Delayed Closure

Delayed closure is a wound treatment strategy in which complex wounds with extensive soft tissue damage and high levels of possible contaminants are treated with initial control of bleeding, cleaning, and debridement, and then left open for a period of time during which the possibility of infection is treated proactively. At the time of delayed wound closure, further debridement of scar tissue or dead tissue takes place.

As I count down the days and prepare for my second trip out to Colorado this year to manage my mother’s recent admission to memory and hospice care, the phrase ‘delayed closure’ reverberates through my mind.

Delayed closure.

I have recognized for some weeks the significance of this second return to the place I called home for more than 20 years and my frail, confused, aging mother. At least, I have begun to recognize the significance. Every day brings added clarity. Awe is not too strong a word for what I feel.

When we flee people, places, or situations (and my flight from Colorado to Maine eight years ago was all three), it’s not an elegant, dignified process. It’s a frantic life-or-death flailing and thrashing, a single-minded determination to survive, whatever it takes.

The process leaves wreckage behind, a lot of unfinished business, a lot of rending and tearing, misunderstanding and hurt. It leaves, in other words, a complex psychic wound, not a clean laceration.

When I found myself in Maine, I thought I would not survive the trauma. I had torn myself up by the roots and gone to ground in a strange place I’d never been before. I felt like skin and hair wrapped around a suppurating wound of such longstanding duration and composed of so many different kinds of damage it didn’t seem possible it would ever heal. I didn’t think of healing. I didn’t hope for healing. I was a feral creature in survival mode.

I had no idea I had in fact saved my own life and taken the first steps to transformation, and I wouldn’t have cared if I’d known.

All I was doing was surviving.

In medical care, part of the strategy of delayed wound closure is giving the body’s natural defenses a chance to overcome infectious bacteria rather than sealing them in.

What were my natural defenses?

Water. My home in Colorado had been enduring a years-long drought. The wind blew all the time. Gaunt, dusty cattle stood sunken-eyed on plots of hard-baked ground. The wind blew relentlessly, scouring the land with flying sand, dust, and debris. We prayed for rain as we hauled grey water to our gardens. The city imposed restrictions on outside watering, car washing, any outside fires. Trees died. Fires consumed the land. It was apocalyptic, a hellscape with no relief in sight. Our water bills went up and up for simple household use. The rain didn’t come, year after year.

Maine was a revelation. Water. Big water, like I’d never seen before. The Kennebec River. Puddles everywhere, each with a duck. The people here call an enormous lake (to my eyes) a pond. Huge trees. Hip-high ferns. Moss.

Moss!

Rain. It rained. It actually rained. Measurable rain falling for hours, sweet, cool, life-giving. Mist. Fog. To breathe was to absorb water like a desiccated sponge. My cracked skin healed, drinking in the moisture. I lived in a house with a hand-dug well. No water bill. Free water! I trained myself to flush the toilet every time! My hair curled, growing out rather than down.

I lived in the country in Maine. No one knew me. No one knew I existed or any member of my family. For the first time in my life I escaped everyone’s expectations. No one demanded anything from me. No one watched me with critical eyes. No one told stories about me. I had no reputation. I was free, untethered from everyone and everything. I could think my thoughts and feel my feelings in safety and privacy. I could read, or work, or sleep, or take a walk, or garden without interruption or someone telling me I was failing. No one demanded anything from me. I had no emotional labor to do. I rested in the healing solitude of nature, laying my hands on trees, sitting on rocks watching little spring streams trickle, sitting in the sun listening to the birds, lying in bed listening to the owls, coyotes, and spring peepers in the pond.

Writing. In 2016, a year after I arrived, I began this blog. I had no expectations. My sole intent was to write my truths in my own uncensored voice without trying to please anyone, in spite of my fear. I had done some writing in Colorado, but always with a sense of guilt and shame, always with the fear of what others would think. I knew everything I wanted to write would be looked upon as unforgiveable betrayal or wildly shameful.

In Maine, so far away in a new life, I discovered my courage and started, week by week, recording my journey from a broken, cringing creature, filled with self-loathing, to a strong, confident woman. At the same time, I pulled together my scrawled notes and the stories I’d written in the dim, hidden edges of my life and finished a book. Then I started another one. Then I finished the second book and started a third one.

These were my natural defenses: water, nature, and writing. Slowly they overcame the infection in my ravaged soul.

Yet the wound did not close. It stopped stinking and bleeding. Scar tissue formed. But I had lost too much to pull the edges together and make a neat closure. I had saved my life. I had survived and gone on to thrive. But I knew I was not done.

I know an old story about amends; it says only the hand that dealt the wound can heal it. Sometimes we must flee in order to live to fight another day. I fled, and I was right to do so, but flight leaves no time for closure. For closure sometimes we must go back.

Delayed closure.

The first time, in January, I was afraid to return. Afraid of judgement. Afraid of old pain. Afraid of what others would think, or say. I was afraid to have my memories stirred up. I was afraid my wound would tear open again, and this time I would not survive.

What happened instead was acceptance and love in the arms of old friends. My love for them was met by their love for me. The place, dear and familiar, welcomed me, though I no longer call it home. I found changes, of course, but not painful changes. Natural changes. I realized my fear had kept me from the closure I need, and my fear, once faced, amounted to nothing. In reclaiming my power, I was able to gain perspective. I’m just a part of that little town in the way it’s a part of me. I’m not the most important part of it and never was. It’s not the most important part of me and never was.

Having reclaimed my power, I felt and expressed my honest love and affection for the place and the people without needing anything in return, although I received much in return with gratitude and, I hope, grace. I examined the wound again, debriding scar tissue, cutting away necrosis, until my soul was healthy and vital once more. Some lines. A few silver scars. But free of infection, free of pain.

Still, when I came home to Maine again, I knew I was still not finished. Closure was not complete. I knew one day I would return once more to the place I had left.

In less than a week I’ll be there again, this time for a longer period. We must prepare for and hold a living estate sale: clean, sort, sell, discard, donate, and perhaps store a house full of, not my mother’s life, but her stuff. The things from which she constructed her identity. We must see to repairs and the business of welcoming renters in.

We will also visit my mother in memory care. If she’s well enough, we’ll take her out for a meal or a little gentle shopping. Perhaps we can sit in the sun with her. Or, perhaps she’ll be angry and bitter, refuse to sit in her wheelchair, demand to go buy a car, or some other wildly inappropriate and impossible thing.

I will see her again, though, speak to her, tell her I love her. I’ll check to be sure she has everything she needs. I’ll speak to the staff, to her hospice team. I’ll buy some books for her from the Friends of the Library bookstore she herself created and helped run for years. If she can’t go out, we’ll bring food in, perhaps a flower in a vase, and sit in the dining room where other residents can see her with her family, give her the dignity of being loved and cared for rather than forgotten and discarded.

It will be hard, or it will be easy, or it will be both. Dementia is like that. However it is, though, I won’t take anything to heart. Her power to hurt me has unraveled, along with her memory and cognition. She’s physically safe at last. Her physical and emotional wellbeing are no longer my responsibility. They never were, of course, but I didn’t believe that until recently.

I’m free. Free of my painful memories, free of old stories and narratives, free of the fear of what people will think of me. Free of fear, most of all. Freedom fills in that old wound and now, at last, I can pull the edges together, stitch them with words, with love, with wisdom, with forgiveness of her and myself. I have traveled a long, long road through darkness, despair, self-hatred, and trauma, but I still love. I still care. I still dance, and laugh, and write, and thrive. I still belong to Life.

I did the very best I could every step of that journey. I was blessed with guidance and friends and teachers. My wounds were not mortal.

Now, journey’s end. Delayed closure. New beginnings.

Questions:

• What is your experience of going to a place you called home after a long absence?
• What open wounds do you still have?
• How have you closed longstanding wounds?
• Do you see a living estate sale as a cruel betrayal or an appropriate business choice?

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