It’s been a challenging two weeks in the family. My wife delivered twins via an operation after a failed normal delivery. However, it has been complicated by a wound breakdown from infection.
What made me particularly unhappy was the fact that I have already noticed that the wound didn’t appear too healthy to me, and thus I’ve began dressing it. However, the nurses and other doctors all noted that the wound was healthy; my wife was even discharged from follow up. I usually try to be a “good husband” and not a doctor husband, and allow others to do their job. But as it was becoming clearer that the management was wrong, I was forced to take things into my own hands. So I called up a specialist colleague (bypassing any protocol) to have a look and behold: after opening the wound by the bedside, out goes pus.
The subsequent plan was difficult. My wife is nursing twins, which means double of everything, while nursing an infected wound. When she was in the hospital during the post-delivery period, finally getting transferred to a first class single bedded room was important for 1 thing: allowing me unfettered access to help out. I was more or less living in the hospital, and usually sleeping in the car. The other kids needed help with daily living and schooling (my in-laws were helping out as per usual). I can’t be both at home and the hospital, especially not when the overwhelmed parking in Hospital Melaka shows only worsening from the time I left to Hospital Kuala Lumpur to work. Me being a meathead has failed miserably to get anyone else to eat more protein. This is an opportunity to do so.
The medical management was of course dressing, antibiotics, and secondary closure. The decision would be inpatient care or outpatient dressing. Taking into consideration all of the factors, we have decided for the latter. And despite getting a slip for dressing at the clinic, I decided to do the dressing myself, for a few reasons:
As the wound was very sloughy, it needed a minimum of 2 dressings a day. Actually I’ve been doing it 3 times a day until now, and it has definitely shown much improvement. The timing doesn’t really matter in the sense that we are not bound to normal working hours, so I can do the dressing at times convenient to me. This has meant doing dressing at 2 am, to get things done. After 1 day, there was no more pus, but there was slough to be dressed. And today morning, I couldn’t see any of that.
I can be as meticulous as I want in doing the dressing. I can take my time differentiating which is slough, or fat/granulation tissue. I can selectively remove what I want while avoiding unnecessary trauma to the rest. In the clinic setting, they are undeniably under time pressure, and this may not help in preserving what is healthy in the wound.
I can choose the materials I want. This problem has led me to (predictably) spend hours reading up on wound care. Everyone has their opinions and biases, costs to think of. At the end of the day I’ve settled on Dermacyn soaked gauze (cut into a ribbon) + Tegaderm. With this, I’d get antisepsis, autolytic debridement, exudate control, and protection against external contamination. I’ve been using Bactigras on and off; the problem is that I get less slough removal for the protection of the other areas with healthy granulation tissue. However, this is much more expensive than good old normal saline soaked gauze + tape. But I wanted accelerated results, and felt that this can reasonably facilitate that. And it allows my wife to go about (and bathe) without worry of contaminating the wound, e.g. with simple sweat. Does anyone have any idea of how hot Melaka is nowadays? I can’t stand it.
Hopefully my wife’s wound would continue to improve, and the next issue of closure would have to be entertained. And soon after that, some normalcy in life.
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