Healing Has Its Own Clock

Healing Was Not Always Well Understood

For much of medical history, wounds were treated according to observation, tradition, and sometimes rather imaginative theories.

Ancient physicians recognised that wounds changed over time, but they did not understand the cellular processes behind healing. For centuries, pus was even considered a desirable sign in some wounds—the so-called laudable pus. We now know, of course, that infection is something we would much rather avoid.

Modern science has shown us that wound healing is not one event. It is a carefully organised sequence.

There are several overlapping phases.

First comes haemostasis, when bleeding stops and a clot forms.

Then comes inflammation, when the body clears damaged tissue and begins defending the area.

Next is proliferation. New tissue forms, tiny blood vessels grow, and collagen is produced to give the wound strength.

Finally comes remodelling, when collagen is reorganised, and the scar gradually becomes stronger, softer and flatter.

These stages overlap. The body does not finish one on Tuesday and start the next on Wednesday.

Healing is much more elegant—and considerably less obedient—than that.

 

Swelling Is Not Always the Enemy

After surgery, swelling worries many patients.

Some swelling is expected. Surgery causes tissue injury, and the body’s normal response is to send fluid and inflammatory cells to the area.

This is part of healing.

Too much swelling, however, can cause discomfort, increase tension on a wound and sometimes interfere with recovery. This is why elevation, rest, compression when appropriate, and sensible limits on activity can be important.

The challenge is knowing what is normal and what is not.

This is where follow-up matters. Plastic surgeons and wound care sisters watch not only the wound itself, but how it changes.

Healing is a moving picture, not a photograph.

 

Timing Is Part of Surgical Skill

Knowing what to do is important.

Knowing when to do it can be just as important.

There are times when a wound needs immediate attention. There are other times when the wisest treatment is to allow swelling to settle or tissue to recover before doing anything further.

The same applies after surgery.

Removing sutures too early may leave a wound without enough support. Leaving certain external sutures too long may create unnecessary marks. Exercise started too soon may place tension on a repair. Waiting too long to address a genuine complication may create another problem.

There is no single timetable that suits every patient or every operation.

Timing requires observation and judgement.

The Stoics placed great value on recognising what a situation requires rather than demanding that circumstances follow our wishes. Healing offers a practical lesson in exactly that.

We cannot command tissue to be ready.

We can watch, support it and act when the time is right.

 

Weeks Are Not Months

One of the strangest parts of recovery is the gap between feeling healed and being healed.

A patient may feel remarkably well a few weeks after surgery. The wound is closed. The dressing is gone. Life feels normal again.

Underneath the skin, however, work continues.

New collagen is being laid down and reorganised. The scar is changing. Swelling continues to settle. Tissue that initially feels firm may gradually soften.

A scar can continue to mature for a year or longer.

This explains why plastic surgeons sometimes ask patients to wait before judging the final result of surgery.

At six weeks, you are looking at a work in progress.

It is rather like walking into a house while the builders have packed away their tools, but the plaster is still drying. The structure may be complete, but the finishing process is not.

 

Reconstruction Has a Longer Horizon

The long view becomes especially important after reconstructive surgery.

A skin graft must first establish itself. A flap needs time to settle. A breast reconstruction changes as swelling decreases and tissues adapt. A scar crossing a moving area must demonstrate it can withstand daily use.

Sometimes reconstruction also happens in stages.

This does not mean that the first operation failed. A staged approach may have been the plan from the beginning.

The aim is not to finish fastest.

The aim is to finish well.

And, as we discussed last month, patients are active participants in this process. Rest when rest is required. Move when movement is appropriate. Elevate when asked. Protect a reconstruction while it is vulnerable. Return for follow-up even when everything appears to be going beautifully.

Patience is not doing nothing.

Sometimes patience is an active part of treatment.

 

The Part of Healing We Cannot See

Not all recovery happens beneath a dressing.

Surgery can also have an emotional recovery.

A person may have undergone treatment for cancer, trauma, a difficult wound, breast reconstruction or an operation that has changed part of their appearance. Even when healing is progressing exactly as expected, becoming comfortable with the result may take time.

There can be relief and gratitude alongside impatience, uncertainty or disappointment that recovery is taking longer than expected.

These feelings do not necessarily mean something has gone wrong.

We are often kinder to our bodies than we are to our minds. We accept that swelling needs time to settle yet expect ourselves to feel completely normal almost immediately.

Perhaps both deserve patience.

 

Patience Is Treatment

There is a temptation in modern life to measure progress by speed.

Faster communication. Faster delivery. Faster results.

The human body has not received this memo.

Healing continues according to rhythms developed over millions of years, and no amount of impatience makes collagen mature faster.

There is something wonderfully grounding about that.

Stoic philosophy reminds us to direct our efforts toward what lies within our control and not waste them fighting what does not. During recovery, we can follow instructions, nourish ourselves well, protect the wound, attend follow-ups and ask for help when something concerns us.

Then we must allow time to do its part.

Stillness does not mean inactivity. Skill does not mean intervention at every opportunity. And the long view asks us not to judge today’s unfinished healing as tomorrow’s final result.

To my patients, friends and colleagues: may we become a little more comfortable with things that take time. Some of the body’s finest work happens quietly, beneath the surface, while we are waiting.

A Special Farewell to Sr Beryl

August also marks the end of an era in our practice as Sr Beryl retires. Many of our patients will know her as the calm, capable presence who has walked beside them through dressings, wounds, worries and the many small milestones of recovery. Wound care requires knowledge and skill, but also patience, kindness and the ability to reassure someone when healing feels slow. Sr Beryl has generously given all of these. We sincerely thank her for everything she has contributed to our patients and our practice and wish her a wonderful retirement. Whatever this next chapter may bring, we hope it gives her time for the people, places and pursuits that make her happy. Thank you, Sr Beryl. May the long view from here be a beautiful one.  We will miss you, always.