Current Rotation: Infectious Disease

Finally, my first love!!!

You start an infectious disease rotation and you think you'll see some osteomyelitis, some abscesses, HIV/AIDS, and maybe you'll get lucky and get an atypical pneumonia or a tricky antibiotics management issue. Have some intelligent discussions about vaccination and epidemiology and discuss whether being an EIS officer is worth living in Atlanta.

You don't expect to see penises.
And if you do, you expect to see your common STIs: gonorrhea, chlamydia, herpes. Syphilis would be on the exciting and unusual end of the spectrum.

But what you DO NOT expect to see is a penis status-post hemipenectomy. Yes, that's right: a penis after the tip-half has been surgically removed.

This man, my patient, has schizophrenia and is on many medications for it. One of them causes priapism, which he unfortunately experienced. He essentially got compartment syndrome of his genitals; they swelled up and cut off his blood circulation. He didn't really do anything about it because he has poorly-controlled schizophrenia. It then developed into gangrene -- wet gangrene all over his testicles and most of his penis, and dry gangrene at the tip (aka, Fournier's gangrene). The result was a need for surgical debridement of his entire groin and a hemipenectomy.

All of that sounds horrible, right? Yeah, it was enough to make my jaw drop, too. But do you know what is a million times worse than hearing that story?

SEEING the result. That image will be burned into my brain forever. Imagine, if you will, someone with all of the skin removed from his testicles. Then imagine a little stump poking out of his body that represents what is left of of his penis. It has a catheter protruding from it, but you really can't tell how they figured out where to put the catheter in the first place because it's just a big mass of wet flesh.

He had plastic surgery today to get a skin graft placed over his groin; I'll get to see the results tomorrow and will report back to you.

(And oh yeah; ID was only consulted because of the gangrene issue. His cultures only grew enterococcus, which is unusual to have caused gangrene. He's on a single antibiotic. Boring.)

The other unexpected thing I saw when I started the service yesterday was a kid who was in a car accident back in September and has been a vegetable ever since. Two things are of interest in this story: His current physical appearance and the story of his car accident.

First, his physical appearance. He was ejected from the car and had so much brain swelling that they had to perform a craniectomy. They took out a chunk of the left side of his skull and sewed the skin back down over it, so when you look at him, it looks like a huge chunk of the left side of his head is missing. It's quite disconcerting to see -- it looks like it's part of his brain that's missing, the indentation goes so deep, but it's really just an illusion.

So here's the story: This 20-year-old kid and his girlfriend were having sex in the car. While it was moving. His friend was driving. His friend got -- surprise, surprise -- distracted, and lost control of the car. He was ejected, and now he's a vegetable. From what I understand, his neurological status is not expected to improve. What a way to go, huh?

(Oh yeah, the reason for the ID consult: possible pneumonia. Except he's "satting" 100% on his t-piece and has perfectly clear lungs. Not on any antibiotics. Boring.)

I guess it's more exciting than abscesses, but it's definitely not what I expected!