These images cover the period from November 24th 2012 through to March 1st 2013

Sarah’s injury

The original injury – the doctors drew this. I took this picture from her notes

Day three – They fixed it into this!

Day four

Day 9 – the black stuff is necrotic tissue

Day 15 – Necrotic tissue expanding

Day 24 – The doctors realised that the necrotic tissue was expanding and
needed to be surgically cleaned.

Day 28 (Four weeks to the day) – The wound has been cleaned and
this is what the wound vacuum dressing has been applied to.

New Era – The Vacuum dressing

The wound vacuum dressing has a mesh which is placed on the wound,
followed by a black sponge. This is then sealed to the skin with copious amounts of sticky plastic until it’s 100% airtight.

A suction cup is placed against the sponge and a machine is switched on which places a vacuum on the wound.

This works in a number of ways:

1. A much more sterile environment
2. The suction draws the wound closer to the surface so you don’t have such a deep hole
3. It draws in granulating cells which encourage wound healing
4 All the muck from the wound is sucked into a replaceable cannister which is detached when full and thrown away

(Cat watches muck move through the clear plastic pipe and is transfixed)

Day 31 – Christmas Eve. Wound Vacuum has been fitted for four days.
Can’t see much evidence in this pic but the ‘hole’ is not quite so deep.

Day 35 – 28Th Dec – Note to self. TRY TAKE PHOTO from the same angle!!
Can’t see any real difference between these photos.

Day 39 – New Years Eve – Hospital
Doctors so pleased with progression they say the vacuum can stop in ten days time

Day 42 – For the first time I can see through the camera what I can usually see only in real life
The wound is definitely getting narrower and shallower. Definite progress!

Day 52 – I forgot to take photos the time before so it’s been ten days and my GOODNESS what a difference! The hospital want to skin grafts but it is healing so well I wish we didn’t have to. I know that they say a skin graft will help hugely and any open wound is not a good thing but even so – It looks amazing to me.

After a three week wait she got the skin graft.
No bending the leg for a full week!

The donor site.
Did not help that the district nurse gave her the wrong dressing which got stuck to the wound!

Skin grafts have taken!! Now we wait for the scar tissue to form.
This will take twelve to eighteen months at least and almost certainly this will mean more surgery.

_________________________________________

The bruise (haematoma) Day three

Day three – while this wound is not open it has been caused by the impact
to the knee bending it sideways and caused internal bleeding

Day five – blisters. but it still looks ‘innocent’ and pretty unscary
Mr Shah warned me that this would become a ‘hole’. I never dreamt how bad it would become.

Day nine – the start of the hole.

Day fifteen – the hole! Hard to think that used to be a ‘bruise’.

 Day fifteen – This is the day Sarah GP Surgery said
she needed to come in herself to get the results of her swabs.
So I lost my temper and showed them this picture and asked if
they thought this wound made it easy to walk…

 Day 19 – New dressings are applied. Manuka honey!
Above is the same area before honey dressing and below (three days later!) Pretty remarkable

Day 24 – The doctors looking at the necrotic tissue on the other side of her leg have decided to do
surgery again and will clean them both up. back in to hospital from four days. :(

Day 24

Day 28  (four weeks to the day after accident) – Before wound vac therapy. The wound has been cleaned and varies between .5cm and 2cm deep. The wound vac therapy is supposed to suck out the yellow gunk and
draw up healthy cells (granulating cells) to encourage the holes to ‘fill up’.

The Vacuum dressing

Day 31 – Vacuum dressing has been on for four days.
Things are looking much better.

Day 34 – You can clearly see the ‘hole’ or ‘divot’ as the nurse called it
but it’s already looking shallower

Day 39 – WOW. You can really really see how the wound is starting to heal.
‘Divot’ shallower and the wound is clearly becoming smaller.

Day 42 – Forgot to take a photo of the inside knee! :(
Here’s a photo of Sarah instead, enduring the agonising process of
removing the sticky plastic. Dressing changes take between four and six hours.
Two hours to remove the tape and another hour and a half at least to reapply, another 30 minutes to seal the leaks.

The worst day was when the district nurses were so useless I had to redo both dressing.
That was a full seven hour procedure.

Day 52 – Again it seems to be healing brilliantly but they are little concerned re infection on this side. Yesterday was Aldo’s birthday and we shopped for a gift for him and did some grocery shopping. By 9 she was asleep and has slept most of the day to day. I know she finds it totally exhausting and gets frustrated.

I know when she is feeling better because she picks fights with me and argues about everything. When she’s not doing so well it’s much more peaceful but it brings a whole bunch of other worries!

(The difference three weeks can make! Image below is from day 32)

Having kept us waiting for three weeks with two ‘get to the hospital
and wait then leave’ she eventually got her skin grafts

‘I want Lisa,’ she whispered. Her sister.
‘I’ll call her in a minute,’ I said. ‘Shall I call your dad?’
‘No, no, no, no. Don’t call him,’ she was panicked at the thought and I wondered where that was coming from.
‘Okay,’ I soothed. ‘I wont.’
‘Cleator’s waiting for me,’ she said. A friend that she was due to meet for a bite to eat.
‘I’ll call him,’ I said.
‘You can’t,’ she said, starting cry again. ‘He hasn’t got a phone.’

Funny how you get hung on a little thing but we both worried and worried about Cleator sitting there in Mcdonalds, cursing her for being so late, never dreaming of the truth. Maybe our fixation with him being upset was easier than worrying about what was going on.

I could hear whispers from all around. ‘You should see her leg.’ I didn’t want to. I didn’t even want to think about it. It was hidden under a pile of coats and I firmly wanted it to stay that way until people who knew about these things could fix her.

Where was the ambulance? I couldn’t even hear a siren in the distance but blue lights were flashing everywhere. I did remember thinking, as we arrived that thank God we lived where we did and emergency help was seldom far away. How wrong I was.

For the first time I looked at the people huddled on either side of Sarah. On Sarah’s right, a small round woman sat on her knees. So calm, holding Sarah still. Her name was Sue. I still don’t know any more than that but I so wish I could thank her. I glanced to my left and to my surprise saw someone I recognised. Mrs Pate. Sarah’s primary school teacher.

She’d seen the accident happen. watched it unfold in that slow motion way. The police man told me later that she’d seen it happen as she sat in her car. Saw the child, saw the bus and screamed inside her head, ‘Look out!!’ Too far away to ever, ever be heard. The horror inside her as she raced to the scene. And then, to her shame but mind numbing relief she realised that the crumpled shape in the road wasn’t her daughter like she’d first thought.

As we sat there in the rain, icy water soaking us all, I felt the teacher shaking like a whippet and she kept crying out for the ambulance. Part of me wished she’d shut up. I wasn’t stupid and nor was Sarah. I knew she must have awful injuries but I didn’t want her frightened and time seems so distorted in moments like this. Each time the teacher yelled for the ambulance in her fear ridden voice it reminded Sarah that it was taking forever and that it was needed.

I heard more people around us whispering about her leg. I heard a policeman mutter than she might lose it. I didn’t want to think about it and felt this sort of ineffectual anger that they were talking about it in front of her. If you don’t acknowledge it, it might not be happening.

I saw a lad both Sarah and I worked with and I got to my feet. ‘Rohan,’ I said, ‘please tell work we wont be in tomorrow.’ I don’t know why that occurred to me to say. Cath, my mind seemed to be working on a thousand different levels.

‘I was on the bus,’ he said, eyes wide with horror as he raised his gaze to mine. ‘You should see her leg.’

The paramedics told me they’d take her to Preston hospital rather then Blackpool and Joe, who’d gone back to the house to grab me dry clothes and whatever stuff he could think of for Sarah didn’t know. I begged the policewoman to contact him, tell him to go to the different hospital but I could see she wouldn’t. I could see she wanted me to break down. I could see she was hungry for gore and mayhem and didn’t want to leave the scene. She kept looking at me with a glitter in her eyes. I knew she wouldn’t call him. It was one of the more vivid memories of the night, that this woman, who could sooo easily have taken a huge chunk of stress out the situation so clearly didn’t want to help.

Meanwhile the paramedics were trying to find a vein in Sarah’s hand. You now how much she hates injections. Remember when she fainted because she needed those blood tests? Her fright and panic makes her veins shrivel up and disappear. So again, it wasn’t like on TV, no simple needle in and drip up. After fifteen endless minutes of prodding and searching they gave up and decided to just give her gas and air. Except the bottle was empty.

They cut off her coat. Her brand new, gorgeous and dearly loved £90 coat. She was more horrified at the sight of the scissors snipping through the dearly loved denim than by the injections.

The driver of the ambulance called a conference. ‘Which way to Preston?’ he wanted to know. My confidence evaporated a little more.

The paramedic lent me his phone so I could call Joe and the relief when he answered was intense and I told him about the change of hospital. Why had that community police woman been like she had been? What had she gained? I will never ever forget that hungry look in her eyes as she studied my face. She wasn’t a policewoman because she wanted to do good, she was a policewoman because she sucked up trauma like a sponge – and loved it.

Driving in the ambulance, sirens blaring, was surreal. Every bump made Sarah whimper and she was shuddering with cold but every shudder that passed through her caused yet more agony. The neck brace was biting into her chin and collar bone and the blood on her face had mixed with her mascara that had spread far and wide in the rain.

We spoke about all sorts of things on that twenty minute drive but I found myself wanting to promise her the world, anything, anything at all, just to make her want to stay.

Even now, writing this some weeks later I have to conclude there was an angel sitting on her shoulder. The dent and the broken glass is where her head and shoulder was. The bus hit her on her right side. While her arms and ribs were bruised and she did have a black eye and a graze on her cheek bone, these were on her LEFT cheek from where she hit the road. Not from the bus at all. Why not?

Maybe there are explanations but I’m sticking with her guardian angel. A job well done. Thank you, from the bottom of my heart, thank you.

They let me into resuss because I was so composed and was able to calm her down but it was at that point that my shoes, shoved on in such a panic what seemed a life time ago, started to haunt me. I’d sat, stood, walked in the rain for an hour, they were drenched and being my revolting work trainers that were four days away from being binned, they began to smell. How could this triviality, in the face of my daughters life, occupy my mind so much?

For each and every xray we’d have to duck behind xray screens and the smell would rise up and make me want vomit. They took endless xrays and Sarah was whimpering about how thirsty she was and it seemed such a tiny thing to ease in the midst of everything but I couldn’t give her anything in case she needed surgery. It made me feel ever more helpless. Eventually someone came over with a thimble sized bottle of water and let me drop the liquid between her dry lips. It was such a wonderful sensation to be able to help, as pathetically tiny help as it might have been.

She’d begged me not to call her dad. When I’d suggested it, as she lay there in the street, blinking rain out of her eyes, she’d panicked, yelling ‘No, no, no.’ I didn’t know why but it was well past the initial accident and it was time I started letting people know.

It’s hard knowing whether to do it, let alone how. A phone call? A text?  And who do you call? Surely, in some ways it’s best not to call anyone. Why instil the panic that you are going through into them? Would I want to know if the shoe was on the other foot? (DON’T even think of shoes) Yes, I would want to know. Why? What would I be able to do once I knew? Nothing. But somehow if I knew, the power of my thoughts could be channelled in their direction. My very knowledge might keep them alive because of the power of my thoughts. Egotistical? Immensely but human nonetheless. If I told everyone and they knew about, maybe their thoughts and prayers would be channelled in her direction, keeping her alive simply by thinking of her, holding her hear.

I opted for texts because that would be how I’d want to know. An instant to assimilate, to formulate questions and then the phone call. Like a coward I left the dad phone call to Joe. Anyway the dad’d already told me a couple of times he’d never wanted to hear from me again. Which as my excuse and I was sticking to it. Poor Lisa got the text but only half of it came through. She saw only that her sister had been involved in a serious accident and was in hospital.

She could barely speak for crying when she called.

Being in the trauma resuss centre brought another experience. I expected everyone to know what they were doing but they didn’t. I expected them to be gentle, they weren’t. I expected them to be professional which they were but I didn’t expect them to run out of oxygen and have to go hunt for another full bottle. I could see the horror on the mothers face in the room at the end who’s infant was having seizures. I could hear them shouting at James, who was dying in the bed next to us. ‘Breathe James, BREATHE!!’

When I stepped out the trauma room to answer my phone, James’s wife, so calm and still, knowing her husband was dying was standing in the hallway like a shadow someone had left behind. His son, eyes filled with tears, sat in the waiting room looking hollow.

The revolting brats who’d got themselves so drunk that the emergency services had to be called lined the corridors on trolleys, being guarded by paramedics as they wretched dizzily into paper bowls. I couldn’t help feeling utter disgust that Sarah had had to lie in the rain for forty minutes because these silly twats needed to have alcohol before they thought they could have a good time. They should have to pay for the ambulances is my feeling.

Sarah’s dad arrived. I hadn’t seen him in years and I was shocked by how much he’d aged, even though I knew I certainly had. Within minutes he was looking at her paperwork and I saw every bone in his body stiffen when he saw her name change. I ignored the whole issue and gently eased the bear, this giant inflatable heating pad thing that wrapped around Sarah, a little tighter like a giant warm hug. I wished it could be me hugging her.

Occasionally a little flicker of expression would flash across her face, a wince mostly and I hovered, ready to ring the bell and call anyone and everyone but by 3 am I’d sunk into the purple chair and just watched her hand, all I could see from the angle at which I lay. I was horribly uncomfortable but it took me until nearly four am to figure out the chair was actually a reclining chair. Duh.

Throughout the night whiffs of my shoes which, courtesy of the radiator, now smelt like some rodent had crept into them and died, wafted under my nose and I was horrified at the thought that the smell had permeated the whole ward. It made me feel ashamed that I could be thinking such ordinary mundane, selfish thoughts.

Flashbacks of her injury, the bus, the poor driver haunted me. I wanted to rush around and hug everyone who’d been so kind. Nameless faceless people who’d provided umbrellas to try and keep the rain off us, the police, Mrs Pate, Sue, the taxi driver, the ambulance people who told me urgently as they’d left us to let ‘Bob and Richie know’ how she was.

I wanted to find the bus driver and make sure he was okay. Sarah kept wondering how he was. He’d started to suffer chest pains after the accident. I could imagine his horror. Sometimes it’s easier to be the hit rather than the ‘hitee’, guilt can be far more painful than injury. I wanted to hug him and say it was ok. It was an accident.

I couldn’t sleep. I’d keep sitting up to check she was still breathing. In the gloom you watch anxiously for that tell tale rise of fabric but when it’s hard to see you want to prod to make sure she’s still with you.

Lisa came in with her dad at around two. They didn’t stay for long, Lisa just watched her sister with big shocked eyes. She suddenly seemed so grown up and not so self-involved but like me she was cracking weak jokes. Trying to find humour in a pretty much humourless situation.

The lack of humour hadn’t stopped the trauma team, when they found out that she been walking back from where she worked at Specsavers, coining the advertising slogan, telling her ‘You should’ve gone to SpecSavers!’ and then cackling away.

Every time exhaustion got the better of me and I dozed off, a nurse would bustle in and take Sarah’s blood pressure etc. Obs as I learned they were called. I was so grateful for them as I studied their concentrating faces for any flickers of unease, feeling intense relief each time they wheeled the obs station away without pushing any alarms.

However we saw Sarah’s leg today! Wow. they did an amazing job. The consultants however are more worried about the bruise on the inside of her knee which looks awful but to my uneducated eye seems less interesting that the other side.

They fixed it into this!

The bruise on the inside of her knee

The original injury – the doctors drew this

They wont let family stay on the ward with her any more. It’s understandable but not easy. She’s on an adult ward and technically classed as an ‘adult’. She signs her own consent forms etc. Which would make me more comfortable if she knew what she was signing. When I ask her she shrugs and says, ‘The doctors talked over me, not to me. I have no idea.’ Hardly informed consent.

Anyway at 16, in many respects, she’s still my ‘baby’. So tonight we’re banished back home, a forty minute drive away. While I could use the sleep it’s hard leaving her. Allison, another ‘inmate’ will keep an eye on her for me but even so.

When they first told us she’d be in hospital for a week we were fine with that. When they said we could go after day four the last three days were this endless procession of goal posts being moved. Each doctor we saw would check his box for the all clear but add another one or two to the list and instead of being closer to leaving it got further away.

Waiting is the strangest thing. When Sarah was first injured, a day seemed to pass in an hour, now an hour feels like a day.

There are about thirty nurses on the ward. About five are brilliant, about three are appalling and the rest are ordinary people, just doing their job. A job that pays a salary but doesn’t appear to give them any real job satisfaction. My admiration for nurses is immense, I couldn’t do their job for all the tea in china.

‘What?’ I said. ‘But she needs her dressing changed!’

‘You have to go to the walk in centre in Blackpool.’ She’s annoyed with me. ‘Next!’

So instead of being a one minute drive from my doctors surgery we have to drive forty minutes through the traffic of Blackpool. It was scary to see how the wound that had been the ‘bruise’ had deteriorated. Even the nurse who was changing the dressing called a senior member of the team in. And took a swab to check for infection.

The initial bruise (haematoma)

has become this

And the original wound, so neatly mended to start with has split and is full of black necrotic tissue and yellow discharge. For some reason we, Sarah and I, are quite relaxed about it. I think it’s because she looks at me to see how I am reacting and because I look completely relaxed about it she’s not too concerned, then because she’s not stressing it makes me feel better so both of us seem more laid back than deck chairs. The nurses don’t quite know what to do with us.

Day 4 – Original wound after surgery

Day 9 after injury

In NHS language it apparently means we’ll see you when we get a chance. Nearly two hours later she was prodded and poked and a parade of surgeons cooed over her wounds with fascination and pronounced she needed more surgery – but after a scan.

We waited for seven hours for a scan before they admitted her. Without actually getting the scan.

Yesterday morning she had it and it involved having a huge injection into the vein in the top of her foot. Sarah’s so funny because she HATES injections and she was describing the Polish doctors frustration and mimicking her accent to a T. ‘Sarah! I am losing patience now’, after twenty minutes of trying to get the needle into Sarah’s squirming foot. It took three nurses to hold her down.

The scan for DVT came up clean and then it was hurry up and wait for surgery. (It WAS a haematoma after all that!)

So we wait. And wait. And wait. Five hours later they come and wheel her off. ‘We’ll be gone an hour’ so I wait, and wait, and wait some more. Two and a half hours later, having convinced myself she’d had a heart attack on the table/had the leg amputated/they operated on the wrong leg etc they trundle her back on the ward. She’s groaning and I lean over, the concerned, anxious mother and all and she whimpers, ‘I’m soooo hungry.’ Lol Whereupon I get chased off the ward because it’s not visiting hours so I wait and wait another hour and a half then head back to the ward where Sarah and I stare at each other in sheer exhaustion, without a word left to say. Eventually she heaves a giant sigh and points at her empty plate and complains they only gave her a cheese sandwich for dinner, which I agree isn’t very much having been nil by mouth for the last 24 hours and ferret out some hula hoops which she munches lugubriously, staring at nothing.

I get home and find my brain, despite having done nothing ALL day is as useful as over-cooked cauliflower. No Christmas cards, no Christmas shopping, no work achieved – again!

Does wound vacuum dressing work?

Well watch this space and we’ll see what happens.

They say she will need a skin graft but the vacuum focusses not so much on the skin healing but on the depth of the wound. The pump means there will be less of a chance of infection because it sucks out any rubbish but at the same it may help to convert a tattered wound bed into a red carpet of healthy granulation tissue so it could progress through the subsequent phases of wound healing.

She has one vacuum pump and suction on both wounds. if all goes to plan it will be on her leg for four more weeks which brings it to exactly 8 weeks since the accident.

These are what the wounds look like on December the 22 after the surgery to clean and debride them.

The wonderful district nurses

Original wound – four weeks after accident – Before wound vac therapy

Haematoma wound – four weeks after accident – Before wound vac therapy