Academic journal article The Virginia Quarterly Review

The Gross-Out Factor

Academic journal article The Virginia Quarterly Review

The Gross-Out Factor

Article excerpt

In the garden that is the body, there is little as fertile as granulation tissue. It is a fleshy version of the richest topsoil, a vermilion carpeting that appears within a few days of injury and gives rise to new blood vessels and skin. Wounds that lack this cover never heal, but those that have it almost invariably will. And when they do, it is a miraculous vision. A cavernous hole on the torso will contract and a broad crevice along the arm or leg will narrow, until each has been transformed into the small pucker or raised line we call a scar.

Surgeons work hard to nurture granulation tissue. They are gardeners at constant odds with the weeds of flesh, clearing away all manner of debris to make room for "the good stuff." Week after week, with tweezers, scissors, scalpels, and a host of ointments and salves, surgeons will groom their plot. They will pull off clingy, yellow fibrinous waste and pick at dried suffocating scabs. Even excess granulation tissue-that exuberant "proud flesh" that pokes out like the soft tongues of infants-gets reined in, the overzealous efforts of a few shaved away for the good of many.

When all of that picking and cutting and scraping is finished, surgeons, like their backyard brethren, will stand and gloat over a job well done. As nurses rush to replace the bandages, these biological gardeners will lean back and admire the gash across their patients' bodies. "That wound," they will murmur with great satisfaction, "looks just beautiful."

I HAVE LONG KNOWN THAT MY SENSIBILITIES are just a little bit different from most people's. It is not that I revel in blood and guts; it's just that they do not perturb me. I hear discussions about disease manifestations and am compelled to participate. I see injuries and do not cover my eyes. Instead, I feel the urge to move closer and even touch or sniff, if given the chance. And that curiosity is a good thing, because wounds and illnesses and human anatomy are the routine of a surgeon's life.

I have learned to be cautious when talking about this part of my work. I speak in generalities and keep close gauge of my audience's reaction. Many people, I have found, have trouble stomaching detailed descriptions. They are not interested in the meaning of the various odors that can emanate from dressings and they prefer not to imagine, let alone hear, all the details of even the most fascinating of lesions. So whenever I begin to sense others moving away, hear them laughing less heartily, or see the color draining from their faces, I stop lest I bring yet another sparkling conversation to a dead halt.

Every so often, however, I'll slip.

My mother-in-law has been plagued with intractable rheumatoid arthritis for over forty years. There are pictures of her before her diagnosis-a tall, determined artist with California movie-star looks, impeccable though somewhat bohemian tastes, and legs that go on forever. Over the years, her drive and taste have remained unchanged. She is one of those women around whom you find yourself quietly tucking in your shirt and checking the color coordination of your outfit, and you always leave her wondering how such individual resolve gets fueled. But she is no longer what she was; the arthritis and medications have reduced her once elegant hands to nearly useless claws and the dewy skin on those endless legs to crinkled rice-paper wrapping.

Last winter, when she brushed against her walker, the skin over her left ankle shredded. She soon developed a gaping, tangerine-size wound. Months later, it is still there, though covered by a layer of bright red granulation tissue that bleeds and oozes with the touch of a hand. A nurse visits to change the dressing once a week, but those bandages can become saturated beforehand and, when removed, reek of moist flesh.

A couple of weeks ago on dressing-change day, my mother-in-law was staying with us, a hundred miles away from her regular nurse. …

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