Terms of Debridement: Living into Grief

“To weep is to make less the depth of grief.”
(Henry VI, Part III, Act II, Scene I, Line 85)

I have learned something important about grief from wound care.

Last summer, before my days shifted into darkness and just before everything I have ever been sure of in my world dissolved, I wrote an essay about the curious medical language of wound care.

In May and June of 2018, I accompanied my then 94-year-old aunt Virginia on her weekly visits to the Presbyterian Hospital Dallas wound clinic to treat the stubborn, angry wound she suffered from somehow hitting the outside of right ankle on her wheelchair. It simply refused to heal. The folks at Presbyterian Village North, her assisted living home, had run out of options.

At that time, little did I know that in a matter of weeks, my precious son Elliot would soar over the miserably inadequate barrier on the LBJ TEXpress entrance ramp – while riding his beloved motorcycle.

Little did I know that my brilliant firstborn son, a truly astonishing human, would take his last shallow breath in just over a month at that same hospital – where he also took his first breath 26 years prior. It’s all too much to process and handle for this bereaved mom. To tell you the truth, it takes every ounce of my depleted energy to barely function every day – still, over a year later. Don’t know how I ever breathe at all? Some days, it takes too much effort, and in some ways, it’s getting more difficult with each passing moment.

One of the reasons is this peculiar and uncomfortable statute of limitations on grief we perpetuate in American culture. Our “get over it, because it makes me uncomfortable” vibe is like living every day with a sheet of Saran wrap on your face. And no one seems to notice you can’t breathe.

I know it’s unpleasant.

I know people mean well. But death sucks. It’s unavoidable. I know they don’t know what to say, but we all need to figure it out – and do a better job seeing each other and caring for each other emotionally. It’s not weakness. We need to stop ranting at each other about all the “big, bad -isms” – and start paying attention to ourselves as individuals with open hearts and tender souls. Being present for each other is what matters – life and death matters. The loss of a child is an emotional wound beyond measure – one you will never get over. You must learn a new way to live. My soul sister Patty says, “If the loss of child were a physical wound, we’d be in the ER.” I’m not saying we all need psychology degrees. It’s about intentional acknowledgement – recognizing the profound wounds of loss – physical and emotional – early and often.

The fact is that we need to talk about the loss to move ahead. I treasure the friends most who say Elliot’s name and ask me to talk about him. His friends Chase, Brian and Alec – they are angels on earth. Overwhelming loss is the deepest, the most insidious kind of wound.

Grief needs air to heal.

We can’t just let it scab over and ignore the tissues below. And, like my aunt’s deep, festering physical wound, an emotional wound often needs debridement. That’s one of the wound words that truly resonates. You may think talking about Elliot will upset me, but that’s exacting what I need. It triggers the pain, but the tears are a tonic. The pain never goes away, anyway. Not ever. And, pain plays a role – signaling that something is horribly wrong, rallying the body’s resources – calling in the Navy Seals of the heart!

Technically, debridement is the term for the medical procedure that deliberately aggravates the wound in order to help it heal. With grief, we must do that – revisit the pain that makes us physically wince. It’s a necessary cringe, but we must not linger there. Telling and retelling our stories – that is our task. Finding situations and people who will listen, allow and support us unconditionally is essential – people who give us the space to remember the losses in our past and foreshadow what they mean for our futures. These people are rare and cherished. Without their divine grace, we will never emerge from this murky miasma (one of Elliot’s favorite words).

With debridement, we remove the unhealthy tissue and promote the healing – exposing a new day. The body is designed to heal, but the muck is heavy. The wound can become senescent or old when the cells are still alive and metabolically active but not able to divide and thrive. They are merely surviving, not thriving . . . senescent.

We can’t let that state persist – with unattended wounds scabbing over, harboring our deepest traumas.

The Power of Words: Senescence and Debridement

Words provide endless fascination for me, and I’ve encountered a couple of gems in the past month that seem to sizzle with relevance. So, here are my words of the week – and how they resonate:

Senescence and Debridement.

Both words I learned accompanying my 94-year-old Aunt Virginia to the Wound Clinic at Presbyterian Hospital in Dallas.  She is a warrior queen of remarkable grit and constitution, but a pesky wound on her outer ankle has refused to heal over the past few months. Since beginning our biweekly visits to see the perspicacious Dr. Moran and her choreographed coterie of clinicians, Virginia’s stubborn sore has much improved.

Debridement. It refers to the forced removal of unhealthy tissue from a wound to promote healing. Mon Dieu! It’s French – from débrider, to remove adhesions or to literally unbridle. Though the body possesses miraculous and mysterious organic self-healing capabilities, sometimes the process hits a snag. It stymies, and it needs a little help to progress. Debridement sends an urgent message to all the white blood cells and healing resources to galvanize the rescue mission – stat.  And, it hurts like hell!

Unfortunately, we don’t always know why we attract the excruciating circumstances we do or why healing pauses, but we do know why pain exists – to tell us something is terribly wrong. Pain  might be the most potent teacher. It’s just a matter of making the right connection.

Senescence. Debridement is a necessary protocol when a wound is senescent – another vocabulary word from the good doc. Senescent comes from the Latin senēscere, “to grow old.” In medicine or biology, it refers to cells that are still metabolically active – but are no longer capable of dividing.  Existing but not thriving. That’s why they need the jump-start.  Life is about living, not just surviving.

Thankfully, we have come to the right place. On our first visit to this chaotic clinic, I was overwhelmed by the number of “customers” – all seeking some sort of relief. There were not even enough chairs for everyone. There were babies, adolescents, grandfathers, society matrons and athletes. I saw one disturbingly gaunt man slouched in his wheelchair with his bandaged ankle plopped in the lap of a young man who looked like his son. He spoke with unconscious gusto. I think he must have been a teacher. “I believe in word economy,” he proclaimed. “I read that boy’s paper, and he used commas like he keeps them in a salt shaker.” I chuckled, but no one else in the room reacted.

“Ms. Thompson,” the out-of-breath nurse shouted as she cracked the door.

That’s Virginia’s married name. More accurately, her divorced name – an identity she’s maintained for more than fifty years. I grabbed the wheelchair she usually propels with her own two feet, and we were off down the hall.

“This is not uncommon,” said the chestnut-maned doc with an easy, warm smile. “But it’s a bear to heal. It’s a problem of pressure. I’ll bet you sleep on your right side, don’t you? We must offload the pressure. That’s all there is to it.”

Offload. There’s the lesson.

“This is gonna to hurt . . . a lot,” Dr. Moran warned as her nurse squirted the swollen, red ankle with lidocaine.

“This is what we call debridement,” Dr. Moran explained. “We have to remind the body how to heal. We need to remove the dead skin that gets in the way. This sends the body’s healing properties and enzymes to the wound.”

Virginia winced and closed her eyes tightly. Then, one glistening droplet ran down her wrinkled cheek.

“Are you OK?” I asked quietly. I have never seen her register pain, and she has endured much in her life.

“I know that hurt . . .  Uh, Ginny, more lidocaine here,” said Dr. Moran. “We need to rally all the resources we can to heal this bugger.”

Virginia began to breathe a little easier as the efficient tech team wrapped her puffy leg with focused precision. Moran gave us a list of instructions and pointed us to our next stop – radiology in the main hospital for an x-ray.

I was not here by accident. In addition to providing companionship and moral support for my only living senior relative, this experience held a lesson for me.  Sometimes the process of removing the dead tissue requires a seismic jolt – maybe two!  We can’t let unattended wounds just scab over – and pretend like everything is OK while the senescent tissue underneath remains.  Ignoring pain does not resolve it. And, the Universe keeps amplifying the intensity of our lessons until we finally get the message.

After all the turmoil, displacement and trauma in recent months (and even years), I know now it’s not my job to change or fix the mess and dysfunction all around me to feel better. That’s a no-win energy suck and likely leads to spiritual senescence. It’s about staying mindful, making higher-grade choices – and getting myself unstuck – not everyone else.

In medical terms, I guess the prescription is debridement – liquefying the icky eschar and slough. But, no more “liquefying” on my home front, please! I get the message! Thank goodness, Virginia’s choices are helping her heal, too. It’s been nice spending this time with her, too.

Let’s rally those inner resources . . . stat.