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.