Maggots, Maggots Everywhere…

Friday, April 3rd – Well, I promised to get back to you “tomorrow,” but I didn’t quite make it. The goings-on the last couple of days have kept me pretty exhausted. Let me inform you.

“Application”

On Wednesday the first, I returned to Scripps Mercy Hospital for the “application” of maggots. (Don’t you love how they find non-threatening and ambiguous words for all kinds of things in the medical world? In this case, they are going to stick a package of 500 fly larvae into one’s open, raw, bleeding, infected flesh and close them up inside. “Application” is good enough, I guess.)

Before we got started, I asked Stacy if I could see the maggots. She produced a large plastic pill bottle, containing a tiny folded piece of fine-mesh gauze. “There they are,” she said. “They’re inside the gauze.” They had traveled from Orange County in gauze, in a pill bottle, in an incubator, via FedEx or UPS! I wondered how many were in there. Would you believe 250 to 500? “Well, each one is only the size of a dot made by a ball-point pen,” said Stacy. “Of course, they’ll grow a lot…” 

Setting the Table

This time there were two other physical therapists, Ryan and Emily, and a student, Ashley, in attendance. Everyone bent eagerly over my leg to watch the process. Stacy unwrapped my bandage and announced that the prospective feeding site looked pretty good. She “set the table,” so to speak, by “tracing the wound”. This involved taking a sheet of thin, flexible, flesh-colored  plastic, laying it gently over the treatment area (another euphemism), and drawing on it with a pen to indicate how big a hole needed to be cut. Stacy cut the hole and placed the piece of plastic on my leg, with the hole over the wound.

Next came something I’m sure has its own name, but I think of it as either the “Containment Field” or the “Containment Hut.” It’s made of thin, flexible, permeable plastic (so the bugs can breathe, don’tcha know), oval in shape and roughly the size of the hole in the previous sheet of plastic. It’s perhaps half an inch high. It looks very much like those molded plastic cups that hold Feta cheese at the grocery store — with a molded lip or edge that is supposed to fit flat against the skin.

But before she put the Hut in place, Stacy removed the gauze from the pill bottle and placed it right into the wound. My wound! on my leg! She said she was just going to leave the gauze too, “or they’d be all over the place in an instant.” Then, just before clapping the Containment Field over the top of the wound, she remarked to her colleagues, “Hey, look at them — they’re getting right down to business!” I really couldn’t stand to look at that point.

Containing the Prisoners

To hold the Containment Field in place and prevent a general exodus of prisoners, they had a strange and magical form of sticky plastic tape, not quite like any I’ve seen before. It was one of those deals where you had to pull Sheet 1 off, then put the tape down, then pull Sheet 2 off, in order to make the tape adhere. Stacy didn’t seem too comfortable with this odd product, and kept asking Ryan and Emily what to pull and where to put it. (Not too confidence-inspiring to the patient…) But eventually the edges of the Containment Hut were sealed down, and the maggots were apparently not quite believing their good luck in finding such a feast after their long and lonely trip in the pill bottle.

Oh, and By the Way…

Then Stacy packed several thick, absorbent gauze pads on top of the Hut and wrapped the whole business up with a stretchy gauze self-adherent bandage. She instructed me to change these dressings, down as far as the Containment Field, every two to five hours, or whenever “brownish wet drainage” seeped up through the top layer of bandage. “Keep an eye out for anything that looks unusual,” said she, ” and if there’s anything, go to the nearest ER right away.”

Unusual?? Meaning just WHAT? This whole thing was unusual in the extreme, at least to me! I pressed for a little more clarification. “Well, if you have to change the dressings every half hour, that’s unusual.Or if you notice bright red blood instead of brownish drainage: that would mean they’d found a blood vessel that had some dead tissue around it. You need to get attention for that right away.”

OR WHAT? Nobody had mentioned this possibility before. “Oh,” said Stacy, “and you may feel some pain, especially toward the end of the 48-hour period. You do have pain meds, don’t you?” Do I ever: I have plenty of Norco, much like Vicodin except containing a smaller proportion of Tylenol and more narcotic. In fact, it seemed like a good idea to pop one of those RIGHT NOW, just in case.

WHAT HAVE I DONE??

Unfortunately, it was just a little too late to change my mind. Just for reassurance, I asked Stacy how long she had been managing this Maggot Debridement Therapy program. “It’ll be two years in October,” she said. That seemed reasonable to me. I guess she really did know what she was doing.

“And how many cases have you had in that time?” I asked, expecting something like 60 or 70. There was a pause, then: “Fourteen,” said Stacy. “You’re the fifteenth.” Well, at least I wasn’t second. Or first.

I guess there are not hordes of people lining up to get a packet of maggots sealed into their limbs. I tried to keep in mind how much I did NOT want to have surgery. I remembered what my wonderful orthopedic surgeon, Dr. William Bugbee, had said to me when I confessed to having chiropractic adjustments three times a week: he took my hands, looked right into my eyes, and said, “I’m so happy for you! ANYTHING THAT KEEPS YOU OUT OF THE HANDS OF THE SURGEONS IS GOOD!”

The saga will continue… tomorrow.

Thanks for reading — Betsy