Sad, Frustrating, GROSS!!!

Two days ago I was working the evening shift. It was a relatively steady evening so I was popping in and out of the wards doing different things when I noticed a patient sitting on the bench in front of the nurses station (which is essentially our ER at night). I went to go see what was up. There was a kiddo about 10 years old sitting in front of the bench. Since I'd say about 97% of our pediatric patients come in with malaria and anemia, when I asked the "Ok, what happened, what brought you here" question, I was expecting what I hear 97% of the time which is "warm body for 3 days" with or without a cough or diarrhea.

Instead, the father went to pull away the lapa (big piece of material) the child was wrapped in....and I couldn't believe it. HUGE chunks of this child's right leg were missing. From mid calf up to the child's buttocks there were huge craters covered with dead skin. The leg was covered in gingin violet which is a common thing to place on wounds here. It actually has bacteriostatic properties (can kill bacteria) so we often prescribe it because it's not going to hurt, it might help, and most importantly it will hopefully prevent any other potentially harmful substance from being applied. The leg also had dried gauze that had adhered to the dead tissue. As soon as I saw all of this, I was immediately angry. One of the most frustrating things about working here is when parents bring their children in so so so so late! When I asked what happened and how long this had been going on, the father told me that he had a "swelling" 2 weeks ago and then this happened.

When I worked in the ER, one of the questions we often had to ask was "how much have you been drinking tonight." An experienced nurse once told me that you have to at least double the amount that the patient tells you. Here, one of the nurses told me that if you ask how long someone has been sick you have to triple it. There's no way that what I was looking at happened in two weeks. So I was angry.

Then as I continued to interview the father, I found that he had actually taken his son to the health center in the area and they had been treating him. Ok, now I'm not so angry at the father....he tried to do the right thing. Now I'm angry at the health center. Clearly, they didn't know what they were doing but didn't refer to a higher level of care. In their defense, health centers are often poorly equipped with supplies and often aren't able to treat what comes to them. However, in this case I got no letter of referral so I can only assume that they were going to continue trying to treat the patient (which CLEARLY wasn't working!) but the father decided it was time to take him somewhere else. Frustrating.

The kiddo had a temp of 103 and was slightly delirious.

My diagnosis for the patient was WTH (what the heck!!!); probable sepsis from wound

What's the diagnosis for the majority of someones leg being rotted off? Seriously, if someone knows what it is, it would be helpful. I've come to recognize the scent of rotting flesh as this is not the first time I've seen something like this here.

Anyway, I admitted the patient, started antibiotics, Tylenol and IV fluids. I debated on trying to get the gauze off but decided to wait until the OR team came in in the morning. This kid needed to be knocked out for what they were going to have to do to debride the wound.

Yesterday as I came into work the OR team was doing the debridement. They had to cut off the majority of the skin on his leg. Aside from a miracle from God, I don't see how this kid is going to make it. We were talking about skin grafts yesterday but weren't sure where to get the skin from. (I wanted to donate myself because A: I have plenty and B: he'd look kind of cool!) but unfortunately it doesn't work that way.

Last night I went in to replace his IV which he'd accidentally pulled out and he was awake and the most lucid that I've seen him. He was acting like a normal, scared 10 year old kid. It broke my heart to think of the painful road he has ahead of him....and whether or not he'll still be alive on the other side. Bleh.

Side note: Since the kiddo was asleep I did take some pictures but have decided that if I posted them my sister would say "Emily!! Social filter!!!" So I'm filtering them but will have copies available for my nursing/friends who like gross stuff when I come home in Dec. :)

If you think about it, pray for this kiddo and his family. Pray that the hospital staff will have wisdom in how best to treat him and that I will know how best to love on he and his family! Thanks!