When I first started working at the hospital in 1999, it never occurred to me that certain odd techniques might be used to remedy extreme ailments. But then, I had also never encountered the horror that is human being either. I was working in the orthopaedic hallway instead of either of the two general medical halls, and the night was going very smoothly indeed. It was an evening of ORIF and I&Ds, and by the gods, it was an evening with coherent patients! After working in the general medical halls, it was a breath of fresh air to not be battling with belligerent and violent elderly folk. That particular evening brought me a man of about 40 years, give or take 5 (it has been awhile and I truly do not remember his precise age). He was pleasant, ‘alert and oriented.’ He was in for a total knee operation, which went well. I scrubbed the iodine from his leg and hips, performed the necessary vital documentation that follows surgery, and my night ended without incident. This man was sent home after a short couple of days.
Something peculiar happened after the man was discharged. At some point following the surgery, the man must have suffered some kind of complete mental breakdown, for two weeks later, he was re-admitted to the hospital… A family member had stopped by his home to see how he was doing, and noted that the house smelled very unpleasant. After a very short time, they realized that it was the man’s leg. After he had arrived home, he had begun to scratch at the surgical site, and by the time this family member had come to visit, his leg had begun to rot. The whole house smelled of rotten meat. And so this man was re-admitted to the hospital, though upon re-admission he seemed perfectly coherent. His leg was examined by both a physician and an orthopaedic surgeon, and it was determined that his leg would have to be removed (an AKA- above the knee amputation). Now, people who are in their ‘right-mind’ are by law able to make their own medical decisions. This man refused the amputation. The doctors tried to convince him otherwise- the necrotic tissue will spread up into his torso, potentially damaging vital tissues, and he could easily end up dead without the operation. The man refused. After several meetings, the doctors re-approached the man and told him that the only other viable solution would be to employ maggot therapy. They would surgically place 100 (or was it 200?) miniscule maggots into the wound and let them eat away all the dead tissue. It was either that or the AKA. The maggot therapy was chosen and the man went away to surgery. Hours later, he returned to the floor and was placed in an isolation room, less for infectious reasons than for the unpleasantness of his operation. With him, I performed my normal routines- vital signs, customer service, companionship, documentation, removal of wastes, IV inspections, etc. etc. It was marvelous- as the maggots ate him, they grew bigger, and you could see them squirming about under a thin layer of gauze over his knee. Just before dinner-time (I was working afternoon shift this particular day), I went in to ask him if he was hungry, and was forced by some invisible hand to halt in the doorway. He was sitting on his bed, cross-legged, scratching furiously at his knee. He had torn the gauze off and there were maggots on his sheets. He was grabbing them and rubbing them in his hair- he was eating them, and again scratching. His wound had started to bleed profusely and I almost could not move. By Zeus, the anticipation and horror of it was wonderful. As soon as I regained my composure, I immediately contacted his nurse who turned a shade of pale green as soon as she entered the isolation room. It became my task to try to gather as many of the maggots as possible before the surgeon arrived on the floor, so I began to collect them off of the floor, the sheets, his hospital gown, and so on. They were collected into a sterile cup ordinarily used for urine or fecal samples- and occasionally emesis. The surgeon arrived and immediately ordered an AKA. He was whisked away to OR. When he arrived on the floor again after surgery, he was sans the right leg, and sedated beyond the point of any type of communication. His vitals were good, but if I remember right, his blood pressure was a little low. His chart read that only about 2/3 of the maggots were accounted for. Those were the days.