From the Editor: Bless the Beasts

  It is almost a year since America shared a collective wince/gasp as Barbaro took his fatal misstep at the Preakness last May 20. That moment (particularly, the fear that they would have to immediately put him down) was especially painful for me. I knew within the hour, in a gesture of love and respect (oh, how I hope he understood), I would say goodbye to Casey Jones, our beloved 15-year-old retriever mix, to preclude his continued suffering with pervasive cancer. For me, the confluence of those two events signified the need, not only to struggle valiantly to restore and maintain health, not only to know when do no harm means having to admit defeat, but also to learn from such experiences.   For many, Barbaro’s 8-month battle – first to heal his injuries and then with laminitis – was symbolic of athletic fortitude, of all fortitude, in the face of overwhelming obstacles. The outpouring of sympathy and gifts, interpreted at times as excessive and misdirected, captured the (dare I say it?) incredibly American, “little-engine-that-could” mentality that affirms hope, that champions determination, that underscores every desperate entreaty to “Do something!” Despite the best of care, Barbaro did not prevail. But with what seemed to be equal parts devastation and resolve, Barbaro’s owners and clinicians pulled a positive thread from the warming blanket of love and care he had received: how much wisdom, clinical and spiritual, was gleaned from their efforts.

  Some might say this is an instance of winning the battle (finding a way to address the injury) but losing the war (the horse ultimately died). If anything, the converse is true – the battle may have been lost, but giant steps were taken in the quest for health. There is a take-away message for all clinicians – that is, every patient, because of his/her individuality and unique combination of symptoms and comorbidities, is a test case, a soldier in the healthcare revolution, a pedagological marvel, regardless of whether treatment is “successful.” Nowhere else in the healthcare arena, because of the inherent mix of art and science, is this more affirmed than in wound care.

  Not only are people often, pardon me, guinea pigs, but so are guinea pigs. And horses. And mice. So are the pigs and cows that provide porcine and bovine skin. So are shrimp (in a recent article, chitosan, a polysaccharide extracted from the exoskeletons of shrimp, was hailed as an instrument in wound healing). So are maggots, despite the yuck factor. We have much to learn from our fellow Earth-dwelling creatures. Throwing creationism caution to the winds, I sometimes wonder if humans are not the subjects of an experiment conducted by a more advanced life form. At the very least, learning from experience is the basis for evidence-based medicine.

  Because every living thing is an original combination of DNA and environmental influence, each approach to care comes with indications; hence, the potential for learning. In this issue of OWM, we are taught about the tenacious nature of biofilms, the ability of “power-washing” to cleanse and debride wounds, and the importance of restoring the matrix platform in filling wound dead space. Most relevant to this editorial topic, we are shown we can learn from the dead – in this instance, about deep tissue injury – proving that even as decedents, we provide vital healthcare information.

  Clinicians frequently are humbled by their inability to cure and heal but they should feel discomfited only if they have failed to learn something. Perhaps the harshest realization is that sometimes, the pain and suffering will end only with the demise of the patient. Although the human species does not readily accept euthanasia, palliative care can be provided and has been proven a comfort and relief for patients and their families.

  We bless the beasts (people among them) for their bravery in the face of physical and spiritual wreckage, for providing in the absolute worst of times (eg, impending death) an opportunity to teach. We are grateful to their front-line companions in combat – clinicians like you who grow their understanding and skills with every wound treated, not to mention through the additional knowledge you seek from others via symposia and journals – clinicians who fight the fight as well as know when to raise the white gauze/flag.

  Thank you, Barbaro, for giving us the hope that they won’t automatically “just shoot horses.” Thank you, Casey Jones, for sharing that last glance that told us we needed to stop hoping. And thank you, readers, who teach me everyday more and more about care and compassion.

  Enjoy your annual poem.

    So here you’ve bounced to Tampa Bay
    Ybor City – place to play
    Mingling, studies coincide
    Party time at Channelside
    Organisms, pressure, pain
    So much info here to gain
    In four short days, you will enhance
    Understanding and advance
    Management of wounded skin
    Let the learning now begin!

This article was not subject to the Ostomy Wound Management peer-review process.