Thought Picnic: Coming to terms with my stupidity

My stupid scars

Sometimes I wonder about the stupid things that I have done that has left deep and enduring scars.

Stitched up and left to heal, I tinker with the freshness of the wounds preventing its prompt healing whilst enduring the pain and itch as if they have become comforts of my existence.

Then I come to myself. The scars will remain but they must become stories, having their own long tales of how I acquired them, but having my body recover, recuperate, regenerated and restored.

Constantly, I have to alert myself to what is good for me and what militates against my health and welfare.

Scars of beauty and hope

Time to nurse my scars to health and deal with the things that so easily distract me, the quest to please myself, the need for approbation in attempting to please people and understanding that from a spiritual standpoint, my God is pleased with me; I just need to understand, honour and become more aware of that truth.

Loved, blessed and favoured beyond what I can find words to express, a rediscovery of spirituality brings grounding without which one is distracted, uninspired and listless.

I am learning new things, and this is offering opportunity and expectations. The story continues; we are on the up.

Thought Picnic: Chronicling the sudden end of bicycle journeys

Bicycle accidents

In my first year in the Netherlands, I had 5 bicycle accidents. Some were avoidable but only two involved other parties. A tourist had just walked into a cycle path without looking, it was impossible to stop without hitting him.

As I got up, I was both apologetic and angry, though on realising his folly, he was more apologetic and thankfully, not too much damage was done to either of us. Last year, I had a similar accident, the lady coming out a shop just walked onto the cycle path without looking – there was just no way I could avoid her as I knocked her over, all her shopping splayed on the ground, I was not going at a high enough speed to be dismounted.

The worse accident I had wrote off my bicycle, the front forks holding the wheel were so bent backwards there wasn’t much that could be done to repair the bicycle. I was about to turn into a side-street and I did not see the cyclist coming towards me so we collided and that was the end of that journey.

In another case, this man on a scooter was definitely drunk coming round a curve and just came straight for me, that bicycle was completely written off too.

Not nice on ice

A few years ago, as I rode in winter, there was still some snow on the ground and one had to be careful to avoid the slippery icy parts. About 15 metres before my fall, I could already see myself having that accident, I do not know if it was prescience but I got to that bit of ice and probably did 5 metres of traction or lack of it after my bicycle and I were separated. Thankfully, the only thing that was bruised was my dignity and though there were onlookers none came to help.

Since then, I have avoided riding my bicycle in the snow just for the fear of falling and coming a cropper.

Yesterday looked fine enough, it was sunny, and though cold it did not appear to be freezing, so I got on my bicycle for a ride without much of a care about it.

I was just about 250 metres from home when I took a turn I usually take to on the long stretch of road that leads to my block, something I have done hundreds of times before but this time as I took the turn the tyres lost all traction and there I was on the ground, literally in the middle of the road.

They walked on by

I could not think of why I had an accident there as it took the best part of 10 minutes for me to get my bearings back, pick myself up and then get my bicycle. The two people who passed me must have thought I was drunk, but I don’t drink and none even cared to be concerned.

It bothers me because it is very unlikely I would see such a situation and never get involved, it is just not my nature to “Walk on by” but that is the community I live in and I have noticed that striking difference between Amsterdam and even Cologne to the South in Germany.

Having another look at the area, I saw the glistening reflection of what could only have been ice; innocuous and dangerous – it is what is known as black-ice, usually hardly visible on macadamised roads but treacherous at best, if I had fallen in front of a moving vehicle, their brakes would not have helped. That was close.

Fixing the damage

In any case, when I picked up my bicycle, I noticed the rear light had stopped working; probably the filament in the electric bulb had broken, then the handle bars were no more at 90 degrees to the front wheel – there wasn’t much I could do about that then and the carriage at the back of the bicycle had come off just below the back of the seat as if two bolts had been broken off.

As for the damage to my person, I was quite bruised in a couple of places around my legs but my left knee seemed to have bled through my trousers showing two big red patches.

I hobbled slowly to my home, chained up my bicycle and then inspected the bodily harm done. I did have methylated spirit but the big-baby in me could not contemplate the pain so I cleaned the wound with hydrogen peroxide instead.

Then I found myself riffling through my box of dressings, I learnt a lot about dressings a few years ago and now I was spoilt for choice. In the end I applied a silicone film to the wound, then an absorbent dressing and bandaged the knee. It is still a bit painful and I have a bit of a limp but I think I will be fine.

I should be back on my bicycle in a few days, I hope.

My bandaged knee.

More chemo but not worried

The early bird, I was

It was exciting as well as the fastest time I have been in and out of hospital; it was all over in just an hour and much really was done.

My appointment was for 9:30 in the morning, which was early, I had to set my alarm for 8:00 AM and after 3 “snooze” knocks, I was up and out of bed in 15 minutes.

I had to get my wounds paraphernalia that is the Mepitel silicone film dressing, the absorbent material and the bandage. I have never said that the bandages are self-adhesive, the nurses love those bandages, it means they do not have to fiddle with sealing tape and there is no danger the bandage would suddenly come off.

Quick to the point

With the bus and the tram, I was in hospital by 9:23 AM and within 5 minutes I was called in by the doctor, the consultant oncologist is away in New Orleans on some peer junket as these very senior people and wont to and I have met this youngish affable doctor before.

I hobbled on my crutches to his office and chatted about my condition, the condition of the wounds, the sudden occurrence and disappearance of dysentery over the last week, the couple of time I was so nauseous I was sick in the toilet and my sometimes itchy hay-fever eyes which he thought might be related to the chemotherapy.

The doctors usually require a nurse to do the bandages, but I am already a dab hand at doing them myself, I wanted him to see the condition of my two feet in the hope that I could persuade them not to put me on another course of chemotherapy.

I got out my scissors and snipped of the bandages and he was quite impressed at the technique first and then the condition of my two feet.

Six courses were prescribed

The minor detail I did not have about my treatment was that normally for Kaposi’s Sarcoma six courses of chemotherapy are recommended – my heart sank, but for good behaviour, if that count he has written in my notes that maybe I be let off after the fifth – it would all be well, I am quite hopeful.

The fact was I thought an assessment was done each time to ascertain the efficacy of the chemotherapy before offering another course – you learn.

Immediately after that, appointments were made for Christmas Eve for another date with the oncologist and the Monday after Christmas for the fifth course of chemotherapy, the fourth course is on Monday.

The trick of a prick

They also needed to do a blood check which was quite an express service, I got my number, I was called and I did not have to wait be get to see the nurse, as I pulled up my sleeve the veins are glowing ready for the needle prick, before I knew it, the cotton wool was on my skin and we were ready to say good bye.

She hoped I had a wonderful day, I wished her a rewarding day which gets quite slow in the afternoons and she was going to be there until 5:00 PM.

When she mentioned the weekend, I hoped she would make the best of it and before I knew it I was talking about my guest from Stockholm who had contacted me through my hospital season blogs, who became friends and is now visiting.

The nurse also blogs about embroidery and I found myself giving her the address of my blog page, I hope I get to see hers if she leaves a comment on my blogs.

The compassionate priest

Then, one final thing, I had promised myself that on days without chemotherapy I would visit the catholic priest who came to my bedside when I was in hospital, so after he attended to patient, customer, parishioner – really what do you call someone who sees the hospital chaplain?

He invited me into his office, offered me a drink and we chatted at length about so many things, I kept in mind he had an appointment in 30 minutes and really, I do not want to take up his time on a seemingly social visit.

I however learnt that it is rewarding for the priests too to know that patients they have seen before are recovering well and though there are dangers of getting emotionally involved the situation is a priest cannot really be apathetic in their ministry which is one that should thrive on compassion.

The hospital parish

A hospital might well be a parish, but the parishioners do not have the essential quality of permanence as you would have in a local community, they come and go, they are old and new, they are ill or well and mostly every time, they are different.

One interesting insight in our conversation was about the professionalism of doctor that do not necessarily have to be empathetic and the caring nature of nurses who are involved in the everyday treatment and recuperation process – the latter do always get the chocolates or flowers but the former, go home sometimes with bottles of wine as gratitude from their patients.

My visit to hospital was no doubt very pleasant and fulfilling, it is however another wonderful course of chemotherapy on Monday again – Thank God always.

A wardrobe of wounds dressings

A different kind of person

The illness I had has been a road of experiences I probably would never have travelled by any other means – I could see nothing that would have brought me in contact with many of the things I have learnt about doctors, nurses, hospitals, care and many other areas of health and healthcare management.

Most importantly, that aspect of humanity that moves beyond sympathy to empathy, the sharing of common interests or experiences and the willingness of many to go long beyond the call of duty for so little remuneration for their services and they gain such satisfaction, fulfilment and contentment for what they do.

As one thinks about these things you can only count your blessings and be in gratitude for meeting people in whom hope and enthusiasm is in ascendancy whilst cynicism, scepticism and apathy finds little place to take root – we can hopefully learn from them that the whole wide selfish and independent world owes a lot more to the better virtues of these people dotted around our lives than the independent spirit of grabbing all you can get for the adrenalin fix of winning against everyone else.

Do not touch those wounds

My last visit to hospital was another revelation in wounds management, now, I have always been of the impression that all wounds need to be treated directly, plasters and bandages need to be under-laid with ointments, potions or some sort of rub, it needs to be picked at, if not molested till it all turns out right – well, that, I have learnt is wrong.

In my case, the cancer lesions which present themselves as deep tissue wounds were never touched except when biopsies were taken, they were covered with a gauze, then some lint to absorb and pus or draining fluids, then bandaged up.

The only time the wounds were touched was a good 4 weeks into my treatment when the wounds nurse decided all the necrotic tissue had to come off to allow fresh tissue to breathe and heal over.

Greasy bits and old things

Until then, the gauze applied as a very greasy fine netting which kept the wounds moist and for a while, it was the best course of treatment, that gauze came under the marketing name of Cuticerin [1]. Before then, when I visited my doctor, she removed the cotton wool which I have put on the wound and as you know that tugs at the main wound if any exudate were produced and it did not help in the healing process.

Then she used Betadine [2], a gauze impregnated with a brownish household disinfectant for wounds, but as I got to the hospital, I was told that kind of treatment was old because it stained the wound and did not help in identifying clearly if the wound was healing or not. I would suppose the brown colour comes from the iodine content.

Gauzes with transparent or colourless impregnations were the in-thing as far as they were concerned, in fact, there was no trace of Betadine in the hospital.

So, for weeks, my wounds were dressed with Cuticerin, until the neighbourhood nurse got concerned that the moistness seemed to be spreading to other seemingly healthy areas and healing did not seem to be progressing as they thought it should.

Ionised from greasy looks

This caused the re-evaluation that had the specialists think things were maybe fine, but in need of the opinion of the wounds nurse.

The wounds nurse had one look and decided the gauze should change whilst cutting away the necrotic tissue. That gauze was an Antimicrobial Calcium Alginate Wound Dressing, generally known as alginate to the industry and this with the tradename Suprasorb A [3].

The active component of this dressing was the silver oxide ions which bind with bacteria in wounds, hence lowering infection; more so, it was dry and very absorbent. You can leave the dressing on for as long as 7 days till it literally falls off, that way you never adversely tampered with the wound or the platelets formed as part of the healing process.

I did not know that there was this big debate about wounds management in the medical world between moist dressings and dry dressings, but the use of alginate represented great progress in the management of the wounds I had.

All those deteriorating moist areas dried up, adhered to the dressing and within weeks all the areas were dry and healing progressing apace. In the process a lot more necrotic tissue could be removed.

Good feeling touch

On my last visit to the hospital, the doctor had a look at my foot and decided the alginate dressing was now not as effective as it should be because the core area of the wound was dry apart from some small areas producing fluid and the source of most of the pain I suffered.

This doctor apparently knows a lot about wounds management and changed the dressing to a silicone based film with 1 millimetre diameter holes commonly called Mepitel [4]. This film places snugly on the wound and allows it to “breathe” and all seepage or exudate to be soaked up on the lint compress which should be thick enough to absorb the fluids if any.

Removing it is also kinder to the wound surface and it can last up 7 days, though the lint dressing should be changed daily as advised.

I must say, through experience, I have learnt quite a bit about wound care, it is all very interesting, I doubt if a new type of dressing would be needed between now and the full healing of the wounds.

Sources

[1] Smith & Nephew - Cuticerin*

[2] Betadine - Wikipedia, the free encyclopedia

[3] Activa Healthcare - Products - Suprasorb A

[4] Mepitel Dressings Datacard

A second course of chemotherapy

The busy insomniac

The neighbourhood nurse arrived a lot earlier than expected; alright I needed an early dressing of my feet because I was to visit hospital today for a second course of chemotherapy.

This disrupted my morning naps which seem to come after drug-induced nocturnal insomnia that I have had since I was in hospital.

Rather than toss and turn in bed, I productively feed my spirit with inspirational and edifying teachings, music or listen to either of the Elizabethan English version of the Bible of the Message Bible in contemporary English.

The most important result of this is to keep ones faith in the ascendancy such that one does not end up hopeless or in despair, in fact, it is impossible to take on that kind of mindset where what you hear and meditate on is encouraging, inspiring and strengthening the will to not just survive but thrive.

The battle is in your mind and if you cannot begin to create new realities with a vivid and thriving imagination, you can easily be swallowed up in your circumstances and never see a way out. I thank God, I have an anchor that keeps my soul from drift – The Psalmist had a lot to say about encouraging oneself out of desperate situations to a winning spirit and mindset.

Excess baggage for the night?

Anyway, beyond the chemotherapy for today, I was also to see the wounds nurse after many consultants observed the condition of the lesions but could not determine what best to do.

When I finally left home for the hospital, I was a bit rushed for time and riding my bicycle took a bit out of me. I was at least prepared for a night of observation at the hospital, if need be, that my rucksack weighed a tonne.

A change of clothes, my mobile phone, the charger, my net book, its power supply, drinks, sweets, medicines and so on, especially considering I had no chaperone. It is one of those times that your sincerely wish you had a companion of sorts – trying to get my clothes out of the washing machine to the drying rack yesterday was such a herculean task on crutches, I never really completed the activity to my satisfaction.

Be reclined rather than seated

The out-patient oncology department was a maze to get to, up the lifts, doors, corridors, signs and a foreboding of getting lost.

The nurse there was in charge when I took my first course as an in-patient on another floor, it is nice to see familiar faces considering, I have literally gone through the pool of neighbourhood nurses, I cannot remember any names anymore.

The seats were setup in such a way that it had a movable back, a movable seat portion and a movable leg portion with foot rests. It could well have been a tumble drier with the tumbling action cut out.

Needles, pricks, tweezers and scalpel blades

The intravenous saline solution was first setup, I seem to prefer all the needles and pricks on my left arm, and it is easier to look away towards the right than to the left for me.

The chemotherapy trademarked Caelyx is wrapped in aluminium foil because it is sensitive to light and attached to the drip mechanism, you can see the red fluid mix up with the saline solution as it enters the body.

I completely reclined and literally fell asleep when the wounds nurse came. Despite what all the specialists had seen and said, she was the first to suggest that she would attack the lesions directly.

Apparently, there was a lot of necrosis or necrotised tissue on the lesions – necro means dead – this was dried up but rotten tissue that needed to be pulled off with tweezers but a good deal was still attached to good tissue and had to be cut off with a scalpel blade. No small pain, all that, but now I know it all has to come off eventually.

New dressings

As a wounds nurse she really knew what had to be done, it was her specialisation and I note that all specialists were ready to defer to the wounds nurse for her opinion.

She is now changing the dressing gauze from the fat-based covering to an algae-based microbial padding which has silver particles that bond with bacteria, killing it and making it ineffective, thereby helping the healing process and removing the smell.

She called my local pharmacy, had an order put in that would be delivered to my home tomorrow. That is one thing I like about our health care system here, the doctor, nurse or hospital can pull up your details, link to your local pharmacy, send the prescriptions and the pharmacy delivers.

I had completed the chemotherapy course by the time all that was done and I now had to contemplate getting back home on my bicycle on rain-drenched roads. I tried laughing through the pain, I did.

I went straight to bed and that was how it was.