Estoy sin palabras.

 I sat trying to dictate what I had just seen. What I had just done. And found myself at a loss for words. There was no official medical term for what I was trying to describe, so was struggling to make my explanation sound official. 

I had been on call and making my way through the list of surgeries that had to get done for the day. This particular case was booked as an Incision and Drainage of a right arm abscess. The patient himself.... not the brightest of fellows as despite strict instruction to not eat anything, had somehow gotten ahold of food. Which moved his case to the end of the line-up and brought us up to about 2am. He had a history of IV drug abuse, with concern for needle being lost in his arm, leading to infection, and bring him to our operating room. I've performed I&D's for similar situations multiple times in the past so honestly, was not quite expecting what I found. The patient had already undergone 2 I&D's on his arm at another hospital prior to coming to us. But when I took down his bandages, I found pus pouring out of his open incisions from those past I&D's. I always feel silly prepping something that is so grossly infected, but I went through the actions nonetheless and dumped on the betadine, skipping the washing part and going straight to the painting part. On exploration of the wounds, the patient's tissues literally would disintegrate between my fingers. I'd probe along the fascial planes and feel the tissues melt allowing more and more pus to escape. I keep going, opening the wounds even wider, looking for any sign of healthy tissue. I could grab chunks of muscle and it would break off in my hand, dead and disintegrating from such horrid infection. Sticking to the basics, which when dealing with such necrotizing soft tissue infection, is wide and aggressive debridement, I kept going until I stopped finding new pockets of pus and I hit tissues that pushed back. I left drains through multiple of the tunnels I had created to prevent any pockets from reforming and blasted the whole arm with pulse lavage, and lots of it. And as I packed the wounds now gaping and bleeding, I kept having to ask for another roll of packing, the defect swallowing up roll after roll.  

I am forever amazed at what our bodies are capable of bearing. What damage we are capable of bringing on ourselves. And I wonder just what pestilences I shall yet see before it ceases to amaze me. I am both thankful and fear I shall never cease to be amazed. 

Much Love and Prayers.