But for Scars

But for Scars

“God will not look you over for medals, degrees or diplomas but for scars.” Elbert Hubbard

Tonight I am invited to a special ceremony to celebrate a group dedicated to improving the health of Asian women. There will be food and a presentation, some entertainment and some awards.

I am one of the recipients of those awards. I am receiving a service award for helping to “advance and improve” Asian women’s health.

To say I am not worthy is not false modesty – for in comparison to most of the people who will be attending my role has been small, my part minimal. I have primarily worked with my friend Chien-Chi who is a force to be reckoned with.

But it makes me think about awards – because our society loves them, and so do I. I’ve received few in my lifetime. I am fairly average but the few I have received have been meaningful. A cheer leading trophy in 9th grade when I was a complete misfit, coming from a small school in Pakistan to a public school in New England; a work award soon after I came back to the United States; and the one I will receive tonight. All of them came at times when I was vulnerable and least expected any tribute, any award.

As much as I love awards – they don’t take you very far. Oh they can in earth time – they can help get you speaking gigs, book deals, obtain tenured positions, raises, prestige. But in other time? Other time doesn’t speak the language of awards.

Other time speaks the language of the scarred.

Because scars mean there was once an open wound. Scars mean we went through the grueling, sometimes agonizing process of healing  – far more work than any medal, any diploma, any award, any other achievement. The fact that the scars are not open wounds is because of the hand of God, the healing by One far bigger and greater than the wounds that cause scars. They are not open because of the hands and feet of those who walked alongside helping to heal the wounds. They are medals of honor disguised as scars.

But for scars we would walk with open wounds. But for scars we would ride on our own merits, our own laurels, our own pride. But for scars we would not realize the need for transformation – the need for a Gospel.

So I’ll accept the award with joy (for who doesn’t love an award) ever aware of the scars I carry and the grace I’ve received.

“Don’t Jostle the Wound!”

“So” I said. “I’m planning to come home on public transportation on Friday. That will be fine, won’t it?”

There was a pause on the other end of the phone. I was speaking with Vanessa from the surgeon’s office. She was giving me instructions for the minor out-patient surgery I was having – specifically an incision to remove tissue from my right thigh.

She responded carefully. “I think it would be better to have someone pick you up. You don’t want anyone to jostle the wound.” 

Okay then. I was underestimating this surgery; minimizing the impact perhaps.

Since that conversation I’ve used the phrase several times; in telling my family that my husband would pick me up, in talking to my sister-in-law, in relaying the conversation to a friend.

The phrase has made its home – because these are wise words.

“Don’t jostle the wound!” Fresh wounds need care and rest, they need us to pay attention, listen to instructions, care for them as prescribed. Fresh wounds of the body and the heart and soul.

How often when my heart feels wounded have I longed to cry “Please! Don’t jostle my wound!” Or how often have I wanted others to cry out for me “Don’t jostle her wound – care for her, love her, nourish her.”

And the wound will heal but often we need that advice, the warning, the encouragement not to jostle the wound. For no matter how we play at being fine, there are times when we are the walking wounded. We are fragile and finite, holding hearts and souls easily wounded, easily bruised.

And so sometimes we need others to say “Don’t jostle the wound! Make sure you don’t jostle the wound!” 

Today is the first day I’ve stepped out of the house without a bandage on my wound. My hand goes protectively toward my thigh as I wait for the bus, continues to guard it as I step onto the subway. I’m now able to care for myself – I don’t need protection. But I still don’t want anyone to jostle the wound.

Ugly Beautiful Scars

The wound did not heal well. Though it was small with only five stitches, it has healed into an angry red scar with jagged edges. By anyone’s assessment it isn’t pretty.

But to me this angry,red scar is beautiful. This ugly scar is a reminder to me every day that the biopsy was normal – it showed “no residual melanoma”.

Because I recently had the “M” word thrown at me – thrown in my face with a smile and a “you’ll probably be fine”. But is anyone fine when the word “malignant” enters their life? The “malignant” word was the first result of a biopsy of a mole. A  mole that seemed so small. So innocent. So benign.

Only it wasn’t. It was malignant.

And the second visit was to take more skin, find out if the melanoma had spread. It was this visit that produced the ugly scar. I saw the chunk of skin go into a small container, undoubtedly labeled with my name and the source of the tissue. Five stitches closed up the wound. The day the stitches came out was the day I heard the news that this mole had no residual malignancy. The bad tissue was gone, in it’s place an ugly scar.

So this ugly scar is beautiful. Like the scar on the woman’s face that makes her appear slightly deformed – beautiful because it is a survival scar from a fire that could have killed her. Instead every day her husband kisses that scar with all the love a human can possibly feel. Like the scar along the leg of the gentleman, for without it he would have been in the grave six years now. Rather, that angry, ugly scar is a beautiful war wound of survival. Like the ‘bikini’ scar low on a woman’s stomach, a scar that ensured a baby would be born healthy, not deprived of oxygen.

My scar is going to grow in size. They didn’t get enough tissue, and they want to do all they can to make sure the ‘M’ word is gone from my body. It will be long, and red, and initially painful, and beautiful ugly.

And as I lay waiting for a surgeon to look at my skin, to assess that ugly scar, to determine just how much longer and more ugly it needs to be, it comes to me, almost like a physical punch: I can enter eternity because of angry, red scars.

Ugly, brutal, Mount Auburn Cemetery angry, red scars on the hands and feet of the Saviour; the ugly become beautiful offering me a hope. an everyday wonder of grace, an eternity of God.

But he was pierced for our transgressions,
    he was crushed for our iniquities;
the punishment that brought us peace was upon him,
    and by his wounds we are healed. Isaiah 53:5


The Wound Healer


My friend Carol is a wound healer – literally.  As a Registered Nurse she completed a specialty in wound care several years ago and has worked as a wound specialist ever since.  She combines a unique gift with a specialty education and the result is quite remarkable. She is good. Really good. Doctors around the area all ask to work with her as she brings this remarkable skill into the lives of their patients.

With knowledge of bandages and salves, antibiotics and specialty products she assesses the wound and moves in with her skill. Old people, young people, surgical wounds, diabetic wounds, deep wounds and less so – they are examined, assessed and she works her magic, a magic born of hard work, knowledge and a gift.

I have learned through Carol and through my training that physical wound healing is a dynamic process. It’s a process that involves a series of  stages or phases – and it’s not necessarily straight forward. The four phases are hemostasis, the inflammatory phase, the proliferation phase and the maturation phase.

Hemostasis is that first response of the body to injury. The body is, in a sense, on high alert and blood clots are formed to stop the bleeding and control the injury. Quickly afterwards comes the inflammatory stage. This is when the wound is red and warm, it hurts and we want to cry as well as guard it. Beyond the pain the body is working hard to repair through getting antibodies, nutrients, and white blood cells to the wounded area. This is a painful stage and we react accordingly.

The proliferation stage is the beginning of rebuilding. The wound begins to granulate from the bottom up, closing in and healing along the way. Essential to this process is that the wound have proper nutrients and oxygen that is supplied by blood vessels. If you cut off the oxygen supply then you jeopardize the healing process.

The last phase is called maturation. This continues the process of rebuilding but takes it a step farther to complete healing – this process works to remodel and refashion the wound. It is important to remember that this process of complete healing can take up to two years. And it’s a critical time. Wounds may look like they have healed, but if not careful they can break down so depending on a number of factors, wounds can go forwards or backwards.

The thing is Carol not only helps to heal physical wounds but in the process of working with salves, antibiotics, gauze, and specialty materials for the physical she interacts with the emotional.

And that is her true gift.  She helps to heal emotional wounds.  She communicates with so much compassion that the patient relaxes under her care and before you know it, she knows everything about the wounds behind the scenes.  The wounds that take way more than betadine dressings and silvadene ointment – the wounds of the heart and the wounds of the soul. Wounds of broken marriages and families torn apart. Wounds of rejection and physical abuse. Wounds between a father and a daughter, a father and a son. Wounds of being told you’ll never amount to anything. Wounds of betrayal. Through the skill of her mind and hands, these other wounds come to light.

And remarkably the process is similar. There is the hemostasis phase of emotional wounds, where the body is fighting to control the damage. And then comes the inflammatory stage – that stage where your heart is so raw, you can’t hide it. It is inflamed. It hurts. You pull back when people try to get close because you are afraid they will wound further.

The wounded heart or soul then goes through the proliferation phase – and the oxygen and nutrients are those people who can come beside us. Those people who bring life to our hurting souls.

Finally the remodeling. Just as the last stage in wound healing is not obvious to the casual observer,this remodeling of the heart and soul does not show; it’s the person who is close who knows it’s taking place. The casual observer doesn’t even know there’s a wound at this point. The blood is gone. The inflammation is gone. But the remodeling is still taking place.

It’s people like Carol who use their gifts and walk the wounded through this. Carol brings compassion to the hurting piece and truth-telling to the healing piece. She is indeed a Wound Healer in a world of the wounded.

In my faith tradition today is an important day. It’s Good Friday, the day that Christians remember the death of Christ in an act of ultimate sacrifice. It seems right that I tell this story of wound healing as I think of  those wounds that healed the world.

Blogger’s Note: Another Carol who is a Wound Healer is my sister-in-law. Maybe it’s in the name….Read this article that she wrote after doing flood relief in Pakistan.

Related Articles:

Series on Pakistan: Wound Care for the Wounded

This is number 5 in a 5-part series on Medical Flood Relief in Pakistan. If you are just beginning to read please feel free to check out the other postings in the series beginning with “Orientation”. The authors are grateful for the interest and emails they have received.

Entry contributed by guest author Carol Brown(See Entry 3 – Triage)

  • Elderly woman
    blunt contusion of the abdomen caused by charging buffalo
  • Twelve-year-old girl
    Infected burns to the bone on three fingers of the right hand caused by electrical wire
  • Four-year-old boy
    friction burn on the posterior thigh caused by injury from wheel of a cart
  • Elderly man
    Cellulitis from infected scabies site on upper arm
    Reluctant to receive treatment from female doctor
  • Elderly, frail woman
    Deep ulcerated heel of right foot caused by  trauma during transport out of flooded area
  •  Seven-year-old boy orphaned of his mother in the flood
    Infected ulcer of left ankle

Wound care was my responsibility in our clinics since it is a routine part of my practice at home. Expensive, high-tech, scientifically-engineered agents of healing are my everyday tools in Western Massachusetts.  Silvadene, Acquacell AG, Versiva, Iodosorb, Duoderm, Kaltostat — the list goes on.   In Pakistan only a single, precious tube of Silvadene, was available to me.  Had I brought supplies, they would have been limited and insufficient for the needs and not reproduceable or sustainable by the families.   My tools here:  Boiled water, gauze pads, rolled bandages of torn sheets, gloves, antiobiotic cream, and the precious Silvadene.

The patient was perched on the wooden frame of a rope bed, with family members and curious bystanders eager to view the wound and watch the procedure, a captive audience for teaching.

“Keep the area clean.  Wash it with boiled and cooled water daily, applying this cream very sparingly over the wound.  Cover it with clean cloth.  Always wash your hands before and after you do the wound care.”   I heard myself explain the details.  My Urdu had come back quickly, and it all made sense — until I stopped to ask myself, how would they actually follow the instructions?

Living in a makeshift IDP camp, alongside their buffalos and chickens, collecting dung for fuel, with a single water pump for the camp, how were they to boil valuable water just to pour it over a wound onto the ground?   Yet they did.

On more than one occasion, I cut away the soiled homemade dressing fearful of what I may find. The wounds were invariably clean and well covered.  The families had been sacrificially caring for and protecting the wounds, salvaging cloth to protect the area.  I praised them and sensitively redressed the wounds.

Hameeda, a vibrant 12 year girl with a bashful smile,whose fingers were coated in yellow salve from the bazaar, was in visible pain. Her mother accompanied her to see Dr Wendel.   I was called over to cleanse and dress the electrical burn.  It was a painful process, and Hameeda was brave.  Dr Wendel had brought one tube of Silvadene from Amsterdam.  This was the day it would be used and given away. I was moved to see the care of the family as her father came in from the fields to see how we would be able to help and to watch the process.  Later in the week we heard from one of the team members who had returned to the village to do surveys of the ongoing needs that Hameeda was doing well.  The family was doing the treatment twice daily as instructed.

These wounds were symbolic to me of all that the people surrounding us had been through —  unspeakable losses, fearful traumatic flight from home, long journeys over rough terrain to an unknown destination.   I could not begin to fathom the full impact.  I felt like my act of pouring water on the wound with prayers in my heart for them was a gift of God to me.  They are a beautiful, resilient, appreciative, teachable and hospitable people!

Because of the interest in this series, a closing entry titled “The Benediction” will be posted on Saturday and “Holy Moments from an Unholy Disaster” will be an extra posting of general reflections before moving on to other topics on Sunday 1.9.11.  Stay tuned on to this blog  for ways to help the people of Pakistan.

Last night PBS Newshour had this special on the floods – A Validation of the ongoing need in Pakistan.