Training a Home Care Giver

Wound Care Supplies

Wound Care Supplies

In a surgical practice the treatment of certain types of wounds requires patience and the presence of a strong stomach in the care givers. As surgeons we become accustomed to sights and smells which often are unpleasant at best and downright repulsive at worst. Infection in a surgical wound is a dreaded complication, and the treatment of such a wound can be unpleasant both to the patient and to the care giver. This is just part of the job but thankfully does not represent the majority of the care giving experience.

One of my senior partners, Dr. C. E. Tommey was one of the best surgeons I’ve known, and also one of the most beloved doctors in El Dorado. His surgical technique was superb, and his patients usually did very well and recovered quickly. In addition he had a quiet and very kind demeanor which not only promoted confidence in his abilities but made his patients believe he always had their best interests in mind. I admired and respected him so much  when I had to have several operations Dr. Tommey was my surgeon. Also when I had a particularly complicated surgical case for which I needed a special assistant, it would usually be Dr. Tommey  I would call to help. On one particular Fourth of July holiday weekend when Dr. Tommey and I happened to be the only surgeons in town we decided to assist each other on all the emergency cases. We did a total of twenty-three major operations from Friday evening to Monday morning, and were both relieved when the weekend was over.

On one particular afternoon Dr. Tommey was scheduled to see patients in the clinic as he had completed his operative surgical cases for the day. Clinic patients included new patients and doctor referrals for consultation. Also scheduled were post-operative patients for suture removal, and patients seen and treated in the ER who needed more care.

One of the patients to be seen was Mr. Johnson whom Dr. Tommey had seen and treated in the ER for an abscess in his groin area. He had never met Mr. Johnson prior to this ER visit, and did not meet the patient’s wife in the ER.  Apparently he had been brought by another family member. Mr. Johnson was an elderly gentleman who had never had a serious infection problem, because he was healthy for his age. In addition he avoided doctors as much as possible. The abscess was quite large but Dr. Tommey had drained it completely and left surgical packing in the wound to facilitate rapid and complete healing.

Dr. Tommey’s nurse, Reba called the patient into the treatment room and prepared him for the packing removal and wound cleansing. Because of the location of the wound and its’ size the entire groin area had to be exposed but was done in such a way to protect his modesty as much as possible. When Dr. Tommey entered the room and inspected the wound, he told Reba that Mr. Johnson needed to have someone cleanse and pack the wound for him daily. He asked Mr. Johnson if he thought his wife would be able to do that, and he replied she could do it and not be bothered too much by the wound. Reba went to the waiting room and called for Mrs. Johnson to come back to the treatment room. Reba had never met either one of the Johnson’s prior to this visit.

When the elderly, grey-haired lady entered the room Dr. Tommey said he wanted to show her just how to cleanse and re-pack the groin wound, and it needed to be done each day. Dr. Tommey gave her the surgical tools to do the job and guided her as she successfully removed the packing , cleansed the wound and re-packed it correctly. She applied a very neat outer dressing and then helped Mr. Johnson put on his underwear and trousers. As he walked out of the room, Dr. Tommey told him he needed to see him again in one week, and Mr. Johnson thanked him for his help.

The lady went to the corner of the room and sat down in the chair, and Reba told her the appointment was over. She told Reba she had an appointment and Reba said, “Oh, you have an appointment on the same day as your husband?” The lady said, “That was not my husband. I’ve never seen him before in my life.” Reba said, “I called for Mrs. Johnson and you stood up and came into the room.” She said, “I misunderstood. I don’t hear very well. My name is Jackson and I thought you called for me!” Both Dr. Tommey and Reba were flabbergasted and apologized profusely to Mrs. Jamison for placing her in such an embarrassing situation. Mrs. Jackson said it was alright, and she was glad to help in any way she could. Apparently she thought it was required for each patient to assist in the care of the patient ahead of them in order to speed up the treatment time and reduce the waiting time.

As a physician it is very gratifying to have a patient or family member follow our instructions to the letter, but in the case of Mrs. Jackson and Mr. Johnson perhaps she should have been a little more suspicious of the wound care training she received. The positive aspect was  she was certainly prepared to provide good home care if her own husband ever developed a wound abscess.

Dr. John

The Passing of Pugh’s Gall Stone

Solitary gall stone

Solitary gall stone

In 47 years of medical practice, I have met and ministered to a number of very interesting people. I have always been attracted to individuals who have interesting facts about themselves and love to tell stories regarding their past. Pops was a master story-teller, and I would sit with him for hours at a time listening to and enjoying all of the past accounts of his life and the characters he had known. Story tellers seem to attract others who are like-minded, and Pops had a bunch of friends that were almost as good at story-telling as he was. I have written about Ike Wilson, and he was a particular favorite. Several of their friends that would occasionally join them were men like Bright Griffin, JC Pendleton, Voyd Wilson and Pugh Wallace. The stories they could spin were as interesting and unusual as their names.

Pugh (pronounced “Pew”) Wallace was born and raised in Union County in the city of Strong, which is located on Highway 82, about 12 miles south and east of El Dorado. The Wallace family were farmers and raised enough livestock to farm and feed the family. Pugh had two sisters; Patty and Butterfly, who I believe were several years older, but I never asked their ages. Pugh told me they didn’t actually live in the “big city” of Strong, but in a smaller community called Skillet Lick. I’ve never seen a sign to indicate that community nor have I heard about it from anyone else, so I’m not sure it really existed.That’s the way it was with Pugh- – one was never quite sure of the veracity of his stories. His sister Patty married a prominent business man, James Garrison and they initially lived in a beautiful 2 story home next door to my Uncle Dick and Aunt Lilly Mae Smith. By the time we moved to El Dorado, Mr. Garrison had died and Patty and Butterfly were living together a smaller house on East 13th Street adjacent to our home on Madison Avenue. We frequently visited with “Miz Patty” in our backyards and usually heard about some of the things that Pugh was doing. She would chuckle and say something like, “It’s hard to keep up with all the things that Pugh is doing.”

Pugh worked for Ritchie Grocer Company as a salesman, and he was very good in his profession. He seemingly knew everyone in Union County, and because Ritchie was a wholesale business, his clientele was widespread. Pugh and Ike Wilson were approximately the same age and had hunted and fished together for years. The two of them could tell the funniest stories of their fishing expeditions in the lakes and sloughs of southeast Arkansas.

In the latter part of the 1970’s when Pugh was in his late 60’s in age, he developed a severe attack of abdominal pain that was unrelenting. He was admitted to the hospital by his primary care physician for tests and pain relief, and the results of his tests and x-rays confirmed that he had a small stone causing blockage of his main bile duct. Several years earlier, my senior partner, Dr. David Yocum had removed Pugh’s gall bladder for gall bladder infection associated with gall stones. Apparently an unrecognized small stone was present in the main bile duct and not removed along with the gall bladder. It had not given him any problem until this present episode of pain. With today’s technology that particular problem seldom requires an operation, because the gastroenterologists have tiny instruments they can pass through the stomach and into the main bile duct under x-ray guidance and are able to remove most small stones. That technology was not available to us then, and Pugh was scheduled for an operation in the early afternoon on the day the stone was discovered. I was planning to assist Dr. Yocum and went to Pugh’s room to visit with him and to pray for him before the planned procedure. Dr. Yocum had already visited him and explained the operation and recovery in detail. This was at 11 AM and the procedure was planned for approximately 2 PM.

Shortly after noon, Dr. Yocum received a telephone call from Pugh’s nurse who reported that Pugh told her he was feeling much better and didn’t think he needed an operation. Dr. Yocum went to his room and after examining him re-ordered the x-rays. We awaited the report from the radiologist, and to our amazement he told us that the stone was no longer present! I have witnessed many kidney stones spontaneously passing, but at that time had not observed the spontaneous passing of a bile duct stone. Dr. Yocum and I both went to his room to report this good news to him and to get his reaction to avoiding a major operation. That’s when we got the story of how this had happened, or at least Pugh’s account!

Pugh’s room was semi-private, and there was a gentleman in the other bed who was in the hospital for tests. When Pugh was told he was scheduled for the operation at 2 PM, he had already been in a fasting state since supper on the previous night. By his account he was “about to starve to death.” When the lunch trays arrived to their room, Pugh, of course did not get a tray because he was on with-hold for the operation. He said that the other gentleman got a tray loaded with “some of the most delicious looking food I’ve ever seen.” He said what happened next saved his life! The nurse came into the room and told his roommate that he had a long distance call, which in those days had to be taken down the hall at a phone designated for such calls. Pugh said that gave him just enough time to eat all the food on his roommate’s tray. When the man returned, he asked Pugh what happened to his food and Pugh told him he didn’t know, because he was napping! Pugh told Dr. Yocum and me that the food “gave me the strength I needed to pass that stone.” We assumed the account was true but never tried to verify the details.

The photo above is a gall stone, but it is much larger than the one that Pugh passed. However,knowing Pugh as I did, when he later recounted this story to Ike, JC or Bright, he likely told them that his stone was about the size of the one in this picture. They would have had trouble topping that one!

Dr. John