A Walk in the Night – A Medical Story

A Walk in the Night:

There was a patient that reported that six months previously – his car had broken down on a highway. It was in the middle of the winter in Wyoming. He feared waiting with his car. So he walked, four miles, back to the nearest gas station. There were several inches of snow on the ground and freezing temperatures. Once he arrived, he called a family member to come and pick him up. He was freezing and was thankful for the ride to his home. Several days later, he returned and was able to tow his car back to his home.

Now, six months later, he was seen in clinic for foul smelling feet. He indicated that this smell has been ongoing for a few weeks. He reported some nausea, fever and chills. He reported that some of the pain in his feet had resolved. But that he was feeling some numbness.

He removed his socks and several of his toes were black. He hadn’t really noticed them before when the findings were pointed out by his provider. He laughed uncomfortably and admitted that he rarely cleaned his feet, let alone, look at them. STAT Blood work was ordered and some abnormal findings were noted. A referral to a specialist was sent out. He had a follow up appointment for the next day for a surgical consult.

First Clinic Visit:  

A Walk in the Night

The provider reported that he felt confident that the patient was at risk for infection and gangrene. He likely would require some debridement or a more serious treatment of amputation.

A week later, he was surprised to see the same patient back on his schedule. He assumed that this was for a follow up visit after surgery. When the patient arrived – he reported that he could pay for surgery. He decided to take dental floss and remove the “black parts” on his own. Of course, he wasn’t completely successful in removing the dead tissue on his own. None of the symptoms had changed, in fact, the patient was worse.

The Second Clinic Visit: 

Self trimming

The provider sat down with the patient and went over the risks at length. The bone was sticking out of the great toe. Finally, the patient agreed on surgery and later than afternoon – he had amputation of at least two toes. He was started on IV antibiotics and was in the hospital for almost a week.  He had a bone infection along with gangrene. It could’ve potentially been life threatening.

***Some of the actual details have been changed in order to preserve patient confidentiality. This is designed for teaching and better understanding. If these details match another person, it is likely coincidental.
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