“Would you like to see my scar doctor?” said my patient today, a young single parent. She had needed a caesarean section for failure to progress in labour and had had an emergency operation for the birth of her first son. “Any problems with the scar? “ I said. Subconsciously I was trying to avoid having her put the baby down get up on the couch, expose her abdomen, only to for me to glance at a normally healing abdominal wound. “Not really” said the new mother and she looked down. I realised that the procedure of looking was going to be necessary. What a waste of my time I thought. “Let’s have a look shall we?” I said patronisingly.
The scar was unsurprisingly normal, red but clean and although wide and a little tight it was a reasonable result. I pronounced that it was a good scar, and so began a conversation about what actually happened to her during the operation.
She had had a difficult labour, was quite alone during that time and when a caesarean section became necessary. She knew that a section was a possibility, but was not prepared for the suddenness of the decisions nor for her sense of loneliness in a crowd of professional healthcare workers that she had never met before. They called her “sweetie”, “pet” and “mum” and did not even use her name. They were over familiar with her and yet cold and distant. They behaved as if they cared, but she felt no genuine warmth, no understanding, no hugs and no physical reassurance that all would be well. Even worse, she had to sign her life away on a consent form, wondering if she could trust them with her baby’s life and her own. She was terrified by all this and gave birth to her first son under a general anaesthetic, only to wake up and find the baby had been taken away from her to give him some oxygen.
The whole heartfelt story came out as she told me tearfully of her alarm, fear and loss of control.
In fact the baby did well, my patient recovered quickly and her mother came the next day to help her, and she is now doing well but finding it difficult to adjust to being a young single mum in a hard society.
I realise now that my patient wanted me to see a lot more than her physical scar, that there were emotional scars and ongoing fears about how she would cope in the future. She needed to tell me about the experience she had had, to describe the scars it had left her with and that we needed to make a plan to heal both the physical and the emotional scars.
In an article in the BMJ, Stowell describes her adjustment to having a wound after an operation for rectal cancer. She says that “In the first days after my operation, my allowing those closest to me to see my wound was crucial in coming to terms with what had happened.” Doctors see parts of us that we will never see, they take things from us, they give us scars that our bodies will show for life, all while we lie unconscious. It is not surprising then that our patients need us to look with them at the scars they bear and come to terms with the deformation of their once perfect bodies. The emotional scars are equally important and can to a large extent be healed by listening to the patients experience, discussing aspects they don’t understand and helping them love their new body, scar and all.
So when the next patient says to me “Do you want to see my scar doctor?” I will say “Yes please”.
Dr Ros Simpson.
PRIME Desk Holder
References
:Stowell, G. Personal View. BMJ (2008) 337: 296.
Acton, A. When we leave hospital: a patient’s perspective
of burn injury. (2004) 329: 504-506. This article describes how you can help
someone come to terms and face the world with a facial burn injury.