Healers

 

To start 2025 on the right foot, and because America has rejected the left for now, I’ll begin the year with a non-political column. Also, in the waning days of a nasty, flu-like illness, I don’t have the psychic wherewithal to address the prospects of another Trump “presidency,” even as it seems to be self-destructing like a “Mission Impossible” tape, which deserves a fun-filled column. Too bad.

I will, however, mention the passing of Jimmy Carter, whose post-presidency, in terms of integrity and righteousness, compares to Trump’s as light does to darkness. No matter what one thinks of his years in the White House, few can disagree that the life President Carter lived for decades after was exemplary.

Nor, though it’s not original with me, can I resist pointing out what might be Carter’s most fitting legacy of all: after the death of a president, flags on federal buildings and locations, by tradition and executive order, fly at half-staff for thirty days. Which means that, during Trump’s inauguration, American flags we and the world will see will be in the mourning position. What could be more appropriate? Thanks for that and for so much more, Jimmy. Also, think how much better off we’d be today if Ronald Reagan hadn’t reversed all of Carter’s green energy initiatives forty-three years ago.

And now, apropos of nothing and of only particular significance, here’s something I wrote, long ago, in my “Surgeonsblog” days: 

In no way is it false modesty to say that physicians are not healers. At best, what we do is clear the way, making conditions as favorable as possible for the body to heal itself. For without the body's amazing powers of defense and repair, nothing we do -- especially we surgeons -- would be lasting at all. The most immediate and palpable evidence of this is watching what happens after an operation. If healing within the abdomen evolves in secret, the incision itself is a biology classroom available to all.

Wound healing is a complex process, and it would be folly for me to attempt explanation in detail; mainly because, so long after medical school, I've forgotten the pathways, the kinins and the prostaglandins involved, and I'm not inclined to look them up again.  Anyone who's had an operation, from minor to a big deal, has had the opportunity to witness it themselves.

Despite having explained it in advance, I’d often get calls of concern about redness of an incision. Of course, it's necessary to separate the natural from the infected (nowadays, digital photography and email can save an office visit); but all incisions get red for a small distance out from the cut. The process of bringing the building materials into the work site is a form of inflammation: capillaries dilate and proliferate, blood flow increases, making a visible Red Zone. Of millimeters, though, not twenty yards.

That, and much more, goes on under the surface as well. Attracted by "injury chemicals," various cell types arrive and unload their cargo, set up lattice work, induce structural changes. The result of this cellular influx is a gradual thickening and hardening of the area for an inch wide or more, and which carries the unofficial-official name "healing ridge." When the ridge isn't there, trouble lies ahead. In the chronically ill, in people on high-dose steroids, in the malnourished, a soft and non-pink incision is an unwelcome and unhappy harbinger.

As much as feeling the swelling and firmness of the healing ridge can alarm the unexpecting, it's a sign of health, indicating that help is on the way, that the work of healing is carrying on. I'd warn people to expect and welcome it. To hernia patients, I'd say, "In a few days it's going to feel like a sausage under there. You might think the hernia is back." Or, after removing a lump of some kind from some place, "In a couple of weeks, you'll think I didn't remove it at all."

It takes months for the ridge to disappear. While the zone of redness dims, the incision itself gets increasingly red, and doesn't simmer down for a year or more. It's a living monitor of how long healing is active. Recipients of an operation get a ridge-side seat from which to watch the body do its work.

A corollary is the tiredness that most everyone feels after surgery. There's lots of work going on, I'd tell them. While you're feeling lazy, your body is doing the equivalent of walking around all day. So, if you’re recovering from surgery, give yourself a break. Watch and feel your body do its amazing work, rising to the occasion and making us surgeons seem like the wizards we aren’t.