The hole on the bottom of my left foot has finally closed up. Now all that is left is some scar tissue and hyperkeratinized skin, more commonly known as a callus. After physical trauma, such as friction or injury, dead skin cells in the most superficial layer of the skin proliferate as a protective mechanism, resulting in the esthetically not-so-pleasing hard skin. Sometimes these calluses disappear on their own with time, other times interventions are required, chemically with salicylic acid, for example, or mechanically by rubbing with a pumice stone. Although I could certainly do without it, the sight of my scar and callus brings back fond memories of Thailand, where I spent a month backpacking before signing my life away to Residency.
It happened during a three-day trek in the jungle near Chiang Mai, the northern capital of Thailand. The trek started with a promenade on elephants through the woods and into the river, then a hike up nonexistent paths under the unforgiving Thai sun, with our backpacks weighing on our backs and sweat dripping from every pore. It was the most gruesome three-hour workout I have ever put myself through. One of the trekkers even vomited from overexertion.
Singing with the Lahu Children
We managed to reach our destination for the day, a small hill tribe village inhabited by the Lahu people, before the sky opened up with a torrential tropical rain. The Lahus hosted us for two nights in one of their bamboo huts. Since there was no electricity at night, we occupied ourselves with Sangsom Thai rum while our guide played the guitar under candlelight. Going to the bathroom was an adventure of its own. With only my dying flashlight to light the way, I had to carefully go down a slope made muddy and slippery by the rain. Then came a balancing act on a few wobbly steps to descend to the “washroom” which consisted of a hole in the ground for our bodily wastes. In this part of the world, squatting is the way to go. The washroom was also equipped with a tub of water for flushing and washing. No paper of course.
As I gingerly stepped down the wobbly and slippery steps, I kept muttering to myself: “Be careful, do not fall, do not fall.” Lo and behold, I fell and slid all the way down. That was my first injury of the trip: A big road rash on the back of my left shoulder. Although it was only a superficial excoriation of the skin, open wounds are prone to infection, especially when you’re in the wilderness and caked with dirt. Luckily, one of the other campers had packed some iodine solution so my wound could be cleaned and disinfected. The wound eventually healed without complication, and I have a scar on the back of my left shoulder to remind me of my voyage to the Lahu toilet.
My left foot, however, was not so lucky. On our last day of the trek, we walked barefoot to a river for some white water rafting. The water wasn’t exactly clear, but more of a muddy yellow color, perhaps partly from all the wastes oozing from houses on the banks. Later that evening it was back to our hotel in the city where I was finally able to take a hot and thorough shower. That’s when I noticed I had a tiny splinter on the bottom of my foot! Being a doctor now, I figured I would just take it out myself. So off I went to my toiletry bag to take out a pair of tweezers that I normally use for my eyebrows and I rummaged through a travel sewing kit for a needle. Being a properly trained physician, at least in the mind of those who granted me a degree, I rubbed alcohol on my skin and on my makeshift surgical instruments, and then proceeded to operate. I’m not sure if the entire splinter came out, but I wasn’t too worried about it. I kept applying topical antibiotic on the small wound, and that would be it. Or so I thought.
In the course of the following few days, the small wound that I had created turned red and slightly purulent, meaning containing pus. The infection was really small and I deemed it insignificant, not much different from a pimple. I squeezed out the pus and continued applying topical antibiotic ointment, thinking that it would go away on its own. Then the redness started to spread. The pain intensified. A week later, the middle of my very small wound had turned black, a sign of necrosis. Necrosis is premature cell death in living tissue, and can result from infection or poor blood circulation. If left untreated, it can progress to gangrene, meaning that there has been tissue death. Treatment is debridement of the dead tissue, or possibly even amputation of the gangrenous limb. Without medical attention, it can be lethal.
Neither death nor amputation struck me as an attractive prospect so I decided I had better drag myself to a hospital, quite literally, since I could hardly walk. By that time, we had made our way to Pai, a lovely northern village best known for its high hippie concentration. Just as I suspected, the doctor prescribed an I&D which stands for incision and drainage, or incision and debridement, a procedure that I have myself performed multiple times. The doctor makes an incision with a scalpel over the abscess to let the pus drain, then uses a pair of forceps to go inside the cavity and clean out the residual pus and dead tissue. All this under local anesthesia, of course. Except that the process of getting the local anesthesia is rather painful, or so I had heard from patients I had treated. They were absolutely right, as I now learned. After the I&D, the cavity is packed with sterile gauze, to be changed daily, which meant that I had to go back to the hospital every day. I left the hospital with a hole in my foot, one week’s worth of oral antibiotics, and a newfound appreciation for what I had put my patients through.
So that is the story of the hole in my foot, and now I have a hyperkeratinized scar as a souvenir. It is not my only one though. Throughout the rest of trip, I fell from a motorbike, the number one tourist killer in Southeast Asia; got stung by jellyfish multiple times while scuba diving; scraped my knee while deep water soloing (a form of free rock climbing on sea cliffs); scratched myself on sea rocks, sea urchins. I have marks all over my body from all over Thailand.
It was a wonderful trip. Residency should be a breeze.
Getting an I&D in an Emergency Room in Thailand