Abscess

We were called down to the Emergency Department because a patient required a surgical consult. Before we stepped into the cubicle, the smell hit us. I was a greenhorn so i did not think much about it. But the Registra immediately balked and choked out that what we were going to see would probably be bad since we can smell it before even locating the source.

A large man laid sprawled on the bed. He was so massive he could barely move. I asked him where the wound was but he did not respond. We wondered whether he was mentally fit. We hunted for the wound but it was not a difficult task. The copious discharge was oozing and staining his t-shirt. We examined the wound. It was a suspected case of necrotizing fasciitis (think: flesh eating bacteria). I palpated the wound, the surrounding skin was stiff as cardboard. It was not even painful, in fact the patient, to our mortification, was trying to scratch his wound because it was itching.

The Registra proceeded to examine the wound himself. To my horror, he did not don on any gloves. He used his bare fingers to squeeze the wound to check for any discharge. The wound made a sickly squelching noise as he did that and some highly purulent and pungent liquid oozed out. Obviously some of the discharge accidentally got onto the doctor’s finger. He could not find any tissue paper in the immediate vicinity and was in no mood to go hunting for one, so he held out his fingers just like one would do after eating oily fried chicken. Then an intern called out to him, and he walked over to the computer terminal where he promptly forgot about his contaminated fingers and proceeded to use the computer mouse. My eyes bulged when i saw that. I could not stop my squeamishness. The most disturbing thing is that i am starting to pick up the terrible habit. Because we are always in a rush, and for some reason, this blasted hospital has a tendency to hide their boxes of gloves; i am forced to do hernia examinations with bare hands. It is not a nice feeling having to touch someone else’s pubic hair without gloves. I have to constantly brush aside the voice in my head that reprimands me for all the infections i am exposing myself to.

Anyway if we had our way we would have immediately sent the patient to the operating theatre to debride the wound. Unfortunately, the patient came with a welcome package of several life-threatening medical conditions, including a very bad heart despite a pacemaker and uncontrolled diabetes. We had to optimize his condition before we could perform surgery. This patient was a disaster waiting to happen; he could very well die on the operating theatre. And he is under fifty years old by the way.

Then the Registra barked an order to the intern. Bloods needed to be taken. I did not understand why the intern was in such a fluster. He prepared the needle and tugged at the patient’s arm, causing the patient to shriek in pain not once but quite a few times. And each time he never apologized nor explained to the patient what he was doing. Patients in Potato Land do not complain either. Doctors have god-like status (though the nurses and hell even the ward clerks think they are the ones who should be worshiped. *Rolls eyes in distaste*). The intern tried to draw blood from the infected arm. He failed on the first try, and using the same needle, he pricked the patient a second time. One thing about taking bloods, if you fail on the first attempt, you should get a new sterilized needle to try a second time, otherwise you will be facilitating the spread of infection. The intern once again failed to hit pay dirt and he progressed down to the back of the hand where he stabbed the patient a third time, using the same needle. And then a fourth where he finally literally drew blood. I was appalled. You know if this patient really has necrotizing fasciitis and it happened to spread to the first puncture site and the intern did not notice it…well then the intern just assisted our resident flesh-devouring bacteria in its quest for territory by facilitating its spread down to the hand.

Sometimes i am bewildered as to how people can leave their wounds to such a disastrous state before seeking medical attention. Is it the smell that finally indicates it is time to see a doctor? My goodness.

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