Today is a day we are all glad is over. When I arrived this morning just before 9:00, the doctors had just taken down the dressings on Seth's skin graft donor sites. He was in a great deal of pain, and both his legs from his knees to his groin were covered in fresh blood. It was normal seepage and to be expected, but it was a horrific sight. I will never have to wonder what it means to bleed at every pore again. Seth was already exhausted because he didn't sleep well, so this didn't help the situation.While the ketamine did help with the pain, it also made him very loopy and forgetful, which was really frustrating to him. He couldn't remember eating his breakfast, ordering his lunch and some of the things different doctors told him during the day.
After much discussion about the best options for his donor sites, it was decided to leave them open to the air; we ran a fan over them for an hour of so and shined a sun lamp on them for 15 minutes--twice in six hours. The sooner the sites and seepage dry up, the better. The difficulty in keeping them open to the air all the time is that Seth was always cold.
When I finally left at 9 p.m., he was doing much better. We had the dose of ketamine lowered in the afternoon, so he felt more in control and more himself. He is excited to start doing physical therapy with his left hand now that the pins are out, so he got out his Nintendo DS at the suggestion of the physical therapist (probably the first time anybody has ever told him playing video games is a good thing). We are hoping tomorrow is a better day--it would be difficult to get much worse.
Charlie Trentleman asked me via Facebook to consider writing a column about the doctors and nurses at Walter Reed. I'm not sure I'm up to that challenge, but I thought I'd include a couple examples of our experiences here. Today, after the shocking and upsetting sight of the skin graft donor sites and Seth being in such agony, I was further challenged by what appeared to be uncertainty on the attending doctor's part on how best to treat the sites. After he left, the nurses asked if I had any questions. I asked is we could go out in the hall. I told them that the discussion between them and the doctor had not inspired confidence. Lt. Deane explained that he is a doctor, but an intern and this is a learning hospital. Because she has been here two years, that is why she was advising him on the treatment rather than vice versa. The other nurse, Major Pulido, added a few insights and then said, "Can I give you a hug?" I said, "Sure," and she threw her stethoscope over her shoulder, hugged me and let me cry it all out.
Later, the attending doctor who had not inspired my confidence returned with the orthopedic doctor who leads Seth's ortho team. He checked the donor sites and gave his recommendations, and then explained why there are several options rather than one best option. After he left, the attending doctor apologized for the earlier deliberation over treatment and said, "I thought I owed it to you to get the lead doctor in here to clear things up." I was very grateful. There was no show of ego--no wanting to be right or appear to know everything. He was more concerned with doing the right thing and making me feel confident about my son's treatment that being right.
These are only two experiences out of hundreds of interactions, but they exemplify the way we have been served and treated here.