24 March 2009

The Toe Story

Medical school is a combination of book-learnin', apprenticeship, hazing, and trial-by-fire. Therefore, it is the source of some great stories. Probably my favorite med school story is the "Toe Story". Not the Tooth Fairy or Toy Story, but the Toe Story. I haven't written it down, so I am not sure if it will work verbally as opposed to vocally.

This story takes place during my 4th year of med school, when I was doing an elective rotation during the fall -- Infectious Diseases. I adored that rotation, to the point that I strongly considered bagging neurology and applying for a medical residency so as to be able to do a fellowship in ID. It was mostly because of the attending physician on the service that month. I will call her Dr. C. She was amazing. She was 10 years older than I and 8 freaking months pregnant and could walk faster and for longer than I could. She knew an enormous amount about medicine, ID, and how to take care of sick-as-shit patients. I didn't want to grow up and be like Dr. C, I wanted to grow up and be Dr. C.

Anyway, on any given day, we would round on established patients in the morning, then be assigned new patients that we would have to see prior to rounds in the early afternoon. That day I was given a patient with possible osteomyelitis to evaluate. Osteomyelitis is infection (or inflammation) of the bone. She was a 50-something year-old woman with juvenile-onset diabetes, who has a non-healing wound on her foot that wasn't responding as well to the wound care as the docs had expected. So I was instructed to evaluate her for the possibility of osteomyelitis, which would most likely require her to have her foot amputated.

I went in and introduced myself to her. "Hi Mrs. X, my name is Neuron Doc. I am a student doctor working with the Infectious Diseases service. Your primary doc asked us to come take a look at your foot."

"Sure, dearie, come one in and take a look," she replied. "You know that I can't see you". I had read her chart prior to coming in, so I knew that she was blind from diabetic retinopathy and had pretty severe neuropathy of her hands and feet.

I went over and did the usual poking and prodding, listened to her heart lungs and belly with my stethoscope ("flea collar" in MedSpeak), etc. Then I went to the end of the bed to look at her foot. It was wrapped up all nice in a big white gauze bandage. I kinda felt bad about messing up the dressing, fully well aware that her nurse was going to be pissed about that. But I carefully unwrapped all the gauze and very daintily removed the pads. It was pretty gross. There was an open wound on the top of the foot, sort of at the base of the two toes just adjacent to the big toe (2nd and 3rd toes). The 2nd toe was almost black, and the 3rd toe was a darkish purple. “Eeuuuw,” I thought. I gingerly reached out and touched the 2nd toe. "Does this hurt?" I started to ask, as I moved the toe up a little. But then the toe came off in my hand. Literally. I was holding this woman's toe.

The look on my face must have been something to behold, but she was blind and couldn't see. And she was basically numb from the knees down, so she couldn't feel. "No, dearie, I can't feel a thing on my feet. Good thing, because my foot should hurt like the devil." But I was still holding her toe as she said this. There was no blood. Just a little slot where the toe should be. And it was in my (gloved, thank goodness) hand. I thought "oh fuck, now what do I do?" Then I very carefully, put the toe back in that little slot, wrapped the foot back up in clean bandages. And left. Quickly.


I went straight to Dr. C's office, hoping she would be there. She was. I knocked and went in. As soon as I got into her office, she could tell something was up and asked if anything was wrong. I lost it and started to cry. I wailed out my story. And she tried. She really tried to hold it in, but she couldn't. She burst out laughing. She asked me if I wanted to go back and finish that consult, or if I wanted to hop to it and see a different patient in time for rounds. Needless to say, I saw a different patient (a nice simple hospital-acquired, multi-drug-resistant pneumonia). When we met for the pre-rounds discussion, Dr. C couldn't resist and told the team the story. In hindsight, it really was hilarious.

The woman's toe had basically auto-amputated due to severe peripheral vascular disease, and that – combined with the poorly healing wound and underlying osteomyelitis – did require a below-the-knee amputation. Which went well. I always wondered what the woman thought when I ran out of her room and am ever grateful she couldn't see the look on my face, when I pulled her toe off. And I never became an Infectious Diseases doc...

13 comments:

Nathan said...

So you're planning to sub-title your blog The Puke Bucket's Annex, right? XD

MWT said...

o.O


(I think that's all I can really manage, comment-wise. O.o)

John the Scientist said...

Hahahahahaha.

And THAT, my dear, is why I majored in chemistry, not biology.

mattw said...

Hahahahahahahaha!

You should have kept the toe and strung it on a necklace, then you could've added other body parts you encountered from other people as they fell off.

What?

neurondoc said...

Nathan -- I haven't put this in the puke bucket simply because I wanted to save it for a blog post...

John, I majored in Classics/archaeology. Just sayin'

Janiece Murphy said...

"oh fuck, now what do I do?"

I always suspected M.D.'s have that very thought more times than they'd like to admit.

Hrmph.

ExpatMom said...

You are popular!!

Who are all these people? You aren't married to anyone there, are you? ;-)

neurondoc said...

No, I am only married to you, the Elder Husband, and the younger Husband. :-) As you said -- there isn't any more room in the marriage.

As for these people -- they are members of the UCF. They tend to suck people in, so be careful. Hee-hee.

neurondoc said...

And Janiece, MD's have that thought a lot more than they are willing to admit to themselves...

John the Scientist said...

"John, I majored in Classics/archaeology. Just sayin'"

I meant in graduate school. I killed plenty of rats as an undergrad. :p

nara-cat said...

And that tops anything that I did/saw in med school... oh, boy.

Just wanted to say hi- if I'm not either wrong and/or crazy (both are entirely possible), I think that you once sent me a lovely and encouraging e-mail regarding neurology as a specialty. (This was was at least five or six years ago and was via the LMB list, so if that _wasn't_ you, then hello from a total stranger who enjoyed cringing at your toe story.) I ended up doing peds... but I'm now half-way through peds neuro, so you must have done something right in that e-mail. *g*

Incidentally, I've often said that icky adult feet were one of my main reasons for doing peds instead of adult. My one year of adult neuro only reinforced that belief...

Bests,
Paige

neurondoc said...

Paige -- that was most definitely me. I've been off-list since early 2003, as working full-time and having a kid ate up too much of my internet time...

I still love neurology (adult not peds), so I am glad to have "infected" you.

Wendy said...

Too funny, and I was not grossed out, frankly because I can relate on at least two levels.

I previouly worked at a geriatric hospital with many research clinics, including one for advanced wound care. When we first started using digital cameras, our department (IT) was frequently asked to come and take photos of patients & treatments for various projects. As I had a strong stomach, the wound care docs would ask for me. Got quite an edumacation for a computer geek. The other techs would get completely grossed out when they'd see me working to correct the color or crop the photos.

Plus, working for personal injury attorneys, I frequently have to review medical records for potential med-mal or nursing home neglect cases. We're usually looking for lack of documentation in those cases. But what cracks me up alot are the nurses notes. Most are fairly professional, but once in awhile you will get an honest reaction comment on a really gross wound or condition such as "stinks really bad" or a very simply "nasty!!" after several scratched out starts.

Hey, we're all human. Those of us that work with clients and patients wouldn't be doing what we are doing if we weren't.

WendyB_09