Sunday, September 30, 2012

27. Home Care: The High-Tech Component

In a previous post (#25) on home care, I mentioned how the wonders of modern technology can speed up healing.  And so they can, at a cost, as Bob and I have learned.  Here follows our tale of woe.

Let’s start with the outlandish hoist that was delivered to our apartment and, when not in use, had to be stored in a hallway, blocking it completely.  It was meant to lift the patient -- rather like a load of freight being transferred from a dock to the hold of an oceangoing vessel -- from his bed to a wheelchair.  With apprehension, I imagined Bob traveling in midair.  But when it turned out that the contraption couldn't be placed properly beside the bed, it had to be sent back.  I was not sorry to see the bulky thing go.

Next, the VAC, the latest in high-tech wound healing, a complicated therapy that boasts of treating six million wounds worldwide, but that I never did manage to wrap my mind around.  It creates a vacuum in a tightly sealed wound, then drains the wound through a tube connected to a vacuum pump, causing the wound edges to contract, but that's about as much as I ever grasped.  But Marge, the young nurse who was coming to us at the time, insisted that I learn how to detach the canister attached to the pump as the canister filled up with an unsightly black guck that somehow resulted from what was going on in the wound.  I protested that I wasn't cut out to be a nurse, and that I wanted nothing to do with that heinous black guck, but she overrode my protestations.

As it happened, I never had to change the canister, but the worst crisis we ever faced came one night at 4 a.m., when my clumsiness disturbed the delicate mechanism of the VAC and unsealed the wound.  Desperate, I phoned the Visiting Nurses and, to my astonishment, reached a Florence Nightingale who understood the problem and advised me to apply a simple wet-and-dry to the wound: gauze moistened with saline, covered with dry gauze to secure it.  When I phoned the VAC supplier, they too had someone on night duty and she gave me exactly the same advice.  So I did as instructed and then, at
a decent hour in the morning, informed the Visiting Nurses that a nurse should come to reinstall the VAC.  All of which confirms what I have always stated with emphasis, that I am not, never have been, and never will become a nurse.  I'm too ignorant, too clumsy, too stupid.

The VAC was a prima donna demanding constant attention, so I was not unhappy when our doctor opined that it had done its job and discontinued the treatment.  But that wasn't the end of high tech, ah no!  Next came the Clinitron bed, which would also speed up the healing of the wound.  Getting it wasn't easy, since Medicare objected to the high cost involved, but our doctor worked his wiles and got it.  "It's better than the bed you have," said Marge, an ardent advocate of the Clinitron.  "With this bed, it's like floating in a boat on the sea.  With the Clinitron, it's like floating in the sea itself.  My patients love it!"  And so, to arrange the transfer, I got in touch with the Clinitron folks and those who had supplied the current bed.  "We don't coordinate with them!" announced the Clinitron spokesman.  "You've got to!" I yelled into the phone.  "If one bed is removed, the other has to replace it at once.  Is the patient supposed to lie on the floor?"  Finally the two outfits coordinated, and a date was set for the transfer.

Naively, I thought it would be a simple matter of taking out one bed and substituting another.  So when the great day came, the home care aid and I got Bob into a wheelchair and took him to another room, where he insisted on facing the room where the action was, so he could watch it step by step.  The
first bed was duly removed; no problem.  Then began the installation of the Clinitron.  Did I say "installation"?  Our apartment became a construction site.  Something that looked like a bed frame was trudged laboriously up the stairs (four flights, remember?), but it proved more of a foundation.  Next, as the three of us watched from a distance in amazement, two workers with large buckets starting dumping what looked like sand into the base or foundation.  This was the installation of a bed?  Bucket after bucket was dumped, then they raked the sand to make it level and evenly distributed.  Then, at last, what looked like a bed frame and mattress -- cushions, really -- were installed on top of all that sand, the whole business was plugged in, and the bed was pronounced ready for its occupant.  So the occupant was also installed.

"I don't like it!" Bob immediately announced.  "It pulses."

Sure enough, it did: the mattress was constantly pulsating, as if some vibrant little creature were inside it.  Air pressure made the sand -- beads, in Clinitron lingo -- dance.  And it whined.  The old bed had produced a gentle purr of a whine, but this one emitted the high-pitched whine of an enraged monster.

"You'll get used to it," I insisted, more out of hope than conviction.

"I won't!"

So began the adventure of the Clinitron bed, another prima donna, even more temperamental and demanding than the VAC.   It pulsed, it whined.  It drew lots of power, sending our electricity bill soaring.  And once, when the bed and the air-conditioner had been on nonstop for several days, our power failed.  To restore it, I had to go down to the basement and move a slew of empty cartons that the bakery (the famous Magnolia) had dumped there, so as to reach our circuit breaker and flip a switch.  "Turn the bed off for an hour every day," suggested Marge; "don't run it nonstop all the time."  Good advice, but when the bed was turned off, the cushions deflated and Bob announced that he was lying on boards: the worst possible outcome for wound healing.  As for the soaring electricity bills, Marge urged me to knock on my neighbors' doors --  every neighbor in the building -- to ask them about their bills, so we could compare them to ours.  "Marge, I announced, "I'm not going to do it!"  And I didn't.

But if the temperature in the room got above 86 degrees -- and it often did, since heat rises, and we are on the top floor -- the bed would shut itself off.  Then all you could do was wait a half hour and turn it on again, until it shut itself off yet again.  So it went for weeks; at night, anticipating a shutdown robbed me of sleep.  Meanwhile Bob hated the pulsing, and we both detested the noise.  The Saint George who delivered us from this monster was, once again, the doctor, who decided that the bed had done enough in accelerating the healing, and too much in fueling our anxiety.  So the bed was dismantled -- another lengthy process -- and removed from our apartment, replaced by another semi-electric bed with an air-filled mattress.  Farewell to the dancing beads.

So ended our adventures with high-tech healing: the little monster, the VAC, and the big monster, the Clinitron bed.  The doctor assures us that they helped in the healing, but we are quite content now without them, attending to a much shrunken wound that has yet to completely close, thus assuring us
of continued Medicare coverage.  (Three cheers for the shrunken wound!)

Another complaint about the prima donnas: unlike the doctor and nurses, they didn’t tell us interesting stories.  They just sat there and did their thing.

Thought for the day:  Hope is the fuel of life.

                                                        © 2012   Clifford Browder

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