Saturday, June 7, 2014

Scars Flown Proud

Or, living with a significant other with severe scars, long after the initial injuries.

Did you notice your handsome hunk who wears old fatigues on his off days has a handicap plate? Or did you finally get her shirt off and find that not all the dips and curves in her flesh were where you expected them to be? This isn't about how love will conquer all, nor about running screaming into the night. This is about living with survivors.

1. Scars are not cosmetic.

Hollywood has a great deal to blame for this - they love to slap a horrific prosthetic on an actor, and then have his stunt men perform feats of athletic prowess while he tries to remember to fake a limp or lisp when needed for the plot. Real injuries don't work that way; the scars on the skin (if any), are the tip of the iceberg to much greater injury below. Nobody wants to be stuck helpless and victimized instead of getting on with life. (If they do, get the heck away from them fast. That mental sickness has a blast radius.) Heck, most of the people walking when they could have been dead men have more of a zeal for life, precisely because they've had a brush with the alternative.

But this means we cover our scars, we work around the limitations so they don't force us to stop, and in general, at first glance, seem pretty normal. Which means he gets yelled at by healthy folks for using the handicapped parking spot on the days where walking in to get our meds and back out will take half his energy, but he looks just fine getting out of the car...

Sometimes, the scars don't even show, or are tiny. Crush injuries, torn tendons and dislocations can wreck a body without a single streak of pink or white on the upper skin. Thanks to amazing advances in surgery, a completely smashed-in face may only have a scar or two left, neatly hidden by the beard, and the stents after the heart attack may only have a small scar on the leg to show where the surgeon went up the vein to mitigate the damage. Brain cancer? You might see a punk-rock hairdo with one slit, stapled six times - not even looking as bad as a broken nose.

2. Hard limits, soft limits, and mental limits.

Hard Limits - things the body can't do. If she has steel rods in her spine, she's never going to bend like a pretzel in yoga class. If he's got an OEM leg and one replacement, he's never going to walk "normally." These are things that will not change, and are as part of them as their eye color and their laugh.

Soft Limits - things the body can do, but there'll be consequences. If he can only sleep four hours at a stretch, it's physically possible for him to stay awake for 16 hours on a road trip instead of the normal 8. If she's on crutches, it may be physically possible for her to cover five miles, instead of the normal 3/4 mile. But there's going to be hell to pay in pain, exhaustion, irritation, medical complications, and long recoveries.

Mental Limits - things mind is certain it can't do. Do not dismiss mental limits lightly; they were often driven home by great pain and repeated failure, and there is no easy way to see how wounded a person is in soul, or to help them heal. Years after the scars are formed, you can say the wrong thing and see their soul bleed.

3. Expertise on injuries.

When you start seeing someone, they are the expert on themselves as certainly as you are the expert on you. No doctor, no advice columnist, no physical therapy website, has to live with the injuries like he does - and so nobody is going to know where his soft, hard, and mental limits are like he does. People don't come with manuals, and you're going to have to learn by asking and by observation. If she never puts anything she uses on the top shelf, you can be pretty certain that scarred shoulder doesn't handle overhead loads well.

Part of the reason people don't come with manuals is also that limits change. Injuries may be healed by the next TV episode or movie sequel with a dashing eyepatch to show, but in real life, the injury isn't over as soon as you ditch the hospital gown or the cast comes off. Some injuries take months to heal, some take years. For most people with severe scars, the complications are going to be there for the rest of their lives.

So what was a hard limit six months after the injury "Thou shalt not wear high heels, lest the earth rise up and meet thine face when thou dost try to take a step."

Becomes a soft limit "I'll have to be carried to the bathroom the next day, then limping for a week, but damnit, I'm going to be wearing heels for my sister's wedding!"

And with years of work, may eventually become a mental limit alone. "Oh, no, I hate wearing heels. You get them; I'll pass."

And that may become a soft limit again. "Oh, dear. I could wear heels, but with the arthritis in these old knees, it'd have to be worth it."

The only way you will learn the difference is by trust, love, and open, honest, respectful conversation, combined with observation and actively working together.

4. There will be complications.

Okay, maybe you just happened on the one guy who will never have complications from the fact that he has a two-inch-deep scar in his midriff. But he wasn't that lucky before, and do you really feel that lucky now? Injuries bad enough to really, really hurt people are complicated, and some complications pop up years after the fact. There's the 80-pound weight gain no matter what you try for diet or exercise, until a pharmacist goes "Oh, yes, that's a side effect of four of these prescriptions. Let's try alternatives..." The prosthetic may not fit well enough right now to go on the hike you were both looking forward to. A storm front is coming (barometric pressure drop), and she went from vivacious to curled up in a stiff little ball with no interest at all in dancing. Cancer can come back.

Expect your love to be on a first-name basis with at least one doctor, often three, and to know their chiropractor's kids' names. Do not be surprised if she brings tiramisu to her physical therapist's office, even though her regular appointments stopped three years ago. The rough and tumble of life, that you expect you can just shake off and walk it off, may well send them back to surgery - and they know it. You're going to learn a whole lot more about the insurance system, medical forms, and the interminable hell that is the VA than you ever wanted to. Insurance benefits are never blithely decided and signed; they will carefully scrutinize for worst-case scenarios, and scour the fine print. (And trust me, they have worse worst-case scenarios than you think. Time enough in the hospital leads to contact with "there but for the grace of G-d go I", and they pay attention.)

5. Things will change for the better.

The longer you are with someone, getting to know them and love them, and the more you two are open and honest and respectful with each other, the more you will learn to
a. Respect the hard limits. Never give an order that can't be obeyed, and never request the impossible from someone you love.
b. Only push the soft limits if the rewards are worth the pain. And when you do push, make sure to do it with love, understanding, respect, and plenty of recovery afterward. Yes, we did the walking tour of Mammoth Caves. Yes, he made it only because the alternative was waiting for a cave rescue team to come in after several hours and try to carry him out on a stretcher.. but he made it! I made sure he took painkillers before, and had them immediately afterward. I did not ask him to go anywhere or do anything that pushed him for two weeks, and made sure he had plenty of rest and chiropractor visits.
c. Slowly, gently, with love and understanding, work on the mental limits. Some are permanent, and they'll never change any more than you can stop a man from responding to an unexpected pounding on the door at 3:30am with his shotgun (and possibly without anything else on.) Some will seem permanent, until the day she wakes up and they suddenly...aren't. Others you can conquer together, like climbing a mountain.

Together, helping each other, you can do far more than you dreamed she could when you first met her. Sure, you like to hike, but she's determined to tackle the Pacific Coast Trail and put the shattered "you'll never walk again" in its grave. You'll climb mountains, ride the Tail of The Dragon, windsurf off Baja, snorkel the Great Barrier reef... or the equivalent, of being able to graduate from walker to cane for an entire trip through the grocery store. It's all in where you start, to how awesome the resulting victory can be. And you'll learn to savor the victories in life, little and big.

Be warned:

It is stupid, malicious, small-minded, petty, and frankly evil to cause hurt and pain to another person only to avoid inconvenience to yourself. It is loving and caring, generous and kind to support and assist a person in painful stretching of boundaries in the long quest to get closer to pre-injury abilities. Be very honest with yourself, and with your significant other, on what you're doing and why.

6. Things will change for the worse.

There's only one way out of this life, and if you don't go young, you'll get old. As the body gets older, the ability to heal slows down, and the wear and tear of life speeds up. Your spouse is much further down this road, in many ways, than you are. When they struggle to get out of bed in the morning at the ripe old age of thirty-two, ten years after a bad day in Iraq... well, you're going to be doing the exact same struggle when you're fifty. This is not as bad as you fear. Because when you hurt, when you are looking at the trail and thinking "I just can't. There's nothing left in me.", well, he's going to be sucking wind right beside you and saying with a grin, "I know exactly how you feel. That's why I got the hotel with the hot tub and the better beds. You'll be okay in the morning."

And you will be, and he'll be right there beside you, every step of the way.


  1. I've rarely seen a more insightful description of the conditions you mention. I'm on painkillers right now due to three crushed vertebrae in 1974. Not as bad as his injury, but painful enough to know the ongoing & permanent truth of what you've written here.

    Of course, you know that better than most. But thank you, anyway.

  2. This is wonderful. Irish Woman has had to learn to put up with my achy, grouchy self, and I've learned to live with her aches and pains.

  3. Well said, no complaining, just facts... WELL SAID!

  4. Too true. - t.b. -

  5. My gimp placard didn't come from anything as noble as a battle injury in Iraq - It took years to inflict that much damage to my Sacro-lumbar vertebrae, feet, and knees at a job I hated every day. I would be delighted to return the handicapped parking if I could return the reason I have it. Also, opioid painkillers stop being fun (unless you consider not having life blighted by constant pain to be "fun") a long time before they quit contributing to one's quality of life. Anyone who uses morphine or it's derivatives for control of chronic pain will not do anything to render it less effective. So piss on anybody who thinks I have perpetrated medical fraud because I park my motorcycle in a handicapped spot. I'm just glad I can still take it for short runs, even if I can't do 500 miles in 10 hours on a 1941 Indian any more.