What Smells Make You Wretch?

One evening we received a radio call that the paramedics were bringing in a homeless man for evaluation. This is not uncommon -- homeless people often end up in Emergency Departments for many reasons: acute illness, hypothermia, hallucinations, injury. The list is long.

A 50--60–year-old overweight man -- alert, a little confused, having slight hallucinations -- was delivered via ambulance. In order to evaluate him we of course had to remove his clothes and put him into a hospital gown. This is usually a simple task; this evening, though, it wasn't. His clothes were stuck to him, he had not been able to bathe in months and his clothes would not come off. We started to moisten them to help get them off without causing any damage to his skin.

Once we were able to evaluate the condition of his skin we found a layer of dirt and old skin that was quite thick, something like an elephant's skin. The smell was so overwhelming we had to take turns, leaving the room gagging. Smells are my trigger. It is a problem, because you can't stop yourself from wretching but you also want to be considerate of your patient.

This is not to make light of this man’s plight; he was severely mentally ill, he was homeless and in terrible condition. According to the Substance Abuse and Mental Health Services Administration, 6% of Americans are severely mentally ill, while 20%-25% of homeless suffer from severe mental illness. 

I was wondering, though, what makes you wretch in a clinical setting? Please share.