Dear Readers

Many times, we are met with difficult problems and, at that particular moment, each problem seems insurmountable. The response many of us have is to throw up our hands, admit defeat, and walk away with the hope that someone else will find a solution to the problem or it will just “go away.” If we are willing to take the time and effort to work through them, there are really few problems that cannot be satisfactorily resolved. Solving some problems may require research to see how others have approached similar issues and may also require that we change our ideas about some things. Sometimes solving a problem may even require some sacrifice on our end to find a sufficient solution. The bottom line is whether we are willing to do what it takes to find a solution to a difficult problem.

We see this every day in wound care. Patients come to us with different types of ulcers and wounds. We evaluate the patient and the problem before outlining the best treatment. I am always amazed at how many patients tell me they cannot wear this dressing and bandage for one reason or another. It may prevent them from going to the beach or swimming. It may not look good with the outfit they are planning to wear to a party, or it keeps them from wearing stylish shoes—I am sure you have heard many similar stories. Patients will not wear their offloading boots because they are uncomfortable and too much trouble. The average HgbA1c of patients with diabetic foot ulcers in our wound center is around 12, even though they know they need to change their diets to improve the chance of the ulcer healing. These are just a few examples. Many patients are just not willing to be “inconvenienced” to help themselves with their wound problems.

There is a great story by Thomas Costain describing the life of a 14th century duke, Raynald III, Duke of Guelders. The duke was very obese, weighing more than 500 lbs. He and his younger brother, Edward, had a major disagreement resulting in Raynald being overthrown by his brother. Edward did not kill his obese brother, as was the custom, but in the castle, he built a room around him with a normal-sized door and several windows all without bars or locks. Edward told Raynald that he was not a prisoner and could leave the room anytime. When he left the room, he would regain his title and his property. The only problem was that Raynald was so large that he could not get through the door without losing weight. Each day during his “stay” in the room, Edward provided his brother with the best of foods. Instead of not eating the food so he could lose weight and leave the room, Raynald ate more and got fatter. Because of his inability or refusal to lose weight, he stayed in the room for 10 years until his brother’s death. Even after he was taken out of the room, he continued to eat and died within a year. He was a prisoner of his inability to stop eating.

Without a doubt, this is a sad story, but we see this problem every day in the clinic. Patients are unwilling to help us help them with their wound problems. Our jobs would certainly be easier if all our patients had the will to get better. It is unfortunate that there is not a “will pill.”