A few days ago, I admitted a 63-year-old man who also happens to have Down's syndrome. That's right. He's 63. (So do NOT try and tell me that people who have disabilities cannot have long and meaningful lives.) He came in for pneumonia from a residential facility where he lives. (And where apparently he enjoys flirting and hugging all the ladies - or so his mom tells us.)

When I did my initial physical, he did seem to have pneumonia, but I also made a rather stupid mistake. He had a bandage on his foot and the nurse who normally takes care of him told me he had an ulcer there. She didn't make it sound very bad. So since it was bandaged, I didn't feel like spending the extra 15 seconds to take off the bandage and actually look. Two whole days later, after he continued to have problems with low blood pressure, our wound nurse at the hospital took a look.

He had BONE sticking out of his skin. His pressure ulcer had actually eroded down to his BONE. And I didn't look. He's been on very good antibiotics since he came in, and probably couldn't have gone to surgery anyway, but I have been feeling very, very dumb. The orthopedic surgeon who I had to call at 4pm on Friday afternoon also wasn't very happy with me. (Rightfully)

The only good thing about making mistakes is that they allow you to learn. I will NOT be making that mistake again, but I'm sure I'll make plenty of others. Hopefully I can learn from them, too.

Residency lesson #242: Always, always, ALWAYS take off the bandage.


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