Debriding the Wound

My heart tightened as I carefully turned my wife onto her side, revealing the oozing wound on her tailbone. A sickening sense of remorse and blame was overpowering. None of my home-grown attempts at fixing this . . . this intruder had helped. The sore appeared deeper, wider and uglier than ever.

I had never heard the term “debriding” (pronounced “debreeding”) until that awful morning when a hospice nurse entered our bedroom.

We had accepted hospice’s caring services six days, as it turned out, before Cindy died. The nurse had specifically come because the bedsore needed professional attention. Large, deep and centered on her tailbone, it seemed to flash at me as a bright neon sign, “Failure! Failure! Failure!” After years of her mobility growing inexorably more limited, her limbs had gradually contracted and frozen in curled positions.

This damnable bedsore gaped menacingly at me, a visible sign of enormous effort completely failed. I had been careful to turn Cindy when she had lost the capability to turn herself. A team of church volunteers had received special training to enable them to come faithfully to her bedside to manipulate her limbs in an heroic effort to extend her use of limbs that had become increasingly disobedient to the MS-ravaged commands of her brain. Her bed had for the past couple of years sported a special air-filled mattress that undulated slowly as sealed pockets were pumped full of air then gradually deflated.

We had made good use of technology, but we had lost. MS had taken its awful toll on Cindy, on the caregivers, and on me and our children.

My mind returned to that recent trip to visit old friends, a trip where the car’s motion as she lay on a special bed in the cargo area had caused her tailbone to break through her now-thinned skin. No longer padded with any fat reserves, Cindy had become a sitting duck, and I blamed myself.

With the nurse by my side my heart filled with remorse over this wound I felt I had caused. “How had I let this happen? She was utterly dependent upon me and I let her down.” I replayed mentally the self-directed anger I had experienced the day before when I realized to my horror that I had failed to properly close her ostomy, allowing urine to leak into the bedding meant to protect her. Instead of meeting her need, she had suffered yet one additional indignity as I moved her temporarily to my own bed so I could change her own.

Self-accusation raged through my mind as the nurse began her work. First applying anesthetic to deaden pain, she began attacking the evidences of death. Snipping, cutting, scraping, she began debriding my wife’s tailbone.

The dictionary matter-of-factly reports what was happening: “Removal of devitalized tissue.” Yes, it was that all right. This mass of grayish death was indeed devitalized tissue. But it was so much more than that. It was also evidence of illness’s victory, a sign of her approaching death. Because no matter how effectively we debrided the wound, her diagnosis of multiple sclerosis would not be debrided. The illness would advance to its inevitable conclusion.

But was the conclusion indeed inevitable? Was it possible that her diagnosis could have been reversed? Everything about our faith journey told me that the reality we were facing did not have to be our shared end . . . that God’s ability was greater than any diagnosis. Yet here we were, at the edge of eternity, having to face the reality that either my theology had been wrong, or God’s abilities had been somehow diminished, or that I had in some way failed Him, causing the result that lay before me.

Questions had tumbled through my spirit for years, trying to make sense of the stark breech between my theology and our experience. But in the end, it was the third option that my mind embraced as the nurse explained not only what she was doing, but what I must do in the days following. That I had somehow failed both Him and my wife scrolled through my mind as I watched with a combination of horror and fascination as we together worked on this latest expression of Cindy’s illness.

I suppose the medical field must necessarily speak in clinical terms of what is a horrific physical experience, else how could they continue to function? This does not necessarily lead to a dehumanization of their hearts; our hospice nurse that day was representative of a deeply caring group of medical professionals we had come into contact with over the years. Yet the language of the task before us was unyieldingly antiseptic. We were waging war at a safe emotional distance from the enemy; as long as our conversation remained coldly impersonal, the name of the patient was immaterial.

A few helpful phrases should be sufficient to convey some understanding of the clinical language describing the care of such wounds; these have been excerpted from Operational Medicine 2001, Health Care In Military Settings:

“Starting at the wound, use a scalpel to incise the skin, extending it far enough to obtain good exposure of the injured tissues. Then make another skin incision, in the opposite direction, again obtaining good exposure.

“Use scissors and tissue forceps (rat-toothed forceps or pickups with teeth) to undermine and then cut the subcutaneous tissues down to the peri-muscular fascia. Try to develop each layer, one at a time, as this will help prevent unnecessary injury and will help you maintain your orientation, despite the tissue destruction of the wound.

“Irrigation fluid . . . . is very helpful in dislodging clots and other foreign material. It can be dripped in under pressure from an IV bag, pulsed into the wound using a syringe, or simply poured in periodically. Gauze sponges help keep the surgical field clear for you to see.

“After completing the superficial soft tissue debridement, then move to the deeper structures and continue debriding.

“After all devitalized tissue is removed, the wound is loosely packed with gauze, and covered with a loose gauze dressing. The wound is almost never closed immediately, but left for re-exploration several days later. Closure may be done then, or even later, via secondary closure, granulation or skin grafting. A wound that requires debridement is not likely to be a good candidate for primary closure.”

That, matter-of-factly, described what we were doing. But this was for me not a clinical setting at all. This was our bedroom . . . a place intended for sublime intimacy, a setting filled with the sun’s warming rays and breathtaking mountain views beyond the edges of our surrounding forest. But there would be no intimacy today. I was reduced to talking about “that”, as though the gaping sore was somehow disembodied from the one I loved. But such distance enabled me to learn what I needed to know to provide ongoing care in the coming days until her worsening condition caused the bedsore, bad as it was, to fade into insignificance.

How had we arrived at this place? As Cindy and I had grown in intimacy with God and with one another, we found ourselves profoundly questioning a God who can do anything but did not do the one thing we most often asked. Mysteriously, we came to know Him as a God who has all power yet chose to withhold the application of it for which we most yearned.

How could a loving God who promised to never leave or forsake us appear to have done just that? What was He thinking, this God of lavish love who promised to replace mourning with joy and ashes with beauty? What went through His eternal mind as He watched my wife’s vibrancy and once-engaging personality gradually become dull and wasted? This God who gave up all He had in search of a bride for His own wedding banquet seemed not to care that I had a bride who could neither sit at a table nor swallow the good things set before her.

The paradox of such horrific personal suffering juxtaposed against the backdrop of a glad bridegroom God became simply unbearable at times. Yet I had walked with Him long enough to kno
w that if there was lack of understanding, the problem was mine, not His. He is, after all, a God who has moved heaven and earth to become known by His children. He invited us to plumb the depths of His personality and emotion, thereby not only learning more about what motivates Him, but growing more intimate with Him in the process.

Her name, “Cynthia”, means “reflector of light”. I found over the years that she was well-named, not because she had within her any more comprehension than I of what God was doing; daily living often seemed dark indeed. But ultimately her life, and our lives together, became a backdrop against which the beauty and majesty and glory of God were reflected. God used her suffering as a crack through which His own suffering in our behalf could be better understood. Ultimately, the crack widened into a doorway we walked through unto her death. He invites each of us to die to self that we might more perfectly identify with Him. In that place of identification has come deeper understanding of His own pain and suffering, ultimately expanding my heart to more fully experience how high, how deep, how wide, and how broad is His marvelous love for us.

There was in our longing an echo of the prophet of old, Jeremiah, who declared in chapter 30, “This is what the Lord says: ‘Your wound is incurable, your injury beyond healing.’ (v. 12) “. . .there is no remedy for your sore, no healing for you.” (v. 13) “Why do you cry out over your wound, your pain that has no cure?” (v. 15) “But I will restore you to health and heal your wounds, declares the Lord . . .” (v. 17)

How shall we make sense of the apparent contradiction in these passages? First we should understand that although Jeremiah speaks in words describing incurable wounds and promises of their healing, the context is not that of physical wounds alone. Rather, He addresses His beloved, Israel, reminding her in v. 11 that he had been the one who had scattered her to begin with. Her trials were profound and were visited upon her by God Himself, yet He promises that His disciplines will not destroy her completely, and that they would come with justice (v. 11). Here we see a wonderful promise of mercy sufficient to temper the justice which should otherwise have brought her complete destruction. He wasn’t going to give her all she deserved, but only what He knew she could bear.

One of the mysteries I came to deeply appreciate yet never to quite fully understand, is this: there sometimes seems in God’s economy to be a distinction between a spiritual healing and a physical healing. There are wounds of the heart which, if not properly debrided and dressed, will bring an everlasting death to the soul itself. Jeremiah understood this and conveyed to his countrymen the promise that although they were being severely disciplined, it was under the administration of a loving Father who wanted only their best. The scalpel’s cuts had to be deep enough to reveal healthy flesh . . . flesh from which bright red blood could once again flow. No half measures would do. Yet their depth would be limited to only what was required to save the patient, and no more. Jeremiah makes clear that no one else was going to be of any help. None of Israel’s enemies would bring a remedy or a cure, none would rescue her from the pain of her circumstances. Only God Himself had both the willingness and the ability to save her.

Spiritual salvation conveys eternal life in Him, life lived in His presence under His anointing and in His power until we depart this physical expression of life. My wife died more at peace, with greater confidence in her eternal life in Him, than she had ever known. As her physical illness had advanced over the years, she had experienced increasing measures of spiritual freedom from the ravages of the enemy’s attacks.

2 Corinthians 5:16 – 17 explores this mystery more fully: “So from now on we regard no one from a worldly point of view. Though we once regarded Christ in this way, we do so no longer. Therefore if anyone is in Christ, he is a new creation; the old has gone, and the new has come!”

What I have come to learn is that apart from Him we carry death around like a weight on our backs . . . a weight that exudes the odor of road-kill on a hot summer day. In fact, the Romans had a particularly hideous way of meting out punishment to those they deemed deserving: lashing the body of a dead person to the back of the intended victim, death from one body moved inexorably into the body next to it, thus extending its killing stench until it had consumed all life within its touch.

Referring briefly back to Health Care in Military Settings, we read that “Incomplete debridement of these damaged tissues increases the risk of infection and complications including gangrene and death.” That is exactly what the Romans intended in the physical realm, but it is also a perfect picture of our spiritual condition as we are born into a sinful condition from which there is no apparent escape save One. “. . . the Lord showed (Moses) a piece of wood. He threw it into the water, and the water became sweet.” (Ex. 15:25). The piece of wood . . . the tree that made bitterness sweet is a wonderful picture of the Cross of Christ. His tree, that source of death to which He was nailed, was intended to bring death even to the Son of God. But it failed. Bitterness was made sweet as Christ Himself was debrided of every scrap of contaminating, sinful humanity that had ever laid upon Him. His debridement continued ‘til bright red blood flowed freely, no longer hidden beneath countless layers of death. He willingly allowed us to be lashed to His body, that His more powerful life could reverse the flow of death and deliver us into His marvelous light.

It is this very thing over which all creation groans: and not only all creation, but “. . . even we ourselves groan within ourselves, eagerly waiting for the adoption, the redemption of our body.” (Romans 8:22)

Debriding the Wound
He gently shifts the settled sands,
exposing things
if left to rot,
would leach poison
into the well of who I am
for years to come.
The pain and despair
blazes out in me
when I touch
those spots.
But already
the air
the Spirit
the gentle words of
others who have walked
in woundedness,
walked in wholeness.
All are
drying out
those weeping wounds
* Used by permission of the author Barbara Francken Kelley, copyright 2006.

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5 Responses to “Debriding the Wound”

  1. Tracey says:

    WOW! Dave, you have captured the essence of what happens when we are wounded and how the Lord takes care of us.
    So often we overlook the blessing God has for us in our and our loved one’s suffering. We need to seek for his goodness and blessing in the midst of our trials, not complain about what we have to go through. He is with us in our suffering and as Isa 30:18 states, “Yet the Lord longs to be gracious to you; he rises to show you compassion.”
    The debriding, though it may be more painful than the actual wound, is for our good. And the cleansing that takes place (if we allow it) will purify us. The Great Physician knows what we need, how we need to be treated and will carefully, lovingly and gently clean our wounds. In the process we grow more closely to him and learn to depend on him. So, what’s the blessing for us in the suffering? Health, purity, cleanliness, wholeness, nearness to God…the list goes on.
    How sad to know people who choose to live in their wounds, festering as they are, and refuse to go through the debriding process. They have to be miserable. Can you imagine if Cindy didn’t want to have the bed sore treated and resisted because she feared the pain?
    What happens when we have wounds that we don’t let God address? I wonder if God allows us to get to the point where we are too weak to resist so he can apply the anesthetic, clean the wound and bring healing. What a merciful God!

  2. Sue Sillavan says:

    Dave, you really have shown how God attends to our loss of a love one.In l990 my father-in-law died,1992,my own father died,in1995 my mother died, inl997 my husband of 35 years died,only 6 weeks after being diagnosised with cancer of pancress and liver.and 1999 my sister died.And you can see all of 1990’s there was nothing but illness.I fell into deep depression after my husband died.I blamed myself,saying to myself, I loved him too much, I must have put him before my Lord in my love for him. I carried on before my church family,but when alone, I did feel God’s grace taking care of me but another day, I had to reach for God’s grace all over again. I am ashamed to say how long this went on, must have been over five years. But I finally was able to listen to my Lord and quit dwelling on this every day.Another problem was, I dreamed every night about my husband and all dreams were, “Don, why did you leave me”? This went on all thoes five years as well. Then one night in my dream,he and I were sitting in the back seat of a car and I was asking, Why did you leave me.and he said” Heaven awaited”. Well I was able to have peace in my heart after that. And this is the only time in my dreams that he ever answered me. Then I was able to ask my heavenly Father to forgive me for being so long to use his grace to bring me back into his service and his will. I told friends, God was really patient with me, looking back, I am surprised he didn’t do as an earthly father would have done and punished me.But he showed His love toward me and at times I was able to help others with their loss of a love one.
    Keep up the writing of your new book, I know it will be a comfort to many that will have some of the same ordeals and put blame on themselves as I did, when it might be that I have become much closer to God ,have a better more consistant prayer life . And since God knows the begining and the end, he knew I would benefit from this experence and depend more on him in my daily life.I didn’t express that too well, I did not mean it to sound like God took my husband for this reason, I think he use this to bring me closer to him.Sincerly, Sue Sillavan

  3. Dixie Hannon says:

    Chapter 1 is so heartfelt, I feel as though I am in the presence with you and Cindy as the nurse is debriding her wound, watching Cindy’s beautiful spirit as she draws closer to Heaven and the feet of Jesus. Debriding is a fascinating yet physically, mentally and visually disgusting procedure. Yet, it is the only way to bring about healing-from the depth of the wound to the surface of the wound-layers of dead skin and tissue must be removed. Even when the wound is completely healed a scar is left as a visual reminder of what was. I am thankful I am a believer and so in love with Him but oh, does God have much debriding to do in me! I pray that my heart will rejoice ‘it is well with my soul’ during those painful cleansing times. I yearn to draw closer in my walk each day and spread the good news. In Christ,
    Dixie Hannon

  4. Thanks for your comments, Dixie. Debriding is hard stuff to read about, I know, yet it is something each of us must experience in ways uniquely designed by Him to enable us to go forward in fulness of life and joy. Of course it’s spiritual debriding . . . the debriding of the heart that really matters. What I am coming to realize is that our perspective is so much more limited than His that self-diagnosis becomes nearly impossible. What we might consider an awful burden may be just the thing He has designed to draw us closer to Himself. I was struck by your writing that a scar is always left behind as a reminder of His cleansing work. That led me to consider that scars and rainbows could fall into the same category . . . evidences and reminders of His cleaning work. And because we have gone through that cleansing, we can know that we have become His. Sometimes the journey isn’t as fun as we would like, but the results are eternal rewards we cannot begin even to imagine.
    Be blessed,

  5. Jody says:

    Dave, As did Dixie,I too felt as if I was right there in the room with you, Cindy, and the nurse. Only I kept seeing my Nanny who lied in her bed dying of cancer while a Hospice nurse cleaned her wounds and changed her dressings. As I read what you did to help Cindy through her sickness, I could only feel ashamed for not doing more for the woman I loved more than anything. I could use the excuse that I was only in my 20’s but truth be told I have never been very good at handling sickness or emotional crisis. I was so weak with this, that I actually asked God to please take her, (and my Pop-Pop when it was his time) when I was not in the house. I know now that all I had to do was to ask God for the strength to be what I needed to be for my Nanny and He would have blessed me with that strength, just as He blessed me with my request; She died when I was out getting coldcuts for lunch. I never realized how much this was bothering me until I read what you wrote. Thank you Dave for allowing me to face my hurt and shame and to say sorry and to now release it. Please keep writing Dave and may God continue to bless you. Jody

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