Tuesday, December 8, 2009

Hack and Slash

For some reason, I always wind up with patients with decaying body parts...

It's not their fault, but I do take a long time to dress these patients. It's not that I'm slow, but I like taking my extra time to really clean out dead tissue, to mop up the blood, clean out the pus...the works. It smells really bad most of the time, that disgustingly dead, (but now familiar)smell of flesh that has not seen the light of day, for a very long time.

Trust me, it is an experience, it assails your senses at first meeting. And, depending on how bad it is, it'll make you want to cancel that lunch date you've been planning with someone.

That bad. what causes it? Where do you often get these "decaying" body parts? Well, most of the time there's the common "diabetic foot", there's necrotizing fasciitis, among others. For tonight's discussion, however, let us focus on the one my patient has. He has had pressure ulcers (that have become infected) from not having been cleaned, properly...for the past two weeks. You can smell decayed flesh from a corridor away.

I won't say what his case was exactly, but suffice to say, he was left in bed for weeks, and thinking they were helping him, his relatives would apply a poultice of mashed nut somethings on his ulcers. AND Betadine. (tragic, really.)

So when he got to the hospital, he was feverish and his ulcers were in pretty bad shape. For some reason, I take it as a personal mission to clean these suckers out, dress them and keep them clean...and do the same thing again every day.

The last time I did this for another patient, his leg got all better...and he got to go home after a long long time of being in the hospital (but it wasn't because of my dressing his leg only, of course. :-p).

I suppose, aside from the fact that it should be done for the patient's good, the act of taking out the bad, dead, devitalized tissue to allow living tissue to granulate and form into new muscles/skin is pretty symbolic. It is a Zen-like experience to have to suffer [the stench, the cost, the time] and to forget yourself, even for a while, because this other person depended on that help you were giving him. He couldn't do it himself, and so he would surely appreciate your efforts. Seeing change and improvement by taking out the bad stuff from something that's meant to be living, useful flesh is therapeutic. In my opinion, it is as much your healing as your patients'. (I can always relate to almost makes me selfish.:-p)

Honestly speaking, when it comes down to it, dressing/debriding meticulously is as much as good for me, the doctor,as it is for my patient. It is a symbiosis, a mutualism that he or she doesn't know about...because most of the time, they think they're the only ones benefiting from it. ;-p

(Of course, there are select cases...some patients can get downright demanding and would want to be dressed more than once a day, paging and paging. This case in point is about the one patient you would dress when you had the time to sit down to it.)


  1. wow. For some reason, I totally identify with what you just wrote.

  2. i guess you are one of those few people who find satisfaction with what you are doing in the end of it all, i was about to take up medicine about 8 years ago. about to. changed my plans in the last sec. and wond up taking engineering. so i guess i understand the motivation for you. what you feel when you see someone you helped, worked on, doing well is a high that not many experience. and i envy that. i liked your blog. and im gonna put it on the roll.

  3. @Nathan Manila: Thanks, Mr. Traveler.:-) I had to stay behind this morning to do this...I couldn't complain, it was good for me too.

    @Nitin: I love my job, always have. It has some perks that you can't find anywhere else. It's not always pretty, nor is it always smooth-sailing, but hey, it is never short on fulfillment. :-)

  4. I love how you present the cleaning out of rotting flesh as a Zen-like experience, with all the inherent symbolisms. It must truly be cathartic, after enduring the stench (for you) and the pain (for them), that both of you benefit from the experience.

    Oh, and I salute you.

  5. @rudeboy: Thanks, I appreciate that. It IS something else...I reckon it's therapeutic because you get face to face with something that's bigger than yourself. Any way you look at it, the other guy always has the bigger problem, you get to appreciate how lucky you are in some ways.It helps you think beyond your own needs and wants.



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