I survived an attack & the ER.

On Monday, May the 4th, 2015, I stopped in to visit a friend. There was a large dog barking very aggressively at me through the window. My friend is a widow with 2 daughters; she has had to take in a tenant to keep her house. The tenant’s dog was the one being aggressive. My friend’s daughter removed the dog from the office and he continued to bark from behind a French door, for about 5 minutes, then got quiet.

My friend assumed that someone had locked the large Shepherd/Lab away, because he was quiet. Her dog, a lovely large Rottweiler, came to greet me and was super friendly. I smelled like work, I’m a veterinarian, so she was quite interested in me and was also taken out of the office.

We visited for about half an hour and I asked to use a washroom – big mistake. The second the French door was opened, the dog who had been aggressively barking when I knocked at the door, rushed in and grabbed my lower left leg. I was wearing black pants, the dog was black, and the corner of the room I was in was dimly lit. The family could not see that the dog was actually biting me.

I sternly keep repeating, “Get him OFF of me, get HIM OFF of me, get him OFF of me.” My friend is about 95 pounds and the dog looked to be over a hundred pounds (adrenaline was high, so I may be overstating his size). She and her daughter were trying to pull him off. He had his teeth sunk deep into my leg for at least 10 seconds and was nearing the bone, so I then, in a much sterner voice said, “He is biting my leg and shredding my flesh – GET HIM OFF!”

They pulled him back once, and he immediately grabbed my right lower leg. I was about 10 seconds from grabbing his left ear with my left hand and shoving his nose with my right hand, to separate his skull from his spine. In retrospect, I should have done it, that would have been a great story, eh?

I got 6 inches of clearance and bolted through the French door, closing it behind me. The girl said, “It’s okay, I’ve got him.” I still do not think she knew that I was truly injured. I said, “No. I am not coming through that room and you are not opening this door. Get that dog away from me and confined, RIGHT NOW!”

Into the washroom I went, my friend on the other side of the door, asking if I was okay. I told her I was a little stressed and to give me 5 minutes. My bladder was full, hence being in that position to start with, so I had to calm myself down enough to be able to urinate. When I lifted my pant leg, I could see the large laceration and the subcutaneous fat and muscle beneath it.

Refusing to open the bathroom door until the dog was contained, because I’m semi-smart, I insisted that someone put the dog behind another closed door. I hurriedly went to retrieve my briefcase and head to the hospital. I lifted my bloody pant leg and my friend’s daughter exclaimed, “OH MY FUCKING GOD!” Yep, I explained again that I had been shredded and that I was on my way to the hospital.

Normally, if I get injured, I simply go to my vet clinic and put on a bandage or have a laser treatment or whatever is needed to be okay. Because I am running for Federal Parliament, I decided to go to the human hospital and see what it was like for people who do not practice medicine for a living. I also fully expected to be treated promptly and effectively.

I called my girlfriend and told her I was hurt, which hospital to meet me at and asked her to bring me some Tylenol 3’s with Codeine. Thank God I did that, because I was not seen by a doctor for more than 5 hours. I knew a clerk who was working there and I’m sure that my visit was at least 3 hours faster than had I not known someone.

The front desk clerk was okay, but did not seem at all concerned for me, other than she did get me a wheelchair because as I walked around, it was causing a lot of bleeding. I was shaking and hyperventilating a bit; truthfully, in a bid to be seen as more urgently needing care than would have been belied by a calm exterior. Just because I was capable of being calm in that situation, did not make my need to be seen less urgent.

That was a good strategy, as they wheeled me to a triage waiting area and a triage nurse saw me within 20 minutes. Her body language and tone of voice gave the impression that I was a bother to her. Her only contribution was taking my temperature and blood pressure and putting the cheapest, scratchiest, most likely to stick into a wound, gauze on the leg so that no one had to see the laceration and punctures. Oh, she did verify my drug allergies to penicillin & Percocet. That would have been an excellent time to take the 3 minutes required to flush the wound to get bacteria and dog saliva out of it.

 

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That hurt.

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The 2 punctures are the size of my thumb and about 1.5 inches deep.

I was put back out in the general waiting room and Amanda arrived shortly with the pain meds for my arthritic knees (Knee pain for the Win!). Thank God I’d had the presence of mind to tell her to bring them, because the adrenaline was waning and I was getting painful.

I also had to complete my application to be a candidate for Parliament and I had assured the National Selection Committee that it would be FedEx’d that day. I was a little stressed, because I am nothing if not punctual & I take my time commitments seriously. Amanda stepped up, made the copies that I had forgotten to make, and got the package together and FedEx’d on time. Thank you, Amanda.

After 4 hours, I was put in a bed in the ER, and, as Amanda pointed out, that did not indicate that a doctor would be there soon.

 

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4 hrs later, still have not seen a Doctor. The leg is noticeably swollen, I have been given nothing for pain, inflammation, nor infection.

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It hasn’t even been so much as wiped off.

 

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The rake marks before the top tooth broke through my skin are impressive and very sore.

 

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At this point I was high on Codeine and decided that if I took the photos just right, I could make it look like a vampire attack.

We talked until my codeine wore off and I took another dose, realize I had been there, with a shredded leg, for over 4 hours and they had offered me nothing for pain, not even an ice pack. While my drug level was low, I realized that the ‘golden period’ for wound closure had already passed. I called Emily at work and had her get a 20ml syringe of sterile saline solution and to pull up some Betadine solution in with it.

Katie dropped that off for me, and I went into the bathroom, took off the horribly adhered bandage of cheap gauze and I flushed out my own wounds, using the toilet as a waste receptacle for my bloody body fluids. I had no choice but to replace the outer layers of the cheap gauze.

The very nice ER doc, did come around, only to be called away twice for long periods of time. He brought in a suture tray & opened it on an instrument table beside me. I did not see him put on his gloves, so I am not sure if they were surgical gloves or simply exam gloves. They were the same colour as the exam gloves the triage nurse wore.

After squirting some saline into a little sterile bowl, while holding the non-sterile bottle in his hand, he started looking for his syringe to flush the wound with. It was under the drape, so gloved in, he pulled the drape back, touched the outside, non-sterile packaging of the syringe and opened it, turning it out onto the ‘sterile’ field. I could have easily opened it aseptically for him. Then still with those gloves that touched the bottle and the syringe packaging, he fitted a teflon catheter to the end of the syringe, before flushing the wounds with only saline solution.

This was now 5 hours after the attack, the golden period for wound closure is 4 hours. Instead of a proper clean-up and surgical prep, he swabbed the open wounds with a chlorhexadine soaked plastic applicator. The skin surrounding the openings, not so much.

After injecting local anesthetic and then disappearing until that anesthetic had mostly worn off, he proceeded to do the worst suture job I had ever seen done by a medical professional. I really like this doctor, I am not trying to get him into trouble. His lack of surgical skill is simply due to lack of training and practice. That he is allowed to suture people in the ER with no surgical training is of a concern to me.

At one point, I told him that the suture was too tight, because the tissue was obviously going to swell, and that I would handle that by pulling the first throw of a knot snug, then leaving a small 1-2 mm loop and closing all the other throws tightly. That allows the suture in the skin to loosen by a millimetre as the tissue swells from the trauma. He pretended to be listening and tightened the first throw even more and closely and tightly placed the other throws.

He then confirmed that I am allergic to Penicillin and Percocet and told me that he would write me a prescription for Clavulan. I said, “Um, no, because that is amoxicillin and clavulanic acid and amoxicillin is a penicillin.” Guess it’s a good thing I know that, eh?

My classmate, Bruce, from vet school, looked at the pics and noticed that he had placed granny knots and not the square knots that surgeons should use. This also indicates a complete lack of surgical suturing training. While placing the inadequate number of stitches, he was leaving 2 inch tails as he tied the knots. That meant that a surgery that should have taken half a package of suture, took an entire package and he still needed one more stitch, so a second, brand new package of suture had to be wasted, due to not conserving suture as any competent surgeon would endeavour to do. It doesn’t decrease his paycheque, so what’s the big deal eh?

I wonder how many millions of dollars in wasted supplies there are in human hospitals, just because there is no incentive to control expenses and utilize the materials efficiently.

There were only 3 sutures placed across that entire laceration, with no subcutaneous sutures to take tension off the skin. One was a simple interrupted pattern and 2 were horizontal mattress, interrupted sutures. All were placed so tightly that by morning, they were damaging and cutting through my skin. A far-near-near-far pattern would have been a much better choice for a wound with so much tension on the suture line.

 

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It looks like it was stitched up by a blind drunk, on a moving streetcar, in San Francisco.  Note the flesh hanging out, and that the wound isn’t even closed fully.

I really liked the doctor, he had great bedside manner; what he did not have, was any surgical skill or training.

I recently had a similar experience with a physician not adhering to aseptic technique while injecting synovial protectants into my knee joint. That doctor, at Fowler-Kennedy, laid out his tray, opened the syringes and needles properly and turned them out onto the tray, then opened the Neovisc (which the packaging makes clear, the outside of the syringe is not sterile, only the contents are) dumped the non-sterile syringe onto the formerly sterile field. He then properly prepped my knee, put on sterile gloves and immediately broke sterility by picking up a bottle of lidocaine from the countertop and filling a previously sterile syringe with it.

When it came time to inject into my joint, he used one of his fingers as a guide to steady the shaft of the needle as it slid into my skin. How gloves were no longer sterile and injecting bacteria into a joint can have devastating consequences, up to and including amputation of the limb, or death, due to sepsis. I immediately went to the waiting room and cancelled all my future appointments. I gave the next 5 intra-articular injections to myself. They are really fun and satisfying to do, plus I’m in much less pain now with my knees.

It’s no wonder there are so many hospital induced infections, is it?

A very nice, pregnant nurse brought me an illegally labelled bottle with 6 Tylenol 3 in it, and then applied a substandard bandage that didn’t last until I got home.

 

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If I sent a controlled drug out the door with no patient name, no date, and no prescribing doctor’s information, I would lose my license.

 

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The next time the codeine wore off, I was in more pain than I had been while to dog was clamping his teeth through my flesh. I took some photos of the poor suturing job, and was able to see that the 2 puncture wounds on the back of my leg not only had sutures that were way too tight, the way the needle bites had been taken, the sutures were pulling hard on my skin between those wounds, in addition to cutting through my actual skin at the wound edges.

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By Tuesday morning, I couldn’t take it any more. After I saw a few appointments, I had Katie surgically prep my leg, and I lasered it to promote healing. The suture lines were horribly inflamed and my skin was actively being strangulated by the way too tight sutures.

 

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I have both a surgical laser and a pain laser in my animal hospital, so I used laser therapy to reduce inflammation and speed healing.

We prepared for self-surgery.

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Injecting local anesthetic into the wound edges.

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Katie did a proper surgical prep on my leg.  You cannot even see 2 of the sutures here, because they are so tight, they are cutting into the skin and my skin has swelled around them.  It looks like I had already removed them here, I had not.

I ripped out all the offending sutures and cut out the dead tissue, then closed my own leg wounds with sterile surgical staples. YouTube links to the video of my performing surgery on my own leg are here.

Me getting set up to do my own surgical repair.

Less than 1 minute long.

Me actually doing self-surgery to repair the wounds.

Less than 8 minutes long.  

The videos are not gory like the photos are.  If you cannot watch, turn away from the screen and just listen to the narration.

 

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This is what it looked like that night, after I was on my feet all afternoon, doing 2 days worth of afternoon appointments.

I woke up in pain at 4AM and took one more Tylenol 3 with Codeine; since that time, I have had no pain and have required no pain medication, despite working today and performing 4 surgeries on my own patients.

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This pic was taken about 7PM on Wednesday night

I think this looks remarkably good, even though there is definitely evidence of infection in the yellow areas under the long suture line.

Wow, that took a long time to detail out.  What do y’all think?  Particularly of my surgery videos?

We only broke sterility one time, and it was only at the very end of the stapling, when I could not see the area I was trying to staple, because it is on the back of my left leg, and I have to staple with my right hand. The one break in sterility was when I asked Katie to position the stapler. Her hands were no where near the incision or the actual staples, so it was okay at that point for her to steady the staple gun as I was getting fatigued.

There is far more to the story, which I will add. I have to source the photos and aggregate the commentary.  I was told to expect it to take a full year to heal.  I healed this leg 9 months ahead of schedule, after being given completely wrong information at 2 separate ER visits.

For now, you can read the entire story by going to the Facebook note and expanding all the comments to see photographic and video updates.  Click here to go to the entire story and see how it played out in real time.