Not a leg to stand on

First, let me apologize for not posting in some time. I have become quite feckless and lazy, well that and I had a clerkship final, my girlfriend broke up with me, and I had a birthday. So, I have been kinda busy with things and such.

I am currently on an Inpatient Internal Medicine service at our county hospital. Not my cup of tea, but some of the patients are interesting. Their illnesses are interesting as well. As is my privilege, I will now delve into a story that is morbid and darkly humorous at the same time, as is my status quo.

First, let me tell you that I really like this lady. She is a hard ass and I respect that. I had a patient on my service who was admitted for a perineal abscess. She got some antibiotics and that resolved, but... one morning while I was looking at her foot, it looked red and irritated, there were some necrotic areas between her toes; it was cold, and there were frank colonies growing on it. For those of you not familiar with some terminology or the impact of that description: she had a horrible infection in her foot and up her leg. Let me give you a bit more background. She was an amputee, having a L BKA several years ago. She was also on dialysis, was anticoagulated to the n-th degree, and had neurodermatitis, among a laundry list of other problems. Neurodermatitis is when someone itches themselves, constantly. They will scratch their skin off frequently. It is really not pretty, and quite sad, because they do it unconsciously.

So, needless to say, we consulted vascular surgery and it was decided to take her to the OR to remove her right leg. Sad, heartbreaking procedure for an already amputated patient. I saw her the morning of her surgery in her room, she looked anxious, as one would expect. Having gone through it before, she knew the risks and complications, so I didn't hit on that too much. She went to surgery and was back in her room that afternoon (amputation is not really a hugely involved procedure, contrary to popular belief). When I saw her that afternoon and the next morning, she was so excited to see me. She thanked me profusely, said she was so thankful for what we had done for her, and was just in a general state of elation. When my intern went and saw her, she gave my intern a high five. We were both speechless. This lady had just become wheelchair dependent after losing both her legs. WTF?

To make sure she wasn't just delerious, I went back after that and chatted with her. She wasn't delerious at all. She was very with it. Apparently that leg was giving her problems for a while. So here is this lady who gets dialysis three times a week, has no legs, and has sores all over her body from scratching constantly, being elated about her condition. Make you change your perspective? Um... yeah. Hilarious? A bit.

I wanted to be in her surgery, but stupid Internal Medicine, non-procedure oriented, mental masturbation, did not allow me that privilege.

She is doing ok. She is currently having some complications of being a bilateral amputee and being dialysis dependent, but I'm hoping she can go to rehab sometime soon.