A TIME FOR EVERY PURPOSE UNDER HEAVEN :
THE BOOK OF ECCLESIASTES AND CONCEPTS ABOUT TIME :
King Solomon is believed to be the author of The Book of Ecclesiastes, The Old Testament Book of Holy Bible. These are his words from Chapter 3, verses 1-11 :
To everything there is a season,
A time for every purpose under Heaven:
A time to be born,
And a time to die;
A time to plant,
And a time to pluck what is planted;
A time to kill,
And a time to heal;
A time to break down,
And a time to build up;
A time to weep,
And a time to laugh;
A time to mourn,
And a time to dance;
A time to cast away stones,
And a time to gather stones;
A time to embrace,
And a time to refrain from embracing;
A time to gain,
And a time to lose;
A time to keep,
And a time to throw away;
A time to tear,
And a time to sew;
A time to keep silence,
And a time to speak;
A time to love,
And a time to hate;
A time of war,
And a time of peace.
What profit has the worker from that in which he labors? I have seen the God-given task with which the sons of men are to be occupied. He has made everything beautiful in its time. Also He has put eternity in their hearts, except that no one can find out the work that God does from beginning to end.
THE HEALING POWER OF TIME :
Human existence could be challenged by physical and psychological injuries. A physical injury could also cause a significant amount of psychological damage and to a similar extent, unhealed psychological wounds may impair physical health and wellbeing. A psychological insult or injury may impact the activities and the normal functioning of a person who is not otherwise physically diseased. Human body is naturally endowed with an ability to repair damage caused to body tissues by physical injuries and other insults. The Repair process by which body heals itself is described as Inflammation and Repair. Human existence is possible because of this valuable, and protective natural healing process. However, this healing process and mechanisms are not under man’s voluntary control. The inflammatory reaction and the repair process result in scars as remnants. Once inflammation has subsided, the body may heal by regeneration of original tissue or the original tissue could be replaced by fibrotic connective tissue leading to scarring; very often wounds heal by a combination of these two events. Different tissues in the human body have different regenerative capacities. Basing upon the ability of regeneration, three different types of cells make up the human body: 1. Labile Cells – have the ability to regenerate throughout life. The epithelial cells of skin surface are regenerated on a regular basis giving us the ability to sustain our physical appearance as long as we live. Several other cells particularly found in blood, lymph, and spleen have this ability. 2. Stable Cells – have the ability to multiply and proliferate throughout life but are dormant unless stimulated. The cells of liver, pancreas, kidney, smooth muscles such as found in the wall of intestines, and the cells of the inner lining of blood vessels belong to this category. If a part of liver is removed, the liver can regenerate new liver cells and the resected liver regains its original size. 3. Permanent Cells – these cells do not have the ability to replicate and when injured or damaged are always replaced by connective tissue that results in loss of function. Neurons, skeletal muscle cells, and cardiac muscle cells belong to this type. The injury of neurons may cause paralysis. The injury of cardiac muscle cells may cause heart failure or cardiac arrest.
The human body’s ability to heal itself also depends upon the nature of the insult and the agent causing the injury. Several physical, chemical, and biological agents have a great potential to cause severe damage and result in structural and functional impairment of the body from which recovery is not possible. Wound healing and restoration of function represent a process critical to the practice of Surgery. Surgeons are able to provide curative and restorative services because of the human body’s natural ability to heal itself.
TYPES OF WOUND HEALING :
Wound Healing is the process in which a physical injury ( like a cut injury ) undergoes repair with restoration of intrinsic tissue strength and function and also with resistance to infection and other external influences. Wound Healing is affected by the type of the Wound. Clean, sterile wounds that are not at the risk of contamination by other body secretions from the gastrointestinal tract, the genitourinary tract, or the respiratory tract heal better. Infected wounds and contaminated wounds heal slowly. If a wound is suspected to be contaminated the wound is often left open to evaluate the problem and to control any infectious agent. There are three types of Wound Healing described.
1. Primary Intention or First Intention Wound Healing – Primary Union occurs when there has been little tissue damage, the wound is clean and is not contaminated by foreign matter, the wound is not infected, and the wound edges are closely approximated and are in proper contact. The edges of a wound should be approximated as early as possible after the injury. The surgical procedure known as Primary Wound Closure allows the wound to heal by First Intention. These wounds heal rapidly with minimal amount of scarring. A Surgeon while operating inflicts clean incised wounds and closes the wounds at the end of the surgical procedure. Nature takes over the process of Healing which proceeds in a timely fashion.
2. Second Intention Wound Healing – It will not be possible to close wounds immediately after an injury if the wound is large, and the two skin edges are not in contact; the wound contains a lot of dead tissue or foreign matter, or is infected. The wound could be intentionally left open until the surgeon could make it clean. Sometimes, the injured person arrives late after sustaining an injury. The time of injury is of critical importance in choosing a course of action for its healing. The surgical procedure known as Delayed or Secondary Closure brings about healing by Secondary Union. Apart from the delay in Wound Healing, the resulting scar tissue is also more extensive.
3. Third Intention Wound Healing – Sometimes, the wound is left open and is observed for several days because of low-grade bacterial contamination. Eventually, when the wound looks healthy and the wound edges are healthy, the Surgeon would close the wound allowing it to heal by Third Intention. Depending upon the amount of loss in skin surface, and the size of the wound, skin grafts may be needed for Wound Healing and the process is delayed until suitable graft material is procured and the grafting process concludes successfully.
Wound Healing is affected by several factors that affect human body. A healthy person recovers faster and better if he is injured. When the health is compromised, the recovery from the wounds would be unsatisfactory. Malnutrition, protein deficiency, iron deficiency, Vitamin-C ( Ascorbic acid ) deficiency, diseases of liver and kidneys delay the natural healing process. Conditions causing poor blood supply( Peripheral Arterial Disease ), diabetes, other severe systemic diseases and infections like Tuberculosis can affect wound healing. After Wound Healing, the tissue never regains its original strength that existed prior to the injury. An uncomplicated wound, six months after its healing has about 80 percent of its original strength. Most wounds continue to remodel for more than one year. First Intention healing would generally produce cosmetically acceptable scars. Some scars are unsightly with a raised surface but the scar lies entirely within the confines of the wound. These Hypertrophic scars eventually stabilize in about six months time and are amenable to further cosmetic surgical correction to improve the appearance and to restore the function of the affected body part. Scars known as ‘Keloids’ invade nearby normal tissue that was not previously involved in the wound. This type of scar continues to enlarge even after six months time and does not usually regress or soften. The Keloids cause cosmetic disfigurement which is not easily treatable. Time plays an important role in all the aspects of Wound Healing and Wound Management and exerts an unique influence of its own in the outcomes.
THE EXPERIENCE OF PAIN AND THE EXPRESSION OF GRIEF :
We seek help and medical attention for our physical injuries and wounds because of our ability to experience pain.The experience of the physical sensation of pain is of utmost importance in defending and in preserving human existence. If the neurological function of pain perception is blunted or impaired for any reason, the recovery from physical wounds would be delayed and the body sustains further physical damage. Pain is of utmost importance in Clinical Medicine, both for diagnosing an underlying medical condition, to watch the progress, and in treating the condition. The human body that can not express pain or experience pain is at a great risk of harming itself. Psychological insults and injuries also cause pain and grief. To experience mental pain or grief is a natural protective, and defensive mechanism. Such ability to perceive pain from psychological attacks and insults is important to preserve the integrity and existence of the entire organism. By expressing grief, body initiates the natural healing process. While physical wounds need to be closed to help them heal faster, psychological wounds need to be exposed to bring about their healing. Emotional pain and grief must not be concealed. By properly expressing mental grievances, mind gets a chance to purge the negative emotions generated by the psychological assault. The grievance must be reported to a friend, a relative, a therapist, a priest, or to the Law Enforcement and if no such avenue is available it must be submitted to the God the person believes. Psychological wounds when hidden, fail to heal.
Time exists even when there is no conscious entity with its awareness of past, present, and the future. Time exists not because of human memory of past events, awareness of present, and expectation of future. Time exerts an influence of its own which changes our perception of events and alters the course of consequences. A person with very good memory function would experience less pain with the passage of time after sustaining psychological trauma. The qualities of patience, tolerance, and forbearance increase our ability to withstand physical and mental pain. In the Sanskrit language, the qualities of patience, tolerance, and forbearance are described as ‘KSHAMA’. These qualities not only make the individual Stress Resistant and Resilient, they would also allow the Time’s Power of Healing to come into play. Indians seek the quality of KSHAMA to withstand the consequences of physical and psychological wounds and they believe in the concept of Time as a Healer of all Wounds.
THE DIVINE HEALING POWER OF TIME :
Human body exists with an ability to recognize its own wounds and initiates its well synchronized response almost simultaneously and this timely response could only be described as a Divine Gift, a gift which humans have no ability to invent on their own.
Please also view my blog post titled ‘Pain and Compassion – Philosophy of Medicine’
Dr. R. Rudra Narasimham, B.Sc., M.B.B.S.,
Kurnool Medical College, Kurnool, Andhra Pradesh, India,
M.B.B.S., Class of April, 1970.