Staying On Solid Ground During An Eruption

   Fridays are the usual days for eruptions in my podiatry clinic. Friday afternoons are the most typical times when Murphy’s Law rules. An eruption is a diabetic patient with a severe infection or an osteotomy that falls apart or a pin tract infection. If patients hate a new pair of orthotics, they usually show up Friday afternoon to give me an earful.    Last Friday was no exception to the eruption rule but the fun started early. Fridays are always busy in our clinic. My schedule was booked solid with mostly straightforward podiatric cases. Then the emergency room called. At the same time, a young lady called. She had fallen and was sure her base wedge osteotomy had fallen apart. She said there was green stuff coming out of a pin hole where a Kirschner wire protruded.    While I was on the phone with the ER, an older gentleman with diabetes came to the front desk complaining that his toe was big and red, and “hurt like hell.” My Friday was about to melt down. While all that was going on, the scheduled patients continued to arrive. People are less patient about delays, emergency or not, on Fridays.    The call from the ER is one I never like to get. A young patient of mine decided to take a vacation from his diabetes and his foot ulcer, which was caused by a pathologic fracture. He stopped taking his insulin and decided to wear regular shoes. The ER physician told me his infection had started up the leg, there was gas in the soft tissue and he was in severe ketoacidosis with a serum glucose in the 600s. Since the hospital was on the same block, I agreed to come in right away.    I walked past a waiting room full of impatient regulars and met the girl with the pin tract infection. She was hobbling in on crutches. The older gentleman with the diabetic infection was still at the front desk giving me a dirty look as I left.    I entered the emergency room and conferred with the physician. He feared my patient was in grave danger of dying due to his multiple problems. The kid looked terrible and was circling the drain with his infection, gas gangrene and ketoacidosis. He was ready to shut down. The ER doc, the kid’s mother and I agreed that he belonged in a trauma center and needed to get there fast. We summoned a helicopter.    I talked with the mother who had been down this road with her son three other times. She knew that his denial of his disease would be the end of him some day. I wished the young man good luck, finished the paperwork and headed out of the door to return to my clinic.    The helicopter was landing on the hospital helipad as I walked across the parking lot. There were too many eruptions on a Friday morning but they were just the beginning.    Mount St. Helens is an active volcano that is 40 miles from my office. In 1980, I had to close my clinic for a week when the mountain exploded and dumped 5 inches of volcanic ash on our community. There had been a series of earthquakes during that past week and the scientists were predicting another eruption.    As I crossed the parking lot on my way back to my clinic, I looked toward the mountain. A plume of steam and ash suddenly shot from the crater. The mountain erupted. It was perfect timing. It was, after all, a Friday.    My mind was on the eruptions that had gone on in my professional life and I barely noticed the spectacular natural event that was happening with the volcano.    The girl with the pin tract problem was okay. There was no pus when I removed the pin and X-rays showed the base wedge osteotomy was in good position and stable.    The older gentleman with diabetes and a hot, red, swollen toe had gout. He responded to a few days of colchicine.    I haven’t heard how the kid who was airlifted to Seattle is doing. I suspect he has lost his leg. I hope he is still with us.    Mount St. Helens had been spewing steam and ash for three days. I wondered if the old gal would give me another week off like she did in 1980. Eruptions on Fridays seem to be my destiny. Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.