Tikkabik

Today’s the first day since mid-August that I haven’t had to drive to the wound care center I’ve been going to for hyperbaric oxygen therapy. It’s a weird feeling, because it’s been such a routine. It’s been this reliable block of four hours when I knew what I had to do, where I had to go and what was expected of me.

10:15 – Leave for the wound care center.

10:45 – Arrive. Wait until the hyperbaric tech was ready to prep me.

11:00 – Change into a hospital johnny. Get a blood glucose check, get a blood pressure check, and depending on the day and the doctor on hand, get my ears and breathing checked.

11:15 – Go into the chamber. Be wary of equalizing the pressure in my ears for the first ten minutes or so of each session. Constant swallowing, yawning and blowing into my nose while pinching my nostrils.

12:45 – Repeat the equalization process as the tech decreases the pressure in the chamber. Get another blood glucose check (damn, but their glucometer needs a lot of blood compared to the one I have at home), another blood pressure read, sometimes ears and breathing, then get changed again and be on my way.

Typically I’d get home between 1:30 and 2:00 PM

That same routine, day in and day out. Except for Thursdays, when they’d ask me to come in in the afternoon so the doctor could check my foot.

There were a few days that I didn’t do it – like the time Bonnie and I had to take James to the oral surgeon to have some teeth extracted as part of his orthodontia; or one day when I just flaked and decided I didn’t want to (the hyperbaric tech tells me that happens pretty frequently, so I didn’t feel too bad about playing hooky). But I was scheduled for thirty treatments and I did the vast majority of them, finally getting the clearance to stop from the doctor who’s been treating me since I was discharged from the hospital.

Now, to be clear, I haven’t totally recovered. There’s still a wound on the bottom of my foot that requires me to wear a dressing and use a special shoe and take a walker or cane with me wherever I go, and they still want me to elevate the foot constantly (I think the actual order is “five times a day”). But I’m confident – and so is the doc – that it’ll heal without surgery, so I’m just taking it day by day at this point.

I won’t miss this four hour void in my schedule that’s been absorbing my late morning and early afternoon every day. Most of it was interminably boring: the treatment involves laying in a lucite tube on a mattress that’s too thin to be comfortable, doing nothing but either napping or staring at a TV screen as the compartment is flooded with pure oxygen at high pressure. Nothing to do but breathe.

The hyperbaric oxygen therapy has been disruptive to me personally and professionally, and I complained about it regularly. But at the same time, the routine of it gave me a sense of purpose and a structure to my day that I found very reassuring. And it was something that had been missing from my life for a while.

The PICC line is finally gone. After a month and a half, my left arm is finally free of the encumbrance of a catheter running to my heart.

Each Thursday I visit the local wound care center, and for the past month and a half the podiatrist who examines my foot has been suggesting that I’ll need more surgery, since the incision made on the plantar side of my foot hasn’t been healing very fast.

At the end of July I went to see the infectious disease doc who ordered the PICC line installed and the IV antibiotic treatment, and he gave the all clear to have the line removed. The podiatrist countermanded that request, however, insisting that it stay in in case I needed to be hospitalized for more surgery, as I’d need more IV treatment.

I’ve made significant progress in the last week or two, however, and the podiatrist gave the all clear to have the line pulled. The visiting nurse who came yesterday pulled it out. So the good news is the PICC line is gone. The better news is that my foot doesn’t need more surgery.

I’m still hobbling around on a walker with one foot clad in a hospital shoe, so I’m not fully recovered yet, but it’s a good feeling to make this progress.

It’s been more than a month since I was discharged from the hospital, and I’m seeing a doctor at the wound care center weekly who has been tracking my progress. He’s not satisfied with the closure of the wound on the bottom of my foot and has indicated I made need more surgery – his suspicion is osteomylitis, or a bone infection – specifically in one of te bones in my third toe. To prepare for that, and in the hopes it may speed my recovery along, he’s ordered hyperbaric oxygen treatment (HBOT).

For the uninitiated, they stick you in a big acrylic tube about seven feet long and flood it with pure oxygen at high pressure for couple of hours. The theory is that HBOT improves the oxygenation of your blood, directly and indirectly helping along tissue regeneration.

It’s an interesting experience. You’re told to strip naked except for a hospital jonny, no jewelry, cologne or even deodorant allowed. Then you’re inserted into this cylindrical chamber of clear one inch-thick acrylic, with a 250 pound steel door locked and bolted above your head. Then you hear the oxygen pressurizing the chamber. Within seconds your ears pop (you have to clear them repeatedly for about 15 minutes until arriving at the appropriate pressure). Then you just sit, and wait.

Fortunately they positioned a TV above the chamber, and sound is pumped in, so I could watch a movie while I lay there. I couldn’t shift or turn very easily, though, which made adjusting my weight difficult – I was getting fidgety by the end.

The closest thing I can compare it to is an MRI, because you’re in this big machine and you have to lie relatively still. But the experience is very different because the acrylic is transparent, so it’s not nearly as claustrophobia-inducing, and there’s no WHAM WHAM WHAM noise – just the hissing of gas.

We’ll see if it’s effective enough to help my body speed the closure of the wound. I’d really like not to have another surgery if I can help it. I’ve been off my feet for a month and a half and don’t want to be off them again for another two months.

I was all set to get the PICC line pulled this week after a meeting with the infectious disease doctor who’s been tracking my progress since I went to the hospital last month. He gave the all clear but then changed his mind after he talked to the doctor at the wound care center who’s treating me; he’s convinced I’ll need more surgery and wants to leave in the line so I can get IV infusions without poking new holes in my arm. So it’s status quo for now, and I can’t say I’m thrilled about it.

One of the big inconveniences of dealing with both a PICC line and a bandaged foot is bathing. Neither can get wet, so they have to be wrapped in something waterproof. For me, this means wrapping my upper arm and my left leg below the knee in plastic cling wrap.

Trying to do it yourself is actually quite difficult, so I’ve recruited my daughter to assist. She’s gotten pretty adept at wrapping me and doesn’t seem to mind too much.

Even then, though, I have to be really careful to avoid letting water get underneath the wrap. The hospital gave me some blue tape called Coflex – a “latex cohesive flexible bandage,” or form of compression wrap, which the nurses used to wrap up the ends of the cling wrap when I showered there. but it invariably unravels in the shower.

So I end up in the shower, balancing all my weight on my “good side,” with the wrapped parts as far away from the water as possible. It’s comical. And a bit horrifying.

Honestly, I’m surprised I haven’t fallen and cracked my head yet.

So if you missed the news on Twitter, Facebook etc., I’ve been in the hospital since last Wednesday. I managed to get an infection in my foot that went septic and required surgery; I’ve been here ever since.

This is my first hospitalization. I think the most serious procedure I’d ever had done before this was my tonsillectomy, and as I recall, I went home that day.

I first noticed a problem with my foot a week ago last Saturday, when we were on the road. I had some swelling and redness, which isn’t all together unusual when I’m on my feet more than usual, so I didn’t think too much of it. But by Sunday the foot had swelled more and I was having trouble walking, so I knew something bad had happened. I went to the doctor Monday, who discovered that I had stepped on a 1.5 centimeter-long piece of sharp black plastic; something rather polished looking that looked like it broke off a toy or a gadget.

I don’t know where it came from or what it was, or, for that matter, how long it had been there. I hadn’t felt it because I have neuropathy – very limited nerve sensation in my feet.

She packed the wound, bound the foot and sent me home with oral antibiotics and a warning to call if anything changed for the worse.

By Wednesday, it had. Bonnie noticed that a new wound had opened near my third toe and was bleeding. The toe had swelled up more and turned an ugly purple color. So we went to the emergency room, and I was admitted, fully expecting to lose part of the foot. A foot surgeon saw me within a couple of hours and I was wheeled into the OR, knocked out, and when I woke up, my left foot was packed and bound.

The surgeon thinks, in retrospect, that I’d had an infection on that toe for some time, but the added trauma of the wound on the bottom of my foot sent things into overdrive. Cellulitis turned into sepsis, and I was one very sick patient.

It’s a small world: the foot surgeon who operated on me shares office space with doctors whom Bonnie worked for several years ago. He remembers her well.

The next couple of days were a bit hazy for me. I was very sick, getting and breaking fevers every few hours while my body fought the infection along with some exotic IV antibiotics. At one point my temperature was near 103. But by Saturday I began feeling like myself again.

Since then it’s been rest and recovery. I’ve strict orders to stay off the foot as much as possible while it heals. I’m allowed to walk from the bed to the toilet and back, but that’s about it. Fortunately, I’ve got a wheelchair, so when I get really bored I can go for a spin around the floor.

This morning I had a PICC line installed – an IV line that runs from my upper arm into the superior vena cava, one of the large blood vessels connected to the heart. This is so I can get IV antibiotics long-term – the ones in your hand usually only last a few days before the tissue gets irritated or an infection sets in. When I go home, I’ll need to continue to get IV medications administered. The doctor suggested that a month or so would probably be a good idea.

In the second case of “it’s a small world,” the IV nurse who installed the PICC line is the mother of a child that James has gone to school with since kindergarten. I’ve dropped him off for a few play dates and birthday parties and their house over the years, and I’ve seen her countless times at school functions, field trips and the like.

As to the care I’ve received, I couldn’t be happier. The staff in Mugar 5 at the Cape Cod Hospital have all been excellent. And since I’m in one of the taller buildings in this part of Hyannis, I have a gorgeous seaside view facing towards Lewis Bay and Nantucket Sound beyond – a reminder that it’s summer on Cape Cod, and in the scheme of things, it doesn’t suck too much to be here.

I’ve been hearing for years about the dangers diabetics with peripheral neuropathy face. I’ve had a few small scares – foot ulcers caused by poorly-fitting shoes, a staph infection on my big toe. But this by far is the biggest, scariest thing that’s ever happened to me, and I don’t want to repeat the experience ever again. I’ll be taking special care not to walk barefoot (or even just with stocking feet) around the house from now on, and I’ll make a better point to visually check my feet when I go to bed.

Unfortunately, beyond that, there’s not a lot more I can do. While I can do a better job of managing my diabetes through exercise and diet, the neuropathy is pretty much here to stay – it’s not reversible. I can just hope that my body will finally get over this infection, my foot will heal and I can get back on with my life.

For whatever reason, I’ve had a very tough reentry since getting back from SF on Saturday. I can’t quite put my finger on why, but I’m having trouble getting to bed, having trouble waking up in the morning, and generally feeling crappy whenever I’m awake.

I just can’t shake it.

In late November I posted a link to an article that talks about the absence of “old” people at Google, and compared that writer’s notes with my own job search. I lamented that I’m having trouble finding companies willing to take on a telecommuter.

One of the comments came from my friend Helen, who works at MIT, and raised her eyebrows a bit at my implication that telecommuting is no big deal. As Helen explained it, her staff is only allowed to telecommute part time, and only after proving themselves.

Helen and I are in different professions, however, and what may be a bit unusual for her line of work has been de rigueur for mine. Especially in tech journalism, it’s been a standard option for many years for writers to work from, well, wherever.

Admittedly, for larger publications, and especially for publications that remain in print, part-time telecommuting is more the norm than full-time; employees are expected to be in the office at least a few days a week for staff meetings, to meet vendors and especially to be on hand as print deadlines loom

But those are not by and large the jobs I’m interested in. I’ve been interviewing with Web-based tech companies that in some cases are veritable content farms. And that’s why I find their insistence that people work from the office to be so off-putting. There’s no real benefit there to keeping people corralled in office cube farms. If you want maximum productivity, let your employees work where they want. Set reasonable metrics to make sure they’re hitting their goals, and clearly define and use bidirectional modes of communication like IM, VoIP and video chat services as necessary.

But get over the idea that your people need to be in an office. It’s 20th century thinking for content production, and it’s just a bad idea.

So on Wednesday I started writing for Engadget. I’m starting out slow, simply contributing short news articles where I think I can make a difference.

This isn’t a full-time gig; I’m writing for them along with all my other endeavors, but if I can get up to speed and contribute regularly, Engadget will make a positive impact to my bottom line, which has been really bad lately.

So far I’m really impressed. The managing editor, Darren Murph, has taken me under his wing and is incredibly patient. There’s a huge amount to learn – a new content management system, a very well-developed and orderly editorial process, a new editorial style, and more – but Engadget really has a well-developed workflow in pace.

Anyway, I’ve been really dour and glum about my professional prospects for the past month or two, so this comes at a great time and I’m very, very happy for the opportunity.