Horrible details follow, read only when you’re ready to be touched by someones hurt.
She is 18, she has pus coming out of her mouth. She cant open her mouth because of a muscle spasm called trismus. She is laying in the pre-op area and the whole place smells like horrible pus. She appears to be in pain and has the very sick look to her. Some of you will know what this looks like. She has had dental abscesses for a week or two. They brought her here on a two wheeled push cart. They put the cart “en gaauge” to pay for her medications and treatment. This means they have money coming but that the cart is the security that money is coming. As she lays on her side I push around on her neck and she spits out some more thick pus. She looks swollen like a chipmunk in her cheeks. I feel they are both very soft around the mandible. This pus near her mandible must communicate with her mouth. She is the last surgery of the day and we take her back to the OR beating off the flys that accompany her. Phillippe doesn’t want to give her any anesthetic as he thinks this will kill her. I tend to agree that intubation is impossible, a tracheostomy has killed two patients here that I know of in the fact that they eventually mucus plug and the patient dies of asphyxiation. Ketamine may be risky, I think a little would help. He doesn’t want it and I don’t push.
As I look over her face and neck, I push on the left chin and more thick pus flows out of her ear. WOW!!! This is horrible. I certainly do not think she will live through this. I put in the local anesthetic after prepping her with betadine. I cut in about a cm and don’t get pus like I expected by palpation. So I use a syringue and needle and aspirate deeper. I get air first, and this happens twice. Oh even worse than I had thought. She has gas, necrotizing bacteria. God, I pray out loud, help this girl, heal her God, she will die unless you heal her!! If it is most merciful to let her go, then do it, otherwise heal her!!
I cut deeper and chunks of pus flow out. I put my finger in and feel around the angle of the mandible, and then down her neck. This is a big pocket. I incise the lower part to of the pocket. All of this is causing her pain, and she’s groaning with each push of my finger. I irrigate out the hole with Dakins solution (a dilute bleach solution). MORE pus and blood flows out. I pack both holes and the bleeding subsides some.
The other side I decide to start lower at the angle of the mandible. I inject lidocaine and incise. Pus flows out of the hole Ive made and as I stick my finger in to feel the size and extent of the pus cavity, pus flows out her ear again. So she has pus up the the base of her skull and it’s coming from her inner ear out. I flush and flush this one too. Then I pack it. Her heart rate stays about 140 and has a blood pressure in the 90’s. She got Amp, Gent, and Flagyl. Wish I had some clindamycin.
The nurses take her to the ward where she’ll sleep on the stretcher for the night because there are no beds on the surgical ward available.
GOD HEAL HER! THAT’S HER ONLY CHANCE!
