6 October 2021
Joyce called when I was paying my mother's bills to tell me Dr. Tong and Cat the Physicians Assistant wanted to meet with me this afternoon. "Any time," I said.
She called again as I was turning the car around to come home to ask if I could be there by 3:30. "No problem," I said.
The trick to getting things done is to, uh, do them.
I went early and was waiting for the elevator when Cat called to say they were running s little late and would 4 p.m. or a little later be OK. "Sure," I said, "but I'm here now." She agreed to meet me on the floor shortly instead.
So it goes.
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IT WAS A 16 MINUTE DISCUSSION I recorded on my phone and sent to Joyce later so she could digest it.
Joyce was in a lot of pain during the dressing change today. So the plan is to do another dressing change in the hospital on Friday. After that, Dr. Tong is agreeable to sending her home with a portable Wound VAC.
I suggested it might be preferable to keep her overnight on Friday to see how she does with the portable so any problem can be addressed on Saturday. I'm concerned about a problem over the weekend when no one is available to deal with it but me.
If everything goes smoothly overnight Friday, they can release her on Saturday. In-home care can the dressing change on Monday.
Dr. Tong thought that was reasonable, although Joyce wasn't happy about it. We'll see if the portable can be supplied before release and if we can get in-home nursing set up for Monday.
Otherwise she would be released on Monday.
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NOW THE GRITTIER details.
Five days ago they took a culture of the yellow slough and found, in addition to the normal staph bacteria you find in open wounds and even on your skin, there was an additional minor infection. So they have begun an antibiotic course of ertapenem which she will continue with pills when she returns home. Dr. Tong wasn't concerned about it.
But the infection, such as it is, precludes a Covid-19 booster for the time being. Dr. Tong assured me that Joyce would get the flu vaccine before she leaves the hospital, though. She doesn't want her running around to get vaccinated.
Neither the nurse nor the doctors seem to know how to get that done. But Dr. Tong asked Cat to look into it and they did reference my email asking about it so they are aware of the issue and plan to address it.
On the wound itself, the yellow is gone and has stayed gone, Dr. Tong said. So the month-long hospital stay has been worth it. She apologized she couldn't do it sooner.
On the other hand, though, there hasn't been the tissue growth she'd like to see. There are a few small spots that are promising but the fire hasn't started yet. The wound is smaller and the skin is closing in somewhat but the pink tissue isn't actually growing yet. Dr. Tong attributes this to the original radiation which retards growth. "It tends to want to go backwards," she said.
In addition, her large exposed muscle is not reacting well to stimulation. It's very weak, Dr. Tong said. I don't think Joyce notices any weakness as she walks around but climbing stairs might be another issue. We'll see.
Dr. Tong will order a dressing that consists of 1) a Lidocaine coating on the wound covered by 2) a petroleum liner (the Adaptec) and 3) the black foam. Eventually she hopes to eliminate the Adaptec but it makes the foam removal less painful right now so it's helpful.
She wants to see Joyce at the clinic every few weeks (three to five, she kept adjusting as she spoke) to keep an eye on the tissue growth. But she expects to close the wound with a skin graft by the end of the year unless Joyce wants to avoid surgery during the holidays.
The alternative to the Wound VAC is the two-a-day wet-to-dry dressings. But we didn't make much progress with that approach. And we're near the finish line.
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SO THE GIST of that 16 minute chat was that this hospitalization has been necessary but remedial treatment and we're still waiting for actual progress in tissue growth so the wound can be closed.
"It's been a very long time," Dr. Tong said. "And I'm sorry about that."