Oooo oooooh, that smell
He was blind from long-standing poorly-controlled diabetes, but he continued to keep his hemodialysis appointments faithfully. Minus one leg, he was able to ambulate with his prosthesis, although frequently his traumatized stump swelled up, so he used crutches as often as not. Not that it hurt. He had long ago lost the sensation in his legs. He just couldn't get the stump to fit in the old cuff. He was "waiting on a new one." But that wasn't his complaint today.
"Something stinks, doc. That isn't me is it?"
His "good leg" was now gangrenous and festering, and nobody had noticed. He only knew that something stunk, and the smell followed him everywhere.
She was a proud but quiet woman from South of the border, and she spoke not a word of English. Her family brought her to the ER because she was "getting weaker" and had a foul odor about her. Probably a UTI, I thought. We'll need her to change into a gown so I can examine her, I told her daughter. My Spanish was not so good in those days, and I was relieved to have a family member who could translate for me.
I stepped outside to give her privacy while she changed, and I had barely closed the door when I heard a yell from inside the room. "Doctor!" My first thought was that she had fallen. I rushed inside the room to see the woman with her head bowed and her daughter with a frightened expression. "Mira!"
The woman raised her blouse to reveal a necrotic, foul-smelling tumor the size of a grapefruit which replaced her left breast. She had never told anyone about it because she was embarrassed.
"Something stinks, doc. That isn't me is it?"
His "good leg" was now gangrenous and festering, and nobody had noticed. He only knew that something stunk, and the smell followed him everywhere.
She was a proud but quiet woman from South of the border, and she spoke not a word of English. Her family brought her to the ER because she was "getting weaker" and had a foul odor about her. Probably a UTI, I thought. We'll need her to change into a gown so I can examine her, I told her daughter. My Spanish was not so good in those days, and I was relieved to have a family member who could translate for me.
I stepped outside to give her privacy while she changed, and I had barely closed the door when I heard a yell from inside the room. "Doctor!" My first thought was that she had fallen. I rushed inside the room to see the woman with her head bowed and her daughter with a frightened expression. "Mira!"
The woman raised her blouse to reveal a necrotic, foul-smelling tumor the size of a grapefruit which replaced her left breast. She had never told anyone about it because she was embarrassed.
posted by scalpel at 4:06 AM
3 Comments:
ooooooh denial! its not just a river.
It's an under-recognized part of practice: recognizing smells. The stink of necrotic foot in a diabetic... awful, and diagnostic.
I had a similar lady patient, once. A bank teller. Fastitidous and prim, an older lady with perfectly coiffed hair, pressed white collar on a dark blouse. And a breast cancer eroded widely through her skin, into which she'd been stuffing kleenex for god knows how long.
Ummmmm, yes, LOVE olfactory diagnosis. How about the third day (which is when they usually seem to hit the clinic door) of a toddler with a round plastic bead up his nose?
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