care – Jesus is for the Wounded

Heal the wound, Heal the heart

Published on September 5, 2021September 11, 2021 by Jesus is for the WoundedLeave a comment

While I don’t claim to be an expert in medical wound care, I have seen enough nasty, smelly, screamingly painful open sores when I worked in healthcare to know that we can learn much from their process of healing. I submit to you that the stages of healing that occur when one’s body works to heal after an injury or surgery run parallel to other types of wounding that happens in life. Further, the risks for complications such as infection or swelling (aka edema) can be symbolic of the “secondary damage” that not only impedes the healing process in both but introduces entirely new problems that must be addressed as well. I have seen in my life that injury, damage, or wounding from various types of abusive behaviors have the same characteristics, the same impacts, the same risks for complications and the same potential for healing in due time as wound care management. These wounds can heal and the scar or scars fade if handled correctly. And while it all can take a little more time than we might like, the process can reveal wondrous truths and blessings as ordained by our Heavenly Father, our Lord and Savior Jesus Christ.

Heal the wound

Check this out from Wound Source:

The stages of wound healing are a complex and fragile process. Failure to progress in the stages of wound healing can lead to chronic wounds. Factors that lead up to chronic wounds are venous disease, infection, diabetes and metabolic deficiencies of the elderly. Careful wound care can speed up the stages of wound healing by keeping wounds moist, clean and protected from reinjury and infection.

Generally, remodeling begins about 21 days after an injury and can continue for a year or more. Even with cross-linking, healed wound areas continue to be weaker than uninjured skin, generally only having 80% of the tensile strength of unwounded skin.

This recovery assumes that the appropriate treatments and dressings are applied right away, any open wound is kept moist, naturally occurring inflammation is controlled, and

a new network of blood vessels must be constructed so that the granulation tissue can be healthy and receive sufficient oxygen and nutrients.

Appropriate compression is applied with proper bandaging, elevation, and reduction of factors that can contribute to swelling. The presence of edema itself is a risk factor for new injuries and complicates the healing process tremendously when dealing with an open wound. According to the EO2 wound care technology company, whatever the reason for the edema, it WILL impair healing through several mechanisms. All of these factors need to be managed well for processes such as granulation and epithelialization to occur. These steps continue at various levels even when the surface wound has closed and things are looking better. The entire amazing physiological process is a testimony to us of the magnificence created by God in our human frame. We can overcome our injuries, our vulnerability to re-injury and complications, whilst moving towards recovery and leaving minimal scarring behind. And even the worst scars do fade in due time.

Heal the heart

Recently I was reflecting on the impact of abusive behavior at various times in my life. The impact was devastating and took on virtually ALL of the characteristics of the injury and damage of a medical wound. Both types of wounds require a careful healing process. In the distant past I defined the abusive behavior that I experienced as that which violated my rights as a human being and professionals labeled as sexual, physical, ritualistic, or verbal abuse. I don’t wish to get caught up in the semantics or seriousness of each type here; all are profoundly impactful.

An individual KNOWS when another person has crossed a line that should never have been crossed and profound damage has occurred even if it takes days, weeks, months, or years to fully realize it. The recipient feels traumatized and goes through a tender, complex grieving and recovery process to heal. For example, the difference between an expression of emotion and abusive behavior can be like a person who uses 1) mean verbiage versus 2) repeated verbal hammering in a tone that purposefully tears down the victim who is yelling “STOP! STOP!” A simple apology may not be enough for the beaten puppy of a person to get past the incident, particularly when the behavior has been repeated. The relationship between the two parties has changed. The recipient is injured, damaged, and wounded kind of like a 3rd degree burn to the soul. Special care and bandaging are needed for as long as it takes for the wound to heal.

Some of my own experiences of abusive behavior happened before I became a Christian: a born-again believer in Jesus Christ. Some of them happened afterwards. Gratefully as unto the Lord, most have healed completely while a few have left their scars. There is nothing unusual about that. My purpose here not to belabor my own experiences but to share with my brothers and sisters in Christ what is and what is not abusive behavior then a model for how a person overcomes it. The Biblical Counseling Coalition provides some definitions as follows.

Abuse entails physical violence (Acts 16:19), threats of physical violence (Eph. 6:9), persecution (Matt. 5:44), sexual mistreatment (Judg. 19:25), reviling (Luke 6:28; 1 Pet. 2:23), speaking evil (James 4:11), or being under the misused power of another person or group of people (Gen. 16:6; 1 Sam. 2:16; Ezra 5:12).

Check the link that I provided above for a more detailed discussion on this topic. Focus on the Family describes emotional and verbal abuse specifically and at more length on their website HERE. They add that

Wounds that typically accompany emotional, physical and sexual abuse must not be ignored. Both men and women inflict verbal abuse, but women tend to be more often on the receiving end of this destructive behaviour. What may seem innocent and infrequent at first can escalate.

All forms of abuse follow a pattern that, left unchecked, will only increase over time. Injuries from verbal and emotional abuse can run deep and leave lasting scars. Many emotionally and verbally abused people reason that, because there are no bruises or broken bones, their abuse must not be serious. But it is. Fortunately, support and resources are readily available to guide individuals into safe, loving relationships. In their well-received book Boundaries, Drs. Henry Cloud and John Townsend state that, “Our pain motivates us to act.” If pain motivates you to act against emotional and verbal abuse, then listen and act.

We can easily see the many parallels between the topics of wound care and recovery from abusive behavior. The pain of each motivates us to act, to fix the situation. What appears on the surface may not reveal all of the layers of injury, damage, wounding that must heal to withstand the testing of the tissues or trials that inevitably follow in life. Choosing to do the work of repairing any remaining wounds of my own experiences required 1) heeding the Lord’s unveiling of my eyes that what actually occurred was damaging and 2) following the leading of the Holy Spirit to move towards restoration. Part of heeding this ongoing process includes writing this blog today. In the past my care also included significant Christian counseling, support groups, Christian books, and the like. Forgiveness, seasoning in my walk with the Lord, restoration of relationships, compassion for others, and spiritual discernment are among the gifts, the fruit for doing the work of recovery.

So what are some specific parallels between healing a physical wound and recovering from abusive behavior?

Stop the source of injury. In wound care they call this hemostasis where the body begins to clot your blood to stop the bleeding. In personal relationships this may include setting some ground rules, some boundaries, or simply separating from the other person for a time. The thrombus or clot must hold lest it become dislodged and result in a more bleeding, a more serious injury. Similarly, the two parties in conflict must, in my humble opinion, work to stop attacking one another. Yes, the recipient has responsibility here too.
Inflammation in wound healing controls bleeding through swelling and helps prevent infection by bringing fluids/nutrients to the site. Inflammatory words are exceedingly difficult to control when emotions are running high in an abusive situation. There can be fallout and setbacks while the two parties seek to figure out the best way forward, if each are committed to actually go forward together. Bringing in a mutually agreed upon 3rd party is much-needed medicine at this time to help tone things down. The effect of inflammation may hurt for an unknown period of time and look as ugly as an open sore desperately trying to turn a corner towards healing. Proper “bandaging” and self care for emotional wounds must begin in a responsible manner.
Wounds are kept moist and hydrated as new cells called collagen and its matrix begin to form. In contrast, the two parties that are able to work together to address the woundedness can do simple things to care for the other parts of the relationship, their shared responsibilities. The darkness still needs to be addressed and treated correctly and what this looks like may change as the two go forward. The antagonist in the story must stop the abusive behavior and create safety in which the protagonist can flourish. New “medicines,” new habits, and new means of communication are needed. Figuring this out takes time. It may actually may be the party that was hurt the most who lovingly leads the two of them through the process of forgiveness and restoration to a better relationship.
An even longer phase of wound healing is that of maturation. Find your own parallels in this summary from Wound Source:

During the maturation phase, collagen is aligned along tension lines and water is reabsorbed so the collagen fibers can lie closer together and cross-link. Cross-linking of collagen reduces scar thickness and also makes the skin area of the wound stronger.

Recognize that, in the words of Bay Care Health, the healing process will vary among individuals and will depend largely on the cause and severity of the wound. I submit to you that all types of wounds are the same in this regard. And as we noted above, the new collagen fibers are vulnerable to re-injury but their re-formation makes the area of the wound even stronger. This process in wound care may take up to a year. We know that while the body never really forgets an injury and neither does the mind, its power over us can change significantly. The things that happen in our past become our story, our testimony of the Lord’s amazing grace in our lives.

When I was working as an Occupational Therapist, we told our patients in rehabilitation all the time when they got discouraged that recovery is usually a jagged line with lots of ups and downs. They had to work through their fears of getting re-injured, having delays due to complications or a re-occurrence of a disease process, and grieve the losses associated with an extended hospitalization and rehabilitation process. Like my older friend Wanda used to remind me in a 12-step support group, “you gotta feel it to heal it.” Range of motion exercises after a shoulder surgery are excruciatingly painful and so are flashbacks of abusive behavior. It’s like the surgery or incident is happening all over again. But it’s not. Eventually the body and the heart starts to heal with ongoing and proper care. Lord willing, most folks do get better. We come to realize that setbacks, hurts or new injuries are just one part of living in a fallen world with fellow sinners just like us. We learn so much in the process. Thank goodness the Lord Jesus Christ helps us to overcome it all!

Interpersonal relationships seem to me to go through the same wound-healing process as restoration comes, as trust is earned: it “takes what it takes” to get there. The prevention of pressure wounds in particular includes daily skin checks. This entails looking for areas of redness over bony areas of the body and making immediate changes to reduce the pressure, nourish the tissues. Could we say that better care of our personal relationships with a better daily maintenance plan can help raise the threshold over which unwanted behavior spills over? I do believe so. Are we following our home exercise programs, our Spirit-led care plans? I could go on but you probably get my point by now.

Gentle Reader, there’s so much to say on these topics and I am not an expert on either one. I am a fellow sojourner to those who have experienced both and I have seen the power of the Lord in healing all kinds of devastation. Let our salty tears be the saline, the healing salve that washes us clean indeed. May the cross-linking of our entanglements in this life give way to the redeeming grace of our risen Lord Who restores us through and through. For His glory! Amen. JJ

1 Corinthians 2:9, No eye has seen nor ear has heard, healing wounds

Do No Harm They Say

Published on January 22, 2017January 24, 2017 by Jesus is for the Wounded2 Comments

²⁵I know that my redeemer lives,
    and that in the end he will stand on the earth.
²⁶And after my skin has been destroyed,
    yet in my flesh I will see God;
²⁷I myself will see him
    with my own eyes—I, and not another.
    How my heart yearns within me! (Job 19)

I was transported from my home via ambulance to the emergency room in the closest hospital on the evening of Tuesday, January 3^rd. My husband, Steven Horney, had called 911 when frightful and unusual writhing movements would not stop. The emergency personnel lifted me off the floor where I had been in distress for about 30 minutes: straining to breathe with my body twisting and contorting in positions of postural extension (choreathetoid-like movements that look like a child disabled with severe cerebral palsy), struggling to communicate, unable to keep my eyes open, bumping into kitchen cabinets and floor, pained by the overhead lights and banter of the personnel, and chilled to the bone. They rolled me out into the wintry air without a coat, shoes, or blanket and with the rain sprinkling down on my exposed skin. “We will turn the heat on once we get into the ambulance,” the man said. I hung on for the ride not knowing what lain ahead of me.

I tried to communicate to the paramedics in broken phrases that the episode that they were witnessing began hours earlier after a scheduled dose of Gabapentin (Neurontin). That drug was prescribed for me September 18^th at the main hospital when I was admitted for management of the complications of shingles. Gabapentin was helping reduce the searing nerve pain in my face. But for some reason starting on Monday, I started to have little tic-like shaking episodes within an hour of taking it. And for some reason on Tuesday, within 2 hours of taking it, things escalated out of control from episodic tic attacks to non-stop writhing on the floor of our home. I had never had symptoms before like what was happening on that Tuesday evening. Having an extensive medical education myself, I suspected an adverse reaction to Gabapentin. Regardless, I was terrified.

This wasn’t my first trip to the Emergency Room in recent years. Another type of shaking episode [diagnosed by Lyme Literate Medical Doctor (LLMD) as symptom of chronic Lyme disease] has required treatment on an urgent basis with intravenous fluids. Other medications were sometimes administered in the ER for pain or symptomatic relief only to exacerbate the shaking episodes. In all of these situations, nothing has helped as much as a minimum of 1,000 ml or more of fluids. So I was pleased when Dr. P evaluated me in the ER at the local hospital on the night of January 3^rd and ordered 2,000 ml of IV fluids. No labs were drawn. I was not pleased with how he or his staff treated me, however.

How can I possibly describe to you how terrifying it feels to be coherent and aware of one’s surroundings yet unable to communicate fluently or control one’s bodily functions above bowel and bladder? You fear you will stop breathing, have a heart attack, not survive. Then again for me, I knew that I had survived severe episodes of frightful symptoms in the past and feebly hoped my body could take yet one more massive assault to my weakened frame. However, when pressured to answer questions over and over again by (condescending) medical personnel doing their periodic “evaluations,” all of this did not come out of me with pretty language. I am sorry for my swearing and inability to communicate clearly.

Perhaps my clinical presentation didn’t make sense compared to say a classic case of epilepsy or maybe the disorientation that goes with a textbook definition of dehydration? I wonder what things looked like to the emergency personnel who came to our home? Or the emergency room staff? The long list of medications, allergies, and diagnoses in my medical records surely confounded things a bit for the Doctor. At least one of the nurses present that night had seen me in that ER before. Would he be able to separate out the prior visits with this one? After all, Gabapentin is used to treat both shingles and seizures, isn’t it? What if this indeed was an adverse drug reaction to Gabapentin? Were procedures followed to rule out an adverse drug reaction?

All I know is that I was horrified and further frustrated by the scornful treatment of Dr. P and the nursing staff in the Emergency Room of our local hospital on the night of January 3, 2017. Dr. P claimed that I should be able to stop the involuntary movements because I had been able to speak at all. He claimed that the involuntary movements had stopped when I was able to push out a response to his question albeit with pressured speech. That simply was not true. (The involuntary movements never stopped until much later.) Dr. P argued this point and others with me! My distress increased. He finally left the room only to return to pressure me some more. Eventually the treatment was administered and completed. Eventually he left the room and did not return.

The involuntary writhing movements did not slow down until nearly ¾ the way through receipt of 1 liter of normal saline via IV. The acute contortions slowed first and were followed by tic attacks: the various involuntary movements became intermittent, flared again, repeated this pattern a few times then finally stopped for a while. I finally was able to lie on the gurney motionless. My dear husband Steve sat nearby. I was exhausted and I think he was too. I felt dejected by the staff. I was afraid to move for fear of retriggering some kind of return of symptoms as this had happened in the past after a neurological event if I tried to move or speak or if the treatment ended too soon. At some point a nurse started a second liter of fluids. I nodded and might have muttered a few words. I needed to use the bathroom and was assisted in the use of a bedside commode.

At this point I was weak but beginning to feel some hope. Sometimes voiding helps these kinds of symptoms. I returned to the gurney. To my surprise, the primary nurse then notified me that the fluids would stop and I would be discharged. Approximately 1,500 ml (of the 2,000 ordered) had been infused and they said that 1) since the shaking had stopped and 2) I had voided a large amount, 3) that constituted proof that I was rehydrated. I still could not speak but may have nodded again. What became clear to me a day later was that the hydration ended WAY TOO SOON. I still could not function when the fluids were stopped. And further, I definitely was not yet stable enough to tolerate what followed next.

Several members of the nursing staff came into the room and tried to help me get dressed while the IV was still connected to the pump and tubing was still connected to my arm. I muttered something about this and the gal next to me stopped tugging at my clothing. The primary nurse (who had brought the commode and each bag of fluids) began RIPPING OFF THE DRESSING from the IV in my arm in one swift motion before I could ask her to go slowly or place my finger over the insertion point to maybe help prevent what would happen next. Even my husband noted how fast she was ripping off the IV! The needle/tubing inserted into my forearm became dislodged with the Tegaderm dressing displayed to one side, still stuck to it! Immediately and violently a searing knife-like pain ratcheted from the back of my right hand to directly to my brain. Welcome to the increased sensitivity of underlying neurological illness! Involuntarily, screams of holy terror erupted from my mouth. Soon Dr. P was standing over me at the foot of the gurney, scolding me some more. Why? Just why was he speaking to me this way? My brain felt like it was on fire. These sensations and symptoms had become markedly different than those that had brought me to the hospital 3 hours earlier yet were equally severe. A new type of episode had started. And all the gains I had realized just moments before were erased by that searing pain in my hand. I was still aware of my surroundings yet powerless to help myself. The grief in my spirit was great. I thought I was getting better!

Steve tried to explain the nature of this complex illness to Dr. P outside of the room. I understand that Dr. P spoke graciously to Steve. That’s nice. I am glad. I did not get to experience grace in any form from Dr. P.

The seizing was now a rapid, violent, involuntary tremor. Three nurses insisted that it was time for me to go and started to take off the gown and put on my shirt. I blurted out that I would do it myself. I really don’t know what I was thinking when I said that. I do recall being afraid that the sensation of them touching me might add to the hypersensitivity and neurological distress. Someone brought in a wheelchair. Another problem surfaced: my initiation of movement from trying to put on my shirt increased the amplitude of the seizing, violence of the shaking, difficulty pushing out words coherently. My back arched against my will as screeches of terror erupted from inside me: half dressed with my bra exposed, crying fiercely, and horrified at the indignity of it all. (Much later I would wonder if they would have treated me like this if, say, we were working together in home health care earlier that day? I was an occupational therapist for the Network of the main hospital long before I got sick with this wretched illness that no one still completely understands. Never mind. No one in that emergency room except Steve appeared to care about me anyways.)

About a half an hour later, I discovered that someone had graciously turned off the lights in the room we were in. Thank you, whoever you are. And thank you to whomever gave me more time to recover. We eventually went home. I felt horrible. Dried tears stained my face. I was very hungry. I still had no coat or shoes to wear but hey, my beloved’s car has heated seats and I knew they would warm at least a part of me quickly. Out into the cold, damp air of night we went. I was also “shell-shocked.” I felt traumatized. Things could have gone so much differently don’t you think?

*********

UPDATE: It is now about 3 weeks later. Last weekend an adverse reaction to another medication sent me to a walk-in clinic who sent me to the emergency room of another hospital in another Health Network. My husband was out of town and dear friends took gracious care of me. The hospital staff cared well for me. It now seems like I am finally starting to stabilize, but hey, who really knows what the future holds? My hope rests in the person of Jesus Christ and His promise to His servant Job who endured far more strife than I can ever imagine. I end with His words, His promise once again. Praise be your name and in your name I will trust: Jesus Christ!

²⁵I know that my redeemer lives,
    and that in the end he will stand on the earth.
²⁶And after my skin has been destroyed,
    yet in my flesh I will see God;
²⁷I myself will see him
    with my own eyes—I, and not another.
    How my heart yearns within me! (Job 19)