Thursday, April 8, 2010

severing metaphor notwithstanding, sometimes you need to see the real thing

Today Mark amputated the feet of a man with trench foot that had progressed to the point of gangrene. Trench Foot occurs from prolonged exposure to damp, cold conditions, and he was a homeless man who was in and out of shelters in all manner of weather conditions. The first time he saw the patient, Mark walked into the room to an odd scene and a bad smell. The man had taken off his shoes (he had walked on these feet to the appointment, painfully) to reveal a left foot that was actually dry and mummified and resembled a piece of charcoal. The right foot however had gas gangrene, which is a serious infection. The clostridium bacteria byproduct was bubbling under the skin and the skin was sloughing off. Needless to say it was super gross. Mark explained to the patient that his feet needed to be removed immediately or he was risking his life, and the man said he would think about it; then proceeded to put his shoes on and walk out of the office. Fifteen minutes later and Mark walked outside to get some lunch and there the man was, standing on those feet, nonchalantly waiting for his ride. Unbelievable.
He waited 3 weeks to return, and unfortunately that cost him another 3 inches of his lower leg. So Mark performed the surgery today (paid by Medicaid HMO) and in another couple of weeks the patient will return to have the second phase of the operation where the permanent cuts and wounds will be made (today was more about removing dead tissue)
yeah I know, gross, but if you are wondering why people have limbs amputated in the year 2010, now you know. Although it's hard to tell from the pictures, this man is actually caucasian. His skin has darkened from a hard life living outdoors.

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