Sunday, January 8, 2012

Of Wounds, Dressings, and Scars

My oldest is a strange child.  The boy has almost no sensation of pain.  I say almost because I have seen him cry once or twice.  He was deathly afraid of needles and would cry at the thought of getting a shot.  He also cried the other day when someone slammed a door down on his head and left a goose egg.  Other than that, he has little sensation of pain.  He ripped open his arm two years ago and needed 40 stitches, but "it doesn't hurt at all, mom".

Last week, he went running and jumping across the parking lot, even though it had just been covered with ice.  He was supposed to bring in our bag from the van.  He came back with the bag and the first aid kit.  "Why did you bring that in?  We don't need it."

"You will need it, mom." was his only response.  Then he turned.  In his new jeans, there was a three inch tear at the knee and blood was pouring down his leg.  He had run and slipped on the ice and hit the curb.  I had him take off the jeans, and the skin on half the knee cap was gone and three large slices were cut under that.


Thankfully, it took off enough skin that the gravel that went in it came off with the layer of skin.  I did need to wash it, so I sprayed it with a bottle of sterile water.  The kid giggled and wiggled.  "Mom!  It tickles! Don't!"  I dried it with a 2x2 guaze, pushing hard to see if the bleeding had settled and what was what in the cuts.  "Does this hurt?"  "nope!  I mean, I can tell you are pushing on it, but I don't feel anything!"

Honestly, the lack of pain is not a good thing.  Pain is given to us to teach us.  We learn, for example, not to swing on rusty bars, not to run on ice, to pick up our feet when we walk, to use the steps when going downstairs.... but without pain, he doesn't learn these lessons.

It's been almost a week.  Every day, sometimes three times a day, I have changed the dressing, washing, putting more antibiotic cream on, non-stick bandages, allowing it to heal.  In a cut, I can pull the edges together, holding them either with steri-strips or stitches (yes, I own a stitch kit or two... these boys!).  Then the edges seal, and the wound heals from the top in with little scarring.  Healing by primary intention.  Healing the way it should be.

But sometimes, there is no skin left.  There is no way to pull the edges of protective skin together and allow the healing to take place deep inside with minimal scarring.  When the skin is ripped away, it will heal by secondary intention - from the bottom up.  With this wound, it was the best I could hope for.  Still, I can care for the wound.  I kept it covered.  I kept it clean.  Daily, I washed it.  I covered it with antibiotic cream - both to kill germs and to keep the skin soft, so it would heal cleanly from the bottom up with little scarring.

Care.  Gentle care.  Meanwhile, my son giggled and wiggled and begged me not to wash it.  He'd rather just leave it open so it scabs over and dries out.  A bandage slows him down.  But I insisted.  I didn't want a big lump of white scar tissue to be in his way for a few years as he played and knelt.

A week later, it was looking great.  Slowly healing.  The open red skin turning white, the depth of the scrape lessening.  I took the bandage off and sent him to go shower before I would re-dress the wound.

Pain.  It is a good thing.  This kid doesn't have the convenient teacher of pain.  He set off running for the shower (why walk when you can run?) and tripped on the first thing he encountered - a step in our dining room.... it's been there the whole six years we've lived here! - and fell.  He hit his knee on the edge of the step, and stood up.  He looked down at the wound and said, "Interesting." and reached down and pulled off a flap of skin that he scraped back off.  Then he turned to look at the step and picked up another piece of skin he had left there.  The wound was open again, and bleeding down his leg.


We're back to bandaging and oiling his wound.  With him, the bandages do a few things.  They cover and keep it clean.  They allow it to heal by secondary intention, but with little scarring.  But they also remind him that he is injured, and cushion the blows that keep coming.  And when the bandage is soaked, I change it once again.

Healing by primary intention is good.  That is when the wound is a clean cut and we get immediate care.  Failing that, the edges may never stick together, or the wound sheared off too much for there to be edges.  Then we have to heal by secondary intention.  That can still be done well - if care is given.  If the wound is washed, oiled, and bandaged - protected and cared for.  When that is not done, when a wound is just left open to air, unwashed, uncared for .... eventually it will still heal, but it will leave a bigger scar.  It will be obvious for years or perhaps forever... there is a wound no one cared for.

That is how I feel about my heart right now.  I'm going on.  I will go on.  I am surviving.  I am moving into new areas of ministry and I still enjoy my work.  But I have a scar.  There was a wound no one cared for.  It did heal, but it healed badly by secondary intention.

One thing I've learned about scar tissue is that it has consequences.  Just this weekend, a friend showed me her back.  She has a two and a half foot long scar curving the length of her back - a remnant of the consequences of her choice to choose Christ.  She's having pain when she works hard and wonders what is wrong.  I examined the scar and the muscles surrounding it.  I think the wound was initially cared for well, but she was sent home, and people were frightened of her wound, so no one washed and bandaged it again.  They were afraid they would faint.  Afraid they could not face the pain of looking at her back.  So she was left alone.  She has more scar tissue than was needed.  I think that now, when she has a physical job, that scar tissue is pulling, and that causes pain.  My incision from surgery did for years, and still does occasionally if I lift too much, hike too far, or work too hard.  I've learned that it will do that, but not to worry.  Actually, as I pushed through the pain, some of the scar tissue broke up.  I hope hers will, too, but I am going to do some research to see what can be done to help her.

Scar tissue can cause pain.  Even after healing.  That is why I work so hard to heal my son's wound.  My friend's scar causes her pain.  Mine cause me pain.  It has healed, but it could have been healed by primary intention.  It could have been healed even later by secondary intention if it had been covered and cared for.  It wasn't, and when the scar tissue pulls, it reminds me... no one was there to bandage and cover with oil.  That fact also hurts.

I can't fix that.  Instead, I can only go on.  And today, I look at my friend's wound, listen to her story, and tell her I wish I had been there to wash and dress her wound.  I run my finger along its length, gently probing its depth, and marvel at her courage.  I promise to do what I can to find out what has promise in decreasing scar tissue, in helping her be strong enough to push through the pain.  And I dress my son's wound again and again, ignoring his wiggling and giggling, determined that he will heal with as little scar tissue as possible.


nicolette said...

Thanks for a great, great post, Ellie!

nora said...

Beautiful, Ellie!