Still at the U . . .

Slow going on the hospital front these days; dressing changes on Bob's back wound site are being done daily, and each time it goes a little quicker, a little easier. According to the docs and wound care nurse, everything looks good, already some signs of healing occurring, though when I peer into it, I think it still looks horrific: "That bloody red hamburger looking stuff there?" the wound nurse says excitedly, pointing to things with the beam of a penlight, "that's a great sign! That's good, healthy tissue healing, regenerating!" ummm, looks like it did yesterday to me, but, you're the experts . . . Their plan sounds radical—to keep the wound open the entire time it heals, from the inside, up (they tell me to think of it as filling in a hole with dirt . . .nice visual). Cleaning the site and repacking the dressings will be daily until it gets to a point where they feel good internal healing has been established before employ the next step(s). A heavy-duty, broad spectrum antibiotic is on board, too, to keep the bugs at bay. These people are experts in caring for severe wounds, I tell myself, over and over. They're used to dealing with these issues all day, every day, on a multitude of patients, with endless various conditions. Right now, as daunting as it is, to see this huge wound, and to think of the time it'll take to "fill in," (we're talking months, peeps) we've been reassured that people do recover amazingly well, from such astounding wounds, they see it all the time. But the path is slow, very slow . . .

I asked the wound care nurse the other day why they weren't involved with Bob's case right from the start, as all the reasons given to us for getting plastic surgery involved at this point were not a big secret. They're reasons that have been around for a long time—his poor nutritional status, the scar tissue remaining from his radiation, the fact that there's a big gap in his pelvis—all of that is common knowledge, not new developments. Why wouldn't the surgeons who did Bob's original surgery be proactive in the situation, instead of reactive, as has been par for the course. Her response was a deep breath, then, "No comment . . ." I rest my case. "That's not fair, I shouldn't say it like that," she continued, "I didn't see Bob's incision right from the start, so it could be that things looked just as they should have after the surgery, but truthfully, for wounds as big as this, and for all the 'strikes' Bob had against him, as far as healing goes, it's my opinion we should have been consulted right away. But, that's something we face all the time; we're so often called in after the fact, when complications arise . . . believe me, I'd love it the other way around, and we go round and round with surgeons about this . . . "

I swear, I'm turning into a Conspiracy Theorist, and my theory is that proactive, preventive medicine just isn't practiced because it isn't profitable. If I didn't know better, I'd swear medical professionals (i.e. doctors) are specifically, secretly trained to ignore the big picture . . . I think of the countless added days in the hospital, the countless setbacks, extra medications, extra treatments, extra specialists, extra this, extra that, days in the ICU, revolving door ER trips . . .and think of all the dollars pouring into the U, from just one patient. . . At the very least, they'd better name one of these damn buildings after Bob, when all is said and done.

I could compose a list that rivals Santa's Bad Children list of all the reactive procedures/treatments that Bob has been subjected to, starting with his heart attack three 1/2 years ago—hell, starting with his childhood cancer. Time and time again, having to backtrack, retrace steps, coming back to fix something that quite likely shouldn't have happened in the first place. Like so much in life, hospitals seem to operation on the instant gratification principle, treating something quickly, right now, instead of taking a little more time and assessing the whole picture, and how one action, one medication, one treatment might affect something else. But, maybe I've just spent too many days, endless hours confined to these rooms these halls, with most of my contact with other humans are of the scrub-clad variety, spend too much time thinking about this, rewinding events endlessly, trying to find answers, gain control of an out-of-control beast . . . maybe I'm just going nuts . . .

PT and OT make their appearances daily, sometimes Bob can participate, more often not for long, as he's had an ongoing blood pressure issue—drops dramatically once he's upright, in the 70/40-ish range, making him dizzy, lightheaded, needing to lie down. Once he's on his back, the blood pressure comes back up fairly quickly. Could be attributed to many factors—dehydration, sensitivity to cardiac meds (of which he has a history), the fact that he's spent most of his time this most recent admission lying on his back in bed. Body at rest tends to stay at rest, gets used to lying down and doesn't like to move. He's given extra fluids, his cardiac meds have been lowered slightly, and the goal has been to get him up as much as possible, even if for just a few minutes, several times a day, get the body "used" to being upright for more frequent and longer durations.

Trouble is, he's also been so sleepy. If he's not up doing PT, OT or taking his meds, he's sleeping, soundly. Sounds good, but it interferes with him moving, eating, participating in therapies throughout the day. And likely interrupts his nightly sleep patterns. The thought just occurred to me today, that he's still on a PCA of Dilauded, since Friday's procedure. Again, in the past, Bob has a history of being very reactive to IV meds; they react very quickly and he gets "zombie-like." I asked if it were possible to get rid of the PCA and just go back to oral Dilauded, see how that works in controlling his pain but keeping him more alert. That was approved by his doc, so we'll wait and see the next few days, if it makes a difference.

So, that's that. Tired, time for bed, but wanted to get a quick update out. Hope everyone enjoys the gorgeous weekend that's rumored to be upon us. Just when I broke out the fleece bedsheets . . .