Monday, February 2, 2015

Scars: Seen and Unseen

Fuji X-T1, 55-200mm, at Sunset in February, 2015.  As the sun set at 15°F, ten minutes of photographing was enough for me.

Last week I caught myself assuming that someone I only met three months ago must already know about all the things that happened five years ago. How could someone know me now, and not know all of the crazy things that have happened to me since September 2009? Assumptions of course are fraught with illusions and confusion. This led me to think about scars. What do we show and what do we hide? What do we share and what has to be pried out of us?

Taken in June of 2009. Nikon D80, 55-200mm  A warm summer evening sunset on Seneca Lake.
Back in June of 2009, as my family and I took some time to hunt for beachwashed bottle glass on the shores of Seneca Lake at Lodi Point, none of us had any idea how radically things could change. A month later, I had my fourth bout of diverticulitis. After meeting with a gastroenterologist, I was encouraged to have my colon resected. On the morning that my daughter went back to school, I went in for surgery. According to family and friends, I was fine for a few days post surgery, and then things went sideways. The anastmosis (the rejoining of the two bits of my large intestine) failed. No one at the hospital noticed that I was in massive uncontrollable pain.

The next thing I knew, I was waking up and was unable to speak. Over a month had passed with me in a coma as my body went through numerous surgeries to deal with the sepsis and peritonitis. On my end, I couldn't wrap my head around what had happened. I was still doped to the hilt with all sorts of sedatives and antibiotics and pain killers. By the time a month and a half had passed in the ICU, I was moved to the rehabilitation floor to begin relearning how to sit, stand, walk and feed myself.

Rather than delve into all of the awfulness that happened in the ICU, what I really want to explore is the shock of discovering how alien my new body was. Every scar tells a story. Most of the time, we remember how we got that scar... what we were doing, who we were with, and there's a story to be shared.

On my 9th day on the rehab floor, I was finally able to stand for more than 5 minutes. Muscles were slowly growing back. I was encouraged to try to shower on my own, albeit with multiple nurses supervising. They wheeled me in in my wheelchair... helped me transfer to the tiled bench. Cold as it was, feeling the water splashing on my legs was wild! It had been nearly two months since I had washed my hair! Holding onto the grab rails, I stood and showered slowly. Always keeping one hand attached to the wall, I slowly explored my body under the hot water.

I was terrified of the colostomy the surgeon had left me with. I had no clue how to care for it. That would come with time and instruction. Lots of trial and error. But under the running water it seemed perfectly normal to be getting it soaking wet. I was scared to get the huge abdominal wound wet. The dressing was soaked, but the nurses reassured me that they could re-pack the wound once I was back in my room.

Trying to settle my nerves, I tried to take an inventory. What was the same, what was new? My legs looked like they belonged to a 90 year old man. All of my muscle was gone. I had tiny thin legs that looked so incredibly alien. Scrubbing my armpits I was shocked to find my big muscular arms had become almost like rubber wings. With no muscle filling things out, the skin fell off my bones. I was vigorously scrubbing my ribs when I came across a tiny scar, maybe one inch long, running horizontally on my right side.

That was new. Hmmm. I asked the nurses what it was from. Neither one had any idea. I asked the next round of nurses that attended to my wound as I was repacked for the day. No one seemed to know what had happened. I couldn't imagine how it related to the gigantic wound on my belly, but just the same, I had no clue.

In the afternoon, after my sessions of occupational and physical therapy, I was wheeled back into my room. Nancy was asleep on the bed adjacent to mine. The nurses helped me transfer to my reclining chair. There was a protein shake waiting for me... gotta consume all that protein to help heal that wound!

When Nancy woke up, I asked her about the wound on my side. She started explaining about how during the coma I had retained a massive amount of fluid. At one point I apparently looked like the Michelin Man... hands like catcher's mitts. During this time, the peritonitis was raging through my body. They had been unable to close the main incision due to all of the swelling and fluid retention.

As Nancy explained things, I had fluid collecting in my third space...the space between my skin and my fascia...which normally isn't full of fluid. In the space behind my right lung, enough fluid had accumulated to collapse that lung. If that wasn't enough, I had also developed pneumonia, brought on by being intubated for so long. In order to drain the fluid from behind my right lung, they made a small incision between my ribs, inserted a drainage tube and proceeded to pull that fluid out of me.

Learning about that tiny scar helped me realize that so many things had happened to my body that I had no recollection of. When the surgeon and the nurses came to clean the big abdominal wound, they were always very polite and kind as they tended to it. Debriding is the term for removing dead skin cells during the healing process. Sounds a lot nicer than it looks. From my perspective, I couldn't see what they were doing. Even more strangely, I couldn't feel what they were doing. If you have ever had a cut on your skin, you know that feeling when someone touches it. It HURTS. This didn't hurt. I asked about that, fearing that maybe infection was making it so I couldn't feel it. Turns out it was a one-two punch. One; I was living on pain meds, via my patch. Two: I was growing new cells... and fibroblasts, those basic building blocks for my wound repair, had no nerve endings yet. They wouldn't grow back at all in some cases.

Which leads me to the second scar. Thanks to Nancy's nightly wound cleaning, the big wound finally healed completely five and a half months after I left the hospital (nearly 7.5 months after the first surgery). Five years later, I have spots on my belly that still have no sensation. I have had four additional surgeries to repair all the damage from the first surgery. For the most part, they have been successful. No one sees these scars. Now that the colostomy has been reversed, and the massive hernia (big as a football!) has been repaired, it is hard to imagine what it used to look like. No one passing me in the grocery store would ever guess what had happened to me.

Which I guess is what prompted this missive. Walking out on the ice at Lodi Point late last week, I thought about how dangerous it was to be scrambling on the ice, trying to take photos in the incredibly cold weather. Five and a half years earlier, I would never have given it a second thought. After all of the experience of fragility brought on by repeated surgeries over the past five years, there is a part of me that wonders when the "new normal" will feel like old hat. How long until there are new scars that have nothing to do with that god-awful surgical debacle?

In closing, let me say that there are tons of stories still to tell from that time in the coma. Some of those stories are intensely personal. Some are painful. Some are downright confusing. If you're curious, just ask. I am always willing to take the time to share. And maybe over time I will add those stories to this blog.

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