Debridement

When I was fourteen, I spent several months doing intensive outpatient physical therapy for an arm that had decided to go on strike. I was receiving therapy at an excellent rehabilitation hospital that primarily served inpatients who were working to overcome severe injuries and illnesses.

I spent most of my time in the outpatient gym, a large room outfitted with various tables, pulleys and other torture devices.

But that’s not where the real torture occurred.

Everyone in the outpatient room was pretty much okay, maybe a 6 or 7 on a Likert scale where 1 is dead and 10 is Olympian-healthy. We may have grumbled and cursed and even shed some tears, but we didn’t know what real torture was.

That was reserved for a couple of small, private therapy areas near the pool, just down the hall from the outpatient area. Those treatment rooms were primarily utilized by the burn patients. That was the hell-hole they had to venture to on a regular basis to have their wounds debrided.

For those of you unfamiliar with the process, this is where the patients are placed in a whirlpool tub and the old, dead or dying skin is removed through mechanical means. The nerves beneath the necrotic tissue are raw, screaming with each assault. Often, the patient’s screams could be heard as well echoing down the hall.

It’s a brutal process, especially for those who have burns over a large area of their body. They would begin to feel healed, a barrier forming over their exposed tissue. But the skin formed too soon, before the blood supply was ready to keep up. So that barrier, although it appeared intact, was really an impediment to healing. If left on its own, the dying tissue would spread infection to the rest of the body. And so the old would be removed to allow fresh real estate for new, healthy skin to grow.

For most of us in the outpatient gym, our healing journeys were pretty linear. The data on our charts and the weights on our pulleys spoke of continuous improvement. We could see the impact of our efforts on a weekly, if not daily, basis.

For those scorched souls that I saw wheeled down the corridors and heard wailing down the halls, a linear path to healing was unthinkable. They would make progress only to start back again after being knocked down by infection or delayed healing. I’m sure on many days, getting healthy felt like an impossibility to them.

But in many cases, it did happen.

I remember one man in particular. He sat next to me one day as we both we on the upper body cycle (picture bicycle pedals that you power with your arms). My right hand was fastened to the handle with an adhesive wrap, but other than that minor adjustment, I was pedaling along just fine.

The man next to me? His fingers gripping the handles had burned to not much more than nubs and kept slipping off the pegs. The scars wove up his wrists, disappearing under his long sleeves. I wondered how far the scars extended. Looking down, I saw his unscathed legs visible beneath his shorts. They looked somehow wrong on him, as though the scars had become his normal tissue and the unblemished flesh belonged to someone else.

We chatted that day as we both rotated our pedals to nowhere. He spoke of being burned in a grilling accident, the flames licking up the lighter fluid and developing a taste for human flesh. He told me he was hospitalized for several weeks and then in the inpatient unit of the rehabilitation center for many more. He had been discharged recently and was in the early stages of outpatient therapy.

I asked him about those treatment rooms, about the screams we could hear down the hall. I asked how it felt, both physically and psychologically, returning for more even knowing what was in store.

He spoke of the pain, both of the body and of the mind. But he said it with a levity that surprised me.

He told me how before each treatment, he reminded himself that the debridement was removing the old, the dead, the poison. He saw the pain as the death throes of his enemies, their waste allowing new life to form. He shared the minor successes that were major celebrations. Even though he had setbacks, he never let them become permanent, choosing instead to focus on the slow, but steady improvement. He pedaled that day, not with a grimace belying the pain I knew he felt, but with a smile, happy to be alive and moving.

I learned two things from him that day-

Be careful what you complain about. Someone always has it worse.

And time doesn’t heal all wounds. It debrides them.

Allowing them to heal.