Inside Job
Ten days after the surgery, six days after returning home from the hospital, and one day after the zipper of staples spanning my abdomen from the pelvis to above and around the belly button is removed, the incision bursts open.
Rolling off my bed, one hand protecting my tender, zipper-free abdomen, I notice something not-quite-blood seeping through today’s “Life is Good” tee shirt. Lifting the shirt reveals a watery, pinkish-orange substance gushing from my now open scar. The fluid looks familiar, but I can’t place it.
“RAMONA! RAMONA! PLEASE COME UPSTAIRS NOW!”
Ramona is on the run. A hard clatter in the kitchen informs me that our dinner has been dropped on the counter. I hope she was careful. Our friend Layne left us wild rice salmon cakes with a wasabi sauce. I have been obsessing about them all afternoon.
Ramona is up the stairs and by my side in seconds. “What!? What!?”
“Look!” I point to the leaking incision.
“Oh my. What the hell is that?”
“I don’t know. Blood? It doesn’t look like blood.” Ramona nods in agreement. “This shouldn’t be happening, right? Did they tell us this would happen?” I am seeking reassurance.
“No. This should not be happening and no, they did not mention this.”
A familiar loud knocking signals the unexpected arrival of our immediate next door neighbor, Skeek.
“COME IN!” We both call.
“HelLO NEIGHBORS!” Her standard greeting.
“SKEEK! SKEEK!” We yell. “COME UPSTAIRS!”
I show Skeek my belly while Ramona gets a towel to clean me up and staunch the fluid.
“Oh my. What is that? It looks like tomato soup.”
“That’s what it looks like!” I’m calming down. I don’t seem to be dying or bleeding out. The fluid has slowed.
“Have you called the doctor yet?”
“Not yet. You came just as we noticed it.”
Ramona calls the doctor, but it’s after office hours on a Friday night and we have to wait for the on-call physician to call back. Skeek goes next door to retrieve our neighbor on the other side of our house. Mary’s a nurse. She focuses on brain injury, but we believe she will know enough about blood and guts to be helpful.
Mary arrives, examines, and pronounces, “It’s serosanguineous fluid. Not fatal, no worries. But you will probably have to go to the emergency room.”
I guessed as much, but I am still deflated. The on-call physician tells Ramona the same thing. The clock says 6:00 pm. I consider the length of time we are about to spend in the emergency room. Decide it’s dinner time.
“Ramona, let’s have dinner. You guys want to join us?”
Skeek and Mary decline our invitation, probably dissuaded by the idea of eating next to an oozing wound, although Skeek does eye the salmon cakes with undisguised envy.
Ramona warms our dinner in the microwave and we eat standing up in the kitchen, a towel between my abdominal wrap and the now wide open incision. The wild rice salmon cakes with wasabi sauce are as yummy as I thought they would be.
In the emergency room, we are not an emergency. It’s still early on a Friday night, but it’s still Friday night. I’m glad we ate. How do you make a wasabi sauce, I wonder, as the emergency room fills up around us with a few drunks and a mix of families with children in varying degrees of distress. “I bet no one here but us,” I comment to Ramona, “has ever had wild rice salmon cakes with wasabi sauce. We are so lucky.” She pats my hand.
When the doctor examines me (after I am probed, questioned and pondered over by several nurses and one earnest resident, all of whom are mildly amused by my tomato soup description and a few who ask for the wild rice salmon cake recipe), I learn they can’t “just sew me back up” as I had requested. Had the incision held, the doctor explains, it would have all healed together but now the healing will have to go layer by layer, from the bottom up. I don’t ask what layer is what layer, like I am thinking, because the concept is grossing me out. She tells me, “Basically, you will have to heal from the inside out.”
Healing from the inside out will require twice daily cleaning, which necessitates the twice daily scheduled appearance of a visiting nurse in my home. The hospital arranges for visits to begin the next day. I am also informed that due to the upcoming chemotherapy regimen, I should expect the healing from the inside out to take longer. Longer than what, I ask. Longer than it should, I am told. But don’t worry, it will heal. Just keep it clean.
After a month of visits by nurses, Ramona takes over the cleaning routine. In the morning and in the evening, I gather the cleaning kit, lie on the couch and remove the bandages. Ramona leans over my belly with a focused frown, saline solution and sterile gauze in hand. She inspects, cleans, re-packs and re-bandages. An iron intimacy is forged. We rarely talk during the cleaning. Occasionally, I ask, “What does it look like?” “Pink. Better,” she always responds.
Except “better” is deceiving. Just when we think the incision has healed, binding my abdomen with a tenuous red line, another small rupture reveals the unhealed layers beneath the skin.
Tiny fragments of clear fishing line, with just a hint of tomato soup, begin emerging from the holes. I call my doctor. I get his nursing assistant.
“There is fishing line coming out of my belly. I’m pretty sure it wasn’t there before the surgery.”
“No worries. Those are sutures, dissolving.”
Or not completely dissolving, as it turns out, and the remnants are working their way up and out from some unnamed layer I hadn’t known had been sewn.
Ramona doubts herself. She has been vigilant, despite conflicting directions. One camp (the doctor) wants the wound packed tight with gauze. The other camp (every visiting nurse) is firm in the loose pack methodology. How can it heal from the inside out if there is no space for the healing? Ramona yields to the nurses, says she can see the difference in healing and, besides, nurses are the ones who tend wounds everyday.
I am doubting myself, too. I am careful with showers, bathing. What are we doing wrong? Why is my body rejecting the suture threads? Once a week a visiting nurse checks the wound, inspects Ramona’s work. Each week she assures us we are doing things right. This happens with other patients. She repeats that chemo interferes with healing. She repeats that we need to be patient, not to worry. Continue the twice daily cleaning.
Nine months of striving not to worry will pass before the inside layers fill in and my abdominal wound closes for good. In the end, what remains is a thick, red, eight-inch scar stretching up from my pelvis, curving around the place where there used to one belly button but now there are three. Sometimes I can’t remember which is the original.
© 2010 Cathy Kidman
