Wearing gloves, carefully remove previous dressings.
Soak any portions that threaten to stick with normal saline.
Protect the intact skin from shear forces.
Avoid disruption of potentially viable tissue.
Once, early on, dad was wedged in the bathtub and couldn’t get out; the water had been drained and although he’d been dried off, his shivering beat a staccato undercurrent in the hard-edged room. Mom had laid a towel across his lap, a modest afterthought, her call for help threaded through with unvarnished panic.
I tried. Touch gentled, cues slowed, process pantomimed. But his breathing got quicker and shallower and shallower and quicker, his joints seemingly yoked by an unseen pilot. I imagined the bloom of tacky synapses beginning to misfire behind his eyes.
To obtain a viable culture, draw the swab across wound bed in a 10-point zig zag pattern.
Apply sufficient pressure to drive exudate from tissues while avoiding undue discomfort.
Package and label the swab without allowing contact with potential sources of contamination.
The conversations about when to start hospice swung like a pendulum, each of us looking for minute daily markers that would help draft the roadmap. We talked as if we were darning a sock, the threads of medical jargon, the warp; the details of the cross-county move, the weft.
Cognition, warp.
Price, weft.
Decline, warp.
Change, weft.
Possessions were distilled down into shrink wrapped parcels inside bubble wrap inside cardboard boxes, some brand new and some inked with their 2nd or 10th iteration of destination. Objects, both meaningful and meaningless, that threatened to leak out into plain sight were deftly moved beyond his questioning eyes. This over-handling of memories, this squeezing out of overlapping stories, brought on confusion like a bruise.
Place sterile field of absorbent material underneath the affected area.
Sample wound depth over multiple regions using a sterile probe.
Carefully document any newly exposed subcutaneous tissue.
Closely observe the margins to monitor tunneling of necrotic processes into healthy skin.
The latest book suggested we limit using open-ended questions to plumb the daily shoreline of dementia, an ask that feels like entombing our familial tongue and unearthing clumsy new ways with words. Now, the parsing of a day takes the shape of a winding, diving and surfacing, arcuate narration of each mundane event from sunup to sundown. Is the hoarseness from effort, from repetition, from fear? A chill finger nudged my heart, an effort to spread a salve over the tiny pluck of alarm, not wanting the rest of my voice to leak down into a pool beneath my feet. The plaques that insinuate themselves into areas that were functioning a moment before become superimposed marks on a faded yardstick. Each morning a new gauge unwrapped. Each day the borders redrawn. Each night the blissful flannel box of sleep.
Protect healthy areas from leakage of caustic exudate with barrier cream.
Adhere the secondary dressing, avoiding compromise of optimal blood flow.
Cushion bony prominences with closed cell foam or similar padding.
Short stretch bandages applied in a herringbone pattern create an ideal pressure gradient.
Some days my mother’s words and mine had a lasting sting like lemon juice on a hangnail, but on others we seemed able to tape subject to predicate in shapes that conveyed meaning as well as intention. Frustrations still flared around hearing aids nestled uselessly in their padded box or her not so subtle acerbic tattling about wetting episodes.
But also. Faith showed up in the oft recounted life chapters from the before. Hope reached out in the cupping of soft hands around edgy elbows. Love came through in the brush of lips along his scowling forehead. Many nights, the anxiety of what I might have forgotten to say in all the unpunctuated potentially parallel conversations tangled my feet in the sheets.
There would be more days pushing up through consciousness like seeds bursting bright glade green. There would be more days of protecting tenderlings from battery by the elements. There would be more days gathered in a crosshatch basket to be chosen, admired, savored. There would be more days collecting like husks in a winter garden. Then there would be no more days.