random

I kept some notes. Here's a couple:

11/15/08 6:15 PM
Dinner was horrible. Overcooked, cold fish patty w/ tartar sauce. Cold, undercooked "french fries" (barf). Vinegary cole slaw (barf). Brownie (OK). Cranberry juice, milk, hot tea. Could only eat fish patty.

11/18/08
Roomy's name is Rigoberto. I know because they put his mail on my bed while I was in PT (Physical Therapy) with Nancy and Al. He actually turned off the Spanish Blaster (TV) at 11:15 PM tonight. I got to watch Seinfeld without competition.

11/19/08
One good thing about this place is that, with the exception of IV's (usually), they won't wake you up when you are sleeping.

You can see from the foregoing that being in the hospital is a real hoot. The CHW Life Care Center at South Mountain houses mostly old timers doing their last burn and fade. Sort of a "you can check out but you can never leave" scenario. They keep most of them in another "ward" that I call the Land of the Lost or the Sleestack Ward. They are turned loose during the day and crowd the hallways like chickens in the yard.
My roommate Rigoberto is paralyzed and spends his day watching Spanish language TV at extremely high volume. His visitors talk over the TV and the volume is increased accordingly. If I could understand more than a word here and there, I might find their conversation interesting but I doubt it. Anyway, I've gotten used to it. Rigoberto doesn't talk much, he just lays there and watches extremely strange Mexican TV. When I get my fill, I hop in my wheelchair and join the yard birds.
The nurses only come to start and complete the antibiotics if they come at all. They take their time and apparently operate without supervision. They move around the different wings so I rarely see one for more than a day or two at a time except for my favorite, the wound specialist named Sam. She has the touch of an angel and even came in on her days off when I first got here and special attention was needed due to the condition of the lower left leg. Sam's worth a letter to the editor regarding a real health professional.
Physical therapy is handled by the bullies. They all must have failed as PE teachers and now take it out on the weak and infirm. They try to rush things through early in the day because they get to leave when they've seen their patient quota (around noon).
The crap work (sometimes literally) is handled by the CNA's (Certified Nursing Assistants). Some are good (Carlos) and some seem to hate their jobs (Adelina). I hit the call button more often for the latter just to aggravate her. All nations are represented by this crew with Mexico and South America holding a wide margin over Africa and the Philippines.
The doctor is sighted least of all. I see mine about two times a week and she's always in a hurry. I think she has a second job.
Well, I think that's about it for the hospital stories. It hasn't been fun for me to be locked up for what will be five weeks when all's said and done and I'm sure this is a downer for you readers so let's get this Hootenanny back on track. While I get things in gear, check out the new Killers tunes uploaded for your listening pleasure. Hasta!

the wound vac

After surgery, they slapped one of these puppies on me. No problem. At first. The wound vac dressing has to be changed every two days. I'd down two Percoset and two syringes of morphine sulfate through the IV but that did nothing to kill the pain. Old sponge out, new sponge in. A real treat I wouldn't wish on my worst enemy (save one who shall remain nameless). Here's the skinny on this device.

When a patient has a large wound or pressure sore that is proving very difficult to heal, this device may be used to promote and speed up the healing process. The name for the device comes from the acronym Vacuum Assisted Closure. The device is a portable vacuum pump attached to a special dressing which helps provide a reduced pressure environment within a wound.

A range of wound sizes may be treated and the user would initially select the appropriate dressing required. The disposable foam dressing is first cut to the correct size and shape and then packed into the wound. An occlusive clear drape is then applied over the foam. A small hole is made within the drape and the tubing-dressing pad is applied over the hole. The tubing is then connected to the pump and when it is switched on, the wound negative pressure therapy commences.

An easy to use touch screen display allows the user to select the appropriate therapy setting and should there be a large amount of exudate (excess fluid) collected within the canister, an alarm will indicate that it requires emptying. A filter system within the canister helps reduce wound odor.

The Pump can operate on battery for up to four hours and display a message on screen when recharging is necessary. There is also a user’s guide for recommended guidelines for treatment and therapy protocols. If the pump does alarm, it will also advise staff how to proceed.

The VAC Pump is used mainly in the surgical, trauma and orthopedic practice areas where more patients present with open wounds. Reducing the time it takes to heal a wound would hopefully mean a patient spending less time in hospital and more at home.

By creating a negative pressure under the special foam dressing, the VAC Pump helps to draw the wound closed. Also, if there is a great deal of fluid coming out of a wound or accumulating under a skin graft, the pump gently draws it away into a storage canister. This has the effect of improving the blood supply to the wound and promoting healing by removing the pressure that excess fluid (exudate) creates.

The pressure within the wound can be pre-set on the VAC Pump and maintained due to the construction of the tubing used to connect the dressing with the Pump. It has a central core to channel the exudate away but also has a separate sensing path to constantly monitor the pressure within the wound and feed back the information to the Pump. This allows the patient to move about without the fear of disturbing the wound environment. The pressure would be set relative to the patient’s needs, taking into account the size of the wound and how much exudate was being removed.

debridement

The great thing about surgery is the anesthesia. When I regained consciousness about an hour and a half later, I hadn't felt a thing and still didn't register any pain. Of course, I had a full tank of post-op morphine sulfate and a pile of warm blankets. On my right, a nurse (I assume) was typing furiously into a laptop on a small platform, apparently recording the essential data of consciousness regained. She asked a few questions to determine whether I was aware of my circumstances and assured that I was, left to seek the surgeon, an orthopedic specialist, to discuss his findings. He soon arrived bedside, still in full surgical garb and gave me the news.

It was good news. The infection was "superficial". It did not compromise any critical tissue. Both muscle and bone were not infected. My leg would remain intact and recovery would likely be complete. With a couple of divots, as another surgeon later quipped.

Without further delay, I was wheeled by the transport squad to my new digs on the 6th floor. It was at this time that I noticed I was attached to a small machine that made an audible whirring noise. I was informed that it was a "wound vac" and that it would clean and drain the debrided area. I did not yet know the extent to which this torture device would come to dominate my stay at St. Joe's.

part one: i am admitted

St. Joseph's Hospital and Medical Center
I called 911 Wednesday morning October 29. This was shortly after calling the hospital to check on the possibility of coming over in a shuttle. Informed they don't provide that service, I was advised to call 911 and arrange transportation accordingly. City of Phoenix emergency personnel arrived in about 20 minutes and after suggesting I take a cab, finally and reluctantly agreed to transport me via ambulance to Catholic Health West affiliate St. Joseph's Hospital and Medical Center in downtown Phoenix. i was laid out, strapped in and rolled into the ambulance on a stretcher and stared at the ceiling as we headed downtown to St. Joe's. I wasn't in pain though I think I was in shock. You probably would be too if you were in my condition.

Gangrene is a complication of necrosis (i.e., cell death) characterized by the decay of body tissues, which become black and malodorous. It is caused by infection or ischemia, such as from thrombosis (blocked blood vessel). It is usually the result of critically insufficient blood supply (e.g., peripheral vascular disease) and is often associated with diabetes and long-term smoking. This condition is most common in the lower extremities. The best treatment for gangrene is revascularization (i.e., restoration of blood flow) of the affected organ, which can reverse some of the effects of necrosis and allow healing. Other treatments include debridement and surgical amputation. The method of treatment is generally determined depending on location of affected tissue and extent of tissue loss.

In just around 72 hours, I had developed gangrene from what started as mildly painful swelling in the week preceding. Much of the tissue surrounding the calf muscle was now loose, hanging, black tissue and smelled to high heaven. It was "malodorous". Or, to put it bluntly, It stank. It stank bad. Like "empty a roomful of people" stank. Folks noticed but were too polite to mention it. Until I got to the hospital.

We made it in to St. Joe's Emergency Waiting Room and I was hurried right on through to see a doctor. He didn't even have to see the affected area before deciding to admit me. I was admitted due to the odor. I was moved to ER Examination Room Four and visited by a parade of surgeons who, after removing the wrapping and viewing the necrosis, agreed on one point; I would lose the leg from the knee down. In fact, they surmised, had I not come in when I did, I could have lost the entire leg including the knee and even my life as we chased the infection through the bone. I was "lucky" they said. Actually, I think I was in shock as the concept of losing a limb just didn't register. Lose my leg? No way, not me. And if I did, I would never have trouble with infection in the prosthesis.

As the surgical professionals continued to file in, the initial prognosis was slowly placed on the back burner and I was scheduled for surgery to determine the full extent of the damage. The last two surgeons to survey the visible damage declined to predict the outcome until getting a better look. I liked these guys. They would try to save the leg. To them it was not a foregone conclusion.

I was moved to a room on the 8th floor to wait for surgery. I made a few cell calls, signed a bunch of releases and contemplated my first time under the knife in more than 30 years. The surgery, "debridement", actually entails removal of the necrotic tissue in the hope that surrounding tissue will heal. It is a major component of surgery for burn patients, for example and in my case, just what the doctor ordered. Surgery was scheduled for 8:00 PM. I was present and accounted for.

he has risen

I'm back! The long sabbatical has ended and I have more than a few stories to tell. I've spent a good chunk of the past few weeks fighting an infection in my lower left leg and am, in fact, still hospitalized at the CHW Life Care Center in Phoenix for rehabilitation . In total, I've undergone three surgeries, skin grafts and four weeks of intravenous antibiotic treatment - every four hours, every day, I suck up about a thousand bucks worth of Zosin alone. I take so many pills I can't keep track of what or what for. Pain med time is my favorite time of day even though morphine no longer affects me.
I can't wait to total the bill.
And I can't wait to tell you folks some of my stories based on direct observation and keen insight. My forced incarceration has been both tragic and comedic. I could write a book about the food but it would be a comic book. A tragic comic book. You'll get the idea as you peruse the stories to follow. They aren't necessarily in order or even completely true but they do great justice to the farce that is US health care at Catholic Health West in Phoenix AZ. So sit down, have a piece of stale white bread with margarine and prepare to get your vitals checked. You'll need your strength.