18 January 2025
I took the 43 Masonic to the Kaiser building at the corner of Geary and Divisadero where, on the second floor under a Surgery sign, the Wound Care Center is doing business. Joyce had a 4 p.m. debridement appointment with Jennifer the RN.
Joyce had called me in the morning upset that she couldn't find her wallet. She has to pay for the wheelchair transport van with a credit card. I couldn't take her call but she left a second voice message to say she found it.
She called later worried about her incontinence, which seems to afflict her after lunch. Better now than later, I told her. She'd be empty for the appointment. And she was.
But the skirt I had brought her to replace the one she soiled had a big tear in it, she point out to me later. You couldn't tell because her dark slip masked it but I put that on my list of things to do.
We were both there early in case Jennifer could start earlier than 4 p.m. She only had a half-hour window for the debridement, which is pushing it, but she thought she could prep in advance, getting the supplies together, to make it work.
She did pop out five minutes early. I rolled the wheelchair into the small exam room, locked it and Joyce got up into Jennifer's arms and swiveled toward the exam chair, which levels into a bed, before she screamed, falling.
After she sat, Jennifer flattened the chair into a bed and got Joyce to roll on her side before Jennifer pulled her into position using her skirt. Which may have been when the skirt tore, come to think of it.
I lifted Joyce's leg so Jennifer could unwind the Ace bandage and she removed what looked like a new dressing. Apparently the treatment nurse changed her dressing in the afternoon for some reason (the incontinence earlier?). But we could still see a bit of greenish discharge on the abdominal pad used in the dressing.
That's also when Jennifer noticed the odor that had alarmed the treatment nurse. I can't smell so I was no help there.
She thought the wound looked very good. They had just debrided it 17 days ago, after all. The large dark area near the top, she thought, was just dead tissue. That was what she was going to debride.
It is also something of an abscess but not infected. So she had to dig with her Exacto knife to get in there.
Then she took three cultures of the wound to check for infection and cancer. She grabbed another nurse to prep the bottles while I held Joyce in position, opening the wound for access while Jennifer poked around.
Before she applied the new dressing, though, Jennifer made an interesting observation.
She detected the very beginnings of a base layer of skin growing along the muscle. I took a peek to see what she was talking about and found more of the same tissue higher up on that side. I'd never seen that before. It was either yellow slough or granulated tissue, not the smooth but thin veil I was looking at now.
She set up an appointment for Valentine's Day to do another debridement. We'll get the test results from the cultures by email in a few days but she wasn't concerned.
Joyce called St. Marks to come pick her up and the driver came a few minutes later, loaded her into the small van and off they went as I walked up the hill to Trader Joe's for a few things.