14 August 2020
Dr. Tong called early this morning to let me know today's sponge replacement went well again. She said the wound looks very good and is healing well.
SEDATION
And while Joyce requires a little less sedation for the procedure, she still requires it. We aren't at the bedside sponge replacement stage yet.
Dr. Tong said she could technically do the surgery as an out-patient but it isn't very practical. It's not as if it can be scheduled and prep can be coordinated at home.
Today, in fact, was a fluke. There was an early cancellation in the schedule so Joyce got in before breakfast.
On the other hand, as you may recall, she had to wait until 11:30 p.m. for the first one.
So it's better to stay in the hospital as long as she requires surgery to handle the pain of the sponge replacement.
PAIN
Which brought up Dr. Tong's main concern. "She's a nice person," she said of Joyce. "She isn't telling the staff what her pain level is."
Dr. Tong sees her every day and discusses her pain level with her. And Joyce is candid, telling her where on the scale she is.
But when the staff checks on her, she's more inclined to tell them she's fine. So the staff is under the impression she can go home.
Not so fast, Dr. Tong says. She's not ambulatory.
And this can be a big problem if the wound leaks during the night or there's a problem during the weekend when the home nurse is not available. That would require a trip to the emergency room. "And we want to avoid that," Dr. Tong said (as she has said before).
"I'll suggest she be more candid with the staff," I promised Dr. Tong. Joyce probably tells them how much she loves the food, too.
WOUND VAC
While I had her on the phone, I asked Dr. Tong about the Wound VAC. Yes, it's on all the time (whether Joyce knows it or not). It's attached to her IV pole.
When she does go home, she'll have a much smaller unit so she can remain mobile.
And while the sponge replacements so far have all been the same large size, eventually they will get smaller and smaller as the wound heals.
OCCUPATIONAL THERAPY
Joyce has a physical therapist getting her out of bed and moving around now. And she will have some sort of out-patient physical therapy when she comes home, Dr. Tong said.
But she'll need some needs assessment for going home. And I'll get to consult. But it will be some strange combination of phone, video and perhaps in-person meetings. Something to look forward to.
[Ringing sound ...]
JOYCE CALLS
Joyce is on the phone.
She had no idea she had surgery. They woke her up, she thought the anesthesia wasn't working. And then they were wheeling her back to her room.
I tell her what happened.
She's groggy so I get my spiel in about pain levels. Gently at first.
It's confusing, Joyce says. They ask her what her pain level is and she tells them how she's feeling right then.
"Average it out over the day," I say. "Tell them how it feels to move around, get up, walk." It feels painful, I suggest. "Oh, and tell them how painful it is to eat the food!"
We have a laugh.
I tell her about the Wound VAC and how the sponges will get smaller. Eventually.
She tells me about the letters and flowers and money tree that arrived. It helps not to be forgotten in isolation.
"It's so hard," she says.
I say, "I know." But I really don't.