Higher Institute of Medical Sciences
Hospital Dr. Salvador Allende
Havana, Cuba

April 2010

In the field of medicine one often times pushes the sense of smell to its limits.  The smell of decaying tissue permeates the circulating air breathed at the hospital.  One is exposed to number of very harmful germs that are resistant to some of the most powerful antibiotics.  Oftentimes I wonder how I manage to avoid getting sick.  Nonetheless, God is kind and protects me at all times.

In geriatrics most of our patients are in their late 80s.  Some of these patients are disabled and have family members that neglect them.  Frequently these patients arrive late at the hospital when their body has already started the process of decaying while still alive.  They normally have bedsores infected with some of the most harmful bacteria resistant to potent antibiotics.  Oftentimes, the wound is so deep that one can appreciate the anatomy of the patient’s bones.  The patient is usually in a confusional state due to the infected bedsores.  The smell of decaying tissue that comes from these wounds is quite insulting to the sense of smell.  One ought to really love medicine to be able to work around these patients.

This month was special to me because I was assigned to work with two patients that were practically decaying when they arrived at the hospital.  One of them in particular, was an elderly patient with a buildup of fluid throughout the body (anasarca) and wounds that had destroyed her buttock muscles and a number of other muscles in different pressure points of the body.  The decaying tissue emanated an unbearable odor that could be smelled meters away from the room where she was staying.  The surgeon visited the patient on a daily basis to clean up her wounds but, despite all the efforts and the powerful antibiotics, the wounds continued to emanate an unbearable smell until the day of her death.  Besides the wounds, she was also eliminating liquid through every pore in her body.  That liquid combined with the decaying tissue was just not a good combination.  Her body was very fragile and did not resist the severe infection that ended up claiming her life. 

It is unfortunate that family members often times wait until the last minute to seek medical attention for their loved one.  As a student of medicine one works side by side with these patients and we simply keep them company during their final moments.  It is not easy to work with these patients but, as a physician, one ought to always remember that we are God’s servants.  Our duty is to look after the sick.   

Sincerely,                                                                                                                                             

Alejandro Bernal
Website: www.pnhpwesternwashington.org
Email: alex238209@yahoo.com