The Man with a Cut on His Foot

I glanced into the Diarrhea Treatment Room, which had zero diarrhea patients at the moment, and and we started using it room for normal inpatients.

I saw a man who looked about 45 years old. His foot dangled over the side of the bed rail and was ensconced in a translucent plastic bag. I assumed it was a foot wound, maybe a diabetic foot wound, even though I have yet to see one here yet. People do have diabetes but it is less common in the USA. The Burmese tend to have controlled weight, and the main diabetic issues seem to be that they eat a lot of rice and don't have easy access to medication. 

The medic went into the room with me to help interpet. The medic told me, "He has a cut on his foot from playing football."

I went to go investigate the wound, but before I could even see the foot, the medic and patient motioned to the patient's right upper thigh and said he also had something there. 

That's weird, I thought. Maybe a cut on his foot spread up his leg?

Then the patient uncovered his right leg from the waist down and revealed this:

Ok, so a fungating mass? "A tumor?" I asked the medic. No, he said, it is due to a cut on the foot. 

It was oozing clear fluid. It was not malodorous but it looked grotesque. I asked how long his leg was like this, and he said 45 days. 

After further questioning, it turned out that he had indeed cut his foot a while back and thought all of these symptoms stemmed from that. He already had 2 toes amputated and his right foot had chronic wounds. I asked why the foot was in a bag. The bag was lined with condensation and I was concerned about infections developing or worsening.  The medic explained that the foot was oozing so much they had to control it dripping everywhere. 

I asked if he had any paperwork delineating prior studies or diagnoses. The patient's dad produced a sheaf of papers that revealed the patient was actually only 29 years old, and one page had a handwritten radiology report: Epithelioid Carcinoma with mets to lungs and abdomen. 

Yikes.

I asked the dad if the family understood the prognosis and treatment. He said yes, they were going to a hospital in Burma where a non-profit would help with the treatment. The patient needed chemo and radiation. 

This young man's case reminded me that in western medicine, we take for granted that we can get to medical care relatively soon and that conditions will be diagnosed. Whether we can afford treatment is another story. 

But here, I am realizing that people either do not have the means to reach out for diagnosis or treatment or sometimes they just don't know they need diagnosis or treatment until very late.