When I slowly opened his hand clutching a dirty, tattered bandage, I saw external fixation pins protruding from his knuckles. When I looked further, I noticed a heavily scabbed scar line, stitches still in place, along the entire length of his left leg. It turns out that almost 4 months ago, he was walking when he was hit by a car. He suffered open fractures of his tibia, fibula, and metacarpals. Tibia intramedullary nailing and external fixation of his fourth and fifth metatarsals stabilized the fracture. But after discharge he was “lost to follow-up.” We spent the rest of the afternoon cleaning his wounds, removing his stiches and his external fixation pins. Our nurse noticed that his toenails needed trimming so she did that also! Mr Thomas (not his real name) is a homeless man with schizophrenia who was seeking care at our office. Our office provides an enhanced primary care model for patients with serious mental illness (SMI).
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