28 April 2022
Just to confirm: Joyce is back home. It was a whirlwind tour, though. She spent the night in Kaiser hospital after Dr. Tong debrided her just before dinner. She couldn't eat a thing, she told me.
A nurse called me from the recovery room to tell me she was still alive and even put her on the phone. At which point I was expecting a ransom demand. Instead, I told the nurse we wanted to leave before noon to make our hyperbaric appointment at St. Francis.
Oh, you should call "the team" around "sevenish" in the morning, she said. Which revised my plans to sleep in.
I did get up at 7:30 and called the nurse who mistook me for the doctor and wanted to know why I hadn't placed an order to that effect. Believe me, I was tempted. But we straightened it all out.
I drove over there just before 10 and went in disguised as a visitor (even though I misremembered the room number). She was sleeping.
A really terrific nurse had already gotten the ball rolling, despite a number of confusions, so we did get out of there on time and were even early for our regular 12:30 appointment at St. Francis.
That's how I roll.
I had helped the nurse with the dressing change, observing yet another approach to the topic while describing what I used to do. He thanked me for my help when I left to get the car.
But that was only lesson one of the day.
At St. Francis, I showed the team photos of the debridement I had just taken and Hawkeye, a wound care specialist filling in for Jessica the RN on vacation this week, gave me lesson two.
He explained how wounds heal, with the skin itching to close but needing some tissue to climb over. And how radiation damage suppresses that growth. So you want to be careful not to inhibit blood flow to the wound by compressing it (like sitting on it).
We also talked about the slough and how Santyl (of which we had just acquired three tubes) attacks the slough and makes it easier to remove with the mechanical debridement of wet-to-dry dressing changes.
I confessed I've had trouble applying the slippery Santyl to the wound and he gave me three different ways of doing it I'd never tried.
I asked him if he had any experience with medical maggots and he said he had seen them work. You have to count them as you put them in the tea bag applied to the wound and count them when you take them out, but they do work. Patients can feel them wiggling around in the wound. Their enzymes absorb the dead tissue as nutrients and leave the good stuff alone.
Kaiser doesn't do medical maggots, Dr. Tong told me a while ago when I asked. But it was interesting to hear someone who had some experience with them. In fact, chimed in Thurman the Director (who was eavesdropping on our conversation), he often saw maggot-infested wounds in homeless people and when they shook out the maggots the wounds were pristine.
More than you wanted to know, I suspect. But I appreciated the conversation. Who else can you talk to about this stuff?
Joyce was in the chamber all this time. So she didn't hear a word.
But tonight she was the beneficiary when I did the dressing change and tried one of Hawkeye's methods for applying the Santyl. Worked like a dream.