here’s a little story
A camper was up on the Kaibab plateau in northern Arizona. The last day in July, a Sunday, he got up, feeling good, and started the day off with an early morning one-hour run along the AZ Trail. In the afternoon, he felt a pain across the top of his chest, moving towards his right shoulder. The camper didn’t want to, but thought it best to drive down to the emergency room in Kanab, UT; the pain was increasing. It took an hour and he barely made it. He must have looked pretty bad when he shuffled through the doors because two staff workers got up and met him half way. So far, really no big thing.
The camper’s upper right arm started turning red during the last 20 minutes or so of the drive. The doctor diagnosed shingles. The camper said the redness was NOT what brought him in here. Then the upper arm started discoloring as we sat there watching. The doctor admitted the camper overnight for strep throat (positive for strep A), shingles, and dehydration. The next morning, cellulitis was added to the diagnosis. Wrong again.
I must have passed out while sitting on the edge of the bed because I woke up in SLC the next afternoon at IHC's Shock and Trauma ICU. I spent the next two weeks there, having three surgeries. My right biceps, right pectoral muscles, and half of my right deltoid muscles were cut out. A plastic surgeon looked on to get an idea of what he will be working with down the line. They kept me under until Thursday. Are you guessing it was NOT shingles, let alone strep throat?
Necrotizing fasciitis (neck-ro-tie-zing fas-e-i-tis) is a nasty, nasty bacteria that spreads rapidly once it enters the body. It infects flat layers of a membrane known as the fascia, which are connective bands of tissue that surround muscles, nerves, fat, and blood vessels. The infection also damages the tissues next to the fascia.
The most common way of getting necrotizing fasciitis is when the bacteria enters the body through a break in the skin, like a cut, scrape, burn, insect bite, or puncture wound. I don’t remember or saw sign of any break in my skin.
The media refers to it as a flesh-eating bacteria, although it does not “eat” the tissue.
It comes from the Greek word ‘nekros,’ wait for it, ‘corpse.’ Hmm.
I SO wish they had made a proper diagnosis down in the Kanab Hospital. If I got flown up to SLC Sunday night, the surgeons would not have had to cut out nearly as much muscle. I wasn’t flown up until Monday afternoon. All that time the bacteria continued to poison my body. Guano! With necrotizing fasciitis, seconds is tissue.
The hospital needed a medical power of attorney. I don’t have family to call on and it is not something one can ask of a friend or acquaintance. Just think of how you would feel if you were asked to act as such. I mean, it can be a life or death decision. With all the mega meds I was on in ICU I don’t see how I managed to suggest a friend. The hospital called Lisa and she agreed to act as my medical power of attorney but she needed to talk with me first. So right there with that decision to help me, she saved my life. I certainly was in no condition to make decisions. The surgeons were concerned about the lose of my right arm, and possibly the left, so I said to Lisa, if they have to take an arm, keep me above ground; if it was going to be both arms, put me down.
I think it was a week or so later when I was talking to Lisa and told her I just can’t take any more of this. I want to be put down. A resident told Lisa and Theresa that I clearly did not do narcotics because the meds had me so out of it. I was having horrific nightmares; it was as if they were my life. One night I thought my nurse was trying to kill me and I was trying to do all I could to escape from the bed. I pulled the feeding tube out of my nose so the nurse had to strap my good arm to the bed rail. Anyway, it was like nothing I’ve ever imagined happening to me. Lisa talked me into hanging on a little longer but I truly could not imagine how I could. Over the next couple weeks it got better in many ways.
How many can say they saved a friend’s life? And not once, but twice.
So, the Nash, the Dodge, and M&M. Glen and David, two other friends from Moab, had to figure out where the Dodge was parked and how to find the Nash where it was set up out in the woods.
I think it was a PA at the Shock and Trauma ICU mentioned that I had been flight lifted from Kanab. Lisa called the Kanab hospital and when she identified herself as my medical POA, the receptionist felt free to talk about me and mentioned that there was a blue Dodge pickup in the lot. The keys, however, were in my pocket, at the trauma ICU up in Salt Lake. Lisa’s mum lives in SL and through Lisa’s POA, was able to acquire the keys and mail them down to Moab.
If you are not interested in this story, feel free to skip it. I might get back to some semblance of simple living and travel in four months or so.
It was Thursday before Glen and David had the keys and could start driving down to Kaibab (I had told them that M&M had enough food and water for a few days). One day, I was apparently coherent enough to give directions on how to find the Nash. Are you believing all this? Glen apparently got enough info from me and along with a national forest map, Glen and David found the Nash. M&M were out of water. I really did not expect to be away this long. They hooked up, spent the night in Bluff and made it back to Moab on Friday.
They just made it along a length highway after coming down off the Kaibab, just before it was closed off due to flooding:
washed out highway
Lisa saved my life, but Glen and David saved the lives of Meadow and Mesa. Ya done good, guys.
The Nash is setup on Glen and Lisa’s proporty. M&M stay inside and are not happy. But then, I’m not presently happy with my present living arrangement either.
Glen even set up a window A/C for them. How cool is that?
After two weeks in the shock and trauma ICU, I needed to be moved to a hospital that focused on wound care and physical therapy. Lisa chose Promise Hospital after researching their programs, here in Salt Lake. I have both a physical and occupational therapy session each weekday. My OT is particularly awesome and my physical therapists push me as much as they think I can take. What a fabulous team. I’ll miss them. All the sessions max me out but I always try to do the best I can and have been adding some additional work on my own back in my room. Remember Janet and her hip replacement? How hard she worked during her rehab and pretty much got back all her movement? Most don’t put in the effort and don’t get much back. Duh. Just listen to people talk about their rehab experiences to pick up on this. I had to work with a speech therapist the first week I was at Promise to strengthen my tongue and learn how to swallow again. It was a big day when he said I could have some crushed ice (still couldn’t have water).
The physical and occupational therapy team surprised me with a beautiful card and a pair of high-top Converse All Stars on my discharge date. I know, it’s not a guy thing, but I definitely choked up.
I lost nearly 20 pounds, down to 142. I was reading through my medical records and noticed on the admitted ones, I was marked down as having “severe malnutrition.“ It had only been 10 days!
When Theresa saw the wound dressing, she said it reminded her of the Jean-Luc Picard character after he go captured by the Borg. I got a good chuckle out of that.
Twice a week, wound care works on my wound for over an hour. After the dressing is taken off they work on cleaning, debridement of any remaining dead tissue and whatnot. A big issue is getting the tissue to granulate. It needs to do this before some of my skin can be grafted onto it.
This is a photo of the wound from August 11. It’s covered with integra, a silicon sheet, hence the shininess.
This is what an arm looks like when the biceps have been cut out. Unfortunately, the arm is mine.
A photo of the wound 30 days after the surgeries. Progress.
This is a photo from September 13. You can see how well the wound is healing.
Putting a new negative pressure dressing on takes around 30 minutes with a nurse working on each side of the bed. First a layer of thin white foam is placed on the wound where it has granulated. 3/8” black foam is placed over the areas that still need to granulate. The tissue grows up into the black foam, forming the granulation. All the foam is cut and fitted, like a puzzle. There is a channel left where a perforated irrigation tube is laid. It’s all covered over with draping (clear plastic sheets), again cut and fitted to the shape of the wound.
The first time I was aware of a dressing change they had to give me 300 micrograms of pain meds and it still hurt! Then it was 200, then 100, and lately only 50 mcg of pain meds and it hurts a lot less. I asked about it and was told, the first time there were exposed nerves. This is all SO much fun.
I have total confidence the highly-skilled wound care team at Promise Hospital. They take the time to explain anything I ask them about. And they are entertaining! I always get laughs while my wound is being worked on and I am glad say that I can make them laugh almost as much. It might seem strange, but after the first two dressing changes, I always looked forward to wound care.
One time, two hospital directors stopped in the see how the wound was progressing. I was thinking my wound must be different to warrant such visitors but hopefully not too complicated.
For that first dressing change there were five staff members clustered around my bed. Lately there are two. I asked about that and was told everyone wanted to see the wound. I got another good chuckle out of that. I’ve chuckled a lot since I’ve been here. A good deal of the staff have a sense of humor so I can joke around with them.
They were not used on my wound but maggots are used here and are pretty effective on some types of wounds. The wound team builds a coral around the patient’s wound, pour in a slew of tiny maggots, and cover them over with a breathable material. The maggots feed only on dead tissue for three or four days, growing the whole time, and then removed. I wonder if you feel them at night when you are sleeping.
Five times a week for 110 minutes, I go upstairs and slide into a hyperbaric oxygen chamber. Maybe, "Once more into the breech" has another meaning. I thought the chambers were just for scuba divers with the bends but they also promote healing. I get to watch a movie each day but have only managed to see the ending of one. Oh well.
The sessions generally go okay, but it can be warm and a tad stuffy. One day however, I was lying there on my back and upchucked. It was all out in half a minute and I asked them to keep me in the chamber but they would not hear of it. They started the decompression. It was nearly an hour into my time and the whole day was wasted. Guano.
Night nurses. When I was in a hospital bed up at the U for six weeks, I rarely was aware of the night nurse coming into my room, totally stealth mode. The patient rarely sees the good ones. They quietly come into the room and use light from the hall, machine faces or a penlight to see. They know that turning on a light will wake the patient, common sense. They don’t talk and if they need to, it’s with a very low voice. Coming into a room with a sleeping patient and using a daytime level voice is going to jar the sh*t out to the patient. Common sense. I might be using faulty logic with this one, but if a person hears speaking while sleeping or on the verge of sleep, it will be processed, setting off tiny electric charges in the brain, further waking up the patient. I have problems with sleeping at night (and no, I don’t take naps during the day). Two nights I had this woman who automatically turned on an overhead light as she came through the door, every time she came in, no matter what time of the night. That alone woke me up each time. She never stopped to access the available light to see if it was enough (it was). She talked every time, with nothing that needed to be said, and NOT in a quiet voice. The first morning, I finally got into a good deep sleep, lying on my back, and still out cold at 6:00 when this creature came in and turned on the bright light directly over the bed. I started grousing but she kept it on until she was finished with what she had to do. Not a thought, of the patient. There’s a word for that kind of woman, rhymes with witch. Sleep has strong healing qualities and for a trained medical professional to needlessly hinder a patient’s healing, is SO not right. And yes, I voiced my thoughts, (some of my friends probably just cringed) but to no effect.
There are many stellar nurses and CNAs here but then there are some I wonder how they got a job, let alone maintain it. I found out I was scheduled to have this woman a third night but the desk switched nurses for me. I knew there were gods.
I called my friend, Pinball (I first met Lynn when she moved to Bisbee from NY, then she moved to Tucson, then Ohio, and recently, back to Arizona). She gave me a laugh after I told her about my present situation. She responded with something like, you’ve been independent and off by yourself for the last ten years. You hike and run trails in areas where there are cougars and bears, camp and climb where there are rattlesnakes, hike in ravines, and take falls from time to time. Come on, you’ve been playing roulette all these years; something was bound to happen. True, and I took one particularly bad fall earlier this summer, after which it took me quite a while to make it back to camp. And the following week, all I could do was hobble. Might be time for a change. Then again, I might not have a choice.
Remember when I wrote about my bone marrow transplant back on the July 2011 page? What a cakewalk compared to this. All in all, it’s been a good experience at Promise. I memorized the names of all the staff who took care of me, always addressed them by name, and tried to pay them back with daily thanks and laughter.
That’s probably enough for this month’s page. Next month I’ll probably continue the story. There is still another hospital for the skin graft, the healing process, time in an acute therapy facility, and getting back in the Nash. I SO miss Meadow and Mesa. And Pinball emailed me with a suggestion for an alternative life when I get out. We’ll see.
The IRS returned a tax return to a man in New York City after he apparently answered one of the questions incorrectly.
In response to the question, "Do you have anyone dependent on you?" the man wrote:
"7.1 million illegal immigrants, 1.1 million crack-heads, 4.4 million unemployable scroungers, 80,000 criminals in more than 85 prisons, plus 450 idiots in Congress, and a group that calls themselves politicians."
The IRS stated that the response he gave was unacceptable.
The man's response back to the IRS was, "Who did I leave out?"
you might as well be dancing.
RVwest article ‘Following a Free Spirit’
RVwest article ‘The Spaces Between the Places’