Sunday night, late, the ER called up with something unusual. A mother-son duo, found down, she headed for the SCU and he for the ICU. "Sorry," said the ER nurse. "It's pretty bad."

This, coming from an ER nurse, had us all suspecting the worst. We were absolutely not fucking prepared in any way.

Our tiniest, sweetest nurse, she of the blonde hair and freckles, took the ICU admit. The guy was in his fifties, with a core temp of 29.5, horrific rhabdomyolysis (muscle breakdown from protracted flaccidity, which clogs up the kidneys and organs with toxins), and "areas of skin breakdown."

He was rotten. There's basically no other way to put it. Sheets and chunks of skin and underlying tissue on his ice-cold arms and legs, and even a pretty good swath on his flank, all rotten and gray and falling to bits. "Uh," said the noc doc, "make sure you don't warm him up too fast. We don't want that shit hitting his core too fast."

The frantic search for family began. Fortunately, as his nurse and I worked to clean and salvage and semi-stabilize his rapidly dying body, they found the family pretty quick-- turns out they'd been the ones to make the welfare check call.

As we poured bottles of saline rinse over his wounds and pounded him with huge boluses of insulin/dextrose/bicarbonate to control his soaring potassium, the doctor pieced together the story: the man lived with his aging, profoundly Alzheimers-ridden mother, her sole and dedicated caretaker, and the rest of the family lived out of state and called in every Sunday to make sure everything was all right. Last Sunday everything was fine; this Sunday nobody answered the phone, so they called the neighbors, and when the neighbors reported a cold dark locked house they called the police.

It seemed, from the EMT report and the family's schedule, that he had fallen some time last Sunday or Monday night, possibly from a stroke, and lain in the kitchen floor with his arm still in the open fridge ever since. His muscles began to rot, and fouled up his kidneys.

His mother, confused and demented, apparently managed to feed and water herself for at least a couple more days, judging from her relative condition. She seems to have been up and moving, walking from her bedroom to the kitchen, pouring herself a glass of water and having a bite of toast, a few feet of linoleum from her dying immobile son. She likely didn't even recognize that he was a person.

After a few days, though, perhaps Wednesday or Thursday, the smell of his feces and rotting flesh had apparently begun to bother her, and she'd tried to move him. Weak with inadequate food and advanced age, however, she'd slipped, fallen, broken her hip and femur, and lain atop his cold, still-breathing body for days.

Days.

The doctor tried to explain code status to them, and how he would likely not survive CPR. Meanwhile, his nurse and I discovered that he still withdrew slightly to noxious stimulus-- a sternal rub got us a grimace, a hard fingernail-pinch warranted a twitch of the fingers.

He was, somehow, faintly awake.

The family agreed quickly to a status change, and the doctor began gently suggesting a withdrawal of life support, to shift from life-saving to comfort care. As he broached the topic, our patient started to drop into little spurts of V-tach, showing that our life-saving efforts were far too little, far too late.

So we dosed him with fentanyl and versed and switched our focus to postmortem care, wrapping wounds and washing the body. Death might be inevitable, but there are other duties to the dead.

On closer inspection, we found worse things. The wounds on his legs were not intact, not merely rotted. Several colors of short hairs were embedded in the flesh, and weird ragged marks were scored into the skin around the wound. Yes, our mother-son duo kept cats, and after a few days without food, the cats had turned to the closest source of protein.

They had been eating him. For days, probably. Chunks of his legs were simply missing. There was a pretty good section gnawed on his flank around the rotten patch there, which (upon closer inspection) sloughed off like wet pastry from a gooey filling, revealing the yellow bubbles of internal fat... with fang-marks.

The family understood. Mourning, they chose to let him go, and we raised his dose of fentanyl and versed and pulled the breathing tube out.

Next door, his mother lay in her bed, awaiting surgical repair of her injuries, convinced she was in a hotel and asking everyone for snacks. She is, to the best of my knowledge, still alive. She's a sweetheart, but so degraded by Alzheimers that she can't remember what a pillow does. It's for the best, probably. Better for her, and for her family, that the events of the previous week be absorbed into the vacant fog of dementia.

Because, as we dressed her son's body for the morgue, as we poured peppermint spirits into our masks and poured the stuff into the trash cans and smeared the stuff on every lintel and doorpost of the ICU like an echo of the first Passover, a guard against the stench of someone's dying firstborn-- as we gagged our way through rotten gnawed carrion and filled in missing places with wadded gauze, we realized that the marks on his legs were sharp gouges like tiny serrated knives, and the marks on his arms were half-moons.

One can only imagine what went through her mind, lying for days on her own house's floor, while her dehydrated and slowly dissolving mind robbed her of words like "kitchen" and "refrigerator" and "son." One can only imagine what connections she made, as the animals that lived in her house discovered the cold meal laid for them, and her stomach growled in response.

We wrote nothing of this on the chart, of course. No sense in burdening the family, with no decisions to be made from any of these suspicions. We rounded out the gnawed parts with bandages, bagged him up, and carried him away in silence.

(His nurse went home.)

- elise the great, SA Forums