Wounds are Tricky, So are People

I’ve been working local contracts for about a year now, and I’m finally getting to be known as the wound guy.  I’m at a teaching hospital with lots of eager-to-learn nursing students from 3 different colleges in the area. So naturally, I get lots of questions.  One young nursing student, we’ll call her Alice, approached me this week asking about a dozen questions, and it reminded me of myself in those years. This girl was on a mission, she knew I was on the schedule for that night, and she had a list of questions she wanted to pick my brain about.  I’m always happy to educate, in fact I love it, but sometimes I understand why so many of my mentors told me with exasperation, “Hey, I have to go do xyz… can we continue this conversation another day.” Alice had questions branching off my answers to her original list of questions making 6 questions turn into 50. Needing to get to my patients and begin the night, departing with a promise to answer more questions another day, I left her with my old wound nurse mentor’s synopsis of wound care, “wounds are tricky”.

If this was a TV show, now is the point the screen starts to wiggle and spin, then some mystical music begins as the camera zooms into my forehead for a flashback! I recall in my earliest years in wound care, my mentor gave me the most confusing summary regarding the ideal wound environment.  “If it’s wet; make it dry. If it’s dry; make it wet”.  Clear as mud, right? She always followed up with, “wounds are tricky.” Eventually I understood what she meant by that enigmatic statement.  If a wound is too moist, it will macerate the skin around the wound or provide a pool for pathogens to thrive and multiply.  On the other hand, if you have a wound that is too dry, then all those building block cells and housekeeper cells cannot move across the wound bed to do their job.  Eventually the wound becomes recalcitrant and an open door for infection. So, if it’s too wet, you need a dressing that can absorb enough of the moisture that it does not eat away at the edges or become a pool of infection.  If the wound is dry, we need to make it just moist enough to allow cell migration across the wound and loosen up dead necrotic tissue so new granulation can proliferate.

Now the camera fades away back to real time. What did I do tonight when Alice came to me, excitedly asking me to follow up on just a few more questions? Her reason for following up impressed me and opened my eyes.  She went home and really thought about the information I gave her but was left confused on a few points and had a few questions as to why we recommend one treatment over another. I was not put out or irritated when she sought me out, I embraced her passion and desire to learn. What cost me 25 minutes more time than what she promised me at the beginning of our talk, left her feeling fulfilled and heard.  All too often growing up, my flame for knowledge was squelched by a mentor because I wanted to know too much.  So often my question of why we do things this way instead of that way got me in trouble. Eventually I would shy away, isolate, and keep my mouth shut and my questions to myself.  I never thrived in that environment, how could I? Therefore, I never want to leave another feeling that way.  Similarly, to filling a wound with good healthy granulation tissue; when trying to grow and fill the minds of those seeking to learn, we need to provide an optimal environment.  Providing education that is too in-depth or filled with technical jargon will oversaturate and leave them with more questions than when they started. Kind of like that wet wound that grew bigger at the edges.  On the other hand, providing shallow and basic knowledge that doesn’t challenge their thoughts won’t encourage their maturity and growth. Not unlike a dry recalcitrant wound, no longer filling in with ruddy, moist, granulation tissue.  Like I said, wounds are tricky, so are people.