The thing that bothers me the most is when patients allow a disease to progress so far that almost nothing can be done – especially when something could perhaps have been done.
My surgery rotation has had numerous such cases.
Once, during a night-time call, the most horrible, moist stench filled the entire corridor of the casualty ward. The cause was a patient with anal carcinoma… so advanced that he had a 10x6cm lesion where his anus should have been. It had completely destroyed much of the muscle and all of the sphincter.
This image is the closest I could get on Google, but it is not nearly close enough:
The link is safe, but the picture is a bit graphic for sensitive readers.
Two days later a lady entered the ward with the worst venous ulcers I have ever seen (not that I have seen terribly many). I could see one of the metatarsals of her right foot. She was in so much pain, but that she had waited til now to seek help goes beyond my understanding.
The thing about the Western Cape is that the Department of Health here has gone through a lot of effort to ensure that there is a community health clinic walking distance from any settlement in the province.
So as much sympathy as I have for these patients, I simply do not think they have a valid excuse.