17 February 2022
Joyce didn't get into surgery until around dinner time and I didn't hear from Dr. Tong until about 8 p.m. after she had finished. The news was not good.
Dr. Tong was disappointed that the muscle showed less response than it had before. The good news was that there was no more yellow but there was not much bleeding. She's concerned that a layer of Integra would just not adhere to the wound in this condition.
She didn't tell Joyce yet about the setback but she's not giving up hope. Between the surgery and antibiotics (which are broad enough to cover anything until the cultures pinpoint what is actually needed), this gives the wound the best chance to heal.
Dr. Tong is concerned that Joyce keeps complaining that she wants to go home but I told her she complains at home too so let's just do what's best for her. Tell her the house burned down, I suggested.
The problem with going home is that it limits her to a life of wound care with daily dressing changes. That means some kind of permanent nursing besides me in case I don't live twenty more years.
But staying in the hospital with the antibiotics and weekly surgery (next Thursday perhaps) and the Wound VAC gives her wound the best chance to heal enough to accept the Integra and close the wound.
But after today's surgery, Dr. Tong was thinking that might take a month. She was hoping it would be next week but she thinks she was too optimistic.
Having been down this road before, I asked her what would indicate amputation. If she were in pain and the limb was useless, then it would make sense, she said. But she can use her leg and foot now so it doesn't enter into the picture.
It may take 10 years to close the wound, she said. I pointed out Joyce isn't young any more. Ten years from now she would be 81. But I also thanked her for not giving up on what's a tough case.
We talked quite a while. She was disappointed by what she saw but she promised to fight on and reserve judgement. Next week may be decisive.
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IT IS IRONIC that I had much the same conversation this morning with the dryer repair guy from Electric Appliance. I played him the recording of the noise and he identified it as the internal vent rattling but said there wasn't much he could do about it.
The floor, he pointed out, isn't level. Yeah, but the cabinet is. Still, he said, eventually, things will rattle.
But he took the thing apart. Completely. Top, front panel, interior panel, drum. All over the garage.
Then he put screws into anything on the vent that might move. Both ends. And taped the ends and the seam running the length of the vent. And then he tightened every other screw he could find inside.
It took an hour before he got it back together and ran a 15 minute test (those always go well). But it's hard to believe anything in there is going to rattle again. I'll find out Sunday.
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AS METAPHORS GO, this one isn't working out. Thumbs up on the dryer, thumbs down for Joyce.
Dr. Tong was not very encouraging. But she was candid and I appreciate that more. I've been looking at that wound for a while now and not very impressed with its healing powers.
I'm also not convinced that continuing wound care for 10 years is feasible, although I appreciate the danger of a more drastic surgery. As Dr. Tong said a fellow surgeon put it, where are you going to get the tissue and how does that not compromise her further?
I said to her I had no idea radiation would cause so much damage. And she said sometimes it does and sometimes you can't even tell. Lucky us.
Despite her disappointment tonight, she's withholding judgement until next week but that may just be time for all of us to get used to the situation.
Sorry to report such discouraging news.