Clinical Week 6/Last Clinical of 1st Rotation

I survived my first clinical rotation! And it ended with a difficult patient...

My patient this week had a whole host issues - which was, of course, sad for him, but good for me because I actually started administering meds this week. (I passed the med math exam on the second try). He was on 23 different meds, so I got a lot of practice, including some injections (insulin and heparin) but his main issue was bilateral foot amputations. He was diabetic and had periperal vascular disease which resulted in his not being able to feel his toes. And because he is also blind, he could not see that his toes were black and blue. So, they had to cut off all of his toes a few months ago. Then, he went home and was bedridden, without proper home care, so his wounds from the amputations did not heal. In fact, his feet became necrotic (all the tissue died) ---> this is also sometimes called gangrene, and so he is now scheduled for both of his feet to be amputated at the ankle, or maybe even below the knee. I had to change his wound dressings, and this was no small feat because they were "packed" wounds. Packed wounds are like holes in the body that are stuffed with gauze and then wrapped. My job was to pull all of that gauze out, inspect the hole and clean it, then repack and wrap it. It is not something you ever want to see. But, what's worse is the smell. It is the smell of necrotic (rotting) flesh. If you ever smell it, you will NEVER, EVER forget it. My preceptor coached me through the whole thing, telling me to open my mouth to breath, but I couldn't because I just didn't want to taste that smell...if that makes sense? We were low to the floor at the foot of the bed when doing the dressing change, and she told me to actually get down on my knees (as she had done) as an attempt to stay steady and not fall back, away from the wound, which is what your body wants to do. She reminded me to take a second to look at the floor to keep from showing the patient all those rude faces one makes when a smell assaults your nostrils. It was also the first time I had to practice sterile technique, so it took a very long time to complete the task because the first time you do it, it's hard to maintain a sterile field!

If you want to see what I was looking at (or as close a picture I can find), click below. The differences were that my patient had no toes, and the wound was a little deeper/more of a hole.

Big picture
or Webpage (see middle picture)