Published in the Charleston Gazette-Mail, September 1

The wound that never healed

When I was assigned to a cardiac unit as a nurse, I recall a woman returning to the hospital several weeks after having open-heart surgery for an aortic valve replacement.  She looked and felt fine, but the staples that had been used to reconnect her sternum, or breastbone, had dislodged, causing a section of her chest incision to reopen.  As she sat on the gurney, you could remove the gauze bandage and look into the 3-inch window where the edges of skin and connective tissue had separated. Through that narrow opening, you could see her heart beating.


What could actually be seen was the pericardium, the protective sac around our hearts.   Hers rebounded with each corresponding throb of her pulse the same way cardiac muscle looks during surgery. It was fascinating to watch an otherwise intact human being, conscious, alert, sitting in a casual upright pose, with her beating heart visible. 


“Wound dehiscence” is the term for the rupture of a surgical site, and it’s not an uncommon post-op complication. Her situation was rare because the dramatic view into her chest cavity gave a clear glimpse of the pump that is the motor of our body.  Usually dehiscence takes the sutures or staples with it, making an unsightly jagged gash, unable to contain the messy underlayment that we all manage to hide beneath our skin—the largest organ of our bodies that is the armor and the image of ourselves in so many ways.  


It’s rarely the fault of the derma; it comes from the faults of what lies underneath.  Often it’s due to contamination during surgery, or from pre-existing conditions.  But penetrating injuries like gunshot wounds, shrapnel or stabbings can carry poisons deep into the pathway of the injuries they create, and the swelling from the inflammation then ruptures the incision, occasionally even after scar tissue appears to have mended it together.  Once the site is re-exposed, it has to heal in the open position, with special dressings, slowing closing from the inside to the outside. 


We live in a country that still suffers from a near-fatal wound; it was actually a defect from our birth.  It was genetic, carried over from those who claimed this continent for themselves.  While intending to bring equality, they merely re-established the same class system of their homelands. They made the same distinctions of caste between low and high---common and royal, illiterate and educated, workers and elites, New World and Old World, women and men, gods and God, Europeans and the rest of the Earth.  Those divisions still disable us today.  But the chasm is deepest between the dark and the Caucasian.


In the effort to fix that abyss, this country wouldn’t have survived without a surgical intervention of massive proportions, which compromised it even further, even as it tried to restore itself.  Forces within it prevented a full recovery, though it looked normal, acted normal, and seemed to thrive.  It adapted to changes, it aged, and from the exterior, had few signs and symptoms of the mortal flaw that could send it back to be medicated for an injury that, left untreated, would end us all.


Now it has flared up yet again.  But like any incision that separates, it has to knit itself back together starting from the inside.  It never heals from the outside. Our skin, which we have elevated to be the defining characteristic of our country, does not work that way.  It can contain the diseased underlying layer for only so long before it gives way and can actually expose our core---the ultimate danger to our lives and this land.  


We didn’t fix the problem at the birth of our nation, we didn’t fix it in 1865, and it doesn’t seem like we know how to fix it now. We appear to be waiting for the discovery of some magical potion that will keep the engine of our nation protected so it can power us up for the long haul.  But we have been blaming our skin when the problem was really our souls.


Again, the scars will be smoothed over, patched up, and will manage to get us through another American Era; limping when we could be running, wincing from pain when we could be laughing, stagnating when we could be growing, and following when we should be leading.  And all the while we are risking our future because we don’t want to accept the fact that we have not yet closed the wound over our living heart.


All because we still refuse to heal from the inside out.