wound care

Despite the late afternoon sunshine, all the curtains and blinds in the Baxter’s flat are drawn. Mrs Baxter is standing in the hallway as we come in, her arms down by her sides, strands of hair frizzling out around her head like static. She doesn’t respond to hello or through here? but watches us as we walk into her son’s bedroom.

John is sitting on the edge of his bed in the greasy, airless room. A heavy man in his late twenties, as inert and fleshy as a mushroom, he has a disconcerting habit of closing his eyes when he looks at me, and then opening them again when he looks away, like he was using some other, deeper sense to gauge any response.

His left leg is markedly swollen, tightly bound in a discoloured bandage, his foot covered in a filthy sock. He obviously hasn’t changed anything in weeks. Unwrapping his leg is an appalling prospect.

‘Basically what I want is some advice,’ he says, his voice rapid and flickering. ‘Because I have to say thus far I’ve had conflicting information. Let me explain. Basically, and for reasons that haven’t been satisfactorily explained to me thus far, I developed a pain in my left calf muscle, which gradually, over-time turned into some kind of blister. Eventually, this blister grew bigger, burst, and left me with something of a crater, which then proceeded to grow wider. I was quite concerned, so I went to my doctor. My doctor told me that it was a venous ulcer, gave me some cream to use, and emphasised the importance of keeping the wound clean, all of which I have done. Unfortunately, after a week or two, the ulcer became quite a bit deeper and wider. I really was quite concerned by this point, so I saw another doctor, who said the ulcer would almost certainly start to heal soon, and that I should carry on keeping the wound clean and dry. I didn’t mention the cream, he didn’t say anything, so I wasn’t sure whether I was supposed to use it or not. Anyway, I’ve left it alone for a week or so, now, but last night I started feeling quite unwell, so I phoned for further advice. Things are a little complicated at the moment. We’re between surgeries, and I wasn’t sure who to turn to. What do you think I should do now? Use the cream? Or carry on keeping it clean and see what happens?’

There’s such a disparity between what he’s saying and the evidence of our eyes – and noses - it’s hard to know how to begin.

‘So no-one’s had a look at your leg in a week or so, John?’

‘No-one. I thought it best if I let it rest for a while.’

‘When did you last change your socks?’

‘My socks? Well – I would say about the same time.’

‘Your leg looks quite swollen.’

‘Yes. Yes, I suppose it does. It’s not painful anymore though. I just feel quite sick and dizzy most of the time. I do suffer with acid reflux, but this feels more like the flu.’

‘Would you mind if we cut the bandage off and had a look?’

‘If you feel you must,’ he says.

We dampen the bandage with saline to stop it sticking to the wound. Even so, cutting it is like breaking the skin of some malign fruit. Of course, the ulcer beneath it is horribly infected, a palm-sized crater so vibrantly coloured and textured you could be looking at the aerial photo of a coral island, blooms of scarlet and black in a darkening sea of green.

John looks down at it, too.

‘Is that good?’ he says.

‘Not really,’ I tell him. ‘It’s badly infected. We need to take you to hospital.’

‘To hospital?’

‘Absolutely.’

‘That’s not what I was expecting,’ he says. ‘I just wanted advice.’

I finish re-dressing the leg.

When I turn round to throw the waste in the bag I see Mrs Baxter, standing in the doorway, staring at me. She has the same expression as before, but this time she has her hand up to her mouth and nose.

‘Are you coming with us?’ I ask her, as brightly as I can. ‘We’ll be a little while getting John settled on the ambulance, so you’ve got five minutes or so to get whatever you need together.’

She doesn’t say anything, but turns, and quietly walks away.