Chapter 76: The Professional

"Oh when the sunshine beckons to ya / And your wings begin to unfold
The thoughts you bring and the songs you sing / Are gonna keep me from the cold
And if the sword is among ya / And it's words may wound my soul
You can fill me up with what you've got / Cos my heart's been keeping old
She is love / And her ways are high and steep
She is love / And I believe her when she speaks.
Love / And her ways are high and steep
She is love / And I believe, I do believe her when she speaks.
You're in all my thoughts of passion / And the dreams of my delight
Whatever stirs my mortal frame / Will you keep it warm at night
I don't know where you come from / No I haven't got a clue
All I know is I'm in love / With someone who loves me too." – "She Is Love" – Oasis

"When we honestly ask ourselves which person in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares." – Henri Nouwen


Sydney opened the door and Tom smiled at her from the other side, "Hey Tom."

"Hello Sydney," Tom said moving into the house, "so what did you do to him?" he asked smiling.

"What do you mean?" she asked confused.

"What," ahem, "exercises were you doing that would cause an infection of this nature?"

She smiled, "You're bad."

"Well, I try," he said.

She moved towards the bedroom, Tom trailing behind.

"So, are your friends here? They didn't have anything to do with this, did they?" Tom said.

Sydney turned around; ready to defend her friends, but she saw the huge smile on Tom's face and instantly started giggling.

"You suck Tom."

"Thank you…"

They were still giggling when they entered the bedroom.

Tom moved past Sydney and went over to Vaughn, taking his hand in a friendly handshake, "Hey man! How's it going? Other than the infection…"

"Not too bad…yourself?"

"I'm good…or as good as can be expected…"

Vaughn gave him a strange questioning look.

"Ah…well…Brianna dumped me…"

"Brianna? Didn't you date her for like two years?"

"Yeah…seems she found someone new, something about doctor's hours being too rough and crap like that."

"Just wait till she finds out you're gonna be making the big bucks – six months tops man – you'll be head of the ER and then she'll be sorry…"

"Yeah…but anyway, we can talk about that later, that's not why I'm here," he said clearing his throat and giving Sydney a sideways glance.

She was grinning like the Cheshire cat watching the men interact. It was nice to see Vaughn chatty with someone.

"This is professional Dr. Thomas Barker here…" she said giggling, and Vaughn joined in.

"You know…I could just leave and y'all can deal with this little problem here on your own," he said teasing.

"I smell malpractice," Vaughn said which sent Sydney off into a fit of giggles again.

"Yeah…now who sucks, little missy?" Tom said with a smile.

He moved over closer to Vaughn, "Ok, let's take a look here," he said as he eased Vaughn into a sitting position.

Sydney turned serious in an instant and moved to the other side of the bed to watch. She cringed when Tom uncovered the wound, but she made sure that Vaughn didn't see her. Tom saw though and gave her a reassuring smile before he started examining.

He prodded the area gently, and used the cloth to wipe the wound clean of some of the oozy material that was surrounding it. Vaughn groaned slightly as Tom tried to determine the extent of the infection.

"Do you have a thermometer?"

"Yeah, sure…" Sydney said, walking off to the bathroom and handing it to Tom. He reached around and stuck the thermometer in Vaughn's ear, waiting for the beep. Once it beeped, he removed it and looked at the LCD display.

"99.0," he said, "not 98.6, but it's not enough to say that the infection has spread. K, I don't think this is a systemic infection. It's swollen, it's red, it's hot, it's exuding," he stopped when Sydney looked at him strangely, "sorry – oozing…exuding means oozing; just some fancy professionalism there," he said with a wink and then continued, "and I'm sure it hurts too…"

Vaughn confirmed with a resigned nod.

"Ok…since it's not systemic, we don't need any more oral antibiotics – plus, all the pain medication and the ibuprofen and naproxen should lessen any swelling or discomfort too. So, all we have to worry about now is dressing it. You're gonna hafta change this one more often than once a day now until it gets better, ok Sydney?"

"Sure…"

"Ok, so this is what I brought. I wasn't sure what I was going to find, so I brought a selection." He reached into the bag he had brought with him and laid out several items on the nightstand.

He looked at the wound again and then picked up a package that said 3M™ Tegagen™ Alginate Dressing.

"What is that?" Sydney asked.

Tom smiled, "You'll like this, it's actually derived from Scottish seaweed – it helps absorb the exudates – or the ooze for those of you not medically inclined."

Sydney stuck out her tongue and Tom smiled.

"You caught this early enough that I don't think it's going to be a real problem. It'll hurt for a while, but it's not a horrible infection – it's not systemic as I said. If it was, then we'd have a problem – deterioration of the wound condition, flu and fever, I & Ds - incision and drainage which can be very unpleasant – that would mean that an incision would have to made in the wound to decompress an abscess or remove devitalized tissue…"

He looked at Sydney who was making a very disgusted face, but then added, "Yuck."

Tom smiled, "Yeah, not very pleasant, but you caught it, so," he made the thumbs up sign.

Vaughn was very quiet during their whole conversation and Sydney was getting rather worried.

Tom seemed kinda oblivious, and just kept giving Sydney instructions, "Ok, so we've got the Tegagen Alginate Dressings, henceforth to be know to you as TADs, and then I also brought these other products," he held them up, "our wonderful 3M™ Tegapore™ Wound Contact Material, which," he turned the package over and read, "is a tactile primary wound contact layer for protecting delicate exuding wounds and skin and can be left in place whilst some secondary absorbent dressings are replaced. And our wonderful 3M™ Cavilon™ No Sting Barrier Film, which," he read again, "is a unique 'no sting' transparent barrier film, which gives up to 72 hours of skin protection." He continued, listing: "Product is dispersed in a unique non-stinging solvent, which dries rapidly; Non-petrolatum base does not clog incontinence pad linings; Non cytotoxic; Film possesses good oxygen and moisture vapor permeability; Available in different sizes and formats to suit application requirements; Removal of film is not required between re-applications; Foam Applicators are sterile; and Enhances the adhesion and wear time of some tapes and dressings…so you said that he's been having some tape irritation – this will help with that too…and it almost is like an invisible band-aid kind of thing…it's pretty neat," he concluded with childlike wonder.

Sydney smiled, "That sounds really great Tom, I'm sure it'll help a lot."

"Let's do the first one now," he added.

"Ok."

"First, I'd check the wound every time you change it…look for any strange discoloration or if it starts to look worse, then I'm gonna hafta come back…after that, try to clean the wound as much as you can…you can put the first aid cream on if you want, but really, the Cavilon stuff is better, the cream won't do much for an infected wound. So, then I'd put some of that on and then finish up with the TADs…ok?"

"Yeah…ok…what about like baths and stuff? Can he do that?"

"Sure…baths are fine, but I'd put the Cavilon on there before you get in. It'll protect the wound from excess moisture and any contaminants in the water. And the cold compresses work well for pain – but again, I'd put on the Cavilon on and then use like an ice pack or something. It'll help with discomfort."

"Ok," Sydney said, looking at Vaughn who was still very silent.

She watched as Tom followed all those steps, showing her how to apply the Cavilon and then he placed the TAD pad over the wound.

"If you put too much of the Cavilon stuff on, it'll get really stiff, just to let you know."

Tom and Sydney eased Vaughn back into the pillow.

"Let him rest for awhile and then you can do the rest of the wounds. If any of them are infected, do the same thing. But, if a bunch get that way, call me."

"Ok."

"How are the exercises going?" he asked no one in particular.

"Well…" Sydney started, looking again at Vaughn, "he gets exercise, just not the regimented kind. We've been kind of lax with that…he moves to the couch and outside and stuff like that, and he gets…other exercise," Sydney said choosing her words carefully, "but we haven't been doing the crunches, not really since he had the little setback."

"That's ok…like I said, they're guidelines, it's not set in stone, do what you think you can," he said to Vaughn who nodded. "By next week though, he should be doing some crunches, ok?"

"Yup…we'll do that."

"Good. You know, I just thought about something – it would be better if that wound didn't have constant pressure on it, like 24/7. If it's possible, try to lay on your side or something for at least a while during the day, otherwise, it might get stuck…even with all of our preventive measures…how are your ribs feeling? You've had the wrap off for a long time now…you're breathing ok?"

"Yeah…it's not too bad…"

"Well…do what you think you can, if laying on your side hurts too much, then stay on your back, but otherwise try another angle for a while." Tom looked at his watch, "Ok…well then, I'm gonna go, I gotta get back to the hospital…you call if you need anything else. Good catch Sydney," he said smiling.

She smiled back, "Thanks for coming over."

"You bet. If I don't hear from you, I'll call you the middle of next week and figure out a time for a check up."

"Sounds good."

"I can let myself out," he said smiling, "Mike…you take it easy…but not too easy."

"Got it Tom, thanks," Vaughn replied.

Tom waved and left unceremoniously.

Sydney looked to Vaughn, worried because he'd been so quiet, "How are you doing?" she asked sitting down beside him again.

"Great," he said quietly.

She took his hand in hers and rubbed soft circles over the top of his hand, "I know this sucks Vaughn…"

"What? Tom coming over?"

"No…the whole thing…the wounds and everything."

"You make it pretty easy…"

"Thanks…you were really quiet, are you ok?"

"Yeah…it hurts…" he looked at her, debating, but then asked, "Do you think I could have my pills?"

"Oh my God!" she ran out of the room and into the kitchen, grabbing the pills and a glass of milk and coming back in. He heard the tail end of a conversation she seemed to be having with herself, "…hell you were thinking…changing bandages and making the poor guy sit up all that while with no pain medication…real smooth Sydney…"

He smiled when she handed him the pills and the glass of milk.

"I'm so sorry Vaughn, I don't know what the hell was wrong with me…"

"There's nothing wrong with you…you were busy saving me from further discomfort by catching an infected wound before it got to be really bad…it's fine…it was just starting to get annoying now…" he smiled.

"C'mere…" he added.

She moved to sit on the bed again and he pulled her over so she was lying against his chest.

"You beat yourself up way too much Sydney…you're too hard on yourself, just give yourself a break and realize that you're doing a great job…you've saved me a million times in the last few months…ok?"

She smiled, "Ok."

"You want breakfast now or do you want to finish the bandage changing first?"

"Just get all the bandage crap over with first."

"Ok…"

She got up and helped him to sit again and then moved on to the other wounds on his back, praying that no others would be infected. She was relieved, as he certainly was, that there weren't any more that were infected.

She found a few more that had tape irritation, but that was nothing compared to the infected one. She reapplied the rib wrap again and he seemed more relaxed when he had it back on. She laid him back then, positioning him so his right side, the side with the wound on it, was actually off of the pillow. He still had enough leverage so he didn't fall over, but it also took the pressure off of his back.

She got up then and went to make breakfast, came back and helped him eat and then cleaned up the dishes and came back yet again to be with him.