On arrival the Emergency Department was bustling as ever.  Beds were crammed into corridors in a regimented fashion, the entire department saturated with the sick and the suffering, the pain streaked across their faces exacerbated by the eight-hour wait.  Eventually we managed to track down Dr Ellis, the particularly lovely if elusive consultant that was to take charge of our teaching today, and were instructed to go and see some patients, clerking forms hurriedly thrust into our hands.

The lucky individual that would experience the joy of medical student attention today was a 73-year-old gentleman named Earl.  He had tripped while carrying a package back into his house, bumping his head and dislocating his shoulder.  He was in pain, but he was alright, as was confirmed by his son-in-law.  The shoulder would need relocating, but in the busy department it would have to wait a moment.

After what was a relatively brief discussion, Tom and I reconvened.  He had spoken to a lady with heart failure.  Or possibly pneumonia.  Her advanced dementia and lack of companion had made it difficult to be sure of the details of the history.

“We’ll chat about your cases in just a sec guys, I just need to see this chap in Bed 4,” Dr Ellis informed us.  The chap in Bed 4 was 42-year-old Darren, or at least that was according to his notes.  A combination of alcoholism and psychotic depression had led him to self-neglect to the point where he seemed to be well into his sixties.  He had been in the department for some time although his unwillingness to communicate meant that nobody was entirely sure why, the only information about him being the testimony of a psychiatric nurse that suspected something was amiss.

As a trio we gathered around Darren and drew the curtain.  Dr Ellis attempted to strike up a dialogue and performed an examination while Tom and I observed.  The findings were unremarkable, and the final check was for diabetic foot ulcers.  As Dr Ellis removed Darren’s socks she turned her body slowly towards the curtain.  Her wide eyes locked with mine for a split second, before she sharply drew air in through her nose and turned to complete the examination.

Interesting. Surely the smell of his feet was not that bad.  The eyes, the rotation of the torso, it all seemed a little excessive, an over-reaction even. This was right up until the point when the deathly stench collided with my olfactory receptors like a freight train travelling at warp speed.  The toxic fumes emitted by this poor set of feet were like nothing I had experienced before.  The odour was hot like wasabi.  It was green like mustard gas.  It was painful, emotionally, physically and spiritually painful.  A patient vomited in one of the bays nearby.  I wondered if they too could smell this concoction of gases, but my wonder soon grew into a concern that I may join them in emptying my stomach.  Through the crack in the curtain I observed the registrar, sat at the island of computers some ten feet away, turn around and sniff the congealing air twice before exclaiming, “Phwoar!  Me eyes!”

Darren remained silent and emotionless throughout, staring blankly ahead at the turquoise curtain.

The examination could not have ended soon enough.  As we left the bay I resolved to bleach my nostrils as soon as I returned home, although I feared they would never truly be clean again.

“That was horrendous!  I genuinely couldn’t believe how bad that was,” said Tom shaking his head.

“Christ, I know.  I’m pretty sure that was the worst thing ever.  Not just the worst smell, the worst thing ever.”  Maybe a slight exaggeration admittedly, but the effluvium emanating from those feet really was remarkable.  Dr Ellis sauntered over, re-joining us after a brief conversation with a nurse.

“Right!” she said blinking widely, still appearing visibly shaken, “Let’s talk about these cases, shall we?”

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