From the Editor: Nothing Happens in a Vacuum

  Since last we anticipated the Symposium, my life has been a series of emotional comorbidities – a proverbial good news/bad news scenario. In no particular order: one daughter embarked on the roller coaster ride better known as adjusting to marriage. My husband’s retail computer system crashed, forcing him to find a suitable replacement (it took three tries), install it, learn it, and teach it to his employees.

My mother, who had been suffering with Alzheimer’s Disease for 15 years, had a heart attack and died two weeks later. The other daughter, after swearing for eight years she absolutely, positively did not want children, decided she wants a baby Right Now. A dear friend was diagnosed (thankfully early) with breast cancer. An MRI performed for an unrelated reason found a tumor (thankfully benign) on my dad’s pituitary gland. We went on vacation where my husband had a sudden, severe attack of vertigo and had a bloody, painful encounter with a marble floor. Our son proposed to his college sweetheart. Each event clamored for but couldn’t necessarily secure my undivided attention. Hence, I adopted an oft-repeated battle cry: Nothing happens in a vacuum.

  It’s not much of a stretch to make the analogy to wound care. Rarely does a wound occur in a healthcare vacuum (although it may be treated with one. See the article on negative pressure by Baharestani). The fact that a wound becomes chronic tends to underscore the probability of concomitant conditions – diabetes, venous insufficiency, infection – that must be addressed before there is any hope for healing. Prioritizing concerns is the substance of protocols and the catalyst for much discussion. Benefits of certain treatments must be weighed against potential side effects, as Miller notes in his article on tacrolimus. Clinicians must be cognizant of subtle changes that may herald potential problems, highlighted in Kelechi’s consideration of temperature increases that may warn of compromised skin integrity in patients with chronic venous disorders.

  Like me handling family matters, practitioners have the wisdom and experience to deal with challenging (we are misspeaking if we think of them as non-compliant) patients: Control your sugar levels. Watch your weight. Wear your compression stockings. Also like me, clinicians probably want a time out (or just some time. Period) to assess, re-group, and provide care unfettered, with the skill and compassion that has been proven to heal wounds. Or maybe, like me, they just want to smack some heads.

  Kohr reminds us to understand the whole of the person – that strengthening interpersonal relationships with patients leads to positive outcomes. This lofty goal seems to be increasingly more difficult because of all the other influences on the care environment. Oh, that encroaching distractions could be sucked into a vacuum and we could address issues, health or otherwise, one at a time.

  Despite biological, chemical, physical, and emotional interlopers, many if not most wounds heal. Daughters find marital (and hopefully, parental) bliss. The new computer system works almost all the time. My friend is cancer-free; my dad’s tumor remains unchanged and non-symptomatic. My husband keeps Dramamine handy. We are planning a wedding.

  My wish for you this year is that your wound care questions and concerns be easily resolved, perhaps with what you learn by attending the Symposium in person or on line. And with regard to more complex matters such as loss, may we all have the humility to accept what we cannot change and give/find comfort in those who appreciate our trying.

Sunshine beaming. Posters gleaming
Young and expert aptly teaming
Making waves, improving care
Prolific information share
Oh, the wonders of exhibits
Savvy salesfolk, time to kibbitz
Impressive all, to say the least
Undoubtedly, a wound care feast
Make SAWC ’08

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