by Michael Mara
This little girl may die, but the thought scarcely enters his mind. Without conscious effort, he embarks on the surgical protocol required for a pediatric road traffic accident. Her injuries are grave, and her outcome uncertain. But this much he knows: he will summon his years of training, his decades of experience, and his exquisite attention to detail.
He will provide the girl her best chance of survival. Beyond this, he is aware that forces beyond his control will decide her fate. A flickering fragment from a long-forgotten poem: “for us there is only the trying, the rest is not our business….”
He vaguely acknowledges his role in this play, costumed in cap, mask, gown, and gloves. Methodically exploring bowel, liver, spleen, he repairs what he can, stops bleeding when possible, and stabilizes the oozing liver.
He muses how his costume both protects the girl from infection, and protects him from her trauma. His membrane-thin gloves and gown serve to separate the traumatized from the healer, and he is grateful for this.
An hour later, he places the last sutures in her small belly, and helps wheel her to the intensive care unit. “The wounded surgeon plies the steel, that questions the distempered part….”
His jaw tightens as he transfers the child’s care to the highly competent ICU specialist. The ICU doctor is young enough to be his daughter, yet blazingly smart, kind, and compassionate. She will shepherd this little girl through the next critical hours and days.
“I heard the surgery went well;, nice job,” she offers, “I’ll implement the sepsis protocol, put in an arterial line, and call you if I see any problems.”
The enthusiastic young doctor still believes she is writing this part of the play, not yet aware that she is but one character penned into the drama. He both envies and pities her illusion, viscerally annoyed at the reminder of his younger, more tender self.
Still clad in his scrubs and cap, he pivots to the waiting room, unconsciously massaging his aching jaw. Time freezes as he covers the few steps between the waiting room door and the questioning eyes of the grief-wracked parents.
The play unfolds: after twenty years of rehearsals, he assumes just the right posture as he makes his way to the parents’ side.
Just the right phrase, allowing for hope, but expressing caution.
Just the right pause, allowing time for the predictable questions.
Just the right inflection, the occasional use of the child’s first name, the appearance of compassion. Each line rehearsed a thousand times, and precisely delivered to the tiny but vigilant audience.
The questions are always the same, but the final one transfixes him:
“Will there be scarring?”
Of course there will.
Humans have only one way to heal from injury: by laying down layers of new fibrous tissue over damaged skin, blood vessels, lungs, even brain. Though this scar can’t replace the function of the original organ, it stops bleeding and protects from further injury.
Without scarring, there is no healing. Scars are a necessary component of surviving the trauma of life.
“Scarring is required to survive the trauma.”
He hears his voice echo clinically in the room, alarmed at the callous words.
His thoughts have escaped him. This is not what the parents are asking. Fumbling now, he reassures them that she will not be disfigured, that the real concern now is for her blood pressure, her lungs, her survival. He departs, distressed by his performance.
The hot sting of the shower in the surgeons’ locker room eases the ache in his jaw. Relaxing under the soothing stream, he thinks of other characters that will ultimately determine the child’s fate.
The lacy, fragile clots must solidify, fibrose, and protect the child from fatal hemorrhage. This same cellular process in her lungs, however, will decrease the delicate tissue’s ability to exchange precious oxygen for toxic carbon dioxide. If the process goes too far, she will die, suffocating inside her own scar-tightened lungs. These characters will play out their parts over the next hours and days, and she will live or die depending on their performance. Her survival depends on the nature of her scarring.
He suddenly finds himself on his knees on the shower room floor, his chest wracked with silent sobs. Yet another fragment: “we die with the dying: see, they depart, and we go with them….” His mind, trained for analytical decision-making in the direst circumstances, cannot connect his emotions to the suffering he has witnessed. He dismisses his momentary collapse as a sign of fatigue.
He composes himself and towels off as the still-unnamed grief subsides. His mind turns to two clinical situations in which an injured human body does not respond with scar tissue.
The first instance, still poorly understood, is an injury to the unborn child. In the rare situation in which an infant is lacerated in the weeks before birth, the wounds heal perfectly, without scar. Nurtured by the Eden-esque protection of the womb, the child enters the world miraculously unscathed.
At the other end of the spectrum lies the corpse. Devoid of life’s essence, the wounds remain as they were formed. With no circulation to bring healing, with no respiration to deliver oxygen, the wounds persist, gaping grotesquely.
Though far from religious, he surprises himself by pondering yet a third scenario: the wounds of the resurrected man. If the story is to be believed, He arose, still bearing the marks of his execution. A man once dead, now alive, displaying the wounds that defined his purpose and chronicled his journey. Wounds that when shared, allow others to take hope in the wounded healer.
He emerges from the shower feeling better, soothed, less constricted. Clad in jeans and a shirt, he swings by the ICU on his way out of the hospital.
As he approaches, the nervous but eager eyes of the ICU doctor greet him: “She’s doing fine! Minimal bleeding, blood pressure is stable, and her lungs are functioning well. Go get some sleep!”
His annoyance begins to flicker, but the shower and her enthusiasm have uplifted his spirit. As he turns to go, he indulges in a cautious half-smile, savoring a once-familiar sense of hope, of healing, even redemption.
Perhaps the child will survive. Perhaps his soul, scarred from treating too many children with too many injuries, can one day breathe easily again. Perhaps he can bear the marks left by his failures as a testament to his purpose. Not unblemished like the unborn child, not gaping like the corpse, but healing as one who has suffered and survived.
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