RheumaBlog

Same dragon, different day.

I left off in the first part of this account of my visits to the ER after being bitten by my dog, Logan, with me and the stunningly handsome Dr. Melody once again sitting face-to-face over an old-fashioned typing table, my swollen, mangled hand between us. I’d been babbling  …

Setting: VA ER, Monday morning: Dr. Melody is looking at my hand again. “Let’s get this cleaned up,” he says, and the med student squeezes back into the tiny room, carrying a rolled up blue cloth. I’ll be honest: I’m not looking forward to this. I’ve seen ER. I know he’s going to pick up a syringe full of something that will numb my hand (thank the gods!) and inject it before he starts slicing and scraping, but I also know that the injections themselves won’t be a picnic. I swallow.

The student unrolls the blue cloth and lays it out. Yep. It’s full of neatly arranged and coldly glittering scalpels and forceps and syringes, oh my. “The lidocaine will burn a little,” he says, picking up a syringe with calm purpose. “It works fast, though.” He looks into my eyes as the student swabs my hand with more Betadine. “Ready?”

“Ready,” I croak. I pride myself on being tough and stoic, and to be honest, I’m really curious about what he’s going to do with my hand. But as he lowers the needle toward the ragged wound, I discover I can’t watch. “A little prick, here,” he says. I feel it. Hey, that’s not so bad! I can handle – and then the back of my hand catches fire. It’s like he just put a blowtorch to the flesh and bones to the left of the wound. I catch my breath, hold it. There’s another prick – amazing that I can feel it, considering the conflagration next to it. More flames. I can feel the blood draining from my face, but I sit as quietly as I can, not moving my hand. Breathe, I think to myself. Breath in, breath out. Breath in … Of course I want to yank my hand away and find a vat of ice water to plunge it into, but I don’t. “Holy hell,” I whisper. “That really burns.” “I’m sorry,” Dr. Melody says. I risk a glance. He’s put on some funny, thick glasses with black rims and what look like big, faceted crystals built into the lenses at the bottom, and he’s totally focused on what he’s doing with that needle. He’s still handsome anyway. I note that the student has very pretty, red-gold hair, scraped neatly into a bun at the nape of her neck, and I wonder what time she got up this morning and how long she’s been on her feet. The pain is huge. The flesh of my hand must be crackling, blackening in the blue-hot fire Dr. Melody is causing with that needle of his. I can’t look at it.

It hurt when Logan bit me. But it was so sudden, and I was so shocked, and so focused on the blood spurting out of my hand as I ran for the kitchen sink that the pain seemed almost secondary.  This is different. This is right here, right now, and my stomach flutters and rolls. There are more tiny pricks, more outrageously intense burning. “You all right?” Dr. Melody asks. “I know it hurts, and I’m really sorry. I’m almost done.” His voice is quiet; I can tell he means every word. He doesn’t like this part any more than I do.

“I’m OK,” I say. It’s the truth. The fires are dying down fast, leaving no feeling at all in their wake. I can look, now. How exceedingly strange. My hand is Betadine orange and looks just like it did before he started, the gaping wound deep, ugly and crimson, but not charred black and smoking like I expected. He sets the syringe aside. “How’s it feel?” he asks, looking across at me again.

“Wow. I can’t … I can’t feel anything.” And that’s true. The bone deep, pulsing ache, the strange coldness, the sharp twinges of pain I’d felt when I tried to flex my fingers, the horrific burning of the lidocaine, they’re all gone. Miracle.

He grins at me and my heart melts again. He could slice my fingers off, one by one, and I wouldn’t bat an eyelash. Quickly, he and the student put blue paper drapes over my hand, leaving a square open around the wound. I can’t see it very well; I expect they both know that and have arranged the folds the way they have on purpose. It wouldn’t do to have their patient faint dead away when he starts cutting. He picks up a sparkling silver scalpel and gets to work. “Feel that?” he asks me calmly. “Nope,” I say.

A new doctor sticks his head in the door, then sidles in sideways. “Hi!” he says with a big smile for me. “I’m Dr. W. I’m a hand surgeon.” Ah. This is the surgeon who’s in charge of Dr. Melody and his student. The big-wig. The top gun. He’s a little older than I am, a heavy-set, tall, balding man with a kind face who obviously smiles frequently. You can tell by the crinkles around his eyes. I greet him, feeling a bit overwhelmed now. The tiny room is packed to the walls with me and doctors.  “Your dog bit you?” he asks me, and then shifts his gaze to the work Dr. Melody is doing on my hand.

“Yeah,” I say. “That’s the pits,” he commiserates, and then starts talking to Dr. Melody about tendons and ligament involvement.  He leans over and looks closely. “Get that bit of gristle,” he says. Gristle. They’re talking about the inside of my hand, I think calmly. Some gristle that got ripped loose. There’s a part of me that wants to scream and run.

“How’re you doing?” It’s Dr. Melody again, those cool brown eyes on my face. He’s sharp, that one. “Fine,” I say. He nods and continues whatever he’s doing behind those drapes. “I’ll just trim the edges of the wound,” he says, “so it can heal up more cleanly and with less of a scar. It will scar,” he says, and looks at me again. “That’s all right,” I say. “I sorta expected that.”

He sits back, and Dr. W takes a close look with his own funny glasses on. “Nice,” he says. Is there another wound?”

“In the palm,” says Dr. Melody. He takes away the drapes and turns my hand over. “It’s not as ragged, but it’s deep. And also infected.”

They decide he needs to do some clean-up on that one, as well. Oh, joy, more fire-needles. And it begins all over again. But this time, I just close my eyes. I know what to expect. It burns like a you-know-what for 30 seconds, I bite back my cries of misery, and then it stops. Just like that. More drapes are applied. Dr. Melody sets to work, scalpel in navy-blue-gloved hand. This one doesn’t take very long. The wound is in the meat of my palm, just beneath my first two fingers. It’s less ragged than the one on the back of my hand. More gristle is sliced away. The two doctors discuss the wounds, both of them concerned about the infection. Dr. Melody is quietly pushing a long, thin ribbon of cloth deep into them. I’m watching, now. It’s rather cool – I should be screaming and hysterical with pain, but I can’t feel a thing. Amazing how deep he stuffs that ribbon into them, and with how much force. “These are wicks. They’ll allow the infection to drain. It’s best to leave the wounds open,” Dr. Melody says. “If we stitch them closed, there’s more chance that the bacteria will grow and multiply inside, because there’s no place else for it to go. The wicks give it a way out of your body.”

I just nod. I know they know what they’re talking about, and I’m just educated enough to know how dangerous infections can be. Given that I’m taking rheuma drugs that impair and slow my overactive autoimmune system, I’m also aware that my body isn’t very good at fighting infections off. I’ll go along with whatever they say.

The discussion turns to which antibiotics to use, and – to my surprise – whether or not I should be admitted to the hospital to receive them intravenously. Dr. W goes back and forth on this, weighing the options. He’s concerned about the infection because if it gets away from us, I could be in serious trouble. At the same time, though, he doesn’t want to make me have to live in the hospital for days if it’s not absolutely necessary. Finally, he says, “We’ll send you home today. But I want to see you again tomorrow morning, first thing.” I agree I’ll be back at the crack of dawn, promise-cross-my-heart. He gives me another lovely smile, wishes me luck, tells me I did just great, and disappears.

Dr. Melody explains how I should do my home care: three soaks a day in Betadine-infused water, and then I should use the pair of forceps and scissors he’s giving me to scrape and pick out any greenish-white goo that appears in the wounds. That done, I should take some of that ribbon and poke it into the wounds again, deep as I can, before covering in all back up. I tell him I will, my stomach fluttering a bit at the thought. But I can do this, I know.

He puts gauze pads over both wounds and wraps them, and my hand, lightly in a soft, cotton-like material. Then he makes a splint from a thick plank of white, reinforced, plastery stuff, dips it in warm water, and shapes it to my palm and forearm, leaving my sausage fingers free as the plaster hardens. All that gets wrapped in more soft cotton stuff, and then finally, a thick pressure bandage from palm to elbow, holding it all in place. It’s oddly warm and comfortable.

“Come back right away if you notice any red streaks moving up your hand toward your heart,” he says, “or if it becomes more painful than it is now. Good luck.”

I thank him and the med student for their kindness, compassion and excellent care. And they’re off to help someone else. An ER nurse appears and equips me with all the supplies I’ll need to care for the wounds at home, along with a bottle of fat, inch-long antibiotic pills And now I’m off too, my arm and hand looking like a short baseball bat with fingers. I’ve escaped being hospitalized, at least for now.

Setting: VA Orthopedics Clinic, Tuesdsay, 7 a.m.: The first day of home care has gone fairly well, at least up to each cleaning of the green goo out of the wounds and replacing the soiled wicks. That, I’ve discovered, hurts like the blazes. Cary offered to help me (she has a strong stomach; must have got it from me) but I found I preferred to do it myself, left-handed, because at least I could stop when the pain got too intense. I was a little concerned because, brave as I tried to be, I couldn’t stuff that wicking material into the wounds as deep as Dr. Melody had gotten them. Just plain couldn’t. The pain would overwhelm me and leave me sweating with butterflies in my stomach. The wounds, while they looked a little better to me, were still pretty nasty 18 hours later. My hand and fingers remained vastly swollen and dark, with wide patches of even darker red around the wounds themselves. Very sore, too, but thankfully, no red streaks headed up my arm toward my heart.

Mr. Wren settles down in the waiting room while I tell the receptionist that I’m here without an appointment, but that Dr. W has instructed me to come in early, before he goes to surgery. She’s pleasant, a little confused, and goes back into the clinic to check. When she returns, she smiles and tells me to sit down, and that Dr. W will be with me shortly.

He appears smiling in the doorway a couple of minutes later, beckons me back, and invites Mr Wren to come back, too. We go into his office and he unwraps my hand. Looks at it closely for a while. “It does look a little better,” Dr. W says, “but this wound on the top – I think I’d better see if I can get some of that stuff out of there for you. Hang on.” He goes into a side room, rummages around and comes back with a basin, Betadine and sterile water. “Soak it for a while for me,” he says, preparing the basin. “That’ll loosen and soften everything up. I’ll be back soon.” I lower my hand once again into the cold orange water, trying not to think of needles, lidocaine and scalpels.

Thirty minutes later, he’s back, carrying the dreaded, rolled blue cloth, which I now know is filled with the sharp instruments of his trade. He asks a passing nurse to bring some lidocaine and a syringe; she returns with astonishing swiftness and gives them to him. “I know you don’t like this,” he says kindly, “but it really is necessary.” “I know,” I say, resigned. “Let’s just do it.” He injects the numbing medication into the area around the wound on the back of my hand. It burns like fire, just like the first time. I hiss and Mr Wren shifts uncomfortably on his chair, then takes my free hand. I grip his, hard. “I’m so sorry,” Dr. W says. “Need me to stop for a moment, let you catch your breath?”

I look at him, touched. “No, go ahead and finish,” I say. “It’s not that bad.” Already, I can feel the stuff working as the fires quench themselves and numbness replaces them. He nods and injects a couple more spots. They burn, but not as much as the first two did. The lidocaine must be making the other areas a little less sensitive.

Dr. W (I can’t help but wonder where the magnificent Dr. Melody has hidden himself) puts on his own pair of crystal eyeglasses, takes up a scalpel and carefully slices, picks away the thick greenish scrim from around the edges of the wound, then digs out the jelly-like greenish stuff that has pooled in the wound’s hollow, malignant and crawling with bacteria. He explains what he’s doing, what I should be looking for when I do this myself, and how he wants the wound to look each time when I’m done – clean, glistening pink and scarlet, and with no extra gunk lurking inside.

“Surgery,”he says conversationally as he works, “is really nothing more than plumbing.” “Really?” I ask. “I’ve always thought of surgery as removing diseased or injured organs, or cleaning and stitching things that are injured back together.”

“That’s it, exactly. But everything in your body needs a way to get rid of toxins. So it’s a little like plumbing, too. We go in and clean everything up, patch things, and provide drainage so it can all heal.” He shoves the wicking material deep into the wound, back up under the skin. Once again, I feel nothing, but it’s surreal, because I know for a fact that it should hurt wildly. Mr Wren shifts in his chair again, but he keeps my free hand, rubbing the back of it gently. “Infection has to have a place to go,” continues Dr. W. “If we let it, it will go further into the body, so we try to give it another option – the wicks draining to the outside. Think of them like a highway right out of town.”

He doesn’t re-clean the palm-wound. “That one looks pretty good,” he says. I’m oddly proud of that. It is smaller than the other one, though, and it has a cleaner edge, more like a traditional puncture. It’s also not as close to my bones. I can get the gook out easier and the wicking into it deeper than I can the other one.

He mentions the low temperature I still have. “I’m still considering admitting you,” he says, turning to his computer to pull up my records and test results. “I’m concerned about your impaired autoimmune status.” He finds the results of the blood test, but nothing has come back on the culture. “That takes a few days,” he tells me. “But overall, your blood is good, considering.” For a moment he’s silent, looking from my hand, to me, to the screen, his wheels turning. “Keep taking the Augmentin,” he says finally. “Don’t miss a dose, please. Go on home, and just keep doing your home care like you have been. You’re doing just fine with it. Come back again and see me early Thursday morning, unless the wounds get worse. If that happens, or you see red streaks, go straight to the ER. Don’t waste any time.” I assure him I won’t. He wraps everything back up and sends me on my way.

Setting: VA Orthopedic Clinic, Thursday, 8 a.m.: The clinic is already stuffed with vets waiting for exams, follow-ups, and procedures. I have to wait an hour this time, but I don’t really mind. I’ve nowhere else to go. When I finally get in to see him, Dr. W is pleased with the healing procress, even though my hand is still swollen, sore and dark.

I tell him that I’m worried that I’m not getting the wounds cleaned out well enough; it seems like each time I do the wound care, they’re a little smaller, a little tighter, and I can get even less gunk out of them or wicking into them. That gunk worries me. My temperature continues to hover between 99 and 100. And while the wounds aren’t very painful (at least, not between cleanings), my right wrist has decided to flare with rheuma and is very sore.

“I was afraid that might happen,” Dr. W. says. “Keeping it immobilized doesn’t do a thing for RA. You need to be able to move it. So we’ll get rid of the splint now.” He looks for the blood culture results. They still haven’t come back, but he seems unconcerned. “No need to admit you,” he says. “You’re doing well.” He tells me to keep on with the home care – and if I can’t get the wicking into the wounds, don’t worry about it now. Unless they suddenly get worse, I don’t need to come back at all. He thinks I’m out of the woods. And finally, there’s no need for him to clean them any deeper than I’m managing on my own. I’m glad, as I was afraid he’d want to slice them open again to drain more gunk, and I wasn’t looking forward to the fires.

That appointment was two weeks ago today. My hand continues to heal. It’s still a little bit darker than my left hand, and it’s still slightly swollen. But both wounds are closed, with only a small amount of redness around them, and while they’re a bit tender and sensitive to pressure, and my first and middle fingers twinge a tiny bit when I bend them, they don’t actively hurt. The fever is long gone. I’m well, once again coping only with the “normal” rheuma pain that I have in my hands.

You know, we’ve all read a lot about Veteran’s Administration hospitals over the last several years, and a lot of the news hasn’t been very good. Until recently, government funding was low and some VA hospitals were simply unable to cope with the massive numbers of vets that needed them, particularly those which were caring for so many young, grievously hurt soldiers from the wars in Iraq and Afghanistan.

But that’s changing. The VA medical center I go to for my medical care is always busy, its clinics crowded, and while I haven’t seen them myself, I imagine that the hospital and surgery wards are full, too. Yet these doctors and nurses, medical students and surgeons, physical therapists, clerks and receptionists are all doing the very best they can under difficult conditions. I’ve received nothing but excellent care – and I appreciate it more than I can say.

If I hadn’t been a veteran (with an old, service related disability, and thus qualified for VA health care), I’d have had to have all this fantastic, competent medical care for my dog bite done through the local civilian hospital ER. I’m unemployed at the moment and cannot afford private health insurance; my income is precarious and there would have been no way I could begin to pay the medical bills that would have soon hit my mailbox. Mr Wren and I would be scrambling right now not to lose our home and everything we have. We’d have to declare bankruptcy. And all of it would have been because of a sudden, unexpected dog bite that went septic.

If that’s not an argument for health care reform, and someday, perhaps, universal health care for all Americans, I don’t know what is. My taxes and yours are used to keep the Veteran’s Administration medical centers open for the men and women who have served their country in its military services, regardless of whether they served during wartime (I never did). Those taxes pay the salaries of medical professionals like Dr. Melody and Dr. O, and Dr. W, and Nurse John. They work long hours and give their time and their expertise to vets of all services, races, genders and ages, many of whom are often non-compliant, grouchy and very, very ill or disabled. And yet these dedicated medical professionals do it with a smile and with more compassion than I’ve ever encountered before, even when I was able to go to civilian doctors when I had health care insurance through my job.

Thank you all for supporting your country’s veterans. At least one of them is deeply grateful – and I know I’m not alone.

4 thoughts on “wren’s er adventures, part 2

  1. kmom says:

    Oh Wren,
    I’m amazed at your bravery, although it was necessary. So glad that is over!
    And I so appreciated that you appreciated that care you got at the VA.
    I did part of my training as a nurse at one many years ago.
    I also appreciated your words on health care. I have insurance, but
    it is precarious and eats up a great portion of my husband’s income.

    Like

  2. Mary says:

    Boy, that home care would have just done me in. Frankly reading about it almost did me in. You are really brave. Year ago one of my dogs was bitten by another dog and she had a wick in her wound. I had to pull on it a few times a day and that was enough for me. Glad that your hand is about healed and that you received such good care.

    Like

  3. Kris says:

    Dear Wren, your writing is wonderful. The right words in the right order–outstanding! Thank you so much for this story. I’ll point my friends and family to this so they can understand how serious injuries and illnesses can be for those of us on immune suppressing drugs. By the way, I think I’m in love with the magnificent Dr. Melody. Blessings, Kris.

    Like

  4. Lene says:

    Gristle? Shoving wicking deep into the wound? Without numbing?? I am in awe of your courage.

    And fantastic argument for healthcare.

    p.s. I’ve thoroughly enjoyed (is that the right word??) your story of this – so well written, but I’m glad it’s over and you’re almost healed.

    Like

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