18 April 2022
She hates this. She doesn't want to do it any more. It's painful.
I try to keep that in mind as we jump through all these hoops. That's why, when Diana called this morning to say she couldn't get us an appointment at the drive-through Covid facility at French, I told her to reschedule the surgery.
That's not a small deal because getting operating room time these days is difficult. But it wasn't our mistake either. When the surgery was scheduled, the Covid test should have been scheduled. This time they'll do them both.
"She's disabled," I explained to Diana. She knew. She was good about it. I had her on speaker phone and Joyce appreciated her cooperation.
Diana tried to expedite the appointment at French but couldn't. So she talked to Dr. Tong, who said she'd reschedule for next week. End of issue.
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JOYCE WAS STILL on the wet-to-dry dressings this morning but I didn't want to put another one on for the day. We haven't heard from in-home nursing about putting a Wound VAC dressing in today. Which is odd. They must be planning on 4 p.m.
Some time ago I wrote out a long checklist for Wound VAC dressing changes, mostly to make sure I could coach the various RNs an LVNs who have to do Joyce's. It's been handy because there's a lot involved.
So I know what to do and I've done parts of the dressing change like fixing leaks and changing the lily pad and taking the whole thing off to put a wet-to-dry dressing on.
All that was missing, really, was cutting the foam to the right shape. I felt completely competent to do this.
Joyce had taken a gram of Tylenol but that was all. Since we only had to remove a wet-to-dry dressing, which bothers her much less than removing the Wound VAC dressing, I thought we could get by on that. And we did but it would have been better to have the Hydrocodine, naturally. Any pressure on the muscle sends her to the ceiling.
We've been having trouble the last two Wound VAC dressing changes with quieting the pump, even with no apparent leaks. I suspected the foam is too large, overlaying the edges of the wound, which are protected from maceration by drape. What if, to have less air to move, we cut the foam to fit inside the wound, like we used to do?
The other question lurking in my mind was about the drape itself. Could we possibly use fewer seams, bigger sheets?
So I thought it would be worth testing those things this morning. If it was inconclusive or a bust (requiring a wet-to-dry dressing again), in-home nursing would ride to the rescue later today. If it worked, we'd be fine until Wednesday's dressing change.
So I gave it a shot.
I removed the wet-to-dry dressing and again saw good blood flow in the wound. I applied some Medihoney to the slough near the top of the wound but stayed away from the muscle.
When I measured the wound it was 7.09 x 3.15 inches. That's smaller than the nurses have been measuring it (but I did a lot of measuring in my graphics arts career, not to mention cutting with scissors, so I'm quite precise). I had noticed, doing the wet-to-dry dressings, that the wound is smaller than it was. Hard to see in pictures.
Then I framed the wound in drape but I used a lot less drape than is usually employed. I just followed the contours. Graphic design again.
I drew an outline of the wound with a Sharpie on a piece of plastic used to protect the foam. When I placed it over a medium-sized foam, it fit lengthwise and was just a bit too wide. So we don't need to cut down the large foams. We can use the small ones.
I snipped it into shape and fit it to the wound. I saved a strip I'd cut off for the bridge of foam that goes from the wound to the outside of her thigh where it connects to the lily pad so she doesn't sit on it.
Then I covered the foam with a single piece of drape. No seams.
I cut a hole in the drape on the foam for one end of the bridge and draped that down. I cut another hole in the other end of the bridge for the lily pad and tacked that on. I reinforced the lily pad connection with drape and turned on the pump.
As it has lately, the pump needed a little help getting suction but as soon as it hit 50, it jumped to 125. I heard some hissing from leaks and ran some SurePrep over the drape to see where they were and patched them. The pump gauge sank quietly into the green part of the bar chart, where it hasn't been for a six days. All was good.
It took less than an hour (less drape cutting), my coffee still warm when I finished. And Joyce is back on the Wound VAC, which is one big reason the wound is smaller.
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IN AN HOUR we go back to St. Francis for another session as if nothing had happened since we were there Friday.
Today's movie is Good Morning, Vietnam with Robin Williams. Kathy the LVN was just a kid when all these movies I've been bringing in were made so she doesn't know any of them or the actors, for that matter. But if she doesn't know Robin Williams, I'm going to tell her to lie to me.
And if she does know who he was, she'll get a kick out of Joyce's story about running into him at the Green Apple bookstore.
For my part, I think I'll be hearing Robin's robust, "Good morning, Vietnam!" over and over in my head. It's been that kind of day.