* * Anonymous Doc: The black toe mystery

Monday, January 9, 2012

The black toe mystery

"So, med student, you're getting more comfortable with the physical exam?"

MED STUDENT: "Yep, definitely."

"Great. You want to take me back in to see the patient and walk me through what's going on?"


[And he talks me through the highlights, from head to... lower leg.]

"You know, with a diabetic patient, it's especially important to check the feet."

MED STUDENT: "Oh, his wife said he's fine."

WIFE: "Yes, he's fine. I check his feet every night."

"Okay, that's great, but I'm just going to take a quick look."

WIFE: "It's so hard for him to get his socks off."

MED STUDENT: "I didn't want to create a whole problem with the socks."

WIFE: "Yeah, it's really hard to get them back on."

"Well, let's just take a quick look, and we can get a nurse's aide to help with the socks if it's a problem."

...And we remove one sock, and his big toe is... black. Like, gangrenous, dead, completely black. The wife gasps. Audibly gasps.

WIFE: "I have never seen that. I swear, doctor, it was not like that yesterday."

"I think it probably was."

WIFE: "Well, it certainly wasn't like that a year ago."

"Okay... somewhere between a year and yesterday seems plausible..."

WIFE: "I don't understand. It was never like that. This is a sudden change. I think it's something in the hospital."

"He's been here for three hours."

WIFE: "And I think something must be going on that made his toe like that."

"I'm sorry. That's not a sudden kind of development. That's not something that happened in the past three hours. I promise you."

WIFE: "Well, it looks terrible. Are you going to have to get him a new toe?"

"Excuse me?"

WIFE: "Will he need a new toe?"

"Um... I think we're going to have to get a specialist to take a look. Why don't you put the sock back on, and we'll be back in a bit."

And as we exit the room:

MED STUDENT: "I don't mean to ask a stupid question, but... should we also look at his other foot."

Yes, uh, indeed. Yes, we should. Thanks, med student.


  1. Ha. Nice to learn the things NOT to do when starting clerkships...

  2. Stinky foot was my arch nemesis in medicine. By the end of my six weeks, I had become the Ceftaz assassin.

  3. I love this blog. All itemized for what NOT to do as an intern, resident, or for that matter, physician.


  4. oh man your med students have added a whole new chapter of hilarity

  5. I heard a horror story of how someone once lifted a sheet to look at the feet...and the diabetic, gangrenous toe had fallen off. eeeee. In case I ever thought it was a big deal to throw on some gloves before an assessment, that sure changed my mind. As a (nursing) student I was shy and didn't want to inconvenience the patients. Then I realized, it wasn't going to work that way.

    What gets me is the wife lying about checking his feet daily. I also once heard a story of a nail being found stuck in the foot of a diabetic patient and nobody had discovered it until several days into the admission. No bueno.