Maggots! I have a love hate relationship with them

Some things are not uncommon where I work.  Up to 40% of the patient population I deal with has diabetes and vascular issues. The smell of rotting flesh goes with the territory.  Here is where the poor folks live. They have very limited access to good healthy food, the kind of food diabetics should be eating and with the per capita gun homicide rate of 25.4 per 100,000, people are afraid of going outside for a run or exercise.

Generations of families rely on public assistance and their health care insurance is through Medicaid and Medicare.  The city has 4 hospitals, but there are limited primary care doctors that take Medicaid, and fewer specialists participate with Medicaid.  In other cities and suburbs you see plenty of doctor offices and doctor practices near hospitals, but not in the poor areas with high gun violence, so people go without.  

One evening a woman came in.  She had the triple threat that is common in our patients: obesity, diabetes and vascular disease.  Her legs had loose dressings that looked like an abstract painting.  There were bits of green, brown, yellow,red and tan, there was no evidence of the white gauze that it started out as.  The EMTs brought her in wearing face masks, so everyone knew it was going to be bad.  But how bad could it be?

My co-worker was the lucky nurse to get this patient.  She was a newer nurse, but well skilled and truly a lovely person.  Out of the corner of my eye I see her running out of the ER towards the ambulance entrance.  I walked out after her to see what was up.  

"I'm going to puke", she said. 

She went on to describe that the woman's bandages were concealing a slew of maggots which where eating her flesh.

Now most people would right away freak out.  Maggots in a hospital.  I know it sounds bad.  Okay in this case it wasn't ideal, but the maggots really were helping.  

In other countries around the world maggots are used to treat diabetic ulcers that won't heal with conventional medicine.  Maggots only eat the rotting flesh which allows the new tissue to grow.  Of course the maggots used for treatment are generally grown under sterile conditions, so yes our ER patient's maggots weren't ideal.

How can this happen you might wonder? Well the patient said she had a nurse come take care of her.  Of course "nurse" is a broad term, read the post about the garlic in the vajayjay, she was a "nurse".  This woman was paying someone from her hood to come take care of her, not an agency, not the VNA, just some girl who she knew.  

When we told he patient about the maggots she was stunned.  See that might shock the reader, "How could she not have known?", well if you are 5 foot 1 inch and weigh 360 pounds, you can't walk, the chances are you aren't bathing everyday and you eventually get use to the smell, she also couldn't see her legs.  

Was there an abundance of flies in her house? Yes, the EMTs said that the house was a mess, but she didn't have anyone who cared.  She finally called 9-1-1 when she couldn't take the pain anymore.  

Perhaps we have the reason why no matter what time of year it is, even when it is snowing outside we still have flies buzzing around the ER.