Tuesday, May 11, 2010

Scheduled Post #1

Today was the Big Day. As written on my pre-op orders, my surgeon performed, on "the lower right extremity," a "deep structure, muscular, and vascular reconstruction followed by a partial-thickness skin graft." I would imagine that right about now, I am in my hospital room either asleep or wishing I was. I'm receiving some pretty heavy duty antibiotics to fight the three bacteria that grew out in very large quantities on the last culture, and have formed obvious colonies in my wound. I've got a couple big whitish-yellow ones, and a couple big greenish ones. Or I should say, I had those. The surgeon removed them.

I can honestly say that while I doubt the next few weeks will be all that enjoyable, I am quite convinced that it is the right decision.

I'm not proud, but the wound was self-inflicted a long time ago. Toward the middle of January, actually. We are now pushing the middle of May. That's five months spent trying to deal with one stupid cut. I'm going to tell you a little bit more about it, just because I want to write it out for my own sake. And maybe some of you will read it and get the guts to stand up for yourself more effectively than I did.

The cut was deep - one of the deeper ones I've ever made. My bone was exposed, a muscle cut through nearly all the way, and an artery severed completely. My husband came home and found me with that and several other cuts, sitting on the floor in a daze. He called 911 - I think I asked him to. I had lost a lot of blood, and was scared. Very scared.

The nearest emergency room happens to be one we don't prefer, but when one calls 911, one loses the option to choose. Fortunately, they allowed me to call my regular physician to come in and do the repairs. He did an excellent job - I was able to walk when he was finished, despite the muscle damage.

I was admitted to the psychiatric unit of a different hospital. While there, nurses changed the dressing on my leg daily. After about a week, I noticed that one cut did not look quite right. I pointed it out to the nurse, and she assured me it looked fine. I know my body pretty well, and knew it didn't look "fine," but I let it go. The next day, it looked even more "off." I pointed it out again, with my husband present. She said that all wounds heal differently and it looked fine to her. The next day, the same thing. 12 days after the original injury, the sutures were removed. The wound looked swollen, was hot, and just a tiny bit pink. But I had no fever and there was no visible pus. I insisted, again with my husband and two nurses present, that it felt very much infected and asked that they please have a physician look at the wound. The nurse practitioner barely pressed on one end and the whole thing split, revealing the infection I had told them was present.

It took a month for the wound to close. Most of that month, I was in the psychiatric unit. I was accused of wound tampering and told that I was the reason for the infection. Cultures grew out bacteria normally found in fecal material, as well as some found in dirt, and some found exclusively in certain species of pet birds. In other words, the infection came from someone who just didn't do a good job of washing his or her hands.

After the scar was fully formed, my leg would frequently swell and get hot just below it. I was assured that that meant nothing. No problem. When yellow fluid began draining from the corner of that scar and from several others, I was told again that it was normal fluid and there was no issue. I let it go. Again.

Nearly a month passed, with constant drainage, swelling, and pain. I was assured by physicians (not mine - he was not yet cleared to see patients following a horrid accident) that it was fine. Told I was being a hypochondriac. My chart was noted that I was suspected to be a Munchhausen's patient. (Munchhausen's is a disease where patients make themselves sick in order to get attention from doctors. For the the record, I loathe having to go to the doctor. For anything.)

I woke up one morning with a leg that was grossly swollen, red, and hot. I had a fever, ached from head to toe, and couldn't stand even the brush of my pant leg against my leg. I emailed my doctor, and waited for the clinic to open. I was given a 2:30 appointment. When we got there, the doctor let us know that a surgeon was on his way over to look at it. Two hours later, I was wheeled into surgery and the abscess was drained. A wide, eye-shaped hole was left that went all the way down to the bone and muscle, to allow all of the "fluid" to drain. Wet-to-dry dressings were applied, that I changed out twice each day. After two weeks of no visible healing happening at all, the surgeon decided he'd order a wound V.A.C. Meanwhile, I noticed that there were little black spots forming inside the wound, around the edges mostly. He assured me that these were just dried spots of blood.

And then the whole thing turned black. As if someone had dumped tar into the wound. And the black started to spread. The surgeon took two days to believe me over the phone, and I came in a day early to get the wound V.A.C. put on. He was shocked to see that it really was black. Rather than do anything, though, he applied the V.A.C. (henceforth referred to as Slurpy) over the top of the eschar. He said he believed it would take care of itself.

Four days later, when I went back in for the dressing change, the necrosis and infection had spread dramatically. Went in the next morning for yet another operation, and stayed in the hospital for 6 days. The day I went home, the doctor applied a special dressing that contained silver. He said that would help kill off any micro-organisms. It started to sting and burn as soon as it was applied, and within two hours, I was in nearly unbearable pain. The doctor did not believe me, said that it was normal for it to burn a little. A nurse brought up Munchhausen's yet again. I asked to either be transferred or released so I could seek a second opinion.

By the next morning when I saw a physician in a wound clinic at a different facility, the reaction between my body and the silver had enlarged the hole in my leg considerably. I was in absolute agony. I was angry, tired, and barely able to think. The dressing was removed, taking with it all of the granulation tissue that had formed during my 6 days in the hospital, as well as the facia over one of my muscles. Fortunately, the exposed nerve stayed intact. The nurse dumped saline into the wound, over and over. Each time, it briefly stung but the agony lessened. By the time she was done, it felt just like it should - sore, a bit of stinging, some aching... nothing even remotely unbearable. The wound doctor looked at the wound and photographed it. Noted that my tibia was exposed. Noted that there were areas of necrosis that went deep into one of the muscles. Noted the exposed nerve. Noted the end of a vein that had been severed by the last surgery. And then referred me to a plastic surgeon.

He took more photographs, looked at the wound more. Talked to me about the fact that he was pretty sure the wound would not heal without significant intervention. Scraped away some colonies of bacteria. Burned away a bit of necrosis. Flushed everything out with saline. Put Slurpy back on, with a normal slurpy sponge. And scheduled today's reconstruction and skin grafts.

The point here? If you know, and I mean absolutely know something is wrong in your body, don't let a doctor or nurse blow it off. I did, and here I sit five months later, waiting to have major surgery and praying that everything can be achieved in one operation. I am on narcotics, and have been for the last three months. I have three types of bacteria that are not antibiotic resistant, and yet continue to colonize the gaping hole in my leg. And if that first nurse, the one who said all wounds heal differently, had listened... well, I wouldn't be in this situation at all. Had it been treated correctly way back in January, all of this would have been avoided.

Speak up folks, and be loud.

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