Lethal Cascade

A physician's anguish over having set in motion a series of events which, despite good intentions, result in the iatrogenic death of a patient.

His feet. That's the reason I saw him. They were impressive enough; smelly, swollen, red, pitted, and scaly. Pieces of dirty sock were imbedded in the skin, and cheesy material oozed from between the toes. They stuck out from beneath the sheets and hung over the edge of the stretcher like beacons. They reminded me of pictures of dead people I'd seen in news magazines, but these feet were moving. The toes circumscribed slow arcs back and forth, in time with his groans.

I looked at the ED triage sheet. His vital signs were normal. The chief complaint was listed simply as “bad feet”. Understatement is often the rule in the medical record. Actually these were “incredibly, stupendously bad feet”.

Naturally, the first impulse was to examine them. As I introduced myself and bent to look closer, he yelled at me, “Don't touch them feet!” In all honesty, without gloves, I had no intention of touching them. “They hurt bad,” he said.

Once you got beyond his feet, he was impressive anyway; older, but impossible to say how old, and encrusted with …