Monday, April 18, 2011

not that kind of plumbing....

26 year old patient walked in today, mentioned he had something "down there" that hurt very much for 3 days, and wanted me to take a peek. As a rule, I never refuse to look at genital lesions and simply re-schedule, even in urgent care, no one wants to miss a new case of HSV that can quickly response to antiviral treatment.... and no poor soul wants to wait even 12 more hours before at least a presumptive diagnosis and routine STD testing is offered.  Apologetically, this patient lowered his drawers, while explaining "I put some tape where it hurts so it wouldn't rub on my shorts...."

Low and behold... in all its glory, silver duct tape wrapped from pubis through perineum.... I truly thought this   guy would demonstrate a self-Brazilian just short of castration during removal of the 10 inch strip of duct tape stuck to his nether regions....

Due to application of super-sticky-duct-tape.... any previous appearance of the painful "area" was now obsured by a hyperpigmented slightly greenish color that left this NP dumbfounded. A consult with friendly physician later, and we were both stumped... threw some septra and clotrimazole at the offending "lesion" and I kindly offered up some telfa pads and paper tape for any further "chafing" needs...

final diagnosis TBD.... (threw in routine STD screening for kicks).

Moral of the story; just because it duct tape is good for most things doesn't mean it's good for EVERYTHING.... no, really!

Wednesday, April 13, 2011


First week on new job in urban community clinic... reception alerts me at 4 pm that there is a patient in the hall way crying.  Broken down in a sad corner of the waiting room, I find "Jane".... obviously in a state of heroin withdrawal disarray, curled into a sad little tear filled ball.  I carefully lead Jane to the nursing office for assessment.

 Turns out this lucky lady is presenting with one huge abscess, worthy of incision and drainage and regular wound care follow up. Good thing that in this urban neighborhood, there is a public outpatient clinic catering to just such skin care services. "Great, this will be easy", I think to referral later, and she can walk in tomorrow morning at the outpatient wound clinic.....

Jane needs ID in order to register as a patient, her only ID is a birth certificate which she cannot find, thus, I begin to aid her in the search for said certificate.  A fascinating experience ensued; if you have never seen the contents of a homeless junkie's backpack,  I highly recommend it.  Amongst newspapers and a hooded sweatshirt of questionable cleanliness were unique talismans, random bits of paper, a few religious iconic cards, and one crumpled, stained birth certificate!  I leave the room, birth certificate in hand to register and refer, with a plan to give some IM antibiotics to stave away the infection until surgical attention tomorrow morning.

Upon returning to the room, Jane has "perked up" quite a bit... enough, in fact, to have taken advantage of all the hospitality an exam room can offer.  I find her standing in front of the sink, her gaunt silhouette accented by fluorescent lighting, and not a SCRAP of clothes on her buck naked body.  She smiles at me confidently while returning to the task of scrubbing her dress in the sink.

Sigh... although this NP appreciates good hygiene, a pre-laundry plan includes  an extra set of clothing, or at least a robe or towel... none of which the patient had thought through prior to plunging said dress into hand sink and dousing with several vigorous pumps of hand soap.

What to do.....?

Several phone calls to shelters, clinics, and homeless resource programs later..... no clothes to be had.  A few minutes later, one kind security guard offered a clean pair of boxers from his locker... bottom of "situation" covered.

 Jane has the final solution.... "I have a hooded sweatshirt that covers the top... it's almost like a dress because I'm so tiny, and anyway, my legs are my biggest asset"... a sweet shot of Rocephin later, a boxer/hooded sweatshirt clad Jane, headed out the door red biohazard laundry bag in one hand, and referral in the other...."biggest assets" in full display as she pranced through the parking lot.