Breaking patients

Every once in awhile, you have an experience where you “break” a patient…like the Nun for example. Or maybe the prisoner. Oh, you don’t know the prisoner, do you? OK…

You aren’t eating lunch, are you? Because this story will really gross you out.

So this prisoner comes into the emergency department. He is on some sort of work-release program at the county jail and can come and go for things like work or doctor’s appointments. So his wife brings him in for horrible, horrible tooth pain. He’s been on antibiotics for 2 weeks, but has a festering abcess in his gums and a mouthful of rotting teeth. His left upper lip, in the area from his left nare (nostril) downward is visibly swollen. His breath is awful. I look inside his mouth with our brand new portible suturing lights, slip on some latex gloves and run my finger over the lump inside his gum. It is soft and squishy and extremely painful. As I start to inject the lidocaine (numbing medicine), I enter a pocket of pus. Suddenly, pus and blood start streaming from his gums and out of the middle of a stump of a tooth. He starts gagging and spitting, so I have him sit up and spit the crap out of his mouth. What I would do ideally, is make a nice clean incision, explore the abcess site and pack it if necessary, but his gums are so friable that they just fall apart when I touch them. I take the largest needle tip that we have, with a beveled edge, and make a slit right over the abcess and more bloody pus comes flooding out. I grab a pack of 4x4s and fold one up in quarters and stuff it iside his mouth. I am extremely grossed out, the odor of the abcess fluid is overwhelming…it smells like rotting death. But I’m not finished. I take the gauze out, put my finger back in his mouth and milk out as much fluid as I can. He immediately tells me that the pain is gone…and the swelling in his face is gone too. I give him a stronger antibiotic that is only dosed twice a day. (the prison had been giving him his penicillin only 3 times a day, instead of 4 as is required for it.

His wife takes him back to the prison. ABout an hour later, I get a call from his wife telling me that he has been having constant shaking chills since he left the emergency department. Ugh. There is no nurse in the prison or doctor on call. It costs him 2 dollars for each phone call he makes. With visions of this prisoner becoming septic overnight, dying in the prison and nobody realizing it until 2 days later prompts me to tell his wife to bring him back to the ED. “How long will it take to get here?” I ask…while thinking to myself that I hope I’m gone when he returns. Somebody else can fix the patient I broke.

Well, he did come back just as I was leaving and one of the interns picked him up. I’m not sure what happened after that.

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