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Tuesday, December 22, 2009

The Great Toe Nail Removal

Toe nail removals need not always be routine and boring. I had to do a toe nail removal for a man who was borderline diabetic, neuronally fired (abused his nerves with alcohol for a long time), quietly fussy and intensly frightened about the situation.
While I could have done it at the minor OT in the clinic, I decided it was better to do it at a nursing home with sterile facilities and all the required instruments and machines for monitoring him.

The left great toe nail was clearly ingrowing and the nail bed had become infected and was oozing pus. There was no question that the nail had to go. At the same time, his right great toe nail was also ingrowing. It wasn't causing him any problem yet, but it would for sure sometime in the near future. I offered him the option of getting both done at the same time so he wouldn't have to travel again to the hospital and for dressings. Also, it would pain less now that it wasn't infected as opposed to the one that was. He said he needed time to think and I should start with the necessary one.

I gave him local anaesthesia, checked it and proceeded to remove the offending nail. To be fair to him, it must have hurt as local anaesthesia rarely acts well in places with infection because of the pus. The funny thing is that the block actually worked well as he had no pain immediately after the removal.

Now the question was whether we do the other toe or not. He said he wanted to think about it and we went out of the OT to the waiting room. His wife then cajoled him into a major guilt trip and how he should get it done if not for himself then for her. Unfortunately, by this time about half an hour had passed and the nurse had washed all the instruments. As is expected in these situations, he chooses that particular time to agree and we had to go in and do the other toe with a fresh set of instruments.

Bottom line: Waste of time (what should have taken 30 mins took 2 hours), resources and money (they charged for the new set of instruments again)

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