She smiled in pain. She held my hand and said, "You have to make my foot better so I can walk again!" I made a noncommital gesture and started with a history. She had been having ischemic rest pain in her right foot for the past month, making it impossible for her to walk or sleep at night. She said she was "worn out" from lack of sleep. "The pain is so bad, I wish I didn't have my foot."
Physical examination confirmed severe arterial ischemia, with femoral-popliteal occlusive disease. I told her I would discuss this problem further with her family physician, to which she replied, "It's my leg, not his. I want to walk again and sleep peacefully. I know I'm 91 years old and have a bad heart, but I'm sharp. Can you do something besides take my leg off?"
After discussion with her family physician, who