The triage paper said, "Sent from NH [nursing home, not New Hampshire] for evaluation of foot wound and r/o sepsis." The nursing home paperwork was at the doctors' station, and I was too lazy to go over there and get it, so I gloved up and went into the patient's room.
The patient was a typical example of what I call "a bug in a bed": A very old person of indeterminate gender, who responds only to painful stimuli, with the majority of limbs contracted so badly that it's nearly impossible to move them, curled up in an almost fetal position under the covers--kind of like one of those roly-poly potato bugs that curl up when you poke them. You know, mouth like an “O,” Crypt-Keeper fluff for hair, PEG feeding tube, awful pressure sores.
I began the usual preparations for a septic workup (IV line, bloods, cultures, Foley catheter) and started wrestling with the patient’s contracted limbs. These patients are a lot heavier than they look because they’re...well, almost-dead weight. As usual, the “vocalizations” began as I moved the patient around, a constant, “LAWD LAWD LAWD LAWD LAWD LAWD” at a surprising volume.
OK, time to make my way to the “foot wound,” which was under layers and layers and layers of gauze dressing. The unmistakable scent of gangrene started to waft delightfully out as I removed the coverings. It looked as if the dressings had never been changed--just added to, since they were full of dried secretions and goo and...some kind of...weird little...nugget-type thing? Some skin? Wha? What IS that? Oh, SHIT! Is that a TOENAIL?
Yeah. While removing the dressings, I also...removed the patient’s gangrenous pinky toe.
(Added Edit: When DR read this, he said, "WHY did you make me read this?!? Now I'm going to puke!" Hee hee hee. Maybe the dogs will take care of it.