I was thinking today, as I looked at the flattened toes on my patient's left foot, about the powerlessness of words at certain times.
Fortunately, there's a unique vocabulary that goes along with the art and science of caring for the sick and injured.
Heart attack patients "circle the drain."
When the drain is empty, they "code."
Congestive heart failure patients who are in acute distress are "full to the gills," while an equally troubled asthmatic or COPD patient is "tight as a drum."
The ambulance is a "bus,"a significantly hypoglycemic patient is "gorked," and a car rammed high-speed into a tree, trapping its occupants, is a "pin job."
And, of course, limbs that get run over by heavy industrial equipment are "pancaked."
Today's patient is a middle-aged guy who has worked in a factory for 30 years.
"Without an injury," he proudly notes.
"Until today!" we say in unison.
It gets the patient laughing, enough that he cheerfully says that he thinks the injury might help his golf game by forcing him to plant that left foot more.
His toes are flattened into gelatinous stubs.
There is not even the slightest suggestion of boney formations left. It's as if the four toes have become the necks from those steamed clams everyone eats on the Cape each summer, with only the big toe miraculously escaping serious harm.
We splint the limb and give him fentanyl for analgesia, and since we're about 40 minutes by ground from the surgeons who have the only shot at saving what's left of the patient's left foot, we send him by helicopter to save time.
Throughout the whole ordeal our patient stayed calm and kept his sense of humor, no small task for someone who, in an instant, is now forced to perhaps say goodbye to an important piece of anatomy.
This is the second time in a couple of weeks that I've really been impressed with a patient.
In the urban systems in which I work, I've had patients call 911 to get a prescription refilled, or because they're convinced that an ambulance ride means faster service in the ED.
Earlier this year I had one of our frequent fliers call 911 demanding to be brought to the hospital for a pregnancy test.
But patients like today's prove that one piece of vocabulary to describe our patients needs no improvement.
It's quite enough to name it for what it was.
Hoist on His Own Petard
1 week ago