Friday, February 10, 2012

Clara & Her Foot Fiasco

Progression 1/14 - 2/8

So I began documenting the story of Clara's pressure ulcer HERE and then followed up HERE. I have posted pictures regularly on Facebook in order to gain as much insight as possible about something that is so very foreign to me.

To read up more about this type of wound you can go HERE. I am absolutely sure from firsthand experience that there is a wealth of information on the internet if you want to read more. It has been referred to as a pressure ulcer or a deep tissue injury. When the splint was incorrectly placed on her foot at the ER and left for those few days it caused her heel undue pressure which in turn led to this deep tissue injury. While this type of injury happens occasionally when using splints and more often casts, it seldom (if almost never) happens with someone in this short period of time. 

It has been described to me as an injury from the inside out. This is why the initial pictures don't look as bad as they do today. However, my friends who work around these sorts of injuries everyday, were quick to note from the onset, that it looked like there was deep tissue damage. As the wound progresses, the evidence of damage will present itself as necrotic tissue (the black areas you see in the wound). 

Hope I say all this right. Nurses E & E, feel free to comment anonymously to fill in the gaps ;)

The most important thing for us to do is to keep her wound clean, especially while it is open. We do dressing changes twice a day and she is currently on antibiotic for the beginning stages of infection. There is a home healthcare nurse who is coming once a day to help with this for the time being. She just started yesterday and I plan on having her continue to come daily until I am comfortable with the condition of her heel and the potential infection.

 Up until yesterday I had done all the dressing changes which were not horrible but the stress and worry of whether I had done things right were really taking a toll. It's nice to know that a professional can assess where she is at each day and make recommendations accordingly.

She is really not fussy about things unless you try and fool with her boo-boo. She does not take kindly to that. She doesn't walk a whole lot and winces quite a bit if you go near it. I expect it hurts most of the time to varying degrees. This week it has seemed to hurt more because of the infection which made the outer skin very tender and inflamed. She mostly knee-walks, which is pretty funny because she did that as a toddler before she took her first steps. When she has had a dose of Ibuprofen she likes to hobble around proudly, like below:

This pic shows the redness from the infection. The dark half-ring 
at the top of the wound is NOT necrotic but is dried blood. 
That was once a complete blood blister ring around the whole wound. 

And don't forget ... she has a broken toe :( Poor little piggy has gotten such little attention but he does still give her some discomfort. I asked the doctor about that today because she still freaks out when I change that bandage and put medicine on it. He said the break was at a particularly sensitive area of her toe and that the nail bed is trying to heal and push out the old nail. The laceration under that nail is still pretty funky too. 

In a nutshell ... her foot is pretty jacked up.

Clara's wound care is being done at the Wound Healing Center at Chippenham Hospital. Dr. Boykin is the director of the HCA Wound Care Centers, has served as a professor of plastic surgery at MCV and is also her doctor. He is awesome and he reminds me of Bill Cosby which is always a plus. I did have some very real concerns and unanswered questions that were brought to light today and I am satisfied with the answers.

Clara & Dr. Boykin

Clara and Nurse Shirley taking care of Bitty's boo-boo.

Not necessarily *happy* but satisfied. The known is much better than the unknown. This will be a long road to recovery but we have been given every indication that things are progressing as they should. 

The projection is 6 months.

Yep. I choked back a few tears on that one too. I knew more than they were telling me and of course I knew what I had been told by my friends in the healthcare industry. He did share with us that he didn't want to say too much too soon. I was frustrated that I wasn't given a clearer picture from the beginning.

But the truth is, it would have really overwhelmed me then. Especially with Chris gone. 

Sound asleep with daddy at the doctor earlier this week.
Thankful he was there because it gave me a chance to have a grown-up chat.
 Eyeball to eyeball. Standing up.With my notebook in hand.

A couple of questions that I've had and I know others have had as well ...
  1. What about the necrotic tissue? The black tissue that is considered necrotic is expected to slough off on it's own. I know that sounds contrary to the norm but because of her age and her health, Dr. Boykin feels like there is no need to be invasive. I am relying on his wisdom and expertise at this point. If things don't progress as they should, I expect he will adjust the plan. He was very clear with us today about his intention to heal our Sassy Britches. If I had doubts before about where this was going, they are gone now. I am still counting on you folks who are masquerading as nurses (and are actually ANGELS in disguise) to provide me with invaluable resources and information as you have thus far. It has made me privy to the gnarly world of wound care and helped me be the best advocate for Clara that I can possibly be!  
  2. What about those responsible? So far, those responsible are responding accordingly. I am jumping the hurdles as we come to them and trying not to let fear dictate how I handle things. In the long run there is a great deal to consider and believe me ... we have considered it. There is no end to the degree that we are willing to go to insure that her foot is healed and that those responsible are held liable for the damage that has been done. 
With that said, I can tell you that this sort of anger can eat you up. I have had fantasies where I invite the guilty party to sit in on a wound cleaning, just to make her understand the gravity of her mistake. Accidents happen. It's easier to forgive an accident, though.

Negligence is different. 

Negligence is the failure to execute care. A hospital's JOB is to care. Clara didn't have a procedure that carried risks. She had a simple splint on her foot. We shouldn't be dealing with this sort of injury. I spend my Fridays with a 2-year old in a waiting room full of elderly, diabetic, or overweight patients.  There is seldom an open spot to sit down and the TV is playing Tyler Perry's House of Payne ... not Blues Clues.

It's not ideal. 

We pack enough to occupy her for several hours days.

See how easily I am provoked to anger? Thankful for His mandates that supersede my "right" to be ticked off.
"A man's wisdom gives him patience; it is to his glory to overlook an offense."
- Proverbs 19:11
"Let all bitterness and wrath and anger and clamor and slander be put away from you, along with all malice. Be kind to one another, tenderhearted, forgiving one another, as God in Christ forgave you." - Ephesians 4:31 & 32

Know this, my beloved brothers: let every person be quick to hear, slow to speak,
 slow to anger; for the anger of man does not produce the righteousness of God."
- James 1:19 & 20

Thank you to those who have prayed for Clara and for our family and continue to do so. 

There is nothing more precious.

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Sarah Painter said...

wow. six months. i bet that was hard to swallow.

i will pray for a peaceful journey of healing.

i will pray for your anger about the issue. i cannot fathom the level of Mama Bear that comes out at certain moments during this.

i am thankful for our Savior's work in your life and your dependence on the Scripture.

Clara still manages to look complete precious through all of the drama and pain.

lori said...

Oh Kim...what an ordeal!! Shaylen continues to remind us to pray for Clara. I am not on facebook anymore so I am so glad you posted! Thankful you are deeply rooted in the Word so as to not be consumed with anger. I am sure that world be a temptation for me. The Raches family sends our love and prayers.

Diane said...

Kim, I'm so sorry this happened to your sweet Clara... and to all of you! One thing I've learned being in healthcare, is that it is just as much 'art' as it is 'science.' Although we are constantly learning, it is so dependent on a particular doctor or nurse's unique experience and training. And since all of us are humans... gaps happen. Which unfortunately leave room for error. It is heartbreaking when we fail to provide the best possible care. I pray every day for the wisdom to be mistake-free. But I've also learned that all of that doesn't really matter when the patient is your very own loved one. :-)

At the hospital, pressure sores (also called bed sores) are a HUGE deal. It is drilled into us constantly. This is why people at risk (elderly, paralyzed, very sick..) are frequently turned and placed on special mattresses. Even in the NICU where we generally don't see pressure sores, we are on constant 'skin vigilance.'

Sorry - I didn't mean to be so long-winded. You are absolutely right to expect them to be responsible for fixing this and seeing it through to a positive end! It should not have happened. And I'm so thankful that God is your true physician. Your willingness to place Mama Bear in Jesus' arms along with your sweet girl is inspiring! Your sharing has me reflecting on how I might respond in similar situations. It has been a HUGE blessing to me to see women of God who turn first to Him and His Word with each care or worry... Thank you for your openness. Praying for Clara and the V family!

Ellen said...
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Kelly said...

Oh Kim, I can hardly bear this. It absolutely brings me to tears every time I see that sweet little thing's foot.

Praying for healing, incredible doctors from here on out, and for peace in your heart. I cannot imagine the anger that wells up when she has to have that wound dressed. Oh my goodness.

robin schmitt said...

Kim, I hope and pray that God will heal Clara's foot more quickly than expected. He can do that, you know. Anger and bitterness certainly do much more damage to you than the person they are aimed toward, so I'm glad you're on guard and examining your heart in that area.

I pray that God gives you and Chris wisdom in how to deal with the caregiver who was negligent. It is so hard to know when--and to what degree--to hold someone responsible and when to extend the mercy that God has blessed each and every one of us with.

3 1/2 years ago I suffered 3 displaced fractures, torn ligaments, and a sprain in my ankle. The next day the dr. told me it would be 3-6 months for a complete recovery. At 6 months I was told that whatever healing had taken place at 1 year was as good as it would get. I was frustrated that I had not been given the complete picture sooner because it led to unrealistic expectations, but maybe I needed time to prepare for that answer. God certainly knows what we can handle when. I'm glad Chris was back in town when you got the recent prognosis for Clara's recovery.

Hang in there and keep your eyes on Christ. He will undoubtedly use this trial to make each of you look more like Him and to bring glory to Himself.

Anonymous said...

You have done an amazing job with the way you are handling this situation. I'm not so sure I would have. Thank you so much for sharing your journey, the scriptures, and your honesty. You are teaching through your blog. I have learned so much from you. We will continue to pray for you, Clara, and the family. From: Andrea Rodgers

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