Update from the homestead.

12 August 2020

CW: Stuff about medicine, post-surgical care, and wounds.  Feel free to close the tab if you need to.

This won't be easy for me to write, mostly because I'm tired, scatterbrained, and trying to put everything in some kind of order.  I'm pretty stressed out and my allergies aren't helping, either.  It's also been difficult to find ideas to put together right now.

Cancer is a nasty adversary.  It runs you down, robs you of your strength, and tries to steal away your dignity.  The overall supply of dignity in the world right now is starting to run low and I don't want to contribute to that.  I'd be lying if I said that I knew, really knew, what mom was going through right now.  I don't, and I can't.  I can imagine what it's like from being here and watching and helping as best I can but that's not the same thing.  Cancer can also throw you curveballs in the same way that an entire team of pissed off baseball pitchers could.  When there are rogue immortal cells gobbling up the body's resources faster than they can be replenished it really wipes you out.

I mentioned a couple of days ago that my mom was diagnosed with cervical cancer and I flew back to Pittsburgh to help take care of her.  Since that time it's been a whirlwind of activity around the old homestead, picking up, cleaning, throwing things out, fixing stuff, ordering parts and tools, and generally trying to get the house ready for her to come home.  It's been a pretty big job, involving more driving in a day than I've done during the entire covid-19 lockdown (that's not saying much, I don't drive all that much back home) and finding myself on a first-name basis with the staff of our friendly neighborhood chain hardware store because they've been helping me track down the stuff I needed.  Closer to mom's discharge date I had to call in assistance with the house because it just got to be too much for one body to handle, and as of when I write this we've been able to make some pretty serious changes for the better.

My mom was discharged from the hospital on 29 July, after over a week of recovering from a full hysterectomy.  She's got a ten inch surgical incision formerly held shut with 30 staples (they've been removed since I started working on this post), which are nothing to sneeze at.  Unfortunately, edema has set in to complicate matters.  Her legs are very swollen with excess fluid, resulting in the formation of hydrostatic bulla, or very large blisters on her lower legs and feet which are full of excess fluid.  We figured out that they'd put four IV lines running at KVO into her prior to and during preparation for surgery, but when they removed the surgical drain some days later they forgot to remove the extra IV lines.  Long story short, more fluid going in than could be removed naturally.  The thing is, the blisters are not from anything other than edema, which is good - there are no indications of secondary infections, no pressure sores or anything of the sort.  Fluid has to go somewhere and in this (unfortunate) case, that somewhere is in between layers of skin when there's no more room anywhere else.  Like other blisters, they're more or less sterile until they rupture, which they did shortly after returning home.  Her physician says that this is probably the best that could be hoped for due to the prevalence of antibiotic-resistant strep in hospitals these days.  Since I started writing this post some days ago mom's been put on a diuretic, which has been doing quite a job of removing the excess fluid through the usual means, and on top of that she's been getting exercise for her legs and back at the same time.  The hydrostatic bullae are no longer dripping constantly and are just draining as one would expect healing wounds to normally do (with all of the ickiness that one would expect, a positive change from before).

We've arranged for in-home assistance a couple of times a week.  A nurse, aide, and physical therapist come in on a rotation that I've yet to really figure out (due to HOPE, taking care of stuff around the house and checking in at work every couple of days).  I'm relieved by this; while I keep my first aid certs up to date with yearly training, a lot of this is just beyond me.  Especially when it comes to the daily injections of an anticoagulant to prevent deep vein thrombosis (though I do think it's pretty cool that syrettes, or more accurately, pre-loaded single-use injectors are coming back into medical fashion).  I will say, however, that I've learned more about wound care and sanitary measures than I ever expected to learn.

As it turned out when the staples were removed, part of the surgical wound hadn't had a chance to knit closed yet.  So, there is a part of the surgical incision near the middle about as long as one of my fingers that's just sort of hanging open.  It hasn't pulled closed yet.  If you look in there (and I do at least once a day when changing the dressing) you can see all the way down to the fascia.  I could stick a fingertip in there and easily cover the nail (not that I would do such a thing).  Now, let's be clear: It is decidedly not normal to be able to peer through about a quarter inch of skin, subcutaneous fat, and blood vessels (with a bit of bleeding).  There's something primal deep inside the brain that says "That's the insides of another being like myself, and I should not be seeing that under any circumstances."  Thing is, that's also the territory where higher parts of the brain have to step up and say "Hey, wait a minute.  That's skin.  That's not organs or bones and gushing blood, that's just a look inside the upper layers of another person.  Sure, it sucks, but it's easy to take care of.  So, get in there and help."

Or at least that's what a subprocess inside my head tells me when I pull that wad of gauze out and hose the incision down with sterile saline solution.  Wound care, like bong hits and memory corruption vulnerabilities, has a learning curve.

I'm sort of glad that mom didn't tell me right away that the official diagnosis from the hospital is stage 3 ovarian cancer.  I don't think I would have been able to hold together very well without a few days to gear up to it.  For folks who've heard the term but don't know exactly what that entails (like me, I had to look it up), this means that as localized cancers go it was pretty advanced.  Multiple tumors were found and removed and there is evidence that they were getting pretty ambitious in there.  Did it metastasize anywhere other than her abdomen?  No idea.  Hence, chemotherapy.  It'll probably be another couple of weeks before she's strong enough to have a mediport installed.  I fully plan on teasing her about being the second cyborg in the family.

I haven't yet figured out what my schedule is going to be like here.  I was planning on four or five weeks in Pittsburgh, then flying back to take care of some stuff at home (including two weeks of covid-19 quarantine at the house) for another few weeks, then flying back to Pittsburgh.  It's going to require nontrivial coordination with folks out here as well as back home.  Just in case, I'm building up supplies of clothing, tools and toiletries to manage how much mass I'll have to fly with.

One of the things I did was dig out my grandfather's old walker and clean it up a bit.  Mom isn't terribly steady on her feet and she needs extra help to move around.  For what it's worth, while she had considerable difficulty getting around the first day or two of being home, she seems to be getting stronger.  My mom's not leaning on the walker as heavily as before, she's able to walk more quickly and more stably, and her legs seem to be getting stronger.  The edema has made it very difficult for her to lift her legs due to the additional mass of the fluid but she's steadily able to move them higher and higher to reposition herself.  These are all good signs.  In addition to this, Dora the cat has rediscovered her love of jumping up onto the walker and riding as mom works her way through the house.  She used to do that when my grandfather was alive, and would fetch my mom when he was having trouble.  I would be entirely unsurprised if she did the same for my mom.

Due to the complicating factors I mentioned above, plus her core muscles being rearranged during surgery, my mom's not able to spend any time in a bed right now.  Getting her into bed is problematic at best, getting out means not being able to get back in unassisted, plus this is an activity which requires said core muscles to not be surgically compromised.  However, she has found that she's able to sit comfortably in an easy chair, with a minimum of difficulty standing up and sitting down, plus she's able to sleep quite comfortably.  A few days ago I called in help to switch out the chair for my grandfather's recliner (stored in the basement at the time), which resulted in some quick planning, some mental math, and a lot of pushing and shoving as hard as I could to get it up the stairs.  While I'm glad that I've kept up my usual exercise routine during covid lockdown, my back isn't inclined to do me any favors for a couple of days.

It seems like things are changing faster than I can keep up with them, let alone blog about them.  As I update this post (11 August 2020) I took my mom to an appointment with her primary care physician that afternoon (yesterday was an appointment for full-leg sonography to see if there were any complications of edema, such as deep vein thrombosis - nothing was found) to check out the blisters on her feet as well as the surgical incision.  The blisters appear to be healing up nicely.  However, there is now concern that the open part of the surgical incision is infected due to irritation, spreading redness and the appearance of the fluid draining from the wound.  Mom's on antibiotics now and I'll be taking her in to see her surgeon tomorrow (today for you, as this is a timed post) for a closer look.  I really hope this turns out to be nothing (or at least, something trivially easy to treat).