Posted by on Jun 15, 2012 in ANDY'S BLOG WITH UPDATES | 292 comments

It’s been a very busy week for Aimee and the Copeland family. On Monday Aimee had her first successful skin graft. The area of her wound, which I saw for the first time on Sunday during a dressing change, is massive. Aimee has been looking at the wound area for quite some time now, so she shelved her modesty and encouraged me to examine it. I didn’t fully examine the wound the way a doctor would, rather,  I respected Aimee’s dignity and examined it the way a father would. Aimee is actually very proud of the progress she has made toward the healing of the wound and she should be.


Please allow me to elucidate a bit about the wound and the nature of necrotizing fasciitis. You might have to understand a little bit about the human anatomy to appreciate the depth and scope of the trauma that Aimee’s body has been through. Beneath our skin lies a layer of fascia, a layer of connective tissue that holds the skin to our muscle. When a person contracts aeromonas hydraphila (the bacteria that causes necrotizing fasciitis) through an open wound, the bacteria doesn’t actually “eat” the flesh, it releases a toxin that destroys skin, fascia and muscle. The surgeons who acted to save Aimee’s life were forced to remove the surface layer of Aimee’s skin and fascia layer to prevent the spread of the toxin to the muscle beneath. Unfortunately, Aimee’s leg was too far gone to save when she arrived at Doctor’s Hospital, but the quick removal of the skin and fascia on her abdomen, side and hip was a timely, life-saving exercise. It also left the massive open wound area that I mentioned.


When I saw the wound I was surprised at how clean it looked. I was concerned that I would see a grayish surface color, which would mean that the exposed muscle was not healing properly, but what I saw looked healthy and red, which was a good sign. The redness meant that the blood vessels had finally worked their way to the top of the muscle layer. When this happens, a skin graft surgery is possible, Simply put, those blood vessels near the surface provide the glue that holds the skin in place. Because of the improved condition of the affected area, the skin graft was allowed to commence on Monday.


Before I continue, I think it is important to note that Aimee despises the use of morphine in her treatment. Although that drug effectively blocks most of the pain associated with her condition, it makes her groggy and confused and it gives her unpleasant hallucinatory episodes. During the dressing change I mentioned above, Aimee refused pain medication and instead opted to meditate through the change. Part of her master’s thesis is focused on holistic pain management techniques and Aimee told me that she feels she is a traitor to her convictions when she uses pharmacological pain management. Incidentally, morphine does nothing to control the phantom sensations in her extremities, in fact, the disorientation she gets from morphine seems to make her meditations less effective, perhaps because her concentration is negatively impacted.


The nurse who completed Aimee’s dressing change was astonished at Aimee’s insistence to avoid morphine during the procedure, as was her mother and I. I know the pain was significant, but Aimee’s courage is greater.


Another important development occurred on Tuesday following her surgery: Aimee was upgraded from critical to serious condition. This was a noteworthy event that I shared with Aimee. Her response was typical. She looked at me and said, “Really?” In Aimee’s mind, her condition has been stable for some time. She can breathe on her own, the trache is gone, she no longer needs dialysis and she is able to eat on her own. Although her major organs are all online and functioning well, Aimee still needs supplemental nutrition through a stomach tube and she needs help with her bladder and bowel control. I suspect that this will continue to be the case until Aimee develops an ambulatory capacity of some kind. All that said, Aimee’s upgrade is a major victory that cannot and sh