cut off by that ___.” I decided to try to talk to him. He wanted to smoke, so we loaded him in his wheelchair with the IV and rolled him back outside. As the sun set, he told me how he became paralyzed.

It was a summer day, eight years earlier. After sweating all day on the cattle ranch, a group went to the river to cool off. A rope swing was the culprit. From high on the bank, he jumped and hung on. But as his weight came to bear, the rope broke, and he landed on the rocks, just short of the water. He was paralyzed immediately, losing the use of his legs and control of his lower body.

After our conversation, he agreed to stay in the hospital, still swearing he would never let that other doctor talk to him or touch him again. But he would consider treatment by someone who cared about him, reinforcing the old adage about a patient’s view of doctors: “They don’t care how much you know until they know how much you care.”

Some patients are harder to provide care for than others. While Josh was offended by the other doctor, he is kind to most patients, some of whom I am impatient with. True treatment and healing begin with the miracle of selflessness. In humility, I need to count others more significant than my interests, my time, and myself.

– Victor Wallenkampf, LLUSM class of 1976-A, is an emergency medicine physician in Humboldt County, California.