Scars. Some are visible to all, some are hidden behind our clothes, some are only found in the deepest recesses of our heart. Some people perceive them as an embarrassment or a time of hardship better left in the closet. But I see scars as a badge of honor, representing a battle fought and won, and a moment of strength and resiliency.
When I see patients, especially for the first time, there is only so much information I can garner through forms they fill out and our conversation before their physical exam. The limited time I have with each patient makes these channels even less revealing. Then there’s the fact that some patients either don’t remember parts of their history or don’t consider the importance of telling me this information. And so I find, in the privacy of the exam room, as their body is revealed to me, I have a chance to understand the rest of their story.
Yesterday, I met you for the first time. You wore your oxygen tubing like a fancy necklace, taking sips of oxygen as if it were hot tea. Beside you was your walker, a carriage for the oxygen tank. You were dressed beautifully in a bright red sweater, lipstick to match and a shiny gold necklace with matching earrings to finish off the look. You weren’t quite sure why you were seeing me in the office, your stories were a little jumbled in your head. You had some records from a nurse practitioner that sent you to me, but you didn’t know what they said. You were a mystery to me, perfectly dressed with your equally imperfect memory. Your history was nearly a blank slate as we exited my office and entered an exam room.
And so, in the exam room with you undressed, I read your history by looking at the scars on your body. The hard, puckering scar on your right breast revealed to me your battle with breast cancer. The dot in the center of your chest, that you also needed radiation to conquer the cancer fully. The long, oblique scar on the right side of your belly revealed that you had your appendix out, probably as a child, since it is rare nowadays to have such a big incision. Despite your memory loss, between the scars and the oxygen, I began putting together the story of your life. Since you were here alone today, I wondered who accompanied you through your breast cancer journey and the challenges it presented to you. And when you were a child, which of your parents carried you to the doctor knowing something was gravely wrong? But for today, as you sipped on your oxygen, unaware of times past, your body told me what your mind had forgotten.
I remember meeting you for the first time in my office. Your wisp of a body barely touching the chair as you sat, your hand floating through mine when we shook hands. As we talked about your past health issues, you shook off your heart problems like it was just a scraped knee. Get up, brush off knee and go on. Nothing else was a big deal either, a bump in the road that was in the past. So when I asked you about other health issues or surgeries, you answered with “oh, no issues, I’m healthy.” The only reaction I saw from you was when we spoke of your daughter, who was a patient of mine as well, and your grandchildren. The smile on your face was bigger than your entire body.
in the exam room, I saw the truth, the real struggles you had to endure. I could see 2 scars from the top of your chest nearly down to your belly button. Twice your heart failed you, twice you had to not only endure a huge incision, but have your sternum cracked and your heart entered. All one hundred pounds of you, having to withstand this invasion by hands that probably eclipsed the size of your heart. And there you lay, on my exam table, calmly telling me “oh yeah, I did have 2 heart surgeries.”
But that was only the tip of the iceberg of scars for you. The c-section, the hysterectomy, the gallbladder removal. Your chest and abdomen were like a series of railroad tracks, crisscrossing over your skin. Although, you may have tried to forget all these invasions into your body, your body cannot forget. I hope one day you can honor the mighty strength your tiny body carries.
I hadn’t seen you since I gave your breast cancer diagnosis and then, your surgery. Because you didn’t want to live with the threat of a recurrence, you decided to go for the big surgery, a double mastectomy. We talked a bit about that experience, how you coped during the surgery and recovery, how supportive your husband was, how you were ready to move on. You laid down on the table for your exam and I opened your exam vest; I hope you didn’t hear my gasp. Despite seeing many mastectomy scars, I never get used to the them. I could see the devastation left on the battlefield of your chest. Your scarred skin was stretched taught over your chest wall, the scars raised and angry as if they were not ready to stop fighting. I wondered how it was for you to shower and feel nothing there. Perhaps relief? Perhaps embarrassment? Perhaps anger?
A year later, you come in for your check up and you have a smile on your face. You are so excited to show me your new breasts. The angry scars have faded and in their place are symmetric mounds of implants encased in skin. The part you are most excited about are the nipples. You had a tattoo artist make them and they look so real. Amazingly, they look 3 dimensional, almost like a hologram. You make sure my assistant and I look very closely at them. We “ooh” and “aah” at these masterpieces. Your scars no longer rule over you, you feel beautiful and whole again. I know what it took to get to this moment and am happy for you. You were always whole, despite the scars. I’m glad it now feels that way to you too.
I also have a scar. It is hidden. I am not ashamed or embarrassed, but it is not something I want to show off. My firstborn was breech the entire pregnancy. “They” say breech babies want to be closer to their mama’s heart, so I suppose, I should have been glad she sat upright like that. But, in reality, I was disappointed. I had hoped for a natural delivery. I even imagined I was so strong, I wouldn’t need any pain medication. I couldn’t wait to tell people my glorious story of strength. And so, I went through an external version, an attempt to turn my baby from breech to head down. I declined any pain medications and with her bottom wedged in my pelvis, I ended up bruised and battered with my breech baby unmoved. I still hoped she would flip on her own, but as the c-section date approached, I knew my fate was sealed.
I insisted on watching my c-section and the birth of my baby, so the staff set up a mirror for me. As I saw her feet being pulled out, and finally, “a girl!” and I cried with a happiness I have never known before. I will never forget the moment I saw her, held up by my doctor above the surgical drape, crying, still attached to me with the umbilical cord. Finally, when I was able to hold her, the disappointment of having a c-section melted away. I didn’t care how she came out of me, she was here and mine. I was still a mother and nothing else mattered.
The scar is my reminder of that day, of realizing it didn’t matter how I became a mother, that I was strong and it was a glorious day.
Scars are only the tip of the iceberg, of a bigger story that lies beneath. Scars may hold secrets, fears, triumphs, and embarrassments. Emotional scars may be unseen by the naked eye, but only seen if we truly look into someone’s heart. In the end, scars make us stronger. I have the privilege of not only seeing other’s scars, but also acknowledging their importance in a patient’s life.