The kid with the amputated foot

I had a weird dream yesterday . One of those dreams that resemble medical dramas , u know ? , something like ( Grey's anatomy ) or ( House MD ) . It has been ages since I last dreamt such dreams , I guess it has something to do with visiting Grandma yesterday . U know ? , getting back to the hospital and sick people environment after a 4 months terribly needed break !



I dreamt tat I was working in a small urban clinic , one of those clinics that has limited facilities , that attract healthy people more often than sick ones . when one lady walked in with her 6 or 7 years old boy . She said he was febrile and that his fever is round 38 or so . I asked if he had any other symptoms like cough , runny nose , ear pain , headache , rash . But she denied . The kid sounded pretty well and interactive . I greeted him & talked a bit  before placing him on the examination couch and start examming him . Routinely I started with the head checking the eyes,  nose , the throat, then the lymph nodes , then the ears . All normal !



Then the chest , clear , equal air entries ,. the heart normal first and second heart sounds nothing to worry about . the abdomen totally fine ! ..then shifted to the legs to continue the examination . He was wearing socks , I took them off  and there was the big SHOCK ! , an amputated left foot at the level of the metatrasals , means all toes of the left foot were gone !



I was horrified , look at the mother questioning , she said it happened about a week ago by a brick that fell on his foot . I was thinking how on earth could a brick fall on a 6 years old foot , wasn’t anyone paying attention ? , and why didn’t she mention it earlier , it wasn’t something to pass someone's mind ? . My mind couldn't absorb it and it went turning on the alarm : ( CHILD ABUSE !...CHILD ABUSE ! )



I started examming the stump, applying all what we learned about wound examination in surgery rotations . The wound was clean , well healed , no signs of infection , no discharge . It looked like it was done by a skilled surgeon , but still to think of it and the 6 year old was terrible !



I thought what to do next ? , the kid is febrile , no focus of infection elsewhere , could it be the wound ? , but it looked pretty healthy . The mother said they didn’t see a physician since the injury that happened a week ago ( don’t ask me how could it be so healthy and well healed in one week ? , it’s just a dream remember ? )



I thought of the blood pressure ( the kid wasn’t bleeding , but I still couldn’t ignore it in the chaos of the situation ) . Antibiotics ? , well he need it ? , should we give orally or I.V ( through veins ) .



Then I started rationalizing , fever = 38 degrees = bacteria in the blood = infection somewhere +  this history was suspicious enough  . IV cant harm anyone ..so IV be it . But what antibiotics ? , cefroxime 1.5 gm / 8 hourly + metronidazole 500 mg / 8 hourly , came the fast answer  !! …I read that few days ago while revisisng surgery . and it went on repeating itself in the pre – operative management of appendectomy , biliray surgery , colorectalsurgery ..etc etc , I think these are the only 2 antibiotics surgeons know of , after all they always liked it the easy way .



Then what next ? , referral ofcourse !!...but to whom ? , General surgeon ? , plastic or orthopedic surgeon ?



Time to consult with the senior , who was unexpectedly more freaked out than I was , he went on saying that we can't manage it in here , the kid has to be sent to the AE , he also went on asking the mother , why did she bring him here ? , that we hadn’t the facility to manage and stuff  . I was trying to say that it wasn’t as bad as he thought , the kid wasn’t bleeding , and the wound was well healed . But who was i to listen to ? , so he went on shouting for an ambulance to be sent over .



Hmmm …weird dream ha ? , l0o0o0o0ol , this is what happenes when u get into medical school , ur peers keep on dreaming about their wedding day ,  shopping or having fun , and u keep dreaming about exams , the scenes u saw at the ER , ICU woest case scenarios , and last but not the least management plans of a metatarsal amputation in a 6 years old foot !!  * sigh *