Monday, February 23, 2009

I Spied Three Things

Three things I've never seen before while doing an observation day with the Wound Care Nurse, all of them vaguely horrifying.

1. The fattest man I have ever seen. I'm not prejudiced against large people, but this guy weighed in, on admission yesterday, at 904 pounds. Yes, NINE HUNDRED AND FOUR. He is scheduled to have some sort of pannus-removal surgery. The docs are pretty sure he has a heart condition, but he's too big for ANY nuclear medicine studies (the tables aren't big enough, and he wouldn't fit inside the machine, and too big for the cath table, the OR table, and pretty much everywhere else. They're planning to do the surgery IN HIS HOSPITAL BED because they can't move him. It took 7 of us to roll him to assess his skin integrity.

2. Somebody's tendon. No, not in surgery, he had a pressure ulcer from where another hospital put pressure ulcer preventing (o irony) boots on him. The inside of said boots were hard plastic, so the skin over his achilles tendon broke down. Voila! Tendon! He was really out of it, and on a vent, but it was still horrifying. I mean, insides are supposed to be on the INSIDE. Also, his big toe was BLACK and about to fall off. I don't think he'll be walking again.

On the other hand, I doubt he's going to be CONSCIOUS ever again either. Sad, either way. He just took really lousy care of himself (smoker, alcoholic, morbidly obese, no exercise, diabetic, dialated cardiomyopathy, cardiogenic shock, etc.)

3. A wound-vac. They're gross. I'm sorry, but I don't know how the floor nurses can deal with that. I mean draining normal stuff like blood or serum? Fine. This was draining...infectious goo. NOT fine. Gross.
And she had the inevitable NON EXISTANT pain tolerance. She screamed when the nurse POINTED at her, and demanded more "mo'phine", because we were "torturing" her. Without touching her. When she said she was comfortable when we walked into the room. Oy.


WardBunny said...

Poked at a guy's tendon once. Diabetic foot ulcer. He already had one amputation because of it and a week after lost the other leg too.
He's up walking around again on 2 prosthetic legs now though!

I love wound care!

little d, S.N. said...

ugh. you can HAVE it!

M.I.A. said...


I do know for a fact that several of our local hospitals use the MRIs and CT scans at one of the local zoos for people who are that large.

I'm not prejudiced against larger people either, but I'm sorry, how does one allow themselves to become 1/2 a ton?! I understand medical conditions sometimes play a part, but seriously, there is a point where you can no longer point the finger at something/someone else. Put down the cheeseburger and walk around the block!

And, btw, your wording of "infectious goo" have me the heebie jeebies!

little d, S.N. said...

Well I didn't culture it, but I KNOW there were things living in it. Things that potentially have IQs.

undergrad RN said...

our floor's nurse educator is really excited about wound vacs. She apologized for 10 minutes when it was discovered no patients actually need wound vac at the moment. Then she told us repeatedly how awesome it was and promised she'd float us up to a floor that was using it by the end of the semester.