I guess in some ways it’s reassuring that St. Vincent’s Hospital didn’t suddenly (since Nyel was last there for six weeks in April/May) get better.  When Nyel was admitted night before last, things looked hopeful.  But now… same old, same old.  At least we know we weren’t crazy the first time around.

The orthopedic surgeon who performed the original (failed) surgery and one of the two “clean-outs” seems to be in charge.  Maybe.  Or maybe not.  As of yesterday, he wants to open Nyel up and clean out the wound (again!) as it has become infected (again!)  The infectious disease doctors and the wound care doctors and the cardio doctors and perhaps even other ortho doctors wanted to do an MRI to try to get more information.   They were advising against surgery but as of yesterday a.m. — the MRI was off the table (so to speak.)  Surgery was on.

By evening, surgery was off the table and the MRI was done.  Apparently, the doctor-in-charge was overruled. As far as Nyel knows, no surgery is planned.  Oh — and let me add that though many doctors have seen and talked to Nyel up close and personal, he has not yet seen the orthopedic surgeon during this stay.  Not hide nor hair.

But it’s the back-story that makes it all the more interesting.  At noon on August 11th Nyel had a follow-up appointment with the ortho surgeon.  Nyel had been home for over a month and had been under the care of Harbor Home Health.  The head nurse was pleased that Nyel was going into Portland for the follow-up appointment.  She had some specific questions about the wound site and whether or not the wound-vac (the pump to which Nyel was attached) was still necessary.

I drove Nyel and his wound vac to Portland (actually to an office in Beaverton) for his appointment.  The doctor was pleasant and chatty but said he “wouldn’t bother” looking at the wound site.  “But… we drove three hours…”  When Nyel mentioned that his home care nurse had some questions about continuing the wound vac, the doctor said that she should be “perfectly capable” of making that decision.

That the home health nurse was frustrated by that news is totally understandable.  A few days later when she suspected the wound was infected, she contacted the doctor who then sent orders for a blood test.  “Yes” came the result.  “Infection.”  The doctor then asked for a culture from the “seepage.”  The nurse picked up the ordered testing materials from the hospital and did the culture.  At that point she also removed the wound vac and showed me how to apply wet/dry dressings — the protocol always used, she said, when there is infection in this sort of wound.

Yesterday, at the hospital, Nyel was asked who made the decision to remove the wound vac.  (He was also informed that he would probably continue to use it for up to a year or a year and a half. YIKES!) Furthermore, Nyel was informed that a culture should never have been taken from the surface seepage.  These criticisms/concerns were (again, “apparently”) coming from the ortho doctor but, as mentioned previously, he has not seen Nyel face-to-face.  And he was the one who ordered the culture.

As for the pain (which is why he went to the ER in the first place on Wenesday night)  — “they” say it is because his body is laying down calcium deposits trying to rebuild his femur.  That could continue for up to three years.  Of course, the femur cannot be “rebuilt.”  Calcium is not bone — no blood supply etc.  But the body doesn’t know that.  Or so the experts are telling Nyel.”  They have increased his pain medication.  Is that working?  “Except when I move,” Nyel says.  “Then, on a scale of one to ten… it’s about a seven.”