The Shrink is doing his best to get me to think positive thoughts, and so I present this little case study.
I was quite pleased with myself this morning because I saw someone whom I had undoubtedly made better. This was a young man I originally saw last week with a nasty flare-up of severe eczema on the soles of his feet and around his toes (known in the trade as "pompholyx"). I had seen from his notes that he had attended with the same problem a year ago, but my partner had been unable to treat it and had needed to refer him to a dermatology clinic urgently. This time the ends of his feet were again white, thickened and macerated, but what I really noticed when he took his shoes and socks off was the smell. This was not your normal smelly foot smell, even though he was wearing trainers. This was a rotting flesh smell. Any of you who have come across partially decomposed bodies will know what I am talking about. Usually I just open the window wide when smelly feet visit my consulting room, but this time I also had to fully open the window of the room across the corridor from mine to set up a through-draft. Eurghh!
The good doctor will use all his senses whenever possible. I can imagine Holmes admonishing the devoted but dense Watson: “you smell but you do not observe”. For me the rotting flesh smell meant anaerobic bacteria, so I prescribed him metronidazole (for anaerobes) as well as flucloxacillin (for staphylococci) and Dermovate cream (for the eczema). Today his feet were much much better, all the white maceration had gone and he just had dry flaky eczematous skin. The feet still smelt, but it was a normal sweaty-feet-in-trainers smell. It was a relief and a pleasure to smell it!