oopsy does it

sometimes, your foot hurts. a lot. it's swollen, hot to touch, hard to put weight on, and, as a result, hard to walk. so you go to urgent care. you're also intellectually disabled but able to speak for yourself for general needs. your family/aid doesn't accompany you to the visit, which is complex and challenging to explain. they just drop you off at the office. and so begins the story of oopsy poopsy and sweaty farts.

this patient was in his mid-20s, on the l but as he was quick to note, he suffered from an ID. i asked who had brought him; he stated his grandmother and cousin were outside. they told him he would be fine, so he came in alone when they refused to accompany him. he was a larger patient. he was sweaty, fidgeting, and unfocused on the exam chair as i started to get a history. he told me his foot had been hurting for over a week and denied any trauma. 

the oopsy

i asked him to remove his shoe and sock and saw a very red, swollen, and hot-to-touch foot. it was very agitated from the toes to the proximal forefoot, with no obvious skin breaks. the patient suddenly exclaimed as i went back to typing that he had an 'oopsy poopsy' and needed to use the bathroom. he quickly got up and rapidly shuffled out the door.

well, the first thing i noticed was the smell. the second thing was the brown puddle on the exam chair. my brain didn't want to make the connection, but i knew, it knew and i sighed as i went for the sani-cloth. after cleaning the table and redressing it with table paper i went to tell the provider what was happening. i first mentioned the ID, then the 'incident' and then the severity of the look to his foot. we agreed to make it thorough, quick, and medically urgent.

the fartsy

the patient returned to the room, sweatier and now breathing heavy. there was toilet paper in the waistband of his shorts and the smell was amplified. he immediately started to apologize. we let him know it was ok and that our concern was his foot. this was still during mandatory n95 masking guidelines, so the smell had it's edge cut, to a degree. as the provider went to look at the foot, the patient through his hands up. 'wait!' he exlclaimed, followed by a gurgling, wet, 5 second fart and then 'sweaty poops!'

the provider and i just looked at each other and then quickly went back to the foot, 'your foot is very angry right now, it has an infection, but don't get upset; the hospital will fix it up nice and easy! can we call your grandma to tell her she has to take you?' he looked defeated and sad, not because of the foot, but the smell and mess he made, to which i told him 'it's ok! let's talk to grandma and get your foot fixed.' he proceeds to call her from his cell phone and tries to explain. the provider asks to take the phone and tells her what's happening. he told her it was negligent to let him come in alone and let his foot get so severe.

the wipedown

we gave him the paperwork for the hospital. she agreed to drive him immediately. as he left, he was happy again and shouted, 'sorry for the oopsy and the farts; you guys are so cool.'

that room was disinfected rigorously for thirty minutes and quarantined for an hour.

for more information on cellulitis (the infection the patient had; an infection of the skin), check out these resources:

https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762