10 February 2022
Joyce's Covid test was once again negative, we learned promptly the next day.
And that Wednesday she went another round with Julie the Physical Therapist, walking around the block and discussing the benefits of KT tape after working with a small and squishy exercise ball.
"Just call me if you want to try it and I'll run over to put it on," she said. Turns out she's a neighbor.
That was after Salwa the LVN had changed her dressing in the morning. We're the only client Salwa has outside her territory, she told us. Which is Hunter's Point. She's not letting us go, she said. She wants to see the wound healed.
And this afternoon we went back to the clinic for a pre-surgery conference with Dr. Tong. This was our chance to clarify what the plan is. And it is pretty much what I expected from our previous chats.
Tomorrow at 5:30 a.m., I'll drop Joyce off at Kaiser Geary (the same place she has been going) and Dr. Tong will get her into surgery as soon as she can get an operating room.
This was our chance to clarify what the plan is.
She'll debride the wound, removing the yellow slough. And she'll take cultures of the wound tissue to determine if and what kind of infection is brewing in there.
The wound does not smell infected, the nurses all tell us, but bacteria inhabits everything everywhere. And it's important to clean it up before applying the Integra or the Integra layer won't bond to the wound.
She'll keep Joyce there on a different kind of Wound VAC after the surgery and bring her back to the operating room as necessary to keep the wound clean. She can't predict how often this stage will go on, but she has to see a clean wound before proceeding.
I asked if it would take two weeks to run a course of antibiotics. It might, she said, but it might be less. She's being optimistic, she said.
At that point they can try the Integra. And once it is laid in the wound, covering the tissue and muscle, they'll again close it with that special Wound VAC. But then they can send her home for at least three weeks, with weekly visits at the clinic to check on it.
We'll also have in-home nursing but they won't be permitted to touch the dressing. The danger is that the silicon layer that protects the outside of the Integra might become damaged, scuttling the whole thing.
So in-home nursing will just be checking for problems and checking Joyce's vital signs.
If, after that time, everything looks good, Dr. Tong can close the wound, grafting skin from her other thigh to the wound. She can come home to in-home nursing as she recovers from that.
Joyce is quite worn down from all this, hates Wound VACs of any kind, and doesn't want to stay in the hospital at all. She was crying on the way home that she doesn't want to do this.
But she hasn't been herself lately. And, as Dr. Tong said, that's the point of all this. To return her to her life again.