Wednesday, October 10, 2007

21st century festering wounds

Samuel Vespucci walked into his doctor's office. Dreading yet another visit but knowing he would die if he missed his appointment, he tapped his feet anxiously in the waiting room.

Despite the fear, there was a methodical feeling to the occasion. He knew the drill by heart now. So rote, but so unbelievably searing, like each time in the past, he filled out the forms. Sure, this time they were 20 minutes late, but the same sights and smells pervaded the room.

And when I bring up smells, I should state here and state it clear: the air was putrid with decay. For you see, Samuel was suffering from a persistent bacterial infection. Only a scientist like myself could call out loudly and say, "Yep, that is E. Coli!", with a twisted trill of triumph in my voice.

Believe, me, that's my usual response when I smell bacteria. However, when I met him some weeks after this hospital visit, there was something more pressing to first note and then subsequently cast as far out of my mind as conceivable, and that was because of the way the air was heavy with the aroma of death.

But, as usual, I am getting ahead of myself. For my role does not enter this story at this point in the space-time continuum.

He walked into the doctor's office, let the nurse measure his blood pressure and take other vitals. Same as it ever was, nothing was wrong, except for the huge pus-filled gash in his body. Of course, that meant that everything was wrong.

Prone to sepsis, Mr. Vespucci clung between the precipice of relative health and fevers full of sweat and delusional dreams that could only be dispelled by extreme doses of antibiotics.

He had had 4 near death experiences, and the fevers kept spiking dangerously close to temperatures that could damage his mind. But things had changed; the situation was even worse.

Uncomfortable in his gown, Mr. Vespucci's attending doctor finally entered the waiting room. Sweat dripping from his brow as he anticipated the inevitable, Samuel felt even more disturbed watching the young resident look back and forth from the charts.

"Um, yeah...Mr. Vespucci, I am Doctor Rothfuchs. It's a pleasure to finally meet you--I see from your file that you are suffering from persistent bacterial infections with significant subinguinal lymph node involvement. As you well know, clonotypic analysis of this particular strain has revealed a fascinating mutation in the large ribosomal subunit of your E. Coli, which renders this specific isolate impervious to any sort of antibiotic-based therapeutic. I hear we may name this subspecies E. Coli Vespucciensis, and it may lead to our hospital being mentioned on the news!"

But that was neither here nor there to one dying man. It was the procedure, and the procedure alone that carried any value to Sam Vespucci.

"Yes, yes, I have heard this all before. Please spare me the details," grumbled Sam. "Let's get on to the treatment."

"Ok, yes, fine, fine--I have never seen your wound before. Can you lift up your gown so that I can begin the procedure?"

The resident's voice wavered in pitch, tone, and rhythm, as Sam's arm reached to open the bottom part of his gown. Removing a makeshift bandage revealed that across the outside part of his right thigh was a seven inch gash in the shape of an oval. It was 2 inches deep, and resembled a stagnant pond covered in a film of moss. Only this film was no green goop---it was a macabre mixture of pus, bacteria, and blood.

Overwhelmed, Dr. Rothfuchs staggered back, and stifled the desire to cough as he looked away and sighed deeply. Of course, sighing deeply was the last thing he needed, as the smell of the wound wafted even more strongly with the wound exposed.

"Sorry, sorry. I had tried to prepare myself, but it was more than I had expected. I am really hopeful that this is the last round of this therapy."

Of course, Sam wasn't--and he had heard other residents say the thing enough times to know that to be dubious.

And with that, Dr. Rothfuchs proceeded to open a large pouchlike bag, which contained a jar of bluish fluid and a large contraption that resembled a q-tip, except for the fact that it was 2 feet long.

"I'm sorry to have to do this, but this is the only way we can kill this strain of bacteria."

While Sam Vespucci and Dr. Rothfuchs knew what was coming, a person who was unlucky enough to have stumbled upon this procedure would have been incredulous that such a treatment was considered humane in the 21st century.

Sam had laid himself down on the examining table, hands feverishly gripping the sides, as Dr. Rothfuchs washed the wound with the blue fluid (which was a combination of soaps and alcohols) and dug deep into the wound with the large swab. He grit his teeth as the procedure went on, and some 15 minutes later, the cleaning apparatus was filth laden, while Mr. Vespucci's leg resembled your garden variety red seen at the butcher's market. Dr. Rothfuchs lay a new set of gauze on the wound, taped it up, and shook Sam's hand. He was pale, had shed some tears, but was still breathing. After all, this was the 12th time he had had this procedure performed.

"I really wish there could be some way for this wound to resolve and heal so that we could stop this regimen, but for whatever reason it looks just as fresh as it did on the day of your accident. Of course, our research department is still looking into all possible mutations that could have arisen. As you may know, Mr. Vespucci, this is a difficult search, as hundreds of genes and many cell types are essential for the coordinated process of wound healing. From fibroblasts to fibrinogen......"----but Dr. Rothfuchs was cut short.

"Listen Doc, you have to understand---if this doesn't get better within a few months, I just, I mean, I don't know if I can take it much longer." Hobbling out of the room, Samuel Vespucci said goodbye to the familiar faces, but could not look his familiar pain in the face.

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