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Toenails and Pecan Pie

Mrs. Beazley comes in a few days before Thanksgiving. Her chief complaint: “My nails look awful.” As she sits on the exam table, I notice that she can’t reach her feet to take off her shoes and socks. I review her labs and note her blood sugar level. My mind starts to outline the lecture I’m about to deliver; I start off by saying, “So, tell me what you ate for breakfast today.”

“My son comes in to help me every day,” she says. “He lives near me and helps me get dressed and does few chores. He was unable to cook for me this morning, so I got lobster bisque from the restaurant across the street. That was my breakfast and lunch.”

I am horrified at this choice, given her uncontrolled diabetes. In the meantime, I’ve taken off her shoes and socks. Thick, deformed, long, discolored toenails are the reason she’s here today. “I’m very embarrassed with my feet,” she says, “and don’t want to go to my son’s Thanksgiving dinner.” Somewhere, behind our masks, our female minds connect and I understand her logic. I push aside my medical mental notes and focus on her chief complaint.

“Let’s see what we can do for you,” I say. I soak her feet in a kidney tray for a few minutes. Then I use some sponges to slough away the dead skin. I rub some bacitracin into her heels and moisturize her skin. My nurse hands me the clippers we use for ingrown toenails. My patient is loving the attention she’s getting. She looks relaxed, enjoying the pampering.

I chip away slowly at her thickened nails—cutting only a millimeter or two at a time. I’m worried about breaking a nail or cutting her skin. But she admires my handiwork and keeps encouraging me to trim a little more. Before I know it, we’ve been laughing and joking together for 45 minutes, and her nails are all trimmed, cleaned, and debrided. She discusses nail color options with my nurse. “Maybe I’ll have them painted Ruby Red,” she says. “I’m not ashamed to get a pedicure now. And a lovely pecan pie is waiting for me at my family’s Thanksgiving table. My son is known for his cooking, and I taught him all he knows.”

After this lovely respite, the physician in me kicks in again, and I bring up food choices. I give her some handouts on healthy eating and a letter for the food pantry on low-fat and low-sugar options. We have a long road ahead of us, but I’ve been her primary-care physician for three years and this is the first time she’s really listened when I talked about food choices. I’m not sure what changes she’ll be able to make, but this listening was a first step.

Nidhi Lal
Acton, Massachusetts

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