This post has been written by one of our readers.
For months now I have been seeing connections between physical wound healing and healing from abuse. The analogies seem to leap at me from all sides. I am sure that engineers see analogies from building, and mechanics can see analogies from car repair. I understand neither of those fields of endeavor but I do understand a bit about how our physical body works and heals. God created us physical and spiritual and He often uses physical word pictures to describe spiritual things. In a similar way, we can take principles of physical wound healing and apply them to victims of abuse.
What is a wound? A wound is any breakdown or opening in your skin. It compromises the integrity of your skin which is Godʼs design to keep your internal workings healthy and functioning and to keep internal and external separate. Proverbs 27:6 says that “Wounds from a friend can be trusted.” I would compare this to surgical wounds that remove a cancerous growth, or like the appendectomy my son had when his appendix was inflamed and ready to burst. Surgery creates wounds that need healing, but the wound edges are often easily drawn together, and if this is done properly the chances of infection and complications are slim. Surgical wounds can easily heal from the deepest point up, and from the outside in.
Pressure ulcers are also wounds, and are sometimes called “bedsores”. Pressure ulcers develop when pressure is continually applied on one area so that blood flow is compromised. Because it is under relentless pressure, the tissue no longer gets all the oxygen, food and trash collection that is needed to keep it healthy, so over time it breaks down. As health professionals we “stage “ wounds such as these. Stage one is just reddened skin that wonʼt “blanch” (when you briefly press it with a finger then release your finger, the tissue stays red, it doesn’t look white as it normally would after that press/release test). If we intervene quickly when we’ve discovered a stage one pressure ulcer and keep pressure off this area the tissue goes back to normal.
Stage two to four involve increasing degrees of skin break down. Pressure has been applied for so long that internal tissue, muscle and bone is now exposed to the outside world. This is scary and often ugly to the general public. These wounds can give off odor, drain blood and ooze “exudate”. They will not easily heal by themselves as their edges are not close and they often need to heal from the deepest point upwards. More intervention needs to occur than just re-positioning the patient’s body to removing the pressure!
How do we heal these wounds? I am not wound care certified, but I have learned many “tricks of the trade” and sound principles to help treat these wounds. It may seem obvious, but the first thing that must be done is remove the pressure. Remove what is causing this breakdown, that is compromising the integrity of the barrier God designed to protect the individual. Secondly we need to assess the damage. It is easier said than done sometimes, due to dead tissue and an abundance of garbage (called slough and eschar) and therefore we canʼt do a complete assessment with all that muck blocking our view of what is going on underneath. With a stage two, we often just have lost the first layer of skin, obviously easier to asses and heal. At stage four we have tissue breakdown to the bone. This kind of pressure ulcer has been going on for a long time with no one noticing and has compromised the entire person. Assessment is often difficult and smelly and is often done in combination with healing strategies and will take a lot longer.
After assessing what we can see and smell of the wound we now are ready to choose our strategy for healing. Some principles apply when we are choosing what products to use and how often are we to change the dressing.
1. Wounds heal best in a moist environment.
2. We need to be aware of the surrounding tissue that can become compromised from the exudate (think extra garbage that isnʼt being picked up by regular trash collection).
3. We need to get the dead tissue out and keep the healthy tissue healthy.
4. We need to know that every time we do a dressing change the wound will take four hours just to get back to homeostasis, so we need to change the dressing often enough that infection is not occurring but not so often that all the wound is doing is coming back to stasis.
Now apply these principles to spiritual, psychological and emotional wounds that victims of abuse have. There are so many, many ways to compare.
First we need to get the pressure off the wound. Pastors, counselors, friends of victims: Donʼt tell the victim they need to go back to the abuser, where the pressure that made the wound is still there. Stage one can so easily become stage two, three and four if the pressure is not removed. And none of these wounds will heal while the pressure is still on them.
Second, assessing the wound. This takes time, itʼs dirty and smells. I have to be careful with my gloves and make sure I donʼt introduce infectious agents as I measure. Often I donʼt know how deep the wound is because of dead tissue. I have apply a silver alginate product to break down the dead tissue and get it removed. (As an instructor said, “when you see Ag, think money”…this process costs something!) This does not happen overnight. This is not one of those cases of ripping off a bandaid quickly. The product has to be in the wound for awhile, undisturbed to do its job. When we are healing from abuse, we often donʼt know how deep it is, sometimes dead areas need to be dealt with and time is involved. Plan on lots of time to heal, healing that might involve breaking down and hauling out trash, dead stuff, stuff that is interfering with healthy tissue granulating … growing new cells from the outside in across the wound. Notice the would heals from the bottom to the top and outside in; the wound is going to be open for a long time if it is to heal properly.
Third, we also need to keep healthy tissue healthy. We need to be so careful to not introduce another source of infection. The person needs to increase their protein consumption to help their compromised body heal. More protein is more of the building blocks needed to replace the wounded, dead tissue. We need something to replace what is gone; and if we want it to be healthy it needs to be good solid building blocks not more garbage. I think this is true in two ways for victims of abuse. We need to up our consumption of the Word, to have the Bible filling our mind and hearts but we also need good physical nutrition.
Fourth, how often do we reopen this wound, remove the garbage that has collected and reapply a fresh dressing? Many of the products we use for physical wound healing need to be on undisturbed for days. How often do we revisit this incident of abuse or this strategy or this fear. It does need to be often enough that further damage does not occur but not so often that we compromise the healing!
This is much longer than I planned and I have so many other things I could say. How wounds needs a moist environment, so the Holy Spirit, our well spring of pure water can cleanse and maintain a healing environment. How pressure ulcers heal but the skin at that point will always be weaker. I have toyed with these comparisons for quite a few months now and every time something new strikes me. Today itʼs the exudate, garbage that needs to be removed. How much daily garbage collection needs to be part of our regular life and what that means in our souls and families. Another thought is that if the wound opens again it is staged (called) as it was at its worse because it will much more easily go back to that compromised place. As victims we have wounds that can be healed, Isaiah 53:5, “by His wounds we are healed” but it is often not instant nor easy. Time, proper care, support and nutrition need to happen.
During my first year separated from my abuser I had a bevy of Biblical counselors trying to help ( I canʼt even write “us” ) be reconciled. One of the pastors would quote things like ”perfect love casts out fear” and that was supposed to remove all my fear. He did not get these principles of wound healing. He was giving me scripture, the extra protein I needed, but the garbage hadn’t been removed. These counselors kept telling me that I was to put the pressure back on (“Family dinners are a great idea once a week”), stopping the blood flow, causing more damage. My body and spirit knew that this was the wrong idea.
Pain is a healthy thing, it lets us know not to touch something. Unfortunately in wound healing pain is often stimulated when we clean out the wound, we need to get rid of the trash and pain tells the body to increase the blood flow. So it is a balancing act, there are times when the dressing needs to be changed more often. Times when we need to revisit the abuse and really see what happened. There are also times when the wound needs to be bandaged well so everything is contained and the patient can go out to dinner and forget they have this gaping hole in themselves. They need a moment to feel whole, to understand why they need to endure the pain of dressing changes because the goal is that wholeness. I could keep writing, drawing analogies but I am not a writer and I know all of you have your own stories that you can put into this analogy and expand out understanding.