A sudden scald. I was seriously scalded recently, and it gave me an instant awful feeling, as if I was suddenly vulnerable and naked. This scary moment was only fleeting because I quickly recalled many facts from history and medical training and sprang into action. It all turned out reasonably well and gave me some good lessons. Like this story.
Dedicated to the skin professor
I spent decades in Neonatology, looking after sick premature infants. Each of our academic faculty members had his own area of expertise. We had a skin guy, Steve Hoath, and this story is inspired by him and dedicated to him, as the skinny (1) on skin.
我长达几十年的新生儿科工作是照顾生病的早产儿。每一个我们的学术成员都有各自的专长。我们当中有一位皮肤科专家 Steve Hoath ，他启发了这个鲜为人知的故事，也因此献给他。
We used to joke that every time we talked about any clinical topic, our skin professor expertly turned the topic into something related to skin. Even when we didn’t think it was related at all. But it was great fun and it resulted in our becoming well versed in the complexities of skin, especially in babies.
What’s the largest organ in the body?! It’s not intuitively obvious, but the skin is really the largest organ in the body. (It also is really an organ.) It’s all over us and protects us continuously, literally all the time, everywhere we go. It is truly an amazing organ with innumerable critical functions that we easily take for granted, and we forget about our skin until it gets into trouble!
Any cut in the skin is instant exposure. Normally, we are well protected and sealed, but any cut in the body instantly exposes our body to the cruel germy outside world. Instantly, opportunistic germs and infections have the long -awaited chance to come in. “The gate is finally open, come on in!” Just a minuscule bite from an insect in your lovely garden can cause instant trouble!
Village disaster awaits! When we were on medical missions to villages, burns were a huge problem in the area. The open fires and hot scalding woks right in the villagers’ cramped homes, where small children were also running around, were disasters just waiting to happen!
I knew of a child who had 20 operations to treat his extensive burns! Just hearing the story made listeners squirm in serious discomfort.
Burns are the most miserable. Frankly, in medical training, the most miserable medical problem I encountered could well be severe burns or scalds. Any visit to the Burn Ward was the most hair-raising experience. Just to see the exposure of the burnt body to the outside world, the rawness of the skin, and the often-painful changing of body fluid-soaked gauze, all of these are still very vivid in my mind.
And often there was the smell of burnt skin in the air, mixed with the smell of infected skin and the smell of antiseptics in the room. Probably among the most traumatic experiences for any budding medical student.
A full glass of boiling water. I was having lunch at one of our favorite Chinese restaurants. Instead of tea, I usually order hot water, which is a common traditional alternative to tea. However, the water was boiling hot, and filled a large drinking glass before me. I tipped it by accident, and my entire forearm instantly felt on fire.
I immediately thought the best thing to do would be to roll up my searingly hot wet sleeve that was clinging to me. But unknowingly, that simple action tore apart an already instantly developing blister.
I intuitively and immediately ran to the washroom and turned on the cold water. I was relieved that the water felt ice-cold, so I didn’t have to get ice. I just kept the cold water running for a long time, and I think that calmed down the whole scald.
Instant damage control. It was only after I stopped the ice-cold water that I realized, however, that half of the two- inch-long scald was already partly denuded because I had pulled my sleeve off of it. The other half, however, to my great relief, was a skin blister still covering the scald, thus not exposing any raw tissue, the layer under skin. I knew instinctively to not tamper with that delicate situation. Definitely not to touch, cut or trim the peeling skin, or some temptation like that.
I remembered the training guidelines, “At all costs, let the natural skin cover the burn, don’t let it get raw, and don’t puncture the blister if there is one.” I kept my respectful distance! “Don’t do anything silly!” Maybe “next time” I should not even roll up my sleeve but rather immediately run to pour ice-cold water on the sleeve and forearm, thus maybe avoiding any tearing of a potential blister.
Our niece also had a germ-killing (bactericidal) spray with lidocaine (a local anesthetic) in her car, so she quickly grabbed that and sprayed it onto the wound. I assume that the quick ice-cold water and the spray did the trick, because everything remained quite calm and, thankfully, even quite pain-free.
Daily color show. Over the next week, I observed the changes happening step-by-step in my scald. The half that was denuded began to look quite frightening, changing color from pink to red to purple to brown to black.
It was actually fascinating to watch it all happening before my eyes. The other half of the scald had been much better protected by skin and calmly turned brown and then blackish.
“That’s why I didn’t go to medical school.” I took daily pictures to watch the “exciting” progress of the scald. I’m not sure whether you would feel the same way, so I’m a bit nervous about even showing you my beautiful photos.
At first, my family members were not all that excited about seeing them either, I think, and I just assumed they were probably thinking, “That’s why we didn’t go to medical school!” But hey, you’re stuck with a doctor father/uncle.
For me, all the “magical healing” reminded me vividly that the healing process is indeed a marvelous one, all the way from creating a new skin covering, step by step, to peeling off the old one, to complete healing.
If not for all the millions of cells rushing to the scene to make the repair system work, the scald could easily have become infected, abscessed or necrotic, or maybe could have even become systemic (full-body) blood poisoning. But none of that happened.
A chance to be creative. In this process, I thought of my plastic eye protector which I had recently used for my glaucoma postoperative care. By cupping it over my eye at night during sleep, it had very efficiently protected my eye from outside injury. So this came in handy now to similarly protect my new scald, perfectly cupped over the scald, especially when I was sleeping and might accidentally injure it. I also regularly sprayed antiseptic spray on the scald to be doubly sure it wouldn’t get infected.
In fact, just by wrapping my forearm with plastic wrap, I could even take a shower with no water splattering on the wound at all. The marvels of modern conveniences! I couldn’t even brag about any real pain at all to get extra sympathy.
Raw skin looks so vulnerable. Looking at raw skin that has been denuded is pretty unnerving, because you know that it’s highly vulnerable to all kinds of bad things happening to it. It’s the kind of bad feeling you have when somebody talks about skinning you alive, which I guess happened in old days, or maybe even happens in torture chambers today.
Touch, pleasure, or pain. When the skin is intact and healthy, we all know that it is a site for touch and pleasurable sensations. Innumerable babies have been studied for the positive effects of skin-to-skin contact on their emotions, growth and development. And we’ve likely all heard of the great psychologic and developmental damage to babies who did not receive normal skin touch sensations from their mothers and family.
However, we also know that the skin can be the location of many of great pain, since there are abundant pain nerve endings in the skin. Pleasure and pain all in one location.
Precious baby skin. The skin of premature babies is particularly sensitive to breaks and injury. How do we protect it from tapes that are too sticky that can tear off the skin, from liquids that injure it, and from germs that are hovering? Especially in the sensitive diaper area. Just even imagine the tiny size of the diapers they need. All were good challenges for our creative skin professor.
Never look down on your humble skin. It’s your one and only organ that wraps all around you and hugs you tightly. In turn, take good care of this wrapper! Like every organ in the body, it is exclusively designed just for you, and has literally thousands of complex mechanisms defending only you, minute by minute. It is so easy not to realize its functions or appreciate it! So, especially keep it intact, safe and sound. Stay away from hot boiling water and keep children away from tipping hot woks!
1.Skinny: the true information about someone or something that is not known by most. Merriam Webster dictionary online.