It all started with two little dogs.
When a litter of puppies was born on the Tohono O’odham reservation, J. Marcel Thomas was quick to take two of them under his wing and work tirelessly to provide a loving home. When he developed two small ulcers on his left foot, at first, he thought little of it. After all, he was simply going about his business, sweeping, mopping, cooking, generally moving through life’s routines.
While two small blisters might have been a relatively minor concern for most, Mr. Thomas was diabetic and particularly susceptible to complications in his extremities. He visited the podiatrists at Sells Reservation Clinic, who placed a cast on his foot to protect the ulcers and advised him to stay off his feet. They would see Mr. Thomas for a follow-up in two weeks.
But Mr. Thomas still had himself and the two little dogs to take care of. He continued on with business as usual. By the end of that first week, he noticed a severe pain in his left foot. That Saturday morning, he woke up and found his dressing completely soaked through, indicating that the ulcers had developed into full-blown blisters. He removed the cast and was alarmed to find his skin peeling off.
Mr. Thomas was rushed to the emergency room at Banner University Medical Center – Tucson. The team at Banner redressed his foot and sent him home with a round of antibiotics. Again, Mr. Thomas continued on with his usual level of activity. By Tuesday, he had run out of clean dressings for his foot. The city charge who would be bringing clean bandages wasn’t scheduled to arrive until Thursday. With no method of transportation to the hospital and no way of contacting anyone, Mr. Thomas had no choice but to wait.
By the time Thursday rolled around, the bandages were soaked and smelly. Even more concerning, signs of infection had started to set in. Mr. Thomas asked the city charge to redress his wound, but the charge wasn’t able to do it. Instead, he drove Mr. Thomas back to the Banner ER. It was clear his advancing foot infection had transcended the tribe’s resources.
Shortly after arriving at Banner, Mr. Thomas initially met with Dr. Allison Rottman, a highly trained podiatric surgeon with the University of Arizona Department of Surgery’s Southern Arizona Limb Salvage Alliance (SALSA), a collaborative clinical and research team dedicated to advancing care of the diabetic foot and preventing amputations related to complications from diabetes. Shortly after, Mr. Thomas was introduced to Dr. Andrew Rice, co-director of SALSA. Dr. Rice knew they had to act quickly. Along with the sores and infection, Mr. Thomas had very poor circulation to his feet. Luckily, Dr. Rice had access to the multidisciplinary SALSA vascular and podiatry team all within the same building.
Dr. Rice called in his colleague Dr. Kay Goshima, a vascular surgeon with the Vascular and Endovascular Surgery Division of the University of Arizona Department of Surgery. Dr. Goshima assessed that there were blockages in both of Mr. Thomas’ feet but more severely in the right side.
Dr. Goshima performed an angioplasty, a minimally invasive procedure in which the surgeon inserts a small tube through the blood vessel in order to clear the artery and restore blood flow. The procedure was fully successful on the left side, but only partially successful on the right due to the severity of Mr. Thomas’ infection. The team decided that the best option would be to reconstruct the vascular structure of Mr. Thomas’ right foot through bypass surgery.
In total, Mr. Thomas underwent 6 procedures in just 10 weeks. While the SALSA team was able to salvage both of his feet (sacrificing a few toes in the process), the recovery process was far from easy. At a time, Mr. Thomas reports, he wanted to give up. It was only through the support of his doctors and sheer faith in a greater purpose that Mr. Thomas kept fighting.
Part of that purpose was being able to take care of the two little dogs he had adopted. One of the puppies, a white dog with a black spot around her eye named Misses, became Mr. Thomas’ guiding light. He recounts a dream he had about her:
“I had an experience with Misses during my surgeries. She was the one leading me around to different rooms upstairs. She’d be talking and she’d wheel me with whatever I was laying on to all these different rooms. And then I would see different people, dressed like [Dr. Rice], and they would start talking to me, or they would ask me questions and I would try to answer them, and they would just fade away. She was like my guardian angel or something. She showed me a lot of good stuff. Even if I’d died, I would have felt good, because she was there. So that was a lot of encouragement through her.”
Even greater, Mr. Thomas believed he was given a second chance to serve as an advocate for other members of the Tohono O’odham Nation and other native communities experiencing discrepancies in healthcare. By sharing his story, he could help make his community more aware of what medical resources are out there and combat the barriers to those resources.
“Through this I’m hoping I’m able to get to the tribe hospital and talk to the people there and improve the situation, instead of not having transportation and not being admitted right away to see what the problems are,” said Mr. Thomas.
Mr. Thomas’ case profoundly changed Dr. Rice’s priorities, too. Newly arrived to Tucson from Connecticut, Dr. Rice was stunned by the barriers to medical care that Mr. Thomas had experienced and how they had contributed to his condition. He knew he needed to do more.
“Mr. Thomas was a great influence in helping me understand what the problems were,” said Dr. Rice. “When I first came from the Northeast, which is about the time [Mr. Thomas and I] met each other, I was very ignorant of the whole condition. Not only on the reservation, but what the different difficulties were both getting access to the system and response from the system and transportation, all of those things. So, he sort of moved my priority list around as far as things to talk about and address.”
Now, 16 weeks after his final surgery, Mr. Thomas has regained his mobility and independence. While unfortunately he had to give Misses away during to his extended hospital stay, he’s returned home and the two have been reunited. Most importantly, he is able to return to business as usual.