Debridement

Contributed by Rivka Jacobs on 16/07/10

Rose-Lynn Mingo ground her teeth together as she listened to her tires crunch and crack over the gravel of the long driveway that led to the trailer. This was her third visit to Spencer Hill’s remote home, and all she wanted to do was turn around and go back to Huntington.

She drew to a stop, her engine idling, her bumper nearly touching the pilings of the wooden porch that had been erected along the front of the dingy white single-wide. She yanked up her parking brake, switched off the ignition. She checked her watch. She didn’t bother to use her cell phone to report her arrival; there was no reception this far out in rural Cabell County.

She gathered her canvas satchel with all her supplies, and exited the silver-blue Nissan Quest. She closed the vehicle’s door with as much noise as she could make. The summer heat hit her hard, as did the foul smell of the place. She immediately looked down at the chalky ground, as she advanced to the porch wheelchair ramp, to make sure she didn’t step in any piles of dog excrement.

“Mr. Hill,” she called loudly as she reached the storm door. At the moment it was the only barrier between the world and the gloomy interior of the living room; she could barely see anything as she squinted through the screen. She knocked on the metal above the latch. “Mr. Hill, I’m the nurse from Genera Home Health Services. I’m Rose-Lynn Mingo, do you remember me? Are you there?”

Several dogs of various sizes charged at her, yiping and howling, leaping and snapping at the other side of the door. She heard a male voice bellow, “Get away from there, you goddamn animals.” Something flew from an invisible point and hit one of the dogs on the back, making it whine with a piercing ar-ar-ar. “Get away from there, I said!” The shout had an angry edge that seemed almost ready to explode into rage. The dogs instantly retreated and moved to the side, forming what looked like a reception line as Rose-Lynn slowly pulled at the handle, and created an opening large enough so that she could slip through.

She took a few steps, and once again glanced down to make sure she wasn’t treading on any of the small, brown piles that littered the worn and stained carpet. She tried not to show any reaction on her face as the stench engulfed her.

She advanced about six feet, paused, letting her eyes adjust to the low light. Behind her one of the dogs growled. She focused on areas piled with clutter and furniture heaped with debris, and then peered across the room. She recognized Spencer Hill. He was, as he always seemed to be, resting in an old recliner patched with duct-tape. His bulk was propped forward and his legs were elevated at an angle in front of him. He appeared to be watching a small television that sat on a cart directly across from him.

“Good afternoon, Mr. Hill,” she said, feeling no relief at finding him. In fact, seeing him again — with his balding head and salt-and-pepper stubble and the mounds of unwashed, pasty flesh rolling from under a filthy T-shirt and sweatpants — almost made her retch. Only her years of experience as a home health nurse prevented her from revealing her thoughts by expression or body language as the revulsion swept through her. “It’s time for your ulcer debridement,” she forced herself to say with a cheerful tone as she tugged her Nitrile blue gloves over her thumbs and fingers.

“I want a bath, too,” he said in a low, gravely voice, his reddened eyes gleaming in the oily folds of his facial skin.

“Now, Mr. Hill, we’ve been through that before,” she said as she retrieved a plastic sheet from her tote, and laid it flat along the edge of the coffee table so she could set her supplies down somewhere without fear of contamination. “I’m the nurse, I handle your wound care. Your home health assistant — who visits on Mondays and Thursdays — helps you with your baths.”

Spencer Hill looked up at her from under his puffy lids as she approached his bandaged right foot. He stretched his thick lips into what could have been a smile. He folded one hand under the other on his enormous belly as he leaned back. “She came on Monday,” he said, and then snorted and coughed vigorously into the air.

Rose-Lynn stopped unwrapping the outer layer of gauze, and straightened. “Mr. Hill, would you like a Kleenex?” she asked, watching the snot roll down his upper lip.

“Why don’t you blow it for me,” Spencer Hill said, puckering his mouth.

“Excuse me?” Rose-Lynn said, taking a step backwards. She heard the dogs panting and pacing behind her.

He chuckled, and reached a meaty hand to the table tray at his left, clutched a bunch of tissues, brought them to his nose and wiped in one direction, then the other. He tossed the crumpled, damp mass on the floor to his right, a couple of inches from her white rubber-soled shoes.

Feeling somewhat mollified, she bent slightly and resumed removing his old wrappings. She continued in silence until the pad underneath lying along his right plantar surface, was exposed. She dropped the old bandage in a red biohazard bag she’d spread on the rug beside her.

“Aren’t you concerned?” he abruptly said, shifting in his chair and farting loudly.

Rose-Lynn’s cheek muscles twitched and she half-closed her eyes, despite all her efforts to appear unaffected. She quickly pulled off the pad, revealed the hydrogel patch below. “Concerned about what?” she finally said.

“About that girl, Melissa. I told you, she came here on Monday. Do you think she came on Thursday?” He winced, the lines on his face heavily incised and shadowed as she tore off the hydrogel and disposed of it.

Using a tweezers, she slowly began withdrawing the strips of gauze that had been packed in the deepest recesses of the Stage IV ulcer. Usually she was concerned about causing her patients pain during a debridement, but at the moment she had an almost perverse sense of satisfaction when she noted — with a sidelong look — that Spencer Hill’s face was screwed up and turning red.

“It’s … it’s … magnificent….” he said, gasping between words. “I … can see … you appreciate … the art … of … pain….”

“Mr. Hill, if I’m hurting you, just say so, and we’ll take a rest,” she said, trying to ignore her growing anxiety and discomfort. She paused, raised her head a little bit, and stared at him. She couldn’t stop herself from jumping slightly as she saw he was grinning and ogling the exposed v-neck of her flowery scrub-top. She scowled, no longer feeling uncomfortable, but only angry. “If you can’t treat our staff with respect, Mr. Hill, then you’ll have to find another company to attend to your health care needs,” she said in a clipped tone.

“Melissa is taking a bath,” he said, smirking and nodding. He pushed the back of his head against his chair.

“What?” she said, standing upright once more; she dropped the tweezers and packing into the biohazard bag. She made the motion of removing her gloves. “That’s enough. I’ve had it,” she said. “I’m going to leave this foot just as it is, if you can’t keep quiet and stop harassing me.”

“You can’t do that,” he said in a phlegm-choked voice. His mouth hung slack and open. His unblinking gaze darkened and sparked as if the discussion itself was giving him physical pleasure. He began to examine every inch of her, his eyes darting up and down and back and forth in sharp, brisk movements.

Rose-Lynn took another step to the rear. She could see at least four of the dogs on the other side of his chair, trotting into the hallway behind him, and returning. They occasionally snarled at one another, and appeared to be wrestling over pieces of something she couldn’t recognize. She knew the hall led to the bathroom and two bedrooms at the other end of the trailer. She craned her neck slightly as she attempted to discern what it was they were fighting over.

“They’re eating,” Spencer Hill said.

Rose-Lynn hesitated a moment, then without a word darted her hand into her supply tote and withdrew the gauze and sterile-saline kit. She peeled off the lid, and quickly began packing the wet material deep into the ulcer’s cavity.

Spencer Hill writhed and grunted, his face contorted with expressions of agony and joy.

In minutes, a fresh hydrogel patch was in place, and all the other new bandages were secured. Rose-Lynn stripped off her gloves and discarded them in the biohazard bag before tying it off. “I think we’re done for the day,” she said.

“You have to take my vital signs,” he said, his eyes lowered. He was breathing heavily, and perspiration dotted his forehead.

“I don’t think so,” she responded. She gathered her belongings.

“Melissa might still be here,” he said.

“She’s not,” Rose-Lynn replied almost at once. I just saw her yesterday at the office.” She stopped what she was doing and grimaced, glared at him. “What did you do or say to her, so that she’s not coming back?” she asked, her annoyance spurring her courage.

Spencer Hill tucked his lower lip between his teeth and shook his head. His eyes were wide and round with eyelashes like an innocent fringe.

She stuck her fists on her hips. “You have diabetes, congestive heart disease, chronic bronchitis, and God knows what else,” she said. “If you don’t behave, no one is going to help you.” She tried to sound like a scolding school-teacher, as if he didn’t intimidate her, but her inflection was too exaggerated and obvious.

“Come here, Bugsy, Locket, here boys….” he called, slapping one of his thighs. Two of the animals — skinny mutts with matted fur and saliva dribbling from between their canines — bounded over to him and stood on their hind legs at his arm, licking his knuckles.

“And someone is going to call animal control, too. Those creatures are neglected. How do you feed them?” she said, her elbows still sticking out, her fingers now drumming at her waist.

He repositioned himself slightly so he could look at her again.

She felt a jolt and almost fell backwards; his thick features had instantly transformed into something flat and dead, pale as ice and shining with a clammy sheen. His frozen eyes were dilated and glassy.

“In the old days, Nurse Rose-Lynn, in the old days, my doggies would have had plenty to eat right about now. I’d ask you to go to the bathroom, on some pretext, after playing the perfect gentleman — or sometimes the fool — it used to depend on my mood. I’d say to you, that Melissa was in there, that I’d put her in the bathtub and after torturing her for days, I carved her up for my babies. I let them have the last parts of her — the guts and squiggly blood vessels and bones — doggies love gnawing on bones — and I’d tell you to go look at what was in my bathtub, and see for yourself, if you didn’t believe me….”

Rose-Lynn tilted her head, trying to think critically, trying to analyze. He was challenging her in some way. She lowered her hands and groped for her bag, grabbed it without taking her eyes off of his face. “I told you, I saw Melissa yesterday.”

They held their positions, motionless, not seeming to breathe. The living room seemed to grow darker.

Spencer Hill abruptly threw out his massive, grimy hands. His demeanor seemed to shift and flow until he appeared almost happy and childlike. A wheezing laugh came from his chest. He exposed his teeth like a Cheshire cat. Three more dogs trotted to his recliner, prancing and woofing. A diminutive chihuahua, yapping in rapid bursts, bounced up on the extension where his swollen legs rested.

Rose-Lynn Mingo tried to suppress a tremor; she lowered her chin to her chest in order to regain control, then lifted her head. “I’m leaving now. Another nurse will be here next time. She can take your vitals then.” She took a couple of steps to the side, turned half-way around.

“Nurse Rose-Lynn,” he said in a sing-song tone. “In the old days, ah in the old days, when I wasn’t so sick and could move around … you would’ve been my best ever. You could’ve made the earth move, it could’ve been like firecrackers, like colored lights and shooting stars…..”

She rotated her head just enough to see him from the corners of her eyes. But he wasn’t looking at her; he was tugging at his dogs’ ears and tussling with them and patting their haunches with a hollow slapping sound.

“That’s a boy,” he said in a garbled, whispery way. “That’s my babies, good doggies, yeah, that’s my babies….”

She folded her tote in her arms, against her chest, and without looking back, she walked with quick and steady steps towards the front door.