I’ve got a plastic surgery clinic on Thursday and I’m going to pack a few things because the last time I went in for a clinic I got readmitted to hospital for two weeks.
When they took the plaster off from the first surgery, there was a big hematoma which is a big swollen blood clot that was from the impact of the taxi bonnet, or the brick wall maybe but that was where it took the biggest bash anyway.
The first four days after the accident were a lifetimes worth of hospital for me so being told I had to go back in for two weeks felt like I was being sucked out to sea. Then I decided to be like the chill-ass orangutan and surrender to the whole process so Christmas and New Year's in hospital for me it was. There are starving children in Africa and people in the ward with lifetime, genetic muscle-wasting illness and stuff like that who needed four people to move them in bed. My leg seemed very minor and temporary in comparison. I've been pretty healthy for the last three years or so. I stopped drinking booze altogether and got a lot more active and tuned into managing stress and just generally realising that I wasn't bulletproof and had to listen to my body more. It made a big difference to my physical healing and just being able to push your body to relearn things. It also meant that I was thumped by all the medicines being pumped into me so I was pretty quick to start refusing pain meds and wanting all the chemicals to stop. I took my last antibiotic tablet yesterday and I'm not on any medication now- fingers crossed that's the end of it.
Of course, you can't just sprinkle some Chia seeds over your leg and have some fish oil tablets when you're having open surgery on your leg. They have to knock you out which involves wheeling you into a cupboard and putting a rubber mask on your face and shoving a pipe down your throat which triggered a reptilian 'do not want' response from me apparently- I don't remember any of that but a traumatic frightened cat hit by a car response seemed pretty understandable. Well done me.
I've finally read the discharge letter and can see what they did now:
Tibial nail insertion and open reduction internal fixation of left medial malleolus 11/12/2014
Titanium rod thing from knee to ankle, inner ankle screws and something to my knee that isn’t a knee replacement but when people say they are having their knees done that’s what I had. Washout is cleaning up all the mess.
Washout left leg wound 23/12/14
Then I had to go in for a second surgery which is a Washout to clean up all the hematoma blood clot stuff and get it back to a point where it could be stitched up.
Washout and application of vac dressing to left leg wound 25/12/14 <<< Christmas Day
plastic surgeon checking the donor muscle -hole left from the hematoma- yes the white part is bone
Turns out the skin had all died above the hematoma so I had to go for surgery number three to have all the skin cut off. Then you get a left with a big hole in the front of your leg. Having a huge hole is a totally bad idea at the best of times but when you’ve just had a metal rod put in your munted leg it’s an even worse idea because you can get a bone infection and if that gets into the metal work then you can’t get it out so you have to amputate the leg. Yes amputate. So as much as everyone reassured me that wasn’t going to happen my brief stint in public health was enough to make me know that there are all sort sorts of ebola-cousins lurking in hospitals and the only places more germy than hospitals are those floating petri dishes called Cruise Ships (seriously: Google cruise ships + norovirus, it’s not just an evening show you’re catching on the Emerald Princess).
vac dressing sucking out all the bad stuff and circulating air and moisture to fast track healing
Then I had a vac dressing put on to prepare for the fourth surgery which means you have a plastic pipe stuck in your leg-hole to suck all the bad stuff out and speed up healing. It also means that you are plumbed to the bed and if you want to go to the toilet, you have to take a big tube and wrap gauze around it with medical tape so you get to do some craft. Then you go to the toilet and hold the pipe that is attached to your leg and are quite convinced that salmonella is setting up shop in your leg and pouring down the pipe like a bacteria hydroslide at Wet n Wild.
Local flap reconstruction of left lower leg wound + skin graft repair
Covering up the hole required plastic surgery and some skin grafts. It’s called Local Flap so they cut a piece of good skin off the side of your leg where it’s just muscle and tissue, and move it around the front to cover the exposed bone. I also had some skin taken from my upper thigh and used to patch up the parts that weren’t covered by the Local Flap. Skin is the most amazing thing in the universe I think (name a man-made thing that can self-heal? exactly…) so the side of my leg skin has covered up the bone and no more Oscar Pistorious for me. OK, technically there is still a risk because when you get a crushing injury, stuff can get left behind and it could go feral but I got doused with IV antibiotics for a week or so to blast all the Cruise Ship germs.
Skin grafts have to be untouched for about five days so you have to lie in the bed and do the worst thing in the world —nothing. You would think that lying in bed watching TV all day and being brought food would be like an awesome long-haul flight but it’s actually terrible because you have to pee in a bed pan which is the most revolting thing I have ever experienced because you are horizontal and you marinade your butt in your pee and have to balance until the nurse comes to take it out or it spills everywhere. After two goes I refused any further bedpan action and opted for the high-tech toilet seat chair option although the nurses would get a bit angry with me because it’s more work for them getting you up and down but the bedpan decision was final.
mobile sanitation device connect to your regular toilet and minimises ebola in your leg
One especially tricky nurse tried to convince me that she had to ‘measure my urine volume’ but I was on to her and her tricky schemes and I had to get my terse voice out, and then she threatened to put a catheter into me, nurses really do have a strong escalation game. So I got the doctors to put on my notes that it was infection control issue and i had to be taken to the toilet, i.e. no bedpans. Touche.
During this time, a lot of attention is paid to your plumbing actually and you soon surrender to the morning ‘have you opened your bowels today’ questioning and it’s all recorded and charted and they give you potions to ensure the question is answered in the affirmative. I was provided with ‘treats for my bowels’ aka Coloxyl and sometimes they just wheel you to the bathroom and leave you there for a while to see if anything happens so you feel like a puppy being left on the lawn to go number twos. When you do go, you get a big pat on the head and tick in your chart so it’s a great shared achievement. The old guy in the room next to me was on Day 15 and refusing treats for his bowels which you’d have to think was a seriously bad life decision. Protip: take the treats.
Local flap 'dusky' due to blood vessels venous congestion -wiring not all connected up yet
The skin is your skin so that part is happy but all the blood vessels have to reconnect. Blood goes in but doesn't come back out so that's when the leeches were brought in to try and save the bottom part of the Local Flap that was looking a bit -according to the discharge letter- Dusky.
Harvard Medical School highly trained specialist surgical leech- likes blood and warm places
The leeches are proper medical ones and you prick the skin like a diabetes person does and get it to attach. The leech has natural anti-coagulant in its saliva so a good one can sit there for a couple of hours and hoover away at the wound. The leech created much excitement- it feels like a normal garden worm on your leg and doesn't hurt.
Leech doing his/her thing on the Local Flap
The only thing is when they bloat up and are full, they wander off really quickly and head for the warm parts of your body so I had one full bloated one travelling at speed up toward my warm parts which was suboptimal so I decided to stop the overnight treatment because nightmares.
The good news is the fracture is all zipped up now. There is a big wound on the side of my leg where the surgeon took the Local Flap from and it looks bad but people in the know assure me that it's all muscle and tissue so meh.
I couldn't care less about scars and how it looks as long as my leg works I'll be beyond happy. A quick journey through disability has been a huge eye-opener for me and I'm beyond blessed that my journey has been relatively short and successful -some people have to live everyday with chronic pain, unhappy outcomes and far worse limitations.
The wound specialist came and visited me yesterday and we put this cool hydrogel stuff on the wound and it soaked up all the bacteria and it's all looking nice and pink and healthy now.
So yes, Plastics clinic on Thursday so I can remove the big dressing on my upper thigh from the skin graft donor site hopefully, and then the big date is Monday 19 January with an orthopaedic clinic and x-ray to see if my leg can bear weight so I don't have to ski around on crutches. Then I can test-drive my new titanium leg- good times :)
7-10 How beautiful on the mountains
are the feet of the messenger bringing good news,
Breaking the news that all’s well,
proclaiming good times, announcing salvation
Related: See how the accident happened - I got in the paper and everything