My brother had wound vac treatments when he was injured last May. They helped his wounds heal a lot faster than they would have normally. (Long story that...accident during a training exercise at Ft. Bragg). Highly recommend the treatment if insurance covers it. Apparently the sponges that are used for the treatments are hella expensive.

thanks wolf. I hope she gets fixed up soon.

I don't know why, they're basically just sterile audio foam... oh wait, audio foam is hella expensive too.

The Adventure Continues ...
 

So, this past Monday, crazynurse was supposed to go directly from dialysis to wound care, because it was really gross looking, necrotic tissue and all that.

Purulent discharge is a bad thing.

So, of course she didn't. Despite having this mess seen by an ER physician on Saturday, who was clearly an idiot who skipped Anatomy class, the dialysis doc on Monday says something on the order of, "Well, you're scheduled to see wound care on Wednesday," and she accepts this statement and goes home.

Her daughter tells me that she gags when she does the dressing changes.

Living things don't smell like that.

So ...

Wednesday afternoon I get a panicky call from her, from dialysis. She says, "wow, this thing is worse. I'm going up to wound care."

Waitaminnit ... didn't you go up to wound care on Monday?

No.

Okay, then. You sound like you need some support, I'll scoot right on over to the hospital.

Then she decides that I should just go straight to the house.

Against my better judgment I do, only to learn that my housekey no longer works ... apparently they changed the locks sometime in the last 25 years (I'm told, btw, that my key probably still fits the basement door, but I haven't bothered to try it).

And so ... since it's stinkin' hot, I drive over to the hospital.

And get to wound care just as they're peeling the gauze off her.

REALLY stenchy. Worse.

The doctor there is snipping bits here and bits there, and dabbing at some of the ooze.

He doesn't seem concerned.

crazynurse at one point mentions that she wants to maybe go to the emergency room, or see the parent hospital's wound care center. (We're doing all of this at Abington-Lansdale, formerly Central Montgomery Medical Center, formerly North Penn Hospital. If you know the area you know ... YOU DON'T GO TO THIS HOSPITAL UNLESS YOU'RE UNCONSCIOUS AND DON'T HAVE A CHOICE. Now that they're under new management, things are getting better, but it's in stages, not all at once.

What does the doctor say to this perfectly reasonable statement about wanting to manage one's care more aggressively? "Why would you want to do that?"

I get crazynurse home. She tries to make contact with the specialist tatadoc recommended. He's out of the office, and is in surgery all day Thursday, but his receptionist tells crazynurse to call the Abington Wound Care Center.

I've had contact with these folks. They are AWESOME. momwolf went there after her abdominal surgery.

So, of course they're closed, but crazynurse leaves messages and will call again Thursday morning to try to secure an appointment, otherwise, we're heading for the good ER, at Abington Memorial Hospital.

Next morning comes, I'm over at crazynurse's house with Egg McMuffins and apple juice (she can no longer mount the one step into her kitchen and can't feed herself, and her offspring aren't doing anything to help her. She has already made the call to Wound Care and they've given her an emergency appointment.

Load her and her wheelchair in her car (as big as my car is I can't get a wheelchair in the trunk even when it's empty) and off we go. Other than an argument about the best way to get to the Wound Care Center. I reminded her that 1. I've been there before and 2. If I go her way I add about 5 miles and at least 20 minutes to the drive with the traffic and lights and stuff, and we're already going to be late.

So ... we get there, and the staff are as awesome as I remember.

The wound care nurse, who sees a lot of bad stuff, recoils from the smell, and gently says, "I think you should start mentally preparing yourself for the possibility that you may need to go to the hospital."

Told her ... yeah, way ahead of you on that one, crazynurse packed a bag.

The surgeon came in, glanced at the wound, asked why crazynurse let this get so far ... politely told him "because the other doctor is a gaping moron and she listened to him."

"You're being admitted to the hospital. I'll do surgery tomorrow to see what we can do to preserve the limb."

So, he takes charge, he's fast, and proactive. I'm digging him.

Less than 45 minutes later, including the drive over and processing all the paperwork, she's in a bed.

Abington Memorial Hospital, incidentally, has grown quite a bit since I was there as a teenager. The original hospital is now called The Elkins Building and there are multiple buildings on the campus, including two parking garages. Not to shabby for a suburban hospital.

Surgery was yesterday afternoon. I didn't get to see her beforehand because they took her to preop straight from dialysis.

So, I waited.

The surgeon came out to see me before he started ... didn't seem to be common practice, there weren't a lot of docs coming out and talking to families ... information is passed through a dude at the desk in the waiting area.

Doc also called me at the conclusion of the procedure, in which he cleaned out a lot of infected tissue. The bad part: Her achilles tendon was ruptured AND infected (shame on you, ER doc who said, "there's no damage to your tendon"). It's unclear at this point how severe her disability will be. The good part: The infection has not gone into the bone.

Finally, her daughters show up ... around 6:30p. Surgery had been scheduled for 3.

Okay, my family is different, but you show up for shit like that. Without question, and without pause.

And they were going to leave before she was out of recovery, but we finally got word that she was headed up to her room, so crazynurse at least got to see her grandchildren (one of whom went to some teen youth group outing instead of coming to see mom-mom).

I hung around a bit after they got crazynurse back into bed. She was awake, alert, and doing pretty well, all things considered.

As a bonus, I overstayed visiting hours and didn't have to pay for parking. I did, however, find out that it's the same cost to self-park as it is to use the valet service.

A word about the family waiting area ...

I've been in a LOT of family waiting rooms.

Usually you get a couple uncomfortable chairs in a small windowless room, have to wander around half the hospital to find a bathroom, and get limited information.

Not at Abington Memorial Hospital.

The room is large and spacious.

It's in a six story atrium, open all the way to the skylights at the top.

And there's a tranquility fountain.

Usually this means a small to moderately sized bowl of water that makes a trickly noise.

This thing is the height of the floor below the waiting area, and about twenty feet wide, so it gives extra tranquility.

The photo really doesn't give the proper sense of the immenseness of the space. The family waiting area is that first level up from the fountain.

Good on you Wolf. You're a great friend.

:headshake This happens so much more often than people think. She's lucky to have you, wolf. Keep up the good work.

Four out of five doctors think the fifth doctor is an idiot.

85% of.....

wolf. you rock. thank goodness you're there for her.

Maybe there are reasons we have so many malpractice suits... like awful doctors. She is so lucky to have you as her advocate. That level of incompetence is shocking. Something is very broken when people like that are allowed to practice.

Wow that is some grade-a scary shit! My dad has been diabetic for years but completely in denial about it. He's finally supposedly doing something about it (he's said that before), I'm thinking about making him read this thread. He also gets frequently wounded with his handy-man do-it yourself take to home repair and his job as a fireplace technician.
You're friend is very lucky to have you and I'm glad to know my 'rents would never be in the same situation with us kids. My sis would definitely take care of them. :P

Wolf, your friend is definitely lucky to have you by her side. I hope she's doing better.

As of last night she has a wound vac, infectious disease is trying to come up with a cocktail of antibiotics and antifungals that will be effective, and I haven't heard anything about how the cultures have come back in terms of exactly what it is that's been eating away at her insides.

I am hoping that my friend heard wrong when someone mentioned discharge as early as tomorrow.

Since she definitely heard wrong that she was permitted to be weight-bearing on her injured leg, there is a good possibility of this.

Last night her mother was on the phone begging me to be there at the hospital when the social worker met with crazynurse. I suggested as politely as possible that either the daughter who will continue to live with her should be doing that, or maybe the sister who is a nurse practitioner ...

What a nightmare, Wolf! Your friend is very lucky to have you. Maybe there is a silver lining of sorts to you being unemployed at the moment? I bet you couldn't spend so much time with her if you were still working your regular job.

I certainly hope she doesn't lose her leg. I had a friend whose dad was diabetic, and the docs had to keep cutting off first his foot, then his leg at the knee and then finally at the thigh. Diabetes sucks. Getting old sucks. ER doc's all too often suck. I have had enough experience with them both personally and with friends that I don't trust them one bit. Thirty years ago, I was in a major accident and the ER doc on call picked that particular night to get drunk on his ass. I was in bad shape to begin with and he almost finished me off. He later TEMPORARILY lost his license due to his alcohol and drug abuse. Then the hospital or the AMA or somebody gave him his license to practice back. He proceeded to actually kill a patient while drunk. I guess I was lucky, but I still have health problems to this day due to what Dr. "It's 5:00 Somewhere" did to me. :greenface

You and your friend are in my thoughts.

Couldn't have said it any better myself.

Actually, I just did.

Sorry to hear about your experience with Doctor Drunk&Stupid. shame on his cow orkers for not diming his ass out.

I have actually done this ... had a shrink come in drunk for night call. Had to call the medical director and find a diplomatic way of asking her to blow into the little tube.

There are a lot of really good ER docs out there, some of whom have chosen to specialize in emergency medicine because they actually like it. But you also get a lot of jackasses who are just looking for the money and are hoping for a slow shift in which to make it.

A social worker met with crazynurse yesterday, because they are starting to look at options for discharge ... not home, but to an extended care facility, which is the polite way of saying "nursing home," which is a polite way of saying "warehouse for the dying" in a lot of cases.

We've got several people working on trying to ascertain, as best as is humanly possible and then some, that the facilities they're offering are not vile pits of suffering.

She already knew enough to reject two of them out of hand.

There are a couple of complications that are limiting the choice of an agency. The first is that she remains on a wound vac, and not a lot of nursing homes take patients with them. She is also non-weight bearing on that leg, and therefore essentially non-ambulatory.

And then there's that she's not sylph-like ... she's short, but her BMI is over 50.

And there's the dialysis.

There seems to be one nursing home with on-site dialysis services, but it falls in the category of vile pit of suffering.

The leading candidate on offer has good surveys ... in their last three state licensing surveys they had two with no deficiences, and one in which they were cited for having offered a straw to a patient who wasn't allowed a straw, and for two instances of staff not having had their TB tests. A re-survey showed that these deficiencies have been addressed and corrected.

In practical terms this means that facility's paperwork is pristine.

They could still suck, but their documentation is excellent.

One of the problems that I have is remembering what the place used to be called. Nursing homes change names faster than porn stars, so while the current name isn't doing anything for me, the old one may make me go, "ooooh, no."

We are being limited by geography on the choice ... there are several good facilities we know of, but they are out of the service area for the good hospital, and, in fact, would be in the service area of the hospital that screwed up my friend on more than one occasion ... this current event, as well as mismanaging some medication doses while she was inpatient seven or so years ago that lead to severe nerve damage and caused her mobility problem.

So, we continue to wait and see.