20 April 2024
It took a while to get an appointment with Jennifer Spitnale the RN at Kaiser's wound care center, recently relocated from Walnut Creek to Geary St. in San Francisco, close to the hospital Joyce is not fond to return to. But yesterday was the day.
BUT WAIT
Unfortunately, an hour before we left my attorney in the Alfa case against the mechanic who lost parts and refused to finish the job called to tell me to bring the registration to court on Monday. After winning arbitration for more than we paid Garcia but not enough to get the car repaired and attorney paid, we opted to go to trial. And Monday is the day.
So I looked around for the registration but only had the 2023 registration, not the current one, which would have been paid at the same time my mother passed away last year.
Joyce couldn't find an entry in her check register so it appeared she just neglected to pay the registration for this year.
Our appointment with Spitnale was for 2 p.m. for an hour. That's plenty of time to drop by the DMV, wait an hour and pay for the registration.
WOUND CARE
I dropped Jouce off in front of the building and parked the car, getting back to the waiting area just as Spitnale is taking Joyce in. We go into the same little exam room we had been in a long time ago.
Spitnale talks about nutrition (you need lots more protein than usual for wound repair) and a daily vitamin (Joyce is taking them ) and not sitting on the wound (compression is bad). She tell us Greek yogurt has a lot of protein.
Joyce was quite confused when I let her out of the car and I see she is hesitant to answer Spitnale's questions. It gets worse as the afternoon wears on.
Meanwhile Spitnale orders a few blood tests (primarily to check wound conditions like zinc levels) and sets up another appointment in five weeks.
In the crisis over the Alfa registration, I'd neglected to bring Mepilex bandage. But Spitnale has them. She thinks they are just the right size for the wound. But then she puts them on opposite of how Kristin ethe LVN and I do.
When she looks at the wound says she smells an odor, which is odd because Kristine hasn't mentioned it. After debridement, she takes a culture to test it for an infection.
I confirm that the Vashe has helped slow down the slough. She says we shouldn't use Dakin's more than two weeks at a time. Which is the first time I've heard that.
She does some debridement but she has only small tools, she says. Joyce does some screaming, lying on her side in the chair that sort of flattens out. She did take Tylenol, though.
Spitnale shows me how she wets the Kerlix quite heavily with Vashe and stuffs the wound more aggressively than I do. She adds an ADP and then the Mepilex. And gets us a new Ace bandages. She brought Joyce a mask too.
I had discussed surgery with her. She asked what Tong is thinking and I say I think she's reluctant to try the Integra because it may not adhere. And as long as things are going well, we can keep doing this, but surgery is in the future before the wound closes. We aren't doing maintenance. Tong was afraid of cancer developing in the open wound, which Spitnale acknowledges is a problem.
She confirms the lab is open late, so I plan to go to the DMV to pay the late registration and then back to Kaiser to do the labs before going home.
WE INTERRUPT THIS EPISODE
Which is what we do. I dash up the hill to get the car, pick up Joyce (who calls me on her phone to tell me she's waiting outside as I asked her to), drive over to the DMV, drag her up to the office while we wait in line for about five minutes.
"What are you here for, sugar?" the check-in lady asks. I tell her I want to pay a late registration. We get an 'I' number only five from where they are.
But 'I' numbers don't come up very often, as one big woman complains loudly. She says she's been there two hours already. And she's before us. It seems like we're waiting almost an hour. Someone gives Joyce a seat, fortunately.
When we finally get to the window, I give the woman the registration from last year and she tells us it will be $215. That's about the $150 registration plus a $60 late fee. Joyce writes a check but asks me to confirm the date, who it's to, how much and what for. Twice. Once for the check, once for her register.
But it's hardly any time at all at the window. The clerk prints out the registration and gets a sticker from a locked drawer she staples to the registration and off we go.
BACK TO THE LAB
I get the car, pick up Joyce at the side of the building where a nice guy holds the door for her when she falters and we drive back to Kaiser.
I let her off and direct her (repeatedly) to the lab on the second floor by the stairs. She keeps forgetting where she's going.
I park by the school on Geary, the building named for Burl Toler.
She's waiting when I get to the lab. The queue system is out of sync on its numbering so a woman is manually calling the numbers. Joyce remains confused when she finally gets a station number for the blood draw, getting the registration and station queues mixed up.
I take her to her station where the tech draws eight vials of blood. Oh my.
I help her put on her two coats and we walk back to the car together. It's only two or three blocks and flat. So she gets some exercise.
I go home along Divisadero and up Market. But it's after five by then and the traffic is not light. I think of stopping at Mollie Stone's for dinner but then decide to make shrimp risotto.
A decision which seems to put everything in place after a hectic afternoon.