Moving Flesh

It was a hot Saturday afternoon and I was working an extremely busy 12 hour shift. I was in the middle of my shift and had not stopped. The wait for patients to be seen had crept up to about 4 hours. The ICU was full and our ED was full We were starting to board patients in the hallways and up against walls. It was a little crazy. In the middle of all of the nonsense patients backing up the ED we had our real emergencies coming in at a nonstop pace. Gunshot wound, Stabbing, Myocardial Infarction (MI), Motor Vehicle Accidents (MVA), Stokes, etc.

I was charting on a patient I had seen and trying to catch up on some of my documentation when I smelled an unpleasantly familiar foul odor in the air. I immediately knew someone was rotting. Flesh that is rotting has a very distinct smell. So I looked around my shoulder and noticed a patient on gurney boarded in the middle of the ED. There was no room in the inn. She was older and it looked like she had some family with her. She did not look acutely ill from where I was sitting. I decided to investigate and make sure she was not a ticking time bomb waiting to expire.

As I made my way to the patient the smell became even stronger and I noted that her foot was wrapped in gauze all the way up to just below the knee. I knew that I needed to unwrap the bandage, but I also knew that upon unwrapping the wound would unleash an odor potent enough to induce vomiting in staff and other patients that had not acquired the ability to coexist with such potent odors. It would have been an unpleasant thing to do and or inflict upon those in the ED minding their own business.

I went over to the Charge Nurse and explained that I needed to take a look at this patients leg but that I needed to do it in a room where the smell could be somewhat contained. She agreed and quickly pulled a patient complaining of an "itchy hand" out of a room and gave the room to my patient. I went into the room and continued to speak with the patient and the family to get a proper history and perform a physical exam. I was excited to see what was behind curtain number 1. I put on my gloves and began to slowly unwrap the gauze bandage and immediately the odor became 10 times more apparent. I looked up the the patient's son was vomiting into the sink but the daughter was holding strong and only gaging. The nurse had to excuse himself from the room. I continued to reveal the wound. Once I had the entire bandage removed it was clear to see that this was a serious wound. She had gangrenous flesh and an open wound with exposed bone from the middle of the shin down to her foot.

I noticed that the wound was "sparkling" in certain places so I moved in closer. I noticed a rippling motion within the wound. The daughter said "why is the flesh moving?" I reached into the wound and pulled out a maggot and removed some of the dead flesh only to reveal several maggots enjoying their lunch. I explained / showed the daughter the maggots and the rotting flesh. I cut away much of the dead flesh and cleaned the wound. I could not appreciate any pulses. The lower leg was unsalvageable and would need to be amputated.

I did all the cultures and lab work and started some powerful antibiotics. The patient was admitted and later taken to the OR for a below the knee amputation. She was fortunate that she had not become septic.