Tuesday, November 24, 2009

Fiction is obliged to stick to possibilities. Truth isn't. ~ Twain

There was a disturbance in the force last night. I was at work and had a person comes in wearing a hoodie with the hood up. Sick person. Anyone wearing a hood here is defiantly sick. We get them all plugged in, they are in a wheel chair, cant use their legs from a MVA a couple years ago. They have a home health who comes to visit them. My first gut reaction is that this person is really really no kidding sick.

I take a history and find that they were in the hospital a few months ago for a wound check. So we roll them over to look at the wounds. I a very infected stage 3 DU on the L hip. There is also a dressing on the sacrum, so I take that down. It’s the worst DU that I have ever seen in my life. 11CM by 12 CM that tunnels another 8 CM around the R side. The sacrum is completely exposed as well as L1, and a good part of the pelvis.

Both heals are eaten down completely to the bone and smell gangrenous. I would not be surprised if the R foot has to come off.

The next person to arrive via EMS is another young person about the same age, who was playing football and ran into another player. But now cant feel anything from mid shin down, and can no longer move the ankle, or foot, or toes. The loss of sensation crosses 4 dermatomes and 3 levels of spinal inervation. Anatomically I don’t believe that there is a way to make this happen. I check the reflexes and at first I note that there are no reflexes on the affected side. But when I go back and check again a little closer I note that the muscle is activated for the reflex, but he is tensing the rest of his foot to hold down his foot. My spidy sense says malingering.

I am sitting out in my area looking at these two rooms with two very different people. One who will never walk again, one who wont walk. I feel like there is something that the force is trying to tell me, I just don’t understand it.