I’ll have to admit, sometimes my work schedule as a trauma surgeon wasn’t exactly all that I had thought it was going to be. Time consuming, usually interesting, well, probably yes. Totally predictable, not a chance.
Let me explain further.
It was a typical Thursday morning for me at the hospital. I had two routine surgery cases that both involved wounds from previous trauma cases that needed to be cleaned up. Not the glamorous life-saving surgeries done every single day by the hero surgeons on afternoon TV soap operas. Speaking of soap operas, I never understood how the physicians on those shows were always in their late twenties, been in practice for over ten years, and spent more time flirting with nurses at the club across the street from the hospital than at their office seeing patients that needed their help.
Just saying.
My two trauma cases that morning involved the honor of cleaning up multiple dirty, torn up, road grit impregnated wounds. These wounds were caused either by being thrown from a vehicle because you weren’t wearing your seat belt, or worse, because you were riding a motorcycle. In my surgery residency training we would call motorcycles “donor sleds.”
No kidding. You figure it out.
By the time I got through washing, debriding, washing, and rewashing the wounds in both cases, I felt like I had spent the morning in a rainstorm with my hands turned to prunes despite using surgical gloves. After each case, I spoke at length to each of the patient’s families explaining slowly what had been done and how it might help things to heal. Because both cases involved multiple trauma, I had to explain how I was only one of the doctors taking care of their loved one. There would be many more questions arise since there were a number of physicians involved in each case.
It was never an easy speech to give.
By now, it was 12:30 p.m. and afternoon office hours were to commence at one o’clock sharp. The number of patients I saw on Thursdays and Fridays were always more than what was printed on the list because so many patients wanted to be seen before the weekend. I quickly made my way to the surgeons’ locker room, changed my clothes, and zipped off to my office a few blocks away.
Upon entering the back-office door, I made a straight line for my cubicle--my employer Columbus HealthCare System did not deem that private offices were necessary for physicians. I knew that I had just under three and a half minutes to cram my sandwich and an apple from my brown bag lunch into my mouth before the fireworks began. I got about three-quarters of it down when, right on schedule, my office assistant Janice, who had been with me from the start over eight years ago, appeared carrying a large stack of medical charts.
“Here’s the charts for the first half of this afternoon’s Funfest,” she proclaimed dumping them into my lap. “The patient list for today is at your dictation booth. And remember, you’re on trauma call tomorrow night for Dr. Norton.”
She trudged away down the hall back to her cluttered desk without any other comment.
Janice was a no-nonsense employee that knew what she was supposed to do and what she didn’t have to do. There was no going over the line with her. When I first started in this surgical practice, I tried to tease her some about her serious approach to everything, and let me tell you, that did NOT work out well. Since then, I just thanked her for keeping the machine going and did what she said for me to do. The result was things ran smoothly for each of us most of the time.
I had forgotten that I had to take extra trauma call to make up for the week I would be gone after my upcoming wedding. Perfect.
Patience, my boy. Just another chance to add to my virtue basket.
The afternoon cruised by at lightning speed with the hoard of patients pushed in and out of the exam rooms like cattle through a branding station. I did my best to dictate progress notes on each patient immediately after seeing each one since I knew I was going to have to split to meet Ian as soon as I was done.
Things were trending fairly well until there was a small hiccup in the flow of patients when a former patient of mine insisted on being seen that afternoon even though she didn’t have an appointment. Rather than fight it, I told Janice to work her in. The face I got back from her in response was not joyously filled with approval. Or, make that even less agreeable than that.
When we approached the door of the patient’s exam room, my nurse Melissa pulled me aside and said, “You saw Mrs. Rice seven years ago for a cholecystectomy where she did fine postop. She is now eighty-four years old, wheelchair bound, and wants you to look at her right lower leg venous stasis ulcers.”
“Sounds exciting. Do you know who’s been taking care of her for that?”
“I didn’t get that far. She only wants to talk to you. And only you.”
“Well, I guess not everyone can be so lucky to have an octogenarian fan club. Let’s go see what we can do to help her.”
“Mrs. Rice, Dr. Chandler. So good to see you again,” I said as I entered and gently shook her frail hand. “You look great. What can we do for you today?”
“Oh, Doctor. You’re so kind to me. I’m so glad to see you again. You’ve been taking care of these leg ulcers for me and I’m scared they are getting bigger.”
“Well Mrs. Rice, it’s not me who has been looking after your leg ulcers. The last time I saw you was when we took out your inflamed gall bladder seven years ago. Do you remember the doctor who sees you for your legs?”
“What did you say?” she answered leaning a little bit forward with her hand cupping her left ear.
I leaned toward her cupped left ear and asked again, “Who is the doctor who sees you for your legs?”
“I thought it was you.”
“Is your family here with you today?” I said still speaking in a slightly louder volume.
“My family? No, my daughter lives over in Topeka and checks on me at the nursing home by phone twice a week.”
“What’s been bothering you about your leg ulcers?” I asked the elderly woman.
“Well, the nurse’s aide is supposed to change the dressing every week. They switched to this once-a-week dressing a while back and it was working pretty good. But they tell me the nurse’s aide has been out sick for a couple weeks. They told me no one else knows how to change it so it’s been a while since it’s been changed. It’s starting to itch and I found a bug on my footstool pillow that I keep my leg elevated on. I got me plum worried.”
“Well, we don’t want to get you worried Mrs. Rice. Let me change you bandage to see what’s going on.”
She had her whole right leg dressing covered by her sweatpants. After pulling exam gloves on, I sat on a small rolling stool. I gently pulled the patient’s loose sweatpants legging up to above her knee and immediately knew what the problem was.
About that time I heard Melissa over my shoulder quietly whisper out loud, “Oh my goodness!”
“Well, well, Mrs. Rice. I haven’t seen this kind of dressing since my days of surgical training at the VA hospital,” I explained calmly. “It’s called an Unna boot. It’s zinc-oxide impregnated gauze wrapped around the lower extremity used for treating venous stasis ulcers. The easy part is that it only needs to be changed once a week. It does a pretty good job, but if you leave it on too long, little bugs can find their way inside and get all over the ulcer.”
“It that what I think it is?” muttered Melissa with both of her hands covering her mouth.
Sure enough, at the open edge on the circumferential dressing just below the patient’s knee were two or three small worm-like creatures slowly wiggling.
“Yes, you are correct. And there will be a whole neighborhood of relatives down lower on the ulcers that are doing nature’s dirty work to actually keep the wound cleaner. I read that it used to happen all the time in wounds during the Civil War. Melissa, if you could get me a large trash bag, a pair of bandage scissors, and a liter of saline, we’ll get this cleaned up for Mrs. Rice in a jiffy.”
“Oh, thank you Doctor. I knew you could help me,” the patient said sounding so relieved.
When my nurse returned, I spread a folded bed sheet on the floor first. Opening the dark colored trash bag, I slid it around the patient’s right lower leg so no one but me could see inside the bag. Cutting the bandage off with the scissors and peeling away the smelly gauze, it revealed two ulcers in her distal leg covered with the rest of the maggot cousins. The insects were doing their job of debriding away the dead tissue, so that left healthy, healing red granulation tissue underneath.
I gently rinsed the bugs away with the saline, patted it dry with some gauze, put some Xeroform gauze and a dry overlying dressing to her leg wounds without the patient or my nurse grossing out over the bugs.
“You might leave housekeeping a note to treat this bag as a biohazard,” I said to Melissa as I tied the trash bag shut.
I took off my gloves and shaking the patient’s hand said to her, “It was so good to see you again Mrs. Rice. I’m going to write some orders for the medical staff at the nursing home to make sure they keep up with your leg. You have a nice day now.”
“Oh, Doctor, thank you so much. You’re such a patient young man.”
“Thank you Mrs. Rice. You have a nice day.”
I left the room happy that I could help an elderly woman in need. Even better, I had a witness in my nurse Melissa to prove to Caroline that maybe, just maybe, someone else thought patience was a virtue of mine.
But then again, it didn’t involve wedding details, so you can probably cross that one off the virtue list.
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