Im going to call her Mary. I had never met her, which at this point, is odd in itself. I've met almost all of our patients at the clinics, and can usually tell you their first and last names, which pharmacy they use, and if its time for them to come in for their lab work. So that day I was back in the office paying bills, and didn't see Mary come in.
I was called to the very last exam room, Amy wanted me to meet a patient. I walked in to see Mary, a 50 something very normal looking woman in a long-sleeved corral colored shirt and grey shorts. I immediately noticed that she had both of her legs bandaged from the ankles to the knees. We see ALL KINDS of things in the clinics, so I wasn't surprised to see Amy kneeling down next to her with gloves on.
What I did NOT expect, was what I would see when she removed the bandages. Mary's legs were rotting. They were swollen with dozens of large(about the size of limes) deep, open wounds. The kind of wound where you can see the meat. They were full of puss, some bleeding, and all the skin that wasn't eaten away was completely black. Not purple, grey, or red... black.
My first thought was that she would most certainly loose her legs, and I was prepared to immediately leave the room and begin preparing the paper work to admit her to the hospital. At this point, I hadn't really heard anything yet. The sight was so overwhelming, I hadn't bothered to use any of my other senses up to that point. The first thing I recall hearing was "So it was just a bad batch? Yes, whatever they used to cut the heroin was bad."
You see Mary has a heroin habit. Has for the last 22 years. I found this out when she looked at me quite frankly and said, "Well you're getting quite the education aren't you? See what 22 years of heroin will do? If you think this is bad, you should see my ass." She has a $50 dollar a day habit, no health insurance, a steady job, a large circle of friends, and grown children. Her ex-husband got her started after a bad back injury to "help her relax". She was hooked after the first injection. She knew how to clean and dress her own wounds, which antibiotics to get in Mexico, when to start them, and obviously, when it was bad enough she needed to come in to see Amy.
Evidently, when you have a heroin addiction for that long, eventually you run out of good juicy veins, so it is necessary to do a method called "skin popping". It involves injecting the drug just under the skin in an attempt to hit one of the millions of capillaries that lie just beneath the surface. Whatever the drug makers used to "cut" the herion and make it go farther was toxic, and everywhere she injected she got a massive, skin eating infection. She was rather calm about this fact, I guess she realized that this was just the risk of it all.
So Amy changed the antibiotic, gave her some new supplies, and told her to follow up in a few days. I love that our clinics are so non-judgmental, and our patients can come in, be honest about their problems, and get kind and appropriate treatment.
Mary was absolutely pleasant, intelligent, and quite frank, all of which I appreciated. In fact, I liked her very much, and I hope she gets to keep her legs awhile longer...