Salami toe

A couple of months ago I was completing a rotation in a rural family medicine clinic in Missouri. I was working with one of my favorite physicians, Dr. S., and I was having a great month. It was typical for us to run behind schedule and I would help the nurse room patients so she could finish up with shots and paperwork. I picked up the next chart and saw that it was a 14 year old white male with a splinter in his toe. I told Dr. S. that I would be glad to take this patient and see if I could get the splinter out. I called the patient back to the room, took his vitals, and then I asked for him to remove his shoe. His father who had been very quiet up until this point looks at me and says...

"Welllll, we're not really here for a splinter" (just imagine a man with a very strong ozark accent)
me: "oh? what are you here for?"
father: "ya see, my son here likes to go hunting and he had a little accident"

I was starting to become worried at this point...maybe I shouldn't have volunteered for this one.

me: : "ok, what kind of accident"
father: "he shot himself in the toe yesterdy"

the room is silent as I'm staring at the father wondering if he is telling me the truth.

me: "so, what did he shoot his toe with?"
father: "a gun"
me: "what kind of gun?"
father: "oh, just a little ole pellet gun...nuthin too serious"
me: "Did the bullet go through the toe?"
father: "nope, I think it's still in there even though we used salami"
me: "salami? why would you need salami?"

at this point the father looks at me like I'm crazy.

father: "Don't you know! Bacon draws out bullets!"
me: "ummm ok, but I thought you said salami...I think I need to hear step by step what we have done to this toe...maybe I should also look at the toe while you're telling me"

I'm really starting to worry at this point. The boy takes off his really sweaty, stinky shoe and he isn't wearing any socks and has no bandage around his 4th right toe. I see a small hole where the pellet entered the top of the toe but no exit wound...the toe is only slightly bruised and does not appear to be infected. I can roll my finger over the pellet. It feels like it is just below the surface.

father: "well you see I have tons of experience takin care of gunshot wounds. I was shot in the butt once and I taped bacon to my butt and the bullet popped right on out in a couple of days. So when Junior shot himself last night I knew just what to do...I soaked his toe in epsom salts for a few hours and since we didn't have no bacon, I wrapped his toe with salami. I don't know why the bullet didn't pop out...I put lots of salami on his toe"

silence...I'm not sure how to respond to this...I couldn't belief that anyone would seriously wrap their toe with salami to get a bullet out.

me: "ok, so I'm going to need to cut out the pellet"
father: "oh, well if thats all you're going to do, I can just cut it out with my pocket knife at home"
me: "no! let me cut it out. I'll need to put in stitches and make sure the pellet comes out in one piece"

I had to do a little more convincing before the father agreed that it would be better for me to cut out the pellet but he finally gave in. I went to find Dr. S. and he looked at the toe and agreed that it should be cut out. I was shocked when he turned to me and said "it's all yours" and turned and walked out of the room. I didn't want the patient to see how nervous I was so I quickly mumbled something about needing to get set up in the procedure room and left. I saw another medical student in the hall so I grabbed him and said that I needed his help with cutting out the pellet. At this point the procedure room was set up and I quickly numb the toe with a digit block (something I had only seen done once before, basically you inject numbing medicine into the nerves on either side of the toe). I was lucky and successfully numbed the toe. I made the incision along the toe and made several attempts to pop the pellet through the slit; I finally asked the nurse to call in Dr. S. It took both of us working the pellet towards the incision before I was finally able to grab it with forceps. Thankfully the pellet was in one piece and I was able to keep the incision small enough that it needed only two stitches. Luckily, the pellet missed his bone and he didn't shatter the bone (confirmed by Xray).

After the pellet was out the father patted the boy on the shoulder and said "well son, guess you won't do that again"

I never saw the boy in clinic for follow-up (even though I asked them repeatedly to come back). I just assumed that everything was fine or else they would have been back.

This was my first encounter with folk medicine. Thankfully, the father brought his son into the clinic before his toe became infected and not after it was too late. This patient was definitely memorable and I think he learned a valuable lesson...salami DOES NOT draw out bullets.

First post!

I have never blogged before, so we'll see how this goes. I'm finally taking my family's advise and journaling a few of my experiences over the past year (and those to come). I'm very reserved when it comes to sharing my personal thoughts, but I'll try to be completely open and honest. I realize that this time of my life is very unique and will greatly influence the person I will become.