Friday Clinic

Have I told you that I do NOT like Friday clinic? We alternate Friday clinics so that the surgeon that is taking weekend call also does clinic on Friday. Well, Friday clinic overwhelms me. First of all, all of the orthopedic patients are told to come to clinic on Friday (remember, I am a general surgeon...bones are not my thing). In addition, most of the inguinal hernia patients are told to come to clinic on Friday and there always seem to be plenty of emergencies. It's can be a lot for one person to manage.

This Friday's clinic was no exception. I left conference early to get started. I spent the first 20 minutes trying to decipher charts to figure out who needed follow-up x-rays so I could send them all to radiology first thing. After sending about ten people to radiology, I started with a couple of inguinal hernia patients.

The first patient had had a successful left inguinal hernia repair here, then last year he went to have his right inguinal hernia fixed at another hospital. Only, he told me, they just "made an incision, looked, and closed without fixing it." Huh? I took a look. Yep, there was a nice incision and an obvious, reducible hernia. I don't know what they did at the other hospital. As usual, we don't have any records. But, he has a hernia and I know how to fix that.

After that, I continued on with the usual smattering of neck masses, mastitis,  non-specific abdominal pain, and spina bifida. After seeing about 10 non-orthopedic cases, I finally started in on the bones. X-rays, X-rays, X-rays. Keep the cast, take it off...not too bad. And then there was this: 

I wish..Proceed with caution: stop here if you don't want to see some slightly disturbing medical stuff.

A bent leg, an x-ray with a metal rod and a loose screw...its been three years since the operation and he is here for follow-up. I guess I should take the dressing off to see what's underneath.

As I unwrapped, suddenly some white things fell out of his ankle and onto the floor. White, wriggling things. Worms. Gross. Gross. Gross. Yep, his wound was full of worms...on the bright side it was otherwise pretty clean because they had been eating all the dead tissue. Once, while I was in training,  I put "sterile" maggots on a wound  to help with healing. Its not always a bad thing.

Fully unwrapped...exposed bone, exposed metal, and a pile of worms. Just when I think, "that's the worst... I've ever seen" I'm wrong again. He needs an amputation, but he refused to have the leg amputated.