Adventures in Gen Med
With this post I do rather hope to inject a bit of humor into our learning environment and potentially spark some discussion regarding patient populations, socioeconomic factors that may affect our practices, and whatever else we find relevant, interesting, or chuckle worthy.
Case I - A Big Pizza Pie
A student-athlete of mine who had expressed a real desire to train for the following years football season with our offseason strength and conditioning program was missing, for multiple days, from the allotted time and did not appear to be at school. When I inquired about his absence I was informed that an administrator was, at that very moment, part of a welfare check regarding this particular individual. When I followed up with the administrator I was informed that the young man had become quite ill. Apparently, after waking up sometime after the witching hour a few days prior he had proceeded to consume an entire, extra large, uncooked take and bake pizza. While this had little direct consequence to my athletic training practice, it seems to merit mention.
Case II - "Trust me it's just a spider bite"
Day 1: Having been absent from my facility for a few days I returned to a 9th-grade female student-athlete asking me to 'look at her leg'. Amazingly this request was, for once, quite literally accurate. One glance at her profoundly inflamed ankle, inability to dorsiflex, plantarflex, or fully weight bear, and the 1.5cm centrally located scab had my brain immediately shouting staph, necrotizing strep, or brown recluse, non of which are exceptional options given the apparent stage of her condition. I asked her when this had begun and she proclaimed '4 days ago, I think it's a spider bite, we have black widows and brown recluse all over my house, so can I practice?' My response was a likely rather obvious "no, you are to go directly to the physician after school, I will talk to coach. I will be quite upset if I see you at practice." After some argument about how she was supposed to arrive at the doctors office, I reminded her that her town has an outreach clinic downtown. Her response "Oh I live right across the street from there!" I reiterated that she was not allowed to practice and absolutely must get medical clearance prior to returning, shook my head, returned to my office and though I had not come within several feet of the patient washed my hands.
Day 2: The following day she reported, still unable to functionally walk and without documentation, to my office with a sharpie drawn circle around the most inflamed area, the central point of her infection, and proclaimed that "the Dr. didn't know what it was so they took a sample and put me on a couple different antibiotics, can I practice?" Again my reply was "No and I would prefer it if you stayed away from your teammates please. Also, why is it not covered? You are just letting it rub inside your boot? Come in here, with your hands in the air, and sit on my treatment table. Don't touch anything." I dressed the area, cleaned every surface in my office with cavicide and washed my recently de-gloved hands.
Day 3: While I still did not have documentation I was informed by the front office secretary that the school nurse had examined the patients leg and was concerned that she may have MRSA. I was also informed by the patient and front office secretary that, prior to my arrival, the patient had been kicked in the leg at which time a large amount of puss had been produced. The secretary had attempted to dress the wound. I followed up with the patient, redressed the wound, informed her that she was most certainly not allowed to practice given the suspicions of the school nurse and my lack of any medical documentation. This was greeted with a rather annoyed "I promise it is just a spider bite".
Day 4 and 5: Still no documentation despite the angry insistence that "it is just a spider bite, I promise", and the patient's progress in having a visible ankle, as well as her improved ability to walk, she was still absolutely not allowed to practice. After another conversation with the coach, a rather expletive-filled (his not mine) phone conversation with her father and a fax from her medical provider, she had been cleared to return to practice with what was absolutely not 'just a spider bite', and also not MRSA, just run of the mill staph.
Case III - "Hey Dex, maybe you should check out my shin"
I arrived at the batting cage to find my best plate protector, a senior, in jeans and cowboy boots taking batting practice. I inquired about his attire after he had exited the cage and he smiled informing me that he had ridden his dirtbike to practice. His expression then changed, as if he had just had a profound 'ah ha' moment. "Hey Dex" he said, "maybe you should check out my shin" while pointing at a fist sized area of blood soaking his pant leg midway down his tibia. "I caught a peg, it's not that bad I guess, but it kinda hurts a bit." My reply, "Coach, I'm going to go clean up his leg". When we arrived in the AT Facility the patient changed into basketball shorts revealing a rather large amount of dried blood and leg hair matted around his tibia. "I think I missed the bone" he proclaimed. After one of my athletic training students cleaned up the area around the wound, I moved in for a closer look. While approximating the tissue in an attempt to gauge the depth and nature of the wound, he had in fact missed the bone, blood began to ooze from an area much deeper than I had anticipated. We dressed the wound and referred him to the local clinic for evaluation and potential suturing. Much to my surprise he reported to the AT facility the following day with a fresh dressing, a prescription for antibiotics, and no sutures. This has proven to be a valuable lesson in wound care for my students as we continued to bandage him while he bled through dressings and pairs of baseball pants in the the week that followed.
I hope you enjoy my recent adventures in gen med and wound care, I know I have.