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The Rustling Beneath The Sheets

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“Sean, you have a new patient in Room 8…and there is something moving under the sheets,” stated the Nurse. I noticed she looked quite pale. I paused…”Okaaaay…..did you say something moving beneath the sheets?” “Yes,” she replied. “Do you know what it was,” I asked? “No but they were large, there were a lot of them, and they were moving….” “Did you look,” I asked with a look of bewilderment, and astonishment. “Hellllll no,” she responded.

I picked up my patient’s chart: “Leg Wound” was the chief complaint. His vitals looked fine, no fever. I reluctantly headed towards his room. My mind was already racing with thoughts of what was hiding under the sheets-a rat, a small reptile, was it a mound of Maggots? He does have a leg wound… I have seen wounds become infected with maggots before, which in reality is not an all together bad thing (they clean the wound of dead tissue)…but it does bring forth memories of a cheap horror story. I turned around to see 2 nurses following me into the room-moral support.

As I entered the room, it was dark, with only one overhead light turned on. The patient, a gaunt, toothless soul, with deep set eyes, a barbed chin, and an ashen face, lay bundled beneath pristine white sheets. David was 40 years old, homeless, and seemed in good spirits. As soon as my mind made a mental annotation of what lay before me, the stench of rotten meat arose from his cocoon. He gave me a gummy grin, and said “Howdy Doc!” “Hey there David,” I replied. “What brings you in today? “, I asked matter of factly. “I got this thing on my leg….” A pause, no other information. “”What kind of thing,” I asked? Here we go; it has to be a rat, or a large something attached to his leg. Maybe it is gnawing at his leg. I had it in my head that when I turned back the sheets, there would be at least 2-3 medium sized Iguanas, feeding on the flesh of his leg.

“It is a hole,” David replied. I breathed a sigh of relief….a hole. OK, no problem…..wait a second, a lot of things can live in a hole. “A hole,” I asked with emphasis. “Yeah, a large hole….here look….” “No, no. no,” I replied holding the sheets down as he tried to throw them off. I was not prepared for a quick flash…this needed to be a s-l-o-w turndown. Just then I heard, and felt the rustle beneath the sheets. Scratching, a lumpy movement over the area of what should have been his right thigh. I heard the nurse let out a “peep,” more like a “mmmeeeep.” The other nurse just twitched a little. I just about messed myself. This was the real deal; there was something, and many of them beneath those virgin sheets. We maintained our professionalism. David was completely un-phased.

“OK, it’s show time,” I thought, time to turn down the sheets….I slowly lowered the sheets, exposing his bare boned chest, depressed abdomen and pelvis, his right leg came into view: I saw a large hole, gnarled, exposed flesh and muscle on top of his thigh….the smell was overwhelming. I saw the movement, glistening….inside the hole….suddenly they saw the light and….RAN. “AHHHHHH!!!!!” The Nurses both screamed bloody murder; I let out a feeble gasp as every hair stood on end ….10-15…1” cockroaches made a break for it. They scampered over the sheets, up David’s chest, over his legs. They seemed to pour out of the wound, they fell onto the floor, instantaneously scurrying in every direction. The Nurses jumped, I see one hop onto the counter. A janitor runs in, alarmed by the ruckus, and starts herding the roaches with his broom… “Ohhhh, look at that! Where’d these guys come from?”

The hole was still filled with a dozen “baby” roaches, squirming around on his exposed thigh bone. David had one of the largest leg wounds I have ever seen, and it was filled with roaches. His leg was mostly without feeling, he was mostly bed-ridden, and the roaches had taken up residence.

“How long have you had this David,” I asked? “I don’t know….maybe a couple of years…” he replied. David is a heroin addict, and had resorted to pumping his muscles full of heroin when his veins became too scared to use. He had the largest “shooters abscess” I have ever seen. Formed by years of injecting the toxic blend of heroin, and God knows whatever else was mixed with it, into his thigh, bacteria and infection slowly eroded his thigh. The hole was about 8 inches by 4 inches, and formed a perfect funnel down through his skin, fat, and muscle. The base was his femur, or thigh bone.

After the roaches were cleaned out of the wound, we could focus on debriding the dead tissue, and irrigating the massive hole. David was admitted to the hospital for antibiotics, fluids for dehydration, and a large “wound vacuum” was placed on his thigh (a sterile, wound cover which continuously sucks air and fluid out of the wound). The plastic surgeons were still evaluating him to devise a way to try to cover the wound….they were not sure if they were going to be able to. He may lose his leg. David is going to be in the hospital, and a rehabilitation unit, for a very long time.

David weighed 110 pounds, he had a small crater in his right leg that was filled with a roaches nest, and he still was caught multiple times with friends trying to sneak drugs into his hospital room. I thought I had seen it all. I thought I knew how bad drugs were.
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The Stanford Emergency Room is the center of emergency care at Stanford University.

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