Welcome to Anne's blog!

If you are new to the blog, you probably want to start at the beginning of the whole sad story. To get there, use the "Blog Archive" tool in the right column of the blog and click on "2009," and then "January 25." From there you can continue to click on each week to see the weekly entries.

I would love to hear from you! If you would like to leave a message, you can reach me at aheetderks@wcsmiami.org!

This is the beginning of the blog! DEAREST FRIENDS AND FAMILY--

Since my fall on the 17th, so many of you have expressed an interest in knowing the details behind my disastrous attempt to take down our Christmas decorations from the front yard.   I thought I would write out a quick “run down” of the positive developments, setbacks, and blessings that we have experienced so far.  From today (January 28) on, I will continue to update this blog with the most recent developments!  

Saturday, January 17, 2009

I placed a ladder on the walk leading up to our house and set it against the palm tree in the center of this photo.  I reached up to take down a star that we had hung up in the tree when the ladder suddenly twisted around the tree and came down.  As I fell, I can remember seeing the faces of Doug and my girls and thinking, “This is it.  This is how someone dies.”  When I landed in the plant beds (in the second photo), I looked down and saw that my foot was literally resting back on the calf of my

 leg.  I grabbed it and kind of tossed it back into place and decided not to look at it again! Doug immediately ran over, cried out, and started calling 911.  As I lay there waiting for the sounds of sirens, I was overwhelmed with gratitude.  Although I knew that my foot was going to be an issue, I realized that I was ALIVE! My body was strong. I didn’t feel pain in other parts of my body. I wasn’t paralyzed. I could talk to my family (even telling the girls to get their shoes on in time for the ambulance’s arrival).  I just needed to keep my cool and wait for help to come. 

As the emergency personnel began rolling in, I repeatedly heard the term “open bone fracture” being mentioned.  They spoke of the amount of dirt and debris on my wound and even poured water over it before bringing me into the ambulance.

Long story short—I was taken to the hospital and immediately prepped for surgery.  During the surgery, they found the talus bone of the foot had been forced through the skin and was broken in many, many pieces.  Furthermore, they found mulch, dirt, ivy leaves, metal fragments (from my landscape lighting?), landscape fabric, etc. mixed throughout the blood, pieces of bone, severed blood vessels, and skin of my foot.  Pretty.

Following the surgery, the Doctor informed me that I had suffered a “catastrophic” injury to my ankle.  He said that he was only able to clean the wound and carefully place the pieces of bone back into my foot and sew it back shut.  He said that he would have a difficult time finding a doctor who would be willing to take such a demanding case.  Even as he was telling me this, I was kind of thinking, “So, I think this means I will probably need a sub for a few days next week.”  Therefore, I was a little taken aback when he told me that I would be needing to take at least three months of disability from my work.  That was a bit of a reality check.

Sunday, January 18, 2009

On Sunday, I was told that a Dr. Carbonell had agreed to take my case and would be performing surgery on Monday afternoon.  I immediately recognized the name and wondered if this doctor could possibly be the father of one of my 1st grade students named Peter Carbonell.  Sure enough—by the next day I knew that the kind Dad who always showed up at school in blue scrubs to pick up Peter was going to be my doctor.  What a blessing. 

Monday, January 19, 2009

While being prepped for my big surgery, Dr. Carbonell stopped by and informed Doug and me of the challenges facing us in the surgery. 

First, he said that the talus bone sometimes breaks in two pieces during a major injury.  When this happens, they pin the two pieces back together and the patient has a very good chance at a complete recovery.  What made my injury so “catastrophic” was that—while the talus did indeed break in two pieces—one of the pieces was shattered into a gazillion pieces (my words—not his) making it almost impossible to pin anything of significance back into one piece of talus.

Second, there was a remarkable amount of debris inside the foot that was causing significant infection.  To avoid blood poisoning, bone death, and/or an inability for the body to heal, it was very important that they clean the wound well, take cultures from the inside of the foot to identify the specific type of bacteria growing in the foot, and then use the proper antibiotics to fight the infection.

Third, any kind of movement following surgery would take the bones out of alignment and make it impossible for the bones to heal properly.  Therefore, I would be fitted with the most beautiful foot accessory ever created—the external fixator.  J  Pins would be placed through the bones of my leg and foot and permanently attached to the fixator. 

As I was being wheeled into surgery, Doug and I both noticed that there were a lot of physicians hanging around.  Turns out they were all waiting for my surgery to start.  Dr. Carbonell later told me that many people wanted to see my surgery because it was very interesting and challenging, and had not been performed in a Miami hospital for at least two years.  You know—if you are going to destroy your ankle, you may as well go all the way and make yourself a superstar . . .

I woke up in recovery at 2:00 a.m. believing that I had just returned from my first visit to the moon.  I truly saw myself wearing an enormous

moon boot, stepping down onto the surface of the moon.  It wasn’t until the anesthesia had worn off a bit that I realize that my moon boot was really a $20,000 piece of space-age metal in the shape of an external fixator (wrapped up here in an ACE bandage).

My Dad spent the rest of the night with me in my hospital room.  It was such a comfort to see the light of the moon reflecting off of his sweet, bald head.  Every time I looked at him, I knew that I wasn’t alone in all of this.

Tuesday, January 20, 2009

Doug and I were hanging out in my hospital room when we received Dr. Carbonell’s report regarding the previous night’s surgery.

1)  He was thrilled to discover that when he went into my ankle, he was actually able to find two pieces of the talus large enough to screw back into one piece.

2)  The cultures they had taken from inside the wound had already started growing some significant bacteria in the incubator.  They found all of the samples were “gram negative rod” bacteria (Don’t you remember the day in high school when we learned about rod, spiral, and comma-shaped bacteria???  Well, I am now a rod bacteria woman).

3) Because so many of the blood vessels had been severed, they would be placing me on Lovenox (a blood thinner) for at least a month to make sure that I didn’t develop a blood clot.

4)  I will wear the external fixator for about 2+ months while the soft tissues of the ankle and the talus bone repair.  After two months, I will probably work through approximately 2-4 months of physical therapy.  

5) After a total of six months, they will assess the function of the ankle.  If the healing has not gone well, they will consider fusing the ankle into a permanent, non-moving position.  If the healing has gone well, they will perform another surgery to remove the small pieces of bone that never attached to the mass of the talus.  Dr. Carbonell will fill in parts of the talus that are missing with living bone from a bone bank using something called the “OATS” procedure.

That night, I watched the inaugural ball with my Mom and one of the many sweet nurses from my floor.  It was the first time since entering the hospital that I felt like I could forget that I had a major problem and just enjoy the moment.  That was nice.

Wednesday through Friday, January 21 – 23, 2009

Over the next few days, Doug and I realized that this new journey we were on was going to be a slow, hour-by-hour, day-by-day process.  Our days were filled with so many blessings . . .

  • My nurse, Jorge, taught me how to take shower without getting my fixator or IVs wet.
  • Doug and I took a nap together on my bed.
  • Dear friends from our school and church supported us by bringing meals, making personal connections with colleagues in the medical community, arranging babysitting or sleepovers for our kids (they had such a great time they didn't want to come back home!), praying earnest prayers for healing, and sending messages of love and support.
  • Our insurance seems to be decent and is (so far) covering my care.
  • Our girls have been so sweet and honest with their feelings of fear, love, and a little bit of denial.  Their presence keeps Doug and I grounded and focused on staying positive.
  • My nurse, Gizele actually walked to a Walgreens to get my pain meds when the delivery didn’t come to the hospital on time.
  • That my dear assistant, Lisa, has taken up the responsibility of teaching my classes at WCS with grace, enthusiasm, and great competence.
  • I was able to sleep for longer than 2 hours at a time.
  • My physical therapist told me about a little scooter that I could use to become more mobile while in the fixator (I will have to pay for it out of pocket so I am doing some research on it right now).
  • Doug was so beautiful with helping the girls come to terms with the reality of their Mom being out of commission for a while.
  • I will be able to collect disability for the three months that I cannot work.
  • I realized that my body is very strong and can handle moving around with the walker with relative ease.  Although the exercises they have given me to do every other hour can be difficult, they make my body feel good and allow me to get my blood moving!
  • Our girls have such dear friends who are trying to support them without making them feel strange or uncomfortable.
  • We began meeting Dr. Carbonell’s residents who were all too willing to offer us realistic expectations, encouraging bits of information, and advice to “take it slow.”
  • Doug and my relationship has taken on a new depth and intensity as our need for each other has become an absolute necessity.  I adore my husband.

Friday afternoon, January 23, 2009

Our big day to go home! 

After having a minor meltdown, Doug put me back together and we started gathering up our stuff to get discharged from the hospital.  I even had a chance to look out my window for the first time and see that I had had quite a lovely view! 

We had to be at my infectious disease doctor’s office by 4:00 to be trained in giving myself antibiotics every 8 hours through a PIC line (a tube that travels from my arm to my heart). Rather than having a home health-care nurse come to our house three times a day, I opted to take advantage of this cool technology that uses pressurized, water-balloon shaped balls that are filled with my antibiotic.  After injecting saline into the port of my PIC line, the antibiotic ball is attached.  When the ball is empty (after about 30 minutes), I make another saline injection, followed by an injection of heparine (a blood thinner designed to keep the line from becoming clogged). 

After creatively fitting me into back seat of Doug’s car (a lovely sight—me in my hospital gown, a walker, hair sticking up everywhere, and the lack of a pair of underwear that will fit over a microwave on my foot!), we raced off to the doctor—only to realize that there was no way that I would be able to waddle the 50 yards to the office door.  That’s just when another one of God’s blessings showed up . . . A lady from the office came out with a wheelchair, picked me up in the parking lot, and not only brought me in the office, but recognized that I was a bit pale and fed me a beautiful meal left over from their office luncheon.  So sweet. 

That is just the way it has been—just when it seems like things are just a little too overwhelming, someone will come in from no where with an act of grace or kindness that gives you enough hope to make it to the next minute. 

In a nutshell—

We called our dear friends, Tom, Sharon & Nancy, and asked them to meet us at the house to help me get settled in.  Upon driving up, we saw that our neighbor, Ken, had taken down all of the remaining Christmas lights and decorations that still remained up following our hurried rush to the hospital (so kind—and such a relief to see that they were gone).  I cried when walking by the spot where I had fallen and again marveled how one false move could result in such a huge consequence. 

We set up the house, ate some food, picked up my meds from Walgreens, arranged ourselves in bed, and looked forward to bringing the girls home on the following day.

Saturday, January 24, 2009

Unfortunately, another one of those setbacks came up.  By 10:00 on Friday night, I could see that there was a lot of brown liquid coming out from around my wound and that I had a large blister on my ankle.  By morning, we were heading back to the hospital—hoping that a simple dressing change was all that would be necessary. 

Dr. Carbonell’s resident, Maribel (soooo awesome), met us at the emergency room, took off the dressing, and was a disappointed by what she saw.  Overnight, the wound had clearly been attacked by infection.  The skin along the sutures was dying, a cloudy liquid was oozing from the wound, and my foot was horribly swollen.  Maribel quickly arranged for a 7:00 surgery with Dr. Carbonell to go back in, clean out the wound, and reassess the antibiotics being used.

My awesome assistant at school, Lisa, met us at the hospital and stayed with us as they prepped me for surgery.  The nurses were fantastic and even set me up with a fancy gown that was fitted with a warm air hose that could be adjusted to achieve optimum comfort.  They started me on a second antibiotic (Vancomycan) in hopes of killing off whatever had attacked my foot so quickly.

Later, some good friends from church sat with us and gave us lots of words of encouragement.

Following the surgery (my third), Dr. Carbonell was very happy.  He said that we had caught the new infection very early and that they suspected that the bacteria we were still dealing with the gram-negative rod bacteria.  He packed the wound with a fabric made of silver that resists bacteria and keeps the wound dry.  He said that much of the skin around the sutures had died during the time from my discharge the night before and my return to the hospital the next day (yikes!).  Therefore, they were going to allow the skin to die away on its own, cut it off, and eventually skin graft new skin to cover the open wound.  In the mean time, the wound would remain open (can you see the hardware that was screwed in during the second surgery under the dying skin??). 

He let us know that the wound not only needed to drain, but that they needed to encourage tissue growth from inside the foot.  Therefore, within the next few days, a “vac” would be attached to my wound.  Basically, they would cut a sponge in the shape of the open wound, seal off the entire wound with a sheet of adhesive, and then insert a small tube into the sponge.  The tube would be attached to a “vac” that would provide constant suction to the wound.  Not only would drainage be sucked out, but the negative pressure would also encourage blood flow and tissue growth around the site.  The vac will actually encourage tissue to grow from the inside of the wound and grow in and around the hardware installed earlier.  When new tissue has filled in the entire wound and the drainage has stopped, they will skin graft on the new skin.

He assured us that he would not discharge me from the hospital until the infectious disease doctors and he were convinced that the infection was under control.

Sunday through Wednesday, January 25-28, 2009

Over the last few days, I have been taking some very strong antibiotics.  I am drinking DanActive like crazy to avoid getting a yeast infection, thrush, diarrhea, etc. that can came as a result of killing off both the bad and good bacteria in your body.

Dr. Carbonell’s residents, Maribel and Bozena, stop by every day and remove all of the dressings from my wounds, clean them completely with sterile water and alcohol, and then repack them with the silver fabric.  The skin around the wound is dying a little more each day (that is a good thing).  Maribel & Bozena have become like dear friends who answer all of my questions, explain what is going on, and genuinely delight in any positive developments in my healing.

On Wednesday, the skin had died off enough that Bozena attached the vac to my wound. These pictures show the sponge placed into the wound, the suction tube placed on top of the adhesive, and then the VAC machine.  

Our new pastor, Joe Dieleman, came to visit me and ended our visit with the following verses from Psalm 27.  Before he started reading it, he told me to think of the “evil men” as the bacteria that keeps trying to hinder my healing.  This is what he read:

1 The LORD is my light and my salvation --whom shall I fear?  The LORD is the stronghold of my life—of whom shall I be afraid?

 2 When evil men advance against me to devour my flesh, when my enemies and my foes attack me, they will stumble and fall.

 3 Though an army besiege me, my heart will not fear; though war break out against me, even then will I be confident.

14 Wait for the LORD; be strong and take heart and wait for the LORD.

Thursday, January 29, 2009

It sounds like everything is set up for me to go home early next week IF THE INFECTION INSIDE MY LEG HAS BEEN WIPED OUT.  Dr. Carbonell took a culture from the inside of my foot tonight and will begin incubating it immediately.  If after three days, NO bacteria grow from that culture, they can safely assume that the infection is gone and send me home.  I would covet your prayers that the infection has indeed been killed off by the intense amount of antibiotics I have been taking this week.

Doug and I are learning to live day to day and to be thankful for each hour that passes.  We know that there are going to be many bumps and trials along the way.  We just hope that we can handle this situation with grace and joy.  This really shouldn’t be too hard to do because we have already been given so much to be thankful for.  My fall from the ladder could have been so much worse—and if the worst that happens is that I lose my foot or walk with a cane for the rest of my life—so be it. 

Please continue to pray for our dear girls.  They are being such troopers but sometimes the intensity of this situation gets to be too much.

I will continue to update this blog as my journey towards healing continues! 

With much love,