triage by zeroing in on either the most potentially
life-threateningproblem(thepossiblemetastasis) orthe
problemthatbotheredherthemost(thebackpain).But
thiswasevidentlynotwhathethought.Heaskedalmost
nothingabouteitherissue.Instead,hespentmuchofthe
exam looking at her feet.
“Isthatreallynecessary?”sheasked,whenheinstructed
her to take off her shoes and socks.
“Yes,”hesaid.Aftershe’dleft,hetoldme,“Youmust
always examine the feet.” He described a bow-tied
gentleman who seemed dapper and fit, until his feet
revealedthetruth:hecouldn’tbenddowntoreachthem,
andtheyturnedoutnottohavebeencleanedinweeks,
suggesting neglect and real danger.
Gavrilleshad difficultytakinghershoesoff, and,after
watching her strugglea bit, Bludauleaned in to help.
Whenhegothersocksoff,hetookherfeetinhishands,
oneatatime.Heinspectedtheminchbyinch—thesoles,
thetoes,thewebspaces.Thenhehelpedhergethersocks
and shoesback onand gave her and herdaughter his
assessment.
She was doing impressively well, he said. She was
mentallysharpandphysicallystrong.Thedangerforher
waslosingwhatshehad.Thesinglemostseriousthreat
shefacedwasnotthelungnoduleorthebackpain.Itwas
falling. Each year, about 350,000 Americans fall and
breaka hip. Ofthose, 40 percent end upin a nursing
home,and 20 percentareneverabletowalkagain.The
three primaryrisk factorsfor falling arepoorbalance,
taking more than four prescription medications, and