Wednesday, June 23, 2010

The case of the maggot infested foot

God being so kind, yesterday was good. ER sent a patient up. As most times, report was shady but the nurse mentioned that the patient, who presented with blisters on bilateral feet that was infested with maggots, was all cleaned up and they'd gotten rid of the maggots. YAY or so i thought.
So up came the guy, btw, he is one of the sweet homeless folks ( i need to blog about the kinds of homeless folks who come to the hospital one of these days) but anyway, after getting him settled, i proceeded to do a skin assessment. when he walked in, i noticed an open wound, from a blister that had burst, on the plantar surface of his left foot. my goal was to figure out the length, breath and depth of it so i can apply an appropriate dressing. In so doing, i noticed something black between his great toe and 2nd toe so i went ahead to take a better look thinking it was gangrene. I mean with all the diabetics in bmore, i see gangrenous toes so often it almost looks like a normal variation of the foot and toes. Anyhoo, i open up the toes and out comes MAGGOTS!!! I freaked silently because i'd hate to have the patient think whatever. Anyway, i say maggots and the nurse doing the validation with me goes "let me see.
" Seriously?! if i was doing a skin validation with someone and they said maggots, i don't think i'd be so quick to see although on second thought, i'm soo nozy when it comes to medical stuff. Tell me a patient in room so and so has this and i'll make sure that even though i've no business in that room, i'll see it. So in hindsight, that would have been my reaction as well. Anyhoo, i call the resident asking if she'll like to order something for me to use to get rid of the maggots because i was told the ER had the guy soak his foot in something. The nurse wasn't sure what.
She turns around and asks me what would you like for me to order? I find it wierd that after 4 years of medical school, you expect a nurse to make a medical judgement for you. So i tell her i think the ED used betadine and she says i'll order it and she never does.

Anyway, the thing here is that there are tons of homeless people here who live in terrible conditions and go through awful things that Christe Eleison! makes my heart ache at times when i see them. To come to the point where maggots feed on you feet? boy, i thought the dead were the ones who had those little creatures feed on them. Are you better off than the dead or not? i mean the only difference is that you breathe but like the corpse underground, you're organic matter.

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