Friday, October 19, 2007

Wound Care....or lack thereof

Wound care has always been about common sense to me, even growing up, it was never something that had to be taught. With all of us sisters it was the same, you get a cut, you clean it and keep it clean. Simple enough, I thought. I'm amazed at how many people seem unable to grasp that concept though, it can be rather disgusting...A warning to my squeamish sisters and friends.....Haha

The man moved towards us slowly with a barely-perceptible limp. John nods towards him, "Looks like you've got a patient." I stand and turn, watching him come over. Mid-thirties, slightly rough looking. He could be the down-on-his-luck family man who is fighting to support his kids or your worst nightmare in a back alley. I prefer to think of him as the former, but John's closer then normal proximity tells me he is considering the latter and is prepared to protect me.

"I cut my foot on my bike gear and was hoping you could bandage it for me." I nod and have him sit, "When did this happen?" I ask. "Last week sometime, I've been wearing workboots all week, but my shoe is bothering it today, it feels like it's rubbing more." He slowly, carefully slides off a dirty sneaker and I pull on a pair of gloves, not quite sure what I'm about to see, but it can't be that bad, just a cut, right?

An angry red gash cuts a jagged swath through the dirt and dried blood of the grotesquely swollen foot. Pus is oozing from the wound, the dried edges of skin gape open to reveal multiple layers of flesh, all swollen and fiery red. Surprised, I draw a quick breath, only to be assaulted by the overwhelming and unmistakable stench of infection. Alright, no more gasps from me, it's not safe! "Uhhh, Sir, it looks quite infected, you need to go to a hospital and have them take care of this." John leans over my shoulder and agrees, we begin to discuss with the guy how he really needs to go have this looked at. It takes key words from John like "gangrene", "amputation", "severe infection" and "blood poisoning", but eventually the guy's shoulders droop slightly and he agrees, "If you think it's really that bad....." I firmly state that is indeed that bad, backing up John's message for proper wound care. He spent a week working without socks in sweaty work boots, I shudder to think of the neglect.

"This may sting a bit, Sir, but I need to clean this up." I say as I begin to swab at the wound, cradling his dirty foot in my gloved hands. I'm not at all sickened by it, more amazed at how nasty this infection is, although I must admit the smell bothers me a bit. "Clean away, girlie" He says with a swaggering grin. "I've been stabbed twice, shot once, this is no big deal." Yet he flinches as I clean, it hurts a great deal more then he'd care to admit to a 'girlie' like me. I finish cleaning, and although there is less dirt and dried blood, it doesn't look any better. I take the gauze John hands me and begin to wrap it up, creating a nice, neat white bandage. I sit back on my heels to admire my handiwork, it doesn't even budge when he jams his foot back into the filthy sneaker.

I ask him to remove his sweater as I begin to take vitals. He pulls it and his T-shirt off, the quick movement catching the eye of the police officer standing across the aisle at the beer tent. He looks away as fast as he looked over, but I am now conscious of the fact that he has been watching every move. As I strap the cuff around his arm, I notice the scars bearing witness to the stories he told mere minutes prior. No previous experience is necessary to recognize the stab wounds or bullet scar that mar his chest. Again I am thankful that John has stayed close, and that the police officer has been watching. I'm not overly concerned, but, like the two of them, I'm just not at ease with this patient. I feel the need to be more cautious, more aware. I finish up and reiterate to him that he really does need to go to a hospital. He promises he will, replaces his shirts and heads back into the crowd. John and I turn, and as one, strip off our gloves and head straight for the hand sanitizer. A lot of hand sanitizer.

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