Don't Poison It

I have taught wound care for years, to university students, to practicing clinicians, and to patients and their caregivers. Here's my lesson, adapted with apologies to the one from whom I learned it, presented so succinctly years ago. At the time I never knew how timeless and universal her teaching would be, and I've long since forgotten the proper citation for my inspiration. Somehow I feel sure she wouldn't mind:

* If it's dirty, clean it.
* If it's broken, protect it.
* If it's dry, moisten it.
* If it's wet, absorb it.
* If it has a hole, fill it up.
* If it's dead, remove it.
* If it's infected, treat it.
* Whatever it is, don't poison it.

That's it. Memorize those,and you can care for any wound, whether you nick yourself shaving, impale yourself on a garden tool, come out on the losing end of a bad car accident, or have the unfortunate experience of surgery gone wrong. Oh, I can turn those eight lines into an hour lecture or an entire course or series of courses, but, bottom line, those simple points are the essence of wound care.

Wounds can't heal properly around dirt, dead matter, and/or infection, so when those are present we need to get rid of them. It's common sense that most anything that's broken benefits from protection until it can be repaired, be it a cracked windshield or a broken heart, and broken skin is no exception. This is why God created bandages. And we know that things function best when they're in optimal condition, be they car engines, the bodies of Olympic athletes, or wounds trying to heal themselves. If those wounds are drowning in excess exudate ("leakage") or are cracked, hard and dry, it's mighty hard for the body to do its healing work. And an empty hole is a flashing neon "Vacancy" sign beckoning infecting organisms to a warm, welcoming place to settle in and have a good meal, so we want to shut down that sign by filling the vacancy, i.e., filling the hole.

We who care professionally for wounds and who have an admittedly bizarre fascination with how the healing process works and how we best can support it can spend years studying the fine points, and we do sit for days in conferences considering the latest data about how best to fill a hole, treat an infection, clean dirt, protect something vulnerable, and create the best possible environment for the body to do its work. But be not confused: We heal nothing. The patient's body does the work, and our job is to give the body the best possible working conditions and then get the heck out of the way.

My patients with wounds often think the purpose of my encounters with them is to change their bandages. It is not. A chimpanzee can learn to change most bandages and doesn't need a professional license to do so, and if a chimp can do it, so can a patient and/or family member or other caregiver. I'm happy to show them how. The only reason they need me is to help them know when a change in the way a wound looks portends healing or a complication, whether a wound is becoming too wet or too dry as it heals and so needs a change in therapy, and if they safely can relax confident in the knowledge that they're doing everything right. Truly, with a little help from his/her friends, the patient does all the work.

And here's the dirty little secret big pharma and insurance companies don't want you to know: In all of healing, not just wound management, the patient does the work. We with our licenses, degrees, and certifications just shine light down the path to wholeness and smooth the way for the body's efforts. Truly: Master light-shining and road-smoothing and you can have yourself a medical degree.

But as an industry we've come to the point of keeping our light under a bushel and of creating more roadblocks than we remove. The body's natural tendency is towards wholeness, yet at every turn we invade it, cut it open, place alien substances inside it, and douse it with chemicals, creating ever more new obstacles for an already challenged body to overcome. We're not evil nor mean-spirited; we're just good science run amok the same way cancer is good cells gone haywire and taking over their host until they kill it. Heaven knows antibiotics and other drugs have saved millions and truly turned the tide of human existence. And so have surgery and angioplasties and CT scans and more. In fact, these have proven to be so good that we look to them more and more . . . more than is necessary, more than is helpful, and more, to the point of being harmful. As with so many things, if a little is good, more isn't always better.

Big pharma's ads on TV say, "Ask your doctor" if you're depressed, impotent, sneezing, sleepless, diagnosed with one disease or another, anxious, headachy, lame, or merely human, yes, ask your doctor if the latest pill won't help you. Usually it won't, bottom line, or your doctor or other provider already would have prescribed it. Trust me: Your doctor watches TV, too, and knew all about those latest pills long before those ads ever ran. S/he doesn't need Madison Avenue to consult in your treatment.

What I long for ads to say is, "Listen to your body and give it a chance." Your doctor is doing his/her job when you walk out of the office without a prescription. Another x-ray, another blood text, another cardiac catheterization may not tell us anything more than your own inner knowing and the wise judgment born of your healthcare provider's years of experience examining and listening to people much like you.

What I long for ads to do is quote one of my old pharmacology professors: "There is only one drug that has no side effects: Arsenic. It just kills you." Sometimes, many times, less is more. That grocery bag full of pill bottles that Grandma carries around may be doing her more harm than good, and when she 'asks her doctor' if she doesn't need the latest pill advertised on TV and the doctor, pressed by financial imperatives to see 15 patients an hour (like Bill Clinton, I like arithmetic: That's four minutes each, folks, including the time to write prescriptions and document in the medical record, with no potty breaks or phone calls allowed), yes, the doctor figures it probably won't hurt and will make her happy and so writes another scrip. Then poor Grandma may go away feeling satisfied that her doctor has done something for her . . . and may add one more toxic substance to a body already processing everything else in that grocery bag of pill bottles, pills to treat the side effects of the side effects of pills, until her kidneys, her liver, or her soul simply says, "Enough."

Can't we say, "Enough" now, before Grandma, or any of us acquires the surgical scars, the stents, the tests, the pills, and the bills? Enough. "Enough" ≠ "none." Enough is enough, that is, enough is what one needs to heal and be whole, nothing more, nothing less.

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That last point in my wound care lecture bears revisiting: Whatever it is, don't poison it." Not all that many years ago, in an effort to serve point #1 and clean a dirty wound or avoid infection, we doused wounds with various forms of iodine, hydrogen peroxide, alcohol, and good ol' soap. These do clean wounds and kill bugs all right . . . and they also kill the new, healthy tissue trying to grow and heal. They're poison, albeit used with good intent, but far more toxic than is warranted in vast majority of situations (there are rare exceptions, rare). The rule of thumb now generally is not to put something into or on a wound that one also wouldn't put in one's eye. Truly. So we cleanse with normal saline (salt water), plain water, or wound cleansers formulated to mimic the body's own fluids and tissues.

Would that we reach the point of doing the same in all of healthcare. Would that providers have time and discernment to say, "Let's just watch this and see what happens; the body is working well to right itself. Let's support, rather than confound it. And I will be here for you to evaluate the process as it unfolds, and intervene if necessary. Yes, I have time, yes, I will, this is what I do." Would that the day comes when attending physicians, and other providers, are able truly and simply to attend, to be present.

Would that we prescribe nutrition (now absent from most medical schools' curricula) before pills, would that our research dollars be invested in natural healing and comprehensive approaches to wellness as much as in disease management and medicine, would that insurers pay for and promote health care instead of merely illness care, would that we teach proper exercise, stress management, sleep hygiene, the art of self-knowledge, and good, old-fashioned play. Would that we prize healthy relationships, work settings, and communities, and stop poisoning our air, water,and soil. Would that we consume real food instead of processed, nutrient-poor, chemical-rich pseudo-foods.

Would that each of us, before asking our doctors for the latest pill, ask our own body what it needs to be whole and require that our healthcare providers and policy makers supply this,and our insurers pay for it. May we each cherish the body we have been given, be supported in caring for it, and, yes, in every way see that we

Don't Poison It.