Thursday, November 29, 2012


I did a dumb thing last week. I was playing at my kids' school with them and banged my right foot really badly wearing Wellies. I am too embarrassed to tell you what I did exactly, but it was a bad connection between foot and metal. I limped home slowly and seriously thought I'd broken my right big toe. I broke my left big toe when I was 18, and it felt remarkably similar. I knew my injury was my fault, and I felt stupid. But there wasn't much I could do about it at that point (my family was having too much fun laughing at me to beat myself up any further). Broken or fractured or bruised, oh well. Ice the toe, take Advil, and suck it up. I had good range of motion, so I knew it wasn't worth darkening my MD's door.

It hurt. It was swollen. It got worse, then better-ish. But it was hot and red. Never a good sign.

On Sunday, I worked. It wasn't awesome to have to hustle in the hallways, but I survived. Then Monday morning, when I was watching The Walking Dead  and drinking my coffee, I noticed that the swelling wasn't inflammation swelling: it was abscess swelling. Double gross.

I am a nurse. I prepared my sterile field and lanced the grossness. It was gratifyingly full bacterial effluvia. Problem was that there was involvement of the nail and atrophy of the tissue behind the nail. I knew that the nail had to go, just not when or how. I knew it should probably go soon to prevent more bacterial growth. I was keeping the wound clean and irrigating it with normal saline; I checked in with my ED nurse and MD friends. I had a nightmare about gangrene. I spiked a temp of 100 degrees.

Wednesday morning I called my MD and made an appointment; my regular MD wasn't there, but I was able to see the new physician in the practice, who is wonderful. She read my complicated history and said, on coming into the room, "You've really been through a lot!" I appreciated that. Then she looked at my gross toe, immediately wrote me a prescription for Bactrim to take orally, and declined to take my nail off. She said she'd never done it before, and that I should see a podiatrist ASAP.

The receptionist referred me to a podiatrist (outside of UCSF); I drove home and called the podiatrist's office, explaining my problem and the urgency. I was offered an appointment on December 7th! I said that I needed an appointment sooner, and she said it wasn't possible. I asked her what I should do, then. Go to the ER? She said I should take the December 7th appointment. I asked if she'd ever heard of sepsis. I asked her if she could refer me to another office. She did.

Best thing.

The next office was the most fabulous place! They fit me in immediately, were kind and compassionate, and understood what an abscess was. I checked out the DPM on yelp and she is covered in love. I can add to that.

Anyway, I showed up at my appointment today, and she giggled that the primary care MD didn't want to take off the toenail. It took her 15 seconds, after she numbed me up with lidocaine and put on an awesome makeshift tourniquet made from an exam glove. She showed me where the nerves are in the toe, where best to numb them, and described rookie mistakes in numbing. She teased me about how as an RN I could be masochistic enough to lance myself but not take off the nail. I said that I don't have my own private stash of lidocaine, and we laughed. She was nerdy and excellent! It was all surprisingly anticlimactic.

It felt great until the lidocaine wore off. And now it hurts, but I am sure as the nail bed dries I will feel much better. I will wait a year for my nail to grow back, and in the meantime marvel at my nail-less toe. The human body never ceases to fascinate me.

Far from the Tree has arrived, as well, and I am deep into the first chapter. It is written so engagingly that I hope I can put it down and not read all night.

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